I first got involved in the gambling industry in 1991 when I started my research into the social, economic and cultural impacts of the Shooting Star Casino on the White Earth Reservation in Minnesota, where I grew up. I was a graduate student in cultural anthropology and was looking for a research topic focused on cultural change. I went home for a college break and visited the new tribal casino in my hometown of Mahnomen. On that visit, I immediately noticed vast local improvements that came from increased employment, infrastructure upgrades, additional housing and healthcare options and a newfound spirit of optimism.
After completing my dissertation on the topic of tribal casino community impacts, I moved to Washington, D.C. to work as a writer and tribal gaming staff person for the National Gambling Impact Study Commission (NGISC), a federal study of gambling policy that included a focus on responsible gaming. This job on Capitol Hill was a lesson in gambling politics and I was dismayed that casinos were being portrayed as “bringing addiction” to American (tribal and non-tribal) communities. At that time, I was fortunate to meet Frank Fahrenkopf and Judy Patterson from the American Gaming Association and Chris Reilly from the International Center for Responsible Gaming (then the National Center) and I was thrilled that their vision was to truly understand gambling disorder by funding scientific research into gaming’s impacts on individuals and basing the proper role for the gambling industry, if any, on the research findings.
Over the past 30 years, the most rewarding aspect of my career has been witnessing and participating in the development of this entirely new academic field that was originally created to understand behavioral addiction and gambling disorder but has led to discoveries that reveal Addiction as a Syndrome, among other incredible findings. I am also grateful to have the role of Endowed Chair and Professor for the Sycuan Institute on Tribal Gaming at San Diego State University so I have the opportunity to incorporate this outstanding body of scientific work into a gaming curriculum that benefits the next generation of tribal gaming professionals, community members, SDSU students and families.
As part of the Tribal Gaming Major at SDSU, I teach a General Education (GE) class called, “Cross-Cultural Interpretations of Gambling Addiction.” As a GE class, it is open to any student on campus and I have over 180 students from 45 or more majors every semester. I cover many topics over the 15-week semester but students consistently report that the most important and impactful are the Addiction Syndrome model and the relationship between this syndrome and the high comorbidity for gambling disorder.
In 2004, Harvard researcher Dr. Howard Shaffer and his colleagues described a syndrome model for classifying addiction. A syndrome is most simply defined as, “a cluster of symptoms and signs related to an abnormal underlying condition.” Until this description emerged, most addicts (often guided by clinicians and their own experience) assumed that a substance or behavior was responsible for causing their pain. An individual’s disorder would be linked to the use of alcohol, drugs, sugar, gambling, shopping or some other expression of addiction rather than the abnormal underlying condition of the Addiction Syndrome itself. In other words, addiction was assumed to have an external “cause” and separating the addict from that substance or place would be a part of the cure (In fact, this “old” view of addiction still underlies many legal prohibitions or limitations on access to certain substances or activities like alcohol or gambling).
Dr. Shaffer’s work demonstrated that it is critical that clinicians and sufferers alike begin to address the underlying Addiction Syndrome—as doctors did with AIDS, another syndrome—rather than continue to treat only the so-called “presenting problems” of drinking or gambling or drug abuse in isolation. Professionals came to understand that peoples’ behavior or substance use was merely a symptom of this underlying syndrome, it was not the core problem. While many clinicians continue to “divide up” people suffering from addiction into categories based on its expression (i.e. gambling disorder, alcoholism, drug addiction) there is a movement in the direction of noticing that people who suffer from one expression of addiction often “hop” to another one—or suffer more from more than one thing at a time. Over time, experts hope that incorporating the Addiction Syndrome model into clinical training can break down the barriers between clinicians who specialize in certain expressions of addiction (i.e. a substance abuse counselor or a problem gambling expert) while also allowing those who suffer from the addiction syndrome to relate to each other “across” substances and behaviors rather than focus on what feels like the specific “call” of the drug, drink or bet.
The Addiction Syndrome—the abnormal underlying condition that can now be described and treated—also explains the high comorbidity (or co-occurrence) for gambling disorder. Very few people suffer “only” from a gambling problem. Large national samples reveal that 75 percent of people with a gambling disorder have a co-occurring problem and 90 percent of the people in that pool of people had the other problem first. So, understanding and treating gambling disorder in isolation doesn’t heal the whole person or address the Addiction Syndrome since it is only a small part of the suffering person’s underlying condition. This important body of work highlights the risk for an individual who is recovering from one addiction expression (perhaps seeking treatment for alcoholism) developing a “new” gambling disorder to replace their use of drinking as a coping strategy.
In other words, if the underlying syndrome is not addressed directly, then a person with Addiction Syndrome may substitute gambling for drinking/eating/shopping and continue to suffer. Students and others have described this phenomenon as a form of “whack-a-mole.” As the academic research continues to evolve, it is imperative that we incorporate new science like the Addiction Syndrome and co-morbidity fully and rapidly into clinical training, industry practices and community outreach to support as many individuals and families as possible, as quickly as possible.
One way I stay apprised of the new science of addiction is in my role as a board member of ICRG. I consistently support and highlight the organization’s dynamic body of research to ensure that the findings can be properly translated into industry practices. It is so difficult to create an entirely new field of study, to recruit talented scientists and researchers into the field (money helps!) and then publish the research in ways that facilitate its usefulness and applicability among multiple stakeholders. One of the things I am most proud of with the ICRG structure is how the research process and findings are shielded from influence by funding entities through both a firewall and a scientific advisory board vetting process. A focus on actionable findings is also important to me since I want to be sure that what we know becomes what we do. Like the tribal communities with whom I work and study, I am grateful that the ICRG and the gambling industry at large is interested in both return on investment but also return on community. I encourage industry newcomers and old-timers alike to stay up-to-date on the latest research so we can all continue to be proud of being part of this industry that brings social, economic and community benefits—and a sense of optimism—to so many.
