Responsible Gambling/Problem Gambling/Voluntary Exclusion Welcome to the Maryland Lottery and Gaming Control Agency's webinar for Bingo Facilities. This webinar will review the topics of problem gambling, responsible gambling and the Maryland Lottery's Voluntary exclusion Program.

PG Pre-Test We will begin this session by having you take a brief pre-test to assess your current knowledge of the issue of problem gambling. You will not be able to move on in the webinar until you have completed this pre-test. Once you complete the pre-test please click on the finish button so you can move forward.

Definition of Gambling To stake or risk money or anything of value on the outcome of something involving chance (i.e. contest; event; game) Any matter or thing involving risk. Let us now review the definition of gambling When gambling the individual is risking something of value upon the outcome of a contest/game of chance or a future contingent event, not under their control or influence, with an understanding that he/she or someone else will receive something of value in the event of a certain outcome. Risk is a predominant component in the definition of gambling

Definition of Problem & Pathological Gambling Pathological (Disordered) gambling is: progressive disorder characterized by a continuous or periodic loss of control over gambling; a preoccupation with gambling or obtaining money with which to gamble; irrational thinking; a continuation of the behavior despite adverse consequences an individual who meets 5 or more of the 9 diagnostic criteria for pathological gambling. Problem gambling is: an individual who meets 1-4 of the diagnostic criteria for pathological gambling • Each Bingo Hall should have VEP/Responsible Gambling brochures on display • The brochures are provided by the MLGCA office - if they require more they contact me (Responsible Gambling Program Coordinator) Now that I have reviewed the definition of gambling lets move on and define pathological gambling (also now know as disordered gambling) and problem gambling Pathological gambling is a progressive disorder. It is characterized by continuous or periodic lack of control over one's gambling activity. The individual becomes obsessed with gambling and getting the money he/she needs to gamble. They are so enthralled in the gambling activity they lose rational thinking and will continue play even though the consequences of their actions may be devastating. These individuals meet 5 or more of the 9 diagnostic criteria for pathological gambling. Problem gambling is often identified if an individual meets 1-4 of the diagnostic criteria of pathological gambling The diagnostic criteria will be reviewed in more detail in one of the next slides.

Gambling Behavior Statistics Problem Gambling is an Addiction About 80% of adults have gambled in the last year Close to 90% of adults have gambled during their lifetime 2-3 million (1%) of U.S. adults are estimated to meet criteria for pathological gambling in a given year. 4-6 million (2-3%) have less serious but still significant problems (problem gamblers). As many as 15 million are at risk, with at least two of the symptoms described by the American Psychiatric Association. Most individuals who choose to gamble can do so safely and responsibly. However there is a percentage of individuals either at risk for problem gambling, already developed a problem , or already diagnosed as a pathological gambler.   In the US currently: Read from slide

Indicators of Pathological Gambling (DSM 5) PREOCCUPATION TOLERANCE WITHDRAWAL ESCAPE CHASING LYING LOSS OF CONTROL RISKED SIGNIFICANT RELATIONSHIPS BAILOUT In a previous slide we discussed how pathological and problem gambling are defined by the criteria for this addiction which can be found in the Diagnostic and Statistical Manual of Mental Disorders , 5th edition ( often referred to as the DSM 5). Lets take a more in depth look at this criteria: As an employee of a gambling establishment you may notice or have heard of some of the following behaviors being engaged in by your patrons. PREOCCUPATION Preoccupation with gambling. TOLERANCE Needs to gamble with increasing amounts of money in order to achieve the desired excitement. WITHDRAWAL Restless or irritable when attempting to cut down or stop gambling. ESCAPE Gambling as a way of escaping from problems CHASING After losing money gambling, often returns another day to get even. LYING Lies to family members or others to conceal the extent of involvement with gambling. LOSS OF CONTROL Makes repeated unsuccessful efforts to control, cut back or stop gambling. RISKED SIGNIFICANT RELATIONSHIPS Jeopardizes or loses a significant relationship, job, educational or career opportunity due to gambling. BAILOUT Relies on others to provide money to relieve a desperate financial situation caused by gambling.

