Presenter: Scott Anderson ODADAS

1. John R. Kasich, Governor Orman Hall, ODADAS Director Tracy Plouk, ODMH Director Problem Gambling Training Presenter: Scott Anderson ODADAS

2. John R. Kasich, Governor Orman Hall, ODADAS Director Tracy Plouk, ODMH Director What is Gambling? • Gambling is risking something of value on an event that is determined mostly by chance. • A person is gambling if he or she puts up something of value, such as money or property • The outcome has an element of chance beyond the person’s control • Once the bet is made, it’s not reversible

3. John R. Kasich, Governor Orman Hall, ODADAS Director Tracy Plouk, ODMH Director Types of Gambling Activities • Lottery and lottery scratch offs • Pull-tabs and raffle tickets • Bingo • Sports betting • Slot machines/VLT’s • Card and table games • Internet/sweepstakes cafes • Horse betting • Internet gambling- poker, bingo sites • Stock market speculation • Betting on other games-pool, bowling etc. • Other?

4. John R. Kasich, Governor Orman Hall, ODADAS Director Tracy Plouk, ODMH Director

5. John R. Kasich, Governor Orman Hall, ODADAS Director Tracy Plouk, ODMH Director How big is Gambling? # ONE –Entertainment/ Leisure activity in USA Grosses $84,000,000,000 (84 BILLION) How much profit was there on Bingo in 2009?

6. John R. Kasich, Governor Orman Hall, ODADAS Director Tracy Plouk, ODMH Director Bingo! • $142,100,000 in profits

7. Gambling behavior John R. Kasich, Governor Orman Hall, ODADAS Director Tracy Plouk, ODMH Director Occurs on a continuum – is not static No Gambling Experimentation Social At-Risk Problem Pathological Level 1 Level 2 Level 3

8. John R. Kasich, Governor Orman Hall, ODADAS Director Tracy Plouk, ODMH Director Comparison of CD and GamblingTolerance Pathological Gambling needs to gamble with increasing amount of money in order to achieve the desired excitement. • Chemical Dependency • Tolerance, as defined by either of the following: • a need for markedly increased amounts of the substance to achieve intoxication or desired effect • markedly diminished effect with continued use of the same amount of substance.

9. John R. Kasich, Governor Orman Hall, ODADAS Director Tracy Plouk, ODMH Director Comparison of CD and Gambling Withdrawal • Chemical Dependency • withdrawal, as manifested by either of the following: • the characteristic withdrawal syndrome for the substance • the same (or closely related) substance is taken to relieve or avoid withdrawal symptoms. Pathological Gambling is restless or irritable when attempting to cut down or stop gambling

10. John R. Kasich, Governor Orman Hall, ODADAS Director Tracy Plouk, ODMH Director Comparison of CD and Gambling Loss of control • Chemical Dependency • the substance is often taken in larger amounts or over a longer period than was intended • there is a persistent desire or unsuccessful efforts to cut down or control substance use. Pathological Gambling: repeated unsuccessful effort to control, cut back, or stop gambling.

11. John R. Kasich, Governor Orman Hall, ODADAS Director Tracy Plouk, ODMH Director Comparison of CD and Gambling Preoccupation Chemical Dependency A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects. Pathological Gambling is preoccupied with gambling …

12. John R. Kasich, Governor Orman Hall, ODADAS Director Tracy Plouk, ODMH Director Co-Occuring Among pathological gamblers, alcohol has been found to be the most common substance of abuse. At minimum, the rate of problem gambling among people with substance use disorders is four to five times that found in the general population.

13. John R. Kasich, Governor Orman Hall, ODADAS Director Tracy Plouk, ODMH Director Screening and Treatment • SOGS- South Oaks Gambling Screening • Widely used, available, easy to use • NODS-based on DSM IV criteria • Lie/Bet- • 1) Have you ever felt the need to bet more and more money? • 2) Have you ever had to lie to people important to you about how much you gambled?

14. John R. Kasich, Governor Orman Hall, ODADAS Director Tracy Plouk, ODMH Director Screening and Treatment • Motivational Interviewing-meet client where they are at. • CBT-magical thinking, belief systems • GA • Harm Reduction

15. John R. Kasich, Governor Orman Hall, ODADAS Director Tracy Plouk, ODMH Director Screening and Treatment Currently listed as Impulse Control Disorder in DSM IV The DSM V will move gambling to the addiction section, it will be the only process disorder, (not involving substance) in this section.

16. John R. Kasich, Governor Orman Hall, ODADAS Director Tracy Plouk, ODMH Director Risk Factors • Significant financial loss • Higher rates of relationship and family breakdown • Higher rates of emotional and health problems • Work-related difficulties • Legal problems • Higher rates of suicide

17. John R. Kasich, Governor Orman Hall, ODADAS Director Tracy Plouk, ODMH Director Risk Factors…suicide • Among those with gambling problems: • 38% suicidal ideation (SI) • 32% suicide attempt • SI leads to more gambling when gambling • SI+ PG = 5x more likely to have depression • PG + Drug history = 6x more likely attempt • 21% of attempters say it is gambling related • Hodgins et al 2006

18. John R. Kasich, Governor Orman Hall, ODADAS Director Tracy Plouk, ODMH Director Risk Factors…medication • Compulsive gambling problems as side effect of medication for Parkinson’s & Restless Leg Syndrome

19. John R. Kasich, Governor Orman Hall, ODADAS Director Tracy Plouk, ODMH Director Risk Factors…Mental Illness • Depression • PTSD/TBI • Mania • Obsessive-Compulsive Disorder • ------------------------------- • also Grief/Loss 19

20. John R. Kasich, Governor Orman Hall, ODADAS Director Tracy Plouk, ODMH Director What to look and listen for • Listen: • There goes the rent/car payment’ • ‘If I go home my wife is going to kill me’ • ‘I would be better off dead’ • Look: • Not eating • Not going to the restroom • Same clothes/grooming • Gut feeling

21. John R. Kasich, Governor Orman Hall, ODADAS Director Tracy Plouk, ODMH Director Self Exclusion/Restriction • Some might not know about this option, customer has ability to voluntarily exclude themselves • Urge to gamble significantly reduced • Perception of control increased • Intensity of negative consequences from gambling decreased

22. John R. Kasich, Governor Orman Hall, ODADAS Director Tracy Plouk, ODMH Director Self Exclusion/Restriction • Some might not know about this option, customer has ability to ask for restrictions • Check cashing • Credit

23. John R. Kasich, Governor Orman Hall, ODADAS Director Tracy Plouk, ODMH Director • Statewide Initiative • Ohio Lottery Commission (OLC) • Ohio Casino Control Commission (OCCC) • Ohio State Racing Commission • Ohio Department of Drug and Alcohol Addiction Services (ODADAS) • www.org.ohio.gov 23

24. John R. Kasich, Governor Orman Hall, ODADAS Director Tracy Plouk, ODMH Director Problem Gambling Helpline • 1 800 589 9966 • Statewide Resource • In operation since 1990 • Continuously Updated • Printed on Ohio Lottery tickets/materials • Gaming Advertising • Ohio for Responsible Gambling website www.org.ohio.gov

25. John R. Kasich, Governor Orman Hall, ODADAS Director Tracy Plouk, ODMH Director Questions? Scott Anderson ODADAS (Treatment) scott.anderson@ada.ohio.gov 614-466-8562 Melinda Norman ODADAS (Prevention) melinda.norman@ada.ohio.gov 614-644-8318