NCRG 2010 Scientific Achievement Award Nomination Deadline Is Sept. 17

The deadline to submit nominations for the NCRG’s 2010 Scientific Achievement Award is Friday, Sept. 17, 2010. The NCRG annually recognizes outstanding contributions to the field of gambling disorders and responsible gaming with the Scientific Achievement Award. The 2010 nominees can include research investigators, educators and a recent publication in a peer-reviewed scientific journal.

The selection committee, composed of distinguished scientists in the addictions field, will select one recipient for the Scientific Achievement Award. The award will be presented on Nov. 15, 2010 at the 11thAnnual NCRG Conference on Gambling and Addiction in Las Vegas, Nev.

For more information about submitting a nomination, visit theScientific Achievement Awardspage on the NCRG website.

NCRG staffICRG Newsgambling researchNCRG Scientific Achievement Awardsproblem gambling

/by

Employee Assistance Certification Commission Approves NCRG Conference On Gambling And Addiction For Continuing Education

The Employee Assistance Certification Commission (EACC) of theEmployee Assistance Professional Association(EAPA) has approved the 2010NCRG Conference on Gambling and Addictionfor 14 Professional Development Hours (PDHs). EAPA is the world’s largest association representing professionals who work in employee assistance programs (EAPS), worksite-based programs designed to assist: (1) work organizations in addressing productivity issues; and (2) ’employee clients’ in identifying and resolving personal concerns, including, but not limited to, health, marital, family, financial, alcohol, drug, legal, emotional, stress, or other personal issues that may affect job performance.

The 11thAnnual NCRG Conference on Gambling and Addiction is scheduled for November 14-16, 2010, in Las Vegas, Nev. This year’s theme is “Redefining Diagnosis, Treatment, Research and Responsible Gaming for the 21stCentury.” Register by Oct. 8 to take advantage of the early-bird discount. For more information or to register for the conference, visit theConference linkon the NCRG website.

NCRG staffConference on Gambling and AddictionEAPAEAPsNCRG Conference on Gambling and Addictionproblem gambling

/by

2010 NCRG Conference Presenter Probes The Borders Between Normal, Eccentric And Disordered Behavior

Defining and categorizing disordered gambling will be one of the featured topics at the 11thannual NCRG Conference on Gambling and Addiction this November. In a presentation titled “Conceptualizing Problem Gambling: Cautionary Lessons from the Over-Pathologization of Depression and Substance Use,” Jerome C. Wakefield, DSW, PhD , a professor at New York University School of Medicine, will critique what he sees as psychiatry’s failure to draw adequate distinctions between disordered behavior, eccentric or unconventional behavior, and normal responses to stress (Wakefield, 2010).

Dr. Wakefield’s presentation will be a counterpoint to a preceding conference session focused on the proposed changes to pathological gambling in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) (American Psychiatric Association, 2010). The DSM is the handbook of mental disorders in the United States, used daily by health care providers, researchers, insurance companies and government agencies.

Dr. Wakefield’s criticism of the DSM centers on its use of symptom-based definitions for mental disorders. That is, the fact that individuals are diagnosed with the disorder if they exhibit a certain number of symptoms. For example, the DSM-IV indicates that individuals who have at least five out of 10 symptoms for pathological gambling, such as a preoccupation with gambling or being unable to cut back on gambling, are regarded as having a pathological gambling disorder (American Psychiatric Association, 1994). According to Dr. Wakefield, symptom-based definitions tend to cause “false positives,” categorizing people as disordered when their behavior is better explained by something else.

One of the factors that may not be considered by symptom-based definitions is context. For example, a person who has experienced the death of a loved one may exhibit all of the symptoms of major depression, but is actually just exhibiting a normal response to loss. (Of note, the DSM includes a caveat for symptoms experienced during bereavement in its definition of major depression; however, Dr. Wakefield’s point about context can be applied to other potential causes for depressive symptoms and other disorders listed in the DSM.)

