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The third morning session at the 12^thannual NCRG Conference on Gambling and Addiction was an especially good fit with the conference theme, “Risk or Reward: The Impact of Technology on Treatment, Research and Responsible Gaming.” Dr. John Cunningham, Canada research chair in brief interventions for addictive behaviors at the University of Toronto, presented a session called “Web-based Interventions for Alcohol Use Disorders: Implications for Gambling.” The session was especially pertinent because it highlighted the possibilities of using web-based treatments for gambling disorders, an option that is sometimes overshadowed by concerns about the potential negative effects of technology.

Dr. Cunningham began his talk by highlighting the tremendous potential that Internet-based interventions (IBIs) have as a treatment method for those with addictive disorders. One of the main benefits of IBIs is their ability to reach people who are not in treatment, a group that ranges from 88 to 93 percent of people with gambling disorders (Slutske, 2006). Dr. Cunningham stated that IBIs are well-suited for people with gambling disorders for a few reasons. First, 73 percent of people with gambling disorders have access to the Internet in their home and are able to access the IBI programs at any time of day. Second, participants like the privacy that IBIs provide, and individuals claim that they find it easier to write their experiences than to speak them. Dr. Cunningham also noted that online participation might be a first step to seeking treatment, and there is no evidence that people are using IBIs instead of attending in-person treatment.

To provide an example of what an IBI might look like, Dr. Cunningham talked about an IBI for alcohol use disorders titledwww.checkyourdrinking.net. The website contains a series of resources for people with alcohol use disorders such as self-tests, cognitive behavioral therapy tools and support group features. The self-test provides normative feedback about the average alcohol consumption for the United States, Canada and the United Kingdom. Research has shown that people want to behave in ways that are similar to their peers, and normative feedback uses this desire to encourage healthy behavior by pointing out when people are drinking more than the average.

The online tools, such as those on chooseyourdrinking.net, are particularly useful to host support groups because people can access their group at any time of day from any location with Internet access. This means that participants with a mobile phone who could connect to the Internet could also connect to their support group at any place where they might need support, including in the parking lot of a liquor store or casino.

Dr. Cunningham concluded that these tools currently being used for alcohol and tobacco use have potential for gambling disorders as well. While gambling research is not as far along as research related to other addictive disorders, there is evidence that similar tools may be useful.

For information about the work of Dr. Cunningham and his colleagues at the Centre for Addiction and Mental Health, you can visit their website athttp://www.camh.net/. For information about other sessions at the 12^thannual Conference on Gambling and Addiction, please visit theconference websiteand check out some of the earlier posts on this page.

References

Slutske, W. S. (2006). Natural recovery and treatment-seeking in pathological gambling: results of two U.S. national surveys.American Journal of Psychiatry,163(2), 297-302. doi:163/2/297 [pii] 10.1176/appi.ajp.163.2.297

NCRG staffConference on Gambling and Addiction

Breakout sessions at the NCRG Conference on Gambling and Addiction are a unique opportunity to hear from leaders in research on gambling disorders and responsible gaming in a smaller setting. Joachim Häeusler, the responsible gaming manager at bwin.party digital entertainment (bwin.party), led a Sunday-evening breakout session at this year’s conference that examined the company’s comprehensive player-protection program, as well as what the company’s goals for future responsible gaming initiatives.

Bwin.party is the largest, publicly listed online gaming operator and a major player in all regulated European online gambling markets. The company has online gaming licenses in 10 jurisdictions, with more than three million customers per year.

The company monitors and saves all Internet transactions, which are linked to player accounts. With this information, they can collect anonymous data such as gambling frequency, volume, betting patterns, usage of responsible gaming tools, usage of payment methods and patterns in deposit and withdrawal behavior.

In 2005, bwin.party collaborated with the Division on Addictions at Cambridge Health Alliance, a teaching affiliate of Harvard Medical School, to study online gaming behavior. Bwin.party provided full access to anonymous gambling transaction data of approximately 100,000 customers, which had been monitored over several years. The goal of this collaboration was to create a base of scientific evidence about actual online gambling behavior to help design a more comprehensive player protection program.

