ken winters. this is your brain on adolescence: a developmental view of problem gambling and other...
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Ken Winters. This is Your Brain on Adolescence: A Developmental View of Problem Gambling and Other Addictions Session 7B Presented at the New Horizons in Responsible Gambling Conference in Vancouver, January 27-29, 2014TRANSCRIPT
Dr. Ken Winters This is Your Brain on Adolescence: A Developmental View of Problem Gambling and Other Addictions
This is Your Brain on Adolescence: A Developmental View of Problem Gambling and Other Addictions
Ken Winters, Ph.D.Professor, Department of PsychiatryUniversity of MinnesotaMinneapolis, MN [email protected]
New Horizons in Responsible Gambling ConferenceVancouver, CAJanuary 29, 2014
www.psychiatry.umn.edu/research/casar/home.html
2. Neuro-development
1. Background
4. Summary
3. Neurodevelopment and gambling
#1 Conclusion
Adolescence is a developmental period often characterized by poor decision making.
#1 Conclusion
Adolescence is a developmental period often characterized by poor decision making.
Brain maturation may be a significant determinant of tendencies for non-thoughtful decision making.
#2 Conclusion
Brain development may also be a contributing factor that places youth at risk for gambling and other addictive disorders.
#3 Conclusion
Most adult gamblers begin to gamble in their youth; early onset gambling is a common feature of the pathway toward developing a gambling problem.
1. Background
Terms of “severe-end” gambling often used when referring to youth
• Gambling Disorder (DSM-5) (GD) = repeated and compulsive involvement in gambling that continues in the face of financial, social, psychological and vocational consequences.
(level 4)
• Problem gambling (not official) = gambling that contributes to financial, social, legal, psychological, school and vocational consequences (level 3)
Point 1: First generation of youth exposed to ready access and varied gambling venues
• Minimum legal age to place a bet varies across countries and games, but many opportunities for youth in the Westernized countries.
U.S. as an Example:43 states with a lottery (blue) 39 states allow age 18 as legal minimum age
U.S. as an Example43 states with casino/slots
14 states allow 18 as legal minimum age
casinos/slots legal
casinos/slots legal
casinos/slots not legal
U.S. Study: Youth Participation in Gambling (age 14 – 21) (Welte et al., 2008)
3330 29
23 21
129 7
68
0
10
20
30
40
50
60
70
cards office pools lottery sportsbetting
skill games bingo dice games casino all gambling
perc
en
t
U.S. Study: Past Year Problem Gambling Prevalence Rate by Age Group (Welte et al., 2002, 2008)
1.32.1
4.3
5.2
3.3 3.3
1.2
0
2
4
6
8
10
<19 19 - 25 26-30 31-40 41-50 51-60 61+
perc
en
t
Some epidemiology studies estimate teen rates are higher than
adult rates
U.S. Data: Estimates of Problem Gambling, Past Year (included U.S. and Canada data; school-based surveys)(National Research Council, 1999)
PercentageGroup Range Median
Adult <1 - 2% 0.9%
Adolescent 1 - 9% 6%
Estimates based on meta-analysis of surveys conducted 1988-1997 (National Research Council, 1999). Problem gambling defined in most studies by the SOGS/SOGS-RA.
Point 2: The newest “waves” of gambling expansion, online gambling and poker, further strengthen involvement in gambling by teens
Online Gambling (internet, online, social networks)
• Various forms of online gambling are legal and regulated in many countries
• U.S. – very limited; permitted in some States
• U.K. and Australia – examples of relatively permissive internet regulations
• Recommended reading:Remote gambling in adolescenceGriffiths, Parke, & Derevensky (2010). In J. Derevensky, D. Shek & J. Merrick (Eds.), Youth gambling problems: The hidden addiction. Berlin: De Gruyter
Gambling Severity by Sample (McBride & Derevensky, 2007)
0
10
20
30
40
50
60
70
80
Fre
qu
en
cy
%
Non-gambler Social gambler Problem gambler
High School
College/University
Internet Sample
University journalism student Mike Schneider won top prize - $1 million - in the Limit Hold'em PartyPoker.com Million V
tournament.
