March 2020

March Problem Gambling Awareness Month; Language of Recovery; No need to panic

savvy

One of the still too neglected manifestations of addiction is Gambling Disorder. So in recent years in honor of March Problem Gambling Awareness Month, I’ve had guest writers raise our awareness about gambling.

Daniel J. Trolaro, Assistant Executive Director, The Council on Compulsive Gambling of New Jersey shares information on video games, E-sports and skin gambling; and George Mladenetz writes about the importance of and the use of language within the addiction and recovery field.

TIP 1

How are video games and gambling related? – Loot Boxes

Loot Boxes are sometimes known as crates, supply drops, treasure chests, bundles; or in sports games are often called ‘card packs’. They contain digital goods allowing players the chance to obtain special items. They can be thought of as a ‘virtual grab bag.’  See more in the March 2018 edition.

Whatever they are called, loot boxes are often purchased with real money and give the game player an opportunity to receive something of value – or not. In the U.S., loot boxes are completely unregulated. There is not even a warning label that a game contains loot boxes. In the United States loot boxes are not considered gambling because these virtual chests always contain something. This lends itself to the argument that purchasing a loot box is a transaction rather than a wager.

However, this ignores a fundamental concept of video game play. Video game characters are limited in the number of items that may be carried. If a player receives an item in a loot box that is of lesser relative value than the items his character already possesses, the item from the box will typically be left right where it was discovered. The player is out the cost of the loot box but has effectively gotten nothing in return.

  • The mechanism of loot boxes is random number generation. Random number generation is the same mechanism at play in modern slot machines.
  • Slot machines are highly regulated, certified and even randomly inspected. Loot boxes are completely unregulated.

Tip 2

Be aware of video game and E-sports gambling

Websites exist where people can go to gamble on video game play. A bettor makes a deposit into a website. The deposit is converted from money to betting credits and the player can then bet on tournaments or even professional players who might be in Europe, the U.S., Asia or anywhere else. On these sites, gamblers can view current odds for tournaments and leagues.

  • People can gamble on video games such as Counter Strike: Global Offensive, Dota 2, League of Legends, World of Warcraft, Starcraft 2, FIFA Soccer, and lots of others.
  • The E-sports market was valued at $900 million in 2018 and is expected to grow to $1.79 billion by 2022.
  • E-sports fantasy – Gamblers can form leagues, draft players to form teams and then characters are awarded points for performance similar to fantasy football or baseball.

Tip 3

What is Skin Gambling?

Skins are decorations for video game characters or weapons and often have no effect on game play. Video game players covet skins because they occur in various states of rarity. Some are rare. Some are common. In some games like Dota 2 or Counter Strike: Global Offensive, players can:

  • Trade skins between each other or even export skins from a game and sell them on a third-party website.
  • Players can also gamble with and for skins.
  • Skins might be used as a sort of currency themselves, like poker chips, or skins might be the potential payout for a wager.

Tip 4

Notice how gambling is becoming more like video games

The phrase used is ‘gamification’ of gambling. Many of today’s gamblers grew up playing video games and there is a push to capture new customers by offering exciting new ways to gamble.

Today’s gamblers are more interested in storylines, unlockable content, variety of levels, and even avatars to represent themselves. Skill-based casino games are taking steps to bring more challenge to the world of gambling. Imagine shooting robots for money or racing virtual cars against artificial intelligence or against other casino patrons – perhaps while other patrons watch and wager on your prowess.

  • In 44 states, individuals can place some type of bet via the internet.
  • Social casinos are not technically gambling. Wagering is either done for free or cannot be cashed out – this is a 4 billion dollar per year industry.
  • 26 states are currently considering expanding either online casino gambling, daily fantasy sports, or online lottery.
  • Virtual Reality Gambling will allow players using Samsung Gear VR or Oculus Rift to walk around a virtual casino and even gamble in a virtual world.

Contact information:

Daniel J. Trolaro, Assistant Executive Director

The Council on Compulsive Gambling of New Jersey

Dan.Trolaro@800gambler.org

skills

Here is George Mladenetz’s contribution:

TIP 1

Consider the Language of Recovery and Why it is important to be mindful of it

Language of Recovery:

  • This means “person first.” A pioneer in the field of disordered gambling, the late Dr. Rena Nora, a psychiatrist with over 25 years of experience, would often preface her presentations to addiction professionals with this statement: “Treat people as people.”  
  •  Individuals with gambling disorder and/or other addictive disorders were people before their addiction became an issue.

Why is it important to use Language of Recovery?

