GAMBLING & OTHER

BEHAVIOURAL ADDICTIONS

I P H E 5 0 3 / 6 0 3 : I N T R O D U C T I O N T O P R A C T I S E I N A D D I C T I O N S

DENISE JOHNSTON, HOLLY KOSTIUK, MEAGAN THORNE & CHRISTINA TRAN

UNIVERSITY OF CALGARY

ORIGINS OF GAMBLING• Definition of Gambling: placing a possession(s) of value at risk with hope of gaining goods of

greater value

• Occurs in nearly all cultures in every period of time

• Historically, gambling was a benign social construct designed for luck-oriented rituals and social entertainment

• Historical Origins included:

• 1000 BC, India;

• 1600 BC, Egypt – evidence of dice and gaming boards

• 4000 BC, Hitties – horse race betting

• Sheep knuckle dice (https://www.youtube.com/watch?feature=player_detailpage&v=elUNJ4a_ISo) – used in Asia and Europe for adult dice games.

• King Richard I of England used gambling as means to maintain discipline amongst his soldiers. Only high ranking knights were permitted to gamble

• In the 16th and 17th centuries, England recognized gambling as a revenue generating method. One example was the first creation of lotteries, for the purpose of raising funds for the financing the colonization of North America (McMillan, J., 1996, pp. 6-8)

HISTORY OF GAMBLING IN CANADA

• During the18th century, gambling consisted of lotteries whose fundraising finances went towards public projects such as bridges, roads, churches and educational institutions

• Traditional aboriginal gambling was ritualistic; a part of religious ceremonies to ensure ritual outcomes

• During economic struggles, gambling provided a means for equality for survival;

• Gambling was discouraged if winnings were affecting others negatively

• Today, many aboriginal communities facilitate casinos; profits used for community improvements (i.e. schools, health centers)

• In 1985, provincial governments were given exclusive authority to govern computer and video gaming devices (i.e. VLTs, slot machines)

• Government policy for gambling was based on the intent to generate additional revenue without increasing taxation, to increase economic development primarily for leisure and entertainment, and to strengthen support for charitable gaming.

• In the 1990s, numbers of casinos, slot machines and video lottery terminals sky rocketed across Canada, therefore, increasing provincial government earnings. (Wardman et al, 2001, pp 82-83); Ferentzy et al. 2012, pp. 266 – 268);

EVOLUTIONARY IMPLICATIONS OF GAMBLING ADDICTION

• Until recently, developments in psychiatry a certain that gambling addiction contributes to key public health issues, including: gambling addiction, family dysfunction and youth gambling

• Early 20th century, problematic gambling was largely seen as the bi-product of alcohol abuse; both seen as moralistic problem rather than scientific. As such, treatment of the topic tended to be the target of church sermons theme of compulsion was often applied

• In 1972, Dr. Robert Custer, a psychiatrist working at a Veterans’ hospital in Ohio, IL, proposed that gambling be considered as a medical disorder, known as “compulsive gambling”

• In 1980, in an order to reduce guilt and stigma, gambling was officially included in the Diagnostic and Statistical Manual of Mental Disorders (3rd ed.; DSM-III; American Psychiatric Association [APA], 1980) as a disorder of ‘‘impulse control’’.

• Today, new technologies, enhanced accessibility, anonymity and marketing promotions of online gambling, is contributing to negative demographic, cultural and individual outcomes (Korn, D., 2000, p. 61-63); (Griffiths, 1999, pp. 265-268); (Tsitsika et al, 1999, pp. 389-391)

KEY TERMINOLOGY

• Persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress, as indicated by the individual exhibiting four (or more) of the following in a 12-month period:

• 1. Needs to gamble with increasing amounts of money in order to achieve the desired excitement.

• 2. Is restless of irritable when attempting to cut down or stop gambling.

• 3. Has made repeated unsuccessful efforts to control, cut back, or stop gambling.

• 4. Is often preoccupied with gambling (e.g., having persistent thoughts of reliving past gambling experiences, handicapping or planning the next venture, thinking of ways to get money with which to gamble).

• 5. Often gambles when feeling distressed (e.g., helpless, guilty, anxious, depressed).

