Our Mission

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

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

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

• Enhancing public awareness of disordered and youth gambling. Table of Contents

Message from the Chairman THE SUCCESS OF THE NCRG IN 1999 ...... 1

State of the Field of Pathological Gambling THE WHO, WHAT, WHERE, WHY AND HOW OF AN EMERGING RESEARCH AREA ...... 2

NCRG Contributors THE LIFEBLOOD OF THE NCRG ...... 4

Creating a Field of Research NCRG EFFORTS IN STUDYING GAMBLING DISORDERS ...... 6

NCRG Outreach BUILDING BRIDGES THROUGH RESEARCH AND DIALOGUE ...... 10

Looking to the Future THE NCRG CONFERENCE 2000 ...... 13

Grant Awards NCRG FUNDS NEW RESEARCH IN 1999 ...... 14

Publications NCRG INVESTIGATORS IN PRINT ...... 15

The NCRG Organization INDEPENDENT AND RESPECTED ...... 16

Board of Directors GAMING ENTERTAINMENT RESEARCH AND EDUCATION FOUNDATION ...... 17

NCRG Advisory Board 1999-2000 MEMBERS ...... 18

Peer Review Panels DISTINGUISHED SCIENTISTS SERVE ON 1999 PANELS ...... 19

1999 Financial Statements BALANCE SHEET ...... 20 THME SUessageCCESS OF TH EfrNComRG IN 1the999 Chairman

In the four years since its Psychological Association and a founding, the National Center for subcommittee of the U.S. Senate. Responsible Gaming (NCRG) has NCRG research also was used by made enormous strides in provid- the National Research Council in a ing help to individuals facing report that the council prepared for gambling disorders through its the National Gambling Impact commitment to the funding of Study Commission. high-quality research and to raising As the NCRG enters its fifth public awareness of the issue. With year, I want to take the opportunity these goals in mind, I believe 1999 to thank all of the center’s donors was the center’s most successful for their generous contributions. year to date. Without you, the important work of In 1999, the NCRG hosted its the NCRG would not be possible. first annual conference at The I also want to add a special note of George Washington University in Maj. Gen. Paul A. Harvey (Ret.) gratitude to all the center’s found- Washington, D.C. “New Chairman ing donors, who renewed their faith Gaming Entertainment Research and Directions in Gambling Addiction Education Foundation in the NCRG last year by commit- Research” was a groundbreaking ting their continued support for the event, featuring 15 of the most noted research scientists years 2000-2002. It is our hope that all segments of the in the area of gambling disorders. Topics discussed gaming industry will recognize the importance of included addiction as a brain disease, youth gambling, studying gambling disorders and contribute to research prevention issues and the latest technology in genetics efforts in the future. and neuroimaging as a way to understand disordered As we begin the new century, the National Center gambling behavior. for Responsible Gaming is dedicated to continuing its The NCRG awarded more than $1.8 million in pivotal role in the creation of a field of research on grants last year to leading institutions around the disordered gambling. We stand ready to build on our United States and Canada, money that will support successes of the past four years and look forward to cutting-edge scientific research into disordered and working together to find answers to this important issue youth gambling. These grants brought the center’s in 2000 and beyond.

total grant awards since 1996 to more than $3 million.

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c c Maj. Gen. Paul A. Harvey (Ret.)c journals, and representatives of the center presented Chairman research findings at public hearings and meetings Gaming Entertainment Research and around the nation, including those of the American Education Foundation

1 State of the Field of

THPathologicalE WHO, WHAT, WHERE, W HYGamblingAND HOW OF AN EMERGING RESEARCH AREA

For the vast majority of Americans, gambling represents a fun, leisure-time activity with little or no negative consequences. A small portion of the population, however, suffers from “pathologi- cal gambling,” a disorder that, to date, has been difficult to explain or understand due to conflicting facts and scientific terminology. Today, pathological gambling is an emerging field of research. Over the past four years, the National Center for Responsible Gaming (NCRG) has taken the lead in this area and awarded more than $3 million in grants to researchers. The work of these individuals has helped to better define the problem of pathological gambling, as well as identify areas for future study.

Gambling Disorders: What We Know According to a 1997 Harvard Medical School study, an esti- mated 1.14 percent to 1.60 percent of the adult population in the United States and Canada meet diagnostic criteria for pathological gambling as defined by the American Psychiatric Association. Two recent studies commissioned by the federal government have esti- mated the number to be in this range or lower. Research into pathological gambling has revealed that young people, individuals undergoing treatment for alcohol and drug abuse, and prison populations have a higher rate of the disorder than the general adult population. In addition, pathological gam- “Conceptual and methodologi- blers frequently suffer from other psychiatric problems such as cal chaos is common among depression, bi-polar disorder, anti-social personality disorder or emerging scientific fields.” attention deficit hyperactivity disorder. Evidence of a strong familial component also has been identified, suggesting that both — From “Estimating the prevalence of dis- genetics and social environment play a role in the development of ordered gambling behavior in the United States and Canada: A research synthesis,” the disorder. by Howard J. Shaffer, Matthew N. Hall and Major questions, however, remain as to the nature, scope and Joni Vander Bilt, published in 1999 in the severity of gambling-related disorders — questions that define the American Journal of Public Health. challenges currently facing researchers in the field.

