Levy settle: A statutory gambling levy is needed to help treat gambling addicts

At the most recent Labour Party conference, the Party’s deputy leader Tom Watson said that if they formed the next Government they would introduce legislation to force gambling operators to pay a levy to fund research and NHS treatment to help problem gamblers deal with their addiction. This is something which I wholeheartedly support and is also something that I have been calling for myself for over a decade

The most recent statistics on gambling participation by the Gambling Commission in August 2017 reported that 63% of the British population had gambled in the last year and that the prevalence rate of problem gambling among those 16 years and over was 0.6%-0.7%. While this is relatively low, this still equates to approximately 360,000 adult problem gamblers and is of serious concern.

At present the gambling industry voluntarily donates money to an independent charitable trust (GambleAware) and most of this money funds gambling treatment (with the remaining monies being used to fund education and research). In the 12 months prior to March 2017, the gambling industry had donated £8 million, an amount still 20% below the £10 million a year I recommended in a report I wrote for the British Medical Association a number of years ago.

A statutory levy of 1% on all gambling profits made by the British gambling industry would raise considerably more money for gambling education, treatment and research than the £8 million voluntarily donated last year and is the main reason why I am in favour of it. Gambling has not been traditionally viewed as a public health matter. However, I believe that gambling addiction is a health issue as much as a social issue because there are many health consequences for those addicted to gambling including depression, insomnia, intestinal disorders, migraine, and other stress related disorders. This is in addition to other personal issues such as problems with personal relationships (including divorce), absenteeism from work, neglect of family, and bankruptcy.

There are also many recommendations that I would make in addition to a statutory levy. These include:

• Brief screening for gambling problems among participants in alcohol and drug treatment facilities, mental health centres and outpatient clinics, as well as probation services and prisons should be routine.
• The need for education and training in the diagnosis and effective treatment of gambling problems must be addressed within GP training. Furthermore, GPs should screen for problem gambling in the same way that they do for other consumptive behaviours such as cigarette smoking and alcohol drinking. At the very least, GPs should know where they can refer their patients with gambling problems to.
• Research into the efficacy of various approaches to the treatment of gambling addiction in the UK needs to be undertaken and should be funded by GambleAware.
• Treatment for problem gambling should be provided under the NHS (either as standalone services or alongside drug and alcohol addiction services) and funded either by gambling-derived revenue (i.e., a ‘polluter pays’ model).
• Given the associations between problem gambling, crime, and other psychological disorders (including other addictions), brief screening should be routine for gambling problems should be carried out in alcohol and drug treatment facilities, mental health centres and outpatient clinics, as well as probation services and prisons.
• Education and prevention programmes should be targeted at adolescents along with other potentially addictive and harmful behaviours (e.g., smoking, drinking, and drug taking) within the school curriculum.

As I have tried to demonstrate, problem gambling is very much a health issue that needs to be taken seriously by all in the medical profession. 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 grey area in the field of health. If the main aim of practitioners is to ensure the health of their patients, then an awareness of gambling and the issues surrounding it should be an important part of basic knowledge in the training of those working in the health field.

Gambling is not an issue that will go away. Opportunities to gamble and access to gambling have increased due to the fact that anyone with Wi-Fi access and a smartphone or tablet can gamble from wherever they are. While problem gambling can never be totally eliminated, the Government must have robust gambling policies in place so that potential harm is minimized for the millions of people that gamble. For the small minority of individuals who develop gambling problems, there must be treatment resources in place that are affordable and easily accessible.

(N.B. This is a longer version of an article that was originally published in The Conversation)

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Auer, M. & Griffiths, M.D. (2013). Behavioral tracking tools, regulation and corporate social responsibility in online gambling. Gaming Law Review and Economics, 17, 579-583.

Griffiths, M.D. (2003). Problem gambling. The Psychologist: Bulletin of the British Psychological Society, 16, 582-584.

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). The lost gamblers: Problem gambling. Journal of the Royal Statistical Society, 3(1), 13-15.

