Responsible Gambling Programs

March 13, 2017
Christine Reilly
Senior Research Director
National Center for Responsible Gaming

Warning messages on gaming machines. Self-exclusion programs. Programs to limit money and time spent gambling. These are just a few responsible gambling strategies in use around the world. Responsible gambling (RG) refers to programs that seek to prevent or reduce gambling-related harms. The impetus behind these programs derives from the public health shift from a reactive posture of trying to eliminate disorders that have already occurred, to a proactive force that seeks to promote positive health behaviors and prevent diseases before they emerge (or at least mitigate their effects).

Source: Independent Gambling Authority

The rise in responsible gambling strategies is a response to this trend of health promotion. Enacted in government regulations, as well as in voluntary programs developed by gambling operators, responsible gambling programs have proliferated in legalized gambling jurisdictions throughout the world. However, are these programs safe? Are they effective? A review of the scientific literature by the leading gambling researchers indicates a dearth of science-based, peer-reviewed programs in this area. Why is peer-reviewed research important? Quality research will answer questions about safety and effectiveness. For example, is self-exclusion an effective intervention? Are limits on time and money wagered safe or do they in some cases cause people to gamble even more than they intended? These questions must be answered to protect people and to ensure that the considerable expense of these programs can be justified as effective. Here a few examples.

Voluntary self-exclusion programs, typically operated by
casinos, online gambling sites and gaming regulators, give individuals the opportunity to exclude themselves from gambling opportunities. Typical programs remove the enrolled person from marketing databases. Some authorize staff to remove the enrolled person from the premises and to deny cash prizes to those on the self-exclusion list.

What the research says

Research indicates that self-exclusion is safe and, for some gamblers, an effective intervention. However, more research is needed to ascertain the long-range impact of the program and to determine the most effective features of the program. For example, it is not clear what the optimum time limit for the ban should be.

Another responsible gambling strategy is to educate gaming employees about responsible gambling and gambling disorder. Research indicates that employee training can improve employees’ knowledge of responsible gambling. However, there is no evidence that increasing knowledge among casino staff can help employees accurately identify casino patrons with a gambling disorder.

In conclusion, the field does not yet have a systematic approach for assessing the quality of research on RG. Instead, a haphazard approach to developing and adopting RG programs has characterized RG efforts. Policymakers and the gambling industry should take a cautious and conservative approach to RG until quality scientific research provides a roadmap to safe and effective programming.

Winning Reads for Problem Gambling Awareness Month

March 5, 2018
Maureen Fitzerald
ATTC Network Coordinating Office/NIATx

We've rounded up a few great resources to help you stay up-to-date on the latest in prevention, education, and treatment for problem gambling--not just during Problem Gambling Awareness Month, but year-round:

Everything you need to know about medications for treating opioid use disorders: SAMHSA TIP 63

February 20, 2018

Maureen Fitzgerald
ATTC Network Coordinating Office/NIATx

Finding the most up-to-date information on how to support people with opioid use disorder (OUD) just got easier with the release of SAMHSA's  TIP 63: Medications for Opioid Use Disorder.  An expert panel of researchers, policy makers, treatment providers, and others helped to develop TIP 63. 

Research supports the use of the three FDA-approved medications—methadone, extended-release naltrexone, and buprenorphine—for treatment of OUD. As TIP 63's Executive Summary states, randomized controlled trials have shown these medications to be effective in reducing illicit opioid use and overdose deaths.  (You'll find citations to latest research throughout TIP 63.)
Patients with OUD should have access to mental health services as needed, medical care, and addiction counseling, as well as recovery support services, to supplement treatment with medication.   SAMHSA TIP 63, Executive Summary 
Source: SAMHSA TIP 63
Yet these medications remain underused in the United States. Researchers from the Foundation for AIDS Research (amfAR) shared an analysis of SAMHSA's National Survey of Substance Abuse Treatment Services in a recent post in the Health Affairs Blog, Where Multiple Modes of Medication-Assisted Treatment Are Available. They found that of the 12,029 U.S. treatment facilities:

  • 41% of treatment facilities offer only one of the medications
  • 23% offer two or more 
  • 2.7 % report offering all three medications
The Health Affairs blog post  includes information on geographic availability of medication-assisted treatment with a link to amfAR's interactive map, Facilities Providing Some Medication Assisted Treatment.

