problem gambling: key issues for behavioral health providers

Julie Hynes, MA, CPS6/9/17

Lane County Behavioral Health

GAMBLING:Key Considerations for Behavioral Health Providers

The complete slide deck & print-friendly handouts are posted at:

www.preventionlane.org/lcbh

9:07 AM

J. Hynes | 6/9/17 | www.preventionlane.org/lcbh

Cover tech & new issues in gambling, DSM-5 criteria fordisordered gambling.

PG services – focus on treatment & screening.

9:09 AM

Understand substance abuse & mental health connections.

J. Hynes | 6/9/17 | www.preventionlane.org/lcbh

How about you--

YOUR expectations for today?

DEFINITION:

______ something of valuein the _________________

something of greater value.hopes of obtaining

RISKING

Source: American Psychiatric Association - DSM-5 (2013).

Image sources: Oregon Lottery, Hynes

out of

every

lottery dollars

ELECTRONIC GAMBLING:“Video Poker/Slots/Line Games”

Source: Oregon Health Authority (2012; ibid)

Photo source: Daniel Berman.

Photo: Hynes

Photo: Daniel Berman

THE GAMIFICATION

problem

NOT ALL GAMBLING IS PROBLEM GAMBLING. IT’S A CONTINUUM.

No Gambling Experimentation

Recreational Problem Pathological

Sources: 1. Moore (2016). 2. Volberg, Hedberg, & Moore (2008). 3. Shaffer & Hall (2001). 4. Northwest Survey & Data Services (2007). 5. Moore (2001).

Between 2-3% adults 18+ problem gamblers (2.6%) Teens (13-17 y.o.): 6% at risk or problem gamblers 2

College age (18-24): 5.6% 3

At-Risk“GAMBLING DISORDER”

“reflects the increasing and consistent evidence that some behaviors, such as gambling, activate the brain reward system with effects similar to those of drugs of abuse.”

Source: American Psychiatric Association, 2013. http://www.dsm5.org/Documents/changes%20from%20dsm-iv-tr%20to%20dsm-5.pdf

According to the American Psychiatric Association (APA), this change to an addiction:

PROCESS of ADDICTION.

Typical Phases of Problem Gambling

Information source: Custer, R. (1982); Lesieur, H. & Rosenthal, M. (1991)

WINNING

LOSING

DESPERATION

HOPELESSNESS

Source: Brain Briefings (2007, October), Society for Neuroscience, Washington, DC

Gambling & Dopamine

Dopamine not released when expecting a loss.Flooded with dopamine when expecting a win!

It’s not about the money –it’s about the ACTION of the game and the HOPE of winning.

Source: http://www.oregon.gov/oha/amh/gambling/gear-workbook.pdf

THOUGHTS, FEELINGS, ANTICIPATION, FANTASY

(Gambler’s Mind, “Gambling Time/ Gambling Money”)

PLANNING(Removing obstacles

to gambling)GAMBLING

(“Winning & Losing”) Serotonin AdrenalineDopamine

CRASHGuilt, Shame, Anger, Denial, Justification, Restless, Irritable, Depression, Panic or Numb, Suicidal Thoughts Dopamine

REALITY(Self with Others)“Real Time, Real Money”

These comparisons are of course generalizations & do not by any means reflect all male & female gamblers.

Comparison by Start gambling at older age

Get addicted fasterMore likely to be “escape”

gamblers (slots)

More likely to seek help

Start gambling fairly young (teens, 20s)

Tend to like games of

strategy & “action”

(poker, sports bets)

Less likely to seek help

$32k

85%

87%

24%

$23k$!

IS THE AVERAGE HOUSEHOLD INCOME. Range is from $0 to over $1million/year.

ARE WHITE. 4.4% Hispanic/Latino., 3.4% Asian. People

of color are under-represented in treatment.

prefer ELECTRONIC GAMBLING. Video (slots/poker/line games). Cards 4.1%; scratch-its 1.3%; sports 0.9%;

HAVE COMMITTED CRIMES TO FINANCE THEIR GAMBLING. Most crimes are “white collar” (forgery,

check fraud, embezzlement.)

IS THE AVERAGE INDIVIDUAL GAMBLING DEBT.

Oregonians in gambling treatment (2014):

connections

(Hodgins et al. 2010; Kraus et al. 2003; Najavits et al. 2010; Petry and Steinberg 2005; Taber et al. 1987)

Exposure to early childhood trauma has consistently been associated with

disordered gambling.

