Gambling and Youth Gambling and Youth Gambling IssuesGambling Issues

Presentation to Value Options EAP Presentation to Value Options EAP ProfessionalsProfessionals

July 24, 2008July 24, 2008

Keith Whyte, Executive DirectorKeith Whyte, Executive DirectorNational Council on Problem GamblingNational Council on Problem Gambling

About NCPGAbout NCPGThe national advocate for people The national advocate for people

affected by problem gambling.affected by problem gambling. NEUTRAL on legalized gambling.NEUTRAL on legalized gambling. Founded in 1972.Founded in 1972. National grassroots non-profit with National grassroots non-profit with

chapters in 36 of 50 states.chapters in 36 of 50 states. Work with government, gaming Work with government, gaming

industry & community.industry & community.

Core ProgramsCore Programs

National Helpline Network National Helpline Network (800.522.4700) (800.522.4700)

Nat’l Problem Gambling Awareness WeekNat’l Problem Gambling Awareness Week Annual Conference on Problem Gambling Annual Conference on Problem Gambling

Prevention, Treatment, Research & Prevention, Treatment, Research & Recovery (June 25-27, 2009, Indianapolis)Recovery (June 25-27, 2009, Indianapolis)

Public Awareness & MediaPublic Awareness & Media Certification AdministrationCertification Administration ADVOCACY!ADVOCACY!

Key Issues and Trends In:Key Issues and Trends In:

Gambling Today—Scope, Gambling Today—Scope, Participation & RevenueParticipation & Revenue

Problem Gambling—Definitions, Problem Gambling—Definitions, Prevalence, Risk Factors, Co-Prevalence, Risk Factors, Co-Occurring Disorders & Service Occurring Disorders & Service DeliveryDelivery

Focus on Youth GamblingFocus on Youth Gambling

Section I: GamblingSection I: Gambling

Scope, Participation & Scope, Participation & RevenueRevenue

What Is Gambling?What Is Gambling? Gambling is risking something of value on an Gambling is risking something of value on an

uncertain outcome. uncertain outcome. One of the oldest human behaviors, indeed, One of the oldest human behaviors, indeed,

an apt description for most human activity. an apt description for most human activity. 3 Prong Test: Prize, Chance, Consideration3 Prong Test: Prize, Chance, Consideration In the US, gambling is generally illegal In the US, gambling is generally illegal

unless a specific form has been specifically unless a specific form has been specifically legalized by government.legalized by government.

Legal in 48 states—what are the 2 without? Legal in 48 states—what are the 2 without? UtahUtah HawaiiHawaii

Are We a Nation of Are We a Nation of Gamblers?Gamblers?

Ever Gambled? 85%Ever Gambled? 85% Gambled in the Past Year? 65%Gambled in the Past Year? 65% Gambled at least weekly? 15%Gambled at least weekly? 15% But 35% of Americans believe that But 35% of Americans believe that

“gambling is morally wrong!”“gambling is morally wrong!” 1818thth century moral mindset & laws v. century moral mindset & laws v.

2121stst century entertainment & century entertainment & technologytechnology

Adult (18+) Risky Behaviors: Adult (18+) Risky Behaviors: Smoking, Gambling & DrinkingSmoking, Gambling & Drinking

Past yearPast year LifetimeLifetime

Tobacco UseTobacco Use 35%35% 71%71%

Alcohol UseAlcohol Use 64%64% 82%82%

GamblingGambling 65%65% 85%85%

2006 Gaming NM & US2006 Gaming NM & USNMNM USUS NM RevNM Rev US RevUS Rev

CasinosCasinos 2121 838399

$238 $238 millionmillion

$47.8 $47.8 billionbillion

RacingRacing 55 121233

$36.8 $36.8 millionmillion

$4.5 billion$4.5 billion

LotteryLottery 11 3737 $73.4 $73.4 millionmillion

$25.1 $25.1 billionbillion

CharitablCharitablee

?? ?? $12 million$12 million $1.5 billion$1.5 billion

TOTALTOTAL 2828 999999

$360 $360 millionmillion

$79 billion$79 billion

Legal Gambling Revenue Legal Gambling Revenue ($billions)($billions)

27

95

$0

$20

$40

$60

$80

$100

$120

$140

$160

$180

1998 2008 2018

To DateProjected

Trends & Issues:Trends & Issues:

Convergence of types of gambling.Convergence of types of gambling. Games become faster, more Games become faster, more

interactive, higher limits.interactive, higher limits. When will gaming participation and When will gaming participation and

revenues peak? Is there a saturation revenues peak? Is there a saturation point? point?

