Issues

1
Julie Hynes, MA, CPS Notes/Guide from 2-Day
Seminar February 2009 University of Oregon
2
Seminar Overview Day 1

• Gambling Overview trends
• Problem gambling
• High risk populations
• Mental health addiction connections

3
Seminar Overview Day 2

• Application Prevention through recovery
• Key speakers
• Navit Parker, UO Problem Gambling Awareness
  Project Coordinator
• Brad Killian, Emergence Gambling Program
  Treatment Counselor
• Guest panel for QA

4
Assumptions

• Oregonians voted for the Lottery
• Most people can gamble without harm
• Some people cannot gamble without harm
• Those who cannot gamble without harm should seek
  help
• So safety is our primary concern.

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Gambling

• To risk money or something of value on the
  outcome of an unpredictable event.

7
Multnomah Falls

• Oregons 1 tourist attraction.
• Until

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9
Legal Gambling in Oregon
?
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11
Gambling in Oregon

• Lottery
• Scratch-its
• Megabucks
• Powerball
• Keno
• Video lottery
• Bingo/charitable gaming
• Casino gaming

• Social gaming (e.g., card houses)
• Sports bets
• Horse racing
• Internet
• Office pools
• Poker/card nights
• Bets among friends
• Stock market (??)

12
Shake Your Money Maker

• Lottery contributes to almost 10 of state
  budget 1

Sources 1. Legislative Revenue Office (2008,
June). LRO Forecast Summary. 2 (pie graphic)
Oregon Lottery, 2009 (oregonlottery.org/owins/owin
s08.html)
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Lottery Revenues Over Time

• Source Oregon Lottery, 2009

15
Oregons spending on gambling

• Oregon Lottery 2008 1.24 billion.
• Oregonians spent 1.6 billion in 2006 on all
  forms of gambling in 2006.
• Oregon s casinos garnered about 32 percent of
  all gambling dollars spent by Oregonians in 2006,
  a decline compared to 2005.

• Sources Oregon Lottery, 2008 ECONorthwest,
  2008. Sources cited from Oregon Department of
  Human Services, Problem Gambling Services (2009).
  Oregon Problem Gambling Awareness Community
  Resource Guide. Salem, OR Author.

16
Local Spending on Lottery

• Lane County citizens spent an average of 360 per
  capita on lottery games in 2008
• About 7 out of every 10 was spent on video
  lottery games (video poker slots)
• Source Oregon Lottery, 2009

17
Age to Play?

• 18
• Traditional Lottery games
• Charitable gaming
• Pari-mutuel betting (e.g., race track)
• 21
• Video Lottery)
• Casinos

18
Is Gambling Good for America? YES

• Brings needed revenue
• Brings jobs and community revitalization
• Supports the American value of individual
  freedoms
• Vast majority gamble without serious harm
• Supports democratic process - citizens approve
• Viable recreation activity - enjoyed by many

19
Is Gambling Good for America? NO

• Economically detrimental
• Unstable revenue source
• Regressive form of taxation
• Diverts spending away from small businesses
• Produces large societal expenses by increasing
  crime, bankruptcy, loss of productivity, medical
  demand, social service costs, etc.
• Social costs are too high
• Harms individuals, families, communities
• Morally and ethically harmful
• Reinforces non-community values
• Inconsistent with governments duty of care
• Preys on vulnerable populations

20
Casino Gambling

• Oregon 9 tribal casinos
• Each tribe has one casino
• Different rules in Oregon
• Tobacco OK
• Alcohol OK
• (2 casinos as of 2/09)

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Casino Tricks of the Trade

• Congratulate players after each win
• Offering refreshments
• Incentives and promotions
• Free food gifts
• Machine features
• Increase near misses
• Lights sound effects
• Financial services
• Gambling environment mazes, clocks, windows

23
Poker tournament play

• Social gaming ordinances
• Allow for limited player betting
• No house profit AKA rake
• Practically speaking, many still offer No Limit
  games house collects profit (membership fee)
• State law no minimum age
• Eugene minimum age 18

24
Horse Racing Your guess is as good as any
Results of various methods used in picking the
winning horse
Average amount of money returned on 2 bet
25
Video Poker/Slots/Line Games

• Bet button on right
• Payout button on left
• Easy access
• Solitary
• Loss of concept of time
• Speed of play
• Online activity can be an addictive behavior in
  its own right

Photo source http//flickr.com/photos/8bitjoystic
k
26
Photo Hynes, 2/09
27
Video Poker Slots

• Video poker and other computerized gambling
  develop gambling disorders faster
• More problem gamblers with a preference for video
  lottery than any other form of gambling
• Provide a mechanism for escape, relieve boredom,
  promote fantasy, stimulate neurological systems
• Deceptively expensive to play
• You can bet 4.50 every five seconds on a five
  cent machine, 54 for each minute of play

28
Online Gambling

• Fact (and Myth) Online gambling now illegal in
  U.S.
• Technically true.
• Practically not enforced.

