Problem Gambling: Key Issues for Behavioral Health Providers

Julie Hynes, MA, CPS
6/9/17
Lane County Behavioral Health
GAMBLING:Key Considerations for
Behavioral Health Providers

The complete slide
deck & print-friendly
handouts are
posted at:
www.preventionlane.org/lcbh
9:07 AM

Cover tech & new
issues in gambling,
DSM-5 criteria for
disordered gambling.
PG services – focus
on treatment &
screening.
9:09 AM
Understand substance abuse
& mental health connections.

How about you--
YOUR expectations for today?

DEFINITION:
______ something of value
in the _________________
something of greater value.
hopes of obtaining
RISKING
Source: American Psychiatric Association - DSM-5 (2013).

Image sources: Oregon Lottery, Hynes

out of
every
lottery
dollars
ELECTRONIC GAMBLING:
“Video Poker/Slots/Line Games”
Source: Oregon Health Authority
(2012; ibid)
Photo source: Daniel Berman.

NOT ALL GAMBLING IS PROBLEM
GAMBLING. IT’S A CONTINUUM.
No
Gambling Experimentation
Recreational Problem Pathological
Sources: 1. Moore (2016). 2. Volberg, Hedberg, & Moore (2008). 3. Shaffer & Hall (2001). 4. Northwest Survey & Data Services
(2007). 5. Moore (2001).
Between 2-3% adults 18+ problem gamblers (2.6%)
Teens (13-17 y.o.): 6% at risk or problem gamblers 2
College age (18-24): 5.6% 3
At-Risk
“GAMBLING DISORDER”

“reflects the increasing and
consistent evidence that some
behaviors, such as gambling,
activate the brain reward system
with effects similar to those of
drugs of abuse.”
Source: American Psychiatric Association, 2013. http://www.dsm5.org/Documents/changes%20from%20dsm-iv-tr%20to%20dsm-5.pdf
According to the American
Psychiatric Association (APA),
this change to an addiction:

Typical Phases
of Problem Gambling
Information source: Custer, R. (1982); Lesieur, H. & Rosenthal, M. (1991)
WINNING
LOSING
DESPERATION
HOPELESSNES
S

Source: Brain Briefings (2007, October), Society for Neuroscience, Washington, DC
Gambling & Dopamine
Dopamine not released when expecting a loss.
Flooded with dopamine when expecting a win!
It’s not about the money –
it’s about the ACTION of the game and the HOPE of winning.

Source: http://www.oregon.gov/oha/amh/gambling/gear-workbook.pdf
THOUGHTS, FEELINGS,
ANTICIPATION, FANTASY
(Gambler’s Mind, “Gambling
Time/ Gambling Money”)
PLANNING
(Removing obstacles
to gambling)
GAMBLING
(“Winning & Losing”)
Serotonin
Adrenaline
Dopamine
CRASH
Guilt, Shame, Anger, Denial,
Justification, Restless, Irritable,
Depression, Panic or Numb,
Suicidal Thoughts Dopamine
REALITY
(Self with Others)
“Real Time, Real Money”

These comparisons are of course generalizations & do not by
any means reflect all male & female gamblers.
Comparison by
Start gambling at older
age
Get addicted faster
More likely to be “escape”
gamblers (slots)
More likely to seek help
Start gambling fairly
young (teens, 20s)
Tend to like games of
strategy & “action”
(poker, sports bets)
Less likely to seek
help

$32k
85%
87%
24%
$23k
$!
IS THE AVERAGE HOUSEHOLD INCOME.
Range is from $0 to over $1million/year.
ARE WHITE. 4.4% Hispanic/Latino., 3.4% Asian. People
of color are under-represented in treatment.
prefer ELECTRONIC GAMBLING.
Video (slots/poker/line games).
Cards 4.1%; scratch-its 1.3%; sports 0.9%;
HAVE COMMITTED CRIMES TO FINANCE THEIR
GAMBLING. Most crimes are “white collar” (forgery,
check fraud, embezzlement.)
IS THE AVERAGE INDIVIDUAL GAMBLING
DEBT.
Oregonians in gambling treatment (2014):

(Hodgins et al. 2010; Kraus et al. 2003; Najavits et al. 2010; Petry and Steinberg 2005;
Taber et al. 1987)
Exposure to early childhood trauma
has consistently been associated with
disordered gambling.