Will states and tribes continue to Will states and tribes continue to expand gambling? expand gambling?

Section II: Problem Section II: Problem GamblingGambling

Definitions, Prevalence, Risk Definitions, Prevalence, Risk Factors, Co-Occurring Factors, Co-Occurring

Disorders & Service DeliveryDisorders & Service Delivery

Working DefinitionsWorking Definitions Problem gambling: “Any gambling Problem gambling: “Any gambling

behavior that causes harm to the behavior that causes harm to the gambler or their family.”gambler or their family.” Gambler does NOT meet current clinical Gambler does NOT meet current clinical

criteria.criteria. Pathological gambling: “Severe and Pathological gambling: “Severe and

persistent problems with gambling persistent problems with gambling behavior, a serious mental health behavior, a serious mental health disorder.”disorder.” Gambler meets clinical criteria.Gambler meets clinical criteria.

Screening ToolsScreening Tools

NODS (NORC Diagnostic Screen)NODS (NORC Diagnostic Screen) CPGI (Canadian Problem Gambling CPGI (Canadian Problem Gambling

Index)Index) SOGS (South Oaks Gambling Screen)SOGS (South Oaks Gambling Screen) GA 20 (Gamblers Anonymous 20 GA 20 (Gamblers Anonymous 20

Questions)Questions) Lie/Bet ScreenLie/Bet Screen

10 Questions DSM IV10 Questions DSM IV You have often gambled longer You have often gambled longer

than you had planned.than you had planned. You have often gambled until your You have often gambled until your

last dollar was gone.last dollar was gone. Thoughts of gambling have caused Thoughts of gambling have caused

you to lose sleep.you to lose sleep. You have used your income or You have used your income or

savings to gamble while letting bills savings to gamble while letting bills go unpaid.go unpaid.

You have made repeated, unsuccessful You have made repeated, unsuccessful attempts to stop gambling.attempts to stop gambling.

You have broken the law or considered You have broken the law or considered breaking the law to finance your breaking the law to finance your gambling.gambling.

You have borrowed money to finance You have borrowed money to finance your gambling.your gambling.

You have felt depressed or suicidal You have felt depressed or suicidal because of your gambling losses.because of your gambling losses.

You have been remorseful after You have been remorseful after gambling.gambling.

You have gambled to get money to You have gambled to get money to meet your financial obligations.meet your financial obligations.

If you or someone you know If you or someone you know answers yes to any of these answers yes to any of these questions, consider seeking questions, consider seeking assistance from a professional assistance from a professional regarding this gambling behavior. regarding this gambling behavior.

Call 800.522.4700: Confidential & Call 800.522.4700: Confidential & toll free, 24/7-there is help and toll free, 24/7-there is help and hope available.hope available. Questions developed by NCPG from Questions developed by NCPG from

DSM-IV criteria. Probable pathological DSM-IV criteria. Probable pathological gamblers score 5+. Probable problem gamblers score 5+. Probable problem gamblers score 1-4.gamblers score 1-4.

Lie/Bet ScreenLie/Bet Screen Have you ever felt the need to bet Have you ever felt the need to bet

more and more money?more and more money? Have you ever had to lie to people Have you ever had to lie to people

important to you about how much important to you about how much you gambled?you gambled?

Yes to one or both classifies Yes to one or both classifies respondent as a pathological gamblerrespondent as a pathological gambler Johnson, et al, (1997) Psychological Johnson, et al, (1997) Psychological

ReportsReports

Problem Gambling RatesProblem Gambling Rates

In the past year, approximately 1% In the past year, approximately 1% of adults (3 million) meet criteria of adults (3 million) meet criteria for pathological gambling.for pathological gambling.