Dr. Wakefield also argues that symptom-based definitions of mental disorders do not leave room for natural human variation. For example, if a person mourns the loss of a spouse for a full year, it could be a sign of a depressive disorder, or just natural variation in the time spent grieving. Dr. Wakefield states that symptom-based definitions are not equipped to deal with these variations, and individuals on the ends of any spectrum should not necessarily be classified as disordered just because they exhibit behaviors outside of more typical behavioral ranges.

Dr. Wakefield contends that clinical definitions based solely on symptoms cast too wide a net, diagnosing people with mental disorders when a consideration of context or natural human variation would better explain the behavior. This can be potentially harmful to people diagnosed with a mental disorder that carries a severe stigma and can lead to the unwarranted use of psychiatric medication.

Dr. Wakefield will apply this critique specifically to pathological gambling at the 2010 NCRG Conference on Gambling and Addiction, taking place on Nov. 14-16, 2010, at the Mandalay Bay Resort & Casino and the Las Vegas Convention Center in Nevada. Dr. Wakefield’s Monday talk sets the stage for a lively debate in the town hall meeting later that day. For details, download theNCRG Conference 2010 Brochure. To register for the conference, visit theConference linkon the NCRG website.

References

American Psychiatric Association. (2010, March 31). DSM-V: The Future of Psychiatric Diagnosis. Retrieved from www.dsm5.org

American Psychiatric Association. (1994).DSM-IV: Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association.

Wakefield, J. C. (2010). Misdiagnosing normality: Psychiatry’s failure to address the problem of false positive diagnoses of mental disorder in a changing professional environment.Journal of Mental Health,19(4), 337-351. doi:10.3109/09638237.2010.492418

NCRG staffConference on Gambling and AddictionDSM-VJerome Wakefieldpathological gambling

/by

2010 NCRG Conference Presenter Brings “Wellbriety” To Native Americans With Addictions

The use of Native American traditions to heal addiction is one of the featured topics at the 11thAnnual NCRG Conference on Gambling and Addiction on Nov. 14-16, 2010, at the Mandalay Bay Resort & Casino and the Las Vegas Convention Center in Nev. Don Coyhis, a member of the Mohican Nation, will hold a session titled “The Wellbriety Movement: Drawing on Native American Tools to Heal from Addiction.”

Wellbriety, a combination of the words “well” and “sobriety,” is a concept of recovery that focuses on a “quality sobriety.” This concept is rooted in Native American cultural values such as respect for all living things and responsibility to self and the community. Coyhis has been teaching the concepts of Wellbriety for 20 years and has held trainings in more than 100 Native American communities, personally training more than 2,000 leaders.

Coyhis based the concept of Wellbriety on his own experience as a recovering alcoholic in traditional 12-step programs. He found that the sobriety he achieved in the program was unfulfilling, a feeling he heard echoed by other recovering Native Americans. In response, he developed Wellbriety by combining aspects of traditional 12-step programs with Native American cultural values, community engagement, and health promotion and prevention.

One example of this integration is the “Medicine Wheel and 12 Steps to Recovery,” a modification of Alcoholics Anonymous that organizes the steps into four categories to correspond with the stages of life represented by the Medicine Wheel. The categories include steps 1-3: Finding the Creator; steps 4-6: Finding Yourself; steps7-9: Finding Your Relationship with Others; and steps 10-12: Finding the Wisdom of the Elders. This approach combines methods of sobriety and wellness with Native ways of communicating cultural knowledge in a single cohesive program.

Wellbriety training is available for families, adults, youth, people in prison, and even whole communities. The training can be done in person at the Wellbriety Training Institute in Colorado Springs, or through books and videos available fromthe Wellbriety Institute’s website.

For more information on Coyhis’s session at the 2010 NCRG conference, as well as other speakers and presentations, please download theNCRG Conference 2010 Brochure. To register for the conference, visit theConference linkon the NCRG website.

