In 2022, nearly 4 percent of Illinoisans, or almost 384,000, were estimated to have a gambling problem, according to an Illinois Department of Human Services report. Plus, nearly 8 percent are at risk of developing one. Maureen McKinney recently interviewed Jim Scarpace, who is chief clinical officer at the Gateway Foundation, which provides treatment for addiction problems, including gambling. This is an edited, excepted version of that conversation. To reach Gateway for an assessment, call 877-505-4673.

It’s Gambling Awareness Month in Illinois. You wanted to speak to that.

We’re in a time now where access to gambling platforms online are greater than they’ve ever been. During the Superbowl this year, I think there were three or four commercials specifically around sports betting. But in addition to that, you know, even at the state level now, our lottery system is virtual and online. So you can place bets virtually for the games that people use to historically play gas stations like lotto, or Mega Millions, or Powerball, even instant tickets are online.

I think all that being said, many people can manage that we know that just like we know substance use disorder. There are people that, for example, drink alcohol and can manage their alcohol use, but there is a percentage of the population who suffer from a gambling disorder. For individuals who suffer from this disease, it leads to devastating consequences not only for them, but for their families, for their careers, for their interactions in the community.

And so we really want to help individuals that fall into that gambling disorder situation, or meet the criteria for what we would call a gambling disorder, get the help and treatment they need to achieve recovery.

Our stance is more to make people aware of the risk of gambling disorder, understanding it to be what we would call a process addiction that impacts the brain and really can change the brain’s physiology. I think there’s many studies that we’ve seen over the last few years that actually can map the parts of the brain now that are impacted by gambling disorder specifically, for us. Those are things like the prefrontal cortex, which manages problem solving, and decision making, and the limbic system, which is the pleasure center of the brain. And that’s really where gambling disorder tends to activate.

Similar to other substance use disorders, I think the difference with gambling, and like substance use disorders where you’re putting a substance in your system, and then eventually, over time are in treatment, that substance can be discontinued, or eventually comes out of the body. Gambling, being a process addiction, doesn’t follow those same principles. So the more someone with a gambling disorder has access to resources that might trigger that gambling disorder, like online sports betting, or really any kind of access to gambling in the community, the harder it is going to be for them to manage the issues that come with a disorder.

Anecdotally, or actually if you have tracked it, has there been an increase in people seeking gambling treatment through Gateway since the increase in Illinois gambling options?

Yes, I would say that over the last few years, we have seen an increase in problem gambling, and individuals and families reaching out for help to try and address this disorder in addition to individuals coming forward with a substance use disorder, for example, that are getting treatment or facilities that also in the course of that treatment. even talk about their issues with problem gambling.

So one of the things we’ve done is for any individual who comes in even with a mental health or substance use disorder, or gambling may not be what’s discussed up front as a need, we do a thorough assessment in that area. And what we find is, many individuals with a substance use disorder, or a mental health disorder have issues with problem gambling or may have a gambling disorder. So continuing to engage in that behavior if you have a gambling disorder, and if that part of your brain is activated as a result of the gambling disorder, you need to engage in more of that behavior over time, in order to activate or activate that pleasure center at the same level that you activated it initially.

So what that means is, I may start out with what I deem as harmless gambling, but then it escalates over time as a result of having a gambling disorder, where I put myself in more high risk situations around gambling where I have more at stake, and more to lose.

The other piece that we know from the science is that individuals with a gambling disorder are also more likely to be at risk for suicide, because of the increased risk of depressive disorder as a result of the gambling experience and being in high risk situations and losing not only money, but possibly their careers, their families, their homes. The risks associated with problem gambling and gambling disorder are not just about losing money or losing relationships, it also increases your risk for substance use disorder, suicidal ideation and major depressive disorder.

And know that that whole piece is so important because as much as this feels overwhelming, as much as this feels like, this is who I am and it can’t be changed., that’s just not true. And we’ve seen thousands of people recover from gambling disorder, as well as mental health and substance use disorders, and we really want to help families and individuals get the services they need so that that can be a reality for them.

What are the signs that someone has an unhealthy relationship with gambling?

