The next time you feel overcome with anger over underfunding and the treatment gap in substance use services, take solace (or get more outraged) in these comparative numbers regarding services for gambling disorders:
Substance use disorders in the U.S. are 3.8 times more common than gambling disorders, but public funding for substance use treatment is a whopping 330-plus times greater than public funding for problem gambling services.
While traditionally around 10% of people who need substance use treatment receive it, the comparative statistic in gambling disorder treatment was around one-quarter of 1% in 2016.
10 states and the District of Columbia provide absolutely no public funding for problem gambling services, even though only two states in the entire country offer no government-sanctioned gambling.
The data come from the newly released 2016 Survey of Problem Gambling Services in the United States, and illustrate the significant challenge treatment and prevention advocates face in elevating gambling's negative effects to a front-burner issue in state policy discussions. The periodic survey, which had been last released for 2013, is co-produced by the Association of Problem Gambling Service Administrators (APGSA), representing state government administrators of public funds for problem gambling services, and the National Council on Problem Gambling, a policy and program development organization.
APGSA president Terri Sue Canale-Dalman, who heads the California Office of Problem Gambling within the state Department of Public Health, says that while virtually no one would contend that substance use treatment services are sufficiently funded, the comparatively more disappointing data for gambling services still startle her every time she studies them.
Some incremental progress has been made at the state level, the latest survey indicates. The total number of states with publicly funded problem gambling services increased to 40 in 2016; the number had been 35 in 2006 and 39 at the time of the previous survey in 2013. Twenty-five states increased funding levels for gambling-related services from 2013 to 2016, but nine saw cuts in funding and Arkansas eliminated all public funding for problem gambling services, according to the report.
Data on per-capita spending in the states shed significant light on the underfunding issue. The average per-capita spending in the 40 states that have publicly funded services for problem gambling is only 37 cents, with a range from a low of one penny in South Carolina to a high of $1.46 in Delaware. If all states, including those with no public funding, are counted in this analysis, per-capita spending drops to an average of 23 cents.
Impact of growth
Canale-Dalman says that in general, growth in legalized gambling opportunities in a state is the factor that ends up spurring interest in initiating or expanding publicly funded treatment. The survey found that increased state funding for problem gambling services was associated with a number of variables, including state spending and revenue from gambling, the estimated number of adult problem gamblers within a state, and the number of problem gamblers treated.
However, Canale-Dalman says this tends to create a scenario in which states are consistently trying to play catch-up while government-sanctioned gambling options relentlessly expand. For example, she says, Massachusetts moved forward with its first dedicated state funding for problem gambling services on the occasion of the development of the state's first casino, which of course was not the state's first foray into sanctioned gambling.
“We need to get out ahead of the gambling growth,” says Canale-Dalman.
Most common services
The 2016 survey also illustrated a lack of uniformity in the types of problem gambling services that receive government funding support in each state. Problem gambling awareness programs remain the most commonly supported service, followed by counselor training, gambling helplines and problem gambling treatment. The researchers reported that higher spending on problem gambling services was associated with increases in gambling treatment utilization.
Twenty-three states reported providing gambling prevention services in 2013, with problem identification and referral the most prominent of the services. Research spending, including for prevalence studies and risk behavior analyses, appears to be very low in the surveyed government agencies and nonprofit organizations.
Integrate with behavioral health
Canale-Dalman says APGSA has traditionally prioritized the need to integrate problem gambling and substance use disorder efforts at the state level. Respondents to the latest survey listed improved integration of problem gambling into behavioral health services as the most pressing need in their state's problem gambling system, followed by the need for federal guidance on how to address various forms of Internet-based gambling.
In times of budget uncertainty, the substance use treatment and problem gambling service communities must look for ways to collaborate and leverage resources, Canale-Dalman suggests.
For a substantial number of state governments, it remains challenging to maintain consistent attention to issues around problem gambling at all. According to the latest survey, only 17 states funded a full-time position devoted to administering problem gambling initiatives, as in what Canale-Dalman is dedicated to in California.
Addiction professionals annually convene at the National Conference on Addiction Disorders to share what’s working: Clinicians hear from thought leaders on delivering treatment, while executives of behavioral healthcare organizations learn how to run more effective, more efficient, and ethically minded businesses.