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Mental Health Services - Compulsive Gambling Treatment and Prevention
Initiatives |
Indiana Problem
Gambling Prevention Plan
July 15, 1998
Developed by:
Louisiana State University
School of Social Work
Office of Social Service Research & Development
311 Huey P. Long Field House
Baton Rouge, LA 70803
P: 504.388.4838
F: 504.388.0428
Reviewed by:
Louisiana State University
Medical Center Shreveport
Department of Psychiatry, Gambling Studies Unit
Project Overview
- Introduction
- Statement of the
Problem
- Development of
Gambling in Indiana
- Indiana
Problem Gambling Research Project
- Development of a Problem
Gambling Prevention Plan
-
Planning Rationale and Evaluation
- Recommended
Indiana Prevention Plan, 1998-99
References
Appendix 1: Prevention Programs
Appendix 2: Community
Readiness Assessment Questionnaire
Appendix 3: Community Problem
Gambling Prevention Team Job Description
Bibliography
Project Overview
In an effort to continue its
commitment to a healthy Indiana, the Indiana Family and Social Services Administration
(FSSA) initiated the Indiana Problem Gambling Research Project in 1996. In the 1993 and
1995 legislative sessions, Indiana lawmakers passed legislation that approved the
FSSAs initiation of the project to ensure the development of healthful behavior
surrounding gambling. The FSSA published a broad agency announcement in September 1996 for
a statewide problem gambling prevention campaign.
The Louisiana State University Division of
Continuing Education submitted a proposal to conduct baseline research that would
determine the prevalence of problem gambling in Indiana and lay the foundation for the
development of an effective problem gambling prevention plan. The LSU proposal was
appealing to grant reviewers because of the social service research expertise available
that had developed to address the serious problem gambling issues confronting Louisiana.
The approach proposed by the research team included quantitative and qualitative
research to establish baseline data that would empirically link the scope of problem
gambling in Indiana to effective social policy and action aimed at problem gambling
prevention and treatment. This project was transferred to the Louisiana State University
School of Social Work Office of Social Service Research and Development (LSU-OSSRD) in
July 1997 and conducted through that office.
The primary goal of the research study was to
determine the prevalence of problem gambling behaviors in order to develop a statewide
prevention plan. From this initial information, a solid foundation for future planning and
programming can be established. The plan is designed, first and foremost, to confront
gambling problems before they occur and to provide programs that discourage irresponsible
gambling by supporting healthy behavioral growth and development.
Indiana is confronting the early stages of problem gambling behavior
development among its citizens. Young children, adolescents and senior citizens are
especially vulnerable to the "glamorization" of gambling and should be educated
about potential problem gambling. Underage gambling must be discouraged at all costs.
A firm basis for future action is critical for the state to effectively deal with the
issue of problem gambling and associated problems and to develop strategies to reduce its
impact on Indianas families and communities.
Based on the findings from the proposed research and
from a review of related social science literature on effective prevention strategies for
addictive behavior, this document proposes a preliminary problem gambling prevention
plan for the state of Indiana. The plan includes recommendations for targeting
primary, secondary and tertiary levels of prevention through the Social Development Model
that has become nationally known for its comprehensive, multi-level approach to preventing
other problem addictive behaviors.
The Indiana Problem
Gambling Research Project is
intended for review and adaptation by policymakers, decisionmakers and the mental health
treatment professionals in Indiana. The plan is designed for implementation at both state
and local levels. The timing for a comprehensive Indiana Problem Gambling
Prevention Plan couldnt be better. There is a
healthy attitude among policymakers, citizens and the gambling industry in Indiana
concerning the potential positive and negative effects of gambling. As one industry
representative said at a recent meeting, "We may work for the industry but we are all
Hoosiers first. We feel the same sense of responsibility about our state". Her
statement seems to reflect the cooperative and community oriented attitude that everyone
involved voiced about maintaining a healthy and progressive state.
I. Introduction
Development of Gambling in the United States
Gambling activities have become
increasingly widespread in the United States since the first modern state lottery was
established in New Hampshire in 1964. Pari-mutuel gambling, or betting pools, began to
spread across the United States, and gambling casinos were legalized in New Jersey in
1978.
Even though Nevada legalized the nations first
casino in 1931, the extensive opportunity of gambling activities did not capture the
American publics attention until the 1970s and 1980s. Casino activities were limited
to Nevada and Atlantic City until federal spending cutbacks and declining tax revenues
forced state legislatures and governments to seek out additional sources of revenue
(Volberg, 1996).
Betting on sports games and playing coin-operated
machines have become common throughout the United States. Many of these activities were
initiated innocently enough, even when they were followed by other games such as lotteries
and racetrack betting. The encroachment of gambling activities was slow, as weekly and
daily drawings, instant games and video games became legal in state after state. The
revenue created was a welcomed relief to the economic recession in many states.
In 1988, the Federal Indian Regulatory Act opened
the door to widespread casino development throughout the country. By 1993, riverboat
gambling had been established in six states, and land-based casinos were legalized in
several additional states. Gambling has become normalized across the nation, and various
gambling activities are legal in all states except Hawaii and Utah.
The effects of the proliferation of gambling have to
be carefully analyzed because the majority of people gamble for entertainment. For many
people, gambling is an acceptable, inexpensive activity to enjoy several times a year.
People who develop gambling problems are in the minority.
The impact of the gambling proliferation can be seen
through the increase in the amount of funds legally gambled as well as gaming industry
earnings. In the nation, the $17 billion gambled in 1979 increased to $247 billion legally
spent in 1989. From 1989 to 1995, the total amount of money spent on legal gambling in the
United States continued to increase yearly, reaching $586.5 billion in 1996 (Christiansen,
1997; National Council on Problem Gambling, 1993). The gaming industry recorded $47.6
billion in earnings in 1996, up 5.6% from the previous year (Christiansen, 1997.)
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As gambling activities have become more
available, the number of people developing problem gambling behavior has increased.
Because of the nature of gambling addiction, individualized problems become major and
often result in hidden social problems because of the financial implications related to
maintaining the addiction. State governments are now in a position where they must
discourage irresponsible gambling behavior and respond to social problems affecting their
communities.
Gambling Behavior:
A Differentiation in Terms
Gambling behavior must be placed
in proper context so that social policy as well as prevention and treatment efforts can be
appropriately directed.
Definitions of Gambling
Gambling is defined by Gamblers Anonymous (GA)
as ". . .any betting or wagering, for self or others, whether for money or not, no
matter how slight or insignificant, where the outcome is uncertain or depends upon chance
or skill."
Shaffer et al (1997) define gambling as ". .
.participants pursue monetary gain on chance outcomes without using skill." They also
differentiate from other similar activities like speculation and investment. Speculation
is defined as "backing ones opinion against the market or an established
opinion without sufficient information about the certainty of the outcome."
Investment is defined as ". . spending time or money engaged in activities where
sufficient experience serves as a guide, however uncertainty still remains."
Dr. Robert L. Custer, the pioneer in gambling
treatment, described compulsive gambling as "an addictive illness in which the
subject is driven by an overwhelming, uncontrollable impulse to gamble. The impulse
persists and progresses in intensity and urgency, consuming more and more of the
individuals time, energy, emotional and material resources. Ultimately, it invades,
undermines and often destroys everything that is meaningful in a persons life."
(Custer, When Luck Runs Out).
Different Types of Gamblers
Current data indicate that more than 80% of the
American public participates in some form of gambling (Lesieur, 1993). Most people who
gamble do not become problem gamblers and do not develop behavior that causes damage to
their families, their communities or their places of work. Those who gamble for
entertainment are called responsible gamblers or social gamblers.
Shaffer, Hall and Vander Bilt (1997) delineated
three levels to describe gambling behavior. Level 1 gambling has little or no adverse
consequences associated with the gambling behavior (a recreational or responsible
gambler). A level 2 gambler has a pattern of gambling behavior that is associated with
a wide range of adverse consequences (a problem gambler). Level 3 gambling refers
to disordered gambling and has the most severe consequences associated with it (a pathological
gambler). Based on their past-year activities, approximately 1.14% of adults and 5.77%
of youth from the general population are pathological gamblers (Shaffer et al, 1997). The
Indiana Problem Gambling Research study also utilizes these levels to describe and
differentiate among the levels of gambling involvement.
Currently, the Diagnostic and Statistical Manual of
Mental Disorders-IV (DSM-IV) defines pathological gambling as "persistent and
recurrent maladaptive gambling behavior" that significantly interferes with personal,
family or vocational pursuits. The terms "pathological" and
"compulsive" are typically used interchangeably, with treatment professionals
preferring the term pathological and lay persons preferring the term compulsive. The term
"problem gambling" usually refers to individuals who exhibit some signs of
pathological gambling but are not significantly symptomatic to meet the full diagnostic
criteria (Lesieur and Blume, 1993).
For the purpose of this document, the term problem
gambling is used to describe any level of problem or pathological gambling behavior
(level 2 and level 3 gamblers) and responsible gambling to describe gambling
behavior that does not indicate a problem (i.e. level 1 gamblers).
Perception of Gambling as an Addiction
When the National Council on Compulsive Gambling
(NCCG) was initiated in 1972, public perception of a compulsive gambler was that of a
"degenerate thief who gambled out of control as a result of greed, with a total
disregard for family, job, and community" (Dunne,1985). The NCCG attempted to change
negative public perception of compulsive gambling so that it was recognized as a treatable
illness. This change was eventually accomplished through educating the public and health
care providers about the social impact of gambling.

This effort also led to gambling being considered a
disease. As recently as 1990, 50% of the public viewed just the act of gambling as a
disease. (Shaffer et al, 1997). Reportedly, the belief that pathological gambling is a
disease decreases the degree of guilt found in compulsive gamblers and their family
members (Murray, 1993), thereby increasing the likelihood of these persons seeking
treatment and not being ostracized by their friends and family members.
Robert Custer established a model of compulsive
gambling and recovery which he delineated into phases. The gambler is seen as progressing
through these phases, the winning phase, the losing phase and the desperation phase (as
shown in Figure 1) in their progression from a social or responsible gambler to a
pathological gambler. Most people begin gambling for a variety of reasons, such as fun,
excitement, or the need of a quick profit. However, for some, these reasons soon become
secondary and non-existent, and are replaced by an all-consuming preoccupation with the
gambling activity. Custer states that this progression usually begins with a "big
win" or a series of wins, which act as a "hook" to getting the person more
deeply involved in the activity (i.e. the winning phase). The person will eventually lose
and begin to chase their losses (i.e. the losing phase). The person may begin to borrow
from their friends and family to finance their gambling and lie to cover up the extent of
their problem gambling behavior. During the last phase (the desperation phase), the
gambling activity is no longer a source of excitement or pleasure but a consuming activity
that occupies the majority of the persons time and serves to alienate them from their
friends and family. The extent of their losses may be great, both financially and
socially, sometimes leading to illegal activities, depression and suicidal thoughts.
Compared to other
addictions, research on gambling treatment and prevention is still in its infancy. While
there is some controversy on what causes an individual to develop an addiction (biological
components, behavior, etc.), professionals agree that the cause is multi-factored and must
be taken into consideration when developing prevention and treatment programming.
Perhaps more importantly, but at least
simultaneously, prevention efforts should be targeted at later childhood and adolescence
because of the increased risk in these age groups. Prevention and treatment efforts must
also be undertaken for specialized at-risk populations, such as the elderly, poverty level
persons and minorities. Additionally, prevention and treatment planning must take into
account the fact that gambling disorders have increased among adults during the past two
decades (Shaffer, Hall and Vander Bilt, 1997).
II. Statement of the Problem
Gambling is big business.
Alleged economic benefits to communities range from increased tax revenue to additional
tourist dollars to more jobs. Gambling opportunities continue to spread despite increasing
evidence that social problems are related to gambling behavior. Other states, including
Indiana, have begun to address the impact of problem gambling on their communities by
considering what educational and prevention strategies must be implemented.
As Shaffer et al (1997) point out, "...gambling
is neither a financially nor a psychologically risk-free experience." The expansion
of gambling activities has resulted in an increased number of people reporting serious
financial difficulties in addition to a variety of psychological, legal and social
problems.
Social and Fiscal Impact of Gambling Nationally
Typically, a problem gambler will
face serious financial, family and work-related problems as a result of his gambling
activities. Financial problems are often one of the first repercussions that will draw
attention to a problem gamblers behavior.
As the gambling problem becomes worse, lying and
deception increase. The individual will often first deplete personal finances and sources
of legal borrowing, usually without the knowledge of the family. When these avenues are
exhausted, the risk of the individual seeking illegal means to support gambling increases.
Many problem gamblers report committing robbery, forgery, insurance fraud and writing bad
checks, which may lead to criminal justice problems.
Significant behavioral changes occur as adults and
youth become more preoccupied with their gambling. Adults may lose time from work and have
decreased productivity. For youth, problem gambling manifests itself as tardiness and
truancy (Haubrish-Casperson, 1993). A problem gamblers family may often suffer from
a lack of attention and financial support. By the time a gambler seeks treatment, he is
often in debt, alienated from friends and family, possibly on the brink of divorce, close
to arrest (about ΒΌ of problem gamblers) and may have difficulties with depression and
suicidal thoughts (Carone, Yolles, Kieffer and Krinkshy, 1982).
Additionally, problem gambling has been associated
with other mental health problems. Research indicates that the most common co-morbid
problems are substance abuse and depression. Ramirez, McCormick, Russo and Taber (1983)
found that 97% of 51 men admitted to their gambling treatment program also met criteria
for major depression. Frank, Lester and Wexler (1991) surveyed 500 Gamblers Anonymous
members and reported that 21% of the participants stated they had never thought of
suicide, 48% said they had thought about suicide and 13% had attempted suicide.
The impact of problem gambling on a community can
also be significant. As an increasing number of states legalize a variety of forms of
gambling, more people are experiencing gambling problems. Politser, Morrow and Leavery
(1985) reported that the social cost of excessive gambling "ranks among the most
expensive illnesses afflicting society, though it is among the least expensive to
treat." In 1995, $500 billion was legally wagered in the United States. This is a
dramatic increase from the estimated $17 billion wagered in 1979, just less than two
decades earlier. With the exception of Utah and Hawaii, all states have some form of
gambling. Lotteries are legal in 37 states as well as Washington, D.C., and 26 states have
casinos. Lottery spending per capita rose from $20 to approximately $150 per year
(Clotfeller and Cook, 1989; McQueen, 1996).
National trends relating to the impact of gambling
are also seen on a statewide level. States must now take a closer look not only at the
economic impact that gambling opportunities have provided but also the social
repercussions that affect their citizens and communities. Indiana and other states where
gambling has not been legal for many years are in a strategic position to curtail or
lessen the effects of problem gambling.
III. Development of Gambling in Indiana
Origin of Legalized Gambling in Indiana
The development of
gambling in Indiana is not significantly different from other states, with the possible
exception of Indianas limited availability of gambling within the last few years.
The Indiana Lottery initiated operation on October 13, 1989, becoming the first of four
forms of legal gambling opportunities in the state. In September 1994, Hoosier Park, the
states first horse racing venue providing wagering opportunities, opened in
Anderson. In 1993, 11 riverboat gambling sites were legislatively authorized. By December
1996, boats had been launched in Evansville, Gary, Hammond, Rising Sun and Lawrenceburg.
Currently, five boats are operating in Lake Michigan and three on the Ohio River (Family
and Social Services Administration, 1997).
Charitable gambling is also big business in Indiana.
Qualified not-for-profit organizations may conduct certain types of legal charity gaming
activities. These activities include bingo, charity game nights, door prizes, festival
events and raffles as well as the sale of pull tabs, punchboards and tip boards. A total
of 930 Annual Bingo Licenses were issued during the fiscal year 1997. The total gross
income of charitable gaming in 1997 was $516 million, which is a reported $58.5 million
increase over 1996 (Indiana Department of Revenue, 1997).
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The Hoosier Lottery is a popular form of
entertainment in Indiana with almost $600 million wagered in 1997 alone. The Hoosier
Lotterys nine varieties of lotto, including the popular Powerball and Hoosier Lotto,
provided $176 million in revenue for the state in 1997. As of February 1998, various state
programs received more than $1.3 billion from the lottery. Since its inception to date,
total prizes awarded by the Hoosier Lottery amount to $2.5 billion (Hoosier Lottery,
1997).
