Preventive Interventions and Harm Reduction in Online and Electronic Gambling: A Systematic Review

Symptom Clusters in Individuals Seeking Treatment for Gambling Disorder

Gambling Disorder (GD), diagnostically, is a unidimensional construct where each additional symptom corresponds to increased severity. Many individuals experience addiction symptoms in specific symptom clusters, with membership to one profile of symptoms or other better representing disorder severity than raw symptom counts. This study explored whether similarly informative symptom clusters exist among adults seeking treatment for gambling harms. The sample included 440 adults seeking treatment for gambling disorder who completed an assessment of diagnostic criteria at intake. Three distinct classes were identified through a latent class analysis of GD criteria: Escape and Chasing, Preoccupation and Distress, and All symptoms. The All-symptoms class showed the highest elevation of cognitive distortions but shared similar levels of self-efficacy with the Preoccupation and Distress class. The Escape and Chasing class was found to exhibit the highest level of gambling-related self-efficacy and shared similar levels of cognitive distortions with the Preoccupation and Distress class. Significant differences were found in the demographic variables of having children under the age of 18 and employment status. Results show symptom profiles that run counter to the DSM-5's conceptualization of GD and indicate heterogeneity of individuals seeking treatment from gambling harms. Future areas of research are discussed.

A qualitative investigation of the feasibility and acceptability of lower risk gambling guidelines

Effective and comprehensive harm reduction strategies to mitigate gambling-related harms are needed worldwide. The development of such strategies is however resource intensive. Using existing models in multiple contexts would thus be advisable. This study is part of a larger project investigating the feasibility and acceptability of the Canadian Lower Risk Gambling Guidelines (LRGG) within a Finnish cultural context. The Canadian guidelines recommend not gambling more than 1% of one's household income, not gambling more than 4 days per month, and to avoid regularly gambling at more than 2 types of gambling products.13 Focus group interviews were conducted (N = 37, 23 women, 14 men) across five subpopulations: individuals gambling at no-risk/low-risk levels, individuals with past experiences of problematic gambling, concerned significant others of those with gambling problems, professional gamblers, and social workers and health care professionals. The analysis utilised a deductive approach.While the subpopulations differed in their assessment of the LRGG in some regards, we were able to synthesise three concrete suggestions to adjust the Canadian LRGGs into the Finnish context. Participants proposed rephrasing the guidelines as follows: (1) Limit gambling to a fixed percentage of monthly personal income after taxes and other fixed expenses, (2) Restrict the number and duration of weekly gambling sessions, (3) Avoid regular participation in the most harmful forms of gambling, such as online casino games.Overall, the LRGG were considered as useful also in the Finnish context. However, our results suggest that some culturally specific rewording may be advisable. The main challenge in the implementation of the LRGG is that respondents across groups considered the guidelines to be aimed at someone else. Implementation therefore requires clear communication that these guidelines are for all individuals who gamble, not only those experiencing problems.

Limit-setting in online gambling: a comparative policy review of European approaches

BACKGROUND

Online gambling products involve a heightened risk of harm, but there are some possibilities to prevent and reduce these harms. Notably, mandatory identification in online gambling environments allows for a range of pre-commitment tools such as limit-setting. Previous research has found that limit-setting tools can be helpful, but effectiveness depends on how policies are outlined and implemented. Limits can be financial or temporal, voluntary or mandatory, and system-level or operator-based. The current paper presents a policy review of European approaches to limit-setting in online environments.

METHODS

We first compared legal provisions on pre-commitment and limit-setting in N = 30 European countries (27 European Union Member States, Great Britain, Norway, and Switzerland). Data were retrieved from Vixio Gambling Compliance country reports and verified against original legal texts. The analysis focused on financial, temporal, maximum wager limits, and any other limits pertaining to online gambling. Second, based on the policy review, we produced a more in-depth analysis of limit-setting provisions in countries with system-level pre-commitment (Finland, Norway, Germany).

RESULTS

Results show important divergence in terms of limit-setting across Europe. While almost all countries (n = 27) have some form of limit-setting, implementation details vary. Financial limits can include loss limits (n = 15 countries), deposit limits (n = 18), and wagering limits (n = 14), with the majority of countries providing several types of financial limits. Temporal limits were available in ten countries. Eleven countries had some mandatory limits, in other countries operators were expected to provide the option to set limits. Statutory maximum limits and lower limits for young adults were not common, but available in some countries. Germany was the only country with a system-level limit-setting scheme that covered multiple licensed operators.

