Self-directed interventions for gambling disorder

What is known about population level programs designed to address gambling-related harm: rapid review of the evidence

BACKGROUND

Gambling and gambling-related harm attract significant researcher and policy attention. The liberalisation of gambling in most western countries is strongly associated with a marked rise in gambling activity and increases in gambling-related harm experienced at the population level. Programs to address gambling-related harm have traditionally focused on individuals who demonstrate problematic gambling behaviour, despite clear evidence of the effectiveness of a public health approach to high-risk activities like gambling. Little is known about the availability or efficacy of programs to address gambling-related harm at a population level.

METHODS

The Victorian Responsible Gambling Foundation commissioned a rapid evidence review of the available evidence on programs designed to reduce gambling-related harm at a population level. The review was conducted using a public health and harm reduction lens. MEDLINE, ProQuest Central and PsychInfo databases were searched systematically. Included studies were published in English between 2017 - 2023 from all countries with gambling policy contexts and public health systems comparable to Australia's; included primary data; and focused on primary and/or secondary prevention of gambling-related harm or problems.

RESULTS

One hundred and sixty-seven articles were eligible for inclusion. Themes identified in the literature included: risk and protective factors; primary prevention; secondary prevention; tertiary prevention; target population group; and public health approach. The evidence review revealed a gap in empirical evidence around effective interventions to reduce gambling-related harm at the population level, particularly from a public health perspective.

CONCLUSIONS

Addressing gambling-related harm requires a nuanced, multi-layered approach that acknowledges the complex social, environmental, and commercial nature of gambling and associated harms. Moreover, evidence demonstrates community programs to reduce gambling-related harm are more successful in reducing harm when based on sound theory of co-design and address the social aspects that contribute to harm.

How We Lost 90% of Participants on a Bad Bet: Results from a Pilot Randomized Controlled Trial on Cognitive Bias Modification in Problem Gamblers

Whilst opportunities to participate in gambling have increased, access to support for problem gamblers is lacking behind. This lack of balance calls for improved and accessible intervention methods. The present double-blind randomized controlled trial (RCT) explored the effectiveness of two interventions targeting automatic cognitive processes, known as Attentional Bias Modification (AtBM) and Approach Bias Modification (ApBM). It was hypothesized these interventions would reduce gambling behavior and reduce or reverse targeted biases. Participants (N = 331) were community-recruited Flemish (35%) and Dutch (65%) adult problem gamblers motivated to reduce or stop their gambling who received either six sessions of active training (AtBM or ApBM) or of the corresponding sham-training (sham-AtBM or sham-ApBM). Due to high attrition rates (90.1% up to the intervention phase) the study was terminated before completion, since it would greatly limit the validity of any results. A post hoc qualitative study was performed on a subset of participants to gain insight into contributing factors for the high attrition rate. Issues negatively impacting participants' motivation to complete the program were identified, as well as elements of the program that received approval. The results from this study provide a first insight into the potential of the use of online cognitive bias modification (CBM) interventions in problem gambling (PG). Suggestions and directions for future studies are discussed.

Gambling Habit Hacker: Protocol for a micro-randomised trial of planning interventions delivered via a Just-In-Time Adaptive Intervention for adult gamblers (Preprint)

Background

People with gambling problems frequently report repeated unsuccessful attempts to change their behavior. Although many behavior change techniques are available to individuals to reduce gambling harm, they can be challenging to implement or maintain. The provision of implementation support tailored for immediate, real-time, individualized circumstances may improve attempts at behavior change.

Objective

We aimed to develop and evaluate a Just-In-Time Adaptive Intervention (JITAI) for individuals who require support to adhere to their gambling limits. JITAI development is based on the principles of the Health Action Process Approach with delivery, in alignment with the principles of self-determination theory. The primary objective was to determine the effect of action- and coping planning compared with no intervention on the goal of subsequently adhering to gambling expenditure limits.

Methods

Gambling Habit Hacker is delivered as a JITAI providing in-the-moment support for adhering to gambling expenditure limits (primary proximal outcome). Delivered via a smartphone app, this JITAI delivers tailored behavior change techniques related to goal setting, action planning, coping planning, and self-monitoring. The Gambling Habit Hacker app will be evaluated using a 28-day microrandomized trial. Up to 200 individuals seeking support for their own gambling from Australia and New Zealand will set a gambling expenditure limit (ie, goal). They will then be asked to complete 3 time-based ecological momentary assessments (EMAs) per day over a 28-day period. EMAs will assess real-time adherence to gambling limits, strength of intention to adhere to goals, goal self-efficacy, urge self-efficacy, and being in high-risk situations. On the basis of the responses to each EMA, participants will be randomized to the control (a set of 25 self-enactable strategies containing names only and no implementation information) or intervention (self-enactable strategy implementation information with facilitated action- and coping planning) conditions. This microrandomized trial will be supplemented with a 6-month within-group follow-up that explores the long-term impact of the app on gambling expenditure (primary distal outcome) and a range of secondary outcomes, as well as an evaluation of the acceptability of the JITAI via postintervention surveys, app use and engagement indices, and semistructured interviews. This trial has been approved by the Deakin University Human Research Ethics Committee (2020-304).

Results

The intervention has been subject to expert user testing, with high acceptability scores. The results will inform a more nuanced version of the Gambling Habit Hacker app for wider use.

Conclusions

Gambling Habit Hacker is part of a suite of interventions for addictive behaviors that deliver implementation support grounded in lived experience. This study may inform the usefulness of delivering implementation intentions in real time and in real-world settings. It potentially offers people with gambling problems new support to set their gambling intentions and adhere to their limits.

Trial Registration

Australian New Zealand Clinical Trials Registry ACTRN12622000497707; www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=383568

International Registered Report Identifier (IRRID)

DERR1-10.2196/38919

Who chooses to enroll in a new national gambling self-exclusion system? A general population survey in Sweden

BACKGROUND

Self-exclusion from gambling is a common method for prevention and harm reduction in hazardous gambling. However, few national self-exclusion programs, involving a large number of gambling operators and activities in a country, have been assessed scientifically. This study aimed to examine characteristics of individuals who chose to enroll in a recently introduced (January, 2019) national self-exclusion system in Sweden.

METHODS

Adults and adolescents (from age 16 and above) were addressed with an online survey sent to members of the web panel of a market survey company (1940 respondents). Psychological distress, previous history of addictive disorders, sociodemographic data, and recent history of gambling patterns and over-indebtedness were recorded. Logistic regression tested associations with self-exclusion, with unadjusted analyses conducted for the sub-group of moderate-risk or problem gamblers.

RESULTS

Four percent reported having self-excluded using the new national self-exclusion system. In logistic regression, self-exclusion was significantly associated with younger age (OR 0.65 [0.54-0.79] for increasing age groups) and with the highest level of problem gambling (OR 2.84 [1.10-7.37]). In moderate-risk or problem gamblers, in unadjusted analyses, younger age (p < 0.05) and psychological distress (p = 0.02) were associated with self-exclusion. In none- or low-risk gamblers, 3% had self-excluded, which was significantly associated with younger age (p < 0.001) and self-reported over-indebtedness (p < 0.001).

CONCLUSIONS

In a national, multi-venue online and land-based self-exclusion system, aiming to reduce the harm of problem gambling, self-exclusion is expectedly more common in problem gamblers, but also occurs among people without recent gambling problems. Further efforts may be needed in order to increase gambling self-exclusion in problem gamblers, and research in reasons for self-excluding, even in non-problem gamblers, is needed.