Editor’s note: This op-ed from Kathleen Scanlan and Howard Shaffer is part of our Special Series on Community Approaches to Addiction.
"The test of our progress is not whether we add more to the abundance of those who have much. It is whether we provide enough for those who have little." -- Franklin D. Roosevelt
A working history of community service organizations provides stakeholders with lessons about community networks, government activities, and the services that these programs provide. The Massachusetts Council on Compulsive Gambling (MCCG) is one program among many that provides a remarkable history that reflects that birth and early development of a field – addiction and gambling studies. It also reflects the shared vision of President Roosevelt and Tom Cummings.
Any history of the MCCG must begin with Tom Cummings and his vision for gambling services in the Commonwealth of Massachusetts. From the outset, Tom wanted the state to establish a position at the Department of Public Health that was dedicated to gambling and its sequelae. Tom was focused on gambling, not the narrower compulsive or responsible gambling.
Tom Cummings began to provide support services for those who needed it and for those lucky enough to find Tom. After all, the roots of the MCCG were established in Tom’s kitchen during the 1970s. While Tom was building his vision for statewide services and helping those who reached out to him, Howard Shaffer was persuading his co-directors of the Harvard Medical School based continuing education course, Treating the Addictions, to broaden the notion of addiction to include gambling.
When Shaffer’s colleagues asked him to find a gambling expert, the path led to Tom Cummings. After a brief meeting, Tom declined to speak at the conference because he thought that an invitation to Dr. Robert Custer – considered the father of the gambling field – was a more appropriate speaker for a medical school conference. True to his form, Tom declined the spotlight and preferred a team-oriented approach that enlisted people of every stripe. These Cummings recruits supported the MCCG and carried his message of advocacy and compassion.
During the early '80s, Custer spoke at the Harvard conference and Tom was recovering from his gambling problems. Tom was an attendee at the conference and noticed that the book table was incomplete. All the books for sale were on the topic of substance use disorders. Tom asked Howard, “Where are the books about gambling problems?” These events began a long relationship, partnership, and collaboration with Howard and Harvard Medical School’s Norman E. Zinberg Center for Addiction Studies, and later the Division on Addiction.
By 1983, Tom and a dedicated group of his friends and colleagues who had also experienced gambling-related problems established the MCCG as a non-profit organization. These founders established the group’s goal, vision, and dream: provide help available for people struggling with gambling and assure that there would be a place for them to go to seek that help – just as there are resources for people struggling with other expressions of addiction.
After a donation from Steve Wynn primed the budget, Tom and his volunteer MCCG recruits made their case to the Massachusetts Legislature and, in 1987, Governor Michael Dukakis signed bi-partisan legislation to provide the necessary funding for problem gambling services in Massachusetts. This funding was tied to Lottery funds at the suggestion of the Lottery Director, Jim Hosker. Tom’s success clearly was connected to his understanding of the importance of partnerships and collaborations. Tom was charismatic as he enlisted an ever-expanding group to achieve his vision of gambling services. From its early days, this funding allowed limited staffing. Tom served as the first MCCG executive director. Kathleen Scanlan was the first program director and Dorothy Corbeil was the first MCCG administrator. After Tom’s untimely death in 1998, Kathy became the second MCCG executive director. Howard Shaffer provided consulting and triage services for the MCCG and many of those who sought evaluation and treatment. The MCCG was born with and nourished by these staff for several years. The success of these founders rested on a commitment to community partnerships and professional collaborations. Under her watch, the Council thrived and became a sanctuary for people struggling with gambling and its many adverse consequences. She continued to develop Cumming’s vision of establishing statewide gambling-related services.
The collaborations between the Norman E. Zinberg Center for Addiction Studies were fruitful and influential as a nascent field was emerging. MCCG and the Zinberg Center picked up where Tom had been interrupted. These organizations collaborated to establish a variety of activities and resources, including a self-help toolkit; a Task Force on College Gambling Policies; a tool to screen for problem gambling among adolescents, and scientific studies of the awareness and prevalence of gambling problems.
Further, the MCCG and the Zinberg Center established the first National Think Tank at Harvard University, June 3-4, 1988. This event led to a seminal publication, Compulsive Gambling: Theory, Research and Practice. After the publication of this book, stakeholder networks grew, and Massachusetts established its first gambling treatment programs. As momentum grew, the Zinberg Center and the MCCG convened a second think tank focusing on the first framework for action about gambling. These early events marked the beginning of a long-standing relationship between Cummings, Scanlan, and Shaffer who guided the MCCG through almost 30 years of development.
It was not always easy to advance the MCCG and its interests. There was a period when attention for gambling-related problems was languishing. As a result, Cummings, Scanlan and Shaffer began to focus on adolescent gambling and its many associated concerns. This led to a flood of national interest, appearances on local and national television (e.g., 20/20; NPR; NBC Nightly News, and others) and related research focusing on adolescents.
During this time, the MCCG and the Massachusetts Department of Public Health (DPH) coordinated purposes and programs. Scanlan conceptualized and established the Massachusetts Partnership for Responsible Gambling. The purpose of this group was to develop responsible gambling protocols and programs in collaboration with gambling industry executives. During this time, the MCCG and DPH worked to include and integrate problem gambling services into DPH/Bureau of Substance Abuse Services activities. Finally, after many years, the Cummings DPH dream was emerging: DPH was integrating gambling services into its statewide system with the addition of 13 treatment programs state-wide.
