Current Research: Findings from Victoria s Problem Gambling Research Program

Transcription

1 Current Research: Findings from Victoria s Problem Gambling Research Program Professor Alun C Jackson Professor Shane A Thomas Dr Neil Thomason Problem Gambling Research Program The University of Melbourne Invitational Paper presented at 3 rd National AIC/AIGR Conference on Gambling Sydney, May. 2000

2 Aim of the Paper [SLIDE 1] The purpose of this paper is to briefly review some of the work undertaken by the PGRP at University of Melbourne, first, to illustrate some aspects of the operation of Victoria s Problem Gambling Services Strategy, second, to spell out some dimensions of problem gambling and third, to demonstrate the usefulness of a problem gambling service-wide minimum data set as an aid to policy and program planning. Problem Gambling Services Strategy [SLIDE 2] The Problem Gambling Services Strategy was implemented in 1993 with a total budgetary commitment to 2001 of $61 million. The PGSS research program is designed to complement that of the VCGA, and has a specific focus on problem gambling. The objectives of the major studies undertaken by the University of Melbourne Problem Gambling Research Program were to: Gather and analyse client and service data to help inform the future planning, design, development and evaluation of problem gambling services. Produce research findings and recommendations to help guide the formulation of departmental policy in relation to client needs. Assist in the development of a responsible and accessible service delivery system. Measure the effectiveness, accessibility and accountability of problem gambling counselling and liaison services and community education strategies. It is important to note that our research program was not an evaluation of the Problem Gambling Services Strategy per se, but of Break Even. An important element of the usefulness of a strategy, however, is the relationship between its elements and there are three elements, at least, of the strategy which we identified during the course of our BreakEven evaluation as needing attention: The integration of financial counselling and problem gambling counselling. This does not work. There is a minimal relationship between the two services with only about 2% of BreakEven clients being referred for financial counselling even though well over half of those presenting to BreakEven do so with financial problems. If these problems are being dealt with effectively by BreakEven counsellors, then this sort of relationship is appropriate. The evidence that this is the case is not very strong, however, with nearly two thirds of financial problem cases reported by counsellors as being unresolved or only partially resolved at case closure. This sort of outcome needs to be compared to the resolution rates being achieved by financial counsellors so that we can determine

3 whether better rates are achievable, and structuring the interaction between the services such that the best possible rate of resolution can be attained. The extent to which general family service agencies outside of the BreakEven network are involved in problem gambling counselling and the implications of this for funding and service co-ordination. In our survey of 121 family service agencies across all nine DHS regions, most (89.3%) of the agencies indicated that their services were being used by people for gamblingrelated problems. For 15% of these agencies clients with gambling-related problems comprised 20% or more of their clientele. Almost half of the agencies surveyed (43.1%) had data collection systems that enabled identification of gambling-related problems and, not surprisingly, agencies that could readily identify clients with issues associated with gambling (98.1%) were significantly more likely to be aware of having clients with gambling issues than agencies not recording this data (82.6%) (χ2 (1) = 7.40, p <.01). What we do not know is whether people with gambling problems are more likely to present to those services that keep statistical information about gambling issues. While it is possible that agencies have begun to collect statistical data about problem gambling because they have identified this as an issue that affects a proportion of their clients, it is equally plausible that counselling staff in agencies that have decided to collect data are more attuned to problem gambling as an issue and hence more likely to probe for the existence of gambling-related issues. The identification of gambling issues may also be affected by staff training. Whereas half (50.5%) of the agencies that identified problem gambling-affected clients had provided staff with specialist training on gambling issues, only one agency (8.3%) that claimed not to have clients affected by gambling had provided such training. The survey results showed that people with gambling-related problems are presenting to a wide range of family support and/or financial counselling services. A greater number and broader variety of agencies, therefore, may need to be targeted for information about identifying and treating problem gambling than at present. This is especially important given that there appeared to be several agencies reporting that they offered problem gambling counselling, and yet were outside the funding umbrella of the BreakEven network. The Strategy needs to address the issue of cohesion and coordination of service delivery between programs in a way that is not currently done. The integration of research into the decision making process about developments in the other strategy components. There has been little effective use of the commissioned research thus far due to tardiness in dissemination of research reports. In addition, important decisions such as the decision to abandon the harm-minimisation oriented education campaign ( If it s no longer fun, walk away ) have not been based on the evidence provided by the research program on the effectiveness of the media campaign component of the strategy, but have been based, rather, on the opinion of the new Minister on assuming the Community Services portfolio, of which the problem gambling strategy is a part.

