Evive Live

Katrina Arroyo | Manager of Clinical Programs, PGNO

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0:00 | 55:15

Gambling harm is invisible — and that's exactly why so many clinicians are missing it. In this episode of Evive Live, Adam and Christina sit down with Katrina Arroyo, Manager of Clinical Programs at the Problem Gambling Network of Ohio, for one of the most candid and fired-up conversations we've had on the show.

Katrina pulls no punches on why gambling is consistently under-screened in behavioral health settings, why the initial intake screen is actually the least effective time to ask about gambling, and what clinicians need to hear about the clients already sitting in their chairs. From seven-year-olds spending thousands on in-app purchases to the transfer of addiction behavior in co-occurring populations — the landscape has shifted, and the field needs to catch up.

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🔗 RESOURCES & LINKS
🟢 Evive — Digital support for gambling behavior change
🌐 https://www.getevive.com/
📱 Download the app: https://apps.apple.com/us/app/evive-gambling-support/id6450926060

🟣 The Broke Girl Society with Christina Cook — Community and recovery support for women
🌐 https://thebrokegirlsociety.com/ 
🎙️Apple Podcasts - https://podcasts.apple.com/us/podcast/the-broke-girl-society-podcast/id1575593868
🎙️Spotify - https://open.spotify.com/show/74DP23EzfR6WPpPMLYq45x
📺 YouTube Channel - https://www.youtube.com/@thebrokegirlsociety

🎧 The Modern Meeting Podcast with Adam Lyons — Gambling recovery, real talk
🌐 https://themodernmeeting.com/ 
🎙️ Apple Podcasts - https://podcasts.apple.com/us/podcast/the-modern-meeting/id1779060982
🎙️ Spotify - https://open.spotify.com/show/1jMSSKkadnvzbvZl33dzZc
📺 YouTube Channel - https://www.youtube.com/@ModernMeeting
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🔔 Subscribe to Evive Live for new episodes featuring the clinicians, researchers, advocates, and people in recovery who are changing how we think about gambling harm.
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Evive Live is produced by Evive, a digital health platform dedicated to gambling behavior change. Views expressed by guests are their own.



SPEAKER_01

All right. Welcome to e Vive Live. I'm Christina Cook.

SPEAKER_02

And I'm Adam Lyons.

SPEAKER_01

And we just finished a great conversation with Katrina from the Problem Gambling Network of Ohio. She was absolutely fantastic, and she gave us some really wonderful insight on what it looks like to facilitate these programs that focus on problem gambling help or help with gambling harm. And it was just a lot of really great insight on what goes on behind the scenes in the treatment space.

SPEAKER_02

Yeah, I mean, we finally found someone on evive live that's more emotional than me. And I loved it. I loved the fact that she got emotional. But it's that's just her passion, right? I mean, it's like, you know, I first met Katrina last year at NCPG. Uh, we met at the same place I met Kim. Shout out to Kim Freudenberg. That speed networking thing. Uh, I think it was like at the end of day one of NCPG, National Conference on Problem Gambling. And uh yeah, we just kind of exchanged numbers. And then by the end of the week, I had her on the modern meeting, and we just kind of kept in touch. And yeah, she's just doing such great things with the team at PGNO. And you obviously were just in Columbus. You said they put on an amazing conference.

SPEAKER_01

Yeah, they absolutely did. And I remember seeing her around, but I didn't really get to meet her. So it was really great to be able to do that on this um podcast and be able to just, you know, connect with her. She was fantastic. And I love that she got emotional, you know, especially as somebody who doesn't necessarily come from a lived experience perspective. She comes from a clinical background. She does a lot of supervising and she's as passionate about certification in the gambling space as I am, as all of us who are working in this space are. And so it was a really informative conversation about kind of what that looks like.

SPEAKER_02

Yeah, and and even though she's super knowledgeable and I feel like she's super professional and amazing, she will never say that. She's very humble. She's always talking about how she she wants to get supervision, you know, when she needs it. And I think that's so important for all of us in this space where if we think that we know everything, we don't. You know, you can always learn, you can always get better. And I think she's just like an amazing example of that. But uh yeah, so here it is. Enough talking about it. Let's let's hear it. Here is our conversation with Katrina Arroyo. Hello, everyone, welcome to another episode of EVOV Live. My name is Adam Lyons of the Modern Meeting Podcast, and I am here with Christina Cook from the Brokeral Society. And this week, our guest is the manager of clinical programs for the Problem Gambling Network of Ohio, Katrina Arroyo. Welcome to Evive Live.

SPEAKER_00

Thanks for having me.

SPEAKER_02

Yeah, absolutely. Um, so you know, before we get into it, tell us who you are and tell us um, you know, for those who don't know, tell us what the Problem Gambling Network of Ohio does.

SPEAKER_00

Oh gosh, what don't we do, honestly? Uh I'm just kidding, gambling related. Um, but yeah, I'm Katrina Arroyo. Um about me, that's a hard question. Uh, if we're talking about me in the gambling space, um, yeah, I work for the Problem Gambling Network of Ohio, and we're a nonprofit organization, um, obviously in Ohio that um helps facilitate programs. You didn't prepare, I didn't know this was gonna be a question. I had my bio taken care of, not PG and O. Okay. And it's I don't know, like PGO really does do everything. Like we help with prevention, education, training. Um, you know, the the the boards will sometimes come to us for consultation um with anything gambling related. We, you know, have uh partnerships with the Department of Behavioral Health, with um all the all the regulators um in the states. We we really pride ourselves in having those those partnerships that you don't really see in other states. Uh we we we work very, very closely with them. Um and when I say we, I mean like you know, Claire and Derek, the big people on campus. And they have worked so hard to really kind of strong arm those relationships and partnerships that honestly I've never seen anywhere else.

