‘Nothing can be done until everything is done’: the use of complexity arguments by food, beverage, alcohol and gambling industries

By Petticrew, M., Katikireddi, S. V., Knai, C., Cassidy, R., Maani Hessari, N., Thomas, J., & Weishaar, H.

Abstract: Background Corporations use a range of strategies to dispute their role in causing public health harms and to limit the scope of effective public health interventions. This is well documented in relation to the activities of the tobacco industry, but research on other industries is less well developed. We therefore analysed public statements and documents from four unhealthy commodity industries to investigate whether and how they used arguments about complexity in this way.Methods We analysed alcohol, food, soda and gambling industry documents and websites and minutes of reports of relevant health select committees, using standard document analysis methods.Results Two main framings were identified: (i) these industries argue that aetiology is complex, so individual products cannot be blamed; and (ii) they argue that population health measures are “too simple” to address complex public health problems. However, in this second framing, there are inherent contradictions in how industry used “complexity”, as their alternative solutions are generally not, in themselves, complex.Conclusion The concept of complexity, as commonly used in public health, is also widely employed by unhealthy commodity industries to influence how the public and policymakers understand health issues. It is frequently used in response to policy announcements and in response to new scientific evidence (particularly evidence on obesity and alcohol harms). The arguments and language may reflect the existence of a cross-industry “playbook”, whose use results in the undermining of effective public health policies – in particular the undermining of effective regulation of profitable industry activities that are harmful to the public’s health.

Petticrew, M., Katikireddi, S. V., Knai, C., Cassidy, R., Maani Hessari, N., Thomas, J., & Weishaar, H. (2017). “Nothing can be done until everything is done”: the use of complexity arguments by food, beverage, alcohol and gambling industries. Journal of Epidemiology and Community Health, 71(11), 1078. https://doi.org/10.1136/jech-2017-209710

 

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A Pilot Evaluation of a Tutorial to Teach Clients and Clinicians About Gambling Game Design

By Turner, N. E., Robinson, J., Harrigan, K., Ferentzy, P., & Jindani, F.

Abstract: This paper describes the pilot evaluation of an Internet-based intervention, designed to teach counselors and problem gamblers about how electronic gambling machines (EGMs) work. This study evaluated the tutorial using assessment tools, such as rating scales and test of knowledge about EGMs and random chance. The study results are based on a number of samples, including problem gambling counselors (n = 25) and problem gamblers (n = 26). The interactive tutorial was positively rated by both clients and counselors. In addition, we found a significant improvement in scores on a content test about EGM games for both clients and counselors. An analysis of the specific items suggests that the effects of the tutorial were mainly on those items that were most directly related to the content of the tutorial and did not always generalize to other items. This tutorial is available for use with clients and for education counselors. The data also suggest that the tutorial is equally effective in group settings and in individual settings. These results are promising and illustrate that the tool can be used to teach counselors and clients about game design. Furthermore, research is needed to evaluate its impact on gambling behavior.

Turner, N. E., Robinson, J., Harrigan, K., Ferentzy, P., & Jindani, F. (2017). A Pilot Evaluation of a Tutorial to Teach Clients and Clinicians About Gambling Game Design. International Journal of Mental Health and Addiction. https://doi.org/10.1007/s11469-017-9816-1

 

When Does Premature Treatment Termination Occur? Examining Session-by-Session Dropout Among Clients with Gambling Disorder

By Pfund, R. A., Peter, S. C., Whelan, J. P., & Meyers, A. W.

Abstract: Premature termination challenges the successful outcomes of psychological treatments for gambling disorder. To date, research has primarily identified clients who are at particular risk for dropping out of treatment. A smaller but growing body of literature has investigated when dropout occurs. Typically, those studies have not considered improvement in psychological distress within their operationalizations of dropout and therefore may have misrepresented when dropout occurs. The current study examined when dropout occurs using an operationalization based on the criteria of attaining reliable change in a naturalistic sample of clients with gambling disorder, and the classification rates yielded from that operationalization were compared to the rates from a more common operationalization. Participants (n = 334) were clients meeting diagnostic criteria for gambling disorder at an outpatient private practice who completed a measure of psychological distress at baseline and prior to each subsequent treatment session. A survival analysis was conducted to determine temporal patterns of treatment dropout (i.e., clients who discontinued treatment before realizing reliable changes in psychological distress) and completion (i.e., clients who discontinued treatment after realizing reliable changes in distress) at each treatment session. Forty-nine percent of clients were classified as dropouts, and the majority of those clients did so in the first few sessions. The more common operationalization of dropout classified clients as dropouts when they had improved in their distress and clients as completers when they had not improved in their distress. Discussion centers on the implications of dropout occurring at various stages of treatment and future directions.

