March 2001
During the recent Problem Gambling Awareness Week, the Minnesota Department of Human Services sponsored a conference for professionals in St. Paul. Despite the bad weather on the day of the conference, nearly 100 people attended. Clinicians comprised the majority of participants, but public health and corrections professionals as well as representatives from the lottery and racing commission were also in attendance. The conference goal was to provide a professional growth opportunity for clinicians in Minnesota that would enhance their ability to identify and respond to clients' gambling problems. Overall, the conference was well received. The following is a synopsis of the presentations that occurred throughout the day.
Dr. Winters provided an overview of current research in the field of gambling. The majority of research has been done on the prevalence of gambling, with moderate research in the areas of gambling etiology, clinical impact and treatment outcomes. Much work still needs to be done in the areas of social impact and the effectiveness of prevention. Dr. Winters indicated that these two areas fall short because they lack discrete variables and are therefore difficult to measure.
He continued with a discussion of the National Research Council's (NRC) review of pathological gambling. The NRC's report found that in a given year 1.8 million adults and 1.1 million adolescents are pathological gamblers, that pathological gambling often occurs with other behavioral disorders and that much of the research on pathological gambling is of limited scientific value.
Dr. Winters then outlined four major knowledge gaps in the area of gambling research:
- Do more gambling opportunities lead to higher rates of problem gambling?
- Will Internet gambling be the "crack cocaine" of the gaming industry?
- What treatment approaches are superior for treating problem gamblers?
- To what extent are individuals not getting help for their gambling problems?
Dr. Winters concluded with a discussion of the barriers to further research progress. These barriers include:
- inconsistent terminology-- this variability may reflect a lack of consensus on the conceptual understanding of gambling,
- measurement-- the accuracy of screening and assessment tools is still being questioned, and
- "pond still too small"-- it is difficult to build a research program because the number of severe-case pathological gamblers is relatively low.
Dr. Rugle's presentation described psychiatric conditions that occur in conjunction with pathological gambling. The main areas of co-morbidity that she discussed are as follows:
- Anxiety disorders (occurring approximately 10-35% of the time)
- Attention deficit disorders (occurring approximately 20-35% of the time)
- Personality disorders (occurring approximately 20-93% of the time)
- Substance use disorders (occurring approximately 25-63% of the time)
- Trauma (occurring approximately 5-30% of the time)
- Affect disorders (occurring approximately 50-80% of the time)
Dr. Rugle emphasized that these are all discreet disorders. When a person is dually addicted or is having multiple problems, each disorder needs to be treated individually. This will increase the effectiveness of the particular treatment.
Suicide is also an area of concern when dealing with compulsive gamblers and Dr. Rugle highlighted several studies during her presentation. Results from these studies indicate that suicidal thoughts occurred in 48-79% of patients and actual attempts occurred in 12-20%. One study found that the number of females contemplating and attempting suicide was higher then the rates for males.
Dr. Rugle concluded her presentation with a discussion of key treatment issues surrounding co-morbidity and compulsive gambling:
- It is essentialthat medication for co-occurring disorders (i.e. depression and anxiety) be addressed.
- Treatment should be longer and more intensive.
- Case management and coordination of services as well as continual assessment be priorities.
Mr. Anderson, a recovering compulsive gambler and treatment professional, spoke on the dream world of the gambler. Compulsive gamblers escape to a dream or fantasy world that consists of thoughts about what their lives will be like once they "win big." They dream of providing great things to family and friends and living a life of luxury themselves. When a gambler is unable to manufacture this fantasy world, they are left with only two options: treatment or suicide. Mr. Anderson also highlighted three characteristics of compulsive gamblers:
- Compulsive gamblers have an inability and unwillingness to accept reality and therefore escape into the dream world of gambling.
- Compulsive gamblers have an emotional insecurity and are only emotionally comfortable when they are "in action".
- Immaturity is also an issue for compulsive gamblers because they often desire all the good things in life without putting forth any effort to obtain them.
Dr. Stinchfield spoke about findings from the Minnesota Student Survey, a 126-item, anonymous, self-administered, paper-and-pencil questionnaire that inquires about multiple behaviors, including gambling. The Minnesota Department of Children, Families and Learning administered the same questionnaire, with minor revisions to the gambling items, in 1992, 1995, and 1998 to classroom students. The purpose of this study was to compare rates of gambling among Minnesota public school students between 1992, 1995, and 1998. The three samples included 75,806 students in the 9th and 12th grades in 1992; 73,897 9th and 12th grade students in 1995; and 78,564 9th and 12th grade students in 1998.
Dr. Stinchfield discussed two opposing trends in the survey results:
- Fewer students were gambling in 1998 than in 1995 and 1992.
- There was a small, but growing number of 12th grade students who gambled frequently.
He also identified a number of variables associated with adolescent gambling frequency:
- antisocial behavior
- gender (being male)
- alcohol and tobacco use
- age
- feeling bad about the amount of money bet
- a desire to stop gambling, and
- increased sexual activity.
While a majority of students were found to have gambled in the past year, most did not report gambling frequently, nor did they report problems associated with their gambling. Gambling appears to be related to other risk-taking behaviors and may be a part of the adolescent experimentation with adult behaviors.
This is the first generation of youth to be exposed to widespread legalized gambling opportunities and gambling advertising. Legalized gambling may be a new "rite of passage" for today's youth. Dr. Stinchfield concluded that it will be important to continue to monitor youth gambling and to provide information and resources to assist youth in making healthy decisions about their gambling behavior.
The North American Training Institute www.nati.org presented its video Andy's Story. In this video, Andy, a nineteen-year-old problem gambler, describes his addiction and recovery.
The day concluded with a presentation by Asian Media Access on a public service announcement they have produced for Asian American youth and the consequences of gambling. Angie Hwang, Executive Director of Asian Media Access, also moderated a panel that included a recovering Hmong gambler who discussed his gambling addiction and process of recovery. A second panel included two female gamblers who also described their addiction and recovery. Both of these female panel members are currently providing treatment services for others in recovery from a gambling addiction.
Gambling Problems Resource Center
2720 Highway 10
Mounds View, MN 55112