Older Adults _ Problem Gambling - Problem Gambling in California by niusheng11


									 Issues Associated with Mental
   Health in Older Adults:
     Problem Gambling

          Debbie Rull, M.A., CCGC-I, NCGC-I
Project Coordinator, UPAC Problem Gambling Prevention

UPAC Problem Gambling Prevention TA and Training Project
Funded by the State of California Office of Problem Gambling
•   Prevalence
•   Progression
•   Characteristics
•   Risk Factors
•   Signs & Symptoms
•   Assessment & Diagnosis
•   Clinical Issues & Treatment
•   Responsible Gambling Guidelines
•   Resources
            Age 65 and Older
• 10.5% (3.8 million) of California:
  the higher number than any other states
  – Florida (2.9 million)
  – New York (2.5 million)
  – Texas (2.2 million)    (2005 US Census Bureau)

• 3.8% (135) California helpline callers were age
  66 and older. (2009 CCPG)
     Older Adult Gamblers - Facts

• This fastest-growing age group
  is gambling more than ever.
• Average adult age 65+ has 7.7 free hours per day.
• Older adults now form the largest group of annual
  visitors to Las Vegas.
• Among adults over 65, gambling is the most frequently
  identified social activity.
 Types of Gambling in California
 State lottery (18,000+ locations)
 Card rooms (102)
       1,515 gaming tables

 Indian casinos (58)
     58,100 slot machines
     1,820 gaming tables
   Horse Tracks (33 includes simulcast facilities)
   Sports bets
   Internet (estimated 2,300 online gambling sites)
   Cell phone gambling (the next wave)
   Bingo and other charitable gaming
   Cockfights, dog fights, numbers
         Older Adults - Types of
          Gambling Activities
•   Casino
•   Slot Machines
•   Lottery-Keno
•   Bingo
•   Sweepstakes

• Other: cards, horses,
  sports, internet
    Gambling: Past and Present
PAST                                NOW
Mainly a male activity              All people regardless of age &
An activity that displayed          A recreational activity
skills and socio-economic power

Less accessible and often illegal   Widely available, and mostly legal

Smaller wins, less variety          Big wins, more variety

Simpler to understand               More complex and harder to
                                    understand with modern
         Gambling in Recent Years
Gambling: incredibly accessible and attractive.
• life changing amount of $ to be won
• glamorous casinos
• advanced technology

    “The changes are so rapid that many of us are ill-
    equipped to deal with them. This can make us vulnerable
    to problem gambling and its effects.
     Problem gambling can bring severe consequences for
    individuals, families and communities.”

Addictions Foundation of Manitoba 2001
“Gambling behavior which causes disruptions in any
major area of life: psychological, physical, social or
    (National Council on Problem Gambling)

A chronic disorder that results in the loss of control
                  over gambling
   California Prevalence Survey

n=7,121 respondents, 18 years and older
Problem gambling        2.2%
Pathological gambling 1.5%
  – Almost 1 million problem/pathological
  – Another 2.5 million at risk
  – CA is 37% higher than the national rate
California Prevalence Survey 2006
Age       # of    At Risk   Problem Pathologic
          Respond %         %       al %
General   7121    9.5       2.2     1.5

Age 65    1432     6.9      2       0.5
Older Adults & Problem Gambling
 Types of Gamblers:
 Action & Escape
Action gambler: addicted to
  the thrill of risk-taking,
  perceived skill & identity as
  a “winner.”
• Engages in competitive
  games (poker, sports bets,
• Starts gambling at a young
  age & progress through          13
   Action & Escape Gamblers

Escape gambler: seek to blot out
  uncomfortable feelings or situations.
• Prefer singular outlets (slot machines &
  video poker).
• Becomes a problem later in life
• Faces faster progression, often becoming
  problematic almost immediately, hitting
  bottom within 1-3 years.
           Machine Gambling = “Crack
             Cocaine of Gambling”

                                            Video poker/slots
                                            Internet
                                            Click & Play Lottery games

                                            Quickest road to addiction: 15
                                               Impulsivity
                                               Isolation
                                               Intermittent rewards         :

                                                       rapid reinforcement patterns of
                                                        unpredictable small wins
                                                        generate excitement &
                                                        encourage continued play.