Photo by Charlie Knutson, from The Minnesota Daily, March 22, 2006
Point 3: There is a disconnect between estimates of youth problem gambling and utilization of clinical services
• From 1999- 2009 in Minnesota:• over 10,000 calls to the problem gambling hotline …
15 calls pertained to teen gambling (< 19 years old)
• over 3,700 referrals to a treatment program…..
0 referrals of teenagers (< 19 years old)
Point 3: There is a disconnect between estimates of youth problem gambling and utilization of clinical services
• From 1999-2009 in Minnesota:• over 10,000 calls to the problem gambling hotline …
14 calls from teenagers (<19 years)
• over 3,700 referrals into the treatment system…..
19 referrals of 19 – 25-years old
Why?• Low public awareness
• Low problem recognition
• No youth-specific services
• Other, more observable problems are viewed as more pressing
• No or minimal financial losses
But there are clinical cases
• Minnesota High School Football Star; was an honor student and had a football scholarship to a Division I school.
• Became an habitual blackjack player at the local casino after he turned 18.
• To finance his habit, he fenced stolen property.
• Was arrested for the thefts.
Point 4: There is a developmental feature to problem gambling
Adolescentgambling
Adult problemgambling
Onset of Gambling Variables and Number of Lifetime Symptoms (Kessler et al., 2008)
23.9
18 18.316.7
0
5
10
15
20
25
30
No Sym 1-2 Sym 3-4 Sym 5+ Sym
Age OnseGambling
mean
ag
e
Age Onset: F = 15.4, p < .001
Earlier onset among those 5+
Onset of Gambling Variables and Number of Lifetime Symptoms (Kessler et al., 2008)
23.9
0
18
26.7
18.3
23.8
16.7
24.3
0
5
10
15
20
25
30
No Sym 1-2 Sym 3-4 Sym 5+ Sym
Age Onset
Age Onset Prb
mean
ag
e
NA
Age Onset Prb: non sig.
ProblemBehaviors
ADHDdelinquency
maledruguse
gambling
sexualbehavior
Point 5: Youth problem gamblingoccurs with other problem behaviors
Gambling Group
Psychosocial problems
Cross-Sectional Study of Adolescents:Association of Psychosocial Problems and Gambling Involvement(Faregh & Derevensky, 2011)
emotional
family
anger
conduct
cognitive
Longitudinal Study of Youth:Association of Psychosocial Problems and Future Gambling(Pagani et al., 2009)
• These variables measured in the kindergarten sample:• Impulsivity• Emotional distress• Family functioning• Maternal education• Parental gambling• Gender
• Measured gambling behavior when they were sixth graders.
Pagani et al., 2009
Childhood Self-Control (Age 3) as a Predictor of Adult (Age 21) Problem Gambling (Slutske et al., 2012)
undercontrolled group > gambling
The children with undercontrolled temperament at 3 years of age were more than twice as likely to evidence disordered gambling at ages 21 than were children who were well-adjusted at age 3.
2. Neuro-development
1. Background
Adolescence is a period of profound brain maturation.
We thought brain development was complete by adolescence
We now know… maturation is not complete until about
age 25 !
An Immature Brain = Less Brakes on the “Go” System
Maturation Occurs from Back to Front of the BrainImages of Brain Development in Healthy Youth
(Ages 5 – 20)
Source: PHAS USA 2004 May 25; 101(21): 8174-8179. Epub 2004 May 17.
Blue represents maturing of brain areas
Earlier: Motor Coordination Emotion Motivation
Later: Judgment
• Preference for ….1. physical activity2. high excitement and rewarding activities3. activities with peers that trigger high
intensity/arousal4. novelty
• Less than optimal..5. control of emotional arousal6. consideration of negative conseq.
• Greater tendency to…7. be attentive to social information8. take risks and show impulsiveness
Implications of Brain Development for Adolescent Behavior
Novelty Activates the Dopamine System
• Compared to adults, adolescents have lower baseline levels of dopamine activity and greater sensitivity to dopamine-triggering activities, such as novelty.
• Thus, adolescents may seek novelty more and may experience a greater reward from novelty as a result of this ‘robust’ dopamine system.