2 Gambling Disorders: The Challenges One factor that has contributed greatly to the lack of understanding, or “conceptual chaos,” surrounding Is Pathological Gambling a the study of pathological gambling is the lack of stan- Unique Phenomenon? dard scientific terminology. The widespread use of var- ious terms such as “problem,” “compulsive,” “patho- Other logical” and “probable pathological” has only served to Unknown Manic Disorder confuse the public and frustrate scientists. Episode The lack of standard terminology also presents a Pathological challenge to scientists attempting to measure the preva- Gambling lence of the disorder in the general population. Although a number of screening and diagnostic instru- ments have been developed over the years, controver- Alcoholism Depression sy continues as to whether criteria used to define a gambling disorder should be based on the dollar amount gambled, frequency of gambling or the individ- ual’s level of preoccupation with gambling. Further Source: Howard J. Shaffer, Matthew N. Hall and Joni Vander Bilt. 1997. “Estimating the Prevalence of complicating the issue is the fact that no independent Disordered Gambling in the United States and Canada: “gold standard” exists against which scientists can judge A Meta-analysis.” Boston: President and Fellows of the validity of these instruments. Harvard College, 73. A related challenge facing researchers of pathologi- cal gambling is the fact that it has yet to be established have a problem, which genes can be implicated? as a unique disorder. The question of whether patho- Moreover, how does the neurobiological predisposition logical gambling is a primary disorder or the conse- interact with environmental factors such as family, quence of other mental health problems remains unan- peers and community? Although limited research and swered. In addition, there is a lack of detail regarding anecdotal evidence suggest that pathological gambling the duration of the disorder, the causes of recovery and is a treatable disorder, the dearth of rigorous clinical relapse, and the varying levels of its severity — all fac- studies leaves treatment providers without a clear tors that have made it difficult to develop intervention guide. and prevention strategies. Moreover, we do not know how many disordered gamblers recover on their own, The NCRG Role without formal treatment. Evidence of “natural recov- These are just a few of the many challenges con- ery” would have profound implications for both the fronting investigators. With its founding in 1996, the study of the disorder and the calculation of its social NCRG became the first organization in the nation to and economic costs. match its recognition of the need for rigorous research Researchers also have much to learn about the risk with the proportionate financial support for such factors for developing a gambling disorder. Do patho- research. Thanks to its many partners in the scientific logical gamblers have a deficient reward system in their community, the center’s goal of “creating a field” of brains? If pathological gamblers are “hard-wired” to research is now being realized.

3 TNHE LCIFERGBLOOD OCF THontributorsE NCRG

In 1999, the National Center for Responsible Gaming’s (NCRG) original contributors renewed their financial commitment to independent research on gambling disorders by pledging an additional three years of support. Combined with the 10-year pledges by founding donors Boyd Gaming Corporation and Station Casinos, Inc., these pledges and donations total $7 million for the period of 1997 through 2006.

Founding Contributors Boyd Gaming Corporation and Station Casinos, Inc., provided the start-up costs for the NCRG in 1996 and pledged a combined $1.8 million between 1997 and 2006. Contributors $100,000-$299,000 Coast Resorts, Inc. 1997-2002 Hollywood Casino Corporation $600,000 Hollywood Park International Game Technology Hotel Employees & Restaurant “Today we continue our com- The Lincy Foundation Employees International Union mitment to funding on-going Mandalay Resort Group $50,000-$99,000 national research efforts tar- Mirage Resorts, Inc. Casino Data Systems geted toward the assessment $450,000 Empress Riverboat Casinos, Inc. Harrah’s Entertainment, Inc. Horseshoe Gaming, Inc. and treatment of gambling Park Place Entertainment Rio Suite Hotel & Casino disorders through support and Corporation Showboat, Inc. Shuffle Master Gaming, Inc. participation with the $300,000 National Center for Aztar Corporation $10,000-$49,000 Caesars World, Inc. Foxwoods Resort Casino Responsible Gaming. Grand Casinos, Inc. Harveys Casino Resorts “In fact, I am privileged to Hilton Hotels Corporation JCM American Corporation Mission Industries serve as a board member of Mohegan Sun the foundation which funds Sandia Casino the center, and I am actively Southern Wine and Spirits of Nevada involved in fund-raising efforts, efforts which in 1997 resulted with rea ay l d in more than 4.5 million dol- pl o ll u a lars being committed by o r y s

, f

I members of our industry to p enable quality, unbiased . l e a s y n nsible Ga During Responsible Gaming Education research. The experts told us w e po m ith l s s ation W in Week, Aug. 2-6, 1999, members of the rea e uc ee g to fund research, and we R d k E Missouri Riverboat Gaming Association raised $1,000 for the NCRG through have.” the commemorative chip program spon- — Testimony of Thomas Brosig, president, sored by the American Gaming Mid-South Region, Park Place A Association (AGA). The non-negotiable U 9 Entertainment Corporation, at a public G 9 chip was donated by the AGA to its U 19 hearing of the National Gambling Impact ST 2– 6, member companies. Study Commission.

