Treatment and help services for gambling during COVID-19: Experiences of gamblers and their concerned significant others

Availability restrictions and mandatory precommitment in land-based gambling: effects on online substitutes and total consumption in longitudinal sales data

BACKGROUND

Gambling causes important harms in societies. According to the public health approach, the most effective policies to reduce harms target full populations. Availability restrictions and mandatory precommitment are among the most effective measures. However, restrictions on the availability of some gambling products or channels may also be offset by increased consumption in other products. Substitution effects can have negative public health impacts due to differing harm potential across different gambling products. This paper uses longitudinal sales data (2019-2022) from the Finnish gambling monopoly Veikkaus. During the observation period, the availability of gambling was restricted in Finland due to subsequent waves of Covid-19-related restrictions. In addition, the gambling monopoly introduced mandatory precommitment to land-based EGMs. We focus on how these restrictive policy changes impacted the total consumption of gambling and possible substitution effects.

METHODS

The Finnish gambling monopoly provided weekly theoretical loss data per gambling product category and gambling channel (online, land-based) for the period of January 2019 - July 2022 based on a statutory obligation. We analysed the effects of availability restrictions and other public health measures on the consumption of different products using descriptive time series and regression analyses. We compared the sale of land-based products to online equivalents at product category level and included main policy change periods in the models.

RESULTS

Total consumption of gambling declined during 2019-2022 mainly due to reduced land-based electronic gambling machine (EGM) consumption. Declines in land-based EGM sales were not offset by online alternatives or other close substitutes in the long term. However, during the first wave of Covid-19, there was an observable substitution of land-based table games by online alternatives and land-based horse betting and possibly sports betting by online horse betting. Overall, the results also show that Covid-19 functioned as a boost to an already existing trend of increasing digitalisation of gambling.

CONCLUSIONS

The study provides empirical support for the effectiveness of public health-oriented policies in reducing the total consumption of gambling. Availability restrictions and mandatory precommitment are therefore likely to also reduce the burden of harms of gambling to individuals and societies.

Gambling helpline contacts during COVID-19-related availability restrictions: an interrupted time series analysis

OBJECTIVES

Gambling causes significant public health harms that are addressed in the help service network. Helplines are the most widely used service among those experiencing harms. The COVID-19 pandemic changed the global gambling landscape. This study assesses the effect of COVID-19-related restrictions on help-seeking for gambling via helplines.

STUDY DESIGN

We analysed data of national helplines in Sweden, Finland, and Denmark before and during the pandemic. The countries differed in their restrictions on the availability and accessibility of gambling during the pandemic.

METHODS

We performed an interrupted time series analysis of contact and web traffic data to helplines in Sweden, Finland, and Denmark before and during the COVID-19 pandemic (2017-2021). We also compared forecasted time series to the actual data to assess change.

RESULTS

The results show diverging patterns across the three countries. In Sweden, the number of helpline contacts remained stable throughout COVID-19, but there was an increasing trend in website visits. In Finland, the number of contacts declined during the first wave but rebounded during the second wave. Website visitation increased moderately. In Denmark, the number of contacts to the helpline soared over the COVID-19 period.

CONCLUSIONS

The diverging results suggest that help-seeking behaviour is likely to be impacted by differing policy approaches to gambling availability and limit-setting, visibility of helplines, and the prevalence of different forms of gambling in the three Nordic countries before and during the pandemic. This has implications for a preventive public health approach for gambling.

Gambling harm prevention and harm reduction in online environments: a call for action

BACKGROUND

Gambling is increasingly offered and consumed in online and mobile environments. The digitalisation of the gambling industry poses new challenges on harm prevention and harm reduction. The digital environment differs from traditional, land-based gambling environments. It increases many risk-factors in gambling, including availability, ease-of-access, but also game characteristics such as speed and intensity. Furthermore, data collected on those gambling in digital environments makes gambling offer increasingly personalised and targeted.

MAIN RESULTS

This paper discusses how harm prevention and harm reduction efforts need to address gambling in online environments. We review existing literature on universal, selective, and indicated harm reduction and harm prevention efforts for online gambling and discuss ways forward. The discussion shows that there are several avenues forward for online gambling harm prevention and reduction at each of the universal, selective, and indicated levels. No measure is likely to be sufficient on its own and multi-modal as well as multi-level interventions are needed. Harm prevention and harm reduction measures online also differ from traditional land-based efforts. Online gambling providers utilise a variety of strategies to enable, market, and personalise their products using data and the wider online ecosystem.

CONCLUSION

We argue that these same tools and channels should also be used for preventive work to better prevent and reduce the public health harms caused by online gambling.

