Understanding and Identifying Process Addictions

1. Understanding and Identifying Process Addictions Developed by DATA of Rhode Island through a special grant with the RI Department of Human Services

2. Group Discussion Questions: Addiction • What is a process addiction? • Are there different types of addictions? • Who becomes an addict? • Is addiction treatable? Review of Training Goals • To understand what is a process addiction • To identify key signs and symptoms • To learn strategies for identification • To better learn about community resources

3. Substance Addictions Legal drugs Illegal drugs Over the counter drugs Tobacco Caffeine Food Process Addictions Gambling Exercise Work Internet Pornography Shopping Sex Types of Addictions

4. What is an Addiction? • Obsession • Negative Consequences • Denial • Loss of Control

5. Gambling Quiz Instructions: Read each statement and determine if you agree or disagree with it. Mark either an "A" for agree, or a "D" for disagree. • Gamblers who lose large amounts of money just don't know how to gamble. • If you flip a penny and it comes up "heads" four times in a row, the next flip will be more likely to come up "tails" than "heads". • About 30% of elders have some level of gambling problem. • "Chasing" is gambling to win back money that has previously been lost through gambling. • Buying raffle tickets and betting on school sports events are not considered gambling. • It makes sense to spend your paycheck on gambling because you might win even more than you earned. • About 90 of American adults have gambled in their lifetime. • People gamble strictly because it's fun. • You must be 18 or older to legally gamble. • Some people who gamble have higher than average intelligence.

6. Gambling Quiz • Disagree. • Skill and knowledge play a small part in some types of gambling, such as certain card games, but for the most part gambling is a game of chance and the gambler has very little control over the outcome. • 2. Disagree. • There is no relationship between previous outcomes and the next flip of the penny. They are unrelated events. The penny is just as likely to come up “heads” as it is to come up “tails”. • 3. Disagree. • The current data shows us that 10-20% of elders, or 2-4 times that of the general population, have some level of gambling problem. • 4. Agree. • Gamblers become desperate to cover their losses and become convinced that if they keep on betting they’re bound to win, sooner or later.

7. Gambling Quiz • Disagree. • Anytime you wager money on an activity or event of uncertain outcome, you are gambling. • 6. Disagree. • It is your choice, of course, but the odds of winning a pile of money are • stacked against you. • 7. Agree. • The 2000 data showed that approximately 96% of American adults have gambled in their lifetimes. As the opportunity for and access to gambling increases, so do these numbers. • 8. Disagree. • While “entertainment” or “fun” is the number one reason mentioned for • gambling, the other two major reasons are: “excitement or challenge” • and “to win money.” Other reasons are “escape” and “glamour.”

8. Gambling Quiz • Disagree. • Legal gambling age is 18 in RI. In other states it differs, and it differs from gambling venue to venue. Example: in CT. you must be 21 to gamble in a casino. • 10.Agree. • It is true that some gamblers have higher than average intelligence and some gamblers have lower than average intelligence, just as it is true that some lawyers, or educators, or accountants have higher than average intelligence and some have lower than average intelligence. The point is, intelligence has nothing to do with it — gambling is primarily a matter of chance!

9. Definitions • Gambling__________________________ • Social Gambling_____________________ • Problem Gambling___________________

10. Lottery and Casino Gambling: 1973Clotfelter & Cook, 1986; Commission on the Review of the National Policy Toward Gambling, 1976.

11. Lottery and Casino Gambling: 1999 (NGISC)

12. US Leisure Expenditures(NGISC, 1999)

13. Legal Gambling Expenditures(NGISC, 1999)

14. Some Examples of Gambling in RI AREA Internet & Electronic Gambling (On-Line Casinos, Poker) Lottery (VLTs, Daily Number, Powerball, Lotto, Scratch Tickets) Tribal casinos Sports betting Bingo(including High stakes bingo at Foxwoods) Simulcast Wagering Horse & Dog Racing (Newport & Lincoln) Informal gambling (cards, dice, craps, cee-lo) Live Greyhound racing $tock market Sweepstakes Charitable gambling (raffles, bingo) Animal fights (dogs, roosters)

