The Rapid Rise of Gambling Addiction with Tim Fong

Dr. Timothy Fong is a Clinical Professor of Psychiatry at the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA.

Dr. Fong completed his undergraduate and medical school at Northwestern University in Chicago. He then came to UCLA and finished his residency in adult general psychiatry in 2002 and was the first accredited addiction psychiatry fellow at the UCLA Neuropsychiatric Institute (2002-2004).

He is the co-director of the UCLA Gambling Studies Program (UGSP). The purpose of this program is to examine the underlying causes and clinical characteristics of gambling disorder in order to develop effective, evidence-based treatment strategies.

Since 2009, he has been the director of the UCLA Addiction Psychiatry Fellowship, a one-year accredited program that provides clinical training in addiction psychiatry.

Finally, he is part of the faculty leadership of the UCLA Cannabis Research Initiative, a multidisciplinary effort to examine the full impact of cannabis on the body, mind and brain.

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Transcript

SPEAKER_00 0:00

Welcome to the Thriving with Addiction Podcast, where we explore how recovery is not just about survival, but about truly with it. Each week we'll dive into the facts, stories, and strategies to help people and families build from addiction and build healthier, more resilient lives. I'm your host, Dr. John Avery. Let's get started. I'm John Avery and welcome back to Thriving with Addiction. Today I'm joined by Tim Fong. Dr. Fong is a clinical professor of psychiatry at the Jane and Terry Semmel Institute for Neuroscience and Human Behavior at UCLA. He completed his undergraduate and medical school at Northwestern University in Chicago. He then came to UCLA and finished his residency and addiction psychiatry fellowship. He now serves as the co-director of the UCLA Gambling Studies Program. The purpose of this program is to examine the underlying causes and clinical characteristics of gambling disorder in order to develop effective evidence-based treatment strategies. He also now runs the UCLA Addiction Psychiatry Fellowship and is part of the faculty leadership of the UCLA Cannabis Research Initiative. Tim, thanks for joining me.

SPEAKER_01 1:12

Thanks for having me. It's great to be here.

SPEAKER_00 1:14

I'll add that you're also the president of the American Academy of Addiction Psychiatry in charge of all the addiction psychiatrists in the country. What are you doing with that power?

SPEAKER_01 1:24

Well, I'm about in charge of all, but it's an amazing institution and organization, the American Academy of Addiction Psychiatry, founded in the mid-80s. We have 1,500 members. It is the home of addiction psychiatrists and also anyone who does addiction care. So uh you've been to those annual meetings, you know what we stand for, we talk about it. And it's just a privilege and an honor to be uh the president for 2026 and 2027.

SPEAKER_00 1:49

Well, I know you'll lead us boldly into the future. And you've always been ahead of your time. You were one of the first experts in gambling. And how tell us how you ended up as an addiction psychiatrist and getting into this field of gambling.

SPEAKER_01 2:02

Yeah, you know, um, it's a fascinating story, at least I think. So I grew up in the suburbs of Chicago uh in the 80s, hard Gen X, you know, enjoying culture and stuff in the 80s and music and movies. And then went to um medical school or college at Northwestern, uh, I got a degree in English and bio. And at the time, I actually wanted to be a science fiction writer. I think Michael Crichton had just come out with ER, you know, um Jurassic Park. And I thought that would be incredible to write science fiction, but that's very, very difficult. I'm like, well, fine, I'll go to medical school. And in medical school, 1994, it was July 1995. I went to the Betty Ford Center, the Summer Institute for Medical Student. I did it to beef up my resume to get a free trip out to Palm Springs, and that changed my life because that's when they talked about addiction as a brain disease. They talked about the psychosocial components of addiction. But furthermore, for spending a whole week with men and women with addictive disorders, just entranced by their stories and by just how they fell into it, how they, you know, the pain and the suffering and the hope and the recovery. They got me interested in addiction. Some of my early mentors were Sheldon Miller and John Franklin, who were pioneers in the field of addiction psychiatry. Uh, Lawrence Westreich, there of New York in 1997. I went to my first addiction uh AAAP meetings, that's how I got started. I came to LA, matched 1998-2002, and one of the first things I saw landing in LA was a casino. I said, I didn't realize that they had casinos in California. And that led me to just always be curious about the gambling culture in America. And obviously, in the last 25, 26 years, we've seen huge changes in American culture around gambling from tribal gaming to destination resorts, online poker, now online sports betting, prediction markets, you literally cannot get away. Massive Powerball numbers. So that's kind of how I got into it all. But addiction psychiatry, for folks who are just hearing about it for the first time, it's a distinct medical field. We are psychiatrists that provide mental health care with addictive disorders and co-occurring mental health illnesses. I folded under the rubric of addiction care. We have our friends and colleagues in addiction medicine, internal internal medicine, family medicine, anesthesiologists. So all of us provide addiction care, but we can't neglect our friends in psychology and social work and marriage and family therapists. You put it all together, we are all addiction specialists. And that's my little uh song and dance about how I got here.

