NATIONAL CENTER FOR RESPONSIBLE GAMING

1998 ANNUAL REPORT OUR MISSION

The mission of the National Center for Responsible Gaming is to help individuals and families affected by gambling disorders and eliminate underage gambling through the following activities:

• Supporting the finest peer-reviewed basic and applied research on disordered gambling behavior.

• Encouraging the application of new research findings to improve prevention, intervention and treatment strategies.

• Enhancing public awareness of disordered and underage gambling. A MESSAGE FROM THE CHAIRMAN

FROM THE DESK OF MAJ. GEN. PAUL A. HARVEY (RET.) 1998 was an especially gratifying year for the National Center for Responsible Gaming (NCRG). The 10 grants awarded by the NCRG in late 1997 funded investigations of gambling disorders and youth gambling, which commenced in the spring of this year. We announced a call for applications in the summer of 1998, a process that was completed in February 1999 with the award of more than $1.06 million in grants, bringing the NCRG’s total research funding to $2.5 million. In 1998, we laid the groundwork for our first conference, “New Directions in Gambling Addiction Research,” on Feb. 5 of this year. More than 150 people attended the Retired Maj. Gen. Paul A. Harvey, chairman of the Gaming conference at The George Washington University, including Entertainment Research and academic researchers, clinicians, and representatives from Education Foundation. Harvey is government and the gaming industry. By all accounts, the the former executive director of the Mississippi Gaming Commission. conference marked a turning point in gambling studies. The NCRG demonstrated that financial support and rigorous standards are the ingredients for creating a thriving and respected field of research. The NCRG’s voice was heard many times during the 1998 deliberations of the National Gambling Impact Study Commission. Excerpts from testimony given to this congressionally mandated federal panel by an NCRG board member and executive director are included in this report. The National Center for Responsible Gaming has made extraordinary progress in three years. We have established a unique and credible organization dedicated exclusively to promoting peer-reviewed research on disordered and underage gambling. For this, we are grateful to our generous donors and to those who have supported our mission. We look forward to building on the progress achieved in 1998 toward creating a rigorous field of scientific research on disordered gambling.

Sincerely,

Maj. Gen. Paul A. Harvey (Ret.) Chairman Gaming Entertainment Research and Education Foundation

1 SCIENCE AND THE PUBLIC Building Bridges

The mission of the National Center for he co-authored, Estimating the Prevalence of Responsible Gaming (NCRG) reaches beyond Disordered Gambling Behavior in the United States funding research. Disseminating and translating and Canada: A Meta-analysis. This the findings of this research is also a top priority. groundbreaking study, funded by a $140,000 grant from the NCRG, was the first comprehensive Seminars: “Understanding Gambling study of disordered gambling prevalence rates in and Its Potential Health the United States and Canada. The NCRG has Consequences” distributed more than 3,000 copies of the study to researchers, policy-makers, treatment providers In 1998, the NCRG sponsored two seminars and others interested in gambling studies. on the topic “Understanding Gambling and Its Shaffer Potential Health Consequences,” conducted a second conducted by Howard Shaffer, director of seminar at the Harvard Medical Southern Gaming School’s Division on Summit in Biloxi, Addictions. Miss., on May 6, The first seminar, 1998. Co- held Feb. 26 at the sponsored by the Golden Nugget in Las Mississippi Vegas, attracted a diverse Council on audience of 130 individuals Problem and from the gaming industry, Compulsive academia and social services Gambling, the sector. Co-sponsored by the ence. seminar was ticipants at confer American Gaming Workshop par attended by more Association (AGA) and the than 100 individuals Council on Problem from the gaming industry and the local Gambling, with generous support from Mirage community. Seminar participants included Resorts, Inc., the seminar featured a three-hour educators, social service professionals, human presentation by Shaffer on the results of the study resources staff, communications and public

hey have well-respected scientists in the crowd (NCRG/The George Washington tUniversity-sponsored conference “New Directions in Gambling Addiction Research”), and as far as I can tell, everyone is interested in the question [of gambling addiction] in an open-ended way.

Alan I. Leshner, Ph.D. Director, National Institute on Drug Abuse

The Chronicle of Higher Education

2 March 5, 1999 relations representatives, corporate responsible gaming staff, table operations personnel, executives, treatment professionals, and problem gambling counselors.

Conference: “New Directions in Gambling Addiction Research” Academic researchers and clinicians were joined by journalists, students, gaming industry representatives and staff from the National Institutes of Health (NIH) and National Research Council (NRC) for the first NCRG conference, “New Directions in Gambling Left to right: Richar Addiction Research.” This one-day event at NCRG advisor d Evans, Ph.D. (University of Houston, The George Washington University Institutes of Health),y boar d),Rober James Br attracted more than 150 people for a NCRG-funded investigator). eiling, Ph.D. (National t Ladouceur discussion of new trends in research. , Ph.D. (Université Laval, Alan I. Leshner, Ph.D., director of the National Institute on Drug Abuse at NIH, delivered the keynote address, “Addiction is a topics such as Brain Disease—and It Matters.” Scientists youth gambling, prevention and currently funded by the NCRG also reported on definitions of pathological gambling. their preliminary findings in the areas of Nigel Turner, a scientist with the Centre for neuroscience, behavioral-social science and Addiction and Mental Health, described the epidemiology. The afternoon workshops conference as “a very stimulating environment for focused on special theoretical discussion” and noted that it inspired him and other NCRG-supported investigators to plan collaborative work “so that we can attempt to integrate the neuro, genetic, cognitive, and clinical aspects of problem gambling into a unified view of the disorder.” The NCRG plans to join with universities and other respected research organizations to host similar conferences in the future.

