Massachusetts Council on
Compulsive Gambling
We understand the problem. We can help.
Who is at Risk? Using Lessons We’ve
Learned to Prevent Gambling Disorder
2
Prevention strategies for youth:
The need for alternative strategies
Jeffrey L. Derevensky, Ph.D.
Professor, School/Applied Child Psychology Professor, Psychiatry
International Centre for Youth Gambling Problems and High-Risk Behaviors
McGill University
www.youthgambling.com
3
Why has the game changed?
• Gambling has become normalized and widely socially
accepted
• Gambling accessibility and types of venues have changed
dramatically
• Technological advances, and acceptance of these advances,
has changed the playing field (e.g., advanced slot machines,
Internet gambling, sports wagering, mobile wagering)
4
Few youth with gambling problems only
have gambling problems
Problem Gambling
Conduct
Disorder
ADHD
Depression
Drug
Dependence
Other
Disorders
Alcohol
Dependence
Is Problem Gambling
A Primary Disorder?
9
Current Prevention Efforts
for Children and Adolescents
www.youthgambling.com
10
11
•
Standards and responsible gambling
programs for Internet and land-based
gambling providers
•
Algorithms being developed (Internet
gambling) to identify high risk individuals for
early intervention
•
Development of advertising policies and
guidelines
•
Personalized normative feedback/greater
individualization
12
•
The importance of social media
•
Greater parental, teacher and mental health
professionals awareness about the risks
associated with youth gambling
Who is At Risk:
Asian-Americans and Gambling
Timothy Fong MD
UCLA Gambling Studies Program
Masschusetts Conference on
Gambling Problems
April 2014
Overview
• Asians and Gambling
– History, Culture, Society
• Treatment Strategies
• How California is Addressing the Issue
• Available Resources
Gambling Expansion in Asia
• Macau: No. 1 gaming market 2006
• Singapore: Dropped its gambling ban
Opened Las Vegas style casinos 2009
• South Korea: 17 casinos; could become
Asia's next casino "gaming giant.”
• Taiwan and Japan: Considering allowing
casinos.
Cultural factors that
promote gambling
– Acceptable way to make money
– Inquire about one’s destiny
– “Honoring the Gods”
• Losses are sacrifice
– Equate gambling with self-worth
and ability to move up classes
Cultural factors that
promote gambling
– Emphasis on numbers that have
power over life events
– Heavy peer involvement
– Gambling is family entertainment
– Gambling as a rite of passage
Nancy Petry Study 2002
• Study on 96 Cambodian, Laotian and
Vietnamese refugees
–59% identified as pathological
gamblers. (1.5% California rate)
–95 % reported gambling in the
previous year, and 93% reported
gambling in the previous two
California Prevalence Study
• Asians (504)
– Low response rate (47% overall, less APIs)
– 7% of survey sample
– Mostly English (1% translated)
– Problem Gambling:
2.3%
– Pathological Gambling 0.7%
– Less aware of helpline
Results
Gender
N=180
Male
75%
Females
25%
Ethnicity
Asians
37%
Chinese, Filipino,
Korean, Japanese
Non-Asians
63%
Results
Screening
Score
APIs
Non-APIs
SOGS >5
42%
36%
NODS >5
35%
26%
PG Alliance San Jose Community Survey
2011
• Gender:
– Male-574 (40%),
– Female-828 (57%), N/A 61 (3%)
• Race:
– Vietnamese-374 (27%),
– Filipino-201 (14%),
– Chinese-145 (10%),
– Mexican-278 (19%)
Results
• PG Prevalence (%)
• San Jose (Gen Pop)
– At Risk:
6.5
– Problem
2.4
– Pathological
1.4
• San Jose (API)
– At Risk:
6.5
– Problem
0.7
Help Seeking Behaviors & Barriers
(PG Alliance San Jose Community Survey
2011)
• APIs reported > non-APIs
– Very Difficult to talk about
– I Would not discuss my problems
• Barriers to Treatment
– No Money
– Shame
Community Awareness
• 84% said PG is an addiction
• 40% had not heard of treatment resources
• Likely sources
– Media
– Friends / Family
– Helpline
Freedom From
Available Languages for WB
Arabic
Hmong
Russian
Armenian
Japanese
Samoan
Cambodian
Korean
Spanish
Chinese
Laotian
Tagalog
English
Lu Mien
Thai
Carlos Reinoso Jr., BS. BHCC
CT Council on Problem Gambling
Latinos and Mental Health
Many Latino families live below the poverty level; poverty level affects mental health status; however, most of them do not report it. Compared to Latinos living over the poverty level who are three times more likely to report psychological distress.
