There are no winners in gambling addiction

Casino culture is set to become a defining presence in downstate New York after the state Gaming Commission signed off this week on three casinos in Queens and the Bronx. The impact of gambling addiction on public health seems an afterthought compared to the lure of billions in gaming, hotel and retail taxes to supposedly boost surrounding communities. My behavioral health team and I will manage the fallout when "entertainment" turns to full-blown addiction.

Our patients with gambling use disorder, or gambling addiction, are an undeniable part of New York's gambling landscape. They embody the concerns the state seemed to have before factoring gambling revenue into the budget. The state Gaming Facility Location Board's decision to approve three licenses in one region — followed by the commission's rubber stamp — may create problems faster than we can solve them.

We'll be reckoning with that worry as calls to gambling help lines surge, while downstate may reckon with what often accompanies gambling addiction: binge drinking, substance use and mental health issues. Reinforcing this reality is a rise in the number of people who mistakenly, sometimes tragically, think they can "win" at gambling. It's a troubling statistic, especially alongside gambling proponents' misunderstanding of the dangers of their products.

Intrusive, compulsive thoughts and behaviors are present across all addictions whether they involve a drink, a drug or a gambling app. Brain imaging studies and neurochemical tests support classifying gambling disorder with other addictions. Fed by uncertainty, gambling activates the brain's reward system. It may seem like a paradox to a nonaddicted person, but for a gambler, risk becomes part of the reward. Telling people to "please gamble responsibly" in casinos, commercials and lottery tickets is no match for the neurobiology of addiction.

This is well understood among addiction treatment professionals, but perhaps less so with gambling proponents who use the vocabulary of personal responsibility. This message misses the point and ignores the nature of addiction. We understand addiction better today than we did during the tobacco crisis of the 1980s and 1990s, and the more recent opioid epidemic. If we don't want gambling to be the next epidemic, we need a new playbook, not waste time denying the allure of harmful products while shifting blame to those addicted to them.

We can start by looking beyond revenue, land and licenses to see the entire landscape. It won't be clear for years how the revenue claims and promised economic benefits of three new casinos in one urban region play out. (Two are aiming to open in 2030.) But we know that accessibility and acceptability of casinos increases gambling participation, which can boost related problems. Accepting the idea that we can win at gambling is a dangerous fallacy. The only winners in gambling are the house and the apps.

Families and communities need to learn how to identify the signs of problem gambling. The health system where I work is trying to stay ahead of it by taking a public health approach. We’re treating gambling as a primary addiction, implementing screenings to identify potential problem gamblers, and educating school leaders about the rise in gambling among teens.

We're thinking preventively because children and teens are at higher risk than adults for developing a gambling problem, and those who start gambling young are more likely to develop gambling addiction later in life. They need to hear early and often: No one is one bet away from a life-changing victory. Hopefully the message can be heard over the noise of three casinos.

Heather Hugelmeyer, LCSW is a senior director for behavioral health at Northwell Health.