Prevention of Problem Gambling a Comprehensive Review of the Evidence
Summary
Recognition is growing that gambling, although highly profitable for corporations and governments, is a source of serious and unevenly distributed harm. This recognition has led to demands for public health strategies at the local, national, and international levels. We aimed to place review-level bear witness for interventions to address or prevent gambling-related harms and explore policy implications, using stakeholder consultation to assess the evidence base, identify gaps, and propose key inquiry questions. We opted for a systematic mapping review and narrative synthesis for all forms of gambling in whatever setting. We included participants from the whole population, identified gamblers including self-divers, and specific populations at take a chance (eg, children and young people). We included all event measures relating to prevention or handling of gambling-related harms that were reported by review authors. After duplication, the searches generated 1080 records. Of 43 potential papers, 13 were excluded at the full paper phase and thirty papers were included in the Review. We identified whole-population preventive interventions, such equally demand reduction (n=3) and supply reduction (north=four) interventions, and targeted treatment interventions for individuals fond to gambling, such as therapeutic (n=12), pharmacological (n=5), and self-help or common support (due north=4) interventions. Nosotros also reviewed studies (northward=2) comparison these approaches. Interventions to screen, identify, and back up individuals at chance of gambling-related harms and interventions to support ongoing recovery and prevent relapse for individuals with a gambling addiction were not represented in the review-level evidence. A public health approach suggests that there are opportunities to reduce gambling-related harms by intervening across the whole gambling pathway, from regulation of access to gambling to screening for individuals at chance and services for individuals with an identified gambling problem. The famine of testify for some interventions means that implementation must exist accompanied by robust evaluation.
Introduction
Gambling is a highly assisting commercial activeness with providers that include international corporations and governments.
The past decade has seen unprecedented growth in commercial gambling. The prevalence of problem gambling in different countries beyond the world was estimated to vary between 0·1% and 5·8% in 2019.
Revenue from advertising has increased substantially, driven past gambling in the habitation and on mobile devices.
In 2018–19, the total revenue for the UK gambling industry was £14·3 billion,
with £5·6 billion lost by online gamblers in 2018.
v
Gambling Related Harm All-Political party Parliamentary Group
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Gambling-related harms are the "adverse impacts from gambling on the health and wellbeing of individuals, families, communities and society".
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Gambling has the potential to negatively bear on physical health, psychological wellness, and the social functioning of the people who gamble and others around them.
Various terms accept been used to describe potentially harmful gambling behaviour, including compulsive gambling, addictive gambling, problem gambling, and pathological gambling.
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These terms all refer to a pattern of excessive gambling with impaired control over gambling behaviour, substantial negative consequences deriving from this impaired control, and persistence in excessive gambling despite these negative consequences.
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Previous reviews take shown that education and prevention initiatives could succeed in increasing knowledge and awareness of the risks associated with gambling, but the extent to which these interventions can alter behaviour and therefore mitigate impairment is yet to be ascertained.
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In several countries, policy documents increasingly propose public health strategies to reduce harms at the national and local level,
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with calls to regulate stakes and prizes, improve affordability checks, and provide ameliorate support to gamblers.
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Nevertheless, it is not clear how best to reduce the wider impact of gambling-related harms. We did a mapping review of review-level evidence to identify, assess, and synthesise existing show for interventions that aim to reduce gambling-related harms, and to identify gaps in the prove base.
Methods
Overview
The objective of the initial phase of our work was to map out and broadly describe the published systematic-review literature on interventions to address or prevent gambling-related harms. Nosotros included only systematic review-level bear witness, but we applied broad criteria to include all forms of gambling and all populations (both studies that considered participants with an increased risk of gambling-related harms and studies that looked at the population as a whole). Although non typical of a mapping review, we carried out extractions at the level of total papers to allow us to generate a typology of the interventions done. The protocol of our mapping review is available online.
Search strategy and selection criteria
We searched the MEDLINE, Embase, Spider web of Science (Scientific discipline Commendation Index and Social Scientific discipline Citation Index), Applied Social Sciences Index and Abstracts, PsycINFO, and Social Policy and Practice databases. The search strategy combined various terms relating to gambling and included both subject (Medical Subject field Headings [MeSH]) and costless-text searches (appendix). Nosotros practical methodological search filters for systematic review-level evidence and scrutinised the reference lists of included studies. We express results to reviews published since 2012—the date of the get-go comprehensive international review of gambling-related harms
7
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- Simpson RI
Prevention of problem gambling: a comprehensive review of the evidence and identified all-time practices.
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—and to reviews published in English. For full details of the search terms used, come across the appendix.
Search results were downloaded with EndNote, screened by LB (with 20% of results checked by SB), and coded with the keyword part. Papers that potentially met the inclusion criteria were coded and retrieved as full newspaper manufactures. For papers for which the title and abstract did not give a clear indication of whether the paper should be considered or non, we took an inclusive approach by examining the full paper.
Papers, to be included in our analysis, were required to address the whole population, identified gamblers (including self-defined), or specific populations at risk (eg, children and young people). The papers were likewise required to use any intervention to forestall or address gambling-related harms, with any or no comparison, and measure any outcome related to the prevention or treatment of gambling-related harms.
Information analysis
For studies judged to be potentially relevant, we obtained full papers and extracted and tabulated information on author, yr, review design, setting, target population, intervention, inclusion criteria and search date, outcomes assessed, findings, conclusions, limitations, and notes. We synthesised the findings narratively and developed a typology of interventions. We drew on a systems approach adopted for the project overall to ensure that the mapping review considered evidence at all levels in systems connecting gambling activity to gambling-related harms. This approach meant we could identify where there were specific gaps in the availability of evidence. As is mutual for a mapping review,
we did not do a quality appraisal but nosotros did record the blazon of written report pattern.
A public advisory group consisting of 8 individuals from across the UK with experience of gambling-related harms themselves, or through family or friends, provided advisory input via teleconference throughout the process. Their input highlighted the changing nature of people affected by addiction, emphasising the need to describe gambling as an addiction, and the lifelong struggles to avoid relapse. The grouping ensured that we considered wider population views on gambling-related harms, rather than just the views of the authors of included studies. We also sought participation from a broad range of stakeholders via a webinar, in which we discussed the initial findings from the mapping review. In total, 19 participants representing a range of practice, clemency, and academic stakeholders from the UK attended the webinar and provided input regarding the implications of the evidence we had identified and gaps in our understanding.
Results
Our searches generated 1080 unique records. Of these records, 43 citations were retrieved as potentially relevant full papers. We excluded thirteen from these 43 citations, generally because the methodology was not systematic or the review did not consider intervention studies (appendix).
