6/14/17 Webinar Moderator USING SBIRT FOR PROBLEM GAMBLING IN THE MILITARY Tracy McPherson, PhD Senior Research Scientist Public Health Department NORC at the University of Chicago PRESENTED BY: THE BIG SBIRT INITIATIVE, NATIONAL SBIRT ATTC, and 4350 East West Highway 8th Floor, NORC at THE UNIVERSITY OF CHICAGO Bethesda, MD 20814 esap1234@gmail.com June 15, 2017 Produced in Partnership… 2017 SBIRT Webinar Series ¨ 1/19/17 - Strategies for Incorporating Universal Education about Healthy Relationships into Clinical Practice to Reduce Substance Use and Intimate Partner Violence ¨ 2/16/17 - Using SBIRT when Intimate Partner Violence has been Disclosed ¨ 3/2/17 - WINGS: An Evidence-based SBIRT Intervention for Addressing Partner Violence Among Young Women Who Use Drugs or Alcohol ¨ 3/16/17 - When One Size Does Not Fit All: Addressing Issues Throughout an SBIRT Project Life Cycle ¨ 4/6/17 - Promoting SBIRT in an Interprofessional Setting with Vulnerable Populations ¨ 5/4/17 - SBIRT in Various Settings: Differences & Common Threads www.sbirteducation.com ¨ 6/15/17 - Using SBIRT for Problem Gambling in the Military hospitalsbirt.webs.com/webinars.htm Download this flyer from our website! Access Materials Ask Questions ¨ PowerPoint Slides Ask questions through the ¨ Materials and Resources “Questions” Pane ¨ Recording ¨ Certificate of Will be Completion answered live at the end http://hospitalsbirt.webs.com/military-problem-gambling 1
6/14/17 Technical Facilitator Webinar Presenter Larry Ashley, EdS, LPC, LMSW Misti Storie, MS, NCC Professor Emeritus of Counseling at the Technical Consultant University of Nevada, Las Vegas misti.storie@gmail.com Addiction Specialist at the University of Nevada, Reno School of Medicine www.mististorie.com larry.ashley@unlv.edu Gambling Among the Military and Veterans u Research suggests that the rate of problem gambling is higher Using SBIRT for Problem among military personnel than Gambling in the Military that of the general population. LARRY ASHLEY, PROFESSOR EMERITUS OF COUNSELING UNIVERSITY OF NEVADA LAS VEGAS u While there is an abundance of u Problem gambling tends to co-occur with opportunities for veterans and enlisted other disorders that have elevated rates personnel to gamble, many members of among those who have served in the military, the military do not have access to treatment for gambling problems and such as substance abuse, intimate partner may face disciplinary action for seeking violence (IPV), post traumatic stress disorder help. (PTSD), depression and suicide. 2
6/14/17 u Gambling opportunities are available on u Present data suggests that military or near most military bases. Surveys of personnel have relatively higher rates active military personnel have revealed of risk-taking and sensation seeking, that between 6.3% and 8.1% of service two constructs associated with persons report experiencing at least one problematic gambling. gambling related problem in their lifetime. u Unfortunately, limited research exists u High levels of risk taking was identified in on military personnel and gambling 28% of their military population and these individuals were prone to several health related issues, thus making the risk behaviors. Taken together, addictive problem difficult to asses, diagnose, behaviors are thought to have a and treat. significant impact on military readiness. u Increased efforts at problem u There is a need to implement new gambling prevention, and the gambling disorder screening expansion and improvement of processes in the military health system existing treatment programs may and related military support help reduce the prevalence of organizations. problem gambling among service u SBIRT opens the door to this. members. 3
6/14/17 Identifying, Assessing and Treating Gambling Disorder in the Military u Screening is important because few seek treatment directly for gambling disorder. u A number of recommendations have been made for Without proactively asking gambling identifying, assessing, and treating gambling disorder questions as part of a screening process it among military personnel. may not be possible to identify affected service members and provide appropriate u The main recommendations are to: treatment/counseling. u (a) incorporate gambling disorder questions in a systematic screening process and u (b) update guidance on how to deal with gambling disorders u There also exists a lack of materials u Gambling problems may not be identified until they reach a critical point affecting available to help support medical the individuals readiness, which could and non medical staff identify have implications for national security, as gambling disorder and adequately well as harming the financial situation of assess the problem. the service member. u Without guidance, treating the u Including guidance for how to deal problem gambling becomes even with those with a gambling problem more difficult, and problem gamblers would clarify the proper steps are left without any way to receive needed to address gambling effective treatment. problems before they become an administrative or disciplinary issue. 4
6/14/17 u Specifically PTSD resulting from combat u It is important to recognize that the trauma may leave military personnel with comorbidity with other diagnosis is active stress. If this stress is untreated, it key to the understanding how/why can negatively affect almost all aspects of gambling may become problematic life, especially once military personnel return back home from active duty. in military personnel. Veterans, Gambling Disorder and Coexisting Diagnosis u Military personnel may then use gambling as a way to cope with this u From the adrenalin thrill of winning to the past trauma, or the relative simple escape from the reality of their downtime/boredom of home life. lives, gambling can become the invisible, undetected, self prescribed medication that glosses over symptoms of PTSD, depression and anxiety . u Research consistently finds that rates of u Veterans with problem gambling problem gambling among veterans are tend to zone out in front of slot significantly higher than average. While machines because they provide a one study suggests that 1 in 10 veterans numbing electronic morphine. may develop disordered gambling in their lifetime, other studies put this figure as high as 1 in 5. 5
6/14/17 • Rates of depression among veterans with u The rates of problem gambling are even higher among veterans seeking treatment for other, possibly co-occuring disorders. pathological gambling problems have been shown to be as high as 76 percent 10 percent of veterans using veteran treatment services are • Suicide is extremely common with 40% of veterans • problem or compulsive gamblers seeking treatment for gambling have reported suicide Veterans in treatment for PTSD may be as much as 60 times more attempts. • likely to have a gambling problem as age matched members of the general population All this suggest that veterans are a priority population Among veterans hospitalized in inpatient psychiatric units, 40% • had some form of gambling problems with which treatment and prevention resources should be targeted. Stigma and Barriers to Seeking Treatment Unfortunately there are many u Approximately 60% of the military barriers to treatment for veterans personnel who experience mental health and military personnel alike. problems do not seek help, yet many of them could benefit from professional treatment. u Military organizations may engender stigmatizing beliefs in relation to help-seeking for mental u Across military studies, one of the health problems that may also persist into civilian most frequently reported barriers to life. help-seeking for mental health problems is stigma. u These beliefs may be related to military culture, rules, and conduct learned and experienced in service. 6
6/14/17 u The value placed on the actions of the u The requirement for operational group to achieve military objectives readiness through good health, above all else, the cultures of reliance conflicts with the direct availability of upon each other, masculinity, self- mental health care provided by the sufficiency, and the stigmas of going sick military for service personnel. or shirking work have been noted to effect help-seeking behaviors. u Military personnel are faced with the u Military objectives, health care, structures, dilemma –disclosure of health and cultures may interact to create problems in order to access care may barriers to seeking help for mental health problems, and personnel may elect not to negatively affect their operational disclose mental health problems such as effectiveness and (consequently) problem gambling. their military career. SBIRT in the Military u Other barriers to help-seeking in military u What is SBIRT? populations, including practical/logistic barriers to care, negative attitudes related u Screening to mental health treatment, and poor u Brief Intervention recognition of a need for treatment. u Referral to Treatment 7
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