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Heather A. Chapman, deputy director of the Veterans Addiction Recovery Center at the Louis Stokes Cleveland VA Medical Center, doesn't have enough room to treat all the veterans who seek refuge in her gambling treatment program.
"I could easily, without blinking, double the size of the program — if we had the beds," she says.
Chapman's clinic — the only inpatient gambling program within the national VA system — recently moved from nearby Brecksville, where it was created in 1972 by the psychiatrist Robert Custer, the man largely responsible for persuading the profession to recognize that pathological gambling is a mental disorder. Custer's Brecksville clinic wasn't only the nation's first gambling treatment program for veterans, it was the first gambling treatment program, period.
Former soldiers still come to Cleveland from all across the U.S. Chapman ticks off a few of the more memorable case studies: the vet who blew $80,000 at a casino over the course of a single day. The vet who gambled away so much in a month that he lost seventeen pounds because he had no money to buy food. The vet who put a staple gun to his head after running his finances into the ground — and kept up the losing streak by blowing the suicide attempt.
Chapman's patients have gambled away nest eggs, discarded friendships, pawned belongings, had cars repossessed, lost jobs, spouses and custody of their children. Seventy percent of her clients report having committed crimes to bankroll their binges.
Apart from Chapman's clinic, only a handful of VA hospitals nationwide operate outpatient gambling-treatment programs. Yet research and anecdotal evidence alike suggest the problem is widespread, and growing. In addition to Westermeyer's study (slated for publication in an upcoming edition of The American Journal on Addictions):
• A 2008 study involving a cohort of 31,000 active-duty airmen showed that 1.9 percent had no control over their gambling and 10.4 percent gambled on a weekly basis at minimum. "This rate is concerning," wrote the authors of the study, which was published in the journal Military Medicine.
• A 2003 VA-funded study of Brecksville patients found that 40 percent had attempted suicide at least once.
• The U.S.VETS (United States Veterans Initiative) Las Vegas Division, a transitional-housing and treatment program, reports that 20 percent of its clients have gambling problems, compared to Nevada's rate of 6 percent calculated by the Nevada Council on Problem Gambling. "The number is growing," says U.S.VETS Las Vegas operations manager Jessica Rohac.
Researchers believe two separate factors make veterans disproportionately susceptible to pathological gambling. One is the rollercoaster-like thrill of winning (or losing) when the stakes are high, which mimics the adrenaline rush that occurs in the heat of battle. Gambling provides a nonlethal escape — and why save today when you could die tomorrow?
The second reason involves escape of another sort: For some veterans who return from combat with deeper psychological wounds, gambling functions much like a narcotic. Rather than seek out crowded poker tables, these vets tend to zone out in front of slot machines, whose hypnotic whirls and hallucinatory lights, whoops and sirens provide a numbing electronic morphine. Chapman estimates that 35 percent to 40 percent of her patients have PTSD; for many, she surmises, slot machines "are like wonder anesthetic."
Research aside, common sense suggests that gambling and the armed forces are a combustible combination. Those who enlist tend to be risk takers to begin with. And because military culture has little tolerance for behavioral problems, there's less motivation to seek counseling. Pathological gambling has long been correlated with elevated rates of trauma, depression and substance abuse —all of which affect veterans at high rates. (And it's safe to say the war-movie poker game is a cinematic cliché rivaled only in the jailhouse genre.)
Duane A. Kees, an Arkansas-based military lawyer, says he deals with two or three gambling cases a year. "You see it over and over with combat vets," he says. "They get caught for stealing or selling military property to support their addiction. They get charged with theft, or fraud — but gambling is their underlying rationale."
Still, some researchers dismiss the oft-cited claim that the overall incidence of pathological gambling in the nation's adult population is roughly half the rate found among military vets.
"I don't see anything that would make me sit up and say, 'Oh my gosh, veterans are ever more so susceptible to developing pathological gambling,'" says psychologist Robert Breen, director of Rhode Island Hospital's Gambling Treatment Program.
"The jury is still out," echoes Christine Reilly, senior research director for the Washington, D.C.-based National Center for Responsible Gaming, a nonprofit operated by the American Gaming Association, the most powerful and well-funded pro-gambling lobby in the country.
Sometime in the next year or two, the American Psychiatric Association is set to publish the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (known as the DSM),the universally accepted compendium of every recognized mental illness in existence. Research teams are considering proposals to redefine autism, depression and schizophrenia, among other disorders.
One pending matter is the proposed reclassification of pathological gambling from its current habitat, the "Impulse-Control Disorders Not Elsewhere Classified" category (which includes obsessive maladies such as pyromania and kleptomania). If the reclassification goes through — as gambling researchers expect it will — pathological gambling will become the first behavioral disorder to be classified as an addiction. Its new home in the DSM, currently labeled "Substance-Related Disorders," will require a rechristening to mark the occasion, to "Addiction and Related Disorders."