PreparedbymembersoftheAPSGamblingWorkingGroup*incollaboration

withJillGieseMAPS,APSExecutiveOfficer
GamblingisanactivitythathasanimpactonmostAustralians.Itisembedded
withinoursocietyasapartofmainstreamculturethroughtheentertainment,
leisure,sportandtourismindustries,andisasignificantsourceofrevenueto
governmentsandprivateenterprise.Italsocausesconsiderableharmtosome
Australiansduetoitsnegativeimpactonindividuals,familiesandcommunities
throughproblemgambling.Consequently,itisessentialthatgamblingand
problemgamblingarewellunderstood,andthattheregulationofgamblingat
individual,community,industryandgovernmentlevelsiswellinformed.
Psychology,asascienceandprofession,hasmuchtocontributeto
understandinggamblingfromtheperspectivesoftheory,researchandpractice.
Recognisingthecriticalroleofpsychologyinaddressingthisimportantpublic
issue,in1997theAPSdevelopedaPositionPapertitledPsychologicalAspectsof
GamblingBehaviour.Muchhaschangedinthesubsequentdecade
opportunitiesforgamblinghaveexpandedandembracedsophisticatednew
technologies,thescientificunderstandingofgamblingbehaviourhasgrown,and
problemgamblinghasbecomeacknowledgedasbothapublichealthandmental
healthissue.TheAPShasconsequentlycommissionedanewReviewPaper,The
PsychologyofGambling,whichprovidesanoverviewofmajordevelopmentsin
understandinggamblingfromapsychologicalperspective.
ThisspecialInPsychreportisbasedonmaterialinthenewReviewPaperand
providescontextualinformationontheaccessibilityandprevalenceofgambling
inAustralia,anaccountofcurrentpsychologicaltheoriesandresearchon
problemgamblingbehaviour,adiscussionofcommunityandpublichealth
approachestoreducinggamblingharm,andanoverviewoftheassessmentand
treatmentofproblemgambling.Thespecialreportconcludeswith
recommendationstoenhancethecontributionofpsychologyinaddressingthis
importantsocialandcommunityissue.
*TheAPSGamblingWorkingGroupiscomprisedofProfessorDebraRickwoodFAPS
(Chair),UniversityofCanberra,ProfessorAlexBlaszczynskiMAPS,UniversityofSydney,
AssociateProfessorPaulDelfabbroMAPS,UniversityofAdelaide,DrNickiDowling
MAPS,ProblemGamblingResearchandTreatmentCentre,UniversityofMelbourneand
KatharineHeading,BreakEvenProgramCoordinator,RelationshipsAustraliaTasmania.

GamblinginAustralia
Understandingproblemgambling
Communityandpublichealthapproachestoreducinggamblingharm
Treatmentofproblemgambling
Enhancingpsychologyscontributiontoaddressingproblemgambling
References

GamblinginAustralia
Accessibility
Althoughlotteries,racingandbettingoncardgameshaveexistedinAustralia
forsometime,manyotherformsofgamblingarerelativelynew.Thefirst
AustraliancasinowasestablishedatWrestpoint,Hobart,in1973followedby12
othercasinosofvarioussizesestablishedsincethenineveryAustralian
jurisdiction.ClubandhotelbasedgamingmachineswerelegalisedinNSWin

jurisdiction.ClubandhotelbasedgamingmachineswerelegalisedinNSWin
1956,theACTin1976,andallotherjurisdictionsexceptWAintheearlytomid
1990s(ProductivityCommission,2009).
InAustralia,thereareover1,100gamingtables,199,271gamingmachines
(99,826inNSWalone),almost6,000venuesthatprovidegamingmachines,
4,756lotteryoutletsand4,652TABoutlets(AustralianGamingCouncil,
2008/09).Gamblingvenuesarelocatedinsuburbanareasofallmajorcitiesand
towns.Ofspecialnote,venuestendtobeclusteredinareaswithlowersocio
economicstatus(Livingstone&Woolley,2007).
Internetgamblingintheformofgamblingoninteractivegamblingsites(e.g.,
onlinecasinos)isnotlegalinAustraliaunderthe2001InteractiveGamblingAct
2001,butuseoftheinternetasavehicletoplacebetsonapprovedformsof
gambling,suchassportingeventsandwagering,isallowed(AustralianGaming
Council,2008/09).Internetandwirelessbasedgamblingisincreasingin
Australiaaselsewhere,andgreatlyincreasesaccessibility(AustralianGaming
Council,2008).
Australiansspendover$18billionperannumongambling,or$1,500per
capita,with60percentofthisexpenditurebeinglostonelectronicgaming
machines(EGMs),mostlylocatedinclubsandhotels(ProductivityCommission,
2009).Thisamountisconsiderablyhigherthaninotherjurisdictions,suchas
NewZealand($495percapita),Canada($393percapita)andtheUnitedStates
($325percapita)(Delfabbro,2010).

Regulation
Onthewhole,gamblingisahighlyregulatedindustry.AllStateandTerritory
Governmentshaveintroducedlegislatedmeasurestoencourageresponsible
gamblingandtherebyreducethepotentialharmsassociatedwithgambling.
Thesemeasuresincluderequirementsforstafftraining,selfexclusionpolicies,
limitsonoperatinghoursandmachinenumbers,advertisingrestrictions,limits
ongamedesignparameters,andtheprovisionofsafegamingmessages
(Delfabbro&LeCouteur,2008).Industrycompliancewiththeseprovisionsis
monitored,althoughthequalityofthisenforcementanddegreeofindustry
collaborationvarysignificantlybetweenjurisdictionsandbetweenvenues
(Breenetal.,2006).Importantly,theProductivityCommission(2009)notes
thatvenueshavemutedincentivestoaddresstheproblemsfacedby
consumers,asthiswouldmeanlowerprofits.

Prevalenceofgambling
Populationsurveysshowthataround70to80percentoftheAustralianadult
populationgamblesatleastonceperyear(ProductivityCommission,2009).
Approximately60percentofadultsgambleonlotteries,athirdonscratch
tickets,30percentongamingmachines,20percentonracing,and10percent
orlessonotherformsincludingcasinotablegamesandsportsbetting
(Delfabbro&LeCouteur,2009).
Regulargamblingisundertakenby15percentofAustralians(excludingthose
whopurchaselotteriesandscratchcards)andaboutfivepercentgamble
regularlyongamingmachines.Ofthe15percentofAustralianswhogamble
regularly,about10percentcanbeclassifiedasproblemgamblersandafurther
15percentasfacingmoderaterisk(ProductivityCommission,2009).Ofthe
fivepercentwhogamblefrequentlyonactivitiessuchasgamingmachines,
about15percentwouldbeclassifiedasproblemgamblersandanother15per
centasexperiencingmoderaterisk.

Ageandgenderdifferences
Gamblingparticipationratesvarysignificantlyaccordingtoageandgender.Men
aretypicallymorelikelythanwomentogambleonsports,casinocardgames
andracing,whereasfewsexdifferencesinparticipationtendtobeobservedin
relationtogamingmachinesandlotteries(ProductivityCommission,2009).
Analysisofagerelateddifferencesrevealsthattherearenumericallymore
gamblersinthemiddleagedrange(4060years),butthattheprobabilityof

gamblingdecreasesduringadulthood(Delfabbro&LeCouteur,2009).Younger
peoplearesignificantlymorelikelytogambleonmostformsofgambling
(exceptlotteriesandbingo)thanolderpeople.Forexample,inasurveyof
17,000adultsinSouthAustralia,itwasfoundthat51percentofpeopleaged
1824yearshadgambledongamingmachinesintheprevious12monthsas
comparedwith29percentof4554yearoldsand29percentof6574year
olds(S.A.DepartmentforFamiliesandCommunities,2005).Underaged
gamblingisparticularlycommonandofconcern,witharound60percentof
youngpeople(1317years)reportinggamblingatleastonceperyear(Lambos
etal.,2007).

Riskfactorsforproblemgambling
Overall,90,000to170,000Australianadultsareestimatedtoexperience
significantproblemsfromtheirgambling(0.5to1.0%ofadults),withafurther
230,000to350,000(1.4to2.1%ofadults)experiencingmoderaterisksthat
maymakethemvulnerabletoproblemgambling(Jacksonetal.,2009).
Problemgamblingratesvaryaccordingtothedemographiccharacteristicsof
individualsaswellastheirpreferredmodeofOfthe15percentofAustralians
whogambleregularly,about10percentcanbeclassifiedasproblemgamblers
andafurther15percentasfacingmoderaterisk.ProductivityCommission,
2009DECEMBER201013gambling(ProductivityCommission,2009).Asa
generalrule,menaresignificantlymorelikelytobeproblemgamblersthen
women(ratio60:40inmostsurveys).Youngerpeople,aged1830years,are
usuallytwiceaslikelytobeproblemgamblersasthosewhoareolder.
Importantly,problemgamblersaremorelikelytobethosewhoaresocially
disadvantagedthroughhavinglowerincomesorbeingunemployed.Theyare
also,overall,morelikelytobesingleorseparated.
IndigenousAustraliansaremorelikelytoexperiencegamblingproblemsthan
nonIndigenouspeople(Youngetal.,2007).Thisgreatervulnerabilityhasbeen
attributedtoavarietyoffactors,includingthelimitedrangeofalternative
leisureactivitiesforIndigenouspeopleinsomeurbancentres,comorbidities
includinggreatersubstanceabuseandpsychologicalproblems,andthegeneral
attractivenessofgamblingtocommunitieswithlowerincomesandfewerother
opportunitiestoearnmoney.
Amajorriskfactorforproblemgamblingisthetypeofactivitytowhichpeople
areexposed.Althoughproblemgamblerstypicallyengageinawiderrangeof
gamblingactivitiesthanothergamblers,moststatisticalmodelsshowthat
continuousformsofgambling,suchasgamingmachines,racingorcasinotable
games,aremostlikelytobeidentifiedasthecauseofproblems(Dowlingetal.,
2005).
Electronicgamingmachinesaretheformofgamblingassociatedwiththemost
harm.LivingstoneandAdams(2010)notethatofthe$17.5billionspenton
gamblingin200506,59percentwasspentonEGMs(ProductivityCommission,
2008)andthesehavebeenshowntobeimplicatedinaround85percentof
gamblingproblems(McMillenetal.,2004).In200809,55percentofgambling
expenditurewasonpokiesinclubsandhotels,andafurthersevenpercentin
casinos(ProductivityCommission,2010).Gamingmachinesarethepreferred
formofcontinuousgamblingforbothsexes,butparticularlyforwomen.
Furthermore,94percentofthearound200,000EGMsarelocatedinlocalclubs
andhotels,whichhavebeenarguedtohavealocationalbiastowardbeingin
areasofrelativesocioeconomicdisadvantage(Marshall&Baker,2002).The
proximityofvenuestopeoplesplaceofresidenceisthoughttoinfluencethe
prevalenceofproblemgambling(Delfabbro&Eltridge,2008).
Thepresenceofpeersandfamilymemberswhosesociallivesrevolvearound
gambling,andthedegreetowhichgamblingisacceptedasalegitimatepastime
byothersinthecommunity,alsocompriserisks.Forexample,thegambling
behaviouroffamilymembers,particularlyfathers,isanimportantriskfactorfor
thedevelopmentofgamblingproblems.Aseriesofstudiesspecificallydesigned
toinvestigatetheintergenerationaltransmissionofgamblingproblems(Dowling
etal.,2010)foundthatupto10percentofindividualsareraisedinfamilies
withaproblemgamblingfamilymember(parentsorsiblings).Thefindingsof
thisprojectclearlyidentifiedthatindividualsraisedinproblemgamblingfamilies
aremorelikelytodevelopgamblingproblemsthemselvesthanindividuals
raisedinnonproblemgamblingfamilies,evenaftercontrollingforarangeof