• 6. After losing money gambling, often returns another day to get even (“chasing” one’s losses).

Gambling Disorder-Diagnostic Criteria in the DSM-5

GAMBLING DISORDER-DIAGNOSTIC CRITERIA IN THE DSM-5 (CONT’D)

• 7. Lies to conceal the extent of involvement with gambling.

• 8. Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling.

• 9. Relies on others to provide money to relieve desperate financial situations caused by gambling.

B. The gambling behavior is not better explained by a manic episode.

Measure of Severity: Mild: 4-5 criteria met.

Moderate: 6-7 criteria metSevere: 8-9 criteria met

(DSM-5. 2013. p.585)

RELEVANT PRACTISES

P r o b l e m G a m b l i n g S c r e e n i n g T o o l s :

CAMH Gambling Screen (Turner & Horbay, 2000) – Developed at the Centre for Addiction and Mental Health is a short screen to identify people who might have a gambling problem, but are not seeking treatment for the addiction. It can be used as a self-assessment tool, or as part of the screening process.

Canadian Problem Gambling Index (Ferris & Wayne, 2001) – This tool is designed to differentiate between levels of problem gambling.

- Scoring: 0 = non-problem, 1-2 = at risk, 3-7 = Moderate risk, 8-27 = Problem gambler

Check Your Gambling (Cunningham et al., 2009) – An anonymous five page questionnaire designed to help the individual or their families answer any questions about gambling.

GA 20 Questions (Gamblers Anonymous, n.d.) – A self-assessment “compulsive gambling” questionnaire developed by Gamblers Anonymous. *Caution, this tool has not been scientifically tested and validated.

South Oaks Gambling Screen (Lesieur & Blume, 1987) – This tool is a 20-item questionnaire used to screen for “pathological gambling” used in clinical settings. The South Oaks Gambling Screen – RA is a revised version that was developed to measure “pathological gambling” in adolescents

K N O W L E D G E A B O U T E V I D E N C E B A S E D P R A C T I S E

Cognitive-behavioural therapy (CBT) is the main evidence-based treatment for pathological gambling.

Problem gamblers differ from social gamblers in that they have cognitive distortions believing that gambling outcomes can be predicted and controlled.

CBT focused on challenging the content of the cognitive distortions.

Mindfulness practices, when used in conjunction with CBT, decrease relapse rates by assisting clients in examining how they relate to their thoughts.(Toneatto, Vettese & Nguyen, 2007)

Developing effective coping skills training programs for problematic gamblers and their families induce significant improvements in depression and anxiety levels;

-Utilizing MI strategies such as brief motivational and self-help interventions; community and clinical based that offer professional and peer supports and services (informal and formal) increase problematic gambling insight, awareness and education  

Solution focused brief therapy (SFBT) has also been found to be an effective treatment by therapists at the well-known Brief Family Therapy Center in Milwaukee, Wisconsin. (Berg & Briggs, 2002)

ISSUES

People with gambling problems may cover up or lie when asked where they have

been

Money missing / Debt

Neglect responsibilities

Mood swings – frequent highs and lows

Prefers gambling to a special family occasion

May seek new places to gamble close to home

CURRENT TRENDS• According to the University of Calgary’s Addictive Behaviour Laboratory Gambling is a $13 billion

a year industry in Canada.

• According to the Centre for Addiction and Mental Health gambling is Canada’s largest entertainment industry—it is about the same size as movies, TV, recorded music and professional sports combined.

• According to Marshall. K and Wynne. H Buying lottery tickets is the most common gambling activity engaged in by adults. Fighting the odds. Perspectives on labour and income, 4(12), 5-13.

• According to the University of Calgary’s Addictive Behaviour Laboratory Over 75% of Canadians have gambled in the past year.

• According to the University of Calgary’s Addictive Behaviour r Laboratory the average Canadian household spends just over $1000 annually on gambling.

• According to the Centre for Addiction and Mental Health the highest rate of moderate and severe gambling problems (6.9%) is among young adults, aged 18 to 24.4.

• According to the University of Calgary’s Addictive Behaviour Laboratory Up to 3% of Canadians suffer from a gambling problem (Cox et al., 2005). This rate is similar to the prevalence of alcoholism in Canada.