CONCLUSIONS

Contextual variations in pre-commitment and limit-setting policies are likely to impact effectiveness in terms of preventing and reducing harm. Our review shows some promising practices, including system-level regimes, mandatory policies, reasonable maximum caps on limits and wagers, the possibility to set limits for various time periods, lower limits for young adults, and coupling limit-setting with other duty-of-care obligations. Learning from other jurisdictions can constitute good practice for future policies on pre-commitment.

Addressing the commercial determinants of mental health: an umbrella review of population-level interventions

There is increasing evidence that commercial determinants impact mental health. Addressing the commercial determinants may therefore be a way of improving population-level mental health. This umbrella review aimed to provide an overview of evidence in this field and identify knowledge gaps. Five databases (MEDLINE, Embase, PsycINFO, Scopus and Cochrane Library) were searched on the 18/19 of July 2022. Eligible papers were systematic reviews published after 31 December 2011. No geographical limits were applied. Eligible interventions were those that targeted the behaviours or products of commercial actors. Ineligible interventions included individual behaviour change interventions, such as those seeking to educate consumers. Included mental health outcomes were anxiety, depression, self-harm and suicide, whilst surrogate outcomes included product consumption. Industry involvement and the quality of included reviews (critical components of A MeaSurement Tool to Assess systematic Reviews - AMSTAR 2) were assessed. A narrative synthesis was used to compare the findings by industry, and a typology of interventions was developed. Eight reviews with mental health outcomes were included, each with multiple methodological weaknesses. There is some evidence that reducing the availability of alcohol or pesticides may lower suicide rates. Despite the known links, no evidence on the mental health impacts of population-level interventions tackling the social media, tobacco, gambling and ultra-processed foods industries were located. All gambling reviews were identified as having links to industry. Future high-quality evaluations of commercial determinants interventions developed specifically with the aim of achieving positive mental health outcomes and/or that evaluate mental health outcomes and are free from industry links are needed. PROSPERO ref. number CRD42022346002.

Individuals with a migratory background can offer valuable insight to improve the treatment and prevention of gambling harms

Migration is a risk factor for gambling-related harms. Little research has been conducted on gambling and gambling harms among migrant groups in Finland, but there are indications that gambling participation is high among migrants also in this context. Russian speakers constitute the largest migrant group in Finland. This study focuses on the experiences and views of Russian speakers in Finland on the Finnish gambling system and its relationship to gambling harms. The study is based on the results of qualitative data collected on gambling experiences among Russian-speaking residents of Finland. The data consist of an online survey directed at individuals who gamble (N = 26) and interviews conducted among family members of those gambling (N = 3). Russian speakers in Finland view gambling as highly normalised in the Finnish society. This normalisation reinforced by availability, accessibility, and state involvement. Russian speakers also have perspective on how to better prevent and treat gambling harms in Finland. Involving migrants with experience of different gambling systems can provide critical insight on established practices in gambling systems.

Gambling harm prevention and harm reduction in online environments: a call for action

BACKGROUND

Gambling is increasingly offered and consumed in online and mobile environments. The digitalisation of the gambling industry poses new challenges on harm prevention and harm reduction. The digital environment differs from traditional, land-based gambling environments. It increases many risk-factors in gambling, including availability, ease-of-access, but also game characteristics such as speed and intensity. Furthermore, data collected on those gambling in digital environments makes gambling offer increasingly personalised and targeted.

MAIN RESULTS

This paper discusses how harm prevention and harm reduction efforts need to address gambling in online environments. We review existing literature on universal, selective, and indicated harm reduction and harm prevention efforts for online gambling and discuss ways forward. The discussion shows that there are several avenues forward for online gambling harm prevention and reduction at each of the universal, selective, and indicated levels. No measure is likely to be sufficient on its own and multi-modal as well as multi-level interventions are needed. Harm prevention and harm reduction measures online also differ from traditional land-based efforts. Online gambling providers utilise a variety of strategies to enable, market, and personalise their products using data and the wider online ecosystem.

CONCLUSION

We argue that these same tools and channels should also be used for preventive work to better prevent and reduce the public health harms caused by online gambling.