Gambling Disorder in Asians

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1 Gambling Disorder in Asians Xu Zhang Chen, M.D. If you don t gamble, you don t know how lucky you are 1

2 Why is gambling so popular among Asians? Gambling disorders 2-3 times more common in Asians (one study showed 60 times greater) Trauma and social isolation increase risk of gambling disorder Immigrants are selected risk takers Immigration is a gamble Gambling in Asian Culture Gambling as a routine social activity Superstition, numerology, and luck Concept of destiny reduces perception of risk Casino Community No language barrier when gambling Marketing targeted at Asians Stigma a moral problem 2

3 Types of gambling in Chinese Community Casino Lottery Mahjong Card clubs OTB (Off track betting) Sports Stock market Gambling is Like a Drug Euphoria of winning Repeated euphoria establishes pattern Anxious, bored, restless, depressed when not gambling Continued gambling to relieve anxiety Tolerance through increased amount gambled or frequency Dependence = Gambling disorder 3

4 Classification of Gambler Social Gambler 1. Social activity 2. Sometimes, Occasionally 3. Limited money Classification of Gambler Regular Gambler 1. Gambling is seen as a regular entertainment or leisure active 2. Gamble with spare money only and with limited time and betting 4

5 Classification of Gambler Transitional Gambler 1. Those who has a sudden change in life e.g. lost love, divorce, death of relative, lost job, business, etc. Classification of Gambler Professional Gambler 1. Gambling as a professional, 2. Studying the ways gambling and Probability with high self-discipline 5

6 DSM-5: Gambling Disorder Needs to gamble more money to maintain excitement Restless/irritable when trying to reduce Repeated attempts to reduce Preoccupied with gambling Gambles when depressed After losing, chases losses by gambling again DSM 5: Gambling Disorder Lies to conceal gambling/losses Gambling affected family/work Relies on others for money for gambing Not due to manic episode > 3 of the above in 12 months. Mild (4-5), Moderate (6-7), Severe (>7) Episodic vs. Persistent 6

7 Process Winning Phase Initially social or entertainment Euphoria of Winning big money Escalation of betting amount (tolerance) Reinforcement effect, which makes gamblers keep gambling even losing money. Process Losing Phase Loan, Lying Neglecting work and family chasing desire of gamble Pattern affecting personality 7

8 Process Desperation Phase Family isolation/conflict Serious debt, may commit crimes Depression No self-reflection, projects blame to others Process Giving up phase Strong guilt and helplessness Crimes for money Defaulting on loans Suicide or homicide attempts 8

9 Positive experience Win Big Money Betting more to pay for loans Winning phase Losing phase Beneficial attachment Irrational thinking Never gamble Social gambler Regular gambler Transitional gambler Gambling disorder Severe gambling disorder Development Depressed Family/work Key Phase impairment Negative experience Desperation phase Giving Up phase Chinese Community Problem Gambling Project (SF, Ca) Early intervention Gambling problems emerge early (10 y/o) Change culture of acceptance Community support ESL, job training, public benefits, financial counseling Family support Involve family, support family treat family members (MH, domestic violence, etc.) 9

10 Chinese Community Problem Gambling Project (SF, Ca) Mental Health Identify comorbid conditions (e.g. mood, compulsive disorders; PTSD; antisocial personality disorder; substance abuse) Culturally sensitive MH treatment chatting over tea rather than therapy/counseling Focus on impact on family rather than gambling behavior Advocacy Public education, research, personal repsonsibility Treatment of Gambling Disorder Fluvoxamine (mean 195 mg/d) Naltrexone (mean mg/d) Lithium Valproate Behavioral therapies Desensitization Spousal contingency contracting 10

11 Treatment of Gambling Disorder Cognitive restructuring Correct cognitive errors (e.g. that outcome can be controlled/predicted) Cognitive behavioral therapy assertiveness, social-skills, problem solving, relaxation Individual or group Gamblers Anonymous 12-step program, no therapist, religion based 11

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