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

Griffiths, M.D. (2017). Gambling regulation from a psychologist’s perspective: Thoughts and recommendations. In Gebhardt, I. (Ed.), Glücksspiel – Ökonomie, Recht, Sucht (Gambling – Economy, Law, Addiction) (Second Edition) (pp. 938-944). Berlin: De Gruyter.

Meyer, G., Hayer, T. & Griffiths, M.D. (2009). Problem Gambling in Europe: Challenges, Prevention, and Interventions. New York: Springer.

Aid and a bet: A brief look at the prevention of problem gambling

While prevention efforts targeting addictive disorders are widely used, there are relatively limited data are available on their effectiveness (particularly in the gambling studies field). According to the US Preventive Services Task Force, prevention has historically been divided into three stages. The term primary prevention has been used to describe measures employed to “prevent the onset of a targeted condition”. Secondary prevention has been used to describe measures that “identify and treat asymptomatic persons who have already developed risk factors or pre-clinical disease but in whom the condition is not clinically apparent”. Tertiary prevention has been used to describe “efforts targeting individuals with identified disease in which the goals involve restoration of function, including minimizing or preventing disease-related adverse consequences”. These divisions of prevention thus focus on different targets, with primary efforts tending to target the general population, secondary efforts at risk or vulnerable groups, and tertiary efforts individuals with an identified disorder.

Primary prevention is typically considered the most cost-effective form of prevention as it helps reduce suffering, cost and burden associated with a disorder. Primary prevention efforts related to problem gambling have generally involved education initiatives. Examples include television commercials, billboards, posters, and postcards, that may feature brief problem gambling screening instruments or advertise gambling helplines and treatment services. Despite widespread use, most primary prevention efforts in gambling have not been empirically validated.

The content and impact of primary prevention is strongly influenced by knowledge of the impact of the behaviour or disorder being prevented. For example, prevention efforts targeting tobacco smoking cessation have changed significantly as more information concerning the health impact of tobacco smoke have become available. Unfortunately, few large-scale, well-designed studies have investigated the health impact of different levels or types of gambling (e.g., recreational, problem, and pathological).

Some primary prevention efforts targeting children and adolescents may influence adult gambling behaviors. Some of these studies have published promising results but all studies have shortcomings (e.g., cross-sectional designs that don’t allow for assessment of lasting positive effects on gambling attitudes or behaviour). Basically, it’s unclear if the positive effects found will be maintained into adulthood or if the same interventions employed on adolescent populations would be effective for adults. Research on prevention programs outside of the gambling field has suggested that regardless of delivery mode (didactic lecture, videotapes, posters, pamphlets, guest speakers etc.), the ‘information only’ approach has relatively little effect on behavioural change.

Another feature to be considered in primary prevention is the impact of gambling availability on the development of problem gambling. Over the past several decades, there has been a rapid increase in the availability of legalized gambling worldwide. Data suggest that concurrent with the increase in availability there have been increase in the rates of recreational, problem and pathological gambling. The extent to which gambling should be regulated and/or restricted remains an area of active debate, with the decisions holding considerable potential impact on public health and prevention efforts. In summary, although primary prevention efforts related to adult gambling exist, they are relatively few in number, particularly when considering the public health impact of problem gambling.

Secondary prevention efforts involve measures that target individuals with risk factors for or pre-clinical forms of a disorder. Secondary prevention measures in general constitute important interventions in general medical settings. Although it is likely that generalist physicians encounter individuals with gambling problems in their provision of clinical care, the extent to which they are trained to examine for or feel comfortable in assessing gambling problems warrants consideration. However, a significant minority of gamblers report health problems as a direct result of their gambling. This indicates that gambling in its most excessive forms should be viewed as a serious health issue to be taken seriously by the medical profession. Adverse health consequences for both the gambler and their partner include depression, insomnia, intestinal disorders, migraines, and other stress-related disorders. 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 medicine and it is therefore is very easy to deny that medics should be playing a role. If the main aim of practitioners is to ensure the health of their clients, then it is quite clear that an awareness of gambling and the issues surrounding should be an important part of basic knowledge.

