Brendan Saloner, PhD, is a Robert Wood Johnson Foundation Health & Society Scholar at the University of Pennsylvania. This post is part of the "Health Care in 2013" series.

New Year’s resolutions are about fresh starts and new beginnings, and for many Americans that includes the decision to finally give up heavy drug and alcohol use. Unfortunately, when it comes to encouraging individuals to enter treatment, providing counseling, and supporting long-term recovery, our health care system is showing up late to the party.

There are 21 million adults and adolescents with a diagnosable substance abuse problem in the United States, but fewer than one in five receive treatment in a given year. The reasons why people do not get treated are complicated. Many are not ready to give up using substances or don’t recognize they have a problem, but many others are discouraged from seeking treatment because of the cost or the perceived lack of treatment options. Opportunities to raise awareness about treatment are often missed, as primary care doctors infrequently screen for substance abuse during routine visits, and are often unaware of where to refer patients for specialized addiction treatment.

The Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative (INQRI) will host a webinar on November 28, where INQRI grantees will discuss their research and future implications of their work. This is the first in a new series of webinars from the program, Translating Research into Practice.

The webinar, which will be held from 12-1 p.m. EST, will feature project investigators Robin Newhouse, PhD, RN, NEA-BC, FAAN, and Bonnie Spring, PhD, discussing their research on nurse-led interventions to improve screening and treatment for substance abuse.

Register for the webinar.
Learn more about the research by Newhouse and Spring.

Natasha Dow Schüll, PhD, MA, is a cultural anthropologist and associate professor at the Massachusetts Institute of Technology's Program in Science, Technology and Society. She is an alumna of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program (2003-2005). Her recent book, Addiction by Design: Machine Gambling in Las Vegas, examines the ways that the gambling industry has designed gambling machines that encourage addiction.

Human Capital Blog: In your book, you describe how electronic gambling machines—the modern equivalent of slot machines—are designed in such a way that they encourage addiction. Tell us about that, please.

Natasha Dow Schüll: If you have never actually been in a Las Vegas casino and your idea of it comes from a James Bond movie, you'd be surprised by what you'd find. Of course they still have card games and roulette wheels, but most of the money casinos make is from electronic gambling machines, which are amazingly sophisticated versions of the classic three-reel slot machine. Every aspect of their design—the hardware, the software, the math, even the seating components—is carefully designed to keep players at the machine, playing game after game. Play is simple and amazingly fast—it takes only three to four seconds per spin. The machines are programmed so gamblers win every now and then, and they give audiovisual feedback to encourage them to continue. They induce players to gamble quickly and repeatedly, developing a sort of rhythmic flow that can sweep them away. Gamblers talk about getting into a "zone" where everything but the game just drops out of their awareness. After a while, they crave the zone itself, so it stops being about beating the machine and becomes instead about staying on the machine for as long as they can so they can be in that zone. They're addicted, and they develop all the behaviors of an addict as a result.

My point is that it's no accident; the machines are designed to drive the kinds of behavior—playing faster, longer, and more intensively—that turns gamblers into addicts.

RWJF Health & Society Scholars program alum (2003-2005) Natasha Schull, Ph.D., M.A., was interviewed by Lesley Stahl for the January 9, 2011 edition of “60 minutes” on CBS. Her topic: a new generation of slot machines that is contributing to gambling addiction. With gambling now legal in 38 states, the latest breed of slots relies on flashing lights, noises, rapid and multiple bets, and other stimuli to lull players into a trance-like state that Schull calls, “the zone.”

Schull is a cultural anthropology professor at MIT and a documentary filmmaker. She has recently finished a book based on her research in Las Vegas among compulsive gamblers and the designers of the slot machines they play. Addiction by Design: Machine Gambling in Las Vegas is scheduled for publication by Princeton University Press later this year.

Watch the 60 Minutes story.

For an overview of RWJF scholar and fellow opportunities, visit www.RWJFLeaders.org.