Hooked in the shadow of casinos

MONTVILLE, Conn. - The road from compulsion to redemption, 6.8 miles long, ends here, in an unassuming red brick church where worshipers pray to their God upstairs while gamblers joust with their demons downstairs.

Rich and Al, the two men smoking in the parking lot of the Montville Union Baptist Church, have been coming here for years, every Wednesday night, for the Gamblers Anonymous meeting. Their old haunt, the Mohegan Sun casino, rises not far away. Until gambling dens arrived in their patch of leafy Connecticut, the men say, they had not been consumed by wagering.

"Once I got started, I couldn't stop," said Al, 77, his words tinged with resignation. "All I thought about was how the hell am I going to get some money to go up there and gamble. We'd stay there playing for 24 hours."

Amid the promises of robust tax coffers and thousands of new jobs, Governor Deval Patrick and his health secretary acknowledged last week that the administration's bid to bring three casinos to the state comes with a price: addiction. They're so certain that some gamblers will be hooked on the slot machines and roulette wheels and blackjack tables that they are vowing to set aside a share of the state's bounty to pay for addiction treatment.

Those concerns are well founded: Research shows that people living within 50 miles of a casino are twice as likely to fall victim to compulsive gambling as those farther away.

Psychiatrists and compulsive behavior specialists have shown that gambling can turn addictive in much the same way that alcohol or illicit drugs do, through a process in which the brain causes the dependence and then is damaged by it. Gamblers can be treated - with counseling, medication, and 12-step programs - but success is far from guaranteed. A year after entering treatment, studies suggest, about half of gamblers return to the slots and gaming tables.

Just as most people can have a glass or two of wine without becoming addicted, so it is with wagering: Most gamblers can place a few bets, down a few free drinks, and head home, specialists said. But for those who can't, gambling addiction is like a pilot light in the brain, waiting for gasoline to be poured on.

Casinos can act like gasoline, or, as Dr. Hans Breiter puts it, "the cue of susceptibility."

"Some people will say with regard to that cue that you can't guard everybody from what's going to potentially harm them," said Breiter, a Massachusetts General Hospital psychiatrist who takes high-tech snapshots of addicts' brains to better understand the roots of compulsion.

"The question every society deals with," he said, "is how far down that road do you go to allow citizens exposure to pleasure that they may not be able to control."

For most of the 10 to 20 people who show up weekly at Gamblers Anonymous meeting at the Montville church, an addiction to wagering emerged when casinos came to town, said Rich, 42, whose broad, round face and twinkling eyes lend him the appearance of a Santa Claus in training. He declined to provide a last name, as much to adhere to the 12-step treatment program's creed of anonymity as to shield his identity.

The first time Rich walked into one of the casinos, he spent about $250 and didn't return for a year. But then he started going regularly to Mohegan and Foxwoods Resort Casino. First, it was every couple of weeks, then every night, right after he closed up the shop he owned.

"There's a feeling of constant exhilaration," Rich recalled, nursing a cup of coffee. "I would get the feeling before I would get to the casino. My hands would shake, and you're just constantly trying to feel that exhilaration, hour after hour. Once you have the need to feel that way, you'll do anything to feed that feeling."

For Rich, the cost was $20,000 in his worst year of gambling. He slipped bills from his shop's cash register into his pocket and drew money from the store's credit line. As bad as that was, other compulsive gamblers go to more extreme lengths, squandering their children's college fund, draining their retirement accounts, or working two or three jobs to cover their losses, said Dr. Lance Dodes of Beth Israel Deaconess Medical Center in Boston.

Studies estimate that at least 3 percent of US adults have a compulsion to gamble so severe that it can lead to obsession, lying, illegal acts, and failed relationships.

A landmark 1999 study commissioned by the National Gambling Impact Study Commission, which was established by Congress, estimated that 5.5 million Americans had serious addictions to wagering. The study also found that 4.4 percent of people living within 50 miles of a casino reported serious wagering problems in their lifetimes. That compared with 2.1 percent of those living 51 to 250 miles from a casino, said Rachel A. Volberg, a Northampton, Mass., researcher involved with the national report.