Of the 30 papers that met the criteria for our Review, search terminate dates varied betwixt 2011 (n=2) and 2018 (due north=1), with half of all searches done between 2015 and 2017 (n=sixteen). Three papers did non state their search dates. Publication dates ranged from 2012 to 2019 (with eight reviews published in 2018–19).
To synthesise the results of the identified systematic reviews, we developed a typology of interventions in terms of the written report target population and the type of intervention. A draft listing of interventions was taken from the work done to inform the Review protocol. Consideration was given to how well the reported interventions fitted the model and whether any gaps were notable.
The reviews were divided into those reporting on universal preventive interventions for the whole population and those evaluating selective interventions for individuals at loftier risk of harms. The whole-population preventive interventions included interventions to reduce the demand for gambling (need reduction; north=3) and interventions to restrict opportunities to risk (interventions restricting gambling action; n=4). Targeted interventions for individuals at increased risk of gambling-related harms included therapeutic interventions (due north=12), self-assistance or mutual-support interventions (n=4), and pharmacological interventions (n=5). Nosotros as well included studies comparison unlike interventions (due north=2).
Ii farther potential types of intervention we had expected to notice were not represented in the systematic review-level bear witness. First, interventions to screen, place, and support individuals at risk of gambling-related harms (whole population). Second, interventions to support ongoing recovery and prevent relapse for gamblers at risk of harms. The intervention typology is outlined in the figure, with written report details summarised in the table.
Tabular array Systematic review-level evidence of interventions to reduce the burden of gambling-related harms
| Review design | Setting | Target population | Intervention | Other inclusion criteria and search appointment | Outcomes assessed | Findings | Conclusion | Limitations and notes | |
|---|---|---|---|---|---|---|---|---|---|
| Demand reduction interventions | |||||||||
| Smashing et al (2017) 15
Systematic review of empirically evaluated school-based gambling didactics programs.
| Systematic review | School-based | Schoolchildren | Gambling education programmes | Quantitative analysis; not therapeutic setting, media entrada, public announcement, or website; search engagement: up to January, 2017 | Behavioural outcomes; cognitive outcomes (noesis, perceptions, and beliefs) | xix studies (xx papers); 20–500 min per programme (very varied); generally class cohort videos; ix studies measured behavioural outcomes and five showed positive effects; universal and targeted approaches | Non possible to establish whether cognitive improvements prevent development of gambling bug: fairly few youths chance at problematic levels and then difficult to appraise real-world outcomes; programmes should be universal and early-age focused | Methodological inadequacies: brief or no follow-up, no control, inconsistencies in measures of gambling behaviours; probable publication bias as large numbers of school programmes exist |
| Ladouceur et al (2013) 16
Prevention programmes for youth gambling: a review of the empirical evidence.
| Systematic review (described as critical review) | Universal and schoolhouse-based | Youths (aged ix–20 years) | Gambling-specific prevention programmes; gambling and related skills workshops | Search appointment not stated | Reducing gambling misconceptions; increasing gambling cognition | xv studies; programmes and workshops effective in reducing misconceptions and increasing knowledge about gambling in the brusk term | No positive effects on gambling behaviours or gambling-related bug; good strategies to raise awareness of problems; targeted preventive approaches required | Review reports private studies only—no synthesis; primary studies did not take long-term follow-up or behavioural outcomes |
| Kourgiantakis et al (2016) 17
Parent problem gambling: a systematic review of prevention programs for children.
| Systematic review | Any | Children or youth (not divers) | Problem gambling prevention programmes | Qualitative, quantitative, and mixed methods; published in English or French; search date: 2000–xiv | Increasing knowledge and modifying misconceptions about gambling; participant skills; gambling behaviour | 16 studies; all programmes were universal and did non target intended subgroups (ie, children of problem gamblers); virtually studies had unmarried postal service-test mensurate (1–3 months); most found increase in noesis and attitude measures; merely two studies showed change in gambling behaviour later intervention | No secondary or tertiary prevention programmes; no family-focused prevention | No study limitations reported |
| Supply reduction interventions | |||||||||
| Ginley et al (2017) 18
Alarm messages for electronic gambling machines: evidence for regulatory policies.
| Systematic review | Laboratory-based interventions; naturalistic studies | Gamblers | Gambling-related warning messages: limit setting, educational animations, cash expended displays, PFIs | On-screen or poster messages; search date: up to June, 2016 | Issue on gambling mental attitude, knowledge, or behaviour | 31 studies; static signs have minor efficacy; on-screen placement of pop-up messages appears to be of import and letters were more constructive if they interrupted play and required agile removal by the player; the most effective letters were brief, easy to read, and direct | Popular-upwards messages are largely supported and potentially reduced harm, particularly loftier-threat messages endorsed by medical and government agencies; greatest effect with messages nigh probable losses and social consequences; limit-setting and personal feedback reduced money spent and time gambling; participants were more likely to set time limits than money limits | Questions over transfer from laboratory (often 1 gambling interaction) to real life; reliance on self-reporting of bulletin event; no long-term follow-up |
| Ladouceur et al (2012) xix
Pre-commitment in gambling: a review of the empirical testify.
| Systematic review (described as critical review) | Electronic gaming machines | Individuals who gamble using electronic gaming machines | Pre-commitment systems for electronic gaming machines (expenditure and time limits) | Search appointment non stated | Self-reported measures of gambling | 17 studies; variable adherence to money and expenditure limits; few gamblers used time limits; suggests lxx% of gamblers positively predisposed to pre-commitment (but not clear where this figure comes from) | Pre-commitment systems testify potential promise for some gamblers, but no conclusive statement is offered | Individual studies only, no synthesis; unclear where discussion comes from; studies failed to control for concurrent gambling outside the trials (eg, other venues) |
| McMahon et al (2019) twenty
Furnishings of prevention and harm reduction interventions on gambling behaviours and gambling related harm: an umbrella review.
