Capitol Alert

As gambling surges in California, treatment for compulsive players lags

The San Diego woman once considered herself one of the millions of Californians who infrequently gamble for fun. That life came crashing down amid a bitter divorce.

“My poison was slots,” the woman said in an interview this month. At 58, she is in treatment and asked that her name not be published. “It was a numbing device. It was probably no different than an addict who shoots a drug when you’re stressed.

“I literally lost anything and everything that was of financial value to me.”

The woman and an estimated 1.5 million pathological or problem gamblers like her exist as the casualties of California’s growing gambling industry. Once mostly limited to racetracks and card clubs, California’s legal gambling options today include 60 tribal casinos and one of the country’s largest state lotteries.

More could be on the way. The state regularly authorizes new tribal casinos. Various gambling interests want the state to license Internet poker, now the domain of illegal websites based offshore that many Californians frequent.

Problem gamblers and treatment experts alike also note with alarm the barrage of television ads for daily fantasy sports websites, which thrive in a legal gray area while attracting investments from several owners of professional sports teams.

“I think we’re going to see a big influx of people who’ve lost everything,” said Susan Campion, a problem gambling counselor in Minneapolis, pointing to the upcoming Super Bowl and March Madness tournament. A pending California bill would license fantasy sports sites.

The gambling surge poses new challenges for efforts to reduce compulsive gambling in California, which a 2006 study pegged as a $1 billion problem. Once nearly nonexistent, the budget for state compulsive gambling efforts has doubled from a decade ago and now includes millions of dollars for research, training, prevention and treatment. Some local governments, casinos, and others also offer prevention programs.

Yet experts say the full scope of the problem is much larger, with those receiving help representing about a fifth, or less, of California’s population of out-of-control gamblers.

The program’s focus remains concentrated in the state’s four largest urban areas. The state has only two residential treatment options. State spending on problem gambling, meanwhile, has changed little this decade, and today represents less than one-tenth of one percent of the estimated $13 billion in gambling activity at the time of the 2006 study. Gambling entities, even within the same industry, contribute widely different amounts to problem-gambling efforts.

Advocates worry that what little funding exists could be at risk. A special account funded by some tribes with casinos, which provides 97 percent of the state office’s revenue, is on track to be in the red by next summer.

“That is the hottest topic right now,” said Dr. Timothy Fong, co-director of UCLA’s Gambling Studies Program, which contracts with the state Office of Problem Gambling for training, treatment reimbursement and other services.

California’s program has become a national leader, Fong said. Many states offer little more than a 1-800 number and a website. California, along with some other states, offers no-cost outpatient treatment and is virtually alone in offering free residential treatment for addicts.

But Fong and others say there is a large unmet need, and officials need to find new ways to reach people who need help.

“I think treatment demands are being met for folks who actually want treatment. But I think there’s a much larger population out there who are not seeking treatment,” Fong said.

Terri Sue Canale, the director of the Office of Problem Gambling, said the state program could serve more people if there was more money.

This year’s budget made permanent the funding for the California Gambling Education and Treatment Services program. But the program remains limited to the Bay Area, Los Angeles, San Diego and Sacramento. That leaves out areas such as the northern and southern Central Valley, where there are multiple tribal casinos and card clubs.

The state won’t turn away people seeking treatment or counselors seeking training in those areas. But the office’s focus is elsewhere, Canale said.

“It’s a resources issues,” she said. “We do a lot of really targeted media to our most vulnerable populations. We’re not trying to message everybody.”

California lawmakers have shown limited interest in the issue, with a smattering of hearings or witnesses devoted to problem gambling over the past several years.

In 1997, more than a decade after the launch of a state lottery, lawmakers authorized the first problem gambling office in the then-Department of Mental Health. But the office never materialized and in 2003, a few years after voters authorized Las Vegas-style gambling on tribal lands, lawmakers created a problem gambling office in the then-Department of Alcohol and Drug Programs.

Lawmakers a few years ago dissolved the department and shifted the problem gambling program to the Department of Public Health, where it remains.

