The Brief Addiction Science Information Source (BASIS)

Op-Ed/Editorials: Private Interest vs. Public Interest: Science Caught in the Crossfire

Leslie Bosworth, B.A.
Debi LaPlante, Ph.D.
Richard LaBrie, Ed.D.
Howard Shaffer, Ph.D, C.A.S.

As public policy makers and scientists address modern public health problems such as obesity, they acknowledge the negative impact the tobacco industry had on public health policy discussions of the past (Danynard, 2003).  For the past few decades, the tobacco industry introduced industry favoring scientific evidence to public policy discussion, slowing legislation addressing health issues such as second hand smoke.  This harmful effect coupled with allegations of biased research has sparked debate among the research community as to the moral integrity of accepting private funding, especially from industries producing negative health consequences (e.g., tobacco, fast food; Adams, 2007).  This debate also strengthened the belief that government funded research is inherently more invested in the public interest than privately funded research (Moskalewicz, 2007), and therefore is more genuine.  This editorial argues that discrediting all privately funded research as vulnerable to bias is just as much of an oversimplification as viewing all government funded research as trustworthy.  All sources of funding have the power to create a conflict of interest among scientists. To illustrate this issue, this editorial contrasts two poor scientific activities of “the worst of the worst” in private funding (i.e., Big Tobacco) with recent scientific activity of a respected US federal government agency.

Tobacco Industry Funded Research

Censorship
Censoring data is one symptom of a conflict of interest.  The tobacco industry funded research in response to the growing body of scientific evidence showing the ill health effects of second hand smoke, but prohibited publication of unfavorable results.  For example, an editor of Psychopharmacology requested revisions of a 1983 article entitled “Nicotine as a positive reinforcer in rats,” submitted by three authors employed by the Phillip Morris Research Center.  In their reply to the editor’s request, the authors withdrew the manuscript, and later stated Phillip Morris issued an injunction against publishing the article (Barry, 2006).  Not releasing information with important health consequences is a form of censorship that the tobacco industry achieved by creating a conflict of interest among the authors.

Approving Flawed Findings
Before academic journals publish scientific evidence, a panel of the journal’s scientists typically reviews the evidence to verify methodological and presentational integrity, an approval process that adds credibility to published scientific data.  A second effect of the conflict of interest, however, is scientists’ approval of flawed findings.  Therefore some findings from tobacco-related research disrupted this peer review process.  For example, the tobacco industry was able to publish research with faulty methods and incorrectly attributed results in Inhalation Toxicology, a peer reviewed journal.  One of the editors of this journal is Dr. David Doolittle, Director of Biological Research at RJ Reynolds, a cigarette company (Inhalation Toxicology Homepage, 2007; Tong & Glantz, 2007).  The journal’s uncharacteristic permissiveness points to a conflict of interest. 

The Reason
The tobacco industry created a conflict of interest among scientists to manipulate scientific evidence and the reason is clear: evidence demonstrating ill health effects could influence legislation and public opinion and, as a result, limit cigarette sales. 

White House Funded Research

Before government officials present findings to Congress, the White House Office of Management and Budget (OMB) reviews all testimonies to ensure the testimonies are consistent with the President’s budget and policies.  Last October, the director of the Centers for Disease Control and Prevention (CDC), Dr. Julie Gerberding, submitted testimony to the OMB on climate change’s ill effects on health before speaking to the Senate Committee on Environment. 

Censorship
According to an anonymous CDC official, the OMB “eviscerated” her testimony: editing out key scientific evidence and informed health recommendations, including the CDC’s position that “climate change [is] a serious public health concern” (Associated Press, October 24, 2007).  Four pages remained after editing the original 14-page manuscript (Associated Press, October 24, 2007).  This apparent censorship mirrors censored reports produced by tobacco funded scientists, as neither released important health information inconsistent with the goals or policies of the funding sources.

Approving Flawed Findings
Just as Inhalation Toxicology published flawed findings due to a conflict of interest on the peer review panel, Dr. Gerberding also denied flaws in her presentation, reporting she “[i]s absolutely happy with my testimony” (Associated Press, October 24, 2007).  Dr. Gerberding’s opinion contrasts with Senator Barbara Boxer’s, the chairman of the committee to which Dr. Gerberding presented, who declared “this is not a country that should be censoring science” (Reuters, October 25, 2007).

This incident provides evidence for a conflict of interest because data were censored, and because a scientist endorsed this flawed presentation of censored information.  Indeed, Dr. Gerberding’s cooperation with the OMB coincides with a recent bonus issued by the Bush administration (Harris, September 17, 2006). 

The Reason
The Committee on Oversight and Government Reform released a report last month that quoted internal documents from the American Petroleum Institute (API); these documents provide the Institute’s rationale for manipulating scientific evidence on climate change.  According to the API, “climate is at the center of industry’s business interests.  Policies limiting carbon emissions reduce petroleum product use” (Committee on Oversight and Government Reform, December 12, 2007).  Both President Bush and Vice President Cheney are former executives of oil companies and have an interest in the stability of that industry.  According to the Center for Public Integrity, the oil industry gave $67 million in campaign contributions from 1998-2004, of which George W. Bush received over $1.7 million (Pilhofer & Williams, July 15, 2004).  A separate internal API document described the API’s communication plan: “Victory will be achieved when… average citizens ‘understand’ uncertainties in climate science.”  The congressional committee’s report responded that “the Bush administration has acted as if the oil industry’s communication plan were its mission statement” by censoring science, media access to scientists, and congressional testimonies (Committee on Oversight and Government Reform, December 12, 2007). The reason for manipulating scientific evidence, according to the congressional committee’s data, is because it could change legislation and public opinion towards improving the environment by limiting demand for oil.

Concluding Thoughts
The tobacco industry served as a litmus test for understanding the ethics of researchers and private funding sources, and recent problems with government funded research expand the scope of this understanding.  The potential risks of close partnerships between scientists and any type of funding source calls into question our ability to evaluate the quality of research and our persistence in accessing censored research.  If even the White House biases research findings, disclosing the source of funding for research is a poor shortcut by which consumers can measure its credibility. 

These problems with private industry and scientists accepting private funding are not, however, monolithic.  These industries and these scientists do not represent all funding sources, all scientists, and do not represent these scientists throughout their entire careers.  The integrity of science relies on the continued responsibility of individuals: scientists; those directing the funding sources; and vigilant audience members with sophisticated means of evaluating possible research biases in every study.

Any funding from a private company “invariably contains the seeds of direct or indirect profit motives” (Batra, 2007); these problems are common to any field accepting money from private sources, such as politicians seeking financing for campaigns.  As the United States increasingly relies on private funding, so does science, but the empirical degree to which this funding biases research is largely unknown (Etter, Burri, & Stapleton, 2007; Moskalewicz, 2007).

References

Adams, P. J. (2007). Assessing whether to receive funding support from tobacco, alcohol, gambling and other dangerous consumption industries. Addiction, 102, 1027-1033.

Associated Press. (October 24, 2007). Sources: White House cut testimony. CNN.Com   Retrieved October 24, 2007, from http://www.cnn.com/2007/HEALTH/10/24/global.warming.ap/index.html

Barry, H. (2006). Censorship by a tobacco company. Psychopharmacology, 184(3-4), 273.

Batra, A. (2007). Funding support - cui bono? Addiction, 102, 1034-1040.

Committee on Oversight and Government Reform. (December 12, 2007). Committee report: White House engaged in systematic effort to manipulate climate change science.   Retrieved December 18, 2007, from http://oversight.house.gov/documents/20071210101633.pdf; http://www.bespacific.com/index.html

Danynard, R. A. (2003). Commentary: Lessons from Tobacco Control for the Obesity Control Movement. Journal of Public Health Policy, 24(3-4), 291-295.

Etter, J.-F., Burri, M., & Stapleton, J. (2007). The impact of pharmaceutical company funding on results of randomized trials of nicotine replacement therapy for smoking cessation: a meta-analysis. Addiction, 102, 815-822.

Harris, G. (September 17, 2006). Gush of bonuses awarded to top CDC administrators.  Generous perks part of Bush push to revamp agency. SFGate.com   Retrieved October 25, 2007, from http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2006/09/17/MNGFIL779F1.DTL&hw=CDC+julie&sn=002&sc=339

Inhalation Toxicology Homepage. (2007). Editorial Board of Inhalation Toxicology.   Retrieved October 20, 2007, from http://www.tandf.co.uk/journals/journal.asp?issn=0895-8378&linktype=5

Moskalewicz, J. (2007). Commentaries on Adams: Moral jeopardy or research integrity. Addiction, 102, 1034-1040.

Pilhofer, A., & Williams, B. (July 15, 2004). Big oil protects its interests: Industry spends hundreds of millions on lobbying, elections. The Center for Public Integrity: Investigative Journalism in the Public Interest.   Retrieved November 13, 2007, from http://www.publicintegrity.org/oil/report.aspx?aid=345

Reuters. (October 25, 2007). Democrats press Bush on climate change testimony. New York Times   Retrieved October 26, 2007, from http://www.nytimes.com/reuters/washington/politics-climate-cdc-congress.html

Tong, E. K., & Glantz, S. A. (2007). Tobacco industry efforts undermining evidence linking secondhand smoke with cardiovascular disease. Circulation, 116, 1845-1854.

Op-Ed/Editorials: Detecting At-risk Internet Gambling Behavior

Howard J. Shaffer, Ph.D.
Debi A. LaPlante, Ph.D.
Richard A. LaBrie, Ph.D.
Sarah E. Nelson, Ph.D.

Land-based and online gaming companies are racing to create universal algorithms that will identify people who are at risk for developing problematic gambling behavior. Unfortunately, supporters of this effort are nowhere near the finish line for that race; perhaps worse, the competitors are quite possibly off-track. Researchers and practitioners have yet to agree upon the most important identifying characteristics of problematic gambling behavior. Land-based efforts are at a starting advantage, simply because the extant scientific gambling literature predominantly addresses land-based gambling. Consequently, innovators who are trying to facilitate the development of identification algorithms for land-based gambling venues have a stronger scientific foundation available to them than online gaming companies.

There is so little available empirical information about Internet gambling behavior and characteristics of problematic Internet gambling, that early efforts to develop appropriate algorithms are at high risk for error. Researchers cannot, at this time, say with confidence that any of the leading candidates for land-based identifying characteristics of problematic gambling behavior apply to online gambling behavior. The nature of Internet gambling is sufficiently distinct from land-based opportunities to suggest that although some factors might generalize fairly well, others will not, and still others unique to Internet gambling remain to be determined. And, we do not know yet if there are unique risk factors associated with Internet gambling.

