Speaking of Psychology - Will easier access to gambling mean more gambling addiction? with Shane Kraus, PhD, and Lia Nower, JD, PhD

Episode Date: July 26, 2023

It used to be that if you wanted to gamble, you had to go to a casino or a racetrack to do it. But the expansion of online gambling and newly loosened laws around sports betting mean that people can now place bets from just about anywhere. Shane Kraus, PhD, of the University of Nevada, Las Vegas, and Lia Nower, PhD, JD, of the Rutgers University Center for Gambling Studies, talk about whether that increased access could lead to an increase in gambling addiction, who is at risk, stigma around gambling, what treatments are available, and the increased exposure kids now have to gambling via ads and video games. This episode was supported by Babbel, get 55% off at babbel.com/apa. And, Rocket Money, learn more at rocketmoney.com/apa. For transcripts, links and more information, please visit the Speaking of Psychology Homepage.  Learn more about your ad choices. Visit megaphone.fm/adchoices

It used to be that if you wanted to gamble, you had to go to a casino or racetrack to do it. But the expansion of online gambling and newly loosened laws around sports betting mean that people can now place bets from just about anywhere. Unlimited gambling opportunities are just a few clicks away on your smartphone. Now psychologists and other researchers are investigating whether that increased access could lead to an increase in problem gambling. Gambling disorder is the only behavioral addiction recognized in the diagnostic and statistical manual of mental disorders. Do new opportunities for gambling mean that more people are at risk of developing it?

And who is at risk? Are there demographic personality or other factors that make people more likely to develop a gambling addiction? What treatments are available and what are the barriers people face in accessing treatment? What role does stigma play? And what will it mean that explains? to gambling is increasing not just for adults, but also for kids via sports, betting ads, and gambling in video games. Welcome to Speaking of Psychology, the flagship podcast of the American Psychological Association that examines the links between psychological science and everyday

life. I'm Kim Mills. We have two guests today. First is Dr. Leah Naur, a distinguished professor and director of the Center for Gambling Studies at Rutgers University. She's a clinician and attorney who specializes in gambling disorder and other behavioral disorders. Her research focuses on online gambling and video gaming, sports wagering, the causes in treatment of gambling and gaming disorder, and gambling-related policy issues. She's a member of the board of directors and chairs the Research Committee of the National Council on Problem Gambling and won that organization's 2019 Research Award and its 2022 Lifetime Research Award. She's authored several policy initiatives regarding responsible gambling and co-edited the book, The Wiley Blackwell Handbook of

Disordered Gambling. Next is Dr. Shane Krause, an assistant professor of psychology and director of the behavioral addictions lab at the University of Nevada, Las Vegas. He's a licensed clinical psychologist and an expert in behavioral disorders, including gambling disorder. He studies the factors that contribute to the development of addictive behaviors and other co-occurring disorders, especially in at-risk groups such as military veterans. He's also exploring effective screening approaches for identifying people with problem gambling. Thank you both for joining me today. Thank you so much.

Thank you. Let's start by giving listeners some context about how the landscape around gambling has changed in the last decade or so. I mentioned it's more available than ever. Dr. Naur, can you start by telling us briefly about why that is? What loss have changed and what other changes have? occurred to make gambling easier to access? Probably the major change has been overturning PAPSA, which was a law that prohibited, I mean, it did a lot of things, but it prohibited sports wagering in 2018.

And in response to that, New Jersey was the first state to actually, after Nevada, to actually start legalized online sports wagering, but a lot of other states have followed suit. Four years prior, New Jersey was one of the states that also initiated online casino gambling, which is in a murkier area and hasn't had as much uptake from the states. But those things have really opened accessibility to pretty much everyone from their smartphone. So let's talk about problem gambling. I mentioned in the introduction that gambling addiction is the only behavioral addiction listed in the diagnostic and statistical manual. What does that mean? What's a behavioral addiction and how is it different from other addictions? Dr. Krauss,

