Mental health advocates warn that Maine does not have enough resources to address gambling addiction as state lawmakers seriously consider expanding gaming options to include betting on professional sports.

The state spends just pennies per person on awareness campaigns and treatment for gambling disorders, a fraction of the budget to address alcohol and drug abuse and nicotine addiction. Licensing barriers and inadequate specialized training limit access to treatment.

Most people can responsibly buy a scratch ticket, pull the lever on a slot machine or play a game of poker. But a for small segment of the population – around 2 percent in the United States – gambling can become a debilitating illness.

“If you have the addiction, you have the addiction,” said Mary Drexler, director of the Maryland Center of Excellence on Problem Gambling. For those at risk, wagering stimulates the brain in the same way drugs and alcohol do, sometimes with similar consequences.

“You get irritable, you’re losing money, you’re preoccupied with it, about to lose your job because you are at the casino or the bingo hall, you start lying, all of those things,” Drexler said. “The gambling not just impacts the gambler, it impacts everyone around them. Especially the family who find out the bills or the mortgage hasn’t been paid.”

In Maine and elsewhere, the problem is poorly recognized because gambling is still regarded as a personal or moral failing, not a mental health disorder, advocates say.

In the seven bills to legalize sports betting lawmakers had considered this session, none included resources to address gambling addiction. The bills received a favorable public hearing last month and a legislative panel will discuss a compromise sports betting bill this week, with a potential vote later this month. Some think sports betting will be inevitable as more than a dozen other states consider similar measures.

There is no definitive count on how many people in Maine suffer from gambling addiction, but there are clues. Almost 330 people have “self-excluded” – voluntarily banned – themselves from entering Maine’s two casinos because they know they have a problem.

Milt Champion, executive director of Maine’s Gambling Control Unit, wants lawmakers to set aside at least 1 percent of tax revenue from future sports betting for the state’s gambling addiction prevention and treatment fund.

“I’m a huge proponent for this cause,” Champion said. “I’ve been in the industry 30-something years and I’ve seen a few things that make me believe this is a huge problem.”

REGULATORY RESTRICTIONS

Since 2014, the state has spent $100,000 a year from taxes on slot machines and table games for awareness, training and treatment of gambling addiction. During the same period, yearly taxes from casino games have grown 7 percent, to almost $58 million.

The state provides considerably more funding to combat other public health problems. In 2018, the Fund for a Healthy Maine, a special budget set up with money from a settlement with tobacco companies, spent $6.7 million on smoking cessation and treatment, and $2 million on substance abuse programs.

Even with its seemingly tiny funding allocation, Maine ranked 29th out of U.S. states for public resources it directs to gambling addiction, according to a 2016 survey conducted by the National Council on Problem Gambling.

“Maine should be commended for providing some public funds,” council director Keith Whyte said. “Ten states provide none.”

If Maine expands gambling options, especially if it includes some version of online sports betting, some worry the meager funding available will not keep pace.

“Most people gamble with no problem,” said Scott Gagnon, operations manager at Adcare, a behavioral health nonprofit that holds a contract to manage the state’s problem gambling program. “We want to make sure we support that percent of the population that do have issues and we feel like we don’t have those resources right now.”

Exacerbating the problem is the dearth of counselors with credentials to treat gambling addiction, and regulations that prohibit reimbursing addiction counselors from health insurance plans.

Out of the nearly 4,900 clinical counselors and social workers in Maine, 626 are licensed drug and alcohol counselors, according to the state office of professional and financial regulation. A state network of problem gambling counselors that started in 2017 has just two members.

Under state law, licensed drug and alcohol counselors may not receive reimbursement for treating problem gambling because it is outside their “scope of practice” narrowly defined to include alcohol, drugs and nicotine.

That means many clinicians don’t attend training to counsel people addicted to gambling because it does not count toward continuing education for their license, Gagnon said.

The state sets aside $10,000 a year to reimburse counselors for treating patients with gambling disorders who have no other means to pay. Last year, only one claim, for $816, was paid out of the fund, according to state records.

“There has been limited participation because treatment providers are not enrolling, and individuals with gambling addiction are likely seeking treatment from other behavioral health providers for co-occurring issues, not just gambling addiction,” Emily Spencer, spokeswoman for the Maine Center for Disease Control and Prevention, said in an email.

Although other counselors may help people struggling with a gambling problem, the licensing issue essentially prevents professionals with specialized training in addiction from doing so, said Bob Long, a counselor at Kennebec Behavioral Health.

Long thinks Maine counselors should start integrating problem gambling screening when they treat patients for other issues. Maryland and other states have pursued similar approaches.

Overall, Long and others think the gambling problems need a higher public profile.

“I think we have to get better about noticing it and having conversations with people about it,” he said.

ADDICTION PRIORITIES

The licensing issue has come up before, but there hasn’t been a legislative push to change it, said Malory Shaughnessy, executive director of the Maine Alliance for Addiction and Mental Health Services.

In the last few years, her group and other behavioral health advocates have focused on the ongoing opiate abuse epidemic, one of Maine’s deadliest public health crises. That didn’t leave a lot of room for gambling, Shaughnessy said.

“I don’t know if the general public knows the extent of the problem,” she said. “That’s why you don’t see people clamoring for something to be done about it.”

The state has a public awareness campaign on problem gambling with social media advertising, training, online videos, some radio ads, an annual conference, published material and training. It recently launched an effort focused on highlighting problem gambling among teens and youth.

On the regulatory side of things, Maine casinos are required to file responsible gambling plans with the state and there are eight locations where someone can self-exclude, including the two casinos. Despite that protection, people keep going back. State authorities seized more than $14,600 in casino winnings from people on the self-exclusion list in the last four years, forfeitures allowed under a provision in Maine’s gambling laws.

Nonprofit groups that offer games of chance such as bingo are required to post near their entrance materials regarding problem gambling and the state’s confidential problem gambling 211 hotline.

The Maine Lottery, through its own budget, produces responsible gaming TV and radio spots and publicizes the state’s hotline on its advertising, website and the backs of scratch tickets.

“We have great programming and partners, but we have to do so much with so little it is hard to scale it up to where we should be,” said Adcare’s Gagnon.