Understanding the Hidden
Addiction and the Pathways to
Recovery
Lori A. Mello
Peter Harrington
Bernard Zietler
History of
Neighborhood Service Organization
 Established in 1955 as a private non-profit human
service agency.
 The Mission of NSO is to provide diverse and
innovative community development programs and
community services to meet the changing needs of
the regions population. We are “ALWAYS WITHIN
REACH”
 Prevention and training are fundamental
components of our programs. These components
empower consumers and enhance the skills of
other professionals.
Michigan Problem Gambling
Help Line
and Treatment Program
1-800-270-7117
Problem Gambling Services are
administered by the Michigan
Department of Community Health
Bureau of Substance Abuse & Addiction
Services,
which are provided through a contract
agreement with Neighborhood Service
Organization (NSO).
MICHIGAN PROBLEM GAMBLING
24 HOUR HELPLINE
1-800-270-7117
 Statewide Helpline funded by the Michigan Dept. of Community
Health, Bureau of Substance Abuse and Addictions Services
 Comprehensive Screening
 Treatment and Information Referrals
 Referral to GA/Gamanon
 Crisis Intervention
 Speakers Bureau
History and Operation of the Michigan
Problem Gambling Helpline
 The MPGHL is:
 A 1-800 helpline for individuals experiencing problems with
gambling
 Funded by the Michigan Department of Community Health
through Neighborhood Service Organization since 1999
 It is and has always been statewide
 On the Helpline, we:
 emphasize to callers that help is available regardless of their
insurance status or financial difficulties.
 help with referrals to community-based mutual support groups
such as Gamblers Anonymous and Gamanon when
appropriate and available
Definition of Gambling
 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.
 To risk money or something of value on the
outcome of a game, contest or other event.
The History of Gambling in the United States
Postcard, circa 1910
A Brief History…
 In 1978 only two states had legalized casino gambling
– New Jersey and Nevada.
 In 1998, only two states did NOT have some form of
legalized gambling.
 This statement underscores the phenomenal growth of
the gambling industry and the exposure of individuals
from all walks of life to it.
 In the United States, gambling is a
$40 billion industry and some type
of legal gambling opportunity is
now available in every state except
Utah and Hawaii.
 Gambling appears to be a common
pursuit of older Americans.
 In a 2001 study, seniors rated a trip
to a casino as their most popular
day-trip social outing.
Prevalence of Compulsive Gambling
 Two million (1%) of U.S. adults are estimated to meet
criteria for compulsive gambling in a given year.
 Four to eight million (2-3%) would be considered
problem gamblers
 they do not meet the full diagnostic criteria for compulsive
gambling
 They do meet one or more of the criteria however
 They are experiencing major problems due to their gambling
behavior.
“A Survey of Gambling Behaviors in Michigan, 2006”
 Number of residents currently having a gambling
problem is 146,854. This estimate is equivalent to
about 1 out of every 50 residents aged 18 and older.
This is a decrease from 205,596 (28%) in 2001.
 Of this number 66,000 are estimated to be “probable
pathological gamblers”. That is about 1 out of every
110 Michigan residents aged 18 and older.
Types of Gambling
 Casino
 Cards
 Dice
 Roulette
 Slot Machines
 Video Poker
 Lottery
 Racetrack
 Keno, Pull Tabs
 Internet
 Sports
 Bingo
Why People Gamble
 Recreation and
entertainment
 Relaxation
 Excitement
 Attempt to make money
 Attempt to feel better
 Escape from feelings of
loneliness, anxiety,
depression, boredom
 To feel important
 Inability to stop
gambling
Types of Gamblers
 Social Gambler
Most individuals fall into this category. Their gambling
activity does not create financial, social or behavioral
problems.
 Problem Gambler
Individuals in this category experience problems related
to their gambling activity. Problems with family
relationships and increasing debt are often present in
this stage.
Types of Gamblers (cont’d)
 Compulsive/Pathological Gambler
This term is used to describe individuals who
meet DSM IV diagnostic criteria. Individuals in
this category are experiencing major life
problems related to their gambling activity.
DSM IV Pathological Gambling Diagnostic Criteria
A. Persistent and recurrent maladaptive gambling
behavior as indicated by five or more of the following:





Is preoccupied with gambling (e.g., preoccupied with reliving past
experiences, handicapping or planning the next venture, or thinking of
ways to get money with which to gamble)
Needs to gamble with increasing amounts of money in order to achieve
the desired excitement
Has repeated unsuccessful attempts to control, cut back, or stop
gambling.
Is restless or irritable when attempting to cut down 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).
DSM IV DIAGNOSTIC CRITERIA (CONT’D)





