Caesars at Woodbury: Problem Gambling ? No Problem

thumbonscale

 

 

 

 

 

Summary: This is a critique of Attachment IX.A.2.a_A2  in  section  07 – IX.A. Assessment of Local Support and Mitigation Local Impact  of the  application by Caesars Entertainment to the New York State Gaming Facilities Location Board.    Being an epidemiologist and physician familiar with problem gambling as a public health problem,  I found  Attachment IX.A.2.a_A2  extremely biased in downplaying,  to near zero.  the possible health impacts  of a new Woodbury Casino.   The report asserts  as follows:

  • no socio-economic costs of pathological gambling and problem gambling warrant $ consideration, as none can be quantified so that all parties are close to agreement.
  • making casinos more convenient hardly  increases the prevalence of pathological gambling and problem gambling in the surrounding population in the long run.
  • the only population within a 50 mile radius of Woodbury that is  at theoretical  risk of having even a temporary surge in prevalence of pathological gambling and problem gambling  is that of Orange, Dutchess and Putnam Counties.
  • efforts by Caesars elsewhere to address “problem gambling” have been highly successful and will minimize “problem gambling” in southern New York State.

The  report greatly understates the possibility of harm to residents of the region due to a casino in Woodbury to residents of the region.  This essay addresses the first three  points in the above order.  The fourth  I have discussed in an e-mail to the NYS Gaming Commission last April.

 

In reading the Caesars Entertainment Inc application for a Woodbury casino I focused as a physician versed in public health  on the 40- page report   Study of Addiction and Public Health Implications of a Proposed Casino and Resort in Woodbury New York by Bo J. Bernhard Ph.D., Khalil Philander Ph.D., and Brett Abarbanel Ph.D.

The authors are all experienced consultants for gambling-related  enterprises. Two are senior members of the International Gaming Institute (IGI) at University of Nevada at Las Vegas. This is a highly polished presentation by experts who know the field but hide large tracts of it from view.   It  dismisses or never mentions four crucial facets of the ecology of pathological gambling and problem gambling. The report basically concludes that

  • socio-economic costs of pathological gambling and problem gambling don’t warrant consideration, as none can be quantified so that all parties are close to agreement.
  • making casinos more convenient does not much increase the prevalence of pathological gambling and problem gambling in the surrounding population in the medium  run of 2 to 4 years.
  • the only population within a 50 mile radius of Woodbury that is now under-served by racinos or casinos (and hence at theoretical  risk of having even a temporary surge in prevalence of pathological gambling and problem gambling) is that of Orange, Dutchess and Putnam Counties.
  • efforts by Caesars elsewhere to address “problem gambling” have been highly successful and can be relied on to minimize “problem gambling” in southern NY

The report nowhere mentions a statistic often cited by opponents of predatory gambling but never addressed head-on by casino advocates and never refuted: 40-50% of revenue at the average casino comes from pathological and problem gamblers, who comprise perhaps 12-15% of its customers, maybe 4% of all adults. [ http://cagnyinf.org/wp/april-9-2014-central-stat-of-casino-revenues] For the casino lobby to refute the statistic (if it is refutable) they would have to acknowledge that they can spot pathological and problem gamblers among their “visitors” while those persons are still active customers. This means before the person has loudly threatened suicide within an employee’s hearing or left town suddenly or thrown an ugly scene on the “gaming floor” or been arraigned or jumped.

Casinos will not acknowledge they have any  ability to spot problem or pathological gambling signs and symptoms that are not florid and end-stage. Why not? To move in even gently on such persons would risk offending them so they would go elsewhere or sending them to premature recovery before they have been “played to extinction.” [ https://www.youtube.com/watch?v=9C2BPZYLW_U ] .  To recognize the problem gamblers before they are end-stage yet not do anything for them  would reveal how insincere are the “preventive measures.” .

