Youth problem gambling is a growing public health concern. While parents may think gambling is less of a problem than drugs, smoking or drinking, there’s still reason to be concerned. Gambling can become an addiction — and is statistically more likely to occur the younger a person first gambles.
Gambling problems have long-term, severe consequences on a teenager’s life and on the life of those close to him or her. Some of the adverse effects of a gambling problem can be seen on various levels of individual functioning (cognitive, social and academic) and on both mental and physical health.
Despite the fact that gambling activities are legally restricted to adults in many jurisdictions —and have traditionally been viewed as an adult activity — there is clear evidence that underage youth actively participate in gambling. According to the most recent Minnesota Student Survey completed in 2019, 30 percent of middle school and high schoolers gambled in the last year, seven percent gambled frequently (more than once a week) and half of one percent (2,000 students in Minnesota) indicated signs of gambling disorder.
In addition to anecdotal and empirical evidence of the dangers of youth gambling, there’s also a physiological explanation. Recent advancements in brain development research indicate that the frontal lobe — the decision-making part of the brain — is not fully developed until age 25.
Thus, youth are less likely to make fully considered decisions about gambling and the risks that they take. This supports the reason why gambling is not allowed until the age of 18 in Minnesota and 21 in many other states.
Youth gambling is also a concern because the lines between “gaming” and “gambling” are becoming increasingly blurred. Problem gambling prevention efforts should really be addressing problem behavior with respect to “gaming” as much as gambling. Video games often have gambling-like features incorporated in them, and there are real opportunities to gamble using features within video games (e.g., skins, or in-game virtual decorative weapons/materials) that meet the definition of gambling in prize, chance and consideration.
There are many overlapping indicators for video gaming disorder and gambling disorder and there is increasing evidence that social casino gaming may cause increased gambling behavior in youth as well as eventual gambling problems. This contention is bolstered by information provided by the U.K. Gaming Commission, which reported that 31 percent of youth age 11 to 16 have paid or used in-game items to open loot boxes while three percent had bet with in-game items. Further, a study (Zendle & Cairns, 2018) also noted that the amount of money spent on loot boxes by those playing video games have been linked to severe gambling problems.
In September, after nearly 40 years, the Massachusetts Council on Compulsive Gambling (MCCG) changed its name to the Massachusetts Council on Gaming and Health (MACGH). Northern Light discussed this change and its implications with Marlene Warner, executive director of MAGH.
Q: Why was the organization renamed?
Marlene Warner
A: We started talking about this around four years ago. For starters, the term “compulsive gambling” was antiquated. We also became involved with GameSense, which meant we were more focused on the full spectrum from prevention to recovery rather than just intervention. We also heard increasingly from people at casinos and on social media, helplines, etc., about the blurring of lines between gaming and gambling. Since iGaming takes place on the casino floor it made sense to talk about “gaming,” which is more of an all-encompassing term. The “health” aspect of our name reflects that we do more than just intervention — we also want to look at the larger public health implications. The intention of the name is to not only expand our mission but also to designate what we’re truly doing as an organization.
Q:Was there a tipping point in the decision to change the name?
A: It was a gradual thing but in the last two years as we’ve realized the blurred lines between gaming and gambling, so have gaming commissions. Congress has even held hearings on gaming. It became clear to us that this was the next wave and we didn’t want to miss it.
Q:What has the response been to the name change?
A: For the most part, everyone has been incredibly supportive. They thought it was appropriate and future-focused.
Q:Have you made any changes to your training since the name change?
A: The very first thing we did was to work on a certificate program and clinical training program to broaden counselor and clinician knowledge of video gaming in a clinical setting. We want to make sure they’ve been prepared so that when someone presents with a gaming problem, they know how to respond.
Q:How is Massachusetts handing gaming disorder? Are counselors encouraged to take the INTENTA training? (INTENTA is the first approved training provider for the new International Gaming Disorder Certificate (IGDC) by the International Gambling Counselor Certification Board).
A: The training that we’re putting together is sort of a competitor to INTENTA. It’s another option that is a little shorter and less expensive. We are collaborating with the Evergreen Council on Problem Gambling and the course is called Foundations in Gaming Disorder. As with INTENTA, it will qualify for international board certification.
Q:Do you plan to measure the impact of the name change, whether through changed attitudes or diminished stigma around gambling disorder?