raisedinnonproblemgamblingfamilies,evenaftercontrollingforarangeof
relevantsociodemographicfactors,familymemberpsychopathology,and
concurrentfamilystressors.Specifically,individualswithfatherswithproblem
gamblingwere10.7to13.5timesmorelikely,andthosewithmotherswith
problemgamblingwere6.7to10.6timesmorelikely,todisplayproblem
gamblingbehaviourthantheirpeers.

Gamblingharm
Gamblingcangiverisetodifferenttypesandlevelsofharmandthesecanbe
personal,social,vocational,financialandlegal.Themostobviousharmis
financial,andthisisclearlyrelatedtomanyoftheotherharms.Intermsof
psychologicalharm,ithasbeenfoundthat4060percentofproblem
gamblersintreatmentsamplesexperienceclinicaldepression,displaysuicidal
ideation,orhavesignificantlevelsofanxiety(Battersby&Tolchard,1996).
Problemgamblersalsohaveagreaterlikelihoodofengaginginother
behavioursthatcompromisetheirwellbeing,particularlysubstanceuse.Data
suggestthat50to60percentofgamblerssmokecomparedto22percentof
thegeneralpopulation,andthat30to40percenthaveaconcurrent
substancedependenceorabuse(Rodda&Cowie,2005)aswellaspoorer
physicalhealth(Delfabbro&LeCouteur,2008).
Problemgamblingcanhavesignificanteffectsonmanyaspectsofthe
gamblerslife,includingtheirrelationshipsandemployment.Manyproblem
gamblersreportintimaterelationshipandfamilydifficulties(Dowlingetal.,
2009)orhavinglostorjeopardisedrelationshipsasaresultofgambling
(Jacksonetal.,1997).Othersreporthavingputoffactivitiesorneglected
theirfamiliesbecauseofgambling,andmostreporthavingliedtofamily
membersorengagedinfurtiveactivitiessoastoconcealtheextentoftheir
gamblingandtheresultantlosses(ProductivityCommission,1999).
Consequently,problemgamblingcanbeparticularlydevastatingforfamilies
becausethenatureandextentofthegamblingproblemoftencanbe
concealedforlongperiods.Apartfromthebetrayaloftrustthatmaybefelt
byfamilieswhentheproblemisfinallyrevealed,thehiddennatureof
gamblingcanmeanthatfamilyfinancesaredepletedbeforefamilymembers
haveanopportunitytoassistthegambleranddirectthemtotreatment.
Similarly,althoughrelativelylessisknownaboutthevocationalimpactsof
problemgambling,thereisevidencethatthoseaffectedreporthavinggiven
uptimefromworktogamble,havelostjobsduetogambling,orhaveused
theirworkplacetocommitcrimestocontinuefundingtheirgambling
(ProductivityCommission,19992009).Inadetailedanalysisofthe
offendingrecordof306problemgamblersintreatment,Blaszczynskiand
McConaghy(1994)showedthatlarceny,embezzlementandthe
misappropriationoffundswerethemostcommoncrimesreported.Manyof
thosewhocommittedthesecrimesdidnothaveaprevioushistoryof
convictionandwerefoundtoworkinwhitecollarprofessionsthatprovided
themwithdirectaccesstomoney.

Understandingproblemgambling
Motivationtogamble
Therearemanyreasonswhypeoplegamblerecreationally.Thesemaybe
broadlyclassifiedundertwononmutuallyexclusivetypesofmotivation:the
desireforpositivelyreinforcingsubjectiveexcitementandarousalandthe
desireforthenegativelyreinforcingrelieforescapefromstressornegative
emotionalstates.Bothsocialandmonetaryrewardexpectanciesfacilitate
gamblingduetothelearntassociationwith,andcapacitytoenhanceor
regulate,positiveaffect(Shead&Hodgins,2009).
Byitsverynature,gamblingrepresentsanopportunitytowinmoney,and,
subjecttothepotentialsizeoftheprize,tochangeoneslifestyle.Theprospect
ofwinninglargeprizesgeneratesexcitementbyallowingparticipantstodream
andfantasiseabouttheimpactthatsuchawindfallwouldhaveontheirwork,
finances,leisure,andcapacitytosupportimmediatefamilymembers.Smaller

finances,leisure,andcapacitytosupportimmediatefamilymembers.Smaller
winsarealsoexcitingsincetheseprovideagaintotheplayerandenable
furthergamblinginpursuitoflargerwins.
Importantly,theformofgamblingandtheenvironmentinwhichittakesplace
areconducivetosocialinteractionandthisaddssubstantiallytoitsinherent
enjoyment.Hotel,club,casinoandoncoursevenuesarerecreationallocations
thatofferarangeofentertainmentoptions(food,beverageandshows).Within
thesecontexts,gamblerscanreadilymeet,interactsocially,andtesttheirluck
andskillinpleasantandsafesurroundings,leadingtoenhancedsocial
integrationandstimulation,selfesteemandapositivesenseof
recreation/leisure.Gamblingisalsoameansofovercomingboredom.
Thecapacityforgamblingtonarrowonesfocusofattention(Anderson&
Brown,1984)andproducedissociativestates(Jacobs,1986)mayaccountfor
thereasonwhymanyindividualsusegamblingasamaladaptivecopingstrategy
todealwithproblems,emotionaldistressandstress/tension.Gamblersoften
reportthatgamblingrepresentsameans,albeittemporary,ofdistractionfrom
worry,demands,responsibilitiesandconfrontingproblems.Thisisoneofthe
morepowerfulmotivatorsunderpinningpersistentgamblinginsamplesof
problemgamblers(Petry,2005),andformsacentralcomponentofanumberof
psychologicalmodelsofgambling(Blaszczynski&Nower,2002Jacobs,1986
Sharpe,2002).Theaffectregulationcomponentofgamblingisdrivenbyaneed
tomaintainoptimallevelsofarousalandaccountsinpartfortheselectionof
certainformsofgamblinglowskillactivitiestoalleviateanxietyandstress,
andhighskillgamestogenerateexcitementandelevatemood(Blaszczynski&
McConaghy,1989Petry2005).
Evidencesuggeststhatproblemandnonproblemgamblershavesimilar
motivationstogamblebutthemotivationalstrengthdiffersforproblem
gamblers.Inparticular,winningmoney(chasinglosses)andrelievingtension
andemotionaldistressareimplicatedinpromotingcontinuedgambling(Clarket
al.,2007Platz&Millar,2001).
Therearegapsintheknowledgebaseaboutgenderandagedifferencesin
respecttogamblingmotivations.Somestudieshavefoundthatfemalesare
morelikelytogambleinresponsetointrapsychicfactorssuchasloneliness,
depression,andtogaincontrolovertheirlivesandemotionalissues,whereas
malesrespondtoexternalfactorssuchaspeergroups,financialpressuresand
employmentrelatedconflicts(Petry,2005).Otherstudieshavefoundno
significantgenderdifferencesforeithercommencingorcontinuinggambling
(e.g.,Clarketal.,2007).Agedifferencesingamblingmotivationarenotwell
understood.

