More and more American have started to recognize substance use disorder (SUD) as a health condition rather than a moral failing. However, other forms of addiction — such as gambling — have yet to be afforded the same courtesy.
Many payers, including Medicaid, still don’t reimburse for gambling addiction treatment. That’s despite state and federal parity laws — and the fact that the American Psychiatric Association (APA) classified gambling as a form of addiction back in 2013.
But the non-profit addiction treatment provider Gateway Foundation wants to change that. While the organization can’t force insurers to pay for gambling addiction treatment, it can make the services more accessible in another way: with the creation of a new grant-funded program.
“We’re still in the initial phases of rolling it out,” Teresa Garate, vice president of strategic partnerships and engagement at Gateway, told Behavioral Health Business. “But our long-term goal, I think, would be to get the payers to pay … to make sure [everyone] can access [gambling addiction treatment].”
Founded in 1968, Gateway bills itself as the largest nonprofit SUD prevention and treatment provider in the country. It accepts various private insurance plans and Medicaid, and it has programs across ten states, including Illinois, where its new gambling services are being offered.
The program is made possible by a $562,000 state-funded grant for gambling disorder services. The one year award, which is financed using some Illinois casino revenues, started in fiscal year 2021 and will be renewed based on quarterly reports.
While Gateway has been serving people with various types of addiction for more than 50 years, it has never had a standalone gambling disorder program until now. Before, it only treated gambling as a secondary, co-occurring condition.
“Part of the challenge and the barrier is that not all insurance carriers pay for treatment for gambling disorder services,” Garate said. “Medicaid does not cover gambling disorder services at all, so we’re using this grant to actually pay for the services that we’ll be providing for those Medicaid clients.”
Developing the program
Gateway’s gambling program is roughly equal parts education and treatment. Grant requirements are one reason for that; another is the nature of the disease itself.
For one, gambling addiction is relatively easy to hide. Plus, a lot of people don’t consider it a behavioral health problem and won’t seek treatment.
“There is a lot of stigma with addiction anyway,” Garate said. “And for gambling, it’s even more confusing and misunderstood. The perception that it is not a disease is high. … But it is a disease.”
To help educate Illinoisians of that fact, Gateway is using PSAs, billboards and media interviews. It’s also targeting specific communities across the state based on their proximity to casinos and slot machines, in addition to launching an outreach initiative to educate local health departments, drug courts, hospitals and other community partners.
“We have a very robust network of business development coordinators,” she said. “While their primary focus is to work in the community to tell people that we’re here for [SUD] treatment and get referrals, we have included them in our education and training for gambling. So now we have a workforce throughout the state giving talks and presentations.”
Gateway first started doing community outreach in late October. Since then, its call center has received about 50 calls for gambling services alone, Garate told BHB in a Dec. 14 interview.
Still, because the program is so new and the educational undertaking associated with it is so great, Gateway is currently treating “very few” gambling patients, she said. That means the organization doesn’t yet have outcome data to share.
The treatment aspect of the program is modeled somewhat after Gateway’s SUD offerings, due to the similarities between the two types of addiction. Plus, there’s a large financial element to treatment.
Gambling addictions usually aren’t as outwardly obvious as SUD issues, and they can’t cause a person to overdose. However, they can bury families in debt and lead to suicide, making the monetary impact of the addiction especially important to address.
“A big piece of the treatment is financial literacy and financial counseling, in addition to other treatments, interventions and supports,” Garate said.
All of Gateway’s gambling treatment services are currently offered in outpatient or virtual settings. Eventually, Garate also hopes to assess patients currently in Gateway’s residential treatment programs to see if they have a gambling disorder.
“If they do, we can add that to their treatment plan and provide it as a supplement,” she said. “But first, we’re going to start with the outpatient group.”
In forming the new program, Gateway employees each completed a 30-hour course, followed by an exam, to become certified in gambling addiction treatment. A few people at the organization already had that certification, which Garate said helped build out the new program.
She recommends providers interested in developing gambling treatment programs of their own to lean on any certified staff they have, as well as employees well-versed in addiction. Plus, Garate advised organizations to talk to their payers and dive into existing literature, as there isn’t one gold standard for gambling treatment.
Opportunities for growth
Because Gateway’s program is still so new, it’s hard to tell how big of an opportunity gambling addiction treatment will present for the organization down the road.
However, an estimated 2.5% of Illinois adults have a gambling problem, and nationally, data suggests there are an estimated 2 million people addicted to gambling. Plus, studies indicate a strong link between gambling addiction and other behavioral health conditions such as SUD — meaning that if a person has one disorder, they’re more likely to also have the other.
Gateway is still in the initial stages of rolling out the program in Illinois, so it hasn’t yet made plans to expand into additional states. But the long-term goal is to get payers to reimburse for gambling addiction treatment so people all over the country can get the help they need, Garate said.
“This is an addiction; this is a disease; and just as they’re paying for substance use disorder treatment, they need to pay for this, as well,” she said. “It’s mental health parity. If you’re going to treat the physical needs of somebody, you have to treat their behavioral health and mental health [needs] — and gambling disorder is one of those needs.”