Review of Self-exclusion from Gambling Venues as an Intervention for Problem Gambling

Sally M. Gainsbury  -  2013   -  Springer Link  - National Library of Medicine Bethesda, Maryland, USA

Based on the available evidence, the following elements are recommended to be included in all self-exclusion programs:

·         Clear information about self-exclusion programs and promotion of programs to increase utilisation. Promotion should include venue-based strategies as well as information provided in the general community and through health and mental health centres, legal offices, and other relevant support services. Relevant professional should all be informed about the program so that they may refer clients as appropriate.

·         To maximise the uptake of self-exclusion agreements, individuals should be able to enact self-exclusion agreements directly at gaming venues and also when off-site. The registration process should be conducted in a respectful manner, in a private setting and should be relatively quick and easy. If registration is perceived to be too difficult or complex, this may act as a barrier to self-exclusion. Self-exclusion agreements should be able to be enacted with treatment providers, counsellors or other suitable health and legal professionals. Self-exclusion agreements may also be initiated by individuals using Internet-based protocols that include webcams for photograph identification, by visiting suitable government agencies or mailing in applications and photographs.

·         Programs must offer a range of time periods for exclusion. There is a lack of empirical evidence to suggest what length of ban is most effective in assisting individuals to control their gambling. Although longer bans may be more effective in providing individuals with the time needed to overcome their gambling-related problems, these may deter some individuals from registering for programs. It is suggested that self-exclusion agreements be a minimum of 6 months to allow individuals sufficient time to enter treatment if desired or deal with their gambling problems.

·         Operators must remove all self-excluded persons from the mailing list and stop offering incentives during the period of self-exclusion. Individuals must not be reinstated on any mailing lists even after their self-exclusion period has expired unless they have specifically applied and been approved to re-enter the venue.

·         Resources must be provided to assist self-excluded persons take further steps to control their gambling including appropriate information and education resources as well as referrals to formal counselling, treatment or self-help programs. Not all people seeking self-exclusion want or are receptive to professional help (Ladouceur et al. 2000, 2007; Tremblay et al. 2008). Hence, mandatory counselling may not be effective and may deter some individuals from entering into self-exclusion agreements. Internet-based treatment and self-help interventions may be particularly useful for those who would benefit from formal help, but are unwilling or unable to attend in-person sessions (Gainsbury and Blaszczynski 2011a, b).

·         Operators must take active steps to identify and remove self-excluded persons who return to gaming facilities. It is reasonable to require that all patrons must show appropriate identification before they are admitted to gaming venues to prevent breaches. This would enable computerised identification checks for enforcement of self-exclusion. Checking identification has become part of standard practices for many businesses (e.g., buying alcohol, boarding planes), is accounted for in customer and queue management and is accepted by consumers.

·         A reinstatement process should occur before the self-excluded individual is permitted re-entry into gaming facilities. When the finishing date of their ban is approaching, self-excluded individuals should be contacted with appropriate information and details should be provided of what is required to reinstate entry. A re-entry session may be held and run by an external organisation to avoid self-excluders having to visit gaming venues. Alternatively, individuals should be able to extend their ban for a renewed time period and have a new photograph taken to ensure that it is current. Again, this process should be provided away from gaming venues to avoid triggering gambling behaviour and referrals should be provided for treatment services.

·         Operators must have an effective training program for all staff who have a role in enforcing the self-exclusion program, including refresher training. The training program should include how to identify individuals who may have a gambling problem and how to adhere to all components of the self-exclusion program.

·         Self-exclusion programs should be monitored and evaluated to ensure programs are effective, have no unintended harmful consequences and are conducted in compliance with the required processes. The limitations of the current literature and few evaluative studies conducted highlight the need to develop a systematic process for the evaluation of self-exclusion programs. A transparent system of monitoring and auditing a self-exclusion program would reduce any perceived conflict of interest by operators and clearly demonstrating a programs’ effectiveness may increase utilisation.

Self-exclusion programs are an essential part of any harm-minimisation strategy offered by a gaming operator or jurisdictional regulator. Although self-exclusion programs have been in use since 1996, there are remarkably few comprehensive evaluative studies that have investigated the impact of these programs and the elements that should be included to maximise benefits. Despite the severe limitations to the available literature, there is some evidence that self-exclusion programs generally provide benefits to problem gamblers in terms of reduced gambling behaviour and reduction of problem gambling severity. There is also evidence of improved psychological functioning and perceptions of control over gambling behaviour. However, existing self-exclusion programs are under-utilised and do not appear to be effective in preventing gamblers from breaching agreements or gambling on non-restricted activities.

Regulation mandating operators to offer a self-exclusion program to patrons is expected to enhance the strength of this program by increasing the power to penalise individuals and operators who do not comply with the standards mandated or breach agreements. This may increase the effectiveness of programs as well as the perception of such strategies, which may in turn increase utilisation rates. Although there is no ‘gold standard’ program that can be implemented, it is important for any regulator to consider the existing evidence and make every attempt to implement minimum standards that are sufficient to ensure a programs feasibility. Self-exclusion programs should be flexible to accommodate the needs of individual gamblers, but must be recognised as a severe form of pre-commitment intended for those who are unable to control their own gambling behaviour. As such it must be sufficiently powerful to uphold self-exclusion agreements to the highest standard that can be reasonably expected in order to offer the maximum benefits and protection for individual self-excluded gamblers. It is expected that such programs would require constant evaluation, monitoring and modification as necessary and in line with developing technological capabilities.

Further research is needed to develop more effective self-exclusion programs and also to consider tailored programs that are more relevant to individuals, for example, based on gender, age and cultural differences. Any jurisdiction that allows the provision of gambling should consider self-exclusion programs carefully in order to provide a duty of care to gamblers.