Phases of Pathological/Problem Gambling Winning Phase: the “big win” encourages more frequent gambling. Losing Phase: the cycle of winning/losing/breaking even begins. Desperation Phase: can no longer pay debts and looks for bailouts. Hopeless Phase: serious problems begin to occur which “seem” irreversible. Next I will briefly discuss 4 phases that have been identified in research relating to pathological/problem gambling: They are as follows: The winning phase: We all know that great feeling when we win at almost anything. All of us at some time have dreamed of the “Big Win”. For the problem/pathological gambler this “Big Win” can be beginning of a downward spiral which he/she is unable to control.. The Losing Phase: In this phase the problem gambling feels lucky from their previous big win and may even continue to have some other wins. But they also begin losing and continue play so to at least break even. This is where the chasing of losses begins to occur.   In the desperation phase the "chasing" of losses becomes even more intense. The individual continues to lose but can't stop playing their own, even though they try to cut back or stop. The individual can't pay their debts and takes money legally or illegally from friends relatives, and possible even their employer; with the intention many times of paying people back when they hit that big win again. In the final stage of Hopelessness, serious problems begin to arise which the gambler perceives as irreversible. These serious problems will be discussed next.

The impact of problem and pathological gambling Individual Impact – depression, substance abuse, decline in productivity, financial devastation, suicide Family Impact – relationship damage, child abuse and neglect, domestic violence, financial ruin Financial Impact – devastation that extends to family, credit history, education, and career Legal Impact – first-time offenses, not exclusive to age, ethnicity or economic status Societal Impact – lifetime costs to society is in the billions and are related to productivity reductions, social service needs and creditor losses. As we just reviewed, when individuals arrive at the desperation and hopeless phase, their lives and the lives of those around them, family, friends, and the community as a whole, are becoming seriously impacted. I will start with the impact on the individuals themselves. Depression, use of substances, decline in productivity, financial devastation often leave the individual with feeling as though there is no way out. They are not aware that there may be help for this addiction and often don't even realize gambling as an addiction, but rather as only their own personal failure and weakness. This could lead the individual to contemplate suicide as their only way out, Gambling is the addiction with the highest rate of suicide. Family impact: As the gambler spirals out of control with his/her gambling activity, the impact on his/her family is often devastating. Often, in the family unit, abuse or neglect of children may occur, instances of domestic violence may arise. Much of this stems from the gambler's inability to end the destructive gambling behavior. Their obsession to win at this point alienates their loved ones and can create a volatile environment for all. Financial Impact: The gambler has often depleted the family funds, ruined their credit history and most likely even jeopardized their ability to maintain their employment, which will lead to further financial devastation. Legal Impact: Desperately seeking money to continue the gambling activity may also lead to engaging in some type of criminal activity. Societal Impact: On society as a whole, the costs of problem and pathological gambling are likely to be seen in the costs to productivity in both the individual's personal and professional life, the increase in social service needs for the gambler and/or their family, and the creditor losses as the individual can no longer pay their bills.

Populations at risk Women: Escape gamblers Rates have doubled those of men Quicker progression Higher suicide attempt rates More socially isolated Greater occurrence of alcohol/drug addiction and mental health disorders Older Adults: Fastest growing group Most frequently identified social activity Higher incidence of cognitive impairment Less willing to seek help Risk includes isolation, loneliness, boredom, physical or mental illness There are certain populations in our society that appear to be at greater risk than the general population. I will review these in the next couple of slides: The first is Women. Women tend to be escape gamblers. Most escape gamblers have been nurturing, caring responsible individuals for most of their lives. Escape from life's problems during the act of gambling is the predominant "WIN" experienced by many escape gamblers. They tend to gamble for different emotional reasons; could be a recent loss; escape from day to day demands placed on them; and they often find themselves free of emotional/physical pain during the gambling activity. They do tend to start gambling later in life but their risk for becoming a problem gambler has a quicker progression. In women problem gamblers there also seems to be an increased risk for alcohol/drug addiction and mental health disorders. Older adults are the fastest growing population at risk for problem gambling. Gambling is often seen and usually promoted significantly as a social activity... With age also comes a higher incidence of cognitive impairment which leads to poor decision-making. Also older adults are less prone to seek out help if the gambling activity begins to become a problem. They do not want others to know what they have done. With older adults there is also an increased risk for loneliness, isolation, boredom, and physical and mental health issues. The gambling activity initially fills that void .

