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A dozen people have gathered inside the Industrial Evangelistic Fellowship's modest community center in Macau, where the Rev. Jimmy Tan strums his guitar and belts out Christian songs with the small group before him. Latecomers trickle in well past the meeting's 9:30 p.m. start time, but no one seems to mind — many of them work multiple jobs and are used to odd hours. Seated in a semicircle of plastic chairs, the engineers, police officers, health-care workers and casino dealers have something in common: they are all addicted to gambling. The group meets once a week to hear Tan speak, and to share stories of angry spouses, loan sharks and backsliding. A young nurse who hadn't placed a bet in six months admits she relapsed four days earlier after a fight with her husband. "He wanted money in order to grant me a divorce," says the mother of two. She lost $515 playing baccarat. A well-dressed engineer says that he's considered kidnapping children for ransom in order to pay off $500,000 in gambling debts. Tan has heard these stories before. He listens patiently and delivers a PowerPoint presentation about coping with addiction. "Don't read the racing papers and don't carry too much cash," he warns. "And stay out of the casinos."

Easier said than done. To get home after they leave the meeting, the afflicted must run Macau's gauntlet of gambling resorts, their mesmerizing neon and ritzy, come-hither ambiance carefully calculated to encourage a fling at the tables. Temptation seems to be everywhere. Since the city began issuing new gaming licenses five years ago, the number of casinos has more than doubled to 27, boosting tourism and investment and revitalizing Macau's economy (the city's gaming industry took in $6.95 billion last year, vaulting Macau past Las Vegas as the city with the most total annual wagering revenue). But for a small proportion of Macanese like those at Tan's meeting, the gambling boom has been a curse that has fed their addiction. For habitual gamblers and those prone to developing the habit, "Macau is really dangerous nowadays," says Ava Chan, former counselor at the Yat On Pathological Gambler's Counselling Centre in Macau. "Next to your house, there are slot machines. Across the street, there are casinos. Society doesn't realize the problem. They just think: Economic growth, no problem."

But Asia does have a gambling problem — and because the industry is expanding rapidly throughout the region, mental-health workers and researchers fear pathological gambling could reach epidemic proportions in coming years. Macau's success has inspired other Asian cities and countries to allow new casinos. In Vietnam, a $4 billion luxury gaming resort will open near Ho Chi Minh City in 2009. Ground has already been broken for a pair of casino complexes in Singapore. The Philippine government is planning to open a 100-acre (405,000-square-meter) gaming complex that will employ 40,000 Filipinos in Manila Bay. In an attempt to lure Chinese gamblers over the border, Kazakhstan is creating the "Las Vegas of the steppe" in Kapchagai and Shchuchinsk. Governments in Taiwan, Thailand and Japan are considering legalizing casinos. According to Merrill Lynch, gaming companies are expected to spend $71 billion in Asia over the next four years alone.

It's impossible to predict how many Asians will become addicted as their access to gambling increases, but "there are going to be victims," says Rachel Volberg, a U.S.-based sociologist and an expert in gambling addiction. Volberg was one of the authors of a 1999 study examining the impact of gambling in the U.S. that found the presence of venues such as casinos and horse-racing tracks roughly doubles the incidence of problem and pathological gambling in the surrounding community within a range of 50 miles (80 km). Throughout the world, Volberg says, the introduction of gambling typically results in a three- to four-fold increase in addiction rates within the first five years.

What's especially worrisome to mental-health experts is that, because of gambling's roots in the region's culture, Asians may be more vulnerable to habitual gambling. The cliché that Asians, and Chinese in particular, love to gamble appears to have anecdotal and statistical support. Hong Kong — which bars casinos but has a $13 billion horse-racing, lottery and sports-book industry — has one of the highest per capita betting averages in the world (about $2,000 annually), according to figures from the Hong Kong Jockey Club. And rates of addiction appear to be higher. A 2004 study by psychiatrists at the University of Queensland found that Chinese were almost 50% more likely to develop a gambling addiction than Caucasians. In the U.S., about 3.5% of people are classified as pathological and problem gamblers (more than the number of people who suffer from bipolar disorder, Alzheimer's disease or schizophrenia). In Hong Kong, 5.3% of the population suffers from problem and pathological gambling, according to the University of Hong Kong.

