Gambling Disorder and its Prevalence
Contact:
Dr. Wiley D. Harwell, D.Min., LPC, NCGC-II
Executive Director
320 W. Main, Suite B
Norman, OK 73069
405-801-3329
405-801-3330 (FAX)
www.oapcg.orgwharwell@oapcg.org
GAMBLING DISORDER
AND
CO-OCCURRING
DISORDERS
Every time you risk
money, service, or an
object
of value on a
game with the hope of
wining more,
you are
gambling!
Examples of Gambling
Bingo
Card & Domino Games when played for $$$$
Games of skill (e.g. pool, darts, shuffleboard, golf) for consideration
Sports betting
Lottery tickets
Games found in a casino (slots, cards, dice)
Horse racing / Dog racing
Lottery video terminals (VLT)
On-line poker, gin-rummy, etc.
Scratch tickets
Cock fighting / Dog Fighting
Stock / Commodity Market
Problem & Compulsive Gambling
Prevalence Rates are Higher For:
adolescents,
casino employees,
college students,
people of lower
socioeconomic
status,
males, but women
are catching up
Ethnic minority
groups
prison populations,
seniors
those with mental
health and
substance abuse
problems.
Historical perspective of
Gambling
1
.
The American Revolution was funded primarily
on a lottery system.
2. Lottery funds in America built the early churches
and Harvard, Princeton, Dartmouth and Yale
University, etc..
3. The North & the South received much of the
funding from Lotteries to support the Civil War (on
both sides)
6. 1930’s - Horse racing and pari-mutuel wagering began
to grow in popularity countrywide
7. A crackdown on illegal gambling interests in the1940’s
forced gambling to Nevada.
8. Bugsy Segal, noted mobster received a legal gaming
license and opened the Las Vegas Flamingo, 1947
9. New Hampshire initiated the first successful state
sponsored lottery in 1967
10. 1978, New Jersey became the second state to legalize
casino gambling
9. The Indian Gaming Act of 1988 now allows
tribal casino gambling in what used to be
limited to only Nevada and New Jersey
10. Gambling (in some form) is legal in all
states but Utah and Hawaii.
With the population of Oklahoma at 3.5
Million people*
*
(Oklahoma Census Report)
1% to 3% of population is pathological in their gambling. Oklahoma
=35,000 to 105,000 citizens. *
An additional 2% - 3% tend to have significant personal & financial
problems. = 70,000 - 105,000 citizens *
* National Council on Problem Gambling, Inc.
Increase in Teen Gambling!
According to information compiled by the National Council on
Problem Gambling, 63% of 16-year-olds gamble.
More gamble as the
opportunity to gamble increases
Research has found between 40% and 60% of teenagers reported
they have gambled for money. *
3% to 6% of teenagers are said to be addicted to video and on-line
gaming. The numbers of teenagers addicted to all forms of
gambling is growing. Little to NO control*
•
Joanna Franklin, Trimeridian, 2004
Pathological Gambling is defined as:
“the persistent and recurrent maladaptive gambling behavior
that disrupts personal, family, or vocational pursuits. The
individual may be preoccupied with gambling
(e.g., reliving past
gambling experiences, planning the next gambling venture, or
thinking of ways to get money with which to gamble).”
*
“Most individuals experiencing pathological gambling say that
they are seeking an aroused, euphoric state that the gambling
gives them, appearing more exhilarating than the money
wagered. Increasingly larger bets, or greater risks, may be
needed to continue to produce the desired level of excitement.”
*
*DSM-IV-R
Criteria for Gambling Disorder DSM-V
D
S
M
-
V
C
r
i
t
e
r
i
a
f
o
r
G
a
m
b
l
i
n
g
D
i
s
o
r
d
e
r
–
S
c
o
r
i
n
g
–
Mild:
4-5 of the 9 criteria met.
–
Moderate:
6 or 7 of the 9 criteria met.
–
Severe:
8 or 9 of the 9 criteria met.
P
r
o
b
l
e
m
g
a
m
b
l
e
r
s
s
e
e
m
t
o
c
o
m
e
i
n
t
h
r
e
e
g
e
n
e
r
a
l
t
y
p
e
s
.
a.
Action gamblers
: often male, competitive, play
games of skill, seek
the
rush of gambling – like
cocaine addicts
b.
Escape gamblers
: often female, less
competitive, passive, play luck games- seek escape-
like narcotics.
c.
