Generally Recognized as Gambling: Daily Fantasy Sports

Testimony Before the Hearing on Daily Fantasy Sports held by Committees of the New York State Legislature,  8 December 2015

GamblinglosspictureMy name is Stephen Shafer. I chair Coalition Against Gambling in New York, an all-volunteer organization registered in Buffalo since 2007. Our members have different philosophies about gambling. The mainstream holds that not all gambling is bad for society or the individual. A March Madness pool where 100% of entry fees are paid out to winners, a game of cards among true friends, a bet on whether it was Yogi or Casey who made a certain remark – these actions don’t bother us. What does, and deeply, is predatory gambling – gambling in which some party profits predictably over time by preying on others. That party can be “the house” or “sharks” or both.

I think Attorney General Eric Schneiderman  is entirely right that Daily Fantasy Sports of the DraftKings and FanDuel type is gambling under New York State law; payback depends on a future contingent event that the person placing the stake cannot control. That person controls the selection of his fantasy team, but not the actual performances of the component athletes from which the outcome of the contest derives. A horseplayer uses skill to decide which horses to pick at for the trifecta, but where the horses place that day is not in her control. No one denies that is gambling.

Assuming DFS is gambling, it is certainly illegal. The State Constitution bans all gambling in New York State except (by specific amendments allowing regulated parimutuel, charitable gambling, Lottery and (as of 2013) up to seven non-Indian casinos in the future. There is no exception for any kind of betting on sports, either live action or fixed odds. There is no exception for internet gambling.

The business model of i-poker and online FS is similar to that of a casino or a state lottery:

  • Recruit people through their hopes of payoffs far greater than investments.
  • Keep their loyalty with frequent small payouts and tidings of rich payoffs to others.
  • Replace them as they burn out, go broke or jump ship.

Result:  some, far from all, of the internet  “players” become problem gamblers and addicted gamblers. They damage, even wreck, not only their own lives but those of all around them, the hidden victims of predatory gambling – spouses, children, parents, in-laws, siblings, employers, employees, clients, neighbors. With  “land-based” casinos and state lotteries, half the revenue (sometimes more than half) comes from problem and addicted gamblers, maybe 12-15% of customers. Their net losses are drained from someone else by deception or bullying or crime. These gamblers need help; so, in greater measure because there are far more of them, do those they are ripping off. My organization has great respect for clinicians and peers who help problem gamblers day to day. Our focus, however, is to stop expansion of predatory gambling. That’s why we hold that DFS and all forms of so-called i-gaming are illegal and should stay that way. That’s why we support the AG’s stance.

There are differences between the model for i-poker and online DFS on the one hand and that for casinos and government-run lotteries on the other. In the first group, “players” pay real attention to the action.   Some win more consistently than others through preparation (e.g. scripts in DFS) and mental probability calculations as in i-poker. This is called skill, though it can verge on insider trading in DFS. In the second group, no decision-making is needed beyond which card to buy or slot machine to go to.

In i-poker and DFS newcomers have no idea how they will fare. They don’t know how their skills stack up to those of other players, most of whom are strangers; moreover, chance has a big role. The game board changes day to day, hour to hour. They are really less well-informed about their chances of success than slot players who know they can expect long-term about 88-93 cents back for every $ invested.

In i-poker and online DFS there are two types of predator: the house, or operator, which takes a  percentage of the pot (“the rake”) or of pooled wagers (which DFS calls “entry fees”);  and the elite stratum of well-prepared pros or near-pros who pocket most of the money laid out  by everyone. In the typical casino or state Lottery setup – a slot machine – the house is the only predator, setting its expected payout % as it sees fit under regulation.

Operations with player predators (“sharks”) need prey (“ fish”) to contribute to the betting pool or join the poker game. Heavy advertisement with upfront incentives is the way to get new fish. Fish may know a lot about their sports, but few can match the preparations of the sharks.   Some fish will fall into the cycle of chasing losses that spells problem gambling. If there are indeed 500,000 DFS participants in New York State , then it is likely there are, or will be soon, at least 20,000 problem gamblers and addicted gamblers among them.

I surmise that the distribution of players’ net losses and net wins is different from that of a casino or Lottery. In the latter, the small fraction of users who are the most “involved” – that is, invest the most time and money– provide the lion’s share of gamblers’ net losses (= house’s net win). In DFS, the biggest investors are the few sharks, who divide among themselves as their winnings nearly all the pooled bets. The investments of problem gamblers and addicted gamblers are perhaps not as over-represented in the winners’ pot as they are (> = 50%) in the gross gaming revenue of a casino or a state Lottery. In that sense the AG’s action in ordering a shutdown of DFS is consumer protection as well as an effort to prevent the cultivation of problem gamblers.

Why don’t we see many problem gamblers or members of their circles here today?  Why do most complaints voiced to the media re DFS relate to how the player was cheated or had winnings withheld, not how he was suckered into layers of debt and despair?

  • Most problem gamblers and addicted gamblers are in denial at any given moment.
  • The culture of recovery says “Don’t make the casino/game/track or whatever responsible for your gambling problem. You take responsibility.” This keeps current and recovering problem gamblers from taking a public stand against gambling.
  • The many victims of state-sponsored predatory gambling who are not gamblers themselves (collateral casualties) need not be “gambling-neutral,” but are often too ashamed or guilty to speak out against the casino or the operator.

Thus DFS and other longer-established forms of internet gambling not legal in most states, like i-poker, have great potential for harm that reaches beyond the ostensible victims, beyond the problem gamblers themselves. This is why they are illegal.

To legalize illegal activities and “regulate” them is not a solution. It gives government a conflict of interest. Tight regulation lowers profit margins and hence government’s share.

When DFS have been unequivocally recognized in NYS courts as gambling and therefore incontestably illegal, the legislature should not cure these companies by legalization and regulation. Thank you.

Post script: the operations of Fan Duel and Draft Kings in New York State have not ceased since the AG called for that to happen.  They  continue  while the case is on appeal.  A decision appears unlikely before the end of 2016.

Permission is hereby granted to reproduce any part of this piece as long as the permalink above is cited.

Hold ’em Harmless?