• According to the Canadian Community Health Survey in 2002 - of the estimated 18.9 million Canadians who gambled in 2002, 17.7 million were non-problem gamblers, while 1.2 million (5%) of the adult population had the potential to become problem gamblers or were already. Marshall, K., & Wynne, H. (2003). Fighting the odds. Perspectives on labour and income, 4(12), 5-13.

INTERPROFESS IONAL ISSUES Issue:

• ‘‘role blurring’’ resulting in role confusion as to where one’s practice boundaries begin and end, as some disciplines overlap; some feel underutilized, some feel overloaded

Solution:

• In collaborative practice, each team member assumes their respective role, while jointly identifying as a team, defining shared goals and responsibilities

• Goals must be harmoniously prioritized

• All must interact respectfully and openly with each other and with the individual and his/her family

• Familiarity of each team members’ expertise and functioning within the team must be exercised

Issue:

• Inter-professional issues of significance for screening, assessment and treatment approaches include: prevalence rates, at-risk populations, concurrent health issues, and possible physiological factors of problematic gambling

Solution:

• Intervention approaches, including client-focused recovery (vignette sharing), should involve disciplines pertinent to pharmacotherapies, family-centered counselling interventions, psychiatric services, behavioral and cognitive therapies, social services, vocational rehabilitation serves and possibly housing supports.

• Case information (clinical and non-clinical) should be shared (i.e. following FOIP protocol) when appropriate, as seamless treatment transitions benefit the delivery and coordination of services and supports

Issue:• Professionals personalities may unconsciously hinder the interprofessional team  as well as the

complex relationships involved.

Solution:• Commit to making team meetings if possible, and allow everyone's thoughts and ideas to be heard.

•Watch your coworkers body language, this is a great way to monitor changing emotions.•Know that being too assertive as well as not assertive enough can hinder the team – you can stand up for what you

believe in, without loosing your voice or overpowering everyone else.

QUESTIONS?? TO ANSWER THESE QUESTIONS PLEASE USE THE CONTENT OF THIS

POWERPOINT, FUNDAMENTALS OF ADDICTIONS - CHAPTER 20 & THE YOUTUBE VIDEOS PROVIDED:

Question #1: - Comment on what your thoughts are on the

changes in gambling from its historical beginnings to how it has developed and changed into what it is now known as today?

Question #2:-Comment on you r professional experience - present or future – and how you could use the material provided in the PowerPoint, to help a client who has a gambling or other behavioral addiction.?

OTHER BEHAVIORAL ADDICTIONS

SEXUAL ADDICTION

Sexual Addiction is a “psychological disorder defined by an inability to control sexual behavior” (Hook et al. 2010, p. 227). Hook et al (2010) argue that two dominant models, sexual compulsivity and sexual addiction are used to examine sexual disorder. The compulsivity model (Hook et al, 2010) argues that uncontrolled sexual behaviors are connected to obsessive-compulsive disorder (by participating in compulsive, sexually natured activities, an individual’s anxieties subside). The sexual addiction model (Hook et al, 2010) highlights similarities between characteristics of sexual addiction and the DSM criteria for substance use disorders (p. 228). Both models observe the following components of sexual addiction for further research for the purpose of being included within the DSM:

Individual experiences persistent, intense, sexually arousing fantasies, urges, or behaviors that cause clinically significant distress or impairment in at least one important area of functioning.

Symptoms are present for at least 6 months.

Condition is not due to another medical condition or better explained by another Axis I or II disorder.

• (Hook et al, 2010, p. 228)

SHOPPING ADDICTION

Definition:

• Compulsive buying is a chronic, repetitive purchasing

• that becomes a primary response to negative events and feelings, and may include symptoms equivalent to craving and withdrawal. Compulsive buyers experience irresistible and overpowering urges to purchase goods.

• Compulsive buyers strongly focus on the buying process itself and describe getting ‘high’ from the purchasing.