SPEAKER_02

And so for those, you know, who aren't aware, so like most states have like a council on problem gambling or have uh you know different organizations that are funded by the state. So you guys are the one uh organization in Ohio that is specifically gambling?

SPEAKER_00

Yes. Gambling, treatment, prevention, education, pretty much yeah, anything.

SPEAKER_01

And you guys put on a really good conference, though. I will give you that. You put on a really good conference, and uh, I had a lot of fun. I was just there a few weeks ago.

SPEAKER_02

Oh yeah, you went back. I thought you were talking about NCPG. You're talking about when you went for Ohio.

SPEAKER_00

Mm-hmm. Yeah.

SPEAKER_02

Yeah, I didn't get the invite. I don't know what happened. Must have got lost in the mail, but that's fine. Next, next year, maybe I guess.

SPEAKER_00

It's called an email. You should probably check them. I'm pretty sure I texted you about it too.

SPEAKER_02

Yeah, I mean, it's it's it's okay.

SPEAKER_00

Um so you said you wanted to be roasted. Here you go.

SPEAKER_02

So now I know that you know, when we last spoke in the modern meeting, you know, for for you know, just not to hear the same story, because I feel like everyone we ask, hey, how'd you get into your role? It's always like, well, I started in public health or I started in social work and there was an opening in gambling, and I kind of just took it. So that is what happened. But now that you're here, now that you've been doing it, what what is it like now compared to like when you first started, as far as like how you look at the job itself?

SPEAKER_00

Gosh, well, first of all, I wouldn't say, yeah, there was just a casual position. I did choose gambling, which is probably the first decision I've ever made in my life on my own. Um, and it was through through a training, and this was back in 2016. I I it was a nonprofit, so you are right in that realm. Um, but my first ever training, I was so blown away uh by just how powerful gambling can be. And, you know, I was working at a dual um a dual diagnosis agency. So I was dealing with severe persistent mental illness, as it was called then, and and substance use or chemical dependency. And we were also the gambling provider for that county, uh, receiving state funds to provide gambling services. So they were really encouraging clinicians to um, you know, go through this training to get that. And it was so different. And I've I've been around addiction my whole life. I've been in, I don't want to say involved in addiction, but like I've been around people experiencing, you know, problems. I've I've been, you know, working in that space. And when I took this the first step into the gambling space, I knew nothing. I was like, oh wow, I really don't know anything, which is pretty much my whole life. Um and the difference is is monument monumental. I mean, at that point, obviously, the the casinos in Ohio had had only been around for for a few years. Sports betting obviously wasn't legalized. The accessibility was far different than what it looks like now. I mean, and I had what people would consider high rollers in quotes, you know, high roller clients at that point, you know, millions and millions of dollars. And I still had that. The impact I am seeing is so much greater. You know, when I worked in in substance use, I would have people coming in after decades of use. You know, I I rarely had somebody coming in with less than five years of being an active addiction. I'm seeing people come in gambling for three months. Like they've never gambled before. It's been three months, and they're already to the point that, you know, they're they're seeking actual treatment services. Um, and and that was something I hadn't ever seen. And the age at which I'm seeing is also far different. You know, I think my youngest client when I first started was 27 maybe. And we are getting parents requesting services for children. I mean, I have one supervisee who has a client who's seven and ended up spending thousands and thousands of dollars on their parents' credit card, and uh the parent didn't know what to do. And thankfully he was already, you know.

SPEAKER_02

Seven years old?

SPEAKER_00

Yeah. And that's common. Children. Ch children are the most are one of the most at-risk populations because everything is gamified.

SPEAKER_02

Yeah.

SPEAKER_01

Well, you see, yeah, you see them, you see them coming in or seeing parents coming in saying, Hey, my kid was doing this on like roadblocks or am I saying that right? Rob Roblox? Roblox.

SPEAKER_02

Roblox, yeah.

SPEAKER_01

Yeah. And like all these kind of different games, and and they're seeing like the exactly what you just said. And I'm just like, when they say how old these kids are, I'm like, this is crazy, but this is also their world. Like, we didn't have these things. Like, I remember when the Atari came out. Oh gosh, I'm really aging myself. Good thing I'm younger than Adam. People still love Atari, it's fine. Yeah. And so it's like, but when I think about that, or like, and and I still I have a Switch and I love it. And I and I play on it, and even in my Zelda games, there's gambling options in the in the Zelda game. And it's not like races, you know. Yeah, yeah. It's just like you go and you like try and figure out which to get whatever power up or whatever it is, but um it's just really interesting that this is their world, this is the younger generation's world, and it's not anything we've ever really experienced at that age. So it's so it's interesting that parents come in and they they're talking about this and they're just like, I had no clue that this was even happening until those credit card charges come in or or something comes in. They think it's just harmless games.

