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annotated gambling bibliographies
The prevention of pathological gambling: An annotated bibliography
Peter Ferentzy, Nigel E. Turner, & Wayne Skinner, Centre for Addiction and
Mental Health, Toronto, Ontario, Canada. E-mail:
Nigel_Turner@camh.net
The preparation of this annotated bibliography was guided by a desire to
include all of the problem gambling research articles related to
prevention that have been published in English. Some exceptions were
made for articles published in other languages but for which an English
abstract was available that provided sufficient details about the study. All
studies were included, regardless of their methodological quality. In some
cases, studies utilizing the same treated sample but providing additional
results of the study were included.
The annotations are brief and simply provide the reader with the full
bibliographic reference, the basic approach that is evaluated in the study,
and, when available, information about the results. No effort was made to
critically appraise or review the study.
Since the problem gambling research field is a growing area of inquiry, this
bibliography will become quickly outdated and will require regular update to
remain current.
Prevention is a
complex topic that must take into consideration the causes of the problems.
As such we not only report papers evaluating prevention programs but also
discuss papers that explore the causes of pathological gambling.
These papers on prevention are divided into four categories:
Each paper was
placed into the category that it best suited.
1. Risk factors
Alberta Alcohol and
Drug Abuse Commission. (2002). Patterns of exposure to risk and
protection for substance and gambling use and abuse: Alberta Youth
Experience Survey 2002. Edmonton, AB: Author.
The Alberta Youth
Experience Survey of 2002 provides information on substance and gambling use
and abuse among adolescents. The main focus was on risk and protective
factors. Three types of prevention programs are discussed: (1)
universal—promotes overall health and the prevention or delay of the onset
of risky behaviours among youth; (2) indicated—promotes efforts to reduce
behaviours among youth who have begun to gamble; and (3) targeted—promotes
efforts directed at those who are at greater risk. The report notes that a
greater number of people at low risk may, overall, generate more harm than a
smaller number at greater risk. Hence, prevention often focuses on those at
lower risk. Along a continuum, the report provides five categories of risk
intensity. Based on a questionnaire, 53.7% fell into the lowest-risk
category, 36.2% fell into the middle-risk category, and 3.9% fell into the
highest-risk category.
Allcock, C.,
Blaszczynski, A., Dickerson, M., Earl, K., Haw, J., Ladouceur, R., et al.
(2002). Current issues related to identifying the problem gambler in the
gambling venue. Melbourne, Australia: Australian Gaming Council.
Available at
http://www.austgamingcouncil.org.au/research/files/Current%20Issues%20Related%20to%20Identifying%20the%20Problem%20Gambler%20in%20the%20Gaming%20Venue.pdf
This report contains
several discussion papers by leaders in the field. Clear, definite
behavioural indicators of harmful gambling can be elusive, so a flexible
approach to identification is best. Staff should not diagnose problem
gamblers. The most obvious indicator of problem gambling is a patron asking
for some form of assistance, such as self-exclusion. Possible indicators
include frequent trips to ATMs, especially just before or after midnight
when a new accounting day begins; requests to borrow money from staff;
disorderly behaviour; inquiries from family members; and long playing
sessions.
Barnes, G., Welte, J., Hoffman, J., & Dintcheff, B. (1999). Gambling and
alcohol use among youth: Influences of demographic, socialization, and
individual factors. Addictive Behaviors, 24, 749–767.
Two studies assessed
common predictors of alcohol use and gambling among youth in the Buffalo,
New York, area with respect to four criteria: (1) sociodemographic, (2)
psychological, (3) parental and peer socialization, and (4) other problem
behaviours. The authors found that "multivariate analyses of variance
revealed that impulsivity, moral disengagement, and delinquency (adolescent
or peer delinquency) predicted alcohol consumption and gambling in both
studies, even after controlling for demographic factors. Parental
monitoring, cigarette use, and illicit drug use predicted alcohol
consumption in both studies, but did not predict gambling once the
demographic and individual factors were taken into account." Like other
studies, this one found higher rates of gambling among males. The authors
argue that preventative efforts must go beyond prevalence and associations
between variables; they need to explore causal factors, or "predictors,"
such as impulsivity and moral disengagement.
Bourget, D., Ward,
H., & Gagne, P. (2003, December). Characteristics of 75 gambling-related
suicides in Quebec. Psychiatry and the Law (CPA Bulletin), 17–21.
This study was
conducted to describe psychiatric, social, and demographic characteristics
of problem gamblers who committed suicide. Seventy-five cases were examined.
Over half were married, and one quarter (25.3%) had attempted suicide in the
past. Sixty-four percent had given no warning of suicidal intentions. One
quarter were intoxicated with alcohol when committing suicide, and one third
had histories of substance abuse. Most had experienced marital and financial
losses because of gambling. The authors claim that these findings suggest
differences between pathological gamblers and nongamblers who commit
suicide. Suicidal intentions and psychiatric issues may be harder to
identify. Impulsiveness associated with problem gambling along with
substance abuse renders this population at high risk. Low levels of marriage
and employment—both considered barriers against suicide—among this group are
also worthy of note. The authors recommend that suicide prevention among
pathological gamblers receive more study.
Felsher, J.,
Derevensky, J., & Gupta, R. (2003). Parental influences and social modelling
of youth lottery participation. Journal of Community and Applied Social
Psychology, 13, 361–377.
This study attempted
to investigate the relation between youth (10 to 18 years) lottery
participation and perceived parental involvement in lottery playing. A
strong association was found, with many youth reporting that parents
purchase tickets for them. Notably, youth problem gambling was associated
with higher perceived parental participation in lotteries. Most participants
did not fear legal repercussions when purchasing tickets, despite awareness
of legal prohibitions. Lotteries are perceived as innocuous, and prevention
must focus on public awareness and education. The authors note that
communities would not accept parents purchasing alcohol for their children,
yet similar awareness of gambling addiction is lacking. Awareness campaigns
must target parents as well as youth, and current legal restrictions on
purchases should be strictly enforced.
Felsher, J.,
Derevensky, J., & Gupta, R. (2004a). Lottery participation by youth with
gambling problems: Are lottery tickets a gateway to other gambling venues?
International Gambling Studies, 4, 109–125.
This study, with
1,072 participants aged 10 to 18, was designed to identify whether lotteries
represent a key option for youth with gambling problems. A secondary
objective was to identify similarities and differences, among youth with
gambling problems, between gambling behaviour associated with lottery
tickets and other, "traditional," forms of gambling. Lotteries were favoured
by youth with gambling problems. This study found that lottery playing is
conducive to pathological behaviours, such as chasing losses, for youth with
gambling problems and that lotteries are potentially addictive as well as a
gateway to gambling in general. Social approval and accessibility of
lotteries, misconceptions about the odds of winning, and parental approval
are all potential factors in the onset of lottery playing among youth.
Focal Research
Consultants Ltd. (Schrans, T., Schellinck, T., & Walsh, G.). (2001).
Technical Report: 2000 regular VL players follow up. Halifax, NS: Nova
Scotia Department of Health. Available at
www.gov.ns.ca/health/downloads/VLPlayers_TechnicalReport.pdf
This is the second
phase of a two-part random survey of video lottery terminal players. The
study was designed to identify contributing factors to problems and
resolution of problems in order to better inform prevention and treatment
initiatives. This lengthy (440-page) document covers many issues, from
situational factors contributing to problems and motivations for first
playing to mitigating factors for stopping or reducing play. Motivations for
playing, negative consequences of stopping, spousal support, and a range of
other issues are covered.
Gibson, B., &
Sanbonmatsu, D. (2004). Optimism, pessimism, and gambling: The downside of
optimism. Personality and Social Psychology Bulletin, 30, 149–160.
Three studies found
that people who were dispositionally optimistic were more likely to expect
to win even after having lost money gambling and were less likely than
pessimists to reduce their expectations and their betting after poor gaming
results. Optimists also reported remembering more near wins. The results
suggest that while optimism may be beneficial in many respects, it could be
a risk factor for gambling-related harm.
Griffiths, M., &
Wood, R. (2000). Risk factors in adolescence: The case of gambling,
videogame playing, and the internet. Journal of Gambling Studies, 16,
199–225.
Observing that
adolescents appear to be at high risk for pathological gambling and that the
condition is often associated with other problematic behaviours, this
article examines risk factors for adolescent gambling and also for video
game playing, as the latter shares many traits with gambling. The effects on
youth of technology, notably the Internet and video games, are explored. The
authors argue that young people may be more attracted to technologically
advanced gambling venues. Access is identified as an important factor. The
authors call for early preventative and intervention strategies. Specific
proposals include raising the minimum age for all commercial gambling
activities to 18, imposing stricter penalties on merchants who sell to
underaged buyers, and limiting television gambling advertising to after 9
p.m. Research recommendations are also made.
Gupta, R., &
Derevensky, J. (1998). Adolescent gambling behavior—A prevalence study and
examination of the correlates associated with problem gambling. Journal
of Gambling Studies, 14, 319–345.
This study finds
that 80.2% of high school students (out of a sample of 817) have gambled in
the past year, 35.1% gamble at least once a week, and 4.7% are pathological.
Engagement in illegal acts and parents with gambling problems were both risk
factors, as was gender, with males gambling more than females. The average
age of gambling onset for the problem gamblers was 11.5 years, indicating
the need for prevention efforts at the elementary school level. Most
adolescents reported gambling at home more than anywhere else. Problem
gambling seems associated with psychosocial risk factors applicable to other
addictions, suggesting the need for broader conceptions of prevention. At
the time of this writing, gambling is the only potentially addictive
activity in which young people engage without the type of disapproval and
educational campaigns aimed at other addictive behaviours.
Hardoon, K., &
Derevensky, J. (2001). Social influences involved in children's gambling
behavior. Journal of Gambling Studies, 17, 191–215.
This study was
designed to measure the betting behaviour of children and to see whether
changes in amounts bet would occur in groups of two or three, and if this
was affected by the inclusion in the groups of peers of the same or opposite
gender. Children (grades 4 and 6) played a computer-simulated roulette game
alone and in groups and were asked to complete a questionnaire addressing
their gambling behaviour. Males were found to bet larger amounts than
females both alone and in groups. Females were found to bet larger amounts
when playing with others of either gender. The authors discuss social
learning theory as a premise for the study. The present study is said to be
largely preliminary, and more work along the lines of peer influence is
required for the development of comprehensive preventative and intervention
strategies.
Hardoon, K., Gupta,
R., & Derevensky, J. (2004). Psychosocial variables associated with
adolescent gambling. Psychology of Addictive Behaviors, 18, 170–179.
This article
discusses empirical findings concerning psychosocial determinants—social
support, substance use, and behaviour and learning problems—associated with
adolescent problem gambling. A questionnaire was given to students (grades 7
to 13). The main psychosocial problems associated with problem gambling
include poor perceived familial and peer support, problems with substance
use, behaviour and family problems, and parents involved with gambling and
substance use. Predictors include gender (being male), family and conduct
problems, and substance addiction. The finding most relevant to prevention
is that at-risk gamblers may have more in common with probable pathological
gamblers than otherwise thought.
Jacobs, D. (2000).
Juvenile gambling in North America: An analysis of long term trends and
future prospects. Journal of Gambling Studies, 16, 119–152.
Studies of middle
and high schools in North America suggest that two thirds of underage youth
have gambled for money within the past year. Serious problems related to
gambling are experienced by 2.2 million North Americans aged 12 to 17.
Lotteries represent the most common form of gambling among this age group.
The number of youth gambling, and the number of those with serious related
problems, is on the rise. This study provides a profile of juveniles who
reported serious gambling problems. Relevant factors include, but are not
limited to, early age of onset for gambling; gender (most problem gamblers
are male); parental gambling; urban environments; ethnicity; preference for
rapid, continuous, and interactive games; likelihood of selling things, even
using lunch money, to generate gambling funds; frequent alcohol and drug
use; psychosocial states associated with the reasons given for gambling; and
dissociative reactions while gambling. Noting that the age of onset for
gambling is likely to decline, the author calls for early prevention efforts
at the primary school level.
Joukhador, J.,
Blaszczynski, A., & Maccallum, F. (2004). Superstitious beliefs in gambling
among problem and non-problem gamblers: Preliminary data. Journal of
Gambling Studies, 20, 171–180.
This study finds
that problem gamblers held more superstitious beliefs about gambling than
non-problem gamblers and that these beliefs were associated with gambling
intensity. Defined as "a strong conviction based on the erroneous perception
of a cause-effect association between two independent events," superstitious
beliefs are considered an important factor in the maintenance of gambling
behaviour. More research is required to determine whether such beliefs
precede problem gambling or are subsequent to gambling behaviour. The
authors caution for cultural sensitivity when identifying, and defining,
superstition. For example, praying for positive results may be culturally
appropriate and hence need not be taken as irrational. Hence, a more
sophisticated grasp of the concept of "superstition" is required.
Kaminer, V., & Petry, N. (1999). Alcohol and drug abuse: Gambling behavior
in youths: Why we should be concerned. Psychiatric Services, 50,
167–168.
Few psychiatrists
have substantial experience dealing with the assessment, treatment, or
prevention of pathological gambling. As well, even as gambling opportunities
have increased over the last decade, the implications of gambling have not
been adequately studied. This is especially true for adolescents and is
comparable to the situation 30 years ago with respect to substance abuse.
Such lack of attention could lead to greater numbers of pathological
gamblers in the next generation. Correlates of problem gambling include poor
academic performance, being male, truancy, problematic parental gambling,
and delinquency. A systematic effort, involving epidemiological and clinical
assessment, treatment with an emphasis on high-risk adolescents, and
prevention, is required.
Ladouceur, R.
(2004). Perceptions among pathological and non-pathological gamblers.
Addictive Behaviors, 29, 555–565.
People's perceptions
while gambling on video lottery terminals were evaluated for the purpose of
comparing the frequency of erroneous perceptions and gambling-related
perceptions, and the degree of conviction with respect to these perceptions,
in pathological and nonpathological gamblers. Participants were assessed
according to DSM-IV criteria. No significant differences were found in the
percentage of erroneous perceptions, but pathological gamblers held more
gambling-related perceptions in general and with greater conviction.
Lynch, W.,
Maciejewski, P., & Potenza, M. (2004). Psychiatric correlates of gambling in
adolescents and young adults grouped by age at gambling onset. Archives
of General Psychiatry, 61, 1116–1122.
Few studies have
investigated the mental health correlates of gambling. While early
participation in behaviours with addictive potential has been associated
with problems, this has not been comprehensively studied with respect to
gambling. This study offers a direct investigation of a nationally
representative sample of adolescent and young adult gamblers grouped by age
of onset (before age 18 and adult onset). The results reveal that adolescent
gamblers were more prone to drinking and drug use, dependence, or abuse, as
well as depression. Early onset adult gamblers were more likely than adult
nongamblers to report use of, and dependence on, alcohol and drugs. Adult
onset gamblers reported higher rates of alcohol use than adult nongamblers.
This study also provides confirmation to other research suggesting that
adolescent gambling may be more socially oriented than adult gambling. The
authors conclude that adolescent onset gambling is associated with
psychiatric disorders, notably those related to substance use, and that more
research is needed to better inform treatment and prevention initiatives.
The authors note that the psychiatric measures employed were limited to
depression and substance use issues and that the questions related to these
issues did not make for proper diagnostic criteria. Questions pertaining to
possible selection bias are also discussed.
McMillen, J.,
Marshal, D., & Murphy, L. (2004). The use of ATMs in ACT gaming venues:
An empirical study. Canberra: The ANU Centre for Gambling Research.
Available at
http://gambling.anu.edu.au/menu/PDFs/ATMs-FINALReport.pdf
This study finds no
strong association between problem gambling and the use of automatic teller
machines (ATMs) on site and finds that removal of such machines would
represent an undue inconvenience for non-problem gambling patrons. Instead,
the authors recommend a daily limit on the amount that can be withdrawn.
