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The fifty-something lab technician swabbing my arm before a routine test this past May nodded toward the symbol on my T-shirt. “Did you get that at Foxwoods?” she asked, referring to one of two Indian casinos in the region. I shook my head. “It’s from New Mexico. Do you go to Foxwoods often?” She nodded. Then, after a moment, with just the two of us in the room, she lowered her head and said softly, “I am in so much trouble with the machines.”

“What kind do you play?” I asked.

“Penny slots,” she replied.

“How can you get in trouble playing penny slots?”

“I play fifty lines at a time,” she said. In other words, she wasn’t betting a penny with every press of the button. She was betting fifty cents. No wonder her losses were adding up.

Her story is nothing new in Connecticut, where casino gambling didn’t exist before a 1991 court decision allowed the Mashantucket Pequot Tribe to open Foxwoods Resort casino, which was followed a few years later by the Mohegan Tribe’s Mohegan Sun casino. Both are now among the largest casinos in the world, located in the nation’s third-smallest state.

After a federal court ruled against the state’s attempts to keep out large-scale casino gambling, the tribe assured residents that a casino would provide thousands of jobs. I was an editorial writer for The Day of New London at the time with experience in addiction counseling, and I grew concerned about the possible negative impact. And so, as the tribe began to construct the casino, I conducted a series of telephone interviews with Atlantic City officials to gauge what we could expect in Connecticut.

The Atlantic City beat cops spoke frankly about the rise in crime they witnessed after the casinos opened in the late 1970s, and others were equally blunt about the decline in the number of local businesses, the continued decay of urban neighborhoods, and the stubbornly high unemployment in the wake of casino gambling. Subsequent studies would later prove the point: In 1976, when New Jersey voters approved casino gambling in Atlantic City, unemployment in the city was 14.7 percent; in 1997, it was 12.7 percent. During those two decades, the number of locally owned businesses in Atlantic City dropped by half. But even at the time, the message I heard was clear: Don’t believe the promises of good times to come. Casinos bring with them a dark underside, and Connecticut had better get ready.

A look at social problems in Nevada, particularly Las Vegas, increased my worry. Las Vegas, then and now, struggles with high rates of suicide, dropouts, childhood problems, and low educational attainment. Later studies again confirmed those early concerns: In 1997, a study of death certificates in Reno, Las Vegas, and Atlantic City found those cities had suicide rates that were up to four times higher than in cities of the same size where gambling was not legal.

As a result of my interviews at the time, I was convinced that the impact in Connecticut, where casinos had never existed before, would be dramatic, obvious, and more or less immediate. I was wrong. The problems have often been communicated in scenes similar to my encounter with the lab technician: Whispered conversations, worried families, and cracks in the social fabric that take place, to a large degree, out of the public eye and off the front pages of the newspapers.

A friend of mine told me that to escape the burdens of motherhood she would go to the casinos at 2 A.M. to gamble until 6:30 A.M., when she would go back home and get her kids ready for school. Until the day she didn’t go home in time—unable to stop playing the slots. A worried state legislator called to tell me her husband emptied her sixteen-year-old son’s college fund to gamble at the casinos. A bank manager told me about a customer who inherited $1 million and—aided by using the ATM machines at the casino to withdraw money—gambled it all away. A woman who worked at my daughter’s day care moved her family to Florida in a desperate attempt at a geographic cure after her husband drained money from his ten-year-old’s savings account and couldn’t stop going to the area casinos.

In 1999, the National Gambling Impact Study Commission released its findings, the most critical and least challenged of which was the discovery that problem gambling doubles within fifty miles of a casino. The statistic is no surprise to anyone who lives near a casino. The effect of casino gambling has become the old news of shared anecdotes at town meetings and backyard barbecues. And the state government—which early on negotiated with the tribes to get 25 percent of the revenue from slot machines—has done little to stem the tide, content to collect more than $1 million a day from the casinos and additional millions from the state lottery, which has been legal in Connecticut for decades.

Occasionally the cost of casino gambling becomes more public—as when, over the last decade, several officials from different towns, all women, were convicted of embezzling money to play the slot machines at the casinos. The tax collector of the town of Ledyard, Yvonne C. Bell, a grandmother with no previous criminal history, was convicted in 2001 of stealing more than $300,000 to feed her slot-machine habit. Another tax collector from the nearby town of Sprague was convicted of stealing $105,000 to gamble away. In 1992, the year Foxwoods opened, there were 43 embezzlements in Connecticut; in 2007, there were 214 such crimes, ten times the national average.

