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"Problem Gambling in Today's World" - November 2018

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A training with Michele Tantriella-Modell (Emergence) and Julie Hynes (PreventionLane at Lane County Public Health). November 30, 2018

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"Problem Gambling in Today's World" - November 2018

  1. 1. Michele Tantriella-Modell & Julie Hynes November 30, 2018 PROBLEM GAMBLING In Today’s World: Trends, Implications & Services
  2. 2. The complete slide deck & print-friendly handouts are posted at: www.preventionlane.org/ gambling-training 8:37 AM
  3. 3. Training Agenda • Introductions & Expectations • Overview, Definitions & Trends • Defining Disordered Gambling • Co-occurring Issues • Screening & Intervention • Problem Gambling Services • Wrap-up (Note to Michele- I will bring a coloring book)
  4. 4. There may be content here that could present as a trigger to some. Please take care of yourself and give yourself a break if needed. HEADS UP
  5. 5. 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.
  6. 6. How about you-- YOUR expectations for today?
  7. 7. TRENDS & DEFNITIONS PART 1.
  8. 8. Image sources: Oregon Lottery, Hynes
  9. 9. $.73out of every Lottery dollar ELECTRONIC GAMBLING: “Video Poker/Slots/Line Games” Photo source: Daniel Berman.
  10. 10. Photo: Hynes
  11. 11. Photo: Daniel Berman
  12. 12. Lottery machine at Sea-Tac Airport , 3/18 - GAMIFICATION - BLURRINESS
  13. 13. We don’t think of these things as gambling. Therefore, we don’t think our young people are gambling.
  14. 14. DEFINITION: GAMBLING __________ something of value in the ______________________ something of greater value. hopes of obtaining Risking Source: American Psychiatric Association - DSM-5 (2013).
  15. 15. • Circle “yes” for the activities which you believe are gambling. • Now, put an “S” next to the activities that are mostly skill-based, and an “L” next to the activities that seem mostly luck-based [Handout/Activity] GAMBLING OR NOT?
  16. 16. BLURRING LINES? 1. PRIZE: 2. CHANCE: 3. CONSIDERATION: Anything of value the sponsor awards in a promotion. (Example: real money or a virtual reward to help advancing in a game.) A process beyond the participant's direct control determines the outcome. (Example: an instant-win game at a fast food restaurant.) Requires money or significant effort. (Example: inviting Facebook friends in order to gain new “lives.”)
  17. 17. FREEMIUM.
  18. 18. “FREEMIUM.” FREE* APPS… * (WITH “IN-APP PURCHASES.”)
  19. 19. REAL MONEY FOR PRETEND MONEY / PRIZES
  20. 20. REAL MONEY FOR PRETEND MONEY / PRIZES
  21. 21. Of 100 most popular Facebook games, more than half (54%) include gambling content (22% are slot-based) Giroux, 2016
  22. 22. OOH! WAYS TO LEVEL UP FASTER! TYPICAL FREEMIUM SCENARIO: Source: Custer, R. & Rosenthal, M. &@*$#! IT’S GETTING HARDER. WOOHOO! COOL FREE GAME!
  23. 23. THE SITES MIGHT CHANGE, BUT FANTASY SPORTS IS NOT GOING ANYWHERE. “DFS”
  24. 24. US SPORTS BETTING 25-year federal ban on legal sports bets for all practical purposes except the State of… $150B illegal market in U.S.
  25. 25. Source: https://www.washingtonpost.com/politics/courts_law/states-are-free-to-authorize-sports-betting-supreme-court- rules/2018/05/14/31a46d16-2af1-11e8-b0b0-f706877db618_story.html?utm_term=.2b221aa0603c “PASPA” Repeal= 2018 Big Deal
  26. 26. Sources: http://www.espn.com/chalk/story/_/id/23716636/delaware-generates-322135-bets-day-1-full-scale-betting-tuesday https://www.nytimes.com/2018/06/11/nyregion/sports-betting-legalized-nj.html
  27. 27. • 2 Online Sports Betting: Still illegal across state lines Wire Act of 1961!
  28. 28. LET’S PLAY “GUESS THE SPORT!”
