addressing problem gambling: lessons from elsewhere

1. Addressing Problem Gambling: Lessons from elsewhere Prof Peter Collins University of Salford and Director of the South African National Responsible Gambling Programme

3. Overview Some remarks about the peculiarity of the gambling industry in relation to other industry where there are problems of excessive consumption, as exemplified by the Prevalence study and reactions to it Some detailed info about the jurisdiction I know best, viz South Africa which is certainly not perfect, which has many problems we don�t have but nevertheless may suggest to you important lessons for us. (Because there�s a lot of data here, This presentation will be put on the Salford website at www.gamblingstudies.salford.ac.uk Some concluding suggestions

4. Some Reactions to the Prevalence Study Problem (excessive and/or compulsive) gambling causes misery quite as severe as any of the other �problem� behaviours to the individuals who are affected by it and we should all seek to minimise this harm �But Whatever else the highly conscientious 2007 UK prevalence study shows, it shows that there is more cause for relief than alarm for all who genuinely want a world in which less suffering is caused by problem gambling: out of 9 000 people surveyed 54 (I think) answered �yes� to three or more DSM IV questions for past year problems It would be helpful to know how many of these 9 000 were regular smokers and how many had drunk (how much) more than four units of alcohol during the past week. I would be astonished if the numbers were not much higher and if the harm which constitutes the individual and social costs were not measurably much greater

5. Some Implications of the UK Prevalence Study, 2007 All this suggests that problem gambling ought to be manageable (unlike, say, drugs) Certainly, these figures provide no evidence that the government has been reckless in its gambling policy and that, had it authorised the 24 casinos it originally wanted to licence it would have launched the kind of epidemic of problem gambling which its opponents predicted. Indeed, I have always maintained that it would be likely not merely not to increase problem gambling but would be likely to reduce it. Nor do the PS 2007 findings contradict findings in other jurisdictions where comparable studies have taken place So why is nobody proclaiming this apparently obvious good news when previously they were content to pontificate on the basis of very flimsy and frankly dishonest evidence about the massive increase in problem gambling which was already taking place and which was certain to get worse? Now the watchword (including my own) is �Let�s not get complacent� rather than let�s now try to �make problem gambling history�, i.e. reduce its incidence to an extremely rare occurrence as we have with other diseases and social problems.

6. Why is problem gambling peculiar? Public debate about problem gambling is peculiar and peculiarly distorted, not to say dishonest, because the public is ambivalent about moral status of gambling itself. Is it like the theatre which used to be thought sinful but is now just a normal part of entertainment (and should be freely available) or is it like taking drugs (something that is profoundly immoral even when it does not lead to addiction or other problems of over-consumption, and should be as far as possible prohibited)? Those who say it�s like the theatre, mainly the industry, in alliance with libertarians, know that their vulnerability relates to the issue of problem gambling and addiction and therefore are tempted to spin any numbers as being reassuringly low Those who say it�s like taking drugs know that the prohibitionist case depends on generating alarm about PG and addiction rather than moral and religious disapproval. They, therefore, tend to spin any PG numbers as being appallingly high

7. Problem Gambling, Votes and Profits What is, frankly, mainly at issue in public controversies about problem gamblers is not a massive concern about a public heath issue but competing sectional self-interest Politicians who like gambling taxes, and possibly believe in freedom of choice as well, know that they have a vital interest in appearing very hard-line on problem gambling. Otherwise they risk losing votes and being pilloried for their immorality and irresponsibility Industry executives know very well that their profits are overwhelmingly determined by the restrictions which governments impose on them and on their competitors. They also know that what political restrictions are imposed is determined by public opinion; and what shapes public opinion is perceptions about problem gambling. Everybody therefore commits, with exceptional solemnity, to rigorous regulations and vigorous programmes to combat problem gambling, though how effective any of this is, we mostly don�t know � mainly because we don�t know how many people would have recovered anyway (without treatment) and how many would have developed a problem but for our efforts at prevention

8. So what really matters? The numbers in themselves tell one almost nothing. Suppose there are 2 million problem gamblers instead of the now alleged quarter million. What would that tell us to do differently? Or suppose the number is only 50 000. What difference does that make? The really depressing statistic concerns how few of those who could benefit from help actually seek it or even know of its availability What matters, therefore, is to ensure that as many people as possible learn how to avoid doing serious damage to themselves and those close to them by gambling too much and that those who develop problems are made aware, and encouraged to make use, of the expert, confidential help that is available free of charge The above is a slight amplification of the mission statement of practically every organisation concerned with problem gambling (incl RIGT and GamCare to which I shall return) as well as of the South African National Responsible Gambling Programme to which I now turn.