I think there’s a few very important signs. One of them is to be unable to stop gambling on their own, despite negative consequences. For most people, for example, if they lost a substantial amount of money on a bet, or, went to a casino and lost some money, that would really be a negative reinforcement for them. And most people would kind of start to manage, you know, their relationship with gambling differently. But someone with a gambling disorder, that’s very challenging to do, and that one loss turns into, well, maybe I’ll win next time. And it’s continuing to engage in that same behavior, despite negative consequences, and unable to beans to be able to stop the behavior of gambling or the process of gambling on their own.

The other piece is to continue to, for lack of a better term, up the stakes, so to speak, to engage in more risky gambling, where there’s more risk for loss of money, higher stakes gambling, where the odds are higher again, hoping to generate that win. And with that, I think with gambling disorder, one of the important things to know it’s not even about winning or losing, it’s the emphasis on waiting for the possibility that I might win as that roulette wheel spinning, for example, a thought that oh my gosh, it could land on my number really creates that high if you will, more so than if someone wins or loses. So the anticipation of the outcome, and the constant need for that anticipation to occur, causes them to gamble more and more as another risk area to pay attention to.

What should love ones or friends do they believe someone has the disorder?

Well, first of all, the most important thing to know is that if you are someone with this disorder, it can feel overwhelming. And we know at Gateway, having provided treatment for addiction and substance use disorder for the last 55 years, that sometimes it could feel like there’s nothing that I can do to change this, and we know that’s the furthest from the truth.

So if you’re someone who’s struggling with what you believe may be a gambling disorder, the first step is to reach out and get an assessment. Allow us to help you figure out what treatment options may be available to you. I think for us at Gateway Foundation, that’s the most important step, if you’re a family member who’s worried about your loved one, and worried that their gambling behaviors may be putting them at risk or your family at risk, ought let them know that treatment is available.

Give them the opportunity to access our services. We know that gambling is not an isolated problem, it tends to be related at times to other mental health issues, like depression and anxiety. It’s not uncommon for many people that suffer from problem gambling to also have a substance use disorder like an alcohol use disorder, for example. Soat Gateway, we’re able to treat the person holistically and really address all of these components. So not only gambling, but mental health and substance use disorders that may be related to the problem gambling.

If you are a family member, don’t blame the person. We wouldn’t blame them for other medical conditions, and gambling disorders and addiction, an illness that affects the brain just like substance use disorder, and it can be treated at Gateway. The most important thing to know is we’ve developed over the last 10 years specialized programs to treat problem gambling and gambling disorder. We, for example, have a virtual gambling treatment program that’s available to individuals so that we can meet clients where they’re at. We also have the ability to assess at all of our treatment centers, problem gambling and help people link to the right services to meet their needs.

Each person’s individual needs and services around gambling, again, whether or not there’s an additional substance use disorder or mental health disorder that needs to be treated are taken into account at Gateway. And we really want to develop an individualized treatment plan to meet the person where they’re at. We have centers all across Illinois. So our goal is to really help people identify their recovery goals develop a plan to address those goals, and put services in place to meet their needs.

Why is it a problem to gamble for some people but not others?

One of the things we know about gambling disorder, just like we’ve known about substance use disorder since the 1950s, believe it or not, when the American Medical Association put out their first article around alcohol use disorder being a disease of the brain.

Gambling disorder impacts the same areas of the brain of substance use disorder. Those disorders have a strong genetic predisposition, meaning family history plays a part in being at risk for problem gambling, or gambling disorder, the same way it plays a part in depressive disorders, and substance use disorders. So individuals who have that genetic predisposition or what we would call an addiction pathway in their brain, for many of those individuals, that pathway is there at birth. And it’s activated by in a substance use disorder, for example, access to the substance, but in a gambling disorder, it’s activated by making that first bet, or engaging in gambling behavior for the first time, and it activates that addiction pathway. And if you do not have that addiction pathway, from a genetic predisposition standpoint, you are able to manage both alcohol use, for example, gambling, and other issues in a way that doesn’t have negative consequences on your life.

But for individuals who do have that genetic predisposition, the pathway is activated the first time they engage in that behavior. And so it’s hard for someone with a gambling disorder the same way it’s hard for someone with an alcohol use disorder. People around them may be able to manage those behaviors, okay, but they’re not able to. And so there’s a lot of shame and stigma associated with that. But again, knowing it’s a medical condition, and we really want to break down those barriers associated with shame and stigma, have people come forward and ask for help and let them know that not only is treatment possible, but it happens every day to 1000s of people who are in treatment with us and that there’s hope for them.