Discussing the Benefits and Challenges of Gambling Self-Exclusion Programs

Sarah E. Nelson, Ph.D., instructor in psychiatry at Harvard Medical School, kicked off an insightful breakout session about gambling self-exclusion programs with a whimsical story excerpted from “Frog and Toad Together,” a book she often reads to her daughter. Nelson told the tale of two friends who rely on their power of will – sometimes unsuccessfully – to stop eating cookies. Nelson said that the story illustrated how unique and challenging gambling self-exclusion programs can be.

Nelson then reviewed the findings from a recent study on the efficacy of the Missouri Voluntary Exclusion Program conducted by the Division on Addictions at the Cambridge Health Alliance. The study, she said, confirmed that the program was largely a success. It found that the majority of gamblers who recently joined the program reported gambling less now. However, this outcome, the study found, was not solely attributable to self-administered casino bans. Many self-excluders also reported enrolling in disordered gambling treatment programs and making other efforts to become healthy.

Nelson also noted that the study identified several vulnerabilities in the Missouri Voluntary Exclusion Program, which could potentially inform the development of similar state-administered programs. For example, she said, “if enforcement is a priority, more stringent measures need to be in place” to prevent self-excluders from entering casinos. Many program participants reported being able to enter a casino without penalty after signing the self-exclusion agreement. Nelson added that program administrators should keep better records of program participants to facilitate research and increase program enforcement.

Nelson then turned the session over to Richard A. LaBrie, Ed.D., instructor in psychiatry at Harvard Medical School, to discuss other key findings from the study. LaBrie discussed how the study identified what appeared to be a sort of adaptation effect. He said that program enrollment, like the illness, demonstrated rapid acceleration in its early stages, but that it leveled off with time. He also discussed how, using simple math, the number of self-excluders can roughly determine the number of pathological gamblers in a given location.

Nelson, LaBrie and Jennifer Shatley, vice president of responsible gaming programs and compliance at Harrah’s Entertainment, Inc., then took questions from the audience. An engaging dialogue about the challenges of implementing and measuring the success of gambling self-exclusion programs followed. LaBrie discussed the long-term efficacy of the programs, wondering, “if you shelter someone from gambling-related harms, do you give them strength to resist them long-term?” The panelists also discussed how difficult it is to ensure that self-exclusion programs are enforced in different states.