Problem Gambling and Its Impacts

1. Problem Gambling and Its Impacts Rachel A. Volberg, Ph.D. Gemini Research, Ltd. Northampton, MA

2. What is Problem Gambling? Gambling behavior that compromises, disrupts or damages personal, family or vocational pursuits National Council on Problem Gambling, 1997 Gambling behaviour that creates negative consequences for the gambler, others in his or her social network, or for the community Ferris and Wynne, 2001 For most people, gambling is a generally positive experience done with friends or family and within reasonable financial limits. For a minority, gambling is associated with difficulties of varying severity and duration (Abbott & Volberg, 1999). There have been changes since 1980 in psychiatric criteria for pathological gambling. Scholarly debates about the best way to define problem gambling, assess prevalence and estimate costs have created public confusion and uncertainty about the impacts of legal gambling. There are also debates about best cutoffs to use when considering problem gambling�some cutoffs are better for assessing impacts in community, others are better for identifying clinical cases.For most people, gambling is a generally positive experience done with friends or family and within reasonable financial limits. For a minority, gambling is associated with difficulties of varying severity and duration (Abbott & Volberg, 1999). There have been changes since 1980 in psychiatric criteria for pathological gambling. Scholarly debates about the best way to define problem gambling, assess prevalence and estimate costs have created public confusion and uncertainty about the impacts of legal gambling. There are also debates about best cutoffs to use when considering problem gambling�some cutoffs are better for assessing impacts in community, others are better for identifying clinical cases.

3. Gambling Problems Occur on a Continuum Most severe end of continuum recognized as psychiatric disorder since 1980 Essential features of pathological gambling: Continuous or periodic loss of control over gambling Progression in frequency, amounts, preoccupation, obtaining money to gamble Continuation of gambling despite adverse consequences American Psychiatric Association, 1994

4. How Many Problem Gamblers? Based on SOGS�oldest and most widely used problem gambling screen 1.9% current probable pathological gamblers 3.6% current problem gamblers Welte et al., 2001. Based on NODS�new screen developed for NGISC survey and based on DSM-IV criteria 1.2% pathological gamblers 1.5% problem gamblers 7.7% at risk gamblers Gerstein et al., 1999. Based on SOGS and 2000 Census, 5 million American adults are probable pathological gamblers and another 10 million are problem gamblers. Based on NODS and 2000 Census, there are nearly 3 & 1/2 million American adults are pathological gamblers, another 4 million are problem gamblers and 22 million are at risk for gambling problems. Comparable figures for Rhode Island are 15,000 probable pathological gamblers and 29,000 problem gamblers. Alternatively, 10,000 pathological gamblers, 12,000 problem gamblers and 62,000 at risk gamblers using the NODS rates. These figures are conservative since they do not include problem gamblers who are adolescents, those living in institutional settings or homeless, and those not living in households with telephones.Based on SOGS and 2000 Census, 5 million American adults are probable pathological gamblers and another 10 million are problem gamblers. Based on NODS and 2000 Census, there are nearly 3 & 1/2 million American adults are pathological gamblers, another 4 million are problem gamblers and 22 million are at risk for gambling problems. Comparable figures for Rhode Island are 15,000 probable pathological gamblers and 29,000 problem gamblers. Alternatively, 10,000 pathological gamblers, 12,000 problem gamblers and 62,000 at risk gamblers using the NODS rates. These figures are conservative since they do not include problem gamblers who are adolescents, those living in institutional settings or homeless, and those not living in households with telephones.

5. Problem Gambling Impacts (1) Personal Stress-related illnesses Depression & anxiety Tobacco, alcohol & drug dependence Suicidality Family / Interpersonal Physical & emotional abuse Neglect, separation, divorce Children more likely to be depressed, suicidal Most of what is known about impacts comes from treatment populations (professional and self-help). Samples small and atypical (NRC, 1999). Those in treatment do not reflect full spectrum of people with gambling problems (Volberg & Steadman, 1992). Most of what is known about impacts comes from treatment populations (professional and self-help). Samples small and atypical (NRC, 1999). Those in treatment do not reflect full spectrum of people with gambling problems (Volberg & Steadman, 1992).

6. Problem Gambling Impacts (2) Employment Poor performance, lowered productivity, impaired judgment, abuse of leave time Theft, embezzlement, loss of job Financial Use of resources for basic expenses for gambling Indebtedness, credit card abuse Loss of credit, loss of savings, bankruptcy Legal Bad checks, forgery, fraud, tax evasion, burglary, selling stolen goods DUI, weapons offenses

7. Past Year Impacts

8. Lifetime Impacts

9. Who Is At Risk? Youth Men College Educated Anti-Social Personality Other Psychiatric Conditions Youth Men and Women All Educational Levels Ethnic Minorities Other Psychiatric Conditions