ector of the National Institute on , Ph.D, dir ess, “Addictionence. is a Alan I. Leshner ed the keynote addr Drug Abuse, deliver Brain Disease—and It Matters,” at the NCRG confer

3 NCRG-FUNDED RESEARCH A New Era Begins

In late 1997, the NCRG awarded 10 grants • University of New Mexico totaling $1,287,427. These investigations of Albuquerque, N.M. disordered gambling behavior, which began in the “A Combined EEG, MEG, MRI, and SPECT spring of 1998, were selected from a highly Imaging Study of Pathological Gamblers,” $76,360 competitive pool of 64 grant applications by peer Disordered gambling behavior may be rooted review panels and the NCRG’s advisory board. in a defect in the brain’s decision-making circuit The NCRG follows the rigorous criteria and that results in impulsivity and an abnormal review procedures of the National Institutes of response to reward and punishment. This Health. A list and brief explanation of the grant project is using various brain imaging awards follows: techniques to assess the brain activity of pathological gamblers while they perform a • City of Hope National Medical Center computerized version of the Gambling Task that Duarte, Calif. simulates the behavioral state of gambling in a “The Molecular Genetics of Pathological laboratory setting. Gambling,” $159,990 Completion date: June 1999 The investigators are testing the hypothesis that some individuals are susceptible to a range • University of Minnesota Medical School of addictive behaviors, impulse control disorders Minneapolis and risk-taking behaviors, including “Double-blind Study of Naltrexone and Placebo in pathological gambling, due to a genetic the Treatment of Pathological Gambling Disorder,” abnormality that results in a malfunctioning of $53,374 the pathways controlling dopamine levels. The drug naltrexone has been effective in They are examining DNA samples from treating psychiatric disorders characterized by pathological gamblers and a control group. excessive urges and loss of behavioral control, Completion date: September 1999 including alcoholism and bulimia nervosa. The investigators have hypothesized that naltrexone • Foundation for Clinical Neuroscience will reduce uncontrollable urges to gamble. Research This trial is testing the safety and efficacy of this Cleveland medication for pathological gamblers. “Relation of Cognitive Status to Brain Blood Flow Completion date: December 1999 and Dopamine Receptors in Pathological Gamblers,” $138,000 • Minnesota Institute of Public Health Past studies have indicated that pathological Anoka, Minn. gamblers may suffer from cognitive impairment “Psychosocial and Behavioral Factors Associated that results in poor judgment and reduced with Problem Gambling by Youth,” $57,339 attention span. The investigators are examining The investigator is conducting a statistical the relationships between regional brain activity analysis of the Minnesota Student Survey and dopamine receptors through neuroimaging database, the world’s largest database of youth scans and DNA samples. This study has gambling information, in order to answer the important implications for the type of therapy following questions: What demographic, offered and may help explain the high rate of psychosocial, and behavioral variables are treatment relapse. associated with underage gambling? Have rates Completion date: February 2000 of youth gambling increased, decreased, or stayed the same from 1992 to 1995 to 1998? Completion date: January 2001

4 • University of Minnesota • University of Calgary Minneapolis Calgary, Alberta “Youth Gambling: Transition from Adolescence to “Critical Dimensions of Relapse in Pathological Young Adulthood,” $56,410 Gambling,” $106,638 The investigator is testing the validity of a The study will follow problem gamblers in developmental model of youth gambling treatment for a year to understand the adapted from drug and alcohol research. One phenomenon of relapse, a subject that has pivotal question is whether adolescents involved received little attention from researchers. in gambling experience the “maturing-out” The findings of this study will have important process young people involved in alcohol and implications for theory and treatment. drug use experience when they reach young Completion date: June 2000 adulthood. The findings will be helpful for improving prevention strategies. • Harvard Medical School Completion date: February 2000 Boston “The Harvard Project on Gambling and Health,” • Addiction Research Foundation $465,069 Toronto This project is a continuation of the “Cognitive Biases in Problem Gambling,” $33,748 groundbreaking research conducted for the first This study seeks to characterize the nature of NCRG grant, Estimating the Prevalence of distorted thinking and erroneous reasoning in Disordered Gambling Behavior in the United States diagnosed pathological gamblers. For example, and Canada: A Meta-analysis. The Harvard gambling behavior appears to be accompanied database is enabling researchers, policy-makers, by beliefs about the ability to control luck and and the public to access the most reliable and about the efficacy of superstitious behavior to precise estimates of the prevalence of gambling- influence gambling outcomes. The findings of related phenomena. The investigators have this study will help clinicians determine the completed five technical reports, including a potential of cognitive approaches to treatment. revision of the meta-analysis that has been Completion date: April 1999 accepted for publication by the prestigious American Journal of Public Health. The • Université Laval investigators have also worked with the Sainte-Foy, Quebec Massachusetts Council on Compulsive “Cognitive Treatment of Pathological Gambling,” Gambling to develop an automated helpline $140,499 number system that will provide higher quality This clinical trial is treating pathological and more standardized data from callers. The gamblers with cognitive therapy, which seeks to NCRG grant also supports the project’s change behavior by modifying thoughts. The publication of The WAGER newsletter, a weekly aim is to modify the disordered gambler’s fax about gambling research with a subscription erroneous notion of randomness. The findings base of nearly 1,000 people and an estimated of this study will help clinicians determine the readership of 7,500. potential of cognitive approaches to treatment. Completion date: January 2000 Completion date: January 2001