The casino cartel does not deny that its net revenues follow the Pareto principle: most come from a small proportion of gamblers. What casino promoters won’t say is what proportion on the average of that small proportion are pathological gamblers or problem gamblers. The promoters just do not want to know who among their customers is a problem gambler or pathological gambler until the gambler hits bottom or worse.   Promoters and detractors alike recognize that not everyone who loses a lot of money over time at casinos is a problem gambler. Anti-casino activists hold that most are; the American Gaming Association counters that most are affluent people having fun with their disposable income.

Assuming the central statistic is close to truth, casinos are not motivated to sincerely counter problem gambling and pathological gambling.  A successful effort to do so would lower their revenues by 40-50%.  Nor is government motivated; lower casino gross gaming revenues   would reduce  government’s share  by a like amount.

The report prepared for Caesars (in this no different from all the literature on problem gambling) also does not recognize that “unchanging prevalence” of problem and pathological gambling requires the formation of replacement problem gamblers and pathological gamblers to fill the shoes of those who have recovered, died, moved far away or are no longer free-living. What might appear a steady state is built on creating new problem gamblers. The more effective  the casino is at encouraging current problem gamblers and pathological gamblers into lasting recovery before they have fiscally and emotionally wiped out themselves and and ten people around them, the faster it must generate replacement problem and pathological gamblers to keep up its high profit margins.

I will now cover the first three bullet points above in more detail. The fourth bullet point I wrote about in the above-mentioned letter to the Gaming Commission.

Continue reading

Whose Problem are Problem Gamblers ?

Central Statistic

Graphic by Dave Colavito, 2014 data from Grinols and Omorov 1996-97

On 24 April 2014  I sent to the Director for Policy,  Development and External Affairs of the NYS Gaming Commission the following  e-note with two attachments, one of which was   posted yesterday on the CAGNY web site below a copy of the April 24  cover e-note, repeated here.

Dear Sir,

Attached are two documents I earnestly hope the Chairman and all the Commissioners will read carefully and discuss with the  GFLB.  Both are about “problem gambling,” the subject of the April 9 forum convened by the Gaming Commission. Watching the videotape and reading the transcript (everyone should thank the GC for providing these so fast) I saw  that “problem gambling” was an elusive term.  The extreme importance to the casino economy of net losses from problem gamblers was nowhere mentioned except when the speaker from Caesars deflected  the issue.  Yet around the “central statistic of casino revenues,” on which I have written to the Commission, is the “central dilemma” of regulation: the better the regulation is at preventing problem gambling, the lower is the casinos’ profit margin.

Selected prevalence statistics were presented as if they are the be-all and the end-all of gambling behavior studies.  They are about all we have, but a poor stand-in for what we really want to know about time trends in social impacts, i.e.  incidence and duration.  Under the placid surface of what looks like stable prevalence,  much new damage continues; as problem gamblers recover or die, new ones must be recruited to take their places.

As I have offered before, I’m  [ready]  almost any time to meet with the Commissioners and staff to explain the critiques in more detail and to talk about “the central statistic.”

Thank you for your attention.

Sincerely, etc.

Stephen Q. Shafer, MD, MA,  MPH Chairperson, Coalition Against Gambling in New York 917 453 7371 http://cagnyinf.org  [ Cover note ends here]

 

No surprise,  the Commission has not responded to these  unsolicited comments. Does that mean the Commissioners have all accepted the assurances (see below) of  the Executive from Caesars Entertainment that the organization does not make money from “problem gamblers” and does ” not want them in [their] venues?”  If yes, it is a monumental  mistake.  I cannot speak for Caesars Entertainment in particular, but it would  be unique  if it does not make money from what most people call problem gamblers To  wrongly  assume Ms Shatley’s artful  discounting  of problem gamblers fits all casinos  would be an easy stretch  to make,  even if Caesars is unique. It would be worse yet if the attitude “casinos don’t want problem gamblers” were communicated to the Gaming Facilities Location Board members.  The GFLB is charged to consider plans by applicants to address problem gambling. The Board must understand how important problem gamblers are to the casino exchange.

