James is a recovering heroin user and alcoholic trying to free himself from an addiction to slot machines. He's driven to the machines to escape other problems, with the spin of the reels subbing for the substances in which he used to lose himself.

Mark is an "action" rather than "escape" gambler, knowledgeable about sports but mistakenly thinking he can profit by betting on them. Instead, at age 41 he's lost everything he's owned. He admitted to his parents recently that he had pilfered one of their checks, forged a signature and almost cashed it for $1,500 to indulge his gambling.

They're two Western Pennsylvania men, their identities protected because of personal shame and social stigma, who are among the 1 percent of Americans believed to be pathological gamblers. They're both in private therapy, receiving state-paid treatment in a new government program that has accompanied -- though at a trailing distance -- Pennsylvania's legalization of casinos.

How much the counseling helps long term, it's hard yet to say.

"I haven't been to [a casino] in a month, but I'm not cured," James said in the Cranberry office of Brent Olean, a licensed social worker who obtained special training to treat gamblers.

"I'm not anywhere near cured ... I'd love to put a shock collar on that would just go off when I'm within 50 feet of a casino."

Excessive gambling has taken place in the Pittsburgh region since the French and British arrived three centuries ago, and perhaps before them with the Indians. But the issue has moved into the spotlight with last month's opening of the Rivers Casino on the North Shore.

Studies have found that the closer you live to a casino, the more likely you are to be a compulsive gambler. A number of researchers also believe slots hook people more than any other form of gambling, because of the pace, sensory stimulation and tantalizing near-misses that flash so often on the screen.

If those findings prove true in Pennsylvania, the state is headed for a significant rise in bankruptcies, crime, domestic strife and other ills associated with an addiction that is often hidden until lives are ruined.

State officials are counting on a newly state-funded treatment system to assist the likes of James and Mark. It was created within the same bureau that oversees drug and alcohol treatment, because of the similarity among the addictions. Pennsylvania's leaders believe the government revenue and jobs created by the casino more than compensate for whatever additional lives are shattered.

They may be right, but it's a gamble -- a poor one for, at the very least, thousands of gambling addicts across the state.

It will take much longer than 28 days for the Rivers Casino's 3,000 slot machines to turn anyone into an addict who wasn't one before, according to gambling treatment experts. But after many months or perhaps years, they say a spike in addicts is inevitable.

"It's going to make a tremendous difference because [previous] opportunities are not as accessible and convenient as a local slots parlor," said Bob Breen, director of the Rhode Island Gambling Treatment Program. "That really makes a tremendous difference when it's close to home and very easy and convenient for people."

John Welte, a State University College at Buffalo researcher, found in a national survey that people living within 10 miles of a casino have twice the rate of gambling problems as other adults. He said it paralleled another broad study, used by a national commission on gambling a decade ago, finding the rate double within 50 miles of a casino.

Despite such data, it is hard to find much tangible evidence of harm yet from the arrival starting in November 2006 of Pennsylvania's casinos.

In southwestern Pennsylvania, where The Meadows Racetrack & Casino began attracting thousands of slots players every day 27 months ago, Gamblers Anonymous has not increased its number of meetings. There have been no reports of high-profile cases of embezzlement or other crimes due to gambling addiction at The Meadows.

The clinicians who have joined the Pennsylvania Health Department's year-old program providing reimbursement for gambling treatment have seen a trickle of clients, not a flood.

The number of gambling patients -- family members also are eligible for paid treatment -- is fewer than 50 statewide since October. If you're a gambling addict, odds are greater that you could successfully pick the 1,000-to-1 Pennsylvania Lottery number tonight than that you're part of the state's treatment system.

That's because there are an estimated 90,000 adult pathological gamblers in the state, (1 percent of the number of Pennsylvanians age 21 and older). An additional 2 percent or more are deemed "problem" gamblers, meaning they're not yet out of control but have shown the potential to become so.

Various factors are cited for the lack of people seeking treatment, including the state's failure to advertise its availability. But also, gambling addictions typically take many months or even years to become apparent.

Unlike disorders such as alcoholism and drug addiction, pathological gambling has no physical signs. Its most tangible impact is the destruction of finances over time, eroding bank accounts, enlarging credit card debt, ensnaring the person in unpayable personal loans or worse. It gnaws at the psyche, causing depression, a cycle of lies and lost productivity.

Typically, only upon some financial crisis does the compulsion become exposed, as well as the extent of its damage. And only then is any help sought, often because gamblers are forced into it when confronted by wronged family members.

Researchers have estimated only 3 percent of pathological gamblers seek professional treatment in a given year. Others join Gamblers Anonymous, which holds weekly meetings in different communities, to seek peer support by swapping stories of personal pain and redemption. Even more people quit gambling -- or get it under control -- on their own, research suggests.