Public information related to land-based identification algorithms is limited. In one exception, the Saskatchewan Gaming Corporation (SGC) has published information in a peer-reviewed journal about their algorithm-guided identification system (iCare) to identify at-risk gamblers; they also presented related peer-reviewed findings at international conferences. (1)  Unless the development of such algorithm-guided systems follows transparent validation procedures (e.g., surveying and comparing validation groups of patrons), the sensitivity (i.e., likelihood of accurate identification of individuals who have a problem), specificity (i.e., likelihood of accurate identification of individuals who do not have a problem), and predictive validity (i.e., the ability to accurately predict future gambling problems) of its identification of “problem gambling” is uncertain. Adapting problematic gambling characteristics gleaned from land-based research and/or relying on professional or conventional wisdom about problematic gambling characteristics is unlikely to result in behavioral profiles that can withstand traditional scientific scrutiny.

The risks and hazards associated with prematurely bringing an identification algorithm to the market are considerable. A product without acceptable specificity, sensitivity, and predictive validity places a company and its consumers at unnecessary risk. To illustrate, problematic gambling behavior is a low base-rate phenomenon. This means that an algorithm can claim a success rate of 90% due to its specificity (i.e., likelihood of accurately identifying individuals who do not have gambling problems), but yield minimal to no sensitivity (i.e., likelihood of accurately identifying individuals who do have problems). Last week we posted an illustration of this phenomenon in the WAGER, The Importance of Sensitivity: In Models and for Interpreting What You Read. Finally, the algorithm must have predictive validity. Absent predictive validity, the best that an algorithm can offer is a transient identification that might not be accurate the next day or beyond. The likelihood of sensitivity errors (i.e., falsely identifying someone who has a problem as being problem-free) and the absence of predictive validity place companies at great risk for litigation and players at risk for ongoing harm that can be avoided with careful and systematic research and planning.

The best next steps in the development of responsible gambling for Internet gambling companies are to identify the actual public health risks of online gambling and to develop a comprehensive profile of characteristics that empirically can distinguish problematic Internet gambling behavior from recreational Internet gambling. Specifics related to the best means of accomplishing these tasks are beyond the scope of this paper. Until the next investigative steps are accomplished, identification algorithms for online gaming consumers will be of dubious value.

Notes

1. Davies, B. (2007). iCare: Integrating Responsible Gaming Into Casino Operation. International Journal of Mental Health & Addiction, 5(4), 307-310.

Op-Ed/Editorials: Toward a Public Health Approach to Improve Parameters for Safer Gambling

Allyson J. Peller, M.P.H.
Research Associate
Harvard Medical School, Division on Addictions, Cambridge Health Alliance

Debi A. LaPlante, Ph.D.
Instructor of Psychology
Harvard Medical School, Division on Addictions, Cambridge Health Alliance

Howard J. Shaffer, Ph.D., C.A.S.
Director
Harvard Medical School, Division on Addictions, Cambridge Health Alliance

During recent years, there has been considerable media attention devoted to the potential harms associated with emerging gambling technology. Some advocates claim that emerging gambling technology is hazardous to the public health (i.e., leads to disordered gambling) while other advocates claim that technological interventions can prevent or alleviate gambling-related problems (e.g., reduce users’ spending by limiting the availability and denominations of bill acceptors) (Bulkeley, 1995; Federal Trade Commission, 2003; Nova Scotia Gaming Corporation, 2006; Wood, Griffiths, & Parke, 2007). Although these advocates have voiced strong opinions, these discussions have not utilized a public health approach to conduct a balanced assessment of factors that contribute to disordered gambling or strategies to control contributing factors.

Korn and Shaffer (1999, 2002) first proposed placing the study of gambling behavior within a public health framework to improve policy, prevention, and treatment practices.  More specifically, public health practitioners and researchers can use the classic three-part public health model, that is the Epidemiologic Triangle of host, agent, and environment, to understand the full spectrum of factors that contribute to a range of public health phenomena (e.g., an epidemic or the subjective effects of gambling). The goal of public health interventions often is to control at least one of the three factors to prevent or stop a challenge to the public’s health (Centers for Disease Control and Prevention, 2007). Applied to the study of disordered gambling, the Epidemiologic Triangle can help researchers to examine a comprehensive range of factors related to host (i.e., player characteristics (e.g., psycho-physiologic characteristics, cognitive characteristics)), agent (i.e., new gambling technology (e.g., Internet gambling, audiovisual game features)), and environment (i.e., context of gambling behavior (e.g., factors within gambling environments, new gambling technology environments)).

There is evidence that utilizing this approach can have some success in improving public health. Zinberg previously applied the Epidemiologic Triangle to the study of drug use; his approach yielded an enduring framework for understanding drug effects (Zinberg, 1984; Zinberg & Shaffer, 1985). Using this framework, Zinberg and others have been able to provide a way of understanding disordered drug use as a result of a complex interaction among drug use, the user’s psychological expectations of such use, and the setting within which the user has these experiences. According to this approach, comprehensive public health intervention strategies to control disordered drug use need to consider more dynamic and comprehensive ways to alter the factors relating to drug (i.e., agent), set (i.e., host), and setting (i.e., environment) rather than just focusing interventions to control the drug.

Using a public health approach to examine the field of gambling-related technology has the potential to yield similarly valuable suggestions about how to create parameters for safer gambling behavior. To fill knowledge gaps about gambling-related technology and help researchers to design innovative studies, we have completed a critical examination of study methodology and findings from the extant empirical literature (Peller, LaPlante, & Shaffer, under review). This work investigates empirical studies that examine game features associated with new gambling technology (i.e., agent) and player characteristics (i.e., host). For example, several studies have investigated how certain audiovisual game features (e.g., game speed, presence of sound, visual complexity (i.e., number of symbols that appear on the screen)) affect self-reported enjoyment and motivation to continue gambling (Christopherson & Weatherly, 2006; Ladouceur & Sevigny, 2005; Loba, Stewart, Klein, & Blackburn, 2001). Contrary to the opinion of some advocates, results of some studies show that complex game features (i.e., number of symbols appearing on screen, rate of speed or sound) did not lead participants to engage in greater gambling persistence (Christopherson & Weatherly, 2006; Loba, Stewart, Klein, & Blackburn, 2001).

Overall, our systematic review of gambling and technology-related literature found disproportionately fewer studies addressing the environment component of the Epidemiologic Triangle than the agent and host components; those studies that do exist show promise for the development and implementation of safety features for new gambling technology. Unfortunately, these studies  have been methodologically rudimentary and limited in scope (Peller, LaPlante, & Shaffer, under review). However, the history of safety feature manufacturing for other industries reminds us that it is possible for safety devices to become safer as they evolve and mature. For example, the effectiveness of automobile safety features has improved dramatically over time (Armes, 2005; Hasbrook, 1956). Empirical research investigating the causes of passenger injuries has been essential to improving the engineering of automobile safety features (Green & Woodrooffe, 2006; Motao, Cummings, Haitao, & Cook, 2007; Shladover & Tan, 2006; Woodruff & Gregory, 2005). Ultimately, the creation of parameters that promote safer gambling for new gambling technology will need to involve collaboration between researchers, industry, and policymakers.

Acknowledgments

The Division on Addictions receives funding for its studies of Internet gambling from bwin.com, Interactive Entertainment AG. The Division also receives funding from the National Center for Responsible Gaming, National Institute of Mental Health (NIMH), National Institute of Alcohol Abuse and Alcoholism (NIAAA), National Institute on Drug Abuse (NIDA), the Massachusetts Council on Compulsive Gambling, the State of Nevada Department of Public Health, the Massachusetts Family Institute, and others. The authors of this editorial take responsibility for its content and do not personally benefit (i.e., stocks, etc.) from gaming interests.

References

Armes, A. (2005). National seat belt usage at record 82 percent. Safety & Health, 172(6), 16-16.

Bulkeley, W. M. (1995, August 16). Feeling Luck? Electronics is bringing gambling into homes, restaurants and planes. Wall Street Journal, pp. 1, A7.

Centers for Disease Control and Prevention. (2007). Understanding the Epidemiologic Triangle through Infectious Disease.   Retrieved September 20, 2007, from http://www.bam.gov/teachers/activities/epi_1_triangle.pdf

Christopherson, K. M., & Weatherly, J. N. (2006). The effect of visual complexity when playing a slot-machine simulation: the role of computer experience, computer anxiety,and optimism. Computers in Human Behavior, 22(6), 1072-1079.

Federal Trade Commission. (2003). Online gambling and kids: a bad bet. Retrieved December 20, 2003, from http://www.ftc.gov/gamble

Green, P. E., & Woodrooffe, J. (2006). The estimated reduction in the odds of loss-of-control type crashes for sport utility vehicles equipped with electronic stability control. Journal of Safety Research, 37(5), 493-499.

Hasbrook, A. H. (1956). The historical development of the crash-impact engineering point of view. Clinical Orthopaedics 8, 268-274.

Korn, D. A., & Shaffer, H. J. (1999). Gambling and the health of the public: Adopting a public health perspective. Journal of Gambling Studies, 15(4), 289-365.

Ladouceur, R., & Sevigny, S. (2005). Structural Characteristics of Video Lotteries: Effects of a Stopping Device on Illusion of Control and Gambling Persistence. Journal of Gambling Studies, 21(2), 117-131.

Loba, P., Stewart, S. H., Klein, R. M., & Blackburn, J. R. (2001). Manipulations of the features of standard video lottery terminal (VLT) games: Effects in pathological and non-pathological gamblers. Journal of Gambling Studies, 17(4), 297-320.

Motao, Z., Cummings, P., Haitao, C., & Cook, L. J. (2007). Association of rear seat safety belt use with death in a traffic crash: a matched cohort study. Injury Prevention, 13(3), 183-185.

Nova Scotia Gaming Corporation. (2006). NSGC Announces Pilot Test of Internet Gambling Software.   Retrieved September 20, 2007, from http://www.nsgc.ca/news.php?news_id=7

Peller, A. J., LaPlante, D. A., & Shaffer, H. J. (under review). Review of Experimental Research Studies Examining Parameters for Safer Gambling Behavior.

Shaffer, H. J., & Korn, D. A. (2002). Gambling and related mental disorders: a public health analysis. In J. E. Fielding, R. C. Brownson & B. Starfield (Eds.), Annual Review of Public Health (Vol. 23, pp. 171-212). Palo Alto: Annual Reviews, Inc.

Shladover, S., & Tan, S.-K. (2006). Analysis of Vehicle Positioning Accuracy Requirements for Communication-Based Cooperative Collision Warning. Journal of Intelligent Transportation Systems, 10(3), 131-140.

