While the vast majority of people enjoy gambling without falling into addiction, the prevalence rate for persons who veer into pathological gambling and potential life-ruining consequences is about 2.2 percent in the U.S., per 2014 findings by the National Council on Problem Gambling.
With an expansion of legal sports wagering in the U.S., a new cohort of citizens, however small, will get introduced to sports betting and struggle to find the line between entertainment and addiction.
To explore this issue and hopefully help at least a few people, or their family and friends, identify that line so they can find recovery, Sports Handle recently spoke to Daniel Lettenberger-Klein, MS, LMFT, Executive Director of the Stella Maris addiction recovery center in Cleveland, Ohio.
This discussion was lightly edited for clarity and brevity.
Addiction recovery expert on gambling addiction and recovery
Sports Handle (SH): As a subset of gambling addiction, if it’s fair to call it a subset, what experiences have you have treating sports betting addiction?
Daniel Lettenberger-Klein (DLK): Well, it’s not so much sports betting-focused, rather the act of risk-taking. Typically, what we’re seeing is high-risk spending. And so that can manifest in high-stakes poker. That can manifest in just spending a lot of time at off-track betting facilities, things like that. There’s not been one constant in terms of presentation from a gambling perspective, but there’s certainly been a plethora of different presentations for what’s commonly a comorbidity (note: comorbidity is defined as the simultaneous presence of two chronic diseases or conditions in a patient.)
SH: On that front, what’s the most common health issue or issues typically connected to problem gambling?
DLK: I would say alcohol use, because of the prevalence of alcohol in those settings. I think there’s a long-held belief that, in casinos especially, not that sports betting takes place primarily in a casino setting, but in those types of settings you’d most often see problem drinking. But also amphetamine use, cocaine use, things like that.
Because someone that’s somewhat addicted to the adrenaline, all about the risk-taking, tends to be that person who prefers the amphetamine side of things, rather than the opiate side, because those are the natural downers. You’d have a relaxing effect. That gambling piece doesn’t necessarily fit in with that relaxing mentality. It’s more the person who might like the adrenaline rush. The risk.
SH: Is there a brain chemistry or chemical change that occurs on when somebody is consumed by the addiction?
DLK: Absolutely. When we go through any “process” addiction, we experience a release of dopamine. And the way dopamine fires on the brain and impacts the brain, we need more. We need more, we want more. And so prolonged exposure to those triggers and the things that we’re doing to facilitate it. Problem behavior isn’t purely psychological, it becomes physiological. And while you will not go through a physical withdrawal because it’s not a substance you’re abusing, people build their whole lives around access to gambling and the other things that are process-focused that they may struggle with. It becomes an entire lifestyle, so the to un-weed and unwind somebody from a process addiction it takes comprehensive treatment.
SH: Based on your research and experience, what’s the number of people who engage in gambling, all those kinds you just referenced, and have or developed what you would classify as an addiction?
DLK: I don’t know that I could give you an accurate number that would reflect the general population. I would say it’s been a small subset, and there’s a number of reasons for that. One, we don’t have the same mores and taboos about gambling. There’s more legal implications in certain states. But there’s a different narrative about gambling than there is about using IV heroin. There’s a dramatically different slant on whether somebody needs help or not. In the gambling realm, you really only see people seek treatment when they encounter negative consequences.
SH: Is there anything unique in your mind about sports betting addiction versus, say, lotto ticket gambling, blackjack, slots?
SLK: There’s a cultural piece to it. I don’t think anybody’s getting together talking about the lottery. There is no communal aspect of lottery. But we are getting together and rooting for teams. We are getting together and rooting for people and outcomes. Outcomes are something that people gather around, and while there are some different types of sports betting that aren’t necessarily all communal, there is a communal aspect to sports gambling, and that’s where I see there being a potential issue.
It’s just like treating alcoholism, to some degree. One of the most challenging aspects is exposure. You walk down any street and at some point you’re going to pass a liquor store. At most restaurants and bars, at some point you’re going to pass a TV with sports on. How do you enjoy sports programming if you’ve had a problem betting experience, without thinking about gambling? The triggers are all around you. There’s just so much exposure that creates such a unique challenge for somebody who may have struggled with it.
SH: In your experience, is there such a thing as a recovering addict gambling occasionally, or is total cessation the only way to go?
DLK: I think that’s a great question, one that gets asked often. “It’s not like I’m using drugs,” the thinking may go. “It’s not like I’m drinking in excess. I’m just doing it socially. Or I could do it more socially, or I could do it only in certain settings, or one time a year for big events.”
The issue is that we don’t determine severity of events, and the impact of that on the brain. Anytime we’re re-exposing ourselves to the triggers that have led us down a predictable path, we re-expose and we reignite that. So I would say for somebody who is truly struggling with gambling addiction, abstinence is the only way.
And there may be some controversy around that, because some people think they just need more parameters. They need to give themselves a debit card that they can’t overdraw. But as soon as you start to handicap yourself through those behaviors, all you’re doing is putting a band-aid on the real issue. Everybody has strengths and weaknesses. One of the greatest strengths people have are understanding their weaknesses so that they don’t fall prey to them.
SH: Can you elaborate on trying to gamble in moderation?
