Mental health is clearly moving up on the public agenda in Canada, as seen in many European countries as well. This was reflected in the choice of the first keynote speaker at the New Horizons in Responsible Gambling Conference: Lieutenant-General (ret) Roméo Dallaire. He shared his experiences from the Genocide in Rwanda, where he was the force commander of the UN assistance mission. As a direct result of his mission in Rwanda, he developed post traumatic stress disorder (PTSD). On a very personal level, he described his struggle with PTSD, including professional treatment as well as life saving peer support – always available when needed the most.
For me, Roméo Dallaire’s presentation brought back my professional experience working with PTSD among former Yugoslavian refugees back in the 90’s and early 00’s. Roméo described PTSD as an invisible wound and a natural consequence from extreme experiences. He described his continuous struggle for good and systematic support for PTSD among veterans and others affected. He described destigmatizing as a key element enabling people talking about their invisible wounds and to lower the threshold for help seeking.
Among my reflections, when I transfer what Roméo said to the gambling field, is that his presentation stresses the importance of being clear and communicate that gambling problems and gambling addiction are possible wounds from gambling, and also the importance that support is available. In this matter, calling a spade a spade is not stigmatizing – it is actually the opposite. I do see the point in describing over consumption, chasing and other early signs of gambling problems along with RG measures to help the customers to stay in control. But asking the player if “gambling has stopped being fun” (an RG and Positive Play trend), instead of describing gambling problems, doesn’t make any sense to me. Let us call it what it is, and stop the stigmatizing.
The gambling industry might be worried to be stigmatized if they are paired with problem gambling. As I see it, they are already in the public eye. Communicating ”positive play behavior” has its points, but does not replace communicating gambling problems, treatment referral and the responsibility of the industry. So again; let us call a spade just that: a spade.
Comorbidity and mental health first aid
In a divided session, Dr. David Hodgins gave us a good overview of comorbidity among problem gamblers. A majority of disordered gamblers have at least one other lifetime mental health or substance use disorder. Comorbidity is associated with more severe gambling problems, but not necessary linked to poorer treatment outcome. My clinical standpoint (and I think David would agree) is that there might be a need for addressing the parallel problem in treatment, not at least to prevent relapses. In the second half of the session, Sarah Hamid-Balma, Director of Mental Health at CMHA BC, talked about mental health first aid; training people (between a half and three days) in how to handle acute mental reactions at the workplace, and elsewhere. Her talk was really inspiring and in line with the need of talking more about mental health problems in our societies.
I myself presented the project carried out at Norsk Tipping, Norway, where I have been involved as a researcher. In a large study (N=3009) Norsk Tipping contacted their biggest players by phone or letter, giving feedback on their yearly loss with the aim to make the customers reflect upon their habits and consider use of RG measures. The intervention by phone was more effective (in reducing gambling) than by letter, and both interventions were better than the control condition.
There are some fears, even among people working with RG, that RG can disturb the ”recreational” gambler. In this study, one could say we ”disturbed” the customers by calling them or sending letter, but they really appreciate it. Recently published research by Ivanova et al (2019) (found here) concluded that recreational gamblers do not tend to be disturbed or channelled away by RG tools, and they found no ground for the fear of disturbing recreational gamblers by RG tools or for limiting the design and implementation of them.
Among the other highlights, I have to mention the extraordinary Craig Kielburger’s fantastic presentation on his work in making the world a better place through the WE movement, www.we.org , all starting when he and his friends were 12. If you haven’t heard about them (I hadn’t), check it out!
I also found Dr Kathleen Vohs presentation on self control and decision makings, stressing the role of executive fatigue as inspiring for developing new RG tools. Gamblers are making many decisions while playing, including deciding if to make another deposit. Self control and long gambling sessions is not a pair that match. Haven taken the decision in advance without the fatigue effect is probably a good idea. And making it mandatory surely makes it more effective.
And remember: gamblers will not mind if RG tools are implemented as a natural part of gambling, as long as both the design and user experience are well executed.