GAMBLING PROBLEMS WITH OLDER ADULTS WITH COD

GAMBLING PROBLEMS WITH OLDER ADULTS WITH COD Patrick Arbore, Ed.D. Founder & Director, CESP & Director Institute on Aging

Center for Elderly Suicide Prevention & Grief Related Services • 24-hour Friendship Line for the Elderly • Local number (415) 752-3778 • 800# -- (800) 971-0016 • Assessment Center (415) 750-4111 • Grief Services including support groups and individual grief counseling (415) 750-4111 • parbore@ioaging.org (415) 750-4180x230

Addiction: What Is It? • Simply put: Addiction is a brain disease • Drugs and alcohol change the brain – they change its structure and how it works • Repeated drug use disrupts well-balanced systems in the brain – the brain develops a one-track mission to seek and use drugs

Differences between Problem Gambling & Chemical Addiction • Problem gamblers do not ingest, inject or inhale substances like chemically addicted people do • What do gamblers become addicted to? – “action” – the “high” – the excitement of the outcome of a gambling event • Problem gambling is often referred to as a hidden addiction

Dopamine • Drugs of abuse cause a surge in levels of a brain chemical called dopamine – which results in feelings of pleasure • The brain remembers this pleasure and wants it repeated • Eventually, the drive to seek and use drugs and alcohol is all that matters

The Disease of Addiction • The disease of addiction is especially insidious because it affects the very brain areas that people need to: think straight – apply good judgment – make good decisions for their lives

Chemical Dependency & Problem Gambling • About 20% of people receiving inpatient treatment for chemical dependency are problem gamblers • Problem gamblers are more likely to be heavy users of alcohol, marijuana and cigarettes

Problem Gambling & Older Adults • Older adults now form the largest group of annual visitors to Las Vegas (The Las Vegas Convention and Visitor’s Authority) • Between 1975 and 1998, the 65+ age group experienced the greatest increase in gambling both for lifetime (from 35% to 80%) and for past-year (from 23% to 50%) (Gambling Impact & Behavior Study, 1999)

2004 National Survey on Drug Use and Health • There were 4.6 million adults with co-occurring serious psychological distress and a substance use disorder • If someone is twenty years or more into addiction, he or she is probably struggling with multiple co-occurring psychiatric problems

Definition of Gambling • Any game of chance or skill that involves a financial risk • Examples – Lottery, Casino games, Racetrack betting, Maj jong for money, raffles, bingo, stock market, scratchers

Triggers & At-Risk Factors for the Elderly • Opportunity – In 1975 Nevada had the only casinos – in 1999 15 states have lottery only; 4 states have casino only; 10 states have lottery & casino and 13 states have lottery & tribal casino • Boredom – Gambling is a way of filling the abundant leisure time that many older people experience following retirement

Triggers Continued • Loneliness & Isolation – After the loss of a spouse or partner, gambling is a way of being in proximity to, if not interacting with people • Escape – It is a fantasy world in which one can leave behind whatever problems they may want to forget – poor health; deaths of loved ones; distant grandchildren

Triggers Continued • A target market – There are many promotions to attract older customers – “Comps” are widely used – Hospitality programs that emphasize making older people feel welcome and “like family”

An Invisible Epidemic • Alcohol abuse and prescription drug abuse among adults 60+ is one of the fastest growing health problems in the U.S. • Substance abuse affects up to 17% of older adults • Elderly substance abuse is often overlooked by health care providers (Frederick Blow, 2001)

American Medical Association • Estimates that about 3 million Americans over the age of 60 have a drinking problem • Consequences of excessive drinking include: nutritional deficiencies, liver disease, cancer and cardiovascular problems (including stroke)

Aging, Drinking & Consequences • Higher BAC from a given dose • More impairment at a given BAC • Interactive effects of alcohol, chronic illness and medication

Types of Older Drinkers • Abstainer and light drinkers – 70% • Moderate drinkers – 15% • At risk drinkers – 10% • Alcoholics – 5%

Patterns of Drinking • Late-onset cases (after age 60) – about 1/3 of older problem drinkers • Early and intermediate onset cases – about 2/3 of older problem drinkers • 95% of all adults dependent on or abusing alcohol started drinking before age 21

Alcohol Guidelines for Older Adults • According to the National Institute on Alcohol Abuse and Alcoholism & the Center for Substance Abuse Treatment’s TIP Series: • People 65+ -- no more than one standard drink per day or 7 standard drinks per week • No more than 2 standard drinks on any one occasion

What Is A Standard Drink • One can of ordinary beer or ale – 12 oz • A single shot of spirits – 1.5 oz • A glass of wine – 5 oz • A small glass of sherry – 4 oz • A small glass of liqueur – 4 oz

Signs & Symptoms • Anxiety and annoyance when asked about alcohol use • Drinking despite medical admonitions • Dehydration • Malnutrition • Sexual dysfunction • Problems with family and/or friends • Sleep problems

Signs & Symptoms • Loss of control • Self-neglect • Neglect of pets and/or home • Suicidal ideation or attempts • Withdrawal symptoms when alcohol removed • Blackouts

Signs & Symptoms • Morning drinking • Morning shakes & tremors • Bladder & bowel incontinence • DUI’s • Gait disorders • Confusion or memory problems • Denial of drinking

Co-Occurring Disorders • Being addicted raises the risk of having depression • Being depressed raises the risk of self-medicating • Self-medicating leads to addiction

Common Issues Affecting Entry Into Treatment • Denial is a major obstacle to getting help • Shame may serve as an obstacle to admitting that a problem exists • Resentment may get triggered when anyone asks questions about how older people spend their money

Communication Factors • Expectations – Keep to a minimum • The individual may not see their alcohol or gambling as a problem although the helper does • Plan a discussion when person is most likely to be sober • Find a private place to talk

Treatment for Problem Gambling • No single treatment approach has emerged for problem gambling • Individual counseling • Participation in Gambler’s Anonymous • Financial advice • Legal assistance

Treatment for Substance Abuse • Psychotherapy • AA – 12 step program • Case Management Team Approach • Group Counseling • Telephone Outreach • Outpatient • Harm Reduction

Resources • 1-800-GAMBLER (California Council on Problem Gambling • 1-800-522-4700 (National Council on Problem Gambling) • Gamblers Anonymous/GAM Anon • Chinese Community Problem Gambling Project (SF Bay Area)

Resources • Institute on Aging Psychology Department (415) 750-4111 • Friendship Line for the Elderly – 24 hour --(415) 752-3778; (800) 971-0016 • Curry Senior Center (415) 885-2274 • Golden Gate for Seniors (415) 626-75533030

GAMBLING PROBLEMS WITH OLDER ADULTS WITH COD