Dr. LaDonna McCune, Assistant Professor Sociology, Gerontology and Substance Abuse Studies University of Central Oklah

1. Dr. LaDonna McCune, Assistant Professor Sociology, Gerontology and Substance Abuse Studies University of Central Oklahoma National Certified Gambling Counselor, II Licensed Alcohol/Drug Counselor Email: lmccune@uco.edu Madyson Roark, UCO Graduate Student Mroark2@uco.edu Deanna Moslander, Certified Alcohol/Drug Counselor in California dmoslander@uco.edu Compulsive Gambling The Cousin to Substance Abuse

2. Compulsive Gambling The Cousin to Substance Abuse Gambling – Every time you risk $$, service or an object of value on a game with the hope of winning more. Uncertain Outcome Risking something of Value Being a Winner or a Loser Bunko played for $$$$ Bingo played for $$$$ Card & Domino Games played for $$$$ Games of Skill (pool, darts, golf, shuffleboard) Sports Betting Lottery Tickets Games found in Casinos Horse Racing/Dog Racing Video Lottery Terminals (VLT) Internet Gambling Scratch Tickets Cock Fighting/Dog Fighting Stock & Commodity Markets

3. Compulsive Gambling The Cousin to Substance Abuse Scope & Prevalence • 85% of adults in the U.S. gamble at one time or another. • 75% gamble once a year. • 15% gamble weekly. • Legal gambling in the U.S. is a 70 billion dollar industry (profit).

4. Compulsive Gambling The Cousin to Substance Abuse Gambling is legal in all states but Hawaii and Utah. Hawaii and Utah do have the stock market, internet and illegal gambling such as sports betting. SCOPE & PREVALENCE 42 states have lotteries, 28 states have casino gambling, six states have river boats. Florida has 56 cruise ships to nowhere.

5. Gambling in Oklahoma 117 casinos – 2nd to Nevada 3rd largest number of slot machines – 67,000 Largest gaming floor in the country at WinStar World Casino – 7,002 machines Estimated 100,000 with a gambling disorder in Oklahoma Indian gaming earned 3.4 billion in fiscal year 2012

6. Compulsive Gambling The Cousin to Substance Abuse In Oklahoma disordered gambling doubles in areas within 50 miles of a casino.

7. Oklahoma Gambling 2013 Oklahoma Gambling Helpline Oklahoma Helpline had 1,845 calls and we served 345 clients in treatment in 2013. Top Five Reasons for Calls: Financial Problems Marital Problems Family Problems Job Problems Mental Health Problems • We began pari-mutuel racing in 1983. • 2004 state lottery

8. Compulsive Gambling The Cousin to Substance Abuse

9. Compulsive Gambling The Cousin to Substance Abuse • Virtually all studies of college-aged samples have demonstrated a higher prevalence of pathological gambling than in adult population studies. • The highest rates reported are among those 18-25 years of age. Pathological Gambling

10. Compulsive Gambling The Cousin to Substance Abuse • Relatively easy access to online gambling and popularity of poker grams and tournaments poses a new risk for youth who are inclined to be over-involved in gambling. • 18 year of age verified by Facebook account birthday. • Non-problem gamblers may develop problems online due to high speed of play, social isolation, use of credit/non-cash payment methods and 24 hour availability.

11. Compulsive Gambling The Cousin to Substance Abuse Progression of Pathological Gambling Winning Growth Big Win Chasing Losing Rebuilding Borrowing Desperation Critical StealingGambling Stops Hopeless Suicidal, Substance Abuse

12. Compulsive Gambling The Cousin to Substance Abuse Diagnostic Statistical Manual of Psychological Disorders (DSM V) - Substance Related & Addictive Disorders • Gambling Disorder – 312.31 • Disordered gambling is 10X higher among substance abusers than in the general population.

13. Compulsive Gambling The Cousin to Substance Abuse • Dr. Robert Custer: Problem gamblers are 80% similar to substance abusers. • Major Difference: Grandiosity – Issues related to Egotism and Entitlement • 2nd Major Difference: Nature of the addiction – Gambling as a psychological compulsion

14. Substance Abuse Any use of substance is mind altering. A recovering addict can avoid all forms of substance abuse. Recovering addicts can avoid people, places and things. Problem Gambling Not all forms of gambling put the gambler in action. Recovering gamblers cannot avoid all forms of gambling. Recovering gamblers cannot avoid people, places and things in an actively gambling culture. HALT Compulsive Gambling The Cousin to Substance Abuse

15. Comparison to Substance Abuse Similarities • Loss of Control • Denial • Preoccupation • Negative Impact on Major Life Areas • Tolerance • Withdrawal Symptoms • Self-Help Groups • Bio-psychosocial/Spiritual Disorder • Family Involvement

16. Compulsive Gambling The Cousin to Substance Abuse • Comparison to Substance Abuse Differences • Gambling is not self-limiting. • Behavior is not attributable to intoxication. • More intense sense of shame and guilt. • Greater denial and stronger defenses. • Unpredictable outcome.

