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Title: 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.

5
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6
Gambling
  • To risk money or something of value on the
    outcome of an unpredictable event.

7
Multnomah Falls
  • Oregons 1 tourist attraction.
  • Until…

8
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9
Legal Gambling in Oregon
?
10
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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)
13
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14
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)

21
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22
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

33
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34
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.

53
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54
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 Survey Drank 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.
68
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69
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

71
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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.
77
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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
(No Transcript)
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
(No Transcript)
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
(No Transcript)
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
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