4 Trends in help-seeking behaviour We would now like to highlight a number of trends in help-seeking behaviour by problem gamblers seeking help for themselves and people seeking help in coping with the gambling of a partner or family member. These trends will be discussed in terms of: Male/female patterns of use Age structure of the help-seeking group Gambling behaviours Debt Presenting problems DSM-IV maladaptive behaviour patterns Crime Male/female patterns of use Between 1 July 1998 and 30 June 1999, 2982 new clients registered with Victoria s problem gambling counselling services. Nearly 80% were people who reported that they had problems with their own gambling behaviour. While the numbers of males and females presenting in respect of their own gambling issues was almost identical, females were more than twice as likely to present due to concerns arising from the impact of another person s gambling, most notably their partner. [SLIDE 3] Female clients presenting to BreakEven agencies in the second year of operation of the program (July 1996 to June 1997) had a number of significantly different characteristics from male clients of these services. Many of these differences persist. When compared to males, females were likely to be older (39.6 years versus 36.1 years), more likely to be born in Australia (79.4 percent versus 74.7 percent), to be married (42.8 percent versus 30.2 percent), living with family (78.9 percent versus 61.5 percent) and to have dependent children (48.4 percent versus 35.7 percent). Despite having similar personal annual incomes (U = , Z = -.493, n.s.), female gamblers reported average debts (A$7,342) of less than half of that owed by male gamblers (A$ 19,091) (F(1,616) = p =.001). Age structure of the help-seeking group For the July 1998 to June 1999 year, when compared with the age distribution of Victorians aged 15 and over at the 1996 Census, problem gamblers in counselling are over represented in the (23.3 compared with 19.5 percent of all Victorians), (32.3 percent cf percent) and (24.9 percent cf 18.4 percent) year age groups. They are under represented in the under 20 (1.1 percent cf 9.0 percent) and over 60 (5.0 percent cf 20.2 percent) age groupings, and consistent with the overall population in the (13.4 percent cf 12.7 percent) age groups.

5 [SLIDE 4] This slide shows that, similar to Break Even clients, the two Productivity Commission samples ( Problem Gamblers and those In Counselling ) were unlike the age profile of adult Victorians reported in the 1996 Census. That is, none of these gambling groups appear to be representative of the general adult Victorian population. Relative to the other groups the Break Even problem gambler clients compared to the Productivity Commission In- Counselling clients are younger (25-34 years) while the In-Counselling group has more people in most of the older age categories, particularly years and years. Are the BreakEven clients reflective of the age structure of problem gamblers? As the following slide indicates, the Productivity Commission Problem Gamblers age profile has a very high under-25 year age group. [SLIDE 5] These comparisons indicate that the BreakEven program in future education campaigns ought to target the under 25 age group of problem gamblers in terms of problem recognition and to encourage their use of this service. Gambling activity [SLIDE 6] Problem gamblers in counselling in 1998/99 reported involvement in a wide range of types of gambling. The most common by far is electronic gaming machines, which are used by more than two-thirds (68.7 percent) of all problem gambler clients (81.7 percent of women and 55.8 percent of men). This has remained the most common form of gambling undertaken by Break Even clients over the last four years, but interestingly the numbers have declined since the first year of operation of the program (91.1 percent women and 61.4 percent of men). The next most often reported type of gambling was off-course betting at the TAB (11.9 percent). No other type of gambling was reported by more than about 4 percent of clients. There was only a very small number of people (about 25) reportedly involved in forms of gambling over the internet, but this form of gambling is quite new and there may be a lag period between the introduction of this type of gambling and clients presenting themselves for problem gambling counselling. [SLIDE 7] For problem gambler clients, their involvement in gambling can vary over time, and as the next slide indicates, Break Even attracts problem gamblers with wide ranging patterns of gambling. Half of the clients gambling behaviour was described as increasing, chaotic or binge gambling. However, nearly one-third (29.8 percent) of problem gamblers had already decreased their gambling, which for some was a total reduction as they were not currently gambling.