GAMBLING & ACEs

Associated w/ ADHD, personality disorders &…

Disordered gamblingPoole, J.C., Kim, H.S., Dobson, K.S., & Hodgins, D.C.(2017, March). Adverse childhood experiences and disordered gambling: Assessing the mediating role of emotion dysregulation. Journal of Gambling Studies, DOI 10.1007/s10899-017-9680-8

Adverse Childhood

Experiences (ACEs)

Emotional disregulation

Self-medicating

w/substance use, eating,

gambling, etc.

Substance use disorders,

eating disorders, disordered gambling

23%are current

tobacco users

66%have current

alcohol problems

39%have had a

mental health episode of care

Source: Oregon Gambling Treatment Programs Evaluation Update, 2016

24%experience

suicidal ideation

Have current drug problems

Spotlight ONMENTAL HEALTH CONNECTIONS• Depression/mood disorders1

– Depression – in one study, 76% of PGS had depression

– Bipolar disorder – correlations with BPD & PG

• PTSD (studies of military veterans)– PTSD among problem gamblers estimated between 12.5 – 29%

2,3

• ADHD4 20-25% of problem gamblers

• Alcohol & other substance abuse disorders

Sources 1. Ledgerwood & Petry (2006). 2. Kausch et al. (2006). 3. Biddle et al. (2005). 4. Waluk, Youssef & Dowling (2015)

addressing the issue

Because of our time limitations, we’re focusing today on the services oftreatment & recovery.

It often takes years for someone to

1) admit they have a problem2) seek help, and then3) continue in recovery

First Steps to getting help could be…

24/7 Helpline: 1.877.MY.LIMIT

Referral to provider for assessment

Often family members come in; later bring gambler in

This is an actual helpline counselor. Everyone who answers the phone is a Certified Gambling Addictions Counselor (CGAC).

SCREENING (Brief Biosocial Gambling Screen - BBGS)• Now considered the gold standard of problem gambling screening

• Division on Addiction, Cambridge Health Alliance, Harvard Medical School

Response to at least ONE of the following indicates need for full assessment:

Gebauer, L., LaBrie, R. A., Shaffer, H. J. (2010).

Larger version of this chart: click here

Source: Written by Robert L. Custer, M.D; image source: Council on Compulsive Gambling of New Jersey, Inc..

Treatment is free.The Oregon legislature requires that 1% OF LOTTERY PROFITS go to a Problem Gambling Treatment Fund.

Minimal intervention (Skype)

Outpatient treatment (44)

Crisis respite (2)

Residential treatment (1)

TREATMENT OPTIONS IN OREGON

Local service(Lane County)

Local service (Lane County)

WHAT OUTPATIENT Tx IS LIKE: (SPOTLIGHT: EMERGENCE IN LANE COUNTY)

Treatment free for gamblers and loved ones- Over 250 problem gamblers and family members treated last year- Gender-specific

Many different things happen in treatment:- Individual sessions - Family therapy- Group sessions - Recreational counseling- Class type lectures - TV/internet/Skype

55 % male 45 % female

IN OREGON GAMBLING TREATMENT:

THE “average” personIN OREGON PROBLEM GAMBLING TREATMENT

55% maleWhite

48 years old

Employed

Problem started at 37

Mostly gambles at video lottery terminals (in delis, bars, restaurants, taverns)

Owes $23K in gambling debt

Started gambling at 24

IN TREATMENT, 2016:

Outpatient (81%) Residential (5%)

Respite (1%) Home-based (4%)

Prison-based education & treatment (10%)

friends & family

134

gamblers1,081

Source: Oregon Gambling Treatment Programs Evaluation Update, 2016

gambler.IT’S NOT ALL JUST ABOUT THE

NEED HELP TOO!

Learning.Education about problem gambling as an addiction. What to watch out for. Gaining tools for financial/legal/other issues.

Dealing with trust issues. Being allowed to vent rage and betrayal. Healing from more “unfolding truths.” No more secrets. No more bailouts!

Getting continued support. Renew sense of hope & empowerment. Determining future of relationship.

Healing.

Growing.

FOR MORE INFO ON Tx OPTIONS IN OREGON:OPGR.ORG (Oregon Problem Gambling Resource)

(ClickableLink)

Where we need your help:SCREENING (Brief Biosocial Gambling Screen - BBGS)

QUESTIONS?COMMENTS?

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