| Review of reviews | Any | Children and adults with or without a diagnosed gambling disorder (studies exclusively in individuals with a gambling disorder excluded) | Prevention and harm-reduction programmes for gambling: supply reduction, demand reduction, and harm reduction (harm minimisation framework) | Iv databases, inception to 2018; reviews including studies with or without controls; qualitative syntheses excluded; reviews met Database of Abstracts of Reviews of Evidence criteria; search date: up to May 1, 2018 | Influence on adequacy, opportunity, motivation–behaviour (COM-B framework); change in gambling-related behaviour or gambling harm; effects on population subgroups | 10 systematic reviews (55 studies); ane review found limiting opening hours and shutdown machines did non lead to positive outcomes; another review constitute that caps on gaming machines had no upshot; some support but overall mixed testify on youth prevention interventions, smoking bans, limit-setting, self-exclusion, prohibiting big notes, maximum bets, removal of cash machines; evidence of positive furnishings of machine letters and PFIs | Some weak back up for smoking bans, limit-setting, self-exclusion, prohibition of big notes, maximum bets, removal of greenbacks machines, car messages, and PFIs; overall quality of evidence is poor | Voluntary interventions express past user adherence to them and could have unintended negative consequences for high-take a chance gamblers; focus on individual reduction rather than supply reduction |
| Tanner et al (2017) 21
Damage reduction in gambling: a systematic review of industry strategies.
| Systematic review | Whatever | People of legal age to gamble (17-year-olds in laboratory-based studies included) | Industry or environmental-based strategies | Published in English; quantitative measures; general awareness and advertising excluded; PsycINFO and PubMed databases; search appointment: up to 2016 | Whatever | 27 studies included; mixed effects for mandatory limit-setting, smaller notes, on-screen clock or counter, smoking bans; by and large positive effects from removal of greenbacks machines; small effects of removing cash machines from venues; most researched area was pop-upwardly messages; self-appraisal messages were more constructive than information messages | Potential for positive effects of cocky-appraisement pop-up messages, US$one maximum bets, removal of large-note acceptors and greenbacks machines, reduced operating hours, and smoking bans; pop-up messages combined with mandatory budgetary limits might be effective | Studies are of poor quality, with reliance on self-reported measures |
| Therapeutic interventions | |||||||||
| Challet-Bouju et al (2017) 22
Cognitive remediation interventions for gambling disorder: a systematic review.
| Systematic review | Not specified | Trouble gamblers, according to DSM and ICD | Cognitive remediation (behavioural preparation intervention to meliorate cognitive processes aiming for durability and generalisation) | Therapeutic aim; search date: Jan, 2017 | Efficacy of interventions to reduce problem gambling | But i study identified; playmaker video game with biofeedback, designed to treat impulse command disorders; positive effect on impulsivity and expression of anger; no show of outcome on relapse | Research needed; cognitive remediation might be combined with unremarkably used interventions (such equally CBT or motivational interviewing) to brand therapeutic interventions more than effective and longer lasting than by itself, and subtract relapse | No study limitations are discussed in this paper; conclusion appears to be speculative |
| Luquiens et al (2018) 23
Cognitive training: a new avenue in gambling disorder direction?.
| Systematic review | Not specified | People with a gambling disorder | Cognitive training (neurocognitive approach for problem behaviours) | PubMed, Google, ClinicalTrials.gov database; no language restriction; reporting efficacy information; search appointment: up to 2017 | Any | No studies identified | No data currently regarding the effectiveness of cognitive training in gambling disorder | Authors argue the approach has potential |
| Chrétien et al (2017) 24
Cognitive restructuring of gambling-related thoughts: a systematic review.
| Systematic review | Not specified | Gamblers; mentions DSM pathological gambling in the paper | Cerebral restructuring (a class of CBT that treats gambling every bit the main problem) | In English or French; search engagement: 1980–2013 | Aims to depict how cognitive remediation is done with gamblers | 39 studies; 69·2% clearly reported therapeutic techniques to correct gamblers' thoughts; 47 treatments described: eight cerebral, 39 cognitive and behavioural; face to face (n=42) or self-handling by manual or internet (northward=5) | Cognitive restructuring seems to include the all-time practices of CBT; more inquiry needed | 39 studies did not describe the blazon of gambling; little detail of the intervention techniques used |
| Tolchard (2017) 25
Cerebral-beliefs therapy for problem gambling: a critique of current treatments and proposed new unified approach.
| Described as not a systematic review but used systematic searching and inclusion criteria | Any | Any | CBT or behavioural approaches (mostly exposure therapy or cerebral restructuring) | CINAHL, MEDLINE databases; search dates: 1980–2015 | Whatever | Unclear how many studies included; exposure therapy reported as being constructive in upward to 70% of cases; evidence on cerebral restructuring similarly positive for all types | Both cognitive and behavioural approaches tin can exist effective in reducing problem gambling; many interventions include elements of both | Studies not controlled; few studies; small-scale sample sizes; multimorbidity often excluded; unclear what active element in combined approaches is |
| Merkouris et al (2016) 26
Predictors of outcomes of psychological treatments for disordered gambling: a systematic review.
| Systematic review | Whatsoever | Adults and adolescents seeking treatment for a gambling disorder | Any psychological treatment (no pharmacological treatments) | Multiple databases; studies doing statistical tests and measurements after handling; published in English; primary studies; search date: 1990–2016 | Gambling behaviours (eg, expenditure, frequency or fourth dimension spent gambling), gambling symptom severity (eg, preoccupation with gambling, gambling urges, gambling impairment), and gambling-related problems (eg, health or financial difficulties) | 50 articles included from 33 studies; one-time age, being in a relationship, no gambling-related debt, small caste of pre-treatment gambling, low levels of booze use, low levels of depression, beingness in the activeness stage of change, being female, being Asian-American, and personality traits (eg, depression self-transcendence, novelty-seeking, avoidance, and persistence) together with higher numbers of treatment sessions attended was associated with better outcomes | Sociodemographic, psychosocial, and psychological characteristics are predictors of gambling treatment outcomes | Demand to consider during-treatment and post-treatment predictors, not simply pretreatment predictors; statistical significance rather than clinical significance |
| Petry et al (2017) 27
A systematic review of treatments for trouble gambling.
| Systematic review | Any | People with a gambling problem (based on clinical diagnosis or screening questionnaire assessment) | Whatever psychological intervention | Trials with random assignment; at least 25 participants per condition; published in English language; PubMed search engine; search date: up to September, 2016 | Gambling outcomes | 21 trials included; most studies found benefits from CBT (solitary or combined with motivational interviewing); interventions tin can be delivered individually or in groups, in person or via the internet; show that motivational interviewing is not constructive unless combined with CBT; brief advice or feedback might exist of benefit simply no better than other interventions and might not be suitable for those seeking treatment | At that place is prove that six to eight sessions or a chapter of CBT that integrates motivational interviewing, if the handling is entirely cocky-directed, for individuals seeking gambling treatment is effective at reducing gambling outcomes; for people with mild gambling problems, interventions involving feedback might suffice; studies found most interventions might be effective, with piffling deviation between them | Benefits reported in the short term, but few studies reported long-term follow-up; included populations differed substantially; most studies used waiting-listing controls; unclear whether interventions outperform natural recovery over long periods; controlled gambling might be more successful than abstinence so goals might be of import in outcomes |
| Cowlishaw et al (2012) 28
Psychological therapies for pathological and problem gambling.