However, some qualitative evidence, based upon interviews with problem
gamblers and their families, was found for the removal of ATMs. The authors
grant that the removal of ATMs might benefit a small (3.1%) segment of the
sample population. Industry representatives were against such a policy. The
study did find a strong relation between problem gambling and the use of
note acceptors for electronic gambling machines (EGMs). But the authors
claim that removing note acceptors would be impractical, so only a limit on
the amounts that can be used this way is recommended (and even this
recommendation is made tentatively, pending further study).
Moore, T., & Jadlos,
T. (2002). The etiology of pathological gambling: A study to enhance
understanding of causal pathways as a step towards improving prevention and
treatment. Wilsonville, OR: Oregon Gambling Addiction Treatment
Foundation. Available at
http://www.gamblingaddiction.org/Etiology/Etio02.PDF
This study was
designed to increase knowledge about the possible "causal pathways" that
lead to pathological gambling. It also tested research methods for
large-scale random population studies. The authors suggest that the roles of
trauma, abuse, and neglect should be taken into account in prevention
initiatives. Prevention measures taken in Oregon are discussed.
Oei, T., & Raylu, N.
(2004). Familial influence on offspring gambling: A cognitive mechanism for
transmission of gambling behavior in families. Psychological Medicine,
34, 1279–1288.
While many factors
in the development and maintenance of problem gambling have been identified,
familial influence is understudied. This study attempts to identify the
influences of parental behaviours and cognitions on the gambling behaviour
of offspring. The South Oaks Gambling Screen, the Gambling Related Cognition
Scale, and other questionnaires were administered to 189 families. The
results suggest that parents, notably fathers, influence the cognitions and
behaviours of their children. One interesting finding is as follows:
"However, SEM [structural equation modelling] analyses showed that although
parental gambling behavior was directly related to offspring gambling
behavior, parental cognitions were not related to offspring gambling
behavior directly but indirectly via offspring cognitions." These findings
suggest that the cognitive mechanism by which attitudes and behaviours are
transmitted may, in some ways, be subtle. More study is required.
Preventative efforts should target parents' cognitions. Early intervention
should focus on the family rather than on the child in isolation.
Potenza, M.,
Fiellin, D., & Heninger, G. (2002). Gambling—An addictive behavior with
health and primary care implications. Journal of General Internal
Medicine, 17, 721–732.
Little work has been
done to study the relation between general health and gambling behaviour,
yet there is some evidence that nongambling health problems are associated
with problem gambling. This article discusses this relationship with an eye
to screening and treatment options for problem and pathological gambling, as
well as the relation between problem gambling and substance abuse. The
authors suggest that general practitioners can play a role in the
identification of pathological gambling. More awareness of the general
health correlates associated with certain gambling behaviours could lead to
physicians assuming a preventative role.
Raylu, N., & Oei, T. (2004). Role of culture in gambling and problem
gambling. Clinical Psychology Review, 23, 1087–1114.
The role of culture
in gambling and problem gambling has not been addressed properly in the
literature. This article discusses these cultural variations and identifies
variables pertinent to the initiation and maintenance of gambling behaviour.
The few studies available suggest that some cultures are more prone to
gambling as well as problem gambling. Familial/genetic factors, along with
individual and sociological determinants, should be investigated among
different cultural groups in order to develop stronger etiological analyses
and culturally sensitive treatment and preventative interventions. An
important consideration is the effect of culture upon help seeking. Yet
knowledge is lacking. For example, despite anecdotal evidence of high rates
of gambling and problem gambling among Asians, this has not been
systematically studied. Few studies have looked at problem gambling among
ethnic minorities. This article attempts to redress this gap by reviewing
available knowledge, gauges the extent to which western studies provide
information applicable to other groups, and makes recommendations for
further research. The authors note that high rates of problem gambling among
certain groups are not reflected in treatment attendance. Culturally
relevant, community-based approaches should replace the current overemphasis
on hospitals and clinics.
Ricketts, T., &
Macaskill, A. (2004). Differentiating normal and problem gambling: A
grounded theory approach. Addiction Research and Theory, 12, 77–87.
This study follows
up on another by the same authors that outlined a theory of problem gambling
involving the experiences of males seeking treatment and the prediction of
processes that differentiate normal and problem gamblers. This study employs
a grounded theory approach and a sample of male high-frequency (but still
"normal") gamblers. Arousal and a sense of achievement were associated with
gambling of all kinds, whereas the use of gambling to manage negative
emotions was associated with problem gambling—notably, problem gamblers
seemed to lack alternative emotional outlets. The ability to control
gambling behaviour was another important marker, with problem gamblers
requiring more "control strategies."
Stinchfield, R.
(2000). Gambling and correlates of gambling among Minnesota public school
students. Journal of Gambling Studies, 16, 153–173.
This study addressed
the prevalence of gambling, and variables associated with gambling
behaviour, among 78,582 Minnesota public school students in the 9th and 12th
grades. Most students had gambled in the past year, though few had gambled
frequently or reported gambling-related difficulties. Asian and Caucasian
students gambled less often than African Americans, Latinos, and Natives.
Age and gender were both significant, as older students and boys gambled
more frequently. Gambling frequency was also associated with higher rates of
sexual activity, the desire to stop gambling, alcohol use, tobacco use,
regret over having bet certain amounts of money, and antisocial behaviour.
The author concludes that gambling is probably associated with other risky
behaviours and that it may also be a function of adolescent experimentation.
The kind of information delivered by this study—involving such a large
sample and shedding some light on specific correlates—should help in the
creation of targeted prevention efforts.
Vachon, J., Vitaro,
F., Wanner, B., & Tremblay, R. (2004). Adolescent gambling: Relationships
with parent gambling and parenting practices. Psychology of Addictive
Behaviors, 18, 398–401.
The additive and
interactive links between family risk factors—parental gambling and
parenting practices—were examined among a community sample of 938
adolescents who completed the South Oaks Gambling Screen Revised for
Adolescents and a questionnaire on parenting practices. Parents completed
the standard South Oaks Gambling Screen. Gambling frequency among
adolescents was related to gambling frequency and problems among parents,
while gambling problems among adolescents were associated only with the
severity of fathers' gambling problems. Low levels of parental monitoring
were associated with gambling and other difficulties, and inadequate
disciplinary practices—referring to inconsistent and harsh attempts to
control a child's behaviour—were another factor associated with gambling
problems in adolescents. The findings suggest that parenting practices and
gambling behaviour should be targeted by prevention strategies.
Vitaro, F., Brendgen,
M., Ladouceur, R., & Tremblay, R. (2001).
Gambling, delinquency, and drug use during adolescence: Mutual influences and common
risk factors. Journal of Gambling Studies, 17, 171–190.
Authors' abstract:
"The purpose of this study was threefold: (1) to assess the possible mutual
influence between gambling, substance use, and delinquency over a two-year
period during mid adolescence, (2) to test whether variables that are
usually predictive of delinquency and substance use also predict gambling,
and (3) to test whether the links between the three problem behaviors could
be, at least partially, accounted for by common antecedent factors
(impulsivity, parental supervision, and deviant friends) assessed during
early adolescence. Seven hundred and seventeen boys participated in the
study. Impulsivity, parental supervision, and friends' deviancy were
collected when participants were 13 and 14 years of age. Gambling, substance
use, and delinquency were collected through self-reports at ages 16 and 17
years. The results showed no influence or modest influence of problem
behaviors on each other from age 16 to age 17 years, once current links and
auto-correlations were accounted for. Conversely, the cross-sectional links
between the three problem behaviors at each age were moderately high.
Impulsivity, low parental supervision, and deviant friends were predictively
related to each problem. Finally, a significant, although modest, portion of
the covariance between the three problem behaviors was accounted for by
these three predictors. The present findings contradict previous findings
about the influence of gambling on other problem behaviors and support the
notion of a 'general problem behavior syndrome' fed by generic risk
factors." The findings suggest that gambling behaviour should not be
targeted in isolation. The authors recommend early efforts to reduce
impulsive-disruptive behaviours, which in turn could be buttressed by
improvement of parental supervision and association with friends who are
less deviant.
Welte, J., Barnes, G., Wieczorek, W., Tidwell, M., & Parker, J. (2004). Risk
factors for pathological gambling. Addictive Behaviors, 29, 323–335.
This study finds
casino gambling, and engagement in many forms of gambling, to be associated
with gambling pathology. Cards, bingo, and lotteries are associated with
moderately high risk. Alcohol abuse, minority (African, Hispanic, Asian),
and low socioeconomic status were each associated with pathological
gambling. When other variables were adjusted for, gender was not a
significant predictor.
Winters, K., &
Anderson, N. (2000). Gambling involvement and drug use among adolescents.
Journal of Gambling Studies, 16, 175–198.
This article
discusses the association between gambling and drug use among youth. Such
knowledge is key to understanding the origins and course of adolescent
gambling. Though many risk factors seem to run across both behaviour
domains, more knowledge is needed about which factors are common and which
are specific to problem gambling. Comparisons of consequences are made, and
the implications of co-occurrence are discussed. In many respects, knowledge
of the nature and consequences of problem gambling is less developed than
that of substance abuse, a situation that must be rectified if better
prevention and intervention strategies are to be developed.
2. Programs
Aboriginal
Responsible Gambling Strategy. (2002). A self-help guide to gambling
responsibly. Toronto: Ontario Ministry of Health.
The Ontario Ministry
of Health funded a special program for Ontario's Métis designed to meet the
needs of this community. This 17-page brochure is written in a personable
style and contains one first-person account of problems with gambling.
Issues pertaining to language (problem/pathological gambler) are discussed
briefly for the purpose of demystification. Readers are directed to ask
themselves relevant questions about their gambling, with risk factors
identified. The pamphlet winds down on a positive note, with messages
pertaining to overall healthy approaches to life and alternatives to
gambling.
Alberta Alcohol and
Drug Abuse Commission. (1999). Playing with fire: Aboriginal adolescent
gambling. Edmonton, AB: Author.
This video explores problem gambling, risk factors, and consequences through
an aboriginal teen's story. Testimonies from gamblers are also provided.
Alberta Alcohol and Drug Abuse Commission. (2001). Your best bet: When
young people gamble. An early intervention resource. Edmonton, AB:
Author.
This gambling education curriculum is designed to function within health,
life skills, mathematics, or language arts classes. Background information
is provided, and an addiction model of problem gambling is employed.
Misconceptions and risk factors are discussed.
Byrne, G. (2001).
The Free Yourself Program. Warrandyte, Australia: Rebound Consulting
Pty. Ltd. Available at
http://www.freeyourself.com.au/freeyourselfprogram.html
In their words: "The 'Free Yourself Program' is a positive, holistic,
pro-active and very effective approach to help people to deal with their
Gambling Addiction. It represents a much-needed 'new model' of gambling
addiction therapy where the main responsibility is given back to the person
directly affected by the addiction to work on changing their 'attitude' and
their 'behaviour.' Most importantly, it provides strategies that people can
use 'in the moment' when the urge to go gambling threatens to become
overpowering. People weren't born addicted, but became so over time. FYP
shows how the addiction process can be reversed and eliminated."
Docherty, C., Frost, A., Transom, A., & Cundall, L. (2004). Youth
education project (When is it not a game?). Auckland, New Zealand:
Problem Gambling Foundation of New Zealand. Available at
http://www.cgs.co.nz/files/YEP%20Report.pdf
When the national
pilot Youth Education Project delivered the gambling resource, When is it
not a game?, it was found that youth are experiencing gambling-related
effects and that they have some knowledge of the issue. The resource offers
a "strengths-based" approach with an emphasis on youth development,
conveying information about the effects of gambling in order to enable young
people to make informed decisions.
Game Planit
Interactive Corp. http://www.gameplanit.com
In their words:
"Game Planit is the leading authority on consumer (player) protection
policies, strategies, information, products and services, for all
stakeholders with an interest in regulated gaming … Product Safety & Game
Evaluation Services are also part of Game Planit's comprehensive array of
products and services. This services [sic] allows various
stakeholders to fulfill their duty-of-care obligations to implement product
safety warnings and other needed protective measures. Overall, Game Planit
is forging the Standards of Excellence for Player Protection by
providing all stakeholders with the highest possible prevention and problem
gambling solutions based on innovation and empirical data into problem
gambling risk factors from the most recent and leading-edge research into
the games and problem gambling." This site features Safe@play (see Horton,
Harrigan, Horbay, & Turner, 2001), other products, workshops, and facts
about gambling and odds, as well as relevant contacts.
Glass, L. (2002). Gambling education: Some strategies for South
Australian schools.
Adelaide, Australia: South Australia Department of Human Services. Available
at
https://www.library.health.sa.gov.au/Portals/0/gambling-education-some-strategies-for-south-australian-schools.pdf
This report examines
state, national, and international preventative strategies along with
opportunities to develop gambling education programs in South Australian
schools. Such education is geared to informing students about the potential
effects of gambling and to assist them in making healthy choices. The author
points out that adult problem gambling often begins as early as the age of
10, rates of problem gambling among youth are higher than among adults, and
gambling among youth is associated with other risky behaviours. The author
also notes that gambling education in schools may in fact increase gambling
rates by generating curiosity. This article discusses prospects, and limits,
of school-based interventions. As knowledge alone is not sufficient to alter
gambling behaviour, this report proposes a constructivist learning theory
approach that emphasizes the active agency of people in the learning
process. Recommendations are divided into those applicable to schools and
those falling outside the purview of educational institutions.
Community-based recommendations involve changing perceptions of gambling,
developing a measure of safe gambling, and educating retailers about laws
governing sales to minors. School-based recommendations include educating
teachers and creating a Project Officer post to oversee this report's
recommendations.
Government and
Public Awareness Task Group of NPNU Consortium. (2000). Harm reduction
information kit: For professionals working with at-risk populations.
Edmonton: Alberta Non-Prescription Needle Use Consortium (NPNU). Available
at http://www.hivedmonton.com/textsite/graphs/hrk_english.pdf
This information kit
discusses the principles of harm reduction, with practical advice on issues
ranging from substance abuse to problem gambling.
Griffiths, M.,
Scarfe, A., & Bellringer, P. (1999). Brief report: The UK National Telephone
Gambling Helpline—Results on the first year of operation. Journal of
Gambling Studies, 15, 83–90.
This article
discusses the U.K.'s national gambling helpline in the first year of its
operation: November 1997 to October 1998. Of 1729 calls, 51% were from
problem gamblers, 90% of whom were male, and 26% of inquiries were from
relatives of problem gamblers. Professionals dealing with problem gamblers
represented 13% of calls. Fruit machine gambling presented itself as the
most problematic of gambling behaviours, especially for adolescents and
women. The authors presented their findings because there had been no
prevalence studies of adult gambling in the U.K., and there was little
knowledge about which types of gambling cause the most problems.
Health-related consequences of problem gambling, including depression,
anxiety, and suicidal ideation, were identified by a significant minority of
callers. The authors advise that excessive gambling be identified as a
serious health issue and point out that while general practitioners
routinely ask patients about smoking and drinking, gambling is rarely
discussed.
Know the Odds Inc.
(2001). You figure it out—Problem gambling today. Auburn, Australia:
Author. Available from http://www.knowodds.org/yfio.html
In their words: "The
kit comprises video, software and notes and is suitable for use in secondary
schools. The purpose of the kit is to educate students to: prevent them
becoming problem gamblers; and understand problem gambling in others." The
education kit is planned around a 20-minute video involving young people
discussing issues related to gambling and interviewing an expert, while the
software is geared to teaching students (even those with little aptitude for
math) about the law of averages and how this works against problem gamblers.
