A tribal perspective on problem gambling

Clinicians will tell you that problem and pathological gamblers are largely co-morbid, meaning they have compulsive behavioral problems beyond an inability to stop gambling.

They may drink too much or take drugs. Many suffer from anxiety and depression. They may be suicidal.

They may be aggressive. They may be domestic abusers. They often lie, cheat and steal.

Some are mentally and physically unhealthy, unable to manage dietary issues and disease, such as diabetes.

“With some people [problem and pathological gambling] is the primary disorder,” said Keith Whyte, executive director of the National Council on Problem Gambling. “But that’s the minority.

“In a lot more folks problem gambling is a secondary disorder. And if it’s lurking in the background it will make the primary disorder worse.

“Problem gambling is a hidden driver of a lot of compulsive behavior,” Whyte said. “If you have one problem, you likely will have multiple problems.”

Whyte does not advocate abolishing legal casino gambling, on the reservation or elsewhere. He recognizes the economic and social progress government casinos have generated in Indian country.

But he also knows there are risks involved in introducing casino gambling to an American Indian community already grappling with depression and suicide; drug and alcohol addiction; domestic abuse and violent crimes; obesity and diabetes.

“We know problem gamblers have poor physical and mental health,” Whyte said. “It’s a hidden driver of things that affect everybody, but tribal communities in particular.”

Whyte said research shows American Indians have problem gambling rates two to 16 times higher than non-natives. Research on returning indigenous military veterans show an even higher prevalence rate.

A recent Veterans Administration study of American Indian military returnees in Arizona, Minnesota and North Dakota reveal a 10 percent prevalence rate of problem gambling and up to 25 percent among women veterans. The nationwide prevalence rate for problem and pathological gambling combined is generally no higher than 5 percent of the population.

I’ve written about problem and pathological gambling since long before passage of the Indian Gaming Regulatory Act of 1988.

In 2005, while on the staff of the California Nations Indian Gaming Association, I worked with Whyte, state Sen. John Burton and others in writing legislation to create California’s first Office of Problem Gambling.

Despite the fact California had the sixth largest gambling industry even before the first compacted tribal casino opened for business in 2000, it wasn’t until the tribes put up $3 million that a statewide office was established to educate the public and help prevent problem gambling.

For decades the California lottery, card clubs and race tracks had done nothing.

Certainly, state governments and the commercial casino industry have lagged in addressing problem gambling. Tribal governments have reacted far better to the issue.

Tribal advocates contend that because indigenous communities have health issues related to depressed economies, including a history of addictive behavior, Indians are more sensitive than the commercial casino industry to gambling-related problems.

Perhaps that’s true.

But the concern of people like Whyte is not so much with the lucrative tribal casinos in urban areas. Foxwoods and Mohegan Sun in Connecticut, Mystic Lakes in Minnesota and a dozen Southern California casinos generate most of their customers from often wealthy and middle-income non-Indian communities with social services to treat gambling and related issues.

Those casinos hang signs on the walls with hotline numbers to Gamblers Anonymous or problem gambling agencies.

They have plaques attesting to the fact employees are trained to “intervene” in the event they see gamblers out of control. (I question the likelihood a well-tipped casino dealer, bartender or cocktail waitress will cut off a gambler, but that’s another story.)

The concern Whyte and I share is with the tribal casinos on remote reservations, where 80 percent or more of the customers are citizens of indigenous communities.

The economic model for small-market casinos driven by slot play is to get gamblers to return two to three times a week or more. How many citizens of Navajo, Hopi and other large Great Plains and Midwest tribes can afford to gamble three times a week, even if they show up with no more than $20 a visit?

The responsibility of a tribal government with a casino on a remote and economically depressed reservation extends far beyond signs and plaques on the walls of the casino.

A tribal government is obligated to take a public health approach to problem gambling in its community.

What does that mean?

That means educating drug and domestic abuse counselors and those dealing with depression and suicide to detect what, if any, role gambling may have on the people they are treating.

It means training police and health officials to look for signs of gambling in the wife-beater, child abuser, drunk driver and embezzlement suspect.

It means community seminars and education programs in the schools to teach people about gambling that gets out of hand. This is particularly necessary for tribal casinos that allow 18-year-olds to gamble, as the prevalence rate for teen-age gambling far exceeds that of adults.

It means including mandatory problem gambling treatment when necessary as a component of sentencing in the tribal courts.

Most of all, it means creating a community awareness that the tribe is introducing a business enterprise that to a limited but significant degree preys on the weaknesses of others.

It means no problem or pathological gambler should be left behind.

It’s not a difficult concept to grasp. But I’m suspicious if tribes are looking at casino gambling from a communitywide perspective, particularly when the Navajo Nation discourages efforts to limit smoking and amends reservation liquor prohibitions to allow alcohol sales in the casino.

Some tribal governments are training social service counselors and educating citizens – particularly young people – about problem and compulsive gambling. There are also efforts to provide culturally sensitive treatment.

I’ve been impressed with problem gambling education programs in Washington state, Arizona, Minnesota and elsewhere.

Rachel Volberg, president of Gemini Research and a leading authority on gambling addiction, has worked with Lakota tribes in establishing reservation treatment programs.

But when I asked her not long ago how many tribes are taking a public health approach to the issue, she replied, “I suspect some are. Most aren’t.”

“Tribes have the same responsibility as state governments,” Whyte said, and perhaps more so when it’s specified in the Indian Gaming Regulatory Act of 1988 that funds from government casinos are to go to the welfare of tribal citizens.

There’s an economic justification to take a public health approach to problem and pathological gambling, Whyte said.

“You cannot maximize the economic benefits [of a tribal government casino] without minimizing the costs,” he said. “Governments that fail to address that cannot get as much revenue out of the casino operation as long as these hidden social costs are draining them; the bankruptcies, addiction and everything else.

“Only by addressing those issues can you realize the maximum economic potential of the gambling operation.”

When Whyte reaches out to the Indian Health Service and other federal agencies dealing with tribes the response is the same.

“When we go to people like IHS or anybody in the federal government, they say, ‘You know what? We get it. We see that where there’s smoke there’s fire. But tribes aren’t asking us for help.’

“We go to the feds and say, ‘You have an obligation to do something about this.’ They say, ‘Hey, the tribes are not asking us for help. And frankly there are too many other priorities.’”

Tribal leaders are suspicious of problem gambling service providers, Whyte said, particularly since gambling addiction is often used by anti-Indian advocates as a means of preventing tribes from establishing government casinos.

“Because people use problem gambling to attack tribal casinos and tribal sovereignty, that makes it harder for tribes to talk about it openly,” Whyte said. “That’s a big issue.”

The National Council on Problem Gambling has approached the National Indian Gaming Association and others with efforts to increase efforts by the IHS and Bureau of Indian Affairs to provide more culturally-specific prevention, education & treatment programs.

The NCPG also wants to develop a national responsible gaming campaign or toolkit (similar to American Gaming Association materials) to complement existing tribal programs. 

“Gambling provides tribal governments with a means to improve the lives of their people, but gambling problems among tribal members will harm individuals, increase the burden on tribal government and impede the growth of future generations.

“Tribes now increasingly have the opportunity and resources to reduce these harms by developing programs to prevent problem gambling and treat those who develop problems.

“Now is time to provide balance by promoting wellness and community health; providing responsible gaming programs and preventing the next generations from falling prey to addiction,” Whyte said.

“By incorporating culturally-specific problem gambling and responsible gaming programs into tribal health and gaming operations, tribal leaders can aggressively confront a public health problem that may have serious social and financial impacts.”