The New Zealand National Survey of Problem and Pathological Gambling Max W. Abbott, Ph.D.
Auckland Institute of Technology, Auckland, New Zealand Rachel A. Volberg, Ph.D.
Gemini Research, Roaring Sprin~ Pennsylvania
In New Zealand, awareness of gambling-related problems has increased in association with the legalization of new forms of gambling. This paper presents the methods and selected results from a national survey of gambling and problem gambling completed in New Zealand in 1991. While the primary aim of the study was to determine the extent of problem gambling in New Zealand, the study included a second phase intended to assess the validity and reliability of the widely-used South Oaks Gambling Screen as well as to examine other aspects of problematic involvement in gambling. The results of the two-phase study in New Zealand show that problem gamblers in different countries are remarkably similar in demographic terms as well as with regard to other risk factors associated with problematic gambling involvement. The New Zealand study of problem gambling points the way toward important research topics that will require further exploration in the furore.
N e w Z e a l a n d is a S o u t h Pacific c o u n t r y o f a p p r o x i m a t e l y 3.4 mill i o n p e o p l e o f p r e d o m i n a n t l y British a n d M a o r i d e s c e n t . Since its c o l o n i z a t i o n m i d - w a y t h r o u g h last c e n t u r y , g a m b l i n g has p l a y e d a s i g n i f i c a n t This research was funded by the New Zealand Department of Internal Affairs and by the US National Institute of Mental Health (MH-44295). Address correspondence and requests for copies of reprints to Dr. Max Abbott, Dean of Health Studies, Auckland Institute of Technology. Private Bag 92006. Auckland, New Zealand.
Journal of Gandding Studies VoL 12(2~ Summer1996 9 1996 H u m a n Sciences Press, Inc.
143
144
JOURNAL OF GAMBLINGSTUDIES
role in New Zealand society. Betting on horse racing, as reflected in the saying "rugby, racing and beer," has been a central feature of the country's popular culture if not national identity. New Zealand is the only country to have a Minister of Racing holding cabinet rank and no other country has the skeleton of a long dead racehorse as a central exhibit in its capital's museum. Although gambling has been legal in New Zealand throughout the present century, during most of this period it has been tightly regulated and confined to specific forms (O'Sullivan & Christoffel, 1992). During the past six years, the situation has changed dramatically with the introduction of Lotto and Instant Kiwi (state lottery games), video gaming machines and facilities for telephone betting on horse and dog races. Currently, the construction of two large casinos is progressing in Auckland and Christchurch, respectively the major cities in the country's North and South Islands. After a decade of stability, per capita expenditure on gambling doubled from 1988 to 1990 (New Zealand Department of Internal Affairs, 1992) and has continued to increase steadily since. In 1992, annual expenditure was estimated to be NZ$2.4 billion, approximately NZ$80 per month for each person aged 18 and over (Lee, 1993). In New Zealand, professional and public awareness of gambling-related problems has increased with the legalization of new forms of gambling. Concern about pathological gambling was expressed in submissions to the Committee of Inquiry into the Establishment of Casinos in New Zealand (New Zealand Department of Internal Affairs, 1989) and Review of Gambling in New Zealand (New Zealand Department of Internal Affairs, 1990). These government reviews concluded that pathological gambling was a problem but that there was a lack of objective information regarding its scale. National public opinion surveys conducted in 1985 and 1990 found that the majority of adult New Zealanders believed that there was a problem with people who gamble excessively (66% agreed with this statement in 1985; 71% in 1990) and that these people should receive special help and support if they want to give up gambling (86% in 1985; 91% in 1990) (Christoffel, 1992). These findings suggest that public awareness of gambling problems and support for specialist treatment provision increased from 1985 to 1990. In 1990, the New Zealand Department of Internal Affairs recomm e n d e d that research be undertaken to establish the prevalence of
MAX W. ABBOTT A N D RACHELA. VOLBERG
145
problem gambling in New Zealand. This agency subsequently contracted the first author (MWA) to conduct the national prevalence survey that is described in this article. The second author (RAV) was the co-principal investigator. The only previous research on the prevalence of pathological gambling in New Zealand had been undertaken during 1986 in Christchurch, as part of a general psychiatric epidemiological survey (Wells, Bushnell, Hornblow, Joyce & Oakley-Brown, 1989). On the basis of the American Psychiatric Association's Diagnostic Interview Schedule (DIS), 3.6% of adult respondents were found to have had a problem with gambling at some time. Less than one percent (0.4%) were diagnosed as pathological gamblers. While the overall methodology used in this study was sound, the estimates of pathological gambling were based on only a few questions and the recency of problems among the identified pathological gamblers was not reported for two of the seven cases.
