Working Together: Responsible Gaming in Indian Country

Jana McKeag, president of Lowry Strategies and a national expert in Indian gaming issues, began this afternoon’s NCRG at G2E session by discussing public misconceptions about problem gambling at tribal casinos. McKeag said that many people assume that few tribal casinos have robust responsible gaming initiatives, and, she explained, these incorrect assumption are often used by gambling opponents to undermine tribal casinos. That is why, she said, tribal casinos must “take the next step” and begin pursuing responsible gaming efforts more aggressively.

McKeag added that the NCRG’s PEER (Partnership for Excellence in Education and Responsible Gaming) program can help tribal casinos take that next step. PEER provides casinos – both large and small – with a blueprint to develop and implement world-class responsible gaming programs. PEER, she said, was a particularly important tool for tribal casinos for two reasons: First, it provides them with a report card that quantifies their responsible gaming efforts, and second, PEER can be customized to meet the distinct needs of tribal casinos.

McKeag turned the presentation over to Dr. Kate Spilde Contreras, chair of the Sycuan Institute on Tribal Gaming at San Diego University, who has conducted research on responsible gaming efforts at tribal casinos in California. In her research, she learned that many tribal casinos wanted to implement responsible gaming programs at their facilities, but that there was a dearth of information available on how to do so. After completing her research, Spilde Contreras joined forces with the NCRG to connect tribal and commercial casinos with practical, easy-to-use responsible gaming resources.

Spilde Contreras then provided audience members with background on the NCRG. She said that the number of responsible gaming resources has grown considerably in recent years, thanks in large part to the NCRG. She added that casinos should approach responsible gaming as a corporate social responsibility initiative. As McKeag said, “responsible gaming helps maximize the benefits of gaming, while minimizing the potential harms.”

Contreras then introduced Jacob Coin, director of the office of public affairs for the San Manuel Band of Mission Indians, and his colleague, Diana Scina. Jacob told a story about his father, who returned home from World War II with severe alcohol problems. He said that similar issues, such as gambling addiction, are plaguing Indian communities. He added that it is the responsibility of tribal leaders to preserve the cultural, spiritual and social health of their communities. He said, “We are in the entertainment business, but there is nothing entertaining about seeing people lose their jobs, homes, or families because of their addictions.”

Scina then discussed the responsible gaming efforts in place at the San Manuel Indian Bingo and Casino. There, she said, they have placed responsible gaming posters throughout the facility. Also, they have trained all front-line employees on how to identify gamblers who may have problems. All management staff is trained to reach out to potential problem gamblers, and management also is prohibited from gambling at the facility. In addition, the San Manuel Indian Bingo and Casino has implemented a self-exclusion program and strict age restrictions for the entire facility, not just the gaming floor.

The panel then accepted questions from audience members, who asked about the specifics of the San Manuel Indian Bingo and Casino self-exclusion programs and marketing materials. Spilde Contreras briefly reviewed the PEER program and encouraged audience members to participate in a demonstration of the program at the conclusion of the breakout session. McKeag concluded the session by reiterating how helpful the PEER program can be for tribal casinos, calling it the “next wave” in responsible gaming.

Interview with Kate Spilde Contreras of San Diego State University

Click here for the NCRG Blog Team interview with Dr. Kate Spilde Contreras, chair of the Sycuan Institute on Tribal Gaming at San Diego State University, about her NCRG Conference experience. Spilde Contreras participated in this afternoon’s NCRG at G2E session, Working Together: Responsible Gaming in Indian Country.

Analyzing the Costs and Benefits of Gambling: Cultural, Historical and Economic Perspectives

In a packed room at the Las Vegas Convention Center this morning, session moderator Alan Feldman, senior vice president of public affairs at MGM MIRAGE, kicked off a much-anticipated discussion about the costs and benefits of gambling by asking the panel why exactly it is so difficult to measure the social and economic impacts of gambling.

Dr. William Eadington, professor of economics and director of the Institute for the Study of Gambling and Commercial Gaming at the University of Nevada, Reno, first reminded the audience that gambling is an inherently political industry because it already is the largest industry in the world created by political processes, a fact that shades the research in this area. Eadington added that another challenge lies in the fact that there simply isn’t much research in this field because there are only a handful of researchers studying the issue.

Dr. Douglas Walker, associate professor in economics at the College of Charleston, built on Eadington’s point about the political nature of this issue, explaining that, in some ways, it makes it difficult to have good, quality research. According to Walker, politicians and policymakers have a low threshold for the quality of the research, and it seems that so long as they have some statistics to cite to show that gambling is either good or bad, they don’t have a strong interest in the quality of that information. Eadington added that this phenomenon extends to the media. He credited our “sound bite” culture and the desire to provide an easy explanation of what is an extremely complicated issue with giving a larger platform to a number of unscientific cost-benefit estimates.

Feldman asked the panelists to describe what the costs and benefits of gambling are. Walker began by explaining that there is some disagreement of what constitutes a social cost – most economists consider a social cost to be a cost which requires society to allocate resources for something when they otherwise would have been used elsewhere. In the case of gambling, this would include costs for treatment of problem and pathological gamblers, regulation and supervision. He mentioned that there is disagreement in the field about whether the transfer of wealth associated with gambling is a social cost. Walker doesn’t believe it should be considered a cost, adding that one problem with research on this topic is that people say, “this sounds like it should be a cost,” and so they decide to include it.