| Systematic review (Cochrane) | Not specified; papers found were in community or outpatient settings | Pathological and trouble gamblers (male person and female of whatever age and ethnicity); included gamblers who were clinically diagnosed and self-assessed | Psychological therapies (CBT, motivational interviewing, integrative therapy, other psychological therapies) | Search engagement: up to October, 2011 | Gambling symptom severity; financial loss from gambling; frequency of gambling; occurrence of pathological gambling diagnoses; anxiety; depression | 14 studies; at 3 months after handling, CBT showed beneficial effects on gambling symptom severity and fiscal loss (n=11); at half dozen–12 months, motivational interviewing showed a significant effect in terms of gambling frequency (n=4); other interventions had very pocket-size numbers of studies | Supports short-term efficacy of CBT in reducing gambling behaviour after treatment; preliminary evidence for some benefits from motivational interviewing | Studies varied in quality; long-term benefits unclear; inadequate concerning relapse; studies had few exclusion criteria and various types of preferred gambling method |
| Yakovenko et al (2015) 29
The efficacy of motivational interviewing for matted gambling: systematic review and meta-analysis.
| Meta-assay | Any | Developed disordered gamblers | Motivational interviewing; most studies were one session face to face | Multiple databases; no linguistic communication restrictions; RCTs with command group of no intervention or no MI (an alternative intervention was provided to the control group); search date: 1966–2013; | Gambling frequency or gambling expenditure (most studies used mean days per month or mean dollars lost per month) | V studies included in meta-analysis, published in 2001–09; meaning reduction in gambling frequency per month at half dozen-calendar month follow-up (mean departure −i·22 days per month, 95% CI −2·06 to −0·38, p<0·05); also significant at ix-calendar month to 12-month follow-upwardly (−1·12 days per month, 95% CI −two·16 to −0·07, p<0·05); no significant reduction in gambling expenditure at 6 months (p=0·07) or ix–12 months (p=0·xv) | Prove of positive (but clinically modest) consequence of motivational interviewing on reducing gambling frequency; authors as well conclude there is evidence for a reduction in gambling expenditure just the data presented shows a non-significant issue | Difference between author determination on effects on both outcomes and analysis presented; authors highlight small number of studies and limitations in measurement comparability between studies |
| Peter et al (2019) 30
A meta-analysis of cursory personalized feedback interventions for problematic gambling.
| Meta-analysis | Minimal or no direct contact or in-person contact | Unclear | Brief PFIs (maximum one session); studies outlined behavioural feedback or psychological measure feedback | Published in English; peer-reviewed studies with random allotment to a comparator condition; included 1 other systematic review; multiple databases; search engagement: upward to 2016 | Behavioural gambling data; measures of gambling problems; | 11 studies included, detailing xvi types of intervention; modest only statistically significant issue of PFIs (d=0·20, 95% CI 0·12–0·27); strongest predictor of effect size was the inclusion of pedagogy, followed past use of motivational interviewing; providing feedback on a psychological mensurate and therapist delivery of the intervention negatively predicted effect size | Gambling-focused PFIs serve as a viable harm-reduction strategy; interventions should include behavioural descriptions of an individual'south own gambling behaviour paired with normative comparisons; interventions that are not in person are more effective and cost-effective than in-person interventions in the absenteeism of motivational interviewing | Only short-term effects examined |
| Quilty et al (2019) 31
Cursory interventions for problem gambling: a meta-analysis.
| Systematic review and meta-analysis | All settings (eg, academic institutions, health-care settings, and community settings) apart from grouping, phone, and online settings | Problem gamblers older than 16 years | In-person brief interventions for gambling behaviours and problem gambling | RCTs; brief intervention of no more than three sessions; search date: 1990–Sept 1, 2017 | Gambling behaviour (presence or absence, frequency, severity); associated problems | 5 studies; small only statistically pregnant reduction in gambling behaviour in brusque term vs assessment-only control; not significant for long-term changes (elapsing unclear); no difference between short and long interventions | Supports the efficacy of brief interventions for trouble gambling over the brusque term; no deviation betwixt brief and long interventions | Few studies; but iv research teams; many had fewer than 25 participants per treatment condition; all done in Northward America |
| Chebli et al (2016) 32
Cyberspace-based interventions for addictive behaviours: a systematic review.
| Systematic review | Online | Treatment-seeking adults | Net-based therapeutic interventions in conjunction with clinical assistance (might be real-time or delayed [eg, chat vs e-mail]) | Excluded cocky-assistance programmes with no therapist input; search engagement: upwardly to May, 2015 | Effectiveness in treating addictive behaviour; follow-upwards period; therapist contact throughout the plan; psychological distress and psychopathology | 16 studies; iv considering pathological gambling (not defined); all interventions were CBT; three non-comparative studies and 1 RCT; favourable changes in pathological gambling sustained at follow-upwardly (maximum 3 years) | Positive treatment outcomes reported for all gambling studies with respect to gambling behaviour | Three studies did not have control and comparison groups; no effect sizes reported; no meta-analyses |
| van der Maas et al (2019) 33
Internet-based interventions for problem gambling: scoping review.
| Scoping review | Online | Any; near studies drew participants from users of gambling aid websites | Internet or online interventions for problem gambling (either exclusively or equally a component); CBT in six of 27 studies, most of which continued clients to mental health counselling | Six databases; search appointment: 2007–17 | Included whatsoever outcomes; studies reported trouble-gambling scores, gambling behaviour, anxiety and low, gambling frequency, faulty cognitions surrounding gambling and booze consumption, distress | 27 studies included; most studies reported improved problem gambling outcomes, including v of 7 RCTs | Internet-based interventions are effective for trouble gambling and offer a modified form of existing therapies | High rates of attrition; variance in the way people used interventions; internet gives easier and more flexible admission to mental health professional person aid; absence of studies in marginalised groups |
| Comparing handling interventions | |||||||||
| Goslar et al (2018) 34
Efficacy of contiguous versus self-guided treatments for disordered gambling: a meta-analysis.
