The Chase: Predecessors and Progress on Problem Gambling
The Chase: Predecessors The Chase: Predecessors and Progress on Problem and Progress on Problem Gambling Gambling Henry R. Lesieur, Ph.D., Psy.D. Rhode Island Hospital Gambling Treatment Program Providence, RI Alberta Gaming Research Institute Annual Conference, Banff, Alberta, April 2008 [email protected]http://www.gamblingtreatment.org
The Chase: Predecessors and Progress on Problem Gambling
The Chase: Predecessors and Progress on Problem Gambling. Henry R. Lesieur, Ph.D., Psy.D. Rhode Island Hospital Gambling Treatment Program Providence, RI Alberta Gaming Research Institute Annual Conference, Banff, Alberta, April 2008 [email protected] http://www.gamblingtreatment.org. - PowerPoint PPT Presentation
Text of The Chase: Predecessors and Progress on Problem Gambling
The Chase: Predecessors and The Chase: Predecessors and Progress on Problem GamblingProgress on Problem Gambling
Henry R. Lesieur, Ph.D., Psy.D. Rhode Island Hospital Gambling Treatment Program
Alberta Gaming Research Institute Annual Conference, Banff, Alberta, April 2008
Major Questions to Major Questions to be Addressedbe Addressed
What was known about problem gambling before The Chase?
What broad socio-cultural patterns preceded the era of modern research?
What was occurring simultaneous to The Chase?
What research and social trends have occurred after The Chase?
Gambling in HistoryGambling in HistoryGambling has existed in most cultures
and in prehistory.Religion, law and play intermingled.Lots were used to determine the will of
the gods.Lots were cast to determine guilt or
Gambling as ProblematicGambling as Problematic Evidence that gambling was a problem for some existed
but there does not appear to be much social commentary on it. There are myths about heavy losses among the gods (Ancient India).
Ancient Egyptians outlawed gambling among the masses (slavery in the salt mines was a penalty for violation).
Nero and Caligula were notorious cheats and loaded dice were found in Pompeii.
Individual problem gambling was mixed in with cheating in the law.
Gambling as Problematic in Gambling as Problematic in North AmericaNorth America
In the year before I started doing gambling research, I searched through the Human Relations Area Files for gambling in North America.
For many tribes, gambling was ubiquitous, yet culturally controlled.
Stick DiceStick Dice
Social Controls among First Social Controls among First Nations PeopleNations People
The Mohave (along the Colorado River in Arizona, California & Nevada) made gambling a formalized, ritualized occasion. Gambling was instrumental to the ritual rather than affectively loaded.
Gros Ventre of Montana had no promissory principle. No debts were incurred.
Yakima in Washington State gambled with surplus property only. Family property was gambled only with spousal consent. Both heavy winners and heavy losers gained prestige. Losers were not stigmatized. Again, no promissory notes.
Gambling as Problematic Gambling as Problematic Among First Nations PeopleAmong First Nations People
Only in rare circumstances were gambling problems mentioned in the Human Relations Area Files.
Among the Mandan Indians of the upper Missouri River, the Yurok of Northern California, the Bella Coola of BC you could become the property of someone else after losing. Problems among family members and loss of children to slavery also occurred.
At least one case of suicide after gambling losses was documented among the Iroquois in 1639.
Characteristics of the Age Characteristics of the Age of Ignoranceof Ignorance
Some cultures implement controls that seem to work
Gambling losses were tied in with cheating in some cultures.
Some cultures outlawed gambling because of the association with cheating.
In spite of it all, problem gambling existed and cases were documented on an anecdotal basis.
Age of SinAge of SinGambling per se was equated with evilThe gambler was either an exploiter or
exploitedFocus on cheating, violating the law, and
corruptionThe player was viewed as a flawed victim
Skip to early 20Skip to early 20thth Century CenturyGambling and Gambling Devices: An
Educational Exposition Designed to Instruct the Youth to Avoid All Forms of Gambling
John Philip QuinnPublished in 1912
Quinn outlined the religious argument against gambling. He focused on crooked gambling devices
Three Stages of a Gambler’s Three Stages of a Gambler’s LifeLife
Three Stages of a Gambler’s LifeThree Stages of a Gambler’s Life
1. High hopes of pleasure. A life devoted to the ruin of his fellowmen. He “takes hold on hell.”
2. The Illusion is dispelled. He becomes a member of a villainous class.
3. He becomes a “fool of fortune … enslaved by his own degraded instincts.”
The Upward and Downward WayThe Upward and Downward Way
This continued:Sucker’s ProgressSucker’s Progress: An Informal : An Informal History of Gambling in America From History of Gambling in America From the Colonies to Canfieldthe Colonies to Canfield Herbert Asbury, 1938Herbert Asbury, 1938An “objective” history that is full of moralizing. For example, he An “objective” history that is full of moralizing. For example, he quotes a New York Herald article: “There is a small and select quotes a New York Herald article: “There is a small and select number of very splendid hells in this city where young men with number of very splendid hells in this city where young men with property are sent to perdition in no time.” From that point on he property are sent to perdition in no time.” From that point on he describes “gambling hells” in different parts of the US.describes “gambling hells” in different parts of the US.
