Oct. 10, 2013
Jennifer Clegg, MSW, LSW, NCGC-II/BACC, OCPS-II
Gambling Program Specialist
Recovery Resources
3950 Chester Ave
Cleveland, OH 44114
216-923-4021
jclegg@recres.org
www.facetheodds.org
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Gambling is risking something of value on an
event that is determined mostly by chance.
A person is gambling if:
• he or she puts up something of value, such as
money or property
• the outcome has an element of chance beyond the
person’s control
• once the bet is made, it’s not reversible
Types of Gambling Activities
–
–
–
–
–
–
–
–
–
–
Lottery, scratch, pull-tabs and raffle tickets
Bingo
Sports betting
Slot machines
Card and table games
Horse betting
Internet gambling
Stock market speculation
Betting on other games
Other?
SOCIAL GAMBLING
PROBLEM GAMBLING
Occasional gambler.
Frequent, or spends
more time gambling.
Sticks to limits of
money to play with.
Plays with $ that is
needed or borrowed.
Hopes to win but
expects to lose.
Can take it or
leave it.
Expects to win;
keeps playing to
win back losses.
Is revolved around
gambling.
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Gambling is a problem when it disrupts or damages
your:
◦ mental or physical health
◦ work, school or other activities
◦ relationships
◦ finances
◦ reputation
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United States Estimates
• 1.5 % Pathological Gamblers
• 4% Problem Gamblers
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Problem and pathological gambling rates in
adolescents at least 2-3 times those of adults
12.00%
10.00%
8.00%
6.00%
Low Risk
4.00%
Moderate Risk
2.00%
High Risk
0.00%
Estimated Percent and Number of Persons for At-Risk
and Problem Gambling in Ohio
Problem
Gambling
The prevalence
of at risk and
problem
gambling in
Ohio is 2.8%,
which equates
to an estimated
246,561
individuals in
the target
population of
8,805,761.*
*(18 years and
older)
No Problem
Don’t Gamble
Gamble
Low
Risk
Moderate
Risk
Problem
43.3%
53.8%
2.2%
0.3%
0.3%
3,812,895
4,737,499
193,727
26,417
26,417
 Of the 8.8 million Ohioans aged 18 and older, an estimated
3.8 million (43.3%) do not gamble. Of the Ohioans who do
gamble, an estimated 4.7 million (53.8%) do not experience
any risk factors.
 Prevention activities may be beneficial if directed at the
220,144 (2.5%) persons who are estimated to be at-risk for
problem gambling, while treatment services and/or self-help
programs such as Gamblers Anonymous should be directed
at the 0.3% who are estimated to have a gambling problem
that meets DSM-IV diagnostic criteria.
 Approximately 10% of those who need treatment will seek
treatment (Cunningham, 2005), suggesting that
approximately 2,640 individuals may seek treatment or seek
out self-help such as Gamblers Anonymous.
9
Map of Cuyahoga Cluster Area
10
Estimated Percent and Number of Persons for At-Risk
and Problem Gambling – Cuyahoga County Cluster
Problem
Gambling
The prevalence
of at risk and
problem
gambling is
11.6% which
equates to an
estimated
145,143
individuals in
the target
population of
1,251,231.*
*(18 years and
older)
No Problem
Don’t Gamble
Gamble
Low
Risk
Moderate Risk
Problem
28.8%
59.6%
9.5%
2.0%
0.1%
360,355
745,734
118,867
25,025
1,251
 Of the 1.25 million Ohioans aged 18 and older in the
Cuyahoga area, an estimated 360,355 (28.8%) do not
gamble. Of the Ohioans in this cluster who do gamble, an
estimated 745,734 (59.6%) do not experience any risk
factors.
 Prevention activities may be beneficial if directed at the
143,892 (11.5%) persons who are estimated to be at-risk for
problem gambling, while treatment services and/or self-help
programs such as gamblers anonymous should be directed