29
Legal to advertise in U.S. Free to play.
30
Not legal to advertise in U.S.Play with real
money.
31
Online Gambling

• 2,500 gambling sites and growing
• May be extra attractive to people who
• want immediate access
• are socially shy
• prefer privacy and/or want to keep their gambling
  secret
• want to decrease social barriers based on sex,
  race, age, disability or other barriers such as
  lack of transportation

32
60 minutes Poker Face (1230)

• To watch this video, go to http//gamblingprevent
  ion.blogspot.com
• Or go to original story source
  http//www.cbsnews.com/stories/2008/11/25/60minute
  s/main4633254.shtml

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Youth A New Social Experiment
35
Messages
36
Product Placement
Photo Hynes, 2008
37
Photo Hynes, 2009
38
Women
39

• Overview
• Pathology
• Effects

40
More Gamblers ? More Problem Gamblers

• Prevalence of gambling problems
• is a function of the overall level of gambling
  participation

41
Definitions
PATHOLOGICAL GAMBLING also called compulsive
gambling or gambling addiction
42
Gambling A Continuum
No Gambling
Social
Problem
Pathological
At-Risk
Experimentation
1.7
1.0
Source Moore, TL. (2006). Oregon Gambling
Prevalence Replication Study. http//gamblingaddic
tion.org/
43
Quick Facts Problem Gambling in Oregon

• Adults 2.7 1
• Teens (13-17 y.o.) 6 at risk or problem
  gamblers 2
• College 5.6 (natl figure)3 3 (UO) 4
• Older adults 1.2 5

Sources 1. Moore (2006 ibid). 2. Volberg,
Hedberg, Moore (2008). Adolescent Gambling in
Oregon. http//gamblingaddiction.org 3. Shaffer
Hall (2001). Updating and refining
meta-analytic prevalence estimates of disordered
gambling behavior in the United States and
Canada. 4. Northwest Survey Data Services
(2007). http//lanecounty.org/prevention/gambling/
college.htm 5. Moore (2001). Older Adult Gambling
in Oregon. http//gamblingaddiction.org
44
Signs of Problem Gambling

• Preoccupation with gambling
• Increases amount of money gambled
• Unsuccessfully tries to quit
• Restless or irritable when trying to cut
  down/stop
• Gambles as an escape

• Chases losses
• Lies to others to conceal gambling
• Has committed illegal acts
• Has jeopardized relationships
• 10. Relies on others to bail him/her out

Pathological gambling At least five of
above, and not accounted for by a Manic Episode.
Pathological Gambling is defined in DSM-IV as an
Impulse Control Disorder Source American
Psychological Association (1994). Diagnostic and
statistical manual of mental disorders.
45
Three Core Phases

• Hitting Bottom
• Desperation
• Crime
• Divorce
• Depression/Suicide
• Getting help?

Desperation
Source Custer, R. (1980). Custer Three Phase
Model.
46
Most Common Effects of Problem Gambling

• Debt - 22,000
• Crime 36
• Depression/suicide
• 48 seriously considered suicide
• 7 attempted suicide
• Relationship/job problems 57
• Concurrent alcohol problems 30
• Concurrent drug problems 13

Source Oregon Department of Human Services,
Problem Gambling Services (2009). Oregon Problem
Gambling Awareness Community Resource Guide.
Salem, OR Author.
47
Economic/Financial Impact

• Clients in Oregon treatment 2008 combined
  gambling-related debt of gt44 million
• Estimated socio-economic cost for each problem
  gambler 3,000 for each pathological gambler
  11,000

Sources Oregon DHS, 2009 (ibid) Grinols, E.
(2004). Gambling in America Costs and Benefits.
48
Effects on children