Other crimes occur, too. Several men have held up banks to get more money to gamble. And the region around Connecticut’s casinos has suffered significant rates of drunken driving, which the state has only begun to acknowledge is due in part to the free alcohol that flows to gamblers. Two fatal drunken-driving crashes this spring made the link impossible to minimize. In one of them, Daniel Musser allegedly drove the wrong way down Interstate 395 after getting drunk at Mohegan Sun casino. His car struck a van carrying Connecticut College students en route to the airport to bring medical supplies to sick children in Africa. The crash killed twenty-year-old Elizabeth Durante, a premed student who had led the campaign on campus to help the less fortunate. A second fatal crash by a Mohegan Sun patron one month later led the casino to reduce, from three to two, the number of free drinks an hour available to gamblers.

Despite all this perfectly apparent—and perfectly well demonstrated—human cost of casino gambling, few institutions, secular or religious, openly criticize casinos. Nor do most decry the spread of gambling that began, innocently enough, when in 1962 New Hampshire legalized twentieth-century America’s first state lottery. Legal gambling now flourishes in every state in the union except Utah and Hawaii. A 1987 Supreme Court decision, California v. Cabazon Band of Mission Indians, with the 1988 Indian Gambling Regulatory Act that followed, opened the door to gambling on reservations; now there are 405 Indian casinos in twenty-eight states. Casino gambling involving slot machines has spread from thirty states in 2000 to thirty-seven states in 2009, with six more considering legislation to legalize slots.

Part of the reason that gambling spread so far and so fast is that the industry markets its product as just another form of harmless fun. In a brilliant move, the industry coined the term gaming as the euphemism of choice. Organized religion was slow to challenge the spread and, even today, rarely speaks out. Most of all, government has become predatory in its use of gambling as a worry-free method of increasing revenue without raising taxes. Indeed, the states have moved from granting permission to cheerleading. Government boosterism has legitimized gambling, eroding what few moral scruples remained on the part of average people against engaging in a behavior that, just a few decades ago, would have been considered largely unacceptable.

In addition, the positive impact of casinos—thousands of jobs, construction spending—is simple to measure, lending itself to triumphant press coverage and promises of easy prosperity. In Connecticut, the casinos are credited with creating 30,000 jobs directly and indirectly. But putting a price tag on the social costs tied to gambling has proved a more complicated task. What price should we pay for addiction, embezzlement, child neglect, increased debt, drunken driving, and suicide, as well as for the prevalence of problem gambling? Governments duck the challenge. Even Connecticut, which to its credit has produced several gambling studies over the past thirty years (the most recent of which came out in June), has consistently refused to tally the total social cost of gambling.

The complex nature of the task didn’t stop the University of Nevada at Las Vegas from doing its own study in 2003. Professor Bill Thompson estimated that the cost of social problems in southern Nevada, a region that includes Las Vegas, amounted, conservatively, to at least $300 million to $450 million a year and possibly as high as $900 million—more than the taxes that gambling contributed to the state treasury.

Casino interests immediately attacked Thompson’s report, no doubt because it was one of the few studies the industry didn’t control. A great deal of gambling research is underwritten by the industry (including millions for Harvard Medical School’s Institute for Research on Pathological Gambling and Related Disorders). That’s one reason comparatively little research is done on the social cost of gambling, and one reason a determination of the social cost has been so elusive. The only entity with deep-enough pockets to do the research is the government, but the government has become so beholden to casinos that it has no interest in exploring the downside of an industry it now promotes. Meanwhile, the gambling industry has billions to fight anything that will slow down its popularity—and its current widespread acceptance.

The federal government did undertake an in-depth study of gambling twice, in 1976 and in 1996, when Congress authorized the National Gambling Impact Study Commission. The 1996 commission had a budget of only $5 million, with only a little over $1 million of that for research. The late Senator Paul Simon (D-Illinois), who coauthored the law that created the commission, told me that gambling interests lobbied so heavily against the proposal he felt lucky to get any budget for the venture at all. And its most important recommendation, that the country put a moratorium on the spread of casino gambling, has been ignored. State revenue from gambling has risen 65 percent since 1998, the year the commission concluded its research. In 1996 there were 500,000 slot machines in the United States; in 2008, the count had reached 817,000, about one for every 275 adults, which does not include slot machines that are illegal or engineered to fit legal definitions of sweepstakes games or bingo machines. The Association of Gaming Equipment Manufacturers projects that the United States will gain an additional 156,000 machines by 2012.

Besides minimizing or ignoring altogether the negative impacts of gambling, elected officials are equally unenthusiastic about open debate that might stem the race for easy money. Pennsylvania, for example, legalized slots in the middle of a July night in 2004 without hearings, research, or public comment. Unabashed gambling booster Governor Ed Rendell said, “For every one person who falls addicted to gambling or loses their paycheck, I’ll show you 500—mostly seniors—who spent $40 at a casino and had the best day of their month.” Surveys vary, but most pin the percentage of Americans that are either problem gamblers—or the more damaging manifestation, pathological gamblers—at around 3 to 4 percent. Those percentages, however, do not include the millions of people who may be at risk.

