This is one of the most important parts of the book. It uses all the available data on suicides and gambling addiction to create a detailed mathematical model for estimating annual gambling related suicides.
How to determine the annual number of gambling caused suicides
Total addicted gamblers in the United States
How many problem (pathological, addicted, disordered…take your pick) gamblers are there in the United States now? Unfortunately, there is not a clear number that can be quoted with much confidence. I’ve spent many hours reading surveys and studies. These studies and surveys use different methods and different criteria for determining the level of gambling disorder, and the results vary by factors of five or more.
There are at least three different criteria used to determine if the person was a problem/compulsive/severe gambler. The studies differ by the number of people asked, and most importantly, they vary by what year they were taken. Many were taken in the 1990’s, well before the explosion of casinos and slot machines. However, they all identify one common trend – they almost always indicate that current year prevalence (meaning the year the survey was taken) is significantly higher than previous year’s prevalence. In other words, addicted gambling is measurably on the rise.
If this was true in the 1990’s, it is certainly increasing twenty years later, as these twenty years have seen a hundred fold increase in casinos and slot machines!
The NCRG (the industry group) states: “Approximately 1 percent of the adult population in the United States (the adult population of the U.S. is 250 million) has a severe gambling problem.” Citing studies from 2008 and 1999. Once again, these studies are outdated.
The National Institutes of Health (NIH) meta-analysis (combining all relevant surveys and studies) puts the current year number of Level-3 (severe) disordered gamblers at 1.6% (and again, many of these studies were from the 1980s and 1990s).
An exhaustive Harvard Medical school meta-analysis pegs current year adult prevalence of level-3 gambling disorder at between 1.12% and 1.29%. This study was done in 1999! This is well before the explosion of casinos and slot machines.
There is no question that many more people are now addicted because of the radical increase in the local availability of casino gambling. And yet there seems to be no current studies that capture both the increase in casinos and the dramatic increase in the sophistication of current slot machines.
The DSM-5 puts the current year prevalence for disordered gambling at .2%-.3%. They cite no surveys, studies or sources to justify this claim. I’m not a fan of the DSM-5’s four pages of description of disordered gambling. They make several outrageous and unsubstantiated claims. For example, they claim (two different times) that disordered gamblers are in poor health. Huh? In my experience at inpatient treatment, GA meetings, in the casino in general, and in discussions with therapists, I’ve not seen or heard anyone support that claim. My experience is that addicted gamblers look very much like a slice of the public at large. Many of the DSM-5 pronouncements seem to me to be grossly out of date. In any case, the DSM-5’s data is, in my opinion, not remotely credible.
I believe a conservative middle ground for the prevalence percentage of addicted gamblers in the current environment of the year 2020 (considering that there are significantly more addicted gamblers now than there were ten and twenty years ago when most of the surveys were taken) is 2.0%.
(It is also important to note that suicides might occur in people who have very recently started gambling. Addiction can happen fast, especially with slot machines.)
Annual attempted suicides by addicted gamblers
In the United States, a report by the National Council on Problem Gaming indicated that one in five pathological gamblers attempts suicide. It is also stated many other times in many other places that one out of five addicted gamblers have attempted suicide (note: an attempted suicide does not have to result in injury, so my high-speed search for a bridge abutment does count as an attempt).
However, this number of attempted suicides does not give us the number of attempted suicides this year. It means that one in five have attempted suicide during their entire gambling experience. There is absolutely no data available to tell us the addicted gambler current year attempted suicides. Again, I will offer an informed guess.
The number of people becoming addicted to gambling in any form is clearly on the rise. It is obvious that newly addicted gamblers (those becoming addicted in the last year), outnumber those gamblers who became un-addicted or died in the last year. I believe that differential is quite large. And that process of adding the newly addicted has been going on for many years and is accelerating (I can think of no reason why it would be decelerating).
So, I will propose that a reasonable number of last year’s addicted gambler suicide attempts is 2%. That equates to one out of ten of the 20% of addicted gamblers who have attempted suicide at some point. I think this number passes the sniff test.
The ratio of attempted suicides to completed (fatal) suicides for the general population.
