2010 Oregon Problem Gambling

Community Resource Guide

This document can be provided upon request in alternative formats for individuals with disabilities. Other formats may include (but are not limited to) large print, Braille, audio recordings, Web-based communications and other electronic formats. E-mail [email protected], telephone 503-945- 9703, or call TTY (800-375-2863) to arrange for the alternative statement that will work best for you.

Correspondence concerning this guide should be addressed to: Problem Gambling Services Manager, Oregon Department of Human Services, Addictions and Mental Health Division, 500 Summer St., NE E86, Salem, OR 97301-1118.

Citation: Department of Human Services, Addictions and Mental Health Division 2010, January. 2010 Oregon Problem Gambling Awareness Week Community Resource Guide, Salem, OR.

Appendices:

A. County problem gambling prevention data

B. County problem gambling treatment data

C. Problem gambling websites

Preface

Oregon Problem Gambling Services is pleased to announce Oregon‘s annual Problem Gambling Awareness Week, March 7-13, 2010. The purpose of the week is to increase public awareness and educate community providers about problem gambling. This year three levels of effort are planned:

1. NATIONAL The National Council on Problem Gambling (NCPG) (www.npgaw.org/) and Association of Problem Gambling Service Administrators (APGSA) are co- sponsors of National Problem Gambling Awareness Week. The theme of the national campaign this year is ―Real Addiction, Real Recovery‖ and the website above offers free information and downloads.

2. STATE Statewide efforts are being led by Department of Human Services (DHS) Problem Gambling Services Program in collaboration with the Oregon Council on Problem Gambling (OCPG) and the Oregon Problem Gambling Awareness Week (OPGAW) Committee. The main efforts on the state level include updating this resource guide, requesting a Governor‘s proclamation and helping to coordinate statewide information and events.

3. LOCAL

Local efforts, by you and your partner agencies, are vital to the success of this project. Local efforts could include collaborating with such partners as Gambler‘s

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Anonymous (GA), mental health advocacy groups, treatment providers, other prevention professionals, school staff, community service groups and others in your area. In addition, you can help get the word out in the schools by participating in the OPGAW middle school artwork search.

Key messages Join Oregon Problem There are three key messages to convey Gambling Awareness during Problem Gambling Awareness Week Week efforts and call and throughout the year. In this resource guide attention to problem you will find materials that support and gambling during the week explain these key ideas: of March 7-13, 2010.

1. Problem gambling is a serious public health issue for Oregon. 2. Oregon’s investment in addressing problem gambling reduces harm and helps the economy. 3. Help and treatment in Oregon is free, confidential, and it works.

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Oregon problem gambling services

 How big is the problem in Oregon? 1  What are the effects of problem gambling in Oregon? 1  Oregon’s comprehensive system 2  Who uses the services and does treatment work? 4  How effective is Oregon’s system? 5  For more information 8

Note: Oregon gaming is covered in Section 3 County-specific data is in Appendices A and B

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Oregon Problem Gambling Services

Gambling has become part of the Oregon landscape, culture and economy. Oregon has more forms of legalized gambling and offers easier access to gambling than most other states. Sixty four and a half percent of all Oregonians gamble some time during the year; 2.7 percent of those who gamble suffer enormous social, economic and psychological implications.

How big is the problem in Oregon?

 More than 74,000 Oregon adults (2.7 percent of adults) are believed to meet the criteria for being current problem or pathological gamblers (Moore, 2006).  About 6,000 Oregonians over 62 years old (1.2 percent) are believed to meet the criteria for problem or pathological gambling (Moore, 2001).  1.3 percent of Oregon youth are problem gamblers; 4.6 percent are at-risk gamblers. That means there are between 1,100 and 6,300 adolescents with severe gambling-related difficulties (Volberg, 2007).

What are the effects of problem gambling in Oregon?

Of the 1,861 gamblers who received publicly funded treatment in Oregon in 2008- 2009, the following gambling-related consequences were reported (Moore, 2009):  Clients‘ average reported gambling debt was $32,000; 102 clients reported gambling debts in excess of $100,000.  34 percent had alcohol-related problems and 15 percent reported problems with substance use.  Approximately 38 percent of clients reported committing illegal acts to obtain gambling money.

 Approximately 48 percent had suicidal thoughts and more than 9 percent had attempted suicide within the past six months.  Approximately 35.2% reported they had jeopardized or lost a significant relationship and 18.5% reported risking or losing a job because of gambling.

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Financial impacts

 According to economist Earl Grinols, in 2004 the average social-economic cost of problem gamblers was approximately $3,000 each and $11,000 for each pathological gambler – or an estimated social-economic cost in excess of $449 million for Oregonians.  Those entering in Oregon treatment had combined debt related to gambling of more than $41 million (Moore, 2009)

Oregon’s comprehensive system

Oregon has one of the most comprehensive problem gambling service systems in the country. The legislatively enacted Gambling Treatment Fund, made up of 1% of net Lottery proceeds, goes to Oregon Department of Human Services Addictions and Mental Health Division which is responsible for the creation and maintenance of a state-wide prevention and treatment system. Service design follows the Institute of Medicine's (IOM) Continuum of Care:

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Prevention and outreach

Problem gambling prevention programs are directed at avoiding or reducing the emotional, physical, social, legal, financial and spiritual consequences of problem gambling for the gambler, the gambler's family, and the community. Oregon‘s prevention efforts are guided by the Center for Substance Abuse Prevention's (CSAP) six core prevention strategies. General awareness and outreach ma involve activities such as providing presentations to various groups, creating public service announcements, exhibiting at conferences and meetings, etc.

Common outreach activities include case finding among high-risk populations including clients within mental health programs, alcohol and drug abuse programs, corrections departments, and at-risk youth programs. In addition, the Oregon Lottery's outreach campaigns generate thousands of calls to the Problem Gambling Help-Line each year.

 More than 2.4 million Oregonians are reached each year by prevention and outreach efforts. The statewide Helpline receives more than 2000 calls per year for help.

Treatment

What services are available? Oregon‘s system offers several levels of care depending on the severity of the gambling problem and the individual client‘s circumstances and needs. Treatment is available across the state and there is no charge to problem gamblers and their family members. Starting with the Helpline, a common point of entry into the system, the levels of care are as follows:

Problem Gambling Help-Line (877-My-LIMIT and 1877mylimit.org) The Help-Line is staffed 24-hours a day by certified problem gambling treatment counselors. Counselors are also available by telephone, interactive chat, or email by accessing the helpline website: 1877mylimit.org. Callers are informed that problem gambling treatment services in Oregon are free of charge and confidential. When appropriate, counselors conduct brief assessments and motivational interviews with callers. The counselor then makes referrals based on screening information, clinical judgment, and available resources. To facilitate a successful referral, Help-Line counselors use three-way calling to place the caller

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in contact with the referral agency, and offer follow-up calls to provide further support.

 Of the 2,068 calls for help or information the statewide Problem Gambling Helpline received in 08-09, over 92 percent resulted in referrals for service.

GEAR (Gambling Evaluation and Reduction) program: is a treatment option for individuals with less severe gambling problems and is the first home- based gambling counseling program in the United States. It combines phone consultation with a certified gambling counselor, workbook exercises, and referral resources to give participants the tools and motivation to make good choices about if and how much to gamble.

Outpatient Treatment: 40 outpatient treatment locations throughout the state of Oregon provide group, individual, couples and family counseling.

Respite programs: are available at two locations in the state. Respite is available for clients enrolled in one of the outpatient facilities

Residential treatment program is located in Salem, Oregon. Eleven beds are dedicated to problem gambling clients.

Who uses theses services and does treatment work? 1,861 gamblers received publicly funded treatment in Oregon in 2009; of those:  Nearly 38 percent of problem gambling clients worked full-time; the average annual household income was $30,776.  Nearly 64 percent of the problem gamblers who enrolled in treatment reported their game of preference was video poker followed by video line games and slot machines at 12 percent each.  Problem gamblers reported that their primary gambling location was Lottery retailers (75.9 percent) followed by Indian gaming centers and casinos (13.8 percent).  Treatment programs within 50 miles of a casino are significantly more likely to enroll gamblers who report their primary gambling venue is a casino than other treatment programs.  42% of successful program completers report no gambling 6 months after treatment

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How effective is Oregon’s system?

The following data points are illustrative of the fact that Oregon‘s system is working and is well worth the investment.

Stable prevalence rates despite increasing gambling opportunities. The prevalence of disordered gambling has remained stable or declined while casino and lottery gambling revenue has more than doubled. This is most likely due to the largest prevention and treatment system in the nation and ongoing aggressive media efforts by the Lottery.*

*Moore, T. (2006). The prevalence of disordered gambling among adults in Oregon: a replication study. Portland, OR: Oregon Gambling Addiction Treatment Foundation. **ECONorthwest (2008). The Contributions of Indian Gaming to Oregon‘s Economy in 2006. Portland, OR: ECONorthwest.

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Treatment saves money. Out of 2,012 people treated for problem gambling in 2008, 822 were not gambling at all 6 months after treatment ended*. Depending on the severity of the problem, gamblers cost society from $3,000 to $11,000 per year**. Treating the 2,012 people for approximately $3.8 million dollars created a savings of $8.1 million dollars—a very good investment.

Problem Gambling Treatment: Costs vs Savings

$9,000,000 $8,055,600 $8,000,000 $7,000,000 $6,000,000 $5,000,000 $3,843,624 $4,000,000 $3,000,000 $2,000,000 $1,000,000 $0 Annual Treatment Costs Socio Economic Costs Saved Year After Treatment

*Herbert and Louis 2008 Oregon Gambling Treatment Evaluation Report **Grinols, E. (2004). Gambling in America Costs and Benefits. Cambridge University Press.

Fewer suicidal thoughts. Problem gamblers experience higher rates of suicide than those with other disorders; of those in treatment in Oregon in 2008, approximately 33% reported suicidal ideation and as many as 8% have attempted suicide. Suicidal ideation was reduced after problem gambling treatment.

Problem Gambling Treatment Reduces Thoughts of Suicide

35.0% 33.2% 30.0% 25.0% 19.6% 20.0% 15.0% 10.0% 5.0% 0.0% Admission Discharge

Source: Herbert and Louis Oregon Gambling Treatment Evaluation Report

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Fewer illegal acts. Approximately 24.6% of problem gamblers entering treatment in 2008 reported committing illegal acts to obtain gambling money; financial desperation leads some to embezzlement, theft and fraud. The gambling related debt of those in treatment exceeded $48.4 million. Illegal acts among problem gamblers were reduced after treatment.

Percent of Problem Gamblers Who Committed Illegal Acts to Get Money

30.0% 24.6% 25.0% 20.0% 15.0% 10.0% 5.3% 5.0% 0.0% At Admission to Treatment Six Months after Treatment

Source: Herbert and Louis Oregon Gambling Treatment Evaluation Report

Integrating youth gambling and other risk behaviors. One in 25 Oregon youth has, or is developing, a gambling problem—that‘s one per classroom, yet it‘s commonly not addressed. Gambling among Oregon adolescents is correlated with alcohol, tobacco and marijuana use, fighting, being in trouble at school and other key risk behaviors. Oregon is a leader in integrating problem gambling into its prevention efforts.

Risk Behaviors Among 11th Grade Youth Who Gamble

70.0% 60.0% 50.0% 40.0% NonGambler 30.0% Gambler 20.0% 10.0% 0.0% Female Male Female Male

Drank Alcohol on one or more occasions w ithin Percent w ho w ere in a physical fight w ithin the the past 30 days past 30 days

Source: Oregon Healthy Teens 2008

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For more information

Problem Gambling Services prepares an annual report which summarizes much more prevention and treatment data. A copy can be obtained by contacting Paul D. Potter, Problem Gambling Services Manager, at 503-945-9709 or [email protected].

There is also a great deal of information on the following websites:

 DHS Problem Gambling Services: http://www.oregon.gov/DHS/addiction/gambling.shtml

 Oregon Council on Problem Gambling: http://www.gamblingaddiction.org/

 Oregon Problem Gambling Prevention Coordinators: http://lanecounty.org/prevention/pgs/

See also other sections of this manual:

 Section 2 contains factsheets with more information on how problem gambling affects vulnerable populations.  Section 3 includes facts on Oregon‘s gaming industry and spending on gaming.  Appendices A and B contain county-specific data

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Problem gambling and vulnerable populations

 Overview: harmful effects of problem gambling 1  Youth/teens 3  Missing link: influence of parents on youth gambling 8  College students 12  Persons with addictions or mental health problems 16  Older adults 18  Women 20  Ethnic groups: African Americans, Asian Americans 23  Domestic violence 30  Incarcerated persons 33  Military 35  PTSD 37

See also: Section 4 for fact sheets on the above

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Overview: harmful impacts of problem gambling

Most people can gamble without negative consequences. A small percent who gamble suffer enormous social, economic and psychological implications. Individuals, families and communities all suffer from problem gambling. While it would be impossible to describe all of the repercussions associated with problem gambling, the following issues help to illustrate why problem gambling can be so destructive.

Snapshot: effects in Oregon Problem gamblers experienced a complex array of mental health, social, financial and legal issues – 48 percent indicated suicidal thoughts, 34 percent alcohol-related problems, and 15 percent drug-related problems. The average gambling-related debt of those in treatment was $32,000, with 102 clients reporting gambling debts well over $100,000. Fifty-four percent reported they either jeopardized or lost a significant relationship or job because of gambling. More than 35 percent committed illegal acts to obtain gambling money (Moore, 2009).

Effects of adult problem gambling on children  ―Children of compulsive gamblers are often prone to suffer abuse, as well as neglect, as a result of parental problem or pathological gambling.‖ (National Opinion Research Center, 1999).  Research consistently shows higher rates of pathological gambling in teens whose parents gamble excessively (Gupta & Derevensky, 1997; Jacobs, 2000; Wallisch & Liu, 1996).  Children of problem gamblers have been shown to have higher levels of tobacco, alcohol and drug use and overeating than do their classroom peers (Gupta & Derevensky, 1997).  The National Research Council (NRC, 1999) reported on studies indicating that 10-17 percent of children of compulsive gamblers had been abused.

Domestic violence (see also Domestic Violence fact sheet)  The National Research Council (1999) reported on studies indicating that 25-50 percent of spouses of pathological gamblers have been abused.

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 Studies of 10 casino communities revealed that domestic violence Community costs of gambling problems rates increased with the opening of casinos (National Opinion Research Recent national estimates place the Center, 1999). social-economic cost at approximately $3,000 for each problem gambler and Crime $11,000 for each pathological gambler  More than one in three (35 percent) (Grinols, 2004). That’s an estimated clients enrolled in Oregon‘s gambling social-economic cost in excess of $449 treatment system reported committing million for Oregonians. illegal acts to finance their gambling

(Moore, 2009).  ―As access to money becomes more limited, gamblers often resort to crime in order to pay debts, appease bookies, maintain appearances, and garner more money to gamble‖ (NRC, 1999).  Gamblers Anonymous (GA) studies report that approximately half of the members had stolen to gamble and more than one-third had been arrested (Thompson, Gazel, & Rickman, 1996).  The majority of gambling-related crimes are non-violent; embezzlement, check forgery, credit card theft, fenced stolen goods, tax evasion, insurance fraud, employee theft and fraud are common gambling-related crimes.

Suicide/depression  Of clients enrolled in Oregon‘s gambling treatment system, 48 percent had suicidal thoughts and about 9 percent had made suicide attempts (Moore, 2009).  A major depressive disorder is likely to occur in 76 percent of pathological gamblers (Unwin, Davis, & Leeuw, 2000).

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Oregon youth/teens and problem gambling

Data Reconfirm Risks Associated with Youth Gambling

Gambling and problem gambling among young people remains an important and growing issue in Oregon. In 2007 a statewide prevalence study (1,555 matched pairs parents and adolescents aged 12 to 17 years and their parents) on youth and gambling revealed the following:

 Six in 10 Oregon adolescents (63 percent) have gambled, 46 percent gambled in the past year and 3 percent gamble weekly or more.  1.3 percent of Oregon youth are problem gamblers; 4.6 percent are at-risk gamblers. That means there are between 1,100 and 6,300 adolescents with severe gambling-related difficulties.  Preferred games in order: free Internet gambling-type games, cards (poker), sports bets, games of personal skill.  Almost half report spending nothing* on gambling per month; 40 percent spend less than $10 per month. Despite being less likely to gamble regularly, African American, Hispanic and Asian adolescents report spending significantly more on gambling per month than white adolescents.  Risk factors that increase the chances of being a problem gambler include: coming from a single-parent household, gambling on card games and sports, being male, older adolescent, household income below median, playing sports for school, having lost more than $50 in a single month, started gambling before 8th grade.  Adolescents in families with parents who gamble are twice as likely to be an at- risk gambler and four times as likely to be a problem gambler.  Adolescent problem gamblers are significantly more likely to have used alcohol, tobacco or drugs in the past year; they are also more likely to have skipped school, been hurt by and to have deliberately hurt someone else, been cautioned by the police, arrested and been to court in the past year.

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 High proportions of parents (regardless of whether they gamble) have inaccurate beliefs about gambling, such as thinking that gambling is harmless. and that youth who gamble are unlikely to have problems in school; they also believe that youth gambling is not associated with alcohol or drug use.

* may be due in part to ―free‖ online gambling

Special concern: Oregon kids and online gambling

Oregon's techno-savvy youth indicate that they're gambling for free on the Internet. Many are playing less poker, which used to be the number one gambling activity among youngsters. "The emergence of free gambling on the Internet is no surprise, but is of real concern," said Paul D. Potter, DHS problem gambling services manager. "Ads for online games pop up, and kids think that if money's not involved there's no risk. "Kids don't realize they're being primed to play for money later, which is illegal. They can also become a victim of identity theft," he said. "Parents need to be vigilant about their kids' Internet use."

According to Oregon’s Healthy Teens Survey, the association between gambling and other risk behaviors is strong.

OREGON HEALTHY TEENS SURVEY 2008 11th graders and gambling

The graphs on the following pages illustrate the connection between youth gambling and other risk behaviors.

 Youth who gamble are much more likely to be involved in other risky behaviors.  Gambling needs to be included in discussions of healthy choices and risky behaviors at school, in the community and at home.  Gambling is not a harmless alternative activity for youth.  Boys are more likely to gamble than girls.  It is important to include gambling in the discussion in places or systems where high-risk youth are already engaged (alternative high schools, juvenile justice, at-risk intervention programs).

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Oregon Healthy Teens data tell us that youth gambling accompanies several other risky behaviors; therefore, it should be addressed as such in prevention awareness and education programs, as illustrated below.

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Missing link: the influence of parents on youth gambling

In Oregon as elsewhere, most parents and kids still don't see gambling as a behavior that can lead to serious problems, even addiction. A 2008 statewide study of Oregon youth and their parents notes that ―high proportions of parents (regardless of whether or not they gamble) believe that gambling is a harmless activity, that youth who gamble are unlikely to have problems in school, and that youth gambling is not associated with alcohol or drug use‖. (http://lanecounty.org/prevention/pgs/Data/OR-Adolescent-Report%20_final_2008.pdf) An Oregon focus group study of parent/child beliefs about gambling revealed that all of the youth had participated in some kind of gambling activities, while all of the parents believed their children had not done any gambling (Farrell, 2006). Typical remarks from parents when asked about their child‘s gambling:

One exception was a parent whose son had lost $500 betting with a bookie:

The report notes that ―this father‘s story was compelling to the rest of the group; for many parents in the group, it was the first time they had considered that teens can get into trouble gambling.‖ When asked about talking to their kids about risky behaviors, ―parents ‗absolutely‘ set rules about behavior with their children. Most common rules are about parties, curfew, drinking, drugs, sex, internet use, cell phone use. No one had set any rules around gambling; it simply did not occur to them.‖

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When youth were asked whether they gambled with their families at home, typical responses included:

Here are some comments made by youth in the focus groups as to why gambling is generally not a high priority issue:

Finally, there were a few examples of parents who had addressed gambling with their kids, such as this focus group participant:

A new study from the International Center on Youth Gambling Problems and High Risk Behaviors (http://www.youthgambling.com/Parents_as_Partners.pdf) corroborates this phenomenon and points to the need to educate parents. The majority (66%) of parents report they ―rarely‖ or ―never‖ have conversations with their child about gambling.

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Gambling isn’t high on the list of concerns parents have for their kids

Parents believe youth gambling can be harmful, yet don’t talk to their kids about it:

Few/no materials are coming from schools re: youth gambling

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As the authors of this study state, ―This research highlights the paradoxes of parental attitudes toward youth gambling. While parents express strong opinions against underage gambling, their actions contradict this stance. The majority believe that, in addition to being highly addictive, gambling can also adversely affect work performance and friendships. Over half of parents believe underage gambling can escalate to a gambling addiction/problem, and approximately two- thirds of parents do not condone teenage gambling. Despite this, most parents report they rarely or never have conversations with their child about gambling and/or gambling-related issues. This may explain why other DECODE research shows that among underage youth reporting gambling activity in the last 12 months, a majority believe their parents were ―indifferent‖ to their participation in these activities. Without clear anti-gambling messaging from parents, it is unclear where teens will get them.‖

―When parents learn more about the potential risks of youth gambling, they do a better job of helping their kids make different choices about using their leisure time," says Paul D. Potter, Manager of Oregon Problem Gambling Services. "When we hear parents say, ‗What's the harm in kids playing poker? At least I know where they are. They could be doing much worse things.', it tells us that they haven't seen the real data," said Potter. "If they did, they'd think twice."

Sources:

DECODE & Derevensky, J. et al (July 1, 2009) Parents as Partners Qualitative National Findings International Centre for Youth Gambling Problems and High Risk Behaviors, Montreal, Quebec.

Farrell, P. (2006) Oregon Teens and Parents Perceptions of Teenage Gambling. Oregon Partnership, Portland, OR

Oregon Department of Human Services (May 29, 2008) Overall youth gambling down, but Internet's lure draws concern, DHS reports news release, Salem, OR. retrieved from http://www.oregon.gov/DHS/news/2008news/2008-0529.shtml

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College students and problem gambling

Gambling is one of the most overlooked issues on campus. For most college students, gambling is a social or recreational activity. It is fun and entertaining. However, it is not without risk. A certain percentage of college gamblers will go on to develop a gambling problem, which can be a major threat to academic success and financial well-being.

Quick facts . An estimated 5.6 percent of college students are problem gamblers, almost double the rate of the adult population (2.7 percent). 1 . Those who play cards are also more likely than other gamblers to gamble on the Internet. 4 . The average college student receives about 25 credit card solicitations per semester. (National Public Radio) . According to the National Council on Problem Gambling, about 4.5 million of the nation‘s 15.3 million college students (29 percent) will gamble on sports this year. (National Council on Problem Gambling) . A 2005 Harvard School of Public Health study of colleges found that all the colleges surveyed had alcohol policies, yet only 22 percent had a gambling policy. . In 2007 the University of Oregon surveyed its students, the first such survey of college gambling in the state. A few highlights follow and the complete report can be found at www.lanecounty.org/prevention/gambling/college- survey-summary.htm o Gambling is a common behavior for University of Oregon students. In the past year, more than half of the students surveyed had gambled, most commonly on the Lottery, board games, or skill games. o Although gambling is fairly common, it is rare for students to gamble more than once a month. It is also rare for students to bet large sums

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of money, with most bets less than $10. Bets higher than $100 are rare. o Some students express attitudes and have engaged in behaviors that would indicate gambling problems. Approximately a quarter of student gamblers have one gambling problem or another, although it is rare to have multiple gambling problems. o Students gamble primarily for fun and excitement, with monetary reward as a minor goal. o Students are generally unaware of community resources available for help with problem gambling. However, they believe that gambling can be a type of addiction which can be treated. If they were looking for resources on problem gambling they would be most likely to look first at the Internet.

There is some good news, however, on the national scene: card-playing for money among college-age youth declined in 2007 for the first time, according to a survey by the Annenberg Public Policy Center of the University of Pennsylvania. (http://online.wsj.com/article/SB123086359472548321.html)

Getting wired: Internet gambling in college The Internet is one of the reasons for an increase in problem gambling among students in recent years. Internet access is readily available on campuses and the convenience and anonymity of online gambling can be appealing.

. Several thousand Internet gambling sites on which to place bets.

. Internet gambling is the fastest growing segment of the gambling industry.

. Presently there are over 5 million transactions conducted per day, or an average of about 300 bets per second

. There is no US regulation on how the sites control payouts and percentages of payoffs. The sites could manipulate the gambler to think they are skilled and can outplay the others on the site. Once winning and playing with greater amounts of money the site could decrease the gamblers odds and take the winnings back with interest.

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Problem or not? Telling the difference No-Problem Gambling Problem Gambling Occasional gambler Frequent, or spends more time gambling Sticks to limits of money Plays with money that is needed or borrowed Hopes to win but expects Expects to win; keeps playing to win back losses Can take it or leave it Life revolves around gambling

Potential consequences of college problem gambling . Academic and athletic failure . Alcohol and substance abuse . Crime . Debt . Relationship problems . Depression and suicide

Oregon college problem gambling awareness program Interested Oregon colleges can select from a menu of options to help them assess and address the problem of campus gambling. DHS Problem Gambling Services will provide materials, training and technical assistance at no charge to the campus, and may provide funding for a student liaison to help implement the program. For information contact: Wendy Hausotter, problem gambling prevention and public health coordinator at 504-945-9703 or [email protected]

College Athletes and Problem Gambling

. Seventy-two percent of student athletes have gambled at least once since entering college; 45 percent of male athletes gamble on sports. 2 . 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. 2 . Twenty-eight percent of athletes have gambled on athletic events. 3

NCAA gambling rules for student athletes  ―You may not place any bet of any sort on any college or professional sports event.‖  ―You may not give information to anyone who does place bets on college or professional sports.‖

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Athletes vs. non-athletes Athletes and non-athletes gamble at about the same frequency (81 percent). 6.2 percent of athletes are problem gamblers, compared with 3.3 percent of non- athletes. 3

Signs of a problem sports gambler  Excessive use of Internet or phone bills to 900-number services;  Obsession with point spreads or ―fantasy‖ scores;  Unusual interest in obscure games or shifting of team allegiances;  Association with other sports bettors;  Frequently borrowing money from friends or family;  Defensive when questioned about gambling behavior;  Debts, unpaid bills, financial troubles;  After losing, desiring to bet again to win back losses.

Sources: 1Shaffer, H. J., and Hall, M. N. (2000). Updating and refining meta-analytic prevalence estimates of disordered gambling behavior in the United States and Canada. Boston: Division of Addictions, Harvard Medical School. 2 Cross, M. E., Del Carmen Lorenzo, M., and Fuentes, M.J. (1999) The Extent and Nature of Gambling Among College student Athletes. Ann Arbor, MI: University of Michigan Department of Athletics. 3Rockey, 2002; Southeastern Conference (SEC) study. 4Univeristy of Pennsylvania, The Annenberg Public Policy Center. (2005, September). National Annenberg Risk Survey of Youth. Retrieved February 24, 2006 from http://www.annenbergpublicpolicycenter.org/07_adolescent_risk/GamblingRelease20050928.pdf. 5Shaffer, h., Donato A., LaBrie., R., Kidman, R., and LaPlante, D. (2005). The epidemiology of college alcohol and gambling policies. Harm Reduction Journal, 2.

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Gambling and other addiction/mental health issues

Gambling is quite often found as a co-occurring disorder with other addiction and mental health issues, including the following. Persons with a history of alcohol issues:  Problem drinkers were shown in one study to be 23 times more likely to have a gambling problem than persons without a drinking problem (Welte, et al., 2001).  Thirty percent of gamblers receiving treatment in Oregon in 2007-08 also had alcohol-related problems (Moore, 2008).  Pathological or problem gamblers had seven times the rate of alcohol dependence of non-gamblers and low-risk gamblers (NORC, 1999).  A 1999 study (Pasternak & Fleming, 1999) revealed that almost one in every three persons with a gambling problem also abused alcohol (compared to about one in 10 without gambling problems), and about twice as many problem gamblers used tobacco.  In a study of more than 21,000 high-school students, (Proimos, DuRant, Pierce, & Goodman, 1998) regular cocaine use and anabolic steroids were significantly associated with a report of problems connected to gambling.

Persons with a history of mental health issues:  Individuals with concurrent psychiatric problems display much higher rates of disordered gambling than either adolescents or adults sampled from the general population (Shaffer et al., 1997).  There are strong associations between pathological gambling and depression (Becona, Del Carmen Lorenzo, & Fuentes, 1996).

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 Forty-eight percent of gamblers treated in Oregon in 2007-08 reported having had suicidal thoughts and up to 7 percent had made a suicide attempt (Moore, 2008).  High rates of personality disorders (e.g., obsessive-compulsive, avoidant, schizotypal and paranoid) are noted in the research (NORC, 1999). Persons who smoke:  Gamblers have high rates of tobacco use and there is a linear relationship between gambling severity and both smoking frequency and nicotine dependency (Rodda et al. 2004)  New Zealand study showed 58% of problem gamblers were daily smokers versus 22% of non-problem gamblers (Ministry of Health 2006)  Gamblers who smoked daily gambled more days and spent more money than non-daily smokers. They craved gambling more and had lower perceived control over gambling (Petry & Oricken 2002)  41.6% of heavy gamblers are smokers versus 30.1% of recreation smokers and 21.3% of non smokers (Smith & Ferris, 1996)  62 % of treatment seeking gamblers in Connecticut and 69% in Minnesota smoked (Petry & Oricken 2002, Stinchfield and Winters 1996) as compared to 25% of general population (Reuter et al.. 1990)  Smoking is powerful reinforcement for the trance-inducing rituals associated with gambling (Harper,2003)

Source: National Council on Problem Gambling, February 2008

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Problem gambling and older adults

 The rate of problem gambling among Oregonian adults ages 65 and older is 1.2 percent, lower than any other age group in Oregon (Moore, 2001b); however, older adults who play at gambling facilities are six times more likely to be problem gamblers than other older adults randomly chosen from the same community, and 3.7 times as likely to be probable pathological gamblers (McNeilly & Burke, 2000).  Older adults are considered at increased risk due to factors such as loneliness, Did You Know…? isolation, and physical or mental illness that Among adults over 65 years of are often more common to that population age, gambling is the most than among other age groups; additionally, frequently identified social in one study of older adults, the most likely activity. reported motivations to gamble were: relaxation, boredom, passing time, and getting away for the day (McNeilly & Burke, 2000).  Compared to those older adults surveyed from senior centers, older adults surveyed from bingo events had higher South Oaks Gambling Screen (SOGS) scores and greater gambling frequency and expenditures (Ladd, Molina, Kerins, & Petry, 2003).  Among adults over 65 years of age, gambling is the most frequently identified social activity (McNeilly & Burke, 2001).  From 1975 to 1997, the number of American adults 65 years of age or older that had ever gambled increased by 45 percent (NORC, 1999).  From 1994 to 1998, the percentage of women 65 years of age or older who had ever gambled rose by 20 percent (NORC, 1999).

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 Some older adults may have cognitive impairment that interferes with their ability to make sound decisions.  Many older adults may not understand addiction, making them less likely to identify a gambling problem; additionally, older adults appear less willing to seek assistance for a gambling problem than younger adults.  There is also concern that gambling-related problems may be more difficult to identify because of increased isolation from co-workers, friends and family.

