July 11, 2012 National Conference on Problem Gambling Presenter:

1. Gambling Prevention:using the Risk and Protective Factors Along With Other Alcohol and Other Drug Prevention Models. July 11, 2012 National Conference on Problem Gambling Presenter: Jennifer Clegg, LSW, MSW, NCGC-II, OCPS-II Recovery Resources 3950 Chester Ave. Cleveland, OH 44114 216-923-4021 Jclegg@recres.org

2. Prevention is… • Prevention is an ordered set of steps along a continuum to promote individual, family and community health, prevent mental and behavioral disorders, support resilience and recovery and prevent relapse. • Prevention is prevention is prevention! • Common risk and protective factors exist for many addictions and mental health problems. Good prevention focuses on these common risk factors that can be altered

3. Resilience is built be developing assets in individual, families and communities through evidenced based health promotion and prevention strategies • Systems of prevention services work better than service silos • Baseline data, common assessment tools and outcomes are shared across service systems can promote accountability and effectiveness of prevention efforts (The Guiding Principals of the Strategic Prevention Framework, SAMHSA)

4. Prevention History • 1950’s- early 1960’s • Scare tactics • Mock crashes • Recovery speakers • Graphic pictures • Research indicated that these strategies are not effective

5. Prevention History (con’t) • Late 1960’s to early 1970’s • Information • Factual information • “medicine show’s” • Teaching what drugs are used and how they are used This strategies was found to be counter productive and actually glamorized drug use

6. Prevention History (con’t) • 1970’s- mid1980’s • Develop curricula providing effective education and alternative activities and trainings • Just Say No • MADD • Mid 1980’s - mid 1990’s • Research based curricula and peer prevention programs • SADD • DARE

7. Prevention History (con’t) • Mid 1990’s - Today • The gap between research and application are gradually bridged • Evidences based curricula developed • Utilizing environmental approaches • Comprehensive programming targeting many domains, strategies evaluation of prevention programs, media campaigns and culturally sensitive programs

8. Implications for Prevention • Adolescents today are the first generation of youth exposed to accessible and various types of gaming. • Gambling has become a new rite of passage • Typically 50-80% of teens reports gambling for money during their lifetime

9. Cards • Sports Bets • Video/Arcade Games • Lottery • Games of Skill (like betting each other in hoops, pool) • Bingo • Internet Common Types of Gambling Among Teens Source: Carlson & Moore, 1998

10. FAMILY COMMUNITY Work Signs that May Point to a Gambling Problem Criminal activity Theft/Robbery Embezzlement Drug dealing Shoplifting Tardiness Missing school Stealing Mood swings Secrecy/withdrawal Unexplained debts/cash Missing money Increased anxiety Substance use

11. Drug and Gambling Addiction • Can’t think of anything else but doing gambling • Need to gamble more and more to maintain a high • Will gamble at any cost • Can’t stop even if they want to • Lying and stealing to keep gambling • Gambling help to escape life’s problem, allows to forget • Consequences: • Failing School • Problems with friends/family • Risk of ending up in jail • Can’t think of anything else but doing drugs • Need more and more to maintain a high • Will do drugs at any cost • Can’t stop even if they want to • Lying and stealing to keep using drugs • Drugs help to escape life’s problem, allows to forget • Consequences: • Failing School • Problems with friends/family • Risk of ending up in jail McGill University

12. Students who gamble are more likely to participate in other risk behaviors • Gambling is one of many activities that carry risk and should be addressed as such in school and community prevention efforts • Casino nights in schools and other forms of gambling should be reconsidered. • Parents need to talk with their kids about gambling and gambling related consequences

13. Prevention Models • What prevention model do you follow? • Public Health Model • Environmental Management • Youth Empowerment and development • Social ecological theory

14. Public Health Agent Host Environment

15. Prevention continuum

16. Target Audience • Universal Intervention refer to efforts focused on every eligible member of a community. • · Selective Intervention are more focused at a more systems domain where higher-risk subgroups are targeted • · Indicated intervention are prevention efforts targeted at individuals, for example those who show signs of developing problems.

