“Gambling: The Hidden Addiction”Prevalence and Screening Tools

PresenterCarl E. Robertson, MRE, MDiv.- Prevention Manager

Funded by DHMH/ADAA

2013 Mid-Atlantic Behavioral Health Conference

Ideas In Action Innovations    -   Partnerships   -  

 Technologies

Maryland Center of Excellence on Problem Gambling

Partnership of Maryland Council on Problem Gambling and the University of Maryland School of Medicine

Funded with a 3 year grant (2012-2015 ) from State Health Department

Purpose:Identify and promote problem gambling treatment resourcesProvide Maryland based prevention and research initiativesEstablish problem gambling lending library resourcesConduct Public and Professional Awareness Outreach CampaignsManage Maryland Problem Gambling Hotline: 1-800-522-4700

Funded by DHMH/ADAA

• If you bet on a horse, that’s gambling.• If you bet you can make three spades, that’s

entertainment.• If you bet cotton will go up three points, that’s

business.• What’s the difference?

• Gambling is any activity or game where you risk Gambling is any activity or game where you risk something of value or money on an outcome that something of value or money on an outcome that is not guaranteed.is not guaranteed.

Funded by DHMH/ADAA

Funded by DHMH/ADAA

Problem and Pathological Gambling Definitions

Problem Gambling – is a descriptive term used to define those individuals with problems in their lives due to gambling.

Pathological/Compulsive Gambling- is the clinical term for the Impulsive Control Disorder defined in DSM IV-312.31 (failure to resist the impulse to gamble)

DSM V

►Leaving- Impulse Control Disorder►Joining- “Substance Use Disorder” section►“Behavioral Addictions” = “Gambling Disorder”►9 vs 10 Criteria (Illegal activities may be dropped)

““In functional brain imaging-whether with gamblers or drug addicts-when they are showed video or photograph In functional brain imaging-whether with gamblers or drug addicts-when they are showed video or photograph cues associated with their addiction, the same brain areas are activated”. Charles O’Brien, M.D. chair of the cues associated with their addiction, the same brain areas are activated”. Charles O’Brien, M.D. chair of the DSM-5 Work Group on Addictive DisordersDSM-5 Work Group on Addictive Disorders

► Compulsive Gambling News

DSM V Severity Criteria

►“Gambling Disorder” Severity Rated►9 vs 10 Criteria (Illegal activities may be dropped)

►2-3 Criteria will be indicative of a Mild Disorder►4-5 Criteria will be indicative of a Moderate Disorder►6 or More will be indicative of a Severe Disorder

► (The threshold for diagnosis (DSM-5) is two or more criteria in contrast to one or more criteria for DSM-4)

Remaining Questions

• Effect on reimbursement• Effect on SAMHSA recognition• Effect on research funding

And remember:We are treating people with gambling problems, not We are treating people with gambling problems, not

problem gamblersproblem gamblers

What do we know about Adult and Adolescent Problem Gambling?

Actually, quite a lot, there is data from sources such as:

• National Research Council – 1999• McGill University – 1998/Present• National Council on Compulsive Gambling• Gambling Prevalence in Maryland: A Baseline

Analysis – 2010• Johns Hopkins Longitudinal Study

Who Are Adult Problem Gamblers based on National Research Council Survey 1999

• About 1-3% of the Adult Population of the U.S. has a Gambling Problem

• Estimated to be over 4-6 million adults in the United States(combination of pathological/problem gamblers)

• Estimated to be over 128,670 adults in Maryland (based on 2011 census projections)

Who Are Adult Problem Gamblers based on Maryland Baseline Survey 2010

• Survey indicated 3.4 % of the Adult Population in Maryland are problem/pathological gamblers

• (1.5% pathological/1.9% are problem gamblers)

• Estimated to be over 154,400 adults in Maryland(based on Maryland Baseline projections)

• Range: 128,670 – 154,400 Adult Marylanders

++WWHATHAT D DOESOES

RREPRESENTEPRESENT??

Capacity 71,008 Capacity 71,008 x 2x 2 = 142,016 = 142,016Represents Represents less than the 154,400less than the 154,400 Adult Gamblers in MD Adult Gamblers in MD

Youth Prevalence Findings

• 4-8 % Level III, Probable Pathological gambler (NRC, 1999)

• 1.1 million youth 12-17 exhibit pathological gambling behavior (NGISC, 1999)

• 10-15% at-risk for Problem Gambling (Shaffer & Hall, 1996; Winters, Stinchfielf, & Fulkerson, 1991; Wiebe, 1999; Wynne, Smith, & Jacobs, 1996)

• Youth Gambling 4 to 6 % (problem/pathological)

• Maryland Youth Estimated: 47,000-50,000 (problem/pathological based on 2011 census projections)

Capacity 45,971 to 48,187Capacity 45,971 to 48,187If you filled Camden Yards what would that represent? If you filled Camden Yards what would that represent?

