CHP Conversations

Exploring gambling addiction in Virginia

Dr. Carolyn Hawley Season 1 Episode 1

Guest: Dr. Carolyn Hawley Ph.D., CRC - Associate Professor, Virginia Commonwealth University Department of Rehabilitation Counseling

Dr. Hawley recently was awarded a contract with the state to coordinate the treatment programming for gambling addiction. She is an expert in this topical area, and serves a critical role in developing and ensuring the provision of treatment for those who experience gambling addiction. This is a growing concern as the prevalence of gambling options is rapidly increasing in Virginia and online.

If you would like to contact the Gambling Addiction Hotline that Dr. Hawley mentioned, please call (888) 532-3500.


Music by Gvidon from Pixabay

Welcome to CHP Conversations: a podcast series produced by the VCU College of Health  Professions. This series includes conversations with faculty, students, and alumni who exemplify our mission to create influential leaders in healthcare. Hi,  my name is Jared  Schultz and I am in the Department of Rehabilitation Counseling here at VCU. I'm joined today by Dr. Carolyn  Holly. Welcome.  Welcome,  Dr. Schultz. Welcome to you, Dr. Holly. Dr. Carolyn Holly is an  Associate Professor in the Department of Rehabilitation Counseling at VCU. She has over two  decades of experience related to counseling, training, research, and education and  employment and community service needs of people with disabilities. She completed a fellowship at McGill University's International Center on youth gambling problems and high-risk  behaviors and has worked in program specializing in traumatic brain injury rehabilitation. She  obtained her MS in rehabilitation counseling at the University of Wisconsin in Milwaukee, and  her  Ph.D. at Virginia Commonwealth University. Recently, Dr. Holly obtained a contract from the  Commonwealth of Virginia to coordinate services for people dealing with problem gambling and gambling addiction. And this is gonna be the focus of our conversation today. Carolyn, it's good to have you with me. I appreciate you coming in and talking about all this. Thank you. So to start with, could you just describe the project that you're getting off the ground here in Virginia. Yes. So this is really exciting. Virginia were one of the few states that hasn't had any treatment programs available for individuals with gambling problems. So with all the gambling expansion that's happened within the state, specifically with sports betting and with casino industry growing. What we did is we lobbied really hard for this problem gambling treatment and support fund, which could be used for not only prevention activities, but treatment activities as well. So this fund is being handled with the Department of Behavioral Health and Developmental  Disabilities and our role in it is going to be developing a gambling treatment workforce, as well as assisting them with the payment for these resources. We're also gonna be working in pulling together training as well as part of the development of this treatment team. Well, so you packed a whole bunch in there. Let's take it a little bit of that apart. That's how I that's how I do. So talk a little bit, if you would, about about the needs. So you've mentioned some sports gambling. What  are some of the other things going on in the community where there's an increased need, right? So historically what we've seen in Virginia is there are three legal forms of gambling and that's been our state lottery, horse racing industry and then charitable gambling. So you have your church bingo, and you're fraternal organizations running bingo as well. So those have been the three main forms. Within the last few years, we've seen an explosion in regards to- First, fantasy sports. And now we're seeing all the sports betting. We know that there's casinos being developed. We have five casinos for possibly one being developed either in Richmond or in Petersburg area as well. And not to mention all of the availability of online forms of gambling  as  well. Wow, and the online piece. Is  there  any  way  to  even  quantify  that? Right? I  mean,  it's  so  difficult  because  we  have  our  online  of some  forms  that  you  can  play mobile  wagering  that  are  legal, and  then  you  have  your  illegal  forms that  are  really  difficult  to  keep  track  of. And  that  also  puts  us  in  a  position where  we're  currently  in  limbo  in regards  to  what  we  call skill-based  gambling  that  has proliferated  throughout  the  state. And  these  are  essentially  slot  machines. We  like,  or  I  should  say, they  state  the  word  skill-based. There's  usually  not  a  lot  of  skill involved  with  these  machines.  