“While grief is fresh, every attempt to divert only irritates. You must wait till grief be digested, and then amusement will dissipate the remains of it.” Samuel Johnson, quoted in James Boswell, Life of Samuel Johnson, 10 April 1776 (1791).

During this anniversary time, our thoughts are with all those who have been touched by the horrible and senseless events of September 11th, 2001. WhatWhat DoDo GamingGaming RegulationsRegulations Regulate?Regulate?

AA PublicPublic HealthHealth PerspectivePerspective onon DisorderedDisordered GamblingGambling && RegulationRegulation

Howard J. Shaffer Richard LaBrie

TheThe DivisionDivision onon AddictionsAddictions HarvardHarvard MedicalMedical SchoolSchool OnOn thethe EconomyEconomy

““TheThe government’sgovernment’s viewview ofof thethe economyeconomy couldcould bebe summedsummed upup inin aa fewfew shortshort phrases...”phrases...” “If“If itit moves,moves, taxtax it.”it.” “If“If itit keepskeeps moving,moving, regulateregulate it.”it.” “And“And ifif itit stopsstops moving,moving, subsidizesubsidize it.”it.”

Ronald Reagan (presidential address, August 15, 1986, to the WhiteWhite HouseHouse ConferenceConference onon SmallSmall BusinessBusiness) ObjectivesObjectives

„ ExamineExamine thethe purposepurpose ofof regulationregulation „ ConsiderConsider thethe epidemiologyepidemiology ofof gamblinggambling „ WhatWhat isis moving?moving? „ DefineDefine thethe objectobject ofof gamblinggambling regulationregulation „ ConsiderConsider modelsmodels ofof disordereddisordered gamblinggambling „ PresentPresent regulatoryregulatory activitiesactivities fromfrom aa publicpublic healthhealth perspectiveperspective „ ConsiderConsider thethe epidemiologyepidemiology ofof regulationsregulations „ SuggestSuggest thethe needneed andand implicationsimplications forfor modelmodel drivendriven regulationsregulations ““IdeasIdeas havehave consequences.”consequences.” RichardRichard WeaverWeaver WhatWhat GamblingGambling EventsEvents areare “Moving”?“Moving”?

„ GrowthGrowth ofof gambling?gambling? „ GrowthGrowth ofof GamblingGambling relatedrelated problems?problems? „ IncreaseIncrease inin numbernumber ofof newlynewly disordereddisordered gamblersgamblers (incidence)?(incidence)? „ IncreaseIncrease inin proportionproportion ofof disordereddisordered gamblersgamblers (prevalence)?(prevalence)? ¾ EachEach ofof thesethese eventsevents reflectsreflects thethe epidemiologyepidemiology ofof gamblinggambling GamblingGambling RelatedRelated EventsEvents thatthat EncourageEncourage RegulationRegulation

„ IncreaseIncrease inin thethe socialsocial perceptionperception thatthat gamblinggambling isis aa problem?problem? „ SocialSocial perceptionperception ofof gamblersgamblers asas unableunable toto regulateregulate themselvesthemselves——asas ifif theythey havehave anan addiction?addiction? „ PerceptionPerception ofof thethe gaminggaming industryindustry asas unableunable toto regulateregulate itself?itself? Dr.Dr. RichardRichard LaBrieLaBrie

AssociateAssociate Director,Director, ResearchResearch && MethodsMethods DivisionDivision onon AddictionsAddictions atat HarvardHarvard MedicalMedical SchoolSchool Gamblers:Gamblers: RatesRates ofof GamblingGambling ParticipationParticipation

90 80 86 70 68 60 61 63 50 40 30 20 10 0 1975 1998 Past-year Gamblers Lifetime Gamblers

Source: National Gambling Impact Study CasinoCasino GamblingGambling Industry:Industry: NumberNumber ofof StatesStates withwith CasinosCasinos

25 21

20

15

10

5 1

0 1975 1998

Source: National Gambling Impact Study GrowthGrowth inin NationalNational GrossGross GamblingGambling RevenueRevenue