Majortheoreticalapproachestounderstandingproblem
gambling
Currently,thereisnowidelyacceptedcausalexplanationorsingletheoretical
modelthatadequatelyaccountsfortheaetiologyofproblemgambling,which
hasimplicationsfortreatmentinterventions.Arangeofinternalandexternal
correlatesandpredictiveriskfactorsassociatedwithproblemgamblinghas
beenidentified,includingage,gender,impulsivity,biological/genetic
vulnerabilities,familyhistory,peergroupinteractionsandsocioecological
variables(Blaszczynski&Nower,2007Breweretal.,2008Toneatto&
Nguyen,2007).Explanatorymodelscanbedividedintosingletheorymodelsor
integratedmultifactorial(biopsychosocial)conceptualframeworks,allofwhich
sharecommonelements.
Learningtheory
Thebasictenetoflearningmodelsisthatgamblingisabehaviourgovernedby
contingenciesofreinforcementoperatingunderoperantandclassical
conditioningparadigms.Positivereinforcementschedulesincludethevariable
ratioscheduleofrandomfinancialgainandthefixedintervalreinforcement
scheduleforsubjectiveexcitementandphysiologicalarousal.Thereisalsoa
negativereinforcementschedulethatprovidesescapefromemotionalpainand
aversivestressstates.Theseoperantreinforcementschedulesallowgamblingto
bemaintainedsufficientlylongenoughforarousalandexcitementtobe
associatedwithgamblingrelatedexternalstimulisuchassituations,placesand

times,orinternalstimulisuchasmoodstates,physiologicalarousalor
cognitions.BothpositiveandThereisnowidelyacceptedcausalexplanationor
singletheoreticalmodelthatadequatelyaccountsfortheaetiologyofproblem
gambling,whichhasimplicationsfortreatmentinterventions.DECEMBER2010
15negativereinforcementincreasetheprobabilityofagamblingresponsebeing
elicitedandexplainpersistenceingambling.Inparticular,therandomratio
reinforcementschedule,wherebythereisanelementofunpredictabilityasto
whetherthenexttrialwillresultinareward,isresistanttoextinctionandcan
accountforpersistenceinplay(McConaghy,1980).
Althoughlearningtheorieshelpunderstandmanyaspectsoftheacquisitionand
maintenanceofgambling,andplayaprominentroleinothertheoreticalmodels,
theydonotexplainwhyonlyasmallpercentageofplayersprogresstoproblem
gamblingortheprocessesthatcauseescalationfromrecreationalto
problematicgambling.However,theydooffersomeexplanationforpersistence
ingamblingandinsightsintotreatmentinterventions(stimuluscontrol,imaginal
desensitisation).

Cognitivemodels
Thecognitivebehaviouralmodelemphasiseserroneousbeliefs,cognitive
distortionsandmisunderstandingofconceptsrelatedtorandomness,
probabilitiesandmutualindependenceofchanceevents,anddrawingfaulty
causalassociationsbetweenevents(Ladouceur&Walker,1996Petry,2005).
Althoughtheoriginofirrationalanderroneouscognitivebeliefsandschemas
remainsunknown,sociallearningexperiences,vicariousandparticipatory
exposuretofamilialandpeerrelatedgambling,mediarepresentations,
religiosityandculturalinfluences,andpersonalexperienceshaveallbeen
hypothesisedtoplaysignificantroles(Blaszczynski&Nower,2007Griffiths,
1994Petry,2005Ladouceuretal.,2002).
Cognitivefactorsthatunderpinpersistenceingamblinginclude:thegamblers
fallacy(beliefthatawinisduefollowingaseriesoflosses)cognitiveregret
(regretoverceasingprematurelyandmissingoutonthenextwin)and
entrapmentorchasinglosses(motivationtomaintainacourseofactionhaving
alreadyinvestedsomuchtodate).Cognitiveexplanationshaveempirical
support,buthaveyettoaccountforthefunctionalinteractionbetween
cognitionsandarousalandconditioning,orthetransitionfromrecreationalto
problemgambling.
Addictionmodels
AlthoughformallyclassifiedinDSMIVasadisorderofimpulsecontrol,the
addictionmodelispresentlythedominanttheoreticalparadigmexplaining
pathologicalgambling(Blaszczynski&Nower,2002NationalResearchCouncil,
1999),andthiswillbereflectedinDSMV.Theaddictionmodelofgamblingis
basedonthesimilaritiesinmotivation,patternsofbehaviourandconsequences
foundamongsubstanceusedisorders.Problemgamblersreportexcessive
preoccupationswithandpersistenturgestogamble,repeatedparticipationin
gamblingdespiteseriousnegativeconsequences,withdrawalandtolerance,and
impairedcontrolevidencedbyrepeatedunsuccessfulattemptstocease.
Gamblingtakesonanincreasedsalienceintheirlives,wheretheactivitytakes
precedenceoverfamilialandothersocialobligations.
Lendingweighttotheaddictionmodelisepidemiologicalsurveydataandclinical
studiesdescribinghighratesofcomorbiditybetweenpathologicalgamblingand
substanceabuse(seePetry,2005).Similaritiesinneurobiologicalactivityand
geneticabnormalitiesfoundamonggamblersandthosewhoaresubstance
dependentinvolvingcorticomesolimbicbrainstructuressuggestcommon
molecularpathways(Goudriaanetal.,2004).However,cautionmustbe
exercisedinconcludingacausallinkbetweenbiologicalmarkersand
pathologicalgambling.Manyassociationsarecorrelationalinnatureand
neurobiologicalchangesmayreflecttheconsequenceofrepeatedexposureto
arousalandaffectiveladenstimuliandbehaviours.Nevertheless,thisisa
promisingareawarrantingfurtherlongitudinalstudies.
Personalitytheory
Thereisnotypicalpersonalityprofilefoundamongproblemorpathological

gamblers.Anumberofstudieshavefoundelevatedscoresonsomepersonality
traits,suchasimpulsivity,withinconsistentfindingsonothers,suchas
sensationseeking(seeRaylu&Oei,2002forareview).Thereisnoconsistent
findinginrelationtoextraversion,neuroticismandlocusofcontrol.However,
whilenopersonalityprofileexists,specifictraits,particularlyimpulsivity,
sensationseekingandpropensityforrisktaking,maybeimportantvariables
moderatingormodulatinggamblingbehaviourandactingasriskfactorsinthe
aetiologyofpathologicalgambling.
AlthoughexistingstudieshavereportedhighratesofAxisIIpersonality
disordersamongpopulationsofpathologicalgamblersintreatment(Speckeret
al.,1996)andinthecommunity(Desai&Potenza,2008),particularlythose
fallingwithintheClusterBcategory(narcissistic,antisocialandborderline),
therearenocoherentoruniquepatternsemerging.
Integratedmodels
Inresponsetothemultiplicityofenvironmental,familialandintrapsychic
variablesidentified,severalintegratedexplanatorymodelshavebeenadvanced.
BlaszczynskiandNower(2002)basedtheirintegratedmodelontheassumption
thatpathologicalgamblersrepresentedaheterogeneousgroupthatcouldbe
subtypedaccordingtounderlyingmotivationandbenefitsderivedfrom
gambling.Themodelidentifiesthreeprimarysubgroupsorclustersofgamblers:
behaviourallyconditioned(conditioningandcognitiveprocessesareprimary),
emotionallyvulnerable(affectivedisturbances,poorcopingskills,dealingwith
painfulemotionalexperiences,socialisolationandlowselfesteemactto
exacerbatetheeffectoftheconditioningandcognitiveprocesses),and
biologicallybasedimpulsive(geneticandneurochemicalfactorscontributeto
impulsivityandneedforstimulation).Itisassumedthatallsubtypesmanifest
similarsymptomsandsignsbutthatthereareimportantdifferencesinthe
pathogenesisofthedisorder.EmpiricalevidencesupportingBlaszczynskiand
Nowers(2002)modelisemerging.
Majortheoreticalmodelsofproblemgambling
Learningtheoryoperantreinforcementandclassicalconditioning
contingenciesincreaseandmaintainbehaviour
Cognitivemodelerroneousbeliefsanddistortions(e.g.,the
gamblersfallacy)drivebehaviour
Addictionmodelmotivationandbehaviourinvolvespersistent
urges,andparticipation,withdrawalandtolerance
Personalitytheoryidentifiedpatternsinvolveimpulsive,sensation
seekingandrisktakingtraits,andhighratesofAxisIIpersonality
disorders
Integratedmodelsbasedonbiopsychosocialvariablesand
subtypingaccordingtopathogenesis

Communityandpublichealthapproachesto
reducinggamblingharm
Gamblingharmisacommunityhealthissue(Nealetal.,2005).Forevery
personwithagamblingproblem,itisestimatedthattherearefivetotenother
peopleaffected,includingfamilymembersandworkcolleagues(Productivity
Commission,2009).Interventionsneedtoreducethepotentialforharmtoboth
theindividualandhisorhercommunity.Furthermore,takingapsychosocialand
environmentalapproachrevealsotherfactorsotherthanthosethatpathologise
theindividual,whichcanbethefocusofeffectiveinterventions.

Publichealthperspective
Thepublichealthperspectivetakesthepositionthatpreventionofhealth
problemsandreductionofharmcanbemoreeffectiveinmaintaining
communityandindividualwellbeingthanindividualfocussedtertiarytreatment

initiatives(DicksonGillespieetal.,2008).Thisperspectivetakesintoaccount
riskandqualityoflifeissuesforthecommunitybyaddressingbiological,
behavioural,socioeconomic,culturalandpublicpolicydeterminantsofgambling
(Korn&Shaffer,1999).
DicksonGillespieetal.(2008)stresstheneedforpublichealthstrategiesthat
addressriskandprotectivefactorsatalllevelsofprevention(primary,
secondaryandtertiary),includingharmminimisationandresponsiblegambling
approaches.Thenotionofharmminimisationwasintroducedasacommunity
healthstrategytoassistinreducingthenegativeconsequencesassociatedwith
substanceuseandlateradaptedtoaddressthenegativeconsequences
associatedwithharmfulgambling.Itisimportanttonote,however,thatthe
harmsassociatedwithgamblingaresubjectiveanddifficulttoquantify.
Althoughfinancial,legal,intraandinterpersonal,andvocationalharmsare
readilyidentifiable,thelackofanoperationaldefinitionofharm(Nealetal.,
2005)meansthattheefficacyofimplementedharmreductionstrategiesis
difficulttoevaluate.
Publichealthapproachesdonotrequireabstinencefromgambling,butpromote
consumersinformedchoice.Notably,suchapproachesalsoincludebroader
structuralstrategiesregardingexposureandaccesstogamblingactivitiesthat
aremostlikelytoresultinharm,suchaslocationofandaccesstoelectronic
gamingmachines(Livingstone&Adams,2010).
Korn,GibbonsandAzmier(2003)identifythreegoalsforpublichealth
approaches:
Topreventgamblingrelatedproblems
Topromoteinformedattitudes,behavioursandpoliciesregarding
gambling
Toprotectvulnerablegroupsfromgamblingrelatedharm.
Althoughabroadrangeofpotentialstrategieshasbeenidentifiedanddiscussed
worldwide,fewinitiativeshavebeenimplementedinanyconsistentororganised
manner.Successfulimplementationrequirescommitmentandcollaboration
fromdiversestakeholdersincludingconsumers,supportservicesand
counsellors,researchers,community(includingculturallyandlinguistically
diversegroups),industryandgovernment(Delfabbroetal.,2007).

