Infusing data-driven gambling information into existing SUD and - PowerPoint PPT Presentation

Infusing data-driven gambling information into existing SUD and Suicide outreach efforts Andy Cartmill, CPS, QMHA Eva Hawes, MPH, CHES Washington County Health & Human Services

Outline Background/Intro Why We’re Sharing Who IS Andy? Understand the relationship • • Who IS Eva? Infusion • • How did we get here? Who needs to know • • What’s the Issue? The Process What the science says Collaboration • • Our Questions Asking the right questions • • ACEs • Trauma •

Objectives part 1  Objective 1: Understand the relationship between gambling and other risky behaviors  What are the associations between problem/disordered gambling and other high risk behaviors?  Objective 2: Understand the relationship between gambling and suicide ideology and behavior  What is the relationship between problem/disordered gambling and suicide risk?

Objectives part 2  Objective 3: Learn how to utilize local data to demonstrate similar relationships  Process for internal collaboration  How did we get here  What questions did we ask  What data did we consult  Objective 4: Understand the benefits of collaboration with other programs within the organization  How to collaborate internally  Learn how to ask the right questions

Outline Why We’re Sharing Background/Intro Understand the relationship • • Who IS Andy? Infusion • • Who IS Eva? Who needs to know • • How did we get here? The Process What’s the Issue? Collaboration • What does the science say? • Asking the right questions • Our Questions • ACEs/Trauma •

Intro

Is Prevention Part of Your Job Responsibilities? Yes A. No B. Not sure C. What’s prevention? D.

Outline Background/Intro Why We’re Sharing Who IS Andy Understand the relationship • • Who IS Eva? Infusion • • How did we get here? Who needs to know • • The Process What’s the Issue? Collaboration • • What does the science say? Asking the right questions • • Our questions • ACEs/Trauma

Which group has a higher suicide attempt rate? Those who abuse alcohol A. Those who abuse other B. drugs Problem gamblers C. They’re about the same D.

Which population has a higher rate of disordered gambling? Adults A. Youth B. They’re about the same C.

Risky Behavior and Washington County youth Past 30-Day Use (2016 Oregon Student Wellness Survey n=14,004) 30 28 27 26 25 25 22 22 20 Gambling 17 16 Percent Alcohol 15 Rx Drugs 10 Marijuana 10 7 Depression 4 5 3 3 1 0.5 0 6th Grade 8th Grade 11th Grade

Objective 1: Understand the relationship between gambling and other risky behaviors  Problem gambling behavior often occurs with other high risk behaviors including:  Illicit drug use  Misuse of prescription drugs  Tobacco use  Alcohol use  Relationship is bidirectional  Students that gamble also engaged in risky behavior  Smaller prevalence but need to include in the prevention message because:  Students that engage in risky behavior also gamble

How to define “high risk” gambling  Oregon Student Wellness Survey  Have you ever lied to anyone about betting/gambling?  Have you ever bet/gambled more than you wanted to?  If yes to one or both, categorized as high risk  Based on problem gambling screening instrument, if yes to either question indicates need for further assessment by a trained counselor

S u b s ta n c e u s e in p a s t 3 0 d a y s b y g a m b lin g ty p e in W a s h in g to n C o u n ty S tu d e n t W e lln e s s S u rv e y 2 0 1 6 8 0 Total N o n g a m b lin g G a m b ling 6 0 6 0 H ig h ris k g a m b lin g P e rc e n t 4 0 4 0 3 7 3 2 2 8 2 3 2 3 2 2 2 0 1 6 1 5 1 5 1 4 1 2 1 1 9 9 7 6 5 4 4 3 2 1 0 T o b a c c o Alc o h o l B in g e d r in k in g M a r iju a n a Illic it d r u g s R x d r u g s

What % of Washington County 8 th graders seriously considered suicide last year? 5% A. 7% B. 11% C. 14% D.

