Maria Bellringer

An Overview of Help Seeking by Problem Gamblers and their Families Including Barriers to and Relevance of Services

Research demonstrates that gambling support services often do not meet the needs of people seeking help for their gambling problems. In particular, the needs of cultural groups, and gender-specific needs of men and women are neglected. Understanding differences in help seeking behaviour can assist in developing early interventions to address gambling related problems and in developing effective strategies. This paper reviews the literature on help seeking by problem gamblers and their families, including barriers to and relevance of services through a gender and cultural lens. Research findings from international and New Zealand studies are examined, highlighting ways in which gender and culturally appropriate strategies can be implemented. Ways of changing barriers and social policies are proposed which may improve the responsiveness of services. Ultimately it may encourage health care access and utilisation for people and their families seeking help for problem gambling.

Problem Gambling and Intimate Partner Violence: A Systematic Review and Meta-Analysis

This study provides a systematic review of the empirical evidence related to the association between problem gambling and intimate partner violence (IPV). We identified 14 available studies in the systematic search (8 for victimisation only, 4 for perpetration only and 2 for both victimisation and perpetration). Although there were some equivocal findings, we found that most of the available research suggests that there is a significant relationship between problem gambling and being a victim of IPV. There was more consistent evidence that there is a significant relationship between problem gambling and perpetration of IPV. Meta-analyses revealed that over one third of problem gamblers report being victims of physical IPV (38.1%) or perpetrators of physical IPV (36.5%) and that the prevalence of problem gambling in IPV perpetrators is 11.3%. Although the exact nature of the relationships between problem gambling and IPV is yet to be determined, the findings suggest that less than full employment and clinical anger problems are implicated in the relationship between problem gambling and IPV victimization and that younger age, less than full employment, clinical anger problems, impulsivity, and alcohol and substance use are implicated in the relationship between problem gambling and IPV perpetration. The findings highlight the need for treatment services to undertake routine screening and assessment of problem gambling, IPV, alcohol and substance use problems, and mental health issues and provide interventions designed to manage this cluster of comorbid conditions. Further research is also required to investigate the relationship between problem gambling and violence that extends into the family beyond intimate partners.

Problem gambling and family violence: Prevalence and patterns in treatment-seekers

The primary aim of this study was to explore the prevalence and patterns of family violence in treatment-seeking problem gamblers. Secondary aims were to identify the prevalence of problem gambling in a family violence victimisation treatment sample and to explore the relationship between problem gambling and family violence in other treatment-seeking samples. Clients from 15 Australian treatment services were systematically screened for problem gambling using the Brief Bio-Social Gambling Screen and for family violence using single victimisation and perpetration items adapted from the Hurt-Insulted-Threatened-Screamed (HITS): gambling services (n=463), family violence services (n=95), alcohol and drug services (n=47), mental health services (n=51), and financial counselling services (n=48). The prevalence of family violence in the gambling sample was 33.9% (11.0% victimisation only, 6.9% perpetration only, and 16.0% both victimisation and perpetration). Female gamblers were significantly more likely to report victimisation only (16.5% cf. 7.8%) and both victimisation and perpetration (21.2% cf. 13.0%) than male gamblers. There were no other demographic differences in family violence prevalence estimates. Gamblers most commonly endorsed their parents as both the perpetrators and victims of family violence, followed by current and former partners. The prevalence of problem gambling in the family violence sample was 2.2%. The alcohol and drug (84.0%) and mental health (61.6%) samples reported significantly higher rates of any family violence than the gambling sample, while the financial counselling sample (10.6%) reported significantly higher rates of problem gambling than the family violence sample. The findings of this study support substantial comorbidity between problem gambling and family violence, although this may be accounted for by a high comorbidity with alcohol and drug use problems and other psychiatric disorders. They highlight the need for routine screening, assessment and management of problem gambling and family violence in a range of services.