The following letter was sent by US mail on 26 October 2015 to the Delhi District office of State Senator John J. Bonacic.  An electronic version  with attachment was transmitted to the  Senator’s  e-mail three days later.



Dear Senator Bonacic,

At the hearing you held Sept 9 regarding S5302 there was good news: you gave at least a little time to the important question of whether legalizing i-poker would have an impact on problem gambling and gambling addiction. The bad news was that you readily accepted a “negdec”   from Mr Pappas of the Poker Players Alliance. I fear your questioning was to get this assurance of no harm onto the record.

Your questioning of Mr Pappas did not show the trial lawyer skills that Mr Featherstonaugh accorded you later in the hearing. Was this just a lapse in preparation, or was it deliberate? Whichever it was, your “OK” to Mr Pappas’s reply surely gave most listeners the false impression that internet gambling — of all kinds – has been well-studied and found not to be worse in any dimension for individuals or populations than other kinds of gambling. Not so.

I would be glad to meet with you and your staff to go over some basic principles of epidemiology and public health that should be applied to the important work you and your colleagues do. They are explained in the enclosed 12-page critique. Sad to say, the approach in the September hearing to this basic science  is no more valid than evaluating a corporation by whether it declared a profit or loss in the most recent annual report.


Stephen Q. Shafer MD MPH

Chairperson,  Coalition Against Gambling in New York  917 453 7371

Below is the critique that was enclosed with the cover letter

Considerations of Internet Problem Gambling in the New York State Senate i-Poker Hearings of September 9 2015: an Epidemiologist’s Critique

Stephen Q. Shafer MD MA MPH                                              27 October 2015


The author is a retired Clinical Professor of Neurology, Columbia University and Chairperson of Coalition Against Gambling in New York, a non-profit all-volunteer organization registered in Buffalo.


During the Sept 9 2015 hearing on legalizing i-poker held by Senator Bonacic there was scant mention of the potential for i-poker or other forms of i-gambling to cause addiction or problem gambling or to sustain these conditions when they had developed in another setting such as a b and m [bricks and mortar] casino. Below is the nearest approach.

At about 15:50 Mr Bonacic, chairing, asked Mr Pappas, CEO of the Poker Players Alliance and the first person to testify, “Is there a ratio for the amount of people that play on line poker, gaming, as opposed to those that get addicted? Is it one in three hundred, one in five hundred?   Is it ascertainable?”

Senator Bonacic seems here to be groping for the prevalence of gambling addiction among persons who do i-poker or i-“gaming.” I expect he meant to make the ratio as he set it up  500 to one, not one in 500. He is certainly leading the witness towards a very low proportion of addicted gamblers among all on-line gamblers.  Note also that the question does not separate poker from other types of i-gambling. This is likely intentional, to blur distinctions in readiness for the transition I think he and associates plan, from two particular forms of i-poker to all forms of casino-type “gaming” on the internet and ultimately to i-betting on sports.

 Mr Pappas responded that he didn’t have notes in hand but that his written testimony gave backup. He summarized,    “There is not a discernible increase, not any increase.” Mr. Bonacic replied “OK. ”

Note well: Mr Pappas did not answer the question Senator Bonacic asked, which was about a “ratio,” not an increase. His response belonged to a question not put. Perhaps he had been expecting something like one of the following:

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From the Front Lines Against Predatory Gambling

Nelson Acquilano photoA Stop Predatory Gambling National Day of Action in Geneva NY 26 September 2015 was co-sponsored by  CAGNY, Women’s Interfaith Institute, Geneva Assembly of God “Celebrate Recovery,” Phelps Baptist Church, and Concerned Citizens of Seneca County (CCSC).       Nelson Acquilano. LMSW, MPA, MA gave the audience his views on the untrue assertion that making  predatory gambling more convenient benefits the community and the region.  Mr Acquilano (pictured) is on the Board  of Directors of CAGNY.

” My name is Nelson Acquilano. Many of you know me because of the work I have done in the Finger Lakes and because of the many different human service groups and agencies I have worked with over these past 40 years.

We have a terrible problem in New York. Our families, our communities are in great crisis. But this is not an economic problem. No, New York has a Quality of Life Problem… and it is a real crisis for our families and our community.  It will only further decline if we allow it.

New York has a high rate of crime…. a high rate of divorce, high rates of child abuse, academic underachievement, teen pregnancy, and drug abuse.….. our jails are full, our schools are faltering, and our families are failing. Now given this background, the introduction of gambling in New York is contra-indicated.

Given these community problems, to allow a known environmental carcinogen such as gambling into an otherwise delicately balanced community… to take a powerful risk factor, a known risk factor — and allow it to flourish will only further undermine the healthy families and healthy communities we are trying to build and maintain.

Gambling is one of the most destructive dynamics that can be introduced into a community, and when it is – it spreads like a cancer – like an epidemic, leaving broken lives, broken families, and broken communities in its path.

All states that have legalized gambling have found subsequent dramatic increases not only in the incidence of compulsive gamblers, but in crime, family dysfunction, divorce, bankruptcy, and mental illness. But by then it’s too late. Once legalized, communities cannot reverse the trend and control the increase in the gambling addiction and negative consequences.

Compulsive gambling leads to many thousands of personal and family bankruptcies each year. It leads to lost homes, broken families, lost savings accounts, lost college funds, and to a dramatic increase in crime including embezzlement at business. It is strongly correlated with mental illness, and also seriously affects the spouse, children, parents, and friends of the problem gambler.

Some states have reported that divorce tripled after the introduction of casinos. Others reported an explosion in domestic violence.

Other research shows that gambling is indirectly subsidized by the taxpayers. For every dollar that gambling contributes in taxes, it usually costs the taxpayers at least 3 dollars (and higher numbers have been calculated) because of major increases in the welfare system, mental health system, and the criminal justice system. The ultimate cost in broken families and disintegrated communities from gambling never even comes close to justifying it as a means to raise revenue.

Gambling is exploding across America but America is not ready for the consequences.

The National Council on Problem Gambling has found that pathological gamblers have a suicide rate twenty times higher than non-gamblers.