5 NCRG-FUNDED RESEARCH Building for the Future

The NCRG’s 1998 request for applications associated with pathological gambling with a (RFA) called for research projects on disordered stress-inoculation approach designed to provide and underage gambling in both neuroscience and emotion-focused coping skills. behavioral-social science. The RFA emphasized Completion date: April 2000 the NCRG’s special interest in youth gambling and prevention research. From a pool of 79 letters • University of Missouri of intent to apply, the advisory board selected 35 Columbia, Mo. proposals for submission to the NCRG in January “The Association of Gambling Problems with 1999. Peer review panels in neuroscience and Impulsivity as a College Student and the Genotype- behavioral-social science assessed the scientific phenotype Relation,” $171,124 merit of the proposals. On the basis of these The researchers will undertake a molecular evaluations, the advisory board awarded eight genetic investigation of a personality trait called research grants for a total commitment of “impulsive nonconformity” that is strongly $1,063,730, bringing the NCRG’s total awards associated with sensation seeking, substance since 1996 to nearly $2.5 million. A list and brief dependence, and other behaviors related to explanation of these grant awards follows: gambling disorders. Using DNA extracted from former college students who produced extremely • University of South Alabama high or low scores on the Impulsive Noncon- Mobile, Ala. formity Scale while they were students, they will “Adolescent Gambling Behavior as a Function of type candidate genetic polymorphisms associated Individual Differences in Risk-taking, Gender, Peer with gambling disorders and test for association and Family Context, and Community Norms for of gambling problems both with personality Legalized Gambling,” $125,800 traits and with the candidate genotypes. This study will focus on 16- to 19 year-old Completion date: May 2001 high school students from three communities. This age group is at high risk for gambling • Massachusetts General Hospital because of increased access to independent trans- Charlestown, Mass. portation and money. The investigators will “Functional MRI of Neural Responses to Monetary develop a comprehensive model of adolescent Gains, Losses and Prospects in Pathological gambling behavior by examining risk factors and Gamblers and Normal Subjects,” $172,500 how they relate to the adolescents’ perceptions The investigators will use functional magnetic- of their peers, family and community context. resonance imaging (fMRI) to localize patterns of Completion date: March 2001 brain activation in pathological gamblers and normal subjects with particular attention to • Centre for Addiction and Mental Health known components of brain reward circuitry, Toronto during (1) the expectation and experience of “Adolescent Understanding of the Emotional and monetary gains and losses, (2) the anticipation Cognitive Aspects of Gambling: The Development of impending victory or defeat in a game of of a Prevention Strategy,” $88,296 chance on which a wager has been made, and The researchers will develop and test a (3) the build-up of craving to resume gambling classroom intervention designed to prevent during an enforced interruption. This study has adolescent gambling in hopes that early significant implications for understanding the intervention may eventually reduce link between the neurobiological bases of development of a gambling disorder in at-risk substance abuse and pathological gambling. adult populations. The researchers will compare Completion date: March 2001 a strategy designed to alter cognitive biases 6 • University of Illinois-Chicago Washington University in St. Louis Chicago St. Louis “Reward Deficiency ERPs: Effects of D2A1, “The Development of a Diagnostic Gambling Gambling Pathology and ADHD,” $172,492 Assessment—the GAM-IV,” $86,321 The primary aim of this study is to investigate This study will develop the computer-based whether certain event-related brain potential Gambling Assessment Module (GAM-IV) in a (ERP) abnormalities in response to gambling three-phase process. The GAM-IV will provide feedback, which were observed among the extensive diagnostic and other gambling gambling disordered in an earlier study, may information, including amount, frequency, type reflect a reward deficiency syndrome whose of gambling activity; onset, recency, and severity is driven partly by presence of the durations of symptoms; amount of money dopamine D2 receptor gene, A1 variant wagered; alcohol- and drug-associated gambling; (D2A1). The study will also introduce a task illicit and underage gambling; help-seeking for designed to foster “chasing” behavior, a gambling problems; family history; and hallmark of pathological gambling, and examine information on social networks and various the effects of Attention Deficit Hyperactivity venues for gambling activity. Disorder (ADHD), a condition associated with Completion date: June 2000 pathological gambling and D2A1, on gambling feedback ERP abnormalities. • University of Illinois at Urbana-Champaign Completion date: March 2001 Champaign, Ill. “Affective, Cognitive and Perceptual Processes in • Centre for Addiction and Mental Health Gambling,” $172,155 Toronto The focus of this study is how people gamble, “Pharmacological Priming of Gambling-related not why. The investigator will attempt to Cognitions by Amphetamine,” $75,042 discern differences between pathological and This study will attempt to provide more recreational gamblers in hopes of than correlational identifying and describing several evidence of the role of distinct types of gambling styles and dopamine in disordered strategies, including ones that will gambling. The distinguish between subtypes of researchers will use a pathological gamblers. Four naming task to assess the experiments will examine effects of amphetamine- connections between erroneous induced dopaminergic perceptions of randomness and activation on automatic gambling behavior, effects of addiction-related cognition positive and negative moods on in problem gamblers and affective and cognitive processes alcoholics. This approach while gambling, the accuracy of could form the basis of a memories for wins and losses, number of related studies and relation between gambling designed to elucidate the role behavior and risk factors. of dopamine and other Completion date: March 2001 neurotransmitters in the neurobiology of addiction. arren, Ph.D. (University of Charles W eceived an ecently r ch. Completion date: October 2000 Illinois-Chicago) r oscience resear NCRG grant for neur 7 NCRG OFFERS INSIGHTS Testimony to the National Gambling Impact Study Commission

