Canadian Low-Canadian Low-Risk Gambling Limits: New Risk Gambling Limits: New 

Evidence and LimitationsEvidence and Limitations

Shawn R. Currie, Ph.D.

April 10, 2010

Gambling in CanadaGambling in CanadaLegal in all provincesLegal in all provinces

76% of Canadians have gambled in the last year (Cox et al., 2005)76% of Canadians have gambled in the last year (Cox et al., 2005)

Gambling venues and opportunities include: Gambling venues and opportunities include:

87,000 electronic gaming machines (VLTs and slots)87,000 electronic gaming machines (VLTs and slots)

33,000 lottery outlets33,000 lottery outlets

250 race tracks250 race tracks

60 permanent casinos60 permanent casinos

25,000 licenses to run temporary bingos, casinos, raffles 25,000 licenses to run temporary bingos, casinos, raffles

Large and growing unregulated gambling market in Large and growing unregulated gambling market in

Internet gambling Internet gambling

Private poker hallsPrivate poker halls

What is Responsible Drinking?What is Responsible Drinking?

AbstainAbstain

Responsible Responsible drinking isdrinking is

• No more than 2 drinks No more than 2 drinks per dayper day

• 1 non-drinking day per 1 non-drinking day per weekweek

• Drink slowly, avoid Drink slowly, avoid intoxication, wait an intoxication, wait an hour between drinkshour between drinks

• Don’t drink if driving, Don’t drink if driving, operating equipment, operating equipment, pregnant, pregnant, othersothers. .

AlcoholAlcohol

abuseabuse

AlcoholAlcohol

dependencedependence

Consumption

What is Responsible Gambling?What is Responsible Gambling?

NoNo

gamblinggambling

Don’t gamble alone, for Don’t gamble alone, for money for basic needs, money for basic needs, with borrowed money, with borrowed money, chase loses, when chase loses, when drinking.drinking.

Responsible gambling?Responsible gambling?- Frequency?Frequency?- Amount?Amount?- Time spent?Time spent?

ProblemProblem

gamblinggamblingPathologicalPathological

gamblinggambling

Level of participation/gambling intensity

0

10

20

30

40

50

60

70

0.01 0.05 0.1 0.2 0.4 0.6 1 1.5 3 20

Perc

ent r

epor

ting

two

or m

ore

harm

s

Percent monthly income spent on gambling activities and harm

0.7

0.8

0.9

1

1.1

1.2

1.3

1.4

1.5

Rel

ativ

e R

isk

Average daily alcohol consumption and risk of all-cause mortality

Source: Alberta Gambling Prevalence Study (2002)

Source: Babor et al. (2003)Males 45 and over

Using National Population Using National Population Health Data to Develop Health Data to Develop

Responsible Gambling LimitsResponsible Gambling Limits

Consequences of Gambling Consequences of Gambling (assessed by Canadian Problem Gambling Index)(assessed by Canadian Problem Gambling Index)

Betting more than can afford to lose.Betting more than can afford to lose.

Gambling caused health problems, including stress/anxiety.Gambling caused health problems, including stress/anxiety.

Gambling caused financial problems.Gambling caused financial problems.

Borrowed money or sold anything to gamble.Borrowed money or sold anything to gamble.

Gambling caused interpersonal problems.Gambling caused interpersonal problems.

Others criticized your gambling.Others criticized your gambling.

Felt guilty about gambling.Felt guilty about gambling.

Felt you might have a gambling problem.Felt you might have a gambling problem.

Harms = Reporting 2 or more negative consequences.

0

10

20

30

40

Pro

po

rtio

n r

ep

ort

ing

tw

o o

r m

ore

ha

rms Males Females Total

NN                  

MalesMales 24722472 18411841 21012101 13421342 745745 435435

FemalesFemales 36793679 21532153 19701970 994994 476476 272272

Total Total   61516151   39943994   40714071   23362336   12211221   707707

CCHS-1.2 CCHS-1.2 Dollars spent per yearDollars spent per year

0

10

20

30

40

50

60

70

80

Pe

rce

nt

rep

ort

ing

tw

o o

r m

ore

ha

rms

EGM in EGM out Lottery Bingo Casino Instant win tickets

CCHS-1.2 CCHS-1.2 Frequency by type of gamblingFrequency by type of gambling

Comparison of CCHS-1.2 with AB, BC, Comparison of CCHS-1.2 with AB, BC, and ON dataand ON data