9. SANRGP Stats Mar 06-Feb 07: Counselling line Estimate of PGs in SA = 250k+ Total people helped (PGs, Fam and Friends) = 3387 - Referrals to F2F counselling = 45%+/- - Telephone counselling = 10%+/- - Info about problem gambling = 45%+/- High severity and/ or other serious problems = 50%+/- (Top 2 on 5-point scale, and/or co-dependence, co-morbidity, suicidal ideation � 10%+/- each) Sources of knowledge about counselling line: Material in venues = 53%; Media = 37%, Other = 10%.

10. SANRGP Stats Mar 06-Feb 07: Treatment Referrals: 87% = new out-patients; 10% = relapsed out-patients; 3% = (Subsidised in-patients) Outpatient (6-9 session customised programme): 1577 = Referred; 1179=1st Appt made; 957 = 1st appt kept; 402= complete course; 80% = report success 6 and 12 months later

11. SANRGP Stats Mar 06-Feb 07:Public Awareness 60 Ads in Print media 25 radio spots 10 TV slots Brochures designed (but paid for by companies) for all gambling venues Brochures distributed at �all-pay� points (welfare offices) etc 200 interviews given, politicians briefed, conferences addressed etc

12. Industry Training Annual Visits by NRGP trainers to all casino staff (70% of SA Market) Video material prepared for non casino staff Covers basic policy and law; basic psychology of normal and problem gambling; appropriate in-house policies including signage, self-exclusion; appropriate responses by staff to requests for help and to symptomatic or out-of-control behaviour.

13. SANRGP Stats Mar 06-Feb 07: Research Write-up (not data-gathering) of Prevalence study of 3000 adults (showing a decrease in problem gambling over 2003) Study of gambling amongst residents in poorest, urban areas Study of Gambling amongst youth Review of the research literature from around the world on the neuroscience of gambling and problem gambling (Ross et al. Midbrain Revolt In press with MIT Press. Boston. USA)

14. SA NRGP Schools Programme Start of three year project to integrate gambling education into the life skills curriculum in all SA schools at grades 7-9 and 10-12. Development of material to be available on the web, via interactive CD-Rom and in print form to all schools in the country including, in addition to education about gambling, reinforcement of learning about other high-risk behaviours, money and debt management skills, additional maths including probabilities, percentages and compound interest Encouragement of debate about ethics of gambling, whether gambling should be banned, how it should be taxed etc

15. Approximate Costs Counselling line = R1.5m F2F = R 2.m Advertising = R 3m Brochures etc = R 0.5m PR = R 0.5m Research = R 2m Industry Training = R 0.5m Nat Schools Prog = R 0.5m Management/Admin = R1.5m Overheads (rent, travel, prof fees, phones etc =R1.0m Total =R13m, i.e.. Just over �1m at the then prevailing exchange rate

16. Organisation A Trust composed of four regulators and four elected industry managers, chaired by a one-time professor, chair of the SABC and now executive chair of Billiton SA has oversight of all the activities of the NRGP They issue contracts to service providers in different areas specifying deliverables with dates, human and material resource implications (including who�s paid what, for what and on what basis) and evaluation procedures. They then meet quarterly to receive reports from the service providers about whether the deliverables have been delivered as per contract and budget They are also all expected to serve NOT as representatives of interest groups but as people with special expertise to contribute to furthering the aims of the Trust by reducing the harm caused by problem gambling They have an administrator who collects revenues from industry according to agreed formulae and distributes them to service providers as per contracts. The administrator also services the Trust in all other respects. The Chair and the Administrator receive modest emoluments. The Trust liaises with the National Gambling Board and the Department of Trade and Industry, the Parliamentary Portfolio Committee and occasionally with the President�s office about all matters to do with problem gambling.