Past year, approximately 2-3% (6 Past year, approximately 2-3% (6 to 9 million) adults meet criteria to 9 million) adults meet criteria for problem gambling.for problem gambling.

Prevalence IssuesPrevalence Issues

States with stable or decreased rates States with stable or decreased rates had relatively larger PG programs.had relatively larger PG programs.

Gaming revenue, type of gambling, Gaming revenue, type of gambling, # of EGMs, proximity to venue, etc…# of EGMs, proximity to venue, etc…likely important but relationship likely important but relationship unclear. unclear.

No significant regional differences.No significant regional differences.

Bio-Psycho-Social Risk Bio-Psycho-Social Risk FactorsFactors

MaleMale AthleteAthlete 18-24 Yrs18-24 Yrs Substance useSubstance use Substance abuseSubstance abuse Other MH problemOther MH problem Family history of Family history of

addictionaddiction

Low SESLow SES Military ServiceMilitary Service Racial/Ethnic Racial/Ethnic

minorityminority Gamble illegallyGamble illegally Early onsetEarly onset Early big winEarly big win Easy access to Easy access to

gamblinggambling

Biological/Environmental Biological/Environmental FactorsFactors

Self controlledSelf controlled ImpulsiveImpulsiveRisk aversiveRisk aversive Prone to take risksProne to take risksPredisposed toPredisposed to No genetic MHNo genetic MHMH problemsMH problems predispositionpredispositionAbusive upbringing Abusive upbringing NurturingNurturingPoor schoolsPoor schools Good schoolsGood schoolsPoor social supportPoor social support Good supportGood supportAvailable gamblingAvailable gambling Restricted gamesRestricted gamesSevere stressSevere stress Absence of stressAbsence of stressPoor coping skillsPoor coping skills Good copingGood coping

SubtypesSubtypes

ActionAction More likely to be More likely to be

malemale Prefer “skill” Prefer “skill”

gamesgames NarcissisticNarcissistic Uses gambling to Uses gambling to

elevate moodelevate mood

EscapeEscape More likely to be More likely to be

femalefemale Prefer “continuous” Prefer “continuous”

gamesgames Uses gambling to Uses gambling to

withdraw “zone withdraw “zone out”out”

Co-Occurring Disorders Among Co-Occurring Disorders Among PGsPGs

35-60% of PGs lifetime criteria for SA.35-60% of PGs lifetime criteria for SA. Alcohol:Alcohol: PGs average 4x higher lifetime PGs average 4x higher lifetime

abuse rate than non-gamblers. abuse rate than non-gamblers. Drugs:Drugs: PGs average 30% lifetime PGs average 30% lifetime

abuse/dependence (6% gen. pop.)abuse/dependence (6% gen. pop.) Tobacco:Tobacco: PGs average 55% lifetime PGs average 55% lifetime

dependence.dependence. SA associated with greater severity SA associated with greater severity

of PG.of PG.

PG in SA PopulationsPG in SA Populations

Tx Seeking SA have 2-10x rate of PG Tx Seeking SA have 2-10x rate of PG than general population.than general population.

Dual diagnosis (SA & PG) have more Dual diagnosis (SA & PG) have more severe consequences (legal, social, severe consequences (legal, social, family)family)

DD have more severe psychiatric DD have more severe psychiatric symptoms (ADD, ADHD, ASPD)symptoms (ADD, ADHD, ASPD)

