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Problem and Pathological Gambling in the Latino Community. 10605 Balboa Blvd. Granada Hills, CA 91344 Phone: (818) 831-3395 Fax: (818) 831-0811 lbhi.org. Presenters. Irma Martinez, MPH , ’SUERTES’ Program Coordinator Latino Behavioral Health Institute Gerry Balcazar , Consultant

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Problem and Pathological Gambling in the Latino Community


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    1. Problem and Pathological Gambling in the Latino Community 10605 Balboa Blvd.Granada Hills, CA 91344Phone: (818) 831-3395Fax: (818) 831-0811lbhi.org

    2. Presenters • Irma Martinez, MPH, ’SUERTES’ Program Coordinator Latino Behavioral Health Institute • Gerry Balcazar, Consultant Latino Behavioral Health Institute • Elizabeth Gonzalez-Jaskulak, LCSW, Consultant Latino Behavioral Health Institute • Eduardo Martinez, BA, Consultant Latino Behavioral Health Institute

    3. Presentation Overview • The LBHI Problem Gambling Technical Assistance and Training Project • Scope of Problem Gambling in the Latino Community • DSM-IV Criteria for PG • Co-morbidity of Problem Gambling • Prevention and Treatment Issues: A Personal Testimony • Q & A / Summary

    4. Background In 2003, the California Department of Alcohol and Drug Program’s Office of Problem Gambling (OPG) launched a statewide campaign to train service providers and the community on recognizing the signs of problem gambling and its impact on individuals, families, and community.

    5. Project Purpose • To provide Gambling Prevention Education and Technical Assistance to service providers, government agencies, community leaders and the general public. • Services include: • Education and Awareness • Program Development • General Information Dissemination

    6. Technical Assistance & Training Project • Module I Overview of Problem Gambling • Module II Latinos & Problem Gambling • Module III Working with Problem Gamblers • Module IV Assessment Tools & Clinical Resources for Families of Problem Gamblers

    7. NAPAfASA Project Partners • Latino Behavioral Health Institute (Los Angeles) • American Society on Aging (San Francisco) • Asian American Drug Abuse Program (Los Angeles) • NICOS Chinese Health Coalition (San Francisco) • ONTRACK Program Resources (Sacramento) • Union of Pan Asian Communities (San Diego) • UCLA Integrated Substance Abuse Program (Los Angeles)

    8. California: Demography 2005

    9. PG Prevalence by Demographic Group * Includes Native Hawaiian and Pacific Islander ** Includes Native American, Middle Eastern, Multi-racial and Unspecified Other 2006 State of California Problem Gambling Prevalence Survey

    10. Training of Trainers (TOT) Curriculum Development NICOS Chinese Health Coalition Goal of TOT Curriculum To increase the knowledge and skill base of individuals so that they may train others to recognize, respond, and prevent problem gambling, and in the process, help increase California’s capacity to address problem gambling.

    11. Curriculum Planning Consortium Expertise Research Synthesis Clinical Experience Expert Review

    12. CULTURE & PROBLEM GAMBLING Social isolation Diversity Acculturation Culture Economics Stress Trauma Discrimination Oppression Inmigration Losses Stigma

    13. LBHI Outreach Strategies • Marketing - LBHI web site - Information dissemination (flyers, brochures, etc.) - On-going outreach via phone calls to various agencies • Training of Trainers (TOT) • Presentations • Training mental health promoters on outreach strategies and how to deliver consultations

    14. Centers that have received TA’s • Community and School Fairs • Churches • Elementary, Middle and High Schools • Cancer & Diabetes Associations • Adult Schools -ESL • Latino Advocacy Groups (CARECEN, COFEM, etc.) • Mental Health Support Groups • Community Based Organizations • Health Promoters Groups (Vision y Compromiso, Esperanza Community Housing Corporation, etc.) • Counseling Clinics • Mental Health Providers

    15. LBHI Suertes Project

    16. Problem Gamblingin theLatino Community

    17. Definition • Gambling refers to any game of chance or skill that involves a financial risk

    18. Facts on Gambling • Americans gamble more each year than they spend on groceries ($600B+ annually) • For 2 - 5% of the population, gambling is an addiction that destroys them personally, professionally and financially, not unlike alcoholism or drug abuse • Pathological gambling is recognized as a mental health disorder • Like adults, teens can be problem gamblers • Family members and friends play a strong role in either reinforcing or stopping a problem gambler’s addiction

    19. Availability of Gambling1975 Timothy Fong, UCLA

    20. Availability of Gambling1999 Timothy Fong, UCLA

    21. Availability of Gambling 2006 • All states with the exception of Utah and Hawaii have legalized some form of gambling • 40 states with lotteries • 28 states with Native American or independent casinos (CA Attorney General’s Office, 2006)

    22. Availability of Gambling in CA • Lottery (18,000+ locations) • Card Rooms (98) • 1,515 gaming tables • Indian Casinos (56) • 58,100 slot machines • 1,820 gaming tables • Horse Race Wagering (33) • Includes simulcast facilities • Other: Charitable gaming, Internet gambling, Nevada casinos, illegal venues “Gambling in the Golden State: 1998 Forward” (California Research Bureau, 2006)

