The self-exclusion program: legal and clinical considerations

In recent years, attention focused on compulsive gambling,¹ and its causes and cures, has increased at a notable rate. Among the measures taken to help the compulsive gambler is the voluntary² self-exclusion program which is either in place or being considered in various states.³ Although the programs differ from jurisdiction to jurisdiction, the basic premise is that the gambler requests that he be banned from the gaming establishment and/or removed from its mailing list. This article examines this new concept primarily from a legal perspective. The self-exclusion program represents a state-created legal entity constructed upon a clinical foundation. It prominently includes several clinical references to mental health principles. Of necessity, there appear some analogies to the field of substance abuse; these have provided at least a starting point for more particularized study and research in the fledgling field of compulsive gambling treatment.     

State lotteries and compulsive gambling

The legalization of gambling, including state lotteries, has resulted in a dramatic increase of compulsive gambling. Not surprisingly, a new profile of compulsive gambler has emerged which differs significantly from the previous profile of white, middle aged, middle class male. This paper discusses public policy issues, lottery advertising, and legislative/lottery support given to address the problems of compulsive gambling.     

The Medicalization of Deviance as an Interactive Achievement: The Construction of Compulsive Gambling

This article joins two lines of research from distinct areas in sociology to illuminate the mechanisms through which the meaning of “compulsive gambling” and what it means to be “a compulsive gambler” are cooperatively constructed in interaction at meetings of the fellowship group Gamblers Anonymous (GA). Combining Conrad's work on the medicalization of deviance with a social psychological focus on support group interaction, I demonstrate how individuals' experiences and identities come to be imbued with a medical vocabulary through the homogenization of the initial diversity among members. This analysis contributes to conceptualizations of the medicalization of deviance as well as to interactionist interests in the social construction of reality.     

Inpatient treatment of male pathological gamblers in Germany

Pathological gambling is viewed as a disease of unknown cause which requires treatment. Demographic and psychological traits of fifty-eight male patients are described. A control group of fifty-four patients with other addictions was used to determine the validity of a diagnostic test which aims to differentiate between harmless gambling behavior and addiction to gambling. This test is described along with the stages of pathological gambling and the process of treatment for the disorder. Most of the gamblers are young, often previously convicted of theft, highly indebted, in danger of committing suicide, and susceptible to other addictive substances, especially alcohol. Harmless, critical and chronic stages are described. Regarding in-patient treatment, it has proved to be useful to integrate individual members into groups of alcoholics as they are a therapeutic benefit to these groups. The pragmatic and symptom-oriented therapy proved to be good for gamblers as well. A follow-up with forty-nine patients for one year and twenty-five for two years found 71% abstinent after one year and 62% abstinent after two years of treatment. These results are similar to those obtained with alcoholics.     

Problem Gambling in Non-English Speaking Background Communities in Queensland,Australia: A Qualitative Exploration

This paper provides an overview of qualitative research into problem gambling among non-English speaking background (NESB) communities in Queensland, Australia. The focus for this pilot study was the Chinese, Greek and Vietnamese communities. Using qualitative methodologies, this community-based research explored the motivations for gambling, and the impacts of problem gambling upon individuals and communities. Findings indicate that problem gambling is evident in each of the communities of study, but the issue is characterised by a pervasive sense of denial. Gambling is an issue of enormous shame and stigma, not only for the problem gambler but their entire family. As a result, most problem gamblers do not seek professional help but try to resolve the problem themselves or within the family unit. Research findings indicate that service access could be increased through a range of strategies including the provision of culturally appropriate community education and gambling help services, partnerships between NESB communities, gambling help services and community workers, and the development and implementation of preventative strategies.     

Parents of male compulsive gamblers: Clinical issues/treatment approaches

This is a study of 126 parents (57 couples and 12 individual parents) of 69 inpatient pathological gamblers. The gamblers ranged in age from 17–37 years. All were males who dated their average age of onset of heavy gambling at 13–14 years. The parents ranged in age from 38–69 years. Treatment approaches specific to parents of compulsive gamblers are discussed. These approaches include education, family therapy, conjoint sessions, combined group, parent group, and aftercare. In addition, the value of self-help through GamAnon is stressed as a means of returning sanity to their lives and as a way of recognizing that these parents have the ability to change their feelings and their behaviors, thereby no longer making the gambler and his gambling the focus of their existence.     

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.     

Impact of problem gambling on financial,emotional and social well-being of Singaporean families

Problem gambling has a profound impact on family members. While this has been previously documented, this paper reports on the first study to consider the extent of this impact in Asian societies where the family continues to be a very important basis for social organization. This study, based on in-depth interviews with 50 Singaporeans with a family member who is a problem or pathological gambler, examines how their financial, emotional and social well-being is impinged upon by gambling. The enormous losses of savings, property and lifestyle, the emotional tensions based on constant harassment from moneylenders, the threats of suicide by the gambler and the distancing of social networks place family members of problem gamblers in a vulnerable state. The qualitative data in this paper fleshes out the lived experience of family members and reveals the extent to which the family is mobilized in Asian societies to cope with problem gambling. While the impact of problem gambling on families is similar across societies, routine mobilization of the extended family and the greater role of public shame and embarrassment in dictating Asian families' responses underscore the need for specialized services in these societies to assist family members to better cope with the financial, emotional and social strains caused by problem gambling.     

