Abstract
Abstract.Background: There is evidence for low rates of help-seeking among problem gamblers. Identifying reasons for and barriers to seeking help is essential for improving help supply and gamblers’ treatment utilisation. The present study examines treatment utilisation of problem or pathological gamblers and reviews the evidence related to motives for and barriers to seeking help. Methods: The databases Medline, PsycInfo, and PubMed were searched for English-, Swedish- and German-language studies published between 2000 and 2017. Furthermore relevant references of included studies were analysed. Results: After exclusion of non-relevant publications 34 journal articles and seven reports covering the prevalence of help-seeking among gamblers or self-reported reasons for/barriers to help-seeking were maintained. The proportion of problem gamblers seeking help was less than 10 % in most studies. Problem severity was found positively associated with treatment attendance. Financial issues, negative emotions and crises were identified as main motives for seeking treatment. Main barriers to seeking treatment were shame, problem denial and lack of treatment availability. The results were similar across the examined studies. Conclusion: Low rates of treatment utilisation by problem gamblers strongly indicate that treatment providers and the society should strive to eliminate structural barriers that hinder gamblers to seek help. To better match problem gamblers´ needs, low-threshold early intervention, increasing knowledge of treatment options and efforts to reduce stigmatisation are important strategies to enhance access to help offers.
Zusammenfassung.Zielsetzung: Trotz gravierender Auswirkungen pathologischen Glückspielens nimmt nur ein geringer Anteil der Betroffenen Hilfe in Anspruch. Eine angemessene Versorgung von Personen mit Glücksspielproblemen erfordert Wissen über Motive und Hindernisse der Inanspruchnahme von Hilfe. Die vorliegende Literaturstudie gibt einen Überblick über den Anteil der Glücksspieler, die Hilfe suchen und berichtet zentrale Forschungsergebnisse zu Motiven und Hindernisse der Inanspruchnahme von Hilfe. Methodik: Die Literatursuche für den Publikationszeitraum 2000–2017 wurde überwiegend in den Datenbanken Medline, PsycInfo und PubMed durchgeführt. Ergebnisse: In die Literaturübersicht wurden 34 Zeitschriftenartikel sowie sieben Berichte aufgenommen, die Prävalenzraten der Inanspruchnahme von Hilfe oder diesbezügliche selbstberichtete Motive beziehungsweise Barrieren der Spielenden beschreiben. Nur ein geringer Anteil der problematischen Glücksspieler nahm Hilfe in Anspruch, in den meisten Studien lag der Anteil unter 10 %. Es zeigte sich ein positiver Zusammenhang zwischen Problemschwere und Inanspruchnahme von Hilfe. Die von den Glücksspielern berichteten Motive waren insbesondere finanzielle Gründe, negative Emotionen und Krisen. Diesen wirkten Stigmatisierung, Scham, Leugnen des Problems sowie schlechte Erreichbarkeit als Hindernisse entgegen. Die Ergebnisse wiesen über die Studien hinweg eine hohe Konsistenz auf. Schlussfolgerungen: Die geringe Inanspruchnahme von Hilfe durch Personen mit Glücksspielproblemen zeigt, dass es der Beseitigung entsprechender Hindernisse bedarf. Hierzu zählen insbesondere die Reduktion der Stigmatisierung von Glücksspielern, die Verbesserung des Wissens über Hilfsangebote und der Zugang zu diesen.
Literature
AC Nielsen (2007). Prevalence of gambling and problem gambling in NSW – a community survey 2006. Sydney: Department of the Arts, Sport, and Recreation.Australian Productivity Commission (2010). Productivity commission inquiry report volume 1 (50). Melbourne: Media and Publications Productivity Commission.2008). Problem gambling – barriers to help-seeking behaviours. Auckland, New Zealand: Gambling Research Centre.
(2012). Inanspruchnahme von Hilfe bei Pathologi-schem Glücksspielen Befunde der PAGE-Studie. Sucht, 58(6), 369–377.
(2014). Gambles seeking treatment: who does and who doesn’t? Journal of Behavioral Addictions, 3(3), 189–198.
(2013). Final Report Stigma and help-seeking for gambling problems. Centre for Gambling Research, School of Sociology, Research School of Social Sciences, College of Arts & Social Sciences, The Australian National University Australian National University.