• Higher abuse neglect
• Higher rates of pathological gambling among teens
• Higher levels of tobacco, alcohol and drug use
  and overeating

Sources Please see comprehensive list of sources
on following slide.
49
Effects on children

• Children of compulsive gamblers are often prone
  to suffer abuse, as well as neglect, as a result
  of parental problem or pathological gambling 1
• Children of problem gamblers were reported to be
  two to three times more likely to be abused (by
  both the gambler and the gamblers spouse) than
  their peers 2
• Research consistently shows higher rates of
  pathological gambling in teens whose parents
  gamble excessively 3
• Adolescents in families with parents who gamble
  are twice as likely to be an at-risk gambler and
  four times as likely to be a problem gambler 4
• Children of problem gamblers have been shown to
  have higher levels of tobacco, alcohol and drug
  use and overeating than do their classroom peers 3

Sources 1. National Opinion Research Center
(1999). 2. Darbyshire, Oster, Carrig (2001). 3.
Gupta Derevensky (1997) Jacobs (2000)
Wallisch Liu (1996). 4 Volberg et al. (2008
ibid).
50
Gamblings Crack Cocaine??
9 in 10 problem gamblers
Source Oregon DHS (2009). Oregon Gambling
Treatment Programs Evaluation Update.
51
Electronic Gambling

• Most Oregon problem gambling treatment clients
  say electronic gambling is their preferred method
  (video poker/slots, line games)

Source Oregon DHS (2009 ibid)
52
Prevalence of problem gambling by age
Average age of problem gambler in Oregon
treatment 46 years old

• Sources Oregon Adults ages 18 Moore, TL
  (2006 ibid) Oregon Adolescents, ages 13-17
  (combined at risk and problem gamblers)
  Volberg, R (2008 ibid) National ages18-24
  y.o. Shaffer, H. Hall, M. (2001). Updating and
  refining meta-analytic prevalence estimates of
  disordered gambling behavior in the United States
  and Canada. Canadian Journal of Public Health,
  92(3), 168-172.

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The earlier people begin gambling, the more
likely they are to experience problems from
gambling. - National Academy of Sciences
55
Not Your Uncles Gambling

• Availability
• Accessibility
• Acceptability
• Age
• Awareness

Youth gambling still under-studied under the
radar
56
Not Your Uncles Gambling (cont)

• AVAILABILITY
• More types of gambling available than ever
• Electronic forms of gambling available almost
  everywhere
• ACCEPTABILITY
• Community laws norms currently favorable toward
  gambling
• Media portrayal of gambling does not
  demonstrate pitfalls
• Family Youth are significantly more likely to
  gamble, and gamble more often, if one or both of
  their parents gamble.
• Youth who gamble are not as afraid of getting
  caught than as with alcohol, drugs, or sex

• ACCESSIBILITY
• First generation of youth exposed to ready access
  ways to gamble
• greater access ? more gambling, greater spent,
  increased problem gamblers
• AGE
• The age at which gambling behavior begins is
  getting younger
• Pathological gamblers and youth in general report
  early gambling in the home
• AWARENESS
• Lack of community family awareness of gambling
  being a potential problem

57
Adolescent Behavior Brain Development

• Preference ?excitement and ? effort activities
• Prefer novelty
• Poor planning judgment
• Minimal consideration of negative consequences
• More risky, impulsive behaviors

Source Grant, J (2008, October). The Adolescent
Brain Impulsive Behaviors. Healthy Brain
Development Key Impacts Interventions
Conference.
58
Gambling Oregon Teens

• Six in 10 Oregon (63 percent) have gambled
• 46 percent gambled in the past year
• 3 percent gamble weekly or more
• Six percent problem gamblers or at risk
• Preferred games in order
• Free Internet gambling-type games
• Cards (poker)
• Sports bets
• Games of personal skill

Source Volberg, et al (2008 bid).
59
Risk Factors for Youth Problem Gambling

• Single-parent household
• Gambling on card games and sports
• Being male, older adolescent
• Household income below median
• Playing sports for school (competition)
• Having lost more than 50 in a single month
• Started gambling before 8th grade (early
  initiation)
• Parents who gamble (favorable parental
  attitudes/behaviors)
• youth twice as likely to be at-risk gamblers
  four times as likely to be problem gamblers

