Clarification: Senator Spilka's Casino Love Fest

After Senator Spilka's Casino Love Fest that allowed casino/racino/slot parlor supporters to present their mostly one-sided informational forum, the following email was sent to Senator Spilka and Menmbers of the Committee on Economic Development and Emerging Technology, that would include: Sen Susan Tucker, Sen. Michael Morrissey, Sen. Anthony Petruccelli, Sen. Stanley Rosenberg --

To: Chair Karen Spilka and Members of the Committee on Economic Development and Emerging Technology.

From: Tom Larkin
Licensed Psychologist

Re: June 29, 2009 Hearing on Gambling

Date:July 1, 2009

Thank you for holding the Hearing. I found it very interesting. This communication is offered to assist you in your deliberations.

1-There appeared to be some misunderstanding, during the hearing, about projections of people with gambling problems.

The attached article attempts to help you understand projections and other aspects of the problem. I hope you find it helpful.

Projections are estimates. Generally, gambling addiction projections are considered to be underestimated because people with gambling problems self refer at only about 3%, compared to people with alcohol (15%) and drug (25%) problems. (Refer to the attached article to better understand the connection between alcohol and other drugs and gambling).

Pathological gambling projections represent a minority on the gambling addiction continuum. They are one aspect of the total number of people with gambling problems. Pathological gambler projections refer to only a small percentage,1 to 2% of the general population and 4 to 5% of active gamblers. Problem gamblers are another significant portion, about 5% of the general population and 9% of active gamblers. At risk gamblers are another group estimated to be about 18% of active gamblers. Therefore, based on National Gambling Impact Study Commission research, expect 1 out of 3 active gamblers to have some level of gambling problem.

Naturally, supporters of the expansion of legalized gambling seek to minimize the problem, hoping public officials interpret the gambling addiction problem as manageable, therefore they usually only refer to projections of pathological gamblers within the total general population (1 to 2 %).

As Dr. Goodman pointed out, increasing gambling opportunities, will increase the total number of pathological, problem and at risk gamblers in the Commonwealth.

2-The presentation of Dr. Hans Breiter, about neuroimaging and gambling addiction, was interesting. However, as a psychologist, I am bound to remind you that all addictions are acquired through the interaction of the brain and central nervous system with a complex variety of both social and psychological influences. All 3 are equally relevant to understanding how all addictions, including gambling, are learned, reinforced and treated.

3-Your Hearing seemed to me to be primarilly about managing the problem of expanding legalized gambling, as though the decision has already been made.

Is it politically naive to suggest future hearings focus first, on whether the state should indeed expand legalized gambling???! !!! This is best done by comparing the costs of any specific proposal to expand legalized gambling with the benefits. There is abundant empirical evidence, from many indepedent sources, showing that, generally, costs outweigh benefits. (Please refer to the references in the attached article, especially Grinols and the National Gambling Impact Study Commission Report.) Please avoid relying on studies done by the gambling industry or their supporters. (This is very challenging, but essential to the credibility of the process of your deliberations) .

4-Finally, I suggest you focus on where the money comes from. Many independent studies indicate about 80% of money lost, comes from low socio-economic groups. Gambling revenues are relentlessly regressive.

About 1/3rd of people, do not gamble at all. Of the 2/3rds that gamble, it is true, they generally do not have gambling problems and it is relatively harmless for them. (As most people who drink do not have drinking problems, but those with drinking problems cause enormous social instability) Supporters of expanding gambling neglect to additionally point out, that large group, for whom gambling is harmless, do not lose much. Like the shameful regressivity of the Lottery, expanded gambling in Massachusetts will inevitably depend, for the giant share of their revenues, on those who can least afford to lose.

I commend you for trying to understand this complex problem.

I would be happy to assist you in any way I can.

Thank you for taking the time to read this.

