problem gambling: key issues for behavioral health providers
TRANSCRIPT
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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