Just why its course is so different for so many is one of its mysteries, but professionals who study and treat problem gambling stress that it is every bit the addiction that alcoholism and drug abuse are.

Compulsive gamblers' brains have been shown to react in a manner similar to those taking drugs. When there's a win, a sense of euphoria comes from dopamine release in the brain's pleasure center, the nucleus accumbens, explains Louis Weigele, director of behavioral health at the Free Clinic of Greater Cleveland and president of the Ohio Council on Problem Gambling.

Action gamblers such as Mark get the type of high provided by cocaine when they win, while escapists such as James get a numbing effect similar to morphine. Either way, more blood flows to their brain while they're playing, keeping them stimulated with the belief they can win. For whatever reason, others' minds aren't wired the same.

"Most people walk away eventually, but for the compulsive gamblers, the misplaced anticipation of their dopamine receptors become their downfall," Mr. Weigele explained at a National Council on Problem Gambling workshop.

Pathological gamblers show a higher percentage than normal of addiction in other family members. They also overlap with dependency on other substances.

Those with gambling problems are more than twice as likely as other people to be alcoholics or drug abusers, said Rani Desai, a Yale University associate professor of psychiatry and epidemiology. By an even larger margin, she said, they're more likely to suffer from depression, obsessive-compulsiveness and anti-social behavior.

But plenty of gambling addicts also have no family history or other addictions. Circumstances of exposure or random chance lead them into unstoppable behavior, even by someone like an ordinary aunt or neighbor who fills idle time in retirement years without having gambled before.

"It's sometimes the folks who have a big win in their first experience with gambling," noted Dennis McNeilly, a geriatric psychiatrist at the University of Nebraska Medical Center who was taken aback by the nature of patients who came in after a casino opened across the border in Iowa.

"A person can have that experience and get convinced on one level they can always go back to recapture that," he said. "That's a hallmark of a pathological gambler, a person who goes back to chase their losses."

At least 95 percent of players avoid over-indulging. That only makes it worse for addicts like James, who feels resentful looking around a casino and seeing other people able to enjoy themselves.

"I'm extremely jealous of people who can walk up to a machine, be happy winning a little, and then walk away," he explained. "I can't do that."

Mark agreed: "The big difference between gambling and compulsive gambling is if I win $500, I can't walk away with that. I've got to turn it into $1,000, because I can't be happy with the $500."

Unlike with alcohol or drugs, there's no saturation point forcing the gambler to stop after indulging so much at one sitting. James has played the same slot machine for half a day, stayed in a casino for 40 straight hours. Time means nothing to a person who enters the trance or zone in which he sometimes finds himself, with most casinos omitting any clocks or natural light that remind customers of the time of day.

One of a compulsive gambler's difficulties, even if he wants to stop, is that legal forms of wagering have grown so much in recent decades without commensurate attention to the potential effects.

Some form of gambling is sanctioned in 48 states, totaling nearly $100 billion a year in revenue -- meaning players' losses -- for operators of casinos, lotteries, bingo halls, racetracks and more, according to a consulting firm, Christiansen Capital Advisors. And that figure does not include informal wagering among acquaintances or illegal forms through bookies, the Internet or other electronic machines.

When so many people participate in those without undermining their lives, it creates more stigma for those who can't control themselves. Many more people have indulged in a night of excessive drinking -- and so understand an alcoholic's temptation -- than have blown a paycheck inexplicably on a football wager or night of slots play.

A recent survey for the National Council on Problem Gambling showed 68 percent of Americans viewed compulsive gambling as mostly a matter of willpower, noted Don Feeney, research and planning director for the Minnesota State Lottery.

"It's something that happens to other people, not to people like me," is how most people see it, he said.

Less heightened public awareness of the gambling problem means far less money is spent on research and treatment of it than other addictions. That is partially justified because there are fewer gambling addicts than alcoholics or drug abusers. But it also leads to shallow efforts by governments to address a problem they help create in pursuit of revenue.

In Pennsylvania, the state's Gaming Control Board has actually received high marks from those inside and outside the casino industry for setting proper standards for what operators must do to recognize problem gambling. All casino employees must receive special training, for instance, and all marketing materials must include a phone number for obtaining compulsive gambling help.

The health department's Bureau of Drug and Alcohol Programs, meanwhile, has been criticized for taking too long and doing too little to educate Pennsylvanians about what problem gambling is and how to get help with it.

The 2004 slots law provided that from among the hundreds of millions of dollars lost each year by gamblers, at least $1.5 million annually should go to awareness, education and treatment of those who are compulsive.

The money has come into the fund, but hasn't gone out. Nearly three years after the first casino opened, the bureau has spent less than $400,000 related to gambling. State officials say they're holding back the unspent funds for treatment needs once the anticipated increase in problems becomes evident.