let's start with you on that one. Yeah, sure. Thank you. So I think, so as you know, gambling disorder is a, is a behavioral addiction. Substance use, I think this came through, you know, many years ago in 2013 when gambling was, went from pathological gambling to gambling disorder because of a really great scholarship and research kind of identifying those issues or really showing that it was addictive behavior. I think that it makes the reason it is an addiction or similar is because of the criteria are things like craving, loss chasing, failure to control oneself, really experiencing a lot of consequences. You know, many of the similarities that we see with addictive behaviors or substance use disorders, there's some slight differences, but really the hallmark symptoms are

similar. And that's been shown through really good longitudinal work, clinical work, research demonstrating that very similar patterns that gambling is an addictive disorder. And a behavioral addiction is just something that you don't have to ingest the substance in your body to have a change or an impact to your body. And in this case, gambling itself can have profound changes to your body as well as to your life, particularly when it's problematic. So I think that's kind of the changes. And right now, gambling disorder is the only behavioral addiction for DSM-5 TR.

so for treatment. So if you were to look at the brain of somebody with a gambling addiction problem in an fMRI machine, for example, would it look like the brain of somebody who is, say, addicted to methamphetamine? Okay. Yeah. So I would, yeah. What I would say is that there are differences, but there are greater similarities in how

cues or reactions or when we think about the, there's a dopamine or D3 receptor in the brain. I think there's a piece, the pathway looks similar between substance use and scambling. And it's actually one of the reasons it was reclassified. All substances are slightly different because of the pathway and how they react in the brain. So we can't say they're the same, but they're similar in a sense. The core ingredients, I would say from a neurobiological perspective are similarly there, which is why it was reclassified. One of the many reasons it was reclassified is addictive behavior.

So how someone experiencing a problem gambling might react to a cue or a gambling cue, a lottery, a slot machine, those reactions in their brain and how it lights up are similar to maybe someone who has substance use, who sees cues as well. So a little different, but also similar enough to say, yes, this is support for kind of a biological mechanistic relationship in the brain here for addiction. Dr. Nauer, let me ask you, do we know whether the increased availability of gambling, is actually leading to an increase in people developing gambling disorder, or is it still too soon for researchers to tell? It's too soon for this particular wave of sports wagering. However, what we do know is areas, and I'll use New Jersey where I am as an example, that have a lot more gambling opportunities, have higher rates. For example, our rate of high risk problem gambling in the state of New Jersey is 6%, which is three times what the last prevalence

national prevalence study said was the rate for the country. And what happens is as you have more availability, you have more acceptability and more accessibility. Over time, more and more people take it up, which means that very small percentage of people that are going to habituate and develop problems also grows. But it's a very, it's a slower process. We're not going to see this nationwide for, you know, another five to ten years. I would absolutely just agree that that's absolutely, I agree 100% with that response. I think when we look at other substance use disorders and other things, when we increase access to things, we generally see a pattern of increase of disorder or problematic use. It's just not immediate.

It's a slow kind of slow start. And I think what we are lacking right now systematically is epidemiological or really prevalence-based research for these, for gambling, for sports wagering, things like. that. I think we really don't have, I think we have some trends here in Nevada. We also have some trends with data we're collecting as well. But I think we really need to be really looking at this because we don't want to wait five years from now, as just discussed. And then suddenly we go, oh, we have some concerns here. That's kind of too long, I think, to really wait, given the wide expansion of sports betting, which is now in 38 states. And a year ago, two years ago, is 31. So it's drastically increasing. What are the biggest risk factors for

problem gambling. Are there demographic variables or personality traits or other things that put people at a higher risk? I mean, there's a lot of ideological factors, which is something that our group studies a lot of, childhood maltreatment, so abuse, neglect, exposure to trauma, experiencing trauma. There's certain personality variables like higher rates of impulsivity and risk-taking. There's a lack of active stress. coping styles such that certain subgroups of individuals use gambling to help them cope restress. And then there's also this intergenerational family modeling piece.

