Observations on Studying Gambling Places: Implications for Regulators and Researchers

Von Prof. Bo Bernhard

Traditionally and understandably, gambling regulation has been problem-focused. For instance, after years of focusing heavily upon the criminological aspects of gambling, today our “problem focus” has shifted to a realm of behavioral and public health science: problem gambling. This makes sense, of course, as the regulation of gambling involves a mandate that regulators focus upon hazard prevention. However, there is a “problem with the problem,” since it is relatively rare. For instance, in Germany the prevalence of pathological gambling is below 0.5%. If we add the subclinical category of problem gambling, the overall prevalence is still below 1% — though of course, the percentage of individuals affected by that 1% is higher. Meanwhile, no matter how we calculate these important figures, vast majorities of gamblers do not suffer these consequences.

Building upon a strong research foundation dating back at least to the Reno Model, one recent ALICE-RAP project policy paper recognized this challenge, suggesting that is the obligation of policy makers and regulators to address the needs of vulnerable groups as well as the rights of recreational gamblers. This is the nature of government, of course: it has to seek to govern all of the population, not just some of the population. Similarly, as researchers we have an obligation when approaching complex questions to use all of our tools, not just some of our tools.

With this in mind, a multi-disciplinary approach can provide a more comprehensive view, relying on sociologists, anthropologists, historians, economists, psychologists, political scientists, biologists, and criminologists to consider the range of costs and benefits of gambling. This, of course, is where university entities like the UNLV International Gaming Institute (IGI) can play a key role.

For instance, at the IGI we host the world’s oldest and largest gathering of gambling researchers, the International Conference on Gambling and Risk Taking, founded in 1974 by the “father of the field,” Bill Eadington. Dr. Eadington was an economist, but the spirit he introduced was collaborative, complementary, and coalitional. The most recent edition of this conference attracted 600+ attendees from 31 countries and virtually every academic field.

This multi-disciplinary approach is vital to understanding something as complex as the modern integrated resort, which today stand as the most expensive buildings humans have ever constructed. Just as Europeans, for millennia, built cathedrals that stood as the most complex buildings of their time, today integrated resorts like CityCenter in Las Vegas (now the Aria) hold that title. Let that sink in for a moment: whereas for a long time humankind’s most complex buildings were dedicated to religion – today, they are dedicated to recreation. Their expense owes much to their vast array of entertainment options– the strong majority of which, on the Las Vegas Strip, is non-gaming in nature. Macao, too, seeks to “Las Vegasize” by broadening its gambling spaces, while Europe will be seeing its first true integrated resorts in the next decade. These complex structures bear little resemblance to the oversimplified “gambling halls” that critics often point to when criticizing gambling – in fact, they are the planet’s most comprehensive houses of entertainment options. While in Germany the gambling environment might be smaller in scale, for the vast majority they can serve the same social function, alongside many other entertainment entities.

Similar oversimplification can be observed with narrow approaches to gambling regulation (and research) that focuses exclusively on singular causes. As is the case with virtually every question that academics, health professionals, and the general public face, we are finding that complex questions require multi-disciplinary answers. Most importantly, to truly help problem gamblers, we need a multi-faceted “safety net,” with diverse expertise arriving on the scene depending on need.

Keith Whyte at the U.S. National Council on Problem Gambling has developed a useful framework that I will refine here for our purposes. This framework is the “PETERR” framework, and it works well to remind us of the types of interventions available and appropriate. PETERR stands for: Prevention, Education, Treatment, Enforcement, Responsible Gaming, and Research.

Prevention is too often under-utilized as a tool in our tool chest – as after all, it is usually far more cost-effective to prevent a health problem than it is to treat it after it has fully manifested. These prevention programs can, for instance, focus on high-risk populations.

I am biased as a professor, but I am a big believer in the power of education. While we are well aware of the risks of any number of problematic behaviors nowadays, too frequently gambling education is lacking. Education needs to take place at multiple levels – with broader, pithy, easy-to-understand public educational messaging targeting the masses, and very specific educational messaging targeting those with severe problems. With the latter group, we should remind ourselves that one of the most important moments for a patient after a heart attack is the moment when the cardiologist sits down and educates the patient on all that we know about the heart, and informs them how this powerful knowledge can now empower the patient to live a healthier life moving forward after this traumatic incident.

Treatment is, of course, vital – even with the best prevention and educational programs in the world, a treatment “safety net” is mandatory. The “founding father” of problem gambling treatment, Dr. Robert Custer, was fond of saying that one would never build a ski slope without building a “hospital at the bottom of the hill,” because we know that inevitably some participants will fall and require treatment. Similarly, where gambling is available, effective treatment for problem gambling should be made available and affordable. Meanwhile, we as educators have a mandate to train our health care providers in proper diagnosis and care.

Enforcement is the job of government regulators, of course, in ensuring that sound problem gambling policies are implemented and executed. I would note here that too often, well-intentioned problem gambling policies are unresearched, so we first should also ensure that these policies are grounded in good science – and then regulators (or their representatives) need to ensure that these policies are actually followed. Too often, I see problem gambling policies on the books that are unchecked by regulators – as if simply having the policy is enough.

Gaming operators, of course, cannot be let off the hook – and as such, responsible gaming is a crucial component of our safety net. These approaches need to be culturally sensitive, appropriate to the gambling venue, and embedded in both the periodic and everyday training programs of employees. Corporate social responsibility must stand as an operational pillar of the company culture, and one of the very best ways to demonstrate this in gaming is through sound RG measures.

Finally, all of these measures – prevention, education, treatment, enforcement, and responsible gaming – need to be subjected to rigorous, peer-reviewed research to ensure that our approaches are actually working. In fact, without research, we may actually be exacerbating the very problem we are seeking to address, and hurting the populations we wish to help. It can be frustrating to wait for research, of course, but we do so with broader health and medical interventions, and problem gambling is a public health issue.

To this end, we need to have well-researched prevention programs targeting vulnerable populations, well-researched educational programs targeting both the masses and those who are suffering, well-researched treatment programs for the interventions required when things reach a crisis point, well-researched enforcement approaches to ensure that policies are scientific (and that those policies are followed), and well-researched responsible gaming approaches to ensure that the gaming venue is a safe place.

In sum, we all have a job to do – as is the case with virtually every major public health challenge. This realization, however, should empower and guide us, via a coalitional approach, to seek to “fill the buckets” in each of these crucial areas. While many jurisdictions boast powerful programs in one of the areas – a brilliant advertising campaign, for instance, that delivers a strong health message about gambling in a powerful way – virtually none can say that they have strong in all areas, and that each of these interventions are backed by sound, ongoing, evaluation research. Perhaps Germany can be the first.


Wolfgang Haß, Peter Lang: Glücksspielverhalten und Glücksspielsucht in Deutschland. Ergebnisse des Surveys 2015 und Trends. Forschungsbericht der BZgA. Köln 2016. http://www.bzga.de/pdf.php?id=7f6f856fc846fc2196919a3d197fcae9.

Gerhard Bühringer u. a.: ALICE RAP Policy Paper Series. Policy Brief 2. Gambling – two sides of the same coin: recreational activity and public health problem. 2013. http://www.alicerap.eu/resources/documents/doc_download/128-policy-paper-2- gambling-two-sides-of-the-same-coin.html.

Prof. Bo Bernhard ist Executive Director des International Gambling Institute der University of Las Vegas.