Problem Gambling

an APS Summary Statement
Gambling has been a component of mainstream Australian culture since colonisation. It is a major entertainment and tourism industry, and a valued source of revenue to government and private enterprise. Nevertheless, for those Australians who are problem gamblers, along with their families and communities, gambling is the cause of considerable harm. Psychology, as a science and profession, has much to offer in understanding gambling behaviour.

Gambling involves the staking of an item of value on an outcome that is governed by chance, and comprises a wide range of commercial activities, including lotteries, electronic gaming machines, casino games, racing and sports-betting. Almost all forms of commercial gambling are designed to provide a negative return to players, that is, a relative advantage to the house or gambling operator. Gambling venues and activities are highly accessible throughout Australia and 70-80% of Australians gamble at least once a year.

Gambling is a regulated industry with statutory regulatory bodies in each jurisdiction. Nevertheless, there is intrinsic conflict in government regulation of an industry that provides significant revenue to government, and self-regulation that if effective would reduce revenue for private enterprise.

Gambling harm is variably defined. A public health approach argues for assessment of harm on a continuum and determined at individual, family and community levels. Harm can be personal, social, vocational, financial and legal. The DSM-IV-TR takes a diagnostic and medical approach in classifying pathological gambling as an impulse control disorder, with many diagnostic items based on those founding traditional addiction models including tolerance, withdrawal, and difficulty controlling urges. The Productivity Commission (2009) estimated that between 90,000 and 170,000 Australian adults (0.5 – 1%) suffer significant gambling problems, a further 230,000 to 350,000 (1.4 – 2.1%) are at moderate risk for problem gambling, and many more people (family members, work colleagues) are indirectly affected by problem gambling. Men, younger people, those who come from a family with a problem-gambling parent, Indigenous Australians and those from some ethnic minorities are most likely to experience gambling problems. Problem gambling has a high level of co-occurrence with mental health and substance use problems.

Continuous forms of gambling, such as electronic gaming machines, racing and casino tables, are most likely to be associated with problem gambling. Electronic gaming machines are the mode of gambling associated with the greatest level of harm. The main measure to assess problem gambling in the community is the Problem Gambling Severity Index of the Canadian Problem Gambling Index. The South Oaks Gambling Screen, which was designed as a clinical measure, is also used.

People are motivated to gamble recreationally by the desire for excitement and arousal, and relief from stress and negative mood. Knowledge of the factors that affect gambling participation across the lifespan is quite limited.

There is no widely accepted causal explanation or single theoretical model that adequately accounts for the aetiology of problem gambling. Learning theory, cognitive models, and neurophysiological models all have some evidence base. Very little evidence supports personality or psycho-analytic explanations.

Integrated models comprising biopsychosocial and pathways approaches are supported by emerging evidence, leading to a framework identifying at least three primary subgroups of gamblers: behaviourally conditioned, emotionally vulnerable, and biologically-based impulsive.

A public health perspective, considering problem gambling as a community and public health issue, supports a harm minimisation approach. Although hampered by the lack of an operational definition of harm, this approach focusses on risk and protective factors to prevent and reduce gambling harm.

Primary prevention approaches have generally relied on educational campaigns to increase knowledge, although these are yet to be demonstrated empirically to be effective in achieving subsequent behaviour change. Secondary prevention approaches address individuals at higher risk and comprise policy initiatives, such as staff training, and modifications to gambling environments and restricting access to cash.

A national approach to responsible gambling has been endorsed by the Council of Australian Governments (COAG), with State and Territory Governments having primary responsibility for regulation of gambling in their jurisdictions, including training of gaming venue staff in responsible gambling provision and encouraging venue-based interventions.

The absence of a unifying theory of problem gambling is reflected in the range of techniques that have been employed in its treatment, and there is some empirical evidence for a number of different interventions.

Although there has been improvement in the evidence base, no psychological treatment satisfies the current standards for evidence of efficacy, and the literature does not provide a strong basis for differentiation of the available treatment options. Nevertheless, cognitive-behavioural therapies have been cautiously recommended as ‘best practice’ for the psychological treatment of problem gambling.

A substantial body of literature evaluating the efficacy of pharmacological interventions to directly treat problem gambling behaviour has recently emerged, and these appear to be more effective than no treatment or placebo.

Future directions for psychology to improve understanding of gambling behaviour include increased focus on:

  • understanding gambling participation using longitudinal designs;
  • agreement on the construct and assessment of problem and pathological gambling, and measurement of harm;
  • investigation of new aspects of gambling, particularly those enabled via global connection through the internet;
  • better evaluation of public health approaches to develop effective primary and secondary prevention;
  • improved methodology for treatment studies;
  • development of guidelines for evidence-based best-practice in treatment; and
  • investigation of forensic implications of the factors that affect problem gambling.