17. “Prevention”=Health Promotion Prevention is not just about “preventing” something from happening: “ Prevention is a proactive process that promotesthe well-being of people and empowers an individual, group, or community to create and reinforce healthy lifestyles and behaviors to meet the challenges, events and transitions of life.” Prevention is building healthy people and healthy communities. DMHAS Problem Gambling Services 2009

18. We know that high risk behaviors tend to cluster and gambling appears to fit within a risk behavior matrix sexual behavior smoking delinquency violent behavior High Risk Behaviors gambling drug use (Marotta, J, 2007)

19. Goals of Prevention Education • Create awareness of gambling attitudes & behaviors; • Increase protective factors; DMHAS Problem Gambling Services 2009

20. Our Approach: Uses CSAP Prevention Strategies Information Dissemination Prevention Education Alternative Activities Community-Based Processes Problem Identification/Referral Environmental Approaches Research shows that it takes ongoing efforts in all 6 areas for prevention to really work (Marotta, J, 2007)

21. Information Dissemination • This strategy provides awareness and knowledge of the nature and extent of substance use, abuse, and addiction and their effects on individuals, families, and communities. Information dissemination is characterized by one-way communication from the source to the audience, with limited contact between the two. [Note: Information dissemination alone has not been shown to be effective at preventing substance abuse.]

22. Information Dissemination • Clearinghouses and other information resources centers • Resource directories • Media campaigns • Brochures • PSA’s • Speaking engagements • Health fairs

23. Prevention Education • This strategy involves two-way communication and is distinguished from the information dissemination strategy by the fact that interaction between the educator/ facilitator and the participants is the basis of its activities. Activities under this strategy aim to affect critical life and social skills, including decision-making, refusal skills, critical analysis (e.g., of media messages), and systematic judgment abilities.

24. Prevention education • Classroom or small group sessions • Peer leadership and peer helper groups • Parenting and family management classes • Educations sessions for youth groups • Groups for children of addicts

25. Alternative Activities • This strategy provides for the participation of target populations in activities that exclude substance use. The assumption is that constructive and healthy activities offset the attraction to--or otherwise meet the needs usually filled by--alcohol and drugs and would, therefore, minimize or obviate resort to the latter. [Note: Alternative activities alone have not been shown to be effective at preventing substance abuse.]

26. Alternative Activities • Social and recreational activities • Youth and adult leadership activities • Community drop in centers • Mentoring programs

27. Community Based Process • This strategy aims to enhance the ability of the community to more effectively provide prevention and treatment services for substance abuse disorders. Activities in this strategy include organizing, planning, enhancing efficiency and effectiveness of services implementation, interagency collaboration, coalition building, and networking.

28. Community Based Process • Community and volunteer training • Systematic planning • Multi agency collaboration and coordination • Accessing services and funding • Community team building

29. Environmental Approach • Individualized environment • Seek to socialize, instruct, guide, & counsel • children to increase their resistance to health • risks • Shared environment • Support healthy behavior, prevent risky • behavior for all children • Environmental strategies • Price interventions, minimum -purchase-age, • deterrence, location & density, counter-ads

30. Problem Identification and Referral • This strategy aims at identification of those who have indulged in illegal/age-inappropriate use of tobacco or alcohol and those individuals who have indulged in the first use of illicit drugs in order to assess if their behavior can be reversed through education. It should be noted, however, that this strategy does not include any activity designed to determine if a person is in need of treatment.

31. Problem ID and referral • Employee assistance programs • Student assistance programs • DUI education programs

32. Prevention Domains • Individual • Peer • Family • School/work • Community • Society/environmental

33. USE MULTIPLE STRATEGIES OVER MULTIPLE DOMAIN

34. Adolescent problem gambling • 37.9% - non-gamblers • 49.3% Social gamblers • 7.8% at risk gambler’s • 9.5% males • 1.6%females • 5% Probable pathological gamblers • 11.7%males • 4.9% females Youth Gambling Problems: The Identification of Risk and Protective Factors: Report to the Ontario Problem Gambling Research Centre” Laurie Dickenson, MA, Jeffery L. Derevensky, Ph.D., Rina Gupta, Ph.D.

