Bet Your Life

As problem gambling ensnares some in a nightmarish cycle of compulsion and shame, one innovative Minnesota center is at the forefront of treatment

gambling, casinos
Photos by Ackerman + gruber

(For problem gambling resources, please click here)

Not long after Mystic Lake Casino opened in 1992, Barb Larson* had a bad night with the slots. She kept winning. The single mother had gone in with $10 and fed quarters into a slot machine, which continued to issue small jackpots that kept her playing for hours. She ended up staying all night but left with only a modest profit. “It was enough to buy food for me and my daughter,” she recalls.

These days, dressed in a robin’s egg sweatshirt and jeans, her blue-rimmed glasses pushed back on top of her brown hair, Larson, 56, looks like any number of middle-aged Minnesota women you see sipping coffee at Caribou or shopping at Target. She’s certainly not what you’d expect of a gambling addict. “You don’t think it will happen to you,” she says. “Until you get to that point.”

The casino started as a place to go; playing the slots gave her something to do. When her boyfriend died unexpectedly in 1996, the casino provided comfort for her grief and also relief from the stress of working two jobs to make ends meet. “I found solitude,” she says. “There was a lot of action, but I didn’t have to associate with anyone.”

Larson, who grew up in St. Louis Park, married a navy man who was transferred to Virginia, Washington, and South Dakota. When he headed out to sea, she found herself alone in places where she did not know anyone. So she sought solace in the casino near the dental lab where she worked as a ceramist making teeth. “I thought, ‘I don’t know anyone here, but I know how to gamble,’” she says. “It was like having a friend.”

She got high playing the slot machines, which have been called “electronic crack” for the powerful jolt of dopamine they can deliver the brain and the hold they can exert over someone. Even driving to the casino, she felt the buzz of anticipation. “It was my drug,” she says. 

Her gambling—and losing—accelerated. Larson spent not only her paycheck, but her husband’s, too. When he found out she had drained his bank account, he made her promise she would stop gambling. So she had to sneak to the casino, telling herself she would stay only half an hour. Three hours later, she was still there. She invented lies to cover up what she was really doing. When she bounced a check, her husband gave her an ultimatum: “Quit or I’m gone.”

But she couldn’t. Not long after, she stayed out all night at the casino. Subsequently, they divorced. “I sabotaged my own marriage,” she admits.

Larson moved back to Minnesota in 2005 and, once again, frequented Mystic Lake. Recognizing the severity of her problem, she started seeing a therapist and attended Gamblers Anonymous, a 12-step support group for gamblers. She managed to stay away from the casino.

gambling, casinos

Life improved. She had her own apartment. She found work at another dental lab, where she helped grow the business and was promoted to president. But in 2012, the lab was sold, and she lost her job. That sent her into a tailspin.

She returned to the only thing that reliably made her feel better. “When I was feeling really low, no self worth, I felt more at peace sitting in front of a slot machine,” she says. “That was my security blanket.”

At the same time, gambling was ruining her. When she wasn’t at the casino, she felt depressed and obsessed about how she could get there. Once there, she would tell herself she would stay only two hours, but she wound up staying two days. In the past she had secured high interest payday loans and asked for advances to have money to gamble. Now she gambled her unemployment checks. She pawned jewelry, a gold watch, a Wii gaming system, even her sewing machine—whatever it took to get money to gamble. 

Every time she won a jackpot, instead of walking away, she plugged it back into the machine to keep playing. Only once, when she won $7,000, did she leave before losing it all. She paid her rent and some other bills, but returned to the casino the next day and fed the rest back into the slots. “It wasn’t about winning anymore, but just to keep playing,” she says.

Regional casinos have proliferated across the country over the past two decades since Congress opened the door for states to legalize gambling in 1988. There are now 1,500 casinos in 40 states that take in nearly $40 billion in annual revenues. American Indian tribes in Minnesota were the first in the nation to negotiate and sign gambling compacts with a state government. In 1992 the Shakopee Mdewakanton Sioux opened Mystic Lake, Minnesota’s first casino. Today, there are 18 casinos statewide run by various tribes plus two racetracks with poker rooms. Many experts believe that the expansion of casinos has increased the incidence of gambling addiction.

There are an estimated 7.7 to 13.6 million gambling addicts like Larson in the United States, according to the National Council on Problem Gambling, yet fewer than 10 percent of them receive treatment. Gambling addiction remains a hidden problem, with awareness lagging about five decades behind that of alcoholism. There are only a handful of residential programs to treat gambling addiction; the only certified one in the country is here in Minnesota.

