Gambling, Gaming and Fantasy Sports—the Holy Trinity of Fun

Gambling,GamingandFantasy
Sports—theHolyTrinityofFun
KirkMoberg,MD,PhD,FASAM
ExecuDveMedicalDirector,UnityPointIllinoisInsDtuteforAddicDonRecovery
ClinicalProfessor,Depts.ofInternalMedicineandPsychiatry&Behavioral
Medicine
UniversityofIllinoisCollegeofMedicine
30thAnnualMeeDngoftheNaDonalCouncilonProblemGambling
Tarrytown,NY
July14,2016
Whatwe’regoingtotalkabout
Discusspre-historyandhistory
Discussprobabilityandgames
Discussneurobiology
Discusshowgamblingisdifferentfromgaming
intheDSMcontext
•  Haveabitmoreofanopendiscussionon
fantasysports
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Gambling
Theactofwageringsomeofvaluefora
chancetowinsomethingofgreatervalue
Givecreditwherecreditisdue
Grantand
Potenza,2008
Givecreditwherecreditisdue
AparDculary
goodbook
Mazur,2010
Gambling
CasDnglots
Astragalus
Knucklebones
CasDnglots
RoyalGameofUr
Mesopotamia
2600-2400BCE
Indiandice
3rdmilleniumBCE
Therules
Romandice—1st-3rdcenturyACE
Ancientliterature
Jonah1:7-Andtheysaideveryonetohisfellow,Come,andletuscastlots,thatwe
mayknowforwhosecausethisevil[is]uponus.Sotheycastlots,andthelotfell
uponJonah.
Acts1:26-Andtheygaveforththeirlots;andthelotfelluponMa^hias;andhewas
numberedwiththeelevenapostles.
FromthesebythecasDngoflotswasIchosentofarehitherward.Argeiphontesto
Priam,Iliadbook24,line400.
LiberdeLudoAleae
“TheBookonGamesofChance”
GerolamoCardano,publishedposthumously1663
Mazur,2010
OnCasDngtheDie
TheDieisCast
Suetonius
Modern
AlCapone
Frank
“thePrimeMinister”
Costello
PercepDon
Gamblingdisorderor
Ludomania
“gamemadness”
0.5%adults(1.5million)
Men>women
SAMHSA,Summer2014
Legalizedgambling:
places
LasVegas
Gamblingoutlawed1909
Gamblinglegalized1931
Frank‘Leky’
Rosenthal
BorgataCasino,2003
AtlanDcCity,NewJersey(1976)
Sam‘Ace’Rothstein
Itallstartedinamobilehomein1972
ItascaCounty
HelenandRussellBryan
Chippewa
$147.95—propertytaxes
RussellBryanv.ItascaCounty
June14,1976
AssociateJusDceWilliamJ.Brennan,Jr.
UnitedStatesSupremeCourt
AppointedbyDwightEisenhowerin1956
InterpretaDon
NotaxaDonNoregulaDon
SeminoleTribev.Bu@erworth
1981
RobertBuTerworth
SheriffofBrowardCounty
CaliforniavCabazonBandofMission
Indians(1987)
AssociateJusDceByronWhite
AppointedbyJohnKennedy,1962
Mazur,2010
IndianGamingRegulatoryAct—1988
•  ClassI—tradiDonalandsocialgambling(minimal
prizes)
•  ClassII—bingoorcardgamesbetween
individualsbutno“house”
•  ClassIII—casinogaming
–  Mustbelegalinthestate
–  CompactnegoDatedbetweentribeandstatethatis
approvedbySecretaryoftheInterior
–  Tribemusthaveatribalgamingordinanceapproved
byChairmanoftheNaDonalIndianGaming
Commission
From$147.95to$27billionperyear
Mys[cLakeCasino
PriorLake,MN
PriorLake
BlackBearCasino(landpurchasedbyChippewa)
Duluth,MN
OwnedandoperatedbyFondduLacBandofLakeSuperiorChippewa
Riverboatgambling:alegalficDon
Timeline
Statesapprovedriverboatcasinoswhenboatswerecruising.Boatshadtocruise
theMississippioritstributaries(Illinois,Indiana,Mississippi,IowaandMissouri)—Iowa
wasfirst4/1/1991
Boatsnotrequiredtoleavedockorhaveacaptainorcrew.
BoatscanbebuiltonsDlts.
