Treatment programs for compulsive gamblers struggle with light funding
FARGO - For Tammy, the doting grandmother, the turning point came that day at the casino when she wrote $400 in checks for cash she didn’t have.
“I had to go home and tell my husband and he had to ask his best friend for money,” she said. “That was so humbling that I just said I need help.”
For Brian, who asked his elderly mother for money claiming he couldn’t make ends meet, the turning point was, ironically, winning a jackpot. He declared bankruptcy just a couple of days before and the casino required him to disclose the big win to the trustee.
“It’s the best thing that ever happened because I was forced to face it,” he said.
For Tim, quiet and inscrutable under his camo cap, it was when he truly hit rock bottom after losing what he figured was $750,000 over 20 years.
“I tried to commit suicide,” he said.
These are not their real names but their brutally honest stories of gambling addiction are real. The Forum agreed to change their names to gain access to their private group therapy session.
They were used to telling these stories about themselves and how they let down the people they love in these sessions because it’s part of their treatment. Few outside these sessions will hear the stories because few can understand the feelings of shame or the loss of control that are hallmarks of gambling addiction.
Having a supportive community is helpful for treating this disease, which can be as devastating as an addiction to drugs, said Lisa Vig, their gambling-addiction counselor at Lutheran Social Services of North Dakota in Fargo.
But supportive communities and treatment are scarce in North Dakota. The state has five counselors: four part-time LSS workers based in Fargo and Minot, and another independent counselor in Bismarck. Gamblers Anonymous groups are present in just five cities.
It’s not enough, Vig said. State funding for gambling-addiction treatment has been stagnant for 10 years and funding from some nonprofit groups is going away this month. She hopes to convince lawmakers to increase funding this session.
Research suggests that few who gamble become addicted, but for those that do get hooked, it’s a disease that can be as damaging as drug and alcohol addiction. It might even be worse because compulsive gamblers don’t see it as an addiction and think they can quit on their own, said Lisa Voller, a counselor in Minot.
“People understand alcoholism or substance abuse better because they know someone is ingesting something and that’s what’s making them behave a certain way,” she said. “With a gambling problem, it’s very similar; it’s just referred to more as a behavioral disorder.”
Until a couple of years ago, the American Psychiatric Association considered gambling addiction as a lack of self-control, in the same class as kleptomania and pyromania. As researchers came to see the similarities between gambling addiction and drug addiction, however, the APA put the two in the same category.
For those who are addicted, the act of gambling releases so much dopamine, a chemical involved in the reward system, that most other pleasurable activities pale in comparison. It’s a mechanism so similar to drug addiction that researchers have suggested treating both addictions with the same medication.
“Quitting alcohol was nothing compared to this for me,” Brian said. “This is the most difficult addiction I think I’ve ever had. Something about the rush.”
Most at the recent group therapy session were addicted to slot machines. Even as they talked ruefully about the consequence of their addiction, they couldn’t help but chuckle at the crazy things their addictions made them do.
Brian and Tammy said they tried to avoid using the bathroom as much as possible.
“I’d avoid going ’cause I didn’t want to spend time away from the machine,” Brian said. “I’d hold it until I almost pop.”
“You have to have somebody watch your machine,” Tammy chimed in. “Nobody takes that one.”
Few seek help
Researchers differ on exactly how many people are addicted to gambling. There are no figures specific to North Dakota, but one national study estimated that 0.6 percent of adults are considered pathological gamblers, a group considered almost helpless against the disease.
While problem gamblers may quit for a few months when they lose too much, pathological gamblers will ignore the consequences and keep going, Vig said.
For context, another national study estimated that 12.5 percent of adults are addicted to alcohol.
If the 0.6 percent figure holds for North Dakota, that means there could be 4,300 pathological gamblers in the state. Last year, Lutheran Social Services, which has the only gambling-addiction treatment program in the state, treated 69 state residents and 33 Minnesota residents. The year before, there were 65 North Dakota residents and 22 Minnesota residents.
Researchers say many compulsive gamblers aren’t willing to seek treatment, believing they can quit on their own. Or they don’t know where to turn for help, they’re deterred by the lack of insurance coverage for treatment, or they have no counselors in their area.
So far, the western population boom that accompanied the oil boom didn’t bring a rush of clients to Lutheran Social Services, said Voller, the Minot counselor. She thinks most in the oil industry are making good money and haven’t had to face the consequences of addiction yet.