at the 0.1% who are estimated to have a gambling problem
that meets DSM-IV diagnostic criteria.
 Approximately 10% of those who need treatment will seek
treatment (Cunningham, 2005), suggesting that
approximately 125 individuals may seek treatment.
11
Map of Lucas County Cluster Area
12
Estimated Percent and Number of Persons for At-Risk
and Problem Gambling – Lucas County Cluster
Problem
Gambling
The prevalence
of at risk and
problem
gambling is
14.8% which
equates to an
estimated
62,652
individuals in
the target
population of
423,316.*
*(18 years and
older)
No Problem
Don’t Gamble
Gamble
Low
Risk
Moderate Risk
Problem
30.7%
54.5%
11.9%
2.7%
0.2%
129,958
230,707
50,375
11,430
847
 Of the 423,316 Ohioans aged 18 and older in the Lucas
County Cluster, an estimated 129,958 (30.7%) do not
gamble. Of the Ohioans in the cluster who do gamble, an
estimated 230,707 (54.5%) do not experience any risk
factors.
 Prevention activities may be beneficial if directed at the
61,805 (14.6%) persons who are estimated to be at-risk for
problem gambling, while treatment services and/or self-help
programs such as gamblers anonymous should be directed
at the 0.2% who are estimated to have a gambling problem
that meets DSM-IV diagnostic criteria.
 Approximately 10% of those who need treatment will seek
treatment (Cunningham, 2005), suggesting that
approximately 84 individuals may seek treatment.
13
Map of Franklin County Cluster Area
14
Estimated Percent and Number of Persons for At-Risk
and Problem Gambling – Franklin County Cluster
Problem
Gambling
The prevalence
of at risk and
problem
gambling is
14.2% which
equates to an
estimated
153,815
individuals in
the target
population of
1,083,205.*
*(18 years and
older)
No Problem
Don’t Gamble
Gamble
Low
Risk
Moderate Risk
Problem
37.6%
48.2%
9.2%
4.8%
0.2%
407,285
522,105
99,655
51,994
2,166
 Of the 1,083,205 Ohioans aged 18 and older in the Franklin
Cluster, an estimated 407,285 (37.6%) do not gamble. Of
the Ohioans in this cluster who do gamble, an estimated
522,105 (48.2%) do not experience any risk factors.
 Prevention activities may be beneficial if directed at the
151,649 (14.0%) persons who are estimated to be at-risk for
problem gambling, while treatment services and/or self-help
programs such as gamblers anonymous should be directed
at the 0.2% who are estimated to have a gambling problem
that meets DSM-IV diagnostic criteria.
 Approximately 10% of those who need treatment will seek
treatment (Cunningham, 2005), suggesting that
approximately 216 individuals may seek treatment.
15
Map of Hamilton County Cluster Area
16
Estimated Percent and Number of Persons for At-Risk
and Problem Gambling – Hamilton County Cluster
Problem
Gambling
The prevalence
of at risk and
problem
gambling is
12.7% which
equates to an
estimated
108,453
individuals in
the target
population of
853,962.*
*(18 years and
older)
No Problem
Don’t Gamble
Gamble
Low
Risk
Moderate Risk
Problem
31.6%
55.7%
7.8%
3.5%
1.4%
269,852
475,657
66,609
29,889
11,955
 Of the 853,962 Ohioans aged 18 and older in the Hamilton
County Cluster, an estimated 269,852 (31.6%) do not
gamble. Of the Ohioans in this cluster who do gamble, an
estimated 475,657 (55.7%) do not experience any risk
factors.
 Prevention activities may be beneficial if directed at the
96,498 (11.3%) persons who are estimated to be at-risk for
problem gambling, while treatment services and/or self-help
programs such as gamblers anonymous should be directed
at the 1.4% who are estimated to have a gambling problem
that meets DSM-IV diagnostic criteria.
 Approximately 10% of those who need treatment will seek
treatment (Cunningham, 2005), suggesting that
approximately 1,195 individuals may seek treatment.
17

