Post on 29-Jul-2020
Alex Blaszczynski PhD
The University of Sydney Gambling Treatment Clinic &
Responsible Gambling Research Group
Gambling-related harm
International Association of Gaming Regulators
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Gambling environment
• Socio-culture
determines attitudes/acceptance
• Government legislation shapes availability/access
• Industry & media promotion increases attractiveness
• Regulators deal with compliance, crime,
exploitation, & mitigation of harm
• Profit & taxation motives are driving forces
Multiple motivations exist
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Irrefutable premise: Excessive gambling causes harm
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Inherent tensions
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Community concerns & harms regulatory control
Prohibitionist
Responsible gambling
is a contradiction in terms
Libertarian
Civil liberties paramount
Restrictivist
Policy outcomes measured by reduction in prevalence rates
Harms assumed to be reduced by decrease in prevalence rates
Irresponsible gambling practices
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Irrefutable premise: Excessive gambling causes harm
Familial Personal Employment Legal Financial Social
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Cultural factors
Reported harm: Focus on severe end of spectrum
Personal
Familial
Employment
Legal
Financial
Social
Depression Substance use
Conflict
Divorce
Employment loss
Productivity loss
Bankruptcy
Loss of assets
Offenses
Debts
Health,
welfare &
legal cost
burdens
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Life course &
intergenerational
Cascading
long term
impact of
loss of assets
& relationship
Responsible Gaming Program must rely on two basic principles: Final decision to gamble…
(1) …belongs to the individual
(2) …must be based on informed choice
Governments, regulators, industry & advocacy
groups influence gambling environments
Responsible gambling
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PRIMARY objective of responsible gambling is
to set up policies & practices designed to
prevent & reduce potential harms associated
with gambling (Blaszczynski, Ladouceur, & Shaffer, 2004)
Premise of responsible gambling
• Balance between acceptable levels of harm
& socio-economic benefits while striving for
continued reduction in harm
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Irrefutable premise: Excessive gambling causes harm
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Primary objective is to limit individual’s expenditure
(time & money) to personally affordable limits
Breaching
cultural
expectations
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Responsible gambling achieved through
Information & persuasion Regulation
Knowing when enough is enough!
Player control
Demand control
Behaviour not tolerated!!
Control of player
Supply control
› Policies appear to lack consistency & coherence within
& across national boundaries
› Uncertainty prevails about what we should be trying to
do & how to maximize outcomes
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“Something needs to be done
This is something
Therefore, let’s do it”
Rationale: If we include all possible RG interventions,
we will never be criticized
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What guides regulators in approving applications for
changes to gambling features/environment?
1. Potential (risk) to cause harm (Risk: probability &
consequences)
What metrics do regulators use to evaluate policy
objectives? Reduction in:
1. Incidence Prevalence
2. Reduction in revenue figures
3. Harm caused
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Responsible Gambling as an empirical procedure
- Program only considered responsible if demonstrated
to actually make consumers gamble more responsibly
- The intent to be responsible is not enough
- Extends beyond simple ‘tick-box’ compliance with
regulations
Policies can only be evaluated
if there exist clear objectives
that can be assessed/measured
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I don’t like data,
data makes me insecure
because data are changing all the time,
I prefer opinions,
mainly my opinions,
because my opinions are
Stable,
Permanent
& resistant to any changes in facts….
Let’s avoid thinking like this famous man
who always says….
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› Gambling Disease Kills One Australian a Day, But It's Too
Lucrative to Cure: Slot machines provide billions in revenue at high
social cost. http://www.bloomberg.com/news/articles/2016-09-
27/gambling-disease-kills-one-australian-a-day-but-it-s-too-lucrative-to-
cure
› According to a new report, almost one in four people arrested
in Australia for drug trafficking have a serious gambling
problem. http://www.thecabinsydney.com.au/gambling-addiction-in-
australia-highest-percentage-of-gamblers-in-the-world/
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› Goals & objectives: policies must clearly operationalize
goals & objectives of an initiative
(e.g., precommitment: use or harm minimization?)