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.     

Editorial comment

The special issue of theJournal of Gambling Behavior, dedicated to a discussion of compulsive gambling and the law, represents a first effort in addressing some of the many complicated issues on this topic. Articles by experts on compulsive gambling—written by legal authorities, a treatment provider, and victims of the disorder—are included to present the broadest possible forum to analyze the turmoil the idea of compulsive gambling is having on the American legal system. Included are an historical account of how changing laws affect compulsive gamblers, problems facing the expert witness, effects of civil service policies and military law, comparisons of U.S. and English legalization debates, lottery issues, concerns of a lawyer representing casinos, and personal accounts by those who are suffering from this disorder.I. Nelson Rose is an Associate Professor of Law at Whittier College School of Law as well as a licensed attorney. Professor Rose is recognized as the nation's leading authority on gambling and the law.Dr. Valerie C. Lorenz has specialized in research, education and treatment of compulsive gamblers since 1973. She has extensive experience in military, state and federal courts, having served as a qualified expert witness on compulsive gambling.     

Discharge planning with pathological gamblers: An ongoing process

Criteria for a diagnosis of pathological gambling include gambling related disruption or damage in legal, financial, family, vocational and personal areas. Therefore, discharge planning with a pathological gambler is much more than a placement problem at the end of an inpatient treatment stay. In fact, discharge planning incorporates and continues a holistic treatment approach at the Cleveland Veterans Administration Medical Center, Brecksville Gambling Treatment Program. This paper discusses all areas of the gambler's life which have been disrupted and need to be considered when working on a discharge and recovery plan.     

Compulsive gambling in Britain

In 1968 England legalized casino gaming. Unlike their counterparts in America, legislators in the House of Lords actively debated ways to help compulsive gamblers. Parliament adopted the 48 hour rule, requiring players to wait two days before gambling, put severe restrictions on check cashing in casinos and, limited the number of slot machines to two per club. England considered, but rejected, other proposals: the method, used in France, of allowing compulsive gamblers to voluntarily put their names on a list of persons to be excluded and, complete prohibitions on casino credit. Although the legislative restrictions greatly reduced compulsive gambling among adult gamers; sadly, Parliament ignored what has become a growing source of compulsive gambling among children: the practically unlimited availability of public arcades with amusement machines paying small cash prizes.The author wishes to thank James Claber for assistance in this article.     

Individual outpatient treatment of pathological gambling

Recovery from pathological gambling is viewed as a process whereby the pathological gambler chooses to lose an addiction to gambling and maintains that choice while mourning the loss of the gambling. The self-induced and self-escalating addictive crisis leading up to that choice is explored, as is the crisis caused by the loss of the gambling itself. It is proposed that gambling provides the gambler with action, a method of dealing with stress aand avoiding unpleasant affect, and a variety of social, psychological, and existential benefits. The loss of gambling is seen as a complicated and significant one which elicits grief responses similar to those seen in response to other types of major loss. It is proposed that in the individual outpatient treatment of pathological gamblers, the therapist helps the recovering gambler to accept the loss of the gambling and learn to live a rewarding life without it. Four phases of treatment are suggested which correspond to stages of grieving and accepting the loss of the gambling.     

The family exclusion order as a harm-minimisation measure for casino gambling: the case of Singapore

Singapore is one of the first jurisdictions in the world that has implemented a harm minimization model based on third party exclusion known as the Family Exclusion Order (FEO). Unlike other forms of third party exclusion practiced in other countries, family members in Singapore are able to apply for FEOs to prevent a gambler from entering the casinos, if the family has experienced harm caused by his/her gambling. In this study, 105 applicants for the FEO were sampled from all successful FEOs granted within a five-year period. Using a qualitative approach, this study attempts to illuminate the intricate issues experienced by family members that provided the impetus for them to apply for the FEO. While the extant literature posits self-exclusion as a superior tool of restraint as it involves the gambler’s personal motivation to curb gambling, this paper reports initial evidence of benefits resulting from family-imposed restraints from the perspective of family members. In particular, positive ratings of the FEO stemmed from a sense of relief experienced by mother and wife applicants. Possible reasons behind these positive outcomes are explicated using intrinsic motivation theory, with sensitivity to gender relations within the family.     

