Background Overall participation in gambling activities by older - PDF document

3/13/2016 Center for Gambling Studies Problem Gam bling Am ong Older Adults: Prevalence, Etiology, and Treatm ent Lia Nower, JD, PhD, Professor and Director, Center for Gambling Studies, Rutgers University, School of Social Work Center for Gambling Studies Background • Overall participation in gambling activities by older adults is increasing. • 1975: 35% of adults 65 and over gambled in lifetime (Kallick et al., 1976) • 2001: 81% of adults 51 to 60 gambled past year (Welte et al., 2001) – 12.6% gambled frequently – 3.3% problem/ pathological gamblers • 69% of those 61 and older gambled past year – 10.2% gambled frequently – 1.2% problem/ pathological gamblers Center for Gambling Studies Old Adults in Prim ary Care • Nearly 70% of 843 adults over 65 in primary care setting gambled past year. • About 11% stated they either wagered more than they could afford or more than $100 on a single bet (Levens et al, 2005) 1

3/13/2016 Center for Gambling Studies Hotline Callers • Of the 1,018 phone calls used in the logistic regression analyses, 168 (16.5% ) • Older adults were more likely to have lower incomes, longer durations of gambling, fewer problem types of gambling, and problems with casino slot machine gambling. (Potenza et al, 2006) Center for Gambling Studies Risk Factors Higher rates of PG found am ong older adults: • Earlier ages of onset, psychiatric comorbidity (anxiety, substance use), poor health (Zai, 2006; Zaranek & Chaplewski, 2005; Zaranak & Lichtenberg, 2008; Pilver et al, 2013) • Frequent buses to casinos (Bazargan, Bazargan, & Akanda, 2000) • Senior centers and bingo halls (Erickson et al, 2005) • Ethnic minorities and veterans (Levens, et al., 2005) Center for Gambling Studies Motivations • Easy access and availability • More disposable income and time • Loneliness and need for socialization • Inducements (meals, busses, events) • Improve cognitive functioning 2

3/13/2016 Center for Gambling Studies One Study Center for Gambling Studies Method Sam ple • De-identified data-set of 1,601 gamblers applying for self-exclusion in Missouri from Jan 01-Mar. 03 • Completed application at one of 11 casinos or three Missouri Gaming Commission offices • Groupings: younger (18-35), middle ages (36-55), older (56+ ) Center for Gambling Studies Measures • Demographic characteristics: age at application, household income, race employment, educational, marital status. • Gambling behavior: years spent gambling, age of onset, forms of gambling. • Reasons for self-exclusion. 3

3/13/2016 Center for Gambling Studies Dem ographic Results • Age: Range 21 to 79 years • Women: 49.8% Men: 50.2% • Women overrepresented among middle aged and older adults • Younger adults: 30.6% (n= 804) • Middle-aged adults: 59.3% (n= 950) • Older adults: 10.1% (n= 161) Center for Gambling Studies Dem ographic Results • Older adults more likely than younger adults to be married and less likely to be single. • Older adults more likely than both younger and middle-aged adults to be widowed and less likely to be separated or divorced. Center for Gambling Studies Gam bling Behaviors • Onset: Younger (20s), middle-aged (30s), older (40s) • Women reported later age of onset than men; among older adults, women initiated mean age 48.7 vs 37.7 for men. • Total years spent gambling increased with age: Older adults gambled average of 17 years before self-excluding – more than twice the time for younger adults (7 years) 4

3/13/2016 Center for Gambling Studies Gam bling Activities at Onset • Older adults first gambled on slots (72.2% ), lottery(32.3% ), video poker(24.2% ), and black jack(20.5% ) as did middle adults. • Younger adults gambled on an average of four games: black jack (59.45), slots (65.9% ), video poker (33.9% ) and lottery (46.7% ). Center for Gambling Studies Past-Year Gam bling Activities • Older adults gambled on average of three games (slots= 80.1% , lottery= 39.8% , video poker 35.4% ) as did middle adults (slots= 80.4% , lottery 47.7% , video poker= 42.2% ) • Younger adults gambled on an average of four games: black jack (59.45% ), slots (65.9% ), video poker (33.9% ) and lottery (46.7% ). Center for Gambling Studies Onset and Past-Year Form s by Age Variables Younger Middle Aged Older Adults adults Adults ( n= 1 6 1 ) ( n= 4 9 0 ) ( n= 9 5 0 ) Onset % % % n n n Gam bling Strategic 120 24.5 124 13.1 21 13.0 form s Non-strategic 132 26.9 449 47.3 91 56.5 form s Mixed form s 238 48.6 347 36.5 47 29.2 Past-Year Gam bling Strategic 95 19.4 54 5.7 9 5.6 gam bling only Non-strategic 121 24.7 491 51.7 95 59.0 gam bling only Mixed 268 54.7 392 41.3 54 33.5 gam bling 5