   Can bet $4.50 every 5 seconds on a ¢5 machine
         Older Adult Gamblers
Many older adult gamblers reported:
• Major financial losses, family crises, and
  suicidal ideation
• Fewer non-gambling activities, poorer
  mental health, lower income and less
  social support (Zarenek & Chapleski,
• Lower expenditure on gambling but
   higher sense of guilt (Robert Williams,
             Older Adult Gamblers
Less likely to seek help:
• View treatment more negatively than other age groups
• Have much shame/stigma
• View the problem as lack of moral strength or will power
  (“bad” or “weak”)
• Be unnoticed until later stages due to their isolated living
• Have higher suicide ideation rate due to physical illness,
  functional impairment, and lack of social support
• Most likely to ban themselves from casinos because of
  their fear of suicide                       (Nower, 2009)
          Older Adult Gamblers - Risk
Gambling can become a coping mechanism
  after a life change:
• Onset of retirement and unstructured time
• Loss of family members and other supports
• Memory challenges
• Physical limitations
• Lack of alternative activities
• Feelings of isolation
• Inability to recover financial losses
• Marketing by gambling industry
• Recreational offerings by senior centers and
  other organization
      (Florida Council on Compulsive
             Older Adults Gamblers
                  Risk Factors
Marketed by the gaming industry:
•   provide transportation
•   easy entry to facility
•   easy access to machines
•   wheelchair access
•   incentives for frequent players:
    –   money to gamble
    –   free meals
    –   free accommodation
    –   even discounts on prescription drugs (in Canada)
Link between Parkinson’s Meds and
       Compulsive Behaviors
New research found certain medications to treat
both Parkinson’s Disease and Restless Leg
Syndrome (RLS) may cause compulsive
behaviors such as:
  –   pathological gambling
  –   compulsive shopping
  –   binge eating
  –   compulsive sexual behavior
                    (2010 University of
Older Adult Gamblers – Parkinson‟s
A study was conducted at the National Institute for
Neurologic Diseases and Stroke in MD in 2006
• 300 Parkinson patients with levodopa or
  dopamine agonists treatment
• 10 patients developed pathological gambling
  (3.4 %) double the number based on population-
  wide surveys
• Lost an average of $150,000
• 7 patient hypersexuality
• 2 patients compulsive shopping
               (2006 American Academy of
Older Women & Problem Gambling
• The National Advisory Council on Aging indicates
  that women living alone are especially vulnerable.
• In a study of the link between caregiving
  responsibilities and compulsive gambling, many
  older women begin gambling as a means of
  reducing the social isolation they feel. However, as
  the problem progresses, most women gamble alone
  and further increase their isolation.
• “Many women gamble in search of a way to numb
  emotions, shut out the world, and orchestrate a time
• “It‟s an opportunity to be around other
  people. You‟re treated well. The parking
  lots are well lit. The marketing is very
  friendly to seniors. The people at the
  casino learn and call you by name. It can
  be a nice feeling.”
      Older Adults - Barriers to
     Getting Help (Lemay, 2002)
• Transportation issues
• Psychological health issues (e.g., depression &
• Physiological health issues (e.g., mobility
  limitations, acute/chronic conditions)
• Cultural practices &/religious beliefs
• Comfort issues (e.g., time to travel to services,
  difficulty sitting in office chairs)
• Lack of independent living (lack of privacy or use
  of vehicle)
         Older Adults - Signs Of
           Problem Gambling
  – Less money available for outings with friends and
    family, buying gifts for grandchildren, or to meet their
    basic needs.
  – Many unexplained unpaid bills, i.e.: phone,
    rent/mortgage, house and car insurance.
  – Constantly receiving phone calls from collection
    agencies & subsequently not answering their phone.
  – Money missing in their bank account; they have
    cashed in their IRA‟s and life insurance.
  – Valuables disappearing.
  – Asking to borrow money and focuses only on money
         Older Adults - Signs Of
           Problem Gambling
 – Slowly withdraw from family or social events.
 – Neglect their daily household duties and
   personal needs.
 – Disappear for many hours at a time.
 – Shift all their interest on gambling activities.
 – A change of eating and sleeping habits.
 – A decline in physical and emotional health.
       Older Adults - Signs Of
         Problem Gambling
 – Decrease contact with family and friends
   except to ask for money.
 – Seem more depressed to family members
   and friends.
 – Always appear to be very busy.
 – Secretive about their whereabouts and their
   daily activities, as well as avoid answering
   any uncomfortable questions.
   Physical Health/Older Adults
• Fail to take care of one‟s needs when gambling such as:
    eating properly,
    taking needed medication,
    taking needed breaks
• Back and neck pain
• Sleep disorders
• High blood pressure (untreated then Stroke, kidney
  failure, and heart attack)
• Heart and lung disease
                   (Florida Council on Compulsive

