UNM Center on Alcohol, Substance Use and Addiction (CASAA) Associate Professor Joshua Grubbs is making sure veterans can trade wagering with a chance to focus on recovery.
Grubbs is dedicating his research to this already vulnerable population, in Addictive Behaviors to understand risks and motivations associated with U.S. armed forces veterans gambling addictions.
"This is one of those things that researchers love to split hairs about and talk about– is something a real addiction or not? It was just kind of mind-boggling to me that someone could get so addicted to something that wasn't a substance. That started kind of a long term research trajectory, trying to understand this better," he said.
Those who return from deployment, no matter location, branch of service or type of situation are uniquely at risk for developing substance use disorders. Problem gambling, on its own, affects 1-4% of the general adult population, versus 9.0 % for veterans.
"Veterans weren't taking substances that were destroying their bodies. They weren't, you know, using and getting in trouble with the law for things like illicit drugs or things like that," Grubbs said. "They were, however, unable to stop gambling. I remember talking to people that were $400,000 in debt with a credit rating below what I thought was even humanly possible because of all the things that had occurred."
After working in the oldest gambling treatment center in Ohio and speaking with veterans firsthand, Grubbs dove into six years of treatment data.
"We were looking at that information of where they started their treatment and trying to understand how to help them. The goal was to understand what people were starting with so we could understand how to help them better," he said. "We were looking specifically within this group of individuals when they were coming into treatment and what was going through their heads and how they were describing their experiences."
Data of over 400 veterans receiving treatment for gambling disorders and problem gambling, revealed important takeaways on the behaviors and their characteristics.
"We also looked at other diagnoses and disorders along with gambling problems. We're not seeing necessarily differences in what's causing the gambling, but we are seeing differences in the games that they're drawn to," Grubbs said.
Grubbs found a stark difference in how veterans gambled, and the difference in the various games they were addicted to. These were separated by strategic games, such as blackjack and Texas hold-em and non-strategic games like slot machines and horse betting.
"What we find pretty clearly is that veterans that have PTSD are certainly more likely to have gambling-related problems than veterans without PTSD." – CASAA Assistant Professor Joshua Grubbs
Veterans who stuck to non-strategic gambling were often older, female and single. They often spent more money and more hours involved in non-strategic gambling as a method of escape from scarring experiences.
"If you sit in front of a slot machine and are just caught up pressing that button or pulling that lever it's very easy to more or less dissociate. You can completely separate yourself from the reality that surrounds you to block out memory and thought," Grubbs said.
To avoid those memories, PTSD was a pronounced incentive in driving veterans to gambling. Although the actual total varies due to failure of reporting, up to 20% of veterans are estimated to experience PTSD. In Grubbs's set of 400 veterans receiving treatment, that was up to 40%.
"They are tormented by their memories, flashbacks, the reliving and re-experiencing, the nightmares, the constantly looking out for threats because their memory is telling them they could be in danger. Slot machines in particular are in a real way an immersive experience," he said.
While hitting a button and crossing two fingers together is an alarmingly simple respite for veterans, Grubbs also found non-strategic gamblers had difficulties moving towards seeking treatment for the addiction. They were also found to experience higher delays in happy emotions.
"Clinically working with veterans like this, I would hear them say things like:
'I would sit at the same machine for 16 hours. I would just sit there and press the button over and over again. I might feel awful afterward, but for those 16 hours that I was sitting there, I didn't think about watching my friend die in front of me. I didn't think about that time that my commanding officer sexually assaulted me. I didn't think about the time that our Humvee got blown up. I just thought about pressing the button again.'"
Still, Grubbs pointed out PTSD drove veterans to strategic gameplay as well. These players were younger, predominantly male, and more likely to regain a sense of control in their lives.
"I think veterans that are turning to strategic gameplay are actually quite similar to what we see of the general population. There tends to be a stronger interest in the action of it," he said. "People who have gambled in multiple ways, will tell you that there's a very qualitative difference to how it feels to gamble on a slot machine versus maybe sports or cards where you're watching every single thing that happens."
These veterans, also fairly emotionally stunted, sought the dual experiences of analytical victory and sensationalism on the table.
"There are just some people that crave more excitement and the action-driven kind of experience. We have a lot of research that broadly shows that in particularly younger men. Anyone that's got a stronger tendency towards something we call positive urgency, acting rashly and impulsively when you're feeling excited, are particularly drawn to strategic gambling," Grubbs said.
It was important to note that the severity of service did not impact the frequency of gambling. Whether it was Gulf War veterans, Afghanistan veterans or PeaceTime veterans, PTSD didn't discriminate.
"We saw veterans everywhere from Vietnam to coming back fresh from the Iraq and Afghanistan conflicts. Broadly speaking, there weren't huge differences across different conflicts, but we did not look in this study as to whether combat trauma itself was a unique risk factor," Grubbs said.
Without treatment, gambling addiction can wreck an already fragile life. Risks include the obvious financial consequences, as well as relationship problems and an increase in chances of suicide.
It's an especially crucial problem here in New Mexico, which not only has one of the highest totals of casinos per capita, but one of the highest rates of veterans.
"New Mexico does have higher than average rates of gambling disorder than you see in the country at large. Although we don't have as many options as other states, we still have these problems which suggest that casinos do play a role in the problems that people are experiencing. Access is always a powerful predictor of problems," Grubbs said.
There's still much to understand in the realm of gambling and veterans. Grubbs is aiming to find more connections when it comes to branches of service, additional substance use problems and specific experiences while still providing care.
"We're trying to change the face of understanding of what veterans with gambling disorders look like, act like, and what their experiences are," he said. "How does that compare to the general population, and how can we leverage the resources? Because veterans in many ways are underserved, but they do have a very robust health care system. Learning how to leverage that to help people is the long term goal."
This will take time, as with so much to unpack psychologically, it's not simple to dive into gruesome, traumatic details in a survey. Still, Grubbs knows that the more he and other researchers can understand about veterans and gambling, the more treatment can be given in the long term.
"This is a very prevalent problem. Historically, there's not been a ton of research in the state looking at how those factors are influencing people with gambling. It's certainly something that we're hoping to change in the future," Grubbs said. "We really do want to expand that body of research and build something more comprehensive so that we can get a much better picture of what gambling disorder looks like here and what's the most effective way to treat it."
