Understanding Adolescent/Young Adult Behavioral Disorders

Jeffrey L. Derevensky, Ph.D. James McGill Professor, School/Applied Child Psychology Professor, Psychiatry McGill University www.youthgambling.com

Champlain College May 2019 Behavioural Addictions

◼ The term became popular with the inclusion in DSM-5 (APA, 2015)

◼ Designed to differentiate between substance abuse and dependency

◼ Prompted by research on gambling and movement away from its prior classification as an impulse control disorder

◼ Concern over rise in number of individuals with Internet gaming disorders and excessive Internet & cell phone dependency Multiple types of behavioral disorders

Characteristics of Behavioural Addictions

◼ Most behavioral addictions represent a part of normal behavior ◼ The concern is when they become excessive and impairs other parts of one’s life Identifying Characteristics of Behavioural Addictions

◼ SALIENCE – the most important activity in the person’s life and tends to dominate his/her thinking, feelings & behaviour

◼ MOOD MODIFICATION – emotional reaction to the behaviour is positive-often serves a a coping strategy, arousal or numbing of adverse events (e.g., escape)

◼ TOLERANCE – The need for increasing amounts of behaviour to achieve the mood modifying effects – can result in increasing frequency, duration & intensity ◼ WITHDRAWAL – unpleasant emotional/physical state when trying to cut down or stopping the behaviour

◼ CONFLICT-discord between people around the individual, conflicts with other activities (e.g., social life, work, hobbies, interests, and inter-personal relationships, school

◼ RELAPSE – often reoccurring patterns of behaviour after periods of control or abstinence Consequences

◼ Short-term rewards that results in persistent behaviour despite knowledge of long-term adverse consequences

◼ The repetitive engagement in these behaviours interferes with functioning in other domains

◼ Many similarities with substance abuse and dependency ◼ Natural histories that exhibit chronic, relapsing patterns with most individuals recovering on their own – “natural recovery” ◼ Individuals often report a “craving” or “urge” to continue ◼ These behaviours often decrease anxiety and result in a positive mood state or physiological arousal (“high”) ◼ Need for increased frequency, duration or intensity ◼ Individuals go through a somewhat analogous state of withdrawal Consequences

◼ Dysphoric mood states often accompany a decrease in addictive behaviour

◼ There is often a high degree of co-morbidity with other mental health and addictive behaviours

◼ Other psychiatric disorders - depression, OCD, Anxiety, Conduct Disorders & ADHD common

◼ Interpersonal difficulties Lifetime Estimates of Substance use Disorders in Behavioral Addictions

Behavioral Lifetime Estimates of Addictions Substance Use Disorder Pathological Gambling 35% − 63% Kleptomania 23% − 50% Pathologic Skin Picking 38% Compulsive Sexual Behavior 64% Internet Addiction 38% Compulsive Buying 21% − 46% So what’s so different??

Technologically sophisticated

Today’s Talk

Focus on technological disorders

◼ Excessive Internet Behaviors ◼ Excessive Reliance on Smartphones ◼ Gaming Disorders ◼ Gambling Disorders

Gaming

◼ Over 2 billion active gamers worldwide (Newzoo, 2017)

◼ 97% of teenage boys play videogames; 83% of teenage girls (Pew, 2018)

◼ Worldwide estimates suggest 1-4% of gamers at risk of addiction

◼ Gaming one of the leading causes of college dropouts (Hlcommission, 2014)

◼ 48% of student gamers report gaming keeps them from studying; 9% use gaming for that reason (Pew, 2003)

◼ Gaming 30 hrs/week is a red flag; 70 hrs/week a real problem Gaming ◼ Gaming fulfills specific emotional/psychological needs: escape, social connection, advancement, certainty

◼ Games are intentionally designed to keep you hooked using behavioral psychology strategies

◼ Games are fully immersive and provide hyper-stimulation (dopamine)

◼ Gaming is a safe place to fail-real world failures can be permanent

◼ Gaming is a community and culture-relationships are meaningful (and may be their only relationships)

◼ Gaming is normalized and socially accepted Gaming Disorder

◼ The World Health Organization in its revision of ICD (11th edition) (scheduled for release in 2018) identified Gaming Disorder as a legitimate disorder.

