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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.
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.
Net losses: What are the downsides of online therapy for problem gamblers and clinicians?
In my last blog, I briefly looked at the advantages of online therapy. However, the growth of online therapy is not without its critics. I may have given the impression in my previous blog that online therapy has nothing but positive implications. However, this blog briefly examines some of the main criticisms that have been levelled against online therapy. This loist is not exhaustive but hopefully covers the key concerns:
- Legal and ethical considerations: As Internet counselling services grow, attention will have to be focused on the specialist construction of a legal and ethical code for this type of work. Cyberspace transcends state and international borders, therefore, there are many legal and regulatory concerns. For example, client/doctor confidentiality regulations differ from one jurisdiction to another. It may not be legal for a clinician to provide chat-room services to problem gamblers who are in a jurisdiction in which the clinician is not licensed. Furthermore, some problem gamblers may be excluded from telehealth services because they lack the financial resources to access the Internet. One potential ethical and legal dilemma is the extent to which service quality can be ensured. It is possible that individuals who register to provide counselling services online do not have the qualifications and skills they advertise. They may not even be licensed to practice. There are also issues regarding the conduct of practitioners engaged in all forms of telecommunication therapy. For example: issues of informed consent, the security of electronic medical records, electronic claims submissions and so forth. Therapy provided over the Internet holds promise but there is a need to check that it works and see to it that, if it is done then it is done well. Underlying guidelines that are applicable to all forms of counselling are that: (i) the therapist must be trained, supervised and accountable with qualifications that can be checked against a list held by a mainstream organisation, and (ii) the nature of the contract between client and practitioner must be spelled out so clients understand the boundaries of what they are receiving for what they are paying.
- Effectiveness of online therapy: There are a growing number of evaluation studies that have examined whether online therapy is an effective treatment approach. With specific regard to problem gambling, my research colleague Dr. Gerry Cooper reported that about 70% spoke of how they benefited from their exposure to and involvement with GAweb, an online peer support group. An evaluation that I carried out with Dr. Richard Wood of Gam-Aid also showed that participants derived great benefit from using the online service and was particularly attractive for problem online gamblers (that are already comfortable with interacting online).
- Confidentiality: Online therapy may compromise privacy and confidentiality, particularly if a skilled computer ‘hacker’ is determined to locate information about a particular individual. There is also some evidence that as more personal information is required of counselling sites online, the attractiveness of these sites is reduced. On the other hand, one of the things that the Internet is especially helpful with is its ability to afford the consumer the control over self-disclosure. In this way, individuals may overestimate the degree to which their information is safe and secure from computer hackers.
- Encryption: No online therapist can confidently promise a problem gamblers confidentiality given the limitations of the medium. That being said, there are some sites that now offer secure messaging systems that offer the same level of protection as banking institutions. To protect confidentiality, care will have to be taken to prevent inappropriate and deliberate hacking into counselling sessions on the Internet. There will need to be a continuous upgrading of technology to stay ahead of hackers’ ability to breach security.
- Complicated payment structures: Given the cross-national nature of the Internet, there may be complicated pay structures for problem gamblers to overcome when selecting a therapist. While universally-accepted credit cards might actually make payment easier (since one can use their credit card online and the credit card company will automatically calculate the currency exchange for the transaction), one may not immediately understand how much the online counselling has cost in their own currency. They may not know this until their credit card invoice arrives at a later date.
- Cost-effectiveness to the therapist: For the therapist, there is the problem that online counselling may be as time consuming as face-to-face therapy with substantially less financial remuneration.
- Identity problems: One of the major potential problems is that online problem gamblers may not be who they say they are, i.e., counsellors may not always know the true identity of their online clients (although identity is an issue only applicable to those services that are not anonymous). This is clearly a major issue since some assumptions (rightly or wrongly) are made by the clinician depending on what the problem gambler presents (including age and other demographics). However, to some extent, these issues also apply to telephone and face-to-face counselling as the therapist has to accept what is said at face value. Additionally, some might argue that merely responding to the words that a problem gambler chooses to use necessitates more focus on the part of the therapist. As a result, this may lead to a more democratic counselling environment. In other words, the role of therapist and problem gambler becomes more equal in this situation. Some therapists may have difficulty adapting to these new roles.
