The effectiveness of gambling exclusion programs in Queensland Nerilee Hing, Barry Tolchard, Elaine Nuske, Alex Russell This study was funded by a Responsible Gambling Research Grant from the Queensland Department of Justice and Attorney General National Association for Gambling Studies Conference, 26-28 November 2014
Background Gambling operators in QLD: must provide SE procedures have authority but not duty to initiate venue exclusions ~ 5,800 active SEs in QLD Jan-Jun 2013: SEs by 42% hotels, 25% clubs, casinos, Tattsbet SEs by 628 gamblers = 320 (hotels), 171 (casinos), 125 (clubs), 12 (Tattsbet) 5 venue-initiated exclusions
Research objectives Assess the effectiveness of Qld gambling exclusion programs as a mechanism to minimise gambling-related harm Determine whether these effects are sustained over time Assess whether exclusion is more effective when combined with counselling and support
Methods 1. Interviews with peak body reps (N = 4) QHA, Clubs Qld, Tattsbet, Echo 2. Interviews with gambling counsellors (N = 18) Representing all but 1 Qld GHS agencies Client experiences & counsellors professional views on SE 3. Surveys & interviews with 103 problem gamblers Group A: SE + counselling = 34 Group B: SE no counselling = 19 Group C: No SE + counselling = 33 Group D: No SE no counselling = 17 Interviewed and surveyed 3 times about 6 months apart Group D not a valid control at T1 Groups A-C, 78% retained at T2, 59% at T3
Measures Quantitative: SE details if applicable, gambling frequency, expenditure & debt, most problematic form, perceived PG severity, PGSI, Gambling Urge Scale, CAGE, GHQ12, Gambling Consequences Scale, use of professional, non-professional and self-help, demographics Qualitative: Motivators, barriers, experiences during SE process, outcomes, suggested improvements Professional gambling help, whether coincided with, prompted and/or supported SE, reasons for not seeking counselling if applicable Other supports used, how they assisted SE or not What had been most effective
Q1: Does SE minimise gamblingrelated harm? Are effects sustained? Surveys revealed significant improvements: on nearly all outcome measures after SE abstinence, expend., debt, perceived problem, PGSI, urge, general health & harmful consequences occurred soon after SE, by first 6 mths of assessment sustained, on average, for 12 mths of assessment Confirmed by qualitative interviews with excluders: reduced gambling, greater control, strategies to resist urges, reduced stress & anxiety, improved self-esteem & physical health, reduced harms e.g, finances, relationships, work, health, wellbeing Aligns with counsellors general view of SE as an external control which can have immediate benefits while build up internal control
Q2: Does SE minimise gambling harm, more than counselling alone? Improvements after SE do not show that SE causes these improvements Thus, compared outcome measures between: Self-excluders (with and without counselling) Non-excluders (with counselling)
Both excluders and non-excluders significantly improved equally on the following outcomes
Monthly gambling expenditure ($) 2,500 2,361 2,000 1,500 1,477 1,000 771 1,009 987 500 407 0 Non-
Gambling debt ($) 20,000 18,000 16,000 14,000 12,000 10,000 8,000 6,000 4,000 2,000 0 18,636 12,205 7,547 3,249 1,426 300 Non-
Perceived severity of gambling problem (1= not at all, to 10 = extremely severe) 10 9 8 7 6 5 4 3 2 1 0 9 9 5 4 4 3 Non-
Mean PGSI score 20.0 18.0 16.0 14.0 12.0 10.0 8.0 6.0 4.0 2.0 0.0 16.8 17.6 11.5 8.2 5.6 6.8 Non-
Mean gambling urge score 30 25 25 25 20 15 12 12 17 16 10 5 0 Non-
Mean General Health Questionnaire score 30 25 20 15 10 5 15 25 27 27 13 22 0 Non-
% reporting that their gambling had left them with no money to pay for household bills 90 80 70 60 50 40 30 20 10 0 77 60 37 23 26 14 Non-
% reporting that their gambling had made it harder to make money last from one payday (or pension day) to the next 100 90 80 70 60 50 40 30 20 10 0 94 87 40 47 42 24 Non-
% reporting that because of their gambling people close to them had difficulties trusting them 80 70 70 70 60 50 40 30 20 45 21 42 32 10 0 Non-
SE group showed significantly greater improvements on the following outcomes
% of respondents reporting abstaining from most problematic gambling form 60 50 40 30 55 55 20 10 0 9 3 5 5 Non-
% reporting that their gambling had left not enough time to look after family interests 70 66 60 50 40 38 53 42 37 30 20 21 10 0 Non-
% reporting that their gambling had impacted negatively on relationship with children 50 45 40 35 30 25 20 15 10 5 0 47 33 26 15 14 16 Non-
% reporting that their gambling had caused them to put off doing things together 90 80 70 60 50 40 30 20 10 0 79 83 55 58 42 17 Non-
% reporting that their gambling had affected their performance in their work, study or main role 80 70 60 74 60 50 40 30 20 33 21 37 37 10 0 Non-
% reporting that their gambling had caused them to lose time from work, study or main role 80 70 60 68 64 50 40 30 20 10 35 42 28 26 0 Non-
% reporting that their gambling had left them no money to pay their rent or mortgage 70 66 60 50 53 40 30 20 23 14 26 16 10 0 Non-
Q3: Is SE more effective when combined with counselling & other supports? Compared: Excluders who had received counselling Excluders who had not received counselling No significant differences found in any outcome measures for these 2 groups BUT, small numbers Qualitative data suggested counselling with SE had numerous benefits for most who had received counselling
Benefits of counselling with SE Raise awareness, influence decision to, and assist with SE Achieve long-term benefits and relapse prevention through resolving underlying problems Participants found counselling very useful to: understand underlying reasons for gambling address gambling and wider life problems devise practical strategies to control gambling build up internal control. Gamblers overwhelmingly believed that a combination of interventions, supports and self-help was most effective for them, including SE
Summary of findings Q1: Does SE minimise gambling-related harm? Are effects sustained? SE associated with significantly reduced problem gambling symptoms & reduced harmful consequences Most improvements happen quickly & sustained for 12 mths Q2: Does SE minimise gambling harm, more than counselling alone? No for most measures, but evidence that SE increases abstinence from most problematic form & reduces some harmful consequences more than counselling alone, at least in short term Q3: Is SE more effective when combined with counselling & other supports? No evidence from quant. data, but qual. data suggested counselling with SE had numerous benefits
Conclusions Given low rates of professional help-seeking, SE provides an important harm minimisation alternative to counselling with at least short-term benefits for many participants Process evaluation showed that uptake of SE could be vastly improved by facilitating access & lowering barriers More uptake of counselling would assist uptake of SE Providing a wide range of supports important to assist gamblers to access those they find most useful
Limitations & strengths of the study Limitations Modest sample sizes limited analyses Could only compare SE to non-se + counselling Were those retained different from those who dropped out? Self-report, retrospective, social desirability Strengths 1 st independent evaluation Informs potential improvements in SE programs 1 st Aust. longitudinal study of role of SE in harm minimisation And of counselling and other supports as adjuncts to SE Further research Bigger samples, longer timeframes And into multi-venue programs and online SE programs
Hing, N., Tolchard, E., Nuske, E., & Russell, A. (2014). The effectiveness of self-exclusion programs in Queensland. Brisbane: Qld Department of Justice and Attorney-General. nerilee.hing@scu.edu.au