normalization of gambling1 new jersey task force on child abuse and neglect opening doors conference...

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New Jersey Task Force on Child Abuse and Neglect

Opening Doors Conference

“Children of Compulsive Gamblers”

Frances L. Gizzi, LCSW, C‐CATODSW, CCGCJeffrey M. Beck, LPC, CCGC, JD, ABD, CART

NORMALIZATION OF GAMBLING

• Lottery Advertisement

• Religion Involvement

• School and Group Fundraising

• Newspapers

• Poker on Television

• Rite of Passage

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GAMBLING PREVALENCE

• Approximately 81% of Americans gamble in th i lif titheir lifetime

• Legal gambling in 2008 was $90 billion profit

• Gambling is legal in 48 states

• 44 states lottery, 28 Indian casino states, 15 states have commercial casinos 11 racinos 5states have commercial casinos, 11 racinos, 5 states with non‐casino egm’s (electronic gaming machines)

GAMBLING PREVALENCE (continued)

• 1999 NGICS found living within 50 miles of casino put one at a greater risk of gambling problemone at a greater risk of gambling problem

• State funded gambling treatment in 31 states• New Jersey $220,000 for treatment, 10 providers• 1% ‐ 3% of adults have a serious gambling problem (3 – 5 million)

• Approximately 3% at risk for developing a problem• Adolescent gambling rate 2‐3 times that of adultsg g• Estimated 350,000 pathological and problem hamblersin NJ

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TYPES OF GAMBLERSSocial gamblers

–Enjoyable experience

–Entertainment

–Gamble with others

–Limit amount of money spent

–Stop after reaching limitsStop after reaching limits

–Gamble for short periods of time

–No interference with other parts of life

TYPES OF GAMBLERS

Problem gamblers

G bl l th l d–Gamble longer than planned

– Loses more than intended

– Starts to borrow money for gambling

–Prolonged losing episodes– Starts to lie about amount gambledg

–Returns to gamble to win back losses

–Relationship problems begin

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TYPES OF GAMBLERS

• Pathological or compulsive gamblersM k d i i bli i d– Marked increase in gambling episodes

– Gambling for larger amounts

– Receives bailout for gambling debt

– Gambling alone

– Alienation from significant others in life

ll l f bl– Illegal acts to finance gambling

– Inability to stop

– Helpless and suicidal

ACTION VS ESCAPE GAMBLERS

• Action gamblers desire excitement, seeks ti l t lik h t i istimulant like amphetamine or cocaine

• Escape gambler seeks relief from painful emotions or stress, sedative or tranquilizer

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ASSESSMENT OF PATHOLOGICAL GAMBLING

• Action gamblers

– Male, competitive, low frustration tolerance

– Aroused euphoric state

– The rush

– Seeks feeling of power

– Fantasy and narcissismFantasy and narcissism

ASSESSMENT OF PATHOLOGICAL GAMBLING

• Escape gamblers

– Female, non‐competitive, passive

– Repair underlying feeling of helplessness

– Gambling as sense of control over emotional experience

– Displacement of rage‐ trapped emotionally or p g pp yphysically

– Distraction from life problems

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ADDICTION

• The use of a substance or activity , for the f l i i tipurpose of lessoning pain or augmenting

pleasure, by a person who has lost control over the rate, frequency or duration of its use and whose life has become progressively unmanageable as a result( SLAA)

GAMBLING, DRUGS & ALCOHOL

• Higher gambling rates in addicted populations

• Higher drug and alcohol rates in pathological gamblers

• Switching of addictions

• Gambling as a relapse trigger for alcohol and drugs

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• 4 similarities for all addictions

– Preoccupation

– Withdrawal

– ProgressionProgression

– Tolerance


• Biological dependence on pleasure pathg p p p

• Provide tension and relief

• Biopsychosocial in nature

f i i li• Loss of spirituality

• Lies to cover up behavior

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• Denial as common response to confrontation

• High relapse potential

• Stigma like alcohol 25 years ago

• Controls person’s whole life

• First drink like first win

• Chasing the high


• All are painkillers

• Physical distress

• Family illness

• Mood swings

• Bankrupt emotionally and morally

• Neglect of responsibilities

• Industry similarities

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• Low self esteem – high ego

• Manipulation

• Spiral downward – chase

• Job problems

• Addiction used to cope and solve problems

• Lack of sex drive


• Differences

• Gambling connected to fantasy

• Gamblers favor suicide, alcoholics hopeless and helpless

• Gamblers fully functional until hitting bottom

• Gambler sees money as drug and power

• Disease model harder for others to accept

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• Cannot measure through blood, urine, hair

