Gambling addiction: A rare niche


Edward Federman, Ph.D., president of Gambling Solutions, a Massachusetts-based organization dedicated to prevention and training, feels that mental health professionals are still behind the curve in treatment of this addiction. (photo by Allison Evans)

By Catherine Robertson Souter

Gambling has existed for centuries. Telling signs include discoveries of gaming dice dating back to Roman times and ancient myths recalling humans making bets with the gods and generally losing.

Today, the gambling industry has exploded, with scratch tickets, bar room Keno and big number lottery games ingrained into the cultural landscape. In states like Nevada and New Jersey, casinos have transformed desert soil into a booming city and a quaint seaside village into a brightly lit mecca.

Over the past decade or so, Native American tribes have established independent casinos, with Connecticut home to two phenomenally successful resorts. Other states have debated creating their own.

Even the Internet features gambling, with everything from online betting sites to inexpensive stock market brokers.

"What do you think was the amount of money spent in the United States legally gambling?" asked Edward Federman, Ph.D., president of Gambling Solutions, a Massachusetts-based organization dedicated to prevention and training. "This survey is a couple of years old, but it says $600 billion. That's bigger than the gross national product of Spain."

While gambling is a socially accepted form of entertainment, its drawbacks and dangers have been well documented. Despite its prevalence in today's society, however, the treatment of compulsive gambling is a relatively under served field in psychology.

Although recognized as a DSM-IV condition, a compulsive gambling diagnosis is not always covered under managed care. Treatment is not commonly taught in schools. And, although certification programs exist, they're not aggressively publicized or always regarded as essential.

The six psychologists featured in this article were hard pressed to identify more than a couple of others sharing their specialty. Some were unaware of any counterparts. Their treatment methods vary and documented studies are rare.

Nancy Petry, Ph.D., conducts several research studies concerning treatment-related issues at the University of Connecticut Health Center in Farmington. She and her colleagues began the studies four years ago when they realized that compulsive gambling research was largely unexplored. The work is funded by grants from the National Institute of Mental Health, National Institute of Drug Abuse and other agencies.

"Five years ago there were no controlled trials," Petry explains. "No one knew what they were doing. There were some free-standing clinics but no standardized treatment."

The researchers are developing a cognitive behavioral treatment evaluation and have completed or are developing several papers on topics related to gambling such as seniors and suicide rates.

Petry has had no formal training in working with gambling addiction and says she is unaware of any such programs.

Frank Luongo, Ph.D., runs a private general practice in Portland, Maine. Although he doesn't call himself a gambling addiction specialist, he has become the local "go-to" man for treatment of the problem. "The local Gamblers Anonymous has been using me as a resource for a number of years," he explains.

Luongo's involvement began when one or two people came to him and then referred others. Experienced in interpersonal psychotherapy, cognitive behavioral therapy and family therapy, Luongo developed a "frame of reference" for working with compulsive gambling that has successfully served his clients over the past decade. While he has no specific training in working with gamblers, it is similar to treating other addictions, he believes.

"The way I work, I see gambling as a part of someone's life gone out of control," Luongo says. "We have to figure out how do their other problems relate to the gambling. What in their lives created such a strong desire?"

Brent Levinson, Ph.D., of the Boston Center for Problem Gambling at Allston Brighton Medical Center in Massachusetts, agrees that treating compulsive gamblers is similar to working with other addictions. However, he does not use a 12-step program to help addicts. For more than 15 years, the center has offered a long-term, sliding scale group therapy. The method is based on a more psychodynamic model than what is generally offered at Gamblers Anonymous (GA) or Alcoholics Anonymous.

The 12-step model, Levinson says, is "not tailored to the particular individual. It's sort of a one-system fits all model and it has a moralizing element to it. It doesn't explore what any of the problem behavior is for the patient, so it leaves him or her open to relapse."

Up to 40 percent of Levinson's patients also attend GA. He says his group demonstrates that there is more than one way to treat the illness.

Others believe that gambling addiction requires a completely different approach than substance abuse and other addictions.

"There is a fair amount of overlap with other addictions, but there are many unique features as well," Federman says.

Marvin Steinberg, Ph.D., executive director of the Connecticut Council on Problem Gambling, concurs.

"Addiction without the ingestion of substances, that's something that people have to understand can happen in a similar way. I've treated alcoholics who were also compulsive gamblers," he says. "They will say that they went to AA, but now find that the gambling addiction is more difficult to deal with."

Because gambling is so widespread and promoted at many levels, it is sometimes difficult for addicts to recognize its ill effects. The field may be under served, in part because of the gambler's attitude. Explaining why one gambling treatment center closed its doors, Federman refers to a three-part problem.

"It's a tri-partide force against it," he says. "The societal attitudes�everybody does it. The zeitgeist is geared towards it. At the level of mental health care, professionals are still behind the curve in treatment. We are behind in it too. We are lagging behind the need here. Then, at the level of the gambler, like with all disorders, they do not want treatment until it's severe."

"Society says it's okay, the mental health professionals are not looking for it, and gamblers are not looking to change their behavior," Federman adds.

According to Henry Lesieur, Ph.D., Psy.D., the gambling treatment center at Rhode Island Hospital has difficulty finding enough clients for its grant-funded program.

"We have to basically advertise for referrals using state funding even to get the case load that we have," he says.

Although managed care funding can be an issue, payment for services is not high on the list of problems for psychologists within this field. In addition to state or grant funding, the larger casinos provide money to gambling addiction programs. In addition, as Luongo points out, most patients with gambling addiction generally have other diagnosable symptoms simultaneously, and those conditions are readily covered by managed care.

The primary reason that the treatment of gambling addiction may never become a major area for specialized clinical practice or research could be that it is rarely a stand-alone issue, some psychologists feel.

"There are not a lot of people experienced in it, so in that sense, yes, it would be a good field to go into," Petry says. "On the other hand, it is not a disease that affects a lot of the population. You would not make a good living with dealing exclusively with treating compulsive gambling. I don't know that it would be a great business venture."

Still, psychologists should become more aware of the disease, screen for it and learn how to treat the condition. Many gamblers do not recognize that they have a problem. Instead, they will present with other issues, such as depression or suicidal ideality.

Lesieur adds, "Two thirds of the people we treat also carry a depression diagnosis. If you had depleted your entire IRA and 401k and were in debt for thousands of dollars, you would be depressed too."

Gambling addiction: A rare niche (December 2002 Issue)

Gambling addiction: A rare niche
(December 2002 Issue)