LAS VEGAS – Problem gambling, or when a person can’t control their urge to gamble even when it starts to harm their life, reaches far beyond the biggest gaming destinations throughout Nevada. Yet the availability of services certified to treat compulsive gambling in rural parts of the state are a drop in the bucket.

Lyon County is located in the southwest region of the state and consists mostly of a desert landscape sprinkled with suburban and rural communities that are home to over 63,000 people.

It is the third most populous county in the state, but remains 40 times less populated than Clark County, the home to Las Vegas and Henderson. The majority of the county’s land remains a dusty desert, with highways and state routes connecting each of the communities.

Lyon County’s biggest city, Fernley, sits about a half-hour drive from Reno with a fair selection of entertainment options: a golf club, bowling alley, public pool, multiple parks, an off-road racetrack and, of course, a few casinos.

However, not all of the Lyon County cities and towns have those luxuries.

“If you look at Yerington, Silver Springs, what is there to do?” asked Rural Nevada Counseling Executive Director Josh Cabral about the county’s fourth and third largest cities, both south of Fernley. “You can go to a casino. There’s no movie theater, there’s no place to go play pool, there’s no public pool, there’s no some place that you can go and do something healthy.”

Even those casinos are not exactly like the ones you might find on the Las Vegas Strip, but are “hole-in-the-wall type casinos,” Cabral said. They typically offer slot machines and sports betting but not table card games because “they wouldn’t staff them like they would a big casino.”

Nevada offers more than 150,000 slot machines at over 2,400 locations. About half of those licenses are in the Las Vegas area, while the remaining licenses are spread across the state, with large numbers in bigger cities like Reno, Sparks and Carson City.

Hundreds of others remain scattered across smaller and more rural cities like those in northern Nevada, including Carlin, Crescent Valley and Winnemucca, or some in the state’s southeastern region, like Beatty, Amargosa Valley and Tonopah.

While slot machines are everywhere – from gas stations and grocery stores to hotels and bars – counseling services for those who struggle with gambling addiction are scarce, and vast deserts leave more challenges for people without reliable transportation.

Cabral leads a nonprofit that offers mental health services to residents of Lyon County, with four locations in Fernley, Silver Springs, Yerington and Dayton. Staff screen each person they serve for compulsive gambling.

“Therapists don’t grow on trees,” Cabral said. “If you look at our Yerington office, that’s our hardest office to staff. It’s literally on the way to nowhere, like you have to go out of your way to find it.”

Yerington, a city of 3,000 people located 80 miles east of Lake Tahoe’s eastern shore and in the center of Lyon County, is surrounded by farmland and desert shrubs and sits along the Walker River.

“I’ve paid people thousands and thousands of dollars to move here,” Cabral said. “I’ve done hiring bonuses and moving incentives and different things to try to get people here, and that’s worked a little bit, but I would say recruitment of good staff is very difficult in rural communities.”

Moving to a rural community doesn’t solve the challenges of treating problem gambling, especially for out-of-state professionals, because Nevada law has special requirements for treating gambling disorder.

There are two types of health professionals who can treat gambling addiction: Certified problem gambling counselors and other qualified mental health professionals. Both groups are required to have problem gambling or addiction in their scope of practice, according to Nevada state law.

Certified problem gambling counselors are required to have a much higher understanding of gambling disorder than anyone else legally allowed to treat it.

This type of counselor must complete 50 work weeks of supervised clinical hours, prove the completion of a 60-hour training specific to problem gambling, successfully pass a written exam and have their application approved by the Board of Examiners for Alcohol, Drug & Gambling Counselors, according to Jesse Stone, a spokesperson for the Nevada Department of Health and Human Services’ Division of Public and Behavioral Health.

The second group, which includes specialists such as clinical professional counselors, marriage and family therapists and licensed clinical social workers, are not required to have the same amount of gambling-specific experience or knowledge.

“They may not have scope of competency,” said Dr. Adrienne Renwick, a teaching associate professor at University of Nevada, Reno’s School of Public Health who also worked as a counselor in rural Nevada for a decade.

“Just because you can doesn’t mean you should,” Renwick said. “They may not have taken any coursework in problem gambling, they may not know how to screen effectively or what best evidence practices are for treating problem gambling. So, even though they’re allowed to do it, it’s always recommended per code of ethics that you gain competency in some way, shape or form.”

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Faced with the demand for and shortage of professionals offering in-person support for gambling addiction, Cabral can’t afford to be too selective.

“What we have done with our clinicians, and I have a couple of them here, is if somebody has interest in treating, diagnosing, assessing gambling disorder, and they’re an MFT (marriage and family therapist) or CPC (clinical professional counselor) or one of those master’s level mental health people, I have them go do a 30-hour training,” Cabral said.

Many of them do not get in-depth training treating problem gambling as a part of completing their programs, according to Renwick.

“I think many behavioral health programs or programs that train behavioral health clinicians don’t focus on training them to recognize and treat addiction, and so maybe in an urban area that’s OK, because you have somebody who you can refer to,” Renwick said. “In a rural area where there might just be one clinician for hundreds of miles, it’s really important to have somebody train competently in all of those areas, because you may not have the benefit of a referral.”

The Clinical Problem Gambling Internship Program at UNR’s School of Public Health, run by Renwick and Jennifer Ross, a certified problem gambling counselor, aims to expand the workforce and provide students with proper education and licensure.

Renwick and Ross sent out a survey to all MFTs and CPCs with licenses under the state board and received 506 responses. About one-fourth of those people “considered themselves in rural or frontier communities,” Ross said. “If that tells you anything, there’s a definite deficit.”

Students in the internship program take required classes with financial assistance from the American Rescue Plan Act. Afterward, they are paired with a clinical supervisor and a site through a paid internship.

“While they’re doing those educational requirements, we are also getting them licensed with the board in addiction work so that they can begin essentially concurrently counting their hours towards their student internship, but then also state licensure to help speed the process up and then produce more addiction counselors in Nevada,” Renwick said.

On the other side of the state, the University of Nevada, Las Vegas is also working to start a similar program that trains more problem gambling-competent professionals, according to Shane Kraus, an associate professor of psychology at UNLV.

“This is our mission for the next two years,” Kraus said. “We need to offer the programs that are free and available for mental health clinicians to come back to get certified in gambling.”