DLK: Some people are just hard-wired to struggle with things that are habit for them. And so those are the people that, we have to understand, won’t necessarily be able to modulate behavior. Everyone says, “Well, if I could do it in moderation…” Well, that’s just not how it works. It’s not a moral failure for someone who struggles with addiction, it’s a willpower issue. We truly get addicted to the process, to the outcomes, even if we know we might lose, just the idea that you could potentially win is enough to drive people to continue to try.
It’s one of those things where the only true form of recovery is abstinence, if you want to not risk increases in severity, and relapse, really. If you’re doing it, one time is considered relapse. You cannot progress unless you know how to have a life without it that’s solvent, and that you can still enjoy. Because so many people who go into recovery, who are engaged in recovery, will complain especially in the first six months to a year, of being miserable. Because they don’t have that dopamine firing, they don’t have that adrenaline rush, so they think that being in recovery is not fun. And that’s because they haven’t done other alternative outlets.
SH: How does one overcome that, weather that initial storm?
DLK: A lot of people exercise to get that endorphin rush, a lot of people do outdoor activities, they do all sorts of things, but first you have to find your “what for.” And your what for is, “Why am I going to this? What am I doing this for? Why am I not going to do this? What about this is a reason for me to stay away? What’s a good enough reason to maintain working on this every day?”
Because, especially for gambling, you’re one click away at all times. So the reality is, especially in such a mobile world, that triggers are literally one click away. It’s not like having to go out and find heroin. Yes, you could send one text, but some dealers get arrested. Not everybody in the gambling world is getting arrested, because exposure is totally different.
Especially since it’s become more legal. That means that there’s going to be a change in narrative. Just like with alcohol after Prohibition, the narratives change, where it’s just part of what we do. People socialize, they have a drink. Same thing, people get together, they bet on games. And everybody is in on it. Some people have bookies, even though they know they shouldn’t, and some people don’t. It’s just one of those things.
SH: Speaking of prohibition, PASPA had stigmatized sports wagering for a long time. I anticipate what will happen now is that some people who might have been interested in but who hadn’t previously bet on sports offshore or with a local guy will dabble. What’s the propensity of a Regular Joe of that kind to potentially develop a problem? Who and how many?
DLK: I think it’s not necessarily going to be something like that. I wouldn’t say that that it would be the average person. Rather, probably the people that struggle with addictive behaviors are going to struggle with gambling. If they’re exposed to it in a way that can become obsessive.
So I would say that there’s no predictable format to determine who’s going to struggle with gambling, at this point. I think the occurrence of it will go up due to exposure and like you said, there’s not the legal consequences, so that always increases the chances. But if you look at decriminalizing drugs in other countries, you don’t see the addiction rates increase, like earlier exposure to alcohol in some cultures.
SH: How effective is it in intercepting a problem for someone to read state-mandated language on gambling platforms: “If you or someone you know has a gambling problem or wants to help, call 1-800-GAMBLER.”
DLK: I think that’s great. I really, really do. I think liquor stores should have that on the door. It’s one of those things where, well it’s not ever going to be a perfect deterrence, it’s an awareness piece, it’s a reminder,”Hey, let me think about that.” And anytime you provide people with a speed bump, you give them an opportunity. And it’s a speed bump. So there’s an extra opportunity. I think it’s the right type of advocacy. It’s definitely a temporary one, and one that’s not going to be effective all the time, but it’s an opportunity. And so it’s absolutely worthwhile.
And it’s not about the person having the problem reading that, but perhaps the person’s brother or best friend. From just a systemic place, I think about, If I’m logging in, and I’m back for my fantasy draft this year, and someone I’m close to has nine other fantasy drafts that day, significant deposits involved in all of those, I might be wondering about that person. I might be more likely to say something if I’m triggered to think about it. So there may not be a significant influence on the individual struggling with addiction, but it can, I believe, have a strong systemic impact.
SH: In some testimony in various state legislatures, witnesses have said that problem gambling preys on the poor. My observation is that it can impact people, and does impact people, of any economic class. Michael Jordan is certainly a big gambler and it’s long rumored to have played a role in his two-year hiatus from basketball into baseball… and longtime WFAN star Craig Carton, to name a couple. What’s your experience here?
DLK: I don’t think that gambling addiction discriminates. It stretches across all socioeconomic classes. I do think that there’s more devastating consequences for those with less resources, just because the ability to overcome as you go further down, the ability to recoup and recover probably decreases dramatically. So I would say there’s probably a difference in the ability to weather the storm, to some degree. But I would say the impact can be just as significant across all groups.
SH: Can you identify a couple resources, phone number or online, you suggest for someone or a family member who believes that someone has a problem?
DLK: Gamblers Anonymous is a good resource. There’s a lot of resources online –I don’t have any one specific number or website that I go to, but I always use Gamblers Anonymous as a resource as a gateway, because I think that they have a ton of good resources on there. And I know there’s a number of treatment facilities that deal directly with gambling addiction.
I would also be very wary of looking at certain programs, and just make sure you’re aware of what you’re going to be working on, what you’re going to be getting, because in a good treatment program such as Gamblers Anonymous, it should be looking at the entire system. I should involve family and anyone who is enabling the behavior.
I recommend looking into Gamblers Anonymous. Go to a meeting. Find a meeting. I think they even have meetings online that you can attend. But I don’t recommend that long-term. I think that a physical presence creates some amount of accountability. But a meeting online can be useful at least as an introduction, to take the temperature.