However, the suicide rate for Hispanics is half that of the Non-Hispanic White population. (Religion and Culture play a major role for
this difference; suicide is viewed as sin and “people who commit suicide go straight to hell”)
Suicide attempts for Hispanic girls, grades 9-12, were 70% higher than for White girls in the same age group, in 2011.
Non-Hispanic Whites received mental health treatment 2 times more often than Hispanics, in 2008.
Latinos are considered a high risk group for depression, anxiety and Substance Abuse
US POPULATION BY RACE: White 65.6% Blacks 12.2% Latinos 15.4%
PERCENT OF LATINOS REPORTING POOR MENTAL HEALTH: 33%
Of that 33%, only 6.8% received treatment.
Compared to other races reporting poor Mental Health:
African American 38% Received Treatment 8.7%
Whites 33% Received Treatment 16%
Last year, 64% of Latinos who reported suffering from Depression DID NOT ACCESS MENTAL HEALTH! -National Alliance on Mental Illness 2010
Top 10 cities with the highest percentages of
Hispanics in CT
City Population
Percentage of Hispanics Hartford (ranked 828thnationally) 122,112 40.41%
Willimantic, CT 18,200 32.34% Bridgeport, CT 139,505 31.88% New Britain, CT 71,546 26.74% Waterbury, CT 107,248 21.77% Meriden, CT 58,244 21.11% New Haven, CT 123,508 21.05% New London, CT 25,671 19.71% Stamford, CT 116,898 16.79% Danbury, CT 74,453 15.80%
Top Six Cities with calls to the helpline (n=311)
Hartford 3.9% Waterbury 3.5% New Haven 3.2% Bridgeport 3.2% Norwich 2.9% Norwalk 1.9% Latino/Hispanic Helpline Callers 6.4% Female 4.1% (97) Male 2.3% (214)
Gambling and Latinos/AS
Lottery (Lotto, Powerball, Scratch-0ffs)
Informal gambling (cards, dice)
Cultural games ( Boleta )
Animal fights (roosters, birds, dogs)
Bingo
Raffles
Dominoes
Sports betting
Casinos
Barriers to
Prevention and Care?
Language
Institutionalize Racism and Discrimination
Cultural Taboos and Characteristics
Lack of Research
Lack of Resources
Beliefs about Addiction and Mental Health
Lack of Bicultural Staff
The Role of Culture
In The Prevention, Intervention, and Treatment Processes
Definition of Culture:
The integrated pattern of human knowledge, beliefs, and behaviors that
depends upon a person’s capacity for learning and transmitting
knowledge to succeeding generations;
The customary beliefs, social forms, and material traits of a racial,
religious, or social group; and
The set of shared attitudes, values, goals, and practices that characterizes
a group.
Latino/a Cultural Characteristics
Familismo
Simpatia
Personalismo
Marianismo
Machismo
Curanderismo
Religion
“perception of time”
Lessons learned..
Prevention programs should enhance protective factors and
reverse or reduce risk factors.
Prevention programs should address all forms of gambling,
including illegal gambling, however, prevention programs
should address the type of gambling problem in the specific
local community, target modifiable risk factors, and strengthen
identified protective factors.
Prevention programs should be tailored to address risks specific
to population or audience characteristics, such as age, gender,
and ethnicity, to improve program effectiveness.
Community prevention programs reaching populations in
multiple settings - for example, schools, clubs, faith-based
organizations, and the media - are most effective when they
present consistent, community-wide messages in each setting
Current work of the Connecticut Council
Multi-lingual Helpline Call Specialists
Translation of all PG materials into Spanish.