Then, after almost 15 years of discussions, the Massachusetts Legislature considered expanding gambling to include casino gambling. During these deliberations, the MCCG and others advocated for legislation that would assure public health services for gamblers. In 2011, the Massachusetts Gambling Act provided funding that would enable a full range of prevention, intervention, and treatment and recovery services for gambling problems with DPH structure and staffing. This development encouraged DPH to create the Office of Problem Gambling Services, with a staff person dedicated to gambling and its many public health issues. The potential for Tom’s vision was becoming reality and the architecture was finally in place! Now, with the creation of the DPH office for gambling services and 40 statewide Department of Public Health sponsored outpatient gambling treatment centers, Tom’s original vision has come to fruition.
Currently, through the office of gambling services at DPH, these 40 treatment centers serve as a centerpiece for gambling services throughout the Commonwealth. Tom’s dream lives on through these programs and Massachusetts is one of the healthiest states in America.
Dr. Howard J. Shaffer is the Morris E. Chafetz Associate Professor of Psychiatry in the Field of Behavioral Sciences at Harvard Medical School, and Distinguished Faculty at the Cambridge Health Alliance Division on Addiction. He has served as principal or co-principal investigator on a variety of government, state, non-profit/foundation, and corporate sponsored research projects. His work focuses on addiction-related clinical, research and educational activities. Dr. Shaffer served as a member of the Committee on the Social and Economic Impact of Pathological Gambling for the National Academy of Sciences, National Research Council. He is the past editor of the Psychology of Addictive Behaviors, the past editor of The Journal of Gambling Studies, and the past associate editor of The Journal of Substance Abuse Treatment. Dr. Shaffer also is a member of numerous editorial boards. His newest books include the APA Addiction Syndrome Handbook (2012), Change Your Gambling, Change Your Life (2012), and Responsible Gambling: Primary Stakeholder Perspectives (2019). In addition to active clinical practice, Dr. Shaffer has written extensively about the treatment of addictive behaviors and the nature of addiction, including more than 250 journal articles, chapters, and reviews. He also has published more than 120 newspaper articles, and 22 books or monographs. His research, writing, and teaching have shaped how the health care field conceptualizes and treats the full range of addictive behaviors. Dr. Shaffer has received many awards, including the 1998 Thomas N. Cummings Leadership Award for Vision, Courage and Dedication in the Field of Compulsive Gambling.
Kathleen M. Scanlan, M.A. has more than 30 years of experience leading the field of problem gambling. She served at the Massachusetts Council on Compulsive Gambling for 27 years, beginning in 1987 as Program Director. Ms. Scanlan became the Mass. Council’s Executive Director in 1998 and held that position until 2011. After transitioning from that position, Ms. Scanlan remained with the Mass. Council through 2013 as Senior Advisor for Special Projects. From July 2014 to September 2019 she served as Executive Director of the Association of Problem Gambling Service Administrators (APGSA), a national membership organization of the state administrators of public funds and services for problem gambling. Kathleen was honored by the New England Collaborative on Problem Gambling in 2002 as the recipient of the Thomas N. Cummings Award for Vision, Courage, and Leadership in the Field of Problem Gambling, and by the National Council on Problem Gambling in 2011 for the Msgr. Dunne Lifetime Achievement Award for Advocacy (previously the Goldman Award). Ms. Scanlan served as a Board member of the New Hampshire Council on Problem Gambling and continues to serve on the board of the International Center for Responsible Gaming. She received her MA degree from Boston College, and an undergraduate degree from the College of St. Rose, in Albany, New York.
During the past 5 years, Kathleen Scanlan has received compensation for her work as the Executive Director of the Association of Problem Gambling Service Administrators, a non-profit group that seeks to organize and unify the work of publicly funded problem gambling services. She did not receive any compensation to prepare this op-ed.
Howard Shaffer and the Division on Addiction have received funding from a variety of sources, including the Foundation for Advancing Alcohol Responsibility, The Healing Lodge of the Seven Nations via the National Institutes of Health (NIH) and Indian Health Services (IHS), the Integrated Centre on Addiction Prevention and Treatment of the Tung Wah Group of Hospitals, which receives funding from The Hong Kong Jockey Club Charities Trust, DraftKings, the Massachusetts Gaming Commission, GVC Holdings PLC, and the Massachusetts Department of Public Health. In addition, during approximately the past 5 years, Shaffer or the Division on Addiction received funding from the National Center for Responsible Gambling, National Institutes of Health, the Alcohol Beverage Management Research Fund, the Danish Council for Independent Research, Heineken USA, Inc., bwin.party, St. Francis House, the State of Florida (i.e., as a subcontract to Spectrum Gaming Group), the Massachusetts Residential Substance Abuse Treatment for State Prisoners Grant Program (i.e., as a subcontracted evaluator for Worcester House of Corrections), and the Massachusetts Juvenile Accountability Block Grant Program — as a subcontracted evaluator for Cambridge Police Department. Dr. Shaffer also has received speaker honoraria and compensation for consultation from the American Psychological Association, Las Vegas Sands Corp., Davies Ward Phillips and Vineberg, LLP, Freshfields Bruckhaus Deringer, LLP, and from the Dunes of Easthampton, a residential addiction treatment program, for serving as a consultant. As a member of the International Working Group on Responsible Gambling, he did not receive any honorarium.