  29. 29. ANSWER: OVERWATCH (VIDEO GAME) Source: http://www.espn.com/esports/story/_/id/24153101/overwatch-league-playoffs-london-spitfire-becomes-first-overwatch- league-playoffs-finalist (July 30, 2018)
  30. 30. May 2, 2018: https://www.nytimes.com/2018/05/02/style/fortnite.html ESPORTS: COMPETITIVE VIDEO GAMING
  31. 31. TRADITIONAL SPORTS A NEW EXPLOSION OF SPORTS. Etc… Etc…And new games keep coming… ESPORTS
  32. 32. GAMERS ARE THE NEW STARS https://www.forbes.com/sites/insertcoin/2018/04/07/ninjas-new-fortnite-twitch-records-5-million-followers-250000-subs-875000-a-month/#5895314b478f Now 9.5 million followers
  33. 33. Source: https://www.gambling.com/news/10-reasons-why-fortnite-will-be-huge-for-esports-betting-1495000 GAMBLING ON THE GAMES
  34. 34. ESPORTS BETTING EXPECTED TO SURPASS $6 BILLION IN 2018
  35. 35. GAMBLING IN ESPORTS. 2. Fantasy esports 1. Betting on professional gaming teams Image source: csgostash.com 3. Betting in-game decorations (skins”) 2017 Overwatch World Cup Image source: pcgamer.com
  36. 36. SKINS. Entertainment. Street Cred. Possible $. Image Source: https://csgostash.com/
  37. 37. PRIZE. CHANCE. CONSIDERATION.
  38. 38. WATCH: “Skin in the Game: Counter-Strike has spawned a wild multibillion-dollar world of online casino gambling; it's barely regulated and open to any kid who wants in.” ESPN.com, 1/20/17
  39. 39. Esports betting = ~$2.3 billion market. J. Hynes | 3/2/18 | www.preventionlane.org/ok Source: http://www.bloomberg.com/features/2016-virtual-guns-counterstrike-gambling/
  40. 40. https://www.cnet.com/news/international-coalition-calls-on-video-game-industry-to-crack-down-on-loot-boxes/#
  41. 41. Sports Illustrated, 4/25/18:
  42. 42. Additional Recommended Video: “Skin in the Game: Counter-Strike has spawned a wild multibillion-dollar world of online casino gambling; it's barely regulated and open to any kid who wants in.” ESPN.com, 1/20/17
  43. 43. “MICROTRANSACTIONS” REAL $, VIRTUAL PRIZES
  44. 44. LOOT BOXES: ANOTHER FORM OF MICROTRANSACTION Small payment. Could get something really cool… but probably not.
  45. 45. LOOT BOXES: ANOTHER FORM OF MICROTRANSACTION Animation source: https://gfycat.com/gifs/detail/zealousglossygazelle
  46. 46. Prize. Chance. Consideration.
  47. 47. Source: https://www.businessinsider.com.au/ how-video-game-companies-are-using-gambling-tactics-to-make-customers-addicted-2017-9 SO MANY CONNECTIONS…
  48. 48. SO MANY CONNECTIONS… • Younger bettors avoid human connections • Recommendation for in-play betting suggests using TV timeouts to offer a two minute window for players to place bets. • Sports betting make up 15% of all global gambling but accounts for 50% online gambling and 68% mobile gambling. Source: Information from 2018 Global Gaming Expo (October 2018). Thanks to Erin Jones, University of Oregon Family & Human Services student intern, for this research!
  49. 49. problem
  50. 50. NOT ALL GAMBLING IS PROBLEM GAMBLING. IT’S A CONTINUUM. No Gambling Experimentation Recreational Problem Pathological Sources: Moore (2016); Volberg, Hedberg, & Moore (2008); Shaffer & Hall (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”
  51. 51. DSM-V (2013): “Addiction & Related Disorders”
  52. 52. PROCESS of ADDICTION.
  53. 53. ACTION CYCLE 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”
  54. 54. Typical Phases of Problem Gambling Information source: Custer, R. (1982); Lesieur, H. & Rosenthal, M. (1991) WINNING LOSING DESPERATION HOPELESSNESS
  55. 55. Winning PHASE • Early “big win” • Excitement • Feeling on top of the world • Gambling is main Image attribution: C-3PO: https://titoupaul.files.wordpress.com Yes! I am a winner.
  56. 56. Losing PHASE • Large losses • Using credit • Borrowing money • Arguing • Missing school I’ll get my money back in no time. My big win is just around the corner!