◼ A pattern of gaming behaviour (“digital-gaming” or “video- gaming”) characterized by impaired control over gaming, increasing priority given to gaming over other activities to the extent that gaming takes precedence over other interests and daily activities, and continuation or escalation of gaming despite the occurrence of negative consequences.

◼ For gaming disorder to be diagnosed, the behaviour pattern must be of sufficient severity to result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning and would normally have been evident for at least 12 months. Gaming Disorder: A Brief History

◼ Since the 1990’s video games have become more technologically sophisticated and increased in popularity ◼ Games are easily accessible via computers, tablets, game consoles and smart phones ◼ Primarily 2 categories ◼ ONLINE GAMING- typically played simultaneously by players who communicate with each other in real time-cooperating or competing with one another ◼ OFFLINE GAMING- typically played alone; well defined start and end ◼ online gamers spend more time, report having ‘online’ friends and report more satisfaction ◼ 70% of gamers prefer online games compared to offline games (De Prato et al., 2010) Gaming Disorder: A Brief History

◼ Online gamers are more likely to be problematic ◼ For gaming disorder to be diagnosed, the behaviour pattern must be of sufficient severity to result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning and would normally have been evident for at least 12 months. MMOGs

◼ MMOGs (Massively Multiplayer Online Games) 3 major groups ◼ role playing games ◼ first player shooting games ◼ real time strategy games

◼ 79% of gamers have a specific preference 100 Social gamer Addicted gamer 90

80

70

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50

Percentage 40

30

20

10 0 World ofStar Warcraft TrekEverquestFinal FantasyAheron's XIStar Call WarsLord of theUltima Rings OnlineHalo Eve OnlineRunescapeCall of DutyDiablo MaplestoryStarCraftRagnarokLeague ofOther Legends

MMORPG

MMORPG participation (N = 357) by gaming addiction McBride & Derevensky, 2015

Assessing Internet Gaming Disorder Internet Gaming Disorder (IGD 9 –SF)

1. Do you feel preoccupied with your gaming behaviour? (Some examples: Do you think about previous gaming activity or anticipate the next gaming session? Do you think gaming has become the dominant activity in your daily life?) 2. Do you feel more irritability, anxiety or even sadness when you try to either reduce or stop your gaming activity? 3. Do you feel the need to spend increasing amount of time engaged gaming in order to achieve satisfaction or pleasure? 4. Do you systematically fail when trying to control or cease your gaming activity? 5. Have you lost interests in previous hobbies and other entertainment activities as a result of your engagement with the game? Pontes & Griffiths, 2016 Internet Gaming Disorder (IGD 9 –SF)

6. Have you continued your gaming activity despite knowing it was causing problems between you and other people? 7. Have you deceived any of your family members, therapists or others because the amount of your gaming activity? 8. Do you play in order to temporarily escape or relieve a negative mood (e.g., helplessness, guilt, anxiety)? 9. Have you jeopardized or lost an important relationship, job or an educational or career opportunity because of your gaming activity?

Pontes & Griffiths, 2016 Prevalence of Gaming Disorder

◼ American youth 8 to 18 years revealed that 8.5% of gamers met 6 of 11 criteria

◼ An Australian youth revealed that ∼5% of video game players met 4 of 9 criteria.

◼ A German study of ninth graders reported a general prevalence of 1.2% (2.0% for boys, 0.3% for girls)

◼ A Netherlands covering different age groups found a general prevalence of 5.5% among adolescents 13 to 20 years of age and a prevalence of 5.4% among adults.

◼ A CAMH study in 2016 estimated 13% of Ontario students- approximately 123,000 children have experienced symptoms of a video gaming problem (up from 9% in 2007). About 1 in 5 boys reported having problematic symptoms linked to their video gaming. Treatment Models for Gaming Disorders

◼ Online help and support for parents

◼ On-Line Gamers Anonymous Organization

◼ Specialty Clinics in certain countries – China, South Korea, U.K.