Some reckon the higher rates are due to differing cultural standards. Although China's Communist Party once deemed gambling to be one of the "six evils" (along with illicit drugs, human trafficking, pornography, prostitution and superstition), Eastern religions such as Buddhism and Taoism don't strictly condemn gambling. "Gambling is seen as a morally recognized way of making money," says Peter Ong, chairman of the Tung Wah Group of Hospitals, which oversees Hong Kong's Even Centre gambling-addiction program. The American Psychiatric Association classifies pathological gambling as an "impulse control disorder," along with kleptomania and pyromania. But throughout Asia, it's considered harmless entertainment. Low-stakes mah-jongg tournaments are a fixture of practically every Chinese family gathering — even at funerals. "In Western culture, people go fishing and have other hobbies," says Elda Chan, a certified gambling counselor and supervisor of the Even Centre. "In Chinese culture, people go gambling."

One of those who succumbed was Hong Kong resident Chor-pat Wong, whose betting habit took him to Hong Kong's horse-racing tracks three times a week. By the time his wife left him in 2004, Wong had drained the couple's $25,000 savings and racked up $90,000 in credit-card debt. Homeless, the 55-year-old bus driver made plans to jump from his sister's ninth-floor apartment. She talked him out of it, and, after she stepped in to help him start over financially by declaring bankruptcy, he hasn't made a single wager. "If I gamble again, no one can help me," he says. "It'll kill me."

Wong was able to control his habit with the help of family. But one reason the region may be ill-prepared for a wave of new addicts is Asians' reticence and shame when it comes to getting mental-health treatment. "In the Chinese community, we don't have a help-seeking culture," says Ong. "Professional counseling and psychotherapy still bear a negative image." And even those who recognize they need help may have difficulty finding it; there are few gambling-treatment programs like Gamblers Anonymous in the region and little public funding is available to form new ones. In Macau, the Industrial Evangelistic Fellowship's center is one of just three small organizations offering counseling to the city's growing number of gambling addicts. The only government-funded organization, the Resilience Centre, was launched two years ago and employs just three counselors. Last year, Recovery Circle, a Manila-based substance-abuse clinic, began hosting weekly Gamblers Anonymous meetings. The center has six counselors on staff, but on average, only 10-15 attend the meetings. "The public is not aware that [gambling addiction] is a disease. They think it's part of the culture," says acting executive director Milagros Eos Capistrano. The clinic runs on patient fees, which don't add up to enough to cover the budget, forcing staff to dig into their own pockets to make up the difference. Without government support, "the disease will continue, the rate of crime will go up," says Capistrano. "It's destroying lives."

The ripple effect that the addiction has on the community may eventually force gambling towns (and soon-to-be gambling towns) to establish and fund treatment programs. A problem gambler can negatively affect 10 to 17 people by borrowing money, underperforming at work, straining family relations, stealing and committing suicide, according to Casino Watch, a U.S.-based antigambling group. A 2003 study conducted by the University of Hong Kong's Centre for Suicide Research and Prevention found that gambling-related financial problems were a factor in more than one out of four Hong Kong suicides.

Treatment programs can help. When computerized poker and slot machines were introduced to New Zealand in 1988, gaming operators provided funding for a national gambling hotline, counseling centers, public-awareness campaigns and research. As a result, gambling addiction rates fell from 7% in 1991 to 3% in 1999. Gambling "is a lot like a ski slope," says Bo Bernhard, director of gambling research at the University of Nevada, Las Vegas. "A bunch of people race down and have a wonderful time, but inevitably, you'll have a proportion that falls. You have to have a hospital at the bottom of the hill."

Leaders in at least one Asian city that's poised for a gambling boom appear to recognize the need to take at least a few measures to protect the vulnerable few. In July, Singapore's National Council on Problem Gambling introduced a responsible-gambling code of practice, urging casinos to display numbers for gambling hotlines and to train staff on how to help problem gamblers. In an effort to keep Singaporeans who can't afford the vice away from the tables when the city's two planned casinos open in 2009, locals will be required to pay a $68 cover charge just to get in the door.

But that relatively small surcharge hardly seems sufficient to overcome the seductive pull of casinos and their multimillion-dollar marketing budgets. "The gambling industry is so big," says Poon Yan-chi, director of the Macau center where Tan delivers his PowerPoint presentations on the evils of gambling. "It's like David and Goliath." David sometimes wins. But that's not the way to bet.

• Ling Woo Liu/Macau