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Gambling Harm Minimisation

ABACUS Feedback to the Ministry of Health
regarding
Emerging Trends in National & International Literature.

This summary of research has relevance to the clinical workforce,
it forms part of a regular six monthly report provided by ABACUS to the Ministry.

All Literature Reports
 
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Feedback to MOH
Emerging Trends in National & International Literature

Report No. 21 / Period covered:
1st July 2020 to 31st December 2020

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Literature:

Covid-19 and gambling: impacts, transformations, and reflections.

2020 Research Chair on Gambling Studies, Hermes, Concordia & Laval Universities, Concordia, CA.

Concordia.ca/research/lifestyle-addiction

http://dx.doi.org/10.11575/PRISM/38266

Findings:

  • This is a Canadian research project conducted across several universities that reviewed current knowledge of gambling during 2020 under the impact of COVID-19.
  • The Universities noted that there has been a major impact on casinos and others in the gambling industry as a result of COVID-19. Horse races are not run, casinos often closed, as are EGM venues, and sports events that are gambled on are not held.
  • During their lockdown, many gambling services closing, although many lotteries remained open.
  • The researchers identified that gambling would reduce with an estimate reached of 11% over 2019. They noted that in the UK under a recent survey (Johal, 2020) the majority of gambling operators have seen their revenue reduce by at least 50%. They noticed in Macau the loss of revenue was 88% during lockdown, and in Italy there was a 59.3% drop in online and offline revenue seen in early 2020 (Italy iGaming Dashboard, 2020). In Europe, where horse racing and sports gambling was popular, there was a significant drop in gambling revenue in 2020.
  • The researchers noted that there was a migration from land-based or offline gambling to online gambling, with many of the gambling operators changing to digital delivery (e.g. Quebec, the State operator concentrated its gambling online). Eight States in the US allowed operators to market lottery products. Norway permitted bingo operators to operate online and an exception to normal in-person mandatory gambler registration was waived for online bingo gambling. 
  • The researchers noted an estimated an increase of revenue from online gambling of 13.2% for 2020 (Online Gambling Global Market Report, May 2020). The increase was seen in poker and online casinos and was attributed to COVID-19.
  • However, online gambling has been growing prior to COVID-19 (2019) with some Canadian gambling operators estimating a growth of 77% over 2018 growth. They also referred to an Australian study (Casino org, 2020) of 250,000 gambling consumers showing a 67% increase in online gambling.
  • The researchers noted a recent study that identified 17% increase in online gambling (Snook, June 2020) and that one third of gamblers surveyed in a UK study tried gambling online for the first time during the confinement period. Existing gamblers tended to diversify their gambling choice, gambled longer, and spent more money gambling. Faster game cycles such as EGMs, saw an increase in players online, and virtual sports  and online poker  revenue increased over 2019 revenue, as well as number of gambling sessions per hour (Gambling Commission, UK, 2020). This increase in online gambling was not found in Finland and Denmark.
  • An Ontario study of N=2005 gambler participants (Responsible Gambling Council, 2020) noted 54% gambled during the week assessment (21-28th April 2020) when the lockdown was in effect, with 77% stating they were exclusively offline gamblers prior to the pandemic. Most popular modes were lottery/raffles (84.6%), instant lotteries (39.4%), and EGMs (21.3%), with one third saying they were influenced by the emergency health measures. Motivation to gamble largely was attributed to making money, fun/excitement, and to pass the time.
  • The researchers noted that sports gambling was limited by less events, but new opportunities arose (e.g. betting on number of COVID-19 cases (Sun, 2020); betting on eSports simulated matches). Overall, though, betting on sports decreased.
  • The researchers review varying protective measures by countries to inform and protect online gamblers, however these were for their country-based providers.
  • They identified many questions were raised about the study (such as quantity of new online gamblers, whether the increase will continue, whether transition back to offline post-COVID, and how will diversified practices continue in the future).