Le groupe Jeunesse. (2001). The count me out (Moi, je passe) awareness
program for the prevention of gambling dependency. Montreal, QC: Le
groupe Jeunesse.
This is a bilingual (French and English) program designed for grade 3
through the end of high school. Knowledge about gambling, inaccurate
cognitions, attitudes, and behaviours are all targeted. Risk and protective
factors are explained.
Macdonald, J., &
Somerset M. (2003, May). Minimizing risk through preventative skills
development. Paper presented at the 12th international conference on
gambling and risk taking, Vancouver, BC.
The authors discuss
school-based problem gambling prevention programs and contrast them with
their own: "Youth making choices: Coping and critical thinking." An
important feature of this program is that it relies on more than mere risk
avoidance messages in favour of a more client-centred approach. The course
is designed to promote coping skills, awareness of randomness,
self-monitoring, and critical thinking. The program comprises seven lessons
with three guiding principles: "Learning and using more coping skills and
stepwise planning to solve stressful problems; Knowing all the ways in which
problem gambling can harm you and learning how to check your thoughts,
feelings and behaviour for signs of the onset of problem gambling or other
problematic behaviours; Understanding that winning and losing are random
events and why most people hold erroneous beliefs about their chances of
winning."
Marotta, J., &
Hynes, J. (2003). Problem gambling prevention resource guide for
prevention professionals. Salem, OR: Oregon Department of Human
Services. Available at
http://www.gamblingaddiction.org/Prevent/PreventGuide.pdf
This guide was
designed to provide professionals with information about the relationship
between problem gambling and other problematic behaviours. As well, it
discusses evidence-based prevention measures for addictions and those
specific to gambling. The authors note that empirical knowledge of
preventative initiatives for gambling is scant. A public health model is
employed, focussing on the interaction of three correlates: host (the
individual), agent (gambling), and environment (social and physical
context). Risk and protective factors, based largely upon Dickson,
Derevensky, and Gupta, (2002), are discussed. The report discusses ways in
which existing prevention programs for substance abuse can be integrated
with gambling initiatives; here, common risk factors are emphasized.
Minnesota Institute
of Public Health (2000). Deal me in: Gambling trigger video and posters.
(Available from the Minnesota Institute of Public Health).
The video is
designed to raise student awareness of the negative consequences of
gambling. Information on the signs of problem gambling is provided.
Erroneous beliefs that often accompany gambling are identified and
dispelled. The posters and pamphlets are aimed not only at youth but also at
women and seniors.
North American
Training Institute (2003). Kids don't gamble…Wanna bet?
(Available from
Manisses Communication Group, Inc.,
http://www.manisses.com/bookstore/bookstore/write-ups/wanna_bet.html, and
North American Training Institute,
http://www.nati.org/products/?mode=desc&ID=28).
This is a curriculum
aimed at children in grades 3 through 8. Younger children are exposed to a
puppet show, while children in grades 6 through 8 witness the experiences of
a peer. Probability and problem gambling are explained. Warning signs are
identified.
Responsible Gambling Council. (n.d.). It's only a game: A quick guide to
low-risk gambling. Toronto: Responsible Gambling Council. Available at
http://www.responsiblegambling.org/articles/generalBrochure.pdf
This short pamphlet offers the Ontario Gambling Helpline's telephone number
and is offered as a general information resource. Tips are given for
low-risk gambling, and major signs of potential problem gambling are
identified. The document is very easy to read.
Responsible Gambling Council. (n.d.). It's only a game: An older person's
guide to low-risk gambling. Toronto: Responsible Gambling Council.
Available at
http://www.responsiblegambling.org/articles/olderAdults.pdf
This short pamphlet offers the Ontario Gambling Helpline's telephone number
and targets seniors. Tips are given for low-risk gambling, such as betting
only money that has been set aside for that purpose, and "signs of trouble"
are listed. The document is very easy to read.
Responsible Gambling Council. (n.d.). Why it's important to talk to your
teens about gambling—and how to do it. Toronto: Responsible Gambling
Council. Available at
http://www.responsiblegambling.org/articles/teensBrochure.pdf
As the title
suggests, this pamphlet offers advice on how to bring up the topic of
gambling with teenaged children. Questions answered include, "How do I
protect them?" (e.g., explaining the risks) and "What do they need to know?"
(e.g., gambling is not a way to make money, and the house is destined to win
in the long run).
Saskatchewan Health.
(n.d.). Gambling: Reducing the risks. (Available from Saskatchewan
Health, (306) 787-7239).
This educational
resource, pilot tested by teachers in urban and rural schools, contains
separate sections designed for grades 6 through 9. It is designed to educate
both teachers and students and is complemented with video education. Odds
and problem gambling are explained. Sound advice, such as not to borrow
money in order to gamble, is provided. There is a strong emphasis on life
experience; e.g., the "gambles" people take in real life (such as starting a
business) are contrasted with gaming. The student information packages
contain useful items such as a brief article on high rates of gambling among
youth.
Takushi, R.,
Neighbors, C., Larimer, M., Lostutter, T., Cronce, J., & Marlatt, G. (2004).
Indicated prevention of problem gambling among college students. Journal
of Gambling Studies, 20, 83–93.
The authors state
that little is known about how best to prevent serious gambling problems
among college students who exhibit moderate problems. This article provides
a qualitative description of an indicated prevention intervention for
college students. Such interventions are designed to identify those who
demonstrate moderate problems and to prevent the onset of more serious ones.
The intervention is based partly upon strategies with proven effectiveness
in the alcohol field—brief motivation enhancement strategies and
broad-spectrum skills training—and also on aspects of gambling treatment.
The results suggest that this approach generated positive responses from
students, who felt they had received some benefit from the intervention. The
authors caution that these results require more research for confirmation.
Ursel, B., & Morgan,
D. (2004). A brochure on Internet awareness and prevention. Journal of
Gambling Issues, 11. Available at
http://www.camh.net/egambling/issue11/jgi_11_ursel.html
The Internet is the
greatest area of current growth in gambling and poses unique risks
associated with isolation. This article comments on a brochure created by
the Regina Committee on Problem Gambling to address and reduce these risks.
It can be found at
http://www.cmhask.com/gambling/InternetGambling.pdf.
3. Evaluations of programs
Abbott, M., Volberg,
R., Bellringer, M., & Reith, G. (2004). A review of research on aspects
of problem gambling: Final report. Auckland, New Zealand: Auckland
University of Technology. Available at
http://www.rigt.org.uk/downloads/Auckland_report.pdf
This report was
designed as a critical review of gambling research with the objective of
clarifying certain issues and establishing future research priorities.
Issues under consideration included risk factors, treatment interventions,
and public education. The authors conclude that the focus of formal
treatment on severe cases has meant that prevention efforts are poorly
developed—even though the latter would be beneficial to far more
individuals. Prevention programs targeting youth are most acceptable to
stakeholders. Experience with campaigns pertaining to tobacco and alcohol
suggests that similar campaigns could be effective for gambling, for both
youth and adults. So far, exclusion programs have received more research
attention than any other preventative strategy (difficulties with
implementation are discussed). Hence, the effectiveness of other options
presents itself as a research priority. One recent innovation, problem
gambling information kiosks inside gambling establishments, is identified as
highly promising, notably because it involves cooperation between gaming
operators and practitioners. Prevention efforts are often undermined by
well-financed industry advertising campaigns.
Benhsain, K., Taillefer, A., & Ladouceur, R. (2004). Awareness of
independence of events and erroneous perceptions while gambling.
Addictive Behaviors, 29, 399–404.
Building upon
studies that have found that individuals who are knowledgeable about the
nature of randomness will nonetheless display erroneous beliefs pertaining
to odds and random sequences while gambling, this study assessed the effect
of reminders of event independence during a game. The findings suggest not
only that such reminders are effective at a cognitive level but that they
decrease the motivation to continue playing. Noting that "illusions of
control" are created by the games themselves, the authors suggest that
appropriate prompts could provide a significant corrective.
Blaszczynski, A.,
Ladouceur, R., & Nower, L. (2004). Self exclusion: A gateway to treatment.
Melbourne, Australia: Australian Gaming Council. Available at
http://www.austgamingcouncil.org.au/research/files/Self%20Exclusion%20A%20Gateway%20to%20Treatment.pdf
Self-exclusion is
the most commonly used strategy by casinos, clubs, and hotels to assist
problem gamblers. Principles
guiding this procedure include, but are not limited to, the following: many
gamble to excess and have trouble controlling their gambling, the gaming
industry has a responsibility to provide safe gambling environments that
minimize effects on those with problems, and individuals also bear some
responsibility. This paper was written to inform concerned parties about how
best to assist those with gambling problems. It builds on previous research
designed to identify behaviours that may indicate problem gambling, noting
that the gaming industry provides an important link to treatment providers.
Barriers to the effectiveness of self-exclusion programs—such as the lack of
integration with other interventions, the perceived conflict of interest
between gaining revenue and excluding gamblers, and the punitive nature of
limiting a gambler's behaviour—are identified. The authors propose an
alternative model of self-exclusion, one that shifts from a punitive
approach to rehabilitation (resumption of control over gambling behaviour)
and reduces perceptions of conflict of interest by increasing transparency.
Self-exclusion should be operated by "independent educators."
Blaszczynski, A.,
Sharpe, L., & Walker, M. (2001). The assessment of the impact of the
reconfiguration on electronic gaming machines as harm minimisation
strategies for problem gambling. Sydney, Australia: University of Sydney
Gambling Research Unit. Available at
http://www.psych.usyd.edu.au/gambling/GIO_report.pdf
In 2000, the New
South Wales Liquor Administration Board recommended modifications to
electronic gaming machines for the purposes of harm reduction: no more
high-value note acceptors, slower game speeds, and maximum bets limited to
$1 (from $10, on a trial basis). This study was meant to assess these
initiatives and to identify any (negative) unintended effects. This study
focussed on four issues: player satisfaction, player behaviour, player
expenditure, and problem gamblers' perceptions of the effects the
initiatives had upon their problem gambling. Little evidence was found that
reconfiguring bill acceptors would help problem gamblers. Reduction of reel
spin time may even exacerbate problems for some. Some preliminary evidence
was found for the effectiveness of reduced bet size as a harm reduction
strategy.
Breen, H.,
Buultjens, J., & Hing, N. (2003). The perceived efficacy of responsible
gambling strategies in Queensland hotels, casinos and licensed clubs.
Brisbane, Australia: Research & Community Engagement Division of QLD
Treasury.
In May 2002,
Queensland introduced its "Responsible Gambling Code of Practice." The Code
covered six themes: provision of information, interaction with customers and
community, exclusion provisions, physical environments, financial
transactions, and advertising and promotions. This study gauges the extent
to which these harm reduction principles have been implemented in casinos,
hotels, and clubs. Managers' and employees' opinions of the code and the
efficacy of the six responsible gambling practices were also solicited. Some
practices were found to be more feasible for implementation than others,
though levels of implementation were not consistent among different venues,
and other factors, such as number of gaming machines, managers' attitudes,
and region, were also linked to compliance. Some practices, e.g., physical
layout, were considered more effective by managers than others, such as
information provision, were. The authors note that "responsible gambling" is
still poorly defined, though the trend is in the direction of placing
responsibility on gambling providers and regulators rather than gamblers.
Small venues and venues in remote areas are less likely to comply with
regulations, and managers and staff in small venues are less likely to view
the regulations in positive terms. The Code can be found in this document.
In all, 18 recommendations are made. These include finding ways to enforce
compliance more effectively, making gambling support services more
proactive, and training staff more frequently in responsible gambling.
Delfabbro, P.
(2004). The stubborn logic of regular gamblers: Obstacles and dilemmas in
cognitive gambling research. Journal of Gambling Studies, 20, 1–21.
Gambling research
has consistently confirmed the fact that gamblers tend to misrepresent the
odds in gambling activities and hold many irrational beliefs. It would thus
seem that providing accurate information in gambling venues or on certain
machines would be a strong preventative tactic. However, the false beliefs
of gamblers do not appear to function at the purely cognitive level, can
result from deliberate distortion, and may even be hard to
"falsify"—gambling-related cognitions often rely upon circular reasoning.
Different aspects of these belief systems are explored to help guide more
effective consumer information initiatives. The "illusion of control"
involves the overestimation of contingency between actions and outcomes. The
"availability heuristic" involves the greater likelihood of remembering wins
than losses. The "gambler's fallacy" involves the attribution of association
between unrelated events (a sequence of "tails" is thought to increase the
likelihood of "heads"). "Attributional biases" refer to taking credit for
wins by reference to one's skill (or other "internal" traits) while blaming
losses on external factors. The author cautions that many cognitive
phenomena are rooted in behavioural realities, suggesting that they be
addressed at that level. The author also suggests that it may be more useful
to educate in a preemptive fashion, before the gambling behaviour and the
ensuing mystification can set in.
Ferland, F., Ladouceur,
R., & Vitaro, F. (2002). Prevention of
problem gambling: Modifying misconceptions and increasing knowledge.
Journal of Gambling Studies, 18, 19–29.
Given research that
demonstrates the high levels of involvement in gambling among youth, along
with the irrational beliefs that often accompany these activities, this
study tested a video designed to educate and dispel misconceptions on 424
seventh and eight grade students. The authors argue that the delivery of
information is an effective preventative tool. This study targeted false
conceptual links between independent events. A video format—designed to
amuse and interest students—was used partly because a purely cognitive form
of communication may be questionable in its effectiveness. This study
suggests that the video is a meaningful resource, and its effectiveness
would be enhanced if teachers played a complementary role.
Govoni, R., Frisch, G., & Johnson, D. (2001). A community effort: Ideas
to action—Understanding and preventing problem gambling in seniors.
Windsor, ON: Problem Gambling Research Group, University of Windsor.
While seniors have
much time and motivation to gamble, their resources are often limited and
they tend to lack the means to recover from financial strain. This report
outlines the testing of a community-based prevention program for seniors.
The authors found that two thirds of seniors gamble, 1.7% of those surveyed
experienced major financial losses due to gambling, and problem gambling
affects more than just money. The authors found that a prevention program
for seniors should not be limited to senior service providers and that the
whole community must be engaged. "Syntegration" is the name given to the
process employed in this strategy and involves bringing together people from
many backgrounds. Proposals include responsible gambling as the basis of
outreach, "multiple strategies for multiple targets," "seniors helping
seniors," and "media blitz."
Hing, N. (2003).
An assessment of member awareness, perceived adequacy and perceived
effectiveness of responsible gambling strategies in Sydney clubs.
Lismore, Australia: Centre for Gambling Education and Research, Southern
Cross University. Available at
http://cger.scu.edu.au/pdfs/hing_2003.pdf
Following the
enactment of responsible gambling legislation in 2000, this report assesses
the awareness of Sydney club members of responsible gambling strategies and
their perceptions of the strategies' adequacy and effectiveness. The study
also assessed perceptions of efficacy according to type of gambler, based
upon games of choice, gender, age, and potential for gambling problems. High
levels of awareness were found with respect to responsible gambling signage
and information measures, including those related to problem gambling,
though respondents were somewhat skeptical about the likelihood of these
measures promoting responsible gambling. However, other measures—such as
prevention of minors and intoxicated people from entering, refusal by clubs
to extend credit or cash advances, payout of big wins by cheque instead of
cash, and self-exclusion—were perceived as likely to promote responsible
gambling. In areas such as self-exclusion policy, local counselling
services, and measures taken to help people keep track of time while playing
poker machines, awareness was low. It is notable, for example, that while
many patrons identified self-exclusion as potentially helpful, awareness of
the existence of such policies was not high. The findings also suggest that
restrictions on minors entering clubs were not always enforced. Problem and
at-risk gamblers were more aware of responsible gambling measures than
non-problem gamblers. Gender was not a significant indicator of awareness.
