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VA Doubles Down On Treatment For Vets With Gambling Addiction

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Veterans Affairs opens the second inpatient treatment center for gambling in Las Vegas, part of a long tradition that dates back to the early days when gambling was first seen as an addiction.

Speaker 1: 00:00 The VA has known for decades that veterans are at higher risk for gambling addiction, but expanding treatment has been slow. KPBS military reporter Steve Walsh visited the Los Vegas VA, which recently opened an inpatient treatment center.

Speaker 2: 00:17 Ronnie Reyes is now just coming to terms with a military sexual trauma from his time in the army in the late 1980s to early 1990s he says he believes it may be one reason he has a gambling addiction.

Speaker 3: 00:30 I think it actually has a numbing effect. Um, when I'm in the heat of the moment at the tables or at a slot machine, I just get tunnel vision and nothing else seems to matter.

Speaker 2: 00:42 Originally from California, Ray has spent the last 26 years in Las Vegas. He continued to gamble even when he was a black Jack dealer. Now he's in treatment. He says it was hard for him to admit he had a problem until he was thousands of dollars in debt.

Speaker 3: 00:57 There's not a substance attached to it. There is no drug, there is no bottle. It's a behavior that can easily be hid.

Speaker 2: 01:06 That's what PTSD are. 60% more likely to have a gambling addiction than the general population. Gambling also contributes to the higher rate of suicide among veterans even. So gambling hasn't attracted nearly as much funding as drug and alcohol addiction. Las Vegas is only the second inpatient treatment program in the VA system that's spend up to 45 days in therapy and in group activities like yoga.

Speaker 4: 01:31 Okay, we're going to stand on one leg. One two, three.

Speaker 2: 01:38 Bernhardt is the executive director of the international gaming Institute at the university of Nevada. Las Vegas.

Speaker 5: 01:44 Drugs and alcohol, uh, have, uh, public faces, public voices, and a much longer history of those voices advocating, uh, in this field. Gambling addiction really is a newer field.

Speaker 2: 01:56 The history of seeing gambling as an addiction actually starts with one pioneering VA doctor Robert Custer in Ohio. Bernard said Custer opened the first inpatient treatment center for problem gambling in 1974 after we saw the symptoms among his drug and alcohol patients,

Speaker 5: 02:13 many of them were, uh, swapping seats on the Titanic as he used to put it. Uh, we're switching from an alcohol or drug addiction to what he thought of first as a gambling addiction.

Speaker 2: 02:25 There are outpatient programs in San Diego. They send vets through treatment programs in the community. But for decades, the Cleveland area VA remained the only inpatient treatment program in the VA system. What this high concentration of gambling and a growing veteran population, Las Vegas seemed the obvious choice for a second.

Speaker 4: 02:48 The

Speaker 2: 02:49 things that makes gambling addiction different from drugs or alcohol is the chase that feeling that even at the lowest point you can somehow win everything back. Roxanne Hutto who runs the 20 bed clinic says she has patients with more than a hundred thousand dollars of den researchers believe it's one reason why veterans with gambling addiction have a higher rate of suicide.

Speaker 3: 03:11 You can treat the gambling. Uh, and once you're treated for the gambling, we're still facing that, that, and how do you go about, um, kind of living a life that's meaningful with that? And I think it's just very different consequences, uh, and kind of very different pathways.

Speaker 2: 03:26 So financial management becomes part of the treatment

Speaker 3: 03:30 paychecks that come in, gone. I get paid one day. The next day I'm broke.

Speaker 2: 03:34 Jim Romero was a mechanic in the air force in the early two thousands it was homeless. By the time he entered the VA program in Las Vegas. He's been battling one addiction or another for 20 years.

Speaker 3: 03:45 I thought I had an under control and I'll never have this disease under control. I have something I have to fight every single day.

Speaker 2: 03:52 The research indicates that among people who have tried gambling, about 5% of the U S population is addicted, but about 8% of the veteran population advocates say those numbers are probably low at the moment. The VA doesn't screen for gambling addiction the way it does for drugs or alcohol. Joining me is KPBS military reporters, Steve Walsh and Steve. Welcome. Hi Maureen. How's it going? When people go in for drug or alcohol treatment, there's a period of detox. Is there anything similar in treatment for gambling addiction? What kind of yes and no. Like we talked about in the piece, there's this chase, this feeling that once I've, I've gambled away all my money, that all I have to do is like get another stock of money and then go right back in the casino and maybe I can win it all back. It really seems like the rock bottom for gambling is this financial distress when you're just so far in debt that you, you really, you really can't do anything but it admit to yourself that you have a problem.

