Instructor: Julie Hynes, MA, CPS Slides from in-class portion, 1/24/13

1. GAMBLING
SAPP 408 | University of Oregon
Winter 2013 | Julie Hynes

2. Outline: Our Time in Class
 History & trends
 Defining the issue
 Gambling & the brain
 Vulnerable populations: spotlight on youth
 Addiction & mental health connections
 Addressing the issue
 Wrapping up & assignments

3. Some of Your Wishes for this
Class (per pre-class survey)
 “I want to know how online gambling is illegal but
yet it is so available.”
 “My interest is learning how to deal with
overcoming a gambling addiction.”
 “I am interested in knowing more about how this
problem begins/when do people know they are
actually addicted.”

4. Learning Preferences
(pre-class survey)
“If I had to choose how we spent most of our time in class
on 1/24, my preference in order would be: (Order: "1" is
MOST preferred, "5" is LEAST preferred)”

5. Getting to Know Each
Other

6. $
 Opportunity

8. Gambling
To risk money or
something of value on
the outcome of an
unpredictable event.

10. Anything Can Be a Bet…
Image sources: ninersnation.com, docsports.com, bovada.lv
Oddsshark.com, wagerminds.com

11. Legal Gambling
?
in Oregon
Nine tribal casinos opened
1994 - 2004
Video poker began
1992
Lottery approved
1931 1984 1989
Sports Action Lottery

12. Image sources: Oregon Lottery, Hynes

13. Image sources: Oregon Lottery, Hynes

14. Oregon Lottery Revenues

15. Electronic Gambling: Big
Hook
Oregon Gambling Treatment
Gamblers' Preferences
Electronic
Gambling
87% Cards
6%
Other
5%
Photo source: Daniel Berman. Source: Oregon Health Authority
(2012; ibid)

16. Photo: Hynes

17. Photo: Hynes

18. Online Gambling
http://abcnews.go.com/GMA/video/fbi-
cracks-internet-gambling-13389539

19. The “Big 3” Screenshots,
1/20/13

20. Online Gambling: Big Changes
http://youtu.be/j0shB567K4M
Source: ABC News

22. [game we played in class]

24. All walks of life, all over
But I'm telling you that if your picture of a
compulsive gambler is a guy
that's got a 5-day beard at 12 o'clock on a
Sunday night at the racetrack, that ain't it. In
going to Gamblers Anonymous for 10 years,
there are doctors, there are lawyers, there are
nurses, there are housewives, there are
school teachers. This disease can affect
anyone.
Source: http://www.businessweek.com/ap/2012-10-02/ohio-gambling-survey-gives-pre-casino-picture

25. Definitions
PATHOLOGICAL:
Persistent and recurrent
maladaptive gambling
behavior...results in the
“PATHOLOGICAL GAMBLING” LOSS OF CONTROL over
gambling. (DSM-IV)
also called
“compulsive gambling” or
“gambling addiction”

26. Gambling: A Continuum
No Recreational At-Risk Problem Pathological
Gambling Experimentation
Between 2-3% adults 18+ problem gamblers
Teens (13-17 y.o.): 6% at risk or problem gamblers 2
College age (18-24): 5.6% 3
Sources: 1. Moore (2006). 2. Volberg, Hedberg, & Moore (2008). 3. Shaffer & Hall (2001). 4. Northwest Survey & Data
Services (2007). 5. Moore (2001).

27. “Social/Recreational” or
Problem Gambler?
Recreational
Problem Gambler
Gambler
Occasional Frequent, preoccupied
Sticks w/ limits Plays w/needed $, borrows
Hopes to win, expects to
Hopes & expects to WIN
lose
Can take it or leave it Primary source of “fun”

28. DSM-IV:
“Impulse Control
Disorder”

29. Signs: Pathological
Gambling (DSM-IV)
1. Preoccupation with 6. “Chases” losses
gambling 7. Lies to others to conceal
2. Increases amount of gambling
money gambled 8. Has committed illegal
3. Unsuccessfully tries to acts
quit 9. Has jeopardized
4. Restless or irritable when relationships
trying to cut down/stop 10. Relies on others to bail
5. Gambles as an escape him/her out
*”Pathological” gambling = At least five of above, and not accounted for by a Manic Episode.
Pathological Gambling is defined in DSM-IV as an “Impulse Control Disorder”
Source: American Psychological Association (1994).