Horton, K., Harrigan, K., Horbay, R., & Turner, N. (2001). The
effectiveness of interactive problem gambling awareness and prevention
programs. Toronto: Ontario Problem Gambling Research Centre. Available
at
http://www.gamblingresearch.org/contentdetail.sz?cid=2371&pageid=1192&r=s
The Safe@play Risk
Quiz is an on-line self-assessment tool that can be placed on video lottery
terminals, video kiosks in gambling venues, and interactive slot machines.
It is designed to provide users with an awareness of risk factors for
problem gambling and to enable them to assume control of their gambling.
This study was designed to provide an initial evaluation—306 university
undergraduates were involved—and results suggest that the quiz was effective
in alerting people to their risk factors, though awareness generated by the
quiz tends to diminish over time. The authors note that these students were
exposed to the quiz only briefly—they were not regular gamblers—and that
people who used this tool more regularly at casinos would conceivably show
stronger and more lasting effects. This should be tested in a real casino
setting.
Independent Pricing and Regulatory Tribunal of New South Wales. (2004).
Gambling: Promoting a culture of responsibility. Sydney, Australia:
Author. Available at
http://www.ipart.nsw.gov.au/files/Gambling04.pdf
This report reviews
the effectiveness of gambling harm reduction measures with respect to their
effects on the community and on gamblers. Indirect effects—related to
employment, support for community projects, and other issues—were also
considered. The report calls for an integrated framework for responsible
gambling designed to promote a "culture of responsibility," wherein
consumers have sufficient information upon which to base their gambling
decisions. Measures designed to protect gamblers should take into account
consequences for recreational gamblers and the gambling industry. A system
of accreditation for counselling services is also called for.
Ladouceur, R.,
Boutin, C., Doucet, C., Dumont, M., Provencher, M., & Giroux, I. (2004).
Awareness promotion about excessive gambling among video lottery retailers.
Journal of Gambling Studies, 20, 181–185.
The authors describe
"responsible gambling" as policies and practices designed to prevent and
reduce harms associated with gambling and argue for harm reduction
approaches similar to what has long been practised with respect to drugs and
alcohol: reducing excess rather than aiming only for abstinence. This
article describes and evaluates "As luck would have it," an awareness
program for video lottery retailers in the province of Quebec. The 2-hour
workshop was designed to educate retailers about excessive gambling, with
answers to the following questions: "1. What is chance and randomness? 2. Is
there a link between misunderstanding the concept of chance and excessive
gambling? 3. How does one recognise the symptoms of this disorder? 4. How
should retailers intervene if they decide to do so?" Retailers who completed
the workshop acquired a better grasp of problem gambling, could recognize
symptoms, and felt better equipped to intervene when appropriate. Follow-up
found that these retailers were considerably more likely to approach problem
gamblers and talk about how to help than those who had not completed the
workshop. The authors emphasize that retailers and the gambling industry in
general often show a willingness to promote responsible gambling.
Ladouceur, R.,
Ferland, F., & Fournier, P. (2003). Correction of erroneous perceptions
regarding the notions of chance and randomness in gambling among primary
school students. American Journal of Health Education, 34 (5), 5–10.
This study finds
that when a program designed to correct misconceptions about chance and
randomness among primary school students was applied by a specialist in the
psychology of gambling, it was more effective than when applied by a
teacher. The results have serious implications for the implementation of
such programs at primary schools and for the role of teachers in the
process.
Ladouceur, R.,
Jacques, C., Giroux, I., Ferland, F., & Leblond, J. (2000). Analysis of a
casino's self-exclusion program. Journal of Gambling Studies, 16,
453–460.
Self-exclusion is an
attractive self-control procedure for people who have trouble controlling
their gambling but are as yet unprepared to seek professional help. Yet
these programs have not been studied. This article discusses characteristics
of people who opted to have themselves barred from a Canadian casino with
respect to sociodemographics, gambling pathology, gambling habits, and past
experience with self-exclusion. Ninety-five percent met the criteria for
severe pathological gambling, and none did for non-problem gambling. Thirty
percent stopped gambling entirely after enrolling in the program.
Participants were concerned with the weakness of detection efforts,
reporting that it was easy to gain access to the casino without being
identified. Some suggested that the procedure should be available by mail
order so that reentering the casino would not be necessary. Seventy percent
of respondents enrolled on their own initiative, without pressure from a
"significant other," helping to explain the high abstinence rate. The
authors argue that, from a preventative perspective, such programs could be
offered to those at risk of becoming pathological gamblers. Risky behaviours
could be described in pamphlets made available to casino patrons. Other
recommendations for such programs and for future research are made.
Ladouceur, R., & Sévigny, S. (2003). Video lottery terminal warning messages
and the persistence to gamble. Gambling Research, 15 (1), 45–50.
This study was
designed to determine whether messages on a video lottery terminal screen,
and breaks, would influence gambling behaviour. The messages were about
illusions of control and the realities of chance. Players were assigned
randomly to three scenarios: no interruption, breaks, and messages. Both
breaks and messages, on their own, were associated with fewer games played.
Theoretical issues pertaining to these results, in the context of
responsible gambling, are discussed.
Ladouceur, R., & Sévigny, S. (2005). Structural characteristics of video lotteries: Effects
of a stopping device on illusion of control and gambling persistence.
Journal of Gambling Studies, 21, 117–131.
A video lottery
terminal stopping device was tested in two studies to gauge its effects on
thinking and behaviour. Players had the ability to stop the reels from
spinning. The first study involved illusions of control. Players were
inclined to believe that symbols would differ with the timing of stoppage,
that they might be able to control outcomes, that skill could be a factor,
and that a stopping device could improve their chances of winning. The
second study involved gambling behaviour itself, and it was found that the
device was conducive to more games being played per session. The results are
discussed in terms of their implications for responsible gambling policy.
Ladouceur, R., Vezina,
L., Jacques, C., & Ferland, F. (2000). Does a brochure
about pathological gambling provide new information? Journal of
Gambling Studies, 16, 103–107.
This study was
designed to determine whether a brochure on pathological gambling would
provide new knowledge and information to the public. One hundred fifteen
people were chosen randomly at malls and parks and then assigned to control
and experimental groups. The findings suggest that the brochure provided new
information about problem gambling, risky behaviours, and help available.
The authors point out that the information contained in brochures is rarely
evaluated. This study may stimulate others in the field to evaluate their
material before distribution, thereby strengthening preventative and
educational efforts. Future studies should also assess whether the effects
of such materials are enduring.
Lavoie, M., &
Ladouceur, R. (2004). Prevention of gambling among youth: Increasing
knowledge and modifying attitudes toward gambling. Electronic Journal of
Gambling Issues, 10. Available at
http://www.camh.net/egambling/archive/pdf/EJGI-issue10/EJGI-Issue10-lavoie-ladouceur.pdf
Gambling has been
identified as popular among youth. With the increase in young people
gambling, the likelihood of irrational thoughts and behaviours associated
with gambling increases as well. A video designed to increase
gambling-related knowledge and to dispel misconceptions was viewed by 273
French-speaking students in grades 5 and 6. The results suggest that the
video was successful on both counts. The authors point out that 7- and
11-year-old children are at a developmental stage where the illusion of
control over chance events is likely to figure prominently and that the
cognitive therapeutic approach suggests that loss of control in gambling
results from such misconceptions. This study suggests that a video alone can
be just as effective as a video combined with discussion, though the authors
grant that discussion may improve the durability of the changes. Further
research should include grade 4 students and also consider the long-term
effects of such interventions on knowledge and attitudes.
Loba, P., Stewart,
S., Klein, R., & Blackburn, J. (2001). Manipulations of the features of
standard video lottery terminal games: Effects in pathological and
non-pathological gamblers. Journal of Gambling Studies, 17, 297–320.
This study was
conducted to identify game features of video lottery terminals (VLTs) that
inhibit abuse by pathological gamblers yet have little effect on the
behaviour of nonpathological players. The study involved a video poker game
as well as a spinning reels game. The study investigated three approaches: a
counter that showed how much money had been spent, a VLT spinning reels game
that did not enable players to stop the reel by touching the screen, and the
manipulation of sensory features (speed and sound). The results suggest that
sensory manipulation delivered the most significant reaction differences
between pathological and nonpathological gamblers. As well, running totals
of money (instead of credits) spent could reduce the desire to play among
pathological gamblers. These findings support the notion that structural
characteristics—such as sound and payout intervals—are significant. The
authors offer possible reasons for their results yet caution that these
findings should be replicated in more natural settings before harm reduction
recommendations are made.
Lostutter, T.,
Larimer, M., & Takushi, R. (2002). Measuring gambling outcomes among college
students. Journal of Gambling Studies, 18, 339–360.
This study
introduces and validates three new gambling outcome measures: the Gambling
Quantity and Perceived Norms Scale (GQPN), the Gambling Problem Index (GPI),
and the Gambling Readiness to Change Questionnaire (GRTC). The
questionnaires, along with other measures, were completed by 560
undergraduate college students. The new measures, two of which are modelled
upon measures used in alcohol studies, displayed good reliability and
convergent validity. The measures deal separately with gambling quantity,
related consequences, and motivation to change and represent in the authors'
view an advance on currently available instruments in terms of their
applicability to the development of effective prevention and treatment
interventions. The authors note, for example, that in secondary prevention,
overlooking someone's readiness to change can be counterproductive.
Macdonald, J.,
Turner, N., & Somerset M. (2003). Life skills, mathematical reasoning and
critical thinking: Curriculum for the prevention of problem gambling.
Toronto: Ontario Problem Gambling Research Centre. Available at
http://www.opgrc.org/contentdetail.sz?cid=138
The subject of this
report is the development and evaluation of a school-based prevention
curriculum for problem gambling. The focus was on subclinical youth.
Knowledge of random events, coping skills, and self-monitoring skills were
addressed. The authors find that cognitive issues are more easily
transmitted than those pertaining to attitude and behaviour. Randomness, and
even knowledge of coping skills, can be more easily taught, whereas the
acquisition of coping resources and the intricacies of self-monitoring would
require a more developed program. Of note is the experiential aspect of
self-monitoring. In the authors' words: "Self-monitoring or meta-questioning
… replaces the traditional risk avoidance messages with questions which
address the experience of the participant.… Engaging in self-monitoring
addresses the onset of problem gambling by allowing a person to recognise
the onset of gambling problem and taking action to reduce involvement or the
problematic thoughts associated with gambling."
Najavits, L.,
Grymala, L., & George, B. (2003). Can advertising increase awareness of
problem gambling? A statewide survey of impact. Psychology of Addictive
Behaviors, 17, 324–327.
In order to gauge
the effects of an advertising campaign (billboards, brochures, posters,
newspaper ads, pens, and T-shirts) meant to raise awareness of problem
gambling, 800 adults in Indiana were surveyed randomly. Pre- and
postcampaign surveys indicated that the campaign had had little effect and
that few were exposed to it. Among different approaches, billboards and
slogans seemed most effective. The authors suggest that more powerful media,
such as television, may be more effective, as would a focus on high-risk
groups.
Napolitano, F.
(2003). The self-exclusion program: Legal and clinical considerations.
Journal of Gambling Studies, 19, 303–315.
This article
discusses some of the difficulties with self-exclusion programs. For
example, legal enforceability is tenuous. The author argues that such
programs inappropriately shift the emphasis from the psychological problem
of the addicted gambler to gambling itself. The author compares such
confusion to the war on drugs, of which he is also critical.
O'Neil, M., Whetton,
S., Dolman, B., Herbert, M., Giannopoulos, V., O'Neil, D., et al. (2003).
Evaluation of self-exclusion programs: Part A—Evaluation of self-exclusion
programs in Victoria and Part B—Summary of self-exclusion programs in
Australian states and territories. Victoria, Australia: Gambling
Research Panel—South Australian Centre for Economic Studies. Available at
http://www.justice.vic.gov.au/CA2569020010922A/page/Gaming+and+Racing-Research-Self-exclusion?OpenDocument&1=0-Gaming+and+Racing~&2=0-Research~&3=0-Self-exclusion~
This two-part study
is both evaluative and descriptive. Part A evaluates self-exclusion programs
in Victoria clubs, pubs, and casinos. It also discusses the literature and
theoretical issues pertaining to self-exclusion. Part B describes the many
self-exclusion programs in Australian states and territories, though some
evaluation is offered. In Part A, interviews with self-excluded individuals
indicate a lack of confidence in the system: identification and detection
failures are common. Surveys of venues suggest that the programs have had
little or no significant effect on problem gambling. The authors recommend
investigation of a new system of uniform identification that would restrict
access to gaming areas. The definition of self-exclusion should be broadened
to include a range of behaviours. Low utilization rates for self-exclusion
indicate that other strategies are also needed. Financial resources should
be increased, and relevant technologies should be improved. In Part B, the
authors find that self-exclusion programs are not homogeneous throughout
Australia and differ in many respects, such as the duration of exclusion and
the method by which a person must initiate the process. Common features
include, but are not limited to, the use of a "deed" of self-exclusion, a
list of undertakings by patrons, and an understanding that the venue has no
legal obligation. Data management and monitoring procedures are inadequate.
Evaluation of effectiveness is also lacking.
Riley-Smith, B., &
Binder, J. (2003). Testing of harm minimisation messages for gaming
machines. Sydney, Australia: NSW Department of Gaming and Racing.
Available at http://www.dgr.nsw.gov.au/pdfs/rr_riley_binder.pdf
This qualitative
study was designed to evaluate gamblers' reactions, while playing poker
machines, to 10 different harm reduction messages. For both regular and
problem gamblers, the following messages were effective in producing more
responsible gambling behaviour: Have you spent more money on gambling
than you intended? Are you gambling longer than planned? Have you felt bad
or guilty about your gambling? Shortcomings and potentials of this type
of strategy are discussed.
Schrans, T., Grace, J., & Schellinck, T. (2004). 2003 NS VL responsible
gaming features evaluation. Halifax, NS: Nova Scotia Gaming Corporation.
Available at http://www.gamingcorp.ns.ca/responsible/pbrgf.htm
This study was
designed to help the Nova Scotia Gaming Corporation evaluate a second series
of modified responsible gaming features (RGFs) implemented for video lottery
terminals in Nova Scotia. RGFs are designed to produce reality checks and
breaks in play and to promote responsible gambling. Main changes to the RGFs
included, but were not limited to, options to set play time limits, a
"pop-up" message every 30 minutes, a response requirement for on-screen
pop-up messages, changes to make time of day more prominent, and replacement
of references to credits with cash amounts. The methodology is described by
the authors: "An 'in vivo' live market test was conducted using a Pre Post
return-to-sample methodology with a Test and Control Market comparison. In
total, 329 Regular VL Players participated in all phases of the study
conducted over a six-month period (October 2003 to April 2004): Test Market
(South Shore: n=168) and Control Market (Valley: n=161). Pre Survey
benchmarks were obtained in each market (Total: n=409; Test Market (South
Shore): n=206, Control Market (Valley): n=203). The new RGFs were introduced
on selected terminals in the Test Market area only (PS5 terminals). A Post
Survey was conducted approximately four months following the introduction of
new terminals with approximately 81% of players in each market completing
the Post Survey measure." The findings suggest that money budgeting is a
more promising feature than time budgeting.
Tse, S., Brown, R.,
& Adams, P. (2003). Assessment of the research on technical modifications
to electronic gaming machines in NSW, Australia. Sydney, Australia: NSW
Department of Gaming and Racing.
http://www.dgr.nsw.gov.au/pdfs/rr_chal.pdf
This report reviews
two research reports that investigated the effects, on players and on gaming
revenue, of proposed technical changes to the operation of gambling
machines. The authors concluded that reducing the maximum bet size could be
a sound harm reduction strategy. Reconfiguring bill collectors is also a
promising idea, but only if proximity to automatic teller machines is taken
into account. Reel spin modifications showed less potential.
