Gambling: The silent addiction

1. Gambling:The silent addiction Oct. 10, 2013 Jennifer Clegg, MSW, LSW, NCGC-II/BACC, OCPS-II Gambling Program Specialist Recovery Resources 3950 Chester Ave Cleveland, OH 44114 216-923-4021 jclegg@recres.org www.facetheodds.org

3. 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

4. Types of Gambling Activities • Lottery, scratch, pull-tabs and raffle tickets • Bingo • Sports betting • Slot machines • Card and table games • Horse betting • Internet gambling • Stock market speculation • Betting on other games • Other?

5. 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.

6. Problem Gambling Definition Gambling is a problemwhen it disrupts or damages your: mental or physical health work, school or other activities relationships finances reputation

7. United States Estimates • 1.5 % Pathological Gamblers • 4% Problem Gamblers • Problem and pathological gambling rates in adolescents at least 2-3 times those of adults

8. 2012 Ohio Survey

9. Estimated Percent and Number of Persons for At-Risk and Problem Gambling in Ohio Problem Gambling The prevalence of at risk and problem gambling in Ohio is 2.8%, which equates to an estimated 246,561 individuals in the target population of 8,805,761.* *(18 years and older) • Of the 8.8 million Ohioans aged 18 and older, an estimated 3.8 million (43.3%) do not gamble. Of the Ohioans who do gamble, an estimated 4.7 million (53.8%) do not experience any risk factors. • Prevention activities may be beneficial if directed at the 220,144 (2.5%) persons who are estimated to be at-risk for problem gambling, while treatment services and/or self-help programs such as Gamblers Anonymous should be directed at the 0.3% who are estimated to have a gambling problem that meets DSM-IV diagnostic criteria. • Approximately 10% of those who need treatment will seek treatment (Cunningham, 2005), suggesting that approximately 2,640 individuals may seek treatment or seek out self-help such as Gamblers Anonymous.

10. Map of Cuyahoga Cluster Area

11. Estimated Percent and Number of Persons for At-Risk and Problem Gambling – Cuyahoga County Cluster Problem Gambling The prevalence of at risk and problem gambling is 11.6% which equates to an estimated 145,143 individuals in the target population of 1,251,231.* *(18 years and older) • Of the 1.25 million Ohioans aged 18 and older in the Cuyahoga area, an estimated 360,355 (28.8%) do not gamble. Of the Ohioans in this cluster who do gamble, an estimated 745,734 (59.6%) do not experience any risk factors. • Prevention activities may be beneficial if directed at the 143,892 (11.5%) persons who are estimated to be at-risk for problem gambling, while treatment services and/or self-help programs such as gamblers anonymous should be directed at the 0.1% who are estimated to have a gambling problem that meets DSM-IV diagnostic criteria. • Approximately 10% of those who need treatment will seek treatment (Cunningham, 2005), suggesting that approximately 125 individuals may seek treatment.

12. Map of Lucas County Cluster Area

13. Estimated Percent and Number of Persons for At-Risk and Problem Gambling – Lucas County Cluster Problem Gambling The prevalence of at risk and problem gambling is 14.8% which equates to an estimated 62,652 individuals in the target population of 423,316.* *(18 years and older) • Of the 423,316 Ohioans aged 18 and older in the Lucas County Cluster, an estimated 129,958 (30.7%) do not gamble. Of the Ohioans in the cluster who do gamble, an estimated 230,707 (54.5%) do not experience any risk factors. • Prevention activities may be beneficial if directed at the 61,805 (14.6%) persons who are estimated to be at-risk for problem gambling, while treatment services and/or self-help programs such as gamblers anonymous should be directed at the 0.2% who are estimated to have a gambling problem that meets DSM-IV diagnostic criteria. • Approximately 10% of those who need treatment will seek treatment (Cunningham, 2005), suggesting that approximately 84 individuals may seek treatment.

14. Map of Franklin County Cluster Area

15. Estimated Percent and Number of Persons for At-Risk and Problem Gambling – Franklin County Cluster Problem Gambling The prevalence of at risk and problem gambling is 14.2% which equates to an estimated 153,815 individuals in the target population of 1,083,205.* *(18 years and older) • Of the 1,083,205 Ohioans aged 18 and older in the Franklin Cluster, an estimated 407,285 (37.6%) do not gamble. Of the Ohioans in this cluster who do gamble, an estimated 522,105 (48.2%) do not experience any risk factors. • Prevention activities may be beneficial if directed at the 151,649 (14.0%) persons who are estimated to be at-risk for problem gambling, while treatment services and/or self-help programs such as gamblers anonymous should be directed at the 0.2% who are estimated to have a gambling problem that meets DSM-IV diagnostic criteria. • Approximately 10% of those who need treatment will seek treatment (Cunningham, 2005), suggesting that approximately 216 individuals may seek treatment.

