Ken Litwak, BA, ICGC-1, CCTP Problem Gambling Prevention Specialist

Transcription

1 Gambling and Trauma

2 Ken Litwak, BA, ICGC-1, CCTP Problem Gambling Prevention Specialist

3 Who is 800Gambler? 800gambler.org Council on Compulsive Gambling of New Jersey, Inc Quakerbridge Rd. Suite 7 Hamilton, NJ ~ GAMBLER CCGNJ is neither for nor against gambling!

4 Gambling, Problem Gambling, and Disordered Gambling Gambling DSM-5: Risking something of value in the hopes of obtaining something of greater value. Problem Gambling: Sub-clinical term for interference without meeting full diagnostic criteria. Disordered Gambling: Persistent and recurrent maladaptive gambling behavior that disrupts personal, family, and/or vocational pursuits.

5 I started going for an hour after work, and then it got, that I couldn t get the work done fast enough to get back to the casino to gamble. I played for twelve hours straight. Because by this time I had let bills go, and I was kind of trying to gain the money, I hid the bills as they came in and when [my husband] wasn t around, and then he started ignoring me. [Feelings]? Well, I didn t care. I just wanted to get back to the machines. It was like easy money.

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10 Trauma Reactive Attachment Disorder grossly underdeveloped attachment between child and caregiving adults Posttraumatic Stress Disorder Exposure - intrusive symptoms - avoidance of stimuli - negative cognition and mood - alterations in arousal

11 Trauma Acute Stress Disorder Intrusion symptoms, negative mood, dissociative symptoms, avoidance, arousal extremely negative thoughts about the event including likelihood of future harm Disinhibited Social Engagement Disorder overly familiar behavior with relative strangers

12 The Relationship Gambling as relief from trauma Gambling and negative life events in a nationally representative sample of UK men University of Lincoln 3025 men aged years Among men in the United Kingdom, disordered gambling remains uniquely associated with trauma and life stressors in childhood and adulthood Early life stressors, specifically adverse childhood experiences and trauma, increase risk for psychopathology later in life, including the development of disordered gambling Gambling as a cause of trauma

13 Sapienza University of Rome (2015) One hundred seventy-one (134 men and 37 women) gamblers recruited in gambling environments (i.e., two Italian casinos) Childhood trauma (CT) may explain gambling severity through pathological dissociation - mechanism of gambling based on the loss of integration between higher and lower mental functions. Gambling severity is associated with both childhood trauma and pathological dissociation in casino gamblers. The effect of childhood trauma on gambling severity is entirely mediated by pathological dissociation. Personal history of childhood abuse or neglect is considered a major risk factor. CT is associated with virtually all DSM-5 diagnostic categories, including Substance-related and Addictive Disorders More severe CT was associated with more severe gambling severity.

14 Sapienza University of Rome (2015) (continued) CT can cause dissociation and both are associated with disordered gambling. Gambling behavior might be considered as a dissociative-like phenomenon aimed at escaping from negative and stressful mental states. Dissociation in gamblers is a way to cope with negative mental states linked to CT. Gambling behavior is not only a defensive strategy to cope with negative mental states related to CT but also one of the multiple and complex outcomes of mental/cerebral dis-integration induced by CT. Gamblers engaged in both video lottery and other forms of gambling reported higher dissociative symptoms compared with control groups (VLT and other gambling may contribute to dissociative symptoms) Likely to state that they lost all track of time while gambling, blocking out all other sights, sounds and interactions and consequently experiencing higher dissociative experiences.

