Putting gambling problems on the agenda—Some Norwegian experiences

Hans Olav Fekjær, Blue Cross Centre, Oslo, Norway.

Although tragedies from gambling are an old phenomenon, gambling problems are often not acknowledged as an appropriate subject for publicly funded treatment and research. This is not difficult to comprehend. Without having met pathological gamblers, one might easily think that people who gamble much more than they can afford must be irresponsible, stupid, and reckless individuals who just need to pull themselves together.

In contrast, the first meeting with pathological gamblers is often an amazing experience, for three reasons. Firstly, the majority of pathological gamblers are remarkably normal individuals who have not faced or caused peculiar problems in other areas of life. Secondly, the consequences are often dramatic beyond imagination. Pathological gamblers experience not only severe economic problems but also crushed self-images, destroyed relationships, severe depressions, suicidal contemplation, and reduced capacity for work. Thirdly, the gambling often has the distinctive characteristics of a compulsion, with a strong contrast between attitudes and actions. Pathological gamblers may feel the need to employ extreme strategies to quit gambling.

In Norway, organised treatment of pathological gamblers started at the end of the 1990s. The problems were rapidly increasing due to our extremely liberal slot machine policy. Only in exceptional cases do Norwegians have the opportunity to buy a loaf of bread or a newspaper without being confronted by greedy slot machines, where you may lose more than $60 US (equivalent) each minute.

In 1999, the government proposed directives for less aggressive and accessible slot machines. But after extensive lobbying by the gambling industry, the proposals were unanimously turned down by the parliament. The representatives of the parliamentary committee of the two large conservative parties referred to gambling problems as 'this so-called problem'. The chief lawyer of the slot machine companies' association estimated the number of gambling addicts at 'some tens or some hundreds', so there was no need for regulation.

Thus, gambling problems were hardly regarded as a problem. Practically no financial resources had been allocated to treatment, prevention, or research. Therefore, we, the few therapists who met gambling addicts, strongly felt the need to put gambling problems on the agenda. We wanted to make a systematic effort to make the public, especially the health workers and the politicians, understand that pathological gambling is a large problem which is not just a moral issue, but a challenge for our society, especially for politicians, health workers, and researchers.

The first step was taken in 1999, when a few Nordic pioneers in gambling treatment and research founded a committee for education on pathological gambling. The committee arranges conferences for therapists, researchers, and state regulators. The next year, we started a national association for gambling problems. Its aim is to provide information on gambling problems, establish adequate treatment, initiate independent (not industry-sponsored) research, be a meeting place for professionals, and influence the political framework regulating gambling. The organisation has an active mailing list of which practically all therapists and some researchers and regulators are members. There are seminars every year.

But how could we exert more influence? In a discussion at the Nordic School of Public Health, leading health bureaucrats and politicians discussed which factors decide the priorities within the health services. They concluded that the priorities are not much influenced by the severity of the problems, nor by the opinions of professionals or by cost-benefit studies of the effects of treatment. The two main factors determining priorities are lobby groups and mass media.

The gambling industry is, of course, a mighty lobby group. Robert Goodman (1995) studied the processes behind the liberalisation of gambling during the last decades. He concluded that there had never been a popular demand for liberalisation of gambling policies. The only groups pushing for liberalisation have been the two groups profiting economically, namely the authorities and the gambling industry.

Their classical arguments have been summed up by Brian Castellani (2000, pp. 30–31) in his book Pathological Gambling:

If you legalize gambling, jobs will be created, money will be given to the schools, your town's economic recession will be lifted, the standard of living will increase, people from out of the state will come to gamble, the restaurants, hotels, malls, bars, and stores in your area will make money, and everyone will be happy.

In altering the impression that gambling is largely a win-win situation for society, the role of the mass media is probably essential. When media present a problem as large and serious, they invariably turn to the politicians, asking what they are going to do. The politicians feel obliged to declare that they are planning to take initiatives to reduce the problem. That is how the system works. It may even be maintained that the media govern the country, with politicians as intermediaries. How, then, can we influence the media?

Our experience has been that the media are interested in gambling problems if they are given the opportunity to present personal narratives, or political conflicts, or numbers indicating the size of the problem.

Journalists often ask therapists for access to pathological gamblers. Although many patients feel there is an urgent need to tell the public what gambling problems are really like, most of them do not want to reveal their identity in public. Thus, there have been many anonymous interviews. But an important minority, mainly gambling addicts in stable, long-term remission, are willing to face the mass media with picture and name.

The personal narrative of the career of a pathological gambler, from being a well-functioning individual to experiencing tragedy for him- or herself and family, often makes a strong impression on readers or viewers. We believe such contributions have been very valuable for putting gambling problems on our society's agenda.

As mass media always focus on political conflicts, they will focus on gambling problems if some politicians propose controversial changes in gambling policy. Therefore, such proposals may be helpful even if they are not approved.

The mass media also like to present the number of pathological gamblers, the number being treated, or the number of suicides related to gambling. Numbers tend to accelerate public debate on any social policy issue, even though the numbers are not always accurate. Therefore, it is probably crucial to perform a population study and collect other quantitative measures of gambling problems. When awareness of gambling problems reaches a certain level, it is possible to get funding for a population study on gambling and gambling problems. This seems to be an important step in the process of increasing awareness of the problems.

Another important strategy for putting gambling problems on the agenda has been to write articles in newspapers and journals and to publish books on the topic. In Norway, the first book on problem gambling was published in 2002 (Fekjær, 2002) and the second in 2005 (Skaug, 2005).

A major change in awareness has taken place during the last 5 years. Gambling problems are clearly on the public agenda, as reflected in the news and in radio and TV debates.

Of course, tragedies from gambling still take place. But nobody may now talk in public of gambling addiction as a 'so-called problem'. Treatment is being offered in most of the country and resources are available for research and prevention. The political climate has changed. The national organisation has good access to key politicians and so the board has meetings with ministers every year. Our parliament has passed a new law aimed at reducing gambling, especially a very strong reduction in slot machine gambling.

Nobody can for sure analyse the reasons behind the changes in public and political attitudes. Attitudes have, of course, also changed in other countries, but the changes over a few years seem to have progressed more strongly and rapidly in Norway than in most other countries. Therefore, we believe a good deal of the progress is due to the systematic efforts by therapists and pathological gamblers. By and large, we are satisfied with the development and looking forward to pushing the development further in the same direction.

References

Castellani, B. (2000). Pathological gambling: The making of a medical problem. Albany, NY: State University of New York Press.

Fekjær, H.O. (2002). 'Spillegalskap'—vår nye landeplage. Oslo: Gyldendal Akademisk.

Goodman, R. (1995). The luck business. New York: Free Press.

Skaug, T. (2005). Spilleavhengighet. Oslo, Norway: Universitetsforlaget.

Manuscript history: Submitted: February 8, 2006. This article was not peer-reviewed.

For correspondence: Hans Olav Fekjær, Psychiatrist, Certified supervisor of psychotherapy, Sjøstrand, 1450 Nesoddtangen, Norway. Phone: +47 908 57 122.
URL: http://www.fekjaer.org/hansolav.html

Competing interests: None declared.