Below is the text of the second attachment  that was sent to the Gaming Commission  on April 24, slightly revised.  The text of the other attachment sent the same day  was posted yesterday on this web site along with the cover e-note.

Continue reading

“Replacement problem gamblers”

snooker 3151824312_431fc8b6f2

 

 

 

 

 

 

 

On 24 April 2014  I sent to the Director for Policy,  Development and External Affairs of the NYS Gaming Commission the following  e-note with two attachments:

Dear Sir,

Attached are two documents I earnestly hope the Chairman and all the Commissioners will read carefully and discuss with the  GFLB.  Both are about “problem gambling,” the subject of the April 9 forum convened by the Gaming Commission. Watching the videotape and reading the transcript (everyone should thank the GC for providing these so fast) I saw  that “problem gambling” was an elusive term.  The extreme importance to the casino economy of net losses from problem gamblers was nowhere mentioned except when the speaker from Caesars deflected  the issue.  Yet around the “central statistic of casino revenues,” on which I have written to the Commission, is the “central dilemma” of regulation: the better the regulation is at preventing problem gambling, the lower is the casinos’ profit margin.

Selected prevalence statistics were presented as if they are the be-all and the end-all of gambling behavior studies.  They are about all we have, but a poor stand-in for what we really want to know about time trends in social impacts, i.e.  incidence and duration.  Under the placid surface of what looks like stable prevalence,  much new damage continues; as problem gamblers recover or die, new ones must be recruited to take their places.

As I have offered before, I am[ready]  almost any time to meet with the Commissioners and staff to explain the critiques in more detail and to talk about “the central statistic.”

Thank you for your attention.

Sincerely, etc.

Stephen Q. Shafer, MD, MA,  MPH Chairperson, Coalition Against Gambling in New York 917 453 7371 http://cagnyinf.org

To no one’s surprise,  the Commission has not responded to my unsolicited comments. Does that mean the Commissioners have all accepted  the ” adaptation hypothesis” [summarized in the next paragraph]   that  gambling expansion has  little long-term population impact?  If they have, ” this  was a grievous fault,”  but unless NYS media call them out  sharply  on it,  the Commission will not have to answer it grievously. If,  as I hope,  they have not bought it,  one sign will be that  the  Facilities Location Board  questions searchingly all applicants for a casino license on  what they will really do that will really  stop new cases of problem gambling.

Gentlemen of the Gaming Commission, how say you?

[Scientists from the Division on Addictions of the Cambridge Health Alliance have proposed an “adaptation hypothesis,” which acknowledges that new gambling opportunities may lead to a temporary increase in prevalence of problem gambling  for the surrounding population. Then, so goes the hypothesis, novelty fades,  individuals become more “responsible” in their gambling behaviors and  the crest subsides.]

One of the two attachments, slightly revised a month later,  is below. It begins with Summary.   It concerns the public health profile  of “problem gambling.”    The other, related to an operational definition of “problem gamblers”  and to their fiscal significance,  will soon be posted on the CAGNY web site.

Summary: “Problem gambling” is not a fixed uniform term. In his introduction to the April 9 forum on Problem Gambling, Dr. Gearan seems to take it, as I do, to mean both strata of gambling disorder combined, not just the less severe stratum often referred to as “problem gambling.” Statistics on the prevalence of “problem gambling” or its subgroup “pathological gambling” are often used to reassure policy-makers that gambling expansion has not worsened problem or pathological gambling. These statistics can be challenged on several grounds, but even if prevalence as a proportion of the population is truly unchanged in the long term, there are hundreds of thousands of new cases nationally hidden in it, millions of individuals affected. To keep prevalence stable there have to be new pathological gamblers brought on to take the place of those who died or entered recovery. Opponents of big tobacco use the term “replacement smokers.”  We extend this concept to “replacement” problem gamblers.   Tobacco companies need replacement smokers; society does not.  Casinos need replacement problem gamblers; society does not.  Quite the reverse.