In the U.S., the National Institute for Mental Health (NIMH) reports there are 11 nonfatal suicide attempts for every suicide death. The American Association of Suicidology reports higher numbers, stating that there are 25 suicide attempts for every suicide completion.
The data for this ratio is for the general public, and not just for addicted gamblers. So, these ratios include a significant number of “call-for-help” suicide attempts that are recorded each year. My belief is that among addicted gamblers, there are very few call-for-help type suicide attempts.
Addicted gamblers want their addiction to be secret. Often, the suicide has the specific purpose of getting insurance money for their family. I believe when they decide that suicide is the only way out, they are committed to doing it. For the committed suicidal addicted gambler, this ratio is probably closer to 5 to 1. To be conservative again, for the purpose of this exercise I’ll propose a ratio of 8 to 1.
We now have all the numbers we need to calculate annual addicted gambler completed suicides.
Total-addicted-gamblers (250 million (the number of adults in the United States)) X (2.0%) = 5,000,000
Annual suicide attempts (5,000,000) X (2%) = 100,000
Annual completed suicides (100,000) / (8) = 12,500
By this method, annual addicted gambler suicides are somewhere around 12,500. I believe my numbers are conservative, and not surprisingly, they yield a reasonable result.
Another path to determining the number of annual gambling-related suicides
Call this the commonsense approach. Once again, I will speak here only of slot machine addicted gamblers. Using the 2.0% prevalence figure, I claimed there were 5 million addicted gamblers. It is now commonly accepted that 60% to 80% of addicted gamblers are addicted to slot machines.
(I believe those percentages are a bit low for slot machine addicts. One only needs to go to any casino, and it is obvious that over 90% of the players at any time of the day are perched on a stool with a borg-like focus on their slot machine only inches away from their brain. Several casinos over the last few years have simply removed the table-games and replaced them with slot machines in order to maximize their financial return-per-square-foot of limited floor space.)
So, let’s say that 70% of addicted gamblers are slot machine players – or 3,500,000 addicted slot players. There are currently between 1,000 and 2,000 casinos in some form of operation in this country. They range from the mega-casinos that have well over 5,000 slot machines to smaller casinos (like those in Montana and Oregon) that have only a few dozen machines. The best information available right now (though already probably out of date) is that there are more than 1,000,000 slot machines in the United States.
If you stood outside an average size casino on any day and watched the people leave, how many people per day would you guess walk out, with their head down, looking depressed or distraught, and slowly head to their car? These are the people that once again lost more money than they could afford. I’ve been part of that parade too many times to count. Every minute there are a handful leaving in that condition, every hour over a hundred, every day well over a thousand.
That’s a million (a thousand casinos, times a thousand distraught people) seriously distressed people walking out of casinos every day! Let’s say for the sake of this exercise that of those million seriously distressed people, just 5% are now suicidal, that only one out of twenty are thinking that suicide might be an option, Now we are talking about 50,000 people (every day!) considering suicide. Of course, almost all will reject even making a suicide attempt.
But what if just 1% of that 50,000 potentially suicidal people follow through and decide to kill themselves. Now we have 500 people on the path of committing suicide. And now what if only 10% of these people do kill themselves? That’s 50 suicides every day, or 18,250 suicides per year!
Is any of what I speculated about above that hard to believe? Is it hard to believe that out of 1,000,000 distraught people leaving the casino having lost a good deal of money, that out of those million people, those with their brain chemistry compromised by extended slot machine torture, that those fundamentally impulsive people wondering why they can’t stop, is it hard to believe that 50 of them would chose to escape by killing themselves?
I would say it is harder to believe why there aren’t more (and my guess is that there are more).
Of course, this commonsense approach is not science. But it is a reasonable thought experiment, I think it passes the sniff test, and the conclusion is completely in line with the proposed gambling-related suicide deaths arrived at by other methods.
One last thought
From a book by June Hunt: Gambling Your Life Away, 2013
“In Gulfport Mississippi, suicides increased by 213 percent (from 24 to 75) in the first two years after casinos arrived. In neighboring Biloxi, suicide attempts jumped by 1,000 percent (from 6 to 66) in the first year alone.”