Source Volberg, et al (2008 bid).
60
Oregon Youth Gambling Study Parents

• High proportions of parents (regardless of
  whether they gamble) have inaccurate beliefs
  about gambling, such as thinking that gambling is
  harmless, and that youth who gamble are unlikely
  to have problems in school
• Parents also believe that youth gambling is not
  associated with alcohol or drug use
• As stated, adolescents in families with parents
  who gamble are twice as likely to be an at-risk
  gambler and four times as likely to be a problem
  gambler

Source Volberg, et al (2008 bid).
61
Recognized Youth Problem Behaviors
Problem gambling?
Information Communities that Care (problem
gambling currently not recognized) for more
information, visit http//www.lanecounty.org/preve
ntion/risk-factors.htm
62
Oregon Healthy Teens SurveyDrank alcohol, past
30 days
Gambler
Gambler
Source Oregon Healthy Teens Survey, 2008.
http//www.dhs.state.or.us/dhs/ph/chs/youthsurvey/
ohtdata.shtml2008. Correlate information
coalesced by Oregon Problem Gambling Services,
2008.
63
Binge drank, past 30 days
Source Oregon Healthy Teens Survey, 2008 (ibid)
64
Been in a physical fight, past 12 months
Source Oregon Healthy Teens Survey, 2008 (ibid)
65
Attacked someone with idea of seriously hurting
them, past 12 months
Source Oregon Healthy Teens Survey, 2008 (ibid)
66
Carried a handgun, past 30 days
Source Oregon Healthy Teens Survey, 2008 (ibid)
67
Interpretations of Data

• High risk behaviors tend to cluster
• Adolescent problem gamblers remain at increased
  risk for the development of an addiction or
  multiple addictions (Gupta Derevensky,1998a,1998
  b, 2001 Kusyszyn, 1972 Lesieur Klein, 1987
  Winters Anderson, 2000)
• Youth problem gambling has been shown to result
  in increased delinquency and crime, disruption of
  familial relationships and decreased academic
  performance (Derevensky Gupta, 1999, Gupta
  Derevensky, 1998a, 2000 Hardoon, Derevensky
  Gupta, 2003 Ladouceur Mireault, 1988 Lesieur
  Klein, 1987 Wynne et al., 1996)
• Gambling should be also addressed in schools
• Address gambling in adolescent high-risk programs

Photo source Phongpaichit, P., Piriyarangsand,
S., Treerat, N. (1999). Guns, girls, gambling,
ganja Thailands illegal economy and public
policy. Silkworm Books.
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College Gambling

• Those who play cards are also more likely than
  other gamblers to gamble on the Internet 1
• A 2005 Harvard School of Public Health study of
  colleges found that all the colleges surveyed had
  alcohol policies, yet only 22 percent had a
  gambling policy 2
• Well-demonstrated relationship of problem
  gambling with other risky behaviors 1,3
• Excessive alcohol use binge drinking
• Regular tobacco use
• Marijuana other illicit drug use
• Overeating/binge eating

Sources 1. Engwall, Hunter Steinberg (2004).
Gambling and Other Risk Behaviors on University
Campuses. Journal of American College Health. 52
(6) 245-255. 2. Shaffer, Donato, Labrie, Kidman,
LaPlante. (2005). The epidemiology of college
alcohol and gambling policies. Harm Reduction
Journal. 2 (1). 3. LaBrie, R., Shaffer, H.,
LaPlante, D., and Wechslet, H. (2003). Correlates
of college student gambling in United States.
Journal ofAmerican College Health. 52 (2) 53-62.
70
UO Gambling Habits Survey

• 437 participants, May 2007
• All four undergraduate classes, plus graduate
  students, represented
• 61 female, 39 male (a limitation of the
  survey)
• 19 had never gambled 25 had not gambled in
  last year
• Full survey report available online
  http//lanecounty.org/prevention/gambling

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72
Total rate of problem gambling (self-report)
3 (n437)
73
Reasons for Gambling
3 Main Reasons for Gambling
26 of the people survey respondents thought had
gambling problems were other U of O students.
Men 8 times more likely as women to gamble for
reasons of competition.
74
UO Survey Findings (cont.) Student Beliefs About
Problem Gambling

• A large majority of students (69) thought
  problems with gambling could be changed through
  willpower
• At the same time, an even larger majority (89)
  agreed that gambling is an addiction similar to a
  drug or alcohol addiction
• Most students (58) thought treatment for problem
  gambling was usually successful
• this set of beliefs is consistent with the idea
  most students share about willpower

