Professional Help-Seeking for Gambling Problems: Awareness,Barriers and Motivators for Treatment

Despite the negative consequences associated with gambling, few problem gamblers seek professional help. This study aimed to examine awareness of professional sources of help and help-seeking behaviour amongst regular and problem gamblers. Australian gamblers (N = 730) were recruited from the general population, multicultural gambling venues, and gambling helplines and treatment services. Surveys measured awareness of professional help services, help-seeking behaviour and motivators and barriers to seeking help. Gamblers demonstrated low awareness of professional help services. Problem gamblers born in Australia or who were divorced were more likely to seek help. Problem gamblers who were reluctant to seek help due to a desire solve the problem on their own and feeling ashamed for themselves or their family pride were more likely to have overcome these barriers to seek help. However, significant barriers related to denial of problem severity and concerns about the ability to access low cost services that cater for multicultural populations predicted a lower likelihood of having sought help. Public education should aim to de-mystify the treatment process and educate gamblers about symptoms of problem gambling to reduce shame, stigma, and denial and encourage help-seeking. Ongoing education and promotion of help services is required to increase awareness of the resources available, including targeted promotions to increase awareness of relevant services among specific populations.     

Motivators for Resolving or Seeking Help for Gambling Problems: A Review of the Empirical Literature

This literature review summarizes recent empirical research on the reasons disordered gamblers try, through treatment or otherwise, to resolve or reduce their gambling problems. Relevant databases and bibliographies were searched for English-language studies, published since 1998, that asked gamblers themselves about motivators for action. Found were ten studies addressing reasons for trying to resolve or reduce gambling problems, five addressing reasons for seeking help and four addressing reasons for requesting self-exclusion from casinos. Help-seeking occurred largely in response to gambling-related harms (especially financial problems, relationship issues and negative emotions) that had already happened or that were imminent. Resolution was often motivated by the same kinds of harms but evaluation/decision-making and changes in lifestyle or environment played a more prominent role. Self-exclusion was motivated by harms, evaluation/decision-making and a wish to regain control. Awareness and educational materials could incorporate messages that might encourage heavy gamblers to make changes before harms became too great. Intervention development could also benefit from more research on the motivators leading to successful (vs. failed) resolution, as well as on the ways in which disordered gamblers are able to overcome specific barriers to seeking help or reaching resolution.     

Significant Others and Gambling Treatment Outcomes

Aims This study investigates the effect of significant others on treatment outcomes among treated pathological gamblers. Design This is a cohort study of individuals who received gambling treatment. Setting Oregon Problem Gambling Services (OPGS) for gamblers and their family members. Participants 4,410 adult gamblers who were discharged from treatment between August, 2001 and April, 2007. Measurements OPGS enrollment forms provided gambler gender, age, ethnicity, education level, employment status, gambling-related debt, and whether the gambler had a significant other at the time of enrollment. Termination forms provided information on the type of discharge (successful/unsuccessful) and treatment length (in days). Participation of the gambler’s significant other in the family treatment program was identified. Findings Results showed that age, ethnicity, gambling debt, and having a significant other are associated with the odds of successful treatment. Education level moderates the effect of having a significant other on treatment success. Age, ethnicity, education, employment, and having a significant other participate in treatment significantly impacted gamblers’ length in treatment. Conclusions These findings indicate that there may be a benefit to integrating significant others in gambling treatment methods. Significant others may act as social supports for gamblers seeking treatment, and involving loved ones in gambling treatment models may positively affect gambler treatment outcomes.     

Using Neural Networks to Model the Behavior and Decisions of Gamblers,in Particular,Cyber-Gamblers

This article describes the use of neural networks (a type of artificial intelligence) and an empirical data sample of, inter alia, the amounts of bets laid and the winnings/losses made in successive games by a number of cyber-gamblers to longitudinally model gamblers’ behavior and decisions as to such bet amounts and the temporal trajectory of winnings/losses. The data was collected by videoing Texas Holdem gamblers at a cyber-gambling website. Six “persistent” gamblers were identified, totaling 675 games. The neural networks on average were able to predict bet amounts and cumulative winnings/losses in successive games accurately to three decimal places of the dollar. A more important conclusion is that the influence of a gambler’s skills, strategies, and personality on his/her successive bet amounts and cumulative winnings/losses is almost totally reflected by the pattern(s) of his/her winnings/losses in the few initial games and his/her gambling account balance. This partially invalidates gamblers’ illusions and fallacies that they can outperform others or even bankers. For government policy-makers, gambling industry operators, economists, sociologists, psychiatrists, and psychologists, this article provides models for gamblers’ behavior and decisions. It also explores and exemplifies the usefulness of neural networks and artificial intelligence at large in the research on gambling.     