Funded by DHMH/ADAA

Johns Hopkins surveyStudy began in 1993 in 27 1st Grade Classrooms in

Baltimore City public schoolsData Sources utilized:Teacher ratingsParent ratingsSelf-reports: 90 minute self-administered computer

interviewGambling data collected via age appropriate scales SOGS-RA in 2004, 2006-07 and SOGS 2008-2011

Prevalence of Baltimore Inner-City Youth

• Found that 11-15% of adolescents/adults have some form of problem gambling from the groups studied since 2004

• (when gambling questions were added to the study.)

What do we know about Emerging Adult Problem Gambling?

• National Research Council – 1999• Delaware College Gambling Study – 2011• Gambling on Campus: New Directions Series• NCRG: College Gambling blueprint

College Problem Gamblers based onNational Data

• About 4-8% of College students of the U.S. have a About 4-8% of College students of the U.S. have a Gambling Problem Gambling Problem (problem/pathological)(problem/pathological)

• Most authors use 6-8% as the average percentageMost authors use 6-8% as the average percentage. . (e.g. NCRG; Oregon)(e.g. NCRG; Oregon)

• 18-23% of students gamble on a weekly basis18-23% of students gamble on a weekly basis• 75-85% of students gambled in the past year75-85% of students gambled in the past year• 22% of colleges have written gambling policies22% of colleges have written gambling policies

Based on Md Higher Education Enrollment Projections: June, 2012

Maryland College Level Problem Gambling •Using 6%: there are at least 18,867 College level Using 6%: there are at least 18,867 College level problem gamblers on Md campusesproblem gamblers on Md campuses•Using 8%: there are at least 25,156 college level Using 8%: there are at least 25,156 college level problem gamblers on Md campusesproblem gamblers on Md campuses•Range: 18,867 – 25,156 Range: 18,867 – 25,156

(Based on Maryland Higher Education Actual Enrollment Projections of: 314,451 students)

Comcast Center: capacity 17,950

Adapted from Understanding Substance Abuse Prevention: Toward 21st Century Primer on Effective Programs (P. Brounstein & J. Zweig, 1999). Center for Substance Abuse Prevention (CSAP) & Substance Abuse and Mental Health Services Administration (SAMHSA). Dickson, Derevensky, & Gupta (2002).

GamblingProblems

GamblingSpecific

Assessment

Screen

Positive

Screen

Positive

Integrated Model: No Wrong Door

PG EnhancedTreatment

PG EnhancedTreatment

MentalHealthCenter

SubstanceAbuseTreatmentCenter

2222

Gambling IntegratedAssessment

(including PGScreen)

GamblingSpecific

Treatment

Pos or NegPos or Neg Pos or Neg Pos or Neg

Gambling IntegratedAssessment

(including PGScreen)

Funded by DHMH/ADAA

Lifetime Co-morbidityKessler et al., 2008 (National Comorbidity Survey Replication)

• Although nearly half (49%) of those with lifetime pathological gambling received treatment for mental health or substance abuse problems, none reported treatment for gambling problems.

Psychiatric Comorbidity in Pathological Gamblers: Summary of Research of PG’s in Treatment

Attention DeficitDisorder

Pathological Gambling

AffectDisorders

Anxiety Disorders Trauma

Personality Disorders

Substance UseDisorders~20-35%

~10-35%

~50-80%

~25-63%

~20-93%

~5-30%

Pathological Gambling: Comparison to Substance Abuse

SimilaritiesLoss of ControlPreoccupationNegative impact on major life areasTolerance

Pathological Gambling: Comparison to Substance Abuse

SimilaritiesWithdrawal SymptomsSelf-help groupsBiopsychosocial/spiritual disordersFamily involvement

Pathological Gambling: Comparison to Substance Abuse

DifferencesUnpredictable outcomeFantasies of successNo biological testEasier to hide

Pathological Gambling: Comparison to Substance Abuse

DifferencesGreater financial problemsIntensity of family angerLess public awareness and acceptance

Screening

• What questions about gambling can you incorporate into each part of your interview?– Biological/Medical– Substance Use/Abuse– Psychological– Social– Leisure Activities– Spiritual

Family Screening

• Does Family Have Significant Financial Problems

• Are Financial Problems Related to Gambling (Either causing them or seen as solution)

• Have You Been Concerned About Extent of Gambling of Family Member?

Instruments

• South Oaks Gambling Screen (SOGS)• PERC-(NODS)instrument• Gambling Severity Index• GA-20 Questions• “Lie-Bet” 2 Question Brief Screen• SOGS-R A- Adolescent Screen• Mass. Adolescent Gambling Screen

Resources for Problem Gamblers

The Maryland Center of Excellence on Problem Gambling is a resource center.

Our Helpline operates 24/7 for referrals for problem gamblers and their families at: 1-800-522-4700

Visit the webpage at: www.MdProblemGambling.com

Funded by DHMH/ADAA

Thank you

Carl Robertson croberts@psych.umaryland.edu

410-328-4710