You don't have a gambling problem, do you?

March 16, 2015

Maureen Fitzgerald
Communications Coordinator, ATTC Network
Senior Editor, NIATx
Have you filled out your bracket?  March Madness officially began on March 15, 2015, Selection Sunday,  with 64 college basketball teams embarking on a four-week odyssey to the Final Four and the ultimate championship game. Across the country people are rooting for their teams, practicing their bracketology skills, and placing bets.

(By the way, how about those Badgers?)

It’s no coincidence that March is also the National Council on Problem Gambling’s Problem Gambling Awareness Month, and in some states (Iowa, for example) March 15-21 is National Problem Gambling Awareness Week.

For many people betting on sports teams is just plain fun, and gambling is considered a harmless pastime. As Christine Reilly, Senior Research Director of the National Center for Responsible Gaming states in this month’s ATTC Messenger, “an estimated 80 percent of adults in the U.S. gambled in the past year,” in activities ranging from buying lottery tickets to making illegal bets with bookies. Of this group, about 1 percent of the U.S. population meets the diagnostic criteria for a gambling disorder.

That seems like a pretty low number. But is it really an accurate estimate of the number of people who may be experiencing serious difficulties because of their  gambling?
 
Dr. Lori Rugle, Program Director of the Maryland Center of Excellence on Problem Gambling at the University of Maryland School of Medicine, has more than 30 years of experience in problem gambling prevention and treatment. Her presentation “Screening, Brief Intervention, and Referral to Treatment,” is the second webinar in the ATTC Network’s Problem Gambling Webinar Series.
  
Dr. Rugle believes that better and wider screening will lead to a more accurate representation of the true extent of gambling disorders, which often accompany substance use and mental health disorders.
 
View Dr. Rugle’s presentation slides and watch her recorded webinar here.

I caught up with Dr. Rugle last week to ask a few questions about gambling disorder screening tools. As she points out in her recorded webinar, some screening tools that work well in research settings are less effective in real-world clinical practice.  (Sound familiar?)

 “After finding this in state after state, we realized that we need to see how we can help counselors use the screening tools more effectively in actual clinical practice,” says Dr. Rugle.
 
It may be that addiction treatment counselors are just as uncomfortable asking their patients about their gambling behavior as, say, some primary care physicians are when asking people about their alcohol and other drug use.

 “What happens so often in clinical practice is that a counselor will ask a Yes/No question such as ‘You don't have a gambling problem, do you?’” says Dr. Rugle.  “Counselors and doctors are wary of asking questions about an area they’re unsure about,” she says. “With training on the right techniques and how to ask the right questions, clinicians can overcome their lack of confidence about exploring their patients’ gambling behaviors.”
 
One solution might be to include a question about problem gambling in existing SBIRT activities.
 
“Asking the question ‘What role does gambling play in your life, and is it helping or hurting?’ could start a longer conversation that might lead to treatment,” says Dr. Rugle.

That question is part of the conversations in Maryland, which has provided funding to agencies to integrate gambling into screening activities.

“I’m asking people to include gambling in every section of the intake, so patients can start making the connection between gambling and other parts of their lives,” she explains.

It's also important to define what is meant by gambling.

"Often, people don't automatically think about playing the lottery or bingo as gambling, just as some may discount beer when asked whether or not they drink alcohol," comments Dr. Rugle. 
 
Maryland is also introducing a program for a high-risk group for problem gambling: young adults. The Above All Odds campaign aims to help young adults recognize how to keep gambling fun and affordable, and how to get help if it gets out of hand.

Gambling disorder awareness has increased significantly since Dr. Rugle began her career.

“The DSM-5 reclassification of gambling disorder with substance use has also brought more attention to gambling disorder, and it has also encouraged state systems to look at it differently,” says Dr. Rugle. “In Maryland, it helped us to include problem gambling in the state’s recent integration of substance use and mental health disorders,” she says. “Without that new definition, it would have been much more difficult.”
   
With the increase of legalized gambling (and no end to that in sight) more treatment for problem gambling is available than in the past.
 
“Right now, 39 states offer funding of varying amounts to address problem gambling, but in most cases it is just a fraction of what’s available for other disorders,” comments Dr. Rugle. She’d like to see a public source of funding for research in this area and to be included along with funding for other addictive disorders, especially as gambling continues to proliferate.

For more information, see the 2013 National Survey of Problem Gambling Services.

One potential funding source is the tax revenue that the federal government receives from gambling winnings. “This could provide more funding for problem gambling prevention and treatment,” notes Dr. Rugle.


In conclusion, Dr. Rugle encourages treatment professionals to think about ways they can “have the conversation” about gambling behaviors with their clients. “People are really surprised to learn how pervasive it is and the issues it’s creating in families, at work, and as a relapse risk factor," says Dr. Rugle. “Not addressing gambling issues decreases treatment effectiveness and adds to treatment costs,” says Dr. Rugle.

For more information, visit:
Maryland Center of Excellence on Problem Gambling
National Council on Problem Gambling
ATTC Network Problem Gambling Webinar Series

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