15. Games of Skill Table games Pari-mutuels Sports wagering Billiards Games of Chance Scratch tickets Daily Number Power Ball Video Poker/Slots VLTs Types of Games

16. Excitement Entertainment Escape (forget about their problems for a while) Economics (they want the money) Ego(the person’s pride or reputation is on the line) Challenge (person likes the feeling of competition involved in gambling) Depression (the person feels better or forget about problems while gambling) Boredom (gambling gives the person something to do) Loneliness ( gambling fills a void in the person’s life) Why Do People Gamble?

17. RI Gambling Trends • Lincoln Park 2501 VLTs + pari-mutuels (60% tax) • Newport Grand 1020 VLTs + pari-mutuels (62% tax) • 2003-4, gross, $1.1 B wagered in RI; VLTs (75% Lottery revenue) • State gambling revenues have increased 1000% in 10 years • RI has highest per capita lottery sales in USA ($1K per man, woman and child) • 3rd leading source of income 2003-4 to RI, net of $281 M to General Treasury • $150K for gambling treatment, $10K train counselors & $15K prevention = total of $175K is .013% of total gambling revenue

18. Continuum of Gambling A B C D E Total abstinence from gambling Compulsive or Pathological Gambling Problem Gambling Experimental Gambling SocialGambling

19. What exactly is gambling anyway? • Every time you risk money or an object of value on a game with the hope of winning more, you are gambling.

20. Definitions • Gambler’s Anonymous definition of gambling: “Any betting or wagering for self or others, whether for money or not, no matter how slight or insignificant, where the outcome is uncertain or depends upon chance or “skill”, constitutes gambling.” • (Gambler’s Anonymous, March 1994, Handbook)

21. Definitions • Social Gambling: people who gamble in social settings & have no ill effects from gambling. There is a continuum in this category: • people who gamble occasionally, with the emphasis on the social context vs. the gambling & who can take or leave the gambling experience, to • others who gamble more heavily, with more of an emphasis on the gambling than the social interactions. • (MCCG Fact Sheet & AADAC)

22. Definitions • Problem Gambling: is the term used to cover the entire range of harmful gambling involvement. That is, gambling that results in some kind of negative impact on the person’s life or on the lives of the gambler’s family, friends, and/or co-workers. It can be an occasional impact or an ongoing and serious situation. • (AADAC)

23. Definitions • DSM-IV Definition of pathological gambling: “Persistent and recurrent maladaptive gambling behavior that disrupts personal, family or vocational pursuits”.

24. DSM-IV Criteria A. Persistent and recurrent maladaptive gambling behavior as indicated by 5 or more: preoccupied with gambling needs to gamble with increasing amounts of money to achieve desired excitement repeated unsuccessful efforts to control gambling restless or irritable when trying to cut down or stop gambles as a way of escaping from problems or of relieving a dysphoric

25. DSM-IV Criteria after losing, often returns another day to get even lies to others to conceal extent of involvement with gambling has committed illegal acts to finance gambling has jeopardized or lost significant relationship, job, educational or career opportunity due to gambling relies on others to provide money to relieve a desperate financial situation caused by gambling B. The gambling behavior is not better accounted for by a Manic Episode.

26. Screening First Rule…ASK • “Do you gamble?” • “How often do you gamble?”

27. Why Ask? • We ask questions about gambling because it is: • Legal • Socially acceptable • Readily accessible • Common • Sensitive • Related to a continuum of risk

28. Defining “At-Risk” Gambling • Differs by age • Differs by gender • Differs by mental health status • Differs by health/medication status • Differs by family history of gambling

29. CAGE Adapted for Gambling • Have you ever attempted to Cut down on your gambling? • Has anyone ever Annoyed you or gotten on your nerves by telling you to cut down or stop gambling? • Have you ever felt Guilty about your gambling? • Have you ever felt the need to gamble when your Eyes opened?