Now if we could stop an epidemic – something that would destroy tens of thousands of families wouldn’t we have an imperative – a compelling moral and ethical responsibility to serve and protect our families?

And that is why I am against gambling anywhere in New York State, but especially in the Finger Lakes. Studies show that the negative consequences impact not just upon the host community, but all communities within a 50 mile radius…. the region I have served for the last 40 years. Gambling is simply the worst strategy for a delicate community.

I would like to leave you with a few final points:

1) It never ceases to amaze me how the moral and ethical implications of gambling are so easily dismissed. When I see casino owners say that the future of gambling is with our youth and we need to have more youth gamble, when I see a casino that comes out and targets women to get more women to gamble, when I see a casino develop a youth program to get more college students to the tables….. then I need to question the morality of that entire industry.

In fact, one college Chaplin told me he is increasingly experiencing college students with a high percent of gambling issues – losing their tuition and room and board monies.

And by the way, a couple of years ago, researcher Natasha Schull who wrote the book “Addiction by Design” was in Rochester. She explained how the gambling industry models psychological experiments on rats for behavior modification techniques on humans, to increase time – and money spent – sitting and playing at slot machines.

She explained extensive studies on Time-on-Device, on algorithms of “Intermittent Positive Reinforcement”, and on how the gambling industry studies the best variance of high-frequency low payout wins and low-frequency high payout wins to keep you gambling. These are some of the strongest shapers of human behavior.

And today’s slot machines are actually learning your preferred method of play….. it hasn’t reached the level of artificial intelligence yet, but according to Natasha… the machines are studying YOU.

There are some 30 organizations opposed to casino gambling in New York, including:- The Institute for American Values

The New Yorkers Family Research Foundation

–   the Roman Catholic Church

– the Episcopal Church

– the United Methodist Church…

– the Baptists….
– the Interfaith Impact of New York State, and

– the New York State Council of Churches!

The Catholics….. Methodists, Baptists and Episcopal Churches are all publicly on record as denouncing the expansion of gambling…..   and I don’t know about you… but I prefer to listen to them for my spiritual health and wellness.

2) Second, the gambling industry follows a business model – that model is all about growth and expansion….. to survive, profits need to grow, which means more and newer ways to gamble… and more and newer ways to get non-gamblers to the table.

At the Senate Hearing one gambling company was asked if they are concerned about the proliferation and saturation of gambling, and their response was “no”, that is not a concern of ours.

Well let me say that it is a concern of ours! And it is already happening. There are all types of efforts to expand gambling throughout New York State. We’ve opened Pandora’s Box.

There is one Italian City, Pavia, that has so much gambling, that it has surpassed most every other city for debt, bankruptcies, depression, domestic violence and broken homes.
It is devastating to the community, and now the people said they have had enough and are trying to pass legislation to curb gambling.

3) And third, if you take a look at the true voting outcome for Proposition I, even with all the manipulation and irregularities to get the voters to vote for it….. Proposition I was voted DOWN in the central Finger Lakes region:

If you include….. Ontario County, Cayuga County, Monroe, Onondaga, Schuyler, Seneca, Wayne and Yates Counties….. 125,031 voted to pass Prop I, but over 126,648 voted against it!

Developers wanted to put a casino in Rochester, but the people defeated it….. they wanted to put a casino in Syracuse, and the people defeated that…. And now they are trying to put one here in the Finger Lakes….

I believe that local citizens groups should be honored, not demonized, for their fight against a proposed casino.

You know, Governor Cuomo accepted some $715,000 from the gambling industry prior to changing the constitution, although he did not include gambling in his pre-election platform. According to Common Cause, over $47 million had been spent on lobbying and campaign contributions to other senators and assemblymen by the gambling industry prior to the changing of the NYS Constitution.

And there have been other discrepancies and irregularities, even with Proposition I itself.

I have reviewed over 100 gambling studies and articles, and I have yet to find one that says that gambling helps to build positive youth development. I have yet to see one that says that gambling supports healthy families. I have yet to see one that says that gambling builds strong communities… in fact, they all say exactly the opposite.

When local groups t recognize the real environmental impact – the human costs, and decide to commit themselves to fight such a devastating dynamic as casinos present, then I applaud their work….. and ask our representatives to remember that the fundamental purpose of public service is for the health, safety and welfare of our residents… and there is nothing about gambling that supports the health, safety and welfare of the people.

Thank you.”

Permission is hereby given to reproduce the words of the above text in whole or part as long as the above permalink is cited and Nelson Acquilano is credited as author.

The Curse




A Talk at Patchogue-Medford Library Long Island NY  July 30, 2015  by Robert H. Steele

Mr. Steele is a Connecticut business executive and former U.S. Congressman, and was a nominee for Governor of Connecticut.


Comment by CAGNY editor: This talk starts about  a book set in Connecticut but moves through many important issues about predatory gambling before homing in on a location in New York State now threatened with the imposition of a 1000-device slot parlor.  It is a privilege to present it here.

Thank you for the invitation to come to Patchogue and for your interest in my book, The Curse: Big-Time Gambling’s Seduction of a Small New England Town.

The book is a fact-based novel set against the explosion of casino gambling that hit southeastern CT during the 1990.

The novel begins with the Pequot War in 1637, when Connecticut’s Puritan colonists joined with their Mohegan allies to defeat and almost destroy the Pequots, who were the largest and most warlike of the Connecticut tribes. The story then jumps 350 years, as these two tribes reemerge to build the world’s two biggest casinos – Foxwoods and Mohegan Sun – and a Connecticut family, led by a descendant of one of the Puritan colonists, becomes embroiled in a battle to stop a third casino that threatens the family’s town and ancestral home.

In the end, a small, quintessential New England town faces a Faustian dilemma in which it must choose between preserving its character and values or accepting an enormously seductive offer that would change the town forever.

The Curse, in sum, is a novel based on fact, and this evening I’d like to focus on the factual background of what has occurred in Connecticut and elsewhere – in other words, on the story behind the book.

First, I should probably give you a little more of my background since it entered into my writing the book.

