With the Nevada legislature recently sending a bill to the governor that would for the first time allocate state funds for problem gambling programs in that state, and several other states passing similar legislation to establish state-funded treatment programs (see story on next page), the issue of how individual states manage problem gambling is at the forefront of discourse in the public health community.
Upon examination, existing state treatment and education programs and funding structures are as varied as the jurisdictions where they operate. Several states send government funds to independent non-profit groups to manage the state's treatment and prevention efforts, while others turn to their own state health departments - also known as single state authorities (SSAs) - to address the issue within their existing alcohol and drug care systems. With so many diverse approaches, and many SSAs inexperienced in dealing with gambling issues, the need for coordination and best practices has emerged.
Recognizing this need, the Center for Substance Abuse Treatment (CSAT) at the Substance Abuse and Mental Health Services Administration (SAMHSA), a division of the U.S. Department of Health and Human Services, last year gathered representatives from Indiana, Louisiana, Maine, Michigan, Nebraska, Nevada, New York and Wisconsin to discuss lessons learned from establishing problem gambling treatment programs at the state level and to develop recommendations for other states. The meeting resulted in development of a white paper that serves as a blueprint for coordinating future state efforts, defining needed research and proven best practices, and developing strategies for assisting problem gamblers.
According to the paper, "Providing Services to Problem and Pathological Gamblers Through the Single State Authority (SSAs): White Paper on Issues for States," many SSA representatives are concerned their program staffs are not appropriately trained to treat gambling addictions and that their systems are already overwhelmed by the demand for treatment of other addictions. Additionally, meeting participants expressed concerns that providing problem gambling treatment may displace those with substance use disorders and that reimbursement streams for problem gambling treatment are not well established.
To address these and other issues, the SSA representatives agreed on five core principles of best practices for the field:
1. Assume a neutral stance. Gaming is a legal activity, and providing help for problem gambling is a public health issue, not a moral issue.
2. Recognize the state's moral responsibility. Gaming provides a strong revenue stream, so if states benefit from the funding, it is only just that some portion of the funds be used to assist those with problems.
3. Work with the gaming industry. It has been the states' experience that the industry has been cooperative and supportive in treatment efforts, so it should be considered a partner in state efforts.
4. Learn from other states. In starting or expanding an initiative, reach out to find out what other states already know or have developed.
5. Be flexible in planning. Be aware that the provision of services for problem gambling is a new and evolving field.
The group further laid out several other detailed recommendations on a variety of topics, including placing gambling services within a state system, directing funding for treatment and education, certification and accreditation of programs and counselors, necessary clinical skills for counselors, public awareness and screening, as well as presenting the case for gambling services to state legislatures.
H. Westley Clark, M.D., J.D., M.P.H., director of CSAT, said finding adequate funding to support problem gambling services is a serious issue. Although at least 30 states provide funds for the efforts, overall support is still quite low.
He indicated he would like to see the state health authorities become more proactive and more assertive in seeking funding, for without a sustained effort, treatment programs will not be effective.
Participant Reece Middleton, executive director of the Louisiana Association on Compulsive Gambling, agreed with the need for continued state funding, but said federal action also is necessary.
"We need to be serious about federal funding for a national initiative in which treatment must be a part," Middleton said. "Problem gambling has become a national health issue, and it's time for the federal government to provide funding to states to address it appropriately."
In addition to recommendations for states, the meeting participants discussed guidelines for how CSAT and SAMHSA can assist states, including raising awareness of the scope of the issue and the importance of adequate funding at the highest levels of state government, engaging other federal agencies on the issue, assisting states in cooperation activities, developing products to codify best practices for treatment and encouraging research opportunities.
For Clark, a significant outcome of the meeting was that it established pathological gambling as an issue of concern to the substance abuse community. He also was encouraged by the support of the gaming industry through funding and support of treatment efforts and would like to see this continue.
"As the industry grows," Clark said, "we need to make sure safeguards are in place ahead of time. The public-private partnership is important to creating this safety net."