Regarding the costs of pathological gambling, Dr. David Schwartz, director of the Center for Gaming Research, at University of Nevada, Las Vegas, explained that while it is possible to track the life and habits of one pathological gambler, it is difficult to abstract this number out to society as a whole. He suggested instead of a cost-benefit ratio, policymakers need to view gambling though the lens of a series of tradeoffs. He said that this is a much more honest and neutral way than a lot of the numbers that are out there, but that, unfortunately, given the nature of the news cycle, people prefer to have a quick and easy number.

Eadington noted that pathological gambling is an individual cost of gambling, but that economic research tends to regard individuals as rational and self-interested. He said that future research on this issue needs to marry issues economists bring to the table with more sensitive issues from psychiatry and other social sciences.

Walker added that the benefits of gambling are easier to measure. He said they usually are measured in employment, tax revenues, and the development within complimentary industries. Ha also added that the major benefit of gambling is that consumers enjoy it and are willing to pay money for it, so why not let people spend their money the way they want to? Despite the fact that this is perhaps the largest benefit of gambling, Walker said it is largely ignored in public policy debate around gambling.

Feldman then asked the panelists what their views are of the statistics that are often used to describe costs and benefits and whether there is any veracity to them. Eadington quickly rattled off three commonly cited statistics about the costs of gambling and explained that there is no evidence to justify any of them, but they have been widely disseminated because of our sound bite culture. He added that once bad statistics are out there, they tend to take on a life of their own.

According to Walker, the fact that the cost ranges are so wide and varied indicates that there’s something wrong with research in this area. He noted that, as of yet, no one has developed a good way to measure the costs. He used the example of the losses of pathological gamblers, explaining that a lot of the existing numbers on this issue are based on self-reporting; however, several scientific studies have shown that many of these people are unable to accurately calculate how much money they lose, so the numbers are almost completely arbitrary.

Feldman then asked the panelists what advice they would give to policymakers who are seeking to understand this issue. Eadington said that pathological gambling has risen to top of public policy debate, and that he believes policy in this arena is moving toward a way to separate people who have gambling problems from those who don’t and finding a way to prevent those with gambling problems from using the product. He mentioned examples of this type of approach currently used in Australia, Singapore and China, in which governments seem to be attempting to keep gambling from “getting too big.”

Walker recommended policymakers not rely on dollar estimates because the ones that exist are unreliable. He instead suggested policymakers focus on the general issues of what the likely costs and benefits are, instead of specific dollar amounts, and more fundamental issues of what role the government has in determining how people spend their money.

Schwartz said he believes it is not the government’s responsibility to decide how much we gamble, that instead policymakers should let the market decide. He said that government has a responsibility to regulate the product and make sure the industry is fairly and honestly run, but that when government tries to regulate the supply, that’s problematic.

Interview with Doug Walker of the College of Charleston

Click here for the NCRG Blog Team interview with Dr. Doug Walker, associate professor in economics at the College of Charleston. Walker participated in one of today’s NCRG at G2E sessions, Analyzing the Costs and Benefits of Gambling: Cultural, Historical and Economic Perspectives.

NCRG Conference: Day 3 At-a-Glance

The 9th annual NCRG Conference on Gambling and Addiction wraps up today at the Las Vegas Convention Center with its special NCRG at G2E sessions, produced in conjunction with Global Gaming Expo. Here’s a quick look at today’s schedule.

8 - 9 a.m. – The Verdict’s Still Out: Updates on Problem Gambling Regulations and Litigation
Moderator:
David Stewart, Of Counsel, Ropes & Gray, LLP
Speakers:
Connie Jones, Director of Responsible Gaming, International Game Technology
Richard A. LaBrie, Ed.D., Instructor in Psychiatry, Harvard Medical
School
Location:
Room N107

9:15 - 10:15 a.m. – Analyzing the Costs and Benefits of Gambling: Cultural, Historical and Economic Perspectives
Moderator:
Alan Feldman, Senior Vice President of Public Affairs, MGM MIRAGE
Speakers:
William Eadington, Ph.D., Professor of Economics and Director, Institute for the Study of Gambling and Commercial Gaming, University of Nevada, Reno
David Schwartz, Ph.D., Director, Center for Gaming Research, University of Nevada, Las Vegas
Douglas M. Walker, Ph.D., Associate Professor in Economics, Georgia College and State University
Location:
Room N107

10:30 - 11:30 a.m. – G2E Opening Day Keynote Address featuring award-winning journalist Ron Insana
Location:
Room N250

11:45 a.m. - 12:45 p.m. – Common Cause: How HR Departments and EAPs Address Gambling Disorders in the Workforce
Moderator:
Sue Cox, Board Member, NCRG
Speakers:
Robert Boswell, Senior Vice President, Pioneer Behavioral Health
Carl G. Braunlich, D.B.A., Associate Professor, William F. Harrah College of Hotel Administration, University of Nevada, Las Vegas
Susan McDaniel, Director of Human Resources, The Mirage
Location:
Room N107

2 - 3 p.m. – Working Together: Responsible Gaming in Indian Country
Moderator:
Jana McKeag, President, Lowry Strategies
Speakers:
Kate Spilde Contreras, Ph.D., Chair, Sycuan Institute on Tribal Gaming, San Diego State University
Jacob Coin, Director, Office of Public Affairs, San Manuel Band of Mission Indians
Location:
Room N102

3 p.m. – G2E Show Floor Tour (Pre-registration Required)

Seeking a Treatment Standard for Gambling Disorders: Are We There Yet?