I represented eastern Connecticut in Congress in the 1970s. Then, after running unsuccessfully for governor, I left politics and my family – my wife and four children and I – moved to Ledyard, Connecticut well before anyone dreamed of casinos coming to Connecticut. Those two experiences – knowing Connecticut’s politics as intimately as I did and then living in the midst of the subsequent casino explosion – gave me a front row seat for watching the political maneuverings that led to the casinos and then seeing their impact.

Indian casinos got their start in 1988, when Congress passed the Indian Gaming Regulatory Act, which was seen as a means of promoting tribal economic development and self-sufficiency by allowing federally recognized tribes to open casinos on their reservations.

It would be fair to say, however, that Congress had no idea of the Pandora’s Box it was opening when it passed the act.

As it turned out, the law not only opened the door to Indian-owned casinos, but it spurred the legalization of commercial casinos as many states rushed to open casinos as way to raise revenue without directly and overly raising taxes.

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Revenue Enhancement via Problem Gambling

Revenue Enhancement Via  Problem Gambling










The operational approach of the NY State Legislature to problem gambling is horribly clear from the voting records on S7833 (passed 55 to 4 on June 20 2014) and the Assembly “same as” (A 10075 , Goldfeder sponsor) which  passed 119 to 9 on June 19.  The approach is to exploit problem gamblers, not help them recover.  The bill, not signed by the Governor yet,  allows racinos to close their  video lottery terminal (VLT) floors  at  6 AM instead of (previously) 4 AM.  It also  increases “free” play credits.   The memo is below in italics.


TITLE OF BILL: An act to amend the tax law, in relation to the

authorized hours of conducting video lottery gaming and the amount of

free play authorized therefor


The purpose of this bill is to enhance the revenues of video lottery

gaming facilities in New York.


Section 1: Amends section 1617-a (b) of the tax law to allow video

lottery gaming facilities to operate until 6:00 a.m.

Section 2: Amends section 1617-a (f)(3) of the tax law to increase the

annual value of free play allowance credits authorized for use by a

video lottery gaming facility from ten to fifteen percent of the total

amount wagered on video lottery games after payout of prizes.

Section 3: The effective date.


This bill is needed to provide incentive for individuals to visit the

video lottery gaming facilities in order for these facilities to enhance

revenues and attendance.


This is new legislation.


None noted.


Comment by CAGNY editor: At 3:50 A.M. those racino VLT users who don’t want to stop at 4 o’clock are not the exhilarated, beaming young couples in racino advertisements. They are mostly problem gamblers and addicted gamblers who, if forced out at 4 A.M., would on the average leave less of the money they are using that morning than if they stayed until 6.  S 7833 was written deliberately to exploit that thin stratum of casino users (perhaps 12%) who provide about half the “net revenue” of the average casino.

Coalition Against Gambling in New York honors the insight and courage of the few legislators who voted NO.


The opinions expressed are those of the writer, Stephen Q. Shafer MD MPH and are not necessarily shared by any or all other members of CAGNY.  Permission is given hereby to quote or copy in whole or in part as long as the above permalink is cited.

The picture is from creative commons  2269211810_030e548987PHLSunrise.jpg

“Replacement problem gamblers”

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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

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.

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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 ?


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.


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    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.

The Crying of Prop. 1, 2013

The Crying of Prop. 1

Stephen Q. Shafer, M.D., M.A. , M.P.H.

Chairperson, Coalition Against Gambling in New York








Summary Social costs due to  increased  problem gambling after  “up to seven” new casinos open in New York State will almost certainly exceed revenues from the State’s taxing new casinos.  These costs are real but externalized,  thus easily hidden or denied.  Just a 10% increase in the statewide prevalence of problem gambling would almost wipe out the gains in revenue to the State treasury and create thousands more gambling addicts than “permanent good jobs.”   A  25%  increase would nearly negate the entire sum ($1.2 billion)  targeted for recovery via in-state casinos.  In their quest for revenue without increases in conventional taxes,  state officials implied by silence  that  the number of  new problem gamblers anticipated either cannot be estimated or need not be. It is a nullity, off  the board.

No public policy can be evaluated properly without considering costs. Yet that’s what happened in the legislature and on the campaign trail.  This paper gives a public health physician’s   viewpoint of  the dishonesty in marketing “Proposal 1” right into the polling booth.

Introduction  The victorious campaign to legalize casinos in New York State  played up  hoped-for benefits and  played down  likely costs.  While conceding when pressed that problem gambling is a problem, promoters never  acknowledged  the flip side to making casinos more convenient to New Yorkers.  This step, to become law on January 1,  will (not might, will) create new addicted gamblers and new problem gamblers as well as service current ones.  Costs quite possibly in the hundreds of millions of dollars per year  will extend  to society from this sector.

Neither government nor business interests have made public any consideration whatsoever of   these costs.  The deliberate silence moved me, as a physician trained in public health, to compare these costs to the much-publicized  benefits.  I focused on a narrow question:  will the inflow of casino money to the State Treasury equal or outweigh the costs of the new casinos, externalized to New York’s people?  This is only one type of benefit, only one category of costs.

Analysis   What inflow is expected?    Proposal 1 promoters  have repeatedly said that gamblers from  NY  “spend”  $ 1.2 billion / yr  at  casinos in adjoining states and Canada.  [1]   The basis for this figure is not known to me.  In 2012 patrons from NY left behind at the two Indian casinos in Connecticut $259 million. [2]   Presumably the other billion was left behind in Pennsylvania, New Jersey, and Canada.  If this amount were lost in NYS  instead of elsewhere,  taxing it at the rates in Table 1  would yield to the State treasury the following amounts:.


                                                       Abbreviations used in the textNYS     New York StateQSEC   Quantifiable Socio-Economic Costs


Table 1.  Division of  $1.2 billion  “spent”  in out-of –NYS  casinos between State Treasury and  casino  ownership if all  $1.2 billion were kept in NYS.

Tax rate     State Treasury                Owners

$ millions               $ millions

20%                   240                            960

25%                   300                            900

30%                   360                            840

35%                   420                            780

40%                   480                            720

45%                   540                            660

At  30%  (reasonable guesstimate for NYS non-tribal casinos with 70% slots 30% other), the State Treasury would gain $360 million.  This is not the only possible benefit to the state, but is the most easily measured and the most talked-about, as in  “educating our children,” “property tax relief.”