35. Risk and Protective Factors • Similar to public health model of disease prevention: focus on decreasing risk and increasing protection • Risk factors predict addictive behaviors and protective factors can buffer risk factors • To prevent high risk behaviors, such as gambling or substance abuse, reduce risk factors and increase protective factors throughout a child’s life

36. High Risk Categories • Child of a compulsive gambler • Belief that skill is involved • An early big win • Feeling that one must chase gambling loss with more gambling • Early age of onset • Large first bets • Otherwise addicted

37. Gambling Risk Factors • Emotional difficulties • Stress • Distorted expectations about winning • Social pressure to gamble • Risky gambling behavior • Attention deficits • Impulsivity • Illusion of control over outcomes • Addiction history

38. SOCIAL GAMBLING PROBLEM GAMBLING Problem or Not? Telling the Difference Frequent, or spends more time gambling. Occasional gambler. Plays with $ that is needed or borrowed. Sticks to limits of money to play with. Expects to win; keeps playing to win back losses. Hopes to win but expects to lose. Is revolved around gambling. Can take it or leave it.

39. Risk Factors for Problem Gambling • At-risk for a substance abuse problem • Having a parent, sibling, relative, friend, or significant person with either a gambling problem or substance use problem • Having or knowing peers with substance use problems is a risk correlate of youth problem gambling • Anxiety • High risk propensity • Low perception of risk regarding problem gambling • Early onset of gambling behavior Youth Gambling Problems: The Identification of Risk and Protective Factors: Report to the Ontario Problem Gambling Research Centre” Laurie Dickenson, MA, Jeffery L. Derevensky, Ph.D., Rina Gupta, Ph.D.

40. Protective Factors • Family connectedness • Designing school-based prevention programs that seek to develop student’s attachment, trust, and identification with larger groups (e.g., school clubs and sports teams, Scouts or Guides). Youth Gambling Problems: The Identification of Risk and Protective Factors: Report to the Ontario Problem Gambling Research Centre” Laurie Dickenson, MA, Jeffery L. Derevensky, Ph.D., Rina Gupta, Ph.D.

41. CSAP’s Strategic Planning Framework

42. SPF • Assessment • Capacity Building • Planning • Implementation • Evaluation • All under the umbrella of cultural competence and sustainability

43. Phase 1 – Assessment What is Assessment? • Assessment of high risk behavior and related problems Assessment requires us to explore rates and patterns of high risk behavior as well as related problems (consequences). • Prevalence data • Incidence data • Consequence data • (Adapted from CSAP Strategic Planning Framework)

44. How do we know if our needs assessment data is valid? Next- Stare at the black "+" in the center. What color are the moving dots now? First- What color dots do you see? Lastly- Keep staring at the black "+" in the center of the picture. What happens to moving dots now?

45. There really is no green dot, and the pink ones really don't disappear. What does this optical illusion have to do with conducting a needs assessment?

46. Steps to Changing Behavior Increase Awareness Change in Attitude Change in Behavior • (Adapted from CSAP Strategic Planning Framework)

47. Stages of ChangePrecontemplationIncrease awareness of need to changeContemplationMotivate, encourage and make plans to changeDecision/DeterminationAssist in developing action plansActionProvide feedback and reinforcement of actionMaintenanceSupport continued progress(Prochaska and DiClemente, 1982)

48. Phase 2 – Capacity Types and levels of resources needed to address identified needs including: • Human resources • Technical resources • Management and Evaluation resources • Financial resources

49. Phase 3 – Develop a Comprehensive Strategic Plan What is a Comprehensive Strategic Plan? • A comprehensive, logical, and data driven plan to address the problems identified in phase 1 using the capacity built or mobilized in phase 2 • The plan includes Strategic Goals, Objectives, and Outcomes, as well as Logic Models and in some cases Action Plans • (Adapted from CSAP Strategic Planning Framework)

50. Phase 4 – Implementation: What is it? • Taking action as guided by the Strategic Plan developed in phase 3 • Developing detailed action plans for elements of your intervention • Developing a final detailed evaluation plan that includes process and outcome measurements and continual monitoring of implementation fidelity • (Adapted from CSAP Strategic Planning Framework)