Disordered Gambling within the Forensic Population and Pris - PowerPoint Presentation

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Disordered Gambling within the Forensic Population and Prison Culture

Daniel J. Trolaro, MSAssistant Executive DirectorCouncil on Compulsive Gambling of NJSlide2

Agenda

Background and overviewWarning signs and characteristicsStages and Co-OccurrenceForensic and Prison culture considerationsScreening and treatment considerationsRecovery culture

Support, Treatment, Hope

Closing and Q&ASlide3

COUNCIL ON COMPULSIVE GAMBLINGBroaden individual, agency and community

awareness in prevention and treatment of gambling disordersServe as statewide advocate to protect rights of problem gamblers yet neutral on gamblingPromote equal access to treatment

and other services required by problem gamblers and their families Slide4

COUNCIL ON COMPULSIVE GAMBLINGRun helpline to provide information and referrals and disperse literature

(800) GAMBLERProvide resources to professionals and employers about problem gamblingServe as point source for public information, providing statistics and interviews to mediaSlide5

NORMALIZATION OF GAMBLING

Lottery advertisementsReligion involvementSchool and group fundraisingNewspapersPoker on televisionRite of passageSocietal viewSlide6

GAMBLING PREVALENCE81% of Americans gambled in lifetime

Gambling is legal in 48 states2005 Univ. of Buffalo Research Institute on Addiction found living within 10 miles of casino increased risk of gambling problems by 90%6-8 million with gambling disorderSlide7

TYPES OF GAMBLERS

Social gamblers - 90%Enjoyable experienceEntertainment

Gamble with others

Limit amount of money spent

Stop after reaching limits

Gamble for short periods of time

No interference with other parts of lifeSlide8

TYPES OF GAMBLERS

Problem gamblers – 7-8%Gamble longer than planned

Loses more than intended

Starts to borrow money for gambling

Prolonged losing episodes

Starts to lie about amount gambled

Returns to gamble to win back losses

Relationship problems beginSlide9

TYPES OF GAMBLERS

Disordered gamblers – 2-3%

Cannot pay household expenses and debts

Marked increase in gambling episodes

Gambling for larger amounts

Receives bailouts for gambling debt

Gambling alone

Alienation from significant others in life

Illegal acts to finance gambling

Unsuccessful attempts to stop

Helpless and suicidalSlide10

SIGNS OF A GAMBLING PROBLEMFinancial signs

Financial problems despite adequate incomeDebts are building upMoney removed from bank accountsValuables have “disappeared”Lots of borrowing and cash advancesInsurance policy cashed in or lapsed

Invading pension moneysSlide11

SIGNS OF A GAMBLING PROBLEMFinancial signs

Person hides financial statementsPerson secretive about moneyThe person cannot explain missing moneyLate in paying bills or missing paymentsExtra jobs or overtime but nothing to show for itPattern of spending all available funds in episode of gambling

Does not want to spend money on anything but gamblingSlide12

SIGNS OF A GAMBLING PROBLEMBehavioral signs

Frequently thinks and talks about gamblingComplains of boredom when not gamblingStops doing things previously enjoyedMisses family eventsChanges patterns of eating, sleeping or intimacyConflicts with others over money

Neglects basic care or those of familySlide13

SIGNS OF A GAMBLING PROBLEMBehavioral signs

Often late to work or schoolGone for long unexplained periods of timeCelebrates wins by gambling moreAfter losing expresses fear of others finding outAfter losing worries about where to get money to cover living expensesReturns to gamble to chase lossesSlide14

SIGNS OF A GAMBLING PROBLEMEmotional signs

Withdraws from friends and familySeems far away and anxiousDifficulty paying attentionMood swings and outbursts of angerComplaints of boredom and restlessnessSeems depressed or suicidal

Communication lessensSlide15

SIGNS OF A GAMBLING PROBLEMEmotional signs

Experiences sadness, anxiety, stress or Anger as result of gamblingMental health negatively affected through gamblingExperiencing remorse or depression after gamblingSlide16

SIGNS OF A GAMBLING PROBLEMRelationship signs

Isolation- withdrawal from othersAppears preoccupiedDeceptive or secretive about behaviorSeems edgy, reactive or defensiveSlide17

CHARACTERISTICS - ACTION & ESCAPE GAMBLERS

Action gamblers desire excitement, stimulant like amphetamines or cocaineEscape gamblers seek relief from painful emotions or stress, seek sedativeAction gamblers tend to be male, competitive, seek rush and power , like skill gamesEscape gamblers tend to be female, gambling as sense of control over emotional experience, seek distraction from life problems , prefer non-skill gamesSlide18

Stages of Problem Gambling

The Winning PhaseThe Losing PhaseThe Desperation PhaseThe Critical PhaseThe Rebuilding PhaseThe Growth and Recovery PhaseSlide19

Stages of Problem GamblingSlide20

CO-OCCURRING DISORDERS

Areas looked at with gambling:Substance use disorder

Suicide

Obsessive-compulsive

Eating disorders

Smoking

Mood

Stress

ADHD

ImpulsivitySlide21

Co-Occurrence with Mental Health Issues

Depression and anxiety most commonly associated.