Prevalence:

Among US adults 6% of the population affected by compulsive shopping. (Sussman, Lisha & Griffiths, 2011)

Risk Factors and Vulnerable Groups

• Being female

• Having a history of depression, bipolar disorder substance use disorders, impulse control disorders

Common Negative Impacts:

• Financial problems

• Legal problems

• Psychological distress

• Interpersonal and marital conflict

(Lejoyeux & Weinstein, 2010)

VIDEO GAMING ADDICTION

• Kuss and Griffiths (2011) explain the risk factors for developing pathological gaming that includes personality styles marked by neuroticism, social isolation and diminished self-control, as well as mental health problems related to depression, anxiety and ADHD.

Ferguson, J. C., Coulson, M., & Barnett, J. (2011) A meta-analysis of pathological gaming prevalence and comorbidity with mental health, academic and social problems: Journal of Psychiatric Research. (p. 1573-1578)

Prevalence

- 2009: 10.3% of Ontario students reported having a pathological gaming problem (97,000 students): 16% male, 4% female. (Paglia-Boak et al., 2010)

- 8% displayed pathological patterns of addicted gaming among U.S. adolescents ages 8 to 18; higher rates among males. (Gentile, 2009)

INTERNET ADDICTION

Prevalence:

Shaw & Black (2008) state that problem internet use affects between 0.9 and 38% of youth

In a study of 3,450 high school students in USA ages 14-18 years, 4% have problematic internet use. (Liu et al., 2011)

2% of U.S. adults are affected in a 12-month period (Sussman et al., 2011)

Signs and Symptoms:

•Losing track of time online

•Having trouble completing tasks at work or home

•Isolation from family and friends

•Feeling guilty or defensive about your internet use

•Feeling a sense of euphoria while involved in internet activities

QUESTIONS?? TO ANSWER THESE QUESTIONS PLEASE USE THE CONTENT OF THIS

POWERPOINT, FUNDAMENTALS OF ADDICTIONS - CHAPTER 20 & THE YOUTUBE VIDEOS PROVIDED:

Question #3: - Please provide and give a brief description of one or

two resources (online/local/national) that would be available for an individual experiencing one of the other behavioural addictions mentioned in this PowerPoint.

OTHER VALUABLE RESOURCES YOU MAY WANT USE !

TedxTalks.  "How to Make a Behavior Addictive: Zoë Chance at TEDxMillRiver." (2014). http://www.youtube.com/watch?v=AHfiKav9fcQ

It’s Our Business, Alcohol, Other Drugs and Gambling: http://www.albertahealthservices.ca/AddictionsSubstanceAbuse/if-wrk-its-our-bus-the-basics.pdf

AHS website: Addiction Services Adult Counselling: http://www.albertahealthservices.ca/services.asp?pid=saf&rid=1093651

Gambling Specific Questionnaire From AHS : http://www.albertahealthservices.ca/AddictionsSubstanceAbuse/hi-asa-gamble-english.pdf

List of Addiction Services in Alberta – AHS: http://www.albertahealthservices.ca/services.asp?pid=stype&type=1

Problem Gambling Alberta: http://www.problemgamblingalberta.ca/index.php?area_id=1008

REFERENCES• Acosta. S. (2010). The Texas Tribune. Gambling Interests Push Lawmakers to Allow Casinos. Date retrieved: March 31st /

2014. Retrieved from: http://www.texastribune.org/2010/07/08/gambling-interests-push-lawmakers-to-allow-casinos/• American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

Arlington, VA: American Psychiatric Association.• Berg, I.K. & Briggs, J.R. (2002). Treating the Person with a Gambling Problem. Journal of Gambling Issues, 6, pp. not listed

(Feb,2002).• Block, J. (2008). Issues for DSM-V: Internet addiction. American Journal of Psychiatry, 165(3), 306-307.• Blakeslee. S. (2007). New York Times. A Small Part of the Brain, and Its Profound Effects. Retrieved: March 31st/2014.

Retrieved from: http://www.nytimes.com/2007/02/06/health/psychology/06brain.html?_r=0• Canada Safety Council. (N.D) Gambling Addiction. Date Retrieved: March. 24th, 2014. Retrieved from: https://

canadasafetycouncil.org/community-safety/gambling-addiction• Centre for Addiction and Mental Health. (2012) Problem Gambling:• Ferentzy, P., Turner, N. (2012). morals, medicine, metaphors, and the history of the disease model of problem gambling.