THE 1991 NATIONAL SURVEY The primary aim of this study was to determine the extent and nature of excessive or problem gambling, including pathological gambling, in New Zealand. The study was conducted in two stages. Phase One was similar in design to previous surveys that had been conducted in the United States and Canada using the South Oaks Gambling Screen (SOGS) (Ladouceur, 1991; Volberg, 1994). It differed in that it was national in scope and used an adaptation of the original SOGS (SOGS-R) that yields both lifetime and current measures of gambling problems and pathology (Volberg & Abbott, 1994). Phase Two involved face-to-face interviews with sub-samples o f Phase One gamblers. These interviews all took place within three months of the initial telephone interviews and were conducted double blind. Among other alms, Phase Two was intended to provide a check on the validity of the Phase One categorizations. Full reports on the two phases of the New Zealand study have been published (Abbott & Volberg, 1991; Abbott & Volberg, 1992).
Phase One: Aims This part of the study was designed to estimate the n u m b e r o f current and past pathological and problem gamblers in the New Zealand
146
JOURNAL OF GAMBLINGSTUDIES
adult population and to compare these prevalence estimates with the findings of other SOGS-based studies. Additional aims included identifying sociodemographic and other factors that discriminate between problem/pathological gamblers and the rest of the population, establishing information on gambling involvement on the part of adult New Zealanders generally, and providing a baseline from which future changes in both gambling participation and gambling-related problems could be determined. Memo&
A nation-wide sample of 3,933 people aged 18 years and older was obtained by random digit dialling of residential dwellings. At the time of the survey, approximately 95% of New Zealand households had telephones. Respondents within households were selected by asking to speak to the person with the "next birthday." Only one person per dwelling was interviewed and substitutions were not allowed. Maori and Pacific Islanders, the largest ethnic minorities in New Zealand, are under-represented by telephone sampling because of lower telephone ownership. To correct for the likely under-representation of these groups in our final sample, an additional 120 people were added to the sample by using the same random digit dialling method but excluding respondents who were not Maori or Pacific Islanders. The overall sample was subsequently weighted to reflect age, gender and household size distributions in the total population. The results reported in this paper are based on a weighted sample of 4,000. All respondents were interviewed over the telephone by experienced interviewers. Up to eight callbacks were made to complete an interview. In the small number of instances where interviewees were not proficient in English, interviews were conducted in other languages including Samoan, Tongan, Nuiean (Pacific Island languages), Mandarin and Cantonese. The response rate was 66%. This is similar to response rates for previous health and epidemiological surveys in New Zealand (Black & Caswell, 1991) and gambling prevalence surveys conducted elsewhere (Ladouceur, 1991; Volberg, 1994; Volberg, 1996). As indicated, the interview incorporated a modified version of SOGS dubbed SOGS-R by the authors. The original 20-item SOGS, based on DSM-III-R diagnostic criteria for pathological gambling, had been shown to be valid and reliable in a variety of populations (Lesieur
MAX W. ABBOTT AND RACHELA. VOLBERG
147
& Blume, 1987). Modifications included an expanded section covering the types of gambling engaged in, frequency and recency o f participation and expenditure involved as well as the addition of a current (6month) measure of problem and pathological gambling. The 6-month measure was added because it is more important for policy makers and service providers to know how many people there are with a problem currently than at some time in the past. Further, it is now standard practice in psychiatric epidemiology to consider both point (current) and lifetime prevalence. The lifetime measure was retained to allow comparison with previous studies and provide a more comprehensive account of changes in gambling problems over time. Both the current and lifetime measures were scored in the same way with individuals scoring 5 or more classified as "probable pathological gamblers" and those scoring 3 or 4 classified as "problem gamblers." A series of sociodemographic questions completed the survey instrument which took, on average, 12 minutes to administer.
Major Findings GamblingParticipation.
