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Ken Winters. This is Your Brain on Adolescence: A Developmental View of Problem Gambling and Other Addictions

Ken Winters. This is Your Brain on Adolescence: A Developmental View of Problem Gambling and Other Addictions

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Ken Winters. This is Your Brain on Adolescence: A Developmental View of Problem Gambling and Other Addictions
Session 7B
Presented at the New Horizons in Responsible Gambling Conference in Vancouver, January 27-29, 2014

Ken Winters. This is Your Brain on Adolescence: A Developmental View of Problem Gambling and Other Addictions
Session 7B
Presented at the New Horizons in Responsible Gambling Conference in Vancouver, January 27-29, 2014

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Ken Winters. This is Your Brain on Adolescence: A Developmental View of Problem Gambling and Other Addictions

  1. 1. Dr. Ken Winters This is Your Brain on Adolescence: A Developmental View of Problem Gambling and Other Addictions
  2. 2. This is Your Brain on Adolescence: A Developmental View of Problem Gambling and Other Addictions Ken Winters, Ph.D. Professor, Department of Psychiatry University of Minnesota Minneapolis, MN USA winte001@umn.edu New Horizons in Responsible Gambling Conference Vancouver, CA January 29, 2014
  3. 3. www.psychiatry.umn.edu/research/casar/home.html
  4. 4. 1. Background 4. Summary 3. Neurodevelopment and gambling 2. Neurodevelopment
  5. 5. #1 Conclusion Adolescence is a developmental period often characterized by poor decision making.
  6. 6. #1 Conclusion Adolescence is a developmental period often characterized by poor decision making. Brain maturation may be a significant determinant of tendencies for nonthoughtful decision making.
  7. 7. #2 Conclusion Brain development may also be a contributing factor that places youth at risk for gambling and other addictive disorders.
  8. 8. #3 Conclusion Most adult gamblers begin to gamble in their youth; early onset gambling is a common feature of the pathway toward developing a gambling problem.
  9. 9. 1. Background
  10. 10. Terms of “severe-end” gambling often used when referring to youth • Gambling Disorder (DSM-5) (GD) = repeated and compulsive involvement in gambling that continues in the face of financial, social, psychological and vocational consequences. (level 4) • Problem gambling (not official) = gambling that contributes to financial, social, legal, psychological, school and vocational consequences (level 3)
  11. 11. Point 1: First generation of youth exposed to ready access and varied gambling venues • Minimum legal age to place a bet varies across countries and games, but many opportunities for youth in the Westernized countries.
  12. 12. U.S. as an Example: 43 states with a lottery (blue) 39 states allow age 18 as legal minimum age
  13. 13. U.S. as an Example 43 states with casino/slots 14 states allow 18 as legal minimum age casinos/slots not legal casinos/slots legal casinos/slots legal
  14. 14. U.S. Study: Youth Participation in Gambling (age 14 – 21) (Welte et al., 2008) 70 68 percent 60 50 40 30 33 30 29 23 20 21 12 10 0 cards office pools lottery sports betting skill games bingo 9 dice games 7 casino all gambling
  15. 15. U.S. Study: Past Year Problem Gambling Prevalence Rate by Age Group (Welte et al., 2002, 2008) 10 Some epidemiology studies estimate teen rates are higher than adult rates percent 8 6 5.2 4.3 4 2 3.3 3.3 2.1 1.3 1.2 0 <19 19 - 25 26-30 31-40 41-50 51-60 61+
  16. 16. U.S. Data: Estimates of Problem Gambling, Past Year (included U.S. and Canada data; school-based surveys) (National Research Council, 1999) Percentage Group Adult Adolescent Range Median <1 - 2% 0.9% 1 - 9% 6% Estimates based on meta-analysis of surveys conducted 1988-1997 (National Research Council, 1999). Problem gambling defined in most studies by the SOGS/SOGS-RA.
