Gaming Education Month CoverageIn June 2020, just as Nevada’s casinos were beginning the process of reopening following nearly three months of closures due to the pandemic, I published an article in GGB. It was an attempt to caution industry at large not to forget its commitment to responsible gambling (RG) principles, and to ensure that the great desire and need to have patrons back on the casino floor would not overwhelm the commitment to the practices designed to keep individuals at a healthy level of gambling and facilitate connections to resources for those who were unable to do so. How have we done since then? As it turns out, perhaps not so well. But first, a little personal context may be helpful so that one may better understand the biases that impact my writing.
In 1991 I moved from Lubbock, Texas to Las Vegas, fresh out of graduate school and ready to begin a career in my chosen profession—archaeology. For quite some time, the joke in my family had been, “Ted, if the archaeology doesn’t work out for you, you have your music to fall back on!” Somehow, I proved the naysayers wrong, and I found myself gainfully employed by the Desert Research Institute (DRI) as a research scientist supervising archaeological investigations at a place then called the Nevada Test Site, where the United States conducted hundreds of nuclear weapons tests between 1951 and 1992.
In the late 1990s, I took on an expanded role at DRI that included managing a fascinating long-term citizen-science program that has a mission of providing the public with a hands-on role in the monitoring of the off-site environment for radioactivity associated with past nuclear testing, a position I held for over two decades until finally passing on the reins to my successor earlier this year.
In the meantime, my music opportunities flourished as well. As a cellist I became a founding member of the Las Vegas Philharmonic, getting the chance to play world-class classical music in the world-class venue that is the Smith Center for the Performing Arts. That association led, in turn, to the opportunity to perform with many of the artists who are constantly engaged by the Las Vegas community to entertain the millions of tourists (and locals) who are vital to our state’s economic health. Over the years, they have included Andrea Bocelli, Plácido Domingo, Vanessa Williams, Stevie Wonder, George Benson, the progressive rock group YES, and just this past year, the Eagles.
I was living the dream!
But lurking in my background was a simmering cocktail that threatened to derail that dream. The ingredients included some significant early childhood trauma, a family history of addictive disorders that went back at least three generations, early exposure to and participation in numerous types of gambling activities as a child (mostly taught to me by my father), and some later life trauma caused by the onset of a voice disorder that led, for a time, to my inability to both lecture and sing, and also to the loss of an important relationship. Throw in an over-inflated sense of my own skill at poker because of frequent wins in a regular “friendly” high-stakes game I played in during my college years, and I was a poster child for the development of a gambling disorder, particularly given the near-constant exposure to gambling opportunities that presented themselves once I moved to Las Vegas.
While the details of my personal descent into gambling madness are too lengthy to discuss here, suffice it to say that over a 10-to-12-year period I gradually developed an inability to consistently set limits of time and/or money around my gambling. What once had been a recreational and disciplined pastime slowly became a means to intentionally isolate myself from others in my life to avoid having to explain what was wrong with my voice, an escape from difficult or challenging situations in my personal and work lives, and ultimately, what I perceived as my only means to recover a substantial and growing amount of gambling-related debt that was hidden from my wife. I became someone who had the capacity to destroy himself and his family, impact multiple jobs and, for a moment in time, the potential to cause harm to this country’s national security. Fortunately, that potential was not realized, but the amount of damage that a single person can do in the grips of this insidious illness is difficult to fathom unless you have experienced it directly. When one is desperate enough to hide one’s activities from family, friends and coworkers, coercion, blackmail and bribery by others who may find out about those activities become potential threats. Financial devastation is not unusual, and suicidal ideation, attempts and deaths by suicide are not uncommon.
After placing what would be my final bet on September 14, 2007, I found my way to both professional treatment (which is free in Nevada to its residents who are otherwise unable to pay for it) and aftercare maintenance through regular participation in a 12-Step program. Participating in these programs gave me the tools to quite literally save my life, and many of my relationships. From early on in my recovery I began to embrace volunteerism in helping to build public awareness of problem gambling as a public health issue. This eventually led to what has been an 8-year role as a part-time consultant to the Nevada Council on Problem Gambling, helping to develop and administer its local community and school-based problem gambling awareness programs, participating in media interviews to illuminate its impact in people’s lives, and helping to train trainers and employees of many Nevada properties to understand the difference between healthy recreational gambling activities and high-risk or problematic gambling and how to connect to resources for help.
During that time, I also leveraged some internal funds at DRI to research attitudes and the impact of gambling and problem gambling in 11 Nevada tribal communities. In 2012 I was appointed to the Nevada Advisory Committee on Problem Gambling by Governor Kenny Guinn and have been honored to be re-appointed to that body by three subsequent governors representing both parties. Twice I traveled to Japan (once at the invitation of MGM Resorts International and once on behalf of the U.S.-Japan Business Council) to discuss the development of problem gambling education and services with Japanese legislators, treatment providers, and businesspeople prior to the advent of integrated resort-casinos in Japan. I was elected to the Board of Directors of the National Council on Problem Gambling in 2021 and continue to serve in that capacity today. So, as you can see, I am somewhat passionate about this topic, and my engagement with it has a happy ending (or at least a happy middle…hopefully, the ending won’t be written for a little while yet!).