16. Map of Hamilton County Cluster Area

17. Estimated Percent and Number of Persons for At-Risk and Problem Gambling – Hamilton County Cluster Problem Gambling The prevalence of at risk and problem gambling is 12.7% which equates to an estimated 108,453 individuals in the target population of 853,962.* *(18 years and older) • Of the 853,962 Ohioans aged 18 and older in the Hamilton County Cluster, an estimated 269,852 (31.6%) do not gamble. Of the Ohioans in this clusterwho do gamble, an estimated 475,657 (55.7%) do not experience any risk factors. • Prevention activities may be beneficial if directed at the 96,498 (11.3%) persons who are estimated to be at-risk for problem gambling, while treatment services and/or self-help programs such as gamblers anonymous should be directed at the 1.4% who are estimated to have a gambling problem that meets DSM-IV diagnostic criteria. • Approximately 10% of those who need treatment will seek treatment (Cunningham, 2005), suggesting that approximately 1,195 individuals may seek treatment.

18. Gambling and Incarceration • 43.7 % of Pathological Gamblers have committed crimes (Blaszynski, McConaghy, Francova, 1989) • Various reports indicate 255-50% of incarcerated offenders meet criteria for problem or pathological gambling (Zorland, Mooss, Perkins, 2008)

19. Gambling and Arrest Rates National Gambling Impact Study, NORC 1999

20. Impact • Each compulsive gambler costs society $13,000.00 each year. • In Ohio: more than $2.2 billion each year. • One estimate: $289 in social costs for every $46 economic benefit • It is estimated that each problem gambler will directly impact the lives of a minimum of 7 other people – mostly family.

21. Gambling Consequences • Debt • $38,000 to $113,000 • Illegal Activities • 60% estimated to commit illegal acts

22. Crimes • Embezzlement • Forgery • Identity Theft • Fraud • Robbery • Drug Dealing • Assault

23. Comparison of CD and GamblingTolerance • 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. • Pathological Gambling • needs to gamble with increasing amount of money in order to achieve the desired excitement.

24. 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

25. 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.

26. 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 …

27. Comparison of CD and Gambling Consequences • Chemical Dependency • important social, occupational, or recreational activities are given up or reduced because of substance use. • the substance is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been causes or exacerbated by the substance… • Pathological Gambling: • lies to family member, therapist, or others to conceal …gambling • has committed illegal act …to finance gambling. • has jeopardized or lost a significant relationship, job or educational or a career opportunity because of gambling

28. Comparison of CD and Gambling • Similarities • Preoccupation • Lack of control • Ambivalence (rather than denial or resistance) • Substance use • Depression • Escape • Family dysfunction • Intolerance • Chasing • Need immediate gratification • Shame • Co morbidity

29. Comparison of CD and Gambling • Differences • Not easily detected • Fantasy/Dream Life • Not self limiting, can’t pass out or overdose • Job, family, functional • Suicidality • Hopelessness • Financial (extreme debt) • Family impact (finances) • Social perception of gambling • Few resources • Solitary

30. Pathological Gambling DSM IV • A. Persistent and recurrent maladaptive gambling behavior as indicated by five (or more) of the following: • Preoccupation • Gamble more money in order for desired excitement • Unsuccessful at control, cut back, or stopping gambling • Restless or irritable when cut down or stop • Escaping problems / relieving a dysphoric mood • Chasing • Lies • Illegal acts to finance gambling • Risked or lost a significant relationship, job, or school • Bailouts to relieve a desperate financial situation • B. The gambling behavior is not better accounted for by a Manic Episode.

31. Pathological Gambling DSM VProposed changes • New Name: • Disordered Gambling • New Classification: • Addiction and Related Disorders • Disordered Gambling the only behavioral addiction

32. Pathological Gambling DSM VProposed changes • Why change? • Reward center research • Similarities to Substance Use Disorders • Cravings • Highs • Hereditary nature • Similar treatment • 12 step • CBT • MI

33. Pathological Gambling DSM VProposed changes • “Is preoccupied with gambling” most useful criteria with lowest levels of gambling severity • “Illegal acts” is most helpful only for highest levels of gambling severity • Result…consider dropping the Illegal Act criteria • Strong and Kahler, 2007

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

35. Warning Signs • Loss of control over gambling behaviors • Spending more money than intended • Playing for longer periods than intended • Playing more often than intended • Wanting to gamble when one knows they should be doing other things • Not being able to stop thinking about gambling

36. Being preoccupied with gambling • Frequently talking about gambling • Often thinking of the next gambling venture • Lying about one’s gambling • Borrowing and stealing money from friends, family members and others in order to keep gambling.

