The Impact of Gambling Disorder on Physical - PowerPoint Presentation

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The Impact of Gambling Disorder on Physical Health

Timothy W. Fong MDUCLA Gambling Studies Program New York Council on Problem GamblingAnnual ConferenceNovember 2017Slide2

Financial Disclosures

Speaker Bureau Research SupportIndivior Onward Constellation Health

Connections in RecoverySlide3

Overview

Physical health overviewGambling’s impact on physical health

Office-based strategiesSlide4

Definitions of HealthTraditional definition

of physical health “A person who is not stricken with a serious illness”Modern definition: World Health Organization “Health is a state of complete physical, mental and social well-being and not

merely the absence of disease or infirmity”Slide5

Components of

Physical HealthSlide6

Components of

Physical HealthPhysical activity – includes strength, flexibility, and endurance Nutrition and diet –

includes nutrient intake, fluid intake, and healthy digestion Alcohol and drugs – includes the abstinence from or reduced consumption of these substances Medical self-care – includes

addressing minor ailments or injuries and seeking emergency care as necessary Rest and sleep – includes periodic rest and relaxation, along with high quality sleep Slide7

Physical Activity

DATA 2010 (US Census) 36% adults aged 18 years and older reported engaging in regular vigorous physical activity in 2005.

23% percent of adults aged 18 years and older reported having no leisure-time physical activity in 2006.Slide8

Nutrition, Diet, Obesity

Obesity = Body Mass Index > 30DATA 2010 for California adults aged 20 years and older

23.6% of Californians are obese. Slide9

Alcohol Use

Binge drinking prevalence rates among California’s adult population 18 years and older 15.4% in 2001 17.6% in 2005 13.3% in 200815.6

% in 2015AUD national prevalence: ~14%Slide10

Tobacco Use

DATA 2010 show that California’s adult cigarette smoking prevalence rates declined significantly from:16.9 percent in 2000 14.5 percent in 200414.6 percent in 2006 13.8 percent in 2010Slide11

DSM-5 and SUD:

10 Drug ClassesAlcoholCaffeineCannabis

HallucinogensTobacco InhalantsOpioidsSedatives, Hypnotics, Anxiolytics

StimulantsOthersSlide12

Medical Self-Care

28.1 million Californians under age 65 (85.4 percent) had some kind of health insurance coverage in 2007 87.8 percent of Californians had a usual source of ongoing care in 2005 Slide13

Rest and Sleep

According to data from the National Health Interview Survey, ~30% of adults reported an average of ≤6 hours of sleep per day In 2014, 31% of high school students reported getting at least 8 hours of sleep on an average school night.

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Rest and sleep“Rest is stressful””I’d rather be at work then on vacation”

”You can rest when you are dead”“Snooze you lose”“Early bird catches the worm””Family time matters most”Slide15

Gambling Disorder and Physical

HealthSlide16

Gambling Disorder and Health

(Pre-2000)Published reports showing association of gambling disorder with poorer overall healthNot enough to impact policies, legislation or practice(Petry, Volberg, National Commission) Slide17

Health Problems and Medical Utilization Associated with Gambling Disorder

Gambling severity associated with higher rates of medical utilization GD

more likely than low-risk individuals to have been treated in the emergency room in the year Psychosom Med.

2006 Nov-Dec;68(6):976-84.Slide18

Gambling and Health:

Primary Care Setting574 adults presenting to an urban primary care medical clinic 10.6% pathological gambling5.1% were classified as problem gamblers.Any GD reported more health-related concerns on indices of physical functioning.

Recreational gambling was not associated with better health. BJ Morasco, KA vom Eigen, NM Petry - General hospital psychiatry, 2006Slide19

PG increases CV Disease

Review of NESARC DataFocus on older adults (55+)PG status was associated with elevated odds for incident arteriosclerosis and heart conditions.Increased risk beyond established risk factorsJ Addict Med. 2013 ; 7(6):Slide20

PG Relation to Obesity, Medical Conditions, Lifestyle

Random survey of 95 PG vs. 91 controls PG had more medical and mental health conditions than controlsMore likely to avoid regular exercise, smoke≥1 pack/day, drink≥5 servings of caffeine daily, and television ≥20hours/week. Compr Psychiatry.

2013 Feb;54(2):97-104Slide21

PG Relation to Obesity, Medical Conditions, Lifestyle

Pathological gamblers reported impaired physical and emotional role functioning, but also bodily pain, impaired social functioning, and low vitality.Compr Psychiatry. 2013 Feb;54(2):97-104Slide22

California Gambling Education and Treatment Services (CALGETS

)problemgambling.ca.govSlide23

Health and Wellness 15-16Medical problems

The most common co-occurring health conditions of CalGETS clients are hypertension, diabetes, and obesityAccess to Healthcare70% of CalGETS client reported that they currently have a physician that they can access for primary care needs. Slide24

Health and Wellness 15-16Alcohol Use

CalGETS clients report a heavy drinking episode (more than five drinks in a single occasion) occurring, on average, every 20 days. MarijuanaAccording NSDUH: 14.7% of the population of California self-reported using marijuana within the last 12 months. Across all treatment components, 16% - 45% of CalGETS clients use marijuana.Slide25

Health and Wellness 15-16SmokingAmong CalGETS outpatients, 31% currently smoke, three times the state average.