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Women and Problem Gambling (excerpted from National Council on Problem Gambling Statement to SAMHSA Advisory Committee for Women‘s Services: Problem Gambling Issues: May 11, 2009)

1. Women are now just as likely as men to gamble at casinos and play the lottery—a significant increase in participation over the past two decades. Women remain generally more likely to play bingo and slot machines,1 though less likely to gamble at the track, on sports, on cards or illegal gambling.2

2. Women problem gamblers generally start gambling later in life than men and progress to pathological gambling more quickly;1,3 however, girls who are impulsive or sensation seeking are as likely as boys to begin gambling in adolescence.4 Adolescent girls who gamble are about four-fold more likely than boys who gamble to experience symptoms of depression.5

3. Women pathological gamblers wager more often in response to gambling cues and advertisements than men pathological gamblers.6

4. Women are now equally represented in treatment, a significant change in the past decade as previously men were overrepresented in treatment.7

5. Problem gambling is more heavily stigmatized for women than for men because of sex role stereotypes.8

6. Problem gambling is more prevalent in minority communities,9,10 and African American, Hispanic and Native American women may be particularly vulnerable because of the role that some forms of gambling (i.e. bingo) plays in the social life of these communities.

7. There is a stronger association in women problem and at-risk gamblers with the following psychiatric disorders:  Nicotine dependence  Major depression

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 Dysthmia  Panic disorder  Generalized anxiety disorder  Social phobia11

In addition, studies comparing male and female gamblers have reported that females were more likely to be African-American and either retired, unemployed or otherwise outside the workforce;1 prefer lower denomination slot machines and longer sessions of play;12 had fewer problems with drugs or gambling-related arrest;13 and higher rates of affective disorders14 and histories of physical abuse.15 Women with disabilities are also at greater risk for gambling problems.16

For more on women and problem gambling: http://lanecounty.org/prevention/pgs/women.htm

1 Nower, L. & Blaszczynski, A. (2006). Characteristics and gender differences in casino selfexcluders: Missouri data. Journal of Gambling Studies, 22, 82-99. 2 Volberg, R. (2001). When the chips are down. NY: Century Foundation Press. 3 Tavares, H., Zilberman, M.L., Beites, F.J., & Gentil, V. (2001). Gender difference in gambling progression. Journal of Gambling Studies, 17, 151-159. 4 Nower, L., Derevensky, J., & Gupta, R. (2004). The relationship of impulsivity, sensation seeking, coping, & substance use in youth gamblers. Psychology of Addictive Beh., 18(1), 49-55. 5 Desai RA, Maciejewski PK, Pantalon MV, Potenza MN (2005) Gender differences in adolescent gambling. Ann Clin Psychiatry 17: 249-258. 6 Weiss, L., & Petry, N. (2008). Psychometric properties of the Inventory of Gambling Situations with a focus on gender and age differences. J of Nervous and Mental Disease, 196, 321-328. 7 Petry, N. Pathological gambling. American Psychological Association, Washington, D.C. (2005). 8 Volberg, R. & Wray, M. (2007). Legal gambling and problem gambling as mechanisms of social domination? American Behavioral Scientist, 51, 56-85. 9 Alegria, A.A., Petry, N.M., Hasin, D.S., Liu, S.M., Grant, B.F., & Blanco, C. (2009). Disordered gambling among racial and ethnic groups in the US: results from the national epidemiologic survey on alcohol and related conditions. CNS Spectrums, 14, 132-142. 10 Westermeyer, J., et al. (2005). Lifetime prevalence of pathological gambling among American Indian and Hispanic American veterans. American Journal of Public Health, 95, 860-866. 11 Desai, R. & Potenza, M. (2007) Gender differences in associations between past-year gambling problems and psychiatric disorders. Soc Psych & Psych Epi, 43, 173-183. 12 Hing, N. & Breen, H. (2001). Profiling lady luck: An empirical study of gambling and problem gambling amongst female club members. Journal of Gambling Studies, 17, 47-69. 13 Potenza, M.N., Steinberg, M.A., McLaughlin, S.D., Wu, R., Rounsaville, B.J., & O'Malley, S.S. (2001). Gender-related differences in the characteristics of problem gamblers using a gambling helpline. American Journal of Psychiatry, 158, 1500-1505. 14 Blanco, C., Hasin, D., Petry, N. Stinson, F.S., & Grant, B.F. (2006). Sex differences in subclinical and DSM-IV pathological gambling: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Psychological Medicine, 36, 943-953. 15 Ibanez, A., Blanco, C., de Castro, I., Fernandez-Piqueras, J., & Saiz-Ruiz, J. (2003). Genetics of pathological gambling. Journal of Gambling Studies, 19, 1-22. 16 Morasco, B, Petry, N. Gambling problems and health functioning in individuals receiving

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disability. Disability and Rehabilitation (2006) 28: 619-623. 17 Shaffer, H., Hall M, & Vander Bilt J. (1999). Estimating the prevalence of disordered gambling behavior in the United States and Canada: a research synthesis. AmerJPubHealth, 89, 1369-1376. 18 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. (2000). Washington, DC: Author. 19 Petry, N.M., Stintson, F.S., & Grant, B.F. (2005). Comorbidity of DSM-IV pathological gambling and psychiatric disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry, 66, 564-574. 20 Morasco B, Pietrzak RH, Blanco C, Grant B, Hasin D, & Petry N. (2006). Health problems and medical utilization associated with gambling disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Psychosomatic Medicine, 68, 976-984. 21 Petry, N.M. & Kiluk,B.D. (2002). Suicidal ideation and suicide attempts in treatment-seeking pathological gamblers. Journal of Nervous and Mental Disease, 190, 462-469. 22 Nower, L. & Blaszczynski, A. (2008). Characteristics of gamblers ages 56 and older: A statewide study of casino gamblers who self-exclude. Psychology and Aging, 23, 577-584. 23 Gerstein, D, Volberg, R, Harwood, R, Christiansen, E, et al. Gambling Impact and Behavior Study. Chicago, IL: National Opinion Research Center, University of Chicago (1999).

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Problem gambling among ethnic groups

 Minority populations most likely have much higher rates of pathological gambling than Caucasians (Moore, Jadlos, & Carlson, 2000, as cited in Moore, 2001).  Minorities spend about two-and-a-half times more on gambling in a typical month than Caucasians (Volberg, 2001).  Ethnic minority groups (except Asians) are over-represented among individuals classified as problem gamblers (Volberg, 2001). A 2007 Oregon survey of African-American clients in treatment was conducted at an alcohol and drug inpatient treatment facility for women and children and through men‘s and women‘s groups at an outpatient treatment facility. Though the survey was small (59 respondents) and has not been studied for statistical validity and reliability, it provides the following useful and intriguing information about gambling in the African-American community:

Preferred games: Caucasians vs. African-Americans

 Caucasians prefer video poker almost 2:1 over African-Americans.  African-Americans prefer dominos about 5:1 over Caucasians.  Caucasians play scratch tickets far more than African-Americans.  African-Americans play dice far more than Caucasians.

Treatment clients: Caucasians vs. African-Americans

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Source of gambling funds: Caucasians vs. African-Americans

What are the implications for family treatment?

 African-American relationships may be more enabling.  Caucasian spouses/partners may be oblivious to their partner‘s gambling.

African-Americans and treatment admission

 Minorities tend to perceive delayed admission as a form of rejection.  Minorities have a history of being abused by bureaucracy and red tape. Complex rules, documents, etc., have historically been used to exploit African-Americans. African-Americans are turned-off by ―red tape.‖  Research shows that delayed admission produces poorer outcomes in minorities compared to Caucasian clients in behavioral health and medical care services. Special thanks to Hubert Evans, CGAC II at Lifeworks NW for collecting and sharing this data.

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Asian Americans and Problem Gambling

Asian American problem gambling in Oregon

Oregon Problem Gambling Services has convened an Asian American Problem Gambling Advisory Group to help shape services in the state. The group sponsored a day-long conference on this issue and has plans to continue working on awareness, prevention and treatment.

After the conference, Bounsang Khamkeo, a behavioral health counselor at the Avel Gordly Center for Healing at OHSU, and Dr. Paul Leung, director of OHSU's Intercultural Psychiatric Program and the Asian Health & Services Center spoke with an Oregonian reporter and shared these thoughts (http://www.oregonlive.com/news/index.ssf/2009/10/specials_will_confront_the_t ab.html):

Why are you concerned about problem gambling? Leung: There's no data [on Asian American gambling]available in Oregon. But it's an open secret that when you go into the Asian community – Chinese, Vietnamese, Laotian – you hear that a way people come together is to gamble instead of drinking or doing drugs. For clinicians like myself, we all recognize there is an ongoing problem with gambling in our community. I have seen patients come in with depression, but as I inquire further into their history, the depression is a result of gambling away their whole salary.

How do Asian American families cope with problem gambling? Khamkeo: It's a loss of face. They feel shame coming for counseling. They ask me, 'Please don't tell my family.' I ask them to bring in their spouse for family counseling, and even though they value family, they still don't want their family involved in treatment.

Leung: It is taboo. This is a shameful thing for any family to acknowledge that you have someone in your family because of his or her gambling destroying his or her life. Somehow, people still don't think gambling addiction equates to drug or alcohol addiction. They see it as a social thing, instead of a mental health or a

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pathological problem. So families, they bail their loved ones out, they pay the debt, they continue to enable the person with the habit.

What does treatment for problem gambling look like? Khamkeo: We teach them how to take care of their money. You can not take your rent money to gamble. It's better to convince them to stop entirely. But even if they stop 50 percent, and gamble half as much, I'm happy, because many of my clients who come to see me have a long history of gambling so we can't solve the problem overnight.

Leung: Once the individual seeks help I can rally the family. You can look at medicine to ease anxiety. You can take financial control away from that person and give it to others. It's one step at a time, but you can curb the behavior.

A Tradition of Gambling

John Glionna (Glionna, John M. 2006. "Gambling, Addiction, and Asian Culture" Asian-Nation: The Landscape of Asian America. December 31, 2009) describes the Asian American tradition of gambling as follows:

―Many Asians -- especially Chinese -- consider gambling an accepted practice at home and at social events, even among the young. Chinese youths often gamble for money with aunts, uncles and grandparents. While growing up in San Francisco's Chinatown, Lee took betting to absurd levels -- wagering on whether the teacher would assign homework. On rainy days, he bet on which drop would first reach the bottom of the classroom window.

Many Chinese are fascinated by the mystical qualities of luck, fate and chance. The Chinese New Year -- this year Jan. 29 -- is a time of heightened wagering, when bad luck of the old year is ushered out by the good luck of the new. Numerology also plays a crucial role in many Asian cultures. The number 8, for example, is considered extremely lucky by many Chinese, while 4, when spoken in Mandarin and Cantonese, sounds like the word for death and is avoided.

Though Chinese believe most strongly in such concepts, other Asian cultures, including Vietnamese, Korean and Filipino, hold similar beliefs -- depending on China's political influence in their history or the extent of Chinese immigration there. Experts believe that recent Asian immigrants -- risk-takers willing to leave

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the familiarity of their homelands -- develop more aggressive gambling strategies than their U.S.-born counterparts.

Often lacking language skills and advanced education, some gravitate to casinos, where waitresses dote on gamblers with free drinks and cigarettes. "They're treated as honored guests even though they work dead-end, minimum-wage jobs," said Tina Shum, a social worker in San Francisco's Chinatown. "That's what they long for." Some eventually engage in "attack" gambling: wagering sums beyond their means in a reckless grab at the American dream. "The immigrant experience is often demeaning," Shum said. "Many get blinded by the neon lights."

Research

UCLA Gambling Studies Program and the Asian Pacific Policy and Planning Council (A3PCON) are doing research on problem gambling in Asian American communities. They held focus groups in Korean, Cambodian and Vietnamese communities which confirmed the following:

1. Gambling was a common thing that a lot of community members did. 2. Gambling was very socially acceptable. 3. Almost everyone knew one or two people that they knew had a gambling problem. It was a very common thread that they also didn‘t know what to do about that person; where to send them, what to say to them, what to do about it.

Dr. Tim Fong, Director of UCLA‘s Program, when asked why there may be a disproportionate percent of Asian gamblers, responded:

“I think there is a blend of biological, psychological and social factors. In these Asian communities, gambling is very accepted for entertainment. So you have higher participation rates, a higher approval rate. I think there’s a huge social component where the majority of social activities are spent at the casino you’re going to do that. If all your friends go to the casino, you’re going to go to the casino. There’s an immigrant mentality as well, where folks who come here to take a chance and come to America are more likely to gamble because immigrating to America from your homeland is a huge gamble in and of itself. We can’t prove this but most likely they have some kind of biological predisposition to gambling in general, in life. It makes it very easy for them to go to the casino when they get here even though they may be very poor. There are all sorts of other factors too. Maybe the recruiting, the advertising by the casino probably has an

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impact. I think it’s all those things. There is no real backlash against gambling in Asian communities. It’s not like the churches are saying don’t do this; or advocacy groups or intervention groups. It’s an activity that’s not frowned upon.” Source: http://www.la.ucla.edu/profiles/fong.shtml

Other studies have revealed:

 Gambling is widely accepted in the Asian American community. Regional surveys indicate that Asian Americans have a higher rate of problem gambling as compared to the general population (Woo 2003, Petry 2003).  Recent immigrants are at especially high risk for gambling addiction. Facing language barriers and limited social venues, many turn to gambling to cope with stress or to seek excitement. Source: http://www.masscompulsivegambling.org/contentmgr/showdetails.php/id/713  In San Francisco‘s Chinatown, which has estimates of up to 15 percent problem gamblers, seventy percent of residents surveyed identified gambling as the number one problem in the community. Similar studies also show that 59 percent of Southeast Asian refugees face gambling addictions.  Problem gambling has taken a painful toll in Asian communities. The Sacramento Bee recently reported that a well-respected traditional Asian medicine healer in California hanged himself after gambling away $400,000 of his home equity. Similar stories of suicide, murder and unbearable debt have been ringing out across Asian communities these past few years.  On average, Asians comprise 30 to 40 percent of clientèle in the Los Angeles area casinos. Casinos aggressively gear their marketing toward Asian communities by offering bus packages, Asian holiday deals, and Asian pop star concerts. A person living in an Asian enclave is often no more than two hours away from a casino.  While the casino industry's explosion in the past decades has catapulted gambling to the mainstream culture, gambling has been a long-standing acceptable form of social entertainment within many Asian cultures. Forms of gambling such as games of mahjong and casino cruises are popular family activities. As a result, problem gambling is not taken seriously unless a gambler amasses serious debt. ―[Many Asians] think it‘s strictly a moral issue, and that gambling does not pose a health risk and therefore they are not seeking help,‖ said Chien-Chi Huang, Asian Community Manager of the Massachusetts Council on Compulsive Gambling.  Factors that thwart preventive measures against problem gambling among Asian communities are: shame, stigma, and the lack of culturally-sensitive services and outreach. In addition, other factors also make it difficult for

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problem gamblers to seek treatment – strong values of self-reliance, cultural mores such as the rejection of therapy, a sense of fatalism, and family insulation. For many members of the Asian American community, there is a thin line between normative gambling and problem gambling. Source: http://sampan.org/show_article.php?display=1896

Links for more general information and resources: http://www.nicoschc.org/ http://www.olgr.qld.gov.au/resources/responsibleGamblingDocuments/gamblingA ndProblemGamblingAmongChinese.pdf http://www.asian- nation.org/gambling.shtml#ixzz0bIfSXYFv http://www.asian-nation.org/gambling.shtml#ixzz0bIfBUCMvhttp://www.asian- nation.org/gambling.shtml http://www.asian-nation.org/gambling.shtml#ixzz0bIetcGLq

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Domestic/family violence and problem gambling

Family violence and the link to problem gambling

To date, research on the link between domestic violence or intimate partner violence (IPV) and problem gambling has been limited. But there is evidence that IPV may be more prevalent among problem gamblers than in the general population. IPV increased with the development of problem gambling.1

A recent Canadian study examined the prevalence and severity of IPV among a group of problem gamblers and found that 62.9 percent reported perpetrating or being a victim of IPV within the past 12 months; 55.6 percent reported perpetrating physical assault, injury and/or sexual coercion; 25.4 percent reported severe IPV; and 64.5 percent had significant anger problems. 2

A 2007 New Zealand study on family violence in Asian communities found that IPV was often due to lifestyle changes caused by immigration, such as finding employment and having problems with finances. The study reported that IPV was considered a private matter and that shame and the desire to keep the marriage intact often were barriers to seeking help. 3

A survey of 144 spouses of compulsive gamblers indicated that 50 percent were physically and verbally abused by their spouses and 12 percent had attempted suicide.4 Brand et al (1993) found that 23 percent of pathologic gamblers admitted to ―hitting or throwing things more than once at their spouse or partner.‖5 One in 10 gamblers in counseling reported domestic or other violent incidents related to their gambling.6

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A 1999 survey of 215 spouses of pathological gamblers indicated that they often suffer from headaches, stomach problems, dizziness and breathing difficulties, in addition to emotional problems of anger, depression and isolation.7 These were usually due to psychological abuse.

Children of problem gamblers were reported to be two to three times more likely to be abused (by both the gambler and the gambler‘s spouse) than their peers.8

In a 2005 study on assault, the most frequently cited reason for assault on women, with the exception of ―not known‖ (41.5 percent), was alcohol and gambling for 37 percent of interviewees.9

In Taiwan a study found that under a traditional Chinese family structure, men had the final authority and women were beaten if they did not give their private money to their husbands for their gambling needs.10

A woman whose partner is a problem gambler is 10.5 times more likely to be a victim of partner violence than are women whose partners are not problem gamblers.11

Alcohol Problem drinking by a problem gambler increases the risk of family violence. In a 2002 study 64 percent of the women interviewed had partners with problem gambling.11

Unemployment The risk of family violence increased if the gambler was not fully employed. Possibly the financial stress of unemployment increases the risk that a man will physically abuse his partner. The additional financial stress brought on by problem gambling could well add to that risk. 3, 11

Co-existence It was suggested that family violence and addiction disorders do not merely co- exist – they actually share many features. These shared features include loss of control, anger, continuation of the behavior despite adverse consequences, preoccupation or obsession, tolerance and withdrawal, involvement of the entire family, and the use of the defenses of denial, minimization, and rationalization.2, 11

Immigration Triggers for IPV included difficulties in adjusting to living in a new country.

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The loss of cultural and traditional dominance by some men, and racism and discrimination some women experienced when trying to find work or resolve financial dependency issues was found to put women at extreme risk of abuse and violence. 3

Control The issue of having control in life and relationships connects IPV and gambling issues.1 Problem gambling is associated with having, asserting, maintaining and/or reclaiming control; it can also be a response to being controlled. Women who experience abuse may gamble as a response to beingcontrolled, because it gives them a chance to get away, to feel numb and not think about their abusive relationships.

Citations: 1. Community West. 2007. Exploring the links between family violence and problem gambling. Melbourne, State Government of Victoria. 2. Koma LM et al. 2008. Problem gambling and intimate partner violence. Journal of Gambling Studies 24: 13 23. 3. Tse S. 2007. Family violence in Asian communities, combining research and community development. Social Policy Journal of New Zealand 31: 170 194. 4. Lorenz VC and Yaffee RA. 1988. Pathological gambling and psychosomatic, emotional and mental difficulties as reported by the spouse. Journal of Gambling Behavior 4 :13 26. 5. Bland RC, Newman SC, Orn H, Stebelski G. 1993. Epidemiology of pathologic gambling in Edmonton. Canadian Journal of Psychiatry 38:108 12. 6. Australian Productivity Commission. 1999. Australia‘s gambling industries. Report no.10. Canberra: AusInfo. 7. National Opinion Research Center, 1999. Gambling impact and behavior study: report to the national gambling impact study commission. Chicago: University of Chicago, p.9. 8. Darbyshire P, Oster C, Carrig H, 2001. Children of parents who have a gambling problem: a review of the literature and commentary of research approaches. Health and Social Care in the Community 9 (4): 185 193. 9. Balci YG, Ayranci U. 2005. Physical violence against women: Evaluation of women assaulted by spouses. Journal of Clinical Forensic Medicine 12 (5): 258 263. 10. Xu X et al. 2005. Prevalence of and Risk Factors for Intimate Partner Violence in China. American Journal of Public Health 95: 78 85. 11. Muelleman RL et al. 2002. Problem Gambling in the Partner of the Emergency Department Patient as a Risk Factor for Intimate Partner Violence. Journal of Emergency Medicine 23 :307 3 12. Problem Gambling Foundation Hotline 0800 664 262

SOURCE: Problem Gambling Foundation of New Zealand www.pfgnz.org.nz

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Problem gambling among incarcerated persons

Studies show that two out of three pathological gamblers commit crimes in order to pay debts or to continue gambling (Brown, 1987). While the majority of crimes are non-violent, they contribute to higher insurance payments, higher taxes and greater societal mistrust. More often than is reported in the news, underlying gambling problems are at the root of embezzlement and fraud cases that make the headlines.

Some of Oregon‘s pathological gamblers end up in the prison system. Once in prison, pathological gamblers typically do not improve. Gambling is common in the prison culture, and is accepted as a way to alleviate boredom. Although research and literature on incarcerated problem/pathological gamblers are limited, the literature suggests that a significant number of inmates have problems related to gambling and many want help to stop. Unfortunately, prisons rarely have education and treatment for gambling. The prison setting could be an excellent venue for gambling addiction education and treatment.

According to a 2006 Oregon Department of Justice report, the extent of illegal gambling activities occurring within the state is currently unknown. Most of the reported illegal gambling has involved individual cheaters instead of organized criminal groups. Law enforcement resources currently devoted to the investigation of this crime are extremely limited.

At the local and county level, current efforts to regulate and investigate suspected criminal activity are decentralized and spread thinly among many agencies. Many city prosecutors and district attorneys‘ offices lack sufficient expertise in local social gambling ordinances or state gambling laws to effectively advise law enforcement or the public. (Myers, Hardy, [2006]. Organized crime in Oregon. Salem, Oregon: Department of Justice.)

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A review of current literature reveals:

 One-third of criminal offenders meet criteria for problem or pathological gambling. This is the highest rate yet found in any population. Approximately 50 percent of crime by incarcerated problem and pathological gamblers is reportedly committed to support gambling. The prevalence of gambling within correctional facilities (40 percent) appears lower than in the general population. However, inmates who do gamble tend to do so regularly, and problem and pathological gamblers are disproportionately represented among this group. Inmate screening for problem gambling and provision of specialized treatment are currently lacking in most correctional facilities. (Criminal Justice and Behavior, Vol. 32, No. 6, 665-689 (2005) Gambling and Problem Gambling Within Forensic Populations, A Review of the Literature, Robert J. Williams, Jennifer Royston, Brad F. Hagen.)

 Pathological gamblers are more likely to have had involvement with the criminal justice system. Most common offenses were fraud, theft and embezzlement or crimes associated with the immediate procurement of funds necessary to continue gambling. (Meyer, G. & Stadler, M. A. [1999]. Criminal behavior associated with pathological gambling. Journal of Gambling Studies, 13, 29-43.)

 Pathological gamblers had higher arrest and imprisonment rates than non- pathological gamblers. A third of problem and pathological gamblers had been arrested, compared to 10 percent of low-risk gamblers and 4 percent of non-gamblers. About 23 percent of pathological gamblers have been imprisoned, as have 13 percent of problem gamblers. Those with gambling problems tend to commit more white-collar crimes, such as fraud, credit card theft and employee theft. (National Gambling Impact Study Commission. [1999, June]. Gambling impact and behavior study. National Opinion Research Center at the University of Chicago.

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Problem gambling and the military

Research suggests that higher levels of problems and pathology are associated with socio-demographic characteristics of military personnel. Those drawn to military life are predisposed to become gambling addicts, because they are generally young and risk-takers.1

A recent study found that pathological gambling is more prevalent among military veterans than in the U.S. general population. Different studies of veterans undergoing treatment for PTSD have shown their current rate of problem gambling to range from 0 to as high as 17 percent, with a lifetime prevalence of 29 percent. The rate of problem gambling in the general population is 1 percent to 2 percent. 2

 About 2.2 percent of military personnel have indicators of probable pathological gambling, compared with 0.77 to 1.6 percent of the general population.3  Research shows that military personnel and their families are susceptible to gambling addiction.

Access to gambling on military bases4

Slot machines have been on some military bases since the 1930s. The machines were banned from domestic military bases in 1951.

The four branches of the armed services operate more than 4,000 modern video slot machines at nine bases overseas.

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The military says revenue from the slots – more than $120 million per year – is used to fund recreation programs overseas, such as swimming pools, movie theaters and concerts.

Treatment within the military Limited confidentiality in the military surrounding mental health treatment is of concern; without confidentiality, many people with gambling addiction may never come forward.

In one study, chaplains said that one in three people who come to them for counseling have a gambling problem, but can‘t tell anyone because they fear dishonorable discharge.

Concerns Currently the Department of Defense and the services lack consistent policies and programs regarding prevention, referral and treatment of problem or pathological gambling. Information available on gambling and gambling problems in the military potentially understates the prevalence and extent of impacts of problem/pathological gambling in the military.

1 Gambling with Terrorism and U.S. Military Readiness Report. Available at www.ideals.uiuc.edu/handle/2142/229 2 Lee, Lexa. (2007) Problematic Gambling Prevalent in US Military Veterans. Available at http://www.medscape.com/viewarticle/564469 3 Available at www.cnn.com/2007/US/05/22/military.gambling/index.html 4 Available at www.liebertonline.com/doi/abs/10.1089/glr.2006.10.524

See also: Problem gambling and PTSD factsheet which follows

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Problem gambling and Post-Traumatic Stress Disorder

What is Post-Traumatic Stress Disorder?

Post-Traumatic Stress Disorder, PTSD, is an anxiety disorder that can develop after exposure to a terrifying event or ordeal. Traumatic events that may trigger PTSD include violent personal assaults, natural or human-caused disasters, accidents, or military combat.

How does PTSD relate to problem gambling?

According to a paper describing proposed research on the topic of problem gambling and posttraumatic stress disorder, Korn and Najavits note:

 It is known that pathological gamblers have high rates of co-occurring disorders, including substance use disorder, mood disorders, and personality disorders (Petry et al., 2005).

 A comprehensive literature search indicates some evidence for a compelling association between trauma and/or PTSD and pathological gambling. Yet only a few studies provide data to address this topic, and no study specifically selected a sample for the presence of both PTSD and pathological gambling.

 In a study of military veterans entering treatment for PTSD (Biddle et al., 2005), 17% met DSM-IV criteria for PG. In another study (Kausch et al., 2006), among 111 veterans entering a gambling treatment program, 64% reported a history of emotional trauma; 40.5%, physical trauma; and 24.3%, sexual trauma; most trauma had occurred in childhood.

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 In another study of treatment-seeking problem gamblers, similar associations were found and a significant gender difference was discovered, with women reporting more childhood abuse than men (Petry & Steinberg, 2005).

 In one of the earliest studies on this topic, Taber et al. (1987) found a 23% rate of major traumatic events in a sample of pathological gamblers seeking treatment. In a study of 843 elderly adults, 11% were identified as "at risk" gamblers, with current PTSD symptoms one of the strongest predictors (Levens et al., 2005).

 Finally, among treatment-seeking pathological gamblers, 34% had a high level of PTSD symptoms with the latter assessed by self-report checklist (Ledgerwood & Petry, 2006).

 Overall, estimates of PTSD among problem gamblers are estimated at 12.5% to 29% (Ledgerwood & Petry, 2006).

 These studies have also been able to identify some basic characteristics of those with trauma history (or PTSD) and pathological gambling. Overall, the common pattern appears to be greater pathology and worse functioning among pathological gamblers with a trauma history (or PTSD) than those without such history. For example:

Taber et al. (1987) found increased depressive, anxiety, and substance abuse symptoms, and greater personality style of avoidance among those with trauma.

Petry and Steinberg (2005) found an association between greater severity of childhood abuse and both earlier age of gambling onset and more severe gambling problems.

Ledgerwood and Petry (2006) found greater lifetime gambling severity, psychiatric symptom severity, impulsivity, and dissociation in high-versus low PTSD subjects.

Kausch et al. (2006) observed that history of trauma was associated with a greater relative frequency of suicide attempts and drug and alcohol dependence, more severe scores in measures of psychiatric distress, and limited effects on personality functioning.

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Biddle et al. (2005) observed "an entrenched gambling culture" and a self-reported desire to escape problems.‖

Source: Korn, D and Najavits, L. Posttraumatic Stress Disorder and Gambling; Univ. of Toronto www.responsiblegambling.org/en/research/PTSD_PG_proposal.pdf

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Oregon gaming

 U.S. and Oregon gambling 1  Oregon gaming history highlights 4  Oregon Lottery sales data 5  Oregon tribal casinos data 6

Gambling in the U.S.

 During fiscal year 2008, U.S. lottery sales totaled $60.6 billion (NASPL, 2008)  According to the 2006 Gross Annual Wager Report, Americans lost nearly $91 billion on all forms of gambling combined.  Legal gaming in America attracted $93 billion in consumer spending in 2007 (Wall St. Journal http://online.wsj.com/article/SB123086359472548321.html)  About 70 percent of Americans believe that legalized gambling encourages people to gamble more than they can afford, according to a Pew Research Center survey in 2006. That's a noteworthy increase from 1989, when 62 percent expressed that concern in a Gallup survey. (Wall St. Journal http://online.wsj.com/article/SB123086359472548321.html)

Gambling in Oregon Note: at the time this publication went to press, the most recent studies on Oregon gaming did not cover the period of economic downturn (and decreased gambling revenues) in which we currently find ourselves. The following general statistics are applicable to this most recent situation:

 The Oregon Lottery had net sales of $1.105 billion in fiscal year 2009 (Oregon Lottery, 2009). According to a report from the Nelson A. Rockefeller Institute of Government: (http://www.rockinst.org/pdf/government_finance/2009-09-21-No_More_Jackpot.pdf)  Over the past year, Oregon's State gambling revenues dropped 15.2 percent, the highest drop in the nation.  Across the nation, state gambling revenues are down for the first time since data was available in the late 1970s.

The data which follow are for 2007 and reflect the more historically typical economics regarding Oregon gaming.

ECONorthwest‘s publication ―The Contributions of Indian Gaming to Oregon‘s Economy in 2007: A Market and Economic Impact Analysis for the Oregon Tribal

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Gaming Alliance‖ (August 14, 2009) provides the most recent look at Oregon‘s overall gaming industry (2007 figures); highlights include:  Overall, the gaming market in Oregon grew 5.85 percent between 2006 and 2007 (up $87.9 million).  Oregonians spent $1,691,247,228 on all forms of gaming, both in Oregon, online and in other states:

 The average Oregonian spent $451.55 on gaming or 1.29 percent of their personal income as follows:

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 Oregonians gambled over $189.9 million at casinos elsewhere with Las Vegas being their most common destination. According the Las Vegas Convention and Visitors Authority, in 2007 Portland International ranked as the 20th largest feeder market into Las Vegas‘ McCarran Airport.

 Oregonians spent an estimated $49.4 million gambling over the Internet via sites other than horse race account wagering hubs.