The six riverboats operational throughout 1997, in
addition the two boats which became operational during 1997, had a total win of $961
million (Indiana Gaming Commission). Other gambling opportunities such as the Hoosier Park
pari-mutuel horse track and three off-track betting parlors had $147 million in monies
wagered in 1997 with total revenue for the state amounting to $4.3 million (Horse Racing
Commission, 1998).
Indiana Legislative Response
As gambling became established in the
state, the Indiana legislature took action to address the social impact that would
predictably develop. In 1993, the Indiana General Assembly passed a law requiring that 10
cents of each admission tax to Indiana riverboats be paid to the Indiana Family and Social
Services Administration Division of Mental Health (DMH). The 1995 General Assembly amended
the law to allow these monies to be used "
for the prevention and treatment of
addictions to drugs, alcohol and compulsive gambling, including the creation and
maintenance of a toll-free telephone line to provide the public with information about
these addictions." The legislature also required that the Division
"
allocate at least 25% of the funds
to the prevention and treatment of
compulsive gambling."
Indiana Governor Frank OBannon appointed a
13-member Gambling Impact Study Commission in January 1998 and charged them with examining
the effect legalized gambling has on Indiana. In the executive order establishing the
commission, OBannon instructed its members to "
assess the impact of
gambling on individuals, families, communities, businesses, social institutions and the
economy. This comprehensive look at the whole picture will enable the committee to assess
revenue and economic growth created by gambling as well as any problems associated with
gambling such as bankruptcies, suicides and other mental health problems." Committee
members representing community interests include but are not limited to representatives
from the Indiana Gaming Commission, Indiana Family and Social Services Administration,
Indiana Chamber of Commerce and representatives from both the House and Senate. The
commission meets regularly and reports on its progress periodically. A final report will
be issued to the Governor by December 31, 1999.
Role of the Indiana Family and Social Services Administration
As the state agency that deals
with Indianas social problems, the Family and Social Services Administration (FSSA)
is the appropriate organization to be responsible for addressing problem gambling and
related issues. Currently, the FSSA provides services to families who have problems
associated with low income, mental illness, addiction, mental retardation, disabilities,
aging and children who are at risk for unhealthy development. FSSA works to strengthen the
ability of families to succeed in their communities.
The Family Social Services Administration Division
of Mental Health (DMH) works to assure the availability of accessible, acceptable
and effective mental health and chemical addiction services for Hoosiers through community
mental health centers. The DMH is the division that will handle gambling addiction and
related problems. In addition to treatment of mental health problems, the FSSA is also
mandated to provide prevention services throughout the state.
For a new problem gambling prevention component to
be effective, it will need to "fit in" with the existing FSSA organization,
philosophical framework and service delivery system. Although the provision of prevention
and treatment services for problem gambling must be differentiated from other substance
abuse services, there must be some type of "integration" of prevention and
treatment philosophy and interaction between the systems for providing the services.
Problem gambling is an addictive issue, which places it into the same social policy arena
as other addictive behaviors. However, the initiation of early problem gambling behaviors,
the progress into addiction and the response from the treatment field is different from
other addictive diseases. For these reasons, an effective plan must integrate the current
prevention services within FSSA.
Current substance abuse prevention funds in Indiana
are derived from the Federal Omnibus Anti-Drug Abuse Act of 1986. Each state is required
to dedicate 20% of their substance abuse block grant funds strictly for alcohol and other
drug prevention services. To continually qualify for federal substance abuse funds, each
state must have a prevention strategy in place. Prevention programming for problem
gambling should be included in the states existing structure because it is a logical
fit and it would be fiscally more responsible than creating a separate system.
The DMH has provided prevention services since 1987
and has distributed more than $50 million in federal block grant funding to
community-based prevention programs. As the prevention system developed in the state
during the past 10 years, there has been an increasing emphasis on placing prevention
monies into empirically-sound services. Because prevention monies are limited, grants
awards are targeted to those organizations and agencies that demonstrate need, offer
services that produce effective outcomes and coordinate cost-effective programs.
The DMH established a network of 14 "Local
Prevention Services Coalitions" to ensure the most effective use of prevention
monies. In August 1997, Governor Frank OBannon announced the new $5.2 million Local
Prevention Services Initiative. The initiative was designed to facilitate the provision of
services across the state that were consistent with extensive effectiveness research
conducted by the Indiana Prevention Resource Center in the Indiana University School of
Health, Physical Education and Recreation.
The research conducted by the IU School of Health,
Physical Education and Recreation examined the most effective types of prevention programs
for specific populations. Researchers provided guidelines to implement the award process
for program funds at the community level. It is important to note that the IU researchers
promote the use of risk and protective factor theory as the framework from which effective
prevention programming occurs. The effectiveness research provided by IU, as the
foundation for alcohol and other drug abuse prevention services, is consistent with the
theoretical framework proposed by the LSU researchers for use in developing problem
gambling prevention services. This will result in a much easier implementation of gambling
prevention planning and programming.
Local coalitions are in place now and are operated
and managed by contractors who coordinate substance abuse prevention services in each of
the defined service areas across the state. Each of the local contractors are responsible
for creating, implementing and managing a Coalition of Direct Prevention Service Programs
in its defined service area. The contractor must recruit collaborating member agencies to
implement Direct Prevention Services Programs in the service area according to criteria
established through the DMH. The regional prevention services program must implement the
DMH recommended evaluation process to demonstrate process and outcome effectiveness. The
regional prevention service centers are supervised and monitored through the DMH
organization.
This structure will be conducive to the development
and implementation of problem gambling prevention services, even though, at this time, the
federal funding for problem gambling and substance abuse prevention cannot be combined.
The federal funds provided to the state are for substance abuse prevention services only.
The problem gambling prevention services will most likely be funded through the funds that
are collected from the various forms of legalized gambling in the state. It should be
feasible to maintain separate funding while utilizing the same system for provision of
prevention services.
Legislative action authorized the FSSA to address
problem gambling prevention needs in the state. To address this responsibility, the FSSA
(DMH) established the Compulsive Gambling Addiction Services Advisory Committee in 1995 to
create a system to fund problem gambling prevention and treatment. This committee met
through February 1996. Members included representatives from the addiction treatment
community, social service agencies, the Indiana Commission for a Drug-Free Indiana and the
Division of Mental Health. Issues addressed included the continuum of care for problem
gamblers, certification of service providers, eligibility standards for funding support
through the DMH and prevention efforts.
The FSSA-DMHs efforts to address problem
gambling are concentrated in four major areas:
1. Toll-Free Telephone Line
In December 1995, the DMH contracted with
the Governors Commission for a Drug-Free Indiana to provide referral information to
persons requesting help with a gambling problem. This toll-free number is printed on
riverboat admission tickets, all state lottery tickets and advertised in other media
markets. Through January 1998, more than 1,104 calls were received.
2. Prevention
A prevention initiative emerged out of
recommendations of the Compulsive Gambling Advisory Board. A broad agency announcement for
a statewide problem gambling prevention campaign was released September 30, 1996. The LSU
Division of Continuing Education was awarded this project. However, the project was
transferred to the LSU School of Social Work Office of Social Service Research and
Development. The LSU-OSSRD was then responsible for designing a prevention plan for
Indiana.
The prevention planning included:
- Conducting quantitative studies to detect the extent
and scope of the gambling problem in Indiana (prevalence) and which populations
(geodemographic clusters) are most likely to be affected. It also established a baseline
to measure prevention activity effectiveness.
- Devising a prevention plan tailored specifically for
Indiana that is based on research results and recommendations and will set specific
outcomes, procedures and responsibilities.
- Establishing and working with an Ad Hoc Advisory
Committee to review and shape the prevention plan.
3. Treatment
In April 1996, the DMH held an informational
meeting for the service provider community to publicize preliminary decisions regarding
the funding of gambling treatment services. The Hoosier Assurance Plan would include
gambling treatment. Providers certified by the DMH as managed care providers for substance
abuse (SA) and serious mental illness (SMI) could qualify for a compulsive gambling
treatment endorsement. As of January 1998, 16 providers had contracted to provide these
treatment services. In July 1998, 20 state-certified providers will offer services.
Clinical eligibility for services is determined by
the following definitions: (a) a compulsive gambler is an individual who meets criteria
for Axis I diagnosis of pathological gambling as set out in the DSM-IV, Diagnosis 312:31,
and Pathological Gambling; and (b) the individual continues gambling behavior despite
repetitive, harmful consequences.
To be eligible for coverage under the Hoosier
Assurance Plan, the individual must have an income at or below 200% of the federal poverty
guidelines. Gambling debts and payments on incurred gambling debts are used in calculating
income eligibility. Clinical assessment is accomplished by the Hoosier Assurance Plan
Assessment instrument (HAPI-A). The South Oaks Gambling Screen (SOGS) is also used on all
persons presenting for service for a compulsive gambling problem. There are 107 people
enrolled for treatment services so far this fiscal year; 31 were enrolled in SFY97.
In addition to the full continuum of care mandated
for the SA and SMI populations, managed care providers for gambling services are required
to offer inpatient and intensive outpatient services, linkage with self-help groups and
financial management counseling. Availability of inpatient care is seen as essential
because severe depression and suicide ideation are frequently present in persons
presenting for treatment. Additionally, linkage to self-help groups such as Gamblers
Anonymous is a part of the continuum of care. An episode rate, the dollar amount the DMH
gives to a certified provider to serve an eligible consumer for a one-year period, was
negotiated with qualified providers. An actuarially based rate is projected to be
established for SFY 2000.
4. Training of Therapists
Recognizing the scarcity of therapists
trained to work with persons with compulsive gambling disorders, the DMH contracted with
the Fairbanks Training and Research Institute of Indianapolis to provide five regional
workshops on the treatment of compulsive / problem gambling. Participants in these
sessions, which were offered at low cost to therapists working with DMH certified managed
care providers, helped qualify therapists for certification as compulsive gambling
counselors by the American Council on Compulsive Gambling. It is estimated that given
present patterns, a minimum of $2.4 million will be deposited in the Gamblers
Assistance Fund each year, allowing the Family and Social Services Administration to
continue to support compulsive gambling prevention efforts and treatment.
(Information provided by the Family and Social
Services Administration, March 1998)
Governors Commission for a Drug-Free Indiana
Indianas commitment to
community based prevention is also demonstrated by the Governors Commission for a
Drug-Free Indiana. The Commission takes a three-pronged approach to prevention and the
development of social policy regarding alcohol, tobacco and other drugs. The agency serves
as an advisor to the Governor to develop policy regarding alcohol, tobacco and other
drugs, collaborates with other state agencies to address concerns in the area alcohol,
tobacco and other drugs, and mobilizes citizens within their own communities around the
reduction of substance abuse.
The commission developed a regional technical
support network consisting of five regional offices representing six regions. Each office
houses three consultants to provide support for state and local coalitions. The network
aims to make government more responsive to the needs of local communities. Each of
Indianas 92 counties has a Local Coordinating Council (LCC) made up of volunteers
that serves as the backbone of the Indiana drug-free effort. The volunteer coalitions are
charged with identifying community drug problems, coordinating local initiatives,
monitoring anti-drug activities at the local level and designing comprehensive,
collaborative community strategies.
LCCs can use their own discretion of what
prevention, treatment or justice programs are needed within its community. Aware of the
relationship between substance abuse and gambling, few communities have already initiated
programs related to the prevention of problem gambling. Clark County located on the river
has included problem gambling prevention as part of their mission while other counties are
beginning to address the whole spectrum of addictive behaviors.
Funding for local drug-free community initiatives is
provided at both state and local levels. LCCs must submit comprehensive action plans
for review and approval by the Governors Commission for a Drug-Free Indiana before
funding is to be allocated. The Drug-Free Communities Funds are collected from local
dollars through various offender fees.
IV. Indiana
Problem Gambling Research Project
Design
The first step of the Indiana Problem
Gambling Research Project was to determine how gambling behavior in Indiana compared to
the rest of the nation. This project was structured to assess whether problem gambling is
significantly different in Indiana than national estimates. Problem gambling in Indiana
needs to be quantified to establish an empirical basis for social policy and ensuing
action.
To address this question, LSU-OSSRD collaborated
with the Louisiana State University Medical Center-Shreveport, Department of Psychiatry,
Gambling Studies Unit (LSUS-MC) to develop the instruments necessary to determine the
prevalence of problem gambling in Indiana.
LSU-MC developed four surveys to determine the
prevalence of disordered gambling behaviors within specific populations in Indiana.
Targeted populations were adults (18 years and older), adolescents in 6th
through 12th grades in public and private schools and incarcerated adult and
adolescent offenders within Indiana correctional facilities. These specific populations
were chosen to determine prevalence rates in both adults and adolescents in the general
population, which have been reported to be different, and the prevalence of gambling
behaviors and disorders in incarcerated populations. The level of problem gambling
behavior has been found to be higher in incarcerated populations nationally, which is
presumably due to the relationship between problem gambling and criminal behavior (to the
extent that the former causes the latter). This will aid in establishing necessary levels
of prevention and treatment in these populations.
To obtain feedback from the citizens of Indiana,
focus groups were conducted to obtain qualitative data regarding the perceptions that
citizens have about gambling. The groups included teachers, minorities, senior citizens,
community service providers and a random group of the population at large. Finally, a
treatment provider survey was distributed to treatment professionals in Indiana to assess
their views about the prevalence of problem gambling across the state and to gather
information regarding their experiences with gambling-related problem behaviors.
Surveys and focus groups were conducted by
subcontractors within Indiana.
Below is a summary of each research study
underscoring its method, sample size, limitations, findings, comparative national data and
implications for prevention and treatment.
Telephone Survey
Shaffer, Hall and Vander Bilt
(1997) delineated three levels of gambling behavior. Level 1 gambling has little or no
adverse consequences associated with the gambling behavior (a responsible gambler). A
level 2 gambler has a pattern of gambling behavior that is associated with a wide range of
adverse consequences (a problem gambler). Level 3 gambling refers to disordered gambling
that meets diagnostic criteria and has the most severe consequences associated with it (a
pathological gambler). A telephone survey of 2,927 Indiana residents was completed to
determine the prevalence of level 2 and level 3 gambling behaviors among adults (18 and
older) and to establish baseline factors that will guide prevention planning.
Persons were selected randomly to complete a survey,
which included the South Oaks Gambling Screen (SOGS). The SOGS is a 20-scorable item
questionnaire based on the criteria in the Diagnostic and Statistical Manual for Mental
Disorders-III. The SOGS identifies pathological gamblers. The SOGS was used to determine
problem levels associated with gambling. A score of 5 or more is consistent with level 3
gambling, a score between 1 and 4 is consistent with level 2 gambling, and zero would be
considered level 1 gambling.
Of the respondents, 87% reported they had gambled.
The majority of the total sample were found to be level 1 gamblers (93.9%), with 5.3%
being level 2 gamblers and 0.8% being level 3 gamblers. Level 2 gamblers spent 40 hours on
average per month gambling, and level 3 gamblers spent 104 hours on average per month
gambling. Level 3 gamblers, on average, missed almost three days from work per month.
The limitation to a study of this type is that the
sample is limited to those persons who have a working phone. Thus, homeless person or
persons without phone service were not sampled. Also, individuals that were not home at
the time of the call were rarely successfully contacted at a later time.
School Survey
Meta-analytic studies of adolescent
gambling disorder prevalence on students have resulted in estimates of possible problem
(level 2) and pathological gambling (level 3) that are higher than estimates in adults
(Shaffer et al., 1997). Past-year level 2 adolescent gamblers are estimated at 14.8%, and
past-year level 3 adolescent gamblers are estimated at 5.8%. Indiana 6th
through 12th graders were surveyed to ascertain the prevalence of gambling
behavior and to assess the average age of onset for experimentation with gambling.
Because few schools agreed to participate, the
sample could not be randomized. Attempts were made to sample all students from 6th
through 12th grades of the schools that participated. A sample of 3,270
accurately completed surveys were returned and analyzed.