| Systematic review and meta-assay | Clinic and habitation | Adults with pathological gambling or problem gambling disorder (DSM-five) | Psychological treatments: contiguous vs self-guided treatment to reduce problematic gambling behaviour | RCT (or quasi-RCT); search date: upward to April 30, 2018 | Global severity of disordered gambling; frequency of gambling; terminal loss from gambling at 0–iii months | 27 studies; significantly college result sizes for face up-to-face treatments in reducing problematic gambling behaviour; intensity of treatment chastened the effect simply non type of intervention | Face-to-face up treatment finer reduced frequency and financial loss from gambling at 0–3 months after treatment; results from self-guided treatment were significantly inferior; individuals who gambled electronically benefited the most | Most studies were on electronic gambling; few studies; participants varied in terms of gambling severity |
| Rodda et al (2018) 35
Therapist-delivered and self-help interventions for gambling issues: a review of contents.
| Systematic review and content assay | Not specified (included studies from community, university, and dispensary settings) | Adult gamblers or problem gamblers | Psychological and cocky-assistance interventions | RCT, quasi-RCT, or cross-over RCT; search date: January, 1980–April, 2016 | Gambling symptom severity; gambling frequency; gambling expenditure | 46 studies; psychological and cocky-help interventions; 35 intervention characteristics to define type of alter technique, participant, written report, intervention delivery and conduct, and evaluation (eg, control grouping); most (30 studies) were delivered by a therapist without a cocky-help element | Review assists in identifying and describing components of interventions, but farther work is needed to identify categories of technique types and delivery characteristics associated with good outcomes | Machinery of change rarely identified in study reports |
| Self-help and common-support interventions | |||||||||
| Drawson et al (2017) 36
The apply of protective behavioural strategies in gambling: a systematic review.
| Systematic review | Non specified | Adult gamblers | Cocky-aid: harm reduction through protective behavioural strategies (eg, self-exclusion, time and, monetary limits, cashless cards) | Actual or perceived benefits of protective behavioural strategies; search appointment: up to August, 2015 | Reducing harms associated with gambling; gamblers' reported views (perceived benefits) | 33 studies; prove was weak; self-exclusion nearly often endorsed by gamblers but many returned to gambling afterward the exclusion period; gambling frequency, duration, expense, debt, and urge were reduced at 12 months | Self-exclusion was accounted the most promising strategy, but evidence was poor; self-exclusion might not be enforced past casinos | Study quality was low; quality analysis was not done as all studies would be excluded |
| Marchica and Derevensky (2016) 37
Examining personalized feedback interventions for gambling disorders: a systematic review.
| Systematic review | Any | No restrictions reported; most studies were in problem or at-risk gamblers, with three in academy students | PFIs | Included a comparator group; published in English; multiple databases; search engagement: 2003–fifteen | Gambling prevention or reduction | Vi studies included; all studies reported some reduction in a range of gambling behaviour outcomes just not all were significant; reduction in perceived norms | PFIs might be an effective intervention for changing perceptions of gambling and reducing at-take a chance problem gambling; altering perceived norms is a factor in change pathways | Half of studies in at-risk student populations; varying outcome measures |
| Schuler et al (2016) 38
Gamblers anonymous as a recovery pathway: a scoping review.
| Scoping review | Any | Adults and adolescents with identified bug with gambling | Gamblers Bearding (attending meetings or being a member); excluded if embedded in a treatment | Multiple databases; any design; search date: 2002–15 | Any | 17 studies in 25 publications; 4 RCTs showed reductions in fourth dimension, money, or symptoms; Gamblers Anonymous plus stress management was more than constructive than Gamblers Anonymous alone; imaginal desensitisation plus motivational interviewing was more constructive than Gamblers Anonymous; CBT was more effective than Gamblers Anonymous; in one RCT, although Gamblers Anonymous was less effective at month ii, by the 12-month follow-up, all interventions were every bit successful in terms of abstinence or gambling reduction | Bear witness for the effectiveness of Gamblers Bearding is inconsistent; in comparisons, other interventions might be more than successful; attendance at meetings and participation were of import factors (different type of person might nourish meetings to different extents) | Sparse evidence regarding outcomes from Gamblers Anonymous; studies were included that had Gamblers Anonymous as a command or an intervention group |
| Shonin et al (2013) 39
Buddhist philosophy for the handling of problem gambling.
| Systematic review | Any | Healthy adults | Buddhist-derived interventions or meditation techniques; includes mindfulness-based cognitive therapy | Multiple databases; published in English; search date: up to 2012 | Trouble gambling; force of relationships | Four included studies; all focused on mindfulness meditation; reported reduction in gambling severity, thought suppression, anxiety, and distress | Mindfulness therapies based on Buddhist philosophies accept potential for reducing problem gambling; potential for these approaches to lead to decreased relapsing | Cross-sectional and instance-study research only; few studies |
| Pharmacological interventions | |||||||||
| Bartley and Bloch (2013) xl
Meta-assay: pharmacological treatment of pathological gambling.
| Systematic review and meta-analysis | Clinical | Adult pathological gamblers | Pharmacological treatments: opioid antagonists, antidepressants, antipsychotics, and topiramate | RCT; search date: 1965–2013 | Endpoint score on a rating scale used to mensurate gambling severity | 14 studies; small just significant do good for opioid antagonists vs placebo; not-significant do good for antidepressants, antipsychotics, and topiramate vs placebo | Available treatments at best have minimal benefit compared with placebo; few data to suggest efficacy of any pharmacological treatment for problem gambling | Flawed early on trials of opioid antagonists suggested significance (non intention-to-treat trials); few trials |
| Lupi et al (2014) 41
Pharmacological treatments in gambling disorder: a qualitative review.
| Systematic review | Any | Pathological gamblers | Pharmacological treatments: antidepressants, opioid antagonists, and mood stabilisers | Multiple databases; published in English language; reviews, trials, and case reports; search engagement: up to 2013 | Any | 75 papers included; conflicting findings for antidepressants (more effective than placebo in 3 of seven studies); opioid antagonists showed promising results (more effective than placebo in iv of v studies); weak evidence for mood stabilisers and atypical antipsychotics (more effective than placebo in ane of four studies) | Pharmacological interventions are promising | Picayune known most mechanisms of action, combinations might be worthwhile to study; studies all in people who had requested help |
| Goslar et al (2018) 42
Pharmacological treatments for disordered gambling: a meta-analysis.
| Systematic review and meta-assay | Clinical | Adults; average age 43 years | Pharmacological treatments (including with psychological treatment at the same fourth dimension) | RCT (or quasi-RCT); not secondary to a medical status (eg, Parkinson's); no search date reported | Global severity of gambling, frequency of gambling, and financial loss from gambling | 39 studies; treatments associated with big and medium pre-mail reduction in global gambling severity and frequency, and financial loss; no advantage of any medical drug class over another; pocket-sized and non-pregnant advantage of combined treatment vs pharmacological treatment alone | Various medications are constructive for the direction of gambling behaviour; authors suggest no pharmacological handling is superior to another, and there is potential additional do good from combination with psychological therapy | Few meta-analyses; varying methodological quality; weak evidence |
| Grant et al (2012) 43
Pharmacological treatment of pathological gambling: opioid antagonists and other addiction-related pharmacological treatments.