NCRG staffConference on Gambling and Addiction12-step programsAmerican Indianconference 2010NCRG Conferencetreatment for pathological gamblingWellbriety

/by

American Academy Approves NCRG Conference On Gambling And Addiction For Continuing Education

The American Academy of Health Care Providers in the Addictive Disordershas approved 14 hours of continuing education offered by the NCRG Conference on Gambling and Addiction, scheduled for Nov. 14-16, 2010 in Las Vegas. Clinicians who attend the conference will be allowed to apply the 14 continuing education hours toward their certification as Certified Addiction Specialists (CAS) and Certified Gambling Addiction Specialists (CGAS).

Created in 1988, the American Academy of Health Care Providers in the Addictive Disorders is an international credentialing body devoted to establishing and upholding the highest standards for the provision of treatment in the addictive disorders.

The academy established a core set of standards of competence for addiction treatment professionals, including psychologists, medical doctors, nurses, social workers and counselors.

Clickherefor more information about the NCRG Conference on Gambling and Addiction.

NCRG staffConference on Gambling and AddictionAmerican Academy of Health Care Providers in the Addictive Disorderscontinuing education for health care providersNCRG Conference on Gambling and Addiction

/by

Drug Treatments For Adolescents With Gambling Problems?

A new review article from the principal investigators of the NCRG Centers of Excellence in Gambling Research at Yale University and the University of Minnesota explores the potential of pharmacological treatments for disordered gambling in adolescents. It is important to identify an effective treatment for this age group, as adolescents are at a higher risk for developing gambling-related problems than adults. However, no drug trials focused on pathological gambling have been conducted with this age group. Determining which drugs might be safe, tolerable and effective for adolescents is more complex than simply applying what we already know about pharmacological treatments for adults (Grant & Potenza, 2010).

Currently, there are no pharmacological treatments approved by the U.S. Food and Drug Administration (FDA) for pathological gambling, though several drugs have shown potential in this area. One medication that has performed well in clinical trials is naltrexone, which has been used to blunt cravings for alcohol. Several studies suggest that naltrexone can reduce the intensity of gambling urges among adults with pathological gambling. Naltrexone is currently approved by the FDA as a treatment for alcohol dependence, and has been used in small doses to treat adolescents.

Lithium, currently used to treat bipolar disorder, is another medication with potential. It has been shown to reduce thoughts and urges associated with pathological gambling in people with both bipolar spectrum disorders and pathological gambling. One attribute that makes lithium particularly appealing is that it has been used safely with adolescents to treat bipolar disorder.

According to the authors, it is difficult to translate pharmacological treatments to adolescents because the adolescent brain is “a changing organ” (Grant & Potenza, 2010, p. 129). That is, the brain’s developmental processes may cause a drug to affect adolescents differently than adults depending on their individual stage of maturation. Consequently, research on adults can only suggest potentially promising pharmacological treatments. Definitive treatment recommendations for adolescents will have to wait for the completion of clinical trials in this population that include a control group for comparison.

More information on NCRG Centers of Excellence in Gambling Research is available on the Institute’swebsite.As always, we welcome your thoughts and questions in the Comments section below.

References

Grant, J. E., & Potenza, M. N. (2010). Pharmacological treatment of adolescent pathological gambling.International Journal of Adolescent Medicine and Health,22(1), 129-138.

NCRG staffResearch Updateadolescent gamblingJon E. GrantlithiumMarc PotenzaNaltrexonenew researchpharmacological treatment of pathological gamblingtreatment for pathological gamblingUniversity of Minnesota

/by

Radio Program Interviews Institute Director On The “Odds Of Recovery”

Viewpoints, a nationally syndicated public affairs radio program, recently aired a segment about pathological gambling that featured Christine Reilly, executive director of the Institute for Research on Gambling Disorders, and Dr. Mitchell E. Wallick, executive director of the C.A.R.E. Florida addiction recovery center in North Palm Beach, Fla. In the segment, Reilly and Dr. Wallick discussed several aspects of disordered gambling and mentioned the similarities between gambling disorders and other addictive behaviors. They also provided information on various interventions, including Gamblers Anonymous, counseling, cognitive behavioral therapy, acupuncture and drugs like naltrexone.