Insomestatescasinoscanbebuiltonlandwithinacertaindistancefromawaterway
(especiallysinceHurricaneKatrina).
NewOrleans
Berngagainstthehouse
1821NaDonalLo^ery
$100,000=$1.8M
ByJanuary1,1894loTeriesillegalforthenext70years
Mazur,2010
StateLo^eries
44states,DC,PuertoRico,USVirginIslands
1974
Nolo^eriesin:
Alabama
Alaska
Hawaii
Mississippi
Nevada
Utah
Berngagainsteachother
Pari-mutuel
playerscompeteagainsteachother
1
$60.00
2
$140.00
3
$24.00
4
$110.00
5
$220.00
6
$94.00
7
$300.00
8
$80.00
Amountwagered
on
eachoutcome
Thewinner!
Totalpool=$1028Eventbegins:nomorebets
Pari-mutuel
$1028x0.15(15%commissionrate)=$154.20
$1028-$154.20=$873.80
$873.80/$110=$7.94returnper$1.00wagered
Win,placeorshow
Racing
Offtrackberng
Horseracing,dogracing
Sportsbernglegal
Hopefully,somethingswillneverbelegal
Authorized
Types
Cardrooms
Lo^ery
Legalbookmaking
Commercialcasino
Pari-mutuel
Bingoand
Charity
Tribal
Revenue
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Cardrooms—1.18billion
Commercialcasinos—34.41billion
Charitablegamesandbingo—2.22billion
Legalbookmaking—168.8million
Lo^eries—24.78billion
NaDveAmericancasinos—26.02billion
Pari-mutuelwagering—3.5billion
TOTAL—92.27billion
Statesthatallowall
Statesthatallownone
Statesthatallowcasinogambling
statewide
ConsideraDons
•  Skillvs.Chance
•  AllgamblersonequalfooDng—nohouseodds
ornohouseincome(Trueoddsv.Houseodds)
•  Amountofmoneyinvolved
•  Place
Whatdoweknow?
•  WeknowlessaboutprocessaddicDonsthansubstance
usedisorders.
•  Weknowmoreaboutgamblingdisorderthanthe
otherprocessaddicDons.
•  Dopamine,achemicalthatplaysaroleinchemical
addicDons,alsoplaysaroleingamblingdisorder.
Thereisevidenceforinvolvementofother
neurotransmi^ersaswell.
•  ThemesolimbicandmesocorDcalsystemsareinvolved
inbothchemicalandgamblingdisorders.
•  Parkinson’sdiseasepaDentsprovideaninteresDng
modeltostudysomeprocessaddicDons.
DSM-5DiagnosDcCriteria
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RequiresfourormorecriteriafromcriteriaA
CriteriaA.
–  Needstogamblewithincreasingamountsofmoneyinordertoachieve
desiredexcitement
–  IsrestlessorirritablewhenaTemp[ngtocutdownorstop
–  Hasmaderepeatedunsuccessfuleffortstocontrol,cutbackorstop
–  Isoeenpreoccupiedwithgambling
–  Oeengambleswhenfeelingdistressed
–  Aeerlosingmoney,oeenreturnsanotherdaytogeteven
–  Liestoconcealtheextentofinvolvementwithgambling
–  Hasjeopardizedorlostasignificantrela[onship,job,oreduca[onalorcareer
opportunitybecauseofgambling
–  Reliesonotherstoprovidemoneytorelievedesperatefinancialsitua[ons
causedbygambling
CriteriaB.
