Author Dr Penny Abbott
Expert reviewer Professor Malcolm Battersby
Gambling has been formally defined as ‘an entertainment based on staking money on uncertain events driven by chance’.114 Gambling disorders are often categorised in the literature into problem and pathological gambling; the latter currently medically defined as an impulse disorder. Problem gambling is more loosely defined,115 but in the Australian context the term problem gambling is generally used to refer to the full continuum of gambling related harm.116 Gambling disorders are characterised by difficulties in limiting money and/or time spent on gambling, which leads to adverse consequences for the gambler, for others, or for the community.114
Recreational gambling takes many forms, with electronic gaming machines (‘pokies’) and table games such as roulette and blackjack accounting for the bulk of expenditure. The main form of gambling in Aboriginal and Torres Strait Islander communities has traditionally been card playing. While this has been problematic for some individuals, where ‘pokies’ have become available locally they have replaced traditional forms of gambling, often with more harmful consequences.114
Gambling is a significant issue for many Aboriginal and Torres Strait Islander people, and can have serious consequences for individuals, families and communities.117–119 Aboriginal and Torres Strait Islander people are more likely to be regular and problem gamblers than non-Indigenous people and to start gambling at a younger age.117,119,120 Problems that have been reported as associated with gambling in surveys of Aboriginal and Torres Strait Islander communities include financial hardship, social and emotional difficulties, substance abuse and contact with the criminal justice system.117,118 Gambling disorders are highly associated with psychiatric comorbidities, particularly substance use disorders.115
Environmental risk factors for problem gambling include the cultural and social normalisation of gambling, exposure to peer and family gambling and introduction to gambling at an early age, including through family activities such as gifting lottery tickets and involvement in sport associated gambling.120–122 Children whose parents and/or siblings have issues with problem gambling or substance abuse are at higher risk of becoming problem gamblers.123 Adolescents who gamble are at particularly high risk for problem gambling and develop problem gambling behaviours at 2–3 times the rate of adults.120,121 There is limited information on the early identification of adolescents with gambling problems.121 Warning signs of adolescent problem gambling include multiple visits to internet gaming sites, finding instant lottery tickets, excessive interest in sports events and significant unexplained monetary outlays.122 Family cohesiveness and school connectedness may protect adolescents from problem gambling.122
Interventions involving a broad group of stakeholders, including government, industry and community, are important to reduce harms caused by gambling.117,123,124 Public health interventions, such as safety controls for technology based gambling and prevention of access to instant lottery tickets for those under 18 years of age, may assist to reduce uptake of gambling and harms from gambling.122,125,127 There is currently little published information internationally on culturally specific prevention initiatives for problem gambling.123 Interventions are likely to be more effective if they take a broad approach to preventing gambling related harms. In Aboriginal and Torres Strait Islander communities this must include attention to the social and environmental context of gambling, and take into account individual community needs and promote whole of community health.117,119
The first Australian guideline on the prevention and treatment of problem gambling has been released, with Cochrane systematic reviews to follow.116 The goal of gambling prevention activities is to encourage responsible and non-harmful gambling activities in those who choose to gamble.123 It should be approached by health professionals in a similar way to other risk behaviours such as smoking and alcohol.122,123
Screening for problem gambling is not generally part of routine general practice in Australia, despite GPs and other primary care workers being well placed to provide early identification and intervention for problem gamblers.125,128 Primary care workers may become more confident and effective at detecting problem gambling through recognising that stress related medical disorders may be a presenting complaint of a person with underlying problem gambling and that problem gambling is commonly associated with other health problems including substance abuse and mental health disorders.125–127 Other vulnerable groups are the elderly, people with intellectual disability and people from poorer, disadvantaged communities.114
There are several tools that can be used to screen for problem gambling behaviours,115,116,125 although some are quite long and therefore, it has been argued, impractical for primary care screening.127 Validated screening measures are most likely to be useful in high risk groups such as those with mental health problems, and recently released Australian clinical guidelines have a guide to available tools.116 The EIGHT questionnaire has been used successfully in general practice settings.129 A simple question as to whether a patient is experiencing problems with their gambling may be as effective as more detailed tools and more appropriate for primary care screening.127 No screening tools have been validated for use with Aboriginal and Torres Strait Islander groups.117 Work is currently being undertaken in New South Wales to develop and test a tool for use with Aboriginal people.130
More research is needed into screening and intervention for adolescents who gamble.131 Most current research has been done in the context of school based interventions.131 Given gambling behaviours begin around 12 or 13 years of age, preventive interventions, such as school based strategies educating young people on basic principles of gambling, should begin before then.123–132 Increasing the awareness of teachers, parents and healthcare professionals in recognising adolescent gambling may assist in the identification of at risk adolescents.122
Reviews and randomised controlled trial evidence around treatment of pathological gambling provide some evidence for the effectiveness of cognitive behaviour therapy.133,134 There is a need for clear local referral pathways and training of staff in Aboriginal and Torres Strait Islander health services to improve the prevention, detection and management of problem gambling.117 Shame and stigma may prevent Aboriginal and Torres Strait Islander people from accessing help for gambling related problems.117
|Preventive intervention type||Who is at risk?||What should be done?||How often?||Level/strength of evidence|
||All people aged >12 years
||Consider asking patients if they participate in gambling activities (eg. ‘pokies’, cards, roulette, blackjack and other table gambling, lotteries, sport associated gambling)
For those who are gambling, screen for problems by asking a simple question such as: ‘Have you ever had an issue with your gambling?’
