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I first met Heiko Ganzer about eight years ago when we were both working in the mental health field "way out" in Suffolk County. He was researching gambling addictions and writing a thesis on the subject for his Master's Degree at Stony Brook University. I did not understand at that time why he seemed so fascinated with gambling and what that had to do with mental illness.

Heiko recently had the chance to explain to me how gambling addiction is frequently overlooked when dealing with mental illness and drug/alcohol addiction. Over the past six years he actually created and implemented a unique and successful treatment program in Suffolk County called GAMPRO. He is now using his past experience to expand upon his original concept, and is adding a residential component that he feels will complete the continuum of services available. The new and improved version of the program is called LAST WAGER, and fortunately, he is bringing LAST WAGER to Queens and Nassau!

At the various program sites, a highly trained staff of clinical social workers and addiction specialists provide a wide range of psychotherapeutic services to people who are diagnosed with pathological gambling. In addition, treatment is provided to family members having a mental health diagnosis as a result of association with a pathological gambler. I was surprised to learn that the program treats patients as young as six years old! In fact, one recent study reported that 87% of high school youth said they had gambled for money at one time. In New York State it is illegal for youth under 18 to gamble, however, despite this adolescents appear to be the largest growing segment of gamblers!

As far as the connection of gambling to mental illness and to substance addiction, I was interested to learn that as many as 30% of gamblers are also diagnosed with substance addiction and 25% of gamblers are also diagnosed with psychiatric disorders. Heiko also showed me literature that documented that the ethnic groups with the largest numbers of gamblers are the Jewish and the Asian populations.

Apparently the elderly are also at high risk due to intimidation by predators. For instance it is not uncommon for an elderly person to incur a small debt by "social gambling" and then becoming involved with predatory "loan sharks". Interest rates often run as high as 100% and within a month a $1,000 debt becomes a $2,000 debt! Staff members have seen many unfortunate seniors lose their life savings or their homes to pay off debts.

The same vulnerability to predators holds true for those struggling with mental illness. What makes the problem even worse is that mental health professionals are often unaware that their patients have a gambling problem. Often this big secret lies hidden and is only revealed when an astute clinician recognizes the signs and symptoms. Heiko says, "Even among mental health and substance addiction professionals, their training in gambling addiction is 20 years behind…they still don't see the whole picture." One of the missions of the LAST WAGER program is to educate professionals to screen for gambling behavior and to train them in treatment techniques.

As with other mental illnesses, psychotropic medication plays an important part in treatment. One issue that complicates treatment among gamblers with a co-existing mental illness is that they are sometimes more resistant to medication compliance or to psychotherapy. Often communication is a problem. For instance, a patient may be selling drugs in order to get money to gamble, and may not necessarily be using the drugs. This same patient gets caught, ends up mandated to a drug program and the gambling problem is never uncovered.

Some of the signs and symptoms to watch for are: debt, requests for money or loans, finding betting slips or lotto tickets, irritability, isolation, lies about money issues, and/or huge purchases. One of the differences between social gambling and addiction is the acknowledgment on the part of the social gambler that over time nearly everyone loses. It is therefore done in a social context, with family, friends, and colleagues-not alone. Also, social gambling is done for limited amounts of time, both in frequency and duration. And finally, social gambling always has predetermined, acceptable limits for losses.

Hopefully, mental health and substance abuse facilities will become increasingly aware of the gambling epidemic and begin to routinely screen for this hidden problem. LAST WAGER hopes that more patients will be able to admit to the problem and get the treatment they need. As one patient sadly stated recently, "I can stop drinking, but I can't stop gambling!"