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Absence of operational measures of direct & indirect
harms
i. Problem gambling refers to the situation in which a
person’s gambling gives rise to harm to the
individual player, &/or to his or her family, & may
extend into the community. (Victorian Casino & Gaming
Authority, 1997)
iii. Similar to definition used in New Zealand Gambling
Act 2003
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Operational definition: (Langham et al., 2016)
Derived from focus group, interviews with experts &
clients
i. Any initial or exacerbated adverse consequence
due to an engagement with gambling that leads to a
decrement to the health or well being of an
individual, family unit, community, or population”
• Any: Very broad & non specific
• Due to engagement: Assumes direct causal
relationship
• Decrement: vague without specifying severity
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Harm assessed across multiple axes
› Chronicity: Isolated or sporadic, or persistent over time (chronic)
› Nature:
i. Affects individual &/or significant others
ii. Contained within: • personal/family domain (quality of life), or
• Involve referral to external services such as mental health services for
depression, domestic violence protection, legal representation, or family
therapy/relationship counselling
› Impact: Outcome of losses can vary from an inconsequential transient
harm through to serious persistent harms
> Severity: Minor to substantial (within & across sessions)
• Upset, discomfort, anger, distress, anguish, angst/pain
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What are the issues?
PGSI
SOGS
NODS
DSM-5
Other
Gambling disorder
prevalence rate
Scores used as
proxy for harm
DSM-5: Jeopardized relationships, job, education or career
PGSI:
• Borrowed money or sold anything to get money to gamble?
• Gambling caused health problems, including stress & anxiety?
• People criticised your betting
• Felt guilty about way you gamble or what happens when you gamble?
Gambling-related
harms
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What do prevalence instruments measure?
› Discriminant between different subgroups of gamblers: - Low risk, moderate risk, problem/pathological
› Frequency (sometimes, often, always) but not - Severity
- Direction of causality (pre-existing disorders?)
- Equal weighting for all items
- Low spend &/or infrequent gamblers assumed to be non-problem
gamblers & therefore often not administered screen
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What are the issues?
PGSI
SOGS
NODS
DSM-5
Other
Gambling disorder
prevalence rate
Scores used as
proxy for harm
Does PGSI score of 16 indicate
twice as much harm as a score of 8?
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What are the issues?
PGSI
SOGS
NODS
DSM-5
Other
Gambling disorder
prevalence rate
Scores used as
proxy for harm
Controversial question:
1. Do all who meet or
not meet criteria
experience harm
that requires
interventions?
Reduction in scores assumed to
reflect recovery
&
reduction in harm
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Prevalence versus harm
Prevalence Instruments:
- Lane & Sher (2014) NESARC database: multiple
measures of severity of harms in a cohort of 22,177
past year drinkers
• Severe harms experienced by some not meeting
criteria
• No severe harms for some meeting criteria
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Prevalence versus harm
Discrepancy between screens & clinical evaluation (r=.48)
- Not all attending treatment exceed threshold scores
(of 258 clients attending University of Sydney
Gambling Treatment Clinic, 52% did not meet formal
DSM criteria)
Conclusion: Spectrum of harms (minor to severe) also
experienced by gamblers not necessarily meeting
diagnostic criteria or threshold scores
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Recalibrate approach to RG
Responsible gambling evaluated by shift in specific
harms rather than prevalence rates
Take away prevalence rates, where is the evidence of
harm found in the community?
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“… lower risk drinkers, by virtue of their sheer numbers, account for
the largest proportion of negative alcohol related consequences in the
population”. (Currie, Miller, Hodgins & Wang, 2014).
It is widely accepted that a large portion of the population experience
harms that, while possibly insignificant at the individual level,
aggregate to a significant cost to the community (Productivity
Commission 2010).
