Oregon Gambling Treatment

System

Jeff Marotta, PhDProblem Gambling Services Manager

Alberta Gaming Research Institute’s 6th Annual ConferenceBanff, Alberta

March 31, 2007

Gambling treatment in the context of emerging evidenced based practices.

This presentation will offer the Oregon experience in piecing the puzzle together:

• Identifying challenges• Employing strategic models• Overview of the Oregon treatment system• Viewing system measures

• 158,337 square KM

• Population 3,690,505– 2006

• Major Industries - timber, paper products, farming (wheat, cattle), mining (coal), computer equipment, electronics

Oregon Gambling Expenditures (2005) $1.3 billion*

In 1986 this figure was $95 million

Source: Eco Northwest, 2007 http://www.econw.com/

Oregon Gambling: Summarized

Oregon has more forms of legalized gambling and offers easier access to gambling than almost any other U.S. state

- AND - Oregon is a nationally recognized leader in

prevention, harm reduction and treatment for gambling problems

Source: National Ctr for the Study of Gambling, 2006

Efforts to Address Problem Gambling

• 1% of Lottery revenues dedicated to a Gambling Treatment Fund administered by DHS

$4,656,000 USD2006-07 Oregon Problem Gambling Services Budget

Information Management2%

Outpatient Treatment56%

Treatment Enhancement2%

Administration6%

Workforce Development2%

Statewide Public Health & Gambling

3%

Community Prevention/Public Health

18%

Gambling Helpline4%

Minimal Intervention (GEAR) 1%

Residential Treatment5%

Designing a treatment system in a young field.

Challenges:• There have been few gambling treatment outcome studies.

Therefore, data to date may not represent the full spectrum of recovery modes.

• Few randomized clinical trials in PG treatment research - meaningful comparisons across treatments difficult.

• Unclear how different subgroups of PGs, including comorbidity profiles, respond to different treatment approaches

Where to start

• Without a menu of evidenced based treatments must rely on theory driven and monitored approaches – Philosophical Models– Surveillance and feedback systems– Flexible design structure to respond to

data driven performance measures

Strategic Plan: Oregon Problem

Gambling Services

Released September 19, 2000Influenced by:

– Stepped-care approach to treatment• Sobell & Sobell (1999)

– Public health approach to gambling• Korn & Shaffer (1999)

Oregon Problem Gambling Services

A Stepped Care Approach

• Treatment should be individualized.• The treatments selected should be

consistent with the contemporary research literature.

• The recommended treatment should be least restrictive but still likely to work.

Sobell, M.B., & Sobell, L.C. (1999). Stepped care for alcohol problems: An efficient method for planning and delivering clinical services. In J.A. Tucker, D.A. Dovovan, & G.A. Marlatt (Eds.), Changing addictive behavior: Bridging clinical and public health strategies (pp. 331-343). New York: Guilford Press.

Three fundamental principles of health care (Sobell & Sobell, 1999)

Public Health Approach(Korn & Shaffer, 1999).

Adoption of strategic goals for gambling preventing gambling-related problems protecting vulnerable groups promoting balanced and informed attitudes, behaviors, and policiesEndorsement of public health principles prevention is a community priority, with appropriate allocation of resources incorporating a mental health promotion approach fostering personal and social responsibility for gambling policies and practicesAdoption of harm reduction strategies. healthy-gambling guidelines for the general public vehicles for early identification flexible treatment goals surveillance and reporting systems Allocation of resources to identify and treat level 2 gamblers.

Korn, D., & Shaffer, H. (1999). Gambling and the health of the public: Adopting a public health perspective. Journal of Gambling Studies, 15, 289–365.

System Components

• Treatment• Prevention and outreach• Quality control and evaluation• Workforce development• Partnerships

Treatment

Continuum of Care– Gambling Evaluation and Reduction

Program (GEAR)– Corrections Program– 27 outpatient treatment centers – 3 crisis-respite programs– 1 residential treatment program

Oregon Problem Gambling Services

Updated 9/20/06

Symbol Key

Outpatient Clinic

Satellite Office

Residential Treatment

Crisis Respite Program

Oregon Problem Gambling Help Line (05-06):

2,129 calls for help

93% resulted in referrals for service

Gambling Treatment in Oregon:An Evidenced Based Process

Evidenced Based Process

• Program development is data based and systematically monitored

• Less concern about component analysis• Focus on outputs and outcomes• Require programs to adapt and develop their

approach to optimize outcomes

Quality Improvement Report

Demographics of Gambling Treatment Centers

Participants in Oregon

Total clients: 1,714 Gamblers / 345 Clients in Family Programs

Gender, Gambler Clients

Males 47.4%

Females 52.6%

Gender, Family Clients

Males 33%

Females 67%

Average Age

44.6 years

Average Household Income

$36,495

Race/Ethnicity

White 87%

Marital Status

Married 36%

Divorced 25.5%

Primary Locations for

Gambling

Lottery retailer (video) 69.9%

Casino 17.3%

Primary Gambling Preference

Video poker 69%

Slot machines 14%

Cards 7%

Average Gambling-Related

Debt

$ 23,331 Source: Moore & Marotta, in press

System Evaluation Results

• Treatment is working– 81% of clients reported either no gambling or reduced

gambling at 6-months post-treatment1

• The system is working:– Oregon is one of the few states that appears to have averted

a significant increase in problem gambling prevalence while expanding legalized gambling2

1. Moore & Marotta, in press2. National Center For the Study of Gambling, 2006.

Putting it all together

We need more work to establish evidence based approaches, in the

meantime, data driven processes can and must make do!

Thank You

Further information can be found at:http://www.oregon.gov/DHS/addiction/gambling.shtml

Or contact:

Jeff Marotta, PhDProblem Gambling Services ManagerOregon Department of Human ServicesAddictions and Mental Health Division503 945-9709

jeffrey.j.marotta@state.or.us