Denise F. Quirk, M.A.

Focus on the Future: Evergreen Council on Compulsive Gambling Training

May 8, 2019

• Marriage and Family Therapist

for 27 years (qualified listener)

• Grandmother, Mother, Wife,

Daughter, Sister, Friend

• Recovering person and

advocate for others in recovery

• Instructor, speaker, trainer,

supervisor, leader

• Spiritual warrior, knitter, book

club nerd, shooter, golfer,

choir member, birder, and

more.

▪No Seniors, Elders, or Older Adults were harmed in the making of this presentation

▪Nothing is being sold

▪ Information was gathered from personal observations and research

▪References will be cited and shared

▪Your involvement and ideas are important for success, diversity, and harmony!

▪ “Beyond the Game: Nevada Seniors & Problem Gambling” was created by the Council and a Prevention Specialist at UNR to share what Seniors in Nevada were experiencing in 2007.

▪ The concepts are still powerful and true. Some of the elders have passed. They were sponsors in Gamblers Anonymous who gave their time freely to produce this video.

▪ Please notice the “V-Chart” being discussed. It was created by Dr. Bob Custer, the founding father of gambling treatment, in the late 1970’s.

▪ We still use the V-Chart today in treatment as a valuable tool to share what gambling addiction and recovery can look like.

▪ Use this video courtesy of the Nevada Council. It can be found on their You Tube channel. You may also order the DVD and discussion booklets from them at nevadacouncil.org.

▪When sharing gambling information with elders, how do you approach them?

▪What kind of environment would you choose?

▪Will there be food?

▪How would a follow-up discussion be started?

▪Who would you want to present this?

▪What is your “why” for bringing prevention information to your elders and families?

What do you

notice about

“then” and

“now?”

➢ Remember

➢ Tell stories

➢ Visit birthplace

➢ Eat familiar food

➢ A little excitement

➢ Dress up (or down)

➢ Visit friends

➢ See, hear, taste, smell, feel

➢ A nice room that someone else

cleans up

❖ We connect to those with

whom we feel shared

beliefs, common interests,

and trust

❖ We like familiar people,

places and things

❖ We have a sense of

security and control

❖ We rely on what others

suggest to be important

❖ We are sometimes lazy and

would rather let others

decide

▪We have our own attitudes, beliefs, and opinions about gambling and casinos, and we don’t take a stand for or against gambling.

▪We treat the disorder along with the shame or judgment that has hurt our clients.

▪ So what? Now what?

▪Older Adults:

▪The “Lonely”

▪Single

▪Bored

▪Widowed

▪Retired

▪Disabled

The neural bases of cognitive processes in gambling disorder

▪ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4112163/

top down active view

Skill Chance

Sports Betting Lottery

Blackjack Bingo

Craps (dice) Roulette

Live poker Slot machines

Video Poker

What do you know ? Prior gambling experience / knowledge

What are you seeking ?

ACTION ESCAPE

Camaraderie Anonymity

Competition Isolation

Aim is to Win Aim is to Play

Thrills /

Excitement

Relief /

Forgetting

Heightened

sensation

Dulling of

feeling

Profile of a Nevada Gambling Woman “Jane Median”

▪51-year-old, married, white, employed mother

▪Started gambling at 23, gambled 20 years, problem for the last 7

▪Biggest one-day win $5,000, biggest one-day loss $1,500, total loss $25,000

▪Presenting problem: Finances

Profile of a Nevada Gambling Woman “Jane Median”

Prior counseling, prior GA

Suicidal ideation

Level of education: 13 years

Non-smoker, not bankrupt (yet), No legal issues (yet)

Game of choice: Video Poker

Not

Immediacy of payout

Increasing size / frequency of

bets

Isolation

Illusion of skill / control

Emo

ProblemG.A. Hope

This Is Worth the 115 Pages!▪“Linking Older Adults with Resources on Medication, Alcohol, and Mental Health”

▪https://store.samhsa.gov/system/files/sma03-3824.pdf

▪ The most common screening tool for substance misuse is the CAGE questionnaire, which focuses on the potential for alcohol dependence. The CAGE was later adapted to assess for alcohol and other drugs and called the CAGE-AID. The CAGE-AID contains the following 4 questions:

▪Have you ever felt that you should Cut down on your drinking or drug use?