Now to costs:   the principal (but far from the only) cost of “up to seven” casinos is the creation of new addicted and problem gamblers through a “distance  effect. ”     For a brief review of the literature, see pages 2-4 of a Dec 2012 paper which looked at the hypothetical scenario of five new casinos in New York City   [3]

The entry of  new gamblers during a specified time (incidence) into a category like “addicted”  is not well  measured by the prevalence (proportion active at a given time) [4].  This is because individuals leave the active prevalence pool over time through recovery, death, imprisonment, totally disabling illness or out-migration.  As hard as it is to measure the  prevalence of problem gambling,  it is far harder to measure incidence. Thus prevalence, fraught with methodological problems,  is the usual benchmark.

To assess costs of new addicted gamblers and problem gamblers we need  head counts and  per-head figures for cost.  The cost figures cited most often are from Earl L. Grinols, Distinguished Professor of Economics at Baylor. His book shows clearly how he came to them. [5]   I call these Quantifiable Socioeconomic Costs  (abbrev. QSEC), though Grinols does not use that term.  In  2012 dollars  QSEC  are $13787 / yr  per pathological (addicted ) gambler; those per problem Gambler are $3600 /yr .  Note well:  QSEC do not include suicide, divorce,  mental anguish, family disruption.  The costs of   these calamities are un-quantifiable; no monetary values can be assigned.  Thus they are even easier to disregard than QSEC.

Regarding the head count: the number of active addicted gamblers in NYS can be estimated by applying to a rounded-off figure of 15 million adults statistics for prevalence among adults of addicted (1.14%) and of problem gamblers (2.8%).  These are not recent but are well-established from a meta-analysis. [6]   In a national sample reported in 2004 [7] the prevalence of pathological and problem gamblers combined was 3.5% .

If at baseline there are 171,000 active addicted gamblers (15 million * 1.14%) and prevalence goes  up  by 5%, NYS  has  at least 9,000 new addicts.  Table 2 shows the number of new cases for a given increment in prevalence,  and the QSEC attached.  Table 3 works the same way for problem gamblers.  Table 4 combines the QSEC  for both types, arrayed by % increase.

Table 2.  Number of  new addicted  gamblers in NYS and Quantifiable Socioeconomic Costs of new addicted gamblers, by increase in prevalence  over baseline.  e.g. 9,000 * $13,787 /yr = $ 124 million/yr

Increase                       New addicted  gamblers   QSEC of increase in $ millions/yr

5%                                             9,000                         124

10%                                         17,000                         234

15%                                         26,000                         358

20%                                         34,000                         469

25%                                         43,000                         593

30%                                         51,000                         703

Table 3.  Number of new problem gamblers in NYS and Quantifiable Socioeconomic Costs of new problem gamblers, by increase in prevalence  over baseline. e.g. 21,000 * $3,600 /yr = $ 76 million/yr

Increase                       New  problem  gamblers   QSEC of increase in $ millions/yr

5%                                           21,000                         76

10%                                         42,000                         151

15%                                         63,000                         227

20%                                         84,000                         302

25%                                       105,000                         378

30%                                       126,000                         454

Table 4.  Quantifiable Socioeconomic Costs of new addicted  gamblers + new problem gamblers by increase in prevalence  over baseline.  e.g. for 5% increase in both,  total is $124 + $76 = $200 million/year.

Increase                       QSEC of increase, in $ millions/yr

5%                                           200

10%                                         385

15%                                         585

20%                                         771

25%                                         971

30%                                       1157

From Table 4 we see that if prevalence of addictive gambling and of problem gambling both  rise by only 10%, the QSEC attached to that rise are more than the $360 million the State would recover by taxing 1.2 billion at 30%.

We must consider, though, that persons who became gamblers because of the convenient casinos (some addicted,  some  problem gamblers, most in neither type) will also lose money there  that can be taxed.  How much might that add to State treasury  revenue?  Would that be enough to “cover” the QSEC springing from new casinos?  To answer that we need an estimate for  losses by type of gambler.

Grinols and Omorov in a 1996 paper [7]  estimated annual losses to casinos by persons living within 35 miles of  Las Vegas or Atlantic City  at $14,200/year (1992 dollars)  per one hundred  persons.    This includes people who do not go to a casino from one year to the next.  Converting to 2012 dollars gives   $ 23, 400 per 100 persons.  This figure was used in my Dec 2012 paper to reckon that losses to casinos by the 8 million residents of Greater New York came to $1.87 billion/year. I assumed that all losses were to casinos outside the reach of NYS taxation.   If  $23, 400 were applied to the entire NYS population it would mean that losses to casinos come to  $3.5 billion /year,  three times higher that of the commonly-cited  estimate of 1.2 billion /year.  Assuming that  $ 1.2 billion for the whole state is correct, a likely explanation is that since no resident of Greater NY  lives within 35 miles of a full-service casino,   the $23,400/100 persons/yr  figure was high; the longer distance lowers willingness to travel then spend.

$1.2 billion lost at out of state casinos by residents of NYS means that the average loss per year is $1.2 billion/15 million, or $8000/100 persons/year.  I took liberties with the famous table in Grinols and Omorow [8] , keeping the ratios of annual loss per gambler between types very much like those in the original but lowering the values so that the annual loss / 100 persons comes out to $8000, not $23,400.  The results in dollars of 1992 are in Table 5.

Table 5.  Hypothetical structure of casino revenues in 1992 dollars, by type of gambler   This table is formatted like the one in Grinols and Omorov [ref 8]  but the input values  in columns 1 and 3 have been altered, producing figures in column 4 very  different from those in the original.  Percentages in column 5 are similar to those in the original.

Prevalence in population

Type of gambler

Annual loss per gambler

Annual loss per 100 adults

Cumulative % of casino gross












Heavy bettor





Light bettor










All types





Converting  $4852 dollars of 1992 to $8006 dollars of 2012 gives the amount lost last year out of state /100 persons in population. For a population of 15 million the annual out of state loss is reckoned at $1.2 billion.  If new casinos caused no rise in prevalence of problem gambling AND stopped 100% of leakage,  this table could also represent the gamblers’ losses ( ~ = “gaming revenue”)  at casinos in New York after new casinos are at full steam.  Of this $1.2 billion the State Treasury gets  $360 million at 30% tax rate.