Turner, N.E., Wiebe,
J., Falkowski-Ham, A., Kelly, J., & Skinner, W. (2005). Public awareness of
responsible gambling and gambling behaviours in Ontario. International
Gambling Studies, 5, 95–112.
This article reports
the findings of a general population survey of knowledge of responsible
gambling. It includes a preliminary measure of public awareness of
information related to the definition of responsible gambling, symptoms of
problem gambling, and awareness of the availability of services. One
particularly interesting finding was that people who gamble on lotteries and
slot machines are more likely to report being aware of services.
Williams, R. (2002).
Prevention of problem gambling—A school-based intervention. Edmonton,
AB: Alberta Gaming Research Institute. Available at
www.uofaweb.ualberta.ca/abgaminginstitute/pdfs/Williams_prevention.pdf
This study was
conducted to design, implement, and evaluate a school-based problem gambling
prevention program. The study was guided by other programs as well as
research on what has been shown to be effective. The curriculum had five
sessions: "1. Information concerning the nature of gambling and problem
gambling. 2. Exercises to make students less susceptible to the cognitive
errors often underlying gambling fallacies. 3. Information on the true odds
involved in gambling activities and exercises on how to calculate these
odds. 4. Teaching and rehearsal of generic decision-making and social
problem-solving skills. 5. Teaching and rehearsal of adaptive coping
skills." The author points out that systematic school-based programs are
wanting, and evaluations remain contentious. In this program, format was
also taken into account: it was designed to be entertaining, emphasized
"skill learning" and the application of knowledge, and focussed on the
social environment of students. Two sites were chosen: the Calgary High
School System and Aboriginal high schools in Southern Alberta. The latter
site experienced low enrolment and poor attendance. At the Calgary site,
results of the program were promising with respect to knowledge, attitudes,
and gambling activity. Short-term results, however, were more significant
than long-term results on some measures. The implications of this are
discussed.
4. Conceptual issues and general information
Adams, P. (2004). Minimising the impact of gambling in the subtle
degradation of democratic systems. Journal of Gambling Issues, 11.
Available at
http://www.camh.net/egambling/issue11/jgi_11_adams.html
This article deals
with the ways in which gambling can undermine democratic participation and
democratic culture itself. Gambling can undermine social and economic
institutions, as well as a society's political processes. Notably in
jurisdictions where gambling is rampant, alliances can form between the
gambling industry and sections of government. Given that their economic
interests converge, the temptation to permit gambling despite the wishes of
a community will loom. Globalization is another factor, permitting the
gambling industry to act in force upon smaller or more vulnerable
communities. But this paper has another focus: with so many individuals at
least partly beholden to gambling revenues (or having some relation with
those who are), the ability (or willingness) of these people to participate
in a democratic critique of gambling can be compromised. This article
addresses subtle questions concerning the psychosocial dimensions of
democratic culture and their relations to economic power. Certain influences
are hard to identify and to report. People working in universities,
government departments, community organizations, and other areas can thus be
affected. Any effort to minimize gambling-related harm must take this into
account. The author calls for independent monitoring of people with public
duties who have relationships to the beneficiaries of gambling profits, as
well as for an international charter to address this matter. Specific
recommendations are given for various sectors, such as universities and the
media.
Alberta Gaming
Research Institute. (2004–present). Research Reveals…. Newsletter.
Available at
http://www.abgaminginstitute.ualberta.ca/newsletter.cfm
This is "an update
on gambling research in Alberta." Often, prevention is the theme. See, for
example, the November 2004 issue (below).
Alberta Gaming Research Institute. (2004, November). The development of
empirically-derived "low-risk" gambling guidelines: An interview with Dr.
Shawn Currie. Research Reveals…, 4 (1). Available at
http://www.abgaminginstitute.ualberta.ca/pdfs/RR-Issue1-vol4-2004.pdf
Given that there is
no scientifically developed definition "that provides clear limits on
exactly how the risks associated with gambling can be significantly
lowered," Dr. Shawn Currie, a clinical psychologist at the Addiction Centre
in Calgary, has embarked upon a study called "An empirical approach to
developing low-risk gambling guidelines." Currently there are no clear
definitions of "safe" or "responsible" gambling. Conversely, for drinking
there are clear limits for frequency and quantity. The aim of Dr. Currie's
work is to set clear "threshold" limits on gambling frequency, duration, and
expenditure in order to better identify high-risk gambling behaviour. With
the endorsement of gambling experts, such guidelines could be disseminated
to the general public. Dr. Currie acknowledges that there is no such thing
as risk-free gambling and that the thresholds could vary according to
demographics (e.g., gender is a factor in similar thresholds for alcohol
consumption). Evidence suggests that guidelines work, as in the case of one
study where problem gamblers were given a strict monetary limit (5% of
income). One of the most significant findings so far in Dr. Currie's study
is that gambling expenditures exceeding 5% of income represent a serious
risk factor.
American Gaming
Association (AGA). (2002). AGA Responsible Gaming Quarterly Archive.
Available at http://www.americangaming.org/rgq/rgq_archive.cfm
This link provides access to articles appearing in the "AGA Responsible
Gaming Quarterly" in 2002. Responsible gambling and prevention are major
themes.
Arnold, G., Collins, P., Eadington, W., Remmers, P., & Ricketts, T. (2003).
Towards a strategy for dealing with problem gambling. London, U.K.:
Gambling Industry Charitable Trust. Available at
http://www.gict.org.uk/reports_towards_a_strategy.asp
This is a general
report, with the authors pointing out that only recently has problem
gambling been identified as a serious concern. The U.K. is behind on this
count compared to many nations, notably in terms of funding, and this report
draws upon the experience of other nations (especially English-speaking
countries). The authors point out that treatment and prevention measures are
too new to have been properly assessed. Priority should be given to a
telephone help-line. Education efforts should inform the public about the
workings of commercial gambling, the serious problems that gambling can
cause for a small minority, the indicators of problem gambling, and the
types of help available. The authors note that many gamblers who may not
suffer from real addiction nonetheless suffer some difficulties and could
benefit from educational efforts.
Bellringer, M., Perese, L., Rossen, F., Tse, S., Adams, P., Brown, R., et
al. (2003). Supporting the wellbeing of young people in relation to
gambling in New Zealand. Auckland, New Zealand: Problem Gambling
Foundation of New Zealand. Available at
http://www.responsiblegambling.org/articles/
supporting_the_wellbeing_of_young_people.pdf
This report
describes the measures taken to reduce harm related to problem gambling
among New Zealand youth and offers many suggestions for improvement. At the
time of writing, New Zealand gambling legislation did not represent an
integrated agenda. The authors note that this generation (aged 12 to 25) is
growing up in an environment of legalized (and normalized) gambling and
hence faces new difficulties, partly due to overly positive perceptions of
gambling and its implications. The authors offer a "strengths-based"
approach that focuses on an individual's positive attributes. Other
highlights are as follows: adults should be equipped with the necessary
knowledge of gambling's negative potential; legislation should be geared to
harm minimization; Maori, Pacific, and Asian concerns must be addressed; and
knowledge should be built upon information and research. Many issues,
including protective and risk factors, are discussed.
Black, R., & Ramsay,
H. (2003). The ethics of gambling: Guidelines for players and commercial
providers. International Gambling Studies, 3, 199–215.
Discussions of
gambling issues tend to focus upon social impact rather than ethics. This
paper offers an alternative, philosophical, perspective on the ethical
issues related to the provision of gambling services. Rather than
moralistic, the authors suggest a "moral realist" approach—taking facts and
concrete issues into account. If gambling is not necessarily wrong, it still
requires an ethical foundation guiding gamblers and providers. The gaming
industry will, however, need to alter the ways in which it perceives itself.
Currently, whatever ethical discourse exists tends to be in the tradition of
public preaching that was practised a century ago. The authors invoke Kant
and Aristotle, with questions pertaining to fulfillment and rationality of
choices. Is it possible to use gambling as a humanly fulfilling experience?
This and other questions are explored. Gambling that took itself seriously
along these lines could undo harm and make a serous contribution to the
common good.
Blaszczynski, A.
(2002). Harm minimization strategies in gambling—An overview of
international initiatives and interventions. Melbourne, Australia:
Australian Gaming Council. Available at
http://www.austgamingcouncil.org.au/research/files/International%20Harm%20minimization%20AGC%20draft%20080301.pdf
This report is an
overview of harm reduction strategies in several nations. The author points
out that there is still little consensus as to what harm reduction means,
though an operational definition is provided. Parallels with substance abuse
are discussed. Primary, secondary, and tertiary prevention are defined and
discussed in terms of their principles and effectiveness.
Blaszczynski, A.,
Ladouceur, R., & Shaffer, H. (2004). A science-based framework for
responsible gambling: The Reno model. Journal of Gambling Studies, 20,
301–317.
This article
identifies key principles that should guide a "strategic framework, or
blueprint for action" in order to better organize efforts to reduce
gambling-related problems. Industry operators, health care providers, social
scientists, community groups, relevant government agencies, and other
interested parties should join together, essentially forming a coalition
geared to reducing or eliminating gambling-related harm while maximizing its
benefits. The strategic framework should be based upon empirical, rather
than anecdotal, evidence, thereby focussing effectively on vulnerable
community members while at the same time avoiding unintended effects upon
the majority of harm-free recreational gamblers. While different
stakeholders (such as industry operators and health service providers) often
define responsible gambling from different perspectives, governments bear
the final responsibility for legislative and regulatory initiatives.
Currently, however, community pressure often leads to restriction or
elimination of gambling venues without scientifically based evidence of harm
reduction. The two main barriers to the implementation and evaluation of
responsible gambling strategies—lack of conceptual clarity and absence of
consensus—should be overcome through empirically and theoretically sound
knowledge. For example, specifically focussed psychometric prevalence
estimates currently fail to distinguish between subgroups within the problem
gambling population (e.g., pathological), making for a lack of clarity,
while there is also very little consensus on what constitutes responsible
gambling. Five principles are laid out: (1) Key stakeholders will commit to
reducing the incidence and prevalence of gambling-related harm. (2) They
will work collaboratively to evaluate policies. (3) They will work
collaboratively to identify short- and long-range priorities. (4) They will
rely on scientific research. (5) Once established, the "action plan" will be
subject to ongoing scientific evaluation. The authors argue for the
establishment of a global body representing everyone associated with the
gambling industry.
Chevalier, S.,
Geoffrion, C., Allard, D., & Audet, C. (2002). Motivations for gambling
as tools for prevention and treatment of pathological gambling. Quebec,
QC: Institut national de santé publique de Québec.
The researchers
discuss the beneficial aspects of gambling with the goal of using some of
these for improving treatment of problem gambling. The authors argue that
understanding precisely what gambling does for people can help to provide
focus for attempts to develop substitute activities that may deliver similar
benefits. For example, some gamble for socialization, to "experience
emotions," or to donate to charities. Despite the title, this report has far
more to do with treatment than prevention.
Connecticut Council
on Problem Gambling (1998–2001). Prevention of problem gambling: A
monthly newsletter on problem gambling prevention information, research, and
initiative. Available at
http://www.ccpg.org/prevention_newsletters.asp
This monthly
newsletter covered issues pertaining to the prevention of problem gambling
and is still available on-line.
Derevensky, J., &
Gupta, R. (2000). Prevalence estimates of adolescent gambling: A comparison
of the SOGS-RA, DSM-IV-J, and the GA 20 Questions. Journal of Gambling
Studies, 16, 227–251.
Gambling levels
among children and adolescents are growing at an unprecedented rate, and
high levels of problem gambling among youth have been identified. The
strengths and weaknesses of various screening instruments, along with some
of the modifications made for addressing youth, are discussed. In this
study, 980 adolescents were administered three gambling screens: the South
Oaks Gambling Screen Revised for Adolescents (SOGS-RA), the DSM-IV-J, and
the GA 20 Questions. The two professionally devised screens delivered
problem/pathological gambling rates of 5.3% (SOGS-RA) and 3.4% (DSM-IV-J),
and the GA 20 Questions identified 6%. The authors discuss qualitative
issues, such as higher correlation between scales for males than for
females, and the items best reflecting the differences between those
reporting mild to moderate gambling problems and those reporting serious
problems. Comparison of the three screens revealed fairly high agreement and
verify the contention that more youth (notably males) report serious
gambling problems than adults. More research is needed to identify
characteristics that differentiate between male and female youth problem
gamblers, and more attention should be paid to the fact that there may be
different types of problem gamblers. The authors point out that problem
gambling rates hinge upon definitions of the issues and that the instruments
under study may not provide a "gold standard." The latter would be
invaluable for the development of education and prevention efforts.
Derevensky, J., &
Gupta, R. (2004). Adolescents with gambling problems: A synopsis of our
current knowledge. Electronic Journal of Gambling Issues, 10.
Available at
http://www.camh.net/egambling/issue10/ejgi_10_derevensky_gupta.html
A significant
minority of adolescents who gamble have serious gambling problems, and this
article reviews current empirical knowledge of problem gambling among youth.
Emphasis is given to the work of Henry Lesieur (to whom this issue is
dedicated). While this article provides little new information, it is, as
the title suggests, a synopsis (and very thorough). Risk factors and
correlates are discussed, and a list of the most important factors and
issues is provided. Treatment issues are also covered. The authors point out
that knowledge of gambling prevention is still embryonic and that the field
must consistently borrow knowledge from the more developed field of
substance abuse. A short, yet erudite, account of the abstinence versus harm
reduction controversy is provided. The authors point out that even if
knowledge of gambling prevention is still wanting, adaptations of theories
governing adolescent risk behaviour can provide a useful starting point. The
authors also point out that today's youth will soon be adults, with the
implication that efforts targeting the young may be a very important aspect
of prevention.
Derevensky, J.,
Gupta, R., Dickson, L., & Deguire, A. (2001). Prevention efforts toward
minimizing gambling problems. Washington, DC: National Council for
Problem Gambling, Center for Mental Health Services (CMHS), and the
Substance Abuse and Mental Health Services Administration (SAMHSA).
This report
discusses many issues pertinent to prevention. Much of the conceptual
framework is explicated below under Dickson, Derevensky, & Gupta (2002). The
theoretical underpinnings of current youth gambling treatment are discussed.
The abstinence versus harm reduction controversy is covered comprehensively.
The report also provides a review of available prevention programs. Emphasis
is placed on viewing risky behaviours on a continuum of harm.
Derevensky, J.,
Gupta, R., & Winters, K. (2003). Prevalence rates of youth gambling
problems: Are the current rates inflated? Journal of Gambling Studies,
19, 405–425.
This article points
to inconsistencies in prevalence estimates of problem gambling among youth
and tackles the question of whether these rates have been inflated.
Screening tools, instruments, and definitions of youth problem gambling all
require greater scientific scrutiny. Risk factors must be understood more
fully. Better screening, prevention, and treatment initiatives will hinge
upon the development of such knowledge. Despite uncertainty about the
prevalence of gambling problems among youth, there is good evidence that
this group is at high risk. Given that it normally takes years for gambling
to reach pathological levels, early intervention could offset many problems.
Dickson, L.,
Derevensky, J., & Gupta, R. (2002). The prevention of gambling problems in
youth: A conceptual framework. Journal of Gambling Studies, 18,
97–159.
This article tackles
the question of whether and to what extent prevention programs for alcohol,
tobacco, and illicit drug abuse can provide elements that could be applied
effectively to similar measures for gambling among youth. Though awareness
of the need to educate children about the dangers of gambling has increased,
empirical knowledge of how to prevent problem gambling among adolescents is
wanting. Various addictions share common risk and protective factors,
suggesting the need for a general model. The authors argue for the
applicability of a general adolescent risk-taking model. The authors argue
that research on resiliency during adolescence should guide preventative
efforts, given that gambling is a socially acceptable activity. Resiliency
literature suggests that some are more immune to stress, deprivation, and
adversity, rendering them less vulnerable to compulsions and addictions than
others in similar situations. The authors argue that children are not born
resilient, so that the environmental risk and protective factors should be
identified (though they do not dismiss biochemical and genetic components).
