10/5/2018 “Blow Up the Pokies:” Problem Electronic Gaming Machine (EGM) Gambling in Older Adults Dr Adam Searby RMIT University, Melbourne, Australia Disclosure: I have received an educational grant from Indivior to attend this year’s IntNSA educational conference. Outline • What are pokies? • Why are we blowing them up? • The scope of the problem in Australia • Older people and pokies • Future directions 1 10/5/2018 What are“pokies?” • Colloquial Australian term for a “poker machine” = “pokie” • Let’s go and play the pokies • Why are all of these places full of pokies? • Just won $100 on the pokies • Internationally known as: • Video poker machine • Fruit machine • Slot machine • Electronic gaming machine • One arm bandit Source: The Source: Advertiser Source: adelaiderememberwhen.com 2 10/5/2018 Source: thewest.com.au 3 10/5/2018 Why blow up the pokies? • In 1999, Australian band The Whitlams released the single Blow Up The Pokies • The song was inspired by two band members, Andy Lewis and Steve Plunder, who both engaged in problematic EGM gambling and lead singer, Dan Freedman’s observation that pokies were replacing live music venues in Sydney • A year after the song was released, Andy Lewis committed suicide – after losing his weekly income on the pokies and then returning to his workplace to hang himself 4 10/5/2018 In Victoria [return to player] is a minimum of 87 per cent. This doesn’t mean that every time you play you will get 87 per cent of your money back. It means that if you could play enough spins to cover every possible combination on a machine (about 80 million) then you could expect to get 87 per cent of your money back. This also means the operator can count on 13 per cent of your money. For this reason the operator doesn’t ‘cheat’ and the machines aren’t ‘rigged’, they simply have a built in advantage for the operator—there are many more losing combinations than winning ones. Gambler’s Help Southern, 2009 A user operating an EGM with a price of [13%] will, on average, lose [13%] of their wager at each spin . The effect is cumulative. So, if a user inserts $10 and wagers $1 each spin, even if the game performs exactly as predicted (and this is extremely unlikely), the user would exhaust their funds in a little more than five minutes (at the rate of one wager every five seconds). With $5 bets, this process would occupy a little over one minute. Livingstone, 2017 5 10/5/2018 “Losses disguised as wins (LDW)” • Where a pokie machine displays celebratory graphics and plays sounds when the player wins an amount less than what was originally gambled • For example: bet $2.50 per spin, “win” $1 on the spin (lights and sounds) = net loss $1.50 • Closely associated with “near misses” • Studies indicate potential for LDWs to motivate ongoing and longer play and lead to overestimation of winning, however results across studies are not uniform (Barton et al, 2017) Are pokies addictive? • Gambling shown to effect “reward pathways” involving prefrontal cortex, dopaminergic midbrain and affiliated regions • DSM-V Behavioural Addictions = recognition that these forms of addiction share many of the same characteristics as “traditional” addiction (Murch and Clarke, 2016) • Pokies designed to exploit traditional psychological concepts such as operant conditioning • Studies have shown a more rapid onset from recreational gambling to problem gambling (i.e. Breen & Zimmerman finding progession in 1.08 years as opposed to 3.58 years in other forms (2002)) (Dowling, Smith and Thomas, 2005) Older people and pokies • Older adults are a market for targeted pokie machine promotions, trips and incentives • Studies have shown a link between availability of gaming machines and increased relationship of at-risk gaming behavior in older adults (Preston et al, 2007) • Prevalence data is limited: Potenza et al (2006) reported that of 1,018 to a Conneticut gambling help line, 168 (16.5%) were from older adults, 66.2% of these reporting EGMs as their problematic gambling source 6 10/5/2018 Pathways to problem gambling in older adults • Distressing situations (eg. Loss) • Urgency or apathy (eg. Financial crisis needing to be “fixed”) • Unsupportive environment (eg. Lack fo recreational options, feeling neglected) • Illusion of control (eg. Superstition, ideas around luck, “machine due to pay out”) • Gambling as part of cultural identity • Disinhibition, impaired decision making (Tirachaimongkol et al, 2010) Outcomes of problem gambling • Financial loss • Strong association with suicidal ideation and attempts (Moghaddam et al, 2015) • Elevated rates of nicotine dependence (Odlaug et al, 2013) • Strong correlation reported between alcohol and other drug use and problem gambling (Peters et al, 2015) Screening • Varying success reported with a one-question screen in primary care: Have you ever had an issue with your gambling? (Rockloff et al, 2011) • A number of longer form screening tools exist with varying applicability to the older adult cohort • The key to screening is applying it universally 7 10/5/2018 Source: Matua Raki (2012) Source: Matua Raki (2012) Future directions • Lack of research needs to be addressed • Prevalence • Qualitative data • Specific screening and treatment options • Advanced practice nurses need to encourage screening in addiction settings • Educators need to teach undergraduate/postgraduate students the issues around gambling and encourage universal screening 8 10/5/2018 Thank you Adam Searby RMIT University, Melbourne, Australia [email protected] 9.