This article is available in: PDF HTML Self-exclusion and imposed exclusion as strategies for reducing harm: Data from three Swiss Casinos

Journal Information
Journal ID (publisher-id): jgi
ISSN: 1910-7595
Publisher: Centre for Addiction and Mental Health
Article Information
Article Categories: Original Research
Publication date: December 2018
Publisher Id: jgi.2018.40.2
DOI: 10.4309/jgi.2018.40.2

Self-exclusion and imposed exclusion as strategies for reducing harm: Data from three Swiss Casinos

Suzanne Lischer Department of Social Work, Lucerne University of Applied Sciences and Arts, Lucerne, Switzerland
Juerg Schwarz Department of Business, Lucerne University of Applied Sciences and Arts, Lucerne, Switzerland

Abstract

Swiss gambling legislation is unique in that it includes health concerns and obligations for gambling operators. Specifically, the operators are required to provide social measures for the prevention of problem gambling. Moreover, gamblers with financial problems must either be banned from all casinos in Switzerland or exclude themselves. This study examines the reasons that lead to the application for a voluntary exclusion. It also considers to what extent excluded gamblers circumvent their respective prohibitions. Furthermore, it aims to identify the self-reported reasons why gamblers seek to lift the exclusion. The present study is the first of its kind to examine these questions, using data provided from three Swiss Casinos. A first step in the study involved analyzing the data obtained by trained Shift Managers during interviews with 8,170 gamblers, with the interviews taking place between 2006 and 2015. An invalidated casino questionnaire, based on DSM-IV criteria, was also completed by 3,650 participants from this sample. A second step involved evaluating forms. These forms were the documents completed during interviews with 1,005 gamblers who had successfully applied to have their interdiction terminated, with the person responsible for implementing social measures completing the forms. The findings indicated that most players had found other ways to gamble, during the exclusion period. The main reason gamblers gave for wishing to remove their ban was wanting to be able to visit a casino again. The possible reasons for this discovery are discussed, alongside the benefits and drawbacks of using industry-generated data.

Keywords: self-exclusion, imposed exclusion, harm reduction, problem gambling, prevention

Résumé

La législation suisse sur les jeux est unique en ce sens qu’elle inclut les problèmes de santé et des obligations pour les opérateurs de jeux. Plus précisément, ces derniers sont tenus de prévoir des mesures sociales pour prévenir la dépendance au jeu. De plus, les joueurs qui ont des problèmes financiers doivent soit être exclus de tous les casinos suisses, soit s’en exclure de manière volontaire. Cette étude examine les raisons qui sous-tendent la demande d’exclusion volontaire. Elle examine également dans quelle mesure les joueurs exclus contournent leur exclusion et elle vise à déterminer les raisons invoquées par les joueurs pour demander la levée de l’exclusion. La présente étude est la première du genre à examiner ces questions, en utilisant les données fournies par trois casinos suisses. Une première étape de l’étude a consisté à analyser les données obtenues auprès de 8 170 joueurs par des chefs de quart qualifiés, entre 2006 et 2015. De cet échantillon, 3 650 participants ont également répondu à un questionnaire non validé sur les casinos, basé sur les critères du DSM-IV. Une deuxième étape a consisté à évaluer les formulaires que la personne responsable de l’application des mesures sociales avait remplis lors d’entretiens auprès de 1 005 joueurs qui avaient réussi à faire lever leur exclusion. Les résultats indiquent que la plupart des joueurs ont trouvé d’autres moyens de jouer pendant la période d’exclusion. La principale raison invoquée par les joueurs pour la levée de leur exclusion est qu’ils souhaitaient pouvoir se rendre à nouveau dans un casino. Nous discutons des raisons possibles de cette situation, ainsi que des avantages et des inconvénients de l’utilisation de données générées par le secteur.