30. DSM-V:
DSM-V will define
pathological gambling as a
“behavioral addiction,”
the first of its kind.

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

32.  Debt - $30,000
 Crime – 25%
Source: Oregon Health Authority, 2012, Register-Guard, 5/13/11

33. OF PROBLEM GAMBLERS IN OREGON TREATMENT:
>70% 48%
are current
experience
tobacco users
suicidal ideation
32% 10%
actually attempt
have current suicide
alcohol
Have current
problems drug problems
Source: Oregon Health Authority, 2012

34. Phases of Problem Gambling
Winning
Losing
Hitting “Bottom”
 Desperation
 Crime
 Divorce
Desperation
 Depression/Suicide
 Getting help?
Source: Custer, R. (1980). “Custer Three Phase Model.”

35. Causes? (Risk Factors)
 Trauma -- stemming  Community norms/laws
from abuse or neglect  Early initiation
 Mental health issues  Friends favorable
 Substance use toward gambling
 Parental attitudes &
behavior
 Competitive family

36. Group Exercises &
Discussions

37. At what age is the
brain considered
fully developed?
18 21
25 16

38. 25
Prefrontal
Cortex

40. Addiction is a “Developmental
Disease”- National institute on Drug Abuse
Prefrontal
Cortex

41. Neurobiology
 Still not well understood
 Multiple neurotransmitter
systems believed involved:
 Seratonin
 Norepinephrine (aka
noradrenalin)
 Opioid
 Dopamine
 Important to consider in
treatment
Source: Grant, 2006. Neurobiology and Pharmacological Treatment of Pathological Gambling.

42. Potential Neurotransmitter
Roles in PG
Neurotransmitter Role in Impulse
Control
Serotonin  Serotonin -- risk taking
Behavior Initiation/Cessation
Norepinephrine -  NE levels
PGsArousal, Excitement
Opioids Gambling -  β-endorphin
Pleasure, Urges
Dopamine PGs -  dopamine response
Reward, Reinforcement
Dopamine: most studied neurotransmitter in problem gambling

43. Gambling & The “Doped” Brain
Decisions that will likely cause us to
lose money vs. win money
Source: Brain Briefings (2007, October), Society for Neuroscience, Washington, DC

45. Superstition

46. Source: Bud Light “Visitor” (superstitious)
https://www.youtube.com/watch?v=CZx5HO_duec
Go Niners!

47. Interpretive bias

48. Source: Bud Light “Labels Out”
https://www.youtube.com/watch?v=GPOQ8pzY0kY

49. Selective
memory

50. Gambler‟s
fallacy

51. How would you describe what
you see below?
[several slides followed during
the lecture regarding pattern
seeking behavior]

52. What Comes Next?
…those are other ways our
minds trick us. We are wired to
see patterns in things.

53. • Gambler’s fallacy
• Failure to see EACH roll of dice or EACH spin of wheel as
independent chance-related events
• “That slot machine is DUE to hit.”
• Illusion of control
• Relating winnings to skill, even in luck-based games
• “I’m smarter than that player.”
• Superstition
• Selective memory
Source: Tonneato, T. (1999). Cognitive psychopathology of problem gambling. Subst Use Misuse. Sep;34(11):1593-604.

