NCRG Conference Attracts Record Number of Attendees

A record number of attendees representing a broad range of sectors involved in gambling issues, including government regulators, elected officials, scientific researchers, clinicians, and gaming operators and manufacturers, gathered for the fifth annual NCRG Conference on Gambling and Addiction. More than 400 people participated in the conference, held Dec. 5-7 at the MGM Grand Conference Center in Las Vegas.

"Gambling and Addiction: Common Causes, Managing Consequences" showcased leaders in the field in a series of 17 sessions on topics as diverse as studying brain imaging and genetics to determine addictive tendencies, the impact of living in the age of terrorism on addictive behaviors, regulating gaming in a global economy, and the history of luck in America. Following are summaries of three key sessions.

"ADDICTION AS SYNDROME:  A NEW MODEL FOR UNDERSTANDING EXCESSIVE BEHAVIORS"

Howard Shaffer, Ph.D., director of the Division on Addictions and associate professor of psychology in the department of psychiatry at Harvard Medical School, framed the context for the entire conference with a presentation on his recent research. The study (Shaffer, H.J., LaPlante, D.A., LaBrie, R.A., Kidman, R.C., Donato, A., & Stanton, M.V. (2004). Toward a syndrome model of addiction: Multiple manifestations, common etiology. Harvard Review of Psychiatry, 12(6), 367-374) points to a growing body of empirical evidence for an underlying addiction syndrome.

Up to this point, addictions to drugs, alcohol, gambling and other substances have been treated as separate and distinct disorders. According to the research, this current view of separate addictions might be similar to the view espoused during the early days of AIDS diagnosis, when rare diseases were not yet recognized as opportunistic infections associated with an underlying immune deficiency syndrome.

In their review, the Harvard researchers cited multiple studies showing shared neurobiological causes, shared psychosocial causes and shared experiences across different addictions that point to the validity of the syndrome model. The research also indicates that addiction to any particular object is due in large part to exposure, access, and the capacity to produce a predictable and sought after shift in the mental state.

Looking at addiction as a syndrome has many important implications for treatment. About 80 percent to 90 percent of individuals entering recovery from addiction will relapse during the first year after treatment. This circumstance might be due in part to the current standard use of focused, object-specific treatment approaches. By shifting to a syndrome approach, the most effective addiction treatments might include both object-specific and addiction-general treatments. The syndrome model further encourages clinicians to recognize that patients develop new risk factors during treatment that can interfere with recovery efforts, requiring clinicians to develop multidimensional treatment plans that account for the many relationships among the multiple influences and consequences of addiction.

Shaffer ended the session on an especially promising note, pointing out that since effective non-object-specific pharmacological and psychological treatments for addiction already exist, perhaps our existing treatments are actually more advanced than our addiction philosophy. Thus, the necessary tools for improving addiction treatment might already be available — all that is required is a rethinking of addiction.

"COGNITIVE BEHAVIORAL THERAPY FOR GAMBLING DISORDERS"

Robert Ladouceur, Ph.D., professor of psychology at Laval University, shared recent research results indicating how cognitive therapy may be a promising treatment strategy for disordered gambling. Cognitive therapy focuses on what people tell themselves, which in turn influences behavior, Ladouceur said. Thus, in order to modify behavior, patients must revise their own thought processes.

Ladouceur explored what it means for gambling to be a game of chance versus a game of skill. The key distinction between the two, he said, is that in a game of skill, practice and continued play lead to better performance, whereas with a game of chance, performance never improves regardless of practice. The key for clinicians is to determine in their problem gaming patients to what extent they perceive gambling as a game of skill and to address these erroneous perceptions.

Ladouceur pointed out that while gambling, problem gamblers forget that the outcome of the game is random. Instead, they feel as if they have control and the ability to affect the outcome of the game. The difference in the cognitive behavior between healthy gamblers and problem gamblers is that while they play, non-problem gamblers use their experience to realize that the events are indeed independent. For problem gamblers, experience - even negative experience - simply reinforces their belief that they can control the game. 

Cognitive therapy focuses on changing this thought process by helping the problem gambler come to grips with the realities of the game. Specifically, the therapy focuses on having the gambler learn that gambling is indeed a game of chance rather than skill, and thus no gambler can control the game or the outcome.

"The key to change is for the problem gambler to realize that gambling is a choice," Ladouceur said, "that he can make an informed choice and has individual responsibility to change his perceptions."

Recent clinical trials have shown great success with cognitive therapy efforts in treating problem gamblers. Yet, while positive results are being seen in several studies, Ladouceur said more research is needed before cognitive therapy can be formally classified as an effective treatment for pathological gambling. 

"HEALTH RISKS FOR CASINO EMPLOYEES"

In discussing whether the casino environment places employees at a higher risk for developing mental and physical health problems, Harvard Medical School's Richard LaBrie, Ph.D., provided the scientific framework for the issue by presenting the results of a three-year, longitudinal study of smoking, drinking and gambling among more than 6,000 casino employees. The study found evidence that among these employees, 28 percent showed some level of problems with gambling, 18 percent showed some level of problems with alcohol, and 38 percent showed some issues with both gambling and alcohol.

Of the employees with identified problems, over the course of the study, a total of 7 percent experienced a worsening of their situation, but 16 percent experienced no change and, more importantly, 16 percent improved their situation. According to LaBrie, these findings indicate that in areas of prolonged exposure, individuals actually adapt to their environment, with the novelty of the exposure wearing off and employees readjusting to normal behavior, which leads to improved situations and lower rates of disordered gambling.

Following LaBrie's presentation, Robert Boswell, senior vice president of Pioneer Behavioral Health, addressed the issue of employee health risks from the treatment perspective. He particularly commended gaming companies for their pro-active, positive approach to Employee Assistance Programs (EAP) and their ability to reach those in need.

"The industry's involvement in highlighting the availability of EAP has reduced the stigmas attached to seeking treatment, leading to more employees participating voluntarily," Boswell said. "The success of EAP programs in the gambling industry is due to direct, senior-level involvement and support. I have not seen this type of support from any other industry."

Arte Nathan, senior vice president and chief human resources officer at Wynn Las Vegas, noted in the discussion that he is a recovering drug addict and that his company makes a particular effort to use real people with real stories as examples for all their employee improvement programs. Nathan works to create an open atmosphere for addressing problems, and thus encourages employees to come forward and seek help. Nathan believes that by showing full support not just at the outset of treatment, but throughout the entire process, employees will succeed. 

Nathan concluded the session by challenging other industries to step up their efforts to improve their employees' lives, indicating employers can make a positive difference by becoming involved at the senior level.

To read more about these and other sessions, visit the NCRG conference Web log. Watch for updates and announcements on the NCRG Web site.