The great majority of the New Zealand respondents (95%) said they had participated in at least one form of gambling at some time. Lotto was the most popular form of gambling: 87% of respondents reported having bought a ticket at some time and 42% reported doing so once a week or more. Weekly participation in other forms o f gambling included Instant Kiwi (13%), lotteries and raffles (7%), betting at the track on horse a n d / o r dog races (4%), gaming machines (3%) and bets with friends and workmates (2%). Mean monthly reported gambling expenditure was NZ$37 per respondent, suggesting a total estimated annual expenditure on gambling of just u n d e r NZ$1 billion. The largest share o f expenditure was on Lotto (35%) followed by track betting (16%), card games (15%), Instant Kiwi (9%), lotteries/raffles (7%), gaming machines (5%) and betting on events (5%). Although gambling was commonplace throughout the population, significant differences between sociodemographic groups were evident with respect to gambling involvement and expenditure. For example men, especially young men, were m u c h m o r e likely to gamble on a regular basis than women. Relative to women, m e n showed strong preferences for track betting, gaming machines and cards. Males also spent
148
J O U R N A L O F G A M B L I N G STUDIES
more (NZ$55 per month) than females (NZ$20). Twenty percent of male gambling expenditure was on track betting compared with 6% for women. Over half (53%) of female gambling expenditure was on Lotto compared with 28% for males. Pacific Islanders reported very high rates of weekly participation in track betting (19%) and Instant Kiwi (22%). Unemployed people also reported significantly higher levels of weekly involvement in track betting (9%) and Instant Kiwi (19%) than other respondents. Unemployed respondents also had high levels of weekly wagering on gaming machines (7%).
Prevalence Estimates. The lifetime prevalence rate for probable pathological gambling, based on responses to the SOGS-R, was found to be 2.7% (• The lifetime rate for problem gamblers was 4.2% (• These data and the population estimates derived from them are shown in Table 1. Current (6-month) prevalence rates and estimates are also provided. It is evident from Table 1 that the current prevalence estimates are approximately half their lifetime counterparts. This suggests that while pathological gamblers may develop disorders that persist for considerable periods of time, a significant number either overcome their problems or pass through phases of control and relapse. Further analysis showed approximately one-third (35%) of respondents who scored as lifetime probable pathological gamblers were reported experiencing
Table 1 1991 Lifetime and Current Prevalence Rates and Population Estimates for Problem and Probable Pathological Gambling in New Zealand
Category Lifetime Pathological Lifetime Problem Current Pathological Current Problem N = 4,000
Prevalence (• SE) 2.7 4.2 1.2 2.1
(• (• (• (•
0.5)% 0.6)% 0.3)% 0.4)%
PopulationEstimate 50,000-73,000 82,000-110,000 20,000-35,000 38,000-58,000
MAX
W. A B B O T T
A N D R A C H E L A. V O L B E R G
149
few or no gambling-related problems during the 6-month period prior to the survey.
Sociodemographic Characteristics of Problem and Probable Pathological Gamblers. Although problem and pathological gamblers came from across the sociodemographic spectrum, some groups were at much greater risk than others. High prevalence rates were found among young people, with 54% of lifetime probable pathological gamblers and 67% of current probable pathological gamblers being in the 18-29 year age group. Only 29% of the weighted sample was in this age category. Males were also over-represented among respondents who scored as probable pathological gamblers. Seventy-nine percent of lifetime probable pathological gamblers and 80% of current probable pathological gamblers were men. Almost a quarter of both lifetime and current probable pathological gamblers (23% and 22% respectively) were Maori. Corresponding figures for Pacific Islanders, who comprised only 3% of the weighted sample, were 18% and 25%. Employment status was another strong predictor of problematic gambling involvement. Seventeen percent of lifetime probable pathological gamblers and 29% of current probable pathological gamblers were unemployed although unemployed people made up just 4% of the sample. Single respondents were also somewhat more at risk. Religion and household income were not important in this regard and education level, while reaching statistical significance, was not a strong predictor of gambling-related problems. Major sociodemographic characteristics that differentiate problem and pathological gamblers from non-problem gamblers and non-gamblers are shown in Table 2. In this table, the lifetime pathological and problem gambling groups have been combined. This grouping is based on a discriminant function analysis that failed to separate the problem and pathological groups but showed a highly significant separation between these two groups and the non-problem group (X ~ = 213.3, p
Auckland Institute of Technology, Auckland, New Zealand Rachel A. Volberg, Ph.D.