- Severity of client problems: Some clients’ problems may be just too severe to be dealt with over the Internet. To some extent, there can always be contingencies, but because people can come from anywhere in the world and have a multitude of circumstances, online clinicians may be hard-pressed to meet everyone’s needs. It is important to acknowledge that this is not a panacea; that online help will not solve everybody’s problems (to be sure, those who are illiterate will likely have a difficult time of it without some additional support nearby). On the other hand, it is likely to go a long way in helping a great many more people than otherwise would have been the case.
- Client referral problems: One obvious difficulty for the counsellor is how to go about making a referral for someone in a faraway town or another country. Once again, one would need to establish basic contingencies. Over time, it could be expected there would be many more international-regional clearinghouses regarding where to get immediate assistance, but to date it is very difficult to know what services are available for many parts of the world.
- Establishing client rapport: It could perhaps be argued that there might be difficulty in establishing rapport with someone that the therapist has never seen. This is an interesting area where clearly more information is needed. One might also argue that because the problem gambler is in a more equal relationship with the therapist, they will feel more comfort. That is, since the problem gambler controls all of the personal disclosure levers, rapport might be established much more easily.
- No face-to-face contact: Online therapy leads to a loss of non-verbal communication cues such as particular body language, voice volume and tone of voice. Furthermore, the lack of face-to-face interaction between problem gambler and therapist could result in a wrong referral or diagnosis. What is known about online communication where cues are filtered out, is that it typically takes more work to accomplish a task where more than one person is involved. It may be the case that with time and experience, therapists who work online will develop skills that will help them compensate for the absence of visual cues. For example, they might become much more skilled and precise with the words they choose to use.
- Incomplete information: The written information provided in online therapy may be incomplete. Online therapy (via e-mail) may not allow the opportunity for immediate follow-up questions. Making a provisional recommendation or diagnosis is fraught with potential problems. For instance, a problem gambler may describe problems that are symptomatic of other more serious underlying disorders. However, diagnostic processes are quite heterogeneous practices even in face-to-face settings. Diagnoses are often provisional and therapists usually require more information to validate initial observations. In fact, clinicians might have better access to their clients through e-mail than trying to track them down face-to-face or exchanging telephone answer messages, should they need further information. Still, the information derived from problem gamblers in online formats may be unverifiable, more so than in face-to-face contexts.
- Loss of therapist contact: Although perhaps more of a possibility than a reality, therapists can just ‘disappear’ only to re-emerge weeks later saying that their server failed and/or leave a problem gambler mid-therapy with little that the problem gambler can do about it. The same problem could occur with some clinicians in face-to-face settings although being online may be more of a problem in finding out what has happened.
- Commercial exploitation: Consumers theoretically are not always as anonymous as they might think when they visit health sites because some sites share visitors’ personal health information with advertisers and business partners without consumers’ knowledge or permission. Some sites allow third-party advertisers to collect visitors’ personal information without disclosing this practice. As a result, visitors may get e-mails from advertisers about their products and services. Information can be collected during a variety of tasks including the visiting of chat rooms and bulletin boards, searching for information, subscribing to electronic newsletters, e-mailing articles to friends or filling out health-assessment forms. This allows third parties to build detailed, personally identified profiles of individuals’ health conditions and patterns of Internet use. In relation to gamblers, this is a real issue. By virtue of posting to places where problem gamblers talk to each other online with an accurate e-mail address shown, online gambling operators have the potential to collect such information in order to later send junk e-mail promoting their gambling websites. Other questionable and fraudulent marketing practices by online operators have also been outlined in my previous blogs.
- Emergency situations: Being online and geographically distant has the potential to cause problems in an acute situation. For instance, if a clinician does not know where a problem gambler lives or can be located, they cannot call for help in the case of an emergency such as a suicidal threat.
- Convenience: Although convenience was outlined as an advantage in the previous section, it can also have a downside. For instance, it may mean that the problem gambler is less likely to draw on their own existing coping strategies and use the online therapist as a convenient crutch (something which is actively discouraged in face-to-face therapy).
Hopefully this blog has redressed the balance of my previous blog on the positive benefits of online therapy. Anyone that seeks online advice, help, and/or treatment needs to carefully do their own cost-benefit analysis as to whether such an online service will be of direct benefit to them after taking into account some of the disadvantages outlined here.
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.
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.
