A Clinician's Guide to Working with Problem Gamblers

Henrietta Bowden-Jones, Sanju George, Henrietta Bowden-Jones, Sanju George

• Publisher: Routledge
• Year: 2015
• eBook ISBN: 9781317560470
• Topic: Psychology
• Subtopic: Addiction in Psychology
• Index: Psychology

Problem gambling is a recognised mental disorder and a significant public health issue internationally. A Clinician's Guide to Working with Problem Gamblers introduces the reader to the concept of problem gambling as an illness, it describes the current gambling habits and explores the way problem gambling may present in an individual. This guide is the product of a collaboration between two of the country's most eminent experts on problem gambling as a psychiatric disorder.

Bowden-Jones and George bring together contributions from leading clinicians working in the field to provide an outline of the epidemiology, aetiology, research, assessment procedures and treatment practices which are discussed and presented in an accessible and engaging manner. The inclusion of questionnaires and screening tools adds to the 'hands on' feel of the book. The book covers a range of topics that clinicians and trainees need in order to review and understand the disorder, including, amongst others:

Cognitive behavioural models of problem gambling

Psychiatric co-morbidity

Family interventions

Gambling and women

Remote gambling

A Clinician's Guide to Working with Problem Gamblers will be essential reading for mental health professionals working with problem gamblers, as well as those in training, it is a comprehensive reference point on all aspects of this psychiatric condition. It is also aimed at various other groups of people who have an interest in the field of problem gambling, including academics, researchers, policy makers, NHS commissioners, probation officers, other health care professionals, the lay reader and family members of those affected by gambling.

Chapter 1

Introduction

Henrietta Bowden-Jones and Sanju George

The first time the idea of editing a UK-based textbook on problem gambling came to us was the day we reached 1000 patients at the National Problem Gambling Clinic. We wanted to celebrate with something tangible that would reflect our dedication to gathering knowledge about this group of patients.

Having founded the clinic in 2008 and set up its first treatment protocols by basing much of our work on the textbooks and research by American colleagues Nancy Petry and Marc Potenza, we felt that five years later, the knowledge base we had acquired at the clinic had become substantial and we wanted to share it.

Our work as members of the Government’s Responsible Gambling Strategy Board further added to the realisation that a significant body of expertise and knowledge now existed in the UK and that it should be these sources the textbook needed to refer to.

The chapter topics will allow any colleague with a wish to learn about this subject to feel comfortable in assessing and treating problem gamblers. Please note that we use the terminology problem gambling wherever possible in this book except when referring to primary research where the term pathological gambling was used.

Nothing teaches you more about a specific psychiatric condition than listening to hundreds of personal accounts of how the illness developed, its impact on the individual, his/her friends and family and his/her career. The people who have contributed to the chapters have become experts by dedicating their careers to this field.

We hope this book will be a companion to many of our colleagues not just in the UK, but all over the world. Although specific references are made to the UK in parts of this book, many of the theories and principles discussed are equally applicable across the world. We are grateful to the problem gambling treatment community for having been, from the beginning, a sharing and nurturing one, and we feel privileged to have worked with such an eminent group of professionals in bringing this book together.

Chapter 2

Gambling behaviour in Britain

Evidence from the British Gambling Prevalence Survey series

Heather Wardle

Aims

1 To describe the historical development of gambling opportunities in Britain, with a particular focus on the impact of the introduction of the National Lottery in 1994 and the Gambling Act in 2005.

2 To describe the purpose and methods of the three British Gambling Prevalence Surveys (1999, 2007 and 2010).

3 To present key findings from the 2010 survey and offer interpretations.

4 To discuss changes in gambling behaviours and prevalence of problem gambling across the three surveys (1999 to 2010).

Introduction

The gambling landscape: pre- and post-introduction of the National Lottery (1994)

Great Britain arguably has one of the most diverse and accessible commercial gambling markets in the world. In every high street, in every community, opportunities to gamble exist. These provisions range from the purchase of lottery tickets and scratch cards, sold in over 28,800 retailers nationwide, to venues where the only or main product on offer is gambling – amusement arcades, betting shops, casinos, bingo halls – to free and open access to Internet gambling, which is heavily advertised. Development of mobile gambling and related applications, which streamline the gambling process, mean that for those who wish to engage with gambling, the opportunities to do so can be omnipresent.

