Ballot questions could impact problem gambling treatment

Bob Breen, Ph.D., is going to vote no on Rhode Island’s statewide Questions 1 and 2 on Nov. 6. But the licensed clinical psychologist and director of Rhode Island Hospital’s Gambling Treatment Program thinks most voters will say yes to the questions seeking to authorize state-operated casino gambling at Twin River in Lincoln and Newport Grand in Newport, respectively.

“I think it’s a slam dunk,” Breen says.

What isn’t so certain is how the state is preparing to address a potential rise in problem gambling if table games become a reality at the two venues. R.I. lawmakers moved to put the two questions on the ballot in response to a Massachusetts plan to allow three resort-style casinos and a slot parlor to be developed in the Bay State. One study found that R.I. could lose more than $100 million in annual revenue if the Massachusetts casinos are built.

Casino backers are spending millions to convince voters to approve the addition of table games like blackjack and poker to the video slot machines already in use at Twin River and Newport Grand. Campaigns called The Coalition to Bring Jobs to R.I. and Keep Newport Working focus on a sensitive issue in a state with the nation’s second highest unemployment rate after Nevada.

The Mass. legislation coincided with an increase in the Massachusetts Council for Compulsive Gambling’s budget from $1 million to about $1.8 million this year. Mass. lawmakers approved provisions to raise awareness about gambling addiction and treatment services. They include requirements for gambling venues to post slot machine payback statistics and provide onsite space for independent mental health counseling services. Another provision calls for research on problem gambling’s impact on the area.

Breen, who founded Rhode Island Hospital’s program in 2001, nearly saw it fold this year when the General Assembly eliminated community service grants to hospitals. In August, legislators restored $50,000 in funding, still less than the program’s $67,332 fiscal 2011 allocation. The program’s budget was $150,000 in 2001.

If voters approve Questions 1 and 2, Twin River and Newport Grand would be required to contribute a minimum of $100,000 for “problem gambling programs,” according to the referenda legislation.

“What those programs are going to look at, who’s going to be providing those services, what that whole network is going to be like is completely undefined,” Breen says.

The $100,000 sum remains inadequate even for a small state, he says: “I think $1 million would be a good start. $5 million would be better.”

R.I. needs an integrated network for outreach, education and prevention services, Breen says. For now, he has no budget to publicize the treatment program, so problem gamblers who need help in R.I. may not know where to turn.

Last year, Breen treated approximately 100 people, down from a peak of 175 several years ago. “I think if we had a good campaign that was put out there that we would be seeing 1,000 people here,” he says.

Most studies suggest that pathological gambling affects between about 0.5-2 percent of the population or as much as 3-5 percent if associated mental health problems are factored in, says Harvard Medical School Assistant Professor Debi LaPlante, Ph.D., director of research and academic affairs at Cambridge Health Alliance’s Division of Addiction. But “just because you have a certain rate of problem within your society that doesn’t translate necessarily into demand for treatment,” LaPlante says, noting stigma and lack of awareness could hinder problem gamblers from seeking treatment.

With casino proposals still in development in Mass., so is the focus of research on compulsive gambling and treatment within its borders.

LaPlante says, “Evidence suggests that people who suffer from gambling problems are not likely to seek treatment for gambling. They might seek treatment for other things.”

Research will have to address whether promoting the development or expansion of gambling-related treatment would help get problem gamblers into treatment or have an unintended boomerang effect, LaPlante says.