Efficient screening methods for problematic gambling behaviours could be of significant value in general medical settings. Several brief screening instruments for problem and pathological have been developed. Although it is likely too early to develop practice guideline for problem and pathological gambling prevention efforts within a general medical setting, generalist physicians could regularly assess patients’ gambling histories, sensitively broach the topic of the possible existence of gambling problems with those patients suspected of engaging problematically in gambling, thoughtfully motivate individuals with gambling problems to seek treatment, and appropriately refer individuals with gambling problems to a self-help group or a gambling to facilitate engagement in locally available gambling treatment.

Brief screening instruments could also be of significant utility in other settings, including mental health and addiction treatment offices, jails and other forensic facilities, and gambling venues. Individuals within these settings should be aware of the high rates of problem gambling in specific groups (e.g., males, adolescents, and individuals with histories of incarceration or psychiatric [including substance use] disorders). Given the high rates of co-occurrence of gambling and other psychiatric disorders, screening of individuals with problem or pathological gambling for other psychiatric disorders (and vice versa) could enhance tertiary prevention efforts (i.e., providing treatment that more effectively reduces the harm associated with each disorder).

Individuals attending gambling venues represent important areas for secondary prevention efforts. Many gambling venues train their staff to identify potential problem or pathological gamblers and advertise within the facilities methods for patrons to obtain help (e.g., through gambling helplines and/or self-exclusion programs). Specific populations, although at arguably lower risk, might require unique prevention efforts. For example, gambling problems are more prevalent in men than women, and there exist gender-related differences in problem gambling behaviours (e.g., women generally beginning to gamble and developing problems with gambling later in life). As such, prevention efforts for men and women might preferentially target specific venues or age groups.

Tertiary prevention efforts, involving reducing disorder-related harm in affected individuals, include treatment efforts, and behavioural and pharmacological therapies for problem gambling. ‘Early’ tertiary prevention efforts involve moving individuals with recently recognized gambling problems into treatment (e.g., through gambling helplines) and non-treatment-related methods for helping individuals with gambling problems refrain from gambling (e.g., through availability and maintenance of casino self-exclusion policies).

Gambling helplines are widely around the world. Information from helpline callers can help enhance prevention efforts. However, further work is needed to examine directly the effectiveness of helplines with regard to treatment referral follow-up. That is, information obtained from callers willing to be called back several months following initial contact with the helpline would be valuable in assessing the extent to which problem gamblers have benefited from the helpline intervention. Self-exclusion policies exist in casinos and other gambling venues (e.g., bookmakers) around the world. Although the precise rules and regulations vary according to geographic location and individual casino, they generally involve voluntary self-exclusion for a period of time (e.g., 6 months to five years).

Increased knowledge regarding the impact of different types/levels of gambling behaviours on health and wellbeing would be extremely valuable in generating guidelines for healthy gambling and primary prevention efforts. An increased understanding of high-risk and vulnerable populations, facilitated through biological, psychological/psychiatric and social investigations, and the natural histories of gambling behaviors within these groups will help enhance secondary and early tertiary prevention efforts. As in other fields of medicine, the effectiveness of individual prevention strategies will need to be empirically validated. Targeted efforts in these areas should lead to a decrease in suffering attributable to problem gambling.

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

Further reading 

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

Griffiths, M.D. (2008). Youth gambling education and prevention: Does it work? Education and Health, 26, 23-26.

Griffiths, M.D. (2010). The gaming industry’s role in the prevention and treatment of problem gambling. Casino and Gaming International, 6(1), 87-90.

Griffiths, M.D. (2012). Self-exclusion services for online gamblers: Are they about responsible gambling or problem gambling? World Online Gambling Law Report, 11(6), 9-10.

Hayer^, T., Griffiths, M.D. & Meyer, G. (2005). The prevention and treatment of problem gambling in adolescence. In T.P. Gullotta & G. Adams (Eds). Handbook of Adolescent Behavioral Problems: Evidence-Based Approaches to Prevention and Treatment (pp. 467-486). New York: Springer.