Tom Larkin


Gambling Addiction

By Tom Larkin

“Life is not a matter of holding good cards, but of playing a poor hand well.”
Robert Louis Stevenson

I-Understanding Gambling Addiction

Gambling problems are defined by the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV), as persistent and recurring maladaptive gambling behaviors characterized by distortions in thinking. DSM-IV sets out 10 criteria;

1-Preoccupation with gambling, 2-Increasingly larger bets and risks, 3-Repeated unsuccessful efforts to cut back or stop, 4-Restless and irritable when attempting to cut back or stop, 5-Gambling to escape or relieve a dysphoric mood (dissatisfaction),
6- Returning to get even, (“chasing” ones losses with greater risks), 7-Lies to conceal the extent of gambling involvement, 8-Committed illegal acts to finance gambling,
9-Jeopardized or lost a significant relationship, job or education, 10-Relies on others to relieve a desperate gambling financial situation. (1)

Pathological gamblers exhibit 5 or more criteria. (About 4% of active gamblers)
Problem gamblers exhibit 3 or 4 criteria (About 9% of active gamblers)
At Risk gamblers exhibit 1 or 2 criteria (About 18% of active gamblers)

The gambling industry uses general population projections of pathological and problem gamblers (1.7% to 3.8%) in an effort to minimize the extent of self defeating gambling behaviors. Using the 1999 National Gambling Impact Study Commission Report (NGISC) active gambler prevalence estimates, about 30% exhibit some level of self defeating gambling behavior. (8, pages 4-1 to 4-9) Gambling problems, like all addictive behaviors, fall on a continuum from mild (at risk gamblers), moderate (problem gamblers) to severe (pathological gamblers).

The cognitive-behavioral psychological approach to addictive behaviors holds that self defeating thoughts, feelings and behaviors, like healthy patterns, are learned and reinforced through the interaction of physical, environmental and psychological influences. (2, 3, 6) The expansion of legalized gambling influences both our environment and the way people think, feel and behave within that environment. The irrational thoughts that drive both unhealthy feelings (dysphoria, low frustration tolerance and depression etc.) and self defeating behaviors (abuse of alcohol and other drugs, criminal behaviors and maladaptive gambling etc.) are exaggerated, demanding and denigrating. Psychologist Albert Ellis described 3 fundamental irrational beliefs;

1-I must succeed , be loved and respected or I am a failure
2-Others must treat me fairly and respect me or they are bad people
3-The world must treat me fairly or it is a rotten place
Treatment seeks to dispute and replace these self defeating ways of thinking. (3)

II-SMART Recovery and Gambling Addiction

The focus of SMART Recovery self help groups are as applicable to gambling as to alcohol or any other self defeating behavior or feeling. (9, 5)
-Strengthening and maintaining motivation to change
-Coping with urges
-Managing thoughts, feelings and behaviors
-Developing a balanced lifestyle

It is important to understand that gambling problems interact with many other self defeating feelings and behaviors. (5, 10) About 50% of people with gambling problems also have problems with alcohol and other drugs. About 40% of those incarcerated and the formerly incarcerated have a history of maladaptive gambling problems. Gambling problems correlate highly with depression, anxiety disorders, suicide attempts, child neglect, abuse and abandonment, domestic violence, homelessness, school drop outs, divorce, criminal behaviors, bankruptcy and the other DSM-IV diagnostic criteria. If group members work on their gambling problem but continue to drink, the likelihood of a gambling relapse is great. However, in SMART Recovery, the group members set their own goals. Cognitive-behavioral tools can be generalized to other problems. (5, 10)

Assuming acknowledgement of a gambling problem, the setting of a goal to abstain or moderate the problem and a commitment to practice changing thoughts feelings and behaviors, the following tools and techniques may be helpful;


1-Compare irrational with rational thoughts, for example;

Irrational Thoughts Rational Thoughts
I am a loser, I might as well gamble I decide whether I gamble
I must be a winner or I am worthless I am worthwhile, win, lose or draw
I am a failure. If I win I am a success There is more to success than money
Life has dealt me a poor hand I can cope and enjoy life without gambling
I cannot win if I do not play Given my history, gambling is very risky
I must win now at any cost Things can get worse, much worse

2-Do an ABC on dysphoria and the urge to gamble
Activating Event-Dysphoria and the urge to gamble
Irrational Beliefs-If I lose I’m a loser, if I win I’m a winner
Consequence-Relapse, continue gambling behavior
Dispute-My gambling is a big problem. I have many reasons not to gamble.
Effect-I have many satisfactions in life; my family, work, hobbies and health.