SPEAKER_00 4:40

Well, we're very lucky you're you're one of our addiction specialists. I meant you decided to specialize in gambling. So let's jump right into gambling. It's changed a lot over time. I think when you and I were growing up, you know, I was into sports too. I mean, we would, you know, we would bet a little bit on March Madness or uh on the Super Bowl, um, play poker with friends, and it wasn't as it is now. How have things developed over time?

SPEAKER_01 5:07

So if you trace the story of the last 20 years, gambling in a lot of different arenas, brick and mortar casino gambling, the lottery, online opportunities, spend money on gains of chance, have all expanded. Uh, the last seven years, with the rapid expansion of sports betting, we've seen what we now have in American culture, which is a normalization of gambling. Gambling is no longer seen as a vice. It's no longer seen as a sin. It's no longer seen as a morally questionable activity. So when you normalize an activity because you have businesses that have sprouted up, governments that have legalized it, advertisements that have promoted it, then of course you're going to get a normalization of gambling everywhere. Combine this with our phones, and we sometimes forget you can gamble not just on sports, but you can gamble on poker, and you can even have video games of which you can spend money on that are essentially forms of gambling. So we've taken a human element, something that we all do every day in our lives, which is take risks, uh, which is gamble with our time, our money, our careers, our relationships. And we've now basically made it into a 24-7 activity we can do on our phones or over the internet. And again, America, American culture has said we are okay, we are completely okay with gambling. We don't mind gambling as an activity, we're not going to forbid it. Imagine, again, growing up in the 80s, you could only bet on sports in person in two states, Nevada and Atlantic City. You know, now every single state in America has unregulated gambling on sports, and now nearly 40 states have state-sanctioned and approved forms of sports betting. So, and you know, no other form of entertainment can I think has changed so dramatically, so quickly in the span of just literally 25 years.

SPEAKER_00 7:02

I have no doubt in my mind that if I was growing up now with my love of sports, with the way I was sort of back then with the guys growing up, I would have been online betting on sports in high school. And I'm sure many of my friends would, and some of them would have ended up in trouble, whereas we sort of escaped it from not having this access and available availability. The access and availability is just so tremendous, as you're highlighting.

SPEAKER_01 7:27

And and that creates risk. Anytime we know in addiction, access, availability, anonymity, um, all that leads to potential risky behaviors that can lead to addiction. I did a presentation a couple weeks ago to a lacrosse high school team. So like 35 young men, all under 18 years of age. So, how many of you guys have a gambling app on your phone? 80%. How many of you are betting real world money on those apps? Every single one of them.

unknown 7:59

Wow.

SPEAKER_01 7:59

I said, You realize every single one of you, that's illegal. That's not allowable. And they were like, no, it is. It's completely why because everybody's doing it. I said, so I said, guys, how are you getting access? Uh my dad has an account, he gave me the password. My brother, who's in college, uh, we share an account. Um, I pretended I was 21 and I used a VPN, and here I am. So if I said, hey, if that entire lacrosse team was drinking alcohol or using drugs, you know, it would be a scandal. So that's a perfect example. Now, do I think that's a bad thing? I think it's a risky thing. I think for at least a few of those team members, they're gonna run into trouble. They're gonna run into some harm, and that's could create problems for them not only right now, but four or five years from now.

