The Self-Exclusion Experience for Problem Gamblers in South Australia

Abstract

Increased prevalence of problem gambling has accompanied the spread of gaming venues in many parts of the world. One intervention to minimise the impact of harmful patterns of gambling behaviours is self-exclusion, where patrons can elect to ban themselves from a gaming venue or its gaming facilities for a specified time period. While self-exclusion programs are widely available, little research has been conducted into their operations and efficacy, particularly from the self-excluders’ perspective. This paper presents findings from 35 survey responses and 23 interviews with gamblers who had self-excluded through a centralised service in South Australia. They identified key program shortcomings as low publicity, limits on how many venues they could self-bar from, and inadequate venue monitoring for breaches of self-barring orders. Nevertheless, the centralised service, staffed by trained psychologists and located away from gaming venues, which allows multiple venue barring in one application, appeared advantageous over programs that require people to self-exclude directly from individual gaming venues. Most respondents (85%) had ceased or lessened their gambling in the 12 months following self-barring. Nevertheless, some continued to struggle to manage their gambling, reflected in breaches of their orders and gambling in venues from which they were not excluded.     

Brief Communications Analysis of a Casino's Self-Exclusion Program

As gambling facilities become more available, the number of pathological gamblers increases. Effective therapeutic and preventive interventions should be developed and systematically evaluated. Self-exclusion programs may be a useful means to facilitate self-control among problem gamblers. This paper describes the characteristics of individuals who decided to bar themselves from a Canadian casino. Two hundred twenty individuals participated in the present study and completed a questionnaire including four sections: (1) socio-demographic data, (2) the South Oaks Gambling Screen, (3) gambling habits, and (4) prior experiences with the self-exclusion program. According to the SOGS, 95% of the participants were classified as severe pathological gamblers on the SOGS (Mean score = 9.87). Furthermore, based on self-reported observation, 30% of the participants completely stopped gambling once enrolled in this program. No one scored within the interval of non-problem gamblers. Suggestions to improve self-exclusion programs are discussed.     

Improved Self-exclusion Program: Preliminary Results

The gambling industry has offered self-exclusion programs for quite a long time. Such measures are designed to limit access to gaming opportunities and provide problem gamblers with the help they need to cease or limit their gambling behaviour. However, few studies have empirically evaluated these programs. This study has three objectives: (1) to observe the participation in an improved self-exclusion program that includes an initial voluntary evaluation, phone support, and a mandatory meeting, (2) to evaluate satisfaction and usefulness of this service as perceived by self-excluders, (3) to measure the preliminary impact of this improved program. One hundred sixteen self-excluders completed a questionnaire about their satisfaction and their perception of the usefulness during the mandatory meeting. Among those participants, 39 attended an initial meeting. Comparisons between data collected at the initial meeting and data taken at the final meeting were made for those 39 participants. Data showed that gamblers chose the improved self-exclusion program 75% of the time; 25% preferred to sign a regular self-exclusion contract. Among those who chose the improved service, 40% wanted an initial voluntary evaluation and 37% of these individuals actually attended that meeting. Seventy percent of gamblers came to the mandatory meeting, which was a required condition to end their self-exclusion. The majority of participants were satisfied with the improved self-exclusion service and perceived it as useful. Major improvements were observed between the final and the initial evaluation on time and money spent, consequences of gambling, DSM-IV score, and psychological distress. The applicability of an improved self-exclusion program is discussed and, as shown in our study, the inclusion of a final mandatory meeting might not be so repulsive for self-excluders. Future research directives are also proposed.