Specific groups at risk of problem gambling include people with stress related medical problems, mental health issues, substance misuse
|Opportunistic and as part of an annual health assessment
|Young people aged 12–24 years
||Consider screening young people for gambling behaviours as part of general screening tools such as HEEADSSS (see Chapter 3: The health of young people)
|High risk groups such as young people or adults with mental health or substance use problems
||Consider use of a validated measurement tool for problem gambling as part of a community based program (see Resources)
|Children with parents/siblings who are known to have problem gambling
||Assess the impact of family gambling on children
||All people identified with problem gambling
||Management options for problem gambling include:
- brief treatments and motivational interviewing aimed at promoting behaviour change
- cognitive behavioural therapy
- treatment of coexistent and complicating factors such as depression and substance abuse
- referral to gambling support helplines and websites (see Resources)
- referral to gambling treatment centres
||Young people aged from 12 years
||Where appropriate, engage with local school authorities and support implementation of school based gambling prevention strategies
Encourage teachers, parents and healthcare professionals to be more aware of adolescent gambling
||Adopt or support community focused activities (eg. community campaigns) that promote strategies to control gambling and related harms
'Let's talk about gambling' (Aboriginal Health and Medical Research Council)
Gambling Help Online
Counselling, information and support service for problem gambling issues, includes contact details for local face-to-face counselling and support
National problem gambling telephone counselling services
National Problem Gambling Hotline: 1800 858 858
Gamblers Anonymous: 1800 002 210
Problem Gambling Research and Treatment Centre
Guidelines for screening, assessment and treatment in problem gambling
- Productivity Commission. Gambling. Canberra: Australian Government, 2010.
- Hodgins DC, Stea JN, Grant JE. Gambling disorders. Lancet 2011;378(9806):1874–84.
- Problem Gambling Research and Treatment Centre (PGRTC). Guideline for screening, assessment and treatment in problem gambling. Melbourne: Monash University, 2011. Cited January 2012. Available at www.med.monash.edu.au/ assets/docs/sphc/pgrtc/guideline/ problem-gambling-guidelines-web.pdf.
- Aboriginal Health and Medical Research Council. Pressing problems: gambling issues and responses for NSW Aboriginal communities. Sydney: AHMRC, 2007.
- Stevens M, Young M. Betting on the evidence: reported gambling problems among the Indigenous population of the Northern Territory. Aust N Z J Public Health 2009;33(6):556–65.
- Young M, Stevens M, Charles Darwin University. Reported gambling problems in the Indigenous and total Australian population. Melbourne: Gambling Research Australia, 2009. Cited October 2011. Available at www.gamblingresearch.org.au/ home/research/gra+research+reports/reported+gambling+problems +in+the+indigenous+and+total+australian+population
- Delfabbro P, Thrupp L. The social determinants of youth gambling in South Australian adolescents. J Adolesc 2003;26(3):313–30.
- Splevins K, Mireskandari S, Clayton K, Blaszczynski A. Prevalence of adolescent problem gambling, related harms and help-seeking behaviours among an Australian population. J Gambl Stud 2010;26(2):189–204.
- Turchi RM, Derevensky JL. Youth gambling: not a safe bet. Curr Opin Pediatr 2006;18(4):454–8.
- Dickson-Gillespie L, Rugle L, Rosenthal R, Fong T. Preventing the incidence and harm of gambling problems. J Prim Prev 2008;29(1):37–55.
- Independent Pricing and Regulatory Tribunal of New South Wales. Gambling: promotong a culture of responsibility: a final report. Sydney: IPART, 2004. Cited October 2011. Available at www.ipart.nsw.gov.au/ Home/Industries/Other/ Reviews_All/Gambling/Review_of_Gambling_Harm_ Minimisation_Measures/23_Jul_2004_-_Final_Report/Final_Report_-_Gambling_ Promoting_a_Culture_of_Responsibility_-_July_2004.
- Tolchard B, Thomas L, Battersby M. GPs and problem gambling: can they help with identification and early intervention? J Gambl Stud 2007;23(4):499–506.
- Goodyear-Smith F, Arroll B, Kerse N, Sullivan S, Coupe N, Tse S, et al. Primary care patients reporting concerns about their gambling frequently have other co-occurring lifestyle and mental health issues. BMC Fam Pract 2006;7(25).
- Thomas SA, Piterman L, Jackson AC. What do GPs need to know about problem gambling and what should they do about it? Med J Aust 2008;189(3):135–6.
- Sullivan S, Arroll B, Coster G, Abbott M, Adams P. Problem gamblers: do GPs want to intervene? NZ Med J 2000;113(1111):204–7.
- Sullivan S. Development of the ‘EIGHT’ problem gambling screen. Auckland: NZ Auckland Medical School, 1999.
- Aboriginal Health and Medical Research Council. AHMRC submission to the Productivity Commission. Sydney: AHMRC, 2009. Cited October 2011. Available at www.pc.gov.au/__data/assets/pdf_file/ 0009/87597/sub150.pdf.
- Blinn-Pike L, Worthy SL, Jonkman JN. Adolescent gambling: a review of an emerging field of research. J Adolesc Health 2010;47(3):223–36.
- Gray KL, Oakley Browne M, Radha Prabhu V. Systematic review and meta-analysis of studies on early intervention and prevention for problem gambling. Gambling Research Australia, 2007.
- Gooding P, Tarrier N. A systematic review and meta-analysis of cognitive-behavioural interventions to reduce problem gambling: hedging our bets? Behav Res Ther 2009;47(7):592–607.
- Oakley-Browne MA, Adams P, Mobberley PM, editors. Interventions for pathological gambling: a systematic review. 8th International Cochrane Colloquium; Cape Town, South Africa: University of Auckland, 2000.
- Williams RJ, Wood RT, Currie SR. Stacked deck: an effective, school-based program for the prevention of problem gambling. J Prim Prev 2010;31(3):109–25.