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Korvuo T, Palomäki J, Castrén S. Dissociative experiences reduce online problem gambling treatment effectiveness. Compr Psychiatry 2023; 127:152414. [PMID: 37688936 DOI: 10.1016/j.comppsych.2023.152414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/08/2023] [Accepted: 08/31/2023] [Indexed: 09/11/2023] Open
Abstract
AIMS To determine whether dissociative experiences moderate online problem gambling treatment effectiveness, and to characterize the temporal persistence of the relationship between dissociation and problem gambling. DESIGN Repeatedly measured self-report data on a guided online cognitive behavioral therapy for problem gambling collected on four occasions: before treatment, after treatment, and at 6- and 12-month follow-ups. SETTING AND PARTICIPANTS The data (N = 1243, 59.2% males) were collected in Finland between 2019 and 2021. MEASUREMENTS The primary outcome variable was the self-reported level of problem gambling. The predictors were the treatment phase and dissociative experiences, their interaction, and the demographic covariates of age, education, income, and gender. FINDINGS Problem gambling scores and dissociative experiences declined significantly following treatment and remained low through the follow-ups (retention rates: 52.6% [post-treatment], 26.3% [at the 6-month follow-up], and 16.1% [at the 12-month follow-up]). However, the treatment was significantly less effective in reducing problem gambling for individuals who kept experiencing dissociation after the treatment. CONCLUSIONS Dissociation is an integral sign of problem gambling severity and sustained dissociative experiences may significantly reduce the long-term effectiveness of online problem gambling treatments. Treatment efforts should be customized to account for individual differences in dissociative tendencies, and future research should broaden the study of dissociative experiences to other behavioral addictions.
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Affiliation(s)
- Tuire Korvuo
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jussi Palomäki
- Finnish Institute for Health and Welfare, Department of Public Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland; Gambling Clinic, Helsinki University Hospital, Finland.
| | - Sari Castrén
- Finnish Institute for Health and Welfare, Department of Public Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland; University of Turku, Department of Psychology and Speech-Language Pathology, Turku, Finland; University of Helsinki, Department of Medicine, Helsinki, Finland
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Macey JR, Abarbanel BL, Castrén S, Hamari JJ, Salonen AH. Public opinions and attitudes toward a state monopoly: a study of the finnish gambling system. BMC Public Health 2023; 23:2012. [PMID: 37845653 PMCID: PMC10580558 DOI: 10.1186/s12889-023-16917-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/06/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Gambling regulated through a state monopoly is often justified for reasons of public health, that is, that monopolies are a more effective means of reducing potential harm. This focus on harm prevention has increased in recent years, particularly as a result of pressures arising from the growth of online gambling and of legislation designed to promote competition. While prior works have examined the role of stakeholders in influencing policy decisions and in public discussions of the monopoly systems, attention has been focused on those with direct financial interests; the opinions of the public have largely been absent from these discussions. In 2017 Finland restructured its monopoly order to improve efficacy of addressing gambling related harms; this restructuring offers a valuable insight into public perceptions of and attitudes toward the suitability of the Finnish system to address gambling-related harm. METHODS This work uses Structural Equation Modelling and compares attitudes toward the Finnish system between 2015 (pre-restructuring) and 2019 (post-restructuring). RESULTS Overall public opinion of the Finnish system as being suitable for addressing gambling harms declined between 2015 and 2019, despite the restructuring. Several predictors of attitudes were identified, however, the majority had small effect sizes, while the model explained little variance. CONCLUSION This work concludes that existing approaches to examining public opinions of gambling regulation should be amended to include additional predictors. Furthermore, it is likely that context-specific predictors should be included in models, in order to reflect the socio-cultural history of the population being investigated. Such predictors should be determined in respect to the population of interest but, for example, could include items measuring trust in authority, political orientation, cultural acceptance of gambling, or religious affiliation.
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Affiliation(s)
- Joseph R Macey
- Centre of Excellence in Game Culture Studies, University of Turku, Turku, Finland.
- Gamification Group, Faculty of Information Technology and Communication Sciences, Tampere University, Room B2125, Pinni B, Kanslerinrinne 1, 33100, Tampere, Finland.
| | - Brett L Abarbanel
- International Gaming Institute, University of Nevada, Las Vegas, NV, USA
- William F. Harrah College of Hospitality, University of Nevada, Las Vegas, NV, USA
| | - Sari Castrén
- Finnish Institute for Health and Welfare, Helsinki, Finland
- University of Turku, Turku, Finland
- University of Helsinki, Helsinki, Finland
| | - Juho J Hamari
- Gamification Group, Faculty of Information Technology and Communication Sciences, Tampere University, Room B2125, Pinni B, Kanslerinrinne 1, 33100, Tampere, Finland
| | - Anne H Salonen
- Finnish Institute for Health and Welfare, Helsinki, Finland
- University of Eastern Finland, Faculty of Health Sciences, Kuopio, Finland
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Palomäki J, Turner N, Macey J, Castrén S. Increased volatility in video poker results in more winning players but shorter winning streaks - Evidence from simulations. J Behav Addict 2023; 12:711-720. [PMID: 37747835 PMCID: PMC10562822 DOI: 10.1556/2006.2023.00048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/19/2023] [Accepted: 08/31/2023] [Indexed: 09/27/2023] Open
Abstract
Objective and Method Electronic gambling machines are a prominent cause of significant gambling harms globally. We use simulations of a simplified video poker game to show how changes in game volatility, defined primarily by the size of the main prize, affect patterns of wins and losses as well as winning streaks. Results We found that in low- and medium volatility games the proportion of winning players quickly drops to zero after about 30 h of play, while in the high volatility game 5% of players are still winning after playing for 100 h. However, the proportion of winning streaks was significantly higher in the low- and medium volatility games compared with high volatility: the simulated players were on a winning streak about 26.3, 25.6 and 18% of the time in the low-, medium- and high volatility games, respectively. Conclusions Fast-paced video poker with varying volatility levels but identical return-to-player rates and win frequencies can yield highly different result patterns across individuals. These patterns may be counter-intuitive for players and difficult to realize without simulations and visualizations. We argue that the findings have relevance for responsible gambling communication and for building a better understanding of how cognitive biases influence gambling behaviour.
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Affiliation(s)
- Jussi Palomäki
- Health and Well-Being Promotion Unit, Finnish Institute for Health and Welfare, P.O. Box 30, FI-00271, Helsinki, Finland
| | - Nigel Turner
- Institute for Mental Health Policy Research, and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Joseph Macey
- Centre of Excellence in Game Culture Studies, University of Turku, Turku, Finland
- Gamification Group, Faculty of Information Technology and Communication Sciences, Tampere University, Tampere, Finland
| | - Sari Castrén
- Health and Well-Being Promotion Unit, Finnish Institute for Health and Welfare, P.O. Box 30, FI-00271, Helsinki, Finland
- Department of Psychology and Speech-Language Pathology, University of Turku, Turku, Finland
- Faculty of Medicine, University of Helsinki, Finland
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Salonen AH, Castrén S, Latvala TA, Grönroos T, Levola J, Vuori M. Gender- and age-stratified analyses of gambling disorder in Finland between 2011 and 2020 based on administrative registers. Nordic Studies on Alcohol and Drugs 2022; 39:623-633. [DOI: 10.1177/14550725221108793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/07/2022] [Indexed: 11/15/2022] Open
Abstract
Aim: Prevalence studies on gambling have largely relied on survey samples. Little is known about the diagnosed prevalence of gambling disorder (GD) based on register data. This study examines the annual prevalence rate of GD between 2011 and 2020 among Finns by gender and age. Methods: Aggregated data on the diagnosis of GD (corresponding to pathological gambling, code F63.0 in the ICD-10) were retrieved from the following national registers: Register of Primary Health Care Visits, and Care Register for Health Care, including specialised outpatient and inpatient health care, and inpatient Care Register for Social Welfare. Primary and secondary diagnoses of adults were included. Average population during a calendar year (4,282,714–4,460,177 individuals) was utilised to calculate annual prevalence. Results: The annual prevalence of diagnosed GD in the population increased from 0.005% ( n = 196) to 0.018% ( n = 804) within nine years. In 2011, the annual prevalence rate was 0.006% for men and 0.003% for women, compared to rates in 2020 of 0.025% and 0.011%. Gender discrepancy was relatively stable across years: 27.2–33.8% of the diagnoses were for women. The prevalence of GD varied between age groups within genders. GD was most prevalent among 18–44-year-olds. The prevalence rates increased the most among 30–44-year-old women. Conclusion: The extremely low prevalence rate of GD implies that the problem remains under-diagnosed, yet, it has increased among all age groups across genders, except for women aged 60 years or older. Active efforts are needed to increase awareness of GD among both primary and specialised healthcare professionals and the public for better recognition and early detection.