SPEAKER_00 8:53

And just to sort of put some numbers behind all that, how how many people are gambling betting these days? How has that changed over time?

SPEAKER_01 9:01

So again, we go back to how do we define gambling? I define gambling as putting something of value, usually money, but it could be your time, on an event of uncertain outcome in the hopes of winning a larger reward, but knowing you could also lose uh your initial investment. So gambling traditionally is thought of games of chance, randomness, slot machines, roulette, blackjack. Then you get into other forms of gambling that people are saying are skill-based gambling, like uh poker or sports betting, like older school sports betting. But you know, things like gambling on the lottery, people will say, Oh, that's there's no skill there, that's clearly chance and randomness. And I think that's where things have changed a lot, where sports betting, sometimes people say, Well, I don't gamble, I bet on sports, because they don't view it as randomness. They think they have a skill to pile it all together. We know that through some surveys, national and local stuff, we that about 65-70% of Americans in general will have gambled on one of those formats in the last year. Wow. We know that in the last couple years, that in the college age groups, that velocity of who's gambling, uh, who's gambling with frequency has gone up dramatically, where now it's almost 60-70% of college students report gambling uh actively. But what I'm more interested in was the number of gambling addiction. So the prevalence of people having gambling disorder in various states has ranged anywhere between 1% up to 6% of a state just walking around claiming that they have some problems related to gambling addiction. That's a big number. So, like Oklahoma, Illinois, uh Massachusetts, 4 or 6%, you know, almost, you know, 1 out of 20, 1 in, you know, 15 people. That's a pretty big number. So I think that's a concern where we see rise of gambling addiction incidence and prevalence. But then on the flip side, we know just by nature, gambling is a risky activity. You are going to spend money, you are going to lose money, you're going to spend time. The sheer nature of it as a form of entertainment can lead to harm, just like alcohol and tobacco. So we have a lot of folks who you know don't have alcohol use disorder, but they get a DUI. Or, you know, they get assaulted. They're not people with addiction. That's just a public health consequence of drinking. Public health consequences such as gambling include gambling disorder, but also include those other things, and other unintended consequences, like debt or spending more than you wanted to, or not spending time on doing something else, or cannibalizing your entertainment dollar. So instead of going to the opera or or or building uh your backyard, it just goes to a casino.

SPEAKER_00 11:57

And how do we know when we've reached that point of the gambling addiction? What does that mean exactly?

SPEAKER_01 12:01

So it's interesting, right? When we went to medical school, you and I and residency, gambling was called pathological gambling, and or at least gambling addiction was called that. And it was considered an impulse control disorder. Meaning it wasn't considered an addiction, it was considered in the same category as pyromania, kleptomania, trichotillomania, impulse control disorder, kind of that catch-all basket that in med school we kind of read, but we knew it wasn't going to be on the test, right? So then you fast forward to 2013, DSM 5 comes out. You believe it's been 13 years, but DSM 5 comes out, and because through the power of science and research, they then place gambling, pathological gambling into the same chapter of other substance use disorder. The chapter, of course, is called substance related and addictive disorders. 10 classes of substances: alcohol, tobacco, cannabis, opioids, sety hypnotics, stimulants, blah, blah, blah, blah. Gambling disorder is inside that chapter now. It's called gambling disorder. The criteria are similar to substance use disorder. It's an addictive disorder. So that's how we categorize and think about it now. We use the term a person with gambling disorder. I don't like hearing, oh, he's a gambling addict, he's a degenerate gambler, he's a compulsive gambler. Those are old terms. And similar to a lot of the work you've been doing, you know, through the years of destigmatizing, we want to destigmatize gambling addiction by calling it what it is, is the person with a gambling disorder.