Can become the cause of a problem or the result of the problem

Up to 3 in 4 of gamblers suffered from depression

Up to 2 in 5 suffered lifetime anxiety

1 in 4 - Bi-Polar Disorder

1 in 5 – ADHD

1 in 5 - Attempt Suicide (Reported only)

Dr. Jon Grant; University of ChicagoSlide22

1998 Nevada Survey – Problem Gamblers are…

3.3 times more likely to have major depression2-3 times more likely to have phobias

6.1 times more likely to be antisocial

2.1 times more likely to consume nicotine

3.3 times more likely to have alcohol dependence or use disorderSlide23

GAMBLING, DRUGS & ALCOHOL Similarities

PreoccupationWithdrawalProgressionToleranceOne can serve as trigger for the otherSubstitution of addiction concernSlide24

GAMBLING, DRUGS & ALCOHOL Similarities

Biological dependency on pleasure pathProvide tension and reliefLoss of spiritualityLies to cover up behaviorDenial as common response to confrontationHigh relapse potentialSlide25

Forensic Population

The clinical forensic population is composed broadly of individuals who may present with mental or emotional disorders, or may have other characteristics, that are relevant to a legal decision. (American Psychological Assoc.)Slide26

Sequential Intercept Model for Criminal Justice

Focuses on interaction between community and law enforcement for those with mental illness entering the criminal realmThe model depicts a series of points at which intervention can be made to prevent people from falling deeper into the criminal justice systemSpeaks to diversion and alternatives for dealing with criminalizationLink Criminal Justice with community treatmentSlide27

Sequential Intercept Model for Criminal JusticeSlide28

GAMBLING IN PRISONGambling and paraphernalia seen as moderate correction concerns

Corrections staff sees gambling as harmlessMany prisons have prohibition as deterrent, hard to enforce- would have to eliminate cards, television, dice games, newspapersGambling to pass time, relieve boredom, socialize, add risk and excitementSlide29

GAMBLING IN PRISONGambling as leisure activity- personal freedom, adventure, relaxation, stress reduction

Gamble for money, commissary items, personal favors, extra supplies, cigarettes, bet on horses with prison bookiesMany develop gambling problem while in jail, part of cultureSlide30

Gambling and Prison Culture

Rates of gambling among inmates tend to continually be higher than that of the general population.Across a survey of 30 studies that were reviewed worldwide, Dr. Robert Williams found that up to one-third of prisoner population met criteria for problem gambling.

Gambling primarily includes cards and sports betting

Prisoners typically gamble for commissary, cigs, food, or a range of ‘specific tasks.’Slide31

Gambling and Prison Culture

The Reason for the High Rates of Gambling / Problem Gambling:Struggle with managing behaviors

Do not have good coping skills

Struggle to find identity

Want to feel a sense of acceptance (i.e. sex offenders)

Want a quick fix solution

Boredom / Escape / Stress relief

SocializationSlide32

Gambling and Prison Culture

Societal and Family Costs on Gambling and Prison

Recidivism

Domestic Violence / Abuse

Child

Neglect /Trauma

Criminal activity to support the addiction

Bankruptcy

Increased cost to legal, correctional, and health care system

Divorce / Trust issues

Depression / Suicidal behaviorSlide33

Barriers Faced by Prison Cultures:

Lack of awareness on dangers and risks of problem gamblingLack of leisure and recreation activities that lead to a more productive re-entry experience.

Prisoners with gambling related problems have a harder time reconnecting and building social support systems.

Weighing the criminal nature vs. the nature of addiction (punish vs. treating)

Lack of resiliency / life skills / coping mechanismsSlide34

RE-ENTRY ISSUESNo support from family lack of trust

Don’t want help for gambling, don’t see it as problemResidency issues- kicked out by familyDifficulty of obtaining workGambling very tied to drug and alcohol use- laundering moneyMere severe the drug problem greater the likelihood of gamblerLack of GA services- AA not enough

Strain prison caused on family relationshipsSlide35

GAMBLING SCREENS20 Questions of Gamblers Anonymous

Lie-Bet 2 Question TestBrief Biosocial Gambling Screen (3 Ques. Test)South Oaks Gambling ScreenDSM-V Addictive Gambling CriteriaSlide36

