Las Vegas Sun

March 28, 2024

Gambling: The neglected addiction

Despite growing consensus that gambling addiction can be as devastating as alcoholism or drug dependency, problem gamblers can face an unfair fight against the disease.

So argues UNLV professor Stacey Tovino, who researched ways gambling addicts are disadvantaged by health and disability laws, which allow some insurance providers not to cover problem gamblers seeking treatment. Tovino argues that people diagnosed with gambling disorder — the clinical name for gambling addiction — should be treated the same as those suffering problems with drinking or drugs.

“If you see someone with severe gambling disorder, that’s all they focus on,” she said. “That’s as serious a drug addiction as alcoholism.”

Until last year, the American Psychiatric Association listed gambling disorder as an “impulse control disorder” in its Diagnostic and Statistical Manual of Mental Disorders. The condition was grouped with kleptomania and pyromania.

In a 2013 update, the association reclassified gambling disorder as a “non-substance-related disorder,” under the same umbrella as alcoholism, in a section on addictive diseases. It was a significant shift, and it reflected a growing consensus in medical research.

“Addiction is a disorder of the brain reward system, and it doesn’t matter whether the system is repeatedly activated by gambling or alcohol or another substance,” Tovino said, quoting Dr. Charles O’Brien, who chaired the work group on substance-related disorders for the 2013 update.

But health and disability laws still have a lot of catching up to do.

The Affordable Care Act was intended in part to bolster insurance coverage for mental health problems. It requires certain health plans to provide “essential health benefits,” including services for mental health and substance use disorders. But not all of those plans have to cover gambling disorder treatment.

Tovino found that Nevada’s requirements for the basic benefits some insurance plans must cover excludes impulse control disorders, including gambling disorder, because the rules were set before the new diagnostic manual was published.

That means some Nevada residents have health insurance coverage for gambling disorder only if their insurers voluntarily choose to provide it.

The National Council on Problem Gambling identified similar issues with the law, saying states could sidestep the spirit of the benefits requirement.

“This process … appears to allow new plans to avoid coverage for gambling disorder, not because of the legitimacy (of) the condition or because the law intended to exclude gambling disorder, but simply because the practical implementation relies on previously existing plans,” the council wrote.

Gambling addicts who try to get disability insurance coverage based on their disorder also face legal roadblocks. Although help for gambling disorder is not excluded in disability law, Tovino found multiple court cases in which people tried and failed to get such coverage.

Nevadans aren’t universally barred from getting health insurance coverage for gambling disorder under the ACA, but it’s unclear how many Nevada plans offer it.

Jake Sunderland, a spokesman for the Nevada Division of Insurance, said there are two plans on the individual and small-group markets that specifically exclude problem gambling. The rest are unclear.

“For a majority of the carriers out there, it’s really up to the patient to work with their physician and their insurance carrier to identify what’s medically necessary and what will be covered,” Sunderland said.

That has proven to be a difficult process for some. Carol O’Hare, executive director of the Nevada Council on Problem Gambling, said her organization has heard from treatment providers that getting an insurance company to cover services is the exception rather than the rule.

“Getting insurance coverage for problem gambling has been historically difficult and at times not cost-effective,” O’Hare said. “It’s so rare that the insurance will cover it, it’s almost a waste of time.”

O’Hare said insurance companies’ reluctance to cover gambling addiction may stem from a lack of understanding about the disorder, since it doesn’t have the same amount of research amassed over decades that substance abuse has had.

Nevada allocates some public money to fund gambling addiction services, so residents are able to get treatment at an affordable price or for free.

But widespread insurance coverage of gambling addiction still would help. O’Hare said about 60 percent of the public funding typically is allocated for treatment. If more insurers covered treatment, more of that money could be used to improve other services, such as training new counselors.

“At the end of the day, if there aren’t more resources somehow to fund the services, the services will not grow,” O’Hare said. “We are not even scratching the surface of being able to really provide the availability of treatment we should provide.”

Patients at the Problem Gambling Center in Las Vegas, for example, can get their treatments covered for free. But the center’s Dr. Robert Hunter said getting insurance companies on board would be beneficial because it would encourage more people to seek treatment. That’s what happened when insurance companies were compelled to pay for alcoholics’ treatment, Hunter said.

“That was when people really started coming forward and getting help,” Hunter said. “I think the same thing would happen.”

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