Risky Business – examining the wisdom of zero tolerance

Zero Tolerance Warning Sign, An American road warning sign with words Zero Tolerance with blue sky

Risky Business – examining the wisdom of zero tolerance

“I want a zero tolerance approach on all patriarchal bullshit” – Caitlin Moran
Striving to make gambling fairer and safer ought to be goals that all can support. However, in order for a collaborative approach to succeed, it is necessary to agree a common definition of the problem to be addressed. Following comments made by the Gambling Commission this week at ICE, we consider whether a zero tolerance approach is really in the best interests of the consumer.
A curious – and possibly existential – paradox was highlighted in this week’s gambling policy discussions at the ICE expo in London. If we accept that gambling is an inherently risky activity, should it to be the goal of regulation and ethical operation to expunge risk entirely – and where should responsibility for addressing risk sit?

The matter was raised within the keynote address from the chief executive of Britain’s Gambling Commission, Neil McArthur who labelled “totally unacceptable” the national estimates of 1.7 million ‘at-risk’ gamblers and 340,000 ‘problem gamblers’ (both figures extrapolated from the 2016 Health Surveys for England, Scotland and Wales and incorporating an element of double-counting due to the use of two screening instruments). As with much of the current discourse on gambling, Mr McArthur’s assessment seemed highly reasonable at first blush – but deeper examination exposes some complex challenges.

First, there is the matter of definition. The 1.7 million figure relates to the estimated number of ‘low risk’ and ‘moderate risk’ gamblers in Great Britain – derived from responses to the Problem Gambling Severity Index questionnaire administered four years ago to a sample of around 14,000 people. According to Jackie Ferris & Harold Wynne, who designed the PGSI, these are sub-clinical categories denoting the low or moderate risk of people experiencing “adverse consequences from gambling”. Contrary to Commission claims this week, the classifications are not intended to indicate “risk of becoming problem gamblers” (most people with a low risk or moderate risk score do not progress to a gambling disorder diagnosis).

It is worth noting in passing that low-risk and moderate risk scores on the PGSI also do not indicate low or moderate levels of harm (as the Commission has suggested at other times). Ferris & Wynne describe people with low risk scores as unlikely “to have experienced adverse consequences, from gambling” while those with moderate risk scores “may or may not have experienced adverse consequences from gambling”. As is becoming increasingly common, scientific caveats are being ignored in favour of pungent rhetoric.

How concerned ought we to be about so-called ‘at-risk’ gamblers? Of the 1.7 million identified in the 2016 Health Surveys, roughly 70% were classified as ‘low-risk’ (denoting a score of 1 or 2 out of 27 on the PGSI) and 50% had a PGSI score of just 1 – indicating that they endorse one risky behaviour or effect “sometimes”. Given that loss-chasing is the most commonly endorsed item in the Health Surveys (accounting for around one-quarter of all PGSI endorsements), it seems plausible that a large number of these at-risk gamblers may be doing nothing more than “sometimes” attempting to win back losses from a previous day. This may not be all that smart – but is it “totally unacceptable”?

As Paul Delfabbro and Daniel King have written, we need to bear in mind that not all of the behaviours screened for in the PGSI are necessarily harmful: “It is questionable whether some of the items identified are really indicators of harm. For example, chasing losses, gambling more to obtain the same excitement, or betting more than one could afford are really behaviours that might lead to harm if repeated too often”. We are inclined to agree – from a harm perspective it is important to consider the nature of the behaviours reported rather than focusing exclusively on scores (we have appended the PGSI questionnaire to this article so that readers unfamiliar with the instrument may judge for themselves whether the diagnostic criteria ought to be considered equally risky).

Analysis of the break-down of PGSI scores raises the question of who is responsible for managing risk. It seems clear from recent invective that the Gambling Commission considers the “totally unacceptable”reported rates of gambling disorder and at risk gambling to be the fault of its licensees; but is this fair and is it helpful? Harm prevention is generally understood to be a collaborative effort, involving legislators, regulators, operators, treatment providers, public health organisations and consumers themselves (indeed, this ethos sits at the heart of the National Strategy to Reduce Harms).

Jamie Wiebe and Jon Kelly of Canada’s Responsible Gambling Council wrote last year, “all stakeholders have a role and contribution to make in the prevention of problem gambling. No one organization can prevent problem gambling on its own”. If we accept this premise of shared responsibility, is it right that operators are singled out for blame where rates of gambling disorder are concerned? We know for example that relapse is one of the reasons that reported rates of gambling disorder are sustained – so should treatment providers also be criticised if rates do not fall? We would argue strongly that those working in treatment deserve our admiration rather than our censure – but we also need to be grown-up about how we apportion accountability.

Then there are the thorny issues of personal autonomy and responsibility. Should we hold operators entirely responsible for the behaviour of their customers? The Health Surveys indicate that in 2016, around 1.2% of us “sometimes” felt guilty about gambling and about 0.9% were “sometimes” criticised for their gambling. These two items (which may in some cases be linked) account for nearly 20% of all PGSI endorsements and so are significant contributors to the “wholly unacceptable situation” that the Commission has identified. To what extent should operators be held accountable if people occasionally feel guilt or receive criticism in relation to their gambling – and what might they be expected to do about it?