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Affiliation(s)
- Anne H. Salonen
- Finnish Institute for Health and Welfare, Helsinki, Finland; and University of Eastern Finland, Kuopio, Finland
| | - Sari Castrén
- Finnish Institute for Health and Welfare, Helsinki, Finland; University of Turku, Turku, Finland; and University of Helsinki, Helsinki, Finland
| | | | - Tanja Grönroos
- Finnish Institute for Health and Welfare, Helsinki, Finland; and University of Helsinki, Helsinki, Finland
| | - Jonna Levola
- University of Helsinki, Helsinki, Finland; and Psychiatry, Hospital District of Helsinki and Uusimaa, HUS, Finland
| | - Miika Vuori
- University of Turku, Research Center for Child Psychiatry, INVEST Research Flagship, Turku, Finland
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Palomäki J, Lind K, Heiskanen M, Castrén S. Predicting online problem gambling treatment discontinuation: New evidence from cross-validated models. Psychol Addict Behav 2022; 37:519-532. [PMID: 35980716 DOI: 10.1037/adb0000875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE There are tens of millions of problem gamblers in the world, many of whom either do not seek treatment or fail to commit to it. Dropout rates are high, and not enough is known about factors predicting treatment adherence. We focus on an online cognitive behavioral therapy program for severe problem gambling to determine the likelihood of treatment discontinuation at three different treatment phases: pretreatment, before halfway, and before the end of the program. METHOD Participants were Finnish adults (N = 1,139, 670 males, Mage = 34.5) registered in the program between 2019 and 2021. Using logistic regression and five-fold cross-validated naïve Bayes classification, we predicted discontinuation with demographic-, psychometric-, and other gambling-related variables, including the quality of one's social relations, time spent on the waiting list, and experienced readiness to behavioral change. RESULTS The models had acceptable predictive ability (area under the curve [AUC] values from .69 to .745; cross-validated balanced classification accuracy = 63.2%). In logistic regressions, treatment discontinuation was prominently associated with younger age (p = .008), lower education (p < .001), not being ready to change gambling behavior (p < .001), problem gambling severity (p < .0001), longer time spent on the treatment waiting list (p < .0001), and fewer close social relationships (p < .001). CONCLUSIONS We found significant new real-world evidence on factors statistically predicting treatment discontinuation, which is crucial when existing programs are modified to better serve those in need. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
| | - Kalle Lind
- Finnish Institute for Health and Welfare
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Lind K, Castrén S, Hagfors H, Salonen AH. Harm as reported by affected others: A population-based cross-sectional Finnish Gambling 2019 study. Addict Behav 2022; 129:107263. [PMID: 35134630 DOI: 10.1016/j.addbeh.2022.107263] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 12/26/2022]
Abstract
This study investigates the prevalence of being an affected other (AO) of a person with problem gambling; and the associations between being an AO and socio-demographics, gambling behaviour, health-related correlates and the amount and type of gambling-related harm (GRH) for the AOs. Furthermore, perspectives of the affected family members (AFMs) and close friends (ACFs) were acknowledged. Cross-sectional, random sample Finnish Gambling population-based survey data (n = 3,994) were collected in 2019. AOs were identified using a question with seven options. Information on GRH was sought using structured questions. One-fifth (21.2 %) of all respondents were AOs, men being typically ACFs and women being more often AFMs. Being an AO was associated with younger age, gambling participation, having a gambling problem of their own and health barriers such as psychological distress. AFMs experienced GRH more often and the amount of different GRHs was greater among the AFMs. The most common harm category experienced by the AOs was emotional harm. Both health-related issues and the amount of GRHs was largest among the AFMs. A substantial amount of GRH was also experienced by ACFs. The study suggests that support could be tailored for AFMs and ACFs, based on their AO status and individual needs. A public health approach for effective harm prevention in primary, secondary and tertiary levels are discussed.
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Macey J, Cantell M, Tossavainen T, Karjala A, Castrén S. How can the potential harms of loot boxes be minimised?: Proposals for understanding and addressing issues at a national level. J Behav Addict 2022; 11. [PMID: 35446784 PMCID: PMC9295237 DOI: 10.1556/2006.2022.00016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 01/10/2022] [Accepted: 03/15/2022] [Indexed: 12/03/2022] Open
Abstract
Background and aims Loot boxes are in-game items which distribute rewards to players via random-number generation; many games require players to make in-game payments to access their contents. The combination of financial outlay and random rewards has raised concern about similarities to gambling. This debate paper presents a series of themes identified by an inter-institutional working group in Finland, alongside suggested actions, and are presented with the intention of stimulating debate among stakeholders. Methods This work uses an exploratory research approach to gather data from a range of sources, including state-of-the-art reports from several fields and qualitative content analysis of invited presentations from a range of stakeholders, including affected individuals, practitioners, and field-specific experts. Results and Discussion Several significant themes emerged from the work and are presented alongside a series of proposed action points. Based on this preliminary exploration we propose a series of, non-exhaustive, actions for both primary and secondary prevention. Furthermore, the group identified the potential for responsible gaming practices to be adopted which would help to minimize the harm from overspending in gaming activities. Finally, we identified the need for further research in the field, for example the use of player data and both longitudinal and qualitative studies. Conclusions The emergent themes are discussed in relation to both the views of the presenters and existing research in the field and are intended to promote discussion concerning the viability of context-specific approaches to an issue of global reach and significance.
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Affiliation(s)
- Joseph Macey
- Centre of Excellence in Game Culture Studies, University of Turku, Porin Yliopistokeskus, Pohjoisranta 11d, 28100, Pori, Finland
- Gamification Group, Tampere University, Kalevantie 4, 33100, Tampere, Finland
| | - Mikko Cantell
- National Police Board, Gambling Administration, PL 50, 11101, Riihimäki, Finland
| | - Tommi Tossavainen
- National Audiovisual Institute, P.O. Box 16, FI-00501, Helsinki, Finland
| | - Antti Karjala
- National Police Board, Gambling Administration, PL 50, 11101, Riihimäki, Finland
| | - Sari Castrén
- Finnish Institute for Health and Welfare, Health and Well-Being Promotion Unit, P.O. Box 30, FI-00271, Helsinki, Finland
- Department of Psychology and Speech-Language Pathology, University of Turku, Social Sciences, P.O. Box 30, FI-00271, Turku, Finland
- Department of Medicine, University of Helsinki, P.O. Box 30, FI-00271, Helsinki, Finland
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Palomäki J, Heiskanen M, Castrén S. Online 8-week cognitive therapy for problem gamblers: The moderating effects of depression symptoms and perceived financial control. J Behav Addict 2022; 11:75-87. [PMID: 35133289 PMCID: PMC9109628 DOI: 10.1556/2006.2021.00091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 12/07/2021] [Accepted: 12/28/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND AIMS Online interventions for problem gambling are increasingly popular, but not everyone benefits from them. We describe 12 years of real-world data from an online intervention for gambling problems and aim to find out the extent to which depression, alcohol use, and sense of financial control influence the effectiveness of the program. METHODS We analyzed treatment effectiveness and moderators in the Finnish "Peli Poikki" program (2007-2018)-an 8-week cognitive behavioral therapy and follow-up program for problem gambling. Participants were Finnish-speaking adults over 18 years of age (N = 2011, 66.9% males). We measured the self-reported level of problem gambling, depression, alcohol use, and sense of financial control across four treatment phases (baseline, post-treatment, 6-month follow-up, and 12-month follow-up), as well as the presence of gambling debt, psychological and physiological health, years suffered from gambling problems, and demographic variables. RESULTS Participation grew across years with retention rates of 55%, 30%, and 19% for post-treatment and the two follow-ups, respectively. The average problem gambling scores declined significantly following treatment and remained low throughout the follow-ups. However, this decline (the beneficial treatment effect) was reversed after the follow-ups for those with high depression scores and those who felt they had no control over their finances. DISCUSSION AND CONCLUSIONS The Peli Poikki program is a well-functioning online intervention but less effective in the long term for participants with persisting symptoms of depression or without a sense of financial control. More attention is needed to screen and direct people with comorbidities to the appropriate services.
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Affiliation(s)
- Jussi Palomäki
- Gambling Clinic (Peliklinikka), Helsinki University Hospital, Siltasaarenkatu 12 A, 00530Helsinki, Finland
| | - Maria Heiskanen
- Finnish Institute for Health and Welfare, Health and Well-Being Promotion Unit, Helsinki, Finland
| | - Sari Castrén
- Finnish Institute for Health and Welfare, Health and Well-Being Promotion Unit, Helsinki, Finland
- Department of Psychology and Speech-Language Pathology, Social Sciences, University of Turku, Turku, Finland
- Department of Medicine, University of Helsinki, Helsinki, Finland
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Hagfors H, Castrén S, Salonen AH. How gambling motives are associated with socio-demographics and gambling behavior - A Finnish population study. J Behav Addict 2022; 11:63-74. [PMID: 35275094 PMCID: PMC9109631 DOI: 10.1556/2006.2022.00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/11/2021] [Accepted: 01/30/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIMS The aims were to examine how socio-demographics and gambling behavior relate to both primary and additional gambling motives, and whether the gambling motives change during a one-year-period. METHODS The Finnish Gambling Harms Survey data was used. Gambling motives were measured with a categorical question. Gambling severity was measured using the Problem and Pathological Gambling Measure (PPGM). Using the first-wave data including only past-year gamblers (n = 5,684), five logistic regression models were utilized to explore the associations of gambling motives with socio-demographics and gambling behavior. The stability of gambling motives was assessed with McNemar's test using longitudinal data (n = 2,078). RESULTS Gambling for positive feeling was associated with younger age, high income, high gambling involvement and at-risk gambling. Monetary motive was associated with female gender, high gambling involvement, online or mixed-mode and at-risk gambling. Supporting worthy causes was associated with older age, monthly and weekly gambling, and land-based gambling. Socializing was associated with younger age and gambling occasionally on land-based venues with multiple game types. Finally, the motive to escape was intensified among 25-34-year-olds, homemakers, and those with high gambling involvement and at-risk or problem gambling. Gambling motives remained relatively stable for one year. DISCUSSION AND CONCLUSIONS Gender and age profiles varied in different motives. Positive feeling, socializing and escape motive was heightened among younger respondents while supporting worthy causes was heightened among the oldest. Women gambled for money more often than men. Escape motive was associated with problem gambling. Longer follow-up is needed to confirm the longitudinal results.
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Affiliation(s)
- Heli Hagfors
- Tampere University, Faculty of Social Science, Finland,Corresponding author. Tel.: +358 45 884 3583. E-mail:
| | - Sari Castrén
- Finnish Institute for Health and Welfare, Health and Well-Being Promotion Unit, Finland,University of Turku, Department of Psychology and Speech Language Pathology, Finland,University of Helsinki, Faculty of Medicine, Finland
| | - Anne H. Salonen
- Finnish Institute for Health and Welfare, Health and Well-Being Promotion Unit, Finland,University of Eastern Finland, Faculty of Health Sciences, Finland
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Edgren R, Pörtfors P, Raisamo S, Castrén S. Treatment for the concerned significant others of gamblers: A systematic review. J Behav Addict 2022; 11:1-25. [PMID: 35044325 PMCID: PMC9109622 DOI: 10.1556/2006.2021.00088] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/19/2021] [Accepted: 12/16/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIMS Research recognizes the extent of harm experienced by concerned significant others (CSOs) of gamblers. This systematic review's aims are to examine the interventions for CSOs, evaluate potential benefits, and thematically describe treatment processes. The Stress-Strain-Coping-Support model (SSCS) served as the theoretical framework. METHODS Database searches were conducted in: MEDLINE, CINAHL Complete, Web of Science Core Collection, Social Services Abstracts, Applied Social Science Index and Abstracts, Cochrane Central Register of Controlled Trials, and APA PsycInfo (between 01/Jan 2011-10/Jun 2021). Other search methods were also utilized. Inclusion criteria: interventions for CSOs with CSO specific outcomes. The Evidence Project Risk of Bias Tool was used for assessment. RESULTS 19/768 records were included. Nine interventions were utilized: 3 CSO directed, 4 for couples, and 2 low threshold online interventions. A quantitative synthesis (N = 7 studies) of effect size estimates for depression and anxiety measures didn't indicate any intervention to have better outcomes than others. Core themes in the treatment process identified in the qualitative synthesis (N = 7) included: information and understanding, social support, coping skills, communication, and strain. Limitations in the evidence related to sampling, control-conditions and outcome measurements. DISCUSSION AND CONCLUSION Several interventions were identified, yet no specific interventions appeared more beneficial than others. Using the SSCS model, commonalities and differences in intervention content were identified, along with themes that influence treatment processes. The need for tailored interventions is discussed. Future treatment efficacy research should carefully select study designs and outcome measurements. PROSPERO (CRD42021229408).
