The Behavioral Corner 

Hi, and welcome. I'm Steve Martorano. And this is the Behavioral Corner; you're invited to hang with us, as we've discussed the ways we live today, the choices we make, the things we do, and how they affect our health and wellbeing. So you're on the corner, the Behavioral Corner, please hang around a while.

Steve Martorano 

Hi, everybody, welcome again to the Behavioral Corner. It's me, your favorite corner hanger, Steve Martorano, here as we are each and every time hanging on the Behavioral Corner, talking about behavioral health. And very briefly what behavioral health is about and what the podcast is about, in a word is everything. Because behavioral health is made up of all the decisions we make and the choices we wind up in the lives we lead and how it affects our health, our emotional, psychological, and physical well-being. So that's what behavioral health is about. And that's what the Corner is all about. And we're lucky we always bump into interesting people they seem...to be this seems to be the crossroads of interesting folks and they stop and they hang with us on the Corner and we...we talk about we hope you'll find interesting things. That's certainly the case today. I should mention that we are partnered up and our underwriter partners are Retreat Behavioral Health, you'll hear about them a little bit later on. We're gonna talk about gambling, why not? It's everywhere and always has been you fans of the New Testament must remember the episode -- that tragic episode -- Jesus hung on the cross the Roman guards were gambling for his robe. So again, he's been around a long time seems to be an instinct we have for risk-taking. And if that's true, this is the golden age for indulging yourself in that risk. You know, there's a lot of money raised by the legalization of gambling, lots of inflows to obviously the companies. But now, municipalities see it as a windfall. Why no better than taxing people? Let's have legalized gambling and let's tax them. Disingenuous at best, right? What happens is, there's a price to pay for that there are a lot of people who can't handle this. And we're gonna find out, you know how big a problem that is, and what can be done about it if it's in your life. To that end, we welcome to the program, Josh Ercole. Josh is the Executive Director of the Council on Compulsive Gambling for the Commonwealth of Pennsylvania. And we welcome into the corner. Josh, thanks for joining us.

Josh Ercole 

Thanks, Steve. It's good to be here. I appreciate...I appreciate you having me.

Steve Martorano 

We'll establish right away because when you do a show about compulsive gambling, these people are going to tell us gambling is bad, or we should outlaw gambling. And no, we're not doing that. Because it's ridiculous. You couldn't possibly get rid of gambling. But there are problems associated with this. Let's talk about what the medical establishment thinks of compulsive or problem gambling, is it a disease in their view?

Josh Ercole 

You know, I'm glad you started off with that to just, you know, just a word about the council and what we do. You know, we are anything but anti-gambling. You know, it's certainly not something that we promote, but it's not something that we try to dissuade folks from participating in, because let's face it, in many cases, it's just an activity and based on statistics and data and all kinds of different types of studies, most people don't have a problem with it. Most people are able to keep it under that entertaining umbrella, you know, as an activity, that's fun. And for them, it's not going to be an issue. But unfortunately for some it is and that's our focus is trying to help them which we'll talk about in a little bit, you know, ways that we can help folks reach resources and reach out to help and that type of thing when we can break down barriers to get help, and then how we can prevent new problems from starting. And you know, the problems that we talked about, yes, this is recognized in the medical community, the American Psychiatric Association in 2013, released the most updated version of what's referred to as the Diagnostic and Statistical Manual. This is the DSM. And it's currently in its fifth iteration. In this fifth...this fifth offering, pathological gambling as it was previously referred to, went through a lot of changes. Significant. It was moved from which category it previously was into a new category, it was given a new name. And some of the criteria were shifted just a bit. And what it was -- was for many years -- it was identified as an impulse control disorder. And that was the category it was under and it was named again pathological gambling. And it was a situation in 2013, whereupon number, a number of different studies and research that was done, it was found that it was better suited to be named what's referred to as a substance related disorder. So believe it or not, in 2013 pathological gambling was actually renamed gambling disorder, and it was moved into the substance use disorder category. Along with other types of substance issues. It was no longer seen in the same way. It was identified as a behavioral addiction that basically because of how the brain chemistry reacts to the activity that was seen as very similar to other substance-related disorders. And it is currently the only behavioral disorder that is in that substance-related disorder category. So, you know, this is...this was kind of groundbreaking because what it did was it sort of opened the door for a lot of more...a lot more attention, a lot more details to really kind of focus on helping folks who were struggling or identifying this as a significant diagnosable disorder. Obviously, it had ramifications as far as insurance coverage for treatment, it had a much, at least the possibility for a much different focus on how it could be recognized -- it gave us a little bit more of a leg to stand on. And, you know, basically, what it's looked at is a way that, you know, by identifying a disorder like this, we can sort of encapsulating treatment in a number of different ways. So rather than working in silos, and looking at gambling, and somebody who has a gambling problem needing gambling help, and then, you know, maybe not necessarily approaching the behavioral side, or maybe the substance-related side -- now we could look at things in a much more uniform way. And approach treatment approach prevention in a way where we're, we're talking about everything at once. And really kind of keeping everything in line in terms of conversation. And when you see a lot of the similarities in the criteria, when you see a lot of the similarities between gambling and other disorders, especially substance-related and mental health disorders, you can see that it makes sense to do that, because there are so many areas of overlap and area convergence, where we do see either gambling leading to involvement and other substance-related activities, or mental health situations, or previous mental health situations or substance-related activity, leading to somebody starting to gamble and ultimately developing a gambling issue. So it's a lot of connectivity, that's really been quite powerful.

