State of Play is a column that focuses on the trending stories in the casino and gambling space with sharp and clever insight from senior staff writer Steve Friess. Over his 25-year career, Friess has contributed to publications such as Newsweek, Time, New York Times and more.
A few weeks ago, I saw my doctor for an annual checkup related to the prescription for an antidepressant I’ve been taking for nearly 20 years. It’s an understandable prerequisite for renewal, this set of questions designed to assess my current mental health.
The form, I’ve always thought, had it all. It asks about drug and alcohol use. Cigarette use and whether anyone nearby smokes. Food insecurity. Suicidal ideation. Sexual behavior. Domestic violence. Sleep patterns. Even medical debt.
This year, though, I noticed what’s not on the form: Anything about gambling.
I live in a state, Michigan, that in 2020 began enabling any adult with a smartphone to legally gamble in just about any way they wish whenever and wherever they wish. We’ve got it all here — iCasino, poker, sports betting, the lottery — and at least a dozen providers vying for our business with constant advertising.
Yet physicians don’t ask, so patients rarely tell.
Just ask a few gambling-related questions
Perhaps questions about financial stress could, theoretically, lead to a discussion about gambling losses or activity. But how hard would it be to add a few questions?
The Harvard-developed Brief Biosocial Gambling Screen, now considered a top instrument, asks just three:
- During the past 12 months, have you become restless, irritable or anxious when trying to stop/cut down on gambling?
- During the past 12 months, have you tried to keep your family or friends from knowing how much you gambled?
- During the past 12 months, did you have such financial trouble as a result of your gambling that you had to get help with living expenses from family, friends, or welfare?
A “yes” to any of these indicates the respondent is at risk for developing a gambling problem.
The problem, experts tell me, is that the medical community, particularly front-line folks like family doctors, have been slow to recognize the growing threat. Most haven’t been trained to consider the signs or to view gambling compulsion as an addiction. It was only in 2013 that gambling disorders became the first non-substance behavioral addiction recognized by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.
Says Dr. Timothy Fong, co-director of the UCLA Gambling Studies Program:
“Only in the past 10 years have people said, ‘Hey, there’s a public health issue with gambling excessively, there’s an addiction here that impacts people’s physical and mental lifestyles. … If you go back before 2013, they didn’t view it as an addiction, they viewed it as a impulse control problem, a morality issue, an issue of greed or selfishness. So we’re definitely several decades behind other addictive disorders like alcohol and tobacco screening, for sure.”
What that means is the vast majority of psychiatrists practicing today, let along general practitioners, didn’t study this in medical school. They’re unprepared. And because of that, they’re missing crucial signs and signals.
What happens after gambling addiction is discovered?
And then, even if your friendly neighborhood doctor did detect a gambling disorder in the few minutes per patient they’re allowed by your managed health plan, then what? Dr. Rory Reid, a research psychologist at Fong’s UCLA center, says doctors who ask make themselves liable if they don’t act on the discovery of a problem. And yet they lack the resources to make useful recommendations, “so they just don’t ask about it — if they’re even aware that they should.”
“We definitely want more screening, but with more screening comes, ‘Well, what do you do with this? Who do you refer to? What should doctors say when they’re not trained?’ There’s a whole host of other unintended consequences that come from that.”
Both agree something’s got to give. Doctors would ask these questions and insurance companies would pay for treatments if states forced them to and, perhaps, shielded the doctors from some liability. Medical schools would teach these matters if their accreditors required it. But none of that is happening, even as the availability of gambling outlets becomes spread ever wider and advertising makes it seem as cool and fun as cigarettes in the 1970s.
Often, the gambling addiction help comes too late
I’ve spent a lot of digital ink questioning the efficacy of gambling hotlines. There are a lot of problems with them, notably that folks who call often aren’t getting someone familiar with resources in the geographic area of the caller.
But the worst part of them isn’t the hotlines’ fault: By the time people are calling, they’re often so damaged by their gambling disorder, in such a crisis, that the help available might be inadequate to fix the wreckage of their financial and personal lives. It takes time for an alcoholic to drink himself to death; it takes minutes for a gambler to blow the mortgage, the kids’ college fund and whatever other money he can get his hands on legally or illegally.
“By the time people show up to experts like ourselves, the damage is really deep, really deep. This isn’t like, ‘Oh, I lost a bunch of parlays on Week 1, and I’m out $200.’ I saw a kid a kid last week, who’s 17 years old and $170,000 in debt. That’s a lifetime of damage he sustained in a matter of two years. Real hard question: How do you get a kid like that to come in and get proper help sooner, like in month one or two?”
There really is only one answer — the rest of the medical world needs to catch wise, and fast. Because this problem is coming at all of us like a speeding train, Fong says.
“What we’re really worried about isn’t tomorrow, it’s about five years from now. Are we going to be looking at a gambling crisis kike what we did with the opioid crisis circa 2000 to 2005? But the answers to your questions are really deep because they require basically every level of medical or mental health care to explain themselves.”
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- Problem Gambling Advocates Must Get Real About National Hotline Problems
- A Debate About Gambling With The Snake Lady On The Plane
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