According to Dr. Peter Nathan, professor emeritus of community and behavioral health at the University of Iowa, we’re getting there.

While no existing pharmacological (drug) or psychosocial (therapy) treatments for pathological gambling have yet met the usual standards that would establish them as empirically-supported, Nathan said there are treatments that show promise. Nathan asserted that, for empirically-supported treatments to be identified, the field must first complete well-designed, large-scale, multisite randomized-clinical-trial studies of treatments. But there are barriers. One particular that he noted was the fact that it is harder to get pathological gamblers to admit they have a problem, and therefore agree to participate in studies, than it is with other, similar groups, such as alcoholics – perhaps because of a lingering social stigma about gambling disorders.

In the last session of the day, which focused on evidence-based (i.e., empirically supported) treatments for pathological gambling, Nathan laid out several criteria for a treatment to be considered empirically-supported, including studies that have a randomized assignment of patients; compare the experimental treatment with an active comparison treatment, rather than a no-treatment control group; the use of multiple outcome measures; and appropriate treatment follow-up, so that the “staying power” of the experimental and comparison treatments can be evaluated. He also noted that the treatment itself must lead to significantly better outcomes for significantly more patients than comparison treatments, and that these findings must ultimately be replicated by more than a single team of investigators.

In his presentation, Nathan mentioned that “it is only human nature to assume that the treatments we have learned to deliver are the most useful,” and that “there is often a special place in our hearts for the treatments we learned in our early years in the field.” He encouraged his fellow clinicians, however, to familiarize themselves with and consider adopting treatments that have been systematically compared to others and shown their efficacy.

Nathan then led attendees through a detailed overview of the existing treatments used to treat pathological gambling, including psychosocial treatments – such as Cognitive Behavioral Therapy, Motivational Enhancement Therapy and Twelve-Step Facilitation Therapy – and pharmacological treatments – such as antidepressants, mood stabilizers and opioid antagonists. These forms of treatment have been the subjects of increasing study over the past several years, yet, Nathan explained that very few studies have examined the combination of drug and behavioral treatments. Similarly, there have been very few studies on the treatment of pathological gambling in conjunction with comorbid conditions, i.e., other disorders, such as drug- or alcohol-use disorders, that a pathological gambler also suffers from.

Following Nathan’s presentation, Dr. Lisa Najavits, professor of psychiatry at Boston University School of Medicine and president-elect of the American Psychological Association’s Division on Addictions, raised some broader themes that have arisen from psychotherapy research. One consistent finding, she noted, is that good manualized treatments (those administered based on a standard, written manual) will almost always be equal to each other, so she encouraged clinicians to find good treatments of this kind that fit them as clinicians while also fitting their clients’ needs.

Another consistent finding Najavits pointed out was that manual-based treatments almost always out-perform “treatment as usual” (i.e., when a clinician simply “makes it up on the spot”). She also mentioned that, while there has not been a considerable amount of literature on this point, existing research does seem to show that the assignment of a therapist is even more important than assignment to treatment type to patient success. Additionally, Najavits reminded the audience that the criteria for evidence-based treatments haven’t been standardized, which further complicates both identifying and implementing efficacious treatments.

In a question-and-answer session with the audience, the panel discussed the growing interest in the certification of therapists for pathological gambling. Nathan said that, in principle, certification makes a lot of sense. He noted that it has been helpful to the alcohol treatment industry because it sets a standard for people to aspire to. He also noted, however, that he did not think pathological gambling is in the same boat, citing the need for more data about empirically-supported treatments.

Najavits added that the problem with the vast majority of certification programs is that they measure knowledge, but they don’t measure the skills that are connected to outcomes. She recommended having a patient evaluation as part of a certification process, and to find other measures to evaluate – such as empathy and interaction with the client – until assessments that can actually measure the work clinicians do are developed.

Culture Counts: Designing Relevant Interventions and Responsible Gaming Strategies for Asians and Asian-Americans

Dr. Nolan Zane, professor of psychology and Asian-American studies at the University of California, Davis, kicked off the session with a discussion about the importance of cultural competency when establishing treatment plans. He outlined three types of cultural competency: cognitive competency, which includes academic knowledge; affective competency, which is the ability to understand unique difficulties that different cultural groups may experience; and role competence, which is a basic understanding of the way roles and behavior influence relationships in a culture. Role competence, he said, is the most difficult to learn.

Zane focused his presentation on cultural values in Asian communities and how they can affect the client-therapist relationship. The first issue he examined was face, which is defined as a person’s set of socially-sanctioned claims concerning his/her social character and integrity. Zane’s research has shown that face can affect self-disclosure among problem gamblers. During treatment, people concerned about face will exhibit certain behaviors, such as careful monitoring of conversations, self-restraint in expression or the use of respect, politeness and courtesy as protective maneuvers. In these situations, a clinician must provide a patient with avenues to save face.

Also, Zane found that East Asian cultures socialize people to handle emotions differently. Western cultures view emotional suppression as negative, but Eastern cultures view emotional suppression more positively. Therefore, since psychotherapy is often centered on catharsis, this approach may be in direct conflict with what Eastern cultures teach.

