What’s the problem?

Problem gambling is frequently cited as a challenge for the industry and society alike, but beneath that phrase lurks a multitude of specific difficulties and solutions. Barnaby Page looks at some of the issues, and ways that the gaming sector and regulators are responding.

Problem gambling, and its more positively-phrased counterpart “responsible gambling”, are persistent items on the gaming industry agenda – not least because regulators are keen they should be. But just what is the problem, and what are the solutions?

One issue that immediately faces anyone trying to develop a problem-gambling policy is uncertainty about precisely what it is. A commonly accepted definition by psychiatrist Richard Rosenthal calls it “a progressive disorder characterized by a continuous or periodic loss of control over gambling; a preoccupation with gambling and with obtaining money with which to gamble; irrational thinking; and a continuation of the behavior despite adverse consequences”, and while few would disagree with his overall thrust, there’s a lot of ambiguity in the nuances.

Most notably, many distinguish between “problem gambling” and more serious “pathological gambling”, but there’s little consensus on where exactly to draw the line. Terminology can be a minefield too: “compulsive”, “at-risk”, “disordered” and “excessive” gambling are also spoken of.

All the same, the phenomenon itself has been long recognised (Dostoyevsy wrote about it in “The Gambler” in the 1860s; Freud studied it; Gamblers Anonymous was founded in 1957, with its questionnaire becoming the foundation for many later definitions). Research interest has been growing since the 1990s – with the US and Australia among the leaders – and the subject has become decidedly medicalised, with much talk of concepts like “prevalence” (how widespread it is) and “etiology” (how it develops).

In plainer terms, though, an individual’s gambling can be defined as problematic when it starts to have an adverse effect on lives (not necessarily just that person’s). Financial losses are a big element, of course, but it can also consume excessive time, impact family and job responsibilities, and lead to legal issues (many problem gamblers commit crimes related to their gambling expenditure). Linkages have been made between problem gambling and physical medical issues, as well as suicide.

It is widely recognised – at least in some forms – as a psychiatric issue, and indeed Clark County in Nevada has recently opened a Gambling Treatment Diversion Court where problem gamblers accused of crimes can have their condition taken into account.

And there are issues for businesses too. Simple corporate social responsibility (CSR) is part of the reason that the gaming industry becomes involved in addressing problem gambling. There are often also legal requirements, and the reality that notproactively tackling the issue will likely lead to tighter regulation. There is the strong risk of gaming staff to develop gambling problems themselves, and at least hypothetically there may be a legal duty of care to customers.

Given that definitions of problem gambling can differ, and given that it’s about behaviour on a continuum from “no problem” to “serious problem” rather than a clear-cut physical issue, pinning down exactly who is a problem gambler – and how many there are – is a challenge in itself.

But a number of tests, or “screens”, have become accepted, where individuals are asked a series of questions and then scored according to their answers. Most notable among these are the South Oaks Gambling Screen (SOGS), Canadian Problem Gambling Index (CPGI) and Victorian Gambling Screen (VGS).

Making sense of the results then depends on exactly how you define a “problem”. For example, one interpretation of the SOGS classifies those who score less than 5 as “recreational gamblers”, those scoring 5-9 as “gamblers at risk”, and those with 10 or more as “problem gamblers”. Similarly, one version of the CPGI classifies respondents as “non-problem”, “low-risk”, “moderate-risk” and “problem”.

But even if these varied approaches can lead to varying results, they do clearly distinguish between people with problems and those without, and this enables researchers to estimate just how widespread problem gambling actually is.

World of difference

The unsurprising answer is that it differs among countries. In broad terms, it seems that around 0.5-4% of the population in most nations has a gambling problem, with somewhat higher figures found in China and South Africa. At the extremes are 0.5% (Denmark and the Netherlands) and 7.6% (Hong Kong); in between those, European figures are generally lower than in the US.

Demographics also differ, but it seems that men are more likely to suffer than women, and younger people rather than older ones – but that’s only on average. It does not mean that there are no elderly female problem gamblers.

So, faced with a challenge like this, what are policy-makers and the industry to do? There are options for treating problem gambling or minimising the harm associated with it, which we’ll discuss later, but clearly the ideal would be to prevent it occurring in the first place.

This is not an easy solution, however, because the causes are still a subject of debate. At the most fundamental level, there’s disagreement over whether problem gamblers are substantively differentfrom non-problem gamblers – for example in genetic or personality terms – or whether they are essentially the same as non-problem gamblers, but gamble more and in a less controlled, less rational way.

Similarly, there is debate over whether to call problem gambling an addiction. It certainly can exhibit many of the same characteristics as substance abuse (euphoria, tolerance, withdrawal); the addiction-related neurotransmitter dopamine, which influences reward-motivated behaviour in the brain, appears to be involved; and many problem gamblers also have substance-abuse issues. But that does not mean that exactly the same strategies are appropriate.

So, in the absence of certainty about what makes someone susceptible to problem gambling in the first place, much attention has turned to the factors that we doknow about and caninfluence – because problem gambling is as much about the activity as about the individuals.

If you build it…

From a regulatory point of view, there seems to be a correlation between the availability of gambling in a community and the proportion of problem gamblers there. At an extreme this means that removing gambling opportunities entirely would almost eliminate problem gambling (there would still be some illegal activity), but the more realistic issue is balancing the needs of non-problem gamblers, and the viability of the industry, with protection for those at risk.