Viewpointsis broadcast weekly on more than 360 radio stations across the United States. To hear this segment, pleaseclick here. As always we welcome your thoughts and questions in the comments section below.

NCRG staffIn the Newsaddiction recovery centercognitive behavioral therapygamblingViewpoints

/by

The NCRG Hits The Road

Last month, the National Center for Responsible Gaming’s (NCRG) annual road tour visited Cleveland – one of Ohio’s new casino jurisdictions – where representatives met with treatment providers, policymakers, researchers and community leaders. As casino development in the city gets underway, the NCRG encouraged these stakeholder groups to work together to implement state-of-the-art responsible gaming programs and to adopt research-based policies that effectively minimize gambling related harms.

The road tour kicked off on July 22 with a workshop for treatment providers, which examined how the latest findings in the field of disordered gambling research can be implemented in a clinical setting. The workshop – which drew more than 100 local clinicians – was the most widely attended event in the four-year history of the road tour. It featured a presentation by Dr. Jon E. Grant, the principal investigator at the NCRG Center of Excellence at the University of Minnesota, who discussed the neurobiology of gambling disorders, comorbidity and the efficacy of various drug treatment strategies.

The following day, NCRG Board Member Phil Satre spoke during the Friday Forum luncheon at The City Club of Cleveland. He discussed the public health implications of gambling disorders and the importance of developing robust responsible gaming programs. He also highlighted several tools available through the NCRG that could be useful in Ohio, including a casino employee training program and recommendations from the National Task Force on College Gambling Policies.

“Ohio has a unique opportunity to be a national leader on responsible gaming – and efforts to address gambling disorders – from the outset,” Satre told attendees. “It is only through collaboration and cooperation that communities can truly endorse a comprehensive approach to these issues.” His speech was broadcasted to more than 160 radio stations in 38 states.

The road tour also included a dinner with Cleveland community leaders and one-on-one meetings with representatives from various local stakeholder groups.

NCRG staffICRG Newscasinos in ClevelandJon E. GrantPhil Satreresponsible gaming

/by

Reminder: Webinar On Self-exclusion Scheduled For August 16th!

As part of its 2010 Webinar Series, theNational Center for Responsible Gamingwill hold its next live, free webinar titled “Regulating Interventions for Disordered Gambling: What New Research Says about the Safety, Effectiveness and Logistics of Self-Exclusion Programs,” this Monday, Aug. 16, 2010, from 2 – 3 p.m. (EDT). The NCRG Webinar Series provides convenient educational opportunities at your desktop for learning about critical issues related to gambling disorders and responsible gaming. Participants in the one-hour program will earn one continuing education unit approved byNAADAC, the Association for Addiction Professionals, the California Foundation for Advancement of Addiction Professionals (CFAAP) and the California Board of Behavioral Sciences. Advance registration for this free program is required. For online registration and more information, visit thewebinar website.

As gaming continues its rapid expansion in jurisdictions around the world, so do the responsible gaming regulations that are intended to keep gambling a fun and safe recreational activity. One of the most popular initiatives is the “self-exclusion program,” which allows gaming patrons to exclude themselves from a casino and all the promotions and privileges typically accorded to customers. Despite the popularity of self-exclusion programs, little research has been conducted on their safety and effectiveness. In this webinar, Robert Ladouceur, Ph.D., C.A.S., professor of psychology at Laval University, Quebec, – one of the few researchers to explore self-exclusion from a scientific perspective – will present his findings from a study of self-exclusion in Quebec and suggest future directions on this topic for researchers, regulators, public policy makers and operators. The session also will feature Kevin Mullally, J.D., general counsel and director of government affairs at Gaming Laboratories International, who will discuss the current international regulatory environment and will reflect on the growth of self-exclusion worldwide. Participants will have the opportunity to post questions and comments during this live program.

