Is counselling for pokie addiction an effective harm minimisation measure?
Posted 27/10/2011 by Amanda Biggs
At a rally at the Canterbury RSL in western Sydney on Tuesday evening, the opposition leader Tony Abbott predicted a future Coalition government would rescind any legislation that introduces mandatory pre-commitment on electronic gaming machines (EGMs). Instead of mandatory pre-commitment, he suggested a greater focus on individual counselling for problem gamblers is needed.
If the opposition leader's support for counselling results in more funding for such services, many who provide help to Australia's estimated 95,000 EGM problem gamblers and their families will probably welcome it. But the efficacy of counselling as a harm minimisation measure is questionable; it is not clear that increased counselling services would significantly reduce problem gambling prevalence rates.
Currently all jurisdictions have in place strategies to promote awareness of gambling help services, including the provision of a national online gambling helpline. As well, jurisdictions actively promote their gambling help services (see examples from Victoria and Tasmania). Most venues with EGMs provide problem gambling counselling services such as the ClubSafe counselling service, and provide training to venue staff to help them to direct problem gamblers to such services.
But even with this range of services available and their wide promotion, problem gambling on EGMs persists. In evidence to the Joint Select Committee on Gambling Reform (see p. 55 in its report), a number of witnesses highlighted that one of the problems is that many problem gamblers simply don't access counselling services. The Productivity Commission (PC) in its report (p. 7.3) also found this problem and estimated that just 8 to 17 per cent of problem gamblers ever sought access to counselling services. The reasons given by the PC for such low uptake include denial around their addiction, stigma and a belief they can solve the problem without help. Many who do seek help only do so after they have reached 'rock bottom'.
In addition, while studies show that counselling can be effective, the type of counselling, methodology and length of time it is offered may all affect efficacy and outcomes. One report into the effectiveness of counselling for problem gambling found that while a majority of problem gamblers felt the counselling they received was beneficial—with two thirds reporting they gambled a 'lot less'—there was insufficient evidence to support one particular counselling approach over another.
Further, a report prepared for beyondblue (the national depression initiative) found that problem gamblers may present with multiple co-morbidities, such as depression, anxiety disorders and other mental health problems which also require treatment. There are also issues around correctly identifying an EGM player as a problem gambler so they can be directed to an appropriate service. Many venue staff report difficulties in identifying problem gamblers even after training. According to a recent Victorian Commission for Gambling Regulation survey (p. 4), 36 per cent of staff who received training had some difficulty in identifying problem gamblers. In any case, by the time a problem gambler presents to a service, much irreparable damage may have already been inflicted—including financial damage, mental anguish and family breakdown.
At a time when many mental health experts are arguing against government proposals to limit funding for certain mental health services, it is not clear how an increase in demand for such services from problem gamblers could be accommodated within existing resources. But while problem gamblers persist in not presenting to such services, many venue staff remain unable to identify problem gamblers, and the optimal counselling approach remains unclear, directing more funding to such services is arguably not an ideal approach.
These limitations around counselling may explain why many problem gambling experts, including those quoted by the Productivity Commission in its report into gambling (see p. 7.6), regard it as the ambulance at the bottom of the cliff. To be effective and prevent harm from problem gambling, measures that provide a fence at the top of the cliff may still need to be considered.
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