 The Oregon Lottery retains the greatest market share of Oregon gaming at 62% of the market:

Source: http://www.econw.com/reports/2009_ECONorthwest_Contributions-Indian-Gaming- Oregon-Economy-2007.pdf

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Oregon gaming history highlights Oregon is one of the top states in gambling revenue, and among the leaders in types of legal gambling available.

Recent history of legal gambling in Oregon 1984 Oregon voters authorize a state-run Lottery. The Lottery begins with scratch tickets in 1985. 1989 Oregon becomes the only state that offers state-operated sports betting with the Sports Action lottery. 1991 Oregon becomes the first state lottery to offer Keno games every five minutes. 1992 Video Lottery is legalized. As of October 2004, 10,238 Lottery-operated video poker machines are in more than 2,000 bars and taverns across the state. 1994 First Native American casino in Oregon opens. Tribal casinos made possible by passage of the federal Indian Gaming Regulatory Act of 1988. 2003 Monday Night Football scratch-it tickets begin. Lottery Commission approves Three-Way Action Poker. Expansion of video lottery from five to six terminals per retailer. Introduction of 10 video lottery terminals in pari-mutuel establishments. 2004 Keno offered every four minutes. Lottery Click&Play computerized game implemented. 2005 Lottery implements video slot machines. 2006 Lottery exceeds $1 billion in biennial revenues. 2007 Lottery offers gadget for Windows®Vista™ which relays the winning numbers, winner stories, Lottery alerts, jackpot alerts, and the Oregon Amber Alert. 2008 Lottery launches state‘s first video poker ad campaign. 2009 State law banning smoking in bars/restaurants/indoor worksites goes into effect.

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Oregon Lottery sales data (07/01/08 – 06/28/09) COUNTY Video Video LotterySM TOTAL SALES TOTAL SALES LotterySM per capita (18 years (% of total) per capita (18 (% of total) and older)* years and older) Baker .43 $254.19 .43 $356.02 Benton .70 $80.34 .83 $133.11 Clackamas 10.34 $276.35 9.92 $379.61 Clatsop 1.67 $444.27** 1.60 $590.50** Columbia 1.65 $355 .01** 1.71 $514.52** Coos .71 $109.70 1.04 $226.10 Crook .52 $201.51 .54 $292.04 Curry .28 $122.01 .38 $230.55 Deschutes 3.28 $197.70 3.33 $279.95 Douglas 2.02 $192.23 2.24 $297.70 Gilliam .05 $234.07 .04 $317.29 Grant .11 $143.95 .14 $256.93 Harney .05 $58.96 .05 $117.87 Hood River .59 $286.06 .57 $386.31 Jackson 4.48 $201.60 4.55 $313.75 Jefferson .41 $197.41 .43 $291.89 Josephine 1.83 $227.74 2.00 $348.31 Klamath 1.29 $201.90 1.42 $310.90 Lake .12 $155.35 .13 $236.05 Lane 8.10 $233.78 8.17 $329.64 Lincoln 1.17 $253.48 1.34 $405.16 Linn 3.18 $300.23 3.31 $437.30 Malheur 1.06 $351.66 .99 $457.02 Marion 8.08 $273.04 8.13 $384.23 Morrow .15 $131.27 .15 $189.40 Multnomah 29.57 $416.35** 28.00 $551.50** Polk .80 $121.30 .92 $193.84 Sherman .13 $691.33** .13 $959.89 ** Tillamook .92 $340.85 .94 $486.36 Umatilla 1.55 $226.53 1.66 $337.04 Union .53 $215.47 .58 $317.00 Wallowa .10 $136.90 .11 $204.00 Wasco .79 $336.50 .82 $487.47 Washington 12.13 $249.55 11.78 $338.29 Wheeler 0 0 .01 $63.59 Yamhill 1.46 $160.62 1.57 $243.70

* Video LotterySM players must be 21 years of age or older. Oregon population figures by age group break at 18-19 years and 20-24 years. Oregonians 18-20 years of age, who are included in this per capita calculation, are not eligible to play Video Lottery SM games. ** Multnomah, Clatsop, Columbia and Sherman Counties are located near major population areas in Washington with easy access to Oregon Lottery® retailers. Per capita sales figures in these counties reflect “cross-over” sales

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Oregon tribal casinos data

Oregon Casinos by Date Opened (Source: ECONorthwest, 2009) 2007 stats Date VLTs/ Table Bingo Poker Casino City/County Tribe Opened Slots Games seats tables 1. Seven Apr Canyonville/ Cow Creek 1,361 22 334 7 Feathers 1994 Douglas Pendleton/ 2. Wildhorse Nov 1994 Umatilla 805 12 400 4 Umatilla 3. Chinook May Lincoln City/ Siletz 1,160 26 1,200 5 Winds 1995 Lincoln May Kah-Nee-Ta/ Warm 4. Kah-Nee-Ta 326 6 0 2 1995 Wasco, Jeff. Springs May North Bend/ 5. The Mill Coquille 748 8 0 2 1995 Coos 6. Spirit Oct Grande Ronde/ Grande 1,912 33 0 17 Mountain 1995 Polk, Yamhill Ronde Jun Chiloquin/ 7. Kla-Mo-Ya Klamath 358 6 0 0 1997 Klamath Burns/ Burns 8. Old Camp Sep 1998 145 0 60 0 Harney Paiute Coos, L. 9. Three Jun Florence/ Umpqua, 650 11 150 6 Rivers 2004 Lane Siuslaw Total (data are from yr end 7465 124 2144 43 2007)

Every Oregon tribe operates a tribal casino.

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Problem gambling fact sheets and handouts  Signs of problem gambling 1  Talking to kids about family gambling problems 2  Teens and problem gambling 5  Oregon kids are gambling online 7  Poker: 5A’s for Alarm 10  The Changing Adolescent Brain 12  Parents: talk to your kids about gambling 14  Educators: signs of a problem in students 18  College students and gambling 19  Older adults 21  Workplace 23  Primary care providers 27  Mental health counselors 31  Bankers and financial institutions 35  10 Rules of responsible gambling 39  Myths and facts about problem gambling 40  Gaming trends 42

Signs of problem gambling

Is someone you know…?

 Preoccupied with gambling (e.g., reliving past gambling experiences, planning the next venture, or thinking of ways to get money with which to gamble);  Secretive about his or her gambling habits, and defensive when confronted;  Increasing bet amounts when gambling in order to achieve the desired excitement (high);  Trying unsuccessfully to control, cut back, or stop gambling;  Restless or irritable when not gambling;  Gambling to escape problems;  ―Chasing‖ losses with more gambling;  Lying to family and others about the extent of gambling;  Committing crimes to finance gambling;  Jeopardizing or losing relationships, jobs, education or career opportunities because of gambling;  Relying on others to bail him or her out to relieve a desperate financial situation caused by gambling;

If any of these statements sound like someone you know, that person may have a problem with gambling. Help is free, confidential, and it works. Call 1-877-MYLIMIT or go to 1877mylimit.org

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Talking to Your Children About Problem Gambling in the Family

It is important for children to know that although their loved ones are struggling with a gambling problem, they have not stopped loving their family.

How to Talk to Your Child  Reassure your children that the gambling problem is not their fault.  Let the child know that they alone cannot influence a problem gambler to stop gambling.  Help them understand the gambling problem by providing them information from this fact sheet and answering their questions.  Ask and listen to each child‘s feelings and concerns o Are your children sad, mistrusting, worried, stressed, embarrassed, alone or angry?  Listen to what they are telling you and watch for warning signs that they are more affected by the problem gambling than you think. o How has your child‘s behavior been at home? o Have any relationships changed? o How is their school and extra-curricular performance? o Are they having trouble sleeping? o Are they suffering from any physical problems?  Speak to school counselors or teachers, to share and listen about your child‘s behavior. o Be aware that not all teachers and counselors are equally aware of how to recognize and handle the effects of problem gambling.  Devise an action plan for your child at home and at school that may include counseling and/or self-help groups.

Suggestions for Families When one parent is a problem gambler, the other parent or another family member is left feeling responsible for maintaining the family‘s well being. Following are a few suggestions of what NOT to do:

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DON’T  Participate in gambling activities with the gambler.  Exclude the gambler from family life and activities.  Bail out the gambler by giving them money or access to money to relieve gambling debts.  Cover-up or deny the existence of the problem to yourself, the family, or others.  Preach, lecture, or allow yourself to lose control of your anger.  Make threats or issue ultimatums unless you intend to carry them out.  Expect immediate recovery—or that all problems will be solved when the gambling stops.

Help your Child to Express their Feelings: Sometimes children are better able to express themselves through art than they are talking about their feelings. After talking with your child, ask them to write a poem, short story or draw or paint a picture to help express feelings about themselves and/or problem gambling. After they are done, ask them to share what the story, picture, or object is about. Ask them to tell you how they felt while producing it.

Resources: Oregon Problem Gambling Help Line :1-877-My LIMIT or www.1877mylimit.org Talk or chat live online with a certified gambling counselor who will listen, educate, answer questions, and refer the gambler and their family members to FREE confidential treatment services. Telephone contact available 24 hours a day, 7 days a week. Online chat available Monday - Friday from 9am to 9pm.

Gamblers Anonymous A fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and help others to recover from a gambling problem. http://www.gamblersanonymous.org/

Oregon Gamblers Anonymous Meetings http://www.1877mylimit.org/gameetings.asp

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Gam-Anon The self-help organization of Gam-Anon is a life saving instrument for the spouse, family or close friends of compulsive gamblers. http://www.gam-anon.org/

Adapted from materials from the Connecticut Council on Problem Gambling

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What’s the big deal? teens and problem gambling

Most young people don‘t consider themselves ―gamblers.‖ Yet most of today‘s teens have been gambling for years; not the way adults gamble – at bingo halls, bars or racetracks – but through casual betting with friends or family.

What are the signs of problem What is gambling? gambling? Gambling is ―the act of risking money People don‘t usually start out as or something else of value on an problem gamblers. Somewhere along activity with an uncertain outcome.‖ the way, though, the casual bets stop being ―just for fun‖ and begin causing Playing cards or video games for problems. money, buying raffle tickets, betting on who‘s going to win the next game How would you know if your of pool, or wagering your favorite CD betting was becoming a problem? on the outcome of a sports event – it‘s all gambling. It may be a problem if you:  Spend more time or money For most, it‘s just for fun. It‘s a way gambling than you intend; of making the game more  Go back another day to try to win challenging, more exciting. But for back your losses; some, gambling becomes a serious  Feel bad about the way you problem. gamble or about what happens What is problem gambling? when you gamble; Problem gambling is any gambling  Tell others you‘ve been winning behavior that has a bad effect on your money from betting when you life or the lives of people close to you really haven‘‘t; – parents, brothers and sisters, your  Want to stop betting money, or friends. gambling, but don‘t think you can;  Hide signs of betting or gambling If your gambling is causing you to fall from your parents, friends or behind on your schoolwork, have others; arguments with family or friends, or worry about money you have lost, it is  Are being criticized for your considered to be ―problem‖ gambling. gambling or told you have a gambling problem;  Argue about money and gambling;

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 Skip school or work to gamble; Often, people with gambling  Borrow gambling money from problems have troubles in other areas someone and don‘‘t pay them of their lives that they need to sort back. out, such as feeling lonely or arguing a lot with parents. Who is at risk for gambling problems? Where can you go for help? Anyone who gambles can develop a If you are worried that you or gambling problem. If you begin at a someone you know may have young age and if gambling is a problems related to gambling, call the frequent activity in your home or Oregon Gambling Helpline at 877- among your friends, you are at greater MYLIMIT or go to risk for developing a problem. You 1877mylimit.org or contact your may not experience any problems at counseling office. You will be able to first, but problems may develop later talk to someone who can answer your on. questions and help you decide if you need further counseling.

Free teen brochure download: 1877mylmit.org – click on Resources

Free parent brochure download: 1877mylimit.org – click on Resources

Modified from information from the Alberta Alcohol and Drug Abuse Commission.

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2008 SURVEY: OREGON KIDS ARE GAMBLING ONLINE

Internet safety is extremely important, yet one key area of concern that generally gets overlooked is INTERNET GAMBLING. Today, anyone with a personal computer or cell phone has the capacity to gamble, virtually creating their own personal casino. The convenience of gambling at home, the ease of setting up a gambling account and the variety of games makes online gambling very appealing. Think it‘s not a problem? Oregon data say otherwise: in 2008 a statewide phone survey of Oregon youth indicated that online gambling for free is the number one gambling activity among Oregon youth ages 10-14.

Gambling online without money gives you a false sense that you can easily win. Free sites are set up so that you win more often, creating a heightened level of excitement and a exaggerated feeling of skill or luck. This misperception can lead youth to try sites for money, and they may use their or others‘ credit cards and quickly get in over their heads.

Unlike licensed gambling activities, internet gambling sites are not regulated anywhere in the United States. You have no idea who is operating the site. Internet gambling is illegal in the U.S. and it is also illegal for operators of offshore sites to solicit players from the U.S, yet it happens frequently. Some internet gambling sites say they are approved, secure, or regulated, but don‘t be fooled.

If you gambling online, you put yourself at risk for:  Not getting paid your winnings  Credit card fraud  Identify theft  Other financial crimes by disclosing information

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How It Works Although it is illegal for minors to use internet gambling sites, the sites don‘t know who is using them, and often their screening measures simply involve asking the user to indicate they are over the age of 18 years, which anyone can say yes to. Teens who play poker online generally register for an account with one of the offshore service providers (since it‘s illegal in the US), then have access to ―poker rooms‖ where they can play, mostly for money, against other players in real time. Often, teenagers can get credit cards as early as 14 years of age, or use a debit card and sometimes will steal or use a parent‘s card in order to play. There can be a sense of camaraderie or community in some virtual poker rooms as players, using nicknames, get to ―know ― each other through their play; this sense of belonging, coupled with the excitement of potential wins, can keep the teen coming back again and again.

Gambling In Any Form Is Risky For Youth

 There are already up to 5,740 adolescents in Oregon with severe gambling- related difficulties

 Kids who gamble are more likely to have used alcohol, tobacco and illicit drugs in the past year according to the Oregon‘s annual survey of teen health

 Kids develop gambling problems faster than adults and the earlier one starts, the more likely they are to develop a problem; Oregon surveys indicate that kids as young as 10 are already gambling

 Oregon youth indicate that their primary gambling locations are at home, at friends‘ houses and at school

What Parents Can Do

 Set a good example: if you gamble, set a limit of time and money and stick to it

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o Families where the parents gamble are twice as likely to have an at-risk adolescent gambler and four times as likely to have an adolescent problem gambler

 When you talk to your kids about risky behaviors, include gambling in the mix

o Gambling is going on among youth, and it carries risk, but it‘s generally not talked about at school, unlike alcohol and drug prevention, so be sure to talk about it at home--set guidelines and enforce them

 Follow general internet safety guidelines, and add gambling to the areas you talk about and monitor; if necessary, consider blocking software (see below)

 Learn more about problem gambling by reading the press release on page 4 and by going to: http://www.1877mylimit.org/ (click on ―Resources‖)

o recent parent/child focus groups in Oregon showed that, while all of parents in the group believed their kids hadn‘t gambled, all of the kids indicated that they had…parents need to learn more about this hidden issue!

Blocking Access to Online Gambling

The following companies have developed blocking software; the list is for convenience only, is not comprehensive and no endorsement of any product is implied: http://www.stopchildgambling.org/ http://www.gamblock.com/ http://www.optenetpc.com/stop-gambling-addiction.html

For more information and/or if you know someone who might have a gambling problem free, confidential help is available statewide by phone, chat, email or instant message: call 1887mylimit or 1877mylimit.org

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Poker and youth: an overview

Playing poker (particularly the Texas Hold‘em) continues to be popular among youth, causing concern about the potential development of gambling problems. In the past two years, the number of products has continued to increase. A search on the word ―poker‖ on Amazon.com in 2009 (Coe, 12/6/09) revealed:

o Books (112,737) o Clothing & Accessories (2,475) o Sports & Outdoors (9,489) o Toys & Games (2,328) o MP3 Downloads (2,137) o Music (363) o Video Games (342) o Software (270)

Five ―A’s‖ for alarm In substance abuse prevention, there are many well-known ―risk factors‖ that increase the likelihood for a youth to develop a problem behavior. There are several similar factors that may also contribute to problem gambling among youth. The following list outlines many of the risks involved with youth poker playing; many of the points apply to all forms of gambling.

Availability  Societal availability:  High availability to kids o ―Social gaming‖ ordinances in o poker kits/toys in stores many cities (allow for such o poker games at schools/in homes games as poker in public and o video games private places) o Internet

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Age  Ways to gamble/play poker are  Easy to start early: available to even more attractive than ever the youngest youths (video and o video games handheld games, poker kits, etc.) o handheld toy games  Pathological gamblers and youth in o first generation to use Internet general report early gambling in the  Gambling often viewed by adults home and with family members as harmless (Dickson et. al, 2002) o seen as healthy alternative to youth drug or alcohol use Accessibility o problem gambling often seen as  Kids can play from their own homes a ―victimless‖ habit o Poker nights  Gambling has become a family o poker kits sold to anyone activity: 80-90 percent of parents o lack of monitoring on Internet report knowing their children o trend toward mobile gambling: gamble for money and do not handheld games, software on cell object (Ladouceur, Vitaro, Cote & phones Dumont, 2001)  Greater access is shown to increase gambling, money spent, and rate of problem gambling (Dickson, Derevensky, & Gupta, 2002)

Advertising  More positive messages: o TV shows o Handheld games o School casino nights o Internet banner ads

Acceptability  More accepted than ever among youth o poker viewed as ―cool‖ o 44 percent of youth gambled because friends did (Dickson et. al, 2002)

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The Changing Adolescent Brain excerpted from an article by Sarah K. Ramowski and Robert J. Nystrom

The idea that the teenage years are full of change and growth is not new to public health professionals, teachers, parents, or teens themselves, for that matter. Adolescence is often a time of encountering new freedoms and new situations.

Over the past few years, strong research has emerged that documents the enormous changes to the brain in the developing years between childhood and adulthood.

Previously, it was thought that most brain development was complete by adolescence and that teenagers‘ brains were as fully matured as adult brains. As the result of increasingly sophisticated research and imaging abilities, we now know this is not the case. Just as teens‘ bodies are maturing and their social skills are expanding, their cognitive centers are also in flux.

During adolescence, the brain adopts a ―use-it-or-lose-it‖ pruning system, resulting in a decreasing number of connections among brain cells even as the speed of these connections increases. Major changes are also underway in the prefrontal cortex (PFC), known as the executive planner of the brain. The PFC is responsible for weighing risks and benefits, strategic thinking, and impulse control. Throughout adolescence, the PFC is refining its wiring to become more sophisticated. Studies demonstrate that the PFC is among the last parts of the brain to fully develop, in many cases not maturing until well into the third decade of life. Unused branches are sloughed off, and other pathways are refined. As this construction phase progresses, synapses that normally go through the PFC in an

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adult brain are instead re-directed to the amygdala, known as the emotional center of the brain. When this happens, the response is rooted in emotion—fight, flight, freeze, freak out—rather than rationality. The amygdala can also misinterpret others‘ facial emotions, perceiving fear or nervousness as anger or hostility.

All these processes can alter the ability of adolescents to harness their decision- making abilities, making them more vulnerable to risk-taking and impulsive behaviors. As a parent, when you sometimes feel your son or daughter is over- reacting or misinterpreting, you have likely met their developing brain in action.

The adolescent brain is especially sensitive to the effects of dopamine, a chemical neurotransmitter that is activated by substance use, exposure to high- intensity media, and gambling, as well as food and sex. It is still not known how much of brain development is influenced by environment vs. genetics, but some evidence suggests that constructive learning experiences can positively shape teen cognitive development.

As research results have emerged, some public health professionals have voiced concern that the results will be used to squelch teen independence or rights in areas such as reproductive health and health care decisions. Public health policy and science provide us with a few key responses to that concern. First, brain development, as an isolated issue, should be just one of several factors considered when designing good programs and policies. Second, it is important to recognize that successful brain development relies on exercising this organ. From a use-it-or- lose-it perspective of refining maturing brain connections, it would be most productive for caring adults to provide meaningful opportunities for adolescents to exercise brain functions that require analytical, decision-making, and valuing skills, to help teens demonstrate their real and valuable role in making good decisions and advocating for their health.

Source: http://www.nwpublichealth.org/archives/s2007/adolescent-brain

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Parents: talk to your teens about the risks of gambling

Worried about your kids using alcohol, tobacco and other drugs? Most parents are, so they talk to their kids about those risk behaviors because that‘s one of the things that research tells us works for prevention. However, you may not have discussed another risky behavior that more and more kids are engaging in – gambling. Unlike the eyeball rolling that a discussion of alcohol, drugs or tobacco will likely evoke, kids have not ―heard it all‖ when it comes to gambling – in fact, they have probably heard nothing in school or elsewhere about the potential risks.

Kids are exposed to gambling every day. All they have to do is turn on the TV to see poker tournaments, or walk into a mini-mart or grocery store to see people buying Lottery tickets, or log onto their computer and get online gambling popup messages. Even churches and schools often use gambling for fund-raising, so the gambling message is everywhere. As responsible parents you can give your kids the full story about gambling, and this factsheet can help guide you in that process.

What are the signs of a possible gambling problem? Some of these signs will sound very familiar – they are also ―signs‖ of adolescence or being in the teenage years. But if they occur in an ongoing pattern, or if you have reason to be concerned about your teen‘s gambling, here are some indicators to look for: . Asking for or borrowing money from the family or unexplained debt . Unexplained absences from school or a sudden drop in grades; . Carries or possesses gambling materials, such as dice, playing cards, or other gambling materials; . Says gambling is one of the best ways to make easy money;

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. Uses desperate measures to get gambling money, such as stealing from family; . Gambles with money that is suppose to be used for something else such as lunch, bus fare, etc.; . Neglects family/friends; . Frequent mood swings –‖ usually high when winning and lower when losing; . Lies to people about gambling; . Displays large amounts of cash and other material possessions;

Why talk about gambling? Teens who understand gambling and its risks are less likely to develop a gambling problem. Parents can protect their kids by helping them gain this understanding. Talk directly with your teen about gambling to make sure that you are communicating exactly what you want him or her to know.

How do I bring it up? Here are some tips for starting the conversation with your teen: . Look for a natural way to raise the topic. For example, discuss gambling after seeing a commercial for a gambling product or casino, or after you find out that a friend has won or lost money gambling. . Ask questions first. Find out what your child thinks and feels about gambling before offering your own opinions or giving information. . Be patient. Several discussions may be needed before your teen understands the ideas that you want to communicate. . When you talk with your teens about drugs or alcohol, include problem gambling in the conversation as another potentially risky activity.

Two more points to make when you talk to your teen 1. Gambling is not a way to make money. Games run by casinos, racetracks, Internet sites, and lotteries are all designed so that most people lose money in the long run. Online gaming sites are not regulated and the financial transactions involved are illegal. Games are designed to make a profit for the house, not the player. Many problem gamblers do not understand this. They believe that they are blessed with special skills or special luck that will allow them to ―beat the odds.‖ They often ―chase losses,‖ betting more money in the belief that they will ―win back‖ the money they have lost. Teens need to understand that these beliefs are illogical and dangerous.

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2. Gambling carries risk and problem gambling can lead to serious consequences throughout life, including the loss of huge amounts of money, destruction of a career, legal problems, and the loss of friends and family.

What to say about Internet gambling

The U.S. Federal Trade Commission is concerned about youth gambling on the Internet and wants teens and parents to understand the risks. Parents should tell their children that:

You can lose your money. Online gambling operations are in business to make a profit. They take in more money than they pay out.

You can ruin a good credit rating. Online gambling generally requires the use of a credit card. If kids rack up debt online, they could ruin their credit rating – or their parent‘s‘.

Online gambling can be addictive. Because Internet gambling is a solitary activity, people can gamble uninterrupted and undetected for hours at a time. Gambling in social isolation and using credit to gamble may be risk factors for developing gambling problems.

Gambling is illegal for kids. Every state prohibits gambling by minors. That‘s why gambling sites don‘t pay out to kids and go to great lengths to verify the identity of any winner.

Parents should also actively monitor their children‘s use of any Internet sites, including those involving gambling. Although not a 100 percent guarantee of protection, there is software that blocks access to online gambling sites. See www.gamblock.com for more details.

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More prevention tips for parents . Set the example you‘d like your teens to follow – if you gamble, do so for fun and in moderation. . Spend quality time with your teen. . Talk to your teen about the risks of gambling, including online gambling. . Set consistent boundaries and consequences. . Know their friends. . Encourage involvement in the arts, sports or other constructive activities. . Avoid hosting or participating in gambling parties involving young people; if you are involved in such an event make sure information about problem gambling and where to get help is provided. . Discuss and monitor use of the internet.

Treatment is free and confidential If you are worried that you or your teen may be having problems related to gambling, help is available. Throughout Oregon help and treatment are free, confidential, and they work.

Call the toll-free Oregon Gambling Help Line at 877-MYLIMIT or go to 1877mylimit.org

Free teen and parent brochure download: 1877mylimit.org – click on Resources

Material in this section was adapted from: www.responsiblegambling.org/articles/teensBrochure.pdf

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For educators: signs of a possible gambling problem in students

 Unexplained absences from school  Using gambling ―lingo‖ in his/her  Grades are dropping conversation (e.g., bookie, loan shark, point spread, underdog or  Asking for/borrowing money from favorite, exaggerated use of the peers word ―bet‖)  Large amounts of money in  Spending unusual amount of time student‘s possession reading newspapers, magazines,  Intense interest in gambling and/or periodicals having to do conversations with sports  Displaying money or other  Selling personal belongings material possessions (e.g., cars,  Bragging about winnings clothes, jewelry)  Lying, cheating, or stealing in  Behavior change (e.g., is school daydreaming, anxious, moody, less participative, appears tired in class)

If you suspect your student has a gambling problem, CALL 877-MYLIMIT or go to 1877mylimit.org for free and confidential help. Don’t wait for the problem to get worse!

Free educator brochure download: 1877mylimit.org – click on Resources

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College student gambling

Gambling in Oregon has changed dramatically over the past several years. It is more accessible, more accepted, and more glamorized than ever before. Every semester students drop out Reality TV shows portray gambling because of gambling problems. They as sexy, as an easy way to get rich, find themselves in a financial mess, and as a harmless activity for they are stressed-out, they miss class, anyone with a sense of excitement. and they often feel angry, shameful and depressed. The truth is, gambling is a fun and entertaining activity for most college Fortunately, many college problem students who play for social or gamblers do get past their gambling recreational reasons. However, it can problem and back on track. Often it cause problems and for some those takes a friend‘s intervention or their problems are harsh. own reality check. Skilled help can be found at the campus counseling center About one in every 20 college and/or health center. Oregon also has students will develop a gambling a statewide toll-free gambling problem (Shaffer, 2001). They usually helpline start out gambling for fun and with (877 MYLIMIT) and an online friends. Then they get sucked in by either believing they can make money helpline at 1877mylimit.org. gambling or by gambling as a means Counselors at the helpline or on to cope with loneliness, stress or campus can offer assistance and help depression. people make changes.

Recreation? For most college students, gambling is a social or recreational activity. It is fun and entertaining. It does not cause problems.

For college students who choose to gamble recreationally, the following tips will help ensure that gambling does not lead to problems: 4-19

 If you choose to gamble, do so for Recognizing gambling problems entertainment purposes; among your friends:  Treat the money you lose as the  Unexplained absences/sudden cost of your entertainment; drop in grades  Set a dollar limit and stick to it;  Change of personality/ visible  Set a time limit and stick to it; changes in behavior   Expect to lose; Possession of a large amount of money; brags about winnings  Don‘t use your credit card to gamble;  An unusual interest in sports scores or stats  Create balance in your life;  An intense interest in gambling  Don‘t increase your bets to recoup conversations lost money;  Unexplained financial problems or  Don‘t gamble as a way to cope with clues about financial problems stress, loneliness, or depression; (borrowing money)  Become educated about problem

gambling. How you can help friends  Tell the person what he or she has Gambling can be risky for those done that has raised your concern who spend a lot of time gambling and how you feel. and do not stay involved in other  Tell the person what you‘d like to activities. see him or her do including.

talking to another trusted person The following are some signs of a and/or getting professional help. possible gambling problem:  Tell the person what you are  Gambling more often; willing to do; this may include being available to talk again, or  Gambling for more money; assisting in finding help.  Gambling for longer periods of  Do not lend money or in any way time; support continued gambling as a  Gambling in spite of negative solution. consequences, such as large losses Free college brochure download: or poor grades; 1877mylimit.org – click on  Gambling as a way to cope. Resources

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Older adults and gambling

Gambling, or playing a game of chance for money or other stakes, has become a popular activity for people of many ages – and seniors are no exception. While experts agree that most adults can gamble without a problem, prevalence studies conducted in Oregon find that 2.7 percent of the general population1 and 1.2 percent of the older adult population become problem or pathological gamblers2.

Gambling opportunities for Oregonians are plentiful. Tribal casinos, Lottery products, sports betting and Internet gambling are more available than ever. The increase in the number of people with gambling problems corresponds to the increase in availability of gambling opportunities. Studies estimate that more than 6,000 Oregonians age 62 years or older currently have a gambling problem.

Concerns about older adults and problem gambling

Older adults‘ gambling differs from younger age groups because:

 People coping with big changes or losses are more vulnerable to developing gambling problems; many older adults face life transitions and losses (deaths, retirement, illness, isolation).  Older adults who have gambled away their retirement savings don‘t have working years to make up their losses.  Many older adults may not understand addiction, making them less likely to identify a gambling problem.

1 Volberg, R. (2001, February). Changes in gambling and problem gambling In Oregon: results from a replication study, 1997-2000. Salem, OR: Gambling Addiction Treatment Foundation. 2 Moore, T. (2001, April). Older adult gambling in Oregon: an epidemiological survey. Salem, OR: Oregon Gambling Addiction Treatment Foundation. 4-21

 Older adults appear less willing to seek assistance for a gambling problem than younger adults.  Many older adults hide their gambling because of the stigma associated with it and health professionals rarely assess for problem gambling.  Many older adults have easy access to gambling and are drawn to gambling to fill their time or to be with other people.  A larger proportion of older adults, compared to younger adults, have cognitive impairment, which may interfere with their ability to make sound decisions.

Problem gambling – signs and symptoms Problem gambling is a term that indicates a person‘s gambling compromises or damages his or her personal, family, or vocational pursuits. Below are some of the more common signs and symptoms of problem gambling:  Gambling to calm nerves, forget worries, or reduce depression;  Losing interest in other things, such as food;  Talking about, thinking about, or planning to gamble and not doing other activities;  Lying about gambling habits;  Gambling alone or gambling more often;  Getting into arguments about gambling;  Going without basic needs in order to gamble;  Needing to gamble more and more money in order to get the desired effect;  Health problems related to gambling, such as headaches, irritable bowel, anxiety and depression;  Having financial problems caused by gambling. Getting help

In Oregon, treatment for problem gambling is free. Treatment options include telephone counseling, in-person individual counseling, and group counseling. Call the confidential, 24-hour phone number below for information or help at no cost: 877-MYLIMIT or go to 1877mylimit.org

Free seniors brochure download: 1877mylimit.org – click on Resources

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Problem gambling and the workplace

Gambling is part of our mainstream culture and we know that most problem gamblers are ordinary hard-working people. More than 72,000 adult Oregonians are problem gamblers and almost all are employed.