75
Athletes vs. Non-Athletes

• Athletes and non-athletes gamble at about the
  same frequency (81)
• However, problem gambling among athletes appears
  higher 6.2 percent of athletes are problem
  gamblers, compared with 3.3 percent of
  non-athletes 2
• 72 of student athletes have gambled at least
  once since entering college 1
• Gambling on sports
• 45 percent of male athletes reported gambling on
  sports 1 28 of SEC athletes reported gambling
  on sports 2
• One in 20 male student athletes admitted
  providing inside information for gambling
  purposes, betting on a game in which they
  participated, or accepting money for performing
  poorly in a game 1
• In one study, problem gambling screening
  indicated that 15 had either problem or
  pathological gambling 3

Sources 1. Cross, Del Carmen Lorenzo, Fuentes
(1999). The Extent and Nature of Gambling Among
College student Athletes. Ann Arbor, MI
University of Michigan Department of Athletics.
2. Rockey (2002). Southeastern Conference (SEC)
study. 3. Kerber (2005). Problem and pathological
gambling among college athletes. Annual of
Clinical Psychiatry. 17 (4) 243-7.
76
Male vs. Female Athletes

• Course reading Huang, J.H., Jacobs, D.F,
  Derevensky, J.L, Gupta, R., Paskus, T.S.
  (2007). A national study on gambling among US
  college student-athletes. Journal of American
  College Health. Sep-Oct56(2)93-9.
• http//sapp.uoregon.edu/course_syllabus.asp?course
  crn26333theyear2009
• Also see Huang, J. H., Jacobs, D. F.,
  Derevensky, J. L., Gupta, R., Paskus, T. S.
  (2007). Gambling and health risk behaviors among
  u.S. College student-athletes Findings from a
  national study. The Journal of Adolescent
  Health, 40(5), 390-397.
• Males consistently reported engaging in gambling
  or sports wagering activities in much higher
  proportions that their female counterparts 1

Source National Collegiate Athletic Association
(NCAA).(2004). National Study on Collegiate
Sports Wagering and Associated Health Risks.
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78
Age 65

• Rate of problem gambling lower (1.2) 1
• BUT living close to gambling facility ?? risk
• six times more likely to be problem gamblers
• ? risk factors 2
• Loneliness/isolation
• Physical/mental illness
• Relaxation/boredom/passing time/escape
• Gambling most frequently identified social
  activity 2
• Challenges in problem
  identification acceptance

Sources 1. Moore (2001, ibid). 2. McNeilly
Burke (2000). Late life gambling The attitudes
and behaviors of older adults. Journal of
Gambling Studies, 16, 393-415.
79
Ethnic Groups

• Ethnic minorities ?er proportion of problem
  gamblers (except Asians)
• Minorities spend 2.5x more on gambling in a
  typical month

Source Moore, Jadlos, Carlson, 2000, as cited
in Moore (2001 ibid)
80
Incarcerated Persons

• One in three offenders meet criteria for PG 1
• Highest rate in any population
• Gambling common in prison culture
• Resources limited to investigate crime gambling
  2

Sources 1. Williams, Roysten Hagen. (2005).
Gambling and Problem Gambling Within Forensic
Populations, A Review of the Literature 2. Myers,
H. (2006). Organized crime in Oregon.
81
Military

• All four branches operate slot machines overseas
• Service members at higher risk
• Male, younger, racial/ethnic minorities
• Marine corps highest rate of PG
• Alcohol gambling connected
• Further article of interest http//www.cnn.com/20
  07/US/05/22/military.gambling/index.html

Source Department of Defense (2002). Survey of
Health Related Behaviors Among Military Personnel
Washington, DC Author. Report information
available at http//www.tricare.mil/main/news/dods
urvey.htm
82

• Thought processes distortions
• Neurobiology addiction connections
• Similarities differences

83
Just Where does it Fit?
PG has addictive and physiological components
PG classified as Impulse Disorder in DSM-IV
AD type tx approach (e.g., GA)
Cognitive/ Behavioral approach to treatment
Co-occurrence with other MH disorders
Co-occurrence with alcohol/drug addiction
84
Mental Health/Addictions Connections

• Depression/mood disorders 1
• 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 3, 4
• Substance abuse
• 13 of problem gamblers in Oregon treatment 5
• Alcohol abuse
• 30 of problem gamblers in Oregon treatment 5