TIP 63: Developed by an expert panel

With TIP 63, SAMHSA provides an essential resource to treatment organizations that want to start or expand their use of medications for opioid use disorders. The TIP includes an Executive Summary followed by five sections:

Part 1: Introduction to Medications for Opioid Use Disorder Treatment, presents information on medications, their effectiveness, how they're prescribed, and barriers to their use.

Part 2: Addressing Opioid Use Disorder in General Medical Settings, covers OUD screening, assessment, treatment, and referral.

Part 3: Pharmacotherapy for Opioid Use Disorder gets into the specifics of prescribing and dispensing OUD medications.

Part 4: Partnering Addiction Treatment Counselors With Clients and Healthcare Professionals,  offers guidance on how substance use disorder counselors and other health care professionals can work together to help people with OUD.

Part 5: Resources Related to Medications for Opioid Use Disorder, includes a glossary, a resource list, and sample forms.

Download for free today 

SAMHSA Tip 63 is free, and you can download digital versions of each section or the entire document from the SAMHSA website. You can also place an order for hard copies on SAMHSA's Publications Ordering page. 

Have you started to use SAMHSA TIP 63?  What's been most useful to you in starting or expanding your use of medications for OUD?  Let us know in the comment section below. 

Understanding Substance Use Disorders: New online course covers the basics

February 6, 2018

Heather Gotham, PhD
Associate Research Professor
Mid-America ATTC

The newest course on HealtheKnowledge, Understanding Substance Use Disorders, is a collaborative effort between the UMKC-SBIRT Project (a SAMHSA-funded SBIRT health professions training grant; and the Mid-America ATTC. Through UMKC-SBIRT we had several requests for a basic training on substance use disorders, as several of the health professions training programs with which we work did not provide even basic instruction on SUD. They wanted a primer course that students could take prior to SBIRT training (SBIRT for Health and Behavioral Health Professionals, also on

In addition, through Mid-America, we had received multiple requests for basic SUD training that could be used during the orientation of new behavioral health staff, as well as training for child welfare, corrections, or other allied professionals. The course is also currently being implemented in baccalaureate nursing and health studies curricula. We hope that other programs will find value in the course and will use it with other student groups.

SoberBowl II: Stealth recovery advocacy

January 29, 2018

Maureen Fitzgerald
ATTC Network Coordinating Office/NIAtx

Tracy Abbott is Director of the ARK, a Houston-based nonprofit dedicated to producing alcohol-free entertainment events. In the fall of 2016, Houston was abuzz with excitement about Super Bowl 2017, which was held at Houston's NRG Stadium. Billboards and restaurants advertised the big game, with accompanying big entertainment and watch parties.

"That's when I realized that people in recovery need an alcohol- and drug-free space where they can participate in all the energy surrounding the Super Bowl," says Abbott.

And in just 60 days, she raised $100k to launch SoberBowl I in Houston, an alcohol- and drug-free Super Bowl party that attracted nearly 1,000 attendees. Athletes and entertainers in recovery provided entertainment and inspiration for the event as they will again this year—with SoberBowl II events scheduled for both Houston and Minneapolis.

The Opioid Crisis: Community is Key to Addressing the Epidemic

January 22, 2018

Holly Ireland, LCSW-C
Co-Project Director
Central East ATTC 

In the spirit of collaboration and given our proximity, the Central East ATTC has offered to attend relevant national policy activities in Washington, D.C. to represent the ATTC Network and to support us all in staying abreast of what's happening and assess any potential future impact on our work or potential collaborations for the Network.

The Opioid Crisis: An Examination of How We Got Here and How We Move Forward
Senate Health, Education, Labor and Pensions (HELP) Committee Hearing, January 9, 2018

The Network Coordinating Office asked the Central East ATTC to attend this particular hearing, given the topic. This was an unexpected and welcome benefit of my new role as the Central East ATTC Co-Director, having joined the team in November 2017. I was excited and honored to go, given my increasing interest in public welfare policy, especially as it relates to the behavioral health of our communities, our states, and our nation. Until now, I have mainly been directly involved in policy action at local and state levels of government. I have always followed national policy action, and have inspired others to do so as a Social Work educator, most recently teaching social welfare policy practice for Salisbury University’s Social Work Department in the semester just ending in December 2017.