◼ Question of harm reduction vs abstinence

◼ Traditional CBT models- identifying the underlying causes

◼ Skill training-alternative use of time

◼ Gamequitters.com Internet Addiction

How Bad Has the Addiction Become? ◼ 27% of people today check Facebook while they are going to the bathroom.

◼ In a small study of internet users, 82% of people who accessed the internet were found to spend more time online than anticipated.

◼ 1 in 5 people will wake up in the middle of the night to check their Facebook account.

◼ 34% of people check for status updates or access their favorite websites from their smartphone before getting out of bed.

◼ People who have long-term internet addiction have found that there is up to a 20% surface area of brain shrinkage that occurs, which is similar to what happens with an addiction to alcohol. Internet Addiction Statistics from Stanford Research

◼ Almost 12½% often or very often were online longer than they intended

◼ The same number had seen a need to cut back on Internet use at some point

◼ Close to 9% tried to hide needless Internet use from their employers, friends, partners, parents and family

◼ Nearly 6% said that their relationships suffered as a result of too much time spent online

◼ Over 8% used the Internet as a method of escaping problems or to ease a negative frame of mind

◼ Over 13½% of people found it hard to stay away from the Internet for more than a few days Who Has The Most Problems With the Internet? ◼ In the 13-17 age demographic, up to 75% of children and youth could be considered addicted to the internet.

◼ 71% of 18-24 year olds would qualify as being addicted to the internet today.

◼ People who are in the 65+ age demographic are more likely to be addicted to the internet [44%] than the 55-64 age demographic [39%] and the 45-54 age demographic [40%].

◼ Starting at the age of 25, internet addiction rates grow steadily less until people reach the age of 65 when usage rates begin to spike again.

◼ Half of individuals age 35-44 may qualify as being addicted to the internet. Assessing Internet Addiction Internet Addictions Test The DSM-5 suggests that IGD may be identified by 5 or more of 9 criteria within a 12-month period. These criteria include:

◼ Preoccupation with the internet/games: The individual thinks about previous activity or anticipates playing the next game; gaming becomes the dominant activity in daily life;

◼ Withdrawal symptoms when the internet is removed: Symptoms are typically described as irritability, anxiety, or sadness;

◼ Tolerance: The need to spend increasing amounts of time on the internet or gaming via the internet;

◼ Unsuccessful attempts to control or reduce participation in internet/games; Internet Addictions Test

◼ Loss of interest in real-life relationships, previous hobbies, and other entertainment as a result of, and with the exception of, games;

◼ Continued excessive use of games despite knowledge of psychosocial problems;

◼ Has deceived family members, therapists, or others regarding the amount of gaming;

◼ Use of games to escape or relieve a negative mood (eg, feelings of helplessness, guilt, or anxiety); and

◼ Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of participation in games. Internet Addiction Test (IAT)

Question Scale 1 How often do you find that you stay on-line longer than you 1 2 3 4 5 0 intended? 2 How often do you neglect household chores to spend more Scale time on-line? 3 How often do you prefer the excitement of the Internet to 0 Does not apply intimacy with your partner? 1 Rarely 4 How often do you form new relationships with fellow on-line 2 Occasionally users? 5 How often do others in your life complain to you about the 3 Frequently amount of time you spend on-line? 4 Often 6 How often do your grades or school work suffer because of 5 Always the amount of time you spend on-line? 7 How often do you check your email before something else that you need to do? 8 How often does your job performance or productivity suffer because of the Internet? 9 How often do you become defensive or secretive when Young, 2018 anyone asks you what you do online? Internet Addiction Test (IAT) – (Cont’d)

Question Scale Scale 10 How often do you block out disturbing thoughts about your 1 2 3 4 5 0 life with soothing thoughts of the Internet? 0 Does not apply 11 How often do you find yourself anticipating when you will go 1 Rarely on-line again? 2 Occasionally 12 How often do you fear that life without the Internet would be 3 Frequently boring, empty and joyless 4 Often 13 How often do you snap, yell or act annoyed if someone 5 Always bothers you while you are on-line? 14 How often do you lose sleep due to late-night log-ins? 15 How often do you feel preoccupied with the Internet when off-line, or fantasize about being on-line?

