Too often, people do not recognize that problem gambling and gaming is an addiction disorder that, like other addictions, causes chemical brain changes in those affected. In Rhode Island, the rates of gambling and gaming addiction have increased due to a number of factors including the impact of isolation caused by COVID-19, greater access to gambling and gaming via phone, and an increase in gaming advertising which targets youth. In this interview, Wendy Looker—Executive Director of the Rhode Island Council on Problem Gambling—and Nancy Murray—Problem Gambling Services Program Manager for the Rhode Island Lottery—discuss the importance of gambling and gaming addiction prevention, strategies that parents and caretakers can utilize to prevent gambling and gaming addiction, and the ways by which substance use prevention providers can support the gambling and gaming prevention efforts that are currently happening in Rhode Island.
Could you start by telling us a bit about yourselves and your roles as problem gambling preventionists in Rhode Island?
Wendy: My name is Wendy Looker and I have a background in nursing and social health services, with a focus on opioid addiction. About four years ago, I became engaged in the Rhode Island Council on Problem Gambling (RICPG). As I understood more about the challenges and needs associated with problem gambling in the state, I quickly became interested in learning more. I am now the Executive Director of the RICPG, and through this role, I support the RICPG board and the board activities.
Nancy: My name is Nancy Murray and I am a licensed addictions clinician with a specialty in gambling. I have been involved in gambling and gaming addiction prevention for quite a while, and currently, I am the Problem Gambling Services (PGS) Program Manager at the Rhode Island Lottery. Through this role, I have oversight of all responsible gaming including retailer and marketing practices, employee education at both the lottery and the casinos, and the problem gambling and gaming treatment program through PGS.
Could you tell us a bit about how gambling and gaming can become addictive and why it is so important to prevent and provide treatment options for problem gambling and gaming?
Wendy: One thing that I think many people may not realize is that if someone is developing an addiction to gambling, the receptors in the brain that are engaged are the same receptors that respond to other addictions, such as opioid addiction. So while many people think you can just stop, that is definitely not the case because there is an actual chemical change that occurs in the brain. For those who experience addiction to gambling and gaming, the brain is conditioned to make more dopamine and serotonin in response to the activity, and these chemicals stimulate our pleasure centers, leading to addiction.
Nancy: As with other addictions, a certain percentage of people can engage in the activity without ever developing a problem. However, about 1-2% of the population will develop an issue when engaging in gambling and gaming. This translates to about 16,000 – 17,000 people in Rhode Island, which is about the same number of people affected by opioid use disorder.
In Rhode Island, which populations are most impacted by problem gambling and gaming and how do you work to reach these groups?
Nancy: Currently in Rhode Island, there are two primary groups most impacted by problem gambling and gaming. Typically, we see gambling and gaming issues occurring most often among white men between the ages of 30 and 55. We continue to focus on this population, but we are also seeing increased rates of gambling and gaming addiction among a new demographic of individuals due to people having greater access to gambling and gaming through their phones. Due to this trend, we are seeing increased rates of problem gambling and gaming among individuals ages 18-25. While rates are highest among men within this age group, women ages 18-25 are also gaming at a higher rate.
Wendy: Most people start gambling before the age of 17, and with the new sports betting app, individuals who are 18 years old and in high school can access gambling on their phones. When we look at this age group, it is important to note that their brains are still developing. The rate of addiction potential is doubled for younger people, so it is extremely important to reach this group before chemical changes occur. As we previously noted, not everyone is going to have a problem, but we do not know who will, so it is important that we provide as much access to problem gambling and gaming information as possible. Having access to this information can help people recognize when they might be experiencing a problem and know where to get help.
Nancy: In order to reach this age group, it is imperative that we do outreach to schools, colleges, and parent groups. As Wendy said, it is so critical that these groups of people have access to the necessary information so that they can understand the signs and symptoms of addiction, and know what to look for and what steps to take if a student or child is struggling.
How has the COVID-19 pandemic impacted problem gambling and gaming in the state?
Wendy: With COVID, children were not physically going to school which meant that many youth experienced lower levels of surveillance regarding how they spent their time. Though some parents were able to be home with their children, most did not have the time or ability to monitor what their children were doing on their electronic devices at all times. Additionally, the isolation caused by COVID-19 forced many people to try to find things to do to fill their time, but young people have an especially difficult time making healthy decisions about how to spend their time, and many youth turned to gaming. These factors led to an enormous increase in the amount of individuals who were playing games, downloading games, and watching other people play games on gaming platforms such as Twitch. As a result of COVID, the rates of gaming and purchasing games are up by 83% and 63%, respectively. In March of 2020, there were about 6 million individuals playing Call of Duty, and by May, this had increased to 60 million players. Similarly, the number of Twitch viewers increased from 10 million in January 2020 to 45 million by the end of March 2020.
Nancy: I would add that in gaming advertising, there was and continues to be a huge push to market to a younger age group. I recently saw this in action when I was watching a college basketball game, and 90% of the banners on the screen were Twitch advertisements. It is important to be aware of the fact that younger people are really being targeted by the gaming advertising industry, and their decision making processes have likely been impacted by this.