Speaker 2: 04:52 So aside from yoga and financial management, how does this VA inpatient program go about treating gambling addiction? Well, it's very intensive and when we talk about a Las Vegas being like the only the second inpatient treatment program for gambling, you can go other places around the country and where you're doing treatment for drugs and alcohol and gambling. But these are the only two where, where you can do just gambling in specific and it's just simply more intensive than outpatient therapy. So you have several counseling sessions a day. You're, you're looking at a past traumas and how and how that relates back to, to your addiction. How that might've caused your addiction. You, you have things like the yoga and the financial management classes and instead of the one or two times a week with the outpatient, the inpatient just is simply far more intensive, really get tries to get to the root of the problem. And do we know what the success rate is for gambling addiction therapy? It's right up there with drugs and alcohol, which means that it's not perfect. There are relapses. Um, we talked the, the doctor at UNL V who said, uh, you know, if, if somebody had a heart attack 10 years later, you wouldn't say that heart treatments don't actually work. So it is not perfect, but there is clear evidence that it does work.

Speaker 1: 06:13 Now, Robert Custer, the VA doctor who originally identified gambling addiction says he saw some patients in for drug or alcohol treatment switch to an obsession with gambling. And I'm wondering, does gambling addiction manifest later for vets than drug or alcohol abuse? So not really. It's just drugs and alcohol or just

Speaker 2: 06:33 so much more obvious. You can hide that gambling addiction. We talked to that one veteran who worked in a casino. He thought that, you know, he had this under control. He saw people who he thought had gambling problems. Me thought, Oh, but I can lick it. I understand these games so much better than they do. I can give up. It's often a matter of bingeing. People will, will gamble intensely for a couple of days, spend all of their paycheck and then they'll go for six or eight months and not gamble. And that gives them that false sense that, Oh, they've really got this under control when in fact they don't.

Speaker 1: 07:04 The statistic of vets with PTSD having a 60% higher incidents of gambling addiction than the general public. That's really startling. Do we know any reasons why that would be?

Speaker 2: 07:15 Well, I talked to the researchers at Las Vegas and Cleveland where, which is dr Custer's old VA, and they are really become the real resource for gambling addition in the VA system. And they say there's just simply not as much research as they would like, but you know it could be an issue of impulse control and there's certain amount of thrill seeking behavior among people who joined the military in general. But really what it probably is is there is a sedating effect of gambling use zone out. The world goes away even though it's kind of aggressive gambling, the lights and sounds of the casino, you block out the world, you block out your problems and that has the sedating effects that is just like drugs and alcohol. What, you know when I talked to those veterans,

Speaker 1: 07:58 now you say that he, that here in San Diego the VA sends veterans who have gambling addictions to treatment programs in the community and it seems that the VA has been slow in rolling out their own gambling addiction programs. Why is that? Well, it's like like

Speaker 2: 08:12 gambling addiction in general, drugs and alcohol. There is simply much more appro, a much bigger apparatus out there. There's more money to study that there is more money for treatment. There are more of these programs out there, not just in the VA system but in general. Um, you know, the really the only two inpatient programs are Cleveland and now Las Vegas. You can get treatment if those two inpatient programs. But one of the things that the VA told me is that, um, they simply don't screen for drugs, uh, for gambling the way they do for drugs and alcohol. So they may not know. I when I talked to the VA, I got some statistics for San Diego and they said they have about 2000 patients annually in our inpatient substance disorder clinics out of a total about 8,500 patients for the outpatient, for gambling. It's only about 50 or 60 veterans. So they can see that that number may be an underestimate of the people who are involved in treatment even in the San Diego VA system. But they, it really is a question of screening. The GAO actually mentioned this, uh, when, when it came to active duty troops that they thought they should start screening those troops as well because there are issues with security clearances and the like. But so far the DOD has rejected that so they may not have really good data.

Speaker 1: 09:26 And finally, Steve, you mentioned that the fallout from a veteran's gambling addiction is often the accumulation of large amounts of debt and that may contribute to higher rates of suicide among veterans. Is the VA doing anything to try to help veterans facing this debt burden?

Speaker 2: 09:42 Well, that is the real difference between drugs and alcohol and gaming, that once you get all this treatment, once you realize you have this addiction, once you have the resources to deal with the gambling addiction itself, you're left with all of this life crushing financial debt. And can the VA go through and are they going? Are they paying off that debt? No, they're not paying it off. So all they can really do is, is give people counseling on how to live a meaningful life facing all of this debt, give them the financial tools that they, that they'll need to try to help pay off some of that debt. But no, even when you get treatment for gambling addiction, you're going to be left with a burden that's going to follow you along in life. For a very long time.

Speaker 1: 10:25 I've been speaking with KPBS military reporter, Steve Walsh. Steve, thanks. Thanks, Maureen. This story was produced by the American Homefront project, a public media collaboration that reports on American military life and veterans funding comes from the corporation for public broadcasting.

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Maureen Cavanaugh and Jade Hindmon host KPBS Midday Edition, a daily radio news magazine keeping San Diego in the know on everything from politics to the arts.