30. CT 4 Question Screen

31. CT 4 Question Screen

32. Problem Gambling Screening • When gambling stops being fun. There’s hope, there’s help. Please read further to see some of the symptoms of problem gambling and answer our questions to help determine if gambling has become a problem for you or someone you know. • Do you know someone who displays these problem gambling symptoms? • Preoccupied with gambling. • Unable to stop gambling. • Brags and boasts about gambling & exaggerates wins. • Minimizes losses. • Increases the size of bets. • Has unexplained financial difficulties. • Is restless or irritable with severe mood swings when not gambling. • Gambles to "feel better".

33. Problem Gambling ScreeningFamily or Significant Other • Whether it’s a spouse, a friend, a member of your family, or even you, the answers to these questions can help you realize if gambling has become a problem. • Is gambling making your home life unhappy? • Are you reluctant to use "gambling money" for normal expenditures? • Do you ever feel remorse after gambling? • After losing, do you feel you must return as soon as possible and win back your losses? • Do you gamble to escape worries and troubles? • Does gambling keep you from sleeping? • Do arguments, disappointments or frustration create an urge to gamble? • Does gambling make you careless about your welfare or that of your family? • Do you gamble longer than you had planned? • Do you gamble until your last dollar is gone? • Do you gamble to get money with which to pay debts or otherwise solve financial difficulties? • Do you borrow to finance your gambling? • If you or someone you know shows these symptoms, there is hope. Problem gambling is a treatable illness. With proper treatment, a problem gambler can begin the recovery process and regain control of his/her life.

34. Step I - Ask about gambling • Gambling Preference • Frequency (wagers per week and per occasion) • Most wagered in a 24 hour period • Any big wins • Borrowing to gamble • CAGE • Men & women: Score 1 or more on CAGE Step II - Assess for gambling problems (is gambling impacting?) • Psychological Functioning • Educational /Vocational /Financial • Legal History • Social History • Physical History Steps for Gambling Screening & Brief Intervention

35. Steps for Gambling Screening & Brief Intervention Step III- Advise Appropriate Action • Problem Gambling • Assess readiness to change • Provide options • Encourage abstinence • Gambling Problems or at Risk for Developing Problems • Assess readiness to change • Advise to cut down • Provide options Step IV- Monitor and Assist

36. Similarities Loss of Control Preoccupation Negative impact on major life areas Tolerance Withdrawal Symptoms Self-help groups Bio/psycho/social/spiritual disorders Family involvement Differences Gambling is not self-limiting Behavior not attributable to intoxication More intense sense of shame and guilt Greater denial and stronger defenses Unpredictable outcome Fantasies of success No biological test Easier to hide Greater financial problems Intensity of family anger Less public awareness and acceptance Comparing Problem Gambling to Substance Abuse

37. Case Study #1 A 20 year old Caucasian man, a senior in college, owes his roommate $1000 that he borrowed to bet on the last Super Bowl. After several months, he finally has the money to repay the debt. He just learned about a betting pool for the NCAA Basketball Championship Tournament. It makes no sense to him to use the $1000 to repay his roommate; if he bets the money he can not only get rid of his debt but can also make some extra cash for himself. He swears he won’t bet again after this. He’s tired of being in debt to his friends. It makes him feel like a loser. This way he can bet and he’ll walk away a winner. What is going on for this young man - what behaviors do you notice? What, if any, consequences has he or is he experiencing?

38. Case Study #2 “The only reason I keep gambling is so I can pay off my debt. It’s not like I’ve lost my home or my car, like some of those losers in GA. As soon as I’m out of debt, I’ll stop. I don’t need meetings.” What is going on for this person - what behaviors do you notice? What, if any, consequences are being experienced?

39. Case Study #3 A 45 year old married Caucasian woman had been secretly gambling on the internet for the past year. She lost all of the family retirement money and then some. Her husband recently discovered this when the bank called about late payments on their mortgage. He threatened to leave her and take the children unless she stopped gambling and went into treatment. She did, and hasn’t gambled in six months, but her relationship with her husband and children continues to be strained. He just wants results. No discussion. She is fraught with guilt for what she has done and often thinks about suicide. What is going on for this woman - what behaviors do you notice? What, if any, consequences has she or is she experiencing?