Chien-Chi Huang, Asian community program specialist for the Massachusetts Council on Compulsive Gambling, discussed the translation of the gambling self-help tool Your First Step to Change into three Asian languages (Mandarin, Khmer and Vietnamese) and the challenges inherent in developing problem gambling resources targeted at Asian communities.

During the translation process, researchers took care to ensure that the tone was gentile and nonjudgmental. During the adaptation process, researchers added new information about family involvement and problem gambling prevalence. Design of the booklets also was important, as each version used a design that was most meaningful to each community’s culture. A natural motif was used in all three to convey health and healing.

During the question and answer portion of the session, the panel was asked how clinicians encourage members of Asian communities to see a value in treatment. Zane said that treatment rates in Asian communities are low and recommended developing ways to help those who need it without having to actually see them face-to-face. Huang added that many Asians see gambling problems as a moral issue. She said that treatment providers should respond by telling problem gamblers that it is a serious health issue that should be addressed.

High-Tech Solutions for Assessment and Counseling: Web-Based Intervention Programs

Reid K. Hester, Ph.D., director of the research division at Behavior Therapy Associates, began his breakout session, High-Tech Solutions for Assessment and Counseling, by discussing the concept of self-motivation.

Hester said that a high percentage of people with impulse disorders – such as alcohol, drug or gambling addictions – will never seek professional treatment. He explained that many people, particularly those with less-severe impulse disorders, can recover from these conditions by self-correcting their behavior. Hester briefly reviewed research on the challenges and benefits of self-recovery for problem gamblers.

Through his work at Behavior Therapy Associates, Hester is finding ways to reach out to individuals working to recover naturally from alcohol-use disorders. He has developed several Web-based intervention programs for people trying to moderate their drinking. Hester focused today on Drinker’s Check-Up, a Web site that helps people with alcohol addiction understand their behaviors and decide whether to change them. The site provides users with confidential screenings, individualized feedback and motivational enhancement exercises. Since the psychology of pathological gambling and alcohol addiction are very similar, Hester explained, Drinker’s Check-Up can serve as a template for comparable programs for problem gamblers.

Hester recently conducted a clinical trial to determine the effectiveness of Drinker’s Check-Up, and he found that most users had positive experiences with the program. The average number of drinks consumed by Drinker’s Check-Up users decreased after they completed the program. Overall dependence on alcohol among users also decreased. Interestingly, Hester also found that drinkers who wish to change their behavior tended to do so immediately, rather than waiting to do so.

In testing the program, Hester learned several important lessons about creating Web-based intervention programs, which he shared during today’s session. First, he found that program participants were very nervous about enrolling; they tended to be afraid of what they might learn about themselves. He said it was important for an intervention Web site to have a nonjudgmental tone. He added that it was critical for a site to include simple, easy-to-understand language that would not intimidate users.

Hester also is involved with several other Web-based intervention programs, including College Drinker’s Check-Up Web site; SMART Recovery, a site that connects people to self-help programs; and Moderation Management, a site about the benefits and risks of drinking in moderation.

Inside the Virtual Casino: Betting Patterns of Online Gamblers

Dr. Sarah Nelson, instructor in psychiatry at Harvard Medical School, opened this afternoon’s session on online gambling by pointing out that the research being discussed in the session was notable because it is based on actual behavioral gambling data, rather than self-report data.

Nelson introduced Dr. Richard LaBrie, instructor in psychiatry at Harvard Medical School, who outlined the results of a longitudinal study of actual Internet casino gambling that used data collected through a collaboration with bwin International, an Internet gambling company based in Austria. The study was a follow-up to previous research that focused on the habits of Internet sports bettors.

In the Internet casino study, researchers studied the gambling behavior of 4,222 gamblers from 46 countries. The sample was 93 percent male; however, results showed that women made more bets per day, played more quickly and with a greater intensity.

The study found discontinuities between the gambling behavior of top 5 percent of the most-involved casino bettors, those who lost the most money, and the gambling behavior of the rest of the sample. This subgroup would be most likely to contain individuals who have gambling problems as defined by large losses, but it also would contain individuals who have a lot of money available to lose.

When the extreme 5 percent of subjects were compared to the rest of the sample, they were found to gamble longer, place more bets per day and place larger bets than the other 95 percent of the sample. Correlations among Internet casino gambling show that gamblers tend to be consistent in their day-to-day betting and that gamblers exhibit rational decision-making because their wagering tended to decrease as losses increased.

Dr. Debi LaPlante, instructor in psychiatry at Harvard Medical School, followed LaBrie with descriptions of two studies of responsible gaming efforts in the virtual world. These studies also utilized data from bwin and examined the effects of corporate deposit limits and self-limitation of deposits on online gamblers.

LaPlante explained that bwin subscribers who try to deposit more than the allowed amount receive a notification message that they are about to exceed the deposit limit, and bwin then rejects the deposit. Only 0.3 percent of the overall sample received at least one notification (exceeders). Exceeders were found to have the same number of active betting days as other gamblers, but their bets per day and the size of bets were higher than others. They were more likely to be members of the most involved bettors group, and while they lost more money overall, exceeders lost a smaller percentage of what they gambled. It was found that once exceeders were notified, they made fewer, larger bets, meaning that notifications did not stop them from betting, they merely changed the way they bet. According to LaPlante, this information illustrates an apparent need to rethink the use of notification systems as harm reduction devices for those at risk for excessive patterns of betting.