Gambling problems, when they are acknowledged at all, are deemed to be the burden of the rare addict who just can’t handle a good time. Many see gambling addiction as a self-inflicted wound, the negative consequence of an optional behavior. Casinos, engaged as they are in the lawful act of making money, have escaped responsibility. The onus, the burden, is on the individual.

It shouldn’t be so one-sided. Anyone who frequents casinos—and thereby experiences the incredible technological and marketing advances in gambling—risks becoming hooked. Gambling researchers refer to bets as “event frequencies”—measuring how often a person can gamble in a given time period. The more event frequencies, the more the behavior can become automatic, rewiring the brain to engage in gambling long after it has ceased to be enjoyable. For such addicts, the brain has changed. The repeat behavior becomes a compulsion, and the individual becomes trapped.

Decades ago it was widely assumed that gambling addiction took fifteen or twenty years to develop in men (and gamblers were once nearly all male). But those were the days when the primary pursuits of gamblers were such games as craps, roulette, poker, blackjack, or even betting on horses. In this context, the long time necessary for addiction to develop made sense. How often could a gambler bet on a horse? Or a sports team? At most, the event frequencies of the average gambler would occur perhaps fifty or a hundred times a day.

That may sound like a lot, until you consider the slot machine, the modern marvel that has done more to spread gambling than any other invention in history—which has been compared, understandably, to crack cocaine. An experienced gambler can bet 600 to 900 times an hour on a modern slot machine. That’s a lot of event frequencies, and the main reason that people are becoming addicted in far less time. This is especially true of women, who, unlike those in previous eras, are now as likely to gamble as men.

For reasons that are not clear, women take less time than men to develop addiction. Female casino customers are more likely to avoid competitive games than are men and are often drawn to casinos by a desire for escape, which slot machines facilitate. Experts say many women gamblers, who prefer slot machines, can become problem gamblers in just three to five years.

The slot machine, which is at the root of so much addiction, is responsible for 70 percent of the gambling revenue in Las Vegas—and the percentage is higher elsewhere. Slot machines are vacuum cleaners designed to swallow money, yet they remain among the least reported, least understood technological innovations influencing modern life.

As one gambling analyst told the newspaper Gaming Today, “The longer you sit in front of one, the more you lose. Next to prostitution, it’s the world’s greatest business. There is no other business in the world where people budget money to lose to you.” The articles published by MIT’s Natasha Dow Schull, who has spent years researching machine gambling, explain why people are so willing to sit in front of those machines for so long. (Schull’s book, Addiction by Design: Machine Gambling in Las Vegas, will be published by Princeton University Press in July 2010. For a summary of what she has found, readers can consult her article, “Digital Gambling: The Coincidence of Desire and Design,” in the January 2005 Annals of the American Academy of Political and Social Science.)

The three-reel, mechanical “one-armed bandit” was invented in the 1890s, but it has evolved dramatically over the past forty years. Slot machines gained a hopper, or internal payout device, in 1963, and in the 1970s video-game technology was adopted. Until these innovations, slot machines were never the star attraction of casinos and remained secondary to table games. But the new technology paid off. By 1980, slot machines had overtaken table games as the leading source of revenue for casinos. As Schull notes, in 1980, slot machines occupied 45 percent of casino floors in Nevada; the percentage now is closer to 80 percent.

Slot machines gained computer chips in the 1980s. Other improvements soon followed. Buttons replaced levers. Large bills inserted in the slot machine give patrons playing “credits”—which disguise the value of money and make it easier for a patron to recycle wins rather than take the cash and leave. Now touch screens are replacing buttons, all to speed up play.

Along the way, the casinos paid for considerable research into how to increase the length of time gamblers stay at the machine—since the longer that patrons play, the more they lose and the more casinos profit. The chairs at slot machines are ergonomically designed to be comfortable, with no hard edges that could decrease leg circulation, Schull observes. Screens slant at 38 degrees to prevent slouching. Game controls are within easy reach, as are computerized menus to have food and drink delivered without leaving the machine. Some have television monitors to keep players from exiting the area to catch their favorite shows. Slot machines have many different themes, mimicking game shows, cartoons, or favorite sitcoms. The sound of jingling coins, the bells, the volume of noise, the flashing lights are all designed to encourage patrons to play, and play, and play.

Casinos defend slot machines by pointing out that each machine gives back in winnings a high percentage of the money that patrons insert. In Connecticut, the “hold”—the casino’s average take—of the tribal slot machines is around 8 percent, which means that the slot machines give back 92 percent of the money gambled. In Las Vegas, the hold is anywhere from 2 to 4 percent, with the machines giving back 96 to 98 percent of the money wagered.

