Problem Gambling and Depression in the Asian Pacific Islander Community

Overview ◦ API Demographics ◦ Problem gambling in Oregon ◦ Problem gambling among Asian Pacific Islanders (API)

Panel Discussion ◦ Cultural context of gambling in the API community ◦ Treatment & intervention of problem gambling among APIs ◦ OHSU Intercultural Psychiatric Clinic as culturally

appropriate resource of APIs

Presented May 13, 2015 | OHSU Hospital Cultural Competency Lecture / Special Grand Rounds

Asian Pacific American Heritage Month

Definition of Asian Pacific Islanders (API):

Individuals of Asian or Pacific Islander descent Over half of Asians are foreign-born (54%) Over 68% speak a non-English language at home Largest Asian subgroups: ◦ Vietnamese (24%) ◦ Chinese (22%) ◦ Filipino (12%)

Preoccupation with gambling Needs to gamble with increasing amounts of money Has repeated unsuccessful attempts to control, cut back, or stop

gambling Is restless/irritable when attempting to cut down or stop gambling Gambles as a way to escape problems or relieve depression Lies to conceal extent of gambling Commits illegal acts (forgery, theft) to finance gambling Has jeopardized or lost significant relationships, jobs, or

educational opportunities because of gambling Relies on others to provide money or relieve desperate financial

situations

Depressed mood Loss of interest or pleasure in

activities most of the day, nearly

Significant weight loss or increase or decrease in appetite

Sleeping too much or too little

Feelings of restlessness or being

slowed down Fatigue or low energy

Feelings of worthlessness or

excessive guilt

Troubles thinking, concentrating or with decision-making

Recurrent thoughts of death, suicide with and without a plan

Experience daily, or nearly everyday:

In 2002 Oregonians spent $1.18 billion on all forms of gambling; $447 per adult; 25% more than the national average (Eco Northwest, 2005)

More than 74,000 Oregon adults (2.7% of all adults in the state) are believed to meet the criteria for being a current problem or pathological gamblers (Moore, 2006)

1.3% of Oregon youth are problem gamblers, and an additional 4.6% are at-risk gamblers. That means there are between 1,100 and 6,300 adolescents with severe gambling-related difficulties (Volberg, 2007)

25 - 50 percent of spouses abused 10 to 17 percent of children neglected or abused FY 07-08 of 2,012 receiving treatment in Oregon:

average gambling debt was $22,000 (underestimated) ◦ combined debt from gambling over $37 million ◦ 99 clients had debts of over $100,000 ◦ 57% jeopardized or lost a significant relationship or job ◦ 21% committed illegal acts to obtain gambling money ◦ 28% had alcohol problems; 12% drug problems ◦ 21% reported suicidal thoughts and 7% reported having

made an attempt

APIs are 3 times more likely than Caucasians to be problem gamblers (Welte et al., 2001) ◦ 2.8 times more likely to be develop problem gambling or

pathological gambling if you are a non-English speaker

Asian American university students had the highest rates of problem gambling (12.5% vs overall 4-5%; Lesieur et al., 1991)

Participation in Oregon state gambling services from 2009 to present (Moore, 2014)

Asian gamblers: 267 (under-estimated)

Counties with highest participation:

◦ Multnomah (112), Washington (64), Clackamas (24)

Gender: Male: 145 mean age: 41 Female: 120 mean age: 47

Males (%) Females (%) Lottery Retailer 44.3 52.0 IGC/Casino 32.9 41.3 Internet 5.1 0.0 Track 3.8 0.0 Home 2.5 0.0 Restaurant/Pub 0.0 2.7

Panel Q1: Are there cultural issues unique to API’s that contribute to problem gambling?

Many Asians are fascinated by the mystical qualities of luck, fate and chance

Chinese and Vietnamese New Year Many Asians -- especially Chinese and

Vietnamese -- consider gambling as acceptable at home and at social events, even among the young. Chinese youths often gamble for money with aunts, uncles and grandparents.

Similarities between Asian cultures Gambling = taking risks Acceptance of gambling as an entertainment

Culture of Acceptance, Availability, and Access

Traumatized Refugees •Painful memories •Difficult adaptation and acculturation •Socially Withdrawn or Isolated •Depression •Lack of knowledge in English, community resources and mental health services

Sensation Seekers •Risk Taking •Adventurous and stimulating lifestyle •Impulsive search of a new life •Competitive

Promotion of theme of good fortune Belief in luck and superstition Fate predetermined by ancestors = self-worth Numerology

Marketing forces

Panel Q2: What strategies have you found to be more effective with API’s who struggle with problem gambling?