The Division on Addictions at Cambridge Health Alliance developed a predictive model of individualized player protection that classifies bwin.party customers into three types of gamblers and offers them different levels of protection:

Type of GamblerLevel of ProtectionModerate gamblers (approximately 95 percent of customers)Informed ChoiceAt-risk gamblers (approximately 4 percent of customers)ControlProblem gamblers (approximately 1 percent of customers)Protection

Informed Choice

For players who were classified as moderate gamblers, bwin.party offers informed choice for player protection. This allows players to educate themselves about responsible gaming and make decisions about their gambling behavior, based on what they learned. A responsible gaming website is located directly on the gambling portal and is accessible with one click. Players are able to see their account balance in real currency denomination of the header of the gambling website and have access to a comprehensive transaction overview. Players also can view a timer on the gambling portal to see how long they have been gambling.

Control

Players who are classified as at-risk gamblers are provided with choices of self-limitation and partial self-exclusion, as well as self-help tools. These customers may increase their limit, but the increased limit is only effective after a delay period of three days and an additional confirmation from the player. Eighty-eight percent of customers remain at the limits they originally imposed. These customers are also monitored by bwin.party for potential increases in problem gambling behavior.

Protection

Problem gamblers are provided with a two options to help them gamble responsible, and are encouraged to select the most appropriate choice for themselves that maximizes responsible gambling behavior and limit problem gambling behavior.
First, problem gamblers have the option to choose self exclusion, either temporarily (for a minimum of six months) or an indefinite period of time. If the player chooses self-exclusion, bwin.party sends them a confirmation email that includes resources for counseling. These customers are also exempt from direct mailings and advertisements. Temporary self-excluders can only reopen their account after explicit confirmation. Indefinite self-excluders can reopen their account after six months with additional requirements: a case investigation and a monitoring phase with a fixed deposit limit. Indefinite self-excluders also are put on national exclusion lists.

A second option for problem gamblers is to close their account. This can be done temporarily (for up to six months) or indefinitely. These customers are referred to counseling via information on the responsible gaming website. Players who choose temporary account closures can automatically reinstate their account once the predetermined time period is finished. Those who indefinitely close their accounts can only reinstate the account after explicit confirmation from the player. Bwin.party also has systems in place to prevent a player from simply creating a new account.

Future of Player Protection

Before the session concluded, Häeusler stated that there is still a missing piece in player protection: early detection or problematic gambling behavior. However, bwin.party is making steps to study the behavioral indicators for early detection of gambling-related problems and design “proactive player protections.”

What do you think about these player protections and methods to help players gamble responsibly? Share your thoughts in the comments below. For more recap posts from the NCRG Conference, make sure to stay tuned to Gambling Disorders 360˚.

NCRG staffConference on Gambling and Addictioncontinuing educationeducationgamblingInternetresponsible gaming

Yesterday’s NCRG Conference attendees were able to hear the latest research on actual Internet gambling behavior from Sarah Nelson, Ph.D., associate director for research at the Division on Addictions at Cambridge Health Alliance, a teaching affiliate of Harvard Medical School, and instructor in psychiatry at Harvard Medical School. Dr. Nelson led the session “Science vs. Myth: Research on Internet Gambling” at the12th annual NCRG Conference on Gambling and Addiction.

Dr. Nelson acknowledged that Internet gambling is growing, which can lead to speculation that increased accessibility makes Internet gambling more addictive than other types of gambling. However, Dr. Nelson stated that there are dangers of speculation without scientific evidence, including public confusion and criticism, misallocation of public health resources and a failure to help people who need help.

Currently, Dr. Nelson explained, there is very little peer-reviewed and published empirical research on Internet gambling. Until recently, theoretical propositions and opinion papers represented most of the professional discussion surrounding this topic, and the available empirical findings have been from studies that use variations of self-reporting methodology.

Dr. Nelson stated that Internet gambling provides unique opportunities for the study of gambling behavior and problem gambling. Unlike land-based gambling, the technology that makes Internet gambling a potential risk also allows for the study of actual real-time gambling behavior.