National statistics indicate that the first personal
participation adolescents have with gambling is at age 11. This finding was essentially
replicated in this survey, with median age of onset being 11 for the current study. In
fact, by 6th grade, approximately 70% report having gambled before. Adolescents
who believe that skill is involved in gambling tended to be more at risk to develop
problems. National data indicates that 33.1% of adolescent gamblers initiate with sports
betting activities, 26.3% with card playing and 10% with the lottery. Adolescents who
believe that skill is involved in gambling tended to be more at risk to develop problems.
Adolescents believed that sports betting and cards required the most skill. The popular
gambling partners for adolescents were friends and members of their family. (Shaffer et
al, 1997) The Indiana School Survey does not provide comparative data to this national
information.
Table 3 provides a comparison between the lifetime
involvement in various gambling activities for the national meta-analytic study by
Shaffer, Hall and Vander Bilt (1997) and the current study of Indiana adolescents.
Table 3: Percent of
adolescents who have ever participated in gambling activities: national statistics versus
Indiana adolescents
Gambling activity |
National (%) |
Indiana (%)1 |
Any gambling activity |
77.55 |
90.10 |
Casino games 2 |
7.74 |
5.90 |
Lottery 3 |
34.89 |
68.20 |
Sports Gambling 4 |
38.17 |
56.00 |
Pari-mutuel |
10.88 |
15.75 |
Financial Markets |
-- |
13.74 |
Non-Casino Card Games |
53.46 |
53.47 |
Games of Skill |
40.43 |
49.45 |
Bingo and charitable games |
-- |
41.13 |
1 Number who said "yes" to activity
divided by 3,270
2 Casino games include land-based and riverboat
casinos
3 Lottery includes the lotto and scratch-off lottery
tickets
4 Sports gambling includes betting on sports pools
and / or on sports teams with friends
In general, the findings in Indiana were similar to
estimates of national trends. Of children in the nation, 77.6% have ever gambled, while
90.1% of Indiana school children have gambled. Interestingly, the number of Indiana
adolescents who have gambled in casinos (5.9%) was lower than the national average (7.7%),
but this may not be statistically significant. This may be due to better
enforcement of legal gambling age limitations in Indiana than in other areas. In terms of
general trends, Indiana adolescents participated at a much higher rate in lottery and
sports gambling and less so for pari-mutuel games and games of skill when compared to
national rates. There are no national comparative data for financial market participation.
Also, Indiana males were more likely to have participated in gambling activity than
Indiana females, 93.6% and 86.7% respectively. Other studies have also shown that males
tend to gamble more than females.
To assess level of probable problem gambling
activity, the South Oaks Gambling Screen, Revised for Adolescents (SOGS-RA), was utilized.
The scoring for this instrument is slightly different from the SOGS, with scores of 0 or 1
being level 1 gambling, scores of 2 or 3 being level 2 gambling, and scores of 4 or
greater being level 3 gambling. Approximately 11.2% of the students indicated level 2
gambling based on SOGS-RA score, with 7.5% having responses indicative of possible level 3
gambling. See Table 4 for a comparison to the national meta-analysis data.
Table 4: Comparison of estimated percent
level 2 and 3 gambling behavior in Indiana adolescents to national statistics
*CI=95% confidence interval
Study |
Level 2 |
Level 3 |
Indiana School Study |
11.2 (CI: 10.1-12.3)* |
7.5 (CI: 6.6-8.9)* |
1997 Meta-analysis |
14.8 (CI: 9.0-20.7)* |
5.8 (CI: 3.2-8.4%)* |
As shown in the table, the estimated prevalence of problem
and pathological gamblers is similar to national estimates with both estimates falling
with the 95% confidence intervals of the national meta-analysis. A major limitation to the
findings of this study was the relatively low participation rate, which did not allow for
random sampling. All conclusions only pertain to those sampled and cannot be extrapolated.
Since most of this research was conducted within the past two to three years, it may still
be too early to determine the trends in adolescent gambling disorders. The repercussions
of the rapid expansion and apparent community acceptance of gambling as a form of
entertainment is most likely unseen at this point because of the age that most compulsive
gamblers report when the first started gambling (approximately 8-10 years of age). In the
next few years, gambling studies will be critical for examining the affects of gambling
upon young populations as they enter adulthood.
Corrections Surveys
Adult Offenders
Research has indicated there is a relationship
between reported gambling behavior and criminal activity. This study was completed to
determine lifetime prevalence of gambling problems and the types of gambling problems
reported in incarcerated adults in Indiana. The SOGS was utilized in this study to
determine the of level of gambling activity involvement. A score of 5 or more is
consistent with level 3 gambling, a score between 1 and 4 is consistent with level 2
gambling, and a score of zero would be considered level 1 gambling. While the SOGS is used
to assess past year and lifetime gambling problems, only those results pertaining to
lifetime involvement will be discussed. The past year results would be affected by their
incarceration status and would not be appropriate comparisons to other research. A total
sample of 1,694 usable surveys were obtained, of which 60.5% were male and 39.5% were
female.
Of those surveyed, 95.5% reported having gambled at
least once in their lifetime, with rates for males and females being similar (96.8% and
93.5% respectively). Higher rates of gambling problems were found in this population than
in the general adult population. The estimated prevalence of level 1 gamblers was 41.7%,
level 2 was 39.8% and level 3 was 18.5%. Of the respondents, 4.0% (64 individuals)
reported being incarcerated as a direct result of their gambling activity. Of those, 71.9%
had level 3 gambling behavior and 25% had level 2 gambling. In general, more of these
individuals were male than female. There are some limitations to these findings. One is
that the sample did not include people under heightened security or those with mental
illnesses. Second, the reading level of the survey, purportedly at the 6th
grade level, may have been beyond the capabilities of some of the respondents. Third, some
of the surveys for the correctional survey were received too late to be included in the
reported analyses.
Adolescent Offenders
Comparatively, little research has examined the
level of gambling activity in the juvenile correctional facility population. The current
study attempted to assess such activity in Indiana and to determine age of onset with
gambling activity experimentation. As with the school survey, the SOGS-RA was utilized to
assess gambling behavior with attention focused on lifetime gambling activity due to their
incarceration status. The scoring for this instrument is slightly different, with scores
of 0 or 1 being level 1 gambling, scores of 2 or 3 being level 2 gambling, and scores of 4
or greater being level 3 gambling. As with the survey in the adult prison population,
those persons with mental illness or those in the highest security were not sampled.
The total sample was 310, with 72.3% were male and
27.7% were female. The majority (94.8%) reported having gambled at least once with money
or something of value. The median age of onset of gambling activity was 12 years. Of the
293 offenders for whom SOGS-RA scores could be tabulated, 28.7% were classified as level 2
gamblers and 38.9% as level 3 gamblers. As in the adult survey, these persons were more
often male than female. Fourteen people (4.6%) reported they have been told they need
professional help for their gambling. Of the fourteen, three were classified as level 2
gamblers and ten as level 3 gamblers. In contrast, a greater number of adolescents (n=27)
felt they had a problem with gambling (8.9%). Five of these (18.5%) were classified as
level 2 gamblers and twenty-one (77.8%) as level 3 gamblers. Interestingly, of the 21
adolescents who felt they had a gambling problem and were classified as level 3 gamblers,
5 had been told they needed professional help for their gambling. Last, 27 offenders
(9.1%) reported being arrested because of gambling related activities. Of the 27, five
were classified by the SOGS-RA as a level 1 gambler, four as level 2 gamblers, and 18 as
level 3 gamblers. These findings together provide some indication that the SOGS-RA is
measuring behavior which observers also feel is problem gambling behavior.
These findings indicate that the level of gambling
problems in this population is greater than that of their non-incarcerated counter-parts
in the school system. As with the adult correctional survey, the limitations of this
survey include the literacy level of those questioned, the inclusion bias, and a packet of
surveys that was received too late to be included in the analyses.
Focus Groups
Focus groups were conducted in Indiana
- to determine how widespread gambling is within the state,
- to ascertain perceptions citizens have about gaming,
- to see what problems, if any, the group members have observed,
- to get recommendations on how to correct any observed problems and
- to get the general publics beliefs and attitudes toward gaming.
There were five independent focus groups held with
teachers, minorities, senior citizens, community service providers and a random group of
the population at large. In general, the findings across the groups were similar. All
groups felt that gambling is primarily a form of entertainment, with only a small
percentage of the participants expressing negative opinions about gambling. Approximately
three-fourths of all participants favored legalized gambling. Interestingly, the minority
group felt that the states legal gambling activities had redirected revenue that was
spent in illegal gaming that is historically part of the African-American community in
some areas. As a result, several minority participants expressed that they would rather
participate in the gambling in their neighborhoods to keep the money in their communities.
The lottery and casinos were identified as gambling activities, possibly because of the
amount of advertising associated with these two forms. All groups perceived the lottery as
a game of the middle and lower classes and that casinos were visited predominantly by the
upper class. However, problems with gambling were seen as a function of individual
personality and not identified with any particular social class, gender or ethnic group.
The groups made several recommendations for the
state to prevent and treat problem gambling. (Recommendations should be considered as
being reflected by all or most groups, except where specifically noted.)
- The state could develop a statewide education program
to create an understanding, within the general public, of gambling problems and warning
signs.
- The state could work with health care and community
service providers to provide aid through existing resources.
- The state could create a balance to existing
advertising, better informing the public of the odds of winning, balancing the
overwhelming perception of "getting something for nothing" that encourages many
people to play.
- Develop educational public service announcements with
phone numbers to locate help.
- Teachers suggested that the state provide
education/prevention aimed at high school youth, establish ID checks at gaming venues and
build lesson plans on the internet.
- Minorities felt the state should establish programs
similar to Alcoholics Anonymous (i.e. Gamblers Anonymous) and place a limit on
advertising.
- Senior citizens felt the state should provide
on-going, open-ended outreach programs, run alternative advertising that does not
glamorize gambling, insert messages in Social Security checks and reduce access to
customers who appear to be buying too many tickets (similar to a bartender "cutting
off" a patron who has drunk too much).
- Community service providers strongly felt the state
should support existing services for families, as opposed to creating new programs, and
that there be a certification for gambling counseling.
Treatment Provider Survey
One of the methods used to assess the prevalence of
problem gambling across the state was to survey the various treatment providers about
their experiences with gambling-related problem behaviors and the treatment modalities
used to treat problem gamblers.
Questions contained in the anonymous survey designed
by Dr. Rachel Volberg were comprised of three categories. The first section dealt
primarily with gambling treatment history and included information such as whether or not
the respondent has ever treated significant family members of gamblers or gamblers
themselves, and if so, how many in the last year, and general characteristics of gamblers
seen. The second section contained questions on the providers treatment practice,
procedures and experiences. The third and final section obtained respondent classification
information such as age, gender, licenses and credentials and primary treatment
population. A complete listing of treatment providers was obtained. Surveys were mailed to
8,500 mental health professionals and 905 (10.6% return rate) completed surveys were
returned. Noteworthy findings are discussed below for
each section.
Gambling Treatment History
The majority of respondents have never treated family
members of gamblers or gamblers themselves. Only 18.7% indicated they have treated
spouses, children, parents or other significant family members of problem or pathological
gamblers. While 30.6% reported having treated problem or pathological gambling problems in
the past, only 17.7% stated they currently treat pathological gambler (see Table 5).
|
Table
5. percent of providers who treat or
have treated problem gamblers.
|
And, of those who are currently in the practice of treating gamblers, most have
seen few in the past twelve months. Almost two-thirds (61.5%) have seen 2 or fewer
gamblers in the last twelve months, and only 5% of the respondents have seen greater than
14. This indicates that few professionals are currently treating problem and pathological
gamblers, and even the professionals treating this population, the large majority has seen
fewer than 14 in the last year. Because so few gamblers have been seen, questions
attempting to obtain the general characteristics of gamblers and the types of gambling
problems these individuals are reporting are not representative and will not be reported.
Many people were reporting information based on seeing 1 or 2 gamblers, which will skew
the results to over-represent the characteristics of those few people.
Treatment Practice, Procedures and Experiences
Most professionals report providing individual
counseling (97.5%) and family counseling (77.2%) to gamblers and their families, with some
providing group counseling (40.7%). Based on responses, outpatient treatment appears to be
the treatment of choice being offered and that the respondents feel is the necessary level
of care for pathological and problem gamblers. Approximately two-thirds indicated that
outpatient service or intensive outpatient service is necessary for most individuals (61%
and 63.5% respectively), with 15% indicating inpatient treatment and 21% indicating
partial hospitalization or day treatment. Additionally, respondents were asked to indicate
what is the typical expected and actual length of stay in treatment. Most professionals
reported providing outpatient treatment (90%).
Outpatient treatment was expected to last 22 weeks, with
most clients staying 16-17 weeks in treatment. Inpatient treatment was expected to last
between 11-12 weeks, with most staying between 4-5. Thus, treatment providers report that
gamblers need outpatient or intensive outpatient services and that the gamblers they have
seen are not staying for the length of time needed for adequate services to be provided.
|
Table 6: Providers
recommendations - services necessary to treat problem gamblers
 |
Interestingly, the majority reported
referring clients to Gamblers Anonymous (87.8%) and that they either require or strongly
recommend GA as a part of treatment (85.8%). However, some persons indicated that GA is
not available in their area.
Respondent Classification Information
The mean age of respondents was 47.9 years old.
Two-thirds were female (65.2%). Most are highly educated, with 55.4% having at least a
Masters degree and 27.2% being either a medical doctor or having a doctorate. The
majority was either social workers (69.5%) or psychologists (19.7%), with a small
percentage of respondents holding other licenses or credentials (e.g., 4.5% psychiatrists,
4.5% marriage/family counselors, 0.6% chemical dependency counselors). Few respondents
have received any specific training in the treatment of problem gambling (11.3%), however,
some indicated they would like to receive such training. Last, not all persons completing
the survey are currently treating people. The survey was intended to be sent to treatment
professionals, but in order to accomplish this, the survey was mailed to all persons
holding any type of degree allowing them to treat persons needing counseling. One-fifth of
the respondents indicated they are not currently treating people. While these individuals
hold the necessary credentials, some have retired or work in non-treatment oriented jobs.
For those who are currently treating people, most work with psychiatric (72.9%) or
non-psychiatric problems (47.5%), but few indicated that gamblers were a predominant part
of the practice (2%). This is not surprising given the above noted findings that most
treatment professionals have never treated gamblers or are not currently in the practice
of treating gamblers.
This information as a whole indicates that few
gamblers are currently being treated in Indiana. There are many hypotheses that may
account for this finding. First, individuals with gambling problems may not be seeking
treatment. Second, treatment professionals are not trained in the treatment of this
disorder and do not accept these clients. Third, that there was a response bias in that
many persons treating gamblers did not complete or return the survey. Fourth, that it is
some combination of the above factors.
Summary of Findings
Overall, there are some findings from the
previous discussion that should be highlighted. First, the telephone survey indicates that
most people participate or have participated in some form of gambling activity (87%), with
relatively few people developing problem gambling behaviors (approximately 6% being either
level 2 or 3 gamblers). This is consistent with national data, which indicates that the
level 2 and level 3 lifetime national prevalence rate among adults is 5.5% (Shaffer et al,
1997).
Second, the survey of adolescents in grades 6th
through 12th was commensurate with national data on the gambling behavior of
this population. Level 2 gambling is lower in Indiana adolescents but higher in level 3
gambling when compared to national data. The median age of onset for gambling behavior was
11 in both Indiana and national data. The Indiana study also demonstrated at a
statistically significant level that probable pathological gamblers initiated gambling
behavior at a lower age level than problem and no problem gamblers. The estimated
prevalence of problem and pathological gambling fell within the confidence limits of the
national meta-analytic study, with 11.2% and 7.5% of adolescents in Indiana being possible
level 2 and level 3 gamblers respectively.
The results of the adult correctional facility
illustrated that more of these individuals have participated in gambling that the general
population (95.5%), and that this population has a higher estimated prevalence of gambling
problems. Of the incarcerated adults, 42% were level 1 gamblers, 40% possible level 2
gamblers and 19% possible level 3 gamblers. These estimates are much greater than those of
the general population. The same was true for the survey of adolescents in juvenile
correctional facilities. The majority has participated in gambling activity (95%). Of the
adolescents, 32% were level 1 gamblers, 29% were level 2 gamblers, and 40% were level 3
gamblers. As can be seen, these estimates are also greater than that of their
non-incarcerated counter-parts in the school system.
