Tuesday, September 11, 2012

Self-Exclusion as an Ineffective Substitute for Self-Control?

Gambling self-exclusion programs prominently indicate that the responsibility to avoid gambling remains with the gambler, not with the program. For example, from the state of Maryland's Voluntary Exclusion Program: "The responsibility for staying out of Maryland casinos rests solely on the individual who voluntarily excludes and not with the Maryland Lottery or any Maryland casino." This notion is in keeping with a frequent mantra in addiction treatment, that the addict must accept responsibility for his or her behavior.

I chose the Maryland program because of this article, a version of which appeared on the front page of Sunday's Baltimore Sun (September 9, 2012). The article details the process of signing up for self-exclusion, and the reactions of some of the participants. One problem the gamblers identify -- not an uncommon one -- is the difficulty of signing up for self-exclusion at a non-casino location. About 40% of the people who volunteered to be excluded from Maryland casinos are from out of state. Currently, Maryland offers only a two-year ban or a lifetime ban; reinstatement following the end of the two-year ban requires some hoop-jumping: an application for reinstatement and evidence that the gambler has received counseling.

The Sun article concludes with an interesting observation from one gambling addict:
Bill S., a 48-year-old compulsive gambler from Fells Point who attends Gamblers Anonymous meetings in Towson, is among the contingent who believe that gambling addiction cannot be dealt with by external constraints. Especially when casinos are such a small piece of legal gambling in Maryland.
"I refuse to do it on principle," Bill said. "What am I going to do? Ban myself from all the gas stations and bars? Ban myself from the grocery store? If you want to stop gambling, it has to come from inside."
Bill identifies a dilemma of sorts. While self-exclusion has shown that it can be very effective for many disordered gamblers, it is never perfectly enforced, nor can it shut the door to all wagering opportunities. (Further, many (possibly most?) problem gamblers move away from problem gambling over time, without self-exclusion or indeed without any treatment -- natural recovery is common among addicts of all stripes.) For some subset of problem gamblers, self-exclusion, even if it works in keeping them away from excluded sites, may indeed undermine their internal mechanisms for controlling their gambling, mechanisms that might be needed for those non-excluded opportunities. As John Stuart Mill noted, "In many cases, though individuals may not do the particular thing so well, on the average, as the officers of government, it is nevertheless desirable that it should be done by them, rather than by the government, as a means to their own mental education—a mode of strengthening their active faculties, exercising their judgment, and giving them a familiar knowledge of the subjects with which they are thus left to deal." Do those problem gamblers who are most susceptible to the erosion of internal control mechanisms recognize this issue, and, like Bill, refrain from self-exclusion?

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