  17. 17. Point 2: The newest “waves” of gambling expansion, online gambling and poker, further strengthen involvement in gambling by teens
  18. 18. Online Gambling (internet, online, social networks) • Various forms of online gambling are legal and regulated in many countries • U.S. – very limited; permitted in some States • U.K. and Australia – examples of relatively permissive internet regulations • Recommended reading: Remote gambling in adolescence Griffiths, Parke, & Derevensky (2010). In J. Derevensky, D. Shek & J. Merrick (Eds.), Youth gambling problems: The hidden addiction. Berlin: De Gruyter
  19. 19. Gambling Severity by Sample (McBride & Derevensky, 2007) 80 70 Frequency % 60 50 High School College/University Internet Sample 40 30 20 10 0 Non-gambler Social gambler Problem gambler
  20. 20. University journalism student Mike Schneider won top prize - $1 million - in the Limit Hold'em PartyPoker.com Million V tournament. Photo by Charlie Knutson, from The Minnesota Daily, March 22, 2006
  21. 21. Point 3: There is a disconnect between estimates of youth problem gambling and utilization of clinical services • From 1999- 2009 in Minnesota: • over 10,000 calls to the problem gambling hotline … 15 calls pertained to teen gambling (< 19 years old) • over 3,700 referrals to a treatment program….. 0 referrals of teenagers (< 19 years old)
  22. 22. Point 3: There is a disconnect between estimates of youth problem gambling and utilization of clinical services • From 1999-2009 in Minnesota: • over 10,000 calls to the problem gambling hotline … 14 calls from teenagers (<19 years) • over 3,700 referrals into the treatment system….. 19 referrals of 19 – 25-years old
  23. 23. Why? • Low public awareness • Low problem recognition • No youth-specific services • Other, more observable problems are viewed as more pressing • No or minimal financial losses
  24. 24. But there are clinical cases • Minnesota High School Football Star; was an honor student and had a football scholarship to a Division I school. • Became an habitual blackjack player at the local casino after he turned 18. • To finance his habit, he fenced stolen property. • Was arrested for the thefts.
  25. 25. Point 4: There is a developmental feature to problem gambling Adolescent gambling Adult problem gambling
  26. 26. Onset of Gambling Variables and Number of Lifetime Symptoms (Kessler et al., 2008) Age Onse Gambling 30 mean age Earlier onset among those 5+ 25 23.9 20 18 18.3 16.7 15 10 5 0 No Sym 1-2 Sym 3-4 Sym 5+ Sym Age Onset: F = 15.4, p < .001
  27. 27. Onset of Gambling Variables and Number of Lifetime Symptoms (Kessler et al., 2008) Age Onset 30 Age Onset Prb 24.3 mean age 26.7 25 23.9 23.8 20 18 18.3 16.7 15 10 5 0 0NA No Sym 1-2 Sym 3-4 Sym 5+ Sym Age Onset Prb: non sig.
  28. 28. Point 5: Youth problem gambling occurs with other problem behaviors sexual behavior delinquency ADHD Problem Behaviors gambling male drug use
  29. 29. Cross-Sectional Study of Adolescents: Association of Psychosocial Problems and Gambling Involvement (Faregh & Derevensky, 2011) Psychosocial problems conduct family emotional cognitive anger Gambling Group
  30. 30. Longitudinal Study of Youth: Association of Psychosocial Problems and Future Gambling (Pagani et al., 2009) • These variables measured in the kindergarten sample: • • • • • • Impulsivity Emotional distress Family functioning Maternal education Parental gambling Gender • Measured gambling behavior when they were sixth graders. Pagani et al., 2009
  31. 31. Childhood Self-Control (Age 3) as a Predictor of Adult (Age 21) Problem Gambling (Slutske et al., 2012) undercontrolled group > gambling The children with undercontrolled temperament at 3 years of age were more than twice as likely to evidence disordered gambling at ages 21 than were children who were well-adjusted at age 3.
  32. 32. 1. Background 2. Neurodevelopment
  33. 33.  Adolescence is a period of profound brain maturation.  We thought brain development was complete by adolescence  We now know… maturation is not complete until about age 25 !
  34. 34. An Immature Brain = Less Brakes on the “Go” System
  35. 35. Maturation Occurs from Back to Front of the Brain Images of Brain Development in Healthy Youth (Ages 5 – 20) Earlier: Motor Coordination Emotion Motivation Later: Judgment Blue represents maturing of brain areas Source: PHAS USA 2004 May 25; 101(21): 8174-8179. Epub 2004 May 17.
  36. 36. Implications of Brain Development for Adolescent Behavior • Preference for …. 1. physical activity 2. high excitement and rewarding activities 3. activities with peers that trigger high intensity/arousal 4. novelty • Less than optimal.. 5. control of emotional arousal 6. consideration of negative conseq. • Greater tendency to… 7. be attentive to social information 8. take risks and show impulsiveness
  37. 37. Novelty Activates the Dopamine System • Compared to adults, adolescents have lower baseline levels of dopamine activity and greater sensitivity to dopamine-triggering activities, such as novelty. • Thus, adolescents may seek novelty more and may experience a greater reward from novelty as a result of this „robust‟ dopamine system.