Prevalence of MH Disorders Prevalence of MH Disorders

Gen PopGen Pop PGsPGs Tx Tx Seeking Seeking PGsPGs

Any Any DisorderDisorder

8%8% 40%40% 60%60%

Maj. Maj. DepressioDepressionn

5%5% 20%20% 60%60%

BipolarBipolar 1.5%1.5% 10%10% 15%15%

SuicidalitySuicidality 5%5% 20%20% 50%50%

Warning SignsWarning Signs

Preoccupation with gamblingPreoccupation with gambling Inability to set a limit/stick to itInability to set a limit/stick to it Borrowing from co-workers/friendsBorrowing from co-workers/friends Unexplained financial difficultiesUnexplained financial difficulties Substance abuse/mental health problemsSubstance abuse/mental health problems Suggestions by others the employee may Suggestions by others the employee may

have a gambling problemhave a gambling problem Mood swings due to winning and losing Mood swings due to winning and losing

streaksstreaks

More Warning SignsMore Warning SignsHenry Lesieur, Ph.D. observed the following Henry Lesieur, Ph.D. observed the following

workplace behaviors as being correlated with a workplace behaviors as being correlated with a gambling addiction:gambling addiction:

Excessive use of telephones (to call bookmakers Excessive use of telephones (to call bookmakers or obtain credit) or obtain credit)

Taking the company vehicle to the casino, etc. Taking the company vehicle to the casino, etc. (parking tickets near gambling locations are a (parking tickets near gambling locations are a "red flag”) "red flag”)

Arriving late (related to all-night card games, Arriving late (related to all-night card games, anxiety-related sleep disturbances) anxiety-related sleep disturbances)

Failure to take days off (obsessed with getting Failure to take days off (obsessed with getting money to pay gambling debts or afraid to leave money to pay gambling debts or afraid to leave because embezzlement or fraud may be because embezzlement or fraud may be discovered in their absence) discovered in their absence)

Organizing office pools and gambling junkets Organizing office pools and gambling junkets Embezzlement, defrauding customers Embezzlement, defrauding customers

Workplace GamblingWorkplace Gambling 19% of all workers (but 1/3 of 19% of all workers (but 1/3 of

professionals, business & financial services professionals, business & financial services workers) participated in March Madness workers) participated in March Madness pool, 24% paid more than $10 to enter pool, 24% paid more than $10 to enter (CareerBuilder.com, 2008)(CareerBuilder.com, 2008)

66% of callers to an EAP program 66% of callers to an EAP program indicated employees gamble in their indicated employees gamble in their workplace, 46% said it negatively impacts workplace, 46% said it negatively impacts productivity (hr.blr.com, 2006).productivity (hr.blr.com, 2006).

Casino employees have higher rates of Casino employees have higher rates of gambling problems, smoking, alcohol use gambling problems, smoking, alcohol use & depression (Am J Ind Med, 1999)& depression (Am J Ind Med, 1999)

Social CostSocial Cost Losses to individuals.Losses to individuals. Problem gamblers generate costs for Problem gamblers generate costs for

society—crime, bankruptcy, divorce, society—crime, bankruptcy, divorce, etc...etc...

U.S. National Gambling Impact Study U.S. National Gambling Impact Study Commission (1999): Commission (1999): $1,200 per adult pathological gambler.$1,200 per adult pathological gambler. $715 per adult problem gambler.$715 per adult problem gambler.

2008 U.S. Estimate: 2008 U.S. Estimate: $6.7 billion$6.7 billion

Treatment Works, If Treatment Works, If AvailableAvailable

Only about 1% of current pathological Only about 1% of current pathological gamblers seek treatment in a given gamblers seek treatment in a given year nationwide v. 20% of substance year nationwide v. 20% of substance abusers.abusers.

States with well funded PG programs States with well funded PG programs have much higher rates of treatment have much higher rates of treatment seeking (4% in OR, 4-10% in IA)seeking (4% in OR, 4-10% in IA)

IA: 61% abstinent at followup. IA: 61% abstinent at followup. OR: 63% not gambled for at least 6 OR: 63% not gambled for at least 6

mos at 1 year followup.mos at 1 year followup.

CounselingCounseling

Several national specialty Several national specialty certifications.certifications.

General state & national MH/SA General state & national MH/SA certifications do not include problem certifications do not include problem gambling training.gambling training.

Not routinely reimbursed by state or Not routinely reimbursed by state or private insurance (54% have private insurance (54% have coverage, but only 9% used it).coverage, but only 9% used it).