Introduction  In the April 9th 2014 Problem Gambling forum hosted by the New York State Gaming Commission two speakers, Dr. Sarah Nelson and Ms Christine Reilly, used lack of change over time in “the prevalence of problem gambling”   to argue that expanded gambling opportunities do not increase endemic harms to public health. I will challenge that premise as an epidemiologist by digging into the population dynamics of “prevalence.”  With problem gambling, as with most chronic conditions, prevalence is more easily measured than the rate at which new cases develop. That does not mean it’s a perfectly valid marker of causation.  It hides new cases, the replacement problem gamblers that predatory gambling must endlessly cultivate to keep profits high.   To speak of the prevalence of “problem gambling” requires first defining the latter term. In the second and third sections of this narrative I will talk about the pitfalls of prevalence to assess “problem gambling” in a population.

Continue reading

The Central Statistic of Casino Revenues

Central Statistic

The central statistic of  casino revenues gives the lie to assurances from casino promoters that they do not want, or need,   problem gamblers. In one line:

52 % of revenue at the average casino is the net losses of  “problem gamblers.”

The term “Problem gamblers”  as used above combines gamblers in two categories: what is now called “disordered gambling” (formerly called “pathological” or “addicted” or level 3); and those in what was formerly called “problem” or “subclinical pathological” or level 2).  There is no universally accepted name and unambiguous term for the combination, which was in the past termed by some “disordered gambling,”   by others “problem gambling.”  The combination  category is about  4 % of the adult population,   perhaps  10 to 15 %  of  casino users.  We recommend that “problem gambling” be kept as the portmanteau term for the combination.  We recommend that  persons whose lives are adversely affected by gambling but who do not meet  criteria for “disordered gambling” be called “at risk for disordered gambling.”

Nearly all the quantifiable socio-economic costs of legalized gambling,  more than $60 billion/year nationally ,2  move through this same 4 %  of adults who are “disordered”   or “at-risk-for-disordered” gamblers.   A program that reduced to zero the number of active disordered and at-risk gamblers and totally prevented formation of new ones would almost wipe away  the huge quantifiable socio-economic costs of legalized gambling, estimated at  $266 per year/capita adult  in the USA. 3

But,  that program would also reduce casino revenues by close on half.  Government’s share, based on taxing the total net losses of gamblers (“gross gaming revenue”), would drop by the same proportion.

The casino exchange exists only for profits.  Do you really think it would support in good faith a prevention and treatment program designed to cut its profit margin by half ?

Do you honestly think the state government would support in good faith a program whose complete success would mean a 50%  decrease in a budgeted revenue line?

Or, do you think the casino exchange and  government agencies would rather cooperate  to showcase  worthy  aims for “regulation” and “prevention  and treatment”  that might just fall short in practice ?

References

1.  Grinols, Earl L. and Omorow  J.D.  16  J. Law and Commerce 1996-97  p. 59 .  Details in appendix below.

2. The figure $60 billion comes from making low-side cost of living adjustments to convert 2003 dollars into those of 2012 and adjusting for population growth between 2003 and 2012.  The 2003 figures are on page 176-177 of Gambling in America by Earl L. Grinols (Cambridge University Press, 2004). This works out to about one-third the annual cost of illicit drug use.    https://www.drugfree.org/join-together/drugs/new-report-estimates-illicit-drug-use-costs-u-s-economy-more-than-193-billion-annually

3. http://cagnyinf.org/wp/gambling-economics-statistical-summary-by-prof-earl-grinols

Appendix:  What Proportion of Gamblers’ Net Losses to Casinos come from Problem Gamblers?  Brief  Review of  Five  Major Reports from the Last Twenty Years

Estimates of what proportion of casino gross gaming revenues derive from the approximately 4% of adults whose lives are adversely affected to varying degrees (“problem gamblers”) by gambling are not many.  The one most directly applicable to the average American casino is that of Grinols and Omorov.  Observations of  types of gambling other than physical casinos accord with Grinols and  Omorov in that  gamblers’ total net losses to a casino (also termed “gross gaming revenues”) have, like many other human activities, a Pareto distribution: the bulk of the output or the uptake   (e.g. consumption, volunteer work done) comes from a relative minority of the participants.

