Contact: Dr. Wiley D. Harwell, D.Min., LPC, NCGC-II Executive Director 320 W. Main, Suite B Norman, OK (FAX)

GAMBLING DISORDER AND CO-OCCURRING DISORDERS

Every time you risk money, service, or an object of value on a game with the hope of wining more, you are gambling!

Examples of Gambling  Bingo  Card & Domino Games when played for $$$$  Games of skill (e.g. pool, darts, shuffleboard, golf) for consideration  Sports betting  Lottery tickets  Games found in a casino (slots, cards, dice)  Horse racing / Dog racing  Lottery video terminals (VLT)  On-line poker, gin-rummy, etc.  Scratch tickets  Cock fighting / Dog Fighting  Stock / Commodity Market

Problem & Compulsive Gambling Prevalence Rates are Higher For:  adolescents,  casino employees,  college students,  people of lower socioeconomic status,  males, but women are catching up  Ethnic minority groups  prison populations,  seniors  those with mental health and substance abuse problems.

Historical perspective of Gambling 1. The American Revolution was funded primarily on a lottery system. 2. Lottery funds in America built the early churches and Harvard, Princeton, Dartmouth and Yale University, etc.. 3. The North & the South received much of the funding from Lotteries to support the Civil War (on both sides)

’s - Horse racing and pari-mutuel wagering began to grow in popularity countrywide 7. A crackdown on illegal gambling interests in the1940’s forced gambling to Nevada. 8. Bugsy Segal, noted mobster received a legal gaming license and opened the Las Vegas Flamingo, New Hampshire initiated the first successful state sponsored lottery in , New Jersey became the second state to legalize casino gambling

9. The Indian Gaming Act of 1988 now allows tribal casino gambling in what used to be limited to only Nevada and New Jersey 10. Gambling (in some form) is legal in all states but Utah and Hawaii.

With the population of Oklahoma at 3.5 Million people* * (Oklahoma Census Report)  1% to 3% of population is pathological in their gambling. Oklahoma =35,000 to 105,000 citizens. *  An additional 2% - 3% tend to have significant personal & financial problems. = 70, ,000 citizens * * National Council on Problem Gambling, Inc.

Increase in Teen Gambling!  According to information compiled by the National Council on Problem Gambling, 63% of 16-year-olds gamble. More gamble as the opportunity to gamble increases  Research has found between 40% and 60% of teenagers reported they have gambled for money. *  3% to 6% of teenagers are said to be addicted to video and on-line gaming. The numbers of teenagers addicted to all forms of gambling is growing. Little to NO control* Joanna Franklin, Trimeridian, 2004

Pathological Gambling is defined as:  “the persistent and recurrent maladaptive gambling behavior that disrupts personal, family, or vocational pursuits. The individual may be preoccupied with gambling (e.g., reliving past gambling experiences, planning the next gambling venture, or thinking of ways to get money with which to gamble).” *  “Most individuals experiencing pathological gambling say that they are seeking an aroused, euphoric state that the gambling gives them, appearing more exhilarating than the money wagered. Increasingly larger bets, or greater risks, may be needed to continue to produce the desired level of excitement.” * *DSM-IV-R

Criteria for Gambling Disorder DSM-V Persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress, as indicated by the individual exhibiting 4 or more of the following in a 12-month period: Preoccupation Planning next venture, handicapping, getting $ Tolerance Gambles with more money to get effect/excitement Withdrawal Restlessness/irritability when stopping Escape Relieving stress and/or depressed mood Chasing losses After losing money, returns to “get even” Lying Conceals extent of involvement to others Loss of Control Unsuccessful efforts to control behavior Risked Sig. Relationship Jeopardized/lost important relationship, job, educational, or career opportunity Bailout Reliance on others to provide money Gambling behavior is not better accounted for by a manic episode

DSM-V Criteria for Gambling Disorder – Scoring – Mild: 4-5 of the 9 criteria met. – Moderate: 6 or 7 of the 9 criteria met. – Severe: 8 or 9 of the 9 criteria met.

