Denise Jewell
CNHI News Service
Fri, May 16 2008
—
Kathy Bassett, 49, a registered nurse from Topeka, Kan., didn't blink when Harrah's opened a casino 15 miles from her front door.
She had zero interest in gambling. Nor did she worry about its social ills.
That was before 2003, a nightmarish year that Bassett said opened her eyes wide to the problems associated with addictive gambling. In sequential order:
-- Her son, a casino pit boss, was arrested for stealing to support his gambling habit.
-- Her mother, retired and in her 70s, filed for bankruptcy after losing her life savings to the slot machines. David Benintendi
-- Her 37-year-old brother, David, in despair and shame over his inability to quit gambling, put a shotgun barrel to his mouth, pulled the trigger and ended his life.
This trilogy of shocks scared Bassett into researching the impact of compulsive gambling on ordinary families such as hers. She soon discovered plenty of others undergoing similar grief. Now, she's an outspoken anti-gambling crusader who is determined to expand and improve prevention and treatment programs.
"I just got so angry," said Bassett. "This is an industry worth hundreds and hundreds of millions of dollars, and ... it means nothing to them" - meaning government, Indian tribes and gambling companies that profit from legal gambling.
Bassett said her research showed that help for problem gamblers in the United States is sporadic, inconsistent and badly underfunded. Especially when compared with tobacco, alcohol and drugs - addictions that states spend $2.5 billion a year to treat, according to the National Center on Addiction and Substance Abuse at Columbia University.
The evidence supports Bassett's analysis, a review of the issue by CNHI News Service showed.
Not one federal dollar has been spent directly for treatment or prevention of problem gambling even though a Harvard University addiction expert, Professor Howard Shaffer of Andover, Mass., framed it as a public health issue in the country for the first time in a 2002 study.
"Excessive gambling, drinking, drugging are different expressions of a common, underlying disorder," said Shaffer of his study. "But pathological gambling is being viewed (by the government) like some rare disease - much like AIDS was in its early stages. It doesn't get the attention it should as a public health issue."
Few federal dollars have been allocated for medical and other research that might help detect the problem before it gets out of hand, or provide guideposts for prevention. Congress did pay for a $5 million, two-year study of the social and economic implications of gambling in the late 1990s, but little came of the short-lived effort.
Indian tribes that own 405 casinos on sovereign tribal lands and the 48 states with some form of legal gambling are similarly stingy with spending on programs that could diminish the volume of high rollers.
Twenty-two states offer no programs at all, CNHI News Service found. And the 26 states that provide treatment don't put a lot of money into it, operate in isolation from others despite the wide ranging mobility of problem gamblers, and appear to accept the claim that sufficient community programs exist to help the truly addicted.
Across the country, the CNHI News Service survey found, state and local governments are spending only $35.5 million of the $20.9 billion they receive annually in gambling taxes for treatment.
Mike Stone, executive director of the Kentucky Council on Compulsive Gambling, said his state falls into the "zero, nada, zilch" category. And, he adds, "we're seeing an increase in people seeking help" because of riverboat casinos along the Indiana border.
The gambling industry as a whole does far better than Kentucky and yet it spends only a slight sum of its billions in profits on research, prevention and treatment. And nowhere close to the many millions it shovels out to influence lawmakers through lobbying, and gamblers through TV, Internet, direct mail and billboard advertising.
The industry has established the National Center on Responsible Gaming, a small nonprofit organization based in Washington, D.C., that says it is trying to develop tools for prevention and treatment of addictive gambling.
The center proudly claims it is "committed to funding research that some day will identify the risk factors for gambling disorders and determine methods for not only treating the disorder but preventing it, much like physicians can identify patients at risk from cardiovascular disease long before a heart attack." Yet it operates on a shoestring budget compared with the huge outlays spent by the government, private agencies, foundations and others on heart disease research.
The center is quick to boast about a $2.4 million startup grant and a $1.1 million annual appropriation to Harvard's Medical School to fund the Institute for Research on Pathological Gambling and Related Disorders. The only other major expenditure ($180,000) is for an annual gambling addiction conference in Las Vegas, attended by researchers, public health administrators, treatment providers and gambling executives.
