2014 Prevention and Recovery Conference Inspiration. Connection. Motivation. Oklahoma City, Oklahoma
Prevention of Problem Gambling: Addressing Special Populations Jim Wuelfing Owner and Principle Associate The New England Center
[email protected]
CHALLENGES AND PRINCIPLES OF PREVENTION PLANNING
Have your prevention work based in tested theory, research and data Use a tested prevention planning model Using multiple strategies over multiple domains Use evidenced-based strategies Reduce risk and enhance protective factors Utilizing best practices
CSAP’S STRATEGIC PLANNING FRAMEWORK Assessment Capacity Building Planning Implementation Evaluation All under the umbrella of cultural competence and sustainability
SIX PREVENTION STRATEGIES [CENTER FOR SUBSTANCE ABUSE PREVENTION (CSAP)]
Information Dissemination
Prevention Education
Alternative Activities
Community-Based Processes
Environmental Approaches
Problem Identification and Referral
PREVENTION DOMAINS Individual Peer Family School/work Community Society/environmental
MULTIPLE STRATEGIES OVER MULTIPLE DOMAINS
PROTECTIVE AND RISK FACTORS
Protective factors – Factors that decrease the chances of someone (or a community) developing health and behavioral problems are called protective factors. Having multiple protective factors can override risk factors.
Risk factors - Factors that increase the chances of someone developing health and behavior problems are called risk factors. Individuals, families and communities which possess these factors are considered at risk. Those that possess several are considered high risk.
ACKNOWLEDGEMENT
The next thirteen slides are taken from the research of: Dr. Robert Williams Professor, Faculty of Health Sciences Coordinator, Alberta Gaming Research Institute University of Lethbridge; Lethbridge, Alberta
IN ORDER TO EFFECTIVELY PREVENT SOMETHING YOU NEED TO KNOW WHAT CAUSES IT
RISK FACTORS FOR PROBLEM GAMBLING Young Age (18 – 25)
Young people engage in high-risk behavior more than other age groups Today’s is the first generation in many years to be raised with legal gambling widely available.
Males Males tend to take more risks than females
RISK FACTORS FOR PROBLEM GAMBLING Started gambling at an early age
Friends that gamble Parents that are heavy or problem gamblers
PGs 3–8 times more likely to have parent, brother, or sister with a gambling problem.
RISK FACTORS FOR PROBLEM GAMBLING Having an early big win at gambling
Most problem gamblers had the misfortune of experiencing a big win when they first started playing.
Playing rapid forms of gambling with a high frequency of betting and reinforcement
EGMs, table games
RISK FACTORS FOR PROBLEM GAMBLING Availability of gambling opportunities
Related to legality and/or proximity
Societal acceptance of gambling
RISK FACTORS FOR PROBLEM GAMBLING Race/Ethnicity Indigenous people Asian ancestry Reasons for Gambling
To escape To win money
RISK FACTORS FOR PROBLEM GAMBLING Importance of Money
as a measure of ‘success’ as a way to solve problems
Gambling Fallacies
Not understanding how gambling works or having erroneous beliefs about how gambling works
RISK FACTORS FOR PROBLEM GAMBLING Impulsivity
ADHD and risk-taking tendencies also related
Mental Health Problems
Particularly Mood Disorders and Anxiety Disorders
Having other addictions
Majority of problem gamblers are smokers High rates of co-morbid alcoholism and drug abuse
BIOPSYCHOSOCIAL ETIOLOGICAL FRAMEWORK
BIOLOGICAL PROPENSITIES 1.
You are born with biological propensities that increase or decrease your susceptibility of engaging in gambling and/or developing problem gambling. Self-controlled Risk aversive No predisposition to addiction
No predisposition to mental health problems
↔ ↔
Impulsive
↔
Predisposition to addiction
↔
Predisposition to mental health problems
Risk seeking
ENVIRONMENTAL EXPERIENCE 2.