Daily

2-6 times/week

About once/week

2-3 times/month

About once/month

6-11 times/year

1-5 times/yearF

requ

ency

of a

ny

gam

blin

g

0 10 20 30 40Percent reporting two or more harms +/- 95% CI limit

Alberta OntarioBC CCHS

Performance of optimal cut-points across surveysPerformance of optimal cut-points across surveys

AB ONT BC CCHS-1.2Frequency

AUC .77 .67 .63 .81.81

Optimal cut-off 2 - 3X / month 2 - 3X / month 3 -5X / month 2 - 3X / month 2 - 3X / month

Sensitivity/specificity 92 / 57 61 / 67 65 / 57 88.3 / 5988.3 / 59

Dollars spent

AUC .89 .75 .74 .81.81

Optimal cut-off $80 / month $400 / year $11 - $50 /month $501-$1000 / $501-$1000 / yearyear

Sensitivity/specificity 82 / 84 61 / 82 73 / 67 78 / 7078 / 70

Percent gross income

AUC .91 .80 NA .79.79

Optimal cut-off 3% 1% 1%1%

Sensitivity/specificity 78 / 89 76 / 66 74 / 74 / 7474AUC = area under ROC curve, Swets (1988) guidelines

0.5 – 0.7 = ‘low accuracy’0.7 – 0.9 = ‘moderate accuracy’> 0.9 = ‘high accuracy’

Soliciting Expert OpinionSoliciting Expert OpinionSurvey Goals:Survey Goals:

(1)(1) ObtainObtain opinions from 171 gambling experts opinions from 171 gambling experts (researchers, clinicians, policy makers) on the (researchers, clinicians, policy makers) on the need for need for low-risk limits low-risk limits

(2)(2) Assess the face validity of CCHS-1.2 derived limitsAssess the face validity of CCHS-1.2 derived limits

0

5

10

15

20

25P

rop

ort

ion

of r

esp

on

ses

Veryconservative

2 3 4 Just right 6 7 8 9 Very liberal

Frequency: 2-3 times/month Dollars spent: $500 - $1000CAN/year

Percent income: 1% gross income

Face Validity of Proposed LimitsFace Validity of Proposed Limits

Source: Currie, S. R., Hodgins, D. C., Wang, J. el-Guebaly, N., & Wynne, H. (2008). In pursuit of empirically derived low-risk gambling limits. International Gambling Studies, 8, 207-227.

Limitations of the MethodLimitations of the Method

Insufficient data to develop game-specific low-Insufficient data to develop game-specific low-risk limitsrisk limits

Reliability of gambler’s self-reported expenditure Reliability of gambler’s self-reported expenditure in phone surveys is questionablein phone surveys is questionable

Lack of agreement on definition of harm in Lack of agreement on definition of harm in context of gamblingcontext of gambling

Retrospective accounts of gambling harm and Retrospective accounts of gambling harm and expenditureexpenditure

Analysis of Low-Risk Gambling Limits in the Analysis of Low-Risk Gambling Limits in the Leisure, Lifestyle, Lifecycle ProjectLeisure, Lifestyle, Lifecycle Project

Investigators:Investigators:Nady el-Guebaly, MD Nady el-Guebaly, MD David Hodgins, PhD David Hodgins, PhD Garry Smith, PhDGarry Smith, PhDRob Williams, PhD Rob Williams, PhD Don Schopflocher, PhD Don Schopflocher, PhD Rob Wood, PhDRob Wood, PhD

MethodMethod

Starting in 2006, longitudinal cohort study of over 1800 adolescents and adults living Starting in 2006, longitudinal cohort study of over 1800 adolescents and adults living in rural and urban Albertain rural and urban Alberta

Individuals in five age cohorts range from 13 to 65 years being followed for five yearsIndividuals in five age cohorts range from 13 to 65 years being followed for five years

The sample includes persons randomly selected from the general population and The sample includes persons randomly selected from the general population and persons considered at-risk for problem gambling based on certain criteria. persons considered at-risk for problem gambling based on certain criteria.

Data collection every 14 monthsData collection every 14 months.