Objective 2: Understand the relationship between gambling and suicide ideology and behavior  Suicide ideation is more prevalent among problem gambling than the general population  Range from about 17% to almost half (48%) of adults in gambling treatment have a history of suicide ideation  The frequency/amount of suicidal ideation increases with gambling pathology  People seeking treatment for problem gambling should be assessed for suicidality

Gambling and suicide in Oregon  About one quarter (25.1%) of adults entering problem gambling treatment in Oregon experience suicide ideation  About 2% of these adults had a suicide attempt  Historical estimates of Oregon adults approximately 3% experience suicide ideation

S u ic id a l id e a tio n a n d s u ic id e a tte m p t b y g a m b lin g ty p e in W a s h in g to n C o u n ty Total S tu d e n t W e lln e s s S u rv e y 2 0 1 6 N o n g a m b lin g 3 0 G a m b ling 2 7 H ig h ris k g a m b lin g 2 1 2 0 1 8 P e rc e n t 1 4 1 2 1 0 1 0 7 5 0 S u ic id a l id e a tio n S u ic id e a tte m p t

Data takeaways  Discussed the relationship between gambling and substance use and suicide behavior  Gambling is associated with other risky health behaviors  But why do we talk about this?

Table talk: why?  Expertise in the room :  Why might someone start in the first place?  Are the reasons different for social gambling vs problem gambling? How so?

Why? Objectives 1, 2 & 4  Audience Question: Why might people start in the first place?  This was our question!  There’s a reason  Perception: makes life better  ACEs  Trauma  Effects on the brain  Ramifications later on

Video

ACEs Adverse Childhood Experiences

Sexual Physical Emotional Use in home Mental Illness Poverty Bullying Discrimination Neglect Other???

From Infant – 12:  Focused on developing volume  Grey matter At 12, the brain has the same:  weight  size  cortical folds  regional specialization From 12 – mid 20’s:  Developing connections  The brain cells are linking up  Developing white matter The Adolescent Brain:  Development shifts to creating efficient neuronal pathways.  Synapses that are most important to survival and function flourish  Connections that are not being used vanish (Neural Pruning)

Prevalence and Impact ACES Primer video

Prevalence in Oregon: Adults 35% 30% 25% 20% 15% 10% 5% 0% Household Household Intimate Jail/prison Emotional Physical Sexual substance Divorce mental partner household abuse abuse abuse abuse illness violence member Prevalence 36% 34% 31% 26% 24% 20% 15% 9% Data from Oregon Health Authority, 2015

Prevalence in Oregon: Kids 30% 25% 20% 15% 10% 5% 0% Socio- Household Household Neighbor- Treated Divorce/ Parent in Domestic Death of economic substance mental hood unfairly separation jail/prison violence parent hardship abuse illness violence due to race Prevalence 29% 25% 11% 11% 7% 6% 3% 3% 2%

ACEs and Substance Use Alcohol Early initiation among ACEs impacted youth Tobacco Prevalence of tobacco use increases with ACEs Prescription Over 80% of the patients seeking treatment for opioid drugs and addiction had at least one form of childhood trauma, opioids with almost two-thirds reporting having witnessed violence in childhood Each ACE increased the likelihood of early initiation into illicit drug use by 2- to 4-fold Illicit drug use

Secondary stress  Trauma experienced by those who hear about or witness an event but don’t directly experience the trauma  Similar impact on brain: physical, psychological, and cognitive changes and symptoms  Can impact all professionals who serve those who have experienced trauma (e.g., health care providers, first responders, home visitors, case workers, clergy, intake workers)

Early death Disease, disability and social problems ACE Study Epigenetics Adoption of health risk behaviors Social, emotional cognitive impairment Adverse childhood experiences Social conditions, local context Historical trauma, multigenerational oppression

Break

Outline Background/Intro Why We’re Sharing Who IS Andy • • Understand the relationship Who IS Eva? • • Infusion How did we get here? • • Who needs to know What’s the Issue? The Process What does the science say? • Collaboration • Our Questions • Asking the right questions • ACEs/Trauma •

Why we’re sharing this Objective 1, 2 & 4  Stakeholders need to understand the relationships between gambling behavior and other risky behaviors.  Not causal  Participate in one high risk behavior, more likely to participate in another  Who’s talking about it?

Why we’re sharing this Objective 1, 2 & 4  Infusion of gambling into other outreach/prevention efforts  Substance Use Disorders  Schools  Parents  Students  Suicide  ASIST (Applied Suicide Intervention Skills Training)  QPR (Question, Persuade, Refer)  MHFA (Mental Health First Aid)  Schools  Parents  Students