Legalized gambling has provided many states a jackpot of tax dollars, but virtually no money is being funneled to treat the exploding numbers of problem players -- the ones who could lose everything.
Louisiana, often thought of as running behind the curve on almost everything, has the nation's only two state-supported residential treatment centers for problem gamblers.
Among the other gambling states, only New Jersey chips in -- on a limited basis -- for outpatient treatment.
"If you took the size of the Earth as being the problem and you took a swimming pool in someone's back yard, that's the size of the resources available for compulsive gamblers," said Arnie Wexler, former executive director of the Council on Compulsive Gambling of New Jersey.
Estimates vary widely on how many problem gamblers there are in the United States.
A national study authorized by Congress in the late 1990s suggested that as much as 6 percent of the adult population has a gambling problem, with about 1 percent being pathological -- or completely out of control.
In Louisiana, with a population of 4.4 million, a recent study by the state health department estimated there are about 74,000 pathological gamblers. No one knows the exact number, Wexler said.
The state has two residential-type treatment centers -- CORE North in Shreveport and CORE South in New Orleans, with a total of 36 beds -- but those are more than in any other gambling state, including Nevada, New Jersey, Illinois, California and Florida.
Problem gamblers from those states regularly wind up in Louisiana's centers, but unlike state residents who are treated free, they pay $6,000 per month for their stay.
"We are only meeting something in the vicinity of 1 percent of the need," said Reece Middleton, head of the Louisiana Association on Compulsive Gambling and co-founder of the Shreveport center, which opened in 1999. "But that's not to say that if we opened 100 beds tomorrow, we'd fill them. People are not real easy to get into treatment."
Nationwide, casinos paid about $4 billion in direct gambling taxes in 2002, according to the American Gaming Association, a casino industry trade group.
Louisiana's two treatment centers get $2 million a year from state gambling taxes: $500,000 each from New Orleans's land casino, the 14 riverboat casinos, the state lottery and video poker. The state's three Indian casinos, which do not pay state taxes, contribute nothing.
The explosion of legalized gambling since the early 1990s has doubtlessly fueled the problem, but the number of Gamblers Anonymous meetings shows that the crisis reaches far beyond states with casinos, Wexler said. Sports betting -- legal only in Nevada -- contributes a big share, he said.
"I'm not going to tell you that availability is the sole problem because you have states like Utah and Hawaii that don't have any legal gambling going on, but you have compulsive gamblers in those states," Wexler said.
Since it opened last year, CORE South has handled 185 clients, program director Corinne Dumestre said. Counselors have seen gamblers who got in trouble with just about every form of wagering imaginable -- illegal sports betting, casinos, video poker, horse racing and Internet casinos.
"You are going to continually have an increasing number of problem gamblers as you increase gaming," Dumestre said.
Those seeking help have limited options. Health insurance coverage generally does not cover treatment.
"There's a catch-22," said Mitch Wallick, who operates the C.A.R.E treatment center, a private facility in Palm Beach, Fla. "By the time a gambler is ready for treatment and recognizes that, he has no money left."
Such is what happened to "Jimmy," a San Francisco resident who wound up in the New Orleans center. He said he started looking for help about a year ago -- while embezzling $500 a week from his employer to fuel forays into high-stakes card games at casinos. Both his company's assistance program and his health insurer told him they could not help.
They did not recognize it as a problem, said Jimmy, who spoke only on the condition that his real name not be used.
By the time Jimmy got into CORE South, he had lost his $65,000-a-year job and separated from his wife and three children. His father lent him the money to get treatment instead of using up what little was left of his retirement fund.
Along with the other residents, Jimmy is learning to control his behavior through individual and group therapy, much of it patterned after the 12-step program of Alcoholics Anonymous.
Dumestre said that treatment alone, no matter how widely offered, is not enough to handle the problem.
"We need to start our children young and educate them about the dangers of gambling," she said. "We need to educate the senior citizens. And we have to offer these seniors something besides gambling" for group entertainment.
Some casino operators are taking steps to limit compulsive gamblers -- at least in their own properties through programs known as "responsible gaming."
Las Vegas-based Caesars Entertainment is implementing a systemwide plan at its 19 U.S. casinos to identify problem gamblers -- and to discourage them from visiting the casinos by banning special privileges. The company will start by targeting the 8,600 gamblers who have asked to be excluded from casinos in Missouri, Louisiana, Michigan, New Jersey, Indiana and Illinois, plus its own customers who asked to be cut off.
"This is a group of people we will not market to, will not cash checks for, will not allow them to participate in our player rewards program, will not extend them complimentary services, will not allow them to sign markers," said Robert Stewart, senior vice president for corporate communications. "We will not extend any services to them."
He said his company endorsed the use of gambling taxes by states for treating compulsive gambling.
"We think our responsibility is to govern our own conduct and respond to the way that we market to these people," he said. "We want to be part of the solution for them and not part of the problem."