Treatment a safe bet for compulsive gamblers

Medical School clinicians and researchers in the Rhode Island Hospital Gambling Treatment Program are helping compulsive gamblers control their impulses.

by Scott Turner

There is a large sign in Mary’s home that reads "JUST FOR TODAY." It’s her way of saying ‘do not gamble!’ And it reminds her that every minute she resists the urge, she earns a small victory.

"It will take a long time for the urge to gamble to go away," said the 60-year-old Rhode Islander. "The sign is a step."

To fight her addiction, Mary recently removed lines of credit in Atlantic City, destroyed her credit cards, locked up the checkbook, and prepaid the electric, heat and phone bills for six months.

These are the kind of strides that Brown Medical School clinicians and researchers in the two-year-old Rhode Island Hospital Gambling Treatment Program hope patients will take to control the impulse to gamble excessively.

"Business is good," when it comes to the number of people seeking treatment for pathological gambling, said the program’s co-founder Bob Breen. A clinical psychologist, Breen is the state’s only certified gambling therapist.

Recent news reports followed Rhode Islanders falling over each other for the chance to win $300 million in the lottery. But not much is said about the growing number of people losing homes and life savings pursuing the relatively small pots spewed out by 25-cent video slot machines.

"With the increase in legalized gambling has come an increase in pathological gamblers," said Mark Zimmerman, M.D., the program’s other co-founder and associate professor of psychiatry and human behavior and director of outpatient psychiatry at Rhode Island Hospital.

"Pathological gambling is like other emotional and psychiatric problems that involve troubles with impulse control that lead to excess," Zimmerman said. The illness is marked by a preoccupation with gambling, the need to gamble with increasing amounts of money and lying to conceal the extent of one’s activities.

Breen calls it a nasty habit. "You can successfully quit and become more functional but may be left with monetary damage, marital, legal and other troubles. You can stop gambling for 5 years and still not pay off all your debts.

"We find that regardless of how small the chance, gamblers believe they can hit that $100,000 jackpot and get their money back. But it’s a hard pill to swallow when the money is gone and so is your home, family, investments and savings."

Their program is one of two local agencies to receive state funding to treat gamblers. The modest support of $87,000 per year allows the four-person operation to treat patients regardless of one’s ability to pay. Zimmerman, Breen and colleagues integrate research on the illness of pathological gambling into their clinical care.

One thing they have observed is a change in the profile of the pathological gambler.

"In the last generation, it was mostly men, but the number of women has exploded as gambling has become a legitimized industry," said Breen, who credits the spread of machine games, such as video poker, with feeding the gambling fever.

"Each type of machine has short intervals between bets," he said. "They pay off instantly and are non-threatening to someone who hasn’t gambled before. These machines are designed to provide no chance for the gambler to think or even take a breath. They promote responding and that makes them more addictive."

In fact, Mary’s gambling habit developed when video slot machines arrived in Rhode Island several years ago.

"You start off saying you are only going to spend a small amount but before you know it, the machine has you by the throat," she said. "You say you will play only $20 and leave. But before long $20 become $40, then $80, then $800.

"I still have my home. But I know people who are willing to jump off a bridge because of their losses." Mary has witnessed people blow their entire paycheck at the slots, and leave in tears.

Based on the advice of a friend, Mary visited Breen last July. They now meet weekly for psychotherapy and she takes Zoloft to control her underlying depression.

About 70 percent of people who seek gambling treatment also have a major depressive disorder, Zimmerman said. A combination of psychotherapy and medications is used to treat many patients, he said.

Gamblers, like other addicts, get caught up in a vicious cycle.

"Gambling helps people forget about their problems," Breen said. "It feels good, so people come back to do it again and again, finding its easy to lose track of time and money.

"Like alcohol or drug abuse, people use gambling to get their excitement and to escape from depression. This adds to all their other problems and stresses in life. When they come out of the casino with no money, their problems are still there."

Breen helps gamblers, who want to change their behaviors, to focus on short-term goals and to break down their habit into segments.

For example, "We may ask someone to delay gambling for a few minutes," Breen said. "If you know you are headed to gamble, get in your car and sit and relax for 10 minutes. If people can just do that, the urges will fade. It could make a difference."

At one point, since beginning treatment, Mary went two-and-a-half weeks without gambling. But she recently blew $1,600 on slots, after her cat, a companion of 14 years, passed away.

The experience was akin to "kicking and kicking yourself when you are down, and you don’t know why you are doing it," she said. "I thought I was on my way until I lost my pet. Anything can trigger you to restart gambling."

Mary urges compulsive gamblers to get help. "You will end up losing everything unless you stop yourself. And the only way to stop yourself is to get help."

Recently, Mary declined an invitation to spend an overnight at Foxwoods. "Normally I would have accepted without question, but I said no. It’s a long road. But I will continue the course." For Mary it was another small step away from a nasty habit.

To reach the Rhode Island Hospital Gambling Treatment Program, call 401-277-0707.