Editor’s note: This op-ed about the application of models and theories to our understanding of responsible gambling was written by Howard Shaffer, Morris E. Chafetz Associate Professor of Psychiatry in the Field of Behavioral Sciences at Harvard Medical School and Distinguished Faculty at the Division on Addiction at Cambridge Health Alliance; Robert Ladouceur, Professor Emeritus in the School of Psychology at the Université Laval; and Alex Blaszczynski, Professorial Research Fellow & Co-Director or the Gambling Treatment & Research Clinic, Brain and Mind Centre, at the University of Sydney. This op-ed is part of this month’s Special Series on Theories of Addiction.
A Public Health Model operates by informing our understanding of the distribution and determinants of diseases and disorders (e.g., gambling disorder, substance use disorder, etc.) within the community and across target populations. This approach encourages the development of evidence-based prevention programs that can influence the behaviors of whole populations rather than targeting individuals. The Reno Model, a complementary component to the Public Health Model for responsible gambling, offered the first organized science-based approach to guide stakeholders as they developed and implemented a host of gambling-related activities that aim to reduce the prevalence and prevent the incidence of gambling-related harm (Blaszczynski, Ladouceur, & Shaffer, 2004; Shaffer, Blaszczynski, Ladouceur, Collins, & Fong, 2019).
Recently, some pundits have criticized the Reno Model expressing preference for a Public Health Model as a “better” framework to achieve the objectives of responsible gambling. Unfortunately, these and other academics have failed to understand the differences between strategic and tactical approaches for preventing and reducing the incidence and prevalence of gambling-related harms (Blaszczynski et al., 2011; Collins et al., 2015; Ladouceur, Blaszczynski, Shaffer, & Fong, 2016; Shaffer, Ladouceur, Blaszczynski, & Whyte, 2015). As we describe in the following discussion, a Public Health Model is, typically, a strategic approach to gambling-related problems. The Reno Model is more of a tactical approach. Rather than advocating for one model over the other, a more appropriate starting point is to determine whether a model can suitably fulfill the stated purpose that it represents. In this regard, we want to highlight that both the Reno Model and Public Health Model are MODELS. It is important to clarify the concept of a model. Models attempt to depict the relationships between worldly events and the concepts that might explain them. A model is not as complete as a theory. Models are absent some elements of theory. Like theories, models offer a framework for generating testable hypotheses that can provide empirical evidence to confirm/disconfirm hypotheses. As applied to gambling, the public health model targets population-level problems and provides guidance for individuals and governments as they plan to respond to these difficulties. In contrast, other responsible gambling models – like the Reno Model – focus on at-risk groups and provide guidance for individual players, gambling operators, and governments.
Currently, both the public health and the Reno models provide touchstones along a path to a more complete understanding of gambling-related problems and how to prevent and treat them. There are important distinctions and overlap between these two models that make them complementary and not competitive. Models can be strategic and/or tactical. When a model targets the “what” of a problem, it is strategic. When a model targets the “how” of problem solving, it is tactical. Public Health models are more strategic than the Reno Model. The Reno Model, on the other hand, is more tactical than the Public Health Model. Strategies are designed to identify and define long-term goals that incorporate plans and initiatives that stakeholders systematically implement to achieve targeted objectives and outcomes. For example, the Public Health Model strategically guides primary, secondary and tertiary interventions for population segments that evidence various levels of risk associated with an array of determinants that adversely influence health. The Reno Model translates this strategy into activities that can prevent the incidence and reduce the prevalence of gambling-related problems empirically. Thus, tactics represent singular or multiple sets of activities that work in combination toward achieving those strategic objectives and outcomes.
We can view a public health approach toward gambling as a model that provides a set of strategies for establishing (1) the incidence and prevalence of gambling-related harms, and (2) the determinants responsible for influencing the distribution of such harms. This public health strategy invites the application of specific tactics (e.g., sampling, research methodologies and procedures, and measurements) to gather data that can inform appropriate policy responses and the development of responsible gambling programs to reduce the incidence and prevalence of gambling-related harms. The Reno Model builds upon this architecture by offering tactical principles and guidelines that key stakeholders can follow as they implement their respective responsible gambling initiatives.