15 Adverse Childhood Experiences (ACE) a collaborative effort between Kaiser Permanente and the CDC stressful or traumatic childhood experiences have negative neurodevelopmental impacts that lead through life pathways and increase the risk of a variety of behavioral, health, and social problems. childhood emotional, physical, or sexual abuse and household dysfunction

16 Adverse Childhood Experience (ACE) Questionnaire Finding your ACE Score While you were growing up, during your first 18 years of life: 1. Did a parent or other adult in the household often Swear at you, insult you, put you down, or humiliate you? or Act in a way that made you afraid that you might be physically hurt? Yes No If yes enter 1 2. Did a parent or other adult in the household often Push, grab, slap, or throw something at you? or Ever hit you so hard that you had marks or were injured? Yes No If yes enter 1

17 3. Did an adult or person at least 5 years older than you ever Touch or fondle you or have you touch their body in a sexual way? or Try to or actually have oral, anal, or vaginal sex with you? Yes No If yes enter 1 4. Did you often feel that No one in your family loved you or thought you were important or special? or Your family didn t look out for each other, feel close to each other, or support each other? Yes No If yes enter 1 5. Did you often feel that You didn t have enough to eat, had to wear dirty clothes, and had no one to protect you? or Your parents were too drunk or high to take care of you or take you to the doctor if you needed it? Yes No If yes enter 1

18 6. Were your parents ever separated or divorced? Yes No If yes enter 1 7. Was your mother or stepmother: Often pushed, grabbed, slapped, or had something thrown at her? or Sometimes or often kicked, bitten, hit with a fist, or hit with something hard? or Ever repeatedly hit over at least a few minutes or threatened with a gun or knife? Yes No If yes enter 1 8. Did you live with anyone who was a problem drinker or alcoholic or who used street drugs? Yes No If yes enter 1

19 9. Was a household member depressed or mentally ill or did a household member attempt suicide? Yes No If yes enter Did a household member go to prison? Yes No If yes enter 1 Now add up your Yes answers: This is your ACE Score

20 International Journal Of Mental Health & Addiction, 2013 University of Lethbridge, Canada Female Gambling, Trauma, and the Not Good Enough Self It is an interesting addiction. Ummm It s the fact that, you know it s glam, right? It s glam. You re somebody else. You feel like somebody else. You get attention because for example, when I went to [a casino] before Christmas never walked in there before in my life I had my black hair with really nice blond streaks Now, because they ve never seen me and because the first thing they usually see is Native probably, who knows? But that s the truth.

21 Female Gambling, Trauma, and the Not Good Enough Self problem gambling may be directly associated with dating violence, marital violence and child abuse. dating violence, marital violence and severe child abuse victimization were associated with increased odds of gambling problems 9 female participants (pathological gamblers) all 9 reported emotional, physical or sexual abuse or multiple abuses Among 365 females gamblers from across the province in Ontario, Boughton and Brewster (2002) found that 46 % of women reported experiencing physical abuse as adults and 28 % reported experiencing sexual abuse as an adult, while another 30 % of married participants reported current physical abuse in their relationships. Is this cause, correlation, or escape? We just don t know.

22 This developmental, yet, non-linear process makes room for gaming venues to begin to occupy space and participants time, setting the stage for the compulsive gambler to take form within each one. Jan immigrant to USA When asked about family, friends, and network support, Jan immediately began to talk about gambling. Glamorizing, and glossing over the harsh realities that exist in the gambling world, as the gambler s mind begins to create all the big win scenarios and ignores the reality of losing money through gambling.

23 Escape It seemed the less absorbed you were with it [grieving], that you re generally up winning, I can t remember trying to win. It always just seemed like it was a place I could go and hide from the world, and I didn t have to do anything or talk to anybody or just soulless You were in a lonely void. (Kathy) I don t know what the hell I would have done to fill those hours; I don t know if I would have gotten really mentally ill.

24 Escape After I broke up with him, it devastated me and it devastated my kids. They called him dad, especially my youngest and then all of the sudden I don t know, one day, like I remember getting my back pay for as far back as I can remember and I had money from here so like I had five thousand And I totally blew it all on the VLTs. Smoking pot and drinking too I guess; just because I was lonely.

