Positive Play Survey: Measuring Responsible Gambling in Minnesota

Positive Play Survey: Measuring Responsible Gambling in Minnesota

While much of the emphasis of problem gambling programs is on making sure that people with disordered gambling are able to find the help they need, it’s also important to understand the attitudes and beliefs of those who play responsibly.

Such insights can help inform policies and practices designed to prevent and reduce potential harms associated with gambling.

One of the ways to objectively identify and measure the extent of responsible play within a sample of players is through the positive play scale (PPS). The PPS looks at a gambler’s beliefs and behaviors and can be used by those in the gambling industry to assess the effectiveness of responsible gambling strategies, identify specific areas for future focus, and examine the potential value of new responsible gambling initiatives aimed at promoting healthy patterns of gambling.

With this in mind, NPGA commissioned Richard Wood, PhD, noted gambling researcher, to study the level of responsible gambling in Minnesota starting in September 2019. The study, which sampled 1,517 Minnesota players, will provide a benchmark so that future changes in responsible gambling behavior, as measured by the PPS, can be noted over time in response to prevention messaging targeted to players’ behaviors and beliefs.

The study measured two sets of beliefs: personal responsibility (the extent to which a player believes they should take ownership of their gambling behavior) and gambling literacy (the extent to which a player has an accurate understanding about the nature of gambling.) The survey also measured two sets of behaviors: honesty and control (extent to which players are honest with others about their gambling behavior and feel in control of their behavior) and pre-commitment (extent to which a player considers how much money and time they should spend gambling).

Most Minnesota players scored highest on personal responsibility, followed by honesty and control. However, more than half of all players scored medium or low on gambling literacy and pre-commitment. In fact, Minnesota’s pre-commitment scores were lower than those from three other states and Canada (which has invested more funds than the United States in responsible gambling initiatives over the last  10-plus years).

There were no significant differences in beliefs and behaviors based on gender. However, there were marked differences in PPS scores by age. While it’s not known why positive play increases systematically with age, it may have to do with overall exposure to responsible gambling messaging or that messaging is tailored to older people. The results show that the literacy rates are quite low among those aged 18-44, suggesting that better messaging can be developed for younger players.

As it relates to the various games people played, it was clear that those who limited themselves to lottery games had higher (better) PPS scores. Those who played a variety of games exhibited a lower PPS score, particularly for gambling literacy. It’s not clear if exposure to a range of games leads to decrements in positive play or whether those who do not hold positive play beliefs or engage in positive play behaviors are more apt to play multiple games more frequently.

Another key measurement was the relationship between positive play and satisfaction with gambling. Players were more satisfied with the gambling experience when they accepted personal responsibility for their gambling, were honest and in control about their gambling, and set limits on time and money spent. Surprisingly, gambling literacy did not correlate with player satisfaction. This was an unexpected finding and is something to be explored as we develop strategies. The results also suggest that segmentation is critical to understanding the responsible gambling needs of different players.

The insights provided by this study will help us design and target prevention messaging to specific kinds of players, including by age or type of play. If we are to succeed in reducing the overall harm that gambling can have on individuals and families, it makes sense to develop multiple strategies that help build knowledge around the risks involved.

Counselor Roundtable: What keeps Minnesotans from Seeking Treatment

Counselor Roundtable: What keeps Minnesotans from Seeking Treatment

We asked some of Minnesota’s certified problem gambling counselors for their thoughts on the barriers for Minnesotans receiving problem gambling treatment. Here is what they said:

Cheryl Minx, Director, Freedom Center, Inc.
I think people may not realize help is free to those who need it. Many people think if they’re broke and in trouble financially that there is no way to pay for help. I also think that the helplines are not very visible so that people don’t know how to find help.


Christina Pristash, MS, LMFT
There can be many contributing factors that interfere with a person reaching out for help or accessing treatment for problem gambling. I know that personal fears get in the way as well as individuals/families not knowing what resources are available and/or what makes a person qualify for help. We are fortunate to have an inpatient option in our state as well as outpatient treatment options, but many people aren’t aware of these resources or the differences between the two. Continued education and information sharing will continue to create fewer barriers for people, but choosing change is still always going to be hard.


Dawn Cronin, LSW NCGC Gamblers Choice, Lutheran Social Services of ND
I think a significant barrier is the nonpayment to phone counseling providers. While most providers recognize phone sessions are not the preferred method for counseling, they are necessary at times. I believe the many rural areas of Minnesota and the frequent poor winter driving conditions are putting severe limitations and interruptions in treatment participation for clients. I have three clients over the age of 62 traveling over 50 miles one way for treatment who have had to interrupt treatment because of travel conditions. We also have limited numbers of Gamblers Anonymous meetings in these rural areas so we are unable to encourage participation at these meetings for the same reasons.


Craig Johnson, LADC, Club Recovery
One of the greatest barriers is the lack of understanding by insurance companies, or just plain recognition, that gambling disorder is the exact same as any other psychological disorder as described in the DSM 5. I also think that clients are often told that gambling disorder is not covered and so they stop right there.