Psychological, family, and peer factors are discussed.
Dickson, L.,
Derevensky, J., & Gupta, R. (2004a). Harm reduction for the prevention of
youth gambling problems: Lessons learned from adolescent high-risk behavior
prevention programs. Journal of Adolescent Research, 19, 233–263.
While harm reduction
has become a favoured approach to adolescent substance abuse, its
application to the treatment and prevention of problem gambling among youth
is still largely unexamined. This study was designed to assess harm
reduction as a preventative paradigm, for gambling and also for other
potentially risky behaviours. From the abstract: "The authors use a
universal, selective, and indicative prevention framework to present current
prevention initiatives that have emerged from the harm reduction health
paradigm for adolescent substance and alcohol abuse. The risk-protective
factor model is used as a conceptual basis for designing youth problem
gambling harm reduction prevention programs. This framework illustrates the
developmental appropriateness of the harm reduction approach for youth.
Implications drawn from this conceptual examination of harm reduction as a
prevention approach to adolescent problem gambling provide valuable
information for treatment providers as well." A harm reduction approach
would be guided by certain principles: value neutrality with respect to
gambling (and other risky behaviours); humanism, in short meaning that the
adolescent is treated with respect and is expected to behave much like an
adult; acknowledging the adolescent's active role in preventative measures;
and integrating other approaches. Harm is perceived as falling upon a
continuum, with people at the extreme of uncontrolled behaviour being
possibly inappropriate candidates for harm reduction strategies.
Dickson, L.,
Derevensky, J., & Gupta, R. (2004b). Youth gambling problems: A harm
reduction prevention model. Addiction Research and Theory, 12,
305–316.
The authors discuss
harm reduction in relation to the prevention of youth gambling problems,
noting that its use has already been established in the substance abuse
field. For a conceptual basis, see Dickson, Derevensky, and Gupta (2004a)
above.
Dyall, L. (2004). Why is wearing glasses useful in New Zealand? Journal
of Gambling Issues, 12. Available at
http://www.camh.net/egambling/issue12/jgi_12_dyall.html
This article was
prepared in support of the development of a public health approach to
gambling and its related harms in New Zealand. Supporting the ideas
presented at the Auckland (2003) conference, Gambling Through a Public
Health Lens, the author argues that issues can be observed through many
"prisms." The Maori perspective on gambling is the "lens" guiding this
article, which argues for a public health approach appropriate for this
aboriginal tribe. Focussing on family networks, tribal communities, and
tribal groups, the author suggests that the Maori may eventually lend
assistance in the reduction of gambling-related harm, through the
maintenance of cultural traditions, to other ethnic communities both in New
Zealand and elsewhere. The paper discusses gambling in its connection to the
Maori's experience with colonialization, as well as how the Maori currently
perceive gambling revenues through their ownership (or partial ownership) of
gambling venues as a means of achieving some economic independence.
Eadington, W.
(2003). Measuring costs from permitted gambling: Concepts and categories in
evaluating gambling's consequences. Journal of Gambling Studies, 19,
185–213.
The author critiques
the methods of determining costs and benefits that guide policies targeting
legalized gambling. The author makes a distinction between narrow, economic
evaluations and a broader conception of "harm." The types of policies
implemented by governments will be greatly affected by which of these
perceptions is prevalent. Many attempts to assess "social costs" are
seriously flawed, as they gloss over the complexities of this question. The
author suggests that casino customers who wish to wager more than a small
amount be required to obtain a gambling licence, which could be revoked
under certain conditions. Above all, the author argues that society should
attain a greater awareness of the personal and social costs associated with
gambling.
Evans, C., Kemish,
K., & Turnbull, O. (2004). Paradoxical effects of education on the Iowa
Gambling Task. Brain and Cognition, 54, 240–244.
The Iowa Gambling Task (IGT) was designed to measure emotion-based learning
systems, or "intuition." This important study provides evidence that
education may in fact undermine emotion-based learning, or at least its role
in decision making. Better educated individuals may hence perform poorly on
the IGT. In a "real-money" version of the Task, less educated individuals
outperformed university-educated people in some categories, while in others
there was no significant variation. The role of education in the maintenance
of false beliefs is one explanation.
Evans, R. (2003).
Some theoretical models and constructs generic to substance abuse prevention
programs for adolescents: Possible relevance and limitations for problem
gambling. Journal of Gambling Studies, 19, 287–301.
The author claims
that most gambling prevention programs have not been based on theoretical
models. This article describes in a historical context various psychosocial
models for the prevention of substance abuse among adolescents with an eye
to how they may apply to problem gambling within that group. These include
social inoculation, reasoned action, planned behaviour, and problem
behaviour theory. Differences between gambling and substance use are
discussed; for example, unlike alcohol and drug use, gambling does not
present immediately recognized adverse effects. The author points out,
however, that even though gambling is a "drugless" addiction, gamblers'
self-descriptions of their experiences often resemble those of
chemical-dependent individuals. The author concludes that substance abuse
prevention research directed at adolescents presents theoretical frameworks
that could be useful to the prevention of pathological gambling.
Felsher, J., Derevensky, J., & Gupta, R. (2004b). Lottery playing amongst youth:
Implications for prevention and social policy. Journal of Gambling
Studies, 20, 127–153.
This study finds
that while many gambling venues are difficult for underage people to access,
many retailers willingly break the law by selling scratch tickets to
children as young as 11. Advertising for lotteries has become more
aggressive and is deceptive about the odds of winning, and children who buy
tickets tend to be poorly informed about their chances of winning. Many
youth do not perceive scratch tickets or lottery draws as "gambling." Since
it is a myth that current legal statutes have presented a serious deterrent
to underage gambling, greater social awareness of this fact along with more
conscientious law enforcement is recommended. Widespread prevention programs
should begin at the elementary school level.
Fisher, S. (2000a).
Developing the DSM-IV-DSM-IV criteria to identify adolescent problem
gambling in non-clinical populations. Journal of Gambling Studies, 16,
253–273.
This article
discusses a revised version of the DSM-IV-J criteria for youth—the
DSM-IV-MR-J—along with psychometric findings stemming from its use in a
prevalence study of adolescent gambling. The author claims that current and
emerging screening instruments for problem gambling among youth require more
testing and development in order to establish an accepted "gold standard."
The revised instrument addresses the appropriateness of "yes–no" responses
outside of clinical situations and seems to discriminate efficiently between
problem and non-problem fruit machine gamblers aged 12 to 15. Yet more
stringent testing is needed. Currently, it is questionable whether various
cultural, social, psychological, and environmental factors are properly
accounted for.
Fisher, S. (2000b).
Measuring the prevalence of sector-specific problem gambling: A study of
casino patrons. Journal of Gambling Studies, 16, 25–51.
Face-to-face
interviews with 1,105 patrons from 40 casinos in the U.K. were conducted in
order to measure the prevalence of problem gambling within a specific sector
of the gambling industry. This study lent support to earlier work suggesting
that casinos in the U.K. could be sustained by regular gamblers among whom
high rates of problem gambling could be found (7% of casino patrons
accounted for 63% of visits). Evidence was also produced for the relevance
of demographic factors to the choice of gambling venue. The author calls for
more sector-specific prevalence studies as a means to identify more problem
gamblers and to provide better knowledge of relevant demographic
characteristics. Such knowledge could help to yield better prevention and
treatment interventions. Asians, for example, were overrepresented among
problem gamblers in this study, as were people with substance addictions and
those who started gambling at earlier ages.
Gardner, L., Kalt,
J., & Spilde, K. (2005). Cabazon, the Indian Gaming Regulatory Act, and
the socioeconomic consequences of American Indian governmental gaming—A ten
year review/annotated bibliography: The social and economic impacts of
Indian and other gaming. Cambridge, MA: The Harvard Project on American
Indian Economic Development, John F. Kennedy School of Government, Harvard
University. Available at
http://www.ksg.harvard.edu/hpaied/pubs/documents/
AmericanIndiansonReservationsADatabookofSocioeconomicChange.pdf
This annotated
bibliography provides an impressive list of titles dealing with the social
and economic effects of gambling.
Gilliland, J.
(2003). Putting gambling in its place: A geographical study of VLT
accessibility and play by Montreal youth. Youth Gambling International, 3
(3), 1–2. Available at
http://www.education.mcgill.ca/gambling/en/PDF/Newsletter/Fall2003.pdf
Video lottery
terminals (VLTs) are widely available in Montreal, and some critics claim
that these machines are in fact aimed at vulnerable populations (youth, the
poor), though this remains unverified. This article discusses preliminary
results of a project still under way attempting to determine whether
placement of VLTs and socioeconomic environment influence youth gambling
behaviour. VLTs are found to be heavily concentrated near secondary schools.
If preliminary findings hold up, this research will conclude that the social
environments conducive to problem gambling among youth have been intensified
in recent years and that lottery sites should be restricted with respect to
their proximity to schools.
Griffiths, M.
(1999). Gambling technologies: Prospects for problem gambling. Journal of
Gambling Studies, 15, 265–283.
Noting a
long-standing link between technology and gambling practices, the author
discusses the potential of newer gambling technologies to generate more
problem gambling. Internet gambling is identified as an area of future
concern.
Hardoon, K., &
Derevensky, J. (2002). Child and adolescent gambling behavior: Current
knowledge. Clinical Child Psychology and Psychiatry, 7, 263–281.
Evidence suggests
that underage youth participate in both legal and illegal types of gambling,
with 4% to 8% reporting serious problems with gambling and another 10% to
15% at risk. Gambling is the addictive behaviour in which children and
adolescents engage with the greatest frequency. This article represents a
synopsis of available knowledge. Current theories of gambling behaviour and
addiction are discussed, along with risk and protective factors. The authors
point out that the early onset of gambling, unique in our time to this
generation of youth, renders the need for prevention programs more pressing.
Coping skills, problem solving, and gambling awareness should be taught at
primary and secondary schools.
Hardoon, K., Derevensky, J., & Gupta, R. (2003). Empirical measures vs. perceived
gambling severity among youth: Why adolescent problem gamblers fail to seek
treatment. Addictive Behaviors, 28, 933–946.
This study finds
that youth who qualify as problem or pathological gamblers according to
accepted gambling screens are likely not to perceive themselves as such.
Though it is possible that the screens overestimate problem gambling
prevalence, the authors consider at least one of the screens (DSM-IV-J)
quite conservative and hence conclude that it is more likely that youth with
gambling problems tend to underestimate severity. The authors note, for
example, that unlike adults, youth often do not have jobs to lose: youth
tend not to seek help until their problems have become overwhelming.
Hing, N. (2003).
Principles, processes and practices in responsible provision of gambling: A
conceptual discussion. Gaming Research and Review Journal, 7 (1),
33–48
The author offers a
definition and conceptual framework for responsible gambling based upon
three "central constructs" from the corporate literature. Responsible
gambling provision is "the congruence between the socially responsible
principles, socially responsive processes, and socially desirable practices
that gambling operators pursue and those expected by their stakeholders in
managing the social impacts of gambling." The author discusses this
framework and its potential research applications.
Hirsch, P. (2000). Seniors and gambling: Exploring the issues.
Edmonton, AB: Alberta Alcohol and Drug Abuse Commission.
Seniors represent a
fast-growing segment of Canada's population, and there is anecdotal evidence
that more of them are gambling. Given the lack of solid information about
gambling among seniors, the Alberta Alcohol and Drug Abuse Commission
conducted a preliminary investigation of this issue. The focus was on
gambling attitudes and behaviours and the effectiveness of intervention and
preventative initiatives. Bingo, lotteries, and casino games were the most
common activities, with women overrepresented in bingo. One important reason
seniors gamble is to socialize, with loneliness as a major inducement.
Problem gamblers among this group were more likely to believe that many
seniors had problems with gambling. Some seniors suggested that the
availability of alternative activities would help to reduce problem
gambling. The author concludes that most Alberta seniors are well adjusted
and healthy with respect to gambling. Yet some problems exist, and these are
two of the author's recommendations: existing problem gambling awareness
campaigns should contain messages aimed at seniors, and these should target
"key influencers" such as clergy, family, and physicians, and the ability of
seniors to help each other should be enhanced.
International Centre
for Youth Gambling Problems and High-Risk Behaviors. (2001–present).
Youth Gambling International Newsletter. Available at
http://www.education.mcgill.ca/gambling/en/newsletter.htm
This quarterly
on-line newsletter is distributed by Youth Gambling International and should
be of interest to anyone involved in the prevention of gambling problems
among youth (see, for example, the Winter 2002 issue of the newsletter, or,
in this bibliography, Gilliland (2003)). In their words: "Prevention—The
Centre develops prevention programs and coordinates prevention efforts on an
international level. We are also supporting the development of social policy
guidelines with respect to advertising and working on developing a public
health framework. Information Dissemination & Library Services—The
Centre operates an online database and central clearinghouse, and
disseminates research and treatment information on youth gambling,
co-occurring addictive disorders, and youth risk-taking behaviours. We also
publish a quarterly online newsletter, Youth Gambling International (YGI),
and an online monthly news update, YGI Flash, which is currently distributed
to over 1000 individuals and organizations."
Katzman, M. (2002). When the stakes are high—Gambling and schools.
Halifax, NS: Addiction Prevention and Treatment Services, Capital Health.
Available at
www.cdha.nshealth.ca/programsandservices/addictionprevention/gamblingPolicy.pdf
This Nova Scotia
report was written to inform decisions regarding school-based gambling policies. Issues covered include the extent and effects of adolescent
gambling, ways in which schools may be aggravating the situation, actions
schools can take to reduce gambling-related harm, and the main issues to
consider. The author points out that schools often raise funds through
activities such as bingo and that at the very least students should be aware
of facts of gambling. For example, a "50/50 Draw" may be taken to entail a
50% chance of winning. As well, in a controlled classroom environment,
students are largely protected and the consequences of losing are minimal,
yet they may not appreciate the fact that similar games in other settings
pose significant risks. As well, adults need to consider how their behaviour
will affect the perception of youths. A comprehensive approach, with six
categories, is suggested: (1) information and awareness; (2) education and
skill development; (3) alternative activities; (4) community development,
capacity building, and institutional change; (5) public social policy; and
(6) intervention strategies aimed at high-risk individuals.
Kelly, J., Skinner, W., Wiebe, J., Turner, N., Noonan, G., & Falkowski-Ham,
A. (2001). Project Weathervane: Measuring gambling behaviours, knowledge
and attitudes in Ontario. Toronto: Responsible Gambling Council and
Centre for Addiction and Mental Health.
The behaviour,
knowledge, and attitudes of Ontario adults are studied with an eye to
informing public awareness and prevention campaigns. Overall, awareness of
the need for such strategies is increasing. The report addresses issues such
as the illusion of control and predictability, and found that misconceptions
along these lines were quite common—above all, knowledge of probability was
associated (though not too strongly) with responsible gambling practices. As
well, it was found that 60.2% of people surveyed had never heard the term
"responsible gambling" and that most respondents had a poor grasp of the
signs of problem gambling.
Korn, D. (2000).
Expansion of gambling in Canada: Implications for health and social policy.
Canadian Medical Association Journal, 163, 61–64.
The recent rise in
legalized gambling, due to the government's need for revenue, is a public
health issue involving gambling addiction, family dysfunction, and youth
gambling. Overall gambling prevalence is low, but rising, and the prevalence
of gambling among youth is a serious concern. New technologies such as video
lottery terminals have been associated with gambling problems and addiction.
