Gambling has been in the news this week, due to some controversies about the funding of its treatment. But how is gambling addictive, and what are the controversies with funding counselling? Mark Sainsbury and I talked about this on Radio Live this week. (Click here for audio of this weeks interview)
The recent changes to the Psychiatric “Bible” the DSM 5 have for the first time classified gambling as an addiction. But to really understand how gambling addiction works it’s important to understand the difference between low intensity gambling and high intensity gambling.
Intensity is defined by the length of time that elapses between when a bet is made, and the result. Lotto and raffle tickets for example, are low intensity: casino gaming and poker machines are high intensity, the result with pokies is almost instantaneous.
The other problem with gaming machines is that they are programmed and continually refined to be as engaging (or addictive) as possible. This is an economic reality, if you’re in the business of making money from gaming machines it’s important to maximise their efficiency.
Largely this is about manipulating the frequency of the wins: in behavioural language the “reinforcement schedule”. Manipulating how frequently and in what pattern the wins occur is the key to “engagement”.
Given all of this, and the damage that clinicians on the front line see as a result of problem gambling, it’s to be ethically expected that health clinicians would lobby to reduce the impact of unhealthy products. Think of it like heart surgeons and GP’s expressing concerns and lobbying government about smoking.
Unfortunately though, our Government and the Ministry of Health have decided that we are only paying for the ambulance (or the hearse) at the bottom of the cliff.
Tobacco and alcohol are taxed at point of sale with the health system generally picking up the tab for treatment and public education about it’s dangers, Gambling however is funded more directly via the gambling levy. This is paid by all licensed gambling providers to specifically fund treatment for problem gambling.
And that direct funding means gambling providers are going to have no interest in funding public education and lobbying; from a business perspective it’s like paying for negative advertising.
It’s also true in this interview the Associate Minister of Health Peter Dunne concedes that the Ministry are only going to pay people to provide treatment, not lobbying and activism, and that’s why the Problem Gambling Foundation lost it’s contract.
But you know what? Over the last five years gambling in New Zealand has decreased. The percentage of those that do gamble has remained the same, and largely on pokies and casino gaming. But overall, we’re gambling less.
I guess in the absence of the Problem Gambling Foundation’s ethical, and science driven concerns we’ll just have to see if that trend continues.
I wouldn’t put money on it.
Gidday Kyle,
I used to work in the area of gambling problems, and for the Problem Gambling Foundation when it was created. We used to refer to high intensity gambling as continuous because you can get your reward (or not) instantly and you can keep going – as with pokies, Lotto cannot not be done continuously unless by scratches at the Lotto Shop.
Actually the providers don’t control how the money is spent on the problem, you don’t say they do but it is important to note that they don’t. And the Ministry of Health is perfectly able to do fund “ethical, science driven concerns” as they do in other areas. The loss of funding is a result of government influence to punish a group who oppose government irresponsibility with gambling. OUr government has long been addicted to the very high tax take on gambling.
Cheers,
Andrew
Thanks for that extra piece of information Andrew. Couldn’t agree more about the Government’s “addiction”
Hi Kyle,
Thanks for that interesting blog. As a clinician who worked in the Problem Gambling sector for many years I have watched with a mixture of sadness and cynicism as the story of PGF’s loss of funding has been realised. Yet again we bear witness to the decimation of a once well-funded, well resourced treatment sector being hobbled by those who seems to be quite happy to see choices for the client eroded.
As we know, funding for this sector comes off a levy that is taken directly off the profits of the gaming industry. Previously this was administered by the Problem Gambling Committee – made up of a mix of treatment providers and gaming industry. Whilst not always ‘ comfortable bed-fellows’ it allowed for a direct dialogue.
Sadly in my time working in this sector I have seen the erosion of much of the wonderful work that was done in terms of therapeutic, reparative work increasingly replaced with a one-size fits all medicalised approach. Counsellors being re-branded as case-workers. I also witnessed the end of residential rehabilitation for someone with purely a Gambling addiction. These people are now only admitted into most of the major residential rehab clinics with a lead diagnosis of alcohol or drug addiction.
Tau Henare was reported as saying that “this is what happens if you bite the hand that feeds” in reference to PGF losing it’s funding. Let’s remember this is a levy so the people who seek treatment have in effect paid for their treatment up front. To me it’s just more of the same … the erosion of choice for the client and ( dare I say), standards of treatment,
The Ministry of Health have succeeded in ‘bureacratising’ this sector and I am not surprised at all that PGF sees this significant funding cut (read destruction of their agency which has always taken on more of an advocacy role for their clients) as punitive. It was a major reason I left the sector as it became less and less about meeting the clients needs – and rather satisfying the bureaucrats and bean-counters.
My heart goes out to the problem gamblers and their families and to the clinicians at PGF. It’s always the ‘little guy’ who loses out to the money men.
Leigh-Ann Pukeroa.