A Systematic Review of Land-Based Self-Exclusion Programs: Demographics, Gambling Behavior, Gambling Problems, Mental Symptoms, and Mental Health

  • Roxana KotterEmail author
  • Anja Kräplin
  • Andre Pittig
  • Gerhard Bühringer
Review Paper


Systematic and quantitative reviews on the effects of land-based self-exclusion are scarce. Therefore, the current review aimed to provide a comprehensive summary of (1) the demographic characteristics of land-based self-excluders and changes after exclusion, including (2) gambling behavior, (3) gambling problems, (4) mental symptoms, and (5) mental health. A systematic database and literature search was performed following PRISMA guidelines. Nineteen naturalistic studies met the eligibility criteria. The quality of all included records was rated via adaption of the Newcastle–Ottawa Scale. Results from higher-quality records were more heavily weighted. Self-excluders were predominantly men in their early or middle forties. Changes after exclusion revealed wide ranges in the rates of abstinence (13–81%), rates of gambling reduction (29–92%), and rates of exclusion breaches (8–59%). The records consistently demonstrated significant changes in pathological gambling from before exclusion (61–95%) to after exclusion (13–26%). Up to 73% of self-excluders exhibited symptoms of anxiety, depression, and substance use disorders at program enrollment. Several aspects of mental health improved after exclusion, e.g., quality of life. Problem and pathological gambling are most prevalent in young men, but self-exclusion was most prominent in middle-aged men. The magnitude of effects widely differed between studies despite overall benefits of self-exclusion, and many individuals continued gambling after exclusion. This shortcoming could be minimized using improved access controls and the extension of exclusion to other gambling segments. High rates of pathological gambling and other mental disorders in self-excluders highlight the need for improved early detection and treatment accessibility.


Prevention Self-exclusion Evaluation Casino Comorbidity Gambling 



This research was funded in part through an unrestricted research donation by the Federal Association of German Casinos (BupriS) to the Technische Universität Dresden. Roxana Kotter, Anja Kräplin, and Andre Pittig declare that they have no further conflict of interest. Gerhard Bühringer has received unrestricted research grants from the Bavarian State Ministry of Finance (regulatory authority for and operator of the state gambling monopoly), via the Bavarian State Ministry of the Environment and Public Health, the German Federal Ministry of Economics and Technology (regulatory authority for the commercial gaming industry), and from public and private gambling providers. The authors extend special thanks to Maria Prkno and Lydia Hinz for their help with this review.

Supplementary material

10899_2018_9777_MOESM1_ESM.pdf (375 kb)
Supplementary material 1 (PDF 375 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Institute of Clinical Psychology and Psychotherapy, Department of PsychologyTechnische Universität DresdenDresdenGermany
  2. 2.Department of Psychology (Biological Psychology, Clinical Psychology, and Psychotherapy)University of WürzburgWürzburgGermany
  3. 3.IFT Institut für TherapieforschungMunichGermany

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