The casino exchange is wont to say that all such problem gambler statistics are wrong, that the biggest chunk of casino revenue is from wealthy “whales”  who  are not problem gamblers, just persons with a lot of discretionary spending money. That is all the rebuttal the exchange offers.

While “whales”  do exist, they do not frequent most casinos or racinos.  Casinos certainly have the information technology to respond with data to the above charges by opponents of predatory gambling, yet they do not.  To weigh in on this they would have to  acknowledge that they can identify all or most of the problem gamblers in their clientele.  This would open them to well-deserved criticism that they are not acting responsibly towards those persons.

Below, we review five documents related to the question of  % gambling revenues from problem gamblers, one each from United States, Alberta, Nova Scotia, Great Britain and Western Europe.

The next section, to the asterisks, is a continuous quote from page 59 of the article by E.L. Grinols and J.D. Omorov “Development or Dreamfield Delusions?: Assessing Casino Gambling’s Costs and Benefits.”  J. Law and Commerce vol. 16 (1996-1997) pp. 49-87.  The table has been re-formatted and footnotes removed.

“Table 1 provides a hypothetical profile of gambling revenues by type of gambler.

                           [table below]

Applying the terms “pathological” and “problem gambling” as

used by the psychology profession to the two groups losing the most to

casinos, we call those who have not gambled in a casino in the past year

“nonbettors,” and divide the remaining gamblers into “heavy” and

“light” bettor categories. Based on prevalence studies, we assume that

1.38 percent of the adults will be pathological gamblers  who lose an

average of $4,01328 and that problem gamblers lose one-seventh the

amount that pathological gamblers lose. This implies that 52 percent of

casino revenues come from the 4.11 percent of the population who are

pathological and problem gamblers.  In this respect, casino gambling resembles

alcohol of which 6.7 percent of the population consumes 50 percent

of all alcohol consumed. Allowing for the average adult to lose as

much as $200 annually to casinos in some areas would still mean that

more than 35 percent of casino revenues in those areas come from problem

and pathological gamblers.

 

The fact that the gambling industry is dependent on problem and

pathological gamblers for a large share of its revenues casts doubt on the

feasibility of treating pathological gamblers using industry tax revenues

to prophylactically prevent the externality costs of gambling addiction.

The treatment cost to the industry would be high, and these costs would

be in addition to existing taxes on gambling gross revenues that are already

high in many cases. Further, if treatment were successful in

preventing gambling by problem and pathological gamblers, it would significantly

reduce industry revenues. It is probably safe to conclude that

not everyone in the casino industry would willingly forego 35 percent or

more of their revenues.”  [emphasis added]

TABLE 1: Representative Distribution of Gambling Revenues by Type of Gambler

% of pop. designation annual loss annual loss cumul % of
per bettor $ per 100 adults $ casino gross
1.38 pathol. gambler 4013 5538 39
2.73 problem gambler 669 1826 52
5.89 heavy bettor 317 1866 65
50 light bettor 99 4970 100
40 non-bettor 0 0 0
100 total 14200 100

 

***********************************************************************

Figures in the table were computed by the authors  using information from  a 1992 report prepared by Deloitte  & Touche for the  City of  Chicago Gaming Commission:  ECONOMIC AND OTHER IMPACTS OF A PROPOSED GAMING. ENTERTAINMENT AND HOTEL FACILITY 137, 146, 147, 162