17. Measures of success for problem gamblers A regrettably small but still significant number of problem gamblers and their families have been helped who might otherwise still be suffering all the miseries of excessive and compulsive gambling Hopefully, some people have absorbed some important consumer education lessons about gambling, about how to recognise problem gambling and about where to get free, confidential and expert help if they do develop problems SA researchers are participating in cutting edge, international addiction research and making the results of honest science readily accessible to treatment and prevention professionals, politicians, regulators, industry professionals, the media and other interested parties SA will over the next two years have a unique distance learning schools programme in place for all SA schools Industry staff now know that they have to be, and be seen to be in the business of providing harmless entertainment responsibly and not ruthlessly ruining lives by exploiting human frailty Problem gambling numbers have come down.

18. Measures of Success for Industry Politicians and Regulators There have been very few anti-gambling stories in the media despite all the same ingredients being present for their generation � sensationalist journalists, anti-gambling lobby, opportunistic politicians etc � Despite the passage of two further gambling amendment acts subsequent to the establishment of the NRGP all damaging but pointless proposals to curb industry�s profitability in the alleged interests of problem gamblers have been dropped Politicians have secured substantial benefits in taxes, job creation, investment etc without incurring the criticism of living off immoral earnings The SA national Lottery which refused to participate in the NRGP has collapsed

19. Why is SA so cheap? Lower costs of labour, space etc. Therefore multiply by 3 = �3m Everyone is (well-)paid but by the hour: their time is bought out from their day jobs The NRGP has very low management, administration and space costs The total costs of running the Trust including travel are about �50 000.

20. Lessons for the UK Not everything is directly comparable and certainly not all comparisons favour SA. But there is self-evidently a massive shortfall between what happens in SA and what we deliver here and what we spend here, as those of you who have been to SA acknowledge The pluses are that thanks mainly to GamCare, as funded by RIGT, we match and can hope to outperform the South Africans on treatment and industry training. Gordon House has no equivalent in SA. RIGT and the GC are also helping us to participate in cutting edge, international research but we are poor at disseminating that research in accessible form to those who need it in politics, the industry and the media and we are very weak on public awareness Above all we deliver poor value for money We also spend far too much time competing amongst ourselves instead of collaborating constructively to further the common interests of problem gamblers as well as our own. This dissipates time, energy, money and goodwill all of which could be put to much better use.

21. What�s the Problem? The problem is not personal: it is structural It centres on the question of what ought to be the relationship between RIGT and the industry, the Gambling Commission, DCMS and the service providers At present RIGT is in the impossible position of being formally a creation and therefore a servant of the industry but also being thought of, and perhaps thinking of itself as, a quasi-quango which the Government has created to be its problem gambling Czar The auguries from the drug world are not auspicious for such a Czardom but in any case a quasi-Czardom is clearly untenable

22. Some Specific Difficulties RIGT irt GamCare and Gordon House. You cannot have three bodies, with three Boards of Trustees, three CEOs, three sets of staff, all with essentially the same mission statement, especially when two are staffed by problem gambling specialists and the other is not, but the one that is not funds the ones that are. This is a recipe for chaos, conflict and acrimony. If RIGT is expected to supplement the work of the GC it can no longer be the servant of the industry. It must become an official division of the GC in which case it would no longer be funded voluntarily and would no longer be an independent charitable Trust: it would, therefore need a different membership. Other problems relate to whether the practical research needs of government and industry in this area might not better be served by contracting directly with researchers rather than going via the ESR. Much such research is already directly contracted. Finally what we most need, I think, is an effective public awareness campaign which would cost, I estimate, �1-2m. Who is to design and deliver this and what kind of say will different stake-holders have regarding its content?

23. What�s the Answer I fear we have to go back to the drawing board and rethink exactly who is to be responsible for what. I strongly commend the idea of having a coherent and comprehensive NRGP of the sort I have described I also strongly recommend the kind of organisational structure and the revisiting of the recommendations about management as drafted by Prof Glen Arnold and myself in the original report prepared for GICT in 2003 I also recommend revisiting some of the other recommendations in that report An implication of this may be that organisations like GamCare in particular may need to cease to be charities and to become professional service-providing businesses, albeit not-for-profit ones.