Crucially, one must not assume that public health strategies or Reno Model activities are effective simply because their stated intentions or tactics appear sensible. There is a need for these models to be evaluated repeatedly using empirical data that can validate or question underlying concepts, syntax and semantics. Unfortunately, in their attempts to advance models, many pundits limit empirical evaluation or, even worse, ignore the evidence completely by substituting opinion and belief for fact.
There are two important questions upon which to reflect. First, are the public health and Reno models incompatible and divergent in their fundamental premises? Second, do the public health and Reno models seek to achieve different objectives? Unfortunately, during recent years, some academics (e.g., Hancock & Smith, 2017) have criticized the Reno Model alleging that it is less integrative and useful than the Public Health Model. However, opinions need to be set aside and replaced with systematic and rigorous scientific evaluations that can determine the effectiveness of each model.
Any program of evaluation needs to consider that these two models are not separate and competitive: they are two distinct, interactive and complementary models. Although both are models, the Public Health Model provides a strategic roadmap for developing activities that can prevent the incidence and reduce the harms associated with gambling. Once a strategy for preventing and reducing harms is selected, then stakeholders can select and implement responsible gambling programs and initiatives. Concomitantly, the Reno Model represents a tactical subset of the global strategic Public Health Model. We encourage BASIS readers to discount criticisms based on opinions and erroneous interpretations and accept the premise that the Reno model is complementary to the Public Health Model by offering tactical principles and guidelines capable of achieving the common goal of all stakeholders: minimize gambling-related harms by preventing the incidence and reducing the prevalence of these problems (Shaffer, Ladouceur, & Blaszcynski, in press).
Blaszczynski, A., Collins, P., Fong, D., Ladouceur, R., Nower, L., Shaffer, H. J., . . . Venisse, J. L. (2011). Responsible gambling: general principles and minimal requirements. Journal of Gambling Studies, 27(4), 565-573.
Blaszczynski, A., Ladouceur, R., & Shaffer, H. J. (2004). A science-based framework for responsible gambling: the Reno model. Journal of Gambling Studies, 20(3), 301-317.
Collins, P., Blaszczynski, A., Ladouceur, R., Shaffer, H. J., Fong, D., & Venisse, J. L. (2015). Responsible gambling: conceptual considerations. Gaming Law Review and Economics, 19(8), 594-599.
Hancock, L., & Smith, G. (2017). Critiquing the Reno Model I-IV International Influence on Regulators and Governments (2004–2015)— the Distorted Reality of “Responsible Gambling”. International Journal of Mental Health & Addiction, 11(2), 145. doi:10.1080/14459795.2013.829515
Ladouceur, R., Blaszczynski, A., Shaffer, H. J., & Fong, D. (2016). Extending the Reno Model: Responsible Gambling Evaluation Guidelines for Gambling Operators, Public Policymakers, and Regulators. Gaming Law Review and Economics, 20(7), 580-586. doi:10.1089/glre.2016.2074
Shaffer, H. J., Blaszczynski, A., Ladouceur, R., Collins, P., & Fong, D. (Eds.). (2019). Responsible gambling: primary stakeholder perspectives. New York: Oxford University Press.
Shaffer, H. J., Ladouceur, R., & Blaszcynski, A. (in press). Considering the Public Health and Reno Models: Strategic and Tactical Approaches for Dealing with Gambling- related Harms. International Journal of Mental Health & Addiction.