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Affiliation(s)
- Robert Edgren
- Finnish Institute for Health and Welfare, Department of Public Health Solutions, The Alcohol, Drugs and Addictions Unit, Helsinki, Finland,Corresponding author. E-mail:
| | - Pia Pörtfors
- Finnish Institute for Health and Welfare, Department of Information Services, Health and Social Services Data and Information Management, Helsinki, Finland
| | - Susanna Raisamo
- Finnish Institute for Health and Welfare, Department of Public Health Solutions, The Alcohol, Drugs and Addictions Unit, Helsinki, Finland
| | - Sari Castrén
- Finnish Institute for Health and Welfare, Department of Public Health Solutions, The Alcohol, Drugs and Addictions Unit, Helsinki, Finland,University of Turku, Social Sciences Department of Psychology and Speech-Language Pathology, Turku, Finland,University of Helsinki, Department of Medicine, Helsinki, Finland
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Castrén S, Järvinen-Tassopoulos J, Raitasalo K. Money used in gaming is associated with problem gambling: Results of the ESPAD 2019 Finland. J Behav Addict 2021; 10:932-940. [PMID: 34797777 PMCID: PMC8987419 DOI: 10.1556/2006.2021.00076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 08/11/2021] [Accepted: 10/14/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIMS The convergence of gaming and gambling may pose a risk for adolescents. Thus, it is important to find out how these behaviours are associated with other addictive behaviours in order to develop efficient preventive measures for youth. The aim of this study was to examine 1) whether problematic gaming and money used for gaming activities are risk factors for gambling, and 2) what kind of impact adolescents' substance use along with other factors related to friends and parents have on this association. METHODS The European School Survey Project on Alcohol and Other Drugs data, 2019 of Finnish adolescents aged 15 to 16 (N = 4595). Cross-tabulations with Rao-Scott's chisquare tests were applied to study the associations of the background factors with gambling in the past 12 months. A multinomial logistic regression model was fitted for the outcome variable (gambling in the past 12 months) adjusted for all independent and background variables. RESULTS Problematic gaming alone was not associated with gambling participation, whereas using money for digital games increased the risk of gambling. Boys gamble more than girls. The use of alcohol and drugs increased the risk of gambling. Parental monitoring reduced the risk of gambling, whereas hanging around weekly with friends increased the risk. DISCUSSION AND CONCLUSIONS Using money on gaming sites may put some adolescents at risk of developing problems with either gaming or gambling. The link between using money in digital games and gambling participation calls for preventive measures, intervention and regulatory acts.
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Affiliation(s)
- Sari Castrén
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Medicine, University of Helsinki, Helsinki, Finland
- Social Sciences Department of Psychology and Speech-Language Pathology, University of Turku, Turku, Finland
| | - Johanna Järvinen-Tassopoulos
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
- Faculty of Social Sciences, Social and Public Policy, University of Helsinki, Helsinki, Finland
| | - Kirsimarja Raitasalo
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Social Sciences, University of Eastern Finland, Kuopio, Finland
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Castrén S, Lind K, Hagfors H, Salonen AH. Gambling-Related Harms for Affected Others: A Finnish Population-Based Survey. Int J Environ Res Public Health 2021; 18:9564. [PMID: 34574487 PMCID: PMC8465844 DOI: 10.3390/ijerph18189564] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/27/2021] [Accepted: 09/02/2021] [Indexed: 12/16/2022]
Abstract
Aims This study explores the prevalence of being a past-year affected other (AO) of a problem gambler by gender. The aims were to study the amount and type of gambling-related harms (GRHs) for subgroups of AOs and to distinguish GRH profiles for AO subgroups. Methods A total of 7186 adults aged 18 years and over participated in the Gambling Harms Survey evaluating year 2016. The data were analyzed using descriptive statistics and binary logistic regression. Results Of all respondents, 12.9% were defined as past-year AOs (women 13.7%; men 12.1%). The proportion of affected non-family members (ANFs) was 8.4%, and 5.6% were affected family members (AFMs). AFMs were usually women, and ANFs were usually men. Emotional, relationship, and financial harms were the most common types of harm. The odds of experiencing financial harm were highest for the 18- to 34-year-olds (OR 1.82) and for those whose partner/ex-partner had a gambling problem (OR 3.91). Having a parent/step-parent (OR 1.93) and child/stepchild (OR 3.64) increased the odds of experiencing emotional harm, whereas male gender (OR 0.50) and being an ANF (OR 0.58) decreased emotional harm. Relationship harm was evident for partners/ex-partners (OR 1.97-5.07). Conclusions GRH profiles for AO subgroups varied, which emphasizes the need for effective harm minimization strategies for those in need.
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Affiliation(s)
- Sari Castrén
- Health and Well-Being Promotion Unit, Finnish Institute for Health and Welfare, P.O. Box 30, 00271 Helsinki, Finland; (K.L.); (A.H.S.)
- Social Sciences Department of Psychology and Speech-Language Pathology, University of Turku, 20014 Turku, Finland
- Department of Medicine, University of Helsinki, P.O. Box 64, 00013 Helsinki, Finland
| | - Kalle Lind
- Health and Well-Being Promotion Unit, Finnish Institute for Health and Welfare, P.O. Box 30, 00271 Helsinki, Finland; (K.L.); (A.H.S.)
| | - Heli Hagfors
- Faculty of Social Sciences (SOC), Tampere University, 33014 Tampere, Finland;
| | - Anne H. Salonen
- Health and Well-Being Promotion Unit, Finnish Institute for Health and Welfare, P.O. Box 30, 00271 Helsinki, Finland; (K.L.); (A.H.S.)
- Faculty of Health Sciences, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland
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Palomäki J, Laakasuo M, Castrén S, Saastamoinen J, Kainulainen T, Suhonen N. Online betting intensity is linked with Extraversion and Conscientiousness. J Pers 2021; 89:1081-1094. [PMID: 33811638 DOI: 10.1111/jopy.12637] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 02/26/2021] [Accepted: 03/22/2021] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Extraversion and Conscientiousness are well-studied personality traits associated with reward processing and goal prioritization, respectively, and bear on individual differences in financial risk-taking. Using unique large datasets, we investigated the link between these traits and male online gamblers' actual betting participation and intensity. METHOD We combined datasets containing online horse betting data (during 2015-2016) from the Finnish monopoly betting company, administrative registry data from Statistics Finland, and personality trait measures from the Finnish Defence Forces corresponding to Extraversion and Conscientiousness as defined in the five-factor model. We modelled associations between these traits and betting participation (n = 471,968) and intensity (n = 11,217) among male horse bettors (age = 36-53). RESULTS Controlling for demographics and IQ, individuals scoring high on Conscientiousness (or Extraversion) were less (or more) likely to bet and less (or more) intensive bettors-even when personality was measured 16-34 years before betting occurred. One SD personality score increase represented an annual decrease (Conscientiousness) or increase (Extraversion) of €570-754 in spending. CONCLUSIONS Extraversion and Conscientiousness are implicated in real-life financial behavior with tangible consequences for individuals. These effects are stronger than for many known demographic variables used in gambling studies and persist up to 34 years after personality has been measured.
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Affiliation(s)
- Jussi Palomäki
- Cognitive Science, Department of Digital Humanities, Faculty of Arts, University of Helsinki, Helsinki, Finland
| | - Michael Laakasuo
- Cognitive Science, Department of Digital Humanities, Faculty of Arts, University of Helsinki, Helsinki, Finland
| | - Sari Castrén
- Department of Public Health Solutions, Alcohol and Drugs and Addictions Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Faculty of Social Sciences, Department of Psychology and Speech-Language Pathology, University of Turku, Turku, Finland
| | - Jani Saastamoinen
- Business School, Joensuu Campus, University of Eastern Finland, Joensuu, Finland
| | - Tuomo Kainulainen
- Business School, Joensuu Campus, University of Eastern Finland, Joensuu, Finland
| | - Niko Suhonen
- Business School, Joensuu Campus, University of Eastern Finland, Joensuu, Finland
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Lind K, Salonen AH, Järvinen-Tassopoulos J, Alho H, Castrén S. Problem gambling and support preferences among Finnish prisoners: a pilot study in an adult correctional population. Int J Prison Health 2019; 15:316-331. [PMID: 31532340 PMCID: PMC6761914 DOI: 10.1108/ijph-07-2018-0041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Purpose The purpose of this paper is to explore the prevalence of potential problem gambling among Finnish prisoners; the associations between problem gambling and demographics, substance use and crime-related factors; and problem gamblers’ support preferences. Design/methodology/approach Prisoners (n=96) from two Finnish prisons were recruited between December 2017 and January 2018. The estimated response rate was 31 percent. Gambling problems were measured using the Brief Biosocial Gambling Screen. The participants were asked to report their gambling both for one year prior to their incarceration and for the past year. The independent variables were demographics (age, gender and marital status), substance use (alcohol, smoking and narcotics) and crime-related factors (crime type, prison type and previous sentence). Statistical significance (p) was determined using Fischer’s exact test. Findings Past-year pre-conviction problem gambling prevalence was 16.3 percent and past-year prevalence 15 percent. Age, gender, smoking, alcohol or illicit drug use were not associated with past-year problem gambling before sentencing. One-third of the prisoners (33.3 percent) who were sentenced for a property crime, financial crime or robbery were problem gamblers. One-quarter (24 percent) of all participants showed an interest in receiving support by identifying one or more support preferences. The most preferred type of support was group support in its all forms. Research limitations/implications It is recommended that correctional institutions undertake systematic screening for potential problem gambling, and implement tailored intervention programs for inmates with gambling problems. Originality/value This study provides a deeper understanding of problem gambling in prisons. Problem gambling is associated with crime and also seems to be linked with serving a previous sentence. Early detection and tailored interventions for problem gambling may help to reduce reoffending rates.
