Place your bets: Has problem gambling in Great Britain decreased?

In the summer of 2014 I was commissioned to review problem gambling in Great Britain (the fall out of which I wrote about in detail in a previous blog). Earlier last year, a detailed report by Heather Wardle and her colleagues examined gambling behaviour in England and Scotland by combining the 2012 data from the Health Survey for England (HSE; n=8,291 aged 16 years and over) and the 2012 Scottish Health Survey (SHeS; n=4,815). To be included in the final data analysis, participants had to have completed at least one of the gambling participation questions. This resulted in a total sample of 11,774 participants. So what did the research find? Here is a brief summary of the main results:

• Two-thirds of the sample (65%) had gambled in the past year, with men (68%) gambling more than women (62%). As with the British Gambling Prevalence Survey (BGPS), past year participation was greatly influenced by the playing of the bi-weekly National Lottery (lotto) game. Removal of those individuals that only played the National Lottery meant that 43% had gambled during the past year (46% males and 40% females).

• Gambling was more likely to be carried out by younger people (50% among those aged 16-24 years and 52% among those aged 25-34 years).

• The findings were similar to the previous BGPS reports and showed that the most popular forms of gambling were playing the National Lottery (52%; 56% males and 49% females), scratchcards (19%; 19% males and 20% females), other lottery games (14%; 14% both males and females), horse race betting (10%; 12% males and 8% females), machines in a bookmaker (3%; 5% males and 1% females), slot machines (7%; 10% males and 4% females), online betting with a bookmaker (5%; 8% males and 2% females), offline sports betting (5%; 8% males and 1% females), private betting (5%; 8% males and 2% females), casino table games (3%; 5% males and 1% females), offline dog race betting (3%; 4% males and 2% females), online casino, slots and/or bing (3%; 4% males and 2% females), betting exchanges (1%; males 2% and females 0%), poker in pubs and clubs (1%; 2% males and 0% females), spread betting (1%; 1% males and 0% females).

• The only form of gambling (excluding lottery games) where females were more likely to gamble was playing bingo (5%; 7% females and 3% males).

• Most participants gambled on one or two different activities a year (1.7 mean average across the total sample).

• Problem gambling assessed using the Problem Gambling Severity (PGSI) criteria was reported to be 0.4%, with males (0.7%) being significantly more likely to be problem gamblers than females (0.1%). This equates to approximately 180,200 British adults aged 16 years and over.

• Problem gambling assessed using the criteria of the fourth Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) was reported to be 0.5%, with males (0.8%) being significantly more likely to be problem gamblers than females (0.1%). This equates to approximately 224,100 British adults aged 16 years and over.

• Using the PGSI screen, problem gambling rates were highest among young men aged 16-24 years (1.7%) and lowest among men aged 65-74 years (0.4%). Using the DSM-IV screen, problem gambling rates were highest among young men aged 16-24 years (2.1%) and lowest among men aged over 74 years (0.4%).

• Problem gambling rates were also examined by type of gambling activity. Results showed that among past year gamblers, problem gambling was highest among spread betting (20.9%), played poker in pubs or clubs (13.2%), bet on other events with a bookmaker (12.9%), bet with a betting exchange (10.6%) and played machines in bookmakers (7.2%).

• The activities with the lowest rates of problem gambling were playing the National Lottery (0.9%) and scratchcards (1.7%).

• Problem gambling rates were highest among individuals that had participated in seven or more activities in the past year (8.6%) and lowest among those that had participated in a single activity (0.1%).

The authors also carried out a latent class analysis and identified seven different types of gambler among both males and females. The male groups comprised:

• Cluster A: non-gamblers (33%)
• Cluster B: National Lottery only gamblers (22%)
• Cluster C: National Lottery and scratchcard gamblers only (20%)
• Cluster D: Minimal, no National Lottery [gambling on 1-2 activities] (9%)
• Cluster E: Moderate [gambling on 3-6 activities] (12%)
• Cluster F: Multiple [gambling on 6-10 activities] (3%)
• Cluster G: multiple, high [gambling on at least 11 activities] (1%).

The female groups comprised:

• Cluster A: non-gamblers (40%)
• Cluster B: National Lottery only gamblers (21%)
• Cluster C: National Lottery and scratchcard gamblers only (7%)
• Cluster D: Minimal, no National Lottery (8%)
• Cluster E: moderate, less varied [2-3 gambling activities, mainly lottery-related] (8%)
• Cluster F: moderate, more varied [2-3 gambling activities but wider range of activities] (6%)
• Cluster G: multiple [gambling on at least four activities] (6%)

Using these groupings, the prevalence of male problem gambling was highest among those in Cluster G: multiple high group (25.0%) followed by Cluster F: multiple group (3.3%) and Cluster E: moderate group (2.6%). The prevalence of problem gambling was lowest among those in the Cluster B; National Lottery Draw only group (0.1%) followed by Cluster C: minimal – lotteries and scratchcards group (0.7%). The prevalence of female problem gambling was highest among those in the Cluster G: multiple group (1.8%) followed by those in Cluster F: moderate – more varied group (0.6%). The number of female gamblers was too low to carry out any further analysis. The report also examined problem gambling (either DSM-IV or PGSI) by gambling activity type.

• The prevalence of problem gambling was highest among spread-bettors (20.9%), poker players in pubs or clubs (13.2%), bettors on events other than sports or horse/dog races (12.9%), betting exchange users (10.6%) and those that played machines in bookmakers (7.2%).

• The lowest problem gambling prevalence rates were among those that played the National Lottery (0.9%) and scratchcards (1.7%).

• These figures are very similar to those found in the 2010 BGPS study although problem gambling among those that played machines in bookmakers was lower (7.2%) than in the 2010 BGPS study (8.8%).

• As with the BGPS 2010 study, the prevalence of problem gambling was highest among those who had participated in seven or more activities in the past year (8.6%) and lowest among those who had taken part in just one activity (0.1%). Furthermore, problem gamblers participated in an average 6.6 activities in the past year.

Given that the same instruments were used to assess problem gambling, the results of the most recent surveys using data combined from the Health Survey for England (HSE) and Scottish Health Survey (SHeS) compared with the most recent British Gambling Prevalence Survey (BGPS) do seem to suggest that problem gambling in Great Britain has decreased over the last few years (from 0.9% to 0.5%). However, Seabury and Wardle again urged caution and noted:

“Comparisons of the combined HSE/SHeS data with the BGPS estimates should be made with caution. While the methods and questions used in each survey were the same, the survey vehicle was not. HSE and SHeS are general population health surveys, whereas the BGPS series was specifically designed to understand gambling behaviour and attitudes to gambling in greater detail. It is widely acknowledged that different survey vehicles can generate different estimates using the same measures because they can appeal to different types of people, with varying patterns of behaviour…Overall, problem gambling rates in Britain appear to be relatively stable, though we caution readers against viewing the combined health survey results as a continuation of the BGPS time series”.

There are other important caveats to take into account including the differences between the two screen tools used in the BGPS, HSE and SHeS studies. Although highly correlated, evidence from all the British surveys suggests that the PGSI and DSM-IV screens capture slightly different groups of problem gamblers. For instance, a 2010 study that I co-authored with Jim Orford, Heather Wardle, and others (in the journal International Gambling Studies) using data from the 2007 BGPS showed that the PGSI may under-estimate certain forms of gambling-related harm (particularly by women) that are more likely to be picked up by some of the DSM-IV items. Our analysis also suggested that the DSM-IV appears to measure two different factors (i.e., gambling-related harm and gambling dependence) rather than a single one. Another important distinction is that the two screens were developed for very different purposes (even though they are attempting to assess the same construct). The PGSI was specifically developed for use in population surveys whereas the DSM-IV was developed with clinical populations in mind. Given these differences, it is therefore unsurprising that national surveys that utilize the screens end up with slightly different results comprising slightly different groups of people.

It also needs stressing (as noted by the authors of most of the national gambling surveys in Great Britain) that the absolute number of problem gamblers identified in any of the surveys published to date has equated to approximately 60 people. To detect any significant differences statistically between any of the studies carried out to date requires very large sample sizes. Given the very low numbers of problem gamblers and the tiny number of pathological gamblers, it is hard to assess with complete accuracy whether there have been any significant changes in problem and pathological gambling between all the published studies over time. Wardle and her colleagues concluded that:

“Overall, based on this evidence, it appears that problem gambling rates in England and Scotland are broadly stable. Whilst problem gambling rates according to either the DSM-IV or the PGSI were higher in 2010, the estimate between 2007 and the health surveys data were similar. Likewise, problem gambling rates according to the DSM-IV and the PGSI individually did not vary statistically between surveys, meaning that they were relatively similar” (p.130).

Dr. Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Griffiths, M.D. (2014). Problem gambling in Great Britain: A brief review. London: Association of British Bookmakers.

Orford, J., Wardle, H., Griffiths, M.D., Sproston, K. & Erens, B. (2010). PGSI and DSM-IV in the 2007 British Gambling Prevalence Survey: Reliability, item response, factor structure and inter-scale agreement. International Gambling Studies, 10, 31-44.

Seabury, C. & Wardle, H. (2014). Gambling behaviour in England and Scotland. Birmingham: Gambling Commission.

Wardle, H. (2013). Gambling Behaviour. In Rutherford, L., Hinchliffe S., Sharp, C. (Eds.), The Scottish Health Survey: Vol 1: Main report. Edinburgh.

Wardle, H., Moody. A., Spence, S., Orford, J., Volberg, R., Jotangia, D., Griffiths, M.D., Hussey, D. & Dobbie, F. (2011). British Gambling Prevalence Survey 2010. London: The Stationery Office.

Wardle, H., & Seabury, C. (2013). Gambling Behaviour. In Craig, R., Mindell, J. (Eds.) Health Survey for England 2012 [Vol 1]. Health, social care and lifestyles. Leeds: Health and Social Care Information Centre.

Wardle, H., Seabury, C., Ahmed, H., Payne, C., Byron, C., Corbett, J. & Sutton, R. (2014). Gambling behaviour in England and Scotland: Findings from the Health Survey for England 2012 and Scottish Health Survey 2012. London: NatCen.

Wardle, H., Sproston, K., Orford, J., Erens, B., Griffiths, M. D., Constantine, R., & Pigott, S. (2007). The British Gambling Prevalence Survey 2007. London: National Centre for Social Research.

Wardle, H., Sutton, R., Philo, D., Hussey, D. & Nass, L. (2013). Examining Machine Gambling in the British Gambling Prevalence Survey. Report by NatCen to the Gambling Commission, Birmingham.