60

50 Total Gambling Revenue 40

30 Non-Casino Revenue 20 Dollars (Billions) Dollars 10 Casino Revenue 0

5 991 992 993 994 99 998 999 000 1990 1 1 1 1 1 1996 1997 1 1 2

Source: Christiansen Capital Advisors, American Gaming Association LevelsLevels ofof GamblingGambling

„ LevelLevel 00

„ No gambling

„ LevelLevel 11

„ Prevalence of Asymptomatic Gambling

„ LevelLevel 22

„ Prevalence of Symptomatic Gambling

„ LevelLevel 33

„ Prevalence of Gambling Disorder *Adapted from Shaffer & Hall, 1996 ComparingComparing PastPast YearYear AdultAdult EstimatesEstimates

Kallick Harvard Harvard NRC NORC Buffalo 1974 1974-97 1974-99 1974-97 1999 2001** Level 1 97.0 96.0 96.7 97.1 95.8 94.5/96.5 95.04 – 97.04 94.82 – 97.26

Level 2 2.2 2.8 2.2 2.0 3.6 3.6/2.2 1.95 – 3.65 1.72 – 3.37

Level 3 0.7 1.1 1.1 .9 0.6 1.9/1.3 .90 - 1.38 .92 – 2.01

• 1997 Harvard data represents unweighted means & 95% confidence intervals • 2000 Harvard data represents Andrews Wave M-estimator & 96% confidence intervals • ** Welte et al., Journal of Studies on Alcohol, Buffalo Research Institute on Addictions, using SOGS/DIS-IV Past Year International Estimates

U.S. U.S. Sweden Switzerland New British South 1979* 2000** 2001*** 2000♦ Zealand 2000♠ Africa Adults 2001♣ 2001♥ LEVEL 97.1 96.8 98.0 97.0 98.7 99.3 -- 1

LEVEL 2.2 2.2 1.4 2.2 0.8 -- -- 2

LEVEL 0.7 1.1 0.6 0.8 0.5 0.7 1.1/1.4♦ 3

*(Kallick, Suits, Dielman, & Hybels, 1979) **(Shaffer & Hall, 2001) ***(Volberg, Abbott, Ronnberg, & Munck, 2001) ♦(Bondolfi, Osiek, & Ferrero, 2000) ♣(Abbott, 2001) ♠(Sproston, Erens, & Orford, 2000) ♥(Collins & Barr, 2001, GA 20 Questions/SOGS estimates)

ThreeThree SidesSides toto EveryEvery StoryStory

„ GamingGaming industryindustry proponentsproponents tendtend toto focusfocus onon populationpopulation segmentssegments withwith lowlow ratesrates (e.g., 1.6 lifetime for adults) „ GamblingGambling opponentsopponents tendtend toto focusfocus onon populationpopulation segmentssegments withwith highhigh ratesrates (e.g., 3.9 for youth or 4.7 for college) „ ScientistsScientists notenote thatthat nono singlesingle raterate adequatelyadequately describesdescribes thethe prevalenceprevalence ofof disordereddisordered gamblinggambling „ For example, a single rate approach exaggerates adults rates while under estimating youth rates ConsideringConsidering NevadaNevada

„ NevadaNevada isis America’sAmerica’s mostmost exposedexposed gamblinggambling settingsetting (e.g.,(e.g., durationduration && dose)dose) „ NewNew findingsfindings andand studystudy characteristicscharacteristics „ MethodMethod „ Random Digit Dialing Telephone survey „ RespondentsRespondents „ Adults – 2217 „ Youth – 1004 „ ResponseResponse RateRate -- Council of American Survey Research Organizations (CASRO) „ Adult – 24% „ Youth – 52% NevadaNevada StudyStudy CharacteristicsCharacteristics

„ InstrumentsInstruments „ AdultAdult –– SOGSSOGS && NODSNODS „ YouthYouth –– SOGSSOGS--RA,RA, DSMDSM--IVIV--MRMR--JJ „ ExclusionExclusion screeningscreening forfor comorbidcomorbid disordersdisorders „ ForFor example,example, maniamania „ UnclearUnclear fromfrom reportreport whetherwhether anyany suchsuch screeningscreening waswas donedone ComparingComparing AdultAdult PastPast YearYear Estimates:Estimates: ConsideringConsidering NevadaNevada NORC Nevada Nevada NODS NODS SOGS 1999 2002 2002 Level 1 95.8 97.9 93.6