Young, 2018 Internet Addiction Test (IAT)

Question Scale Scale 1 How often do you find yourself saying “just a few more 1 2 3 4 5 0 0 Does not apply 6 minutes” when on-line? 1 How often do you try to cut down the amount of time you 1 Rarely 7 spend on-line and fail? 2 Occasionally 1 How often do you try to hide how long you’ve been on-line? 3 Frequently 8 4 Often 1 How often do you choose to spend more time on-line over 5 Always 9 going out with others? 2 How often do you feel depressed, moody or nervous when you 0 are off-line, which goes away once you are back on-line?

Young, 2018 Internet Addiction Test (IAT) Scoring Total up the scores for each item. The higher your score, the greater level of addiction is. ◼ 20 – 49 points: You are an average on-line user. You may surf the Web a bit too long at times, but you have control over your usage. ◼ 50 – 79 points: You are experiencing occasional or frequent problems because of the Internet. You should consider their full impact on your life. ◼ 80 – 100 points: Your Internet usage is causing significant problems in your life. You should elevate the impact of the Internet on your life and address the problems directly caused by your Internet usage.

Wikipedia lists 200+ social networking websites

Popular Social Networking Websites Facebook, Instagram, Snapchat, Twitter, Google+, YouTube, Tumblr, Reddit, Flickr, Swarm, Kik, Periscope, Tinder, WhatsApp SoundCloud and more Wireless Services

◼ Canadians increasingly rely on wireless services ◼ Wireless services have become an integral part of Canadians’ lives. Whether to stay in touch with family and friends, consume content, or work while on the move, wireless services have become indispensable for most Canadians.

◼ Nearly 31 million Canadians subscribe to wireless services (CRTC, Communications Monitoring Report, 2017) – that’s 87.5% of Canadians based on the 2016 Census of Population.

◼ More Canadians have mobile phones (86.1%) than landlines (71.9%), and 27.5% of households rely exclusively on wireless services. (CRTC, Communications Monitoring Report, 2017)

The Changing Face of Gambling Gambling: A recognized behavioural addiction (DSM-5; ICD 11)

Practice Sites

This website does not permit players to wager real money. Chips in players' accounts have no monetary value, and cannot be exchanged for anything of value. Any and all references in the website to "pots," "limits", "betting” or the like are solely for instructional or illustrative purposes and do not involve wagering real money.

Problem Severity Continuum Gambling (gaming) has become normalized in our society

Chocolate poker chips for kids Poker chips for adults

ebay.com (May 19, 2019)

◼ “gambling” 70,289 listings

◼ “poker” 185,461 listings Amazon.com(May 19, 2019)

◼ “gambling” 20,000+ listings

◼ “poker” 40,000+ listings

Lottery scratch cards

Ease of accessibility

The Normalization of Gambling

Slots for kids Slots for adults

Safety 1st Jack Potty Training Seat ‘New’ Forms of Gambling: Concerns? Circa 1920’s Slot Machine Slot Machine 2013

Skill-Based Slots Guitar Warrior A skill-based Guitar Warrior slot game. The machine plays a predetermined wager every time a user hits a correct note Texas Tea Pinball

Simpsons Slot Machine

A camera captures the location of a player’s hand and copies it into a bonus round of a Simpsons slot machine at the Scientific Games booth during the Global Gaming Expo (G2E) at the Sands Expo Center Tuesday, Sept. 29, 2015.

Internet gambling

Poker heroes Joe Cada, age 21, Community College dropout, winner World Series of Poker, 2009, $8.55 million Jonathan Duhamel, age 23, University dropout, winner World Series of Poker, 2010, $8.944 million Pius Heinz, age 22, University Student, winner World Series of Poker, 2011, $8.72 million Greg Merson, age 24, University dropout, winner World Series of Poker, 2012, $8.528 million Ryan Reiss, age 23, wins $8.36 million in 2013 WSP recent college grad

“I’ve been dreaming about it a long time, ever since I was 14 and saw (Chris) Moneymaker win it.”

Gambling (gaming) has become glamorized

The New Face of Youth Gambling

What are Some Popular Facebook Fan Sites?