Wood, R. T., Griffiths, M. D., & Parke, J. (2007). Acquisition, development, and maintenance of online poker playing in a student sample. Cyberpsychology and Behavior, 10(3), 354-361.

Woodruff, C., & Gregory, S. (2005). Profile of Internet Gamblers: Betting on the Future. UNLV Gaming Research & Review Journal, 9(1), 1-14.

Zinberg, N. E. (1984). Drug, set, and setting: the basis for controlled intoxicant use. . New Haven: Yale University Press.

Zinberg, N. E., & Shaffer, H. J. (1985). The social psychology of intoxicant use: the interaction of personality and social setting. In H. B. Milkman & H. J. Shaffer (Eds.), The Addictions: Multidisciplinary Perspectives and Treatments. Lexington, MA: Lexington Books.

Op-Ed/Editorials: Toward a Balanced Discussion of Exposure to Gambling: The Importance of Social Context

Discussions about gambling expansion, actual and virtual, are often emotion laden. Rarely do such conversations take place within a public health approach to the issue, which requires a consideration of both benefits and harms. Rather, advocates on both sides tend to gravitate toward evidence that supports only their position. For example, anti-gambling advocates might highlight instances of increased crime, and pro-gambling advocates might highlight instances of improved economics. Alternatively, considering both the pros and cons of such situations has the potential to expand the discussion to include existing theories and models of behavior related to gambling. When this happens, a full consideration of potential gambling outcomes prompts consideration of both exposure and adaptation effects.

 Claims about the harmful effects of exposure to gambling have circulated over time, but Shaffer, LaBrie, & LaPlante (2004) were the first to conceptualize gambling as a possible social toxin. Advancing from earlier related work, Shaffer et al. argued that if gambling is indeed a social toxin, researchers should be able to accurately estimate its effects by extent of exposure. Shaffer et al. found support for this argument; but, they also found preliminary support for the idea that environmental factors modify exposure effects.[1] Through this work they expanded common conceptualizations of exposure (i.e., that increased exposure leads to a proportionate increase in harms) to suggest the existence of adaptation (i.e., that some individuals and societies develop adaptations to gambling exposure, and therefore do not succumb to prototypical exposure effects).

Recently, like earlier work with intoxicant use (e.g., Shaffer & Zinberg, 1985; Zinberg & Fraser, 1979; Zinberg & Shaffer, 1985), research has made it apparent that the social context is extremely important to any understanding of exposure effects. Exposure-related research is often inconsistent. Depending on the sample, the location of a study, and the historical time at which a study occurred, very different patterns emerge. For example, areas that have had more exposure with greater intensity and for longer periods of time can evidence fewer problems than anticipated (Shaffer & Hall, 2002; Shaffer, Vander Bilt, & Hall, 1999; Volberg, 2002). Over time, gambling-related behavior patterns in the community appear similar to the prototypical adaptation curves apparent for numerous biological toxins (e.g., viruses and bacterial infections, LaPlante & Shaffer, in press). This is important because anticipating such patterns of infection can facilitate the development of prevention and/or catalyst public health strategies or public policies.

As researchers, public policy makers, and advocates of both stripes continue to consider this issue, they should keep in mind that social contextual factors make any one-size-fits-all approach to gambling expansion likely to be insufficient. Until we identify the many social contextual factors that moderate gambling exposure, however, it is important to progress in a conservative manner. Taking a conservative approach might create some inconveniences, but ultimately will provide a measure of protection for those who remain at risk.

References

LaPlante, D. A., & Shaffer, H. J. (in press). Understanding the influence of gambling opportunities: Expanding exposure models to include adaptation. American Journal of Orthopsychiatry.

Shaffer, H. J., & Hall, M. N. (2002). The natural history of gambling and drinking problems among casino employees. Journal of Social Psychology, 142(4), 405-424.

Shaffer, H. J., LaBrie, R. A., & LaPlante, D. A. (2004). Laying the foundation for quantifying regional exposure to social phenomena: Considering the case of legalized gambling as a public health toxin. Psychology of Addictive Behaviors, 18(1), 40-48.

Shaffer, H. J., Vander Bilt, J., & Hall, M. N. (1999). Gambling, drinking, smoking, and other health risk activities among casino employees. American Journal of Industrial Medicine, 36(3), 365-378.

Shaffer, H. J., & Zinberg, N. E. (1985). The social psychology of intoxicant use: The natural history of social settings and social control. Bulletin of the Society of Psychologists in Addictive Behaviors, 4, 49-55.

Volberg, R. A. (2002). Gambling and problem gambling in Nevada: Report to the Nevada Department of Human Resources. Northampton, MA: Gemini Research Ltd.

Zinberg, N. E., & Fraser, K. M. (1979). The role of the social setting in the prevention and treatment of alcoholism. In J. Mendelson & N. Mello (Eds.), The Diagnosis & Treatment of Alcoholism (pp. 359-385). New York: McGraw-Hill Book Company.

Zinberg, N. E., & Shaffer, H. J. (1985). The social psychology of intoxicant use: The interaction of personality and social setting. In H. B. Milkman & H. J. Shaffer (Eds.), The Addictions: Multidisciplinary Perspectives and Treatments. Lexington: Lexington Books.

 

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[1] Related work suggests that the social setting moderates alcohol effects. Alcohol is a central nervous system depressant. However, in certain social situations, low dose alcohol use often results in stimulation rather than depression (e.g., the party effect). The same dose of beverage alcohol taken alone might encourage sleep.

Op-Ed/Editorials: World Series Proves Poker Game Of Skill

The final table of the World Series of Poker’s main event shows, once again, that poker tournaments are games of skill.

Courts have developed tests over the last couple of hundred years to determine whether a particular game is predominantly chance or skill.  If courts and prosecutors were honest in applying these tests, at least No Limit Texas Hold 'em tournaments would have to be considered skill contests and not gambling.

Let’s take a look at the most common tests and what happened on July 18, 2007.

1)  A skillful player will win more than an unskillful one.  The tournament started 12 days earlier, with 6,358 paying $10,000 each to enter.  All the chips that were lost by players went to other players, not the house.

2)  Skill can be learned from experience, from real or mock play.  Here’s how the Associate Press described the nine players at the final table, in the order in which they were eliminated:

• Lee Childs, a 35-year-old software engineer from Reston, Va., who quit his job a month ago to play poker for a living.
• Philip Hilm, a 31-year-old Dane making a living from poker in England.
• Lee Watkinson, a 40-year-old poker pro from Cheney, Wash.
• Hevad Khan, an Internet poker pro from Poughkeepsie, N.Y.
• Jon Kalmar, a 34-year-old poker pro from Chorley, England.
• Alex Kravchenko, 36.  No other information given.  AP did not mention that Kravchenko has been in the money in numerous poker events, including winning three European tournaments.
• Raymond Rahme, a South African retiree.  AP did not mention that Rahme had previously came in first, second and fourth in major South African poker tournaments.
• Tuan Lam, a 40-year-old Vietnamese Canadian online poker pro from Mississauga, Ontario.
• California psychologist Jerry Yang.

Question:  If poker is not a game of skill, how can there be professional poker players?  No one makes a living playing lotteries.

3)  Skill games usually require a knowledge of mathematics and psychological skill.  Here’s how Yang described his playing style:  “I study my opponents very carefully, and when I sensed something, when I sensed some weakness, I took a chance.  Even if I had nothing, I decided to raise, reraise, push all-in or make a call.”

When courts or attorneys general want to declare a game, such as poker, is predominantly luck, they focus on the fact that cards are involved.  The most common argument is that even a complete novice could beat a professional if the amateur were dealt better cards.

This shows a fundamental lack of understanding of how poker is played.  Nobody ever sits down to a single hand of poker.  And even if they did, the rules of elimination tournaments require that there be more than a single hand.

And poker is not just about being dealt the best cards.  We do not yet have the wonderful 20-20 hindsight provided by the cameras that show TV viewers the players’ down cards.  But we do know at least one important hand.

On the ninth hand of play at the final table, the flop was seven, four and deuce.  Yang declared an all-in reraise.  His opponent, Lee Childs, folded, showing pocket queens, face up.

Now, maybe Yang had the better hand, with two pair.  But maybe not.

It is very possible that Childs’ queens were the best cards before the flop.  He might still have had the best hand after that flop of little cards.  And he might have had the best hand if he had stayed in to the end.  But Yang won. 

Because it is fundamental to the game of poker that the best hand does not necessarily win.

© Copyright 2007.  Professor I Nelson Rose is recognized as one of the world’s leading experts on gambling law.  His latest books, INTERNET GAMING LAW and GAMING LAW: CASES AND MATERIALS, are available through his website, www.GamblingAndTheLaw.com.

Op-Ed/Editorials - A Surge In The War (Of Intimidation)

The latest news in the United States Department of Justice’s war against Internet gambling is not good news for online poker players.

Up until 2006, most of the attacks by law enforcement were against sports betting sites.  The DOJ has publicly taken the position that the Wire Act, the main federal anti-gambling law that might apply to the Internet, outlaws all forms of gambling.  However, a couple of courts have ruled the Wire Act is limited to bets on sports events and races.  The DOJ does not want to lose its power of intimidation by losing a case, so it has not brought any charges against pure poker sites.

But in April 2006, the House of Representative’s Judiciary Committee and later the full House approved a bill to amend the Wire Act to cover all gambling, including poker. 

At least it was limited to operators not players.

But in June 2006, the state of Washington passed a law to clearly make it a crime, even a felony, to merely play poker online.

Then there were the dramatic arrests.  The CEO of BetOnSports, flying from England to Costa Rica, was nabbed while changing planes in Dallas and charged with violating the Wire Act.  Then the CEO of SportingBet was arrested at JFK for violating a Louisiana state law, which seemed broad enough to cover poker.

In the last days of the Republican-controlled Congress, then-Senate-majority leader Bill Frist rammed through the Unlawful Internet Gambling Enforcement Act, designed to stop any “game subject to chance.”  Although the UIGEA, which I call “Prohibition 2.0,” was the faulty act of a failed politician, it has scared everyone remotely connected with the industry.

The sites of the largest publicly traded operators, like PartyGaming’s PartyPoker, immediately announced that they would no longer accept players from the U.S.  Online poker players were forced to switch to one of the many privately-owned sites which continued to take bets from Americans.

Getting the money to the operator became more of a problem with payment processors like FirePay also cutting off the U.S.  Fortunately, Neteller, the largest e-wallet, announced it would wait to see what the eventual regulations looked like.