Pulling  the  handle, that's  a  pretty  significant  skill. You know, I  think  that's  what  we're  referring  to,  right? So they're  currently  in  a  state  of  legal  limbo. They  were,  the  General  Assembly said  that  they  were  illegal. The  governor  came,  governor  Northam  during the  time  of  COVID  made  them legal  for  a  period  and  regulated  them  for tax  revenue  to  assist  with,  with  COVID  relief. And  then  it  became illegal  again  and  now  it's  up  for  lawsuits. And  the  General  Assembly  is  gonna  be  doing a  study  and  exploring  this  some  more. So  they’re currently running unregulated  throughout  the  state. But  wow. But  despite  all  of  that,  I  mean, really  we're  talking  in  the  last  ten  years just  exponentially. Oh  my  goodness. The  last  five  years. Last  five  years. Wow. And so  what  we've  had  as  I-  as  I  mentioned, we've  been  one  of  the  few  states  that  hasn't had  treatment  mechanism  available. And  we  know  when  we're  working  with  gamblers, just  like  when  we're  working  with individuals  with  other  forms  of  addictions, alcohol  or  substance  use, but  particularly  with  gamblers. They  don't  have  the  financial  resources available  for  treatment. Or  if  they  do. Um, you know very  often  when  we're  looking  at  relapse, the  money  that  they  could  use  for  treatment. What  ends  up  happening  is  they  use  that  for  gambling. Well,  so  it's  a  vicious  cycle,  I  mean,  yeah. Okay. How  do  you  find  or what-  how  do  people  generally  access  services? So  the  one  thing  that  we  have  had and  the  Virginia  Council  on  problem  gambling, they've  been  administering the  Virginia  problem  gambling  helpline, and  this  is  funded  by  the  Virginia  lottery. So  this  is  a  24/7  free  service to  all  Virginia  residents. So  whether  you're  an  individual who  thinks  they  might  have  a  problem, or  a  family  member  or  a  friend, or  just  anybody  looking  for information  about  gambling  addiction, wanting  to  learn  more, they  can  call  the  helpline  and  access  those  services. However,  there's  been  some  struggles,  as  I  mentioned, in  regards  to  not  having a  treatment  force  to  work  with individuals  for  those  treatment  needs. So  a  lot  of  the  services  that have  been  available  up-to-date are  a  lot  of  self-help  or  peer  group  resources, which  are  good  to  supplement  other  forms  of  care. But  we  really  have  need treatment  providers  out  there that  can  work  with  these  individuals. So  that's  a  great  segue  into what  I  wanted  to  touch  on  just  a  little  bit. So  what  does  the  treatment  approach  look like  for  people  who are  struggling  with  gambling  addiction? And  what  are  some  of the  key  components  of  that  intervention? Well,  just  as  I  mentioned, alcohol  and  substance  use, what  you  see  are  very  similar  approaches to  treatment  for  individuals  with  gambling. So  your  cognitive  behavioral  therapies, motivational  interviewing,  these  all  have shown  to  be  effective  in  working  with  gamblers. Some  of  the  differences  though, this  can  be  more  challenging for  our  treatment  professionals, is  the  focus  on  finances. And so, you know finances- they're, they're a  part of  the  problem  when  we  look at  this  addiction  and  with  gambling  as  well, it's  also  seen  as the  source  of  relief  for their financial problems. So  it  can  be,  as  you  mentioned, just  a  cycle  where  you  want  individuals  to quit  gambling  and  they're  in  such  financial  strains. But  the  only  way  they  see  that  they're  gonna  get  out  of the  financial  hole  that  they've  dug themselves  in  is  through  gambling. So  looking  at  also  a  lot  of those  cognitive  distortions and the  role  and  influence  of  money. And  if  you're  not  able  to  talk  about  that, if  you're  not comfortable talking about  that  as  a  counselor, that  individuals  just  going  to  relapse because  of  that  secular nature  with  money. Yeah. That's  fascinating.  