2013 Mid-Atlantic
Behavioral Health Conference
Ideas In Action
Innovations - Partnerships Technologies
“Gambling: The Hidden Addiction”
Prevalence and Screening Tools
Presenter
Carl E. Robertson, MRE, MDiv.- Prevention Manager
Funded by DHMH/ADAA
Maryland Center of Excellence on Problem Gambling
Partnership of Maryland Council on Problem Gambling and the University
of Maryland School of Medicine
Funded with a 3 year grant (2012-2015 ) from State Health Department
Purpose:
 Identify and promote problem gambling treatment resources
 Provide Maryland based prevention and research initiatives
 Establish problem gambling lending library resources
 Conduct Public and Professional Awareness Outreach Campaigns
 Manage Maryland Problem Gambling Hotline: 1-800-522-4700
Funded by DHMH/ADAA
• If you bet on a horse, that’s gambling.
• If you bet you can make three spades, that’s
entertainment.
• If you bet cotton will go up three points, that’s
business.
• What’s the difference?
• Gambling is any activity or game where you risk
something of value or money on an outcome that
is not guaranteed.
Funded by DHMH/ADAA
Problem and Pathological Gambling Definitions
Problem Gambling – is a descriptive term used to define
those individuals with problems in their lives due to
gambling.
Pathological/Compulsive Gambling- is the clinical term
for the Impulsive Control Disorder defined in DSM IV312.31 (failure to resist the impulse to gamble)
Funded by DHMH/ADAA
DSM V
►Leaving- Impulse Control Disorder
►Joining- “Substance Use Disorder” section
►“Behavioral Addictions” = “Gambling Disorder”
►9 vs 10 Criteria (Illegal activities may be dropped)
“In functional brain imaging-whether with gamblers or drug addicts-when they are showed video or
photograph cues associated with their addiction, the same brain areas are activated”. Charles
O’Brien, M.D. chair of the DSM-5 Work Group on Addictive Disorders
► Compulsive Gambling News
DSM V Severity Criteria
►“Gambling Disorder” Severity Rated
►9 vs 10 Criteria (Illegal activities may be dropped)
►2-3 Criteria will be indicative of a Mild Disorder
►4-5 Criteria will be indicative of a Moderate Disorder
►6 or More will be indicative of a Severe Disorder
► (The threshold for diagnosis (DSM-5) is two or more criteria in contrast to one
or more criteria for DSM-4)
Remaining Questions
• Effect on reimbursement
• Effect on SAMHSA recognition
• Effect on research funding
And remember:
We are treating people with gambling problems, not
problem gamblers
What do we know about Adult and Adolescent
Problem Gambling?
Actually, quite a lot, there is data from sources such as:
•
•
•
•
National Research Council – 1999
McGill University – 1998/Present
National Council on Compulsive Gambling
Gambling Prevalence in Maryland: A Baseline
Analysis – 2010
• Johns Hopkins Longitudinal Study
Who Are Adult Problem Gamblers based on
National Research Council Survey 1999
• About 1-3% of the Adult Population of the
U.S. has a Gambling Problem
• Estimated to be over 4-6 million adults in the
United States(combination of pathological/problem gamblers)
• Estimated to be over 128,670 adults in
Maryland (based on 2011 census projections)
Who Are Adult Problem Gamblers based on
Maryland Baseline Survey 2010
• Survey indicated 3.4 % of the Adult Population in
Maryland are problem/pathological gamblers
•
(1.5% pathological/1.9% are problem gamblers)
• Estimated to be over 154,400 adults in
Maryland(based on Maryland Baseline projections)
• Range: 128,670 – 154,400 Adult Marylanders
WHAT DOES
+
REPRESENT?
Capacity 71,008 x 2 = 142,016
Represents less than the 154,400 Adult Gamblers in MD
Youth Prevalence Findings
• 4-8 % Level III, Probable Pathological gambler (NRC,
1999)
• 1.1 million youth 12-17 exhibit pathological
gambling behavior (NGISC, 1999)
• 10-15% at-risk for Problem Gambling (Shaffer & Hall, 1996;
Winters, Stinchfielf, & Fulkerson, 1991; Wiebe, 1999; Wynne, Smith, & Jacobs,
1996)
• Youth Gambling 4 to 6 % (problem/pathological)
• Maryland Youth Estimated: 47,000-50,000
(problem/pathological based on 2011 census projections)
Capacity 45,971 to 48,187
If you filled Camden Yards what would that represent?
Johns Hopkins survey
Study began in 1993 in 27 1st Grade Classrooms in
Baltimore City public schools
