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This study evaluates the effectiveness of treatment centers for problem and pathological gamblers, focusing on the adequacy of services, screening tools, factors related to success or failure, and recommendations for longer-term treatment services. Findings show the validation of screening tools, service output and outcomes, users' profile, and treatment methods. The study concludes that the services provided by the centers are cost-effective and result in improved social skills and family relationships for users.
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Evaluation Study on the Effectiveness of the Counselling and Treatment Centers for Problem and Pathological Gamblers Department of Applied Social Sciences The Hong Kong Polytechnic University 28 July 2006
The Research Team Prof. CHENG Chi-ho, Howard (Principal investigator), Professor and Associate Head, Dr. CHAN Ching-hai, Charles, Associate Professor, Dr. HO Kit-wan, Helen, Assistant Professor, Mrs. HUI LO Man-chun, Jenny, Lecturer, Dr. WONG Lai Kuen, Irene, Instructor, Ms. LAM Yu Kiu, Rita (From October to December 2004), Research Associate, Mr. LEE Ka Man (from 1st January 2005 onwards), Research Associate,and Ms. LUI Wai Sze, Clinical Psychologist, Dept. of Applied Social Sciences, Hong Kong Polytechnic University
Objectives • a comprehensive review on adequacy and effectiveness of the services of the 2 Centres; • examine the validity and usefulness of the screening tools adopted by the 2 Centres in assessing gambling-related problems; • identity factors related to success or failure of services; and • recommend to Govt. on longer term gambling treatment services.
Findings: (1) Validation of Screening Tools • DSM-IV is a relatively reliable and valid tool that to be adopted for screening pathological gamblers: • screening & assessing the severity of gambling problems of service-seekers • identifying pathological gamblers from service seekers.
Findings: (2) Service Output (as at 31st Decembr 2005) a. Hotline service and telephone enquiry were most welcomed and frequently used:
b. Caseload (Level II cases – those screened as problem and/or pathological gamblers)
c. Caseload (Level III cases - those who received psychiatric and/or residential treatment services) :
i. No. of Closed Cases (Level II cases) / Reasons for Closing
Findings: (3) Service Outcomes • The 2 Centres have been operating in the right direction, and are able to meet requirements of Service Agreement. • Over 90% service users (gamblers & family members) were satisfied with the quality and quantity of services • Close to 70% of the closed cases were successful cases.
Findings: (3) Service Outcomes The 2 Centres were: • providing appropriate & effective counselling & treatment services for gamblers & family members; • facilitating the development of best practices & expertise in counselling & treatment services for gamblers; • building up the requisite network for gambling treatment in Hong Kong; • collecting required data and statistics which contribute to a better understanding of problem gambling; and • reaching out to and educating the general public for prevention of problematic / pathological gambling.
Findings: (3) Service Outcomes Most significant service effectiveness: • the ability to control desire to gamble; • development of responsibility for own gambling behaviours and consequences; and • improved social skills and family relationships.
Findings: (3) Service Outcomes After receiving services for 6 months, gambling behaviours of users had not deteriorated, and their perceived service by priority were, • better understanding of one’s own gambling behavior & consequences; • more capable of controlling one’s desire for gambling; • able to solve financial problems; and • able to solve family problems. To conclude, outcome measurement reflected satisfactory cost-effectiveness of the services provided by the 2 Centres.
Findings: (4) Users’ Profile / Level II P/P Gamblers • middle-aged male in their 30s and 50s • with primary and junior secondary school education • over 60% are working in the service sector • over 80% have financial and debts problems • over 60% have emotional problems • about 50% are suffering from poor family and marital relationships
Summary Remarks • Literature revealed some gamblers dropped or cut down gambling without receiving service. • Causes of pathological gambling are complicated and are embedded in the culture, subculture, social systems and one’s psychological and social conditions. There is no single cure or the best model for treatment.
Summary Remarks • Total abstinence of gambling addiction is very difficult. Positive treatment outcomes should be helping gamblers understand personal responsibility so that they can develop self control when engaging in gambling activities, and reduce the harm of gambling as far as possible.
