Gaming disorder (GD) is characterized by impaired control over playing video games and a continuation or escalation of gaming despite negative consequences. Screening, brief intervention, and referral to treatment (SBIRT) is a popular approach for quickly identifying and addressing substance use disorders, and it may also be beneficial for gaming problems. This week, The WAGER reviews a study by Jennifer J. Park and colleagues that examined clinician attitudes toward and approaches to screening, treatment, and referral for GD in addiction and youth service settings.
What were the research questions?
What are clinician attitudes toward screening for GD in addiction and youth service settings? Which behavioral change techniques would clinicians use to treat GD, and how confident are clinicians in using each technique?
What did the researchers do?
The researchers surveyed 88 experienced clinicians (e.g., counselors, psychologists, social workers) who provide SBIRT to adolescents or adults from 35 gambling, substance use disorder, and youth service programs across New Zealand. They reported their average monthly caseload of clients with GD and completed questionnaires that assessed their attitudes toward screening for GD and the actions they would take if GD was detected in a client. Participants also reported the types of behavioral change techniques1 they would use to treat GD and their level of confidence with each technique. The researchers calculated frequencies, averages, and percentages for the survey items.
What did they find?
Most clinicians had at least one consultation in the past year with someone with gaming-related problems (84.1%) and reported a mean monthly caseload of 4.1 individuals experiencing gaming problems. The majority of clinicians felt somewhat comfortable or very comfortable with screening for GD. Barriers to screening included lack of clinician awareness of available screening tools and the perception that people accessing services would not want to be screened for GD (see Figure). Nearly one-fifth of participants felt that screening and referral for GD is not a part of their job.
Figure. Clinician attitudes toward screening for GD in addiction and youth service programs, with the percentage of clinicians (n = 88) who agreed/strongly agreed, felt neutral, or disagreed/strongly disagreed with each statement. Click image to enlarge.
Most clinicians agreed that if a client disclosed a gaming problem they would administer a screen, conduct further assessment, or help address immediate gaming-related harms. About one-third of clinicians indicated they often or always refer the client to another agency. Clinicians reported they generally felt confident in delivering behavioral change techniques, including motivational interviewing, relapse prevention, problem-solving, and skill-building. They felt less confident in using behavioral change techniques that require gaming-specific knowledge, such as exposure therapy, social comparison, and imaginal desensitization. Finally, 58% of clinicians had attended a general information session about GD, yet few reported receiving training on screening or treatment for GD.
Why do these findings matter?
This study found that clinicians in addiction and youth service settings were largely supportive of providing SBIRT for gaming-related problems, but that challenges and barriers exist. Challenges, including lack of awareness of appropriate screening tools and low-to-moderate confidence in applying treatment techniques that require gaming-specific knowledge, might be addressed through training. Clinicians might benefit from increased education around gaming, such as the 15-hour Foundations in Gaming Disorder course. The low referral rate to external treatment or support potentially reflects the absence of referral pathways and specialized gaming treatment options in New Zealand. This finding points to the need for a comprehensive healthcare approach to support individuals with gaming-related problems.
Every study has limitations. What are the limitations of this study?
The actual prevalence of gaming-related problems in addiction and youth services cannot be determined from this study because this study only included clinicians who had provided care to at least one individual with an internet-enabled addiction. Findings from this study might not be generalizable to other types of clinical settings (e.g., primary care) and geographic locations outside of New Zealand.
For more information:
Do you think you or someone you know has a problem with gaming? Visit this webpage hosted by the Evergreen Council on Problem Gambling for treatment and support services for gaming disorder and internet addiction.
MNAPG’s outreach efforts continue in full swing. Sonja Mertz, our community educator, went through training to become a certified prevention professional. This will allow for access to prevention resources and continued involvement in prevention training.
The fall season was packed with conference and training opportunities. MNAPG hosted exhibit tables at a co-occurring disorder conference, the Addiction and Faith conference, Program Sharing conference (hosted by the Minnesota Prevention Resource Center), MARRCH (Minnesota Association of Resources for Recovery and Chemical Health) conference, Minnesota Corrections Association conference in Nisswa, Evergreen Family Services conference in Bemidji, recovery seminar at Metro State University, National Alliance on Mental Illness conference, Allied Charities convention and the Association of Minnesota Counties conference.
Sonja also had the opportunity to provide presentations at the Evergreen Conference (family and youth services) and the Allied Charities Convention (charitable gambling managers). Both audiences seemed particularly interested in youth gambling and how gaming and sports betting are impacting the gambling behavior of young people.
