GAMBLING SCREENING: HOW TO MAKE IT FUN! Tracy McPherson, PhD - PDF document

3/14/16 ¡ Webinar Moderator GAMBLING SCREENING: HOW TO MAKE IT FUN! Tracy McPherson, PhD Senior Research Scientist Public Health Department PRESENTED BY: NORC at the University of Chicago THE BIG SBIRT INITIATIVE, NATIONAL SBIRT ATTC, and 4350 East West Highway 8th Floor, NORC at THE UNIVERSITY OF CHICAGO Bethesda, MD 20814 esap1234@gmail.com March 16, 2016 Produced in Partnership… 2016 SBIRT Webinar Series January 27 th – Mini-Guide to SBIRT: An Overview of ¨ SBIRT and Resources – NOW ON-DEMAND February 17 th – Integrating Adolescent SBIRT in Nursing ¨ and Social Work Education March 9 th – Reducing Teen Substance Misuse: What ¨ Really Works March 16 th – Gambling Screening: How to Make it Fun! ¨ April 27 th – Integrating Motivational Interviewing ¨ Techniques for Brief Intervention into the Curriculum May 4 th – Part IV: Using Case Studies for Integrating ¨ SBIRT into Curriculum May 23 rd – Preventing Prescription Drug Abuse and ¨ Doctor Shopping: Prescribing Guidelines and Intervention Skills for Nurses and Healthcare Professionals www.sbirteducation.com June 22 nd – Intimate Partner Violence SBIRT: The WINGS ¨ Intervention Model hospitalsbirt.webs.com/webinars.htm Access Materials Ask Questions Ask questions ¨ PowerPoint Slides through the “Questions” ¨ Materials and Pane Resources ¨ Recording Will be ¨ Certificate of answered live Completion at the end http://hospitalsbirt.webs.com/problem-gambling 1 ¡

3/14/16 ¡ Technical Facilitator Webinar Presenter Jody Bechtold, LCSW, NCGC-II, BACC Misti Storie, MS, NCC Private clinician Technical Consultant jody@jodybechtold.com misti.storie@gmail.com & www.mististorie.com VP Clinical Affairs, Wellbridge Health, Inc. jody@wellbridgehealth.com What is Gambling? Webster's New World Dictionary as the following: What is Gambling? — to play games of chance for money or some other stake, or — to take a risk in order to gain some advantage. Gambler ’ s Anonymous definition of 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. ” (Gambler ’ s Anonymous, March 1994, Handbook) What Does a Gambler Look Like? The New Face of Gambling 2 ¡

3/14/16 ¡ Why Do People Gamble? ¨ Excitement Polling Question #1 ¨ Entertainment ¨ Escape (forget about Which one of these activities is NOT considered their problems for a gambling? while) ¨ Economics (they Buying lottery tickets • want the money) Playing fantasy football for money • ¨ Ego (the person ’ s Playing free blackjack online • pride or reputation) Stock Market trading/investing • Buying raffle tickets • 15 Gambling and Problem Gambling Continuum of Gambling Gambling Continuum ¨ No Gambling None ¤ A person does not gambling on any forms of gaming Mild (lottery, scratch offs, raffles, fund raisers, etc. ) Moderate ¨ Social Gambling (Recreational) Severe Problem Social gambling No gambling Gambling Disorder ¤ One form of entertainment; typically with others, time & Gambling At-Risk money is limited. No adverse consequences. Brief Intensive Treatment ¨ At-Risk Gambling Secondary Prevention ¤ Increasing frequency & duration of gambling; Primary Prevention increasing total money and per bet money. Harm Reduction Korn & Shaffer , 99 Continuum of Gambling ¨ Problem Gambling Understanding the “Hook” ¤ Experiencing difficulties in some major areas of life; having more difficulty cutting back or stopping; Gaming Psychology continued despite consequences ¨ Disordered Gambling ¤ DSM – 5 criteria 3 ¡

3/14/16 ¡ Independence of Turns: Independence of Turns: A Fundamental Concept Coin Toss Heads 1 2 Heads Tails 3 Heads 4 Tails 5 6 Heads Heads 7 Tails 8 9 Heads _________ 10 Skill vs Chance ¨ “What is the definition of skill ?” Polling Question #2 ¨ “The more you practice, the better you will be” ¨ “What is the definition of chance ?” Which of the following is a game of SKILL? ¨ “All unforeseen or unpredictable events over which a person Lottery • has no control.” Sports betting • Bingo • Poker / Blackjack • Illusions of Control Chance Skill slots Poker (table games) bingo card games lottery Sports(?) 4 ¡

