SIOUX CITY | Siouxlanders can try their luck at the roulette wheel at a local casino, purchase a scratch ticket at various grocery stores or play slot machines at a North Sioux City gas station.

And with the proliferation of mobile online gambling sites, they can gamble anytime, anywhere -- at home, work or school.

There's no shortage of gaming options, and some people who take advantage of them will develop an addiction, a chronic disease that changes the brain's structure and function, as a result. Adults, seniors and even youth, can all fall victim to compulsive gambling, which affects an estimated 2.5 million Americans.

"People can gamble on nearly anything. You can gamble when you play golf on the golf score, you can gamble on who the next president of the United States is going to be," said Nick Brown clinical supervisor at Jackson Recovery Centers. "It can be one of those exponential loss-type things, where I lost 100, then 200, then 400. It can just take off and skyrocket really quickly."

On a monthly basis, Jackson Recovery Centers staffs a booth just off the Hard Rock Hotel & Casino's gaming floor in effort to reach problem-gamblers and their family members. In 2016, the addiction treatment center served 40 patients who were struggling with problem-gambling.

"People will say just jokingly, 'If I lose, maybe I’ll come back and talk to you,'" Brown said. "A lot of times, we'll get people who say, 'I really have a loved one whom I’m really concerned may have a problem.' We try to have the conversation with people and we encouraged them to have the conversation with their loved ones, too."

A statewide voluntary self-exclusion program was created in 2004 that allows persons to ban themselves from all commercial casinos in Iowa for a lifetime by signing a single form. This year, the Iowa Legislature passed a reform bill that allows a person to choose a 5-year ban or the lifetime irrevocable option.

"It used to be that you couldn't even come into the property. Now, you are only prevented from entering the gaming floor," said Scott Knutson, director of security for the Hard Rock Hotel & Casino. "You could come to the hotel and stay or you could go to the restaurants, but you can't do anything that's going to have you cross onto the gaming floor."

Knutson said some 8,000 names are in the program's confidential database, which is maintained by the Iowa Gaming Association. Association-member casinos are required by law to have procedures in place to identify people who have banned themselves if they were to show up on gaming floors.

Knutson said names are checked against the database when Hard Rock Hotel & Casino customers try to obtain a players club card and when they hit a taxable jackpot of $1,200 or more. He said security and surveillance staff who've helped problem-gamblers ban themselves are also good at remembering names and faces.

"If you're identified, then your jackpot is seized and you're also charged with trespassing," explained Knutson, who said the casino wants its patrons to be responsible when they gamble.

"If you're spending too much money, you don't have the means to or it's causing you problems where you're unable to pay your bills due to the addiction, that's not what we want. We want to be good stewards to the community."

A serious problem

A decade ago, a Northwest Iowa woman in her 70s, who agreed to speak to the Journal on condition of anonymity, turned to casino slot machines to escape personal problems.

"I went into my happy place," she recalled while clutching a turquoise journal in her lap in a group therapy room at Jackson's River Hills Recovery Center in Sioux City. "It just got to the point where I would play every day."

The woman, who fell behind on her bills and responsibilities, said she tried to hide her addiction by lying and avoiding family members. Eventually, she said two of her loved ones confronted her about her gambling problem.

"It was not a pretty scene. I was so mad at them," she said. "It took me three or four days to realize I had a serious problem."

Jackson Recovery Centers holds training sessions for Hard Rock Hotel & Casino employees to help them recognize signs of problem-gambling, which include lying, chasing losses, always betting more and being unable to stop gambling. Physical symptoms of gambling addiction include sleep deprivation, depression and suicidal ideation.

Brown said studies have shown that gambling affects the brain's reward system in a way that's very similar to that of substance abuse. MRI scans conducted by British researchers found that certain areas of the brain were highly active in problem-gamblers when they were just shown photos of gambling scenes.

"Gambling or substance abuse is similar in that it's able to open up this rewards system without necessarily having something gratifying happening," Brown said. "So much of substance abuse is anticipation. It's not just actually the using of the drug or drinking, it's everything I do in order to look forward to actually doing that. Gambling is very similar."

Problem-gamblers, he said, eventually need to bet more and more money in order to feel the same thrill that they did the first time they gambled.

"It's kind of like drinking. Four beers doesn't do it for me, now, I need to drink eight beers to get a buzz," he said. "It can be the same way with gambling — I have to bet more and more money to get that sensation — that rush I want to get."

People who don’t gamble for some time, Brown said, will experience withdrawal symptoms, such as restlessness and irritability. He said family members of problem-gamblers won't only be affected by their moods, but also by their failure to meet obligations and cover debts.

Brown said help is available for both addicts and their family members who call Jackson Recovery Centers directly or 1-800-BETS OFF, a free helpline that crosses state boundaries.

"With gambling treatment, it's based off the state that you live in," he said. "That makes it kind of a challenge for us in this Tri-State area, because if somebody from Nebraska calls, we want to make sure that we hook them up with a Nebraska counselor so they can get their treatment subsidized."

The Iowa Gambling Treatment Program funds a range of services for Iowans and their family members, including outpatient individual and group counseling at treatment facilities such as River Hills Recovery Center, which offers a 12-step-based addiction recovery program.

Recovery support services are also available to cover expenses that keep people from continuing treatment, such as gas, utilities, toiletries and clothing for a job interview.

After 10 months of treatment at River Hills Recovery Center, the Northwest Iowa woman said she's happy again and proud of the progress she has made overcoming her addiction. She said her relationships with her family members have improved, as have her finances, since she stopped gambling.

"It's nice to have money in my pocket. It's nice to be able to go shopping once in a while," she said. "Before, I would get paid and I'd go right to the casino."

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