Effects of a national preventive intervention against potential COVID-19-related gambling problems. A self-report survey in online gamblers

Nationwide, Multioperator Self-Exclusion and Psychiatric Comorbidity in Patients with Gambling Disorder: A Retrospective Chart Review Study from a Regional Treatment Unit

Gambling disorder is an addictive disorder that has been shown to have a detrimental effect on an individual's health, social, and financial situations. Voluntary self-exclusion is one way for patients to reduce harm in gambling disorder, but breaching one's self-exclusion appears to be common. In January 2019, Sweden launched a nationwide, multioperator self-exclusion instrument called Spelpaus (literally "game break"). Spelpaus is unique to Sweden, and there is limited research on the use of this type of nationwide, multioperator self-exclusion services, also in relation to gambling disorder and mental health. There is a reason to follow the clinical picture of treatment seeking for gambling disorder over time, and this study aims to explore clinical characteristics of patients seeking clinical gambling disorder treatment, including sex distribution and mental health comorbidity, as well as the use of Spelpaus amongst patients with gambling disorder and how frequently users gambled despite ongoing self-exclusion, in relation to sex and psychiatric comorbidities. A retrospective chart study was carried out on patients presenting to a regional gambling disorder treatment unit. Information regarding self-exclusions using Spelpaus, gambling despite self-exclusion, and the method of gambling despite self-exclusion as well as psychiatric comorbidities were extracted from medical records. Females were markedly more likely to report overall psychiatric comorbidities (48% vs. 25% among males, p < 0.001), affective, neurotic/anxiety-related (p < 0.001), and behavioral/emotional (p = 0.028) diagnoses and more likely to have two or more diagnoses excluding gambling disorder (p = 0.001). From 120 patients from whom information regarding self-exclusion was present, 114 (95%) had chosen to self-exclude. From the 114 self-excluders, 67 reported to have gambled despite self-exclusion, with unregistered websites being the most common method. Self-exclusion was not significantly related to sex (p = 0.146) or to psychiatric comorbidities (p = 0.178). In conclusion, psychiatric comorbidity was particularly common in female gambling disorder patients and gambling despite self-exclusion was common. Gambling regulations should be improved to help self-excluders avoid being able to gamble on unlicensed gambling operators. Further research should focus on sex differences and the association with psychiatric comorbidities.

Responsible gambling through a motivational telephone intervention to high-risk gamblers - An evaluation of user satisfaction and subjective intervention effects

BACKGROUND AND AIMS

Problem gambling causes major social and psychiatric consequences, and there is need to develop feasible harm-reducing or therapeutic interventions. It has been suggested that gambling operators with responsible gambling intentions can intervene in order to identify and help reduce the harm in problem gamblers. However, user satisfaction, and the risk of negative reactions and gamblers' transfer to other operators, rarely have been explored scientifically.

METHODS

This is a retrospective survey study of gamblers reached by a motivational, telephone intervention by the Swedish state-owned gambling operator (Svenska Spel), addressing gamblers with indicators of high-risk gambling practices (n = 197). Surveys were answered approximately 10 days after the intervention.

RESULTS

Thirty-seven percent perceived their gambling to have decreased due to the intervention, whereas 7% perceived their gambling instead had increased. A large majority (80%) reported a subjective favorable experience from the intervention. Forty percent reported gambling on other operators than Svenska Spel after the intervention, but only 7% gambled on a new operator following the intervention.

CONCLUSION

Survey data in gamblers reached with a motivational telephone intervention present mainly promising findings, and should be replicated in future studies in larger samples. The main findings display an overwhelmingly favorable subjective experience, and a limited risk of gamblers migrating to other operators.

Multi-operator Self-exclusion as a Harm Reduction Measure in Problem Gambling: Retrospective Clinical Study on Gambling Relapse Despite Self-exclusion

BACKGROUND

Voluntary self-exclusion from gambling is a common harm reduction option for individuals with gambling problems. Multi-operator, nationwide self-exclusion services are rare, and a system introduced in the highly web-based gambling market of Sweden is a rare and recent example. However, where web-based casino gambling and web-based betting are the predominate gambling types in those seeking treatment, the risk of breaching one's own self-exclusion through overseas web-based operators may also be high.

OBJECTIVE

This study aims to assess the prevalence of a nationwide Spelpaus ("gambling break") self-exclusion and the prevalence of gambling despite self-exclusion in patients seeking treatment for gambling disorder in 2021.

METHODS

Health care documentation of recent treatment seekers (January 1 through September 1, 2021, N=85) in a Swedish treatment facility was reviewed for data regarding problematic gambling types reported, history of self-exclusion, and history of breaching of that self-exclusion.

RESULTS

Common problem gambling types were web-based casino gambling (49/74, 66%) and sports betting (19/74, 26%). The majority who participated in this study (62/85, 73%) were men. All women reported web-based casino gambling. Self-exclusion through Spelpaus was common (60/74, 81%). Among self-excluders, gambling despite self-exclusion was common (41/60, 68%), most commonly on unlicensed gambling websites.

CONCLUSIONS

The nationwide, multi-operator self-exclusion service of Sweden appears to reach many patients with a gambling disorder. However, the remaining gambling options in an web-based gambling setting present a major challenge despite self-exclusion. The recent data calls for further treatment efforts and potential improvements in services aiming to help voluntary self-excluders abstain from gambling.