1 2012 PREVENTION OF PROBLEM GAMBLING: A Comprehensive Review of the Evidence and Identified Best Practices Robert J. Williams Professor, Faculty of Health Sciences, and Coordinator, Alberta Gambling Research Institute University of Lethbridge, Lethbridge, Alberta, Canada Beverly L. West Research Associate, Faculty of Health Sciences University of Lethbridge, Lethbridge, Alberta, Canada Robert I. Simpson Past CEO, Ontario Problem Gambling Research Centre Guelph, Ontario, Canada REPORT PREPARED FOR THE ONTARIO PROBLEM GAMBLING RESEARCH CENTRE AND THE ONTARIO MINISTRY OF HEALTH AND LONG TERM CARE October 1 2012 2 History of this document Short version appears in a book chapter: Aug 2007 Williams, R.J., West, B.L., & Simpson, R.I. (2007a). Prevention of problem gambling. In G. Smith, D. Hodgins, and R.J. Williams (Eds.), Research and Measurement Issues in Gambling Studies. pp. 399-435. San Diego, CA: Elsevier. http://hdl.handle.net/10133/414 Long version prepared as a report for the Ontario Problem Gambling Research Centre: Williams, R.J., West, B.L., & Simpson, R.I. (2007b). Prevention of Problem Gambling: A Dec 2007 Comprehensive Review of the Evidence. Report prepared for the Ontario Problem Gambling Research Centre. Guelph, Ontario, Canada. Dec 1, 2007. http://hdl.handle.net/10133/414 Separate report prepared on Promising Practices in Prevention: Williams, R.J., & Simpson, R.I. (2008). Promising Practices in the Prevention of Problem Nov 2008 Gambling. Final Report prepared for the Ontario Problem Gambling Research Centre and the Ontario Ministry of Health and Long Term Care. November 14, 2008. http://hdl.handle.net/10133/751 Minor literature update to the Dec 2007 report: Williams, R.J., West, B.L., & Simpson, R.I. (2008). Prevention of Problem/Pathological Dec 2008 Gambling: A Comprehensive Review of the Evidence. Report prepared for the Ontario Problem Gambling Research Centre. Guelph, Ontario, Canada. December 1, 2008. http://hdl.handle.net/10133/414 Current Substantive literature update and integration with the Promising Practices in the document Prevention of Problem Gambling document. Citation Williams, R.J., West, B.L., & Simpson, R.I. (2012). Prevention of Problem Gambling: A Comprehensive Review of the Evidence, and Identified Best Practices. Report prepared for the Ontario Problem Gambling Research Centre and the Ontario Ministry of Health and Long Term Care. October 1, 2012. http://hdl.handle.net/10133/3121 Acknowledgements There are many external reviewers who have provided helpful feedback on the current and earlier versions of this document. However, in particular, the authors acknowledge the very useful feedback provided by Dr. Tim Stockwell (Director, Centre for Addictions Research of British Columbia, University of Victoria). Contact Information Dr. Robert Williams Professor, Faculty of Health Sciences & Coordinator, Alberta Gambling Research Institute University of Lethbridge Lethbridge, Alberta, Canada; T1K 3M4 [email protected] 3 INTRODUCTION………………………………………………………………………………………………..…………………….…… 5 ETIOLOGICAL FRAMEWORK FOR PROBLEM GAMBLING………………………………….……………………….….. 7 Indirect Biological Risk Factors…………………………………………………………………………..… 7 Indirect Environmental Risk Factors…………………………………………………………………….. 9 Direct Risk Factors……………………………………………………………………………………………….. 9 Problem and Pathological Gambling…………………………………………………………………….. 10 METHODOLOGICAL APPROACH…………………………………………………………………………………………………… 13 EDUCATIONAL INITIATIVES……………………………………………..…………………………………………………………… 15 Childhood Interventions ……………………..………..…………………………………………………,…. 15 Information/Awareness Campaigns………………………………………................................ 15 Responsible Gambling Information Centres…………………………………………………………. 20 Statistical Instruction…………………….……………………………………………………………………… 21 School-Based Prevention Programs…………………………………….................................... 22 POLICY INITIATIVES………………………………………………………….………………………………………………………….. 25 RESTRICTIONS ON THE GENERAL AVAILABILITY OF GAMBLING……………………………………….. 25 Restricting the Number of Gambling Venues……………………………………………………….. 26 Restricting More Harmful Types of Gambling….…………………………………………………… 29 Continuous Forms of Gambling………….…………………………………………………….. 29 Internet Gambling……………………………….…………………………………………………… 35 Restricting the Number of Gambling Formats……………..….…………………………………… 37 Restricting Gambling to Dedicated Gambling Venues ………….................................. 37 Restricting the Location of Gambling Venues……………….......................................... 40 Limiting Gambling Venue Hours of Operation………………….…..……………………………… 41 RESTRICTIONS ON WHO CAN GAMBLE………………………………………….………………………………… 43 Prohibition of Youth Gambling…………………………………………………………………………….. 