Isolation and worry in relation to gambling and onset of gambling among psychiatry patients during the COVID-19 pandemic: A mediation study

When the COVID-19 pandemic started spreading globally, there was a fear that addictive behaviors would increase due to changes in everyday life caused by restrictions due to COVID-19. Studies were carried out to explore if this was true for gambling, typically revealing no overall increase in gambling behavior, although individuals who had previous experience with gambling problems were more likely to increase gambling during the pandemic. However, these studies only included individuals with previous gambling problems. It remains unknown whether other vulnerable groups, such as individuals with common mental disorders increased their gambling. This study aimed to explore the level of gambling problems among individuals with a history of mental disorders, namely, (i) pre-pandemic gamblers and (ii) pandemic-onset gamblers. Furthermore, we explored if worry and isolation mediate gambling and problem gambling. The data were analyzed using descriptive statistics and a structural equation model to investigate mediation. The results showed a high prevalence of at-risk and problem gambling in both groups. The pre-pandemic gamblers had a high level of at-risk and problem gambling. Furthermore, the individuals that started to gamble during the pandemic had an even higher degree of at-risk and problem gambling. The mediation showed that the onset of gambling was linked with the worry of COVID-infection and that worry predicted the level of gambling problems. This study highlights that vulnerability factors, isolation, and worry can be triggers for individuals with common mental disorders to engage in gambling as well as the importance of screening this population for gambling problems.

What About Affected Family Members of Disordered Gamblers During the COVID-19 Pandemic? A Study in Italy During the Lockdown Restrictions

Although some studies have been conducted on gambling behaviour in the general population or in clinical samples during the COVID-19 pandemic, less attention has been focused on Affected Family Members (AFMs) of disordered gamblers. To fill this gap, this study investigated the psychological state of disordered gamblers' AFMs during the COVID-19 lockdown in Italy, the European country first affected by the virus and with the largest gambling market. We were interested in understanding if the unavailability of most land-based gambling offerings during the lockdown created a sense of relief in AFMs. We also compared the quality of family relationships and emotional state during the lockdown of AFMs with those of their relative with Gambling Disorder (GD). Participants were 53 disordered gamblers' AFMs (77% female; mean age = 50.28). For 42 out of the 53 AFMs, we also recruited their relative with GD (86% male; mean age = 48.98). A semi-structured telephone interview was developed. Although AFMs reported a general interruption of the relative's gambling behaviour and a general sense of relief for the closure of gambling activities, accompanied by the perception of good family relationships, AFMs still felt tired, worried, and apprehensive and perceived more fear, stress, and anxiety than before the lockdown. A large proportion of AFMs engaged in potentially addictive behaviours, especially TV and mobile phone and Internet use, which increased in frequency compared to before the pandemic. They still perceived some gambling-related problematic behaviours from their relative and put in place coping strategies to manage the gambling problem. Even if they had a general positive orientation towards the future, they experienced fear when thinking about the reopening of gambling opportunities at the end of the lockdown. Compared to their relatives with GD, AFMs appeared more prone to perceiving a general negative state and a worsening of it from before the lockdown. Overall, this study shows that disordered gambling's AFMs can be considered as a particularly at-risk group who deserves focused clinical attention even during gambling closures related to pandemic lockdown.

From Habit-Forming to Habit-Breaking Availability: Experiences on Electronic Gambling Machine Closures During COVID-19

Electronic gambling machines (EGMs) are among the most harmful forms of gambling. The structural characteristics of EGMs prolong and reinforce gambling similarly to other habit-forming technologies. In Finland, the wide availability of EGMs in non-casino locations is likely to further reinforce the habit-creating nature of gambling offer by incorporating EGMs into everyday practices. The COVID-19 pandemic changed the landscape of gambling in Finland. The most visible change was the closure of land-based EGMs in non-casino environments, arcades, and the casino in March 2020. Since then, the status of EGMs has varied depending on the pandemic situation. The current qualitative study focuses on how Finnish past-year gamblers experience prolonged EGM closures and occasional re-openings 1 year into the pandemic. The data consist of responses to an online questionnaire eliciting experiences (N = 187) as well as interviews (N = 27, conducted in groups or alone). To aid our analysis, we employ the sociological pragmatist theory of the concept of "habit." The analysis focuses on gambler experiences on EGM shutdowns and re-openings, and views on whether closures have contributed to abstaining from gambling or to shifting to other gambling products. Policy implications of the results are discussed.

The impact of the COVID-19 lockdown on services for substance use in Denmark: Implications for meeting users’ needs and recommendations for the future

Background: The aim of this study was to document employees’ experiences of changes in service provision for substance use disorders (SUDs) during the first COVID-19 lockdown in Denmark (spring 2020), as well as to examine their relation to challenges in meeting the service users’ needs. Methods: Employees (N = 373) working in SUD treatment and harm reduction services completed an online survey soon after the first national lockdown. The survey included questions about changes in service provision during the lockdown, perceived concerns of the service users, and challenges in meeting the users’ emerging needs. Results: Employees reported some positive changes in service provisions, such as increased flexibility in appointments, administering medication-assisted treatment (MAT), and use of telehealth. Negative changes were related to reduced contact with practitioners and harm reduction facilities. Approximately one third of employees reported significant challenges in meeting the users’ emerging needs. This was particularly so when users’ concerns were about physical and mental well-being, and substance use. In regression models, negative changes in the access to practitioners and MAT administration (but not other changes) predicted difficulties meeting the users’ needs. Conclusion: Employees in SUD treatment and harm reduction services in Denmark experienced both positive and negative changes as a result of the first lockdown. However, not all the provision changes were linked to challenges in meeting the users’ needs. We discuss practical and research implications of our findings with a focus on the users’ physical and mental health, use of telehealth, MAT, and overall service reorganisation.