Level 2 3.6 1.8 2.9

Level 3 0.6 0.3 3.5

• Nevada data collected during 2000 ComparingComparing PastPast YearYear EstimatesEstimates inin thethe AbsenceAbsence ofof aa GoldGold StandardStandard National Nevada Estimates Estimates Kallick NORC Nevada Kallick Nevada et al. NODS NODS et al. SOGS 1979 1999 2002 1979 2002

Level 1 97.1 95.8 97.9 93.6

Level 2 2.2 3.6 1.8 2.9

Level 3 0.7 0.6 0.3 2.6 3.5

• Nevada data collected during 2000 •Have rates in Nevada declined since 1979? •Are the NV rates higher or lower than recent national estimates? •Have Nevada rates changed in proportion to the growth of gambling?

ObjectivesObjectives

„ ExamineExamine thethe purposepurpose ofof regulationregulation „ ConsiderConsider thethe epidemiologyepidemiology ofof gamblinggambling „ DefineDefine thethe objectobject ofof gamblinggambling regulationregulation „ ConsiderConsider modelsmodels ofof disordereddisordered gamblinggambling „ PresentPresent regulatoryregulatory activitiesactivities fromfrom aa publicpublic healthhealth perspectiveperspective „ ConsiderConsider thethe epidemiologyepidemiology ofof regulationsregulations „ SuggestSuggest thethe needneed andand implicationsimplications forfor modelmodel drivendriven regulationsregulations ConsideringConsidering ModelsModels ofof DisorderedDisordered GamblingGambling

HowHow wewe explainexplain gamblinggambling determinesdetermines howhow wewe treattreat andand regulateregulate itit JaneJane WagnerWagner (Playwright)(Playwright)

“After all, what is reality anyway? Nothin’ but a collective hunch.... reality is the leading cause of stress amongst those in touch with it.”

(Wagner, 1986, p. 18; & spoken by Lilly Tomlin in Search for Signs of Intelligent Life in the Universe). SelectedSelected ModelsModels

„ Moral turpitude „ Psycho-Social „ Psychological „ Psycho-economic „ Bad Judgment „ Impulse Control Disorder „ Regulatory problems „ Behavioral „ Cognitive „ Biological „ Cognitive-Behavioral „ Reward deficiency „ Adaptation „ Neuro-genetic vulnerability „ Social „ Public Health „ Economic „ Multidimensional issue „ Exposure The highlighted models are most sensitive to regulatory activity PathologicalPathological Gambling?Gambling? Spectrum Dependence Other Unknown Disorder? Disorders Manic Episodes

Pathological Gambling Personality Disorder Depression WilliamWilliam ShakespeareShakespeare

““MiseryMisery acquaintsacquaints aa manman withwith strangestrange bedfellows”bedfellows” (The(The tempest,tempest, actact 2,2, scenescene 22) Disorder (18 Years & Older) % ComparingComparing Anorexia Nervosa 0.1 Schizophrenia 1.0 RevisedRevised Kleptomania 1.1 OneOne--YearYear Level 3 Gambling♣ 1.1 PrevalencePrevalence Panic 1.4 Antisocial Personality 1.5 RatesRates ofof Dysthymia 1.6 MentalMental Level 2 Gambling♣ 2.1 DisordersDisorders Obsessive-Compulsive 2.1 Agoraphobia 2.1 Major Depression 4.0 Narrow et al. (2002). Arch. of Gen. Psych. Any Alcohol 5.2 Any Substance Use Disorder 6.0 ♣ Shaffer & Hall (2001) Canadian J. Public Any Anxiety 11.8 Health. Any Mental 14.9 RegulationRegulation && ComorbidityComorbidity

„ ItIt isis notnot possiblepossible toto regulateregulate comorbidcomorbid psychiatricpsychiatric disordersdisorders withwith publicpublic policypolicy „ ItIt mightmight notnot bebe possiblepossible toto regulateregulate disordereddisordered gamblinggambling ifif itit isis aa “true”“true” impulseimpulse disorderdisorder withwith biogeneticbiogenetic originsorigins BehavioralBehavioral ModelModel ofof Gambling:Gambling: SchedulesSchedules ofof OperantOperant ReinforcementReinforcement

