That’s the percentage of the adult population classified as problem gamblers. The percentage has not changed much over the years, even as new casinos entered the picture and new forms of gambling surfaced such as sports betting and online gaming.
“That tells me the population has adapted behavior to the presence of new gaming opportunities,” says Russell Sanna, executive director of the International Center for Responsible Gaming. “The rate reflects a snapshot in time. Some people get better. New people come into the system.”
That kind of stability, while commendable, doesn’t mean this problem isn’t a problem anymore. Problem Gambling Disorder (as it is clinically defined) remains a public health matter without regard to the existence of legalized gambling, Alan Feldman, chairman of the ICRG, says.
“The number of people engaged in gambling continues to increase, so the number of people impacted is getting larger,” he says.
Healthy gaming is gambling without problems. Problem gaming is excessive gambling.
“The idea is to keep one from becoming the other,” says Christine Reilly, senior research director at ICRG.
Picking out a problem gambler is not as easy as flagging an inebriated patron, she says. “It’s difficult to identify just by watching them.” Money spent is just one factor in trying to identify problem gamblers. “Time invested is a hallmark, and everything is always related to context,” Reilly says.
Throwing Money at the Problem
Over the years, casinos have taken on more responsibility to help identify and deal with the problem. Operators often need to craft a responsible gaming plan as a requirement for licensure.
“In our 2018 survey of 28,000 Americans, 63 percent agreed the industry should do more to help people with gambling problems,” says Keith Whyte, executive director of the National Council on Problem Gambling.
There are some commonly accepted general practices that should be in place, the most important being accessibility, Feldman says. “Too often, companies bury their information in hard-to-find locations either on property or on their websites.”
Some casino companies do a lot on their own not required by regulations, Reilly says.
“We encourage them to customize their programs to reflect the company’s unique brand and identity,” Whyte says.
Most of the larger casino companies take the issue seriously, and find innovative ways of incorporating ever more responsible gaming efforts into their operations, Feldman says. But the effectiveness only works when the culture supports the effort.
“It starts at the top, but it also must be accepted and internalized throughout a company.
“There are still quite a few companies that simply want to check off their requirements and nothing more. That’s too bad,” he says.
“If there were greater understanding that this is all about customer service, it might cause some companies to change their operational and cultural approach to the topic,” Feldman says.
Caesars has an ambassador program with staff on the floor to answer questions, Reilly says. MGM Resorts has a program called GameSense that originated in British Columbia, which connects people with a problem to resources, such as Gamblers Anonymous or a counselor.
Still, there are limits to what casinos can do, Reilly says. “It’s dependent on people coming in for help.”
There’s no evidence any one type of gambling is more of a concern than others.
“Both sports betting and online gambling come with unique risk and protective factors,” Whyte says. Gamblers are now able to bet around the clock around the world. Many can make these bets instantly and continuously through their mobile phones. On the plus side, account-based wagering allows for better tracking and identification of risk factors for gambling problems.
“I don’t think that sports betting, per se, adds to the problem,” Feldman says. What is interesting is the massive amount of media discussion about sports gambling and gambling language that has suddenly become a part of daily coverage, he says.
“This may turn out not be problematic at all; in fact, it may help to normalize sports gambling and lead to far greater understanding of the best practices for consumers. On the other hand, I think it would be best if sportscasters didn’t suggest to their audiences that they ‘bet the house’ on anything,” Feldman says.
The evidence about online gambling suggests that it has not increased problem gambling as some had feared and, in fact, may well have far fewer customers impacted than other forms of gambling.
“Industry providers, regulators, and gamblers themselves potentially have a much greater opportunity to intervene and prevent harm from occurring online,” Associate Professor Sally Gainsbury, of the University of Sydney, says in a paper co-authored by Dr. Robert Heirene.
Online gambling is continuously monitored, allowing operators to detect escalating or irregular spending behaviors such as changes in volatility and bet size, she says. Additionally, operators are uniquely placed to contact their customers about consumer protection tools.
Such tools allow gamblers to direct their own efforts to minimize problems, Gainsbury says. Customers can temporarily deactivate their accounts using a time-out or “take a break” feature, or permanently close them via self-exclusion. “They can set limits on the amount of money they are able to deposit into their online account or lose. Online activity statements also allow customers to track their expenditures over time.”
Operators can also provide customers with access to responsible gambling information pages and helpline contacts.
In one study of Australian wagerers, only 24.5 percent and 8.1 percent say they have used limits and time-outs, respectively. In the U.K., the Gambling Commission’s 2019 survey of 6,425 gamblers found rates of 9 percent for limit setting, 3 percent for time-outs, and 2 percent for self-exclusion from specific products.
Evidence is inconsistent and the field is limited due to few studies, Gainsbury says.
The most support exists for deposit limits. One study with a European casino found that customers who set deposit limits reduced the number of days they place bets, their betting frequency, and the overall amount they gamble.
“Among the most intense gamblers, setting limits has been linked to reduced gambling expenditure,” Gainsbury says.
The Covid-19 pandemic presents an interesting dilemma when it comes to problem gaming. “While there hasn’t yet been a scientific study, logic dictates that Covid-19 has had an impact on problem gambling,” Feldman says.