B.
After losing money gambling, often returns another
day to get even (“chasing” one’s losses).
Lies to family members, therapist or others to conceal the
extent of involvement with gambling.
Has committed illegal acts such as forgery, fraud, theft, or
embezzlement to finance gambling.
Has jeopardized or lost a significant relationship, job, or
educational or career opportunity because of gambling.
Relies on others to provide money to relieve a desperate
financial situation caused by gambling.
The gambling is not better accounted for by a Manic
Episode
Characteristics of Compulsive Gambling
 Preoccupation: Measured
through frequency of
participation, time lost from
work.
 Tolerance: Needing to spend
progressively more money.
 Escape: Gambling to escape
or celebrate.
 Lying: About winning, hiding
proof of participation.
 Loss of control: Borrowing
to relieve desperate financial
stress.
 “Chasing” losses: Going to
win back losses.
 Illegal acts: Forgery, fraud,
theft, embezzlement
 Risking jobs, education, or
relationships: Arguing about
gambling with friends or
relatives, loss of reputation,
unhappy home life.
Progression of Compulsive Gambling
 Winning Phase
 Losing Phase
 Desperation Phase
 Hopelessness Phase
I. Winning Phase




Wins more than loses.
Gambling NOT creating financial burden.
May have big win/increase time spent gambling.
Distinction from social gambling:
 sometimes slow onset, other times more rapid onset
 winning is linked to self-esteem
 preoccupied with gambling, affects social and work life
as other activities become secondary to gambling
 Physiologically-extreme excitement, rapid heartbeat, nausea,
queasiness.
II. Losing Phase




Prolonged losing episodes.
Gambling alone.
Obsessed with gambling.
Begins legal borrowing to cover losses or to obtain
more gambling money.
 Begins chasing losses; abandons strategies; tries to
win back all at once; lies to conceal extent of losses.
II. Losing Phase - Cont’d
 Runs out of all usual sources from which to obtain
money. May switch to illegal sources of borrowing.
 Unable to pay debts.
 Personality changes (irritable, restless, withdrawn).
 Careless about spouse and family (unhappy home life).
 Losing time from work.
III. Desperation Phase
 Crossing the line: commits acts never thought
he/she would commit to continue gambling (to cover
losses), like:




Writing bad checks
Borrowing or taking money from family
Behind on rent or mortgage/bills
Stealing (i.e. embezzlement)
III. Desperation Phase - Cont’d
 Increased depression/anxiety (emotional roller
coaster).
 Ego-dystonic: repeated acts that violate one’s logic,
values, commitment or sense of what one thought one
would never do.
 At beginning says one time occurrence (rationalization)
 when it recurs, he/she continues to keep track or score
 by the end he/she is no longer keeping track.
 Suicidal thoughts or attempts may occur.
IV. Hopelessness Phase
 Continue gambling with increasing sense of
hopelessness and despair
 Increasing isolation and loss of remaining support
systems
 Feeling “burned out”
 Realizes one won’t ever win (or win back losses), yet
continues to gamble (can’t stop)
 Substance use/abuse
 Emotional breakdown
 Suicidal thoughts or attempts may occur
Impact of Compulsive Gambling
 Insurmountable debts
 Loss of employment
 Legal battles
 Neglect or abuse
 Physical illness
 Divorce
 Mental health issues
 Isolation
 Shame/guilt
 Arrest and/or
imprisonment
 Suicide
ROLE OF THE CLINICIAN