Primaryprevention
Primarypreventionprogramsareimplementedatthecommunitylevelto
preventproblemsbeforetheyoccur(Messerlianetal.,2005).Thefocusison
educationalcampaignsusingelectronicandprintmedia,schoolprograms,
videosandpresentationsdesignedtoraiseawarenessandimproveknowledge
abouttherisksandbenefitsofgamblingandgamblingproducts(Williamsetal.,
2007).Thesecampaignsmayaddressmisconceptionsaboutluckandchancein
gambling,assistindevelopingandenhancingabroadrangeoflivingskills
includingcoping,socialandfinancialmanagement,educateaboutthewarning
signsofproblemgambling,andpromotegamblinghelpservices(Dickson
Gillespieetal.,2008).However,thereislimitedliteraturesupportingthe
efficacyoftheseapproachesinreducingtheprevalenceofproblemgambling,
withfewrandomisedcontrolledstudiespublished(Grayetal.,2007).
Thedesignofinterventionsandresearchmethodologieswascriticallyevaluated
inareviewofAustralianandinternationalprimarypreventioninterventions
(Williamsetal.,2007).Despitethenumerous,potentiallyeffectiveeducational
strategiesdescribed,successwasreportedintermsofchangeinknowledge,
ratherthanchangeingamblingbehaviour.Improvementingamblingrelated
knowledgewasnecessarybutnotsufficienttobringaboutmeaningfulbehaviour
changewithregardtorisktakingingambling.Furthermore,knowledge
improvementsgenerallywerenotsustainedlongterm(Grayetal.,2007).
Theeffectivenessoftheinterventionshasbeenlimitedbythelackofevidence
basedprinciplesinformingthem,withthemostcommonlyimplemented
initiatives(educationalcampaigns)beingtheleasteffectiveinchanging
gamblingbehaviourcomparedtomoretargetedsecondaryinterventions.An
evidencebasedapproachtodevelopingprimarypreventionstrategiesis

warranted,guidedbypsychologicalprinciplesincludingtheTheoryofPlanned
Behaviour(Fishbein&Ajzen,1975)andtheTranstheoreticalModelofChange
(Prochaska&DiClemente,1982),andmoreresearchtoexplainmeaningful
gamblingbehaviourchange(Williamsetal.,2007).Inaddition,therehasbeen
limitedgamblingresearchinvolvingdiversepopulations,andfewlongitudinal
studiesexaminingthenaturalhistoryofgamblingbehaviours(Rodgersetal.,
2009).
Notably,youngpeoplearearecommendedtargetpopulationforprimary
preventionbasedonthepremisethatgamblingexposuremaybeinitiatedearly
withinfamilies(Dowlingetal.,2010),andeducationalinterventionshavebeen
providedtothisgroupinvariouscountries,althoughnolongtermoutcome
studieshavebeenreported(Grayetal.,2007).Theseprogramshavefocused
oneducatingyouthabouttherisksandbenefitsofgambling,andstrategiesto
controlfuturegamblingbehaviour.Schoolsbasedprimarypreventionprograms
oftenincludemodulesonunderstandingoddsusinggamesofchanceto
demonstrate(e.g.,WhatstheRealDeal?DepartmentofHealthandHuman
Services,2007),withnoapparentguidancefordebriefingstudentsexposedto
winningorwithheightenedarousal,bothconsideredriskfactorsfordeveloping
gamblingproblems(Turchi&Derevensky,2006).
IntheirdetailedFrameworkforActionbasedontheOttawaCharterforHealth
Promotion(WHO,1986),Messerlianetal.,(2005)describefourprimary
preventionprinciplesforyouthgambling:
Preventionofgamblingproblems,includingstrategiessuchasinformed
decisionmakingaboutparticipationanddevelopmentofproblemsolving,
copingandsocialskills
Denormalisationofunderagegambling,includingeducationaddressing
industrymarketingandgamblingmisconceptions
Harmreductionapproaches,includingaccurateevidencebased
knowledgeaboutthedevelopmentalneedsofyouthandidentificationof,
andtreatmentandsupportfor,youthproblemgamblinginthe
community
Protectionofchildrenagainstpotentialharmsassociatedwithgambling
byremovingorreducingdirectandindirectexposuretogambling
productsandpromotions.
Importantly,thislastprincipleseemstorecommendagainstintroducingyoung
peopletogamesofchanceandpossiblyallgamingindustrystimuliwithinthe
educationsystem,asthereappearstobelimitedevidencesupportingthis
approachtoreducingproblemgambling(e.g.,Williams&Connolly,2006).

Secondaryprevention
Secondarypreventionaimstodecreasetheharmexperiencedbyindividualsat
higherriskandthepotentialforharmtoothersparticipatingingambling
activities(DicksonGillespieetal.,2008).Theseapproachesusuallytakethe
formofpolicyinitiatives(mandatoryorvoluntary)andcomprisemodificationsto
gamingmachines(e.g.,changingreinforcementschedules,slowingrateofplay,
reducingsizeofthemaximumwins),orthegamblingenvironment(e.g.,
includingclocks,improvinglighting)topreventdevelopmentofgambling
problems.Otherinitiativesincludegamingstafftraining,restrictingaccessto
cashforgambling,andimprovedawarenessof,andaccessto,problem
gamblingsupportinformationandservices.However,thereislimitedevidence
oftheefficacyoftheseapproaches,withcriticalevaluationssuggestingthatthe
potentiallymosteffectiveinterventions,involvingchangestothegambling
environmentandgamingmachines,havebeenineffectivelyimplemented
(Williamsetal.,2007).Somereluctancetoapplyeffectivepreventionmeasures
isattributedtoconflictinginterests,intermsofbalancingthegoalofpreventing
andreducingharmwithreductionsingamblingrevenueandpotentialchanges
ingamblingasanentertainmentforconsumers(Adams,2009Williamsetal.,
2007).

Responsiblegamblingapproaches
Responsiblegamblingisapublichealthstrategybasedonharmminimisation

principles,wheregovernmentagenciesandthegamblingindustryhavea
responsibilitytominimisetheharmthatmayarisefromgambling(Delfabbroet
al.,2007).Thephilosophydirectsstakeholderstodevelopandimplement
strategiesthatminimiseharmassociatedwithgambling,whichmaybespecified
atlegislativeorregulatorylevelsandbyvoluntaryormandatorycodesof
practiceadministeredbygovernmentandindustry.Anationalapproachto
responsiblegamblinghasbeenendorsedbytheCouncilofAustralian
Governments(COAG),withStateandTerritoryGovernmentshavingprimary
responsibilityforregulationofgamblingintheirjurisdictions.
Inherentinthegamblingindustry,andparticularlyinrelationtogaming
machines,isthepropensityforconsumerstolosecontrolovertheirpurchasing
decisions(Dickerson,2003).Thepredominantapproachtoresponsiblegambling
invenuesisviaprovisionofsignsandbrochures,warningconsumersabout
problemgamblingandpromotingcounsellingsupportservices.
Ifgamblingisconsideredtobeaseriesofpurchasingdecisions,beingableto
predeterminetheamountofmoneyspentgamblingbeforebecomingaffected
bylossofcontrol(e.g.,bytheuseofprecommitmentcards),mayallowfor
greaterenjoymentofgamblingwithoutfearofadverseconsequences
(Dickerson,2003).Inaddition,physicallyremovingthepurchasingprocessfrom
theinfluenceofthegamblingarea(e.g.,ensuringATMmachinesarenotin
closeproximity)providesawaytoensurethatconsumersarefullyinformed
aboutthenatureandconsequencesofgamblingandareawareofthesignsof
problemgambling,therebyenhancingconsumersresponsiblegambling
behaviourandtheindustrysdutyofcare(Dickerson,2003).
COAGhasendorsedtrainingofgamingvenuestaffinresponsiblegambling
provisionandencouragedvenuebasedinterventionsforconsumers(Delfabbro
etal.,2007).Thereisvariability,however,intrainingrequirementsfor
employmentasgamingstaffacrossAustralia.ResponsibleServiceorConductof
Gamblingtrainingmodulesincludecoverageofregulatoryandlegislative
policies,understandingthenatureofgambling,problemgamblingandprovision
ofresponsiblegambling,gamblingexclusionprocessesandtheidentificationof,
andcommunicationskillsinapproaching,patronsexperiencinggambling
problems(Delfabbroetal.,2007).
Reducinggamblingharm
Primarypreventioncommunityandindividuallevelinitiativestoprevent
problemsbeforetheyoccure.g.,educationcampaigns
Secondarypreventionminimisingtheharmexperiencedbyindividualsat
riske.g.,modificationstoelectronicgamingmachines
Responsiblegamblingapproachesenableconsumerstohavegreater
controlof'purchasing'decisionse.g.,useofprecommitmentcards

Treatmentofproblemgambling
Theabsenceofaunifyingtheoryofproblemgamblingisreflectedintherange
oftechniquesemployedinitstreatment.Althoughtheevaluationof
interventionsforproblemgamblingremainsrelativelylimited,thereissome
empiricalevidenceforanumberofinterventions,includingbehavioural
interventions,cognitiveinterventions,cognitivebehaviouraltherapy(CBT),
minimalorbriefinterventions,motivationalenhancementtherapies(MET),
GamblersAnonymous(GA),inpatientrehabilitationprograms,mindfulness
basedtherapies,coupletherapiesandpharmacologicalinterventions.Guidelines
forscreening,assessmentandtreatmentforproblemgamblingarebeginningto
bedeveloped(e.g.,ProblemGamblingResearchandTreatmentCentre,2010).
Theoverallsuccessratesforpsychologicaltreatmentshavebeenestimatedto
be70percentat6monthfollowup,50percentat1yearfollowup,and30
percentat2years(LpezViets&Miller,1997).Ametaanalysisrevealedthat
psychologicaltreatmentsweremoreeffectivethannotreatmentat
posttreatmentandatfollowupevaluations(Pallesonetal.,2005).