A: For now, we’re just collecting anecdotal feedback. But a year from now, we’ll want to know we’ve done the right thing. I think we’re gaining a lot of traction. We’re also in the process of putting together a major national study with gambling and gaming stakeholders with major universities. That, alone, has been well received.
Q: Do you think other state councils will make similar name changes?
A: Several fellow state councils have asked us how to do it. Many of us were trained on the idea of calling it “gambling” rather than “gaming” so it takes some fresh thinking. It’s not a change to be done lightly.
For me, gambling led to two lifechanging experiences.
The first changed me for the worse. The second connected me to a support network I’d never had before.
My first experience gambling was when my brother gave me $20 and took me to a casino. His intent was to teach me a lesson in how easy it is to throw money away gambling. Our birth father had a gambling addiction that devastated my brother’s childhood and he didn’t want the same thing to happen to me. (I was adopted at an early age and escaped those consequences.) But the problem with that lesson was that I actually turned that $20 into $60, and I guess I became unknowingly hooked.
The next time I gambled was several years later when I was out on a date after I’d been divorced and gone through having breast cancer. I just loved it. So much so that I went back the next day by myself. I enjoyed not having to answer to anyone. I’d been through a lot and figured I deserved to have fun.
I started going to the casinos more often. I’d make the 200-mile drive from Wichita to casinos in Kansas City and sometimes even further to play at larger casinos. It was a big investment of time and money, but I looked forward to it.
What started as recreation and something fun to do, became an obsession. I probably gambled for more than 20 years.
It got to the point where I lost a whole paycheck. That was the most irresponsible thing I’d ever done. I remember thinking, “What the hell?!” I endeavored that that would never happen again, but it did.
Things got scarier and scarier. I lied about where I was going and to friends about the reasons I needed money. At the same time, I felt pressure to provide for my girls. I convinced myself that I would try to win to pay everyone back and pay my bills. It got so bad, I started writing bad checks and stealing.
I couldn’t reconcile the person I had become with the person I thought I was. I didn’t understand then — because I didn’t know about gambling addiction — but now I realize I was in the throes of addiction.
I couldn’t keep up with rent and was continually evicted. I ended up living in my car, which I tried to hide. I then lost my job because I performed badly after being out all night gambling.
I decided I was going to kill myself. I went to the Emergency Room and explained that I felt suicidal. The staff wanted to admit me but I convinced them I’d be OK and left.
A short time later, I found myself back in the hospital parking lot, ready to go back in, but I fell asleep in my car. That’s when the first of several extraordinary moments happened. A security guard knocked on the window, waking me up. She walked me into the hospital, where I was admitted to the Behavior Health unit and for a week had three meals a day and a roof over my head.
The next extraordinary moment occurred when the social worker at the hospital, who knew about gambling addiction, recommended a residential gambling treatment center in Minnesota (Vanguard Center for Gambling Recovery at Project Turnabout) where I could go at no cost. She made the arrangements and, not trusting I wouldn’t try to go back to gambling after treatment, made me think about planning my life after I finished treatment.
I finally told my daughters about everything and they were very supportive. I felt this, too, was extraordinary.
I expected to return to Wichita but Sheryl Anderson, program coordinator at Vanguard, convinced me that I’d be better off starting a new life of sober living in Minneapolis, where I could live with other recovering addicts and learn how to build a life without gambling. Another extraordinary moment in the series was having John Rundquist as my counselor after I left Vanguard. He has made such a difference for me.
Perhaps the crowning extraordinary moment was getting involved in Gamblers Anonymous (GA). Through GA, I have met such wonderful people that have supported me in my recovery and in so many other ways. It is such a gift to be honest, to be accepted and to be understood.
On March 3, 2020, Susan Sheridan Tucker, NPGA executive director, and Brianna Doura-Schawohl, director of advocacy for the National Council on Problem Gambling (NCPG), addressed the Minnesota senate’s Government Finance and Policy and Elections Committee. They advocated for funding for problem gambling in SF1894. The following are some excerpts from this testimony (the complete testimony can be found at www.northstarproblemgambling.org/advocacy.
“We insist that any measure affecting the availability of gambling must provide for those adversely affected by this activity and will oppose any bill that does not include these provisions.”