43.7 % of Pathological Gamblers have
committed crimes
(Blaszynski, McConaghy, Francova, 1989)

Various reports indicate 255-50% of
incarcerated offenders meet criteria for
problem or pathological gambling
(Zorland, Mooss, Perkins, 2008)
Pathologica Problem
l gambler
Gambler
Low Risk
Gambler
No Gambling
Arrest rates
32%
32%
10%
4.5%
# of times
arrested
3.3
1.6
2.1
1.7
Imprisoned
23%
13%
6%
National Gambling Impact Study, NORC 1999
Impact
• Each compulsive gambler costs society $13,000.00 each
year.
• In Ohio: more than $2.2 billion each year.
• One estimate: $289 in social costs for every $46
economic benefit
• It is estimated that each problem gambler will directly
impact the lives of a minimum of 7 other people – mostly
family.

Debt
◦ $38,000 to $113,000

Illegal Activities
◦ 60% estimated to commit illegal acts
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Embezzlement
Forgery
Identity Theft
Fraud
Robbery
Drug Dealing
Assault
Comparison of CD and Gambling
Tolerance
• Chemical Dependency
• Tolerance, as defined by either
of the following:
o a need for markedly
increased amounts of the
substance to achieve
intoxication or desired
effect
o markedly diminished effect
with continued use of the
same amount of
substance.
• Pathological Gambling
• needs to gamble with
increasing amount of money in
order to achieve the desired
excitement.
Comparison of CD and Gambling
Withdrawal
• Chemical Dependency
• withdrawal, as manifested by
either of the following:
o the characteristic
withdrawal syndrome for
the substance
o the same (or closely
related) substance is taken
to relieve or avoid
withdrawal symptoms.
• Pathological Gambling
• is restless or irritable when
attempting to cut down or stop
gambling
Comparison of CD and Gambling
Loss of control
• Chemical Dependency
o the substance is often taken in
larger amounts or over a
longer period than was
intended
o there is a persistent desire or
unsuccessful efforts to cut
down or control substance use.
• Pathological Gambling:
• repeated unsuccessful effort to
control, cut back, or stop
gambling.
Comparison of CD and Gambling
Preoccupation
Chemical Dependency
A great deal of time is spent in
activities necessary to obtain
the substance, use the
substance, or recover from its
effects.
• Pathological Gambling
• is preoccupied with gambling …
Comparison of CD and Gambling
Consequences
• Chemical Dependency
o important social, occupational,
or recreational activities are
given up or reduced because
of substance use.
o the substance is continued
despite knowledge of having a
persistent or recurrent physical
or psychological problem that
is likely to have been causes
or exacerbated by the
substance…
• Pathological Gambling:
o lies to family member,
therapist, or others to conceal
…gambling
o has committed illegal act …to
finance gambling.
o has jeopardized or lost a
significant relationship, job or
educational or a career
opportunity because of
gambling
Comparison of CD and Gambling
• Similarities
Preoccupation
•
•
•
•
•
•
•
•
•
•
•
Lack of control
Ambivalence (rather than denial or resistance)
Substance use
Depression
Escape
Family dysfunction
Intolerance
Chasing
Need immediate gratification
Shame
Co morbidity
Comparison of CD and Gambling
• Differences
Not easily detected
•
•
•
•
•
•
•
•
•
Fantasy/Dream Life
Not self limiting, can’t pass out or overdose
Job, family, functional
Suicidality
Hopelessness
Financial (extreme debt)
Family impact (finances)
Social perception of gambling
Few resources
Solitary
Pathological Gambling DSM IV
•
A. Persistent and recurrent maladaptive gambling behavior as indicated by five (or more) of
the following:
•
•
•
•
•
•
•
•
•
•
Preoccupation
Gamble more money in order for desired excitement
Unsuccessful at control, cut back, or stopping gambling
Restless or irritable when cut down or stop
Escaping problems / relieving a dysphoric mood
Chasing
Lies
Illegal acts to finance gambling
Risked or lost a significant relationship, job, or school
Bailouts to relieve a desperate financial situation
•
B. The gambling behavior is not better accounted for by a Manic Episode.
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New Name:
◦ Disordered Gambling
New Classification:
◦ Addiction and Related Disorders
Disordered Gambling the only behavioral addiction
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Why change?
◦ Reward center research
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Similarities to Substance Use Disorders
Cravings
Highs
Hereditary nature
Similar treatment
 12 step
 CBT
 MI