Emotional and economic problems such as stress, anxiety, depression and job loss that are exacerbated by the coronavirus are all known to be associated with higher rates of gambling addiction, Whyte says.
This has become reality for many people.
“Individuals may use gambling to self-medicate as an escape from the stress of the pandemic or as an attempt to recoup lost income,” Feldman says. “In doing so, they are at a higher risk for experiencing harms from gambling.”
People with gambling problems already lack accessible, available and affordable problem gambling treatment services in many states. “The pandemic has disrupted most counseling and self-help meetings and further reduced access to care, which may increase the rate and severity of gambling problems,” Whyte says.
At the same time, there have been reports of people taking advantage of the break caused by the closure of the nation’s casinos. Some were able to stop gambling during this time and may have been able to make a decision to not gamble in the future. “Others may have been able to use the pause to consider whether treatment might be called for in their circumstances,” Feldman says.
Yet another reaction to the virus is the real danger of shrinking budgets for state health departments. That creates a serious danger of further cuts to problem gambling prevention, treatment and research services, Whyte says. “That will likely increase reliance on casino companies to step up to support the safety net.”
Players and employees appreciate companies who care about their health and happiness.
“There is a great opportunity to strengthen these relationships by embracing responsible gambling messaging and programs during the pandemic,” Whyte says.
Treating It Seriously
Treatment of gambling disorders lags behind treatment for problems such as alcoholism. Gamblers Anonymous is not as big or extensive as Alcoholics Anonymous, Reilly says.
“There’s no gold standard for treatment,” she says. There’s not much research in the field. There’s a stigma that prevents getting help. With treatment centers few and far between, it’s hard to find treatment.
“Insurance is part of the problem. They do not reimburse for care,” Reilly says.
Treatment can be self-help, group help, individual therapy or a combination of the three. Studies show cognitive-behavioral therapy and motivational intervention have the best outcomes for people with gambling problems, Whyte says. The basic rule of thumb is that roughly two-thirds of those who complete a treatment program or attend self-help groups for a sustained period of time are able to greatly reduce their gambling-related harm. “They also show significant improvements in family relationships, finances, job performance and even physical health,” he says.
Yet many people cling to the fantasy they are just one bet away from winning everything back, which encourages persistence in the face of even catastrophic losses. “This belief also contributes to relapse among gamblers who are trying to quit,” Whyte says.
That is why reinforcing responsible gambling messages is so important. Every sign or message provides an opportunity to reach someone right when they have a brief moment of clarity.
Exclusion lists are effective for some but not all, Reilly says. Those customers who use self-exclusion report high levels of satisfaction.
“The concept is extremely valuable; the challenge is the wide variety of rules and regulations around implementation and use,” Feldman says.
Few jurisdictions make the process easy. Each jurisdiction has different lengths and processes for getting off the list (or no process to do so).
“And no jurisdictions share their information, so currently, if a customer has excluded in one state, they may simply travel to another and circumvent the program entirely,” he says.
It needs continued innovation and improvement rather than elimination, Feldman says.
Most excluders are caught only when they win a jackpot and are required to show ID for tax purposes. “Few who exclude receive referrals to treatment or are able to afford it own their own,” Whyte says.
But the NCPG, along with other individuals and organizations, is working to reduce barriers, provide free services to address the root of the problem, and link together hundreds of self-exclusion programs with the goal of creating a more therapeutic, seamless and consumer-centric program, Whyte says.
Technology is another promising avenue. Researchers are working with an online algorithm showing a pattern of play.
“If excessive, it triggers a message to give them something to think about or cut them off. But we’re not there yet,” Reilly says.
Newer technologies include online sources such as podcasts, chats, Gamblers Anonymous Zoom meetings, and telehealth visits with clinicians, Feldman says.
“At the same time, technology developers who were working on apps that might be beneficial to those experiencing harm from gambling now have new opportunities as public health officials seek new ways to improve health while social distancing,” he says.
Responsible gambling technology has made enormous leaps, but problem gambling technology is in its infancy, Whyte says. “The vast majority of problem gambling treatment in the U.S. is still delivered face to face by an outpatient counselor or by peers in a self-help group. While some apps that help monitor gambling urges, provide feedback or block access to gambling sites are available, they all tend to be supplemental to a treatment plan, not an integral part of it.”
As with any addiction, the first step to recovery is for the individual to acknowledge that a problem exists and that they need help finding a solution. “If the individual isn’t willing to address the situation, it is all but impossible to provide treatment,” Feldman says.
The objective for everyone involved should be to remember that any road to treatment is viable and none should be ruled out.
“Maybe it’s a talk with a friend, neighbor, co-worker or family member; maybe it’s reading an article or hearing a radio program; maybe it’s seeing a website or listening to a podcast; maybe it’s being motivated by someone in the faith community. Or, maybe it’s a conversation with a casino employee,” says Feldman.
“Whatever helps get someone on the road to recovery is worth it.”
To read the full transcript of Sally Gainsbury’s report, visit: https://www.iagr.org.