Pathological Gambling Among AsianAmericans: The Hidden Addiction

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Pathological Gambling Among Asian-Americans The
Hidden Addiction

• Timothy W. Fong MD
• UCLA Gambling Studies Program
• San Mateo County
• Behavioral Health Services
• Psychiatry Grand Rounds
• January 22, 2008

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Financial Disclosures

• Speaker Bureau Research Support
• Reckitt Benckiser NIDA
• Pfizer OPG (California)
• Cephalon Ortho-McNeil
• Forest Annenberg Foundation

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Overview

• Gambling in America
• APIs and Pathological Gambling
• Cultural Factors
• Prevalence Surveys
• Treatment
• Overcoming barriers

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Availability of Gambling, 1975
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Availability of Gambling, 1999
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The California Scene

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Background

• Exponential growth of legalized gambling
• 2.5 billion (1997) to 13 billion (2003)
• Horse race wagering (4 billion)
• Lottery (3 billion)
• Card rooms (1 billion)
• Tribal casinos (5 billion)
• 60 Californians gambled last year

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California Prevalence Study (2005)

• n7,121 respondents, 18 years and older
• Problem gambling 2.2
• Pathological gambling 1.5
• 1,000,000 problem/pathological cases
• Highest Risk African-Americans, Disabled,
  Unemployed

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The Range of Gambling Behavior

• Social Gambler (85 of the population)
• Problem Gambler (5-6)
• Pathological Gambler (1)
• (or Compulsive Gambling, Gambling Addict)

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Pathological Gambling DSM-IV Criteria

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Consequences ofPathological Gambling
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Asians and Gambling

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History of Gambling in China

• 3,000 B.C.
• Many games invented
• All segments of society
• Officials of government
• Gambling as a profession
• Gambling associated with secret society,
  corruption and drugs

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History of Gambling and Asia

• Different story in each country
• Forbidden, ambivalent, promoted
• Unique definitions of gambling
• Mahjong, lottery, stocks vs. casinos
• Common thread gambling always part of the
  social dialogue

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Cultural factors that promote gambling

• Acceptable way to make money
• Inquire about ones destiny
• Honoring the Gods
• Losses are sacrifice
• Equate gambling with self-worth and ability to
  move up classes

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Cultural factors that promote gambling

• Emphasis on numbers that have power over life
  events
• Heavy peer involvement
• Gambling is family entertainment
• Gambling as a rite of passage
• Superstitions

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Asian Gambling Expansion

• Vietnam Ho Chi Minh (2009)
• Singapore Two casinos (2009)
• Phillipines Manila Bay
• Hong Kong Horse-racing, lottery,
• Taiwan / Thailand / Japan Considering
• China Not on the mainland

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Asians in America
US Census 2000
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Asians in California

• 12 of Californians are AAPIs
• 4 million
• Highest rate of growth
• 1.2 million Los Angeles County
• State population 35 million
• (2000 Census)

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Asians in California

• Largest Asian Groups
• Filipino
• Chinese
• Vietnamese
• Korean
• Asian Indian
• Japanese
• Fastest growing
• Asian Indian, Vietnamese, Hmong

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Asian Communities

• Monterey Park (64)
• Cerritos (61)
• Rowland Heights (52)
• San Gabriel (51)
• San Marino (50)
• Alhambra (48)

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Background Data

• NICOS (SF)
• 70 identified gambling as number one social
  concern (1999)
• 15 problem gamblers
• 21 pathological gamblers

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Asians and Gambling(Los Angeles)

• 30-40 of casino clientele are AAPIs
• Casinos market toward AAPIs
• Significant percentage of casino revenue comes
  from local AAPI residents
• Social activity of choice

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Consequences of PG on APIs

• 20 of child neglect cases
• (Santa Clara)
• 30 of API DV cases (SF Chinatown)
• Numerous bankruptcy reports from Monterey Park
• Recent cases of family violence
• (April 2006)

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Case Examples Bong Joo Lee (April 2006)

• Fontana, California
• Unemployed
• 200,000 in gambling debt.
• Recent separation
• Family discord over gambling
• Past history of assaulting wife
• End Result Murder-Suicide

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Case Example David Lam (2007)

• Casino Employee
• Wife seen, not heard
• Gambling debt (50,000) bankruptcy
• Marital discord
• Lam heads to Singapore 9/18/2005
• Body found 9/23/2005
• Caught in 11/2007, w/family in Indonesia

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Impact of Gambling on Los Angeles Asian
Communities

• To understand the impact of problem gambling on
  AAPIs.
• To understand cultural influences which will
  inform prevention and treatment
• (Funded by UCLA in LA)

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Surveys
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Prevalence Survey

• 180 surveys collected over 3 days at Commerce
  Casino (March 2006)
• SOGS
• NODS
• UCLA Gambling Survey
• Convenience Sampling
• 5 Starbucks reimbursement

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Prevalence Survey

• Objectives
• What is the rate of PG among casino patrons?
• What is the rate of PG of AAPIs vs. Non-AAPIs?

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Results
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Results
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Results
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Conclusions

• High rates of PG inside a casino
• How many require treatment?
• No obvious ethnic differences BUT APIs will have
  more PGs
• Replication needed
• Secondary analysis underway (gender, time, health
  status)

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Treatment of AAPI Pathological Gamblers and Their
Families
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Treatment Approaches to Pathological Gambling

• Medications
• Psychotherapy
• Gamblers Anonymous
• Family Therapy
• Brief Interventions
• Prevention

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Existing Treatment for AAPIs

• Gamblers Anonymous
• (Korean, Chinese)
• NICOS (SF)
• AAPI mental health providers
• AAPI substance abuse providers
• Churches
• Families

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Barriers to Treatment

• Shame and Stigma
• Lack of culturally appropriate services
• Lack of outreach programs
• Language
• Access to insurance
• Transportation

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Barriers to Treatment

• Familial insulation
• Self-reliance
• Therapy not accepted in community
• Sense of fatalism (wont get better)
• Level of education
• Level of acculturation

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Survey results

• N 59 ( AADAP, WRAP, UPAC)
• Male 36
• Female 64
• Ethnicity
• 68 Asians
• 13 Caucasians
• 6 African Americans
• 6 Hispanic
• 7 Others

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Findings

• Training in treatment
• 0.5 clinical experience
• 0.3 certificate
• 0.2 both
• 78 no experience

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Findings

• Do you routinely screen for gambling problems?
• Yes 15
• No 85

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Treatment Needs

• Interventions for Asian Americans
• Adapting treatment to be culturally responsive
• Need more gambling specialists
• More research needed
• Stigma operates at all levels

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Clinical Pearls

• Work with the family, first
• Minimize shame through education
• Involve respected elders
• Address co-occurring disorders
• Medicalize treatments
• Develop 12-step alternatives

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Where do we go from here?

• Demonstration Projects
• Increase visibility (media)
• Document extent of problems
• Increase treatment and intervention capacity
• Decrease stigma
• Better understand impact on communities

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Contact Information Timothy Fong MD
310-825-4845tfong_at_mednet.ucla.eduwww.uclagambli
ngprogram.org