Continuation in late 20Continuation in late 20thth Century – Century – Ambivalence about sin and diseaseAmbivalence about sin and disease
National Coalition Against Legalized Gambling (US)
Arguments similar to those in the 19th and early 20th century but with the addition of an acceptance of the medical model.
See Suzanne Morton At Odds: Gambling and Canadians 1919-1969
Medicalization Medicalization (prior to The Chase)(prior to The Chase)
1 – Psychoanalytic theorizingFreud; Bergler (1958); and others
2 – Gamblers Anonymous (1957)3 – Robert L. Custer, MD (collected data
from VA hospital in Brecksville, Ohio) (1972)
4 – National Council on Compulsive Gambling (New York) (1972)
Bergler Psychology of GamblingBergler Psychology of Gambling
Number of States with Legal Number of States with Legal Gambling in the US – 1974Gambling in the US – 1974
1 1 20
Number of States with Legal Number of States with Legal Gambling in the US – 2005Gambling in the US – 2005
48 43 41
Gross Win in Billions of Gross Win in Billions of Dollars 1974-2004 (US)Dollars 1974-2004 (US)
Sociology of Problem Gambling prior Sociology of Problem Gambling prior to The Chaseto The Chase
Basically a Desert except for:Basically a Desert except for:Edward Devereux Jr – Gambling and the
Social Structure – 1949 – a study of the numbers racket and racetrack – excessive gambling conflicts with the basic tenets of the Protestant ethic and has dysfunctional consequences for the social system
Sociology of DevianceSociology of Deviance
Anti-medicalization“Labeling Theory”Symbolic Interaction and
PhenomenologyEmphasis on Qualitative Research
including participant observation and intensive interviews
Quitting Gambling Through Gamblers Anonymous
University of Massachusetts -- SociologyTV show and my ex-bossGA meetings in ConnecticutPh.D. thesisObservations & Interviews
Compulsive Gambler’s Spiral of Options and Involvement
Criminology – Missing Information in the Research Literature
1. Gambling as deviant behavior – Nothing about CGs in articles or textbooks
2. Gambling as crime3. Gambling = Organized Crime 4. Nothing about route CGs take to Criminal Behavior
The Chase Book CoverThe Chase Book Cover
Methods Used (Qualitative) Attended Gamblers Anonymous meetings CT,
RI, MA & prisons (non-participant observation) Intensive semi-structured, open-ended
interviews (tape recorded) with– CGs (all white males)– Wives– Bookmakers– Loan sharks– Regular gamblers I knew from gas station– prisoners
The ChaseShort-term chasing -- normalCG = long-term chasingUnderstanding CG view of the world: Action: Chasing; Finances; Family; Work; Gambling as Illegal activity; Crime CG Spiral of Options and Involvement
Crime Types Among Crime Types Among Pathological GamblersPathological Gamblers
Biologically Base Impulsive Gambler -- Impulsive & Attention Deficits -- High Severity of Gambling Problems -- Substance Dependence -- High Suicidal -- High Irritability -- Low Tolerance for Boredom -- Sensation Seeking; High Criminality -- Poor interpersonal relationships -- Early age of onset; rapid increase of problems -- Binge Gambling
Public Health ModelPublic Health ModelKorn & Shaffer (1999)Korn & Shaffer (1999)
Views gambling problems as occurring along a continuum
Looks at health, social & economic costs and benefits
Emphasizes prevention and harm reduction
Levels of Gambling
Gambling w/ No
Gambling w/ Some Adverse
Gambling w/ Severe Adverse
Continuum of Problems
Public Health Model - 2Public Health Model - 2Korn & ShafferKorn & Shaffer
Public Health Action Plan1. Prevent gambling-related problems via public
awareness, early identification & treatment 2. Promote informed and balanced attitudes
towards gambling via knowledge, responsible choices and community participation
3. Protect vulnerable groups from harm (harm reduction focus)
Gambling Choices and GuidelinesGambling Choices and Guidelines – – Roger Svendsen & Tom Griffin (1993)Roger Svendsen & Tom Griffin (1993) Gambling is a source of recreation with risk Gambling is a matter of choice and not essential for
having a good time Low-Risk Gambling is social, limited, and with
predetermined loss limits There are times when people should not gamble There are high-risk situations when gambling
should be avoided What to do if you know someone has a problem Self-test and resources for help
