Before the state's first slot machine is plugged in or the first dollar is spent under Pennsylvania's gambling laws, state leaders have admitted that gambling will harm some citizens and their families.
The legislature's acknowledgement appears 112 pages into the July 2004 gambling law: The measure sets aside $1.5 million of slots profits each year to fund education and treatment for the state's problem gamblers. The law calls for a gambling-problem hotline, studies to identify at-risk segments of the population, and public-education efforts. It puts the state Department of Health in charge of setting up single-county authorities for local treatment efforts.
There's just one problem.
"There is a concern," says Richard McGarvey, spokesman for the state health department, "that when the first casino opens its doors, we won't be ready to deal with this."
Dr. Bruce Dixon, director of the Allegheny County Health Department, says the city's Department of Human Services has traditionally dealt with behavioral health issues, and handles compulsive gamblers as well. But regardless of which agency gets the nod, Dixon says, "There's potentially a major problem here, because the people who become deeply involved in this are the people who don't have a lot of money. A lot of people are going to be looking to strike it rich, and that could really cost them."
As early as this fall, the state will begin issuing licenses for 14 new slots parlors. The parlors will be divided among seven racetracks and two resorts, as well as five stand-alone casinos: one in Pittsburgh, two in Philadelphia, and two in other parts of the state. The legislature has approved 61,000 slots machines in total -- the second-largest roster of slots in one state after Nevada, according to Keith Whyte of the National Council on Problem Gambling, which advocates for gambling-treatment services.
Even before stand-alone casinos can be built, most companies vying to build Pittsburgh's parlor say they will operate temporary sites beginning next year. According to impact studies submitted by all three applicants, the casinos could see eight million to 10 million gamblers every year. Whyte says that based on the number of machines, the state's population and rates of gambling addiction, Pennsylvania could find itself treating between 36,000 and 48,000 Pennsylvanians for gambling problems.
Those problems, says the National Council's Web site, can start long before you lose the family farm. They can include a gambling "preoccupation," increasing bets or a decreasing ability to stop. "In extreme cases, problem gambling can result in financial ruin, legal problems, loss of career and family, or even suicide," the site concludes.
Unfortunately, the law doesn't precisely define the state's responsibility to problem gamblers. There may not be adequate funding, or an adequate number of trained professionals, to care for problem gamblers or their families.
McGarvey, of the state health department, says his agency is preparing a Web site and hotline and is still working on other requirements of the law.
State Rep. Paul Clymer (R-Bucks), one of the state's most outspoken gambling critics, says there is no way the state will be ready for the influx of problem gamblers -- and that $1.5 million is inadequate anyway. "We can't underestimate the resources we need to treat problem gambling," Clymer says. "This isn't a sickness you can cure with a 72-hour program."
Larry Ashley, an addiction specialist with the Department of Addiction at the University of Nevada-Las Vegas, agrees. Nevada, whose population of 2.4 million is roughly one-fifth that of Pennsylvania, allocates about $2.5 million every year to treat gambling addiction among its residents. Ashley says that spending on prevention and education eats into that money, leaving less-than-ideal amounts for treatment. Pennsylvania's earmarked $1.5 million, he believes, will barely cover the demand in Philadelphia alone.
By comparison, Oregon, which has about 16,000 slot machines and 3.6 million people, spends $5 million every year on problem gambling. About $2.8 million of that is on treatment alone for about 2,000 problem gamblers, according to Jeff Marotta, who manages problem-gambling services for the state.
Saturating the population with information about problem gambling is the only way to make such a program successful, says Marotta. "To do it for $1.5 million," Marotta adds, "they would have to develop some pretty efficient programs. It may seem adequate the first year, because you treat very few people in the beginning until word gets out. Once that happens, however, you'll find it's going to take increasing amounts of money."
In Oregon, slightly more than one-half of 1 percent of the state's residents receives treatment for problem gambling. If Pennsylvania had similar rates of addition, some 6,200 of its 12.4 million residents would end up seeking treatment. That could prove costly.
Ken Ramsey, president and CEO of Gateway Rehabilitation, which runs addiction-treatment clinics throughout the region, says it's tough to put a price on treatment. Current addiction treatments cost between $5,000 and $10,000 per person; at treatment centers that require a fixed-length stay, that amount can jump as high as $15,000 to $33,000 a month. Ramsey anticipates his facility will add treatment for gambling addiction in the future.
According to Whyte, there is only one such treatment program in the state, the private Keystone Center in Philadelphia.
Minnesota has been running gambling-treatment and education programs since 1991. According to Kathleen Porter of the Compulsive/Problem Gambling Services Program of the Minnesota Department of Human Services, in 2004, Minnesota treated 1,000 residents for gambling addiction as outpatients at a cost of nearly $600,000. Another 188 residents were treated as inpatients, a cost of $641,000.
"Of course, the money will only take you so far," says Porter. "You've got to have people qualified to deal with the problem."
Ashley, the Nevada addiction specialist, says there has been a long-standing problem nationwide in finding counselors to treat gambling addicts. While there are similarities in treating all addictions, gambling brings its own baggage. Sometimes the addiction stems from mental-health issues, such as depression and bipolar disorder. But the biggest difference is the need for specialized treatments, such as credit counseling and debt resolution.
"If you're a drug addict or alcoholic, you can live without those substances," Ashley says. "But you have to have money. You can't take that out of a person's life, so the temptation is always going to be there."
Ashley is developing a program for UNLV to train gambling-addiction counselors, while Oregon's Marotta says that state has spent years developing a network of its own local counselors. "There's an additional cost for that as well," he notes.
McGarvey, of Pennsylvania's health department, says the state is working toward getting an education program in place to help train counselors. "Before that first arm on that first slot machine is pulled, our goal is to have the hotline up and ready with addiction counselors standing by," he assures.
But Whyte has doubts that the state can handle its own gambling problem. "They don't have the experience to deal with this problem like we or other groups do," he says. "Why should we trust them now just because there is some money to deal with the problem?"