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› Effectiveness of public health policies for alcohol abuse
not assessed by measuring number of cases meeting
criteria for alcohol abuse or dependence
› Specific harms are targeted:
- Physical assaults
- Drink driving
- Industrial & motor vehicle accidents
- Hospital admissions (cirrhosis, injuries)
- Domestic violence
- Homicides
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A proposed paradigm shift
Prevalence
rates
Identify specific harms: • Relationship conflicts
• Substance abuse
• Depression/stress
• Criminal behaviors
• Debts/bankruptcy
• Health-related
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Reduced demand
& targeted harms
A proposed paradigm shift
Prevalence
rates
Identify specific harms • Domestic conflicts
• Substance abuse
• Depression/stress
• Criminal behaviors
• Debts/bankruptcy
• Health-related
Apply interventions to
reduce excessive
gambling
Outcome measures
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Top ten gambling related harms by aggregate score: Gambling Effect Scale
Items
1. Loss of savings 6. Hopelessness
2. Worry 7. Debt
3. Unhappiness/depression 8. Restricted leisure pursuits
4. Personal sense of loss of control 9. Relationship conflicts
5. Loss of self-respect 10. Poor sleep
Common harms experienced
1. Self-inflicted injury & suicide attempts
2. Bankruptcy
3. Eviction/loss of home
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Harms least commonly endorsed were:
Diminished quality of life (majority) vs serious/critical harms
(minority)
- Explains why only 10-30% meeting criteria enter treatment at any time
- Severity/impact of harm does not reach threshold for perceived need
for treatment
- Are policies driven by the impacts on a minority of problem gamblers?
Responsible gambling initiatives should determine:
• If strategies to reduce harms in those adversely
affected by gambling are effective & not just for those
categorised as problem gamblers
• If prevalence of problem gambling is reduced are
aggregated community harms also reduced?
• If more appropriate allocation of resources to services
targeting particular harms can be offered
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Alex Blaszczynski PhD
The University of Sydney Gambling Treatment Clinic &
Responsible Gambling Research Group
Gambling-related harm
International Association of Gaming Regulators
Challenges
› Operators, regulators & policy-makers often rely on research
data that reports tentative, inconsistent or inconclusive
findings, expressed opinions, or contain methodological flaws
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Two approaches to retrieve RG relevant articles used:
- A systematic search of library databases
- Search targeted period 1962 to October 31, 2015
- 2,548 publications identified
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Examining the quality of evidence
› We excluded 2,496 publications that were:
- In the ‘grey’ literature domain (non-peer reviewed)
- Duplicates
- Not relevant to RG
- Containing insufficient methodological information
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› Used four inclusion criteria:
1) Real gamblers in real environments
2) Included a comparison group
3) Repeated measures &
4) One or more measurement scales
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Only 30 articles met at least one of the four criteria
Only 6 of the 30 articles satisfied all four inclusion criteria
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Content analysis revealed focus on five strategies:
1. Self-exclusion programs
2. Tracking behavioral characteristics or behavior patterns
3. Setting gambling limits
4. Responsible gambling game features, such as warning
messages
5. Staff training
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Conclusion
• Current evidence on effectiveness of RG initiatives is very limited
• Evidence reveals that overall effectiveness & impact of RG activities remains uncertain
• Outcomes assessed by reduction in gambling behaviours, &/or scores on diagnostic instruments, but not in relation to overt harm
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Need to adopt a framework
Responsible policies should emphasize:
- Different stakeholders should work together
- Balance consumer (informed) choice vs consumer
(imposed) protection; liberalism vs paternalism
- Decisions guided by scientific research &
knowledge rather than ideology, politics or opinions
- Ask the correct questions:
• What type & level of harms & its level do we need
to prevent?
• What are the real risk factors that can be modified?
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Online sports betting
Social media: New policies
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Alex Blaszczynski PhD
The University of Sydney Gambling Treatment Clinic &
Responsible Gambling Research Group
Gambling-related harm
International Association of Gaming Regulators