1. Trimeridian Problem Gambling: Definitions and Problem Gambling Joanna Franklin MS NCGC II Maryland Council on Problem Gambling Jfranklin.ipg@gmail.com

2. Trimeridian Types of Gamblers ► Continuum No Gambling Social Gam. Serious Social Gam. Problem Gam. Pathological Professional Gambler Antisocial Gambler ?? Bungler ?? 012 3 “Disordered Gambling”

3. Trimeridian Types of Gamblers ► 1. Social Gambler- Gambles occasionally, for fun, sticks to limits ► Serious Social Gambler-Gambles regularly, hobby, avocation, still does not spend more time or money than can afford, sticks to limits ► Professional Gambler- Gambles as a way of earning a living, very, very rare. ► 2. Problem Gambler- Beginning to have problems due to gambling. Has 3 or 4 on the SOGS, has 3 or 4 of DSM IV criteria.

4. Trimeridian Types of Gamblers ► 3. Pathological Gambler- Major life problems due to gambling. 5 or more on SOGS, 5 or more of DSM IV criteria) ► Anti-social Gambler – gambles as part of antisocial life style. However, can be both ASPD and pathological gambler. ► Client must meet clinical criteria.

5. Trimeridian DEFINING PROBLEM AND PATHOLOGICAL GAMBLING ► 1980 – American Psychiatric Assoc. – DSM III  Disorder of Impulse Control Not Elsewhere Classified  312.31 ► 1994 – DSM-IV  “The essential feature of Pathological Gambling is persistent and recurrent maladaptive gambling behavior that disrupts personal, family or vocational pursuits

6. Trimeridian Pathological Gambling: DSM-IV Criteria ► Preoccupation  Is preoccupied with gambling (e.g., reliving past gambling experiences, handicapping or planning the next venture, or thinking of ways to get money with which to gamble ► Tolerance  Needs to gamble with increasing amounts of money in order to achieve the desired excitement ► Withdrawal  Is restless or irritable when attempting to cut down or stop gambling

7. Trimeridian Pathological Gambling: DSM-IV Criteria ► Escape  Gambles as a way of escaping from problems or relieving dysphoric mood (feelings of helplessness, guilt, anxiety or depression ► Chasing  After losing money gambling, often returns another day in order to get even ► Lying  Lies to family members, therapists, or others to conceal the extent of involvement with gambling

8. Trimeridian Pathological Gambling: DSM-IV Criteria  Loss of control ► Has made repeated unsuccessful efforts to control, cut back, or stop gambling  Illegal acts ► Has committed illegal acts (forgery, fraud, theft, or embezzlement) to finance gambling  Risked significant relationship ► Has jeopardized or lost a significant relationship, job, education or career opportunity because of gambling  Bailout ► Has relied on others to provide money to relieve a desperate financial situation caused by gambling

9. Trimeridian Subtypes of Pathological Gamblers ► Action  Early Onset  Narcissistic  MDE - Current  Games of Skill  Competition/Power  Winning Phase  More likely to be male ► Escape  Later Onset  Dysthymia  Machine Games (Slots/VP)  Relief/Dissociation  No Winning Phase  Gender Bias?

10. Trimeridian Progression of Problem Gambling Winning/Social Winning/Social Losing Losing Desperation Desperation Hopelessness Hopelessness

11. Progression of Problem Gambling Trimeridian Critical Rebuilding Growth

12. Trimeridian Winning/Social Phase ► Gambling for Pleasure  Action and Escape Gamblers Differ  Escape – may not have “winning phase”  Gambling is a social activity  Action gamblers may be good at the game or strategy of gambling  Action gamblers enjoy the competition  Escape gamblers enjoy relaxation, relief

13. Trimeridian Winning/Social Phase ► There may be a “Big Win” ► Recognition for early successes boosts self-esteem ► Increasing involvement in gambling  Size of bets  Time  Preoccupation  Enjoy “reputation”  Increasing self-esteem or stress relief dependent on gambling

14. Trimeridian Winning/Social Phase ► Increasing involvement with fantasies or use of gambling for escape  Need for spectacular, fast success  Playing the big shot, impressing others  Need for relief, avoidance, self-soothing  Gambling to exclusion of other social and recreational activities  Money viewed as solution to problems

15. Trimeridian Losing Phase ► May begin with a prolonged losing streak, bad beat or big loss ► Chasing begins and progresses from short to long term ► Social aspect decreases  Gambling becomes increasingly solitary  Covering up, lying

16. Trimeridian Losing Phase ► Borrowing begins (Spiral of Options)  Credit cards, friends  Legal Loans, family  Progressively more outrageous stories  Illegal sources ► Losing becomes increasingly intolerable  Depression following losses  Irritability, anger, blaming others

17. Trimeridian Losing Phase ► Bailouts can take place at any time  Lead to upsurge of omnipotence, greater loss of control  Personal or institutional

18. Trimeridian Desperation Phase ► Begins with “crossing the line”  May involve illegal activities  Differs for each gambler  When this occurs depends on social, reality factors, exhaustion of other options  Happens repeatedly

19. Trimeridian Desperation Phase ► Theft initially viewed as short term loan  May keep records  Intent to repay with winnings  Becomes easier each time  Stops keeping track

20. Trimeridian Desperation Phase ► Paradox of Desperation  Leads to false sense of optimism  More loses – closer to next big win  Sense of conviction, knows how bet will turn out

21. Trimeridian Desperation Phase ► Depression and withdrawal progress  Sleeping, eating poorly  Unconcerned about others  Often suicidal ► Common fantasy of starting over

22. Trimeridian Hopelessness Phase ► Begins with awareness will never get even  Stops chasing, but doesn’t stop gambling  Doesn’t care if wins or loses  Playing is all that matter ► Playing to “get it over with”  Often knows will lose  Can’t seem to get rid of money fast enough  Play sloppily  Relief when money gone

23. Trimeridian Hopelessness Phase ► Playing just to “stay in action” for arousal or energy ► Like lab rats with electrodes in pleasure center, gambling to point of physical and emotional exhaustion ► Gambles because doesn’t know what else to do