What is problem gambling? A problem gambler is anyone whose gambling is causing psychological, financial, emotional, marital, legal, or other difficulties for himself or herself and the people around him or her.

Co-workers – the first line of defense Gambling and gambling-related activities are frequently carried out during work hours. The workplace is used as a shield to hide the problem gambling from family members. This leaves managers and co-workers as the first line of defense. It is important that all employers and employees develop a greater awareness of the signs associated with a gambling problem.

Workplace signs of a gambling problem

 Work performance  Frequent unexplained deteriorates; the person is absences or disappearances preoccupied, has trouble from work. concentrating, is absent or late  Eager to organize and for meetings and misses participate in betting assignment deadlines. opportunities.

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 Pay is requested in lieu of  Experiences mood swings, vacation time, large blocks of often related to winning and vacation time are not taken. losing streaks.  Frequently borrows money,  Credit card or loan bills are argues with co-workers about mailed to work rather than money that is owed to him or home. her.  Increasingly spends more  Complains about mounting time gambling during lunch debts. hours and coffee breaks.  Excessive use of the telephone  False claims are made against and Internet for personal expense accounts. matters.  Theft of company property.

Effects on the workplace Although not often recognized, problem gambling is a significant workforce issue. The workplace is primarily affected through lost time and lost productivity, but in desperate situations the gambler may resort to theft, fraud, or embezzlement.

Lost time Individuals with gambling problems can become completely preoccupied with gambling. The workday is often spent either in the act of gambling, planning the next opportunity, or plotting to get money for gambling. Family members also become pre-occupied, worrying about finances and holding the family together.

Lost productivity As a result of lost time, the company‘s productivity is damaged. The gambler becomes unreliable, misses project deadlines and important meetings and produces work that is of poor quality.

Physical and emotional health problems associated with excessive gambling can further diminish work performance and attendance. Depression, anxiety, high blood pressure, or stress-related illness can surface.

Individuals with gambling problems have a high rate of suicide and suicide attempts. Stressed family members also are at risk of suicide. The emotional, financial or legal problems can appear to be so severe that suicide looks like the only ―way out.‖

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Theft, fraud and embezzlement Employees with severe problems may commit theft, fraud or embezzlement. Money is the gambler‘s key to action. Once all legitimate avenues to obtain cash are exhausted, the gambler, in desperation, may resort to illegal acts to acquire cash. Problem gamblers do not see this activity as theft. They see it as ―borrowing money‖ and plan to replace it when they win.

What can supervisors do?

Express concerns in a caring and supportive manner. Do not diagnose the problem or tell the individual what to do. Be clear, non-judgmental and speak only for yourself. o I’ve been noticing changes in your work, and I am concerned about you. Use work-related observations. o I see you coming in very late from lunch every day, too distracted to work all afternoon. Be positive. o You are a conscientious person with a history of doing good work. Explain how the problem affects you. o I had to reassign two of your projects, because you missed three deadlines. Be clear about your position. o I need you to perform your job duties to the best of your ability; your performance has been slipping and without corrective actions your job is in jeopardy. Respect personal boundaries. o I don’t want to pry into your life, but I had to let you know I am concerned. I would be happy to talk to you about anything that is troubling you or assist you in making an EAP appointment. When a gambling problem is known, provide information, not advice. o Here is some information about available problem gambling resources. Another resource available to you is our EAP professional; here is the name and number. Be prepared for denial or a hostile reaction. o It must be uncomfortable to hear this. It’s difficult for me to bring it up, but I am concerned about you.

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What can organizations do?

 Policy statements Incorporate the topic of gambling into relevant policies on Internet use, phone use, and disallowed activities during work hours.  Provide awareness training Without awareness, problem gambling will not be detected. Training can help employees and employers to identify and assist the problem gambler.  Make financial counseling available It is important that financial counseling be made available to employees who are in a fiscal crisis.  Monitor the money stream Occupations involving direct contact with money or where money can be “moved” can be high-risk for the problem gambler and a monitoring system can protect employee and employer.

What resources are available?

Problem Gambling Help Line: 877-MYLIMIT or 1877mylimit.og Callers receive confidential, professional service from trained counselors. The line operates 24 hours a day, seven days a week and is free to gamblers and family members. State-funded professional, confidential and effective treatment Counseling services for gamblers and their families are available free of charge in Oregon. Contact the Problem Gambling Helpline for info and referrals. Oregon’s Gambling Evaluation And Reduction Program (GEAR) Provides gamblers with tools and support to change unwanted gambling patterns without traveling to a counselor‘s office. For more information call 877-278-6766. Gamblers Anonymous (GA) and Gam-Anon Gamblers Anonymous provides people with a place to share experience, support and hope. Gam-Anon provides a support for the families of problem gamblers. A list of local meetings is available from the Problem Gambling Helpline.

Free workplace brochure download: 1877mylimit.org – click on Resources Material in this section was adapted from Saskatchewan Health and the Nevada Council on Problem Gambling.

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Primary care providers

Place your bets: Assessing for problem gambling pays off

By Jeffrey Marotta, Ph.D.

If you treat adult patients, you‘ve provided care to someone who has a gambling disorder – whether you knew it or not. Although one in 10 primary care patients may have a gambling problem,1 you won‘t find patients volunteering information about their gambling behavior. Instead, they present with secondary symptoms such as depression, anxiety, sleep disturbances, headaches, or other somatic symptoms associated with stress.

Although most health care providers are aware of problem gambling, studies find that very few ask their patients about problem gambling.2,3 Physicians can play an integral role in this process by recognizing early signs of problems, motivating patients to seek help, and readily providing useful referral resources such as the number to the Oregon Problem Gambling Helpline (call 877-MYLIMIT or log onto 1877mylimit.org).

How big is the problem? Persons seeking medical care generally have higher psychiatric co-morbidity rates than the general population. This is true for chemical dependency and for problem gambling. Studies conducted in Oregon found past-year prevalence rates in adults of 1 percent for pathological gambling and an additional 1.7 percent for problem gambling.4 However, the prevalence of problem gambling among persons entering a primary care setting appears to be closer to 10 percent (6.2 percent for pathological gambling and 4.2 percent for problem gambling). 1 The incidence rate of problem gambling is expected to grow as gambling becomes more culturally accepted and legalized gambling opportunities expand.5 How is problem gambling associated with patient health? 4-27

Similar to other addictive behaviors, problem gambling affects not only the gamblers and their family finances, but also their mental and physical well-being., Several studies have documented the relationship between problem gambling and specific health issues found in general medical care.6 The three broad categories of co-occurring conditions include mental health problems, chemical dependency problems, and stress-related problems. Problem gamblers are at increased risk of dysthymia, major depression, anti-social personality disorder, phobias and chemical dependency. Studies identify problem gamblers as being at increased risk for cardiac arrest due to sustained stress and hypertension. Additionally, problem gamblers present with higher rates of stress-related physical problems, including migraine headache, tension headache, irritable bowel syndrome, peptic ulcer, GERD, insomnia, sexual dysfunction, myalgias, and neurotic dermatitis.

What is problem gambling? Gambling is a widespread activity, with 86 percent of the general adult population having some gambling activity over a lifetime. 5 While the majority of people gamble, a small minority has a gambling problem. Pathological gambling (Table 1) represents the most severe pattern of excessive or destructive gambling behavior and is the only gambling-related disorder for which there are formal diagnostic criteria. Although pathological gambling originally was seen as a chronic and progressive disorder, new evidence suggests there are multiple courses the disorder can follow.7 Sometimes the gambling problem is transient; sometimes it plateaus and maintains for years; and sometimes it follows a progressive course. Regardless of the course, it is common for a problem gambler to experience mental and physical health problems.

Table 1. DSM IV Diagnostic Criteria for Pathological Gambling A. Persistent and recurrent maladaptive gambling behavior as indicated by five (or more) of the following: (1) Is preoccupied with gambling (e.g., preoccupied with reliving past gambling experiences, handicapping or planning the next venture, or thinking of ways to get money with which to gamble) (2) Needs to gamble with increasing amounts of money in order to achieve the desired excitement (3) Has repeated unsuccessful efforts to control, cut back, or stop gambling (4) Is restless or irritable when attempting to cut down or stop gambling (5) Gambles as a way of escaping from problems or of relieving a dysphoric mood (e.g., feelings of helplessness, guilt, anxiety, depression) (6) After losing money gambling, often returns another day to get even (―chasing‖ after one‘s losses) (7) Lies to family members, therapist, or others to conceal the extent of involvement with gambling (8) Has committed illegal acts such as forgery, fraud, theft, or embezzlement to finance gambling (9) Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling (10) Relies on others to provide money to relieve a desperate financial situation caused by gambling

B. The gambling behavior is not better accounted for by a manic episode.

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Problem gambling treatment Research concerning the treatment of problem gambling is early in its development, but has benefited from the body of evidence on other addictive and impulse disorders. Multiple pharmacological approaches to reduce problem gambling behaviors or craving have been evaluated in small pilot studies, including lithium carbonate, carbamazepine, clomipramine, naltrexone, and fluvoxamine. However, there are presently no FDA-approved medications for problem gambling.

Gambler‘s Anonymous (GA) is a self-help fellowship based on 12-step principles, similar in approach to other addictive disorders. Regular GA participation can be greatly facilitated by directive and supportive physicians or other health care providers.

Most problem gambling treatment programs employ cognitive-behavioral and addiction-based change techniques. As with other psychiatric disorders, a combination of treatment methods is often most useful, such as GA with professional psychosocial treatment. Co-morbid chemical dependency, affective, or anxiety disorders need to be treated and stabilized by health care professionals in conjunction with specialized behavioral treatment for the gambling disorder.

To screen or not to screen Screening for gambling-related history and symptoms is justified because of the prevalence and potential severity of problem gambling, the potential to improve patient outcomes, and the low costs and low risk associated with asking about problem gambling. Simple asking and advising have been proven to be effective interventions in the allied field of alcohol abuse.8 Early intervention of problem gambling through screening and motivating help-seeking may reduce the harm of problem gambling on individuals and their families.

Problem gambling screening procedures Health care providers see problem gambling as a medical issue and believe that they have a mandate to intervene when such issues arise. 3 If patients present with symptoms that could be related to sustained stress, include questions on gambling when you assess for behavioral conditions. If gambling is a frequent activity, then consider using a simple screening tool: the Lie-Bet Questionnaire.9 This

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questionnaire is valid and reliable for ruling out pathological gambling behaviors.

The Lie-Bet questions 1) Have you ever felt the need to bet more and more money? 2) Have you ever had to lie to people important to you about how much you gambled?

If a patient answers yes to one or both of the questions on the Lie-Bet questionnaire, further assessment is indicated. Patients suspected of manifesting a gambling problem should be encouraged to seek specialized treatment and provided with a referral for such services.

Resources for clinicians Oregon operates a 24-hour confidential Problem Gambling Helpline at 877- MYLIMIT and 1877mylimit.org (via chat, IM, email). Operators are certified problem-gambling counselors and can answer questions, do crisis intervention and make referrals to state-funded gambling treatment providers (outpatient, crisis- respite and residential) or the minimal intervention GEAR program. About 75 percent of the problem gamblers who enroll in Oregon‘s treatment programs report significantly reduced or no gambling at 90 days post-discharge.10

Free clinician brochure download: 1877mylimit.org – click on Resources

REFERENCES 1 Pasternak IV, A.V. & Fleming, M.F. (1999). Prevalence of gambling disorders in a primary care setting. Archives of Family Medicine, 8, 515-520. 2 Christensen, M.H., Patsdaughter, C.A., & Babington, L.M. (2001). Health care providers‘ experiences with problem gamblers. Journal of Gambling Studies, 17 (1), 71-79. 3 Sullivan, S., Arroll, B., Coster, G., Abbott, M., & Adams, P. (2000). Problem gamblers: Do GPs want to intervene? New Zealand Medical Journal, 113(1111), 204-207. 4 Volberg, R. (2001, February). Changes in gambling and problem gambling in Oregon: Results from a replication study, 1997 to 2000. Salem, OR: Oregon Gambling Addiction Treatment Foundation. 5 National Opinion Research Center (NORC). (1999). Gambling impact and behavior study, report to the national gambling impact study commission. Chicago, IL: Author. 6 Potenza, M.N., Fiellin, D.A., Heninger, G.R., Rounsaville, B.J., & Mazure, C.M. (2002). Gambling: An addictive behavior with health and primary care implications. Journal of General Internal Medicine, 17, 721-732. 7 Abbott, M, Williams, M, Volberg, R. (1999). Seven years on: A follow-up study of frequent and problem gamblers living in the community. Wellington: Department of Internal Affairs. 8 WHO Brief Intervention Study Group. (1996). A cross-national trial of brief interventions with heavy drinkers. AMJ Public Health, 86, 948-955. 9 Johnson, E.E., Hamer, R., Nora, R.M., Tan, B., Eistenstein, N., & Englehart, C. (1988). The lie/bet questionnaire for screening pathological gamblers. Psychological Reports, 80, 83-88. 10 Moore, T. (2003). Oregon gambling treatment programs evaluation update 2002. Salem, OR: Department of Human Services, Office of Mental Health and Addiction Services.

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Mental health clinicians

Are problem gamblers in your caseload? By Jeffrey Marotta, Ph.D.

If you are a practicing mental health clinician, chances are you‘ve provided care to someone who has a gambling disorder – whether you knew it or not. Epidemiologic findings suggest that one in 10 persons with psychiatric disorders may have a gambling problem.1 Persons struggling with mental illness appear at high risk for using gambling as a coping mechanism.

Clients with active gambling problems often seek therapy not for their gambling problem but for help with related symptoms such as depression, anxiety and sleep disturbances, or for functional problems with relationships, school, or job. These clients may not conceptualize gambling as part of the problem but rather as part of the solution. Gambling may be offering them hope and possibility – a big win to provide needed cash or needed validation. Gambling may create a feeling of normalcy – the excitement of gambling can change the perceived valence of underlying anxiety from feeling ―bad‖ to feeling ―good.‖ Gambling may serve as a powerful opioid with the ability to tame emotional and physical pain. Gambling may be viewed as ―my only recreation‖ or an excuse to leave an unpleasant home or work environment.

Although most mental health providers are aware of problem gambling, studies find that very few clinician ask their clients about problem gambling.2,3 Psychologists and other mental health professionals can play an integral role in this process by educating clients about risks associated with gambling, recognizing early signs of problems, and by motivating clients to address unhelpful gambling behaviors.

How big is the problem? Studies conducted in Oregon found past-year prevalence rates in an at-large community sample of adults at 1 percent for pathological gambling and an additional 1.7 percent for problem gambling.4 The prevalence of problem gambling

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among persons entering a primary care setting appears to be closer to 10 percent, and for those entering an alcohol and drug treatment agency the rate is between 10 percent and 30 percent.5 Based on this information, one can speculate that the prevalence of problem gamblers within a mental health setting could be at least 10 percent.

What is problem gambling? Gambling is a widespread activity, with 86 percent of the general adult population having some gambling activity over a lifetime.6 Although the majority of people gamble, a small minority has a gambling problem. Pathological gambling (Table 1) represents the most severe pattern of excessive or destructive gambling behavior and is the only gambling-related disorder for which there are formal diagnostic criteria.7

Although pathological gambling originally was seen as a chronic and progressive disorder, new evidence suggests there are multiple courses the disorder can follow.9 Sometimes the gambling problem is transient; sometimes it plateaus and maintains for years; and sometimes it follows a progressive course. Regardless of the course, it is common for a problem gambler to experience mental and physical health problems.

Table 1. DSM IV Diagnostic Criteria for Pathological Gambling

A. Persistent and recurrent maladaptive gambling behavior as indicated by five (or more) of the following: (1) Is preoccupied with gambling (e.g., preoccupied with reliving past gambling experiences, handicapping or planning the next venture, or thinking of ways to get money with which to gamble) (2) Needs to gamble with increasing amounts of money in order to achieve the desired excitement (3) Has repeated unsuccessful efforts to control, cut back, or stop gambling (4) Is restless or irritable when attempting to cut down or stop gambling (5) Gambles as a way of escaping from problems or of relieving a dysphoric mood (e.g., feelings of helplessness, guilt, anxiety, depression) (6) After losing money gambling, often returns another day to get even (―chasing‖ after one‘s losses) (7) Lies to family members, therapist, or others to conceal the extent of involvement with gambling (8) Has committed illegal acts such as forgery, fraud, theft, or embezzlement to finance gambling (9) Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling (10) Relies on others to provide money to relieve a desperate financial situation caused by gambling B. The gambling behavior is not better accounted for by a manic episode.

Problem-gambling treatment Cognitive-behavioral treatment (CBT) approaches, even when delivered via a manual and involving only minimal therapist contact, have the most empirical support. CBTs, generally brief and delivered on an outpatient basis, have been shown to strengthen motivation.

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Pharmacotherapy (most commonly Nalmefene, Naltrexone, Welbutrin, and selective serotonin reuptake inhibitors [SSRIs]) may be an important adjunct to verbal interventions. However, the body of knowledge on problem gambling treatment has not determined which specific type of CBT or medication is most effective. The initial intervention should strive to increase the individual‘s commitment to treatment and resolve treatment-disrupting ambivalence as much as possible. The relatively high rates of dropout and treatment non-completion among problem gamblers suggest that more effort should be made to strengthen the client‘s commitment to change. Interventions consistent with the motivation stage of change model would be appropriate. Gambling-treatment outcomes can be improved by addressing the factors contributing to treatment failure.10 Several predictors of poor treatment outcome include gambling-related cognitive distortions and beliefs about randomness, impulsivity or sensation seeking, biological vulnerabilities, and negative affect or mood symptoms.

Screening Screening for gambling-related history and symptoms is justified because of the prevalence and potential severity of problem gambling, the potential to improve client outcomes, and the low costs and low risk associated with asking about problem gambling.

Problem gambling screening procedures When conducting a biopsychosocial assessment , include questions on gambling. If gambling is a frequent activity, use the Lie-Bet Questionnaire.11which is valid and reliable for ruling out pathological gambling behaviors.

The Lie-Bet Questions 1) Have you ever felt the need to bet more and more money? 2) Have you ever had to lie to people important to you about how much you gambled?

If a client answers yes to one or both of the questions on the Lie-Bet Questionnaire, further assessment is indicated. Either make an assessment based on the clinical interview, using the DSM-IV criteria provided in Table 1, or provide self-assessments such as the South Oaks Gambling Screen (SOGS) at http://www.npgaw.org/tools/screeningtools.asp

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If a client‘s primary diagnosis is pathological gambling, the treating clinician should have specialized training and competence in problem gambling. If not, a referral is warranted. When treating a client with a co-occurring gambling disorder, whether a gambling disorder is treated first, second or simultaneously is a matter of clinical judgment based on the relative intensity or emergent nature of the various disorders present. Don‘t underemphasizing a co-occurring gambling problem that is in need of immediate attention. When treatment planning for a client with a co- occurring gambling problem, seek consultation from a colleague with problem gambling expertise.

Resources for clinicians Oregon operates a 24-hour confidential Problem Gambling Helpline at 877- MYLIMIT and 1877mylimit.org (via chat, IM, email). Operators are certified problem-gambling counselors and can answer questions, do crisis intervention and make referrals to state-funded gambling treatment providers (outpatient, crisis- respite and residential) or the minimal intervention GEAR program. About 75 percent of the problem gamblers who enroll in Oregon‘s treatment programs report significantly reduced or no gambling at 90 days post-discharge.12

Free clinician brochure download: 1877mylimit.org – click on Resources

REFERENCES 1 Cunningham-Williams, R., Cottler, L., Compton, W., & Spitznagel, E. (1998). Taking chances: Problem gamblers and mental health disorders – results from the St. Louis Epidemiologic Catchment Area Study, American Journal of Public Health, 88, 1093-1096. 2 Christensen, M.H., Patsdaughter, C.A., & Babington, L.M. (2001). Health care providers‘ experiences with problem gamblers. Journal of Gambling Studies, 17 (1), 71-79. 3 Sullivan, S., Arroll, B., Coster, G., Abbott, M., & Adams, P. (2000). Problem gamblers: Do GP‘s want to intervene? New Zealand Medical Journal, 113(1111), 204-207. 4 Volberg, R. (2001, February). Changes in gambling and problem gambling in Oregon: Results from a replication study, 1997 to 2000. Salem, OR: Oregon Gambling Addiction Treatment Foundation. 5 Pasternak IV, A.V., Fleming, M.F. Prevalence of gambling disorders in a primary care setting. Arch Fam Med 1999; 8: 515–20. 6 National Opinion Research Center (NORC). (1999). Gambling impact and behavior study, report to the national gambling impact study commission. Chicago, IL: Author. 7 American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. Washington, D.C.: Government Printing Office. 8 Potenza, M.N., Fiellin, D.A., Heninger, G.R., Rounsaville, B.J., & Mazure, C.M. (2002). Gambling: An addictive behavior with health and primary care implications. Journal of General Internal Medicine, 17, 721-732. 9 Abbott, M., Williams, M., Volberg, R. (1999). Seven years on: A follow-up study of frequent and problem gamblers living in the community. Wellington: Department of Internal Affairs. 10 Daughters, S.B., Lejuez, C.W., Lesieur, H.R., Strong, D.R., Zvolensky, M.J. Towards a better understanding of gambling treatment failure: implications of translational research. Clin Psychol Rev 2003;23:573–86 11 Johnson, E.E., Hamer, R., Nora, R.M., Tan, B., Eistenstein, N., & Englehart, C. (1988). The lie/bet questionnaire for screening pathological gamblers. Psychological Reports, 80, 83-88. 12 Marotta, J. (2003). Oregon‘s Problem Gambling Services: Public health orientation in a stepped-care approach. Electronic Journal of Gambling Studies, 9, 129-133.

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Problem gambling information for bankers and financial institutions

What financial institutions need to know about problem gambling

Problem gamblers come from all walks of life. Many of them appear to be fully competent and successful members of the community. Gambling is called the hidden addiction because, in some ways, it is easier to hide than an addiction to alcohol or other substances. You can’t physically OD on it, you don’t stumble around or slur your speech. Before there are other signs of a problem, chances are good there will be signs in a person’s financial life. It is not unusual for someone with a healthy financial history to be in a financial crisis after a few months of regular gambling.

In the general population in Oregon, we estimate that there are 76,000 adult problem gamblers – unfortunately, most of them are not in treatment, although free treatment is available throughout the state. Among those who do seek treatment, the average age is approximately 45 years, with an average income of over $32,000 per year, and split equally between men and women. There is denial with gambling addiction, just as with any other addiction, so by the time people get into treatment they have an average gambling debt of more than $33,000.

Financial institutions may be among the first to see the effects of problem gambling, so are in a key position to help customers who may have a problem. Signs that a customer might have a gambling problem include:

 A marked difference between your customer‘s reported expenditures and debt load.  Your customer‘s bills are going unpaid even though, according to their income, they should be affordable.

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 Your customer‘s financial picture shows many credit card and/or ATM withdrawals; multiple withdrawals at bars, restaurants, and casinos are signs of concern.  Your customer is showing an increase in requests for personal loans or debt consolidation.  You ask your customer about gambling, but he or she is vague about the amount of time and money spent gambling.

If you know that your customer gambles, even if he or she does not identify it as a problem, asking the following questions can lead to an opportunity to connect your customer with the help he or she may need:

 Do you spend more money on gambling than you mean to?  Do you spend more time gambling than you mean to?  Does your family or friends express concern about your gambling?  Do you have concerns about your gambling?

If they answer yes to any of these questions, encourage your customer to learn more about the risks of gambling. Suggest that he or she speak to a professional (see ―helping your customer,‖ below).

If your customer is elderly and if his or her finances are being compromised by a relative or other person with account access, it is considered elder abuse and should be reported.

Helping your customers

We understand that you are not a health care professional or a counselor. However, you can help your customer in important ways.

As you provide your customer with financial help and advice, you can do a great service by encouraging him or her to explore the impact of gambling on his or her financial picture. Resolving the financial situation, but not dealing with the gambling behavior will place your customer at risk for increased debt over the long term.

Encourage your customer to call or log onto the Problem Gambling Helpline at 877-MYLIMIT or 1877mylimit.org. It is staffed by professionals trained in problem gambling counseling. Remind your customer that he or she can call

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without giving a name and that no one is there to judge, just to help. Help is available 24 hours per day, seven days a week. It also is open to family members, with or without the involvement of the gambler.

Problem gambling among employees

Although not often recognized, problem gambling is a significant workforce issue. The effects of a gambling problem almost always spill over into the workplace. The workplace is primarily affected through lost time and lost productivity, but in desperate situations, the gambler may resort to theft, fraud, or embezzlement.

Gambling and gambling-related activities are frequently carried out during work hours. The workplace is used as a shield to hide the problem gambling from family members. This leaves managers and co-workers as the first line of defense. The challenge is to identify the problem gambler before he or she becomes desperate. To this end, it is important that all employers and employees develop a greater awareness of the signs associated with a gambling problem.

Workplace signs of gambling problems

• Work performance deteriorates – the person is preoccupied, has trouble concentrating, is absent from or late for meetings and misses assignment deadlines; • Frequent, unexplained absences or disappearances from work; • Eager to organize and participate in betting opportunities.; • Pay is requested in lieu of vacation; large blocks of vacation time aren‘t used; • Frequently borrows money, argues with coworkers about money that is owed; • Complains about mounting debts; • Excessive use of the telephone and Internet for personal matters; • Experiences mood swings, often related to winning and losing streaks; • Credit card or loan bills are mailed to work rather than home; • Increasingly spends more time gambling during lunch hours and coffee breaks; Of course, many of these issues are similar to those produced by other employee problems, not just problem gambling. You can‘t and shouldn‘t accuse or diagnose, but there are things employers can do to help.

What can your organization do?

 Awareness training: Supervisors and employees need to be able to recognize the signs of gambling problems and know how to respond.

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 Policy statements: Incorporate the topic of gambling into relevant policies such as Internet use, phone use, and disallowed activities during work hours.  Use your Employee Assistance Program: Check with your EAP to be sure it routinely screens for problem gambling and is aware of Oregon‘s free treatment.  Make information available about the Problem Gambling Helpline: 877- MYLIMIT or 1877mylimit.org. Brochures and posters are available free by calling 503-945-9703. Help is available 24 hours a day, seven days a week and is open to family members whether or not the gambler is involved.  Make financial counseling available: It is important that financial counseling be made available to employees who are in a fiscal crisis.  Monitor the money stream: Some occupations involve direct contact with money; in other occupations money can be ―moved.‖ These occupations might be considered high-risk for the problem gambler; a monitoring system can protect employee and employer.

Problem gambling counseling includes intervention on financial issues

You may be surprised to learn that, unlike treatment for other addictions, problem gambling counseling involves direct intervention on the customer‘s financial situation. It is common to remove fund access for these customers and place it in the hands of a spouse or other responsible person.

Lifeworks counselor Joe Reisman says, ―we set up barriers between the gambler and their [sic] money – ideally the gambler and person designated to manage their [sic] money will come to a session together so we can develop a plan that does not enable the gambler and is also not abusive.‖ Joe indicates that ―the gambler needs to develop a relationship with ‗real‘ money again, because while they [sic] are compulsively gambling, money loses its real meaning.‖

The good news, then, for financial institutions is that part of problem gambling recovery is learning to manage money. Suggesting that a customer talk to a professional may be the best thing you can do to help them ultimately get back on top of his or her life and finances. Joe Reisman sums it up well by saying,‖Ignoring the reality of compulsive gambling becomes a bad bet for everyone.‖

Adapted from Nova Scotia’s Health Promotion and Protection Web site: http://www.gov.ns.ca/hpp/gambling/pg-financial-helping.asp

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10 rules of responsible gambling

1. If you choose to gamble, do so for entertainment purposes - If your gambling is no longer an enjoyable activity then ask yourself why you are still “playing”? 2. Treat the money you lose as the cost of your entertainment - Treat any winnings as a bonus. 3. Set a dollar limit and stick to it - Decide before you go not only what you can “afford” to lose, but how much you want to spend. Do not change your mind after losing. 4. Set a time limit and stick to it - Decide how much of your time you want to allow for gambling. Leave when you reach the time limit whether you are winning or losing. 5. Expect to lose - The odds are that you will lose. Accept loss as part of the game. 6. Make it a private rule not to gamble on credit - Do not borrow money to gamble. 7. Create balance in your life - Gambling should not interfere with or substitute for friends, family, work or other worthwhile activities. 8. Avoid ―chasing‖ lost money - The more you try to recoup your losses the larger your losses will be. 9. Don’t gamble as a way to cope with emotional or physical pain - Gambling for reasons other than entertainment can lead to problems. 10. Become educated about the warning signs of problem gambling - The more you know, the better choices you can make.

If you can’t follow these suggestions, you may need to contact the Oregon Problem Gambling Helpline: 1-877-mylimit or 1877mylimit.org 4-39

Myths and facts about problem gambling

MYTH: You have to gamble every day to be a problem gambler. FACT: A problem gambler may gamble frequently or infrequently. If a person‘s gambling is causing psychological, financial, emotional, marital, legal, or other difficulties for that person and the people around him or her, then he or she has a gambling problem.

MYTH: Problem gamblers gamble at any opportunity on any form of gambling. FACT: Most problem gamblers have a favorite form of gambling that causes them problems. Some gamblers also engage in secondary forms of gambling, but these other forms are not usually as problematic.

MYTH: Problem gambling is not really a problem if the gambler can afford it. FACT: Problems caused by excessive gambling are not just financial. If a person‘s gambling is interfering with the ability to act in accordance with his or her values, then there is a problem. For example, too much time spent on gambling means less time to spend with family, friends and others. It can lead to relationship breakdown and loss of important friendships.

MYTH: Problem gamblers are irresponsible people. FACT: Many problem gamblers hold, or have held, responsible community positions. In addition, even people with a long history of responsible behavior are vulnerable to developing a gambling problem. When a person is having a problem gambling episode, that person is unable to control the gambling and in this compromised state his or her actions look like irresponsible behavior.

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MYTH: Children are not affected by problem gambling. FACT: Surveys show that about 10 percent to 15 percent of American and Canadian youth have experienced gambling-related problems, and 1 percent to 6 percent of these individuals may satisfy diagnostic criteria for pathological gambling. Additionally, children of problem gamblers have been shown to be at a higher risk of developing health-threatening behaviors. This includes alcohol and drug use, problem gambling, eating disorders, depression and suicide.

MYTH: Partners of problem gamblers often drive problem gamblers to gamble. FACT: Problem gamblers are skilled in finding ways to rationalize their gambling. Blaming others is one way to avoid taking responsibility for actions – including actions needed to overcome the gambling problem.

MYTH: Financial problems are the main reason that problem gambler’s’ relationships break down. FACT: It is true that money problems play an important part in ending relationships. However, many non-gambling partners say that lying and the associated lack of trust is the biggest cause.

MYTH: Parents of problem gamblers are to blame for their children’s behavior. FACT: Many parents of problem gamblers feel hurt and guilty about their son‘s or daughter‘s gambling behavior, but they are not to blame.

MYTH: If a problem gambler builds up a debt, the important thing to do is to help him or her get out of the financial problem as soon as possible. FACT: Quick fix solutions are often attractive to everyone involved and may appear to be the right thing to do. However, ―bailing‖ the gambler out of debt may actually make matters worse by enabling gambling problems to continue.

