Gambling Call to Action Statement

The October 1, 2017 mass shooting event in Las Vegas was perpetrated by a man, who according to media reports, exhibited behaviors suggestive of a significant gambling problem.i  This tragedy raises important questions about gambling and its potential role in this particular disaster. Feelings of isolation, despondency, and suicide, mixed with (1) a perceived injustice, (2) a disregard for and violation of the rights of others, and (3) availability of lethal means to kill and injure a great number of individuals in a short amount of time, can result in disastrous events. A tragedy of this magnitude is rare, but human suffering is not. The relationship between suffering and gambling disorder is complex because suffering can lead to intemperate gambling and vice versa. We must learn more about gambling and its potential role in human suffering. 

We are writing this letter as a call for action. Our society does little to help those suffering from gambling disorder. Resources for gambling-related treatments and research are sparse.  The American Psychiatric Association classifies gambling disorder as an addiction and estimates that it affects about 1-3% of individuals from all walks of life. Harms include financial ruin for individuals and families, significant guilt and shame, disrupted social relationships, engagement in illegal behaviors, occupational impairment, despair, and suicide.  The impact of these harms is greater than the harms associated with many well researched medical and psychiatric conditions.ii Few with the disorder seek treatment,iii and the amount spent on publically funded outreach and gambling treatment across the nation is small ($73 million)iv compared to the billions of dollars our society spends on substance abuse treatment and prevention. 

The federal government does not programmatically fund research focusing on gambling disorder nor does it monitor the impact of gambling activities on society, despite the gambling industry generating approximately $100 billion in annual tax revenue for local, state, and federal governments.v  An additional $7 billion is generated from taxes on individuals’ gambling winnings.  Responsible gambling initiatives by the gambling industry are critical and need greater support and examination to ensure that patrons use their product safely as a form of entertainment and recreation. More could and should be done to understand, prevent and treat this condition by state and federal governments and by the gambling industry.

We call for three primary initiatives.

The federal government needs to programmatically conduct research regarding gambling and its mental and physical health consequences.

• We call upon the National Institutes of Health (NIH) to fund research surrounding the etiology, prevention, and treatment of gambling disorder.  Currently, unlike other addictions such as alcohol, cocaine, and opiates use disorders (e.g., National Institute on Alcohol Abuse and Alcoholism, National Institute on Drug Abuse), no institute at the NIH has gambling disorder within its research mandate. We ask that NIH funding dedicated to the study of gambling disorder be allocated and placed within the research mandate of an NIH institute.  
• To monitor and study the impact and harms associated with gambling, we call upon the Centers for Disease Control and Prevention and other government agencies to consistently include a five-item assessment of gambling behavior and gambling disorder in their epidemiological surveys, such as the Behavioral Risk Factor Surveillance System.  These items would assess gambling frequency, amount risked, and a three-item gambling disorder screen.vi

The federal and state governments and the gambling industry need to improve access to prevention, treatment and recovery services for gambling disorder. The points of contact for offering a range of services for gambling problems are underdeveloped.

• For example, fewer than 13,000 Americans sought publically (state) funded treatment for gambling problems - despite estimates of over three-to-five million people with the disorder.  Approximately 10 states and the District of Columbia do not currently offer any state funded gambling treatment, despite gambling-related tax revenues being collected in 48 of the 50 iv We call for all states to offer free and easily accessible treatment for gambling disorder. 
• We call for increasing the visibility and impact of resources to assess for gambling-related harms at gambling venues.
• We must increase the identification of individuals with potential gambling problems and access to treatment via gambling helplines, referral networks, and screening in settings where gambling disorder prevalence is elevated. We call on substance abuse treatment centers, community mental health clinics, and criminal justice settings to implement routine screenings for gambling disorder.
• While Gamblers Anonymous (GA) is a free self-help resource, few with gambling disorder utilize GA in a way that results in sustained recovery.vii We call for the development of alternative treatment options. Empirically-supported treatments for gambling disorder currently are underdeveloped and inadequately researched. 