In 1996, the U.S. Congress created the considerable conceptual confusion and National Gambling Impact Study Commission to inconsistency about the terminology that conduct a comprehensive legal and factual study of scientists have used to describe intemperate the social and economic impact of gambling on gambling…. As a result, we adopted some governments, businesses, families and individuals in different language to classify intemperate or the United States. The nine members of the disordered gambling…. [L]evel one commission were appointed by the president, the prevalence rates…reflect people who do speaker of the house and the Senate majority leader not have any gambling problems at all, and are required to submit a final report on their level two represents those findings to the president, Congress and state individuals who failed to governors in June 1999. satisfy the multiple criteria for The commission has met in a clinical disorder, but do various cities across the country and experience some of the heard testimony from public officials, adverse symptoms that can experts in the field of gaming and be associated with gambling, private citizens. Howard Shaffer, a and level three reflects member of the board of directors of the those people who meet Gaming Entertainment Research and sufficient criteria for Education Foundation and director of the having a disorder. Harvard Medical School Division on Our new research Addictions, testified before the reveals that during the commission on Jan. 22, 1998, in Atlantic past 23 years, in spite of City, N.J. Christine Reilly, executive higher rates of disordered fer, director of director of the NCRG, testified before the Howard J. Shaf s gambling among commission on Nov. 11, 1998, in Las Vegas Harvard Medical School’ adolescents and Division on Addictions and and was invited to offer recommendations to Estimating the substance abusing or the commission on Feb. 9, 1999, in Virginia co-author of dered Gambling psychiatric patients in evalence of Disor Beach, Va. Pr treatment, only the behavior in the United States and The testimony of both Shaffer and Reilly adult segment of the Canada: A Meta-analysis. provided the panel with up-to-date general population has information and insights on disordered shown an increasing rate of gambling gambling. Shaffer shared the results of the NCRG- disorders. funded study, Estimating the Prevalence of Disordered The rate increase we observed among Gambling Behavior in the United States and Canada: adults from the general population could be A Meta-analysis, the most comprehensive study to due to many factors. For example, during date on disordered gambling. He provided the the past two decades there’s been an commission with wide-ranging views on the subject increased availability and accessibility to honed from years of experience and an intimate gambling. There’s been an increased social knowledge of the subject matter. Following are acceptance of gambling. There are few excerpts from his testimony: messages about the potential risks and hazards of gambling. There’s been an Recently, my colleagues and I increasing desire to participate in risk- completed a study which includes the most taking activities in general. And, perhaps, comprehensive analysis of the gambling there’s been a decline in the belief that one prevalence research literature in the United can achieve the American dream, a States and Canada. This work revealed growing sense of emotional discomfort, a 8 malaise or dysthymia among the American people. All of these things could play a role in increasing the rate for disordered gambling among the general adult population. Observers tend to think that disordered gambling is growing in direct proportion to the expansion of ambling researchers who have been legalized gambling opportunities. This may not be an accurate perception. Assessing shifting social trends is g very difficult without evidence from prospective in the field for a while, have been research, and…we have no prospective research to date…. However, gambling certainly has expanded much calling for some kind of effort to more rapidly than the rate of disordered gambling. We do know that. Tobacco, arguably the most virile and objective chemical dependence, has been widely fund research for many years. The available, and despite this wide availability tobacco has a much smaller user base than 20 years ago. We must conclude that availability is not a sufficient, sole NCRG is the first effort that we’ve explanation for the increased rate of gambling as an addictive disorder in the United States. In part, the history of gambling research seen, and I absolutely have to inadvertently has fueled this very perception that expanded gaming, and by expanded I mean lottery, applaud the casino industry for casino, charitable gaming, is the sole course of increased gambling problems. And, the reason for this is that early gambling prevalence studies tended to focus on coming up with that particular the adult general population. This is the population segment with the lowest rate of gambling disorder. More recently…their research interests have become method, it’s a peer reviewed, much more diversified and they’ve examined young people and other high-risk population segments. Consequently, the shifting evidence provided by more scientifically sound way of getting recent studies of new population segments with higher rates of the disorder have, perhaps, biased the prevailing subjective impressions of our disordered gambling research done…. prevalence rates. At the risk of being misinterpreted and Rachel Volberg, Ph.D. misrepresented, I’d like to note that many economists, President, Gemini Research researchers and social policymakers have made two important assumptions about disordered gambling that Testimony before National Gambling Impact are often incorrect. It’s incorrect that all gamblers who Study Commission experience problems with gambling eventually progress to become level three or pathological gamblers. Jan. 22, 1998 Secondly, it’s incorrect to assume that once someone becomes a disordered gambler only professional treatment will arrest the problem. 9 NCRG OFFERS INSIGHTS Testimony to the National Gambling Impact Study Commission

