Experts: Nevada Behind in Problem Gambling Treatment

The Problem Gambling Center, located in a warren of office complexes on the north side of Sahara Avenue and across from the Palace Station casino, isn't easy to find. But if more people knew about it, they might very well be put on a waiting list.

The nonprofit treatment center counsels more than 200 people each year on an annual budget of less than $350,000 that's funded chiefly by gaming companies. It is the only formal public treatment program in Las Vegas devoted to treating compulsive gamblers. A few more recent donations has led to new daytime sessions for graveyard shift workers on top of its existing evening sessions.

Robert Hunter, a psychologist who runs the center, says he is "keeping a finger in the dike." He hopes things will change next year, when he expects the state to finally devote money to fund treatment for gambling addicts.

Bills allocating $250,000 per year for problem gambling treatment failed in both the 2001 and 2003 legislative sessions. But Hunter thinks 2005 will be different because the fate of those bills put Nevada in a bad light nationally.

"I've said it before, but it's a travesty," he said. "As a citizen of Nevada, as someone who raised my kids here, (the Legislature) has never addressed this as a public health issue."

States with comparatively miniscule gambling revenue have funnelled millions of dollars to treat compulsive gamblers over the years, he said.

"In Louisiana they have an intensive outpatient program. You can pick up the phone and you're in (treatment) an hour later," Hunter said."It's not just humanitarian but it's cheaper to treat gamblers than to leave them untreated."

The Nevada Resort Association, which represents many of the state's major casinos, has supported the initiative over the past several years. Association President Bill Bible said he hasn't recently discussed the issue with legislators but says the industry expects to press the issue in the 2005 session.

While the casino industry was somewhat blamed the first time around for not pursuing the issue aggressively enough, observers say the 2003 bill died over concerns about the budget deficit.

The Governor's position on the issue also may have killed the bill, observers say.

Gov. Kenny Guinn, through his spokesman Greg Bortolin, this month reiterated that problem gambling "is the responsibility of the industry" and that government shouldn't be involved in funding treatment.

Bible said the industry has acknowledged that problem gambling can be an addiction like other disorders such as drug and alcohol abuse. This session marks a new beginning for the issue in the Legislature because the state, after passage of a new tax package, now faces a budget surplus instead of a deficit, he said.

Bible wouldn't speculate about whether that will make it any easier to pass problem gambling legislation. The industry will stand behind it, though, he said.

"Everyone in this industry would support this," he said. That Nevada doesn't fund treatment is "somewhat of an embarrassment," he said. "We're concerned that Nevada is lagging efforts that have occurred in other states."

About 17 states fund treatment for compulsive gamblers, according to the National Council on Problem Gambling.

Several of those states are newer to gambling and established a funding mechanism as a condition of legalizing casinos.

One state often cited by problem gambling experts is Missouri, which has offered riverboat casinos since 1994. The state funds problem gambling efforts from a $2 admission tax paid by the casino for each customer. One cent of the state's share of the admission tax ($1 of the tax goes to the state and the other half goes to the community where each casino is located) is directed toward treatment and education efforts for compulsive gamblers.

Initially the state wasn't involved in problem gambling efforts and local communities getting the casino money were urged to help compulsive gamblers, said Mike Ryan, executive director of the Missouri Riverboat Gaming Commission, that state's equivalent of the Nevada Resort Association.

"Funding was much less certain" before the state inserted itself, Ryan said. Some of the cities were objecting and others weren't contributing at all."

About four years ago, Missouri passed legislation directing the state to appropriate treatment and education funds from its cut of the admissions tax. Missouri now has about 150 certified gambling counselors and several dozen treatment centers, 28 of them treating gamblers for free through state contracts.

Kevin Mullally, executive director of the Missouri Gaming Commission, said the process has worked well so far.

"I think it makes sense to have it go through the state," he said. "It can be audited, there's a paper trail and public scrutiny through open meetings."

In 1997, the Commission joined the Missouri Alliance to Curb Compulsive Gambling, a group that now includes the riverboat casino association as well as the Missouri Lottery, the Missouri Department of Mental Health, the Port Authority of Kansas City and the Missouri affiliate of the National Council on Problem Gambling.