„ FixedFixed IntervalInterval „ VariableVariable IntervalInterval „ FixedFixed ratioratio „ VariableVariable ratioratio VariableVariable RatioRatio ReinforcementReinforcement

„ ReinforcingReinforcing eventsevents occuroccur afterafter aa variablevariable oror constantlyconstantly changingchanging numbernumber ofof eventsevents oror actsacts (e.g.,(e.g., wagers)wagers) „ ReinforcementReinforcement holdsholds thethe potentialpotential toto shapeshape behaviorbehavior „ IncreasesIncreases thethe likelihoodlikelihood ofof precedingpreceding behaviorbehavior occurringoccurring againagain „ ReinforcementReinforcement isis thethe psychoactivepsychoactive componentcomponent ofof gamblinggambling (i.e.,(i.e., thethe whatwhat somesome thinkthink ofof asas “addictiveness”)“addictiveness”) ActivitiesActivities withwith VRRVRR schedulesschedules

„ GamblingGambling –– regulatedregulated byby federalfederal && statestate governmentgovernment „ InvestingInvesting –– regulatedregulated byby federalfederal governmentgovernment „ FishingFishing && huntinghunting –– regulatedregulated byby locallocal governmentgovernment „ GolfingGolfing –– regulatedregulated byby twotwo internationalinternational bodiesbodies (USGA(USGA && R&A)R&A) „ GreatGreat sexsex –– regulatedregulated byby …… „ ScientificScientific researchresearch –– regulatedregulated byby professionalprofessional associationsassociations (APA)(APA) OnOn ScienceScience && GamblingGambling

“All scientific work pays off on a variable ratio schedule of reinforcement. So do hunting, fishing, exploring, prospecting, and so on. You never can tell when you are going to be reinforced, but reinforcements do keep turning up. The dedicated scientist is exactly like a pathological gambler. He's been hooked by a system, but in a way which is profitable for everyone. The scientist is fascinated by what he does, just as the gambler is, but nobody is taking his shirt. He's getting something out of it, and so is society” (B.F. Skinner, August, 1983, p. 39). RegulationRegulation andand TheoryTheory

„ ModelsModels ofof gamblinggambling cancan bebe eithereither implicitimplicit oror explicitexplicit „ RegulatoryRegulatory activitiesactivities areare notnot randomrandom „ RegulationRegulation isis modelmodel drivendriven „ TheseThese modelsmodels oftenoften areare implicitimplicit „ TwoTwo importantimportant modelsmodels drivedrive socialsocial perceptionperception andand thereforetherefore regulationregulation „ ExposureExposure „ AdaptationAdaptation „ AreAre thesethese modelsmodels supportedsupported byby evidence?evidence? ExposureExposure

MeasuringMeasuring ExposureExposure toto Gambling:Gambling: NoveltyNovelty andand IncreasingIncreasing RatesRates

AdaptationAdaptation

HabituationHabituation andand DecreasingDecreasing RatesRates ComparingComparing NevadaNevada YouthYouth PastPast YearYear EstimatesEstimates DSM-IV-MR-J SOGS-RA

Level 1 94.4 87.9

Level 2 4.5 9.9

Level 3 1.1 2.2

• Nevada data collected during 2001 • Age 13-17; N = 1004 ComparingComparing NevadaNevada YouthYouth PastPast YearYear EstimatesEstimates

Nevada National DSM-IV- SOGS- Harvard NRC NORC MR-J RA 2000 1999 1999 2001 2001 Level 1 94.4 87.9 82.7 80.0 82.0

Level 2 4.5 9.9 14.6 13.9 15.0*

Level 3 1.1 2.2 4.8 6.1 3.0

• Nevada youth ages 13-17; N= 1004 • *Type C, without $100.00 NODS loss requirement