So one study that we did really sort of showed that people that were exposed to gambling in addition to other substances, they would increase their frequency, not just of that behavior, but of other addictive behaviors. And that then led to higher levels of problems. gambling severity. So what you see at home and what you participate in as a child, very predictive of your patterns as you get older. Yeah. And I would say that work in military, you know, we know a risk group, we see strong, robust relationship with exactly trauma history and childhood as well as PTSD, current trauma, many deployments, increased levels of mental health, other issues. So gambling disorder,

unfortunately often co-occurred with other behaviors or in other issues. It does not happen in isolation. So I think we see similar relationships. I would say, though, for sports betting and sports wagering that we're doing kind of our work is our labs also doing some work in this area. I think we're getting signals of younger under 30 male. I think there are some demographics that we need to be thinking about. And part of that is a technology.

Who's using the technology for gambling? And I think some of these technologies might be more used by younger populations. And that's not necessarily a bad thing. But what are the safeguards? How do we look at to make sure we don't have a problem developing for critically younger people? And this is what we're publishing and finding in our literature as well. So I do think we need to be thinking about these issues for online activity that we're. I don't know that we have all those answers yet.

I think that's true. I think with the emerging adult population, we just got the. Center of Excellence grant to look at emerging adults who gamble in a national prevalence study. So we're going to be able to tell whether or not there's higher rates in states that are gambling involved versus those that have less gambling. It might be interesting. It may not be, that may not be as much of a driver as we think it is. Dr. Krause, I know that part of your research is on developing effective screening methods for a gambling disorder. How much screening is done now in places like primary care doctors, offices, or other settings, and what does

effective screening look like? Yeah. So I think the short answer, the first answer is that there's not enough, right? So I'm not surprising. Oh, my gosh, there's really not a lot. I think there's just really not a lot of standard screening. I think you can screen. So we did a study a number of years ago in VA and veterans health care and primary care.

And we show that you can screen three items screeners, very effective and could be I don't think it takes a lot of time to screen. I mean, you can be screening in primary care in one or two minutes. The issue is we're not having conversations with medical providers, mental health providers, with people around problem gambling. This is why we call the hidden epidemic or the hidden issue, hidden addiction. So I think there really isn't standardized screening. I think some organizations, the VA, for example, Veterans Affairs, I think is really embracing more standardized screening.

That's a lot of our work that we're doing. It's a group that serves 10 million patients. So from my perspective, if I can make a big change, I'm going to make it in the largest healthcare organization in the country. And I think those are inroads that we're making. And I think we've established effective screening tools. The brief biosocial screening gambling screener is a BBGS is quite good. So I think there are effective ways, but I think getting people to be invested and realize,

wow, I need to screen my patients for gambling just like I do for alcohol, depression, suicide. It should be an annual screen given that people who have gambling disorder often go 10, 20 years before they get help after they really have had a lot of profound issues, you know, whether legal or, yeah, good, yeah. How do you get past people's tendency to basically lie? I mean, this is something that if, you know, you've lost the house, you're going to be feeling an awful lot of shame. So how can you screen for people who aren't going to tell you the truth? Well, so the veterans, Shane's group, they've done a fabulous job of really raising awareness in their population. I can tell you in the studies that we're doing, we've developed this short kind of gambling, what's called an expert, which is a very brief intervention to use in doctor's offices, you know, other settings. We've had that exact problem where if the word gambling is mentioned, so Shane mentioned the brief biosocial gambling screen, that mentions the word,

gambling. So we have had to adapt all of our materials such that people are asked about activities and only when they're locked into the activities do we then ask them questions about gambling because gambling is acceptable, but it's also highly stigmatizing to be a gambler. And people who buy lottery tickets or buy raffle tickets or whatever will say, well, I don't gamble because they don't want that label on themselves. So right now, I'd say things. are where alcohol was, you know, in the 50s and where cigarettes were in the 40s. We're really in the glamorized slash stigmatized stage right now. Yeah, absolutely.

