pathological gambling among asian-americans: the hidden addiction

1. Pathological Gambling Among Asian-Americans: The Hidden Addiction Timothy W. Fong MD UCLA Gambling Studies Program San Mateo County Behavioral Health Services Psychiatry Grand Rounds January 22, 2008

3. Overview Gambling in America APIs and Pathological Gambling Cultural Factors Prevalence Surveys Treatment Overcoming barriers

4. Availability of Gambling, 1975 History of gambling in america is ambivalence . . History of gambling in america is ambivalence . .

5. Availability of Gambling, 1999 Indian Gaming Regulatory Act 1988 Corporation of gambling in Las Vegas Rise of technologyIndian Gaming Regulatory Act 1988 Corporation of gambling in Las Vegas Rise of technology

6. The California Scene

7. Background Exponential growth of legalized gambling $2.5 billion (1997) to $13 billion (2003) Horse race wagering ($4 billion) Lottery ($3 billion) Card rooms ($1 billion) Tribal casinos ($5 billion) 60% Californians gambled last year

9. California Prevalence Study (2005) n=7,121 respondents, 18 years and older Problem gambling 2.2% Pathological gambling 1.5% ~1,000,000 problem/pathological cases Highest Risk: African-Americans, Disabled, Unemployed

10. The Range of Gambling Behavior Social Gambler (85% of the population) Problem Gambler (5-6%) Pathological Gambler (1%) (or Compulsive Gambling, Gambling Addict) gambling is entertainment, fun, and relaxation aware that losing is �part of the game� doesn�t bet more than can afford gambling doesn�t disrupt or damage personal, family or vocational pusuits PROFESSIONAL Gamblergambling is entertainment, fun, and relaxation aware that losing is �part of the game� doesn�t bet more than can afford gambling doesn�t disrupt or damage personal, family or vocational pusuits PROFESSIONAL Gambler

11. Classified in Impulse Control Disorders section Classified in Impulse Control Disorders section

12. Consequences ofPathological Gambling

14. Asians and Gambling

15. History of Gambling in China 3,000 B.C. Many games invented All segments of society Officials of government Gambling as a profession Gambling associated with secret society, corruption and drugs

16. History of Gambling and Asia Different story in each country Forbidden, ambivalent, promoted Unique definitions of gambling Mahjong, lottery, stocks vs. casinos Common thread � gambling always part of the social dialogue

17. Acceptable way to make money Inquire about one�s destiny �Honoring the Gods� Losses are sacrifice Equate gambling with self-worth and ability to move up classes

18. Emphasis on numbers that have power over life events Heavy peer involvement Gambling is family entertainment Gambling as a rite of passage Superstitions

19. Asian Gambling Expansion Vietnam: Ho Chi Minh (2009) Singapore: Two casinos (2009) Phillipines: Manila Bay Hong Kong: Horse-racing, lottery, Taiwan / Thailand / Japan: Considering China: Not on the mainland

22. Asians in America

23. Asians in California 12 % of Californians are AAPIs ~ 4 million Highest rate of growth 1.2 million Los Angeles County State population ~ 35 million (2000 Census)

24. Asians in California Largest Asian Groups: Filipino Chinese Vietnamese Korean Asian Indian Japanese Fastest growing Asian Indian, Vietnamese, Hmong

25. Asian Communities Monterey Park (64%) Cerritos (61%) Rowland Heights (52%) San Gabriel (51%) San Marino (50%) Alhambra (48%)

26. Background Data NICOS (SF) 70% identified gambling as number one social concern (1999) 15 % problem gamblers 21% pathological gamblers

27. Asians and Gambling(Los Angeles) 30-40% of casino clientele are AAPIs Casinos market toward AAPIs Significant percentage of casino revenue comes from local AAPI residents Social activity of choice

29. Consequences of PG on APIs 20% of child neglect cases (Santa Clara) 30% of API DV cases (SF Chinatown) Numerous bankruptcy reports from Monterey Park Recent cases of family violence (April 2006)

30. Case Examples: Bong Joo Lee (April 2006) Fontana, California Unemployed $200,000 in gambling debt. Recent separation Family discord over gambling Past history of assaulting wife End Result: Murder-Suicide

31. Case Example: David Lam (2007) Casino Employee Wife seen, not heard Gambling debt (>$50,000) ; bankruptcy Marital discord Lam heads to Singapore 9/18/2005 Body found 9/23/2005 Caught in 11/2007, w/family in Indonesia

32. To understand the impact of problem gambling on AAPIs. To understand cultural influences which will inform prevention and treatment (Funded by UCLA in LA)

33. Surveys

34. Prevalence Survey 180 surveys collected over 3 days at Commerce Casino (March 2006) SOGS NODS UCLA Gambling Survey Convenience Sampling $5 Starbucks reimbursement

35. Prevalence Survey Objectives: What is the rate of PG among casino patrons? What is the rate of PG of AAPIs vs. Non-AAPIs?

36. Results

37. Results

38. Results

39. Conclusions High rates of PG inside a casino How many require treatment? No obvious ethnic differences BUT APIs will have more PGs Replication needed Secondary analysis underway (gender, time, health status)

40. Treatment of AAPI Pathological Gamblers and Their Families

41. Treatment Approaches to Pathological Gambling Medications Psychotherapy Gambler�s Anonymous Family Therapy Brief Interventions Prevention

42. Existing Treatment for AAPIs Gambler�s Anonymous (Korean, Chinese) NICOS � (SF) AAPI mental health providers AAPI substance abuse providers Churches Families

43. Barriers to Treatment Shame and Stigma Lack of culturally appropriate services Lack of outreach programs Language Access to insurance Transportation

44. Barriers to Treatment Familial insulation Self-reliance Therapy not accepted in community Sense of fatalism (won�t get better) Level of education Level of acculturation

45. Survey results N= 59 ( AADAP, WRAP, UPAC) Male: 36% Female: 64% Ethnicity 68% Asians 13 % Caucasians 6% African Americans 6% Hispanic 7% Others

46. Findings Training in treatment 0.5 % = clinical experience 0.3 % = certificate 0.2% = both 78 % = no experience

47. Findings Do you routinely screen for gambling problems? Yes 15% No 85%

48. Treatment Needs Interventions for Asian Americans Adapting treatment to be culturally responsive Need more gambling specialists More research needed Stigma operates at all levels

49. Clinical Pearls Work with the family, first Minimize shame through education Involve respected elders Address co-occurring disorders �Medicalize� treatments Develop 12-step alternatives

50. Where do we go from here? Demonstration Projects Increase visibility (media) Document extent of problems Increase treatment and intervention capacity Decrease stigma Better understand impact on communities