Introduction

The ratification of the new Casino Act in 2000 marked the end of the decades-long ban on casinos in Switzerland. Today, Switzerland’s gambling market includes not only the lottery and betting sector but also the casino sector—the former being subject to the 1923 Federal Act on Lotteries and Commercial Betting (Lottery Act) and the latter the 1998 Federal Act on Games of Chance and Casinos (Casino Act) (Häfeli, 2009). Today, 21 casinos operate in Switzerland, institutions which offer a range of gaming tables and slot machines. Online gambling remains prohibited at this time but will be legal as of 2019. Gambler protection is exceptionally important in Swiss society, and few other countries maintain such stringent legal provisions for identifying and preventing problem gambling behaviour in casinos. To this end, the independent Swiss Federal Gaming Board (SFGB) supervises casinos in Switzerland and is responsible for enforcing the Casino Act and the associated ordinances for reducing, through social measures, the socially harmful effects of gambling. Before obtaining a license, each casino must develop a clear prevention strategy for gambling addiction, which includes training the personnel in charge of social measures, and collecting data relating to gambling addiction. One important approach involves the early detection of problem gambling. For this, casino staff must follow guidelines and use checklists to identify at-risk gamblers and engage them in dialogue. This approach aims to help casinos to implement appropriate intervention measures. Accordingly, when potential problem gamblers are identified, the casino staff can then ask them for a salary or bank account statement or another valid and relevant document. Gamblers who fail to present proof of sound financial status and whose stakes when gambling are disproportionate to their assets must be banned from all Swiss casinos (Billieux et al., 2016). Bans are imposed if proof or strong suspicion can be found to indicate that, because of their gambling actions, specific gamblers are maintaining excessive debts, holding stakes that are unequal to their financial circumstances, or experiencing other disruptions. On the other hand, gamblers can also ask to be self-excluded. Spouses and partners can also ask the casinos to stop their immediate relations from entering casinos. In such circumstances, it is the casino that is then legally obliged to investigate and clarify whether the preconditions for an imposed ban are fulfilled. Generally, concerns raised by a spouse or partner lead to an imposed exclusion by the casino. The ban applies throughout Switzerland, and the casino must share the gambler’s identity with all the other Swiss casinos, regardless of whether the ban is voluntary or imposed. In Switzerland, electronic access systems and ID checks can help to enforce bans, which in principle are open-ended. A gambler can ask for a ban to be lifted one year after it was imposed, at the earliest. This procedure is a complex one, a process that requires proof of a healthy financial situation (Häfeli, 2009). In principle, no consequences should flow from the lifting process because of whether the ban was imposed or voluntary.

Exclusions—as above, whether imposed or voluntary—are designed to limit potential damage from gambling, deter gamblers from placing disproportionate bets, and provide support, while at the same time addressing issues specifically relating to the person’s behaviour. The trend of using exclusions has been exceptionally steady ever since casinos became legal in Switzerland, with just over 3,200 persons being banned annually and roughly 10% of the bans being lifted again. At the end of 2017, Switzerland’s nationwide exclusion register comprised 53,920 names (Swiss Federal Gaming Board, 2018), a relatively large number compared to those of the neighbouring countries with larger populations. The German database of gamblers banned from gambling and lotteries had only 32,989 persons as of 2016 (Meyer, 2017). Contrary to popular belief, most problem gamblers in Switzerland choose to bar themselves voluntarily. A study conducted in 2010 showed that 70% of those gamblers excluded had excluded themselves and 30% had been barred by the casinos (Häfeli & Lischer, 2010). Despite the high number of exclusions in Switzerland, prevention measures—including the Swiss practice of serving exclusion orders—have not been comprehensively studied. More specifically, few empirical studies have been conducted in Switzerland, a country which excludes gambling addiction or gamblers’ decisions to self-exclude (Carlevaro, Lischer, Sani, Simon, & Tomei, 2017).