Just as most people who occasionally as Americans have been reducing their use feel depressed do not progress to a state of of tobacco and alcohol during the past two clinical depression, most gamblers with decades, in spite of the widespread level two gambling-related problems do availability of these products, the rates of not experience a progression to level three gambling excess will also begin to diminish states. as people learn of the potential personal Further, in addition to professional and social risks associated with gambling. treatment, there are many different This has happened on two previous pathways out of disordered gambling. occasions, it’s likely to happen again. Gamblers Anonymous, perhaps, is best I’d like to offer…five suggestions for known, but natural recovery is certainly your consideration. First, since gambling another pathway out of disordered problems, particularly, among the young, gambling. are not dramatically different from alcohol Current research has not identified and other drug-using problems, I believe reliable methods for determining which that gambling proponents and opponents gamblers will develop gambling disorders, alike should join forces to develop and or who will recover with or without implement prevention, education and treatment. treatment initiatives for disordered Furthermore, without precise estimates gambling that are commensurate with of the duration of gambling disorders, and these other problems. the extent of people who recover without Second, to engage in this bipartisan any treatment at all, it’s not possible to program initiative, it will be necessary to estimate accurately the economic and use the most rigorous scientific social impact of disordered gambling. information, and provide improved While the rate of disordered gambling education, training and clinical among adults may continue to increase, supervision to both gambling and other such an increase is not without end. Just addiction treatment specialists.

asinos in Nevada and around the country recognized long ago they were going to cbe asked to heighten awareness and contribute more to the treatment of addictive gamblers. It is why they created and formed the National Center for Responsible Gaming in Kansas City. After a few short years, the center now is recognized as one of the country’s leading authorities on problem gambling.

Jeff German Las Vegas Sun

Nov. 15, 1998 10 Third, to advance this scientific Research Issues knowledge, I encourage…this Recognize the importance of Commission to prioritize a prospective or understanding disordered gambling incidence study of gambling disorders behavior as a multidimensional problem, among high-risk population segments, for comprised of biological, psychological, example, adolescent males. More than and sociological factors. any single prevalence study, an incidence The NCRG believes that disordered study will help us understand what gamblers deserve to benefit from the same specific factors encourage level one scientific and technological advances that gamblers to become level two or three are helping people who suffer from gamblers. depression, alcoholism and other I believe that the federal and state disorders. The NCRG encourages the government should advocate for the commission to resist the uninformed and treatment of those suffering with out-dated notion that brain research has disordered gambling by requiring the no contribution to make in understanding insurance industry…to allocate the disordered gambling. resources necessary to support this Recognize the benefits of the meta- important and legitimate health care analytic approach to gauging national service. prevalence estimates. Finally, I respectfully encourage this The NCRG funded the 1997 meta- Commission to press the federal analysis of prevalence studies by Harvard government, through its National Medical School because of the Institutes of Health, to develop a rigorous insurmountable problems that would have research and treatment improvement been posed by a national prevalence study initiative, along with the funding stream including the time, exorbitant expense, necessary to advance the study of and the lack of consensus about which disordered gambling and its treatment. scale to use. Meta-analysis, a research technique used to review and synthesize a Reilly’s initial appearance before the National body of research, offers a valuable Gambling Impact Study Commission alternative. concentrated on providing information about the Encourage an intellectual climate NCRG and its activities. She met again with the that challenges existing views and commission to provide recommendations to the assumptions and allows for a resolution panel. Excerpts from her presentation follow: of fundamental, unresolved issues in the field. Our recommendations to this panel Gambling researchers have paid very cover three main areas of concern to both little attention to the high rate of the NCRG and the commission: Research comorbidity with other psychiatric Issues, Financial Resources, and Bridging disorders. The implications of this issue Research and Practice. The following are potentially significant for measuring, recommendations reflect the wisdom and preventing and treating disordered experience of NCRG advisory board gambling. members, foundation members and the distinguished scientists conducting Financial Resources NCRG-funded projects. Encourage support for high quality research on disordered gambling 11 NCRG OFFERS INSIGHTS Testimony to the National Gambling Impact Study Commission