In dependence days: A brief overview of behavioural addictions

Please note: A version of this blog first appeared on addiction.com

Conceptualizing addiction has been a matter of great debate for decades. For many people the concept of addiction involves the taking of drugs. Therefore it is perhaps unsurprising that most official definitions concentrate on drug ingestion. Despite such definitions, there is now a growing movement that views a number of behaviours as potentially addictive including those that do not involve the ingestion of a drug. These include behaviours diverse as gambling, eating, sex, exercise, videogame playing, love, shopping, Internet use, social networking, and work. I have argued in many of my papers that all addictions – irrespective of whether they are chemical or behavioural – comprise six components (i.e., salience, mood modification, tolerance, withdrawal, conflict and relapse). More specifically:

• Salience – This occurs when the activity becomes the single most important activity in the person’s life and dominates their thinking (preoccupations and cognitive distortions), feelings (cravings) and behaviour (deterioration of socialized behaviour). For instance, even if the person is not actually engaged in the activity they will be constantly thinking about the next time that they will be (i.e., a total preoccupation with the activity).
• Mood modification – This refers to the subjective experiences that people report as a consequence of engaging in the activity and can be seen as a coping strategy (i.e., they experience an arousing ‘buzz’ or a ‘high’ or paradoxically a tranquilizing feel of ‘escape’ or ‘numbing’).
• Tolerance – This is the process whereby increasing amounts of the activity are required to achieve the former mood modifying effects. This basically means that for someone engaged in the activity, they gradually build up the amount of the time they spend engaging in the activity every day.
• Withdrawal symptoms – These are the unpleasant feeling states and/or physical effects (e.g., the shakes, moodiness, irritability, etc.) that occur when the person is unable to engage in the activity.
• Conflict – This refers to the conflicts between the person and those around them (interpersonal conflict), conflicts with other activities (e.g., work, social life, hobbies and interests) or from within the individual (e.g., intra-psychic conflict and/or subjective feelings of loss of control) that are concerned with spending too much time engaging in the activity.
• Relapse – This is the tendency for repeated reversions to earlier patterns of excessive engagement in the activity to recur, and for even the most extreme patterns typical of the height of excessive engagement in the activity to be quickly restored after periods of control.

In May 2013, the new criteria for problem gambling (now called ‘Gambling Disorder’) were published in the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5), and for the very first time, problem gambling was included in the section ‘Substance-related and Addiction Disorders’ (rather than in the section on impulse control disorders as had been the case since 1980 when it was first included in the DSM-III). Although most of us in the field had been conceptualizing extreme problem gambling as an addiction for many years, this was arguably the first time that an established medical body had described it as such.

There had also been debates about whether or not ‘Internet Addiction Disorder’ should have been included in the DSM-5. As a result of these debates, the Substance Use Disorder Work Group recommended that the DSM-5 include ‘Internet Gaming Disorder’ [IGD] in Section III (“Emerging Measures and Models”) as an area that required further research before possible inclusion in future editions of the DSM. To be included in its own right in the next edition, research will have to establish the defining features of IGD, obtain cross-cultural data on reliability and validity of specific diagnostic criteria, determine prevalence rates in representative epidemiological samples in countries around the world, and examine its associated biological features. Other than gambling and gaming, no other behaviour (e.g., sex, work, exercise, etc.) has yet to be classified as a genuine addiction by established medical and/or psychiatric organizations.

In one of the most comprehensive reviews of chemical and behavioural addictions, Dr. Steve Sussman, Nadra Lisha and myself examined all the prevalence literature relating to 11 different potentially addictive behaviours. We reported overall prevalence rates of addictions to cigarette smoking (15%), drinking alcohol (10%), illicit drug taking (5%), eating (2%), gambling (2%), internet use (2%), love (3%), sex (3%), exercise (3%), work (10%), and shopping (6%). However, most of the prevalence data relating to behavioural addictions (with the exception of gambling) did not have prevalence data from nationally representative samples and therefore relied on small and/or self-selected samples.

Addiction is an incredibly complex behaviour and always result from an interaction and interplay between many factors including the person’s biological and/or genetic predisposition, their psychological constitution (personality factors, unconscious motivations, attitudes, expectations, beliefs, etc.), their social environment (i.e. situational characteristics such as accessibility and availability of the activity, the advertising of the activity) and the nature of the activity itself (i.e. structural characteristics such as the size of the stake or jackpot in gambling). This ‘global’ view of addiction highlights the interconnected processes and integration between individual differences (i.e. personal vulnerability factors), situational characteristics, structural characteristics, and the resulting addictive behaviour.

There are many individual (personal vulnerability) factors that may be involved in the acquisition, development and maintenance of behavioural addictions (e.g. personality traits, biological and genetic predispositions, unconscious motivations, learning and conditioning effects, thoughts, beliefs, and attitudes), although some factors are more personal (e.g. financial motivation and economic pressures in the case of gambling addiction). However, there are also some key risk factors that are highly associated with developing almost any (chemical or behavioural) addiction such as having a family history of addiction, having co-morbid psychological problems, and having a lack of family involvement and supervision. Psychosocial factors such as low self-esteem, loneliness, depression, high anxiety, and stress all appear to be common among those with behavioural addictions.

This article briefly demonstrates that behavioural addictions are a part of a biopsychosocial process and not just restricted to drug-ingested (chemical) behaviours. Evidence is growing that excessive behaviours of all types do seem to have many commonalities and this may reflect a common etiology of addictive behaviour. Such commonalities may have implications not only for treatment of such behaviours but also for how the general public perceive such behaviours.

Dr. Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Berczik, K., Griffiths, M.D., Szabó, A., Kurimay, T., Urban, R. & Demetrovics, Z. (2014). Exercise addiction. In K. Rosenberg & L. Feder (Eds.), Behavioral Addictions: Criteria, Evidence and Treatment (pp.317-342). New York: Elsevier.

Demetrovics, Z. & Griffiths, M.D. (2012). Behavioral addictions: Past, present and future. Journal of Behavioral Addictions, 1, 1-2.

Griffiths, M.D. (1996). Behavioural addictions: An issue for everybody? Journal of Workplace Learning, 8(3), 19-25.

Griffiths, M.D. (2009). Gambling addictions. In A. Browne-Miller (Ed.), The Praeger International Collection on Addictions: Behavioral Addictions from Concept to Compulsion (pp. 235-257). Westport, CT: Praeger.

Griffiths, M.D. (2010). Addicted to sex? Psychology Review, 16(1), 27-29

Griffiths, M.D. (2011). Behavioural addiction: The case for a biopsychosocial approach. Transgressive Culture, 1(1), 7-28.

Griffiths, M.D. (2011). Workaholism: A 21^st century addiction. The Psychologist: Bulletin of the British Psychological Society, 24, 740-744.

Griffiths, M.D., Kuss, D.J. & Demetrovics, Z. (2014). Social networking addiction: An overview of preliminary findings. In K. Rosenberg & L. Feder (Eds.), Behavioral Addictions: Criteria, Evidence and Treatment (pp.119-141). New York: Elsevier.

Griffiths, M.D. (2005). A ‘components’ model of addiction within a biopsychosocial framework. Journal of Substance Use, 10, 191-197.

Király, O., Nagygyörgy, K., Griffiths, M.D. & Demetrovics, Z. (2014). Problematic online gaming. In K. Rosenberg & L. Feder (Eds.), Behavioral Addictions: Criteria, Evidence and Treatment (pp.61-95). New York: Elsevier.

Kuss, D.J., Griffiths, M.D., Karila, L. & Billieux, J. (2014).  Internet addiction: A systematic review of epidemiological research for the last decade. Current Pharmaceutical Design, 20, 4026-4052.

Sussman, S., Lisha, N. & Griffiths, M.D. (2011). Prevalence of the addictions: A problem of the majority or the minority? Evaluation and the Health Professions, 34, 3-56.

Flying ‘high’: A brief look at ‘binge flying’ and ‘flying addiction’

As part of my job I do a lot of travel. It’s an occupational necessity. Last year alone I did over 20 work trips abroad that comprised over 50 flights (such as the six flights that I had to take to get to a conference in Uruguay and then back to the UK). One of my research colleagues at a conference in Taiwan jokingly accused me of being ‘addicted’ to flying. Nothing could be further from the truth. For me, flying is little more than a way to get from A to B. However, I have tried to turn my experiences into something more positive and have written a number of short articles providing tips about flying and travelling abroad for outlets such as the British Medical Journal and the PsyPAG Quarterly (see ‘Further Reading’ below).

However, there are a few papers in the academic literature that have proposed the idea of ‘binge flying’ and ‘flying addiction’ in the Annals of Tourism Research. One British research team (Drs. Scott Cohen, James Higham and Christina Cavaliere) have written various papers on flying, particularly the dilemma that many business travellers face in wanting to be ‘green’ and ‘eco-friendly’ but knowing that the amount of flying they are doing is contributing to climate change and leaving a ‘carbon footprint’.

One of the papers published by Cohen and his colleagues was entitled ‘Binge flying: Behavioural addiction and climate change’. In their introduction to the topic, the authors referenced my 1996 paper in the Journal of Workplace Learning on behavioural addictions to argue there was now evidence that many behaviours could be potentially addictive even without the ingestion of a psychoactive substance. They then went on to say:

“[Two] articles in the popular press have further implicated frequent tourist air travel as a practice that may constitute behavioural addiction (Hill, 2007; Rosenthal, 2010). In stark contrast to most behavioural addictions, which are characterised by severe negative consequences for individuals directly, the destructive outcome attributable to excessive flying is premised upon air travel’s growing contribution to global climate change. Both Burns and Bibbings (2009) and Randles and Mander (2009) cite Hill’s (2007) interview in ‘The Observer’ with ‘Rough Guides’ founder Mark Ellingham, who coins the term ‘binge flying’ in critiquing the public’s growing appetite for holidays accessed through air travel”.

They also used my 1996 paper to make a number of points to support their premise that excessive flying can be conceptualized as an addiction. More specifically, they noted:

“Griffiths (1996) notes that behavioural addictions may have ‘normative ambiguity’, in that moderate use is accepted but stigma can result from over-enactment of the behaviour, or compulsive consumption (Hirschman, 1992)…Even though addictions are typically conceptualised as purely negative, Griffiths (1996) distinguishes a number of possible addiction benefits that individuals may perceive, such as changes of mood and feelings of escape, positive experiences of pleasure, excitement, relaxation, disinhibition of behaviour and the activity as a source of identity and/or meaning in life…Not only does excessive tourist air travel meet this basic criterion of behavioural addiction where longer-term outlooks are sacrificed for immediate gratification, but tourist experiences also supply many of the psychological benefits that Griffiths (1996) uses to characterise sites of potential behavioural addiction. These include feelings of escape, heightened experiences of pleasure and excitement (a ‘buzz’ or ‘rush’), relaxation, disinhibition of behaviour and the activity as an arena for identity work and searching for meaning in life”.

