WASHINGTON — Military personnel are at risk for problem gambling, but it is often difficult for them to get adequate treatment, according to the director of a Veterans Affairs program for problem gamblers.
In 2002, there were 1.4 million active service members. That year, the Pentagon conducted a survey of health-related behaviors among military personnel. According to that survey, about 17,500 service members, or 1.2% of the military, met the DSM-IV criteria for pathological gambling. For comparison, the national average is 1.6%. In a 2005 VA study, 10% of Native American soldiers and 4.3% of Hispanic soldiers met the DSM-IV criteria for pathological gambling, Dr. Rena Nora said at the annual meeting of the American Psychiatric Association.
Yet only three programs for military members with problem gambling exist: one at Camp Pendleton in California; one at the VA facility in Brecksville, Ohio; and the intensive outpatient program for problem gamblers at the VA Southern Nevada Healthcare System in Las Vegas, of which Dr. Nora is the medical director.
Military personnel have a number of risk factors for gambling: the sociodemographic composition of the military (mostly young males), feelings of loneliness and alienation, prevalence of risk-taking personality, and severe stress and anxiety. The accessibility of gambling also is a risk factor because there are approximately 8,000 slot machines at 94 military facilities overseas.
Limited confidentiality for mental health treatment is also problematic. A soldier's commanding officer can request and obtain access to mental health records. “When the commander or anyone else wants the records, you do not say no,” said Dr. Nora, who also is with the department of psychiatry at the University of Nevada, Reno. “There is really no confidentiality if you are an active-duty service member.”
Although there is legislation that provides for treatment of mental health disorders such as pathological gambling, the provision of services in reality it is not so easy. “I had to go all of the way to the Department of Defense to get something in writing, so that we were able to justify budget and staffing for a gambling program,” said Dr. Nora. Since the program in Las Vegas began in fiscal year 2004, she and her colleagues have treated 1,423 patients.
Dr. Nora reported that she had no relevant conflicts of interest.