behavior by the federal government and The National Gambling Impact the foundation community. Study Commission should encourage The field of disordered gambling has government entities to use only the been compared to the under-developed leading scientists, as recognized by their state of alcoholism research in the late peers and the major funding sources, to 1960s and early 1970s. An infusion of consult on the development of requests significant support is vital to the for proposals and to review proposals development of the gambling field. according to the rigorous criteria used by Encourage all segments of the the National Institutes of Health and the gaming industry to support the National National Center for Responsible Gaming. Center for Responsible Gaming. The casino industry has provided the Bridging Research and Practice venture capital to launch innovative Encourage the improvement of scientific research on disordered training and elevation of standards for gambling. The other segments of the clinicians. gaming industry can make a powerful Organizations that provide training statement and set an example for the and certification in the addictive entire private sector by joining NCRG’s disorders should be encouraged to find donors as responsible corporate citizens. ways to stay in touch with developments Along these lines, we encourage the in the field of disordered gambling commission to recognize the important research. role that the private sector plays in Encourage collaboration between supporting research. researchers, clinicians and institutions Encourage public policy makers at to strengthen the national network of the local, state and federal level to helplines currently in existence. support studies that are based on The national helpline number offers scientific, peer-reviewed research. an important form of early intervention; however, the existing system needs to be strengthened and expanded. Furthermore, the potential of helpline data for research should be mined. The data could serve as a warning mechanism by alerting researchers and clinicians to shifting trends in gambling abuse. Encourage dialogue between scientists, clinicians, and the public about disordered and underage gambling research.

ch.” ections in Gambling Addiction Resear ence, “New Dir Workshop at confer 12 National Research Council Uses ashington NCRG-Funded Research Linda Cottler, Ph.D. (W University School of Medicine in The National Gambling inters, Ph.D. Impact Study Commission charged St. Louis) and Ken W e (University of Minnesota) ar the National Research Council ch members of the National Resear (NRC) of the National Academy of Council’s Committee on the Social Sciences, one of the most respected and Economic Impact of Pathological academic bodies in the nation, with Gambling. Cottler is a member of the y board. Winters is studying the impact of problem and NCRG’s advisor the principal investigator of an pathological gambling. The esearch NCRG-funded r National Center for Responsible project on youth Gaming has played a pivotal role in gambling. this important study. In 1998, the NRC invited leading scholars from fields relevant to the study of disordered gambling to conduct a 15-month study. Ten of the investigators currently working on NCRG-funded studies were invited to present their research to the panel. The panel’s membership includes NCRG-funded investigators Howard Shaffer and Ken Winters and NCRG advisory board member Linda Cottler. Perhaps most significantly, the NRC panel was granted permission to use the prevalence database developed by Harvard Medical School’s Division on Addictions with grant support from the NCRG. Concerning the NRC study and the role of convened groups of leading experts in the the National Center for Responsible Gaming, field to address the Committee on the Christine Reilly noted during her Nov. 11, 1998, Social and Economic Impact of testimony to the National Gambling Impact Study Pathological Gambling. Ten of the Commission: presenters selected by the NRC serve as key personnel on NCRG-funded research We hold a very high opinion of projects: Robert Ladouceur, Université NCRG’s investigators, an opinion that is Laval; Peter Goyer and William Semple, shared by many of the most prestigious VA Medical Center Cleveland; Howard academic bodies in the country, including Shaffer, Harvard Medical School; Ken one employed by the National Gambling Winters, University of Minnesota; David Impact Study Commission. The National Comings, City of Hope National Medical Research Council (NRC) of the National Center; Randy Stinchfield and Roger Academy of Sciences has been engaged by Svendsen, Minnesota Institute of Public the commission to study the social and Health; Tony Toneatto, Addiction economic impact of pathological Research Foundation; and Lori Rugle, gambling. This past year, the NRC Trimeridian.

13 NCRG ORGANIZATION Independent and Respected

NATIONAL CENTER FOR RESPONSIBLE GAMING A Division of the Gaming Entertainment Research and Education Foundation Organizational structure parallel with National Institutes of Health

GEREF Advisory Board, Peer Review Panels Applicants for Grants Board of Directors National Center for Research Domains Responsible Gaming

Membership: Membership: Academics Membership: Scientists Neuroscience Epidemiology Multi-disciplinary and health care providers in mental health and 50 percent of membership No gaming industry addictions research may be from gaming industry representation No gaming industry Role: Raises funds for Role: Selects research representation the NCRG for funding Role: Evaluate grant Behavioral & applications Social Sciences

Christine Reilly Executive Director = No gaming industry members National Center for Responsible Gaming

540 Pierce Avenue = Gaming industry members Kansas City, MO 64110-2026 Telephone: 816-531-1878 Fax: 816-531-3459 www.ncrg.org

The NCRG has modeled its organizational structure and decision-making procedures on the National Institutes of Health (NIH), ensuring that the highest standards are employed in evaluating research grant proposals submitted to the NCRG.

