Oregon Develops "Public Health" Approach to Problem Gambling

Within the problem gambling research community, a consensus is growing that, rather than look at problem gambling as an individual pathology, the future of the field should be focused on developing a public health approach to the disorder. In Oregon, a state where legalized forms of gambling include the lottery, charitable gaming and pari-mutuel wagering, state officials have developed a program that will determine whether this recommendation works in the real world – and the results so far have been a resounding "yes."

In the first seven months since the implementation of Oregon's new Problem Gambling Services program, 40 percent more Oregonians have successfully entered problem gambling treatment programs than in the same time period before the new program's debut.

Oregon's Problem Gambling Services program was implemented July 1, 2001. Developed and directed by Jeffrey Marotta under the auspices of the Oregon Office of Mental Health and Addiction Services, the two-year, $6.3 million program is guided by the public health paradigm focusing on three distinct service areas – prevention, outreach and treatment.  Funding for the project comes from a percentage of the Oregon State Lottery's net proceeds. 
According to research, the public health approach takes into consideration biological, behavioral, economic, cultural and policy determinants influencing gambling and health.  It incorporates prevention, harm reduction and multiple levels of treatment by placing emphasis on quality of life issues for the gambler, families and communities.

Before implementation of the new program, Marotta said the primary focus of state problem gambling efforts was on targeting the most severe pathological gamblers.

"I knew we needed to take a broader approach to do what we could to prevent harm," Marotta said. "We need to reach out to those with a less severe problem – before they become pathological and suffer serious consequences."

The new program has revolutionized the way problem gambling treatment is delivered in Oregon. Marotta developed a complex system based on multiple levels of care that offers different types of treatment for different levels of problem gamblers. The Level I home-based treatment tools, for example, include self-change guides, telephone counseling through the state's problem gambling help line, Internet support groups and psycho-educational videos and CDs. Level II treatment focuses on outpatient, professionally delivered face-to-face interventions, and, for the most severe problem gamblers, Level III programs are administered through a network of inpatient care centers that provide on-site treatment and support.

Marotta attributed the program's success to three factors: 1) bringing the problem gambling issue down to the community level thereby heightening awareness of the issue; 2) increasing the number of treatment options and tailoring them to people's learning style and addiction severity; and 3) delivering different messages about problem gambling.

"We're saying that if gambling is interfering with the way you want to live your life, you're a problem gambler, and people are responding to that message," Marotta said. "We're de-stigmatizing it a little."

The real success of the program will be determined by strict and measured evaluation procedures. With their consent, people who receive treatment through the program will be followed for two years to track both gambling-related and quality of life changes. A full report on the project will be released after the trial phase ends in 2003. A one-year progress report should be released later this year.