2. Recognizing Problem Gambling Developed by Peter Walsh, MA, CGACII, NCGCII Presented by Richard Johnson, MA, CGAC II, CADC III, NCGC II Gambling Outreach/Prevention

3. Goals for presentation  Understand gambling in Oregon  Intimate Partner Violence and gambling  Differences/similarities with substance abuse  Indicators and impact of problem gambling  Become familiar with resources to address problem gambling

4. Gambling in Oregon is Growing Spirit Mt. Casino has replaced Multnomah Falls as our #1 tourist attraction

5. Societal Acceptance = More Gamblers  Industry perpetuates a vision of gambling as entertaining, glamorous and as a means of achieving financial freedom.  Recent surge in reality TV gambling shows

6. Oregon Numbers  2002 Oregonians spent $1.18 billion on all forms of gambling, $447 per adult 25% more than the national average*  2003 Legislation made way for a 20% increase in Video Lottery Terminals  2004A ninth tribal casino opened in Oregon  2005The Lottery expanded into video slots  2006Lottery exceeds $1 billion in sales, video lottery sales up 24% over previous year Source: * Eco Northwest, 2005

7. More Casinos?

8. Oregon Gambling: Summarized Oregon Gambling: Summarized Oregon has more forms of legalized gambling and offers easier access to gambling than almost any other state Oregon has more forms of legalized gambling and offers easier access to gambling than almost any other state - AND - - AND - Oregon is a nationally recognized leader in prevention, harm reduction and treatment for gambling problems Source: National Ctr for the Study of Gambling, 2006

9. What is Problem Gambling?  All patterns of gambling behavior that compromise, disrupt, or damage personal, family, educational or vocational pursuits  Pathological gambling is the most severe pattern of excessive or destructive gambling

10. Pathological gambling  Synonymous with “compulsive”, “addicted”, “clinical”, “diagnosable” and “Level 3”  Classified in DSM-IV as an Impulse Control Disorder  Diagnostic criteria is similar to that of Substance Abuse/Dependence

11. How Many adult problem or pathological gamblers in Oregon? more than 74,000 Oregon adults (2.7% of adults) (Moore, 2006) about 6,000 are over 62 years old (1.2%) (Moore, 2001)

12. Costs of problem gambling  25 - 50 percent of spouses abused  10 to 17 percent of children neglected or abused  FY 06-07 of 1,986 receiving treatment in Oregon: average gambling debt was $26,099 (underestimated) combined debt from gambling over $37 million; 99 clients had debts of over $100,000 57% jeopardized or lost a significant relationship or job 21% committed illegal acts to obtain gambling money 28% had alcohol problems; 12% drug problems 21% reported suicidal thoughts and 7% reported having made an attempt

13. Problem Gambling and Intimate Partner Violence Study  248 Problem Gamblers (43 women, 205 men)  75.8% substance use in past 30 days  74.6% lifetime substance abuse or dependence  29.4% current substance abuse or dependence  63.4% of males and 69.8% of females had clinically significant problem anger as measured by State-Trait Anger Expression Inventory-II

14. Study Results…  55.6% perpetrated IPV  25.4% perpetrated severe IPV  74% perpetrated psychological aggression  59.7% victims of IPV

15. Study Results…  No significant relationship between IPV perpetration and/or victimization and:  Gambling severity or type of gambling  Substance use in past 30 days  Presence of substance use disorder either current or lifetime did not predict IPV

16. Study Conclusions  Significant relationship between problem anger and IPV  74% of angry gamblers reported IPV  45% of non-angry gamblers reported IPV  Lifetime substance use disorder and anger problem further increased likelihood of IPV perpetration and victimization

17. Pathological Gambling: Comparison to Substance Abuse –Similarities  Loss of Control  Preoccupation  Negative impact on major life areas  Tolerance  Immediate gratification  Agent used as avoidance tool (e.g., pain)

18. Pathological Gambling: Comparison to Substance Abuse –Similarities  Withdrawal Symptoms  Self-help groups  Biopsychosocial/spiritual disorders  Family involvement  Use of rituals

19. Pathological Gambling: Comparison to Substance Abuse –Differences  Gambling is not self-limiting  Behavior not attributable to intoxication / chemical ingestion  More intense sense of shame and guilt  Greater denial and stronger defenses

20. Pathological Gambling: Comparison to Substance Abuse –Differences  Unpredictable outcome  Fantasies of success /quitting is giving up hope  No biological test  Easier to hide

21. Indicators of problem gambling Increase in gambling time and places Increase in gambling time and places Increase in size of bets Increase in size of bets Increase in intensity of interest in gambling Increase in intensity of interest in gambling Working up special occasions for gambling Working up special occasions for gambling Boasting about wins; not talking about losses Boasting about wins; not talking about losses Exaggerated display of money and other possessions Exaggerated display of money and other possessions