Internet gambling is another new concern. This article recommends the
adoption of a public health approach to the issue, with five specific
suggestions: (1) balance the public interest with respect to revenue
generation and gambling-related harm, (2) monitor gambling advertising, (3)
gauge the impact on quality of life, (4) develop a research agenda, and (5)
adopt a harm reduction approach.
Korn, D., Gibbins,
R., & Azmier, J. (2003). Framing a public policy towards a public health
paradigm for gambling. Journal of Gambling Studies, 19, 235–256.
The authors argue
for public policy on gambling based upon a public health perspective. The
ways in which policy debates are currently framed do not take into account
the broader social and economic effects of gambling, which a public health
frame is designed to consider. Though economic and political interests pose
obstacles to the adoption of this alternative paradigm, and cultural
attitudes are also resistant, research can overcome these challenges as it
has with other issues, such as smoking and product liability. Traditional
gambling frames include the following: "gambling is a matter of individual
freedom," "gambling is a recreational activity," "gambling is an important
tool for economic development," and "gambling addiction is an individual
rather than a social pathology." Different frames need not be mutually
exclusive, and no combination need be exhaustive. But a public health frame
is best suited to prevention and harm reduction. The authors argue that the
ideology of individual rights may account for the framework that offers the
strongest resistance to a public health perspective.
Korn, D., & Shaffer,
H. (1999). Gambling and the health of the public: Adopting a public health
perspective. Journal of Gambling Studies, 15, 289–365.
The recent rise in
legalized gambling has been accompanied by an increase in problem and
pathological gambling among adults, and gambling-related problems among
youth are also a serious concern. Yet gambling-related problems have
received little attention in terms of their impact on health. This article
was written with four goals: (1) raise awareness among health professionals;
(2) place gambling within a public health framework; (3) identify major
public health issues related to gambling; and (4) propose an agenda for
policy, prevention, and treatment based upon the Ottawa Charter for Health
Promotion. Unlike a narrow clinical model, a public health perspective is
multifaceted and better equipped to address preventative issues. The authors
argue for a broader conception of "health" involving a range of socially
based criteria. Significant theoretical constructs, such as the human
ecology paradigm, are discussed, along with the differences and similarities
between problem gambling and substance addiction. Key proposals include
suggestions for educational initiatives and healthy gambling guidelines
comparable to those already in place for alcohol.
Ladouceur, R.,
Ferland, F., Coté, M., & Vitaro, F. (2004). Teachers' knowledge and training
needs regarding youth gambling. School Psychology International, 25,
472–479.
This study was
designed to gauge teachers' understanding of youth problem gambling and to
assess their interest in applying prevention programs. While teachers were
found to have a good grasp of youth gambling problems and were interested in
learning more, they were not ready to spend time on gambling prevention.
Ladouceur, R., Vitaro,
F., & Coté, M. (2001). Parents' attitudes,
knowledge, and behavior toward youth gambling: A five-year follow-up.
Journal of Gambling Studies, 17, 101–116.
Based on two
telephone surveys of parents of 5- to 17-year-old children in the Quebec
City area, one in 1995 and one in 2000, parents' attitudes, knowledge, and
behaviour regarding youth gambling were compared. Several changes were found
on all three counts. Parents perceived the age of onset of gambling
behaviour more correctly (though they still underestimated it), were more
satisfied with government limits on access to gambling, and were more
knowledgeable about the legal status of lottery ticket sales. Conversely, a
larger percentage of parents did not associate youth gambling with some of
its correlates (such as parental gambling problems and friendship with
gamblers). Though public education was likely responsible for the observed
improvements, inconsistent results suggest that further education efforts
are required. The results of this study shed light upon which aspects of
parenting were amenable to public information and which were more resistant,
knowledge that should assist in the development of future preventative and
educational measures.
Law, M. (2004).
From patron care to consumer protection: Poker machines in Tasmania.
Hobart, Tasmania: Anglicare Tasmania. Available at
http://www.anglicare-tas.org.au/pdfs/pokercare.pdf
One in 10 poker
machine players experience some problems. Just as there are strategies in
place to minimize harm associated with alcohol and other drugs, the gaming
industry should also be regulated in an appropriate fashion. Treatment and
referral present too narrow a focus—the identifiable problem gambler—whereas
all consumers of poker machines should be taken into account in the
provision of safe gambling environments. Strategies to protect the gambling
consumer can be called "patron care." This involves harm reduction rather
than prohibition, as well as the acknowledgement that harmful consequences
are not limited to pathological gamblers and can occur on occasion with
recreational gamblers as well. Such difficulties can affect not only the
gambler but the gambler's family and larger community. Research has shown
that the public perception is that governments that make money from gambling
also have a duty of care. Currently, the Tasmanian gaming industry focuses
on those who have already developed problems and who are willing to seek
help. This must be revised. Certain strategies—such as warnings on gambling
products, regional caps on the number of machines per population, and a $50
limit on note acceptors—are recommended for investigation as to their
effectiveness. Other proposals are recommended for immediate enactment.
These include slower game speeds, legal limits on the amount that can be bet
per game, and independent investigation of several current practices.
Leeds, Grenville &
Lanark District Health Unit. (2005). A public health perspective on
gambling in Ontario. Author. Available at
http://www.healthunit.org/adults/php_gambling.htm
This paper provides
information on recent gambling research, with an emphasis on youth gambling.
Facts about gambling in Ontario, from demographics to legal issues, are
provided. A separate section is devoted to a general discussion of
prevention programs for youth. A public health approach is advocated.
Messerlian, C.,
Derevensky, J., & Gupta, R. (2004). A public health perspective for youth
gambling. International Gambling Studies 4, 147–160.
Gambling problems
among youth are increasing at alarming rates worldwide. This represents a
public health concern. A conceptual framework is needed. This article
discusses such a framework, a theoretical model designed to assist in the
development, implementation, and evaluation of a multilevel health promotion
and prevention strategy. Problem gambling is "socially invisible," and many
are unaware of its seriousness as it relates to youth. Noting that problem
gambling is governed by complex and interacting determinants, the authors
argue that gambling expansion and the related problems must be viewed
socially, politically, and economically. They recommend a population
approach that would "shift the distribution of all risk factors in a
favourable direction." Unlike the medical approach, this approach would
address the problem at its roots and has more preemptive merit. Though
overall gambling levels may not be an absolute determinant for problem
gambling, they must still be taken into account. The authors suggest
developing personal skills (of youth, parents, and professionals),
strengthening community capacity, encouraging supportive environments (in a
larger sense, involving issues not directly related to gambling),
recommending health-oriented public policy, and reorienting health services.
Messerlian, C.,
Derevensky, J., & Gupta, R. (2005). Youth gambling problems: A public health
perspective. Health Promotion International, 20, 69–79.
Problem gambling has
only recently been identified as a major public health issue, with an
emerging awareness that adolescents and young adults may represent the
highest risk in this area. Initiatives targeting youth are only now
receiving scrutiny. The Ottawa Charter of Health Promotion provides a
framework for a prevention model and "framework for action" to address and
understand the issue of youth gambling problems from a population-based
viewpoint: "This framework applies denormalization, protection, prevention,
and harm-reduction principles to youth gambling problems and describes
primary, secondary and tertiary prevention objectives." This article
describes a "Youth Gambling Risk Prevention Model," which identifies youth
gambling behaviour along a continuum of risk, with appropriate interventions
for different levels of risk. The authors note that while knowledge of youth
gambling is still limited, more developed knowledge of substance abuse can
be used in this area. A population-based approach involves a broader focus
upon the social, rather than an individualistic medical, framework.
New Zealand Ministry
of Health (2004). Preventing and minimising gambling harm: Strategic plan
2004–2010, Needs assessment, Proposed three-year funding plan, Proposed
problem gambling levy rates. Wellington, New Zealand: Author. Available
at
http://www.moh.govt.nz/moh.nsf/0/CA598932BB52A37DCC256E610016B0AE/$File/
ProblemGamblingConsultation.pdf
In 2004, the New
Zealand Ministry of Health assumed responsibility for the funding and
coordination of problem gambling services with a mandate to prevent and
minimize gambling-related harm. The Ministry asked for feedback on four
documents: (1) Strategic plan for preventing and minimising gambling harm:
2004–2010, (2) Problem gambling needs assessment, (3) Proposed three-year
funding plan, and (4) Proposed problem gambling levy rates. Primary
prevention is described as a largely preemptive measure with an emphasis on
positive health promotion. Secondary prevention addresses problems in their
early stages. Tertiary prevention addresses the full-blown harms associated
with problem gambling. Supply reduction strategies, demand reduction
strategies, and problem limitation strategies are all discussed. Guiding
principles include a "whole-government (multi-faceted) approach," cultural
relevance, reduction of health inequalities, and addressing harm on a
continuum.
Noonan, G., Turner,
N., & Macdonald, J. (1999). Gambling and problem gambling amongst
students in grades 5 to 11. Toronto: Problem Gambling Service and
Addiction Research Foundation, Divisions of Centre for Addiction and Mental
Health. Available at
http://www.responsiblegambling.org/articles/
Gambling_and_problem_gambling_amongst_students_in_grades_5_to_11.pdf
This study finds
fairly high levels of gambling among students, with rates increasing with
each grade level. Over 22% of students reported buying lottery tickets or
similar products despite legal restrictions on sales to minors, and almost
50% engage in some form of gambling. Problem gambling behaviours among some
students were also evident, with games of skill and betting on sports events
demonstrating stronger associations with problem gambling (except for
younger students, for whom lottery purchases showed such a correlation). The
authors note that today's children are among the first to grow up in an
environment wherein gambling is a common and accepted activity and that
problem gambling rates among youth are much higher than among adults. A key
issue is the possibility of many children developing into adult problem
gamblers. Prevention efforts should target the distorted ideas about winning
that are often associated with problem gambling. While the nature of random
events must be understood, the authors point out that cognitive education is
insufficient and that emotional issues must be addressed.
North American
Training Institute. (Current). http://www.nati.org
This Web site
provides information on all relevant aspects of responsible gambling.
Accessible options include "prevention tools," "responsible gaming," and
"educator tools." Special attention is given to information for teens and
seniors. In their own words: "Providing gambling addiction clinical
coursework, youth gambling prevention programs, and responsible gaming
services for over a decade."
Nowatzki, N., &
Williams, R. (2002). Casino self-exclusion programmes: A review of the
issues. International Gambling Studies, 2, 3–25.
Authors' abstract:
"Casino self-exclusion is a procedure by which individuals can have
themselves banned from entering a casino. One of the purposes of this paper
is to present information about the availability and features of these
programmes. A second purpose is to make recommendations about how to best
operate them based on cross-jurisdictional analysis and lessons from the
addiction literature. The first section of the paper describes the typical
casino self-exclusion programme, outlining the features common to most
policies. The second section provides a detailed overview of the programmes
operating in Canada in order to give the reader an appreciation of the
procedural variations that exist. The third section discusses the
effectiveness of self-exclusion programmes. Finally, the fourth section
contains recommendations on ways to improve effectiveness. When properly
implemented, self-exclusion can be a valuable tool in helping to curb
problem gambling."
Petry, N.,
Armentano, C., Kuoch, T., Norinth, T., & Smith, L. (2003). Gambling
participation and problems among South East Asian refugees to the United
States. Psychiatric Services, 54, 1142–1148.
This study was
conducted to investigate rates of gambling and problem gambling among South
East Asian refugees. No other known study has done so. The South Oaks
Gambling Screen was administered to 96 immigrants from Laos, Cambodia, and
Vietnam. They were also asked to provide demographic information and data on
recent gambling behaviour. Fifty-nine percent registered for lifetime
prevalence of pathological gambling. The authors note that these rates of
pathological gambling are 10 to 25 times as high as that found in the
general population (higher, for example, than for substance abusers). While
country of origin did not figure in rates of problem gambling, being male,
divorced, and young were strong predictors. The findings indicate that more
should be known about the social, cultural, and environmental issues
associated with gambling in this group. Prevention and intervention
strategies must be ethnically sensitive.
Pitcher, A. (1999).
Responsible promotion of gaming and dealing with problem gamblers.
Journal of Gambling Studies, 15, 149–159.
The Chief Executive
of Christchurch Casino in New Zealand discusses the importance of
responsible gambling. Casinos especially are the targets of media and
political attention. The author argues that governments could do more to
fulfill their obligations and that casinos have good economic reasons to be
responsive to community concerns. In fact, casinos are compatible with
public health. Greed, vanity, and envy make all people latent problem
gamblers, and this is not the fault of casinos. Casinos did not cause
problem gambling. Instead, their high profile drew attention to an already
existing problem. Sound community relations are in a casino's interests, and
hence the interests of this industry converge with those of the public.
Quinn, F. (2001). First do no harm: What could be done by casinos to limit
pathological gambling. Managerial and Decision Economics, 22,
133–142.
Casinos could
curtail pathological gambling by limiting their own contributions to its
development. The sizes of jackpots and length of play could be limited. As
well, limiting access and decreasing arousal, having less variability in
games, and offering fewer inducements to play are all reasonable strategies.
An external regulatory agency may be required to this end. Despite
resistance, casinos may benefit in the long run, partly because their
advertising and capital expenditures would be smaller.
Raeburn, John.
(2004). An international charter for gambling: The Auckland Conference and
beyond. Journal of Gambling Issues, 12. Available at
http://www.camh.net/egambling/issue12/jgi_12_raeburn.html
Claiming to be the
first international conference devoted exclusively to the idea of public
health in gambling, the Auckland Conference also had an objective: an
International Charter for Gambling designed to raise awareness of
governments worldwide of their responsibility to exercise a duty of care
toward their citizens with respect to gambling. Most governments that permit
gambling are actively involved in its promotion and development. They are
hence responsible for much of the harm associated with this activity. These
governments profit from gambling, which serves as an alternative to higher
taxes. Despite the political expediency of this approach to revenue
generation, governments tend to be part of the problem, the public health
and societal dimensions of gambling need to be addressed, and those
concerned should have an established mechanism by which to convey their
views on the ways in which governments should address gambling-related
matters. The proposed Charter would enforce government accountability. The
author grants, however, that in the current political climate it would be
difficult to take such a Charter to world bodies such as the United Nations
and the World Health Organization. The proposed Charter would be guided by
seven principles: (1) enjoyment of gambling and freedom from harm, (2)
government duty of care and protection, (3) community empowerment, (4)
informed consent and education, (5) protection of populations from negative
effects of gambling, (6) access to care and effective resources for those
affected by problem gambling, and (7) the right to abstain or limit
consumption.
Roney, C., & Trick,
L. (2003). Grouping and gambling: A Gestalt approach to understanding the
gambler's fallacy. Canadian Journal of Experimental Psychology, 57,
69–75.
The gambler's
fallacy, the mistaken belief that independent events such as the results of
a coin toss are influenced by recent outcomes (for example, that "tails" is
more likely to turn up after several "heads"), is studied under two
conditions: a clinical trial following a run of several heads or tails was
grouped with the prior sequence as part of "Block 1," and the trial was
grouped as the start of a new sequence, as the start of "Block 2." In the
former case, the gambler's fallacy was evident, but not in the latter. These
findings suggest that the standard "judgment approach," involving education
on the nature of random sequences, may not yield the desired results.
Conversely, a Gestalt approach, wherein people are taught to reframe the
sequence in such a way that the following event is perceived as a new
starting point rather than as a continuation of the prior sequence, may
prove more effective. The authors caution that their findings are
preliminary and that more study is required.
Shaffer, H. (2003).