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Affiliation(s)
- Kalle Lind
- Alcohol, Drugs and Addictions Unit, Terveyden ja hyvinvoinnin laitos, Helsinki, Finland
| | - Anne H Salonen
- Alcohol, Drugs and Addiction Unit, Terveyden ja hyvinvoinnin laitos, Helsinki, Finland.,Terveystieteiden tiedekunta, Itä-Suomen yliopisto , Kuopio, Finland
| | - Johanna Järvinen-Tassopoulos
- Alcohol, Drugs and Addictions Unit, Terveyden ja hyvinvoinnin laitos, Helsinki, Finland.,Faculty of Social Sciences, University of Helsinki , Helsinki, Finland
| | - Hannu Alho
- Alcohol, Drugs and Addictions Unit, Terveyden ja hyvinvoinnin laitos, Helsinki, Finland.,Institute of Clinical Medicine, Helsingin Yliopisto , Helsinki, Finland
| | - Sari Castrén
- Alcohol Drugs and Addictions Unit, National Institute for Health and Welfare, Helsinki, Finland.,Department of Psychology and Speech and Language Pathology, University of Turku , Turku, Finland.,Helsingin Yliopisto , Helsinki, Finland
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Castrén S, Mäkelä N, Haikola J, Salonen AH, Crystal R, Scheinin M, Alho H. Treating gambling disorder with as needed administration of intranasal naloxone: a pilot study to evaluate acceptability, feasibility and outcomes. BMJ Open 2019; 9:e023728. [PMID: 31439593 PMCID: PMC6707653 DOI: 10.1136/bmjopen-2018-023728] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND AIM There is growing interest in the use of medication-assisted treatments for gambling disorder (GD). Opioid receptor antagonists are hypothesised to blunt the craving associated with gambling. This study was designed to assess the feasibility of using an intranasal naloxone spray to treat GD. DESIGN An 8-week, open-label, uncontrolled pilot study. SETTING A single study site in the capital region of Finland. SUBJECTS Twenty problem gamblers (nine men) were randomised into two groups. Group A (n=10) took one dose into one nostril (2 mg naloxone), as needed, with a maximum of 4 doses/day (max. 8 mg/day). Group B (n=10) took one dose into each nostril (4 mg naloxone) as needed, with a maximum of 4 doses/day (max. 16 mg/day). INTERVENTION Naloxone hydrochloride nasal spray. MEASURES Acceptability and feasibility of the intervention were assessed. Use of study medication, adverse events, gambling frequency and gambling expenditure were recorded in a mobile diary. Problem gambling: South Oaks Gambling Screen (SOGS), depressive symptoms: Beck Depression Inventory (BDI) and alcohol use: Alcohol Use Disorders Identification Test were recorded. RESULTS Study completion rate was 90%. Acceptability and feasibility scores were high. Group B used intranasal naloxone more frequently than group A, and consequently used more naloxone. No serious adverse events were reported. The postintervention SOGS scores were lower (median=4 (IQR=3.75) versus preintervention scores (median=12 (IQR=4.75)). Depressive symptoms were reduced during the trial (preintervention BDI median=9, IQR=9 vs postintervention BDI median=6, IQR=6). CONCLUSIONS The acceptability and feasibility of using intranasal naloxone were high, and no serious adverse events were reported. Preliminary results suggest mixed results in terms of gambling behaviour (ie, reduced frequency but not expenditure) and decreased depressive symptoms. TRIAL REGISTRATION NUMBER EudraCT2016-001828-56.
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Affiliation(s)
- Sari Castrén
- Department of Public Health Solutions, Terveyden ja hyvinvoinnin laitos, Helsinki, Finland
- Faculty of Social Science, Department of Psychology and Speech Language Pathology, Turun Yliopisto, Turku, Finland
| | - Niklas Mäkelä
- Alcohol, Drugs and Addictions Unit, Terveyden ja hyvinvoinnin laitos, Helsinki, Finland
- Clinicum, University of Helsinki, Helsinki, Finland
| | - Janne Haikola
- Faculty of Natural Sciences, University of Tampere, Tampere, Finland
| | - Anne H Salonen
- Alcohol, Drugs and Addictions Unit, Terveyden ja hyvinvoinnin laitos, Helsinki, Finland
- Ita-Suomen yliopisto Terveystieteiden tiedekunta, Kuopio, Finland
| | | | - Mika Scheinin
- Institute of Biomedicine, University of Turku, Turku, Finland
| | - Hannu Alho
- Alcohol, Drugs and Addictions Unit, Terveyden ja hyvinvoinnin laitos, Helsinki, Finland
- Abdominal Center, University and University of Helsinki, Helsinki, Finland
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Castrén S, Heiskanen M, Salonen AH. Trends in gambling participation and gambling severity among Finnish men and women: cross-sectional population surveys in 2007, 2010 and 2015. BMJ Open 2018; 8:e022129. [PMID: 30139904 PMCID: PMC6112397 DOI: 10.1136/bmjopen-2018-022129] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 06/29/2018] [Accepted: 07/17/2018] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The aim of this study is to evaluate trends in past-year gambling participation and gambling severity among Finnish men and women from 2007 to 2015. DESIGN Cross-sectional population surveys from years 2007, 2011 and 2015. SETTING Data were drawn from the population register and collected using computer-assisted telephone interviews. PARTICIPANTS Representative random samples of Finns aged 15-74 were drawn in the study in 2007 (n=5008), 2011 (n=4484) and 2015 (n=4515) with response rates of 58%, 40% and 62%, respectively. OUTCOME MEASURES The outcome measures were gambling versatility, type of games, gambling intensity and gambling severity. Significance (p) between time points was determined using χ2 tests. All temporal comparisons between 2007-2011, 2011-2015 and 2007-2015 were performed separately for all respondents aged 15-74 and for women and men. RESULTS Gambling participation overall showed a rising trend (6.6 percentage points, 95% CI 4.9 to 8.3) from 2007 to 2015. In 2007-2011 women's gambling participation increased more (7.8 percentage points, 95% CI 5.5 to 10.4) than men's (5.4 percentage points, 95% CI 3.2 to 7.6). The most popular game types since 2007 have been lottery games, scratch cards and electronic gaming machines (EGMs). EGM gambling, on the other hand, has decreased since 2007. Online gambling has increased significantly from 2007 to 2015 in both genders. Men's at-risk gambling decreased from 2007 to 2011, while women's at-risk gambling and problem gambling increased from 2011 to 2015. CONCLUSIONS Women's increasing gambling participation is causing gender differences in gambling behaviour to narrow. The article concludes with a discussion of the need for gender-specific interventions aimed at preventing gambling-related harm and ultimately at protecting the most vulnerable groups.
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Affiliation(s)
- Sari Castrén
- The Alcohol, Drugs and Addictions Unit, Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
- Institute of Clinical Medicine, University and University Hospital of Helsinki, Helsinki, Finland
- Department of Psychology and Speech Language Pathology, Faculty of Social Science, University of Turku, Turku, Finland
| | | | - Anne H Salonen
- The Alcohol, Drugs and Addictions Unit, Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
- Faculty of Health Sciences, University of Eastern Finland, Helsinki, Finland
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Salonen AH, Kontto J, Perhoniemi R, Alho H, Castrén S. Gambling expenditure by game type among weekly gamblers in Finland. BMC Public Health 2018; 18:697. [PMID: 29871617 PMCID: PMC5989364 DOI: 10.1186/s12889-018-5613-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 05/25/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Excessive expenditure and financial harms are core features of problem gambling. There are various forms of gambling and their nature varies. The aim was to measure gambling expenditure by game type while controlling for demographics and other gambling participation factors. A further aim was to find out how each game type was associated with gambling expenditure when the number of game types played is adjusted for. METHODS Using data from the 2015 Finnish Gambling survey on adult gamblers (n = 3555), multiple log-linear regression was used to examine the effects of demographics, gambling participation, and engaging in different game types on weekly gambling expenditure (WGE) and relative gambling expenditure (RGE). RESULTS Male gender, lower education level, higher gambling frequency and higher number of game types increased both WGE and RGE, while younger age decreased WGE but increased RGE. Furthermore, seven specific game types increased both WGE and RGE. Weekly horse race betting and non-monopoly gambling had the strongest increasing effect on expenditure. Betting games and online poker were associated with higher expenditure even when they were played less often than weekly. Among weekly gamblers the highest mean WGE was recorded for those who played non-monopoly games (146.84 €/week), online poker (59.61 €/week), scratch games (51.77 €/week) and horse race betting (48.67 €/week). Those who played only 1-2 game types a week had the highest mean WGE and RGE on horse race betting and other betting games. CONCLUSIONS It seems that overall gambling frequency is the strongest indicator of high gambling expenditure. Our results showed that different game types had different effect sizes on gambling expenditure. Weekly gambling on horse races and non-monopoly games had the greatest increasing effect on expenditure. However, different game types also varied based on their popularity. The extent of potential harms caused by high expenditure therefore also varies on the population level. Based on our results, future prevention and harm minimization efforts should be tailored to different game types for greater effectiveness.
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Affiliation(s)
- Anne H. Salonen
- Alcohol, Drugs and Addictions Unit, National Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland
- Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Jukka Kontto
- Public Health Evaluation and Projection Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Riku Perhoniemi
- Alcohol, Drugs and Addictions Unit, National Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland
| | - Hannu Alho
- Alcohol, Drugs and Addictions Unit, National Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland
- Abdominal Center, University and University Hospital of Helsinki, Helsinki, Finland
| | - Sari Castrén
- Alcohol, Drugs and Addictions Unit, National Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland
- Department of Psychology and Speech-Language Pathology, Faculty of Social Sciences, University of Turku, Turku, Finland
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Salonen AH, Hellman M, Latvala T, Castrén S. Gambling participation, gambling habits, gambling-related harm, and opinions on gambling advertising in Finland in 2016. Nordisk Alkohol Nark 2018; 35:215-234. [PMID: 32934528 PMCID: PMC7434154 DOI: 10.1177/1455072518765875] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 02/28/2018] [Indexed: 11/30/2022] Open
Abstract
Background: This report is an overview of results from the 2016 Finnish Gambling Harms Survey covering the population and clinical perspectives. It summarises the main findings on gambling participation, gambling habits, gambling-related harm, and opinions on gambling advertising. Methods: The population sample (n = 7186) was collected from three regions and the clinical sample (n = 119) in a gambling help clinic. Results: Frequency of gambling in the population sample was characteristically once a week, while in the clinical sample it was daily. Men gambled more often than women only in the population sample. The most common gambling environments were kiosks, grocery stores or supermarkets, and home. The most typical gambling-related harms were financial or emotional/psychological harms; the amount of experienced harm was considerable among the clinical sample. The clinical sample also perceived gambling advertising as obtrusive and as a driving force for gambling. Conclusions: The results of the clinical sample imply that when gambling gets out of hand, the distinctions between gamblers’ habits diminish and become more streamlined, focusing on gambling per se – doing it often, and in greater varieties (different game types). There is a heightened need to monitor gambling and gambling-related harm at the population level, especially amongst heavy consumers, in order to understand what type of external factors pertaining to policy and governance may contribute to the shift from recreational to problem gambling.
