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Sports Gambling: Increasing Older Adults’ Vulnerability to GamblingBy Kate Jackson Legal sports betting has arrived. What are the ramifications for those already struggling and vulnerable others soon to be lured by greater access and intensified advertising? In May 2018, the US Supreme Court overruled the Professional and Amateur Sports Protection Act of 1992, a federal law that banned sports betting in most states, declaring the prior law unconstitutional. Before that ruling, sports betting was permissible in only four states. Now, with sports betting legal in 13 states and likely soon to be legal in an additional six, gamblers can bet at virtually any time by just picking up their phones. And with “in-game wagering,” they can make rapid-fire bets. The stakes are higher and the velocity of betting is a game-changer. What effect will this expansion of legalized sports betting have on the rate and severity of gambling addiction? While it’s too soon to point to numbers, experts suggest it will be like setting a match to tinder and fanning the flames. They’re skeptical, however, about whether the states and the gambling industry that will reap enormous financial rewards will step up and contribute funding for research about gambling addiction or promote responsible gambling measures. They’re doubtful, as well, that behavioral health professionals will be equipped to prevent or address the inevitable boom in problem gamblers or that services for people with addictions will be adequate to meet needs. In March 2019, the National Council on Problem Gambling released a national survey of 28,000 people about gambling attitudes and experiences. “We found that sports betters were almost twice as likely as other gamblers to report problematic gambling behaviors,” says Keith Whyte, executive director of the council. More than different types of gamblers, Whyte says, they rely on others to pay debts and bills, lie to hide gambling, and are twice as likely to report feeling restless or irritable. From this broad survey, he suggests, it seems that sports betters may be at higher risk for gambling problems: “We think, without strong responsible gambling measures in these bills that expand sports betting, there will be an increase in both the rate and the severity of gambling problems.” Although just how much isn’t yet clear, it’s indisputable that more access will lead to more gambling. “What we know from the evidence is the more acceptable and accessible gambling is, the more people will gamble. And the more frequently you gamble, the more activities you play, and the more places you place your bets, the more likely you will be to develop a gambling problem,” says Lia Nower, JD, PhD, a professor and director of the Center for Gambling Studies and the Addiction Counselor Training Certificate Program at Rutgers University School of Social Work. “Interactive forms of gambling such as mobile phones and computers,” she adds, “have turned gambling into a 24/7 activity that you can do anywhere without leaving your home. It’s easy to hide as well. This accessibility also increases the risk that people will develop problems.” Furthermore, she says, technology plays a role. “As people are aging out of traditional gambling settings such as bingo and casinos, operators are finding ways to tap into the interests of people who weren’t formerly gamblers. So new technologies will attract former nongamblers and will also add additional gambling opportunities for those who are already recreational and/or problem gamblers.” But it’s not only the ubiquitous access to sports betting and technology that are likely to contribute to increased gambling and consequently rising rates of gambling disorders. Advertising Lures Gamblers in New Ways This on-the-spot direct connection, Whyte says, is allowed by most regulations now, and this type of betting is only just beginning. “As more and more states expand and as the industry starts to strike deals with the leagues, we’re on the cusp of an explosion in gambling advertising, which is going to be particularly driven by both the partnerships the gambling companies are striking with leagues and teams as well as with the embrace of internet mobile betting which, for the first time, will deliver targeted sports betting ads directly to your phone, even—or especially—when you’re in the stadium or watching your team play.” Lack of Education, Funding, and Services First, there’s a widespread belief that gambling addiction is a moral issue rather than the medical issue it’s been demonstrated to be. Even though gambling disorders have been in the DSM since 1980 and were recategorized in the DSM-5 as the first addiction without a substance, Whyte says, “There’s enormous shame and stigma in the general population, and a lack of understanding even in the health care community. We still have people who come to us and say, ‘I went to my therapist or social worker and told them I had a gambling problem and they told me to just stop gambling.’ They’re outdated or outmoded responses to what is a recognized medical disorder,” he says. Also contributing greatly to gambling addiction is the lack of government funding for research and services. The National Council on Problem Gambling surveys every state every three years to determine the amount of public funding for problem gambling. The total in 2016, when the last survey was taken, was 72 million. “On per capita basis that’s 284 times less than per capita funding for substance treatment alone, and that covers all problem gambling programs—less than 25 cents per capita,” Whyte says, which points to an enormous gap. “Most states that legalize gambling will take a small percentage of the revenue to fund problem gambling—but that’s not the rule. Twenty percent of states that do not have legalized gambling don’t put any of their revenue back into preventing problem gambling.” Measures to Stem the Tide What’s more broadly needed, he says, are increased general public awareness, and education and training of health care providers, particularly because “gambling addiction is highly comorbid with other disorders such as depression and substance use disorders,” Whyte says. The council reaches out to allied health professionals, especially during Problem Gambling Awareness Month each March, to remind them that there are brief and free screening tools available and to educate them so they can make good assessments and decide whether the issues are within their scope of practice or whether they should refer clients to treatment professionals certified in gambling disorders. Raising Awareness and Recognizing Risk In the meantime, geriatricians can be on the lookout for new opportunities to get continuing education in gambling, whether in a webinar or at a state college, according to Jody Bechtold, LCSW, ICGC-II, BACC, a specialist in gambling addiction with a private practice, The Better Institute, in Pennsylvania. Becoming better educated goes hand in hand with understanding that gambling is not the consequence of a moral failure or a flawed character, but instead, Bechtold says, “is a brain disorder, even though one doesn’t ingest anything. It’s not about willpower.” Problem gamblers’ brains “are wired in a way that makes them more vulnerable,” she says. Next, the most important thing to do is to recognize that anyone is vulnerable. Surprisingly, experts say, gambling often begins in childhood. “For many problem gamblers, gambling typically begins at home with parents buying lottery tickets for kids’ stockings, playing dice games, attending events at the track,” Nower says. However, she says, “that’s changing as the lines blur between gaming and gambling.” If health care professionals don’t know the questions to ask, they won’t uncover gambling disorder, which is a hidden addiction, Bechtold says. “You don’t see it. Their speech isn’t slurred. You can’t do a urine test. If you’re not trained, you could easily miss it.” Look for underlying other family problems, such as marital strain, financial stresses, and depression. And, Bechtold says, recognize that it’s especially common in individuals with a history of trauma. According to Elizabeth Mulvaney, MSW, LCSW, a lecturer at the University of Pittsburgh, people who have had sexual trauma and other traumas related to violence, as well as those with adverse childhood events, are especially vulnerable. Access to money is another important aspect of the disorder, Mulvaney says. “Frequently when we’re working with clients with other addictions, we don’t have to be as involved with what’s going on with them financially,” but a therapist working with gambling disorders has to delve into a client’s financial status and work with them about how to handle money. “The addiction will drive them to spend their money on gambling vs on the rent or insurance or any of the other bills we would consider a priority.” Older adults are particularly vulnerable. Ageism may cause them to be overlooked, a common assumption being that older adults don’t have addiction. “They do,” says Mulvaney, who observes that the presentation of their problems may look more like something else, such as stress. “Individuals who are retired and not in the position of going back to work and who fall into a financial hole may not have the financial reserves to dig out. “Older adults with gambling problems, she says, “will deplete their entire retirements savings and jeopardize not only their own but their spouses’ retirement funds.” In addition to recognizing risk and learning about harm reduction interventions, health care workers can create an atmosphere that communicates awareness and concern. Prime your environment, Bechtold says, prominently displaying the hotline number, and placing pamphlets in the waiting room. “Anything you can do to say, ‘hey, we know about gambling here and you can talk to us,’ will help people open up.” Treat it as has been done with intimate partner violence, where, for example, a hotline number would be placed in bathrooms or posters placed on the back of stalls. Making a Difference —Kate Jackson is editor of Today’s Geriatric Medicine. |