The types of game that problem gamblers play have come under much scrutiny. While problem gambling can be found everywhere from sports betting to table games to lotteries, attention has focused on those that have a short time between placing the bet and getting the result, allowing for more frequent betting; that potentially offer very large wins; that are based on luck rather than skill; and that encourage the gambler with “near misses”. Use of tokens or electronic funds rather than real cash can also contribute.

In practice for western operators this means slots, VLTs, video poker and the like, whether online or land-based, although in Asian countries table games are more common sites for problem gambling.

So, with the problem at least partially identified, how is it being dealt with? There are three strategies: preventive (stopping problem gambling occurring), harm reduction (recognising that people with problems willgamble, but trying to minimise the adverse effects), and abstinence (helping them stop entirely). These responses are typically formulated by policy-makers, health bodies or non-profits, but implementing them very much involves the industry.

Treatment for individual problem gamblers – including psychological therapies, self-help groups, and medication – is also available but rarely concerns the industry directly, except on the level of funding services and perhaps disseminating information.

Preventive measures can include limitations on advertising, and education – problem gamblers typically hold incorrect beliefs about probability which lead them to continue believing they are on the verge of the big win. (A classic example is imagining that a random event is “due to happen” – for example, if the roulette ball hasn’t fallen on red in the previous four spins, that makes red “more likely” this time.)

This education can be directed at children as well as adults, although there is controversy over whether kids should be helped to gamble responsibly – in the recognition that many of them willgamble – or instead urged to abstain altogether.

Harm reduction measures involve the industry even more closely, as they’re often specifically linked to game design. Among the many that have been proposed for gaming machines (though not all of them have been proven to work) are:

  • Modifying bill acceptors to take only small denominations.
  • Reducing game speeds.
  • Reducing stakes and payouts.
  • Removing features such as autoplay.
  • Minimising sensory cues associated with wins, such as bells and lights – and maximising cues associated with losses.
  • Removing ATMs from gaming areas.
  • Forcing breaks in play, in order to prevent dissociation – the phenomenon where the player forgets about the world beyond the machine entirely.
  • Pre-commitment, where a player must set a limit to their expenditure or losses before they play.

None of these eliminate problem gambling, but instead they should mean fewer adverse effects (for example, lower total losses) for the individual problem gambler.

Abstinence is a more radical solution for individuals, involving complete self-exclusion from all gambling for a period. It has the potential to be effective but is only useful if it is completely enforceable, and enforced – self-exclusion from some venues but not others is unlikely to deter the problem gambler.

The sector is also involved in tackling problem gambling in other ways. Employee training to identify potential problem gamblers and offer them help has been identified as a key requirement. Technology can also assist, particularly where online gaming is concerned and also where players belong to loyalty or bonus schemes: patterns in their play can flag up potential problems.

Practical steps

How these solutions are put into practice varies substantially. Sweden and Norway have been pioneers in the use of pre-commitment, with Sweden requiring all players on any legal gambling platform to set daily and monthly monetary limits as well as a daily time limit for play. Australia has also extensively trialled pre-commitment, with Victoria becoming the first state to introduce a system throughout its jurisdiction – but unlike in Sweden, it is voluntary, and many question how effective that will be.

In the Canadian province of Nova Scotia, however, a pre-commitment system was launched in 2010 and later abandoned after it emerged that customers could play under multiple different identities with separate limits (among other design problems).

In the UK, self-exclusion is a principal element in problem-gambling strategy. All gaming businesses must offer players the opportunity for self-exclusion, lasting for six months and starting immediately. As in other jurisdictions, the industry is also expected to help fund anti-problem-gambling measures including education and treatment, although the Gambling Commission recently noted that “the response overall by operators has been slow and insufficient”; it has threatened a compulsory levy.

In the US, by contrast, problem gambling is normally addressed at a state level, but that could change for sports betting at least following the recent introduction of proposed legislation (the Sports Wagering Market Integrity Act of 2018) which would create a nationwide self-exclusion system, and allocate federal money for prevention and treatment as well as research.

None of these measures will, alone, solve the issue of problem gambling. But the fact that there are so many potential partial solutions reflects the reality that there are so many likely factors involved in making an individual’s recreational gambling a problem. The challenge that still remains for regulators and the gaming industry is to figure out which strategies will make the most difference, and which are ineffective distractions.


Remote gambling has raised particular concern among researchers into problem gambling, because it’s so easy to access and can be so immersive. But there’s also a positive: by its nature, remote gambling activity is very easy to monitor, so individuals with problems can be identified and helped.

The UK harm-reduction charity GambleAware asked PricewaterhouseCoopers to investigate how this might be done, and in 2017 PwC came up with a list of factors that could contribute to a “customer-specific risk score”.

These included individual demographics; general behaviour (such as size of bets and day of the week); preferred gambling products; and specific actions such as the customer’s response immediately following a win or a loss.

Operators could start building a score at sign-up, then improve it steadily as transactional data amassed; after three to six months it would have “strong predictive capability”.

Certain “trigger” actions could also allow operators to identify likely problem gambling as it actually happened, allowing intervention such as messaging to the consumer.