Steve Martorano 

Yeah. And in a very short period of time, I mean, it's sort of...sort of remarkable that it took what -- would you say, 2013, before the medical establishment went, "You know, we've seen this before. Oh, we've seen this behavior before. It's like this." It is not a character flaw. These are not necessarily bad actors. They're people that have a problem. So they change the designation. And now as you said, it opens the doors to an enormous amount of research. I wonder if that change in attitude or awareness by the medical establishment had anything at all to do with the proliferation of gambling? I mean, you know, when your neighborhood bookie was the only place you could make the bet it was underground, everyone knew it was going on. But there weren't ads, there weren't television commercials, there were big buildings being built that flashed lights and come and gamble. So the idea that this might have been a disease was suppressed. Do you think it had something to do with the fact that the medical establishment went, "Wait a minute, a lot of people are doing this and a lot of people are getting hurt? This is a problem."

Josh Ercole 

It's certainly a possibility. I mean, let's face it, there's been a lot more awareness over the course of the past five years, 10 years 15...20, you know, and you break it down, and you do see a lot more attention. You figure in 1978 when New Jersey first got casinos, -- when they first started opening casinos in Atlantic City -- that marked the second state with casino gambling, and just two years later, pathological gambling was included in the DSM three at that point. 

Steve Martorano 

Right.

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Over the course of the past 40 years or so, you know, we've gone from two states with casinos to 38 states that have casinos -- and you know, not even talking about online gambling and other types of gambling and, you know, lotteries and different types of things that are widely available -- much more than we ever saw before, obviously. And you know, in the last five years, you know, that's increased exponentially, even in single states like Pennsylvania. So, you know, what that kind of leads toward is, yeah, there was more availability. There was more participation. Unfortunately, when you see that combination of those two things, you know, more participation, anything, you're going to have problems. You're going to have problems that continue to grow, and you're going to see an increase in them. So, yeah, I think it makes a lot of sense that as we started to see more availability and participation, the problems started to be identified in a greater capacity.

Steve Martorano 

that also shed some light on one of the standard responses by the gaming industry that we heard also from the alcohol industry as well, which looks this, this is now legal. Overwhelmingly -- overwhelmingly, they would say people can handle alcohol. And gambling responsibly doesn't result in negative effects on their lives. And we're sorry that there's a small number of people who can't deal with it. We're now poised if not already well into a period of time when that small number, while still not the majority, is growing exponentially. Is that true?

Josh Ercole 

Yeah, it continues to be, you know, a situation that it's tough to identify in terms of specifics or numbers, and, you know, the data that we see, obviously, you know, we get a lot of national studies, we get a lot of different reports, we get a lot of, you know, numbers that identify what percentage of folks struggle with a disorder versus a problem versus are at risk. Even when that doesn't change. You're absolutely right. When we see the overall population participating in greater numbers and having more access, you know, even if that percentage stays the same, that the actual number that is applied to that percentage is going to continue to grow. Right? 

