Prevalence rates of at risk, problematic and pathological gambling in Switzerland

Background and Objectives: Few studies have assessed pathological gambling in Switzerland. We employed the National Opinion Research Center DSM Screen for Gambling Problems (NODS) to assess prevalence of gambling problems in Germanand Italian-speaking Switzerland. Methods: A random sample of 4997 individuals participated in a computer-assisted telephone interview in 2007 and 1388 of the individuals who refused to participate on the telephone interview completed a paper questionnaire. The total sample included 6385 participants (52% women); the return rate was 52.2%. Results: Among the general population over 18 years of age, 2% engaged in lifetime atrisk gambling, 0.5% in problematic and 0.3% in pathological gambling. We found pastyear prevalence rates of 0.7% of at-risk gambling, 0.1% for problematic and 0.02% for pathological gambling. Conclusions: These rates are at the lower end of international statistics and are lower than rates in previous Swiss studies. This may be due to measures to reduce false positive diagnoses in our study. Large differences between lifetime and past-year prevalence rates indicate that problematic and pathological gambling are not necessarily progressive and chronic disorders. Received 14 March 2008 Revised 31 October 2008 Accepted 19 November 2008 s o u r c e : h t t p s : / / d o i . o r g / 1 0 . 7 8 9 2 / b o r i s . 3 4 1 7 5 | d o w n l o a d e d : 7 . 9 . 2 0 1 7 68 JEANNETTE BRODBECK ET AL. However, some researchers consider a cutoff score of four criteria as more adequate for a diagnosis of pathological gambling1,2. In addition to person-based cognitive, personality and biological factors, structural characteristics of the games and social factors such as cultural attitudes towards gambling, structural preventive measures and the accessibility of gambling activities have an impact on the development of gambling problems3,4. Slot-machines especially have great potential for addiction5. In Switzerland, gambling is legally regulated by a governmental monopoly. The most popular gambling activities are lotteries. Casinos were prohibited until 2002. Today, Switzerland has a very high ‘density’ of casinos (19 for a population of 7,459,000 inhabitants). Casinos are legally obliged to implement prevention measures to detect at-risk gamblers early and harm reduction measures to reduce problematic and pathological gambling, such as (self-)exclusion at casinos. In addition, proper training of casino staff and provision of data for research are required. Counselling facilities and public campaigns to increase community awareness of problematic gambling have been established during the last years. Slot-machines, other than in casinos, have been prohibited since 2005; before that they had to make a submission for authorization. To assess prevalence of problematic and pathological gambling, two instruments have been established and frequently used: The South Oaks Gambling Screen (SOGS)6 and DSM-IV-based instruments such as the National Opinion Research Center DSM Screen for Gambling Problems (NODS)7. The NODS is designed to be more restrictive than the SOGS and relates more closely to the DSM-IV-TR criteria of pathological gambling. About half of the SOGS items focus on sources of borrowed money and no items regard tolerance and withdrawal. Since, to date, there is no gold standard for the definition of pathological gambling, we rely on the current clinical definition of the DSM-IV-TR and the NODS. Until now, few gambling prevalence surveys have been conducted in European countries. Different or even not specified timeframes, selection or sampling biases and different assessment measures complicate comparison of the existing studies8. Replications of results are often missing. Thus it is difficult to formulate well-founded statements about the frequency of excessive gambling in European countries. Excessive gambling seems to be more prevalent in the US, Canada and countries of Asia than in Europe3,8. A recent British study found oneyear prevalence rates of 0.6% of problematic (including pathological) gambling in 20079. In Scandinavian countries recent one-year prevalence rates were around 0.4% for problem gambling and 0.1-0.2% for pathological gambling. An Italian study found one-year prevalence rates of 0.7% for problem gambling and 0.4% for pathological gambling8. In Switzerland only three prevalence studies of gambling problems exist. Bondolfi and colleagues10,11 found lifetime prevalence rates of 2.2% for problematic and 0.8% for pathological gambling in 1998 and of 2.2% for problematic and 1.1% for pathological gambling in 2005. Participants of the German-speaking part of Switzerland are however under-represented in these studies (32 and 36% in the study samples compared with 71% Swiss inhabitants in the German-speaking part of Switzerland). Therefore the database for this region is small and the generalizability is questionable. This is relevant because in the French-speaking part of Switzerland, the availability of gambling activities such as electronic gambling machines outside of casinos differs from the rest of Switzerland. A study by Zangerl and colleagues12 found five-year prevalence rates in the year 2004 of 1.9% for probable pathological gamblers and 1.8% for potential pathological gamblers or problem gamblers. One other study covering the Italian-speaking part of Switzerland found lifetime prevalence rates of 0.6% for both problematic and pathological gambling13.