Althoughtherehasbeenimprovementintheevidencebase,nopsychological
treatmentsatisfiesthecurrentstandardsforevidenceofefficacy.Cognitive
behaviouraltherapieshavebeencautiouslyrecommendedasbestpracticefor
thepsychologicaltreatmentofproblemgambling(Westphal,2008).
Importantly,however,recentlongitudinalepidemiologicstudiesofnontreatment
seekingadultssuggestthattheclinicalcourseofproblemgamblingmayinvolve
spontaneousremissionsandnaturalrecoverywithoutformalintervention
(Slutske,2006).

Cognitiveandbehaviouralinterventions
Asubstantialliteraturehasevaluatedarangeofbehaviouralprocedures,
includingaversivetechniques,covertsensitisation,positivereinforcement,
exposuretechniques,stimuluscontroltechniques,systematicdesensitisation,
behaviouralcounselling,cueexposureandimaginaldesensitisation(e.g.,
McConaghy,etal.,1991).Theexclusiveuseofcognitiverestructuring
techniqueshasbeenpositivelyevaluatedinseveralrandomisedtrialsusing
individualandgroupformats(e.g.,Blaszczynskietal.,2001Ladouceuretal.,
2001,2003).
ThereisincreasingevidenceoftheefficacyofCBTinindividualoutpatient
settings(e.g.,Dowlingetal.,2006,2007,2009b),groupsettings(Blaszczynski
etal.,2001Dowlingetal.,2007),andinpatientsettings(Ladouceuretal.,
2006).CBThasalsobeensuccessfullyappliedincombinationwithmotivation
enhancementtherapy(MET)(e.g.,Carlbring&Smit,2008),referraltoGamblers
Anonymousmeetings(Petryetal.,2006),andpharmacotherapy(Ravindranet
al.,2006).
RecentresearchhasshownsuccessfuldeliveryofCBTwithagoalofcontrolled
gambling(e.g.,Dowlingetal.,2009Ladouceur,Lachance,&Fournier,2009),
overtheinternet(Carlbring&Smit,2008),andthroughselfhelpworkbooks
(e.g.,Petryetal.,2006).Thetechniquesemployedinthesestudieshave
includedcognitiverestructuring,alternativeactivityplanning,problemsolving
financialplanningandlimitsetting,socialskillsandcommunicationtraining,
relapseprevention,stimuluscontrol,invivoexposureandimaginal
desensitisation.

Minimalandbriefinterventions
Minimalorbriefinterventionsarethosetreatmentsinvolvinglessprofessional
timeand/orresourcesthanaretypicaloftraditionaltherapy.Fromastepped
careperspective,theseinterventionsmayprovidenonthreatening,cost
effectiveandtimeefficientalternativestotraditionalpsychological
interventions,particularlyforthoseproblemgamblerswhohaveearlieronset
andlessseveregamblingproblems.Manyoftheseinterventionsmayalsobe
appropriateforproblemgamblersunableorunwillingtoaccesslocalservices
andincreasetheaccessibilityoftreatmentforproblemgamblerslocatedin
geographicallyremoteareas.
Arecentliteraturehassuccessfullyemployedarangeofinterventionswith
minimaltherapistinterventionincludingselfhelpworkbooks(e.g.,Petryetal.,
2006),internetbasedCBT(Carlbring&Smit,2008),briefadvice(Petryetal.,
2008),METandCBTapproaches(Petryetal.,2008),informationmaterials
deliveredthroughthemail(Hodginsetal.,2007),andbehaviouralinterventions
deliveredthroughaudiocassette(Blaszczynskietal.,2005)and
videoconferencing(Oakesetal.,2008).

GamblersAnonymous
GamblersAnonymous(GA),theparallelorganisationforAlcoholicsAnonymous
(AA),isavoluntaryfellowshipthatemploysabstinentgamblersascounsellors.
WhileGAisacommonformoftreatment,evaluativeresearchislimited.Recent
studieshaveemployedcomparativedesignstoevaluatetheefficacyof
GAorientedtreatmentprograms,demonstratingthatGAalonedoesnotappear
tobesufficienttoproducerecoveryforthemajorityofproblemgamblers
(Toneatto&Dragonetti,2008).

Controlledgamblinginterventions

Although,historically,totalabstinencehasbeenviewedastheonlylegitimate
andacceptablecriteriaofsuccess,asubstantialproportionofproblemgamblers
selectcontrolledorreducedgamblingasatreatmentgoalwhenitisavailable
(e.g.,Blaszczynskietal.,2005Dowling,2007).Whilethemostcommonreason
forselectingabstinenceisabeliefthatcontrolisnotpossible,thereasonsfor
problemgamblerstoselectcontrolledgamblingarethatgamblingretainssome
enjoyment,thatabstinenceisunrealisticoroverwhelming,andthattheywant
tosuccessfullymanagesocialsituationsinvolvinggambling(Dowling&Smith,
2007).Thisresearchalsoshowsthatfewdifferenceshavebeenfoundbetween
problemsgamblersselectingabstinenceandcontrolledgamblingastreatment
goals.
Theviabilityofcontrolledgamblingasatreatmentgoalisgenerallysupported
byrecentstudies(Dowlingetal.,2009b).Notably,likecontrolleddrinking,the
choiceoftreatmentgoalinproblemgamblingappearsfluid,withthemajorityof
participantsshiftingfromthegoalofcontrolledgamblingtoabstinenceatleast
onceduringintervention(Ladouceuretal.,2009).

Treatmentofconcernedsignificantothers
Severalstudieshaveevaluatedcopingskillinterventionsspecificallydesignedto
assistpartnersor'concernedsignificantothers'(CSOs).Inthelargeststudy,
Hodginsandcolleagues(2007)evaluatedtheefficacyofaselfhelpworkbook
basedontheCommunityReinforcementandFamilyTherapy(CRAFT)model.
Thismodel,whichhasbeensuccessfullyemployedwiththeCSOsofproblem
drinkers,isaCBTinterventionthataimstoimproveCSOpersonaland
relationshipfunctioning,engagetheproblemgamblerintreatment,and
decreasegamblingbehaviour.Inthisstudy,theworkbookconditionsproduced
betteroutcomesthanthecontrolconditionintermsofgamblingbehaviour,
programsatisfactionandhavingneedsmet.

Pharmacologicalinterventions
Researchevaluatingtheefficacyofpharmacologicalinterventionsinproblem
gamblingbehaviourhasrecentlyemerged.Theclinicalheterogeneityofproblem
gamblinghasledtothestudyofawiderangeofpsychopharmacologicalagents,
includingantidepressants,moodstabilisersandopioidantagonists.Arecent
metaanalysisrevealedthatpharmacologicaltreatmentsaremoreeffectivethan
notreatment/placeboatposttreatment(Pallesonetal.,2007).However,to
date,nospecificpharmacologicalagenthasbeenfoundtobeeffectiveinat
leasttwodoubleblindstudiesconductedbyindependentresearchteams,and
thereislittleempiricaldatatoguidetheselectionofonepharmacological
interventionoveranother.

Combinedpsychosocialandpharmacological
interventions
Combinedpharmacologicalandpsychologicalinterventionisconsideredthe
optimaltreatmentstrategyformanypsychiatricdisorders.However,thereisa
dearthofstudiesevaluatingthisinthetreatmentofproblemgambling.

Treatmentinthecontextofcomorbidities
Thetreatmentofproblemgamblingiscomplicatedbysubstantialvariationin
theclinicalpresentationofproblemgamblers,inpartduetoahighcomorbidity
withpsychiatricdisorders.However,theimplicationsfortreatmenthave
receivedlittleattention.
Therecognitionofpsychiatriccomorbidityandthedevelopmentofsubtypesof
problemgambling(e.g.,Blaszczynski&Nower,2002)mayeventuallyhave
implicationsforindividuallytailoredinterventionapproaches.Forexample,the
threesubtypesofproblemgamblingthathavebeenproposedareeachbasedon
adifferentprimaryaetiologyandconsequentlyhavedifferentimplicationsfor
treatment:thebehaviourallyconditionedsubgroup(giventheabsenceof
psychopathology)mayrespondwelltobriefinterventionsusingpsychoeducation
andbasiccognitivetherapydesignedtocorrectirrationalbeliefsthe
emotionallyvulnerablesubgroupmayrespondtoproblemsolvingandstress
basedinterventionscomprisingmoreextensivecognitivebehaviouraltherapies