These propensities shaped by environmental experience to either further increase or decrease risk. Abusive/Neglectful upbringing
Peer group nongambling
↔ ↔ ↔
Societal nonacceptance of gambling
↔
Societal acceptance of gambling
Gambling not readily available
↔ ↔ ↔ ↔
Gambling readily available
Nurturing/Disciplined upbringing Parental nongambling
High income Safe provision of gambling Low stress & high support
Parental gambling Peer group gambling
Low income Unsafe provision of gambling High stress & low support
PSYCHOLOGICAL MAKE-UP & EARLY LEARNING 3.
Continued involvement influenced by biological propensities and environmental experience, combined with psychological makeup and early learning. Lack of knowledge about gambling Gambling fallacies Gambling serving a psychological need Positive/Rewarding early gambling experiences
PROGRESSION TO PROBLEM GAMBLING 5.
Whether the behaviour remits or the person progresses to problem gambling depends on the:
Strength of biological propensities + environmental experience + psychological make-up + early learning + and behavioural conditioning RELATIVE TO Strength of the negative consequences person begins to experience
CONSTELLATION OF PROBLEMS People who progress to problem gambling will usually have many associated comorbidities. Psychological Problems (depression, anxiety, low self-esteem, poor decision making skills, poor coping skills)
Problem Gambling Antisocial Behaviour
Substance Abuse
School/Work Problems
Poor Health Practices
Interpersonal Problems
Similarly, people who do not become problem gamblers often have many associated ‘strengths’. Good Psychological Health (positive self-esteem, achievement motivation, good decision making skills, good coping skills)
Non Problem Gambling Prosocial Behaviour
Substance Moderation or Abstinence
Positive School/Work Functioning
Good Health Practises
Good social skills and social support
FOCUS ON YOUTH GAMBLING
HOW DO STUDENTS GAMBLE?
What are some of the ways that students gamble?
IS STUDENT GAMBLING LEGAL?
What is the legal age for sports betting in Oklahoma?
21?
Other?
What is the legal age to buy scratch tickets or play the lottery in Oklahoma?
18?
16?
18?
21?
Other?
What is the legal age for playing cards for money in your home Oklahoma?
16?
18?
21?
Other?
GAMBLING AMONG TEENS AND YOUNG ADULTS
Gambling in an increasing phenomena and warrants attention and concern Gambling at a casino has become a new rite of passage for many students turning 21 Most youth learn to gamble from their parents with an average age of onset of 11.5 years There is a belief that as gambling becomes more accessible and convenient for teens and young adults, problems will increase Gambling problems among teens and young adults can remain hidden for a long time, and many school faculty, coaches, and staff are not asking questions of students that might surface these problems
GAMBLING AMONG TEENS AND YOUNG ADULTS (CONT’D)
Students gamble for a variety of reasons. Those cited most often include: seeking
excitement, a rush, a high…and to decrease boredom the powerful influence of advertising and television parental influence and role models teacher/environmental influence and role models
GAMBLING AMONG YOUTH (CONT’D) Parental gambling can lead to serious problems for younger children who are neglected when one or both parents gamble Gambling by students is common and has led to negative consequences for over 5% of 12th graders Gambling risk behavior is associated with other risky behavior
GAMBLING AMONG YOUTH (CONT’D)
There is nearly universal consensus about the need for prevention efforts to prevent future problems. Some respondents to surveys also identified the need for expanded services for youth affected by gambling problems in schools and youth groups. Other ideas focus on reducing gambling advertising, creating a “higher profile of gambling problems” within local communities as they occur, and to increase the availability of healthy and positive activities for youth so they would not feel bored and be as attracted to gambling
SOME SUMMARY OBSERVATIONS Gender (male) Age (initiation and game) Substance use Anti-social behavior Parental gambling Depression
CHARACTERISTICS OF STUDENT GAMBLERS
Male Competitive Intelligent Risk takers High energy Good students
With part time jobs Popular Usually participates in athletics Many times children of substance abusers or gamblers
WHAT ABOUT THE POKER CRAZE?