Sources 1. Ledgerwood Petry (2006). 2. Kausch
et al. (2006). 3. Biddle et al. (2005). 5. Oregon
DHS (2009).
85
Problem Gambling Mental Health Impulsivity

• Self-control/impulsivity problems associated in
  the research with pathological gambling are
  common to several mental health disorders
• An impulse control disorder other than
  pathological gambling was noted in 35 of all
  pathological gamblers, compared with 3 controls
• Persons with pathological gambling exhibit
  significantly greater
• Novelty seeking
• Impulsiveness
• Extravagance

Sources 1. The WAGER (2002, February 12) 2.
(Specker, et al., 1995) 3. Kim Grant (2001)
86
Problem Gambling Mental Health ADHD

• Strong correlations between pathological gambling
  and childhood behaviors related to ADHD-related
  behaviors 1
• In one study, ADHD was seen in 20 of
  pathological gamblers 2
• Problem gamblers had poorer performance on tasks
  demanding executive attentional processes 3
• Hypothesis that the stimulating effect of
  gambling could be comparable to the paradoxical
  effect of Ritalin. Self-medication? Used to
  combat depression? 3
• Sources 1. Carlton, P.L., Manowitz, P.,
  McBride, H., Nora, R., Swartzburg, M., Goldstein,
  L. (1987). Attention deficit disorder and
  pathological gambling. Journal of Clinical
  Psychiatry, 48, 487-488. 3. Rugle, L., Melamed,
  L. (1993). Neuropsychological assessment of
  attention problems in pathological gamblers.
  Journal of Nervous and Mental Disease, 181,
  107-112.

87
Mental Process
Thoughts Fantasies
88
Cognitive Distortions

• Gamblers fallacy
• Failure to see EACH roll of dice or EACH spin of
  wheel as independent chance-related events
• That slot machine is DUE to hit.
• Illusion of control
• Relating winnings to skill, even in luck-based
  games
• Im smarter than that player.
• Superstition
• Selective memory

 Source Tonneato, T. (1999). Cognitive
psychopathology of problem gambling. Subst Use
Misuse. Sep34(11)1593-604.
89
Special The Online Gambler

• You dont know me anonymity
• You cant see me invisibility
• See you later dont relate in real time
• Its just a game real money does not change
  hands its all credits
• Were equals authority really does not exist

Harvard researcher Christine Reilly on online
gambling "The Internet is quick and easy and
offers instant gratification. It leaves you very
little time to think. You just act without noting
the drawbacks."
Source National Council on Problem Gambling
90
Online Gambler (cont.)

• Gratification Instant
• Anticipation Removed, instant action, adrenaline
  rush
• Companion Always there when needed
• Fantasy Change persona
• Expression In a private world, more satisfying
  than real life
• Ego Boosts fragile/bruised ego
• Constraints Lacking boundaries limit only by
  extent cash/credit
• Chasing Several times a day PC is a right there
  
• Source Bellringer (2006)

Gambling online enables an accelerated speed of
play for example, casino card games have an
average rate of play of around 30 hands per hour,
compared to online poker, which can average 60 to
80 hands per hour.
91
Addiction Connection

• More easily hidden
• Cant overdose-no saturation point
• Cant be tested
• Doesnt require ingestion
• Fewer resources available
• Societal perceptions

• Loss of control
• Denial
• Depression/mood swings
• Progressive
• First win/high remembered
• Use as an escape
• Preoccupation
• Similar highs

This slide courtesy Andy Cartmill, Washington
County HHS
92
Neurobiology of Problem Gambling

• Still not well understood
• Multiple neurotransmitter systems believed
  involved
• Seratonin
• Norepinephrine (aka noradrenalin)
• Opioid
• Dopamine
• Important to consider in treatment

Source Grant, 2006. Neurobiology and
Pharmacological Treatment of Pathological
Gambling.
93
Roles for Neurotransmitters
Dopamine most studied neurotransmitter in
problem gambling
94
Neurotransmitters Roles

• Serotonin
• Decreased serotonin associated with adult
  risk-taking behaviors - alcoholism and
  pathological gambling
• Implicated in disadvantageous decision-making -
  adults with gambling or drug addictions
• Opioid system
• Gambling or related behaviors have been
  associated with elevated blood levels of the
  endogenous opioid ß-endorphin.
• Norephinephrine (NE)
• Pathological gamblers had higher higher urine
  levels of NE.