25 PTSD among problem gamblers is estimated at 12.5% to 29% PG is a significant predictor of PTSD Among treatment-seekers with PG, 34% had a high level of PTSD symptoms Among military veterans entering treatment for PTSD 17% met DSM-IV criteria for PG. of 111 veterans entering a gambling treatment program, 64% reported a history of emotional trauma, 40.5% reported physical trauma, and 24.3% sexual trauma; most trauma had occurred in childhood Najavits, Johnson, Lung, Smylie, Gallop, & Classen, (n.d).

26 Kathy describes going to the casino by herself after her husband was hospitalized for Alzheimer s disease: One day I turned in there [casino] and decided it was one place I could go by myself I didn t know anybody, I didn t have to talk to anybody, I could just sit down on the machine and you re anonymous, for some reason or another I just remember thinking I m going to go there, I can, it s not like walking into a bar, where you need a partner.

27 Gambling offers a refuge from both traumatic experiences and the stressors of daily life Lizzy explains, It s all about changing the way you feel, it s all about not wanting to deal with things that are painful. I think to me, that has been my experience. You feel you got some control over a situation that is completely out of control, like I mean who has got control over a stupid machine.

28 Problem Gambling and Developmental Trauma My Dad was dead, my step Dad gambled, he gambled away our money so we didn t always have enough, or whatever, and my mother would try to chase him around to try to get the paycheck before he spent it all, and stuff like that. It was a taboo just the fact that they fought about it all the time was quite upsetting. I guess you could say that was traumatic (Eve) Watching her step dad hit her mom while fighting over money became a regular occurrence for Kathy

29 National Association for Gambling Studies (NAGS)Conference Australia in November Eleven mental disorders commonly co-occurring with problem gambling in both the national and international literature. This list included: post traumatic stress disorder, social phobia, depression, Alcohol dependence, drug dependence, agoraphobia, panic disorder, bipolar disorder, generalized anxiety disorder, phobia and nicotine dependence

30 Which Came First? it is difficult to make a blanket statement as to the temporal sequencing of disorders as this depends on individual circumstances including the nature of the disorder. Indeed, the conundrum of determining the sequencing of disorders was commonly referred to amongst therapists as the chicken or the egg question.

31 References Imperatori, C., Innamorati, M., Bersani, F. S., Imbimbo, F., Pompili, M., Contardi, A., & Farina, B. (2017). The Association among Childhood Trauma, Pathological Dissociation and Gambling Severity in Casino Gamblers. Clinical Psychology & Psychotherapy, (1), 203. doi: /cpp.1997 Holdsworth, L., Haw, J., & Hing, N. (2012). The Temporal Sequencing of Problem Gambling and Comorbid Disorders. International Journal Of Mental Health & Addiction, 10(2), doi: /s Ledgerwood, D. M., & Petry, N. M. (2006). Posttraumatic stress disorder symptoms in treatment-seeking pathological gamblers. Journal Of Traumatic Stress, 19(3), doi: /jts Najavits, L. M., Johnson, K., Lung, J., Smylie, D., Gallop, R. J., & Classen, C. C. (n.d). Seeking Safety Therapy for Pathological Gambling and PTSD: A Pilot Outcome Study. Journal Of Psychoactive Drugs, 45(1), Nixon, G., Evans, K., Grant Kalischuk, R., Solowoniuk, J., McCallum, K., & Hagen, B. (2013). Female Gambling, Trauma, and the Not Good Enough Self: An Interpretative Phenomenological Analysis. International Journal Of Mental Health & Addiction, 11(2), doi: /s

32 Journal Of Traumatic Stress (2006) Reporting on a study of gamblers in treatment Gamblers who had high PTSD scores also had elevated scores on a lifetime measure of pathological gambling symptoms. Most studies of PGs reported elevated dissociation (1999, 2001, 1988) gambling provides a way to escape from painful emotional experiences for some gamblers (and calls for more research more PTSD symptoms experienced more lifetime gambling symptoms