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Affiliation(s)
| | | | | | - Sari Castrén
- National Institute for Health and Welfare, Finland; and University of Helsinki, Finland
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Castrén S, Kontto J, Alho H, Salonen AH. The relationship between gambling expenditure, socio-demographics, health-related correlates and gambling behaviour-a cross-sectional population-based survey in Finland. Addiction 2018; 113:91-106. [PMID: 28667828 PMCID: PMC5763410 DOI: 10.1111/add.13929] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 01/25/2017] [Accepted: 06/26/2017] [Indexed: 12/11/2022]
Abstract
AIMS To investigate gambling expenditure and its relationship with socio-demographics, health-related correlates and past-year gambling behaviour. DESIGN Cross-sectional population survey. SETTING Population-based survey in Finland. PARTICIPANTS Finnish people aged 15-74 years drawn randomly from the Population Information System. The participants in this study were past-year gamblers with gambling expenditure data available (n = 3251, 1418 women and 1833 men). MEASUREMENTS Expenditure shares, means of weekly gambling expenditure (WGE, €) and monthly gambling expenditure as a percentage of net income (MGE/NI, %) were calculated. The correlates used were perceived health, smoking, mental health [Mental Health Inventory (MHI)-5], alcohol use [Alcohol Use Disorders Identification Test (AUDIT)-C], game types, gambling frequency, gambling mode and gambling severity [South Oaks Gambling Screen (SOGS)]. FINDINGS Gender (men versus women) was found to be associated significantly with gambling expenditure, with exp(β) = 1.40, 95% confidence interval (CI) = 1.29, 1.52 and P < 0.005 for WGE, and exp(β) = 1.39, 95% CI = 1.27, 1.51 and P < 0.005 for MGE/NI. All gambling behaviour correlates were associated significantly with WGE and MGE/NI: gambling frequency (several times a week versus once a month/less than monthly, exp(β) = 30.75, 95% CI = 26.89, 35.17 and P < 0.005 for WGE, and exp(β) = 31.43, 95% CI = 27.41, 36.03 and P < 0.005 for MGE/NI), gambling severity (probable pathological gamblers versus non-problem gamblers, exp(β) = 2.83, 95% CI = 2.12, 3.77 and P < 0.005 for WGE, and exp(β) = 2.67, 95% CI = 2.00, 3.57 and P < 0.005 for MGE/NI) and on-line gambling (on-line and land-based versus land-based only, exp(β) = 1.35, 95% CI = 1.24, 1.47 and P < 0.005 for WGE, and exp(β) = 1.35, 95% CI = 1.24, 1.47 and P < 0.005 for MGE/NI). CONCLUSIONS In Finland, male gender is associated significantly with both weekly gambling expenditure and monthly gambling expenditure related to net income. People in Finland with lower incomes contribute proportionally more of their income to gambling compared with middle- and high-income groups.
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Affiliation(s)
- Sari Castrén
- Department of Public Health Solutions, Alcohol, Drugs and Addictions UnitNational Institute for Health and WelfareHelsinkiFinland
- Institute of Clinical MedicineUniversity and University Hospital of HelsinkiHelsinkiFinland
- Faculty of Social Sciences, Department of Psychology and Speech‐Language PathologyUniversity of TurkuTurkuFinland
| | - Jukka Kontto
- Department of Public Health Solutions, Health Monitoring UnitNational Institute for Health and WelfareHelsinkiFinland
| | - Hannu Alho
- Department of Public Health Solutions, Alcohol, Drugs and Addictions UnitNational Institute for Health and WelfareHelsinkiFinland
- Abdominal CenterUniversity of HelsinkiHelsinkiFinland
| | - Anne H. Salonen
- Department of Public Health Solutions, Alcohol, Drugs and Addictions UnitNational Institute for Health and WelfareHelsinkiFinland
- Institute of Clinical MedicineUniversity and University Hospital of HelsinkiHelsinkiFinland
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Castrén S, Perhoniemi R, Kontto J, Alho H, Salonen AH. Association between gambling harms and game types: Finnish population study. International Gambling Studies 2017. [DOI: 10.1080/14459795.2017.1388830] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Sari Castrén
- Alcohol, Drugs and Addictions Unit, National Institute for Health and Welfare, Helsinki, Finland
- Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland
- Faculty of Social Sciences, Department of Psychology and Speech-Language Pathology, University of Turku, Turku, Finland
| | - Riku Perhoniemi
- Alcohol, Drugs and Addictions Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Jukka Kontto
- Health Monitoring Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Hannu Alho
- Alcohol, Drugs and Addictions Unit, National Institute for Health and Welfare, Helsinki, Finland
- Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland
- Abdominal Center, University and University Hospital of Helsinki, Helsinki, Finland
| | - Anne H. Salonen
- Alcohol, Drugs and Addictions Unit, National Institute for Health and Welfare, Helsinki, Finland
- Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland
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Abstract
AIMS This study aims to explore the associations between final compulsory school grades and gambling and their relation to substance use and perceived mental health among people aged 18-29 in Finland (N = 831). METHODS Cross-sectional random sample data, weighted on the basis of age, gender and region of residence, were collected in 2015. The data were analysed using logistic regression models adjusted for sociodemographic variables, risky alcohol use, daily smoking, and perceived mental health. RESULTS Weekly gambling and at-risk and problem gambling (ARPG) were more common among men. Weekly gambling was linked to smoking and risky alcohol use among men and smoking among women. Additionally, ARPG was linked to risky alcohol use among men. ARPG was associated with moderate/poor mental health among men and women, but this was not the case with weekly gambling. Among men, low and average final school grades at age 16 were associated with weekly gambling later in life, even when adjusting for other variables. Among women, low and average final school grades were not associated with weekly gambling when adjusting for substance use. Lower final school grades were associated with ARPG among women but not among men when all potential confounders were adjusted for. CONCLUSIONS Adolescents with lower final school grades are more likely to gamble weekly later in life. Lower final school grades are also linked with ARPG among women. It is important therefore for schools to have clear policies on gambling and to implement early prevention programmes.
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Affiliation(s)
- Tiina Latvala
- 1 Alcohol, drugs and addictions unit, Department of Public Health Solutions, National Institute for Health and Welfare, Finland.,2 The Finnish Foundation for Alcohol Studies, Finland
| | - Sari Castrén
- 1 Alcohol, drugs and addictions unit, Department of Public Health Solutions, National Institute for Health and Welfare, Finland.,3 Institute of Clinical Medicine, University and University Hospital of Helsinki, Finland.,4 Department of Psychology and Speech Language Pathology, University of Turku, Finland
| | - Hannu Alho
- 3 Institute of Clinical Medicine, University and University Hospital of Helsinki, Finland.,5 Abdominal Centre, University and University Hospital of Helsinki, Finland
| | - Anne Salonen
- 1 Alcohol, drugs and addictions unit, Department of Public Health Solutions, National Institute for Health and Welfare, Finland.,3 Institute of Clinical Medicine, University and University Hospital of Helsinki, Finland
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Salonen AH, Rosenström T, Edgren R, Volberg R, Alho H, Castrén S. Dimensions of the South Oaks Gambling Screen in Finland: A cross-sectional population study. Scand J Psychol 2017; 58:228-237. [PMID: 28247931 DOI: 10.1111/sjop.12357] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 01/12/2017] [Indexed: 11/27/2022]
Abstract
The underlying structure of problematic gambling behaviors, such as those assessed by the South Oaks Gambling Screen (SOGS), remain unknown: Can problem gambling be assessed unidimensionally or should multiple qualitatively different dimensions be taken into account, and if so, what do these qualitative dimensions indicate? How significant are the deviations from unidimensionality in practice? A cross-sectional random sample of Finns aged 15-74 (n = 4,484) was drawn from the Population Information Registry and surveyed in 2011-2012. Analyses were conducted using descriptive statistics, Confirmatory factor analysis (CFA) and multidimensional item response theory (MIRT) models. Altogether, 14.9% of the population endorsed at least one of the 20 SOGS items, but nine items had low endorsement rates (≤ 0.2%). CFA and MIRT techniques suggested that individuals differed from each other in two positively correlated (r = 0.70) underlying dimensions: "impact on self primarily" and "impact on others also". This two-factor correlated-factors model can be reinterpreted as a bifactor model with one general gambling-problem factor and two specific factors with similar interpretation as in the correlated-factors model but with non-overlapping items. The two specific factors may provide clinically useful information without extra costs of assessment.
