New Trends in Gambling New Trends in Gambling ResearchResearch

Christine ReillyChristine Reilly

Institute for Research on Pathological Institute for Research on Pathological Gambling and Related DisordersGambling and Related Disorders

Division on AddictionsDivision on Addictions

Cambridge Health Alliance, affiliate of Harvard Medical Cambridge Health Alliance, affiliate of Harvard Medical SchoolSchool

Explosion of KnowledgeExplosion of Knowledge

1/3 of all knowledge 1/3 of all knowledge about gambling about gambling published 1999-2003published 1999-2003

Much of what we know Much of what we know has been learned only has been learned only in the past few yearsin the past few years

Findings have Findings have challenged challenged conventional wisdomconventional wisdom

Research TrendsResearch Trends Population StudiesPopulation Studies

– Trajectory dynamic, not staticTrajectory dynamic, not static– Transition to adulthood Transition to adulthood – Natural recovery Natural recovery – Similarity of international prevalence Similarity of international prevalence

ratesrates GeneticsGenetics Drug TreatmentsDrug Treatments

Trajectory of gambling Trajectory of gambling disordersdisorders

Conventional wisdomConventional wisdom– Gambling addiction chronic, progressiveGambling addiction chronic, progressive

Research indicatesResearch indicates– DynamicDynamic– Episodic rather than chronicEpisodic rather than chronic– Moving toward healthMoving toward health

From adolescence to From adolescence to adulthoodadulthood

Longitudinal study by Winters, Stinchfield, Longitudinal study by Winters, Stinchfield, Botzet, & Slutske (2005)Botzet, & Slutske (2005)

Gambling problem progression during Gambling problem progression during adolescence dynamicadolescence dynamic

No evidence of automatic progression to most No evidence of automatic progression to most disordered statedisordered state

No evidence that increased gambling in No evidence that increased gambling in Minnesota triggered increase in PG among Minnesota triggered increase in PG among youthyouth

Demonstrates importance of longitudinal Demonstrates importance of longitudinal studiesstudies

Natural RecoveryNatural Recovery

Conventional wisdomConventional wisdom– People with gambling addiction need People with gambling addiction need

treatment or self-help groups to recovertreatment or self-help groups to recover New Research – University of Missouri New Research – University of Missouri

(Slutske, 2006)(Slutske, 2006)– First empirical evidence for natural First empirical evidence for natural

recoveryrecovery– Analysis of 2 national community surveysAnalysis of 2 national community surveys– Approximately 1/3 got well on their own Approximately 1/3 got well on their own – Similar to other addictive disordersSimilar to other addictive disorders

Adults

U.S. 1979*

U.S. 2001**

Sweden 2001***

Switzerland 2000

New Zealand 2001

British 2000

South Africa 2001

Norway 2003

Hong Kong

2002 LEVEL

1

97.05 96.75

98.00 97.00 98.7 99.3 -- 99.3 94.1

LEVEL

2

2.2 2.2 1.4 2.2 0.8 -- -- 0.5 4

LEVEL

3

0.7 1.1 0.6 0.8 0.5 0.7 1.1/1.4 0.2 1.9

*(Kallick, Suits, Dielman, & Hybels, 1979) **(Shaffer & Hall, 2001) ***(Volberg, Abbott, Ronnberg, & Munck, 2001) (Bondolfi, Osiek, & Ferrero, 2000) (Abbott, 2001) ´ (Sproston, Erens, & Orford, 2000) ™(Collins & Barr, 2001, GA 20 Questions/SOGS estimates) Gotestam, K. G., & Johansson, A. (2003), DSM-IV (Centre for Social Policy Studies of The Department of Applied Social Sciences & The General Education Centre of The Hong Kong Polytechnic University, 2002)

International Prevalence International Prevalence RatesRates

Role of Genetics

Conventional wisdomConventional wisdom– Clinicians have suspected genetic linkClinicians have suspected genetic link

Research now provides evidence for Research now provides evidence for genetic rolegenetic role– University of Iowa study (funded by University of Iowa study (funded by

NCRG)NCRG)– National Institutes of Health National Institutes of Health

Treatment Treatment

No treatment standard yetNo treatment standard yet Promising strategies:Promising strategies:

– Pharmacological interventionsPharmacological interventions– Cognitive Behavioral TherapyCognitive Behavioral Therapy– Brief interventionsBrief interventions

Drug TreatmentsDrug Treatments

Nalmefene study released in 2006Nalmefene study released in 2006– Used for alcohol disordersUsed for alcohol disorders– Largest randomized pharmacotherapy Largest randomized pharmacotherapy

trial for PGtrial for PG– Nalmefene effective for reducing PG Nalmefene effective for reducing PG

symptomssymptoms– Published in Published in American Journal of American Journal of

PsychiatryPsychiatry (Grant, JE, et al., 2006) (Grant, JE, et al., 2006)

Implications for Gaming Implications for Gaming RegulationsRegulations

Understanding of PG shifting constantlyUnderstanding of PG shifting constantly It’s not about the gameIt’s not about the game Responsible gaming policies should be Responsible gaming policies should be

based on empirical not anecdotal evidencebased on empirical not anecdotal evidence Prevalence does not = treatment-seekingPrevalence does not = treatment-seeking Educational materials must be updated Educational materials must be updated

periodicallyperiodically– EMERGE: Executive, Management and EMERGE: Executive, Management and

Employee Responsible Gaming EducationEmployee Responsible Gaming Education Evaluation of prevention and intervention Evaluation of prevention and intervention

programs essential programs essential

How to keep up with How to keep up with researchresearch

Subscribe to the BASISSubscribe to the BASIS– Monthly research report on gambling Monthly research report on gambling

research – The WAGERresearch – The WAGER Contact the Institute (781-306-8604); Contact the Institute (781-306-8604);

christine_reilly@hms.harvard.edu Attend Annual NCRG Conference on Attend Annual NCRG Conference on

Gambling and AddictionGambling and Addiction

7th Annual7th Annual NCRG NCRGConferenceConference

on Gambling & on Gambling & AddictionAddiction

Lost in Translation?Lost in Translation?The Challenge of The Challenge of

TurningTurningGood Research into Good Research into

BestBestPracticesPractices

November 12-14, 2006Las Vegas