To support their argument that flying can be an addiction, they assert there are three key characteristics that can be found in addictive behavior that can be applied to flying: (i) a drive or urge to engage in the behaviour, (ii) a denial of the harmful consequences of the behaviour, and (iii) a failure in attempts to modify the behaviour. As regular readers of my blog will know, I operationally define addictive behaviour as comprising six components (salience, mood modification, tolerance, withdrawal, conflict and relapse), and as such, flying would be unlikely to be classed as an addiction by my own criteria. The authors interviewed 30 participants as part of their research but little of the qualitative data presented made any reference to addiction or elements of addictive behaviour. They somehow concluded that:

“Continued movement in consumer discourses towards a mainstream negative perception of the practice of holiday frequent flying may eventually find tourism consumption the further subject of query as an addictive phenomenon. Frequent air travel may then join gambling, smoking, shopping, video games and Internet use, (Clark & Calleja, 2008), amongst others, as ‘pathologised’ sites of behavioural addiction that reflect society’s (re)positioning of certain types of behaviour as socially dysfunctional”.

The concept of ‘binge flying’ and ‘flying addiction’ were more recently critiqued by Dr. Martin Young and colleagues in a 2014 issue of the Annals of Tourism Research. Their view closely matches my own view (and they also cite my 1996 paper on behavioural addictions) when they asserted:

“We take issue with the application of a behavioural addiction framework in the context of consumption generally, and frequent flying specifically. We argue that while the conceptual lens of behavioural addiction may be seductive to some (cf. Hill, 2007), it is, in contrast to the position of Cohen et al. (2011), ultimately counterproductive to the development of a meaningful critical response to the question of frequent flying and environmental damage… There is, of course, a deep irony in even trying to view frequent flying through the lens of addiction. Tourism, traditionally the realm of freedom, unconstraint and abandon (Crompton, 1979; Sharpley, 2003) is now recast as a pathology, associated with the pernicious tendencies of the human psyche.

Dr. Young and colleagues’ paper asserts that the idea that flying in extreme cases could be classed as a behavioural addiction is “unconvincing” (and again is something that I agree with). The paper also adapts the 2013 DSM-5 criteria for gambling disorder (substituting the word ‘gambling’ with ‘flying’) to highlight that while it is theoretically possible for someone to have an addiction to flying, it is highly unlikely even amongst the most frequent of flyers. As they note:

“A diagnosed flying addict (and some may exist) would appear to differ from the frequent flyer who is feeling guilty about the environmental consequences of flying. Indeed, the latter would appear to be entirely rational. Flying may be associated with feelings of guilt and suppression, but so are many other activities, like driving to work, using plastic bags, and using electricity from coal-powered generators. This does not make flying an addiction as defined by the DSM-5. In addition, a flying addict would be addicted to the act of flying when, in reality, people fly as part of a broader tourism or business journey or experience. Flying may be incidental to the motivations for travel, merely an unavoidable part of attaining a particular experience. In other words, the focus of flying addiction is likely to be complicated and shifting, unlike, for instance, gambling addiction, that is more clear-cut”.

Pathologizing a behaviour like flying may be stretching the addiction analogy a little too far, but I don’t see a theoretical reason why someone could not become addicted. However, it’s unknown as to what the actual object of flying addiction might be. Is it the actual flying and being in the air? The thrill of take-offs and landings? Is it the feeling of being attended and catered for (especially when flying business class) by the airline staff? Is it the anticipation associated of visiting somewhere new? All of these suggestions could be empirically tested but probably from a purely motivational view rather than from an addiction perspective.

Dr. Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Burns, P., & Bibbings, L. (2009). The end of tourism? Climate change and societal challenges. 21st Century Society, 4(1), 31-51.

Clark, M., & Calleja, K. (2008). Shopping addiction: A preliminary investigation among Maltese university students. Addiction Research and Theory, 16(6), 633-649.

Cohen, S. A., Higham, J. E., & Cavaliere, C. T. (2011). Binge flying: Behavioural addiction and climate change. Annals of Tourism Research, 38(3), 1070-1089.

Crompton, J. (1979). Motivations for pleasure vacation. Annals of Tourism Research, 6(4), 408–424.

Griffiths, M.D. (1996). Behavioural addictions: An issue for everybody? Journal of Workplace Learning, 8(3), 19-25.

Griffiths, M.D. (2003). Tips on…Business travel abroad, British Medical Journal, 327, S38.

Griffiths, M.D. (2005). A ‘components’ model of addiction within a biopsychosocial framework. Journal of Substance Use, 10, 191-197.

Griffiths, M.D. (2012). Tips on…Conference travel abroad. Psy-PAG Quarterly, 83, 4-6.

Higham, J. Cohen, S. & Cavaliere, C. (2013). ‘Climate breakdown’ and the ‘flyer’s dilemma’: Insights from three European societies. In: Fountain, J. & Moore, K. (Eds.). CAUTHE 2013: Tourism and Global Change: On the Edge of Something Big (pp. 321-324). Christchurch, N.Z.: Lincoln University.

Hill, A. (2007). Travel: The new tobacco. The Observer, May 6. Located at: http://www.guardian.co.uk/travel/2007/may/06/travelnews.climatechange

Hirschman, E. C. (1992). The consciousness of addiction: Toward a general theory of compulsive consumption. Journal of Consumer Research, 19(2), 155-179.

Randles, S., & Mander, S. (2009a). Practice(s) and ratchet(s): A sociological examination of frequent flying. In S. Gössling & P. Upham (Eds.), Climate change and aviation: Issues, challenges and solutions (pp. 245-271). London: Earthscan.

Rosenthal, E. (2010, 24 May). Can we kick our addiction to flying? Guardian, May 24. Located at: http://www.guardian.co.uk/environment/2010/may/24/kick- addiction-flying

Sharpley, R. (2003). Tourism, tourists and society. Huntingdon: Elm Publications.

Young, M., Higham, J.E.S. & Reis, A.C. (2014). ‘Up in the air’: A conceptual critique of flying addiction. Annals of Tourism Research, 49, 51-64.

Slots of fun: What should parents and teachers know about adolescent gambling? (Part 2)

Today’s blog is the second part of a two-part article (the first of which can be found here). The previous blog briefly examined risk factors in adolescent gamblers and signs of problem gambling in adolescents. The three lists below highlight some early warning signs of a possible gambling problem, some definite signs and a thumbnail profile of a problem gambler. This is followed by some (hopefully) helpful tips and hints.

Early warning signs of a gambling addiction

• Unexplained absences from home
• Continual lying about day-to-day movements
• Constant shortage of money
• General increase in secretiveness
• Neglect of studies, family, friends, health and appearance
• Agitation (if unable to gamble)
• Mood swings
• Loss of friends and social life
• Gambling seen as a legitimate way of making money

Signs of a definite gambling problem

• Large debts (which are always explained away)
• Trouble at school or college about non-attendance
• Unexplained borrowing from family and friends
• Unwillingness to repay borrowed money
• Total preoccupation with gambling and spending money on gambling
• Gambling alone for long periods
• Constantly chasing losses in an attempt to win money back
• Constantly gambling until all money is gone
• Complete alienation and rejection from family and friends
• Lying about the extent of their gambling to family and friends
• Committing crimes as a way of getting money for gambling or paying off debts
• Gambling overriding all other interests and obligations

Profile of the problem adolescent gambler

• Unwilling to accept reality and has a lack of responsibility for gambling
• Gambles to escape deeper problems (and the gambling environment may even be a substitute for parental affection)
• Insecure and feels inferior to parents and elders
• Wants good things without making an effort and loves games of chance
• Likes to be a ‘big shot’ and feels it’s important to win (gambling offers them status and a way of defining achievement)
• Likes to compete
• Feels guilty with losses acting as a punishing behaviour
• May be depressed
• Low self-esteem and confidence
• Other compulsive and/or addictive traits

Finally it is worth noting some of the ‘trigger’ situations and circumstances that a gambling problem might first come to light. Paul Bellringer has highlighted an array of situations that provide an opportunity to help the gambler focus on their need to change. These are:

• Acceptance by the gambler that control has been lost: This is the step before they ask for help.
• Asking for help: Having realised for themselves that gambling has taken control over their life, they may reach out to those closest to them
• Observation of too much time spent in a gambling environment: Such observations by friends or family may provoke discussion as to how this is affecting the life of a gambler.
• Getting in to financial trouble/Accumulation of debts: This might be a crisis point at which problem gambling might raise its head for the first time.
• Uncovered lies: Realization that the gambler has been caught lying may lead to admissions about their gambling problems
• Dwindling social circles/Losing close relationships: These observation may again lead to problem gambling being discovered by family or friends.
• Discovered crime: This is usually a real crisis point that the family may discover the truth for the first time.
• Homelessness: Being thrown out of the family home may be the trigger for problem gamblers to be honest for the first time about the mess they are in. 

Discovering that you are the parent of an adolescent problem gambler can be highly stressful – particularly as it is often a problem that parents feel they have to face on their own. Before getting involved with their children parents have to understand the problem as well as the process of problem gambling. By the time a young gambler acknowledges they have a problem, the family may have already gone through a lot of emotional turmoil including feelings of anger, sadness, puzzlement and guilt. Parents should try and get in touch with a helping agency as soon as possible. The following points are appropriate for parents either during or as a follow-up to their initial contact with a helping agency.

• Remember that you are not the only family facing this problem.
• You may be able to help your child by talking the problem through but it is probably better if a skilled person outside the family is also involved.
• Keep in mind that it is a serious matter and that the gambler cannot “just give up”.
• Take a firm stand; whilst it might feel easier to give in to demands and to believe everything they say, this allows your child to avoid facing the problem.
• Remember that your child likes to gamble and is getting something from the activity quite apart from money.
• Do not forget that gamblers are good at lying – to themselves as well as you
• Let your child know that you believe it is a problem even though they may not admit it.
• Encourage your child all the time as they have to be motivated to change
• Be prepared to accept that your child may not be motivated to change until they are faced with an acute crisis.
• Leave the responsibility for gambling and its consequences with the gambler, but also help them to face up to it and to work at overcoming the dependency.
• Do not condemn them, as it is likely to be unhelpful and may drive them further into gambling.
• Setting firm and fair boundaries for your child’s behaviour is appropriate and is likely to be constructive in providing a framework with which to address the dependency.
• Despite what your child may have done it is important to let them know that you still love them. This should be done even if you have to make a ‘tough love’ decision such as asking them to leave home.
• Do not trust them with money until the dependency has been broken. If they are agreeable it is a helpful strategy for a defined short period of time to manage their money for them. In addition, help develop their financial management skills.
• Encourage other alternative activities. Try to identify other activities that the child is good at and encourage them in that.
• Give praise for any achievements (however small) although don’t go over the top.
• Provide opportunities to contribute to the family or the running of the house to develop responsibility.
• Try to listen with understanding and look at them with pleasure. Communication channels between child and parent can easily be blocked so simple measures can pay big dividends.
• Bear in mind that as a parent you will need support too through this long process of helping the child. You will need the support of your family and may also need additional support from a helping agency.