Internationally, researchers have conducted several studies concerning self-exclusion programs, as a measure of harm reduction (for a review, see Gainsbury, 2014; Ladouceur, Shaffer, Blaszczynski, & Shaffer, 2017; Suurvali, Hodgins, & Cunningham, 2010). Whereas most studies find financial problems and the inability to control gambling to be the main reasons for self-exclusion (Abbott, Francis, Dowling, & Coull, 2011; Hayer & Meyer, 2011; Hodgins, Makarchuk, Guebaly, & Peden, 2002; Ladouceur, Jacques, Giroux, Ferland, & Leblond, 2000; Ladouceur, Sylvain, & Gosselin, 2007; Nelson, Kleschinsky, LaBrie, Kaplan, & Shaffer, 2010), Nower & Blaszczynski (2006, 2008) instead reported that self-excluders act as they do because they realize they need help to control their gambling problem. Ladouceur and colleagues (2007) pointed out that the majority (90.7%) of the self-excluded gamblers were motivated by a specific event, one which led them to join a self-exclusion program. Hayer and Meyer (2011) conducted the first study of its kind to examine the effectiveness of self-exclusion schemes. This project involved the casino sector across several European countries. To determine the circumstances leading to a voluntary removal, the authors used the Swiss Casino Data Management System. The device is employed for the self-exclusion process in Swiss casinos and includes lists with twelve possible motives for the exclusion. From their sample, 76.2% of the respondents stated that they had applied for a voluntary exclusion because they had lost too much money in the casino, and 60.3% indicated that they applied for it as a preventive measure. Just over half of the respondents noted that they had lost control of their gambling (53.6%) (Hayer & Meyer, 2011). It should be stressed that this study was the first to find a so-called preventive reason to be the motive for self-exclusion: In contrast to Anglo-Saxon countries, certain European casinos (e.g., in Germany or Switzerland) are required by law to offer specific “preventive measures” that identify problem gamblers at an early stage.

Previous studies only examined self-excluded participants who had already recognized their gambling problems, and who were willing to deal with them accordingly. However, a recent study conducted in Germany assessed for the first time whether imposed exclusion is possibly associated with fewer benefits compared to self-exclusion. The study revealed that gamblers with imposed exclusions reported having spent more time and money on gambling, before the exclusion, compared to self-excluders. Nonetheless, imposed exclusion was not associated with a greater reduction in gambling when compared to cases of self-exclusion. Instead, similar rates of abstinence and gambling reduction for those participants with an imposed or self-exclusion were determined. Overall, results indicated that 20.5% of those gamblers excluded stopped all gambling activities and another 66.5% instead reduced their gambling. Those persons who continued gambling significantly reduced this behaviour in every segment. Findings indicate that self-imposed exclusions were associated with similar reductions in gambling behaviour, even in other segments, where the ban was not imposed (Kotter, Kräplin, & Bühringer, 2017). To the best of our knowledge, no research has thus far been published concerning the differences in effectiveness of either family or casinos exclusions. However, Kotter et. al.’s findings provide counter-intuitive evidence of effectiveness even when the exclusion is involuntarily imposed.

Earlier research has highlighted studies have highlighted the fact that almost all participants who signed self-exclusion agreements were potential pathological gamblers (95%) (Ladouceur et al., 2000). However, more recent studies suggest that certain non-pathological, at-risk or problem gamblers may also choose to take advantage of the program and apply for voluntary exclusion. Such a determination may be done for various reasons, including awareness of early signs of a developing problem (Blaszczynski, Ladouceur, & Nower, 2007). Kotter and colleagues revealed, that 61% of their sample of excluded gamblers (imposed or voluntary) were potential pathological gamblers (4−9 DSM-5 criteria), whereas 18% fulfilled 1−3 criteria. 21% did not fulfill any of the DSM-5 criteria (Kotter, Kräplin, & Bühringer, 2016).

