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Wednesday, September 24, 2008

Comments

The article on living close to casino with no real effect is simply not true. Most of my criminal cases as a result of gambling addiction came about when casino play became more available by being close to client.

Thank you for your interest and response to this post. In your correspondence, you wrote that you noticed that more criminal cases related to gambling occurred when casino play became more accessible; therefore, the findings of Sevigny’s study were false.

Sevigny, Ladouceur, Jacques, & Cantinotti’s 2008 study reports trends – that is, what is true for most people. They aggregated data from many individuals and report about the trends across the individuals included in the sample. For any given individual, the trend they report might not apply. Their study tells us whether, in general, there is a systematic relationship between exposure and gambling problems that exceeds chance. Therefore, the report lacks information about each individual’s experience. On the other hand, your evidence base is case oriented. Ultimately, cases are anecdotal evidence and do not necessarily represent the population.

Thus, there is a divide between clinicians’ experience with individuals and scientists’ experience with groups. The well-known Berkson’s bias (1946) is but one example of this divide. One way research in this area can bridge this divide is to identify for whom casino exposure results in problems and why.

Another consideration in clarifying the relationship between casino exposure and gambling problems is the length of time your criminal cases were exposed to casino games versus how long participants in the Sevigny et al. study were exposed. Your letter implies gambling problems arose soon after the introduction of casino games; Sevigny et al.’s participants were exposed to a casino for ten years before they were surveyed. We have reported previously that people appear to adapt to the presence of the casino (LaPlante, D.A. & Shaffer, H. J. (2007). Understanding the influence of gambling opportunities: Expanding exposure models to include adaptation. American Journal of Orthopsychiatry, 77, 616-623). Gambling-related problems that might be similar to those of your clients tend to happen most when the casino gambling opportunity is new. As the novelty effect wears off, however, people adapt and fewer have gambling related problems.

Identifying these complex issues and the broad research base associated with addictive behaviors is one of the main reasons why we write the BASIS and encourage feedback from readers.

Again thank you for your interest in the BASIS and for your comments. We always appreciate feedback, questions, and comments from readers.

-The BASIS Staff

References

LaPlante, D.A. & Shaffer, H. J. (2007). Understanding the influence of gambling opportunities: Expanding exposure models to include adaptation. American Journal of Orthopsychiatry, 77, 616-623.

Berkson’s bias is detailed in Berkson, J. (1946). Limitations of the application of fourfold table analysis to hospital data. Biometrics, 2, 47-53.

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The BASIS is a product of the Division on Addiction, Cambridge Health Alliance, a Harvard Medical School teaching hospital. The Division is an entirely self-funded academic organization that relies on grants, contracts, and gifts in order to produce The BASIS and our other high-quality work.
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