Sally M Gainsbury

A systematic review of Internet-based therapy for the treatment of addictions

Traditional therapies for addictions are underutilized and characterized by high attrition rates suggesting they may not meet the needs of a proportion of individuals with addiction-related problems including problem drinking, smoking, substance use and problem gambling. Internet-based therapy has emerged as a new treatment modality for psychological disorders and health issues and this review is the first attempt to summarize and evaluate the evidence of the effectiveness of Internet therapy for addictions. Extensive literature searches were conducted to identify studies meeting the criteria of delivering structured Internet-based treatment programs for addictions that incorporated a component of trained therapist interaction. Only nine studies met criteria for inclusion with seven representing a randomized controlled trial. These included seven papers reporting on tobacco-cessation programs, one Internet-based therapy for pathological gambling, and one treatment program for substance abuse. A range of therapeutic models, treatment components and outcome measures was included across these studies. Positive treatment effects were reported following completion of therapy and at longer-term follow-up. The review concluded that Internet-based therapies for addictions are effective in achieving positive behavioral changes but that more research is required to determine the comparative effectiveness of various Internet-based therapies and their components.

A digital revolution: Comparison of demographic profiles, attitudes and gambling behavior of Internet and non-Internet gamblers

Internet gambling is one of the fastest growing sectors of e-commerce and rapidly growing as a mode of gambling. Although Internet gambling is characterized by high levels of customer choice, little is known about Internet gamblers or their engagement with Internet and non-Internet forms of gambling. Regulators are struggling to respond to Internet gambling given that little is known about the impact of this mode of gambling on the existing gambling market, who is gambling online and how. This paper presents one of the largest studies of Internet gambling; an online survey completed by 6682 Australian gamblers. Results show that Internet gamblers are a heterogeneous group, although there is a tendency for Internet gamblers to be male, have high incomes and be well educated. Internet gamblers have more positive attitudes towards gambling and are more highly involved gamblers, engaging in many different gambling activities in both online and offline forms. However, a proportion of Internet gamblers prefer the privacy and anonymity of Internet gambling and do not like land-based venues, suggesting that Internet gambling is creating a new market of gambling customers. Understanding the impact of this new mode of gamblers on existing gamblers and new players is important to contribute to the appropriate regulation of this activity.

The prevalence and determinants of problem gambling in Australia: assessing the impact of interactive gambling and new technologies

New technology is changing the nature of gambling with interactive modes of gambling becoming putatively associated with higher rates of problem gambling. This paper presents the first nationally representative data on the prevalence and correlates of problem gambling among Australian adults since 1999 and focuses on the impact of interactive gambling. A telephone survey of 15,006 adults was conducted. Of these, 2,010 gamblers (all interactive gamblers and a randomly selected subsample of those reporting land-based gambling in the past 12 months) also completed more detailed measures of problem gambling, substance use, psychological distress, and help-seeking. Problem gambling rates among interactive gamblers were 3 times higher than for noninteractive gamblers. However, problem and moderate risk gamblers were most likely to attribute problems to electronic gaming machines and land-based gambling, suggesting that although interactive forms of gambling are associated with substantial problems, interactive gamblers experience significant harms from land-based gambling. The findings demonstrate that problem gambling remains a significant public health issue that is changing in response to new technologies, and it is important to develop strategies that minimize harms among interactive gamblers.

A taxonomy of gambling and casino games via social media and online technologies

The increased popularity of casino games on social media platforms has prompted international jurisdictions to consider the extent to which these games may be similar to Internet gambling activities and therefore subject to regulatory action. Gambling themes are popular in video and computer games, and simulated-gambling activities are commonly offered by gambling operators as a way of enticing users to gamble online with money. However, little research has evaluated the impact of the digital convergence of gambling and gaming. The lack of a clear definition of online gambling-themed activities to guide such research undertakings represents a significant hurdle to the fields of gambling and gaming. Based on a review of the extant literature, this article proposes a taxonomy to distinguish between many types of online activities with gambling-themed content. This taxonomy suggests that the principal features that differentiate online gambling games include the requirement for payment, the role of skill, the type of platform and the centrality of the gambling theme. The proposed hierarchical framework aims to promote clear and consistent discussion to guide ongoing investigation of new and emerging Internet gambling and gaming technologies.

Internet gambling policy in critical comparative perspective: the effectiveness of existing regulatory frameworks

Following the rapid progression of Internet gambling, governments internationally are struggling to create and enact appropriate and effective regulations. A situation of inter-jurisdictional inconsistency exists and regulatory frameworks are constantly changing, with international policies of prohibition, legalization or partial legalization, or imprecise legal limbo. The ambiguity of the current situation and questionable effectiveness of policies in place makes it difficult for gambling operators, treatment providers, players and other stakeholders to formulate appropriate responses to online gambling. This article aims to bring some clarity and offer guidance for the effective implementation of gambling policy by examining the comparative evolution of Internet gambling in Australia and Canada, and the respective social, legal, economic and political responses. The differences in the development of online gambling highlight the unique paths possible, yet the similarities between these jurisdictions provide key examples of how policymakers, gambling operators, researchers and consumers can respond to this phenomenon.

The impact of internet gambling on gambling problems: a comparison of moderate-risk and problem Internet and non-Internet gamblers.