Comment:

  • As online gambling continued and revenue measures were difficult to assess (private organisations, based overseas) there was a real barrier to estimating whether there was an uptake of such options and if revenue increased through that source.
  • Estimates of increases in online gambling merged with natural trending of increased gambling online from the previous year and this would impact upon the extent of attribution of increased revenue to COVID-19.
  • An important question is also whether people with existing gambling harm transferred to online gambling, and would continue post-COVID on both land-based and online gambling, with greater harm ensuing. 
  • Overall, the study was informative of overall gambling, with some findings that increased gambling occurred in many cases outside of the jurisdiction of countries, with little control apart from online messages and help availability. Many countries, however, were treating online gambling as an important aspect to be managed where possible.
  • Risks for harm increase with online gambling, as there is little control over gambling outside of NZ gambling providers (and by registering overseas, this can obviate obligations to comply with NZ law by NZ sited providers); also, as gambling occurs usually in the home, there is none of the usual oversight where trained staff can intervene when possible gambling harm is occurring.
  • The use of unrestrained alcohol or other drugs while gambling can also add to the risk of harm when gambling from home.
  • This may suggest the importance of enquiring of all clients about their use of online gambling, the risks thereof, and continued enquiry as an ongoing approach, especially until the pandemic has been addressed safely.

Literature:

Changes in online gambling during the COVID-19 pandemic.

Authors: Brown R & Hickman A

May 2020. Australian Government; Australian Institute of Criminology

ISSN 2206 7302, ISBN 978-1-925304-57-7

Findings:

  • The authors conducted a survey of (N=1000 adults) in Australia to assess gambling behaviour during the pandemic.
  • They noted that there had been a rapid advance in availability of online gambling in the last 20 years, with sports and racing the main Australian gambling preferred (especially young men), with up to 92% of those who bet on these forms having online accounts.
  • They noted that one source (AlphaBeta, 2020) had identified a 67% increase in transactions online during the pandemic.
  • In the current study, the authors noted that 24% of the 1,000 surveyed had gambled online in the previous month (use compared with their online banking  (85%), social media use (78%), and online shopping (70%)). Of the 1000,  11% of all participants had increased their gambling, but 45% of online gamblers during the past month had increased their gambling compared with the first two months (pre-COVID) of 2020. Sports gambling online was most popular, although 20% of online gamblers reported more EGM gambling (more often).   
  • Males were more likely to have increased their gambling during lockdown (16%, versus females at 6%), as were younger gamblers. As age increased, so reduced the prevalence of increased online gambling (18-39 years six times greater than that for gamblers over 50 years of age).
  • Gambling modes often changed (switched) when moving to online with approximately 29% having  increased their gambling in one mode of gambling and decreased their gambling in another.
  • The authors noted that males under 30 years in full employment were most often likely to engage in more online gambling (46%).

Comment:

  • This study acknowledged that it didn’t examine the implications of increased online gambling, or negative social impacts of gambling for households during a pandemic.
  • However, the increased use and availability of online gambling was noted, especially during the pandemic.
  • Swapping of modes again raised risk, as broader opportunities to gamble on less knowledgeable gambling modes, and persistence when usual modes were unavailable, raised the possibility of longer sessions.
  • The authors noted increased gambling, particularly by young males during lockdown. This was often by those in full employment, having the means to participate longer, and possibly raising the risk for moving to higher- risk gambling.
  • Many findings in Australian settings apply to NZ gamblers, even if the amount of money lost per person is less. These findings could suggest increased risk for NZ young men during lockdown, and also that having tried online gambling, opportunities to gamble will increase even after lockdown ends.
  • This is further evidence to make enquiries of all clients around use of online gambling, increased use, and reasons for its use.

Literature:

The impact of the COVID-19 lockdown on gambling behaviour, harms and demand for treatment and support.

Authors: Gunstone B, Gosschalk K, Joyner O, Diaconu A & Sheikh M.

(October 2020) YouGov, London, GambleAware

GambleAware is an independent framework agent with the UK Gambling Commission to deliver the National Strategy to Reduce Gambling Harm.