The alliance is an effective way for various stakeholders to sit down together and collaborate on various initiatives, Mullally said.

The casino association maintains a toll-free helpine for gamblers, the Missouri Lottery produces television and radio ads and the Gaming Commission maintains a list of gamblers who have elected to be banned from the state's casinos.

"It's a loose affiliation, so no one alliance member can tell another what to do," Mullally said. "It's a cooperative arrangement."

There's little controversy about the money raised for problem gambling, he said.

"It's hard for anybody to argue that taking one penny out of this tax is unreasonable. It sounds reasonable and it is," he said.

Missouri's program may not be working as well as initially hoped, however.

Only 344 people received treatment in 2003 compared with 373 people in 2002 and 335 in 2001, according to state figures.

That stands in contrast with the more than 7,200 people who requested to be banned from the state's casinos through the fiscal year that ended last June. Mullally said many addicts end up getting better on their own without intervention.

But Ryan attributes the low treatment numbers to the difficulty in attracting and keeping clients.

"People with this disorder do not understand the need for treatment," he said. "The problem we hear most frequently from providers is the problem in getting clients to come in and stay for treatment."

Counselors in Missouri often let their state certifications lapse because they don't have enough patients, instead falling back on more widely funded drug and alcohol counseling, he said.

Keith Whyte, executive director of the National Council on Problem Gambling, said many states including Missouri aren't putting enough money toward public awareness.

"I don't think we can start to say there's less of a problem (in Missouri)," he said. "If we were to put increased resources into advertising you'd see more people in treatment."

Advertising, especially TV ads that can reach large numbers of people, "takes time and a tremendous amount of money," Whyte said.

State governments, casinos and other groups nationwide spent roughly $2 million in 1998 to fund treatment for problem gamblers, according to the most recent research available from the National Council on Problem Gambling, which is in the process of updating those figures. That's much less than what gambling addicts are estimated to cost society in terms of theft, fraud and other problems, Whyte said.

In the the field of addictive disorders, prevention and treatment is widely viewed as a more cost-effective strategy "than trying to pick up the pieces after the disease has progressed," he said.

The casino industry largely accepts research indicating that about one percent of the nation's population -- or around 2.9 million people -- suffers from the worst form of gambling problem.

And regardless of what that percentage is, Nevada has a higher percentage of problem gamblers relative to its population than many other states, said Carol O'Hare, executive director of the Nevada Council on Problem Gambling.

Problem gambling isn't only an industry responsibility because it is a health issue that touches on the entire community, said O'Hare, who has also lobbied the Legislature for treatment money.

In Nevada, the safety net for gamblers "looks a little like swiss cheese now," she said.

The Nevada Council, an affiliate of the National Council on Problem Gambling, receives donations -- chiefly from gaming companies -- to maintain a toll-free hotline for people with gambling problems as well as distribute educational pamphlets for display in casinos and train casino workers on spotting problems.

Locally, the Nevada Council refers hotline callers to the Problem Gambling center for treatment or to self-help groups, such as Gamblers Anonymous. The state, through the Department of Human Resources, is funding drug and alcohol treatment services but hasn't incorporated gambling into the mix in spite of offering a structure that would readily allow it, O'Hare said.

Nevada now has a handful of state certified counselors made possible by legislation in 2003 that created a certification through the Board of Examiners for Alcohol and Drug Abuse Counselors. Most addictions counselors in Nevada specialize in drug and alcohol abuse.

"We have experienced counselors. We have a help line in place. It's almost like the last piece of the puzzle is missing," O'Hare said.

Hunter, of the Problem Gambling Center, doesn't worry about not having enough patients should public funds become a reality. He also welcomes the prospect of other area nonprofit and for-profit counseling services entering the field that have so far been dissuaded because no money is available, he said.

Supporting education and research is important but isn't as critical for gamblers who need immediate help, Hunter said. "If all the hotlines do their job ... they are just going to funnel (gamblers) down to us," he said.