Steve Martorano 

Yeah, yeah. 

Josh Ercole 

You know, I think what we've seen, in addition to the shift in the medical community looking at gambling, as obviously something that can be identified, I think, within the gaming industry, in large part, we're starting to see a shift as well, in terms of the culture. You know, there's a term that, you know, however you look at it, the term is often responsible gambling, responsible gaming, something along those lines, where, by implementing some fairly simple rules and put a pin in that word simple, you know, things like sticking to limits with the amount of time that you're playing; sticking a limit to how much money you're spending; looking at gambling as a way of having fun and not as a way of, of coping or a way of making money or whatever the case is. The goal is to prevent problems from starting. And the gaming industry has, you know, they've embraced this, this approach. And they do support the fact that this is something that if you're going to play with us, we want you to do it in a responsible way. Now, the problem is, there are some folks out there who aren't going to be able to do that. They're not going to be able to stick to responsible limits. So that's the concern is, that's great that we can put these tools in place that we can put these outlines and guidelines in a situation where to prevent new problems from starting, let's have some protections. And you know, I think Pennsylvania did a great job in terms of establishing some of those protections, and really kind of setting things up from the onset of the expansion that we saw a few years ago. But the problem is, is there are going to be some folks that aren't going to be able to just stick to limits. So that word "simple" that I use, that's not necessarily going to be something that applies to everybody. And that's our concern. We want to make sure that if it's not simple for somebody to stay responsible with how they participate, that we're taking it a step further. So you know, by promoting services by reaching out to different communities. By trying to break down barriers associated with getting help. And by putting them in touch, and not just with the individual but I think it's it's equally, if not even more important, to make family members aware of help. To make family members aware of warning signs and things that they might identify. Because a lot of times what we're going to find, obviously, you know, until somebody is ready to get help, it's going to be a challenge to get them to do that to seek that help. But if we don't even identify that somebody may have a problem, that's just going to put it that much further away. And the fact of the matter is, is unlike substance use and other disorders like that, where there's going to be some type of physical impact associated with the issue. A lot of times with gambling, you're going to see that. You're going to see somebody who's stopping a casino on the way home from work or, you know, stopping at a casino on their way into work. Do you know? And their bosses won't know about it. Their spouses won't know about it. Their kids won't know about it, because the physical signs are very, very limited.

Steve Martorano 

And now, there are no limitations. There are no outward signs. You don't have to drive anywhere...

Josh Ercole 

Right.

Steve Martorano 

...to engage in this behavior. You can do it from your phone, which means you can do it from your desk at work, just before you put the kids to bed -- all night long. Talk a little bit about...because we mentioned the gambling industry has been around for a very long time. But it's a very recent phenomenon that the states have legalized online gambling. And like everything else, the internet has touched. Everything else. It has had a profound effect on the business or the process. Tell me what you think the impact of online gambling now -- for those of you who don't know, as Josh just showed you, you can do it on your phone. You can bet anything, literally anything on your phone. What's going to be the effect of that do you think?