"The studies do show there's been an increase in problem gambling coinciding with the greater availability of legal forms of gambling," said Dr. Paul Laffer, an addiction specialist affiliated with McLean Hospital in Belmont. "In recent decades, we've had lots more becoming available, including what's sanctioned and promoted by the state."

In an interview, Dr. JudyAnn Bigby, the Massachusetts secretary of health and human services, said that as part of Patrick's proposal, casinos would have to post signs warning patrons about the addictive propensity of wagering and train employees to spot troubled gamblers and direct them to addiction treatment. The governor's plan also pledges a 2.5 percent cut of casino pretax revenues, an estimated $51 million a year, to pay for education campaigns and expand addiction treatment.

Bigby defended the governor's plan. "I think it's important to acknowledge that if in fact 20,000 new jobs will be developed in Massachusetts, that has a major impact on people's health and well-being," she said. "Overall, I think there are a small percentage of people who we might anticipate would have some problems, but the overall majority of people who go to casinos or participate in gaming do not have problems."

In a briefing book prepared for the governor, the Department of Public Health estimated that nearly 250,000 Massachusetts residents have had a gambling problem in the past year. The book stated that it is hard to determine how many additional people would become addicted after casinos open in the state, but concluded, "We can anticipate that [social costs] would increase with greater availability."

Gambling addiction reflects a complex interaction of biological, psychological, and genetic characteristics, specialists said.

Not so long ago, Dr. Timothy Fong of the University of California at Los Angeles said, gambling addicts were dismissed as ne'er-do-wells marked by greed, sloth, or immorality.

"But over the last 10 to 15 years there's been a lot more science showing that these are folks with . . . differences in their brain functioning," said Fong, codirector of the UCLA Gambling Studies Program. "Even though they may intend to stop gambling or to limit the amount of money they spend on gambling, their brains don't let them do it."

Researchers such as Breiter at Mass. General have found that brain wiring involved with rewards and sanctions appears to be implicated in gambling, alcohol, and drug addictions. Scientists also believe that gamblers, as well as alcoholics and drug addicts, have imbalances of certain brain chemicals that regulate mood, arousal, and risk-taking.

Within three or four years, Breiter predicted, researchers will be able to show a detailed picture of what is different in the brains of people suffering from pathological gambling and alcoholism. That, in turn, could lead to better diagnosis and treatment.

Bob Breen, director of the Rhode Island Hospital Gambling Treatment Program in Providence, estimates he has treated more than 1,000 compulsive gamblers in the past 15 years, some who have forfeited their homes, life savings, and families. Breen and other specialists said treatment for gambling addicts embraces methods similar to what is used to help alcoholics and other patients with dependencies.

That means, in some cases, therapy to understand the outside events that might inflame addictive behavior and eliminating those factors. For other patients, medications are prescribed. Although there are no drugs specifically approved for the treatment of gambling addiction, some depression medications have been shown to help.

But overall, the few studies on treatment have found mixed results. Breen tracked about 120 patients for a year and found slightly more than half were not gambling at the end of the study.

"I believe from all my experience that there's one reasonable and effective goal for people who are addicted to gambling, and that's the abstinence highway," Breen said. "I have never met anybody who's been addicted who's attempted to go back after a period of abstinence and control their gambling."

Rich has not gambled, he said, since a friend first dragged him to a Gamblers Anonymous meeting in December 1998. He found the meeting site unexpectedly shuttered, with a few members outside. "They wouldn't let me go," Rich said, so they conducted an impromptu session in his car.

For Al, who also declined to provide his last name, wagering stopped more than six years ago.

As last week's meeting was about to begin, a car jerked into the parking lot. The woman inside waved to Rich and Al. She wore the uniform of a casino employee.

She's a dealer at one of the casinos, Rich said, a dealer addicted to gambling, though not at her own casino, because employees can't wager where they work. The woman has been in and out of Gamblers Anonymous.

"I'm going to get back into the program," the woman said to the men. "It's worse than ever."

A few hours later, she was presiding over a red-felt gaming table, cradling colorful chips. Not far away stood a slot machine. Emblazoned across the front were the words: "All that glitters."

Stephen Smith can be reached at stsmith@globe.com.