Yeah. And that's part of our project was to train, you know, medical nurses and doctors and, you know, therapists just to ask these basic questions. And really, it wasn't that once they realized the importance of it. So when we found identified people with gambling, that almost all of them were sort of recital and had high risk that was unknown due to gambling. And they go, oh, when I screened for gambling and I do find it and I can treat someone who's high risk for suicide, suddenly it was like, oh, and best. So part of it is really that knowledge. But I think it has to happen from,

there are many reasons we need to change our attitude around, you know, providing free access to treatment for gambling, you know, in each state. And there's really, we have to have changed the culture around gambling, as, as mentioned earlier. It's just not there. So. And now here's a message from our sponsor. Do you know how much your subscriptions really cost? Most Americans think they spend around $80 a month on subscriptions, but the actual total is closer to $200. Maybe you downloaded an app just to watch one show, or you got lured in by a free seven-day trial, and then you forgot all about it. I know I've done that. If you have forgotten or have unwanted subscriptions, or if you don't know exactly how much you're spending every month, then you need Rocket Money. Rocket Money is a personal

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Cancel unwanted subscriptions and manage your expenses the easy way by going to rocketmoney.com slash APA. That's rocketmoney.com slash APA. RocketMoney.com slash APA. For our listeners who might be thinking about whether they buy lottery tickets or go online and do sports betting, what are the hallmarks of having a problem? How do you know when you've stepped over the line from, you know, I'm just an occasional gambler and this is kind of fun to this is a problem?

So, you know, it sort of starts with being preoccupied. You're thinking about it at times you should be doing other things. And then there are some symptoms that parallel substances like experiencing withdrawal when you're not doing it, having to gamble with more and more, you know, money to achieve the same level of excitement. There's also then more serious symptoms like you recognize you're doing this to escape from your problems, you're losing jobs, you're losing relationships, you're borrowing money in the form of bailouts from other people to pay your bills. So as it goes along, the symptoms get progressively. And then you're chasing your losses. So you go back another day to try to recoup the money that you lost the day before. And when you start to see these symptoms sort of pile up, you then know you're kind of moving across this spectrum toward disorder.

Yeah, absolutely. When I do trainings, I was just to jump to say that chasing losses is a big one. That's often the turning point when someone's like, oh, I'm going to go back the next day. I know I can win it back. That to me, I always tell people when you hear that, I want the hair in the back of your neck to stand up immediately. I think it's, yeah, that's what I literally say that in trainings. I think that's a big one. It's a turning point when you're losing more money than you can afford.

You know, when you're losing money, you can't afford to lose, really is when you're really having issues. What kinds of treatments and therapies are available to treat gambling disorder and how effective are they? I would just say that treatments for gambling work. I think there's a couple big issues, as mentioned, you know, we're kind of in the 50s, 60s, you know, for addictions. how we think about it. So stigma is a big thing. People don't want to, they have a lot of shame and stigma. We morally judge people for gambling if they have an issue. But if they have substance use, we go, oh, yeah, it's a brain disease and we have a little bit more. And I think that they're both addictions. We should not have that differential, you know, we shouldn't make a difference. So I think people often go a long time before getting help. But if they're engaged in treatment, we know evidence-based treatments, cognitive behavioral therapy can be very effective. We knew psychoeducation can be effective. We know groups can be effective. group therapy, gamblers anonymous. I think what matters is when someone's working towards treatment that's helpful. Treatment works, but gambling is an addiction.

It is people have to know that relapse is common. I always tell people, they're like, oh, I slipped. And I said, oh, well, thank you for being honest. And I expected that. This is part of the struggle. I think personally, our lab, we're looking more things like mindfulness-based relapse prevention or more kind of newer terms, helping people kind of slow down, connect with their body because gambling just doesn't happen. It's not automatic. It's a process.

So treatment does work and I always want people to have hope, but they also have to kind of, you know, disclose they have an issue and seek help and talk to someone. And I think there are many programs out there who will work with them. And I think it's important to find the treatment that works, but we know from really good established literature that brief treatments work. So, you know, sometimes a 45-minute conversation with someone who's early in having some issues can make some profound changes and that's a wonderful thing versus someone who might have had issues for many years. We're thinking about medication as well like an off-label medication for like an atrexone or something like that with psychotherapy right. So it's really about matching the treatment based on the

severity and where that person's at. And my goal is always get people very early and not 20 years later and I do both. But 20 years later is three divorces, homelessness, $200,000 in debt with often lots of issues rather than they're having some struggles. Let's hook them up right now. And so, yeah. And I also think it's important to identify the underlying risk factors that I mentioned before because what I've seen in my own practice and in my research is this addiction shifting where, you know, people can have the best gambling treatment, but then they're not telling anyone they've developed a sex addiction or they're, you know, they're binge eating to, so they're shifting these addictions and those things go back to these ideological risk factors like trauma,