However, it has not always been this way. Prior to the introduction of the National Lottery in 1994, gambling provisions were limited to certain venues, such as bookmakers, bingo halls, casinos, amusement arcades, racecourses, pubs and clubs or other venues where slot machines were allowed. Whilst for some, gambling was part of the nation’s pastimes, it was arguably not as visible prior to the introduction of the National Lottery and was confined to certain spaces and locations within communities. That is not to say that gambling was not popular. Estimates produced from national surveys in 1951 and 1977 show that the vast majority of adults, both men and women, gambled (Hoinville et al., 1977; Kemsley & Ginsburg, 1951). In fact when the findings of the 1951 study were published, the national and international press reported that gambling was ‘almost universal’. Therefore, the popularity of gambling and betting has clear historical antecedents. In particular, the late nineteenth and early twentieth centuries were boom times for gambling and betting. As Reith (1999) describes, technological advances in the nineteenth century, particularly the development of the telegraph system improving communication systems and the opening of the rail networks, served to democratise horse racing and betting. It was no longer the preserve of the elite and became embedded as a form of popular entertainment and recreation among the working classes (Clapson, 1992; Reith, 1999). The popularity of horse racing betting among the working classes is still evident today, with regular betting on horse races being most prevalent among those in routine and manual occupations. Similar patterns can be traced for other gambling activities, specifically the development and growth of commercial bingo and the football pools.

The introduction of the National Lottery in 1994 can be seen as a step change in the way gambling was provided, regulated and promoted, for two main reasons. The first is that it broadened access to gambling opportunities in a way that had not been seen before. Lottery tickets and subsequently scratch cards were made available in many different venues, ranging from corner shops and petrol stations to major high street chains. Secondly, the introduction of the National Lottery represented widespread government endorsement of gambling. This endorsement was actively promoted through advertising, as, at that point, the National Lottery and its related products were the only forms of gambling allowed to promote their services via television and radio campaigns. The net effect, according to one commentator, was to turn Britain into a ‘Nation of Gamblers’ overnight (Atherton, 2006), though, as can be seen from the 1951 and 1977 studies, arguably we already were.

However, Britain was somewhat behind the curve when it came to the implementation of a nationwide lottery. The majority of US states had established lotteries in the 1970s and 1980s, Canadian state lotteries were established within a similar timeframe, as too were those in Australia, France, Ireland and Germany. Therefore, the implementation of the National Lottery could be viewed as Britain simply catching up with other nations. However, combining this provision with a number of other land-based gambling opportunities served to create one of the most accessible gambling markets in the world.

The Gambling Act (2005)

A second step change in how gambling was provided, regulated and controlled was the implementation of the Gambling Act 2005. Depending on your viewpoint, this legislation was either a wholescale liberalisation of the gambling market or a badly needed update to allow government to meet the increasing challenges of modern gambling practice, or, indeed, was both (Light, 2007). The Act included the creation of a new regulator, the Gambling Commission, charged with the objectives to keep gambling crime free, to ensure gambling is conducted fairly and openly and to protect children and vulnerable people from harm. To meet these objectives, a whole new regulatory and licensing regime was implemented based on dual principles of compliance and enforcement. However, much commentary about the Act has focused on its more visible clauses. For example, a key aspect, which has received increasing attention, was the removal of the demand criterion in the licensing process. Previously, operators had to demonstrate that there was substantial unmet demand for their products before being granted a licence to operate in a local area. However, under the Gambling Act 2005 these restrictions were removed, with the explicit instruction that when considering applications for premises licences, Local Authorities should not have ‘regard for the expected demand for facilities’ (DCMS, 2005). Since the implementation of the Act, debate has raged about the consequences of this, with many high-profile politicians and other stakeholders arguing that this has led to clustering of gambling establishments on some local high streets (Harman, 2011; Orford, 2010). Another visible aspect was permission for all gambling operators from all sectors to advertise their products on television and radio, albeit with certain restrictions. The Act also included provisions for a so-called ‘super casino’, which dominated debate although never came to fruition. The Act itself was fully implemented on 1 September 2007 and arguably heralded a key shift by which commercial gambling was mandated to become an increasingly visible commodity.

It is against this backdrop that the British Gambling Prevalence Survey series was developed and conducted. This aimed to understand and measure gambling behaviour in Great Britain and, crucially, to measure prevalence rates of problem gambling. It is this series of research to which the rest of the chapter now turns.

Measuring gambling behaviour and problem gambling among adults: the British Gambling Prevalence Survey series (BGPS)

The British Gambling Prevalence Survey series (BGPS) was a nationally representative survey of gambling behaviour among adults aged 16 and over living in private households in Great Britain. It was the only national study that focused solely on this topic. The first study was conducted in 1999, commissioned by GamCare, a then newly created treatment service for problem gamblers. Up until that point, it was widely acknowledged that there was a distinct lack of reliable information about gambling behaviour in Britain and that this represented a major gap in the evidence base. Specifically, there was no information about the magnitude or otherwise of problem gambling in Britain, which represented a challenge when estimating resource need for treatment services. The 1999 study was designed to fill this gap. Further studies were conducted in 2007 and 2010, funded by the Gambling Commission.

The purpose of each study was to monitor participation rates in all forms of gambling, to estimate the extent of gambling problems, explore attitudes to gambling and investigate the socio-demographic and economic characteristics of both gamblers and problem gamblers. In 2010, a further remit was added, which was, where possible, to provide comparisons pre and post implementation of the Gambling Act 2005.