MYTH: Problem gambling is easy to recognize. FACT: Problem gambling has been called the hidden addiction. It is very easy to hide, because it has few recognizable symptoms, unlike alcohol and drug use. Many problem gamblers themselves do not recognize that they have a gambling problem. Problem gamblers often engage in self-deception.

Adapted from Chris Lobsinger’s Problem Gambling Pages

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Gaming Trends: Internet and Cell Phones

Internet gambling: a casino in every home and office?

Today, anyone with a personal computer and modem, interactive television or a cell phone has the capacity to gamble, virtually creating his or her own personal casino. Internet gambling is becoming an increasingly popular form of gambling, and there are now several thousand internet gambling sites.

The convenience of gambling at home, the ease of setting up a gambling account and the variety of forms of gambling – from traditional betting, to casino gambling, bingo and lotteries – make online gambling very appealing; that appeal leads to increased risk of problems with this new form of gambling.

Risks of Internet gambling

 The financial transactions associated with online gambling are illegal in the US.

 It‘s too easy to access; people can gamble 24 hours a day.

 It‘s too solitary: you can gamble in your own home undetected and unnoticed.

 There‘s an increased risk that children will find and use these sites.

 The absorbing nature of computers can lead people to lose track of time while gambling.

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 Gambling online enables an accelerated speed of play; for example, casino card games have an average rate of play of around 30 hands per hour, compared to online poker, which can average 60 to 80 hands per hour.

 Persons seeking gambling treatment who used the Internet to gamble tended to have more severe problems.

 Perception of the value of cash decreases; i.e., players are forgetting that they are spending real money.

 A gambling site on the other side of the world may or may not be legitimate; there may be very little to prevent the provider of online gambling services from taking ‘a customer‘s money and shutting down, or failing to pay winnings.

 Credit card or account details may be vulnerable to capture, and funds may be vulnerable to theft by computer hackers.

 Internet gambling may be vulnerable to invasions of privacy. Information given to casino operators can be used for other purposes; for example, a service that uses telemarketing to persuade people to bet on its football betting system may be willing to pay money for a list of Internet sports book players.

 Online activity, which appears addictive in its own right for a minority of users, may interact synergistically with the propensity for problem gambling and thereby increase the number of online problem gamblers.

Young males at highest risk?

Data released in October 2006 by the Annenberg Public Policy Center show that at that time, more than one million young people were using Internet gambling sites on a monthly basis. Among males 18 to 22, Internet gambling doubled between 2005 and 2006. The new data were released by the National Annenberg Risk Survey of Youth, which has tracked gambling among young people ages 14 to 22 since 2002. Based on the survey‘s most recent estimates, approximately 850,000 males ages 18 to 22 gamble online at least once a month. The corresponding number for males between 14 and 17 is 357,000. Among the 18- to 22-year-old age group, weekly use of Internet gambling sites increased from 2.3 percent in 2005 to 5.8 percent a statistically significant increase.

Full survey results may be found at http://www.annenbergpublicpolicycenter.org/ProjectDetails.aspx?myId=10 4-43

Internet sales are predicted tol expand

Source: http://grossannualwager.com/Primary%20Navigation/Online%20Data%20Store/internet_gamblin g_data.htm

Web sites on Internet gambling

Managing Internet Gambling in the Workplace http://firstmonday.org/htbin/cgiwrap/bin/ojs/index.php/fm/article/view/1044/965 eGambling issue on Internet gambling: www.camh.net/egambling/archive/pdf/EJGI-issue5/EJGI-issue5-complete.pdf

GAO report on Internet gambling www.gao.gov/new.items/d0389.pdf

Internet gambling: legal issues www.gamblingandthelaw.com/antigua.html

Newshour: legislation banning fund transfers for online gambling www.pbs.org/newshour/bb/business/july-dec06/gambling_10-16.html

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CBS 60 Minutes story on Internet gambling www.cbsnews.com/stories/2005/11/17/60minutes/main1052420.shtml

American Gaming Association fact sheet on industry issues www.americangaming.org/Industry/factsheets/issues_detail.cfv?id=17

Washington State Gambling Commission fact sheet www.wsgc.wa.gov/faq/internet_gambling.pdf

Media Awareness article www.media- awareness.ca/english/teachers/wa_teachers/safe_passage_teachers/risks_gambling.c fm

FTC guidelines for parents regarding youth online gambling www.ftc.gov/opa/2002/06/onlinegambling.htm

Sources (all accessed online on Dec. 5, 2009): http://www.ftc.gov/opa/2002/06/onlinegambling.shtm www.aic.gov.au/publications/tandi/tandi88t.html www.impactlab.com/modules.php?name=News&file=article&sid=7254

Gambling on the cell phone

Cell phone gambling is still getting off the ground but, thanks to its convenience and a receptive 20- to 35-year-old age bracket, the sector is primed for growth. Cell phone gambling currently is illegal in the United States, but global revenues from cell phone-based casino games will grow at an accelerated pace and are projected to total over $2.2 billion by 2010 more than five times the revenues generated in 2004.

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Cell phone users in the UK who were surveyed regarding the appeal of cell phone gambling overwhelmingly cited convenience as a benefit (70 percent), with smaller numbers saying that it was less intimidating and allowed for more discretion.

A 2003 article in Forbes Magazine notes:

 Cell phones themselves are becoming better suited to gambling. The newest cell phones are essentially mini-PCs, with full operating systems, heavy-duty processor power and high-resolution color screens. Pricey phones, PDAs and phone-PDA combos now offer an expensive but accessible way to get online  Software within phones is also helping to further gambling. Smart phones now accept a version of the Java programming language, as well as a competing language for so-called applets, BREW, which is licensed by Qualcomm (nasdaq: QCOM - news - people ). Developers would use an applet--easily downloadable software--to deal a card in blackjack, depositing the graphics on the user's cell phone and sending a request to the casino's server for a random card, says Don C. Harold, vice president of operations for Chartwell Technology, a gaming software company for online casinos based in Calgary, Canada.  Software vendors expect wireless gambling to take off first in sports betting, including horse races and wagering on team matches. Initially, the bets will be made using simple text-based programs or instant messaging, although a gambler's wish list would include streaming video of live games and races once 3G networks can handle the huge amount of data required. (http://www.forbes.com/2003/02/10/cz_cs_0210gaming.html)

To see an industry publication on the potential of this type of gaming go to http://www.cellgambling.com/

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Schools

 School-based problem gambling prevention 1  Connecting the dots 2  Majoring in wagering 3  Casino nights 5  Free youth video 7  Free high school awareness activities 8  Health education standards 9  ODE tips for partnering with schools 11  Model school program 12

See also: Sec. 2 ―Problem gambling and vulnerable populations‖ and Sec. 4 ―Problem gambling factsheets and handouts‖ for more on youth gambling

School based problem gambling prevention

Successful prevention efforts are those that are comprehensive, multi-faceted, employ multiple strategies, and are committed to changing the conditions in which problem behaviors thrive.

By promoting healthy choices and reducing risks, we can go a long way toward improving students‘ academic performance.

This section is designed for educators, prevention coordinators, school counselors and other public health professionals who would like more tools to help implement problem gambling prevention strategies in school-based settings.

It includes data, handouts and information pieces to help you 1) promote education to help influence healthy choices, and 2) encourage development and enforcement of school-based gambling policies.

A selection of school gambling policies

Research shows that limiting the availability and accessibility of problem behaviors limits the likelihood that they will occur. And considering that about one in four Oregon teens report gambling at school, there is much opportunity to influence the context in which gambling occurs.

A sampling of school gambling policies can be found at: gamblingprevention.blogspot.com/2006/10/oregon-school-gambling- policies.html

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connectingthe dots: substance use gambling

prevention gprprogambli Why you need to include problem gambling in your substance abuse preventionng curriculum.

Kids who gamble are twice as likely to use alcohol or marijuana (Oregon Healthy Teens 2005 data, 30-day use among 8th and 11th graders) and are more likely to be involved in other risk behaviors such as fighting, carrying weapons, etc. (Oregon Healthy Teens 2006 data).

One in 25 Oregon teens meet the criteria for being problem gamblers. Problem gambling is easy to hide and often mistaken for other behavioral and academic issues.

Problem gambling shares the same risk factors as alcohol and drug problems. See the connections? Now

Approaches to prevent problem gambling connect with us. and substance abuse are very similar. Oregon Problem Gambling Services can

provide you with free, evidence-based, Gambling is everywhere — on TV, in easy-to-use materials. stores, and in schools. Young people need

to learn that there are risks involved, and  In-class presentations make healthy decisions.  Educational materials  Integration of problem gambling into approved curricula Contact us Oregon Problem Gambling Services 503-945-6187 [email protected]

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Majoring in wagering?

If they‟re not smoking, drinking, or using drugs, what‟s the big deal? With gambling‘s increasing availability, accessibility and acceptability, more young people than ever are gambling. What may seem like harmless fun can develop into a serious problem for some people. As educators or counselors, you play an important role in the prevention of problem behaviors among your students.

Three key points about youth gambling:

1. Gambling is not a safe alternative to alcohol or drug use. Many people think that poker among friends is totally safe because young people are not drinking or smoking. The truth is, while most people don‘t have a gambling problem, more young people are developing problems with gambling. Consequences of problem gambling include more than lost money. Depression, social withdrawal and dropping out of school are just a few of the potential consequences of a gambling problem.

2. Many teens already have gambling problems. It may be only a harmless bet of a dollar or two, but it can become a lot more serious. An Oregon study showed that one in every 25 teens (4 percent) have a gambling problem. An additional 15 percent are at risk for developing a gambling problem.

3. Teens are only a few years away from being adults who can gamble legally. Honest education about gambling is important to preparing young people to make responsible choices

Why should I be concerned about my students?

 Problem gambling affects school performance and increases the dropout rate.

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 Many problem gamblers say they started gambling at an early age – approximately 10 years old.  About one in every 25 Oregon teens already has a gambling problem.  Young people often don‘t have well-developed coping or decision-making skills.  Young people can easily hide a gambling problem.  There are no needle marks, drowsy walking, bloodshot eyes, or other tell-tale signs so that others can get help.  The problem typically develops over several years. Without prevention efforts now, small problems can escalate into serious consequences down the line.

One in 25 Oregon teens meet the criteria for problem gambling. Is there a problem gambler in your class?

How we can help you Problem gambling prevention can supplement your current classroom activities – not add more work for you. Problem gambling activities and information that ―plug in‖ to existing substance abuse prevention curriculum:  Educational materials;  Free youth gambling awareness video (featuring Oregon teens) and educational guide;  Presentations to educators, administrators and parent groups; Call 503-945-9703 to access these and other resources.

Free educator brochure download: 1877mylimit.org – click on Resources

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I’m planning a casino night for my school. What do I need to know? Casino nights or other related events are often fun and good as fundraisers. But consider another side: problem gambling. Four percent of Oregon teens (one in 25 teens) already have problems with gambling, and an additional 15 percent are considered ―at risk.‖ Youth who gamble excessively are prone to problems in school, at work and with peer and family relationships. Those who take gambling too far may commit crimes to finance their gambling, are more at risk for alcohol and drug abuse, and are much more likely to commit or attempt suicide.

―But these events are harmless ―Yes, but no one’s exchanging real compared with kids drinking or money!‖ using drugs.‖ That may be true. But think of it this As with alcohol and substance way: would you consider holding a abuse, accessibility, availability, ―mock-tail‖ party for kids with non- and acceptability are key factors alcoholic umbrella drinks? Probably in increasing the rate of youth not, because it gives kids the wrong gambling and associated message. The same is true for casino problems. The reality is that there nights or other school organized is little difference between an gambling activities. Even though real addiction to a substance and an money isn‘t being used, casino nights addiction to gambling; the or other gambling related activities and consequences are often every bit fundraisers promote a behavior that is as devastating. dangerous and sends the wrong message – that gambling is risk-free.

―So…how can we still have a successful event AND attract the kids?‖ Students and parents have offered us a number of suggestions that would be both effective and fun. These alternatives include activities like:  Movie night  Video game night  Board game night  Game show madness

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 ―Survivor‖ theme  ―Fear Factor‖ theme  ―Amazing Race‖ theme  Whodunit mystery night  Athletic center activities (swimming, racquetball, Sumo wrestling, etc.)  Silent auction (for fundraisers)  ――The Bachelor‖― theme / date auction (for fundraisers)

If you still decide to have a casino night, we have valuable resources for you to help educate people about gambling, including free brochures and posters, as well as information on:  Real odds and probabilities of gambling  Responsible gambling tips  Resources for people with gambling problems

Contact us for useful, REAL, and fun information!

We can help! Oregon Problem Gambling Services 503-945-6187 [email protected]

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Free youth problem gambling awareness video featuring Oregon kids

“You mean, gambling can be addictive?”

Here‘s a great, free resource to help kids understand that gambling is not a risk-free activity. The video features kids from urban and rural Oregon talking about gambling – their thoughts and beliefs, what they have observed, advice they have to give and more. The video is brief and humorous, using a ―mythbusters‖ theme. It comes with a facilitator‘s guide that includes discussion questions and key points to cover.

The information Middle school students will learn: Video Stats:  What is gambling? - Less than 8 minutes.  Gambling is not risk-free. - For middle school  How to recognize problem gambling. students.

 How to get help.

What it is: to educate young people about the risks and pitfalls of gambling. Order your FREE video What it‘s NOT: to pass judgment on gambling being Contact Greta Coe at 503-945- a ―good‖ or ―bad‖ activity. 6187 or [email protected] to The idea is to encourage kids to adopt ―street-smart‖ order your copy! awareness when faced with choices about gambling activities at school, on the Internet, at home, or with friends.

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NEW! High School Health Problem Gambling Awareness Activities

Developed by Oregon high school teacher Trisha Ebbs, these two activities come complete with everything you need to conduct one or two awareness activities (―Gambling Myths & Facts‖ and ―Bust an Ad‖) that really engage high schoolers…they‘re tried and tested in the classroom, so we know they work! To download a free copy go to: http://lanecounty.org/prevention/pgs/educators.htm (scroll down to the high school level curricula. To request a hard copy in the mail, contact Wendy Hausotter at [email protected].

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Oregon revised health education standards Note: this is the first time problem gambling has been mentioned in these standards, which are important because they form the basis for curriculum development; the inclusion of problem gambling will make it more likely that the topic will be addressed in school curricula. 6-8 Health Skills and Concepts Instruction aligned to the Oregon Health Education Standards PROMOTION OF MENTAL, SOCIAL AND EMOTIONAL HEALTH

KNOWLEDGE SKILLS The filled-in boxes below are skills that we felt are most appropriate to teach the concept on the left. Some concepts do not have an associated skill, because they areheavily based on knowledge. By no means do empty boxes signify ―no skill‖’. Feel free to add skills as needed.

Promotion of Accessing Self Analyzing Interpersonal Goal Decision Advocacy mental, social Information Management Influences Communication Setting Making and emotional health concepts

Explain how to build Demonstrate effective Make Advocate for and maintain healthy communication skills decisions that healthy family and peer that encourage healthy enhance or communication relationships. relationships. establish skills within healthy relationships relationships. Identify qualities that Analyze Set goals contribute to a positive influences that around self-image. may affect self- increasing esteem (e.g., positive peers, media, self-image. adults). Identify personal Practice managing Develop stressors at home, in personal stressors at achievable school and with peers. home, in school, goals to and with peers. handle stressors in a healthy way. Recognize diversity Demonstrate Advocate among people, appropriate ways to respect for including disability, respect and include diversity. gender, race, sexual others who are orientation and body different from size. yourself.

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KNOWLEDGE SKILLS The filled-in boxes below are skills that we felt are most appropriate to teach the concept on the left. Some concepts do not have an associated skill, because they areheavily based on knowledge. By no means do empty boxes signify ―no skill‖’. Feel free to add skills as needed.

Promotion of Accessing Self Analyzing Interpersonal Goal Decision Advocacy mental, social Information Management Influences Communication Setting Making and emotional health concepts

Identify how emotions Identify school, change during home and adolescence. community resources for mental and emotional health concerns.

Identify the causes, Identify school Communicate to a peer effects and symptoms of and community ways of accessing help depression, including resources that can in a critical situation. suicide. help a person who is depressed or contemplating suicide.

Explain eating disorders Identify how and symptoms. food choices are influenced by culture, family, media, technology, peers, body image and emotions. Identify Identify school Identify the Use a and community influences that decision different types resources that may encourage making provide support young people model to of addictive avoid or for addictive to try addictive refuse behaviors, behaviors. drugs and addictive participate in substances including drug and/or addictive behaviors. use AND behaviors. PROBLEM GAMBLING.

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Tips for working with schools from Oregon Department of Education The best times to approach schools are October, late January, February and

1 early May.

If possible, approach a school with an internal partner; e.g., a teacher or

2 parent you already have a relationship with.

Working with schools should be a partnership. Explain what you can offer

3 and why you benefit from working with schools.

Ask yourself, ―Why Should They Care?‖ Why are your prevention services

4 important? Be brief and to the point.

Use local (school or county) data if possible to talk about prevention in the

5 school.

Know the education language. The word ―standards‖ means one thing to

6 someone in public health and something very different to a teacher.

Align what you are offering to curriculum standards, school policies,

7 raising test scores, increasing attendance, etc.

Many teachers and other school staff are overwhelmed, sodon‘t add 8 something to their plate. Consider having them do what they do, but in a different way.

Schools are stressed. There is overall a lack of funding, support, resources 9 and pressure to raise test scores. If you can offer a solution (for example, be a resource) you‘re in!

Ask questions. If you don‘t understand something, explain that you come

10 from a different perspective and schools are a different beast.

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10 elements of a model school problem-gambling awareness and prevention program

1. The school‘s policies and procedures include restrictions on gambling‘. 2. Problem gambling awareness posters, brochures are posted in buildings. 3. School counselors (and appropriate others) have received an in-service on problem gambling and are able to help or refer a student who needs help or information. 4. Problem gambling is addressed as part of the healthy choices or ATOD curriculum; or is included in risk/healthy choices activities and events (teen mazes, assembly speakers, etc.). 5. School uses promising practice curricula for problem gambling. 6. The use of gambling events as fundraisers is discouraged; if allowed, they always include problem-gambling awareness information. 7. Gambling is incorporated into examples in classes such as math (probability/risk), social studies (societal costs/benefits), health (see No.4). 8. In-service on problem gambling is provided every five years to school staff. 9. PTA or PTO is knowledgeable about problem gambling. 10. School observes annual problem-gambling awareness week in cooperation with the local problem gambling prevention and outreach coordinator.

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Problem gambling and the brain

 Article excerpts on the brain and problem gambling 2001-08 1  Other resources 9

Problem gambling and the brain

An exciting and relatively new addition to the research on the causes and treatments of problem gambling is emerging from work being done on brain development and function. For the most part, the research is too new to come to solid conclusions, so we offer an overview of some of the findings over the past several years. Some of the studies are very small and all require much more exploration, but the findings are intriguing and may lead the way to new treatment and prevention strategies.

Article excerpts on the brain and problem gambling

Gambling has drug-like effect on brain (2001) The brains of people anticipating a win at the roulette table appear to react much like those taking euphoria-inducing drugs. A team of investigators reports that the parts of the brain that respond to the prospects of winning and losing money while gambling are the same as those that appear to respond to cocaine and morphine.

The overlap of brain activity seen in the gambling experiment with that found in earlier studies of drug use indicates, the researchers said, that the brain uses the same circuitry for ―the processing of diverse rewards.‖

―The results of our gaming experiment, coupled with findings from prior studies of the anticipation and experience of positive and negative outcomes in humans and laboratory animals, suggest that a network of interrelated structures ... coordinate the processing of goal-related stimuli,‖ the team led by Dr. Hans C. Breiter of Massachusetts General Hospital said.

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They found that in the gambling experiment, blood flow to the brain changed in ways similar to that seen in other experiments during an infusion of cocaine in subjects addicted to that drug and to low doses of morphine in drug-free individuals.The changes varied in accordance with the amount of money involved, and a broadly distributed set of brain regions were involved in anticipating a win. The more money involved, the more excited the person became. The primary response to winning, or the prospect of winning, was seen in the right hemisphere of the brain, while the left hemisphere was more active in response to losing, the researchers reported. Source: http://www.usatoday.com/news/health/2001-05-24-gambling.htm

The medial frontal cortex and the rapid processing of monetary gains and losses (2002) Choices made after losses were riskier and were associated with greater loss-related activity than choices made after gains. It follows that medial-frontal computations may contribute to mental states that participate in higher-level decisions, including economic choices. Source: http://www.sciencemag.org/cgi/content/abstract/295/5563/2279

Brain activities differ in problem gamblers (2003) Imaging studies have identified unique brain activity changes in men with pathological gambling when they viewed videotapes about betting on cards or rolling dice at a casino, a Yale study has found.

The fMRI study showed that the men with gambling problems had a temporally dynamic pattern of brain activity when viewing gambling videotapes, with changes observed in frontal, paralimbic, and limbic brain structures. When viewing gambling cues, men with pathological gambling demonstrated relatively decreased activity in brain regions implicated in impulse regulation.

Another finding is that the pattern of brain activity changes more closely paralleled those observed in the cocaine cravings of cocaine addicts than the anticipatory urges in persons with OCD. Source: http://opa.yale.edu/news/article.aspx?id=3025

Gambling addiction resembles brain problem: Poorer choices, more errors seen in chronic gamblers‟ mental tests (2005) Gambling addiction may have something in common with certain brain impairments. Both conditions can hinder decision-making and the ability to determine the consequences of actions, according to Franco Manes, M.D., and

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colleagues. They say it‘s possible that gambling addiction is associated with impairments in the brain‘s prefrontal cortex, affecting the ability of gamblers to consider future consequences before taking action. Those with a gambling addiction made ―disadvantageous choices‖ on the decision-making task. The gamblers also made more impulse control errors on another task, say Manes and colleagues.

The errors and poor choices are similar to those made by people with problems in the brain‘s prefrontal cortex, the researchers say. Source: http://www.webmd.com/mental-health/news/20050413/gambling-addiction- resembles-brain-problem

Brain‟s „gambling circuitry‟ identified (2006) From gamblers playing blackjack to investors picking stocks, humans make a wide range of decisions that require gauging risk versus reward. However, laboratory studies have not been able to unequivocally determine how the very basic information-processing ―subcortical‖ regions of the brain function in processing risk and reward.

Now, Steven Quartz and colleagues at the California Institute of Technology have created a simple gambling task that, when performed by humans undergoing functional magnetic resonance imaging (fMRI) of their brains, distinguishes the ―gambling‖ structures in the brain. Importantly, their findings tease apart the gambling function of these brain structures from their functions in learning, motivation, and assessment of the salience of a stimulus.

The researchers concentrated their analysis on the ―anticipatory period‖ between the display of the first and second card, since it was then that the subjects were able to judge from the number on the card the risk of whether they were likely to win or lose their bet that the second card would be higher or lower.

Furthermore, the researchers divided that anticipatory period into two subperiods. During a one second [sic] period immediately after the first card was displayed,

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subjects were concentrating on expected reward, theorized the researchers; and in the following six seconds before the second card, they were assessing the risk revealed by the first card. The researchers based this approach on studies by other researchers of such processes in primates.

Quartz and colleagues found they could distinguish brain regions that specifically responded to either reward expectation or risk. Importantly, these areas showed activity that increased with the level of expected reward and perceived risk. The researchers found that the activation related to expected reward was immediate, while the activation related to risk was delayed.

Of the practical implications of their findings, the researchers wrote that ―pathological behaviors ranging from addiction to gambling, as well as a variety of mental illnesses such as bipolar disorder and schizophrenia, are partially characterized by risk taking.‖ To date, it is unknown whether such pathological decision making [sic] under risk is due to misperception of risk or disruptions in cognitive processes, such as learning, planning, and choice. Source:http://www.sciencedaily.com/releases/2006/08/060803091759.htm

Brain atrophy in elderly leads to unintended racism, depression and problem gambling (2007) University of Queensland psychologist Bill von Hippel reports that decreased inhibitory ability in late adulthood can lead to unintended prejudice, social inappropriateness, depression, and gambling problems. Von Hippel also found that a penchant for gambling can be toxic for older adults, as those with poor executive functioning are particularly likely to have gambling problems. Interestingly, these problems are exacerbated in the afternoon, when older adults are less mentally alert. Older adults were more likely to get into an unnecessary argument and were also more likely to gamble all their money away later rather than earlier in the day. These findings suggest a possible avenue for intervention, by scheduling their important social activities or gambling excursions earlier in the day.

While social changes commonly occur with age, they are widely assumed a function of changes in preferences and values as people get older. Von Hippel argues that there may be more to the story and that some of the changes may be unintended and brought about by losses in executive control. Source:http://www.sciencedaily.com/releases/2007/09/070921100332.htm

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Science shows how slot machines take over your mind (2007) From the perspective of the brain, gambling has much in common with addictive drugs, like cocaine. Both work by hijacking the brain‘s pleasure centers -- a lure that some people are literally incapable of resisting. ―Gambling games grew up around the frailty of our nervous system,‖ says Read Montague, a professor of neuroscience at Baylor University. ―They evolved to exploit specific hiccups in our brain.‖

The neural circuits manipulated by gambling originally evolved to help animals assess rewards, such as food, that are crucial for survival. Dopamine is the neurotransmitter involved with the processing of these rewards. Whenever we experience something pleasurable, such as winning a hand of blackjack or eating a piece of chocolate cake, our dopamine neurons get excited. These neurons help the brain learn about the pleasure, and attempt to predict when it will happen again.

Wolfram Schultz, a neuroscientist at Cambridge University, has exposed how this system operates on a molecular level. He has spent the past two decades measuring the activity of dopamine neurons in the brains of monkeys as they receive rewards of fruit juice. His experiments observe a simple protocol: Schultz flashes a light, waits a few seconds, and then squirts a few drops of apple juice into the monkey‘s mouth. While the monkeys are waiting for the sweet liquid, Schultz painstakingly monitors the response of individual cells.

At first, the neurons don‘t get excited until the juice is delivered. The cells are reacting to the actual reward. However, once the animal learns that the light always precedes the arrival of juice, the same neurons begin firing at the sight of the light instead of the reward. Schultz calls these cells ―prediction neurons,‖ since they are more interested in predicting rewards than in the rewards themselves.

These predictions are a crucial source of learning, since the monkey constantly compares its expectations of juice with what actually happens. For example, if the light is flashed but the juice never arrives, then the monkey‘s dopamine neurons stop firing. This is known as the ―error signal.‖ The monkey is disappointed, and begins to change its future predictions. However, if the monkey receives an unexpected reward -- the juice arrives without warning -- then the dopamine neurons get extremely excited. A surprising treat registers much larger than an expected one.

―A reward that‘s unpredictable typically counts three or four times as much,‖ Schultz says. Games of chance prey on this neural system. Consider, for example, 6-5

the slot machine. You put in a coin and pull the lever. The reels start to whirr. Eventually, the machine settles on its verdict. Chances are you lost money. But think about the slot machine from the perspective of your dopamine neurons. Whenever you win some money, the reward activates those brain cells intent on anticipating future rewards. These neurons want to predict the patterns inside the machine, to decode the logic of luck. Yet here‘s the catch: slot machines can‘t be solved. They use random number generators to determine their payout. There are no patterns to decipher. There is only a little microchip, churning out arbitrary digits.

At this point, our dopamine neurons should just turn themselves off: the slot machine is a waste of mental energy. But this isn‘t what happens. Instead of getting bored by the haphazard payouts, our dopamine neurons become obsessed. The random rewards of gambling are much more seductive than a more predictable reward cycle. When we pull the lever and win some money, we experience a potent rush of pleasurable dopamine precisely because the reward was so unexpected. The clanging coins and flashing lights are like a surprising squirt of juice. The end result is that we are transfixed by the slot machine, riveted by the fickle nature of its payouts. ―The trick of a one-armed bandit,‖ Montague says, ―is that it provides us with the illusion of a pattern. We get enough rewards so that we keep on playing. Our cells think they‘ll figure out the pattern soon. But of course they won‘t.‖

The irony of gambling is that it‘s entertaining because it‘s so frustrating, at least for our dopamine neurons. One of the big remaining questions for scientists is why only some gamblers get addicted. While most people can walk away from the slot machines, some gamblers ... can‘t resist the temptation. For these compulsive gamblers, the misplaced predictions of their dopamine neurons become self- destructive. Source: http://www.boston.com/news/globe/ideas/articles/2007/08/19/your_brain_on_gam bling/

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Gambling and risk taking (2007)

Once considered a character defect, gambling is now known to be a highly addictive disorder with neurological causes. Thanks to new advances in brain imaging, scientists are beginning to identify the neural mechanisms that go awry in the brains of pathological and problem gamblers. What they‘re learning from such research is also shedding light on how these same mechanisms determine individual risk tolerance – and influence the financial choices we all make throughout our lives.

You hold your breath as the wheel spins on the roulette table. You briefly close your eyes as the croupier deals you another card at the blackjack table. You stand frozen in place as the horse you bet on lunges toward the finish line.

At such moments – when you‘re anticipating the possibility of a financial reward – certain areas of your brain jump into action. The particular pattern of that activity, neuroscientists are now discovering, helps identify how risk-averse you are – not only when you‘re at the gambling table or the racetrack – but when you ponder any decision that involves some financial risk. Should you take a new job? Should you invest in a new business? Should you put your savings in potentially volatile stocks or in the ―sure thing‖ of a bank certificate of deposit?

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Those same neural patterns may also reveal whether you‘re at risk of becoming a pathological gambler, someone so addicted to gambling that you continue the activity even while mounting losses ruin your personal finances and relationships. Recent studies have found that when we anticipate financial gains – whether at the gaming tables or on the stock market – an area of our brain known as the ventral6-7 striatum becomes activated and flooded with dopamine, a brain chemical linked to pleasurable sensations. The release of this chemical also occurs during physically rewarding activities such as eating, sex and taking drugs, and is a key factor behind our desire to repeat these activities.

When we start to consider the possibility of losing money, however, the same brain areas become less active. In fact, most people‘s brains show more negative sensitivity to losses than positive sensitivity to gains – neural evidence of our tendency toward risk aversion. In one study, researchers could predict how tolerant individuals were to risk by analyzing how their brains responded to potential gains versus potential losses. Those whose brains were less turned off by the possibility of increasing their losses tended to be more eager gamblers.

In pathological gamblers, neural activity in the ventral striatum remains remarkably unreactive – even during winning streaks. Their brains also show decreased activation in the ventrolateral prefrontal cortex – the brain‘s ―superego‖ – which, when functioning normally, keeps people from acting impulsively. This finding may explain why pathological gamblers keep betting despite the havoc it inflicts on their lives. To maintain even a normal level of dopamine in their brains, they must gamble with increasing frequency – and often for greater and greater stakes. And the impulse control in their brain is not functioning properly. Drug addicts show a similar brain pattern – and a similar need to keep feeding their addiction.

