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Risk Management: Addicted to Gambling

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When Mark Wahlberg’s gambling-consumed character in the aptly titled movie “The Gambler” seeks help to finance his habit, a loan shark asks him, “What’s wrong with you—you got brain damage?” In a manner of speaking—yes.

Excessive gambling, long considered a vice, is now classified as an addiction, one that derails lives irrespective of age, gender, class or ethnicity. It can be quite stealthy, with victim and family oblivious to the toll until it’s too late. “It is insidious,” says Arlene Simon, executive director of the Delaware Council on Gambling Problems (DCGP), which provides services for both prevention and treatment. “They usually don’t seek help until reaching rock bottom.”

The descent can be breathtaking—401(k)s drained, second mortgages taken out, company funds embezzled, Social Security checks pfft—all to sustain a gambling habit. Federal charges of money laundering brought against heiress and former San Diego mayor Maureen O’Connor two years ago spotlighted gambling addiction. Other high-profile victims such as late Philadelphia Eagles’ owner Leonard Tose also come to mind. But most people gripped by gambling suffer privately, and their numbers are greater than you’d think—according to the National Council on Problem Gambling, between 6 and 8 million adults and a half-million adolescents in the United States alone.

Simon, who took the reins at Wilmington-based DCGP less than a year ago, speaks from experience—her late husband, a respected local businessman, kept his gambling problem hidden but eventually sought help and recovered. Deputy director Susan Edgar’s passion is also born of familiarity—her father’s longtime gambling troubles surfaced only in recent years. “We wondered why he never had any money,” says Edgar.

More often than not, problem gamblers also have other addictions, which share the same neurological patterns. “An addict’s brain reacts differently than that of a normal person,” says Edgar. “There has been a lot of research; MRIs enable us to see what parts of the brain light up.” The brain’s behavior in this instance is driven largely by dopamine, which Edgar calls an “excitatory neurotransmitter.” A chemical that has numerous functions in the body, dopamine is most often associated with the human need for reward and pleasure. “Addicts seem to have fewer dopamine receptor sites in their brains,” says Edgar. “There’s no place to plug in.”

Addiction springs from this overloaded circuitry. “It may lie dormant in the brain and be triggered by physiological or psychological factors,” says Sachin Karnik, DCGP’s director of prevention and criminal justice. Karnik calls problem gambling a “chronic, relapsing disorder.” Even for those who have undergone therapy, he urges continued participation in the support group Gamblers Anonymous to keep the demons at bay.

Until last year, problem gambling had been termed an “impulse control disorder” in the “Diagnostic and Statistical Manual of Mental Disorders,” the standard reference in the field of mental health. It is now classified as an addictive disorder, the only one among the 11 defined that does not entail the use of a substance. “It is the purest of addictions—it’s triggered internally,” says Steve Gonzer, DCGP’s director of downstate services. 

The new classification followed years of research funded by the National Institutes of Health. Studies revealed that, when a problem gambler sees people gambling, changes in his brain parallel those of, say, a cocaine abuser anticipating his next snort. Dr. Charles O’Brien, a professor at the University of Pennsylvania, chaired the American Psychiatric Association committee that reviewed the evidence.

“This will stimulate more research and help us come up with better treatment,” says O’Brien. “We’ve already seen that compulsive gamblers respond to some of the same medications used to treat drug addiction.”

“It gives us more credibility,” says DCGP’s Simon, formerly with the Delaware State Chamber of Commerce. Simon’s marketing efforts already have enlarged the nonprofit agency’s visibility among business and political leaders, minority communities, the elderly and women. Fundraising will continue to address new projects. The media strategy is being refined to better connect with young people.

The message is not that gambling should be eradicated, but that problem gambling needs to be controlled. Most people who place a bet or sidle up to a slot machine are not candidates for financial ruin. For those who are, DCGP—with a current budget of just under $1.4 million provided by the state Division of Substance Abuse and Mental Health (DSAMH), a staff of 11, and a network of nine gambling counselors—can offer far more help than when it was launched in 1979.

“A holistic treatment approach is needed to attack addiction,” says Marc Richman, DSAMH’s assistant director for community mental health and addiction services. DCGP relies on DSAMH funding that comes—courtesy of 1994 legislation—from the state’s portion of gross receipts from “video lottery terminals” (slots) at Delaware Park, Dover Downs and Harrington Raceway. DSAMH’s current budget of about $107 million provides an array of mental health services, including those available at Delaware Psychiatric Center and three community clinics. DCGP bids for its funding via the division’s proposal process.

The money pays for 20 sessions with a nationally certified gambling counselor for the individual plus family members. It pays the salaries of DCGP staffers, all of whom are trained to answer Helpline calls, some of which result in referrals for counseling. Beyond regular working hours, the 24/7 Helpline (1-888-850-8888) is manned by comparably trained call-takers, who receive a stipend for their services. Call-takers are equipped to deal with those in desperate straits, even to the brink of suicide. For all calls, interpreters intervene for the non-English-speaking.
 

 

In 2014, the Helpline fielded just under 5,000 calls, of which about 400 became clients, according to program director Barbara Barr-Lodge. Kicking the gambling habit is not easy money. “Sometimes, they are just not ready to hear about the time and effort it will take to work a recovery program,” says Barr-Lodge.