14 BOARD OF DIRECTORS The Gaming Entertainment Research and Education Foundation

The National Center for Responsible Gaming David A. Korn, M.D. Assistant Professor is an unincorporated division of the Gaming University of Toronto Entertainment Research and Education Visiting Professor 1998-99 Foundation, a tax-exempt nonprofit organization. Harvard Medical School The foundation was created in 1996 to address Alfred C. Lomax Airport Police Chief disordered and underage gambling through Kansas City International Airport research and public education. According to foundation bylaws, at least 50 percent of the Brian McKay Vice President and General Counsel governing board must represent sectors other than International Game Technology the gaming industry. The following served in Carol O’Hare 1998: Executive Director Nevada Council on Problem Gambling Maj. Gen. Paul A. Harvey (Ret.), chairman President and CEO Philip G. Satre Signature Works President and CEO Harrah’s Entertainment, Inc. William Boyd, president Chairman and CEO Glenn Schaeffer Corporation President, CFO and Treasurer Circus Circus Enterprises, Inc. Robert Boswell, Ph.D. Executive Vice President Howard J. Shaffer, Ph.D. Pioneer Health Care Director Division on Addictions Thomas Brosig Harvard Medical School President, Mid-South Region Corporation Louis W. Sullivan, M.D. President Roland W. Burris School of Medicine Of Counsel Morehouse College Buford, Peters, Ware & Zansitis Steven A. Weiss F.M. “Bud” Celey Chairman of the Board President and CEO Casino Data Systems, Inc. Foxwoods Resort Casino Pauline Yoshihashi Sue Cox Senior Vice President Executive Director Abernathy, MacGregor & Frank Texas Council on Problem and Compulsive Gambling Judy Patterson, secretary and treasurer Frank Fahrenkopf, Jr. Senior Vice President and Executive Director President and CEO American Gaming Association American Gaming Association Frank Fertitta III President and CEO Station Casinos, Inc. Arthur Goldberg Executive Vice President and President Hilton Gaming Hilton Hotels Corporation

15 THE NCRG ADVISORY BOARD

The NCRG’s advisory board determines the Sue Giles Director focus of NCRG’s initiatives and selects research Addiction Technology Transfer Center projects for funding. It is composed of academic University of Missouri - Kansas City researchers, health and social services Frederick Goodwin, M.D. professionals and other experts in addiction and Professor of Psychiatry and Director Center on Neuroscience, Medical Progress and Society disordered gambling. The George Washington University Medical Center Suck Won Kim, M.D. Robert Boswell, Ph.D., chairman Associate Professor of Psychiatry Executive Vice President University of Minnesota Medical School Pioneer Health Care Barry Kosofsky, M.D., Ph.D. Mark Appelbaum, Ph.D. Assistant Neurologist Professor of Psychology Massachusetts General Hospital University of California, San Diego Assistant Professor of Neurology Harvard Medical School Linda Cottler, Ph.D. Professor of Epidemiology in Psychiatry Lisa M. Najavits, Ph.D. Washington University School of Medicine in St. Louis Assistant Professor of Psychology Harvard Medical School William Eadington, Ph.D. Associate Psychologist Director McLean Hospital and Massachusetts General Hospital Institute for the Study of Gambling and Commercial Gaming University of Nevada, Reno Francisco Napolitano, Esq. Attorney at Law Richard Evans, Ph.D. Board Member, American Academy of Distinguished University Professor of Psychology Health Care Providers in the Addictive Disorders Director, Social Psychology/Behavioral Medicine Research & Graduate Training Group Peter E. Nathan, Ph.D. Director, Social Psychology Program Professor of Psychology University of Houston University of Iowa Elizabeth George David Self, Ph.D. Executive Director Assistant Professor of Psychiatry North American Training Institute Yale University School of Medicine Duluth, Minn.

on Kim, M.D. (University of Minnesota Medical School), David E. Left to right: Suck W ence. Comings, M.D. (The City ofvar Hoped University National Medical Medical School) Center), at Lisathe NCRGNajavits, Confer Ph.D. (McLean Hospital and Har 16 THE NCRG PEER REVIEW PANELS

The peer review panels evaluate the scientific Neuroscience Peer Review Panel merit of research proposals submitted to the Barry Kosofsky, Ph.D., M.D., chairman NCRG. Members are drawn from a national pool Assistant Neurologist of leading scientists, active and productive Massachusetts General Hospital Assistant Professor of Neurology researchers recognized by their peers and by major Harvard Medical School funding sources as experts in mental health and Vincent Chiappinelli, Ph.D. addiction research. Professor and Chair of Pharmacology Director, Neuroscience Program Behavioral and Social Science Peer The George Washington University Review Panel Seth Eisen, M.D. Associate Professor of Medicine Richard I. Evans, Ph.D., chairman St. Louis VA Medical Center Distinguished University Professor of Psychology Director, Social Psychology/Behavioral Medicine Research & Suck Won Kim, M.D. Graduate Training Group Associate Professor of Psychiatry Director, Social Psychology Program University of Minnesota Medical School University of Houston Richard LaBrie, Ph.D. Mark Appelbaum, Ph.D. Director Professor of Psychology National Technical Center for University of California, San Diego Substance Abuse Needs Assessment Mitchell Berman, Ph.D. Elizabeth Matthew, M.D. Assistant Professor of Psychology Assistant Professor of Radiology University of Southern Mississippi Beth Israel Deaconess Medical Center-West Robert Booth, Ph.D. David Self, Ph.D. Associate Professor, Addiction Research & Treatment Assistant Professor of Psychiatry University of Colorado Health Sciences Yale School of Medicine G. Ron Frisch, Ph.D. Robert Sutherland, Ph.D. Associate Professor of Clinical Psychology Professor of Psychology & Psychiatry & Consulting Psychologist University of New Mexico Psychological Services Centre University of Windsor Barbara Mellers, Ph.D. Professor of Psychology Ohio State University Peter Nathan, Ph.D. Professor of Psychology University of Iowa Kenneth J. Sher, Ph.D. Frederick A. Middlebush Professor of Psychology University of Missouri-Columbia

NCRG advisor Ph.D. (right), chairy board members Richar ed the most r d Evans, Ph.D. (left) and Bar ecent peer r eview panels for the NCRG.ry Kosofsky , M.D.,

17 NCRG DONORS The Venture Capitalists of Gambling Research

Founding contributors Boyd Gaming Corporation and Station Casinos, Inc. provided the start-up costs for the National Center for Responsible Gaming and pledged a total of $1.8 million over a 10-year period. In addition, the following contributors have made annual donations to the NCRG. As of March 1, 1999, the total amount pledged through 2006 is $5 million.

