In the final part of Right Casino’s interview with Dr Mark Griffiths, we turn our attention to the main focus of his research: problem gambling and addiction. Dr Griffiths explains the difference between ‘problem’ gamblers and addicts, points out how addiction figures have been misrepresented in the British media and suggests ways that gambling companies can better protect players.
Right Casino: And finally, let’s talk about obviously the hottest topic in terms of representation of gambling: ‘Problem gambling and addiction.’ Problem gambling has obviously received lots of attention recently, particularly with high profile footballers documenting their latest addiction in the popular media. How do you define problem gambling versus say gambling addiction or gambling compulsion? Could you possibly elaborate on that for me?
Dr Griffiths: I can. The thing is every researcher in the area probably has a different personal definition of what for instance a problem gambling is.
Right Casino: Okay.
Dr Griffiths: When we do research, problem gambling or pathological gambling or addictive gambling is always used as what we call an operational definition. Typically what we have at the moment is there are two particular screens that are used in the British Gambling Prevalence survey. So we use what’s called the diagnostic and statistical manual of the American Psychiatric Association. That currently has nine items and if you endorse four or more of those nine items you are classed as a pathological gambler. If you endorse two or three of those items you’re classed as a problem gambler. If you don’t endorse any items or just one item then you’re basically classed as a non-problem gambler.
In terms of do I think that reliably picks up people who genuinely have problems? There is a lot of debate about that. I think personally if you only score three items out of the nine criteria…I think you can score those three and not necessarily have any major problems in your life. My guess is though if you’re scoring, endorsing five or six of those items.
There would be items like has gambling become the single most important thing in your life? Does it compromise your relationship, your work? Often these are about the consequences of that particular gambling behaviour.
Now me personally, because I work in the areas of gambling addiction, videogame addiction, Internet addiction, sex addiction, workaholism, I use the same criteria across all my work, okay? I basically have six criteria. For me for somebody to be a gambling addict what I would expect is that gambling is the single most important thing in that person’s life and they would do it to neglect almost everything else in their life. They use gambling as a way of consistently and reliably shifting their mood state either to get buzzed up, high, aroused or to do the exact opposite. To tranquilise, to escape, to numb, to de-stress, to relax. I would expect the behaviour to build up over time needing more and more of that activity. It’s what we call tolerance. For gamblers what you tend to find is that over time they gamble with bigger and bigger amounts of money for longer and longer periods. I would expect that they have withdrawal symptoms if they’re unable to gamble. I do mean genuine withdrawal symptoms. So on psychological level I expect people to be moody and irritable if they’re unable to gamble. On a physiological level I’d expect them to have nausea, hand sweats, stomach cramps, anxiety attacks. All the kinds of things you’ll find with other more traditional withdrawal symptoms.
The most important thing is something that I call conflict and what I mean by here is that this activity is so conflicting in this person’s life it compromises their relationships, their jobs, their hobbies. They basically do this activity to the neglect of everything else, okay? Even to the point of they experience what I can intra-psychic conflict. Conflict within themselves. They know that they are doing this -activity too much. They know they should probably cut down and stop but they feel unable to do so and they experience a subjective loss of control.
Finally we’ve got relapse is that people have managed to give up gambling for two days, two weeks, two months, even two years is that once if they start doing it again they quickly get back into the cycle they were in before.
For me there are six components there. Salience, mood modification, tolerance, withdrawal, conflict, and relapse. If I find a person and I don’t care whether the behaviour is gambling, videogame playing, sex, work. If those six components are there I would operationally define that person as addicted to that activity.
Now the thing about the British Gambling Prevalence survey that we do the number of people that endorse each of those six because those six items are actually embedded within the questions that we use in the British Gambling Prevalence survey. Typically the number of people, so we take the British Gambling Prevalence survey, we typically survey between eight and nine and a half thousand people. In that we typically find that maybe just under 1% have a problem with their gambling. That equates to about sixty people out of – only sixty people out of all the people we’ve surveyed have got a gambling problem, okay?