40. Case Study #4 “If you want to know why I gamble I’ll tell you about last weekend. I borrowed $500 from a friend. I went to a casino and came home with $5000! Where else can you get that kind of return? Yeah, I’m still about $100 in debt, but not to worry! Wait till my next trip!” What is going on for this person - what behaviors do you notice? What, if any, consequences are being experienced?

41. Case Study #5 A 50 year old African American man works in a factory but at a solitary task requiring little if no interaction with others. The only time he is with his co-workers is during break time and lunch, where the talk is about the office betting pool. How could he be a part of the group if he didn’t bet a dollar or two? What would he talk about? So, he bets a couple of dollars on each pool that comes up, and feels like he’s part of the group. What is going on for this man - what behaviors do you notice? What, if any, consequences has he or is he experiencing?

42. Self HelpGamblers Anonymous • Founded in 1957 • 12 Step Program • Only requirement for membership is a desire to stop gambling • “GAMBLERS ANONYMOUS is a fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and help others to recover from a gambling problem."

43. MONDAY Pawtucket G.A.7:00 PMSt. Matthew Trinity Church (Basement)690 Newport AvenuePawtucket, RINon-Smoking Providence G.A.New Beginnings Red Book Study6:30 - 7:30 PMButler Hospital (Ray Conference Center)345 Butler AvenueProvidence, RI TUESDAY Providence G.A.7:00 - 8:30 PMSt. Anthony's Parish CenterMineral Spring Avenue NorthProvidence, RI Rumford G.A.7:00 PM St. Michael & Grace ChurchPawtucket Avenue Rumford, RINon-Smoking WEDNESDAY Cumberland G.A.7:00 PMSt. Joseph's Parish Center1303 Mendon RoadCumberland, RINon-Smoking THURSDAY Providence G.A.11:30 AM -12:30 PMSt. Raymond Church1240 North Main St.Providence, RI THURSDAY Warwick G.A.7:30 PMSt. Paul's Lutheran Church389 Greenwich Avenue (Near Apex)Warwick, RIGam-Anon MeetingGam-anon; Non-Smoking FRIDAY Warwick G.A.7:30 PMKent House (Basement)2020 Elmwood AvenueWarwick, RINon-Smoking SATURDAY Warwick G.A.9:30 - 11:30 AMCare New England Wellness Center2191 Post Road, Room B(Behind Chellos)Warwick, RINon-Smoking SUNDAY Women in RecoveryEast Greenwich G.A.6:00 - 8:00 PM St. Luke's Church(Pierce & Church Street)  East Greenwich, RIWomen Preferred RI Gamblers Anonymous MeetingsRhode Island Hotline Number: (401) 886-6850

44. Resources 12 Step Support Groups • Bettors Anonymous – for those with a gambling problem • 978-988-1777 ; 781-662-5199 • Gam-Anon - for family members and friends of problem gamblers 888-644-8482

45. Problem Gambling Resources RI Treatment Resources The RI Department of MHRH, Division of Behavioral Healthcare offers gambling treatment programs – outpatient counseling for people experiencing gambling problems &/or their families. • Currently RI Hospital is the only state-funded program for uninsured problem gamblers & their families

46. Rhode Island Gambling Treatment Program,Rhode Island Hospital, Dept of Psychiatry • Bayside Medical Center, 235 Plain St., Suite 501, Prov., RI 02905 • Bob Breen, PhD [277.0707] • Henry R. Lesieur, Psy.D., Ph.D. [277.0721] • http//www:gamblingtreatment.org

47. Resources National Treatment & Education Resources The National Council on Problem Gambling216 G Street NE, Suite 200Washington, D.C. 200021-202-547-9204 - Fax 1-202-547-9206E-mail: ncpg@ncpgambling.org

49. Questions?

50. Closing Exercise • Something I liked? • Something I’ll use? • This training will help me? • Something more I wanted more of?