Gambling and Youth Gambling Issues

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Gambling and Youth Gambling Issues

• Presentation to Value Options EAP Professionals
• July 24, 2008
• Keith Whyte, Executive Director
• National Council on Problem Gambling

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About NCPG

• The national advocate for people affected by
  problem gambling.
• NEUTRAL on legalized gambling.
• Founded in 1972.
• National grassroots non-profit with chapters in
  36 of 50 states.
• Work with government, gaming industry community.

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Core Programs

• National Helpline Network (800.522.4700)
• Natl Problem Gambling Awareness Week
• Annual Conference on Problem Gambling Prevention,
  Treatment, Research Recovery (June 25-27, 2009,
  Indianapolis)
• Public Awareness Media
• Certification Administration
• ADVOCACY!

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Key Issues and Trends In

• Gambling TodayScope, Participation Revenue
• Problem GamblingDefinitions, Prevalence, Risk
  Factors, Co-Occurring Disorders Service
  Delivery
• Focus on Youth Gambling

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Section I Gambling

• Scope, Participation Revenue

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What Is Gambling?

• Gambling is risking something of value on an
  uncertain outcome.
• One of the oldest human behaviors, indeed, an apt
  description for most human activity.
• 3 Prong Test Prize, Chance, Consideration
• In the US, gambling is generally illegal unless a
  specific form has been specifically legalized by
  government.
• Legal in 48 stateswhat are the 2 without?
• Utah
• Hawaii

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Are We a Nation of Gamblers?

• Ever Gambled? 85
• Gambled in the Past Year? 65
• Gambled at least weekly? 15
• But 35 of Americans believe that gambling is
  morally wrong!
• 18th century moral mindset laws v. 21st century
  entertainment technology

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Adult (18) Risky Behaviors Smoking, Gambling
Drinking
Past year Lifetime
Tobacco Use 35 71
Alcohol Use 64 82
Gambling 65 85
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2006 Gaming NM US
NM US NM Rev US Rev
Casinos 21 839 238 million 47.8 billion
Racing 5 123 36.8 million 4.5 billion
Lottery 1 37 73.4 million 25.1 billion
Charitable ? ? 12 million 1.5 billion
TOTAL 28 999 360 million 79 billion
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Legal Gambling Revenue (billions)
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Trends Issues

• Convergence of types of gambling.
• Games become faster, more interactive, higher
  limits.
• When will gaming participation and revenues peak?
  Is there a saturation point?
• Will states and tribes continue to expand
  gambling?

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Section II Problem Gambling

• Definitions, Prevalence, Risk Factors,
  Co-Occurring Disorders Service Delivery

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Working Definitions

• Problem gambling Any gambling behavior that
  causes harm to the gambler or their family.
• Gambler does NOT meet current clinical criteria.
• Pathological gambling Severe and persistent
  problems with gambling behavior, a serious mental
  health disorder.
• Gambler meets clinical criteria.

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Screening Tools

• NODS (NORC Diagnostic Screen)
• CPGI (Canadian Problem Gambling Index)
• SOGS (South Oaks Gambling Screen)
• GA 20 (Gamblers Anonymous 20 Questions)
• Lie/Bet Screen

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10 Questions DSM IV

• You have often gambled longer than you had
  planned.
• You have often gambled until your last dollar was
  gone.
• Thoughts of gambling have caused you to lose
  sleep.
• You have used your income or savings to gamble
  while letting bills go unpaid.

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• You have made repeated, unsuccessful attempts to
  stop gambling.
• You have broken the law or considered breaking
  the law to finance your gambling.
• You have borrowed money to finance your gambling.
• You have felt depressed or suicidal because of
  your gambling losses.
• You have been remorseful after gambling.
• You have gambled to get money to meet your
  financial obligations.

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• If you or someone you know answers yes to any of
  these questions, consider seeking assistance from
  a professional regarding this gambling behavior.
• Call 800.522.4700 Confidential toll free,
  24/7-there is help and hope available.
• Questions developed by NCPG from DSM-IV criteria.
  Probable pathological gamblers score 5.
  Probable problem gamblers score 1-4.

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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?
• Yes to one or both classifies respondent as a
  pathological gambler
• Johnson, et al, (1997) Psychological Reports

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Problem Gambling Rates

• In the past year, approximately 1 of adults (3
  million) meet criteria for pathological gambling.
• Past year, approximately 2-3 (6 to 9 million)
  adults meet criteria for problem gambling.

