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Emerging Gambling Problems and Suggested Interventions: A Systematic Review of Empirical Research

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Abstract

The goal of the present systematic review is to identify emerging gambling problems and the harm minimization strategies proposed to address them. Our interdisciplinary research team conducted this systematic literature review in 5 nations between which there is significant gambling research exchange. A keyword search of the Scopus and Web of Science databases followed by filtering using inclusion criteria identified 1292 empirical gambling studies from peer-reviewed journals. The data obtained from the articles were analyzed using the content analysis technique. We then used a unique approach to identify relationships between harm minimization strategies and gambling problems. The findings reveal that the most frequently reported gambling problems are related to young gamblers, online gambling, electronic gaming machines, and children and adolescents (underage gamblers). Harm minimization strategies to address these included creating educational and awareness programs, further restrictions on gambling advertising, developing an intervention mechanism for online gambling, and remote gambling-related help (i.e., online counseling, online treatment).

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Funding

Murat Akçayır was an Alberta Gambling Research Institute (AGRI) funded postdoctoral fellow in the Department of Political Science at the University of Alberta. David Baxter is a current recipient of the AGRI graduate scholarship. Fiona Nicoll is the author of Gambling in Everyday Life: Spaces, Moments and Products of Enjoyment and based in the Political Science department at the University of Alberta where she held an AGRI Chair in gambling policy from 2016–2021. Research for this manuscript was supported by this Research Chair.

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Correspondence to Murat Akçayır.

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Conflict of interest

All authors declare no conflict of interest in the preparation of this manuscript. David Baxter has previously worked as an employee of Greo (formerly Gambling Research Exchange Ontario) and received research consulting fees from Greo and AGRI.

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Appendices

Appendix A: Gambling problems

Problems

Frequency

Young gamblers

111

Online gambling

110

EGM

86

Children & Adolescents

60

Treatment

56

Advertising

47

Characteristics

47

Gambling motivations

46

Sports betting

45

Impulsivity

43

Gambling Behaviour

37

Risk factors

34

Responsible gambling

23

Gamblers' fallacy

22

Help-seeking

21

Decision making

19

Therapy

18

Near-misses

17

Lottery gambling

17

Older adults

17

Risk-taking

17

Indigenous gambling

16

Prevention

15

Female gamblers

15

Cognitive distortions

14

Fantasy sports

13

Substance use

13

Attention problems

12

Parkinson's disease

11

Alcohol use disorders

11

Family (e.g., violance)

10

Harm minimisation

10

Personalized feedback

10

Dopamine

9

Gambling harms

9

Suicidal ideation

9

Mental health

9

Tourism

9

Treatment-seeking

9

Cognitions

9

Attitudes

8

Psychiatric disorders

8

Sound (background or machine)