Now out of those sixty the number out of those sixty people that fulfil what I consider to be the six basic criteria to class them as an addict maybe just a handful. Maybe four or five. The problem is and it’s the way that these things are often reported. The media will say the British Gambling Prevalence survey is just come out. It’s found that 0.9% of people were classed as a problem gambler using what was then the DSM formal criteria and they interpret that as just under 1% have a gambling addiction. What I was saying before is that all gambling addicts are problem gamblers but not all problem gamblers are addicts. There’s a very different distinction.
And also people talk about compulsive gambling. Well compulsive gambling technically means is that you engage in gambling but you don’t want to. You have a compulsive need to do it but you don’t actually want to do it. I can tell you now that most addicted gamblers they do want to gamble. There’s no compulsion to it. They really love gambling and they want to gamble. The thing is compulsive gambling, addictive gambling, problem gambling and even so called pathological gambling these are all different things and you could line fifty psychologists up in a room and we’ll all give you a slightly different definition of what it is to be pathological, to be addicted, to be compulsive, or have a problem.
To me a problem gambler is anybody who says they have a problem with their gambling. If they say I’m a problem gambler because I spend too much money that is problem gambling. Now that’s not a very good criterion in terms of how does this affect somebody’s life, but that’s not to take away the person’s own perception is they have a problem with it. If they say well I have a problem with this because my work productivity is down because I gamble too much. That could be a problem gambler but overall it may not affect their life that much here or there.
That’s why I think the rates that we have for problem gambling because in the last survey there were ten criteria then that have changed now since the last survey. There were ten criteria and you had to score five or more to be a pathological gambler, three or four to be a problem gambler. Now the number of people scoring five or more was infinitesimally small. I think we had maybe four or five individuals that classed as a pathological gambler and they really would be somebody that would equate to a gambling addict. But most people where problem gamblers only scoring endorsing three or four items.
Right Casino: Given these figures do you feel that the issue of problem gambling is overstated? And also following on from that to say I understand that the gambling prevalence survey has been cancelled this year?
Dr Griffiths: It’s been – it’s not just been cancelled this year. It’s cancelled full stop at the moment.
Right Casino: Oh okay, can you explain why?
Dr Griffiths: Well I think they think that the Gambling Commission runs their own omnibus surveys that go every month and to be honest what comes out in those is they sample a thousand people. The results aren’t that different from what we find in the National Gambling Survey. Really it’s just about saving money. It’s not to say there won’t be another one in the future. They typically happen once every four or five years. We had one in ’99, one in 2007, one in 2011. So I mean I hope there’s another in the future.
But to be honest the biggest difference we have between the current survey and the previous one is there was a 50% increase in problem gambling. Now obviously the report itself and I was one of the co-authors of that report, we were told very specifically by the Gambling Commission that we weren’t to speculate why that increase might have happened. I personally think that the biggest noticeable increase between the 2007 survey and the 2011 was the fact that advertising came in 2007, September 2007. That’s the biggest noticeable difference plus of course more opportunities to gamble online and remotely. So those two things I think probably accounted.
Now if you’re saying should we be worried? The answer is that just under 1% of British adults still equates to around half a million people and if half a million people truly have a gambling problem that’s something that society should be concerned about. Now we can argue ‘til the cows come home whether it’s half a per cent, 0.8%, 1.2%. To me that’s irrelevant. The bottom line out and I get calls every week, emails every week from people where gambling has just destroyed their lives. For them it’s as real as somebody addicted to drugs and alcohol. I work at the Coalface and I did something very naughty a number of years ago because the Slot Machine Association told me that there was - this was a long time ago. This is going back to the mid-90s. They told me that there was no evidence that gambling caused any problems whatsoever and that we didn’t need a gambling helpline at all. Every person that basically contacted me I gave them BACTOR’s number. I said here’s the helpline even though it wasn’t. Then they rang me and said why are you keep sending all these problem gamblers to us? I said you told me there wasn’t any.