–  GamblingisnotbeTerexplainedbymania
Severity
•  Mild—4-5
•  Moderate—6-7
•  Severe—8-9
OpDcs
ClinicalSimilariDes
Earlyageofonset
Chronicrelapsingpa^erns
Toleranceandwithdrawal
Inabilitytoabstainor“cutdown”
PersistentusedespitenegaDveconsequences
Tensionorarousalbefore(anxietyvs.excitement)
Reliefduring(“high”)
Manyresolveontheirown
ProbabilitydiscounDng(goingforlarger,lessprobable
reward)
•  AltereddelaydiscounDng(goingforimmediate,smaller
rewards)
•  Telescoping
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Grantetal.,2010;Koretal.,2013
Manyresolveontheirown
FyodorDostoyevsky
TheGambler
Falsebeliefs=CogniDvedistorDons
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Gambler’sfallacy
Chasingone’slosses
Nearmiss
SupersDDons
Lawoflargenumbers
TheoreDc—expectedvalue
ExperienDal—asthenumberofeventsincreasethe
actualaveragevalueapproachestheexpectedvalue
Gambler’sfallacy
Odds1:6
1+2+3+4+5+6
6
=3.5
Co-morbidiDes
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28%workingcompulsively
26%spendingcompulsively
38%disorderedeaDng
60.4%nicoDnedependence
49.6%mooddisorder
41.3%anxietydisorder
60.8%personalitydisorder
SomedefiniDons
•  Reward(reinforcement)
•  Vulnerability(riskfactors)
•  NeuroplasDcity(learning)
THEREWARDSYSTEM:
THECORE
MESOCORTICALANDMESOLIMBIC
Functionally…
Dopamine D2 Receptors are Decreased by Addiction
DA D2 Receptor Availability
Cocaine
Meth
Alcohol
Heroin
Control
Addicted
Individual Differences in Response to Drugs: DA
Receptors influence drug liking
High DA
receptor
high
Low DA
receptor
low
As a group, subjects with low receptor levels found MP pleasant while those
with high levels found MP unpleasant
Adapted from Volkow et al., Am. J. Psychiatry, 1999.
Compulsiveuse
Socialuse
Neuropsychopharmacology (2008) 33, 166-180
doi:10.1038/sj.npp.1301564
KalivasandO’Brien,2008
PFC=Prefrontalcortex
NA=Nucleusaccumbens
VP=Ventralpallidum
BLA=Basolateralamygdala
VTA=Ventraltegmentalarea
1.  Moredopaminereleasedasa
resultofaddicDvedrugs.
2.TolerancedevelopstobiologicalsDmuli*
KalivasandO’Brien,2008
Nucleus
accumbens
UpregulaDon
yields
toleranceto
effects
Increaseand
decreasedrug
reward
KalivasandO’Brien,2008
IniDalexposure
Tolerance
SiteofacDon SocialtoRelapsing
AccumulaDon
ofproteins=
neuroplasDcity=
learning
Repeated
exposure
Vulnerabilitytorelapse
IniDalvulnerability
KalivasandO’Brien,2008
1.decreased
2.increased
3.Spiny
projecDons
NA
Dysregulatedglutamaterelease
KalivasandO’Brien,2008
Muni[onsforeman
PhineasGage
Cavendish,VT;Sep13,1848
Delaydiscoun[ng=prefersmalleramountnowasopposedtolargeramountlater
Ventro-medialprefrontalcortex
Text:BrewerandPotenza,2007
MRIScansofHealthy
ChildrenandTeensOverTime
GM loss = maturation
Copyright ©2004 by the National Academy of Sciences
Gogtay, Giedd, et al. Proc. Natl. Acad. Sci., 2004
Neuroanatomicalhypothesis
Cilia2010and2011
•  Isgamblingdisorderaneuraldisconnec[vitydisorder?
•  3popula[ons
–  Parkinson’sdisease+gambling(group1)
–  Parkinson’sdiseasew/ogambling(group2)
–  Normalcontrols(group3)
•  SinglePhotonEmissionComputedTomography(SPECT)
•  Normalconnec[onbetweenanteriorcingulatecortexand
striatum
–  Anteriorcingulatecortex—errordetec[on(visualizedbyincreasing
ac[vity)—losing
–  Striatum—shiesbehaviorinthecontextinincreasingerrors—
stopping
•  Shieingstrategyabnormalingroup1
•  Conclusion:behaviorsdon’tchangedespiteerrors
Cingulate=errordetec[on
Striatum=appropriateresponse
PossibiliDes
•  UnderacDvityoftherewardcenter
•  OveracDvityoftherewardcenter
•  UnderacDvityoftheexecuDvefuncDons
(increasedvulnerability)
•  DisconnecDvityhypothesis
Implicatedneurotransmi^ers
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Norepinephrine—arousalandexcitement
Serotonin—impulsecontrol
Dopamine—rewardingandreinforcingaspects
Opioids—pleasuresandurges
CorDsol—stressresponsiveness
Glutamate—cogniDvefuncDoningand
flexibility
Potenza,2013
Isgamblingdisorderadopamine
deficiencydisorder?