NevadaNevada YouthYouth

„ ComparedCompared withwith theirtheir counterpartscounterparts fromfrom lessless gamblinggambling exposedexposed settingssettings „ NevadaNevada youthyouth diddid notnot gamblegamble atat anan earlierearlier ageage „ DidDid notnot gamblegamble atat casinoscasinos moremore „ WillWill thisthis cohortcohort decreasedecrease thethe prevalenceprevalence raterate ofof adultsadults whenwhen theythey mature?mature? „ ObserversObservers havehave suggestedsuggested thatthat higherhigher youthyouth ratesrates meansmeans thatthat adultadult ratesrates willwill gogo upup –– itit seemsseems thethe oppositeopposite alsoalso shouldshould bebe true!true! PublicPublic HealthHealth PerspectivesPerspectives onon GamblingGambling

FromFrom CostsCosts && BenefitsBenefits toto RegulatoryRegulatory OpportunitiesOpportunities PublicPublic HealthHealth FrameworkFramework toto UnderstandUnderstand GamblingGambling

Gambling Problems none mild moderate

No severe Healthy Unhealthy Gambling Gambling Gambling

brief intensive treatment Tertiary prevention or harm reduction primary prevention

secondary prevention

Public Health Interventions AssessingAssessing thethe ImpactImpact ofof GamblingGambling

„ CostsCosts „ BenefitsBenefits PotentialPotential CostsCosts

„ GamblingGambling disordersdisorders „ AlcoholAlcohol && DrugDrug „ FamilyFamily problemsproblems ProblemsProblems „ SuicideSuicide „ YouthYouth GamblingGambling „ PsychiatricPsychiatric „ CrimeCrime ConditionsConditions „ FinancialFinancial ProblemsProblems VulnerableVulnerable PopulationPopulation SegmentsSegments

„ SocioSocio--economicallyeconomically disadvantageddisadvantaged „ HomelessHomeless „ EthnicEthnic minorityminority groupsgroups „ YouthYouth „ ElderlyElderly „ CasinoCasino employeesemployees ComparingComparing YouthYouth EstimatesEstimates

Past Year Harvard NRC NORC

Level 1/Type A+B* 82.7

Level 2/Type C* 14.6 13.9 15.0*

Level 3/Type D+E 4.8 6.1 3.0

• NORC Classification System • Unweighted Means & 95% Confidence Intervals • *Type C, without $100.00 NODS loss requirement LifetimeLifetime EstimatesEstimates ofof “Special”“Special” PopulationsPopulations Unweighted Means & 95% Confidence Intervals College Adults in Students Treatment N = 8,918 N = 6,590 Level 1 86.66 71.54 80.90 – 92.42 62.90 – 80.18 Level 2 9.28 15.01 4.43 – 14.12 8.94 – 21.07 Level 3 4.67 14.23 3.44 – 5.90 10.70 – 17.75

HomelessHomeless TreatmentTreatment SeekersSeekers

N Valid Percent Cumulative % Level 1 134 81.7 81.7 Level 2 21 12.8 94.5 Level 3 9 5.5 100.0 Total 164 100.0 Missing 7 Total 171

Shaffer, Freed & Healea, 2002 PotentialPotential BenefitsBenefits

„ AdultAdult playplay „ ReducesReduces anxietyanxiety && stressstress „ CardiovascularCardiovascular stimulationstimulation „ SimilarSimilar toto sexsex oror winewine „ SocialSocial integrationintegration „ RelevantRelevant forfor thethe elderlyelderly „ EconomicEconomic developmentdevelopment General Accounting Office (2000)

"Neither NGISC nor our Atlantic City case study was able to clearly identify the social effects of gambling for a variety of reasons. The amount of high quality and relevant research on social effects is extremely limited. While data on family problems, crime, and suicide are available, tracking systems generally do not collect data on the causes of these incidents, so they cannot be linked to gambling...” General Accounting Office (2000)

“… while studies have shown increases in social costs of pathological gamblers, it is difficult to isolate whether gambling is the only factor causing these problems because pathological gamblers often have other behavior disorders” (General Accounting Office, 2000, p. 3). General Accounting Office (2000) “While …some testimonial evidence that gambling, particularly pathological gambling, has resulted in increased family problems…, crime, and suicides, NGISC reached no conclusions on whether gambling increased family problems, crime, or suicide for the general population. Similarly, we found no conclusive evidence on whether or not gambling caused increased social problems in Atlantic City” (General Accounting Office, 2000, p. 3). ObjectivesObjectives

