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Assistant Director Evergreen Council on Problem TANA RUSSELL, SUDP, NCTTP, [email protected] WSCGC-II TOBACCO AND (SHE/HER) Website: PROBLEM GAMBLING www.evergreencpg.org

Key things you should know

Wife, daughter, MK in Kenya, grand-daughter, Dog Crocheter/ Africa, sister owner Crafty-person World-view formed • We are very much FOR help being available by 10 countries to anyone and everyone who needs it, to cope and recover from problems related to Non-profit gambling and gaming Asst. Dir. Favorite color is green ECPG IS NEITHER FOR • Our Mission: The Evergreen Council on NOR AGAINST Problem Gambling is dedicated to increasing SUDP GAMBLING awareness of public health issues around AND GAMING NCTTP Person of faith, problem gambling and gaming, expanding WSCGC-II Forgiven much the availability and integration of services, and supporting advocacy, research, and programs for education, prevention, treatment, recovery, and responsible gambling and gaming. Creative Heterosexual, American, Work hard, cisgendered Caucasian-mut, Play hard, thinker privileged Work out hard 3

QUESTION GAMBLING AND CO-OCCURRING CONDITIONS

Of those who have/may have problem gambling or Gambling • With PG, is the rule, not the exception Disorder…how many of them would you guess also use • ~75% have a history of an use d/o tobacco products? • ~40% have a history of a substance use d/o A. None • ~60% have a history of dependence B. Very few • ~50% have a history of a C. Around half • ~40% have a history of an D. Most • ~60% have a history of a

Petry et al. (2005) OBJECTIVES PART 2 AGENDA

• Have a clear understanding of the nature Key elements you should know 1 and addictive qualities of tobacco

About Stats and • Understand the relationship between Tob. & PG 2 tobacco and gambling. Tobacco Data

Types, Starting and • Know where to find resources and good ingredients, NRT/Pharm. COVID-19 stopping 3 research data. vape

SMOKING TOBACCO

ABOUT Types of Tobacco Products TOBACCO - TYPES

SMOKELESS TOBACCO DISSOLVABLE TOBACCO VAPE VAPE WARNING LABELS – REAL AND FAKE

Also fake, but slightly more honest

Vape confiscations at Junior/Senior HS in Indiana

FDA VIDEO: ABOUT CHEMICALS IN Ingredients in CIGARETTES – FROM PLANT, TO Tobacco and Vape TOBACCO - PRODUCT, TO PUFF INGREDIENTS

https://www.youtube.com/watch?v=0- FdLCcFyQc&feature=emb_logo

Created from lighting it EFFECTS OF SMOKING

EFFECTS OF SECOND- HAND SMOKE ON ABOUT CHILDREN Some things you should know about TOBACCO – AND ADULTS vaping VAPE

E-CIG/VAPE HAS POTENTIAL FOR WHAT’S IN AN E-CIG? SERIOUS HARM

• http://smokefreeteens.smokefree.hk/en/smo • The more ingredients there are in e-juice, the more toxic to the body’s cells ke_free_academy/tobacco_scourge/emergin g_products/upload/page/39/self/5b90e2909d • Can cause lung disease, as well as cardiovascular (heart) disease 507.pdf • Can cause acute lung injury, COPD, asthma, lung cancer • Secondhand emissions may also be harmful, as they contain many toxic chemicals as well • FDA has not found any e-cigarette to be safe and effective in helping smokers quit. • Source: American Lung Association https://www.lung.org/quit-smoking/e-cigarettes-vaping/impact-of-e-cigarettes-on- lung E-CIGARETTE, OR VAPING, PRODUCTS VISUAL VAPE AND HEALTH RISKS DICTIONARY

• Devices • Substances (Tobacco and Cannabis) • Hacking or Modifying • https://www.cdc.gov/tobacco/ba sic_information/e- cigarettes/pdfs/ecigarette-or- vaping-products-visual- dictionary-508.pdf

Source: https://www.levinsimes.com/flavor-vaping-mice-show-signs-of-juul-lung-damage/