I have often wondered in recent years, however, whether brief interventions and/or access to better RG tools might not have prevented or arrested the progression of my gambling problem before it began to impact many areas of my life, or at least resulted in much earlier treatment-seeking on my part. Might I still be an engaged customer today? While Nevada can be proud that it was the first state in the country to have any regulations related to responsible gambling and problem gambling, those regulations have long since fallen behind nearly every other state that has legalized gambling in terms of access to and requirements for various player protections.
While there are significant exceptions, I’ve found it to be generally true that, unless regulators require RG tools and measures, they are unlikely to be adopted voluntarily by operators. Earlier this month, Dr. Kahlil Philander published an interesting article proposing increased involvement of regulators that includes incentivizing the creation of strong RG programs as a potential solution to what would seem to be otherwise lukewarm engagement by industry. Some preliminary findings from across the pond suggesting that strong RG programs, including easy access to one’s own gambling history and personalized messaging to players when self-imposed limits are reached or certain indicators of potential harm are measured, may actually lead to longer-term player loyalty and value, with a commensurate decrease in gambling harms and associated self-exclusions. That seems like it should be enough incentive.
But what about simply doing the right thing? It seems that the onus of the “R” in “RG” has for entirely too long been focused on the patron, and not on the shared responsibility with industry and government to address problem gambling and its prevention through RG as a serious public health issue, to say nothing of the need for public funding for education, public awareness and research into these and related issues. There are historical reasons for this emphasis that have been discussed elsewhere. But it is unrealistic and unreasonable to expect a player to hear or read the phrase “gamble responsibly” and have any idea what that means, especially given that most RG programs and tools require the patron to make a choice to engage with brochures, kiosk displays or app sections with very little incentive for doing so.
In most states, early discussion of substance use, smoking and alcohol consumption begins to occur in elementary school and continues throughout a student’s secondary education. At least there is some context already present for knowing generally what it means when one hears the phrase “drink responsibly.” We need to explore ways to market the presence of and incentivize the use of RG tools so that they are as prominently featured as any other promotion within the gambling environment, and embraced with pride by the corporate culture that proffers them (race to the top, anyone?).
A seemingly perfect storm of events has occurred over the past five years to the great concern of many of us working in the problem gambling space. These included the repeal of PASPA in spring of 2018, the advent of the pandemic about 20 months later, the resultant shrinking of state coffers due to stay-at-home orders for non-essential work personnel, which likely accelerated the legalization of sports betting across the country to address state funding shortfalls (with most states ignoring guidance suggested by the National Council on Problem Gambling to allocate at least 1 percent of revenue from new gambling streams toward addressing problem gambling awareness, education, treatment and research), and a glut of advertising across state and national markets by emergent sportsbooks and fantasy sports companies with massive spending focused on player acquisition and capture of market share (and perhaps regulators).
Now entire television programs immediately prior to sporting events are devoted to discussing the various odds of game outcomes and in-game events, and these discussions often carry over into the games themselves, which are being watched by families, including children. Most parents are ill-equipped with the knowledge to have a discussion with their kids about why the gambling opportunities being advertised are for adults only. In my household these discussions would have initiated a “friendly” bet between my father and me. Overlaying all these factors against the backdrop of severe emotional distress, loss, disconnection from family, friends, schools and services that all of us experienced to some degree or another during and following the pandemic, and the resulting trauma many experienced as a result, provides a recipe for disaster.
Industry webinars I took part in during the shutdown provided lots of mention of RG, though no one seemed long on specifics about how it was being elevated, if at all. Most of the focus seemed to be on how to stay in touch with patrons during the shutdown to maintain player loyalty. One that I attended encouraged operators to involve their customers through online social casinos to maintain their connection to the brand, so that when the time came for reopening, it would be easier to “drive patrons back to casinos.” I actually heard that phrase used more than once.
Once the casinos reopened in June of 2020, it was less than a year before we began to see month-over-month record gambling revenues in the state of Nevada. This was a trend by no means confined to Nevada, though the numbers here were particularly mind-boggling. Nevada saw record gambling revenue long before the return of visitation to the state. 2022 saw 4,000,000 fewer visitors to Nevada than pre-pandemic visitation levels in 2019 and yet Nevada’s own citizens and those who did visit more than made up for their absence by leaving behind a staggering $2.4 billion dollars in gambling revenue above the high-water mark seen in 2019. 2023 is on track to eclipse that record and may also experience record visitation.