3/14/16 ¡ Which lottery ticket Recognizing Traps – Illusions of Control do you want? ¨ Slot Machines Illusions ¨ Lottery Illusions 1 2 3 4 5 A ¨ Bingo Illusions ¨ Blackjack Illusions ¨ Roulette Illusions ¨ Horse Racing Illusions 11 4 7 28 32 B Type “A” or “B” into the Chat Box Reinforcement/Punishment Understanding “Randomness” Type of Event Positive Event Aversive Event Presented Positive reinforcement Punishment Negative Removed Punishment reinforcement Reinforcement/Punishment Reinforcement/Punishment Type of Event Type of Event Positive Event Aversive Event Positive Event Aversive Event Get what you don’t Gamble and win $$ Gamble and Debt Presented Get what you want Presented (+/+) (+/+) want Gamble and lose $ Gamble and bailout Take away what Take away what Removed Removed $ (+/-) (+/-) you want you don’t want 5 ¡

3/14/16 ¡ The “Hook” ¨ Independence of Turns Gambling: Myths & Assumptions ¨ Chance vs. Skill ¨ Illusions of Control ¨ Randomness ¨ Reward/Punishment (Intermittent Reward) Gambling: Myths & Assumptions Impact: Myths & Assumptions ¨ If you can afford it, gambling is not a problem. ¨ S/He doesn’t look like a gambler ¨ Playing the lottery is not gambling. ¨ Countertransference issues ¨ People that are home bound don’t gamble. ¨ Poor people don’t gamble. ¨ Playing bingo at the retirement community isn’t gambling. ¨ The Deaf don’t gamble at casinos. Gambling in the US ¨ Approximately 85% of US Adults gambled at least Gambling : Clinical once in their lives; 60% in the past year. ¨ 2 million (1%) of US Adults are estimated to meet Prevalence criteria for disordered gambling in a given year. DSM-5 criteria ¨ Another 4-6 million (2-3%) would be considered Problem Gamblers. ¨ Source: National Council on Problem Gambling 6 ¡

3/14/16 ¡ Gambling DISORDER: DSM-5 Criteria 312.31 DSM – 5 ¨ Preoccupation Addictive Disorders: Behavioral Addiction ¤ Is often preoccupied with gambling (e.g. having persistent thoughts or reliving past gambling experiences, handicapping or planning the next venture, thinking of ways to get money with which to gamble) ¨ Tolerance ¤ Needs to gamble with increasing amounts of money in order to achieve the desired excitement ¨ Withdrawal ¤ Is restless or irritable when attempting to cut down or stop gambling Gambling DISORDER: Gambling DISORDER: DSM-5 Criteria 312.31 DSM-5 Criteria 312.31 ¨ Escape ¨ Loss of control ¤ Often gambles when feeling distressed (e.g. helpless, guilty, anxious, ¤ Has made repeated unsuccessful efforts to control, cut back, or stop depressed) gambling ¨ Chasing ¨ Risked significant relationship ¤ After losing money gambling, often returns another day in order to get ¤ Has jeopardized or lost a significant relationship, job, education or even (chasing one’s losses) career opportunity because of gambling ¨ Lying ¨ Bailout ¤ Lies to conceal the extent of involvement with gambling ¤ Relies on others to provide money to relieve a desperate financial situation caused by gambling Gambling DISORDER: Diagnosis / Terminology DSM-5 Criteria 312.31 ¨ Gambling Disorder: 4 or more of the DSM-5 criteria ¤ The gambling behavior is not better explained by a manic ¤ 4-5 Mild episode. ¤ 6-7 Moderate ¤ 8-9 Severe ¨ Problem Gambling: more than 1 but fewer than 4 of the DSM-5 criteria 7 ¡

3/14/16 ¡ Disordered Gambling: Comparison to Substance Abuse Similarities Co-Occurring Rates ¨ Preoccupation with the activity and a loss of control Drug / Alcohol ¨ Abuse of drugs/alcohol and problem gambling can Mental Health both be progressive ¨ Denial is the hallmark of both: the problem resides outside the person who is exhibiting the disordered behavior Disordered Gambling: Disordered Gambling: Comparison to Substance Abuse Comparison to Substance Abuse Similarities Differences ¨ Continued behavior despite negative consequences in ¨ Gambling is not self-limiting major life areas ¨ Behavior not attributable to intoxication ¨ Tolerance develops – more of the substance or ¨ More intense sense of shame and guilt gambling is needed to attain same feelings ¨ Greater denial and stronger defenses ¨ Urges and cravings develop among problem gamblers too ¨ Similar psychological drives including escape, excitement, self-medication and avoidance Disordered Gambling: Disordered Gambling: Comparison to Substance Abuse Comparison to Substance Abuse Differences Differences ¨ Fantasies of success ¨ Intensity of family anger ¨ Unpredictable outcome ¨ There is much less public awareness about problem gambling ¨ Easier to hide (no biological tests) ¨ Acceptance of gambling is even more widespread ¨ Problem gambler’s financial situation is often critically than for alcohol damaged and must be addressed as part of treatment 8 ¡