like impulsivity, like these different things that if left unaddressed, you're just going to be, you know, moving the little shill under this shell to the other shell. So where can individuals go to get this kind of effective treatment? I mean, if most primary care physicians are not even screening, I would assume that they're also not not treating, but how do you get effective treatment? Well, it's state by state, sadly. I mean, this goes to, you know, what's lacking in the U.S., which I know is not an answer to this question, but if you ask it, I will, I have a lot of thoughts. But it's on a state by state basis. And so, and I'm just going to speak to New Jersey because that's where I live. I mean, we have one of the most robust networks, as you do in Nevada, where it's free treatment, not just for the person with the individual with the gambling problem, but also their families. you can get resources pretty much everywhere in the state. And now the state has begun certifying whole treatment centers to treat throughout the state multiculturally so that we're making sure we get, you know, people of different races, ethnicities, sexual orientations.

We have counselors who are going to meet people where they are. But some states don't even have free treatment. Yeah. Yeah, I was just going to say, I think if someone, the first thing, I think if someone's not sure, I think sometimes looking at their local place, I think the National Center, I think, for problem gambling, the NCPG. I think if you go to their website, you can search and we can give you some links on that. But, yeah, in Nevada, for example, I'm actually sitting on that board where we spent over $2 million a year for free treatment for problem gambling. And Nevada and New Jersey really lead this way.

And I think that should be standard. If a state has legalized gambling, they should be offering free treatment to the, individual, their families, their spouses, and their members because gambling affects spouses and family members and children. It's devastating, right? And I think Nevada is something that they do that. And so does New Jersey. Other states as well, California, there are other states as well. But it should be universal. I think if you're going to operate any gambling, there should be free treatment. And when we're, you know, when we're waging $15 billion for Super Bowl Sunday in one day, I don't think there's any excuses that the money's not there when Nevada spends about two

million, which I would argue we need a little bit more money. But I really think if we did this across the states, we're not looking at billions of dollars. I mean, really, there's plenty of funding there. And it's really quite unfortunate for that. But again, I think people, if they have insurance, they should be searching. I think most states have great programs that are doing problem gambling work and will connect people. So, but there's also some national organizations that if they're not sure, they can look

them up and they can type in their zip code and they'll find it right away. And we'll also send you some of some of them. links as well that we can provide on this podcast as well for folks. Yeah. And you want to make sure that whoever you go to is a certified gambling counselor. I mean, those of us that treat in this field have had to mop up complete messes from people who just are schooled in substance use counseling and don't know a thing about gambling. Now, it's not just adults who have increased exposure to gambling these days. Kids and teens do as well. And one thing I understand that you gambling researchers are interested in is video game loot boxes. Now, for listeners who aren't familiar with this term,

what are loot boxes? Lute boxes are little sort of prize. So let's say your child like mine begins on robox at a young age. Lute boxes pop up all the time. Do you want to skip levels? you pay a certain amount of robux if you want a particular sword or a particular item but there's usually a chance element to it like you're not sure which one you're going to get and some are worth a lot and it'll really help you and some aren't worth anything and in the more in the higher level games the adult games these things can cost a lot of money and you can then sell them on a secondary market and people spend thousands of dollars and this is gambling with and and children are primed at a very young age for loob boxes.

Yeah, I would say that. And some of the research, I think we need more really longitudinal research. We really kind of have to understand what's happening early in life course versus adulthood. But there's definitely some relationships, you know, more correlational but still important, that earlier loopbox kind of is kind of somewhat predicting or kind of related to a younger adulthood developing into gambling behaviors, which kind of keeps going. So this is where, you know, having these longitudinal designs are important. I would say I also have a young child.

He's almost nine. And I'm always surprised. We always travel. So we got those play arcades. And I remember arcades of my, I'm a child of the 80s. I'll just admit that. And the arcades of the 80s and 90s are very different to today. We're in so many of the games and arcades look very much like slot machines or acts of gambling.