4 1999 GAMING HALL OF FAME CHARITY DINNER AND INDUCTION CEREMONY The American Gaming Association and International Gaming & Wagering Business annually sponsor a dinner to honor that year’s inductees into the Gaming Hall of Fame. The dinner benefits the NCRG and Safe Nest, a Las Vegas-based organization that provides temporary assistance and shelter to abused women and their children. The following compa- nies and individuals sponsored tables and provided in-kind contributions for the event in 1999: $8,000 Las Vegas Convention and Akiyoshi Isoi, president of JCM American International Game Technology Visitors Authority Corporation, entertainer Wayne Newton $7,000 Mission Industries and Frank J. Fahrenkopf, Jr., president of Mirage Resorts, Inc. Nevada Power Company the American Gaming Association and Paul-Son Gaming Supplies member of the Gaming Entertainment $6,000 Prairie Meadows Racetrack and Research and Education Foundation, at the GEM Communications Casino 1999 golf tournament. $5,000 Shuffle Master Gaming, Inc. Boyd Gaming Corporation Southwest Gas Corporation 1999 JCM/AGA Caesars World, Inc. Sprint Foxwoods Resort Casino Station Casinos, Inc. GAMING GOLF Mandalay Resort Group Wells Fargo Bank CLASSIC Marnell Corrao Associates Willis JCM American Corporation Silver Legacy and Eldorado Hotel YESCO and the American Gaming Casinos Frank A. Modica Bob and Lovee Arum Sandy and Roger Peltyn Association sponsored a charity golf tournament March 31, 1999, Irwin and Susan Molasky $1,000+ Claudine Williams Aztar Corporation at the Tournament Players Club at $4,000 Casino Data Systems The Canyons in Las Vegas to bene- MGM Grand, Inc. Cohn & Wolfe fit the NCRG. The following com- Spintek Gaming Technologies, The Friedmutter Group panies supported the tournament: Inc. Houssels Family Foundation Aristocrat $3,000 Corporation Atronic Bank of America Sun International Boyd Gaming Corporation CIBC World Markets John Angus Casinovations Gaming Systems International In-kind Sponsors Chase Products Company The Greenspun Family American Gaming Association Harmony Healthcare Foundation Continental Services Incorporated IC/BCA Harrah’s Entertainment, Inc. The French Bouquet Shoppe Mikohn Gaming Corporation Harveys Casino Resorts GEM Communications Paradigm Gaming Systems, Inc. Hotel Employees & Restaurant Goetz Printing Performance Contracting, Inc. Employees International Union Nevada Color Litho Southern Wine and Spirits of House of Blues Las Vegas Southern Wine and Spirits of Nevada Hyatt Regency Lake Las Vegas Nevada The Resort at Summerlin Viejas Casino & Turf Club VLC of Nevada WMS Gaming, Inc.

GEREF board member Phil Satre (right), chairman and CEO of Harrah’s Entertainment Inc., attends the 1999 Gaming Hall of Fame Charity Dinner and Induction Ceremony with (pictured from left) Charles Mathewson, chairman of International Game Technology; Jennifer Satre; Claudine Williams, chairman of the board of Harrah’s Las Vegas and a member of the Hall of Fame Host Committee; and Thalia Dondero, former Clark County (Nev.) commissioner.

5 NCCrRG eatingEFFORTS IN S TUaD YIFieldNG GAMB LIofNG D ResearISORDERS ch

Since 1996, the National Center for Responsible Gaming (NCRG) has awarded $3.2 million in support of 20 scientific investigations of gambling disorders — an unprecedented level of funding for this area of research. As the only independent, nonprofit organization in the United States dedi- cated exclusively to peer-reviewed research on gambling, the NCRG has provided the financial support necessary for conducting meaningful inves- tigations. Moreover, the center has raised the bar for research by following the high standards of the National Institutes of Health.

Prevalence of the Disorder The NCRG’s first research project tackled the basic question of how many people have a gambling problem. With a grant from the center, Harvard Medical School’s Division on Addictions conducted a meta- analysis of 120 prevalence studies and produced the first reliable national estimates of the problem. According to the study, titled “Estimating the Prevalence of Disordered Gambling Behavior in the United States and Canada: A Meta-analysis,” between 1.14 percent and 1.60 percent of the adult population could be classified as having pathological problems incident to gambling. The Harvard team also developed a classification system to describe the varying degrees of disordered gambling behavior and to solve the chaotic terminology problem in gambling research:

• Level 1 prevalence rates represent people who do not have gambling problems. • Level 2 represents those who do not have a “clinical” disorder but do exhibit a pattern of gambling that is associated with a range of adverse reactions or consequences. • Level 3 gambling refers to disordered gambling that satisfies “diagnos- tic” criteria and, therefore, is clinically meaningful.

The methodological rigor of the Harvard study was confirmed by the National Research Council of the National Academy of Sciences, which praised the meta-analysis for providing “the best current estimates of David Comings, M.D., director of the pathological and problem gambling among the general adult U.S. popula- Department of Medical Genetics at the tion and selected subpopulations” in Pathological Gambling: A Critical City of Hope Medical Center, recently Review (1999). The study, which was published in the September 1999 completed the NCRG-funded research on “The Molecular Genetics of Pathological issue of the American Journal of Public Health, also argued for more exacting Gambling.” standards in the conduct of future prevalence studies. With continuing

6 Suck Won Kim, M.D., of the University of Minnesota Medical School, is directing a drug trial with support from the NCRG.

support from the NCRG, the Harvard study’s lead Many researchers also suspect that “cognitive dis- author, Howard Shaffer, Ph.D., and his colleagues tortions,” or faulty notions of probability, in the mind have continued to accept new studies and now offer of a disordered gambler are the root of the problem. the most comprehensive and up-to-date database of Centre for Addiction and Mental Health researcher prevalence studies available to researchers. Nigel Turner, Ph.D., has developed an interactive curriculum — “Really, What Are Your Chances of Youth Gambling Winning?” — to enhance middle- and high-school stu- The Harvard study identified a higher rate of gam- dents’ understanding of the role of randomness, proba- bling disorders among adolescent and college-age pop- bility and emotion in gambling. A grant from the ulations than among the general adult population. NCRG is supporting a controlled trial of this preven- Many researchers suspect that early involvement in tion strategy in the Toronto public school system. gambling may be a risk factor for developing a prob- lem later in life. In addition, gambling has been con- Casino Employees nected with other risky behaviors often characteristic of The NCRG has supported groundbreaking this age group. Not enough is known, however, about research on another group of individuals that may be the dynamics of youth gambling to develop effective vulnerable to gambling disorders – gaming industry prevention and intervention strategies. For this reason, employees. The NCRG-funded “Harvard Project on the NCRG has made the study of youth gambling a Gambling and Health” has produced the first broad- top priority, funding seven investigations on this popu- based prevalence study focused on this group. lation since 1996. Researchers are looking at the demographic, psychosocial and behavioral variables of this phenomenon. Ken Winters, Ph.D., at the University of Minnesota, for example, is studying “As with most addictions, the common how young gamblers make the transition to young perception is that people should be able to adulthood and if the developmental model used for control their involvement and those who substance abuse is helpful for understanding youth overindulge have only themselves to blame. gambling. A University of South Alabama project While it is important for individuals to take is studying high school students in three different responsibility for their own behavior, it is southeastern U.S. communities to explore individual risk factors, including depression, substance abuse and equally clear that biological and genetic fac- involvement in risk-taking activities. The study’s prin- tors can play a role in increasing the risk of cipal investigator, Jennifer Langhinrichsen-Rohling, becoming a pathological gambler.” Ph.D., is looking at these individual factors in relation- ship to the adolescents’ perceptions of their peers, — David E. Comings, M.D.,“The Molecular Genetics of Pathological Gambling,” CNS Spectrums (1998). families and communities.