Leaving the baseline of  Table 5, consider the changes in  losses at casinos by gamblers after new casinos open in state,  assuming a 10% rise in prevalences of gambling addiction and problem gambling.  In Table 6,  note  new figures in column 1, same figures in column 3.  The annual loss to casinos rises, as does the revenue to the state treasury.

Table 6.  Hypothetical structure of casino revenues in 1992 dollars, by type of gambler, reflecting changes in relative frequencies of type in population due to new casinos    Assumption: compared to baseline there is a 10 % increase in prevalence of all types of gambler and a decrease in proportion of non-bettors from 40% at baseline to 34%.

Prevalence in population

Type of gambler

Annual loss per gambler

Annual loss per 100 adults

Cumulative % of casino gross












Heavy bettor





Light bettor










All types






Converting $5336 to dollars of 2012 gives $8804 / 100 adults/yr .  This, multiplied by 15 million adults,    yields $1.32 billion as the amount that would be lost by gamblers from New York at casinos in  New York after new casinos are built.  In this scenario the non-tribal New York casinos realize from the losses of  new gamblers an extra $120 million  ( = $1.32B – $1.2B) of which the State gets by taxation 30 % , or $ 36 million.

If  the prevalences of addicted gambling and problem gambling rise by 25% with new casinos, not just by 10%, the annual loss to casinos rises in proportion.  See Table 7.

Table 7.  Hypothetical structure of casino revenues in 1992 dollars, by type of gambler, reflecting changes in relative frequencies of type in population due to new casinos   Assumption: compared to baseline there is a 25% increase in prevalence of  all types of gambler  and a decrease in proportion of non-bettors from 40% at baseline to 29%.

Prevalence in population

Type of gambler

Annual loss per gambler

Annual loss per 100 adults

Cumulative % of casino gross












Heavy bettor





Light bettor










All types




Converting $6099 to dollars of 2012 gives $10063 / 100 adults/yr. This figure, multiplied by  15 million adults,  yields $1.51 billion as the amount that would be lost at New York casinos by New Yorkers.  Casinos take  in $310 million above baseline (=$1.51B – $1.2B) from the new gamblers, of  which  the State Treasury collects 30%  or $93 million above the baseline intake of $360 million.

Discussion The QSEC to New York society associated with generating 17,000 new addicted gamblers and 42,000 new problem gamblers (10% increase in prevalence of both) are  $385 million, very nearly as much as the revenue to the state ($396 M) from taxing the losses by established and new gamblers at its new casinos.    If the State attended to costs, not just to revenues,  it would see this barely breaks even. The QSEC to New York society associated with generating 43,000 new addicted gamblers and 105,000 new problem gamblers (25% increase in prevalence of both)  are  $971 million, more than twice as much  as much as the revenue to the state ($450 million) from taxing the losses by established and new gamblers at its new casinos. If the State paid attention to costs,  it would see a fiasco.  This $971 million quantifiable cost almost equals the total of  $1.2 billion supposedly at stake.

The advertisements run by NY JOBS NOW implied that every dollar of the 1.2 billion that is lost to a casino in New York rather than across a border will benefit New York.    One ostensible benefit,  outweighed by QSEC,  is tax revenue to be disbursed  back to the populace as “aid to education” or  “property tax relief.”  Another,  not touted so loudly,  might be  to keep the rest of the money within the state where  it will go to overhead and profits of businesses with structures in NYS..  Much of that overhead will, we presume, pass to persons now living in the state as wages and as property tax paid to municipalities (if no abatements).  This would be a benefit to the state.  In fairness and transparency, however,  it  must still be weighed against QSEC, which in the 25% increase scenario may equal or exceed it.   That leaves profit.  Is this a benefit to NYS?    The casino buildings  will be in our state.  Where will the profit-takers be?

It  is too early to know if any of the owners will be NY companies.  Front-running candidates as of  Nov 18  include  Foxwoods, a Connecticut company;  Claremont Partners, “ a partnership of  mostly offshore investors based in the  Isle of Man;”  EPR Properties, based in Kansas City;  Empire Resorts, based in Kuala Lumpur; Concord Associates, New York; Muss Development, New York City; and Jeff  Gural, who lives in New York City.  RH Land Development has its New York State location in Rochester.  Traditions at the Glen Resort has one location, in Johnson City.    Vista Hospitality has its American offices in Binghamton. Caesar’s Entertainment, Las Vegas, is reported to be interested after having been dismissed in Massachusetts.  Rumor says the Stockbridge-Munsee Tribe of Wisconsin is interested. A list like this will change week-to-week.

Conclusion It is sad indeed that voters were sold the amendment by being shown none of the debits, only the income.  In place of a cost-benefit analysis,  the electorate got the travesty of a benefit-only analysis.  New York State’s leaders and legislative followers sought  revenue at any cost, as long as the latter was out of sight.

Most of the debit side of the ledger springs from the formation of new gambling addicts and problem gamblers, creating a public health problem never recognized as such.  In a progressive state such as New York has been and should be, this would have been addressed by Health in All Policy.  HiAP is a fairly new concept, not the law of the land but gaining ground in North America (e.g. California and Ontario).  It came out of a 1998 resolution by the World Health Organization .  Basically, it requires that large – scale governmental policy have a health impact assessment before adoption.  New York State deliberately bypassed the responsibility to offer voters a traditional cost-benefit analysis of policy.  Just as deliberately the state passed up the challenge of  applying innovative HiAP.

It is impossible to predict exactly how many new problem gamblers will develop in the “up to seven casinos” future.  It is also impossible  that there will not be more of  them as our state gets more convenient casinos. Legislators hinted at the threat by putting some funding for treatment and prevention into the Upstate Gaming and Economic Development Act passed last June.  Then they withdrew attention.  No one in Albany made any estimate of the scope of the problem, thus zeroing it away.  If it has no size, it’s nothing.