Predictors of help-seeking for gambling disorder from the transtheoretical model perspective

Few gamblers seek treatment despite the severe negative impacts prolonged gambling can have. Research surrounding the predictors of help-seeking for problem gambling is often retrospective in design and inconsistent in findings. This study prospectively investigated whether transtheoretical model (TTM) constructs (readiness to change, ratings of temptations and self-efficacy, decisional balance and processes of change) have utility in predicting help-seeking among disordered gamblers. Community-recruited disordered gamblers (N = 136; 47.06% female; mean age = 44.5 years, SD = 12.8; 80.1% Caucasian) completed three assessments of TTM constructs, help-seeking behaviour, gambling problem severity, and other potential predictors of help-seeking. Informal help-seeking was common (6-month = 71.1%; 12-month = 79.6%); however, formal help-seeking was relatively infrequent (6-month = 22.7%; 12-month = 35.1%). Logistic regression demonstrated that gambling problem severity and the social liberation process of change (i.e. endorsing public awareness of gambling problems or non-gambling role models) consistently predicted formal help-seeking. Helping relationships and counter-conditioning (i.e. engaging in other activities as a replacement for gambling) processes of change uniquely predicted informal help-seeking at 12 months. Individuals most likely to seek formal help have greater problem severity and greater readiness to address problems. Seeking informal help is less predictable but more common.     

Internet Gamblers: A Latent Class Analysis of Their Behaviours and Health Experiences

In order to learn about the behaviours and health experiences of people who gamble on the Internet, we conducted an international online survey with respondents recruited via gambling and gambling-related websites. The mean (SD) age of the 4,125 respondents completing the survey was 35.5 (11.8) years, with 79.1% being male and 68.8% UK residents. Respondents provided demographic details and completed validated psychometric screening instruments for problem gambling, mood disturbances, as well as alcohol and substance misuse, and history of deliberate self harm. We applied latent class analysis to respondents’ patterns of regular online gambling activities, and identified subgroups of individuals who used the Internet to gamble in different ways (L ² = 44.27, bootstrap P = 0.07). We termed the characteristic profiles as ‘non-to-minimal gamblers’; ‘sports bettors’; ‘casino & sports gamblers’; ‘lottery players’; and ‘multi-activity gamblers’. Furthermore, these subgroups of respondents differed on other demographic and psychological dimensions, with significant inter-cluster differences in proportion of individuals scoring above threshold for problem gambling, mood disorders and substance misuse, and history of deliberate self harm (all Χ ²s > 23.4, all P-values <0.001). The ‘casino & sports’ and ‘multi-activity-gamblers’ clusters had the highest prevalence of mental disorder. Internet gamblers appear to be heterogeneous but composed of several subgroups, differing markedly on both demographic and clinical characteristics.     

Differences in Cognitive Distortions Between Pathological and Non-Pathological Gamblers with Preferences for Chance or Skill Games

Cognitive distortions have been thought to play an important role in the development and maintenance of pathological gambling. The present study investigated whether severity of gambling problems and gamblers’ preference for chance or skill games were related to two sub-factors of cognitive distortions as measured by the Gamblers Belief Questionnaire: Luck/Perseverance, which reflects an individual’s perception that chance is favorable to him/her, and Illusion of Control, which reflects an individual’s perception that his/her behavior influences chance occurrences. Participants (N = 166) were recruited from a race track (n = 79), off-course betting facilities (n = 50) and from an online treatment program for problem gamblers (n = 49). Gambling severity was measured by the South Oaks Gambling Screen, and 73 were classified as pathological gamblers whereas 93 were classified as non-pathological gamblers. The present study supports previous proposals that cognitive distortions are core processes related to gambling behavior as pathological gamblers reported more cognitive distortions than did non-pathological gamblers. A preference for skill games was also associated with greater Illusion of Control compared to a preference for chance games. For gamblers preferring skill games there were no differences in Luck/Perseverance or Illusion of Control between pathological and non-pathological gamblers.     