I  don't  know  of any  other  situation  where the  perceived  answer  is  the  problem. I  mean,  I  can  tell  you  I've  recently  we  have  a  caller to the  helpline,  and  this  is an  individual  who's  living  in  their  car. They've  lost  everything  to  gambling. They've  lost  their  home. They've  lost  their  family, they  lost  their  job. They  still  have  their  car. They  do  on  the  weekends  is they  go  to  one  of  the  casinos  in Maryland  and  they're  known  as  a  high  spender. And  so  this  way  they're  comped  their  room. They  have  food,  room,  shelter. So  in  this  instance, the  casino  is  seen  as their  only  source  of  relief,  the  only  source  of  safety. So  that's  something  different  that  we  don't  find  with alcohol  or  other  forms  of  drug  use  with  treatment. Wow. So  what  are  some  suggestions  you  might  have  for individuals  who  think  they  might  need  help? Number  one,  call  us at the helpline,  (888)-532-3500. Reach  out.  The  sooner  you  get  help, the  easier  it  is  to  stop  the  progression  of  the  illness. It's  a  challenging  call  to  make, I  would  imagine. Family  member  is  just  asked  the  question. Reach  out  to  someone. They  may  not  like  that you're  asking  the  question  about  their  gambling, but  if  you  do  so  in a  caring  and  supportive  way  and  show  that  you’re  concerned, it  often  starts  opening  up  that  dialogue  in somebody  being  more  willing to  discuss  that  they  need  help. So  for  professionals  working  in  the  counseling  field, if  you  wouldn't  mind, just  discuss  a  little  bit, what  are  some  specialized  training? Because  it's  not  just  anybody  can step  in  and  be  effective  in  this. There  needs  to  be  some,  some  training  involved. And  so  what  are  some  key  pieces  to  that? Absolutely.  So  there  actually  is a  certification  for  gambling  treatment, so  the  International  Gambling  Counselor  certification, and  they  have  two  levels. And so the  first  level  is  geared  more  towards  individuals, perhaps  in  peer  recovery or doing  coaching  level  work. And  then  the  second  tier  level  is  for  individuals  who hold a  licensure  in  counseling, in  social  work, and in psychology, something  of  that  nature. And  at  the  initial  level, there's 30 continuing  education  hours  that  you  need to  complete  along  with  some  clinical  experience also.  And so what  we're  gonna  be  doing  in Virginia  as  looking  at  that  curriculum  and also  providing  some  of those  opportunities  through  our  work  here  at VCU  so  that  we  can  get  counselors  up  to  speed. And  these  are  gonna  be  available, they're  gonna  be  free. So  I'm  so  hopeful  that  we're  going  to  get a  large  interest  in  this  and  be  able  to  fill  our, our  classrooms.  Because  there's a  real  need  for  clinicians. Absolutely. Just  as  I  was  talking  about, one  of  the  hard  things  of working  within  this  specialization is  we  have  to  be  honest  about  this  in  regards to  having  a  population  that  can't  pay. And  we  also  have  a  condition  that  receives no  federal  funding  whatsoever  in  the  country, unlike  what  we  see  with  alcohol  and  substance  use. So  for  a  clinician,  I  mean, we  recognize  you  need  to eat  and  be  housed  and  live  as  well. So  it  can  be  very  difficult  to  take on  clients  who  you  know  aren't  gonna  be  able  to  pay. So  hopefully  now  that  we  have  this  fund  available, we're  going  to  have  more  counselors  that are  interested  and  willing  to  specialize. So  to  clarify  then, the  part  of  the  contract  that  you  receive from  the  Commonwealth  is  to provide  funding  so  you  can  pay for  those  services  that those  clients  may  not  be  able  to  afford. Absolutely.  Huge  piece  of  what we're  gonna  be  doing  is  handling that  reimbursement  for  treatment  professionals so  that  individuals  can  get  those  services. Wow. What  are  some  of  the  national  trends  that  you  see? So  sports  betting  now, we've  seen  with  a  landmark  Supreme  Court  case that  it's  now  legal  in  the  country. And  so  states,  Virginia was  one  of  the  first  to  legalize  it. And  I  can  say  from  the  experience here  in  Virginia  in  regards  to  the  helpline, what  we've  seen  is  a  huge  increase since  it's  legalization  last  year. And  the  volume  of  calls,  so  114%  growth. Wow  and  calls  for  individuals  who are  specifically  seeking  health. We've  also  seen  a  huge  shift  with  demographics. Now.  