Anyway, but what happened was shortly after that we formed GamCare and now we do have a national telephone helpline. We get over fifty thousand and calls a year to that. To me that’s not an insignificant problem that we can sweep under the carpet. That’s not to say that every one of those are addicted to gambling because my guess is not but obviously it’s causing problems for people. It’s often we get the wives of husbands or parents of children, well adolescents who have problems.
So it’s something that we should be concerned about but I think the good news is internationally we have one of the lowest gambling prevalence rates amongst adults in the world. Unfortunately we have one of the highest adolescent gambling rates in the world. Although as I say the good news it is coming down.
Right Casino: We’ve talked a lot about the individual impact of problem gambling, a loosely defined term and individual responsibility in regulating one’s own gambling practices. But to what extent does society at large bear the brunt of gambling addiction? Presumably it’s very different from say alcohol addiction, which is associated with high medical costs and a noticeable strain on the penal system. Is gambling addition more or less carried by individuals rather than by the rest of society?
Dr Griffiths: I would say that often a lot of gambling problems do result in lots of – I can tell you now that gambling is associated with lots of criminal consequences. I certainly know in terms of medical consequences. The thing is though you don’t report to treatment saying, ‘I’ve got a gambling problem.’ It might be that I’m severely depressed or I’m highly anxious and it’s gambling that’s causing those problems. That’s not what’s down on the doctor’s sheet of what you’re being treated for.
Yes obviously gambling is unlike say other drugs in the sense that people don’t overdose on gambling. But having said that I’ve written a number of – I wrote the British Medical Association’s kind of opinion document on problem gambling in this country. I’ve written articles and editorials to the British Medical Journal arguing that gambling is a health issue for those it affects.
Now often it can be because of the consequences of financial ruin in terms of people feeling suicidal, people feeling panic attacks, anxiety attacks, depression. These are all things that are genuine being caused by gambling problems. I don’t see why – people seem to think that the attitude that the people I speak to say well, they’ve caused it themselves. How is that different from someone who goes skiing and breaks their leg?
The point is you’ve put yourself in a position where something medically has gone wrong because you are in a high-risk situation. We still treat smokers for cancer. We still alcoholics. You could argue all those are self-inflicted to some extent but there does seem to be this kind of difference between people’s perceptions of gambling compared to other types of potential addictive activity. But I would argue that there are costs to the criminal system, to the heath system but most of them just go unnoticed because they’re classed as something else.
Again, I was just going to say I’ve written loads of articles for legal magazines etc. and I’ve appeared in courts a number of a times on the behalf of individuals who have a gambling problem. One of the things that comes through there is if you’re in court and you say I did this because I had an alcohol problem or I did this because I have a gambling problem. Saying you have an alcohol problem gets you a lighter sentence.
So again if people have got co-dependency and we often find that gamblers sometimes have problems with alcohol and nicotine and other things. If you present it in that criminal situation that it’s something that basically a judge or a jury understands is that you’re given more leniency than if it’s to do with gambling. Again that’s the idea that sometimes it’s a hidden addiction is that because it’s not – it has been medically recognised now but still in a court situation it doesn’t get the same kind of weight as if you’ve got another addictive type of problem.
Right Casino: Okay. Just to finish, in your writings you say that operators should pursue cutting edge protocols to ensure player protection. Could you briefly outline your vision for a fair, socially responsible and sustainable gambling industry?
Dr Griffiths: Well I don’t know whether my vision is sustainable. I’ve researched this area for so long now and I started talking about responsible gambling back in the mid-1990s and people hadn’t even heard of this. Didn’t even know the words responsible gambling or social responsibility within the gambling industry.
Now of course you can’t get an operating license unless you’re showing, at least in this country unless you’re showing what you’re doing in terms of being socially responsible in terms of player protection and harm minimisation.