Hayer, T. & Griffiths, M.D. (in press). The prevention and treatment of problem gambling in adolescence. In T.P. Gullotta & G. Adams (Eds). Handbook of Adolescent Behavioral Problems: Evidence-based Approaches to Prevention and Treatment (Second Edition). New York: Kluwer.

Korn, D., Shaffer HJ. (1999). Gambling and the health of the public: Adopting a public health perspective. Journal of Gambling Studies, 15, 289-365.

Meyer, G., Hayer, T. & Griffiths, M.D. (2009). Problem Gaming in Europe: Challenges, Prevention, and Interventions. New York: Springer.

Potenza, M. & Griffiths, M.D. (2004). Prevention efforts and the role of the clinician. In J.E. Grant & M. N. Potenza (Eds.), Pathological Gambling: A Clinical Guide To Treatment (pp. 145-157). Washington DC: American Psychiatric Publishing Inc.

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.

Shaffer, H., Korn DA. (2002). Gambling and related mental disorders: A public health analysis. Annual Review of Public Health, 23, 171-212.

US Preventive Services Task Force (1996). Guide to clinical preventative services (2nd edition). Baltimore, MD: Williams & Wilkens.

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.

What is the gaming industry’s role in the prevention and treatment of problem gambling?

Over the last decade, social responsibility in gambling has become one of the major issues for professional gaming operators. Although the gaming industry understandably keeps an eye on their bottom line profits, there is an increasing adherence to social responsibility standards. Evidence for this is demonstrated by the fact that the gaming industry now has formal relationships with numerous organizations that address training, compliance, accreditation, and governance. There is also increasing integration between the gaming industry and a diverse set of stakeholders including government, practitioners, and researchers.

There have been some recent soundings about land-based casinos (e.g., Harrahs) directly helping problem gamblers through the use of on site treatment specialists (i.e., problem gamblers having access to treatment in the gambling environment itself). Although this sounds like a very socially responsible move on the part of the operators, it is my view is that it is not the gaming industry’s responsibility to treat gamblers but it is their responsibility to provide referral for problem gamblers to specialist third party helping agencies (e.g., problem gambling helplines, counselling services, etc.). It is thought that the number of problem gamblers who actively seek treatment is only a small percentage of the overall number of problem gamblers. This is because problem gamblers may feel embarrassed and/or stigmatized via face-to-face treatment interventions. This suggests that one of the ways forward may be for the industry to refer their problem clients towards online (rather than offline) help.

Dr Richard Wood (GamRes Ltd.) and I reported one of the first ever studies that evaluated the effectiveness of an online help and guidance service for problem gamblers (i.e., GamAid). The evaluation utilized a mixed methods design in order to examine both primary and secondary data relating to the client experience. GamAid is an online advisory and guidance service whereby the problem gambler can either browse the available links and information provided, or talks to an online advisor (during the available hours of service), or request information to be sent via email, mobile phone (SMS/texting), or post. If the problem gambler connects to an online advisor then a real-time image of the advisor appears on the client’s screen in a small web-cam box. Next to the image box, is a dialogue box where the client can type messages to the advisor and in which the advisor can type a reply. Although the client can see the advisor, the advisor cannot see the client. The advisor also has the option to provide links to other relevant online services, and these appear on the left hand side of the client’s screen and remain there after the client logs off from the advisor. The links that are given are in response to statements or requests made by the client for specific (and where possible) local services (e.g., a local debt advice service, or a local Gamblers Anonymous meeting).

A total of 80 problem gamblers completed an in-depth online evaluation questionnaire, and secondary data were gathered from a further 413 clients who contacted a GamAid advisor. It was reported that the majority of the problem gamblers who completed the feedback survey were satisfied with the guidance and “counselling” service that GamAid offered. Most problem gamblers (i) agreed that GamAid provided information for local services where they could get help, (ii) agreed that they had or would follow the links given, (iii) felt the advisor was supportive and understood their needs, (iv) would consider using the service again, and (v) would recommend the service to others. Being able to see the advisor enabled the client to feel reassured, whilst at the same time, this one-way feature maintained anonymity, as the advisor cannot see the client.