Characteristics and Gender Differences Among Self-Excluded Casino Problem Gamblers: Missouri Data

The present study explores gender-related differences in the demographic and gambling-related characteristics of 2670 problem gamblers participating in a state-administered (Missouri) casino self-exclusion program between 2001 and 2003. Female (n=1298, 48.4%) and male (n=1372, 51.1%) participants ranged in age from 21 to 84 years. Gender-related differences were noted among demographic variables, patterns of gambling behavior, reasons for self-exclusion, and involvement in self-help, counseling, and bankruptcy services. Female self-excluders were more likely than males to be older at time of application, African American, and either retired, unemployed or otherwise outside the traditional workforce. In addition, female self-excluders were more likely to report a later age of gambling onset, a shorter period between onset and self-exclusion, a preference for non-strategic forms of gambling and prior bankruptcy. The main predictors for female participation in self-exclusion included a desire to gain control and prevent suicide and referral by a counselor. The desire to save the marriage was a motivating factor for all participants. Findings suggest that the most efficacious treatment strategies with this group will include family systemic therapy and financial management in addition to pharmaco-treatment and culturally-sensitive individual therapy.     

Self-Exclusion as a Harm Minimization Strategy: Evidence for the Casino Sector from Selected European Countries

As the international gambling market continues to expand, determining effective approaches to prevent gambling-related problems becomes increasingly important. Despite a lack of in-depth research into its benefits, self-exclusion is one such measure already in use around the world in various sectors of the gambling industry. The present study is the first of its kind to examine the effectiveness of self-exclusion schemes in the casino sector in selected European countries. A written survey yielded a sample of N = 152 (self)-excluded gamblers. In addition to this cross-section analysis, a small sub-group (n = 31) was monitored over time by means of follow-up surveys carried out 1, 6, and 12 month(s) after the exclusion agreement came into force. The results reveal that the self-excluded individuals are typically under a great deal of strain and show a relatively pronounced willingness to change. However, this largely reaches its peak at the time the decision to self-exclude is made. From a longitudinal perspective, various parameters indicate a clear improvement in psychosocial functioning; a favorable effect that also starts directly after the exclusion agreement was signed. Finally, considering theoretical and empirical findings, possibilities for optimizing (self-)exclusion schemes will be discussed.     

One Decade of Self Exclusion: Missouri Casino Self-Excluders Four to Ten Years after Enrollment

For more than a decade, casinos around the world have offered self-exclusion programs (SEPs) to gamblers seeking help with their gambling behavior. Despite the proliferation of SEPs, little is known about the long-term outcomes for gamblers who utilize these programs. The current study assessed the experiences of a sample (N = 113) of Missouri self-excluders (SEs) for as long as 10 years after their initial enrollment in the Missouri Voluntary Exclusion Program (MVEP). Most SEs had positive experiences with MVEP and reduced their gambling and gambling problems after enrollment. However, 50% of SEs who attempted to trespass at Missouri casinos after enrollment were able to, indicating that the benefit of MVEP was attributable more to the act of enrollment than enforcement. SEs who engaged in complementary treatment or self-help groups had more positive outcomes than those who did not, suggesting that SEPs ought to encourage and provide information about additional support and treatment options to participants.     

Gambling decisions: an early intervention program for problem gamblers

An implementation and one-year follow-up of the Gambling Decisions program attempted to answer several important questions. First, is controlled gambling a viable treatment option for some gamblers? Can earlier stage problem gamblers be separated for treatment from those with more severe problems? Finally, would problem gamblers utilize a community health agency for treatment of their excessive gambling? A pretest/posttest design was chosen where the efficacy of the program was assessed using repeated measures ANOVA analysis. Results showed that an average loss of $608 over a 4-week period was reduced to $113 immediately after the 6-week program and to a loss of $73 at 12 months. The average number of hours spent gambling per 4 weeks was significantly reduced from 23.5 at pretest to 6.5 at the 12 month posttest. Significant decreases were also observed in the number of days per week that clients gambled, and clients reported significant reductions in everyday life problems related to gambling after completing the program.     

Missouri Casino Self-Excluders: Distributions Across Time and Space

According to public health research, exposure to casinos is a risk factor for disordered gambling. Consequently, casino self-exclusion programs, which provide gamblers with the opportunity to voluntarily seek limits on their access to gambling venues, can serve as a barometer of the concentration of disordered gambling in an area. This study reports on the distribution, both temporally and geographically, of 6,599 people who applied to exclude themselves from Missouri casinos between November, 1996 and February, 2004. Analyses used Microsoft MapPoint to plot the location of casinos and self-excluders (SEs) across Missouri and its constituent counties. These regional exposure analyses showed that the Western region around Kansas City is an epicenter of disordered gambling as, to a lesser extent, is the Eastern region around St. Louis. The annual number of SE enrollments increased during the first few years of the Missouri self-exclusion program and then leveled off during the later years. These findings have important implications for public health and the development of public health interventions for disordered gamblers.     