Approximately three-fourths of focus group
participants were in favor of legalized gambling, which they view as a form of
entertainment. The groups recognized that some individuals develop problems because of
their gambling behavior but that these are the minority of gambling participants. The
groups had a number of recommendations aimed at the state to alleviate problems resulting
from problem gambling.
The survey of treatment providers indicated that few
professionals have ever or currently treat problem or pathological gamblers. And, of those
treating gamblers, few have presented for treatment in the 12 months prior to the survey.
This indicates the problem gambling population is currently under-served. Last, some of
the respondents indicated interest in training in treating this population.
These findings taken together indicate that some
individuals in Indiana are experiencing problems as a result of their gambling behavior,
and that the prevalence of gambling related problems is similar in Indiana to findings
nationally.
Implications for Social Policy, Prevention and
Treatment
Gambling research is still in its infancy.
Obtaining accurate data is complicated by various methodological problems and the unknown
affect that gambling will have on a population that has been exposed to legal gambling
only for the past few years in Indiana. However, the baseline research obtained in
Indiana, along with national studies, provides preliminary information to guide prevention
and treatment efforts.
Based on the information obtained from the
adolescent survey, it is imperative that primary prevention programs be implemented prior
to the age 11, the median age when Indiana adolescents initiate gambling activities.
Prevention activities need to be directed at both males and females but must be gender
sensitive because males engage in gambling activities at a higher rate than females.
Because national statistics demonstrate that adolescents are engaging in gambling
activities with friends and family members, it is essential that prevention programming is
directed at changing peer norms and that parent education and training with a non-gambling
theme is included (Shaffer et al, 1997).
Prevention efforts need to focus on public policy
and law enforcement surrounding legal age limits in venues such as casinos and charitable
gambling establishments. The school research found that Indiana adolescents are engaging
in illegal gambling activities at higher levels than national estimates.
Some research indicates that gambling problems are
more prevalent among the non-Caucasian populations (Volberg, 1993). In the nation, 16.1%
of the population is non-Caucasian. In Indiana, this population is 10% (U.S. Census,
1990). However, based on the focus group information, minorities seem distrustful of the
gaming industry. This information is valuable to prevention and treatment providers since
it may shed light on mistrust that also affects help-seeking behavior. Prevention and
treatment efforts must be culturally competent by defining societal and cultural
influences that affect health behavior decision-making and help-seeking behavior of
specific groups and individuals.
Research has indicated that problem gamblers share
certain characteristics. It is likely that they are male, are under the age of 30, earn a
low income and have co-occurring psychological difficulties. Prevalence rates are higher
among non-Caucasians as well. Males clearly outnumber females in the gambling
participation rates and problem gambling behavior. (Shaffer, Hall and Vander Bilt, 1997;
Volberg, 1993; Volberg and Steadman, 1988). Prevention programs including social marketing
campaigns must target specific groups that are at risk for gambling problems. In
developing programs, it is first essential to understand what influences their behavior
and how they make decisions regarding their health.
The treatment provider survey indicates that problem
gamblers in Indiana are currently underserved. If the explanation lies in the lack of
training of professionals or that gamblers are not seeking treatment, these are conditions
that should be remedied. This could be accomplished through a variety of means, such as
training workshops (in addition to the five offered by FSSA) offered by professionals
trained in the treatment of gambling problems, awareness campaigns to explain the nature
of the problem and information as to the location and types of services available to help
these individuals.
Recommendations for Further Research
- Research targeting the behaviors of specific groups
demonstrated to be at high risk for gambling addiction.
- Research to identify regional clusters in the state
of Indiana where gambling is a problem.
- Research that identifies the type of gambling
activities through which Indiana adolescents initiate.
- Research on the accessibility of gambling to
adolescents.
Specific Populations and Issues
Seniors
When developing prevention and treatment programs
for problem gambling, attention must focus on the senior population. While there is little
data on the prevalence of gambling problems in older adults, this population is heavily
targeted by the gambling industry and may experience unique lifestyle changes that put
them at risk for engaging in problem gambling behavior. Due to the large population of
seniors that exists in Indiana, prevention programming must be tailored to meet the needs
of this group.
There are a number of reasons why the senior
population is beginning to exhibit problem gambling behavior, such as opportunity,
boredom, loneliness, escape and sense of entitlement. (Wisconsin Council on Problem
Gambling, 1998). Seniors often have a need for interaction with others and a lot of
leisure time. They may attend casinos to fill their time and seek out social relationships
with other people.
Also, opportunities to gamble are increasing over
time, with the distance to gambling venues decreasing as such places increase in number.
Many gambling casinos are now sponsoring bus tours for seniors, with casinos providing
buses to drive seniors from their home to the casino for no charge, and sometimes
including a monetary incentive for seniors (e.g., ten dollars). Seniors living in
residential communities may also have opportunities to engage in gaming activities, such
as bingo, on a regular basis Among seniors, gambling can also be a form of escape from the
reality of their life circumstances. Man seniors may be experiencing grief from loss of
their spouse, family and friends or experiencing physical difficulties and pain as a
result of the aging process.
Findings from a telephone survey of Indiana adults
indicated that 2.2% of the population surveyed were baby boomers (40-59 years of age) and
probable problem gamblers (level 2) while .31% were baby boomers and probable pathological
gamblers (level 3). The data also indicated that .83% of those surveyed were seniors (age
60 and older) and probable problem gamblers while only .03% were seniors and probable
pathological gamblers.
Even though this information demonstrates that
gambling problems actually decrease as one gets older, it should not be misleading.
Seniors are at high risk for gambling problems since they are heavily targeted and
experience unique psychological risk factors. Furthermore, once they develop a gambling
problem, the effects are usually devastating and irreversible. This data does indicate
that baby boomers and pre-retirees need to be targeted for prevention to circumvent
problem gambling behavior that may arise from lifestyle changes due to retirement, boredom
and increased time ad opportunity.
Prevention of gambling problems in seniors should be
aimed at providing education to discourage irresponsible or excessive gambling.
Educational programs may also include money management information as well as how to
identify and address the signs and symptoms of problem gambling. Programs should provide
information on how to seek help and address the obstacles that may make a senior resist
help. It is essential to develop programs providing seniors with alternate activities
aimed to curb many of the psychological risk factors thought to contribute to problem
gambling behavior. Awareness campaigns should be developed that offset existing campaigns
making gambling appear glamorous.
Prevention programs should be on-site in retirement
communities and religious organizations that provide charitable gaming activities.
Prevention professionals need to work with organizations that provide services for seniors
such as the American Association of Retired Persons (AARP) and Seniors Unlimited to share
information and provide educational programming.
College Students
Comparable to the adolescent population, problem
gambling behavior among college students is on the rise. Studies have shown that college
students are 4 to 8 times more likely than the adult population to experience a gambling
problem. (Lesieur et al. 1991). The Harvard meta-analysis looked at more than 20 studies
focusing on college student gambling behavior and found 9.3% of college students to be
probable problem gamblers and 4.7% to be probable pathological gamblers. These rates are
similar to adolescents but are considerably higher than that of the adult population.
As adolescents move into college, gambling behavior
can become problematic for many reasons. They are out of parental supervision giving them
more freedom, they may be more apt to take risks, have access to new sources of money
(i.e.credit cards) and may engage in gambling behaviors along with the consumption of
alcohol, tobacco and other drugs. In a study of six colleges and universities within five
states, 85% of the college students reported that they have gambled, and 23% gamble once a
week or more. Slot and poker machines were the most popular form of gambling with playing
cards for money and casino games close behind. On a weekly basis, games of skill such as
pool, golf, or bowling were the most popular games played for money. Another popular type
of gambling for college students included sports betting, causing alarm for coaches that
student athletes might get involved. College students also have unique access to other
types of gaming activities through student organization sponsored "casino
nights" and gambling on the Internet. Pathological gambling behavior was almost three
times more likely in males than females and highly correlated with the use of alcohol and
other drugs (Lesieur et al, 1991).
Prevention professionals need to work with Wellness
Education Programs and Mental Health Departments within Student Health Centers on campuses
to provide further research and prevention programs surrounding problem gambling.
Educational and awareness programs regarding the dangers of excessive gambling are
essential. Information regarding gambling and addiction would fit in with campus-wide
mental health and substance abuse awareness campaigns. Programs that focus on impacting
campus norms surrounding gambling behavior should be employed especially in those
communities where gambling is the normative behavior and gambling opportunities are easily
accessible. Programs need to reach both students living on campus as well as commuters.
Students residing on-campus can be reached through residence hall activities and campus
gathering places. Commuters, a much more difficult population to reach, can be targeted
through classroom presentations, activities inside and in front of the Student Union as
well as information placed strategically on signs along routes entering the school.
Internet Gambling
The proliferation of Internet gambling poses a
challenge for states in their effort to prevent problem gambling. The Internet hosts
hundreds of gambling sites with little regulation and protection against underage
gambling. With over 175 million Internet users worldwide, it is evident that the easy
access to this type of gambling activity is bound to cause problems. Concerns about
consumer protection, underage gambling and gambling addiction have made studying the
effects of Internet gambling a priority both in many states and at the federal level.
While Internet gambling is illegal in many states including Indiana, enforcement of laws
surrounding gambling on the Internet can be futile since most sites are located outside
the country.
Due to poor regulation of gambling activities on the
Internet, there have been increased incidences of fraud. How does the gambler know that
his $1,000 wager on black in roulette was a loser? How is a gambler assured of receiving
his/her due winnings (Collesano, 1997). Other concerns surround the lure of Internet
gambling to students and employees with Internet access at schools and places of
employment. Such concerns may lead to strict policies regarding gambling in the workplace
and serve as an impetus for the development of blocking software that would decrease
access to underage gamblers.
The Council on Compulsive Gambling of New Jersey has
responded to the serious problem of Internet gambling with a home page dedicated to
fighting cyberspace bookies, and encouraging problem gamblers to seek help (Seattle Post
Intelligencer, 1997). Prevention and treatment programs need to reach people "where
they are". If they receive information on the Internet, it is the most appropriate
place for them to receive messages regarding the identification of problem gambling
behavior and how to seek help. The dangers of Internet gambling should also be highlighted
in problem gambling prevention curricula and other public awareness campaigns.
V. Development of a Problem Gambling Prevention Plan
Linking Research to Planning
For program planning and implementation to be
effective, there should be a logical link between the empirical foundation established
through the research and the type of programming that develops. In this case, the FSSA-DMH
has consistently indicated that outcome effectiveness is a critical part of their planning
and programming efforts. The effectiveness research conducted by the Indiana University
School of Health, Physical Education and Recreation and the LSU-OSSRDs research
should be used to plan for prevention services. Although the IU research was conducted for
substance abuse prevention, it should be linked with prevention of problem gambling.
Little is known about effective prevention of
problem gambling behaviors. Examples of effective prevention strategies for other
addictive illnesses offer methods that could be applied to problem gambling prevention.
The application of known substance abuse prevention strategies to problem gambling will
provide a starting point from which revisions and alterations can be made as more is
learned about the nature of problem gambling.
To provide some background for the current state of
knowledge in prevention services, selective treatment and prevention research is discussed
in the next section.
Review of Related Prevention and Treatment Literature
Treatment
Gambling treatment knowledge is more developed than
prevention knowledge. One of the well-known treatment models for problem gamblers is
offered through Gamblers Anonymous (GA). Modeled after Alcoholics Anonymous, GA is a
12-step program for compulsive gamblers. This mode of intervention is also popular among
Indiana treatment providers, with 87.8% reporting that they refer clients to Gamblers
Anonymous and 85.8% either require or strongly recommend GA as a part of treatment.
Programs for the families and children of compulsive gamblers include GamAnon and
GamAteen. There have been few studies completed on gambling treatment that seem applicable
for a majority of people. Although GA is the most frequently used treatment of gambling
problems, there has been no research to date providing a systematic study of its efficacy
(Knapp and Lech, 1987).
Some of the therapeutic techniques referenced in the
literature include psychoanalytic treatment, self-help groups and cognitive and behavioral
therapies such as aversion therapy, desensitization and Rational Emotive Therapy.
Sometimes, family and marital therapy is also used as a component of treatment. Indiana
providers reported using the following treatment techniques to treat gambling problems:
the medical/addiction model, cognitive /behavioral and an eclectic approach.
Most professionals in Indiana report providing
individual counseling (97.5%) and family counseling (77.2%) to gamblers and their
families, with some providing group counseling (40.7%). Based on responses, outpatient
treatment appears to be the treatment of choice being offered and that the respondents
feel is the necessary level of care for pathological and problem gamblers. Approximately
two-thirds indicated that outpatient service or intensive outpatient service is necessary
for most individuals (61% and 63.5% respectively), with 15% indicating inpatient treatment
and 21% indicating partial hospitalization or day treatment. As of yet, there is a lack of
established psychological treatments for gambling (Lesieur and Rosenthal, 1991).
Prevention
Prevention refers to the identification of the onset
of use or early stage problems in individuals or groups who do not yet require treatment
(SAMHSA, Making Prevention Work, 1995). As applied through the Center for Substance
Abuse Prevention (CSAP) approach, prevention stops the development of alcohol and other
drug-related problems by encouraging people to develop positive and constructive
lifestyles. The aim of successful prevention efforts is to support the healthy development
of children so they will be protected against the availability of substances in their
pre-adolescent and adolescent years. By reducing the personal risk factors associated with
addictive behavior, the problem is prevented. Consequently, effective prevention
strategies must be comprehensive, multi-level and aimed at the variety of influences upon
the child as he/she develops.
The overall goal of preventive intervention is the
reduction of the occurrence of new cases. To establish a comprehensive prevention plan,
several levels of prevention planning should be used. These are:
Primary prevention: seeks to decrease
the number of new cases of a disorder of illness ( incidence).
Secondary prevention: seeks to lower
the rate of established cases of the disorder or illness in the population (prevalence).
Tertiary prevention: seeks to decrease
the amount of disability associated with an existing disorder or illness.
The most effective prevention strategies are applied
as primary prevention because the problem never develops. Secondary prevention efforts
address prevalence and attempt to reduce the existence of the problem behavior. Finally,
tertiary prevention efforts attempt to lessen the impact of the problem behavior once it
has begun. The prevention strategies for problem gambling behavior must incorporate these
three levels of prevention if comprehensive prevention is to occur.
CSAP stresses the importance of primary prevention
and early intervention in dealing with substance abuse addiction. Early intervention
efforts are also considered to be preventive in that they prevent the progression of
initial indicators of abuse. For substance abuse and gambling problem development among
youth, primary prevention and early intervention programs are critical to the success of
any programs.
In developing an effective prevention strategy, it
is not just the specific intervention to be applied, but the manner in which it is applied
and to whom it is applied. Haphazardly planned prevention programs base their intervention
on the belief that "one size fits all." In reality, the effectiveness of a
prevention strategy is heavily dependent upon targeting the intervention to the
appropriate population and delivering the intervention in the correct amount and intensity
for the chosen target. It is with this background knowledge that CSAP developed its
recommended strategies for implementation of the interventions that have been empirically
related to effectiveness. Prevention strategies should be selected based upon the
characteristics of specific populations. Mrazek and Hagerty (1994) identify three types of
prevention interventions that can be used when developing a plan to address multi-levels
of a community or target population, focusing on the level of risk at various segments of
the population. These interventions are described by Mrazek and Hagerty as
Universal preventive interventions, which
target the general public or a whole population group that has not been identified on the
basis of individual risk;
Selective preventive interventions,
which target individuals or a subgroup of the population whose risk of developing mental
disorders is significantly higher than average and
Indicated preventive interventions,
which target high-risk individuals who are identified as having minimal but detectable
signs or symptoms foreshadowing mental disorders or biological markers indicating
predisposition for mental disorder but who do not meet the diagnostic levels at the
present time.