An interesting observation was the extent to which GamAid was meeting a need not met by other UK gambling help services. This was examined by looking at the profiles of those clients using GamAid in comparison with the most similar service currently on offer, that being the UK GamCare telephone help line. The data recorded by GamAid advisors during the evaluation period found that 413 distinct clients contacted an advisor. Unsurprisingly (given the medium of the study), online gambling was the single most popular location for clients to gamble with 31% of males and 19% of females reporting that they gambled this way. By comparison, the GamCare helpline found that only 12% of their male and 7% of their female callers gambled online. Therefore, it could be argued that the GamAid service is the preferred modality for seeking support for online gamblers. This is perhaps not surprising given that online gamblers are likely to have a greater degree of overall competence in using, familiarity with, and access to Internet facilities. Problem gamblers may therefore be more likely to seek help using the media that they are most comfortable in.

GamAid advisors identified gender for 304 clients of which 71% were male and 29% were female. By comparison, the GamCare helpline identified that 89% of their callers were male and 11% were female. Therefore, it would appear that the online service might be appealing more to women than other comparable services. There are several speculative reasons why this may be the case. For instance, online gambling is gender-neutral and may therefore be more appealing to women than more traditional forms of gambling, which (on the whole) are traditionally male-oriented (with the exception of bingo) (Wardle et al, 2007). Women may feel more stigmatised as problem gamblers than males and/or less likely to approach other help services where males dominate (e.g., GA). If this is the case, then the high degree of anonymity offered by GamAid may be one of the reasons it is preferred. Most of those who had used another service reported that they preferred GamAid because they specifically wanted online help. Those who had used another service reported that the particular benefits of GamAid were that they were more comfortable talking online than on the phone or face-to–face. They also reported that (in their view) GamAid was easier to access, and the advisors were more caring.

In their review of preventing problem gambling, Professor Robert Williams and colleagues at the University of Lethbridge (Canada) make several important points that need to be taken on board by the gaming industry (and other interested parties) in relation to problem gambling prevention. These observations are also important for gaming operators when considering best practice in terms of social responsibility.

• There exists a very large array of prevention initiatives.
• Much is still unknown about the effectiveness of many individual initiatives.
• The most commonly implemented measures tend to be among the less effective measures (e.g., casino self-exclusion, awareness/information campaigns).
• There is almost nothing that is not helpful to some extent and that there is almost nothing that, by itself, has high potential to prevent harm.
• Primary prevention initiatives are almost always more effective than tertiary prevention measures.
• External controls (i.e., policy) tend to be just as useful as internal knowledge (e.g., education).
• Effective prevention in most fields actually requires co-ordinated, extensive, and enduring efforts between effective educational initiatives and effective policy initiatives.
• Prevention efforts have to be sustained and enduring, because behavioural change takes a long time.

It would therefore appear that there are many factors that could be incorporated within a gaming company’s framework of social responsibility and that while the industry should be proactive in the prevention of problem gambling, the treatment of problem gambling should be done by those outside of the gaming industry and that one of the ways forward may be online rather than offline help.

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

Further reading

Gainsbury, S.M. & Blaszczynski, A. (2011). ‘A systematic review of Internet-based therapy for the treatment of addictions’, Clinical Psychology Review, 31, 490-498.

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

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

Williams, R.J., Simpson, R.I. & West, B.L. (2007). Prevention of problem gambling. In G. Smith, D. Hodgins & R. Williams (Eds.), Research and Measurement Issues in Gambling Studies. pp.399-435. New York: Elsevier.

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 GamAid pilot service. British Journal of Guidance and Counselling, 35, 373-389.

 

Gambling in Great Britain: What are the real issues the Government need to think about?

