Prevention methods part of new law

It’s been a long road since Gov. Deval Patrick introduced his proposal to bring gambling to Massachusetts on Sept. 17, 2007. But after more than four years of additional study, debate and compromise, Patrick signed a bill on Nov. 22 that will allow construction of three casinos and a slot machine operation in the Commonwealth. Although supporters hail the new legislation, some consumers and advocacy groups have expressed concern about potential negative social consequences.

While much of the wrangling over the casino issue has taken place on the political stage, some community-minded agencies have been working diligently to prevent repercussions associated with gambling addiction. According to Margo Cahoon, communications director at the Massachusetts Council on Compulsive Gambling (Mass. Council), her organization has been closely involved in talks revolving around the casino issue.

In fact, a collaborative effort has helped to ensure that the issue of gambling addiction and problems associated with excessive gambling are addressed. “People from all the gambling industries joined forces to talk about responsible public policy and to offer suggestions,” she says. In addition to the Mass. Council, representatives from Mohegan Sun, Suffolk Downs, the Massachusetts State Lottery Commission, Wonderland Greyhound Park and the State Racing Commission combined to form The Massachusetts Partnership for Responsible Gambling in Sept. 2009, Cahoon notes.

To drive home the importance of preventative measures, the Partnership invited individuals with gambling problems to share their stories with the lawmakers before the bill came up for a vote, according to Cahoon. “We wanted legislators to look at this issue from the human angle, not just the dollar angle,” she says. “We are not anti-gambling. But we see the devastation first hand.”

This group also held leadership forums to examine the best practices across the country and in Canada before compiling a list of recommendations, which it presented to the legislature. Cahoon is happy to report that most of the suggestions were included in the final bill. Two of the provisions include on-site counseling and an exclusion list. “This will allow families and the individual to propose exclusion and prevent entry to the casino,” says Cahoon. “They will have a hearing, which doesn’t usually happen elsewhere in the U.S. It’s a positive step.”

The casinos will dedicate on-site space for compulsive gambling and substance abuse services where individuals can get information. “Casino workers will be trained to recognize problem behavior and they can refer people to treatment,” says Cahoon.

The bill also requires that payback statistics be displayed prominently on slot machines. “This is a good educational tool. It’s a reminder that the statistics are stacked against the gambler,” Cahoon says. Additionally, the casino bill will establish a public health trust fund that will provide services and programs for problems directly related to gambling. This initiative will supply research related to problem gambling. “There is currently not a lot of data available to inform policy,” says Cahoon. “This is a strong start.”

While gambling in and of itself may pose a problem to the individual, the family, community and greater society, the issue of dual diagnoses complicates the picture. According to Cahoon, approximately 75 percent of problem gamblers also have another health problem, such as anxiety, depression, bipolar disorder, alcohol or substance abuse. The National Comorbidity Survey Replication reports that pathological gamblers are significantly more likely to have mental health disorders and/or substance use disorders compared to those without gambling problems.

Several towns in the Commonwealth are lobbying to have a casino built in its community, none more strenuously than Palmer in the western part of the state. Christopher E. Overtree, Ph.D., director of The Psychological Services Center at the University of Massachusetts Amherst, points out that residents in western Massachusetts currently have several casinos in close proximity. “For hardcore gamblers, having a casino in western Massachusetts won’t change their behavior,” he says. “It’s a matter of impulse control. Closer access might increase the chance of becoming addicted for some individuals. It’s a good idea to anticipate an increase in this type of behavior.”

Overtree explains that a person addicted to gambling does not usually self-identify until a secondary problem arises. “One would hope that when evaluating the true cost and benefits of casinos, which are obviously designed to increase revenue for the Commonwealth and create jobs, [legislators] would factor in the true cost of fallback on taxpayers. The people who access mental health care for gambling problems are most likely in financial trouble due to foreclosures and other economic catastrophes. People who fall into this condition may not be able to afford co-pays,” he says. “Those costs shouldn’t be hidden; they should be on the table. This is the true picture of what the pros and cons are. Gambling addiction can have a disproportionately negative impact on publicly funded support services. This differentiates it from other mental health problems.”

“We should buttress available mental health resources, both specialty programs and for addiction and addiction counselors as well as mental health programs. In western Massachusetts, certain segments struggle to access mental health care now,” says Overtree. “It’s a problem of an adequate supply of competent clinicians and institutions that can accept people quickly. Expanding available services should be a priority.”

However, Overtree admits that creating such programs poses a dilemma. “There is not a lot of financial incentive to do this, unless there is a clear process for getting reimbursement. This may require state funds or fast-tracking payment through insurance companies,” he says.

The Mass. Council offers a special certificate program that qualifies social workers and psychologists to work with problem gamblers. “We want to have more people in certain areas of the state. We don’t feel we have enough coverage, particularly in western Massachusetts,” Cahoon says. She notes that discussions with R.I. and N.Y. after those states instituted gambling revealed an increase in problem behavior, particularly with slot machine use. “We expect to see an increase in problem gambling, especially in the first two years,” she says.