Having successfully broken a dependency on gambling, it is important to put in place measures that will help prevent gambling relapses. Useful strategies include the following:

• Place a limit on future gambling, or avoid gambling altogether.
• Internalise learning and avoid reverting to ingrained reactions to difficult or stressful situations.
• Watch for situations and circumstances that trigger the urge to gamble and be ready to face them.
• Nurture self-esteem – work at feeling good about yourself.
• Develop a range of interests that, preferably, meet similar needs to those that were previously being met by gambling.
• Spend time and energy working at building good human relationships.
• Reassess the significance of money and endeavour to reduce its importance in your life.
• Continue to explore, on occasion, reasons why gambling became so significant in your life.

Other more general steps that gamblers should be encouraged to do include:

• Be honest with themselves and others
• Deal with all outstanding debts
• Accept responsibility for their gambling
• Abstain from gambling while trying to break the dependency
• Talk about how gambling makes them feel
• Take one day at a time
• Keep a record of ‘gambling-free’ days
• Be positive and not give up after a ‘slip’ or a ‘lapse’
• Reward themselves after a gambling-free period
• Develop alternative interests

Parents and practitioners should also be aware that problems are likely to be avoided when the young gambler keeps in control of the situation and ensures that their gambling remains a social activity. The following brief guide is aimed particularly for working with young gamblers but applicable to everyone. It will help ensure that gambling remains an enjoyable and problem-free experience. It is wise to remember that:

• When you are gambling you are buying entertainment, not investing money
• You are unlikely to make money from gambling
• The gaming industry and the government are the real winners
• You should only gamble with money that you can afford to lose
• You should set strict limits on how much you will gamble
• To make profit from gambling you should quit when ahead
• Gambling should only take up a small amount of your time and interest
• Problems will arise if you become preoccupied with gambling
• Gambling within your means is a fun and exciting activity
• Gambling outside your means is likely to create serious problems
• You should not gamble to escape from worries or pressures
• The feeling of being powerful and in control when gambling is a delusion
• A gambling dependency is as damaging as other addictions
• Always gamble responsibly

Hopefully the two parts of this blog have highlighted a potential danger among children and adolescence. It covered risk factors, warning signs to look for, and strategies to help those with a problem. Through education and awareness, it is hoped that gambling problems will be viewed no differently from other potentially addictive substances and that schools will take the issue seriously.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK 

Further reading

Bellringer, P. (1999). Understanding Problem Gamblers. London : Free Association Books.

Griffiths, M.D. (1995). Adolescent Gambling. London: Routledge.

Griffiths, M.D. (2002). Gambling and Gaming Addictions in Adolescence. Leicester: British Psychological Society/Blackwells.

Griffiths, M.D. (2003). Adolescent gambling: Risk factors and implications for prevention, intervention, and treatment. In D. Romer (Ed.), Reducing Adolescent Risk: Toward An Integrated Approach (pp. 223-238). London: Sage.

Griffiths, M.D. (2008). Adolescent gambling in Great Britain. Education Today: Quarterly Journal of the College of Teachers. 58(1), 7-11.

Griffiths, M.D. (2011). Adolescent gambling. In B. Bradford Brown & Mitch Prinstein (Eds.), Encyclopedia of Adolescence (Volume 3) (pp.11-20). San Diego: Academic Press.

Griffiths, M.D. (2013). Adolescent gambling via social networking sites: A brief overview. Education and Health, 31, 84-87.

Griffiths, M.D. & Linsey, A. (2006). Adolescent gambling: Still a cause for concern? Education and Health, 24, 9-11.

Griffiths, M.D. & Parke, J. (2010). Adolescent gambling on the Internet: A review. International Journal of Adolescent Medicine and Health, 22, 59-75.

Griffiths, M.D. & Wood, R.T.A. (2000). Risk factors in adolescence: The case of gambling, video-game playing and the internet. Journal of Gambling Studies, 16, 199-225.

Slots of fun: What should parents and teachers know about adolescent gambling? (Part 1)

Research has consistently shown that a small but significant minority of adolescents have a gambling problem. It has also been noted that adolescents may be more susceptible to problem gambling than adults. In Great Britain, the most recent statistics suggest that around 2% of adolescents have a gambling problem. This figure is two to three times higher than that identified in the adult population. On this evidence, young people are clearly more vulnerable to the negative consequences of gambling than adults.

A typical finding of many adolescent gambling studies has been that problem gambling appears to be a primarily male phenomenon. It also appears that adults may to some extent be fostering adolescent gambling. For example, a strong correlation has been found between adolescent gambling and parental gambling. Similarly, many studies have indicated a strong link between adult problem gamblers and later problem gambling amongst their children. Other factors that have been linked with adolescent problem gambling include working class youth culture, delinquency, alcohol and substance abuse, poor school performance, theft and truancy.

One consequence of the research into adolescent gambling is that we can now start to put together a ‘risk factor model’ of those individuals who might be at the most risk of developing problem gambling tendencies. Based on summaries of empirical research, a number of clear risk factors in the development of problem adolescent gambling emerge. Adolescent problem gamblers are more likely to:

• Be male (16-25 years)
• Have begun gambling at an early age (as young as 8 years of age)
• Have had a big win earlier in their gambling careers
• Consistently chase losses
• Gamble on their own
• Have parents who gamble
• Feel depressed before a gambling session
• Have low self-esteem
• Use gambling to cultivate status among peers
• Be excited and aroused during gambling
• Be irrational (i.e. have erroneous perceptions) during gambling
• Use gambling as a means of escape
• Have bad grades at school
• Engage in other addictive behaviours (smoking, drinking alcohol, illegal drug use)
• Come from the lower social classes
• Have parents who have a gambling (or other addiction) problem
• Have a history of delinquency
• Steal money to fund their gambling
• Truant from school to go gambling

There are also some general background factors that might increase the risk of becoming a problem gambler. Common factors include:

• Broken, disruptive or very poor family
• Difficult and stressful situations within the home
• Heavy emphasis on money within the family
• The death of a parent or parental figure in their childhood
• Serious injury or illness in the family or themselves
• Infidelity by parents
• High incidence of abuse (verbal, physical and/or sexual)
• Feeling of rejection as a child
• Feelings of belittlement and disempowerment

This list is probably not exhaustive but incorporates what is known empirically and anecdotally about adolescent problem gambling. As research into the area grows, new items to such a list will be added while factors, signs and symptoms already on these lists will be adapted and modified. Gambling has often been termed the ‘hidden addiction’. The main reasons for this arise from the problem with the identification. This is because:

• There are no observable signs or symptoms like other addictions (e.g. alcoholism, heroin addiction etc.)
• Money shortages and debts can be explained away with ease in a materialistic society
• Adolescent gamblers do not believe they have a problem or wish to hide the fact
• Adolescent gamblers are exceedingly plausible and become adept at lying to mask the truth
• Adolescent gambling may be only one of several excessive behaviours

Although there have been some reports of a personality change in young gamblers many parents may attribute the change to adolescence itself (i.e., evasive behaviour, mood swings etc. are commonly associated with adolescence). It is quite often the case that many parents do not even realize they have a problem until their son or daughter is in trouble with the police. I have noted there are a number of possible warning signs to look for although individually, many of these signs could be put down to adolescence. However, if several of them apply to a child or adolescent it could be that they will have a gambling problem. The signs include:

• No interest in school highlighted by a sudden drop in the standard of schoolwork
• Unexplained free time such as going out each evening and being evasive about where they have been
• Coming home later than expected from school each day and not being able to account for it
• A marked change in overall behaviour (that perhaps only a parent would notice). Such personality changes could include becoming sullen, irritable, restless, moody, touchy, bad-tempered or constantly on the defensive
• Constant shortage of money
• Constant borrowing of money
• Money missing from home (e.g., from mother’s purse or father’s wallet)
• Selling personal possessions and not being able to account for the money
• Criminal activity (e.g., shoplifting in order to sell things to get money for gambling)
• Coming home hungry each afternoon after school (because lunch money has been spent on gambling)
• Loss of interest in activities they used to enjoy
• Lack of concentration
• A “couldn’t care less” attitude
• Lack of friends and/or falling out with friends
• Not taking care of their appearance or personal hygiene
• Constantly telling lies (particularly over money)

However, many of these ‘warning signs’ are not necessarily unique to gambling addictions and can also be indicative of other addictions (e.g. alcohol and other drugs). Confirming that gambling is indeed the problem may prove equally as difficult as spotting the problem in the first place. Directly asking an individual if they have a problem is likely to lead to an outright denial. Talking with them about their use of leisure time, money and spending preferences, and their view about gambling in general is likely to be more effective. Part 2 to follow in my next blog!

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Bellringer, P. (1999). Understanding Problem Gamblers. London : Free Association Books.

Griffiths, M.D. (1995). Adolescent Gambling. London: Routledge.

Griffiths, M.D. (2002). Gambling and Gaming Addictions in Adolescence. Leicester: British Psychological Society/Blackwells.

Griffiths, M.D. (2003). Adolescent gambling: Risk factors and implications for prevention, intervention, and treatment. In D. Romer (Ed.), Reducing Adolescent Risk: Toward An Integrated Approach (pp. 223-238). London: Sage.

Griffiths, M.D. (2008). Adolescent gambling in Great Britain. Education Today: Quarterly Journal of the College of Teachers. 58(1), 7-11.

Griffiths, M.D. (2011). Adolescent gambling. In B. Bradford Brown & Mitch Prinstein (Eds.), Encyclopedia of Adolescence (Volume 3) (pp.11-20). San Diego: Academic Press.

Griffiths, M.D. (2013). Adolescent gambling via social networking sites: A brief overview. Education and Health, 31, 84-87.

Griffiths, M.D. & Linsey, A. (2006). Adolescent gambling: Still a cause for concern? Education and Health, 24, 9-11.

Griffiths, M.D. & Parke, J. (2010). Adolescent gambling on the Internet: A review. International Journal of Adolescent Medicine and Health, 22, 59-75.

Griffiths, M.D. & Wood, R.T.A. (2000). Risk factors in adolescence: The case of gambling, video-game playing and the internet. Journal of Gambling Studies, 16, 199-225.

The weighting game: Gambling with the nation’s health (revisited)

A couple of weeks ago I wrote a blog on why problem gambling should be considered a health issue. Earlier this week, I came across an interesting study carried out by jackpot.co.uk who surveyed 2,131 online gamblers (58% males and 42% female) about their health. After the self-reported data had been collected, the gamblers were classed into one of nine categories based on the casino game type that the gambler played most often (i.e., slot machines, video poker, blackjack, roulette, dice/craps, baccarat, poker, pai gow, and ‘other’). The data were then tabulated so that all the health variables (including obesity) corresponded to the gambler’s preferred casino game.