Numerous studies have reported higher rates of gambling problems among Internet compared with non-Internet gamblers. However, little research has examined those at risk of developing gambling problems or overall gambling involvement. This study aimed to examine differences between problem and moderate-risk gamblers among Internet and non-Internet gamblers to determine the mechanisms for how Internet gambling may contribute to gambling problems. Australian gamblers (N = 6,682) completed an online survey that included measures of gambling participation, problem gambling severity, and help seeking. Compared with non-Internet gamblers, Internet gamblers were younger, engaged in a greater number of gambling activities, and were more likely to bet on sports. These differences were significantly greater for problem than moderate-risk gamblers. Non-Internet gamblers were more likely to gamble on electronic gaming machines, and a significantly higher proportion of problem gamblers participated in this gambling activity. Non-Internet gamblers were more likely to report health and psychological impacts of problem gambling and having sought help for gambling problems. Internet gamblers who experience gambling-related harms appear to represent a somewhat different group from non-Internet problem and moderate-risk gamblers. This has implications for the development of treatment and prevention programs, which are often based on research that does not cater for differences between subgroups of gamblers.

Player account-based gambling: potentials for behaviour-based research methodologies

The emergence of player account-based gambling is a result of escalating technological sophistication and the incorporation of these developments into gambling. This term refers to gambling from a centralized account that is linked to an identified individual. Player account-based gambling is increasingly being utilized for multiple forms of Internet, mobile and land-based gambling through player cards and user-names. Player accounts track and store a wealth of data on gambling behaviour and related activities. Gambling research has been justifiably criticized for its reliance on self-report rather than behavioural measures. Research analysing player account data may advance conceptual models, identify behavioural risk factors for problem gambling and evaluate and guide effective policy and responsible gambling programmes. Although research utilizing player account data has unique limitations, it offers considerable benefits for researchers, operators and regulators. Research methodology incorporating the use of player account data stands to make significant contributions to the gambling field.

Consumer attitudes towards Internet gambling: Perceptions of responsible gambling policies, consumer protection, and regulation of online gambling sites

There is an insufficient understanding of consumer attitudes towards Internet gambling, which contributes to difficulties in developing policies to encourage the use of regulated online gambling sites. This research aimed to generate knowledge about consumer attitudes towards online gambling, specifically concerning the issues of player protection, regulation, and responsible gambling. An online survey was completed by 10,838 online casino and poker players from 96 countries. Responsible gambling features were generally viewed positively, particularly by casino game players, those who chased losses, and younger adults. Over one-third of participants reported having experienced a dispute with an online gambling operator. Respondents reported high levels of mistrust and concerns regarding online gambling and confusion regarding the appropriate regulation of Internet gambling. Consumer attitudes play a significant role in driving behavior and must be considered if regulators and operators are to effectively encourage online gamblers to use regulated gambling sites that include consumer protection and harm minimization measures. The results suggest that responsible gambling features, such as the ability to set spending limits, should be implemented on Internet gambling sites to increase consumer trust and favorable attitudes towards online gambling operators, and reduce disputes associated with excessive gambling.

Online self-guided interventions for the treatment of problem gambling

A minority of problem gamblers access formal treatment. Factors contributing to this low service utilization rate include geographical and time constraints, a desire to self-manage problems, shame, denial and concerns over privacy/confidentiality. The Internet is an effective medium for the delivery of health-related information, self-assessment, counselling, peer-based support and other therapeutic interventions. Consequently, online self-help programs should be offered as an alternative means to access treatment for gamblers reluctant to pursue traditional options. Benefits of the Internet include its capacity to provide a systematic delivery of cognitive-behavioural therapies, practical visual demonstrations of probabilities correcting erroneous beliefs, accessibility, convenience, cost-effectiveness, anonymity and privacy. We conducted a review of the literature to outline the advantages and current status of self-guided online interventions for gambling-related problem. Although this is a new field, empirical evidence indicates that online self-guided interventions are efficacious and represent an important treatment adjunct for individuals with gambling-related problems.

Facilitating responsible gambling: the relative effectiveness of education-based animation and monetary limit setting pop-up messages among electronic gaming machine players.

Although most gamblers set a monetary limit on their play, many exceed this limit—an antecedent of problematic gambling. Responsible gambling tools may assist players to gamble within their means. Historically, however, the impact of such tools has been assessed in isolation. In the current research, two responsible gambling tools that target adherence to a monetary limit were assessed among 72 electronic gaming machine (EGM) players. Participants watched an educational animation explaining how EGMs work (or a neutral video) and then played an EGM in a virtual reality environment. All participants were asked to set a monetary limit on their play, but only half were reminded when that limit was reached. Results showed that both the animation and pop-up limit reminder helped gamblers stay within their preset monetary limit; however, an interaction qualified these main effects. Among participants who did not experience the pop-up reminder, those who watched the animation stayed within their preset monetary limits more than those who did not watch the animation. For those who were reminded of their limit, however, there was no difference in limit adherence between those who watched the animation and those who did not watch the animation. From a responsible gambling perspective, the current study suggests that there is no additive effect of exposure to both responsible gambling tools. Therefore, for minimal disruption in play, a pop-up message reminding gamblers of their preset monetary limit might be preferred over the lengthier educational animation.