SPEAKER_00 13:34

That's right. And I guess related to the definitions for other addictions, it's when the gambling starts to impair the function or there's other criteria that need to be hit when it's uh qualifies for an addiction?

SPEAKER_01 13:46

Yeah, and again, people ask that all the time. And I say we don't have a blood test, we don't have a brain scan. Our clinical interview looks for the following things. We look for that basic pattern. Does someone's gambling behavior increase and improve their quality of life, or does it create harm? If it creates harm, do they view gambling as a solution to their problems? If they say yes, then that's really leaning toward the lane of gambling disorder. Uh the specific symptoms are going to be things like preoccupation with gambling, uh, lying about your gambling, tolerance and withdrawal to gambling activities, meaning you bet the same amount, but you don't get the same sense of thrill. Or you need to bet more and more and more and more to get a sense of action. Withdrawal, where you literally cannot gamble and you have like flu-like symptoms which are impairing you. Uh, you have things like continuing to gamble despite harmful consequences to your work or losing opportunities. One unique one in the gambling addiction world is called is chasing, where the symptom is you chase your losses by repeatedly going back to get your losses back. Now, people will say, Well, doesn't everybody do that? And the answer is no. There's lots of people that have a weekend gambling or download an app and they spend a couple hundred dollars and they said, That's enough, I don't want to do this again, and they just literally stop and they don't gamble again for a year or long longer. Someone who chases their losses, they lose that money, and then they immediately have an intense desire to get back that money. So they chase their money even though they may not have the financial means to it, or it's just it's a struggle. And I think that's a perfect example of a gambling disorder or symptom.

SPEAKER_00 15:35

And so many of us are gonna get exposed to gambling now with this availability. Are there certain people that are at risk of uh transitioning on to full gambling disorder?

SPEAKER_01 15:45

You know, one of the things we've all been working on, right, is what causes addiction. You know, and I'm excited to read about your book because I'm sure there's gonna be some things I'm gonna learn there. But biological, psychological, social, spiritual causes for addiction. Gambling disorder is no different. So it's interesting. We know that there are some biological risk factors: family history, head injuries, other certain types of neurologic conditions, being exposed to certain medications that uh alter your dopamine system. All these things could generate biological risk. Sleep deprivation, that's a biological risk. Not exercising, not the biological risks. Psychological risks are personality folks who are very impulsive, who are sensation-seeking, people who like to take risks, people who also aren't bothered by losing. So the irony is that many people with gambling disorder, the losses hurt, but the loss, the hurt from the losses don't stick. They may have a big loss, and then that's why two or three days later, they're like, I gotta get it back, and they don't remember how bad the pain was, right? So it's kind of a loss aversion sort of quality. But high levels of impulsivity, high levels of wanting action, um, and other psychological risk factors are clear where it's going to be untreated mental health conditions, ADHD, depression, bipolar disorder, personality disorder. I had a patient with ADHD who said it's so well. I'm bored with everything in my life. That's part of my ADD. I need a high level of stimulating activities that draw my attention. The only activity I can do that draws my attention is betting on sports. So that's kind of like a self-medication hypothesis. And then lastly, the social risk factors that lead to gambling disorder, of course, is what we mentioned briefly earlier. Availability, access, anonymity, and social acceptance of gambling. I had a young man who came to my office last week, uh, college sophomore. Didn't gamble at all in high school, zero. Love sports. Got into a very good school here on the West Coast. Um and within a couple of months of coming here, uh, was gambling on the app because that's what all the college students and his friends he met were doing. That was the major social point of discussion. What are you betting on today? What games do you like? What numbers are you into? That's what the young men were talking about. Instead of saying what what music are you listening to, or what do you think of that movie, or what do you think of that Marvel show? They were talking about what bets do you have going on tonight. Fast forward about a year and a half later, unfortunately, he's developed a severe gambling disorder, uh, lost uh well over a hundred thousand dollars of his savings, lost time, lost productivity, grades declined, stopped exercising, isolated, more lonely, more emotional pain. All that can be tied directly from the gambling behavior. A gambling disorder that created misery financially, misery emotionally. So his story is not uncommon. So when people say, Well, what does it look like? It looks like that. Visually, when I met him, strapping, healthy young man, fit looks great. Inside, though, he's really, really hurting. I think that's the sort of thing that makes it so difficult with gambling disorder is people can say, Well, everybody's doing it. It's natural to lose money. So how do you tell the difference? Well, we spent a good part of an hour highlighting how his gambling behavior was not normative, was not part of the typical experience that people have with sports betting, and that all the pain and suffering he had wasn't normal, that that was part of the condition that comes with addiction.