I was interested in the findings not only because I am a Professor of Gambling Studies, but also because I was a member of the Department of Health’s ‘Expert Working Group on Sedentary Behaviour, Screen Time and Obesity’ (a reference to our final report to the British government can be found in the ‘Further Reading’ section below). The study took an objective measurement of physical condition by asking each gambler their height (centimetres) and their weight (kilograms) to calculate each person’s Body Mass Index (BMI) by dividing the gamblers’ weight by height (metres) and dividing by height again (for example, someone who weighs 80kg and is 180cm tall, the BMI is 24.1 as this is 80/1.80)/1.80). The survey then asked s few general health and lifestyle questions (similar to ones that we have used in the last few British Gambling Prevalence Surveys:

• Do you normally drink more than the recommended limit for weekly alcohol consumption (21 units of alcohol for men and 14 for women)? (Yes/No)
• Do you smoke regularly? (Yes/No)
• Do you normally engage in at least 30 minutes of physical activity, 5 times per week? (Yes/No)

Overall, the survey found that British casino gamblers as a group were no less healthy than the rest of the British population, with an average Body Mass index (BMI) of 27 (which is the same as the UK national average). However, the survey also reported that the average BMIs, health, and lifestyle choices (such as smoking cigarettes, engaging in exercise, and drinking alcohol varied considerably depending on the casino games that the respondents played. Here are some of the main findings:

• Slots players were the least healthy. They took less exercise and had an average BMI of 31, pushing them into the category of obese (which is linked to increased chance of developing illnesses such as Type 2 diabetes and reduced life expectancy)
• Roulette, blackjack, video poker and craps/dice players were not far behind slots players, each having BMI levels higher than the national average.
• Those that played poker, baccarat and Pai Gow had an average BMI of 25 or under (well within the normal range recommended by the World Health Organisation.
• Whilst drinking levels might be reasonably high among poker players, they were very exercise conscious, with 58% engaging in physical activity for at least 30 minutes, five times a week. For slots players the figure was 27% meeting this government recommended target.
• Overall slots players drink the most, with 24.1% drinking over the recommended weekly limit. Poker players are not far behind on 23%. Female slots players were the biggest drinking subgroup, closely followed by male poker players.
• Slots players also smoked more, with 24% being regular smokers (compared to the UK national average of 20%). Blackjack and roulette players smoked slightly more than average, on 21% and 22% respectively, while poker players smoked slightly less than average, on 19.5%.

None of these results is overly surprising as there are many studies (including my own) showing comorbidity between gambling and other potentially addictive behaviours. However, very few academic studies have ever looked at these health variables by game type. Although this was not an academic study, the results will likely be of interest to those in the gambling studies field.

The survey also examined the most common platform on which the gamblers played casino games. The most common was the desktop computer (65%), followed by mobiles and tablets (20%) and land-based casinos (14%). This is not surprising given the survey was completed by online gamblers. Interestingly, desktop use was linked to higher levels of obesity, drinking and smoking. This is something that I would expect given that online gambling is the most sedentary of these activities.

There are (of course) some limitations with the data collected particularly as it comprised a self-selected sample of online gamblers that played via jackpot.co.uk websites. We have no idea as to whether the sample is representative of all online gamblers but as I noted above, it is no surprise that online gamblers preferred playing casino games online compared to offline (i.e., land-based casinos). The data were also self-report and are therefore open to any number of individual biases including recall biases and social desirability biases. Also, we have no geographical breakdown of the sample as the internet (by definition) is global. However, the sample size is good in comparison to many published studies on gambling and the sample included individuals that were actually gamblers (as opposed to university undergraduates or members of the general public). According to Sam Marsden (editor of jackpot.co.uk and author of the report):

“There’s an undeniable link connecting passive games like slots and video poker to unhealthy, sedentary lifestyles. On the other hand, games that require concentration, strategy and some physical stamina like poker and blackjack seem to fare much better in the health stakes. It seems it’s less a case of ‘you are what you eat’ and more ‘you are what you play’.”  

Although such a conclusion could be argued to be PR spin on the findings, the results suggest that more rigorous studies could be carried out in the area including secondary analyses of the robust datasets that already exist including the British Gambling Prevalence Surveys, the English Health Surveys, and the Scottish health Surveys.

Dr. Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Biddle, S., Cavill, N., Ekelund, U., Gorely, T., Griffiths, M.D., Jago, R., et al. (2010). Sedentary Behaviour and Obesity: Review of the Current Scientific Evidence. London: Department of Health/Department For Children, Schools and Families (126pp).

Griffiths, M.D. (2001). Gambling – An emerging area of concern for health psychologists. Journal of Health Psychology, 6, 477-479.

Griffiths, M.D. (2004). Betting your life on it: Problem gambling has clear health related consequences. British Medical Journal, 329, 1055-1056.

Griffiths, M.D. (2007). Gambling Addiction and its Treatment Within the NHS. London: British Medical Association (ISBN 1-905545-11-8).

Griffiths, M.D., Wardle, J., Orford, J., Sproston, K. & Erens, B. (2010). Gambling, alcohol consumption, cigarette smoking and health: findings from the 2007 British Gambling Prevalence Survey. Addiction Research and Theory, 18, 208-223.

Griffiths, M.D., Wardle, J., Orford, J., Sproston, K. & Erens, B. (2011). Internet gambling, health. Smoking and alcohol use: Findings from the 2007 British Gambling Prevalence Survey. International Journal of Mental Health and Addiction, 9, 1-11.

Marsden, S. (2014). Booze, bets, and BMI. Jackpot.co.uk, October 6. Located at: http://www.jackpot.co.uk/online-casino-articles/booze-bets-bmi

Rigbye, J. & Griffiths, M.D. (2011). Problem gambling treatment within the British National Health Service. International Journal of Mental Health and Addiction, 9, 276-281.

Wardle, H., Griffiths, M.D., Orford, J., Moody, A. & Volberg, R. (2012). Gambling in Britain: A time of change? Health implications from the British Gambling Prevalence Survey 2010. International Journal of Mental Health and Addiction, 10, 273-277.

Wardle, H., Moody. A., Spence, S., Orford, J., Volberg, R., Jotangia, D., Griffiths, M.D., Hussey, D. & Dobbie, F. (2011). British Gambling Prevalence Survey 2010. London: The Stationery Office.

Wardle, H., Seabury, C., Ahmed, H., Payne, C., Byron, C., Corbett, J. & Sutton, R. (2014). Gambling behaviour in England and Scotland: Findings from the Health Survey for England 2012 and Scottish Health Survey 2012. London: NatCen.

Wardle, H., Sproston, K., Orford, J., Erens, B., Griffiths, M. D., Constantine, R., & Pigott, S. (2007). The British Gambling Prevalence Survey 2007. London: National Centre for Social Research.

The national wealth service: Problem gambling is a health issue

Over the last decade, the United Kingdom has undergone major changes of gambling legislation (most notably, the 2005 Gambling Act that came into force on September 1, 2007). The Gambling Act has provided the British public with increased opportunities and access to gambling like they have never seen before. Gambling legislation was revolutionized and many of the tight restrictions on gambling dating back to the 1968 Gaming Act were relaxed (particularly in relation to the advertising of gambling). The deregulation of gambling has also been coupled with the many new media in which people can gamble (internet gambling, mobile phone gambling, interactive television gambling, gambling via social networking sites). Given the expected explosion in gambling opportunities, is this something that the health and medical professions should be concerned about?

Gambling has not been traditionally viewed as a public health matter although research into the health, social and economic impacts of gambling has grown considerably since the 1990s. In August 1995, the British Medical Journal published an editorial called ‘Gambling with the nation’s health?’ which argued that gambling was a health issue because it widened the inequalities of income and that there was an association between inequality of income in industrialized countries and lower life expectancy. However, there are many other more specific reasons why gambling should be viewed as an issue for the medical profession.

According to the last British Gambling Prevalence Survey (BGPS) published in 2011, just under 1% of the British population have a severe gambling problem although the rate is approximately twice as high in adolescents, particularly as a result of problematic slot machine gambling. Disordered gambling is characterized by unrealistic optimism on the gambler’s part. All bets are made in an effort to recoup their losses. The result is that instead of “cutting their losses”, gamblers get deeper into debt pre-occupying themselves with gambling, determined that a big win will repay their loans and solve all their problems.

It is clear that the social and health costs of problem gambling can be large on both an individual and societal level. Personal costs can include irritability, extreme moodiness, problems with personal relationships (including divorce), absenteeism from work, family neglect, and bankruptcy. I have also reported in a number of my papers (including a 2007 report I wrote for the British Medical Association) that there can also be adverse health consequences for both the gambler and their partner including depression, insomnia, intestinal disorders, migraines, and other stress-related disorders. In the UK, preliminary analysis of the calls to the national gambling helpline also indicated that a significant minority of the callers reported health-related consequences as a result of their problem gambling. These include depression, anxiety, stomach problems, other stress-related disorders and suicidal ideation.

There are also other issues relating to problem gambling that may have medical consequences. One US study published in the Journal of Emergency Medicine by Dr. Robert Muellman and his colleagues found that intimate partner violence (IPV) was predicted by pathological gambling in the perpetrator. In a sample of 286 women admitted to the emergency department at a University Hospital in Nebraska, findings revealed that a woman whose partner was a problem gambler was 10.5 times more likely to be a victim of IPV than partners of a non-problem gambler.

Health-related problems due to problem gambling can also result from withdrawal effects. In a study published in the American Journal of the Addictions, Dr. Richard Rosenthal and Dr. Henry Lesieur found that at least 65% of pathological gamblers reported at least one physical side-effect during withdrawal including insomnia, headaches, upset stomach, loss of appetite, physical weakness, heart racing, muscle aches, breathing difficulty and/or chills. Their results were also compared to the withdrawal effects from a substance-dependent control group. They concluded that pathological gamblers experienced more physical withdrawal effects when attempting to stop than the substance-dependent group. I also found similar things in a small study that I published in the Social Psychological Review (with Michael Smeaton).

Pathological gambling is very much the ‘hidden’ addiction. Unlike (say) alcoholism, there is no slurred speech and no stumbling into work. Furthermore, overt signs of problems often don’t occur until late in the pathological gambler’s career. If problem gambling is an addiction that can destroy families and have medical consequences, it becomes clear that medical professionals should be aware of the effects of gambling in just the same way that they are with other potentially addictive activities like drinking (alcohol) and smoking (nicotine).