171

Gambling Camp

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Can Gambling be Dangerous??

Developmental Issues

◼ Nature of adolescence (developmental stage associated with risk-taking, experimentation, for acceptance by peers, group conformity, etc.)

◼ First generation of youth exposed to accessible and varied gambling venues

◼ Gambling has become the new rite of passage

◼ Minimum legal age to place a bet varies around the world ▪ Adolescence is a period of profound brain maturation.

▪ Previous belief that brain development was complete during childhood

▪ The maturation process is not complete until about age 24!!! Youth Involvement in Addictive Behaviors Involvement in Addictive Behaviors

Total use Weekly use

Gr 7 Gr 9 Gr 11 Gr 7 Gr 9 Gr 11 Alcohol 36.8% 62.2% 79.8% 7.4% 14.0% 20.2% Drugs 3.5% 13.4% 26.5% 2.7% 2.1% 9.0% Cigarettes 18.2% 34.5% 48.4% 7.0% 16.1% 31.4% Gambling 79.1% 78.9% 83.4% 30.4% 37.4% 37.1% Adolescent Problem Gambling Prevalence Studies Canada Derevensky & Gupta (2001) 3.4% Lussier, Derevensky, & Gupta (2007) 3.2% Hardoon, Derevensky & Gupta (2002) 4.9% Poulin (2000) 6.4%

U.S. National Research Council (1999) 3.5-5.0% Welte et al. (2008) 2.1% U.K. Fisher (1999) 5.6% Wood et al. (2006) 3.5% Scotland Moodie & Finnigan (2006) 9.0% Adolescent Problem Gambling Prevalence Studies Iceland Olason et al. (2005a, 2006, 2008) 1.9%/2.8% Olason et al. (2005b) 3.2%/4.4% Olason et al. (2011) 2.2% Norway Gotestam (2003) 1.8% Hansen & Rossow (2008) 3.1% Sweden Volberg et al. (2001) 2.0% adults 15-24 151% greater risk Adolescent Problem Gambling Prevalence Studies Spain Becona & Miguez 5.6%

Lithuania Skokauskas, (2007) 4.2%

Romania Lupu et al. (2002) 6.8%

Australia Moore & Ohtsuka (2000) 3.8% Delfabro et al. (2005) 4.4% Youth gambling……. Reasons why children & adolescents gamble (N=1040)

100 90 80 70 60 enjoyment 50 excitement 40 money social pressure 30 20 10 0 grade 4 grade 6 grade 7 grade 8 grade 9 grade 11 Preferred Activities……. Percentage of Youth Engaging in Various Gambling Activities Kentucky Incentives for Prevention, 2008

100 90 grade 6 80 grade 8 70 grade 10 grade 12 60 50 40 30 20 10 0 cards sports horse lottery internet bingo dice games of casino racing skill Percentage of Children and Adolescents Engaging in Various Gambling Activities (N=1294) 100

90 grade 4 grade 6 80 grade 7 70 grade 8 grade 9 60 grade 11 50 40 30 20 10 0 cards sports sports lottery video bingo slots games of pools lottery poker skill Participation in Gambling Activities

30

25 Occasionally Regularly 20

15

10

5

0 cards sports poolssports lotterylottery videogamesVLT's bingo slots Internet ($)Internet (no$) Where do they gamble……. Reported Gambling Venues (N=1294)

100 90 80 70

60 home 50 friend's house school 40 30 20 10 0 grade 4 grade 6 grade 7 grade 8 grade 9 grade 11

(Derevensky & Gupta, 1997; Gupta & Derevensky, 1998a) With whom do adolescents gamble……. With whom adolescents gamble (N=817)

100 90 grade 7 grade 9 80 grade 11 70 60 50 40 30 20 10 0 alone friends strangers parents siblings relatives total family Problem gamblers……. Percentage of Adolescents Engaging in Various Gambling Activities* (N = 817)

no problem gambler 100 social gambler 90 gambler with some problems 80 probable pathological gambler 70 60 50 40 30 20 10 0 cards sports sports lottery video bingo slots games casino pools lottery poker of skill

