Gambling addicts face tough climb out

PHOTOGRAPHER: Sara Foss

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Even when her husband was dragging her out of the racino, Sheri didn’t really think she had a problem.

Nor did she really think she had a problem when she started getting treatment from The Center for Problem Gamblers in Albany. She attended group meetings, where gamblers told their stories and discussed their problems, and met with a counselor one-on-one.

“I went to the program for a year and a half, and I was half-motivated to stop,” recalled Sheri, a 50-year-old Clifton Park-area resident who asked that only her first name be used. “After my first meeting, I went right out and gambled. … It was hard to accept it as a problem. Denial is a very powerful coping mechanism.”

Gambling problems?

In an interview earlier this year, Jim Maney, executive director of the New York Council on Problem Gambling, outlined questions people should ask themselves to determine if they have a gambling problem:

• Am I losing money?

• Am I going back to try to win more?

• Am I lying about gambling?

• Am I spending more time on gambling than other activities I used to enjoy?

• Is gambling causing problems at home?

“I was lying, sneaking around, sneaking money,” she said. “My attitude was very selfish. I was suffering from spiritual deprivation. My conscience would come back just enough to make myself miserable.”

Sheri relapsed every two to four months, and finally had what she described as an epiphany.

“I got honest with my counselor,” she said. “I needed to be honest about gambling and drugs, that I couldn’t stop using or gambling. I finally accepted that I’m an addict. I surrendered.”

After a brief stint in rehab — she also struggled with an addiction to prescription drugs — she returned to The Center for Problem Gambling, fully committed to a new lifestyle.

“I haven’t gambled or used drugs since then,” she said. “It’s been two years, eight months and 18 days. The program saved my life.”

According to a 2011 study from the University at Buffalo’s Research Institute on Addictions, problem gambling is more common among U.S. adults than alcohol dependence. More than 80 percent of Americans gamble each year and between 3 percent and 5 percent of Americans have a gambling problem.

There aren’t many resources for gambling addicts in the Capital Region, and many find themselves at The Center for Problem Gambling, an outpatient treatment center in Albany that is funded and licensed through the state Office of Alcoholism and Substance Abuse Services. Established in 1996, the center is one of the oldest such centers in the state, and the largest program in New York.

About four years ago, the center revamped its treatment program, combining a 12-step recovery approach to treating addiction with behavioral therapy, which encourages patients to talk through their feelings and motivations.

This shift was necessary because gamblers are notoriously hard to treat. Gamblers are much more likely to drop out of treatment programs than drug addicts and alcoholics, and tend to have a higher rate of relapse as well as higher rates of suicide and depression, according to Phil Rainer, the center’s director of clinical services.

Better results

Under the new treatment model, “We’ve been able to attract and retain a lot of clients,” Rainer said. “We’ve seen significant levels of abstinence since we began using this approach. … People feel a sense of membership in a community, and they come back more frequently. What we’ve seen is that reduction and abstention from gambling is at a much higher rate than when we were using a more traditional counseling approach.” This more traditional approach emphasized some individual and group counseling, but didn’t offer the same fellowship and sense of community that the group meetings provide.

“One thing we’ve found is that if the treatment is peripheral, if it’s an add-on to the rest of their lives, if every couple of weeks they go see a counselor, it will not do the trick,” Rainer said. “When you make the treatment central, you can get your life back in order. Recovery must be a first priority. Our first challenge as a program is to get people to understand that they’ve got to take care of their addiction first if they’re going to get the other pieces of their life in order.”

One challenge is that relatively little is known about how to treat gambling addicts, and that gambling has only been recognized as an addiction on par with alcoholism or substance abuse in the past decade.

In response to this shift in thinking, the upcoming edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders will classify gambling as an addiction for the first time. Right now, gambling is classified under “Impulse-Control Disorders Not Elsewhere Classified,” along with compulsive stealing, fire starting and hair pulling. Research has shown that gambling can have the same effect on the brain as cocaine, Rainer noted.

Different turf

Jerry Kriss had a lot of experience treating people with substance abuse problems when he was hired to serve as The Center for Problem Gambling’s senior clinician. But he soon discovered that the approach that had served him so well when working with alcoholics and drug addicts was far less successful with gambling addicts.

“I had never treated gambling addictions before, but I didn’t think it would be that much different, because an addiction is an addiction,” Kriss said. But that wasn’t the case at all. “I couldn’t attract or keep clients,” he said. This low rate of success is what inspired him to develop the center’s current, more successful model of treatment.

Because gambling addicts tend to be more successful than drug and alcohol addicts, with good jobs and a relatively intact home life, they are more likely to quit treatment programs when told to do things they don’t want to do, Kriss said.

“A gambling addict will not tolerate being treated as the typical drug addict or alcoholic is treated,” Kriss said. “Many places, if you come late to a group meeting, they won’t let you in, because it creates chaotic conditions. With our fellowship model, we let you come when you can. If you treat gamblers with disrespect, they will not come back.”