Two hours west of Minneapolis, just off Highway 212 in Granite Falls, there’s a sprawling single story complex with long corridors connecting a detox center, a gym, a fitness center, a chapel, a cafeteria, meeting areas, and living quarters with 122 beds. This is Project Turnabout, a nonprofit chemical dependency treatment center that opened in 1970. In 1992, its staff adapted the program blending education, therapy, and the 12 steps to create the Vanguard Center for Gambling Recovery, which can accommodate up to 20 patients at a time. 

They arrive broken. Even more so than alcohol or drug addicts. Many have stolen from employers and families, lied to those closest to them to conceal their addiction, and lost everything financially before they are ready to accept help. The consequences of their addiction often impact their loved ones deeply—wiping out their life’s savings and betraying their trust. Gambling can also be a far more secretive addiction, one the addict has taken pains to conceal, which only heightens their sense of isolation and sharpens their shame once exposed. “It can be harder to deal with than drug addiction,” says Project Turnabout executive director Mike Schiks, who previously worked at Hazelden for 25 years. “These addicts are more desperate in many ways.”

After losing her job at the dental lab, Larson found part-time work in a convenience store, but she gambled away her paychecks. She had no food at home. She could not pay her rent on her apartment in Maple Plain. Her landlord sued, and she fell behind on her court-ordered repayment schedule. By then she was chasing, desperate for that one jackpot that could lift her out of debt.

gambling, casinos

It never came. Not only was she broke, she felt worthless. In the summer of 2012, she tried to kill herself four times within two days. The last time, she attempted to hang herself but the rope broke. “I get it,” she said to herself. “It’s not my time.”

But the despair didn’t lift. Two weeks later she stole $400 from the convenience store cash register and headed to Mystic Lake. The hours passed. She had vouchers for free food but didn’t use them. Her wrist hurt from pushing the slot’s button repetitively. But she just kept feeding the machine—one penny at a time so she could play as long as possible—and wondering, “Why can’t I stop?”

Three days later she finally ran out of money. She had not slept. She had not eaten. She walked out of the casino and knew she could no longer deny she needed help. She called Vanguard and asked, “Do you have a bed?”

Larson wasnt the only one who did not understand her condition. Even the medical community has been slow to catch on to the severity of gambling addiction. It wasn’t until 2013, when the American Psychiatric Association published the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-V, that gambling was classified under addictions along with drugs and alcohol. Until then, it was considered an “impulse control disorder” similar to pyromania and kleptomania. 

Recent brain research confirms that gambling addiction works the same way on the neurochemistry as addiction to drugs. Both trip the brain’s reward system to release dopamine, which creates the high. In fact, one study using MRI scanners discovered that the neural activity in people playing slot machines resembled that of subjects high on cocaine. 

Brain researchers have also discovered many addicts have deficiencies with the functioning of the prefontal cortex, which exerts impulse control. That may explain why Larson and others like her can’t walk away when they’re losing. They persist in the dopamine-releasing behavior without regard to the mounting consequences.

Gambling addicts are more likely to try to kill themselves than seek treatment. An estimated 20 percent of gambling addicts attempt suicide—more so than addicts of any other sort—according to the National Council on Problem Gambling. Vanguard patients have talked about injecting bleach into their veins, rigging up a truck to crush them, throwing themselves into a snowblower’s auger. “They choose these self-punishing forms of suicide because of the shame and self-loathing,” says Sheryl Anderson, program coordinator at Vanguard.

“You want to find gamblers? Just look at the middle-aged housewife who’s been a law-abiding citizen all her life and just took all of the church money.”

Many get stuck chasing, like Larson did, believing they are only one win away from the only way they can see to save themselves—until they have lost everything and can no longer sustain their addiction. By that point, many have betrayed their loved ones with lies and theft and feel very much alone. 

They also suffer from the stigma fueled by lack of understanding. How can they become addicted when they are not putting a substance into their bodies? Not understanding the nature of their addiction, they blame themselves, which deepens their shame. “The chemically dependent person says, ‘I have to quit the drug because that’s what’s causing my problems,” Anderson says. “The gambling addicts thinks, ‘I’m the bad one.’” 

While online gambling and fantasy sports have garnered headlines lately, casino slot machines remain far and away the most popular form of gambling. Not only are they are quick and easy to play, they have become socially acceptable. More than 70 percent of casino patrons say their favorite activity is playing the slots.