▪Have people Annoyed you by criticizing your drinking or drug use?

▪Have you ever felt bad or Guilty about your drinking or drug use?

▪Have you ever had a drink or used drugs first thing in the morning to steady your nerves or to get rid of a hangover (Eye opener)?

▪“Gambling disorder in older adults: a cross-cultural perspective”

▪ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4369430/

▪ Now, anyone, anytime, can gamble without supervision

▪ What else do you notice? What else does this elder need/want?

▪

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4146436/

What “age” were

you raised in?

Many of our elders

were raised with the

idea that medicine

from doctors equals

health.

Inviting a person to

choose healthy foods

and natural ways

towards fitness and

health may require

extra marketing, bright

colors, juicy

presentation.

As told to Denise Quirk

by a friend who is an

“Aging and Addictions”

counselor and teacher

How would you know what

you’re taking?

How would you know what

your elders are taking?

What are some ways to

help be an accountability

partner?

How would you discuss

natural healing methods

with your elders?

Does your elderly family

member use massage for

healing?

Do you use massage or body

work in your life or your

practice? How often? Is it in

your budget?

How would you help your

elders achieve more success

in addressing the needs of

their bodies?

We produce natural opiates.

Endorphins, dynorphins and

enkephalins are produced during

intense exercise and other

pleasurable activities, such as

sex.

Endogenous opiates along with

dopamine play pivotal roles in the

brain’s reward system, so that we

enjoy oxytocin and bonding as

much as we do food.

When outside opiates (man-made opiates such as heroin, morphine, fentanyl, oxycontin, oxycodone, hydrocodone, tramadol, codeine, etc.) are taken over an extended period of time, the body decreases production of endogenous opiates (natural feel-good hormones: the receptors and the molecules themselves).

Studies in humans and animals show that when ingested opioids are stopped, the production of endogenous opioids does not resume quickly, and might never return to its prior status.

▪ 40-50% of adults over age 65 report chronic pain.

▪ Use of opioids increases the risk of falls and fractures in elders.

▪ Elders are prescribed 1/3 of all prescription medications; often without adequate workup and indications for the medications they take.

▪ 19% of men and 23% of women take at least 5 prescription medications.

▪ As Baby Boomers age, there is an increase in elders with substance-use disorders.

▪ By age 85, 35-50% of elders will have some form of dementia.

▪ Short-term memory loss is associated with inaccurate medication administration, so early dementia diagnoses are frequently missed: our elders may look and sound “fine.”

▪ Saint Louis University Mental Status Exam (SLUMS), which is used by the Veterans Administration

▪ Montreal Cognitive Assessment (MOCA) is available online at:

https://www.parkinsons.va.gov/MOCA-Test-English.pdf

▪ For possible co-occurring Geriatric Depression: The Geriatric Depression Scale https://web.Stanford.edu/~yesavage/GDS.html

▪ Always remember to triage for co-occurring medical problems

~ The most common reason an elder develops an opioid use disorder is that they were started on opioids for a medical problem. It is the clinician’s job to slowly ascertain the origin of the appropriate use for the medicine and what led to a disorder, non-judgmentally.

▪ Monitor MSE’s regularly, and make appropriate geriatric referrals.

▪ Avoid combinations of sedating medications (esp. benzodiazepines) with prescription sleeping medications.

▪ Test for other potential substances of misuse, including alcohol.

▪ Encourage maintenance of the elder’s list of medications to be updated and carried with them at all times, including dosages and why they take them.

▪ Check the PDMP for your state. (Prescription Drug Monitoring Program)

▪ If cognitive deficits are already occurring, employ strategies to ensure accurate medication administration: reminder calls, nurses aides, or more.

▪ Get releases and coordinate care with family and all medical providers. All elders need advocates and support.

“I’ll just ask

my grandson

to show me

how….”