LV hosts problem gambling panel

One of the hosts of this week's 12th National Conference on Problem Gambling almost didn't make it.

Depressed and distraught over a life spinning out of control, Carol O'Hare phoned a friend to beg for a bottle of tranquilizers.

"I had begun to believe I'd lost my mind," she recalled at a recent State Gaming Control Board hearing as she described her addiction to gambling.

"I had no understanding that it was possible to follow an addictive process without chemicals ... or that anything could be done about it," she said.

"I lied, cheated, stole money from my children, lost jobs. Finally, I just wanted out of the pain I was in and made that call."

The friend listened quietly as O'Hare described her desperation, then offered an alternative: Why don't you just quit gambling?

"I ranted and raved that he didn't understand," she said. "He replied, 'Of course I understand. I'm a compulsive gambler myself.' "

"To this day," O'Hare said, "I think about what might have happened if I'd called a different friend."

Today, the recovering gambling addict is executive director of the Nevada Council on Problem Gambling, a sponsor of the three-day national conference beginning Thursday at the Alexis Park Resort.

More than 300 psychiatrists, psychologists, gaming executives and opponents from the United States and Canada will join National Council on Problem Gambling members from 34 state affiliates to discuss the recognition and treatment of problem and underage gamblers.

Aiding them in the complex task of recognizing and treating problem gambling will be what American Gaming Association President Frank Fahrenkopf calls "the definitive work on the issue" -- a Harvard Medical School analysis of 152 separate studies of disordered gambling.

The analysis was conducted by a team headed by Dr. Howard Shaffer, director of Harvard Medical School's Division on Addictions.

Shaffer's team concluded that only 1.29 percent of U.S. and Canadian adults can be classified as problem, addicted or compulsive gamblers. It also found significantly higher rates of problem non-casino gambling among those age 19 and younger. And they found no significant regional variations in the rates of gambling disorders, though there is evidence that rates are higher near gaming centers.

Shaffer's study, completed late last year, "did not include some of the most recent Nevada numbers, which will be discussed at the national conference," clinical psychologist Robert Hunter of Las Vegas said.

"Those numbers will show some fairly significant increases in rates of problem gambling among video poker players, including those playing at their friendly neighborhood casinos."

Fred Preston, a UNLV sociology professor, said 32 percent of Las Vegas residents who gambled in 1984 identified video poker as their game of choice. The number jumped to 54 percent in the latest survey, taken earlier this year.

Preston said 56 percent of Las Vegans identified as problem gamblers preferred video poker. The only other form of gambling to show an increase since 1984 is race and sports betting, which he attributed to an explosion of televised sports events, sports bars and legal books in Nevada casinos.

"Video poker has cannibalized other slots and table games," Preston said.

"Video poker is one of my special interests," Hunter said. "I think it's a markedly different form of gambling than traditional table games or slot machines.

"There are several qualities that determine the addictive power of a game. Video poker has them all. No. 1 is its immediacy. You can get results right away and, win or lose, play another hand within seconds."

Accomplished players, in fact, can play 20 to 30 hands per minute for short periods.

"No. 2 is that it offers you the ability to increase your play, staying longer and gambling for higher amounts," Hunter said.

"No. 3 is that it offers the perception -- not the reality, mind you -- that skill matters. But I don't think you can outwit a microchip.

"And No. 4, and perhaps most powerful, is the fact that it lets you block out external stimuli, to make the real world go away and let you escape into your own world."

Video poker is also the "overwhelming game of choice for women," Hunter said, a comment echoed by Dr. Rena Nora, chief of psychiatric services for the Veterans' Administration in Las Vegas.

"There is a high number of females in Gamblers Anonymous who say they are in their own universe when they're playing video poker," she said.

"More than 90 percent of the addicted females I've treated played nothing but video poker," Hunter said. "It's the ideal game because it seems the least threatening but is actually the most powerful."

Calling it the "crack cocaine" of gambling, Hunter said video poker can destroy addicted players in just a few years, rather than the few decades it takes for other addicted gamblers to hit bottom.

"I'm talking about maybe 5 percent, not the 95 percent who can play and have fun," he said.