17. Comparison to Substance Abuse Differences • Fantasies of success • No biological test • Easier to hide • Greater financial problems • Intensity of family anger • Less public awareness and acceptance

18. Compulsive Gambling The Cousin to Substance Abuse Recycle Relapse Creates feelings of shame, embarrassment, guilt and hopelessness. Contributes to thoughts of failure and wasted effort. Demoralizes and encourages thoughts of giving up and sliding all the way back to pre-contemplation. • Creates opportunities to use setbacks in a constructive way. • Offers possibility of hope • Normalizes the setback and keeps thoughts focused on continuing the change process rather than quitting.

19. Compulsive Gambling The Cousin to Substance Abuse Turning the Negative into a Positive • Recycling allows the gambler to renew their commitment. • Recycling often strengthens the gamblers resolve. • Recycling allows the gambler to assess their support system. • Recycling allows the gambler to review self and the problem areas. ALL CHANGE IS CIRCULAR!

20. Compulsive Gambling The Cousin to Substance Abuse • Harm Reduction – a strategy for use with those problem gamblers unwilling or unable to use abstinence programs. • Identify the highest risk areas and help client with reduction, containment and limit setting behaviors. • Not a one size fits all treatment.

21. Compulsive Gambling The Cousin to Substance Abuse Harm Reduction – reducing the harm of excessive gambling • Strategy for use with those problem gamblers unwilling or unable to use abstinence program. • Recognizes abstinence as ideal outcome but accepts alternatives that reduce harm. • Illogic of abstinence as requirement for continuing treatment • Prevention efforts target high risk behaviors and focus on reducing potential for harm. • Involve family if at all possible. • Reality of high relapse rates (similar to substance abuse) – 97% of gamblers recycle. • Identify the highest risk areas and help clients with reduction, containment and limit setting behaviors.

22. Compulsive Gambling The Cousin to Substance Abuse • Harm reduction is not an alternative to relapse; is a way to break down barriers to engaging the client. • Counseling begins with harm reduction; not used only when all else fails. • Harm reduction is against harm, not against gambling. • Harm reduction is in favor of any positive change as defined by the client. • Client sets their own rate of change, the best pace possible for them.

23. Compulsive Gambling The Cousin to Substance Abuse • Help client see the consequences of their choices • Help client see they have options. • Help clients analyze the likelihood of success if they follow guidelines. • Help client sincerely try options but failure or inability to stay with limits leads to commitment to abstinence. • Allows client to define their own problems and find collaborative solutions.

24. Compulsive Gambling The Cousin to Substance Abuse • Discover the triggers or links in the chain leading to gambling. • Containing the impulse by managing the environmental triggers. • Controlling the impulses by managing the urges, negative emotions and cognitive expectations that lead to gambling. Building a fence around the impulse

25. Compulsive Gambling The Cousin to Substance Abuse • Reduce access to money and credit. • Involve family, individual or hopefully both. • Reduce addictive potential of games. • Decrease speed of play. • Decrease cost of play. • Loss limits • Time limits

26. Compulsive Gambling The Cousin to Substance Abuse • Avoid being near or driving by casino or betting venues. • Alter route to and from work. • Practice alienation leisure activities. • Develop an exit strategy when asked about gambling or if others are talking about gambling. • Willingness to attend G.A. meetings • Determine ways to cope with co-occurring issues such as alcohol and other drug use associate with gambling.

27. Compulsive Gambling The Cousin to Substance Abuse • Develop a buddy system, if client does go to casino. • Limit exposure to television ads. • Assist client with developing a pros and cons list to include family and friends in the circle of trust about their gambling issues. • Assist client in working towards telling family and friends their needs for support in limiting exposure, such as never lending them money.

28. Compulsive Gambling The Cousin to Substance Abuse • Atmosphere conducive to change • Has client examined risks to: family, job, health, finances and legal status? • Has client selected an effective limit setting strategy? • Has client built an evaluation of the effectiveness of the harm reduction strategy? • Is there a Plan B in case of need?

29. Compulsive Gambling The Cousin to Substance Abuse TYPES OF GAMBLERS • Professional Gambler • Social Gambler • Serious Social Gambler • Problem Gambler Gambling Disorder • Pathological Gambler • Antisocial Gambler

30. Compulsive Gambling The Cousin to Substance Abuse • Problem and pathological gambler seem to come in two general types: Action/Skill and Escape/Luck. • Action gamblers, early onset, skill: often male, competitive, play games of skill, seek the rush of gambling – like cocaine addicts. • Escape gamblers, late onset, luck: often female, less competitive, passive, play luck games, seek escape – like narcotic addicts.

31. ACTION Early Onset Narcissistic Games of Skill Competition/Power Winning Phase More likely to be male ESCAPE Later Onset Dysthmia Machine Games (slots/VP) Relief/Dissociation No Winning Phase Often female Compulsive Gambling The Cousin to Substance Abuse

32. Compulsive Gambling The Cousin to Substance Abuse • We know that problem gamblers cost society millions each year in criminal justice expenses, lost wages, unpaid taxes, use/reuse and inappropriate use of social services. • Problem gambling becomes everyone’s problem when we examine the impact on society, family, criminal justice and the job market. • Yet legalized gaming opportunities far out-pace the development of coordinated services for problem gamblers. • Adequately addressing this mental health issue is good health care, good social policy and good business. It is far too expense a problem to ignore.

33. Compulsive Gambling The Cousin to Substance Abuse • Gambler’s Anonymous [1957] 12 Step Philosophy • Gam-Anon is for family and friends of the gambler