GAMBLING & ACEs
Associated w/ ADHD, personality disorders &…
Disordered gambling
Poole, J.C., Kim, H.S., Dobson, K.S., & Hodgins, D.C.(2017, March). Adverse childhood experiences and
disordered gambling: Assessing the mediating role of emotion dysregulation. Journal of Gambling
Studies, DOI 10.1007/s10899-017-9680-8
Adverse
Childhood
Experiences
(ACEs)
Emotional
disregulation
Self-
medicating
w/substance
use, eating,
gambling, etc.
Substance use
disorders,
eating
disorders,
disordered
gambling

23%
are current
tobacco users
66%
have current
alcohol problems
39%
have had a
mental health
episode of care
Source: Oregon Gambling Treatment Programs Evaluation Update, 2016
24%
experience
suicidal ideation
Have current drug
problems

Spotlight ON
MENTAL HEALTH CONNECTIONS
• Depression/mood disorders1
– Depression – in one study, 76% of PGS had depression
– Bipolar disorder – correlations with BPD & PG
• PTSD (studies of military veterans)
– PTSD among problem gamblers estimated between 12.5 – 29%
2,3
• ADHD4 20-25% of problem gamblers
• Alcohol & other substance abuse disorders
Sources 1. Ledgerwood & Petry (2006). 2. Kausch et al. (2006). 3. Biddle et al. (2005). 4. Waluk, Youssef & Dowling (2015)

Because of our time limitations, we’re
focusing today on the services of
treatment & recovery.

It often takes
years for
someone to
1) admit they have a problem
2) seek help, and then
3) continue in recovery

First Steps to getting help
could be…
24/7 Helpline:
1.877.MY.LIMIT
Referral to provider for
assessment
Often family members come
in; later bring gambler in
This is an actual helpline counselor. Everyone
who answers the phone is a Certified Gambling
Addictions Counselor (CGAC).

SCREENING (Brief Biosocial
Gambling Screen - BBGS)
• Now considered the gold standard of problem gambling screening
• Division on Addiction, Cambridge Health Alliance, Harvard Medical School
Response to at least ONE of the following indicates need
for full assessment:
Gebauer, L., LaBrie, R. A., Shaffer, H. J. (2010).

Larger version of this
chart: click here
Source: Written by Robert L. Custer, M.D; image source: Council on Compulsive Gambling of New Jersey, Inc..

Treatment is free.
The Oregon legislature requires that 1% OF LOTTERY
PROFITS go to a Problem Gambling Treatment Fund.

Minimal intervention (Skype)
Outpatient treatment (44)
Crisis respite (2)
Residential treatment (1)
TREATMENT OPTIONS IN OREGON
Local
service
(Lane County)
Local service
(Lane County)

WHAT OUTPATIENT Tx IS LIKE:
(SPOTLIGHT: EMERGENCE IN LANE COUNTY)
Treatment free for gamblers and loved ones
- Over 250 problem gamblers and family members treated last year
- Gender-specific
Many different things happen in treatment:
- Individual sessions - Family therapy
- Group sessions - Recreational counseling
- Class type lectures - TV/internet/Skype
55 % male 45% female
IN OREGON GAMBLING TREATMENT:

THE “average” person
IN OREGON PROBLEM
GAMBLING TREATMENT
55% male
White
48years old
Employed
Problem started at 37
Mostly gambles at video lottery terminals (in delis, bars, restaurants, taverns)
Owes $23K in gambling debt
Started gambling at 24

IN TREATMENT, 2016:
Outpatient (81%) Residential (5%)
Respite (1%) Home-based (4%)
Prison-based education & treatment (10%)
friends
& family
134
gamblers1,081
Source: Oregon Gambling Treatment Programs Evaluation Update, 2016

gambler.
IT’S NOT ALL JUST
ABOUT THE
NEED HELP TOO!

Learning.
Education about problem gambling as an addiction. What to
watch out for. Gaining tools for financial/legal/other issues.
Dealing with trust issues. Being allowed to vent rage and betrayal.
Healing from more “unfolding truths.”
No more secrets. No more bailouts!
Getting continued support. Renew sense of hope &
empowerment. Determining future of relationship.
Healing.
Growing.

FOR MORE INFO ON Tx OPTIONS IN OREGON:
OPGR.ORG (Oregon Problem Gambling Resource)
(Clickable
Link)

Where we need your help:
SCREENING (Brief Biosocial
Gambling Screen - BBGS)

facebook.com/preventionlane@PreventionLane

Problem Gambling: Key Issues for Behavioral Health Providers

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