Killings illuminate issue of problem gambling

David Strow

Tuesday, Dec. 5, 2000 | 11:13 a.m.

Michigan resident Jihad Moukalled, a regular Las Vegas Strip visitor, put a horrific new face on the issue of pathological gambling last month.

Shortly after returning from a weekend gambling trip to the MGM Grand Las Vegas -- a trip in which he lost more than $100,000 -- Moukalled killed himself and his family, leaving those that knew him stunned by his violent actions.

On Monday, researchers, scientists and gaming regulators from across the world met, ironically, for a long-planned meeting at the MGM Grand.

They opened a two-day conference devoted to the latest research conducted in the field of pathological gambling diagnosis and treatment. But as the Moukalled murder-suicide so graphically illustrated, pathological gambling is proving to be a difficult disease to diagnose, let alone treat.

And no one yet knows what causes gambling, a relatively harmless activity for most, to become a vicious, sometimes deadly addiction for 1 to 2 percent of the population.

"It's taking on a lot of urgency," said Linda Cottler, a professor in the department of psychiatry at the Washington University School of Medicine in St. Louis. "We really are at a point ... where we were 25 years ago with substance abuse. We really need to get this moving. We hope to leave here with a more unified plan and concept (of problem gambling)."

A big difficulty, researchers agreed, is that research into the field -- and the gaming industry's backing of research -- is only a few years old.

"If this is a journey of a thousand miles, we've just taken the first few steps," said Bill Eadington, director of the Institute for the Study of Gambling and Commercial Gaming at the University of Nevada, Reno.

One reason the public has been somewhat ambivalent about the problem, Eadington said, is that problem gambling doesn't affect the public as a problem like drug abuse does. He cited an Australian study that put the cost of pathological gambling as high as 5.6 billion Australian dollars per year -- but showed that more than 90 percent of these costs were borne by gamblers and their families and friends, not the public.

"The pain is largely self-inflicted," Eadington said. "People with serious problems with their gambling ... do not affect the society at large much."

Still, the gaming industry could be at risk of a public backlash, deserved or not, if "copycat" cases similar to the Moukalled murder-suicide occur, Eadington said.

"Then it (problem gambling) would be at the top of the agenda," Eadington said. "The public can be very fickle."

But one of the biggest problems in trying to combat this disease is that researchers and therapists haven't even agreed on a single definition. Gambling researchers refer to "problem" gamblers, "pathological" gamblers and "at-risk" gamblers, all terms with differing definitions. "Pathological gambling," the most serious diagnosis, is estimated to currently afflict about 1 percent of the population; the less severe "problem gambling," by comparison, afflicts about 3 percent.

Differing definitions and terms makes it difficult to combat the problem, or even to discuss it clearly, one gaming industry executive said.

"It doesn't sound that important, but the end result is confusion," said Alan Feldman, spokesman for MGM MIRAGE. "We really have a hard time having a dialogue with the public to tell them what's going on, and to give them clues for what to look for. In order for us to move to the next level ... we've got to have a firm foundation, and that doesn't quite exist yet."

Even more confusing are the means by which researchers arrive at diagnoses of problem gambling. Renee Cunningham-Williams, professor of social work in psychiatry at Washington University School of Medicine, pointed out that there are literally dozens of tests used to identify those with gambling problems, each with different wording, different criteria and different thresholds used to identify the onset of the disease. Each produces a different conclusion in how widespread problem gambling is in the general population.

Even the slightest change in wording or differences in how interviewers are trained can result in different diagnoses, Cunningham-Williams said. When asked to review one commonly used study, adults misunderstood about one-fourth of the questions, she said.

"These are the tiny details. that are tremendously important if we are going to get good data," Cunningham-Williams said.

Another key issue is the co-existence of other psychological problems with problem gambling. Cottler said two disorders -- antisocial behavior and alcoholism -- have been most strongly linked with problem gambling.

But what still remains unknown, she said, is whether problem gambling starts before the other problems do, whether one problem triggers the other, or whether the two problems have a single cause. Identifying these co-existing issues is important, because it will assist in the prevention and treatment of problem gambling.

Also unknown is why minorities show higher incidences of problem gambling than other groups of the population. The reason could be that minorities tend to be in lower income groups than whites, and lower income groups tend to have higher incidences of problem gambling than middle- and high -income individuals.

"You might think certain groups are inherently vulnerable, but for the wrong reasons," said Howard Shaffer, director of the division of addictions at Harvard Medical School.

The evolution of problem gambling also isn't clear, Shaffer said. While attention is often focused on problem gambling that worsens, Shaffer said there are also many problem gamblers whose afflictions lessen or disappear with time.

"The thought that these folks don't change is misleading," Shaffer said. "They do change and move in both directions."

Despite these difficulties, Eadington said the gaming industry must take pro-active steps to aggressively combat the problem, rather than assuming a reactive posture. Such strategies could include "casual intervention" of casino employees with customers believed to have gambling problems, stopping patrons from cashing welfare, Social Security and payroll checks at a casino, offering patrons the ability to ban themselves from a casino, and investment in "serious, unbiased research" without fearing the results, Eadington said.

The benefit for the industry, Eadington said, would be a more sensitive image in the public eye, and governments more willing to help the gaming industry with its issues.

Appearing to "treat one's customers in an abusive manner can result in liability against a company and destruction of goodwill," he said.

"The alternative for self-regulation," Eadington said, "is for a regulator to impose something on you."

Despite the difficulties for casinos in trying to identify which of their patrons have problems with gambling, Shaffer is optimistic that the gaming industry will one day have the tools necessary to pick out problem gamblers on the casino floor.

"That's not going to be immediate, but it is likely," Shaffer said. "We have done it in many other areas."

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