Voters considering Propositions 26 and 27, California’s gambling initiatives, should think again if they believe they’re getting all they need to know from the Secretary of State’s official voters’ guide. It’s bad enough that voters endure a biased bombardment of advertising from monied special interests. It’s even worse that they can’t depend on the State to supply critical information on the substantial health impact of California initiatives.
If you review the guide’s twelve pages on the two initiatives you’ll see assessments of their possible impact on state revenues, law enforcement and local governments. Never once does the guide or its pro and con commentaries consider the major group most affected: California’s gamblers. The initiatives would allocate a small proportion of anticipated revenue to social programs for problem gamblers. But do these programs really help those with gambling addiction? Do they effectively address any of the adverse financial, social or health effects of gambling? You won’t find a comment. Will greater access to gambling increase the number of Californians struggling with gambling addiction? The State doesn’t seem to think that’s important enough to consider.
One reason that gamblers may be off the Secretary of State’s radar is that they are a stealth population. Although research suggests that about 500,000 Californians are problem gamblers, they are out of the public eye, both collectively and individually. Many hide their financial tracks leaving their families completely unaware of the issue. With alcohol addiction, in contrast, families can notice leftover bottles, altered behavior and tell-tale alcohol breath. Doctors also have trouble identifying problem gamblers. We don’t screen for gambling addiction and, also unlike alcoholism, gambling addiction lacks characteristic laboratory findings.
Research also suggests that having a casino within 50 miles doubles the prevalence of the condition. The highest risk individuals are those suffering from substance abuse and mental illnesses such as depression and bipolar affective disorder. We should ask ourselves if these individuals would be likely to resist the temptation of a constant on-line “casino in your pocket,” as proposed by Prop 27. Many would likely suffer de-stabilization of their family life as well as their physical and mental health.
We should ask ourselves if these individuals would be likely to resist the temptation of a constant on-line “casino in your pocket,” as proposed by Prop 27.
I have only one patient with a known history of gambling addiction. JR, 65, has abstained for many years since getting help from Gamblers Anonymous. Still, he vividly remembers the rush of winning and the intoxicating power of “chasing that high.” He also remembers the secrecy and the path of broken trust as his family’s finances were strained and relationships damaged. JR’s problem centered around slots and electronic poker, not the sports betting currently on the ballot. But he recognizes that the gamblers’ rush affects different people in different ways. He sees sports betting as a gamblers’ “gateway drug.” He also worries about the reliability of the measures to prevent minors from using on-line gambling. Not surprisingly, this key issue was also not adequately addressed by the state’s ballot guide.
Despite the experience of a gambling nightmare, JR appreciates the flip side of the coin. Those who bet responsibly on sports using disposable income want convenient, legal options. They might ask why others’ addiction problems should interfere with their choices for the “pursuit of happiness.”
Striking a balance between the libertarian pursuit of individual freedom and the social benefit of reducing risk to the community is just one issue posed by the gambling propositions. Voters will also need to consider the potential benefits of the anticipated increase in tax revenue. Some will also view these initiatives as a test of the legitimacy of the special interest tactic of allocating a cut of the profit to socially popular programs, like aid to the homeless, to attract support.
Sorting out all these complexities would challenge any voter. But how can we expect citizens to make appropriately informed choices when the State reneges on its obligation to fully inform them? The initiative process should not be a game of chance in which voters choose now and learn about undisclosed health consequences later. Rather than rolling the dice on these initiatives California’s voters should oppose both and send a message to the Secretary of State and the initiative industry that they won’t approve ballot measures that neglect adequate consideration of public health.
Daniel Stone is Regional Medical Director of Cedars-Sinai Valley Network and a practicing internist and geriatrician with Cedars Sinai Medical Group. The views expressed in this column do not necessarily reflect those of Cedars-Sinai.