The Development of an Internet-Based Treatment for Problem Gamblers and Concerned Significant Others: A Pilot Randomized Controlled Trial

Problem gambling creates significant harm for the gambler and for concerned significant others (CSOs). While several studies have investigated the effects of individual cognitive behavioral therapy (CBT) for problem gambling, less is known about the effects of involving CSOs in treatment. Behavioral couples therapy (BCT) has shown promising results when working with substance use disorders by involving both the user and a CSO. This pilot study investigated BCT for problem gambling, as well as the feasibility of performing a larger scale randomized controlled trial. 36 participants, 18 gamblers and 18 CSOs, were randomized to either BCT or individual CBT for the gambler. Both interventions were Internet-delivered self-help interventions with therapist support. Both groups of gamblers improved on all outcome measures, but there were no differences between the groups. The CSOs in the BCT group lowered their scores on anxiety and depression more than the CSOs of those randomized to the individual CBT group did. The implications of the results and the feasibility of the trial are discussed.     

Pathological gambling as a defense against loss

The notion of pathological gambling as an elaborate defense against psychic pain is consistent with the traditional psychoanalytic literature, as well as recent writing on the process of addiction. The losses that pathological gamblers experience as a result of their gambling are enormous and well-documented, but losses suffered prior to the onset of gambling behavior may be far more significant. This paper explores the idea that pervasive developmental loss is a core issue for the compulsive gambler resulting in an intolerance for the anticipation of future losses and the certainty of mortality. Eight semistructured interviews were conducted with pathological gamblers in Gamblers Anonymous to explore the incidence of developmental loss and consequent styles of coping. An in-depth genogram and developmental history were done with each subject, revealing extensive developmental losses in all subjects.     

The Relationship Between Distance from Gambling Venues and Gambling Participation and Problem Gambling Among U.S. Adults

In this article we examine the relationship between extent of gambling for U.S. adults and the distance from their residence to the nearest casino or track. We employ data from a telephone survey of U.S. adults conducted in 2011–2013. The chances that the respondents gambled in the past year, were frequent gamblers, or were problem gamblers were greater if they lived close to a casino. The chances that the respondents gambled in the past year or were frequent gamblers were greater if they lived close to a horse or dog track. The effects of closeness to a casino on the likelihood of past-year gambling, frequent gambling, and problem gambling, as well as the effect of closeness to a track on past-year gambling, extended to about 30 miles from the respondent’s home. In addition, the concentration of casinos within 30 miles of the respondent’s home was positively related to the respondents’ chance of being a frequent or problem gambler. If a respondent had no casinos within 30 miles, he or she had a 2.7 % chance of being a problem gambler; if one casino, a 3.9 % chance; if six or more, a 6.2 % chance. The authors estimate that at least part of this effect is causal.     

A typical problem gambler affects six others

While the financial and psychological burden on problem gamblers can be severe, at least some of the ill effects are also passed on to family or other close social ties. The present study estimated the number of affected-others for the typical problem gambler. Australian members of an online panel with gambling problems (N = 3076) and panel members who indicated that they had been affected by someone else’s gambling (N = 2129) were asked to estimate the number of other people who were negatively affected by their gambling. Using robust statistics to analyse this data, the study found lower estimates made by problem gamblers (four affected people) compared to estimates made by affected others (six affected people, including the respondent). It was concluded that a point-estimate of six people affected is a more accurate figure since it does not suffer from self-presentation effects of problem gamblers. Low-risk and moderate-risk gamblers, unsurprisingly, affected far fewer other people (one and three, respectively). Both gamblers and affected-others most often identified close family members, including spouses and children, as the people impacted by others’ gambling problems. These results provide an approximate measure of the number of people affected, per problem gambler, to facilitate accurate accounting of the harms accruing from gambling problems.     

Women Who Have Taken Their Lives Back from Compulsive Gambling: Results from an Online Survey

ABSTRACT

Although up to half of all gamblers and at least one-third of all problem gamblers are women in the United States, they are underrepresented and overlooked in research studies, treatment, and in the minds of the American public. This paper describes the results of an online survey of women in recovery from compulsive gambling, including demographics, family history, gambling activities, and consequences, and recovery patterns. The results indicate that the primarily white, middle-class, and professional women who responded (N = 178) experienced a high rate of co-occurring substance abuse and depression, troubled family histories, and an array of serious consequences to their gambling. Recovery was primarily supported through Gamblers Anonymous (GA), although 24% recovered without professional or GA help. Their experiences present a compelling case for professional helpers to become informed about this growing problem.     

Subtypes of Problem Gamblers,Sociocultural Factors,and Availability of Gambling

Finnish treatment-seeking gamblers were examined in light of predominant problem gambler subtype models. “Psy science” oriented problem gambler subtypes were found to be considerably influenced by gambling cultures and treatment traditions in the countries from which the mainstream problem gambler research originates. Thus, models that emphasize the psychopathology of the individual might cause some friction when applied to countries like Finland with a quite particular gambling culture and addiction treatment system that traditionally functions on a social work basis. It is suggested that specialists helping problem gamblers should acquire local knowledge with which to complete psychiatrically oriented scientific knowledge.