ABSTRACT
Background: Gambling disorder is the first non-substance-related addiction which is recognized as a diagnostic entity and assessed in treatment settings. However, in many clinical settings, assessment, and structured treatment for this condition is severely under-developed, and treatment seeking in many settings is low. This is a protocol paper describing the rationale and structure of a recently established quality register, allowing for structured monitoring of treatment seeking, treatment needs and treatment provision in Swedish health care settings, for gambling disorder and associated conditions. Methods: Since 2019, a Swedish quality register is in use for the systematic data collection from patients receiving treatment in specialized health care. The register is held by Region Skåne, and approved for national use. Swedish quality registers allow for the clinical monitoring of treatment uptake and needs, for quality improvement purposes, and collect systematic cohort data for these purposes. In addition, these quality registers potentially allow for future research projects, after separate ethics applications, allowing for clinical follow-up studies based on non-identified quality register data. Clinical challenges and research knowledge gaps are addressed in the present register, including mental health comorbidity, history of suicidal behavior, comorbid alcohol, drugs and gaming behaviors, and fundamental psycho-social variables such as violence victimization, concerned significant others including children's situation in families of problem gamblers, and main income and involvements with social services and enforcement agency. In addition, patient flows, including rates of referral from primary care and other treatment settings, can be followed. The overall quality register project is registered at clinicaltrials.gov (NCT05276193). Discussion: The present protocol paper will allow for systematic reporting and future projects addressing knowledge gaps in clinical treatment for gambling disorder, and highlight the importance for evidence-based treatment in a behavioral addiction. Importantly, the current data will contribute to a better understanding of which patient groups may be less likely to seek or to be referred to treatment, and thereby may shape future initiatives to increase screening and referral in targeted, vulnerable groups.
ABSTRACT
BACKGROUND: Voluntary self-exclusion from gambling is a common harm reduction option for individuals with gambling problems. Multi-operator, nationwide self-exclusion services are rare, and a system introduced in the highly web-based gambling market of Sweden is a rare and recent example. However, where web-based casino gambling and web-based betting are the predominate gambling types in those seeking treatment, the risk of breaching one's own self-exclusion through overseas web-based operators may also be high. OBJECTIVE: This study aims to assess the prevalence of a nationwide Spelpaus ("gambling break") self-exclusion and the prevalence of gambling despite self-exclusion in patients seeking treatment for gambling disorder in 2021. METHODS: Health care documentation of recent treatment seekers (January 1 through September 1, 2021, N=85) in a Swedish treatment facility was reviewed for data regarding problematic gambling types reported, history of self-exclusion, and history of breaching of that self-exclusion. RESULTS: Common problem gambling types were web-based casino gambling (49/74, 66%) and sports betting (19/74, 26%). The majority who participated in this study (62/85, 73%) were men. All women reported web-based casino gambling. Self-exclusion through Spelpaus was common (60/74, 81%). Among self-excluders, gambling despite self-exclusion was common (41/60, 68%), most commonly on unlicensed gambling websites. CONCLUSIONS: The nationwide, multi-operator self-exclusion service of Sweden appears to reach many patients with a gambling disorder. However, the remaining gambling options in an web-based gambling setting present a major challenge despite self-exclusion. The recent data calls for further treatment efforts and potential improvements in services aiming to help voluntary self-excluders abstain from gambling.
ABSTRACT
The COVID-19 pandemic and its impact on society has been suspected to affect gambling behaviors. Potentially, the pandemic crisis may result in increased problem gambling, for example, due to COVID-19-related psychological distress, unemployment, and financial difficulties. In addition, the cancellation of sports in early parts of the crisis has been suspected to alter gambling behaviors. Policy makers have called for action and, in some cases, have changed regulations, and media have reported possible increases in treatment seeking. However, research data are hitherto lacking. The present study assessed the treatment uptake at a regional specialized gambling-disorder unit in the healthcare system of Region Skåne, Sweden. Number of patients, treatment contacts, and patterns of rescheduling or cancellations of appointments were quantified for each month, January-December 2020, and compared to corresponding months of 2018 and 2019. Possible trends were analyzed, using an interrupted time-series analysis. Results did not indicate an increase in treatment uptake for gambling disorder during the months of COVID-19 impact in Sweden. The proportion of digital treatment increased, but total treatment uptake was unaffected by the pandemic. In conclusion, during the first ten months of the pandemic in Sweden, no obvious increase in treatment uptake for gambling disorder could be seen. Moreover, longer follow-up may be necessary in order to see if effects of worsening socioeconomic conditions may be a possible long-term risk factor of increased gambling after COVID-19.