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Campaign killer? Gambling with people’s reputations (revisited)
On Twitter last week, Adrian Parkinson of the Campaign for Fairer Gambling (and the associated Stop The FOBTs campaign) posted a number of tweets about me (and my research). In the tweets, Parkinson said that (a) I am a “supposed academic”, (b) I am the “industry ‘funded’ defender of FOBTs” (fixed odds betting terminals), (c) I am “doing more dirty work” for the Association of British Bookmakers, and (d) I do “what the industry tells [me] to do”.
All of these assertions are untrue and potentially libellous. According to legal dictionaries, the official definition of libel is “to publish in print (including pictures), writing or broadcast through radio, television or film, an untruth about another which will do harm to that person or his/her reputation, by tending to bring the target into ridicule, hatred, scorn or contempt of others”. Based on this defintion, Parkinson’s tweets are potentially libellous and are definitely an attack on my professional integrity. This cannot go unchallenged so here are the facts of the matter in relation to the claims made.
- “Supposed academic”: Obviously the assertion by Parkinson that I am a “supposed academic” is both false and deliberately malicious. An academic by most dictionary definitions is “a teacher or scholar in a university or other institute of higher education”. As a professor employed at an English university, there is nothing “supposed” about my occupation or status. To add to this, I would point out that on the basis of my academic research and reputation I became of one of the UK’s youngest ever professors (aged 34 years). So far in my career, I have been awarded 14 national and/or international awards and prizes for my gambling research and research dissemination including three Fellowship awards (British Psychological Society, Royal Society of Arts, and the Academy of Social Sciences) and two Lifetime Achievement awards. I am also one of the most highly cited psychologists in the world (currently 17,500 citations on Google Scholar that you can check here).
- “Industry funded’ defender of FOBTs”: Parkinson claimed that I am “funded defender” of FOBTs and the gambling industry. In my career to date, I have published approximately 460 academic peer reviewed journal papers (which most academics would describe as ‘prolific’ – and not bad for a “supposed academic”) and another 1000+ academic articles (in professional/practitioner journals, gambling trade press, newspapers, magazines, etc.). Of these 1500 or so papers and articles, none were funded by a research grant from the gaming industry. Two of the papers I have published – both concerning social responsibility in gambling initiatives – did arise out of gaming industry consultancy (one study was about gamblers’ attitudes toward the social responsibility tool PlayScan funded by Svenska Spel, and the other was the development of a new social responsibility tool for the gaming industry to use to protect vulnerable player funded by the Nova Scotia Gaming Corporation). Also, none of my published academic papers has ever been specifically about FOBTS. I have published a handful academic journal papers that have mentioned FOBTs in passing but all of those were papers based on data collected in the British Gambling Prevalence Surveys (of which I was one of the co-authors) and were funded by the Gambling Commission not the gambling industry. In 2008, I also wrote a report for the Department of Culture, Media and Sport (again funded by the Gambling Commission) on high stake-high prize machines that included references to FOBTs. However, the only article I have ever published specifically on FOBTs was one of my previous blogs (which looked at FOBTS in relation to the BGPS findings). In short, the assertion that I am an “industry ‘funded’ defender of FOBTs” simply has no basis in truth whatsoever.
- “Dirty work” for the Association of British Association of Bookmakers: Parkinson claimed I carry out “dirty work” for the ABB. In my academic career I have been a consultant in the area of responsible gambling for approximately 15 years and have written in the region of 150 consultancy reports. Of these reports, three have been for the Association of British Bookmakers. The first report (in June 2013) was evaluation and input into the new code of conduct concerning responsible gambling and player protection (and which I wrote about in a previous blog). I was invited to carry out this piece of work by Neil Goulden (Chairman of the UK’s Responsible Gambling Trust) specifically because of my reputation of being both totally independent and as someone that has been critical of the gambling industry on previous occasions in relation to social responsibility and player protection. More recently (July 2014), I was commissioned to carry out two further pieces of consultancy for the ABB. The first was a review of problem gambling in Great Britain and the second was a preliminary evaluation of the responsible gambling initiatives relating to the introduction of the ABB’s new Code of Conduct (both of which are being published today). All three pieces of consultancy that I have carried out for the ABB concerned player protection and responsible gambling. Far from being “dirty work” they are the very areas areas that are at the heart of almost all the research that I carry out into problem gambling.