•  Lowdopaminelevelsmaybebaseline
•  Lowdopaminelevelsmaybetheresult
•  …andtheresultsareequivocalingambling
Joutsaetal.,2012;Probst&Eimeren,2013
Wheredoesdopaminefitin?
•  Rewarddeficiencyhypothesis
–  VulnerableindividualshavelowD2receptordensityand
haveaneedforstrongreinforcers.
–  Blumetal.,1996.
•  Sensi[za[ontheory(salienceaTribu[onresultsin
dopaminerelease)
–  Vulnerableindividualsaresensi[zedtotriggersandcues
aeerrepeateduse.
•  Robinson&Berridge,2008.
•  Impairedresponseinhibi[onandsalienceaTribu[on
–  LowD2receptordensitycreatesandismaintainedby
salienceaTribu[on.
•  Goldstein&Volkow,2002.
Reuteretal.,2005;Grantetal.,2006;Grantetal.,2010;vanHolstetal.,
2010,Karim&Chaudhri,2012;Probst&Elmeren,2012;Grantetal.,2013;
Potenzaetal.,2013;Potenza,2013
Salience
Wheredoesdopaminefitin?
•  Rewarddeficiencyhypothesis
–  VulnerableindividualshavelowD2receptordensityand
haveaneedforstrongreinforcers.
–  Blumetal.,1996.
•  Sensi[za[ontheory(salienceaTribu[on)
–  Vulnerableindividualsaresensi[zedtotriggersandcues
aeerrepeateduse.
•  Robinson&Berridge,2008.
•  Impairedresponseinhibi[onandsalienceaTribu[on
–  LowD2receptordensitycreatesvulnerabilityandis
maintainedbysalienceaTribu[on.
•  Goldstein&Volkow,2002.
Reuteretal.,2005;Grantetal.,2006;Grantetal.,2010;vanHolstetal.,
2010,Karim&Chaudhri,2012;Probst&Elmeren,2012;Grantetal.,2013;
Potenzaetal.,2013;Potenza,2013
AddiDonalobservaDons
Mesolimbicdopaminereleaseislinkedto
symptomseverityinpathologicalgambling
Joutsaetal.,2012
Design
•  Twogroupsof12men(onegroupwith
pathologicalgamblingandonewithout)
•  EachgroupwasPETscannedtodetermine
dopaminereleaseduringthreetasks
•  Eachgroupwasevaluatedformood(subjec[ve
“high”)duringthreetasks
•  Threetaskswere
–  Control
–  Lowreward(nomarkednetwinnorloss)
–  Highreward(meanpayback371%)
a.  Screen view of slot machine used in high reward and low reward task
b.  Screen view of sensorimotor control task
c.  Mean net win curves for high reward task (upper curves) and low reward
task (lower curves); blue = control; red = pathological gamblers
Joutsa et al., 2012
a. Dopamine release in right striatal region during high reward tasks—
associative area and ventral striatum (nucleus accumbens).
b. Dopamine release in right striatal region during low reward tasks—
associative area
Joutsa et al., 2012
a. Change in binding potential in striatum increases in high reward as it
does in low reward.
b.  “High” in high reward is positively correlated with dopamine release.
c.  SOGS (South Oaks Gambling Screen) score positively correlated with
dopamine release
Δ BP=changeinbindingpoten[alof[11-C]raclopride
Blue = control
Red = pathological gambling
Wheredoesdopaminefitin?
•  Gamblingreleasesdopamineforthosewith
“nonetwins”or“netwins.”
•  “High”isonlyexperiencedbythosewith“net
wins.”
•  Dopaminereleaseduringhighreward
correlateswithlowrewardforboth
pathologicalgamblersandcontrols.
•  DopaminereleasecorrelateswithaddicDon
severity.*
Joutsaetal.,2012
Andanother…
Striataldopaminereleasecodesuncertainty
inpathologicalgambling
Linnetetal.,2012
Thetest
IowaGamblingTask
Feedback
2gooddecks=ini[allysmallgainfollowedbylowpenaltyleadingtonetgains
2baddecks=ini[allyhighgainfollowedbyhighpenaltyleadingtonetlosses
Probabilitycalculatedthatpar[cipantschoseanadvantageousdeck
Samplecurves
…sowhichisit?
Linnetetal.,2012
IowaGamblingTask
BindingPoten[alNeo-striatum
[11C]raclopride
Results
Pathologicalgambling(18)
Linnetetal.,2012
Control(16)
Doesthisexplain“chasinglosses”?