7 Published in the American Journal of Industrial Medicine in 1999, the study found that casino employees have a higher prevalence rate of pathological gambling behavior than the general adult population (2.1 percent versus 1.14 percent to 1.60 percent). The investigators also observed a close con- nection between gambling problems and alcoholism and depression. They also found that casino employees have a lower prevalence rate of level 2 gambling disorder (i.e., problems that do not meet diagnostic requirements for the disorder) than the general population. They con- cluded that, although more research is warranted, this observation may have important implications for understanding how people cope with increased availability to gambling; in other words, casino employees may learn from their direct observations of the “downside” of gambling, which then serves as a protective factor against developing sub-clinical levels of gambling problems.

Measuring Problem Gambling In response to the need for a more comprehensive diagnostic gambling module, Renee M. Cunningham-Williams, Ph.D., at the Robert Sutherland, Ph.D., is principal Washington University School of Medicine is using NCRG support to investigator of a brain imaging study at develop, refine and test an assessment tool. The Gambling Assessment the University of New Mexico. Module IV will provide a more detailed portrait of disordered gamblers than other instruments by collecting information about amounts gambled, frequency of gambling, types of gambling activity, duration of symptoms, associations with drug and alcohol use, illicit and underage gambling, efforts at help-seeking, family history, information on social networks and various venues for gambling.

Giving Clinicians the Right Tools Clinicians face a daunting task when confronted by a problem gambler. Although there is a wide repertoire of treatment therapies for addictive behaviors and mood disorders, the absence of rigorous research on what works for problem gamblers leaves providers without a clear map. The high rate of comorbidity, i.e., the co-existence of gambling problems with other psychiatric disorders, makes it difficult to determine whether the gambling behavior is a primary or secondary disorder. Consequently, the NCRG is supporting several investigations that eventu- ally will point the way to the most effective forms of treatment. Suck Won Kim, M.D., at the University of Minnesota Medical School is conducting a double-blind trial of the drug Naltrexone. Used effectively in treating psychiatric disorders characterized by excessive urges and loss of behavioral control, such as alcoholism and bulimia nervosa, Kim hypothesized that Naltrexone could reduce uncontrollable urges to gam- ble. The NCRG also is supporting trials testing the efficacy of other forms of treatment, including cognitive therapy, which attempts to modify dis- torted thoughts that underlie a pathological symptom.

8 Nigel Turner, Ph.D., is the principal investigator of an NCRG-funded project on prevention in Toronto.

Neuroscience conducting a molecular genetic investigation of the Neuroscientists supported by the NCRG are “impulsive nonconformity” personality trait that is exploring the possibility that disordered gambling strongly associated with sensation seeking, substance behavior may be influenced, in part, by a deficient dependence and other behaviors associated with gam- brain reward system. In other words, a neurochemical bling. The investigators will collect both DNA and imbalance may alter an individual’s ability to derive questionnaires about gambling behavior from former satisfaction or pleasure from the usual activities and, college students who scored either high or low on the therefore, drive him or her to activities that stimulate Impulsive Nonconformity Scale while they were stu- the level of dopamine in the brain. Researchers dents. Although testing for genetic associations with believe that this would explain the fierce cravings and gambling behaviors has just begun, it is an area of self-destructive patterns commonly seen in pathological research that will have a profound impact on how to gamblers. Charles Warren, Ph.D., of the University understand, measure and treat gambling disorders. For of Illinois-Chicago is using his NCRG grant to test example, by providing biological markers for the disor- the reward deficiency syndrome by measuring brain der, genetics research will provide a truly independent, activity through an EEG. Massachusetts General objective standard against which the validity of screen- Hospital researcher Hans Breiter, M.D., is using ing and diagnostic instruments can be measured. another imaging technique — functional magnetic-reso- The research work of the NCRG is garnering the nance imaging (fMRI) — to localize patterns of brain respect of the scientific community. As researchers activation in both pathological gamblers and normal Linda B. Cottler, Ph.D., and Renee M. subjects with particular attention to brain reward cir- Cunningham-Williams, Ph.D., of Washington cuitry and the build-up of craving. University School of Medicine, noted in a March 2000 guest editorial in the St. Louis Post-Dispatch: “One Genetics of Pathological Gambling research organization funded by the gaming industry — Identifying the genes that play a role in a deficient the National Center for Responsible Gaming — actually reward system ultimately will help researchers to funds more gambling research than the National understand who is at greatest risk for pathological gam- Institutes of Health. And it has mechanisms in place, bling and how to prevent and treat the problem. The including peer review, that attempt to safeguard NCRG-funded research of David Comings, M.D., at research against any influence or bias from the indus- the City of Hope Medical Center has bolstered the try. In this case, the gaming industry deserves credit theory that defects in dopamine receptor genes play a for its efforts to maintain a ‘hands-off’ approach in its role in the development of a gambling problem, as financial support of rigorous, methodologically sound well as other addictive disorders. Michael Miller, research.” Ph.D., at the University of Missouri-Columbia is

9 BUNILDCING RGBRIDGE SOutrTHROUGHeachRESEARCH AND DIALOGUE NCRG Hosts Groundbreaking Conference Disseminating the findings of research on pathological and youth gambling is a top priority for the National Center for Responsible Gaming (NCRG). In 1999, the NCRG held its first annual conference, “New Directions in Gambling Addiction Research,” which was cosponsored and hosted by The George Washington University in Washington, D.C. Fifteen of the most noted research scientists in the United States and Canada joined together with 150 people from across the nation to discuss research trends in gambling studies and the impact of NCRG support.