Little research data on prevalence and consequence. Anecdotal accounts suggest increasing number of teens/young adults in trouble with gambling.
Increasing calls to gambling help lines regarding teen/young adult gambling Reports of unmanageable debt, problems in school, violence and resorting to criminal activity to pay debts
MORE ON THE POKER CRAZE
Need to be careful not to pathologize a fad, yet recognize that:
Although most teens/young adults will not develop gambling problems, the sheer numbers of those playing will increase the numbers of those needing help. Poker, like other forms of gambling, carries some degree of personal risk and can lead to a range of negative consequences. Studies show that students who gamble are more likely to engage in a number of high risk behaviors.
INTERNET GAMBLING Estimated 6000+ sites and growing daily Estimated 35+ billion dollars in revenue >70% of worldwide Internet gambling coming from U.S. bettors Illegal in the United States but confusion around players or sites Available 24/7
INTERNET GAMBLING (CONTINUED) Needs credit card or account to play Losses charged to credit card Wins credited to credit card, cashier check or accounts
SPECIAL ISSUES FOR STUDENTS Ready access to credit (if over 18) Little awareness of credit issues Computer literacy 24/7 availability Among the highest addiction rates Internet gambling often comes in low on a list of gambling activities yet high in terms of problems associated with it.
IF PROBLEMS DEVELOP, WHAT MIGHT THEY LOOK LIKE
Debt and credit card problems Interpersonal conflict and anger surrounding lost/owed money Violence (dating violence and violence around debt collection) Losing and chasing losses Magical and “quick fix” mentality Progression
Frequency of gambling Amount of money Form of gambling
IF PROBLEMS DEVELOP, WHAT MIGHT THEY LOOK LIKE (CONT.)
Negative consequences
Limited circle of friends, loss of friendships Family conflict School problems (truancy, slipping academic performance, policy violations) Lying Stealing Loss of self-esteem Depression and suicidality
OTHER VULNERABILITIES Adolescent brain development Students who show:
Impulsivity Poor
concentration Hyperactivity A need for excitement and risk taking Involvement in other risk behaviors such as alcohol, tobacco and other drugs
RISK FACTORS FOR PROBLEM GAMBLING
At-risk for a substance abuse problem Having a parent, sibling, relative, friend, or significant person with either a gambling problem or substance use problem Having or knowing peers with substance use problems is a risk correlate of youth problem gambling Anxiety High risk propensity Low perception of risk regarding problem gambling Early onset of gambling behaviour YOUTH GAMBLING PROBLEMS: THE IDENTIFICATION OF RISK AND PROTECTIVE FACTORS::Report to the Ontario Problem Gambling Research Centre: Laurie Dickson, M.A. Jeffrey L. Derevensky, Ph.D., Rina Gupta, Ph.D.
HIGH RISK CATEGORIES
Child of a compulsive gambler Belief that skill is involved An early big win Feeling that one must chase gambling loss with more gambling
Early age of onset (8.5 years for pathological gamblers; 11.5 years for non-pathological gamblers) Large first bets Otherwise addicted
PROTECTIVE FACTORS
A relationship with a caring adult role model Having an opportunity to contribute and be seen as a resource Effectiveness in work, play and relationships Healthy expectations and a positive outlook
Self-esteem and an internal locus of control Self-discipline Problem solving and critical thinking skills A sense of humor
PROTECTIVE FACTORS Family connectedness Designing school-based prevention programs that seek to develop student’s attachment, trust, and identification with larger groups (e.g., school clubs and sports teams, Scouts or Guides).
YOUTH GAMBLING PROBLEMS: THE IDENTIFICATION OF RISK AND PROTECTIVE FACTORS:: Report to the Ontario Problem Gambling Research Centre: Laurie Dickson, M.A. Jeffrey L. Derevensky, Ph.D., Rina Gupta, Ph.D.