“Is preoccupied with gambling” most useful criteria
with lowest levels of gambling severity

“Illegal acts” is most helpful only for highest levels
of gambling severity

Result…consider dropping the Illegal Act criteria

Strong and Kahler, 2007
FAMILY
Secrecy/withdrawal
Unexplained
debts/cash
Missing money
Increased anxiety
Substance use
Work
Tardiness
Missing work
Stealing
Mood swings
COMMUNITY
Criminal activity
Theft/Robbery
Embezzlement
Drug dealing
Shoplifting
♠
Loss of control over gambling behaviors
Spending more money than intended
Playing for longer periods than intended
Playing more often than intended
Wanting to gamble when one knows
they should be doing other things
Not being able to stop thinking
about gambling
♦
Being preoccupied with gambling
Frequently talking about gambling
Often thinking of the next
gambling venture
♥
♣
Lying about one’s gambling
Borrowing and stealing
money from friends, family
members and others in order to keep
gambling.
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The following can be found at:
http://www.problemgambling.az.gov/screeningtools.htm
◦ SOGS-R (South Oaks Gambling Screen-Revised)
◦ NODS (National Opinion Research Center DSM
Screen for Gambling Problems)
◦ NODs CLiP
◦ GA 20 Questions

The following can be found at:
http://www.npgaw.org/media/pdfs/PDF3.pdf
◦ SOGS-RA (South Oaks Gambling Screen-Revised
Adolescent)

The following can be found at:
http://www.oregon.gov/DHS/addiction/gambling/2010/bbgs
.pdf?ga=t
◦ BBGS – Bio-Social Gambling Screen

The following can be found at:
http://www.problemgambling.ca/EN/ResourcesForProfession
als/Pages/IGS.aspx
◦ IGS- Inventory of Gambling Situations
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Identification of risk adverse..at the track and
further
WIN
◦ Ventral striatum becomes activated, flooded with
dopamine (sex, drugs, pleasure)
◦ Once activated want more..and more and more

LOSS
◦ The same area of the brain become less active
◦ Risk aversion
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The Ventral Striatum remains unreactive
EVEN DURING WINNING STREAKS
Decreased response to the “high”
Decreased activation in the ventrolateral
prefrontal cortex
Keep gambling despite negative impact
Keep gambling to increase to normal levels
of dopamine
Seen in SUD
2009
Clark et al