Review of Self-exclusion from Gambling Venues as an Intervention for Problem Gambling

Self-exclusion programs are required to be provided by gambling operators in many international jurisdictions in an attempt to provide an option for those who have gambling problems to avoid further gambling. However, minimal robust and comprehensive research has been conducted to evaluate the effectiveness of self-exclusion programs. There is much scope for reform and greater cohesion between jurisdictions, particularly neighbouring jurisdictions that would offer greater protection to individuals and industry bodies. This review outlines the evidence surrounding existing self-exclusion strategies, the benefits and limitations of such programs, and provides potential recommendations for an effective intervention program. Research suggests that self-exclusion programs are under-utilised by problem gamblers and are not completely effective in preventing individuals from gambling in venues from which they have excluded, or on other forms. Nonetheless, self-report indicates that self-excluders generally experience benefits from programs, including decreased gambling and increased psychological wellbeing and overall functioning. There are many areas in which existing programs could be improved, such as providing more resources for excluded individuals and reducing barriers to program entry, and more research is needed. However, self-exclusion programs are an important component of any public health strategy that aims to minimise gambling-related harms and these should be based as far as possible on empirical evidence for effective program components.     

Venue Staff Knowledge of Their Patrons’ Gambling and Problem Gambling

In several jurisdictions around the world, venue staff are encouraged to make reasonable attempts to determine whether patrons may be experiencing problems associated with their gambling. Although a number of visible indicators and behaviours are recognised as being indicative of gambling problems, no research has investigated how effective staff might be in identifying problem gamblers in venues. The aim of this field test was to examine the level of patron familiarity amongst staff working in small to moderate-sized venues. Patrons (n = 303) were asked to complete a short survey including the Problem Gambling Severity Index and venue staff were asked to describe their knowledge of the same patrons independently. The results showed that patrons rated as more at risk by staff scored significantly higher on the PGSI, but that point-in-time staff ratings were not sufficiently accurate to allow effective identification of problem gamblers. The importance of using accumulated information over multiple sessions as well as technological monitoring of behaviour was emphasised by these results.     

Predicting online gambling self-exclusion: an analysis of the performance of supervised machine learning models

As gambling operators become increasingly sophisticated in their analysis of individual gambling behaviour, this study evaluates the potential for using machine learning techniques to identify individuals who used self-exclusion tools out of a sample of 845 online gamblers, based on analysing trends in their gambling behaviour. Being able to identify other gamblers whose behaviour is similar to those who decided to use self-exclusion tools could, for instance, be used to share responsible gaming messages or other information that aids self-aware gambling and reduces the risk of adverse outcomes. However, operators need to understand how accurate models can be and which techniques work well. The purpose of the article is to identify the most accurate technique out of four highly diverse techniques and to discuss how to deal analytically and practically with a rare event like self-exclusion, which was used by fewer than 1% of gamblers in our data-set. We conclude that balanced training data-sets are necessary for creating effective models and that, on our data-set, the most effective method is the random forest technique which achieves an accuracy improvement of 35 percentage points versus baseline estimates.     

Does Providing Extended Relapse Prevention Bibliotherapy to Problem Gamblers Improve Outcome?