Clockwise from top: • Alan I. Leshner, Ph.D., director of the National Institute on Drug Abuse, delivered the keynote address, “Addiction is a Brain Disease — and It Matters” at the NCRG conference. • Stephen Joel Trachtenberg, Ph.D., president of The George Washington University, welcomed the NCRG conference participants to GW’s campus. • Workshop at NCRG conference at GW.

10 NCRG Representatives Present Research to Public in 1999 Representatives from the NCRG presented research findings and “Perhaps surprising to some, testified at the following public meetings and hearings in 1999: the largest source of funding • American Psychological Association • Casino Ops for research on problem and • International Association of Gaming Attorneys pathological gambling is the • Missouri Alliance to Curb Compulsive Gambling commercial casino industry. • Missouri Gaming Commission “The American Gaming • National Council of Legislators from Gaming States Association (AGA)—which • National Council on Problem Gambling represents a wide range of • National Gambling Impact Study Commission casinos—has initiated several • Nevada Gaming Attorneys • Northern Gaming Summit efforts to address problem • Public Sector Gaming Study Commission and pathological gambling • Southern Gaming Summit and is the largest source of • U.S. Senate Subcommittee on Labor, Health and Human Services funding for research on prob- and Education and Related Agencies lem and pathological gam- bling. Members of the AGA have committed $7 million to researching several aspects of problem and pathological gambling.”

— Final Report,The National Gambling Impact Study Commission, 1999. Left: NCRG investigator Ken Winters, Ph.D., University of Minnesota, testified before the U.S. Senate Subcommittee on Labor, Health and Human Services and Education and Related Agencies on June 30, 1999. Below: Howard Shaffer, Ph.D., presented the findings of his research at a conference of the Nevada Gaming Attorneys in 1999. egas Sun. V Las tesy of Photo cour

11 The NCRG Online To enhance its efforts to increase public awareness of disordered gambling and to facilitate the finest research on the subject, the National Center for Responsible Gaming (NCRG) has established a comprehen- sive and user-friendly Web site — www.ncrg.org — featuring the latest on the center and its work, as well as an archive of useful information. At the NCRG’s home page, visitors can point and click to a variety of categories, including: • Grants Program, where interested scientists can go for a posting of current requests for applications for research into disordered gam- bling. This section also contains criteria for funding, research areas eligible for support, deadlines, instructions for preparing a letter of intent, details on the review process and the criteria used to deter- mine the scientific merit of all applications. • Who’s Who, which contains a listing of current members of the NCRG advisory board and peer review panels and members of the board of the Gaming Entertainment Research and Education Foundation. • Contributors lists the many companies and individuals who have given generously to the NCRG. • NCRG-Funded Research itemizes research done by NCRG-funded investigators, divided into the categories of epidemiology, neuro- science, and social and behavioral sciences. • Publications by NCRG Investigators lets interested individuals know where to find the work of NCRG researchers in print. • The Press Room features current press releases and statements, as well as an archive of past releases. • Links & Resources lists resources available to help researchers, treatment providers and others interested in problem and youth gambling.

In addition, the Web site posts information on current outreach efforts of the center, including a calendar of upcoming NCRG-sponsored events.

12 THLookingE NCRG CONFER ENtoCE 2000the Future

In keeping with its commitment to open dialogue on the issue of gam- bling disorders, the National Center for Responsible Gaming (NCRG) will “Unlike the tobacco indus- hold its second annual conference, “The Comorbidity of Pathological try, which attempted to Gambling,” on Dec. 3-5, 2000, in Las Vegas. The comorbidity of pathological gambling — the concurrence of other debunk accepted research mental health problems such as depression and substance abuse in patho- about the dangers of smok- logical gamblers — presents researchers with a great challenge in that the ing, the gaming industry coexistence of other disorders clouds the picture of pathological gambling, seems genuinely interested making it difficult to define, measure, prevent and treat. in learning just what effect The NCRG selected the topic in order to stimulate a fresh approach gambling has on gamblers to the problem and advance the field. Knowledge of comorbidity is vital and communities.” to understanding the etiology of pathological gambling, the course of the illness, affected populations, treatment plans, interventions and, ultimately, — Guest editorial by Linda B. Cottler, social policy. professor of psychiatric epidemiology The conference will feature leaders in comorbidity research in dia- at Washington University School of Medicine, St. Louis Post-Dispatch, logue with gambling researchers, new investigators and others interested May 6, 1999. in gambling disorders. The program will focus on epidemiology, neurobi- ology, prevention, treatment and social policy. Members of the Conference 2000 Planning Committee Executive Subcommittee: Committee: Sue Giles Eileen Luna, J.D., Linda B. Cottler, Ph.D., Robert Boswell Director M.P.A. Addiction Technology Chair Executive Vice President Assistant Professor of Transfer Center American Indian Professor of Epidemiology in Pioneer Behavioral Health University of Missouri- Studies Psychiatry Hans Breiter, M.D. Kansas City University of Arizona Washington University School of Clinical Assistant in Suck Won Kim, M.D. Medicine Psychiatry Lisa Najavits, Ph.D. Associate Professor of Mark Appelbaum, Ph.D. Dept. of Psychiatry & Assistant Professor of Psychiatry Psychology Professor of Psychology Radiology University of Minnesota Harvard Medical School University of California, San Diego Massachusetts General Medical School Hospital McLean Hospital Renee M. Cunningham- William Eadington, George Koob, Ph.D. Francisco Napolitano, Williams, Ph.D. Professor and Director Ph.D. Esquire Research Assistant Professor of Division of Director Attorney at Law Social Work Psychopharmacology Institute for the Study of Board Member, Washington University School of The Scripps Research Gambling and American Academy of Medicine Institute Commerical Gaming Health Care Providers Richard Evans, Ph.D. University of Nevada, Barry Kosofsky, in the Addictive Distinguished University Professor Reno M.D., Ph.D. Disorders of Psychology Associate Neurologist David Self, Ph.D. University of Houston Elizabeth George Massachusetts General Executive Director Assistant Professor of Peter E. Nathan, Ph.D. Hospital North American Training Psychiatry University of Iowa Foundation Associate Professor of Institute Yale University School of Professor of Psychology Neurology Medicine University of Iowa Harvard Medical School

