The Pandemic’s Impact on Mental Health

Feb 23, 2022 | PROBLEM GAMBLING, RESEARCH

While the impact of the COVID-19 pandemic on mental health is undoubtedly significant, how traumatic has it been and how does it compare to other traumatic events? This was among the topics discussed in “Understanding and Addressing Post-Pandemic Trauma,” a presentation by Ken Roberts, chief clinical officer for NUWAY, at the Minnesota Conference on Problem Gambling in November.

The term “trauma” can apply to a broad range of experiences that impact each individual differently. However, there are well-established data patterns that offer useful learning applicable to current pandemic circumstances.

Two relatively recent community-based traumas include the Sept. 11 terrorist attacks in 2001 and Hurricane Katrina in 2005. These large-scale traumatic events were shown to have a significant negative impact on substance use disorder and mental health patterns. In both events, the trends identified at year one actually continued to increase for another two to three years, a pattern consistent for a range of community traumas. Data has shown there are similar outcomes from other events, such as wildfires and mass shootings.

The scope and duration of the pandemic suggests a long-term impact. Although there are some potentially positive signs for dissipation of the latest pandemic wave, it is an experience that has had a global impact for two years without a foreseeable definitive resolution.

Since the early months of 2020, we’ve been on a roller coaster ride that has included the promise of vaccine relief and lessening restrictions, all too rapidly undercut by new waves of variants. Both our personal and professional worlds have been turned upside down in what is likely to be a generational event. As we consider the potential long-term impact of the pandemic, we must recognize that versions of the individual challenges each of us have faced are occupying the consciousness of billions of people around the world.

It’s important to recognize the paradox of the pandemic trauma experience. On one hand, there are the common experiences we all relate to that have become the themes of our daily conversation. Yet, on the other hand, there are myriad unique and intensely personal stories often borne in silence and solitude.

Part of the enduring strain of the pandemic has been the uncertainly of its actual end, leading to chronic stress and erosion of even our most healthy coping strategies. This prolonged period of instability has set the stage for potential behavioral health service needs over the next several years that mirror the patterns of Sept. 11 and Katrina, but are almost incomprehensible in possible magnitude.

Notable increases in anxiety, depression, trauma/stressor disorders, substance use, self-harm, and overdose that have occurred since the pandemic began are all grim indicators reflecting the needs and deficits seen by mental health professionals. If we are unable to expand access and improve outcomes, we will continue to add many “deaths of despair” to our numerous COVID-19 fatalities.

Whether we are considering the traditional clinical trauma disorders or the new conceptualization of Pandemic Trauma and Stress Experience (PTSE), the individual experience is always the key consideration in considering subsequent effects and impact on functionality, as well as what trauma-focused interventions might be best for those individuals. Similarly, just as one person’s experience after a car crash might different from another’s, the same is true for how each of us is experiencing the current pandemic.

Thankfully, the majority of individuals who experience trauma events and effects also possess sufficient protective factors that allow for adaptions and resiliency to overcome traumatic circumstances through what is frequently termed a “natural recovery.” The concepts of enhancing protective factors and empowering resilience will be an important focus as mental health professionals consider trauma intervention strategies.

The American Psychoanalytic Association is seeking to distinguish between PTSE and Post Traumatic Stress Disorder (PTSD). Understanding the difference is important to both educating and normalizing clients while avoiding the potential stigma of unwarranted diagnosis and targeting effective interventions.

It’s also important for providers to cultivate resilience, altruism and creativity in ourselves, our teams and our agencies in order to best serve those in need.

In summary, our extended experience of the COVID-19 pandemic is currently and will continue to drive the need for co-occurring services. Understanding the additional layers of pandemic trauma and stress as a potentially new concern and an amplifier of existing conditions allows us to be strategic in conceptualizing and evolving client care while maintaining professional resiliency. These steps will drive the direction of our industry in years ahead.

Survey Suggests Gambling Participation Continues to Increase in U.S.

Feb 23, 2022 | PROBLEM GAMBLING, RESEARCH

Results from a new national survey of gambling attitudes and gambling experiences (NGAGE 2.0) indicate that Americans are gambling more than ever. The study, the second of its kind produced by the National Council on Problem Gambling, provides a glimpse into gambling activity in a time of rapid changes in the gambling landscape. The survey took place in April 2021 and included 2,000 Americans.

The 2021 survey attempted to address the following questions:

• Has the popularity of gambling changed?
• What types of gambling have become more or less popular?
• What’s the effect of restricting gambling or legalizing gambling?
• What has been the effect of the pandemic?
• How has legalizing sports betting affected gambling behavior?
• Are more people gambling online?
• Is there a relationship between risky investing and risky gambling?
• Who is at the highest risk for gambling problems?
• Does the public understand or stigmatize problem gambling?

