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Problem Gambling Research: What is Known and What is Needed 2008 IAGR/IAGA Joint International Conference September 23, 2008 Rome, Italy Rachel A. Volberg , Ph.D. Gemini Research, Ltd. Overview

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Problem Gambling Research: What is Known and What is Needed

2008 IAGR/IAGA

Joint International Conference

September 23, 2008

Rome, Italy

Rachel A. Volberg, Ph.D.

Gemini Research, Ltd.


Overview

  • Intent – to move away from regulation in response to political pressures, toward regulation based on empirical evidence

  • Form the basis for dialogue between researchers & regulators

    • What can researchers tell regulators?

    • What can regulators tell researchers?


Funds for problem gambling services vary widely by jurisdiction

International

United States

Volberg, Rugle, Rosenthal & Fong, 2005


Most of the available funding goes for treatment

Christensen, 2002


As a result …

  • Research has been hampered by lack of funding & lack of continuity of funding

  • Focus has been primarily on prevalence

    • Identifying the number of problem gamblers in a jurisdiction & their characteristics

    • Useful in planning for provision of services

  • However, there has been progress with the small number of prospective, longitudinal studies, in particular, “punching above their weight”

Abbott & Clarke, 2007


So what have we learned?

  • Impaired control is a common outcome of regular (EGM) gambling, with emotional (not cognitive) factors driving impairment

  • There are high rates of transition into & out of problem gambling

  • The strongest predictors of continued gambling problems over time are a preference for track betting, problem gambling severity (at T1) & hazardous alcohol use

  • In other studies, emotional stress, loneliness & lack of social support were most closely associated with continued problems

  • There appear to be different & distinct trajectories into problem gambling

Abbott & Clarke, 2007; Abbott, Williams & Volberg, 2004; Dickerson et al., 2003; Schrans et al., 2000; Shaffer & Hall, 2002; Slutske et al., 2003; Vitaro et al., 2004


We now know that gambling problems exist on a continuum with movement between risk levels

Ontario Problem Gambling Research Centre Framework


Subtypes of problem gamblers: The pathways model

Ecological Factors

Biological Vulnerability

Classical & Operant Conditioning

Emotional Vulnerability

Impulsivist Traits

Habituation

Chasing

Problem & Pathological Gambling

Blaszcyznski & Nower, 2002


A chicken-and-egg question

  • Problem/pathological gambling known to often co-occur with other psychiatric disorders

    • Most often associated with depression, anxiety & substance use disorders

    • Temporal ordering has not been clear

  • Although not a longitudinal study, NCS-R sheds light on this issue

    • Face-to-face survey with large, nationally representative sample (~9,200) and high response rate

    • Lifetime PG assessed along with other DSM-IV disorders

    • Gambling problems typically begin in mid-20s & persist for average of 9.4 years

    • Persistence of PG predicted by variety of prior anxiety, mood, impulse-control & substance use disorders

    • PG predicted subsequent onset of anxiety disorders, PTSD & subtance dependence

Kessler et al., 2008


Are increases in availability linked to increases in problem rates?

  • During exposure to new forms of gambling (esp. EGMs), previously unexposed individuals & groups are at high risk for the development of gambling problems

  • Over time, adaptation typically occurs & problem levels reduce, even in the face of increasing exposure

  • Adaptation can be accelerated by regulatory and public health measures

  • While strongly associated with problem development, EGMs typically give rise to more transient problems than other continuous forms of gambling

Abbott, 2006


From exposure to adaptation

LaPlante & Shaffer, 2008


Reducing machine numbers – is this effective?

  • South Dakota, 1994

    • All VLTs shut down for 3 months due to court challenge

    • Average # calls to helpline reduced by 85% during shutdown, did not return to previous level after VLTs reactivated

  • Victoria, 1995-2002

    • Statewide cap on # of machines followed by regional caps & smoking ban & reduction in operating hours

    • 6-9% reduction in expenditure on machines in capped & non-capped regions (probably due to smoking ban & reduction in hours)

    • Reductions in average # calls to helpline & 51% decline in # of counseling cases statewide

  • Norway, 2006-2007

    • Ban on note acceptors in 2006 followed by ban on all machines in 2007

    • Participation in other forms of gambling did not change & machine players did not migrate to other forms

    • Annual # calls to helpline declined 91%

    • # clients seeking treatment declined 72%

    • # calls to support group for problem gamblers’ families declined 60%

    • Two waves of reduction noted, first after note acceptor ban, second after total ban

Abbott, Volberg, Bellringer & Reith, 2004; Engebø & Gyllstrøm, 2008


Only a few studies have evaluated the effectiveness of prevention programs

  • Mandatory or voluntary casino exclusion programs

  • Public awareness media campaigns

  • Youth prevention programs

  • Training programs for VLT retailers

  • Responsible gambling features on EGMs

    • On-screen clocks & displays in cash amounts rather than credits appear to be effective

    • Evidence on game speed, bill acceptors is equivocal

    • Pop-up reminders, mandatory cash-outs increase intensity of play

    • Dynamic message presentation results in greater recall & accuracy of recall

Abbott, Volberg, Bellringer & Reith, 2004; Monaghan & Blaszczynski, 2007


What are the current gaps in knowledge?

  • Focus to date has been on distribution rather than determinants

  • What are the determinants & consequences of gambling & problem gambling?

  • Additionally, need to focus on the changing landscape of gambling environments (poker, Internet)

  • Are there patterns of change in gambling behavior & in the experience of gambling harms?

  • What are the rates & reasons for natural recovery?


Why are longitudinal studies so important?

  • Overcome reliance on retrospective accounts & cross-sectional correlation

  • Allow changes to be tracked at individual level

  • Allow stronger causal inferences to be drawn

  • Focus on determinants of problem onset & development

  • Test validity of developmental theories


Feedback: What kinds of research would be most useful to regulators?