55. In Perspective

56. Mental Health/Addictions
Connections
 Depression/mood disorders
 Narcissistic personality disorder
 PTSD
 Impulsivity
 ADHD
 Substance abuse
 Alcohol abuse
Sources Ledgerwood & Petry (2006). Kausch et al. (2006). Biddle et al. (2005). Oregon Health Authority (2010). The
WAGER (2002, February 12); Specker, et al., (1995); Kim & Grant (2001)

57. UO Survey 2010
A majority of students (62%) thought
problems with gambling could be
changed through „will power.‟
At the same time, an even larger
majority (87%) agreed that gambling is
an addiction similar to a drug
or alcohol addiction.
Complete survey summary available at: http://preventionlane.org/gambling/collegesurvey.htm

58. Is it an “Addiction”
1. Solidly established, problematic pattern of a
pleasurable & reinforcing behavior
2. Physiological/psychological components of
behavior pattern that create dependence
3. Interaction of these components in an
individual which makes person resistant to
change
Definition of addiction from Diclemente (2003) Addiction And Change:
How Addictions Develop And Addicted People Recover.

59. The “Addiction” Connection
Similarities? Differences?
 
Group activity
(we skipped this in class; see next slide)

60. The “Addiction” Connection
Similarities? Differences?
 Loss of control  Defining “use” (gambling)
 Denial  Behavior not attributable to
 Depression/mood swings chemical ingestion
 Progressive
 No biological test
 Tolerance
 Use as an escape  More intense sense of shame
 Preoccupation and guilt (anecdotal)
 Similar “highs”  Unpredictable outcome
 Self-help groups  Fantasies of success /quitting is
 Family involvement giving up hope
 Use of rituals  Easier to hide

61. Vulnerable Populations
• Older adults • Substance abuse
• College students history
• Ethnic minorities • Mental health
• Incarcerated persons history
• Military & veterans • Youth
• Women

63. Effects of Problem Gambling on
Children
• Prone to abuse and/or neglect
• Child endangerment may increase
• Higher levels of tobacco,
alcohol, drug use, and overeating than
peers
• Higher risk of pathological gambling
• Suffer effects from lack of financial
stability

64. “The earlier people begin
gambling, the more likely
they are to experience
problems from gambling.”
- National Academy of Sciences

65. Not Your Uncle‟s
Gambling
Research
on:
Youth gambling still under-studied & under the radar

70. •Amygdala active
• Fight or flight,
“The adolescent brain is
emotion especially sensitive to the
• Decision-making effects of dopamine.
altered
•More vulnerable to risk-
taking & impulsive
behaviors
Source: Ramoski, S., Nystrom, R. (2007).

71. Gambling & Oregon Teens
• Six in 10 Oregon (63 percent) have
gambled
• 46 percent gambled in the past year
• 3 percent gamble weekly or more
• Six percent problem gamblers or at risk
• Preferred games in order:
– Free Internet gambling-type games
– Cards (poker)
– Sports bets
– Games of personal skill
Source: Volberg, et al (2008; bid).

72. Lane County 2012
Student Wellness Survey (SWS)
2012 Gambling, Substance Use and Mental Health
among Oregon Youth
50%
40% 6th 8th
Percentage
30% 11th
20%
10%
0%
Gambling Alcohol Binge Marijuana Cigarettes Depression Psych
Alcohol distress
Source: http://oregon.pridesurveys.com/esds.php?year=2011
n=55,611 students (18,885 6th grade; 21,368 8th grade; 15,358 11th grade)

73. Used alcohol in the past month
100%
90%
80%
70%
60%
Percentage
50% Did not gamble
40%
Gambled
30%
20%
10%
0%
Grade 6 Grade 8 Grade 11
Available at: www.preventionlane.org/sws.htm

74. Binge drank in the last 30 days
50%
45%
40%
35%
30%
Percentage
25% Did not gamble
20%
Gambled
15%
10%
5%
0%
Grade 6 Grade 8 Grade 11
Available at: www.preventionlane.org/sws.htm

75. Smoked cigarettes in the past
month
50%
45%
40%
35%
30%
Percentage
25% Did not gamble
20%
Gambled
15%
10%
5%
0%
Grade 6 Grade 8 Grade 11
Available at: www.preventionlane.org/sws.htm