The morning of the hearing, my four-block walk from the metro station to the Dirksen Senate Building took me past the Capitol, the Library of Congress, and the Supreme Court. Walking along, I recalled the last time I had been in view of the Capitol: almost a year ago, participating in the Women's March with my then 11-year old daughter. Once I arrived at the Senate Building, I proceeded through security and navigated the halls filled with citizens, media, staffers, and elected officials. I shared an elevator with several others, including a senator, and found my way to the hearing room, where an audience of about 70 journalists, staffers, and citizens awaited the hearing.

Sam Quinones, featured witness and author of Dreamland, The True Tale of America's Opiate Epidemic, was already at the witness table, with his wife and daughter in the first row to his right. Several of the senators greeted him personally, expressing their appreciation for his journalistic insights and willingness to testify. All took their seats and the hearing began on schedule.

The HELP Committee 

All Committee Members are listed and those present for the hearing are in bold:

Democrats: Patty Murray (WA) (ranking), Bernie Sanders (VT), Robert P. Casey, Jr. (PA), Al Franken  (MN), Michael F. Bennet (CO), Sheldon Whitehouse (RI), Tammy Baldwin (WI), Christopher S. Murphy (CT), Elizabeth Warren (MA), Tim Kaine, (VA), Maggie Hassan (NH)
Republicans: Lamar Alexander (TN), Chair; Michael B. Enzi (WY), Richard Burr (NC), Johnny Isakson (GA), Rand Paul (KY), Susan Collins (ME), Bill Cassidy, M.D., (LA), Todd Young (IN), Orrin Hatch (UT), Pat Roberts (KS), Lisa Murkowski (AK), Tim Scott (SC) (Scott attended briefly, but did not speak.) 

During opening remarks, Senator Alexander stated that the opioid epidemic is the number one public health problem in America, with overdose deaths now exceeding the number of motor vehicle accident deaths per day. Alexander emphasized that this was a bipartisan hearing with full support of all committee members, and remarked on the CARA and CURES Acts to address the effort. Senator Murray specifically addressed the committee’s commitment to move supplemental funding state’s need for implementing evidence-based practices (EBPs) to address the epidemic. This was the most direct reference to the work of the ATTCs.

Mr. Quinones testified for about 10 minutes, and then each of the Senators asked at least one question. Several of the Senators had in front of them a copy of Mr. Quinones book, referring to it directly.

There was no remarkably new information regarding the causes of the epidemic or strategies to address it. Mr. Quinones emphasized several times that this crisis has been in the making for more than two decades and that addressing it will take sustained efforts, resources, and funding. The CARA and CURES Acts are solid beginnings but only that, beginnings.

Major themes of Quinones' testimony

  • Prevention, emphasizing community building, investing in recovery, increasing education about the addictive qualities of prescription medications, and decreasing the number and amount of prescriptions provided by health care professionals to the public. Senator Warren specifically spoke to the need for DEA and states to comply with the "Partial Fill" provision in CARA. 
  • Criminal Justice intersection: Retooling law enforcement agency and detention center responses to treatment needs.
  • Public/Private Sector Partnerships: Increase accountability of the private sector that is profiting from this crisis to support and align with the public sector that is bearing the costs.
  • Intervention: Expand access to care, specifically MAT, in detention centers, and also in the community. Increase access to alternative pain management—teach both health care professionals and the public about these alternatives—and make them reimbursable).
  • Funding: Sustain the CDC’s role in funding Prescription Drug Monitoring Program (PDMPs), public awareness campaigns, and national surveillance data for both fatal and non-fatal overdose deaths.
  • Research: Increase funding for research for addiction treatment and pain management and local community partnerships with law enforcement agencies, coroners, public health, health care, courts, detention centers, social services, and community members (persons in recovery, family members and advocacy groups - my editorial definition). 
  • Overcome access barriers: Develop resources in in rural areas and services to families (parents with addictions, parents with addicted children of all ages, grandparents as parents). Fund infrastructure: current CARA and CURES allocation fund interventions (e.g., Naloxone) but not the infrastructure to support it (e.g., personnel to educate and distribute to the public).
  • Stigma: Address and defeat stigma by mainstreaming storytelling of addiction and recovery to create a social movement of recovery. 
  • Build a global partnership to address supply of heroin, fentanyl, and carfentanyl. Build partnership and community with Mexico and other source countries to stem the supply flow.