  • European perspective: important not to ignore results of research conducted in languages other than English

  • Research is needed on the following topics:

    • Voluntary vs. mandatory exclusion programmes

    • Effectiveness of responsible gaming features (RGFs) on EGMs

    • Impact of selected structural features of EGMs (free credits, reward games, prevention of automatic play) on player enjoyment & harm generation

    • Effectiveness of age limits & vulnerability of youth

    • Extent of comorbidity between PG & other addictions

    • What is the likely impact on the base rate of PG of population growth, changes in disposable income, cultural changes?

    • Can social, informal gambling be properly regulated to prevent harm?

    • Impacts of gambling on people who can afford to gamble


Feedback: How can research be made more useful for regulators?

  • Improved accessibility & understandability of research results is critically needed

  • Researchers should offer help in how to operationalise/implement their conclusions

  • Available funds for research could be more effectively mobilised


Feedback: What are the main deficiencies in research currently being undertaken?

  • Most studies are too general, not specific enough regarding features of gambling in specific jurisdictions

  • Lack of funding hampers research efforts

  • There is concern that research does not build on previous efforts – researchers engage in research projects rather than developing research programmes

  • There should be a focus on what regulators are charged to do


Feedback: What are the greatest obstacles in getting research that is useful to regulators/policy makers?

  • Funding comes from industry which affects the questions asked & findings obtained – “he who pays the piper calls the tune”

  • Focus on legal gambling leads to neglect of research on illegal gambling

  • Not all relevant parties are taking responsibility for conducting research – e.g., youth gambling should be a concern to education agencies

  • Research is often done without reference to or input from regulators

  • Sharing of information across jurisdictions is lacking

  • More communication among regulators regarding what research is needed


Feedback: Where is there scope for international cooperation & what is needed to make this happen?

  • There is a need to coordinate the research that is done

  • Clearinghouse is needed – but this is easier to say than do

  • Jurisdictional differences in types of games need to be better understood

  • A database template to monitor research activities in different jurisdictions is needed, similar to existing template on regulatory controls

  • Regulators in developed countries should have “open door” policy to assist developing regimes

  • Stronger relationships with academia are needed


Feedback: How can regulators keep up with research findings & evaluate their relevance?

  • Organizations & associations that already gather information should make this available online

  • Trade publications – researchers should submit results from their work to trade publications to educate regulators & industry readers

  • Help is needed to evaluate the relevance of specific research findings

  • Partnerships of regulators, operators & the public are needed


Works Cited

Abbott, M. W., & Clarke, D. (2007). Prospective problem gambling research: Contribution and potential. International Gambling Studies, 7(1), 123-144.

Abbott, M. W., & Volberg, R. A. (2006). The measurement of adult problem and pathological gambling. International Gambling Studies, 6(2), 175-200.

Abbott, M. W., Volberg, R. A., Bellringer, M., & Reith, G. (2004). A Review of Research on Aspects of Problem Gambling. London: Responsibility in Gambling Trust.

Abbott, M. W., Williams, M., & Volberg, R. A. (2004). A prospective study of problem and regular non-problem gamblers living in the community. Substance Use and Misuse, 39(6), 855-884.

Blaszczynski, A., & Nower, L. (2002). A pathways model of problem and pathological gambling. Addiction, 9, 487-499.

Christensen, T. (2002). Problem Gambling Policy: Current Status of State Approaches. Paper presented at the Annual Conference of the National Council of Legislators from Gaming States.

Dickerson, M., Haw, J., & Shepherd, L. (2003). The Psychological Causes of Problem Gambling: A Longitudinal Study of At Risk Recreational EGM Players. Sydney: University of Western Sydney, School of Psychology.

Engebø, J., & Gyllstrøm, F. (2008). Regulatory changes and finally a ban on existing slot machines in Norway: What's the impact on the market and problem gambling? A short presentation of various data. Paper presented at the 2008 International Gambling Conference: Looking Forward: New Directions in Research and Minimising Public Harm.

Kessler, R. C., Hwang, I., LaBrie, R. A., Petukhova, M., Sampson, N. A., Winters, K. C., et al. (2008). DSM-IV pathological gambling in the National Comorbidity Survey Replication. Psychological Medicine, Online Edition.

LaPlante, D. A., & Shaffer, H. J. (in press 2008). Understanding the influence of gambling opportunities: Expanding exposure models to include adaptation. American Journal of Orthopsychiatry.

Monaghan, S., & Blaszcynski, A. (2007). Recall of electronic gaming machine signs: A statis versus a dynamic mode of presentation. Journal of Gambling Issues, 20.

Schrans, T., Schellink, T., & Walsh, G. (2000). Technical Report: 2000 Regular VLT Players Followup: A Comparative Analysis of Problem Development and Resolution. Halifax, Nova Scotia: Focal Research Consultants.

Shaffer, H. J., & Hall, M. N. (2002). The natural history of gambling and drinking problems among casino employees. Journal of Social Psychology, 142(4), 405-424.

Slutske, W. S., Jackson, K. M., & Sher, K. J. (2003). The natural history of problem gambling from age 18 to 29. Journal of Abnormal Psychology, 112(2), 263-274.

Vitaro, F., Wanner, B., Ladouceur, R., Brendgen, M., & Tremblay, R. E. (2004). Trajectories of gambling during adolescence. Journal of Gambling Studies, 20(1), 47-69.

Volberg, R. A., Rugle, L., Rosenthal, R. J., & Fong, T. (2005). Situational Assessment of Problem Gambling Services in California. Sacramento, CA: California Department of Alcohol and Drug Programs.


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