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Affiliation(s)
- Anne H Salonen
- National Institute for Health and Welfare, Department of Public Health Solutions, Alcohol, Drugs and Addictions Unit, Finland.,Institute of Clinical Medicine, University of Helsinki, Finland
| | - Tom Rosenström
- Institute of Behavioral Sciences, University of Helsinki, Finland
| | - Robert Edgren
- National Institute for Health and Welfare, Department of Public Health Solutions, Alcohol, Drugs and Addictions Unit, Finland.,Institute of Behavioral Sciences, University of Helsinki, Finland
| | - Rachel Volberg
- School of Public Health and Health Sciences, University of Massachusetts Amherst, USA
| | - Hannu Alho
- National Institute for Health and Welfare, Department of Public Health Solutions, Alcohol, Drugs and Addictions Unit, Finland.,Institute of Clinical Medicine, University of Helsinki, Finland.,Abdominal Center, University of Helsinki, Finland
| | - Sari Castrén
- National Institute for Health and Welfare, Department of Public Health Solutions, Alcohol, Drugs and Addictions Unit, Finland.,Institute of Clinical Medicine, University of Helsinki, Finland
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Edgren R, Castrén S, Jokela M, Salonen AH. At-Risk and Problem Gambling among Finnish Youth: The Examination of Risky Alcohol Consumption, Tobacco Smoking, Mental Health and Loneliness as Gender-Specific Correlates. Nordic Studies on Alcohol and Drugs 2017. [DOI: 10.1515/nsad-2016-0005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Aims The aims were to compare past-year at-risk and problem gambling (ARPG) and other at-risk behaviours (computer gaming, risky alcohol consumption, tobacco smoking) by age and gender, and to explore how ARPG is associated with risky alcohol consumption, tobacco smoking, poor mental health and loneliness in males and females. Design Data from respondents aged 15–28 (n = 822) were derived from a cross-sectional random sample of population-based data (n = 4484). The data were collected in 2011–2012 by telephone interviews. The Problem Gambling Severity Index (PGSI, score≥2) was used to evaluate ARPG. Prevalence rates for risk behaviours were compared for within gender-specific age groups. Regression models were gender-specific. Results The proportion of at-risk and problem gamblers was higher among males than females in all age groups except among 18–21-year-olds, while frequent computer gaming was higher among males in all age groups. The odds ratio (95% CI) of being a male ARPGer was 2.57 (1.40–4.74) for risky alcohol consumption; 1.95 (1.07–3.56) for tobacco smoking; 2.63 (0.96–7.26) for poor mental health; and 4.41 (1.20–16.23) for feeling lonely. Likewise, the odds ratio (95% CI) of being a female ARPGer was 1.19 (0.45–3.12) for risky alcohol consumption; 4.01 (1.43–11.24) for tobacco smoking; 0.99 (0.18–5.39) for poor mental health; and 6.46 (1.42–29.34) for feeling lonely. All 95% CIs of ARPG correlates overlapped among males and females. Conclusions Overall, past-year at-risk and problem gambling and computer gaming seem to be more common among males than females; however, for risky alcohol consumption similar gender differences were evident only for the older half of the sample. No clear gender differences were seen in correlates associated with ARPG.
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Affiliation(s)
- Robert Edgren
- Tobacco, Gambling and Addiction Unit National Institute for Health and Welfare, Finland Institute of Clinical Medicine University of Helsinki, Finland
| | - Sari Castrén
- Institute of Behavioural Sciences University of Helsinki, Finland
| | - Markus Jokela
- Tobacco, Gambling and Addiction Unit National Institute for Health and Welfare, Finland
| | - Anne H. Salonen
- Institute of Clinical Medicine University of Helsinki, Finland
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Salonen AH, Alho H, Castrén S. Attitudes towards gambling, gambling participation, and gambling-related harm: cross-sectional Finnish population studies in 2011 and 2015. BMC Public Health 2017; 17:122. [PMID: 28122531 PMCID: PMC5267383 DOI: 10.1186/s12889-017-4056-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 01/21/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Information about public gambling attitudes and gambling participation is crucial for the effective prevention of gambling-related harm. This study investigates female and male attitudes towards gambling, gambling participation, and gambling-related harm in the Finnish population aged 15-74. METHODS Cross-sectional random sample data were collected in 2011 (n = 4484) and 2015 (n = 4515). The data were weighted based on gender, age and region of residence. Attitudes were measured using the Attitudes Towards Gambling Scale (ATGS-8). Gambling-related harms were studied using the Problem Gambling Severity Index and the South Oaks Gambling Screen. RESULTS Attitudes towards gambling became more positive from 2011 to 2015. Female attitudes were generally negative, but nonetheless moved in a positive direction except in age groups under 25. Occasional gambling increased among women aged 18-24. Women aged 18-24 and 45-54 experienced more harms in 2015 than in 2011. Both land and online gambling increased among women aged 65-74. Male attitudes towards gambling were generally positive, and became more positive from 2011 to 2015 in all age groups except 15-17. Weekly gambling decreased among males aged 15-17. Gambling overall increased among males aged 18-24. Gambling several times a week decreased among men aged 35-44 and 45-54, and gambling 1-3 times a month increased in the latter age group. Online gambling increased only among men aged 55-64. CONCLUSIONS Attitudes towards gambling became more positive in all except the youngest age groups. Under-age male gambling continued to decrease. We need to make decision-makers better aware of the continuing growth of online gambling among older people and women's increasing experiences of gambling-related harm. This is vital to ensure more effective prevention.
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Affiliation(s)
- Anne H. Salonen
- Department of Tobacco, Gambling and Addiction, National Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland
- Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland
| | - Hannu Alho
- Department of Tobacco, Gambling and Addiction, National Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland
- Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland
| | - Sari Castrén
- Department of Tobacco, Gambling and Addiction, National Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland
- Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland
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25
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Castrén S, Temcheff CE, Derevensky J, Josefsson K, Alho H, Salonen AH. Teacher Awareness and Attitudes Regarding Adolescent Risk Behaviours: a Sample of Finnish Middle and High School Teachers. Int J Ment Health Addict 2016; 15:295-311. [PMID: 28424568 PMCID: PMC5378733 DOI: 10.1007/s11469-016-9721-z] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Empirical evidence has shown that youth gamble on both regulated and unregulated games, despite legislative prohibitions. This study assesses middle and high school teachers' awareness and attitudes regarding adolescent gambling and other potentially high-risk behaviours in Finland. A convenience sample of teachers (N = 157) from 13 provinces participated in the survey. The results suggest that teachers in Finland were more knowledgeable of the age limits of other adolescent high-risk behaviours than the legal age for gambling. Teachers were somewhat familiar with the behaviours and consequences associated with adolescent gambling. All other risk behaviours were perceived as being more important than gambling. Teachers' awareness about gambling prevention material in Finnish schools was limited. Results suggest that initiatives are required to enhance teachers' knowledge of adolescent problem gambling and its harmful short- and long-term consequences. School policies and guidelines including gambling behavior should be implemented in middle and high schools globally.
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Affiliation(s)
- Sari Castrén
- Clinicum, Internal Medicine, University of Helsinki and Helsinki University Hospital, POB 63, 00014 Helsinki, Finland
| | | | | | | | - Hannu Alho
- Clinicum, Internal Medicine, University of Helsinki and Helsinki University Hospital, POB 63, 00014 Helsinki, Finland
| | - Anne H Salonen
- Clinicum, Internal Medicine, University of Helsinki and Helsinki University Hospital, POB 63, 00014 Helsinki, Finland
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Salonen AH, Alho H, Castrén S. The extent and type of gambling harms for concerned significant others: A cross-sectional population study in Finland. Scand J Public Health 2016; 44:799-804. [PMID: 28929933 DOI: 10.1177/1403494816673529] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS This study investigates the proportion of concerned significant others (CSOs) of problem gamblers at population level and describes the extent and type of gambling harms for CSOs. METHODS Cross-sectional random sample data ( n = 4515) were collected in 2015. The data were weighted based on age, gender and residence. CSOs were identified using a question including seven options. Gambling harms were inquired using structured questions. Descriptive statistics and Chi-Squared and Fischer's exact tests were used. RESULTS Overall, the proportion of CSOs was 19.3%. Males had close friends with gambling problems more often than females, while females had family members with gambling problems more often than males. Of the CSOs, 59.5% had experienced one or more harms. Females experienced more harms than males. Typical harms were worry about health or well-being of close ones, emotional distress and problems in interpersonal relationships. CSOs with a problem gambler in the family, particularly a partner, child/children or mother, experienced harms more often than CSOs with a problem gambler as a close friend. CONCLUSIONS Female gender was associated with a larger extent of harms. The extent of harms was greatest if the problem gambler was a family member; however, a substantial amount of harms were experienced when the problem gambler was a close friend. CSOs and their position in evaluating gambling harms in general should be acknowledged. Persons beyond the nuclear family and the harms they encounter should be better acknowledged in prevention and harm minimisation. Early identification and a clear referral path to tailored support in occupational, social and healthcare settings may be considered.
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Affiliation(s)
- Anne H Salonen
- 1 National Institute for Health and Welfare, Tobacco, Gambling and Addiction Unit, Helsinki, Finland.,2 Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland
| | - Hannu Alho
- 1 National Institute for Health and Welfare, Tobacco, Gambling and Addiction Unit, Helsinki, Finland.,2 Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland
| | - Sari Castrén
- 1 National Institute for Health and Welfare, Tobacco, Gambling and Addiction Unit, Helsinki, Finland.,2 Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland
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27
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Kovanen L, Basnet S, Castrén S, Pankakoski M, Saarikoski ST, Partonen T, Alho H, Lahti T. A Randomised, Double-Blind, Placebo-Controlled Trial of As-Needed Naltrexone in the Treatment of Pathological Gambling. Eur Addict Res 2016; 22:70-9. [PMID: 26339899 DOI: 10.1159/000435876] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 06/10/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Effective treatment strategies are needed for the treatment of pathological gambling (PG). The efficacy of as-needed naltrexone was assessed in a single-centre, randomised, double-blind, placebo-controlled trial. METHODS The participants (n = 101) received either as-needed placebo or naltrexone (50 mg) and psychosocial support for 20 weeks. The primary outcome measure was the severity of PG assessed by the Yale-Brown Obsessive Compulsive Scale adapted for PG (PG-YBOCS). Secondary gambling-related outcome measures included thoughts/urges and behaviour subscales of PG-YBOCS as well as the highest daily expenditure and gambling frequency. In addition, RAND-36 scales of emotional well-being and social functioning were used as outcomes. The results were analysed using the intention-to-treat principle and linear random effects modelling. RESULTS No significant treatment group differences were found. In an exploratory analysis, emotional well-being increased in a subgroup of participants with AA genotype of opioid receptor, mu 1 (OPRM1) A118G polymorphism (p = 0.02). CONCLUSION Overall, the as-needed naltrexone may not provide substantial additional benefit for PG patients receiving psychosocial support. Replication by larger scale studies is warranted to further evaluate naltrexone administration schedules for the treatment of PG and the role of OPRM1.
