Effects on the Family of the Elderly Gambling Addict
High Run a risk Recreation — Problem Gambling In Older Adults
By David Surface
Social Work Today
Vol. nine No. 2 P. 18
Busloads of elders commute daily to the casinos. For some, it is harmless fun; for others, it is an invitation for trouble.
For many decades, the stereotypical concept of what a gambler looked like has been dominated past images culled from movies and television: the swaggering tough guy in a tuxedo at the blackjack tabular array, the middle-aged human with a cigar in his oral fissure at the racetrack. As gambling has get more accessible and adequate in our culture, our awareness of who gamblers really are has too broadened to include immature and old akin.
A 2008 study conducted at Wayne State University examining the motivations among older adults for participating in casino gambling reveals that they gamble for both extrinsic and intrinsic reasons. While extrinsic reasons include winning money and supplementing income, intrinsic reasons include entertainment, being effectually other people, lark from everyday problems such as loneliness and boredom, and escaping feelings of grief and loss associated with the decease of a loved 1 or close friend.
People are more likely to develop a gambling problem when they're coping with major life changes or losses. The sudden social isolation that can come with retirement, the increased sensation of physical limitations that accompany aging, and the grief afterwards the death of loved ones constitutes an overwhelming number of difficult life transitions that make older adults peculiarly vulnerable to developing gambling problems. In addition, many older adults may hide their gambling problem due to shame and social stigma, while reduced contact with friends, family, and coworkers can make the signs of problem gambling hard to spot, creating the ingredients for a formidable issue that social workers working with elders must address.
Casinos: The New Senior Centers?
Fayetta Martin, MLS, MSW, DL, is an banana professor at Wayne Land University whose current research focuses on women's gambling behavior and treatment barriers for older women with disabilities. She is also interested in older women with and without disabilities who gamble and how gambling addiction is associated with other mental wellness and substance use disorders among older Americans.
Martin kickoff became interested in problem gambling among older adults in 2004 during her postdoctoral piece of work, which was funded past the National Plant on Drug Abuse at the George Warren Brown School of Social Work at Washington Academy in St. Louis. What surprised Martin was not merely how many older adults have an addictive human relationship with gambling but the extent to which the gambling industry appeared to enable the problem.
"During my research and visits to the casinos, I noticed that the casino was supplying older adults with scooters and wheelchairs," Martin recalls. "Many even provided oxygen. In the bathroom, there were boxes for diabetics to dispose needles. Older adults told me stories of how the casinos always remember their birthday, and if they stayed away too long, the casino would send them a card saying that they were missed."
Of course, casinos are not the but businesses that make a witting effort to market gambling to elders. Today, older adults can find plentiful opportunities to gamble in senior centers and retirement homes where bingo nights and poker clubs are frequently role of standard activities.
While gambling'southward temptation can accept a powerful event, gambling solitary doesn't depict older adults to the casinos; every bit with other addictive behaviors, the social experience can exert an equally strong attraction.
Lia Nower, JD, PhD, an associate professor and the director of the Center for Gambling Studies at the School of Social Piece of work at Rutgers University in New Jersey, points out how shame is non the but motivating factor for older adults who hide their gambling trouble. "For those in senior centers who have bus trips to the casino, poker clubs, and bingo nights, i reason for them to hide their problem is because this is their social outlet," Nower explains. "They're alone and isolated, and this provides some chemical element of camaraderie."
Nower describes a phenomenon that may also concenter older adults to gambling. "Some elders say that when they're gambling, they don't discover their hurting," says Nower. "This is something that'due south been said to me past a lot of treatment providers who specialize in older adults, that they are not as preoccupied with their physical discomfort when their minds are disengaged that mode."
"At whatever given hour at the casino, yous find older adults," says Martin. "Just this by weekend I was at the MGM [1000 Casino] in Detroit counting the number of people who appeared to be over lx who were on the slot machines at ii in the morning. I would say five out of x were older adults, by and large women. 1 lady who was in a wheelchair told me that the casino for her was a safe identify, and when she was at the casino, nobody noticed the fact that she was in a wheelchair."
Risks for Older Adults
In some ways, the risks of problem gambling for older adults are the aforementioned equally those faced past younger gamblers—a sudden, devastating loss of financial security and accompanying legal troubles. But older adults with gambling problems likewise have unique risks. Reduced cognitive chapters among some elders tin can make it difficult for them to brand sound decisions. Also, older adults living on a fixed income with limited savings can't necessarily beget the financial drain of a gambling disorder.
Nower describes a related trouble that should concern social workers. "The law limits the 'await back' period for qualifying financially for a Medicaid bed in a nursing home," Nower explains, "Though rules vary by state, if you've divested yourself of a sizeable portion of your assets within the last five years, you may not be eligible for Medicaid. And the police doesn't distinguish between gifts to relatives and gambling losses. Imagine an older adult who loses their savings and even so they can't qualify for a Medicaid bed."