Historically  again,  what  we  saw  with gambling  disorder  is  it  tended  to be  more  males  versus  females. And  over  the  past  decade  or  so, that's  actually  become  more  equitable. However,  this  last  year  with  sports  betting  in  Virginia, 74%  of  callers  were  male. So  that's  also  a  new  trend  that  reflects  the  old  trend, as  well  as  younger  callers. So  male,  younger  callers  and  sports  betting is one  of  the  top  forms  of  play, the  actual  top  form  of  play  is  slot  machines. We're  also  seeing  more  callers  reaching  out  to  us  in regards  to  gaming.  Internet  gaming. So  not  gambling  but  but  gaming. So  so  yeah,  so  a  gaming  addiction  as  well, because  there's  no  place  for  them  to  go. We  see  so  many  parallels  to  what  we  see  with, with  gambling  as  we  do  with  gaming. Wow,  that's  fascinating  because  I  could, I  could  imagine  that  a  lot  of the  techniques  that  are  utilized  in developing  a  gambling  scenario  where  you're  trying  to reinforce  the  activity  because you  want  to  keep  the  person  involved. Is  this  similar  to  the  things  being used  in  the  gamification process,  right? Right.  I  mean,  there's  some  reward  happening  there. And  people  often  think that  money  is  a  motivator  even  with  gambling. But  when  you  actually  talk  to  individuals who  have  a  gambling  disorder, many  times  it's  not. In  fact,  it's  not  uncommon  to  hear individuals  talking  about  how  upset  they  were. They  were  at  their  slot  machine  and playing  and  they  just  had a  big  win  and  that  meant  they  had  to go  and  stop  playing  and  cash  in  their, their  chips  and  it  was  frustrating. So  there's  something  else  operating  there. What  do  you  think  it  is? I  think  it's the  whole  process  when  we  talk  about  that  reward  system and  when  we  look  at  gambling  in  particular and  that  intermittent  reinforcing as  being  highly  addictive. People- we  don't  like  things  that  are  the  same. We  like  the  unknown. Things  that  are  predictable  are  boring  and  gambling, it  provides  some  sort  of  primitive  need  for  uncertainty, just  like  what  we  see  with  gaming  and  not knowing  whether  or  not  you're going  to  win  or  you're  going  to  lose. And  we  know  that  there's  that  dopamine  hit, that  happens  when  we're  gambling. And  dopamine  is  related  to  craving. And  so  over  time, as  you're  continuing  with  this  pleasurable  activity, those  associations  are  connecting. And the  more  you  play, the  stronger  those  cues  become, and  the  stronger  that  compulsion  becomes. And when  you  have  somebody  in  active  addiction, whether  it's  gambling  or  gaming  or alcohol  or  other  forms  of  substances. They  no  longer  enjoy  that  activity. But  they  can't  stop. The  tolerance  is  built  enough  that  the, that  the  activity  itself. Exactly. And  tolerance,  what  we  see  with  gambling, certainly  needing  more  and  more  to experience  that  same  level  of excitement. Withdrawal  as  well. I  mean,  those  are  some  of  the  key  hallmarks  that  we know  that  there's  some  form  of  neuroadaptation  occurring. And  so  not  surprising  to  hear  individuals  who  are trying  to  quit  gambling  talk  about  their  insomnia, their  headaches,  sweating,  having  shakes. Yeah, the  physiological  response. Fascinating,  you  could  expect  that  from  a  drug  or alcohol  or  something  like  that  where  there would  be  a  physiological  withdrawal. But  from  an  activity (Mhm), you  wouldn't  necessarily  (Right, right)  expect  that. Yes.  So  we  used  to  think  it's  all about  the  substance,  just like  the  money  with  the  gambling, but  it's  that  ingestion  of  some  particular  substance. So  yes,  certainly  some  substances are  more  addictive  than  others. But  now  that  we  know  and  we're  looking  at  brain  changes, we're  looking  at  genetics  as  well, those  family  histories, that  there's  some  underlying  addiction  mechanism. That  whatever  is  going  to  be  pleasurable  that  we as  humans  find  joy  and  pleasure  in  that there  is  some  propensity towards  developing  this  addictive  process. It's  interesting  as  you  are, as  you  were  discussing  the  dopamine  hit, I  just  remembered  a  conversation  I  had  with a  teenager  talking  about  texting. And  I  was  talking  to  him  and  I  said So  what's  the  what's the–  I  sound  like  