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“Gambling: The Hidden Addiction” Prevalence and Screening Tools Presenter

2013 Mid-Atlantic  Behavioral Health Conference Ideas In Action  Innovations    -   Partnerships   -    Technologies. “Gambling: The Hidden Addiction” Prevalence and Screening Tools Presenter Carl E. Robertson, MRE, MDiv.- Prevention Manager.

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“Gambling: The Hidden Addiction” Prevalence and Screening Tools Presenter

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  1. 2013 Mid-Atlantic  Behavioral Health Conference Ideas In Action  Innovations    -   Partnerships   -    Technologies “Gambling: The Hidden Addiction” Prevalence and Screening Tools Presenter Carl E. Robertson, MRE, MDiv.- Prevention Manager Funded by DHMH/ADAA

  2. Maryland Center of Excellence on Problem Gambling Partnership of Maryland Council on Problem Gambling and the University of Maryland School of Medicine Funded with a 3 year grant (2012-2015 ) from State Health Department Purpose: Identify and promote problem gambling treatment resources Provide Maryland based prevention and research initiatives Establish problem gambling lending library resources Conduct Public and Professional Awareness Outreach Campaigns Manage Maryland Problem Gambling Hotline: 1-800-522-4700 Funded by DHMH/ADAA

  3. If you bet on a horse, that’s gambling. If you bet you can make three spades, that’s entertainment. If you bet cotton will go up three points, that’s business. What’s the difference? Gambling is any activity or game where you risk something of value or money on an outcome that is not guaranteed. Funded by DHMH/ADAA

  4. Problem and Pathological Gambling Definitions Problem Gambling – is a descriptive term used to define those individuals with problems in their lives due to gambling. Pathological/Compulsive Gambling- is the clinical term for the Impulsive Control Disorder defined in DSM IV-312.31 (failure to resist the impulse to gamble) Funded by DHMH/ADAA

  5. Leaving- Impulse Control Disorder Joining- “Substance Use Disorder” section “Behavioral Addictions” = “Gambling Disorder” 9 vs 10 Criteria (Illegal activities may be dropped) “In functional brain imaging-whether with gamblers or drug addicts-when they are showed video or photograph cues associated with their addiction, the same brain areas are activated”. Charles O’Brien, M.D. chair of the DSM-5 Work Group on Addictive Disorders Compulsive Gambling News DSM V

  6. “Gambling Disorder” Severity Rated 9 vs 10 Criteria (Illegal activities may be dropped) 2-3 Criteria will be indicative of a Mild Disorder 4-5 Criteria will be indicative of a Moderate Disorder 6 or More will be indicative of a Severe Disorder (The threshold for diagnosis (DSM-5) is two or more criteria in contrast to one or more criteria for DSM-4) DSM V Severity Criteria

  7. Effect on reimbursement Effect on SAMHSA recognition Effect on research funding And remember: We are treating people with gambling problems, not problem gamblers Remaining Questions

  8. Actually, quite a lot, there is data from sources such as: National Research Council – 1999 McGill University – 1998/Present National Council on Compulsive Gambling Gambling Prevalence in Maryland: A Baseline Analysis – 2010 Johns Hopkins Longitudinal Study What do we know about Adult and Adolescent Problem Gambling?

  9. About 1-3% of the Adult Population of the U.S. has a Gambling Problem Estimated to be over 4-6 million adults in the United States(combination of pathological/problem gamblers) Estimated to be over 128,670 adults in Maryland (based on 2011 census projections) Who Are Adult Problem Gamblers based on National Research Council Survey 1999

  10. Survey indicated 3.4 % of the Adult Population in Maryland are problem/pathological gamblers (1.5% pathological/1.9% are problem gamblers) Estimated to be over 154,400 adults in Maryland(based on Maryland Baseline projections) Range: 128,670 – 154,400 Adult Marylanders Who Are Adult Problem Gamblers based on Maryland Baseline Survey 2010

  11. WHAT DOES + REPRESENT?

  12. Capacity 71,008 x 2 = 142,016 Represents less than the 154,400 Adult Gamblers in MD

  13. 4-8 % Level III, Probable Pathological gambler (NRC, 1999) 1.1 million youth 12-17 exhibit pathological gambling behavior (NGISC, 1999) 10-15% at-risk for Problem Gambling (Shaffer & Hall, 1996; Winters, Stinchfielf, & Fulkerson, 1991; Wiebe, 1999; Wynne, Smith, & Jacobs, 1996) Youth Gambling 4 to 6 % (problem/pathological) Maryland Youth Estimated: 47,000-50,000 (problem/pathological based on 2011 census projections) Youth Prevalence Findings

