Pennsylvania has begun opening its slot machine parlors before it has a plan for how to treat the compulsive gamblers expected to latch onto them, risking an array of financial and personal problems.

"There's no way we can respond to this obvious disaster," James Allen, administrator of Allegheny County's Bureau of Drug and Alcohol Services, warned a group at the University of Pittsburgh's School of Social Work last week.

His comments came one day after the machines began taking money at the state's first slots casino, Mohegan Sun at Pocono Downs racetrack near Wilkes-Barre. In the first week, customers who filled a temporary casino lost a combined $4 million, which is the same as the gross revenue divided among the slots operator and state and local governments.

Industry and government officials appeared elated at the popularity of the first 1,096 slot machines in a state expected to have 30,000 to 40,000 of them within a couple of years, generating as much as $3 billion in annual revenue.

If Pennsylvania's slots experience correlates with national studies of problem gambling, at least 95 percent of the slots patrons will treat their gambling funds as an entertainment expense, playing within their means and not disrupting their lives.

But in creating a minimum $1.5 million annual fund to address compulsive gambling, state officials acknowledged the need to assist the one out of 100 individuals considered by researchers to be "pathological," and the other 2 percent to 4 percent considered problem gamblers at risk for that disease.

The problem, according to Mr. Allen and others in the addictions field, is that the state funds won't be available until a year from now. The state's slots law dictated that sufficient gambling revenue be collected before funds are released for the education, treatment and research programs.

In the meantime, Pennsylvania has few counselors certified to treat gambling addiction. And if someone admitting an addiction is lucky enough to find a therapist with gambling expertise, there is no government assistance -- and rare third-party insurance coverage -- to cover its cost.

Since many compulsive gamblers admit their problem only after they go broke, they're often in no position to pay for therapy themselves.

How big a problem?

"Because people will come [to the slots parlors] and have those problems, there is a sense of urgency for us," Mr. Allen said. "We want to be able to provide treatment for them, and right now, we're sort of in the position of, 'Let's wait and see how bad it really gets, and then develop a system based on what we actually see.' "

Officials from the Pennsylvania Department of Health and the Pennsylvania Gaming Control Board, the two agencies planning how to address problem gambling, maintain that necessary help will be in place despite the lack of immediate funds or professional treatment options.

The casinos themselves that have been enlisted to distribute information on problem gambling have shown they are prepared to help address such issues, according to Nanette Horner, the gaming board's director of compulsive and problem gaming enforcement.

Prior to opening, she said, the Mohegan Sun had to demonstrate it had trained employees about compulsive gambling and would post prominent signs and distribute brochures advising customers how to detect addiction and get help for it. Other casinos will be required to do the same before opening.

"We would be remiss if we allowed any facility to open without having this program in place," Ms. Horner said. "As each facility opens, they will have to receive approval of their [compulsive gambling] plan, their training procedures and their training materials."

The law requires the Pennsylvania Department of Health to establish a toll-free hotline to handle problem gambling questions and referrals. Since that is not in place yet, the Mohegan Sun is advertising the services of the private Council on Compulsive Gambling of Pennsylvania, at 800-848-1880.

Among other things, the Philadelphia-based council directs people toward Gamblers Anonymous meetings, including the 13 held on a weekly basis in Western Pennsylvania to assist some 200 individuals.

Norm B., a local spokesman for GA (the organization's members do not publicize their surnames), said that based on experience in other states that legalized casinos, "there is going to be increased demand for what we do and offer, but where and when, we don't know."

Mohegan Sun spokesman Jim Wise said brochures educating customers about addictive behavior and advertisements for the council's helpline are provided throughout the casino at entrances, at ATM machines, cashier windows and elsewhere. Admitted compulsive gamblers may also sign up for a statewide self-exclusion list to be barred from casinos.

While the casino's staff is educated on compulsive gambling as part of its training, employees are instructed to react to requests for information rather than approach players about it, Mr. Wise said.

"It's challenging to tell who is in need of assistance," he said. "You would have to be extremely careful with how you would broach that with a customer. You're treading on dangerous ground."

Gene Boyle, director of the state Health Department's Bureau of Drug and Alcohol Programs, which will begin handling gambling addiction as well, said that officials are discussing ways to begin addressing necessary issues without yet obtaining specific funds.

(The $1.5 million in annual program funding is a minimum. If the gross revenue from slots exceeds $1.5 billion, the amount in the compulsive treatment fund will equal $1 million for every $1 billion in the fund -- in other words, $3 million if the $3 billion state goal for revenue is reached.)

Shortage of counselors

Mr. Boyle expects an official hotline and referral service to be in place within several months, either by expanding existing hotline services within the state Health Department or contracting with the Council on Compulsive Gambling. The council lacks funding to staff its phone at all times, instead of using a recording.

Also, a state training program is being developed to certify those private counselors who want expertise in gambling treatment. Mr. Boyle said the state should probably have 400 such individuals once all 14 slot parlors are operating, and it doesn't even have one-tenth of that number now.

In a review of two national certification programs, it's not clear that anyone is certified in Western Pennsylvania. The Pennsylvania Council on Compulsive Gambling says it has referred Pittsburgh-area callers seeking treatment beyond Gamblers Anonymous to either Gateway Rehabilitation Center or Persoma PC, but officials of those agencies said they have no one on staff with special gambling training.

"Right now we are not in this line of work, and our intention is not to become a gambling treatment center," said Jim Aiello, Gateway's executive vice president of treatment programs. "There's no money for it. Unless we get some kind of grant, or this money floats down from the state, we can't just treat people with a gambling disorder" without compensation.

Mr. Boyle said state officials are devising their plan for how to help subsidize treatment services. It apparently will be at least a year before that begins, based on the need for funds, and it's unclear just who will be eligible for funding and how much it will cost.

At this time, the state is not headed toward anything approaching the comprehensive treatment services covered by two states considered models in the field, Louisiana and Oregon.

Both of those states, though smaller than Pennsylvania, dedicate more funding for problem gambling -- $4.65 million in Oregon and $2.5 million in Louisiana -- and fully subsidize both outpatient and inpatient costs of any residents requiring therapy. They have state-supported residential centers for monthlong treatment, if necessary.

No special facilities

No similar gambling-specific facilities exist in Pennsylvania, officials say. The Keystone Center in Chester, Delaware County, typically has one or two of its 26 beds occupied by a compulsive gambler referred to its intensive addiction program. They are treated alongside drug and alcohol users rather than separately, said program coordinator Deborah Voluck.

The Veterans Administration medical center in Brecksville, Ohio, south of Cleveland, has one of the leading residential programs for treating hard-core gamblers, but it is open only to qualifying military veterans.

Mr. Boyle said it is too early to say the extent to which Pennsylvania might need such programs, but, "I'm going to assume they're going to have to be developed along the way."

He said it's unclear as yet how those will be developed and funded. The health department will contract for a state-specific prevalence study of compulsive gambling to help determine needs, Mr. Boyle said.

And at some point, officials will determine how far the state's $1.5 million -- or more, if gamblers lose more than $1.5 billion a year -- will go in terms of meeting needs. A legislative proposal this fall to increase that amount to at least $4 million failed to win passage.

"Obviously, we need to look at the numbers, and as numbers increase, if they do, we need to be looking for additional money to pay for those services," Mr. Boyle said.