Problem gamblers may be just as elusive to therapists as they are to family and friends. DCGP follow-up surveys are frequently unreturned. Barr-Lodge says that what begins as a “great escape” inevitably leads to a “chasing phase that becomes like a job.” For those who do not receive therapy, “the best-case scenario is that they find their way to Gamblers Anonymous,” whose 12-step program parallels that of Alcoholics Anonymous. (In like fashion, the organization Gam-Anon focuses on the problem gambler’s family.)

Though DCGP has been extending its reach, the number of Helpline calls dipped last year, as did the number of cases resulting in treatment. A likely explanation is that strengthened counterparts in Pennsylvania and Maryland now handle more calls directly. “Gamblers move from one venue to another,” says Edgar.

And multiple venues, including casinos in Philadelphia and Atlantic City, are not far away for Delawareans. (These properties all promote responsible gaming and typically offer direct help for problem gamblers.) Crisis management is critical, but the greater goal is to connect with potential problem gamblers before they hit that stage. DSAMH funding pays for a range of programs, outreach activities and professional training seminars delivered by DCGP. “Some medical insurers are starting to cover gambling disorders,” says Simon. “We’re on the cusp of broader coverage.”

Educating young people is a priority. “Problem gambling tends to run in families,” says DCGP’s Judy McCormick, whose tabletop presentations, self-tests and Q&A sessions spread the word at health fairs and elementary and middle schools. “We look for teachable moments,” she says. In high-school health classes, McCormick’s entertainment quotient rises—rap videos and instructional dice games demonstrate that, for some, casual gambling is not so casual. Alternative schools are on her itinerary, and she educates teachers and parents at every stop.

To further engage youth and young adults, DCGP has both a Twitter and Facebook presence and online chat availability. The next frontier may be texting. “We need a comprehensive approach to reach different age groups and the different cultures within them,” says IT director Jerry Tiano. “The question is, ‘How do we use our media tools to address these groups?’”

The most effective tools in DCGP’s kit are its people, who have been bringing their message to African-American churches, Latino community centers, businesses and even assisted-living centers. “The elderly are one of the fastest growing populations [in problem gambling], and the most difficult group to handle,” says Barr-Lodge. Often fighting loneliness, many older citizens are drawn to gambling’s bright lights and clamor. For some, it leads to an addiction. Barr-Lodge reports that a proposed DCGP program tailored to seniors awaits approval by funder DSAMH.
 

 

DCGP has done perhaps its most innovative work in the prison system. Gonzer, DCGP’s downstate staffer (with an office in Rehoboth), makes a monthly presentation before dozens of inmates at Sussex Correctional Institution in Georgetown. He emphasizes to them that, when it’s compulsive, gambling is not fun and games.

“Some prisoners have told me about their gambling problem,” says Gonzer, who also speaks at Stevenson House, a youth detention center in Milford. “Some are there due to their gambling problem. When we’ve discussed will power and choice versus addiction, I’ve brought PET scans [of the brain] to show them the difference.”

More than a decade ago, DCGP’s Hector Garcia established a pilot program at Vaughn Correctional Center in Smyrna and is still providing treatment for prisoners there. “There’s a correlation with crime and gambling just as with crime and substance abuse,” says Garcia. “There is plenty of gambling activity in prison, though it may involve things from the commissary rather than actual money. And you have to pay up.”

As with Gonzer’s talks, Garcia’s treatment aims to equip problem gamblers for the day when they leave the high walls behind. His prison-based program consists of 26 sessions that explore the addiction’s psychological underpinnings in a personalized way—topics include narcissism, belief systems, shame and relationships.

One of Garcia’s standout successes has been an inmate named John, whose out-of-control sports betting turned him into a bank robber, landing him in prison. Still incarcerated, John is enrolled in college courses and helps other inmates get their GEDs. “He has completely transformed himself,” says Garcia, “and will be a force in the gambling treatment field after his release.”

Last March, timed for Problem Gambling Awareness Month, a program at the Wilmington Sheraton considered the value and feasibility of establishing a “gambling court” in Delaware. Judge Mark Farrell, who has held such a court in Amherst, N.Y., since 2001, spoke of this unique enterprise, which consigns offenders to treatment rather than prison.

To pay for this special event, Simon raised money from the legal and business communities. Fund-raising earmarked for specific projects outside of regular DCGP operations is a task she welcomes, and she forecasts more to come. Board member George Meldrum is her political liaison in this regard. “Part of my role is helping her navigate political minefields,” says Meldrum, a lobbyist for Nemours and a former DCGP deputy director. “We need to educate legislators about gambling problems. Arlene creatively uses the board in this process.”

Getting elected officials on board would help DCGP’s mission to treat problem gambling and inform the public. “In some communities, it’s acceptable even to excess,” says Tiano. “When it’s not, no one wants to admit it. And there’s the allure that, the next time, they will strike it rich.” But the payoff’s only value is that it ensures more action. “It’s not about the money,” explains Karnik.

“Money is only the agent of the addiction,” confirms Edgar.

Visit the Delaware Council on Gambling Problems online at www.dcgp.org, or for general information, call the offices at 655-3261 (New Castle County) and 226-5041 (Kent/Sussex counties).  
 


Illustration by Nicholas Little

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