If you’d like to have Sonja speak to a group about gambling addiction prevention, please call (612) 424-8595.
When you find yourself up at 2 a.m. betting on Chinese league basketball games, something you know nothing about, you have to realize that maybe you’ve got a gambling problem.
My relationship with gambling started when I was young. I remember playing cards with my uncle when I was nine or ten years old. At that time, poker was all over television, with ESPN broadcasting various poker tours. I found a website where I could play online for practice, and I spent many hours doing that.
By the time I was 14, I was staying up until four or five in the morning playing poker with my parent’s credit cards. My gambling progressed, and when I moved out on my own, I thought that maybe I could gamble all the time.
But by the time I was 18, I ended up in Gamblers Anonymous (GA). It was at a church and there were only two people there. At the time, it didn’t feel like the place for me. I had a full college scholarship for chess and figured I’d grow out of gambling. Unfortunately, I only lasted three months in college, and when I lost my scholarship, I lost some of my identity. I continued to gamble and also found substances as a way to try to keep gambling away.
There was a lot of pain and suffering between age 19 and 25. Although I visited GA again in 2013, I was very stubborn and didn’t stick with it. I got sober when I was 25 but didn’t give up gambling. By that time my income was substantially higher and my bets were larger. I also got involved in illegal activities to sustain my gambling.
In 2021, I had a substantial win and thought that would change everything. But, of course, it didn’t. I found myself sick and tired of being sick and tired. This time, my involvement with GA feels different. I’m more committed, have sponsors, chair meetings and go every week. While treatment centers may work for some (I went to the Vanguard Center for Gambling Recovery in Granite Falls as well as to a gambling treatment center in Florida), I’ve found that GA works best for me.
It’s now been eight months since I gambled. I’m very happy now. I have a great job and great friends. I’m back together with my girlfriend, who has been through a lot with me.
As someone who got into heroin at one point, I can honestly say that the high from gambling was greater than that of heroin. It is the hardest of the addictions. It’s easier to lie
to think you can win something. With drugs and alcohol, you won’t win anything, but with gambling, you can trick yourself.
To those who are struggling with gambling and wondering what to do, I would say this. Nobody accidentally finds their way into a GA meeting. If you think you’re having an issue, you more than likely do. But there’s help out there. There are a lot of different meetings and a lot of people are willing to help you. The environment is very welcoming and nonjudgmental. I realize now that the age factor — my being younger than many in GA — was simply a copout.
But I do think there’s a need for more GA meetings focused on young people, particularly now there are likely more younger people gambling because of the easy access. It can be difficult when you look around and see that most of the other meeting attendees are older. For this reason, I’ve worked to create a “young persons” GA meeting. My hope is that it will help others like myself.
There has been increasing national attention on the recent push to legalize sports betting. (Minnesota has yet to pass a bill but look for action this legislative session.) However, another potentially lucrative expansion may be iGaming, defined as all forms of gambling games available through online apps. We were introduced to online gaming unknowingly through social casinos and “free-to-play” games on our phones. In a relatively short period of time (the iPhone came to market in 2007), gaming designers and gambling operators have exploited the tremendous opportunities to gain new customers and revenue through these relatively new venues.
At the Fall 2022 gathering of the Global Gaming Expo (G2E) in Las Vegas, a panel of gaming industry leaders discussed the opportunities afforded by legalizing iGaming. Currently, only six states allow iGaming: Pennsylvania, Michigan, Connecticut, New Jersey, West Virginia and Delaware. Leaders throughout the industry have asserted that the U.S. could gain $30 billion in annual revenue if iGaming were legalized in 42 states with commercial and/or tribal casinos and mobile sports betting. Some leaders expressed that iGaming would be quite competitive with commercial brick and mortar gambling. So, why aren’t more states jumping on this potential windfall?
Four reasons were cited by the panel.
1. Most states experienced a budget windfall due to COVID federal payments, reducing the need for additional revenue.
2. Lawmakers are concerned that adding iGaming will lower land-based revenue and cost jobs.
3. The risk that iGaming could lead to more gambling addiction.
4. iGaming doesn’t appear to have the same consumer interest as sports betting.
