Research has demonstrated that problem gambling is associated with substance and alcohol abuse (Petry, Stinson, & Grant, 2005), participation in criminal activities (McCorkle, 2002; Meyer & Stadler, 1999), and involvement in the criminal justice system (NORC, 1999). This study assessed problem gambling and its relation to crime and substance use within a population in which these risk factors are compounded: Adults mandated to participate in drug and DUI courts. Results indicate that the prevalence and severity of problem gambling may be higher within this population than any other. Furthermore, the results of qualitative and quantitative analyses converged to highlight that gambling, crime and substance use are interrelated behaviors, as each may lead to and/or reinforce the other. These findings suggest that problem gambling is a salient issue among substance-abusing offenders and that resources should be dedicated to screening those involved with the criminal justice system for problem gambling, establishing evidence based best practices in the prevention and treatment of problem gambling within this population, and that such practices may incorporate components addressing gambling, crime, and substance use.

Gambling is a very popular form of entertainment and socialization in the US and is generally considered a safe form of recreational activity. There is some evidence of associations between positive health outcomes, as well as poor behavioral and mental health conditions with gambling. However, the relationship between recreational gambling and risk health behaviors has been under researched and thus poorly understood. The 2011 Massachusetts Expanded Gaming Act provides the impetus to understand gambling related problems prior to the introduction of new gambling opportunities. The objectives of the study are twofold: (1) examine associations between recreational gambling and, behavioral and mental health disorders, (2) provide a description of health care services used and costs associated with pathological gambling and co-occurring substance use and mental health disorders. Study data was derived from the 2008 and 2013 Massachusetts Behavioral Risk Factor Surveillance System (BRFSS) as well as the All Payers Claim Data from 2009 to 2013. This study finds significant associations between recreational gambling and co-occurring behavioral and mental health conditions which include nicotine use, alcohol abuse and poor mental health status. These findings persist with increasing risk when gambling is dissected by frequency which suggests that the overall assessment of gambling participation tends to obscure related health risks. Further, individuals with pathological gambling are important consumers of health care; they utilize a variety of use a variety of health care services and health care institutions. Approximately $1.9 million (in 2013 dollars) was spent from 2009 - June 30, 2013 on patients with pathological gambling and co-occurring substance abuse and mental health disorders. Total average expenditure was estimated at $491.0 (in 2013 dollars). Study findings provide critical baseline information on the risk factors of co-occurring conditions associated with recreational gambling as well as health care utilization patterns and costs associated with pathological gambling prior to gambling expansion in Massachusetts. These findings have significant public health implications for the need for increased surveillance of gambling related problems.

Over the past 30 years there has been a dramatic increase in the availability of convenient and legal gambling opportunities. Most people can reach a casino in a matter of a few hours, lottery tickets in minutes, or an online gaming site in seconds. Accompanying this proliferation of gambling is a growing understanding that between 5% and 9% of adults experience significant to severe problems due to their gambling activities. These problems have become a real health concern, with substantial costs to individuals, families, and communities. The objective of this book is to provide the clinician or graduate student with essential information about problem and pathological gambling. After placing this behavioral addiction and its co-occurring difficulties in perspective, by describing its proliferation, the associated costs, and diagnostic criteria and definitions, the authors present detailed information on a strategy to assess and treat gambling problems in an outpatient setting. They go on to provide clear and easy-to-follow intervention guidelines, including homework assignments, for a brief and cost-efficient cognitive behavioral approach to problem gambling, involving stepped care and guided self-change. Means of countering problems and barriers to change and vivid case vignettes round off this thorough, but compact guide for clinicians.

Problem gambling currently affects between 5-7% of youth ages 12-18 (Hardooon & Derevensky, 2002); however, rates of problem gambling among youth who are involved with the Juvenile Justice System are more than twice that of school sample rates (Lieberman & Cuadrado, 2002). Furthermore, disordered gambling often co-occurs with substance use and criminal activity (Huang & Boyer, 2007), issues that are compounded in the Juvenile Justice population. The current study assessed gambling behaviors and risk factors of 145 youth involved in juvenile, juvenile drug, and family courts. Results indicated that nearly 13% of these youth are currently problem gamblers, and that males and African-Americans had higher problem gambling rates than female and Caucasian youth. Furthermore, gambling-related crime, substance use, scope of gambling activities, and time in detention facilities were all predictive of problem gambling severity, while suicidal ideation, urban environment, and lottery sales per capita were not. Finally, having a parent with a gambling problem also emerged as a risk factor; however, the risk was greater for males than for females. These results present a distinct need for youth to be screened for gambling problems upon entering and exiting the Juvenile Justice System, and for prevention and intervention services to be offered within juvenile and family court settings. Furthermore, communities need to take an active role in preventing youth gambling problems through increasing public awareness and insuring that appropriate and accurate messages reflecting gambling opportunities and outcomes are presented.

Estimates indicate that as many as 1 in 4 Americans will experience a mental health problem or will misuse alcohol or drugs in their lifetimes. These disorders are among the most highly stigmatized health conditions in the United States, and they remain barriers to full participation in society in areas as basic as education, housing, and employment. Improving the lives of people with mental health and substance abuse disorders has been a priority in the United States for more than 50 years. The Community Mental Health Act of 1963 is considered a major turning point in America's efforts to improve behavioral healthcare. It ushered in an era of optimism and hope and laid the groundwork for the consumer movement and new models of recovery. The consumer movement gave voice to people with mental and substance use disorders and brought their perspectives and experience into national discussions about mental health. However over the same 50-year period, positive change in American public attitudes and beliefs about mental and substance use disorders has lagged behind these advances. Stigma is a complex social phenomenon based on a relationship between an attribute and a stereotype that assigns undesirable labels, qualities, and behaviors to a person with that attribute. Labeled individuals are then socially devalued, which leads to inequality and discrimination. This report contributes to national efforts to understand and change attitudes, beliefs and behaviors that can lead to stigma and discrimination. Changing stigma in a lasting way will require coordinated efforts, which are based on the best possible evidence, supported at the national level with multiyear funding, and planned and implemented by an effective coalition of representative stakeholders. Ending Discrimination Against People with Mental and Substance Use Disorders: The Evidence for Stigma Change explores stigma and discrimination faced by individuals with mental or substance use disorders and recommends effective strategies for reducing stigma and encouraging people to seek treatment and other supportive services. It offers a set of conclusions and recommendations about successful stigma change strategies and the research needed to inform and evaluate these efforts in the United States.

Motivation is key to substance use behavior change. Counselors can support clients' movement toward positive changes in their substance use by identifying and enhancing motivation that already exists. Motivational approaches are based on the principles of person-centered counseling. Counselors' use of empathy, not authority and power, is key to enhancing clients' motivation to change. Clients are experts in their own recovery from SUDs. Counselors should engage them in collaborative partnerships. Ambivalence about change is normal. Resistance to change is an expression of ambivalence about change, not a client trait or characteristic. Confrontational approaches increase client resistance and discord in the counseling relationship. Motivational approaches explore ambivalence in a nonjudgmental and compassionate way.