13 Peter Goyer, M.D., has an NCRG grant to investigate the “Relation of Cognitive Status to Brain Blood Flow and Dopamine Receptors in Pathological Gamblers.”

NCGrantRG FUNDS NAEW warRESEARCdsH IN 1999

The National Center for Responsible Gaming (NCRG) was created to encourage and support new research on pathological and youth gambling. To achieve this goal, the center has established a highly competitive and widely respected grants program that has, since 1996, awarded $3.2 million to leading research institutions across the United States and in Canada. In 1999, the NCRG awarded more than $1.8 million in grants to the following research projects:

“Adolescent Gambling Behavior as a Function of “Reward Deficiency ERPs: Effects of D2A1, Individual Differences in Risk-taking, Gender, Peer Gambling Pathology and ADHD” and Family Context, and Community Norms for Principal Investigator: Charles Warren, Ph.D., Research Legalized Gambling” Assistant Professor, University of Illinois-Chicago, Principal Investigator: Jennifer Langhinrichsen- Chicago. Rohling, Ph.D., Associate Professor of Psychology, Grant amount: $172,492 University of South Alabama, Mobile, Ala. Completion date: March 2001 Grant amount: $125,800 Completion date: March 2001 “Pharmacological Priming of Gambling-related Cognitions by Amphetamine” “Adolescent Understanding of the Emotional and Principal Investigator: Martin Zack, Ph.D., Scientist, Cognitive Aspects of Gambling:The Development Centre for Addiction and Mental Health, Toronto. of a Prevention Strategy” Grant amount: $75,042 Principal Investigator: Nigel Turner, Ph.D., Scientist, Completion date: October 2000 Centre for Addiction and Mental Health, Toronto. Grant amount: $88,296 “The Development of a Diagnostic Gambling Completion date: May 2000 Assessment—the GAM-IV” Principal Investigator: Renee M. Cunningham- “The Association of Gambling Problems with Williams, Ph.D., Research Assistant Professor of Social Impulsivity as a College Student and the Work, Washington University School of Medicine, St. Genotype-phenotype Relation” Louis. Principal Investigator: Michael Miller, Ph.D., Assistant Grant amount: $86,321 Research Professor of Psychology, University of Missouri, Completion date: August 2000 Columbia, Mo. Grant amount: $171,124 “Affective, Cognitive and Perceptual Processes in Completion date: May 2001 Gambling” Principal Investigator: Lawrence Jones, Ph.D., “Functional MRI of Neural Responses to Monetary Professor of Psychology, University of Illinois at Gains, Losses and Prospects in Pathological Urbana-Champaign, Champaign, Ill. Gamblers and Normal Subjects” Grant amount: $172,155 Completion date: March 2001 Principal Investigator: Hans Breiter, M.D., Clinical Assistant in Psychiatry, Massachusetts General Hospital, Charlestown, Mass. “The Harvard Project on Gambling and Health, II” Grant amount: $172,500 Principal Investigator: Howard J. Shaffer, Ph.D., Completion date: March 2001 Director, Division on Addictions, Harvard Medical School, Boston. Grant amount: $751,268 Completion date: December 2001