Gemini Research, Roaring Sprin~ Pennsylvania
In New Zealand, awareness of gambling-related problems has increased in association with the legalization of new forms of gambling. This paper presents the methods and selected results from a national survey of gambling and problem gambling completed in New Zealand in 1991. While the primary aim of the study was to determine the extent of problem gambling in New Zealand, the study included a second phase intended to assess the validity and reliability of the widely-used South Oaks Gambling Screen as well as to examine other aspects of problematic involvement in gambling. The results of the two-phase study in New Zealand show that problem gamblers in different countries are remarkably similar in demographic terms as well as with regard to other risk factors associated with problematic gambling involvement. The New Zealand study of problem gambling points the way toward important research topics that will require further exploration in the furore.
N e w Z e a l a n d is a S o u t h Pacific c o u n t r y o f a p p r o x i m a t e l y 3.4 mill i o n p e o p l e o f p r e d o m i n a n t l y British a n d M a o r i d e s c e n t . Since its c o l o n i z a t i o n m i d - w a y t h r o u g h last c e n t u r y , g a m b l i n g has p l a y e d a s i g n i f i c a n t This research was funded by the New Zealand Department of Internal Affairs and by the US National Institute of Mental Health (MH-44295). Address correspondence and requests for copies of reprints to Dr. Max Abbott, Dean of Health Studies, Auckland Institute of Technology. Private Bag 92006. Auckland, New Zealand.
Journal of Gandding Studies VoL 12(2~ Summer1996 9 1996 H u m a n Sciences Press, Inc.
143
144
JOURNAL OF GAMBLINGSTUDIES
role in New Zealand society. Betting on horse racing, as reflected in the saying "rugby, racing and beer," has been a central feature of the country's popular culture if not national identity. New Zealand is the only country to have a Minister of Racing holding cabinet rank and no other country has the skeleton of a long dead racehorse as a central exhibit in its capital's museum. Although gambling has been legal in New Zealand throughout the present century, during most of this period it has been tightly regulated and confined to specific forms (O'Sullivan & Christoffel, 1992). During the past six years, the situation has changed dramatically with the introduction of Lotto and Instant Kiwi (state lottery games), video gaming machines and facilities for telephone betting on horse and dog races. Currently, the construction of two large casinos is progressing in Auckland and Christchurch, respectively the major cities in the country's North and South Islands. After a decade of stability, per capita expenditure on gambling doubled from 1988 to 1990 (New Zealand Department of Internal Affairs, 1992) and has continued to increase steadily since. In 1992, annual expenditure was estimated to be NZ$2.4 billion, approximately NZ$80 per month for each person aged 18 and over (Lee, 1993). In New Zealand, professional and public awareness of gambling-related problems has increased with the legalization of new forms of gambling. Concern about pathological gambling was expressed in submissions to the Committee of Inquiry into the Establishment of Casinos in New Zealand (New Zealand Department of Internal Affairs, 1989) and Review of Gambling in New Zealand (New Zealand Department of Internal Affairs, 1990). These government reviews concluded that pathological gambling was a problem but that there was a lack of objective information regarding its scale. National public opinion surveys conducted in 1985 and 1990 found that the majority of adult New Zealanders believed that there was a problem with people who gamble excessively (66% agreed with this statement in 1985; 71% in 1990) and that these people should receive special help and support if they want to give up gambling (86% in 1985; 91% in 1990) (Christoffel, 1992). These findings suggest that public awareness of gambling problems and support for specialist treatment provision increased from 1985 to 1990. In 1990, the New Zealand Department of Internal Affairs recomm e n d e d that research be undertaken to establish the prevalence of
MAX W. ABBOTT A N D RACHELA. VOLBERG
145
problem gambling in New Zealand. This agency subsequently contracted the first author (MWA) to conduct the national prevalence survey that is described in this article. The second author (RAV) was the co-principal investigator. The only previous research on the prevalence of pathological gambling in New Zealand had been undertaken during 1986 in Christchurch, as part of a general psychiatric epidemiological survey (Wells, Bushnell, Hornblow, Joyce & Oakley-Brown, 1989). On the basis of the American Psychiatric Association's Diagnostic Interview Schedule (DIS), 3.6% of adult respondents were found to have had a problem with gambling at some time. Less than one percent (0.4%) were diagnosed as pathological gamblers. While the overall methodology used in this study was sound, the estimates of pathological gambling were based on only a few questions and the recency of problems among the identified pathological gamblers was not reported for two of the seven cases.
