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Background and aim: Evidence on the course of gambling disorder (GD) in clients seeking help from outpatient addiction care facilities is sparse. To close this knowledge gap, this longitudinal one-armed cohort study portrays the development of GD in help-seeking clients over a 3-year timeframe. Methods: We investigated changes in severity of GD as well as in gambling frequency and intensity in 145 gamblers in outpatient treatment in Bavaria using generalized estimation equations (GEEs). To investigate potentially different trajectories between study participants with and without migration background (MB), additional analyses were applied with time*migration interaction. All analyses were adjusted for age, gender, education, electronic gambling machine (EGM) gambling, MB, GD, related help sought before and treatment status. Results: Within the entire study population, improvements in severity of GD (reduction of 39.2%), gambling intensity (reduction of 75.6%) and gambling frequency (reduction of 77.0%) were observed between baseline and 36 months of follow-up. The declines were most pronounced between baseline and follow-up 1 and stabilized thereafter. Participants with MB improved consistently less than participants without MB. Discussion and conclusion: Our study suggests that severity of GD and gambling patterns improve in the context of outpatient treatment. The beneficial results furthermore persist for 36 months after treatment termination. As clients with MB seem to profit less than clients without MB, improvements in outpatient gambling services to the specific needs of this clientele are required.

Spielersperren stellen eine Maßnahme des Spielerschutzes dar. Ziel der vorliegenden Arbeit ist die Darstellung der derzeitigen Gesetzesgrundlage von Spielersperren in Deutschland und den Bundesländern und beispielhaft ihrer Nutzung in Bayern. Während auf Basis des Glücksspielstaatsvertrags für das staatliche Glücksspiel eine bundesweite Sperrdatei existiert, werden Spielersperren für das gewerbliche Glücksspiel länderspezifisch organisiert. Aufgrund der uneinheitlichen Gesetzeslage besteht trotz einer ausgesprochenen Spielersperre die Möglichkeit, auf andere Spielformen oder Spielstätten auszuweichen. Diese Gegebenheiten sollten im Beratungs- oder Behandlungskontext aufgegriffen werden, um betroffenen Glücksspielenden eine Abstinenz zu erleichtern. Für eine breite Nutzung von Spielersperren sind strukturelle Veränderungen der derzeitigen Organisation von Spielersperren nötig. Zum einem bedarf es unter Einbeziehung des gewerblichen Glücksspiels einer einheitlichen Regelung mit einer übergreifenden Sperrdatei. Zum anderen könnte über den Abbau von Barrieren und die Einführung transparenter Kriterien für die Entsperrung die Akzeptanz von Spielersperren erhöht werden., The exclusion of gamblers is a measure of gambler protection. This paper aims at giving an overview of the current legal regulations for the exclusion of gamblers in Germany and its Federal States as well as its utilisation in Bavaria, one of the largest Federal States. Whereas exclusions for state-provided gambling are regulated nationwide by the State Treaty on Gambling, exclusions for commercially provided gambling are organised by each federal state separately. Due to the inconsistent legal basis for the exclusion of gamblers, excluded gamblers are able to circumvent their exclusion by using other forms of gambling or gambling venues. These factors should be addressed in the counselling or therapeutic context to facilitate abstinence of gambling. For a broad utilisation of exclusions, structural changes in the present organisation of exclusions are needed. A comprehensive exclusion system for both state-provided as well as commercially provided gambling is necessary. Furthermore, the acceptance of exclusions could be increased by reducing barriers and the introduction of transparent criteria for the revokement of exclusions.

BACKGROUND AND AIMS: Self-exclusion programs offer an intervention for individuals with problem gambling behavior. However, these programs are insufficiently used. This review describes sociodemographic features and gambling behavior of self-excluders as well as goals and motives for initiating self-exclusion from terrestrial and online gambling. In addition, use of further professional help and barriers to self-exclusion are examined.METHODS: Based on systematic literature search and quality assessment, n = 16 original studies (13 quantitative, 2 qualitative, and 1 mixed method) published between 1997 and 2017 in English or German language were analyzed. Results are presented for online and terrestrial gambling separately.RESULTS: Online self-excluders were on average 10 years younger than terrestrial self-excluders. Self-exclusion was mainly motivated by financial problems, followed by feelings of losing control and problems with significant others. Financial problems and significant others were less important for online than for terrestrial gamblers. Main barriers for self-exclusion were complicated enrollment processes, lack of complete exclusion from all venues, little support from venue staff, and lack of adequate information on self-exclusion programs. Both self-excluders from terrestrial and online gambling had negative attitudes toward the need of professional addiction care.CONCLUSION: To exploit the full potential of self-exclusion as a measure of gambler protection, its acceptance and its utilization need to be increased by target-group-specific information addressing financial issues and the role of significant others, simplifying the administrative processes, facilitating self-exclusion at an early stage of the gambling career, offering self-determined exclusion durations, and promoting additional use of professional addiction care.