Relapse rates among pathological gamblers are high with as many as 75% of gamblers returning to gambling shortly after a serious attempt to quit. The present study focused on providing a low cost, easy to access relapse prevention program to such individuals. Based on information collected in our ongoing study of the process of relapse, a series of relapse prevention booklets were developed and evaluated. Individuals who had recently quit gambling (N = 169) were recruited (through media announcements) and randomly assigned to a single mailing condition in which they received one booklet summarizing all of the relapse prevention information or a repeated mailing condition in which they received the summary booklet plus 7 additional booklets mailed to them at regular intervals over the course of a year period. Gambling involvement over the course of the 12-month follow-up period, confirmed by family or friends, was compared between the two groups. Results indicated that participants receiving the repeated mailings were more likely to meet their goal, but they did not differ from participants receiving the single mailing in frequency of gambling or extent of gambling losses. The results of this project suggest that providing extended relapse prevention bibliotherapy to problem gamblers does not improve outcome. However, providing the overview booklet may be a low cost, easy to access alternative for individuals who have quit gambling.     

Treatment of Female Pathological Gambling: The Efficacy of a Cognitive-Behavioural Approach

Given that a substantial proportion of current pathological gamblers are female, it is evident that women are underrepresented in the treatment outcome literature. The current study was designed to redress the limited information on the treatment of female pathological gambling. Although the use of cognitive-behavioural therapy is the most highly recommended approach as ‘best practice’ for the treatment of pathological gambling, no attempt to date has been made to evaluate the efficacy of this approach for female pathological gambling. Nineteen female pathological gamblers with electronic gaming machine problems were treated with a cognitive-behavioural program. While pathological gamblers placed on a waiting list did not show significant improvement on gambling behaviour and psychological functioning measures, the female pathological gamblers showed significant improvement on these measures over the treatment period, and maintained this improvement at the 6-month follow-up evaluation. By the completion of the follow-up period, 89% of participants no longer met diagnostic criteria for pathological gambling. Although further scientific demonstration and replication are required, the outcomes of this study indicate that the therapy that is considered ‘best practice’ in the treatment of pathological gambling is effective for female pathological gambling.     

Measuring the Prevalence of Sector-Specific Problem Gambling: A Study of Casino Patrons

This study is the first attempt to measure the prevalence of problem gambling attributable to a specific sector of the gambling industry. One thousand, one hundred and five casino patrons in 40 casinos in the UK were interviewed, face-to-face. Respondents were screened for problem gambling using a multiple response version of DSM-IV (DSM-IV-MR). The study found support for Eadington's (1988) hypothesis, that UK casinos could be largely sustained by regular players, among whom the prevalence of problem gambling is high. The study also found support for the hypothesis that, to the extent different gambling sectors are patronised by demographically different client groups, so the problem gamblers associated with them will reflect these client groups. The problem gamblers among the regular casino patrons were demographically distinct from the problem gamblers in the sample who showed a preference for other gambling forms. Other key findings support those found in other jurisdictions. Sector-specific prevalence studies may be the next step forward in epidemiological research on problem gambling. They have the major advantage of netting significantly more problem gamblers from much smaller samples than similar studies in the general population. They also have the potential to reveal the proportion of problem gamblers attributable to each sector, along with their demographic characteristics. Such information would result in more specific information being available for regulators seeking to minimise the social impact of problem gambling and those involved in the development of prevention and treatment strategies.     

Problem and Pathological Gambling in a Sample of Casino Patrons

Relatively few studies have examined gambling problems among individuals in a casino setting. The current study sought to examine the prevalence of gambling problems among a sample of casino patrons and examine alcohol and tobacco use, health status, and quality of life by gambling problem status. To these ends, 176 casino patrons were recruited by going to a Southern California casino and requesting that they complete an anonymous survey. Results indicated the following lifetime rates for at-risk, problem, and pathological gambling: 29.2, 10.7, and 29.8%. Differences were found with regards to gambling behavior, and results indicated higher rates of smoking among individuals with gambling problems, but not higher rates of alcohol use. Self-rated quality of life was lower among pathological gamblers relative to non-problem gamblers, but did not differ from at-risk or problem gamblers. Although subject to some limitations, our data support the notion of higher frequency of gambling problems among casino patrons and may suggest the need for increased interventions for gambling problems on-site at casinos.     

After the Ban of Slot Machines in Norway: A New Group of Treatment-Seeking Pathological Gamblers?