an  old  grandpa  or  something, you  know–  what's  the  big  deal  about, you  know,  why  why  are  you  glued  to  your  phone? And  he  said  something  that  I  thought  was  and  he  goes, it's  really  not  even  the  communicating. It's  the  thrill  of  your  phone vibrating (Mhm)  and  connecting (Right?). And  that  just  reminds  me  of  that. That  dopamine  hit. It's  the  intermittent  reinforcement. It's  going  so  long  without  something, but  then  it  kicks  in. Yes! And when  you  look  at  our  social  media  sites, when  you  look  at  things  like  Facebook  or  Twitter, what  you  find  is  the  developers  of those  sites  that  they paralleled  gambling, and that  intermittent  reinforcement. And  so  you  have  the  same  strategies at  play. Say  for  instance  with  Facebook, our  desire  to  be  liked,  to  be  wanted. And  so  they  use  that  intermittent  reinforcement  where  a withholding  our  likes  and then  if  we're  not  paying  attention, doing  them  in  bursts, so  we  have  this  release  or that  we're  constantly  checking  their well-timed  and  they're  not  always  in real  time,  just  to  keep  us  engaged. Wow,  excuse  rather  malevolent,  doesn't  it? I  mean,  it's  just  frightening  how (it's either genius or scary) how  easy  we  are to um-  I  don't  know  if  it's  control is  the  right  word- but,  but  to  purchase (Influence at the very least), to participate, and yeah. And  we  also  know  also  when  we're  talking about  those  mechanisms  and  social  media  as  well, is  that  they  know,  particularly  with  gaming, that  if  they  can  get  you  to  spend  money  early  on  upfront, the  more  likely  you  are  to continue  playing  and  to  be  an  active  user. So  it's,  it's  a  little  disturbing. I  mean,  because  you  look at  the  similarities  across  all  of  those. And  if  you  were  to  ask  the  average  person, what's  the  connection  between  gaming, gambling, Facebook  or  social  media. They  might  go,  “I  don't  know. There's  computers  involved,  I  guess.” But  the  underlying  foundation  and the  construction  of  those  are  very  purposeful.  Right. Right.  The  hard  thing  we  have  to, in  regards  to  a  prevention  and  education  aspect is, what  we  found, particularly  when  we're  talking  to parents  and  things,  that  we have  judgments  about  the  harm  of  various  activities. So  it's  not  uncommon  to  hear  parents  say,  “well, I'm glad  my  child  is  gaming  or  even gambling  because  that's  not  as  bad  as  using  a  substance.” And  so  we  just  want  to  make  people  aware that  an  addiction  can  develop  and  it  can  be just  as  devastating,  if  not  more  devastating. For  instance,  with  gambling,  I  mean, out  of  the  addictions, what  research  tells  us  is  it  has the  highest  suicide  rate for  individuals  with  this  disorder. Wow,  I  mean,  you're  talking  about suicide  rate  and  we're  talking  about  that  sort  of  thing. You  mentioned  earlier  that  we're seeing  younger  and  younger. What's  the  range  that  a  parent  may  want  to  check  in? I  mean,  because  a  lot  of  times  parents  are  like,  ‘Oh, my  kids  only  15, they  don't  do  that’  and  (Right) they  could  be. So  I'm  curious,  what- where  do you  see  the  range  of  people  with  this? Well,  we  know  it. If  you  start  playing, say  around  ten  years  of  age, the  more  likely  you  are  to  develop  an  addiction. So  not  sure  what's, what's  happening  there  in  regards  to our  brain  development  or  socialization. But  there  is  research  that  supports  that  level. And when  you  think  of  gambling, I want  parents  to  understand  some  of the  subtle  ways  that  this  happens, such  as  grandma  getting  lottery  tickets  for  holidays, even  though  that's  illegal, you're  not  allowed  to  purchase a  ticket  until  you're 18  or  gifted  ticket  to  somebody  under  18, that  that  happens,  that's  commonplace. Or  even  sitting  around  the  table  as  a  family  and gambling  together.  Right  now we're  in  the  midst  of  March  Madness. Family,  friends,  coworkers,  everybody  has  been filling  out  their  brackets  and  placing  bets. And  these  are  meant  to  be  fun  activities. But  just  as  we  would  with  say, a  drink,  we  need  to  be  mindful  that  this  can  be  harmful. And  so  we  have  to  be  aware  of  what  are  some  of  the  signs, what  are  some  of  the  risks, and  have  discussions  about  this  and understand  that  you  need  to  set  a  limit,  and stick  to  it. And  if  you're  not  sticking  to  it, [understand] that  a  problem  might  be  developing. So  let's  stay  on  track  just  a  little  bit  with  that, what  you  just  talked  about  in  terms  of the  kids  and  the  exposure. Um, I  would  assume  that one  incident  doesn't  create  an  addiction. Right.  