Integrity in Science Project, a group that monitors scientific research for conflicts of interest, has indicated concern over Harvard accepting research money from an industry that reaps handsome rewards from the very problem under study. The unstated worry is research skewed to reflect a desired outcome - specifically, that addiction has been overstated by critics of legal gambling.
Christine Reilly, executive director of the Harvard institute, rejects any notion the gambling industry could manipulate the research. She said it funds the institute but has no say in how the research is conducted or the results - which, she added, are subject to rigorous peer review by scientific journals.
Two unaffiliated nonprofits are making independent efforts to help problem and compulsive gamblers, although both suffer from lack of resources. They are Gamblers Anonymous, which has more than 1,400 chapters in the United States, and the National Council on Problem Gambling, which has 34 state affiliates.
Gamblers Anonymous is modeled after the 12-step program of Alcoholics Anonymous. A state-by-state directory of local meetings is posted on its Web site (gamblersanonymous.org/mtgdirTOP.html). Financial support comes from private contributions.
The Council on Problem Gambling is an advocacy group to increase public awareness and encourage treatment programs for troubled gamblers and their families. Funds for the group's $500,000-a-year budget come from private and foundation contributions and at least two casino companies. It operates a national hotline (1-800-522-4700) for problem gamblers, and more than 200,000 problem gamblers call it over the course of a year. Keith Whythe
Keith S. Whyte is the council's executive director and once worked for the American Gaming Association, the industry's lobbying arm. He said the council is neutral on the debate over legalized gambling, focusing its efforts instead on helping addicts overcome their problem.
The federal government, Whyte said, has been unhelpful in the effort to get mental health care for compulsive gamblers, pointing to the absence of compulsive gambling from mention in the Americans with Disabilities Act. The exclusion, he said, allows insurance companies to refuse to pay for treatment programs for problem gamblers.
"Addictive gambling is a rare and stigmatized sort of behavioral health disorder because there's no physical or outward signs," said Whyte. "It has slipped through the legislative cracks."
Congress, he added, could easily fix the issue by expanding the definition of the disabilities law to include compulsive gambling as a public health problem, the same as it did with alcoholism and drug abuse.
Medical researchers say compulsive gambling is not as visible to the public health as alcoholism and drug overdosing, but it can be equally devastating to social behavior. They also say some of the brain receptors in gambling addicts appear to be different.
Magnetic Resonance Imaging studies have found abnormal signs of attention deficit disorder in pathological gamblers. Neurobiology research has indicated their brain chemistry is not the same as that in problem alcohol and drug users. This has led to experiments with the drugs Nalmefene and Revia to try to curb gambling cravings.
"If you look at the MRI of a gambler, his brain looks different," said Whyte, who tracks the research. "But it is very hard to get that across to the admitting nurse that's going to say, 'Why don't you just stop gambling? Why don't you go home? You shouldn't have been gambling in the first place.' "
But self-discipline is not a characteristic of compulsive gamblers. Few of them put their names on exclusion lists required to be kept by casinos for problem gamblers who want to quit on their own. Gamblers who sign up are banned from receiving credit or gambling. Casinos can also add problem gamblers to the list and arrest violators for trespass.
There are other ways the industry says it tries to discourage gambling by people who shouldn't do it or can't afford it. They include posted warnings in casinos, race tracks and video poker parlors about overdoing it, cautionary wording on the back of lottery tickets, public service announcements about the consequences of addictive gambling, and Web sites that test for symptoms of compulsive behavior.
Ken Davie, a vice president at Foxwoods Casino in Connecticut, said the Mashantucket Pequot Tribal Nation donates $200,000 a year to that state's council on problem gambling and also distributes warning pamphlets. But he said it is hard to detect problem gamblers in a state that features 7,000 slot machines at Foxwoods and another 6,000 at nearby Mohegan Sun Casino.
"You have 13,000 opportunities to be hidden," said Davie. "Some of these machines are sitting in the corner. You can be hidden away. You could come in and feed 100-dollar bills all day and we wouldn't know you're gambling away your life fortune."
The American Psychiatric Association describes impulse playing of slots and other instant response games as "persistent and recurrent maladaptive gambling behavior" personified by symptoms such as obsession with risk, lack of self-control and lying.
"Pathological gambling is a condition where the person's out of control," said Jon Welte, a researcher at the University of Buffalo's Research Institute on Addictions. "They can't stop gambling and they can't moderate the amount they do. Gambling has kind of taken over their life."