  38. 38. Implications of Brain Development for Adolescent Behavior • Preference for …. 1. 2. 3. 4. • physical activity high excitement and rewarding activities activities with peers that trigger high intensity/arousal novelty Less than optimal.. 5. control of emotional arousal 6. consideration of negative conseq. • Greater tendency to… 7. be attentive to social information 8. take risks and show impulsiveness
  39. 39. Risk-Taking • Based on science of brain development, a modern view of risk taking in adolescence … • is normative; important to development • has evolutionarily adaptive value • significant individual differences • not a result of poor assessment of risk; rather, is due primarily to self-control and contextual factors, not cognitive influences
  40. 40. An Immature Brain = Low Brain Power
  41. 41. An Immature Brain = reward incentives > Absence of Judgment perception of consequences
  42. 42. 1. Background 3. Neurodevelopment and gambling • youth in general • ADHD youth 2. Neurodevelopment
  43. 43. Point 1: Normal brain development may contribute to adolescent susceptibility to gambling involvement. • Preference for …. 1. 2. 3. 4. • Less than optimal.. 5. 6. • physical activity high excitement and rewarding activities activities with peers that trigger high intensity/arousal novelty control of emotional arousal consideration of negative consequences Greater tendency to… 7. 8. be attentive to social information take risks and show impulsiveness
  44. 44. Point 2: The neuro-plasticity of normal brain development may contribute to continued, and perhaps accelerated, gambling involvement.
  45. 45. Point 3: ADHD may put a person at heightened risk for gambling involvement • Individuals with ADHD suffer from problems with judgment and selfregulation, believed to be linked to prefrontal cortex deficits. • These deficits in pre-frontal cortex contribute to a disorder likely related to another addictive disorder - drug addiction. (Barkley, 1997; Martin, Earlywine, Blackson et al., 1994)
  46. 46. Link of ADHD and Drug Abuse adapted Molina et al., unpublished Teenagers with a childhood diagnosis of ADHD are about 2 – 4 times more likely to have a Substance Use Disorder compared to teenagers without ADHD.
  47. 47. Is There a Link between ADHD and Problem Gambling? • Adult studies • Youth studies
  48. 48. Adult: Link of ADHD and Gambling Disorder Among Adults With and Without a Gambling Disorder (Carlton et al., 1987; Rugle & Melamed, 1993) Gambling Disorder Rate of childhood ADHD 15-36% psych., non-GD 4-8% (sig.)
  49. 49. Adult: Link of ADHD and Gambling Disorder Among Adults With and Without a Gambling Disorder (Specker et al., 1995) Gambling Disorder Rate of adulthood ADHD 21% psych., non-GD < 1% (sig.)
  50. 50. Adult: Link of ADHD and Gambling Disorder Among Adults With and Without ADHD (Harrow, 2009) Gambling Disorder Rate of adulthood GD 12% controls < 1% (sig.)
  51. 51. Youth: Link of ADHD and Problem Gambling Association of Adolescent Gambling and Probable ADHD Status 1 (Derevensky et al., 2007) “ADHD”+ Groups (N = 2336) “ADHD”- (n = 231) % (n =2105) % Nongamblers (30%) 6 94 Social 8 92 At-Risk (8%) 20 80 Prob. Path. (5%) 34 66 1 (54%) Based on the ADHD Index (Conners & Wells, 1997) X2 = 113, p < .001 Derevensky JL, Pratt LM, Hardoon KK, Gupta R. (2007). Gambling problems and features of attention deficit hyperactivity disorder among children and adolescents. Journal of Addiction Medicine, 1, 165-172.