CSAP has developed a typology for prevention
strategies that is recommended for use in the development of a comprehensive prevention
plan. The strategies have been developed over the years of working with states and
communities and may serve as the foundation for effective prevention planning and program
development (SAMHSA, Making Prevention Work). The recommended strategies are
described as:
1. Information dissemination - which is
defined by CSAP as "one way communication from the source to the audience, with
limited contact between the two" (p. 10). The aim of this strategy is to provide awareness,
knowledge and information relevant to certain problem behaviors and/or to certain
targeted populations, i.e. parents, community groups, etc. The dissemination of
information includes content regarding specific problems as well as information on where
to get further information or assistance. Recommended information dissemination activities
include:
* clearinghouse /information resource centers
* resource directories
* media campaigns
* brochures
* radio/television PSAs
* speaking bureaus
* health fairs
* information lines/hotlines
2. Education - described by CSAP at two-way
communication, involving an educator/facilitator and participants in the process. This
strategy aims at affecting critical life and social skills including decision making,
refusal skills, critical analysis and systematic judgment abilities. Recommended
educational activities include:
* classroom and/or small group behavior
* parenting and family management classes
* peer leader/helper programs
* education programs for youth groups
* children of substance abuser groups
* mentoring programs
* preschool alcohol and drug prevention programs
3. Alternatives - refers to the provision of
the target population in activities that are free of the problem behavior, i.e. alcohol,
tobacco and other drugs. This strategy attempts to offer alternatives to the deviant
behavior, assuming that constructive and healthy activities provided at the right time can
minimize the attraction to other activities that meet certain needs. Recommended
alternative activities include:
* alcohol, tobacco and other drug free dances and
parties
* youth/adult leadership activities
* community drop-in centers
* community service activities
* outward-bound type programs
* recreation activities
4. Problem Identification and Referral -
primarily used as an early intervention activity for those youth who have engaged in
initial or inappropriate use of alcohol, drugs and tobacco. This strategy is not aimed at
determination of need for treatment, but identification of initial use that can be
reversed through education efforts. Recommended early intervention activities include:
* employee assistance programs
* student assistance programs
* DWI type programs
5. Community-Based Process - described
as the process of enhancing the communitys ability to provide effective prevention
and treatment services for alcohol, tobacco and drug related disorders. These activities
aim to enhance efficiency and effectiveness of existing services, implementation of those
services, collaboration across the community, coalition building and networking. Basically
this strategy attempts to foster community mobilization and empowerment to address
identified problems. Recommended community-based activities include:
* community and volunteer training
* systematic planning
* coordinating and collaborating with other agencies
* accessing services and funding
* community team-building
6. Environmental - described as activities
undertaken to change written and unwritten community standards, codes and attitudes,
thereby influencing incidence and prevalence of the abuse of alcohol, tobacco and other
drugs in the general population CSAP differentiates these activities into ones that
address legal and regulatory initiatives and ones that address service and action oriented
initiatives. Recommended environmental activities include:
* promoting the establishment or review of alcohol,
tobacco and drug use policies in schools
* providing technical assistance to communities to
maximize local enforcement procedures
* governing availability and distribution of
alcohol, tobacco and other drugs
* modifying alcohol and tobacco advertising
practices and product pricing strategies.
The discussion on CSAP recommended strategies has
been taken from the SAMHSA publication Making Prevention Work, pps. 10-12. The
six-point classification system is identified as the Comprehensive Public Health Model.
Although these strategies developed out of alcohol and other drug prevention theory, the
methods would be revised for specific compulsive gambling issues.
Effectiveness Research on Specific Prevention Activities
Little research currently exists
evaluating specific prevention of gambling. This may be partly due to the fact that few
states are currently employing such programs, and existing programs are relatively new and
have not been evaluated for efficacy. Gaboury and Ladouceur (1993) assessed a prevention
program developed for adolescents in Quebec. The aim of the program was to increase
knowledge of gambling, decrease amount of money spent and frequency of gambling activity
and to change attitudes towards gambling. Three 75-minute sessions were utilized during
which information was provided concerning the above-noted topics. The results were not
encouraging but informative. Adolescents who participated in the sessions performed better
on a post-test, compared to control subjects not exposed to the information. However, this
was not maintained at six-month follow-up.
Additionally, the program did not seem to
significantly affect gambling behavior or attitudes and improvements in social skills
obtained by the experimental group were also not maintained at follow-up. The researchers
concluded that increased knowledge may not be sufficient to modify behavior and attitudes
and coping skills may require intensive practice and feedback to resist extinction.
However, this study comprises only one component of a prevention program. And, as noted by
the authors, having been exposed to the experimental material may still result in an
increased likelihood that the experimental participants will seek treatment if problems
arise for themselves or their family members and friends, due to their sensitization of
the issues surrounding gambling.
In a discussion of prevention research, Volberg
(1996) cited the 1993 Gaboury study as the only one on prevention. She further described
current prevention efforts "in states where services are now being established, they
will most likely consist of hotline or crisis counseling, training for addictions and
mental health professionals who may already be seeing gambling-related problems among
their clients, and education and information activities, including development of
brochures and public service messages for broadcast and print media."
Findings in Youth Substance Abuse Prevention Relevant to Problem
Gambling Prevention
SAMHSA has also reported findings
based on a decade of experience and research in prevention that may prove relevant to the
current effort. Although the particular issue being addressed is youth substance abuse
prevention, several of the findings are relevant to gambling prevention.
1. Initiation of substance use
Adolescent perceptions of the risks and benefits of
alcohol and other drug use correlate with the likelihood of initial use.
Parental use, or parental attitudes toward the use,
of alcohol, tobacco and illicit drugs tend to correlate with adolescent attitudes toward
the use of these substances.
A lack of close relationships in the family tends to
correlate with adolescent substance abuse.
Students who perform poorly in school or who have a
perception of themselves as academic failures are more likely than other youth to engage
in early alcohol use.
2. Effectiveness of prevention activities
Teaching life skills (e.g., problem solving,
decision making, social skills) is effective in reducing the incidence of substance abuse
among youth when it has a non-substance abuse theme instead of targeting general goals.
Interpersonal counseling, mentoring and other forms
of intensive interaction strengthened protective factors against drug use among youth at
high risk.
3. Program implementation
Turf conflicts and time constraints are most often
cited as barriers to the creation of successful community prevention coalitions.
Longer-term interventions and delivering booster
sessions are associated with more effective outcomes.
Simultaneous efforts to operate a wide variety of
prevention-related activities among an adolescent population reduced effectiveness of the
intervention.
4. Cost and financing of substance abuse prevention
Drug-free recreational and cultural activities are
often the most costly element of community-based prevention programs
Even cost-effective, community-based prevention
efforts quickly erode without stable, dedicated funding.
Although these findings apply to the substance abuse
problems, many of them will be applicable to gambling addiction problems. They are
important to consider in the development of a comprehensive prevention plan.
Social Development Strategy Model
Based on the current literature, the best prevention
strategies are aimed at strengthening individual resiliency to problem behavior, reducing
risk factors that promote addictions, developing clear and consistent community standards
for appropriate behavior and teaching children the skills they need to follow community
standards (DRP, 1993). Because of the comprehensive nature of the Social Development
Strategy Model, the plan being proposed for Indiana will largely be focused on this model.
Risk-focused prevention was developed through the
research of Dr. David Hawkins and Dr. Richard F. Catalano. It is a comprehensive
prevention strategy aimed at preventing adolescent health and behavior problems.
Risk-focused prevention is based upon the theory that children and adolescents face
certain risk factors that inhibit their ability to develop in a normal, healthy manner.
The risk factors may exist throughout various domains in which the youth must function.
There are various risk factors that youth may face in their neighborhoods, their schools
or their families, in addition to other settings. Applying this theory to gambling
addiction is highly recommended.
An additional part of Catalano and Hawkins
theory is that children and youth may also maintain certain protective factors that make
them more resilient to the risks that they will face as they develop. The Social
Development model focuses on the reduction of known risk factors and the enhancement of
protective factors to achieve a balance that will help youth develop as healthy as
possible. Risk-focused prevention is primary prevention, and it attempts to prevent
problems from happening by identifying the known risks and enhancing protective factors
that will address the hazardous situation.
Catalano and Hawkins (DRP, 1993) have identified
four primary areas of risk. These include community, family, school and individual/peer
risk factors. Within each of these areas, the risk factor predicts the type of problem the
adolescent will face when specific areas of risk are present.
Community Risk
Factors include: |
|
Area of Risk |
Predicted problem Behavior |
Drug availability |
Substance abuse |
Laws/norms
favorable to drug use, firearms and crime |
Substance abuse, delinquency and violence |
Media portrayals
of violence |
Violence |
Transitions and
mobility |
Substance abuse, delinquency and school
dropout |
Low neighborhood
attachment and community disorganization |
Substance abuse, deliquency and violence |
Extreme economic
deprivation |
Substance abuse, deliquency, violence,
teen pregnancy and school dropout |
|
|
Family Risk
Factors include: |
|
Area of Risk |
Predicted Problem Behavior |
Family history of
problem behavior |
Substance abuse, delinquency, violence,
teen pregnancy and school dropout |
Family management
problems |
Same as above |
Family conflict |
Same as above |
Favorable parental attitudes and involvement in behavior |
Substance abuse, deliquency and violence |
|
|
School risk factors include: |
|
Area of Risk |
Predicted Problem Behavior |
Early and persistent anti-social
behavior |
Substance abuse,
delinquency, violence teen pregnancy and school dropout |
Academic failure in elementary school |
Same as above |
Lack of commitment to school |
Same as above |
|
|
Individual/peer factors include: |
|
Area of Risk |
Predicted Problem Behavior |
Alienation,
rebelliousness and lack of bonding to society |
Substance abuse, delinquency and school
dropout |
Friends who
engage in problem behavior |
Substance abuse, delinquency, violence,
teen pregnancy and school dropout |
Favorable
attitude towards the problem behavior |
Same as above |
Early initiation
of the problem behavior |
Same as above |
Constitutional
factors |
Substance abuse, delinquency and violence |
The identified protective factors
either reduce the effect of the risk factors or they change the individual response to
risk. The most important protective factors to guard young people against risk are those
that promote positive behavior, health, well-being and personal success (DRP, p.11). The
Catalano and Hawkins research has also identified certain categories of protective
factors.
Protective Factors:
Individual characteristics- described as a
resilient temperament or a positive social orientation.
Bonding - positive relationships that
promote close bonds; warm relationships with family, teachers, adults, close friendships
Healthy beliefs and standards- when clear
standards for healthy behavior are presented by parents, peers, families, schools.
The Catalano and Hawkins theory continues to
describe other characteristics of risk factors, especially when considering the potential
impact of specific protective factors. These include the belief that risks exist in
multiple domains. Domains in which risk factors have been identified include the family,
peer group, school, neighborhood, environment and society. The individual domain is also
included as a critical area in which to provide protection, for example, with children who
have poor temperaments or developmental disabilities. Additionally, the Social Development
Theory also stresses that the more risk factors that are present, the greater the risk for
the youth.
Programs based on the Social Development Model are
designed to:
- Strengthen childrens bonds by providing
opportunities, skills and recognition,
- Reduce risk factors in a way that strengthens
protective factors,
- Develop clear and consistent standards for behavior
across families, schools and communities and
- Teach children the skills they need to be able to
follow clear standards
( the material on the Social Development Model was
taken from the Communities that Care publication, Developmental Research
and Programs, Inc., 1993)
To develop an effective problem gambling prevention
plan, the risk and protective factors affecting a communitys children must be
discussed. Certainly, in the field of gambling, there are diverse ranges of the problems
across the state, depending on factors such as poverty, availability or access to gambling
and community norms. Prevention planning efforts must address each communitys
identified needs.
Building Cultural Competence in Prevention Programming
When developing prevention
programming for individuals from a variety of backgrounds, it is essential to create
educational strategies that are based on diverse perspectives. Curriculum that is based on
a narrow perspective often fails to engage youth from diverse racial, cultural and
socioeconomic backgrounds. Because gambling addiction is more prevalent among specific
groups and each community has its own sense of culture, the diversity within local
communities must be examined before creating plans for the implementation of the problem
gambling prevention plan.
Culture is defined as "a body of learned
beliefs, traditions, principles and guides for behavior that are commonly shared among
members of a particular group. Culture serves as a road map for both perceiving and
interacting with the world." (Advocates for Youth, 1994). Indiana must use the
culture of its state - such as demographic make-up, attitudes, opinions, and beliefs of
various racial, cultural, and socioeconomic groups - to guide the planning of cultural
competent prevention programming.
Research has indicated that problem gamblers share
certain characteristics. It is likely that they are male, are under the age of 30, earn a
low income and have co-occurring psychological difficulties. Prevalence rates are higher
among non-Caucasians as well. (Shaffer, Hall and Vander Bilt, 1997). Not only does
prevention programming need to target these groups, but also it needs to be based on a
comprehensive understanding of what influences their health behavior and help-seeking
behavior.
Cultural Competence moves beyond the concepts of
"cultural awareness" (knowledge about a particular group primarily gained
through reading and studies) and "cultural sensitivity" (knowledge as well as
some level of experience with a group other than ones own). Instead, cultural
competence is achieved through a long-term process that requires some level of skill
development to occur. In other words, achieving cultural competence can be seen as a
process rather than a goal. Culturally competent individuals have a mixture of
beliefs/attitudes, knowledge and skills that help them establish trust and communicate
with others (Advocates for Youth, 1994).
Advocates for Youth propose a four-step model of
building Cultural Competence for working effectively and respectfully with youth from a
variety of backgrounds. The following excerpts have been taken from Advocates for Youth, A
Youth Leaders Guide to Building Cultural Competence, p. 4-6, with slight
modification. The four steps are:
- learning about culture and important cultural
components,
- learning about ones own culture through a
process of self-assessment that includes examining ones cultures assumptions
and values and ones perspectives on them
- learning about the individual young people within the
program and
- learning as much as possible about important aspects
of participants cultural backgrounds with a focus on health beliefs and decision-making
behaviors.
Beliefs/Attitudes - The culturally
competent individual is:
- aware of and sensitive to his/her own cultural
heritage and respects and values different heritages,
- aware of her/his own values and biases and how they
may affect perception of other cultures,
- comfortable with differences that exist between
her/his culture and other cultures values and beliefs and
- sensitive to circumstances (personal biases, ethnic
identity, political influence, etc.) that may require seeking assistance from a member of
a different culture when interacting with another member of that culture.
Knowledge - The
culturally competent individual must:
- must have good understanding of the power structure
in society and how non-dominant groups are treated,
- acquire specific knowledge and information about the
particular group(s) she/he is working with and
- be aware of institutional barriers that prevent
members of disadvantaged groups from using organizational and societal resources.
Skills - The culturally competent
individual can:
- generate a wide variety of verbal and nonverbal
responses when dealing with difference,
- send and receive both verbal and nonverbal messages
(body language) accurately and appropriately and
- intervene appropriately and advocate on behalf of
people from different cultures backgrounds.
Community-wide Approach to Implementing a Prevention Plan
Even though the Family and Social
Services Administration is planning a statewide approach to problem gambling in Indiana,
each local community will need to be assessed for risk and protective factors. Plans must
be made to address the identified problems of priority specific to each local community.
Engaging support at the state level for prevention planning, as in this case, can only
strengthen the efforts of local communities.
Certainly, in the field of gambling, there are
diverse ranges of the problems across the state, depending on factors such as poverty,
availability or access to gambling, community norms, etc. Research suggests that
prevention strategies with a community-wide approach are more likely to result in
long-lasting changes by impacting community norms, values and policies as well as
developing a broad base of support and collaboration ensuring that no single organization
carries the burden of responsibility (DRP, 1997).
According to Catalano and Hawkins (Communities
That Care), community-wide prevention approaches are likely to produce the
following outcomes:
- Reduced costs for intervention and treatment.
- More effective use of resources through collaborative
planning and program implementation.
- A more integrated support network for young people
and their families, resulting in fewer young people "falling through the
cracks".
Catalano and Hawkins Communities That
Care offers a process for mobilizing a community to implement risk-focused
prevention.
Define your community through an
understanding of the geographic boundaries and the diverse make-up of the people who live
there. Diversity needs to be thought of in terms that go beyond racial diversity to
include class, religious and political backgrounds, as well as health belief systems and
differences in help-seeking behavior.