SPEAKER_00

Well, and they're also not even realizing that it's gambling-related behaviors. They they are saying, you know, little Timmy spent a$7,000 on my credit card. He's a deviant. And then they get a little bit deeper in it, and it's like, oh no, actually, little Timmy's gambling, and the mom is or dad or caregiver is like, what? Like, he's not even of age. Like, there's no way he's gambling, and it's because, again, that that language piece of it of gambling. People aren't identifying with gambling unless you're like 40 and up, no offense. Um, you know, that is you said you aged yourself, sorry. I well, that's I was like, sorry. Um, but the this the the verbiage that people are using, it's they're not um making the connection with that. It's like, no, he was actually buying this to try to get something of value, which when we kind of break it down like that, my uh caregiver is like uh, oh my gosh, I didn't know that that could even be possible. And so, like, people, the the parents aren't even coming in requesting gambling services. They're saying, My kid is stealing from me.

SPEAKER_02

Well, and that's the that's like what I was gonna ask you is how do you even approach that situation where the kid is obviously completing the action of gambling, but he doesn't realize he or she doesn't realize it is gambling. So, how do you like when someone comes in and they're seven, eight, nine, ten, eleven, twelve years old and they're paying, is the kid there when you talk or is it just with the parent?

SPEAKER_00

So, so again, I I personally don't work with children. These are things that we hear, and and you know, I do our supervision program across the state for the gambling endorsement, and these are stories that I hear from, you know, people in the field. The kid is already there for services. They're not there for gambling services, they're there for mental health, you know, family issues, school issues, things like that. And these things are coming out in the course of their counseling sessions. And the parent, you know, typically how, at least in Ohio, how therapy with a minor works is, you know, the the child has the option of having the parent in there. Typically, the the the clinician will talk with caregiver at the beginning for a couple minutes, meet with the child, potentially give a short, brief, very vague recap, unless there are any confidentiality confidentiality issues that need to be taken care of. And so it's not usually until Caregiver says, Did you tell X, Y, and Z about what you did at home? That they do that. Because again, the kids not realizing that things are an issue until somebody else brings it up. Because again, they're children. They're innocent. Yeah.

SPEAKER_02

I mean, and it's it's just so it's so scary because even though they don't know it, those are seeds being planted, right? Like those are those that's that's behavior being formed and and habits being formed that are gonna be hard hard to break, you know what I mean?

SPEAKER_01

Yeah, yeah. And it's it's always so interesting when we're trying to figure out how how do we educate how you know for those prevention kind of um things. It's just it's always an interesting conversation, you know, when we're looking at how do we help younger generations better understand what gambling looks like. You know, we've heard all those situations where you can ask a younger person if if they gamble and they're like, no. Well, do you buy skins? Yes. Do you do this? Yes, but they don't, they don't realize. Um, so let's kind of pivot back to what you were talking about being supervision for Ohio and kind of what that what that entails and what that looks like for for you and and for those clinicians.

SPEAKER_00

So um in Ohio, for through the chemical dependency board, we have um, you know, when we're talking about clinical services or behavioral health services, the the two main boards in Ohio are are, you know, the Council of Social Work Marriage and Family Therapist Board and the Chemical Dependency Board. And the chemical dependency board has a gambling endorsement. It's the only non-supervision endorsement you can get through a board. And as we know, gambling isn't a chemical. So it's not a chemical dependency, but it's still a very problematic thing. And we can say that about any process addiction, right? Um, so through that, you have to get a certain number of hours of education, which um you can get through any type of continuing education that's approved by the board, uh, gambling specific. PGO does offer a three-stages series where we go through, you know, personally not biased or anything. I am. It covers so much in-depth and it is structured so proficiently to give you kind of that well-rounded education. Again, experience is always going to be the best education, in my opinion. And I do our entire treatment stage two with some of my colleagues. And so, you know, through those stages, you get the amount of education that you need. And then you can apply for your preliminary gambling endorsement, which means I can provide these services with competency. And then you have to get a hundred clinical hours to um apply for your renewable gambling endorsement, which means I am competent in this. I don't necessarily need supervision. Always seek supervision, no matter how high your credential is. I just reached out to a supervisor today because I was like, I had a very difficult client that I need supervision on, and I am a supervisor. So good clinicians get supervision. So they um, you know, if you do, you don't have to do supervision through PGO, but we do offer free supervision to people um, you know, uh getting their renewable gambling endorsement. And then we will actually reimburse your gambling endorsement fee if you go through us. So we will help you. It's it's anything to reduce the barriers for people to just get the education and training that they need to be able to provide the services, you know, across the state.

SPEAKER_02

Yeah, I love I love what you're saying about supervision and clinicians, and I'm not gonna put this state on blast, but recently I was in a state in the middle of our country, and the level of or actually it's it's the lack of, I mean, I was talking to several clinicians who, you know, may have had a gambling certification, but gambling wasn't their primary, you know, most of their clients was substance abuse. And you know, they're coming up to our booth and they're cracking jokes, and they're saying, Oh yeah, my my I'm gonna take this flyer, my my husband might need this or this or that. Just an overall feeling of like just not quite taking it as seriously as we wish they would.

SPEAKER_00

Do you normalization?

SPEAKER_02

Do you say that again?

SPEAKER_00

Normalization.

SPEAKER_02

Sure, sure. And like, so yeah, I guess my question is, have you seen that in your um, you know, in your state? And if so, if not, like what can we do to um just kind of have people understand that like listen, more and more of your clients after you peel back the onion and and maybe some screen, like some some questions, like you're gonna realize that they have an issue with gambling as well, and you need to be prepared to to give them some hope about that, right?