  52. 52. Youth: Link of ADHD and Problem Gambling Minnesota ADHD Study (Breyer, Winters, August, & Realmuto, 2009) ADHD-persis ADHD-desist Controls sig. any gambling (%) 79 77 80 PG among all1 (%) 19 5 5 PG among gamb1 (%) 24 7 7 SOGS-RA score (mean) 0.5 0.2 0.2 (p < .05) Count games played (mean) 3.0 2.4 2.7 1 PG = SOGS-RA 2+ (p < .05) (p < .01)
  53. 53. 1. Background 4. Summary 3. Neurodevelopment and gambling 2. Neurodevelopment
  54. 54. Summary 1. Evidence is accumulating that… • most youth gamble, yet many do so infrequently • the prevalence of “problem gambling” is noteworthy
  55. 55. Summary 2. Possible links between neurodevelopment and gambling behavior • Gambling may be a very attractive activity for the developing brain • Neuro-plasticity may impact future risk. • Deficits in brain structures responsible for self-regulation may place youth with ADHD at elevated risk for problem gambling
  56. 56. Summary 3. Relatively easy access to online gambling and popularity of poker games and tournaments poses a new risk for youth who may be inclined to overindulge in e-gambling
  57. 57. “Maryland CPA hit it big, but he worries about those who won’t” (Jon Saraceno, USA Today, August 1, 2006) “Steve Dannenmann, who honed his skills with online poker-playing, won $4.25 million as runner-up in the 2005 World Series of Poker tournament. This summer, while playing poker in Vegas for a few weeks, he has made it his personal project to quiz young people who have fallen for the allure of the game and its potential financial bonanza.” Steve: “I‟ve met so many kids who have packed it in and came out here with a $2,000-$3,000 bankroll thinking they‟re going to make it big. They‟ve quit college or their jobs. I quiz them like I do my clients who come in with money concerns.” „Why did you quit school? What‟s your bankroll? What is your back-up plan?‟ “If they don‟t give a good answer, I call their bluff.” „What are you thinking?‟ “It‟s absolutely crazy, and pretty sad.”
  58. 58. Summary 4. Clinical issue: Screen for problem gambling among youth with drug abuse or ADHD
  59. 59. Brief Screen - Adult Lie/Bet Screen (Johnson et al., 1997) 2-question version of the DSM-5 criteria: 1. Have you ever had to lie to people important to you about how much you gambled? 2. Ever felt the need to bet more and more money? Score of 1+ is a red flag.
  60. 60. Brief Screens - Youth SOGS-RA • Winters, Stinchfield, & Fulkerson, 1989/1993 DSM-IV-J • Fisher, 1992
  61. 61. Sampling of Themes from Adolescent Problem Gambling Screens 1. There is money missing from the parents. 2. The teenager asks for an increase in allowance. 3. The parent finds evidence of internet gambling when searching the teenagers computer. 4. The teenager is secretive about how they are spending their money.
  62. 62. Summary 5. Clinical issue: For youth being treated for a substance use disorder or ADHD: •raise insights as to the risks of gambling; educate that gambling may be a source of relapse
  63. 63. Summary • 6. Prevention programs exist • Gambling prevention can be integrated into a school‟s drug prevention program • International Centre for Youth Gambling • www.youthgambling.com/ • Illinois Institute for Addiction Recovery • www.addictionrecov.org • Williams, Woods & Currie: Stacked Deck
  64. 64. Summary CollegeGambling.org • Tools for • Students • College health professionals • College administrators
  65. 65. THANK YOU! winte001@umn.edu
  66. 66. extras
  67. 67. Internet and Youth Study (McBride & Derevensky, 2007) • High-school students, Montreal: N = 1113 • College/University students, Canada and U.S.: N = 1273 • Young adults and adults, on-line gaming newsletter link: N = 546
  68. 68. Gambling for Money on the Internet (McBride & Derevensky, 2007) Frequency % 100 90 80 70 60 High School College/University Internet Sample 50 40 30 20 10 0 never less than once a month monthly weekly
  69. 69. Past Year Gambling (McBride & Derevensky, 2007) 100 90 Frequency % 80 70 High School College/University Internet Sample 18-24 Internet Sample 25+ 60 50 40 30 20 10 0 Male Female
  70. 70. Session Evaluation
  71. 71. 1. The information presented was useful to me a. b. c. d. e. Strongly agree Somewhat agree Neither agree nor disagree Somewhat disagree Strongly disagree
  72. 72. 2. The information presented was clear and organized a. b. c. d. e. Strongly agree Somewhat agree Neither agree nor disagree Somewhat disagree Strongly disagree
  73. 73. 3. I would recommend this session to a friend/colleague a. b. c. d. e. Strongly agree Somewhat agree Neither agree nor disagree Somewhat disagree Strongly disagree
  74. 74. 4. I learned something new a. b. c. d. e. Strongly agree Somewhat agree Neither agree nor disagree Somewhat disagree Strongly disagree
  75. 75. 5. The presenter(s) was/were engaging a. b. c. d. e. Strongly agree Somewhat agree Neither agree nor disagree Somewhat disagree Strongly disagree
  76. 76. 6. Please rate this session overall a. b. c. d. e. Very good Good Average Poor Very poor

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