„ ExamineExamine thethe purposepurpose ofof regulationregulation „ ConsiderConsider thethe epidemiologyepidemiology ofof gamblinggambling „ DefineDefine thethe objectobject ofof gamblinggambling regulationregulation „ ConsiderConsider modelsmodels ofof disordereddisordered gamblinggambling „ PresentPresent regulatoryregulatory activitiesactivities fromfrom aa publicpublic healthhealth perspectiveperspective „ ConsiderConsider thethe epidemiologyepidemiology ofof regulationsregulations „ SuggestSuggest thethe needneed andand implicationsimplications forfor modelmodel drivendriven regulationsregulations RegulatingRegulating GamblingGambling && ItsIts ConsequencesConsequences

PrimaryPrimary ObjectsObjects ofof RegulationRegulation PublicPublic HealthHealth RegulatoryRegulatory TargetsTargets

„ PeoplePeople && GroupsGroups „ PopulationPopulation ofof gamblersgamblers „ GamingGaming industryindustry „ GamblingGambling activitiesactivities „ ExposureExposure && accessaccess toto gamblinggambling „ GamblingGambling settingssettings „ IndustryIndustry growthgrowth „ ActivitiesActivities withinwithin gamblinggambling settingsetting „ ActivitiesActivities aroundaround gamblinggambling settingsetting PrimaryPrimary ProductsProducts ofof RegulatoryRegulatory EffortsEfforts

„ HotlinesHotlines && helphelp „ LossLoss limitslimits lineslines „ MarketingMarketing && directdirect „ AdvertisingAdvertising mailmail „ AlcoholAlcohol serviceservice „ SignageSignage „ CreditCredit „ PublicPublic awarenessawareness „ EmployeeEmployee trainingtraining „ SelfSelf--exclusionexclusion „ TreatmentTreatment fundingfunding

Source: American Gaming Association (March 2002). Statutes and regulations in commercial casino states concerning responsible gaming. ClassifyingClassifying thethe ObjectsObjects ofof RegulatoryRegulatory ActivitiesActivities „ InitiationInitiation „ Awareness „ Prevention „ Advertising/Marketing „ GamblingGambling && gamblinggambling--relatedrelated activitiesactivities „ Signage „ Employee training – pathological gambling & education „ Alcohol service „ Credit restrictions „ Loss limits „ ConsequencesConsequences ofof GamblingGambling „ Self-exclusion „ Helpline „ Treatment RegulatoryRegulatory ActivitiesActivities 20022002 Helpline Advertising Alcohol Credit Employee Training Employee PG prevention Loss limits Marketing Signage Public Awareness Self-exclusion Treatment funding

8 6 4 2 0

Regulations ri y a s u pi i ta gan ip i Iowa ako Nevad Illino D Indiana Misso . Mich ississ Louisiana S Colorado New JerseM Casino States

Source: American Gaming Association. (2002). Statutes & Regulations in Commercial Casino States Concerning Responsible Gaming. RegulatoryRegulatory ActivitiesActivities 20022002 Colorado Illinois Indiana Iowa Louisiana Michigan Mississippi Missouri New Jersey Nevada S. Dakota

8 6 4 2 States 0

. edit lu... imits w... sing Cr rti Alcohol e tment.. HelplineSignage ic A v bl Marketingd ea Loss l A Tr Self-exc Emp. Training Pu Emp. PG p... Regulatory Activities

Source: American Gaming Association. (2002). Statutes & Regulations in Commercial Casino States Concerning Responsible Gaming. NaturalNatural HistoryHistory ofof Gambling:Gambling: TargetsTargets ofof StatutesStatutes && RegulationsRegulations inin CasinoCasino StatesStates (2002)(2002)

13%

40% Initiation Gambling Consequences

47%

Source: American Gaming Association. (2002). Statutes & Regulations in Commercial Casino States Concerning Responsible Gaming. TargetsTargets ofof RegulatoryRegulatory ActivitiesActivities 20022002

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

a w pi na ouri sey ada s r Io v sip s isiana Illinois dia orado ichigan is Je Ne si u In M w s M e Lo S. Dakota Col N Mi