I have heard that a large hospital program discourages clients who do not have private pay insurance from seeking services because the reimbursement rate from the state gambling fund is significantly lower than what a given provider might pay.


There is a distinct lack of providers in outstate Minnesota, where access to treatment can be a challenge. We need to push telehealth as a way to reach individuals who either don’t have the means or the access to a provider near their home. I think that prevention programs need to include education on gambling disorder.


Programs aimed at young adults mention the opioid crisis, the vaping crisis, legalizing marijuana and so on, but often do not even mention gambling.


Lisa Vig, LAC, NCGC, Gamblers Choice
I’m concerned about those who live in rural Minnesota who may not have access to a trained counselor, access to a GA meeting and may not have reliable transportation or funds to travel the necessary distance to receive treatment and support. We need to explore other options to reach these individuals, such as phone counseling, telehealth treatment and/or online resources. The challenge to find appropriate, reputable financial management services for this population in conjunction with treatment is also a concern.


Paul Mladnick, LADC, NCGC, LMFT, Bridges and Pathways Counseling Services
One barrier that I see is a lack of awareness of gambling treatment services and that financial help is available for Minnesota residents, so I think we need to do more to advertise gambling treatment resources.


Also, there is still much ignorance over problem gambling and many people still think this is more of a moral problem or a lack of common sense. An educational campaign to alert people that this, too, is an addiction that can happen to anyone would be helpful.

Do you have a thought on barriers to treatment that you’d like to share? If so, please send your comment to sstucker@mnapg.org.

Sports Gambling is Alive and Well in Iowa

Sports Gambling is Alive and Well in Iowa


In response to the Supreme Court’s legalization of sports gambling in May 2018, more and more states are now introducing sports wagering. Iowa began offering sports betting in August 2019. To get a sense of how things are going for our neighbor to the south — both for sports gambling and the state’s gambling treatment and prevention program in general — Northern Light talked with Eric Preuss, MA, IAADC, CCS, program manager for the Office of Problem Gambling Treatment and Prevention at the Iowa Department of Public Health.

NL: Do you know how much money has been wagered on sports in Iowa since sports gambling has been offered?


EP: The Iowa Racing and Gaming Commission has indicated that $212 million has been wagered from August 15, 2019 through December 2019.


NL: How does this compare to expectations?


EP: I don’t think anybody had a really good idea of expectations, but it appears to be doing well. I am hearing there are a lot of new players. Some casinos are reporting that up to eighty percent of wagering is happening online — and that’s without every casino having an online app.


NL: Do you have any idea how many Minnesotans have crossed the state line to place sports wagers?


EP: The Iowa Racing and Gambling Commission and/or Iowa Gaming Association would have a better idea of that number, but in general the Iowa Gaming Association reports that about 60% of those visiting Iowa casinos are from out of state. Diamond Jo Casino in Worth County is one of the Iowa casinos near the Iowa Minnesota border.


NL: Have you learned anything specific about sports gambling and related problem gambling at this early juncture?


EP: We have been very intentional about gathering baseline data about the percentage of Iowans participating in sports betting of all kinds — from legal sports betting of all kinds, to illegal-bookmaking, fantasy sports, and March Madness — so that we can compare behavior before and after the legalization of sports betting. We know that 99% of Iowans who gamble on sports also participate in other gambling activities (lottery, casino and social/ charitable gaming). I suspect that first-time gamblers are coming in who have never made sports bets or even been in a casino before. Our challenge is to make sure that our partners (casinos) make available the materials we provide that are targeted to sports gamblers about responsible gambling , positive play, etc.


The recent Gambling Attitudes and Behavior Sur vey we completed in late 2018 shows that about 14% of Iowans (315,141) have experienced at least one problem related to their gambling and would be considered “at-risk” for developing a gambling disorder. Approximately 18,500 adults Iowa meet the criteria for a gambling disorder, which is about 1% of the adult population. When looking at sports gamblers in Iowa, 23% are considered “at-risk” for problem gambling. So it’s a concern and the challenge is to mitigate the harm to these gamblers, particularly those who are new players.


NL: Do Iowans accept gambling disorder as a public health issue?


EP: That’s a good question. It’s part of a larger series of questions, such as whether Iowans accept tobacco or alcohol use as a public health issue. One in four Iowans knows someone who has been impacted by gambling and one in five has been personally impacted. So there’s good data that suggests

Iowans have been impacted by problem gambling. But there may not be a good understanding about what to do next and the knowledge that treatment is available and helpful. We still have people whose lives are being destroyed and who don’t have a sense of hope that it can be better.


NL: In Minnesota, the problem gambling program resides in human services while it’s in the health department in Iowa. Do you have any insights on that?


EP: Substance use disorder and problem gambling ser vices are housed in the Iowa Department of Public Health while mental health services are within the Department of Human Services. However there is a good working relationship between departments, as well as at the legislative level, to ensure that effective, collaborative, efficient co-occurring ser vices are available and accessible for Iowans. Once such product is yourlifeiowa.org and the Your Life Iowa system, which is an integrated network of services (website, phone, text and chat) offering information and resources for problem gambling, substance use, suicide and mental health. As of July 1, 2019, Your Life Iowa became the statewide crisis line for mental health ser vices and referral. There is continued work as to how to enhance Your Life Iowa to help reduce barriers to care and support those in care.