Recently, pathological gambling has been found to be a rare side effect of specific types of dopamine agonists, drugs used to treat the tremors and balance problems associated with Parkinson‘s disease. The dopamine boost from these drugs appears to overload receptors in the ventral striatum, causing an irresistible urge to gamble. The effect does not occur in everybody who takes dopamine agonists and it dissipates once the medication is discontinued. Source: http://www.sfn.org/index.cfm?pagename=brainbriefings_gambling#full (pdf of full article is available)

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Brain challenges for compulsive gamblers (2008)

A new research study finds that gambling addicts do not learn from their mistakes. The finding suggests [that] differences in the prefrontal cortex of the brain may explain the development of impulsive or compulsive behavior that can lead to pathological gambling. The research team evaluated a group of 15 male and five female pathological gamblers. They carried out various neuropsychological tests in order to explore which areas of the brain are related to the disorder. The tests included the Wisconsin Card Sorting Test (WCST), the Wechsler Memory Scale revised (WMS-R) and the Verbal Associative Fluency Test (FAS). Each of which can assess particular problem-solving abilities. [sic] They compared the results with those of healthy individuals.

They found that the pathological gamblers scored well in all tests except the card sorting. In this test, the patients had great difficulty in finding different ways to solve each problem in the test as they worked through them, whereas the healthy individuals got better with practice.

―Our findings show that in spite of normal intellectual, linguistic and visual-spatial abilities, the pathological gamblers could not learn from their mistakes to look for alternative solutions in the WCST,‖ say the researchers.

This suggests that there are differences in the part of the brain involved in this kind of problem solving, the prefrontal region. ―These differences might provoke a sort of cognitive ‗rigidity‘ that predisposes a person to the development of impulsive or compulsive behaviour, leading to pathological gambling.‖ Source: http://psychcentral.com/news/2008/03/27/brain-challenges-for-compulsive- gamblers/2089.html

Other resources on gambling and the brain

―Youth, Brain Development and Gambling Risk: Intersections on the Developmental Highway‖ PowerPoint presentation by Dr. Ken Winters www.dmh.missouri.gov/ada/provider/Wintersyouthbrainandgamblingtalk.ppt

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―Gambling Addiction: What‘s the Brain Got to do With It?‖ PowerPoint presentation by Dr. Mark Potenza http://braininstitute.vanderbilt.edu/Vanderbilt_March07_PotenzaLecture.ppt

The Brain From Top to Bottom: brain function tutorial/overview Web site http://thebrain.mcgill.ca/

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Spanish materials  Signs of a problem gambler 1  Offering help (for the family) 2  Older adults and gambling 3  Responsible gambling tips 6  Myths and facts on problem gambling 7  Parents: signs of a gambling problem in kids 10  Similarities and differences between problem gambling and substance abuse 11  Cycle of addiction in problem gambling 12  Irrational beliefs of problem gamblers 13  10 rules of responsible gambling 15  Spanish South Oaks Gambling Screen (SOGS) 17  Web site links 22

For more Oregon-specific resources in Spanish go to: http://lanecounty.org/prevention/gambling/Espanol/default.htm http://lanecounty.org/prevention/pgs/media.htm

Señales de un jugador problemático ¿Conoce a alguien que está…?

 preocupado con el juego (es decir, revive experiencias de juegos pasados, planea la siguiente aventura o piensa en formas de conseguir más dinero para poder jugar)  mintiendo respecto a sus hábitos de juego y actuando de manera defensiva cuando se le confronta  aumentando sus apuestas cuando juega con el fin de obtener la emoción deseada (la sensación de estar ―intoxicado‖ o ―elevado‖)  tratando sin éxito de controlar el tiempo que pasa jugando, tratando de jugar menos o dejar de jugar  irritable o inquieto cuando no puede jugar  jugando para escapar de los problemas  tratando de recuperar lo que ha perdido jugando más  cometiendo delitos para financiar sus apuestas  poniendo en peligro o perdiendo sus relación familiar o personal, perdiendo oportunidades de trabajo, profesionales o de capacitación debido al juego  dependiendo de otros para que lo saquen de apuros o le ayuden ante una situación financiera desesperada causada por el juego

¿Conoce a alguien o cree usted tener un problema con el juego? Hay ayuda gratuita y confidencial. Llame a 1-877-695-4648. ¡No espere hasta que el problema empeore!

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Para la familia del jugador problemático: ofrezca su ayuda

Solo el pensar en hablarle a alguien acerca de su problema de apuestas puede ser algo intimidante, pero el saber como comenzar puede ayudarle a tener el valor para iniciar la conversación, y así poder ayudar a la persona que tiene este problema. Primero, escoja un lugar tranquilo donde no vayan a ser interrumpidos, después mantenga la conversación simple y al punto.

 Dígale a la persona lo importante que el o ella es para usted y que usted está preocupado(a) por él o ella.  Menciónele a la persona exactamente lo que a usted le preocupa de lo que él o ella ha estado haciendo.  Explique a la persona como su comportamiento afecta a otros -- sea específico.  Hable con claridad lo que usted espera que la persona haga (―Quiero que hables con alguien acerca de tu problema de apuestas.‖) y de lo que ellos pueden esperar de usted (―Ya no te voy a sacar de tus problemas de dinero.‖)  Después de que usted le haya dicho a la persona lo que usted ha visto y cómo se siente, deje que le responda. Escúchele sin juzgar.  Diga a la persona que usted está dispuesto/a a ayudarle, pero no intente darle consejos.  Ofrezca información a la persona, pero no le aconseje que hacer. Aliéntelo a que llame a la línea de ayuda. No es necesario que un jugador ―toque fondo‖ para que decida obtener ayuda. Para recibir información específica de cuándo y cómo afrontar a una persona que usted conozca con este problema, llame al 1-877-695-4648.

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Los ancianos y el juego

El juego de apuestas, o jugar cualquier tipo de juego de azar por dinero u otras apuestas, se ha vuelto una actividad popular para gente de todas las edades, y los ancianos no son la excepción. Mientras que los expertos concuerdan en que la mayoría de los adultos pueden jugar sin tener problemas, las investigaciones sobre el predominio del juego llevadas a cabo en Oregón demuestran que el 2,7% de la población general1 y el 1,2% de la población de ancianos se convierten en jugadores problemáticos o patológicos2.

Las oportunidades que tienen los ciudadanos de Oregón para jugar son muchísimas. Cada vez existen más casinos tribales, productos de lotería, apuestas en deportes y juegos de apuestas por Internet. El aumento de la cantidad de gente que sufre problemas de juego se corresponde con el aumento en la disponibilidad de oportunidades de juego. Según los estudios realizados, más de 6.000 ciudadanos de Oregón mayores de 62 años de edad tienen en la actualidad un problema con el juego.

Preocupaciones acerca de los ancianos y el juego problemático La forma de jugar de los ancianos es diferente de la de otros grupos más jóvenes debido a lo siguiente:

 Las personas que deben sobrellevar grandes cambios o pérdidas en sus vidas son más vulnerables a desarrollar problemas con el juego. Muchos ancianos enfrentan transiciones y pérdidas en sus vidas (muertes, jubilación, enfermedades, aislamiento).  Los ancianos que han perdido sus ahorros de jubilación en el juego ya no tienen años de trabajo para poder recuperar sus pérdidas.  Muchos ancianos no entienden la adicción, por lo que les resulta más difícil identificar si tienen un problema con el juego.

1 Volberg, R. (febrero de 2001). ―Changes In Gambling And Problem Gambling In Oregon: Results From A Replication Study‖, 1997-2000. Salem, OR: Fundación para el Tratamiento de la Adicción al Juego (Oregon Gambling Addiction Treatment Foundation). 2 Moore, T. (abril de 2001). ―Older Adult Gambling In Oregon: An Epidemiological Survey‖. Salem, OR: Fundación para el Tratamiento de la Adicción al Juego.

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 Los ancianos no piden ayuda tanto como los jóvenes por un problema con el juego.  Muchos ancianos ocultan sus actividades de juego debido al estigma asociado con esta actividad, y los profesionales de la salud muy pocas veces evalúan el juego problemático.  Muchos ancianos tienen un fácil acceso al juego y son atraídos por esta actividad para ocupar su tiempo o estar con otras personas.  Una gran proporción de ancianos (comparada con los adultos más jóvenes) sufre alguna discapacidad cognitiva que puede interferir en su habilidad para tomar decisiones juiciosas.

Juego problemático: señales y síntomas El término ―juego problemático‖ indica que las actividades de juego de una persona comprometen o dañan sus metas personales, familiares o vocacionales. El juego problemático implica un amplio rango de gravedad y parece ser el resultado de varios factores. A continuación mencionamos las señales y síntomas más comunes del juego problemático:

 Jugar para calmar los nervios,  Tener discusiones acerca del olvidarse de las preocupaciones juego. o reducir la depresión.  Dejar de lado las necesidades  Perder el interés en otras cosas, básicas para poder jugar. como por ejemplo, comer.  Apostar cada vez más dinero  Hablar, pensar o planificar todo para obtener el efecto deseado. el tiempo las actividades de  Sufrir problemas de salud juego sin realizar otras relacionados con el juego, actividades. como por ejemplo, dolor de  Mentir sobre los hábitos de cabeza, ansiedad por colon juego. irritable y depresión.  Jugar solo o jugar con más  Tener problemas económicos frecuencia. causados por el juego

Cómo obtener ayuda Si cree que algún conocido o usted mismo puede tener un problema con el juego, existe ayuda disponible. Si el juego problemático no se trata, puede causar graves problemas físicos, emocionales y económicos, en especial entre los ancianos. En

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Oregón, el tratamiento contra el juego problemático es gratis. Entre las opciones de tratamiento se encuentra la consejería telefónica, la consejería individual en persona y la consejería grupal.

Para obtener información o ayuda gratuita, comuníquese con el siguiente número de teléfono confidencial y disponible las 24 hs: 1-877-MY-LIMIT (1-877-695-4648) El contenido incluido en este material fue adaptado de “Elder Health Tips”, primavera de 2001, publicado por el Departamento de Salud Pública de Massachussets (Massachusetts Department of Public Health).

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como no perderlo todo: jugar responsablemente

 La decisión de jugar en una elección personal

 Ponga un límite de cuánto va a gastar

 Cuando llegue a su límite, deje de jugar; no sienta la tentación de pedir dinero prestado o de sobrepasar su límite

 Entienda las reglas del juego: así como se gana se pierde; es mejor hacerlo con la esperanza de ganar pero con la certeza de que va a perder.

 El dinero que necesita es sólo eso: para necesidades Esta información está proporcionado por la loteria de Oregón.

 No es necesario jugar para pasarla bien

 Entienda que todas las formas del juego tienen el potencial de crearle un hábito

 El juego no es un buen sustituto para el alcohol o las drogas

 Si pierde, no se empeñe en apostar más para ―recuperarse‖; acepte las pérdidas como el costo del entretenimiento

¿Cree que usted o un ser querido tiene un problema con el juego? Hay ayuda gratuita y confidencial. Llame a 1-877-695-4648 ¡No espere hasta que el problema empeore!

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mitos y realidades acerca del juego problemático

MITO: Para ser un jugador problemático hay que jugar todos los días. REALIDAD: El jugador problemático puede jugar con frecuencia o no. Si la actividad de juego de una persona le provoca problemas psicológicos, económicos, emocionales, de pareja, legales o de cualquier otro tipo, tanto a él como a quienes le rodean, esta persona tiene un problema con el juego.

MITO: Los jugadores problemáticos juegan en cualquier momento y con cualquier forma de juego. REALIDAD: La mayoría de los jugadores problemáticos tienen una forma preferida de jugar que les causa problemas. Algunos jugadores también se involucran en otras actividades de juego, pero por lo general éstas no son tan problemáticas.

MITO: El juego problemático en realidad no es un problema si el jugador puede afrontar los gastos. REALIDAD: Los problemas causados por el juego excesivo no son sólo económicos. Si el juego de una persona interfiere con su habilidad para actuar de acuerdo con sus valores, entonces hay un problema. Por ejemplo, pasar mucho tiempo jugando significa pasar menos tiempo con la familia, los amigos y otras personas. Esto puede llevar a la ruptura de una relación y a la pérdida de amistades importantes.

MITO: Los jugadores problemáticos son personas irresponsables. REALIDAD: Muchos jugadores problemáticos son (o han sido) personas importantes en la comunidad. Además, aún las personas con antecedentes de comportamiento responsable son vulnerables a desarrollar un problema de juego. Cuando una persona tiene un episodio de juego problemático, no puede controlar

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su juego y, en este estado comprometido, sus acciones parecen ser un comportamiento irresponsable.

MITO: El juego problemático no afecta a los niños. REALIDAD: Según las encuestas, entre el 10% y el 15% de los jóvenes estadounidenses y canadienses han tenido problemas relacionados con el juego, y entre el 1% y el 6% de estas personas pueden reunir los criterios de diagnóstico para juego patológico. Además, los hijos de jugadores problemáticos tienen mayor riesgo de desarrollar comportamientos peligrosos para su salud, tales como uso de drogas y alcohol, juego problemático, trastornos de la alimentación, depresión y suicidio.

MITO: Las parejas de los jugadores problemáticos con frecuencia son quienes los llevan a jugar. REALIDAD: Los jugadores problemáticos tienen una gran habilidad para encontrar formas de racionalizar su juego. Culpar a los demás es una manera de evitar aceptar la responsabilidad por sus actos, incluso los necesarios para superar su problema de juego.

MITO: Los problemas económicos son la razón principal de la ruptura de las relaciones del jugador problemático. REALIDAD: Es verdad que los problemas de dinero juegan un papel importante en la ruptura de relaciones. Sin embargo, muchas parejas de jugadores dicen que las principales causas de los problemas en la relación son las mentiras y la falta de confianza.

MITO: Los padres de los jugadores problemáticos tienen la culpa del comportamiento de sus hijos. REALIDAD: Muchos padres de jugadores problemáticos se sienten heridos y culpables por el comportamiento de juego de sus hijos, pero no tienen la culpa.

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MITO: Si un jugador problemático tiene una deuda de juego, lo importante es ayudarlo a salir de su problema económico lo antes posible. REALIDAD: Las soluciones rápidas por lo general son atractivas para las personas involucradas en el problema y pueden parecer lo correcto. Sin embargo, ―sacar del apuro‖ al jugador para que pueda salir de sus deudas en realidad empeora las cosas, ya que permite que continúen los problemas de juego.

MITO: El juego problemático es fácil de reconocer. REALIDAD: El juego problemático también se conoce como la ―adicción oculta‖. A diferencia del uso de alcohol y drogas, el juego es muy fácil de ocultar, ya que tiene muy pocos síntomas reconocibles. Muchos jugadores problemáticos ni siquiera reconocen que tienen un problema de juego, y con frecuencia se sumergen en la autonegación.

Adaptado de “Problem Gambling Pages” de Chris Lobsinger.

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Para padres: señales de un posible problema de juego en los niños

 Pedir o pedir prestado dinero a la familia.  Cosas relacionadas con el juego en la casa (boletos de lotería, hojas de apuestas).  Deudas inexplicables o ingresos imprevistos y bienes nuevos (ropa o joyas nuevas).  Pasar tiempo fuera del hogar, trabajo o escuela sin explicación.  Cambios en el comportamiento (distraído, malhumorado, triste, preocupado, nervioso, etc.).  Retraimiento con respecto a la familia.  Menor participación en actividades afuera.  Pasa demasiado tiempo viendo deportes en la TV o leyendo periódicos o revistas de deportes.  Se molesta exageradamente cuando termina un partido de algún deporte.  Llamadas de extraños y aumentos en las cuentas de teléfono.  Jactancia al ganar.  Interés intenso en conversaciones sobre apuestas.  Juega en Internet con juegos de apuestas.  Falta dinero y objetos de valor en el hogar

Si sospecha que su hijo tiene un problema con el juego, LLAME AL 1-877-MY-LIMIT (1-877-695-4648) para obtener ayuda gratuita y confidencial.

¡No espere a que el problema empeore!

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Diferencias entre el juego compulsivo y el abuso de sustancias

El juego no es auto-limitante: puede seguir El uso de sustancias es auto-limitante: pérdida jugando mientras pueda conseguir dinero. del conocimiento, sobredosis, etc. El comportamiento no se puede atribuir a una El comportamiento puede excusarse o intoxicación, por lo tanto: explicarse como resultado de la intoxicación, * Sentido más intenso de vergüenza y culpa. por lo que la culpa y la vergüenza son * Mayor negación y mayores defensas. moderadas. Resultados impredecibles, mayor Los efectos de la droga se vuelven predecibles incertidumbre, por lo que necesita mantener la con la experiencia. ilusión de control. Fantasías de éxito. No hay fantasías de obtener una fortuna por tomar o drogarse más. No existe un test biológico, por lo que la Los tests biológicos pueden confirmar la familia, los proveedores de tratamiento y los abstinencia y el cumplimiento del tratamiento. empleadores tienen una gran incertidumbre y los jugadores se enfrentan a un mayor nivel de escrutinio y desconfianza. Fácil de ocultar: no se puede oler en el aliento, Signos indicadores. no hay tambaleos, dilatación de las pupilas, etc. Los mayores problemas económicos Los problemas económicos no son el aspecto contribuyen a una mayor intensidad del enojo central de la recuperación. de la familia, consecuencias a más largo plazo y necesidad de consejería en temas financieros como parte integral del tratamiento. No se puede abstener completamente de todas Puede abstenerse completamente del uso de las experiencias de riesgo o competencia. sustancias. Menor nivel de conciencia y aceptación Gran nivel de conciencia y aceptación pública pública. de este trastorno. GA (Jugadores Anónimos) sólo se encuentra AA (Alcohólicos Anónimos) se encuentra disponible en ciertas áreas. ampliamente disponible. Los recursos para el tratamiento son limitados. Recursos para tratamiento disponibles en todo el país.

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Interrumpir el ciclo de acción Crear una zona de seguridad CICLO DE ACCIÓN del - Poner obstáculos a la obtención de dinero. juego compulsivo - Tratamiento. - Sistemas de ayuda. - Responsabilidad. - H.A.L.T.S. - ______- ______Pensamientos, sentimientos, anticipación, fantasía Mente del jugador ―Tiempo de juego / dinero del juego‖

Realidad Planificación Uno mismo con otros Quitar los obstáculos ―Tiempo real / dinero real‖ para poder jugar

Crisis Juego Culpa/vergüenza ―Ganar y perder‖ Ira Serotonina Negación/justificación Adrenalina Inquietud/irritabilidad Dopamina Depresión Pánico o parálisis Los tres ingredientes Pensamientos suicidas del juego: Programa de tratamiento contra el juego Instituto de Cuidado de la Salud Conductual de Cascadia (Cascadia Behavioral Healthcare) DINERO Portland, Oregón Junio de 2004 TIEMPO LUGAR 7-12

Ideas irracionales que tienen algunos jugadores acerca del juego

1. El juego es una actividad humana importante. 2. El juego es una forma fácil de ganar dinero. 3. Los que no juegan son tontos, lentos o miedosos. 4. Los jugadores especializados por lo general son brillantes y creativos. 5. El juego es una recreación saludable. 6. Tengo al juego bajo control, o puedo controlarlo con poco esfuerzo. 7. No tengo por qué dejar el juego, puedo reducir la cantidad de tiempo que invierto en el juego. 8. Puedo recuperar el dinero. 9. Soy inteligente, tengo un sistema para obtener ventaja. 10. La gente respeta a los grandes apostadores. 11. Algún día ganaré una apuesta realmente grande y me retiraré con honores. 12. El juego será la solución a mis problemas. 13. Algunos regalos costosos pueden compensar las desilusiones del pasado. 14. El juego me hace sentir mejor. 15. Mi problema es el dinero. 16. Lo devolveré. 17. Está bien pedir prestado para jugar. 18. Robar para jugar en realidad no es robar. 19. Cuanto más dinero tenga para apostar, más puedo ganar. 20. Aunque tenga poco dinero, prefiero correr el riesgo para ver si gano. 21. Siempre habrá alguien que me ayude cuando las cosas estén yendo realmente mal. 22. Si sólo supiera por qué juego, entonces podría abandonarlo. 23. La clave está en la fuerza de voluntad. 24. A la larga siempre gano. 25. Tengo buena suerte cuando gano y tengo mala suerte cuando pierdo. 26. ¿Y qué? No puedo parar.

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27. A veces pienso que tengo dos personalidades: el jugador y el no jugador. 28. El suicidio solucionaría todos mis problemas de juego. 29. No puedo pagar el tratamiento ni dejar de trabajar para obtener ayuda. 30. Debo ganar todo el dinero que pueda de la forma más rápida posible. 31. Tengo más suerte que la mayoría de las personas. 32. El juego es una buena forma de olvidarme de todos mis problemas. 33. Mis actividades de juego no le hacen mal a nadie.

[adaptado de “In the Shadow of Chance”, libro online de Julian I. Taber, 1998]

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diez reglas para el juego responsable

1.Si elige jugar, hágalo para divertirse. - Si el juego ya no es un actividad que disfruta, pregúntese por qué sigue “jugando”. 2. Considere el dinero que pierde como un costo de la diversión. - Considere lo que gane como una bonificación. 3. Establezca el monto límite que va a jugar y respételo. - Antes de ir, decida no sólo cuánto usted “puede” perder”, sino cuánto quiere gastar. No cambie de parecer cuando pierde. 4. Establezca el límite de tiempo que va a jugar y respételo. - Decida cuánto tiempo le quiere dedicar al juego. Una vez que llega la hora de irse, retírese, sin importar si está ganando o perdiendo 5. Considere perder como una opción. - Existe la posibilidad de perder. Acepte la pérdida como parte del juego. 6. Hágase una regla personal de no jugar a crédito. - No pida prestado dinero para jugar. 7. Tenga equilibrio en su vida. - El juego no debe interferir ni ser un sustituto de sus amigos, familia, trabajo u otras actividades que valen la pena. 8. Evite ―tomar revanchas‖ por el dinero que perdió. - Lo más probable es que cuanto más juegue para recuperar sus pérdidas, más pérdidas tendrá. 9. No juegue para mitigar su dolor emocional o físico. - Jugar por cualquier otra razón que no sea entretenerse puede dar como resultado muchos problemas. 10. Sepa cuáles son los signos de advertencia del juego problemático. - Cuanto más sepa, mejores decisiones tomará Si no puede seguir estas sugerencias, comuníquese con la línea de ayuda para el juego problemático de Oregón: 1-877-695-4648

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Sample public service announcements: Spanish

30 Seconds ¿USTED O UN SER QUERIDO APUESTA MÁS DE LO PLANEADO? ¿SIENTE LA NECESIDAD DE ―VOLVER A GANAR‖ EL DINERO PERDIDO?

PARA ALGUNAS PERSONAS, EL APOSTAR SE HA CONVERTIDO DE UNA ACTIVIDAD DIVERTIDA EN UNA PESADILLA. COMO LA ADICCIÓN DE ALCOHOL Y DROGAS, PARA UN APOSTADOR ADICTO ES DIFICIL CONTENERSE, AÚN CUANDO ESTÉ DESTRUYENDO A SU FAMILIA O A ÉL MISMO.

EL PRIMER PASO PARA AYUDAR A ALGUIEN CON UNA ADICCIÓN AL JUEGO ES RECONOCER QUE UN EXISTE PROBLEMA. TOME EL PRIMER PASO. LLÁME A 1-877- 695-4648. EL TRATAMIENTO ES GRATIS, CONFIDENCIAL, ¡Y SÍ FUNCIONA! 877-695- 4648. ###

From The Oregon Lottery (for 2003 OPGAW) 30 Seconds NO IMPORTA A QUÉ JUEGUE, EL JUEGO ES SOLO ESO, UN JUEGO. SEGÚN COMO LO JUEGUE, SERÁ DIVERTIDO, FRUSTRANTE, O PELIGROSO. ESTO ES ASÍ EN TODOS LOS JUEGOS-INCLUSO AL APOSTAR. EL TRES POR CIENTO DE LOS OREGONIANOS PUEDEN TENER UNA ADICCIÓN A JUGAR POR DINERO. CUANDO JUEGAN, ES MÁS QUE UN JUEGO. ES UNA OBSESIÓN. SI NO PUEDE DEJAR DE JUGAR, DÉJESE DE JUEGOS Y LLAME AL 877-MY_LIMIT. O VISITE EL SITIO OREGON-LOTTERY-HELP.ORG. EL TRATAMIENTO ES GRATIS, CONFIDENCIAL Y EFECTIVO. EL TRATAMIENTO ES GRATIS, CONFIDENCIAL Y EFECTIVO.

###

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South Oaks Gambling Screen: Spanish

1. Indique en cual de las siguientes clases del juego Ud. ha participado durante su vida. Para cada clase del juego, conteste: ―nunca,‖ ―menos de una vez por semana,‖ o ―una vez por semana o más.‖

Nunca Menos de Una vez por una vez por semana o más semana a. ______He jugado a cartas por dinero. b. ______He apostado en las carreras de caballos o de perros, en las peleas de gallos o de otros animales (en el hipódromo, en la pista, o con un corredor de apuestas). c. ______He apostado en los deportes (con quinielas, con un corredor de apuestas, o en jai alai). d. ______He jugado a los de dados por dinero. e. ______He jugado en un casino (legítimo o no). f. ______He jugado a números o a la lotería. g. ______He jugado al bingo por dinero. h. ______He jugado a la bolsa de valores (acciones, opciones de compra). i. ______He jugado a las máquinas (tragaperras, poker, u otras). j. ______He jugado al boliche, al billar, al golf (u otro juego de habilidad) por dinero. k. ______He jugado a ―pull tabs‖ o ―destapaditas‖ de la

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lotería. l. ______He participado en alguna forma de apostar no mencionada (indique cuales son, por favor).

2. ¿Cuál es la mayor cantidad de dinero que Ud. ha apostado en un solo día?

_____ nunca he apostado _____ más de $100 y menos de $1,000 _____ $1 o menos _____ más de $1,000 y menos de $10,000 _____ más de $1 y menos de $10 _____ más de $10,000 _____ más de $10 y menos de $100

3. Indique cuales personas en su vida han tenido (o tienen) un problema con el juego.

_____ padre _____ madre _____ hermano(a) _____ abuelo(a) _____ esposo(a) _____ hijo(s) _____ otro pariente un amigo u otra persona importante en su vida

4. Cuando Ud. juega, ¿cada cuándo vuelven para recuperar el dinero que ha perdido?

_____ nunca _____ algunas veces (menos de la mitad del tiempo) _____ la mayoría del tiempo _____ siempre

5. ¿Alguna vez ha pretendido Ud. haber ganado dinero cuando en realidad perdió?

_____ nunca _____ sí, algunas veces (menos de la mitad de las veces que he perdido) _____ sí, casi siempre

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6. ¿Cree Ud. que ha tenido un problema con el juego?

_____ no _____ en el pasado, sí; ahora, no _____ sí

7. ¿Alguna vez ha jugado Ud. más de lo que quería?

_____ sí _____ no

8. ¿Alguien ha criticado su manera de jugar?

_____ sí _____ no

9. ¿Ha tenido remordimientos debido a su manera de jugar, o por las consecuencias de su juego?

_____ sí _____ no

10. ¿Alguna vez ha querido Ud. dejar de jugar pero no se creía capaz de hacerlo?

_____ sí _____ no

11. ¿ha discutido Ud. con los de su casa sobre su manera de manejar el dinero?

_____ sí _____ no

12. ¿Ha discutido Ud. con la gente en su casa sobre su manera de manejar el dinero?

_____ sí _____ no

13. (Si Ud. ha contestado sí a la pregunta número 12): ¿Estas discusiones han sido a consecuencia del juego?

_____ sí _____ no

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14. ¿Ha pedido Ud. un préstamo a alguien y no lo pudo pagar a causa del juego?

_____ sí _____ no

15. ¿Ha perdido Ud. tiempo de su trabajo (o de la escuela) a causa del juego?

_____ sí _____ no

16. Si Ud. ha pedido dinero prestado para jugar o para pagar las deudas del juego, ¿a quien ha pedido (o de dónde ha sacado) el dinero? (Indique sí o no.) a. de los gastos del hogar ______sí no b. de su esposo/a ______sí no c. de un familiar ______sí no d. del banco, de la caja de ahorros de la compañía, un ______préstamo del ―credit union‖ sí no e. de las tarjetas de crédito ______sí no f. de un usurero ______sí no g. del cobro de acciones, bonos, u otras fianzas ______sí no h. por vender sus posesiones o las de la familia ______sí no i. por escribir cheques sin fondos o firmar cheques falsos ______sí no k. de una línea de crédito con su corredor de apuestas ______sí no

Muchas gracias por completar este cuestionario.

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Guía para calificar el SOGS en español

El resultado se determina al sumar el número de preguntas que muestran una respuesta riesgosa como se indica mas abajo.

Si usted respondió las preguntas anteriores con la siguiente respuesta, marque la línea que está antes de la pregunta:

Preguntas 1-3 no se cuentan ___ Pregunta 4: ―sí‖ (cualquier respuesta) ___ Pregunta 5: ―sí‖ (cualquier respuesta) ___ Pregunta 6: ―sí‖ (cualquier respuesta) ___ Pregunta 7: ―sí‖ ___ Pregunta 8: ―sí‖ ___ Pregunta 9: ―sí‖ ___ Pregunta 10: ―sí‖ ___ Pregunta 11: ―sí‖ Pregunta 12 no se cuenta Total = ______Pregunta 13: ―sí‖ (Se suman las 20 preguntas) ___ Pregunta 14: ―sí‖ **3 o 4 = En peligro de volverse ___ Pregunta 15: ―sí‖ un jugador patológico (jugador ___ Pregunta 16a: ―sí‖ con problemas) ___ Pregunta 16b: ―sí‖ **5 o mas = Posible jugador patológico ___ Pregunta 16c: ―sí‖

___ Pregunta 16d: ―sí‖ ___ Pregunta 16e: ―sí‖ ___ Pregunta 16f: ―sí‖ ___ Pregunta 16g: ―sí‖ ___ Pregunta 16h: ―sí‖ ___ Pregunta 16i: ―sí‖ Preguntas 16j y 16k no se cuentan

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sitios Web en español

www.cop.es/colegiados/M-13641 Juego patológico (ludopatía) en España. Más información y enlaces sobre el juego patológico; artículos (dirigido a los profesionales) de investigaciones sobre el juego patológico. www.lanecounty.org/prevention/gambling/espanol El sitio Web del Condado Lane; las páginas en español están destinadas a proporcionar información confiable y verdadera acerca del juego problemático a la comunidad.

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Policy change

 Charitable and social gaming policy overview 1  Policy change: big impacts 2  How to get started 3  Caution 4  Spotlight: social gaming 5  Information resources for decision makers 9

Charitable and social gaming: policy overview

Charitable gaming ―Charitable gaming regulated by the Oregon Department of Justice consists of bingo, raffle and Monte Carlo events in which the proceeds are used to fund the activities of charitable organizations. It does not include tribal casinos, which are federally regulated with local oversight provided by the Oregon State Police‘s Gaming Enforcement Division.‖ (Oregon Department of Justice)

Social gaming ―A ‗social game‘ is one in which all the money wagered is returned to the players in the form of prizes. The house cannot take a ‗cut‘ or percentage of the money or otherwise profit in any manner from the operation of a game. Social games in businesses, private clubs, or places of public accommodation can be conducted only if there is an enabling ordinance (usually a social gaming ordinance) by the local jurisdiction. Social games that are conducted in private residences are permissible.‖ (Oregon Department of Justice).