Welte said researchers struggle to understand why some people develop problems gambling while others can do it recreationally for years without becoming addicted.
"We're 20 or 30 years behind the research that's been done on alcohol and drugs," he said. "There's been a lot of (gambling) research done about prevalence. We need more research that gets closer at examining the causes." Mark Farrell
A local judge in the western New York town of Amherst isn't into medical research, but he presides over the nation's first and only gambling court to treat the addiction problem when it is related to crime. Sentences can include psychiatric evaluation and counseling.
Judge Mark G. Farrell created the court five years ago after several unlikely defendants in a string of theft and embezzlement cases admitted they were addicted to gambling at casinos a half-hour away in Canada. Since then, two Indian casinos have opened nearby in the United States.
Farrell said the public perception that reckless gambling is a "character flaw" rather than a disease or addiction has contributed to the slow development of programs to treat problem gamblers.
"They are more likely to admit they're a heroin addict than they would be to admit they're a compulsive gambler," he said. "And yet they've gone through their own money, their family's money, their kids' money. There could be a divorce action going on. They've had DWIs - a whole range of things."
Some states earmark gambling revenue for treatment services, but even they have not kept pace with the rapid expansion of gambling within their borders and nearby states.
Nevada, where gambling has been legal since 1931, did not set aside money for treatment until last year. Indiana, a leader among states using casino revenues ($1.6 million a year) to help problem gamblers, limits access to low-income residents. And the director of the Indiana Council on Problem Gambling, Jerry Long, complains the bulk of the treatment money is siphoned off for addictions other than gambling. T. Andrew Pearson
T. Andrew Pearson, a psychologist and executive vice president of LifeSpring Mental Health Services in Jeffersonville, Ind., said it's difficult in Indiana and many other states to reach gamblers who need help because, unlike alcohol and drug abuse, the criminal justice system makes few referrals.
Furthermore, there are only two residential treatment centers specifically for problem gamblers, places where addicts can go for several days or weeks to overcome their compulsion. One is in Baltimore and the other in Louisiana.
Tim Christensen, treatment administrator for the Arizona Office of Problem Gambling, said the gambling industry and the states that rely on it will be forced to change as public awareness grows.
"Look at the tobacco issues that our country has gone through," said Christensen. "You went from a vast majority of people that smoked to a vast minority. That happened over time and with tons of resources put into it."
For advocates like Bassett, the nurse from Topeka who lost her brother to death by suicide, the time of enlightenment can't come soon enough. Prevention, she said, is also more complex than hotlines, self-exclusion lists, warning pamphlets.
She said her brother, a social worker who once manned a crisis hotline, had sought help from a private counselor and had even banned himself from the casino near his home. But the day before he died, she said, he drove right past it to another and proceeded to spend most of the day losing money he was holding for his mother.
"There are no clocks. There are no windows," said Bassett. "It's an unreal existence in there. It's not like playing with real money. It gives you the delusion of not really losing."
Denise Jewell is a CNHI News Service Elite Reporting Program fellow. She writes for the Niagara Gazette in Niagara Falls, N.Y.
Copyright © 1999-2008 cnhi, inc.
Photos
Kathy Bassett sits in her home in Topeka, Kan., with a picture of her brother and other family members, Friday, April 7, 2006. Bassett's brother, David Benintendi, far right, committed suicide in 2003. Others pictured include Blake Curry (Bassett's son) and Benintendi's former wife, Kelli. Associated Press for CNHI News Service
This photo hangs in the Topeka, Kan., home of Kathy Bassett as a reminder of happy times with her brother, David Benintendi, hugging Bassett at far right. Also in the picture are Blake Curry (Bassett's son), and Benintendi's former wife Kelli (Benintendi) Stevens. Associated Press for CNHI News Service
Christine Rilley, executive director for the Institute for Research on Pathological Gambling and Related
Disorders. The Salem News, Salem, MA
Sandy Bartholomew, 52, of Concord N.H., plays keno at Ted's Stateline Mobil in Methuen, Mass. She said she once lost $4,000 in one day playing the slot machines at Foxwoods Casino in Connecticut. The Eagle-Tribune, N. Andover, MA