76. Used marijuana in the past month
50%
45%
40%
35%
30%
Percentage
25% Did not gamble
20%
Gambled
15%
10%
5%
0%
Grade 6 Grade 8 Grade 11
Available at: www.preventionlane.org/sws.htm

77. Skipped school one or more days
in the past month
50%
45%
40%
35%
Percentage
30%
25% Did not gamble
20% Gambled
15%
10%
5%
0%
Grade 6 Grade 8 Grade 11
Available at: www.preventionlane.org/sws.htm

80. Conclusion?
Teens who gamble are
smoked up, toked up,
drunk emo delinquents.

81. Conclusion?
Teens who gamble are
smoked up, toked up,
drunk emo delinquents.

82. Conclusion: Problem Gambling is
ONE COMPONENT of
Problem Behaviors
sexual
behavior
delinquency
Problem
Behaviors depression
gambling
substance
use

83. …yet it‟s not always communicated
at home or school.
2012 Oregon Student Wellness Survey, Lane County (“Esd”) and Oregon;
available at http://oregon.pridesurveys.com/esds.php?year=2011

85. Identification & Treatment

86. Online: click here
Source: Written by Robert L. Custer, M.D; retrieved from Council on Compulsive Gambling of New Jersey, Inc..

87. Intervention
 Helpline
541.741.7107:
emergence
Or 24/7:
1.877.MY.LIMIT
 Referred to provider
for assessment
 Family members come
in; later bring gambler
in

88. A Simple Screen: Lie-Bet Tool
(Johnson et al., 1988)
1.Have you ever felt the need to bet more
and more money?
2.Have you ever had to lie to people
important to you about how much you
gambled?
 Valid and reliable for ruling out pathological gambling behavior
 Response to ONE or both indicates referral for longer assessment
 useful in screening to determine whether a longer tool (e.g., SOGS, DSM-IV)
should be used in diagnostics

89. Assessment Tools
 “Valid and Reliable”
 DSM-IV 10
 South Oaks Gambling Screen (SOGS)
 SOGS-RA (Revised for Adolescents)
 Frequently Used
 Gamblers Anonymous 20 Questions (GA-
20)

90. DSM-IV Criteria Revisited
1. Preoccupation with 6. “Chases” losses
gambling
7. Lies to others to
2. Increases amount of conceal gambling
money gambled
8. Has committed illegal
3. Unsuccessfully tries
to quit acts
4. Restless or irritable 9. Has jeopardized
when trying to cut relationships
down/stop 10. Relies on others to
5. Gambles as an escape bail him/her out
Pathological Gambling =
Five or more of above, AND: The gambling behavior is not
better accounted for by a Manic Episode.

91. Treatment is Free.
24 hrs: 1877-my-limit
Online: 1877mylimit.org

92. Treatment Options in Oregon
• Minimal intervention: GEAR (Gambling
Education and Reduction)
• Outpatient treatment (44)
• Crisis respite (2)
• Residential treatment (1)

93. Emergence Gambling
Treatment Program
• Treatment free for gamblers and loved ones
– 275 problem gamblers and family members
treated last year
– Gender-specific
• Multimodal treatment
– Individual sessions - Family therapy
– Group sessions - Recreational
counseling
– Didactic lectures - Audiovisual educ.
• Suggest to explore 12-step program

94. Other Facts on
Gambling Treatment in Oregon
• Only about 2% of Oregonians who need
treatment enroll
• Those enrolling who lived within a 50 mile
radius of a casino were significantly more likely
to report casino as their primary venue
• 30% enter treatment through the statewide
helpline

95. Treatment is Effective
and Inexpensive
• $3,224: Cost
per successful
completer
• 86%: Report
no, or far
reduced, gambling
Source: Moore, T. 2011 Gambling Programs Evaluation Update.

