Problem Gambling A New Zealand Perspective On Treatment
- Problem Gambling A New Zealand Perspective On Treatment Theory
- Problem Gambling A New Zealand Perspective On Treatment Plan
- Problem Gambling A New Zealand Perspective On Treatment Center
- Problem Gambling A New Zealand Perspective On Treatments
“The key benefit of utilising a public health model is its focus on prevention and early intervention rather than simply treating people in the most severe cases and has the potential to address problem gambling at the grass roots level” (SACOSS 2008). As is highlighted in Korn and Shaffer’s proposed framework for action on gambling (Fig. Bibliography (PDF.1mb) Problem Gambling: A New Zealand Perspective on Treatment Problem gambling is a major social issue and a challenging area of social work practice. This new book explores issues facing those treating problem gambling in New Zealand. The purpose of this article is to provide a perspective on the relationship between gambling behaviors and substance use disorders, review the data regarding health associations and screening and treatment options for problem and pathological gambling, and suggest a role for generalist physicians in assessing problem and pathological gambling. The intervention was trialled in three treatment centres within New Zealand. Results indicate that the inter-vention positively affected several measures of gambling behaviour and self-reported.
Introduction
A substantial change is about to occur in the provision of services for problem gambling services in New Zealand. Legislation (the Gambling Act) that was enacted by September 2003 will move prevention, protection and treatment of problem gambling into the arena of public funding. The Ministry of Health has assumed responsibility for the coordination of problem gambling with responsibility within the Ministry shared between the Mental Health and Public Health Directorates. Funding of services and programmes will be ring-fenced from a levy on the gambling industry, with the amount estimated at $15-20m over the next year. Although this is a substantial increase in available funding, existing specialist problem gambling treatment services will shortly be required to compete for that money. Competition may come from services that provide treatment for alcohol and other drug misuse (AOD), or provide mental health services. In addition, with the redirection towards health promotion, there will be a focus upon early intervention with these services able to offer opportunistic interventions.
Should AOD And Mental Health Services Be Interested?
Many addiction and mental health services may understandably feel that they are already over-provided with clients and too under-resourced to take up a new area of addictive behaviour. Following a recent period of development of competencies, career paths for AOD workers, staff retention difficulties and merger with mental health divisions of District Health Boards, there may not be a strong motivation to complicate matters further with the provision of a new, relatively small health service.
A closer inspection of the opportunity suggests that these services should not be too quick to dismiss the possibility as being without merit. Although problem gambling has a relatively new profile, there is a growing interest in the field that has identified a number of factors that would warrant a further interest of both AOD and mental health services.
Aspects Of Problem Gambling Treatment That Suggest Further Enquiry
A growing problem
Research suggests that the prevalence of problem gambling ranges between 1%-2% of the population for the serious stage of behaviour (the Axis 1 mental health disorder, Pathological Gambling; DSMIV 312.31) (1) with possibly a similar percentage experiencing a sub-clinical degree of gambling problems. This clinical prevalence (1%-2%) may compare with 3%-5% of the population dependent upon alcohol (2). There is strong evidence to support that increased access to gambling correlates positively with the prevalence of problem gambling (3), (as has been demonstrated with alcohol), and whereas the causation question may remain open (4), access to gambling as well as spending on gambling is rapidly increasing both in New Zealand and overseas. This compares with the relatively stable access to alcohol, barring age of access adjustments, and the estimates of the national consumption.
Co-existing alcohol problems
Research indicates that there may be a considerable overlap between problem gambling and alcohol misuse (5). Between 10%-20% of those seeking help for alcohol use problems may also have gambling problems, while between 20%-50% of those seeking help for gambling problems may be experiencing alcohol use problems (6). Clients of these services may not voluntarily disclose these co-existing problems unless an appropriate enquiry is made. If such an enquiry is not made, the client may draw the conclusion that it is irrelevant, and fail (along with their counsellor) to note that slips or relapses occur because of the influence of the untreated problem (7). In New Zealand, gambling licences for intensive gambling modes are generally granted to organisations with liquor licences, with the exception of some TAB’s and Internet gambling. This results in dually addicted clients frequenting environments dangerous to their continued well-being.
