Infusing data-driven gambling information into existing SUD and - - PowerPoint PPT Presentation

Infusing data-driven gambling information into existing SUD and Suicide

• utreach efforts

Andy Cartmill, CPS, QMHA Eva Hawes, MPH, CHES Washington County Health & Human Services

Outline

Background/Intro

• Who IS Andy?
• Who IS Eva?
• How did we get here?

What’s the Issue?

• What the science says
• Our Questions
• ACEs
• Trauma

Why We’re Sharing

• Understand the relationship
• Infusion
• Who needs to know

The Process

• Collaboration
• Asking the right questions

Objectives part 1

 Objective 1: Understand the relationship between gambling and other

risky behaviors

 What are the associations between problem/disordered gambling and

• ther high risk behaviors?

 Objective 2: Understand the relationship between gambling and suicide

ideology and behavior

 What is the relationship between problem/disordered gambling and

suicide risk?

Objectives part 2

 Objective 3: Learn how to utilize local data to demonstrate similar

relationships

 Process for internal collaboration  How did we get here  What questions did we ask  What data did we consult

 Objective 4: Understand the benefits of collaboration with other

programs within the organization

 How to collaborate internally  Learn how to ask the right questions

Outline

Background/Intro

• Who IS Andy?
• Who IS Eva?
• How did we get here?

What’s the Issue?

• What does the science say?
• Our Questions
• ACEs/Trauma

Why We’re Sharing

• Understand the relationship
• Infusion
• Who needs to know

The Process

• Collaboration
• Asking the right questions

Intro

Is Prevention Part of Your Job Responsibilities?

A.

Yes

B.

No

C.

Not sure

D.

What’s prevention?

Outline

Background/Intro

• Who IS Andy
• Who IS Eva?
• How did we get here?

What’s the Issue?

• What does the science say?
• Our questions
• ACEs/Trauma

Why We’re Sharing

• Understand the relationship
• Infusion
• Who needs to know

The Process

• Collaboration
• Asking the right questions

Which group has a higher suicide attempt rate?

A.

Those who abuse alcohol

B.

Those who abuse other drugs

C.

Problem gamblers

D.

They’re about the same

Which population has a higher rate of disordered gambling?

A.

Adults

B.

Youth

C.

They’re about the same

22 26 25 3 10 27 1 3 7 0.5 4 17 16 22 28 5 10 15 20 25 30 6th Grade 8th Grade 11th Grade Percent Gambling Alcohol Rx Drugs Marijuana Depression

Risky Behavior and Washington County youth Past 30-Day Use

(2016 Oregon Student Wellness Survey n=14,004)

Objective 1: Understand the relationship between gambling and other risky behaviors

 Problem gambling behavior often occurs with other high risk

behaviors including:

 Illicit drug use  Misuse of prescription drugs  Tobacco use  Alcohol use

 Relationship is bidirectional

 Students that gamble also engaged in risky behavior  Smaller prevalence but need to include in the prevention message

because:

 Students that engage in risky behavior also gamble

How to define “high risk” gambling

 Oregon Student Wellness Survey

 Have you ever lied to anyone about betting/gambling?  Have you ever bet/gambled more than you wanted to?

 If yes to one or both, categorized as high risk  Based on problem gambling screening instrument, if yes to

either question indicates need for further assessment by a trained counselor

T o b a c c o Alc o h o l B in g e d r in k in g M a r iju a n a Illic it d r u g s R x d r u g s 2 0 4 0 6 0 8 0

S u b s ta n c e u s e in p a s t 3 0 d a y s b y g a m b lin g ty p e in W a s h in g to n C o u n ty S tu d e n t W e lln e s s S u rv e y 2 0 1 6

P e rc e n t Total N o n g a m b lin g G a m b ling H ig h ris k g a m b lin g

What % of Washington County 8th graders seriously considered suicide last year?

A.

5%

B.

7%

C.

11%

D.

14%

Objective 2: Understand the relationship between gambling and suicide ideology and behavior

 Suicide ideation is more prevalent among problem gambling

than the general population

 Range from about 17% to almost half (48%) of adults in

gambling treatment have a history of suicide ideation

 The frequency/amount of suicidal ideation increases with

gambling pathology

 People seeking treatment for problem gambling should be

assessed for suicidality

Gambling and suicide in Oregon

 About one quarter (25.1%) of adults entering problem

gambling treatment in Oregon experience suicide ideation

 About 2% of these adults had a suicide attempt

 Historical estimates of Oregon adults approximately 3%

experience suicide ideation

S u ic id a l id e a tio n S u ic id e a tte m p t 1 0 2 0 3 0

S u ic id a l id e a tio n a n d s u ic id e a tte m p t b y g a m b lin g ty p e in W a s h in g to n C o u n ty S tu d e n t W e lln e s s S u rv e y 2 0 1 6

P e rc e n t Total N o n g a m b lin g G a m b ling H ig h ris k g a m b lin g

Data takeaways

 Discussed the relationship

between gambling and substance use and suicide behavior

 Gambling is associated with

• ther risky health behaviors

 But why do we talk about this?

Table talk: why?

 Expertise in the room:

 Why might someone start in the first

place?

 Are the reasons different for social

gambling vs problem gambling? How so?

Why?

Objectives 1, 2 & 4

 Audience Question: Why might people start in the first place?  This was our question!