And I think we're kind of mirroring that. And what does that mean for very young people? And we don't want to panic. But at the same time, we have a moral responsibility to be looking at that. And I think that's not necessarily happening as much as it should be. with really high quality research. Yeah. You've both done research on problem gambling and military veterans.

Why is that a group you're particularly interested in? Shane, you're the expert. I think I was, I think, you know, it actually just started years ago. When I was at the Bedford VA in Massachusetts, I started the behavioral addiction clinic there, the first one. I was kind of outpatient. And I started immediately getting these gambling veterans with gambling. And at the time, I was doing more of the work in compulsive sexual behavior and other areas and trauma. And I just said, wow.

And I realized there's not as much there are people like Dr. Heather Chapman, who's in Cleveland, VA, who's doing amazing work. And there's some really great folks in the VA. But I realized, wow, this is a problem. And then we started doing the research. And I said, well, let me start looking at the medical records. Let's start publishing. And we found, holy moly, there are problems, right? There really are some issues.

And I think it's that narrative with trauma. I think people go through really difficult things and they cope differently. And I think sometimes it's alcohol and drugs and cannabis and sometimes it's pornography or sexual behavior and sometimes it's gambling. And sometimes these things earlier in our life are not problematic. But when trauma and other mental health is intermixed, they become problematic. And I think veterans, given, have higher rates of trauma and other mental health disorders, depression, anxiety, other things. And, you know, divorces, separations, deployments. When you mix all that in, it's not really surprising.

The other thing is that they also have a lot of gambling on overseas bases. Each year of the bases make about $100 million in slot machines, of which none of the revenue goes for treatment or research, which I just want to put that out there, as I always say. So I think doesn't mean that necessarily people at 18, 19, 20 in the military developing a problem, but when they're under stress deployed away from family, we have seen many patients starting to have issues at a young age that continue throughout their once they discharge from the military. So I think we needed to be doing a better job of, you know, preventive and we're not, I think, right now. And the issue is that we see this all over in the VA and our publications demonstrate veterans have high rates of mental health and addictive disorders, including gambling, including pornography, sex, you name it, because I think of the trauma component. I think that's one of the key factors that, you know, has been discussed. I didn't realize that about slot machines on military bases. Is that being supported by our military?

I mean, are they the ones who are doing this or are they outsourcing this to contractors? So it's outsourced, but they, in a sense, it's for the military. It's for recreation and leisure. And they use the money internally on the basis overseas, not in the states. But there's really lack of prevention or education or psychoeducation happening. There's really not a lot of responsible gaming or gambling messaging happening. Yeah. So it's been happening for many years.

It's kind of a big secret. So whenever I tell people, I do these talks, I go, no way. And I said, oh, yes, yes, way. It's a big deal. A hundred million a year. And not a penny of it goes for treatment or for prevention. And I think give us five million of that hundred million and we can do a lot of good for our military. So, you know, just putting that out there.

Given the laws that we have right now, what's the most important policy change you think could be made to help mitigate the harms and protect people from developing gambling disorder? So this is my huge bandwagon. The federal government needs to take the hands off their eyes, their ears, and their mouth and get involved. The federal government gets enormous amounts of tax revenue from legalized gambling. But unlike in the UK, where there is a federal organization that oversees all these different regulations, et cetera, for gambling to have some uniformity, there is no presence at the U.K. There is no presence at the federal organization. that oversees all these different regulations, et cetera, for gambling to have some uniformity, there is no presence at the federal level. There is no money for, not a dollar for research. People like Shane and me, we have been very entrepreneurial to just stay in this field. A lot of people leave because there's money for alcohol, drugs, everything else, but not gambling.

And there's nobody regulating advertising. There's nobody policing operators are ensuring that there are standards that give the person a fair playing field. It's terrible. And it's my biggest sorrow is that we just have no federal presence. I would just say, yeah, absolutely, I couldn't agree with that more. It's just really, it's just really surprising, too, given the amount of revenue and the expansion of gambling. And you kind of think is kind of a preemptive, well, that's like, let's put some money into the research and prevention. Let's just make sure, you know, let's just spend, you know,

50 million expand free treatment just to prevent it because we know those with gambling disorder are more likely to kill themselves or more likely to have homeless. Everything you can think of, that's bad news bears, as we say, is good to happen, right? Partly because they go eight to 10 years before they tell someone, so they destroyed their life versus with substance use, if my patients are really actively using for four or five days and I see them, I go, hey, what's going on? I can tell something's up. But with gambling, you can walk to the slot machine or the casino lose $50,000 in a day and I can't tell. So this is why they're difference.