Findings:

  • The authors initially conducted two phases  in the UK, Phase 1 (2019; treatment demand; N=12,161 ) and Phase 2 (2019). In May 2020 participants (N=9,067) were recontacted to identify gambling change during the pandemic. Before the pandemic, 45% gambled at least weekly, and this decreased to 37% during the pandemic.
  • Participation in gambling activity during the pandemic decreased substantially (39%) from the previous year, with almost all gambling modes reducing, including the National Lottery.
  • They concluded that offline gambling was not replaced with online gambling during the pandemic except for online casino games which increased from 1.5% in 2019 to 2.3% in 2020.
  • A significant change in stated motivation to gamble was to escape boredom or ‘fill my time’ (increased in the period from 26% to 29%).
  • In 2019, 13% met PGSI score of one or more (low risk to problem gambler; ‘positives’) and this marginally reduced in 2020 to 12%. Of the 2019 ‘positives’, 62% changed their categories, 54% reducing to a lower category and 7% had increased. In addition, 7% of all had increased to the ‘positive’ category and 14% of previously non-gamblers had started to gamble.
  • When changes were matched against actual scores rather than categories, 67% of ‘positives’ reduced their score in the period, and 18% increased their score.
  • Of the increases, those originally in the ‘problem’ category of the PGSI (8 or greater), 27% increased their score.
  • When surveyed , half of the gamblers (52%) said they gambled the same amount during the pandemic, compared with 41% who said they reduced gambling (4% stated they gambled more; moreso for ‘problem gamblers’ (20% of ‘problem gamblers’ 8+)).
  • Of moderate gamblers (PGSI score 3-7), 12% reported gambling more, with 9% of low-risk (score 1-2) gambling more. ‘Non-problem’ gamblers increased their gambling marginally (2%).
  • Reduction in gambling was reported as being due to lack of desire (30%), gambling only on specific occasions, or preferring land-based or horse racing which was not available (28%; males moreso). Just 11% stated gambling less because of less income (11%).
  • For those who gambled more during the pandemic, reasons were relieving boredom (52%), to win money (48%), while 26% said they had more disposable income because the lockdown prevented spending.
  • Few used safe gambling tools (e.g. exclusion; 5%) but gamblers experiencing harm were more likely to use these (63%; versus moderate gamblers 22%, low risk 6%, or ‘non-problem’ 2% ).
  • Ethnic minorities and younger gamblers were more likely to use a safer gambling tool, although these groups were more likely to have higher PGSI scores.
  • Support advice to reduce gambling (GP, MH services, family/friends) or treatment prior to the pandemic remained similar during the pandemic with 17% scoring as ‘positive’ (1+) prior and after (16%) and similar numbers wanting some support or treatment.
  • Alcohol use did not increase (AUDIT-C) although 31% of younger gamblers experiencing harm were drinking at a risk level or ‘problem’ level in 2020 compared with 2019 (20%).
  • ‘Positives’ did not increase in smokers or those psychologically distressed in the pandemic study over the 2019-2020 period.

Comment:

  • This was a large study where clients were recontacted to identify later changes to gambling occurring during the pandemic.
  • Contrary to the above Australian study, this UK study noted an overall reduction in gambling during the pandemic. Overall, gambling decreased in this study. However, gamblers experiencing harm were found in 27% of cases to increase their PGSI score, indicating that for those with existing problems, gambling harm may increase during a pandemic, contrary to lesser harm categories.
  • The authors noted that the increase in scores of the PGSI during the pandemic could not be attributed causally to it.

Literature:

Gambling in Australia during COVID-19

Jenkinson R, Sakata K, Khokhar, Tajin R, Jatkar U

October 2020. Australian Gambling Research Centre, Australian Institute of Family Studies

https://aifs.gov.au/agrc

Findings:

  • The authors surveyed 2,019 gamblers across Australia during the temporary close of many gambling venues during June and July 2020 to ascertain how they adjusted; they also spoke with key experts working in research, regulation, policy and treatment around these issues.
  • A number of key findings raised concerns. First, almost one-third of those gamblers surveyed opened an online betting account during the pandemic, and one in twenty started gambling online. Notwithstanding the reduced access to venues, participants gambled more during the pandemic, with those gambling four or more times weekly increasing from 23% to 32%.
  • Prior to the pandemic, horse and greyhound racing, sports and Lotto were the main pre-pandemic gambling focus.
  • 79% of participants were classified as being ‘at risk’ or experiencing gambling harm (PGSI)
  • Those males in the 18-34 year old cohort were most likely to open a new account online, to increase their frequency and monthly spending ($687 increased to $1,075), and to be at-risk for gambling harm
  • Around half of the participants noted their mental health and or physical health had been negatively affected during the pandemic
  • Key experts reported benefits through closure of EGM venues that were immediate (for essential items such as food and their savings).

Comment:

  • Contrary to the UK study above, Australian gamblers often opened their first online account to gamble during the pandemic, gambled more, and 5% of those surveyed started their gambling online.
  • A high proportion of gambling participants (79%) were at some degree of risk (PGSI; low, moderate, problem), again with young males having the higher risk cohort.
  • Half acknowledged negative mental or physical health during the pandemic, however other research has found a correlation between poor mental health and gambling harm (see Gainsbury & WAGER below).

Literature:

Impact of COVID-19 on online gambling – a general population survey during the pandemic.

Author: Hakansson A

25 September 2020: Frontiers in Psychology, 36 (52)

Doi.org/10.3389/fpsyg.2020.568543

Findings:

  • The authors noted a concern that the pandemic may impact on mental health through the possibility of greater gambling or transfer to riskier forms of gambling online. Inability due to a lockdown and other gambling (sports cancellations causing new gambling), may result in increased harm.
  • N=997 gamblers (past year online gamblers) were assessed for their gambling over a 30 day lockdown period.
  • Online non-sports gambling remained at high levels, while several other types of gambling were at lower levels than a similar past period. However, even with the reduction in sports events upon which to gamble, those betting on sports events were found to have ‘markedly higher gambling problems’.

Comment:

  • Although mental health and gambling harm was not a focus in this Scandinavian study, non-sports gambling remained high and these participants were found to be at higher levels of harm than other gamblers who gambled on other modes.

Literature:

The impact of the COVID-19 shutdown on gambling in Australia.

Authors: Gainsbury S, Blaszczynski A.

August 2020. Gambling treatment & Research Clinic, Technology Addiction Team, Brain & Mind Centre,

School of Psychology, Faculty of Science, U of Sydney.

Findings:

  • The pandemic reduced gambling opportunities in Australia with closure of land-based venue and cancellation of sporting events. Access to lottery venues was also limited.
  • A study of N=764 adults (mainly male- 85%) who had gambled in the past 12 months was conducted.
  • These were the preliminary results from Wave 1 cross-sectional study.
  • Three out of four participants gambled less during the lockdown, most not increasing the frequency of their gambling online.
  • Those at moderate risk for harm through their gambling were more likely to increase their gambling frequency (14%; compared with 9% for ‘non-problem’ gamblers, 12% for low-risk gamblers, and 9% for ‘problem gamblers’ (PGSI)).
  • 63% of ‘non-problem’, low-risk, and moderate risk gamblers  reduced their gambling, and 68% of gamblers experiencing harm reduced their gambling by 10% or more.
  • Those gamblers in the moderate to severe categories (PGSI) were more likely to have higher gambling spending (27% and 25% respectively), compared with ‘non-problem’ gamblers’ increases (14%), and low-risk gamblers (22%). Those gamblers with the higher gambling severity surprisingly also had the largest reductions ((10% or more)  - moderate gamblers 39%, ‘problem’ gamblers 38%). ‘Problem’ gamblers had the most responses that they stopped gambling during the pandemic, (19% vs 7%-12% for other categories).
  • Average (median) spending decreased ($450 down to $200 during shutdown)
  • Of those whose gambling increased substantially (10% or more) 17% were ‘problem’ gamblers, 38% were moderate gamblers, and of these gamblers who substantially increased their gambling, 10% reported severe distress, and 35% reported moderate distress, and 25% noted COVID financial problems and had difficulty making ends meet.
  • Only 1% gambled online for the first time during the lockdown.
  • Of the gamblers spending substantially more time gambling online (n=133), 24% were ‘problem’ gamblers, and 35% moderate gamblers; 11% reported severe distress psychologically, 35% moderate distress, and 30% were having difficulty making ends meet.
  • Of the almost one in four (N=172) experienced gambling problems in the previous 12 months, 6% were seeking help (down to 4% during the lockdown). Help sought included professional help (27%, 17% pre and since lockdown)), with most problems reducing during lockdown (60%; 21% stayed the same). When enquires were made, 76% of those with problems said they were unlikely to seek professional gambling treatment in the next three months.