However, gambling addiction is an activity that is not (at present) being treated via the British National Health Service (NHS). This was shown in a paper that I published with Dr. Jane Rigbye in a paper we published in a 2011 issue of the International Journal of Mental Health and Addiction. We sent a total of 327 letters were sent to all Primary Care Trusts, Foundation Trusts and Mental Health Trusts in the UK requesting information about problem gambling service provision and past year treatment of gambling problems within their Trust under the Freedom of Information Act. Our findings showed that 97% of the NHS Trusts did not provide any service (specialist or otherwise) for treating those with gambling problems (i.e., only nine Trusts provided evidence of how they deal with problem gambling). Only one Trust offered dedicated specialist help for problem gambling. Our study showed there was some evidence that problem gamblers may get treatment via the NHS if that person has other co-morbid disorders as the primary referral problem.

Problem gambling is very much a health issue that needs to be taken seriously by all within the health and medical professions. General practitioners routinely ask patients about smoking and drinking but gambling is something that is not generally discussed. Problem gambling may be perceived as a somewhat ‘grey area’ in the field of health and it is therefore very easy to deny that those in the medical profession should be playing a role. If the main aim of practitioners is to ensure the health of their patients, then it is quite clear that an awareness of gambling and the issues surrounding it should be an important part of basic knowledge.

As briefly outlined above, opportunities to gamble and access to gambling have increased because of deregulation and technology. What has been demonstrated from research evidence in other countries is that – in general – where accessibility of gambling is increased there is an increase not only in the number of regular gamblers but also an increase in the number of problem gamblers – although this may not be proportional. This obviously means that not everyone is susceptible to developing gambling addictions but it does mean that at a societal (rather than individual) level, in general, the more gambling opportunities, the more problems. Other countries such as Australia, Canada and New Zealand have seen increases in problem gambling as a result of gambling liberalization. In the UK, the last BGPS showed that problem gambling in Great Britain had increased by 50% compared to the previous BGPS published in 2007. (However, the latest data from the combined Health Survey for England and the Scottish Health Survey in 2014 reported that problem gambling had fallen to about 0.5%).

Gambling is without doubt a health and issue and there is an urgent need to enhance awareness within the medical and health professions about gambling-related problems and to develop effective strategies to prevent and treat problem gambling. The rapid expansion of gambling represents a significant public health concern and health/medical practitioners also need to research into the impact of gambling on vulnerable, at-risk, and special populations. It is inevitable that a small minority of people will become casualties of gambling in the UK, and therefore help should be provided for the problem gamblers. Since gambling is here to stay and is effectively state-sponsored, the Government should consider giving priority funding (out of taxes raised from gambling revenue) to organizations and practitioners who provide advice, counselling and treatment for people with severe gambling problems.

Dr. Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Griffiths, M.D. (2004). Betting your life on it: Problem gambling has clear health related consequences. British Medical Journal, 329, 1055-1056.

Griffiths, M.D. (2007). Gambling Addiction and its Treatment Within the NHS. London: British Medical Association.

Griffiths, M.D. (2011). Adolescent gambling. In B. Bradford Brown & Mitch Prinstein (Eds.), Encyclopedia of Adolescence (Volume 3) (pp.11-20). San Diego: Academic Press.

Griffiths, M.D., Scarfe, A. & Bellringer, P. (1999). The UK National telephone Helpline – Results on the first year of operation. Journal of Gambling Studies, 15, 83-90.

McKee, M. & Sassi, F. (1995). Gambling with the nation’s health. British Medical Journal, 311, 521-522.

Muelleman, R. L., DenOtter, T., Wadman, M. C., Tran, T. P., & Anderson, J. (2002). Problem gambling in the partner of the emergency department patient as a risk factor for intimate partner violence. Journal of Emergency Medicine, 23, 307-312.

Rigbye, J. & Griffiths, M.D. (2011). Problem gambling treatment within the British National Health Service. International Journal of Mental Health and Addiction, 9, 276-281.

Rosenthal, R. & Lesieur, H (1992). Self-reported withdrawal symptoms and pathological gambling. American Journal of the Addictions, 1, 150-154.

Setness, P.A. (1997). Pathological gambling: When do social issues become medical issues? Postgraduate Medicine, 102, 13-18.

Wardle, H., Moody. A., Spence, S., Orford, J., Volberg, R., Jotangia, D., Griffiths, M.D., Hussey, D. & Dobbie, F. (2011). British Gambling Prevalence Survey 2010. London: The Stationery Office.

Wardle, H., Seabury, C., Ahmed, H., Payne, C., Byron, C., Corbett, J. & Sutton, R. (2014). Gambling behaviour in England and Scotland: Findings from the Health Survey for England 2012 and Scottish Health Survey 2012. London: NatCen.

Net gains: What are the benefits of online therapy for problem gamblers and clinicians?

“A 35-year old man comes home very late from a night out at the casino having lost all his savings at the roulette wheel. Unable to sleep, he logs onto the Internet and locates a self-help site for problem gambling and fills out a 20-item gambling checklist. Within a few hours he receives an E-mail which suggests he may have an undiagnosed gambling disorder. He is invited to revisit the site to learn more about his possible gambling disorder, seek further advice from an online gambling counsellor and join an online gambling self-help group” (from Griffiths and Cooper, 2003)

On initial examination, this fictitious scenario appears of little concern until a number of questions raise serious concerns. For instance, who scored the gambling test? Who will monitor the gambling self-help group? Who will give online counselling advice for the gambling problem? Does the counsellor have legitimate qualifications and experience regarding gambling problems? Who sponsors the gambling website? What influence do the sponsors have over content of the site? Do the sponsors have access to visitor data collected by the website? These are all questions that may not be raised by a problem gambler in crisis seeking help but they are important questions that require answers. Of course, these are also questions that should apply to any comparable face-to-face interventions.

The Internet could be viewed as just a further extension of technology being used to transmit and receive communications between the helper and the helped. If gambling practitioners shun the new technologies, others who might have questionable ethics will likely come in to fill the clinical vacuum. Online therapy is growing. Furthermore, its growth appears to outstrip any efforts to organize, limit and regulate it. It has been claimed that online therapy is a viable alternative source of help when traditional psychotherapy is not accessible. Proponents claim it is effective, private and conducted by skilled, qualified, ethical professionals. It is further claimed that for some people, it is the only way they either can or will get help (from professional therapists and/or self-help groups).

Psychological services provided on the Internet range from basic information sites about specific disorders, to self-help sites that assess a person’s problem, to comprehensive psychotherapy services offering assessment, diagnosis and intervention. Most experts agree that online therapy currently available is not traditional psychotherapy. For many, it appears to be an alternative for those who are either unable or reluctant to seek face-to-face treatment. There have been many reasons put forward as to why online assistance is advantageous. Here are the main ones:

• Online therapy is convenient: Online therapy is convenient to deliver, and can provide a way to seek instant advice or get quick and discreet information. In the case of counselling by E-mail, one needs to keep in mind that therapy per se can occur either via professionally delivered formats or via peer-delivered self-help groups. In addition, the counselling might not necessarily be restricted to E-mail; some might augment face-to-face counselling with E-mail ‘booster’ sessions. In this way, correspondence happens at the convenience of both the client and the counsellor. Online therapy avoids the need for scheduling and the setting of appointments, although for those who want them, appointments can be scheduled over a potential 24-hour period. For problem gamblers who might have a sense of increased risk or vulnerability, they can take immediate action via online interventions, as these are available on demand and at any time. Crisis workers often report that personal crises occur beyond normal office hours, making it difficult for people to obtain help from mental health clinicians and the like. If a problem gambler has lost track of time at the casino only to depart depressed, broke, and suicidal at 4am in the morning, they can perhaps reach someone at that hour who will be understanding, empathic and knowledgeable. They likely have a better chance of finding someone at an online peer-support site like GamTalk (gamtalk.org) than they would at their local mental health centre.
• Online therapy is cost-effective for clients: Compared with traditional face-to-face therapies, online therapy is cheaper. This is a big selling point often used by those selling their services online (for instance, some sites advertise their online services as ‘less than the customary cost of a private therapy session’ or ‘help and therapy at a reasonable fee’). This is obviously an advantage to those who may have low financial resources. It may also allow practitioners to provide services to more clients because less time is spent travelling to see them. Since there are financial consequences for a gambler, cheaper forms of therapy such as online therapy may be a preferred option out of necessity rather than choice. The cost factor is particularly important in countries where people are often forced to pay for health care (for example, in the United States). With the Internet, quality information and support (even if treatment is not yet freely available online) is available without cost. Arguably, one needs Internet access, but this too is becoming more freely available, and conceivably, even those who are homeless would be able to utilize such services through places like public libraries (although, literacy would continue to be an important requirement).
• Online therapy overcomes barriers that otherwise may prevent people from seeking face-to-face help: There are many different groups of people who might benefit from online therapy. For example, those who are (i) physically disabled, (ii) agoraphobic, (iii) geographically isolated and/or do not have access to a nearby therapist (military personnel, prison inmates, housebound individuals etc.), (iv) linguistically isolated, and (v) embarrassed, anxious and/or too nervous to talk about their problems face-to-face with someone, and/or those who have never been to a therapist before might benefit from online therapy. Some like those with agoraphobia and/or the geographically isolated, might be more susceptible to activities like online gambling because they either tend not to leave home much or they do not have access to more traditional gambling facilities (like casinos, bingo halls, racetracks and so forth). It is clear that those that are most in need of help (whether it is for mental health problems, substance abuse or problem gambling often do not receive it).
• Online therapy helps to overcome social stigma: The social stigma of seeing a therapist can be the source of profound anxiety for some people. However, online psychotherapists offer clients a degree of anonymity that reduces the potential stigma. Gambling may be particularly stigmatic for some because they may find it is a self-initiated problem. Others have found that the issue of stigma has caused some problem gamblers to avoid seeking treatment. Furthermore, in an exploratory study, my research colleague Dr. Gerry Cooper found that there was a correlation between higher levels of concerns about stigma and the absence of treatment utilization, and that lurking (i.e., visiting but not registering presence to other users) at a problem gambling support group website made it easier for many to seek help including face-to-face help. It should also be noted that there is strong emerging evidence for the power and effectiveness of narrative therapies. For example, there is some evidence to suggest that a person’s use of positive emotion words in their written articulations of difficult or problematic experiences lead to improved health changes.
• Online therapy allows therapists to reach an exponential amount of people: Given the truly international cross-border nature of the Internet, therapists have a potential global clientele. Furthermore, gambling itself has been described as the ‘international language’ and has spread almost everywhere within international arenas.

