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RAPID GROWTH OF LEGALIZED GAMBLING

Historically, gambling in the United States had not been integrated into the larger culture as a major legal recreational pastime until the largest continuous expansion of legalized gambling that began during the last quarter of the twentieth century. Gross gambling revenues dramatically increased in the 1990s. For example, in 1996, $47.6 billion in revenues surpassed the $40.8 billion of combined revenues from movies, recorded music, cruise ships, live entertainment, and spectator sports (Christiansen, 1998). In the 1990s, there were major increases in the availability of some forms of gambling (casino and lottery) as well as new locations (riverboats and Native American reservations), many of which were immediately accessible (convenience stores). By the end of the twentieth century, gambling in the public mind had moved away from being associated with immorality, personal deviance, and crime and had become a major socially acceptable form of entertainment. At the turn of the twentieth-first century, lottery and casino gambling are the prominent forms of legal gambling in the United States, and there is no indication that this trend is slowing down.

The factors contributing to increased gambling include the perceived need by governments for lottery revenue to avoid raising taxes and to stimulate economic growth in distressed areas. Also contributing are the efforts of gambling entrepreneurs in the private sector and the simultaneous development of new forms of gambling technology, principally electronic gaming devices.

The private gaming industry and state governments trumpet gambling as exciting entertainment that also brings the benefits of more jobs and lower taxes. However, gambling is not solely a societal plus. When gambling is legalized and made more accessible, the number of people who try it increases and a certain percentage of those new gamblers who are vulnerable to addiction develop a problem. Social costs of pathological gambling, such as addiction, bankruptcy, divorce, and crime have been found to be severe in clinical samples of pathological gamblers. Assessment on a large scale of these social costs has only just begun (Lesieur, 1998).

PREVALENCE OF PROBLEM GAMING

The first national study of gambling and problem gambling in 1974 indicated that .77 percent of the sample had at some time in their lifetime been probable pathological gamblers, with another 2.33 percent potential compulsive gamblers (University of Michigan Survey Research Center, 1976). The second federally supported national study was conducted by the National Gambling Impact Study Commission (NGISC) in 1999. It was found that 1.20 percent (2.5 million) of the adult population were probable pathological gamblers in their lifetime and 1.50 percent (3 million) were lifetime problem gamblers (National Research Council, 1999). An additional fifteen million adults were identified as being at risk for developing a gambling problem. As compared to these statistics for the telephone sample where a total of 2.70 percent were lifetime problem and pathological gamblers, this study also surveyed patrons at gambling facilities (regular gamblers) and found that 13.00 percent met criteria for lifetime problem and pathological gambling. The NGISC report estimated that the annual cost for problem and pathological gambling is $5 billion, plus $40 billion in lifetime costs associated with decreased productivity, social service costs, and creditor losses (Gersten et al., 1999).

The prevalence of gambling problems is affected by many factors including the number of legal (and illegal) forms of gambling that are available and accessible. Prevalence rates may also be affected by the increasing availability of forms of electronic gaming. These machines are intrinsically engaging and even mesmerizing for many people. This form of gambling involves an insulated person-machine interaction, which provides the opportunity for more frequent play and reinforcement than other forms of gambling. For the individual susceptible to a gambling addiction, the time in which addiction may occur is foreshortened, especially when such machines are available 24 hours a day. However, any form of gambling may result in addiction for an individual who is vulnerable.

Higher prevalence rates for problem gambling are also likely to result when there is an increased acceptance in society of financial risk taking as gambling. In today's financial world financial resources are gambled away in ways that have not been traditionally considered forms of gambling. For example, excessive and destructive risks are being taken in the business world by pathological gamblers who are not aware that they are acting out a gambling problem. Slightly greater awareness is developing that the stockmarket and other financial markets are also arenas for problem gambling. Despite the fact that most people invest prudently in the financial markets, enormous sums are gambled daily in the markets. In 1997, the United States Securities and Exchange Commission acknowledged for the first time that problem gambling occurs in the financial markets by way of its agreement to distribute a pamphlet on investor problem gambling (Connecticut Council on Problem Gambling, 1997). However, the brokerage industry has not yet acknowledged problem gambling as a concern.

An additional fact that may influence the prevalence rate of problem gambling is the dramatic increase of accessibility to gambling via the Internet. The number of gambling sites available and number of online gamblers have been increasing rapidly, as indicated by the more than doubling of Internet gambling revenues from $445.4 million in 1997 to $919.1 million in 1998 (Barry, 1998). People at risk for a gambling problem will find it more difficult to avoid gambling and youth will be further tempted with increased accessibility by way of home computers. Even if the federal bill in the year 2000 to prohibit Internet gambling in the United States is enacted, online gambling will still be available on the Internet emanating from many other locations. Regardless of the legal status of Internet gambling, Intranet gambling sites involving pari-mutuel wagering will continue to be available to subscribers on home televisions and computers.

PREDISPOSING FACTORS

The National Opinion Research Center (NGISC, 1999) reviewed the available literature on problem gambling and concluded that the following are major predisposing factors to the development of a gambling problem:

• Problem gambling often occurs jointly with substance abuse, mood disorders, and personality disorders.
• Pathological gamblers more often than non-pathological gamblers report having a parent who is a pathological gambler.
• The earlier gambling starts, the more likely pathological gambling will occur.