The brain is hijacked….
◦ When triggered with a gambling cue the area of the
brain responsible for impulse control is off
◦ Potenza et al 2003
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It is a therapeutic, intervention and
rehabilitative approach — within the criminal
justice system and under judicial supervision
— for defendants who commit non-violent
crimes because of gambling addiction.
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Started by Judge Mark Farrell in New York State
in 2001
350 people screened for gambling addiction
100 deemed appropriate for diversion
27 have graduated from treatment programs
Only 3 have returned to the legal system, with
non-gambling offenses
The cost of gambling court treatment is only
one sixth the amount of money it costs to keep
someone in jail.
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http://gamblingcourt.org/videoFarrell.php
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www.gamblingcourt.org
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TREAT THE MONEY YOU LOSE AS THE COST OF YOUR ENTERTAINMENT: Treat
any winnings as a bonus.
PLAN AHEAD: SET A DOLLAR LIMIT AND STICK TO IT. Decide before you go
not only what you can "afford" to lose, but how much you want to spend. Do
not change your mind at the casino after losing.
SET A TIME LIMIT AND STICK TO IT: Decide how much of your time you want
to allow for gambling - leave when you reach the time limit whether you are
winning or losing.
BE PREPARED TO LOSE: The odds are that you will lose. Accept loss as part of
the game.
MAKE IT A PRIVATE RULE NOT TO GAMBLE ON CREDIT: Do not borrow to
gamble.
CREATE BALANCE IN YOUR LIFE: Gambling should not interfere with or
substitute for friends, family, work or other worthwhile activities
AVOID "CHASING" LOST MONEY. After you've reached your designated dollar
limit, DON'T continue to play in order to try to win back the money. Stop
gambling and go see a show, or go home.
DON’T GAMBLE AS A WAY TO COPE WITH EMOTIONAL OR PHYSICAL PAIN.
Instead, talk to a friend, a family member or a professional counselor.
BECOME EDUCATED ABOUT THE WARNING SIGNS OF COMPULSIVE GAMBLING
• you are experiencing significant financial
problems;
• you continue to see gambling as a solution to
financial problems;
• you gamble to escape and/or cope with
negative situations and moods;
• your gambling is related to an impulse
disorder;
• you have been mandated to by the legal
system;
• you have already made unsuccessful attempts
to reduce your gambling; or
• your relationships or employment may be at
risk if you continue to gamble.
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Recovery Resources Gambling Service
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Assessment
Individual Counseling
Group Therapy
Family Therapy
Prevention Education Services
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Recovery Resources Services
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Assessment
Substance abuse treatment
Case management
Mental health services
Education and prevention services
Adolescent treatment services
For more information about our services at
Recovery Resources, please call,
216-431-4131.
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Please visit our website at
www.recovery-resources.org

For more information about the gambling
services at Recovery Resources, visit our
website at www.facetheodds.org
1-800-589-9966
Cleveland
Toledo
Youngtown
Columbus
Athens
Cincinnati

www.facetheodds.org – Recovery Resources Gambling website
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www.recovery-resources.org – Recovery Resources website
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www.gamblingcourt.org – Gambling Court in New York State
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www.ncpgambling.org – National Council on Problem Gambling
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www.pgnohio.org – Problem Gambling Network of Ohio
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http://www.gamblersanonymous.org/mtgdirOH.html - GA
meetings
www.npgaw.org – National Problem Gambling Awareness Week
www.odadas.state.oh.us – Ohio Department of Alcohol and Drug
Addiction Services
Athens
Health Recovery Services
244 West State St.
Athens, Ohio 45701
Toll Free: 866-614-9588
Phone: 740-589-3680
Fax: 740-594-3727
Cincinnati
Central Community Health Board
Drug Services Program
3020 Vernon Place
Cincinnati, OH 45219
513-559-2056
Cleveland
Recovery Resources
Jennifer Clegg, MSW, LSW, NCGCI
14805 Detroit Ave. Suite 200
Lakewood, OH 44107
216-923-4001 ext. 4215
jclegg@recres.org
www.facetheodds.org
www.recovery-resources.org
Cleveland
Cleveland V.A. Hospital Wade Park
Heather A. Chapman, Ph.D., NCGC II
10701 East Blvd., 3rd Floor, Room # 3A165
Cleveland, OH 44106
(440) 526-3030 x 6962
Columbus
MARYHAVEN MAIN CAMPUS
1791 Alum Creek Drive
Columbus, Ohio 43207
Phone (614) 445-8131
Toledo
Substance Abuse Services
832 Adams Street
Toledo, OH 43624
419-243-7274
Youngstown
Meridian Services
Lynn Burkey NCGCI
527 North Meridian Road
Youngstown, OH 44509
330-797-0070

www.facetheodds.org – Recovery Resources Gambling website

www.recovery-resources.org – Recovery Resources website

www.gamblingcourt.org – Gambling Court in New York State
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www.ncpgambling.org – National Council on Problem
Gambling
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http://www.gamblersanonymous.org/ - GA meetings
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www.npgaw.org – National Problem Gambling Awareness
Week
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www.odadas.state.oh.us – Ohio Department of Alcohol and
Drug
Addiction Services
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www.org.ohio.gov – Ohio for Responsible Gambling