In a recent meta-analysis on self-exclusion, Ladouceur, P. Shaffer, Blaszczynski and H. Shaffer (2017) concluded that this measure demonstrates some effectiveness as a component of responsible gambling (RG) programs. This determination is useful despite various limitations including low-uptake rates, breaching the agreement, and minimal evidence for the long-term outcomes. However, in the Swiss gambling environment, the problem of low uptake rates for self-exclusion is not appropriate. This situation is because the problem of gamblers who circumvent the bans is here virulent. Still that certain excluded gamblers circumvent their bans is a known phenomenon (Blaszczynski et al., 2007; Croucher, Croucher, & Leslie, 2006; Ladouceur et al., 2000, 2007). Today, casinos in neighbouring countries consider barred gamblers from Switzerland to be a significant source of revenue. It can also be assumed that at least certain number of such gamblers circumvent their exclusion by visiting illegal gambling venues in Switzerland, or by taking advantage of foreign online gambling sites (Lischer, Häfeli, & Villiger, 2014). However, to date, no information is available on the extent to which excluded gamblers in Switzerland circumvent their respective bans.

Objectives and research questions

As mentioned above, each Swiss casino was legally obliged to collect data concerning gambling difficulties. Access to such large-scale data offered unique insight into problematic gambling and exclusion for this otherwise often inaccessible population. This study therefore aimed to use such existing data to:

  • determine the self-reported reasons leading to the application for a voluntary exclusion.
  • identify voluntarily-excluded gamblers’ self-reported casino gambling problems.
  • explore to what extent alternative forms of gambling are used during the exclusion period.
  • understand the motivations for seeking to lift the exclusion.

Method

Participants/Sample

Whereas the implementation of social safeguards is mandatory for Swiss casinos (Häfeli & Lischer, 2010), differences nonetheless exist in the implementation of the player protection processes between the different casinos. To ensure the comparability of the data, the study examined three casinos, all of which used the same data collection tools for the exclusion and exclusion-lifting process. All were supervised by the Swiss Gaming Board, which ensures reliability in their chosen data collection practices. After a request, the directors of the three casinos consented that the data could be used for the purpose of this research.

The analyses described below were based on self-reports obtained from two samples of excluded gamblers. Sample 1 involved gamblers who were questioned by trained casino shift managers when seeking a voluntary exclusion. Here, only voluntary exclusion interviews were used, as operator-excluded gamblers often failed, upon request, to present proof of their sound financial status, and consequently did not complete an interview. Sample 2 included gamblers interviewed by the person responsible for implementing social measures whose application to lift an exclusion had been successful. (The original exclusion was either imposed or voluntary.) In those cases where a degree of overlap inevitably occurred between the samples, most participants only appeared in one or other of the two data sets. It is therefore most appropriate to consider these samples as distinct from each other.

The collection of data relating to the social safeguards measures was obligatory and supervised by the Federal Board. This standardized procedure has been consistently implemented over a period of at least 10 years. The data used in the study comprised the period from January 2006 to December 2015.

Materials and Procedure

Questionnaire

According to the Gambling Act and to its dispositions, casinos should register the reason or reasons that led to exclusion. Furthermore, the government obligates casinos to collect data relating to gambling addiction. The casinos themselves can decide how they will fulfill this obligation. The three casinos participating in this study all used a questionnaire, based on the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) (hereinafter “Questionnaire on Gambling Behavior”), which aimed specifically to collect information on those specific behaviours which might be considered problematic. This information was culled from a set of 10 questions relating to gambling. However, the questions have been adapted to suit better a casino context (see Table 2, results section for the list of questions). We should also highlight that this tool was not validated following its adaptation. Furthermore, no clinician reviewed the answers, and thus the tool the tool did not in fact provide diagnostic classification, but rather an overview of the participants’ self-reported difficulties in relation to their casino gambling instead. The questionnaires were completed during the initial self-exclusion interviews. The data therefore related to those players seeking a voluntary exclusion (Sample 1).