“Alice laughed: “There’s no use trying,” she said; “one can’t believe impossible things.”
“I daresay you haven’t had much practice,” said the Queen. “When I was younger, I always did it for half an hour a day. Why, sometimes I’ve believed as many as six impossible things before breakfast.”     Lewis Carroll,   Through the Looking Glass



Afterword on prevalence Even if the prevalences of  addiction  and  problem gambling could be shown by a crystal ball to be absolutely stable over (say) four years following the introduction  of casinos, that first phase has created  new disordered gamblers.   Every year, some gambling addicts and problem gamblers leave the “active prevalence” pool  through  recovery, death,  imprisonment, disabling illness or out-migration. Suppose this rate is truly 10% a year;  after  four years,  prevalence of active addiction  that began at (say)  1.14% should be down to 0.75%.  If  it is not, “replacement addicts” have entered the pool,   Some are in-migrants, some relapses, many newly-minted.


Studies that purport to find no statistically significant increase in the prevalence of (say) problem gambling over time after exposure rises may also be underpowered.  A study to detect with reasonable statistical power a near-doubling of  prevalence from 1.14% to a prevalence of 2.17% would require 2000 interviews at each point.  This is impossibly expensive for a public agency to do.  A study to detect a 25% increase from 0.0114 to 0.0142 would require 20,000 interviews at each point.  The increase seems less than minuscule, yet in a population of 15 million it represents 43,000 new addicts.  No wonder the gambling promoters have no fear of someone’s proving an increase in the prevalence of addiction and thus no fear of being held responsible for any ominous trends.


  1. From the Home Page of  NY Jobs Now


New Yorkers currently spend more than $1.2 billion a year at destination casinos in neighboring states. Allowing casinos in New York will keep a lot of that money right here in New York where it belongs — helping to generate economic activity, fund our schools, and provide tax relief.

On the ballot this November, Proposal 1 will ask voters to approve the casino plan passed by Governor Andrew Cuomo and the State Legislature this spring.

2. Center for  Policy Analysis, University of Massachusetts at Dartmouth: New England Casino    Gaming Update 2013.  Economic Development series no. 74

3. Shafer, Stephen Q. New Commercial Casinos Will Mean Thousands of New Gambling Addicts  Dec. 2012

4. Shafer, Stephen Q.  Measure Something: Prevalence of Pathological and of Problem Gamblers.

5. Earl L. Grinols. Gambling in America Cambridge University Press 2004 pp. 171-174.

6. Shaffer HJ, Hall MN, Vander Bilt J. Estimated Disordered Gambling Behavior in the United States and Canada Report to National Gambling Impact Study Final Report 1999

7.  Welte JW et al. The Relationship of Ecological and Geographic Factors to Gambling Behavior.  J. Gambling Studies ( 2004) 20: 405-442

8. Grinols EL and  Omorov  JD.  Development or Dreamfield Delusions? Assessing Casino Gambling’s Costs and Benefits.  J. Law and Commerce 1996-97, vol 16 p 59

The drawing is captured from Wikipedia.  Original by John Tenniel for  Through the Looking Glass and What Alice Found There, by Lewis Carroll

photograph of buckets is by Kevin Krebs from photos 8561188366_eda5d758cf_

The author retired in 2010 as Clinical Professor of Neurology at Harlem Hospital Center, Columbia University. He has an M.P.H. in Epidemiology and an M.A. in Political Science gained while (1976-78) a Robert Wood Johnson Clinical Scholar in the Department of Medicine,  Columbia College of Physicians and Surgeons.  He is Chairperson of Coalition Against Gambling in New York,  a non-profit  registered in Buffalo.

Permission is hereby given to reproduce this post in whole or part as long as the permalink above is cited.

“Measure Something:” Prevalence of Pathological and of Problem Gamblers






Most American adults gamble not at all (20-30%) or so little they get no damage from it. The gigantic social costs of legalized gambling move almost entirely through current “pathological gamblers,” who enmesh and drain their families, employers, employees and associates, and   through current “problem gamblers.”   Problem gamblers, more common,  impose each a smaller social cost. The two groups combined make up 4 % of the U.S. and Canadian adult (>18) population.1   Lower estimates for prevalence are also in the literature. 2, 3     CAGNY reports  use the 4% from the update of the Shaffer et al 1997 meta-analysis 4  as it is based on over a hundred studies, not a single survey.

Pathological gamblers (addicts) and problem gamblers combined generate almost all the costs of legalized gambling. Pathological (addicted) gamblers make up conservatively 1.14% of adults in North America; problem gamblers, at least 2.8%. In the U.S. that’s 2.5 million pathological gamblers (addicts) and 6.5 million problem gamblers.

Prevalence is not a good marker of the rate at which new cases occur. If it seems  stable over time, that does not mean no new  problem gamblers are forming. Not at all. To maintain the same prevalence of current pathological gambling, replacement pathological gamblers must  take the place of those who have recovered or died or disappeared.

Prevalence is usually given as the proportion (can be %) of a population that has the condition of interest (in this case a certain level of gambling) at a given moment or at some point in a time interval.  Prevalence can also be a count. It is not the same thing as incidence. Incidence is a rate,  the number of new cases in a time divided by the number at risk. It too can be correctly given as a count of cases.  Incidence, a rate,  must  be written per <time interval>  e.g  ” per year.”

Prevalence is governed by incidence  and  duration. Cases prevalent at a certain time will not be all the same ones as at a different time. Individuals leave the active ( = “past-year”) prevalence pool by out-migration, recovery, death, incarceration or disabling illness. New cases enter the pool. If prevalence, accurately measured,   is  steady over (say)  ten years,  that stability requires  replacement problem gamblers in the stead of those who died; or recovered (one estimate is that 1/3 recover 5 ); or went to jail (more than half of PGs commit prosecutable crimes); or moved to another country. The lifetime prevalence pool is depleted only by death or out-migration.

There are very few figures on incidence of pathological or problem gambling in adults, though in adolescents and college students these are available, and horrifying.  Estimates of incidence of pathological gambling in North American adults must be drawn from changes in prevalence, full of pitfalls. Rapid climbs in past-year or even lifetime prevalence imply relatively high incidence; rapid drops suggest high rates of recovery or death combined with low replacement.