10. The Costs of Problem Gambling (1) Widely divergent estimates of the costs of problem gambling have been published Differences based on: Definition of �problem gambler� Characteristics of samples First, it is extremely difficult to separate social and economic impacts of gambling. Second, it is also extremely difficult to quantify SOCIAL costs and benefits. Third, the �gambling industry� is actually made up of quite different segments that represent different balances of costs and benefits. Finally, scholars disagree on approaches to estimating costs. Goodman, Kindt provide highest estimates derived from models and assumptions and based on limited empirical data. More empirically based estimates developed using surveys of treatment-seeking problem gamblers (Lesieur & Anderson, 1995; Thompson, Gazel & Rickman, 1999). However, treatment seekers are not representative of entire population of problem and pathological gmablers (Abbott & Volberg, 1996; Volberg & Steadman, 1992). First, it is extremely difficult to separate social and economic impacts of gambling. Second, it is also extremely difficult to quantify SOCIAL costs and benefits. Third, the �gambling industry� is actually made up of quite different segments that represent different balances of costs and benefits. Finally, scholars disagree on approaches to estimating costs. Goodman, Kindt provide highest estimates derived from models and assumptions and based on limited empirical data. More empirically based estimates developed using surveys of treatment-seeking problem gamblers (Lesieur & Anderson, 1995; Thompson, Gazel & Rickman, 1999). However, treatment seekers are not representative of entire population of problem and pathological gmablers (Abbott & Volberg, 1996; Volberg & Steadman, 1992).

11. The Costs of Problem Gambling (2) Important to differentiate lifetime and annual costs Annual costs of $715 and $1,200 per problem & pathological gambler Lifetime costs of $5,000 and $10,500 per problem & pathological gambler Gerstein et al., 1999. Costs of problem gambling developed by NORC in work for NGISC are conservative. These estimates are economically derived from empirical research with individuals in the general population. These estimates are based on accepted approaches in research on �costs of illness� to society. Differentiation based on rare events in an individual�s life (eg divorce, bankruptcy, incarceration) as well as duration of problem gambling career. Annual costs include poor physical and mental health, job loss. Lifetime costs include depression, alcohol and drug problems, divorce, bankruptcy, arrest, incarceration. NORC study estimated that total annualized costs for problem gambling in US were $5 billion in 1998. Does not include many difficult-to-quantify impacts such as emotional effects of divorce. If there are 10,000 pathological gamblers and 12,000 problem gamblers in Rhode Island, this means that annual costs to State are approximately $20 million and the lifetime costs are another $165 million.Costs of problem gambling developed by NORC in work for NGISC are conservative. These estimates are economically derived from empirical research with individuals in the general population. These estimates are based on accepted approaches in research on �costs of illness� to society. Differentiation based on rare events in an individual�s life (eg divorce, bankruptcy, incarceration) as well as duration of problem gambling career. Annual costs include poor physical and mental health, job loss. Lifetime costs include depression, alcohol and drug problems, divorce, bankruptcy, arrest, incarceration. NORC study estimated that total annualized costs for problem gambling in US were $5 billion in 1998. Does not include many difficult-to-quantify impacts such as emotional effects of divorce. If there are 10,000 pathological gamblers and 12,000 problem gamblers in Rhode Island, this means that annual costs to State are approximately $20 million and the lifetime costs are another $165 million.

12. Addressing Problem Gambling Need for broad array of services: Public education Prevention Outreach / crisis counseling Training Treatment Monitoring / research Growing public interest in addressing problem gambling has not kept pace with expansion of legal gambling 1998 survey found $22 million spent by state governments, gaming companies and private foundations. Represented 1/10th of 1% of $18 billion in gaming privilege taxes collected by state governments and even smaller fraction of $54 billion in gross gaming revenues in that same year (Christiansen, 1999). 1998 survey found $22 million spent by state governments, gaming companies and private foundations. Represented 1/10th of 1% of $18 billion in gaming privilege taxes collected by state governments and even smaller fraction of $54 billion in gross gaming revenues in that same year (Christiansen, 1999).

13. Monitoring & Research Need for commitment to monitoring gambling & problem gambling in coherent & consistent fashion Monitoring & research include: Prevalence surveys @ regular intervals with large samples Research on tax streams, economic & social impacts Evaluation of effectiveness of services One consequence of the blurring of the boundary between governments as regulators and as providers of legal gambling has been a failure to monitor these activities in a coherent and consistent fashion. Constant innovation is an important feature of modern, commercial gambling and provides further incentive for regular monitoring of gambling and problem gambling in the general population. Prevalence surveys at regular intervals are needed with samples large enough to detect changes among subgroups in the population. Additional information about revenues as well as social and economic impacts also needs to be monitored on a regular basis. Prevention and treatment services also require monitoring and evaluation for their effectiveness. One consequence of the blurring of the boundary between governments as regulators and as providers of legal gambling has been a failure to monitor these activities in a coherent and consistent fashion. Constant innovation is an important feature of modern, commercial gambling and provides further incentive for regular monitoring of gambling and problem gambling in the general population. Prevalence surveys at regular intervals are needed with samples large enough to detect changes among subgroups in the population. Additional information about revenues as well as social and economic impacts also needs to be monitored on a regular basis. Prevention and treatment services also require monitoring and evaluation for their effectiveness.

14. Why Study Youth Separately? Ethical concerns Illegal behavior for adolescents Requires informed consent from parent or guardian Conceptual concerns Should problem gambling among adults & adolescents be measured the same way?