Scientific Scrutiny Accompanies Expansion of Self-Exclusion Programs

In just two years, the self-exclusion landscape has shifted, as an increasing number of gaming jurisdictions and gaming companies have embraced the idea of allowing casino patrons to limit their own access to gaming opportunities in an effort to curb disordered gambling.

In 2002, five of the 11 casino states in the United States had state-mandated programs, and a handful of gaming companies - most notably Harrah's - had introduced property-based self-exclusion efforts.

Currently, seven U.S. casino states - Illinois, Iowa, Louisiana, Michigan, Mississippi, Missouri and New Jersey - have some form of state-mandated self-exclusion program in place. The recently implemented American Gaming Association (AGA) Code of Conduct for Responsible Gaming includes a provision that calls for every member company to allow patrons who have a gambling problem to self-exclude themselves from gaming activities. And, the expansion of legalized gaming outside the United States has led to the development of self-exclusion programs in international gaming jurisdictions including South Africa, Poland, France, Switzerland and the Netherlands.

Self-exclusion programs vary widely across borders in terms of their administration and the number of years a person remains on the self-exclusion list once he signs on to the program. In Missouri, which has the oldest state-administered self-exclusion program in the United States, individuals who place themselves on the List of Disassociated Persons remain on the list for life, while other states allow for shorter alternatives to the lifetime ban.

Programs also vary according to the scope of their provisions. According to the AGA Code of Conduct, all member companies must include opportunities for patrons to request to be removed from promotional mailing lists and to revoke privileges for casino services such as casino-issued markers, player club/card privileges and on-site check-cashing.

The expansion of self-exclusion programs across the country and around the world has led addictions researchers to increase their focus on the issue, investigating the effectiveness of the programs and analyzing how self-exclusion participants may help public health officials better allocate resources to combat problem gambling.

Exploring a New Model for Self-Exclusion

A team of international scientists from the University of Sydney in Australia, Laval University in Quebec, Canada and the University of Missouri in the United States, recently completed an analysis of self-exclusion efforts, including a detailed look at barriers that diminish the effective implementation of current programs as well as specific recommendations for a new model to overcome those barriers.

According to "Self-Exclusion: A Gateway to Treatment," barriers to the effectiveness of international self-exclusion programs include the fact that many programs are not integrated with other interventions designed to assist pathological gamblers. The researchers also noted a lack of clarity in the definition of roles and responsibilities of the individuals and industries involved in the self-exclusion programs, and faulted the programs for primarily focusing on external controls of an individual's behavior as well as for adopting a punitive approach to limiting gambling behavior. Additionally, they noted there are perceived conflicts of interest between a venue gaining revenue from a patron and excluding that person from continued gambling that have yet to be addressed.

To overcome these inadequacies, the researchers propose a new model for self-exclusion programs that shifts from a punitive approach to an integrated, individual-centered focus where emphasis is placed on the self-exclusion process as a gateway to further education and treatment for problem gambling. In addition, the new model would reduce conflicts of interest and increase transparency over the implementation and monitoring of self-exclusion programs by allowing them to be operated by independent "educators."

According to researchers, the roles and responsibilities of these educators would include informing individuals of the purposes of self-exclusion, establishing links and a gateway for access to supplementary psychological counseling services and monitoring and reporting on the effectiveness of the overall program.

Missouri Self-Exclusion Study

While the international team of researchers focused analysis on the effectiveness of self-exclusion, preliminary findings of a recent research study of the Missouri Gaming Commission's List of Disassociated Persons indicate that self-exclusion programs may actually hold the key to more effectively targeting public health resources for problem gamblers.

According to an analysis by Harvard Medical School's Division on Addictions, it is possible to use self-exclusion numbers to determine the disordered gambling prevalence rates both on a statewide basis, and, more importantly, at the county level. According to the study authors, this means Missouri public health officials can use readily available self-exclusion program enrollment information to systematically update estimated prevalence more efficiently, accurately and economically.

This would allow public health officials, regulators and lawmakers to track levels of disordered gambling and determine appropriate prevention and treatment strategies on a more timely basis.

In addition to providing timely information, the self-exclusion data is considered a more accurate index because research on gambling and other addictions shows that treatment seeking, not prevalence, is a direct indicator of treatment need, and self excluders are a help-seeking group.

Establishing the relative prevalence rates is important, according to the researchers, because it will help define the need for treatment at the county level and provide accurate information to use in reducing the impact of disordered gambling on public health. The current methods of establishing prevalence rates make it economically unviable to review rates frequently and are unable to provide the county-level information the Harvard approach provides.

Results of the Harvard study represent Phase I of a two-part study of Missouri's self-exclusion program. The objective of Phase I was to determine the relative prevalence of gambling disorders in Missouri's counties and the city of St. Louis. Researchers noted that, while the new findings are specific to Missouri, they are confident that, upon completion, the full study will provide valuable guidance to other states.

Phase II of the study will begin this fall and will focus on determining the effectiveness of the Missouri self-exclusion program for helping people resolve their gambling problems, what modifications might improve the program's impact and what other assistance would improve healthy responses to combating gambling-related problems.

The Harvard study was made possible by a competitive grant from the Port Authority of Kansas City's Problem Gambling Fund. Partial support came from the Institute for Research on Pathological Gambling and Related Disorders, a program of the Harvard Medical School Division on Addictions; the National Center for Responsible Gaming; and the Missouri Gaming Commission.