* grades 7, 9, 11 Our Current State of Knowledge

◼ Gambling is more popular amongst males than females ◼ Adolescent pathological gamblers are greater risk- takers ◼ Adolescent prevalence rates of problem gambling are 2-4 times that of adults ◼ Gambling has become a family activity ◼ 40-68% of youth gamble with family members ◼ 80-90% of parents report knowing their children gamble for money and do not object ◼ 77% of adolescents reported their parents purchased lottery tickets for them Our Current State of Knowledge

◼ have poor general coping skills ◼ report beginning gambling at earlier ages, approximately 10 years of age ◼ rapid movement from social gambler to problem gambler ◼ see both the benefits AND risks associated with excessive gambling ◼ believe gambling to be a relatively benign activity: ◼ 40% of participants believe that playing cards for money is harmless even when played at least once a week ◼ 37% believe that teens should be allowed to use EGMs ◼ while 72% agree that gambling can be bad for you, there remains 28% of participants who either disagree or are neutral in this matter

◼ few fear getting caught gambling Percentage of Children & Adolescents who fear Being Caught while Gambling (N=1294)

100 90 80 70 60 50 44 40 26 30 17 20 10 9.1 8.6 10 0 grade 4 grade 6 grade 7 grade 8 grade 9 grade 11 (Gupta & Derevensky, 1998c) ◼ Adolescent problem gamblers have ◼ lower self- esteem compared with other adolescents ◼ higher rates of depression ◼ dissociate more frequently when gambling ◼ are at heightened risk for suicide ideation and suicide attempts ◼ increased delinquency and criminal behaviors ◼ disruption of familial relationships and decreased academic performance ◼ report having a support group, old friends are often replaced by gambling associates ◼ score higher on excitability, extroversion, impulsive and anxiety & lower on conformity and self- discipline measures ◼ score lower on a measure of resiliency in light of risk factors ◼ experienced more major life events and early childhood traumas ◼ are more likely to have parents with either a gambling problem or other form of mental health or substance abuse ◼ display significant cognitive distortions compared to peers when gambling ◼ remain at increased risk for the development of an addiction or multiple addictions Reported Percentage of Substance Use (past year) According to Gambling Severity (N=817)

no problem gambler 100 social gambler 90 gambler with some problems 80 probable pathological gambler 70 60 50 40 30 20 10 0 alcohol drugs smoking * grades 7, 9, & 11 ◼ Most teens view gambling as a socially acceptable and enjoyable form of entertainment, significantly less harmful than alcohol, drugs or cigarettes

◼ Adolescents are easily influenced by advertisements

◼ Problem adolescent gamblers have more legal problems Percentage of Respondents who Have Legal Actions Pending Against Them (N=817)

50 45 40 35 30 25 20 15 10 5 0 non gambler gambler NP gambler SP PPG

* grades 7, 9, & 11

Assessing Problem/Disordered Youth Gamblers DSM-IV-J gambling screen (Fisher, 1992)*

Do you often find yourself thinking about gambling activities at odd times of the day and/or planning the next time you will play? (81.6%)

Do you lie to your family or friends or hide how much you gamble? (78.9%)

After spending money on gambling activities do you play again another day to try and win your money back? (More than half the time?) (73.7%)

In the past year have you spent your school dinner money, or money for bus fares, on gambling activities? (68.4%) In the past year have you taken money from someone you live with, without their knowing, to gamble? (57.9%)

Do you ever gamble as a way of escaping problems? (50.0%)

Do you find you need to spend more and more money on gambling activities? (36.8%)

In the past year, have you stolen money from outside the family, or shoplifted, to gamble? (28.9%)

Do you become restless, tense, fed up, or bad tempered when trying to cut down or stop gambling? (26.3%) In the past year, have you gone to someone for help with a serious money worry caused by participation in gambling? (21.1%)

Have you fallen out with members of your family, or close friends, because of your gambling behavior? (10.5%)

In the past year, have you missed school to participate in gambling experiences? (5 times or more) (7.9%)

4 or more to meet the criteria for PPG

* Percentages of endorsements from study of adolescents by Gupta & Derevensky (2012). Why do I gamble?