(2007). An overview of help-seeking by problem gamblers and their families including barriers to and relevance of services. International Journal of Mental Health and Addiction, 5(4), 292–306.
(2004). Exploring and understanding online assistance for problem gamblers: The pathways disclosure model. International Journal of Mental Health and Addiction, 1(2), 32–38.
(2001). Online assistance for problem gamblers: An examination of participant characteristics and the role of stigma. ProQuest Information & Learning, US.
(2017). Barriers in access to the treatment for people with gambling disorders. are they different from those experienced by people with alcohol and/or drug dependence? Journal of Gambling Studies, 33(2), 487–503.
(2005). Motivators for Change and Barriers to Help-Seeking in Australian Problem Gamblers. Journal of Gambling Studies, 21(2), 133–155.
(2012). Pathological gambling – prevalence, diagnosis, comorbidity, and intervention in Germany. Deutsches Ärzteblatt, 109(10), 173–179.
(2001). The canadian problem gambling index: final report. Toronto (ON): Canadian Centre on Substance Abuse.
(2015). Evaluierung des Sperrsystems in deutschen Spielbanken. https://www.bwl.uni-hamburg.de/irdw/dokumente/publikationen/evaluierung-von-sperrsystemen-in-spielbanken.pdf. Last access: 23.08.2018.
(2011). Online self-guided interventions for the treatment of problem gambling. International Gambling Studies, 11(3), 289–308.
(2014). Professional help-seeking for gambling problems: awareness, barriers and motivators for treatment. Journal of Gambling Studies, 30(2) 503–2019.
(1999). Gambling impact and behavior study: Report to the national gambling impact study commission. Chicago: National Opinion Research Center.
(2011). Gamblers at risk and their help-seeking behaviour. Lismore – Centre for Gambling Education and Research School of Tourism and Hospitality Management Southern Cross University.
(2014). Stigma and problem gambling: current knowledge and future research directions. International Gambling Studies, 14(1), 64–81.
(2015). What influences the types of help that problem gamblers choose? A preliminary grounded theory model. International Journal of Mental Health and Addiction, 13(2), 241–256.
(2015). Characteristics and help-seeking behaviors of internet gamblers based on most problematic mode of gambling. Journal of Medical Internet Research, 17(1), 1–12.
(2016). How does the stigma of problem gambling influence help-seeking, treatment and recovery? A view from the counselling sector. International Gambling Studies, 16(2), 263–280.
(2009). Randomized trial of brief motivational treatments for pathological gamblers: More is not becessarily better. Journal of Consulting and Clinical Psychology, 77(5), 950–960.
(2000). Natural and treatment-assisted recovery from gambling problems: A comparison of resolved and active gamblers. Addiction, 95(5), 777–789.
(2008). Public stigma of disordered gambling: Social distance, dangerousness, and familiarity. Journal of Social and Clinical Psychology, 27(5), 505–528.
(2015). Self-stigma coping and treatment-seeking in problem gambling. International Gambling Studies, 15(3), 470–488.
(2017). Barriers to treatment for female problem gamblers: a UK perspective. Journal of Gambling Studies, 33(3) 975–991.
(2015). Barriers to and reasons for treatment initiation among gambling help-line callers. The Journal of Nervous and Mental Disease, 203(8), 641–645.
(2018). Casino self- and forced excluders’ gambling behavior before and after exclusion. Journal of Gambling Studies, 34(2), 597–615.
(2015). Predictors of help-seeking for gambling disorder from the transtheoretical model perspective. International Gambling Studies, 15(3), 450–469.
(1987). The South Oaks Gambling Screen (SOGS): A new instrument for the identification of pathological gamblers. The American Journal of Psychiatry, 144(9), 1184–1188.
(2012). The effectiveness of interventions for reducing stigma related to substance use disorders: a systematic review. Addiction, 107(1), 39–50.
(2004). 2003 Victorian Longitudinal Community attitudes survey. Melbourne: Gambling Research Panel.
(2004). Help-Seeking by problem gamblers, friends and families: a focus on gender and cultural groups. Centre for Gambling Research, Australian National University.
