1. Trauma & Gambling Addiction: An Overview

2. Workshop Objectives
Have an understanding of the Adverse Childhood Experiences study
Understand how the risk of poor health outcomes increases when people have experienced trauma
Understand why addiction is one of the negative health outcomes associated with trauma

3. The ACE Study
Dr. Felitti of Kaiser Permanente & Dr. Anda of Center for Disease Control
A study examining the correlation between adverse childhood experiences and outcomes later in life.
Initially recruited participants between Study published Ongoing date continues to be collected through CDC

5. Incarcerated Relative Mother Treated Violently
What are the ACEs?
Before the age of 18 did you experience…
Abuse Neglect Household Dysfunction
Physical
Physical
Mental Illness
Incarcerated Relative
Emotional
Emotional
Mother Treated Violently
Substance Abuse
Sexual
Divorce

6. Adverse Childhood Experience (ACE) Questionnaire
Finding your ACE Score While you were growing up, during your first 18 years of life:
1. Did a parent or other adult in the household often …
Swear at you, insult you, put you down, or humiliate you?
or Act in a way that made you afraid that you might be physically hurt?
2. Did a parent or other adult in the household often …
Push, grab, slap, or throw something at you?
or Ever hit you so hard that you had marks or were injured?
3. Did an adult or person at least 5 years older than you ever…
Touch or fondle you or have you touch their body in a sexual way?
or Try to or actually have oral, anal, or vaginal sex with you?
4. Did you often feel that …
No one in your family loved you or thought you were important or special?
or Your family didn’t look out for each other, feel close to each other, or support each other?
5. Did you often feel that …
You didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you?
or Your parents were too drunk or high to take care of you or take you to the doctor if you needed it?
6. Were your parents ever separated or divorced?
7. Was your mother or stepmother:
Often pushed, grabbed, slapped, or had something thrown at her?
or Sometimes or often kicked, bitten, hit with a fist, or hit with something hard?
or Ever repeatedly hit over at least a few minutes or threatened with a gun or knife?
8. Did you live with anyone who was a problem drinker or alcoholic or who used street drugs?
9. Was a household member depressed or mentally ill or did a household member attempt suicide?
10. Did a household member go to prison?
Now add up your “Yes” answers: _______ This is your ACE Score

7. As ACEs Increase so does Risk…

8. A Dose-Response Relationship
Response = Health, Social, Learning Issues, etc…
1 ACE
2 ACEs
3 ACEs
4 or more ACEs
Dose = Accumulation of ACEs

9. Defining Trauma:
The 3 “E”s
Event: Exposure to an event or series of events that threatens the well-being of an individual or group
Experience: Respond to the event with intense fear, helplessness and/or horror
Event: Shakes our basic beliefs about safety, predictability & trust

10. Trauma Video

11. Effects of Stress Short-Term Long-Term
Increased: blood flow to muscles, blood pressure, heart rate, blood sugar, muscle tension, and more
Changes in emotional regulation and reactivity
Trouble accessing our “thinking brain”
Lowered ability to empathize
High likelihood of negative perceptions of others behaviors, tone, words, and facial expressions
Changes reward center of brain
Inhibits development of prefrontal cortex
May increase size of amygdala
Changes development of immune system
Changes DNA transcription
Changes development of hormonal systems

12. Prefrontal Cortex is the brain’s center for executive control
Amygdala is the threat detection center
Hippocampus controls memory processing

13. Brain Chemistry Cortisol, “UH-OH” Stress hormone (steroid)
Aids in glucose metabolism
Serotonin, “Ahhh”
Derived from tryptophan
Regulates mood, sleep, appetite
Adrenaline, “Yikes!”
Stress hormone
CNS excitement
Fright/flight
Dopamine, “YAHOO”
Neurotransmitter
Drugs, sex, food
Antidote to cortisol
Role in addiction

14. Dopamine Release & The Near Miss

15. Addictive Behaviors as Coping Mechanisms
Stay safe
Escape memories 
Soothe pain
Be in control
Create a world you can tolerate
Treat yourself the way you feel you deserve
Redefine who you are

16. Creating A Foundation of Resilience

17. Core Values of Trauma Informed Care:
Safety: Ensuring physical and emotional safety
Cultural, and Gender Issues: Working to address cultural stereotypes and biases, offering gender responsive services, leveraging the healing value of traditional cultural connections
Trustworthiness & Transparency: Maximizing trustworthiness, making tasks clear, and maintaining appropriate boundaries
Empowerment, Voice & Choice: Prioritizing developmentally appropriate choice and control for the participant
Peer Support and mutual self-help: Understanding peer support as integral to building trust, safety, and empowerment