Lie-Bet 2 Question TestLie Bet Questionnaire

Have you ever lied to the people important to you about how much you gambled?Have you ever felt the need to bet more and more moneySlide37

Brief Biosocial Gambling Screen

Brief Bio-social Gambling Screen (BBGS)During the last 12 months have you become restless, irritable or anxious when trying to stop/cut down your gambling?During the past 12 months , have you tried to keep your family or friends from knowing how much you gambled?During the past 12 months, did you have such financial troubles that you had to get help from family or friends?Slide38

South Oaks Screen

ComprehensiveUsually completed if one of preliminary screens yields positive result in questioningBased on DSM-3 CriteriaCan be self administered or given by clinicianPsychometric tool used internationallySlide39

New DSM - 5

The Diagnostic and Statistical Manual of Mental Disorders (DSM)The “bible” of mental disorders published by the American Psychiatric AssociationNo longer uses the word Illness or Disease

Disorders acknowledge the correlation between social, biological, cultural, and psychological factors

Gambling is the only Behavioral DisorderSlide40

New DSM - 5

Persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress, as indicated by the individual exhibiting four (or more) of the following in a 12­month period:

a. Needs to gamble with increasing amounts of money in order to achieve the desired excitement.

b. Is restless or irritable when attempting to cut down or stop gambling.

c. Has made repeated unsuccessful efforts to control, cut back, or stop gambling.Slide41

New DSM – 5 continued

d. Is often preoccupied with gambling (e.g., having persistent thoughts of reliving past gambling experiences, handicapping or planning the next venture, thinking of ways to get money with which to gamble).

e. Often gambles when feeling distressed (e.g., helpless, guilty, anxious, depressed).

f. After losing money gambling, often returns another day to get even (“chasing” one’s losses). Slide42

New DSM – 5 continued

g. Lies to conceal the extent of involvement with gambling.

h. Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling.

i. Relies on others to provide money to relieve desperate financial situations caused by gambling.Slide43

DSM 5 CHANGESNew term is disordered gambling

Classified as “addiction and related disorder”Separate category under behavioral addictionEliminated illegal acts as criteriaFirst time we have addiction without ingestion of substance- sex addiction and Internet addiction in appendixDescribed on severity continuum- 4-5 mild, 6-7 moderate, 8-9 severeSlide44

IMPLICATIONS OF DSM CHANGESGiven medical legitimacy- not excuse for behavior

May be important for funding and insuranceGambling presently not covered under ADAAffects primary and secondary preventionMore diagnosed but less in treatmentSlide45

Cultivate a Recovery Culture

Mindfulness

Laughter / Levity

Identity

Life Skills

Multiple “Tools in the Toolbelt”

Resiliency

Self-Empowerment

Respond vs. React

H.A.L.T

Accountability

Emotional Awareness

Others First

Language

Presence

Balance

“Feeling Safe”

Care and ConnectionSlide46

Commonly Cited Strengths for Recovery

Recovery Group Participation (Attendance alone is not enough.)

Social Support

Meaningful Relationships

Gainful and Meaningful Employment

Commitment to Change / Transformation

Best, David et al. "Measuring and Individual's Recovery Barriers and Strengths." Addiction Professional, Fall 2016Slide47

Commonly Cited Barriers to Recovery

Housing (eviction, problems, debt)

Transportation

Substance Use (Tobacco common)

Risk Taking (Addiction switch)

Offense (Police involvement, probation or parole violation)

Lack of meaningful activities (includes employment)

Lack of meaningful relationships

Best, David et al. "Measuring and Individual's Recovery Barriers and Strengths." Addiction Professional, Fall 2016Slide48

Where to Go for Help

Council on Compulsive Gambling of NJ – In-state 3635 Quakerbridge Rd. Suite 7,

Hamilton

, NJ 08619

(

609) 588-5515

800-GAMBLER

Offers state-funded gambling treatment provided

by

contracted treatment providers

Offers no cost

in-state outreach

, prevention, intervention and referral servicesSlide49

Where to Go for Help

Gamblers Anonymous World Service Office PO Box 17173, Los Angeles, CA 90017 (213) 386-8789 Gam-Anon International Service Office, Inc.

PO Box 157, Whitestone, NY 11357

(718) 352-1671

GA4NJ.com

GA Hotline in NJ 855-2-CALL GA

www.njgamanon.org

Gam-Anon Hotline in NJ 1-888-263-1885Slide50

Contact Info

Daniel J. Trolaro, MSAssistant Executive DirectorCouncil on Compulsive Gambling of NJ3635 Quakerbridge Rd, #7

Hamilton, NJ 08619

609-588-5515 x 17

609-588-5665 – Fax

www.800gambler.orgSlide51

AcknowledgmentsMade Possible by a Grant through The Department of Mental Health and Addiction Services