There’s a hidden addiction problem in the Omaha metropolitan area and it’s affecting older adults in growing numbers. The increasing problem of gambling addictions among the elderly has been the focus of a UNMC clinical psychologist’s study, and he has some unsettling results.

Dennis McNeilly, Psy.D., geriatric psychiatry, uncovered the problem three years ago when he was asked to evaluate a 73-year-old married woman for depression and anxiety. She was referred to him by the inpatient geriatric rehabilitation unit, where the woman was recovering from a small stroke.

The woman’s gambling problems came to light when her children came home to care for her and discovered she had maxed out her credit cards. She was $35,000 in debt — all to one casino. She eventually filed for bankruptcy and has since been involved in Gamblers Anonymous.

"This is perhaps the saddest example of pathological gambling that I’ve treated. Younger people who gamble have the opportunity to recover from their losses, but retired people can’t do that. Older adults who have gambled away a pension have little time for a new start at life," Dr. McNeilly said.

"Ten years ago, our outpatient geriatric psychiatry clinic never had a patient with this problem. Since the casinos have opened in Iowa, we now have more than 25 patients who have a gambling behavior problem."

This case was so striking that Dr. McNeilly and William Burke, M.D., professor and director of the division of geriatric psychiatry, decided to research this subject. "Little has been done to study this age group," Dr. McNeilly said.

They have completed two studies on elderly gamblers. One study identifies the types of elderly gamblers and outlines the progressive stages of each type. The second study details the prevalence of casino gambling as a social activity for senior citizens in the Omaha metropolitan area.

Legal gambling is a $40 billion a year industry in this country and it is available in 27 states. The three casinos in this area constitute the second highest amount of revenue generated of all the 12 casinos in Iowa.

Seven out of 100 Americans and Canadians — more than 20 million people — are problem gamblers, with perhaps 2 in 100 considered compulsive gamblers. Studies of gambling in Iowa showed that the number of lifetime problem and probable pathological gamblers in the state has tripled after five years of casino gambling. State-supported hotlines for problem gamblers has reported a 248 percent increase in calls, Dr. McNeilly said.

The researchers began their investigation with a case study of patients at the combined psychiatry department at UNMC and Creighton University. Six types of adult gamblers have been identified among the individuals seeking treatment for gambling problems. The six types are: professional gambler, antisocial personality gamble, casual social gamble, serious social gambler, relief-escape gambler and the pathological gambler.

"Sixty percent of the elderly people gamble infrequently — for excitement and entertainment — and are considered casual social gamblers. They set limits and they know what they’re going to spend. But, there are a growing number of older adults who have reached more dangerous levels. These are the "relief-escape" gamblers," Dr. McNeilly said.

The "relief-escape" gambler’s wins and losses go along with his or her mood and gambling is a major source of entertainment. Gambling for the relief-escape gambler is a major activity of equal importance with family and work.

"Like the binge drinker, the relief-escape gambler uses gambling to escape boredom, loneliness and to avoid difficult situations. This group has the biggest proportion of older people and, as a result, a growing number of older women" he said.

The more serious pathological gamblers exhibit persistent and recurrent maladaptive gambling behaviors in five or more established areas. Once identified, the pathological or compulsive gambler is said to go through a progression of three predictable phases of gambling: the winning phase, the losing phase and the desperation phase, Dr. McNeilly said.

In their case study, Drs. McNeilly and Burke discussed the cases of three people who were identified as relief-escape gamblers and a fourth person who was diagnosed as a pathological gambler.

"Important in each case is the hidden nature of problem gambling behaviors, which emerged almost by accident while these older adults were being treated for other, and usually, affective disorders.

"These are people who grew up in the Depression era. They are self-reliant, independent and tend to think they can solve their own problems. They have found in gambling a source of entertainment, relaxation and the opportunity to get something for nothing," he said.

Slot machines hold the interest of 68 percent of the elderly gamblers, mostly women, who are apparently not as focused on the amount of money taken, as in the amount of action available. While the activity is stimulating for some, it can open the door to a life-threatening addiction for others who have been left vulnerable by life changes, such as loneliness, the loss of a spouse, family member or special friends, or the anxiety that often results from changes in health, Dr. McNeilly said.

"Older adults may have more disposable income and time than those who were previously in their age group. That’s what makes this a lucrative market group for the casinos. Older people can be the largest group of people at the casinos from 6 a.m. to 2 p.m. during the weekdays," he said.

Casinos offer senior citizen discounts, slot machine club cards that give 50 percent discounts on prescriptions and other over-the-counter drugs, free transportation from retirement homes, low-cost or free buffets and entertainment featuring former stars of the Lawrence Welk show.

"The casinos are people friendly, safe and there is no distinction as to age. In this place, an older person has equal access to all of the activities. That’s important to this age group, which generally finds itself marginalized and isolated by society," Dr. McNeilly said.

The popularity of casino gambling as a social activity among the elderly was measured in the second study that surveyed activity directors from 49 senior centers, assisted-care retirement centers, nursing homes and a church in the Omaha area. The survey results represented 6,957 older adults.

Out of 11 different social activities, bingo came in first with 23 percent of the older adults playing more than four times a month. Trips to the casinos on a more than once a month basis was an activity in which 16 percent of the adults participated.

Dr. McNeilly has become a national expert on the problem of elderly gamblers. His research and findings were presented at the 12th National Conference on Problem Gambling in Las Vegas in June. His research also made front-page stories in the New York Times, Los Angeles Times, Omaha World-Herald and Las Vegas Review Journal.

He now is conducting a survey among older adults about their feelings, attitudes and gambling behaviors. The anonymous survey is being gathered through senior centers, retirement centers and the American Association of Retired Persons. It also includes questions about other impulsive behaviors, such as smoking, drinking alcohol, or playing bingo and the lottery.