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Affiliation(s)
- Leena Kovanen
- Mental Health Unit, National Institute for Health and Welfare, Department of Health, Helsinki, Finland
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28
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Tammi T, Castrén S, Lintonen T. Gambling in Finland: problem gambling in the context of a national monopoly in the European Union. Addiction 2015; 110:746-50. [PMID: 25664583 DOI: 10.1111/add.12877] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 06/25/2014] [Accepted: 02/03/2015] [Indexed: 11/30/2022]
Abstract
AIM To describe and analyse the Finnish gambling market, regulatory system and the state of gambling research as well as the treatment system in operation for problem gamblers. METHOD A review of the literature and official documents relating to gambling in Finland, focusing primarily on the 1990s and 2000s. RESULTS Only in recent years have gambling problems become a major issue for public debate in Finland. One reason for the increase in activity to address gambling problems is that, after Finland became a member of the European Union in 1995, the Finnish state gambling monopoly and its compatibility with European Union (EU) regulations have been questioned repeatedly. Since 2000, the Finnish government has put significant new resources into the research as well as the prevention and treatment of gambling problems. The resources grew from almost nothing to several million Euros in less than 10 years. This could be seen as an attempt to protect the national gambling monopoly system by showing that the Finnish monopoly system meets EU requirements. CONCLUSIONS Since joining the European Union in 1995, the Finnish government has been able to maintain its gambling monopoly by providing substantial resources to signal a commitment to minimizing problem gambling.
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Affiliation(s)
- Tuukka Tammi
- National Institute for Health and Welfare, Department of Mental Health and Substance Abuse Services, Helsinki, Finland
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29
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Castrén S, Grainger M, Lahti T, Alho H, Salonen AH. At-risk and problem gambling among adolescents: a convenience sample of first-year junior high school students in Finland. Subst Abuse Treat Prev Policy 2015; 10:9. [PMID: 25879923 PMCID: PMC4381398 DOI: 10.1186/s13011-015-0003-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 02/06/2015] [Indexed: 12/15/2022]
Abstract
Background Adolescent gambling and substance use are viewed as a public health concern internationally. The early onset age of gambling is a known risk factor for developing gambling problems later in life. The aims of this study are: to evaluate the internal consistency reliability, factorial validity and classification accuracy of the Finnish version of DSM-IV-Multiple Response-Juvenile (DSM-IV-MR-J) criteria measuring at-risk/problem gambling (ARPG); to examine gender differences in gambling participation, ARPG and substance use among first-year junior high school students; and to investigate the association of gambling and gaming (video game playing) participation, substance use and social variables with ARPG. Methods This study examined 988 adolescents (mean age 13.4 years) at 11 public schools in Finland between October-December 2013. The response rate was 91.6%. Chi-squared test and binary logistic regression analysis were used. Results ‘Illegal acts’ was the most endorsed and sensitive, but the least specific criteria identifying ARPG. During the past year, 51.6% of the respondents had gambled, 7.9% were identified as at-risk/problem gamblers (DSM-IV-MR-J score ≥ 2), 8.0% had smoked and 8.9% had been drinking for intoxication, and the first three were significantly more common among boys than girls. The odds ratio of being a male past-year at-risk/problem gambler was 2.27, 5.78 for gambling often or sometimes, 2.42 for video game playing weekly or more often and 6.23 for having peer gamblers. Conclusions Overall, the Finnish version of the DSM-IV-MR-J had acceptable internal consistency reliability and factorial validity. None of the DSM-IV-MR-J criteria were accurate enough to screen ARPG per se. ARPG past-year prevalence was relatively high with males gambling more than females. ARPG was as common as drinking alcohol for intoxication and smoking. Peer gambling was strongly associated with ARPG. Efficient strategies to minimise the risks of gambling problems, tools for prevention and identification of ARPG among the underage are needed.
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Affiliation(s)
- Sari Castrén
- Clinicum, Internal Medicine, University of Helsinki and Helsinki University Hospital, 00014, Helsinki, Finland. .,Department of Tobacco, Gambling and Addiction, National Institute for Health and Welfare, P.O. Box 30, FI-00271, Helsinki, Finland.
| | - Marjut Grainger
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, P.O. Box 30, FI-00271, Helsinki, Finland.
| | - Tuuli Lahti
- Department of Tobacco, Gambling and Addiction, National Institute for Health and Welfare, P.O. Box 30, FI-00271, Helsinki, Finland. .,Faculty of Social Sciences, Department of Behavioural Sciences and Philosophy University of Turku, Turku, Finland.
| | - Hannu Alho
- Clinicum, Internal Medicine, University of Helsinki and Helsinki University Hospital, 00014, Helsinki, Finland. .,Department of Tobacco, Gambling and Addiction, National Institute for Health and Welfare, P.O. Box 30, FI-00271, Helsinki, Finland.
| | - Anne H Salonen
- Clinicum, Internal Medicine, University of Helsinki and Helsinki University Hospital, 00014, Helsinki, Finland. .,Department of Tobacco, Gambling and Addiction, National Institute for Health and Welfare, P.O. Box 30, FI-00271, Helsinki, Finland.
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30
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Salonen AH, Alho H, Castrén S. Gambling frequency, gambling problems and concerned significant others of problem gamblers in Finland: cross-sectional population studies in 2007 and 2011. Scand J Public Health 2015; 43:229-35. [PMID: 25740616 DOI: 10.1177/1403494815569866] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2015] [Indexed: 11/15/2022]
Abstract
AIMS This study compares past-year gambling frequency, gambling problems and concerned significant others (CSOs) of problem gamblers in Finland by age, from 2007 and 2011. METHODS We used random sample data collected in 2007 (n = 4722) and 2011 (n = 4484). The data were weighted, based on gender, age and region of residence. We measured the past-year gambling frequency using a categorical variable, while gambling severity was measured with the South Oaks Gambling Screen. We identified CSOs by a single question including seven response options. Chi-Squared and Fisher's exact tests were used. RESULTS Overall, the past-year gambling frequency change was statistically significant between 2007 and 2011. Among 18-64-year-old Finnish people, the proportion of non-gamblers decreased. Yet, among 15-17-year-old respondents, non-gambling increased and gambling problems decreased. Among 18-24 year olds, the proportion of close ones with gambling problems also decreased. On the other hand, the proportion of family members with gambling problems increased among the 50-64 year olds. CONCLUSIONS The increase in adult gambling participation was mainly explained by infrequent gambling. The proportion of gambling problems from the gamblers' and CSOs' perspective remained unchanged, yet significant changes were observed within age groups. The short-term changes in under-age gambling problems were desirable. Future studies should explore the adaptation and access hypotheses alongside gambling problems.
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Affiliation(s)
- Anne H Salonen
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland Internal Medicine, University of Helsinki, Helsinki, Finland
| | - Hannu Alho
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland Internal Medicine, University of Helsinki, Helsinki, Finland
| | - Sari Castrén
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland Internal Medicine, University of Helsinki, Helsinki, Finland
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Castrén S, Salonen AH, Alho H, Lahti T, Simojoki K. Past-year gambling behaviour among patients receiving opioid substitution treatment. Subst Abuse Treat Prev Policy 2015; 10:4. [PMID: 25626451 PMCID: PMC4417343 DOI: 10.1186/1747-597x-10-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 01/19/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Substance abuse and gambling problems are associated, however, studies on gambling problems among opioid substitution treatment (OST) patients are scarce. The aims of this study are to explore the association of gender, age, treatment medication and treatment program with gambling behaviour, including gambling participation and gambling problems, among OST patients. FINDINGS All OST patients (n = 244) in three Finnish outpatient clinics were recruited in March - April 2014. The response rate was 64.3%. OST programs included two choices of orientation (rehabilitative/harm reduction) and two choices for treatment medication (methadone/buprenorphine-naloxone). Of 144 respondents, 70.1% had gambled during the past year and 12.5% were identified as potential past-year problem gamblers. Gambling was statistically significant more commonly among males (79.8%) compared with females (53.7%). Similarly patients in the rehabilitative program gambled (75.9%) more than those in the harm reduction program (50.0%). Gender, age, treatment medication or treatment program was not associated with past-year gambling problems. CONCLUSIONS Gambling participation of the OST patients seemed to be somewhat similar compared with the Finnish general population, but gambling problems were more common among OST patients. Gender and age may not be very strong indicators of risk while screening problem gamblers among OST patients. Institution of a problem gambling screening program is recommended, and additional intervention for gambling problems should be implemented for that need as a part of OST.
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Affiliation(s)
- Sari Castrén
- Department of Tobacco, Gambling and Addiction, National Institute for Health and Welfare, P.O. Box 30, FIN-00271, Helsinki, Finland.
- Internal Medicine, University of Helsinki, Helsinki, Finland.
| | - Anne H Salonen
- Department of Tobacco, Gambling and Addiction, National Institute for Health and Welfare, P.O. Box 30, FIN-00271, Helsinki, Finland.
- Internal Medicine, University of Helsinki, Helsinki, Finland.
| | - Hannu Alho
- Department of Tobacco, Gambling and Addiction, National Institute for Health and Welfare, P.O. Box 30, FIN-00271, Helsinki, Finland.
- Internal Medicine, University of Helsinki, Helsinki, Finland.
| | - Tuuli Lahti
- Department of Tobacco, Gambling and Addiction, National Institute for Health and Welfare, P.O. Box 30, FIN-00271, Helsinki, Finland.
- Faculty of Social Sciences, Department of Behavioural Sciences and Philosophy, University of Turku, Turku, Finland.
| | - Kaarlo Simojoki
- Internal Medicine, University of Helsinki, Helsinki, Finland.
- A-clinic Foundation, Maistraatinportti 2, 00240, Helsinki, Finland.
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Castrén S, Grainger M, Alho H, Lahti T. [The Finnish first year junior high school students gambling behaviour is associated with substance use and low academic performance]. Duodecim 2015; 131:163-171. [PMID: 26237919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND The study investigated Finnish 7th grade school children's gambling behaviour and gambling prevalence. METHOD Participants (N = 988) in this study were from eleven schools in Finland.Χ2X-tests, mean comparisons and correlations were used to analyse the data. The retention rate was 9.,6%. RESULTS Nearly one-third of the participants had gambled once or twice. .,0% of the participants were problem gamblers and .,8% gambled at-risk level. Significant others' gambling was associated with participants 'problem gambling. CONCLUSIONS Adolescent problem gambling prevalence and at-risk level of gambling were higher compared to the adult population. Replication of this study with the larger sample is needed in order to confirm the results.
