Where is Public Health Policy on Gambling Headed?

This question drew a large crowd to this morning’s first plenary, where moderator Don Feeney, research and planning director of the Minnesota State Lottery, kicked off the discussion by saying that historically, public health policy tends to treat problem gambling as “someone else’s problem.” And as “someone else’s problem,” the issue becomes conveniently invisible.

Feeney, with more than 20 years of experience working with public and elected officials at the state level, went on to say that, to the extent problem gambling hasn’t been invisible in state-level public policy, the policy isn’t based on science – it is based on guilt. To these states, he said, the important matter is that something has been done, but what that something is doesn’t necessarily matter.

According to Feeney, elected officials are very good barometers of their constituencies and, therefore, one of the challenges problem gambling policy faces is that the conventional wisdom that exists within the public is also evident in the officials. To the public, a problem gambler is “that guy next door” who visits the casino frequently and is irresponsible with his money. People still view problem gambling as a moral problem and consider it to be different from chemical addictions. This conventional wisdom trivializes the issue, said Feeney, and therefore diminishes the need for a public response in the eyes of the public and elected officials.

“There is a lot of work to be done to overcome conventional wisdom,” said Feeney, “Which is a tremendous barrier to effective public policy.”

Feeney went on to say that stakeholders in the prevention and treatment of problem gambling need to make elected officials understand what it is. He emphasized the need for those who work in the field of problem gambling to develop advocacy skills, saying “We need to know how to effectively work with our elected officials. These are not skills you are born knowing, they can be learned. Knowing who to talk to, what their key issues are, and finding a champion.”

Feeney pointed out that one champion in a legislature of a few hundred can be a powerful tool. “We need to find those champions and advocates, work with them, and try our best to educate the others.”

With that, Feeney introduced Dr. Westley Clark, director of the Center for Substance Abuse Treatment at the Substance Abuse and Mental Health Services Administration (SAMHSA). Dr. Clark presented on the federal government’s response to problem gambling, which has been minimal because it was determined in 1999 by the congressional National Gambling Impact Study Commission that problem gambling is a state responsibility. Clark said SAMHSA has almost exclusively deferred to states and nonprofit organizations when it comes to problem gambling.

Forty-eight of the 50 states in the U.S. receive proceeds from some type of gambling. Clark pointed out this conflict of interest a one challenge facing the development of effective public health policy on pathological gambling. He also pointed to the “perceived need for treatment by those who are affected by the condition” as a major problem for those concerned about problem or pathological gambling.

Clark cited research showing that problem gambling is more common among people with alcohol use disorders than it is among those without such disorders. Due to this and the high rate of other co-occurring disorders, Clark pointed out that SAMHSA is faced with a dilemma about whether or not to get involved as the organization currently does not address gambling problems.

In addition, he emphasized that there currently is no public health paradigm for problem gambling, and encouraged those in the audience interested in the issue to pursue and encourage that goal. He concluded his presentation by providing recommendations for the development of state-level public health policy, which are: assume a neutral stance, recognize the state’s ethical responsibility, work with the gaming industry, learn from other states and be flexible in the planning.

To open his presentation, Gary Fisher, professor in the College of Health and Human Services at the University of Nevada, Reno, reminded the audience that there will be natural conflicts between industries that produce products that can cause harm and the people who are seeking to prevent or treat that harm.

He pointed out a disconnect in the substance abuse field with regard to the size of the problem and the size of the solution. For example, though alcohol abuse results in double the economic costs of drug abuse, said Fisher, government funding doesn’t reflect this as the National Institute for Alcohol Abuse receives less than half the funding of the National Institute for Drug Abuse.

He also pointed to the stigma surrounding addiction – addicts are perceived as weak-willed, and the public perceives that treatment doesn’t work because they see movie stars, athletes, politicians, and their friends and family continually bouncing in and out of treatment programs.

Fisher said alcohol policy is the best place for guidance because it is very comparable to gambling due to the fact that it is legal and can be used safely. Alcohol policies include environmental strategies, such as limiting the locations where it can be sold and the days on which it can be sold. According to Fisher, these types of strategies might also work for casinos.

He emphasized the need for a commitment to treatment, competing marketing campaigns and the need to find common ground where industry, government, nonprofit and all other stakeholders can come together. In addition, he stressed the importance of states taking action, saying that “you can’t count on the federal government” to take the lead.