Life Skills & Help for Life Skills & Help for FamiliesFamilies

Prevention programsPrevention programs Financial guidesFinancial guides Conflict between GA pressure relief & Conflict between GA pressure relief &

credit counselingcredit counseling Some treatment programs include Some treatment programs include

family therapy.family therapy. Spouses can be liable for unpaid Spouses can be liable for unpaid

taxes on gambling winnings.taxes on gambling winnings.

PG Specific PG Specific Residential/InpatientResidential/Inpatient

10 centers (incl. VA) Less than 10 centers (incl. VA) Less than 100 beds for 3 million pathological 100 beds for 3 million pathological gamblers.gamblers.

Who is payor of last resort?Who is payor of last resort? VA 1 Year followup: 55% abstinent VA 1 Year followup: 55% abstinent

for 1 year + 27% abstinent at least for 1 year + 27% abstinent at least 1 month 1 month

Services ImplicationsServices Implications

Tx for PG may be less expensive than Tx for PG may be less expensive than substance abuse (no medical detox)substance abuse (no medical detox)

Majority seem to be effectively Majority seem to be effectively treated in outpatient settings.treated in outpatient settings.

Public/private partnerships are the Public/private partnerships are the dominant method of service delivery.dominant method of service delivery.

National Problem National Problem Gambling Gambling Awareness Week Awareness Week

March 2-8, 2009March 2-8, 2009

www.npgaw.orgwww.npgaw.org 50+ free 50+ free

materialsmaterials Screening toolsScreening tools PostersPosters FlyersFlyers BrochuresBrochures Press releasesPress releases StoriesStories

Section III: Youth Section III: Youth GamblingGambling

Kids Today…Kids Today… Increasing Majority of Youth Gamble Increasing Majority of Youth Gamble

(approximately 70% in past year, average (approximately 70% in past year, average prior to 1988 was 45%, between 1988 and prior to 1988 was 45%, between 1988 and 1999 65%)1999 65%)

First generation of kids to grow up with: First generation of kids to grow up with: unprecedented levels of legalized gambling (in unprecedented levels of legalized gambling (in

1976 less than a dozen states allowed gambling1976 less than a dozen states allowed gambling—48 plus more than 250 tribes today); —48 plus more than 250 tribes today);

pervasive promotion (state lotteries alone spent pervasive promotion (state lotteries alone spent $400 million on advertising in 1999);$400 million on advertising in 1999);

high rates of implicit parental endorsement high rates of implicit parental endorsement (over 50% gamble with family members, 78% (over 50% gamble with family members, 78% gamble in own homes)gamble in own homes)

Adults Adolescents College

Casino 14.9% 12.5% 60.8%

Lottery 49.0% 30.1% 60.1%

Sports 14.7% 30.6% 30.5%

Parimutuel 7.1% 11.2% 8.9%

Cards 15.8% 39.6% 36.1%

Skill Games 10.2% 31.6% 23.9%

Past Year Prevalence of Past Year Prevalence of GamblingGambling

Gambling Participation (14-Gambling Participation (14-17)17)

0%

5%

10%

15%

20%

25%

30%

35%

40%

2002 2003 2004 2005 2006 2007

Cards/ MonthAll Gamb/ MonthCards/ WeekAll Gamb/ Week

Gateway?Gateway?

May be the “gateway” activity as age May be the “gateway” activity as age of onset for gambling is earlier than of onset for gambling is earlier than all other risky behavior.all other risky behavior.

Youth who gamble have higher rates Youth who gamble have higher rates of substance use, drunk driving, of substance use, drunk driving, delinquency, sexual behavior and delinquency, sexual behavior and other antisocial behavior. other antisocial behavior.

Maybe it is because kids become Maybe it is because kids become accustomed to and enjoy risk taking accustomed to and enjoy risk taking learned in gambling? learned in gambling?

Youth Problem GamblingYouth Problem Gambling

Approximately 4-6% of youth (< 17) Approximately 4-6% of youth (< 17) meet criteria for a gambling problem.meet criteria for a gambling problem.

Risk factors include: male, low SES, Risk factors include: male, low SES, other risk taking behavior, other risk taking behavior, racial/ethnic minority.racial/ethnic minority.

