Electronic gaming machine accessibility and gambling problems: A natural policy experiment

Background: Electronic gaming machines (EGMs) are recognised as one of the most harmful forms of gambling at an individual level. However, it is unclear whether restriction of EGM functions and accessibility results in meaningful reductions in population-level gambling harm. Methods: This study employed a natural policy experiment to compare gambling problems between Australian residents in Western Australia (WA), where EGMs are restricted to a single venue and have different structural features, and residents in other Australian jurisdictions where EGMs are widely accessible in casinos, hotels and clubs. The accessibility of non-EGM forms of gambling is generally similar across all Australian jurisdictions. The study draws on a large (N = 15,000) nationally-representative dataset.Findings: Although gambling participation was slightly higher in WA, EGM participation was approximately half that found in the rest of Australia. Aggregate gambling problems and harm were about one-third lower in WA, and self-reported attribution of harm to EGMs by gamblers and affected others was 2·7x and 4x lower, respectively. Analyses using mediation and moderation determined that the attributable impact of EGMs in WA was 70% lower than elsewhere, and was responsible for the vast majority of the discrepancy in gambling problems (indirect path = -0·055, 95% CI -0·071; -0·038). Attributable problems to casino table games were slightly higher in WA, potentially due to redirection of demand, but this effect size was small relative to the reduction of problems due to EGMs. On an individual level, for a given level of participation in EGMs and other forms, the risk of problems were similar in WA and the rest of Australia. Interpretation: Reduced harm from gambling in WA is due to restricted accessibility of EGMs, and there is little transfer of problems to other gambling forms. These results suggest that restricting the accessibility of EGMs substantially reduces gambling harm.Funding: Gambling Research Australia (GRA) funded this research. GRA is a partnership between the Commonwealth, State and Territory Governments to initiate and manage a national program of gambling research.

Psychometric Evaluation of the NORC Diagnostic Screen for Gambling Problems (NODS) for the Assessment of DSM-5 Gambling Disorder

The National Opinion Research Center (NORC) Diagnostic Screen for Gambling Problems (NODS) is one of the most used outcome measures in gambling intervention trials. However, a screen based on DSM-5 gambling disorder criteria has yet to be developed or validated since the DSM-5 release in 2013. This omission is possibly because the criteria for gambling disorder only underwent minor changes from DSM-IV to DSM-5: the diagnostic threshold was reduced from 5 to 4 criteria, and the illegal activity criterion was removed. Validation of a measure that captures these changes is still warranted. The current study examined the psychometric properties of an online self-report past-year adaptation of the NODS based on DSM-5 diagnostic criteria for gambling disorder. Additionally, the new NODS was evaluated for how well it identifies ICD-10 pathological gambling. A diverse sample of participants (N = 959) was crowdsourced via Amazon’s TurkPrime. Internal consistency and one-week test-retest reliability were good. High correlations (r = .74–.77) with other measures of gambling problem severity were observed in addition to moderate correlations (r = .21–.36) with related but distinct constructs (e.g., gambling expenditures, time spent gambling, other addictive behaviours). All nine of the DSM-5 criteria loaded positively on one principal component, which accounted for 40% of the variance. Classification accuracy (i.e., sensitivity, specificity, predictive power) was generally very good with respect to the PGSI and ICD-10 diagnostic criteria. Future validation studies are encouraged to establish a gold standard measurement of gambling problem severity.

Associations between Risk Factors in Late Adolescence and Problem Behaviors in Young Adulthood: A Six-Year Follow-Up of Substance Related and Behavioral Addictions in Swedish High School Seniors

Introduction: Risk factors of traditional substance use related problems in young adults are more well-known than for behavioral addictions such as gambling and gaming problems. The present study aims to provide knowledge about the longitudinal patters of substance use related and behavioral addictions in early adulthood. Methods: Using self-report surveys, substance-related, psychiatric, and demographic predictors were assessed in Swedish high school seniors and re-assessed six years later along with gambling and gaming problems, n = 800. Associations (Risk Ratios) between risk factors in late adolescence and problem behaviors in young adulthood were analyzed. Results: Tobacco use, illicit drug use, and hazardous drinking in young adulthood were associated with tobacco use, illicit drug use, alcohol use, conduct problems, and impaired impulse control in late adolescence. Gambling problems in young adulthood were only associated with heredity of alcohol problems, while gaming was not associated to any problem behavior in late adolescence. Conclusion: It is concluded that predictors for traditional substance-related addictions differ from predictors for behavioral addictions, and that this difference is more pronounced for gaming problems than for gambling problems.