Comment:

  • This was the first wave of a continuing study in Australia.
  • Although most gamblers reduced their gambling during the pandemic, moderate gamblers (PGSI) were most likely to increase their gambling. Of interest was the finding that almost 70% of ‘problem’ gamblers reduced their gambling by 10% or more during the pandemic.
  • Of those gambling more during the pandemic, most were moderate and ‘problem’ gamblers, with a significant percentage of each noting increased mental health issues.
  • Few participants took up gambling for the first time during the pandemic.
  • Few surveyed affected by problems had sought health support (4%-6%) and for those choosing help, specialist services were low. 76% said they were unlikely to seek help from ‘problem gambling’ treatment specialists in the next three months.
  • This first wave will be informed by next waves, however, the reluctance to seek help is emphasised and the need to make services more attractive for help-seeking ‘problem’ gamblers (and their whanau) remains a much-needed but elusive solution.

Literature:

Gambling in the time of COVID-19: mental health, substance use, financial distress among high-risk online gamblers.

The WAGER Volume 25 (8).

https://basisonline.org/2020/08

Findings:

  • WAGER is the addiction resource for Harvard Medical School. This study reviewed Price A (2020) www.ncbi.nlm.nih.gov/pmc.
  • The study comprised N=2005 Ontario, Canada, residents who were gamblers (at least once in last 12 months). N=1081 gamblers had gambled online during the initial weeks of the pandemic measures, and most had gambled online before.
  • Those at high risk for gambling harm had a greater likelihood of being male (age 25-44), reported more anxiety and depression, lost employment or reduced working hours, and gambling under the influence of cannabis or alcohol.
  • In using the PGSI to categorise all respondents, 71.7% were ‘non-problem’ gamblers, 14.2% low-risk, 6.5% moderate-risk, and 7.6% high-risk gamblers.
  • Those at high risk were more likely to report that they gambled in order to earn (win) income (40.6% vs 6.6% of non-high-risk gamblers). High risk gamblers were also more likely to return to win back lost gambling money (42% vs 3.3%), and to use gambling to cope with feeling nervous or depressed (33.3% vs 2.3%).
  • The WAGER authors noted that these findings highlighted the potential secondary impacts of COVID-19 on risky behaviours among online gamblers. Previous studies have noted the relationship of depression/anxiety, substance use, and financial distress to gambling risk and the pandemic. They also note gambling motives associated with mental health and financial problems’ association to gambling problems. They concluded that harm reduction and prevention efforts when directed at online gambling should be used holistically and not independently of these factors.

Comment:

  • This study was reported in the first part of this year, however, the WAGER review has highlighted other less direct findings of why those who gamble more problematically differentially gamble when compared with those who are non-high risk gamblers.
  • Those with reduced or lost work, male, depressed/anxious, and young, remain at highest risk for gambling harm.
  • Many of those experiencing gambling problems (PGSI 8+) considered they could win at gambling, earning money (40%+), or gambled to recover gambling losses (42%). Others also considered that gambling provided a relief for their anxiety (nervousness) or depression (one-third; 33.3%). These perceptions were substantially above the same view held by non-high-risk gamblers, suggesting these perceptions may be an important focus for treatment and harm reduction strategies.
  • The WAGER authors considered a holistic approach (all public) rather than individual ‘problem’ gamblers as a topic to be addressed.