It is unfathomable to think that it took the medical profession in the United States until 1980 to recognize pathological gambling as a psychiatric disorder. Even after it was classified as a psychiatric disorder, it took another decade for effective treatments.
Fortunately, significant forms of treatment were created 20 years ago, and their effectiveness seems to be improving every year. There are also new forms being brought to the fight. It is a battle that those on the front lines are convinced they can win.
“I think that we’ve gained momentum,” says Felicia Grondin,
executive director for the Council on Compulsive Gambling of New Jersey. “But we just have so much more work to do.”
Gambling has been around the United States since 1665, when settlers in Jamestown, Virginia, held a lottery to raise funds for their colony.
During the 1800s, lotteries were commonplace. They were used as a way to fund public work projects, such as roads and bridges. There was no negative connotation associated with them, since the proceeds were often used to improve a town.
In the 1900s, casinos started to show up in Las Vegas and Atlantic City, but even before then, gamblers could find crap games in neighborhood alleys and backroom blackjack or roulette games in bars.
Still, while gambling was flourishing, treatment was non-existent until 1957. That is when a man named Jim W started Gamblers Anonymous. He had joined Alcoholics Anonymous 11 years earlier, and seeing the benefits, he started applying the similar principles to problem gambling, and GA was born.
Signs of Problem Gambling
GA identified the outward signs of the disorder:
- Needs to gamble with increasing amounts of money in order to achieve the desired excitement.
- Is restless or irritable with attempting to cut down or stop gambling.
- Has made repeated unsuccessful efforts to control, cut back or stop gambling.
- Is often preoccupied with gambling (e.g., having persistent thoughts of reliving past gambling experiences, handicapping or planning the next venture, thinking of ways to get money with which to gamble).
- Often gambles when feeling distressed (e.g., helpless, guilty, anxious, depressed).
- After losing money gambling, often returns another day to get even (“chasing” one’s losses).
- Lies to conceal the extent of involvement with gambling.
- Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling.
- Relies on others to provide money or relieve desperate financial situations caused by gambling.
Treatment, however, was unable to keep up with the explosion in gambling. In 1979, the first Native tribal casino opened when the Seminole Tribe built a bingo parlor in Hollywood, Florida. They beat back a legal challenge and soon had slot machines in their facility.
That opened the door for other tribes, and by 2000, more than 150 tribes in 24 states had opened casino or bingo operations on their reservations. By 2022, there were an estimated 523 tribal casinos in 29 U.S. states.
Two developments increased problem gambling exponentially. The first was online casinos. With people allowed to gamble from the comfort of their house, getting in trouble with gambling was way too easy. The other was the proliferation of sports betting. There are now 38 states that allow wagering on sports.
Grondin says her home state of New Jersey saw an explosion of calls to the help line regarding sports betting after the Supreme Court overturned the Professional and Amateur Sports Protection Act in 2018, making wagering on sports legal across the country.
“I would say about anywhere between 25 percent and 28 percent of our calls are either related to online gambling or sportsbooks,” Grondin says. “I think they went up around 233 percent after sports betting was legalized.”
With casinos more accessible than ever, reaching problem gamblers has never been more crucial. Those working in treatment centers say one of the hardest things is getting people to accept that they need help.
“Maybe 15 percent of people with gambling problems seek help,” says Christine Reilly, senior research director for the International Center for Responsible Gaming. “That could be a treatment provider, a Gamblers Anonymous meeting or whatever. So, you’re dealing with a population that really doesn’t want to have a lot to do with treatment.
“You can have the best thing in the world, but if customers don’t want use it, they don’t want use it,” Reilly says. “There’s nothing you can do about that.”
Varying Results on Treatment
Reilly says if a person makes the decision to get help for their gambling addiction, what type of treatment they get could be the difference between success and failure.
The International Center for Responsible Gaming researches science-based treatments. They have only been in operation since 1996, so a lot of the data is new.
“It is not evolving fast enough, though,” Reilly says. “The problem is we don’t have enough peer-reviewed research on treatment to say this is a best practice in treatment.”
There are various treatments available for problem gambling, each with its own strengths and limitations. Cognitive behavioral therapy (CBT) and motivational interviewing (MI) are two of the most commonly used approaches.
CBT aims to identify and change negative thought patterns and behaviors related to gambling. MI, on the other hand, focuses on exploring and enhancing an individual’s motivation to change. These treatments can be delivered individually or in group settings, depending on the preferences and needs of the individual.
Research has shown that both CBT and MI are effective in reducing gambling-related behaviors and improving overall well-being. A meta-analysis of various studies concluded that CBT was particularly effective in reducing gambling frequency and severity.
MI, on the other hand, was found to be beneficial in increasing treatment engagement and motivation to change. It is important to note that the effectiveness of these treatments may vary depending on individual factors such as the severity of the gambling problem and the presence of co-occurring mental health disorders.
CBT is a widely used therapeutic approach for problem gambling. It focuses on identifying and challenging irrational thoughts and beliefs that contribute to gambling behavior. By replacing negative thoughts with healthier and more positive ones, individuals can develop healthier coping mechanisms and reduce the urge to gamble.
