PROBLEM GAMBLING

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PROBLEM GAMBLING As a CO-OCCURRING DISORDER
2007 Co-Occurring Disorders Conference October
1-2, 2007
Linda Graves Problem Gambling Program
Manager Division of Alcohol and Substance Abuse
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DSM-IV criteriaPathological Gambling 312.31

• PERSISTENT AND RECURRENT MALADAPTIVE GAMBLING
  BEHAVIOR AS INDICATED BY AT LEAST FIVE OF THE
  FOLLOWING
• Is preoccupied with gambling
• 2. Needs to gamble increasing amounts of money
  in order to achieve the desired excitement
• 3. Has repeated unsuccessful efforts to control,
  cut back, or stop gambling

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DSM-IV criteriaPathological Gambling 312.31

• Is restless or irritable when attempting to cut
  down or stop gambling
• Gambles as a way of escaping from problems or of
  relieving a dysphoric mood
• After losing money gambling, often returns
  another day in order to get even
• 7. Lies to family members, therapist, or
  others to conceal the extent of involvement with
  gambling

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DSM-IV criteriaPathological Gambling 312.31

• Has committed illegal acts, such as forgery,
  fraud, theft, or embezzlement, in order to
  finance gambling
• Has jeopardized or lost a significant
  relationship, job, or educational or career
  opportunity because of gambling
• Relies on others to provide money to relieve a
  desperate financial situation caused by gambling
• B. THE GAMBLING BEHAVIOR IS NOT BETTER
  ACCOUNTED FOR BY A MANIC EPISODE.

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pathological gambling and substance use disorders

• Alberta, Canada (Bland, Newman, Korn and
  Stebelsky, 1993)
• General population study
• 20 of non-gamblers identified themselves as
• having a substance abuse disorder
• Over 50 of those identified as pathological
  gamblers by the survey also had a substance use
  disorder

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pathological gambling and substance use disorders
(2)

• Texas--Feigelman, Wallisch, and Lesieur (1998)
• Among all respondents that were problem or
  pathological gamblers, 1/3 also had a substance
  use problem
• Feigelman et al (1998) also explored the converse
  situation.
• Among respondents who had a substance use
  disorder, 20.1 also had a gambling problem

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pathological gambling and substance use disorders
(3)

• National study, Petry, Stinson, and Grant (in
  publication)
• Found a strong association between alcohol and
  gambling disorders.
• Rates of alcohol abuse or dependence at four or
  more times higher among individuals identified as
  having a gambling disorder compared to those
  without the gambling disorder

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pathological gambling and substance use disorders

• In most cases, substance use disorders were in
  the past, not current with gambling disorders.
• Connecticut, clients seeking treatment for
  gambling problems, about 10 reported current
  illicit drug use or regular heavy use of alcohol.

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pathological gambling and substance use disorders

• IMPORTANT NOTE
• Treatment seeking gamblers with a history of
  substance use disorders tend to have
• More severe gambling problems
• Psychiatric symptoms
• Other psychosocial difficulties
• Than gamblers without histories of substance use
  problems
• (Petry, 2004)

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pathological gambling and substance use disorders

• Ladd and Petry (2003)
• Compared the 31 of gamblers with substance abuse
  histories with the remainder without such
  histories.
• More years of gambling problems
• More frequent gambling activity
• More likely to be receiving tx for mental health
  problems
• Reported greater psychiatric distress than
  gamblers without prior substance abuse problems.

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pathological gambling and substance use disorders

• Langenbucher et al.(2001)
• In a mixed sample of substance abusers,
• Higher nicotine dependence scores
• More frequent use of alcohol
• More alcohol and other drug dependence symptoms
• In the pathological versus the non-pathological
  gamblers

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pathological gambling and nicotine use

• Smart and Ferris (1996)
• 41.6 of heavy gamblers were smokers
• 30.1 of recreational gamblers were smokers
• 21.3 of non-gamblers were smokers
• This study is 11 years old.

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pathological gambling and other psychiatric
disorders
Mood disorders and suicidality
Is the client depressed because of his or her
gambling? OR Is the client treating a mental
health problem by self-medicating with gambling?
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pathological gambling and other psychiatric
disorders

• Petry, Stinson, and Grant (in publication)
• 43,000 surveyed
• 195 pathological gamblers
• 49.6 had lifetime prevalence of any affective
  disorder
• Compared to 18.5 in non-gamblers

• 37 of pathological gamblers had major
  depression
• Compared to 12.3 of non-gamblers

• 22.8 of pathological gamblers had bipolar
  disorder
• Compared to 2.5 of non-gamblers

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pathological gambling and other psychiatric
disorders

• College students and suicide
• Ladouceur, Dube, and Bujold (1994)
• 1471 college students
• 26.8 of pathological gamblers had attempted
  suicide compared to 7.2 who were not
  pathological gamblers.
• Many studies report high rates of suicide
  ideation and suicide attempts in gamblers.