Termination interviews

Furthermore, we evaluated the notes taken by the person responsible for social measures, when interviewing gamblers who wanted to have their exclusions lifted. To follow the four-eyes principle, a counselor from an addiction center participated in the interview and provides expert interpretation concerning the final decision. The interviews were conducted with both gamblers with an imposed and a voluntary exclusion (Sample 2). The exclusion termination interviews followed standardized forms for open-ended and closed-ended questions concerning sociodemographic characteristics, gambling behaviour before and after the exclusion, and the reasons why the individual was applying for the exclusion to be lifted. The data generated were categorized into one of a possible 17 qualitative and quantitative variables, by two raters. They were then recorded electronically and used for answering research questions 1 and 2 (above). To demonstrate consistency among observational ratings provided by two raters using the same coding system (interrater reliability), we coded 10% of the minutes (n=100) twice, i.e., both raters coded the same cases. Afterwards, a measurement of the extent of agreement was obtained for each of the 17 variables (Cohen’s Kappa). The medium consistency of the raters was high (Median Kappa = 0.79). In the case of variables with a lower consistency, the respective cases were discussed, and any ambiguity was eliminated from the coding system.

Data analysis

Data analysis involved descriptive statistics and several significance tests, conducted with SPSS for Windows (Version 24.0). Statistical relationships were analyzed with Pearson’s chi-square test (χ2) for nominal scale variables. Furthermore, a nonparametric Kruskal-Wallis test with subsequent pair-wise post-hoc analysis was used to examine the correlation between the frequency of monthly visits and the reasons for exclusion. The adjusted future gambling behaviour was evaluated based on a Wilcoxon signed-rank test. Two-sided tests, each with the significance level set at <.05, were used to test the hypotheses.

Results

Motives for voluntary exclusion

Between 2006 and 2015, the three casinos mentioned above issued 8,170 voluntary exclusion orders. The exclusion rate was roughly equal for each casino and relatively stable over the 10-year period. The reasons that gamblers gave for self-exclusion were analyzed first. During the self-exclusion interview, the gambler indicated his or her reasons, from a list of 11 options, predefined in the Swiss Management System. The overall percentages over the ten years can be seen in Table 1. We should highlight that multiple responses were possible, should participants wish to report more than one reason for seeking an exclusion.

Table 1 Reasons for self-exclusion (multiple answers possible)

The presentation of the results of multiple response questions is generally difficult because the results are not straightforward and easy to understand. We have therefore chosen a simplified version, one which consists of calculating the percentage of participants who chose each statement, and also reporting the total number of responses given (presented as a percentage). This total percentage is greater than 100 (157.6%), a result which demonstrated that more than one response was frequently given.

Various indicators, such as time and money spent on casino gambling, and having lost control, imply that the respondents’ gambling had become excessive. The most common reason for voluntary exclusion was “Lost too much money at the casino.” The second most common reason was “Needed the exclusion as a preventive measure.” In contrast, respondents mentioned family or work problems much less frequently.

Gambling-related problems and voluntary exclusions

Whereas completing the questionnaire about the motives for a voluntary exclusion, and providing information about themselves, was mandatory, completion of the Questionnaire on Gambling Behaviour was instead optional. Under these circumstances, only 44.7% (n=3,650) of the gamblers undertaking a voluntary exclusion interview (Sample 1) completed the questionnaire. Although incomplete, these data provide some insight into the extent of gambling-related problems for this subset. On average, 33.7% of gamblers seeking voluntary exclusion met 0–2 of the questionnaire criteria per casino and year. Furthermore, 39.0% of the gamblers surveyed met 3–4 criteria, while 27.3% met 5 or more such criteria.

The study then focused on the percentage of those participants who agreed with the items from the Questionnaire on Gambling Behavior (see Table 2). The self-excluded gamblers agreed most often to the questions “When gambling, do you often try to win back the money you lost?” and “Do you frequently gamble for longer than planned?” Gamblers almost never indicated having lost an important relationship or job because of their playing, or that they had eliminated or lessened gambling debts through illegal means. Gambling-related problems at the time of a voluntary exclusion may therefore be more likely be related to personal factors (e.g., lost too much money, spent too much time at the casino), and may not yet affected the person’s family members or colleagues at work.