Now Neteller is gone.  Its founders, who no longer had active roles in the business, were arrested in the U.S.  The company announced that, “Due to recent U.S. legislative changes and events, effective immediately, U.S. members are no longer able to transfer funds to or from any online gambling sites.”  This left the company’s 640,701Amercian account holders supposedly able to get their money back from Neteller, but unable to get their money back to Neteller from the gambling sites.

Neteller claimed this sudden change was due more to the timing and content uncertainty of future regulations.  But a few days later it was also disclosed that the financial banks, attorneys and accountants responsible for companies like Neteller going public had received subpoenas from the DOJ.  Even Google was told to stop taking paid ads from Internet gambling sites (Yahoo had quit three years ago).  Another payment processor, Citadel, read the writing on the wall and also cut off Americans.

The most recent skirmish was timed to coincide with the SuperBowl, by far the largest betting event of the year.  And it worked: Pinnacle, the leading sports betting site, also pulled out of the U.S. market.  American bettors now have to struggle to find a site they trust, and then figure out how to get the money there.

The only good news is that prosecutors will never go after mere players.

And in the long run, the government’s war against Internet gambling will be merely a blip.  The first Prohibition did not stop people from drinking.  Prohibition 2.0 will not stop players from betting.

© Copyright 2007.  Professor I Nelson Rose is recognized as one of the world’s leading experts on gambling law.  His latest books, GAMING LAW: CASES AND MATERIALS and INTERNET GAMING LAW, are available through his website, www.GAMBLINGANDTHELAW.com.

The Division on Addictions is proud to present Your First Step to Change: Smoking

Many people are able to change their excessive behavior patterns without entering formal treatment. The Division on Addictions, Cambridge Health Alliance and Harvard Medical School has created a series of self-change toolkits. We are proud to launch the next edition in The First Step series, Your First Step to Change: Smoking.

Op-Ed/Editorials - Gambling and the Law®: The U.S. Gets An “F” From The WTO

The United States has failed again in trying to overturn the ruling that it is discriminating against Antigua’s Internet gambling.  Worse, by failing to admit defeat, the Department of Justice has now turned a minor legal problem, limited to the issue of interstate horseracing, into a major headache for the U.S. on all aspects of remote wagering, including purely intrastate betting on horseracing, dogracing, sports, jai alai and maybe even poker.

I would have given a law student a grade of “D” if he or she had done what the D.O.J. did.  And that’s only because I do not like to fail anyone.

Imagine a student turning in a paper containing a very weak argument.  The professor gives the paper a poor grade and explains why the argument won’t work.  The professor then gives the next assignment:  Explain what changes your client now has to make in the way it does business to comply with the law. 

The student now takes a year to answer.  And, instead of stating what changes have to be made, the student says that the client is now in complete compliance, because it deserved to win. 

This is what the D.O.J. did.

It is hard to conceive of a lawyer making the same losing arguments – again – in front of the same judges.

The original decision, April 2005, was not that bad for the U.S.  The W.T.O. had ruled that the U.S. had indeed (accidentally) agreed to let in all forms of gambling when it signed the General Agreement on Trade in Services (GATS) treaty.  But, the U.S. won on the argument that it had to outlaw people betting from their homes and offices because it has reasonable fears that remote gaming will bring in crime and corrupt the morals of America.

The only thing the U.S. lost on was the minor issue of interstate horseracing.  Congress had amended the Interstate Horseracing Act (“IHA”) in December 2000 to expressly allow individuals to bet on horseraces from their homes by phone or computer, so long as the bets were legal in the states where they were made and accepted.

The D.O.J. had raised the rather unique legal argument that the IHA did not mean what it said.  Besides being factually questionable, given the large, established cross-border betting industries involving horse races, the argument was legal nonsense.  And the W.T.O. politely said so.

The W.T.O. held that the express language of the IHA allowed cross-border betting between states of the U.S., but not with foreign nations.  The W.T.O. ordered the U.S. to change its laws.

The remedy was simple: Change the Interstate Horseracing Act into an International Horseracing Act. 
Instead Congress did nothing. 

So, of course the U.S. lost, again.  But taking ridiculous positions can lead to more than losing a case.  It can tempt a decision-maker to reexamine the entire record, to find more things wrong.

By failing to quickly comply with the W.T.O.’s original decision, the D.O.J. allowed time for Antigua to find ways to bring in all the intrastate gambling that is allowed in the U.S.  Even the D.O.J. had to admit that the Wire Act did not prohibit remote wagering that took place entirely within one state.  Antigua showed that 18 states allow people to bet from their homes, not only on horseraces, but also on dograces, sports (in Nevada) and jai alai.

Amending the IHA to include foreign licensed OTBs might not now be enough.  The only legally safe position would be to outlaw all intrastate as well as interstate betting.  But the horseracing industry is not going to let this happen.

So, the U.S. is going to have to pay off Antigua.  It will probably be cash.  Fortunately, Antigua is small, so if will be only a few tens or hundreds of millions of dollars.

But what happens if the next complaint in the W.T.O. is filed by the European Union?

© Copyright 2007.  Professor I Nelson Rose is recognized as one of the world’s leading experts on gambling law.  His latest books, Internet Gaming Law and Gaming Law: Cases and Materials, are available through his website,  www.GamblingAndTheLaw.com.

Op-Ed/Editorials - The State of Public Health Research on Internet Gambling

Debi A. LaPlante, Ph.D.
Instructor of Psychology
Harvard Medical School, Division on Addictions, Cambridge Health Alliance

Richard A. LaBrie, Ed.D.
Associate Director of Research and Data Analysis
Harvard Medical School, Division on Addictions, Cambridge Health Alliance

Sarah E. Nelson, Ph.D.
Instructor of Psychology
Harvard Medical School, Division on Addictions, Cambridge Health Alliance

Anja Schumann, Ph.D.
Research Associate
Harvard Medical School, Division on Addictions, Cambridge Health Alliance

Howard J. Shaffer, Ph.D., C.A.S.
Director
Harvard Medical School, Division on Addictions, Cambridge Health Alliance

Scientific medical research advances in progressive stages and at a deliberate pace. This approach to knowledge development requires several stages of inquiry, analysis, and review before advocacy and action can occur. Although this structure might frustrate some (e.g., anti-gambling activists and pro-gaming corporations), it is essential to the accumulation of accurate information. Too often, well-meaning people rush ahead of scientific knowledge (e.g., despite limited evidence, policy makers worldwide are legislating Internet gaming issues). Doing so has three potential costs: (1) over-intervention for problems that are more minimal than expected or non-existent; (2) insufficient response for circumstances that require specific interventions; or (3) inappropriately applied and potentially damaging interventions for problems that require unique strategies that are not obvious from anecdotal observation. The principle of unanticipated consequences suggests that prematurely accepting information or adopting a public policy position about a phenomenon can create more confusion than it resolves.

Consider, for example, the Unlawful Internet Gambling Enforcement Act (hereafter, Internet Gambling Act) approved by the United States Congress in 2006. Rose (Rose, 2006a, 2006b, 2006c, 2006d; 2006e) provided a series of legal analyses of the Internet Gambling Act, which expands the reach of federal anti-gambling statutes. According to Rose, the bill makes it a crime to accept or facilitate funds for unlawful Internet gambling. Not all Internet gambling is unlawful. Some forms of Internet gambling, such as horse racing, lottery, and fantasy league games, remain legal. In the absence of science related to Internet gambling, public arguments for the law included assertions about the harmfulness of Internet gambling to families and individuals (e.g., Kyl, 2003). However, it is unclear what public health equation allowed for some types of Internet gambling, but not others. Most recently, news reports suggest that online gambling is growing among ever-changing, unregulated, websites and/or disreputable web operators (e.g., Hartman, 2007; Holahan, 2006). Time will tell whether these problems are realized and if an unintended consequence of the legislation is that people who want to wager their money actually become more at-risk financially because of dealing with unscrupulous vendors.

One reason why Internet gambling alarms so many people is that it is prolific and expected to grow (Christian Capital Advisers, 2006); though, some observers note that its consumer growth is slow, compared to other forms of gambling (e.g., casinos and lottery) (Miller, 2006). Growth increases exposure, and research suggests that the newly exposed have special risks for poor health outcomes (LaPlante & Shaffer, under review; Shaffer, LaBrie, & LaPlante, 2004). Poor gambling-related outcomes often include financial distress, emotional and physical deterioration, and damaged interpersonal relationships (Shaffer & Korn, 2002). Some research suggests that disordered gambling relates to poor mental health, such as personality and psychiatric disorders (Petry, Stinson, & Grant, 2005; Slutske, Caspi, Moffitt, & Poulton, 2005).

Other speculations about potential hazards particular to Internet gambling include the apparent lack of fail-safes, such as the ability to protect individuals who are underage or people known to have problems from participating and the potential for unprincipled marketing techniques, such as embedding (i.e., gaming sites using keywords like “compulsive gambling” for search engines) and serial pop-ups (Griffiths & Parke, 2002). Similarly, some observers have speculated that Internet gambling sites can do little to prevent gambling while intoxicated or gambling at work (Griffiths, 1999).

At this time, there is very little peer-reviewed and published empirical research about Internet gambling. With some exceptions, theoretical propositions and opinion papers represent most of the professional discussion surrounding this topic (e.g., Bulkeley, 1995; Federal Trade Commission, 2003; Griffiths, 1996; Griffiths, 2003; Griffiths, Parke, Wood, & Parke, 2006; Griffiths, 1999, 2001; Ialomiteanu & Adlaf, 2002; LaBrie, Shaffer, LaPlante, & Wechsler, 2003; Ladd & Petry, 2002; Miller, 2006; Petry & Mallya, 2004; Shaffer, 1996; Volberg, 2000; Woodruff & Gregory, 2005). Most of the opinion papers suggest that Internet gambling is inherently harmful to individuals and society. Unlike other forms of gambling, which have benefited from a diversity of methodological approaches, including observational, experimental, and neuropsychological approaches (e.g., Anderson & Brown, 1984; Baboushkin, Hardoon, Derevensky, & Gupta, 2001; Breen & Frank, 1993; Ladouceur, Gaboury, Bujold, Lachance, & et al., 1991; Potenza et al., 2003; Shaffer, LaPlante et al., 2004), the available empirical findings are from studies that use variations of retrospective self-report methodology. Consequently, what we actually know about the effect of Internet gambling on individuals is limited, at best.