Pfund, R. A., Peter, S. C., Whelan, J. P., & Meyers, A. W. (2017). When Does Premature Treatment Termination Occur? Examining Session-by-Session Dropout Among Clients with Gambling Disorder. Journal of Gambling Studies. https://doi.org/10.1007/s10899-017-9733-z

 

Casino Self- and Forced Excluders’ Gambling Behavior Before and After Exclusion

By Kotter, R., Kräplin, A., & Bühringer, G.

Casino exclusion programs are intended to prevent or limit gambling-related harm. Although previous research showed that self-exclusion is associated with reduced gambling, it remains unknown whether self- and forced excluded subjects show different patterns of gambling behavior and if exclusion from casino gambling affects all gambling activities. The present study retrospectively investigated (1) the role of voluntariness of exclusion for the first time, and (2) general gambling behavior of excluded individuals before and after exclusion. A total of N = 215 casino excluders (self-excluders: n = 187, forced excluders: n = 28) completed an online survey or a face-to-face interview up to 8 years after enrollment. Self- and forced excluders showed similar rates of abstinence (self-excluders: 19.3%, forced excluders: 28.6%) and reduction (self-excluders: 67.4%, forced excluders: 60.7%), even though forced excluders reported a significantly greater initial gambling intensity compared to self-excluders (e.g., pre-exclusion gambling time; self-excluders: 3.2 days/week, forced excluders: 4.3 days/week). Overall, results indicated that 20.5% of excluders stopped all gambling activities and another 66.5% reduced their gambling. Those who continued gambling significantly reduced this behavior in every segment, except for gambling halls. Findings indicate that self- and forced exclusion are associated with similarly reduced gambling behavior, even in non-excluded segments. However, unchanged gambling in gambling halls emphasizes the importance to implement consistent exclusion programs over all gambling segments.

 

Kotter, R., Kräplin, A., & Bühringer, G. (2017). Casino Self- and Forced Excluders’ Gambling Behavior Before and After Exclusion. Journal of Gambling Studies. https://doi.org/10.1007/s10899-017-9732-0

Testing an Incentive-Sensitisation Approach to Understanding Problem Slot-Machine Gambling Using an Online Slot-Machine Simulation

By Davey, B., & Cummins, R.

Abstract: This study aims to test the application of the incentive-sensitisation theory to slot-machine gambling behaviour. The theory posits that for problem gamblers (PGs), gambling strengthens the response of motivational pathways in the mid-brain to gambling cues, eliciting strong wanting, independent of liking. Non-problem gamblers (NPGs) experience weaker changes to motivational pathways so liking and wanting remain associated. Hence, it is predicted that wanting to gamble will be greater than liking for PGs but there will be no difference for NPGs; wanting will be greater for PGs than for NPGs; and, wanting but not liking will predict whether PGs continue gambling, whereas both will predict this for NPGs. During gambling on an online simulated slot-machine, 39 PGs and 87 NPGs rated “liking” and “wanting”. Participants played at least 3 blocks of 10–20 spins, and then had the option of playing up to 4 additional blocks; to continue playing they had to complete an effortful task, so that “number of blocks played” acted as an additional indirect measure of wanting. Results supported hypotheses except on the indirect measure of wanting (the number of blocks played).

Davey, B., & Cummins, R. (2017). Testing an Incentive-Sensitisation Approach to Understanding Problem Slot-Machine Gambling Using an Online Slot-Machine Simulation. Journal of Gambling Studies, 1–12. https://doi.org/10.1007/s10899-017-9718-y

 

The Economic Burden of Pathological Gambling and Co-occurring Mental Health and Substance Use Disorders

By Rodriguez-Monguio, R., Brand, E., & Volberg, R.

