Work in Progress – Malmo June 2005
Problem Gambling and SuicideA Deadly Game
PREPARED FOR:
Work in Progress6 th European Conference on Gambling
Studies and Policy IssuesBrian Carlson BSc; MSW; CPGC
Centre for Addiction and Mental HealthProblem Gambling Project and Service
Brian CarlsonProblem Gambling Project
CAMH2
Work in Progress – Malmo June 2005Stretch your mindWhat are the Odds??
• Choose a number between 1 and 10• Multiply by 2• Add 8• Divide by 2• Subtract original number• With A=1; B=2; C=3 and so on think of a country
whose name begins with the corresponding number• Got it! Now think of an animal whose names begins
with the second letter of the country’s name.
Brian CarlsonProblem Gambling Project
CAMH3
Work in Progress – Malmo June 2005
Brian CarlsonProblem Gambling Project
CAMH4
Work in Progress – Malmo June 2005
Why did gambling expand??
To generate revenues for government
To stimulate the economy
To assist certain populations (First nations, etc.)
To rehabilitate areas & to rebuild cities
To stimulate tourism
To reduce illegal gambling
Brian CarlsonProblem Gambling Project
CAMH5
Work in Progress – Malmo June 2005
Gambling Overview
• Ontario (2003)• Casinos 10• Lotteries ~ 83• Racetracks (Slots) 16• Online Bingo Halls 70• Revenues $5.5 Billion
• Canada (2000)• Casinos ~ 50• Slot Machines ~ 21000• VLT’s ~ 38,000• Bingo Events ~ 20,000• Racetracks ~ 44
Brian CarlsonProblem Gambling Project
CAMH6
Work in Progress – Malmo June 2005
New Ontario Gaming Strategy
• No additional commercial or charity casinos• No additional racetrack slot facilities• No VLT’s• No slot machines in Bingo Halls, etc• No involvement in Internet gaming.
Brian CarlsonProblem Gambling Project
CAMH7
Work in Progress – Malmo June 2005
New Ontario Gaming Strategy
• Customer service centres staffed by problem gaming counsellors
• $4 million for problem gaming public awareness
• Education and training programs for retailers and employees
Brian CarlsonProblem Gambling Project
CAMH8
Work in Progress – Malmo June 2005
Some Features of Problem Gambling
• Competitive/energetic/restless/easily bored
• Prone to stress-related illnesses
• Distortions in thinking re: gambling ability*
• High rates of suicidal ideation / attempts*
Brian CarlsonProblem Gambling Project
CAMH9
Work in Progress – Malmo June 2005
Gambling Related Suicides
National Council of Welfare 1996 report:
• Attempts by PG more frequent than general population
• Attempts more common with PG than other addictions
• Survey of GA (US) – 48% considered and 13% attempted
Brian CarlsonProblem Gambling Project
CAMH10
Work in Progress – Malmo June 2005
Tracking Suicides• ~ 4000 Canadians die by suicide each year• 11.7 deaths per 100,000 people• 10.7 United States • 10.1 United Kingdom• 13.4 Sweden• 12.1 Norway• 14.3 Denmark• 38.7 Russian federation• 14.5. World rate
Brian CarlsonProblem Gambling Project
CAMH11
Work in Progress – Malmo June 2005 TrackingGambling Related Suicides
• 2002 – only eight provinces asking questions about gambling when investigating suicides
• 2003 – Coroners from across the country agree to track suicides related to gambling
Brian CarlsonProblem Gambling Project
CAMH12
Work in Progress – Malmo June 2005
Gambling Related SuicidesCanada
• Nova Scotia - 6.3%• NL - 6%• ON - 6 deaths • Manitoba -12 cases• BC - 1 case• QUE – 129 cases• AL – 9.5%
• Estimates
• Safety Council 360 –400
• Newspapers - 85
Brian CarlsonProblem Gambling Project
CAMH13
Work in Progress – Malmo June 2005
Why the Increasing Numbers???• Financial stresses• Relationship issues• Work related problems• Legal concerns• Hidden• Sudden realization• Total desperation
Ensuing mental health issues
Brian CarlsonProblem Gambling Project
CAMH14
Work in Progress – Malmo June 2005
Problem Gambling, Mental Health& Suicide
What’s The Connection?• Reduce feelings of loneliness and depression
• Depression as a result of gambling
• Reoccurring bouts of depression & anxiety
• Downward Spiral
Brian CarlsonProblem Gambling Project
CAMH15
Work in Progress – Malmo June 2005
Problem Gambling and Mental Health