6 [SLIDE 8] Debt The extent of gambling related debt is reported in this slide and shows that males report being far more in debt as a result of their gambling than females. We also found that males are more likely to borrow money to fund their gambling. The mean debt however has decreased from $14,140 in 1997/98 to $8,295 in 1998/99, and 37.2% of problem gamblers now presenting for counselling have nil debt. This may be a positive sign that many problem gamblers are presenting for assistance before they are in trouble financially. It could also mean that they have no debt because major assets have been sold to pay the debt. While over a third of Break Even clients in 1998/99 have nil debt, there is a small group of people who have considerable debts. Simple addition of the reported debt for 98/99 clients results in a total debt of $15, 342,362 amongst the study group. However, looking at those with large debt we find that only 1.3% of problem gamblers account for 29% of the total debt (26 people owe $4,486,000). Further disaggregation of this small high debt group, compared to the total 98/99 clients, shows that they are more likely to be male (62%), older (mean age of 41 years), born overseas, employed full-time, a manager or clerical worker, with a very high or very low individual income. They have higher proportions of most presenting problems, particularly financial and employment problems, and are four times more likely to have the maximum 10 maladaptive behaviours or DSMIV items. Thus, while it is probably a good sign that people are attending counselling with nil or low debt, we cannot lose sight of the fact that the problem gambling population includes people who have what can only be described as massive financial problems. Presenting problems In a specialist problem gambling counselling service it is hardly surprising that overwhelmingly the problem gamblers (94.0%) are concerned about their gambling behaviour. Other presenting problems as reported by half or more of these clients in 98/99 were financial (56.3%), intrapersonal (57.4%) and relationship / interpersonal (49.7%) issues. While some problems were similarly likely to be reported by both sexes, there were some substantial differences between the sexes in respect of some problem types. Employment/ work related issues and legal issues were more frequent among the presenting problems for men whereas women were more likely to report relationship and family problems, and having physical symptoms associated with their gambling. Partners and others who seek assistance from Break Even services do so for somewhat different reasons than do problem gamblers, and it is hardly surprising that the most common reasons for attending are due to relationship (66.1%) and family (51.6%) issues. [SLIDE 9] Comparing the presenting problems reported by problem gamblers over the last four years reveals some fairly dramatic changes. We can see quite distinct differences between the

7 periods and In the period all presenting problems with the exception of gambling behaviour have declined, in some cases by as much as 50 percent, in the case of leisure use issues and physical symptoms. It may be that in the first two years of operation of Break Even, there was a pool of people who had lived with gambling related problems for some time, without seeking assistance who did so once the specialist counselling service was operational. This is probably most evident in the 80.1% presenting with intrapersonal problems in the second year of operation of the service. These may well be people who had been anxious or depressed about their gambling but had, until Break Even opened, been reluctant to disclose these problems. Generally, the first two years of operation of the counselling service may be characterised by a high level of help-seeking for the symptomatic effects of gambling. There has been a steady decline since 1997 of this, and a somewhat greater emphasis on gambling behaviour as the problem for which help is sought rather than the consequential problems. This is not to suggest a simplistic notion of causality, however, with all problems being deemed to be the result of gambling. It is clear that for a number of people in counselling, the gambling itself is symptomatic of other problems, such as loneliness, poor familial and interpersonal relations and lack of perceived alternative leisure pursuits. [SLIDE 10] However, the number of presenting problems has also decreased over the years. This suggests to us, both that individuals are seeking help from Break Even earlier in their career as problem gamblers and that the backlog of people with longer standing problems who had not previously sought help, were dealt with by the service primarily in the first two years of operation. Almost one fifth (19.9%) of problem gamblers in 1998/99 presented with either one or none of the problems listed in this slide compared to 17.6% in 1997/98; 3% in 1996/97 and 2.4% in 1995/6. Conversely, the proportion of those presenting with six or more problems was down to 19.7% in 1998/99 from a high of 49.4% in 1995/96. DSM-IV maladaptive behaviour patterns [SLIDE 11] The client assessment form measures the extent to which gambling has become problematic by using the DSM-IV criteria to measure the type, frequency and intensity of gambling behaviours and their adverse effects. [SLIDE 12] As this slide demonstrates, the extent to which maladaptive behaviours manifest themselves also varies according to the type of gambling. Comparing those who gamble on electronic gaming machines to those who gamble at the TAB, the TAB clients were more likely to report being preoccupied with gambling, chasing losses, relying on others for money and