22. More Indicators Gambling when there is a crisis Gambling when there is a crisis Drop off in other activities/interests Drop off in other activities/interests Frequent absences from school, work and home Frequent absences from school, work and home Diversion of funds earmarked for other purposes Diversion of funds earmarked for other purposes Hidden Funds Hidden Funds Personality changes (irritability/hostility) Personality changes (irritability/hostility) Withdrawal from family Withdrawal from family

23. The More Problem Gamblers, the More Gambling Related Crimes  Moore & Marotta ( 2006). –43% of women and 38% of men entering gambling treatment reported to have committed an illegal act related to their gambling.  National Gambling Impact Study Commission (1999). –A third of problem and pathological gamblers had been arrested, compared to 10% of low-risk gamblers and 4% of non-gamblers

24. Embezzler’s sentenced: 8 years West Linn- During sentencing for stealing $1.4 million, the city’s former finance chief talks of “terrible shame” West Linn- During sentencing for stealing $1.4 million, the city’s former finance chief talks of “terrible shame” The Oregonian, November 18, 2006

25. Samuel Hopkins, Pastor of First Congregational Church, Montpelier Vermont on April 19, 1835  “Let the gambler suffer this persecution. Lay upon him the biting lash of public odium. Let him be conscious that… he must bear the superadded curse of unrestrained abhorrence; that whatever else may be tolerated, there can be no tolerance and no c ourtesy for a vice so foul as his” (Hopkins 1835:15).  Stigma of PG remains today – a clinician needs to understand the social stigma that remains with this disorder. We are not far removed from Pastor Hopkins.

26. Co-occurring Disorders  Substance use disorders: About 30% of problem gamblers report a current substance use disorder at intake.  Mood disorders: About 50% of problem gamblers report significant depression symptoms at intake.  Suicide: About 10 percent of pathological gamblers report frequent suicidal ideation at intake.

27. Co-occurring Disorders (Continued)  Personality Disorders: Problem gamblers in the general population were over 6 times more likely to meet criteria for ASPD than non-gamblers.  Anxiety disorders: 12 - 28% of treatment seekers met criteria for an anxiety disorder.

28. Problem Gambling Screening Procedures  The Lie-Bet Questions: 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? If yes to one or both, further assessment is indicated

29. Screening techniques  Ask on intake about gambling –Also ask during collateral contacts  Assess financial issues –Is income in line with current economic status  Ask “How often…” and “How much…”  Ask about Leisure and recreational interests

30. Gambling Treatment in Oregon  Oregon has 27 outpatient gambling treatment programs  3 crisis-respite programs  1 residential treatment program  Free Treatment for gamblers and family members

31. Gambling Treatment in Multnomah County: 1- Cascadia Behavioral Health Care 2415 SE 43 rd. Avenue, Suite 200 2415 SE 43 rd. Avenue, Suite 200 Portland, Oregon 97206 Portland, Oregon 97206 (503) 239-5952 (503) 239-5952 2- InAct 727 NE 24 th Avenue 727 NE 24 th Avenue Portland, Oregon 97232 Portland, Oregon 97232 (503) 228-9229 (503) 228-9229

32. Gambling Treatment in Multnomah County : Gambling Treatment in Multnomah County : 3- Lifeworks NW 3- Lifeworks NW 4925 N Albina 4925 N Albina Portland, Oregon 97217 Portland, Oregon 97217 (503) 548-4922 (503) 548-4922 (African American Specific Services) (African American Specific Services) 4- NARA Northwest 1776 SW Madison St. 1776 SW Madison St. Portland, Oregon 97205 Portland, Oregon 97205 (503) 896-2946 (503) 896-2946 (503) 224-1044 #262 (503) 224-1044 #262

33. Gambling Treatment in Multnomah County : 4- OHSU Behavioral Health Clinic 621 SW Alder Street, #520 621 SW Alder Street, #520 Portland, Oregon 97205 Portland, Oregon 97205 (503) 494-4745 (503) 494-4745

34. Problem Gambling Help Line: Free and confidential; staffed by professional counselors Phone: 1 (877) MY LIMIT (1-877-695-4648) 1(877)-2-STOP-NOW (1-877-278-6766) 1(877)-2-STOP-NOW (1-877-278-6766) Online: 1877mylimit.org (chat, IM, email)

35. Conclusions  Problem gambling is a real and growing concern  Effects about 1 in 37 adults.  Significant relationship between IPV and problem gambling  Help is available for gamblers and family members  81% of clients reported either no gambling or reduced gambling at 6-months post-treatment  Treatment is free, confidential and effective