• Even mice exposed to e-juice vapor free of nicotine and flavoring, NATIONAL showed cellular changes and lung inflamation OUTBREAK OF • Source: https://www.levinsimes.com/flavor-vaping-mice-show-signs-of- LUNG INJURY juul-lung-damage/ ASSOCIATED WITH THE USE VAPE VS OF E- CIGARETTES, CIGARETTE, LUNG OR VAPING, INFLAMMATION PRODUCTS (ON MICE) • E-cigarette or vaping associated lung injury (EVALI) • Investigated by CDC, FDA, state and local health departments, and other clinical and public health partners • Vitamin E acetate strongly linked to the EVALI outbreak • 68 deaths, 2,022 hospitalizations (82% used THC products, 33% used THC products exclusively, 57% used nicotine products, 14% use nicotine products exclusively) Source: https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html#key-facts

PHARMACOTHERAPY

Pharmacotherapy

Pharmacotherapy: Nicotine Replacement Rx Pills Nicotine ABOUT Therapy (NRT) Replacement Therapy (NRT) TOBACCO – Bupropion Rx Medications Varenicline OTC Rx (ZYBAN/ (CHANTIX) NRT/PHARM. WELLBUTRIN)

Gum Lozenge Patch Nasal Spray Inhaler GUM IS THE MOST POPULAR OTC NRT ABOUT • 2020 : A Reasons people start Report of the Surgeon General: TOBACCO – https://www.hhs.gov/sites/de Reasons people quit fault/files/2020-cessation- STARTING AND sgr-full-report.pdf STOPPING

MOST PEOPLE DO WANT TO QUIT WHY DO PEOPLE CONTINUE TO SMOKE?

2020 Smoking Cessation – surgeon general’s report Physical and psychological addiction • Shows many have tried to quit and are still interested in quitting. Routine Daily routines, social routines, relaxation routines, auto-pilot • https://www.hhs.gov/sites/defaul t/files/2020-cessation-sgr-full- report.pdf Reward Stress-relief, time-filler, transition between activities, completion of tasks

Perception That it’s worth it, beneficial, relaxing, enjoyable

3 KEY CHANGE GOALS FOR QUITTING TOBACCO

Routine Reward Perception TOBACCO AND What is the • Change any routine • Tobacco is no • Mindful smoking relationship? PROBLEM associated w/ tob. longer to be used • Stop seeing use as a “reward” tobacco as a GAMBLING • Gets brain used to • Come up with positive change that “won’t other rewards • Intentionally focus hurt you” on negatives of • Success can be tobacco use “addicting” too More Daily smoker gamblers…. severe PG Sx SMOKING CORRELATES TO Gambled on more days Prevention Spend/lose INCREASED WHAT IS THE overlap more $ SEVERITY OF RELATIONSHIP Spent more money gambling GAMBLING BETWEEN Smoking PROBLEMS TOBACCO + Craved gambling more AND Gambling Had lower perceived control over their GAMBLING? Inc. EGM gambling COVID Source: NIH, Cigarette smoking is risk? use associated with increased severity of More likely to be taking psychiatric medications gambling problems in treatment- seeking gamblers More https://pubmed.ncbi.nlm.nih.gov/12 Experienced psychiatric symptoms on a greater COD 084144/ number of days than non-daily smokers

• Negative Urgency = a lack of control when one experiences SMOKING + extreme negative emotions SMOKING CORRELATES TO INCREASED GAMBLING • Those who smoked daily experienced significantly more negative urgency than those who did not smoke SEVERITY OF GAMBLING PROBLEMS • Source: ASHES, Vol. 14 (3) Double trouble: Smoking, gambling, and INCREASES https://www.basisonline.org/2018/03/ashes-vol143-double- NEGATIVE trouble.html • Odlaug, B. L., Stinchfield, R., Golberstein, E., & Grant, J. E. (2013). The relationship of tobacco use with gambling problem severity and gambling treatment outcome. Psychology of Addictive Behaviors, 27(3), 696-704. Retrieved April 2020, URGENCY from https://psycnet.apa.org/doiLanding?doi=10.1037%2Fa0029812 • Harper, T. (2003). Smoking and gambling: a trance inducing ritual. Tobacco Control. Retrieved April 2020, from https://tobaccocontrol.bmj.com/content/12/2/231 • Grant, J. E., Kim, S. W., Odalaug, B. L., & Potenza, M. N. (2008). Daily Tobacco Smoking in Treatment-Seeking Pathological Gamblers: Clinical Correlates and Co-occurring Psychiatric Disorders. Journal of , 2(4), 178-184. Retrieved “Having greater negative April 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2727939/ urgency means that when • Petry, N., & Oncken, C. A. (2002, June). Cigarette smoking is associated with increased severity of gambling problems in these people face difficult treatment-seeking gamblers. Addiction, 97(6), 745-53. Retrieved April 2020, from https://www.ncbi.nlm.nih.gov/pubmed/12084144 emotional situations, they • Wiley, R. C. (2018, March 13). Double trouble: Smoking, gambling, and impulsivity. ASHES, 14(3). Retrieved might be more likely to from https://www.basisonline.org/2018/03/ashes-vol143-double-trouble.html engage in impulsive • Weinberger, A. H., Franco, C. A., Hoff, R. A., Pilver, C., Steinberg, M. A., Rugle, L., . . . Potenza, M. N. (2015). Cigarette smoking or gambling.” smoking, problem-gambling severity, and health behaviors in high-school students. Addictive Behaviors Reports, 1, 40-48. Retrieved from https://www.sciencedirect.com/science/article/pii/S2352853215000024