14 NCPublicationsRG INVESTIGATORS IN PRINT

The National Center for Responsible Gaming • Comings, D.E. et al. (1999). Association of the (NCRG) employs the rigorous, peer review procedures androgen receptor gene (AR) with ADHD, and and standards used by the National Institutes of Health conduct disorder. NeuroReport, 10, 1589-1592. to evaluate the scientific merit of proposals submitted • Eber, G. (1999). When gambling becomes a losing for funding. The peer review process, however, does battle. American Journal of Nursing, 99 (5), 22. not end there. • Korn, D.A., & Shaffer, H.J. (In press) Gambling The NCRG strongly encourages investigators to and the health of the public: Adopting a public publish their research findings in the most prestigious health perspective. Journal of Gambling Studies. academic journals, which employ an arduous review • Shaffer, H.J. (1999). Addiction and gambling dis- process. The center is proud that, although only two orders: On matters of measurement and validity. NCRG projects have been completed since 1996, the The Behavioral Measurement Letter, 6, 2-6. investigators of these projects have already been pub- • Shaffer, H.J. (1999). Strange bedfellows: A critical lished in some of the leading journals in the nation. view of pathological gambling and addiction. The published NCRG researchers are listed below, Addiction, 94, 1445-1448. with citations: • Shaffer, H.J., Hall, M.N. & Vander Bilt, J. (2000). • Comings, D.E. (1999). Molecular heterosis as the Computer addiction: A critical consideration. explanation for the controversy about the effect of American Journal of Orthopsychiatry, 70. the DRD2 gene on dopamine D2 receptor density. Molecular Psychiatry, 4, 213-215. • Shaffer, H.J., Hall, M.N. & Vander Bilt, J. (1999). Gambling, drinking, smoking and other health risk • Comings, D.E. (1999). SNPs and polygenic disor- activities among casino employees. American ders: A less gloomy view. Molecular Psychiatry (in Journal of Industrial Medicine, 36, 365-378. press). • Shaffer, H.J., Hall, M.N. & Vander Bilt, J. (1999). • Comings, D.E. The role of the DRD2 and other Estimating the prevalence of disordered gambling dopamine genes in personality traits. In Epstein et behavior in the United States and Canada: A al (Eds.), The Molecular Genetics of Personality. research synthesis. American Journal of Public Health, • Comings, D.E. (2000). The molecular genetics of 89, 1369-1376. ADHD and conduct disorder: Relevance to the • Shaffer, H.J. (1999) On the nature and meaning of treatment of recidivistic antisocial behavior. addiction. National Forum: The Phi Kappa Phi In D. Fishbein (Ed.), Prevention of Antisocial Behavior. Journal, 79 (4), 9-14. New York: Civic Research. • Shaffer, H.J., Eber, G.B., Hall, M.N. & • Comings, D.E. (1998). The molecular genetics of Vander Bilt, J. (in press). Smoking behavior pathological gambling. CNS Spectrums, 3, 20-37. among casino employees: Self-report validation • Comings, D.E. & Blum, K. (2000). Reward defi- using plasma cotinine. Addictive Behaviors. ciency syndrome: Genetic aspects of behavioral • Sylvain, C., Ladouceur, R. & Boisvert, J.M. (in disorders. In Uylings et. al. (Eds.), Cognition, press). Cognitive and behavioral treatment of Emotion and Autonomic Responses. Elsiver, pathological gambling: A controlled study. Journal Amsterdam. of Consulting and Clinical Psychology. • Comings et al. (1999). Studies of the 48 bp repeat • Wu, S. & Comings, D.E. (1999). A common polymorphism of the DRD4 gene in impulsive, C-1018G polymorphism in the human 5-HT1A compulsive, addictive behaviors: Tourette receptor gene. Psychiatric Genetics, 9, 105-106. Syndrome, ADHD, pathological gambling, and substance abuse. American Journal of Medical Genetics (Neuropsychiatric Genetics), 88, 358-368. NCRG-funded investigators also contributed to • Comings et al. (in press). Potential role of the Pathological Gambling: A Critical Review (1999) estrogen receptor gene (ESR1) in anxiety. published by National Academy Press. This study, Molecular Psychiatry. commissioned by the National Gambling Impact Study • Comings, D.E. et al. (1999). Motivation, emotion, Commission, was conducted by the Committee on the feeding, drinking: Association of enkephalinase Social and Economic Impact of Pathological Gambling gene with low amplitude P300 waves. NeuroReport, at the National Research Council of the National 10, 2283-2285. Academy of Sciences. The committee based its preva- lence estimates on the NCRG-funded Harvard study.

15 INTDEPheENDE NTNANCD RRGESPECTE DOrganization

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

Organizational structure parallel with National Institutes of Health

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

Membership: Membership: Academics Membership: Scientists Neuroscience Epidemiology Multidisciplinary 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

= No gaming industry members

= Gaming industry members

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.

16 GAMBoarING ENTEdRT AIofNM ENTDRirESEARCectorsH AND EDUCATION FOUNDATION

The National Center for Responsible Gaming is an unincorporated division of the Gaming Entertainment Research and Education Foundation, a tax-exempt, nonprofit organization. The foundation was established in 1996 to address problem and youth gambling through research and public education. According to the founda- tion’s bylaws, at least 50 percent of the governing board must represent sectors other than the gaming industry.

The following individuals from The following individuals from The following individuals outside the gaming industry served on the gaming industry served on the served as staff members for the the foundation’s board in 1999: foundation’s board in 1999: foundation’s board in 1999: Maj. Gen. Paul A. Harvey (Ret.), William Boyd, President Christine Reilly Chairman Chairman and CEO Executive Director President and CEO Boyd Gaming Corporation National Center for Responsible Gaming Signature Works Judy L. Patterson, Secretary Robert Boswell and Treasurer Aleasha Herdina Executive Vice President Senior Vice President and Adminstrative Associate Pioneer Behavioral Health Executive Director National Center for Responsible Gaming Roland W. Burris American Gaming Association Of Counsel Thomas Brosig Buford, Peters, Ware & Zansitis President, Mid-South Region Sue Cox Park Place Entertainment Corporation Executive Director Texas Council on Problem and F.M. “Bud” Celey Compulsive Gambling President and CEO Joyce Dugan Foxwoods Resort Casino Eastern Band of Cherokee Indians Frank J. Fahrenkopf, Jr. David A. Korn, M.D. President and CEO American Gaming Association Assistant Professor University of Toronto Frank Fertitta III Alfred C. Lomax President and CEO Station Casinos, Inc. Airport Police Chief Kansas City International Airport Brian McKay Carol O’Hare Of Counsel Lionel, Sawyer and Collins Executive Director Nevada Council on Problem Gambling Phillip Martin Howard J. Shaffer, Ph.D. Tribal Chief Mississippi Band of Choctaw Indians Director, Division on Addictions Harvard Medical School Philip G. Satre Pauline Yoshihashi Chairman and CEO Harrah’s Entertainment, Inc. Senior Vice President Abernathy, MacGregor & Frank Glenn Schaeffer President and CEO Mandalay Resort Group