Josh Ercole 

Just in case anybody who's listening didn't, isn't aware of everything that we have. Online gambling in Pennsylvania is nothing new, as far as people being able to gamble online, on their computer or their phone, or whatever the case is. The thing is, they weren't doing it legally. And I don't mean to say that, you know, there were breaking laws or anything like that I'm not trying to sound dramatic. It was just an unregulated, unlicensed, you know, offshore betting site that they were doing on. In 2017, in Pennsylvania, we had a huge expansion of gambling, legal gambling. So in addition to things like, you know, legalized fantasy sports and new categories of casinos being legislated. We also the two major ones were online casino gambling, and then sports wagering -- which obviously, I'm sure most of, well, most of anybody listening or anybody not listening because seen at least ads or commercials or heard about it. We're seeing a lot more folks who are aware that that sports betting is something that's now legal. Obviously, it's supported not only by the gaming industry, but you know, leagues and commentators, news, I mean, you can't...you can't turn anywhere. You know, you can't turn on sports radio, you can't turn on a football game, you can't even turn on a TV channel and just watch a show that has nothing to do with sports without seeing one of the advertisements. Now, you know, all of this came in a very, very short amount of time. Not to mention, it came at a time that was followed very, very soon after by a pandemic, where everything shut down. So you know, this perfect or imperfect storm, however you want to call it, within a couple of year period, we had a rapid expansion that allowed for folks to access gambling, basically anywhere within the geographic boundaries of Pennsylvania. So now you're not driving five minutes, an hour, two hours to the closest Casino. Now you're doing it right on your phone, or your tablet or your desktop, computer, whatever the case is. That availability obviously was was quite remarkable. And then in addition to that, obviously, there's these new types of gambling, which led to a whole new well, that kind of led to a really interesting breakdown in terms of demographic and participation. So you know, what we found was, this was something that was attractive to a younger crowd, we saw younger folks starting set up accounts, we saw younger folks starting to participate both in online casino based gambling, whether it was poker or slots, or, or table games, but also the online sports gambling. Obviously, this now offered folks a chance to switch how they were gambling on sports, how they were, you know, instead of using a bookie, they were now able to do it in a regulated manner. Get sign-on bonuses, you get all kinds of different things. Once the pandemic struck, now, we saw something really interesting happen, we saw the existing population who was already going to casinos who was frequenting them, they couldn't go, right, everything's shut down. So now what do they do? Well, I'm going to try it online, because I can still access the same activity. So we saw new accounts being set up by these folks. And then what else is interesting is you also had folks that "I don't gamble at all, I don't really do that. It's not my thing. But I can't go to work, I can't go out, I can't see my friends. So what can I do? Oh, I keep turning on the TV and I see these ads, maybe I'll try it out. Maybe it'll be fun." So now you have three different groups that just a year before weren't doing something -- now starting to set up accounts. And, you know, obviously with that obviously resulted in a tremendous amount of revenue that was generated. But what we've been seeing over the course of the past 18 months or so is this frequent increase in calls to the helpline, identify, online gambling has become increasingly problematic for them. The situation that they thought was just something that would be entertaining to get them through this shutdown period has now become something that they're doing a little bit too much. You know, when we talk to people, we always, you know, it always comes back to money. That's the association with gambling problems. Why don't people just stop, don't say, Well, I worked too hard for my money. I don't want to lose money, why would they keep spending money? Why don't they identify? What's really important about this is yes, money does come into play a lot. And that is often identified as one of the frequent issues -- that largely imparts not necessarily to huge bets being placed, but more frequently, what we see is the rapid continuous play that is available. And you know, this kind of goes into the question you were asking some of the changes that we've seen, you know, this online availability has increased the speed and availability just exponentially. I mean, things are just meteorically different than they were just a couple of years ago.

Steve Martorano 

I'll never forget the first time I was in an airport in Rhode Island, mind you, and I was looking at video screens for flights information. And then there was another video screen that kept flashing grids of numbers. Okay. I found out later that it was Keno. If you don't know what Keno is -- Keno is just what Josh talked about -- an absolute mainline shot, allowing you to gamble, just pick numbers, they come up every 20 minutes or so you could do it in Vegas, it's a casino gaming and doing Vegas. It's just to keep that action going. And now you've got the ability to do very much like that on your telephone. It's simply amazing. And when you talk about the numbers, the one that took my breath away, was that in Pennsylvania, prior to the certainly the pandemic and online legalization of online casino gambling, the numbers were relatively modest, I mean, $30 or $40 million in 2019. And that number jumped to over a half-billion in one year. 