Table 2 Percentage of positive responses to items in the Questionnaire on Gambling Behaviour

Evaluation of the application of those gamblers requesting for their exclusion to be lifted

The second step in this study was to evaluate the data for those gamblers who applied to terminate their exclusion (Sample 2). This process involved the applicant submitting his or her documents (salary statement, debt enforcement registers, etc.) to provide proof that the reason for the exclusion no longer existed. In cases where this documentation was accepted as proof, the applicant was then invited to an interview to ensure that he or she was deemed ready to return to the casino. Depending on the outcome of the interview, the exclusion was either to be lifted, or left in place. The man or woman responsible for social measures and a specialist from an addiction-center were the two persons responsible for the interviews.

During 2006 and 2015, 3,670 applications for lifting the exclusions were registered in the three casinos. 1,275 applications were deemed to have provided sufficient documentary proof and were therefore invited to interview. Of these, 1,064 (80%) subsequently had their exclusions lifted, and we were given access to 1,005 interview forms from this sample (95.5% of the successful applicants). Most of the exclusions (n=1005) were voluntary (n=891; 88.7%) as opposed to imposed (n=111); three cases were missing. The youngest gambler was 19 years old at the time of the interview; the oldest 82 (Md = 37). 25.2% were female and 74.8% male. There were no significant gender differences (χ2 = 2.701, p = .10) in the exclusion type. Voluntary exclusions were more frequently lifted than imposed ones (χ2 = 7.169, p = .007). It was impossible to calculate the mean duration of the exclusion because some interview notes did not include the date.

Alternative forms of gambling

The data from exclusion termination interviews show that gamblers make extensive use of alternative gambling opportunities during their exclusion, mainly at casinos abroad. Exclusion orders are therefore ineffective in forcing most gamblers to abstain from gambling. Almost 90% of those respondents looking to have their exclusion orders lifted engaged in other forms of gambling (59.7% at casinos abroad; 21.2% in lotteries; 6.9% other). Only 12.2% of the applicants claimed not to have used alternative forms of gambling. The study found no gender differences in this regard: Both men and women sought other opportunities to gamble (χ2 = 7.127, p = .068). Nevertheless, this finding must be interpreted cautiously. Only 61% (n=613) of those participants seeking readmission to Swiss casinos—i.e., by those persons who wanted to gamble again—did in fact answer the question.

Reasons for applying to lift an exclusion

This question was answered by 99.8% (n=994) of those gamblers seeking readmission to Swiss casinos. The main reason respondents gave for wishing to have their exclusion order lifted was wanting to be able to visit the casino again (42.1%) or social reasons (39.4%). Many participants also reported experiencing social pressure to visit a casino, e.g., for a Christmas party with the company (10.0%). As mentioned earlier, 60% of gamblers claimed to have visited casinos during their exclusion, often ones immediately across the Swiss border, and thus involve only little extra travel. Therefore, “casino visits abroad are too time-consuming” is almost never indicated as a reason (only 5.6%). Almost one in five gamblers felt that their personal freedom was constrained by the exclusion and therefore wished to terminate it (desire for self-determination) (17.4%). Furthermore, 7.4% of the players claimed to control their gambling behaviour, to have enough financial means (3.0%) or other reasons (10.7%).

Discussion

Motives for the voluntary exclusion

The most frequently named reasons for a voluntary exclusion are having “lost too much money in the casino” and having applied for a voluntary exclusion for “preventive reasons.” These findings correspond with the results from Meyer and Hayer’s study (2011). Only a few players (4.7%) indicated family pressure as the reason for requesting a voluntary exclusion. Thus, the findings do not allow for firm conclusions to be drawn concerning the role that family members play leading up to the exclusion. As mentioned above, research into third party or specifically family-initiated exclusion is highly limited (Goh, Ng, & Yeoh, 2016). Thus, further research into this area is required.

