On the limits and challenges of public health approaches in addressing gambling-related problems [subscription access article]

Abstract
Many governments around the world have adopted a public health (PH) approach as a framework to minimise, reduce or prevent gambling-related harm. In principle, this appears very sensible given the success of PH approaches in other areas of society: in disease control, nutrition, physical exercise and reductions in smoking. In this paper, we examine the challenges that are faced in applying PH principles to gambling. We argue that gambling is a difficult activity to address because of the highly skewed distribution of severity that makes PH interventions seem less relevant for the majority and difficult to apply to the complex minority. In our view, gambling harm can really only be reduced by changing the behaviour of individuals, and this objective is very much informed by the principles and practices of ‘individual-focused disciplines’ including psychology, social work and the medical sciences. Greater evidence and evaluation are needed to demonstrate how the ‘whole of population’ approaches advocated by PH are superior than ecological, individual-focused or responsible gambling approaches to reduce gambling-related harm. Article details and access conditions

Citation: Delfabbro, P., King, D.L. On the Limits and Challenges of Public Health Approaches in Addressing Gambling-Related Problems. International Journal of Mental Health and Addiction 18, 844–859 (2020). https://doi.org/10.1007/s11469-020-00276-2

Isolating the impact of specific gambling activities and modes on problem gambling and psychological distress in internet gamblers [article]

Abstract
Background: Gambling disorder is related to high overall gambling engagement; however specific activities and modalities are thought to have stronger relationships with gambling problems. This study aimed to isolate the relationship between specific gambling activities and modalities (Internet and venue/land-based) to gambling disorder and general psychological distress. Past-month Internet gamblers were the focus of this investigation because this modality may be associated with gambling disorders in a unique way that needs to be separated from overall gambling intensity.

Methods: Australians who had gambled online in the prior 30 days (N = 998, 57% male) were recruited through a market research company to complete an online survey measuring self-reported gambling participation, problem gambling severity, and psychological distress.

Results: When controlling for overall gambling frequency, problem gambling was significantly positively associated with the frequency of online and venue-based gambling using electronic gaming machines (EGMs) and venue-based sports betting. Psychological distress was uniquely associated with higher frequency of venue gambling using EGMs, sports betting, and casino card/table games.

Conclusions: This study advances our understanding of how specific gambling activities are associated with disordered gambling and psychological distress in users of Internet gambling services. Our results suggest that among Internet gamblers, online and land-based EGMs are strongly associated with gambling disorder severity. High overall gambling engagement is an important predictor of gambling-related harms, nonetheless, venue-based EGMs, sports betting and casinos warrant specific attention to address gambling-related harms and psychological distress among gamblers.
Link to the article

Citation: Gainsbury, S.M., Angus, D.J. & Blaszczynski, A. (2019). Isolating the impact of specific gambling activities and modes on problem gambling and psychological distress in internet gamblers. BMC Public Health, 19(1372). DOI: https://doi.org/10.1186/s12889-019-7738-5

Gamblers’ (mis-)interpretations of Problem Gambling Severity Index items: Ambiguities in qualitative accounts from the Swedish longitudinal gambling study [open-access article]

Abstract: The Problem Gambling Severity Index (PGSI) is a screening instrument frequently used to identify risk and problem gambling. Even though the PGSI has good psychometric properties, it still produces a large proportion of misclassifications. Aims: To explore possible reasons for misclassifications in problem gambling level by analysing previously classified moderate-risk gamblers’ answers to the PGSI items, in relation to their own current and past gambling behaviours.
Methods: Semi-structured telephone interviews were conducted with 19 participants reporting no negative consequences from gambling. They were asked the PGSI questions within an eight-year time frame (2008 to 2016). Ambiguous answers to PGSI items were subject to content analysis.
Results: Several answers to the PGSI items contained ambiguities and misinterpretations, making it difficult to assess to what extent their answers actually indicated any problematic gambling over time. The item about feelings of guilt generated accounts rather reflecting self-recrimination over wasting money or regretting gambling as a meaningless or immoral activity. The item concerning critique involved mild interpretations such as being ridiculed for buying lottery tickets or getting comments for being boring. Similar accounts were given by the participants irrespective of initial
endorsement of the items. Other possible reasons for misclassifications were related to recall bias, language difficulties, selective memory, and a tendency to answer one part of the question without taking the whole question into account.
Conclusions: Answers to the PGSI can contain a variety of meanings based on the respondents’ subjective interpretations. Reports of lower levels of harm in the population should thus be interpreted with caution. In clinical settings it is important to combine use of screening instruments with interviews, to be able to better understand gamblers’ perceptions of the gambling behaviour and its negative consequences.
Article available online

Reference: Samuelsson, E., Wennberg, P., & Sundqvist, K. (2019). Gamblers’ (mis-)interpretations of Problem Gambling Severity Index items: Ambiguities in qualitative accounts from the Swedish longitudinal gambling study. Nordic Studies on Alcohol and Drugs, 36(2), 140–160. DOI: 10.1177/1455072519829407

The “Zone”: a qualitative exploratory study of an altered state of awareness in electronic gaming machine problem gambling [subscription access article]

Oakes, J., Pols, R., Lawn, S. et al. (2018). International Journal of Mental Health and Addiction. doi: https://doi.org/10.1007/s11469-018-9976-7

Abstract: This paper reports a state of mind described by electronic gaming machine (EGM) problem gamblers (PGs) as the “zone”. Twenty-nine PGs engaged in focus groups and in-depth interviews. Participants described an altered state of awareness: the zone, which was highly desirable providing relief from negative emotions. PGs had difficulty recalling experiences whilst in the zone but described a constriction of attention, awareness and impairment of cognitive functions. During this time, the PG could not think critically, exercise self-observation, realistically appraise the use of money, see the consequences of their actions, exercise the will to cease gambling or learn from harms. Memory was impaired, as was decision-making and the capacity to make rational choices. Understanding the zone may provide insight into treatment where the capacity to learn may be reduced. Further research is needed to determine what proportions of EGM gamblers experience the zone and if this occurs with non-EGM gamblers. Article and access details

Prevention paradox logic and problem gambling: Does low-risk gambling impose a greater burden of harm than high-risk gambling? (Open access)

By Paul Delfabbro and Daniel King.

Background and aims: The aim of this paper is to examine the evidence and arguments in favor of prevention paradox (PP) logic in the context of problem gambling. Evidence from recent studies of gambling and the distribution of harm across lower and higher risk gamblers is reviewed to examine the contention that the absolute burden of harm is greater in low-risk (LR) gamblers than the problem gamblers.
Methods: The review examines a number of methodological and conceptual concerns about existing evidence in support of the PP.
Results: The principal problems identified include the misclassification of LR gamblers; the use of binary scoring method that understates the frequency of harms in high-risk populations; a tendency to confuse behavior and harm; and the use of potentially overly inclusive definitions of harm with low thresholds of severity.
Discussion and conclusions: This paper makes a number of recommendations for enhancement of this area of research, including the use of clear definitions of harm and LR behavior and a greater focus on harm with material impacts on people’s quality of life.