  57. 57. Desperation PHASE • Obsessed with next win/game • Lying • Depressed I sold my arm but still short of cash. Maybe I can ask han solo for a loan.
  58. 58. Hopelessness PHASE • Major life consequences • Winning no longer a goal; staying in “action” is the goal • Lost relationships, isolation • Considering suicide • Hitting “bottom”
  59. 59. connections
  60. 60. The PREFRONTAL CORTEX is the LAST PART to develop. The brain is still developing until
  61. 61. 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.
  62. 62. Neurotransmitter Serotonin Norepinephrine Opioids Dopamine Role in Impulse Control Behavior Initiation/Cessation Arousal, Excitement Pleasure, Urges Reward, Reinforcement  Serotonin -- risk taking Gambling -  β-endorphin PGs -  NE levels PGs -  dopamine response Potential Neurotransmitter Roles in Disordered Gambling Dopamine: most studied neurotransmitter in problem gambling
  63. 63. Sources: Tonneato, T. (1999). Cognitive psychopathology of problem gambling. Subst Use Misuse. Sep;34(11):159
  64. 64. Image source: Anheuser-Busch Cognitive Distortions • Lucky #’s • Favorite shirt • “My” machine Superstition Rituals/habits that are believed to affect the outcome.
  65. 65. Cognitive Distortions • Example (win): “Yeah buddy! I was just waiting on my card. I know this game inside and out.” • Example (loss): “I would’ve won if that idiot didn’t get lucky and draw an ace.” Biased Evaluation Attributing wins to one’s special skill or luck, while losses are blamed on external circumstances.
  66. 66. Image source: Anheuser-Busch Cognitive Distortions Forgetting about losses, only remembering wins. Selective Memory
  67. 67. Cognitive Distortions Failure to see each event as independent. Examples: • Trying to see patterns in coin flips. • “This slot machine is DUE to hit!” Gambler’s Fallacy
  68. 68. Image source: http://www.drugabuse.gov/pubs/teaching/largegifs/slide-2.gif Survival Reward Pathway
  69. 69. Trauma. (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.
  70. 70. 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
  71. 71. 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, 24% experience suicidal ideation Have current drug problems
  72. 72. 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)
  73. 73. The “Addiction” Connection • Loss of control • Denial • Depression/mood swings • Progressive • Tolerance • Use as an escape • Preoccupation • Similar “highs” • Self-help groups • Family involvement • Use of rituals Differences?Similarities?  Defining “use” (gambling)  Behavior not attributable to chemical ingestion  No biological test  More intense sense of shame and guilt (anecdotal)  Unpredictable outcome  Fantasies of success /quitting is giving up hope  Easier to hide
  74. 74. Some Key Risk Factors Other addiction issues Starting early in life Friends / family favorable Community laws & norms Mental health issues
  75. 75. Vulnerable Populations People with other addictions issues People with other mental health issues Military/ Veterans Young people Incarcerated persons People of color Older adults WomenPeople of lower SES People with history of trauma Men LGBTQA+
  76. 76. Adolescent Behavior & Brain Development • Preference: excitement and  effort activities • Prefer novelty • Poor planning & judgment • Minimal consideration of negative consequences • More risky, impulsive Source: Grant, J (2008, October). The Adolescent Brain & Impulsive Behaviors. Healthy Brain Development: Key Impacts &
  77. 77. Age 65+ • Rate of problem gambling lower (1.2%) 1 • BUT living close to gambling facility  risk – six times more likely to be problem gamblers •  risk factors 2 • Gambling = most frequently identified social activity 2 • Challenges in problem acceptance Sources: 1. Moore (2001, ibid). 2. McNeilly & Burke (2000). Late life gambling: The attitudes and behaviors of older adults. Journal of Gambling Studies, 16, 393-415.
  78. 78. People of Color • Higher proportion of problem gamblers (except Asians) • Spend 2.5x more on gambling in a typical month Source: Moore, Jadlos, & Carlson, 2000
  79. 79. Incarcerated Persons • One in three offenders meet criteria for PG 1 – Highest rate in any population • Gambling common in prison culture • Resources limited to investigate crime & gambling 2 Sources: 1. Williams, Roysten & Hagen. (2005). Gambling and Problem Gambling Within Forensic Populations, A Review of the Literature 2. Myers, H. (2006). Organized crime in Oregon.