A study of the “self-limitation of deposits” option that bwin gives its subscribers found that 1.2 percent of the overall sample were “limiters.” Compared to those who did not self-limit their deposits, limiters were found to play a greater diversity of games, bet on more days, place more bets per day and wager less money per bet. The study found that after self-limitation, limiters generally moved toward fewer active betting days, fewer bets per day and smaller amounts wagered. LaPlante pointed out that since limiters were more active bettors than the rest of the sample, if self-limitation is a sign of disordered gambling, involvement might be as important to indicating gambling-related problems as expenditures.

LaPlante concluded by noting that the Internet provides unique opportunities for harm-reduction devices that might be executed with some degree of success; however, limiting resources are only helpful if people can access them easily and interventions can only work if messages reach the intended target.

During the question and answer period, an audience member asked if self-limitation could be viewed as a marker of a gambler’s intention to modify behavior and practice a greater level of self-control. Nelson replied that many people stopped gambling altogether after imposing limits and 7 percent of people set self-limitation before they placed a bet.

Outstanding Poster Award Presentation

Dr. Richard LaBrie of Harvard Medical School's Psychiatry Department presented this year's Outstanding Poster Award to a team from Jamaica including representatives from Hope Enterprises, Ltd. and RISE Life Management Services for their study entitled Jamaica Child and Adolescent Gambling Survey 2007. Team members included Deborah Bourne from Hope Enterprises Ltd. and Sonita Morin-Abrahams, Richard Henry, Fay Williams and Winston De La Haye from RISE Life Management Services.

Their study, which surveyed 2,299 Jamaican youth aged 10-19 years, found that 45 percent of youth had gambled at least once, and 30 percent had gambled within the last 12 months. It also found that male gender, age, the presence of a family member who gambles and an accepting attitude toward gambling were all significantly associated with gambling initiation.

This year 19 groups submitted posters with empirical research, 13 of which included members from countries outside the United States.

Grand Theft Childhood: Do Video Games Present Health Risks for Children?

Day two of the NCRG Conference on Gambling and Addiction kicked-off with the much-anticipated plenary session, Grand Theft Childhood: What Are the Health Risks of Video Gaming? The session’s featured speaker was Lawrence Kutner, Ph.D., co-director of The Harvard Center for Mental Health and Media, whose groundbreaking research on the health effects of video and computer games on children is featured in a new book, Grand Theft Childhood: The Surprising Truth About Violent Video Games and What Parents Can Do.

Kutner explained that, although pundits and politicians often blame violent video games for increased aggression in children, it is very difficult to measure such a relationship. In fact, Kutner argued, regular video and computer game play can impact children in both positive and negative ways. In his evaluation of 1,300 middle-school gamers and their parents, Kutner identified some unexpected trends that can inform parents’ decisions about what games to allow in their homes.

Not surprisingly, an overwhelming majority of children play video or computers games; very few do not. Boys typically play games more frequently (often several times a week), and they are more likely to play violent (Mature, i.e., M-rated) games. Perhaps alarmingly, 20 percent of boys and 11 percent of girls report playing with strangers over the Internet regularly. Fun, excitement and competition were among the most prominent reasons cited for playing video and computer games. Children also consider gaming a very social activity, and some children use games to regulate their emotions.

The data from Kutner’s study identified, for the first time ever, a tentative relationship between violent video games and behavioral problems. Children who play M-rated games are more likely to get into fights, start trouble at school, damage property and get poor grades. Kutner noted, however, that violent crime among children is down nationwide, and he argues that the correlation between violent games and misbehavior may be indirect. He added that, “other factors are likely at play.”

Conversely, Kutner listed several benefits for children who play video and computer games. Gaming appears to improve selective attention span, help children cope with stress and inspire new interests. Interestingly, Kutner noted that children diagnosed with attention deficit disorder (commonly referred to as ADD) can play video games for hours without losing interest.

After his presentation, Kutner answered audience questions, discussing the effects of text messaging on children, the risks of gaming alone and the potential physical health problems as a result of gaming too frequently. Kutner closed the session by discussing what he called a “tradition of moral outrage” about new media in the U.S. He said that, years ago, people worried about the potentially negative social consequences of comic books, movies and even paperback novels. Kutner said, “I worry about worrying too much,” and added that he believes that video and computer games, too, will eventually prove to be less risky than initially feared.

NCRG Conference: Day 2 At-a-Glance

The 9th annual NCRG Conference on Gambling and Addiction continues today with a full day of sessions. Here’s a quick look at today’s schedule.