References and notes to “Prevalence of Pathological and of Problem Gamblers”

1. Shaffer HJ, Hall MN Updating and Refining Prevalence Estimates of Disordered Gambling Behaviour in the United States and Canada. Canadian J Pub Health 2001 92(3): 168-172

2. Gerstein D et al Gambling Impact and Behavior Study. Research done by NORC for NGISC .

3. Petry N, Stinson FS, Grant B Comorbidity of DSM-IV Pathological Gamblers and Other Psychiatric Disorders. J Clin Psychiatry 2005. 66(5): 566-574

[ NOTE:In this report the lifetime prevalence of pathological gambling is 0.6% and of problem, 2.3%. A past-year figure would be lower.]

4. Shaffer HJ, Hall MN, Vander Bilt J Estimated Disordered Gambling Behavior in the United States and Canada Report to National Gambling Impact Study Final Report 1999

Using these past-year prevalence figures the Shaffer et al study projected the following figures in millions of persons who were in each category (based on US pop in 1997)

Table 1. Number of persons classed as Problem or Pathological Gamblers, by age group,  USA , millions


ADULT                                  YOUTH (age 16-17)   ADULT & YOUTH

Prob     Pathol Both                Prob     Pathol Both                Prob     Pathol Both

5.3       2.2       7.5                   5.7       2.2       7.9                   11        4.4      15.4

IMPORTANT NOTE On p. 43 of Shaffer et al are figures showing an increase in the prevalence of past-year level 3  (abbreviated here to PYL3) between the earlier years covered by their meta-analysis (1977-1993) and the most recent three years (1994-1997). PYL3 in adults went from 0.84% to 1.29%, a statistically significant increase (p<.05). Comparing the same two epochs, lifetime level 2 in adults went from 2.93% to 4.88% (p < .05). The absolute increase in prevalence of PYL3 in adults was 0.45% , the relative increase 154%. When the authors merged all the studies, earlier and later, the higher prevalence figure (1.29%) was lost to view. The lower figure of 1.14 is probably too conservative.

A later paper (Shaffer and Hall Can J Pub Health 2001, referenced above as ref 1 found strong evidence that PYL3 continued to rise in the last years of the study interval. The authors updated the library of studies to review, adding ones published since 1997 and also some 91 studies that had never been published, furnished by their authors. 139 studies with at least one prevalence estimate (some compared two instruments) were analyzed for the 2001 paper. For adults only  Past year level 3 1.46%  lifetime level 3 1.92%.  There was a  positive correlation (r = .313, p<.05) for later year and higher prevalence. The authors found fifteen geographic areas in which earlier and later estimates had been done by the same methods. PYL3 averaged 1.02% in the earlier look, 1.33% in the second (p < .05)

5. Slutske WS Natural Recovery and Treatment –Seeking in Pathological Gambling. Am J. Psychiatry 2006: 163:297-502  The researcher looked at the past-year experience of the 201 persons who had met criteria for lifetime pathological gambling in one of two surveys, found that about a third no longer met criteria for the preceding year. The two surveys are in refs 2 and 3


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A Christian Faith Perspective on Gambling

Where there's Muck there's Brass 2295584401_e68196285a_m


Sermon – September 29, 2013 by the Rev. Michael Phillips, Interim Rector,  Trinity Episcopal Church, Saugerties,  New York

Consider these two scenarios:

Number 1: Four men gather at the club house of a local golf course for their monthly outing.  They have been playing together for years and always make a friendly wager.  Each golfer puts $20 into the kitty and then at the end of the round they tally their scores, weighted for each player’s handicap, and distribute the money like this: out of the $80 total, the golfer with the best score gets $50, the second place golfer gets $20, the third place golfer gets $10, and the loser gets nothing.

Number 2: The four golfing buddies decide to take a Saturday and drive to a casino resort where they can try their luck.  When they arrive, they find a parking spot in the huge lot and walk to the casino entrance past rows and rows of buses and cars.  They enter the bright, lively, bustling main room of the casino and wonder where to start.  Each one of the men decides to gamble with $20 and keep gambling until it’s gone.  One guy starts by taking $10 and getting a roll of quarters for the slot machines.  He goes through most of his quarters until he hits a jackpot and walks away with $50.  He takes the $50 and moves to the black jack table where after a few games, wins again, this time $2,500.  He takes his $2,500 to the roulette table and by the end of the night walks away with $50,000.  His buddies were not so fortunate.  One went home with $50, and the other two, after a lackluster evening of ups but mostly downs, lost everything.

What’s the difference between these two scenes? Both have winners and losers.  Both involve making an initial investment with the hope of gaining more.  However, they also have significant differences.  For example, in the first scene, the winnings are modest, at the most $50.  The second place golfer gets his ante back and the third place golfer gets half of his orginal investment back.  Only the last place golfer loses everything.  But also and more importantly, the winning is based upon the skill of the golfer.  Even though they have handicapped the scoring, it turns out that the winner is the golfer who spent hours at the driving range and on the putting green, working on the details of his game.  The loser is the guy who only plays a few times each summer and doesn’t really take the game that seriously. With his handicap he sometimes comes in third and once on a really good day he actually came in second. But for the most part, the dedication and commitment of the serious golfer pays off.

In the second scene, gambling, it’s a “no skills required” environment.  Practicing pulling the lever of a slot machine does not increase or decrease your chances of winning. Winning big at gambling is a matter of pure, dumb, luck.  The other difference is that one person won big, really big, $50,000 big, while most of the thousands of people who came to the casino that night walked away losers.  But even though the one guy won $50,000, the truly big winner, consistently, every night, at every casino without question is “the House.”  The House never loses.  The House will share some of its profit with a few random individuals to keep people coming back, and when I say “people,” I mean, contributors to the House coffers.  The House knows exactly how much to share to keep gambling appetites whetted, and how much to keep for itself.  Casinos do not exist for the gambler.  They exist for the House.

So let’s take a look at the proposed casino legislation in New York State from a faith perspective.

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