Minimum legal ages to gamble in Oregon 18:  Traditional Lottery games  Charitable gaming  Pari-mutuel betting (e.g., race track)

21:  Video Lottery (includes video poker, video slots)  Tribal casinos

No minimum age: Social gaming. Social gaming is allowed by city or county ordinance, and no minimum age is specified in state law. A 2006 review of Oregon social gaming ordinances found that only four jurisdictions had a minimum age.

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Policy change: big impacts

Broad interventions with potentially the greatest community impact, gambling- related policy changes affect the whole environment in which gambling happens.

Why gambling-related policy change matters

One way to prevent gambling problems, among young people and even the population as a whole, is to establish public and institutional policies that reduce overall rates of under-age gambling and promote harm reduction measures. This is commonly referred to as the ―environmental approach‖ – changing the community and policy environment to promote health and reduce social problems associated with problem behaviors. This ―environmental approach‖ has been shown to be very effective with alcohol and tobacco prevention efforts.

Gambling-related policies can affect these community ―risk factors‖ that have been shown to increase the rate of gambling among young people:

 Availability/accessibility: Greater accessibility of gambling is shown to increase youth gambling, money spent on gambling, and numbers of problem gamblers (Dickson, Derevensky, & Gupta, 2002). Availability of gambling can be determined by policies that specify who can gamble, where gambling can occur, and types of gambling that may occur.

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 Advertising: Gambling is heavily advertised and readily available to youth. Youth who recall advertising are more likely to play (Dickson et al., 2002).  Awareness: Parents and family members are not aware of the dangers inherent in children regularly engaging in gambling activities; educators are not aware of the prevalence of children gambling on a regular basis (Dickson et al., 2002). Gambling-related policies can help educate the community on the risks of gambling and acceptable and legal youth behavior.

Partners in prevention: examples of effective alcohol and tobacco policies:  Prohibiting sales of tobacco/alcohol to minors (proven to reduce underage availability/accessibility)  Taxes on tobacco/alcohol (proven to reduce consumption)  Limiting number of alcohol outlets (proven to reduce availability/accessibility)

Gambling-related policies might include, among other changes:  Stipulating age minimums to gamble  Limiting gambling types and stakes  Limiting locations at which to gamble

How to get started

What are your local gambling-related policies?  Schools: Visit our schools section, or your local college/university Web site. See also: gamblingprevention.blogspot.com/2006/10/oregon-school-gambling- policies.html  Workplace: Most employers have a manual that lists prohibited activities. Find out if, and how, gambling is included.  Community: Look at your local jurisdiction‘s ordinances pertaining to gambling. ―Social gaming‖ is a recent hot topic in local communities. See our segment on social gaming policy in the following pages.

Are there issues/problems that seem to be arising from existing policy? Find out from the local paper if there‘s been any news on this issue.

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Is there community support for change? If you have funds, you could do a formal poll or survey. Since most of us don‘t, find out from the local paper if there‘s been any news on this issue.

Do you have allies? Community groups can be very supportive, and have much more influence than one person. If you don‘t have a gambling-related coalition in your community, consider taking this issue to a substance abuse or related prevention coalition.

Do you have help? Policy work is time-consuming. See if there‘s anyone else in your community who is also interested in this issue, to help research, craft language and provide information.

How much can you participate? Public employees have restrictions on what they can and can‘t do (see ―Policy prudence‖ box below). Once a policy is up for consideration, public employees must only be in a position of providing information – not actively campaigning for or against the issue. Keep in mind that members of the community are not subject to these rules.

Reference: Dickson, L.M., Derevensky, J.L., & Gupta, R. (2002). The prevention of gambling problems in youth: A conceptual framework. Journal of Gambling Studies, 18, 97-159.

CAUTION! Public employees: policy prudence Policy work can be risky business for public employees. While they are allowed to provide information about problem gambling any time, active campaigning on pending policies is a no-no. For a good primer on state law, see Restrictions on Political Campaigning by Public Employees, ORS 260.432 (http://www.sos.state.or.us/elections/publications/restrictions.pdf). Be sure to check your local jurisdiction’s guidelines as well.

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Policy spotlight: social gaming

A recent trend and hot topic, social gaming is making waves across local jurisdictions across the state. Find out what the issue is and ways to address social gaming concerns.

What is ―social gaming‖? ―A ‗social game‘ is one in which all the money wagered is returned to the players in the form of prizes. The house cannot take a ‗rake‘ or portion of the money played. Social games in businesses, private clubs, or places of public accommodation can be conducted only if there is an enabling ordinance (usually a social gaming ordinance) by the local jurisdiction. Social games that are conducted in private residences are permissible.‖ (Oregon Department of Justice)

Definition in depth Oregon Revised Statutes cover state social gamin laws www.leg.state.or.us/ors/167.html

Oregon Revised Statutes (ORS) 167.117: ― (7) ‗Gambling‘ means that a person stakes or risks something of value upon the outcome of a contest of chance or a future contingent event not under the control or influence of the person, upon an agreement For more info… or understanding that the person or The full text of these and other someone else will receive something of value in the event of a certain outcome. gambling-related statutes is ‗Gambling‘ does not include…(c) social available at: games… http://www.leg.state.or.us/ors/

―A person who gambles at a social game of chance on equal terms with the other participants therein is a person who does not otherwise render material assistance to the establishment, conduct or operation thereof by performing, without fee or remuneration, acts directed toward the arrangement or facilitation of the game, such as inviting persons to play, permitting the use of premises therefore and supplying cards or other equipment used therein.

―(21) ‗Social game‘ means: (a) A game, other than a lottery, between players in a private home where no 8-5

house player, house bank or house odds exist and there is no house income from the operation of the social game; and (b) If authorized pursuant to ORS 167.121, a game, other than a lottery, between players in a private business, private club or place of public accommodation where no house player, house bank or house odds exist and there is no house income from the operation of the social game.‖

Oregon Revised Statutes (ORS) 167.121: ―Local regulation of social games. Counties and cities may, by ordinance, authorize the playing or conducting of a social game in a private business, private club or in a place of public accommodation. Such ordinances may provide for regulation or licensing of the social games authorized. [1974 c.7 §3]‖

Social gaming laws: concerns and recommendations for local jurisdictions

(The following is a paper that outlines potential community concerns as related to social gaming, and ways to address the issue through policy. You may choose to use the information in this paper to create your own, or simply to extract pieces of it to provide further information on social gaming to your community.)

Primary concern: social gaming may be contributing to the broader issue of problem gambling facing many Oregon citizens, families, and communities.

1. Youth are able to engage in organized gambling in social gaming establishments, because there is no legal age minimum in the state of Oregon.

ORS 167.117 defines social games. Regulation, per ORS 167.121 (www.leg.state.or.us/ors/167.html), is conducted on a local level per city/county ordinance. Many local jurisdictions do not stipulate age minimums. a. Several cases of youth as young as middle school age have been reported gambling in local premises offering social gaming. b. Research shows that the earlier in life people begin to gamble, the more at risk those people are for developing gambling problems later in life. c. One in 25 Oregon teens meet the criteria for being problem gamblers (Carlson & Moore, 1998).

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d. Some consequences of problem gambling among youth include, but are not limited to: . School problems and/or dropping out; . Use of alcohol and/or drugs; . Depression and later suicide; . Debt; . Family and social problems.

2. There are few resources to enforce social gambling laws.

Per ORS 167.127, unlawful gambling is a class C felony. However, unless specifically reported (and often even if reported), this law is not consistently enforced. According to an article in The Register-Guard (Eugene) of Sept. 8, 2006, local law enforcement officials note that, ―when blackjack was the game of choice…a brief ordinance was all the regulation that was needed…but Texas Hold ‘em has soared in popularity over the past few years. … with regular dealers, wide- ranging betting limits, pot ―rakes,‖ tournament fees and other variables, the old blackjack-inspired rules have become inadequate to keep the action in line….the current gambling scene is difficult to regulate, at best.‖

3. The current social gambling ordinances do not require operators to conduct harm-mitigation efforts (e.g., help line information, training for dealers and other employees to intervene with their customers who are suspected of being problem gamblers). a. In Oregon, 2.7 percent of adults are problem gamblers (Moore, 2006). b. Surveys of problem gamblers in Oregon treatment programs in 2008-9 showed (Moore, 2009):  Clients‘ average reported gambling debt was $32,000; 102 clients reported gambling debts in excess of $100,000.  34 percent had alcohol-related problems and 15 percent reported problems with substance use.  Approximately 38 percent of clients reported committing illegal acts to obtain gambling money.

 Approximately 48 percent had suicidal thoughts and more than 9 percent had attempted suicide within the past six months.

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Potential mitigations: increased regulations and enforcement to protect citizens from unhealthy and/or illegal social gaming.

1. It is the position of ______that social gaming ordinances should include an age minimum to participate. The minimum age should be 21 years to: a. coincide with most casinos and Lottery line game age minimums, and, b. be consistent with Oregon Liquor Control Commission licensed establishments, thereby more feasibly enforceable.

2. It is the position of ______that laws governing social gaming should be enforced with consistency in order to protect consumers, employees, and the community from the harm caused by problem gambling. a. Premises desiring social games should be required to obtain a social gaming license from their local governing jurisdictions. These licenses should require renewal on a minimum of annual basis, provided social gaming premises are in compliance with gaming and OLCC (if applicable) laws. b. Social gaming premises should post at a minimum ORS 167.117(7c),(16),(21),(22), ORS 167.121, and the local jurisdiction‘s social gaming ordinance/code in a conspicuous place to ensure knowledge of the law among customers and purveyors.

3. It is the position of ______that responsible gambling information and problem gambling resources may be provided free upon request to local social gaming premises. a. Oregon Lottery retailers are required to post problem gambling help line information, and social gaming purveyors could benefit from providing this information as well. Materials are available free of charge from the ______Program, or Oregon Problem Gambling Services. b. Any ordinance adopted should allow for (not necessarily require) card dealers and management to reserve the right to cut off play to any person who appears to be exhibiting signs of a gambling problem. The rationale for this allowance is law surrounding liquor provision: establishments that furnish liquor are required to not ―sell, give or otherwise make available any alcoholic liquor to any person who is visibly intoxicated‖ (ORS 471.410(1)).

Further information is available by contacting:

(fill in your contact information here)

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Information resources for decision makers

The following are organizations that may be of interest to decision makers, policy makers, legislators:

Oregon system information and data (see also Section One of this manual): State of Oregon DHS Problem Gambling Services www.oregon.gov/DHS/addiction/gambling.shtml

Oregon Council on Problem Gambling www.gamblingaddiction.org/

Oregon Lottery www.oregonlottery.org/

Oregon Casinos www.oregon.com/casinos/index.cfm

Oregon Problem Gambling Helpline www.1877mylimit.org/

Policy-related national organizations Association of Problem Gambling Service Administrators (APGSA) www.apgsa.org/State/index.aspx

The APGSA is made up of administrators from states with publicly funded problem-gambling prevention and treatment systems. The APGSA Web site provides an overview of publicly funded programs in the United States, including a member states map and a quick reference table with information on each member‘s program structure.

National Council on Problem Gambling www.ncpgambling.org

The National Council on Problem Gambling‘s mission is to increase public awareness of pathological gambling, ensure the widespread availability of treatment for problem gamblers and their families, and to encourage research and

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programs for prevention and education. NCPG‘s Web site includes member information, awareness materials, a directory of certified problem gambling counselors and links to state affiliates.

National Council of Legislators From Gaming States www.nclgs.org/

The National Council of Legislators from Gaming States (NCLGS) is an organization of state lawmakers that meets on a regular basis to discuss gaming issues. NCLGS members chair or are members of legislative committees that regulate gaming in their states. NCLGS does not promote or oppose gaming but is primarily concerned with regulation of the industry. The Web site includes information on various committees and their activities, research information, links.

North American Association of State and Provincial Lotteries www.naspl.org The association represents 51 lottery organizations. Its mission is to disseminate information about state and provincial lottery organizations through education and communications and to advocate its members‘ positions on general policy. The Web site includes links to state members, information and resources, reports.

American Gaming Association www.americangaming.org/

The American Gaming Association represents the casino entertainment industry. It provides information about industry to the public, regulators, elected officials and the media. The organization sponsors a public information campaign, addresses legislative and public policy issues relevant to casino gaming, and works to serve as a clearinghouse for casino industry information.

National regulatory agencies Association of Racing Commissioners International, Inc. www.arci.com/

The Association of Racing Commissioners International, Inc., is a non-profit corporation founded in the 1930s to uphold uniform pari-mutuel racing rules and practices. The ARCI serves as a resource for pari-mutuel rulings, including equine

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medication issues. The ARCI works to preserve the integrity of horse racing, jai- alai, and dog racing.

North American Gaming Regulators Association www.nagra.org/

NAGRA was created in 1984. Members are federal, state, local, tribal and provincial government gaming regulators.

National Indian Gaming Commission www.nigc.gov/

The National Indian Gaming Commission is an independent federal regulatory agency charged with the regulation of gaming on Native American land, specifically to protect tribes from corrupt influences, including organized crime; also to make sure tribes receive the benefits of Indian gaming and to ensure that fair playing practices protect tribes and players. The NIGC maintains a list of gaming tribes on its Web site.

National policy-related information:

Pew Research public opinion (2006) pewresearch.org/pubs/314/gambling-as-the-take-rises-so-does-public-concern

Institute for the Study of Gambling and Commercial Gaming www.unr.edu/gaming

Located at the University of Nevada, Reno, the institute was created in 1989 as the first academic research center dedicated to promoting the examination of gambling and commercial gaming, the impact of gambling on society, and how related issues might be addressed.

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Recovery

 Real Addiction, Real Recovery 1  What is recovery? 2  Recovery resources 3  Tips for clinicians on referring clients to GA 6  Oregon’s Voices of Problem Gambling Recovery 8

Real Addiction, Real Recovery

This is the National Council on Problem Gambling‘s theme for 2010 Problem Gambling Awareness Week; go to http://www.npgaw.org/ to see their information and materials.

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Recovery from gambling problems

There are many ways to recover from a gambling problem. They include informal approaches and formal interventions such as Gamblers Anonymous and Gam- Anon meetings to group therapy meetings, one-on-one and family counseling, treatment programs, self-help books, Internet support groups, and more.

Because every person is different, deciding which recovery process and method will work best comes down to an individual assessment. Variations in motivation, desired goals, personal beliefs, financial situations, stress levels, family situation, self-esteem and confidence levels, shame and guilt levels, and employment all have an impact on an individual‘s recovery process.

What is recovery?

Recovery is the gradual process of re-establishing control over one‘s life. It involves confronting the problems that have resulted from unhealthy gambling behavior and learning strategies to successfully manage life. Recovery is often a difficult, complex and painful process. But problem gamblers in recovery know it is worth it. Recovery saves lives.

Some problem gamblers stop on their own

Recent studies and clinical experience have shown that some problem gamblers can and do stop gambling on their own. Others reduce their gambling to non- problem levels. This is called ―natural recovery.‖ The problem is that, at present, we cannot predict who will naturally recover and who needs professional help.

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Many problem gamblers cannot stop on their own

There are different forms of help available. Some problem gamblers prefer working with a professional counselor. Others respond more favorably to structured peer-support approaches such as those advocated by Gamblers Anonymous (GA). Yet others seek and receive effective help from other sources including their families, friends, doctors or clergy

Recovery resources

1. Treatment programs: Part of the process of treatment should be planning for recovery and relapse prevention.

. For a list of Gambling Treatment Providers throughout Oregon visit: 1877mylimit.org

2. Twelve-step recovery support: Gambler‘s Anonymous is a 12-step organization for problem gamblers, operating on principles similar to AA and other such organizations. Gam-Anon is the organization for the family members of problem gamblers. GA and Gam-Anon meetings are not as widespread as other 12-step programs, so interested persons should call the Problem Gambling Helpline to verify meeting status; the Helpline makes efforts to maintain up-to-date information on current meetings and can be reached at 877-MYLIMIT or 1877mylimit.org.

. For a list of Gamblers Anonymous meeting in Oregon visit: www.gamblersanonymous.org/mtgdirOR.html

. For a list of Gam-Anon meetings in Oregon visit: www.gam-anon.org/meeting.asp

―Tips for Clinicians: Referring A Client to GA‖ is included at the end of this section.

3. Online and Web-based recovery There are a variety of online and Web-based resources for problem gamblers who prefer this approach; this list is not an endorsement of any of these sites but is provided as a convenient reference:

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www.wanttostopgambling.com/ A site created by a recovering problem gambler that includes a self-help guide and many other links and resources (www.wanttostopgambling.com/info2.cfm?info_id=21947)

Getting Past Gambling www.gettingpastgambling.com/ A place to come and share experiences, to find support and strength, for those of us who are putting gambling behind us and finding new exciting and happier ways to live our lives.

Recovery Places www.recoveryplaces.com/ This web site is intended to be a safe place to connect with others who are seeking to overcome or recover from all sorts of addictive behaviors.

Safe Harbor Compulsive Gambling Hub www.sfcghub.com/cgsf1.html Compulsive Gambler Room

I Stopped Gambling www.istoppedgambling.com/ As an I Stopped Gambling member you will have access to a 24/7 online stop gambling chat room and message board. Helpful stop gambling tips and useful stop gambling addiction resources will also be available.

Gam Care www.gamcare.org.uk/forum/index.php?tid=2272 Gam Care has now successfully launched a chat/support room for Forum members to talk ―‗live‖‗ with others. This forum gives you the opportunity to ask questions, share advice and support with other people working to overcome their own or somebody else‘s gambling problem.

Chat rooms with others, no professional intervention

12 Step Space www.12stepspace.com/ A community networking site catering to the needs of people interested in recovery.

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The 12-Step Café Chat Room www.12steps.org/chatroom.htm

Compulsive Gambling Recovery health.groups.yahoo.com/group/compulsivegamblingrecovery/

Gambler Outreach health.groups.yahoo.com/group/GamblerOutreach/

The Last Bet health.groups.yahoo.com/group/thelastbet/

Sources: Nova Scotia Office of Health Promotion, Problem Gambling guide available at www.problemgamblingguide.com/

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Tips for clinicians on making referrals to Gamblers Anonymous

Problem gamblers often say they are not comfortable sharing in a group setting. What they are feeling is an intense level of fear associated with the thought of sharing their gambling experiences with a group of strangers, since many have not spoken honestly about their gambling behavior for years.

If you want to most effectively use GA as a referral source, take the time to attend a meeting and observe how they are run. Call the contact person in the area and ask if you can attend a meeting. Explain why you want to attend. Don‘t just show up. Be aware that some groups may view the clinician‘s attendance as an effort to recruit clients so be sure not to have that as a motive, nor convey any messages along those lines, if you attend a meeting.

Here are some helpful tips in helping a client reduce the level of fear associated with attending their [sic] first Gamblers Anonymous meeting.

 Make sure your client understands you are not abandoning him or her. You can do this by continuing to see him or her on an individual basis to monitor the effectiveness, positive or negative, that GA is having on his or her recovery.  Sometimes gamblers will say, ―What if I see someone I know at the meeting?‖ It is important for the client to know that everyone at the meeting is there for the same reason and that members of GA have empathy for one another based on personal experience. There is an agreement to hold confidential all information from a GA meeting. All new members are welcomed unconditionally.  Clients need to know that no one in GA is going to tell them what to do. More important, if they choose not to speak at a meeting, that is their right. The only requirement for GA membership is a desire to stop gambling.  Tell your client that all new members will receive a phone list of all active GA members in their area. This can be a welcome support tool.  New members of GA need to feel safe. You can inform your client that personal anonymity and confidentiality are crucial to the unity of each group and GA holds this principle in the highest regard.  The buddy system can also be helpful in someone getting to her or his first meeting. Introducing your client to a GA member prior to a first meeting can be comforting for the new member. 9-6

Cautioning your client in a couple of areas can also be helpful:

 Too often a new member of GA sees a gambling problem in terms of how much money is lost gambling. An individual may think or say, ―I didn‘t lose as much as everyone else,‖ therefore I can‘t have a problem. It is important for clients to know that the severity of a gambling problem is measured not by how much money is lost, but by the degree of negative impact that gambling is having on his or her life.

 Members may find the apparent emphasis on spirituality or religion disconcerting. However, spiritual or religious orientation should not be a concern for GA or Gam-Anon membership. It might be helpful to suggest that there are alternative ways of interpreting the idea of a ―Power greater than oneself.‖ For example, if the problem gambler was unable to stop gambling before GA and has now been able to abstain through regular meetings, he or she may view his or her GA group as a ―Power greater than themselves.‖ Likewise, a Gam-Anon member may be an atheist yet find that a sponsor or group was helpful in overcoming problems. If positive change is occurring, the initial goal of GA is to experience and acknowledge that a power greater than oneself is at work in some form.

 Inform the client that although members of GA are brought together through a common problem, each person is in a unique situation and at different levels of recovery. Newer members may speak more about the negative impact that their gambling experiences had on them while longer-standing members focus their dialog on everyday living problems and how they are learning new coping strategies. New members do not have to agree with everything they hear in order to grow in the program.

 It is also common for newer members to experience a change in their belief systems. Members have often said, ―Six months ago I honestly answered yes to 15 of the 20 questions. Today I can honestly answer yes to 19.‖ Their beliefs or perceptions of their behavior can continue to change.

 Counselors should discuss and contract a time frame appropriate enough for the client to evaluate whether this group is beneficial. Too often clients will return to their counselor after their first GA meeting and say, ―This is not for me.‖ They may be right, but one or two meetings are not enough to make that evaluation. Eight weeks of regular attendance (at least once per week) should be sufficient for a client to determine if GA is helpful or not.

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Voices of problem gambling recovery An affiliate of the Oregon Council on Problem Gambling

Problem gamblers and their families need a voice in Oregon. This is why the Oregon Council on Problem Gambling organized a ready group of people to provide first-hand witness of the effects of problem gambling and serve as advocates for community action. Meetings consist of sharing ideas, creating initiatives, and educating members about topics such as the legislative process and effective communication. Members have a place where they can go to give back to their community, positively harness their energy, and promote recovery.

The group‘s objectives are:

 To educate others about gambling and problem gambling  To promote recovery  To advocate on behalf of problem gamblers and their families  To increase community awareness of problem gambling

The group has only been in existence since September 2008 and has proved to be an effective advocate for problem gamblers. To increase the organization‘s impact, more members are needed.

Meetings are held every other Monday, 6 to 8 p.m., at the ACCBO Office Building, 2054 N Vancouver, Portland.

For more information: Website: http://vpgr.net/

Email: [email protected]

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A. County Problem Gambling Prevention Data Source: Oregon Healthy Teens Survey 2008/9

B. County Problem Gambling Treatment Data Source: Herbert and Louis: [email protected]

C. Problem Gambling on the Web

Appendix A. County Problem Gambling Prevention Data

Overall youth gambling participation by County in rank order

County-specific Oregon Healthy Teens data, by county in alphabetical order

Overall youth gambling participation in rank order by County

Source: 2008-9 Oregon Healthy Teens Survey question “During the past 12 months, how often have you: Played cards for money? Gambled at a casino? Bought lottery tickets or scratch offs? Bet money Lake 51.2 on games of personal skill like pool, golf or bowling? Bet Gilliam 43.8 money on sports teams?”

Sherman 43.8 Wheeler 43.8 Crook 42.8 Polk 37.2 Klamath 36.8 Morrow 36.6 Oregon Malheur 36.3 statewide Curry 35.2 Jefferson 35.1 average 32.3** Douglas 34.8 Tillamook 34.4 Columbia 34.3 **Note: the past year rate of Deschutes 33.3 gambling participation in this study is Grant 33.3 Clackamas 33.2 lower than the statewide average of Hood River 32.6 46% that was reported by Oregon Multnomah 31.8 youth in a 2008 study done by the Union 31.3 national expert on problem gambling Marion 31.0 prevalence:http://lanecounty.org/prev Baker 30.9 ention/pgs/Data/OR-Adolescent- Lincoln 30.2 Report%20_final_2008.pdf Washington 30.2

Umatilla 29.6 Linn 29.3 The discrepancy is probably due to Lane 29.2 differences in how the questions were Yamhill 29.2 worded. Jackson 28.5 Coos 27.0 Benton 26.8 Harney 26.1 Clatsop 25.7 Wasco 25.7 Josephine No data avail. Wallowa No data avail.

Baker County Problem Gambling Prevention 08-09

Youth who gamble are much more likely to be involved in other risky behaviors.

Gambling is not a harmless alternative activity for youth.

Gambling should be included in discussions of healthy choices and risky behaviors.

Stattewide Oregon Healthy Teens survey data shows a significant correlation between youth gambling and engaging in other risk behaviors such as drinking, for example:

Benton County Problem Gambling Prevention 08-09

Youth who gamble are much more likely to be involved in other risky behaviors.

Gambling is not a harmless alternative activity for youth.

Gambling should be included in discussions of healthy choices and risky behaviors at school, in the community and at home.

Statewide Oregon Healthy Teens survey data shows a significant correlation between youth gambling and engaging in other risk behaviors such as drinking, for example:

Clackamas County Problem Gambling Prevention 08-09

Youth who gamble are much more likely to be involved in other risky behaviors.

Gambling is not a harmless alternative activity for youth.

Gambling should be included in discussions of healthy choices and risky behaviors at school, in the community and at home.

Statewide Oregon Healthy Teens survey data shows a significant correlation between youth gambling and engaging in other risk behaviors such as drinking, for example:

Clatsop County Problem Gambling Prevention 08-09

Youth who gamble are much more likely to be involved in other risky behaviors.

Gambling is not a harmless alternative activity for youth.

Gambling should be included in discussions of healthy choices and risky behaviors at school, in the community and at home.

Statewide Oregon Healthy Teens survey data shows a significant correlation between youth gambling and engaging in other risk behaviors such as drinking, for example:

Columbia County Problem Gambling Prevention 08-09

Youth who gamble are much more likely to be involved in other risky behaviors.

Gambling is not a harmless alternative activity for youth.

Gambling should be included in discussions of healthy choices and risky behaviors at school, in the community and at home.

Statewide Oregon Healthy Teens survey data shows a significant correlation between youth gambling and engaging in other risk behaviors such as drinking, for example:

Coos County Problem Gambling Prevention 08-09

Youth who gamble are much more likely to be involved in other risky behaviors.

Gambling is not a harmless alternative activity for youth.

Gambling should be included in discussions of healthy choices and risky behaviors at school, in the community and at home.

Statewide Oregon Healthy Teens survey data shows a significant correlation between youth gambling and engaging in other risk behaviors such as drinking, for example:

Crook County Problem Gambling Prevention 08-09

Youth who gamble are much more likely to be involved in other risky behaviors.

Gambling is not a harmless alternative activity for youth.

Gambling should be included in discussions of healthy choices and risky behaviors at school, in the community and at home.

Statewide Oregon Healthy Teens survey data shows a significant correlation between youth gambling and engaging in other risk behaviors such as drinking, for example:

Curry County Problem Gambling Prevention 08-09

Youth who gamble are much more likely to be involved in other risky behaviors.

Gambling is not a harmless alternative activity for youth.

Gambling should be included in discussions of healthy choices and risky behaviors at school, in the community and at home.

Statewide Oregon Healthy Teens survey data shows a significant correlation between youth gambling and engaging in other risk behaviors such as drinking, for example:

Deschutes County Problem Gambling Prevention 08-09

Youth who gamble are much more likely to be involved in other risky behaviors.

Gambling is not a harmless alternative activity for youth.

Gambling should be included in discussions of healthy choices and risky behaviors at school, in the community and at home.

Statewide Oregon Healthy Teens survey data shows a significant correlation between youth gambling and engaging in other risk behaviors such as drinking, for example:

Douglas County Problem Gambling Prevention 08-09

Youth who gamble are much more likely to be involved in other risky behaviors.

Gambling is not a harmless alternative activity for youth.

Gambling should be included in discussions of healthy choices and risky behaviors at school, in the community and at home.

Statewide Oregon Healthy Teens survey data shows a significant correlation between youth gambling and engaging in other risk behaviors such as drinking, for example:

Gilliam County Problem Gambling Prevention 08-09

Youth who gamble are much more likely to be involved in other risky behaviors.

Gambling is not a harmless alternative activity for youth.

Gambling should be included in discussions of healthy choices and risky behaviors at school, in the community and at home.

Statewide Oregon Healthy Teens survey data shows a significant correlation between youth gambling and engaging in other risk behaviors such as drinking, for example:

Grant County Problem Gambling Prevention 08-09

Youth who gamble are much more likely to be involved in other risky behaviors.

Gambling is not a harmless alternative activity for youth.

Gambling should be included in discussions of healthy choices and risky behaviors at school, in the community and at home.

Statewide Oregon Healthy Teens survey data shows a significant correlation between youth gambling and engaging in other risk behaviors such as drinking, for example:

Harney County Problem Gambling Prevention 08-09

Youth who gamble are much more likely to be involved in other risky behaviors.

Gambling is not a harmless alternative activity for youth.

Gambling should be included in discussions of healthy choices and risky behaviors at school, in the community and at home.

Statewide Oregon Healthy Teens survey data shows a significant correlation between youth gambling and engaging in other risk behaviors such as drinking, for example:

Hood River County Problem Gambling Prevention 08-09

Youth who gamble are much more likely to be involved in other risky behaviors.

Gambling is not a harmless alternative activity for youth.

Gambling should be included in discussions of healthy choices and risky behaviors at school, in the community and at home.

Statewide Oregon Healthy Teens survey data shows a significant correlation between youth gambling and engaging in other risk behaviors such as drinking, for example:

Jackson County Problem Gambling Prevention 08-09

Youth who gamble are much more likely to be involved in other risky behaviors.

Gambling is not a harmless alternative activity for youth.

Gambling should be included in discussions of healthy choices and risky behaviors at school, in the community and at home.

Statewide Oregon Healthy Teens survey data shows a significant correlation between youth gambling and engaging in other risk behaviors such as drinking, for example:

Jefferson County Problem Gambling Prevention 08-09

Youth who gamble are much more likely to be involved in other risky behaviors.

Gambling is not a harmless alternative activity for youth.

Gambling should be included in discussions of healthy choices and risky behaviors at school, in the community and at home.

Statewide Oregon Healthy Teens survey data shows a significant correlation between youth gambling and engaging in other risk behaviors such as drinking, for example:

Josephine County Problem Gambling Prevention 08-09

Youth who gamble are much more likely to be involved in other risky behaviors.

Gambling is not a harmless alternative activity for youth.

Gambling should be included in discussions of healthy choices and risky behaviors at school, in the community and at home.

Statewide Oregon Healthy Teens survey data shows a significant correlation between youth gambling and engaging in other risk behaviors such as drinking, for example:

Klamath County Problem Gambling Prevention 08-09

Youth who gamble are much more likely to be involved in other risky behaviors.

Gambling is not a harmless alternative activity for youth.

Gambling should be included in discussions of healthy choices and risky behaviors at school, in the community and at home.

Statewide Oregon Healthy Teens survey data shows a significant correlation between youth gambling and engaging in other risk behaviors such as drinking, for example:

Lake County Problem Gambling Prevention 08-09

Youth who gamble are much more likely to be involved in other risky behaviors.

Gambling is not a harmless alternative activity for youth.

Gambling should be included in discussions of healthy choices and risky behaviors at school, in the community and at home.

Statewide Oregon Healthy Teens survey data shows a significant correlation between youth gambling and engaging in other risk behaviors such as drinking, for example:

Lane County Problem Gambling Prevention 08-09

Youth who gamble are much more likely to be involved in other risky behaviors.

