PROBLEM GAMBLING
As a
CO-OCCURRING DISORDER
2007 Co-Occurring Disorders Conference
October 1-2, 2007
Linda Graves
Problem Gambling Program Manager
Division of Alcohol and Substance Abuse
DSM-IV criteria
Pathological Gambling 312.31
A. PERSISTENT AND RECURRENT MALADAPTIVE
GAMBLING BEHAVIOR AS INDICATED BY AT
LEAST FIVE OF THE FOLLOWING:
1. Is preoccupied with gambling
2. Needs to gamble increasing amounts of money in order
to achieve the desired excitement
3. Has repeated unsuccessful efforts to control, cut back,
or stop gambling
DSM-IV criteria
Pathological Gambling 312.31
4. Is restless or irritable when attempting to cut down or
stop gambling
5. Gambles as a way of escaping from problems or of
relieving a dysphoric mood
6. After losing money gambling, often returns another day
in order to get even
7. Lies to family members, therapist, or others to conceal
the extent of involvement with gambling
DSM-IV criteria
Pathological Gambling 312.31
8. Has committed illegal acts, such as forgery, fraud,
theft, or embezzlement, in order to finance gambling
9. Has jeopardized or lost a significant relationship, job,
or educational or career opportunity because of
gambling
10. Relies on others to provide money to relieve a
desperate financial situation caused by gambling
B. THE GAMBLING BEHAVIOR IS NOT BETTER
ACCOUNTED FOR BY A MANIC EPISODE.
pathological gambling and
substance use disorders
Alberta, Canada (Bland, Newman, Korn and
Stebelsky, 1993)
• General population study
– 20% of non-gamblers identified themselves as
having a substance abuse disorder
– Over 50% of those identified as pathological gamblers
by the survey also had a substance use disorder
pathological gambling and
substance use disorders (2)
Texas--Feigelman, Wallisch, and Lesieur (1998)
• Among all respondents that were problem or
pathological gamblers, 1/3 also had a substance
use problem
Feigelman et al (1998) also explored the converse
situation.
• Among respondents who had a substance use
disorder, 20.1% also had a gambling problem
pathological gambling and
substance use disorders (3)
National study, Petry, Stinson, and Grant (in
publication)
• Found a strong association between
alcohol and gambling disorders.
• Rates of alcohol abuse or dependence at
four or more times higher among
individuals identified as having a gambling
disorder compared to those without the
gambling disorder
pathological gambling and
substance use disorders
In most cases, substance use disorders
were in the past, not current with gambling
disorders.
Connecticut, clients seeking treatment for
gambling problems, about 10% reported
current illicit drug use or regular heavy use
of alcohol.
pathological gambling and
substance use disorders
IMPORTANT NOTE:
• Treatment seeking gamblers with a history
of substance use disorders tend to have
– More severe gambling problems
– Psychiatric symptoms
– Other psychosocial difficulties
Than gamblers without histories of substance
use problems
(Petry, 2004)
pathological gambling and
substance use disorders
Ladd and Petry (2003)
Compared the 31% of gamblers with substance
abuse histories with the remainder without such
histories.
• More years of gambling problems
• More frequent gambling activity
• More likely to be receiving tx for mental health
problems
• Reported greater psychiatric distress than
gamblers without prior substance abuse
problems.
pathological gambling and
substance use disorders
Langenbucher et al.(2001)
In a mixed sample of substance abusers,
• Higher nicotine dependence scores
• More frequent use of alcohol
• More alcohol and other drug dependence
symptoms
In the pathological versus the non-
pathological gamblers
pathological gambling and
nicotine use
Smart and Ferris (1996)
• 41.6% of heavy gamblers were smokers
• 30.1% of recreational gamblers were
smokers
• 21.3% of non-gamblers were smokers
• This study is 11 years old.
pathological gambling and other
psychiatric disorders
Mood disorders and suicidality
Is the client depressed because
of his or her gambling?
OR
Is the client treating a mental health
problem by self-medicating
with gambling?
pathological gambling and other
psychiatric disorders
Petry, Stinson, and Grant (in publication)
43,000+ surveyed
195 pathological gamblers
• 49.6% had lifetime prevalence of any affective disorder
Compared to 18.5 % in non-gamblers
• 37% of pathological gamblers had major depression
Compared to 12.3 % of non-gamblers
• 22.8% of pathological gamblers had bipolar disorder
Compared to 2.5% of non-gamblers
pathological gambling and other
psychiatric disorders
College students and suicide
Ladouceur, Dube’, and Bujold (1994)
1471 college students
26.8% of pathological gamblers had
attempted suicide compared to 7.2% who
were not pathological gamblers.