SPEAKER_01

And I want to kind of tag on to the back of that before you answer, is like I have been to several conferences that are mainly SUD, um, you know, substance, alcohol. And I've gone up to like a lot of the booths that are, you know, have clinician clinicians or addiction centers or, you know, some type of treatment professional. And I've said, so what does it look like? And I'm in a state where we have a 6.3 prevalence rate um percent of our adult population is it's impacted by gambling in some some way. Um, but I went up to all, like there was probably 50 of them, and I went up to all these different treatment booths and things like that. And I was like, so how what are you seeing in gambling? They're like, we don't see gambling. And I'm like, but you're in a state that has a 6.3 prevalence rate, and you're telling me you don't see gambling. And then I always turn it back to, well, are you asking the right questions? Because you are seeing people impacted by gambling, but maybe the people that you're seeing that are impacted by gambling aren't necessarily recognizing that gambling is harmful because they think it's better than, you know, the drugs or the alcohol.

SPEAKER_00

And I'm actually gonna challenge you and and say they're not seeing them. They're exactly right. They're not seeing them because as we know, gambling harm is invisible, right? And that's what makes it so easy for people to crack jokes. You know, nobody's gonna have we all have the person in the community that we're like, oh yeah, you know, you know, blah, blah, blah, going to the dealer again. Nobody's gonna crack jokes and be like, I don't even know, because nobody like, and I'm sure there are very, you know, untasteful people that like again, we we don't, you can't sit with us anyway. But this actually is a huge thing, not to like not not to like boast PG and O programs, although I would all day long. We also do what's called agency service consultation. So that is a program where agencies that, you know, they're either maybe receiving board funds or not for gambling services, but they want to integrate gambling services. And they get so frustrated with me because first of all, I'm a very direct person. And again, when it comes to individuals impacted by gambling, I am going to be blunt and I'm not going to make jokes, and I am, I am going to tell you how it is. And a lot of places, you know, pee that that raises defensiveness in people. And it's actually like some of my coworkers will be like, Yeah, repeat, uh, repeat what you say all the time, Katrina. And it's if you have a caseload, you have a client who's experiencing gambling-related harm. So many of these, you know, in with my supervisees and the agencies and things like that, they'll say, We're just not getting people coming through the door for gambling. And it's like, yeah, I know. And they're like, what do you mean? Like, you're supposed to be telling us how to do that. I'm like, your clients are already there. We we need to be focusing on who's already there because as we know, co-occurring conditions are, you know, a major at-risk population for gambling related harm. And it usually is because, oh, it's safer. Like, I can't OD on gambling. You know, I've got more money in my pocket. I'm socializing. I'm not drinking. I'm not shooting up. I'm not talking to the dope man. I'm, you know, I'm going here, there, and everywhere. And like I have a relationship with people now. And it's like all these other things that were maybe damaged by their co-occurring condition, whether it's mental health or substance use, it does look better until you really dig down deep. And I'm not saying everybody who has a co-occurring condition is experiencing gambling-related harm, absolutely not. But people don't like it when I say that. Screen the clients you already have. And again, it doesn't have to be, I don't care if you use a validated screening or not, but just ask a question and use appropriate language. Because again, if you like you said, if you say, Hey, do you gamble? They're gonna be like, No. But if you say, hey, how many sports books do you have on your phone? Or, you know, does your kid do this, that, or the other? Or, you know, what about these prediction markets going on? Do you bet on that meteor we just had up here, right above my county? Because there is a contract for that, by the way. And people are like, well, yeah, but that's not, you know, I'm betting, I'm wagering, I'm investing, I'm, you know, predicting, I'm buying skins, I'm doing this, I'm doing that. And so it's like you're not asking the right questions. Why are we not assessing for gambling the same way we do for heroin? Because we're not just people are like, well, we don't want to, we don't want to label them, or we don't want to assume they're, you know, gambling. It's like, we don't want to assume they're doing heroin either or crack, but we ask them about it, right? And we don't, we don't assume they've experienced sexual trauma, but we ask about that in the first five minutes we met somebody, right? It's like, how are we so comfortable asking these uncomfortable questions? But gambling is the line. And that's like so what is it?

SPEAKER_02

Like, what that's what I was gonna ask you. You're making me feel a little bit better about that state. If if they truly, if their clients are truly still just too afraid to admit it, but like forget about like a proper screening.

SPEAKER_00

They're not too afraid to admit it, they don't have awareness.

SPEAKER_02

The person who's gambling, you're saying?

SPEAKER_00

Yes.

SPEAKER_02

I don't know about that.

SPEAKER_00

Um, I think experiencing gambling-related harm, not full-blown gambling disorder level. We're talking gambling-related harm does not have to be diagnosable gambling.

SPEAKER_02

Right, right, right.

SPEAKER_00

So many people who are actually statistics show gambling-related harm is experienced by so many people, and and they don't realize it until it gets to almost crisis level.

SPEAKER_02

Sure. But but to your earlier point, why is it forget about a screener? Why can't just in the process of a session, if your spidey sense is going off as the clinician, why can't you just ask that question of like, well, let me ask you this like, do you, you know, what's your relationship like with betting sports or anything? Like, why is that why is that taboo? But like you said, they can say, so we got any sexual trauma, like within five minutes, like what? Like, why it's like apples in boulders. Like, what are we talking about?

SPEAKER_01

It's because we're training clinicians' understanding of gambling themselves, right? Is it that's that's what I would say.