SUBGROUPS AT RISK

The identification and modification of risk factors have been hampered by the confusion from the mixed messages the public receives. On the one hand, private and government sponsers of gambling on a large scale encourage gambling. On the other hand, consumers receive strong but less frequent messages that gambling to excess or inappropriate gambling can create addiction and related negative life consequences.

Evidence suggests that certain groups are at risk, such as older people, youth, women, and people with low income. Seniors are gambling more frequently and they are one of the major groups being targeted by casinos in their promotional efforts. There is building evidence that people of low income gamble a higher percent of their income than people with higher income. The rate of problem gambling among women appears to have dramatically increased in the 1990s, growing from a small percentage to more than 25 percent of all identified problem gamblers. Statewide prevalence studies have consistently identified teenagers as having a greater number of problem gamblers than adults in the same states (National Research Council, 1999).

These emerging facts raise many more questions that need to be investigated. For example, although seniors are a vulnerable group because of declining physical heath and mental capacity as well as depression due to loss and isolation, it is not known whether seniors as a whole experience a greater rate of problem gambling than adults in general. Perhaps the social contact available in a gambling environment and the alertness and required in concentration on gambling have positive mental health benefits for seniors? Research with subgroups in the population, especially groups at risk, across a wide range of geographical areas is needed.

GROWTH OF COUNCILS ON PROBLEM GAMBLING

To meet the challenges of problem gambling, which have increased with the growth of gambling in the last quarter of the twentieth century, councils on problem gambling have been created in the United States and Canada. As spiritual advisor to Gamblers Anonymous, Monsignor Joseph Dunne, along with recovering compulsive gamblers and family members, founded the National Council on Problem Gambling (NCPG) in 1972. Connecticut became the first state affiliate of the NCPG in 1980 and by 2000 there were thirty-four state affiliate councils. The NCPG was the first professional organization to educate the public about compulsive gambling as a serious public health problem and to advocate for treatment services. Other major priorities of the NCPG and its affiliates include the following: sponsoring helplines, conducting prevention programs, training human services personnel, conducting surveys on problem gambling, and collaborating with a variety of relevant organizations, including the public and private gaming industry.

GAMING INDUSTRY'S RESPONSIBLE GAMBLING PROGRAMS

The American Gaming Association (AGA), the national trade association for casinos, in 1996 took a major voluntary step forward in creating the Responsible Gaming Resource Guide, which provided a blueprint for establishing a responsible gaming program. In 1997, AGA also established the National Center for Responsible Gaming that is a significant funder of basic research into problem gambling (American Gaming Association, 1998). In the late 1990s, a few state gaming regulatory bodies began to require responsible gaming programs in order for private sector gambling operators to be licensed. Native American-owned casinos have also developed innovative responsible gambling programs. Although most state lotteries have responsible play programs in the year 2000, government efforts to promote responsible gambling (with a few exceptions) are not as progressive as those of the private sector. This may be due to the inherent difficulty of serving as both the regulator and operator of the lottery or because the lottery is incorrectly viewed as a relatively benign form of gambling. Funding for treatment, prevention and research programs by state governments began gradually in the late 1970s and by the end of the twentieth century approximately half the fifty states funded significant programs.

RECOMMENDATIONS OF THE NGISC

The NGISC's (1999) two-year examination of gambling in the United States has been the most extensive and systematic study of the state of seventy-four recommendations for changes in policies and practices for the public and private and Native American sectors of the gambling industry, state regulators, and the federal government. Some of the major recommendations include:

• A pause in the processing of all new gambling applications to allow for adequate assessment of the gambling already in place
• A rollback of all convenience gambling in communities and a halt to authorization of all new convenience gambling
• A restriction of the minimum legal gambling age to 21
• A ban on betting on collegiate and amateur athletics
• A ban on all aggressive gambling advertisements, and the creation of responsible gambling advertisement guidelines
• Prohibition of Internet gambling not already authorized
• A ban on ATM and credit card machines within or near the immediate gambling area
• Gambling establishments policies to ensure the safety of children and prevent underage gambling
• School programs from the elementary through college level should include warning of the dangers of gambling

NEED FOR A COMPREHENSIVE PLAN

Few epidemiological studies have been undertaken primarily due to an underestimation of gambling's impact on all levels of the community. Most communities lack a comprehensive approach and systematic methodology to determine the overall value of gambling to the community. Given the rush to profit from the popularity of gambling, most state and local governments have not systematically planned (e.g., articulated-short and long-term goals) and conducted a comprehensive study of the likely impact of new or significantly expanded gambling on their communities. Economic projections and gambling regulation have been the primary interests. Consequences can be enormous if initial assessments are not comprehensive, thorough, and accurate. Once gambling is introduced, it is very difficult to roll it back as governments become highly dependent on the revenue. Further, evaluation and monitoring programs have typically not been set up to assess the impact of gambling on communities over time. Needed are the short- and long-term assessment of social costs, the extent to which projected economic benefits have been met and sustained, and the extent to which gambling has changed the communities in other positive and negative ways (NGISC, 1999).

MARVIN A. STEINBERG