Journal of Gambling Issues, 4(27), pp. 1-27.• Griffiths, M. (1999). Gambling Technologies: Prospects for Problem Gambling. Journal of Gambling Studies, 15(3), pp. 265-

283• Hall, P. (2005). Interprofessional teamwork: Professional cultures as Barriers. Journal of Interprofessional Care, 1, pp. 188 –

196• HelpGuide.Org. Retrieved from: http://www.helpguide.org/mental/internet_cybersex_addiction.htm• Hook, J.N. , Hook, J.P., , Davis, D., Worthington Jr., E. & Penberthy, K. (2010) Measuring Sexual Addiction and Compulsivity: A

Critical Review of Instruments. Journal of Sex & Marital Therapy, Journal of Sex & Marital Therapy, 36(3), 227-260.

REFERENCES• Hook, J.N. , Hook, J.P., , Davis, D., Worthington Jr., E. & Penberthy, K. (2010) Measuring Sexual Addiction and

Compulsivity: A Critical Review of Instruments. Journal of Sex & Marital Therapy, Journal of Sex & Marital Therapy, 36(3), 227-260.

• Korn, D. (2000). Expansion of gambling in Canada: implications for health and social policy. Canadian Medical Association Journal, 163(1). Pp. 61-64

• Kuss, D. J., van Rooij, A. J., Shorter, G. W., Griffiths M. D., van de Mheen, D. (2013) Internet addiction in adolescents: Prevalence and risk factors: Computers in Human Behavior. (p. 1987-1996)

• Lejoyeux, M. & Weinstein, A. (2010) Compulsive Buying. American Journal of Drug and Alcohol Abuse, 36, 248-253.

• Littman-Sharp, N., Weiser, K., Pont, L., Wolfe, J., & Ballon, B. Found in Herie & Skinner (2014): What if it’s Not About a Drug? Addiction as Problematic Behaviour. (p. 481-520)

• Marshall, K., & Wynne, H. (2003). Fighting the odds. Perspectives on labour and income, 4(12), 5-13.

• McMillan, J. (1996). Gambling Cultures: Studies in history and interpretation. Routledge, NY:NY 10001

• Problem Gambling Institute of Ontario. (2014) About Gambling and Problem Gambling. Date Retrieved: March. 24th, 2014. Retrieved from: http://www.problemgambling.ca/EN/AboutGamblingandProblemGambling/Pages/default.aspx

REFERENCES

• Sussman, S., Lisha, N. & Griffiths, M. (2011). Prevalence of the addictions: A problem of the majority or the minority? Evaluation & the Health Professions, 34, 3-56.

• The Issues, the Options. Date Retrieved: March. 24th, 2014. Retrieved from: http://www.problemgambling.ca/EN/Documents/2845-PG_IssuesOptions_Dec08.pdf

• Tsitsika, A., Critselis, E., Janikian, M. & Kormas, E. (2011). Association Between Internet Gambling and Problematic Internet Use Among Adolescents. Journal of Gambling Studies, 27, pp. 389–400

• Toneatto, T., Vettese, L. & Nguyen, L. (2007) The Role of Mindfulness in the Cognitive- behavioural Treatment of Problem Gambling. Journal of Gambling Issues,19, pp. 91-100

• University of Calgary. (N.D) Addictive Behaviours Laboratory. Date Retrieved: March. 24th, 2014. Retrieved from: http://addiction.ucalgary.ca/gamblingincanada

• Wardman, D., el-Guebaly, N. & Hodgins, D. (2001). Problem and Pathological Gambling in North American Aboriginal Populations: A Review of the Empirical Literature. Journal of Gambling Studies, 17(2), pp. 81-100

• Westphal, J. (2008). How Well are We Helping Problem Gamblers? An Update to the Evidence Base Supporting Problem Gambling Treatment. International Journal of Mental Health and Addiction 6 (4), pp. 249–264

• Whelan, J. (2008). Review of Pathological Gambling: Etiology, Comorbidity, and Treatment. Journal of Gambling Issues, 21, pp. 113-116