SPEAKER_00 19:37

And a lot of the examples you've given today are are males. Does it impact males more than than females?

SPEAKER_01 19:43

You know, it does in the sense that we have many, many, many more males coming into treatment. When we do survey data of prevalence rates, it does tend to be uh more male than female, particularly in the sports betting world, but it's narrowed. And a lot, for instance, like if you look at just slot machines, it's about 50-50 in terms of who comes to treatment for slot machine gambling disorder in terms of gender. The question I can't answer, and we've been trying to debate, is why aren't there more women coming into treatment with sports betting gambling disorder? Um, I just don't see any of that. I know that there are a lot of women out there betting on sports more so now than ever before. Um, but we're not seeing at least them present the treatment. So I think that it's happening. I think it's still very stigmatized in terms for a female with a gambling problem, and particularly betting on sports, which is a predominantly male world, to admit in a in a public setting that yeah, I I have a gambling problem on sports.

SPEAKER_00 20:46

And then when gambling does develop, does it make changes to the brain, or what have we uh learned in terms of the neurobiology of all this?

SPEAKER_01 20:52

So the question I would say is do you think gambling can be neurotoxic? We have no doubt in our minds, of course, through science and methamphetamine, cocaine, and and even cannabis to a degree impacts brain structure and functioning. We now are are recognizing that gambling does the same thing too. You know, we know that there's some biological vulnerabilities from folks, but then again, just the sheer act of gambling excessively over months or years is probably not good for brain structure and functioning.

SPEAKER_00 21:21

All right. Well, I have a good sense now of how gambling develops, what it looks like, what to do when you're in trouble with gambling. What are some of the treatments that are out there?

SPEAKER_01 21:30

So we're changing our language to say to folks, um, if you're curious about what gambling is doing to your body, your brain, your mind, your wall, or your future, that's the time to go in and talk to a person who is very, very familiar with gambling behavior. That's a way kind of destigmatizing it. However, you know, um the simple matter is when people know, by the time people call me, they know they have a serious problem. They've suffered a lot of damage. Like this young man, I I spoke to. He was hurting. He was hurting hard. And his parents had no clue. They just thought he was fine. He looked great. He showed up on time and they weren't looking at his bank accounts. So he said to his mom and dad, Oh my God, I made this terrible mistake. I spent all this money in gambling. I don't know what to do. But he's not the one that called me. His mom then said, Okay, let's get you professional help. So she googles gambling addiction help, finds my number, and then calls. So I think for anyone watching this who's concerned about your own gambling or someone else's gambling, the first stop is professional help. So we thankfully we have a lot of helplines, 1-800 GAMBLER or 1-800 My Reset that gets you linked up to gambling treatment experts right away. But I think people have to recognize, like any other medical or psychiatric condition, the longer you wait, the worse it's likely to become. By definition, addiction can be progressive. Sometimes people figure it out on their own, they able to modify and cut back on their own. And those are probably going to be the mild and more moderate cases. But I think it just behooves people to realize well, if gambling is taking on too big of a role in your life, um, it's okay. And it's probably better for you to go talk to a professional therapist. And even just one time or two times can make a huge difference in the clinical course of gambling disorder.

SPEAKER_00 23:28

And so you call, you you look for help, and and then you're seeing a therapist, a psychiatrist. What what sort of therapies exist for this?