    23. Blue cards = tribal casinos • Turquoise dots = card rooms

    24. Problem Gambling in CA Attorney General’s Report (2006) • 1.52M CA adults and minors • 589,000 adult problem gamblers • 333,000 adult pathological gamblers • 436,800 youth problem gamblers • 159,900 youth pathological gamblers • Annual societal cost: $998.1M “Gambling in the Golden State: 1998 Forward” (California Research Bureau, 2006) Hispanics 30%

    25. Examples • Lottery/Bingo • Casino games • Card Games • Racetrack betting • Sports Betting • Cock fighting/ Dog fighting • Street Dice / Numbers • Raffles • Stock market

    26. Types of Gamblers • Social • Professional • Problem • Pathological/ Compulsive

    27. No Gambling At-risk Gambling Pathological Gambling Social Gambling Problem Gambling

    28. Definition • Problem Gambling refers to gambling that significantly interferes with a person’s basic occupational, interpersonal, and financial functioning. (Gambling in the Golden State: 1998 Forward)

    29. Definition • Pathological Gambling is the most severe form of problem gambling and is classified as a mental health disorder with similarities to drug abuse including features of tolerance, withdrawal, diminished control, and relinquishing of important activities. (Gambling in the Golden State: 1998 Forward)

    30. LATINOSChallenges • Immigration status • “Machismo” and “Marianismo” • Carnalismo • Language access and other barriers • Help seeking behaviors: Less likely to seek help

    31. Problem Gambling:DSM IV Criteria

    32. Pathological Gambling:DSM IV Criteria • Persistent and recurrent maladaptive gambling behavior that disrupts personal, family, or vocational pursuits. • 5 of 10 criteria

    33. DSM-IV criteria for PG a) DSM Criteria for Disorder b) Comparison between PG and other addictions c) Sociological factors d) Psychological factors e) Physiological factors: studies of brain chemicals alterations • Co-morbidity of PG • a) PG and other addictions • b) Mood disorders • c) Physical conditions

    34. Characteristics:Loss of Control (I) • Is preoccupied with gambling • Has repeated unsuccessful efforts to control, cut back, or stop gambling • Gambles as a way of escaping from problems or of relieving a dysphoric mood (e.g., feelings of helplessness, guilt, anxiety, depression) • After losing money gambling, often returns another day to get even • Lie to family members, therapist, or others to conceal the extent of involvement in gambling

    35. Characteristics: Dependence (II) • Restless or irritable when attempting to cut down or stop (Withdrawal) • Needs to gamble with increasing amounts of money in order to achieve desired excitement (tolerance)

    36. Characteristics:Damage or Disruption (III) • Has committed illegal acts such as forgery, theft, fraud or embezzlement to finance gambling • Has jeopardized or lost a significant relationship, job, or education or career opportunity because of gambling • Relies on others to provide money to relieve a desperate financial situation caused by gambling

    37. Problem Gambling & Co-Morbidity

    38. Statistics • Steinberg et al. (1992) evaluated gambling problems in 298 treatment-seeking cocaine abusers using and found a 15% prevalence rate of pathological gambling • Review of literature: found rates of PG among substance abusers to be between 7%-39%. • Between 25%-63% of pathological gamblers also abuse substances.

    39. Similarities between Pathological 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 are progressive diseases with similar phases and stages

    40. Similarities(cont) • Addicts are often chasing the feeling of the first win or the first high • There are often blackouts or brownouts • The substance or behavior is frequently used to escape from pain • Low self-esteem is often present • Dysfunctional families are often involved • There is a use of rituals or patterns

    41. Differences between Pathological Gambler and a Substance Abuser • Gambling is often a hidden addiction • As long as there is money, overdose is not possible • You cannot drug test for pathological 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 compulsive gamblers and their families

    42. Differences (cont) • A problem with alcohol or other substances may progress for several years before becoming a debilitating problem, while pathological gambling usually is characterized by a sudden decline, perhaps in less than a year

    43. Micro-Level Risk Factors

    44. Psychological Factors • Personality • Sensation Seeking • Impulsivity • Mood States • Depression • Anxiety

    45. Familial Factors • Social Learning • Parents may serve to model gambling behaviors • Study participants who reported that parents have gambling problems were more likely to be pathological gamblers themselves. • Genetic Predisposition • Twin study found some heritability for pathological gambling symptoms based on DSM-III • Molecular genetic study found evidence for shared genetic component among pathological gamblers

    46. Macro-Level Risk Factors

    47. Sociological Factors • Social Rewards • Social Interaction • Sensory Stimulation • Decision-making Opportunities • Group Membership • Emotional / Moral Support • Self Esteem • Problems with Outside Society • Loss of Social Networks • External conflicts

    48. Culture & Problem Gambling • Cultural values found to: • influence the social acceptance of behaviors such as alcohol consumption • influence attitudes toward gambling, ranging from total abstinence to qualified endorsements • Collectivist cultures might exert greater influence over gambling behaviors • influence the type of gambling that may be punished and those that may be reinforced