• Gambling sponsored by religion and state

• Bailout or big win can stop self destructive cycle

• Gambling win seen as solution for problems

• Gamblers do it alone, addicts in groups

• More difficult to define gambling


Gamblers run show in treatment

No saturation point for gamblers

Gamblers wonderful at math

Gamblers tend to be superstitious

Gamblers recovery requires financial restitution

Gamblers commit non‐violent crimes

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• No hangover

• Overlooked by professionals until late stages

• No preventative medicine

• Good employment record – still functioning well

PROFILE OF CHILDREN

• Takes on extreme family roles: high achiever, t l t hildscapegoat, lost child

• Mediator, identified patient, invisible‐ can be carried to adulthood

• Strong sense of shame and guilt‐ feeling they are bad but not knowing whyare bad but not knowing why

• Super competent to build self esteem or acting out for attention

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EFFECTS ON CHILDREN

• Poor social and inter‐personal skills, lack of d limodeling

• Inconsistent academic performance

• Learns to keep secrets, protects gambler ( don’t tell mom) and protects non‐gambler

• Sense that something is wrong egocentric• Sense that something is wrong‐ egocentric, what did I do

EFFECTS ON CHILDREN

• See other adults as role models

• Fear of abandonment

• Sees money as expression of love

• Always seeks positive feedback from gambler‐takes lack of same as criticism

• Projects anger and depression on peers

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EFFECTS ON CHILDREN

• Role conflict‐ doted on or ignored

• Greater risk for health threatening behavior –smoking, alcohol or drug use

• 4 times more likely to become problem gambler

• Addiction within family system results in• Addiction within family system results in stress, frustration and fear within system

EFFECT ON CHILDREN

• Gambling as constant, invisible presence

• Happy surprises or angry outbursts

• Frequent moves‐ geographic cure

• Find someone to blame for lack of possessions‐ become angry

• Learn not to answer the phone

• Learn to isolate from outside world

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LACK OF EMOTIONAL VALIDATION

• Sense feelings and experiences not confirmed t d b th it fior noted by authority figures

• Confusion about perceptions and knowledge of world

• Harder to judge, evaluate and cope with events around themevents around them,

• Lack of confidence leads to insecurity and fear

LACK OF ENVIRONMENTAL STABILITY

• Need for events to happen in familiar patterns

F il l d ti t h f t ti• Family rules and routines teach frustration tolerance and need to delay gratification

• Children feel stressed in households where gambling undermines family rules and routines

• Stability allows children to practice what they learn about the world and safety knowing what is there today will be there tomorrow

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LACK OF EMOTIONAL PREDICTABILITY

• Sense of self based on reaction of parents, l i t tapproval messages important

• Gambling parent may be excessively indulgent, physically absent and self‐focused

• Children may cope by identifying with gambler‐magical thinking and magicalgambler‐magical thinking and magical solutions

EVALUATING MONEY AND MATERIALISM

• Money as expression of love, kids want gifts showing love and approvalshowing love and approval

• Difficult to understand parents fighting about money

• Can see non‐gambling parent as unreasonable and gambler as victim

• “honored” to have their piggybank money borrowed

• Leads to difficulty trusting

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AUSTRALIAN QUALITATIVE STUDY

• Gambling parent kept leaving and returning

• Loss of parent physically and existentially

• Loss of relationship with extended family

• Loss of security and trust

• Tangible financial loss

• Gambling behavior by parents suggests not caring about kids


• Familiarity, reliability and consistency replaced b di di t bilit i it bilit dby moodiness, unpredictability, irritability and tension

• Loss of hope for future

• Tangible loss‐money, home, holidays, security

• Elements of schooling• Elements of schooling

• Loss of childhood

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• Sense of pervasive loss‐ relationship, trust, sense of homesense of home,

• Disappointments due to broken promises

• “Because I only live across the road from school I get to come home for lunch every day and sometimes my mum’s not home and then I b k t h l I ’t t tI go back to school, I can’t concentrate on my work because I am always thinking where is mum” (13 year old )


“ Wh h t th ki ll h• “ When she goes to the pokies all she becomes is a selfish person, only thinks about herself. She doesn’t care about us at all”. ( 13 year old)

• In the end she just wasn’t the mum I thought I j gknew” (18 year old)

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PHYSICAL AILMENTS FOR CHILDREN

• Children of gamblers more likely to suffer asthma and allergiesasthma and allergies