SPEAKER_01 23:36

So the the good news is that treatment works for gambling disorder. And people say, well, what do you actually do other than tell people to stop gambling? Do a lot. Uh a lot of what we do in the principles of other addictive disorders. We have biological treatments, psychological treatments, social treatments, and spiritual treatments. So on the biological treatments, we have certain medications that have been shown to reduce and d'urges, the craving, the preoccupation, the rewarding experience that gambling has. So that's kind of cool, right?

SPEAKER_00 24:06

And that's notrexone, the primary primary.

SPEAKER_01 24:09

Yeah, notrexone is the main one, but we'll also use lithium uh now emerging or potentially transcranial magnetic stimulation. That's very, very interesting. Um, we've had a lot of antidepressants have been tried with not a lot of success. But a lot of medication strategies are about treating the co-occurring disorder that's driving gambling addiction. So again, if ADHD is not treated, or depression is not treated well, we know the gambling disorder will continue to thrive. You treat those other co-occurring disorders, things get better. I also think that, again, biological treatments are sleep and exercise and nutrition. So people are like, you gotta be kidding me. You know, I mean, no, sleep, nutrition, physical movement allows your brain to heal. So those are the things that we do in that the psychological treatment, a wide variety of psychotherapies that work, from supportive psychotherapy, cognitive behavioral therapy, motivational interviewing, psychodynamic therapy. But the relationship of the therapist that allows you to talk about what gambling did and didn't do to your life, I think is profound. I've had so many folks come in and say, I don't know what good it's going to be to talk to you about all the money I spent and lost gambling, because I can't get that money back. And I'll say our goal isn't for you to get that money back, our goal is to deal with the emotional pain that came with losing that money. Then they're like, aha, now we get it. Uh and then the social treatments, of course, the mainstay is gamblers anonymous and providing 12-step fellowship and support for folks experiencing gambling disorder. But there are now new social treatments, such as self-exclusion programs where you ban yourself from casinos and apps. We have software blockers. We have now uh a gambling recovery app, and one that I I'm working with is a group called Evi, the E-V-I-V-E, where it's a very neutral gambling app that gives messages of hope, built up skill base, kind of like calm and headspace for meditation, but now we have that for gambling behavior as well.

SPEAKER_00 26:11

If you're struggling, how do you decide which of these to tackle first? Do you go to Gambling Anonymous, try the apps, see a psychologist for the therapy? How do you know where to turn first?

SPEAKER_01 26:20

So a lot of my patients have said, well, I'm just gonna go online and see what I can do. So you can do things immediately right now, 24-7. You can download the app, you can listen to gambling recovery podcasts, or you can hear other people's journey through recovery and try to apply it to your own life. These are things that are completely free and could make a huge impact for you right now. You can call a helpline, and even just calling a helpline and talking about your situation can be helpful. Getting guidance from a helpline counselor. Um, but again, when people want to get down to the much more sophisticated route of a professional, that's going to be checking with your insurance or checking with a therapist directory through these gambling helplines to get therapists that are very, very well trained in gambling treatment.

SPEAKER_00 27:07

Okay. And is gambling anonymous similar to AA or other 12-step work, or are there differences there?

SPEAKER_01 27:13

The principles are similar. The idea of fellowship, the idea of safety, the idea of a room or Zoom or an online meeting full of other people who aren't going to judge you, who aren't going to criticize you, who aren't going to blame you for what you've done or what you think you might do, uh, and instead provide messages of hope and support. They have online meetings, they have in-person meetings, they have some things that GA that can with anonymous do a little bit differently. They have like pressure relief meetings where they will talk a lot more about managing debt and finances. Uh, they obviously don't give out chips, you know, to mark recovery abstinence, they give out, you know, pins or other things there. But the data, and you know, it's kind of not nearly as well studied as we'd like, but the whatever data does exist shows that if you have a sponsor and a commitment to a meeting, uh, you tend to have better recovery rates and higher abstinence rates from Gambling.

SPEAKER_00 28:12

And I find it very hard some of the behavioral stuff for people to do, like exclude yourself from all these different um apps and opportunities, but also like how to involve family in managing your money or keeping an eyeball on your money and managing finances in general. What do you recommend around those sort of things and how to involve family in in helping with the checks and balances?