Involve key leaders in your community. These
influential individuals should represent the schools, government, law enforcement
agencies, social services, business, religious and cultural groups within your community.
Involving key leaders is essential to the success of the implementation phase of the
prevention plan. They have the status, position and authority in their communities to
launch a prevention project of this magnitude. Their involvement will not only provide
credibility but also will access resources and remove barriers supporting prevention. Key
leaders may be asked to sit on a community prevention board or may assist in the
recruitment process of members. In some instances, they may appoint an appropriate
individual to represent them.
Create a community-wide prevention board.
This group should be made up of diverse and concerned community members representing all
the significant areas affecting young people: educators, government officials, law
enforcement, juvenile justice personnel, social service providers, parents, religious and
cultural leaders, business people and young people. This prevention team or community
board is different from a statewide Ad Hoc Committee or Advisory Group which has been
formed to oversee the process of developing prevention strategies on a statewide level.
This local prevention team is a working group for the implementation of risk-focused
prevention within a local community (See Community-Wide Prevention Board Member Job
Description in Appendix).
Assessing community readiness is perhaps the
most important step before mobilizing a community to implement a problem gambling
prevention plan. Before introducing a prevention plan into a community, board members need
to identify the organizations and people likely to support or hinder efforts to
institutionalize risk-focused prevention.
Since the first step to addressing a problem is to
acknowledge it, it is crucial to assess whether major groups within a community are aware
of problem gambling behavior. Do they regard this as a problem for adolescents in their
community? It is also important to determine a particular groups view of prevention.
Do they see prevention as one of the solutions to problem gambling? Finally, a community
must look at its history to determine its ability to work together through establishing
collaborative relationship in the pursuit of a solution. (See Assessing Community
Readiness Questionnaire in Appendix 2)
Every community will have building blocks and
stumbling blocks among the major constituencies in each of these areas. The above process
will help to build upon the strengths in each community and minimize the challenges. The
statewide Ad Hoc Committee that has been established through the Family and Social
Services Administration can serve as a support network for local initiatives to implement
a problem gambling prevention plan.
Identification of Specific Prevention Activities
As discussed earlier, the CSAP
literature strongly recommends the use of activities aimed at the individual, family,
school, community and workplace levels. The tables on the following pages present the
types of activities that may be considered within communities across the state.
DOMAIN: INDIVIDUAL/PEER
Strategy |
Possible Interventions
|
Education
K 6th grades
(Implement through public and private schools) |
Teacher training in age appropriate information about consequences
Implement curriculum on probability information (Harvards
"Facing the Odds" curriculum; Minnesotas "Improving Your Odds"
curriculum)
Introduce at 3rd and 4th grade
Schedule "booster sessions" for all knowledge /
information curricula
After-school programs to enhance academic performance
School-sponsored parental education, family management skills
enhancement
|
Education School Age Youth
6th-12th |
Classroom / peer led curriculum specific compulsive
gambling issues- gambling, financial management, addictions, probability (North American
Training Institutes "Wanna Bet?" Curriculum; Nova Scotias Department
of Healths "Drawing the Line." Curriculum)
Life Skills training
Social Skills- develop healthy friendships, effective communication
skills, overcome shyness
Resistance Skills
Increase awareness
Correct misconceptions
Active learning of refusal skills
Booster session at 7th grade
Self-Management Skills
Personal control
Independence
Self-mastery
Problem solving
Decision making
Critical thinking
Assertiveness Training
Coping mechanisms
Develop life skills training curricula to fit local profile
After-school programming to include gambling education information
Develop culturally competent programming
Peer / leader programs
Mentoring programs
After-school programs that include gambling education curriculum
Revise and replicate Minnesota "Improving Your Odds"
curriculum, including new title
|
Information
Dissemination |
School media type campaigns
PSAs to youth radio stations and popular youth programs on
television
Famous speakers at schools to speak
|
Alternatives |
Recreational activities focused on non-gaming,
non-addiction (would focus on recreation that is drug and alcohol free)
Youth / adult leadership activities
|
Problem
Identification and Referral |
Student assistance programs
Compulsive gambling family case study education program
Peer counseling
|
Community-Based
Process |
Community service programs
Community level PSAs
Alternative community recreational activities
|
DOMAIN: FAMILY
Strategy |
Possible Interventions |
Education |
Parent Education/parenting skills
training
Parent Education/family therapy
Parent Education/problem behavior identification
Task-oriented family education sessions combining
social skills training to improve family interaction
|
Information
Dissemination |
Provide information to PTAs about
problem gambling
|
Alternatives |
Recreational activities for families
focused on non-gaming, non-addiction
|
DOMAIN: SCHOOL
Strategy |
Possible Interventions
|
Education |
Curricula with negative effects of gambling
Curricula to support positive peer relationships
School-based support group and skills development class
Tutoring, peer tutoring, homework assistance programs
|
Information
Dissemination |
In school presentations
Website
|
Problem
Identification and Referral |
Student Assistant Programs
Train teachers and counselors to recognize signs of problem gambling
|
Community-Based
Process |
Creating supportive school communities to strengthen
bonding to school
|
DOMAIN: COMMUNITY
Strategy |
Possible
Interventions |
Education |
Education to alter perception of societal
norms/expectations
Media messages supporting problem gambling prevention
PSAs warning of dangers of excessive gambling and other risk taking
behaviors
Work with Indiana Public Television to create problem gambling
prevention programs
|
Information
Dissemination |
Develop pamphlets to be provided to targeted at risk
groups
Develop mass media campaign for community awareness for continuous,
on-going effort.
Create a community speakers bureau
|
Alternatives |
Community drop-in centers
Community service activities?
Community-wide activities with a non-gambling theme
|
Problem
Identification and Referral |
Employee Assistance Programs
Enhancement of referral resources
Resource directory to regional FSSA offices
Update gambling hotline on related gambling information and referral
sources
Enhance awareness of GA and GamAnon
|
Community-Based
Process |
Targeted enforcement against underage gambling
Establish minimum age requirement for bingo
|
VI. Planning Rationale and
Evaluation
In planning for system-wide prevention programming, it is
important to:
- Clearly identify the behaviors or circumstances that are the
target of change
- Examine the underlying rationale or assumptions driving the
need for change
- Select appropriate methods for targeting the change effort.
- Delineate the desired outcome of the change effort
- Determine how effectiveness of the change effort will be
measured
- Establish evaluative feedback mechanism to continuously revise
methods for optimal desired outcome.
It is easy enough to identify situations or behaviors that
need to be changed, but for change efforts to be effective, the parties involved in
effecting the change must have some common beliefs about the nature of the problem and the
reason it must be changed.
The entire issue of gambling, gambling behaviors and the
societal impact of gambling, both short and long term, evoke such a multitude of emotions
and responses from the community that the prevention planning process is critical to use
in developing a system to prevent problem gambling. One reason that such a process must be
followed is because of the diverse views on the effects of gambling and the questions
raised concerning appropriate social policy response and regulation.
If the specific issue of gambling can be placed into a larger
societal context, support for prevention and treatment efforts may be more forthcoming.
Gambling is not the real social problem. Pathological gambling is simply an indication of
a bigger social problem. The real social issue to consider is the unhealthy person
who becomes a problem gambler and the havoc that this person creates in communities across
the nation. The "havoc" may be seen in financial outcomes, family dissolution,
marital strain, poor job performance, absenteeism, psychological problems, suicide,
bankruptcies, criminal behavior, substance abuse and potential violence. To a large
extent, the social issue becomes individual addiction, its effects and the eventual
outcome for society.
When placed in this type of context, the point of prevention
is clear. Prevention efforts should be directed to prevention of the development of the
unhealthy characteristics, beliefs and values that propel a person into addictive
behavior, whether it is gambling, drinking or drugs. This type of prevention addresses
long term individual and societal change. It is primary prevention and it focuses on the
development of programs and services that ensure a person is healthy enough to avoid
problem gambling behavioral development.
Secondary prevention efforts may be aimed at preventing the
further development of a problem. Secondary prevention efforts in the gambling arena may
be aimed at those persons whose behavior indicates they are on the pathway to developing
pathological gambling problems. Although limited, the literature indicates that many of
those behaviors or risk factors are well known and prevention outcomes would be aimed at
stopping the progression of the problem. Again, gambling in itself is not the problem;
rather it is the characteristics and circumstances of the person that lead them into the
problem behavior.
For primary prevention efforts to be effective, the community
standards, social policies and laws must support the development of healthy beliefs,
values and behaviors in childhood or the strengthening and reinforcement of these values
as a person progresses in life. Resiliency to problem behavior is especially important
when a person enters a "high risk" category or is moving through an unstable
transitional period in life (i.e. senior citizen status, college, unemployed, etc.)
Individual values and beliefs must be strong enough to maintain responsibility through the
natural stresses and pressures of life. Secondary prevention efforts attempt to intervene
with persons who are already showing unhealthy behaviors and who are in a "high
risk" category for developing unhealthy behaviors, i.e. senior citizens, neglected
children, school failure/drop-outs.
The Social Development Model focuses on the development of
resiliency to the stresses of life and this type of resiliency generally has to be learned
early in life for optimal effectiveness.
One of the significant findings from the Indiana school
survey was that an earlier age of onset was significantly related to progression into
pathological gambling behaviors. This finding is comparable to the substance abuse field,
where prior research has clearly shown that the earlier a youth begins to drink alcohol,
the greater the possibility that he/she will become a problem drinker. For these reasons,
underage gambling should be heavily discouraged and prevention planning should address
this goal.
Tertiary prevention efforts should also be considered in
planning so that the effects of pathological gambling can be reduced. Although these types
of efforts are aimed at the reduction of the pathological gambling problem within an
individual, the rationale for prevention efforts is different, relying on the treatment
community to ameliorate the individual disabilities resulting from the pathological
gambling behavior.
In system-wide or community planning initiatives, there are
rarely enough resources to comprehensively address all three levels of need. The community
need and the effects to be gained from multi-level intervention must be assessed and the
prevention strategies clearly prioritized to meet the defined need.
In summary, to facilitate an effective prevention planning
process, agreement on the problem, the rationale for change and the outcome expected from
change efforts must be clearly defined. The Indiana Problem Gambling Research Project as
the initial part of the planning process, has identified the baseline problem through
multiple data gathering methods and has conducted research to understand the rationale for
change in the state.
The FSSA has interacted with the research project team and
has provided continuous feedback on the direction in which the state wants to move in
regard to gambling prevention activities. An "ad hoc" committee was also
appointed to review the initial prevention plan. The desired outcome for problem gambling
prevention efforts has been obtained through focus groups, Indiana officials and
professional "ad hoc" committee members. Through this information base,
accountability and evaluative outcome is presented, followed by a discussion of the
primary prevention strategies and sample evaluative process and outcome measures.
Accountability and Evaluation in Prevention
Planning Efforts
Since Indiana is in the early stages of
problem gambling prevention planning, it is strongly recommended that an evaluative system
be established to document activities and measure the progress of the prevention and early
intervention efforts. Through a well-planned evaluation, the state can develop good
process evaluative procedures to demonstrate accountability with funds and resources.
Secondly, the FSSA can establish criteria for short and long term outcome data so that
programming effects can be consistently measured across the state. As funds are dispersed
to local communities to implement prevention programs, the FSSA will be in a good position
to require process and outcome data on individual programs as a part of the funding
requirements.
Specific process and outcome measures are
exemplified on pages 52 - 58 in the discussion on prevention strategy development. In
general, the process evaluation will document the activities that are undertaken as
prevention programs are established. Process data will provide information on the number
of activities, the participants involved, the actual tasks carried out, etc. This type of
information is critically important to a new prevention plan, as new knowledge is
consistently available to improve the manner in which prevention services are provided.
For example, what is the content of a particular school based curriculum? Is attendance at
one type of program better than at another type of program? Was a particular subgrant
program accountable for the services they provided? Were the services provided in the
manner in which they were proposed? Process data are a reliable way to demonstrate
accountability with funds.
Outcome data provide information on
the actual impact of a program. Did the program reduce problem gambling in the long run?
Were interim indicators of success present? Did a group of students or parents increase
their knowledge or change their attitudes after participating in a prevention program? Did
the program achieve the desired effect? Outcome data in prevention are not readily
available for many years, in most cases. If Indiana implements a statewide problem
gambling prevention program, is the prevalence or incidence of problem gambling reduced in
ten years?
Since outcome data take so long to reveal change,
interim indicators should be set up to measure progress towards the object of change.
The essential point for the state and FSSA to
consider is the opportunity that is being presented now to document expenditure of funds
and set up the structure for long term outcome of prevention programs for problem
gamblers.
The
common prevention strategies are presented below, with an identification of underlying
assumptions, sample programs, desired outcomes and sample outcome measures (Office of
Substance Abuse Prevention, 1991).
1. Raise awareness in the Community
Assumption: Members of the community
are not sufficiently aware of the problems associated with gambling in their
neighborhood. Such knowledge could then lead to new program initiatives, and greater
concern and monitoring of the activities of the community's children, friends or
neighbors.
Sample program: Targeted social marketing
campaigns, mass-media campaigns, community speaker's bureau, public service announcements.
Desired outcome: Education of
community, over time, a reduction in problem gambling activity.
Desired outcome: Increased knowledge of
the effects of problem gambling on their community.
Process
measures |
Outcome
measures |
Documentation
of activities Brief evaluation form for speaking
engagements |
Short
term Community attitude surveys to measure pre and
post effects of the social marketing campaign
Pre/post measures of increased knowledge for targeted population
Long term
Survey research to track problem gambling prevalence data to
show reduction in problem behavior |
2. Community Involvement Activities
Assumption: The more segments
of the community that are involved, the more successful prevention efforts will be.
Sample Program: Local Community Coalitions or
Prevention Teams are formed across the state to address local issues within their
communities.
Desired Outcomes: Increased community
knowledge and reduction in problem behavior.
Process measures |
Outcome
measures |
Documentation of activities conducted
Description of community involvement plan
Minutes from coalition meetings
Rosters of community membership to reflect diversity
Attendance data |
Short term
Pre/post testing of community sample
exposed to coalition activities
Qualitative surveys with coalition or prevention
team members or participants
Long term
Prevalence survey research; research on related
problems for example related crime, bankruptcies, qualitative or quantitative
survey of treatment professionals. |
3. Increase knowledge of teachers,
parents and students
Assumption #1: If adolescents
understood the dangers associated with excessive gambling they would not engage in the
behavior.
Assumption #2: If parents and teachers
have accurate information they can communicate this to students and if they understand the
signs and symptoms of problem gambling, they can identify it early and take steps to
prevent continued problem behavior.
Assumption #3: Research suggests
that adolescents are engaging in gambling activity with their parents.
Sample Programs: School-based programs
that include classroom/peer led curriculum specific to compulsive gambling issues, parent
and teacher training regarding problem behavior identification.
Desired Outcome: Increase in knowledge
of parents, teachers, and students regarding the dangers of excessive gambling.
Reduction in gambling behavior.
Note: These programs are
generally not effective if they are not part of a broader base prevention effort.
Process measures |
Outcome
measures |
Documentation
of school based program; Preparation
of school based program model for replication
Documentation of education curriculum
Training curriculums and
agendas
Description of youth participation/rosters |
Short
term Pre/post testing of parents or students on
increased knowledge
Focus groups with youth for qualitative outcome data
Long term
Prevalence survey data in schools with program
Prevalence research in community |
4. Change norms and
expectations surrounding gambling
Assumption: Youth that are
engaged in problem gambling behavior believe that this behavior is okay and will not have
negative effects on them. Change norms by promoting youth attitudes that are negative
toward problem gambling behavior.
Sample Programs: Peer led
curricula regarding dangers of problem gambling
School and community activities with
a non-gambling theme.
Desired Outcome: Create a culture that is
intolerant of problem gambling behavior and that promotes healthful behavior.
Process measures |
Outcome
measures |
Prevention program
curriculums Documentation/description
of school/community activities
Attendance/participation rosters |
Short term
Pre/post attitudinal school test
Pre/post group interviews
Key leader survey to assess norm/culture
Long term
Prevalence survey data in schools with programs
Prevalence research in community |
5. Enhance parenting and positive family influence
Assumption: Evidence exists that
youth who become involved in problem gambling behavior come from families where there is
poor discipline, poor supervision, and poor parent child communication. Strategy aims at
enhancing parenting skills including parent-child communication, organizational and
networking skills. Enhancing these skills will lead to increased parental involvement with
the child and more effective supervision and discipline.