Leisure, Lifestyle, Lifecycle Project: Demographics at Leisure, Lifestyle, Lifecycle Project: Demographics at Time 1Time 1

VariableVariable Total Adult Completes (N=1372)Total Adult Completes (N=1372)

NN %%

AgeAge 18-20 18-20 23-25 23-25 43-45 43-45 63-6563-65

315315341341403403313313

23.023.024.924.929.429.422.822.8

GenderGender MaleMale FemaleFemale

602602770770

43.943.956.156.1

LocationLocation CalgaryCalgary EdmontonEdmonton Grande PrairieGrande Prairie LethbridgeLethbridge

577577405405170170220220

42.142.129.529.512.412.416.016.0

Leisure, Lifestyle, Lifecycle Project: Description of Leisure, Lifestyle, Lifecycle Project: Description of Longitudinal Sample Longitudinal Sample (N=809)(N=809)

VariableVariable NN % (weighted)% (weighted)

AgeAge 18-20 18-20 23-25 23-25 43-45 43-45 63-6563-65

146146182182283283198198

2626272732321515

GenderGender MaleMale FemaleFemale

348348461461

50505050

EmployEmploy PT or FT PT or FTUnemployedUnemployed

587587222222

75752525

Health Health SmokersSmokers Good-excellent physical healthGood-excellent physical health Good-Excellent mental health Good-Excellent mental health

185185638638737737

191978789191

Inclusion criteria: • Adults (>17 years)• Participated in Time 1 and 2

Exclusion criteria: • No gambling at Time 1 and 2

Gambling above the Risk Limits at Gambling above the Risk Limits at Time 1 & Time 2 (~18 months)Time 1 & Time 2 (~18 months)

Low risk Low risk gambling gambling

limitlimit

Time 1Time 1 Time 2Time 2

Chi-Chi-squaresquare

NN % % (weighted)(weighted)

NN % % (weighted)(weighted)

> 1% income> 1% income 137137 12%12% 237237 23%23% 140.71*140.71*

> $500/year> $500/year 8787 7.5%7.5% 193193 18%18% 74.94*74.94*

> 2-3 > 2-3 times/monthtimes/month

168168 17%17% 226226 21%21% 88.65*88.65*

Any risk Any risk factorfactor

237237 23%23% 368368 36%36% 136.04*136.04*

* p < .0001

Gambling above the Risk Limits at Gambling above the Risk Limits at Time 1 & Time 2Time 1 & Time 2

0

5

10

15

20

25

30

35

40

Pe

rce

nta

ge

> 1% income > $500/year > 2-3 times/month Any low-risk limit

Time 1 Time 2

Cross-Sectional Data Time 1Cross-Sectional Data Time 1

Low risk Low risk gambling gambling

limitlimit

Weighted proportion Weighted proportion gambling gambling over limitover limit

who report harmwho report harm

Weighted proportion Weighted proportion gambling gambling under limitunder limit

who report harmwho report harm

Odds Odds ratioratio

Chi-squareChi-square(weighted)(weighted)

> 1% income> 1% income 31% 6% 7.3 65.09*

> $500/year> $500/year 43% 6% 11.7 94.71*

> 2-3 > 2-3 times/monthtimes/month

29% 4% 8.6 85.77*

* p < .0001

Change in Risk Category between Change in Risk Category between Time 1 & Time 2Time 1 & Time 2

N = 809 Gamblers

n = 400 Low risk at

T1 & T2(59%)

n = 175 Low risk (T1) to

High risk (T2)(19%)

n = 50 High risk (T1) to

Low risk (T2)(6%)

n = 184 High risk at

T1 & T2(16%)

Low risk = gambling below all risk limits

High risk = exceeds at least one low risk limit

Game preferences at Time 1 & Time 2 Game preferences at Time 1 & Time 2 (all gamblers)(all gamblers)

0

10

20

30

40

50

60

Pe

rce

nta

ge

VLTs or Slots Casino games Raffle Instant win Bingo

Time 1 Time 2

Game preferences at Time 1 & Time 2Game preferences at Time 1 & Time 2(gamblers shifting from low risk to high risk)(gamblers shifting from low risk to high risk)

0

10

20

30

40

50

60

70

80

Pe

rce

nta

ge

VLTs or Slots Casino games Raffle Instant win

Time 1 Time 2

p < .0001

p < .001

p < .01

p < .0001

Game preferences at Time 2Game preferences at Time 2 (gamblers who were low risk at Time 1)(gamblers who were low risk at Time 1)