Shaffer, H. J., Ladouceur, R., Blaszczynski, A., & Whyte, K. (2015). Extending the RENO model: clinical and ethical applications. American Journal of Orthopsychiatry, 86(3), 297-309. doi:10.1037/ort0000123
Howard Shaffer, PhD, is the Morris E. Chafetz Associate Professor of Psychiatry in the Field of Behavioral Sciences at Harvard Medical School; in addition, he is Distinguished Faculty at the Division on Addiction at Cambridge Health Alliance. Dr. Shaffer is a fellow of the American Psychological Association. He has written extensively about the treatment and nature of addiction, including more than 260 chapters, journal articles, and reviews. In addition to many books and monographs, he has published more than 120 newspaper articles. His newest book (2019), with Drs. Ladouceur, Blaszczynski, Collins, and Fong is Responsible gambling: primary stakeholder perspectives, published by Oxford University Press. Dr. Shaffer’s research, writing, and teaching have shaped how the health care field conceptualizes and treats the full range of addictive behaviors. His Syndrome Model of addiction has gained broad acceptance, influencing how we think about both behavioral and substance related addiction. He has received many awards for his work, including the 2010 American Psychological Association, Division 50, award for “Outstanding Contributions to Advancing the Understanding of Addictions,” the 2010 Ira Grief Community Partnership award from the St. Francis House Moving Ahead Program, the 2015 the Lifetime Research Award from the National Council on Problem Gambling, and the 2012 The American Library Association Choice award for the APA Addiction Syndrome Handbook (Volumes 1&2) with Drs. LaPlante and Nelson.
Robert Ladouceur, PhD, is a Professor Emeritus at the School of Psychology at the Université Laval de Québec. During his academic career, he has published over 400 scientific papers and written or edited five books. Dr. Ladouceur is a pioneer in the field of pathological gambling and an internationally recognized authority in this field. In 1996, he received the National Award from the National Council on Problem Gambling in the United States, for his exceptional contribution to research and intervention. In 2001, he received the Adrien-Pinard Prize from the Société Québécoise pour la Recherche en Psychologie which recognized his exceptional contribution to Quebec research in psychology. In 2003, he received the Senior Scientific Achievement Award from the National Center for Responsible Gaming for his exceptional contribution to research and intervention.
Alex Blaszczynski, PhD, is a Professorial Research Fellow and Co-Director of the University of Sydney Gambling and Research Clinic. He is an academic and clinical psychologist with a long history of involvement in treatment and clinical studies on gambling disorders, the psychology of gambling, and principles and policies related to responsible gambling behaviour. He developed a conceptual pathways model explaining the etiology of gambling disorder. He is the Editor-in-Chief of International Gambling Studies.
During the last few years, Howard Shaffer has received funding from a variety of sources, including the Foundation for Advancing Alcohol Responsibility, the National Institutes of Health (NIH) and Indian Health Services (IHS), the Integrated Centre on Addiction Prevention and Treatment of the Tung Wah Group of Hospitals, which receives funding from the Hong Kong Jockey Club Charities Trust, DraftKings, the Massachusetts Gaming Commission, GVC Holdings PLC, and the Massachusetts Department of Public Health. Dr. Shaffer also has received speaker honoraria and compensation for consultation from the American Psychological Association, Las Vegas Sands Corp., Davies Ward Phillips and Vineberg, LLP, Freshfields Bruckhaus Deringer, LLP, Winston & Strawn, LLP, and from the Dunes of Easthampton, a residential addiction treatment program.
Robert Ladouceur has received funding during the last few years for consultancies, book royalties, honoraria for conference presentations, and to cover travel expenses from sources including La Loterie Romande (Switzerland), Club NSW (Australia), Comelot (UK), La Française des Jeux (France), Loto-Québec (Québec, Canada), and National Lottery (Belgium). He is a member of the Independent Assessment Panel of the World Lottery Association.
Alex Blaszczynski has received direct and indirect funding during the last few years for research projects, consultancies, book royalties, honoraria for conference presentations, and to cover travel expenses from sources including La Loterie Romande (Switzerland), Svenska Spel (Sweden), Club NSW (Australia), Comelot (UK), La Française des Jeux (France), Loto-Québec (Québec, Canada), Casino Austria, National Lottery (Belgium), Sportsbet, Aristocrat Leisure Industries, Victorian Responsible Gambling Foundation, Gambling Research Exchange Ontario, Crown Casino, Responsible Gambling Trust (GambleAware), Manitoba Gambling Research Program, NSW Office of Liquor, Gaming, and Racing, Gambling Research Australia, Racing and Wagering Australia, National Association for Gambling Studies, National Council on Problem Gambling, and Le Comité d’organisation Congrès international sur les troubles addictifs. He receives funding from the Routledge Group in his role as Editor-in-Chief for International Gambling Studies.