Co-existing mental health problems
Once the gambling has progressed to meet the criteria of pathological gambling, many other mental health problems have been found to co-exist. These include depression (25% or more), anxiety (50%), suicidal ideation (estimate 20% of pathological gamblers attempt suicide), other drug misuse (over 10%), and many personality disorders (8) (9). If the problem gambling behaviour is not identified, stressors associated with continued gambling will tend to exacerbate other mental health problems due to stress that results from problematic gambling (10).
This has also been raised in the substantial body of research presented by the Australian Productivity Commission (1999) (3):
“Counselling for problem gambling will need to also deal with these comorbidities, and treatment for other dependencies may need to take into account secondary gambling problems that may not be transparent”
and
“It underlines the complex causality of problems experienced by problem gamblers. Problem gambling may exacerbate other dependencies, and they in turn may exacerbate problem gambling”
Problem Gambling A New Zealand Perspective On Treatment Theory
Co-existing physical health problems
Problem gamblers appear to have poor physical health that may also be attributable to their gambling behaviour. These include peptic ulcer disease, hypertension, cardio-vascular problems, migraines as well as musculo-skeletal problems (11) (12). Loss of sleep is a common side-effect of the gambling behaviour that may also lead to drug and alcohol misuse to enforce sleep.
Social problems
Problem gambling commonly accompanies loss of employment (due to unreliability or dishonesty arising from gambling), family problems, criminal offending, isolating behaviour, and losses of important social and career opportunities. These outcomes can lead to both more intensive gambling (self medicating) and to deterioration in mental and physical health (12).
Positive Aspects Of Intervention In Problem Gambling By AOD/Mental Health Workers
There are many indicators that suggest that interventions by AOD/Mental Health workers are not only appropriate, but highly desirable (13). These include:
- Problem gambling may be intrinsically interwoven with the condition/behaviour that the client is receiving help for. If addressed, this may lessen the primary treated condition while reducing the chance of relapse in the case of alcohol and drug misuse.
- Many of the skills that AOD and Mental Health workers have will be appropriate to intervene in problem gambling. Upskilling is both desirable from a career perspective as well as in the interests of the client.
- Referral completion is a common problem amongst addiction and mental health treatment providers. Providing an enhanced opportunity for the client to utilise the therapeutic connection that they have with their counsellor is a sensible and ‘best practice’ approach.
- Opportunistic screening for a non-presenting condition enables early intervention to be effected, and may avoid the development of other commonly co-existing disorders, such as depression, anxiety and physical problems, that may entrench the conditions and resist treatment if allowed to progress.
- Existing clients with previously unidentified problem gambling behaviour may continue to require substantial resources over extended periods. Research suggests that this is a common situation. Identifying and addressing the problem may result in the client’s improvement. Resources may then be available to other clients.
- As yet there has been no decision as to the devolution of the purchasing of problem gambling services from the Ministry of Health. If this were to occur, District health Boards may assume full responsibility for the provision of these services.
- Financial resources will shortly exist as a result of the Ministry of Health assuming responsibility for this domain. In addition to the beneficial results to core clients from identification and interventions for problem gambling, further funds will be available to treat the gambling aspect of the client’s needs while such funding will be independent of mainstream funding. As the prevalence of the problem is identified, there is a process to meet the financial needs through established hypothecated funding processes.
Conclusion
The advent of the change in both funding and administration of problem gambling is an opportunity for both AOD and mental Health workers to both improve the health of many of their clients and to enhance their range of skills. The outcome is likely to reduce the stress and workload of counsellors through job satisfaction (effectiveness) and targeting previously unidentified factors resulting in clients’ resistance to change (efficiency). The existing structures and previous experience that these organisations have with the new funding authority will place them in good stead to elect and be granted contracts to provide either early intervention or harm reduction for those experiencing gambling problems. That many of these clients will also be experiencing the problems that are the core work of these services are an additional advantage for both the service and the clients. Training is available to provide an interesting and effective additional skill-base for counsellors who have made their career in AOD and Mental Health.