In the residential treatment setting, the prevalence rate of smoking is 60%. Slide26

Health and Wellness 15-16State of Health

30% of gamblers across all modalities reported their health as “fair or poor”Health Insurance78% of all CalGETS clients reported having health insurance but less is known about how much their premiums, deductibles or costs are to maintain insurance. Slide27

Health and Wellness 15-16Affected Individuals

Health and Wellness profile mirrored that of the general population across all domains Slide28

Gambling and SleepSlide29

UCLA Gambling Sleep Study -ResultsNational Epidemiological Survey: (N=3412)

PGs were almost 3.5 times more likely to experience a sleep problem compared to individuals who did not have a gambling problemCommunity Survey: (N=120)PGs experience significantly poorer sleep quality and increased daytime sleepiness relative to those that recreationally gamble. Slide30

UCLA Gambling Sleep Study

Problematic Sleep Causes:impair self-control and decision-making increase impulsivity, attenuate responses to losses and increase expectations of gains

degrade cognition in executive functioning tasksBecome clinically aware whether client is also suffering sleep problems and include that in managementSlide31

Understanding the link between gambling and physical

healthSlide32

Explaining this association

Stress ModelIncreased physical and emotional stress leads directly to poor overall healthLack of exercise Gambling is sedentarySelf-care neglect impulsivity / risk-taking / lack of interestSlide33

Explaining this association

Lack of access to careInsurance, fundsGeneticsShared risk factors Co-occurring SUD Primarily Tobacco and AlcoholSlide34

What about gambling promoting health?Slide35

Casino Openings and Childhood Weight

Fitness testing of American Indians in California (tribes with casinos vs. tribes without a casino)Opening or expanding a casino was associated with increased economic resources and decreased risk of childhood overweight/obesityJAMA. 2014 Mar 5;311(9):929-36Slide36

Gambling, Health and Age

NESARC DataAmong older respondents, recreational gambling was associated not only with some negative measures (e.g., obesity) but also with some positive measures (e.g., better physical and mental functioning). Psychol Addict Behav.

2007 Dec;21(4):431-40.Slide37

Office Strategies

to Improve Physical HealthSlide38

Case StudySlide39

Intake to CALGETS

43 yo female referred to CALGETS via online searchPresents with 10 year history of gambling disorder (slots, online slots)Main damage -- $75K debt, diminished friends, low life satisfaction, personal development stalledModerate depressive sxsSlide40

Health Overview

Does not exercise (0)Does not smokeDrinks 10 standard drinks per weekHas health insuranceWorks night shift, sleep not consistent and 3-5 hours blocks5’

2”; 185lbsDiet – Comfort eating; “

no idea”Slide41

Physical Activity

Exercise must be prescribed3 times per week for 90 minutes“10,000 Steps per day”Emerging use of Smartphone apps and digital trackersTake advantage of local fitness trends

Partner with local trainer Slide42

Diet and Nutrition

Start with Food DiaryDevelop local connections with cooking classes, private nutritionists and dietitiansWeight loss goals = ½ lb per week (approximately 1100 calorie difference)Slide43

Alcohol and Tobacco

SBIRT practicesIncrease Smoking Cessation Toolbox1-800-NO-BUTTSFocus on characterizing relationship between substances, gambling and health Slide44

Medical Care

Identify primary care providerOvercome treatment barriersBecome familiar with insurance optionsLearn healthcare milestones and encourage discussion Create healthcare goalsSlide45

Rest and Sleep

Sleep diariesSleep hygiene practicesScreen TimeCaffeineScheduled NapsSchedule Rest PeriodsVacation time NOT family tripsSlide46
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The key to good health:

“Hot” off the pressesSlide48

Association Between Sauna Bathing and Fatal Cardiovascular and All-Cause Mortality Events

Increased frequency of sauna bathing is associated with a reduced risk of SCD, CHD, CVD, and all-cause mortality. JAMA Intern Med. February 23, 2015. Slide49

Possible Trends

WearablesMonitoring all aspects of healthReal-time information / feedback

Provider-client-linked incentives for health outcomesBonus payments?

Integrated care with community partnersRecovery “Prime” ServicesSlide50

California Gambling Education and Treatment Services (CALGETS

)problemgambling.ca.govSlide51

Contact Information

Timothy Fong MD

UCLA Gambling Studies Program310-825-1479 (office)tfong@mednet.ucla.edu

uclagamblingprogram.org