SPEAKER_00

You have to have the spidey senses.

SPEAKER_02

Yeah, okay. Yeah, you know, you're right.

SPEAKER_00

The spidey senses, we're trained to listen for warning signs of substance abuse, trauma, depression, anxiety, right? We're trained to screen for that all the time because money, money, money. You know, it really should be care about our clients, but we know how it goes. And that's, you know, Christina, you're exactly right. If you don't, if you're not Spider-Man, you're not gonna have Spidey sense. So if you're not trained in it, if you don't know what to listen for, you are not going to pick up on those because I literally just had this conversation. I work, I have a handful of clients in a private practice up by me. And um, they finally asked me to talk about gambling after I've been begging for six years. And they let me talk for, they gave me uh 30 minutes, which I was very grateful for, to talk about gambling. And I'm like, I could literally talk about gambling for days. And that's what I talked about was this idea of what to listen for as a clinician when it relates to gambling, how there are so endless opportunities for gambling screening and everyday session conversations, especially surrounding major sporting events. We know for say, you know, I mean March Madness is happening right now. We know that non, you know, people that don't typically bet in sports, they fill out a bracket. You know, people who don't typically bet on sports, they buy a football, they buy a Super Bowl square, they, you know, help their kids fundraise with Super Bowl squares. Like these people are betting in these moments. And there are things that, again, we're not assuming this person has a problem with gambling, but we're just saying, hey, you've mentioned, you know, this a couple times. Is this a part of your everyday life? It doesn't have to be, oh, this sounds really concerning to me, and that's the only time I get to bring it up. It's about creating that awareness. And again, if we don't know what to have the spidey sense about, we're never going to develop it. And that's what's happening is in and programs are getting so much better about addiction, like specific addiction programs are getting so much better about including gambling. But I heard way more about porn eating, obviously, substances and gaming. Well, that was like gaming in the sense of internet stuff, like not actual like betting during the games, other than rather than gambling.

SPEAKER_01

There's a lot of conversation right now about the gap between what clinicians are trained to do and what people actually need when they walk in the door. So, from your perspective, what's the thing you find yourself correcting or reinforcing most often in your role?

SPEAKER_00

Oh my gosh. Sometimes I feel really bad because I forget that I was there at one point. I was that dumb clinician. Like, no, I don't want to say dumb because that's invalidating, but like I was ignorant. And it's like it's just like subset. I know what I know how to work with, you know, people who are struggling with addiction. And again, I'm like straight out of grad school, like, absolutely not go sit down. And I feel like there are so many points to this that when you started asking the question, I was like, oh my gosh, I know where this is going. It is so much. And again, that's why I said earlier, experience will always be the best tool over education. Not education is always important. I'm not saying that either. But and if Jesse listens to this, he's gonna be like, oh my gosh, Katrina, again. Because there's so many times that I'm like, you know, our stage two through our gambling education series is all about treatment. And I'm like, Jesse, you can't teach treatment through a PowerPoint. You can't teach treatment through a PowerPoint. And I'm like, I just want to change literally everything. And he's like, oh my God, stop, Katrina. He doesn't, he's very, he's wonderful. But I'm like, there are so many things that are nuanced about gambling treatment or get you know individuals experiencing gambling-related harm because we know so many more people are experiencing gambling-related harm than those are who are in treatment for gambling specific services. And so I talk about so many different things. Number one, what we already talked about, screening. And again, not using validated, I'm not saying don't use validated screens. Please use validated screens. Um, but screening not just at intake, it is so important. The actual screen at intake is the least effective screen you can do, especially for gambling, because again, at this point in time, very few people are coming for gambling speci.

SPEAKER_02

Like the wall is up, right?

SPEAKER_00

I thought you were saying stuff. What are what are you doing? Or or it's again, they're coming for their primary concern. They're coming for because they're court mandated, or you know, they're really struggling with depression, or you know, they're they're dealing with a different substance. And and then with that initial screener, they're like, well, yeah, I've gambled, but like, okay, whatever. They're not really focused on that because there are more in their mind, more pressing issues in their life happening. And they might be gambling at that time, or they might not, because we also know the transfer of behavior is is a very big part with co-occurring conditions. And so the secondary or any subsequent subsequent screen, this is another one of my like key phrases that I say probably 75,000 times in a week. The secondary screen is more important than the initial screen, which again, people get mad at because they're like, are you saying we shouldn't screen at intake? I'm not saying that at all. I'm saying if you're only screening your clients at intake for gambling-related harm, that's why you think nobody in your agency is see, look, I'm getting passionate. That's why you think nobody at your agency is there for gambling because you are not providing care in the services that you want to provide. Your clients are gambling. I just said this yesterday. Your clients are gambling in group. And I had several clinicians that were like, Yeah, how do we get them to stop that? Well, first of all, you don't. Why why is that the first thing you're saying? You you bring it up to them, like, hey, like I've I've noticed you doing that a lot. What's what's up with that? Like, we're we're here for something else. Like, we can can we hold off until afterwards? And if you feel like you can't hold off, like what's going on? It's again paying attention to what's going on, or listening for those cues, or you know, policy things in the agency, or um again, thinking that they have to have a diagnosis to talk about gambling. I I harp on that so often too, is like your client doesn't have to have a gambling disorder diagnosis for you to talk about gambling with them the same exact way that they don't have to have a trauma disorder for you to talk to them about trauma.