Community is key

The hearing was scheduled to end at noon, but continued beyond. When finally adjourned, it was with many questions remaining unasked and unanswered, and several senators requesting follow up discussion with Mr. Quinones. It was clear the senators were cognizant of the impact of the opioid epidemic on citizens, families, communities, states and the nation. It was also evident how thoughtful and contemplative the committee members were about the responsibility in addressing this epidemic. However, it was also clearly recognized by all that to bring the opioid epidemic to an end, effort and engagement is needed from all, from everyone throughout the country, from every state, and from every strong and ever-strengthening community.

Read the transcript of Quinones testimony
Watch the video of the session 

About our blogger: 

Holly Ireland, LCSW-C, joined The Danya Institute/Central East ATTC team as Co-Project Director in November 2017.

Holly has 27 years’ experience working in the behavioral health field, beginning her career as a Residential Rehabilitation Counselor while working on her undergraduate degree in psychology at Towson University. She graduated from University of Maryland, Baltimore with a master’s in Social Work with a primary concentration of Clinical and a secondary concentration of Management and Community Organization. During her career, she has provided direct service in outpatient behavioral health and recovery support settings, including individual, group and family therapy for co-occurring disorders, crisis intervention, trauma treatment, Assertive Community Treatment, and advocacy. Holly currently serves as adjunct faculty for Salisbury University’s Social Work Department, teaching social welfare policy and advanced practice courses.

Most recently she provided leadership and administration of Mid Shore Behavioral Health, Inc., a non-profit organization responsible for planning and management of the continuum of services in Public Behavioral Health System in Caroline, Dorchester, Kent, Queen Anne’s and Talbot Counties on the Eastern Shore of Maryland. Holly joined the MSBH team in 2006, serving as executive director since 2010.

A native of Easton, Holly loves the Eastern Shore of Maryland, its culture, its people, and its ecology. When not serving as a clinician, administrator or advocate, Holly enjoys spending time with her family and friends, traveling, being an active member of the community, and being outdoors – basically doing anything that advances health and wellbeing.

New Year--New Web Accessibility Laws

January 8, 2018

Kendra Barker, M.Ed.
Instructional Designer – Specialist
Collaborative to Advance Health Services
University of Missouri - Kansas City | School of Nursing and Health Studies

It’s that time when we start planning for the New Year: budgets, conferences, marketing materials, and more. As we ring in 2018, it's also time to be thinking about 508 compliance—the laws that require an organizations websites and other electronic publications accessible to people with disabilities. Updates to these laws take effect January 18, 2018, making it vitally important for ATTC to make any changes needed.

See related blog post: Tips for Navigating 508 Compliance

There are new updates of Section 508 Standards and Section 255 Guidelines for Information and Communication Technology (ICT), often referred to as the Section 508 Refresher, or the Final Rule. Section 508 Standards and Section 255 Guidelines relate to the accessibility of information and resources managed through websites, blogs, web content, etc.

The United States Access Board website states that Section 508 Standards and Section 205 Guidelines apply “to ICT development, procured, maintained, or used by federal agencies,” meaning that any federally-funded agency must follow the new Section 508 Refresher when creating anything that will go on the Internet and out to the public. However, it does not apply to websites or web content created before this date.

Web Content Accessibility Guidelines (WCAG)

The main goal of the law is to ensure that newly developed webpages and content will pass the Web Content Accessibility Guidelines (WCAG) version 2.0, Levels A and AA. WCAG 2.0 was developed by the World Wide Web Consortium (W3C) and sets international accessibility standards. The law not only includes web-based content, but all electronic content.

The best way to make sure you are addressing these changes to the accessibility laws is to plan your project from the beginning with WCAG 2.0 Levels A and AA in mind. It is much more difficult and time-consuming to make websites, web content, etc., compliant after they are created. This includes Word documents, PowerPoints, online courses, marketing material, videos, etc.

Here are some useful resources for you to check out:

WebAim (includes training)

The new web accessibility laws affect the entire ATTC Network. The ATTC Network Coordinating Office will take the lead in keeping us compliant with the accessibility laws and keep the will ATTCs informed.

Hall of Fame--Online Museum of African American Addictions, Treatment and Recovery

January 3, 2018

This week, we are pleased to bring you the 2018 inductees into the
Hall of Fame for the Online Museum of African American Addictions, Treatment, and Recovery!

We join the Online Museum in thanking these notable individuals for their important work and their contributions to the substance use disorder treatment and recovery fields.