Morning Plenary Sessions
8:15 - 9:30 a.m. – Grand Theft Childhood: What Are the Health Risks of Video Gaming?
Moderator:
Howard J. Shaffer, Ph.D. C.A.S., Associate Professor of Psychology in Psychiatry, Harvard Medical School
Speaker:
Lawrence Kutner, Ph.D., Co-Director, The Harvard Center for Mental Health and Media
Location:
South Seas Ballroom B

10 - 11:15 a.m. – Inside the Virtual Casino: The Betting Patterns of Online Gamblers
Moderator:
Sarah E. Nelson, Ph.D., Instructor in Psychiatry, Harvard Medical School
Speakers:
Richard A. LaBrie, Ed.D., Instructor in Psychiatry, Harvard Medical School
Debi A. LaPlante, Ph.D., Instructor in Psychiatry, Harvard Medical School
Location:
South Seas Ballroom B

Breakout Sessions – 11:30 a.m. - 12:30 p.m.
High-Tech Solutions for Assessment and Counseling
Moderator:
Lisa Najavits, Ph.D., Professor of Psychiatry, Boston University School of Medicine
Speaker:
Reid K. Hester, Ph.D., Director, Research Division, Behavior Therapy Associates
Location:
South Seas Ballroom B

Gambling Responsibly in Cyberspace
Moderator:
Glenn Christenson, Board Member, NCRG, and Managing Director, Velstand Investments, LLC
Speakers:
Bo Bernhard, Ph.D., Assistant Professor of Sociology, University of Nevada, Las Vegas
Sue Schneider, Founder, Interactive Gaming News
Location:
South Seas Ballroom H

Event
12:30 - 2 p.m. – Networking Luncheon and Poster Award Session
Location:
South Seas Ballroom E

Afternoon Plenary Sessions
2:15 - 3:45 p.m. – Culture Counts: Designing Relevant Interventions and Responsible Gaming Strategies for Asians and Asian-Americans
Moderator:
Kathy Scanlan, Executive Director, Massachusetts Council on Compulsive Gambling
Speakers:
Chien-Chi Huang, M.S., Asian Community Program Specialist, Massachusetts Council on Compulsive Gambling
Nolan Zane, Ph.D., Professor of Psychology and Asian-American Studies, University of California, Davis
Location:
South Seas Ballroom B

4 - 5:30 p.m. – Seeking a Treatment Standard for Gambling Disorders: Are We There Yet?
Moderator:
Harold Wynne, Ph.D., President, Wynne Resources
Speakers:
Lisa Najavits, Ph.D., Professor of Psychiatry, Boston University School of Medicine
Peter Nathan, Ph.D., Professor Emeritus of Community and Behavioral Health, University of Iowa
Location:
South Seas Ballroom B

Discussing the Benefits and Challenges of Gambling Self-Exclusion Programs

Sarah E. Nelson, Ph.D., instructor in psychiatry at Harvard Medical School, kicked off an insightful breakout session about gambling self-exclusion programs with a whimsical story excerpted from “Frog and Toad Together,” a book she often reads to her daughter. Nelson told the tale of two friends who rely on their power of will – sometimes unsuccessfully – to stop eating cookies. Nelson said that the story illustrated how unique and challenging gambling self-exclusion programs can be.

Nelson then reviewed the findings from a recent study on the efficacy of the Missouri Voluntary Exclusion Program conducted by the Division on Addictions at the Cambridge Health Alliance. The study, she said, confirmed that the program was largely a success. It found that the majority of gamblers who recently joined the program reported gambling less now. However, this outcome, the study found, was not solely attributable to self-administered casino bans. Many self-excluders also reported enrolling in disordered gambling treatment programs and making other efforts to become healthy.

Nelson also noted that the study identified several vulnerabilities in the Missouri Voluntary Exclusion Program, which could potentially inform the development of similar state-administered programs. For example, she said, “if enforcement is a priority, more stringent measures need to be in place” to prevent self-excluders from entering casinos. Many program participants reported being able to enter a casino without penalty after signing the self-exclusion agreement. Nelson added that program administrators should keep better records of program participants to facilitate research and increase program enforcement.

Nelson then turned the session over to Richard A. LaBrie, Ed.D., instructor in psychiatry at Harvard Medical School, to discuss other key findings from the study. LaBrie discussed how the study identified what appeared to be a sort of adaptation effect. He said that program enrollment, like the illness, demonstrated rapid acceleration in its early stages, but that it leveled off with time. He also discussed how, using simple math, the number of self-excluders can roughly determine the number of pathological gamblers in a given location.

Nelson, LaBrie and Jennifer Shatley, vice president of responsible gaming programs and compliance at Harrah’s Entertainment, Inc., then took questions from the audience. An engaging dialogue about the challenges of implementing and measuring the success of gambling self-exclusion programs followed. LaBrie discussed the long-term efficacy of the programs, wondering, “if you shelter someone from gambling-related harms, do you give them strength to resist them long-term?” The panelists also discussed how difficult it is to ensure that self-exclusion programs are enforced in different states.

Scientific Achievement Award Presentation

Dr. Marc Potenza, associate professor of psychiatry and director of the problem gambling clinic at Yale University, was named as the recipient of the 2008 NCRG Scientific Achievement Award today in the senior investigator category. Potenza is the first person to receive NCRG Scientific Achievement Awards in both the Young Investigator (2003) and Senior Investigator categories.

The award was presented by Dr. Peter Nathan, professor emeritus of community and behavioral health at the University of Iowa. The senior investigator award honors scientists whose career work has led to important advancements, discoveries or developments in the field of gambling-related research.

Potenza, who was selected by an independent awards committee, has made contributions to the study of gambling disorders in the areas of population studies, genetics, treatment outcome research and neuroscience. Among the many milestones of his career is his completion of the first two brain imaging studies conducted in this field.