Problem gamblers seem to come in three general types. a. Action gamblers: often male, competitive, play games of skill, seek the rush of gambling – like cocaine addicts b. Escape gamblers: often female, less competitive, passive, play luck games- seek escape- like narcotics. c. Antisocial gamblers: can be either an action or escape gambler that is oppositional in the motives for gambling. They are trying to win in order to beat the other players or the casino because they feel harmed by life and society. Playing for long periods of time is equivalent to winning.

Subtypes of Gamblers Social Gambler Serious Social Gambler Anti-Social Gambler Professional Gambler The Bungler Pathological Gambler

Co-occurring with Gambling 1.Co-occurring disorders, dual diagnosis and cross addictions are high among pathological gamblers presenting for care, i.e., Alcohol, drugs, sex, etc. 2.Affect disorders: depressions, anxiety and bipolar disorder are major concerns. 3.ADD, PTSD, and Substance Abuse Disorders seem unusually common to the problem gambling population. 4.Suicide attempt rates have been reported as high as % of those who present for care. National Council on Problem Gambling, Inc.

Financial Facts

The Financial Facts: Billion gaming revenue Billion gaming revenue Billion gaming revenue Billion Gaming revenue

The Financial Facts: 2009The State of Oklahoma received 118 Million from Tribal Compact agreements Million to the State Million to the State

The Financial Facts: 2009 Oklahoma Lottery had 198 Million in total revenue Million contributed to Oklahoma Education Lottery Trust Fund Million in total revenue Million to Education

Contribution for Problem Gambling Each Year: 750,000 contribution from the Lottery from unclaimed lottery winnings 250,000 is taken from the State’s compact agreement income All money goes to ODMHSAS for Problem Gambling treatment, education, awareness.

Resistance of the Gambler 1.Nothing in normal life can replace the high. 2.Gambler is not ready to see discrepancy in their story. Too much confrontation early on reinforces resistance. 3.Egotism/Narcissistic – no one can understand what I think. 4.For escape gamblers – painful emotions are motivating escape & gambler is not ready to face blocked trauma, pain. 5.Normal is boring. 6.Honesty is a challenge. 7.Gambling is the only time I – don’t hurt, don’t think, don’t feel depressed, don’t worry, etc. 8.Ciarrocchi reports MMPI cluster. Most common cluster for gamblers (Scales 4 &9). Characterized by rebellion, immaturity, and acting out.

Dissociative Reactions While Gambling: 1.Pure Escape: a) goes into trance-like state b) feels like a different person c) loss of time and space d) sometimes feels as if I am outside myself e) brown out – like a black out state – loss of memory

Dissociative Reactions While Gambling: 2.Self regulation deteriorates: a) inability to limit spending b) when real money translates to gambling money c) can’t set goals & achieve them d) boredom sabotages goals e) inability to delay gratification f) play is actually parallel play – no real interaction g) repeated failures = moral decline h) beliefs & expectations are unrealistic/grandiose i) self esteem bottoms out/overcompensation escalates j) physiological arousal continues to increase k) impulsivity plays increasing role in gamblers life

Most Common Co-Occurring Disorders 1.Alcoholism – 30% of gamblers were also alcoholics. 2.Depression – major, dysthymic. 3.Suicidal – National Gambling Impact Study 1999: ideation – 48-79% attempts % debt - $38,000 to $113,000

Most Common Co-Occurring Disorders 4.Bi-Polar disorders. 5.Other addictions – i.e., cocaine, meth. 6.Issues of abuse: emotional abuse – 69% physical abuse – 46% sexual abuse – 28%

Most Common Co-Occurring Disorders 7.Anxiety disorders Generalized, Panic Disorder, Phobias 8.PTSD 9.ADD & ADHD

Contact: Dr. Wiley D. Harwell, D.Min., LPC, NCGC-II Executive Director 320 W. Main, Suite B Norman, OK (FAX)