For the gambling industry to make greater investment in identifying and validating responsible gambling initiatives.

• Casinos and other gambling outlets must engage in greater accountability to ensure that their product is used safely, otherwise the industry may encounter exposure to legal liability like alcohol servers and cigarette manufactures. In fact, excessive gambling may be rewarded through loyalty programs and comps.  We call on both the gambling industry and for public policy initiatives to design and evaluate evidence-based approaches to advance responsible gambling.viii

 Signatories 

• Jeremiah Weinstock, D., Saint Louis University
• Antoine Bechara, Ph.D., University of Southern California
• Donald Black, D., University of Iowa
• Tony Buchanan, D., Saint Louis University
• Michael Campos, D., University of California, Los Angeles
• Renee Cunningham-Williams, D., Washington University in St. Louis
• Mark Dixon, Ph.D., Southern Illinois University
• Timothy Fong, D., University of California, Los Angeles
• Meredith Ginley, D., University of Connecticut Health Center
• Jon Grant, D., University of Chicago
• David Ledgerwood, D., Wayne State University
• Matthew Martens, Ph.D., University of Missouri
• Lisa Najavits, Ph.D., Boston University
• Clayton Neighbors, D., University of Houston
• Lia Nower, J.D., D., Rutgers University
• Marc Potenza, M.D., D., Yale University
• Carla Rash, D., University of Connecticut Health Center
• Rory Reid, Ph.D., University of California, Los Angeles
• Richard Rosenthal, M.D., University of California, Los Angeles
• Paul Sacco, Ph.D., LCSW, University of Maryland
• Lori Rugle, Ph.D., University of Maryland
• Jeffrey Scherrer, D., Saint Louis University
• Howard Shaffer, Ph.D., Harvard Medical School 
• Randy Stinchfield, Ph.D., University of Minnesota
• Jeffrey Weatherly, Ph.D., University of North Dakota
• James Whelan, D., University of Memphis
• Alyssa Wilson, D., Saint Louis University
• Edelgard Wulfert, Ph.D., University at Albany, SUNY

--------------------------------------------------------------------------------------------

i https://www.cbsnews.com/news/las-vegas-shooter-stephen-paddock-had-lost-money-been-depressed-sheriff-says/; accessed November 9, 2017.

 ii Browne, M., Langham, E., Rawat, V., Greer, N., Li, E., Rose, J.,… Best, T. (2016) Assessing gambling-related harm in Victoria: a public health perspective, Victorian Responsible Gambling Foundation, Melbourne. Retrieved from: http://www.responsiblegambling.vic.gov.au/__data/assets/pdf_file/0003/29145/Harm-study-Fact-sheet-4-Distribution-of-harm.pdf

iii Slutske, W.S. (2006). Natural recovery and treatment-seeking in pathological gambling: Results of two US national surveys. American Journal of Psychiatry, 163, 297-302.

iv Marotta, J., Hynes, J., Rugle, L., Whyte, K., Scanlan, K., Shledrup, J., & Dukart, J. (2017). 2016 survey of problem gambling services in the United States. Boston, MA: Association of Problem Gambling Service Administrators.

v American Gaming Association (2014). Gaming’s quarter of a trillion dollar impact on the U.S. economy.

vi Gebauer, L., LaBrie, R., & Shaffer, H. J. (2010). Optimizing DSM-IV-TR classification accuracy: A brief biosocial screen for detecting current gambling disorders among gamblers in the general household population. The Canadian Journal of Psychiatry, 55(2), 82-90.

vii Schuler, A., Ferentzy, P., Turner, N. E., Skinner, W., McIsaac, K. E., Ziegler, C. P., & Matheson, F. I. (2016). Gamblers Anonymous as a recovery pathway: A scoping review. Journal of Gambling Studies, 32(4), 1261-1278.

viii Ladouceur, R., Shaffer, P. M., Blaszcynski, A., & Shaffer, H. J. (2017). Responsible gambling: A synthesis of the empirical evidence. Addiction Research & Theory, 25(3), 225-235.