whilethoseinthebiologicallybasedimpulsivesubgroupmayrequireadjunct
psychopharmacotherapy,intensivecognitivebehaviouraltherapyandimpulse
controlstrategies.
Theassessmentofproblemgambling
PathologicalgamblingwasrecognisedasaclinicaldisorderintheDSMIIIin
1980andremainsinthecurrentDSMIVTR(2000)asanimpulsecontrol
disordernototherwiseclassified.Draftproposalsforthefiftheditionofthe
DSMrevealthatproblemgamblingwillbeclassifiedasanaddiction,basedon
behaviouralandbiologicalsimilaritiestosubstanceusedisorders.Thecurrent
DSMIVTRclassificationcomprises10criteriaandrequirestheendorsement
offiveormoreforadiagnosisofpathologicalgambling.Anumberofthe
itemsarebaseduponthetraditionaladdictionmodelforsubstanceuse
disordersandincludeitemsrelatedtotolerance,withdrawalanddifficulty
controllingurges.Otheritemsrelatetopreoccupation,chasinglossesandthe
harmsassociatedwithpathologicalgambling.TheDSMIVistheonly
recognisedclinicaltoolfordiagnosingpathologicalgambling,andissuitable
foruseinclinicalsettingsandforforensicreportingbecauseitprovidesa
clinicaldiagnosisthatismorelikelytoberecognisedbycourts.
Screeningtools
Generally,theDSMIVitisnotsuitableasascreeningtoolforpopulation
surveyswheretheintentionmaybetoidentifyindividualswithproblemsof
varyingseverityasrequiredbypublichealthapproaches.Inthesebroader
contexts,psychologistshavetypicallyusedmoregeneralscreeningtools.The
twomostwidelyusedaretheSouthOaksGamblingScreen(SOGS)(Lesieur
&Blume,1987)andtheProblemGamblingSeverityIndex(PGSI)ofthe
CanadianProblemGamblingIndex(CPGI)(Ferris&Wynne,2001),although
goodqualityvalidationinformationisalsoavailablefortheAustralian
developedVictorianGamblingScreen(VGS)(BenTovimetal.,2001).
TheSOGSisa20itemscalebasedlargelyontheDSMclassificationwith
itemsrelatingtotolerance,withdrawalandimpairedcontrol.Itisheavily
weightedtowardsitemsrelatingtoexcessiveexpenditure.Despiteits
widespreadusage,particularlyinthe1990s,theSOGShasfallenintosome
disfavourinAustraliabecauseofconcernsaboutthehighratesoffalse
positivesandthefactthatitwasdevelopedasaclinicalscreeningtoolusing
anongamblingsampleasacomparisongroup(Battersbyetal.,2002
Lesieur&Blume,1987).
ThePGSIoftheCPGIwasdevelopedspecificallyforuseincommunity
prevalencesurveysandcontainsnineitems,eachofwhichisscoredona4
pointscale.TheCPGIhasbeenadoptedasthemethodofchoiceinAustralian
prevalenceresearchasitappearstohavesuperiorpsychometricqualities
comparedwiththeSOGS(McMillen&Wenzel,2006).Itgeneratesa
continuumofriskthatisattractivetoexponentsofapublichealthapproach
andisamoreconservativemeasurethantheSOGS.Itisawidelyused
screeningtoolwithgoodcurrentnormativedataandoftenusedby
psychologistsinresearchstudies

Enhancingpsychologyscontributiontoaddressing
problemgambling
ThisspecialInPsychreporthashighlightedthecontributionofthescienceand
practiceofpsychologytounderstandinggamblingbehaviourandaddressing
problemgambling.Itishopedthatthisoverviewofthecurrentstateof
knowledgewillencourageanincreasedfocusbypsychologistsonthisimportant
publichealthandwellbeingissue.
Therearemajoropportunitiesforpsychologiststocontributetomoreinformed
publichealthpolicydecisionstoaddressproblemgambling,developmore
effectivepreventionprograms,andenhancetheprovisionofeffectivetreatment
interventions.Greaterinvestmentingamblingresearchcouldfurtherthe

understandingofgamblingbehaviourandprogressionfromrecreationalto
problemgambling,andenablethedevelopmentofevidencebasedinterventions
forproblemgambling,particularlyinthecontextofgrowingawarenessofahigh
levelofcomorbidity.Thefollowingareasareidentifiedaswaysinwhich
psychologyscontributiontoaddressingthissignificantconcernforthe
Australiancommunitycanbeenhanced.

Informpublicdebateandpolicywithpsychological
knowledge
Increaseawarenessofknownriskfactorsandgroupsatriskofproblem
gambling
Regulationofgamblingshouldbeinformedbytheknowledgeofidentifiedrisk
factorsforproblemgambling,suchaschildrenraisedinfamilieswherethereis
afamilymemberaffectedbyproblemgambling,vulnerablepeopleinlower
socioeconomicgroups,typeofgamblingactivity,andproximityofgambling
venuetoplaceofresidence.Suchknowledgewillinformpolicyresponsestothe
differentialimpactofproblemgamblingondifferentpartsoftheAustralian
community.
Focusattentiononelectronicgamingmachines
GiventheknowledgethatEGMsareimplicatedin85percentofgambling
problemsinAustralia,psychologistscouldcontributetodebateregardingthe
numberandlocationofEGMs,waystoreducetheharmofEGMsthrough
machinemodificationsandwaystoincreaseconsumercontrol.
Considertheimpactoftheincreaseingamblingadvertising
Therehasbeenanoticeableincreaseintheadvertisingofgambling
opportunitiesintheelectronicmediaandatsportingfixtures,aimedat
increasinggamblingparticipationrates.Anunderstandingoftheimpactofthis
advertisingonproblemgamblersandvulnerablegroupsatriskofproblem
gamblingisrequiredtoenableinformedpolicyandpossibleregulationin
gamblingadvertising.

Informpreventioninitiatives
Argueforbetterimplementationofeffectivepublichealthapproaches
Effectiveimplementationofpreventativepublichealthinitiativeshasbeen
hamperedbytheconflictingdemandsofharmminimisationandprofit
maximisation.Evaluationsdemonstratingeffectivepreventioninitiativescanbe
usedtoargueforinvestmentinimplementationtoovercomethereluctanceof
vestedinterests,includingthoseofgovernmentsthataredependenton
gamblingrevenue.
Betterunderstandthedevelopmentalpathwaystoproblemgambling
Adolescenceisaparticularlyvulnerabledevelopmentalstageandthehigh
prevalenceofgamblinginthisagegroupisofsignificantconcern.Adolescents
shouldbethefocusofthedevelopmentoftargetedpreventionprograms,and
considerationshouldbegiventoregulatingtheburgeoningadvertisingof
gamblingsothatitdoesnotdeliberatelytargetthisvulnerablegroup.The
impactoftheincreasinginternetgamblingopportunitiesonthisgroupalso
warrantsattention.

Enhanceeffectivetreatmentinterventions
Establishtraininginitiativesforprimaryhealthproviders
Giventheassociatedstigma,gamblingproblemsarefrequentlyunderreported.
TraininginitiativesforGPsandmentalhealthpractitionerscouldraise
awarenessofriskfactorsandpopulationgroupsatriskofproblemgambling,
improveidentificationofpeoplewithgamblingproblems,enhancereferral
pathwaysfortreatmentandprovideknowledgeofinterventionswiththebest
evidenceofeffectiveness.

Improvescreeningprotocolsforproblemgamblinginmentalhealth
services
Thehighrateofcomorbidityofproblemgamblingwithotherpsychiatric
disorders,suchasdepression,anxiety,alcohol/substanceusedisordersand
personalitydisorders,suggeststhatpeoplewhoarepresentingforassessment
ortreatmentformentalhealthproblemsshouldbescreenedforproblem
gamblingusingvalidatedmeasurementtools.
Improvescreeningprotocolsforcomorbidityinproblemgambling
services
Thecomorbidityofproblemgamblingwitharangeofotherpsychiatric
disordersalsosuggeststhatpeoplepresentingforassessmentortreatmentfor
gamblingproblemsshouldbescreenedforothermentalhealthproblems,
includinganxietydisorders,depression,personalitydisorders,andalcoholor
substanceuseproblems.Suicideriskscreeningprotocolsshouldbeconsidered
whendepressionisevident.
Developtreatmentguidelinesforevidencebasedinterventions
Thereisaclearneedfortreatmentguidelinesregardingevidencebased
interventionsforproblemgambling.Thedevelopmentoftheseneedstobe
informedbyfurtherinvestmentinbuildingarobustevidencebase.
Undertakemoreextensivetreatmentstudieswithimproved
methodology
Whilethetreatmentoutcomeliteratureprovidessomeresearchevidencethat
problemgamblingisamenabletointervention,theoutcomeliteratureis
characterisedbyarangeofmethodologicallimitations,includingsmallsample
sizes,highattritionrates,lownumbersofwomenaffectedbyproblemgambling
andheterogeneityinformsofgambling.Importantdirectionsforfuture
investigationareconductingindependentrandomisedcontrolledoutcometrials
comparinginterventions,andevaluatinginterventionsforsubtypesofproblem
gamblerssothatclinicianscanoffermoredefinitiveandindividuallytailored
interventionrecommendations.Pilotevaluationsofnewtreatmentsforproblem
gamblingarealsowarranted.

Furthertheknowledgebase
Investigatenewaspectsofgambling,particularlythoseenabledvia
globalconnectionthroughtheinternet
Thepast10yearshasseenaburgeoningofmoresophisticatedwaystogamble,
includinghighlyengagingelectronicgamingmachinesandaccessto24hour
gamblingthroughtheinternet,mobilephonetechnologyandinteractive
televisionplatforms.Internetaccessposesuniqueproblemsfornational
regulationandregulationofaccessviaminors.Greaterunderstandingofthe
effectsofexposureandaccesstogamblingactivities,particularlythosemost
likelytocauseharmsuchaselectronicgaming,needstobeprogressed.
Developaninternationallyacceptedmeasureofproblemgambling
Thereiscurrentlymuchdebateabouttheappropriateconceptualisationof
problemgamblingandthebestwaytomeasureit.Agreementonthe
assessmentofproblemgamblingandtheoperationalisationofgamblingharm
wouldenablecomparativestudies.Comparingperformanceofscreeningand
assessmenttoolsagainstclinicianadministeredDSMbasedcriteriameasuresis
required.
Betterunderstandgamblingparticipationacrossthelifespan
Longitudinalstudiesofdevelopmentaltrendsingamblingparticipationare
requiredtodescribeitsnaturalhistory,whichwouldenablebetter
understandingofriskandprotectivefactorsforproblemgamblingandthe
relationshipbetweenexposureandharm.Thecomplexinterplayofindividual
factors,gamblingactivitycharacteristics,andenvironmentalfactorsneedstobe
betterunderstood.