  • Words have power – “They have the power to teach, the power to wound, the power to shape the way people think, feel and act towards others.” (Otto Wahl)
  • Clients with gambling disorder and/or other addictive disorders often present having low self-esteem, feel devalued and stigmatized.
  • The language spoken by clinicians often can empower clients to believe in themselves, realize they have strengths and reinforce their ability to maintain recovery.
  • The “addict” label suggests the whole person is the problem rather than the problem being the problem.
  • By continuing to use terms like “degenerate gambler”, “addict” or “alcoholic”, treatment providers are doing a disservice to their clients and potentially negating progress toward destigmatization and successful long-term treatment.

TIP 2

Be mindful of stigma associated with gambling disorder and/or other addictive disorders

Impact of Stigma:

  • Remember the time when individuals who were affected by substance misuse and also mental health disorders were labeled as “Mentally Ill Chemical Abusers” or “MICA” clients? Additionally, these individuals were often referred to a self-help group whose meetings were called “Double Trouble Meetings.” Clearly, there was much less awareness of the powerful nature of stigma at that time.
  • More research is needed in this area; however, it is known that stigma and shame have been identified as major barriers to help-seeking for disordered gamblers. (Gainsbury, Hing & Suhonen, et al. 2014).
  • Experiencing stigma  can prevent people from seeking treatment for a mental health condition, as well.
  • Decreasing stigma can encourage people to successfully seek and complete treatment
  • Michael Botticelli, former Director of the White House Office of National Drug Control Policy, has emphasized that reducing stigma allows family and friends of those affected by addiction to provide better social support and ensure their loved ones seek treatment.

TIP 3

Be aware, be proactive regarding the language of recovery

Here are some suggestions:

  • Watch your language! Learn the language of recovery.  
  • Be aware of your own attitudes and biases.
  • Public education for stigma reduction to change attitudes.
  • Demystify treatment and recovery, e.g., invite the community to “open houses” held by your program
  • Check the name of your program – Is it recovery oriented?

TIP 4

Remember, the language of recovery is evolving

Here are some changes we are beginning to see:

  • Gamblers Anonymous (GA) members appear to be using less stigmatizing language in their meetings, e.g., the term “degenerate gambler” is used less often.
  • Some GA members have even noted changes in the way individuals speak at meetings with less “gambling stories” and more focus on the steps, making changes, spirituality, the focus being on recovery not just abstinence.
  • Gam-Anon, a twelve-step fellowship for the family members/loved ones also appears to have begun to incorporate the language of recovery.
  • Members are beginning to introduce themselves as “I’m ___, wife of ____, who has a gambling disorder, using “person first” language.
  • This allows the member to feel less stigmatized, thus enhancing their own recovery.
  • Gam-Anon’s International Service Office has included “The Language of Recovery” in their literature and is available to Gam-Anon members. 

Bio:

George Mladenetz worked in the addiction and mental health fields for over 30 years within the NJ Division of Mental Health & Addiction Services. George possesses a Master’s degree in Counseling from The College of NJ. He has been licensed as a Clinical Alcohol and Drug Counselor since 2005 and is also an International Certified Gambling Counselor-II. As Treatment Coordinator for The Council on Compulsive Gambling of NJ since 2014, George monitors the operations of over 20 gambling treatment providers who serve problem/disordered gamblers and family members. In addition, he assists in providing the 30 hour gambling specific training in NJ. George’s experience in gambling addiction helped him realize that stigma is often seen as a barrier keeping individuals from seeking treatment and also negatively impacts the family/loved ones of disordered gamblers.  

References:

1. Central East Addiction Technology Transfer Center Network. Anti-Stigma Toolkit: A Guide to Reducing Addiction-Related Stigma, 2012.

2. Hing,N., E.Nuske, S. Gainsbury, A. Russell. Perceived Stigma and Self-Stigma of Problem Gambling: Perspectives of People with Gambling Problems. International Gambling Studies, Vol. 16, Issue 1, 2016.

3. Massachusetts.gov The Official Website of the Office of Health and Human Services. State Without Stigma. Retrieved from “Stop Addiction; State Without Stigma,” 2012.

4. Office of National Drug Control Policy. Changing the Language of Addictions. Announcement for Public Comments, 2016.

5. Southeast Addiction Technology Transfer Center Network. The Most Respectful Way of Referring to People is as People, 2016.

6. Wahl, Otto F. Telling is Risky Business. Rutgers University Press, 1999.

soul

Yesterday, I had a slightly sore throat and runny nose, itchy eyes and coughed a couple of times. With all the coronavirus COVID-19 worries, it crossed my mind, is this the beginning of the dreaded virus?

