1. Massachusetts Council on Compulsive Gambling We understand the problem. We can help. Problem Gambling: New Challenges and Opportunities Victor Ortiz, MSW, LADC I, CADC II

2. 2 U.S. Gambling History and Expansion

3. U.S. Gambling History and Expansion o According to noted gambling law expert I. Nelson Rose, gambling has gone through three waves of expansion in the US. o The first wave of gambling, before the US was founded, was when lotteries were used to finance the settlement of the first colonies. o The second happened during the 1800s when gambling was often tolerated (though not always legal) as we began to “go west.” o And the third wave began when Nevada legalized casinos (again) during the Great Depression in 1931.

4. U.S. Gambling History and Expansion o During the 1930s, 40s, and 50s, several forms of gambling were legalized in various regions of the country. These included horse tracks, charity bingo and other social games. o Then, in 1963, New Hampshire legalized a state lottery. Over the ensuing decade and a half, 11 more states (for a total of 12) legalized lotteries; however, Nevada remained the only state with legalized casino-style gambling until New Jersey began to allow it in Atlantic City in 1976 (with the first casino opening in 1978).

5. U.S. Gambling History and Expansion o 1988- The Indian Gaming Regulatory Act (IGRA) was passed o 48 out of 50 states have legalized gambling (Utah, Hawaii) o According to various reports, over $100 billion dollars per year in total revenue

6. The 4 th Wave o The gambling environment is evolving o Technologies initiatives and creations are growing o Fantasy sports and social games (gaming vs gambling) o Gambling is perceived as an ever more important source of public revenues o Marginalized communities and health disparities o

8. The Field of Gambling Disorders o It was not until 1972 that Dr. Robert Cluster, a physician working at the Veterans' Administration hospital in Brecksville, Ohio, first proposed a clinical entity, which he termed compulsive gambling. o In 1980, the American Psychiatric Association incorporated "pathological gambling" into its diagnostic and statistical manual (American Psychiatric Association, 1980) and thus legitimated this entity within the mainstream mental health field.

9. Gambling in the U.S. o Approximately 85% of U.S. adults have gambled at least once in their lives; 60% in the past year. o 2 million (1%) of U.S. adults are estimated to meet criteria for pathological gambling in a given year. o Another 4-6 million (2-3%) would be considered problem gamblers. Source: National Council on Problem Gambling, Retrieved from http://www.ncpgambling.org/i4a/pages/index.cfm?pageid=3314#widespread

10. Gambling Disorders and Substance Abuse

11. National Epidemiologic Survey on Alcohol and Related Conditions The 2008 NESARC study reported that: o 73.2 percent of pathological gamblers had an alcohol use disorder (73.2%), o 38.1 percent had a drug use disorder, o 60.4 percent had nicotine dependence,

12. Gambling and Opioid The prevalence of opioid abuse worldwide is 0.4%, while the standardized problem gambling prevalence rate varies from 0.5% to 7.6%. Among misusers, however, the prevalence of GD is considerably higher varying from 8% to 21% and even higher (17% to 27%) among patients in methadone maintenance treatment (MMT).

15. 15 Evidence supporting a broader conceptualization of addiction is emerging. For example, neurobiological research suggests that addictive disorders might not be independent: each outwardly unique addiction disorder might be a distinctive expression of the same underlying addiction syndrome. Howard J. Shaffer, PhD, CAS,, 2004

17. Gambling Disorders and Mental Health

18. National Epidemiologic Survey on Alcohol and Related Conditions The 2008 NESARC study reported that: o 49.6 percent had a mood disorder, o 41.3 percent had an anxiety disorder, o 60.8 percent had a personality disorder.

19. DSM-5 and Health Care Reform H ome DSM. (/)

20. Tuesday, November 22, 2011 – Governor Deval Patrick today signed H. 3807, "An Act Establishing Expanded Gaming in the Commonwealth," legislation

21. Massachusetts Expanded Gaming Legislation Questions o How is the expansion of gambling going to impact public health? o What is going to be the resources in order to serve and prevent problem gambling? o How is expansion gambling going to impact health dipartites and marginalized communities?

22. Massachusetts Expanded Gaming Legislation PG Highlights in the legislation o Public health trust fund o Onsite “treatment” center o Statewide Exclusion list—self and 3 rd party o Helpline number(s) posted (multilingual) o Research agenda o Guidelines on credit extension/ check cashing o Responsible Gambling guidelines on marketing o Payback statistics posted o Gaming divisions of the AG and State Police

23. Gambling Treatment/Services in Massachusetts Opportunities o Develop a continuum of care that is informed by evidence o Workforce development o Best practice guidelines o Restructure data collection o Policy that promote interagency relationships for service and care o Research o Standardized assessment and screening tools

24. 24 Massachusetts Council on Compulsive Gambling Victor Ortiz, MSW, LADC I, CADC II Sr. Director of Programs and Services victor@masscompulsivegambling.org Twitter- @Victor_Ortiz21 617-426-4554

25. Work Cited o Petry, NM, et al. (2005) Comorbidity of DSM-IV pathological gambling and other psychiatric disorders: Results from the national epidemiologic survey on alcohol and related conditions. Journal of clinical Psychiatry. 66:564-574 o Grant, J.E. J.D. Potenza, M. MD, Weinstein, A. PhD., Gorelick, D. MD, PhD. (2010) The American Journal of Drug and Alcohol Use, Early Online 1-9. DOI: 10.3109/00952990.2010.491884 o Petry, NM, et al. (2013). An Overview of and Rationale for Changes Proposed for Pathological Gambling in DSM-5. J Gambl Studies. o Howard J. Shaffer, PhD, CAS, Debi A. LaPlante, PhD, Richard A. LaBrie, EdD, Rachel C. Kidman, BA, Anthony N. Donato, MPP, and Michael V. Stanton, BA; Toward a Syndrome Model of Addiction: Multiple Expressions, Common Etiology, Harv Rev Psychiatry 2004;12:367–374. 2004 o Shaffer HJ, Martin R. Disordered gambling: etiology, trajectory, and clinical considerations. Annual Rev Clinical Psychol. 2011; 7: 483-510. Korn D., Shaffer HJ. (1999) Gambling and the Health of the Public: Adopting a Public Health Perspective. Journal of Gambling Studies Vol. 15, No. 4,