Attitudes toward problem gambling evolved during that time. Funding for the nonprofit California Council on Problem Gambling totaled about $2,500 in the early 1980s, recalled I. Nelson Rose, a Whittier Law School professor and gambling expert. For the current fiscal year, the Office of Problem Gambling has an $8.4 million budget.

Problem gambling was once viewed as a standalone behavioral problem, but the latest psychiatric classification system puts it in the same group of ailments as drug addiction and alcoholism.

“There are a lot of similarities,” said Michael S. Liao, the director of programs at the NICOS Chinese Health Coalition in San Francisco, which offers problem gambling treatment for people of Asian heritage. “People feel like they need it. Some of our clients have physical withdrawal symptoms, not unlike someone coming off drugs or alcohol.”

While the human body puts a limit on drug or alcohol consumption, the “body doesn’t protect you against over-gambling,” Liao said. “You can hit rock bottom a lot quicker.”

Rock bottom was familiar territory for the five men and three women who attended a Gamblers Anonymous meeting one recent evening in Manteca.

Some had been in recovery for decades, others for weeks or months, all trying to move beyond a habit that had left a trail of ruined finances and relationships.

One of those present was a Stockton man who, in an interview, said he last gambled in the mid-1980s after decades “in the dream world of the compulsive gambler,” spending time in prison and contemplating suicide at one point. He noted that his many years in recovery leave him better able to resist the many triggers that can lead to relapses.

“A dollar is no big problem, but once you start chasing that fantasy, there never seems to be an end to that longing,” said the man, 82, who asked that his name not be used. “There is going to be an explosion of people who are suffering from this disease.”

Almost 260 counselors, therapists and other providers – many more than a few years ago – are certified to work with compulsive youth and adult gamblers as well as their family members. The increase reflects training funded by the state. State money also pays for no-cost outpatient services.

For particularly difficult cases, the state will pay for residential treatment at centers in Los Angeles or San Francisco that also treat people with other addictions. Jean LeFlore, the director of residential services at HealthRight 360 in San Francisco, said the compulsive gambler sent to residential treatment “basically is somebody who is unable to keep themselves out of gambling situations.”

“Most of them are broke and heavy in debt. Some of the ones I’ve dealt with are facing charges for theft or embezzlement,” he said, and would otherwise have no way to pay for the services themselves.

The state needs more residential treatment options, LeFlore said. Other experts said outcomes improve when residential treatment doesn’t include people suffering from other addictions.

“In my first month of abstinence, if you had tried to convince me I had anything in common with a heroin addict with needle tracks, a meth addict with rotten teeth, or an alcoholic with a cirrhotic liver, I would have said, ‘that’s not me,’ ” said Rick Benson, a former compulsive gambler and director of Algamus Recovery Services in Arizona.

At the time of the 2006 gambling study, experts said it would cost about $280 million to offer all of California’s adult problem gamblers a six-week intensive treatment course.

Almost all of the money for the state office comes from the Indian Gaming Special Distribution Fund, created in 1999. But less than one-half of the 58 tribes with casinos pay into the fund. And what was a $113 million balance in mid-2010 will be exhausted by next June, according to the Department of Finance.

Officials note that state law gives problem gambling programs first call on deposits into the account. Yet the fund’s tight finances suggest there is little chance of a larger share for problem-gambling efforts. “We are watching this very closely,” Canale said.

It also seems unlikely the state will find other sources in the near future. The 1984 ballot measure that authorized the California Lottery, for example, included no provision to help pay for compulsive gambling efforts. Lottery sales totaled $5.5 billion last year.

For 2015-16, the lottery will contribute $120,000 to the Office of Problem Gambling to help pay for the problem-gambling phone line. The contribution represents about two-tenths of 1 percent of what the lottery annually spends on average for general-purpose advertising.

Lottery spokesman Alex Traverso said the lottery is committed to responsible gambling. But lottery finances are tight after payouts for prizes, ticket vendors and California schools, which received $1.3 billion in 2014-15.

“There’s not a lot of wiggle-room in our budget,” he said.