THE 1991 NATIONAL SURVEY The primary aim of this study was to determine the extent and nature of excessive or problem gambling, including pathological gambling, in New Zealand. The study was conducted in two stages. Phase One was similar in design to previous surveys that had been conducted in the United States and Canada using the South Oaks Gambling Screen (SOGS) (Ladouceur, 1991; Volberg, 1994). It differed in that it was national in scope and used an adaptation of the original SOGS (SOGS-R) that yields both lifetime and current measures of gambling problems and pathology (Volberg & Abbott, 1994). Phase Two involved face-to-face interviews with sub-samples o f Phase One gamblers. These interviews all took place within three months of the initial telephone interviews and were conducted double blind. Among other alms, Phase Two was intended to provide a check on the validity of the Phase One categorizations. Full reports on the two phases of the New Zealand study have been published (Abbott & Volberg, 1991; Abbott & Volberg, 1992).
Phase One: Aims This part of the study was designed to estimate the n u m b e r o f current and past pathological and problem gamblers in the New Zealand
146
JOURNAL OF GAMBLINGSTUDIES
adult population and to compare these prevalence estimates with the findings of other SOGS-based studies. Additional aims included identifying sociodemographic and other factors that discriminate between problem/pathological gamblers and the rest of the population, establishing information on gambling involvement on the part of adult New Zealanders generally, and providing a baseline from which future changes in both gambling participation and gambling-related problems could be determined. Memo&
A nation-wide sample of 3,933 people aged 18 years and older was obtained by random digit dialling of residential dwellings. At the time of the survey, approximately 95% of New Zealand households had telephones. Respondents within households were selected by asking to speak to the person with the "next birthday." Only one person per dwelling was interviewed and substitutions were not allowed. Maori and Pacific Islanders, the largest ethnic minorities in New Zealand, are under-represented by telephone sampling because of lower telephone ownership. To correct for the likely under-representation of these groups in our final sample, an additional 120 people were added to the sample by using the same random digit dialling method but excluding respondents who were not Maori or Pacific Islanders. The overall sample was subsequently weighted to reflect age, gender and household size distributions in the total population. The results reported in this paper are based on a weighted sample of 4,000. All respondents were interviewed over the telephone by experienced interviewers. Up to eight callbacks were made to complete an interview. In the small number of instances where interviewees were not proficient in English, interviews were conducted in other languages including Samoan, Tongan, Nuiean (Pacific Island languages), Mandarin and Cantonese. The response rate was 66%. This is similar to response rates for previous health and epidemiological surveys in New Zealand (Black & Caswell, 1991) and gambling prevalence surveys conducted elsewhere (Ladouceur, 1991; Volberg, 1994; Volberg, 1996). As indicated, the interview incorporated a modified version of SOGS dubbed SOGS-R by the authors. The original 20-item SOGS, based on DSM-III-R diagnostic criteria for pathological gambling, had been shown to be valid and reliable in a variety of populations (Lesieur
MAX W. ABBOTT AND RACHELA. VOLBERG
147
& Blume, 1987). Modifications included an expanded section covering the types of gambling engaged in, frequency and recency o f participation and expenditure involved as well as the addition of a current (6month) measure of problem and pathological gambling. The 6-month measure was added because it is more important for policy makers and service providers to know how many people there are with a problem currently than at some time in the past. Further, it is now standard practice in psychiatric epidemiology to consider both point (current) and lifetime prevalence. The lifetime measure was retained to allow comparison with previous studies and provide a more comprehensive account of changes in gambling problems over time. Both the current and lifetime measures were scored in the same way with individuals scoring 5 or more classified as "probable pathological gamblers" and those scoring 3 or 4 classified as "problem gamblers." A series of sociodemographic questions completed the survey instrument which took, on average, 12 minutes to administer.
Major Findings GamblingParticipation.