Sample Programs: Parenting
skills training, task-oriented family education sessions combining social skills training
to improve family interaction.
Desired Outcomes: Reductions in
problem gambling behavior. Improved parenting skills, improved parent-child communication,
and more consistent and effective discipline practices. The creation of parent networks
and increase in parental awareness of the dangers of excessive gambling.
Process
measures |
Outcome measures |
Copy of
parenting program Attendance
rosters
Description of participants with related problem
identification |
Short term
Brief evaluation from participants
Satisfaction surveys
Pre/post testing of increased knowledge
Pre/post measure of interaction levels
Qualitative interviews with families
Long term
Prevalence data on problem gambling
Follow-up on families-interviews, related data tracking, i.e.
Arrests, marital status, etc. |
6. Enhance student skills
Assumption: Youth that become
involved in problem behavior have a difficult time resisting peer pressure, making good
decisions, and coping with the everyday social and interpersonal demands of their lives.
Sample Programs: School based
life skills training and social skills training including assertiveness, communication
skills, healthy friendships.
Desired Outcomes: Enhancement
of peer resistance skills, coping skills, and stress reduction skills.
Note: Need to focus
specifically on gambling or targeted behavior.
Process
measures |
Outcome
measures |
Copies
of curriculums Participant rosters |
Short
term Pre/post testing of knowledge/skills
Follow-up interview or data collection from school
Long term
Prevalence data at school with program compared to control
school with no program
Prevalence data on problem gambling
Participant follow-up for stress-related problems |
7. Increase involvement in school by parents and students
Assumption: Increased involvement in
non-gambling activities leaves little time for gambling-involved activities.
Assumption 2: Increasing parental involvement
in school and school functions contributes to the prevention of gambling problems by
involving parents in a setting that includes their children and their neighborhood
increasing a sense of community and cohesion.
Assumption 3: Parents are more likely to know
what is going on in their childs life and may be instrumental in encouraging
achievement of school goals.
Sample Programs: Opportunities for parents
and children to come together through school clubs, social activities, and other school
sponsored events
Desired Outcome 1: Increased student
attendance, participation rates, parent attendance and the reduction of absenteeism and
dropping out.
Desired Outcome 2: Satisfaction with school,
enhanced education aspirations,and improvements in school climate.
Process
measures |
Outcome
measures |
School
attendance records Participation records
Parental involvement documentation
Documentation of activities |
Short term
Pre/post measure of attendance and school progress by participants
Track incidence of dropouts
School satisfaction exit tests
Target school prevalence research
Long term
Comparison with control group school
School prevalence survey
Community prevalence rates
Follow-up with participant and younger siblings |
8. Increase involvement in healthy/legal alternatives
Assumption: Provides youth
with choices for other types of recreational activities than gambling activities.
Sample Programs: Recreational
activities focused on non-gaming, non-addiction. Youth/adult leadership activities.
Desired Outcomes: Increased
number of youth participation and activities initiated.
Measurement
Outcomes: Measure, document
Process
measures |
Outcome
measures |
Documentation
of recreational activities provided Copies of
leadership training curriculums |
Short
term Pre/post survey of youth
Qualitative interview with leadership groups
Focus groups to assess outcome
Long term
Prevalence research
Tracking of participants
Follow-up questionnaires to participants
Comparative study with other strategies |
9. Increase Support Services for students, teachers and parents
Assumption: With
additional support, youth may receive the help they need to resist gambling activities and
to cope with problems and pressures in more productive ways.
Assumption 2: Parent support
groups may help parents become more aware of the problems facing their community youth and
gives parents a forum to share ideas and solutions.
Assumption 3: Allows more
time for teachers to spend with students and gather student input making the school
experience more enjoyable thus decreasing drop outs.
Assumption 4: Support service
directories for parents and teachers so they can seek assistance before a gambling problem
becomes very serious.
Sample Programs: Peer
Counseling, student assistance programs, Parent and Teacher training to recognize the
early signs of problem gambling.
Desired Outcomes: Increased
sense of support and involvement, greater confidence in coping with problems, and
increased use of support services.
Process measures |
Outcome measures
|
Documentation of
programs Attendance rosters
Documentation of types of student problems
Training curriculums |
Short term Pre/post measure of related behaviors
Satisfaction surveys for services
Participant evaluative form for programs
Teacher surveys for increased identification, etc.
Records of early identification
Utilization rates
Long term
Prevalence research
Comparative research on service types
Analysis of outcome by type of service
and characteristics of participants
Incidence data collection |
10. Deterrence
through regulatory and legal action
Assumption:
If you make it more difficult to engage in under age or illegal gaming activities by
better enforcement of existing laws it will deter this behavior.
Assumption 2: To be used in conjunction with
other prevention techniques to reduce risks across populations.
Sample Programs: Enforcement of existing laws
regulating gambling. Monitoring of legislative activities to ensure knowledge of gambling
related policy level activities for example age of legalized gambling.
Desired Outcomes: Violations for those
that violate existing laws.
Process
measures |
Outcome
measures |
Document
policies/laws targeted and outcome Document efforts to
change/methods and type of support
Monitor enforcement with compliance checks
Describe legislative changes |
Short
term Immediate policy/law changes
Improved compliance check rating
Attitudinal surveys of legislators
Industry recording of illegal attempts over years
Long term
Compliance checks reveal minimal violation of laws
Industry report of minimal recording of attempts
Prevalence surveys to show reduction if problem behavior
Institutionalized legislative support for enforcement |
VII.& Recommended
Indiana Prevention Plan 1998-99
The 1998-99 interim statewide program gambling preention
plan has been developed to establish an infrastructure for comprehensive planning on a
long-term basis. The purpose of hte proposed plan is to ensure that prevention
begins across the state as the baseline data are compiled that more specifically define
the extent of the program in Indiana. The following plan is a possible strategy for
addressing the prevention needs that are known to exist across the state and that can be
accomplished at the current funding level. Once the interim plan is implemented, the
FSSA staff and the Ad Hoc Prevention Committee will assist local prevention teams to begin
athe process of establishing a long-range plan that will address anticipated problems
during the next five years. The recommended plan's activities include:
Activities |
Date of Completion |
Person Responsible |
I.
Establishment of a statewide structure and process to address problem and compulsive
gambling |
|
|
a.
Formalization of the existence and activities of the FSSA Ad Hoc Problem Gambling
Prevention Committee or Advisory Group will be established to provide statewide input into
gambling prevention and treatment needs. Additionally, the Committee will work with the
FSSA to establish a long-term problem gambling prevention plan as research further defines
the problem. This committee will ultimately provide support and guidance to local/regional
community prevention teams charged with adapting the plan to meet the needs of their
community. |
|
|
b. Formal designation
of one regional level FSSA staff person to be responsible for regional gambling prevention
and treatment activities. This person may be an interim assignment until a long-range plan
is in place. |
|
|
c. Develop a risk/protective factor
profile on each of the regions, ensuring that specific gambling related issues are
included. |
|
|
d. As other epidemiological data are
collected throughout the state, ensure that a section related to gambling behaviors and
risk factors is included. |
|
|
e. Establish university based research
component to conduct research, analyze results, develop effective programs, and work with
the Advisory Group and local regions to link prevention activities to empirically based
effectiveness models and strategies. |
|
|
II. Activate Initial Public Awareness
Strategies |
|
|
a. Develop regional and statewide
public awareness campaigns. |
|
|
b. Develop billboard campaign for use
across the state. |
|
|
c. Establish public media plan to
continually "get out the message" about the social impact of problem gambling. |
|
|
d. Develop a targeted social marketing
campaign demonstrating the benefits of not gambling. |
|
|
e. Segment target audiences and obtain
information regarding what motivates them and the media messages they respond to. |
|
|
f. Ensure stable and consistent access
to information through telephone directory listings and Toll-Free Telephone Referral Line. |
|
|
g. Ensure that compulsive gambling
prevention materials are in public libraries across the state. |
|
|
III. Primary Prevention Strategies |
|
|
a. Legislative/Policy Related -
Monitor legislative activities to ensure knowledge of gambling related policy level
activities, for example, age of legalized gambling.
Examine needed legislative change or policy related action that must be passed through
the legislature. Secure relationships with representatives and senators who have aided in
the addiction and/or problem gambling arena.
Identify and ensure legislative action needed for 1999 session.
Work closely with the Governors Gambling Impact Study Commission.
|
|
|
b. Conduct baseline research throughout state on prevalence of problem
gambling across age, gender, and geographic and cultural and high-risk populations.
Include data on related areas such as the relationship between homeless status and
gambling problem, suicide incidence, etc. |
|
|
c. Monitor enforcement of existing laws
regulating gambling, including lotteries, casinos, bingo, etc. |
|
|
d. Determine process for implementing
effective school based prevention programs, including education and awareness. School
based programs would include classroom strategies as well as working with parent groups. |
|
|
e. Work with universities student
health centers to provide responsible gambling education for students |
|
|
IV. Secondary Prevention Strategies |
|
|
a. Assess and intervene with high-risk
populations, including juvenile delinquency populations and older citizens. Lower criteria
for receiving treatment from pathological gambling to problem gambling. Problem gamblers
outnumber pathological gamblers six to one in Indiana. |
|
|
b. Develop programs or strategies to
impact the high-risk populations. |
|
|
c. Develop training program for
counselors who will deal with persons experiencing problem or compulsive gambling
behaviors. Contact licensing boards for training and information dissemination. |
|
|
d. Select one-two pilot sites for
school based program implementation and evaluation. |
|
|
e. Complete gambling resource directory
for use across the state. |
|
|
V. Community Mobilization Activities |
|
|
a. Enlist the participation of key
leaders with influence within local communities. Form a Key Leaders Group to assist in the
development of local or Regional Community Prevention Teams. |
|
|
b. Create Community Prevention Teams at
either the regional or local level. Provide training and orientation for members regarding
problem gambling behavior. |
|
|
c. Use Readiness Assessment
Questionnaire to assess communities readiness for implementing a problem gambling
prevention plan. |
|
|
d. Involve community groups who can
consistently mobilize their own community-wide membership, including:
faith community
corporate and business community
justice/legal community
school system
Council on Aging
Cultural Groups
|
|
|
e. Facilitate community efforts and
empower local communities to address specific problem gambling concerns. |
|
|
f. Link local efforts to existing
providers in the community to ensure community-wide support, including:
local court or correctional programs, e.g. drug courts
probation and parole regional offices
school corporations
social service/mental health providers
|
|
|
g. Work with Governors Commission
of Drug-Free Indiana for a working template or design for effective community organization
and local prevention initiatives. |
|
|
Prioritization of
Prevention Activities
Determining which activities can
produce the most effective outcomes is a difficult task, but generally necessary because
of limited resources. This case will probably be the same for Indiana as it is for most
other states that have struggled with the problem gambling issue. The selection of
strategies must be based upon the identification of the types of problems across the state
or community and the desired outcomes for the change effort.
Normally, the desired outcomes will be for both
short and long-term results. In other words, policy makers want to see an immediate
outcome in terms of problem reduction. However, in prevention programming, the effects of
the programs or interventions are not seen for many years when the effects of
community education or targeted school programming begins to, hopefully, show reductions
in the prevalence or incidence of the problem behavior. The aim of prevention programming
is to deter the development of some behavior or activity, so the outcome may not be
evident for 10-20 years, depending on the type of problem.
An example of prevention programming effects may be
seen in the tremendous campaign aimed at prevention of lung cancer. After 20 years, there
is finally a sign that adult behavior has changed, most likely as a result of the strong
educational messages that began when current adults were 10-12 years old or younger.
Unfortunately, the educational message has been less effective for todays teens as
there has been an increase in tobacco use among youth. Again, there is a massive
prevention plan underway. Indicators of successful intervention will be measured through
continuous school surveys, purchasing habits, compliance checks, etc. However, the desired
long-term effect will only be seen as illness related to using tobacco is decreasing.
The same is true for problem gambling behavior or
underage drinking. Tremendous prevention efforts may go into these two problem areas, but
it will be another generation before there is enough time passed to determine if underage
drinking has been curtailed.
However, there are numerous "interim"
indicators to show whether a prevention strategy is accountable and if it is demonstrating
some type of interim effect. In the gambling area, one indicator might be a decreasing
number of underage gamblers attempting to obtain entrance to casinos.
All of these issues must be considered when
selecting the strategies most important for immediate implementation.
Indiana officials have indicated that they are
interested in not only the sustained outcomes related to long term prevention of problem
gambling behavior, but they are also interested in accountability measures related to
prevention programming and the short term effect that can be expected from certain
strategies. At this point, the state may be interested in prioritizing programming that
will yield the "best bang for the buck".
Effective primary prevention is expensive in the
short term because it must be targeted and part of an overall prevention strategy. The
question is: "Is the output of funding now going to ensure less cost in the future
because of reduced problem gambling and its effects on society?" Unfortunately, there
is no firm answer to that question, but it is clear that prevention of problem and
pathological gambling behavior is much more cost efficient than dealing with the problem
once the effects are being seen. This does not mean that secondary prevention efforts
should receive less attention. For example, the treatment of problem gamblers now will
surely be more cost effective than allowing them to become pathological gamblers. In
reality, some balance of the competing issues must be achieved. In general, the long-term
decrease in problem or pathological gambling behaviors is the desirable outcome. However,
both primary and secondary efforts must be developed to achieve that goal.
Considering the various arguments that can be made
in support of one type of prevention effort over another, the recommended prioritization
of strategies is presented for consideration by the Indiana decisionmakers:
1. Primary prevention efforts with school-age
children
This is the recommended first priority because
of the elevated prevalence rates from the Indiana School Survey. Although the school
survey was limited in scope, its interpretation suggests that youth in Indiana are
involved in some type of gambling behavior at an early age and the prevalence rate for
probable problem gambling among Indiana youth is slightly higher than related prevalence
research.
This type of programming involves school-based
programs, including education, awareness, specialized curriculums, skills development,
student assistance programs, teacher training and education programs and parental
education and awareness programs. These programs must be targeted to a specific age group
and problem area. It is also suggested that school based programming be tailored to local
needs.
Programs addressing the school age population can be
provided somewhere other than schools.
Community centers, religious institutions, summer
recreational programs and housing community programs can all deliver effective primary
prevention with school-aged youth.
2. Secondary prevention activities targeting
adolescents>
Since this is the group that responded to the
current school survey, it is recommended that secondary prevention efforts begin with this
"high risk" category. Programs addressing this priority area include family
involvement and education, school-based programs, community programs and specialized
summer recreation alternatives.
Compliance checks by law enforcement of gambling
opportunities for adolescents to ensure that laws are being enforced and community action
to review and make any necessary changes to social policy are also critical parts of this
effort.
Community standards and practices must be consistent
in discouraging underage gambling.
3. Secondary and tertiary prevention efforts to
address immediate problems
There are a number of possibilities for good
short-term outcome in preventing the progression of problem gambling Indiana. For example,
secondary prevention initiatives are useful in lessening the social costs of a problem
behavior. Currently, a person must be a pathological gambler to receive treatment serves
through the DMH. Research indicates that problem gamblers outnumber pathological gambler
in Indiana six to one, demonstrating a need to intervene before a gambling problem meets
the diagnostic criteria for pathological gambling. In order to reach more individuals with
gambling problems, it is recommended that the DMH lower its criteria to receive treatment
to a problem gambling diagnosis instead of pathological gambling. Based on the ratio of
problem to pathological gamblers in Indiana, it is estimated that the DMH could reach 186
individuals, compared to the 31 people assisted in 1997.
These priorities are suggested because they
progressing address the population that is presenting the greatest danger to the state at
this time. However, Indiana should develop some type of site specific program in the next
several years to address "high risk" population issues, which may include
minorities, unemployed persons, lower socio-economic males, etc. FSSA and the treatment
community are advised to track the progression of pathological gambling problem
development so that the highest risk groups can be identified for specialized programming.