Potenza’s initial groundbreaking brain imaging studies involving subjects with pathological gambling, published in 2003, showed differences in the brain activity of pathological gamblers compared with control subjects and laid the groundwork for future investigations of the neurobiological elements of pathological gambling. Potenza since has conducted research using brain imaging in clinical trials to help identify brain characteristics that may be able to predict whether or not a particular drug treatment will be successful for the patient. His current research also includes a brain-imaging study that has found similarities in the brain activity of pathological gamblers when they experience gambling urges to the brain activity of people with cocaine dependence when they experience cocaine cravings.

Potenza has conducted significant investigations into a biological basis for pathological gambling. This research has included a study into the relationship between pathological gambling and major depression in men, which has helped the scientific community to better identify the genetic and environmental factors that contribute to pathological gambling. In his roles as director of the Women and Addictive Disorders Core, Women’s Health Research at Yale and director of neuroimaging at the Mental Illness Research, Education and Clinical Center (MIRECC) in West Haven, Conn., Potenza has conducted a substantial amount of research into the differences between men and women with pathological gambling, as well as pathological gambling in the context of co-occurring disorders.

Potenza is internationally recognized for his research into drug treatments for pathological gambling and has investigated a series of possible drug therapy treatments, a subject he addressed in today’s conference session, Working with Clients on Medication Management for Gambling and Alcohol Use Disorders.

In addition to his research, Potenza regularly treats individuals with gambling problems and serves as an editorial board member for a number of peer-reviewed scientific journals including the Journal of Addiction Medicine and The American Journal on Addictions. He has authored more than 100 research and theoretical articles and has contributed to more than 40 books. Potenza earned his M.D. at Yale University School of Medicine and his Ph.D. in cell biology at Yale University.

Government Support for Addressing Gambling Disorders: Practice and Pitfalls

In this afternoon’s session on government support for addressing gambling disorders, attendees heard from representatives from Indiana, California and Nevada. While each state faces different challenges based on resources, and the geographic location and type of gaming facilities, there was unanimous consent among the panelists that perhaps the most significant challenge they face is a lack of properly trained and certified treatment providers.

Mike Smith, executive director of the Casino Association of Indiana, described how the state has recognized the clear need to build an infrastructure for treatment. According to Smith, this means both making sure there are treatment providers who have the proper training and certification, but also that these providers are located throughout the state so that individuals with gambling problems don’t have to travel a considerable distance to get help. Indiana also has used tax dollars collected from the state’s casinos to conduct research on disordered gambling, which is due out early next year. In addition, Smith mentioned that, due to the fact that Indiana’s casinos are located close to the state’s borders, the state is attempting to work with its neighboring states – Illinois and Kentucky – to find a way to help problem gamblers from these states who gamble in Indiana have access to the help they need.

Jodi Tyson, M.P.H., a social service program specialist in the Nevada Department of Health and Human Service’s Grants Management Unit, discussed Nevada’s Problem Gambling Revolving Account, which was established by state legislation in 2005. The Revolving Account, which is funded through a tax of approximately $2 on each slot machine in the state, is used to fund prevention, treatment, research and workforce development initiatives throughout the state. Tyson pointed out that treatment always was intended to be the primary focus of the Revolving Account’s funds, with 60 percent of the grant money distributed by the Revolving Account dedicated to treatment initiatives.

Alexandra Vuksich, commissioner of the California Gambling Control Commission, was the final panelist for the session. She explained how the complicated gambling landscape in California – which includes tribal gaming, horse-racing tracks, a lottery and card clubs – has led to unique challenges in addressing problem gambling issues. One example, said Vuksich, is tribal gaming compacts, which represent the state's only opportunity to negotiate regulatory matters with the tribes' sovreign governments. According to Vuksich, California's tribal gaming compacts, the first of which were signed in 1999, have gone from hardly mentioning problem gambling to having much more of a focus on the issue in more recent compacts. She also pointed to the economic challenges the state is facing; California is currently $11.2 billion in debt, which, she said, means the prospect for money coming out of the state’s general fund to support disordered gambling treatment is unlikely.

As a whole, the panel emphasized the fact that state support for addressing problem gambling is evolving. As the body of sound research on disordered gambling continues to grow, and more research is conducted at the state level, it continues to shape the way states address this issue.

Does the Diagnostic Definition of Pathological Gambling Need Revising? Debating DSM-V

To kick-off the opening plenary session of the 2008 NCRG Conference on Gambling and Addiction, NCRG Board Director Glenn Christenson welcomed nearly 350 attendees from across the globe and introduced this year’s conference theme, The Changing Landscape of Treatment, Responsible Gaming and Public Policy. Christenson took a moment to report the news of the recent passing of Dr. Rena Nora, a leader in the field of pathological gambling research, and dedicated the session – titled Debating DSM-V: Will New Research Change the Diagnosis of Pathological Gambling? – to her memory.

Linda B. Cottler, Ph.D., professor of epidemiology in psychiatry at the Washington University School of Medicine, began the session with a presentation on the history of the DSM – the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders – and its evolving definition of pathological gambling. She also discussed how new research developments could again reshape the definition of the disorder in the DSM-V, which will have profound implications for how pathological gambling is diagnosed and treated. The APA has assembled a Workgroup on Substance Use Disorders to prepare for the next installment of the manual, and Cottler encouraged conference attendees to contact the group to “let your voices be known and your concerns be heard.”