3-Do a cost-benefit analysis of gambling and of not gambling
Use time lines. Try to shift the focus toward long term thinking.


4-Do unconditional self acceptance and value clarification exercises

-Gambling is driven by feelings of dissatisfaction. Do a hierarchy of values, focusing on the things in life that are satisfying, other than having money. This list usually includes; time with children, family, health, happiness experiences that are free, education, hobbies, credibility (credit cards), loving relationships, special skills, volunteer work, politics, sports, the arts (music, books, films, TV), computer use, spirituality, friendships etc. It is important that the brainstorming come from the group and not the Facilitator.

-Demonstrate the over generalizing fallacy of putting yourself down instead of your behaviors. The human condition is such that all people exhibit both good and bad behaviors at different times. Teach acceptance of self, but not self defeating behaviors.

5-Behavioral Tools

-Brainstorm healthy activities to replace gambling; sports, books, exercise, taking a course, helping others with their drinking or gambling problem.

-Find new non-gambling friends and people who have coped with gambling.

-Acknowledge the gambling problem and take pride in abstaining instead of being ashamed to discuss it with family and friends.

-Practice low cost satisfactory experiences such as taking a walk in the park, reading the morning newspaper, learning to play bridge, doing puzzles and joining a committee at church or on town boards.

-Study gambling’s mathematical certainties. Learn why the house always wins. Become an expert on gambling. Learn how gambling exploits the poor, the less educated and the emotionally vulnerable. Become an activist opposed to expanded gambling.

6-Keep a journal of coping self statements and quotes about gambling.

-“Life’s goal is to enjoy myself, not prove myself.”

-Gambling is driven by exaggerated feelings of dissatisfaction and unworthiness.

-Money has become equated with worth. Gambling has become its short cut. Self worth is far more than money. It is contentment, health, relationships and happiness.

-“I can enjoy life without ever gambling again. If I continue to gamble, I risk my emotional health, my family’s stability and my long range goals.”

-“The gambling industry exploit people like me. I will refuse to be exploited.”

-“ I am rich because I am alive, healthy, have family relationships and have learned to enjoy life, in spite of its grim realities.”

-“The thing about the rat race is that, even when you win, you’re still a rat.” Lily Tomlin





References

1-Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition -1994

2-DiClemente, Carlo C. Addiction and Change, Guilford Press, 2003

3-Dryden, Windy. Rational Emotive Behavioral Therapy-Theoretical Developments, Brunner-Routledge Publishers, 2003

4-Grinols, Earl. Gambling in America-Costs and Benefits, Cambridge University Press, NY, NY, 2005

5-Horvath, Thomas. Sex, Drugs, Gambling and Chocolate, Impact Publishers, Inc. 1989

7-National Coalition Against Legalized Gambling. (ncalg@ncalg.org)

8-National Gambling Impact Study Commission Report. 1999

9-SMART Recovery Handbook-2nd Edition 2004

10-Whelan, James P., Steenbergh, Timothy A. and Meyers, Andrew W. Problem and Psychological Gambling, Hogrefe & Huber Publishers, Cambridge, Ma. 2007


Tom Larkin is a licensed psychologist and a Facilitator for SMART Recovery, a free abstinence based program. Go to www.SMARTRecovery.org for a list of area meetings.
Go to tomlarkin@verizon.net to provide feedback.


April, 2008