The limitations of retrospective self-report are well-known. In brief, some common biases associated with this type of methodology are memory-errors, self-presentation strategies, and simple miscomprehension. Subtle factors, such as the phrasing of survey questions, provoke additional biases. For example, in one study, researchers took a large group of gamblers and divided them randomly into groups that would be asked different “spending” questions (Williams & Wood, 2004). The questions ranged from asking respondents simply to report their total money won or lost, to asking for complicated monetary breakdowns by type of gambling activity, unit of play, and typical number of units of play. The range of responses to the spending questions was large. In brief, the question “Roughly how much money do you come out ahead or behind on gambling in a typical month?” resulted in a mean loss of $10 CAN. The most complicated framing of spending, a series of estimates of frequency and amount by type of gamble, produced an average loss of about $50 CAN.

One way to avoid these retrospective self-report problems is to use objective data.  Many life sciences researchers rely, for example, on biological estimates of nicotine consumption to determine the accuracy of study participants’ self-reports of tobacco smoking. Absent the possibility of easily obtainable biological estimates in the social sciences, researchers can examine individuals’ actual behavior over time (e.g., the bets that people make or betting patterns that people adopt). Although this might seem like common sense, scientists have not had actual real-time Internet gambling behavior to examine, so their only option has been to study self-reports about gambling behavior.

Public policy makers, public health officials, researchers, and gaming-operators would gain numerous benefits from studies that measure actual Internet gambling behavior. First, this strategy avoids relying on data that might be compromised by poor recall. Second, it avoids utilizing data liable to self-presentation biases. Whereas adults notoriously underestimate negative behavior to put themselves in a good light, youth notoriously overestimate negative behavior to put themselves in a “good” light. Third, examining real-time gambling behavior avoids the perils of miscommunication and subsequent data ambiguity.

It is time to stop speculating about Internet gambling and actually see it for what it is. To do this, more researchers need to adopt multiple methodological approaches to the study of Internet gambling. Those approaches need to go beyond retrospective self-report and include objective measures, such as actual Internet gambling behavior. Until then, our knowledge about any harm Internet gambling exerts on individuals will remain limited.

Acknowledgments

The Division on Addictions receives funding for its studies of Internet sports gambling from bwin.com, Interactive Entertainment AG. The Division also receives funding from the National Center for Responsible Gaming, National Institute of Mental Health (NIMH), National Institute of Alcohol Abuse and Alcoholism (NIAAA), National Institute on Drug Abuse (NIDA), the Massachusetts Council on Compulsive Gambling, the State of Nevada Department of Public Health, the Massachusetts Family Institute, and others. The authors of this editorial take responsibility for its content and do not personally benefit (i.e., stocks, etc.) from gaming interests.

References

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Baboushkin, H. R., Hardoon, K. K., Derevensky, J. L., & Gupta, R. (2001). Underlying cognitions in gambling behavior among university students. Journal of Applied Social Psychology, 31(7), 1409-1430.

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Bulkeley, W. M. (1995, August 16). Feeling Luck? Electronics is bringing gambling into homes, restaurants and planes. Wall Street Journal, pp. 1, A7.

Christian Capital Advisers, I. (2006). Global Internet Gambling Revenue Estimates and Projections (2001-2010, $M, US). Retrieved, from the World Wide Web: http://www.cca-i.com/Primary%20Navigation/Online%20Data%20Store/internet_gambling_data.htm

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Griffiths, M. D. (1999). Gambling technologies: Prospects for problem gambling. Journal of Gambling Studies, 15(3), 265-283.

Griffiths, M. D. (2001). Internet gambling: Preliminary results of the first U.K. prevalence study. Centre for Addiction and Mental Health. Retrieved June 3, 2004, from the World Wide Web: http://www.camh.net/egambling/issue5/research/griffiths_article.html

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Hartman, B. (2007). No Neteller, Prohibition, No Problem : Gamblers Find Alternatives. CasinoGamblingWeb.com. Retrieved February 2, 2007, from the World Wide Web: http://www.casinogamblingweb.com/gambling-news/online-casino/no_neteller_prohibition_no_problem_gamblers_find_alternatives_29009.html

Holahan, C. (2006). Online gambling goes underground. BusinessWeek.com. Retrieved February 2, 2007, from the World Wide Web: http://www.businessweek.com/technology/content/oct2006/tc20061019_454543.htm

Ialomiteanu, A., & Adlaf, E., M. (2002). Internet gambling among Ontario Adults. Centre for Addiction and Mental Health. Retrieved June 3, 2004, from the World Wide Web: http://www.camh.net/egambling/issue5/research/ialomiteanu_adlaf_article.html

Kyl, J. (2003). Illegal Internet Gambling: Problems and Solutions. Retrieved February 2, 2007, from the World Wide Web: http://www.ncalg.org/Library/internet/Kyl_Internet.pdf

LaBrie, R. A., Shaffer, H. J., LaPlante, D. A., & Wechsler, H. (2003). Correlates of college student gambling in the United States. Journal of American College Health, 52(2), 53-62.

Ladd, G. T., & Petry, N. M. (2002). Disordered gambling among university-based medical and dental patients: A focus on Internet gambling. Psychology of Addictive Behaviors, 16(1), 76-79.

Ladouceur, R., Gaboury, A., Bujold, A., Lachance, N., & et al. (1991). Ecological validity of laboratory studies of videopoker gaming. Journal of Gambling Studies, 7(2), 109-116.

LaPlante, D. A., & Shaffer, H. J. (under review). A consideration of exposure and adaptation to gambling opportunities.

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Petry, N. M., & Mallya, S. (2004). Gambling participation and problems among employees at a university health center. Journal of Gambling Studies, 20(2), 155-170.

Petry, N. M., Stinson, F. S., & Grant, B. F. (2005). Comorbidity of DSM-IV pathological gambling and other psychiatric disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry, 66(5), 564-574.

Potenza, M. N., Leung, H.-C., Blumberg, H. P., Peterson, B. S., Fulbright, R. K., Lacadie, C. M.,
Skudlarski, P., & Gore, J. C. (2003). An fMRI Stroop Task Study of Ventromedial Prefrontal Cortical Function in Pathological Gamblers. American Journal of Psychiatry, 160(11), 1990-1994.

Rose, I. N. (2006a). The new anti-Internet gaming law. www.gamblingandthelaw.com. Retrieved February 2, 2007, from the World Wide Web: http://www.basisonling.org/editorials.htm

Rose, I. N. (2006b). Operators risk arrest for online poker. www.gamblingandthelaw.com. Retrieved February 2, 2007, from the World Wide Web: http://www.basisonling.org/editorials.htm

Rose, I. N. (2006c). The Unlawful Internet Gambling Enforcement Act of 2006 analyzed. www.gamblingandthelaw.com. Retrieved February 2, 2007, from the World Wide Web: http://www.basisonling.org/editorials.htm

Rose, I. N. (2006d). Will congress cripple Internet poker? www.gamblingandthelaw.com. Retrieved February 2, 2007, from the World Wide Web: http://www.basisonling.org/editorials.htm

Rose, I. N. (2006e). Will you be arrested for playing poker online? www.gamblingandthelaw.com. Retrieved February 2, 2007, from the World Wide Web: http://www.basisonling.org/editorials.htm

Shaffer, H. J. (1996). Understanding the means and objects of addiction: Technology, the Internet, and gambling. Journal of Gambling Studies, 12(4), 461-469.

Shaffer, H. J., & Korn, D. A. (2002). Gambling and related mental disorders: A public health analysis. Annual Review of Public Health, 23, 171-212.

Shaffer, H. J., LaBrie, R. A., & LaPlante, D. A. (2004). Laying the foundation for quantifying regional exposure to social phenomena: Considering the case of legalized gambling as a public health toxin. Psychology of Addictive Behaviors, 18(1), 40-48.

Shaffer, H. J., LaPlante, D. A., LaBrie, R. A., Kidman, R. C., Donato, T., & Stanton, M. V. (2004). Toward a syndrome model of addiction: Multiple expressions, common etiology. Harvard Review of Psychiatry, 12, 367-374.

Slutske, W. S., Caspi, A., Moffitt, T. E., & Poulton, R. (2005). Personality and problem gambling: A prospective study of a birth cohort of young adults. Archives of General Psychiatry, 62, 769-775.

Volberg, R. A. (2000). The future of gambling in the United Kingdom: increasing access creates more problem gamblers. British Medical Journal, 320(7249), 1556.

Williams, R., & Wood, R. (2004). The demographic sources of Ontario gaming. Prepared for the Ontario Problem Gambling Research Centre. Retrieved May 31, 2007, from the World Wide Web: http://www.gamblingresearch.org/fcdetail.sz?cmd=add&type=doc&itemid=6117

Woodruff, C., & Gregory, S. (2005). Profile of Internet gamblers: Betting on the future. UNLV Gaming Research & Review Journal, 9(1), 1-14.

Op-Ed/Editorials: Some Psychological Understanding of Chinese Gamblers

The theme of the 2006 Institute for Research on Pathological Gambling and Related Disorders annual conference on gambling addiction was Lost in Translation? The Challenge of Turning Good Research into Best Practice. During the next few weeks, The BASIS is pleased to present a series of editorials from some of the faculty members of that conference. In this week's editorial, Dr. Desmond Lam discusses Psychological Understanding of Chinese Gamblers.

Desmond Lam, Ph.D.
Assistant Professor of Marketing, University of Macau
Faculty of Business Administration, University of Macau
Av. Padre Tomas Pereira
S.J. Taipa, Macau S.A.R.
China

According to numerous accounts, wagering on games of chance in China began around the period of Xia (2000-1500 B.C.) and Shang (1700-1027 B.C.) dynasties (Ge, 2004; Lam, 2004). Today, social gambling in the form of mahjong playing (c.f. Home Affairs Bureau, 2002) is common in China and among Chinese overseas (Sweets, 2002). Government-approved lottery is also available to 95% of China’s cities and counties, with annual sales approaching US$20 billion by 2006 (Access Asia Limited, 2002). In addition, legal racetrack betting is available in Hong Kong and Macau. Macau, the only place in China where casino gambling is allowed, has experienced tremendous growth in recent years and is on track to be the Las Vegas of the East.

Despite numerous studies on gambling in Western countries, few researchers examine the Chinese psychology of gambling. Given the unique legal, cultural, economic and social development of Chinese society, Chinese gambling psychology deserves greater attention than it is currently given.

In fact, many Chinese gamble for financial reasons (c.f. Access Asia Limited, 2002). The motivation to gamble for money as seen in the casinos of Macau may have stemmed from China’s recent transition from economic poverty to prosperity. For more than a century, the Chinese have experienced great insecurity caused by political and economic events that shaped their attitudes and behavior (Redding, 1990). Only in the last few decades did stability set in. Traditionally, wealth and fame have been treated by the Chinese as collective representations of a person’s achievement, deserving of ancestral glorification (Yu, 1996). These concepts of achievement were influenced by Confucianism, which also stresses hierarchical relationship and filial piety (Fan, 2000).

