Anna Thomas

Gaming machine addiction: the role of avoidance, accessibility and social support.

Commonality in etiology and clinical expression plus high comorbidity between pathological gambling and substance use disorders suggest common underlying motives. It is important to understand common motivators and differentiating factors. An overarching framework of addiction was used to examine predictors of problem gambling in current electronic gaming machine (EGM) gamblers. Path analysis was used to examine the relationships between antecedent factors (stressors, coping habits, social support), gambling motivations (avoidance, accessibility, social) and gambling behavior. Three hundred and forty seven (229 females: M = 29.20 years, SD = 14.93; 118 males: M = 29.64 years, SD = 12.49) people participated. Consistent with stress, coping and addiction theory, situational life stressors and general avoidance coping were positively related to avoidance-motivated gambling. In turn, avoidance-motivated gambling was positively related to EGM gambling frequency and problems. Consistent with exposure theory, life stressors were positively related to accessibility-motivated gambling, and accessibility-motivated gambling was positively related to EGM gambling frequency and gambling problems. These findings are consistent with other addiction research and suggest avoidance-motivated gambling is part of a more generalized pattern of avoidance coping with relative accessibility to EGM gambling explaining its choice as a method of avoidance. Findings also showed social support acted as a direct protective factor in relation to gambling frequency and problems and indirectly via avoidance and accessibility gambling motivations. Finally, life stressors were positively related to socially motivated gambling but this motivation was not related to either social support or gambling behavior suggesting it has little direct influence on gambling problems.

Gambling accessibility: a scale to measure gambler preferences

Geographic closeness of gambling venues is not the only aspect of accessibility likely to affect gambling frequency. Perceived accessibility of gambling venues may include other features such as convenience (e.g., opening hours) or “atmosphere”. The aim of the current study was to develop a multidimensional measure of gamblers’ perceptions of accessibility, and present evidence for its reliability and validity. We surveyed 303 gamblers with 43 items developed to measure different dimensions of accessibility. Factor analysis of the items produced a two factor solution. The first, Social Accessibility related to the level at which gambling venues were enjoyed because they were social places, provided varying entertainment options and had a pleasant atmosphere. The second factor, Accessible Retreat related to the degree to which venues were enjoyed because they were geographically and temporally available and provided a familiar and anonymous retreat with few interruptions or distractions. Both factors, developed as reliable subscales of the new Gambling Access Scale, demonstrated construct validity through their correlations with other gambling-related measures. Social Accessibility was moderately related to gambling frequency and amount spent, but not to problem gambling, while, as hypothesised, Accessible Retreat was associated with stronger urges to gamble and gambling problems.

An Update on Gender Differences in the Characteristics Associated with Problem Gambling: a Systematic Review

Purpose of ReviewIdentifying and understanding gender differences associated with the development, maintenance and consequences of problem gambling has important implications for improving prevention and treatment interventions. The current paper systematically reviews the most recent evidence (2012–2015) examining gender differences in the prevalence of problem gambling and the characteristics associated with problem gambling.Recent FindingsTwenty-nine articles, including treatment-seeking and community representative adult and adolescent samples, were included. Males were typically more likely than females to be either at-risk or problem gamblers, although this finding may be an artefact of other characteristics, such as preferred gambling activity. There was consistent evidence that male problem gambling was associated with impulsivity, substance and alcohol use, while female problem gambling was associated with unemployment, psychological distress and childhood abuse.SummaryThe majority of findings, however, were mixed or limited by the small number of studies, highlighting the need for further gender-sensitive research to improve prevention and intervention approaches.