| Systematic review | Not specified | Pathological gamblers | Pharmacotherapeutic gambling interventions (eg, opioid antagonists, glutamatergic agents, antidepressants, antipsychotics, mood stabilisers) | Not stated | Not stated; very sparse information on review methodology | xviii double-bullheaded, placebo-controlled trials; opioid antagonists and glutamatergic agents were well-nigh promising; antidepressants, antipsychotics, and mood stabilisers showed mixed results | Opioid antagonists are the most promising treatment | Small sample sizes; non-representative groups (eg, without co-occurring psychiatric disorder) |
| Victorri-Vigneau et al (2018) 44
Opioid antagonists for pharmacological handling of gambling disorder: are they relevant?.
| Systematic review | Any | Pathological gamblers, problem gamblers; individuals with gambling or addictive-like disorders (unclear inclusion criteria) | Treatment with opioid antagonists (ie, naltrexone and nalmefene) | PubMed, PsycINFO, Cochrane databases; whatsoever written report blueprint, including reviews and stance pieces; no engagement restrictions; | Any, including urges to gamble and gambling episodes | 34 articles included; 7 RCTs with iv indicating positive furnishings, 2 non-significant differences, and i but a weak effect; prove is weak simply supports opioids having potential every bit a treatment either alone or in conjunction with other behavioural interventions | Opioids are effective in reducing gambling disorders, particularly in people with a history of alcohol use disorder or strong gambling tendencies | Treatment outcome is on underlying addictive susceptibility rather than gambling behaviours; well-nigh all studies excluded people with psychiatric comorbidities, although these people are a large proportion of the population; high brusk-term response to placebo noted in several studies |
CBT=cognitive behavioural therapy. CINAHL=Cumulative Alphabetize to Nursing and Centrolineal Health Literature. DSM=Diagnostic and Statistical Manual of Mental Disorders. ICD=International Nomenclature of Diseases. PFI=personalised feedback intervention. RCT=randomised controlled trial.
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Whole-population preventive interventions
Demand reduction
The interventions to reduce need identified past our searches were limited to interventions delivered to children and immature people. Three reviews reporting school-based educational activity programmes were identified.
,
,
Bully and colleagues
identified 19 studies of school-based education programmes for gambling. Programmes ranged from 20 to 500 min in length and typically consisted of videos viewed by whole classes. Nine studies measured outcomes related to gambling behaviour, of which five showed positive effects. Follow-upwardly for about studies was brusque, and definitions of gambling-related damage and measures of gambling behaviour varied betwixt studies. Ladouceur and colleagues
reviewed both school-based programmes for the prevention of gambling-related harms, and gambling and related skills workshops to prevent gambling-related harms for youths (anile 9–twenty years). The authors reported that programmes and workshops were both effective in reducing misconceptions and increasing knowledge about gambling in the short term, merely a scarcity of long-term follow-up was noted. Kourgiantakis and colleagues
aimed to place programmes for the prevention of gambling-related harms that targeted children of gamblers. Nonetheless, the xvi studies that they identified were all universal interventions and did not target their population of interest. Kourgiantakis and colleagues also reported a scarcity of long-term follow-up (no more than 3 months in nigh cases).
Review-level evidence on demand reduction interventions therefore, although sparse, suggests probable benefits of better gambling knowledge and attitudes of young people in the short term. However, little evidence regarding longer-term benefit exists. Establishing whether interventions are able to prevent the development of gambling-related harms in youths remains difficult.
Supply reduction
We identified four systematic reviews of interventions that aimed to facilitate gamblers themselves to restrict their gambling activity. Ginley and colleagues
eighteen
- Ginley MK
- Whelan JP
- Pfund RA
- Peter SC
- Meyers AW
Warning messages for electronic gambling machines: evidence for regulatory policies.
- Crossref
- Scopus (20)
- Google Scholar
reviewed on-screen and poster alarm letters related to gambling (limit-setting messages, educational animations, greenbacks-expended displays, and personalised feedback) in both laboratory-based then-chosen naturalistic studies (n=31). The review indicated that static signs have poor efficacy, but that pop-up letters can potentially reduce harm, peculiarly high-threat messages endorsed by medical or government agencies. Ladouceur and colleagues
reviewed pre-commitment systems for electronic gaming machines. The studies (n=17) found variable adherence to time limits. Importantly, these studies failed to control for concurrent gambling outside the trial venues. McMahon and colleagues
xx
- McMahon N
- Thomson K
- Kaner E
- Bambra C
Effects of prevention and damage reduction interventions on gambling behaviours and gambling related damage: an umbrella review.
- Crossref
- PubMed
- Scopus (38)
- Google Scholar
did a review of reviews on prevention and harm-reduction programmes for gambling in adults and youths, with and without a diagnosed gambling-related status. They identified ten systematic reviews that met their inclusion criteria (n=55 studies). They reported some support for smoking bans, limit-setting messages, self-exclusion, prohibition of big notes, maximum bets, removal of cash machines, machine letters, and personalised feedback interventions just stated that the evidence overall was poor. Tanner and colleagues
evaluated industry and environment-based strategies for the prevention of gambling-related harms (n=27 studies). They constitute mixed effects for mandatory limit-setting, smaller notes, on-screen clocks or counters, and smoking bans, only by and large positive effects for removal of greenbacks machines. Equally with the other reviews, the authors reported that studies were of poor quality, and in that location was a reliance on self-reported measures.
Up-to-date review-level evidence exists, therefore, for gambling interventions that encourage individual gamblers to restrict their own gambling, with on-screen pop-up messages appearing to be the about promising approach identified, especially loftier-threat messages endorsed by medical or government agencies. However, no reviews were institute that considered adherence to or regulation of enforcement interventions by these agencies. Little testify to back up industry supply-reduction initiatives was found.
Targeted interventions for individuals at increased risk of damage
Therapeutic interventions
12 reviews considered different types of therapeutic interventions for gamblers at risk of harm, including cognitive and behavioural therapies, motivational interviewing, psychological therapies in general, cursory psychological interventions, self-help and common-support interventions, and internet-based therapies.