NCRG staffContinuing Education Opportunitiescontinuing educationgaming regulationsKevin MullallyNAADACNCRG Webinar SeriesRobert Ladouceurself-exclusionwebinars

/by

Issues &Amp; Insights Explores Self-exclusion Research

Self-exclusion is one of the most widely used responsible gaming strategies. These programs allow individuals to literally “exclude” themselves from a gaming venue as a way of dealing with problematic gambling behavior. Scientific research on the safety and effectiveness of self-exclusion is just now catching up to the establishment of such programs, which began more than a decade ago.

The NCRG’s Aug. 16 webinar, “Regulating Interventions for Disordered Gambling: What New Research Says about the Safety, Effectiveness and Logistics of Self-Exclusion Programs,” will feature research by Robert Ladouceur, Ph.D., C.A.S., professor of psychology, Laval University, Quebec. (Clickherefor more details or to register for this free, one-hour program.) This month’sIssues & Insightshighlights selected peer-reviewed studies in this emerging area of research.

Self-exclusion programs provide a way for a person to voluntarily ban him or herself from a casino as a way to deal with a gambling problem. These programs can be mandated by the government or voluntarily established by casinos and other gaming operators. For example, casinos that are members of the American Gaming Association, which represents commercial casinos in the United States, are required by the association’s Code of Conduct to provide their guests with the option to self-exclude. Under most self-exclusion agreements, the individual risks trespassing charges if she or he attempts to return to the casino and forfeits any winnings. The casino agrees to remove the self-excluded person from its direct mail lists, and many programs require a lifetime ban. However, some governments and casinos are experimenting with shorter bans because clinicians and researchers have expressed concerns that a lifetime ban may prevent people from enrolling.

Researchers are interested in what motivates an individual to enroll in a self-exclusion program because the act of enrollment represents treatment-seeking behavior. Since only a fraction of the population with a gambling problem seeks external assistance, understanding why gamblers choose to enter a self-exclusion program will help inform treatment strategies for disordered gambling. A 2010 study, “Motivators for resolving or seeking help for gambling problems: A review of the empirical literature,” found that self-excluders were motivated by a weighing of the pros and cons of gambling and the desire to regain control over their gambling as well as concern about the impact on relationships and financial difficulties (Suurvali, Hodgins, & Cunningham).

The Missouri Gaming Commission, which created the Missouri Voluntary Exclusion Program (MVEP) in 1995, has made its data available to researchers, resulting in several publications. For example, researchers analyzed the Missouri enrollment data from the perspectives of age and gender (Nower & Blaszczynski, 2006, 2008). In “Characteristics of problem gamblers 56 years of age or older: A statewide study of casino self-excluders,” they reported that older adult self-excluders typically began gambling in midlife, experienced gambling problems around age 60, reported preferences for nonstrategic forms of gambling (e.g., slot machines) and identified fear of suicide as the primary reason for enrolling in the MVEP (Nower & Blaszczynski, 2008). In another study of the MVEP, “Characteristics and gender differences among self-excluded casino problem gamblers: Missouri data,” Nower and Blaszczynski observed that female self-excluders were more likely than males to be African American, older at time of application, and either retired, unemployed or otherwise outside the traditional workforce (2006). In addition, female self-excluders were more likely to report a later age of gambling onset, a shorter period between onset and self-exclusion, a preference for non-strategic forms of gambling and prior bankruptcy.

The Harvard Medical School faculty at the Division on Addictions, Cambridge Health Alliance, conducted a two-phase research project on the MVEP. As reported in “Missouri casino self-excluders: Distributions across time and space,”a geographic and time-based analysis of the 6,599 people who applied to exclude themselves from Missouri casinos between 1996 and 2004 demonstrated that the epicenters of disordered gambling were the Western region around Kansas City and the Eastern region around St. Louis (LaBrie, Nelson, LaPlante, Peller, Caro, & Shaffer, 2007). The authors observed that the annual number of self-exclusion enrollments increased during the first few years of the MVEP before leveling off during the later years, suggesting a process of adaptation to the presence of casinos in Missouri.