- “Doing what the industry tells me to do”: Of all the potentially libellous claims made about me by Parkinson, this is the one that is the most ludicrous. The main reason I was asked for my expertise in the first place by the ABB was because I have never been afraid to criticize the gaming industry when they have done something I believe to be wrong and/or socially irresponsible. Anyone who actually knows me and has followed my research career over the last three decades will tell you that the one common denominator is my absolute independence in anything that I do. For the best part of 15 years I was vilified and criticized by some members of the gaming industry because of my belief that vulnerable and susceptible people should be protected from the potential harms of gambling. When ‘social responsibility’ and ‘responsible gambling’ became important issues in gaining operating licenses, gaming companies soon started approaching me to help them develop their codes of conduct and player protection programs. In short, I have spent years telling the gambling industry what I think they should do to minimize problem gambling (not the other way around).
There are of course bigger issues here concerning research funding, and this is an issue on which I have published my own views (see ‘Further reading’ below). Parkinson’s incorrect and misguided comments about me appear to be based on the view that academics shouldn’t have any association whatsoever with the gambling industry. Unfortunately, this (in my opinion) is a blinkered view that will not help those that need it (i.e., vulnerable populations). Almost all of the ‘big name’ researchers in the gambling studies field have carried out research and/or consultancy funded by the gambling industry. When this happens it may call into question academic ‘independence’. However, industry funded research appears to be an increasing economic reality in many countries across the world. In the UK, the governmental philosophy of research funding relating to gambling is now ‘polluter pays’ (i.e., the UK government has said it will not fund research on gambling and that the industry will have to pay for such work itself). Although my own research is not industry funded, the current funding model is pushing researchers in the gambling field down such a route.
One researcher that I have published with (now retired from day-to-day university life) refuses to carry out research or consultancy if it is sponsored or funded by the gambling industry (even indirectly via the Responsible Gambling Trust because the money is accrued from voluntary donations by the gambling industry). Furthermore, he will not attend conferences that have gaming industry sponsorship and declines invitations to speak if they are held on gaming premises. Although laudable and highly principled, researchers who now want to pursue a research career in the gambling studies field will are likely to find that taking such principled actions will become a barrier to career enhancement.
Having been in the gambling studies field for nearly 30 years now, I feel very proud that over the last decade, some sectors of the gaming industry have now started to take the issue of social responsibility in gambling seriously. All the personal vitriol that I received for years from certain individuals working in the gaming industry appears (in retrospect) to have been worth it. My own view is that if those in the gambling industry are really serious about social responsibility, they need to sometimes work in partnership with researchers in the gambling studies field if the end goal is the same (i.e., protection of vulnerable individuals and minimization of problem gambling).
From my research, I have gotten to know people that have had gambling problems and that would like to ban slot machines (including FOBTs). This is highly unlikely to reduce gambling problems. We know that banning alcohol does not cure alcoholism. Similarly, banning gambling products will not solve the issue of problem gambling. It would only drive the activity underground. Most people that gamble (including myself) do not have a problem. The underlying principle of social responsibility is to maximize fun for those that enjoy gambling and minimize harm for those that may be vulnerable. Mr. Parkinson and his campaign have every right to express their views but what they say should have a basis in fact (rather than prejudice) and they definitely shouldn’t resort to questioning my reputation or research in the absence of the full facts.
Dr. Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Psychology Division, Nottingham Trent University, Nottingham
Further reading
Adams P. J., Raeburn J., De Silva K. (2009). A question of balance: prioritizing public health responses to harm from gambling. Addiction, 104: 688–91.
Griffiths, M.D. (2009). Minimising harm from gambling: What is the gambling industry’s role? Addiction, 104, 696-697.
Griffiths, M.D. (2008). Impact of high stake, high prize gaming machines on problem gaming. Birmingham: Gambling Commission.
Griffiths, M.D. (2009). Gambling research and the search for a sustainable funding infrastructure. Gambling Research, 21(1), 28-32.
Griffiths, M.D., Wood, R.T.A. & Parke, J. (2009). Social responsibility tools in online gambling: A survey of attitudes and behaviour among Internet gamblers. CyberPsychology and Behavior, 12, 413-421.
Morrison, P. (2009). A new national framework for Australian gambling research: A discussion paper on the potential challenges and processes involved. Gambling Research, 21(1), 8-24.
Wood, R.T.A., Shorter, G.W. & Griffiths, M.D. (2014). Rating the suitability of responsible gambling features for specific game types: A resource for optimizing responsible gambling strategy. International Journal of Mental Health and Addiction, 12, 94–112.