SMOKING AND EGMS SMOKING + GAMBLING INDIVIDUALS ARE MORE SMOKING AND GAMBLING: A TRANCE INDUCING LIKELY TO SPEND MORE MONEY ON SLOT- MACHINES OR ELECTRONIC GAMING MACHINES RITUAL (EGMS)

• • • Harper, T. (2003). Smoking and gambling: a trance inducing ritual. Tobacco Control. “Smokers were no more likely to “Tattersalls [casino] identified a Retrieved April 2020, from https://tobaccocontrol.bmj.com/content/12/2/231 play with EGMs than non- higher proportion of its customers • Potenza, M. N., Stenberg, M. A., McLaughlin, S. D., Wu, R., Rounsaville, B. J., smokers, but if smokers did play, were smokers, comprising 36% of Krishnan-Sarin, S., . . . O'Malley, S. S. (2004). Characteristics of Tobacco-Smoking Problem Gamblers Calling a Gambling Helpline. American Journal on (5), they spent over twice as EGM players, who contributed 471-493. Retrieved April 2020, much.” 50% of the revenue.” from https://www.tandfonline.com/doi/abs/10.1080/10550490490483044 • Rodda, S., Brown, S. L., & Phillips, J. G. (2004). The Relationship Between Anxiety, Smoking, and Gambling in Electronci Gaming Machine Players. Journal of Gambling Studies, 20, 71-81. Retrieved from https://link.springer.com/article/10.1023/B:JOGS.0000016704.06088.85

Source: BMJ Journals, Tobacco Control https://tobaccocontrol.bmj.com/content/12/2/231 SMOKING + GAMBLING INDIVIDUALS HAVE SMOKING + GAMBLING INDIVIDUALS HIGHER RATES OF OTHER CO-OCCURRING SPEND/LOSE MORE MONEY ON GAMBLING ISSUES

• Harper, T. (2003). Smoking and gambling: a trance inducing ritual. Tobacco Control. “Characteristics of Tobacco-Smoking [people with ] Problem Gambl[ing] Calling Retrieved April 2020, from https://tobaccocontrol.bmj.com/content/12/2/231 a Gambling Helpline” • Grant, J. E., Kim, S. W., Odalaug, B. L., & Potenza, M. N. (2008). Daily Tobacco Smoking in Treatment-Seeking Pathological Gamblers: Clinical Correlates and Co- • More frequently acknowledged depression and suicidality secondary to occurring Psychiatric Disorders. Journal of Addiction Medicine, 2(4), 178-184. gambling Retrieved April 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2727939/ • Gambling-related arrests “The high proportion of callers reporting daily tobacco smoking • Petry, N., & Oncken, C. A. (2002, June). Cigarette smoking is associated with • Alcohol and drug use problems increased severity of gambling problems in treatment-seeking gamblers. Addiction, highlights the need for enhanced 97(6), 745-53. Retrieved April 2020, • Mental health treatment from https://www.ncbi.nlm.nih.gov/pubmed/12084144 smoking cessation efforts in [those • Problems with casino gambling with] problem gambl[ing].” • Source: American Journal on Addictions https://www.tandfonline.com/doi/abs/10.1080/10550490490483044

TOBACCO AND GAMBLING MAY HAVE SMOKING + GAMBLING INDIVIDUALS HAVE OVERLAPPING PREVENTION EFFORT HIGHER RATES OF OTHER CO-OCCURRING IMPLICATIONS ISSUES