The second phase of the Harvard study, as reported in the article, “One decade of self exclusion: Missouri casino self-excluders four to ten years after enrollment,” focused on the effectiveness of the MVEP by assessing the experiences of a sample of Missouri self-excluders for as long as 10 years after their initial enrollment in the program (Nelson, Kleschinsky, LaBrie, Kaplan, & Shaffer, 2010). According to this study, most of the self-excluders had positive experiences with MVEP and reduced their gambling and gambling problems after enrollment. However, 50 percent of the self-excluders succeeded in trespassing at Missouri casinos after enrollment, indicating that the benefit of MVEP was attributable more to the act of enrollment than enforcement.

Dr. Robert Ladouceur and his colleagues at Laval University also have conducted extensive research on the effectiveness of self-exclusion. Their studies of a self-exclusion program in a Quebec casino demonstrated the promise of this approach for helping individuals reduce problem gambling behaviors (Ladouceur, Jacques, Giroux, Ferland, & Leblond, 2000; Ladouceur, Sylvain & Gosselin, 2007). Their most recent study (Tremblay, Boutin, & Ladouceur, 2008) is the first to evaluate efforts to make self-exclusion a therapeutic program (e.g., providing counseling support to enrollees) rather than just a legal agreement about trespassing. The authors observed major improvements in the study sample between the initial and final evaluation in terms of the amount of time and money they spent gambling, the consequences of their gambling, scores on the criteria for diagnosing pathological gambling and levels of psychological distress.

Such findings appear to support the notion of self-exclusion as a gateway to treatment. In their 2007 publication, Blaszczynski, Ladouceur, and Nower argued for a unifying structure for self-exclusion programs as a gateway to treatment based on a system operated by independent educators. These educators would inform individuals of the purpose of self-exclusion, establish links and access to supplementary services and monitor and report the effectiveness of the overall program.

Although these studies reveal the promise of self-exclusion, all identify the need for larger sample sizes in future research to determine more definitively the effectiveness of self-exclusion as an intervention for disordered gambling.

Despite this interest in self-exclusion as a therapeutic program or harm reduction strategy, self-exclusion programs administered by governments are technically considered legal agreements with penalties for self-excluders who violate the terms of the contract. For example, self-excluders can be arrested for trespassing or fined if caught on the premises of a casino in many jurisdictions. Self-exclusion has raised questions among legal specialists about the responsibility and liability of the gaming operator. Self-excluders have initiated lawsuits in cases where the casino did not enforce the ban (Faregh, & Leth-Steensen, 2009; Czegledy, 2009). Questions such as, “Who is responsible if a self-excluded person gains entry to a casino and goes bankrupt?” and “Should casinos withhold winnings from self-excluded patrons?” have been posed in several court cases (Rhea, 2005). Some also have questioned whether self-exclusion agreements even meet the legal standards of an enforceable legal contract (Napolitano, 2003).

Although most of the peer-reviewed research on self-exclusion is focused on the U.S. and Canada, studies on this intervention have been conducted all over the world. Both peer-reviewed and “grey” literature (publications that are not peer-reviewed, such as government reports) indicate that self-exclusion has been studied in Australia, New Zealand, Switzerland, South Africa and the United Kingdom (Breen, 2005; Townshend, 2007; Haefeli, 2005; O’Neil, Whetton, Dolman, et al., 2003; Collins, & Kelly, 2002; Jackson, & Thomas, 2005).

If you are interested in learning more about self-exclusion research, note that two upcoming educational programs will focus on translating several of the studies cited above for a non-scientific audience. First, Dr. Robert Ladouceur will present his findings from the self-exclusion program in Quebec during the NCRG Webinar, “Regulating Interventions for Disordered Gambling: What New Research Says about the Safety, Effectiveness and Logistics of Self-Exclusion Programs.”This free, one-hour webinar will be held onAug. 16, 2010, at 2 p.m. (EDT), and also will feature Kevin Mullally, J.D., general counsel and director of government affairs at Gaming Laboratories International,and the developer of Missouri Voluntary Exclusion Program.Advance registration is required.