SPEAKER_01 28:34

So, you know, for years I would just see gamblers in isolation, just the patient. Then I realized would we ever treat cancer just the patient? No. And that all medical conditions are always better outcomes and better treatment when you involve family members and other folks to create a village around that person. So that's really kind of where that's broadened out, where I've been spending a lot more time with bringing family members than earlier to talk about things like money management, who's gonna pay the bills, consequences if gambling continues to go uh unchecked, reducing enabling. I get a lot of cases where folks are enabled very, very much so by their family or by their friends, and they just keep getting money sent to them, and that's a form of enabling. So that's something how we involve the family. We like to do that super early on. I think for folks that are again are having so much shame about what they've done, is we work a lot in the beginning to reduce that shame and say, you know, you do deserve to come here. Uh you there is a way out. Uh, there is a way to improve your life. And I think that a lot of times people don't think there is. And there's still a lot of puzzling. A lot of people are wondering, what do you actually do inside that hour with patients? Like, you how do you actually help them? And I think that's what I've learned through the years by helping them by just actually letting them hear their story, letting them find their voice, and then highlighting things for them that they may have neglected or just not taken seriously. I mean, so many of my patients just don't take exercise or physical sleep as a serious part of recovery, right? They're just like, oh, well, no. But I tell them exercise has been shown to be as powerful as any pill we can prescribe. Uh and I think that those are the sort of things that we really focus on.

SPEAKER_00 30:23

Well, at what point do you start to consider more intensive treatments like outpatient rehab or inpatient rehab? Does that play a role in this addiction as well?

SPEAKER_01 30:31

You know, it does. And some people are surprised to find out that there are brick and mortar residential treatment programs for gambling disorder. Uh, there's um one here in Los Angeles called Right Action through a place called Betshuva. Algamus, you know, is out there in uh uh Arizona. There's Prescott House, there's Core in Louisiana. So there are a number of dedicated programs where it's gambling only. But clearly residential treatment is required, just like it is for other addictive disorders, when there's a threat of significant loss of life, an overdose, if there's morbidity, if there's a clear need for containment, where if someone isn't contained, their mental health is going to get worse and worse, or they may do something regrettable or you know, that would set them back. I think also when people have have declared that, hey, I want a lot of treatment quickly, that's where a residential treatment setting makes sense. I want a lot of groups, I want to be removed from this world, I want to be able to really work on my gambling and mental health problems, you know, much faster. Like when people see me, we're talking about once every two weeks, maybe, once a month. You know, there's a lot of questions that people have instead, and that's where a residential program might do it. But it tends to be uh, you know, again, folks who are in crisis and need that containment. For instance, folks, you know, dealing with the criminal justice system, where if they don't go to treatment, they're likely potentially to be uh incarcerated or you know in jail or something worse. So those are some sort of scenarios. But but again, co-occurring things like act of suicidality, active substance use that's really, really dangerous, unable to function in your daily life, um, concerned that if you don't get treatment, your behavior could lead to other really darker chapters, including things like intimate partner violence, white-collar crime, blue collar crime, you know, whatnot. Uh those are the levels of containment.

SPEAKER_00 32:27

Okay. Well, I have a good sense of what each individual should do. I feel like you've highlighted a lot of things we need to think about as a society, too. I mean, it's, you know, we've talked about big tobacco and big marijuana, but there seems like there's almost this big gambling lobby or forces that have really caused gambling to be everywhere and accessible to everyone. And do we have to think about it like we're thinking about it with social media and getting it off the phones and not exposing kids to it? Or what's sort of the bigger societal strategy to tackle this, do you think?