• Reported overall poor physical health (2007 Desai)
     Mental Health/Older Adults

Among older adult problem gamblers:
• 40% Mood Disorder (depression, bi-polar)
  among general population: 20% attempted
 suicide (DSM IV)(GA Survey)
• 35% Anxiety Disorder (phobia, social
  phobia, generalized anxiety disorder)
• 43% Personality Disorder (anti-social,
  schizoid, obsessive-compulsive)
                               (2007 Grant, Petry)
Substance Addictions/Older Adults
Among older adult problem gamblers:
 43.2% Nicotine Dependence
 53.2% Alcohol/Abuse Dependence
 4.6% Non-Alcohol Drug disorder
                 (2007 Grant, Petry)
Diagnosis & Assessment
    2-Question Gambling Screen

• 2-Question Screening Tool (lie/bet):
   1) Have you ever felt the need to bet more and more
   2) Have you ever had to lie to people important to you
     about how much you gamble?

Answering “yes” to 1 or both questions suggests a problem deserving
further assessment.
   The Windsor Problem Gambling
      Screen For Older Adults
1. Since you started gambling, have you felt more depressed, either
   after gambling or in general?
2. Does gambling give you a sense of excitement or a „high,‟ which
   makes you feel more alive?
3. When you lose money gambling do you return to try and win it back?
4. Have you ever been surprised by the amount of time that has
   passed when you‟ve finished gambling?
5. Have you ever spent more money than planned when gambling?
6. Have you ever hidden your gambling activities, for example, where
   you were or how much you won or lost?
7. Each time you go gambling, do you believe that you could win big?
8. When you‟re feeling “bad” does gambling make you feel better?
9. Has gambling filled a void in your life and helped you feel less
Pathological Gambling (312.31)
               DSM-IV Diagnostic Criteria

Preoccupation                     Lying
Tolerance                         Withdrawal
Chases                            Bailed Out
Can‟t stop                        Loses Opportunities
Illegal Acts                      Gambles to escape

               More than 5 = pathological gambler
                   3 to 4 = problem gambler
                   1 or 2 = “at risk” gambler
Clinical Issues in Problem
              Modes of Therapy
Self-Help Manuals
• Help-Line Counseling 1-800-GAMBLER
• Financial Counseling
• Cognitive Behavioral Therapies
• Motivational Enhancement Therapies
• Spiritual (GA, churches, eastern religions)
• Pharmacological Treatment (naltrexone, anti-
• Multimodal treatment shows substantial
   – 81% of clients reported either no gambling or reduced gambling
     at 6-months post-treatment (Moore & Marotta, 2007)
         Clinical Approaches with
               Older Adults
• Indirect, nonconfrontational approach:
  –   What do you do for fun?
  –   Do you ever go to the casino or play bingo or lottery?
  –   What do you like about…? Anything you don‟t like?
  –   I‟ve heard gambling can cause problems for many
      people and there are specialists who treat gambling