Problem Gambling related to Intimate Partner Violence: findings from the Pacific Islands Families Study

Intimate partner violence (IPV) and problem gambling are becoming increasingly significant public health issues, especially amongst Pacific populations within New Zealand, yet no general population studies have explicitly investigated the association between these factors. This study aims to determine whether problem gambling is an independent risk factor for IPV victimization in 700 couples with a Pacific infant, after accounting for problem drinking. Victimization of any and severe physical IPV was indicated for 33% and 18% mothers, and 38% and 22% fathers, respectively. For mothers, 1% were classified as problem gamblers and 15% as problem drinkers; while for fathers, 2% were defined as problem gamblers and 26% as problem drinkers. In this first published study to simultaneously relate current problem gambling to IPV victimization in a general population, no association could be found.

An exploratory study of problem gambling on casino versus non-casino electronic gaming machines

Electronic gaming machines (EGMs) have been frequently associated with problem gambling. Little research has compared the relative contribution of casino EGMs versus non-casino EGMs on current problem gambling, after controlling for demographic factors and gambling behaviour. Our exploratory study obtained data from questionnaires administered to a convenient, non-representative New Zealand sample of 138 problem gamblers (66 male, 70 female) and 73 non-problem gamblers (41 male, 32 female) categorized by scores on the Problem Gambling Severity Index (PGSI). Age groups ranged from 20 to 60+ years. Of 11 gambling activities, only gambling on EGMs in casinos and EGMs in pubs and clubs distinguished problem gamblers from non-problem gamblers. There were some significant interactions between marital status and types of gambling activities on problem gambling status. From multivariate logistic regression analysis, gambling on EGMs in pubs and clubs was a stronger, unique predictor of current problem gambling than EGMs in casinos, after controlling for demographic factors and total gambling activities. We suggest directions for future large-scale research and interventions for reducing the harm of gambling on non-casino EGMs.

Recruiting Gamblers from the General Population for Research Purposes: Outcomes from Two Contrasting Approaches

Multiple means exist by which gamblers including problem gamblers may be recruited from the general population for research survey purposes. However, there appears to be limited discussion in the published literature about the relative merits of one or other approach. This paper addresses this gap, in part, by reporting the experiences of employing two contrasting approaches to survey recruitment: passive advertisement versus active solicitation outside gambling venues. Fifty participants were recruited by advertisement and 54 by active solicitation. The former group was found to be less ethnically diverse and more likely to be problem gamblers than the latter group which, due to the nature of the recruitment process, showed a more even distribution of ethnicity and PGSI classified risk and problem gambler categories. Results also indicated that recruitment by advertisement was more cost effective for reaching problem gamblers whilst active solicitation was more cost effective for the recruitment of low risk and moderate risk gamblers.

Electronic Gaming Machine Characteristics: It’s the Little Things That Count

A range of gamblers, from low-frequency social gamblers through to problem gamblers in treatment, participated in focus groups discussing the characteristics of Electronic Gaming Machines (EGMs) that they found attractive. Analyses of the resulting transcripts resulted in two groups of EGM characteristics being identified as important, one group associated with winning and one with betting. Overall, free spin features were identified in all groups as the most attractive characteristic of EGMS. Beyond that it was smaller win-related characteristics, and low-denomination machines with multiple playable lines that were associated with increased duration and intensity of gambling behaviour. The important characteristics were consistent across different levels of gamblers, with the key behavioural difference being a self-reported ‘expertise’, and ‘strategic’ approach to gambling amongst higher-frequency gamblers and problem gamblers in treatment. The key characteristics all occur frequently and result in more wins and extended gambling sessions. The patterns identified resonated with established behavioural principles, and with models describing the development of problem gambling and addictions more generally.

Effectiveness of problem gambling interventions in a service setting: a protocol for a pragmatic randomised controlled clinical trial.