Abstract: Objectives: Disordered gambling often co-occurs with psychiatric and substance use disorders. The study aim was to assess the healthcare costs of pathological gambling (PG) and co-occurring mental health and substance use disorders by payer. This is the first-of-its-kind economic analysis of addictive behaviors and mental health disorders.
Methods: Study data were derived from the Massachusetts All-Payer Claims Data-a representative health claims database-for the period 2009 to 2013. The study analytical sample contained all medical and pharmaceutical claims for commercially insured Massachusetts residents who were aged >=18 years, had health insurance coverage, had a diagnosis of PG, and sought care in the Commonwealth. Healthcare cost components included outpatient, inpatient, emergency room visits, and prescription drugs. Bootstrap analysis was performed to account for skewed distribution of cost data. All costs were adjusted to constant dollars.
Results: The study sample included 599 patients over the study period. The most prevalent principal diagnoses were disorders of impulse control (50%), episodic mood disorders (31%), anxiety disorders (14%), and psychoactive substance (9%). The mean annual total expenditures on health care per patient with diagnosis of pathological gambling were $7993 +/- $11,847 (bias-corrected 95% confidence interval) in 2009, $10,054 +/- $14,555 in 2010, $9093 +/- $13,422 in 2011, and $9523 +/- $14,505 in 2012. Pharmaceutical expenditures represented 16% to 22% of total healthcare expenditures. In the study period, prescription drug co-pays represented approximately 16% of the pharmaceutical expenditures.
Conclusions: Psychiatric comorbidity and substance use disorders, and nondependent abuse of drugs are highly prevalent among pathological gamblers. These disorders pose an economic burden to patients and healthcare payers.
(C) 2017 American Society of Addiction Medicine

Rodriguez-Monguio, R., Brand, E., & Volberg, R. (2017). The Economic Burden of Pathological Gambling and Co-occurring Mental Health and Substance Use Disorders. Journal of Addiction Medicine, Publish Ahead of Print. https://doi.org/10.1097/ADM.0000000000000363

 

Measuring Gambling Reinforcers, Over Consumption and Fallacies: The Psychometric Properties and Predictive Validity of the Jonsson-Abbott Scale (open access)

By Jonsson, J., Abbott, M. W., Sjöberg, A., & Carlbring, P.

Abstract: Traditionally, gambling and problem gambling research relies on cross-sectional and retrospective designs. This has compromised identification of temporal relationships and causal inference. To overcome these problems a new questionnaire, the Jonsson-Abbott Scale (JAS), was developed and used in a large, prospective, general population study, The Swedish Longitudinal Gambling Study (Swelogs). The JAS has 11 items and seeks to identify early indicators, examine relationships between indicators and assess their capacity to predict future problem progression. The aims of the study were to examine psychometric properties of the JAS (internal consistency and dimensionality) and predictive validity with respect to increased gambling risk and problem gambling onset. The results are based on repeated interviews with 3818 participants. The response rate from the initial baseline wave was 74 %. The original sample consisted of a random, stratified selection from the Swedish population register aged between 16 and 84. The results indicate an acceptable fit of a three-factor solution in a confirmatory factor analysis with “Over consumption”, “Gambling fallacies” and “Reinforcers” as factors. Reinforcers, Over consumption and Gambling fallacies were significant predictors of gambling risk potential and Gambling fallacies and Over consumption were significant predictors of problem gambling onset (incident cases) at 12 month follow up. When controlled for risk potential measured at baseline, the predictor Over consumption was not significant for gambling risk potential at follow up. For incident cases, Gambling fallacies and Over consumption remained significant when controlled for risk potential. Implications of the results for the development of problem gambling, early detection, prevention and future research are discussed.

Jonsson, J., Abbott, M. W., Sjöberg, A., & Carlbring, P. (2017). Measuring Gambling Reinforcers, Over Consumption and Fallacies: The Psychometric Properties and Predictive Validity of the Jonsson-Abbott Scale. Frontiers in Psychology, 8. https://doi.org/10.3389/fpsyg.2017.01807