  Martin, Wayne State University, 2009
          Clinical Approaches with
                Older Adults
• Incorporate pain, grief & loss, a sense of
  meaning, hopelessness
• Feelings of abandonment by ones children
  if placed in assisted living facilities
• Importance of empathy: nonjudgmental,
  nonthreatening, active listeners
Nower, Rutgers Gambling Studies Program, 2009
       Clinical Approaches with
             Older Adults
• Be aware of the possibility of depression
  or other mental health concerns, and
  encourage clients to talk to their doctors
• Frame gambling as a health issue to
  reduce resistance. “Planting the seed” as
  a possible health matter may prevent
  progression of gambling behavior even if
  help is refused at this time.
                   Older Adults:
• Encourage help seeking behaviors and use of counseling,
  decreasing the stigma attached to seeking help.
• Provide information through public education to demonstrate
  how gambling becomes a problem and where one can seek
• Establish more support groups for older adults as an opportunity
  for them to share issues/problems in a safe environment.
• Replace casino visits as a social activity, substituting other group
  activities that provide social networking.
July 2006, Problem Gambling Foundation of New Zealand
           Alternative Activities
• Board games, scrabble, chess, billiards, bowling, golf
• Walking, swimming, water aerobics, deep water running
• Social/ballroom dancing
• Tai chi, self defense, yoga
• Arts & crafts, sewing
• Fishing, gardening
• Visit friends
• Meditation, prayer, reading
• Phone calls, letters, email
• Take a class: computers, language, cooking, music,
• Volunteer: Humane Society, Companion Hospice Care
• Join a support group, interest group, political group
• Travel
   Tips to Keep Gambling Fun
           Older Adults
• Set limits on amount of time and number of days you gamble
  per month;
• Do not borrow;
• Gamble only what you can afford for entertainment;
• Do not gamble to cope, solve or avoid problems;
• Avoid magical thinking or belief in a “System of Winning”;
• Take only the cash you plan to spend;
• Leave all bank cards at home;
• Keep a healthy balance in your leisure activities;
• Make plans to protect yourself from staying too long; arrange a
  social outing with someone at a specific time to avoid gambling
  longer than intended;
• Avoid on-site cash machines at the gaming venue;
• Decide on a spending limit ahead of time and stick to it.
• California Department of Alcohol and Drug
  www.adp.cahwnet.gov (Office of Problem Gambling)

• CPGTS (California Problem Gambling
  Treatment Services Program)

  – Provides 6 free sessions for gambler or affected
  – Licensed therapists who complete:
      • Application process
      • Phase 1 training: 30 hours, throughout state
      • 10 hours of annual supervision, gambling CEUs
      • Patient Forms
• CPGTSP, Self Help Manual, Self Exclusion
   – Office of Problem Gambling
   – www.adp.ca.gov/OPG/resources
• Counseling/ Treatment programs
   – Inpatient and outpatient
   – Certified counselors and programs:
• Self Screening / Assessment
   – National Problem Gambling Awareness
• Gamblers Anonymous/ Gam Anon
  – Gamblers Anonymous (International)
  – GamAnon (International)
  – Language specific GA available on website
• Helplines
  – 1-800-GAMBLER (California Council on Problem Gambling)
         • All languages available upon request
  – 1-800-522-4700 (National Council on Problem Gambling)
          All language available upon request
  – 1-888-968-7888 (NICOS)
         • Starting Statewide October 2010
           Older Adult Resources
• American Society on Aging (Education resources, publication, etc.)
• U.S. Administration on Aging (Extensive list of related internet
• Virginia Center on Aging (Booklets and video/DVD)
• Florida Council on Compulsive Gambling (On-line
  questionnaire for seniors at risk, brochures, info)
• Ontario Ministry of Health (Betting on Older Adults: A Problem
  Gambling Prevention Manual for Service Providers)

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