Challet-Bouju and colleagues
considered cerebral remediation interventions to reduce gambling-related harms only just identified one written report. Similarly, Luquiens and colleagues
reviewed cognitive grooming interventions but did not notice any studies. Chrétien and colleagues
reviewed cognitive restructuring interventions, a type of cognitive behavioural therapy (CBT), and identified 39 studies, just their review aimed to depict how the interventions were implemented with gamblers rather than evaluate effectiveness. Tolchard
reviewed studies of CBT or behavioural approaches, or both, including exposure therapy and cognitive restructuring. He suggested that both cerebral and behavioural approaches can be effective in reducing gambling-related harms. Notwithstanding, despite the use of systematic searching and inclusion criteria, this paper provides no clear indication of the volume of show considered. In a farther report, Merkouris and colleagues
reviewed all psychological treatments for adults seeking handling for a gambling disorder and identified 50 papers reporting 33 studies. They reported that higher numbers of treatment sessions attended was associated with amend gambling behaviour outcomes, and a range of socioeconomic factors also predicted treatment outcomes.
Petry and colleagues
reviewed whatsoever psychological intervention for gambling (clinically or cocky-diagnosed). They included 21 trials and suggested that there is evidence regarding do good from CBT alone or in combination with motivational interviewing simply non from motivational interviewing alone. The authors also highlighted the scarcity of long-term follow-upward. Cowlishaw and colleagues
28
- Cowlishaw S
- Merkouris S
- Dowling N
- Anderson C
- Jackson A
- Thomas S
Psychological therapies for pathological and problem gambling.
- PubMed
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as well considered psychological therapies, including CBT, motivational interviewing, and integrative therapy. Their review identified 14 studies, of which xi suggested that, at 3 months after handling, CBT showed beneficial furnishings on gambling symptom severity and financial loss; nevertheless, longer-term benefits were unclear. Yakovenko and colleagues
29
- Yakovenko I
- Quigley L
- Hemmelgarn BR
- Hodgins DC
- Ronksley P
The efficacy of motivational interviewing for disordered gambling: systematic review and meta-analysis.
- Crossref
- PubMed
- Scopus (75)
- Google Scholar
reviewed motivational-interviewing interventions (generally 1 contiguous session) in adult and so-called disordered gamblers and reported a significant reduction in gambling frequency per month at six-month follow-upward (mean divergence −1·22 days per month; 95% CI −2·06 to −0·38; p<0·05), and also at 9-month to 12-month follow-up (−1·12 days per calendar month; 95% CI −two·16 to −0·07; p<0·05). However, they found no significant reduction in gambling expenditure at half-dozen months (p=0·07) or 9–12 months (p=0·15).
2 reviews considered brief psychological interventions for gambling-related harms. Peters and colleagues
establish that, in brief interventions of ane session, the strongest predictor of short-term positive effect was the inclusion of an educational chemical element, followed by motivational interviewing (northward=11 studies). By contrast, Quilty and colleagues
defined brief interventions as interventions that terminal no more than 3 sessions and found evidence of a small but meaning reduction in gambling behaviour in the brusk term.
The terminal 2 reviews in the group examining targeted treatments evaluated the testify for internet-based therapies for gambling-related harms. Chebli and colleagues
considered interventions that combined online therapeutic interventions with clinical assistance (via real-time chat or follow-upwardly email) for adults seeking treatment. Simply four of 16 studies considered pathological gambling. All studies evaluated CBT-based interventions and reported that favourable changes in gambling behaviours were sustained upwards to three years after intervention. van der Maas and colleagues
reviewed internet-based interventions for gambling. Of 27 studies, virtually reported positive gambling outcomes, although only five of seven randomised controlled trials did so, and high rates of attrition were reported in some studies.
A considerable number of reviews of therapeutic interventions for gambling have been done in recent years. Despite this number, the evidence simply indicates positive outcomes in the curt term, with little evidence to support longer term effects or to favour 1 therapeutic intervention or manner of delivery over another.
Studies comparing targeted treatments
Goslar and colleagues
compared face-to-face with self-guided therapy. 27 studies, mostly on electronic gambling, indicated college event sizes for contiguous treatments in reducing gambling behaviour (frequency and financial loss) at three months than event sizes for self-guided therapy. The intensity of treatment moderated the result merely the type of intervention did not. Sample sizes were small, and studies varied in terms of participant gambling severity. Rodda and colleagues
35
- Rodda S
- Merkouris SS
- Abraham C
- Hodgins DC
- Cowlishaw S
- Dowling NA
Therapist-delivered and self-assistance interventions for gambling bug: a review of contents.
- Crossref
- PubMed
- Scopus (16)
- Google Scholar
identified 46 studies of 35 psychological and self-help interventions. However, they did a content analysis of the blazon of modify technique used in the interventions and did not consider effectiveness as an outcome measure. Therefore, there is lilliputian evidence available to compare one type of targeted intervention with another for reducing gambling behaviours.
Self-assist and mutual-support interventions
4 reviews evaluated interventions that can exist characterised as taking a self-aid or common-support arroyo to managing gambling-related harms. Drawson and colleagues
36
- Drawson AS
- Tanner J
- Mushquash CJ
- Mushquash AR
- Mazmanian D
The employ of protective behavioural strategies in gambling: a systematic review.
- Crossref
- Scopus (21)
- Google Scholar
considered self-help interventions that aimed to reduce gambling behaviours through protective behavioural strategies such as cocky-exclusion, time and monetary limits, and cashless cards (instigated past the private, not the service provider). Although they identified 33 studies, they reported that bear witness was limited by depression report quality. Self-exclusion was mostly endorsed by gamblers, but many returned to gambling afterwards the exclusion period, and self-exclusion was not enforced by the casinos. Withal, gambling frequency, duration, expense, debt, and urge were reduced up to 12 months afterward the intervention. Marchica and Derevensky
considered personal feedback interventions for gambling. Half dozen studies, including three with academy students, reported some reduction in a range of gambling behaviour outcomes and change in perceived norms around gambling behaviours. Schuler and colleagues
reviewed Gamblers Anonymous meetings every bit a treatment for gambling behaviours. 17 studies in 25 publications (including four randomised controlled trials) showed a reduction in fourth dimension and money spent on gambling. Even so, the review found that Gamblers Anonymous coupled with stress management was more than effective than Gamblers Anonymous alone. The authors noted that attending meetings (rather than participating online) was important in achieving optimal outcomes. The review concluded that motivational interviewing and CBT combined were more effective than Gamblers Anonymous. Shonin and colleagues
reviewed interventions derived from Buddhist philosophies or meditation techniques. The four included studies (cross-sectional and example studies) focused on mindfulness meditation with reported reductions in gambling severity, thought suppression, anxiety, and distress.
