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:
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.
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.