From the brief outline presented here, it would appear that in some situations, online therapy can be helpful – at least to some specific sub-groups of society, some of which may include problem gamblers. Furthermore, online therapists will argue that there are responsible, competent, ethical mental health professionals forming effective helping relationships via the Internet, and that these relationships help and heal. However, online therapy is not appropriate for everyone. As with any new frontier, there are some issues to consider before trying it. In my next blog I will look at some of the downsides of online therapy.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Bloom, W. J. (1998). The ethical practice of Web Counseling. British Journal of Guidance and Counselling, 26 (1), 53-59.

Connall, J. (2000). At your fingertips: Five online options. Psychology Today, May/June, 40.

Griffiths, M.D. (2001). Online therapy: A cause for concern? The Psychologist: Bulletin of the British Psychological Society, 14, 244-248.

Griffiths, M.D. (2005). Online therapy for addictive behaviors. CyberPsychology and Behavior, 8, 555-561.

Griffiths, M.D. (2010). Online advice, guidance and counseling for problem gamblers. In M. Manuela Cunha, António Tavares & Ricardo Simões (Eds.), Handbook of Research on Developments in e-Health and Telemedicine: Technological and Social Perspectives (pp. 1116-1132). Hershey, Pennsylvania: Idea Publishing.

Griffiths, M.D. & Cooper, G. (2003). Online therapy: Implications for problem gamblers and clinicians, British Journal of Guidance and Counselling, 13, 113-135.

Rabasca, L. (2000). Self-help sites: A blessing or a bane? APA Monitor on Psychology, 31(4), 28-30.

Segall, R. (2000). Online shrinks: The inside story. Psychology Today, May/June, 38-43.

Wood, R.T.A. & Griffiths, M.D. (2007). Online guidance, advice, and support for problem gamblers and concerned relatives and friends: An evaluation of the Gam-Aid pilot service. British Journal of Guidance and Counselling, 35, 373-389.

Wood, R. T., & Wood, S. A. (2009). An evaluation of two United Kingdom online support forums designed to help people with gambling issues. Journal of Gambling Issues, 23, 5-30.

Period pain: A brief look at ‘binge gambling’

Most of you reading this will have probably heard of ‘binge drinking’ and ‘binge eating’. These behaviours are well known in the psychological literature. However, there has been very little research into the phenomenon of binge gambling. Binge gambling shares many similarities with other binge behaviours including loss of control, salience, mood modification, conflict, withdrawal symptoms, denial, etc. However, there are also clear differences between some binge behaviours. For instance, amounts of alcohol and food can be quantified and measured in terms of physical factors (e.g., organ capacity, weight, metabolic rate), and are therefore subject to physical limitation. The amount of money spent gambling can be highly individual, related to the gambler’s income and access to money, and is limited by few external controls aside from time, fatigue, and lack of funds.

In 2003, Dr. Lia Nower and Dr. Alex Blaszczynski published a case study of a binge gambler in the journal International Gambling Studies. They hypothesized the existence of a unique typology of adult gamblers that are distinctly different from traditional pathological gamblers. They hypothesized that gambling binges are characterized by six factors including:

• Sudden onset of irregular or intermittent periods of sustained gambling
• Excessive expenditures relative to income
• Rapidly spent money over a discrete interval of time
• Sense of urgency and impaired control
• Marked intra-and inter-personal distress
• Absence between bouts of any rumination, preoccupation or cravings to resume gambling participation.

More recently I also published a case study of a binge gambler in the International Journal of Mental Health and Addiction – a male slot machine addict that I called ‘Trevor’ (and aged 31 years when I published my study). I met Trevor in my capacity as an expert witness in a court trial. Trevor was charged with criminal offences related to his gambling behaviour.

Trevor’s initial gambling involvement started in the summer of 1990 when he was 16 years of age. At the time, Trevor had just begun working on a Youth Training Scheme in a West Midland town in the UK. His place of work was situated right next to an amusement arcade that housed many slot machines. Trevor’s normal routine was to go to the arcade every Friday (on his ‘pay day’). At this stage, Trevor rarely spent more than £3 at any one time on the machines and they were clearly unproblematic at that point.

Over the following years (1993–1996), Trevor’s slot machine gambling became progressively worse (at least in the amount he was spending on them) although not necessarily problematic. From 1995 onwards, Trevor had a good job as a support worker for people with disabilities. He was 21-years old and “making good money” (£250 a week), but about half of his salary was used to fund his slot machine gambling. Trevor recalled very vividly one Friday evening at the end of 1995 when he lost £200 of his weekly wage playing a slot machine. This he said was “devastating” to him. It was after this single incident that Trevor admitted to himself that he may have a problem with his gambling. Trevor is what would best be described as a binge gambler and did not gamble daily. His typical pattern would be to gamble only once or twice a week (most Fridays and the occasional Sunday). However, these binges often resulted in the losing of substantial sums of money — at least substantial to Trevor.

The real “crunch” in Trevor’s life came in the latter half of 1997 (aged 23 years) when because of his excessive gambling he failed to pay any rent or bills and was evicted from the flat he was living in at the time. In February 1998, Trevor started attending Gamblers Anonymous (GA) even though there was not a local group to attend. This meant he had to travel to Birmingham, which was three-quarters of an hour away from where he lived. Trevor attended GA for just over a year and eventually left in March 1999. While drop out rates for GA tend to be high (over 90% in the first few weeks of attendance), Trevor gained immense benefit from this group by the fact he attended for a significant period of his life. The weekly GA meeting provided a supportive network that helped Trevor’s gambling problem subside. He also knew he wasn’t alone in experiencing these types of problem.

During the following five-year period (early 1999 to early 2004), Trevor didn’t gamble at all, took control of his own earnings, and appeared to have his slot machine gambling under control. During this period, his gambling problem almost totally subsided. He began a relationship in 2000, and in 2002, they had a baby son. Trevor gambled small amounts (approximately £2 to £3) very occasionally on slot machines and always in the company of his partner who would be “keeping an eye on him” to make sure he didn’t overspend. During this period of over three years, Trevor claimed he was in control of his gambling and that because his life had some stability.

In February 2004, Trevor and his partner split up and Trevor’s gambling once again “spiralled out of control”. Most of the time Trevor would be gambling on his favourite slot machine in his local pub because it served as an escape from the breakdown of his relationship. Trevor claimed that only a quarter of his wages at this point was spent on gambling because he needed to keep money back to buy things for when he got periodic access to his young son (such as nappies, food, etc.).

On the surface, this type of behaviour does not appear to be indicative of someone totally out of control with their gambling, as most problem gamblers do not think about the consequences of their actions before they gamble. It could be the case that Trevor was either lying about how much money he spent or — like many gamblers — was not accurately recalling how much money he was spending during this period. Alternatively, and perhaps more likely, he only gambled excessively when there was nothing else to focus on his life. If Trevor’s self-report is to be believed, his son appeared to act as a barrier to the worst excesses of his gambling as his son came first when he had access to him. On the occasions where Trevor was totally responsible for his son, it forced Trevor’s problem gambling into the background somewhat.

The research literature (including my own work) certainly shows that major life events often cause spontaneous remission in gambling addictions (e.g., getting married, birth of first child, getting a job etc.). During this period in 1994, Trevor didn’t feel he had enough to support his gambling from his wages as he resorted to criminal acts, (i.e., opening mail at the postal depot where he worked in an attempt to get money to gamble on slot machines). Being caught stealing money to feed his gambling habit clearly indicated to Trevor that he needed help with his gambling again. He once again attended GA in the latter half of 2004.

Trevor believed his gambling problems were related to low self-esteem coupled with feeling depressed and having nothing else to do. Such feelings are typically found in problem gamblers who use gambling as a way of modifying their mood. Trevor claimed that his excessive gambling was integrally linked with his mood state and that when he was feeling down and/or agitated he sought solace in gambling that made him (temporarily) feel better. However, when he lost money, he would feel even worse. Trevor’s gambling problems were usually linked to other underlying problems. When these were dealt with, his problem gambling all but disappeared. It became obvious that Trevor’s gambling binges were typically caused by very specific ‘trigger’ incidents and that Trevor used gambling as a way of making himself feel better. The break-up of his last relationship was such a clear trigger incident.

Compared to other problem gamblers I have known, Trevor’s gambling was much less problematic. The gambling was usually symptomatic of other problems in Trevor’s life. In short, problem gambling only occurred at two very specific periods in Trevor’s life (1997 and 2004) and that these binges were triggered by very specific incidents. It is also worth noting that Trevor’s gambling problem was very specific (i.e., slot machines) and that no other types of gambling caused him any problems. Trevor’s case appears to adhere to the six characteristics of binge gambling outlined above by Dr. Nower and Dr. Blaszczynski in that there was irregular or intermittent periods of sustained gambling, excessive expenditures relative to income, rapidly spent money over a discrete interval of time, a sense of urgency and impaired control (at least at the times of problem gambling), marked intra- and inter-personal distress, and absence between bouts of any rumination, preoccupation or cravings to resume gambling participation.

It is not uncommon for problem gamblers to gamble excessively on ‘pay days’, lose their money, and wait for the next cycle. What really distinguishes Trevor as a binge gambler is that there is clear evidence that Trevor has had long periods of trouble-free gambling in his life (e.g., 1990 to 1995; 2000 to 2004). When things were going well for Trevor, gambling was simply not an issue. When given access and responsibility for his son, Trevor clearly puts him before anything else. Being totally responsible for his son appears be a major protective barrier in preventing him gamble.

It is also interesting to note that between his two major binges of problem gambling (1997 and 2004), Trevor appeared to have phases of both abstinent and controlled gambling. This shares some similarities with the literature on controlled drinking (particularly the pioneering research of Dr. Linda Sobell and Dr. Mark Sobell) which suggests that alcoholics who had sustained periods of non-problematic social drinking may be more likely to be able return to controlled drinking. Trevor’s case also supports other case studies in the gambling literature showing that controlled gambling after periods of problem gambling is possible.

The concept of problem binge gambling is still a much overlooked area. It appears to be less serious than chronic problem gambling but can still cause significant problems in the lives of people it affects. More research should be carried out along the lines of the types of research that are currently being carried out into binge drinking.

Dr. Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Dickerson, M. G., & Weeks, D. (1979). Controlled gambling as a therapeutic technique for compulsive gamblers. Journal of Behavioural Therapy and Experimental Psychiatry, 10, 139–141.

Griffiths, M.D. (1994). The role of cognitive bias and skill in fruit machine gambling. British Journal of Psychology, 85, 351–369.

Griffiths, M.D. (1995). Adolescent gambling. London: Routledge.

Griffiths, M.D. (2002). Gambling and gaming addictions in adolescence. Leicester: British Psychological Society/Blackwells.

Griffiths, M.D. (2004). Betting your life on it: Problem gambling has clear health related consequences. British Medical Journal, 329, 1055–1056.

Griffiths, M.D. (2006). A case study of binge problem gambling. International Journal of Mental Health and Addiction, 4, 369-376.