Populations at risk Youth: College Students: 2% are at-risk 1.5% are problem/pathological gamblers 2.2% experience serious problems Engage in more risk-taking behavior Gambling has been normalized in their generation College Students: 23% gamble weekly 6-8% are problem/pathological gamblers More common in males Higher incidence of virtual gambling Higher incidence of Texas Hold’em Youth are another segment of the population at higher risk for developing a gambling problem, especially males. To begin with youth tend to engage in more risk-taking behavior. Gambling is a risky behavior especially for the younger population. We know through research they are more impulsive and tend to engage in behaviors without focusing on the longer term costs for that behavior. The younger one starts gambling the more apt they are to develop a gambling problem later in life. Also important to know that for youth today, gambling has become much more normalized and accepted. Educating youth on the issue of problem gambling and responsible gambling could help them should they choose to engage in gambling activity as an adult.   Finally college students, Males once again are at higher risk than females. In surveys conducted it has been found that at least 23% of this age group engages in gambling behavior weekly and 6-8% of this population are categorized already as problem and/or pathological gamblers. Online gambling, whether legal or illegal, is an activity engaged in at a higher incidence by youth.

Identifying Patrons Who May Be at Risk for PG: What can you do? Individuals who sits at the Video lottery terminal without a break for extensive periods of time. An individual whose judgment may be compromised by excessive use of alcohol. An individual who appears to be overly emotional while engaging in gambling activity. An individual whose cash runs out, but repeatedly visits the ATM to get more money to play. An individual who after losing continuously expresses that if they continue to play they “know” their luck will change and everything will be better. Here is some information that may be helpful to you in identifying patrons who may be at risk or already experiencing a problem due to their gambling activity: If you see an individual who appears to have lost track of time and appears too immersed in and/or frustrated with the gambling activity you might suggest they take a short break and return the activity at a later time. Often this individual does not even realize how caught up they are in the gambling activity. If you notice a patron who clearly appears to be under the influence of alcohol or drugs, approach the individual with your concerns about their ability to engage in gambling activity responsibly at this time. Someone who appears to be angry and becoming more aggressive as play continues may be a sign of someone already in the desperation phase, someone who has already had gambling become a problem for them. This individual may need to be removed from play, hopefully accomplished through approaching the individual in a sincere and caring manner regarding your concerns. Someone who is repeatedly running to the ATM to withdraw more cash may be another indication of a gambling problem. Although you cannot necessarily curtail that behavior, as an employee you could point out to the individual that you have noticed this behavior and just want them to be cognizant that this is happening, The problem gambler is so caught up in the activity they may not even realize this behavior has been occurring. Educatingpatrons by providing them with information on how recreational gambling can easily turn into an addiction for some individuals. Brochures provided by the Maryland Lottery and Gaming Control Agency on Responsible Gambling may be helpful to some of your patrons as a means to identify resources available to them, resources they may not even know exist. These brochures should be predominantly displayed within the Bingo facility.

Remember You Can HELP As an employee at your gambling facility communicate to patrons that gambling should remain a fun and safe activity. Whether through conversation and/or signage remind patrons to keep their gambling activity safe and problem free. Remind patrons that your facility also offers the opportunity to socialize and access refreshments, thus providing an opportunity for them to take a break from the gambling activity. If you begin to suspect there may be someone whose gambling is getting out of control be sure they are aware of the resources you have on display in your facility that can help them with their gambling problem. Remember you are a significant resource for your patrons.