SPEAKER_01 32:57

Well, you know, that's that's that's the ticket, right? It starts with the adults in the room who make laws around gambling or regulate gambling. We made a a clear decision that we thought as a society that we should regulate gambling from the government level. We regulate a lot of things from the government food quality, air safety, air quality, radio, television, you know, communication, tobacco, alcohol. So it makes sense that we're gambling, we're regulating gambling because of the risk involved. And we want a fair game, you want a product that is not rigged, right? So that's why we regulate these sorts of things. Um, on the flip side, though, states earn a lot of revenue from gambling. So, you know, it's kind of a strange position to be in. So on one hand, you're saying, hey, it's so dangerous and risky we got to regulate it. But on the other hand, you're saying, hey, we want as many people to do it because the more people that do this activity, the better it is for our state, and we don't have to raise taxes, which is highly unpopular. So that's one thing from a societal standpoint. I think any of our state laws have to be enforced better, firmer, and with more clarity. As an example, regulations around gambling advertising don't happen nearly as well as I'd like to see. Trying to go after under unregulated forms of online gambling and shutting those nefarious websites down. That needs to happen. Monitoring gambling apps from a regulatory standpoint and saying which apps and which features of the app are the most addictive and the one that we should ban, right? We ban certain types of alcohol, right? And when it's above certain proof, right? You know, with cannabis, you know, you you're there's certain dose limits and and and concentration limits that you can't sell legally. So why aren't we putting these kind of practices in place for gambling? You know, to say if there's a type of bet or waiter that's very, very addictive, it's not likely to generate any positive return for folks, then maybe we should get rid of it. So, but it all starts also with uh the consumer. You know, why are people so into these things? Well, they're interesting, the promise of fast money, peer pressure. It's frictionless, that's the term we use, right? It doesn't take much to get a bet down. And once the bet's down, that's when the dopamine starts flowing about maybe I'll win, maybe I'll get some money, maybe something good will happen, might come my way. So I think that part has to be really, very, very much attached to say to folks and educating people of all age groups, from teenagers, young adults, adults, middle-aged, older adults, to say if you start to spend money on your phone on a gambling-related platform, whether it's sports betting or jurisdiction markets or iCasino or poker, you really have to be well informed about what these products are and aren't. And you really have to recognize that you need to be educated to do this thing well. You know, it's funny, we don't teach our young kids how to drink, how to smoke, how to use cannabis, right? We teach our young kids how to drive a car. And we say in order for you to drive a car, you have to meet these basic standards of safety. I've always wondered that. Was there a society at one point where there was no driver's head? Yeah, you know, when it first came out, right? And at some point someone made a decision to say no, we want to protect the young people. Same thing goes with gambling. Are we gonna reach a point where we say in order to protect new people coming into gambling, that maybe you gotta have a gambling license card before you can actually place bets, meaning you've taken, you know, a four or five hour course. I don't know, but I think about that, those are some solutions where society could come from. And the last big one, of course, is holding credit uh card companies and banking companies accountable for money that's way too easy. When I was 19, when you were 19, if I said go get $500, there's no way either one of us could do it. You know, you can't get a loan, you can't get an advancement from a friend that fast. But nowadays 19-year-olds can. Payday loans, reaching out to PayPal, putting up a GoFundMe, uh, taking out things on credit and using that to do other things. So all that I think has to be looked at about how do we limit credit in a way that doesn't diminish people's uh ability to spend money quickly. But also, is there really a need to have $30,000 of credit available to you uh every single day on your credit cards? And you know, those sorts of things.

SPEAKER_00 37:36

Well, Tim, I really appreciate you joining us today. This is why you're the president. You're you've got such great information and and really can educate us on this really under recognized uh issue. So thank you very much for shedding light on all this.

SPEAKER_01 37:50

Thank you for having me and the only reason you're not present, you didn't run. So it's always great to spend time with you, Dr. Avery, and uh, all that great stuff. And uh look forward to seeing you in person, hopefully this year.

SPEAKER_00 38:02

Thanks for listening to the Thriving with Addiction Podcast. If you found today's episode helpful, please follow and subscribe wherever you listen to your podcast, and share it with someone who might be. You can also connect with me on Instagram, LinkedIn, and YouTube, or visit thrivingwithaddiction.com. Stay tuned for next week's episode and remember Thriving is podcasts.