Sources 1. Grant (2006 ibid). 2. Tamminga,
CA., Nestler, EJ (2006, Feb). Pathological
Gambling Focusing on the Addiction, Not the
Activity. http//ajp.psychiatryonline.org/cgi/cont
ent/full/163/2/180 3. Anderson G, Brown R
(1984). Real and laboratory gambling,
sensation-seeking, and arousal. Br J Psychol
75401-411.
95
Role of Dopamine in Gambling

• Dopamine release into the nucleus accumbens -
  translates motivated drive into action - a go
  signal
• Dopamine release associated with rewards and
  reinforcing
• Dopamine release - maximal when reward is most
  uncertain, suggesting it plays a central role in
  guiding behavior during risk-taking situations.

Source Grant, 2006. Neurobiology and
Pharmacological Treatment of Pathological
Gambling.
96
Problem Gambling Dopamine

• Decisions that will likely cause us to
• lose money vs. win money

Source Brain Briefings (2007, October), Society
for Neuroscience, Washington, DC
97
Problem Gambling Dopamine (explanation of prev.
slide)

• Recent studies have found that when we anticipate
  financial gains, an area of our brain known as
  the ventral striatum becomes activated and
  flooded with dopamine
• Release of dopamine also occurs during naturally
  rewarding activities such as eating, sex,
  physical activity -- is a key factor behind our
  desire to repeat these activities
• To maintain even a normal level of dopamine in
  their brains, they must gamble with increasing
  frequency and often for greater and greater
  stakes
• The impulse control in their brain is not
  functioning properly drug addicts show a similar
  brain pattern and a similar need to keep
  feeding their addiction

Source Brain Briefings (2007, October), Society
for Neuroscience, Washington, DC
98

• "Monetary reward in a gambling-like experiment
• produces brain activation very similar to that
  observed
• in a cocaine addict receiving an infusion of
  cocaine.
• Hans Breiter, MD, co-director of the Motivation
  Emotion Neuroscience Center,
• Massachusetts General Hospital

• Dopamine levels and behavioral pattern resulting
  from learned audiovisual cue (Figure from Self,
  2003)

Source Biology, Addiction Gambling
(http//www.basisonline.org/backissues/2003/vol8pd
f/wager838.pdf)
99
Different Types of Gambling Different
Experiences

• Lottery scratch-offs
• tend to be high on anticipation fantasy
• Video poker and slots
• tend to be high on escape
• Craps and sports betting
• tend to be high on excitement

100
The Adolescent Brain Revisited 1

• Cognitive centers in flux
• Amygdala active
• Fight or flight, emotion
• Decision-making altered
• More vulnerable to risk-taking impulsive
  behaviors
• Brain especially sensitive to dopamine

1. Source Ramoski, S., Nystrom, R. (2007,
summer). The Changing Adolescent Brain. Northwest
Public Health. http//www.nwpublichealth.org/archi
ves/s2007/adolescent-brain
101
Other References on Gambling the Brain

• Gambling has drug-like effect on brain (2001)
• http//www.usatoday.com/news/health/2001-05-24-gam
  bling.htm
• The Medial Frontal Cortex and the Rapid
  Processing of Monetary Gains and Losses
• http//www.sciencemag.org/cgi/content/abstract/295
  /5563/2279
• Brain activities differ in problem gamblers
  (2003) Source http//opa.yale.edu/news/article.as
  px?id3025
• Gambling addiction resembles brain problem
  Poorer choices, more errors seen in chronic
  gamblers?? mental tests (2005)
• http//www.webmd.com/mental-health/news/20050413/g
  ambling-addiction-resembles-brain-problem
• Gambling addiction Whats the brain got to do
  with it?http//braininstitute.vanderbilt.edu/Van
  derbilt_March07_PotenzaLecture.ppt

102

• http//bjkeira.blogspot.com

103
Day 2
problem gambling prevention identification
treatment recovery
104
Continuum of Care
Institute of Medicine Continuum of Care graphic
source mentalhealth.samhsa.gov
105
Prevention Statewide Local Efforts

• Partnership with Department of Education
• Curriculum integration in schools
• Youth video
• Oregon youth prevalence study
• Community Resource Guide
• Middle School Poster Contest
• Partnering with addictions prevention
  providers/groups
• Policy coalition work