Oregon has 27 outpatient gambling

treatment programs 3 crisis-respite programs 1 residential treatment program Free Treatment for gamblers and family

members

Please know help is available in English, Japanese, Vietnamese, Chinese, and Lao in Multnomah County. Please call this number 503-988-7872 or 1-877-MY_LIMIT for any help you may need. Help is free, confidential, and it works.

即使問題賭搏的負面後果巨大,在 美籍亞洲人它乃然是個不為人知 的上癮性健康問題. 在麥特努瑪區有提供各樣語文服務; 英, 中, 日, 越, 寮文, 如有

任何需要. 請致電話: 503-988-7872或 1-877-695-4648.所有提供的服務 都是免費, 保密,並能解决你的賭搏問題.

Mặc dù hậu quả của những thiệt hại to lớn do cờ bạc gây ra, nó vẫn còn là

một nạn ghiền mê ẩn trong cộng đồng người Mỹ gốc Á Đông. Xin lưu ý là có chương trình sẵn sàng giúp đỡ, với các thứ tiếng: Anh, Nhật, Việt, Quảng Đông và Quang Thoại trong QuậnMultnomah. Xin gọi số 503-988-7872 hay số 1-877-695-4648, bất kỳ bạn cần sự giúp đỡ nào. Giúp bỏ cờ bạc miễn phí, bảo mật và chắc chắn hữu ích.

Intercultural Psychiatric Program (IPP) Department of Psychiatry, OHSU

Dr. Paul Leung, Director

Established in 1977 by David Kinzie, MD, originally served mostly SE Asians (Vietnamese, Lao, Hmong, Mien, Cambodians)

Later added programs to serve Russians, Bosnians, Latino Hispanics, Somali, Ethiopian, Iranian, Kurdish

More recently, serves new immigrants from Burmese, Karen, Bhutanese, Nepalese

Our basic service delivery approach is to provide state-of-the-art psychiatric services in a way that both recognizes the particular cultural needs and tradition of our clients and that capitalizes on aspects of these cultural tradition that can be used to augment treatment and contribute to positive outcomes.

Outreach & Support Training & Education Building Relationships Receive Referrals Provide Treatment

8 Part-time psychiatrists 17 bilingual staff trained in mental health 20 languages

Treatment for mental health: Problem gambling, Post-traumatic stress disorder (PTSD), depression, psychosis, schizophrenia, etc.

Divorce/lost house/Bankruptcy Domestic/Child Protective

Panel Q3: How might depression contribute to problem gambling for API’s?

35.1% present with DSM/ICD 9 diagnosis other than problem gambling

18.7% Mood disorder 7.5% Substance related disorder 7.5% Anxiety disorder

Lesieur H.R., Cross J., Frank M., Welch M., White C.M., Rubenstein G., Moseley K., Mark M. (1991). Gambling and pathological gambling among university students. Addict Behav.,16(6):517-27.

Moore, T. (2014). Oregon gambling treatment programs evaluation update 2014. Salem, OR: Oregon Health Authority, Addictions and Mental Health Division, Problem Gambling Services.

Moore, T. (2006). The prevalence of gambling among adults in Oregon. Wilsonville, OR: Oregon Gambling Addiction Treatment Foundation

Welte, J.W., Barnes, G.M., Wieczorec, W.F., Tidwell, M. & Parker, J. (2001). Alcohol and gambling pathology among U.S. adults: Prevalence, demographic patterns and comorbidity, Journal of Studies on Alcohol, 706-712.

Volberg, R.A., Hedberg, E.C. & Moore, T.L. (2008). Oregon Youth and Their Parents: Gambling and Problem Gambling Prevalence and Attitudes. Salem, OR: Oregon Department of Human Services.

Greta Coe, CPS, Problem Gambling Services Manager, Oregon Health Authority

Thomas Moore, PhD, CEO, Herbert & Louis, LLC Maileen Hamto, Communications Manager, OHSU

Center for Diversity & Inclusion Rocio Pozo, Administrative Assistant, OHSU

Department of Psychiatry John McKinney, Tai Chi Master, American Style Tai-Chi http://www.americanstyletaichi.com/team.html