Bwin.party, the largest publicly-listed online gambling operator, offered data to help Dr. Nelson and her colleagues improve the player protection process of Internet gambling. Dr. Nelson and her colleagues identified four key questions to help them study real-time gambling behavior:

1. Who gambles on the Internet?

2. What are the play patterns of most Internet gamblers?

3. Is Internet gambling particularly addictive?

4. Is it possible to detect and isolate individuals with excess patterns of play?

The bwin.party data provided three different samples of Internet gambling:

– Internet sports betting, which consisted of a sample size of 40,499 sequentially subscribed Internet sports gamblers over the course of eight months.

– Internet casino betting, which consisted of 4,222 sequentially subscribed Internet casino gamblers over the course of 24 months.

– Internet poker betting, which consisted of 3,445 sequentially subscribed Internet poker players over the course of 24 months.

After further examination of these data, Dr. Nelson and her colleagues made the conclusion that “the results do suggest problem gambling is not as common among Internet gamblers as the speculations and the consequent conventional wisdom suggested.” One caveat was that researchers were not able to capture the players’ variations in levels of disposable income, which might broaden understanding of Internet gambling behavior. Dr. Nelson stated that the project revealed it is possible to study actual gambling behavior, and the results from these studies reveal findings quite different from expectations. She also noted that behavioral markers can be used to identify Internet gamblers at risk for experiencing problems.

Dr. Nelson also mentioned that she and her colleagues are currently working to develop an algorithm to help with early detection of gambling-related problems to all for proactive player protection.

Continue to visitGambling Disorders 360°for daily updates, on-site reporting about the sessions and audio interviews from leading researchers and industry representatives.

NCRG staffConference on Gambling and Addictioncontinuing educationgamblingInternetresearch

Prior to the start of the12th annual NCRG Conference on Gambling and Addiction, David Hodgins, Ph.D., professor of psychology and adjunct professor in the department of psychiatry at the University of Calgary, led a workshop on how clinicians can incorporate Motivational Interviewing (MI) into their treatment plan for patients with gambling disorders. During this workshop, Dr. Hodgins described the principles of MI, explained MI strategies and discussed how to apply MI in a clinical practice.

Dr. Hodgins began the workshop by providing the definition of MI, as described by William R. Miller and Stephen Rollnick (the inventors of MI): MI is “a directive, client-centered method for enhancing intrinsic motivation to change by exploring and resolving ambivalence.” Dr. Hodgins explained that MI provides clients with a “motivational nudge.” When using MI, counselors should elicit client concerns, explore ambivalence, promote self-efficacy and suggest strategies for the counselor to use to assist the clients in discussing changes to problematic behavior.

Dr. Hodgins stated that there are three components to MI: Spirit; Basic Principles; and Phases of MI.

Spirit

Motivational Interviewing is “all about active listening and resolving ambivalence to change,” said Dr. Hodgins as he emphasized the importance of spirit over technique when interacting with clients. The MI spirit is (1) collaborative: provides a partner-like relationship; (2) evocative: elicits motivation rather than instilling it; and (3) respectful: the responsibility for change is with the client. Dr. Hodgins emphasized the importance of spirit over technique when interacting with client According to Dr. Hodgins, when a therapist increases empathy in their interaction with the client, the result is that clients are usually more likely to stay in treatment and less likely to relapse.

Basic Principles

Next, Dr. Hodgins discussed the four basic principles of MI:

1. Express empathy by listening to the patient;

2. Helping clients appreciate the value of change by exploring the discrepancy between how clients want their lives to be versus how they currently are;

3. Address and move forward despite resistance with the goal of evoking solutions; and

4. Support self-efficacy by helping the patient believe he/she can change.

Of these four basic principles, Dr. Hodgins stated, “Empathy is single-best predictor of success of success in addition counseling.”

Phases

Dr. Hodgins then explained the two phases of MI: (1) building motivation to change by eliciting change talk and exploring ambivalence and (2) strengthen the commitment to change by helping the patient begin to plan for change. He provided several suggestions for evoking and responding to change talk.

Also during the workshop, Dr. Hogins provided several interaction techniques that can be used throughout the process of MI. The techniques are called “OARS” and include:

Open-ended questions

Affirmations

Reflective listening

Summaries

Dr. Hodgins concluded the workshop with a video showing himself and a graduate student role-playing a counseling session and how MI is incorporated into the session.