But as any gambler can tell you, it is still quite possible to play a slot machine and lose your shirt, no matter how small the hold of the casino. The real genius of the gambling industry was to combine B.F. Skinner’s work on operant conditioning with intense research on how and why gamblers play on the machines. Every casino has a rewards card (Foxwoods’ was once called the Wampum Card, but now it is called the Dream Card), which the gamblers insert into machines at the beginning of play. The gimmick is that, when customers use the cards, the casinos pay them a small amount for every hour they gamble and send them special offers, the value of which escalates the more they bet. In the process, casinos gain a treasure trove of information.

The data culled from customer cards at Harrah’s, for example, helped the gambling chain amass a staggering database on 16 million gamblers. The casinos set calendars and budgets that predicted when certain gamblers would show up, how much they would spend, and their “lifetime value” to the company, according to Winner Takes All: Steve Wynn, Kirk Kerkorian, Gary Loveman and the Race to Own Las Vegas, the 2008 book by Christina Binkley. Company computers produced “behavior modification reports,” suggesting which gamblers would respond to the offer of a free hotel room and which ones would prefer free gambling chips. The computers measured the “velocity” of gambling based on how often gamblers hit the buttons on slot machines, and Harrah’s used the data to entice them to gamble even more. The company measured how often casino patrons visited, and it called them with free offers if the research indicated they were “overdue.” High rollers had always gotten such careful attention, but Harrah’s showed that paying attention to the low-rolling majority of gamblers would make casinos even more lucrative.

Slot machines have long been programmed to show “near misses” and give gamblers the impression that they came this close to winning, the better to encourage them to keep playing. The machines give back enough money in the process to make gamblers feel like winners even when they are losing. But Harrah’s developed the technique of intervening when reality began to dawn on gamblers—when they lost so much the experience was becoming negative. The company tracked, in real time, customers’ losing streaks and would send “luck ambassadors” to perk them up, give them a token gift—free lunch or some free credits on the machine—to reduce their perception of losing and keep them gambling longer.

In the process, Harrah’s discovered that 90 percent of its profits came from 10 percent of its most avid customers, according to Binkley. This is unsurprising. Many reports suggest that addicts produce a disproportionate share of casino profits. A 1998 Nova Scotia study found that 6 percent of regular gamblers produced 96 percent of gambling revenue, and a whopping 54 percent of the revenue came from just 1 percent of problem gamblers—leading researchers to conclude that, at any one time, half the patrons in front of slot machines in Nova Scotia were problem gamblers. A 1999 study estimated that more than 42 percent of all spending at Indian-reservation casinos came from problem gamblers. A study in Australia concluded that problem gamblers were only 4.7 percent of the population yet generated 42 percent of machine revenues.

Those who defend gambling say that it should be a matter of free will, just like any other adult habit. But when a customer is pitted against researchers armed with psychological techniques, marketing studies, and computer analyses of a patron’s own behavior for the express purpose of extracting ever larger amounts of money, how much choice is really involved?

When casinos, once limited to Nevada and New Jersey, are now within a few hours’ drive of most of the American population, and casinos are proven to double the rate of problem gambling, what is the moral leadership of the country waiting for before they say enough?

When corporations spend millions to design machines that keep patrons gambling indefinitely, when is it time to acknowledge that the machines, not the people, are the problem? Why is it unreasonable to expect casinos to intervene when individual losses cascade, even when the companies track relentlessly every penny a patron spends? If slot machines are legal, why are they not more stringently regulated by government? How many lives must be wrecked before we denounce government’s alliance with gambling interests? And when will more churches speak out?

Tom Grey, a Methodist minister and founder and former leader of the National Coalition Against Legalized Gambling (which has recently changed its name to Stop Predatory Gambling), pointed out that several faiths, including the Methodists, Lutherans, and Presbyterians, have official stances against gambling.

“But they take a position and think the war is over,” he said. “This is idiocy what is going on. If Jesus came back he wouldn’t go to the temples to clean them out. He’d go to the statehouses where the money changers are. Gambling unites liberals and conservatives, and gives churches opportunities to speak truth to power. It gives churches the chance to get out of their pulpits and stand up.”

Grey finds it unbelievable that his tiny organization is the only consistent national voice speaking out against the spread of gambling—unbelievable that gambling has never been framed as he and others see it: as one of the major public-health issues of our time.

But that is what it is. A few weeks ago I showed up at the lab once more for a cholesterol test. The same technician to whom I had spoken in May recognized me. “I haven’t gone to the casino in two weeks!” she said. She seemed giddy with relief, and I wished her well. People can, after all, self-correct. I hope she resists when the casino notices that she is overdue and calls with an offer of free credits for the slot machines, or emails her gift certificates for a buffet lunch, or sends her a birthday card in the mail. But, sad to say, I wouldn’t bet on it.

Maura J. Casey has been a newspaper journalist for twenty-six years. She has been a member of four editorial boards, most recently that of the New York Times. In April she founded the communications firm CaseyInk.

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