References
(1) American Psychiatric Assn. Diagnostic and statistical manual of mental disorders. 4th Ed. Washington DC:APA, 1994
(2) O’Hagan J, Robinson G, Whiteside E. Alcohol and drug problems: handbook for health professionals. Wellington: ALAC: 1993
(3) Productivity Commission. Australia’s Gambling Industries. Canberra: AusInfo:1999
(4) Shaffer H, Korn D (2002) Gambling and Related Mental Disorders: a Public Health analysis. Annu Rev Public Health 23:171-212
(5) Lesieur H, Rosenthal R (1991) Pathological gambling: a review of the literature (prepared for the American Psychiatric Association task Force on DSM-IV Committee on Disorders of Impulse Not Elsewhere Classified). J Gambling Studies.;7(1):5-39
(6) Sullivan S (1999) Alcohol and Problem Gambling: a hidden partner in dual diagnosis. Australasian Symposium on Professional Education and Training on Alcohol and Other Drugs. (Adelaide). ALAC & NCETA, May 1999.
(7) Sullivan S & Coster G (1997) Case finding, assessment, and brief intervention in problem gambling: a role for General Practitioners. Tenth International Conference on Gambling and Risk-taking (Montreal)
(8) Sullivan S, Arroll B, Coster G, Abbott M (1998) Problem gamblers: a challenge for General Practitioners. NZ Family Physician;25:1:37-42
(9) Sellman D, Adamson S, Robertson P, Sullivan S & Coverdale J (2002) Gambling in mild-moderate alcohol-dependent outpatients. J Substance Use & Misuse 37(2):199-213
(10) Garretsen H, Plant M (1997) Primary prevention and compulsive/problem gambling: the lessons from alcohol. J Substance Abuse:2;121-3.
(11) Pasternak A & Fleming M (1999) Prevalence of gambling disorders in a primary care setting. Archives Family Medicine 8:515-20
(12) Sullivan S The GP ‘Eight’ Screen. Thesis for PhD. Auckland University, Auckland 1999 (Philson Ref W4 S952-1999)
(13) Sullivan S & Penfold A (1999) Taking a gamble with alcohol: problem gambling in an alcohol treatment environment. Cutting Edge ’99 Conference. Christchurch 13-14th August. ALAC & NCTD.
- About problem gambling
- Measures to limit problem gambling
- Regulatory agency roles
- Gambling host responsibility
- Support services for problem gamblers
- Research and other useful resources
About problem gambling
Problem gambling is gambling that causes or may cause harm to an individual, his or her family, or the wider community.Problem gambling is most commonly associated with gaming machines. Approximately two in five regular gamblers on gaming machines experience problems with gambling.
Sometimes the harm may result from just one gambling session. In other cases, it might be the result of regular gambling sessions over a period of time and involving substantial amounts of money.
The harmful effects of problem gambling can include:
- Financial problems
- Problems at work (ranging from poor performance to fraud)
- Poor parenting and other relationship problems
- Family violence
- Alcohol abuse
- Mental health problems
- Suicide.
Measures to limit problem gambling
Problem Gambling A New Zealand Perspective On Treatment Plan
A key intention of the Gambling Act 2003 is controlling the growth of gambling, and preventing and minimising the harm caused by gambling.To support this, the Gambling (Harm Prevention and Minimisation) Regulations, last amended in March 2015, contain a range of measures including:
- Restrictions on venues suitable for operating gaming machines
- No automated teller machines (ATMs) allowed in the gambling area of a venue
- Maximum stake and prize limits for gaming machines
- A feature on each gaming machine which interrupts play at intervals of not more than 30 minutes of continuous play (the messages display information about the duration of play, amount of money spent and net wins or losses)
- Restrictions on jackpot branding and advertising
- Requirement to give venue staff problem gambling awareness training
- Requirement to make information about problem gambling available to patrons
- Ability for venue staff to issue exclusion orders to patrons
Problem gambling levy
Problem gambling services are funded through a levy on gambling operators. The levy is collected from the profits of New Zealand’s four main forms of gambling: gaming machines in pubs and clubs; casinos; the New Zealand Racing Board and the New Zealand Lotteries Commission.The Ministry of Health is responsible for the prevention and treatment of problem gambling, including the funding and co-ordination of problem gambling services.
The current regulations came into force on 1 July 2016.
Problem Gambling A New Zealand Perspective On Treatment Center
The levy rates are payable for the period from 1 July 2016 to 30 June 2019 (inclusive).
Regulatory agency roles
The Department of Internal Affairs administers the gambling legislation (the Gambling Act 2003), licences gambling activities (except for casino gambling) and provides public information and education on gambling harm prevention and minimisation.The Ministry of Health is responsible for funding and coordinating problem gambling services.