• Preference for ….1. physical activity2. high excitement and rewarding activities3. activities with peers that trigger high
intensity/arousal4. novelty
• Less than optimal..5. control of emotional arousal6. consideration of negative conseq.
• Greater tendency to…7. be attentive to social information8. take risks and show impulsiveness
Implications of Brain Development for Adolescent Behavior
Risk-Taking
• Based on science of brain development, a modern view of risk taking in adolescence …• is normative; important to development
• has evolutionarily adaptive value
• significant individual differences
• not a result of poor assessment of risk; rather, is due primarily to self-control and contextual factors, not cognitive influences
An Immature Brain =
Low Brain Power
An Immature Brain =
Absence of Judgmentreward incentives >
perception of consequences
2. Neuro-development
1. Background
• youth in general• ADHD youth
3. Neurodevelopment and gambling
• Preference for ….1. physical activity2. high excitement and rewarding activities3. activities with peers that trigger high intensity/arousal4. novelty
• Less than optimal..5. control of emotional arousal6. consideration of negative consequences
• Greater tendency to…7. be attentive to social information8. take risks and show impulsiveness
Point 1: Normal brain development may contribute to adolescent susceptibility to gambling involvement.
Point 2: The neuro-plasticity of normal brain development may contribute to continued, and perhaps accelerated, gambling involvement.
Point 3: ADHD may put a person at heightened risk for gambling involvement
• Individuals with ADHD suffer from problems with judgment and self-regulation, believed to be linked to pre-frontal cortex deficits.
• These deficits in pre-frontal cortex contribute to a disorder likely related to another addictive disorder - drug addiction. (Barkley, 1997; Martin, Earlywine, Blackson et al., 1994)
Link of ADHD and Drug Abuse
Teenagers with a childhood diagnosis of ADHD are about 2 – 4 times more likely to have a Substance Use Disorder compared to teenagers without ADHD.
adapted Molina et al., unpublished
Is There a Link between ADHD and Problem Gambling?
• Adult studies
• Youth studies
Among Adults With and Without a Gambling Disorder
(Carlton et al., 1987; Rugle & Melamed, 1993)
Gambling Disorder psych., non-GD
Rate of childhood ADHD 15-36% 4-8% (sig.)
Adult: Link of ADHD and Gambling Disorder
Among Adults With and Without a Gambling Disorder
(Specker et al., 1995)
Gambling Disorder psych., non-GD
Rate of adulthood ADHD 21% < 1% (sig.)
Adult: Link of ADHD and Gambling Disorder
Among Adults With and Without ADHD(Harrow, 2009)
Gambling Disorder controls
Rate of adulthood GD 12% < 1% (sig.)
Adult: Link of ADHD and Gambling Disorder
“ADHD”+ “ADHD”- (n = 231) (n =2105)
Groups (N = 2336) % %
Nongamblers (30%) 6 94
Social (54%) 8 92
At-Risk (8%) 20 80
Prob. Path. (5%) 34 661 Based on the ADHD Index (Conners & Wells, 1997)
X2 = 113, p < .001
Association of Adolescent Gambling and Probable ADHD Status1
(Derevensky et al., 2007)
Derevensky JL, Pratt LM, Hardoon KK, Gupta R. (2007). Gambling problems and features of attention deficit hyperactivity disorder among children and adolescents. Journal of Addiction Medicine, 1, 165-172.
Youth: Link of ADHD and Problem Gambling
ADHD-persis ADHD-desist Controls sig.
any gambling (%) 79 77 80
PG among all1 (%) 19 5 5 (p < .05)
PG among gamb1 (%) 24 7 7 (p < .01)
SOGS-RA score (mean) 0.5 0.2 0.2 (p < .05)
Count games played (mean) 3.0 2.4 2.7
1 PG = SOGS-RA 2+
Minnesota ADHD Study(Breyer, Winters, August, & Realmuto, 2009)
Youth: Link of ADHD and Problem Gambling
2. Neuro-development
1. Background
4. Summary
3. Neurodevelopment and gambling
Summary
1. Evidence is accumulating that…
• most youth gamble, yet many do so infrequently
• the prevalence of “problem gambling” is noteworthy
Summary
2. Possible links between neurodevelopment and gambling behavior
• Gambling may be a very attractive activity for the developing brain
• Neuro-plasticity may impact future risk.
