VCU Research in Action: Understanding and treating problem gambling

By Joan Tupponce

Elizabeth Childress doesn't remember a time from her youth when she wasn't gambling.

"I gambled my life, my freedom and my money every day," Childress said.

By the age of 18, Childress was also using substances and drinking with friends, a path that quickly led to felony convictions and time in a maximum-security prison where her days were consumed in an endless cycle of gambling.

"When I was incarcerated, every day we would play spades and gamble everything from noodles to meal trays," she said.

Now, thanks to the efforts of a Virginia Commonwealth University professor and her colleagues, researchers are seeking to not only better understand stories such as Childress' but to better understand how to help her and others who suffer from gambling addiction, a condition that is still too often overlooked and understudied.

A growing problem

Carolyn E. Hawley, Ph.D., a professor in the Department of Rehabilitation and Mental Health Counseling in the College of Health Professions at VCU, is keenly aware of the risks associated with gambling through an assortment of community-minded research projects. Those studies include analyzing the demographics and gambling preferences of people who seek treatment and recovery support through the Virginia Partnership for Gaming and Health, a consortium of organizations committed to strengthening treatment and recovery services for individuals who need support for problem gambling. Hawley serves as executive director of the VPGH.

As gambling options have become more accessible in recent years, more people are choosing to participate in the activity, said Jennifer Davis-Walton, director of gambling services at the VPGH, whose members include the Virginia Department of Behavioral Health and Development Services, the Virginia Lottery, the Virginia Council on Problem Gambling and the VCU Department of Rehabilitation and Mental Health Counseling in the College of Health Professions.

For instance, recent demographics from the Virginia Problem Gambling Helpline point to a 63% increase in callers aged 18 to 24 since 2019.

"That is amazing, particularly when you are looking at a young group who are probably people who would not typically reach out," Hawley said.

With the increased availability of gambling in general, and sports betting specifically, the age of people seeking treatment and recovery support has trended younger than before - in fact, 25-to-44-year-olds accounted for 50% of hotline support seekers.

"That is really alarming," Hawley said.

The primary forms of gambling in Virginia - in order of prevalence - are sports betting, slots at casinos and online gambling, according to Davis-Walton. Hawley noted that younger people are more likely to play online games, while older populations who may be otherwise socially isolated are more likely to gamble in person.During COVID, sports wagering and wagering on a range of topics, such as the race for governor, became popular.

"A lot of gambling is like the Wild West. These are huge markets that are not regulated," Hawley said, adding, "We are way behind the growth of what we see in the gaming market."

'A hidden addiction'

Virginia currently has seven Rosie's Gaming Emporium locations in operation with another being built in Henrico County and five casinos, three of which are up and running. Unlike cities such as Las Vegas and Atlantic City, the casinos in Virginia haven't become destinations for out-of-state patrons. "It is mostly Virginians using these venues," Hawley said.

"Some of those folks will develop social problems that we end up taking care of - problems that can decimate families," she said.

Hawley called gambling "a hidden addiction," noting that "you can't smell it or see it in bloodshot eyes." That does not mean it isn't devastating. A gambling addiction too often goes unrevealed until serious consequences for it arrive. For instance, Hawley said some people do not realize they have family members with a gambling addiction until a large sum of money is missing from their accounts or their family member gets arrested for embezzling or otherwise trying to come up with the money for their gambling debts. By then, sometimes, "there is nothing left," she said.

There hasn't been a prevalence study on gambling disorder in the U.S. since 1998 because federal funding for research on the issue has not been available, resulting in a lack of critical data, Hawley said. Through her research, though, Hawley estimates there are six to eight million people in the U.S. with a gambling problem, which refers both to severe gambling issues that meet the clinical criteria for gambling disorder and gambling-related problems that occur at a subclinical level or have not yet been formally diagnosed. She estimates two million qualify as having a disorder.

"We see higher rates in prevalence studies worldwide with youth and college students in the higher percentile," Hawley said.

As part of her role as president of the Virginia Council on Problem Gambling, Hawley took leadership of the Virginia Problem Gambling Helpline, which is funded by the Virginia Lottery. She was surprised to find the extent of the barriers to connecting people with treatment resources. A primary culprit is a lack of federal funding for gambling disorders - especially when compared to other addictions.

Hawley is currently looking at what "we can do with the information we have to better inform policy, workforce development, legislators and service delivery so we know how we can reach people earlier and provide better-informed care," she said.

Knowing the issues with gambling disorders and addictions, Hawley and VCPG advocated for a problem gambling treatment support fund in the state, using some of the tax revenue from sports and casino gambling to form a program that would target prevention and treatment services. The Virginia Problem Gambling Treatment and Support Fund, established in 2020, is overseen by the Department of Behavioral Health and Developmental Services.

With a funding source in place, VCPG, the Virginia Lottery and VCU met to develop a proposal to quickly get workforce in the state trained to treat individuals with a gambling disorder and to quickly set up an infrastructure to get people into these services.

The VPGH's Treatment and Recovery Model, which includes collecting data for research, is designed to ensure that individuals experiencing gambling problems can quickly and seamlessly access help through a coordinated continuum of care that includes regional peer recovery specialists and a statewide referral network.

The model emphasizes speed and efficiency in connecting individuals with care to strengthen outcomes and reduce barriers to care.

"That is where we worked and built this model at VCU," Hawley said. "We thought with VCU's resources and support, that it would be the best and easiest way. We want to keep growing and building as time goes on.

A helpline with results

After many years contending with addiction, Childress put her gambling and substance use behind her and, now in recovery, is dedicated to helping other individuals struggling with gambling as a certified peer recovery specialist for the helpline. Childress also is set to graduate from VCU in the spring with a master's degree from the School of Social Work.

When people call into the helpline, they are connected to a staff peer such as Childress who will connect them with a treatment professional.

The VPGH is continually trying to create awareness about gambling and the importance of support services.

"Gambling has the highest rate of suicide among all addictions," Davis-Walton said. "Research is needed to help support and further develop prevention, treatment, recovery and training."

Peer recovery specialists like Childress have proven to be highly effective, Hawley said.

"Since we've added the peer recovery services, there has been a huge increase in people getting help," she said. "People want to talk to people who have been there. They serve as a model to them on what it means to get past this point and provide that help and hope that their life can change. They are invaluable."

Childress recognizes the signs and hazards of gambling now, but for years was oblivious to how the addiction was harming her and her loved ones. That's why her position with the VPGH is so important to her. "I have loved the journey of this job and helping other individuals with a gambling problem," she said. Ultimately, she said she appreciates the opportunity to be part of the solution in Virginia, one that is strengthening its research roots and expanding its impact.