Gambling host responsibility
Venues which have gaming machines have a legal duty to minimise gambling harm. Venue staff also have certain responsibilities to keep gamblers safe.Gambling host responsibility has some challenges. It’s important to know what the signs of harmful gambling are and how to check in with gamblers about whether they’re ok.
The Health Promotion Agency, in partnership with the Department of Internal Affairs and the Ministry of Health, have developed a Gamble Host Pack with resources to support venue staff meet their host responsibility requirements. Resources in this pack include:
- Gambling Host Responsibility - Guidance for venue staff
- Gambling Harm Reference Resources
- Everyday Tips for Gambling Hosts
- Posters and Leaflets
- Gambling Harm Logbook Template
Problem gambling awareness training
The Gambling (Harm Prevention and Minimisation) Regulations 2004 require that Class 4 licence holders provide problem gambling awareness training to the venue manager and any other staff, so to ensure there is always a trained person at the venue whenever the pokies are available.It is leading practice that training is available to all staff members who have regular contact with gamblers.
A person who is trained should be able to identify signs of problem gambling, and know how to approach a gambler who is experiencing harm.
The Gamble Host Pack has useful resources to help operators and staff in their problem gambling awareness training. The pack includes a clear checklist of the most common signs of problem gambling and tips of how staff can interact with gamblers they’re concerned about.
The Department can also help operators by providing information about problem gambling awareness training for staff and the legal harm prevention and minimisation requirements. If you’d like more information please contact the Gambling Group.
- See also: Fact Sheet 32: Problem Gambling Awareness Training
Problem Gambling A New Zealand Perspective On Treatments
Signage for pubs, clubs and casinos
All pubs and clubs with gaming machines and casinos must have problem gambling pamphlets and signs in their venues.Regulation 11 of the Gambling (Harm Prevention and Minimisation) Regulations 2004 requires this information to be displayed and available to players.
The Gamble Host Pack includes posters and leaflets to help meet these requirements and can be printed from the links below:
- Harm Minimisation Poster A3 (PDF, 88KB)*
- Harm Minimisation Poster A4 (PDF, 88KB)*
- Harm Minimisation Wallet Leaflet (PDF, 95KB)*
- Harm Minimisation Brochure (PDF, 113KB)*
Support services for problem gamblers
Self Exclusion Orders
If you think you, or someone you know, may have a gambling problem you may like to consider self-excluding (or talking to your relative / friend about self-excluding) from a gambling venue(s).Self-exclusion means that if a patron identifies him or herself as a problem gambler they can ask a gambling venue(s) to exclude them from the gambling area of the venue(s) for a period of up to two years.
Multi Venue Exclusion
Multiple Venue Exclusion (MVE) is an extension to single venue self-exclusion. It allows gamblers to self-exclude from multiple venues without having to visit each individual site.It has been used as an intervention tool in New Zealand since 2004. Since then MVE has evolved and expanded to most parts of the country.
A Multi Venue Exclusion is generally initiated by a problem gambling service provider on behalf of a client who has opted to self-exclude from the gambling venues of their choice. If a gambler requests self-exclusion at a venue, the venue manager must exclude the individual immediately and should help them contact the local MVE coordinator and exclude that gambler from their venue.Once the exclusion process is initiated, it is a criminal offence to breach an exclusion order and a gambler may face a fine of up to $500 (Section 312, Gambling Act 2003).
Failure by a venue manager to prevent an excluded person entering the gambling area or removing them is also a criminal offence. The penalty for venue managers, or a person acting on their behalf, is a maximum fine of $5,000.
To avoid a conviction venue staff need to prove:
- Suitable harm minimisation procedures and measures were in place; and
- The procedures and measures were being implemented.
- Report: Multi Venue Exclusion Recommendations - August 2016 (PDF, 486KB)
- Report: Multi Venue Exclusion Recommendations - August 2016 (.DOCX, 213KB)
Support Services for Problem Gamblers
If you think you or someone you know may have a gambling problem, talking to someone can help. Find a problem gambling service near you.- Contact details for problem gambling services around the country (www.health.govt.nz)
Research and other useful resources
Key facts based on research and other data:AUT problem gambling conference presentation about ensuring that gambling operators maintain an appropriate focus on the safety requirements of the Gambling Act 2003:- International Gambling Conference - The Regulators' Challenge: Looking Forward (22 February 2008) (PPT, 100K)**
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