CHARACTERISTICS OF LOW RISK GAMBLING
For fun or recreation, never for financial gain Knowledge that over time nearly everyone loses Socially with family and friends, not alone
Limited time – frequency and duration With predetermined limits for losses Acknowledging that knowing a lot does not make you a better gambler
MINIMIZING YOUR RISK Always bet with a predetermined amount of money to be lost Never borrow money to gamble Never gamble illegally Know your personal risk factors Know where to get help Be willing to help others
FOUR CONSISTENT MESSAGES
Gambling is not a risk-free activity. The choice to abstain from gambling as a regular practice is a legitimate choice that many people make. We do not want you to gamble illegally ever. If you still choose to gamble, we want you to know enough about gambling so that you can lower your risk of gambling problems.
SOME YOUTH EXAMPLES
CAPS (Creative Activities in Probability and Statistics)
Based on research that showed High
rates of incidence and prevalence in students Critical thinking skills are a protective factor in the development of addictive disorders A connection between gambling behavior and knowledge of math Kinesthetic learning often aids in retention
Twelve Activities Deal or No Deal Basketball Court Cover-up Target Ball Shoot and Score Parachute Yahtzee Liar’s Dice
Number Mania Ice Cream Adventure Who Won It? Lifeopoly Delta Three Scavenger Hunt
Examples
Basketball Court Coverup
M&M’s cover a picture, the pictures cover a newspaper page, the newspaper pages cover a basketball court all in an effort to understand large numbers
Ice Cream Adventure
Three flavors of ice cream, four toppings, five sauces; a delicious exercise in counting possibilities
CAPS Example
Lifeopoly
A life-sized board game where students discover an understanding of number sense, risk and critical thinking
CAPS Example
Parachute Yahtzee
Play the games in teams with large dice and a parachute to demonstrate number sense and predictions
Teens About Gambling (T.A.G.)
Youth empowerment model employed Did own research on youth gambling Attended trainings Developed own vision and mission statements Developed video and training curriculum.
T.A.G. Vision and Mission
Vision Statement We envision a Massachusetts where all teens are empowered to make responsible gambling decisions thus reducing the negative consequences to themselves, their families, and the community.
T.A.G. Vision and Mission
Mission Statement Teens About Gambling (TAG) seeks to accomplish its vision by: Raising awareness about problem gambling. Providing information and skill development that supports responsible decision making. Providing resource information. Empowering other teen groups to do the same.
STACKED DECK Evidenced-based curriculum for the prevention of problem gambling among teens and young adults. Created by Robert Williams, Ph.D., Alberta Gaming Research Institute and Robert Wood, Ph.D., University of Lethbridge, Alberta Teaches young people to approach life as smart risk-takers, weighing the pros and cons of their actions to determine the odds of achieving positive results.
GOALS OF STACKED DECK Teach young people the facts about gambling and related risks. Encourage responsible decision making. Prevent young people from becoming problem gamblers.
HOW DOES IT WORK? Six multi-media 35-45 minutes sessions Session 1-3 focus specifically on gambling Sessions 4-5 more generally about risk and decision making Session 6 is a booster session designed to help students retain knowledge and skills learned. It should be delivered a few weeks after the first five sessions
FOCUS ON COLLEGE STUDENTS
“College Class President Charged in Bank Robbery”
“Police say 19-year-old Lehigh University student admitted the crime”
GAMBLING AMONG COLLEGE & UNIVERSITY STUDENTS 16
30
14
25
12 10
20
8 2002 2005
6 4 2
15
% Female Students
10
% Male Students
5
0 % of post-secondary students gambling each week
0 2002
Annenberg Public Policy Center 2002
2005
STUDENT ATHLETE GAMBLING
72% of student of all student athletes have gambled at least once since entering college One in 20 male student athletes admitted: • providing inside information for gambling purposes • betting on a game in which they participated, or • accepting money for performing poorly in a game
Student athletes who gambled on sports with bookies gambled an average of $225 per month Cross & Vollano, University of Michigan
STUDENTS AT HIGH RISK: RATES OF PROBLEM GAMBLING BY AGE
6% 4%
5.6% 4.1%
2%
2.3%
0%
Adolescent
College
1.2%
General Adult Pop.
