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Sports Gambling: Increasing Older Adults’ Vulnerability to Gambling

By 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
The influence of increased advertising for sports betting on problem gambling behaviors and addiction, Whyte says, will be significant. “Until now, most gambling on sporting events has been prohibited, so there are generations of Americans who’ve grown up without ever having seen broadcast advertising for gambling. What we’ll start seeing soon is not just advertising in stadiums but on your phone during the game, urging you to bet now, and to bet what we call ‘in play.’” Gamblers will be encouraged to bet, for example, on whether someone will score a basket in the next five seconds or a player will score in a particular time period, he explains. “So Americans, or anyone around the world, have never been exposed to this type of pervasive, aggressive promotion of betting opportunities on a very personalized basis,” direct to the cell phones of anyone with an online betting account set up in states that allow it.

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
According to Whyte, about 2% of adults, or roughly 6 million people, meet the criteria for having a gambling problem in a given year. Of that 2% he says, about one-half have a severe problem, while the other half experience mild to moderate gambling problems. Even before the population swells with new gamblers as an inevitable result of legalized sports betting, the existing population of problem gamblers often isn’t getting needed help for a variety of reasons.

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
In an effort to mitigate the influence of legalized sports betting on addiction rates and severity, the council has established responsible gaming principles for sports gambling legislation (available at ncpgambling.org), chief among which are that legislators and regulators should monitor the impacts of sports gambling through research and “ensure that any expansion of sports gambling includes dedicated funds to prevent and treat gambling addiction.” Responsible gaming measures within the gambling environment include allowing individuals to set limits on the amount of time and money they can spend on gambling and making sure that the National Problem Gambling Help Line (800-522-4700) is promoted. And to ensure that there are adequate services to meet rising needs, the council urges states to make 1% of their revenues from legalized sports betting available to state health agencies and private nonprofits for problem gambling services. That, however, is an uphill battle. “Only New Jersey is funding any sort of research into the possible impacts or changes, and so state after state is jumping into this without any idea of what the impacts might be on existing problem gamblers or on new gamblers coming in and getting hooked. It’s incredibly irresponsible,” Whyte says.

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
As sports betting is poised to boost the numbers of problem gamblers and potentially increase the severity of existing problem gamblers, it’s crucial that geriatrics professionals are prepared to recognize the signs. Not only may they uncover hidden cases, they also, Whyte says, might recognize that problem gambling may be a precipitating factor for many of the other issues their clients present with, such as relationship conflicts, relapse, treatment nonadherence, or physical ailments resulting from stress, eg, gastrointestinal disorders.

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
All health care workers, Mulvaney says, need to be aware of the signs of gambling disorder, know how to screen for it, and be aware of community resources, especially those in states in which legalized gambling has been expanded. “You don’t need to be able to treat it, but you need to be able to talk about it and help people get to treatment if they need it. And for people who don’t have a full-blown disorder but need some help, it’s important to be able to engage in harm reduction.”

Kate Jackson is editor of Today’s Geriatric Medicine.