Reward-Sensitivity,Inhibition of Reward-Seeking,and Dorsolateral Prefrontal Working Memory Function in Problem Gamblers not in Treatment

Given the central role of perseverative chasing in problem gambling, the present study sought to find evidence for three hypothesized components of perseveration in problem gamblers: reward-sensitivity dominance, deficient inhibition of reward-seeking behavior, and working memory deficits. This was the first attempt to examine working memory deficits in problem gamblers using a conditional association task, which is associated with posterior-dorsolateral prefrontal functioning. In a sample that was not in treatment, and representative in terms of comorbidity, problem gamblers performed significantly worse on the conditional association working memory tasks after controlling for general memory function, compared to demographically-matched controls. This is significant because deficits in the dorsolateral prefrontal region have been consistently associated with perseveration, which suggests that problem gamblers’ perseverative chasing may be associated with a working memory deficit. Problem gamblers were not significantly higher than at-risk gamblers in terms of reward-sensitivity dominance (measured as a personality trait in terms of extraversion) suggesting that it may not be specifically associated with problem gambling. Sensation-seeking was also not associated with problem gambling in a sample that corrected for the methodological problems of previous studies which examined it. The need for gambling research to focus specifically on the perseverative inability to stop gambling is emphasized, and the present findings of specific working memory deficits in problem gamblers suggest the need for further examination of working memory as a potential risk factor for problem gambling. We propose that subsequent studies examine working memory in terms of the self-regulatory capacity for goal maintenance where attention must specifically be allocated to resist interference.     

Improved outcomes following contact with a gambling helpline: the impact of gender on barriers and facilitators

Gambling helplines were developed at a time when evidence for help-seeking was almost entirely based on male gamblers and there is limited evidence that helplines have changed in response to the exponential increase in female gamblers over the past 20 years. The current study aimed to explore the impact of gender on calls to Australian helplines, including caller characteristics, barriers and facilitators to contact as well as call outcomes. We surveyed 170 callers (94% problem gamblers, 61% male) approximately 1 month following their helpline call and found gender differences in terms of age, preferred gambling type, employment and source of referral. Males reported barriers related to pride and problem denial more frequently than females did, and also reported more frequent problems associated with the welfare of others and/or their living arrangements that facilitated their calling. Males and females were equally likely to seek further help from formal, informal and self-help resources. With only 10% of callers not accessing further help, these findings highlight the importance of helplines as a key support for both men and women with gambling problems.     

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.     

Barriers to Help-seeking for a Gambling Problem: The Experiences of Gamblers Who Have Sought Specialist Assistance and the Perceptions of Those Who Have Not

This paper presents barriers to help-seeking data as reported by users of a national gambling helpline (help-seekers, HS, N = 125) as well as data pertaining to perceived barriers to seeking help as reported by gamblers recruited from the general population (non-help-seekers, NHS, N = 104). All data were collected via a structured, multi-modal survey. When asked to identify actual or perceived barriers to seeking help, responses indicative of pride (78% of HS participants, 84% of NHS participants), shame (73% of HS participants, 84% of NHS participants) or denial (87% of NHS participants) were most frequently reported. These three factors were also most often identified as the real or perceived primary barrier to help-seeking (collectively accounting for 55% of HS, and 60% of NHS, responses to this question) and were the only barriers to be identified by more than 10% of either HS and NHS participants without prompting. It was of note, however, that participants in both groups identified multiple barriers to help-seeking (mean of 6.7 and 12.2, respectively) and that, when presented with a list of 21 possible barrier items, NHS participants endorsed 19 of the listed items significantly more often than their HS counterparts. The implications of these findings, with respect to promoting greater or earlier help-seeking activity amongst problem gamblers, are discussed.

Mental Health and Online,Land-Based and Mixed Gamblers

Although high rates of problem gambling have been identified among Internet gamblers, most studies have failed to identify the relative contribution of multiple forms of gambling as opposed to the exclusive participation in online forms. The aim of this study was to investigate differences in mental health status in exclusive online, exclusive land-based, and mixed Internet and land-based samples of gamblers drawn from the general population. A sample of 4594 respondents completing an online survey were categorised as exclusive online, land-based and mixed form gamblers. Participants completed a questionnaire eliciting demographic details, participation on all forms of gambling, use of alcohol, tobacco and drugs, help-seeking, and personal problems experienced due to gambling, as well as measures of problem gambling and psychological distress. Findings indicated that mixed gamblers exhibited higher problem gambling scores, level of gambling involvement, and consumption of alcohol during gambling than exclusive online gamblers. Land-based gamblers experienced higher levels of psychological distress, self-acknowledged need for treatment, and help-seeking behaviour. These findings suggest that exclusive online gamblers represent a different subpopulation at lower risk of harm compared to gamblers engaging in multiple forms. Understanding the characteristics of different problem gambling subpopulations may inform the development of more effective targeted interventions.     