• Children’s health and development at risk from parent’s gambling

• Improper diet and insufficient food may impact

• Disappointment of broken promises leads to anxiety and stress and creates vulnerability to illness

BRINGING KIDS INTO TREATMENT

• Invite them in if:

– They ask to come

– The parents want them to come

– There are signs of serious decompensation or acting out: fights, drops in grade, stealing, biting, licking, bedwetting

– Get immediate help for any child starting fires or hurting animals‐ have crossed the line and need help

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ASSESSING EFFECTS ON CHILDREN

• Benefits of having kids in counseling

– Offer safe environment to express feelings

– Educate children about gambling

– See that needs for security are met

– Genograms‐ roles‐ pseudo‐parents

– Explain about gambling with parent‐cards, bingo,Explain about gambling with parent cards, bingo, sports

FAMILY: DAMAGE & RESULTS

• Loss of : Results in:

– Trust Stress

– Respect Isolation

– Relationship Neglect

– Family dynamic Distrust

– Employment ResentmentEmployment Resentment

– Financial security Co‐occurring

– Reputation

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GAMBLING & DOMESTIC VIOLENCE

• Physical violence‐ hitting, biting, throwing, hi llpunching walls

• Sexual abuse‐ any non‐consented to act

• Psychological and emotional abuse‐ degrading comments, threats, put‐downs

• Social abuse limited contact with family and• Social abuse‐ limited contact with family and friends, monitoring phone calls and mail

• Financial abuse‐ harassment and stalking

RATES OF DOMESTIC VIOLENCE AND ABUSE

• 50% of spouses say verbally or physically abused ( p y y p y y (Bland, 1993)

• 25% of spouses have been abused ( National Research Council 1999)

• 223.3% of PGs are abusing partners( Bland 1993)

E t d h d dd ti f• Emergency room study showed odds ration of intimate partner violence elevated 10.5 times for woman whose partner was PG ( Muellman, 2002)

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INTERACTION OF DOMESTIC VIOLENCE AND GAMBLING

• Gambling venue as refuge from violence

• Child abuse or neglect by gambling parent‐Indiana 72 children abandoned on casino property in 14 month period, Parx casino and kids left in parking lotkids left in parking lot

• Parent as criminal or mentally ill‐ in any case need to devise safety plan for children

FEATURES OF DOMESTIC VIOLENCE AND ADDICTION

L f t l• Loss of control

• Continuation despite adverse consequences

• Preoccupation and obsession

• Defenses of denial, minimization and rationalizationrationalization

• Entire family gets involved (Muellman 2002)

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INCREASE IN DOMESTIC VIOLENCE AS GAMBLING EXPANDS

• 6 of 10 communities had increases in d ti i l ft i t d ti fdomestic violence cases after introduction of casinos

• In Mississippi domestic violence centers had 300% increase in help requests after casinos came in (National Gambling Impact Study)( g p y)

• Nebraska medical school study‐ gambling as much a risk as alcohol abuse (Jejkal, 2000)

PURPOSES OF ASSESSMENT

• Understand gambler and gambling problem

• Blueprint for treatment planning

• Reference point for treatment monitoring and continuum of care

• Understand motivation for gambling

• Find personal meaning of gambling

• Locate client strengths

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TASKS OF ASSESSMENT

• Formal diagnosis of gambling problem

• Establish severity of problem

• Recognize other mental and physical conditions , co‐morbidity

• Gambling history including precipitating factors and those that hastened progressionfactors and those that hastened progression

TASKS OF ASSESSMENT CTD

• Psychological portrait: conflicts, defenses, i t lcoping styles

• Pertinent reality factors that limit treatment

• Psychodynamic formulation

• Treatment plan

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GOALS OF ASSESSMENT

• Start treatment alliance

• Obtain data

• Share nature and scope of treatment

• Impact of gambling on individual

• Begin motivational interviewing

DSM HISTORY

• DSM III(1980) first to classify pathological gambling as mental disordergambling as mental disorder

• DSM IIIR (1987) classified as impulse control disorder– Failure to resist impulse to perform act harmful to self or others

Experience increasing sense of tension before– Experience increasing sense of tension before committing act

– Pleasure or relief upon act

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DSM IV

• Preoccupation with gambling

• Need to increase amount of bet to achieve same pleasure

• Failed attempts to stop or control

• Restlessness or irritability when stopping gamblinggambling

• Gambling to escape

• Chasing losses

DSM IV CTD

• Lies to others about gambling

• Illegal acts to finance gambling

• Damage to relationships

• Borrowing from others to finance gambling

• Need 5 out of 10 criteria

• Not in manic stage of bipolar disorder

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SOGS‐RA

• How often have you gone back another day to win back money you lost gambling?win back money you lost gambling?