◼ Gambling was there for me when no one else was. Gambling made me know I was special and even powerful. The days flew by…I was in a different world. Nothing else was important to me (male, age 14).

◼ Of course I stole money from my family. It’s nothing personal, I needed the money (male, age 18).

◼ If you really think of it, it was easy to come up with reasons why I should keep playing. If I was winning..well that was reason enough. If I was losing, well that is OK because I’d be winning soon. But its more about the chase than the actual dollars. The chase allows you to forget about everything else (male, age 14). ◼ Everything that was good about gambling is now bad. It is my whole life and I’m tired. I’m tired of lying and stealing…for something I can’t seem to control, but don’t want to do. What has happened to me? I need help (male, age 14).

◼ My problems are like a tree. The root is my gambling with one branch being a thief, another a liar, another being out of school and work. If you cut a branch off you haven’t gotten to the root of my problem…gambling (male, age 19). Profile of the adolescent problem gambler

• Predominantly male • Significant anxiety • Familial problems and poor peer relationships • Preoccupation with gambling- reported inability to stop despite repeated efforts • VLT, sports betting, cards • Serious financial difficulties • Failure in school and/or at work • Lying to family and friends Profile - continued

• Friends usually have similar gambling problems • Stealing from family, friends, stores, bank fraud, etc.. • Depression or “feeling dead inside” • Gambling to escape and to feel better • General lack of coping abilities • Confused and conflicted about whether they really want to stop gambling • Need for arousal or strong sensations Consequences

The New Face of Internet Gambling

Why is Internet Gambling Potentially Problematic for Youth?

• Increased accessibility & availability • Convenience • Similarity with video-game technology • Can gamble for small amounts of money • Play in comfortable, non-intrusive environments often results in longer play • Anonymity • No travel barriers • Psychologically youth perceive themselves as invincible and smarter than adults Are Internet Gamblers More Likely to Have Problems? Wood & Williams (2007) - Sample of on-line adult gamblers ◼ Non-problem gamblers: 34% ◼ At-risk gamblers: 24% ◼ Moderate problem gamblers: 23% ◼ Severe problem gamblers: 20% ◼ 2/3 of those respondents gambling on the Internet are likely to have problems

Internet Gambling Without Money….Play for Fun Practice Sites

This website does not permit players to wager real money. Chips in players' accounts have no monetary value, and cannot be exchanged for anything of value. Any and all references in the website to "pots," "limits", "betting” or the like are solely for instructional or illustrative purposes and do not involve wagering real money.

Frequency of Play on Internet Gambling Sites Without Money in the Past 12 Months by Gambling Severity

Internet Gambling N = Without Money1 2205 Yes No (n = 1082) (n = 1123)

Gambling Groups***

Non Gambler n = 726 33.9 66.1

Social Gambler n = 1278 56.6 43.4

At-Risk Gambler n = 129 74.4 25.6 Probable n = 72 80.6 19.4 Pathological Gambler

Total 49.1 50.9 1Percentage. ***p<.001. Frequency of Play on Internet Gambling Sites With Money in the Past 12 Months by Gambling Severity

Internet Gambling With Money1 N = 2292 Yes No (n = 183) (n = 2109) Gambling Groups***

Non Gambler n = 745 0 100

Social Gambler n = 1333 9.5 90.5

At-Risk Gambler n = 139 21.6 78.4

Probable n = 75 34.7 65.3 Pathological Gambler Total 8.0* 92.0

1Percentage *13.1% males; 4.6% females are gambling on Internet Reasons Youth Gamble on Internet Internet sample 18-24 100

90

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70

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50

40

30

20

10

0 Game High speed Bonuses Competition Convenience Privacy Anonymity Don't need to Good odds Fair/reliable 24-hour diversity play leave house payouts accessibility How Youth Are Paying

45 40 35 30 25

20 Frequency % Frequency 15 10 5 0 Personal Family credit Family credit Debit Personal Wire/bank credit card card (with card (without card/ATM cheque transfer permission) permission)

Mobile Wagering

Social Casino Gambling Minneapolis Airport

Social Casino Games

• Social casino games one of the fastest growing and most profitable genres of social gaming (Superdata, 2012)