Antisocial gamblers
: can be either an action or
escape gambler that is oppositional in the motives
for gambling. They are trying to win in order to
beat the other players or the casino because they
feel harmed by life and society. Playing for long
periods of time is equivalent to winning.
Subtypes of Gamblers
•
Social Gambler
•
Serious Social Gambler
•
Anti-Social Gambler
•
Professional Gambler
•
The Bungler
•
Pathological Gambler
Co-occurring with Gambling
1.
Co-occurring disorders
, dual diagnosis and cross
addictions are high among pathological gamblers
presenting for care, i.e., Alcohol, drugs, sex, etc.
2.
Affect disorders
: depressions, anxiety and bipolar
disorder are major concerns.
3.
ADD, PTSD, and Substance Abuse Disorders
seem
unusually common to the problem gambling population.
4.
Suicide attempt
rates have been reported as high as 15-
20% of those who present for care.
National Council on Problem Gambling, Inc.
Financial Facts
The Financial Facts:
•
2009
2.9 Billion gaming revenue
•
2010
3.1 Billion gaming revenue
•
2011
3.23 Billion gaming revenue
•
2012
3.48 Billion Gaming revenue
The Financial Facts:
•
2009
The State of Oklahoma
received 118 Million from Tribal
Compact agreements
•
2010
122 Million to the State
•
2012
127 Million to the State
The Financial Facts:
•
2009 Oklahoma Lottery had 198 Million in
total revenue
•
2009 69 Million contributed to Oklahoma
Education Lottery Trust Fund
•
2010 199.9 Million in total revenue
•
2010 69.9 Million to Education
Contribution for Problem Gambling
•
Each Year:
•
750,000 contribution from the Lottery from
unclaimed lottery winnings
•
250,000 is taken from the State’s compact
agreement income
•
All money goes to ODMHSAS for Problem
Gambling treatment, education, awareness.
Resistance of the Gambler
1.
Nothing in normal life can replace the high.
2.
Gambler is not ready to see discrepancy in their story. Too much
confrontation early on reinforces resistance.
3.
Egotism/Narcissistic – no one can understand what I think.
4.
For escape gamblers – painful emotions are motivating escape &
gambler is not ready to face blocked trauma, pain.
5.
Normal is boring.
6.
Honesty is a challenge.
7.
Gambling is the only time I – don’t hurt, don’t think, don’t feel
depressed, don’t worry, etc.
8.
Ciarrocchi reports MMPI cluster. Most common cluster for
gamblers (Scales 4 &9). Characterized by rebellion, immaturity, and
acting out.
D
i
s
s
o
c
i
a
t
i
v
e
R
e
a
c
t
i
o
n
s
W
h
i
l
e
G
a
m
b
l
i
n
g
:
1.
Pure Escape:
a) goes into trance-like state
b) feels like a different person
c) loss of time and space
d) sometimes feels as if I am outside myself
e) brown out – like a black out state – loss of
memory
D
i
s
s
o
c
i
a
t
i
v
e
R
e
a
c
t
i
o
n
s
W
h
i
l
e
G
a
m
b
l
i
n
g
:
2.
Self regulation deteriorates:
a) inability to limit spending
b) when real money translates to gambling money
c) can’t set goals & achieve them
d) boredom sabotages goals
e) inability to delay gratification
f) play is actually parallel play – no real interaction
g) repeated failures = moral decline
h) beliefs & expectations are unrealistic/grandiose
i) self esteem bottoms out/overcompensation escalates
j) physiological arousal continues to increase
k) impulsivity plays increasing role in gamblers life
Most Common Co-Occurring Disorders
1.
Alcoholism – 30% of gamblers were also
alcoholics.
2.
Depression – major, dysthymic.
3.
Suicidal – National Gambling Impact Study
1999:
ideation – 48-79%
attempts - 12-26%
debt - $38,000 to $113,000
Most Common Co-Occurring Disorders
4.
Bi-Polar disorders.
5.
Other addictions – i.e., cocaine, meth.
6.
Issues of abuse:
emotional abuse – 69%
physical abuse – 46%
sexual abuse – 28%
Most Common Co-Occurring Disorders
7.
Anxiety disorders
Generalized, Panic
Disorder, Phobias
8.
PTSD
9.