Josh Ercole 

It's definitely become absolutely, you know, incredible in terms of how much revenue has been generated. It's not just here, you know, I mean, you have the increased sports handle, you have the increased amount of revenue that's being generated. I mean, we see higher numbers across the river in Jersey, you know, you see high numbers in states that previously didn't have or had very little legalized gambling, and now that they've expanded it, and that expansion has been fast. This wasn't federal legalization, that with regard to sports betting, you know, what we saw was a federal...a federal ruling was overturned in 2018. And, as you might remember me saying in 2017, we paved the way in Pennsylvania to allow for it. So once that federal ruling was overturned, Pennsylvania was in a good position to quickly move to legalize sports wagering. And basically, this ruling that I'm talking about, allowed for states to determine whether or not they wanted to have legalized sports betting within their jurisdiction. And you know, within a two year period, we have seen roughly half of the states go ahead with some type of legislation for either brick and mortar or online sports gambling, there's a lot that people see in this as a benefit to their tax, you know, the general fund to their taxation, relief, whatever the case might be. The problem is, there's also going to be issued, and that's the thing is making sure that there are protections that there are, you know, avenues to help the door prevention initiatives in place. And that's where, you know, in some of the states that we've seen, you know, have clearly done more than others put it that way.

Steve Martorano 

Yeah, yeah. Well, that was the case that changed the law that said only Nevada, and to a limited extent, Delaware..R

Josh Ercole 

Right. 

Steve Martorano 

...that great, but grandfathered in, when New Jersey challenged that law in federal court. If you were paying any attention at all, you knew that... First I thought they would, I thought they had a great case. But it was clear that the minute that law went down, everyone was going to get into this game. You know, we could go on and on about the get into the weeds about the dynamic of gambling. But what we really are interested in is what you're hearing from people who call the council and I would guess lots of people, particularly the family members that you mentioned, want to know what to look out for? What are the signs of this behavior now that it's easier than ever to get in trouble? What can you tell us about symptoms and signs of problem gambling?

Josh Ercole 

Like I mentioned before, Steve, it's tough because you don't have the same physical science. Right? You know you don't have somebody that's passing out from blackjack or you know, overdosing on sports betting whatever. So you what you kind of has to look for are behaviors -- are really changes in behaviors. You know, and if you know that, somebody Gamble's you know, if you have a loved one, if you have a friend, you know that they're gambling, again, what I started talking about before, it's not always going to be about money, you know, you're not going to have somebody that I'm, you know, I'm down $500 I'm going to try to dig myself out of this hole, but better than $1000 to overcome it. You know, this, this could be a situation where either that increased frequency of play, starts to kind of overtake their thinking starts to overtake their judgment starts to cloud, how they're rationalizing and then become ultimately preoccupied with gambling. So you know, like, "Leave me alone. I have to place my bets" "Leave me alone when I'm watching the game. I don't want to do this. You guys go I'm gonna stay here and do this. And you know, I have all these things lined up." It can be a very gradual change. But it's something that we often see as it becomes more and more prominent, it really has a greater impact

Steve Martorano 

If people suspect that there is a potential problem either personally or in the family and wait to see it manifested as a financial thing. If you first discover that there's a gambling problem, because your accounts have been drained, you missed the boat. So it's about watching people's behavior.

Josh Ercole 

With the exception of bailouts, or receiving financial assistance to pay off debts -- it's really money -- the amount of money -- that's not a component, of the criteria for a gambling disorder diagnosis. It's all about the behaviors associated with it, and how folks interpret, how folks feel, you know, elements of withdrawal, very similar to substance use when trying to stop. Increased tolerance - needing to maybe a bit more frequently, or increase the amount that you're betting with. Preoccupation is a big one. Risking relationships or things like that. But it's not about you know, "Oh, geez, I've bet so much money, or I bet you know, $10,000 in losses, so now I have a gambling problem? You know, that's all going to be relative. If somebody is missing important life events, placing 15 cent bet, after 15 cent bet, to try to win back previous losses to try to, you know, continue staying in the game and, and come out ahead. If it's changing how they're approaching watching a game or playing any type of casino game, you know if it's something like that. You know, again, the financial impact can happen really quickly, you know, with with the amount, you know, so you know, growing up, you know, just talking about sports betting or, or talking about, you know, Atlantic City casinos when, you know, they first arrived. Remember the old slot machines, and when our bandits you know, you put a quarter in and spin the...you know, pull the reel and the reels would spin and it would stop, and then it would stop and it would stop. You know, that's entirely different today, right? You know, you have a button, hit a button, hit a button, hit a button, so it's very fast. The same thing with sports betting, I remember going to Eagles games as a kid. And I remember my dad would tell me, see all the guys at the phone, you know, the payphone, they'd be a line at the payphone. Go to one o'clock game. halftime, the line at the pay phones was just huge. He said a lot of them, they're probably placing their four o'clock bets trying to you know, trying to get their bets in with their bookies. Totally different, right? You know, countless how many wages you can place within a single sporting event. Now, you know, you can, you know, is this next play going to be a run play? Is it going to be a passing play is going to be a first down what's you're going to do on third and 10? You don't need to bet a lot of money. It doesn't necessarily need to be that.