The Alberta study ( Williams et al)   two direct quotes

“ In 2008/2009 it is estimated that problem gamblers in Alberta account for 50% of all reported gambling expenditures, with that ratio being even higher for VLTs, slot machine and casino table games .”  Williams Robert J,  Belanger Yale, and Harris Jennifer N.  Gaming in Alberta  Final Report to the Alberta Gaming Research Institute 2011 p. 259

 

“A much more serious concern is that 75% of reported gambling expenditure comes from roughly 6% of the population. The most distinguishing feature of these individuals is the fact that 40.6% of them are problem gamblers. Overall, problem gamblers in 2008/2009 in Alberta appear to account for roughly 50% of all reported expenditure, a percentage that is even higher than previous Canadian estimates of between 23% – 36% (Williams & Wood, 2004; 2007). It is ethically problematic for governments and charity organizations to be drawing such a significant percentage of their revenue from a vulnerable segment of the population.”  [emphasis added]  Williams et al   op cit   Final Report to the Alberta Gaming Research Institute 2011 page 280

 

The Bwin study (Planzer, Gray and Howard Shaffer)

A study in Europe on internet gambling with casino type “games” authorized by the internet gaming company Bwin was reported on in an October 2013 article in the Wall Street Journal by Mark Maremont and Alexandra Berzon.   The investigators were Planzer,  Gray  and Howard Shaffer; their report is not yet published.  IThe WSJ article says that  3% of the 4222 customers tracked provided “half  the casino’s take.”  The  WSJ article did not say what proportion of the adult population the 3%  of the 4222 customers were.  Certainly it would be less than 3%, since only a minority of the adults do internet gambling.   The  article did not identify how many of the 3% were problem gamblers.  Safe guess it’s at least half.

Nova Scotia Video Lottery  (report by Focal Research)

A 470 page report on the Nova Scotia Lottery done by Focal Research [Schellink and Schrans principal authors] concluded that

“in 1997/98  5.7% of adults in Nova Scotia (approximately 38,750 adults) did most of the video lottery activity in the province and are contributing approximately $113,236,800, or approximately 96%, of the annual net revenue for video lottery gambling in the province.  Therefore, it can be assumed that VL   play behaviour differs significantly among those who are Casual VL Players and those who play on a regular, continuous basis and that these distinctions have significant implications, in terms of profiling VL gambling within the population at large.”

The Nova Scotia report (pages 3-42, 3-43) found that 55% of VL revenues were from “problem VL players,” who were about one-sixth  of the 5.75% of adults classed as “regular players” [defined as once a month or more].  Problem VL players thus comprised about .92% of adults.

The authors observe “It is obvious that success in helping Problem Players to reduce their expenditures will have a substantial impact on the total revenue Nova Scotia derives from VL play. If  Problem Players’ expenditure was similar to that noted for Frequent Players, there would be a reduction in total revenues from VL gambling of approximately 35% to 40%.

Using  the 2010 British Gambling Prevalence Survey, James Orford (Univ Birmingham), Heather Wardle and Mark Griffiths derived a lower figure for % of gamblers’ net losses coming from problem gamblers: 23% at FOBTs [Fixed Odds Betting Terminals].  We note, however, that the prevalence of current problem gambling in this survey (0.9% by DSM –IV and 0.7% by PGSI criteria)  was much lower than the 2-4% figures from elsewhere.  This difference is more likely to be due to methods than to Britons’ being less vulnerable.  In this study, then,  23% of the FOBT revenues come from less than 1% of the adult population.  This ratio is even more skewed than what what Grinols and Omorov reported for “the average casino” (52% from 4%) .

The opinions expressed above are those of the writer,  Stephen Q. Shafer  MD, MPH, MA retired Clinical Professor of Neurology at Harlem Hospital Center, Columbia University , New York City.  He is Chairperson of Coalition Against Gambling in New York, a non-profit registered in Buffalo  http://cagnyinf.org    Permission is hereby given to quote in whole or in part as long as the permalink is cited and all citations to other work are correctly conveyed.