In a recently published study, Nower and her colleagues institute that older adults were nigh probable to ban themselves from casinos because of their fearfulness of suicide.
"When you're younger, maybe yous're $100,000 in debt, but you've got your spouse, you've got your children, your job; you lot all the same accept some reason to get upward in the morning," Nower says. "If you're an older adult who lives on a fixed income and now you don't take enough money to pay for your Medicaid bed, why would you lot desire to go up tomorrow?"
Problem Behaviors, Problematic Definitions
The ability of mental health professionals to diagnose and treat any behavioral trouble has always been afflicted (and often express) by the current definition of the problem. This is particularly true of addictive behaviors, and gambling is no exception.
Like other addictive behaviors, such every bit alcohol and drug addiction, gambling has historically been thought of equally a character flaw signifying a lack of moral strength or willpower; in other words, information technology'due south something that but "bad" or "weak" people do.
Today, trouble gambling is all the same identified by terminology that came in use in 1980: "pathological gambling." According to the DSM-IV-TR , there are 10 criteria for pathological gambling, including a preoccupation with gambling, the demand to gamble with increasing amounts of coin to accomplish the desired excitement, lying to others to conceal the extent of the interest with gambling, and committing illegal acts such as forgery, theft, or embezzlement to finance gambling. 5 out of the 10 criteria are required for a pathological gambling diagnosis.
Martin believes that this current definition of pathological gambling has serious drawbacks. "The quantitative framework of DSM-4 diagnosis requires that people be separated into two groups—either pathological gamblers or nonpathological gamblers," says Martin. While this type of diagnosis is conspicuously defined and allows clinicians to communicate with one some other and make treatment result comparisons across cases, Martin believes it also excludes a lot of information.
"If at that place are variations inside the groups," Martin says, "information technology may lead to overinclusion or inaccurate diagnosis of people who practice not take serious gambling bug." More than alarmingly, the 5-out-of-10 criteria definition of pathological gambling may also leave people with destructive gambling problems undiagnosed. "It does not include people who neglect to come across the five criteria," explains Martin. "This group would not exist diagnosed equally pathological gamblers but may be serious problem gamblers, creating exactly the same social issues in their surrounding environment."
Many professionals in the field have been lobbying for changes in the DSM-Four definition of problem gambling, and Nower is 1 of them. "Pathological gambling is categorized with impulse control disorders like kleptomania, chronic fire setting, hair pulling—things that don't really seem a lot like gambling," she says. "Gambling is a behavioral addiction. We need a reconceptualization of addictive disorders, looking at them every bit substance and nonsubstance based or behavioral disorders."
Co-ordinate to James Loree, LMSW, ACSW, CAAC, of the Center for Habit and Relationship Recovery in Okemos, MI, there are many negative consequences of the current definition. "The fact that pathological gambling is located in the DSM-4 as an impulse control disorder seems to undermine the severity of the addiction, the demand for valid recognition and accurate reimbursement past insurance companies, and deliberate and proactive diagnosis by clinicians," he says.
Identifying the Problem
According to Martin, gambling should exist identified as a trouble when it disrupts, amercement, or limits a person's life. Signs of problem gambling that Martin points out for inclusion are spending more money on gambling than intended; feeling bad, distressing, or guilty about gambling; not having enough money for food, rent, or bills; existence unable to account for blocks of fourth dimension; experiencing social withdrawal; and experiencing feet or depression.
While these signs of trouble gambling apply to all age groups, they may be more difficult to place in older adults. Older adults may try to hide or deny a gambling problem, they may feel hopeless or ashamed almost the situation, or they may be unaware that help is available. In addition, because older adults tend to have less contact with friends and family, gambling-related problems may get unnoticed.
"With a substance abuse disorder, you tin can tell when someone'due south intoxicated," Nower points out. "But with gambling, you can't come across it in their eyes or smell it on their breath. It'south very easy for someone to become hundreds of thousands of dollars in debt and maintain a façade that there are no problems."
Perhaps the greatest obstruction to identifying problem gambling among older adults is their unwillingness to seek handling. "There is a stigma in older adults that's attached to any type of addictive behavior," says Martin, "specifically, those behaviors that are seen as a moral vice or a failure of willpower."
Martin advises that social workers employ an indirect, nonconfrontational approach when attempting to determine when an older customer has a gambling problem.
"If you call up that an older developed may accept a trouble with gambling," Martin advises, "first past asking a few questions like, 'What practice you do for fun?' 'Exercise yous always play bingo or the lottery?' 'Do you ever go to the casino?' Then, if the person says that he or she does gamble regularly and seems willing to talk about information technology, enquire them what they like about going to the casino or playing the slots, bingo, or the lottery. Then enquire them if there'due south anything they don't like nearly it. The way older adults answer these concluding questions may suggest that they spend more than they feel they should, or that they wish they could finish but need to win first. 1 can then mention that y'all have heard that gambling tin cause problems for many people and that some social workers specialize in helping people with gambling-related problems."