Data Sources utilized:
Teacher ratings
Parent ratings
Self-reports: 90 minute self-administered computer
interview
Gambling data collected via age appropriate scales
SOGS-RA in 2004, 2006-07 and SOGS 2008-2011
Funded by DHMH/ADAA
Prevalence of Baltimore
Inner-City Youth
• Found that 11-15% of adolescents/adults have
some form of problem gambling from the
groups studied since 2004
• (when gambling questions were added to the study.)
What do we know about Emerging Adult
Problem Gambling?
•
•
•
•
National Research Council – 1999
Delaware College Gambling Study – 2011
Gambling on Campus: New Directions Series
NCRG: College Gambling blueprint
College Problem Gamblers based on
National Data
• About 4-8% of College students of the U.S. have a
Gambling Problem (problem/pathological)
• Most authors use 6-8% as the average percentage.
(e.g. NCRG; Oregon)
• 18-23% of students gamble on a weekly basis
• 75-85% of students gambled in the past year
• 22% of colleges have written gambling policies
Based on Md Higher Education Enrollment
Projections: June, 2012
Maryland College Level Problem Gambling
• Using 6%: there are at least 18,867 College level
problem gamblers on Md campuses
• Using 8%: there are at least 25,156 college level
problem gamblers on Md campuses
• Range: 18,867 – 25,156
(Based on Maryland Higher Education Actual Enrollment Projections of: 314,451 students)
Comcast Center: capacity 17,950
Adapted from Understanding Substance Abuse Prevention: Toward 21st Century Primer on Effective
Programs (P. Brounstein & J. Zweig, 1999). Center for Substance Abuse Prevention (CSAP) &
Substance Abuse and Mental Health Services Administration (SAMHSA). Dickson, Derevensky, &
Gupta (2002).
Integrated Model: No Wrong Door
Mental
Health
Center
Gambling Integrated
Assessment
(including PG
Screen)
Pos or Neg
PG Enhanced
Treatment
Gambling
Problems
Screen
Positive
Substance
Abuse
Treatment
Center
Screen
Gambling
Specific
Assessment
Pos or Neg
Positive
Pos or Neg
Gambling
Specific
Treatment
Funded by DHMH/ADAA
Gambling Integrated
Assessment
(including PG
Screen)
Pos or Neg
PG Enhanced
Treatment
22
Lifetime Co-morbidity
Kessler et al., 2008 (National Comorbidity Survey Replication)
• Although nearly half (49%) of those with
lifetime pathological gambling received
treatment for mental health or substance
abuse problems, none reported treatment for
gambling problems.
Psychiatric Comorbidity in Pathological Gamblers: Summary of Research of PG’s in Treatment
~50-80%
Affect
Disorders
~10-35%
~5-30%
Anxiety
Disorders
Trauma
Pathological
Gambling
~20-35%
Attention Deficit
Disorder
Substance Use
Disorders
Personality
Disorders
~20-93%
~25-63%
Pathological Gambling: Comparison to Substance
Abuse
ySimilarities
xLoss of Control
xPreoccupation
xNegative impact on major life areas
xTolerance
Pathological Gambling: Comparison to Substance
Abuse
ySimilarities
xWithdrawal Symptoms
xSelf-help groups
xBiopsychosocial/spiritual disorders
xFamily involvement
Pathological Gambling: Comparison to Substance
Abuse
yDifferences
xUnpredictable outcome
xFantasies of success
xNo biological test
xEasier to hide
Pathological Gambling: Comparison to Substance
Abuse
yDifferences
xGreater financial problems
xIntensity of family anger
xLess public awareness and
acceptance
Screening
• What questions about gambling can you incorporate
into each part of your interview?
–
–
–
–
–
–
Biological/Medical
Substance Use/Abuse
Psychological
Social
Leisure Activities
Spiritual
Family Screening
• Does Family Have Significant Financial
Problems
• Are Financial Problems Related to Gambling
(Either causing them or seen as solution)
• Have You Been Concerned About Extent of
Gambling of Family Member?
Instruments
•
•
•
•
•
•
•
South Oaks Gambling Screen (SOGS)
PERC-(NODS)instrument
Gambling Severity Index
GA-20 Questions
“Lie-Bet” 2 Question Brief Screen
SOGS-R A- Adolescent Screen
Mass. Adolescent Gambling Screen
Resources for Problem Gamblers


The Maryland Center of Excellence on Problem
Gambling is a resource center.
Our Helpline operates 24/7 for referrals for
problem gamblers and their families at:
1-800-522-4700


Visit the webpage at:

www.MdProblemGambling.com
Thank you
Carl Robertson
croberts@psych.umaryland.edu
410-328-4710
Funded by DHMH/ADAA