Some of the key findings include:

• The number of people gambling on 11 or more activities during the past year nearly doubled since the first survey in 2018.
• Approximately 26 million more people bet online from 2018 to 2021.
• In the three-year period (2018-2021), there were approximately 15.3 million more sports bettors, 18 million more fantasy sports players and 25.5 million more online gamblers.
• While sports betting has increased, it does not appear to be because of legalization of sports gambling.
• Participation in fantasy sports did not differ between states where sports gambling is legal vs. where it is not.
• During the pandemic, more people have gambled less than have gambled more; however, those who gambled more during the pandemic are at higher risk for problem gambling than those who gambled less.
• The percentage of gamblers increasing play during the pandemic was highest in those under the age of 45.
• People in states where sports betting is legal are slightly more likely to gamble on sports more frequently than people in states where sports gamble is not legal.
• There was no difference in the types of sports bets — single bets on game outcomes, prop bets or parlay bets — made in states where sports gambling is legal vs. those where it is not. At this time, the concern that prop bets will grow rapidly is not founded in the survey.
• There is no evidence that legalization of sports betting has caused an increase in problem betting.
• There has been a decline in betting on football but growth in betting on more obscure sports, such as soccer, eSports and tennis.
• Gambling that has increased online include table games (blackjack, roulette, etc.), eSports, horse racing and bingo.
• Online gambling has increased most in the 18-24, 35-44 and 45-54 age groups. The growth is larger in men vs. women (though they are similar in percentage increase).
• Weekly traders gamble on many activities. They are also much more likely to answer yes to at least one of four problem gambling behaviors, suggesting that counselors should ask about investment behavior (as a possible risk factor) as much as gambling behavior.
• From 2018 to 2021, the percent of gamblers showing no problem behavior was much lower in younger people, while remaining the same in older people.
• Only approximately one in four young people (ages 18 to 34) say that gambling isn’t a good way to make money.
• Men are approximately 50% more likely to be problem gamblers than women.
• Sports gamblers are far more likely (approximately 13x more likely) to become problem gamblers than other gamblers. It’s not clear if that’s because sports gamblers tend to be younger or because they are sports bettors.
• Approximately one-third of gamblers bet on sports.
• Nearly a quarter of those surveyed feel people with a gambling problem are unlikely to get better or recover.

The WAGER: Pay to play too much?: Gambling and pay-to-win video games

Jan 10, 2022 | PROBLEM GAMBLING, RESEARCH

Read the original article on The BASIS website.

By Matthew Tom, PhD

Many video games provide players with opportunities to purchase in-game items after they’ve already started playing. If these items give players a better chance of advancing in the game or help players stay competitive in online matches against other players, then the game is called Pay-to-Win (P2W). Some researchers have noted parallels between P2W games and some forms of gambling. For example, both can tap into people’s competitive spirits, getting them to spend more than they might otherwise. In this last week of 2021, as millions try out the new toys and games they received as holiday gifts, The WAGER reviews a study by Fred Steinmetz and colleagues that explores possible links between purchasing in P2W games, problems controlling gambling, and between gambling participation and problems controlling P2W purchasing.

What was the research question?
Are there associations between aspects of pay-to-win purchases in video games and problems controlling gambling?

What did the researchers do?
The researchers acquired data from the German online panel of the e-GAMES (Electronic Gam(bl)ing: Multinational Empirical Surveys). Participants responded to survey items related to (1) demographics, (2) participation in various gambling games, (3) number of payments and (4) total amount paid in P2W game purchases, and (5) motivations for making P2W purchases. Participants also filled out a screener questionnaire that measures risks associated with gambling (the Problem Gambling Severity Index; PGSI) and an analogous screener for risks associated with P2W game purchases (the PGSI modified for Pay-to-Win gaming, yielding a “P2W risk score”). The researchers used data from the 700 participants who both gambled online and were P2W players. They used linear regression models to estimate the associations between gambling activity and P2W risk score, between P2W purchasing and PGSI score, and between P2W risk score and PGSI score.

What did they find?
Gambling by itself was not a risk factor for problems with P2W games. However, extreme levels of gambling were. More specifically, participation in any of the eight forms of gambling listed in the survey had no or very small associations with P2W risk scores (see Figure), but people who spent more money on gambling, and those who had relatively high PGSI scores, had higher P2W risk scores. The reverse was also true; higher P2W risk scores and more frequent P2W purchases both predicted higher PGSI scores. However, in contrast, spending more money on P2W purchases was linked to lower PGSI scores.

Figure. Gambling activities used in linear regressions to predict pay-to-win risk score in Steinmetz et al. (2021).

Why do these findings matter?
Simply participating in P2W gaming does not appear to increase the risk for gambling problems, or vice versa. However, excessively participating in one activity was linked with excessively participating in the other activity. There could be something connecting problems with one form of entertainment and problems with the other. For example, some P2W games contain gambling mechanics (e.g., loot boxes), so it is possible that these items are serving as substitutes for traditional gambling for some people. These findings suggest that those who experience problems with gambling should avoid getting deeply involved with P2W games, and that those who have had issues with P2W games should be careful around gambling.

Every study has limitations. What are the limitations in this study?
This survey was cross-sectional, so the researchers could not determine whether the problems with P2W games caused problems with gambling or vice versa. The screener for problems with P2W games has not been validated, so the risk score measured might not represent risk of harm accurately.

For more information: As publishers release new games, and add loot boxes and P2W mechanics to current games, fans and players with mathematical savvy post articles with their calculations of the utility (or lack thereof) of these items on forums such as Reddit. Much like with many forms of gambling, educating oneself about the games and how they function is one possible step towards preventing these games from creating problems in the future.

If you think you might have trouble controlling your video gaming (or gambling), resources are available for gaming and for gambling. Additional resources, including gambling and self-help tools, can be found on our Addiction Resources page.

— Matthew Tom, PhD