Improving services for individuals with a dual diagnosis: A qualitative study reporting on the views of service users

Individuals with high prevalence mental health (HPMH) and concurrent alcohol and/or drug disorders are vulnerable to falling ‘between the gaps’ of existing service systems. The aim of the current qualitative study was to explore service experiences (barriers to treatment and suggestions for improvements) from the perspective of those with this type of dual diagnosis. Of the individuals, 44 with a HPMH dual diagnosis participated in qualitative interviews. Thematic analysis was conducted on the data and major themes from the analysis presented. Barriers to treatment related primarily to knowledge (not knowing that services existed; breakdowns in referrals) and structure (delays in response; system inflexibility). Suggestions for improvements to services targeted barriers but took a holistic view including the need for worker and community education, addressing issues beyond the illness and the importance of relationships. The complex interaction between the disorders means that navigating either of the specialist systems has pitfalls not faced by people with a single disorder. Service user input is vital to minimise gaps and ensure service provision meets the needs of this group. These findings can now be used to inform service system redesign so that services are better able to meet the needs of this group.

Gender Differences in the Presentation of Observable Risk Indicators of Problem Gambling

In many countries where gambling is legalised, there has been a strong public policy focus on the need for strategies to reduce gambling related harm. These have often included policies requiring staff in gambling venues to identify and/or assist people who might be experiencing gambling-related harm. To facilitate this process, researchers have developed visible behavioural indicators that might be used to profile potentially problematic gambling. Few of these studies have, however, examined whether such indicators or ‘warning signs’ might differ between men and women. In this study, we describe the results of an analysis of data drawn from 1185 fortnightly gamblers that included 338 problem gamblers as classified by the Problem Gambling Severity Index. Indicators of problem gambling were similar between males and females with a few key exceptions. Indicators reflecting emotional distress were more commonly reported by females with gambling problems, whereas problem gambling males were more likely to display aggressive behaviour towards gambling devices and others in the venue. Amongst males, signs of emotional distress as well as attempts to conceal their presence in venues from others most strongly differentiated between problem and non-problem gamblers. Amongst females, signs of anger, a decline in grooming and those attempts to access credit were the most distinguishing indicators. These findings have implications for the refinement of identification policies and practices.

Observable indicators and behaviors for the identification of problem gamblers in venue environments

Background and aims In many jurisdictions, where gambling services are provided, regulatory codes require gambling operators to apply a duty of care toward patrons. A common feature of these provisions is some expectation that venue staff identify and assist patrons who might be experiencing problems with their gambling. The effectiveness of such measures is, however, predicated on the assumption that there are reliable and observable indicators that might be used to allow problem gamblers to be distinguished from other gamblers. Methods In this study, we consolidate the findings from two large Australian studies (n = 505 and n = 680) of regular gamblers that were designed to identify reliable and useful indicators for identifying problem gambling in venues. Results It was found that problem gamblers are much more likely to report potentially visible emotional reactions, unusual social behaviors, and very intense or frenetic gambling behavior. Discussion and conclusions This study shows that there are a range of indicators that could potentially be used to identify people experiencing problems in venues, but that decisions are most likely to be accurate if based on an accumulation of a diverse range of indicators.

Introducing mental health and substance use screening into a community‐based health service in Australia: usefulness and implications for service change

Mental health issues such as depression or anxiety and alcohol or other drug (AOD) problems often remain undiagnosed and untreated despite their prevalence in the community. This paper reports on the implementation and evaluation of an AOD and depression/anxiety screening programme within two Community Health Services (CHS) in Australia. Study 1 examined results from 5 weeks of screening (March-April 2008) using the Patient Health Questionnaire (two- and nine-item, Kroenke et al. 2001, 2003), the Conjoint Screen for Alcohol and other Drug Problems (Brown et al. 2001) and the Alcohol, Smoking and Substance Involvement Screening Test (Humeniuk & Ali 2006). Of the 55 clients screened, 33% were at risk of depression or anxiety, 22% reporting moderate-severe depression. Thirteen per cent were at risk of substance use disorders. A substantial proportion of at-risk clients were not currently accessing help for these issues from the CHS and therefore screening can facilitate identification and treatment referral. However, the majority of eligible clients were not screened, limiting screening reach. A second study evaluated the screening implementation from a process perspective via thematic analysis of focus group data from six managers and 14 intake/assessment workers (April 2008). This showed that when screening occurred, it facilitated opportunities for education and intervention with at-risk clients, although cultural mores, privacy concerns and shame/stigma could affect accuracy of screen scores at times. Importantly, the evaluation revealed that most decisions not to screen were made by workers, not by clients. Reasons for non-screening related to worker discomfort in asking sensitive questions and/or managing client distress, and a reluctance to spend long periods of time screening in time-pressured environments. The evaluation suggested that these problems could be resolved by splitting screening responsibilities, enhancing worker training and expanding follow-up screening. Findings will inform any community-based health system considering introducing screening.

