1. Gambling Harm Reduction: Are You Serious?
Jim Orford
School of Psychology, University of Birmingham, UK
Gambling Watch UK
Harm Minimisation in Gambling Conference
Responsible Gambling Trust, London, December 11th 2013

2. Forms of harm from gambling
Form of harm
Harm to individuals who gamble
A continuum of risky and harmful gambling
Harm to their family members
Financial, relational and emotional harm
Harm to the community
Harm to the quality of the high street, financial drain, community health affected
Harm to society
Normalisation of gambling, risks to young people, contributes to inequality

3. PGSI score 0 Non-problem gambler PGSI score 1-2 At risk (low)
The gambling risk/harm continuum according to the Canadian Problem Gambling Severity Index (PGSI)
PGSI score 0 Non-problem gambler
PGSI score 1-2 At risk (low)
PGSI score 3-7 At risk (moderate )
PGSI score 8 plus Problem gambler

4. The gambling control continuum according to Dickerson and O’Connor, Gambling as an Addictive Behaviour, Cambridge University Press, 2006
Never strong impulses, no problems
Sometimes strong impulses, easily resisted, no problems
Sometimes strong impulses, can resist with effort, no problems
Often strong impulses, difficult to resist, few minor problems
Strong impulses, difficult but not impossible to resist, several problems
Frequent strong impulses, impossible to resist, several significant distressing problems

5. Natasha Schüll, Addiction by Design: Machine Gambling in Las Vegas (2012, Princeton University Press)
By the mid-1990s, the gambling industry had already grasped... that a medical diagnosis linked to the excessive consumption of its product by some individuals could serve to deflect attention away from the product's potentially problematic role in promoting that consumption, and onto the biological and psychological vulnerabilities of a small minority of its customers (page 261).

6. Martin Young, Statistics, scapegoats and social control: A critique of pathological gambling prevalence research, Addiction Research and Theory, 2013, 21, pp.1-11
… the industry is dependent on the pathological gambler to … absolve itself from the harm it produces…
… problem gambling prevalence surveys… construct and mobilise the pathological gambler as the object of policy and intervention

7. Forms of harm from gambling
Form of harm
Harm to individuals who gamble
A continuum of risky and harmful gambling
Harm to their family members
Financial, relational and emotional harm
Harm to the community
Harm to the quality of the high street, financial drain, community health affected
Harm to society
Normalisation of gambling, risks to young people, contributes to inequality

8. Affected family members: a group with no voice
‘It is the nature of emotional disorders that when one member of the family is afflicted, the effects are felt by all the others. There are few, however, in which the impact is felt with such severity as in the case of compulsive gambling’ (When Luck Runs Out, Custer & Milt, 1985).
‘… we have had a monster living with our family – a monster in the shape of a fruit-machine. Practically every penny my husband earned went into that machine’ (a wife cited by Barker & Miller, 1968).

9. Forms of harm from gambling
Form of harm
Harm to individuals who gamble
A continuum of risky and harmful gambling
Harm to their family members
Financial, relational and emotional harm
Harm to the community
Harm to the quality of the high street, financial drain, community health affected
Harm to society
Normalisation of gambling, risks to young people, contributes to inequality

10. A sample of British attitudes towards gambling in 2010 (percent agree or disagree)

11. Types of gambling harm reduction measures
Reduce gambling by reducing demand
Reduce gambling by reducing supply
Harm reduction that does not require a reduction in gambling
Education campaigns
Limit availability
Reduce criminality by legalisation
Controls on advertising
Limit accessibility
Help for affected family members
Player-centred e.g. pre-commitment, self-exclusion
Modify gambling features
On-site crisis intervention

12. Three types of evidence (Glasby, 2011) and their relevance to High Stake-High Prize Electronic Gambling Machines (HS-HP EGMs) such as Fixed Odds Betting Terminals (FOBTs)
Theoretical evidence
HS-HP EGMs have features that would lead us to expect them to have high harm potential
Experiential evidence
Gamblers and their family members are telling us that HS-HP EGMs are causing particular harm
Empirical evidence
Evidence from the 2007 and 2010 BGPSs support the conclusion that HS-HP EGMs are specially harmful

13. Gross Gambling Yield (GGY) from some different forms of British Gambling and losses attributable to People with Gambling Problems (PGPs) 2010
GGY % of losses amount of losses
£m from PGPs from PGPs £m
FOBTs in betting shops 1,
Table games in casinos
Betting on dog races
Betting on horse races
Slot machines in arcades
Football pools
Bingo

14. Models of the evidence and policy relationship (Monaghan, Evidence versus politics, The Policy Press, 2011)
Linear or rational model: a linear process from defining a problem to identifying missing knowledge to acquiring research, interpreting it and then making a policy choice
Enlightenment model: a process of 'indirect diffusion' whereby an entire body of research or evidence, accumulating over time, sensitises policymakers to new issues
Evolutionary model: 'survival of the fittest': ideas that fit the interests of powerful groups will be picked up and those that do not, will not
Political or tactical model: new research is unlikely to have a bearing on predetermined positions allied to various interests and political ideologies
Interactive, dialogic or processual models: concepts and therefore knowledge are inherently contested and meaning emerges from negotiation and dialogue between relevant constituents

15. Two contrasting policy perspectives
Gambling is seen as an ordinary entertainment product
In Government, the department responsible for Culture and Sport should take the lead
The industry should sit at the policy table and fund prevention, treatment and research (PT&R)
Gambling is seen as a commodity dangerous to health
In Government, the department responsible for Health should take the lead
Policy formation should be independent of the industry and PT&R should be funded by government

16. Dr Margaret Chan, Director General World Health Organization, Doctors and the alcohol industry: an unhealthy mix? British Medical Journal, 2013
In the view of WHO, the alcohol industry has no role in the formulation of alcohol policies, which must be protected from distortion by commercial or vested interests.

17. Responsible Gambling Strategy Board Strategy 2012
… whether bespoke harm-prevention measures might be effective… player-centred measures tailored to a gambler’s actual machine play… in contrast to the current across-the board regulatory controls, such as limits to stakes and prizes and number and location of gaming machines (para 49)
… wider societal risks… recession… low income groups… important contextual considerations… probably too broad and complex to prioritise for research (para 52)