Social workers should also be aware of the possibility of problem gambling in whatsoever professional setting they observe themselves in, including those involving older adults.
"If yous're a social worker and you work in a facility that treats drug and alcohol addiction, you should always screen for gambling problems," Nower advises. "If you work in an [emergency department] where people come in with drug-related problems, you lot should screen for problem gambling. If y'all're a social worker who works at a senior eye and your senior center sponsors casino trips or poker night, you lot should likewise be actively sponsoring programs to educate older adults in the dangers of gambling and dispel some of the myths. Nosotros need to provide prevention at every opportunity, particularly since a majority of older adults won't seek out assist on their own."
Treatments: Not One Size Fits All
Existing treatments for trouble gamblers largely follow a uniform cognitive behavioral therapy model that, co-ordinate to many in the field, does not take into account particular differences between varying groups of people—and older adults are no exception.
According to Nower, any constructive therapy for older adults must adjust for the fact that older trouble gamblers are oftentimes motivated by grief and loss issues. "I think that any treatment for older adults has to involve pain, grief, loss, a sense of meaning, hopelessness," says Nower. "These are issues that older adults deal with."
Feelings of abandonment, most oftentimes by one'south own children, frequently provokes problem gambling in older adults who've been placed in assisted living facilities. Nower recalls 1 example: "I had an older adult tell me one time, 'You know, I never heard from my son until I started squandering his inheritance, and then, suddenly, he was very interested in me—and that made me all the more determined to spend every single dime.'"
Social Work Teaching: A Wider Focus
While social workers are ordinarily trained to identify substance abuse, depression, anxiety, and other concerns, problem gambling is not an effect often addressed in social work educational activity.
Nower agrees: "Social workers are not being trained to identify this problem at all. There are just two universities in the country that offer education in problem gambling. Both Rutgers and the University of Pittsburgh accept programs to train counselors in trouble gambling." Of those two, merely Rutgers has problem gambling as an official role of its curriculum.
Fortunately, there seems to be some motion toward addressing this. "I was at the Hartford Partnership Program for Aging Didactics concluding February in New York," says Martin, "and the dean of [the University of] Albany School of Social [Welfare], Katharine Briar-Lawson, [MSW, PhD], stated in her presentation to a room full of social workers that problem gambling amongst older adults needs to become a priority amongst social workers and schools of social work."
Loree pulls no punches when describing the inequity of the situation: "Unfortunately, gambling makes billions of dollars in revenue for the casinos and others, while millions of Americans face up bankruptcy, relationship conflict or divorce, low, fines, incarceration, or lost time by becoming addicted to gambling. The consequences touch on every level of our existence, yet students today know well-nigh nothing about information technology. I'd like to see trouble gambling as a current events topic to be addressed past habit and behavioral health curriculum worldwide."
The Importance of Empathy
Given that the older adult population is poised to undergo unprecedented growth, social workers can look to encounter problem gambling among their older clients with increasing frequency. How then should social workers best prepare themselves to deal with this event?
"Social workers working with older adults with gambling problems must testify empathy," says Martin. "They cannot be morally opposed to gambling. They must exist active listeners. They must be nonthreatening and nonjudgmental. But most essential, social workers must realize that older adult clients need to exist met where they are, not where the social worker wants them to be. Social workers can help add quality of life to the years older adults have left, and that is well worth the endeavour."
— David Surface is a freelance author and editor based in Brooklyn, NY. He is a frequent contributor to Social Work Today.
Screening For Gambling Disorders
James Loree, LMSW, ACSW, CAAC, of the Center for Addiction and Relationship Recovery, provides the following list of diagnostic tools for social workers and other behavioral wellness professionals who are interested in screening clients for gambling disorders:
• The National Stance Research Center DSM Screen for Gambling Issues is widely used by clinicians to demonstrate a client showing problem gambling as evidenced past a score of 3 or 4 and pathological gambling with a score of 5 or more.
• The Southward Oaks Gambling Screen is a legally valid instrument that asks more than specific questions than the National Opinion Research Middle DSM Screen, yet it is still relatively brief.
• The DSM-IV-TR lists 10 criteria to diagnose pathological gambling (five of which must be met for the diagnosis) and is coded as 312.31 nether the Impulse Command section; currently, no DSM-IV diagnosis for trouble gambling exists.
• Finally, the Lie-Bet tool is a 2-question screen that whatsoever wellness professional tin can incorporate into an assessment or conversation with a client to reveal if a more comprehensive gambling assessment is warranted.
PDF versions of the above screening tools are bachelor on the National Problem Gambling Awareness Web site at www.npgaw.org/tools/screeningtools.asp.
Source: https://www.socialworktoday.com/archive/031109p18.shtml
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