Community-Based Outreach
Building Relationships and Collaborations
Prevention, Education and Awareness Trainings
Technical Assistance and Capacity Building
Examples of Latino Outreach in CT
Listed in La Guia Hispana (Hispanic yellow pages)
Listed in “Salud y Nutricion” magazine (Health and Nutrition)
The Bridgeport Project – a community based project addressing problem gambling in at risk and underserved groups.
Greater Bridgeport Community Resource Collaborative (CRC) Greater New Haven Latino Outreach Meetings
Hispanic Health Council, Hartford, CT. Norwich Safety Net Meetings
CT Multicultural Health Partnership Telemundo, Hartford/Springfield - “La Feria De La Familia”
Church Health and Wellness Fairs – “Feria de Salud”
Community Health Clinic – Health Fairs
LESGISLATIVE UPDATE REGARDING Cultural
Competency
Connecticut Passes Cultural Competency Bill
Following Oregon, the Connecticut state Senate passed a bill requiring Cultural Competency training for healthcare professionals. CTLatinoNews.com
"We want to make sure that folks don't fall through the cracks, and we also want to make sure that folks are not misdiagnosed either," Senator Andres Ayala (D-Bridgeport) said.
Ayala is the co-sponsor of a bill mandating courses in cultural competency for social workers, professional counselors, alcohol and drug counselors, as well as marital and family therapists. It passed unanimously in the state Senate. CT Latino News article.
http://www.cga.ct.gov/2013/ACT/PA/2013PA-00076-R00SB-00366-PA.htm http://senatedems.ct.gov/pr/ayala-130508a.php
http://ctlatinonews.com/blog/2013/05/15/a-move-to-mandate-cultural-competency-making-its-way-through-legislature/
Carlos Reinoso Jr. BS. BHCC Community Outreach and Legislative Advocacy
CT. Council on Problem Gambling (860)664-3996
CT PG Helpline: 1-800-346-6238 or 1-877-789-7777 Live Chat & Text via www.problemgambling.org
Rita Nieves, RN, MPH, LICSW
Bureau Director
Addictions Prevention, Treatment and Recovery Support Services
Boston Public Health Commission
Who is at risk? Using Lessons We’ve
Learned to Prevent Gambling
Boston Public Health Commission’s Bureau of
Addictions Prevention, Treatment and Recovery
Support Services provides addictions prevention, risk
reduction and treatment services, as well as other
addiction resources and referrals, to Boston residents.
Its mission is to set the direction and priorities for the
City’s comprehensive system of prevention, treatment
and recovery support services.
Mortality: Opioid overdose is the leading cause of accidental death in Boston. Of the 106 drug-related deaths reported in 2010, 45 were
opioid-related and 23 were due to cocaine.
Emergency Department Visits: In 2011, there were 29,607 illicit drug misuse and abuse-related ED visits in the metro-Boston region.
Treatment Admissions: In 2012, there were 15,182 treatment admissions for Boston residents [8,342 unique clients (55%)].
1.Drug of choice reported at treatment admission 54% for heroin, 32% for alcohol
2. Rate of tx. admission for White residents was approx. 180 per 10,000 residents, Black residents 162.8, and Latino residents 147.7 per 10,000. Tx. admission rates for White residents have remained stable over the period of 2001-2012, admissions rate for Black and Latino residents have declined substantially over the same time frame, showing a 53% and 41% reduction, respectively.
The Connection between gambling disorders and SA:
The 2008 national telephone survey done by Kessler, et al showed that often problem gambling is associated with SA disorders. This survey shows that 1:
75% of all pathological gamblers have had problems with alcohol.
38% of all pathological gamblers have had problems with other drugs.
Increased access and opportunity as Casino gambling becomes a reality in the surrounding areas of Boston neighborhoods.
Increase marketing targeting communities of color.
Potential Challenges
Implement prevention and education activities to
address problem gambling.
Develop and implement screening and assessment
tools as part of the standard of care.
Identify at high risk groups within the larger SA
system of care and develop intervention strategies.
Adopt lessons learned and best practices that have
been successful in other jurisdictions.
Develop and integrate prevention and education
curricula within the SA treatment continuum.
Cross training of providers.
Increase treatment capacity within the SA
continuum.