So  what  is  what  is the  the  path  or  what's the  progression  that  you would  describe  if  a  parent  is  like, ‘Okay,  I'm  buying  into  this. I'm  hearing  the  warning. But  tell  me  how  this  works.’ Right.  Is that clear? Yeah. Well,  I  think  what  you're  talking  about again is going  back  to  some  of  those  signs we  need  to  we  need  to  notice. So  do  you  have  a  limit  for your  child  that  they're  exposed  to  these  devices, whether  whether  it's  gaming  or  gambling?  These  brackets, what  type  of  setting  is  this in?  And  so  if  an  individual, if  your  child  is  starting  to  spend more  time  than  their  allotted,  that's  a  problem. If  they're  starting  to  not  engage  in other  activities  because  now  they're  doing  that instead, that's  a  problem. If  they're  lying  to you  about  how  much  they're  playing,  you  know, you  have  a  problem  and  if  you  have  any  one  of  these, this  is  a  time  where  you  need  to intervene  before  further  consequences  happen. Yeah. You know, as  you're  describing  that  I was: number  one, my  kids  have  never  lied  to  me. Never?!  Children  lie? Oh that doesn’t happen.  But  there's  a  challenge  there  for  parents  too. Because, you know,  and this  is totally  personal  experience  where I  would  go  to  my  kids  and  I  would  say, “okay,  there's  the  limit. We're  not  doing  that  anymore.” And  they're  like,  Oh  my  gosh, you  think  I'm  going  to  be  a  terrible  person  because I  do  it  this  once.  And  it's  like  No. But  the  habitual  doing  of  that. And  kids  don't  necessarily understand  that  abstract  progression. They  see  what's  right  in  front  of  them. And  so  as  a  parent, to say “it  doesn't  matter  what  you  freak  out  about, I'm  not  going  to  let  you  do  this  so  hard.” I  mean,  this  is  very  challenging because  what  we're  talking  about  as well  is  being  able  to  self-regulate, being  able  to  have  that  impulse  control. And  we  know  that's  associated  to  a  region  in  our  brain, our  prefrontal  cortex, that  isn't  fully developed  until  somebody  is  in  their  early  20s. So  it  makes  it, the  impetus  is  even  harder  on  the  parents because  you  are  going  to  have  to  be the  individual  that  really  helps setting  these  boundaries  and  monitoring  them. Yeah,  that's  a  great  point  where the  brain  isn't  developed  to,  for that  capacity  yet  in  a  child  or  a  young  adult,  right? And  then  you  add  the  biological  dopamine hit  that  reinforcer  that. and  the  amazing  marketing, (Yeah) the amazing marketing  that  knows,  it's  going  to  suck  us  in. Wow,  Any  other  thoughts  and fascinating  conversation?  Carolyn,  love  it. It's  brilliant. Any  other  thoughts  and  what  you think  is  important  for  people  to  know. As  I  said,  this  is such  a  novel  and innovative  approach  that  we're  taking  here  in  Virginia. This  is  so  exciting  because  what  we're doing  here  with  our  state  agencies  is having  this  truly  what  we're  calling  it  as the  Partnership  for  Gaming  and  Gambling  Services. And this  is  a  partnership with  Virginia  Commonwealth  University, our  Department  of  Behavioral Health  and  Developmental  Services, the  Virginia  lottery,  as  well as  the  Virginia  Council  on  Problem  Gambling. So  we  have  this  unique  group  of  stakeholders  in  here looking  to  help  mitigate  problems  from  gambling. What  are  some  of  the  challenges  of  getting  the  word  out? Um, you know I  think  right  now, many  of  the  challenges  are getting  into  these  various  networks. People  are  tired. There's  often  time  constraints and  so  trying  to  get  people  to understand  that  we  need  to  make time  for  this  issue  as  well can  be  a  little  challenging. So  having  the  opportunity,  doing  things  like  this, it  really  helps  get  the  message  out  there. Fantastic.  Thank  you  so much  for  your  time.  I appreciate  it. Thank  you.


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