Association of Problem Gambling with Type of Gambling Among the Italian General Population Elisa Benedetti, PhD Institute of Clinical Physiology, National Research Council of Italy (CNR) Lisbon Addiction Conference Lisbon 26 October 2017 .

Paper published in 2016 in the Journal of Gambling Studies twelve countries provide prevalence estimates and the respective confidence intervals for the use of alcohol, tobacco, cannabis and medication with and without medical prescription. Six of the countries, i.e. Cyprus (CY), Greece (GR), France (FR), Italy (IT), Malta (MT) and Portugal (PT), border the northern rim of the Mediterranean whereas the other six countries, namely, Algeria (DZ), Egypt (EG), Israel (IL), Lebanon (LB), Morocco (MA) and Tunisia (TN) border the southern rim of the Mediterranean. Moreover, it would be more accurate to state that four countries from the southern rim, Algeria, Egypt, Morocco and Tunisia form part of North Africa whereas Israel and Lebanon can be considered to be part of the Middle East.

INTRODUCTION: STATE OF THE ART KILDE: Spel om pengar och spelproblem i Sverige 2008/2009

INTRODUCTION: STATE OF THE ART Estimated global gambling gross win in 2012, by nation (in billion euros) Source: © Statista 2015

INTRODUCTION: STATE OF THE ART Scale of the phenomenon in Italy (LY) Quasi 17 milioni di persone (oltre 5,5 milioni sono 15-34enni), hanno giocato d’azzardo almeno una volta (43% sia 15-64enni sia 15-34enni) M 53,3%; F 33,2% 2007-2008 42,1 % Total Aged 15-64 M 58,9%; F 38,2% 2010-2011 47,3 % M 55,7%; F 30,3% 2013-2014 42,7 %

INTRODUCTION: STATE OF THE ART 13 million 2 million 900.000 over 200.000 problem gamblers

INTRODUCTION: STATE OF THE ART Geographical distribution Prevalence gamblers % problem gamblers IPSAD® 2010-2011 IPSAD® 2010-2011

INTRODUCTION: STATE OF THE ART It has been proposed that specific types of gambling, such as slot machines, may be associated with greater difficulty in stopping habitual gambling (Griffiths 1995) Clinicians refer to as additional risk factors for cash games in order of importance: • The immediacy of the response; • The absence of social control over the behavior, even nonspecific by outsiders (the game online in the closed walls of their homes); • The proposal for winnings in the form of goods morally acceptable (the house, the annuity, etc.); • The simplicity of the game; • Accessibility.

Research question WHAT IS THE RELATIONSHIPS BETWEEN PATTERNS and TYPES OF GAMBLING PRACTICE AND GAMBLING DISORDER? Indeed, understanding how types of gambling practices are related to problem gambling is one mean to identify individuals who are more likely to become problem gamblers.

DESIGN AND METHODS The study is based on data drawn from the IPSAD®Italia survey. The sample of the 2010-2011 data collection wave used for this study consisted of more than 33,127. Total age range covered: 15-64 Sampling frame: registry of the resident population Sampling procedure: Multistage stratified random sampling Mode of data collection: self administered questionnaire by mail The response rate of participants in the study was about 35 % of the selected sample with a final sample size of 11,845, but the present analysis was restricted to those who completed the PGSI questionnaire (5292 questionnaires).

DESIGN AND METHODS In order to identify the ‘‘problem gambler’’ we used the Problem Gambling Severity Index (PGSI), part of the CPGI Three groups are considered in this analysis: no-risk gamblers, low-risk gamblers, Moderate-risk/problem gamblers. Type of gambling practice was considered among two types of gambler: one-game players, multi-games players.

DESIGN AND METHODS In the section on gambling habits only the type of gambling practice was investigated: Scratch cards and instantaneous lotteries, Lotteries with deferred result, Slot machine, Sport betting and other betting, Texas hold’em/poker and other card games. Logistic regression models were used to evaluate strength of the association between type of gambling and PGSI categories. Each type of gambling practice was considered separately and adjusted for age, gender, employment status and educational level.

RESULTS

RESULTS

RESULTS One-game players: Association of different game-types with gambling severity

RESULTS Multi-game players: association of different game-types with gambling severity

CONCLUSION As might be expected, the percentage of players who were at risk or problem gamblers was much higher among multi-game players. SLOT MACHINES The strongest associations with problematic gambling, for both type of players. These games are highly addictive due to their short satisfaction time and the ease with which one can re-bet. In Italy they are very accessible and can be found in the majority of tobacco shop and bars. The fact that slot machines can be found in situations where people usually drink alcohol inhibits impulse control and supports continuing to play.

CONCLUSION SPORT BETTING AND OTHER BETTING The second strongest association was with sport betting and other betting As with slot machines, access to this form of betting is easy; TEXAS HOLD’EM, POKER, CARD GAMES Only among the multi-games players, Texas hold’em, poker other card games were associated with gambling problems.

Thank you for your attention! Acknowledgment Marco Scalese Luca Bastiani Stefano Salvadori Mercedes Gori Isabella Lewis Paolo Jarre Sabrina Molinaro www.epid.ifc.cnr.it elisa.benedetti@ifc.cnr.it Thank you for your attention!