Gambling is not a harmless alternative activity for youth.

Gambling should be included in discussions of healthy choices and risky behaviors at school, in the community and at home.

Statewide Oregon Healthy Teens survey data shows a significant correlation between youth gambling and engaging in other risk behaviors such as drinking, for example:

Lincoln County Problem Gambling Prevention 08-09

Youth who gamble are much more likely to be involved in other risky behaviors.

Gambling is not a harmless alternative activity for youth.

Gambling should be included in discussions of healthy choices and risky behaviors at school, in the community and at home.

Statewide Oregon Healthy Teens survey data shows a significant correlation between youth gambling and engaging in other risk behaviors such as drinking, for example:

Linn County Problem Gambling Prevention 08-09

Youth who gamble are much more likely to be involved in other risky behaviors.

Gambling is not a harmless alternative activity for youth.

Gambling should be included in discussions of healthy choices and risky behaviors at school, in the community and at home.

Statewide Oregon Healthy Teens survey data shows a significant correlation between youth gambling and engaging in other risk behaviors such as drinking, for example:

Malheur County Problem Gambling Prevention 08-09

Youth who gamble are much more likely to be involved in other risky behaviors.

Gambling is not a harmless alternative activity for youth.

Gambling should be included in discussions of healthy choices and risky behaviors at school, in the community and at home.

Statewide Oregon Healthy Teens survey data shows a significant correlation between youth gambling and engaging in other risk behaviors such as drinking, for example:

Marion County Problem Gambling Prevention 08-09

Youth who gamble are much more likely to be involved in other risky behaviors.

Gambling is not a harmless alternative activity for youth.

Gambling should be included in discussions of healthy choices and risky behaviors at school, in the community and at home.

Statewide Oregon Healthy Teens survey data shows a significant correlation between youth gambling and engaging in other risk behaviors such as drinking, for example:

Morrow County Problem Gambling Prevention 08-09

Youth who gamble are much more likely to be involved in other risky behaviors.

Gambling is not a harmless alternative activity for youth.

Gambling should be included in discussions of healthy choices and risky behaviors at school, in the community and at home.

Statewide Oregon Healthy Teens survey data shows a significant correlation between youth gambling and engaging in other risk behaviors such as drinking, for example:

Multnomah County Problem Gambling Prevention 08-09

Youth who gamble are much more likely to be involved in other risky behaviors.

Gambling is not a harmless alternative activity for youth.

Gambling should be included in discussions of healthy choices and risky behaviors at school, in the community and at home.

Statewide Oregon Healthy Teens survey data shows a significant correlation between youth gambling and engaging in other risk behaviors such as drinking, for example:

Polk County Problem Gambling Prevention 08-09

Youth who gamble are much more likely to be involved in other risky behaviors.

Gambling is not a harmless alternative activity for youth.

Gambling should be included in discussions of healthy choices and risky behaviors at school, in the community and at home.

Statewide Oregon Healthy Teens survey data shows a significant correlation between youth gambling and engaging in other risk behaviors such as drinking, for example:

Sherman County Problem Gambling Prevention 08-09

Youth who gamble are much more likely to be involved in other risky behaviors.

Gambling is not a harmless alternative activity for youth.

Gambling should be included in discussions of healthy choices and risky behaviors at school, in the community and at home.

Statewide Oregon Healthy Teens survey data shows a significant correlation between youth gambling and engaging in other risk behaviors such as drinking, for example:

Tillamook County Problem Gambling Prevention 08-09

Youth who gamble are much more likely to be involved in other risky behaviors.

Gambling is not a harmless alternative activity for youth.

Gambling should be included in discussions of healthy choices and risky behaviors at school, in the community and at home.

Statewide Oregon Healthy Teens survey data shows a significant correlation between youth gambling and engaging in other risk behaviors such as drinking, for example:

Umatilla County Problem Gambling Prevention 08-09

Youth who gamble are much more likely to be involved in other risky behaviors.

Gambling is not a harmless alternative activity for youth.

Gambling should be included in discussions of healthy choices and risky behaviors at school, in the community and at home.

Statewide Oregon Healthy Teens survey data shows a significant correlation between youth gambling and engaging in other risk behaviors such as drinking, for example:

Union County Problem Gambling Prevention 08-09

Youth who gamble are much more likely to be involved in other risky behaviors.

Gambling is not a harmless alternative activity for youth.

Gambling should be included in discussions of healthy choices and risky behaviors at school, in the community and at home.

Statewide Oregon Healthy Teens survey data shows a significant correlation between youth gambling and engaging in other risk behaviors such as drinking, for example:

Wallowa County Problem Gambling Prevention 08-09

Youth who gamble are much more likely to be involved in other risky behaviors.

Gambling is not a harmless alternative activity for youth.

Gambling should be included in discussions of healthy choices and risky behaviors at school, in the community and at home.

Statewide Oregon Healthy Teens survey data shows a significant correlation between youth gambling and engaging in other risk behaviors such as drinking, for example:

Wasco County Problem Gambling Prevention 08-09

Youth who gamble are much more likely to be involved in other risky behaviors.

Gambling is not a harmless alternative activity for youth.

Gambling should be included in discussions of healthy choices and risky behaviors at school, in the community and at home.

Statewide Oregon Healthy Teens survey data shows a significant correlation between youth gambling and engaging in other risk behaviors such as drinking, for example:

Washington County Problem Gambling Prevention 08-09

Youth who gamble are much more likely to be involved in other risky behaviors.

Gambling is not a harmless alternative activity for youth.

Gambling should be included in discussions of healthy choices and risky behaviors at school, in the community and at home.

Statewide Oregon Healthy Teens survey data shows a significant correlation between youth gambling and engaging in other risk behaviors such as drinking, for example:

Wheeler County Problem Gambling Prevention 08-09

Youth who gamble are much more likely to be involved in other risky behaviors.

Gambling is not a harmless alternative activity for youth.

Gambling should be included in discussions of healthy choices and risky behaviors at school, in the community and at home.

Statewide Oregon Healthy Teens survey data shows a significant correlation between youth gambling and engaging in other risk behaviors such as drinking, for example:

Yamhill County Problem Gambling Prevention 08-09

Youth who gamble are much more likely to be involved in other risky behaviors.

Gambling is not a harmless alternative activity for youth.

Gambling should be included in discussions of healthy choices and risky behaviors at school, in the community and at home.

Statewide Oregon Healthy Teens survey data shows a significant correlation between youth gambling and engaging in other risk behaviors such as drinking, for example:

Appendix B.

County Problem Gambling Treatment Data 08-09

Baker County 7/08 - 6/09

Estimated adult population:1 12,192 Number of gamblers enrolled in treatment: 7 Average age of gamblers seeking treatment: 51.0 Gender of gamblers seeking treatment: Female 85.7% Male 14.3% Ethnicity of gamblers seeking treatment: White 100.0%

Primary gambling activity:2 Video Poker 100%

Source of referral to the treatment program: Previous program client 42.9% Other 14.3% Number of family members enrolled in treatment: 0

1 Population data provided by AMH – 18 years and above 2 Game of choice of gamblers enrolled in treatment during the year.

Benton County 7/08 - 6/09

Estimated adult population:1 62,344 Number of gamblers enrolled in treatment: 14 Average age of gamblers seeking treatment: 51.0 Gender of gamblers seeking treatment: Male 71.4% Female 28.6% Ethnicity of gamblers seeking treatment: White 100%

Primary gambling activity:2 Video Poker 64.3% Slots 28.6% Horses/dogs/animals 7.1% Source of referral to the treatment program: Gambling Helpline 35.7% Previous client 14.3% Number of family members enrolled in treatment: 2

1 Population data provided by AMH – 18 years and above 2 Game of choice of gamblers enrolled in treatment during the year.

Clackamas County 7/08 - 6/09

Estimated adult population: 1 288,069 Number of gamblers enrolled in treatment: 136 Average age of gamblers seeking treatment: 46.9 Gender of gamblers seeking treatment: Male 47.1% Female 52.9% Ethnicity of gamblers seeking treatment: White 87.5% Asian 5.9% Primary gambling activity: 2 Video Poker 59.6% Slots 27.9% Cards 7.4% Source of referral to the treatment program: Gambling Helpline 30.1% Family/Friend 10.3% Number of family members enrolled in treatment: 43

1 Population data provided by AMH – 18 years and above 1 Game of choice of gamblers enrolled in treatment during the year.

Clatsop County 7/08 - 6/09

Estimated adult population:1 28,607 Number of gamblers enrolled in treatment: 7 Average age of gamblers seeking treatment: 37.7 Gender of gamblers seeking treatment: Female 57.1% Male 42.9% Ethnicity of gamblers seeking treatment: White 100.0%

Primary gambling activity:2 Video Poker 100% Source of referral to the treatment program: Gambling Helpline 71.4% Previous client 14.3% Number of family members enrolled in treatment: 1

1 Population data provided by AMH – 18 years and above 2 Game of choice of gamblers enrolled in treatment during the year.

Columbia County 7/08 - 6/09

Estimated adult population:1 37,513 Number of gamblers enrolled in treatment: 23 Average age of gamblers seeking treatment: 40.3 Gender of gamblers seeking treatment: Female 60.9% Male 39.1% Ethnicity of gamblers seeking treatment: White 95.7% Hispanic 4.3%

Primary gambling activity:2 Video Poker 60.9% Slots 21.7% Source of referral to the treatment program: Previous client 34.8% Gambling Helpline 26.1% Number of family members enrolled in treatment: 4

1 Population data provided by AMH – 18 years and above 2 Game of choice of gamblers enrolled in treatment during the year.

Coos County 7/08 - 6/09

Estimated adult population:1 48,621 Number of gamblers enrolled in treatment: 26 Average age of gamblers seeking treatment: 49.4 Gender of gamblers seeking treatment: Female 57.7% Male 42.3% Ethnicity of gamblers seeking treatment: White 96.2% Hispanic 3.8%

Primary gambling activity:2 Slots 69.2% Video Poker 23.1% Cards 3.8% Source of referral to the treatment program: Gambling Helpline 26.9% Previous client 15.4% Number of family members enrolled in treatment: 3

1 Population data provided by AMH – 18 years and above 2 Game of choice of gamblers enrolled in treatment during the year.

Crook County 7/08 - 6/09

Estimated adult population:1 17,538 Number of gamblers enrolled in treatment: 3 Average age of gamblers seeking treatment: 55.3 Gender of gamblers seeking treatment: Male 33.3% Female 66.7% Ethnicity of gamblers seeking treatment: White 100%

Primary gambling activity:2 Slots 66.7% Video Poker 33.3% Source of referral to the treatment program: Community service provider 33.3% Other MH service provider 33.3% Number of family members enrolled in treatment: 1

1 Population data provided by AMH – 18 years and above 2 Game of choice of gamblers enrolled in treatment during the year.

Curry County 7/08 - 6/09

Estimated adult population:1 16,665 Number of gamblers enrolled in treatment: 9 Average age of gamblers seeking treatment: 47.4 Gender of gamblers seeking treatment: Male 22.2% Female 77.8% Ethnicity of gamblers seeking treatment: White 77.8% Alaska Native 22.2%

Primary gambling activity:2 Slots 55.6% Video Poker 11.1% Cards 11.1% Source of referral to the treatment program: Gamblers Anonymous 33.3% Previous client 22.2% Number of family members enrolled in treatment: 0

1 Population data provided by AMH – 18 years and above 2 Game of choice of gamblers enrolled in treatment during the year.

Deschutes County 7/08 - 6/09

Estimated adult population:1 117,928 Number of gamblers enrolled in treatment: 41 Average age of gamblers seeking treatment: 46.8 Gender of gamblers seeking treatment: Male 41.5% Female 58.5% Ethnicity of gamblers seeking treatment: White 87.5% Native American 5.0%

Primary gambling activity:2 Video Poker 63.4% Slots 31.7% Cards 2.4% Source of referral to the treatment program: Gambling Helpline 46.3% Parole 12.2% Number of family members enrolled in treatment: 6

1 Population data provided by AMH – 18 years and above 2 Game of choice of gamblers enrolled in treatment during the year.

Douglas County 7/08 - 6/09

Estimated adult population:1 79,717 Number of gamblers enrolled in treatment: 51 Average age of gamblers seeking treatment: 50.1 Gender of gamblers seeking treatment: Female 66.7% Male 33.3% Ethnicity of gamblers seeking treatment: White 94.1% Native American 5.9%

Primary gambling activity:2 Slots 47.1% Video Poker 43.1 % Cards 7.8% Source of referral to the treatment program: Gambling Helpline 31.4 % Prev. Client 19.6% Number of family members enrolled in treatment: 8

1 Population data provided by AMH – 18 years and above 2 Game of choice of gamblers enrolled in treatment during the year.

Gilliam County 7/08 - 6/09

Estimated adult population:1 1,294 Number of gamblers enrolled in treatment: 0 Average age of gamblers seeking treatment: N/A Gender of gamblers seeking treatment: N/A Ethnicity of gamblers seeking treatment: N/A

Primary gambling activity:2 0 Source of referral to the treatment program: 0 Number of family members enrolled in treatment: 0

1 Population data provided by AMH – 18 years and above 2 Game of choice of gamblers enrolled in treatment during the year.

Grant County 7/08 - 6/09

Estimated adult population:1 5,286 Number of gamblers enrolled in treatment: 2 Average age of gamblers seeking treatment: 40.0 Gender of gamblers seeking treatment: Female 100.0% Male 0.0% Ethnicity of gamblers seeking treatment: White 100.0 %

Primary gambling activity:2 Video Poker 50.0% Slots 50.0% Source of referral to the treatment program: Previous client 50% Community service provider 50% Number of family members enrolled in treatment: 1

1 Population data provided by AMH – 18 years and above 2 Game of choice of gamblers enrolled in treatment during the year.

Harney County 7/08 - 6/09

Estimated adult population:1 5,181 Number of gamblers enrolled in treatment: 2 Average age of gamblers seeking treatment: 53.0 Gender of gamblers seeking treatment: Male 50% Female 50% Ethnicity of gamblers seeking treatment: White 100%

Primary gambling activity:2 Video Poker 50% Slots 50% Source of referral to the treatment program: Employer 505 Helpline 50% Number of family members enrolled in treatment: 0

1 Population data provided by AMH – 18 years and above 2 Game of choice of gamblers enrolled in treatment during the year.

Hood River County 7/08 - 6/09

Estimated adult population:1 16,305 Number of gamblers enrolled in treatment: 6 Average age of gamblers seeking treatment: 40.8 Gender of gamblers seeking treatment: Male 66.7% Female 33.3% Ethnicity of gamblers seeking treatment: White 60% Unknown 20%

Primary gambling activity:2 Video Poker 83.3% Slots 16.7% Source of referral to the treatment program: Placard on VL machine 33.3% Helpline 33.3% Number of family members enrolled in treatment: 0

1 Population data provided by AMH – 18 years and above 2 Game of choice of gamblers enrolled in treatment during the year.

Jackson County 7/08 - 6/09

Estimated adult population:1 152, 586 Number of gamblers enrolled in treatment: 88 Average age of gamblers seeking treatment: 48.9 Gender of gamblers seeking treatment: Male 54.5% Female 45.5% Ethnicity of gamblers seeking treatment: White 87.2% Hispanic 4.7%

Primary gambling activity:2 Video Poker 63.2% Slots 19.5% Cards 6.9% Source of referral to the treatment program: Gambling Helpline 33.3% Other 18.2% Number of family members enrolled in treatment: 5

1 Population data provided by AMH – 18 years and above 2 Game of choice of gamblers enrolled in treatment during the year.

Jefferson County 7/08 - 6/09

Estimated adult population: 1 15,839 Number of gamblers enrolled in treatment: 1 Average age of gamblers seeking treatment: 69.0 Gender of gamblers seeking treatment: Male 100.0% Ethnicity of gamblers seeking treatment: White 100.0% Primary gambling activity: 2 Slots 100.0% Source of referral to the treatment program: Gambling Helpline 100.0% Number of family members enrolled in treatment: 0

1 Population data provided by AMH – 18 years and above 1 Game of choice of gamblers enrolled in treatment during the year.

Josephine County 7/08 - 6/09

Estimated adult population:1 62,059 Number of gamblers enrolled in treatment: 51 Average age of gamblers seeking treatment: 47.6 Gender of gamblers seeking treatment: Female 71.4% Male 21.6% Ethnicity of gamblers seeking treatment: White 94.1% Native American 3.9%

Primary gambling activity:2 Video Poker 44.0% Slots 34% Scratch tickets 6.0% Source of referral to the treatment program: Prev. Client 45.1% Help Line 13.7% Number of family members enrolled in treatment: 0

1 Population data provided by AMH – 18 years and above 2 Game of choice of gamblers enrolled in treatment during the year.

Klamath County 7/08 - 6/09

Estimated adult population:1 50,924 Number of gamblers enrolled in treatment: 6 Average age of gamblers seeking treatment: 63.3 Gender of gamblers seeking treatment: Male 66.7% Female 33.3% Ethnicity of gamblers seeking treatment: White 66.7% African American 16.7%

Primary gambling activity:2 Slots 50.0% Video Poker 33.3% Keno 16.7% Source of referral to the treatment program: Gambling Helpline 100.0% Number of family members enrolled in treatment: 0

1 Population data provided by AMH – 18 years and above 2 Game of choice of gamblers enrolled in treatment during the year.

Lake County 7/08 - 6/09

Estimated adult population:1 5,571 Number of gamblers enrolled in treatment: 0 Average age of gamblers seeking treatment: 0 Gender of gamblers seeking treatment: 0 Ethnicity of gamblers seeking treatment: 0

Primary gambling activity:2 0 Source of referral to the treatment program: 0 Number of family members enrolled in treatment: 0

1 Population data provided by AMH – 18 years and above 2 Game of choice of gamblers enrolled in treatment during the year.

Lane County 7/08 - 6/09

Estimated adult population:1 256,173 Number of gamblers enrolled in treatment: 194 Average age of gamblers seeking treatment: 47.1 Gender of gamblers seeking treatment: Female 62.9% Male 37.1% Ethnicity of gamblers seeking treatment: White 89.7% Hispanic 4.1%

Primary gambling activity:2 Video Poker 64.9% Slots 27.8% Cards 3.6% Source of referral to the treatment program: Gambling Helpline 60.8% Prev. Client 17.0% Number of family members enrolled in treatment: 50

1 Population data provided by AMH – 18 years and above 2 Game of choice of gamblers enrolled in treatment during the year.

Lincoln County 7/08 - 6/09

Estimated adult population:1 35,116 Number of gamblers enrolled in treatment: 27 Average age of gamblers seeking treatment: 45.9 Gender of gamblers seeking treatment: Female 44.4% Male 55.6% Ethnicity of gamblers seeking treatment: White 88.9% Native American 3.7%

Primary gambling activity:2 Slots 44.1% Video Poker 37.0% Cards 11.1% Source of referral to the treatment program: Gambling Helpline 22.2% Prev. Client 22.2% Number of family members enrolled in treatment: 7

1 Population data provided by AMH – 18 years and above 2 Game of choice of gamblers enrolled in treatment during the year.

Linn County 7/08 - 6/09

Estimated adult population:1 86,718 Number of gamblers enrolled in treatment: 62 Average age of gamblers seeking treatment: 47.3 Gender of gamblers seeking treatment: Female 59.7% Male 40.3% Ethnicity of gamblers seeking treatment: White 91.9% Hispanic 6.5%

Primary gambling activity:2 Video Poker 55.7% Slots 29.5% Keno 6.6% Source of referral to the treatment program: Gambling Helpline 38.7% Prev. Client 19.4% Number of family members enrolled in treatment: 12

1 Population data provided by AMH – 18 years and above 2 Game of choice of gamblers enrolled in treatment during the year.

Malheur County 7/08 - 6/09

Estimated adult population:1 23,838 Number of gamblers enrolled in treatment: 7 Average age of gamblers seeking treatment: 55.4 Gender of gamblers seeking treatment: Female 85.7% Male 14.3% Ethnicity of gamblers seeking treatment: White 42.9% African American 14.3%

Primary gambling activity:2 Video Poker 85.7% Slots 14.3% Source of referral to the treatment program: Previous client 28.6% Family/Friend 28.6% Number of family members enrolled in treatment: 0

1 Population data provided by AMH – 18 years and above 2 Game of choice of gamblers enrolled in treatment during the year.

Marion County 7/08 - 6/09

Estimated adult population:1 238,455 Number of gamblers enrolled in treatment: 145 Average age of gamblers seeking treatment: 46.5 Gender of gamblers seeking treatment: Male 39.3% Family 60.7% Ethnicity of gamblers seeking treatment: White 81.0% Hispanic 8.3%

Primary gambling activity:2 Video Poker 61.4% Slots 31.7% Cards 1.4% Source of referral to the treatment program: Gambling Helpline 28.3% Previous client 11.7% Number of family members enrolled in treatment: 31

1 Population data provided by AMH – 18 years and above 2 Game of choice of gamblers enrolled in treatment during the year.

Morrow County 7/08 - 6/09

Estimated adult population:1 8,574 Number of gamblers enrolled in treatment: 5 Average age of gamblers seeking treatment: 38.6 Gender of gamblers seeking treatment: Female 40.0% Male 60.0% Ethnicity of gamblers seeking treatment: White 100.0%

Primary gambling activity:2 Video Poker 80.0% Slots 20.0% Source of referral to the treatment program: Other outpatient gambling pgm 40.0% Voc. Rehab 20.0% Number of family members enrolled in treatment: 0

1 Population data provided by AMH – 18 years and above 2 Game of choice of gamblers enrolled in treatment during the year.

Multnomah County 7/08 - 6/09

Estimated adult population:1 537,462 Number of gamblers enrolled in treatment: 443 Average age of gamblers seeking treatment: 43.4 Gender of gamblers seeking treatment: Male 52.0% Female 48% Ethnicity of gamblers seeking treatment: White 74.2% African-American 12.5%

Primary gambling activity:2 Video Poker 74.2% Slots 15.4% Cards 3.2% Source of referral to the treatment program: Gambling Helpline 30.5% Family/Friend 19.4% Number of family members enrolled in treatment: 60

1 Population data provided by AMH – 18 years and above 2 Game of choice of gamblers enrolled in treatment during the year.

Polk County 7/08 - 6/09

Estimated adult population:1 57,625 Number of gamblers enrolled in treatment: 25 Average age of gamblers seeking treatment: 44.0 Gender of gamblers seeking treatment: Female 68.0% Male 32.0% Ethnicity of gamblers seeking treatment: White 88.0% Native American 8.0%

Primary gambling activity:2 Video Poker 48.0% Slots 44.0% Cards 8.0% Source of referral to the treatment program: Helpline 28.0% Internet 16.0% Number of family members enrolled in treatment: 6

1 Population data provided by AMH – 18 years and above 2 Game of choice of gamblers enrolled in treatment during the year.

Sherman County 7/08 - 6/09

Estimated adult population:1 1,284 Number of gamblers enrolled in treatment: 1 Average age of gamblers seeking treatment: 57.0 Gender of gamblers seeking treatment: Male 100% Ethnicity of gamblers seeking treatment: White 100%

Primary gambling activity:2 Video Poker 100% Source of referral to the treatment program: Parole 100% Number of family members enrolled in treatment: 0

1 Population data provided by AMH – 18 years and above 2 Game of choice of gamblers enrolled in treatment during the year.

Tillamook County 7/08 - 6/09

Estimated adult population:1 19,170 Number of gamblers enrolled in treatment: 11 Average age of gamblers seeking treatment: 55.1 Gender of gamblers seeking treatment: Female 72.7% Male 27.3% Ethnicity of gamblers seeking treatment: White 100.0%

Primary gambling activity:2 Video Poker 72.7% Slots 27.3% Source of referral to the treatment program: Family/friend 18.2% Community Service Provider 18.2% Number of family members enrolled in treatment: 1

1 Population data provided by AMH – 18 years and above 2 Game of choice of gamblers enrolled in treatment during the year.

Umatilla County 7/08 - 6/09

Estimated adult population:1 56,267 Number of gamblers enrolled in treatment: 24 Average age of gamblers seeking treatment: 47.4 Gender of gamblers seeking treatment: Female 62.5% Male 37.5% Ethnicity of gamblers seeking treatment: White 70.8% Hispanic 25.0%

Primary gambling activity:2 Video Poker 50.0% Slots 37.5% Scratch tickets 8.3% Source of referral to the treatment program: Gambling Helpline 33.3% Family/friend 20.8% Number of family members enrolled in treatment: 0

1 Population data provided by AMH – 18 years and above 2 Game of choice of gamblers enrolled in treatment during the year.

Union County 7/08 - 6/09

Estimated adult population:1 26,608 Number of gamblers enrolled in treatment: 7 Average age of gamblers seeking treatment: 47.3 Gender of gamblers seeking treatment: Male 71.4% Female 28.6% Ethnicity of gamblers seeking treatment: White 100.0%

Primary gambling activity:2 Video Poker 57.1% Slots 14.3% Cards 14.3% Source of referral to the treatment program: Previous client 42.9% Community service provider 14.3% Number of family members enrolled in treatment: 0

1 Population data provided by AMH – 18 years and above 2 Game of choice of gamblers enrolled in treatment during the year.

Wallowa County 7/08 - 6/09

Estimated adult population:1 5,175 Number of gamblers enrolled in treatment: 5 Average age of gamblers seeking treatment: 50.0 Gender of gamblers seeking treatment: Male 60.0% Female 40.0% Ethnicity of gamblers seeking treatment: White 100%

Primary gambling activity:2 Video Poker 100% Source of referral to the treatment program: Parole 20.0% Probation 20.0% Number of family members enrolled in treatment: 0

1 Population data provided by AMH – 18 years and above 2 Game of choice of gamblers enrolled in treatment during the year.

Wasco County 7/08 - 6/09

Estimated adult population:1 18,193 Number of gamblers enrolled in treatment: 11 Average age of gamblers seeking treatment: 37.7 Gender of gamblers seeking treatment: Female 27.3% Male 72.7% Ethnicity of gamblers seeking treatment: White 90.0%

Primary gambling activity:2 Video Poker 100% Source of referral to the treatment program: Helpline 36.4% Family/Friend 18.2% Number of family members enrolled in treatment: 0

1 Population data provided by AMH – 18 years and above 2 Game of choice of gamblers enrolled in treatment during the year.

Washington County 7/08 - 6/09

Estimated adult population:1 400,052 Number of gamblers enrolled in treatment: 232 Average age of gamblers seeking treatment: 46.3 Gender of gamblers seeking treatment: Female 50.0% Male 50.0% Ethnicity of gamblers seeking treatment: White 81.7% Hispanic 5.7%

Primary gambling activity:2 Video Poker 64.2% Slots 28.0% Cards 3.9% Source of referral to the treatment program: Gambling Helpline 30.6% Other 16.8% Number of family members enrolled in treatment: 43

1 Population data provided by AMH – 18 years and above 2 Game of choice of gamblers enrolled in treatment during the year.

Wheeler County 7/08 - 6/09

Estimated adult population:1 1,042 Number of gamblers enrolled in treatment: 1 Average age of gamblers seeking treatment: 26 Gender of gamblers seeking treatment: Male 100% Ethnicity of gamblers seeking treatment: White 100%

Primary gambling activity:2 Electronic dog/horse 100% Source of referral to the treatment program: N/A Number of family members enrolled in treatment: 0

1 Population data provided by AMH – 18 years and above 2 Game of choice of gamblers enrolled in treatment during the year.

Yamhill County 7/08 - 6/09

Estimated adult population:1 73,939 Number of gamblers enrolled in treatment: 45 Average age of gamblers seeking treatment: 43.6 Gender of gamblers seeking treatment: Females 53.3% Male 46.7% Ethnicity of gamblers seeking treatment: White 93.3% African American 2.2%

Primary gambling activity:2 Video Poker 48.9% Slots 35.6% Cards 8.9% Source of referral to the treatment program: Gambling Helpline 24.4% Prev. Client 13.3% Number of family members enrolled in treatment: 2

1 Population data provided by AMH – 18 years and above 2 Game of choice of gamblers enrolled in treatment during the year.

Appendix C. Problem gambling on the web

Check the individual sections in this manual for more topic-specific web links and resources.

Oregon links www.oregon.gov/DHS/addiction/gambling.shtml Oregon Department of Human Services Addiction and Mental Health Division; information about problem gambling services in Oregon. www.1877mylimit.org Oregon Problem Gambling Helpline Web site offers live chat, instant messaging, e-mail or telephone contact to certified gambling counselors 24 hours a day, seven days a week. Resources section includes fact sheets, pamphlets, etc. http://www.gamblingaddiction.org/foundation.htm The Oregon Council on Problem Gambling, the state affiliate to the National Council on Problem Gambling. http://lanecounty.org/prevention/pgs/ Oregon problem gambling prevention coordinator‘s webpage is filled with resources for problem gambling prevention; coordinated by the State of Oregon Problem Gambling Services and hosted by Lane County.

About and for youth www.youthbet.net For youth, this site from the University of Toronto is highly interactive and focuses on youth gambling and problem gambling. www.youthgambling.com International Center for Youth Gambling Problems and High-Risk Behaviors. www.camh.net/egambling/issue14/jgi_14_messerlian.html ―Youth gambling: A public health perspective,‖ by Carmen Messerlian and Jeffrey Derevensky. From the September 15, 2005, edition of The Electronic Journal of Gambling Issues, this paper focuses on the importance of addressing youth gambling prevention as a public health strategy.

www.ctprevention.org/necasa/gambling.pdf ―Talk to kids about poker‖ brochure from the Connecticut DMHAS Problem Gambling Services and Northeast Communities against Substance Abuse.

Help and treatment www.1877mylimit.org/directory.asp Oregon gambling treatment list of state-funded treatment providers. www.gamblersanonymous.org Official Gamblers Anonymous Web site. www.gam-anon.org/ Gam-Anon. Support for spouse, family, or close friends of the problem gambler. www.ncpgambling.org National Council on Problem Gambling. Provides information on state affiliates, a counselor search and other resources.

Problem gambling research www.gamblingaddiction.org/ OregonCouncil on Problem Gambling. A research and education resource for problem gambling prevention and treatment professionals. www.gamblingandthelaw.com Minimum legal ages to gamble throughout U.S. states and the world; information about and status of Internet gambling. gamingresearch.blogspot.com Alberta Gaming Research Institute Library Weblog. Provides a selection of Internet gambling research resources updated regularly. www.geminiresearch.com/ The ―Reports and Links‖ section offers a number of international research studies and reports available online. govinfo.library.unt.edu/ngisc/reports/fullrpt.html National Gaming Impact Study Commission Final Report, 1999.

www.responsiblegambling.org The Responsible Gambling Council (Ontario) provides a collection of more than 2,500 articles, reports and documents on a ―wide range of gambling-related issues.‖ Click the ―e-Library‖ link to reach the gambling prevention and awareness resource e-library.

General prevention and treatment resources casat.unr.edu/bestpractices Western Center for the Application of Prevention Technology (CAPT) provides information about building a successful prevention program, from needs assessment to program evaluation. www.oregon.gov/DHS/ph/chs/youthsurvey/index.shtml Oregon Healthy Teens (OHT) data. OHT is Oregon‘s effort to monitor the health and well-being of adolescents. An anonymous and voluntary research-based survey, OHT is conducted among 8th- and 11th-graders statewide.