43 Increasing the Legal Age for Gambling …………………………………………………… 44 Restricting Venue Entry to Non-Residents……………………………………………………………. 45 Restricting Venue Entry to Higher Socioeconomic Classes….................................... 46 Casino Self-Exclusion……………………………………………………………………………………………. 46 RESTRICTIONS OR ALTERATIONS ON HOW GAMBLING IS PROVIDED.................................. 52 Modifying Electronic Gambling Machine (EGM) Parameters………………………………… 52 Win/Loss Patterns…………………………………………………………………………………….. 52 Game Play Speed……………………………………………………………………………………… 53 Near Misses…………………………………………………………….……………………………….. 53 Number of Play Lines………………………………………………………………………………… 54 Bill Acceptors………………………………………………………….………………………………… 54 4 Stake and Prize Size…………………………………………………………………………………. 55 Payback Percentage……………………………………………….………………………………… 56 Interactive Features………………………………………………………………………………….. 57 Pop-Up Messages…………………………………………………………………………………….. 58 On-Screen Clocks……………………………………………………………………………………… 59 Mandatory Cash-Out………………………………………………………………………………… 59 Privacy……………………………………………………………………………………………………… 59 Money versus Credits……………………………………………………………………………….. 60 Lights and Sounds…………………………………………………………………………………….. 60 Seating……………………………………………………………………………………………………… 60 Summary of EGM Parameter Modifications………………………………………………….. 61 Player Pre-Commitment………………………………………………………………………………………. 61 Eliminating Reward/Loyalty Cards or Changing Their Parameters.……………………….. 65 Operator Imposed Maximum Loss Limits……………………………………………………………… 66 Proactive Intervention with ‘At-Risk’ Gamblers……………………………………………………. 67 Problem Gambling Awareness Training to Employees………………………………. 67 Automated or Mandated Intervention……………………………………………………… 68 Restricting Access to Money………………………………………………….……………………………. 70 Restrictions on Concurrent use of Alcohol and Tobacco……..................................... 72 Restricting Advertising………………………………………..…………........................................ 74 Gambling Venue Design ………………………………………………………………………………………. 76 Increasing the Cost of Gambling…………………………………………………………………………… 77 Government Provision of Gambling..……………………..……………………………………………. 78 SUMMARY OF THE EFFECTIVENESS OF EDUCATIONAL AND POLICY INITIATIVES…………………………. 81 BEST PRACTICES TO PREVENT PROBLEM GAMBLING…………………………………………………………………… 84 1. Strive for Optimal Design and Evaluation of New Initiatives………………………….…………… 84 2. Recognize that Effective Prevention requires Decreased Revenue and some Inconvenience to Non-Problem Gamblers……………………………………………………………….… 86 3. Employ a Wide Array of Educational and Policy Initiatives…………………………………………. 87 4. Coordinate these Multiple Educational and Policy Initiatives..…………………………………… 89 5. Decrease the General Availability of Gambling………………………………………………………….. 90 6. Eliminate, Reduce, and/or Constrain Higher-Risk Forms of Gambling………………………… 92 7. Eliminate Reward Cards or use them to Foster Responsible Gambling………………………. 93 8. Restrict who is Eligible to Gamble……………………………………………………………………………… 94 9. Restrict the use of Tobacco and Alcohol while Gambling…………………………………………… 95 10. Restrict Access to Money while Gambling…………………………………………………………………. 96 11. Impart Knowledge, Attitudes, and Skills to Gamblers ..……………………………………………… 97 12. Keep Prevention Initiatives in Place for a Sustained Period..……………………………………… 99 REFERENCES………………………………………………………………………………………………………………………………… 100 5 INTRODUCTION The past 30 years has seen a dramatic worldwide expansion of legalized gambling. The overall social and economic costs and benefits of this expansion are mixed (Williams, Rehm, & Stevens, 2011). However, what is clear is that one of the primary negative impacts of widely available gambling opportunities is the development of disordered gambling in a minority of people. Various terms have been use to describe disordered gambling, including ‘compulsive gambling’, ‘addictive gambling’, ‘problem gambling’, and ‘pathological gambling’. The term used in the present document is ‘problem gambling’. The definition of problem gambling put forward by Neal, Delfabbro, & O’Neil (2005) captures the essential elements common to almost all definitions: “Problem Gambling is characterized by difficulties in limiting money and/or time spent on gambling which leads to adverse consequences for the gambler, others, or for the community.” Essentially, a problem gambler is someone with a pattern of excessive gambling; impaired control over their gambling behaviour; significant negative consequences deriving from this impaired control; and persistence in excessive gambling despite these negative consequences. Problem gambling is assumed to have varying degrees of severity, ranging from mild, moderate to severe. The term ‘pathological gambling’ is synonymous with severe problem gambling.1 Depending on the year and the jurisdiction, the past year prevalence