Methodology

All three surveys were conducted by NatCen Social Research. To ensure maximum comparability across survey years, the study design broadly followed that used for the first study in 1999. First, a random sample of private households was drawn from the Small Users Postcode Address File. Advance letters were sent to these addresses to inform residents that they had been selected. Trained NatCen interviewers visited each address and attempted to interview the primary householder to obtain broad demographic information about the household. All adults aged 16 and over within co-operating households were eligible to participate and were asked to complete an individual questionnaire using either a paper selfcompletion booklet (as used in 1999 and 2007) or using computer-assisted selfinterviewing methods whereby the respondent reads and types responses directly into a laptop computer (as used in 2010).

In each study respondents were asked to consider a list of gambling activities and to indicate whether they had participated in them in the past 12 months or not. The activities included were intended to cover all types of gambling available in Britain and were updated to reflect changes in gambling activities and provisions in each study year. Types of commercial gambling included were the National Lottery, other lotteries, scratch cards, bingo, betting on any event or sports, casino table games, poker, machine gambling, football pools, spread betting, etc. Private betting or gambling was also included, as were questions about online gambling.

Response rates varied from 65% in 1999 to 47% in 2010 and in each year the survey data were weighted to match the age, sex and regional distribution of the British population. Responses were obtained from 7680 participants in 1999, 9003 participants in 2007 and 7756 participants in 2010. Fuller technical details can be found in the main report of survey findings (see Sproston et al., 2000; Wardle et al., 2007; Wardle et al. 2011a).

Limitations

As with any social survey, there are important measurement issues to bear in mind when reviewing results from this study series. The first relates to the sample frame used. The BGPS is a study of people living in private households. This means those living in institutions are excluded from the study. The most pertinent population groups for this study are the prison population and young people living in student halls of residence. Both of these groups are likely to experience higher rates of problem gambling, meaning that the estimates provided by the BGPS across all three studies are likely to be a marginal underestimate of the true population value. Secondly, the methods used to measure problem gambling prevalence rely on respondents answering a set of questions based on specific criteria (typically, in this case, based on the ten DSM-IV criteria for pathological gambling). Once data are summed and scored, a threshold is set above which a person is deemed to be a problem gambler or not. As with any screening instrument, the possibility of including either false positives (i.e. identification of people as problem gamblers who are not) or false negatives (people who are problem gamblers being identified as non-problem gamblers) exists. Finally, any survey estimate may be subject to sampling error; that is, the possibility that differences between survey years are observed by chance simply because a different sample of the population has been drawn.

The BGPS survey was designed to minimise the potential impact of these measurement issues. For example, self-completion methodologies were used to elicit more honest responses, a standard threshold for the identification of problem gamblers was used in every survey year, detailed analysis comparing the profile of the BGPS responding sample to the population of profile of Great Britain was conducted to provide information about how and in what ways the sampled respondents may vary year on year. Nevertheless, no social survey is without its limitations and it is important that these be recognised.

Given below are some of the key findings from these surveys.

Who gambles and what on?

Data from the BGPS series show that the majority of adults in Britain take part in some form of gambling. In 2010, 73% of adults gambled at least once in the past year. This ranged from buying a single lottery ticket to regularly betting with bookmakers or playing table games in a casino. In population terms, this equates to around 35.5 million adults, making gambling an activity that the majority engage in.

Across all survey years, the most popular form of gambling activity was, and remains, purchase of National Lottery tickets. In 2010, 59% of adults bought a lottery ticket at least once in the past year and 60% of this group bought tickets at least once a week or more often. The next most popular activity was other lotteries (25%) and then the purchase of scratch cards (24%), followed by betting on horse races (16%) and playing slot machines (13%). Aside from private betting, all other forms of gambling activity were undertaken by less than 10% of adults.

Whilst these figures are of ...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• List of figures and tables
• List of contributors
• 1 Introduction
• 2 Gambling behaviour in Britain: evidence from the British Gambling Prevalence Survey series
• 3 Gambling and public health
• 4 Aetiology of problem gambling
• 5 Cognitive-behavioural models of problem gambling
• 6 Neurobiology of pathological gambling
• 7 Psychiatric co-morbidity in gambling
• 8 Effects of gambling on the family
• 9 Pathological gambling: screening, diagnosis and assessment
• 10 Psychosocial treatments for problem and pathological gambling
• 11 Pharmacological treatments
• 12 Family interventions in gambling
• 13 Women and gambling
• 14 Young people and problem gambling
• 15 Remote gambling: an overview of Internet gambling, mobile phone gambling and interactive television gambling
• Appendix 1 National Problem Gambling Clinic CBT group programme
• Appendix 2 Assessment form for problem gambling
• Appendix 3 Client-administered questionnaire
• Index