Most in the public only view the term “addiction” in terms of illicit drugs and alcohol, but the recent spate of celebrity deaths connected to prescription drug abuse has begun to raise the public awareness of addiction to drugs other than illicit ones. Even so, the public and policymakers remain largely unaware of what makes addiction a disease and how it affects the brain and body. Addicts are still too often seen as those who have no willpower or simply do not want to quit. The view that the public has of gambling addiction is similar in the sense that those who suffer from the problem are often dismissed as weak or morally depleted.
Yet while legislation and federal funding exist to provide for the prevention and treatment of substance abuse and addiction, no such programs exist for the protection and care of problem gamblers. The same applies to the professionals who treat these patients. While funding for the training of substance abuse counselors and the treatment of drug addicts and alcoholics is small when compared to the size of the problem drug addiction presents for our country, these funds tower over the funding received by the problem gambling field, which hovers dangerously close to zero.
However, the statistics on those who problem gambling affects warrant a review of the allocation of these funds. Four to six million American adults and 500,000 adolescents meet the criteria for a gambling problem. Fifty percent of problem gamblers in treatment meet current or lifetime criteria for substance abuse, and 30 percent of substance abusers in treatment meet current or lifetime criteria for problem gambling.
Problem gambling is defined as gambling behavior that causes disruptions in any major area of life: psychological, physical, social or vocational. The term problem gambling includes, but is not limited to, the condition known as Pathological or Compulsive Gambling, a progressive addiction characterized by increasing preoccupation with gambling; a need to bet more money more frequently; restlessness or irritability when attempting to stop; chasing losses; and loss of control manifested by continuation of the gambling behavior in spite of mounting, serious, negative consequences.
Recently, federal legislation has been introduced to address the issue. The Comprehensive Problem Gambling Act authorizes the Federal health agencies to address problem gambling and provides an appropriation of $71 million over five years for grants to state, tribal and local government health agencies, non-profits and universities on the prevention, treatment and research of problem gambling. Introduced in June 2009 by Reps. Moran, Terry and Wolf, HR 2906 has 42 sponsors to date: 33 Democrats and nine Republicans. Such senior members of the House as Rosa DeLauro (D-CT), Barney Frank (D-MA) and Mike Castle (R-DE) have signed on as co-sponsors. Senators Brownback (R-KS) and Merkley (D-OR) are scheduled to introduce the Senate companion bill, hopefully on March 8 (as of this writing).
“While no hearings have been scheduled, we remain optimistic the bill will pass this year,” said Keith Whyte, Executive Director of the National Council on Problem Gambling (NCPG), the national advocate for programs and services to assist problem gamblers and their families. “When [the Comprehensive Problem Gambling Act] passes, it will literally be the first-ever Federal grants for problem gambling prevention and treatment programs.” The mission of the NCPG is to increase public awareness of pathological gambling, to ensure the widespread availability of treatment for problem gamblers and their families and to encourage research and programs for prevention and education. There are currently 35 state affiliates of the NCPG.
The act would amend the Public Health Service Act to require the Secretary of Health and Human Services (HHS), acting through the Administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA), to establish and implement programs for the identification, prevention and treatment of problem and pathological gambling. It would require the Secretary to carry out a national campaign to increase knowledge and raise awareness of problem gambling. The Secretary would also be empowered to encourage media outlets to provide information aimed at preventing problem gambling and target their message to radio and television audiences of, but not limited to, sporting events and gambling. The Secretary would be authorized to make grants to states, local and tribal governments and nonprofit agencies to provide comprehensive services with respect to the treatment and prevention of, and education about, problem gambling.
The act would also require the President to establish and implement a national program of research on problem gambling, appoint an advisory commission to coordinate federal research, and consider the National Gambling Impact Study Commission’s recommendations. Acting through the SAMHSA Administrator, the President would also be required to develop a Treatment Improvement Protocol for problem gambling.
There are now 33 states that provide some public funds, usually through the Single State Agency (SSA). The Association of Problem Gambling Service Administrators (www.apgsa.org) is the trade association that represents problem gambling services at the state level, similar to how the National Association of State Alcohol/Drug Abuse Directors (NASADAD) represents the SSAs.
A search of the National Institutes of Health (NIH) database revealed that there are currently nine active NIH-funded studies that focus on pathological gambling. This is not to say that there are not other NIH-funded studies that could provide insight to the brain activity that relates to problem gambling. Several studies on other types of addictions could help the problem-gambling field find answers and develop better treatment protocols. But only nine such studies represent research directly related to problem gambling, with the funding for these grants totaling less than $2 million.
“There is a dire need for SAMHSA and other agencies to provide technical assistance, program development and best practices to make the most efficient and effective use of these funds,” said Whyte. “Problem gambling is highly co-morbid with substance abuse, and there is increasing evidence that providing services to treat problem gamblers will reduce usage of other public services, not just health-related but also criminal justice, and provide overall savings to agencies and states.”
Given the high co-morbidity of problem gambling with substance abuse and mental health, the resistance of many substance abuse/mental health providers to brief screening and prevention initiatives has been a major challenge. In response, NCPG has developed National Problem Gambling Awareness Week (www.npgaw.org), a grassroots campaign to raise awareness of problem gambling and to encourage health care providers, especially substance abuse and mental health personnel, to screen their clients for problem gambling during the week.
The American Psychiatric Association recently proposed to shift problem gambling into the new Behavioral Addictions section of the DSM-V, which is currently being compiled. This has the potential to help substance abuse and mental health professionals recognize the relationship between substance abuse and problem gambling, given the similarities in the underlying neuro-biological mechanisms. It would also provide additional validity to problem gambling as an addiction, requiring the necessary programs to appropriately diagnose and treat the disorder.
The author wishes to thank Keith Whyte for his cooperation in developing this article.