96. Disrupting the Action Cycle
 Barriers to Money
 Treatment
 Support Systems
 Accountability
 H.A.L.T.S.
Slide credit: Janese Olalde, MEd, CGAC, CADC

97. FAMILY TREATMENT ISSUES
• Allow venting of rage and betrayal
• Education of compulsive gambling as an illness
• Family Groups
• Renew sense of hope
• Empowerment
• Seek support – treatment
• GAM-ANON
• DON‟T KEEP SECRETS!
Slide credit: Janese Olalde, MEd, CGAC, CADC

98. Family Financial Issues
• Create own avenue to financial stability
(employment or other)
• Protect financial assets
• Close joint accounts
• Use automatic/electronic
deposits for gambler‟s income
• NO BAILOUTS!
Slide credit: Janese Olalde, MEd, CGAC, CADC

99. Couple Issues in Therapy
Sequencing with individual work
Assess possibility of domestic violence
Impact on partner and children
Role of money in the relationship
Deal with hurt, anger, mistrust
Dealing with “unfolding truths”
Slide credit: Janese Olalde, MEd, CGAC, CADC

100. Comparison of “Action” and
“Escape” Pathological Gamblers
Action Escape
Excitement, competition Relief, escape from stress
“Skilled” forms of gambling “Luck” forms of gambling
(sports/poker, etc) (lottery, slots, bingo)
Early onset of gambling Later onset of gambling
More likely to present More likely to present
narcissistic or antisocial traits depressive/dysthymic traits
Source: Center for Substance Abuse Treatment, 2005.

101. Promotion & Prevention

102. Creating conditions in families, schools, and
communities that promote the
wellbeing of people
–Emotional and behavioral health
–Physical health

103. Targeting Parental Attitudes
Parental attitudes
Oregon parent/youth focus
groups revealed:
– All parents in the groups said their kids
didn‟t gamble
– All kids in the groups said they did gamble
– Neither sees gambling as risky

104. Targeting Parental Attitudes
Most parents believe:
• Youth gambling is harmless
• Youth who gamble are unlikely to have
problems in school
• Youth gambling is not associated with
alcohol or drug use
…and those beliefs are part of the
problem

105. Risk Factors
• Single-parent household • Started gambling before
• Gambling on 8th grade (early
cards/sports initiation)
• Being male, older teen • Parents who gamble--
• Lower household income youth twice as likely to
be at-risk gamblers &
• Competitive
four times as likely to
• Having lost more than be problem gamblers
$50 in a single month
Source: Volberg, et al (2008; bid).

106. Prevention:
Statewide & Local Efforts
 Partnership with Department of
Education
 Curriculum integration in schools
 Youth video
 Oregon youth prevalence study
 Community Resource Guide*
 Middle School Poster Contest
 Partnering with addictions
prevention providers/groups
 Policy & coalition work
Resource guide can be downloaded at:

107. • Crashed cars
• “Scared straight”
• Boot camp
• One-time activities

108. [follow-up link: best practices
http://preventionlane.org/best-practices.h

110. Focus
Our efforts have
a focus on:
• Public awareness
• Policy

111. Problem Gambling
Advisory Committee
• Meets monthly in
Eugene
• Works on policy &
awareness issues
• Comprised of
professionals &
community
members

112. Various Methods

113. Results
• Prevention and awareness efforts in
Oregon have been able to avert an
increase in the prevalence while facing a
dramatic increase in the availability of
gambling opportunities.
• Local efforts have provided prevention
and awareness information to an
estimated 1.3 million Oregonians.

114. Key Challenges in Prevention
• Youthful subject
• Perception of
harmlessness
• Stigma/shame
• Industry

115. Under $100 $1,000-$2,500
$100-$1,000 More than $2,500

116. Problem gambling
treatment is ‘free’ in
Oregon for gamblers
AND loved ones.

117. Summarizing this evening
• Defining gambling & problem gambling
• Trends
• Addictions connections
• The brain
• Addressing problem gambling

118. Some of Your Wishes for this
Class (per pre-class survey)
 “I want to know how online gambling is illegal but
yet it is so available.”
 “My interest is learning how to deal with
overcoming a gambling addiction.”
 “I am interested in knowing more about how this
problem begins/when do people know they are
actually addicted.”