• 92% -Major psychiatric disorder (LT)
• 54% - Psychiatric disorder (T of T)
Brian CarlsonProblem Gambling Project
CAMH16
Work in Progress – Malmo June 2005
Problem Gambling and Anxiety
– 3x higher rates of anxiety disorders
– 5x higher rates of agoraphobia
– 6x higher rates of OCD
Brian CarlsonProblem Gambling Project
CAMH17
Work in Progress – Malmo June 2005
Problem Gambling and Depression
• 50-75% -experienced depression (Inpatient)
• 20% - depression after stopping gambling
Brian CarlsonProblem Gambling Project
CAMH18
Work in Progress – Malmo June 2005
Indicators of SuicideEmotional
• Desperate
• Angry
• Sad
• Ashamed
• Guilty / Worthless
• Lonely
• Disconnected
• Hopeless / Helpless
Brian CarlsonProblem Gambling Project
CAMH19
Work in Progress – Malmo June 2005
Indicators of Suicide Behavioral
• Putting affairs in order
• Withdrawal from friends
• Impulsivity
• Giving away possessions
• Loss of interest in hobbies
• High-risk behaviours
Brian CarlsonProblem Gambling Project
CAMH20
Work in Progress – Malmo June 2005
Indicators of SuicidePhysical
•Lack of interest in things
•Disturbed sleep
•Lack of physical energy
•Loss of sexual interest
•Increased substance use
•Adverse life situations
•Lack interest in appearance
•Talk of successful suicides
Brian CarlsonProblem Gambling Project
CAMH21
Work in Progress – Malmo June 2005
Indicators of SuicideCognitive
• “All of my problems will end soon.”
• “No one can do anything to help me now.”
• “I just can’t take it anymore.”
• “I wish I were dead.”
• “Everyone will be better off without me.”
• “I can’t do anything right.”
• “How could I be so stupid!”
Brian CarlsonProblem Gambling Project
CAMH22
Work in Progress – Malmo June 2005
Assessing Suicidal RiskRisk Factors used to estimate Suicide Risk:
7 Age6 Gender5 Stress
4 Symptoms3 Resources
2 Prior Suicidal Behaviour1 Current Suicide Plan
Brian CarlsonProblem Gambling Project
CAMH23
Work in Progress – Malmo June 2005
Suicide Intervention
Assessing Risk:– Current Suicide Plan– Prior Suicidal Behaviour– Resources
These are the 3 highest risk factors (immediate) when people are contemplating suicide.
Brian CarlsonProblem Gambling Project
CAMH24
Work in Progress – Malmo June 2005
How to respondDo:
Be availableBe attentive, sincere Be respectfulTell them you care
DON’T:Be judgmentalDon’t give advice or lectureDon’t leave them aloneDon’t interrogate
Brian CarlsonProblem Gambling Project
CAMH25
Work in Progress – Malmo June 2005
Intervention Techniques
• Internal Resources• Self – esteem
• Self – confidence
• Coping skills
• Problem Solving abilities
• Employability
• Others….
Brian CarlsonProblem Gambling Project
CAMH26
Work in Progress – Malmo June 2005
Intervention Techniques• External Resources
• Emergency ( short –term ) supports
• Long term
• Lifetime
Brian CarlsonProblem Gambling Project
CAMH27
Work in Progress – Malmo June 2005
Survivors of Suicide• Usually experience
– Shock– Guilt– Denial– Shame– Self-blame– Depression– Stress– Despair– Overwhelmed
Brian CarlsonProblem Gambling Project
CAMH28
Work in Progress – Malmo June 2005
Family Members
Brian CarlsonProblem Gambling Project
CAMH29
Work in Progress – Malmo June 2005
Canadian ResourcesCanadian Association on Suicide Prevention http://www.suicideprevention.ca.
Understanding Suicide Prevention – Canadian Mental Health Association-Wellington Dufferin Branchhttp://www.cmhawdb.on.ca/suicide.htm
Suicide Information and Education Centrehttp://www.suicideinfo.ca/
For further local resources for Ontario check the following website: http://www.suicideinfo.ca/csp/go.aspx?tabid=86
Brian CarlsonProblem Gambling Project
CAMH30
Work in Progress – Malmo June 2005
International Resourceswww.who.int/mental_health/prevention/suicide/country_reports/en/index.html
www.suicide-helplines.org 51 Countries
www.befrienders.org 15 Languages
www.survivorsofsuicide.com
September 10, 2005 WORLD SUICIDE PREVENTION DAYInternational Association for Suicide Prevention(Co-sponsored by the WHO)
Brian CarlsonProblem Gambling Project
CAMH31
Work in Progress – Malmo June 2005
Thank you !!