• When you were betting, have you ever told others you were winning money when you weren’t?

• Has your betting money valued any problems for you such as arguments with family and friends, or problems at school or work?

• Have you ever gambled more than you planned?

SOGS ‐RA

• Has anyone criticized your betting, or told you th t h d bli bl h ththat you had a gambling problem whether you thought it true or not?

• Have you ever felt bad about the amount of money you bet, or about what happans when you bet money?y y

• Have you ever felt like you would like to stiop betting, but didn’t think you could?

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SOGS‐RA

• Have you ever hidden from family ofr friends any betting slips IOUs lottery tickets moneyany betting slips, IOUs, lottery tickets, money that you won or any signs of gambling?

• Have you ever had money arguments with friends or family that centered on gambling?

• Have you ever borrowed money to bet and t id it b k?not paid it back?

• Have you ever skipped or been absent from school or work due to betting activities?

SOGS‐ RA

• Have you ever borrowed money or stolen thi i d t b tsomething in order to bet or cover up

gambling activities?

• SOGS‐RA Scoring

– Level 0‐ no past year gambling

– Level 1‐ RA score of 1Level 1 RA score of 1

– Level 2‐ RA Score of 2 or 3

– Level 3‐ RA score of 4

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SOUTH OAKS GAMBLING SCREEN

• Created by Henry Lesieur Ph,D. and Shelia Blume MDBlume, MD.

• Most frequently used gambling screen

• 20 1tem questions based on DSM

• Assesses lifetime gambling or last year

• Score of 1‐4 reflects some problemp

• Score over 5 shows pathological gambling

• Often used for survey data

GA 20 QUESTIONS

• Asked to any one attending first Gamblers Anonymous meetingAnonymous meeting

• Designed to allow for self assessment rather than clinical assessment

• It is suggested that most compulsive gamblers answer yes to at least 7

• Addresses behaviors related to compulsive gambling such as remorse and sleep difficulty

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GAMBLING AND SUICIDE

• 1997 8th leading cause of death 30,000

• Suicides age 15‐24 increased 200% from 50s to 70s

• Highest percentage is for elderly

• Preventable‐ wants to live but sees no way to resolve problemresolve problem

• 4 times as many men commit suicide

• 3‐4 times as many women attempt suicide

GAMBLING AND SUICIDE

• 2006 Study (Hodgins) interviewed 101 people with gambling problems who had tried towith gambling problems who had tried to quite; 32.7% attempted suicide; 38.6 % suicidal thoughts; 28.7% o suicidal thoughts

• “Suicide attempts among compulsive gamblers are higher than for any other addiction” Rachel Volbergaddiction Rachel Volberg

• NGISC stated 20% of pathological gamblers have attempted suicide

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SUICIDE RISK FACTORS AND PATHOLOGIAL GAMBLING

• Burden and magnitude of stress‐ family, fi i lfinancial

• Alcoholism

• Anger and hostility

• Breakup of relationships

• Changes in sleep patterns

• Disruption in social relations

SUICIDE RISK FACTORS AND PATHOLOGICAL GAMBLING

• Emotional difficulties

• Not confiding on others

• Parental and sibling suicides

• Previous attempts

• Social isolation

• State of confusion

• Omnipotence

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GAI INDICATERS

• I have no quality of life( fun, enjoyment or joy) i lifin my,life anymore

• At this point in my life it would be less painful to die then to try and endure living

• I often think about different ways I can accidentally kill myselfaccidentally kill myself

• I cannot stand the embarrassment, humiliation and pain that is coming

GAI INDICATERS

• I do not want to live in pain and agony anymore

N b d ll b t• Nobody really cares about me anymore

• My status and reputation will be destroyed because of what I have done

• Life is just not worth living anymore

• I never thought I would say this but death would be a blessing for me

• The loneliness is becoming unbearable for me

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Conclusions

• Parental gambling can have significant effect on lives of childrenon lives of children

• Children of compulsive gamblers at increased risk for gambling problems

• Often there are no telltale signs of gambling

• A careful assessment will help determine if gambling is an issue

• There is still a large stigma about gambling; unless asked people will not discuss

normalization of gambling1 new jersey task force on child abuse and neglect opening doors conference...

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