I’ve spent much of my recent research trying to advocate there are things that operators can do to help players make informed choices. They can help players that get into trouble. You can help players not into trouble but give them the kind of what I call a kind of seatbelt approach by allowing them to set limits or temporarily exclude themselves from a gambling situation. Basically to empower people – basically to get people to pre-commit about how much they want to gamble in terms of time and money.
We’ve now got the technology of course particularly through with online we’ve got behavioural tracking data. We can actually do that offline. We’ve got now a couple of countries, Norway and Sweden both introduced player cards, which means that any form of gambling activity they do they have to show the player card. Basically it logs everything that you do. Through behavioural tracking I know it’s kind of Big Brother-ish but it’s there. Once gamblers realise it’s there to actually protect them and to hopefully intervene when people are getting into trouble.
Now in this country we just don’t - the idea of an ID card is not something that’s very popular. My guess is if we tried to introduce the player card here straightaway that just wouldn’t happen. We have to do things in stages. I think what’s happening now is that every sector in this country has its own kind of code of conduct in terms of what they should do in terms of either terms of game design.
For instance one of the products that I developed is that we have over thirty companies worldwide using it. A tool called Gam Guard. This basically assesses the riskiness of a game based on the structural characteristics that have been designed into that game. So companies have a basically a traffic light system. It would be the red, yellow, or green about whether that product they’re going to put out in the market is likely to be problematic to a risky or vulnerable susceptible individual. Companies can then make a decision about whether they want to change the characteristics, if you like to make it safer. Whether they want to still introduce it but decide they’re not going to market it heavily or they’re only going to put it into a dedicated gambling environment or whatever.
Companies in terms of game design can be socially responsible. They can be socially responsible in terms of how they protect their customers. So if a customer comes to them and says I think I’m developing a problem. What do I do? They should have referral through to known gambling treatment or counselling services. If a gambler comes to them and says I want to not gamble for this next month. Can you exclude me? They should either temporary or permanent exclusion should be given to the gamblers without any fuss at all. If people want to set limits it’s harder to do it offline but you could do it certainly with player cards. But online for instance now we’ve got loads of companies using limit setting in terms of initial deposit amounts, in terms of how much money they want to lose either per day, per month, over a year. We’ve got time limit.
And the great thing is we’ve just done some research and we got a player database of over a million online gamblers. We found that these limit setting features do work with the people that most need them i.e. the most gaming intense people.
So really, a lot of it is kind of common sense but obviously what you don’t want to do is be so heavy handed that it stops people who have no problems whatsoever engaging in the activity. That’s the balance you have to kind of weigh up.
But to be honest now I think jurisdictions all around the world, Australia , New Zealand, Canada, here in Britain, other European countries, to get an operating license people will just have to do this as the norm. And if people want to gamble they’re going to have to expect – just as the way we get into a car and there are seatbelts, airbags and whatever. All these tools they are there hopefully that you never use but should that situation arise that you reach a crisis point they all come into fruition.
That’s the analogy that I have is that when we were told in 1974 by Jimmy Saviile to clunk click every trip; it’s taken twenty years. I can’t think apart from ironically taxi drivers, people that just don’t put their seatbelts on as soon as they get into the car. It’s become second nature. I think responsible gambling features and measures and protocols, the more you introduce and the more you just make it part of the experience people will just come to accept it. It’s going to take time. It won’t happen overnight.
Things are starting to happen already and people probably don’t even know it. But yes, for me we’re not there yet but I think we’ve come a great way. It’s been radically shifted. Last ten years to come from a situation where no company was really talking about responsible gambling to every major company now having a code of conduct and a whole set of things they have to do.
The lottery sector they now have a whole accreditation program now around levels of social responsibility. It’s on four levels and of course all the major companies are trying to get to level four. I think we’ve got ten companies in the world that have reached level four in terms of protecting its customers. I would hope that would be shifted across to other sectors.
Right Casino: Thank you very much Dr Griffiths.
Dr Griffiths: Pleasure!