For millions of Americans, playing poker with friends or hitting the slots while on vacation are harmless ways to unwind.
But, for an estimated 1 to 2 percent of people who gamble, the pursuit has turned from a hobby to a dangerous addiction that they are unable to control, leading them to spend massive amounts of money on their addiction. According to Mollie Schull, author of the nonfiction book “Addiction by Design,” gambling addicts generate 30 to 60 percent of all revenues for the machine-gambling industry.
What is gambling addiction?
According to the National Council for Problem Gambling, some warning signs that you might have a gambling addiction are:
• You gamble until your last dollar is gone.
• You use your income or savings to gamble while ignoring bills.
• You have broken the law to finance your gambling.
• You have tried unsuccessfully to stop gambling.
Gambling addiction has been listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the manual that psychiatrists use to make diagnoses, since 1980. However, in all previous editions, it has been classified as “pathological gambling” under “Impulse-Control Disorders Not Elsewhere Classified.” In the DSM-5, which has just been released, “gambling disorder” is now listed as a substance abuse disorder, alongside alcoholism and drug addiction.
“There is substantive research that supports the position that pathological gambling and substance-use disorders are very similar in the way they affect the brain and neurological reward system,” says Charles O’Brien, chair of the American Psychological Association’s DSMSubstance-Related Disorders Work Group, in a press release. “Both are related to poor impulse control and the brain’s system of reward and aggression.”
How gambling addiction has been viewed in the past
Keith Whyte, executive director of the National Council on Problem Gambling (NCPG), says that gambling addiction often has been heavily stigmatized. “Most Americans still regard gambling as a personal weakness rather than a disorder that needs treatment.”
According to a 1999 survey from NCPG (the most recent statistics available), 80 percent of clinicians that applied for reimbursement from health care providers for gambling addiction-related treatment didn’t receive it routinely.
And many problem gamblers did not even apply for health insurance coverage for gambling treatment. “They may not have known to ask their providers before,” says Whyte.
Additionally, many people didn’t submit gambling treatment claims for coverage because they were concerned it would stigmatize them with current or future employers, Whyte says. “They’re concerned that no one will want to hire them. Seventy percent of gambling addicts commit white-collar crime. If you want to hire a drug abuser you can test them, but with a behavioral disorder like gambling, there’s no way to tell if they still have a problem.”
Treatment options for gambling addicts
Because the majority of problem gamblers had been denied health insurance coverage for treatment, they’ve had to either go without treatment or finance it in other ways.
Many problem gamblers have associated disorders, such as depression or substance abuse, for which they are able to receive covered treatment.
Additionally, Whyte says, half of all U.S. states have public funds that provide financial assistance with treatment for problem gamblers. “In those states, you have access to outpatient therapy with an addiction/mental health counselor with some experience in problem gambling,” Whyte says.
For people in other states without the means to hire a counselor, treatment often comes in the form of free group meetings, such as Gamblers Anonymous.
What the change means
Although the new DSM definition doesn’t legally bind health insurers to provide coverage, most problem gamblers, and those who treat them, see the new DSM definition as a positive thing.
“The new definition helps create a new public understanding,” Whyte says.
By placing gambling disorder alongside substance abuse, Whyte believes that more people are likely to obtain coverage from their health care providers for gambling-related treatment issues.
“It may help consumers, and it may help large employers and insurers understand that it should be seen within the mainstream of disorders,” Whyte says.
Under the new classification, “there is no clear rationale for excluding health insurance coverage.” Whyte adds that there is a significant cost benefit to society for providing better treatment for problem gamblers: he says that problem gamblers lose as much as $7 billion each year, in terms of savings and income lost and money stolen from other sources.
The new classification may also help more people recognize the signs of gambling addiction.
“Much like alcoholism, we need to help people understand how to do it responsibly, who’s at risk, what a problem looks like, and where you go to get help,” Whyte says. “These changes to the DSM provide a good time to have that conversation.”