Iowa's Problem Gambling Program Pays Real Dividends for Individuals and Families

June 17, 2015|11:40 a.m.| John Skendall

While its most severe harms manifest in only a small segment of the population, games of chance like lotteries, casinos, and other forms of gambling have addictive properties that can carry significant harms.

Iowa's Office of Problem Gambling Treatment and Prevention

To address these needs, the Iowa Department of Public Health’s (IDPH) Office of Problem Gambling Treatment and Prevention employs a range of services including special recovery support services to help alleviate specific barriers to successful treatment; outpatient services that extend to the family and friends of problem gamblers; and distance treatment options that enable individuals to attend treatment and meetings remotely by phone, video, or chat if deemed appropriate to help them meet their recovery goals.

Prevention of, and recovery from, gambling addiction are certainly achievable. Treatment is effective and individuals can and do recover. Helping individuals to understand and change the behaviors that are causing problems usually involves treatment, skill building, and recovery support.

I spoke to Eric Preuss from Iowa’s office of problem gambling to find out more about Iowa’s comprehensive approach to prevention and treatment. Preuss spent 25 years working in behavioral health as a clinician, supervisor, and executive director before coming to IDPH in 2010 and then in 2013 moving into his current role leading Iowa’s problem gambling prevention and treatment efforts.

Would you please describe for us the nature of gambling addiction disorder?

Thank you for this opportunity. Sadly, the issues individuals experience with problem gambling often are just as disruptive to their lives, employment, finances, and relationships as the abuse of alcohol, prescription and illicit drugs, and other harmful substances. And the challenge is that these disorders often overlap and interrelate. There is a high co-occurrence between problem gambling and substance abuse and mental health disorders.There is a high co-occurrence between problem gambling and substance abuse and mental health disorders. Studies indicate 73 percent of problem gamblers have an alcohol use disorder, 38 percent have drug use disorder, and 60 percent are nicotine dependent, and the vast majority of those seeking problem gambling treatment (92 percent) had a lifetime history of a mental health disorder.

Opportunities to gamble—that is, to play a game for money or property with no guaranteed returned good or service beyond the chance of a win—are accessible to Iowans well beyond the walls of the 18 casinos licensed by the Iowa Racing and Gaming Commission and three tribal casinos in the state. Iowa has 2,400 lottery outlets, 2,600 licensed social and charitable gaming events, as well as numerous internet and other illegal gaming opportunities. With smartphones, the opportunity is right in your pocket.

And I want to be very clear that gambling in itself is not a harmful activity. Many individuals enjoy games of chance in its various forms without negative consequences to their health and wellbeing. In Iowa, 93 percent of adults have gambled in their lifetime and 76 percent reported gambling for entertainment and fun. However, 16 percent of adults in the past year experienced at least one sign and symptom of a gambling disorder, and as many as 2 percent of adults in Iowa may have a gambling disorder.

It feels good to play and win—or possibly win big. But some find themselves betting or wagering more than they intended, and that leads to problems. They start to spend money that would have gone to pay for housing, utilities, groceries, bills, or other necessities. Often they look to gambling as a way to help them get out of the financial trouble they find themselves in. Perhaps they will win again, but eventually, if they’re looking to gambling to recover from a gambling loss, they’ll more often than not experience additional financial consequences related to their gambling.

What is the scope of problem gambling incidence in Iowa?

On average in the past year, about 16 percent of adult Iowans experience at least one sign of problem gambling, with about .4 to 2 percent who meet the criteria for a gambling disorder. That compares to the national average (depending on the study) of about 1.5 to 2.5 percent of the U.S. population. Additionally, almost 1 in 5 adult Iowans report they have been negatively affected by the gambling behavior of someone they know.

What are the harms experienced by problem gamblers?

For a percentage of the population, in both Iowa and the U.S. broadly, the temptation of a “big win” and the ease of access to gambling opportunities can be disruptive to their lives. For some it is tragic, losing their savings, their jobs, their families, friends, their health, while not seeing gambling as the cause of the problems they are experiencing.

How is problem gambling related to other addictive disorders such as substance abuse?

Gambling addiction is a behavioral health problem, and is in the Substance-Related and Addictive Disorders section in the new DSM-5. It is treated with an individualized recovery plan that may include individual and family therapy, group meetings, 12-step participation, and other recovery support services meant to assist individuals achieve their recovery goals.

In 2009, IDPH initiated a transition to a comprehensive and integrated resiliency- and recovery-oriented system of care for Iowans with addictive disorders. This system transition focuses on coordination and collaboration across problem gambling and substance use disorder education, prevention, treatment, and recovery support. We can’t treat one addictive disorder effectively without being aware of and addressing other disorders and/or related behaviors that prevent the individual from reaching their recovery goals.We can’t treat one addictive disorder effectively without being aware of and addressing other disorders and/or related behaviors that prevent the individual from reaching their recovery goals.

When did you first realize gambling disorder and substance abuse can be interrelated?

Years ago, while I was working in the area of substance abuse treatment and prevention, the daughter of a woman struggling with alcohol described to me her mother’s infatuation with scratch tickets. Her mother had participated in treatment programs in multiple occasions in the past, would have some success, but for some reason, was unable to stay on the road to recovery. As the daughter talked about her mother’s recovery attempts, she would talk about trips with her mother to the convenience store to pick up snacks or something for supper after school, and her mom would come back out to the car and would pull out the scratch tickets she just purchased and start shaking as she scratched them off. If she won, she’d go back in and buy more, and they cycle would continue until she did not win anymore, or as what the daughter feared most, was her mom coming out with alcohol on her last trip back into the store. That never led to anything good for her. At the time it was just a story from a teenager trying to make sense of what was going on in her life. In retrospect it was a first-hand account of how recovery is impacted by multiple factors, including how gambling and substance use disorders can be intertwined.