Continue to visitGambling Disorders 360°for daily updates, on-site reporting about the sessions and audio interviews from leading researchers and industry representatives.

Spirit

Motivational Interviewing is “all about active listening and resolving ambivalence to change,” said Dr. Hodgins as he emphasized the importance of spirit over technique when interacting with clients. The MI spirit is (1) collaborative: provides a partner-like relationship; (2) evocative: elicits motivation rather than instilling it; and (3) respectful: the responsibility for change is with the client. Dr. Hodgins emphasized the importance of spirit over technique when interacting with client According to Dr. Hodgins, when a therapist increases empathy in their interaction with the client, the result is that clients are usually more likely to stay in treatment and less likely to relapse.

NCRG staffConference on Gambling and AddictionConferencecontinuing educationMotivational Interviewingresearchtherapy

Responsible gaming programs typically advise gamblers to set a budget for time and money spent gambling and other self-management techniques designed to avoid problems with gambling. Research is now beginning to examine the types of strategies used by recreational gamblers and people with gambling problems. A new study from Australia demonstrates this trend (Moore et al., 2011).

The authors of this preliminary study were interested not only in how those without gambling problems avoid problematic gambling behavior, but also how people with gambling disorders reduced or stopped their gambling. One of the most recent studies in this literature, to be discussed by Dr. Wendy Slutske at theNCRG Conference on Gambling and Addiction, revealed that a large percentage of Australians who have recovered from a gambling disorder are able to participate in “controlled gambling.” In other words, they are able to gamble without relapse (Slutske, 2009). Understanding their strategies will help inform responsible gaming programs, brief interventions and treatment approaches.

In Dr. Moore’s research with his colleagues, the study sample of 303 gamblers included 63 who qualified as problem gamblers, according to the Problem Gambling Severity Index of the Canadian Problem Gambling Index (CPGI; Ferris and Wynne 2001; Moore et al, 2011). The study participants identified how often they used each of 27 strategies that complete the statement, “To help me limit or manage my gambling, I….”

The total sample, including both non-problem and problem gamblers, rated the following as the top four strategies to limit gambling behaviors:

– ‘Focus on other hobbies’

– ‘Set a target budget for my gambling and stick to it’

– ‘Think about the negative consequences of excessive gambling’

– ‘Keep track of the money I spend on gambling’

Among non-problem gamblers only, the following ranked as their top four strategies:

– ‘Focus on other hobbies’

– ‘Think about the negative consequences of excessive gambling’

– ‘Set a target budget for my gambling and stick to it’

– ‘Keep track of the money I spend on gambling’

The strategies least subscribed to by non-problem gamblers were: cut up my credit cards; get professional help for my gambling; and have myself voluntarily excluded from a gambling venue.

Individuals who met criteria for problem gambling ranked the following management techniques as most used:

– ‘Focus on other hobbies’

– ‘Spend more time with family and friends’

– ‘Think about the negative consequences of excessive gambling’

– ‘Keep track of the money I spend on gambling’

– ‘Talk to family and friends about my gambling’

The lowest ranked techniques for this group were: having myself voluntarily excluded from a gambling venue; ask a friend to look out for me when I’m at a gambling venue; and cut up my credit cards.

The authors summarized the findings: “Overall, strategies concerned with setting limits on bet size and time spent gambling, reminding oneself of the negative consequences of gambling and distraction with other activities were the most frequently used techniques, with about half the sample employing these at some time or other. Most of these techniques involve some kind of cognitive restructuring—thinking about gambling in a different way, either to attempt to reduce its attraction or to try to rein in that attraction” (Moore et al., 2011, p. 13). The researchers recommend future research focused on the use of these strategies among larger samples.

References

Ferris, J., & Wynne, H. J. (2001). The Canadian problem gambling index: Final report. Available from www.ccsa.ca/pdf/ccsa-00805-200.pdf.

Moore, S.M., Thomas, A.C., Kyrios, M., & Bates, G. (2011). The Self-Regulation of Gambling.Journal of Gambling Studies. [Epub ahead of print]

Slutske, W.S., Piasecki, T.M., Blaszczynski, A., & Martin, N.G. (2010). Pathological gambling recovery in the absence of abstinence.Addiction,105(12), 2169-2175.

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