Drawing any articulate conclusions from the review-level testify for self-help interventions is difficult because of the diversity of interventions and a focus on adequately curt-term cocky-reported behaviour change rather than long-term outcomes or directly measures of impairment.
Pharmacological interventions
5 papers compared outcomes of pharmacological treatments for medically diagnosed gambling habit and gambling-related harms (the evidence generally came from randomised controlled trials). The drugs nether consideration included opioid antagonists, glutamatergic agents, antidepressants, antipsychotics, mood stabilisers, and topiramate (an anticonvulsant).
Bartley and Bloch
compared opioid antagonists with placebo, identifying small benefits in fourteen studies. Non-significant benefits were reported for antidepressants, antipsychotics, and topiramate versus placebo. However, the authors noted that early opioid trials were flawed because they did not use intention-to-treat analyses; therefore, the results might be skewed. Lupi and colleagues
identified 75 papers with conflicting findings for antidepressants, opioid antagonists, and mood stabilisers, and concluded that pharmacological interventions are promising for the treatment of gambling. More recently, Goslar and colleagues
identified 39 studies and reported pre-post reduction in global gambling severity, frequency, and financial loss but did not observe an advantage for whatever one blazon of pharmacological treatment over another. They note a small, non-meaning advantage for combining a therapeutic handling with a pharmacological intervention. Grant and colleagues
43
- Grant J
- Odlaug BL
- Schreiber LRN
Pharmacological handling of pathological gambling: opioid antagonists and other habit-related pharmacological treatments.
- Crossref
- Google Scholar
reviewed eighteen randomised controlled trials and suggested that opioid antagonists and glutamatergic agents might be the virtually promising treatments. However, the studies were small and the review method was not robust. In the fifth review in this group, Victorri-Vigneau and colleagues
reviewed handling with the opioid antagonists naltrexone and nalmefene. They identified 34 articles including 7 randomised controlled trials, of which 4 showed positive furnishings. The authors hypothesised that pharmacological treatment is interim on underlying susceptibilities (eg, booze use disorder) as opposed to the gambling behaviour itself.
Therefore, as with the previous types of interventions, there is no conclusive bulletin to support or abnegate the effectiveness of pharmacological interventions to reduce harm related to gambling behaviour. It is likewise not possible from the evidence identified to confidently recommend one drug treatment over another.
Discussion
Our mapping review of interventions to accost or foreclose gambling-related harms identified systematic reviews evaluating whole-population preventive interventions and targeted interventions for individuals at loftier risk of gambling-related harms. Gambling-related harms are a fairly new concept with most of the literature focusing on and then-called trouble gamblers. This concept implies that interventions to address gambling-related harms should focus on changing the behaviour of individuals rather than on addressing the underlying causes of harmful behaviour that are related to gambling policies or provision. Moreover, gambling is different to other harmful behaviours, such as tobacco and alcohol consumption, for which a much more straight relationship has been established betwixt the behaviour and risk of experiencing harm. Although studies of interventions to accost and then-called problem gambling or target problem gamblers tin can inform progress in preventing and treating gambling-related harms, information technology is important to admit the limitations of these terms in addressing gambling-related harms at a societal or population level.
Although there have been some contempo reviews, show from the primary literature remains sparse and weak, and review authors struggled to make conclusive statements near the evidence they examined, in terms of clear back up for any specific types of intervention or for relative superiority of detail interventions or approaches over others. In addition to the weak study designs, the mapping-review method itself is restricted in scope in comparison with a complete systematic review
and, as a issue, findings should be treated with caution. Still, given the demand to accelerate gambling as a public health priority and the beingness of a volume of relevant review-level prove, this type of review remains an efficient way to consider and synthesise the electric current evidence base.
Review-level bear witness was identified for gambling interventions that can reduce opportunities for potentially harmful gambling and for interventions that can reduce demand through information provision or educational programmes. However, the scope of interventions is restricted and the quality of bear witness for reported effectiveness is very poor. Ii clear gaps were identified in the review-level evidence. Firstly, screening interventions to identify individuals at hazard of gambling-related harms who would benefit from brief interventions or referral to specialist treatment services. Secondly, bear witness for on-going support after treatment for gambling-related harms. With show to suggest that well over half of all incident problem-gambling cases are previous trouble gamblers who are relapsing,
this absence of support is an important omission. Further reviews of the chief report evidence for these two intervention approaches could clarify the current show base.
A policy report
46
- Livingstone C
- Rintoul A
- de Lacy-Vawdon C
- et al.
Identifying effective policy interventions to prevent gambling-related harm.
- Google Scholar
has highlighted the complexity in addressing gambling-related harms merely did not synthesise the testify for intervention effectiveness. The authors emphasise the need for multifaceted and systemic interventions, including restrictions on advertisement and marketing, changes to the structure of the industry and regulatory frameworks, and the tacking of industrial influence on inquiry. These interventions would be needed to back up the public health approaches considered in this Review.
Previous experience suggests that the gambling industry volition strongly resist and argue against proposals to innovate interventions that might regulate or restrict their commercial activities. Common arguments from commercial interests include the suggestion that the complexity of the human relationship between gambling action and associated harms and the scarcity of robust evidence of effectiveness are rationales for delaying policy interventions until better show is available.
47
- Knai C
- Petticrew Grand
- Douglas Northward
- et al.
The public health responsibility deal: using a systems-level analysis to understand the lack of impact on alcohol, nutrient, concrete activeness, and workplace wellness sub-systems.
- Crossref
- Scopus (22)
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The systems approach adopted for the project overall ensured that the mapping review considered evidence at all levels and all points in the systems connecting gambling activity to gambling-related harms. This approach meant we could identify where there were specific gaps in the show. It is, therefore, imperative to ensure that a scarcity of evidence is non used as a justification for inaction in addressing the growing burden of gambling-related harms. Instead, although activeness still needs to exist based on the best available evidence, implementation needs to be accompanied by a comprehensive evaluation of both the intended and unintended consequences. This arroyo will, in time, let the current deficiencies in the evidence base to be systematically addressed.
Contributors
LB was co-pb reviewer and the pb author for the manuscript, and contributed to data assay and interpretation. SB was co-lead reviewer and contributed to data analysis and estimation. HBW was literature search lead and provided comments on drafts of the manuscript. EG was strategic project lead and provided comments on drafts of the manuscript.
Proclamation of interests
We declare no competing interests.
Acknowledgments
Nosotros thank all our Patient and Public Involvement participants for their contribution to this work.
Supplementary Fabric
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