Q: You’ve spent over two decades researching problem gambling. Please tell us a bit about yourself, your work, and what first drew you to this research?
I used to be a criminal trial attorney. When I was training as a public defender, I struck up a work friendship with a court clerk. One day she disappeared, and I was told she had embezzled money for gambling. It was an incredible revelation for me—that an activity could lead an otherwise law-abiding citizen to crime. A few years later, I was on the other side of the courtroom as a prosecutor, and I started seeing people charged with gambling-related offenses. This was back in the days of riverboat casinos—nothing like we have today. So when I decided to go into mental health and research, I decided I wanted to know more about gambling and addiction and I became a gambling counselor. It is so much more complex to treat than substance-based addictions; I got hooked and my career was set.
Q: How do you describe problem gambling?
Addiction to gambling runs along a spectrum from recreational to habitual to problem gambling to gambling disorder. Problem gambling is a term of art used for the presence of problem symptoms that don’t rise to the level of a gambling disorder diagnosis.
Q: Your research shows that people develop gambling problems for different reasons, and that not everyone is the same. Can you explain your Pathways Model, and how this model helps with treatment and prevention?
Sure. The Pathways Model suggests that people with gambling problems are not a homogeneous group. People develop problems for different reasons and in different ways. The first group of problem gamblers have no preexisting mental health problems or addictions. They develop problems because they are exposed to gambling, start gambling more and more frequently, develop of habit due to the operant conditioning that takes place when you know you could win big but just don’t know when, then start having irrational thoughts about outsmarting random chance. This leads to more losses and problem gambling. The second group has a history of mental health-related issues like depression, anxiety, childhood trauma etc., so they are gambling for escape and then the operant conditioning and irrational thoughts kick in. The third group is made up of highly impulsive risk-takers for whom gambling is just one of many things they do for pleasure seeking and then they become habituated to gambling.
Q: What does the research show about the emotional side of gambling problems, and using gambling as a way to cope with stress, anxiety, or emotional pain?
For those who gamble for escape—Pathway 2 in the Pathways Model—gambling is like a drug. It numbs them out and lets them be someone else for a while. This makes the activity highly addictive for these people.
..It should stand as a dire warning for parents who are gambling on sports with their kids now, thinking it is a “harmless” activity…
Q: You published a study in 2021 that shows the connection between mindfulness and gambling behavior. Can you describe the overall results, and why mindfulness could matter in terms of the intersection between problem gambling and mental health?
The study found that people who were “judgmentally unaware,” rather than mindful, had higher levels of problem gambling, depression, anxiety and other negative factors. The research supported the notion that, when you are high in mindfulness, you tend to be fully immersed in the current moment and what is going on in your life now. You would then be more likely to recognize it if you were gambling too much. People who are judgmental of themselves and others tend to relive past negative events—they “beat themselves up” and are more likely to be depressed, anxious and to ignore the warning signs that they may be gambling too much.
Q: You’ve also researched how gambling and addictive behaviors can be intergenerational and passed down in families. Based on your research, what patterns do you see, and what should families know about the risk?
This is one of the most important lines of research we have done, particularly in this era of rampant sports wagering. What we found was that adults who, as children, either witnessed or participated in gambling and/or had household members who participated in addictive behaviors, were more likely to drink, drug, or gamble frequently and to develop problems with one or more of those behaviors. The most interesting thing was that adult modeling of addictive behaviors resulted in the child not just becoming addicted to what the adult was doing but also to other addictive behaviors that weren’t modeled. It should stand as a dire warning for parents who are gambling on sports with their kids now, thinking it is a “harmless” activity, or other adults who don’t understand that gambling is just as potentially addictive as substances. Don’t put a lottery ticket in your child’s holiday stocking or take them to the racetrack or let them place a sports bet, because you never know whether this will be the start of an addictive pattern for them.
Q: Have you found any interesting patterns around age and the accessibility of online casinos, sport betting apps, advertising, and gambling?
We know a few things for certain from research. First, the younger people start, the more likely they are to develop problems over time. So initiating gambling as a child or adolescent is predictive of more serious problems than gambling for the first time as an adult. We also know that the more activities people gamble on, the more frequently they gamble and the more ways they gamble (online, in land-based venues or both), the higher the risk of problems. Social sports wagering apps, prediction market apps, loot boxes in video games—they are all forms of gambling and advertising continually brings people’s attention back to gambling. This will invariably lead to higher rates of addiction over time for those growing up in this environment as they move into emerging and young adulthood.
Q: You’ve been a major contributor to raising awareness around problem gambling, and evidence-based approaches for prevention and treatment. What are some important insights that you’ve gained about addiction, resilience, and recovery?
It is easier to stop before you develop a problem than after. So, as a society, it is our obligation if we are going to legalize and sanction all these forms of gambling, to ensure that children, through adults, see gambling as potentially as addictive as substances. There is currently no federal agency that regulates any form of gambling—not advertising or activities—in a unified way. There are no federal dollars for research. Until we have a federal commitment to treat gambling disorder at parity with substance use disorder, the problem is only going to get worse.
Lia Nower is a Distinguished Professor, Associate Dean for Research, and Director of the Center for Gambling Studies at Rutgers University School of Social Work. A clinician and attorney, she specializes in gambling disorder and related harm and co-directs the Rutgers Addiction Counselor Training Certificate (ACT) Program, which provides training toward licensure in drug and alcohol counselors. The ACT program is also the first educational program nationwide to provide IGCCB-certified training for gambling counselors. Dr. Nower also serves as chair of the public policy committee of the Rutgers Addiction Research Center in the Brain Health Institute, Rutgers Biomedical and Health Sciences.
Dr. Nower’s research focuses on online gambling and sports wagering; gambling and video gaming in adolescents and emerging adults; policy initiatives around harm reduction and responsible gambling; measurement, etiology and treatment of gambling and video gaming disorders; forensic issues in gambling and video gaming, and big data analyses. Dr. Nower serves as a senior editor for Addiction. In 2022, she received the Lifetime Research Award from the National Council on Problem Gambling in Washington D.C. for her research contributions over the prior 20 years. She also received the Rutgers Board of Trustees Award for Excellence in Research, which recognizes tenured faculty members who have made distinguished research contributions to their discipline and/or to society at large.
