Telephone Help-line Program for Pathological Gambling: A Preliminary Study in California

1. Telephone Help-line Program for Pathological Gambling:A Preliminary Study in California UCLA Gambling Studies Program

2. Overview • Background • Conceptual framework • Research questions and hypotheses • Methods • Results • Implications • Limitations • Conclusion

3. Background: Definition and Criteria Social Gambling Problem Gambling • NODS Score: 3 – 4 • Gambling that significantly interferes with a person’s life Pathological Gambling • NODS Score: 5-10 • The most severe form of problem gambling • Mental Health Disorder

4. Background: Prevalence Prevalence in California: • Pathological gambling (PaG): 1.5% (296,500 – 490,000) • Problem gambling (PrG): 2.2%(450,000 -713,400) • At-risk gambling: 9.5% (2.2 million – 2.7 million) Risk Factors: • gender (males) • ethnicity (African-Americans) • age (>65 years) • employment (unemployed and disabled)

5. Background: Related Issues Smoking ¼ PaGs and PrGs smoke daily Substance abuse alcohol, marijuana, cocaine, etc. Psychological difficulties anxiety, depression, antisocial personality disorder etc. Suicidal ideation Stress-related physical impairment hypertension, heart disease, etc. Criminal behavior

6. Background: Services Barriers to seeking help Embarrassment and denial of the gambling issues; and mistrust of the effectiveness of treatments ⇨National estimate: < 3% of PrGs seek treatment A 24-hour, toll-free service for PrGs and PaGs is available ⇨4/5 CA adults (2/3 PrGs, 1/2PaGs) are not aware of this service

7. Background: “Chance to Change (C2C)” Bensinger DuPont and Associates (BDA) implemented the C2C program • BDA provides substance abuse intervention and prevention • BDA’s telephone counselors are trained and certified gambling counselors • Masters level degree • Utilize standardized technique

8. Background: “Chance to Change (C2C)” Program Components: - Initial Session: Baseline Assessment - Session 1 (W1): Assign homework - Session 2 (W2): Support client’s plan of change, educate about course of pathological gambling - Session 3 (W4 ): Motivate client for recovery - Session 4 (W8): Motivate client for recovery - Session 5 (W12): Review client’s progress, end session

9. The Transtheoretical Model Conceptual Framework Precontenmplation : No intention to quit gambling within the next 6 months Conscious raising Dramatic Relief Environmental reevaluation The Transtheoretical Model has been successfully applied to motivate cessation of gambling among PaGs. (Petty, 2005) Contemplation: Intention to quit gambling within the next 6 months Self-reevaluation Preparation: Intention to quit gambling within the next 30 days and has taken some behavioral steps in this direction Self-liberation Target Population Intervention Action: Has quitted gambling for less than 6 months Contingent management Helping relationship Counter-conditioning Situational control Maintenance: Has quitted gambling behavior for more than 6 months

10. Research Question & Hypothesis Research Question: Are pathological gamblers who completed the C2C likely to cease or reduce the frequency of gambling? Hypotheses: • Participants who completed C2C program will have a significantly lower NODS score than their counterparts. • The average number of hours spent gambling a week by participants will be significantly lower at week 8 and 12 than at baseline. • The average amount of money allotted for gambling by participants will be significantly lower at weeks 8 and 12 than at baseline.

11. Methods: Sampling • Inclusion Criteria - 18 years old or older - Ability to read and write English at an 8th grade level - Meet DSM-IV criteria for pathological gambling (NODS score >5) - Have gambled within 4 weeks of screening - Have a reliable telephone number • Exclusion Criteria - Currently enrolled in a gambling treatment program - Meet criteria for clinically significant psychiatric disorder that would impair judgment or medical decision-making capacity

12. Methods: Variables • Dependent Variables (outcomes) - NODS score - Hours of gambling (W12) - Amount of money allotted for gambling (W12) • Independent Variables (predictors) - Demographics - Gambling preference - Frequency, hours of gambling - Family gambling history - Reason of gambling - Smoking, drinking habit - Self-rated health and QOL - First gambling age - Problem gambling starting age - Self goal (reduce/quit) - Money started (W12) - gambling wins and loses

13. Attrition Rate: 45.45% Initial Interview: 33/109 W12: 18/33 N=18, Age: M=42.83, SD=11.57, Range= 27-65 Gender ratio: Male=50%, Female: 50% Primary Gambling Preference: - Nevada Casinos => 1 (5.6%) - Indian Casinos => 15 (83.3%) - Card Rooms => 1 (5.6%) - Sports betting => 1 (5.6%) Race/Ethnicity: - African American => 1 (5.6%) - Asian American => 3 (16.7%) - Caucasian => 6 (33.3%) - Latino => 6 (33.3%) - Other => 2 (11.1%) Results: Sample Demographics

14. Results (cont’d) Table 1. Comparison of Initial and 12-week Assessment *Statistically significant (p < .05) as tested by Paired-sample t-test **Statistically significant (p < .001) as tested by Paired-sample t-test

15. Implications This study demonstrated that offering telephone help-line program may help pathological gamblers, who are in the Preparation or Action stages of change, to reduce or maintain cessation of gambling in terms ofNODS score and the number of hours spent gambling.

16. Limitations/ Future Directions • Sample size is small • Non-randomized sample • No control group - Does not necessarily represent PrGs - Randomized controlled studies are needed • Self-report biases - Need to evaluate the accuracy of self-report

17. Limitations/ Future Directions • Some participants were already motivated to take action to change their pathological gambling behavior at the initial point • Limited to a performance over a 3 month period - Other factors may affect their behavior (e.g. relapse due to ambivalent characteristics of gambling addiction) • High attrition rate

18. Acknowledgements We, the UCLA Gambling Studies Program, gratefully acknowledge the support of this study by Ms.Isabelle Duguay fromBensinger DuPont and Associates. This program was funded by the California Alcohol and Drug Programs, Office of Problem Gambling.

19. Reference • California Department of Alcohol and Drug Programs Office of Problem and Pathological Gambling. (2006). 2006 California Problem Gambling Prevalence Survey . Retrieved at April 7, 2008, from http://www.adp.ca.gov/opg/pdf/CA_Problem_Gambling_Prevalence _ Survey-Final_Report.pdf • Desai, R. &Potenza, M. (2008). Gender differences in the associations between past-year gambling problems and psychiatric disorders. Social psychiatry and psychiatric epidemiology. 43(3), 173-183. • Pantalon, M. V., Maciejewski, P. K., Desai, R. A. & Potenza, M. N.  (2007). Excitement-seeking gambling in a nationally representative sample of recreational gamblers. Journal of Gambling Studies. 24(1), 63-78. • Petty, N.M. (2005). Stages of change in treatment-seeking pathological gamblers. Journal of Consulting & Clinical Psychology. 73 (2), 312-322. • Shaffer, H. J. & Korn, D. A. (2002). Gambling and related mental disorders: a public health analysis. Annual review of public health. 23, 171 -212. • Wood, R. T. A. & Griffiths, M. D. (2007). A qualitative investigation of problem gambling as an escape-based coping strategy. Psychology & Psychotherapy: Theory, Research & Practice. (80)1, 107-125.

20. Thanks for listening! Akiko Sato akisato@ucla.edu