In addition to these four reasons, the panelists discussed the need for non-industry leaders to champion the cause. The tsunami-like approval by 35 states to legalize sports betting after the U.S. Supreme Court’s decision to overturn the ban in May 2018 was attributable in part to the number of consumers who were in favor of its passage. Currently, there doesn’t appear to be an equivalent level of enthusiasm for iGaming. In hindsight, the industry is thinking it may have moved too quickly to get sports betting through, when it should have paired the two in legislation, taking advantage of the pent-up demand for sports betting. Nor did it anticipate the level of federal COVID money going to the states, which has created at least a pause in lawmakers’ thinking about the benefits of expanding gambling again. Some lawmakers are considering that the expansion of slot machines and table games on a phone 24/7 may contribute to more gambling problems than sports betting.
(While it’s still early in the cycle and not a lot of data has been collected to measure the impacts of sports betting and iGaming, there are real concerns being raised about the level of advertising for sports betting and its influence over consumers, whether adequate consumer protections are in place in states that have passed sports betting and/or iGaming, and what states’ responses will be if addiction rates rise while minimal funds were set aside to address the issues.)
MNAPG will be watching this carefully and will continue to keep you informed of changes in the field.
The Minnesota Conference on Problem Gambling, produced by MNAPG, took place in mid-November. The theme was Connecting. Reflecting. Moving Forward. Assessing the state of problem gambling. Our conference featured counselors, researchers, an economist and individuals with lived experience.
In this issue of Northern Light, we’re highlighting two of our most powerful presentations, both from those with lived experience. Stories of recovery are always among the most popular sessions at our conference. While each of these stories is unique in terms of games of choice, length of addiction and recovery motivation, they also share common elements, such as greater self-awareness and a much-needed sense of peace.
Women’s Panel Discussion
The women’s panel discussion included four women of various ages and backgrounds detailing their experiences: three were gamblers in recovery and one was an affected family member. Each of the panelists were mothers and were motivated in their recovery to do better not just for themselves but for their children as well.
Among the perspectives shared was the need for there to be safe spaces for woman in recovery, particularly for women of color. Many incorrect assumptions are made about women gamblers and clinicians don’t typically pursue gambling behaviors with their female clients, not realizing that it can be a part of their addiction or mental health story.
Other takeaways from the presentation include:
o Women’s betting isn’t any different than men, though other aspects of their stories are different.
o It’s important to have women-only safe spaces for those whoe have experienced sexual traumas.
o Recovery is not one-size-fits-all, and finding spaces to meet their particular needs was vital to their recovery.
o In some instances, there was generational trauma/addiction, necessitating the need to have frank conversations to break the chain.
Several times throughout the presentation, the women expressed the desire for clinicians and researchers to pay more attention to women, to ask questions about gambling, and to dig deeper into the behavior. They felt that women have been long ignored and that diagnosing the gambling addiction didn’t come to light until each were far along in the addiction.
It takes tremendous courage to relate one’s story to an audience. MNAPG is so grateful to each of these women for agreeing to participate and sharing some of their insights and experiences.
Financial Risk Discussion
Chris Farrell of Minnesota Public Radio and Dan Trolaro of Epic Risk Management spoke about financial literacy and financial freedom and its relationship to gambling. Chris, who has a background in finance and investments, emphasized the importance of weighing risks. Dan, formerly a finance and investment trader, is a person in recovery who used gambling as a salve after experiencing first-hand trauma and tragedy from the World Trade Center attack. His gambling led him to embezzle millions and he ultimately served time for his crimes. Together, Chris and Dan offered a great dialogue about investing today, understanding the differences between risk – appropriate vs. inappropriate, and reframing the understanding of financial literacy.
The speakers emphasized that investing is not a bad thing, but stressed that if one is to do it, they need to understand the vehicles in which they are investing. Additionally, before any investing takes place, it’s important to have conversations with yourself and family as to what you want your money to do for you. Is it for retirement, college, family vacations or long-term health needs? It’s important to set goals and hold yourself accountable to those goals.
Chris talked about peer groups that come together with similar investing goals and values, holding each other accountable and supporting one another as they try to obtain those goals. There’s nothing wrong with putting some money into the market as long as you fully understand what you are putting at risk. Financial literacy is meant to inform you about the risks and to develop good habits; it’s not a tool to determine what to invest in. Establishing goals and holding particular values about money is key.
Financial literacy is about freedom, opportunity and risk, and creating a life that incorporates these three elements. We want people to make appropriate decisions by asking, “What does financial freedom look like to you?” “What do you want your money story to be?” “What are the appropriate risks to get you there?”
The question was raised as to whether people who are early in their recovery should invest at all. Dan said it was important in his early recovery not to invest. He feels a sustainable and meaningful long-term recovery must be a total transformation. Recovery is the path that leads to a whole new life where there isn’t room for gambling. It’s a wholesale change to the way one lives one’s life.