SPEAKER_02

Yeah, I yeah.

SPEAKER_00

What's what's your reaction for?

SPEAKER_02

No, I just I don't I don't understand. Like, why why why won't we talk about it? It's just so weird. But real quick, because um I want to make sure that everyone knows what we're talking about. And if I don't know, I'm sure the audience doesn't know who's Jesse and what does like stage two mean?

SPEAKER_00

So Jesse is is the director of um clinical clinical programs at Problem Gambling Network of Ohio. Awesome shop. Um and we work, yes, we work very, very closely um together. Our our clinical team at PG, I mean the PGO team is very small, just in general, um, and we work beautifully together. But Jesse and Olivia are are part of our clinical team who are amazing at what they do. I think everybody at PGO is just chef's kiss to Derek for uh almost handpicking the the people that work there, and and it's it's just such a a good atmosphere to be in. Um stage two is part of our stages series when I was talking about the gambling endorsements. There are, you know, three stages or three parts to achieving the education required for uh your gambling um endorsements or your your preliminary gambling endorsement in the state of Ohio. So stage one is kind of, you know, it's done by Claire and Olivia, um, primarily gambling 101. And honestly, I just told Claire the other day, I said, I'm gonna have to sit through another stage one because even being in the field, I'm like, there are some like background things that I need to get caught up on because I'm very, again, passionate about like staying up to date on things. So much has changed since I've been through a stage one. And so, you know, that's like the background, what the organization, like the the um regulation pieces are in Ohio, like trends, you know, kind of like the gambling foundation, gambling 101, what we have in our state, what we offer, what um just like some of those things, a little bit about cognitive distortions and things like that. And then stage two is the treatment piece. So again, traditionally, when we first started doing this, well, when I went through stages, again, way back in the day when it was done through recovery resources, it was very different than what it is now. And it was a lot of clinicians that were like brand new in the in in just you know, treatment in general, not just gambling, but treatment. And now we're seeing so many more people who they truly want to get a full foundation of problem gambling and gambling-related harm. And so we've had to switch it up a bit because it was just like treatment basics, and then like with gambling-specific things, part of it. Now I'm like, no, people know all of this stuff. We have to get into like the nitty-gritty of how these cognitive distortions are so much different, you know, the nuances of gambling treatment that are different from just regular addiction work, not regular, that's invalidating, but like, you know, uh other struggles that people are are going through. And like really the differences that clinicians need to be prepared for to reduce honestly client harm in counseling, because we know that's a thing too. If you're not, if you aren't educated in the fact that like gambling has the highest rate of suicide of any addictive condition, and you're not screening for suicide with your clients who are presenting with gambling-related concerns, that is potential harm to them. Yeah.

SPEAKER_01

And even to kind of follow up on that, like just not understanding gambling addiction itself or gambling disorder as itself, um, can be invalidating to a client who might be struggling with it, right? You go in and you you think, oh, this person um has a background in addictions, um mental health disorders, they're gonna, they're gonna get it, right? Addiction is addiction is addiction. That's what you hear in the rooms. And then you go into to an office with somebody who doesn't have a gambling specific certification, and they're like, oh yeah, my grandma likes to play bingo. And it's just like, you know what I mean? Like, and then all of a sudden, all the harm they're experiencing is invalid, like invalidated in just that one statement of like, oh, so this person's comparing the fact that I just lost my car to repossession. My husband said they are out of here because of my gambling, all to a funny comment about my grandma's bingo. And it's just like, and that's just an example. And I have had somebody tell me that's exactly what happened to them. Um, but it's just even if you don't understand it, right? Um, oftentimes it's like I assume they think, well, it's a maybe we can treat the behavior, right? Or something like that, and kind of that connection without again having the understanding of the gambling aspect. What does this look like? What does the behaviors even look like, right? They're gonna be different to somebody who ingests something, or you know, those behaviors are gonna look a little bit different and things like that. So yeah, it's I I'm a true advocate for gambling specific training and credentialing certification. I'm also on the International Problem Gambling and Gaming Certification Board, which makes me a little more like um IDR us, um, a little more kind of an advocate in that role as well. But I mean, I really appreciate what you're saying around that and how important that really is.

SPEAKER_00

We don't get to choose what, like as a clinician, we don't get to say what problematic is for somebody. So often clients will come in and say, this is a problem for me, and the clinician's like, but you don't meet the criteria. It's like this person is saying, I am struggling with this, and you are, and this has literally happened to me personally in my own therapy. And I'm like, I'm sitting here telling you my drinking, self-disclosure, my drinking is a problem to me. And I know as a chemical dependency clinician that I don't meet criteria for alcohol use disorder, but I'm telling you I don't like the way that this is presenting in my life. And they're like, well, yeah, but you know, this isn't, you know, causing you harm and blah, blah, blah. Yes, it is. I'm sitting here telling you it is. And we see that so often. And but the thing is, people who are experiencing gambling, gambling-related harm, don't recognize that it's due to their gambling. And if you don't know what to listen to for, because I know my drinking or my X, Y, and Z is causing this consequence. That's not necessarily true with gambling because the consequences are separated from the behavior itself. So if somebody's coming in and saying, like, I'm four months behind on my car payment, if that's not a warning sign to you to ask, like, you know, what's the preceding behavior that's creating this lack of funding? And again, it's not always gambling. I'm not saying that at all. But if you don't know what to listen for, you can't even pick up on this harm that somebody's talking about. And then you still have clients that come in and say, I feel like I'm gambling too much. I spent five dollars on a scratch off. And if you have a client clinician that's not trained in it, they're gonna be like, five bucks, like, and it's like, but that five dollars was supposed to feed my kids tonight.

