Introduction: Gambling issues and problems in the Nordic countries

The present issue includes a broad selection of current research and thinking about gambling in the Nordic countries—Denmark, Finland, Iceland, Norway, and Sweden. The issue is based on presentations at a seminar on gambling issues organized by the Nordic Council for Alcohol and Drug Research (NAD) in 2005 and sponsored by the Swedish National Institute of Public Health. A paper by Cisneros Örnberg sets the framework for the papers, discussing both the general nature and organization of the Nordic gambling markets and the pending efforts by European Union institutions to transform them. Jonsson reviews Nordic studies of the prevalence of problem gambling, and Ólason et al. discuss the literature on teenage gambling in the course of their report on a large survey in Reykjavík, Iceland. Rossow and Molde offer a psychometric contribution to the epidemiological work, discussing the relation between different measures in a study of Norwegian adolescents. Lalander gives a vivid view of the world of gambling machine betting in Sweden and of the types of players that inhabit it. Hansen offers an overview of the treatment response to problem gambling in the Nordic countries in a report that draws on a series of visits to different treatment agencies across the Nordic region. Last, a physician and researcher who has been active in gambling policy discussion in Norway, Hans Olav Fekjær, offers a perspective on difficulties experienced in putting gambling problems on the social agenda. The diversity of work represented means that the reader will come away from this issue with a good overview of current work and thinking about gambling problems in the Nordic region.

Finland was the last of the Nordic countries that Marianne Hansen visited when she wrote her report on the treatment of problem gamblers in the Nordic countries. The study required visits to and interviews at a number of Nordic institutes, and by the time she came to Finland she had already visited dozens of institutions and met several Nordic experts in the field. As Marianne Hansen's host, I was curious about what would happen while in Finland. Gambling in Finland is quite often associated with pensioners standing at supermarkets playing slot machines. To my great surprise, one of the experts interviewed, who worked at a big addiction institute in Finland, didn't think this was a problem at all: 'But isn't it good there is something that keeps the pensioners busy?' he asked, leaving me and Marianne Hansen absolutely dumbfounded.

In March 2005, as a project secretary at the Nordic Council for Alcohol and Drug Research, I organized a seminar in Helsinki about problem gambling. At that time, I was glad to find out that even though not much is known about problem gambling in general, a broad range of literature and research exists in the area. However, relatively little of the empirical knowledge seems to have leaked from academic circles to the public. Many devoted people are involved in treating problem gamblers, but their knowledge is seldom based on empirical studies. Most of the interviewees who were treating problem gamblers in Finland had got their education in the early 1990s, with some occasional further training, if any, after that. A Swedish report states that the majority of the staff in the outpatient institutions in Sweden primarily received their knowledge about gambling from television documentaries. Only 5% had had any education in gambling issues, according to a study from the Swedish National Institute of Public Health. Problem gamblers in Finland are generally offered the same care as all other addicts, since not much else is available.

The Nordic countries vary when it comes to the public's awareness and acceptance of gambling as a serious problem, and this seems to be true among the gamblers themselves as well. Since the issue of gambling is seldom on the public agenda and often isn't taken seriously at all, people having problems with it might not know where to turn. They might even doubt that there is any reason to look for help in the first place, since gambling generally isn't considered as a real problem in Nordic societies. The general view of gambling is still, to a great extent, that it is mostly a harmless hobby. Public opinion is important to how the gambler understands his/her situation. 'A gambler is even more ashamed of himself than an alcoholic, since alcoholism is an accepted diagnosis', said one of the interviewees in Finland. This might be why relatively few people seek help for their gambling problems in any of the Nordic countries, as stated at the seminar in Helsinki.

The importance of reliable prevalence studies was often mentioned in Helsinki in March 2005. The question was raised whether the existing methods and tools are good enough to measure such a heterogeneous phenomenon as problem gambling. The methods often fail to classify the different types of gamblers or the level and extent of the problem for the individual. There is, for the time being, no consensus about how to measure problem gambling. Several methods are available, but they all have their weaknesses. The most used test until now has been the South Oaks Gambling Screen Revised (SOGS-R), which might give useful information about large populations but tells very little about individual gambling habits. 'All the people who walk in through my door score at least 13 points in SOGS, so I don't even use that test any more', said one interviewee in Finland. In the different surveys made in the Nordic countries, 0.3% to 6% of the population has been identified as problem gamblers, depending on the test and the country. The tests at hand seem to be able to tell whether a person has problems with gambling, but not much more. Jakob Jonsson believes that even the present methods could give better information if more attention was paid to the implementation of the surveys and also to their comparability.