NL: Did Iowa increase funding for treatment and prevention as part of sports gambling expansion? Where does your existing funding come from and how is it used?


EP: Yes. As part of the introduction of sports betting, our program received an additional $300,000, increasing our overall budget to $2.9 million. These new funds will be used in two ways: 1. Awareness efforts focused on students (primarily 9th grade through 12th grade), and 2. A targeted message media plan. From 1985 through about 2008, our funding was .5% of casino tax revenue, which generated between $6 to $10 million for the Iowa Gambling Treatment Fund. However, since then, due to legislative action, the Iowa Gambling Treatment Program fund was disbanded, and funding has been part of the addiction service appropriation from the state legislature.


NL: Does Iowa pay for gambling treatment? If so, is it for both the gambler and affected others?


EP: Gambling treatment in Iowa is paid for through third-party insurance (Medicaid and other insurers). For those who don’t have insurance, or don’t have insurance that pays for gambling treatment, the Iowa Gambling Treatment Program can assist through our Integrated Provider Network (IPN). IPN-funded providers offer assistance and treatment to the problem gambler, as well as their family members and concerned persons. Additionally, we fund 1-800-BETSOFF through our Your Life Iowa project to assist Iowans in accessing information, resources and locating help/ treatment locations in their county.

Loot Boxes: What Are They and What Safeguards are Needed?

A feature that has become part of the majority of popular video games threatens to become a gateway to problem gambling according to many experts in the field.

Loot boxes are consumable virtual items in video games that can be redeemed to receive a randomized selection of further virtual items, or loot, ranging from simple customization options for a player’s avatar or character, to game-changing equipment such as weapons and armor.

Loot boxes are extremely profitable for video game companies. Payments are made through micro-transactions that may involve box purchases of 99 cents. However, repeated purchases of loot boxes can quickly escalate into thousands of dollars of purchases over time.

Similarity to Gambling

The issue is whether the features of loot boxes are similar to those of slot machines or other forms of gambling. Recently, Keith White, executive director of the National Council on Problem Gambling, issued a statement to the U.S. Federal Trade Commission summarizing NCPG’s perspective.

“Players who pay to play a slot machine or unlock a loot box are risking that money for the chance of winning a prize or reward that is of value to them,” Keith says in the statement. “Factors common to many loot boxes and slot machines include random distribution of prizes, variable value of the prizes, near-miss features, and visual and sound cues associated with participation and reward. These feature are well known to trigger urges to play along with increase excitement and faster play.”

Research Shows Cause for Concern

While research on loot boxes and gambling problems is in its infancy, early reports show reason for concern, concluding that paying for loot boxes is linked to problem gambling. This includes behavioral patterns that damage personal, family or vocational pursuits, and can result in increasing preoccupation with gambling, a need to bet more money more frequently, and restlessness or irritability when attempting to stop. The behavior also included “chasing” losses and the inability to stop despite negative consequences.

An early large study of more than 7,000 gamers found evidence of a link between the amount that gamers spent on loot boxes and the severity of their gambling problems. Further, Mark Griffiths, Ph.D., prominent gambling researcher, has stated that loot boxes meet “almost any definition of gambling currently used in the field of social sciences.”

NCPG’s Recommendations

The NCPG believes a precautionary approach is appropriate for loot boxes given the potential negative impacts on youth. It recommends a multi-layered approach to users, parents and communities to ensure an appropriate range of protections is put into place for youth and other vulnerable populations. The goal is for measures to:

  1. Better inform consumers. Some of the possible tactics include facilitating informed choice (i.e., disclosing the number and value of items in loot boxes and the frequency of distribution), developing youth-specific addiction messaging, providing addiction rates among users paying for loot boxes, and prohibiting ads targeting youth.
  2. Prevent gambling-related problems. Some of the strategies NCPG calls for in this area include encouraging parents to enable parental controls, allowing players to set limits on time and money spent, developing third party consumer protection to verify compliance by designers and game companies, and funding media literacy campaigns dedicated to vulnerable populations on loot boxes and other in-game gambling-like mechanisms and advertising.
  3. Facilitate treatment seeking and support recovery. This includes providing links to NCPG’s upcoming ResponsiblePlay.org website (a resource for children and adults concerned with the negative consequences of online gaming behavior) and allowing for self exclusion through payment providers and global lists.
  4. Increase the evidence base. This involves requiring companies that include loot boxes in their games to provide access to anonymous player data (which can be used to develop gaming behavior profiles) and calling for NIH Institutes, particularly NICHD (National Institute of Child Health and Human Development), NIMH (National Institute of Mental Health) and NIDA (National Institute on Drug Abuse), and CDC (Centers for Disease Controland Prevention) to commission intra- and extra-mural research into loot boxes.

The NCPG emphasizes that while regulation is important, maximum effectiveness will be reached when accompanied by prevention, education, treatment, and recovery and research services. NCPG’s statement on loot boxes can be found here.

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