Compulsive Gambling: The Invisible Addiction June 24, 2010

1. Compulsive Gambling:The Invisible AddictionJune 24, 2010 Donald Weinbaum, MBA, LCADC, CCJP Executive Director The Council on Compulsive Gambling of NJ, Inc. 3635 Quakerbridge Rd, Suite 7 Hamilton, NJ 08619 609-588-5515 ext 17 1-800-GAMBLER ® Don@800gambler.org

2. About CCGNJ • The Statewide ADVOCATE for problem gamblers and their families. • Founded in 1982- Second State Council in US • NEUTRAL on legalized gambling. • Affiliated with NCPG, which has chapters in 35 of 50 states. • Work with government, gaming industry & community.

3. Legal Gaming in the U.S. (Data from NCPG)

4. Adult Rates of Smoking, Drinking & Gambling (Data from NCPG)

5. Who Gambles? Adults: • Ever Gambled? 85% • Past Year? 65% • At Least Weekly? 15% • Path. Past Year? 1% • Prob. Past Year? 2% Youth: • Ever Gambled? 85% • Past Year? 70% • At Least 2x Wk.? 11% • Prob. Past Year? 2% • At-Risk Past Year? 6% (Data from NCPG)

6. LEGAL GAMBLING IN NJ • Pari-mutuel gambling at race tracks • New Jersey legalized Bingo (charitable wagering) • First Lottery (.50 ticket twice weekly) was approved by New Jersey voters in 1970 • Casino gambling was approved by New Jersey residents in 1976 and the first casino opened in 1978

7. OTHER FORMS OF LEGALIZED GAMBLING • Spinning wheel type amusement game • Arcade type games • Chances for Fundraisers • Stock market gambling • Fantasy football? • Office pools?

8. Illegal Gambling • Sports Betting • Internet Gambling • First Internet Gambling site – 1995 • Over 2,000 Gambling sites – 2005 • 1,100 Casino Gambling sites • 700 Sports Gambling sites • 200 + Poker Gambling sites • Estimated revenue – 2006 - $12 billion • Others

9. Types of Gamblers • Social (80%) • Problem (15%) • Compulsive (Pathological) (5%)

10. TYPES OF GAMBLERS • Social gamblers-80% • Enjoyable experience • Entertainment • Gamble with others • Limit amount of money spent • Stop after reaching limits • Gamble for short periods of time • No interference with other parts of life

11. TYPES OF GAMBLERS • Problem gamblers- 15% • Gambles longer than planned • Loses more than intended • Starts to borrow money for gambling • Prolonged losing episodes • Starts to lie about amount gambled • Returns to gamble to win back losses • Relationship problems begin

12. TYPES OF GAMBLERS • Compulsive (pathological) gamblers- 5% • Cannot pay household expenses and debts • Marked increase in gambling episodes • Gambling for larger amounts • Receives bailouts for gambling debt • Gambling alone • Alienation from significant others in life • Illegal acts to finance gambling • Unsuccessful attempts to stop • Helpless and suicidal

13. What is Pathological Gambling? • Enters DSM III in 1980 • DSM IV (1994): (312.31) Impulse Control Disorders, NEC • DSM5 (2013?) – Addictive disorder

14. DSM IV-TR(312.31) Pathological Gambling(Impulse-Control Disorders, NEC) A. Must meet 5 out of 10 criteria: • Preoccupation • Tolerance (increasing amounts of $) • Inability to control, cut back or stop • Restless, irritable when not gambling • Escape or relief of dysphoric mood

15. DSM IV-TR(312.31) Pathological Gambling (Impulse-Control Disorders, NEC) A. Must meet 5 out of 10 criteria (cont.): • “Chasing” –trying to win back losses • Lying to family members and others • Illegal acts to finance gambling • Jeopardized relationship, job, education, career • “Bail Outs” – relies on others to cover debts B. Not better accounted for by a Manic Episode

16. Adult Problem Gambling Rates(US) (per NCPG) • (Past year) – Approx. 1% (2.3 million) meet Pathological Gambling criteria. • (Past year) – Approx. 2% (5 million) adults meet criteria for Problem Gambling. (Data from NCPG)

17. Bio-Psycho-Social Risk Factors • Male • Athlete • 18-24 Yrs • Substance use • Substance abuse • Other MH problem • Family history of addiction (Data courtesy of NCPG) • Low SES • Military Service • Racial/Ethnic minority • Gamble illegally • Early onset • Early big win • Easy access to gambling

19. PHASES OF COMPULSIVE GAMBLING • Winning phase (1-2 years) • Early big win • Excitement prior and during gambling • Unreasonable optimism • Feel special • Euphoria and fantasy • Gifts for wife and children • Part -time activity

