How does that play out?
BY KAREN BROWN
This article originally appeared in Harvard Public Health magazine.
“They may tell me, ‘Oh no, I spent more than I meant to.’ And I say, ‘Oh, yeah? When you come in, do you normally try to set a budget?’ And we’ll go from there,” she says.
Gabrila, 47, who has short spiky hair and a no-nonsense
demeanor, works for the state-funded GameSense program, now operating at all
three casinos in Massachusetts and meant to promote responsible gambling. She used to be
part of the casino industry; as a table dealer, she says, “my job was to keep
butts in the seats.”
Now, as a GameSense advisor, Gabrila’s job is to watch
for people who have been in their seats too long, and possibly lost too much
money. The advisors are trained to offer information and teach basic gambling
literacy, including the slim odds of winning. “We understand these guys,”
she says. “We know how they think; we know their misconceptions; we know their
jargon.”
Mark Vander Linden, the director of Responsible Gaming
and Research at the Massachusetts Gaming Commission, launched GameSense in
2015, when the first slots parlor opened. He says the program’s mantra is harm reduction — not judging or even
necessarily discouraging gambling, but meeting people “where they’re at, and
where they’re gambling.”
Massachusetts is the only state that requires gambling intervention in its casinos, paid for by the casinos themselves.
A 2011 state gambling law requires casinos to funnel a portion of their revenue into the Public Health Trust Fund, now reported at $24 million, which is distributed by the gaming commission and the state’s public health department.
The law
requires regulators to develop a comprehensive framework to address problem
gambling and to fund research. Most other states are less attentive to the potential
harms of gambling, even as experts worry about the rapid expansion of
gambling across the country, through legalized sports betting, online gambling,
and mobile betting apps.
The National Council on Problem Gambling estimates that
people in the U.S. lose about $125 billion on gambling every
year. Forty-five states now host casinos, and 38 states have legalized
sports betting. Only Utah and Hawaii continue to outlaw gambling altogether.
So far, national surveys have found the majority of gamblers are “recreational,” but research shows that two percent of the population suffers from severe gambling problems — with ruinous financial, relationship, or mental health results.
States have
been piloting piecemeal solutions, often without knowing whether they will
work. A National Association of Administrators for Disordered Gambling
Services survey found
that state spending on problem gambling ranges from nothing at all to $10.2
million per year.
GameSense was created in 2009 in Canada, by the British
Columbia Lottery Commission, to educate people about how gambling works and to
try to reduce its harms. Typically, the program hires advisors like Gabrila and
mandates that casinos install tools like “Play My Way,” which allows players to
set a budget and notifies them when they near their limit.
When he traveled to seek ideas for Massachusetts, Vander Linden saw versions of “Play My Way” in places like Scandinavia and Singapore, where budgeting tools are mandatory. Gambling experts have praised measures in Norway, in particular, where the central gambling authority replaced older electronic gambling machines with (fewer) new models that limit players’ losses over a given time period. Researchers found the rate of problem gambling went down.
But Massachusetts regulators decided the Norwegian
approach was unlikely to be accepted in the U.S. “Americans don’t like anything
that smells like a nanny state,” says Rachel Volberg, a University of
Massachusetts at Amherst professor who conducts gambling research for the
Massachusetts Gaming Commission. (Self-budgeting is voluntary in
Massachusetts.)
GameSense also allows gamblers to join the state’s
“voluntary self-exclusion list.” Users choose a one-year, five-year, or
lifetime ban, with the option of receiving follow-up recovery coaching by
phone. More than 1,500 gamblers have signed up for the “self-ban,” Vander
Linden says, and early evidence suggests problem gamblers find it helpful.
Lia Nower, who directs the Center for Gambling Studies at Rutgers University, says it’s possible to skirt the self-exclusion list by gambling out-of-state or creating a fake account online. Still, she believes bans can be effective tools for many gamblers.
Gabrila, who has been with GameSense since it launched,
was originally skeptical; she didn’t believe players could learn to gamble in
moderation. Indeed, evidence supporting GameSense’s approach is mixed.
An early evaluation of
the program found that while advisors like Gabrila had thousands of player
interactions a year, many were superficial and did not change gambling
behavior.
In Gabrila’s experience, some relationships she builds
with players over time can lead to subtle changes in habits, although not
always. On a recent afternoon, she chatted with an MGM regular named Monroe who
says he used to spend multiple days inside casinos, never seeing the sun.
“I got some horror stories to tell, but I keep them to
the grave because it was that bad,” he says.
He says he learned to limit himself to winning or losing
$50 per visit — partly by using the Play My Way tool, and partly by choosing
electronic games that allow smaller bets.
“And now I’m going to take my money out and just walk
around with my $12 and be happy,” he says.
Experts say the GameSense approach likely works with some players better than others. “It depends on where along the problem gambling spectrum they are and why they’re gambling,” says Nower.
Ted Hartwell, now with the Nevada Council on Problem
Gambling, once had such a gambling addiction — resulting in massive debt and
lying to family — that he had to quit entirely. But he supports the harm
reduction model as a way of reaching the most people.
“These programs should be for everyone, so everyone has
access to budgeting tools that set personal limits or learn to take healthy
breaks in play,” he says. “Those can be protective factors for people who are
gambling normally, before they have a problem.”
Vander Linden says a new evaluation of GameSense is
underway, and his office has learned that meaningfully addressing problem
gambling requires a range of interventions. Some people might need basic
tutoring on low-risk gambling; others need more aggressive budgeting help; and
still others need mental health treatment.
Just 150 therapists are certified to treat problem gambling in Massachusetts. And only one outpatient clinic within 20 miles of the MGM casino in Springfield offers treatment.
GameSense advisors are not licensed counselors, nor do
they claim to be. When they sense a player is in distress, they are told to
share a list of certified treatment providers or support groups.
But few therapists are certified to treat problem gambling in Massachusetts. Although the state offers a free 30-hour training for therapists, only 150 providers are certified, and only one outpatient clinic within 20 miles of the MGM casino in Springfield offers treatment.
“It’s
not clear to me that … most Massachusetts residents with gambling problems are
able to access the level of problem gambling treatment that’s appropriate for
their condition,” says Keith Whyte, director of the National Council on Problem
Gambling.
A treatment shortage is not unique to Massachusetts.
Emily Brunner, a physician and member of the
board of directors of the American Society of Addiction Medicine, calls
the national landscape for problem gambling services “a horrifying
desert.” A 2021 survey found that of the approximately 6 million people in
the U.S. with a gambling disorder, less than one percent received any
treatment.
Advocates would also like more data on specific ways to
reduce problem gambling, but few states conduct that kind of research.
The National Council on Problem Gambling is pushing for passage of the Grit Act, which would create funding gambling addiction research and treatment, similar existing resources for smoking, alcohol, and other drugs.
Karen Brown is a print and public radio reporter based in
western Massachusetts who frequently covers mental health issues.