So like a lot of people, I checked Dr. Google and found just what I was looking for:

Allergies vs. Coronavirus: Here’s How to Tell the Difference

Here in northern California, we are well and truly into spring allergy season. It’s going to hit 80 degrees farenheit today and there’s pollen everywhere. So I figured, it’s just allergies. But I was reminded of my November 2019 edition of Tips and Topics, SAVVY, TIP 1 on “Observations in India and implications for behavioral health services and systems.”

I wrote: “the fear of the unknown, the worry of more serious developments, and the pressure to not be sick on a vacation were all more energy-draining than the actual maladies.”

That’s what the world is facing now – fear of the unknown and worry about getting sick and making other people sick. I’m sure you have access to a lot of resources, but here’s one that I found helpful and it gets updated regularly:

Don’t Panic: The comprehensive Ars Technica guide to the coronavirus [Updated 3/11]

Last November, I continued:

When I was in the throes of my symptoms, I struggled to have positive expectations and hope, which made the situation worse.

Or said another way in the Ars Technica guide: “Now is not the time for panic, which will only get in the way of what you need to be doing. While it’s completely understandable to be worried, your best bet to getting through this unscathed is to channel that anxious energy into doing what you can to stop SARS-COV-2 from spreading.”

So join me in accepting the the fact that COVID-19 is here; do whatever we can to stay healthy and not spread the virus; and get informed with the wisdom to know what you can and cannot change.

That sounds like a familiar prayer

January 2020

Frustrations, frustrations – what kind are they and what to do; visioning a new year and decade

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December 2019

Thinking beyond medication; “Just give me medication”; consumerism and loving yourself

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November 2019

Lessons learned from my journey to India and Japan; travel tips; Laughter Meditation; Sharing Solutions

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October 2019

Two STUMP THE SHRINK questions on passive compliance and substance use while in treatment; customer-focused and friendly

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September 2019

What are social determinants of health? Aging providers and the next generation

Welcome to the September edition of Tips and Topics (TNT). My heartfelt thanks to the many readers who took the time to write and share their support and feelings about the August all-SOUL edition.
This month in SAVVY, the focus is on social determinants of health.
In SKILLS, it is important to assess and include social determinants in treatment planning, not as an afterthought or “discharge planning” task.
In SOUL, a guest contributor asks “how do we capture our faith, skills and experiences in order to share and pass them along to the next generations of professionals?”

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August 2019

All SOUL – grief, loss, and moving forward. Perspectives from my children and me.

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July 2019

Behavior Contracts – the good, the bad and how to move away from them; Surpises about food and the environment

In SAVVY, we focus on the advantages and disadvantages of Behavior Contracts.
In SKILLS, I invite you to delete Behavior Contracts from your clinical toolkit.
In SOUL, I was shocked to learn that that a quarter of the world’s greenhouse gas emissions come from putting food on the table.

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June 2019

What to do about addiction clients with prescribed, potentially addictive medications; Pickleball anyone?

In SAVVY and STUMP THE SHRINK, I respond to a question on what to do about psychiatric prescriptions for benzodiazepines and amphetamines in addiction treatment.
In SKILLS, assessment needs a skilled clinician who is savvy about addiction and mental illness who can evaluate specific diagnostic and treatment questions.
In SOUL, I was introduced to Pickleball and now exercise could actually be fun for me.

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May 2019

Lying and dishonesty in Treatment Courts and what to do; using ACCEPT with dishonesty; update on my grief process.

Welcome to the May edition of Tips and Topics (TNT). A special welcome and thanks to those readers who have been with me from the beginning and wrote to express their appreciation through all the years.

In SAVVY and STUMP THE SHRINK, I respond to a question on what to do about lying and dishonesty in Drug Courts – what is the role of sanctions?

In SKILLS, what is the role of treatment and judges and court teams when participants lie? Using ACCEPT as a structure to guide what to do.

In SOUL, I update where I am in my grieving process. It helps me to reflect and I hope helps you understand grief too.

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April 2019

What to do with poor outcomes: ACCEPT; my top 10 “Unvarnished Truths”

Welcome to the start of the 17th year of Tips and Topics (TNT). Most of you were not a reader from Day 1 when I started writing TNT, April 2003. If you were, please write and let me know.
In SAVVY, I’m introducing an acronym to help think through what to do when a client, patient or participant is not doing well in treatment – ACCEPT © David Mee-Lee 2019.
In SKILLS, what is a poor outcome for your client in addiction treatment?
In SOUL, whether you are thinking about retirement or not, “21 Unvarnished Truths about Retirement” is a worthwhile list from which I highlight my favorites.

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