Massachusetts Council on Compulsive Gambling

Transcription

1 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 April 10, 2014

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 Massachusetts Conference on Gambling Problems 2

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) 3

4 Few youth with gambling problems only have gambling problems 4

5 Is Problem Gambling A Primary Disorder? Alcohol Dependence ADHD Other Disorders Problem Gambling Drug Dependence Conduct Disorder Depression

6 Problem Gamblers

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9 Current Prevention Efforts for Children and Adolescents 9

10 Where do we go from here????? 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 Use of smartphones, tablets and laptops 11

12 The importance of social media Greater parental, teacher and mental health professionals awareness about the risks associated with youth gambling 12

13 Who is At Risk: Asian-Americans and Gambling Timothy Fong MD UCLA Gambling Studies Program Masschusetts Conference on Gambling Problems April 2014

14 Overview Asians and Gambling History, Culture, Society Treatment Strategies How California is Addressing the Issue Available Resources

15 Asians and Gambling

16 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. The Philippines: Manila Bay 2010.

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18 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

19 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 Superstitions

20 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 months.

21 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

22 CCPG Help Line Calls 2009

23 Results Gender N=180 Male 75% Females 25% Ethnicity Asians 37% Non-Asians 63% Chinese, Filipino, Korean, Japanese

24 Results Screening Score APIs Non-APIs SOGS >5 42% 36% NODS >5 35% 26%

25 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%)

26 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 Pathological 3.4

27 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 No idea where to go

28 Community Awareness 84% said PG is an addiction 40% had not heard of treatment resources Likely sources Media Friends / Family Helpline

29 Freedom From Problem Gambling Workbook

30 Available Languages for WB Arabic Hmong Russian Armenian Japanese Samoan Cambodian Korean Spanish Chinese Laotian Tagalog English Lu Mien Thai Farsi Punjab Vietnamese

31 Contact Information Timothy Fong MD

32 Carlos Reinoso Jr., BS. BHCC CT Council on Problem Gambling

33 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 Non-Hispanic Whites received mental health treatment 2 times more often than Hispanics, in 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

34 Top 10 cities with the highest percentages of Hispanics in CT City Population Percentage of Hispanics Hartford (ranked 828 th nationally) 122, % Willimantic, CT 18, % Bridgeport, CT 139, % New Britain, CT 71, % Waterbury, CT 107, % Meriden, CT 58, % New Haven, CT 123, % New London, CT 25, % Stamford, CT 116, % Danbury, CT 74, %

35 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) CCPG Helpline 2013 Report

36 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

37 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 Lack of Culturally Competent Evidence Based Programs

38 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.

39 Latino/a Cultural Characteristics Familismo Simpatia Personalismo Marianismo Machismo Curanderismo Religion perception of time

40 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

41 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

42 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 Older Adult(Seniors) Health and Wellness Expos or Fairs

43 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

44 Latino Outreach

45 Carlos Reinoso Jr. BS. BHCC Community Outreach and Legislative Advocacy CT. Council on Problem Gambling (860) CT PG Helpline: or Live Chat & Text via

46 Who is at risk? Using Lessons We ve Learned to Prevent Gambling Workshop Rita Nieves, RN, MPH, LICSW Bureau Director Addictions Prevention, Treatment and Recovery Support Services Boston Public Health Commission

47 A Providers Perspective 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.

48 Epidemiology of SA in Boston 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 per 10,000. Tx. admission rates for White residents have remained stable over the period of , admissions rate for Black and Latino residents have declined substantially over the same time frame, showing a 53% and 41% reduction, respectively.

49 Potential Challenges 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. 1 Kessler, R. C. et al. DSM-IV pathological gambling in the National Comorbidity Survey Replication. Psychol. Med. 38, (2008).

50 STRATEGIES 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.