Many studies report high rates of suicide
ideation and suicide attempts in gamblers.
pathological gambling and other
psychiatric disorders
• Anxiety disorders
The research is not conclusive regarding anxiety
disorders being elevated among pathological
gamblers. Studies can be shown that indicate
no higher rates than among the general
population (Ibanez et al, 2001; Blaszczynski and
McConaghy, 1989) while others show high rates
of generalized anxiety disorders (Black & Moyer,
1998; Specker, 1996, and others)
pathological gambling and other
psychiatric disorders
• Studies have been done regarding OCD
and PTSD. The numbers in the studies
were very small, and have not been
replicated, so further research is needed
before any conclusions can be drawn.
• This is also true for other psychotic
disorders. If studies exist at all, the
sample sizes are too small to draw
conclusions.
So. . .
What can we learn from all of this?
CONCLUSION?
Research presents enough data to show
both clients with substance use disorders
and
mental health disorders need to be screened
for
gambling problems.
I CAN’T DO ONE MORE
ASSESSMENT. I HAVE TOO
MUCH TO DO ALREADY!
I DON’T
HAVE TIME.
I DON’T want to
know if they have
another problem. I DON’T KNOW H
Just
LEAVE ME
ALONE!!
TWO THINGS: THAT’S ALL IT
TAKES
• Lie/Bet Screen
– Have you ever felt the need to bet more and
more money?
– Have you ever had to lie to people important to
you about how much you gambled?
Help your client make a call to get help if they
answer affirmatively to either of the two questions.
1-800-547-6133
•24/7
•Live voice response 24 hrs a day
•Will send literature
•Offer resources in caller’s area
•Will offer locations of GA meetings
Problem Gambling Treatment Provider Locations
Bellingham (2)
Burlington (3)
Mt. Vernon (8)
Tulalip( 16)
Spokane (12)
See
Map Inset Of Puget
Sound Area
Skokomish (11)
Montesano (7)
Olympia (9)
Tumwater (17)
Yakima (19)
Vancouver (18)
INSET MAP
Kirkland (5)
Bellevue (1)
Seattle (10)
Renton(9)
Tukwila (15)
Kent (4)
Lakebay (6)
Tacoma (14)
Sumner (13)
Publicly Funded Treatment
July, 2007
Page 2
12. Spokane: 15. Tukwila:
Camas Institute Behavioral Health Seattle Mental Health
Services, 509-456-0799 800-828-1449
youth and adults
Henry Montgomery, Ph. D.
509-744-0778 16. Tulalip/ Everett:
youth and adults Tulalip Tribes Family Services
360-651-4400
New Horizon Counseling Services
509-838-6092 ext. 32 17. Tumwater:
A Healthy Risk
13. Sumner: 360-352-1052
The Center
253-863-0682 ext. 2 18. Vancouver:
youth and adults Community Services Northwest
Northwest Recovery Center
360-397-8488 ext. 7915
14. Tacoma:
Metropolitan Development Council 19. Yakima:
(The Center) Center for Counseling and Psychotherapy, LLC
253-593-2740 509-966-7246
youth and adults
Triumph Treatment Services
Tahoma Counseling Services 509-248-1800
253-572-5035
Dr. Carmela Washington-Harvey
youth and adults
253-852-3666
Publicly Funded Treatment
July, 2007
1. Bellevue: 5. Kirkland:
Coastal Treatment Services Youth Eastside Services
425-646-4406 425-747-4937
youth and adults adolescents 12-20 years old
Consejo Counseling 6. Lakebay (Key Peninsula):
425-746-4512 .Key Counseling
Spanish and English 253-884-4860
Youth Eastside Services 7. Montesano:
425-747-4937 A Healthy Risk
adolescents 12-20 years old 360-249-2297
8. Mt. Vernon:
2. Bellingham: Phoenix Recovery Services
Verry-Uhl Associates 360-848-8437
(360) 676-4999 youth and adults
.
3. Burlington: 9. Renton:
Follman Agency Donna Whitmire
360-755-1125 425-227-0447
Youth and adults
10. Seattle:
Asian Counseling and Referral Services
4. Kent: 206-695-7511
Dr. Carmela Washington-Harvey
253-852-3666
youth and adults 11. Skokomish/Shelton:
Skokomish HOPE Alcohol & Drug Program
360-426-7788 ext. 200
Seattle Mental Health – Kent Spanish and English
youth and adults youth and adults,
800-828-1449 All are Welcome!
Linda Graves
Problem Gambling Program Manager
gravell@dshs.wa.gov
360-725-3813