A review of research on aspects of problem gambling

Abstract

AIM: To review research on the development of, and risk factors for, problem gambling; on intervention options for the treatment of problem gambling and the effectiveness of these options; and on alternative approaches to public education and awareness raising about the risks of gambling and assessment of their effectiveness. METHOD: Hundreds of publications were identified through online databases as well as in specialist libraries accessed through web-based searches. RESULTS: Adoption of a public health approach to problem gambling challenges the view of this disorder as relatively rare and shifts the focus to include gambling provision and regulation. There are strong conceptual and methodological disagreements about what constitutes problem gambling and how to measure it. Significant increases in access to continuous gambling forms will likely generate increases in problem gambling. It is not known is if problem escalation can be prevented through active measures. Very few people with gambling problems report them or receive assistance. Most health professionals who have contact with problem gamblers are probably unaware that they do. Due to lack of evaluation, little can be said with confidence about the effectiveness of intervention options for the treatment of problem gambling. This includes the needs of population subgroups, although the expansion in gambling opportunities in the U.K. can be expected to affect youth, women and ethnic and new migrant minorities disproportionately. It is not yet possible to identify the most effective public health methods to prevent the onset and progression of gambling problems in the general population. Strategies which stretch across the domains of family, school and community, include a range of activities and target multiple risk behaviours are most likely to be effective. Evidence suggests that effective problem gambling awareness campaigns targeting adults can lead to measurable positive effects. Evaluation of industry preventative policies tends to have focused on exclusion, although other measures also require attention. Future directions for prevention research in relation to practitioners are suggested by the growing involvement of counsellors in voluntary exclusion programmes as well as the promise of brief interventions in formal problem gambling treatment. CONCLUSION: There is a need for a comprehensive gambling monitoring system in the U.K. Credible measures need to be developed from a clear conceptual framework. There is a tremendous need for longitudinal research to improve our understanding of the relative role of different risk factors. There is a need for education and training for non-specialist professionals as well as additional training in substance misuse and mental illness among specialist professionals working with problem gamblers. Long-term strategic plans for treatment research and evaluation are needed along with provision for multi-year funding streams. In developing mass media campaigns, it will be essential to conduct formative research to develop targeted and effective messages, use television as a broadcast medium and plan for extended campaigns. Research on gambling provision should focus on Responsible Gaming Features (RGFs), the effectiveness of pre-commitment betting limits and links between pre-commitment limits and RGFs or exclusion programmes, as well as 'host responsibility' training of staff.

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