SPEAKER_02

Yeah. It it makes me uh so oftentimes I talk to people early on, and you know, for lack of a better phrase, like sometimes there's too many cooks in the kitchen, recovery-wise, where you know, they're hearing certain things from certain people that they're reaching out to, which comes to my question in Ohio, how do you think what's the state of the relationship between peer support and clinical care? And oh, okay. But are are you guys like working together or is there still kind of a gap? Because I I feel like in my personal experience, I I think that sometimes, you know, the person really likes the person they're working with as a peer, they really like their clinician, they really like going to a meeting. But if those if there's varying pieces of advice in those three things, it kind of pits them like, well, what person's right, or which one should I be listening to?

SPEAKER_01

Yeah, I am always I was just impressed. That was a good question, Adam. I'm just impressed. Sorry.

SPEAKER_02

I'm good for every once in a while.

SPEAKER_00

So this is these are relationships that that we and again very proud of in our state in particular, our relationship with you know, not only our state partnerships and you know, people that you know people think are important, but really when you're trying to make change, and I I just did a clinical conversation on advocacy, and when you're you're trying to advocate for something like this, like that experience of of somebody who has been through that is so much more important than numbers on a piece of paper. And we have worked very hard to foster relationships with communities, um, peer support specialists, um, peer support uh certifications, you know, pushing for things like that because that's available for uh substance use, but gambling we that has had to be fought for. Like, what's the difference of somebody who's had lived experience with gambling and somebody who's had lived experience with crack? Like, you know, uh there isn't anything. Both of those communities need peer support. And so, you know, you probably saw my face in that. And the reason that is, is because I think kind of what we were talking about earlier, there are certain people in the community that it really feels like aren't really here for the, hey, let's just love everyone and help everyone. And they really just want to be like, you have to do this, or or you're not in recovery. I've had so many clients that they say they're in counseling in their 12-step program, and they're like, Why are you there? Why are you there? You know, this is all you need. And I I am in absolutely no way bashing 12-step programs. Please never take it that way. It's I always suggest it to people. That way of thinking is harmful because when we look at recovery and and and stop now, I'm gonna get emotional. Um, cut that out. Let me recon, let me compose myself. See, I told you, we're gonna get real passionate.

SPEAKER_01

Yeah, we're not cutting out.

SPEAKER_00

This is what we call podcast gold. Nobody gets to tell us how to seek help and how to change our life. How if To change our life for the better. And it really hurts my heart as a clinician when people in the recovery community go against anything that's we're literally like we're not here. You know, I'm sure there are some people that like they just want to bill your insurance. I have given so many sessions that I've like forgotten to bill, like because like I'm just here to help you, or I've taken so many phone calls that have lasted 37 minutes, which would, you know, I could go into the billing codes or whatever. Like, I'm not gonna bill you for that because I'm just glad you chose to call me. I'm just glad, and I'm sure that people in the recovery community they say the same exact thing. They're not over here thinking, oh, I wonder I could have billed for that or I could have done that. Like, no, they're just there to help. So when people in the community go against other resources, that really bothers me. And that has happened so many times in my experience of my clients saying, you know, this person yelled at me because I told them I was in counseling. I'm like, that doesn't sound like a very supportive person to you. Is there another meeting we can look at attending? Or is that person, you know, somebody that regularly attends that? Like, again, it's not, oh, you don't need to go to GA anymore because that person, but like, absolutely not. How can we modify things to support what you need right now? And so there are people that resist relationships with people who we really just want to help you. And we know that if we don't have lived experience, like we rely on, like you are the experts. You know, people always call us the experts. And I, you'll, this is another one of my key phrases. Like, absolutely, I am, I will never consider myself an expert in in gambling-related harm ever. If you ever hear me say I'm an expert in gambling-related harm to my clients, like please smite me on on set right there. I will never say that because I don't believe that. And I tell my supervisees that they're like, I just I want to become an expert like you. It's like, first of all, I'm not an expert. And if you think you're an expert, then we need to kind of like check ourselves because your client is the expert of their lives. And and that's what really we really need to be focusing on. And so when we talk about the the the peer recovery community or or anything in the community of recovery, that we want to have those relationships, but there's still so much resistance for that side of things. And we are working so hard to try to break those walls down. And like we were talking about with the conferences, like when you all come, God bless you guys. Cut this out. I'm getting so emotional. When you all come, when I say your session was one of my favorites at the conference, I I requested to be at your all's session specifically as a by your mean myself and Jody Bechtold and we did a session about women and gambling uh women, gambling, and hormones. Yes. And the fact that men were standing up saying, I'm gonna start doing this. I was like, yes, like where is this everywhere else? Where is this everywhere else? Like, where are the people that are so resistant to these connections that that are that like I I I need to hear from you so I can change the way I'm I show up for my clients because that's why we're here. Well, that found talking now because I'm getting emotional.