In terms of operator responsibilities, it may be more instructive to consider the 0.2% of people estimated to bet more than they can afford either “most of the time” or “almost always”; or the 0.8% for whom gambling appears to cause financial problems either “sometimes” (roughly three-quarters of this figure), “most of the time” or “almost always”. Questions of financial harm are complex (unaffordable gambling needs to be contextualised by reference to a range of factors, including income and broader expenditure) but this seems a more valid area for scrutiny – particularly as the Commission has achieved some success in persuading licensees to focus efforts on affordability.

It is all too easy to use statistics from prevalence surveys to knock the industry but we should not lose sight of the fact that the abstract is underpinned by reality. If it is “wholly unacceptable” that there are estimated to be 1.9m people in Britain with PGSI scores above zero – and those scores are based in large part on their behaviours – then we must logically conclude that it is the behaviour of these consumers that the Commission deems to be unacceptable. The regulator may still decide that industry is to blame for all this but the implied (if unintended) judgement on consumers seems inescapable. Last month, Neil McArthur questioned claims that attitudes towards gambling in Britain were becoming paternalistic; yet we would argue that branding as “unacceptable” the behaviours of 1.9 million consumers is indeed symptomatic of paternalism.

It is not clear – because presumably they have not been asked – where the British gambling consumer perceives responsibility to rest. A recent study of members of a casino rewards programme in the US (Gray, LaPlante, Abarbanel & Bernhard, 2019) found that “nearly three quarters of participants held individual gamblers responsible for minimizing gambling harm”. Between 9% and 10% answered that responsibility resided with (separately) the government, regulator or operator; although rates roughly doubled amongst those screening positive for gambling problems. While care should be taken not to generalise from one study, it does seem plausible that the majority of adult consumers do indeed hold themselves principally (if not exclusively) responsible for what they eat, what they drink, whether they exercise, and whether they gamble.

The intention here is not to write an apologia for licensed gambling operators. Gambling can involve significant harms – particularly where operators behave negligently or unethically; or where effects of product, placement and positioning are poorly understood. However, criticism of the industry at large in relation to something as heterogenous and complex as gambling disorder (and risk) is not helpful; and the current obsession with amplifying scale may distract from attempts to address the depth of gambling harms.

Wiebe and Kelly comment critically that “all too often the goal of the [harm prevention] programme is set at reducing levels of problem gambling” and observe that “a single focus on outcome measurement may…result in failure to understand why an outcome has or has not come about, what components of the programme are or are not working, and whether failures are due to programme conceptualization and design or programme implementation”.

It is central to the effective functioning of any market that trust exists between the regulator and the regulated. The Commission has every right to talk tough with its licensees but it also has a duty to be absolutely rigorous in how it presents information. By the same token, the tendency of some industry representatives to marginalise disorder, typically by conflating gambling-specific rates with population levels (also seen this week), is counter-productive and needs to stop.

All must relearn the art of talking to (rather than at) one another rather. Perhaps – as the Commission avers – we do need a change of mindset with regards to gambling harm; but that is unlikely to be achieved via an exchange of competing press releases or public speaking engagements. In fact, it seems evident that mindsets have changed already and there is now an opportunity to go with the grain. This will involve having the strength of character to resist the calls for a state of licensing quarantine based on sanctimonious, unscientific and often hypocritical claims that engagement with regulated gambling firms results in moral corruption. It is not always easy but the regulator and the licensee should strive to establish and maintain constructive and honest relations. The wellbeing of the consumer demands it.

Problem Gambling Severity Index
This self-assessment is based on the Canadian Problem Gambling Index. It will give you a good idea of whether you need to take corrective action.

Thinking about the last 12 months…

Have you bet more than you could really afford to lose?
0 Never. 1 Sometimes. 2 Most of the time. 3 Almost always.
Still thinking about the last 12 months, have you needed to gamble with larger amounts of money to get the same feeling of excitement?
0 Never. 1 Sometimes. 2 Most of the time. 3 Almost always.
When you gambled, did you go back another day to try to win back the money you lost?
0 Never. 1 Sometimes. 2 Most of the time. 3 Almost always.
Have you borrowed money or sold anything to get money to gamble?
0 Never. 1 Sometimes. 2 Most of the time. 3 Almost always.
Have you felt that you might have a problem with gambling?
0 Never. 1 Sometimes. 2 Most of the time. 3 Almost always.
Has gambling caused you any health problems, including stress or anxiety?
0 Never. 1 Sometimes. 2 Most of the time. 3 Almost always.
Have people criticized your betting or told you that you had a gambling problem, regardless of whether or not you thought it was true?
0 Never. 1 Sometimes. 2 Most of the time. 3 Almost always.
Has your gambling caused any financial problems for you or your household?
0 Never. 1 Sometimes. 2 Most of the time. 3 Almost always.
Have you felt guilty about the way you gamble or what happens when you gamble?
0 Never. 1 Sometimes. 2 Most of the time. 3 Almost always.

Total your score. The higher your score, the greater the risk that your gambling is a problem.
Score of 0 = Non-problem gambling.
Score of 1 or 2 = Low level of problems with few or no identified negative consequences.
Score of 3 to 7 = Moderate level of problems leading to some negative consequences.
Score of 8 or more = Problem gambling with negative consequences and a possible loss of control.