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PROBLEM GAMBLING As a CO-OCCURRING DISORDER

PROBLEM GAMBLING As a CO-OCCURRING DISORDER. 2007 Co-Occurring Disorders Conference October 1-2, 2007. Linda Graves Problem Gambling Program Manager Division of Alcohol and Substance Abuse. DSM-IV criteria Pathological Gambling 312.31.

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PROBLEM GAMBLING As a CO-OCCURRING DISORDER

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  1. PROBLEM GAMBLING As a CO-OCCURRING DISORDER 2007 Co-Occurring Disorders Conference October 1-2, 2007 Linda Graves Problem Gambling Program Manager Division of Alcohol and Substance Abuse

  2. DSM-IV criteriaPathological Gambling 312.31 • PERSISTENT AND RECURRENT MALADAPTIVE GAMBLING BEHAVIOR AS INDICATED BY AT LEAST FIVE OF THE FOLLOWING: • Is preoccupied with gambling 2. Needs to gamble increasing amounts of money in order to achieve the desired excitement 3. Has repeated unsuccessful efforts to control, cut back, or stop gambling

  3. DSM-IV criteriaPathological Gambling 312.31 • Is restless or irritable when attempting to cut down or stop gambling • Gambles as a way of escaping from problems or of relieving a dysphoric mood • After losing money gambling, often returns another day in order to get even 7. Lies to family members, therapist, or others to conceal the extent of involvement with gambling

  4. DSM-IV criteriaPathological Gambling 312.31 • Has committed illegal acts, such as forgery, fraud, theft, or embezzlement, in order to finance gambling • Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling • Relies on others to provide money to relieve a desperate financial situation caused by gambling B. THE GAMBLING BEHAVIOR IS NOT BETTER ACCOUNTED FOR BY A MANIC EPISODE.

  5. pathological gambling and substance use disorders Alberta, Canada (Bland, Newman, Korn and Stebelsky, 1993) • General population study • 20% of non-gamblers identified themselves as having a substance abuse disorder • Over 50% of those identified as pathological gamblers by the survey also had a substance use disorder

  6. pathological gambling and substance use disorders (2) Texas--Feigelman, Wallisch, and Lesieur (1998) • Among all respondents that were problem or pathological gamblers, 1/3 also had a substance use problem Feigelman et al (1998) also explored the converse situation. • Among respondents who had a substance use disorder, 20.1% also had a gambling problem

  7. pathological gambling and substance use disorders (3) National study, Petry, Stinson, and Grant (in publication) • Found a strong association between alcohol and gambling disorders. • Rates of alcohol abuse or dependence at four or more times higher among individuals identified as having a gambling disorder compared to those without the gambling disorder

  8. pathological gambling and substance use disorders In most cases, substance use disorders were in the past, not current with gambling disorders. Connecticut, clients seeking treatment for gambling problems, about 10% reported current illicit drug use or regular heavy use of alcohol.

  9. pathological gambling and substance use disorders IMPORTANT NOTE: • Treatment seeking gamblers with a history of substance use disorders tend to have • More severe gambling problems • Psychiatric symptoms • Other psychosocial difficulties Than gamblers without histories of substance use problems (Petry, 2004)

  10. pathological gambling and substance use disorders Ladd and Petry (2003) Compared the 31% of gamblers with substance abuse histories with the remainder without such histories. • More years of gambling problems • More frequent gambling activity • More likely to be receiving tx for mental health problems • Reported greater psychiatric distress than gamblers without prior substance abuse problems.

  11. pathological gambling and substance use disorders Langenbucher et al.(2001) In a mixed sample of substance abusers, • Higher nicotine dependence scores • More frequent use of alcohol • More alcohol and other drug dependence symptoms In the pathological versus the non-pathological gamblers

  12. pathological gambling and nicotine use Smart and Ferris (1996) • 41.6% of heavy gamblers were smokers • 30.1% of recreational gamblers were smokers • 21.3% of non-gamblers were smokers • This study is 11 years old.

  13. pathological gambling and other psychiatric disorders Mood disorders and suicidality Is the client depressed because of his or her gambling? OR Is the client treating a mental health problem by self-medicating with gambling?

  14. pathological gambling and other psychiatric disorders Petry, Stinson, and Grant (in publication) 43,000+ surveyed 195 pathological gamblers • 49.6% had lifetime prevalence of any affective disorder Compared to 18.5 % in non-gamblers • 37% of pathological gamblers had major depression • Compared to 12.3 % of non-gamblers • 22.8% of pathological gamblers had bipolar disorder • Compared to 2.5% of non-gamblers

  15. pathological gambling and other psychiatric disorders College students and suicide Ladouceur, Dube’, and Bujold (1994) 1471 college students 26.8% of pathological gamblers had attempted suicide compared to 7.2% who were not pathological gamblers. Many studies report high rates of suicide ideation and suicide attempts in gamblers.