You may remember that back in 2007, Gordon Brown’s first major decision as Prime Minister was to put on ice the building of a Las Vegas-style ‘super-casino’ in Manchester. At a stroke, Brown distanced himself from the policies of Tony Blair while appearing to take the moral high ground over proposals that had attracted fierce condemnation from both inside and outside Parliament. In truth, the decision almost completely missed the point. Whether or not Manchester has a super-casino will make no practical difference to the ongoing rise of gambling in our society. Furthermore, the Labour Government’s apparent U-turn did little to protect those who are most vulnerable to gambling addiction. If anything, it was a further example of the Government’s lack of joined-up thinking over the whole issue of gambling.

Whether we like it or not, widespread gambling is here to stay. Over the last 10 years, the introduction of fixed odds betting terminals in betting shops, internet gambling (including online poker, online bingo and online betting exchanges), spread-betting, mobile phone gambling, and interactive television gambling have revolutionized the world of gambling. Gambling has slowly moved away from dedicated gambling venues and into our home and workplaces.

A large and growing number of people now enjoy gambling and see it as a socially acceptable form of entertainment, rather than a stigma-laden vice. For many people, a night at a casino is seen as little different – and certainly no more expensive – than a trip to a Premiership football match. The world has changed and Government policy and legislation has to keep up – or risk being discredited. Online poker and betting exchanges are now the two big growth areas on the internet. Men and women are now equally likely to gamble. The genie cannot suddenly be put back in the bottle.

The political challenge now, which the Coalition Government are only beginning to fully grasp, is to safeguard those most at risk from problem gambling while educating gamblers about the risks they face. There is no doubt that gambling addiction can wreck lives, turn some previously law-abiding people to crime, and contribute to relationship breakdowns. Gambling – like drinking, sex or even driving a car – is an adult activity that contains an element of risk. A small number of people will get into problems, but the legislator’s job is not to ban it, but to ensure that there are proper safeguards, education and help for those who become problem gamblers.

The first principle should be to protect the vulnerable. And the first thing I would do is ban all child gambling. Slot machines are often described as the ‘crack cocaine’ of gambling. The bright lights, noises, rapid turnover, relatively small stake and frequent small wins or ‘near wins’ combine to make a potent mix for gambling addicts. Yet in this country there are thousands of machines that children can legally play on, mainly in family leisure centres and seaside amusement arcades.

The Government should also reconsider a statutory levy on the gaming industry to help pay for research into problem gambling, treatment, education and prevention. Over the last few years – and to their credit – the gaming industry has given up to £5 million a year as a voluntary contribution to the Responsible Gambling Fund, but with more than 500,000 adult problem gamblers in the UK, this represents a contribution of around £10 per problem gambler, which I believe is inadequate. I would suggest that we examine the examples of other countries that have liberalized gambling such as Australia, where in some jurisdictions the gambling industry has to pay a mandatory contribution of around one per cent of profits to pay for social welfare. This would provide millions of extra pounds for research, education and treatment, yet would be relatively small change to the industry.

Another nettle the Government has failed to grasp is bringing all gambling (including spread betting, lottery, and scratchcards) under the control of a single regulatory authority. Only in this way can the British Government take an overall strategic view –  for example making sure that all pro-gambling advertising is balanced by educational advertising.

The great irony of the previous Government’s U-turn on super-casinos is that Manchester won the bid to build Britain’s first-ever super-casino precisely because the city council pledged to put in place a social support network of education and research, coupled with professional support for problem gamblers. There are conflicting views on whether super-casinos provide meaningful levels of additional local employment and whether they bring wealth or take money out of the local community. The Manchester project was to test this out with the best available social safeguards.

Whatever the Government does about super-casinos – and my instinct is that, sooner or later, public demand will bring super-casinos to Britain – problem gambling has significantly increased in this country according to the most recent British Gambling Prevalence Survey. However, this can be minimized through education, prevention, and intervention. Instead of making decisions about a solitary super-casino in Manchester, the Government should act to minimize the risk of gambling addiction on a practical level by introducing controls on industry practice, education in schools and elsewhere, and treatment on the NHS for those who get into difficulty. And let the gaming industry – rather than the taxpayer – foot the bill.

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

Further reading

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. Available at: http://www.gamblingcommission.gov.uk/PDF/British%20Gambling%20Prevalence%20Survey%202010.pdf