Andanother…
•  Reuteretal.,2005
•  Pathologicalgamblingislinkedtoreduced
acDvaDonofthemesolimbicrewardsystem
AnotherdopamineobservaDon
•  Ecopipam(D1/D5antagonist)hasbeen
linkedtoreducinggamblingbehaviors.
•  Aripriprazoleisapar[alD2/D3agonistand
hasbeenlinkedtoimpulsivebehaviors
(Gaboriauetal.,2014).
Potenza,2013
Aripiprazole(Abilify®)
AbilifyWarningIssuedbyFDA
D2
WASHINGTON—TheFoodandDrug
Administra[ononTuesdaywarnedofrare
casesinwhichpa[entstakingthe
an[psycho[cmedica[onAbilifyhave
experienceduncontrollableurgestogamble,
bingeeat,shopandengageinsex.
Thedrugisalsosoldunderthegenericname
aripiprazoleandthebrandnamesAbilify
MaintenaandAristada.TheFDAnotedthat
suchcases,whilerare,canintheoryaffect
anyonetakingthemedica[on
WSJ,May3,2016
ThelensofParkinson’sDisease:
aknowndopaminedeficiencysyndrome
Addinganotherdopaminecircuit
VTAtoNA:rewardpathway
SNtodorsalstriatum:coordina[onofmotorfunc[onandmo[va[on
SymptomaDccomplicaDons
•  Dopaminedeficiencysyndrome(intrinsic)
–  Lossofdopamineduetounderlyingdiseaseprocess
•  Movement
•  Cogni[ve
•  Impulsiveness
•  Dopaminedependencysyndrome(intrinsicandextrinsic)
–  Dysphoriaduringabs[nence
•  Dopaminedysregula[onsyndrome(intrinsicand
extrinsic)
–  Dependencypluspunding
•  Impulsecontroldisorders(extrinsic)
–  Refertospecificprocessaddic[ons(gambling,sex,Internet,
shopping,bingeea[ng,skinpickingamongothers)
Punding
AnD-ParkinsonianMedicaDons
•  Dopaminereplacementtherapy—allDreceptors
–  levodopa
•  Monoamineoxidaseinhibitors—inhibitmetabolism
–  Selegiline
•  Dopamineagonists—D2/D3
–  Bromocrip[ne
•  Parlodel®
–  Amantadine*
•  Symmetrel®
–  Ropinirole
•  Requip®
–  Pramipexole
•  Mirapex®
*Indirect:increasesreleaseandinhibitsre-uptakeofdopamine
AnD-ParkinsonianMedicaDons
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Gambling
Hypersexuality
Spending
BingeEaDng
Skinpicking
Pathologicalinternetuse
Punding
Fenuetal.,2009
Intotalthereare5
dopaminereceptors
D3receptors
Highinlimbicarea
Lowinmotorareaand
cor[calareas
ergo,cor[calimpulse
controlremains
impaired
Fenuetal.,2009
ThankYou
Treatment
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CogniDveBehavioralTherapy
Mindfulness
MoDvaDonalInterviewing
12step
FinancialPlanning
SelfrestricDon
MedicaDonAssistedTreatment
Exclusionvs.Self-exclusion
JULY2002
Theexclusionisenforcedbythe
IllinoisGamingBoard…
Theexclusionisenforcedbythe
IllinoisGamingBoard…
NOTTHETREATMENTCENTER
The$1200rule
$1200trigger
Moneyin“play”
CentrefortheAdvancementofBestPrac[ces,2014
IGB-15
Gamblingdisorder
Statement
Designa[on
DesignaDon
•  OutreachFoundaDon—$374,000
•  IllinoisCouncilonProblemGambling—
$331,420
•  IllinoisInsDtuteforAddicDonRecovery—
$243,447
2011data,ABCEyewitnessNews,July27,2011
IadmitIhaveagamblingaddic[on
DuraDon
Whocanrevokeself-exclusion?
+
Obtainingsuchanaffidavitwill
bedifficult.