The road to prosperity has fueled the desire for the Chinese to pursue quick individual wealth, which at the same time has created an unequal distribution of wealth (Tse, 1996). As prosperity spreads, everyone wants to be rich and enjoy the material gains that they were deprived of for so many years; no one wants to lose out. The potential for earning quick wealth may explain why Chinese in the lower social classes engage in gambling activities (Ozorio and Fong 2004). Gambling is seen as a shortcut to financial achievement for these Chinese. At the same time, the propensity to take more risk during consumption of goods or services increases (Tse, 1996) among the upper social classes; these Chinese have more money to experiment with new purchases or make different choices. Wealth leads to greater risk appetite, which may develop into an increased appetite to gamble for this group of Chinese.

While Chinese set their sights on monetary gain as a measure of success in their lives, their strong illusion of control affects their evaluation of gambling odds. In fact, many Chinese gamblers believe that their luck and skills can help them to win (Ozorio & Fong, 2004). They feel that gambling outcomes are within their control (Hong & Chiu, 1988). According to a study by Hong and Chiu (1988) in Hong Kong, illusion of control was found to be positively correlated with gambling involvement.

A strong belief in superstitions by the Chinese also enhances their illusion of control when gambling and further distorts their evaluation of their odds of winning. Chinese superstition is unique in its forms and is popularly accepted by the Chinese population in numerous contexts. For example, the Chinese are very concerned about numbers that they believe can influence an individual’s fortune (Ang, 1997; Pitta, Fung, & Isberg, 1999). For Chinese, superstitious behavior would include avoiding numbers like ‘4’ and ‘14’ or picking auspicious numbers like ‘8’ or ‘18’. Simmons and Schindler (2003) conducted a study on the price endings used in Chinese price advertisements and found that a high proportion of these advertisements favored the number ‘8’ and avoided the number ‘4’.

In addition, many Chinese believe in feng shui (Zetlin, 1995; Pitta, Fung, & Isberg, 1999). Feng shui is a century-old belief (Pye, 1984; Schmitt & Pan, 1994), in which one modifies his physical environment (e.g., facing of his house door) to influence events (Hobson, 1994; Leung, 1996) and/ or to harmonize with his surroundings. The concept of feng shui reveals one of the key differences between Chinese and Western cultures: Chinese believe that humans are insignificant souls in this complex universe and should exist in harmony with it (Ekblad, 1996). Some Chinese use feng shui techniques to avoid bad fortune and increase the amount of fortune they get. Superstitious gamblers may sometimes look out for specific locations within a casino that offer the best feng shui to beat the house.

According to Pitta, Fung, and Isberg (1999), Chinese believe that success in businesses depends on several factors namely, (1) fate, (2) luck, (3) feng shui, (4) accumulation of good deeds, and (5) knowledge (ranked according to the level of importance). Business knowledge is deemed to be the least important of all, while other factors like luck and feng shui increase a Chinese’s illusion of control over events. Presumably, success in gambling is thought to depend on similar factors.

Chinese have also demonstrated unique characteristics in their decision making that may reflect their strong illusion of control. Research on Chinese and non-Chinese decision making processes found a consistent and significant difference in probability judgment accuracy – one that concerns Chinese people’s overconfidence in judgment (Wright & Philips 1980; Yates et al. 1989). In addition, past research has found that Chinese showed a lack of concern for uncertainty (Pollock & Chen, 1986) and exhibited less probabilistic thinking when making decisions (Lau & Ranyard, 2005).

Relating all of these findings on Chinese gambling, this illusion of control likely increases Chinese people’s risk-taking in gambling situations. A person’s perceived control over an event is positively associated to his or her appetite for risk (Wehrung et al., 1990). Higher perceived (or illusion of) control may increase risk appetite and, hence, fuel more gambling among Chinese.

Supporting this, Ozorio and Fong (2004), who conducted a recent study on Chinese casino gambling behavior, found that these Chinese gamblers were taking high risk when they gamble. Their findings were supported by Lau and Ranyard (2005) who found that Chinese subjects made riskier gambling decisions than English subjects. Ozorio and Fong (2004) postulated that this risk-taking appetite could be fueled by the gamblers’ desire to win and to fulfill their sense of excitement. A study commissioned by Hong Kong Home Affairs Bureau (2001) found that almost 87% of Hong Kong residents who made bets in Macau’s casinos regarded casino gambling as exciting.

Gambling is also a major form of entertainment among the Chinese. It can induce pleasure (Cotte, 1997), is a way of relaxation (Brown, 1986), and offers a chance for people to escape from their daily lives (Aasved, 2003). As they gain entertainment value, people may gamble despite losses. In a survey on the general gambling attitudes and behavior of Macau’s residents, Kwan (2004) found the top reason for gambling among respondents was for entertainment. While 92% of these respondents generally did not gamble in casinos (in fact, the most popular games cited were mahjong, lottery and soccer betting), the survey did reveal that many Chinese gamble for entertainment value.

Some gambling activities such as card games have social elements in them (Rogers 1998). Socialization is a major reason why people gamble and represents a form of reward from persistent gambling, which may exceed the economic value of gambling (Aasved, 2003). In a collectivistic society where group bonding overrides individualistic behavior (Lasserre & Schütte 1999), many Chinese consider gambling in friends or relatives' homes an acceptable form of social activity. Gambling is, historically, performed as a form of social activity and part of festive celebration. This has become a form of habit for many Chinese. While engaging in these gambling activities, Chinese deepen their friendship with each other and realize the real characters of those who gamble. For some Chinese, gambling provides a form of business networking or guanxi opportunities.

This article touches on some aspects relating to the psychology of Chinese gamblers and, hopefully, provides a crucial starting point for further discussion into Chinese gambling behavior. It may help researchers to identify areas that suggest how gambling addiction manifests in Chinese gamblers. The belief in (and quest for) monetary gain as a measure of individual success, coupled with ‘flawed’ evaluation of the chances of achieving this goal through gambling, may explain Chinese gambling addiction at the lower social class levels. At higher social class levels,  excitement, entertainment and social rather than monetary values may better explain such strong interest in gambling.

To conclude, the material covered in this article would suggest the applicability of expectancy-values models to explain Chinese gambling behavior. The theory of planned behavior (Ajzen, 2002), in particular, may provide an initial model for this understanding. Chinese gamblers’ intention to gamble may be based on their (1) beliefs about the likely outcomes of gambling and their evaluation of these outcomes, (2) beliefs about the normative expectations of others toward gambling and their willingness to comply to these social expectations, and (3) beliefs about the presence of factors (i.e. skills or luck) that may aid or hinder their gambling performance and the perceived power of these beliefs. Hence, a strong belief in gambling to attain wealth and fame and positive evaluation of the value of these outcomes (i.e. for ancestral glorification) (1) would fuel a positive attitude toward gambling. At the same time, a high illusion of control (i.e. belief in the power of gambling skills and luck) (3) would likely strengthen their gambling intention and lead to actual gambling.

What do you think? Comments on this article can be addressed to Desmond Lam.

References

Aasved, M. (2003). The Sociology of Gambling. Springfield, IL: Charles C. Thomas Publisher.
Access Asia Limited (2002). Lotteries and Gambling in China: A Market Analysis. Shanghai, China: China Contact.

Ajzen, Icek (2002). Constructing a TpB Questionnaire: Conceptual and Methodological Considerations. Retrieved from: http://www-unix.oit.umass. edu/~aizen/pdf/tpb.measurement.pdf.

Ang, S.H. (1997). Chinese consumers’ perception of alpha-numeric brand names. Journal of Consumer Marketing, 14(3), 220-233.

Anonymous (1997). Pathological gambling as a reflection of cultural norms. The Wager, 2(43). Retrieved from: http://www.thewager.org/current. htm.

Blaszczynski, A., Huynh, S., & Farrell, V.J.D.E. (1998). Problem gambling within a Chinese speaking community. Journal of Gambling Studies, 14 (4), 359-380.

Bond, M.H. (1996). The Handbook of Chinese Psychology. Hong Kong: Oxford University Press.
Brown, R.I.F. (1986). Arousal and sensation-seeking components in the general explanations of gambling and gambling addictions. The International Journal of the Addictions, 21, 1001-16.

BusinessWorld (2001, January 19). Weekender: The different rituals and symbols of the Chinese Lunar New Year. Businessworld (Philippines), pp.1.

Cotte, J. (1997). Chances, trances, and lots of slots: Gambling motives and consumption experiences. Journal of Leisure Research, 29 (4), 380-406.

Ekblad, S. (1996). Ecological psychology in Chinese societies. In M. H. Bond (Ed.), The Handbook of Chinese Psychology (pp. 379-392). Hong Kong: Oxford University Press.

Fan, Y. (2000). A classification of Chinese culture. Cross Cultural Management – An International Journal, 7(2), 3-10.

Ge, C.Y. (2004). Gambling – A journey through time. Taipei, Taiwan: Far Reaching.
Hobson, J.S. (1994). Feng shui: Its impacts on the Asian hospitality industry. International Journal of Contemporary Hospitality Management, 6(6), 21-26.

Home Affairs Bureau (2002). Report on a Study of Hong Kong People’s Participation in Gambling Activities. Centre for Social Policy Studies of The Department of Applied Social Sciences and The General Education Centre of The Hong Kong Polytechnic University. Retrieved December 10, 2005, from http://www.hab.gov.hk/file_manager/en/documents/whats_new/gambling/report-eng.pdf.

Hong, Y. Y. & Chiu, C. Y. (1988). Sex, locus of control, and illusion of control in Hong Kong as correlates of gambling involvement. Journal of Social Psychology, 128(5), 667-673.

Kwan, F.V.C. (2004). Gambling attitudes and gambling behavior of residents of Macau: The Monte Carol of the orient. Journal of Travel Research, 42(3), 271-278.

Lam, Y.P (2004). Outline of Chinese Gambling History. Retrieved April 13, 2005, from www.gongfa.com/duboshi.doc.

Lasserre, P. and Schütte, H. (1999). Strategies for Asia Pacific. New York, U.S.A.: Palgrave.
Lau, L. Y. & Ranyard, R. (2005). Chinese and English probabilistic thinking and risk taking in gambling. Journal of Cross-Cultural Psychology, 36(5), 621-627.

Leung, K. (1996). The role of beliefs in Chinese culture. In M. H. Bond (Ed.), The Handbook of Chinese Psychology (pp. 309-321). Hong Kong: Oxford University Press.