Introduction The primary purpose of this study is to evaluate the relative effectiveness of 2 of the best developed and most promising forms of therapy for problem gambling, namely face-to-face motivational interviewing (MI) combined with a self-instruction booklet (W) and follow-up telephone booster sessions (B; MI+W+B) and face-to-face cognitive–behavioural therapy (CBT). Methods and analysis This project is a single-blind pragmatic randomised clinical trial of 2 interventions, with and without the addition of relapse-prevention text messages. Trial assessments take place pretreatment, at 3 and 12 months. A total of 300 participants will be recruited through a community treatment agency that provides services across New Zealand and randomised to up to 10 face-to-face sessions of CBT or 1 face-to-face session of MI+W+up to 5 B. Participants will also be randomised to 9 months of postcare text messaging. Eligibility criteria include a self-perception of having a current gambling problem and a willingness to participate in all components of the study (eg, read workbook). The statistical analysis will use an intent-to-treat approach. Primary outcome measures are days spent gambling and amount of money spent per day gambling in the prior month. Secondary outcome measures include problem gambling severity, gambling urges, gambling cognitions, mood, alcohol, drug use, tobacco, psychological distress, quality of life, health status and direct and indirect costs associated with treatment. Ethics and dissemination The research methods to be used in this study have been approved by the Ministry of Health, Health and Disability Ethics Committees (HDEC) 15/CEN/99. The investigators will provide annual reports to the HDEC and report any adverse events to this committee. Amendments will also be submitted to this committee. The results of this trial will be submitted for publication in peer-reviewed journals and as a report to the funding body. Additionally, the results will be presented at national and international conferences. Trial registration number ACTRN12615000637549.

Pop-up messages on electronic gaming machines in New Zealand: experiences and views of gamblers and venue staff

Abstract In New Zealand, a pop-up message feature that interrupts gambling is mandatory on all electronic gaming machines (EGMs) in all venues. The present research documented the views and experiences of pop-up messages from a range of gamblers and gambling venue staff. A series of focus groups was held with 40 gamblers (ranging from infrequent gamblers to current/former problem gamblers), and 19 staff from casino and non-casino venues. Most participants thought that pop-up messages were ineffective as a harm-minimization measure. Venue staff participants viewed pop-up messages much more negatively than gamblers, who were generally accepting of their existence and sometimes described them as useful. Venue staff participants were also very negative about the additional hassles and confusion they believed to be caused by pop-up messages, and a range of problems they perceived with their accuracy. Nonetheless, there was a consistent although less prevalent view that pop-up messages were useful in reducing gambling harm and potentially bringing harmful gamblers to the attention of others. Participants raised some possibilities for enhancing their effectiveness; these were generally consistent with the evidence base developed since the introduction of pop-up messages in the New Zealand gambling environment.

A tale of two countries: comparing disability weights for gambling problems in New Zealand and Australia

PurposeThis study aimed to assess the impact of gambling problems on quality of life. Specifically, we generated disability weight estimates for gambling problems in New Zealand, and compared these results with (i) Australian figures (J Gambl Issues, 10.4309/jgi.v0i36.3978, 2017) and (ii) other health states (Lancet, 10.1016/S0140-6736(12)61680-8, 2013); such as anxiety and alcohol use disorders.MethodThe 324 participants (48 experts and 276 general population members) evaluated a series of gambling harm vignettes. The participants rated the decrement to one’s quality of life using Visual Analogue Scale and Time Trade-Off protocols (Br Med Bull, 10.1093/bmb/ldq033, 2010). These evaluations enabled the calculation of disability weights for three categories of gamblers (low-risk, moderate-risk, and problem gamblers).ResultsDisability weight estimates for low-risk, moderate-risk, and problem gamblers in NZ were consistently higher than the Australian weights: low (0.18 vs. 0.13), moderate (0.37 vs. 0.29), and problem (0.54 vs. 0.44). The quality of life impact for problem gambling in NZ (0.54) was comparable to that experienced in severe alcohol use disorder (0.55) (Lancet, 10.1016/S0140-6736(12)61680-8, 2013).ConclusionsThis study represents one of the first attempts to assess gambling-related harm through a public health perspective. The results of this study are informative for policy-making, resource allocation, and service planning. These estimates now allow for the population-level impact of gambling in NZ to be calculated and tracked over time, which is essential for informing harm-minimisation initiatives.