I heard the term “pent-up demand” continuing to be used to explain the record increase in gambling revenue more than two years following reopening. I find this explanation highly implausible and believe that what we were seeing and are continuing to see are more likely to be the residual effects of the pandemic on mental health. Specifically, the progressive deterioration of those who, for the first time during the pandemic, began to use gambling in unhealthy ways to relieve the stress and pain of that experience. Problem gambling is known to have significant co-occurrence with substance use, alcohol use and nicotine use disorders, though the effects of gambling disorder are much more easily hidden and tend to lag indicators that become more quickly evident with other addictive disorders, sometimes by many years. Since the onset of the pandemic, there have been record overdose deaths year-over-year, both in Nevada and nationally, and while fentanyl is implicated as a major contributing factor in most of the deaths, this does not explain the continued rise in generally affected individuals. Using substance use disorders as a proxy for what is likely happening with a newly affected population of individuals experiencing gambling harm does not paint a rosy picture, contrary to the positive outlook with which most view the increase in gambling revenues and the resultant overflowing state coffers (there was a surplus of $251 million dollars in the recently concluded Nevada state legislative session).
Many of us in the problem gambling treatment and recovery communities have viewed the pandemic as a major earthquake, with the tsunami on its way. While treatment-seeking was generally down during the heart of the pandemic, during the most recent session of the Nevada Advisory Committee on Problem Gambling, we learned that the Robert L. Hunter International Problem Gambling Center in Las Vegas is currently seeing all-time record enrollment, which is particularly sobering for an illness that generally has very low treatment-seeking. Unfortunately, we do not have the RG tools in place in Nevada (nor in most other states) to identify, reach out to and otherwise proactively engage those who may be transitioning into or are in the midst of a gambling disorder. Where’s the responsibility in that?
I don’t want to end on a negative note without offering any potential solutions, so here are a few ideas.
It’s time to stop “elevating the conversation around RG” and begin elevating and implementing the actual RG tools themselves. They already exist in more mature forms across the pond, and even in the digital products that many properties in the US are already using…they just need to be turned on. In the absence of regulations requiring it, I know it is a tall order, and perhaps I am being naïve to think it could happen. There are many simple behavioral tools that can be used to engage patrons which are evidence-based. Dr. Sally Gainsbury discussed many of them in an article earlier this month. Simple measures like the delivery of a report of monthly spending behavior conveyed in graphic formats and personalized messaging can be effective drivers of changes in behavioral decision-making. Breaks in play can also short-circuit continued mindless gambling and are to be encouraged. It was distressing to learn of an ongoing test in Nevada of the use of AI to use player play history to predict when an individual is about to quit and supply them with bonuses designed to get them to return to play as soon as possible after cashing out. Can we instead please use AI to identify which players may be particularly vulnerable to such an approach first so that they are not drawn into a cycle from which it is increasingly difficult to extricate themselves? Ironically, much of what I’ve mentioned above can be implemented using the same data that casinos have already been collecting on individual players for decades through their membership and rewards cards and using to market to those players. Speaking of marketing…
In 1974, Congress passed the National Research Act to address ethical considerations related to past human subjects research, and to form a commission to develop guidelines for the conduct of future research involving human subjects. This legislation was largely in response to serious ethical transgressions that had occurred in past academic and government research of human subjects (e.g., the Tuskegee Syphilis Study, the Stanford Prison Experiment). The resulting document, known as the Belmont Report, set the standards for the conduct of future human subjects research. In a nutshell, it required that research involving human subjects be rigorously reviewed to identify and mitigate to the greatest extent possible any potential harms that might occur to the human subjects through their participation in such a study.
The likelihood of beneficial outcomes relative to incurred risks are to be weighed. Additionally, there is a recognition that certain populations (e.g., children, prisoners, minorities) were particularly vulnerable and in some cases unable to give personal consent to participate in such studies for various reasons and should be conveyed with a special status when their participation in such studies is under consideration. Finally, an Institutional Review Board (IRB) independent of the research team reviews proposed research studies to ensure that they comply with applicable regulations, meet commonly accepted ethical standards, follow institutional policies and adequately protect research participants.
Might I suggest that an IRB process for marketing and advertising is an idea whose time has come? Might such a body have identified potential issues with sportsbooks entering into agreements with colleges and indirectly marketing to a population mostly not of legal age and in the most problematic demographic for this activity? Congress is certainly becoming more interested in being involved because of recent transgressions in both the collegiate and professional sports worlds. There are many arguments for breaking down the various silos in industry, and forging a closer relationship between marketing and RG is a no-brainer.
Finally, the industry can show that it’s serious about RG by creating at least Director-level and preferably VP-level positions of Responsible Gambling within their organizations, so that these responsibilities are not simply one area among a dozen other compliance-related duties assigned to a single individual. Having someone whose primary job is overseeing the administration, data-tracking, evaluation and improvement of the RG program is much more likely to drive significant positive cultural change within the organization.
We must endeavor to do better and implement positive change in the RG space and in the corporate culture in which it lives, not only for patrons but also for team members, who often suffer from problem gambling at higher rates than the general population, and who are often much more reticent to engage in treatment-seeking for fear of retaliation from their employers. It behooves all of us to engage in more collaborative processes to enhance existing RG programs and share best practices with our colleagues. The time to do so is now.
To learn more about responsible gambling training opportunities and resources to address problem gambling in Nevada, please visit the Nevada Council on Problem Gambling. For immediate free and confidential assistance anywhere in the United States, please call the 24-hour Problem Gambling HelpLine at 1-800-GAMBLER.
