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Problem Gambling and Co-Occurring Disorders

Problem Gambling and Co-Occurring Disorders. Hiroko Makiyama, LCSW Asian American Drug Abuse Program. Co-Occurring disorders. Pathological Gambling Mental Disorders Anxiety Trauma Depression Suicide Child Neglect Substance Abuse. Co-Occurring Disorders. Two or more disorders

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Problem Gambling and Co-Occurring Disorders

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  1. Problem Gambling andCo-Occurring Disorders Hiroko Makiyama, LCSW Asian American Drug Abuse Program

  2. Co-Occurring disorders • Pathological Gambling • Mental Disorders • Anxiety • Trauma • Depression • Suicide • Child Neglect • Substance Abuse

  3. Co-Occurring Disorders • Two or more disorders • Mental disorders (including pathological gambling) • Substance use disorders and other addictive behaviors

  4. Pathological Gambling (DSM IV) • Indicated by 5 or more of the following: • Preoccupation with gambling • The need to gamble with more money • Irritability or restlessness when attempting to stop • Gambling to escape problems • Chasing losses • Lying to conceal gambling • Committing illegal acts to finance gambling • Jeopardizing relationships, job, education, etc. • Repeated unsuccessful attempts to cut back

  5. Personality Traits • Sensation seeking • Need for novel and diverse experiences and feelings, even if it means taking risks to achieve it • Impulsivity • Spontaneous acts and behaviors lacking premeditation or self-control • Pathological gambling is classified under Impulse-Control Disorders Not Elsewhere Classified

  6. Differential Diagnosis • Personality traits may be suggestive of other disorders • Social Gambling • Professional Gambling • Manic Episode/Bipolar Disorder • Antisocial Disorder • A person might meet criteria for both PG and mental disorder

  7. Physical and Mental Health Differences in physical and mental health by problem gambler type (2006 California Problem Gambling Prevalence Survey)

  8. Pathological Gambling • Moore, 2002 – Preoccurring disorders • Any mental condition – 81.6% • Dissociative disorder – 68.4% • Mood disorder – 39.5% • Anxiety disorder – 7.9%

  9. Percentage of Pathological Gamblers with Comorbid Disorders (adapted from Petry et al, 2005) 9

  10. Mental Disorders • Depression • Several studies have identified high rates of depression among PG • Comorbidity ranging from 21% to 75% (Burgh & Khulhorn 1994) • Unclear whether depression is the cause or the result of gambling

  11. Mental Disorders • Suicide • PGs who are depressed are at an increased risk for suicide (Blaszczynski & Farrell 1998) • California Problem Gambling Prevalence Survey (2006) – see previous slide • Gambling Impact and Behavior Study (April 1999) • Negative Effect of Casinos in communities • increased youth crime • increased white collar crime • increased domestic violence • increased “family stress” • increased suicides • increased substance abuse

  12. Mental Disorders • Anxiety • Pathological gamblers upon completing clinical treatment are found to have decreased anxiety as compared to those who are still gambling (Blaszczynski et. al. 1991) • Unknown whether anxiety is the cause or the result of gambling

  13. Mental Disorders • Trauma • Trauma from abuse and neglect was the strongest predictor of future mental health problems including PG (Moore 2002) • Women reported higher rates of abuse than men • 84.2% of women reported history of any abuse or neglect, 65.8% reported history of emotional abuse, 63.2% reported physical abuse, and 47.4% reported sexual abuse • 63% reported having medium, overwhelming, or severe family problems (Davis & Avery 2004)

  14. Negative Impact on Family Members • There is no evidence that problem gambling is associated with child abuse, PG is linked to child neglect. • Gambling Impact and Behavior Study found that among six U.S. communities, the reports of child neglect surged in correspondence to the advent of casinos (1999) • Parents leaving their children at home, parked cars, or on casino premises while they gambled. • PGs lose track of how much time they have spent gambling due to having no clocks or windows in casinos • PGs sometimes report experiencing “brown outs” where they suffer time disorientation and memory loss (McNeilly and Burke 2002)

  15. Negative Impact on Family Members Similar to children of alcoholics or substance abusers, children who grew up in families of gambling frequently present behavioral problems such as delinquency and difficulties in school (Lorenz & Yaffee 1988) Children who grew up in homes where one or more parents gambled excessively are more likely to gamble and subsequently become problem gamblers (Lesieur et. al. 1991)

  16. Negative Impact on Families • PG closely linked to family violence • A survey study of 144 spouses of PGs in Canada found that half of those surveyed had been physically and verbally abused by their spouses • DV increased in communities corresponding to the advent of casinos (Gambling Impact and Behavior Study 1999) • Data on Women PGs

  17. Substance Abuse • Gambling Impact and Behavior Study (1999) • increased substance abuse • Spunt et. al. (1998) • Co-occurring substance abuse among PGs range from 7% to 39% • Steinberg et al. (1992) evaluated gambling problems in 298 treatment-seeking cocaine abusers using and found a 15% prevalence rate of pathological gambling