  14. Capacity 45,971 to 48,187 If you filled Camden Yards what would that represent?

  15. Johns Hopkins survey Study began in 1993 in 27 1st Grade Classrooms in Baltimore City public schools Data Sources utilized: Teacher ratings Parent ratings Self-reports: 90 minute self-administered computer interview Gambling data collected via age appropriate scales SOGS-RA in 2004, 2006-07 and SOGS 2008-2011 Funded by DHMH/ADAA

  16. Found that 11-15% of adolescents/adults have some form of problem gambling from the groups studied since 2004 (when gambling questions were added to the study.) Prevalence of Baltimore Inner-City Youth

  17. National Research Council – 1999 Delaware College Gambling Study – 2011 Gambling on Campus: New Directions Series NCRG: College Gambling blueprint What do we know about Emerging Adult Problem Gambling?

  18. About 4-8% of College students of the U.S. have a Gambling Problem (problem/pathological) Most authors use 6-8% as the average percentage. (e.g. NCRG; Oregon) 18-23% of students gamble on a weekly basis 75-85% of students gambled in the past year 22% of colleges have written gambling policies College Problem Gamblers based onNational Data

  19. Using 6%: there are at least 18,867 College level problem gamblers on Md campuses Using 8%: there are at least 25,156 college level problem gamblers on Md campuses Range: 18,867 – 25,156 (Based on Maryland Higher Education Actual Enrollment Projections of: 314,451 students) Based on Md Higher Education Enrollment Projections: June, 2012 Maryland College Level Problem Gambling

  20. Comcast Center: capacity 17,950

  21. Adaptedfrom Understanding Substance Abuse Prevention: Toward 21st Century Primer on Effective Programs (P. Brounstein & J. Zweig, 1999). Center for Substance Abuse Prevention (CSAP) & Substance Abuse and Mental Health Services Administration (SAMHSA). Dickson, Derevensky, & Gupta (2002).

  22. Integrated Model: No Wrong Door Substance Abuse Treatment Center Mental Health Center Gambling Problems Gambling Integrated Assessment (including PG Screen) Screen Positive Screen Positive Gambling Integrated Assessment (including PG Screen) Gambling Specific Assessment Pos or Neg Pos or Neg Pos or Neg Pos or Neg PG Enhanced Treatment PG Enhanced Treatment Gambling Specific Treatment 22 Funded by DHMH/ADAA

  23. Although nearly half (49%) of those with lifetime pathological gambling received treatment for mental health or substance abuse problems, none reported treatment for gambling problems. Lifetime Co-morbidityKessler et al., 2008 (National Comorbidity Survey Replication)

  24. Psychiatric Comorbidity in Pathological Gamblers: Summary of Research of PG’s in Treatment Affect Disorders ~50-80% Anxiety Disorders Trauma ~10-35% ~5-30% Pathological Gambling Attention Deficit Disorder Substance Use Disorders Personality Disorders ~20-35% ~25-63% ~20-93%

  25. Pathological Gambling: Comparison to Substance Abuse • Similarities • Loss of Control • Preoccupation • Negative impact on major life areas • Tolerance

  26. Pathological Gambling: Comparison to Substance Abuse • Similarities • Withdrawal Symptoms • Self-help groups • Biopsychosocial/spiritual disorders • Family involvement

  27. Pathological Gambling: Comparison to Substance Abuse • Differences • Unpredictable outcome • Fantasies of success • No biological test • Easier to hide

  28. Pathological Gambling: Comparison to Substance Abuse • Differences • Greater financial problems • Intensity of family anger • Less public awareness and acceptance

  29. What questions about gambling can you incorporate into each part of your interview? Biological/Medical Substance Use/Abuse Psychological Social Leisure Activities Spiritual Screening

  30. Does Family Have Significant Financial Problems Are Financial Problems Related to Gambling (Either causing them or seen as solution) Have You Been Concerned About Extent of Gambling of Family Member? Family Screening

  31. South Oaks Gambling Screen (SOGS) PERC-(NODS)instrument Gambling Severity Index GA-20 Questions “Lie-Bet” 2 Question Brief Screen SOGS-R A- Adolescent Screen Mass. Adolescent Gambling Screen Instruments

  32. Resources for Problem Gamblers • The Maryland Center of Excellence on Problem Gambling is a resource center. • Our Helpline operates 24/7 for referrals for problem gamblers and their families at: • 1-800-522-4700 • Visit the webpage at: • www.MdProblemGambling.com

  33. Thank you Carl Robertson croberts@psych.umaryland.edu 410-328-4710 Funded by DHMH/ADAA

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