8

Scratch cards

8

Identifying problem gamblers

7

Staff

7

Prisoners

7

Stigma

7

Video gaming

6

Veterans

6

Gambling availability

6

Casino development

6

Depression

6

Gambling policy

6

DSM-IV-V comparison

6

New forms of gambling

5

Genes

5

Gambling beliefs

5

Intervention

5

Gambling expectancies

5

Ethnicity

5

Smoking ban

5

Self-exclusion

5

Childhood experience

5

Subjective well-being

5

Stress

5

Religiosity

5

Mindfulness

4

Social casino games

4

Criminality

4

Prevalance

4

Type of gambling

4

Social reponsibility

4

Smoking

4

Levy

4

Psychological factors

4

Parenting

4

Psychopathology

4

Homeless people

4

Jackpot

4

Economic impact

4

Loss-chasing

4

Gambling venue

3

Illegal gambling

3

Neurocognitive deficits

3

Sponsorship

3

Anxiety

3

Coping strategies

3

Poker players

3

Sibling influence

3

Protective factors

3

Poker-machine

3

Peer influence/effects

3

Personality disorder

3

Licensing

2

Alexithymia

2

Loneliness

2

Athletes gambling

2

Internet addiction

2

Immigrant gambling

2

Bus tours

2

Early intervention

2

DSM-V

2

Depressive disorder

2

Emotion

2

Family involvement

2

Education

2

Gambling craving

2

Cognitive inflexibility

2

Health problem/ well-being

2

Casino services

2

Compulsivity

2

Comorbidity

2

Addictive disorder

2

Obesity

2

Mood disorder

2

Metacognition

2

Trauma

2

Motivation to Quit Gambling

2

Relative deprivation

2

Near-wins

2

Skewness

2

Social norms

2

Sociocultural influences

2

Self-help

2

Video-lottery terminal

2

Regulatory reform

2

Wagering

2

Psychosocial factors

2

Teacher awareness

2

Treatment-dropout

2

Self-discontinuity

2

Psychological co-morbidities

2

Social influences

1

Sleep difficulty

1

Social support

1

Chronic Schizophrenia

1

Spatial microsimulation

1

Compensation

1

College counseling center

1

Social relationships

1

Sex addiction

1

Sexual behavior

1

Sexual stimuli

1

Dissociation

1

Dialectical behaviour therapy

1

Desire thinking

1

DBH gene

1

D1 receptor

1

Corticolimbic connectivity

1

Cortical morphometry

1

Dark triad

1

Damage to insula abolishes

1

D2 receptor

1

Special Needs Students

1

Authenticity

1

Trait urgency

1

Transcranial magnetic stimulation

1

Betting shops

1

Blackjack skills

1

Bingo

1

Binge eating

1

Alcohol serving

1

Violence

1

ADHD symptoms

1

Tribal gambling

1

Assessment

1

Anger

1

Amphetamine

1

Stimulus value

1

Stop button

1

Casino Architecture and Struct.

1

Spectrum disorders

1

Child sexual abuse

1

Cheating

1

Charity

1

Breaks in play

1

Brain activity

1

Bonus round feature

1

Caffeine's influence

1

Cashless and card based gambling

1

Cannabis use

1

Calorie intake

1

Neuroeconomics

1

Neurological activity

1

Genome-wide

1

Neurocognitive differences

1

Naltexrone use

1

Hoarding symptoms

1

Hippocampal and amygdalar volu.

1

gambling perceptions

1

Parental monitoring

1

Gambling in prison

1

P300

1

Number of terminals

1

Game lights

1

Gambling promotions

1

Illegal acts

1

Limit setting (loss limit)

1

Life events

1

Male gamblers

1

Loss of control

1

Loss aversion

1

Losing

1

Loot boxes

1

Inhibitory

1

Money laundering

1

Motivational treatment

1

Mindfulness-Based Treatment

1

Matter integrity

1

Mesostriatal dopamine function

1

IQ

1

Emotional regulation strategies

1

Electronic cigarettes

1

Repetitive behaviour

1

Environmental factors

1

Exposure therapy

1

Executive function

1

Relapse

1

Dysregulated opioid system

1

Driving after gambling

1

Sensation-seeking

1

Self-awarness

1

Reward

1

Roulette gambling

1

Eating behaviour

1

Quality of life

1

Gambling at school

1

Gambling area characteristics

1

Gambling addiction

1

Psychological states

1

Positive aspects of casinos

1

Pricing strategy

1

Problematic internet use

1

Public sphere

1

Fearless Dominance

1

Punishment

1

Fraud

1

Gambling-related cues

1

Public opinion

1

Frontal cortex activity

1

Appendix B: The entire list of suggestions

Suggested solutions

Frequency

Creating educational and awareness program/campaigns

74

Further restrictions/regulations on gambling advertising/marketing (considering all forms)

48

Screen for comorbid gambling problems (clinicians)

35

Responsible gambling messaging in advertising, websites and TV

32

Develop intervention mechanism/programmes for online gambling and problematic internet use

31

Public health interventions to minimise gambling related harm (Health care institutions)

28

More tailored intervention and prevention

28

Increase gambling treatment services availability and access

25

Educate youth about gambling and healthy internet

25

Remote gambling-related help (treatments, counselling, helpline, website, materials)

24

New strategies to increase identification and early intervention

23

Increase prevention and intervention programs and strategies

23

Addressing the cognitive, affective, and behavioral difficulties/distortions

23

Cognitive behavioral therapy

22

Emotion regulation therapies (e.g., mindfulness training, attention debiasing)

21

Personalized feedback

21

Augment social support (altering social network, mutual aid fellowships, decrease loneliness)

19

Encourage schools, colleges and universities to develop appropriate gambling-related policies and initiatives

18

Family/couple involvement in treatment/therapy

17

Prevention/interventions efforts directed at youth gambling

17

Personalized interventions/prevention (gender, culture, past)

17

Limiting access to gambling funds (cancelling credit cards, electronic money transfers)

17

Self-help strategies and actions

16

Limits on gambling activity, such as time and bet size

15

Educate families/parents

14

Education about gambling fallacies

13

Culturally-sensitive prevention and treatment programmes

13

Using pop-up message

13

More effective treatment and prevention approaches (Policy makers and health practitioners)

13

Financial counselling & Education

12

Routine screening and monitoring of gambling severity

11

Further staff/employee training (e.g., confidence in respond)

11

Governmental regulations on online game/gambling

10

Provide alternative (social) activities

10

Brief interventions focused on gambling behaviour (Clinicians)

10

Prevention/warning messages

10

Reducing accessibility of alcohol in gaming venues

10

Support from close personal relationships

9

Address adverse childhood/past experiences

8

Policies related to specific prevention programmes for EGM

8

Regulating gambling accessibility both online and land-based

8

Collaboration between key stakeholders

8

Clinicians should be cognisant of the risk of suicidality

8

Intensive integrated therapy

8

Permitting/Advertising gambling treatment services/information close to or in gaming venues