Nepstad, P. (2000). Gods of gambling. The illuminated lantern, 2 (April/May). Retrieved June 20, 2005, from http://www.illusminatedlantern.com/ cinema/features/gambling.html.

Ozorio, B. and Fong, D.K.C. (2004). Chinese casino gambling behaviors: Risk taking in casinos vs. investments. UNLV Gaming Research & Review Journal, 8(2), 27-38.

Pitta, D.A., Fung, H.G., & Isberg, S. (1999). Ethical issues across cultures: Managing the differing perspectives of China and the USA. Journal of Consumer Marketing, 16(3), 240-256.

Pollock, S.M. & Chen, K. (1986). Strive to conquer the Black Stink: Decision analysis in the People’s Republic of China. Interfaces, 16(2), 31-37.

Pye, L.W. (1984). China: An introduction. (3rd ed.). Boston, U.S.A.: Little, Borwn and Company.

Redding, S.G. (1990). The Spirit of Chinese Capitalism. New York: Walter de Gruyter.

Rogers, P. (1998). The cognitive psychology of lottery gambling: A theoretical review. Journal of Gambling Studies, 14(2), 111-134.

Schmitt, B.H., & Pan, Y.G. (1994). Managing corporate and brand identities in the Asia-Pacific region. California Management Review, 36(4), 32-48.

Simmons, L.C. & Schindler, R.M. (2003). Cultural superstitions and the price endings used in Chinese advertising. Journal of International  Marketing, 11(2), 101-111.

Sweets, E. (2002). Game of the centuries Ancient Chinese pastime is alive and well in Denver. Denver Post, Denver, Colorado, December 1, L.01.

Tse, D.K. (1996). Understanding Chinese people as consumers: Past findings and future propositions. In M. H. Bond (Ed.), The Handbook of Chinese Psychology (pp. 309-321). Hong Kong: Oxford University Press.

Walker, M.B. (1992), The Psychology of Gambling, Oxford: Pergamon Press.

Wehrung, D.A., Lee, K., Tse, D.K., & Vertinsky, I. (1989). Adjusting risky situations: theory and empirical tests. Journal of Risk and Uncertainty, 2,

The views expressed in the Op-Ed/Editorials page are solely the views of the author(s) and do not necessarily reflect the views of the BASIS, its sponsors, or affiliated organizations.

Op-Ed/Editorials - On Science and the Unintended Consequences of Problem Gambling Policy

The theme of the 2006 Institute for Research on Pathological Gambling and Related Disorders annual conference on gambling addiction was Lost in Translation? The Challenge of Turning Good Research into Best Practice. During the next few weeks, The BASIS is pleased to present a series of editorials from some of the faculty members of that conference. In this week's editorial, Dr. Bo Bernhard discusses unintended consequences of problem gambling policy.

Bo Jason Bernhard, Ph.D.
Assistant Professor of Sociology and Hotel Management, UNLV
Director, Gambling Research at UNLV’s International Gaming Institute
Faculty, The 2006 Institute for Research on Pathological Gambling and Related Disorders annual conference on gambling and addiction

Having written in the past on the unintended consequences of problem gambling policy (Bernhard, 2004), I was humbled to be asked to deliver a presentation that covers similar intellectual terrain and in the company of so many intellectual giants from my bibliography pages. The topic of unintended consequences seems a natural one whenever contemplating policy decisions today, but it is useful to take a step back to think about these concepts’ historical foundations and manifestations. It is interesting to note, for instance, that when the state of Nevada legalized gambling in 1931, problem gambling itself might have been fairly characterized as an unintended consequence of this policy decision. Contrary to many popular portrayals of this decision, legalizing gambling was not a rash decision made in response to desperate economic times brought on by the Depression. In fact, legalization was a decision that was pushed strongly by local business elites who wished to promote a broader economic agenda of economic growth via tourism promotion (Moehring & Green, 2005). In this sense, this historical tale is a familiar one – one not unlike current-day Singapore, which recently decided to legalize gambling for strikingly similar reasons. In those early days in Nevada, problem gambling was seen as sin rather than sickness (Bernhard, forthcoming), and our current understandings of the disorder were generations away. Responsible gaming policies, to the extent we might call them that, were similarly underdeveloped. As a fifth-generation Las Vegan, I can recall conversations with my great-grandfather – himself a proud Las Vegan who was one of the oldest dealers on the Strip when he passed away – telling stories of how management would hand bus tickets home to gamblers who were “down on their luck” and lacked the financial means to leave Las Vegas. To be sure, this was hardly a scientific approach to responsible gaming, but it does demonstrate at least an early commitment to the idea that some intervention was necessary with some patrons who gambled to excess. Further exploration reveals that the state that has been at it the longest with legal gaming policy has had its own interesting brushes with these policies’ unintended consequences. Famously, for years a Mafia sensibility ruled the state of Nevada. While for many this was hardly a troubling development (as my grandmother – echoing Debbie Reynolds – once said, “in those days, nobody got killed that didn’t deserve killin’”), for government leaders at the federal and even the state level, the Bugsy Siegels and Meyer Lanskys constituted an unwelcome presence. Interestingly, when the feds got serious about cracking down on the Mafia influence, their RICO statutes did little to rid Las Vegas of its mob influence. It was in fact the state’s Corporate Gaming Act that led to the first major victories over organized crime. This Act focused on allowing corporate investment in casino gaming – specifically by relaxing the requirements for background investigations into investors’ business and personal dealings. In the end, the deep pockets of Wall Street won out over the shallower pockets of the Midwestern Mafia leaders, and corporate money squeezed out mob money (Moehring and Green). Hence, the policy designed to rid society of a presumed wrong did little to right things, while a policy that ostensibly targeted other activities did the trick.

This brings us to Robert King Merton. Merton was one of those rare social scientists whose work truly endures. His contributions are so profound that many have entered into common usage without proper attribution. From the “self-fulfilling prophecy” (which he coined) to the “focused group interview” (which he invented, and which evolved into the now-ubiquitous focus group – though in common usage it is a methodology that is far inferior to Merton’s original creation), to “unintended consequences” (another everyday analytical phrase that he gave to us), Merton’s ideas continue to influence our professional and lay analyses in a vast array of important settings.

The latter contribution proves especially useful for those of us interested in analyzing problem gambling policy. Merton felt that any study of policy and human behavior must strive to distinguish between the reasons behind a policy and the empirically demonstrated consequences of that policy (1967). The field of sociology ran with this conceptualization, and today is often characterized as a field that is methodologically inclined to embrace a “debunking motif” (Berger, 1963) that seeks to explore real effects hidden behind stated ones.

Merton has since inspired generations of sociologists to do just that (including this sociologist, who was inspired to explore these kinds of processes with problem gambling policy.) In the problem gambling field, a variety of unintended consequences might emerge from noble-intentioned policies. For instance, Australian policies that slow the reel speed of machine games were thought to slow the rapid-fire gambling pace of problem gamblers – but when implemented, evidence showed that problem gamblers actually gambled for longer periods of time on these devices (Blasczyzynski, Sharpe, & Walker, 2001). In the U.S., placing gambling on riverboats was ostensibly intended to “remove” social costs – at least in the physical sense – from local communities. However, one surely unintended consequence of this policy was that problem gamblers sometimes found themselves trapped and unable to disembark these “cruises to nowhere.” Mandated win-loss displays that reveal the amount won or lost on a machine (rather than credits accumulated) were designed to make potentially problematic gamblers aware of financial consequences. To problem gamblers, however, seeing that they were $200 down could well trigger “chasing” thinking. Finally, ergonomic requirements that insist upon well-lit, comfortable surroundings to create a more healthy environment might well allow problem gamblers to gamble for longer periods of time before carpal pains interfere with their play (Bernhard, 2004).

As articulated in the Reno Model (Blasczynzski, Ladoceur, and Shaffer, 2004), these examples illustrate the need to use systematic and scientific research to evaluate the real effects often hidden behind the stated ones. Hence, noble intentions are not enough – we must use our research to develop best practices that effect the changes that we seek.

At this stage, however, I must insert a caveat – and one that I have increasingly grown aware of during my travels. I have had the fantastically good fortune to get to study gambling behaviors on six inhabited continents, and having watched a variety of humans gamble in a variety of global settings, I am in the end struck not by similarity – but by difference. To cite but one striking example, gambling settings in Asia look and feel profoundly different than those outside of the doors of this conference. Casinos have none of the cacophony typically present in Las Vegas. In many Asian locales, gambling is a quiet, serious, and even job-like endeavor – in stark contrast to the more festive environs often observed in Sin City.

Hence, in my mind it would be naïve to suggest that anthropology is an insignificant factor, and that gambling behaviors should unfold in the same ways regardless of whether the gambler sits in Des Moines or Damascus. Hence, we cannot uncritically export even scientific findings from one locale without spending rigorous research time with that vital but oft-neglected construct: generalizability.

I learned this lesson the hard way. Asked early on to help the nation of South Korea develop problem gambling policies prior to the lifting of gambling prohibitions in the Kang-Won province, I suggested that the provision of help lines was a sound strategy supported by what little we knew from research. In practice, however, exporting this best practice from the environment with which I was most familiar (North America) proved problematic in a different anthropological locale. As it turns out, whereas the catchphrase in Las Vegas has become “What Happens Here, Stays Here” – in South Korea, the dominant ethos might well have been “What Happens in the Family, Stays in the Family.” In South Korea, one most decidedly did not air the family’s dirty laundry to some stranger over the phone. Nor did one reach out to conventional (conventional to me, at least) mental health structures to solve what was often deemed an “in-house” family problem. In this case, we failed because we simply did not pay enough attention to anthropology, or to generalizability.

In the spirit of learning from past mistakes and effecting intended change in the future, I would like to make a single policy recommendation that might address the ever-present challenges of unintended consequences in gaming industry policymaking. Once again, we might learn valuable lessons from history – and specifically, gaming regulatory history.

In this field, changing times have necessitated changing strategies for addressing the pressing problems that gaming regulators face. As we have discussed, early on gaming regulators found themselves charged with ridding the gaming industry of undesirables – a task that was understandably assigned to a team of law enforcement experts, who now commonly work in gaming regulatory environments everywhere. Later, gaming regulators were confronted by problems associated with monitoring the complex challenges of technology in gambling devices, which led to a team of ‘techies” being hired (and to this day maintained) in regulatory settings worldwide.

Today, very often one of the key challenges faced by regulators are those that are associated with the social costs of gambling – and once again, it seems that we might benefit from bringing on board a team of experts who are best suited to sift through the research evidence on this topics. I would argue, then, that gaming regulatory bodies need to have on staff a cadre of social scientists (and what an odd cadre we would constitute!) to assist with what must be daunting challenges pertaining to problem gambling.