Self-Help ManualsSelf-Help Manuals Note: Mark Dickerson initiated this for problem
gambling. They have developed to include: Self-assessment Gambling Diary Goal Setting Triggers/High Risk Situations Gambling Cognitions Alternatives to Gambling Resources for further help (GA/treatment)
Stages of ChangeProchaska & DiClemente
Precontemplation-- Resisting ChangeContemplation -- Change is NeededPreparation -- Readying for ChangeAction -- Time to changeMaintenance -- Continue ChangeRelapse -- What did person learn?Termination – Change has occurred
Pathways to Recovery
General Population SurveysRate of Lifetime PG > Rate of Past
Year PG by 36-46% WHY?Hypothesis 1 – They received Treatment
and no longer have problems – evidence doesn’t support this
Pathways to Recovery 2
Hypothesis 2 – Problems with the Measures Used
Hypothesis 3 – Denial (not willing to acknowledge current problem) – there is some support for this
Hypothesis 4 – Natural Recovery – some support for this
Natural Recovery 1Natural Recovery 1 Hodgins & el-Guebaly -- Naturally recovered gamblers had less severe
problems -- No difference in rate of co-morbid conditions
Marotta – Naturally recovered gamblers less severe problems than treatment seekers Less Likely to have co-morbid conditions Less likely to be video machine players
Natural Recovery 2Natural Recovery 2Jeff MarottaWhy not seek treatment?-- no Identification with CG image-- did not want abstinence
How did they change? Numerous strategies but more likely to weigh pros & cons as motive to quit
Stability & Progression of Disordered Stability & Progression of Disordered Gambling: Lessons from Longitudinal Gambling: Lessons from Longitudinal Studies:Studies: D.LaPlante, S.Nelson, R.LaBrie & H ShafferD.LaPlante, S.Nelson, R.LaBrie & H Shaffer
Reviewed 5 prospective studies of gambling behavior among non-treatment samples
Excluded treatment samples Looked at Level 1, 2 & 3 gamblers at T1 &
followed them to T2 No evidence that individuals progress Most improved over time; no evidence that
individuals worsen from T1 to T2Source: La Revue Canadiene de Psychiatrie, 53, 1, Jan 2008
Comments on Stability & Comments on Stability & ProgressionProgression
They excluded treatment samples from which the model of progression was generated.
No control for regression to the mean. Not all individuals are followed up in these studies.
Some cannot be located or refuse to participate in the follow-up. Are those not followed like those who are followed?
Medical/addictive model on the other hand is based in what criminologists call “the warden’s fallacy.” (i.e. The people “out there” are like the people we see “in here.”)
Prevention Research (Willams, Prevention Research (Willams, West & Simpson, 2007)West & Simpson, 2007)
Limited data exist on effectiveness Research needs to focus on behavioral change Current programs are too small to make an
impact (e.g. information/awareness campaigns are too shot-term and too restricted)
Effective prevention programs are likely to inconvenience gamblers without problems and are likely to reduce revenues (e.g. restriction on locations of venues and on concurrent use of alcohol and tobacco in gaming facilities)
Medical Model Redux: Medical Model Redux: Physiological StudiesPhysiological Studies
Gambling appears to operate similar to other pleasurable behaviors
PET scans; Functional MRIs validate this Frontal lobe impairment found (higher rate of
ADD & ADHD among PGs) PG & Dopamine activity among Parkinson’s
patients Pharmacotherapy with SSRIs, opioid agonists,
and mood stabilizers show some efficacy
Medical Model Redux -- 2Medical Model Redux -- 2Gamblers Anonymous which assumes a
disease model is an effective adjunct to therapy.
Moral Model ReduxMoral Model ReduxAnti-gambling proponents typically focus
on zero access rather than harm reduction strategies
GA is spiritually based; as such it takes a zero tolerance approach to gambling. In spite of this, GA is growing.
Gambling: A Deadly GameLarry Braidfoot, 1985Larry Braidfoot, 1985
The religious, moral model, continues in a different form as exemplified in this book.
Compulsive gamblers are seen as victims of an immoral industry that should not exist.
His conclusion: “These individuals represent a harvest of shame for not only the …
gambling industry but also for those of us who as citizens have allowed this nightmare to develop.”