A losing game for some older adults

Medical science has given us greater longevity, but for many seniors that also means facing extended years combating loneliness, uncertain finances and age-related infirmities. For today’s growing population of Baby Boom generation seniors, the recreational options to cope with these challenges extend well beyond the benign shuffleboard, checkers and dance classes of an earlier era. Now there’s gambling.

Veteran gambling counselor Lori Rugle, PhD, has seen gambling’s dynamics change dramatically over the past three decades. “One of the best attended activities at senior centers now is junkets to casinos,” observes Rugle, director of problem gambling services at the Connecticut Department of Mental Health and Addiction Services.

“It’s always open, even on holidays, and for seniors, especially older women, a casino is one place where you can go and you are not invisible and you can have fun in a safe environment,” says Rugle.

Rugle says gambling’s attraction for seniors manifests differently for each person, “but inevitably there is some kind of hope, an expectation of providing social interaction, a means to get out of the house, and maybe win something to be life changing.” The odds of the latter are not in their favor, of course.

Defining the effects

Of course, only a small percentage of elderly individuals who gamble develop a gambling problem. Further complicating the picture is some research evidence that elderly people who do gamble live longer and healthier lives, indicates Mark Dixon, PhD, professor at the Rehabilitation Institute at Southern Illinois University and director of a gambling intervention program.

In a study entitled “The Effect of Gambling Activities on Happiness Level of Nursing Home Residents,” published in the Journal of Applied Behavior Analysis in 2010, Dixon and colleagues learned how seniors in nursing homes benefited from gaming.

“Part of the magic is in sustaining social relationships, feeling better, and not letting the inevitable end of your life come to everyday existence,” Dixon says. But for some seniors, this hope transcends the casual outing, and problems develop.

Inside their unconventional research domain that replicates a colorful, activity-filled casino environment, Dixon and his team investigate the effects of the “magic,” using sophisticated neurobiological technologies. “We were shocked that the entire brain activity in gambling excitement is identical to that of substance abuse and drugs,” he says.

“Your brain operates as a dopaminergic system, and when you see a jackpot on the slots’ computer screen, parts of the brain ‘light up,’ just as if we gave you cocaine.”

This indicates that therapies for problem gambling could develop in the same manner as those for substance abuse.

“Problem gambling is where substance abuse was 20 years ago,” says Keith Whyte, executive director of the National Council on Problem Gambling. While most of today’s seniors grew up in a non-legalized gambling environment, today only two states prohibit gambling. Whyte says it is the combination of Internet gambling’s emergence, an explosion of new casinos driven by states desperate for new revenue streams, and an evolution in the games that is designed to increase time spent on the machine “that has transformed gambling from an illegal vice to recreation.”

Whyte says there are few outward signs of problem gambling, and therefore in seniors it is often recognized too late, which “has a direct effect on recovery.”

He adds that comorbidity is a huge problem. Seniors with substance use problems are as much as 40 percent more likely to gamble. This can be uncovered by using some “good cue questions” during an assessment, Whyte says.

He adds that most seniors are able to make informed choices about risk. He believes all casinos, senior activity centers, and any other venue offering gaming should provide literature on recognizing risks, as well as share information on treatment referral sources.

Stepping in to help

Lou Weigle, a Cleveland-based certified gambling counselor who has studied the profiles of gamblers for more than three decades, says “there is not a great structure for intervention” to help problem gamblers. He has developed his own strategy to identify and assist people.

“Once I understand how gambling compensates, and the reasons why people are gambling—whether it is an escape from personal responsibilities, or whether they believe they are inherently lucky, or whether they’re looking to solve money problems—then  I can help them restructure their time, identify anticipatory patterns, and avoid the triggers placing them at risk.”

Weigle cites how some older people who grew up in a time when gambling was not socially acceptable will carry greater guilt over money lost while gambling and will be careful to hide their losses. He says a high level of denial can be addressed through motivational suggestions, “to make people more aware of the negative consequences.”

He adds, “The first step is to talk to them and suggest how this can interfere with how they want the rest of their retirement to look; is the behavior moving them to it, or away from it? You really have to dig into specifics about depression, pharmaceutical treatments, what is their social isolation that is aided by a changing social structure.”

Weigle emphasizes that finding out if people are taking medication for Parkinson’s disease is essential. He recalls what he describes as “a classic gambling addict story” of a respected retired colonel taking a dopamine-based medication who gambled away everything he owned.

Dig deeper

Rugle believes the behavioral health treatment community should expand its screening to analyze gambling issues in a more comprehensive fashion than many current assessments allow. “People don’t come in for problem gambling, but a problem can be there nonetheless,” she says.

“In some cases we learn older people are not taking needed medicine, saying it is too expensive for them,” she adds. “But when asked how they solve money problems, and do they gamble, they will say no, but they will talk about buying lottery or scratch cards every other day.”

While there are common patterns in problem gambling, each client is different, experts say, and interventions should be individualized. There is consensus among those who treat gambling problems that gambling addiction will be the next wave in addictions, particularly in the next few decades as the senior population grows dramatically.

The positive piece, Weigle says, is “if you catch it early enough you can really change the individual’s beliefs.” ■