The great majority of the New Zealand respondents (95%) said they had participated in at least one form of gambling at some time. Lotto was the most popular form of gambling: 87% of respondents reported having bought a ticket at some time and 42% reported doing so once a week or more. Weekly participation in other forms o f gambling included Instant Kiwi (13%), lotteries and raffles (7%), betting at the track on horse a n d / o r dog races (4%), gaming machines (3%) and bets with friends and workmates (2%). Mean monthly reported gambling expenditure was NZ$37 per respondent, suggesting a total estimated annual expenditure on gambling of just u n d e r NZ$1 billion. The largest share o f expenditure was on Lotto (35%) followed by track betting (16%), card games (15%), Instant Kiwi (9%), lotteries/raffles (7%), gaming machines (5%) and betting on events (5%). Although gambling was commonplace throughout the population, significant differences between sociodemographic groups were evident with respect to gambling involvement and expenditure. For example men, especially young men, were m u c h m o r e likely to gamble on a regular basis than women. Relative to women, m e n showed strong preferences for track betting, gaming machines and cards. Males also spent
148
J O U R N A L O F G A M B L I N G STUDIES
more (NZ$55 per month) than females (NZ$20). Twenty percent of male gambling expenditure was on track betting compared with 6% for women. Over half (53%) of female gambling expenditure was on Lotto compared with 28% for males. Pacific Islanders reported very high rates of weekly participation in track betting (19%) and Instant Kiwi (22%). Unemployed people also reported significantly higher levels of weekly involvement in track betting (9%) and Instant Kiwi (19%) than other respondents. Unemployed respondents also had high levels of weekly wagering on gaming machines (7%).
Prevalence Estimates. The lifetime prevalence rate for probable pathological gambling, based on responses to the SOGS-R, was found to be 2.7% (• The lifetime rate for problem gamblers was 4.2% (• These data and the population estimates derived from them are shown in Table 1. Current (6-month) prevalence rates and estimates are also provided. It is evident from Table 1 that the current prevalence estimates are approximately half their lifetime counterparts. This suggests that while pathological gamblers may develop disorders that persist for considerable periods of time, a significant number either overcome their problems or pass through phases of control and relapse. Further analysis showed approximately one-third (35%) of respondents who scored as lifetime probable pathological gamblers were reported experiencing
Table 1 1991 Lifetime and Current Prevalence Rates and Population Estimates for Problem and Probable Pathological Gambling in New Zealand
Category Lifetime Pathological Lifetime Problem Current Pathological Current Problem N = 4,000
Prevalence (• SE) 2.7 4.2 1.2 2.1
(• (• (• (•
0.5)% 0.6)% 0.3)% 0.4)%
PopulationEstimate 50,000-73,000 82,000-110,000 20,000-35,000 38,000-58,000
MAX
W. A B B O T T
A N D R A C H E L A. V O L B E R G
149
few or no gambling-related problems during the 6-month period prior to the survey.
Sociodemographic Characteristics of Problem and Probable Pathological Gamblers. Although problem and pathological gamblers came from across the sociodemographic spectrum, some groups were at much greater risk than others. High prevalence rates were found among young people, with 54% of lifetime probable pathological gamblers and 67% of current probable pathological gamblers being in the 18-29 year age group. Only 29% of the weighted sample was in this age category. Males were also over-represented among respondents who scored as probable pathological gamblers. Seventy-nine percent of lifetime probable pathological gamblers and 80% of current probable pathological gamblers were men. Almost a quarter of both lifetime and current probable pathological gamblers (23% and 22% respectively) were Maori. Corresponding figures for Pacific Islanders, who comprised only 3% of the weighted sample, were 18% and 25%. Employment status was another strong predictor of problematic gambling involvement. Seventeen percent of lifetime probable pathological gamblers and 29% of current probable pathological gamblers were unemployed although unemployed people made up just 4% of the sample. Single respondents were also somewhat more at risk. Religion and household income were not important in this regard and education level, while reaching statistical significance, was not a strong predictor of gambling-related problems. Major sociodemographic characteristics that differentiate problem and pathological gamblers from non-problem gamblers and non-gamblers are shown in Table 2. In this table, the lifetime pathological and problem gambling groups have been combined. This grouping is based on a discriminant function analysis that failed to separate the problem and pathological groups but showed a highly significant separation between these two groups and the non-problem group (X ~ = 213.3, p