Remember to ask the questions
The minimal amount of questions should include
the following:
 Do you gamble? More specifically, do you…go to
the casino, play the lottery, buy scratch-offs, go to
BINGO, play “numbers,” participate in sports betting,
etc.? How often and for what duration?
 Have any of these activities ever caused you any
problems such as work issues, health issues,
relationship issues, etc.? There are specific
questions regarding this, such as…
 Have you ever sold anything to finance the activity?
 Were you reluctant to use "gambling money" for normal
expenditures?
 Did this activity make you careless of the welfare of yourself or
your family?
 Did you ever play for a longer period than you had planned?
 Have you ever played to escape worry or trouble?
 Have you ever committed, or considered committing, an illegal act
to finance more time with the activity?
 Did it ever or does it cause you to have difficulty in sleeping?
 Do arguments, disappointments or frustrations create within you
an urge to go out and play/engage in the activity?
 Did you ever have an urge to celebrate any good fortune by a few
hours of gambling (any of the activities)?
 Have you ever considered self destruction or suicide as a result of
your gambling (i.e. lost a great deal of something as a result?)
Remember…this is
The “HIDDEN ADDICTION”
There is no substance ingested
There are usually no visible signs.
Unlike alcohol or other drug abuse where
those under the influence may appear
intoxicated or "high," problem gamblers
usually do not exhibit easily recognizable
signs. However, there are signs that may
indicate someone is experiencing a gambling
problem.
TREATMENT CONSIDERATIONS
 Individuals with active gambling problems often
seek help not for their gambling but for related
symptoms such as depression, anxiety, sleep
disturbances, or for functional problems with
relationships, school, or job.
 They may not conceptualize gambling as part
of the problem but rather as part of the
solution.
Challenges in Treatment
 There is, most often, treatment of more than one mental
health issue.
 Gambling can both relieve AND contribute to depression.
 The belief system of the compulsive gambler—difficult to
identify the gambling as a “destructive force” in his/her
life
 Preventing relapse—gambling very “normalized” in our
society
 Finding activities that will easily replace the gambling
activity
Similarities and Differences Between Problem
Gambling and Substance Abuse
 SIMILARITIES
Lying (to family, friends) to support use
Used as means of escaping problems
Withdrawal symptoms common
Co-morbidity
Poor self esteem
Depression
Poor communication/intimacy skills
Low tolerance for frustration
Poor coping skills
Similarities and Differences Between
Problem Gambling and Substance Abuse
 DIFFERENCES
 Diagnostic classification.
• Currently, Pathological gambling is classified as a progressive
psychological disorder (impulse control)
• Substance abuse disorders are classified as substancerelated disorders.
 Problem gambling is an invisible disorder.
 No substance is ingested with gambling disorders.
 No chemical overdose with gambling disorders.
 Unpredictability of the gambling activity.
 Problem gambling is easy to hide.
 Perception/acceptance of gambling disorder.
 Denial somewhat more pervasive in problem gambling.
Similarities and Differences Between
Problem Gambling and Substance Abuse
 DIFFERENCES (cont’d)
Financial crisis VERY likely for gambler
Fantasy of gambling becoming a career or “success”
path
No physical signs with problem gambling
High suicide attempt rate with problem gamblers
Fewer treatment resources
Prevention programs not prevalent
Family impact felt longer with problem gambling
100% abstinence very difficult with problem gambling
Public awareness of problem gambling is improving but
still many are resistant to the idea that this is an
“addiction”
Comorbidity among pathological gamblers
Alcohol use disorder (44.5-73.2%)
Drug use disorder (23.3%-38.1%)
Major depression (8.8%-37%)
Dysthymia (4.2%-20%)
Mania (3.1%-22.8%)
Generalized anxiety (7.7%-11.2%)
Panic disorder (3.3%-23.3%)
Agoraphobia (5.1%-13.3%)
Phobia (10%-23.5%)
Obsessive-compulsive disorder (3.9%- 16.7%)
Source: Bland, Newman, & Stebelsky, 1993; Cunningham-Williams, Cottler, Compton, &
1998; Petry, 2005
Spitznagel,
CROSS ADDICTION
 Cross addiction is the presence of two or more
substance dependencies.
 Cross addictions are very common and can
usually be treated simultaneously.
 Many cross addicted consumers have
developed their dependencies in an effort to
deal with their primary addiction.
CHEMICAL AND BEHAVIORAL CROSS
ADDICTION
 A growing body of empirical and theoretical
research has concentrated on the overlaps and
commonalities among chemical and non-chemical
(behavioral) addictions.
 Pathological gambling has perhaps been the most
widely researched behavioral addiction.
 Some of this research has concerned the coexisting links between pathological gambling and
alcohol/drug addiction in both the gambling
substance abuser and the substance abusing
gambler (i.e. cross addiction).
Disassociated Persons List
To help those who believe they have a problem with
gambling, the Michigan Gaming Control Board (MGCB), with
the assistance of Detroit's commercial casinos, has developed
a list of Disassociated Persons, pursuant to Michigan law (MCL
432.225). Participation in the Disassociated Persons program is
completely voluntary - no one but the voluntary participant
may be added to the list. Persons placed on the List voluntarily
pledge never to visit a Detroit casino. This is a LIFELONG
BAN.
If You Have a Gambling Problem, You Can Request the
Michigan Gaming Control Board to Permanently Bar You From
the Licensed Detroit Casinos. Call 1-888-223-3044 for
application information.
SCREENING INSTRUMENTS
SOGS – South Oaks Gambling Screen
MAGS – Massachusetts Gambling
Screen
GA 20 - Gamblers Anonymous self
assessment questionnaire
NODS – National Opinion (NO) Research
Center Diagnostic Statistical Manual
(DS)
Professional Contact information
Neighborhood Service Organization
Emergency Telephone Service
220 Bagley, 12th Floor
Detroit, Michigan 48226
(313) 961-4890
Consumer Contact information
MICHIGAN PROBLEM GAMBLING
HELP LINE
1-800-270-7117