$300,000 Wlliam Boyd, chair Circus Circus Enterprises, Inc. a check for $54,913 manto r and CEO of Boyd Gaming Corporation, pr Gaming Enter etired Maj. Gen. Paul Har Grand Casinos, Inc. tainment Resear esents contribution, ear ch and Education Foundation.vey, chairman The of the marked for disor Hilton Hotels Corporation National Center for Responsible Gaming,dered gambling was over r and above Boyd esear Gaming Corporation’ ch through the International Game Technology s annual contribution of $100,000 to the NCRG. The Lincy Foundation , Inc.

$100,000-$299,000 $10,000-$49,000 Aztar Corporation Foxwoods Resort Casino Coast Resorts, Inc. Harveys Casino Resorts Harrah’s Entertainment, Inc. Mission Industries Mohegan Sun $50,000-$99,000 Southern Wine and Spirits of Nevada Boomtown, Inc. Casino Data Systems, Inc. The NCRG has received significant in-kind contributions from the University of Missouri- Empress Riverboat Casinos, Inc. Kansas City, which provides office space and Hollywood Casino Corporation services, and from The George Washington University, co-sponsor and host of the recent Horseshoe Gaming, Inc. NCRG conference “New Directions in Gambling Rio Suite Hotel & Casino Addiction Research.” Showboat, Inc. Shuffle Master Gaming, Inc.

18 1998 Gaming Hall of Fame Charity Aztar Corporation Dinner Cohn & Wolfe The World Gaming Congress and the Howard Hughes Corporation American Gaming Association (AGA) annually sponsor a dinner to honor the inductees into the Kummer Kaempfer Bonner & Renshaw Gaming Hall of Fame. The dinner benefits the Marshall Management Company National Center for Responsible Gaming and SafeNest, a Las Vegas-based organization that Mirage Resorts, Inc. provides temporary assistance and shelter to Nevada Power Company abused women and their children. The following companies and individuals sponsored tables and Paradigm Gaming Systems, Inc. provided in-kind contributions for this event in Paul-Son Gaming 1998. PricewaterhouseCoopers Gold Sponsor ($5,000) Showboat, Inc. International Game Technology* Southwest Gas Corporation Harrah’s Entertainment, Inc.* Spintek Gaming Technologies Rio Suite Hotel and Casino* Sprint Mr. and Mrs. J.K. Houssels* Station Casinos, Inc. Corrao, Inc.* YESCO Boyd Gaming Corporation Caesars World* Sandy and Roger Peltyn Circus Circus Enterprises, Inc. Kitty Rodman and Claudine Williams

Eldorado Hotel & Casino/Silver Legacy *Amount of donation exceeded level of Resort Casino sponsorship Foxwoods Resort and Casino Marnell Corrao Associates In-kind Sponsors MGM Grand, Inc. American Gaming Association The Official Information Company Goetz Printing Silver Sponsors ($4,500) International Gaming and Wagering Business Hilton Hotels Corporation Jon Tullis Studio Las Vegas Hilton Sponsors ($3,000) Marketing Database Services Casino America, Inc.* Nevada Color Litho JBA Consulting Engineers* Southern Wine & Spirits of Prairie Meadows Racetrack & Casino* Nevada/Comstock Wine & Spirits

19 FINANCIAL STATEMENTS (UNAUDITED) January 1, 1998 - December 31, 1998

National Center for Responsible Gaming and Gaming Entertainment Research and Education Foundation BALANCE SHEET Assets Cash $1,488,600 Grants receivable* 1,648,100 Other assets 300 TOTAL ASSETS $3,137,000

*Grants pledged to GEREF. Receivables are to be collected over the next nine years.

Liabilities Research grants payable** $532,000 Other payables 5,500 Equity 2,599,500 TOTAL LIABILITIES & EQUITY $3,137,000

**Research grants are payable over multiple years based upon the research program term.

National Center for Responsible Gaming and National Center for Responsible Gaming and Gaming Entertainment Research and Education Foundation Gaming Entertainment Research and Education Foundation

REVENUES EXPENSES Fundraising 7% Special Events/ Miscellaneous 30% Management and General 15%

Contributions Revenue *Grants and Program 70% Expenses 78%

*includes $1,149,427 paid in research grants and expenses related to seminars, the conference and the distribution of the Harvard study.

All financial information as of December 31, 1998, compiled by Mayer Hoffman McCann L.C.

20 NATIONAL CENTER FOR RESPONSIBLE GAMING A division of the Gaming Entertainment Research & Education Foundation

540 Pierce Avenue Kansas City, MO 64110-2026 Telephone: 816-531-1878 Fax: 816-531-3459 www.ncrg.org