• Deficits in brain structures responsible for self-regulation may place youth with ADHD at elevated risk for problem gambling
Summary
3. Relatively easy access to online gambling and popularity of poker games and tournaments poses a new risk for youth who may be inclined to over-indulge in e-gambling
“Maryland CPA hit it big, but he worries about those who won’t”(Jon Saraceno, USA Today, August 1, 2006)
“Steve Dannenmann, who honed his skills with online poker-playing, won $4.25 million
as runner-up in the 2005 World Series of Poker tournament.
This summer, while playing poker in Vegas for a few weeks, he has made it his personal
project to quiz young people who have fallen for the allure of the game and its potential
financial bonanza.”
Steve: “I’ve met so many kids who have packed it in and came out here with a $2,000-$3,000
bankroll thinking they’re going to make it big. They’ve quit college or their jobs. I quiz them
like I do my clients who come in with money concerns.”
‘Why did you quit school? What’s your bankroll? What is your back-up plan?’
“If they don’t give a good answer, I call their bluff.” ‘What are you thinking?’
“It’s absolutely crazy, and pretty sad.”
Summary
4. Clinical issue: Screen for problem gambling among youth with drug abuse or ADHD
Brief Screen - AdultLie/Bet Screen (Johnson et al., 1997)
2-question version of the DSM-5 criteria:1. Have you ever had to lie to people important to you about how much you gambled?
2. Ever felt the need to bet more and more money?
Score of 1+ is a red flag.
SOGS-RA• Winters, Stinchfield, & Fulkerson,
1989/1993
DSM-IV-J• Fisher, 1992
Brief Screens - Youth
1. There is money missing from the parents.
2. The teenager asks for an increase in allowance.
3. The parent finds evidence of internet gambling when searching the teenagers computer.
4. The teenager is secretive about how they are spending their money.
Sampling of Themes from Adolescent Problem Gambling Screens
Summary
5. Clinical issue: For youth being treated for a substance use disorder or ADHD:• raise insights as to the risks of gambling; educate that gambling may be a source of relapse
Summary
• 6. Prevention programs exist • Gambling prevention can be
integrated into a school’s drug prevention program
• International Centre for Youth Gambling
• www.youthgambling.com/
• Illinois Institute for Addiction Recovery• www.addictionrecov.org
• Williams, Woods & Currie: Stacked Deck
Summary
CollegeGambling.org
• Tools for• Students• College health professionals• College administrators
THANK [email protected]
extras
Internet and Youth Study (McBride & Derevensky, 2007)
• High-school students, Montreal: N = 1113
• College/University students, Canada and U.S.: N = 1273
• Young adults and adults, on-line gaming newsletter link: N = 546
Gambling for Money on the Internet (McBride & Derevensky, 2007)
0
10
20
30
40
50
60
70
80
90
100
Fre
qu
en
cy
%
never less than oncea month
monthly weekly
High School
College/University
Internet Sample
Past Year Gambling(McBride & Derevensky, 2007)
0
10
20
30
40
50
60
70
80
90
100
Fre
qu
en
cy
%
Male Female
High School
College/University
Internet Sample 18-24
Internet Sample 25+
Session Evaluation
1. The information presented was useful to me
a. Strongly agree
b. Somewhat agree
c. Neither agree nor disagree
d. Somewhat disagree
e. Strongly disagree
2. The information presented was clear and organized
a. Strongly agree
b. Somewhat agree
c. Neither agree nor disagree
d. Somewhat disagree
e. Strongly disagree
3. I would recommend this session to a friend/colleague
a. Strongly agree
b. Somewhat agree
c. Neither agree nor disagree
d. Somewhat disagree
e. Strongly disagree
4. I learned something new
a. Strongly agree
b. Somewhat agree
c. Neither agree nor disagree
d. Somewhat disagree
e. Strongly disagree
5. The presenter(s) was/were engaging
a. Strongly agree
b. Somewhat agree
c. Neither agree nor disagree
d. Somewhat disagree
e. Strongly disagree
6. Please rate this session overall
a. Very good
b. Good
c. Average
d. Poor
e. Very poor