  16. pathological gambling and other psychiatric disorders • Anxiety disorders The research is not conclusive regarding anxiety disorders being elevated among pathological gamblers. Studies can be shown that indicate no higher rates than among the general population (Ibanez et al, 2001; Blaszczynski and McConaghy, 1989) while others show high rates of generalized anxiety disorders (Black & Moyer, 1998; Specker, 1996, and others)

  17. pathological gambling and other psychiatric disorders • Studies have been done regarding OCD and PTSD. The numbers in the studies were very small, and have not been replicated, so further research is needed before any conclusions can be drawn. • This is also true for other psychotic disorders. If studies exist at all, the sample sizes are too small to draw conclusions.

  18. So. . . What can we learn from all of this?

  19. CONCLUSION? Research presents enough data to show both clients with substance use disorders and mental health disorders need to be screened for gambling problems.

  20. But you might say. . . I CAN’T DO ONE MORE ASSESSMENT. I HAVE TOO MUCH TO DO ALREADY! I DON’T HAVE TIME. I DON’T want to know if they have another problem. I DON’T KNOW HOW. Just LEAVE ME ALONE!!

  21. TWO THINGS: THAT’S ALL IT TAKES • Lie/Bet Screen • Have you ever felt the need to bet more and more money? • Have you ever had to lie to people important to you about how much you gambled?

  22. Help your client make a call to get help if they answer affirmatively to either of the two questions. • 1-800-547-6133 • 24/7 • Live voice response 24 hrs a day • Will send literature • Offer resources in caller’s area • Will offer locations of GA meetings

  23. Problem Gambling Treatment Provider Locations Bellingham (2) Burlington (3) Mt. Vernon (8) Tulalip( 16) Spokane (12) See Map Inset Of Puget Sound Area Skokomish (11) Montesano (7) Olympia (9) Tumwater (17) Yakima (19) Vancouver (18)

  24. INSET MAP Kirkland (5) Bellevue (1) Seattle (10) Renton(9) Tukwila (15) Kent (4) Lakebay (6) Tacoma (14) Sumner (13)

  25. Publicly Funded TreatmentJuly, 2007 Page 2 15. Tukwila: Seattle Mental Health 800-828-1449 youth and adults 16. Tulalip/ Everett: Tulalip Tribes Family Services 360-651-4400 17. Tumwater: A Healthy Risk 360-352-1052 18. Vancouver: Community Services Northwest Northwest Recovery Center 360-397-8488 ext. 7915 19. Yakima: Center for Counseling and Psychotherapy, LLC 509-966-7246 Triumph Treatment Services 509-248-1800 12. Spokane: Camas Institute Behavioral Health Services, 509-456-0799 Henry Montgomery, Ph. D. 509-744-0778 youth and adults New Horizon Counseling Services 509-838-6092 ext. 32 13. Sumner: The Center 253-863-0682 ext. 2 youth and adults 14. Tacoma: Metropolitan Development Council (The Center) 253-593-2740 youth and adults Tahoma Counseling Services 253-572-5035 Dr. Carmela Washington-Harvey youth and adults 253-852-3666

  26. Publicly Funded TreatmentJuly, 2007 5. Kirkland: Youth Eastside Services 425-747-4937 adolescents 12-20 years old 6. Lakebay (Key Peninsula): .Key Counseling 253-884-4860 7. Montesano: A Healthy Risk 360-249-2297 8. Mt. Vernon: Phoenix Recovery Services 360-848-8437 youth and adults 9. Renton: Donna Whitmire 425-227-0447 10. Seattle: Asian Counseling and Referral Services 206-695-7511 11. Skokomish/Shelton: Skokomish HOPE Alcohol & Drug Program 360-426-7788 ext. 200 Spanish and English youth and adults, All are Welcome! 1. Bellevue: Coastal Treatment Services 425-646-4406 youth and adults Consejo Counseling 425-746-4512 Spanish and English Youth Eastside Services 425-747-4937 adolescents 12-20 years old 2. Bellingham: Verry-Uhl Associates (360) 676-4999 . 3. Burlington: Follman Agency 360-755-1125 Youth and adults 4. Kent: Dr. Carmela Washington-Harvey 253-852-3666 youth and adults Seattle Mental Health – Kent youth and adults 800-828-1449

  27. Thanks for your participation today. Linda Graves Problem Gambling Program Manager gravell@dshs.wa.gov 360-725-3813

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