119. Assignments:
Blackboard

120. Contact info:
Julie Hynes, MA, CPS
Course questions:
hynes@uoregon.edu
Other contact info:
Lane County Public Health Prevention
Program
541.682.3928 | julie.hynes@co.lane.or.us
preventionlane.org
problemgamblingprevention.org

121. Additional References
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text
revision). Washington, DC: Author.
Cross, Del Carmen Lorenzo, & Fuentes (1999). The extent and nature of gambling among college student
athletes. Ann Arbor, MI: University of Michigan Department of Athletics.
Department of Defense (2002). Survey of health related behaviors among military personnel Washington, DC:
Author. Report information available http://www.tricare.mil/main/news/dodsurvey.htm
DiClemente, C. (2003). Addiction and change: How addictions develop and addicted people recover. New York:
Guilford Press.
ECONorthwest (2009). The contributions of Indian gaming to Oregon’s economy.
http://www.econw.com/reports/2009_ECONorthwest_Contributions-Indian-Gaming-Oregon-Economy-
2007.pdf
Engwall, Hunter & Steinberg (2004). Gambling and other risk behaviors on university campuses. Journal of
American College Health. 52 (6); 245-255.
Freimuth, M. (2008). Addicted? Recognizing Destructive Behavior Before It's Too Late
. Maryland: Rowman & Littlefield Publishers.
Kerber (2005). Problem and pathological gambling among college athletes. Annual of Clinical Psychiatry. 17 (4);
243-7.
LaBrie, R., Shaffer, H., LaPlante, D., and Wechslet, H. (2003). Correlates of college student gambling in United
States. Journal of American College Health. 52 (2); 53-62.
Marotta, J. & Hynes, J. (2003, August). Problem Gambling Prevention Resource Guide for Prevention
Professionals. Salem, OR. Oregon Department of Human Services.
http://preventionlane.org/gambling/Docs/Problem-Gambling-Prevention-Guide-Marotta-Jeffrey-Hynes-
Julie.pdf
Moore , T.L. (2002.) The etiology of pathological gambling. Salem, OR: Department of Human Services.
http://www.oregoncpg.com

122. Additional References
Moore, TL. (2006). Oregon gambling prevalence replication study. Salem, OR: Department of Human Services.
http://www.oregoncpg.com
Moore (2001). Older adult gambling in Oregon. Salem, OR: Department of Human Services.
http://www.oregoncpg.com
Northwest Survey & Data Services (2010). Lane County Health & Human Services college gambling survey.
http://www.preventionlane.org/gambling/college.htm
Oregon Health Authority, Problem Gambling Services (2011). Oregon problem gambling awareness community
resource guide. Salem, OR: Author.
Oregon Lottery (2009). Oregon State Lottery Behavior and Attitude Tracking Study. November 2008. InfoTek
Research Group, Inc.
Oregon Lottery (2008). Overview through fiscal year 2009. Salem, OR: Author.
Ramoski, S., Nystrom, R. (2007). The changing adolescent brain. Northwest Public Health.
http://www.nwpublichealth.org/archives/s2007/adolescent-brain
Rockey, D.L., Beason, K.R., & Gilbert, J.D. (2002). Gambling by college athletes: An association between
problem gambling and athletes. http://www.camh.net/egambling/archive/pdf/EJGI-issue7/EJGI-issue7-
research-rockey.pdf
Shaffer, H.J., Donato, Labrie, Kidman, & LaPlante. (2005). The epidemiology of college alcohol and gambling
policies. Harm Reduction Journal. 2 (1).
Shaffer, H.J. & Hall, M.N. (2001). Updating and refining meta-analytic prevalence estimates of disordered
gambling behavior in the United States and Canada. Canadian Journal of Public Health, 92(3), 168-172.
Volberg, R.A., Hedberg, E.C., & Moore, T.L. (2008). Adolescent Gambling in Oregon. Northhampton, MA: Gemini
Research. http://gamblingaddiction.org