References
Adams,P.J.(2009).Redefiningthegamblingproblem:Theproductionand
consumptionofgamblingproducts.JournaloftheNationalAssociationfor
GamblingStudies,21,5154.
AmericanPsychiatricAssociation(2000).Diagnosticandstatisticalmanualof
mentaldisorders(4thEd.TextRevised).Author,WashingtonD.C.
Anderson,G.,&Brown,R.I.F.(1984).Realandlaboratorygambling:Sensation
seekingandarousal.BritishJournalofPsychology,75,401410.
AustralianGamingCouncil(2008).Internetandwirelessgambling:Acurrent
profile.Melbourne:AGC.
AustralianGamingCouncil(2008/09).AdatabaseonAustraliasgambling
industries.Melbourne:AustralianGamingCouncil.
Battersby,M.,&Tolchard,B.(1996).Theeffectoftreatmentofpathological
gamblersreferredtoabehaviouralpsychotherapyunit:IIOutcomeofthree
kindsofbehaviouralintervention.InB.Tolchard(Ed.).Towards2000:The
futureofgambling:Proceedingsofthe7thannualconferenceoftheNational
AssociationforGamblingStudies(pp.219227),Adelaide,SouthAustralia.
Battersby,M.W.,Thomas,L.,Tolchard,B.,&Esterman,A.(2002).TheSouth
OaksGamblingScreen:AreviewwithreferencetoAustralianuse.Journalof
GamblingStudies,18,257271.
BenTovim,D.,Esterman,A.,Tolchard,B.,&Battersby,M.(2001).The
VictorianGamblingScreen.ReportpreparedfortheGamblingResearchPanel,
Melbourne,Victoria.
Blaszczynski,A.,Drobny,J.,&Steel,Z.(2005).Homebasedimaginal
desensitisationinpathologicalgambling:Shorttermoutcomes.Behaviour
Change,22(1),1321.
Blaszczynski,A.,MacCallum,F.,&Joukhador,J.(2001).Acomparative
evaluationofimaginaldesensitisationandgroupcognitivetherapyinthe
treatmentofpathologicalgambling.InG.Coman(Ed.),Lessonsofthepast.
Proceedingsofthe10thconferenceoftheNationalAssociationforGambling
Studies(pp.2939).Australia:NationalAssociationforGamblingStudies.
Blaszczynski,A.,&McConaghy,N.(1989).Anxietyand/ordepressioninthe
pathogenesisofaddictivegambling.TheInternationalJournalofAddiction,24,
337350.
Blaszczynski,A.,&McConaghy.N.(1994).CriminaloffencesinGamblers
Anonymousandhospitaltreatedpathologicalgamblers.JournalofGambling
Studies,10,99127.
Blaszczynski,A.,&Nower,L.(2002).Apathwaysmodelofproblemand
pathologicalgambling.Addiction,97,487499.
Blaszczynski,A.,&Nower,L.(2007).Etiologicalprocesses.InG.Smith,D.
Hodgins,&R.Williams(Eds.),Researchandmeasurementissuesingambling
studies.Elsevier:Toronto.pp.317338.
Breen,H.,Buultjens,J.,&Hing,N.(2006).Responsegamblingpracticesin
outbackQueensland:Distinctivechallengesinaremotelocation.Journalof
EconomicandSocialPolicy,11,4571.
Brewer,J.A.,Grant,J.E.,&Potenza,M.N.(2008).Thetreatmentofpathological
gambling.AddictiveDisordersTreatment,7,113.
Carlbring,P.,&Smit,F.(2008).Randomizedtrialofinternetdeliveredselfhelp
withtelephonesupportforpathologicalgamblers.JournalofConsultingand
ClinicalPsychology,76(6),10901094.
Clark,D.,Tse,S.,Abbott,M.W.,Townsend,S.,Kingi,P.,&Manaia,W.(2007).

Reasonsforstartingandcontinuingagamblinginamixedethniccommunity
sampleofpathologicalandnonpathologicalgamblers.InternationalGambling
Studies,7,299313.
Delfabbro,P.H.(2010).Exploringthemythsaroundgambling.Paperpresented
atGamblingAwarenessWeek,MelbourneTownHall,Melbourne.
Delfabbro,P.H.&Eltridge,F.(2008).Evaluatingtheeffectivenessofalimited
reductioninelectronicgamingmachineavailabilityonperceivedgambling
behaviourandobjectiveexpenditure.InternationalGamblingStudies,8,151
166.
Delfabbro,P.H.,&LeCouteur,A.L.(2009).Australasiangamblingreview(4th
Ed.).Adelaide:IndependentGamblingAuthorityofSouthAustralia.
Delfabbro,P.,Osborn,A.,Nevile,M.,Skelt,L.,&McMillen,J.(2007).Identifying
problemgamblersingamblingvenues.GamblingResearchAustralia:
Melbourne.
DepartmentofHealthandHumanServices(2007).Whatstherealdeal?
RetrievedfromtheDepartmentofHealthandHumanServices
Tasmaniawebsite.
Desai,R.A.,&Potenza,M.N.(2008).Genderdifferencesintheassociations
betweenpastyeargamblingproblemsandpsychiatricdisorders.Social
PsychiatryandPsychiatricEpidemiology,43,173183.
Dickerson,M.G.(1979).FIschedulesandpersistenceatgamblingintheU.K.
bettingoffice.JournalofAppliedBehaviourAnalysis,12,315323.
Dickerson,M.(2003).ExploringthelimitsofResponsibleGambling:Harm
minimisationorconsumerprotection?Proceedingsofthe12thAnnual
ConferenceoftheNationalAssociationforGamblingStudies,Melbourne.
DicksonGillespie,L.,Rugle,L.,Rosenthal,R.,&Fong,T.(2008).Preventingthe
incidenceandharmofgamblingproblems:Problemgamblingprevention:
Conceptualmodelsandassociatedpreventioninitiatives.JournalofPrimary
Prevention,29,3755.
Dowling,N.(2007).TheselectionofcontrolledgamblinginAustralianproblem
gamblingtreatmentservices.Proceedingsof42ndAustralianPsychological
SocietyAnnualConference.Brisbane:AustralianPsychologicalSociety.pp.133
137.
Dowling,N.A.,Jackson,A.C.,Thomas,S.A.,&Frydenberg,E.F.(2010).Children
atriskofdevelopingproblemgambling.AreporttoGamblingResearch
Australia.GamblingResearchAustraliawebsitesearchfunction
Dowling,N.,&Smith,D.(2007).Treatmentgoalselectionbyfemale
pathologicalgamblers:Acomparisonofabstinenceandcontrolledgambling.
JournalofGamblingStudies,23,335345.
Dowling,N.,Smith,D.,&Thomas,T.(2005).Electronicgamingmachines:Are
theythe"crackcocaine"ofgambling?Addiction,100,3345.
Dowling,N.,Smith,D.,&Thomas,T.(2006).Treatmentoffemalepathological
gambling:Efficacyofacognitivebehaviouralapproach.JournalofGambling
Studies,22,355372.
Dowling,N.,Smith,D.,&Thomas,T.(2007).Acomparisonofindividualand
groupcognitivebehavioraltreatmentforfemalepathologicalgambling.
BehaviourResearchandTherapy,45,21922202.
Dowling,N.,Smith,D.,&Thomas,T.(2009a).Thefamilyfunctioningoffemale
pathologicalgamblers.InternationalJournalofMentalHealthandAddiction,
7(1),2944.
Dowling,N.,Smith,D.,&Thomas,T.(2009b).Apreliminaryinvestigationof
abstinenceandcontrolledgamblingasselfselectedgoalsoftreatmentfor

femalepathologicalgambling.JournalofGamblingStudies,25(2),201214.
Ferris,J.,&Wynne,H.,(2001).TheCanadianProblemGamblingIndexFinal
Report.PhaseII.FinalreporttotheCanadianInterprovincialTaskForceon
ProblemGambling.
Fishbein,M.,&Ajzen,I.(1975).Belief,attitude,intention,andbehaviour:An
introductiontotheoryandresearch.Reading,MA:AddisonWesley.
Goudriaan,A.E.,Oosterlaan,J.,deBeurs,E.,&VandenBrink,W.(2004).
Pathologicalgambling:Acomprehensivereviewofbiobehavioralfindings.
Neuroscience&BiobehavioralReviews,28,123141.
Gray,K.L.,OakleyBrowne,M.A.,&Prabhu,V.R.(2007).Systematicreviewand
metaanalysisofstudiesonearlyinterventionandpreventionforproblem
gambling.GamblingResearchAustralia:Melbourne.
Griffiths,M.(1994).Theroleofcognitivebiasandskillinfruitmachine
gambling.BritishJournalofPsychology,85,351369.
Holdgins,D.C.,Currie,S.R.,elGuebaly,N.,&Diskin,K.M.(2007).Does
providingextendedrelapsepreventionbibliotherapytoproblemgamblers
improveoutcome?JournalofGamblingStudies,23,4154.
Hodgins,D.C.,Toneatto,T.,Makarchuk,K.,Skinner,W.,&Vincent,S.(2007).
Minimaltreatmentapproachesforconcernedsignificantothersofproblem
gamblers:Arandomizedcontrolledtrial.JournalofGamblingStudies,23,215
230.
Jackson,A.,Thomason,N.,Crisp,B.,Ho,W.,&Borrell,J.(1997).Analysisof
clientspresentingtoproblemgamblingcounsellingfrom1July1996to30June
1997,ClientandServiceAnalysisReportNo.2.Melbourne:Victorian
DepartmentofHumanServices.
Jackson,A.C.,Wynne,H.,Dowling,N.A.,Tomnay,J.E.,&Thomas,S.A.(2009).
UsingtheCPGItodetermineproblemgamblingprevalenceinAustralia:
Measurementissues.InternationalJournalofMentalHealthandAddiction.
AvailableOnlineFirst.
Jacobs,D.F.(1986).Ageneraltheoryofaddictions:Anewtheoreticalmodel.
JournalofGamblingBehavior,2,1531.
Korn,D.A.,&Shaffer,H.J.(1999).Gamblingandthehealthofthepublic:
Adoptingapublichealthperspective.JournalofGamblingStudies,15,289365.
Korn,D.,Gibbons,R.,&Azmier,J.(2003).Framingpublicpolicytowardsa
publichealthparadigmforgambling.JournalofGamblingStudies,19,235256.
Ladouceur,R.,Lachance,S.,&Fournier,P.M.(2009).Iscontrolaviablegoalin
thetreatmentofpathologicalgambling?BehaviourResearchandTherapy,
47(3),189197.
Ladouceur,R.,Sylvain,C.,Boutin,C.,&Doucet,C.(2002).Understandingand
treatingthepathologicalgambler.Ontario:JohnWiley&Sons.
Ladouceur,R.,Sylvain,C.,Boutin,C.,Lachance,S.,Doucet,C.,&Leblond,J.
(2003).Grouptherapyforpathologicalgamblers:Acognitiveapproach.
BehaviourResearchandTherapy,41,587596.
Ladouceur,R.,Sylvain,C.,Boutin,C.,Lachance,S.,Doucet,C.,&Leblond,J.,&
Jaceques,C.(2001).Cognitivetreatmentofpathologicalgambling.Journalof
NervousandMentalDisease,189,774780.
Ladouceur,R.,Sylvain,C.,Svigny,S.,Poirier,L.,Brisson,L.,etal.(2006).
Pathologicalgamblers:Inpatientsversusoutpatientscharacteristics.Journalof
GamblingStudies,22,443450.
Ladouceur,R.,&Walker,M.(1996).Acognitiveperspectiveongambling.In:
Salkovskis,P.M.(ed.),Trendsincognitivebehaviouraltherapies(pp.89120).