 There’s a reason  Perception: makes life better

 ACEs  Trauma

 Effects on the brain  Ramifications later on

Video

ACEs

Adverse Childhood Experiences

Mental Illness Sexual Physical Emotional Discrimination Neglect Poverty Use in home Bullying Other???

At 12, the brain has the same:

• weight
• size
• cortical folds
• regional specialization

From 12 – mid 20’s:

• Developing connections
• The brain cells are linking up
• Developing white matter

The Adolescent Brain:

• Development shifts to creating efficient neuronal pathways.
• Synapses that are most important to survival and function flourish
• Connections that are not being used vanish (Neural Pruning)

From Infant – 12:

• Focused on developing volume
• Grey matter

ACES Primer video

Prevalence and Impact

Emotional abuse Household substance abuse Divorce Household mental illness Physical abuse Intimate partner violence Sexual abuse Jail/prison household member Prevalence 36% 34% 31% 26% 24% 20% 15% 9%

0% 5% 10% 15% 20% 25% 30% 35%

Prevalence in Oregon: Adults

Data from Oregon Health Authority, 2015

Socio- economic hardship Divorce/ separation Household substance abuse Household mental illness Parent in jail/prison Domestic violence Neighbor- hood violence Treated unfairly due to race Death of parent Prevalence 29% 25% 11% 11% 7% 6% 3% 3% 2%

0% 5% 10% 15% 20% 25% 30%

Prevalence in Oregon: Kids

ACEs and Substance Use

Alcohol Tobacco Prescription drugs and

• pioids

Illicit drug use Early initiation among ACEs impacted youth Prevalence of tobacco use increases with ACEs Over 80% of the patients seeking treatment for opioid addiction had at least one form of childhood trauma, with almost two-thirds reporting having witnessed violence in childhood Each ACE increased the likelihood of early initiation into illicit drug use by 2- to 4-fold

 Trauma experienced by those who

hear about or witness an event but don’t directly experience the trauma

 Similar impact on brain: physical,

psychological, and cognitive changes and symptoms

 Can impact all professionals who

serve those who have experienced trauma (e.g., health care providers, first responders, home visitors, case workers, clergy, intake workers)

Secondary stress

Early death Disease, disability and social problems Adoption of health risk behaviors Social, emotional cognitive impairment Adverse childhood experiences Social conditions, local context Historical trauma, multigenerational oppression ACE Study Epigenetics

Break

Outline

Background/Intro

• Who IS Andy
• Who IS Eva?
• How did we get here?

What’s the Issue?

• What does the science say?
• Our Questions
• ACEs/Trauma

Why We’re Sharing

• Understand the relationship
• Infusion
• Who needs to know

The Process

• Collaboration
• Asking the right questions

Why we’re sharing this

Objective 1, 2 & 4

 Stakeholders need to understand the relationships between

gambling behavior and other risky behaviors.

 Not causal  Participate in one high risk behavior, more likely to participate in

another

 Who’s talking about it?

Why we’re sharing this

Objective 1, 2 & 4

 Infusion of gambling into other outreach/prevention efforts

 Substance Use Disorders  Schools  Parents  Students  Suicide  ASIST (Applied Suicide Intervention Skills Training)  QPR (Question, Persuade, Refer)  MHFA (Mental Health First Aid)  Schools  Parents  Students

___% of Washington County 8th graders report talking to their parents about the risks of betting/gambling?

A.

51

B.

63

C.

72

D.

81

Compared to…

69% who reported that they talked with at least one of their parents about the dangers of tobacco, alcohol, or drug use! 6th graders: 64% 11th graders: 70%

Who’s Talking About It?

(2016 SWS)

P a r e n ts ta lk e d a b o u t g a m b lin g T e a c h e r s ta lk e d a b o u t g a m b lin g 2 0 4 0 6 0

T a lk in g a b o u t ris k s o f b e ttin g /g a m b lin g b y g ra d e a n d ty p e W a s h in g to n C o u n ty S tu d e n t W e lln e s s S u rv e y 2 0 1 6

P e rc e n t A ll a g e s 6 th g ra d e 8 th g ra d e 1 1 th g ra d e

Who needs to know?

 Students  Parents  School districts  MH professionals

 Clinicians  Prevention Specialists

 SUD professionals

 Clinicians  Prevention Specialists

 Presentations

 1,400 to over 40,000  Variety of

groups/organizations

Outline

Background/Intro

• Who IS Andy?
• Who IS Eva?
• How did we get here?

What’s the Issue?

• What does the science say?
• Our questions
• ACEs/Trauma

Why We’re Sharing

• Understand the relationship
• Infusion
• Who needs to know

The Process

• Collaboration
• Asking the right

questions

The Process

Objectives 3 & 4

 What data did we access?

 How can you access your data?

 How can you access the right person?  What are the questions to ask?

 What do you want to know?

What’s out there?

 Behavioral Risk Factor Surveillance System  Youth Behavior Surveys  Gambling prevalence surveys

Do you have an Epidemiologist or Research Analyst on staff?

A.

Yes

B.

No

C.

No idea

D.

An Epi-what, now?

Which group has a higher suicide attempt rate?

A.

Those who abuse alcohol

B.

Those who abuse other drugs

C.

Problem gamblers

D.

They’re about the same

Which population has a higher rate of disordered gambling

A.

Adults

B.

Youth

C.

They’re about the same

Thank you!