Extremely low rate of Extremely low rate of awareness/treatment seeking. awareness/treatment seeking.

Early OnsetEarly Onset

All use starts recreationally, but may All use starts recreationally, but may lead to abuse.lead to abuse.

Earlier the age of onset for gambling, Earlier the age of onset for gambling, the greater risk for a gambling the greater risk for a gambling problem (pathological gamblers in problem (pathological gamblers in treatment report onset at 11 years). treatment report onset at 11 years).

BWI Airport, Across from Play BWI Airport, Across from Play AreaArea

Who Is Most Likely To Play Who Is Most Likely To Play Poker?Poker?

Annenberg SurveysAnnenberg Surveys 2.9 million youth play cards in 2.9 million youth play cards in

average week.average week. Monthly card playing jumped 20% Monthly card playing jumped 20%

to 42%. to 42%. 580,000 between 14 and 22 gamble 580,000 between 14 and 22 gamble

on Internet on a on Internet on a weeklyweekly basis. basis. 44% of weekly gamblers report 44% of weekly gamblers report

either preoccupation, over-either preoccupation, over-spending, tolerance or withdrawal. spending, tolerance or withdrawal.

Does Normal Brain Does Normal Brain Development Encourage Development Encourage Gambling (& Other Risky Gambling (& Other Risky

Behavior) ?Behavior) ?> risk taking (particularly in groups)> risk taking (particularly in groups)

> propensity toward low effort - high > propensity toward low effort - high excitement activitiesexcitement activities

< capacity for good judgment & < capacity for good judgment & weighing consequencesweighing consequences

> sensitivity to novel stimuli….> sensitivity to novel stimuli….

• Adolescence is a Adolescence is a period of period of profound brain profound brain maturation.maturation.

• It was believed It was believed

that brain that brain

development was development was

complete during complete during

childhoodchildhood

• The maturation The maturation

process is not process is not

complete until complete until

about age 24.about age 24.

Involvement in Addictive Involvement in Addictive BehaviorsBehaviors

Total useTotal use Weekly useWeekly use

7th7th 9th9th 11th11th 7th 7th 9th9th 11th11th

AlcoholAlcohol 37%37% 62%62% 80%80% 7% 7% 14%14% 20%20%

DrugsDrugs 4%4% 13%13% 27%27% 3% 3% 2% 2% 9% 9%

CigarettesCigarettes 18%18% 35%35% 48%48% 7% 7% 16%16% 31%31%

GamblingGambling 79%79% 79%79% 83%83% 30%30% 37%37% 37%37%

Kids have access to formal (credit cards), Kids have access to formal (credit cards), informal (bookies) and illegal (stealing) informal (bookies) and illegal (stealing) means of financing gambling.means of financing gambling.

Losses are “real” only when gambling Losses are “real” only when gambling stops, until then the problem gambler is stops, until then the problem gambler is just the next bet away from winning just the next bet away from winning everything back. everything back.

ProblemGambling

Chase Losses

Truancy/Delinquency

Stealing Money

Lying about

Gambling

Preference for

Gambling

Gamble to Escape

Gambling Problems

Family/Peer

Problems

The Good News: There is Hope The Good News: There is Hope and Helpand Help

While the majority of Americans While the majority of Americans gamble, most never develop problems.gamble, most never develop problems.

A total of 3-4% of the general A total of 3-4% of the general population will experience problems population will experience problems with their gambling in a given year. with their gambling in a given year.

PG often clusters with other problems. PG often clusters with other problems. PG is a treatable disorder, like all PG is a treatable disorder, like all

addiction most efficiently and addiction most efficiently and effectively when detected early. effectively when detected early.

National Council on National Council on Problem GamblingProblem Gambling

216 G Street, NE 2nd Floor216 G Street, NE 2nd FloorWashington, DC 20002Washington, DC 20002

Tel: 202.547.9204Tel: 202.547.9204Fax: 202.547.9206Fax: 202.547.9206

Email: Email: keithw@ncpgambling.orgkeithw@ncpgambling.org

Web: www.ncpgambling.orgWeb: www.ncpgambling.org