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Prevalence Issues

• States with stable or decreased rates had
  relatively larger PG programs.
• Gaming revenue, type of gambling, of EGMs,
  proximity to venue, etclikely important but
  relationship unclear.
• No significant regional differences.

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Bio-Psycho-Social Risk Factors

• Male
• Athlete
• 18-24 Yrs
• Substance use
• Substance abuse
• Other MH problem
• Family history of addiction

• Low SES
• Military Service
• Racial/Ethnic minority
• Gamble illegally
• Early onset
• Early big win
• Easy access to gambling

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Biological/Environmental Factors

• Self controlled Impulsive
• Risk aversive Prone to take risks
• Predisposed to No genetic MH
• MH problems predisposition
• Abusive upbringing Nurturing
• Poor schools Good schools
• Poor social support Good support
• Available gambling Restricted games
• Severe stress Absence of stress
• Poor coping skills Good coping

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Subtypes

• Action
• More likely to be male
• Prefer skill games
• Narcissistic
• Uses gambling to elevate mood

• Escape
• More likely to be female
• Prefer continuous games
• Uses gambling to withdraw zone out

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Co-Occurring Disorders Among PGs

• 35-60 of PGs lifetime criteria for SA.
• Alcohol PGs average 4x higher lifetime abuse
  rate than non-gamblers.
• Drugs PGs average 30 lifetime abuse/dependence
  (6 gen. pop.)
• Tobacco PGs average 55 lifetime dependence.
• SA associated with greater severity of PG.

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PG in SA Populations

• Tx Seeking SA have 2-10x rate of PG than general
  population.
• Dual diagnosis (SA PG) have more severe
  consequences (legal, social, family)
• DD have more severe psychiatric symptoms (ADD,
  ADHD, ASPD)

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Prevalence of MH Disorders
Gen Pop PGs Tx Seeking PGs
Any Disorder 8 40 60
Maj. Depression 5 20 60
Bipolar 1.5 10 15
Suicidality 5 20 50
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Warning Signs

• Preoccupation with gambling
• Inability to set a limit/stick to it
• Borrowing from co-workers/friends
• Unexplained financial difficulties
• Substance abuse/mental health problems
• Suggestions by others the employee may have a
  gambling problem
• Mood swings due to winning and losing streaks

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More Warning Signs

• Henry Lesieur, Ph.D. observed the following
  workplace behaviors as being correlated with a
  gambling addiction
• Excessive use of telephones (to call bookmakers
  or obtain credit)
• Taking the company vehicle to the casino, etc.
  (parking tickets near gambling locations are a
  "red flag)
• Arriving late (related to all-night card games,
  anxiety-related sleep disturbances)
• Failure to take days off (obsessed with getting
  money to pay gambling debts or afraid to leave
  because embezzlement or fraud may be discovered
  in their absence)
• Organizing office pools and gambling junkets
• Embezzlement, defrauding customers

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Workplace Gambling

• 19 of all workers (but 1/3 of professionals,
  business financial services workers)
  participated in March Madness pool, 24 paid more
  than 10 to enter (CareerBuilder.com, 2008)
• 66 of callers to an EAP program indicated
  employees gamble in their workplace, 46 said it
  negatively impacts productivity (hr.blr.com,
  2006).
• Casino employees have higher rates of gambling
  problems, smoking, alcohol use depression (Am J
  Ind Med, 1999)

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Social Cost

• Losses to individuals.
• Problem gamblers generate costs for
  societycrime, bankruptcy, divorce, etc...
• U.S. National Gambling Impact Study Commission
  (1999)
• 1,200 per adult pathological gambler.
• 715 per adult problem gambler.
• 2008 U.S. Estimate 6.7 billion

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Treatment Works, If Available

• Only about 1 of current pathological gamblers
  seek treatment in a given year nationwide v. 20
  of substance abusers.
• States with well funded PG programs have much
  higher rates of treatment seeking (4 in OR,
  4-10 in IA)
• IA 61 abstinent at followup.
• OR 63 not gambled for at least 6 mos at 1 year
  followup.

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Counseling

• Several national specialty certifications.
• General state national MH/SA certifications do
  not include problem gambling training.
• Not routinely reimbursed by state or private
  insurance (54 have coverage, but only 9 used
  it).

