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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 Jurisdiction Total Spending 2004 $16 million $10 million $44 million $25 million $2 million Per Capita Spending $4.19 $2.04 $1.47 $0.09 $0.04 United States Jurisdiction Total Spending 2004 $2.9 million $2.1 million $1.2 million $1.5 million $2 million $1.5 million Per Capita Spending $0.89 $0.72 $0.71 $0.44 $0.44 $0.31 New Zealand Victoria (Australia) Canada United States South Africa Oregon Iowa Nebraska Connecticut Louisiana Minnesota Illinois New York Volberg, Rugle, Rosenthal & Fong, 2005 $2 million $2.3 million $3 million $0.16 $0.13 $0.09 California 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 Classical & Operant Conditioning Emotional Vulnerability Biological 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, impulsecontrol & 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), 405424. 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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