Summary Remarks • Treatment methods: Cognitive-behavioural therapies which focus on altering cognitions and changing gambling behaviours are effective in casework services for pathological gamblers, and supplemented by treatment groups for gamblers and family members. The “case-in-group” approach is effective in treating local p/p gamblers and their families in HK.
Summary Remarks • Government has a responsibility, through law enactment and enforcement, to supervise the operations of gambling activities and keep them under control. On the other hand, the media also has the social responsibility to exercise restraint in disseminating gambling-related information. • Prevention is better than cure. There is a need to develop a long term strategy in gambling prevention among young people.
Summary Remarks • In developing a service delivery model, its feasibility, cost-effectiveness, sustainability, and financial support must be carefully considered. • The need for service expansion is obvious, the research team supports with caution for a unlimited expansion of services in view of competing community needs. A careful and affordable expansion of treatment programmes for p/p gamblers is recommended.
Justification for Continuous Funding Support • Gambling, esp. social gambling, is perceived as a culturally acceptable form of entertainment in HK. • About 80% of HK residents aged 15 - 64 report having gambled in the past year (A Study of HK People’s Participation in Gambling Activities, HKU, 2005), compared to 78 % in Gambling Prevalence Survey (HK PolyU, 2001). • Development of internet gambling and telephone wagering. • Rapid expansion of gambling industries in Asia, esp. in Macau with liberalization of gambling monopoly in 2001 Pathological gambling may become more widespread in Hong Kong.
Justification of Continuous Funding Support • Findings of a HKU Study held the same views: “While there is a modest increase in the estimated number of pathological gamblers in the society, as assessed using DSM-IV, the overall percentage share of p/p gamblers in the community has remained stable (around 5%). This points to a continued need to provide appropriate remedial service for p/p gamblers.” (A Study of Hong Kong People’s Participation in Gambling Activities, Social Science Research Centre, The University of Hong Kong, Pg. 96).
Recommendations • Support the 2 gambling treatment centres at the current service level for another 2 years up to 30 September, 2008. • With the existing level of resource provision, the operating hours of the current hotline service could be considered to be extended to 24 hours on a pilot basis. • The future development of and resource input to the treatment centres to be reviewed after commissioning another in-depth research to evaluate their cost-effectiveness and demonstration of continuous service needs.
Recommendations • A community-based approach focusing on establishing capacity building among gamblers, potential gamblers and their families to be considered as an alternative treatment model. • Consider to establish 2 small treatment centres with a smaller group of counsellors / social workers providing treatment services to p/p gamblers and their families in Kowloon and other areas.
Recommendations • These two new treatment centres may consider using alternative treatment models and a community-based approach, to serve the needs of : • elderly gamblers (e.g. those involved frequently in group gambling in public housing estates); • gamblers who belong to ethnic minorities; • youth, especially secondary school students; and • women, especially housewives aged between 30-60.
Recommendations • The Ping Wo Fund may consider as appropriate applications from non-governmental organizations, schools and other community organizations to launch prevention and/or treatment programmes for p/p gamblers on a smaller scale. • Service output and outcome indicators should be standardized for all gambling treatment centres.
Recommendations: Standardization of Service Output Indicators
Recommendations: Standardization of Service Outcome Indicators
Limitations of the Study • The first study on the effectiveness of the gambling services in Hong Kong, there is no local reference data for comparison. • The cut-off date for data collection is 31.12.2005. Performance of the 2 Centres from 1.1.2006 to 30.9.2006 is not evaluated. • Some users refused to participate in the study. • No longitudinal data to study changes, effects and sustainability over time.
Acknowledgement • The research team is grateful to have this valuable opportunity to engage in a meaningful study. • We have learned a lot and this study has developed a better understanding of pathological gambling in Hong Kong. • The research team thanks for the support and assistance from the HAB, the Ping Wo Fund, Caritas and Tung Wah. • We look forward to further collaboration with you all in working towards developing more effective services in the treatment of p/p gambling.