A public health perspective on gambling: The four principles. AGA
Responsible Gaming Lecture Series, 2 (1), 1–27. Available at
http://www.americangaming.org/assets/files/LectureSHAFFERfnl.pdf
The author
identifies four principles upon which a public health perspective should be
based: (1) Scientific research should form the basis of public health
knowledge. (2) Such knowledge should be derived from population-based
observations. (3) Health initiatives should be proactive. (4) A balanced
perspective, incorporating harms as well as benefits of gambling, is
required. The author discusses four "opposite" principles and their
implications in order to firmly validate his own position.
Shaffer, H. (2004).
The road less travelled: Moving from distribution to determinants in the
study of gambling epidemiology. Canadian Journal of Psychiatry, 49,
504–516.
The author argues
that it is time to put less emphasis on general population-prevalence data
and instead focus upon the risk and protective factors associated with the
onset of gambling disorders. Little is known about incidence among
vulnerable and resilient populations. Yet prevalence studies should focus
upon groups with increased vulnerability (such as adolescents and substance
abusers). More focus should be directed at onset and determinants of problem
gambling. But before we can travel down this road, current diagnostic
screens, theoretical constructs, and epidemiological tools require revision.
Primary and secondary prevention options are discussed with an eye to how
they could be improved once research has taken this direction. Matching
specific efforts to specific populations will be key.
Shaffer, H., Forman,
D., Scanlan, K., & Smith, F. (2000). Awareness of gambling-related problems,
policies and educational programs among high school and college
administrators. Journal of Gambling Studies, 16, 93–101.
A survey of high
school and college representatives in Massachusetts found that educators
were largely unaware of the prevalence of gambling-related problems among
youth. A survey instrument designed to evaluate policies and training
programs was employed. Both high schools and colleges were found to lack
policies and regulations pertaining to gambling and to provide few channels
for students and faculty to educate themselves on the potential hazards. The
authors suggest that it is unlikely that the educators under study are
equipped to engage in meaningful detection and preventative efforts.
Shaffer, H., & Korn, D. (2002). Gambling and related mental disorders: A
public health analysis. Annual Review of Public Health, 23, 171–212
The authors apply a
public health perspective (see Korn & Shaffer, 1999; Shaffer, 2003) to the
prevalence of gambling and related mental disorders. Effects on public
health are discussed in psychological, economic, and social terms, with
harms and benefits taken into account. Vulnerable groups are examined. The
public health "paradigm" implies a broad approach to prevention, the latter
being promoted as a "community priority." Harm reduction should focus more
on people with subclinical levels of gambling problems.
Shaffer, H., LaBrie,
R., & LaPlante, D. (2004). Laying the foundation for quantifying regional
exposure to social phenomena: Considering the case of legalized gambling as
a public health toxin. Psychology of Addictive Behaviors, 18, 40–48.
Exposure and
adaptation models offer divergent, even conflicting, viewpoints on the
relation between addictions and environmental influence. Exposure theory
identifies certain influences as "toxins," with the corollary that an
institution such as a casino would have a direct effect upon the frequency
of problem gambling. Conversely, adaptation theory grants this premise only
for the short term, proposing that individuals should eventually become
resistant to the aggravating agent. This article discusses a public health
regional exposure model (REM) designed to acquire empirical evidence for
both perspectives. Modified to address gambling, the REM is able to quantify
social constructs by means of standard indices of regional social exposure.
Given that gambling studies is a new field, the numerous sources of gambling
exposure are hard to identify and measure, and this article makes use of
some knowledge already available in the substance abuse field. The
methodology section discusses the ways in which exposure can be calculated.
Themes discussed include dose, potency, and duration. Limitations, such as
the time sensitivity of REM calculations, are also discussed. Adaptation
theory is treated as relevant to understanding the prevention of gambling
problems.
Smeaton, M., Poole,
A., Chevis, A., & Carr, J. (2004). Study into underage access to online
gambling and betting sites. London: GamCare. Available at
http://www.gamcare.org.uk/pdfs/StudyReportFinal.pdf
The authors of this
U.K. study note that debit cards are available to minors, sometimes as young
as 11. This makes Internet and other remote forms of gambling among youth a
serious concern. Age verification procedures are inconsistent and
inadequate. Of 37 sites tested, only 7 blocked an underage volunteer posing
as a player (and claiming to be 21).
Smith, G., & Wynne,
H. (2004). VLT gambling in Alberta: A preliminary analysis. Edmonton,
AB: Alberta Gaming Research Institute.
This comprehensive
report covers its topic at many levels and even contains a 27-page
literature review. A main rationale for the study is that video lottery
terminal (VLT) gambling is still a novelty, so its implications are still
poorly understood. This is largely a social impact study, though information
provided about the demographic characteristics of VLT players (both problem
gambler and non-problem gambler) is very pertinent to the theme of
prevention.
Stinchfield, R.
(2002). A comparison of gambling by Minnesota public school students in
1992, 1995, and 1998. Journal of Gambling Studies, 17, 273–296.
Rates of gambling
among Minnesota public school students in the 9th and 12th grades were
compared for 1992, 1995, and 1998. While fewer students gambled in 1998 than
in the other years, the number of 12th-grade students who had gambled
frequently had increased slightly. Participation in the lottery among
9th-grade students declined, though it increased among 12th-graders. The
authors note that illegal ticket playing among youth is cause for concern
and that the generation under investigation is the first to be exposed to
widespread access to legal gambling venues and advertising. Fewer students
gambling overall suggests that prevention efforts may be working, though
other explanations are possible. Yet more youth are gambling frequently.
Prevention efforts targeted at specific types of youth are needed, and some
may require more intensive efforts as they may already be overinvolved in
gambling. Schools are a good place for the enactment of such measures.
Strong, D., Breen,
R., Lesieur, H., & LeJuez, C. (2003). Using the Rasch model to evaluate the
South Oaks Gambling Screen for use with nonpathological gamblers.
Addictive Behaviors, 28, 1465–1472.
While the South Oaks
Gambling Screen (SOGS) may be effective in identifying pathological
gamblers, this study found it to be less effective in determining the
degrees of severity among those who may be at risk yet do not meet the
criteria for full-blown pathology. Notably, the SOGS relies upon informants
identifying a sufficient number of items, without consideration of the type
of problem within each category. Investigators used a logistic item response
model, Rasch, to identify levels of problem gambling severity reflected in
each item. Items best suited to identify those at risk involve financial
difficulty, and this study supports the movement toward a harm-based
conception of problem gambling, which treats the issue on a continuum,
rather than a strict conception of pathology such as that offered by DSM-IV.
Tse, S., Wong, J., &
Kim, H. (2004). A public health approach for Asian people with problem
gambling in foreign countries. Journal of Gambling Issues, 12.
Available at http://www.camh.net/egambling/issue12/jgi_12_tse.html
Asians make up the
fastest growing ethnic group in New Zealand, due largely to the increase in
Asian immigration to English-speaking countries in general. Recent research
and news articles give credence to anecdotal accounts of high levels of
gambling among Asian people. The article treats problem gambling among
Asians in social terms, with an emphasis on the difficulties associated with
adjusting to life in a new country. Public health involves more than
biological and behavioural considerations. Access to health care and social
services along with socioeconomic issues such as income and employment are
all pertinent to a public health approach to gambling. This article presents
five principles, based on a public health perspective, for an effective
strategy for preventing gambling-related harm among Asian populations: (1)
"Acknowledging similarities and differences within Asian populations": while
acknowledging that "Asian" makes a useful umbrella, the author cautions
against overlooking the differences between, for example, immigrants from
Japan and the Philippines. (2) "Ensuring that approaches are
evidence-based": a comprehensive typology of different forms of evidence is
provided. (3) "Treating Asian problem gambling in an acculturation
framework": this refers to issues pertaining to people (notably immigrants)
coming into contact with different cultures and trying to adjust to the
ensuing realities. (4) "Addressing the issue of shame associated with
problem gambling": themes such as "keeping face" tend to be family related
among Asians, and the shame associated with problem gambling can be
aggravated by issues specific to immigration. (5) Targeting at-risk
subgroups: the author discusses subgroups within the Asian community at
greater risk of developing gambling problems.
Tu'itahi, S.,
Guttenbeil-Po'uhila, Y., & Hand, J. (2004). Gambling issues for Tongan
people in Auckland, Aotearoa-New Zealand. Journal of Gambling Issues, 12.
Available at
http://www.camh.net/egambling/issue12/jgi_12_tuitahi.html
This article
discusses a research project, conducted by the Auckland Regional Public
Health Service, on gambling issues among the Tongan people in Auckland, New
Zealand. Low socioeconomic status and low education levels, both indicators
of gambling prevalence in the region, figure significantly among the
Tongans. Another rationale for studying the Tongan community was the lack of
knowledge about gambling in that community and the potential for comparison
with the Samoan community, which had already been studied. The article
outlines progress made at the time of writing and preliminary findings.
Fifty interviews had been conducted, and the data were still under analysis,
though anecdotal evidence that gambling is a serious health issue within
this community had been confirmed. The stated research goals for this
project were as follows: (1) "To explore the relevant issues for Tongan
people in Auckland which contribute to the risk of developing addiction to
gambling and problem gambling"; (2) "To identify the effects of gambling on
Tongan people in Auckland"; (3) "To provide relevant information to health
providers and planners in the planning and implementation of culturally
appropriate strategies against problem gambling for Tongan people in New
Zealand."
Turner, N., &
Horbay, R. (2004). How do slot machines and other electronic gambling
machines actually work? Journal of Gambling Issues, 11. Available at
http://www.camh.net/egambling/issue11/jgi_11_turner_horbay.html
Electronic gaming
machines (EGMs) are now available in many venues, and they seem to generate
many myths. This is partly because of the absence of accurate information
and partly because of the way the machines are designed. This article was
written to demystify the machines and to dispel some myths, with counsellors
and prevention workers as the main target audience. The paper discusses the
ways in which EGMs can effectively simulate randomness in payouts. The paper
describes the problems with human reasoning responsible for certain myths
(most of which are due to misunderstanding the independent nature of random
events) and provides a technical account of how the machines function. There
is even a list of questions and answers. It is important to note that
payment is not determined by how recently a machine has paid out. As
well, reasoning that may work with cards (a number that has not come up
recently may be due) does not apply to EGMs. Such information is important
to the creation of effective prevention programs.
Volberg, R. (2002).
Gambling and problem gambling among adolescents in Nevada. Carson
City, NV: Nevada Department of Human Resources. Available at
http://www.hr.state.nv.us/directors/NV_Adult_Report_final.pdf
This report presents
the findings of a statewide survey of gambling and related problems in
Nevada. Some demographic information was found. For example, while whites
and Hispanics were likely to identify "entertainment" as a reason for
gambling, blacks were more likely to play in order to win money. Hispanic
nongamblers were most likely to refrain from gambling for moral reasons. The
author recommends extending healthcare insurance coverage to problem
gambling, promoting responsible gambling policies, and providing more money
for public education and prevention. Public education should target the
increasing number of gambling venues, from grocery stores to Laundromats
(where gaming machines may be located). Prevention should focus on those at
greatest risk—including youth and certain minorities—who may be more
responsive to such efforts than full-blown pathological gamblers.
Wiebe, J., &
Falkowski-Ham, A. (2003). Understanding the audience: The key to
preventing youth gambling problems. Toronto: Responsible Gambling
Council of Ontario. Available at
http://www.responsiblegambling.org/articles/
understanding_the_audience_youth_2003.pdf
This study was
designed to assist in the development of problem gambling prevention
strategies for youth between the ages of 9 and 16. In a quest to learn about
the early development of gambling-related attitudes, beliefs, and
behaviours, the authors focus upon the general lifestyles of young people
along with issues such as attitudes toward responsible and problem gambling,
the language they employ to address these issues, and their reactions to
gambling advertisements. Methodology involved three phases: (1) building
upon a YTV (a Canadian children's television channel) report on youth
lifestyle; (2) focus groups designed to assess linguistic, experiential, and
cognitive issues; and (3) quantitative analysis of the findings from Phase
2. Key findings include the following: youth attribute different meanings to
betting and gambling, with the latter perceived in more negative terms;
Internet gambling among youth is on the rise, and a serious concern; over 4%
of youth in this study reported problems related to gambling, including
fights and loss of money; fewer than 25% of youth consider gambling cool,
though youth who perceive themselves as either leaders or risk-takers are
more likely to gamble; though youth understand that they are likely to lose
on scratch or lottery tickets, their understanding of probability is
wanting; most youth realize that gambling can lead to difficulties and
understand that behaviours such as borrowing money to gamble are
problematic; parental behaviours and attitudes are highly influential; and
far more young people have seen advertisements promoting gambling than ads
addressing problem or responsible gambling. The authors claim that their
findings highlight the importance of prevention strategies aimed at younger
ages. They identify understanding the language of the target group as key.
Wynne Resources.
(1999). Problem gambling public awareness campaigns in North America.
Toronto: Ontario Substance Abuse Bureau.
This study conducted
for the Ontario Substance Abuse Bureau examines problem gambling public
awareness campaigns throughout North America with the objective of informing
the implementation of a campaign for Ontario. While many organizations and
representatives were contacted, no formal evidence of effectiveness was
provided. Instead, generic indicators—such as requests for information from
the public—are taken by many representatives as evidence that awareness must
be on the rise. There was at the time of this report no consensus of which
approaches were most effective. This report makes six recommendations: (1)
coordinate efforts among different regions and concerned parties for
information sharing, and develop other means of accumulating knowledge; (2)
implement a strategic plan with a clear statement of purpose, within an
overall prevention program; (3) select specific promotional activities and
media; (4) identify target groups; (5) involve other stakeholders beyond the
Bureau; and (6) evaluate the campaign's effectiveness.
Manuscript history:
Submitted August 19, 2005.
This article was not peer-reviewed.
For correspondence: Peter Ferentzy, PhD, Centre for
Addiction and Mental Health,
45 Wynford Heights Cres., #1901. Toronto, ON, M3C 1L3. Phone: 416-779-9286,
e-mail:
pferentzy@earthlink.net
Contributors: WS
originated the idea of the bibliography. PF conducted most of the library
research and wrote the summaries; NT and WS contributed some items. NT read
and revised the summaries and wrote the introduction.
Competing interests:
None declared.
Funding: The Ontario Ministry of Health and Long-Term Care funded this
annotated bibliography.
Peter Ferentzy (PhD, social and political thought, York
University) is a research scientist at CAMH and has been studying GA since
2002. He has published on GA as well as the history of addiction.
Nigel Turner, PhD,
is a research scientist at the Centre for Addiction and Mental Health (CAMH)
in Toronto. He received his doctorate in cognitive psychology at the
University of Western Ontario (1995) and has worked for CAMH for the past 11
years. He has extensive experience in quantitative research methods,
including psychometrics, surveys, experimental studies, and computer
simulations. Nigel has received grants from the National Center for
Responsible Gaming and the Ontario Problem Gambling Research Centre and
funding from the Ontario Ministry of Health. He has published in
peer-reviewed journals and has given a large number of conference
presentations. He is particularly interested in cognitive models of problem
gambling and has authored three papers on gambling systems. Outside of CAMH,
Nigel has a keen interest in history and takes part in reenactments of
historically important 19th-century battles. E-mail:
Nigel_Turner@camh.net
Wayne Skinner (MSW,
RSW, University of Toronto) is clinical director of the Concurrent Disorders
Program and the Problem Gambling Service of the Centre for Addiction and
Mental Health in Toronto, Canada. He has over 25 years' experience as a
clinician, supervisor, researcher, consultant, and educator. Wayne is an
assistant professor in the Department of Psychiatry at the University of
Toronto. He also directs and teaches in the Addiction Studies certificate
program in Continuing Education at the University of Toronto. He has studied
at the doctoral level at York University, where he is an adjunct faculty
member of the School of Social Work. He is editing a clinical handbook on
the treatment of co-occurring addiction and mental health problems. He is
co-investigator on several research studies on problem gambling.
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