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Salonen AH, Castrén S, Raisamo S, Orford J, Alho H, Lahti T. Attitudes towards gambling in Finland: a cross-sectional population study. BMC Public Health 2014; 14:982. [PMID: 25240625 PMCID: PMC4246492 DOI: 10.1186/1471-2458-14-982] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 09/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Attitudes towards gambling influence gambling behaviour but also reflect the existing gambling policy in a society. However, studies examining general attitudes towards gambling at the population level are scarce. The first aim of this study was to investigate general attitudes of the Finnish population towards gambling. The second aim was to explore the association of socio-demographics, gambling behaviours, being a concerned significant other (CSO) of a problem gambler and perceived health and lifestyle with attitudes towards gambling among the Finnish population. METHODS A cross-sectional study was performed by structured telephone interview on a random sample of 15-74-year-old Finns between October 2011 and January 2012. The data (n = 4484) was weighted based on age, gender and region of residence. Attitudes towards gambling were measured with the eight-item version of the Attitude Towards Gambling Scale (ATGS-8). A factor analysis was performed to test the structure of the Finnish version of the ATGS-8. The data were analysed using one-way ANOVA test, t-test and multiple regression analysis. RESULTS On average, attitudes of Finns towards gambling were negative. The most significant factors associated with positive attitudes towards gambling were male gender, young age, 12 years or more education and net income more than 2000€, low score on gambling severity, being a non-CSO of a problem gambler and high alcohol consumption CONCLUSIONS The association between young age, male gender, high net income and risky alcohol consumption, and favourable gambling attitudes was strong, and also reflects risky gambling behaviour. Experiencing gambling-related harms caused by one's own or significant other's excessive gambling seems to indicate unfavourable attitudes towards gambling.
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Affiliation(s)
- Anne H Salonen
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, P,O, Box 30, Helsinki, Finland.
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Salonen AH, Castrén S, Alho H, Lahti T. Concerned significant others of people with gambling problems in Finland: a cross-sectional population study. BMC Public Health 2014; 14:398. [PMID: 24758313 PMCID: PMC4058717 DOI: 10.1186/1471-2458-14-398] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 04/15/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Problem gambling not only impacts those directly involved, but also the concerned significant others (CSOs) of problem gamblers. The aims of this study were to investigate the proportion of male and female CSOs at the population level; to investigate who the CSOs were concerned about; and to investigate sociodemographic factors, gender differences, gambling behaviour, and health and well-being among CSOs and non-CSOs. METHODS The data (n = 4484) were based on a cross-sectional population study. Structured telephone interviews were conducted in 2011-2012. The data were weighted based on age, gender and residency. The respondents were defined as CSOs if they reported that at least one of their significant others (father, mother, sister/brother, grandparent, spouse, own child/children, close friend) had had gambling problems. Statistical significance was determined by chi-squared and Fisher's exact tests, and logistic regression analysis. RESULTS Altogether, 19.3% of the respondents were identified as CSOs. Most commonly, the problem gambler was a close friend (12.4%) of the CSO. The percentage of close friends having a gambling problem was larger among male CSOs (14.4%) compared with female CSOs (10.3%; p ≤ 0.001), while the percentage of partners with gambling problem was larger among females (2.6%) than among males (0.8%; p ≤ 0.001). In the best fitting model, the odds ratio (95% CI) of being a male CSO was 2.03 (1.24-3.31) for past-year gambling problems, 1.46 (1.08-1.97) for loneliness and 1.78 (1.38-2.29) for risky alcohol consumption. The odds ratio (95% CI) of being a female CSO was 1.51 (1.09-2.08) for past-year gambling involvement, 3.05 (1.18-7.90) for past-year gambling problems, 2.21 (1.24-3.93) for mental health problems, 1.39 (1.03-1.89) for loneliness and 1.97 (1.43-2.71) for daily smoking. CONCLUSIONS CSOs of problem gamblers often experience cumulating problems such as their own risky gambling behaviour, health problems and other addictive disorders. The clearest gender difference was seen in smoking by CSO. In order to develop efficient and targeted support and services for CSOs, it is necessary to understand the correlates related to different subgroups of CSOs.
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Affiliation(s)
- Anne H Salonen
- National Institute for Health and Welfare, Department of Mental Health and Substance Abuse Services, P.O. Box 30, Helsinki FIN-00271, Finland
| | - Sari Castrén
- National Institute for Health and Welfare, Department of Mental Health and Substance Abuse Services, P.O. Box 30, Helsinki FIN-00271, Finland
| | - Hannu Alho
- National Institute for Health and Welfare, Department of Mental Health and Substance Abuse Services, P.O. Box 30, Helsinki FIN-00271, Finland
- Research Unit of Substance Abuse Medicine, University of Helsinki, Helsinki, Finland
| | - Tuuli Lahti
- National Institute for Health and Welfare, Department of Mental Health and Substance Abuse Services, P.O. Box 30, Helsinki FIN-00271, Finland
- Faculty of Social Sciences, Department of Behavioral Sciences and Philosophy, University of Turku, Turku, Finland
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Castrén S, Basnet S, Salonen AH, Pankakoski M, Ronkainen JE, Alho H, Lahti T. Factors associated with disordered gambling in Finland. Subst Abuse Treat Prev Policy 2013; 8:24. [PMID: 23816162 PMCID: PMC3706208 DOI: 10.1186/1747-597x-8-24] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 06/20/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND The purpose of this study was to compare the socio-demographic characteristics of non-problem gamblers, problem gamblers and pathological gamblers, to investigate the association between gambling related factors and perceived health and well-being among the three subgroups of gamblers, and to analyse simultaneously socio-demographic characteristics, gambling related factors and perceived health and well-being and the severity of disordered gambling (problem gamblers and pathological gamblers). METHODS The data were collected through a nationwide telephone survey in 2011. Participants were selected through a random population sample of 15-74-year-old Finns. From that sample, persons with any past-year gambling involvement (N = 3451) were selected for a subsample for the descriptive and inferential analysis in the present paper. Gambling was assessed using the South Oaks Gambling Screen. Statistical significance was determined by chi-squared tests. The odds ratio and effect size were computed by using multivariate-adjusted multinomial logistic regression analysis. RESULTS The most significant socio-demographic characteristics (male gender, young age, education ≤ 12 years), gambling related factors (slot machine gambling, internet gambling) and perceived health and well-being (feeling lonely, smoking daily, risky alcohol consumption, mental health problems) explained 22.9 per cent of the variation in the severity of disordered gambling. CONCLUSION Male gender and loneliness were found to be associated with problem gambling in particular, along with smoking and risky alcohol consumption. Mental health problems and risky alcohol consumption were associated with pathological gambling. These identified associations between disordered gambling, mental health problems and risky alcohol consumption should be taken into consideration when implementing screenings of disordered gambling.
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Castrén S, Basnet S, Pankakoski M, Ronkainen JE, Helakorpi S, Uutela A, Alho H, Lahti T. An analysis of problem gambling among the Finnish working-age population: a population survey. BMC Public Health 2013; 13:519. [PMID: 23714573 PMCID: PMC3673882 DOI: 10.1186/1471-2458-13-519] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 05/22/2013] [Indexed: 11/27/2022] Open
Abstract
Background Gambling problems currently affect approximately 100 000 Finns. In order to prevent and reduce gambling-related harms it is crucial for the Finnish public health authorities to gain a stronger understanding of the association between gambling problems and related socio-demographic factors, other commonly co-occurring dependencies (e.g. alcohol and nicotine) and the type of games gambled. In this article the prevalence of problem gambling in Finland and the socio-demographic profiles of problem gamblers are studied. Method An annual postal survey entitled Health Behaviour and Health among the Finnish Adult Population AVTK was sent to a random sample of Finnish adults (N=5000) aged between 15 and 64. The sample was derived from the Finnish Population Register. The survey was mailed to the participants in April 2010. Gender differences in socio-demographic variables and Problem Gambling Severity Index PGSI were assessed. A multinomial regression model was created in order to explore the association between socio-demographic factors and the severity of gambling. Results A total of 2826 individuals (1243 males and 1583 females) replied to the survey. Of the respondents, 1.1% (2.1% of males, 0.3% of females) were identified as problem gamblers. Those who were of younger age, gender, had less than twelve years of education, consumed alcohol at risk level and smoked had higher odds of having low or moderate levels of gambling problems. Whereas, unemployment and smoking predicted significantly for problem gambling. Females gambled Lotto and slot machines less frequently than males and had more low level gambling problems. Males gambled more with a higher frequency and had a more severe level of gambling problems. Females were more attracted to scratch card gambling and daily Keno lotteries compared to males. In comparison, males gambled more on internet poker sites than females. Overall, a high frequency of gambling in Lotto, daily lotteries, slot machines, horse race betting and internet gambling was significantly associated with a more severe level of problem gambling. Conclusion Gambling problems affect tens of thousands of individuals annually, therefore certain vulnerabilities should be noted. Comorbid dependencies, smoking in particular, ought to be screened for and recognised in the public health sector. Regulating the availability of slot machine gambling and enforcement of the age limit should be acknowledged. In establishing new gambling venues, prevalence rates in those particular areas should be actively monitored.
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Affiliation(s)
- Sari Castrén
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland.
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Castrén S, Pankakoski M, Tamminen M, Lipsanen J, Ladouceur R, Lahti T. Internet-based CBT intervention for gamblers in Finland: experiences from the field. Scand J Psychol 2013; 54:230-5. [PMID: 23398086 DOI: 10.1111/sjop.12034] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 11/26/2012] [Indexed: 11/30/2022]
Abstract
From September 2007 to May 2011 a total of 471 participants (325 males and 146 females) signed up for an 8-week Internet-based cognitive behavioral therapy offered for gamblers in Finland. Sixty-four percent of the participants were pathological gamblers (PGs) (NODS 5> points), 14% were problem gamblers (NODS 3-4 points) and 10% were at risk of gambling problems (NODS 1-2 points). Two hundred and twenty four participants completed the treatment and after the treatment period significant changes were found in the following variables: gambling related problems (NODS), gambling urge, impaired control of gambling, alcohol consumption (AUDIT-C), social consequences, gambling-related cognitive erroneous thoughts and depression (MARD-S). In this sample co-morbid alcohol consumption was stronger among males. The main finding of this study was that the onset age of gambling was associated with a greater amount of gambling-related cognitive erroneous thoughts.
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Affiliation(s)
- Sari Castrén
- National Institute for Health and Welfare, Department of Mental Health and Substance Abuse Services, Helsinki, Finland.
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Castrén S, Sjöholm M, Lahti T. [Virtual support for problem gamblers]. Duodecim 2013; 129:1773-1777. [PMID: 24159710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Low threshold virtual support is an emerging form of treatment for problem gamblers. The advantages of virtual support are cost-efficacy and good availability. A special advantage of web-environment is the possibility to modify the virtual support programs separately for diverse subgroups of problem gamblers.
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Affiliation(s)
- Sari Castrén
- Terveyden ja hyvinvoinnin laitos, mielenterveys ja päihdepalvelut -osasto
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