7

Tailored approaches in clinical practice

7

Address substance dependence problems

7

Teacher education in terms of assisting young people and early identification

6

Increase in social responsibility initiatives

6

Addressing symptoms of depression

6

Inform players about harms of gambling

6

Incorporating gambling preventive intervention within curricula

6

Immediate planning to address Indigenous gambling problems (health interventions)

6

Consider the implications of new forms of gambling on policy

5

Increase the interactions between staff and gamblers

5

Stricter age restrictions & verifications

5

Collaborations with school/university health professionals

5

Provide motivational enhancement therapy

5

Smoke-free efforts at casinos

5

Further reductions in EGM density

5

Increase consumer protection measures

5

Motivational interviewing

5

Parent-based interventions

5

Training coping skills (clinicians)

5

Addressing the psychological needs

5

Encouraging treatment-seeking and emphasize the importance of treatment

4

Prevention efforts and regulations associated with fantasy sports

4

Compulsivity and impulsivity should consider when attempting to optimize treatment for gamblers

4

Creating EGM awareness program

3

Using protective behavioral strategies

3

Treatment of trauma symptomatology

3

Parental monitoring

3

Metacognitive therapy

3

Mental health should be addressed initially

3

An easy to use voluntary self-exclusion system

3

Religious service attendance

3

Reducing gambling expectancies

3

Administering satisfaction questionnaires at varying stages in the treatment process

3

Revising regulations (governments)

3

Involving families and consumers in the planning and development of policies, programmes and services

3

Alternative measures of GD severity

2

Restricting jackpot and general prize to reduce gambling motivations

2

Prevention and intervention programs for the homeless

2

Disorder-focused therapy

2

Reducing/targeting shame (clinical intervention)

2

Relaxation training and distress tolerance training

2

Changing the tax structure in the industry

2

Loot box regulations

2

Motivation-matched treatment

2

Build and validate specific assessment tools

2

Increase the motivation of adolescents to quit smoking

2

Win limit

2

Addressing stigma early in treatment

2

Group-specific treatment (due to different gambling behaviour, motives)

2

Participation in therapy

2

Discontinuation of loan shark loans

1

Discriminate between wins and near-misses

1

Addressing cue-reactive imagery and rationality (Treatments)

1

Control for the exposure and selling superstitious-related objects near places

1

Build and maintain relationships with jail administration and health care providers

1

Campaign to be developed for Indigenous women

1

Constructivist treatment to normalize self-feelings

1

A greater role for consumer advocates in gambling policy and programs

1

Aerobic exercise

1

Demo play EGM

1

Attenuating theta oscillations

1

Attending group therapy

1

Dopaminergic sensitization involving D3-related mechanisms

1

Providing caffeinated beverages at casinos

1

Provide testimonials

1

Reduce corpus callosum fractional anisotropy

1

Redistribute wealth and create more egalitarian societies (Policy)

1

Pharmacological therapy in order to decrease the risk of suicide

1

Minimal nudges on gambling machines

1

Measuring locus of control

1

Pharmacologic targeting of the dopamine-1 receptor

1

Paying bills before gambling

1

Sanctions for gambling at work

1

Restrictions on EGM

1

Targeting anxiety and attempting to rechannel dissociative behaviour

1

Spend more time at work

1

Restrictions on casino bus-tour operations

1

Reduce the availability of and use of offshore gambling sites (Policy)

1

Reduce dopamine levels

1

Removing the sonic disguise of losses disguised as wins

1

Reducing gamblers’ relative deprivation and delay intolerance of rewards

1

Gambling operators should develop training programs

1

Further limiting the frequency of near-misses in gambling games

1

Increasing a gambler's autonomous motivation for quitting

1

Governments should consider reinvesting a portion of funds back into the at-risk communities

1

Exposure therapies

1

Effective policies and regulations to reduce children’s exposure to gambling products

1

Educate clients on the driving risks related to gambling

1

Existential therapy

1

Employ peripheral cues while treating problem gamblers (clinicians)

1

Legislation requiring venues to respond to signs of gambling problems

1

Leaving bank cards at home

1

Measures to monitor alcohol sales outlets around campuses

1

Lowering treatment costs

1

Interventions to reduce drug use

1

Induction of precommitment-oriented thinking

1

Increasing scrutiny

1

Interventions for immigrants

1

Industry self-regulation and guidelines

1

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Akçayır, M., Nicoll, F. & Baxter, D.G. Emerging Gambling Problems and Suggested Interventions: A Systematic Review of Empirical Research. J Gambl Stud 39, 857–882 (2023). https://doi.org/10.1007/s10899-022-10122-w

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