As mentioned above, gamblers with an imposed exclusion are not interviewed in the exclusion process. However, it can nevertheless be assumed, that the reasons for the exclusion, as defined in the Swiss Gaming Act (concerning gamblers with excessive debt, stakes disproportionate to their financial circumstances, or both) are genuine.

Gambling-related problems and voluntary exclusions

The study’s evaluation of the Questionnaire on Gambling Behaviour provides insight into the extent of problems caused by gambling. The findings therefore indicate that one-third of gamblers seeking voluntary exclusion exhibit low-level problems in relation to their casino gambling, while two-thirds report more troubling problems. It should be noted that only 44.7% of self-excluders filled out the questionnaire on addiction. We can only speculate about the reasons why, for certain players, this section was not completed. The decision could have been because of their wish to avoid facing the extent of the situation or, conversely, because of staff members not having proposed the questionnaire. Given the potential implications for staff training, these possibilities highlight an important area for further investigation. Given that highly emotional moments often precede the person asking to be excluded, it cannot be ruled out that gamblers are not representing their situation accurately. Either they are exaggerating or trivializing their situation. Their decision, whichever one it was, may have influenced the low rate of self-reporting for illegal activities (to cover gambling debts), loss of employment, or an important personal relationship.

Evaluation of the application of those gamblers requesting for their exclusion to be lifted

Evaluation of the data generated during exclusion termination interviews reveals the following. During their exclusion, the gamblers made extensive use of alternative gambling opportunities, mainly casinos abroad. Exclusion orders therefore do not lead most of the gamblers to abstain from gambling. Almost 90% of those gamblers applying to have their exclusion orders lifted had availed themselves of other forms of gambling. It should be noted that this question was answered by only 61% (n=613) of applicants. Furthermore, the applicants are seeking readmission to Swiss casinos, i.e., they want to participate in gambling. Not all excluded gamblers share this wish: Many excluded gamblers remain abstinent or lose interest. In that respect, the aforementioned 90% are not representative of all excluded gamblers. Despite this caveat, it can be assumed that a substantial number of the excluded gamblers circumvent their exclusion by availing themselves of alternative forms of gambling. This finding is consistent with other studies. With regard to this issue of circumvention of exclusion orders, the question arises as to whether any complementary measures exist that are capable of preventing this behaviour. Because many gambling dens reside close to the Swiss border, the idea of gambling elsewhere being too “time-consuming” was almost never provided as a reason for lifting the exclusion. The majority of the players claimed social reasons or, not surprisingly, the wish to visit a casino again as a reason for seeking a lifting of the exclusion.

Limitations

The study analyzes the characteristics and experience of a substantially large number of individuals excluded in Switzerland, where exclusion can be voluntary or mandatory. Furthermore, this inquiry considered data spanning a period of 10 years, providing insight into a population otherwise hard to reach. Nevertheless, acquiring data from gambling operators may be problematic: thus. caveats cannot be ignored. The data were collected for the casinos in compliance with their legal requirements, which limited the possibilities for obtaining and evaluating specific data for research purposes. Thus, the questionnaires are relatively rudimentary and no elaborate survey methods were used. In the same vein, the Questionnaire on Gambling Behaviour had been adapted for use within the casinos to gauge the extent of gambling problems and was therefore not a clinically validated tool. Furthermore, certain variables are missing, that would have been useful for this study, e.g., the duration of the exclusion or sociodemographic characteristics of the voluntarily-excluded gamblers, gambling behaviour and gaming preferences, etc. These variables can be seen as confounding, and therefore, the inability to control them, must be stressed as a limitation. Elsewhere, gaps resided in the data: For example, with the 1,064 interviews resulting in an exclusion being lifted, only 1,005 forms were available for analysis, and we cannot know what happened to the remaining 49 forms. Similarly, at other times, respondents chose not to reply to certain questions: for example, only 44.7% of the sample agreed to complete the Questionnaire on Gambling Behaviour during the self-exclusion interview.