Gambling Harms and Gambling Help-Seeking Amongst Indigenous Australians

This paper aimed to analyze the harms arising from gambling and gambling-related help-seeking behaviour within a large sample of Indigenous Australians. A self-selected sample of 1,259 Indigenous Australian adults completed a gambling survey at three Indigenous sports and cultural events, in several communities and online. Based on responses to the problem gambling severity index (PGSI), the proportions of the sample in the moderate risk and problem gambler groups were higher than those for the population of New South Wales. Many in our sample appeared to face higher risks with their gambling and experience severe gambling harms. From PGSI responses, notable harms include financial difficulties and feelings of guilt and regret about gambling. Further harms, including personal, relationship, family, community, legal and housing impacts, were shown to be significantly higher for problem gamblers than for the other PGSI groups. Most problem gamblers relied on family, extended family and friends for financial help or went without due to gambling losses. Nearly half the sample did not think they had a problem with gambling but the results show that the majority (57.7 %) faced some risk with their gambling. Of those who sought gambling help, family, extended family, friends and respected community members were consulted, demonstrating the reciprocal obligations underpinning traditional Aboriginal culture. The strength of this finding is that these people are potentially the greatest source of gambling help, but need knowledge and resources to provide that help effectively. Local Aboriginal services were preferred as the main sources of professional help for gambling-related problems.     

Barriers to Seeking Help for Gambling Problems: A Review of the Empirical Literature

This literature review summarizes recent empirical research on obstacles preventing problem gamblers from seeking treatment for their gambling problems. Relevant databases and bibliographies were searched for English-language papers and reports published since 1998. The only methodological requirement was that gamblers themselves be asked about reasons for not seeking help. Nineteen studies conducted in five countries were identified. All except one targeted adults. Despite differences in methodology, many of the same barriers to treatment were identified. Most commonly reported barriers were: wish to handle problem by oneself; shame/embarrassment/stigma; unwillingness to admit problem; and issues with treatment itself. The authors of the review argue that unwillingness to admit to the problem may be even more prevalent than is typically indicated by the results of barriers studies. Other frequently reported barriers included lack of knowledge about treatment options and practical issues around attending treatment. More research is needed on barriers to treatment-seeking experienced by subgroups of gamblers defined by culture, ethnicity, gender, age. Open-ended questioning methods can help provide insights into what barrier categories mean to different groups and individuals. Input directly from gamblers can be combined with information from other kinds of studies to devise better ways of reaching problem gamblers, especially those in underserviced populations. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

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.     

The Relationship of Problem Gambling to Criminal Behavior in a Sample of Canadian Male Federal Offenders

This article examines the prevalence of moderate and severe problem gambling in a sample of 254 incarcerated Canadian male federal offenders (completion rate of 39.0%). The prevalence of disordered gambling was measured using the PGSI, DSM-IV-TR, and SOGS that yielded estimates of 9.4%, 6.3%, and 13.0%, respectively. Severe problem gamblers were significantly more likely to have committed income producing offences, but were neither more nor less likely than other offenders to have committed violent offences. The majority of severe problem gamblers (65.2%) and a fifth of the moderate problem gamblers (20.0%) reported that their criminal activity was a result of their gambling (e.g., to pay off debts). Based on these findings there appears to be a need to offer problem gambling treatment services to offenders in order to help them break the cycle of gambling, debt and crime.     