Initiation Gambling Related Activities Consequences

Source: American Gaming Association. (2002). Statutes & Regulations in Commercial Casino States Concerning Responsible Gaming. ExplainingExplaining RegulatoryRegulatory PatternsPatterns

„ PerhapsPerhaps regulatoryregulatory activitiesactivities areare aa functionfunction ofof durationduration ofof legalizedlegalized gamblinggambling „ WeWe cancan comparecompare thethe regulationsregulations ofof NevadaNevada && NewNew JerseyJersey withwith otherother statesstates toto testtest thisthis ideaidea „ TheyThey havehave similarsimilar oror fewerfewer regulationsregulations „ SoSo wewe concludeconclude thatthat durationduration doesdoes notnot explainexplain statestate differencesdifferences ObjectivesObjectives

„ ExamineExamine thethe purposepurpose ofof regulationregulation „ ConsiderConsider thethe epidemiologyepidemiology ofof gamblinggambling „ DefineDefine thethe objectobject ofof gamblinggambling regulationregulation „ ConsiderConsider modelsmodels ofof disordereddisordered gamblinggambling „ PresentPresent regulatoryregulatory activitiesactivities fromfrom aa publicpublic healthhealth perspectiveperspective „ ConsiderConsider thethe epidemiologyepidemiology ofof regulationsregulations „ SuggestSuggest thethe needneed andand implicationsimplications forfor modelmodel drivendriven regulationsregulations OnOn PublicPublic PolicyPolicy

““BadBad lawslaws punishpunish manymany peoplepeople andand deterdeter few.few. “Good“Good lawslaws punishpunish fewfew peoplepeople andand preventprevent many.”many.” „ NormanNorman E.E. ZinbergZinberg EffortsEfforts toto RegulateRegulate cancan havehave ManyMany DifferentDifferent EffectsEffects

„ IncreaseIncrease gamblinggambling relatedrelated problemsproblems „ DecreaseDecrease gamblinggambling relatedrelated problemsproblems „ BeBe independentindependent ofof gamblinggambling relatedrelated problemsproblems „ InfluenceInfluence gamblinggambling relatedrelated problemsproblems throughthrough anotheranother independentindependent factorfactor RegulationRegulation andand TheoryTheory

„ RegulatoryRegulatory activitiesactivities areare notnot randomrandom „ TheThe modelmodel drivingdriving regulatoryregulatory activitiesactivities isis notnot readilyreadily apparentapparent „ ModelsModels cancan bebe eithereither implicitimplicit oror explicitexplicit „ ToTo advanceadvance aa sciencescience ofof regulation,regulation, wewe encourageencourage developingdeveloping explicitexplicit modelsmodels RegulatoryRegulatory ConsequencesConsequences ofof ExposureExposure && AdaptationAdaptation ModelsModels

„ TwoTwo modelsmodels influenceinfluence socialsocial perceptionperception andand thereforetherefore regulatoryregulatory activities:activities: „ Exposure „ Adaptation „ ExposureExposure „ If accurate, is associated with a slow regulatory response, or under-reaction given the “incubation” of disease following exposure „ AdaptationAdaptation „ If accurate, suggests that there is regulatory over- reaction since the population tends to adjust for the presence of the toxic agent AvailableAvailable ResourcesResources && LinksLinks

„ www.hms.harvard.edu/doawww.hms.harvard.edu/doa „ ThisThis presentationpresentation willwill bebe availableavailable inin thethe TimesTimeslibrarylibrary andand archivesarchives sectionsection ofof ourour HarvardHarvard webweb sitesite „ www.thewager.orgwww.thewager.org „ TheseThese sitessites werewere featuredfeatured inin thethe NewNew YorkYork technologytechnology sectionsection onon MarchMarch 29,29, 20012001 AcknowledgementsAcknowledgements

„ DebiDebi LaPlanteLaPlante „ RachelRachel KidmanKidman „ ChrissyChrissy ThurmondThurmond „ ChrisChris ReillyReilly „ MatthewMatthew HallHall „ JoniJoni VanderVander BiltBilt „ ChrisChris FreedFreed „ TheThe NationalNational CenterCenter forfor ResponsibleResponsible GamingGaming