“Governor Walz recognized March as Problem Gambling Awareness Month. All over the country organizations like ours will make special efforts throughout the month to educate all that problem gambling is an addiction, a public health issue and treatment is available and works.”
“We must not expand an industry without making provisions for the real people and their families who suffer the psychological, emotional and financial consequences from this insidious addiction.”
“Unlike the bill introduced last session, this version fails to set aside any money for treatment, training, prevention, research and responsible gambling. This is a huge missed opportunity for Minnesota to set a new standard for its gaming industry. Nor does it provide enough language to identify whose standards the new commission will use to prevent compulsive and problem gambling.”
“The United States is undergoing a rapid and massive expansion of gambling since the U.S. Supreme Court overturned Murphy vs. NCAA in May 2018. NCPG and the NPGA urge including the following four principles in the bill.”
Ensure that any expansion legislation includes dedicated funds to prevent and treat gambling addiction.
Require operators to implement responsible gaming programs that include comprehensive employee training, access to self-exclusion programs, ability to set limits on time and money spent on betting, and specific requirements for the inclusion of help/prevention messages in external marketing.
Identify an agency or entity with the tools and expertise to enforce responsible gaming requirements and create a comprehensive self-exclusion program.
Conduct research on the prevalence of gambling addiction prior to expansion and at regular periods thereafter in order to monitor impacts of gambling and have data that will support evidence-based mitigation efforts.
“Why wouldn’t Minnesota want to include consumer protection tools? Gaming regulators around the world are adopting more responsible gambling programs because they have made this connection and acknowledge they would prefer to have healthy players participate in their business.”
“We ask that before this bill goes any further, please build in the provisions NPGA and NCPG support. Any and all gambling expansion should mandate adequate consumer protections and set aside at least 1% of the funds from the tax revenue to support Minnesota’s problem gambling programs. We look forward to working with the authors of the bill to ensure that any expansion of sports betting comes with the greatest benefit to the state, at the least risk to its citizens.”
In early March 2020, I attended the annual New Horizons Conference on Responsible Gambling. It’s a conference that always provides great insights and this year did not disappoint.
The theme was Future-Proofing the Gambling Industry, an aspirational goal where a gambling operator no longer makes money from those exhibiting problem gambling. This may seem like pie-in-the-sky, but several countries are taking steps through advancements in technology that enable them to better identify customers taking too many gambling risks and to engage them in conversations about risks and potential financial harm. We are seeing a subtle shift in the goals of responsible gambling from providing safeguards and prevention initiatives to supporting safer gambling for all, including reinforcing “ideal” consumer behaviors.
“Future-Proofing the Industry: Player Safeguards and Prevention” There was much discussion about a paper by Judith Glynn of Strategic Science titled, “Future Proofing the Industry: Player Safeguards and Prevention.” The paper sparked conversation about the role of responsible gambling tools, how to make those tools more efficient and effective, and determining ways in which the risks can be identified and addressed. The paper called for greater cooperation between regulators, operators and players, recognizing each has an important role in determining the best ways to minimize the harms associated with gambling.
Some highlights of the paper include:
Establish the objective as making gambling safer for all players through education and awareness resources. This includes limit-setting tools, self-assessment tools and revising policies for on-site access to personal credit (ATMs, credit cards and limits on house credit, which ensures that the operator has ownership in the process).
Operators must take a direct role in keeping their players safe. They see firsthand the risky behavior in their customers and have the ability to understand their players’ playing activities and payment practices.
Operators can respond to a customer exhibiting risky behavior through well-designed messages and personal intervention with trained staff on the floor intervening when a customer escalates their risk levels.
Success in “future-proofing” will require cooperative efforts from operators, regulators and customers.
The issue that remains with responsible gambling programs is evidence showing that reliable and effective changes ensue in a customer’s behavior. While there is some evidence showing that responsible gambling tools create positive changes in behavior and reduce risk, the adoption rate of such tools is still too low. More work needs to be done to provide messaging that stimulates self-evaluation and personal relevance. Players need to receive messaging that instills autonomy and assists the player in their decision making.
Additionally, self-assessment tools must provide immediate results with personalized and actionable feedback. It’s equally important to respond to the risk as much as just identifying it. While self-assessment tools provide a window to communicate with players, more research is needed to evaluate its effectiveness on actual behavioral change.