Criteria
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Treatment
Affidavit
Possiblesecondopinion
Waiverofliability
Release
IGB-18
•  RefrainfromvisiDnganyIllinoiscasinos
•  Noauthoritytoenterorremainonproperty
•  ItisnotthedutyofthecasinoortheStateof
Illinoistopreventsuchentry
•  Ifgamblingoccursandwinningsobtained,all
winningsareconfiscatedanddonatedtothe
appropriatecharity
•  Gamblinglossesaretheresponsibilityofthe
gambler
•  Thecasinoownershallretainthisdocument
Summary
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Voluntary
ConfidenDal
Notintoxicated
Acknowledgementofdisease
Release
5yearrule
Trespassing
THEREARENOFDA
APPROVEDMEDICATIONS
TOTREATGAMBLINGDISORDER
MedicaDonAssistedTreatment
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Opioidantagonists(familyhistoryofalcoholism)
–  Nalmefene—Grantetal.,2006;Grantetal.,2010
–  Naltrexone—Kimetal.,2001;Grantetal.,2008;Grantetal.,2008
Selec[veserotoninreuptakeinhibitors(mixedtonega[ve)
–  Paroxe[ne—Kimetal.,2002
–  Fluvoxamine—Hollanderetal.,2000;Blancoetal.,2002
–  Sertraline—Saiz-Ruizetal.,2005
–  Escitalopram—Grant&Potenza,2006;Blacketal.,2007
N-AcetylCysteine—Grantetal.,2007
Carbamazepine—Blacketal.,2008
Lithium—Pallan[etal.,2002Hollanderetal.,2005(pa[entswithbipolardisorder)
Amantadine—PeTorrusoetal,2012(CR);Thomasetal.,2010(PDpa[ents)
Topirimate—Dannonetal.,2005(maylimitimpulsivity)
Modafanil—Zack&Poulos,2009
Meman[ne—Grantetal.,2010
Acamprosate—Blacketal,2011
Tolcapone—Grantetal.,2013
Bupropion—Dannonetal.,2005
YipandPotenza,2014
AmantadineisacomplexmedicaDon…oradruglooking
foranindicaDon
•  AnD-viral(influenza)
•  Dopaminergic(Parkinson’s,cocaine
withdrawal)
•  NMDAreceptorantagonist(Alzheimer’s,
gambling)
Hubsheretal.,2012
Gaming
Somethingofvaluedoes
nothavetobewagered
IsthisreallyanaddicDon?
…oristheInternetameanstoobtainchemicals,gamble,
watchpornographyorengageincompulsivesexualrela[onships?
Case
18yearoldmanpresentedtothetreatmentcenter
aeerbeingurgedbyhisparentstoseetreatmentwhenhis
gaminggottothepointwherehewasplaying18hours
inarowtotheexclusionoffoodandwater.
Gaming
Householdsandvideogames
40
60
With
Without
www.theesa.com
EntertainmentSoewareAssocia[on
ESAGovAffairs
Researchdatesbackto1983
Kuss,2013
Incidencevaries
•  Germany—0.2%
•  SouthKorea—50%
Internetgamingdisorder
DSM-5;SecDon3
•  Pre-occupa[onwithInternet
games(notincludinggambling)
•  Withdrawal(irritability,sadness,
anxiety—nophysicalsigns)
•  Tolerance
•  UnsuccessfulaTemptstostopor
cutdown
•  Lossofinterestinprevious
hobbiesorentertainment
•  Con[nuedusedespite
knowledgeofpsychosocial
problems
•  Hasdeceivedfamilymembers,
therapistsorothersregarding
use
•  Useofgamingtorelieve
dysphoricmood
•  Lostorjeopardizedasignificant
rela[onship,joboreduca[onal
careeropportunitybecauseof
par[cipa[oninInternetgames.
•  Exclusions—gambling,useof
Internetforrequiredbusiness
ac[vi[es,otherrecrea[onalor
socialInternetuse,sexual
Internetsites
MMORPGs
MassivelyMulDplayerOnlineRolePlayingGames
46%
Kuss,2013
Inthetheatres
Internetcafé
Physiologicconsequences
• 
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• 
Obesity
VenousThrombo-embolicDisease
Sleepdisorders
Carpaltunnelsyndrome
DehydraDon
ElectrolyteabnormaliDes
Seizures
SuddenCardiacDeath
FoxNews.com,August1,2011
NYDailyNews,December12,2013
January9,2015
Themanwasreportedlyaregular
customerwhooeenplayedfor
days
The32-year-oldmanwiththesurnameHsiehdiedfromcardiacfailure,andanemployee
foundhimmo[onlessonthemorningofJan.8,CNNreportedMonday.Hsiehentered
thecafeonJan.6,accordingtoJenniferWu,apolicespokespersonfromTaiwan’sHunei
district.
intheUSA
• 
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• 
BenjaminWalkerdiedfromhirnghisheadonatable
andsustaininginternalinjuriesduringagame-induced
seizure,January2001
ShawnWoolleycommi^edsuicidesuspectedtobe
relatedtoarejecDoninEverQuest,November2001.