Carlson & Moore, 1998; Shaffer & Hall, 2001; Moore, 2001; Volberg, 2001
Elderly
Rate of problem gambling among college students is about 5.6 percent
About 15 percent of college students are at risk for developing gambling problems
Shaffer & Hall 2001
THE SURGE IN STUDENT GAMBLING
Increased Availability Increased Accessibility Increased Acceptability Increased Marketing
INCREASED AVAILABILITY AND ACCESSIBILITY
Casino Gambling Online Gambling Sports Betting State Lottery
The casino “that never sleeps” supports its customers 24/7
SPORTS BETTING
About 30% of U.S. college students will gamble on sports this year (NCPG) Only a few states where sports wagering is legal
A NEW CAMPUS ACTIVITY: ONLINE GAMBLING
More than 5,000 Internet casinos All offshore Challenges
Not
much oversight Difficult to monitor use Open 24 hours
RELATIONSHIP OF PROBLEMATIC GAMBLERS TO OTHER PROBLEMS
Among college problem gamblers, significantly greater: tobacco,
alcohol, and marijuana use binge drinking number of negative outcomes from drug and alcohol use binge eating and efforts at weight control Engwall & Steinberg, 2003
A COLLEGE EXAMPLE
College Athlete Outreach and Training Research indicates that college students are a high risk group and student athletes are a particular high risk subgroup. NCAA regulations support addressing the issue. Local campus needs assessment supplied data and direction for one hour training curriculum development Training for athletes and coaches Added FBI video Evaluation of program shows promise.
Focus on Older Adults
PROBLEM GAMBLING AMONG OLDER ADULTS
Gambling in older populations is on the rise The percentage of older Americans who gamble has doubled in the past 25 years Older adults are aggressively targeted by the gambling industry Sometimes gambling problems can be hidden for a long time.
PROBLEM GAMBLING AMONG OLDER ADULTS
Many older adults do not understand addictions Older adults may be drawn to gambling to fill their time or to be with other people Older adults who have gambled away their pensions and savings may have little chance of getting their money back. Older adults may be more likely to hide their gambling because of the stigma associated with it.
PROBLEM GAMBLING AMONG OLDER ADULTS
Many older adults have suffered some type of loss such as the death of loved ones or isolation from family and friends; gambling may help fill that loss Some older adults may have cognitive impairment that interferes with decision-making Many older adults have limited funds and may see gambling as a way to supplement their finances
UNIQUE ISSUES WITH IDENTIFYING PROBLEM GAMBLING IN OLDER ADULTS
Older adult/loved ones may not be aware gambling can be a problem Shame/ embarrassment attached to stigma May be unwilling to give up their main entertainment activity Information about problem gambling not readily available, smaller social circle means less people who may recognize a problem in behavior
POSSIBLE WARNING SIGNS OF PROBLEM GAMBLING
Withdrawal from family and friends Gambling with money meant for other necessities Gambling on credit Missing personal or household items Borrowing from family and friends
Gambling alone Already struggling with some form of addiction Lying about or hiding gambling Only talks about wins, not losses Betting more than he/she can afford to lose
RISK FACTORS FOR PROBLEM GAMBLING IN OLDER ADULTS
Recent loss of spouse/partner or friends Retirement Isolation Depression Dementia or other cognitive impairments Chronic illness Financial worries Ease of access to lottery tickets, bingo, and casinos
SOME PROGRAMS TO ADDRESS PREVENTION OF PROBLEM GAMBLING AMONG OLDER ADULTS
“Bait and Hook” Staff training “Making the Most of Your Leisure Time”
THANK YOU
Any additional questions or comments?