01.05.2014 Help for people who gamble excessively

Preventing addictive gambling. Addictive gambling, or gambling disorder, is a growing social problem. In Switzerland, about three percent of the population, i. e. some 250,000 people, are directly affected; if family members are included, then approximately one fifth of the inhabitants of our country suffer from the consequences of excessive gambling behaviour. The new Article 106 of the Swiss Constitution empowers the Swiss government to set up a comprehensive legal framework for regulating gambling – creating an opportunity for a key shift in prevention policy. But will the opportunity be grasped?

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Addictive gambling is a recognised mental disorder. In the standard work, "Diagnostic and Statistical Manual of Mental Disorders (DSM-5)”, “pathological gambling” has been renamed  “gambling disorder” and reclassified from an “impulse control disorder” to a “substance-related and addictive disorder”. A state that permits gambling also has a duty to protect society and individuals from the negative consequences of excessive gambling behaviour.

Isolation, suicide and consequential social costs
The effects of addictive gambling on individuals and their environment are similar to those of other forms of addiction. Gambling addicts therefore often suffer from an additional mental disorder such as depression or they exhibit symptoms of stress, and many are suicidal: about one third of those who seek counselling refer to suicidal ideation. A study performed in Canada concludes that around five percent of successful suicides are due to gambling disorder. Extrapolated to Switzerland, this would account for 50 to 100 suicides a year. Compared with the rest of the population, addictive or problem gamblers are also associated with a much higher prevalence of harmful substance use: about 60 percent of them smoke, 40 percent drink to excess and four percent use illegal substances.
Besides its effects on health, addictive gambling often causes far-reaching social problems. Debt is a particularly significant concern for gamblers. Around 17 percent of problem gamblers declare private bankruptcy. For many individuals, pathological gambling often causes conflicts with their environment (separation, divorce, discord at work) and leads to growing social isolation. Pathological gamblers suffer from depression and stress and feel shame, guilt and hopelessness.
Young people and men are more at risk of indulging in problem gambling or of becoming addicted to it. Various studies point to a correlation with lower social status. And in the last three years a number of cantons have registered an increase in the number of inquiries from individuals addicted to gambling.
According to a 2012 study by the University of Neuchâtel's Institute of Economic Research, the overall social costs resulting from addictive gambling amount to between 545 and 658 million francs a year.

A market with growth potential
The gambling (also referred to as gaming) market is expanding rapidly. Gross gambling revenue has tripled over the last ten years. In 2012, Swiss casinos generated earnings of around 957 million francs, while lotteries and betting generated 910 million. Some 320 million francs from casino gambling revenues were channelled to the AHV (Old Age, Survivors' and Invalidity Insurance), while the cantons (through cantonal lottery funds) used the earnings from lotteries to support sports, cultural and social projects and events. Studies from other countries conclude that around a third of gross gambling revenues stem from addicted players, even though they account for only 4 percent of customers.
The new Gambling Act will authorise online games in Switzerland as well as improving coordination of lotteries and casinos. Developments abroad show that a vast market in online games is opening up, causing major problems for both the licensing authority and prevention efforts. It is also potentiating the risk of addiction. Unlimited availability of games on smartphones for under-18s as well as for adults makes it difficult for individuals to set themselves limits. And game providers have hardly any means of identifying players who are at risk of developing a gambling addiction or becoming hugely indebted as a result of excessive gambling behaviour.

New legal basis
The Gambling Act is based on Article 106 of the Swiss Constitution and will replace the respective Lottery and Casino Acts. Lotteries and betting are currently regulated under the Lottery Act and are subject to cantonal jurisdiction. Cantonal supervision is exercised through the Conference of Cantonal Ministers Responsible for the Lottery Market and Lottery Act (FDKL), while licences are granted through Comlot (Lottery and Betting Commission). Gambling revenues are channelled into the cantonal lottery funds with which the cantons support cultural, sports and social events and projects. At the present time, 0.5 percent of these revenues is earmarked for prevention, early identification and treatment of addictive gambling. Casinos are regulated under the Casino Act. Supervision is the responsibility of the Swiss Federal Gaming Board, which grants licences to class A and B casinos to operate gambling facilities. The earnings of the casinos are channelled in large part to the AHV and (in the case of B casinos) to the cantons in which they are located. No problem-gambling levy is raised from the casinos, though operators are obliged to take measures aimed at the prevention and early identification of addictive gambling.  
In compliance with Article 106 in the Swiss Constitution, i.e. "ensure that appropriate protection is provided through legislation and supervisory measures and in doing so ... take account of the different characteristics of the games and the form and location of the gambling opportunity offered" , the new Act will provide for the deployment of an independent commission of experts to advise the bodies implementing this law, i.e. the cantons, game operators and prevention and treatment specialists. In addition, the commission will draw up recommendations on early identification of addictive behaviour, monitor national and international developments concerning all aspects of addictive gambling and keep the Swiss government and the cantons regularly informed on its activities. Furthermore, the game operators' obligation to take preventive measures against addictive gambling will continue to be enshrined in the law.

Conference on addictive gambling
A conference on the topic of addictive gambling was held in Neuchâtel from 15 to 17 January 2014. The following flashpoints emerged from the internationally oriented presentations and workshops:
Basic conflicts of interest exist: game operators strive to maximise their earnings while players in the social and health sectors want to prevent individuals from becoming addicted to gambling and to protect society from the negative consequences of excessive gambling behaviour. Conclusion: there needs to be closer cooperation between gambling licensees and the health authorities. This means that prevention has to be a key condition for games to be authorised, and the health and social-service authorities must be involved in the selection of games offered.
Besides more effective integration of prevention in the licensing process, there will have to be an improvement in the interaction between research and practice in the next few years. Particularly because gambling addiction has such varied consequences, many questions need to be answered with regard to the options for action from the viewpoint of both public health and  social security.

Four-pillar policy also applies to gambling disorder
The future development of efforts to prevent addictive gambling could, it is generally felt, build on the experience Switzerland has gained with the harm reduction approach on abuse of psychoactive substances. The interplay of prevention, harm reduction, treatment and – with regard to gambling – targeted restrictions on permitted games is considered to be the best solution for protecting players from the risks associated with gambling and for controlling addictive gambling. However, adequate resources will have to be made available, for only then can effective and efficient prevention and treatment measures be guaranteed. The problem-gambling levy currently applied will certainly have to be retained, and consideration could also be given to levying a similar charge on casino gambling revenues.
Last but not least, it is considered essential that the knowledge bases of the game operators and the supervisory authorities should be made accessible to prevention and research workers. Only then can optimum cooperation between the players and research into addictive gambling and how it develops be guaranteed. This exchange is not considered to function adequately at present; in particular, game operators derive too
little benefit from addiction and prevention specialists' knowledge.
When the Casino Act was approved in 1998, thereby authorising gambling casinos in Switzerland for the first time, great importance was attached to prevention. The coming political debate will show whether that is still the case in 2014 and whether protection of players will also be a prime concern in relation to the newly permitted online games.


Astrid Wüthrich, Coordination Platform concerning Drugs and Addiction, astrid.wuethrich@bag.admin.ch

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