Resource guide can be downloaded at
http//lanecounty.org/prevention/gambling/opgaw.ht
m
106
Examples in Lane County
inform educate prevent harm
107
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108
UO Problem Gambling Awareness Project (PGAP)

• Fall 2008- June 2009
• Coordinator Navit Parker
• navit_at_sapp.uoregon.edu 346.0412
• Three goals
• Student awareness
• Health/counseling staff awareness, identification
  referral
• On-campus housing staff awareness safe online
  gambling

109
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110
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111
Small numbers, big deal

• Emergence Parents call, but students never show
  up
• Weve all heard the stories
• They just disappear
• Were young, right?

112
Getting Started

• Making friends
• Hello my name is Navit and I am not going to add
  to your work load.
• Know the issue
• Know the resources
• Know the population
• Slogo time
• Ad Team! Glory be!

113
Photo by Daniel Berman
114
Intercepts

• 20 students
• Randomly pulled aside and asked to answer a few
  questions
• Given Starbucks cards for incentive
• Results

115
Men
Women
116
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117
Whats

• Media Campaign
• Dorms
• OPGAW
• (Additional) Inspiration

Next?
118
Thank you!
Navit Parker navit_at_sapp.uoregon.edu 346-0412
119
Getting Results

• Oregon is one of the few states that appears
  to have averted a
  significant increase in problem gambling
  prevalence while expanding legalized gambling.

Source National Center For the Study of
Gambling, 2006.
Source 2. National Center For the Study of
Gambling, 2006.
120
Key Challenges

• Youthful subject
• Perception of harmlessness
• Stigma/shame
• Industry

121
Continuum of Care
Institute of Medicine Continuum of Care graphic
source mentalhealth.samhsa.gov
122
Intervention

• Helpline 541.741.7107 emergence
• Or 24/7 1.877.MY.LIMIT
• Online
• 1877mylimit.org
• Problem gamblers /OR loved ones
• Help is FREE

123
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124
Continuum of Care
Institute of Medicine Continuum of Care graphic
source mentalhealth.samhsa.gov
125
Treatment is Free.

• 24 hrs 1877-my-limit
• Online 1877mylimit.org

126
Treatment

• Emergence Gambling Treatment Program
• Treatment free for gamblers and loved ones
• Over 200 problem gamblers and family members
  treated last year
• Gender-specific
• Multimodal treatment (shows substantial
  effectiveness)
• Individual sessions - Vocational counseling
• Group sessions - Recreational counseling
• Didactic lectures - 12-step mtgs
• Audiovisual educ. - Financial legal counseling
• Family therapy - Pharmacotherapy (if required)

127
Lane County Problem Gambling Treatment Clients
Source Oregon DHS (2009 ibid)
128
Oregon Gambling Treatment Clients, 2007-08

• 2,012 gamblers received treatment in outpatient,
  residential, and minimal intervention programs.
• 15.2 more clients were served over the previous
  year.
• The total gambling debt reported of all clients
  entering services was 44,276,489.
• 60 of successful program completers report no
  gambling 6 months after treatment.

Source Oregon DHS (2009 ibid)
129
System Evaluation Results

• Treatment is working
• 60 of clients reported either no gambling or
  reduced gambling at 6-months post-treatment1
• Prevention and outreach are working
• Oregon is one of the few states that appears to
  have averted a significant increase in problem
  gambling prevalence while expanding legalized
  gambling2

1. Oregon DHS (2009 ibid) 2. National Center
For the Study of Gambling, 2006.
130
Identification Social or Problem Gambler?
131
Guest Panel

• Brad Killian
• Michel Savage
• Pat Kellison
• Ronda Hatefi

132
Wrapping it All Up

• Gamblings recent popularity has not come without
  cost
• Many population groups are susceptible to
  gambling problems
• Problem gambling has strong addictions mental
  health connections
• Balance is needed study impact, make informed
  decisions
• Problem gambling services are free, confidential,
  available and effective

133
Thank You! For More Info

• Julie Hynes
• Lane County Health Human Services
• 541.682.3928 julie.hynes_at_co.lane.or.us
• lanecounty.org/prevention/gambling
• Navit Parker
• UO Problem Gambling Awareness Project Coordinator
• 541.346.0412 navit_at_sapp.uoregon.edu