8 having jeopardised relationships, jobs, education etc than EGM users who were more likely to report gambling as a form of escape. TAB clients were twice as likely to report committing illegal acts to finance their gambling. These characteristics also reflect gender differences women are more likely to play EGMs and men are more likely to bet at the TAB. [SLIDE 13] As can be seen in this slide, the proportion of gamblers reporting five or more maladaptive behaviours is reasonably stable at about three-quarters (76.2% in 1997/98; 74.3% in 1998/99; 73.6% in 1996/97). These contrast somewhat with the 1995/96 figure of 81.7 percent, although this may be elevated due to the same backlog effect noted earlier. As with the number of presenting problems, there has been some decrease in the number of maladaptive behaviours presented with. In 1995/96, 18.2% of people presented with fewer than five of these behaviours, compared to 25.7% so doing in 1998/99. Crime In 1998/99, the DSM-IV data revealed that 20.5% (26.7% for males and 14.8% for females) of the problem gambler clients had committed illegal acts which were associated with their gambling. Further disaggregation of the two variables in the Minimum Data Set relating to illegal actions in relation to gambling show that males are twice as likely as females to commit such illegal acts. Also, over-representation in illegal acts is reported by those problem gamblers who are younger, never married, living in a shared household, unemployed, have debt in excess of $10,000, present with legal problems, and report the full range of maladaptive behaviours. While this group of problem gamblers comprise only 20% of all people attending Break Even in 1998/99, they have a disproportionate number and severity of problems to resolve. Adolescent gambling This section of the paper briefly reports data arising from the Impact of Gambling on Adolescents and Children Report. Gambling behaviours A state-wide survey of 2,788 year 8 students examined gambling behaviour in the context of depression, substance abuse and deliberate self-harm. Intermediary factors included social and school attachment with a focus on measures of connectedness, security and positive regard. The survey made it possible to estimate the prevalence of gambling activities of young adolescents and to measure the association between these activities, social and familial factors and other adolescent behaviour. The survey contained questions regarding personal and family demographics, measures of stress, parental bonding, social attachment, school attachment, commitment,

9 disincentives and rewards, victimisation (being bullied), depression, dieting, alcohol consumption, smoking, anti-social behaviour and gambling. The adolescents were asked if they gambled in the last year with money or possessions for five types of gambling: card games; lottery tickets; racing or sports; poker machines, video games; or on the internet. [SLIDE 14] Forty-one percent of year 8 adolescents had gambled on at least one of the five types of gambling covered in the survey in the past year. There were significant differences between males and females on all forms of gambling covered by the survey except for lottery tickets. The most frequent form of gambling was races or sporting events (24%) or lottery tickets (23%). The least commonly engaged in was gambling on the internet (4%). Eight percent had engaged in three or more different forms of gambling in the last year (12% of the boys and 5% of the girls). There were no significant differences in gambling overall, or in particular forms of gambling between adolescents from metropolitan Melbourne and those from regional Victoria. There was a small but statistically significant association between mothers working and increased involvement in gambling. It is unclear whether this finding relates to decreased supervision of adolescents whose mothers work or increased available income to gamble. No significant associations were found with parents separation and divorce or family structure. There was an association between gambling and being Australian born. Being born overseas was associated with reduced involvement in gambling. [SLIDE 15] There were statistically significant differences between boys and girls in their responses to the gambling attitudes questions. More boys than girls believed gambling to be entertaining, to be a way to make money, to be okay if not overdone, and agreed that gambling makes you feel better. [SLIDE 16] More girls believed it to be a waste of time. On the whole, more young people who completed the survey held negative attitudes towards gambling than positive, although more boys were positive about gambling than girls. There was no association between any amount of gambling and being victimised, where victimisation was defined as ever having been bullied, having been frequently bullied, or having become upset by bullying. There was, however, a positive association between gambling three ways or more and depressive symptomology and deliberate self-harm, which was almost twice as common in this group who had wider experience of gambling. Positive associations were found between gambling three ways or more and substance abuse; antisocial behaviour; being a drinker, smoker, or user of marijuana in the past six months, or having problems with money. The adolescents with

10 greater breadth of experience of gambling reported negative views of school with lower levels of commitment, fewer perceived benefits from engagement and major disincentives to do so. We obviously need to know more about this association between breadth of experience in gambling and anti-social behaviours in adolescents, and we have followed this cohort for a further year to see if the pattern of association is modified in any way over time. That 1 in 8 of 13 and 14 year old boys, in particular, in the State, exhibit this range of risk behaviours is a concern, and given the focus of our research, we obviously need to determine what meaning gambling has in the lives of these young people. Conclusion Obvious that the people presenting for help with their gambling problems are hurting. A co-ordinated service response within the context of a state-wide strategy is worth the effort of co-ordination and planning involved, but there are dangers in an overly centralised system. This is a tension that needs to be addressed. Usefulness of MDS for benchmarking, inter-agency comparison, regional comparisons, at a state-wide level, but also at a national level.

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