But I think with this massive expansion and a lot of revenue, it is really irresponsible at this point. And I think sports betting, the revenue from that is just, I mean, wow, even for me, I'm shocked at how much it is. And yet that isn't being, none of that's going back into kind of a new federal agency or some way regulatory body. And I think it's really irresponsible. And I do think in the next four or five years we're going to really might be paying for it.

And that's going to be, you know, and we don't need to be doing cleanup crew five years from now. We need to be preventing people from suffering rather than treating suffering later. I talked to a journalist from the UK and he said, when I look at the U.S., I feel like I'm watching a car crash but can't look away. And I thought that was a beautiful way of capturing it. So what are you both researching now? what are the big questions that you're trying to answer? Dr. Nower, you want to start with that one? So we do all the big data analysis on every bet placed in the state of New Jersey, even online or sports. So we're looking at trends, patterns, problematic play patterns, responsible gambling and harm reduction strategies.

We just got this grant from the International Center for Responsible Gaming, a Center of Excellence grant to look at, at gambling among emerging adults. So we're looking at genetics that are paired with these sort of ideological risk factors we've been talking about. We're doing a national prevalence study on emerging adults in highly involved versus lower, moderately involved gambling states. Gosh, we're trying to pilot this brief treatment that we're, that in like health settings, just a few of the things we're doing.

We're doing lots of stuff. Dr. Krause, what about you? Oh, same here. We're doing lots of stuff. So I think some of the big things we're doing with VA, so we're looking here, working with our local VA here. And this is Nevada, Southern Nevada healthcare system here. And we're looking at treatment. So we're looking at kind of psychopharmacology, in this case, Vivitrol or Nautroxone, with co-occurring substance use and gambling. Is that helpful?

We're also looking at mindfulness-based relapse prevention broadly for gambling, including substance use. It's been shown to be effective. We've published, you know, kind of a pilot on that, but we want to explore that. We're also doing some community-based work here, trying to understand really actually getting great data here in our community around barriers to care, why people don't get help in our community. Why? Because we know our population about it's growing and how do we increase Spanish-speaking services, lots of things. We really need to adapt. And so I think that's that.

Just doing a lot of, we also have sports wagering. ICRG has funded a grant. We're on year two now with my colleague, Dr. Joshua, jobs, University of New Mexico, and we're looking at, we're getting the fourth wave of data longitudinally on sports betting. So we're going to be hoping to look at risk factors for sports betting as well or wagering, particularly within groups, because we really need longitudinalal and kind of these epidemiological, you know, people say, well, how bad is it? And I don't know. And I don't know that like, like in Nevada, it's kind of amazing. Nevada hasn't had a prevalence

study. And over 20 something years, yet our population's tripled and, you know, our revenue is up. And it's great. It's a lot of positive things for Nevada. But yet, we don't, we need a prevalence. We need true accurate prevalence to understand our community and risk factors for a lot of people. So we don't have that. So that's what those are things we're working on. Well, this is all really interesting. I want to thank you both for joining me today. I think you've given us a lot of good information and I hope our listeners will find it useful. Thank you. Thank you so much. You can learn more about psychologists' research on gambling in the July issue of APA's magazine Monitor on Psychology. Go to www.apa.org slash monitor. You can find previous episodes of Speaking of Psychology on our website at www.w.combeatingof psychology.org or on Apple, Spotify, YouTube, or wherever you get your podcasts.

And if you like what you've heard, please leave us a review. If you have comments or ideas for future podcasts, you can email us. us at Speaking of Psychology at APA.org. Speaking of Psychology is produced by Lee Weinerman. Our sound editor is Chris Kondyian. Thank you for listening for the American Psychological Association. I'm Kim Mills.