CBT also incorporates strategies to manage triggers and high-risk situations. This form of therapy typically involves weekly sessions with a trained therapist over a period of several months.
Motivational interviewing is a client-centered approach that aims to enhance an individual’s motivation to change. It involves a collaborative and non-confrontational dialogue between the therapist and the individual struggling with problem gambling.
MI helps individuals explore their ambivalence towards change and identify their own reasons for wanting to overcome their addiction. This approach emphasizes empathy, active listening, and the importance of self-efficacy. MI can be particularly effective for individuals who may be resistant to traditional treatment methods.
Reilly says a combination of both can be beneficial.
“I think any approach, mindfulness, motivational interviewing, CBT, that can take away the stigma and can help people learn to deal with that is enormously helpful,” Reilly says. “Because as long as you’re feeling stigmatized, you’re going to feel bad about yourself. And it’s going to be really hard to make a change.”
One program that is having remarkable success is the Intensive Outpatient Program (IOP) at the Dr. Robert Hunter International Problem Gambling Center in Las Vegas.
Stephanie Goodman, executive director of the facility, explains that there are three components of the program: education, counseling, and individual therapy.
“We have just implemented these new programs, and we have found that if somebody goes through the IOP and continues on with those programs, and at least comes in twice a month, that we have a success rate of 92 percent,” Goodman says. “Our normal success rate for, let’s say, this person that went to the IOP and then that was it, is 44 percent. It’s significantly higher than the national average.”
The national figure on people that relapse varies anywhere from 70 percent to 80 percent.
That is why Goodman says it is so important to stay involved with their recovery. Some people are afraid they can’t afford it, but several treatment centers, including IPGC, have programs that can cover the cost of people who can’t afford it.
Research in the field of problem gambling is ongoing, and new treatments are being explored to improve outcomes for individuals seeking help. Some of these promising treatments include mindfulness-based therapies, virtual reality interventions, and neurofeedback. Mindfulness-based therapies aim to increase awareness of triggers and cravings while cultivating non-judgmental acceptance. Virtual reality interventions provide a safe environment for individuals to practice coping strategies and resist gambling urges. Neurofeedback, on the other hand, focuses on training individuals to regulate their brain activity and reduce impulsivity.
How are Programs Funded?
Of course, someone has to pay for the programs, and getting funding from the government is often difficult. Goodman and Grondin say they both rely on private donations and fundraising efforts.
Grondin has experience working with the state legislators and has been successful lobbying New Jersey politicians.
“Since I’ve gotten here, one of my primary efforts is to educate the legislature as to what’s happening,” Grondin says. “This is having a major social impact that needs to be considered, and we’ve been pretty aggressive about that. We’re at the state house, and whenever anything comes up with regards to a piece of legislation, we are there to testify. We’re a small nonprofit. It’s hard to devote that degree of time that I wish I could devote towards this.”
Grondin did see her state bolster its problem gaming initiatives in April. New Jersey Attorney General Matthew J. Platkin announced that he is creating a new position dedicated to problem gaming.
Other programs implemented were displaying prominently New Jersey’s 1-800-GAMBLER hotline in their ads, ending dubious promises of “guaranteed wins” or “risk-free” bets if the patron will not be fully compensated for the loss of their funds, making wagering requirements clear in their terms and conditions, limiting advertising in locations where it would entice those under 21 years of age to play, and providing the public with the ability to swiftly opt out of direct advertising.
“As New Jersey’s gaming and sports wagering industries continue to grow and mature, so do our obligations to assist patrons who are at risk for problem gambling,” Platkin said in the April news conference announcing the improvements.
“By establishing a dedicated, senior-level position within the Division of Gaming Enforcement to focus on responsible gaming, we are sending a clear message that we take this work seriously—and so should the industry. Our other initiatives announced today will help protect consumers and make it easier for individuals to access the help they need when their gaming behavior becomes problematic.”
Surprisingly, a major source of funding for problem gambling is the casinos themselves and others in the industry that have made contributions to programs.
Connie Jones is the director of responsible gaming for the Association of Gaming Equipment Manufacturers, and when she took that role, she says, it was difficult at first to convince the gaming industry they needed to be a part of this.
“The gaming industry suppliers need to be part of the discussion,” Jones says. “When I first became involved with the National Council on Problem Gambling, there was very little industry interface. And now the participation by the industry is unprecedented—not only by suppliers, but operators. It’s amazing. It’s mind-boggling the way it’s changed.”
Jones says companies are even working on making products more in tune with problem gaming.
“There are so many new technologies that do provide a safer product,” Jones says. “If players utilized the tools that are being made available to them, perhaps they could have been helped earlier.”
The problem gambler has more tools now than they have ever had. Treatment is still in its infancy, and getting those with a problem educated that there is a place that can help them is crucial.
“I think it has more to do with awareness,” Goodman says. “We are spending more money on advertising. It also has to do with the fact that I think people are more willing to talk about mental health. We have made strides with this issue, but there is so much more work we need to do.”