Steve Martorano 

You know, what's interesting about this -- Charles Barkley, the great Charles Barkley, when it was revealed several years ago -- he acknowledged it -- that he had gambled something like $40 million. I think his initial reaction was to immediately appear embarrassed and say, "I guess I have a problem." And then a couple of years later, his attitude changed completely. He said, "Naw I don't have a problem. I'm rich."

Josh Ercole 

He can afford it.

Steve Martorano 

"I got more money, you know, and I enjoy gambling, and it didn't hurt anybody." So in that sense, I guess he didn't have a problem.

Josh Ercole 

So you know, what I would recommend, in terms of, of a way to look at it is yeah, so financially, he may not have been in jeopardy, or dramatically impacted. Again, if you were going to take each of the nine criteria associated with a gambling disorder, and remove the financial piece from the situation, you know, maybe he's never received a bailout to get them out of financial debt. 

Steve Martorano 

Right. 

Josh Ercole 

But I would be willing to suspect that he is probably meeting a good number of the other criteria. And the issue is you don't need to meet all nine of those criteria in order to receive a diagnosis. You only need four of the nine. And the fact is, if he's, you know if he's going through preoccupation if he is getting more and more -- let's face if you're betting $40 million, probably didn't start out betting high numbers like that. So there's probably some type of increased tolerance for him to get that same thrill -- that same rush, right? If he is feeling the need to win back losses, you know, I'm going to focus on -- "I'm going to keep playing until I went back what I've lost so far." You know, that's referred to as chasing. Each of these components really plays a major role in determining whether or not somebody meets the criteria again, for a diagnosis of an issue. Let's remove the financial piece from the discussion and look at all the other pieces.

Steve Martorano 

Yeah. And you're right, if you take the money out, there's still a whole slew of things that you would characterize as a problem at the Council when people call for help. What are the numbers regarding men and women -- more men than women are, is that number to level out or what?

Josh Ercole 

It's definitely more men that we have called, you know, I would say it's probably usually in the, you know, two thirds to three-quarters of calls we get are coming in from males, that number changes, you know, when we see different types of gambling availability, you know, increase or change in over the years, we've seen more females calling, and certainly, from different areas of estate, we have different numbers of folks. You know, calling in terms of, you know, gender identity they fall under. The big difference that we've seen over the course of the past couple of years has to do with age. And as we've seen these new types of games, we've seen a tremendous increase in younger folks, you know, the highest rates we've ever seen folks in the 25 to 34, age range. And traditionally, what we would find is that would be in the 45 to 54 range or in that in that ballpark. But you know, the increase in the availability of internet gambling, it seems to be directly related to a younger generation. And what we're finding is that these calls that are coming in, they're coming in not just in the form of phone calls. So obviously, we have 1-800-GAMBLER, that's the number that we advertise in Pennsylvania. And it's advertised by the gaming industry and the Department of Drug and alcohol programs and the lottery in a number of other groups. We have folks calling that number, but on our website, which is pacouncil.com. We also have a chat and text feature available that we've had available since about 2015. And in the last year or so that the numbers of folks who are reaching out using that method of communication, that's expanded dramatically as well.

Steve Martorano 

We will have links to that on the Behavioral Corner site when we get around to posting..

Josh Ercole 

Great.

Steve Martorano 

...our interview with Josh. Josh, let's finish up here. You know, what kind of treatments are available. Problem gambling may mirror substance abuse problems, but I wonder if like residential treatment, as opposed to outpatient? What are some of the techniques used to treat this?