Health Outcomes in Individuals with Problem and Pathological Gambling: An Analysis of the 2014 North Carolina Behavioral Risk Factor Survey System (BRFSS)

Problem and pathological gambling refers to subclinical and clinical levels of maladaptive gambling, respectively, and is associated with specific sociodemographic characteristics as well as a number of poor health outcomes. We examined such demographic, physical health, mental health, and health-related behaviors in a sample of 7045 low-risk gamblers and 244 problem/pathological gamblers. Participants completed the 2014 North Carolina Behavioral Risk Factor Surveillance System telephone survey. Using the National Opinion Research Center’s Diagnostic Screen for Gambling Disorders-CLiP, participants were categorized as either “problem/pathological gamblers” or “low-risk gamblers.” Problem/pathological gamblers were younger, more likely to be male, of ethnic minority status, unmarried, and of lower education than low-risk gamblers. No physical health variables differentiated the groups but problem/pathological gamblers reported experiencing significantly more adverse childhood experiences and engaging in significantly more tobacco and alcohol use compared to low-risk gamblers. Moreover, gender moderated relationships between gambling group and several of the alcohol use variables such that male problem/pathological gamblers exhibited greater alcohol use behavior than male low-risk gamblers but no such relationship was present in females. Overall, this study expands the current knowledgebase on disordered gambling and highlights the need to assess disordered gambling in public health samples. Clinical implications are discussed.     

Gambling Motivations,Money-Limiting Strategies,and Precommitment Preferences of Problem Versus Non-Problem Gamblers

Studies attempting to identify the specific ‘addictive’ features of electronic gaming machines (EGMs) have yielded largely inconclusive results, suggesting that it is the interaction between a gambler’s cognitions and the machine, rather than the machine itself, which fuels excessive play. Research has reported that machine players with gambling problems adopt a number of erroneous cognitive perceptions regarding the probability of winning and the nature of randomness. What is unknown, however, is whether motivations for gambling and attitudes toward pre-session monetary limit-setting vary across levels of gambling severity, and whether proposed precommitment strategies would be useful in minimizing excessive gambling expenditures. The current study explored these concepts in a sample of 127 adults, ages 18 to 81, attending one of four gambling venues in Queensland, Australia. The study found that problem gamblers were more likely than other gamblers to play machines to earn income or escape their problems rather than for fun and enjoyment. Similarly, they were less likely to endorse any type of monetary limit-setting prior to play. They were also reticent to adopt the use of a ‘smart card’ or other strategy to limit access to money during a session, though they indicated they lost track of money while gambling and were rarely aware of whether they were winning or losing during play. Implications for precommitment policies and further research are discussed.     

GPs and Problem Gambling: Can they Help with Identification and Early Intervention?

General Practitioners (GPs) are well placed to identify problem gamblers and provide early intervention. To date there is no evidence to suggest that GP’s are routinely screening patients for potential gambling problems. This paper discusses the prevalence of problem gambling, the links with other health problems and ways that GPs can assist. Results from a pilot project that provided educational resources to GPS are also discussed. Suitable screening tools are available that could easily be used by GPs to assess the possibility of gambling problems in patients who may be at increased risk but do not seek help. Early identification and intervention may help prevent a gambling habit escalating to a serious problem. More work needs to be done to increase awareness with GPs of the extent of problem gambling in our community and to alert patients to the fact that gambling can affect their health and that GPs can help.     

Me,Myself, and Money II: Relative Deprivation Predicts Disordered Gambling Severity via Delay Discounting,Especially Among Gamblers Who Have a Financially Focused Self-Concept

In the current research, we examined whether the known link between relative deprivation and disordered gambling (via delay discounting; i.e., preferences for immediate smaller rewards relative to delayed larger rewards) is moderated by the extent to which gamblers have a financially focused self-concept. Specifically, we hypothesized that delay discounting would be a strong predictor of disordered gambling among those who base their self-worth on their financial success. To test this moderated-mediation model, a community sample of gamblers (N = 239) completed measures that assessed relative deprivation, delay discounting, financially focused self-concept, and disordered gambling severity. As predicted, people who felt more relative deprivation reported more severe symptoms of disordered gambling and this association was mediated by delay discounting. Importantly, this mediated relationship was moderated by the extent to which participants’ self-concept was focused on financial success. Among participants whose self-concept was high in financial focus, greater delay discounting (stemming from relative deprivation) was a strong predictor of disordered gambling. Among people whose self-concept was low in financial focus, delay discounting (stemming from relative deprivation) was a weak predictor of disordered gambling. Thus, the magnitude of the indirect effect of relative deprivation on disordered gambling severity was larger among people with a more financially focused self-concept—an effect mediated by delay discounting. These findings suggest that targeting gamblers’ financial focus in prevention and treatment interventions may be instrumental in curtailing the development and maintenance of disordered gambling.