NewYork:JohnWiley&Sons.
Lambos,C.,Delfabbro,P.H.,&Pulgies,S.(2007).AdolescentgamblinginSouth
Australia.ReportpreparedfortheIndependentGamblingAuthorityofSouth
Australia.Adelaide.
Lesieur,H.R.,&Blume,S.(1987).TheSouthOaksGamblingScreen(the
SOGS):Anewinstrumentfortheidentificationofpathologicalgamblers.
AmericanJournalofPsychiatry,144,11841188.
Livingstone,C.,&Adams,P.J.(2010).Harmpromotion:Observationsonthe
symbiosisbetweengovernmentandprivateindustriesinAustralasiaforthe
developmentofhighlyaccessiblegamblingmarkets.Addiction,no.
doi:10.1111/j.13600443.2010.03137.x
Livingstone,C.,&Woolley,R.(2007).Riskybusiness:Afewprovocationsonthe
regulationofelectronicgamingmachines.InternationalGamblingStudies,7,
361376.
LpezViets,V.C.,&Miller,W.R.(1997).Treatmentapproachesforpathological
gamblers.ClinicalPsychologyReview,17,689702.
Marshall,D.C.,&Baker,R.G.V.(2002).Theevolvingmarketstructuresof
gambling:Casestudiesmodellingthesocioeconomicassignmentofgaming
machinesinMelbourneandSydney,Australia.JournalofGamblingStudies,18,
273291.
McConaghy,N.(1980).Behaviouralcompletionmechanismsratherthanprimary
drivemaintainbehaviouralpatterns.ActivasNervosaSuperior(Praha),22,138
151.
McConaghy,N.,Blaszczynski,A.,&Frankova,A.(1991).Comparisonof
imaginaldesensitisationwithotherbehaviouraltreatmentsofpathological
gambling:Atwotonineyearfollowup.BritishJournalofPsychiatry,159,390
393.
McMillen,J.,Marshall,D.,Ahmed,E.,&Wenzel,M.(2004).Victorian
longitudinalcommunityattitudessurvey.Melbourne:VictorianGambling
ResearchPanel.
McMillen,J.,&Wenzel,M.(2006).Measuringproblemgambling:Assessmentof
threeprevalencescreens.InternationalGamblingStudies,6,147174.
Messerlian,C.,Derevensk,yJ.,&Gupta,R.(2005).Youthgamblingproblems:A
publichealthperspective.HealthPromotionInternational,20,6979.
NationalResearchCouncil(1999).Pathologicalgambling:Acriticalreview.
WashingtonD.C.:NationalAcademyPress.
Neal,P.,Delfabbro,P.H.,&ONeil,M.(2005).Problemgamblingandharm:
Towardsanationaldefinition.GamblingResearchAustralia:Melbourne.
Oakes,J.,Battersby,M.W.,Pols,R.G.,&Cromarty,P.(2008).Exposure
therapyforproblemgamblingviavideoconferencing:Acasereport.Journalof
GamblingStudies,14,107118.
Pallesen,S.,Mitsem,M.,Kvale,G.,Johnsen,B.,&Molde,H.(2005).Outcome
ofpsychologicaltreatmentsofpathologicalgambling:Areviewandmeta
analysis.Addiction,100,14121422.
Pallesen,S.,Molde,H.,Arnestad,H.M.,Laberg,J.C.,Skutle,A.,etal.(2007).
Outcomeofpharmacologicaltreatmentsofpathologicalgambling:Areviewand
metaanalysis.JournalofClinicalPsychophamacology,27(4),357364.
Petry,N.M.(2005).Pathologicalgambling:Etiology,comorbidityandtreatment.
WashingtonD.C.:AmericanPsychologicalAssociation.
Petry,N.M.,Ammerman,Y.,Bohl,J.,Doersch,A.,Gay,H.,etal.(2006).
Cognitivebehavioraltherapyforpathologicalgamblers.JournalofConsulting

andClinicalPsychology,74,555567.
Petry,N.M.,Weinstock,J.,Ledgerwood,D.M.,&Morasco,B.(2008).A
randomizedtrialofbriefinterventionsforproblemandpathologicalgamblers.
JournalofConsultingandClinicalPsychology,76(2),318328.
Platz,L.,&Millar,M.(2001).Gamblinginthecontextofotherrecreation
activity:Aquantitativecomparison,casualandpathologicalstudentat
gamblers.JournalofLeisureResearch,33,383395.
ProblemGamblingResearchandTreatmentCentre(2010).Guidelinesforthe
screening,assessmentandtreatmentofproblemandpathologicalgambling.
MonashUniversity,Clayton:Author.
ProductivityCommission(1999).Australiasgamblingindustries.Canberra:
ProductivityCommission.
ProductivityCommission(2008).GamblingIssuespaper.Canberra:
ProductivityCommission.
ProductivityCommission(2009).Gambling.ProductivityCommissionDraft
Report.Canberra:ProductivityCommission.
ProductivityCommission(2010).Gambling.ProductivityCommissionInquiry
Report.Volume1.Reportno.50.Canberra:ProductivityCommission.
Raylu,N.,&Oei,T.P.(2002).Pathologicalgambling:Acomprehensivereview.
ClinicalPsychologyReview,22,10091061.
Prochaska,J.O.,&DiClemente,C.C.(1982).Transtheoreticaltherapy:Towarda
moreintegrativetheoryofchange.Psychotherapy:Theory,Researchand
Practice,19,276288.
Ravindran,A.V.,Telner,J.,Bhatla,R.,Cameron,C.,Horn,E.,etal.(2006).
Pathologicalgambling:Treatmentcorrelates.European
Neuropsychpharmacology,16(4),20.
Rodda,S.,&Cowie,M.(2005).Evaluationofelectronicgamingmachineharm
minimisationinVictoria.ReportpreparedfortheVictorianDepartmentof
Justice.Melbourne,CaranichePty.Ltd.
Rodgers,B.,Caldwell,T.,&Butterworth,P.(2009).Measuringgambling
participation.Addiction,104,10651069.
S.A.DepartmentforFamilyandCommunityServices(2005).Gamblingpatterns
inSouthAustralia.Adelaide:Author.
Sharpe,L.(2002).Areformulatedcognitivebehaviouralmodelofproblem
gambling:Abiopsychosocialperspective.ClinicalPsychologyReview,22,125.
Shead,N.W.,&Hodgins,D.C.(2009).Affectregulationexpectanciesamong
gamblers.JournalofGamblingStudies,25,357375.
Slutske,W.S.(2006).Naturalrecoveryandtreatmentseekinginpathological
gambling:ResultsoftwoUSnationalsurveys.AmericanJournalofPsychiatry,
163(2),297302.
Specker,S.M.,Carlson,G.A.,Edmonson,K.M.,Johnson,P.E.,&Marcotte,M.
(1996).Psychopathologyinpathologicalgamblersseekingtreatment.Journalof
GamblingStudies,12,6782.
Toneatto,T.,&Dragonetti,R.(2008).Effectivenessofcommunitybased
treatmentforproblemgambling:Aquasiexperimentalevaluationofcognitive
behavioralvs.twelvesteptherapy.AmericanJournalonAddictions,17(4),298
303.
Toneatto,T.,&Nguyen,L.(2007).IndividualCharacteristicsandProblem
GamblingBehavior.InG.Smith,D.Hodgins&R.Williams(Eds).Researchand
measurementissuesingamblingstudies,Elsevier.

Turchi,R.M.,&Derevensky,J.L.(2006).Youthgambling:Notasafebet.
CurrentOpinioninPediatrics,18(4),454458.
Westphal,J.R.(2008).Howwellarewehelpingproblemgamblers?Anupdate
totheevidencebasesupportingproblemgamblingtreatment.International
JournalofMentalHealthandAddiction,6(2),249264.
Williams,R.J.,&Connolly,D.(2006).Doeslearningaboutthemathematicsof
gamblingchangegamblingbehavior?PsychologyofAddictiveBehaviors,2(1),
6268.
Williams,R.J.,West,B.L.,&Simpson,R.I.(2007).Preventionofproblem
gambling:Acomprehensivereviewoftheevidence.Reportpreparedforthe
OntarioProblemGamblingResearchCentre,Guelph,Ontario,Canada.
Winters,K.C.,&Kushner,M.G.(2003).Treatmentissuespertainingto
pathologicalgamblerswithacomorbiddisorder.JournalofGamblingStudies,
19(3),261277.
WorldHealthOrganization(WHO).(1986).OttawaCharterforHealth
Promotion.CanadianJournalofPublicHealth,77,425430.
Young,M.,Barnes,T.,Stevens,M.,Paterson,M.,&Morris,M.(2007).The
changinglandscapeofindigenousgamblinginNorthernAustralia:Current
knowledgeandfuturedirections.InternationalGamblingStudies,7,327344.
2016TheAustralianPsychologicalSocietyLimited.ACN000543788.AllRightsReserved.