ADD & ADHD
Contact:
Dr. Wiley D. Harwell, D.Min., LPC, NCGC-II
Executive Director
320 W. Main, Suite B
Norman, OK 73069
405-801-3329
405-801-3330 (FAX)
wharwell@oapcg.org
www.oapcg.org
Explore the world of gambling disorder, its historical background, examples of gambling activities, and the prevalence rates among different population groups. Learn about Dr. Wiley D. Harwell, a licensed professional offering support for individuals dealing with gambling issues.
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Contact: Dr. Wiley D. Harwell, D.Min., LPC, NCGC-II Executive Director 320 W. Main, Suite B Norman, OK 73069 405-801-3329 405-801-3330 (FAX) wharwell@oapcg.org www.oapcg.org
GAMBLING DISORDER AND CO-OCCURRING DISORDERS
Every time you risk money, service, or an objectof value on a game with the hope of wining more, you are gambling!
Examples of Gambling Bingo Card & Domino Games when played for $$$$ Games of skill (e.g. pool, darts, shuffleboard, golf) for consideration Sports betting Lottery tickets Games found in a casino (slots, cards, dice) Horse racing / Dog racing Lottery video terminals (VLT) On-line poker, gin-rummy, etc. Scratch tickets Cock fighting / Dog Fighting Stock / Commodity Market
Problem & Compulsive Gambling Prevalence Rates are Higher For: Ethnic minority groups prison populations, seniors those with mental health and substance abuse problems. adolescents, casino employees, college students, people of lower socioeconomic status, males, but women are catching up
Historical perspective of Gambling 1.The American Revolution was funded primarily on a lottery system. 2. Lottery funds in America built the early churches and Harvard, Princeton, Dartmouth and Yale University, etc.. 3. The North & the South received much of the funding from Lotteries to support the Civil War (on both sides)
6. 1930s - Horse racing and pari-mutuel wagering began to grow in popularity countrywide 7. A crackdown on illegal gambling interests in the1940 s forced gambling to Nevada. 8. Bugsy Segal, noted mobster received a legal gaming license and opened the Las Vegas Flamingo, 1947 9. New Hampshire initiated the first successful state sponsored lottery in 1967 10. 1978, New Jersey became the second state to legalize casino gambling
9. The Indian Gaming Act of 1988 now allows tribal casino gambling in what used to be limited to only Nevada and New Jersey 10. Gambling (in some form) is legal in all states but Utah and Hawaii.
With the population of Oklahoma at 3.5 Million people* * (Oklahoma Census Report) 1% to 3% of population is pathological in their gambling. Oklahoma =35,000 to 105,000 citizens. * An additional 2% - 3% tend to have significant personal & financial problems. = 70,000 - 105,000 citizens * * National Council on Problem Gambling, Inc.
Increase in Teen Gambling! According to information compiled by the National Council on Problem Gambling, 63% of 16-year-olds gamble. More gamble as the opportunity to gamble increases Research has found between 40% and 60% of teenagers reported they have gambled for money. * 3% to 6% of teenagers are said to be addicted to video and on-line gaming. The numbers of teenagers addicted to all forms of gambling is growing. Little to NO control* Joanna Franklin, Trimeridian, 2004
Pathological Gambling is defined as: the persistent and recurrent maladaptive gambling behavior that disrupts personal, family, or vocational pursuits. The individual may be preoccupied with gambling (e.g., reliving past gambling experiences, planning the next gambling venture, or thinking of ways to get money with which to gamble). * Most individuals experiencing pathological gambling say that they are seeking an aroused, euphoric state that the gambling gives them, appearing more exhilarating than the money wagered. Increasingly larger bets, or greater risks, may be needed to continue to produce the desired level of excitement. * *DSM-IV-R
Criteria for Gambling Disorder DSM-V Persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress, as indicated by the individual exhibiting 4 or more of the following in a 12-month period: Preoccupation Planning next venture, handicapping, getting $ Tolerance Gambles with more money to get effect/excitement Withdrawal Restlessness/irritability when stopping Escape Relieving stress and/or depressed mood Chasing losses After losing money, returns to get even Lying Conceals extent of involvement to others Loss of Control Unsuccessful efforts to control behavior Risked Sig. Relationship educational, or career opportunity Bailout Reliance on others to provide money Gambling behavior is not better accounted for by a manic episode Jeopardized/lost important relationship, job,
DSM-V Criteria for Gambling Disorder Scoring Mild: 4-5 of the 9 criteria met. Moderate: 6 or 7 of the 9 criteria met. Severe: 8 or 9 of the 9 criteria met.