What can parents/caretakers do to help prevent problem gambling and gaming among youth?
Wendy: The first thing parents and caretakers can do is to figure out how much time their children are spending gaming. Parents and caretakers can work to promote gaming best practices, such as not exceeding 7-21 hours of gaming per week (depending on the child’s age), playing real games with friends and family rather than electronic games with strangers, and supporting cooperative rather than competitive goals by working together. I would really encourage parents and caretakers to think about how much time they want their child using electronic devices, as well as ways to monitor time spent gaming. Some families might make a media plan to map out how much time their children can do things like watching TV or playing games. Parents and caretakers can also directly control access to gaming within the home by doing things like turning off the WiFi at times when they do not want their child gaming, such as at night.
Nancy: I would also recommend that parents and caretakers try to get familiar with the jargon because it is a whole different world. If you are familiar with the language, you can more easily ask open ended questions with your child. With other addictions, we tell parents and caretakers to try to be aware of what their child is doing, and that advice also applies to problem gambling and gaming. Parents and caretakers should try not to assume they know what their child is doing on the computer, and having an awareness of the gaming language can help parents and caretakers to speak openly with their children about how they are spending their time on devices. We also know that gamers are targeted by pedophiles, so it is very important that parents and caretakers remain vigilant in monitoring what their children are doing on electronic devices.
What are some of the greatest challenges regarding problem gambling and gaming prevention? How can substance use prevention providers within the state help to address these challenges?
Nancy: I would say that the greatest challenge is that the addiction is invisible. Gambling and gaming addiction is often a hidden disorder—you cannot smell it or see it, and there is no test to determine whether or not someone is engaging in addictive behaviors. Typically, the only way folks find out about a person’s gambling and gaming addiction is when the person gets in trouble, financially or legally.
Wendy: COVID also presented some additional challenges around reaching people who might be dealing with gambling and gaming addiction. Gambling and gaming prevention activities often rely on our ability to go out into the community and share information with people through discussion, but with the lock down, we had a difficult time connecting with people. We adapted our outreach strategies by doing more mailings and email communication, as well as developing an informational podcast and webinar, but reaching people throughout this time has still been quite challenging. Adapting our outreach strategies was also challenged by the fact that these activities require a bit more money. Doing a large media push with targeted ads could be very helpful in terms of sharing information, but without additional funding, this type of activity would be quite difficult.
Any support that substance use prevention providers in the state can provide would be greatly appreciated. We would love to be able to share more gambling and gaming prevention resources and information with substance use prevention providers so that they could help us share these resources more widely. Things like providing links to the RICPG website and Facebook page would also be very helpful, as if people know how to access these sites, we can help to provide them with more problem gambling and gaming specific information.
Nancy: Substance use prevention providers can also help us to normalize referring to gambling and gaming addiction as just that, an addiction. When we talk about addiction, we regularly talk about substance use disorders and mental health disorders, but we also need to use language that supports the fact that problem gambling and gaming is an addiction. I remember when the alcohol treatment and drug treatment certification boards were separate entities, and it was very difficult to bring them together and to promote language that was inclusive of both alcohol use disorder and other substance use disorders. When we talk about any kind of addiction, I think we need to actually use the terms addiction and disorder so that our language is inclusive of all of the things with which people might be struggling.
Could you tell us about the problem gambling and gaming services and programs that are currently available in Rhode Island? Who are some of your community partners and how do you work with them to spread information about problem gambling and gaming?
Nancy: The services provided through PGS include assessment, referral, case management, and individual, group, and family intervention. At PGS, our community partners include the RICPG, the gaming industry, casinos, IGT—a group that developed electronic chips to randomize games, and the Rhode Island Lottery. The Rhode Island Lottery does a great deal to support prevention efforts within the state. By funding and working closely with the PGS program, they help to identify successful gambling and gaming addiction prevention strategies, gaps, and needs within their program and within the state.
Are there any other messages you would like to share with substance use prevention providers throughout the state regarding problem gambling and gaming prevention?
Wendy: I think one of the most important takeaways for substance use prevention providers is that they should contact us at PGS or RICPG if they have any questions. We do have a number of projects we are hoping to work on over the next year, and collaborating with substance use prevention providers to promote these efforts would be very helpful. During COVID, the RICPG developed a 15 part problem gambling and gaming training for clinicians which took place in June with 51 participants. With our upcoming projects, we are continuing to work on targeting clinicians, but we are also working to create content that would be helpful for other community members such as parents, teachers, and coaches. We always welcome the opportunity to do more work with substance use prevention providers in order to promote these types of trainings and webinars more broadly.
Nancy: Right now there are 23 gambling and gaming addiction treatment providers in Rhode Island. Last year, these individuals provided 2,577 services to 253 people despite COVID. This is a tremendous accomplishment, and I think it is so important to recognize all of the successes that are happening despite the challenges.