In view of the data, we need to consider that gamblers’ requests for voluntary exclusion were often preceded by an exceptionally emotional moment, and that they may have accordingly described their situation inaccurately. Considering it was casino employees who conducted the interviews, it cannot be ruled out that gamblers misrepresented their respective situations.

It should be stressed that the answers given by individuals who wanted to revoke their exclusion with regard to their future gambling behaviour was open to response bias (social desirability). Furthermore, the question concerning the use of alternative forms of gambling was related to past gambling behaviour (these may be affected by a recall bias), and the information was based on notes taken by the person responsible for social measures. Moreover, no data were available on the average length of the exclusion so it is possible that participants are recalling information several years after the original exclusion. The results must thus be treated with appropriate caution.

Another important limitation was that the notes taken during the exclusion-termination interviews included only those gamblers with a stable financial situation (no debts) whose exclusion was ultimately lifted. Consequently, there is still a considerable lack of research on the behaviour of excluded gamblers with unstable financial circumstances. While this study provides some unique insight into self-reported gambling and exclusion, more targeted, research could be useful to explore the questions raised.

Conclusions and recommendations

During those interviews, 35% of those participants seeking voluntary exclusion reported doing so for preventive reasons. To date, researchers have not examined the impact of the social safeguards in Swiss casinos. It would be interesting to explore the effectiveness of preventive measures upon awareness of problem gambling, both by the gamblers and the employees. Nevertheless, Swiss casinos, with their preventive social measures, constitute a special case in the world of international gambling. Such a position is particularly the case with training employees in the early detection of problem gamblers.

Evaluation of the notes taken during the exclusion termination interviews reveals that many gamblers served with exclusion orders find other ways of continuing to gamble. As a result, the overarching objective of Switzerland’s exclusion policy—an enduring abstinence from gambling—needs in turn to be modified. The question then arises as to whether exclusions should be the only means of protecting gamblers who are deemed to be at risk. The possibilities for individual limitations on the frequency of visits, or the stakes, should both be discussed as another measure of player protection.

Despite its numerous limitations, this study demonstrates how access to data from the gambling industry can provide important information for prevention efforts. Data from the gambling industry provide access to problem gamblers who are not in treatment, thus broadening the target population otherwise limited on one hand to patients in treatment centers and, on the other, on gamblers who, first, need to be identified, and second, agree to participate in a survey (Carlevaro et al., 2017). We should note that this study would not have been possible without the Swiss Confederation’s legal provisions, with regard to problem gambling prevention and to industry data. These provisions clearly contribute to the fulfilment of the “responsible gambling” principle that prevention programs need to be evaluated and monitored (Blaszczynski et al., 2011; Blaszczynski, Ladouceur, & Shaffer, 2004). Evidence is necessary for the effective deployment and development of the exclusions, as an important measure for safeguarding gamblers.

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Submitted October 24, 2017; accepted June 20, 2018. This article was peer reviewed. All URLs were available at the time of submission.

For correspondence: Dr. Suzanne Lischer, Lucerne University of Applied Sciences and Arts, Werftestrasse 1, Postfach 2945, 6002 Lucerne, Switzerland. E-mail: suzanne.lischer@hslu.ch

Competing interests: Funding bodies had no influence over the design and conduct of the study, and analysis and interpretation of the data.

Ethics approval: The Ethics committee Northwest- and Central Switzerland (EKNZ) approved on November 30, 2015 the research project “Die freiwillige Spielsperre als Massnahme des Spielerschutzes” (EKNZ UBW 15/102). The use of anonymous gambling data for research purposes is subject to the terms and conditions of the operator who provided the data.

Acknowledgements: This research was supported by a grant from the “Sucht Schweiz”.

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