(2011). Pathologisches Glücksspielen und Epidemiologie (PAGE): Entstehung, Komorbidität, Remission und Behandlung. Greifswald, Lübeck: Universitätsmedizin Greifswald, Institut für Epidemiologie und Sozialmedizin; Universität zu Lübeck, Forschungsgruppe S:TEP, Klinik für Psychiatrie und Psychotherapie.
(2014). Discussion paper: seeking help for gambling problems. Melbourne: Victorian Responsible Gambling Foundation.
(2007). Women problem gamblers want more. The Canadian Centre for Policy Alternatives – Saskatchewan, 6(5), 1–4.
(2009a). Barriers to help-seeking for a gambling problem: The experiences of gamblers who have sought specialist assistance and the perceptions of those who have not. Journal of Gambling Studies, 25(1), 33–48.
(2009b). Reasons for seeking help for a gambling problem: the experiences of gamblers who have sought specialist assistance and the perceptions of those who have not. Journal of Gambling Studies, 25(1), 19–32.
(2004). Factor analysis of barriers to treatment for problem gambling. Journal of Gambling Studies, 20(2), 121–126.
(2014). Characteristics of gamblers using a national online counselling service for problem gambling. Journal of Gambling Studies, 30(2), 277–289.
(2013). Web-based counseling for problem gambling: exploring motivations and recommendations. Journal of Medical Internet Research, 15(5), e99.
(2014). Improved outcomes following contact with a gambling helpline: the impact of gender on barriers and facilitators. International Gambling Studies, 14(2), 318–329.
(2009). Remission ohne formelle Hilfe bei Alkoholabhängigkeit: Der Stand der Forschung. Sucht, 55(2), 75–85.
(2011). Differences in pathological gambling prevalence estimates: Facts or artefacts? International Journal of Methods in Psychiatric Research, 20(4), 83–99.
(1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption--II. Addiction, 88(6), 791–801.
(2017). Understanding and overcoming the stigma of substance use disorders. Sucht, 63(5), 253–259.
(2011). The stigma of alcohol dependence compared with other mental disorders: a review of population studies. Alcohol and Alcoholism, 46(2), 105–112.
(1992).
(Self-efficacy in the adoption and maintenance of health behaviors: theoretical approaches and a new model . In R. Schwarzer (Ed.), Self-efficacy: thought control of action (pp. 217–243). Bristol: Taylor&Francis.2002).
(Health Action Process Approach (HAPA) . In R. Schwarzer (Ed.), Gesundheitspsychologie von A bis Z (pp. 241–245). Göttingen: Hogrefe.2006). Natural recovery and treatment-seeking in pathological gambling: Results of two U. S. National Surveys. Amercian Journal of Psychiatry, 163(2), 297–302.
(2009). Sex differences in the rates of recovery, treatment-seeking, and natural recovery in pathological gambling: Results from an Australian Community-Based Twin Survey. Twin Research and Human Genetics, 12(5), 425–432.
(1992). The Structured Clinical Interview for DSM-III-R (SCID). I: History, Rationale, and Description. Archives of General Psychiatry, 49(8), 624–629.
(2009). Barriers to seeking help for gambling problems: a review of the empirical literature. Journal of Gambling Studies, 25(3), 407–424.
(2010). Motivators for resolving or seeking help for gambling problems: a review of the empirical literature. Journal of Gambling Studies, 26(1), 1–33.
(2008). Treatment seeking among Ontario problem gamblers: results of a population survey. Psychiatric Services, 59(11), 1343–1346.
(2012). Motivators for seeking gambling-related treatment among Ontario problem gamblers. Journal of Gambling Studies, 28(2), 273–296.
(2002). Gamblers seeking treatment: why haven’t they come earlier? Addictibe Disorders and Their Treatment, 1(2), 65–69.
(The Public Health Agency of Sweden (2016). Gambling and gambling problems in Sweden 2008–2010. Östersund: Folkhälsomyndigheten.2009). The NODS-CLiP: A rapid screen for adult pathological and problem gambling. Journal of Gambling Studies, 25(4), 541–555.
(2014). Treatment-Seeking precipitators in problem gambling: analysis of data from a gambling helpline. Psychology of Addictive Behaviors, 28(1), 300–306.
(2006). 2006 California problem gambling prevalence survey. National Opinion Research Center.
(