17 1999-2000NC RGMEMBE RAS dvisory Board

The advisory board of the National Center for Responsible Gaming (NCRG) is an independent body of academic researchers and other men- “Ken Winters, an expert on tal health experts that has responsibility for establishing NCRG’s research youth gambling at the priorities, selecting proposals for funding and conference planning. University of Minnesota, Robert Boswell, Chairman Suck Won Kim, M.D. received a $56,410 grant Executive Vice President Associate Professor of Psychiatry from the center to see Pioneer Behavioral Health University of Minnesota Medical whether adolescents outgrow Mark Appelbaum, Ph.D. School Professor of Psychology George Koob, Ph.D. their gambling problems. He University of California, San Diego Professor and Director credits the center’s advisory Hans Breiter, M.D. Division of Psychopharmacology The Scripps Research Institute board and ‘peer review pan- Clinical Assistant in Psychiatry Dept. of Psychiatry & Radiology Barry Kosofsky, M.D., Ph.D. els’ with keeping the process Massachusetts General Hospital Associate Neurologist honest and the science true.” Linda B. Cottler, Ph.D. Massachusetts General Hospital Associate Professor of Neurology Professor of Epidemiology in — St. Louis Post-Dispatch, Feb. 10, 2000. Harvard Medical School Psychiatry Washington University School of Eileen Luna, J.D., M.P.A. Medicine Assistant Professor of American William Eadington, Ph.D. Indian Studies University of Arizona Director Institute for the Study of Gambling Lisa Najavits, Ph.D. and Commercial Gaming Assistant Professor of Psychology University of Nevada, Reno Harvard Medical School Richard Evans, Ph.D. McLean Hospital Distinguished University Professor Francisco Napolitano, Esquire of Psychology Attorney at Law University of Houston Board Member, American Academy Elizabeth George of Health Care Providers in the Addictive Disorders Executive Director North American Training Institute Peter E. Nathan, Ph.D. Sue Giles University of Iowa Foundation Professor of Psychology Director University of Iowa Addiction Technology Transfer Center David Self, Ph.D. University of Missouri-Kansas City Assistant Professor of Psychiatry Yale University School of Medicine

18 DIPSTIeerNGUISH EReviewD SCIENTISTS SER VEPanelsON 1999 PAN ELS

The peer review panels evaluate the scientific merit of research proposals submitted to the National Center for Responsible Gaming. Panel members are recruited from a national pool of leading scientists who are active researchers recognized by their peers and by major funding sources as experts in mental health and addiction research.

Behavioral And Social Science Neuroscience Peer Review Peer Review Panel Panel Richard I. Evans, Ph.D., Barry Kosofsky, M.D., Ph.D., Chairman Chairman Distinguished University Associate Neurologist Professor of Psychology Massachusetts General Hospital University of Houston Associate Professor of Neurology Mark Appelbaum, Ph.D. Harvard Medical School Professor of Psychology Vincent Chiappinelli, Ph.D. University of California, San Professor and Chair of Diego Pharmacology Mitchell Berman, Ph.D. Director, Neuroscience Program The George Washington Assistant Professor of Psychology University University of Southern Mississippi Seth Eisen, M.D. Robert Booth, Ph.D. Associate Professor of Medicine Associate Professor St. Louis VA Medical Center Addiction Research and Treatment Suck Won Kim, M.D. University of Colorado Health Associate Professor of Psychiatry Sciences University of Minnesota Medical G. Ron Frisch, Ph.D. School Associate Professor of Clinical Richard LaBrie, Ph.D. Psychology Director University of Windsor National Technical Center for Barbara Mellers, Ph.D. Substance Abuse Needs Assessment Professor of Psychology Ohio State University Elizabeth Matthew, M.D. Peter Nathan, Ph.D. Assistant Professor of Radiology Beth Israel Deaconess Medical University of Iowa Foundation Center-West Professor of Psychology University of Iowa David Self, Ph.D. Kenneth J. Sher, Ph.D. Assistant Professor of Psychiatry Yale School of Medicine Frederick A. Middlebush Professor of Psychology Robert Sutherland, Ph.D. Richard Evans, Ph.D. (left), and Barry Kosofsky, University of Missouri-Columbia Professor of Psychology and M.D., Ph.D. (right), chaired the NCRG 1999 peer Psychiatry review panels. University of New Mexico

19 (unaudited) JANFinancialUARY 1, 1999 – D EStatementsCEMBER 31, 1999

National Center for Responsible Gaming and Gaming Entertainment Research and Education Foundation BALANCE SHEET ASSETS Current Assets Checking/Savings Account Nations Bank — GEREF $1,163,744.51 National Center for Responsible Gaming Nations Bank — NCRG 305,082.50 and Gaming Entertainment Research Total Checking Account 1,468,827.01 and Education Foundation Total Checking/Savings 1,468,827.01 REVENUES Accounts Receivable Special Events/Miscellaneous Accounts Receivable 2,143.89 7% Total Accounts Receivable 2,143.89

Total Current Assets 1,470,970.90 Other Assets Grants Receivable* 1999 210,000.00 2000 1,093,000.00 Contributions 2001 1,015,000.00 93% 2002 955,000.00 Beyond 2002 650,000.00 Unamortized Discount -229,040.37 Uncollectible Estimate -600,000.00 Total Grants Receivable 3,093,959.63

Total Other Assets 3,093,959.63 EXPENSES Fund Raising TOTAL ASSETS 4,564,930.53 9% Management and LIABILITIES & EQUITY General 14% Liabilities Current Liabilities Other Current Liabilities Accrued Vacation 4,193.56 Research Grants Payable** 935,871.17 Grants and Program Total Other Current Liabilities 940,064.73 Expenses 77% Total Current Liabilities 940,064.73 Total Liabilities 940,064.73 Equity Retained Earnings 2,599,428.14 Net Income 1,025,437.66 Total Equity 3,624,865.80 TOTAL LIABILITIES & EQUITY $4,564,930.53

*Grants pledged to GEREF. Receivables are to be collected over the next seven years. All financial information as of Dec. 31, 1999, **Research grants are payable over multiple years based upon the research program term. compiled by Mayer Hoffman McCann L.C.

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

Christine Reilly, Executive Director Aleasha Herdina, Administrative Associate

P.O. Box 25366 Kansas City, MO 64119 Tel: (816) 453-9964 Fax: (816) 453-9964 www.ncrg.org