DavinMoorewentonacrimespree,a^ackedand
killed3officersbeforetakingoffinapolicecruiserlike
GrandThekAuto,June2003.
DanielPetricshothisparents,killinghismother,aker
theytookawayhiscopyofHalo3,October2007.
AlexandraTobiaspleadedguiltytosecond-degree
murderforshakingherbabytodeathforinterrupDng
herplayingafacebookgame,2010.
TREATMENT
outpaDent
Fas[ngcamps
NYPost,August27,2013
InpaDentcentersinWashingtonand
Pennsylvania
Kuss,2013
Treatment
China
“Bootcamp”
CNN,April26,2016
TheUSconundrum
ISITADISEASE?
On-LineGamersAnonymous
On-LineGamers-Anon
www.olganon/org/home
MedicaDonAssistedTreatment
•  Internetgaming
–  SSRIs—escitalopram(Dell’Ossoetal.,2008)
–  Methylphenidate(Hanetal.,2009)
–  Extendedreleasebuproprion(Hanetal.,2010)
Cashetal.,2012
FantasySports
www.cnbc.com,December23,2015
DanielOkrent—sportswriter—firstfantasyleague(1980)
LaRo0sserieFrancaise
FutureofFantasy.com,January25,2011
Fantasy-Sport.net,May4,2016
Ma^Hunt"HowFantasyFootball
Works"12December2005.
HowStuffWorks.com.<h^p://
entertainment.howstuffworks.com/
fantasy-football.htm>26June2016
MilfordPlazaHotel
Wilfred“Bill”Winkenbach
Limitedpartner—OaklandRaiders
GOPPPL
GreaterOaklandProfessionalPigskin
Prognos[catorsLeague
Fantasy-Sport.net,May4,2016
March1962
1950s
FantasySports
UnlawfulInternetGambling
EnforcementActof2006
UIGEA
2006—over12
millionplaying
fantasyfootball
Fantasy-Sport.net,May4,2016
Regulatedtransferof
fundsusedinon-line
gambling
NelsonRose
Sr.Professor,Whi}er
LawSchool
UIGEA
DOESNOTLEGALIZEFANTASYSPORTS
Twomajorissues
Seasonalvs.Daily
UIGEAspecificallysaidthaton-line
seasonalfantasysportsbetsweren’tillegal
bydefiniDon
Luckvs.Skill
CataniaandKelly,2016,GamingLawReviewandEconomics
Boston
Organizedin2009
Valua[onis>$1B
Organizedin2011
Valua[onis>$1B
Fantasy-Sport.net,May4,2016
NewYork
2014—41.5millionfantasysports
playersinUSandCanada
Fantasy-Sport.net,May4,2016
Controversy
“Theindustrycameunderscru[nylastyearaeera
DraeKingsemployeewon$750,000inaFanDuel
fantasyfootballcontest.”
ChicagoSun-Times,April20,2016
YahooAgreesToShutDownFantasySportsinNewYork
Yahooalsorolledoutnewsafetymeasuresforitsotherdailyfantasysports
opera[ons
WSJ,March22,2016
KeyNYlawmakersback
legalizingdailyfantasy
sports
WSJ,March23,2016
NYlegislaturepassesFantasySports
WSJ,June20,2016
Statesthathavepassedit
Newlegisla[on
•  Mississippi
•  Missouri
•  Virginia
•  Colorado
•  Indiana
•  Tennessee
ATorneyGeneralopinion
•  WestVirginia
•  Maryland
•  Massachuse^s
•  Kansas
•  RhodeIsland
espn.com,June16,2016
IllinoisSaysDailyFantasySportsAreIllegal
December23,2015
April20,2016
Illinoisweighslegaliza[onofdailyfantasysportsbe}ng
April22,2016
BetonStrictRulesforDailyFantasySports
May29,2016
Illinoisdailyfantasysportsbe}ngbillshelved
Duetoallega[onsofillegal
campaigncontribu[ons
?
[email protected]