Hunter praised the gaming industry's support of studies and treatment programs for gambling addicts.

"One of the most telling things about this conference is that we've got the industry's support," he said. "They are at the table in a serious way and finally starting to look at preventive issues.

"They've slipped into the alcohol industry's model and out of the cigarette industry's model, and I think it's wonderful progress."

Shaffer also lauded the gaming industry's willingness to confront the issue.

"This is a watershed event in the history of understanding this type of behavior," Shaffer said of the study, which was funded by the gaming industry.

When the results were released at an AGA board meeting last December, he said, "The group was dramatically receptive, concerned and very conscious of the need to identify these people and prevent these problems."

"This was a group that said, 'Tell us the extent of the problem so we can decide what to do about it.' The gaming industry is showing up. And in the long run, those who deal with the issue responsibly will make more money, because disordered gamblers wind up costing casinos through lawsuits, bad publicity, suicides and other destructive behavior."

Subhead: Insurance consequences

Casinos aren't the only businesses affected by problem gamblers.

Though their problems may affect their performance at work, addictions are rarely covered by employee health-insurance programs. Two exceptions are Harrah's Entertainment and Boyd Gaming, which offer treatment in their employee health plans.

"Gambling addiction is a treatable illness, diagnosable as a psychiatric disorder, but it's not treated that way by insurers," Lynn Rosenbach, chief executive officer of Charter Behavioral Health System of Nevada, said.

Shaffer said addictions are rooted in diversions that "take people's minds off unpleasant events."

Throughout history, governments have periodically embraced gambling as a means of distracting the populace, often distributing dice during famines to keep people from thinking about hunger, he noted.

People with other behavioral disorders -- such as depression, alcoholism and manic episodes -- and the poor are at the greatest risk of becoming gambling addicts, Shaffer said. "Money is on their minds because winning can move them to a different place in life."

Despite the absence of drugs, gambling can become an addiction through a combination of neuro-chemistry, "addictive clusters" and risk-taking behavior.

"There's a reward mechanism in the human brain that overrides much of our cognitive thinking," Shaffer said. "This mechanism gets stimulated when something makes us feel good, such as music, eating, sex or gambling."

Such activities stimulate the production of dopamine proteins, which begin flowing to dopamine receptors in the brain, thus rewarding certain behavior by inducing feelings of pleasure, euphoria and well-being.

Geneticists at the City of Hope National Medical Center have identified an allele, or genetic marker, of the dopamine D2 receptor gene (DRD2) that appears twice as often in pathological gamblers as in a control group.

They found that problem gamblers "have noted an aroused, euphoric state comparable to the 'high' derived from cocaine or other drugs, the presence of cravings, the development of tolerance (increasingly larger bets or greater risks needed to produce a desired level of excitement) and the experience of withdrawal-like symptoms."

"We now know for the first time that there's genetic material available in the brain that's associated with novelty-seeking, investigating new experiences, risk-taking. It's a natural phenomenon," Shaffer said.

In a similar study, Israeli geneticists discovered that babies with another dopamine receptor -- the DRD4 gene -- are more impulsive and sensation-seeking than other babies.

"If you're excited by gambling, you're pumping more dopamine into the brain," Shaffer said.

Problem gamblers exhibit the three "C's" of addiction -- loss of control, intense craving and continued involvement in spite of adverse consequences.

"Stopping doesn't provide satisfaction, so you become paralyzed. You're in a constant, painful struggle with yourself," Shaffer said.

"It's very difficult for someone to give up or change behavior that some part of them likes. We have to find a replacement for it."

Drugs such as Wellbutrin and Prozac may offer hope for treating compulsive behavior by blocking the brain's dopamine receptors and short-cutting the euphoria that gambling produces. Those and other treatment alternatives will be discussed at the conference this week.

But Shaffer cautioned against setting social policies that target problem gambling as a stand-alone phenomenon.

"Most gambling problems are an expression, because of our moment in history, of other causes or factors," he said.

"Gambling isn't limited to meccas any more. It may be that America is in one of its moments where risk-taking is important. New Wave music and mantras might be next."

archive