The Treatment of Problem and Pathological Gambling and Private Sector Efforts
Unfortunately, as the NRC report noted, few studies exist that measure the effectiveness of different treatment methods. Those that do exist “lack a clear conceptual model and specification of outcome criteria, fail to report compliance and attrition rates, offer little description of actual treatment involved or measures to maintain treatment fidelity by the counselors, and provide inadequate length of follow-up.” 45 Not surprisingly, the effectiveness of these various treatments are “not well substantiated in the literature.” 46 However, one thing that is known is that each has a high recidivist rate. For example, the only known survey on the effectiveness of Gamblers Anonymous found that only 8 percent of GA members were in abstinence after one year in the group. 47
Understanding the rate and processes of natural recovery among pathological gamblers also would enhance our understanding of the etiology of the disorder and advance the development of treatment strategies. Several Canadian investigators have recently embarked on investigations of natural recovery among disordered gamblers. Dr. Rachel Volberg has conjectured that prevalence studies, which usually show a lower rate of pathological gambling among adults than youth, might be evidence of one form of natural recovery, as young people experience the “maturing-out” process and leave behind risky behaviors as they enter adulthood. 48 Natural recovery estimates also will affect economic cost studies.
The majority of state affiliates of the National Council on Problem Gambling report that most insurance companies and managed care providers do not reimburse treatment for pathological gambling, even though pathological gambling is a recognized medical disorder. As a result, people seeking treatment generally must pay out of their own pockets, which severely limits treatment options given the limited financial resources of most pathological gamblers. Even where treatment is available, however, only a small percentage of pathological gamblers may actually seek help. According to NORC, preliminary research suggests that only 3 percent of pathological gamblers seek professional assistance in a given year. 49
Private Sector Efforts
After a quarter century of dynamic growth and heated competition, leaders in the gambling industry are only now beginning to seriously address the existence of problem and pathological gambling among millions of their patrons. The American Gaming Association (AGA)— which represents a wide range of casinos— has initiated several efforts to address problem and pathological gambling and is the largest source of funding for research on problem and pathological gambling. Members of the AGA have committed $7 million to researching several aspects of problem and pathological gambling. Helplines also have been established by AGA. In addition, the industry has created the Responsible Gaming Resource Guide (2nd Ed.), which lists programs and efforts in each state to assist problem and pathological gamblers.
However laudable these efforts, industry funds earmarked for treatment for pathological gambling are miniscule compared to that industry’s total revenue. Critics have assailed the relatively modest industry efforts in this area by asserting that a large percentage of gambling revenues are derived from problem and pathological gamblers. NORC calculated that they account for about 15 percent of total U. S. gambling revenues, 50 or about $7.6 billion per year (based on total annual gambling revenues of $50 billion). Dr. Henry Lesieur calculated that problem and pathological gamblers account for an average of 30.4 percent of total gambling expenditures in the 4 U. S. states and 3 Canadian provinces he examined.
45 NRC. 46 NRC. 47 Ruth M. Stewart and r. Iain Brown, “an Outcome Study of Gamblers Anonymous,” British Journal of Psychiatry, volume 152, pp. 284– 288, 1988, as cited in Henry R. Lesieur, “Costs and Treatment of Pathological Gambling,” The Annals of the American Academy of Political and Social Science, March 1998, p. 259. 48 Rachel A. Volberg, “Wagering and problem wagering in Louisiana,” Report to the Louisiana Economic Development and Gaming Corporation (Roaring Spring, PA: Gemini Research). 49 NRC, p. 51. 50 NORC, p. 33.