This cadre – and those of us who might inform this cadre – might stand on the shoulders of Merton and others of his ilk. We might be inspired by practitioners like Carl Sagan, who memorably articulated a scientific method founded on twin pillars of inquiry: wonder and skepticism (1997). The former might best be captured by imagining the wide-eyed five year-old in all of us, taking in oceans and galaxies with an inextinguishable desire to wonder at the reasons behind their workings. The latter might actually be illustrated by thinking of a curmudgeonly grandmother that we might have known, constantly questioning with a vigilant skepticism the world as we “know” it. Both of these sensibilities, Sagan argues, are necessary for good research.

Importantly, Sagan also reminds us to recall the modest, tentative, humble (and humbling!) foundations of science – a science that is always open to counter-evidence, and that accepts the “truth” as always partial. Those of us who believe that today’s insights into problem gambling are infallible might simply be reminded that yesterday’s (moral) “experts” on people who gambled too much delivered their “definitive” truth accounts of this “sin” with a stunning degree of certitude and authority – one that is similar to much of the discourse that often emerges from our research today. Tellingly, they were no less certain of the truthfulness of their tales in their day than we are of ours in our day (Bernhard, forthcoming).

In the end, Sagan says that science is like democracy – in that science might be said to be the worst, most flawed system ever devised to understand human beings (and their consequences) – with the notable exception of every other system ever devised to do so. In the problem gambling field, we have indeed come a long way – and as always, we indeed have much that remains to be done. Certainly, we have evolved in remarkable ways: conferences such as the NCRG’s annual gathering would have been unimaginable in my great-grandfather’s day. One wonders what marvels await us a generation from now, should we continue to adhere skeptically to these principles and this spirit.

What do you think? Comments on this article can be addressed to Bo Bernhard.

References

Berger, P. 1963. Invitation to Sociology. New York: Doubleday.

Bernhard, B.J. (forthcoming). The voices of vices: Sociological perspectives on the DSM-IV pathological gambling entry. American Behavioral Scientist.

Bernhard, B.J. & Preston, F.W. (2004). On the shoulders of Merton: Potentially sobering consequences of problem gambling policy. American Behavioral Scientist 47(11), 1395-1405.

Blaszczynski, A., Ladouceur, R., and Shaffer, H.J. 2004. A science-based framework for responsible gambling: The Reno model.” Journal of Gambling Studies 20(3), 301-317.

Blasczyzynski, A., Sharpe, L., & Walker, M. (2001). Final report: The assessment of the impact of the reconfiguration of electronic game machines as harm minimization strategies for problem gambling. Sydney: University of Sydney Gambling Research Unit.

Merton, R.K. (1967). On theoretical sociology. New York: Free Press.

The views expressed in the Op-Ed/Editorials page are solely the views of the author(s) and do not necessarily reflect the views of the BASIS, its sponsors, or affiliated organizations.

Op-Ed/Editorials - Cognitive-behavioral therapy for pathological gamblers

The theme of the 2006 Institute for Research on Pathological Gambling and Related Disorders annual conference on gambling addiction was Lost in Translation? The Challenge of Turning Good Research into Best Practice. During the next few weeks, The BASIS is pleased to present a series of editorials from some of the faculty members of that conference. In this week's editorial, Dr. Nancy Petry discusses cognitive-behavioral therapy for pathological gamblers.

Nancy Petry, Ph.D.
Gambling Treatment and Research Clinic
University of Connecticut Health Center
Faculty, The 2006 Institute for Research on Pathological Gambling and Related Disorders annual conference on gambling and addiction

Few controlled studies have evaluated the efficacy of psychotherapies for pathological gambling, but Gamblers Anonymous and cognitive-behavioral therapies are two interventions commonly applied. In the first federally funded clinical research study investigating treatments for pathological gambling, Petry et al. (2006) randomly assigned 231 pathological gamblers to: referral to Gamblers Anonymous (GA) alone, GA referral plus a cognitive-behavioral workbook, or GA referral plus 8 sessions of individual cognitive-behavioral therapy. Gambling and related problems were assessed at baseline, one month later, post-treatment, and at 6- and 12-month follow-ups.

On average, participants were about 45 years of age, over 40% were women, and almost half were married. Most were employed full-time, with an average education of 14 years and an annual income of $40,000, ranging from $0 to over $200,000 per year. Participants gambled on multiple forms, with about 40% indicating that slot machines was their primary form of problem gambling, followed by cards (about 18%), and scratch/ lottery tickets and sports betting (about 10% each). Most had severe problems with gambling, with an average of 7 criteria for pathological gambling endorsed from the Diagnostic and Statistical Manual of Mental Disorders. There were no baseline demographic differences between participants assigned to the three treatment conditions.

In the month before treatment, participants wagered an average of 14 days and spent about $1,200 gambling. Although all groups, on average, decreased gambling during the treatment period, those receiving cognitive-behavioral therapy reduced days and amounts gambled more than those in the GA referral condition. For example, days gambled decreased to about 8 in the GA referral condition and to less than 5 in the individual cognitive-behavioral therapy condition. Some beneficial effects of the cognitive-behavioral therapy were maintained throughout the one-year follow-up period. Further, individually delivered cognitive-behavioral therapy improved some outcomes compared to the cognitive-behavioral workbook condition, with most effects being related to the number of therapy sessions or workbook exercises completed. These data suggest the efficacy of this cognitive-behavioral therapy approach in treating gamblers.

A follow-up study, again supported by the National Institute on Health, is currently underway to further examine the efficacy of this approach. An additional 210 pathological gamblers are being randomized to one of three conditions: cognitive-behavioral therapy, cognitive-behavioral therapy plus contingency management in which participants earn gift certificates for completing homework assignments associated with the cognitive-behavioral therapy, or a psychoeducational treatment approach. In this study, all participants receive individual therapy, free of charge, for 8 weeks. Effects of the interventions will be evaluated for up to two years following treatment.

In summary, we showed that cognitive-behavioral treatment does improve outcomes of pathological gamblers who seek treatment. Our results also highlight that many gamblers who seek treatment do quite well with respect to decreasing their gambling with only minimal interventions.

Future research will need to determine which individuals are more likely to need more extensive treatments, and which do well with only minimal interventions. One possibility along this regard relates to motivation to change; that is, gamblers with greater motivation seem to be more likely to achieve gambling abstinence (Petry, 2005). Visit our website at www.gamblingtreatment.net to learn more about our studies.

What do you think? Comments on this article can be addressed to Nancy Petry.

References

Petry, N.M., et al. (2006). Cognitive-behavioral therapy for pathological gamblers. Journal of Consulting and Clinical Psychology, 74, 555-567.

Petry, N.M. (2005). Stages of change in treatment-seeking pathological gamblers. Journal of Consulting and Clinical Psychology, 73, 312-322.

The views expressed in the Op-Ed/Editorials page are solely the views of the author(s) and do not necessarily reflect the views of the BASIS, its sponsors, or affiliated organizations.

Op-Ed/Editorials - Making the call: Gambling helplines in the U.S.

The theme of the 2006 Institute for Research on Pathological Gambling and Related Disorders annual conference on gambling addiction was Lost in Translation? The Challenge of Turning Good Research into Best Practice. During the next few weeks, The BASIS is pleased to present a series of editorials from some of the faculty members of that conference. In this week's editorial, Christine Reilly discusses a brief survey of gambling helplines in the United States.

Christine Reilly
Executive Director Institute for Research on Pathological Gambling and Related Disorders

One of the most visible resources for individuals concerned about their gambling is the helpline or hotline. Toll-free helpline numbers are often posted in casinos, printed on lottery tickets, and featured in public services announcements on television and radio. The quality of care offered by helplines or any other intervention should be a priority. That is why the Institute for Research on Pathological Gambling and Related Disorders and the National Center for Responsible Gaming presented a session on helplines at the 2006 NCRG Conference on Gambling and Addiction in November. A search of the scientific literature revealed that very little had been written about helplines for disordered gamblers, and, therefore, the Division on Addictions faculty and staff conducted a brief survey of gambling helplines in the U.S. in order to provide background for the conference panel. The findings of this survey suggest possible directions for future research and evaluation, especially in the area of helpline personnel.

We gathered the data through a telephone survey with 27 gambling helplines and a review of materials available online (1).  Helpline administrators were asked about the credentials and training of helpline personnel; nature of services provided; geographical scope; funding sources; advertising sources; and volume of calls. We found that nearly all gambling helplines offer the same services, including distribution of educational materials, referrals to Gamblers Anonymous and treatment professionals, and crisis counseling. It is interesting that this near unanimity on the purpose of a helpline was not matched by the responses to questions about credentials and training of helpline personnel. Although all of the respondents require some sort of training for the staff answering helpline calls, there was no agreement on other aspects of personnel qualifications. Nearly 50 percent had no educational requirements while 25 percent required a graduate degree (e.g., master’s degree), 21 percent a four-year college degree and 8 percent a high school degree. For 50 percent of the helplines, certification and/or licensure is mandatory and only one-third provide clinical supervision. Clearly, there is no consensus about what constitutes the ideal qualifications and training needs for a helpline worker. While some maintain that a paid staff with graduate training in a clinical specialty should be the standard, other helplines use volunteers with little or no education other than in-house training. It might be useful for the organizations that sponsor helplines to revisit the issue of educational qualifications and training needs of their personnel. The recent explosion of new research on gambling has made this an opportune time to re­evaluate strategies for assisting individuals with a gambling problem (Shaffer, et al., 2006). As new research changes our understanding of the disorder, we will need to adjust intervention, prevention and treatment strategies accordingly. Fortunately, there will be new resources for this re­appraisal. The Prairielands Addiction Technology and Transfer Center at the University of Iowa recently launched a two-year study of the health care providers focused on gambling disorders. The operators of helplines could benefit from the findings and recommendations of this project. We encourage helpline operators to take advantage of the development of evidence-based resources and to keep in mind that the dictum, “First, do no harm,” applies even to straightforward activities like disseminating educational materials.

For a copy of the PowerPoint presented at the 2006 NCRG Conference on Gambling and Addiction, contact Christine Reilly (Christine_reilly@hms. harvard.edu).

What do you think? Comments on this article can be addressed to Christine Reilly.

Notes

1. Jenna Tonet, research administrator coordinator for the Division on Addictions, conducted most of the interviews. Sarah Nelson, instructor of psychology in psychiatry, Harvard Medical School (HMS), and Howard Shaffer, associate professor of psychology in psychiatry, HMS, helped design the questionnaire and analyzed the data.

References

Shaffer, H.J., Stanton,