Today there are telephone helplines for problem gamblers in all Nordic countries, including Iceland. One might wonder about the relatively low numbers of calls to the helplines, but, as noted at the seminar in Helsinki, very few know about these help lines and about the support they provide. Still, the thousands of calls are a useful source of information on the negative sides of gambling—and they also verify that the problem is real. The results from both Finland and Sweden show that gambling is first of all a problem for young and middle-aged men. The gambling pensioners might indeed be a Finnish speciality, but for the callers in both Finland and Sweden the biggest source of problems are indeed those innocent slot machines. Slot machines are easily available and the response comes quickly—something that is central to all addictions.

The big question for all the Nordic countries concerning gambling is, of course, the EU and the changes EU legislation and court decisions might bring in the near future. There is a fear that the liberal market policies of the EU will ruin the possibilities for Nordic countries to control, limit, or prevent the negative effects of gambling while cynics might say, that not much has been done to prevent the negative sides of gambling anyhow—which is only partly true. Preventive work is being done at several levels and in several ways in all the Nordic countries, although these actions seem almost non-existent when compared with the size of the gambling business. At the same time the society in whole is already involved in the gambling market as long as our states regulate it. This means that, first of all, we all have a responsibility to be aware of the impacts of gambling—even if these phenomena seem remote to us Secondly, we need to take action when needed.

Manuscript history: Submitted: Februray 8, 2006.

For correspondence: Jan Liesaho, (formerly) Nordic Council for Research on Alcohol and Drugs (NAD), Helsinki, Finland. E-mail: liesaho@nic.fi

Competing interests: None declared.

Jan Liesaho (Pol. mag., cultural studies, University of Helsinki) was with the Nordic Council for Research on Alcohol and Drugs (NAD).

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Statement of purpose

The Journal of Gambling Issues (JGI) offers an Internet-based forum for developments in gambling-related research, policy and treatment as well as personal accounts about gambling and gambling behaviour. Through publishing peer-reviewed articles about gambling as a social phenomenon and the prevention and treatment of gambling problems, it is our aim is to help make sense of how gambling affects us all.

The JGI is published by the Centre for Addiction and Mental Health and is fully funded by the Ontario Substance Abuse Bureau of the Ministry of Health and Long-Term Care. We welcome manuscripts submitted by researchers and clinicians, people involved in gambling as players, and family and friends of gamblers.

Disclaimer: The opinions expressed in this journal do not necessarily reflect those of the Centre for Addiction and Mental Health.

Ethics and accountability

The Journal of Gambling Issues is a member of the International Society of Addiction Journal Editors and supports the Farmington Consensus statement on ethical standards in publishing:
http://www-users.york.ac.uk/~sjp22/isaje/farmington.htm

Editor
Phil Lange

Editorial Board

Bruce Ballon, Peter Ferentzy, Nina Littman-Sharp, Robert Murray, Wayne Skinner, Tony Toneatto, Nigel E. Turner, and Martin Zack, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
 

Advisory Board

Peter Adams, Dept. of Psychiatry & Behavioural Science, University of Auckland, Auckland, New Zealand
 

Will Bennis, Max Planck Institute, Berlin, Germany
 

Alex Blaszczynski, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
 

Jeffrey L. Derevensky, International Center for Youth Gambling Problems and High-Risk Behaviors, Montreal, Quebec, Canada
 

Mark Griffiths, Psychology Division, Nottingham Trent University, Nottingham, U.K.
 

David C. Hodgins, Dept. of Psychology, University of Calgary, Calgary, Alberta, Canada
 

Edward Kwan, Independent practice, Hong Kong, China
 

Ray McNeil, Nova Scotia Department of Health, Halifax, Nova Scotia, Canada
 

Lia Nower, School of Social Welfare, University of Missouri-St. Louis, St. Louis, Misouri, U.S.A.
 

Nancy Petry, University of Connecticut Health Center, Farmington, Connecticut, U.S.A.
 

María Prieto, Dept. of Psychological Intervention, University P. Comillas, Madrid, Spain
 

Lusanda U.Z. Rataemane, National Gambling Board, Hatfield, Pretoria, South Africa
 

Gerda Reith, Dept. of Sociology, Anthropology and Applied Social Sciences, University of Glasgow, Glasgow, Scotland
 

Cesar A. Sanchez-Bello, Pathological Gambling Section of Latin-American Psychiatric Association, Isla de Margarita, Venezuela
 

Målfrid Todal, Division of Psychiatry, St. Olav's Hospital, Trondheim, Norway
 

Rachel A. Volberg, Gemini Research, Ltd., Northampton, Massachusetts, U.S.A.
 