Dr. Thomas Widiger, Ph.D., professor of psychology at the University of Kentucky, discussed how the DSM-V would likely shift from the current categorical classifications of mental disorders toward dimensional classifications of mental disorders, which will better capture the range and intensity of problem behaviors attributed to different disorders. He added that there was no gold standard for diagnosing pathological gambling, explaining that DSM’s prototype of the disorder represents the most severe form of the condition. This, he said, can lead to a large number of sub-threshold cases and poor treatment options.

Dr. Howard J. Shaffer, Ph.D. C.A.S. associate professor of psychology in psychiatry at Harvard Medical School, said that one challenge facing clinicians and researchers was that few people understand the term “diagnosis” in the same way. Shaffer said that diagnosis means “understanding people through and through,” and said that the DSM was a tool for accomplishing that goal. He added that he felt “pathological gambling” was a pejorative term and should no longer be used.

A lively question and answer session with members of the audience followed, during which Cottler, Widiger and Shaffer offered their perspectives on dimensional classification, defining addiction, sharing information with others in the field and developing a flexible definition for pathological gambling that applies to a wide range of demographic groups. Shaffer closed the plenary session by saying that “pathological gambling research is still a young field. We have a long way to go, but we have already accomplished a great deal.”

Interview with Linda Cottler of the Washington University School of Medicine

Click here for the NCRG Blog Team interview with Dr. Linda Cottler, professor of epidemiology in psychiatry at the Washington University School of Medicine, about her NCRG Conference experience. Cottler participated in today’s opening plenary session.

Interview with Howard Shaffer of Harvard Medical School and the Division on Addictions

Click here for the NCRG Blog Team interview with Dr. Howard Shaffer, associate professor of psychology in the department of psychiatry at Harvard Medical School and director of the Division on Addictions at the Cambridge Health Alliance. Shaffer is one of the co-hosts of the 9th annual NCRG Conference on Gambling and Addiction and participated in today’s opening plenary session.

Interview with Glenn Christenson of the National Center for Responsible Gaming

Click here for the NCRG Blog Team interview with Glenn Christenson, board member of the National Center for Responsible Gaming and managing director of Velstand Investments, LLC, about his NCRG Conference experience. Christenson gave the opening welcome address today, and tomorrow will be moderating the Gambling Responsibly in Cyberspace panel.

NCRG Conference: Day 1 At-a-Glance

The 9th annual NCRG Conference on Gambling and Addiction kicks-off today at 1 p.m. Here’s a quick look at the sessions and special events taking place this afternoon.

1 - 1:15 p.m. – Welcome Address
Speaker:
Glenn C. Christenson, Board Member, National Center for Responsible Gaming, and Managing Director, Velstand Investments, LLC
Location:
South Seas Ballroom B

Plenary Session
1:15 - 3:15 p.m. – Debating DSM-V: Will New Research Change the Diagnosis of Pathological Gambling?
Moderator:
Brian McKay, Former Attorney General, State of Nevada
Speakers:
Linda B. Cottler, Ph.D., Professor of Epidemiology in Psychiatry, Washington University School of Medicine
Alan Feldman, Senior Vice President of Public Affairs, MGM MIRAGE
Howard J. Shaffer, Ph.D. C.A.S., Associate Professor of Psychology in Psychiatry, Harvard Medical School
Thomas Widiger, Ph.D., Professor of Psychology, University of Kentucky
Location:
South Seas Ballroom B

Breakout Sessions – 3:30 – 4:45 p.m.
How Addictions Develop and Addicted People Recover: Stages of Change and Addiction Revisited
Moderator:
Ken C. Winters, Ph.D., Professor of Psychiatry, University of Minnesota Medical School
Speaker:
Carlo C. DiClemente, Ph.D., A.B.P.P., Professor of Psychology, University of Maryland, Baltimore County
Location:
South Seas Ballroom B

Government Support for Addressing Gambling Disorders: Practice and Pitfalls
Moderator:
Gary Fisher, Ph.D., Professor, College of Health and Human Sciences, University of Nevada, Reno
Speakers:
Jodi Tyson, M.P.H., Social Services Program Specialist III, Grants Management Unit, Nevada Department of Health and Human Services
Mike Smith, Executive Director, Casino Association of Indiana
Alexandra Vuksich, Commissioner, California Gambling Control Commission
Location:
South Seas Ballroom H

Breakout Sessions – 5 – 6:15 p.m.
Working with Clients on Medication for Addictive and Psychiatric Disorders
Moderator:
Ken C. Winters, Ph.D., Professor of Psychiatry, University of Minnesota Medical School
Speaker:
Marc N. Potenza, M.D., Ph.D., Associate Professor of Psychiatry, Yale University School of Medicine
Location:
South Seas Ballroom B

Evaluating Self-Exclusion Programs: From Theory to Practice
Moderator:
Jennifer Shatley, Vice President, Responsible Gaming Programs and Compliance, Harrah’s Entertainment, Inc.
Speakers:
Richard A. LaBrie, Ed.D., Instructor in Psychiatry, Harvard Medical School
Sarah E. Nelson, Ph.D., Instructor in Psychiatry, Harvard Medical School
Location:
South Seas Ballroom H

6:15 - 7:30 p.m. – Poster Session and 2008 Scientific Achievement Award Presentation Reception
Location:
South Seas Ballroom E