Problem gamblers seem to come in three general types. a. Action gamblers: often male, competitive, play games of skill, seek the rush of gambling like cocaine addicts b. Escape gamblers: often female, less competitive, passive, play luck games- seek escape- like narcotics. c. Antisocial gamblers: can be either an action or escape gambler that is oppositional in the motives for gambling. They are trying to win in order to beat the other players or the casino because they feel harmed by life and society. Playing for long periods of time is equivalent to winning.
Subtypes of Gamblers Social Gambler Serious Social Gambler Anti-Social Gambler Professional Gambler The Bungler Pathological Gambler
Co-occurring with Gambling 1. Co-occurring disorders, dual diagnosis and cross addictions are high among pathological gamblers presenting for care, i.e., Alcohol, drugs, sex, etc. Affect disorders: depressions, anxiety and bipolar disorder are major concerns. ADD, PTSD, and Substance Abuse Disorders seem unusually common to the problem gambling population. Suicide attempt rates have been reported as high as 15- 20% of those who present for care. 2. 3. 4. National Council on Problem Gambling, Inc.
The Financial Facts: 2009 2.9 Billion gaming revenue 2010 3.1 Billion gaming revenue 2011 3.23 Billion gaming revenue 2012 3.48 Billion Gaming revenue
The Financial Facts: 2009 The State of Oklahoma received 118 Million from Tribal Compact agreements 2010 122 Million to the State 2012 127 Million to the State
The Financial Facts: 2009 Oklahoma Lottery had 198 Million in total revenue 2009 69 Million contributed to Oklahoma Education Lottery Trust Fund 2010 199.9 Million in total revenue 2010 69.9 Million to Education
Contribution for Problem Gambling Each Year: 750,000 contribution from the Lottery from unclaimed lottery winnings 250,000 is taken from the State s compact agreement income All money goes to ODMHSAS for Problem Gambling treatment, education, awareness.
Resistance of the Gambler 1. 2. Nothing in normal life can replace the high. Gambler is not ready to see discrepancy in their story. Too much confrontation early on reinforces resistance. Egotism/Narcissistic no one can understand what I think. For escape gamblers painful emotions are motivating escape & gambler is not ready to face blocked trauma, pain. Normal is boring. Honesty is a challenge. Gambling is the only time I don t hurt, don t think, don t feel depressed, don t worry, etc. Ciarrocchi reports MMPI cluster. Most common cluster for gamblers (Scales 4 &9). Characterized by rebellion, immaturity, and acting out. 3. 4. 5. 6. 7. 8.
Dissociative Reactions While Dissociative Reactions While Gambling: Gambling: 1. Pure Escape: a) goes into trance-like state b) feels like a different person c) loss of time and space d) sometimes feels as if I am outside myself e) brown out like a black out state loss of memory
Dissociative Reactions While Dissociative Reactions While Gambling: Gambling: 2. Self regulation deteriorates: a) inability to limit spending b) when real money translates to gambling money c) can t set goals & achieve them d) boredom sabotages goals e) inability to delay gratification f) play is actually parallel play no real interaction g) repeated failures = moral decline h) beliefs & expectations are unrealistic/grandiose i) self esteem bottoms out/overcompensation escalates j) physiological arousal continues to increase k) impulsivity plays increasing role in gamblers life
Most Common Co-Occurring Disorders 1. Alcoholism 30% of gamblers were also alcoholics. 2. Depression major, dysthymic. 3. Suicidal National Gambling Impact Study 1999: ideation 48-79% attempts - 12-26% debt - $38,000 to $113,000
Most Common Co-Occurring Disorders 4. Bi-Polar disorders. 5. Other addictions i.e., cocaine, meth. 6. Issues of abuse: emotional abuse 69% physical abuse 46% sexual abuse 28%
Most Common Co-Occurring Disorders 7. Anxiety disorders Generalized, Panic Disorder, Phobias PTSD ADD & ADHD 8. 9.
Contact: Dr. Wiley D. Harwell, D.Min., LPC, NCGC-II Executive Director 320 W. Main, Suite B Norman, OK 73069 405-801-3329 405-801-3330 (FAX) wharwell@oapcg.org www.oapcg.org