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pathological gambling and other psychiatric
disorders

• Anxiety disorders
• The research is not conclusive regarding anxiety
  disorders being elevated among pathological
  gamblers. Studies can be shown that indicate no
  higher rates than among the general population
  (Ibanez et al, 2001 Blaszczynski and McConaghy,
  1989) while others show high rates of generalized
  anxiety disorders (Black Moyer, 1998 Specker,
  1996, and others)

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pathological gambling and other psychiatric
disorders

• Studies have been done regarding OCD and PTSD.
  The numbers in the studies were very small, and
  have not been replicated, so further research is
  needed before any conclusions can be drawn.
• This is also true for other psychotic disorders.
  If studies exist at all, the sample sizes are too
  small to draw conclusions.

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So. . . What can we learn from all of this?
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CONCLUSION?
Research presents enough data to show both
clients with substance use disorders and mental
health disorders need to be screened
for gambling problems.
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But you might say. . .
I CANT DO ONE MORE ASSESSMENT. I HAVE TOO
MUCH TO DO ALREADY!
I DONT HAVE TIME.
I DONT want to know if they have another
problem.
I DONT KNOW HOW.
Just LEAVE ME ALONE!!
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TWO THINGS THATS ALL IT TAKES

• Lie/Bet Screen
• Have you ever felt the need to bet more and more
  money?
• Have you ever had to lie to people important to
  you about how much you gambled?

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Help your client make a call to get help if they
answer affirmatively to either of the two
questions.

• 1-800-547-6133
• 24/7
• Live voice response 24 hrs a day
• Will send literature
• Offer resources in callers area
• Will offer locations of GA meetings

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Problem Gambling Treatment Provider Locations
Bellingham (2)
Burlington (3)
Mt. Vernon (8)
Tulalip( 16)
Spokane (12)
See Map Inset Of Puget Sound Area
Skokomish (11)
Montesano (7)
Olympia (9)
Tumwater (17)
Yakima (19)
Vancouver (18)
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INSET MAP
Kirkland (5)
Bellevue (1)
Seattle (10)
Renton(9)
Tukwila (15)
Kent (4)
Lakebay (6)
Tacoma (14)
Sumner (13)
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Publicly Funded TreatmentJuly, 2007 Page 2
15. Tukwila Seattle Mental
Health 800-828-1449 youth and adults 16.
Tulalip/ Everett Tulalip Tribes Family
Services 360-651-4400 17. Tumwater A Healthy
Risk 360-352-1052 18. Vancouver Community
Services Northwest Northwest Recovery
Center 360-397-8488 ext. 7915 19.
Yakima Center for Counseling and Psychotherapy,
LLC 509-966-7246 Triumph Treatment
Services 509-248-1800
12. Spokane Camas Institute Behavioral
Health Services, 509-456-0799 Henry
Montgomery, Ph. D. 509-744-0778 youth and
adults New Horizon Counseling Services 509-838-6
092 ext. 32 13. Sumner The Center 253-863-068
2 ext. 2 youth and adults 14.
Tacoma Metropolitan Development Council (The
Center) 253-593-2740 youth and adults Tahoma
Counseling Services 253-572-5035 Dr. Carmela
Washington-Harvey youth and adults 253-852-3666

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Publicly Funded TreatmentJuly, 2007
5. Kirkland Youth Eastside Services 425-747-4
937 adolescents 12-20 years old 6. Lakebay
(Key Peninsula) .Key Counseling 253-884-4860 7.
Montesano A Healthy Risk 360-249-2297 8.
Mt. Vernon Phoenix Recovery Services 360-848-843
7 youth and adults 9. Renton Donna
Whitmire 425-227-0447 10. Seattle Asian
Counseling and Referral Services 206-695-7511
11. Skokomish/Shelton Skokomish HOPE Alcohol
Drug Program 360-426-7788 ext. 200 Spanish and
English youth and adults, All are Welcome!

• 1. Bellevue
• Coastal Treatment Services
• 425-646-4406
• youth and adults
• Consejo Counseling
• 425-746-4512
• Spanish and English
• Youth Eastside Services
• 425-747-4937
• adolescents 12-20 years old
• 2. Bellingham
• Verry-Uhl Associates
• [phone]
• .

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Thanks for your participation today.

Linda Graves Problem Gambling Program
Manager gravell_at_dshs.wa.gov 360-725-3813