The Impacts of Gambling, eSports Betting and Gaming on Adolescent Mental Health - PowerPoint Presentation

1. The Impactsof Gambling, eSports Betting and Gaming on Adolescent Mental HealthDate: November 16, 2023Time: 12PMDr. Loredana MarchicaClinical Psychologist

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3. The Impactsof Gambling, eSports Betting and Gaming on Adolescent Mental HealthDate: November 16, 2023Time: 12PMDr. Loredana MarchicaClinical Psychologist

4. CAMH is situated on lands that have been occupied by First Nations for millennia; lands rich in civilizations with knowledge of medicine, architecture, technology, and extensive trade routes throughout the Americas. In 1860, the site of CAMH appeared in the Colonial Records Office of the British Crown as the council grounds of the Mississaugas of the New Credit, as they were known at the time. Today, Toronto is covered by the Toronto Purchase, Treaty No. 13 of 1805 with the Mississaugas of the Credit. Toronto is now home to a vast diversity of First Nations, Inuit and Métis who enrich this city.CAMH is committed to reconciliation. We will honour the land through programs and places that reflect and respect its heritage. We will embrace the healing traditions of the Ancestors, and weave them into our caring practices. We will create new relationships and partnerships with First Nations, Inuit and Métis – share the land and protect it for future generations.CAMH Land Acknowledgement4

5. CAMH places equity, diversity and inclusion (EDI) at the centre of our work. We understand that language is constantly evolving as societal and cultural values change. We strive to use language that celebrates the diversity of the communities we serve and remains respectful, inclusive and free of bias. As part of our commitment to EDI, we welcome feedback on our language use and routinely review our content, updating the language as needed.5Language

6. The Gambling, Gaming and Technology Use (GGTU) program is part of the Knowledge Exchange and Training portfolio in CAMH’s Provincial System Support Program. GGTU aims to build a stronger mental health and addictions system in Ontario by supporting addictions and mental health service providers through training and education, digital tools and resources, and knowledge sharing activities. 6About GGTU

7. Dr. Loredana Marchica is an OPQ registered psychologist currently working at the Montreal Children's Hospital within the Brain, Development and Behavior Clinic conducting neurodevelopmental assessments and at Le Spot Montreal where she provides clinical services to adolescents and their families with varying degrees of suicidality. Her research is on adolescent and young adult engagement in risky behaviors that include behavioral addictions, substance abuse, and suicidality. She has over 20 peer-reviewed publications, multiple book chapters, and over three dozen paper and poster presentations at national and international conferences. Dr. Marchica’s research has been supported by governmental agencies including, the Fonds de Recherche de Québec-Société et Culture and Manitoba Liquor and Lotteries. She has over 12 years of clinical experience including working with children, adolescents, and their families. She has worked in both private practice and within hospital settings. 7Presenter Information

8. AgendaOverview of topicAddictions definedBehavioral AddictionsGamblingGamingeSports bettingDevelopmental ConsiderationsRisk factorsIntervention Strategies

9. AddictionsRecognized as both a medical and psychological disorderDSM-V describes addictions under substance use and related disorders which refers to recurrent use or engagement that causes significant clinical and functional impairment; measured on a continuum from mild to severeEleven criteria that fit into four overall groupings (must display 2 out of 11 criteria within past 12 months for a diagnosis)Impaired ControlSocial ImpairmentRisky UsePharmacological criteria(Marchica et al. 2022; APA, 2013; American Society of Addiction Medicine, 2011)

10. Behavioral AddictionsDefined as; a form of addiction that involves a compulsion or impulse to engage in a rewarding non-drug-related behavior despite any negative consequences to the person's physical, psychological, social or financial well-being DSM-5 added a new category under substance use and related disorders coined “behavioral addictions” or “nonsubstance-related addictions” to include gambling and other potential behavioral addictions (e.g., IGD). Diagnosis requires presence of 4+ symptoms over a period of 12 months and can range from mild severity to severe(APA, 2013; Grant, Potenza, Weinstein, & Gorelick 2010)

11. Behavioral AddictionsEssential features:Failure to resist an impulse, drive, or temptation to perform an act that is harmful to the person or to othersRecurrent pattern Repetitive engagement Diminished control Interfere with daily functioning Similar neurological circuits to substance-related disordersTypes of Behavioral AddictionsGambling disorderCompulsive buying*Sexual addiction*Problematic internet use *Problematic video gaming (or IGD in DSM-5)(Grant, Potenza, Weinstein, & Gorelick 2010)

12. Clinically differentiating characteristics of adolescent users from adult users(Gaur et al., 2019)Briefer history of involvement in behaviorHigher changes of episodic use than chronic daily useMore often associated with co-occurring psychiatric comorbidity, family disruption, academic problems, problem behaviors, deviance, and substance useHigher occurrence of improvements by early adulthood without formal intervention or treatment (i.e., spontaneous recovery)