Resources Problem Gambling treatment (Individual/Family) Help is available for problem gamblers. Access: Problem Gambling treatment (Individual/Family) Gamblers Anonymous(GA) and Gam-Anon. Maryland Alliance for Responsible Gambling mdgamblinghelp.org Maryland Problem Gambling Helpline 800.522.4700 Maryland Center of Excellence on Problem Gambling mdcepgreview.com How can your patrons access help for a gambling problem. Here are a few resources in Maryland you can make them aware of: The Maryland Problem Gambling Helpline Number: This number is on all printed materials on Responsible Gambling provided to the Bingo facilities. The number can also be found on all the ATM's within your facility. This resource, which is staffed by individuals with experience in the field of problem gambling, can provide options to the individual to help them cope with their gambling problem. Available options include support groups for you and/or family members, as well as opportunities for individual or family treatment. The Helpline is a program administered by the Maryland Center for Excellence and the Maryland Council on Problem Gambling. You can visit the Center for Excellence's website at mdcepreview.com Here in Maryland we see responsible gambling as very important to the welfare of all our residents. In that vain the Maryland Alliance for Responsible Gambling has been created. This group brings together the Gambling industry with treatment providers and other community organizations who wish to see gambling remain a safe activity, problem-free.

mdgamblinghelp.org This Alliance which i just spoke about has also created a website for how to get help for problem gambling. Some individuals may not be ready to speak with someone to get the help they may need. This website is an alternative means for accessing the information on the resources an individual may need.

Maryland’s Voluntary Exclusion Program The voluntary Exclusion Program for the casinos began in January 2011. The voluntary Exclusion Program for the traditional lottery began in 2013. As of January 2, 2015, the casino voluntary exclusion program has 689 VEP participants. As of January 2, 2015, 85 individuals have chosen to voluntarily exclude from the Maryland Lottery Next I would like to briefly provide you with information on the Maryland Lottery and gaming Control Agency's Voluntary Exclusion Program. There is both a Casino and a traditional Lottery voluntary exclusion program.

Enrollment An individual may sign up for the Voluntary Exclusion Program at any Maryland Casino or at Maryland Lottery and Gaming Control Agency in Baltimore. The application for voluntary exclusion for both is the same. Individuals may select the length of exclusion: at least two years or lifetime. At 2 years it is not an automatic removal from the VEP List. It is an active removal process which must be initiated by the individual who chose to voluntarily exclude. Applicants for the program need to be interviewed alone, unless an Interpreter is necessary. This is important to ensure the individual has voluntarily chosen to take this step as a means for handling their gambling problem. If at any time during the application process an individual changes their mind, has a question that can’t be answered at that time, the process will be terminated until the individual is sure this is a process they want to partake in. However, once the application is completed and signed and they have left, the signed application is in effect and cannot be changed. The MLGCA confirms through an official letter to the individual that their voluntary self- exclusion has been processed and in effect for the time period they chose.

Confidentiality Information provided to the MLGCA by a participant in the Voluntary Exclusion Program cannot be given to family or friends. For example, if a family member calls and asks if their son has enrolled in the program like he promised, they cannot be told this information, no matter what the circumstances are. Confidentiality is a very important component of this application process.

PG Post-Test It is now time for the post-test to see if you feel more knowledgeable about problem gambling, responsible gambling, and the Maryland Lottery's Voluntary Exclusion Program after taking this webinar. Please be sure to hit finish to continue with the webinar

Contact Information: Mary Drexler, MSW Responsible Gambling Program Coordinator, MLGCA mary.drexler@maryland.gov 410-230-8798 Thank you participating in this webinar. I hope this information will help you to even better serve your patrons.