3/13/2016 Center for Gambling Studies Reasons for Self- Excluding • Older adults more likely than other groups to indicate they self-excluded to prevent suicide (13.7% versus 6.7% of younger and 7.7% of middle-aged adults). • Older adults were less likely to self- exclude because they hit rock bottom, recognized they needed help or wanted to save their marriage. Center for Gambling Studies Logistic Regression Results • Compared to younger adults, older adults were more likely: – To have gambled longer before self-exclusion. – To be married and/ or retired/ unemployed. – To express a strong preference for non-strategic forms of gambling. – They were nearly four times as likely to self-exclude in an effort to prevent suicide. • Compared to middle-aged adults, older adults were more likely: – To have gambled longer and/ or be unemployed. – They were nearly three times as likely to self-ban to prevent suicide. Center for Gambling Studies Predictors of Older Adult Self-Excluders Variable Older Adults vs. Younger Adults B SE p value Odds ratio ( 9 5 % CI ) Years gam bled 0 .1 3 0 .0 2 < 0 .0 0 0 1 1 .1 4 ( 1 .1 0 , 1 .1 8 ) Married 0 .6 9 0 .2 9 < 0 .0 2 1 .9 9 ( 1 .1 2 , 3 .5 1 ) Not in 1 .7 3 0 .3 1 < 0 .0 0 0 1 5 .6 5 ( 3 .0 6 , 1 0 .4 5 ) w orkforce Past-year, non- 2 .3 6 0 .9 7 < 0 .0 2 1 0 .5 4 ( 1 .5 7 , 3 5 .6 6 ) strategic only Prevent suicide 1 .3 4 0 .4 7 < 0 .0 0 4 3 .8 2 ( 1 .5 3 , 9 .5 4 ) Older Adults vs. Middle-Aged Adults Years gam bled 0 .0 4 0 .0 1 < 0 .0 0 0 1 1 .0 4 ( 1 .0 2 , 1 .0 6 ) Not in 1 .4 4 0 .2 1 < 0 .0 0 0 1 4 .2 2 ( 2 .8 0 , 6 .3 6 ) w orkforce Prevent suicide 0 .9 7 0 .3 2 < 0 .0 0 3 2 .6 3 ( 1 .3 9 , 4 .9 7 ) 6

3/13/2016 Center for Gambling Studies I m plications • Older adults progressed from first gambling on black jack as well as non-strategic forms to a clear preference for non-strategic forms of play (93% ), particularly slots and video poker. • Older adults feared suicide with continued gambling. – This is particularly troubling in light of higher suicide rates among both pgs and older adults, who are often reticent to access care. – Highlights need for targeted prevention, intervention and treatment services. Center for Gambling Studies DSM 5 Criteria: Gam bling Disorder 3 1 2 .3 1 • Tolerance ( increasing am ounts of m oney to achieve desired excitem ent) • W ithdraw al ( restless or irritable w hen attem pting to cut dow n or stop) • Loss of Control ( repeated, unsuccessful efforts to control, cut back, or stop) • Escape ( often gam bles w hen feeling distressed) • Chasing ( going back another day) • Lying ( concealing extent of involvem ent) • Lost relationships • Bailouts Center for Gambling Studies DI SORDERED GAMBLI NG • 1 9 8 0 -2 0 1 3 : I m pulse control disorder characterized by the inability to cut back or stop gam bling. • 1 .7 % of adults and 3 -5 % of youth m eet clinical criteria for disorder. • 3 % of adults and 6 -8 % youth have serious gam bling problem s that lead to adverse consequences: legal, fam ilial, psycho-social. 7

3/13/2016 Center for Gambling Studies PHASES OF DI SORDERED GAMBLI NG Center for Gambling Studies • Big w in or series of sm aller w ins • Praise and recognition • I ncreasing desire to gam ble m ore to “chase” the w in Center for Gambling Studies W inning Phase: play for excitem ent, w in fuels m ore frequent play 8

3/13/2016 Center for Gambling Studies Phases of Disordered Gam bling: Losing Phase • I ncreased gam bling activity leads to losses • Chasing losses to recoup m oney • I ncreased gam bling generating m ore losses Center for Gambling Studies Losing Phase : I ncrease frequency of bets to w in back lost funds Center for Gambling Studies Phases of Disordered Gam bling: Desperation Phase • Lying • Borrow ing from friends, fam ily • Crim inal activity ( stealing, em bezzling, w riting bad checks) • Bankruptcy, unem ploym ent, hom elessness • I ncreasing w ithdraw al, preoccupation and m oodiness • Depression, hopeless and thoughts of suicide 9