13. GamblingGambling has become increasingly popular over the last decadeIncreased accessibility; new gambling venues (i.e., online)Associated harmsGreater depression and anxietyPoorer psychological well-beingPoorer interpersonal relationshipsGreater alcohol, tobacco, and other substance useSuicidal ideation, non-suicidal self-injuryMotivations for gamblingSocialEnhancementCoping(Afifi et al., 2016; Farhat et al., 2020 ; Grant et al., 2010; Juodis & Stewart, 2016; Lambe, et al., 2015; Manning et al., 2015; Potenza et al., 2019; Stewart & Zack, 2008)

14. Video GamingDefined as; interactive games played on electronic devices either online or not (e.g., Minecraft, MMORPGs, candy crush)Extraordinarily popular - 66% of Americans play video games weeklyVideo games are recreational activities Did you know: 48% of gamers identify as female and 52% as male The average age of video game players is 33 The video gaming industry projected to reach $385 billion in 2023(ESA, 2022; Statista, 2023)

15. Video Gaming DisorderIGD can have deleterious consequences include severe psychological, financial, and social challengesFemale gamers are more likely to report poorer mental health outcomes than malesContinued disagreement with criteria and cutoff thresholds(Gonzalez-Bueso, et al., 2018; Marchica et al., 2020; Wang et al., 2018)

16. eSportseSports are organized video gaming competitions where individuals or teams compete in leagues and/or tournaments to win monetary prizes.The eSports gaming industry will ascend to $2.2 billion by 2023In eSports betting rather than wagering on the outcome of traditional sports, bets are placed on the outcomes of these video gaming competitions.(Arbarbanel et al., 2020; Greer et al., 2019; Markets & Markets, 2019)

17. eSportsPreliminary findings indicate that individuals betting on eSports are younger, male, regularly engage in video gaming, and are more frequent eSport spectators.More frequent eSport betting has been associated with greater problem gambling (PG) and positively associated with both PG and problem video gaming (PVG). Nonetheless, the link between esports betting and mental health remains unexplored. Unlike other in-game gambling-like activities (i.e., loot boxes, social casino gaming), eSports betting is external to video games, suggesting it may overlap more with sports betting. (Arbarbanel et al., 2020; Macey & Hamari, 2019; Zendle, 2020)

18. Prevalence rates(Calado et al., 2017; ESA, 2022; Richard et al., 2021; Rotermann & Gilmour, 2022; SAMHSA, 2022; Stevens et al. 2021)Prevalence rates among adolescents0.2-12.3% of youth worldwide meet diagnostic criteria for gambling disorderGlobal prevalence rates of internet gaming disorder range from 1-3% of youth Average time spent gaming/week – 13 hours4.5% reported past year participation in esports betting with 27% of these bettors being at-risk for a gambling disorder

19. AdolescenceDistinct developmental period of transition and experimentationRoles change and responsibility increasesGreater independence is exerted Importance of peer groups begins to outweigh parents’Increased engagement in at-risk behaviors(Derevensky, 2012; Marchica et al., 2019; Richard et al., 2021;)

20. Adolescent risk factorsFamily dynamicsPeer dynamicsPersonality factors (impulsivity, sensation seeking, hopelessness, anxiety sensitivity) Adverse Childhood Experiences (physical, emotional, and sexual abuse, physical and emotional neglect, witnessing violent treatment towards one’s parent, household mental illness, household substance abuse, parental separation or divorce, and member of family incarcerated)(Edalati et al., 2019; Marchica et al., 2020; Richard et al. 2021 )

21. Adolescent Gambling 2018 vs. 2020(Richard, Marchica, Ivoska, Derevensky, 2020)

22. Relationship between PG and SURecent study of 7,002 students (12- 18-year-olds)(Marchica, Ivoska, Derevensky, 2019)Male (N = 3,553)Female (N = 3,418)SubstanceAt-risk/Regular userAt-risk/Regular userCigarettes2%2%Alcohol5%5%Binge drinking7%8%Marijuana5%6%Painkillers4.5%8%Problem Gamb11%5%At-risk gambler9% were also regular drinkers*12% regular binge drinkers*7.8% regularly smoked marijuana8.6% regularly ingested painkillers*7.8% regularly used 2+ substances/mth (polysubstance use)

23. PG, PVG, and eSportsPG and PVG share several mental health problems including depression, anxiety, impaired sleep, and increased substance use and aggression.PVGs form a heterogenous group and preliminary studies support three distinct subgroups like those proposed by the original Pathways Model for PGeSports betting and video gaming intensity have been significantly associated with internalizing and externalizing behaviors through PVG.Recent studies suggest that it is possible that eSports betters are at a greater risk of PVG as compared to PG(Marchica et al., 2021; Marchica et al., 2022; Mills et al., 2020; )