37. Screening Tools • The following can be found at: http://www.problemgambling.az.gov/screeningtools.htm • SOGS-R(South Oaks Gambling Screen-Revised) • NODS (National Opinion Research Center DSM Screen for Gambling Problems) • NODs CLiP • GA 20 Questions • The following can be found at: http://www.npgaw.org/media/pdfs/PDF3.pdf • SOGS-RA (South Oaks Gambling Screen-Revised Adolescent)

38. Additional Screening Tools • The following can be found at: http://www.oregon.gov/DHS/addiction/gambling/2010/bbgs.pdf?ga=t • BBGS – Bio-Social Gambling Screen • The following can be found at: http://www.problemgambling.ca/EN/ResourcesForProfessionals/Pages/IGS.aspx • IGS- Inventory of Gambling Situations

39. Brain Activity to losses/gains

40. Gambling Activity • Identification of risk adverse..at the track and further • WIN • Ventral striatum becomes activated, flooded with dopamine (sex, drugs, pleasure) • Once activated want more..and more and more • LOSS • The same area of the brain become less active • Risk aversion

41. For Pathological Gamblers in that gambling activity • The Ventral Striatum remains unreactive EVEN DURING WINNING STREAKS • Decreased response to the “high” • Decreased activation in the ventrolateral prefrontal cortex • Keep gambling despite negative impact • Keep gambling to increase to normal levels of dopamine • Seen in SUD Clark et al 2009

42. Pathological Gambling addiction • The brain is hijacked…. • When triggered with a gambling cue the area of the brain responsible for impulse control is off • Potenza et al 2003

43. Gambling Court • It is a therapeutic, intervention and rehabilitative approach — within the criminal justice system and under judicial supervision — for defendants who commit non-violent crimes because of gambling addiction.

44. Gambling Court • Started by Judge Mark Farrell in New York State in 2001 • 350 people screened for gambling addiction • 100 deemed appropriate for diversion • 27 have graduated from treatment programs • Only 3 have returned to the legal system, with non-gambling offenses • The cost of gambling court treatment is only one sixth the amount of money it costs to keep someone in jail.

45. Gambling Court • http://gamblingcourt.org/videoFarrell.php • www.gamblingcourt.org

46. RULES OF RESPONSIBLE GAMBLING • TREAT THE MONEY YOU LOSE AS THE COST OF YOUR ENTERTAINMENT: Treat any winnings as a bonus. • PLAN AHEAD: SET A DOLLAR LIMIT AND STICK TO IT. Decide before you go not only what you can "afford" to lose, but how much you want to spend. Do not change your mind at the casino after losing. • SET A TIME LIMIT AND STICK TO IT: Decide how much of your time you want to allow for gambling - leave when you reach the time limit whether you are winning or losing. • BE PREPARED TO LOSE: The odds are that you will lose. Accept loss as part of the game. • MAKE IT A PRIVATE RULE NOT TO GAMBLE ON CREDIT: Do not borrow to gamble. • CREATE BALANCE IN YOUR LIFE: Gambling should not interfere with or substitute for friends, family, work or other worthwhile activities • AVOID "CHASING" LOST MONEY. After you've reached your designated dollar limit, DON'T continue to play in order to try to win back the money. Stop gambling and go see a show, or go home. • DON’T GAMBLE AS A WAY TO COPE WITH EMOTIONAL OR PHYSICAL PAIN. Instead, talk to a friend, a family member or a professional counselor. • BECOME EDUCATED ABOUT THE WARNING SIGNS OF COMPULSIVE GAMBLING

47. Abstinence is recommended when: you are experiencing significant financial problems; you continue to see gambling as a solution to financial problems; you gamble to escape and/or cope with negative situations and moods; your gambling is related to an impulse disorder; you have been mandated to by the legal system; you have already made unsuccessful attempts to reduce your gambling; or your relationships or employment may be at risk if you continue to gamble.

48. Treatment • Recovery Resources Gambling Service • Assessment • Individual Counseling • Group Therapy • Family Therapy • Prevention Education Services

49. Treatment • Recovery Resources Services • Assessment • Substance abuse treatment • Case management • Mental health services • Education and prevention services • Adolescent treatment services

50. What can you do? • For more information about our services at Recovery Resources, please call, 216-431-4131. Please visit our website at www.recovery-resources.org