While some compulsive gamblers are convinced they can quit on their own, others want help but are too worried about being judged, Vig said.
“They come in with a great amount of remorse and regret and feel very ashamed,” she said. “Especially women have a tremendous amount of shame. ‘This is not the person I was raised to be. This is not how my parents taught me to live my life. I used to be frugal, I used to be reliable, I used to be dependable. Now I’m just this horrible person.’ ”
Treatment involves what Vig calls the “hard emotional work” of the 12-step model commonly used in Alcoholics Anonymous. It starts with admitting helplessness in the face of gambling addiction, followed by compulsive gamblers taking inventory of everyone they harmed.
It helps to share the journey with others.
At the recent group therapy, Brian had an imaginary conversation with those he hurt as part of Step 8:
“Mom, sorry for causing you to go without because you always borrowed me money. I basically lied and said I could not make ends meet. That was true, but I led you to believe it was because of bills and not gambling. Very sorry Mom.”
He said his kids know about his addiction, but he couldn’t tell his elderly mother, not after the disappointment of his and his sister’s alcoholism.
A compulsive gambler’s family members are trained to take part in the treatment.
“Family does the wrong thing by often giving them money, giving them bailouts, which just prolongs the addictions,” Vig said. “It’d be sort of like giving alcohol to an alcoholic.”
She said the hardest thing is for family members to just let the compulsive gambler mess up financially because that’s sometimes the way the gambler’s denial is broken.
Family members also need to understand how addiction works so they aren’t hurt when they’re lied to or when they can’t understand why the gambler can’t just get up from the slot machine, she said.
Lutheran Social Service’s four gambling addiction counselors have enough funding to work 102 hours a week. They served 102 clients last year.
LSS has received $200,000 a year from the state since the 2003-2005 biennium. Indian casinos have chipped in $30,000 a year, increasing that to $45,000 since 2008. United Way has provided $5,000 in Minot and $45,000 in Fargo, but the Fargo funding ends this month.
Vig said having part-time counselors in only a few locations means clients can’t always get treatment when they want and where they want. She said there are probably many more compulsive gamblers who need help but can’t get it.
Earlier this month, she visited with state lawmakers who were receptive to increasing funding.
One of the lawmakers was Sen. Tim Mathern, D-Fargo.
He said earlier this week that the state should double the $200,000 to get counselors in unserved parts of the state. That’s probably not enough, he said, but low oil prices have made lawmakers cautious about spending.
Gambling addiction by the numbers
5: The minimum number of symptoms required to be diagnosed for pathological gambling, or gambling addiction. This includes committing crimes or borrowing money to fuel gambling habit, gambling to escape problems in life, lying about the amount of time spent gambling, trying to quit and failing, gambling bigger amounts to make up for losses, and losing a job or relationship because of gambling.
0.6: The percent of U.S. adults estimated to be pathological gamblers, meaning they’re addicted to gaming. That’s compared to 12.5 percent of adults addicted to alcohol. There are no comparable statistics for North Dakota, but if these rates are applied here there would be 4,340 state residents addicted to gambling and 90,424 addicted to alcohol.
2.3: The percent of U.S. adults estimated to have or have had a problem with gambling, meaning they gamble too much but aren’t yet physically addicted. That’s compared to 17.8 percent of adults who have abused alcohol.
69: The number of North Dakotans who went to treatment for gambling addiction in 2014. Experts say many compulsive gamblers deny they have a problem or are too ashamed to seek treatment.
5: The number of certified gambling-addiction counselors in North Dakota.
12: The number of steps in Lutheran Social Services’ treatment program. Steps include acknowledging who compulsive gamblers have harmed and atoning for the harm. In the case of embezzlement, this may even include putting money in an envelope and leaving it for the victim.
200,000: How much the state invests each year on gambling-addiction treatment, which has not changed since fiscal year 2004. Inflation has gone up 23 percent since then.
279.8 million: The number of dollars spent on gambling at charitable gaming operations in the 2014 fiscal year.
184 million: The number of dollars spent at Indian casinos in North Dakota in 2012. Indian casinos give LSS $45,000 a year for gambling-addiction treatment.
Sources: Lutheran Social Services, state of North Dakota, National Institutes of Health, AP