  18. Prevalence Rates of Substance Abuse Disorders in Treatment-Seeking PGs

  19. Tobacco, Alcohol and Illicit Drugs Tobacco, Alcohol and Drug Use Among Low-Risk, At-Risk, and Problem Gamblers (2006 California Problem Gambling Prevalence Survey)

  20. Tobacco, Alcohol and Illicit Drugs Relationship between weekly alcohol consumption and gambling-related problems in California is not statistically significant Problem gamblers in California are the least likely respondents to have consumed any alcoholic beverages in the past year Despite significantly lower rates of past-year alcohol consumption, the lifetime rate of help-seeking for an alcohol or drug problem is significantly higher among problem gamblers than among low-risk or at-risk gamblers. Among respondents who had consumed alcohol in the past year, 4% of low-risk gamblers and 7% of at-risk gamblers have ever sought help for problems related to their drinking or drug use compared with 10% of problem gamblers and 23% of pathological gamblers.

  21. Similarities between Problem Gambler and a Substance Abuser Immediate gratification is sought Preoccupation with the behavior or substance, and an inability to stop Denial is very common Severe depression and mood swings often occur Both may be progressive diseases with similar phases and stages

  22. Similarities (Continued) Both often chase the feeling of the first win or the first high The substance or gambling is frequently used to escape from pain There are often blackouts or brownouts Low self-esteem is often present Dysfunctional families are often involved There is a use of rituals or patterns

  23. Differences between Problem Gambler and a Substance Abuser Problem gambling is largely hidden As long as there is money, overdose is not possible You cannot drug test for problem gambling. There are no card marks on the arm, or the breath does not smell like lottery tickets Gambling requires no ingestion of chemicals It is usually not perceived as a disease Fewer resources are available for problem gamblers and their families A problem with alcohol or other substances may progress for several years before becoming a debilitating problem, while problem gambling usually is characterized by a sudden decline, perhaps in less than a year

  24. Conclusion PG is a mental disorder Correlated with other mental disorders, childhood trauma, substance abuse, with all of these problems possibly contributing to or resulting from others Must assess for these issues PG and other mental disorders should be treated as primary disorders

  25. References • Volberg, r. A., Nysse-Carris, K. L., & Gerstein, D. R. (2006). 2006 California Problem Gambling Prevalence Survey. (August 2006). Office of Problem Gambling. Sacramento, CA: Author. • Moore, T. L. (2002). The etiology of pathological gambling. Oregon Gambling Addiction Treatment Foundation. Available: http://www.gamblingaddiction.org/Etiology/Etio02.pdf • Petry, N. M., Stinson, F. S., & Grant, B. F. (2005). Comorbidity of DSM-IV pathological gambling and other psychiatric disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry, 66(5), 564-574. • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (Revised 4th ed.). Washington, DC: Author. • Bergh, C., & Kuhlhorn, E. (1994). Social, psychological and physical consequences of pathological gambling in Sweden. Journal of Gambling Studies, 10, 275-285. • Blaszczynski, A., & Farrell, E. (1998). A case series of 44 completed gambling-relate suicides. Journal of Gambling Studies, 14 (2), 93-109. • Gerstein, D. R., Volberg, R. A., Toce, M. T., Harwood, H., Palmer, A., Johnson, R., Larison, C., Chuchro, L., Buie, T., Engelman, L. & Hill, M.A. (1999). Gambling impact and behavior study: Report to the National Gambling Impact Study Commission. Chicago, IL: National Opinion Research Center at the University of Chicago. Available at http://clound9.norc.uchicago.edu/dlib/ngis.htm • Blaszczynski, A., McConaghy, N., & Frankova, A. (1991). Control versus abstinence in the treatment of pathological gambling: a two to nine year follow-up. British Journal of Addiction, 86 (3), 299-306. • Davis, D. R., & Avery, L. (2004). Women who have taken their lives back from compulsive gambling: Results from an online survey. Journal of Social Work Practice in the Addictions, 4, 61-80. • McNeilley, D. P., & Burke, W. J. (2000). Late life gambing: The attitudes and behaviors of older adults. Journal of Gambling Studies, 16 (4), 393-415. • Lorenz, V. C., & Yaffee, R. A. (1988). Pathological gambling: psychosomatic, emotional, and marital difficulties as reported by the spouse. Journal of Gambling Behvaior, 4, 13-26. • Lasieur, H. R., Cross, J., Frank, M., Welch, M., White, C. M., Rubenstein, G., Moseley, K., & Mark, M. (1991). Gambling and pathological gambling among university students. Addictive Behaviors: An International Journal, 16, 517-527. • Spunt, B., Dupont, I., Lesieur, H., Liberty, H. J., & Hunt, D. (1998). Pathological gambling and substance misuse: a review of the literature. Substance Use and Misuse, 33 (13), 2535-2560. • Steinberg, M.A., Kosten, T. A., & Rounsaville, B. J. (1992). Cocaine abuse and pathological gambling. American Journal of Addictions, 1, 121-132.

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