24. TreatmentUnderstanding our motivation for engagement can lead to insight regarding what we need to focus our attention towards and how to use adaptive coping strategies

25. Treatment: Harm reductionHow to speak to adolescents about at-risk engagementPatient-centered approachesUsing a collaborative approachValidate perceived/ short-term benefits Creative hopelessness (short-term benefit vs. long-term costs)Provide guidance to minimize harms*Keeping in mind safety considerations(Winer, Yule, Hadland, & Bagley, 2022)

26. TreatmentPrevention: targeting mental health and well-beingPersonality targeted InterventionsPreventure: successful at reducing rates of alcohol and illicit drug use and substance-related harms by ~50% in high-risk adolescents with effects lasting up to 3 years.  can it be applied to behavioral addictions?Often co-occurs with psychiatric disorder  Need to address co-occurring psychopathology (Edalati & Conrod, 2019)

27. Treatment: Targeting MHEmotion Regulation (ER)Internal and external processes involved in monitoring, evaluating, and altering intensity and timing of emotional reactionDifficulties with ERLinked to higher likelihood of psychological disorders (SUDs, GD, Anxiety, Depression)Social problemsAnger(Cole et al., 2004; Eisenberg et al., 2004; Gross, 1998; Gross et al., 1995; Thompson, 1994)

28. Model of ERAccording to Gratz & Roemer (2004) ER encompasses six dimensions:An (1) awareness and (2) understanding of emotionsAn (3) acceptance of experienced emotionsThe ability to engage in (4) goal-directed behavior when experiencing negative emotionsThe ability to (5) control impulsive behaviors when experiencing negative emotionsThe ability to be (6) flexible in using emotion regulation strategies(Gratz & Roemer, 2004)

29. ER deficitsEmotion regulation as a central factor in the study of addictive behaviorsER deficits related to behavioral addictions Recent study found that ER was a significant predictor of video gaming, gambling addiction, and problematic internet useRecent systematic review demonstrated that 90% of studies found ER deficits to be associated with reports of greater gaming/ gambling addictions Addictive behaviors as a means of ER Individuals with an addiction often engage as a means of coping with unwanted emotions or to escape negative affect importance of targeting ER deficits(Estevez et al. 2017; Giordano et al., 2021; Marchica et al., 2019)

30. Practical SuggestionsIntroduction to automaticity; acting without awarenessMindful eating (e.g., raisin exercise)Body scansRecognizing triggers Spot the Function (functional analysis; ABCs)Urge surfingAcceptanceNot struggling with the present moment, but meeting it with compassion and acceptanceProvides more freedom and choices in responding, rather than reactingCultivating a willingness/curiosity (Bowen et al., 2011; Hayes, 2013)

31. Practical SuggestionsRecognize thoughts for what they areWatch each thought pass, like boxes on a conveyor belt without picking them up or holding on to themIdentify ValuesWhat activities are in line with your valuesLink goals to valuesCarrot vs. StickAcknowledge the small stepsHave compassion for selfFind positive activities for self-care(Bowen et al., 2011; Hayes, 2013)

32. Promoting AutonomyDecide What to Do and How to Do itAllow for choice in life activities/workSet Autonomy-Supportive LimitsLimit danger/harm to self/others Setting Goals and Evaluating PerformanceIndividualized and optimalAdminister Rewards and RecognitionAs a means of rewarding the person, not to motivate themRecognize Obstacles & Find SupportConsider Reasons for Change/Behavioral Engagement Intrinsic Motivation vs. Extrinsic Motivation(Deci & Flaste, 1996; Ryan & Deci 2000; 2017)

33. EXTRA SLIDES POSTER PRESENTATIONS CPA + AGRI 202133POSTER 1: Between two worlds: Exploring esports betting in relation to problem gambling, gaming, and mental health problemsPOSTER 2: Problem video gaming in adolescents: An examination of the Pathways Model

34. PG, PVG, and eSportsPG and PVG share several mental health problems including depression, anxiety, impaired sleep, and increased substance use and aggression.PVGs form a heterogenous group and preliminary studies support three distinct subgroups like those proposed by the original Pathways Model for PGeSports betting and video gaming intensity were significantly associated with internalizing and externalizing behaviors through PVG.Recent studies suggest that it is possible that eSports betters are at a greater risk of PVG as compared to PG(Marchica et al., 2021; Marchica et al., 2022; Mills et al., 2020; )

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36. QuestionsDr. Loredana MarchicaClinical Psychologistdr.marchica@outlook.com

37. Gambling, Gaming, and Technology Use (GGTU)Website: https://kmb.camh.ca/ggtuJoin the GGTU Community of Interest! https://www.eenetconnect.ca/g/gambling-gaming-technology-use 

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