The graphic is by Dave Colavito.  He places no restrictions on use  but please attribute work to him.

Problem Gambling Misery Summated

 

Graphic by Dave Colavito

Graphic by Dave Colavito

      The central statistic of casino finances is that 50% of taxable revenue comes from pathological and problem gamblers, about 4% of adults.  One evil of casino gambling is that almost none of the money that these unfortunate persons leave at casinos belongs clearly to them alone unless they have recently, and legally,  become very rich, without dependents.  Thus 50% of pre-tax revenue, more than 50% of profit, has been diverted from persons who may never have gambled, innocent bystanders or co-dependents.  Spouses, children, siblings, parents, employers, employees, clients – these are just a few examples.  The typical gambling addict is into eight, twelve, fifteen other people whom he or she will serially sacrifice to “the chase,” usually until it has consumed the gambler and destroyed all good social and emotional relationships.

     Most residents of the U.S. can recite that gambling addiction is a true addiction. Secretly, however, many believe it is a moral failing or a defect in reasoning that deserves catastrophe.  They rationalize that, if everyone can avoid a small increase in  personal tax outlays by the exenterating exploitation of the 4% who are problem gamblers,  that’s a win for the other 96%.   This “devil take the hindmost” approach may look utilitarian.  It does not take account of the dozen or more people around each problem gambler who are wrung out fiscally and emotionally in the quest for “more revenue to education.”  See the April 15 post “Robbing Peter” on this web site. 

      To comprehend the total misery dealt out by predatory gambling to a specified group of individuals would need much study. Consensus would be unlikely.  Economists like Earl Grinols have painstakingly  presented harm in terms of dollars.  While we respect this completely for cost-benefit analysis, we have always noted that  it understates the total impact, which is a stew of fiscal loss and emotional hurt.  Quantifying in an entire population the cumulative lifetime misery associated with problem gambling so as to reach consensus is impossible.  There are two aspects, however,  that everyone can agree on qualitatively.  First, the problem gambler alone does not sustain or mete out all the damage; second, not all the damage can be measured  econometrically.

          The graphic above, realized by Dave Colavito,  is an abstraction, not data-based.  It shows that the high casino profits due to problem gamblers,  which are taxed into “revenues to education” via gambling “regulated” or operated by state government come at the expense  — literal and figurative — of many more parties than those individual gamblers.  The “iceberg”  (actually it looks  more like a volcano rising above the waves from the ocean floor ) schematizes lifetime gambling-related cumulative misery as a function of psychosocial closeness to a problem gambler.  The problem gambler is the red apex.  The strata of adjoining locations represent lifetime cumulative misery of other parties at varying psychosocial distances from the problem gambler.  The anguish of a wife who has seen the furniture sold, the children made homeless and the husband she still tries to love gone  or jailed will be more than that of a client cheated or a friend whose loan to “help pay my kid’s doctor bill” is never repaid.  There are, however,  more clients and friends around a problem gambler than spouses.  Integrated  over all these more distant persons, the totality of hurt and loss is likely to exceed that of the very nearest and dearest. 

          However we define misery –as pure fiscal deprivation or that plus emotional damage  — it is not “just” the problem gambler who loses something lifelong  in the havoc of out-of-control gambling.  It is a dozen or more other people, whether innocent,  trusting, co-dependent or any combination. To the  casinos that prey on problem gamblers and governments that get income therefrom, these people are chopped liver.

Three references about impact on families http://s3.amazonaws.com/publicationslist.org/data/philip.darbyshire/ref-36/JGS%20gambling%20paper.pdf 

http://www.problemgambling.ca/gambling-help/support-for-families/effects-on-families.aspx

http://www.ncbi.nlm.nih.gov/pubmed/17667890 

Permission is given by Cagnyeditor to reproduce this in full or part as long as the permalink above is cited and the graphic is attributed to Dave Colavito.