For the most part, the addicts who seek help from the center have recognized that they are out of control, Rainer said.

“Their addiction is pretty advanced by the time they contact us,” he said. “They’re experiencing high levels of anxiety and depression. Their finances are a mess, and their relationships are a disaster. They’re in tough shape.” Problem gamblers are much better at hiding their addiction than alcoholics or drug addicts, he noted. “They can look OK when they’re much further along in their addiction,” he said. “They’re not drunk, they’re not slurring their words. … Most of them are still working. They have homes and intact families. They’re well educated and hold skilled jobs.”

The Center for Problem Gambling hosts five or six fellowship groups a week, a dramatic increase from the program’s early days, when meetings attracted between four and five people. There are co-ed meetings as well as single-sex groups. Participants have developed a phone list, and call each other frequently.

The program’s success has fueled an increase in clients.

In 2008 the center provided between 90 and 100 “units of service” each month; that number has risen to between 450 and 500 units of service.

Services expand

In the fall, the center will expand services, sponsoring a new group for people who have graduated from their treatment program. This program will be coordinated by two “recovery coaches” — addicts who have been through the program. Sheri has been tapped to serve as a coach, and said she will serve as an advocate for addicts, helping them remove barriers to recovery. If someone lacks transportation, or doesn’t have a cooperative spouse, “I’ll try to help with that,” she said.

When gambling opportunities increase, as they have in the Capital Region, the number of problem gamblers also increases. But there are still only four Gamblers Anonymous meetings in the area, and two of them are hosted by The Center for Problem Gambling.

“We want to discharge people from our program, but we know there isn’t much of a community for them to go to,” Rainer said. “We’d like to see Gamblers Anonymous become a more active and vibrant community is this area.” Gamblers Anonymous is a recovery program that follows the popular 12-step model, which, among other things, asks addicts to admit that they cannot control their compulsions or addictions, recognize that a higher power can give them strength, and examine past errors with the help of a sponsor.

To beat their addiction, gamblers must find activities to fill the time they spent gambling; for many of the center’s clients, the program becomes the alternative.

“If their existing habit is to go to the racino, this program gives people a different place to go,” Rainer said. As they get better, addicts begin to return to the more positive activities. “They may become more active in family life,” he said. “They might get back into a bowling league.”

Edelgard Wulfert, a professor of psychology at the University at Albany, has been researching gambling for the past 12 years, and is conducting a study on gamblers at The Center for Problem Gambling and the New York State Psychiatric Institute in New York City. This study compares the success rate of a treatment program Wulfert developed with that of Gamblers Anonymous.

“GA has a huge dropout rate, but the patients in our program are returning,” Wulfert said. “One of the biggest problems with treating gamblers is that they often drop out of treatment. People who stay with GA are often very successful — the problem is the drop-out rate.”

Options

Gambling often fills a void in the lives of addicts, and Wulfert tries to figure out what that void is, and how else to fill it. For instance, many people begin gambling when they retire. One woman began gambling on a church trip to a casino that offered a rare break from caring for a sick husband. To help this woman, Wulfert made arrangements for one of her adult children to take care of her husband for a period of time each week, which allowed the woman to socialize with her friends more regularly.

“We are trying very hard to help people adopt a different lifestyle, and recognize that what they’re doing is a losing game,” Wulfert said. “There’s no lottery game or casino game where you come out a winner in the long run.”

Sheri’s gambling problem developed quickly, seemingly out of the blue, although she had been struggling with an addiction to prescription painkillers — propoxyphene, Klonopin and hydrocodone — initially prescribed for back and neck problems.

“I had been gradually getting addicted to drugs, but I wasn’t aware of it,” she explained. “By the time I started gambling, I was addicted to drugs.” Her addictions coincided with her return to the workforce, and a well-paying, part-time job. She soon found herself at the racino three or four times a week, gambling for hours at a stretch.

“I spent my whole paycheck,” Sheri said. “My husband could tell right away that there was a problem. He gave me a lot of grief.”

Her gambling was escapist in nature, and although she had never gambled much before, she soon found herself spending more and more of her time at the racino, Sheri said.

“It was exciting, but the main thing was that once I stepped in that door, it was like a whole different world,” Sheri said. “I didn’t have problems there. I wasn’t a person in there. It was like the world didn’t exist. Money became play money in there.”

With her husband’s urging, Sheri eventually sought help from The Center for Problem Gambling. This ultimately led her to quit her job, start exercising more, and find other ways to keep active, such as gardening and reading. She has emerged as a leader at the center, calling her fellow addicts daily to touch base and discuss problems, and reaching out to newcomers with encouragement and insights.

“I was shy, and I didn’t have a lot of friends before,” she said. “Now I have a lot of friends.”