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., 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., Responding to and Reducing Gambling Problems Studies (Regaps) – Studies in Help-seeking, Measurement, Comorbidity and Policy Impacts

Background: Although young adult men are at an elevated risk for gambling problems (GP), compared to adolescents and adults in general this group is still largely unresearched. The current study investigates whether family functioning, which is associated with reduced risk for GP in adolescence, also affects gambling in young adults, who are more independent than minors. It analyses the relationship between GP and two core components of family functioning, the effectiveness of problem-solving in the family and perceived concordance of values. Methods: Data came from the baseline, 12- and 24-month follow-up assessments of Munich Leisure-time Study (MLS), a longitudinal online study in young male gamblers. Young men were recruited via the Munich citizens’ registry (n = 2,693) and Facebook invites (n = 105). In total, n = 173 individuals positively screened for frequent and/or regular gambling participated in the study. The hypothesised relations between problem-solving, concordance of values and GP were investigated with a path model controlling for non-planning impulsiveness and psychological distress. Results: Higher concordance of family values was significantly related to less GP in cross-sectional and longitudinal analyses. It mediated the relation between the effectiveness of problem-solving and GP. Conclusions: While previous studies indicated good family functioning as a factor preventive of GP, the current results indicate that this association is mediated by the perceived concordance of family values. In families with effective problem-solving, common family values might facilitate recognition of and reaction to first signs of problems. Perceived discordance may lead to feelings of shame and concealment of GP.

Objective: This study aimed to (a) investigate the relationship between drinking location and adolescent alcohol use, (b) analyze the association of drinking culture indicators with alcohol use, and (c) explore interaction effects of drinking location and drinking culture indicators. Method: Analyses were based on the 2011 European School Survey Project on Alcohol and Other Drugs (ESPAD). The analytical sample consisted of 15-to 16-year-old students (N = 36,366; 51.6% female) from 11 countries. Alcohol volume and perceived drunkenness were used as outcomes. Drinking location was used as predictor variable. Per capita consumption and restrictions on public drinking were used as country-level predictors. Sex-stratified generalized linear models with cluster robust standard errors were applied. Results: Compared with drinking outdoors, the reported alcohol volume was lower when drinking at home and higher when drinking in multiple locations or at someone else's home. Drunkenness was highest among boys drinking at someone else's home and, compared with drinking outdoors, lower among girls drinking on premise. Per capita consumption was positively associated with alcohol volume. Among girls, the association between per capita consumption and both outcomes was stronger when drinking in multiple locations than when drinking outdoors. A ban on public drinking showed a negative effect on drinking volume and drunkenness among girls. Conclusions: The role of different drinking locations in alcohol use as well as sex differences should be considered in prevention and intervention of adolescent heavy drinking. Setting-specific prevention and intervention measures are of greater importance in medium-or high-consumption societies.

Objectives: Male sex, young age, and frequent gambling are considered as risk factors for gambling disorder (GD) and stress might be one of the triggers of gambling behavior among problem gamblers. Conversely, well-developed coping with stress might counteract gambling problems. The Proactive Coping Theory provides a promising approach for the further development of preventive and treatment measures. The objective of the study was to investigate different facets of proactive coping (PC) in young male gamblers. Methods: Young men from Bavaria were recruited via the Munich citizens’ registry (n = 2,588) and Facebook invitations (n = 105). In total, 173 out of 398 individuals were positively screened for frequent gambling and/or signs of related problems and completed the baseline questionnaire of the Munich Leisure-time Study. Factors investigated include gambling problems, PC, impulsiveness, social support, and psychological distress. Results: Gambling problems were associated with lower levels of preventive coping as well as of adaptive reaction delay. The associations were also significant when controlled for impulsiveness and general psychological distress. Preventive coping moderated the association between social support and gambling problems. Discussion and conclusions: Young men with gambling problems less frequently prevent the occurrence of stressors and more often react hasty when these occur. While the investigated group reported good social support, this factor was negatively associated with GD only among individuals with good preventive coping. Preventive coping poses a useful construct for selective prevention and treatment as it can be modified in professional interventions.