Second, the next volume of the NCRG’s publication series,Increasing the Odds: A Series Dedicated to Understanding Gambling Disorders, focuses on research about self-exclusion, providing summaries of several of the articles cited above, written for a non-scientific audience. This free publication will be available in October 2010.

References

Blaszczynski, A., Ladouceur, R., & Nower, L. (2007). Self-exclusion: A proposed gateway to treatment model.International Gambling Studies,7(1), 59-71.

Breen, H., Buultjens, J., & Hing, N. (2005). Evaluating implementation of a voluntary responsible gambling code in Queensland, Australia.International Journal of Mental Health & Addiction,3(1), 15–25.

Collins, P. & Kelly, J. (2002). Problem Gambling and Self-Exclusion: A Report to the South African Responsible Gambling Trust.Gaming Law Review,6(6), 517-531.

Czegledy, P. (2009). The Legal Risk of Problem Gambling.Gaming Law Review and Economics,13(3), 233-240.

Haefeli, J. (2005).Swiss experience with self-exclusion programs. Presented at the Niagara Falls Self Exclusion Panel, Niagara Falls. Retrieved fromhttp://www.responsiblegambling.org/articles/jorg_hafeli_discovery_2005.pdf

Jackson, A., & Thomas, S. (2005). Clients’ perspectives of, and experiences with, selected Australian problem gambling services.Journal of Gambling Issues,14. Retrieved fromhttp://jgi.camh.net/doi/full/10.4309/jgi.2005.14.7

LaBrie, R. A., Nelson, S. E., LaPlante, D. A., Peller, A. J., Caro, G., & Shaffer, H. J. (2007). Missouri casino self-excluders: distributions across time and space.Journal of Gambling Studies, 23(2), 231-243.

Ladouceur, R., Jacques, C., Giroux, I., Ferland, F., & Leblond, J. (2000). Analysis of a casino’s self-exclusion program.Journal of Gambling Studies,16(4), 453-460.

Ladouceur, R., Sylvain, C., & Gosselin, P. (2007). Self-exclusion program: a longitudinal evaluation study.Journal of Gambling Studies,23(1), 85-94.

Napolitano, F. (2003). The self-exclusion program: legal and clinical considerations.Journal of Gambling Studies,19(3), 303-315.

Nelson, S. E., Kleschinsky, J. H., LaBrie, R. A., Kaplan, S., & Shaffer, H. J. (2010). One decade of self exclusion: Missouri casino self-excluders four to ten years after enrollment.Journal of Gambling Studies,26(1), 129-144.

Nower, L., & Blaszczynski, A. (2006). Characteristics and gender differences among self-excluded casino problem gamblers: Missouri data.Journal of Gambling Studies,22(1), 81-99

Nower, L., & Blaszczynski, A. (2008). Characteristics of problem gamblers 56 years of age or older: a statewide study of casino self-excluders.Psychology and Aging,23(3), 577-584.

O’Neil, M., Whetton, S., Dolman, B., Herbert, M., Giannopoulos, V., O’Neil, D., & Wordley, J. (2003).Evaluation of Self-exclusion Programs. South Australian Centre for Economic Studies. Retrieved fromhttp://www.justice.vic.gov.au

Rhea, A. (2005). Voluntary Self Exclusion Lists: How They Work and Potential Problems.Gaming Law Review,9(5), 462-469.

Suurvali, H., Hodgins, D.C., & Cunningham, J.A. (2010). Motivators for resolving or seeking help for gambling problems: A review of the empirical literature.Journal of Gambling Studies, 26, 1-33.

Townshend, P. (2007). Self-exclusion in a Public Health Environment: An Effective Treatment Option in New Zealand.International Journal of Mental Health and Addiction,5(4), 390-395.

NCRG staffIssues & Insightsinterventions for problem gamblingMissouri Voluntary Exclusion Programresponsible gamingself-exclusion

/by