• Predicted to grow from 173 million users (2012) to 269 million users (2016) (Morgan Stanley, 2012)

• Social casino gaming equally popular with males & females and especially for youth ages 14-19 (McBride & Derevensky, 2015)

• In 2012, social casino games accounted for almost 25% of social gaming revenue (Superdata, 2012) Popularity • Wide variety of social casino games (e.g., poker, card games, slots, etc.) • Preferred access – personal computers (83%), mobile phone (51%), tablets (36%) (Superdata, 2013) • Mobile platforms growing quickly • Average age of social casino gaming 35-44 years old – more likely to be females • Growing number of young people Social Gaming

53% of Facebook users play social media games (81 million people play at least one game daily)…. many of which are social casino games. Risks of Social Casino Games • Gateway to excessive gambling • Behavior modifications/normalization • Relapse risks for problem gamblers • Social casino gambling problems (excessive time, avoidance of other social interactions, familial issues) • Migration to online gambling • Short longitudinal study (6 months) found 25% of social casino gamers migrated to online gambling (Kim et al., 2014) • Gambling as a gateway to excessive social casino gaming ( Parke, Wardle, Rigbye & Parke, 2013) • Inflated payout rates on social casino games • Keeps players interested • Fosters a perceived illusion of control • Increases likelihood of higher online wagers • Social casino games • May be the first exposure for young people to gambling (Morgan Stanley, 2012) Convergence of Social Media & Gambling

◼ Poker/card games ◼ Casino games ◼ Sports wagering ◼ Reality shows ◼ Celebrity adoptions, arrests, etc. ◼ Any form of contest/Political race Social Casino Gaming Among Young People

• In U.K., 10% of children 11-16 played a social casino or practice game in past week (Parke et al., 2013)

• In Australia, 13% of children 12-17 played simulated casino games past year (32% during their lifetime) (King et al., 2014) Student-Athletes Reporting Playing Simulated Gambling Activity (Past Year) (Paskus & Derevensky, 2013)

2012 Study

Males 28.1%

Females 10.2% ◼ Gambling operators will continue to expand into social gambling

◼ Morgan Stanley report on social gambling (Nov., 2012) suggests that social gambling offers the potential to “teach young people to gamble”

◼ Australian Government Review of the Interactive Gambling act (2012): “The public policy argument for prohibiting access to such gaming simulations is that it potentially normalises gambling amongst children and may lead them to become problem gamblers in the future.” Sports Wagering in the U.S.

• Sports Gambling $380 billion industry and rapidly growing

• Nevada's legal sports book $12 billion <1% of the market.

• Insatiable appetite for sports wagering Fantasy Sports

• Pick players and follow their performance-not wagering on the outcome of a game but rather player statistics and player performance. Fantasy Sports Trade Association (2013)

• Player draft before the season, allows for management of one's team-periodic line-up changes, player drops and player adds.

• Daily/weekly-pick players from different teams. Is There a Relationship between Fantasy Sports and Problem Gambling? Other Areas of Concern esports Gambling

Virtual Reality

Attitudes and Perceptions of Adolescent Risky Behaviors Parental perceptions: Serious Youth Issues

Drug use (1) 87%

Alcohol use (2) 82%

Drinking and driving (3) 81%

Unsafe sexual activities (3) 81%

Violence in schools, bullying (6) 75%

Smoking (7) 73%

Obesity, eating disorders (8) 66%

Spending too much time online (8) 66%

Negative body image (10) 64%

Excessive video game playing (10) 64%

Depression (12) 60%

Gambling (13) 40% A comparison of parents and teachers perceptions concerning adolescent risky behaviours Mental Health Professionals’ Beliefs about the Seriousness of Youth Issues

Violence in… 70% Depression 67% Drug use 60% Academic problems 56% Alcohol use 53% Negative body image 50% Unsafe sexual… 48% Obesity/eating… 41% Unsafe online 39% Too much time… 39% Excessive video… 38% Drinking & driving 36% Smoking 22% Gambling problems 18%

Figure represents responses “serious” and “very serious”