  80. 80. Military & Veterans • All four branches operate slot machines overseas • Service members at higher risk – Male, younger, racial/ethnic minorities – Marine corps highest rate of PG Source: Department of Defense (2002). Survey of Health Related Behaviors Among Military Personnel Washington, DC: Author. Report information available at http://www.tricare.mil/main/news/dodsurvey.htm
  81. 81. Typical Issues: (problem gamblers in Oregon treatment) >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
  82. 82. addressing the issue
  83. 83. THE BARRIERS OUR PROFESSION ARE REAL. Tobacco Substance Abuse Problem Gambling
  84. 84. Prevention
  85. 85. FAMILY COMMUNITY Barnes et al.,1999; Hayatbakhsh et al., 2006; Johansson et al., 2009; King & Delfabbro, 2016; Raylu & Oei, 2002; Scholes-Balog et al., 2014; Shead et al., 2010; Volberg, 2008; Winters et al., 2002 SCHOOL INDIVIDUAL/PEER - Family conflict - Family history antisocial behavior - Parental gambling - Academic failure & poor school performance - Low school commitment - Male - Early initiation - Early big wins - Rebelliousness - Delinquency - Impulsivity - Competitiveness - Interaction w/ antisocial peers - Friends’ use/pressure - ATOD use - Psychological distress, mental health issues ADDRESS RISK FACTORS BY DOMAIN - Exposure to gambling - Availability & accessibility - Media portrayal
  86. 86. i.e., • Prevention efforts that address RISK FACTORS common to other problem behaviors; • Prevention efforts that address PROTECTIVE FACTORS (e.g., prosocial behaviors) Examples: Alcohol & drug curricula, Life Skills programs, parenting programs, etc. RESEARCHERS RECOMMEND OVERALL PREVENTION INITIATIVES AS MOST EFFECTIVE.
  87. 87. WHAT CAN WE DO IN OREGON ? Px education & awareness Track policy, work w/ stakeholders ID & referral to treatment PREVENTION
  88. 88. Treatment & Recovery
  89. 89. DSM Criteria Revisited 1. Preoccupation with gambling 2. Increases amount of money gambled 3. Unsuccessfully tries to quit 4. Restless or irritable when trying to cut down/stop 5. Gambles as an escape 6. “Chases” losses 7. Lies to others to conceal gambling 8. Has jeopardized relationships 9. Relies on others to bail him/her out Gambling Disorder = Four or more of above, AND: The gambling behavior is not better accounted for by a Manic Episode. Mild (4-5) / Moderate (6-7) /Severe (8-9)
  90. 90. Intervention Helpline emergence 24/7: 1.877.MY.LIMIT Referred to provider for assessment 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).
  91. 91. Treatment Options in Oregon •Minimal intervention: GEAR (Gambling Education and Reduction) •Outpatient treatment •Crisis respite (1) •Residential treatment (1)
  92. 92. IT OFTEN TAKES YEARSFOR SOMEONE TO 1) admit they have a problem 2) seek help, and then 3) continue in recovery
  93. 93. 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..
  94. 94. Treatment is free.The Oregon legislature requires that 1% OF LOTTERY PROFITS go to a Problem Gambling Treatment Fund.
  95. 95. Emergence Gambling Treatment Program Treatment is gender-specific Multimodal treatment - Individual sessions - Family therapy - Group sessions - Recreational counseling - Didactic lectures - Audiovisual education Suggest to explore 12-step program
  96. 96. 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
  97. 97. 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
  98. 98. gambler. IT’S NOT ALL JUST ABOUT THE NEED HELP TOO!
  99. 99. 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.
  100. 100. Where we need your help: SCREENING (Brief Biosocial Gambling Screen - BBGS)
  101. 101. Wrapping it All Up • The lines of gaming and gambling have blurred, and it’s become much more popular • This popularity doesn’t come without cost • Gambling problems often mimic other disorders in manifestation, consequences, & co-occurrence • Problem gambling services are free, confidential, available and effective • Important to assess for issue & make your clients aware of services
  102. 102. COMMENTS? QUESTIONS?
  103. 103. Evaluations
  104. 104. Thank You!! Julie Hynes Prevention Specialist Lane County Public Health Prevention Program 541.682.3928 Julie.Hynes@co.lane.or.us Michele Tantriella-Modell Program Director Emergence Meridian Gambling Treatment Program 541.741.7107 mtmodell@4emergence.com

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