Changes in demographical and clinical features of treatment-seeking pathological gamblers, and their gambling preferences before and after the ban of slot machines in Norway from 1 July 2007. Is there an emergence of a new group of gamblers seeking treatment after the ban? The participants were 99 patients, 16 women and 83 men, with the mean age of 35 years. All were referred to the Bergen Clinics Foundation, Norway, for treatment of gambling addiction in the period October 2006 to October 2009. A comprehensive assessment package was applied, focusing on demographical characteristics, the severity of pathological gambling, mental health and substance use disorder. After the ban the mean age was significantly lower, and significantly more were highly educated, in regular employment, and married. Internet gambling and a sport betting game called Odds were the most common options, and gambling problems had become more severe with greater depth due to gambling, bad conscious, heavy alcohol consumption, and more suicidal thoughts and attempts. After the ban of slot machines, the characteristics of treatment-seeking gamblers have been changed, and with great implications for treatment strategies.     

Self-Directed Gambling Changes: Trajectory of Problem Gambling Severity in Absence of Treatment

Most problem gamblers do not seek formal treatment, recovering on their own through cognitive re-appraisal or self-help strategies. Although barriers to treatment have been extensively studied, there is a paucity of research on self-directed changes in problem gambling and very few studies have examined these changes prospectively. The aim of this study was to examine the trajectory of gambling severity and behavior change over an 18-month period, among a sample of non-treatment seeking/attending problem gamblers recruited from the community (N?=?204) interested in quitting or reducing gambling. Separate mixed effects models revealed that in absence of formal treatment, significant reductions in gambling severity, frequency, and amount gambled could be observed over the course of a 6 to 9-month period and that changes experienced within the first 12 months were maintained for an extended 6 months. Problem gambling severity at baseline was significantly associated with changes in severity over time, such that participants with more severe gambling problems demonstrated greater reductions in their gambling severity over time. A total of 11.1% of participants gambled within a low-risk threshold at 18 months, although 28.7% of the sample reported consecutive gambling severity scores below problem levels for the duration of 1 year or longer. The findings suggest that among problem gamblers motivated to quit or reduce their gambling, significant self-directed changes in gambling severity can occur over a relatively short time. Additional prospective studies are needed to document the role of specific self-help tools or thought processes in exacting gambling changes.     

Self-exclusion: A Proposed Gateway to Treatment Model

Self-exclusion is a programme utilized by the gaming industry to limit access to gaming opportunities for problem gamblers. It is based on the following principles: (1) The gaming industry recognizes that a proportion of community members gamble excessively and have difficulty controlling gambling behaviours; (2) The gaming industry has a responsibility to provide a safe gaming environment and to assist in minimizing the negative impact on individuals displaying problem gambling behaviours; (3) Individuals must accept personal responsibility for limiting gambling behaviours to affordable levels; and (4) Self-exclusion is not a treatment designed to address psychological processes. The objective of the present paper is to propose a unifying structure for self-exclusion programmes as a gateway to treatment based on a system operated by independent ‘educators’ whose roles and responsibilities include informing individuals of the purpose of self-exclusion, establishing links and a gateway for access to supplementary services and monitoring and reporting the effectiveness of the overall programme.     

A Preliminary Investigation of Abstinence and Controlled Gambling as Self-Selected Goals of Treatment for Female Pathological Gambling

The current study aimed to provide a preliminary evaluation of the differential efficacy of a cognitive-behavioural treatment program for female pathological gamblers delivered with the goals of abstinence or controlled gambling. The findings were based on the comparison of pathological gamblers selecting abstinence and pathological gamblers selecting controlled gambling on measures of gambling behaviour and psychological functioning. The findings revealed that pathological gamblers selecting controlled gambling displayed comparable levels of improvement to those displayed by gamblers selecting abstinence. Using a treatment completer approach, 89% of the gamblers selecting abstinence compared with 82% selecting controlled gambling no longer satisfied the diagnostic criteria for pathological gambling by the completion of the 6-month follow-up period. Although further scientific demonstration is required, the findings of this study provide preliminary support for the practice of offering controlled gambling as an alternative goal in the treatment of pathological gambling.