One year after the first slots casino opened in Pennsylvania, the state has yet to provide a dollar for treatment of problem gamblers, and it is at least a half-year away from doing so.

While some therapists are impatient for the state to begin funding treatment, many in the compulsive gambling field say there's little evidence yet of additional problems emerging from slots addicts. The pathological gamblers' money is certainly among the more than $900 million lost by players at the six casinos that have opened since last November, but they have yet to show up with any significance in the social service or criminal justice system.

That includes Western Pennsylvania, where Presque Isle Downs & Casino opened in Erie County in February and Washington County's Meadows Racetrack & Casino opened the closest slots parlor to Pittsburgh in June. The latter has been so successful that its officials obtained permission last week to add 78 high-stakes machines.

"I would have thought that the Meadows would have had a greater impact than it has" on the number of problem gamblers seeking help, said Norm B., local spokesman for Gamblers Anonymous, which operates the same 14 weekly meetings in Western Pennsylvania as it did a year ago. They draw about 225 to 250 people, which he said is perhaps a 10 percent increase over the past year but not all due to slots.

"Fortunately, the majority of people do it as entertainment and don't get carried away. Maybe the ones creating a problem don't reach out to us first for help," said Norm, who like other GA attendees, keeps his last name confidential. He said he knows of one participant, in a group he attends, who admitted stealing from an employer to fund slots play at the Meadows and other casinos.

Researchers have generally placed the number of compulsive gamblers in the range of 1 percent to 3 percent of the population, and noted that those playing slots become addicted at a faster rate than other types of gamblers. The rate of addiction can double when new access to legal gambling is created, such as a casino opening nearby. Still, it is usually a year or more before the addictions become noticeable through financial losses or other troubles.

The lack of evidence of immediate problems has influenced the Pennsylvania Department of Health's approach to using $1.5 million in annual new funding to address problem gambling issues. Only $205,000 has been spent so far, said Robin Rothermel, acting director of the Bureau of Drug and Alcohol Programs, and that has been mostly for training of future gambling counselors and to set up a hot line that has been minimally advertised and used.

Most of the remaining money will be added to new funding next year of treatment services, once the state establishes a system of service providers with gambling-certified counselors and determines how they will be reimbursed. Ms. Rothermel said it will probably be March before agencies and individuals can apply to be part of that system, and July before the state begins covering outpatient therapy for those unable to pay for it themselves.

The health department had discretion to use the $1.5 million annual funding as it deemed appropriate for awareness, education, training and treatment, and it has chosen to hold most of that for treatment without any sense of urgency.

"We have not formally surveyed the counties, but we have not received from them anything suggesting that since the casinos opened, they see a big increase in the people they serve reporting gambling problems," Ms. Rothermel said.

The department has begun adding gambling questions to annual surveys it conducts of Pennsylvanians' health issues, in hoping to assess the extent of problems related to the casinos, but no results from those are yet available.

The Pennsylvania Gaming Control Board has registered 146 compulsive gamblers on a voluntary self-exclusion list, where they acknowledge their problem to the extent they're willing to be cited for trespassing if they attempt to enter any casino. Two of those individuals have since been caught at casinos: one while attempting to enter and the other while trying to cash in winnings after playing, board officials said.

In general, casinos have done a good job of training employees to look out for compulsive gamblers and in advertising how people with problems can obtain help, said Nanette Horner, the state board's director of compulsive and problem gambling.

"I am certain that more people know where to go for help today than they did a year ago," Ms. Horner said.

Questions have arisen, however, over the state's adoption of a new gambling problem hot line different from services provided for years by the Council on Compulsive Gambling of Pennsylvania. All of the Pennsylvania casinos and racetracks, as well as the Pennsylvania Lottery, advertise either 1-800-GAMBLER, or 1-800-848-1880, both of which connect to the council's services. Callers are directed to help in their area, such as GA meetings or treatment specialists.

Council Executive Director Jim Pappas said his office receives about 140 "crisis" calls a month, from people with real gambling problems, from among more than 1,000 calls of all kinds. The number of casino-related calls received is two to three times higher than at the start of the year.

A separate 24-hour hot line, 1-877-525-2112, was set up by the state in July through a contractor it is paying $102,000 over three years, Ms. Rothermel said. There are only four treatment calls a month coming to that line, she said, but she expects that to increase the longer it is established. She said the state wants to have control of the number, instead of using the same number as the private, nonprofit compulsive gambling council.

The health department's use of a separate, little-used hot line drew puzzled questioning and suggestions of unnecessary duplication from lawmakers at a Nov. 1 meeting of the state House Gambling Oversight Committee. In general, however, the state has done well with the amount of attention to problem gambling in the short time casinos have been operating compared to other states, said Rep. Chris Sainato, D-Lawrence, a committee member.

Meanwhile, the number of counselors in Pennsylvania obtaining gambling-specific training continues to increase, in anticipation of offering more treatment when it's reimbursable by the state. But that issue also has caused debate.

Ms. Rothermel said 103 people who were certified in other counseling, such as substance abuse or mental health, have taken 30 hours of gambling course work to become recognized by the Pennsylvania Certification Board to treat gambling. She said the state will qualify them for treatment reimbursement the same as people certified by the National Council on Problem Gambling, which requires additional completion of a written exam and a period of supervision of counselors' clinical work.

Only six Pennsylvanians are known to have National Council on Problem Gambling certification, and some in the field believe the state should be applying those more rigorous requirements to all therapists.

"We believe the problem gamblers and their families in Pennsylvania are entitled to competent clinical care and we insist that those delivering such care provide evidence of such competence," said Joanna Franklin, a Pennsylvania council staffer who has coordinated training for the National Council on Problem Gambling.

"I am not sure why our problem gamblers are not entitled to the same reassurances of competent care as other addicts or mental health clients," she said in written testimony to the House committee, in which she also suggested the health department has been too slow to release treatment funds.

One of those who obtained national council certification this year is Jody Bechtold, a part-time therapist in Mt. Lebanon and University of Pittsburgh School of Social Work coordinator who is setting up a gambling certification program that will start training counselors at the school in February.

She and Lisbeth Mihok, a counselor at Turning Point II in Washington, Pa., who also obtained national certification, said they have yet to see any increase in clients resulting directly from Pennsylvania's new casinos, but they expect that to change as the state begins reimbursing for gambling-specific services. They say their clients' gambling therapy is only covered by private insurers, in most cases, during simultaneous treatment of related disorders such as drug and alcohol abuse.

"It's not a lot yet [seeking gambling help], but nobody knows how to get the treatment," Ms. Mihok said. "It's going to grow definitely once they have money for treatment."