• Potenza, M. N., Stenberg, M. A., McLaughlin, S. D., Wu, R., Rounsaville, B. J., Krishnan-Sarin, S., . . . • In September 2002, the Australian O'Malley, S. S. (2004). Characteristics of Tobacco-Smoking Problem Gamblers Calling a Gambling state of Victoria implemented Helpline. American Journal on Addictions(5), 471-493. Retrieved April 2020, smokefree laws for the gambling • “The report appeared to confirm the hopes of from https://www.tandfonline.com/doi/abs/10.1080/10550490490483044 industry. gambling control advocates that the smokefree laws would force smokers to take a break in play. The • Odlaug, B. L., Stinchfield, R., Golberstein, E., & Grant, J. E. (2013). The relationship of tobacco use with • Why? - To protect staff from the gambling problem severity and gambling treatment outcome. Psychology of Addictive Behaviors, 27(3), harms of smoke exposure report said the smokefree laws were breaking the 696-704. Retrieved April 2020, from https://psycnet.apa.org/doiLanding?doi=10.1037%2Fa0029812 gambling routine of smokers, and that cigarette • What happened? - Problem cravings were breaking player concentration. Further, • Petry, N., & Oncken, C. A. (2002, June). Cigarette smoking is associated wth increaed severity of gambling gambling decreased. For a time, when smokers did take a cigarette break they were problems in treatment-seeking gamblers. Addiction, 97(6), 745-53. Retrieved April 2020, revenues decreased. from https://www.ncbi.nlm.nih.gov/pubmed/12084144 reviewing their gambling expenditure and in some • Source: BMJ Journals, Tobacco cases prompting gamblers to consider their gambling • Weinberger, A. H., Franco, C. A., Hoff, R. A., Pilver, C., Steinberg, M. A., Rugle, L., . . . Potenza, M. N. Control: was “a waste of money” or tempting players to “go (2015). Cigarette smoking, problem-gambling severity, and health behaviors in high-school https://tobaccocontrol.bmj.com/cont students. Addictive Behaviors Reports, 1, 40-48. Retrieved home rather than play on”. from https://www.sciencedirect.com/science/article/pii/S2352853215000024 ent/12/2/231

RELIABLE TOBACCO RESEARCH AND RESOURCES

What does the latest • American Lung Association • National Institute on Drug Abuse research say about tobacco and OTHER STATS • American Cancer Society • National Institute on Health problem • American Heart Association • Smoking Cessation: Surgeon General’s Report gambling….and AND DATA • AHA Quit resources (2020) COVID-19? • Center for Disease Control • Washington Healthy Youth Survey • Mayo Clinic Center • Washington Department of Health • Food and Drug Administration • Truth Initiative – Tobacco use in Washington 2019 CDC CAMPAIGN FOR WOMEN'S HEALTH

• Source: TOBACCO- https://www.cdc.gov/tobacco/ba RELATED sic_information/health_effects/ women-smoking/index.htm DISPARITIES

• PDF: https://www.cdc.gov/tobacco/ba Source: sic_information/health_effects/ https://www.cdc.gov/tobac women-smoking/pdfs/women- co/disparities/index.htm smoking-disease-p.pdf

QUESTIONS ABOUT COVID-19 AND TOBACCO (NEEDS MORE RESEARCH DATA)

Two key facts: ANNUAL DEATHS FROM • Smoking history is an important risk factor for more severe COVID-19 symptoms SMOKING, • Smoking and problem gambling often co-occur UNITED STATES World Health Organization Coronavirus disease (COVID-19): Source: CDC Key questions: Tobacco https://www.cdc.gov/tobac • Are smokers with problem gambling more likely to… co/infographics/health- effects/index.htm • Be at risk of exposure to the novel coronavirus? • Have more severe COVID-19 symptoms? • How will this impact access to help services and recovery efforts?

RESOURCE LIST OTHER GREAT RESOURCES

• Nicotine Anonymous • Quit smoking apps • CDC Resource List: • Social Media support groups • Smoke Free https://www.cdc.gov/to • Facebook: Quit Smoking groups bacco/campaign/tips/pa • QuitNow! rtners/health/materials/ • Reddit: r/stopsmoking twyd-5a-2a-tobacco- • EasyQuit intervention-pocket- • card.pdf Websites • Quit Genius • Smokefree.gov • Stop Smoking • ALA Freedom from Smoking program • 2Morrow Health (Vaping and • WA DOH: How To Quit tobacco site Smoking)