Neuroscience in gambling policy and treatment: an interdisciplinary perspective

Neuroscientific explanations of gambling disorder can help people make sense of their experiences and guide the development of psychosocial interventions. However, the societal perceptions and implications of these explanations are not always clear or helpful. Two workshops in 2013 and 2014 brought together multidisciplinary researchers aiming to improve the clinical and policy-related effects of neuroscience research on gambling. The workshops revealed that neuroscience can be used to improve identification of the dangers of products used in gambling. Additionally, there was optimism associated with the diagnostic and prognostic uses of neuroscience in problem gambling and the provision of novel tools (eg, virtual reality) to assess the effectiveness of new policy interventions before their implementation. Other messages from these workshops were that neuroscientific models of decision making could provide a strong rationale for precommitment strategies and that interdisciplinary collaborations are needed to reduce the harms of gambling.

Responsible gambling codes of conduct: lack of harm minimisation intervention in the context of venue self-regulation

Abstract Responsible Gambling Codes of Conduct (CoC) are used around the world to describe electronic gambling machine (EGM) operator commitments to reducing harm from gambling. In addition to the provision of passive product information and warnings, CoC describe how venues should assist EGM users displaying signs of problematic gambling. The focus in this paper is on venue adherence to the active strategies described in these documents relating to supporting ‘responsible gambling’ and discouraging harmful, intensive and extended gambling. The paper triangulates data from aspirational statements by EGM operators published in CoC documents; structured, unannounced observations by the research team in 11 EGM venues; and interviews and focus groups conducted with 40 gamblers and 20 professionals in Melbourne, Australia. Results showed only isolated evidence of supportive interactions between staff and gamblers to address gambling harm. The weight of evidence demonstrated that venues often fail to respond to signs of gambling problems and instead encourage continued gambling in contradiction of their CoC responsibilities. Signs of gambling problems are a normalised feature of EGM use in these venues. To genuinely address this public health and public policy challenge, improved consumer protection for gamblers may be achieved through legislation requiring venues to respond to signs of gambling problems. This may include a range of measures such as banning food and beverage service at machines and limiting withdrawals of cash by gamblers, as well as using behavioural tracking algorithms to identify problematic gambling patterns and binding universal pre-commitment systems to complement supportive interventions by venue staff.

Recovery Agency and Informal Recovery Pathways from Gambling Problems

This study applied a holistic, strength-based lens to better articulate the impetus for, and processes of, informal recovery from gambling problems. Two research objectives framed the parameters of the study: to explore (a) the process by which gamblers move from recognition of a gambling problem to action for recovery and (b) the experiences, perceptions and contextual factors that shape the features of this process. Narrative telephone interviews were conducted with adult residents of Victoria, Australia. Thirty-two adult participants (22 males and 10 females) were recruited from the general community. All participants were self-identified as recovering or recovered from gambling problems. Participants primarily used informal recovery strategies, rather than professional services or support groups. The impetus for informal recovery was identified broadly as either (a) dissonance between desired and actual self-image and goals, (b) an uncontrollable adverse event, or (c) confrontation and decisive action by others affected by the individual’s gambling involvement. The impetus, process and goals of recovery were best described by pathways that were distinguished by agency in recovery: externally directed and self-directed. The application of a strength-based lens helped to illuminate the role of agency in informal recovery. A proposed pathways framework may inform strength-based informal recovery strategies for gamblers and affected others, and therapeutic approaches. The pathways, which have not been articulated in previous gambling recovery literature, generally cohere with pathways articulated in the alcohol and substance recovery literature.