Monica L. Zilberman, Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
 

Reviewers

Peter Adams, Dept. of Psychiatry & Behavioural Science, University of Auckland, Auckland, New Zealand
 

Alex Blaszczynski, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
 

Linda Chamberlain, Denver, Colorado, U.S.A.
 

Gerry Cooper, Centre for Addiction and Mental Health, Sudbury, Ontario, Canada
 

Jeff Derevensky, Youth Gambling Research & Treatment Clinic, Dept of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
 

William Eadington, Institute for the Study of Gambling and Commercial Gaming, University of Nevada at Reno, Reno, Nevada, U.S.A.
 

Pat Erickson, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
 

Jackie Ferris, Ferris Research, Toronto, Ontario, Canada
 

G. Ron Frisch, Problem Gambling Research Group, Dept of Psychology, University of Windsor, Ontario, Canada
 

Richard Govoni, Problem Gambling Research Group, Dept of Psychology, University of Windsor, Windsor, Ontario, Canada
 

Mark Griffiths, Psychology Division, Nottingham Trent University, Nottingham, U.K.
 

Rina Gupta, Youth Gambling Research & Treatment Clinic, Dept of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
 

David C. Hodgins, Addiction Centre, Foothills Medical Centre, Calgary, Alberta, Canada
 

Roger Horbay, Game Planit Interactive Corp., Toronto, Ontario, Canada
 

Alun C. Jackson, School of Social Work, University of Melbourne, Melbourne, New South Wales, Australia
 

Durand Jacobs, Loma Linda University Medical Center, Loma Linda, California, U.S.A.
 

Jeffrey Kassinove, Dept of Psychology, Monmouth University, West Long Branch, New Jersey, U.S.A.
 

David Korn, Dept. of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada
 

Igor Kusyszyn, Dept. of Psychology, York University, Toronto, Ontario, Canada
 

Robert Ladouceur, École de Psychologie, Université Laval, Québec, Canada
 

Samuel Law, St. Michael's Hospital, Toronto, Ontario, Canada
 

Henry Lesieur, Dept of Psychiatry, Rhode Island Hospital, Providence, Rhode Island, U.S.A.
 

Vanessa López-Viets, Dept of Psychology, University of New Mexico, Albuquerque, New Mexico, U.S.A.
 

Ray MacNeil, Nova Scotia Department of Health, Halifax, Nova Scotia, Canada
 

Virginia McGowan, Addictions Counselling Program, The University of Lethbridge, Lethbridge, Alberta, Canada
 

Goldie Millar, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
 

Sally Monaghan, University of Sydney, Sydney, New South Wales, Australia
 

Daniela Penickova, University of Oregon, Eugene, Oregon, U.S.A.
 

María Prieto, Dept. of Psychological Intervention, University P. Comillas, Madrid, Spain
 

Gerda Reith, Dept. of Sociology and Anthropology, University of Glasgow, Glasgow, Scotland
 

Robin Room, Centre for Social Research on Alcohol and Drugs, University of Stockholm, Stockholm, Sweden
 

Lisa Root, The Niagara Alcohol and Drug Assessment Service, St. Catherines, Ontario, Canada
 

Richard J. Rosenthal, UCLA Gambling Studies Program, Los Angeles, California, U.S.A.
 

Loreen Rugle, Clinical and Research Services, Trimeridian, Inc., Carmel, Indiana, U.S.A.
 

Randy Stinchfield, University of Minnesota Medical School, St. Paul, Minnesota, U.S.A.
 

David Streiner, Baycrest Centre for Geriatric Care, Toronto, Ontario, Canada
 

William Thompson, Dept. of Public Administration, University of Nevada, Las Vegas, Nevada, U.S.A.
 

Marianna Toce-Gerstein, NORC at the University of Chicago, Washington, D.C., U.S.A.
 

Lisa Vig, Lutheran Social Services of North Dakota, Fargo, North Dakota, U.S.A.
 

Rachel Volberg, Gemini Research, Ltd., Northampton, Massachusetts, U.S.A.
 

Keith Whyte, National Council on Problem Gambling, Washington D.C., U.S.A.
 

Jamie Wiebe, Responsible Gambling Council (Ontario), Toronto, Ontario, Canada
 

Robert J. Williams, School of Health Sciences, University of Lethbridge, Lethbridge, Alberta, Canada
 

Harold Wynne, Wynne Resources Ltd., Edmonton, Alberta, Canada
 

Reviews editor

Marianna Toce Gerstein, Georgetown University, Washington, D.C., U.S.A.
 

Design staff

Graphic designer: Mara Korkola, Centre for Addiction and Mental Health, Toronto, Ontario, Canada