Mental health workers brace for wave of problem gamblers
By Susan Spencer, TELEGRAM & GAZETTE STAFFsusan.spencer@telegram.comIn just a few short months, the Massachusetts Gaming Commission will award its first casino license, for a slots parlor in Leominster, Plainville or Raynham. A few months later, two resort casino licenses will follow, with a third in Southeastern Massachusetts after that.
Many area residents eagerly anticipate the promised construction and permanent jobs, the added revenue to state and municipal coffers and the specter of economic development.
But others, particularly those in the mental health and addiction fields, are gravely concerned that nearby casinos will spur more problem gambling. And they say there aren't sufficient treatment resources available.
"There are very few programs in the Commonwealth that are specifically focused on gambling," said Deborah J. Ekstrom, chief executive officer of Community Healthlink, a nonprofit behavioral health center based in Worcester.
Community Healthlink serves more than 17,000 adults and children, who receive treatment, housing and support services through outpatient clinics and homelessness prevention programs in Worcester, Leominster, Clinton, Fitchburg and Gardner.
"We definitely need to get more people in the field," said Margot Cahoon, communications director for the Massachusetts Council on Compulsive Gambling. "When someone calls our help line, it's hard to find services for them. We definitely need to build capacity."
The council's treatment referral list doesn't include any private practitioners in Central Massachusetts. The closest are in Amherst, Northampton or Belmont.
LUK, Inc. in Fitchburg is the only Central Massachusetts outpatient counseling center on the referral list.
Ms. Cahoon said that Worcester was one of the areas the council was focusing on to prepare clinicians for an expected surge in demand.
The council and the state Department of Public Health are working to get more clinicians — particularly certified drug and alcohol counselors and those who deal with personality disorders — certified as problem gambling specialists.
"We've been offering more training to understand the differences between problem gambling and other substance abuse and mental health disorders," she said.
The 2011 Expanded Gaming Act requires licensed casinos to pay, in aggregate, at least $5 million to the state for programs addressing problem gambling. Other resources, including self-exclusion lists and complimentary on-site space for independent substance abuse and mental health counseling services, must also be provided by casinos.
But Ms. Cahoon said that those resources won't be received until the casinos are up and running, at least a year or two from now.
Pathological, or addicted gambling, is said to occur in 1 to 2 percent of the U.S. population, according to researchers. Including problem gambling that doesn't quite meet the level of addiction, the prevalence of what the council refers to as "disordered gambling" rises to 2 to 3 percent.
Ms. Cahoon said that the University of Massachusetts at Amherst is studying the current statewide prevalence, but the council estimates between 85,000 and 185,000 Massachusetts residents have experienced disordered gambling.
"Gambling addiction is probably harder for people to spot than addiction to drugs or alcohol because it doesn't cause any of the physiological changes in people," Ms. Ekstrom said, "But it does cause depression, you'll see higher rates of alcoholism among problem gamblers, there's a higher rate of family violence, domestic violence, and then a whole host of financial problems."
Electronic gaming machines like slots and video poker, which make up about 85 percent of casinos' revenue, are particularly dangerous to compulsive gamblers, referred to by some researchers as "the crack-cocaine of gambling." The rapid play, lights, sounds and multiple-play manipulation are designed to keep the gambler playing — and losing — as long as possible.
"The neurological research shows that people actually get more of a rush from losing when they're almost winning, than they do from actually winning. We're wired to lose," Ms. Ekstrom said.
"It is a public health menace. It has these terrible social consequences and the health research about it is shocking."
A research summary prepared in March by the Worcester Regional Research Bureau, "Should Worcester Welcome a Slot-Machine Casino?" reported that those who play the new slot machines regularly become addicted three to four times more rapidly than other gamblers, who play at table games like craps, blackjack and roulette.
Bay Staters aren't exactly strangers to casinos already. Casinos in Rhode Island and Connecticut are just an hour or so, or even less, away.
So will it make much difference if there's a casino in Leominster, Milford or Palmer?
"The cost to get to Foxwoods is a barrier for some people, and we're glad about that," Ms. Ekstrom said. "The convenience factor impacts the frequency.
"One of the things I worry about is whether people will run shuttle buses from Worcester to Leominster."
The Research Bureau's report cited a 2004 study, which found that living within 10 miles of a large-scale gaming operation put individuals at a 90 percent increased risk for problems.
Noting that Rhode Island and New York had similar experience, Ms. Cahoon said, "We want to be prepared for the onslaught of people needing services."
Ms. Ekstrom said that treatment for problem or addicted gambling runs from 12-step programs like Gamblers Anonymous, which holds meetings in Worcester, Millbury, Westboro, Leominster and Gardner, according to its website, to cognitive-behavioral therapy, to other types of counseling and medication.
She said that the philosophy at Community Healthlink regarding any addiction is that people are generally using a substance or activity to deal with emotional problems they may have, such as trauma or depression. Once those underlying issues are dealt with, it's easier to address the addiction.
Deborah L. Greenslit, of Rutland, has seen problem gambling from both sides. The 57-year-old licensed mental health counselor and wellness specialist found herself drawn into high-rolling gambling after she hit the jackpot on a penny slot machine at Mohegan Sun, in Uncasville, Conn., in 2010.
Ms. Greenslit said she used the several hundred thousand dollars she won that day — it was far less than the reported $752,000 after taxes and payout options — to pay off debt, help friends and family and give some to charity.
But the winnings soon evaporated, after leading her into a downward spiral of more gambling to distract her from emotional losses and health problems she was facing.
"It sort of sucked me into that lure of escaping that pain," she said.
Ms. Greenslit is writing a book, "Living with a Loving Heart... Lessons Learned on Suffering and Pain," and is turning her counseling practice into a healing center for all forms of addiction. She said she prefers to focus on self-empowerment and helping people redirect their pain in positive ways.
"There's a lot of clinicians out there who don't know how to deal with gamblers," Ms. Greenslit said. "People kind of bunch up gambling with other addictions. There's a spectrum."
Ms. Greenslit also sees an urgent need for more and better gambling addiction resources as casinos crop up in nearby communities. She noted that problem gamblers have a high suicide rate. "People's lives are in our hand," she said. "I think it's very, very important that people are properly trained."
http://www.telegram.com/article/20130926/NEWS/309269523/1116
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