At what point has someone become addicted to gambling?

On our website, we list the warning signs of problem gambling. Generally, one to three symptoms would indicate that a problem exists that could be leading to a gambling disorder, and four or more symptoms would classify as a gambling disorder.

Is Someone You Know...?

  • Preoccupied with gambling (i.e. reliving past gambling experiences, planning the next venture, or thinking of ways to get money with which to gamble)
  • Secretive about his/her gambling habits, and defensive when confronted
  • Increasing bet amounts when gambling in order to achieve the desired excitement ("high")
  • Trying unsuccessfully to control, cut back or stop gambling
  • Restless or irritable when not gambling
  • Gambling to escape problems
  • Chasing losses with more gambling
  • Lying to family and others about the extent of gambling
  • Committing crimes to finance gambling
  • Jeopardizing or losing relationships, jobs, education or career opportunities because of gambling
  • Relying on others to bail him or her out relieve a desperate financial situation caused by gambling

Source: Iowa Department of Public Health, Office of Gambling Treatment & Prevention

What services does Iowa offer to those seeking help with a gambling problem?

Through our 1-800-BETS OFF telephone hotline and website resource ( we connect individuals with information about problem gambling and how to access help. Programs licensed and funded to provide problem gambling treatment in Iowa, offer individual and family counseling as well as group and recovery support services. Financial counseling, budgeting and debt reduction plans can be part of treatment as well. One of the unique features of problem gambling treatment in Iowa is that we offer treatment for family members or concerned persons of the problem gambler, even if the problem gambler is not interested in treatment. We help the family member or concerned person get help for themselves and learn how to set appropriate boundaries with the problem gambler.

What elements of Iowa’s problem gambling program do you feel are particularly innovative or unique?

Distance treatment options

One thing I think that we’ve pioneered in the state of Iowa is incorporating distance treatment options for clients. We have found that for some clients who have transportation difficulties, or have jobs that take them across the state or country, are able to participate in treatment even when they are not able to come to the office. Treatment providers are experienced in using  HIPAA compliant video conferencing, phone, and secure chat/email through Recoveration, offering Iowans an alternative by using technology to keep them engaged in treatment and not miss a step as they continue on their recovery path. About 30 percent of the problem gambling treatment sessions in Iowa is done via technology.

One problem gambling treatment provider in northwest Iowa uses video conferencing to enable Iowans access to group therapy, linking together as many as four satellite offices for a group session. Each program has distance treatment policy and procedures that guide the considering and screening for the use of technology, to aid in treatment. We look to answer the question: ‘Will distance treatment be a positive enhancement of treatment to achieve the outcomes the provider and client are looking for?’ If yes, then technology is another tool that can be used to meet a client’s recovery needs.

Targeted recovery support services

We offer recovery support services that are specifically designed to help alleviate barriers to recovery. Recovery Support Services are a broad array of client-selected provider or community-based supports and services intended to further enhance and further the client’s recovery journey. Clients select the recovery support service that best meets their needs through a care coordination process. Funding for recovery support services is available only when the client does not have sufficient personal resources and there is not another funding source available. Eligible clients can access gas cards and bus or cab vouchers to assist in getting to treatment. As you can imagine, this can be a great help to clients, especially as they try to get back on their feet financially, or need to look for a new job. There are eligibility requirements and we have checks and balances in place to make sure the resources are being used for the designated purpose.

And on the prevention side, we fund prevention education and outreach services (almost 8,000 hours of direct service this year). Just like with treatment, these prevention services are available in all 99 counties.

Integrated substance abuse/problem gambling screening

With the continued focus on integrated care—in other words, looking at the whole picture of the person—we want to be sure there is no wrong door to access needed services. When someone walks into a treatment program or center and asks for assistance, we try to do a good job of screening and being aware of the range of behavioral and physical factors that may be involved. A person may be walking in because they got a DUI, which served as a wake-up call for them. But they might have gotten the DUI on the way back from the casino, for example. Perhaps they went to the casino because they had a bad day at work and in fact are suffering some longer term depression symptoms. And so either in an initial interview, or gradually through the process of treatment and recovery, we work with the client to unravel it piece by piece. It’s usually not just one issue that brought them to our door.

What would you say is your overarching approach or guiding principle as a department?

The Iowa Gambling Treatment Program works to reduce the harm caused by problem gambling by funding a range of services for Iowans. We are guided by a public health approach that considers the biological, behavioral, economic, and cultural determinants that influence gambling and health. This approach incorporates a balance of outreach, education, prevention, treatment, and recovery support efforts that work together to minimize gambling’s potential negative impacts on individuals, families, and communities, while recognizing gambling’s availability, cultural acceptance, and economic appeal.

We aim to provide Iowans with effective, accessible, and flexible services, and help remove barriers to recovery, helping problem gamblers and their loved ones build their recovery skills, and ultimately to help them meet their recovery goals. Our licensed and certified counselors are here to listen and provide those seeking services the assistance they’ve asked for, and to walk with them as they begin their journey of recovery.

Eric Preuss

Eric M. Preuss, MA, IAADC, CCS, is program manager of Iowa’s Office of Problem Gambling Treatment and Prevention at the Iowa Department of Public Health. For more information, please see the Iowa Gambling Treatment Program’s reports and studies page, including the report Gambling Attitudes and Behaviors: A 2013 Survey of Adult Iowans.