Josh Ercole 

So in Pennsylvania, there is a fund that is, as part of the original legislation that brought casino gambling, and each of the new types of expansion. They put dollars into this fund. And basically, it filters through the Department of Drug and Alcohol Programs. This covers treatment. It covers prevention. And what happens is the department works with treatment providers, so either agencies or individuals who offer gambling treatment services, for the treatment side of things, and then they work with single county authorities throughout the state for the prevention side of things. Now, the treatment providers typically are folks who work either in substance use already or work in some type of mental health situation. A lot of times what we see are, the approaches are going to be very similar. I see a lot of cognitive behavioral therapy, we see a lot of motivational interviewing, we do see a lot with gambling, that seems to help keep people engaged in the process is using some type of harm reduction technique. Obviously not going to work for everybody, but something that we have seen a lot of success for a lot of folks. And then there are other state programs, there are things like self-exclusion, which folks can implement into the treatment process. So it's actually a self-imposed voluntary, confidential ban, that's available for online, you know, gaming, online sports betting casino brick and mortar establishment gambling. So a number of different approaches that way,

Steve Martorano 

How does harm reduction work? How would that work? 

Josh Ercole 

So if you have somebody who you're working with that is not ready to stop gambling, but is maybe put in a position where they've been given, you know, some type of ultimatum from a loved one, maybe they're interested in getting help for themselves because they realize that there's a problem, but they're not ready to stop entirely. A number of counselors who can work with that individual to maybe start by limiting how much time they're spending, maybe limit how much money they're spending, and, you know, and approach it from an angle that is going to work for them, again, not to solve the problem or not to allow them to continue gambling, but to keep them coming back. You know, I mean, that's the goal is if you meet with somebody, that initial session, and they never come back again. Well, you're not going to help. You know, that's not going to fix their problem. And not to say that if somebody does come in, and they say, "Well, I can limit it to two hours this week, or I can limit it to 10 hours this week." but that's going to be you know, the be all end all. You know, the ultimate goal may still be abstinence from gambling. But to get to that point, it might not be something that they're able to do overnight. So working in stages and meeting them where they're at, you know, and that's where that motivational interviewing approach really comes into play.

Steve Martorano 

It's important to remind people that certain things look like enabling when in fact they are about just reducing the harm and keeping people on the right track. Josh Ercole thanks so much. Again, Josh's organization is the Council on Compulsive Gambling of PA. If you're listening to this someplace else, I'll bet you can be directed to one in your area as well. We'll have a link-up there so you can -- it's a great site, a lot of information on it. And of course, 1-800 -- is it gamblers or gamblers, right?

Josh Ercole 

GAMBLER. Yep. Yeah, 1-800-GAMBLER. You know, and again, I mean, this is a 24/7 -- obviously, the website's up 24/7. But the service is 24/7. So folks can call anytime. It's confidential. It's a free call. We have live helpline specialists ready to take calls at any point, again, via chat call or text. I encourage people to call for information. If you're curious if you're even thinking about -- you're not locking yourself into anything. So if there's somebody that you're working with, if there's somebody you know, a loved one, don't be afraid to call. I know it's a huge step. It really is. But it's a huge step in a really, really positive direction. So we encourage folks to call if there's any question about, you know, the issues that they might be facing if they're struggling, we have -- I don't want to call it a quiz -- but we have a questionnaire, a survey, on our website that kind of focuses on do I have a gambling issue. And it's a great tool for folks to use to see if maybe I'm taking things a little bit too far, I didn't really recognize that maybe the things that I'm doing could be putting me in a problematic position. 

Steve Martorano 

Josh, thanks so much. We appreciate you shedding more light on this that needs to be shared. And we...I'm glad we can leave people with this, which is clearly true when it comes to the issue of problem gambling: The only sure thing is that there's help. That's the only bet you can't lose on. There's help out there. But you got to go looking for it. And you got to want it. Thanks, Josh. We hope we can have you visit on another topic. We can talk about a lot of stuff for a lot. It's fascinating, dynamic. Thanks for your work. Thanks for joining us on the Corner. Thank you guys for hanging with us as well. Don't forget to follow us on Facebook and do all that stuff about liking us. We like to be liked, and we'll catch you next time on the Behavioral Corner.

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