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GAMBLING PROBLEMS WITH OLDER ADULTS WITH COD. Patrick Arbore, Ed.D. Founder & Director, CESP & Director Institute on Aging. Center for Elderly Suicide Prevention & Grief Related Services. 24-hour Friendship Line for the Elderly Local number (415) 752-3778 800# -- (800) 971-0016

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GAMBLING PROBLEMS WITH OLDER ADULTS WITH COD

Patrick Arbore, Ed.D.

Founder & Director, CESP & Director

Institute on Aging


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Center for Elderly Suicide Prevention & Grief Related Services

  • 24-hour Friendship Line for the Elderly

  • Local number (415) 752-3778

  • 800# -- (800) 971-0016

  • Assessment Center (415) 750-4111

  • Grief Services including support groups and individual grief counseling (415) 750-4111

  • [email protected] (415) 750-4180x230


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Addiction: What Is It? Services

  • Simply put: Addiction is a brain disease

  • Drugs and alcohol change the brain – they change its structure and how it works

  • Repeated drug use disrupts well-balanced systems in the brain – the brain develops a one-track mission to seek and use drugs


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Differences between Problem Gambling & Chemical Addiction Services

  • Problem gamblers do not ingest, inject or inhale substances like chemically addicted people do

  • What do gamblers become addicted to? – “action” – the “high” – the excitement of the outcome of a gambling event

  • Problem gambling is often referred to as a hidden addiction


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Dopamine Services

  • Drugs of abuse cause a surge in levels of a brain chemical called dopamine – which results in feelings of pleasure

  • The brain remembers this pleasure and wants it repeated

  • Eventually, the drive to seek and use drugs and alcohol is all that matters


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The Disease of Addiction Services

  • The disease of addiction is especially insidious because it affects the very brain areas that people need to: think straight – apply good judgment – make good decisions for their lives


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Chemical Dependency & Problem Gambling Services

  • About 20% of people receiving inpatient treatment for chemical dependency are problem gamblers

  • Problem gamblers are more likely to be heavy users of alcohol, marijuana and cigarettes


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Problem Gambling & Older Adults Services

  • Older adults now form the largest group of annual visitors to Las Vegas (The Las Vegas Convention and Visitor’s Authority)

  • Between 1975 and 1998, the 65+ age group experienced the greatest increase in gambling both for lifetime (from 35% to 80%) and for past-year (from 23% to 50%) (Gambling Impact & Behavior Study, 1999)


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2004 National Survey on Drug Use and Health Services

  • There were 4.6 million adults with co-occurring serious psychological distress and a substance use disorder

  • If someone is twenty years or more into addiction, he or she is probably struggling with multiple co-occurring psychiatric problems


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Definition of Gambling Services

  • Any game of chance or skill that involves a financial risk

  • Examples – Lottery, Casino games, Racetrack betting, Maj jong for money, raffles, bingo, stock market, scratchers


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Triggers & At-Risk Factors for the Elderly Services

  • Opportunity – In 1975 Nevada had the only casinos – in 1999 15 states have lottery only; 4 states have casino only; 10 states have lottery & casino and 13 states have lottery & tribal casino

  • Boredom – Gambling is a way of filling the abundant leisure time that many older people experience following retirement


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Triggers Continued Services

  • Loneliness & Isolation – After the loss of a spouse or partner, gambling is a way of being in proximity to, if not interacting with people

  • Escape – It is a fantasy world in which one can leave behind whatever problems they may want to forget – poor health; deaths of loved ones; distant grandchildren


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Triggers Continued Services

  • A target market – There are many promotions to attract older customers – “Comps” are widely used – Hospitality programs that emphasize making older people feel welcome and “like family”


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An Invisible Epidemic Services

  • Alcohol abuse and prescription drug abuse among adults 60+ is one of the fastest growing health problems in the U.S.

  • Substance abuse affects up to 17% of older adults

  • Elderly substance abuse is often overlooked by health care providers (Frederick Blow, 2001)


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American Medical Association Services

  • Estimates that about 3 million Americans over the age of 60 have a drinking problem

  • Consequences of excessive drinking include: nutritional deficiencies, liver disease, cancer and cardiovascular problems (including stroke)


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Aging, Drinking & Consequences Services

  • Higher BAC from a given dose

  • More impairment at a given BAC

  • Interactive effects of alcohol, chronic illness and medication


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Types of Older Drinkers Services

  • Abstainer and light drinkers – 70%

  • Moderate drinkers – 15%

  • At risk drinkers – 10%

  • Alcoholics – 5%


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Patterns of Drinking Services

  • Late-onset cases (after age 60) – about 1/3 of older problem drinkers

  • Early and intermediate onset cases – about 2/3 of older problem drinkers

  • 95% of all adults dependent on or abusing alcohol started drinking before age 21


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Alcohol Guidelines for Older Adults Services

  • According to the National Institute on Alcohol Abuse and Alcoholism & the Center for Substance Abuse Treatment’s TIP Series:

  • People 65+ -- no more than one standard drink per day or 7 standard drinks per week

  • No more than 2 standard drinks on any one occasion


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What Is A Standard Drink Services

  • One can of ordinary beer or ale – 12 oz

  • A single shot of spirits – 1.5 oz

  • A glass of wine – 5 oz

  • A small glass of sherry – 4 oz

  • A small glass of liqueur – 4 oz


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Signs & Symptoms Services

  • Anxiety and annoyance when asked about alcohol use

  • Drinking despite medical admonitions

  • Dehydration

  • Malnutrition

  • Sexual dysfunction

  • Problems with family and/or friends

  • Sleep problems


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Signs & Symptoms Services

  • Loss of control

  • Self-neglect

  • Neglect of pets and/or home

  • Suicidal ideation or attempts

  • Withdrawal symptoms when alcohol removed

  • Blackouts


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Signs & Symptoms Services

  • Morning drinking

  • Morning shakes & tremors

  • Bladder & bowel incontinence

  • DUI’s

  • Gait disorders

  • Confusion or memory problems

  • Denial of drinking


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Co-Occurring Disorders Services

  • Being addicted raises the risk of having depression

  • Being depressed raises the risk of self-medicating

  • Self-medicating leads to addiction


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Common Issues Affecting Entry Into Treatment Services

  • Denial is a major obstacle to getting help

  • Shame may serve as an obstacle to admitting that a problem exists

  • Resentment may get triggered when anyone asks questions about how older people spend their money


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Communication Factors Services

  • Expectations – Keep to a minimum

  • The individual may not see their alcohol or gambling as a problem although the helper does

  • Plan a discussion when person is most likely to be sober

  • Find a private place to talk


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Treatment for Problem Gambling Services

  • No single treatment approach has emerged for problem gambling

  • Individual counseling

  • Participation in Gambler’s Anonymous

  • Financial advice

  • Legal assistance


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Treatment for Substance Abuse Services

  • Psychotherapy

  • AA – 12 step program

  • Case Management Team Approach

  • Group Counseling

  • Telephone Outreach

  • Outpatient

  • Harm Reduction


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Resources Services

  • 1-800-GAMBLER (California Council on Problem Gambling

  • 1-800-522-4700 (National Council on Problem Gambling)

  • Gamblers Anonymous/GAM Anon

  • Chinese Community Problem Gambling Project (SF Bay Area)


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Resources Services

  • Institute on Aging Psychology Department (415) 750-4111

  • Friendship Line for the Elderly – 24 hour --(415) 752-3778; (800) 971-0016

  • Curry Senior Center (415) 885-2274

  • Golden Gate for Seniors (415) 626-75533030


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