Gambling Harm Reduction: Are You Serious?

Jim OrfordSchool of Psychology, University of

Birmingham, UKGambling Watch UK

Harm Minimisation in Gambling ConferenceResponsible Gambling Trust, London, December 11th 2013

Forms of harm from gambling

Form of harm

Harm to individuals who gamble A continuum of risky and harmful gambling

Harm to their family members Financial, relational and emotional harm

Harm to the community Harm to the quality of the high street, financial drain, community health affected

Harm to society Normalisation of gambling, risks to young people, contributes to inequality

The gambling risk/harm continuum according to the Canadian Problem Gambling Severity Index (PGSI)

• PGSI score 0 Non-problem gambler• PGSI score 1-2 At risk (low)• PGSI score 3-7 At risk (moderate )• PGSI score 8 plus Problem gambler

The gambling control continuum according to Dickerson and O’Connor, Gambling as an Addictive Behaviour,

Cambridge University Press, 2006

• Never strong impulses, no problems• Sometimes strong impulses, easily resisted, no problems• Sometimes strong impulses, can resist with effort, no

problems• Often strong impulses, difficult to resist, few minor problems• Strong impulses, difficult but not impossible to resist, several

problems• Frequent strong impulses, impossible to resist, several

significant distressing problems

Natasha Schüll, Addiction by Design: Machine Gambling in Las Vegas

(2012, Princeton University Press)

By the mid-1990s, the gambling industry had already grasped... that a medical diagnosis linked to the excessive consumption of its product by some individuals could serve to deflect attention away from the product's potentially problematic role in promoting that consumption, and onto the biological and psychological vulnerabilities of a small minority of its customers (page 261).

Martin Young, Statistics, scapegoats and social control: A critique of pathological gambling

prevalence research, Addiction Research and Theory, 2013, 21, pp.1-11

• … the industry is dependent on the pathological gambler to … absolve itself from the harm it produces…

• … problem gambling prevalence surveys… construct and mobilise the pathological gambler as the object of policy and intervention

Forms of harm from gambling

Form of harm

Harm to individuals who gamble A continuum of risky and harmful gambling

Harm to their family members Financial, relational and emotional harm

Harm to the community Harm to the quality of the high street, financial drain, community health affected

Harm to society Normalisation of gambling, risks to young people, contributes to inequality

Affected family members: a group with no voice

• ‘It is the nature of emotional disorders that when one member of the family is afflicted, the effects are felt by all the others. There are few, however, in which the impact is felt with such severity as in the case of compulsive gambling’ (When Luck Runs Out, Custer & Milt, 1985).

• ‘… we have had a monster living with our family – a monster in the shape of a fruit-machine. Practically every penny my husband earned went into that machine’ (a wife cited by Barker & Miller, 1968).

Forms of harm from gambling

Form of harm

Harm to individuals who gamble A continuum of risky and harmful gambling

Harm to their family members Financial, relational and emotional harm

Harm to the community Harm to the quality of the high street, financial drain, community health affected

Harm to society Normalisation of gambling, risks to young people, contributes to inequality

A sample of British attitudes towards gambling in 2010 (percent agree or disagree)

People should hav

e the rig

ht to ga

mble

Too man

y opportu

nities to ga

mble

Gamblin

g should be disc

ouraged

On balance

gamblin

g is g

ood for s

ociety

0

20

40

60

80

AgreeDisagree

Types of gambling harm reduction measures

Reduce gambling by reducing demand

Reduce gambling by reducing supply

Harm reduction that does not require a reduction in gambling

Education campaigns Limit availability Reduce criminality by legalisation

Controls on advertising Limit accessibility Help for affected family members

Player-centred e.g. pre-commitment, self-exclusion

Modify gambling features On-site crisis intervention

Three types of evidence (Glasby, 2011) and their relevance to High Stake-High Prize Electronic Gambling

Machines (HS-HP EGMs) such as Fixed Odds Betting Terminals (FOBTs)

Theoretical evidence HS-HP EGMs have features that would lead us to expect them to have high harm potential

Experiential evidence Gamblers and their family members are telling us that HS-HP EGMs are causing particular harm

Empirical evidence Evidence from the 2007 and 2010 BGPSs support the conclusion that HS-HP EGMs are specially harmful

Gross Gambling Yield (GGY) from some different forms of British Gambling 2010-11 and losses attributable to People with

Gambling Problems (PGPs) 2010

• GGY % of losses amount of losses• £m from PGPs from PGPs £m• • FOBTs in betting shops 1,295 23 297• • Table games in casinos 685 11 76• • Betting on dog races 275 27 75• • Betting on horse races 810 7 57• • Slot machines in arcades 396 12 47• • Football pools 324 6 18• • Bingo 386 4 16

Models of the evidence and policy relationship(Monaghan, Evidence versus politics, The Policy Press, 2011)

• Linear or rational model: a linear process from defining a problem to identifying missing knowledge to acquiring research, interpreting it and then making a policy choice

• Enlightenment model: a process of 'indirect diffusion' whereby an entire body of research or evidence, accumulating over time, sensitises policymakers to new issues

• Evolutionary model: 'survival of the fittest': ideas that fit the interests of powerful groups will be picked up and those that do not, will not

• Political or tactical model: new research is unlikely to have a bearing on predetermined positions allied to various interests and political ideologies

• Interactive, dialogic or processual models: concepts and therefore knowledge are inherently contested and meaning emerges from negotiation and dialogue between relevant constituents

Two contrasting policy perspectives

• Gambling is seen as an ordinary entertainment product

• In Government, the department responsible for Culture and Sport should take the lead

• The industry should sit at the policy table and fund prevention, treatment and research (PT&R)

• Gambling is seen as a commodity dangerous to health

• In Government, the department responsible for Health should take the lead

• Policy formation should be independent of the industry and PT&R should be funded by government

Dr Margaret Chan, Director General World Health Organization, Doctors and the alcohol industry: an unhealthy mix?

British Medical Journal, 2013

• In the view of WHO, the alcohol industry has no role in the formulation of alcohol policies, which must be protected from distortion by commercial or vested interests.

Responsible Gambling Strategy BoardStrategy 2012

• … whether bespoke harm-prevention measures might be effective… player-centred measures tailored to a gambler’s actual machine play… in contrast to the current across-the board regulatory controls, such as limits to stakes and prizes and number and location of gaming machines (para 49)

• … wider societal risks… recession… low income groups… important contextual considerations… probably too broad and complex to prioritise for research (para 52)

www.gamblingwatchuk.org