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Life Skills Help for Families

• Prevention programs
• Financial guides
• Conflict between GA pressure relief credit
  counseling
• Some treatment programs include family therapy.
• Spouses can be liable for unpaid taxes on
  gambling winnings.

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PG Specific Residential/Inpatient

• 10 centers (incl. VA) Less than 100 beds for 3
  million pathological gamblers.
• Who is payor of last resort?
• VA 1 Year followup 55 abstinent for 1 year
  27 abstinent at least 1 month

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Services Implications

• Tx for PG may be less expensive than substance
  abuse (no medical detox)
• Majority seem to be effectively treated in
  outpatient settings.
• Public/private partnerships are the dominant
  method of service delivery.

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• National Problem Gambling Awareness Week
• March 2-8, 2009
• www.npgaw.org
• 50 free materials
• Screening tools
• Posters
• Flyers
• Brochures
• Press releases
• Stories

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Section III Youth Gambling
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Kids Today

• Increasing Majority of Youth Gamble
  (approximately 70 in past year, average prior to
  1988 was 45, between 1988 and 1999 65)
• First generation of kids to grow up with
• unprecedented levels of legalized gambling (in
  1976 less than a dozen states allowed gambling48
  plus more than 250 tribes today)
• pervasive promotion (state lotteries alone spent
  400 million on advertising in 1999)
• high rates of implicit parental endorsement (over
  50 gamble with family members, 78 gamble in own
  homes)

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Past Year Prevalence of Gambling
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Gambling Participation (14-17)
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Gateway?

• May be the gateway activity as age of onset for
  gambling is earlier than all other risky
  behavior.
• Youth who gamble have higher rates of substance
  use, drunk driving, delinquency, sexual behavior
  and other antisocial behavior.
• Maybe it is because kids become accustomed to and
  enjoy risk taking learned in gambling?

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Youth Problem Gambling

• Approximately 4-6 of youth (lt 17) meet criteria
  for a gambling problem.
• Risk factors include male, low SES, other risk
  taking behavior, racial/ethnic minority.
• Extremely low rate of awareness/treatment
  seeking.

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Early Onset

• All use starts recreationally, but may lead to
  abuse.
• Earlier the age of onset for gambling, the
  greater risk for a gambling problem (pathological
  gamblers in treatment report onset at 11 years).

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BWI Airport, Across from Play Area
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Who Is Most Likely To Play Poker?
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Annenberg Surveys

• 2.9 million youth play cards in average week.
• Monthly card playing jumped 20 to 42.
• 580,000 between 14 and 22 gamble on Internet on a
  weekly basis.
• 44 of weekly gamblers report either
  preoccupation, over-spending, tolerance or
  withdrawal.

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Does Normal Brain Development Encourage Gambling
( Other Risky Behavior) ?

• gt risk taking (particularly in groups)
• gt propensity toward low effort - high excitement
  activities
• lt capacity for good judgment weighing
  consequences
• gt sensitivity to novel stimuli.

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• Adolescence is a period of profound brain
  maturation.
• It was believed that brain development was
  complete during childhood
• The maturation process is not complete until
  about age 24.

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Involvement in Addictive Behaviors
Total use Weekly use 7th 9th 11th
7th 9th 11th Alcohol 37 62 80
7 14 20 Drugs 4 13 27 3 2
9 Cigarettes 18 35 48 7 16 31 Gambling
79 79 83 30 37 37

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• Kids have access to formal (credit cards),
  informal (bookies) and illegal (stealing) means
  of financing gambling.
• Losses are real only when gambling stops, until
  then the problem gambler is just the next bet
  away from winning everything back.

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Gambling Problems
Gamble to Escape
Truancy/ Delinquency
Chase Losses
Preference for Gambling
Stealing Money
Problem Gambling
Lying about Gambling
Family/ Peer Problems
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The Good News There is Hope and Help

• While the majority of Americans gamble, most
  never develop problems.
• A total of 3-4 of the general population will
  experience problems with their gambling in a
  given year.
• PG often clusters with other problems.
• PG is a treatable disorder, like all addiction
  most efficiently and effectively when detected
  early.

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National Council on Problem Gambling216 G
Street, NE 2nd FloorWashington, DC 20002Tel
202.547.9204Fax [phone]Email
keithw_at_ncpgambling.orgWeb www.ncpgambling.org