While patients at Vanguard gambled in many varieties—pull tabs, lottery tickets, cards, dice, roulette, etc.—the majority come in with a primary addiction to slot machines, like Larson. One Brown University study estimated that people playing slot machines can become addicted to gambling three to four times faster than those gambling in other ways—mostly due to the way the rapid and continuous play triggers their rewards systems and inhibits their impulse control. 

The modern slot machine has evolved into a sophisticated electronic device powered by algorithms designed to maximize “time on machine”—an industry term—so that people will play to the “point of extinction.” “In some cases they may have started with tables or cards but that got too social and slow, so they gravitated toward slots,” Anderson says. 

When Larson arrived at Vanguard in August 2012, she went through withdrawal. She had trouble sleeping. She lost her appetite. She experienced nausea and diarrhea. She suffered severe headaches. “You don’t think of a gambler going through withdrawal, but you do,” she says.

That’s part of the disease, something she learned about in treatment. At Vanguard, the daily routine includes lectures on addiction and managing finances, individual therapy, meditation, physical fitness, and group therapy, a critical component. “Finding out they’re not alone in the world is a big help,” Schiks says. “When they hear someone else has had the same problems with gambling, it’s not uncommon for them to break down and cry.”

It’s not possible to stereotype gambling addicts; they come from all walks of life. Of 152 patients at Vanguard from 2013–14, nearly half were men, half women. They ranged in age from 18 to elderly, and 74 percent gambled without using alcohol or other drugs. More than half had some college education; 14 percent were professionals. “You want to find gamblers?” Schiks says. “Just look at the middle-aged housewife who’s been a law-abiding citizen all her life and just took all of the church money.”

Larson was surprised to meet an attorney and a pastor at Vanguard. “That was my aha moment,” she says. “It doesn’t matter who you are. Anyone can have this disease.”

Accepting the fact she had a disease over which she was powerless opened the door for Larson to forgive herself. She also had to come to terms with her daughter during the semimonthly family days. Her daughter had been hurt by Larson’s irresponsibility and lies and they talked about Larson’s suicide attempts. “It was hard to hear,” Larson says. “I cried a lot, but it made me want to make things right.”

gambling, casinos

Residential treatment is expensive, costing $7,500 for the average 30-day stay at Vanguard (though it is far below the $36,500 cost of a 30-day stay at Hazelden). Health insurance usually does not cover treatment because gambling addiction is not recognized as a treatable condition under the provisions of Obamacare, which is another example of lagging public awareness. Most individuals arrive at treatment destitute—losing everything financially spurred them to seek help—so they can’t afford to pay. 

On average, patients contribute about $900 out of pocket and the state of Minnesota picks up the tab for the majority of treatment costs with a portion of gambling profits from casinos, racetracks, pull tabs, and the lottery earmarked for prevention, education, and treatment. Last year, under the purview of the Department of Human Services, the state gave about a million dollars to Vanguard, outpatient programs, and private therapists who treat gambling addiction. 

“We want people to know that there is treatment available and that it is effective,” says Catherine Perrault, executive director of Northstar Problem Gambling Alliance, a nonprofit funded by the DHS to provide awareness and train addiction therapists.

Larson hasnt been back to Mystic Lake since her three-day binge in 2012 and has been abstinent from gambling for three and a half years. Since completing the program at Vanguard, she has lived at Crossroads, a halfway house in Minneapolis for people in recovery from various addictions. She is once again employed in a dental lab and enjoys spending time with her daughter and her granddaughter.

Larson now finds comfort not at the casinos but in the company of others who share her experience. In three and a half years, she has missed her Tuesday evening 12-step meeting only twice. “It’s magical to be in a room with people who have all been there and understand,” she says. “It’s even more rewarding to see a sponsee go from her worst self to her best self and keep going when, like me, she shouldn’t even be alive.”

*As a member of an anonymous 12-step recovery group, Larson requested that we not use her real name.

Problem Gambling Resources

  • Project Turnabout’s Vanguard Compulsive Gambling Treatment Program: or call 1-800-862-1453
  • The Northstar Problem Gambling Alliance, the Minnesota affiliate to the National Council on Problem Gambling:
  • Gamblers Anonymous: Locate a meeting near you by visiting or calling 1-855-222-5542
  • Minnesota Department of Human Resources gambling help: visit or call 1-800-333-HOPE