SPEAKER_01

The foundation of clinical, the foundation of treatment, like all of these are built on that lived experience insight, right? This is how all these the research is done that then is turned into treatment and protocols and things like that. And it's like it's all based, even you know, when we look at GA, right? And we look at some of the councils throughout the state who were created because of lived experience or by lived experience, right? NCPG was created, the National Council on Problem Gambling. Sorry, I'm trying not to use all the the just I can't even think, but acronyms. I forget about I forget about the terminology too. It's like, oh yeah, not everybody's as well versed in So when you're when you're when you know about the history of a lot of this, it was all started by people who experienced gambling harm, right? And who wanted to help other people and who wanted to advocate, um, who share their stories so that and and just just this is my soapbox now. It's never easy to go back to that space of where we experienced harm and pain and sadness and and all these things, and we hurt the people that we truly care about. We hurt ourselves. So we don't go around like sharing the story just so somebody can be on their phone in your conference. You know, you know what I mean? The person on their phone or the person on their laptop because they're just trying to get the CEs. But you know, or the person who's like, I hear lived experience stories every day, it's part of my practice. You know what I mean? That kind of thing. Like, like I had somebody actually say that to me one time. It's like, I don't usually go to lived experience presentations because I hear lived experience all day. That's what I do.

SPEAKER_00

You know all of it's story. Go ahead.

SPEAKER_01

Yeah. And so it's just it's always interesting, but but lived experience and those people who who show up these things to share, and this isn't this isn't has nothing to do with ego. It just has very much to do with we, you know, those of us who do this, do this so that the information that our stories, as painful as they are, and Adam cries every time he shares it, his story. It's like it's never, it's never gonna be it's never gonna be easy, but it's important. And it's the foundation of the whole recovery space, the treatment space when it comes to problem gambling or any type of addiction or disorder, right? So it's a very, very important piece.

SPEAKER_00

And it is the most important piece. It is not just a piece, it is the piece.

SPEAKER_02

Yeah, I agree. I mean, it's it's it's you know, it's what I felt the first night of my recovery, just that connection. Like when you hear when you go, when you go an extended period of time in the throes of addiction, and you have that feeling of being alone, and then you just hear a random person talk about the exact same thing that you went through. I mean, there's nothing that can replicate that feeling in therapy and peer and group. I mean Yeah.

SPEAKER_00

So there's a there's a reason why peer experience is one of the highest success rates out there.

SPEAKER_02

Yeah. I mean, we have so many more questions for you, but we're we're already hitting the mark.

SPEAKER_00

So I'm getting emotional, so good.

SPEAKER_02

I'd be crying along with you, but I cried at the statehouse today, so like I'm I'll I'm I'll dry it up. But yeah, but uh you know, last question is the same thing we ask everybody on eBive Live. Katrina Arroyo, what gives you hope for the future?

SPEAKER_00

You all I mean I I'm I'm like I know that it sounds so like they I promise you they did not tell me to say that, but no, seriously, you all inviting you all inviting peons like us to to this community is so special and it really does speak volumes like we were talking about to to these relationships that that you know have been built, need to continue to build and and will continue to be built because people are starting to realize like we don't have to be, I mean, there's so many things that people are divided on these days, like come on, like we just like I again, this is another thing that people always make fun of me for. I'm like, can't we just all love each other? Like, you know, people, especially in this community, there is so much ego, and it's like, I like aren't we all here to just help each other and whatever capacity we're coming in? If we say, I want to help you, like I'm not telling you how to live your life, but like, and when I say I want to help you, I don't mean you, I mean I want to help this cause, I want to help what's going on. I want to help, I want to build awareness, I want to build resources, I want to build what is needed. And I don't know what's needed. And even, you know, people who have lived experience know what's needed in their experience, but there's somebody right next to them that needs something different. So let's get together, like let's get together and let's figure it out. And we're never gonna figure it out because it's ever changing. That's part of the gambling landscape that again is so different than any other addiction. It's so different. And so we all have to be here together because we're on this wild ride and we don't know where it's going, but we know more things need to be put in place for just the the overall well-being of anybody impacted and anybody involved. I love that.

SPEAKER_02

Yeah, I mean, I knew you were passionate, but you're extra passionate today. You're getting me fired up. I really appreciate it.

SPEAKER_00

Because it's the end of the day, and I had a difficult client earlier, a gambling client, somebody who doesn't want to be here, and it has really gotten me back on my like thing. And again, it's like been a long day, and so you caught me at a vulnerable time. We love it. That's it. I mean, this is what we need. Like this thing we like.

SPEAKER_02

Well, Katrina.

SPEAKER_00

Thank you all so much. Appreciate it.

SPEAKER_02

Where can people find you and uh PGNO?

SPEAKER_00

The website, um, you know, PGNO.org. Again, I didn't prepare for them. PGNO. It'll take you, it'll take you to the PGNO and um Ohio Gambling Telehealth Network, which is, you know, another subtle, subtle thing. Uh Ohio Gambling Telehealth Network. We are there for anybody that doesn't have services in their area to kind of be that that safety net that you need, um, providing telehealth services for for those that that don't have access to services or are impacted by by things that are um barriers to them receiving services in their community. So um, yeah, Problem Gambling Network of Ohio, Ohio Gambling Telehealth Network. Um, you can reach me at karroyo at pgnoohio.org.

SPEAKER_02

Amazing. Well, Katrina, thank you so much for being on evive live. Christina, you got anything else?

SPEAKER_00

I know. You are so great. Thank you so much. Thank you all. You all really don't know how much it means for you all to trust me with speaking on this platform.

SPEAKER_02

Love it. Thank you so much.