The effect of gambling problems on the subjective wellbeing of gamblers’ family and friends: Evidence from large-scale population research in Australia and Canada

Background and Aims Excessive time and money spent on gambling can result in harms, not only to people experiencing a gambling problem but also to their close family and friends (“concerned significant others”; CSOs). The current study aimed to explore whether, and to what extent, CSOs experience decrements to their wellbeing due to another person’s gambling. Methods We analysed data from The Household Income and Labour Dynamics in Australia Survey (HILDA; N = 19,064) and the Canadian Quinte Longitudinal Study (QLS; N = 3,904). Participants either self-identified as CSOs (QLS) or were identified by living in a household with a person classified in the problem gambling category by the PGSI (HILDA). Subjective well-being was measured using the Personal Wellbeing Index and single-item questions on happiness and satisfaction with life. Results CSOs reported lower subjective wellbeing than non-CSOs across both countries and on all three wellbeing measures. CSO status remained a significant predictor of lower wellbeing after controlling for demographic and socio-economic factors, and own-gambling problems. There were no significant differences across various relationships to the gambler, by gender, or between household and non-household CSOs. Discussion and Conclusions Gambling-related harms experienced by CSOs was reliably associated with a decrease in wellbeing. This decrement to CSO’s wellbeing was not as strong as that experienced by the person with the first-order gambling problem. Nevertheless, wellbeing decrements to CSOs are not limited to those living with a person with gambling problems in the household and thus affect many people.

Reasons for dropping out of internet-based problem gambling treatment, and the process of recovery – a qualitative assessment

Problem gambling (PG) is a condition affecting the economy, mental health, and relationships of both the individuals with gambling problems, and concerned significant others (CSOs). While PG is treatable, few individuals with gambling problems seek treatment, and many drop out of treatment. This qualitative study aims to investigate a) the reasons for individuals with gambling problems to drop-out from Internet-based PG treatment, and b) what individuals with gambling problems and CSOs find helpful and unhelpful processes in PG recovery. A total of 16 participants (8 individuals with gambling problems and 8 CSOs) who had participated in an Internet-based PG treatment were interviewed over the telephone in a semi-structured interview. The interviews were analyzed using thematic analysis. Drop-out from treatment was one aspect of an overarching theme identified as unstable path to recovery, where alternating periods of progress and setbacks delineate several aspects of PG. Relapses, negative emotions, and changing life circumstances were identified to separately, and in combination, contribute to drop-out. Drop-outs were also explained by participants’ experiences of a reduced need for treatment. Openness and a support from CSOs and peers were identified as themes important for recovery. The results suggest that PG treatments should consider the emotional state, and comorbidities of the patients, in order to reduce drop-out and improve chances of recovery.

A Longitudinal Study of Gambling Behaviors During the COVID-19 Pandemic in Sweden

This study aimed to investigate changes in gambling behaviors during the first and second waves of the COVID-19 pandemic in Sweden. Participants who had gambled within the past year were recruited from social media and the Swedish National Helpline (n = 325, mean age 39.8 years, 64.8% males, 31.3% with problem gambling) and completed an online survey measuring gambling behaviors, consequences of the pandemic in general and worries related to the pandemic. A sub-sample (n = 139) completed a follow-up survey, during the second wave. The results showed no significant associations between COVID-19 consequences (financial or increased isolation) and increased monthly gambling behavior. No major migrations were observed between game types. However, gambling on a high-risk game (OR = 7.44, p < 0.001) and worrying about mental health due to the pandemic (OR = 2.85, p < 0.001) were significantly associated with past year gambling problems and increased monthly gambling problems from the first to the second wave. More longitudinal research is needed in vulnerable populations, to fully understand the long-term consequences of the pandemic.

Gambling Prevention Mobile Applications: Understanding the Inclusion and Use of Behaviour Change Techniques

Online gambling is emerging as a significant health behaviour of concern at a population level. Mobile applications (apps) are a popular tool to target change in health behaviour. Behaviour change techniques (BCTs) can be included within such apps to change relevant psychological mechanisms along established pathways, yet the content of apps targeting gambling problems specifically is not currently known. The purpose of the review was to identify the BCTs included in gambling prevention apps. Apps were downloaded from the Apple App Store and Google Play Store in October 2020. Apps were included if they related to gambling problems, were freely downloadable, and available in English. Once downloaded, two researchers independently coded the apps in November 2020 using the behaviour change technique taxonomy version 1 (Michie et al., 2013). The screening led to forty apps meeting the inclusion criteria (12 Apple App Store, 28 Google Play). The analyses identified 32 BCTs (20 Apple apps, 28 Google Play apps), with apps including between 0 and 9 BCTs (mean = 2.82, median = 2). The BCTs included most frequently were “3.1. Social support (unspecified),” “2.3. Self-monitoring of behaviour,” and “7.4. Remove access to the reward.” The review provides important information on the BCTs used in apps developed to reduce gambling-related problems. A limited number of BCTs were adopted within apps. Developers of apps seeking to develop effective gambling reduction products should draw upon a greater variety of BCTs.