Nower, L., & Blaszczynski, A. (2003). Binge gambling: A neglected concept. International Gambling Studies, 3, 23–35.

Rankin, H. (1982). Control rather than abstinence as a goal in the treatment of excessive gambling. Behavioural Research Therapy, 20, 185–187.

Sobell, L. C., Sobell, M. B., & Ward, E. (Eds.) (1980). Evaluating alcohol and drug abuse treatment effectiveness. Elmsford, New York: Pergamon.

No lady luck: A case study of adolescent female slot machine addiction

Based on research into adolescent slot machine playing, all British research has found that most adolescent slot machine players are male and that very few female adolescent slot machine addicts have ever been identified in the literature. The main findings relating to adolescent female slot machine players were published in papers by Dr. Sue Fisher and myself (mostly in the 1990s). In 1993, Dr. Fisher reported the existence of teenage females with no playing skills and little interest in acquiring them, and who gamble on slot machines primarily to gain access to the arcade venue where they can socialize with their friends (calling them ‘Rent-a-Spacers’). Their preferred role is one of ‘spectator’. In an earlier published (1991) study in the Journal of Applied and Community Psychology, I observed that arcades were a meeting place for adolescent social groups in which playing activity was predominantly male-oriented with girls looking on in ‘cheerleader’ roles. In 2003, I published a rare case study of an adolescent female slot machine addict (who I called ‘Jo’) and thought I would share some of the things I found from that study in today’s blog

During a nine-month period, I interviewed Jo three times formally and also maintained regular contact with her on an informal basis. She was confirmed as a probable pathological gambler using the American Psychiatric Association’s DSM-IV criteria for pathological gambling.

Jo was brought up as an only child in a seaside town in the South West of England. She described her parents as “comfortable, middle class and loving”. However, she also made reference to the fact that there were reasonably strict rules in the house. Her father was an insurance salesman and her mother was a schoolteacher. She went to a mixed school, and up to the age of 13 years she had good school reports and was in the top 10% of her class academically. She was also very good at sports (and was an active member of the school athletics club) and described herself as “physically stronger” than most of her peers. Jo claims she did not really relate to the other girls in her school and often got into playground fights with them. During her early adolescence she made a few good friends although these were mostly boys of her own age or a little older. She herself described her adolescent years as a “tomboy”. Educationally, she left school when she was 16 years old and got an office job working as an administrative assistant.

Jo started playing slot machines at a young age because they were so abundant in the town where she lived. She described them as “being part of the wallpaper”. To some extent, her parents encouraged her gambling. Like a lot of “seaside parents”, they often took Jo to the amusement arcades as a child for “a weekend treat”. Like many families, they did not see anything wrong with going to the seaside arcade because they felt it was “harmless fun and didn’t cost much.” However, these early experiences coupled with exposure to slot machines in her peer group were instrumental factors in Jo’s acquisition of slot machine playing. Living in a seaside town, access to the machines was widespread, and the main place for “hanging out” was at the local arcades. There were four or five of them because the town was a popular tourist attraction. Arcades provided a meeting point for her friends. She was part of a gang in which hanging around the arcades was one of the few activities that the group could engage in.

At 13 years old, she mainly used to just watch her male friends play on the slot machines and video games. However, within a year, she was playing on slot machines as much as her peers. The arcade was where Jo “felt safe and protected”. She liked it that everyone who worked there knew who she was. In the arcade she was a ‘somebody’ rather than a ‘nobody’. In essence, the arcade provided a medium where Jo’s self-esteem was raised.

Jo gave a number of insights into her motivations for slot machine playing. Skill did not appear to be a motivating factor for continued play. She played to win money (to further her playing rather than fuel any winning fantasies) and did not see the machines as particularly skilful. Although most of Jo’s (male) friends claimed that slot machine playing was very skillful if you were good at it, Jo always believed that slot machines were not like video games and that “winning big” had a lot of luck to it. Knowing her way round a slot machine while helpful, didn’t make her feel as though she was especially skilful except when complete novices would play. Also, being female, the older age women who played on the simple machines would talk to her (unlike the adolescent males who would be shunned by this clientele). This made her feel wanted and needed. However, between the ages of 14 and 15 years, Jo’s slot machine playing became all encompassing. As she explains:

“There was a period in my life between the ages of 15 and 17 where the machines became the most important thing in my life. I didn’t worry about money. I just believed I would win it back or that money would come from somewhere because it always had. I was forever chasing my losses. I would always tell myself that after a bad loss, the arcade was only ‘borrowing’ my money and that they would have to ‘pay it back’ next time I was in there. Of course, that rarely happened but once I was playing again, money worries and losses went out of the window. Gambling became my primary means of escape. On the positive side, at least it helped me to give up smoking and drinking. I simply couldn’t afford to buy nicotine or alcohol – or anything else for that matter. I never believed that gambling would make me rich – I just thought it would help me clear my debts.”

Jo didn’t acknowledge that she had a problem – even when she started to go down to the arcade on her own and using all her disposable income to fund her slot machine playing. However, in retrospect, she realized a problem was developing.

“I used to spend every penny I had on the (slot) machines. It was a good job I wasn’t into clothes like the other girls at school. I couldn’t have afforded to buy anything as I lost everything I had in the long run. I used to wear the same pair of jeans for months. I don’t even think I washed them”.

When Jo was 15 years old, a telephone call from the school headmaster alerted Jo’s mother that her daughter might be having some problems in her life. The headmaster phoned to say that Jo’s attendance had been very poor during the previous three months and that she had stopped attending athletics practice. When confronted, Jo admitted that she had not been attending school but said that all the girls in her class hated her. To some extent this was true (she didn’t get on with any of the girls at her school) but was not the reason she was truanting. Instead of going to school she had been spending her time in the local arcades. For a few weeks she tried to stop her gambling. Now that her parents knew there were problems, she thought this would be the ideal time to give up. However, after 17 days without gambling, her boyfriend split up with her and she relapsed by gambling again. This then carried on for almost two years.

Jo’s parents were very understanding and looked for alternatives to help their daughter. They considered moving classes within the school and moving schools completely. Jo simply said she would try to integrate more. At no stage did Jo’s parents ever suspect that her erratic behaviour was linked to anything other than the problems of adolescent mixing. Jo managed to successfully hide her problem for a further two years before everything came out into the open.

As an only child it was difficult for Jo’s parents to know whether their experience was normal. They hardly saw Jo. At the age of 16 years, Jo upset her parents not only by leaving school but also by leaving home. They knew there was little that they could do. When Jo left home, she assumed that all her problems would disappear. However, she got into more and more trouble and was unable to make ends meet. She lived from hand to mouth. She began to steal from friends, from work and from anyone she met. On two occasions she met males she had never met before that moment, went back to their houses, and then stole their money and/or valuables.

Over this period of nearly two years Jo became more and more withdrawn, lost her friends and ended up resorting to stealing from her place of work. Eventually she was sacked (for taking the petty cash) although her employers were unaware that her problem was gambling (or that she even had a problem). They assumed she wanted more money to supplement her very modest wages. Although she lost her job, the company did not instigate criminal charges.

The first major turning point was being sacked from her first job for theft of the petty cash. She had nowhere else to go but back home. Her parents were a tremendous support although were surprised that slot machines were the heart of the problem. Jo claimed her mother didn’t believe her at first. They wondered how someone could get addicted to a machine. Jo claimed it would have been easier for her mother to accept if she had a drug or alcohol problem rather than a gambling problem.

The cessation of her gambling began when Jo (with her parents’ help) got another job in a remote village in Cornwall (in South West England). There was no arcade, no slot machines in the local pub, and no slot machine within a four-mile radius. She did not drive a car and it was too far to walk to the nearest town. In essence, the lack of access to a slot machine forced her to stop playing. She still got the cravings but there was nothing she could do. She also claimed to have a number of serious self-reported withdrawal symptoms. At work she was short-tempered, irritable with colleagues, and constantly moody. Physically, she had trouble sleeping, and occasionally had stomach cramps, and felt nauseous through lack of play.

Jo eventually joined a local Gamblers Anonymous (GA) that her parents drove her to every week. She only attended a handful of times and stopped attending because she was the only female in the group, the only slot machine player, and also the youngest. Despite the opportunity to share her experiences with eleven or twelve people in a similar position to herself, she felt psychologically isolated. Being able to talk about the problem with people she could trust (i.e., her parents) was a great help. In addition, with her desire to stop and with no access to slot machines, Jo managed to curtail her gambling. She claims she “wasted four years of her adolescence” due to slot machine playing – and she doesn’t want to waste any more of her life. However, there is no certainty that Jo is ‘cured’ – Jo feels a number of triggers could set her off again (like rejection of someone close to her). Talking to people has been Jo’s “salvation” as she calls it. She had always thought that slot machine playing couldn’t be a problem and therefore found it hard that people would accept the “addiction” she had. Other people’s acceptance that she suffered something akin to alcoholism or drug addiction has helped her recovery.

From my own personal research experience, Jo’ account is fairly typical of slot machine addicts. This is an individual who began playing slot machines socially, steadily gambled more and more over time, spent every last penny on gambling and resorted to the cycle of using their own money, borrowing money, and then finally stealing money, just to fund their gambling habit. Criminal proceedings could have occurred but fortunately (for Jo), she was punished by losing her job. The one major difference between this and all other accounts is that Jo happens to be female.

The major limitation of a study such as this is that it relied totally on retrospective self-report. Not only do I have to take Jo’s account as true but it is also subject to the fallibility of human memory. There is also the major limitation that the findings here are based on one person only and there is little that can be said about generalizability.

Dr. Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Fisher, S. E. (1992). Measuring pathological gambling in children: The case of fruit machines in the U.K. Journal of Gambling Studies, 8, 263-285.

Fisher, S. (1993). The pull of the fruit machine: A sociological typology of young players. Sociological Review, 41, 446-474.

Griffiths, M.D. (1991). The observational analysis of adolescent gambling in UK amusement arcades. Journal of Community and Applied Social Psychology, 1, 309-320.

Griffiths, M.D. (1995). Adolescent Gambling. London : Routledge.

Griffiths, M.D. (2002). Gambling and Gaming Addictions in Adolescence. Leicester: British Psychological Society/Blackwells.

Griffiths, M.D. (2003). Fruit machine addiction in females: A case study. Journal of Gambling Issues, 8. Located at: http://jgi.camh.net/doi/full/10.4309/jgi.2003.8.6

Griffiths, M.D. (2011). Adolescent gambling. In B. Bradford Brown & Mitch Prinstein(Eds.), Encyclopedia of Adolescence (Volume 3) (pp.11-20). San Diego: Academic Press.

Griffiths, M.D. (2011).A typology of UK slot machine gamblers: A longitudinal observational and interview study. International Journal of Mental Health and Addiction, 9, 606-626.