There will also be a good short-term benefit to
specialized training of treatment professionals to learn to recognize and treat those
persons with problem and pathological gambling behaviors.
However, community coalitions, citizen groups, etc.
are advised to establish legislative monitoring efforts to ensure that Indiana laws and
the enforcement of those laws are consistent with community standards and practices since
these efforts impact all levels of prevention.
Conclusions
It is important to reiterate the opportunity that
Indiana has to establish an effective problem gambling prevention program aimed at the
development and strengthening of healthy beliefs, values and standards that encourage
responsible behavior in all potential problem areas. Problem and pathological gambling can
be prevented through coordinated and empirically related community prevention programs.
Research increasingly indicates that prevention and treatment programs work and can be
accountable in outcome.
The array of persons and
agencies involved in the Indiana Problem Gambling Research Project has clearly indicated
an initiative to establish an effective program for the state. There seems to be a clear
commitment from the elected officials, the treatment and academic communities and the
gambling industry to work with the FSSA to develop an effective statewide initiative of
which the state can be proud.
The coordination efforts at the state and community level and the interest demonstrated
by the participants in the project clearly show that the ensuing prevention planning
effort will be effective and a positive experience for the state.
References
Advocates for Youth.
(1994). A youth leaders guide to building cultural competence.
Christiansen, E. M. (1997). The U.S. 1996 gross annual wager. International
Gaming & Wagering Business (Special Supplement).
Clotfelter, C. T., & Cook, P. J. (1989). Selling hope: State
lotteries in America. Cambridge, MA: Harvard University Press.
Custer, R., & Milt, H. When luck runs out: Help for
compulsive gamblers and their families. New York: Facts on File, Inc.
Developmental Research and Programs, Inc. (1993). Communities that
Care: Risk-focused prevention using the Social Development Strategy.
Dunne, J. A. (1985). Increasing public awareness of pathological
gambling behavior: A history of the National Council on Compulsive Gambling. Journal of
Gambling Behavior, 1(1), 8-16.
Frank, M. L., Lester, D., & Wexler, A. (1991). Suicidal behavior
among members of Gamblers Anonymous. Journal of Gambling Studies, 7, 249-254.
Gaboury, A., & Ladouceur, R. (1993). Evaluation of a prevention
program for pathological gambling among adolescents. Journal of Primary Prevention,
14(1), 21-28.
Haubrich-Casperson, J. (1993). Coping with Teen Gambling. New York:
Ro0sen Publishing Group, Inc.
Knapp, T. J., & Lech, B. C. (1987). Pathological gambling: A
review with recommendations. Advances in Behavior Research and Therapy, 9, 21-49.
Lesieur, H. R. (1993). Understanding compulsive gambling.
Center City, MN: Hazelden.
Lesieur, H. R., Blume, S. B. (1993). Pathological gambling, eating
disorders, and the psychoactive substance use disorders. Journal of Addictive Diseases,
12(3), 89-102.
Lesieur, H. R., & Rosenthal, R. J. (1991). Pathological
gambling: a review of the literature. Journal of Gambling Studies, 7, 5-39.
McQueen, P. A. (1996). North American lottery sales report. International
Gaming & Wagering Business, 17(10), 73-76.
Mrazek, P. J., and Haggerty, R. J., Es. (1994). Reducing risks
for Mental Disorders: Frontiers for Preventive Intervention Research. Washington,
D.C.: National Academy Press.
Norman, E., Turner, S., Zuzn, S., & Stillson, K. (1997).
Prevention programs reviewed: what works? In Elaine Norman (Ed.), Drug-Free Youth: A
Comendium for Prevention Specialists, (pp. 22-45). New York and London: Garland
Publishing.
Politzer, R. M., Morrow, J. S., & Leavey, R. (1985). Report on
the cost benefit/effectiveness of treatment at the Johns Hopkins Center for Pathological
Gambling. Journal of Gambling Behavior, 1, 131-142.
Ramirez, L. F., McCormick, R. A., Russo, A. M., & Taber, J. I. (1983). Patterns of
substance abuse in pathological gamblers undergoing treatment. Addictive Behavior, 8,
425-428.
Appendix I:
Prevention Programs
Few prevention programs exist that
address problem gambling behavior because of the newness of the field. However, five
programs discussed below have set a trend for problem gambling-based curricula aimed at
adolescents and older adults. These include: Drawing the Line: A Resource for the
Prevention of Problem Gambling, Volume I (Junior High); and Volume II (Senior
High); Improving Your Odds: A Curriculum about Winning, Losing, and
Staying out of Trouble with Gambling; Wanna Bet? Preventing Adolescent
Compulsive Gambling and Gambling Away the Golden Years. The following programs can be
adapted to meet the needs of adolescents and older adults in Indiana.
Drawing the Line: A Resource for the Prevention of Problem Gambling, Volume I
(Junior High)
This three-year prevention program was designed as a supplement to Nova Scotias
junior high course, Personal Development and Relationships (PDR), for students in
grades seven through nine. Five lessons are included in each grade level, beginning with
daily risk-taking and concluding with a detailed analysis of the stages of compulsive
gambling.
Grade sevens Drawing the Line program is entitled Life is a Gamble.
Gambling is presented within a larger context of daily risks. Youth learn to differentiate
between positive and negative risk taking and apply the skills of responsible risk-taking.
They also examine the relationship between risk-taking and self-esteem, and become aware
of how factors such as peers and excitement can influence gambling behavior.
Be a Winner is the title of grade eights prevention program. Social forces
that influence students gambling-related values and decisions are explored. Youth
also examine their own values and irrational beliefs regarding gambling, and learn that
being a "real winner" only results from self-acceptance and the realization that
gambling makes false promises.
Grade nines prevention program is entitled When Gambling Becomes a Problem.
Substance abuse prevention (to which gambling prevention principles are similar) is
stressed. Students learn how a gambling problem can develop and progress. A video
challenges youth to examine their own gambling behaviors and attitudes.
Methods used in lesson activities include: a) providing information necessary for value
development, b) aiding in the exploration of social and personal influences which
predispose students to compulsive gambling, c) maximizing student participation and
experiential exercises, and, d) providing tasks which develop personal and social skills
(e.g., problem-solving skills).
Youth participating in this program learn the skills needed to recognize the difference
between low-risk social gambling and high-risk compulsive gambling. It is hoped that
students who complete this three-year program will leave junior high more informed of how
to lead a healthy lifestyle and how to "draw the line" when gambling
opportunities arise.
Drawing the Line: A Resource for the Prevention of Problem Gambling, Volume II
(Senior High)
Drawing the Line for
Nova Scotian senior high students, a prevention program with lesson activity methods and
program goals identical to those of the junior high version, was developed as a supplement
to three high school courses. These include: Career and Life Management, Math
231/432, and Economics 331.
Three program lessons are incorporated into the Career and Life Management
(CALM): Self-Management course, which include: a) How does gambling become a
problem? b) Gambling as an addiction, and, c) Values. Youth explore their own values,
beliefs, and attitudes in regard to gambling, while becoming more conscious of the
consequences and risks of this activity. Youth who have completed this course will be
better prepared to make responsible decisions regarding their own gambling behaviors. Math
231 and 432: Probability also contain three program lessons which help students
realize that participation in gambling results in inevitable loss. Students calculate the
odds of winning three commercial gambling games, the roulette wheel, video gambling
machines, and the lottery. Through probability exercises and examples, students learn to
recognize types of irrational thought that deny the real odds. Through this use of math,
students challenge their own irrational thinking.
Two lessons are included in Economics 331: Gambling as an Industry, Industry
Profile, and Costs and Benefits. These aid youth in understanding the social context of
gambling better by examining political, economic, and social forces that affect
policy-making procedures. Through class exercises, students become better prepared to
function as informed consumers and decision makers in areas where gambling is a popular
form of amusement.
Improving Your Odds: A Curriculum about Winning, Losing, and Staying Out of Trouble
with Gambling
Improving Your Odds was designed to aid teachers and youth leaders in
helping youth living in Minnesota make choices about when, whether, and how much to
gamble. Although the program manual does not specify which age groups are targeted,
materials are to be incorporated into the regular classroom curriculum. This program can
be completed in four to ten hours, depending on the time spent on class discussion and
completion of activities.
This prevention programs curriculum, which is characteristically less
experiential and more instructive than both volumes of Drawing the Line: A Resource
for the Prevention of Problem Gambling, is divided into six sections. These
sections aid students in exploring the role of gambling in our society and in their own
lives. Youth learn about the risks and advantages of gambling and explore their own
attitudes, feelings and opinions regarding gambling. Program activities guide students in
developing values related to their own views on gambling. Topics such as how to identify a
gambling problem, how to confront someone who is gambling, and where to seek help, are
also addressed.
All sections of Improving Your Odds contain activities that are designed
to promote classroom sharing, mutual learning, and the development of a social support
system. Each section requires participation at least once. The activities in Section I-
Gambling in Minnesota emphasize the history of gambling in Minnesota, current gambling
activity in the state, and related problems. Section II- Gambling: Choices and Guidelines,
Part 1 and 2 help youth to ascertain personal guidelines about if, when, and how much to
gamble. Activities in Section III-Gambling Problems review types of gamblers and the
characteristics of pathological gambling. Section IV-What to Say, What to Do When
Some-ones Gambling Concerns You teaches students sound ways to confront a problem
gambler. Activities in Section V-Gambling Expansion in Minnesota allow students to
consider the positive and negative effects of expanding gambling opportunities. The
purpose of Section VI-Evaluation and Enrichment is for teachers, youth leaders, and
students to integrate information from other sections and evaluate whether learning
objectives have been achieved.
After completion of this program, it is hoped that students will be able to: a)
describe the history of gambling in Minnesota, b) describe the types of gambling available
in Minnesota, c) explain the impact of gambling in Minnesota, d) explain characteristics
and statistics of gambling and gambling problems in Minnesota, e) identify three societal
influences that encourage gambling, f) describe six types of gamblers, g) identify common
characteristics of problem gambling, h) establish and follow personal guidelines about
whether, when, and how much to gamble, i) share concern with a friend or family member who
is gambling in a high-risk way, j) list three helping resources for problem gamblers.
Wanna Bet? Preventing Adolescent
Compulsive Gambling
This brief gambling prevention program teaches middle school students in grades
five through eight how to think critically about gambling. Program curriculum, consisting
of three lessons, may be incorporated in health, math, social studies, English, or life
skills classes, or in combination with an existing prevention program. Youth evaluate
their own attitudes towards gambling by applying lessons learned through experiential
activities. Each lesson, which is supplemented by transparency materials, only takes 40
minutes to present and may be taught in blocks of one, two, or three days.
The first lesson of Wanna Bet?, Games of Chance, reviews
the concepts of probability and underage gambling, games of skill versus games of chance,
gambling addictions, and warning signs of adolescent gambling addictions. It also explores
how societal trends and family attitudes have influence on students views of
gambling.
The Power of the Win, in which students learn about the three phases of
compulsive gambling, is the title of Wanna Bets second lesson. A video
entitled "Andys Story" accompanies the class presentation so that students
can better understand how gambling can progress into compulsive behavior. This short video
specifically designed for teenagers is about an 18 year-old male athlete who develops an
unsatiated taste for blackjack. He and his family tell his story and answer questions
about his gambling problem, recovery, and experience in jail. A class discussion of
"Andys Story" follows.
The third lesson, Quit While Youre Ahead, challenges students to clarify
what they would do to resist invitations to gamble. Students prepare a set of refusal
responses and role-play them.
The goals of Wanna Bet? are to: a) dissuade underage gambling and enrich
critical thinking by: focusing on the realities of gambling and the increased risk for
teenagers, b) confirm that odds oppose the gambler, c) identify behaviors which lead to a
gambling addiction, and, d) stress that underage gambling is illegal in the United States
and results in serious consequences.
Gambling Away the Golden Years
The Gambling Away the Golden Years program was developed to prevent
the onset of compulsive gambling in senior citizen populations. Due to retirement and
other stressful life transitions occurring in midlife, (e.g., finding oneself in an
"empty nest"), gambling has heightened potential to become a high-risk hobby.
Materials used in this program include pamphlets and a short video entitled
"Gambling Away the Golden Years," which provide heartfelt stories told by
spouses and adult children of gamblers and gamblers themselves regarding the fear, loss,
pain, and shame related to compulsive gambling. These materials also examine gambling as
an addiction, review early warning signs of problem gambling, and list the three phases of
compulsive gambling. In addition, the necessary components for recovery and information
regarding where to seek help are presented.
Appendix 2:
Community Readiness Assessment Questionnaire
The following questionnaire will give you an opportunity to identify the prevention
building blocks and stumbling blocks for various groups within your community. To complete
this activity think of two groups in your community who are likely to have divergent views
on the issue of problem gambling prevention. Answer the questions from the point of view
of each of these different groups. Brainstorm a list of community stakeholders who could
assist in developing a positive plan for your community. Use this worksheet with other key
leaders or members of your team back in your community.
Awareness of the Problem
1. What problems do you think adolescents have in your community?
Substance Abuse Violence
Problem Gambling School Drop-out
Juvenile Delinquency Other: ____________________________________
Teen Pregnancy
2. What is the level of awareness in your community of adolescent problem behaviors
related to gambling?
Very aware Not aware at all
Somewhat aware Other: _________________________________________
3. What do you think are the views of key leaders within your community with regard
to adolescent problem behaviors?
4. What community groups are most affected by adolescent problem behaviors?
Families Government agencies
Schools Children
Service Providers Business and industry
Community organizations Other:___________________________________
5. Who are the stakeholders in the community who are likely to represent different
positions on the issue of problem gambling?
6. Who in the community could facilitate the development of a positive strategy
involving these different stakeholders?
View of Prevention
1. Does the group view prevention as one of the solutions to adolescent problem
behaviors? Yes No
How do they view prevention?
2. What other solutions have been tried? How were those efforts viewed?
3. Will key group leaders support or block prevention efforts.
Please give an explanation for your answer.
4. Will key institutions, businesses and social services in the community block or
support prevention efforts?
Please give an explanation for your answer.
5. Who are the stakeholders in the community who are likely to represent different
positions regarding prevention programming?
6. Who in the community could facilitate the development of a positive strategy
involving these different stakeholders?
Community Relationships
1. What challenges do you foresee for the implementation phase of a problem
gambling prevention plan?
2. Can problems be openly identified and discussed?
Yes No Sometimes
It depends on the problem.
Examples:
3. Is there a history of successful community change?
Yes No Sometimes
It depends on the problem.
Examples:
4. Are community leaders and citizens able to work together to identify community
problems and needs?
Yes No Sometimes
It depends on the problem.
Explain:
5. Do grass-roots groups work cooperatively with community leaders, and are they
involved in community decision-making?
Yes No Sometimes
It depends on the problem.
Explain:
6. What organization(s) and or people should be responsible for the implementation
of the Problem Gambling Prevention Plan? (Both management and funding.)
Appendix 3
Community Problem Gambling Prevention Team
Job Description
Title: Community Prevention Board or Team Member
Responsible to: Community Prevention Board Chairperson and Key Leaders
Group
Responsibilities:
- Participate in training to learn the risk factors for adolescent problem behaviors, the
Social Development Strategy for prevention and a process for planning based on a community
risk and resource assessment.
- Participate in training related to gambling opportunities and problem gambling behavior
in Indiana.
- With the Board, conduct a community risk and resource assessment, analyze results and
report to Key Leaders Group and the Family and Social Service Administration.
- With the Board, prioritize which risk factors need to be address within your community.
Develop plans based on suggestions in statewide prevention plan.
- Mobilize the community to implement the plan to reduce risk factors and increase
protective factors.
- Attend regular and special meetings of the board.
- Maintain records of meetings and activities in order to facilitate evaluation of this
strategy.
Qualifications:
- Must be appointed by Key Leaders Group.
- Adequate time to ensure effective participation.
Time Commitment:
- Board members must commit to a two-year term.
- Meetings will be on a monthly basis.
Benefits:
An opportunity to:
- Promote the welfare of young people in your community.
- Help Indiana be one of a few states with a comprehensive prevention plan to combat
problem gambling behavior among adolescents.
- Network with colleagues, community members, and young people.
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