20. PHASES OF COMPULSIVE GAMBLING • Losing Phase • Prolonged losing and chasing losses • Lies about gambling • Personality changes • Starts to borrow • Home life begins to be unhappy • Conversion of assets to cash • Fearful • Bets impulsively

21. PHASES OF COMPULSIVE GAMBLING • Desperation Phase • Constant bailouts and increased debts • More time spent gambling • Remorse and isolation • Illegal activity • Thinking impaired • Physical symptoms of gambling • Helpless, hopeless, mental breakdown, divorce, substance abuse, suicide

22. Subtypes Action • More likely to be male • Prefer “skill” games (poker, sports betting, horses, casino table games) • Aroused euphoric state • Seeking the rush • Narcissistic, fantasy Escape • More likely to be female • Prefer “luck” forms of gambling - lottery, slots, bingo • Gamble for relief, escape from stress or negative affect

23. PREVALENCE - NJ Compulsive and Problem Gamblers: 350,000 Substance Abusers: 806,000

24. PG in SA Populations Rates are 2-10 times higher among substance abusers than in general population • Substance abuse (overall) (5 studies): 12.2 % and 8% • Alcohol (5 studies): 14.5% and 5.0% • Cocaine: 8 to 15% • Methadone (3 studies): 30% • Cannabis found most related to gambling problems

25. Co-Occurring Disorders Among PGs • 35-60% of PGs meet 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.

26. GAMBLING AMONG SUBSTANCE ABUSE TREATMENT POPULATION • 30% of drug and alcohol clients in treatment likely have gambling problem • 50% of compulsive gamblers in treatment have substance abuse or dependence

27. Prevalence of MH Disorders (Data from NCPG)

28. ADOLESCENT PREVALENCE • 2-4 times higher rate than among adults • Past year gambling problem: 1-6%

29. GAMBLING, DRUGS & ALCOHOL Four (4) Similarities for all addictions • Preoccupation • Withdrawal • Progression • Tolerance

30. GAMBLING, DRUGS & ALCOHOL Differences • Gambling connected to fantasy • Gamblers favor suicide, alcoholics hopeless and helpless • Gamblers fully functional until hitting bottom • Gambler sees money as drug and power. • Disease model harder for others to accept.

31. GAMBLING, DRUGS & ALCOHOL Differences (cont.) • Cannot measure through blood, urine, hair • Gambling sponsored by religion and state • Bailout or big win can stop self destructive cycle • Gambling win seen as solution for problems • Gamblers do it alone, addicts often in groups

32. GAMBLING, DRUGS & ALCOHOL Differences (cont.) • No saturation point for gamblers • Gamblers excel at math and/or superstitious • Gambler’s recovery requires financial restitution

33. 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

34. NJ-SAMS All clients answer a 3-Question Screen. If “yes” is answered for any question counselor will be directed automatically to Council’s web site, where they can answer “20 Questions”. If a problem or compulsive gambler, the client/counselor will be referred to a page that lists professional help (free or low cost) and 12-step meetings.

35. 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 (95% accuracy) • Johnson, et al, (1997) Psychological Reports

36. TREATMENT OPTIONS • Treatment Planning/Aftercare – Integrate Svcs • 12 Treatment Providers in CCGNJ Network • Free or Low Cost Services for Gamblers and Significant Others • Funding Cutbacks limit network expansion at this time • 12-Step Self Help Groups: • Gamblers Anonymous • Gam-Anon

37. MORE TOOLS

38. TIP 42 “At a minimum, the rate of problem gambling among people with substance use disorders is 4 to 5 times that found in the general population.” • PGKIT (BKD 535) Includes: • excerpts from TIP 42 • Problem Gamblers and Their Finances: A Guide for Treatment Professionals • Personal Financial Strategies for Loved Ones of Problem Gamblers

39. National Problem Gambling Awareness Week ( March 6-12, 2011) • In NJ, Month of March www.800gambler.org/GAW 50+ free materials • Screening tools • Posters • Flyers • Brochures • Press releases • Stories

40. CCGNJ Programs and Services • Public Awareness • Prevention and Education (Schools & Colleges) • Intervention • 1-800-GAMBLER® Helpline • Outreach to Seniors, Treatment , IDRCs and Community Agencies • Criminal Justice Initiatives • Training & Workforce Development • Free 30 hr CCGC Workshops • Consultation on cases • 28th Statewide Conference (10/7/10) • In-Service Trainings • Advocacy & Collaboration

41. FOR MORE INFORMATION: Contact us at: The Council on Compulsive Gambling of NJ, Inc. 3635 Quakerbridge Rd Suite 7 Hamilton, NJ 08619 609-588-5515 Don@800gambler.org http://www.800gambler.org For Immediate Assistance 24 hours a day: 1-800-GAMBLER®