Problem Gambling Research: What is Known and What is Needed

1. 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.

2. 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?

3. Funds for problem gambling services vary widely by jurisdiction International United States Volberg, Rugle, Rosenthal & Fong, 2005

4. Most of the available funding goes for treatment Christensen, 2002

5. 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

6. 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

7. We now know that gambling problems exist on a continuum with movement between risk levels Ontario Problem Gambling Research Centre Framework

8. 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

9. 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

10. 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

11. From exposure to adaptation LaPlante & Shaffer, 2008

12. 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

13. 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

14. 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?

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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.