0

10

20

30

40

50

60

70

80

Pe

rce

nta

ge

VLTs or Slots Casino games Raffle Instant win

Below all low-risk limits at Time 2 Exceeds at least one low-risk limit at Time 2

p < .0001

p = NS

p < .05

p < .001

Gamblers who shift from low risk to high risk Gamblers who shift from low risk to high risk on frequency of gamblingon frequency of gambling

Time 1

Low risk

< 2-3 times/mo

N= 637

(83%)

Time 2

High Risk

> 2-3 times/mo

N= 129

(23%)

Low Risk

< 2-3 times/mo

N= 507

(77%)

Harm

N = 22 (17%)

No harm

N = 107 (83%)

Harm

N = 55 (9%)

No harm

N = 452 (90%)

Χ2 = 3.21, p = .07

Gamblers who shift from low risk to high risk Gamblers who shift from low risk to high risk on percent of incomeon percent of income

Time 1

Low risk

< 1% income

N= 635

Time 2

High Risk

> 1% income

N= 136

(37%)

Low Risk

< 1% income

N=499

(63%)

Harm

N = 31 (23%)

No harm

N = 105 (77%)

Harm

N = 42 (8%)

No harm

N = 457 (92%)

Χ2 = 22.15, p < .0001

Gamblers who shift from low risk to high risk Gamblers who shift from low risk to high risk on dollars spenton dollars spent

Time 1

Low risk

< $500/yr

N = 722

Time 2

High Risk

> $500/yr

N= 137

(15%)

Low Risk

< $500/yr

N=585

(85%)

Harm

N = 31 (22%)

No harm

N = 106 (78%)

Harm

N = 59 (9%)

No harm

N = 526 (91%)

Χ2 = 13.53, p < .001

Gamblers who shift from low risk to high risk Gamblers who shift from low risk to high risk on any low risk limiton any low risk limit

Time 1

Low risk

on all limits

N = 549

Time 2

High Risk

on at least one limit

N= 175

(25%)

Low risk

on all limits

N=374

(75%)

Harm

N = 31 (18%)

No harm

N = 144 (82%)

Harm

N = 26 (7%)

No harm

N = 348 (93%)

Χ2 = 12.52, p < .001

Impact of Changing Risk Category on DSM Impact of Changing Risk Category on DSM Symptoms of Pathological Gambling Symptoms of Pathological Gambling

Change from Change from Time 1 to 2Time 1 to 2

CIDI-Gambling Time 2CIDI-Gambling Time 2(Mean symptom count)(Mean symptom count)

T-valueT-value SignifSignifHarmHarm No harm No harm DifferDiffer

Low risk to high Low risk to high risk (n = 175)risk (n = 175)

1.65 (0.43)1.65 (0.43) 0.13 (0.05)0.13 (0.05) 1.511.51 4.81 4.81 ** <.0001

Low risk to low Low risk to low risk (n = 374)risk (n = 374)

0.19 (0.19)0.19 (0.19) 0.07 (0.03)0.07 (0.03) .09.09 1.31 *1.31 * NSNS

Gamblers who shift from high risk to low risk Gamblers who shift from high risk to low risk on any low risk limiton any low risk limit

Time 1

High risk

on at least one limit

N = 234

Time 2

High Risk

on at least one limit

N= 184

(73%)

Low risk

on all limits

N=50

(28%)

Harm

N =59 (31%)

No harm

N = 125 (69%)

Harm

N = 10 (19%)

No harm

N = 40 (81%)

Χ2 = 3.41, p = 0.16

ConclusionsConclusions

Cross-sectional data:Cross-sectional data:

The risk curve method appears to be valid for identifying low risk The risk curve method appears to be valid for identifying low risk gambling limitsgambling limits

Limitations of current population data dictate that disseminating Limitations of current population data dictate that disseminating actual limits to public would be premature at this pointactual limits to public would be premature at this point

Longitudinal data:Longitudinal data:

Large number of people shift to higher risk gambling and begin to Large number of people shift to higher risk gambling and begin to experience more harmexperience more harm

Change from low-risk to high risk gambling based on exceeding the Change from low-risk to high risk gambling based on exceeding the quantitative limits is associated with: quantitative limits is associated with: - increased harmincreased harm

- preference for higher risk forms of gambling (EGMs, casino gambling, preference for higher risk forms of gambling (EGMs, casino gambling, instant win tickets)instant win tickets)

- more symptoms of pathological gambling.more symptoms of pathological gambling.