Norwatzki and Williams (2002) define self-exclusion as a process where problem gamblers enter into an agreement with a casino [or other gambling venue] that is distinct from involuntary bans which casinos initiate to exclude unruly customers. As well as exclusion this process includes a time frame for exclusion and generally the provision for the applicant to be removed from the venue’s mailing lists and have telephone gambling accounts closed.

The use of self-exclusion in the area of problem gambling falls within the concept identified in other health areas as intermittent and variable impairment of autonomy, McCullough et al. (1996). This refers to the situation where at times an individual may experience reduced levels of autonomy, and that at those times they may be incapable of making rational decisions in their own interests. While the reduction of autonomy may justify the decision to paternalistically subject a client to treatment without their consent in health treatment, it is important to remain aware that the intermittent nature of this impairment means that the capacity to consent must not be assumed to be absent.

Self-exclusion embodies paternalist features initiated by the gambler. The problem gambler recognises that in the presence of known triggers for gambling or, on the basis of their experience of being unable to choose not to gamble at particular times, they are proactive and make an advance directive to be excluded from a gambling venue rather than making the decision voluntarily at that time.

Napolitano (2003) discusses the legal basis for this process and notes that self-exclusion is an unusual entity as it is an agreement intended to be binding on both parties but it lacks the form of a contract, the usual form for an agreement that is intended to be enforced. Self-exclusion agreements lack consideration (the exchange of items of tangible value, usually money for service) that is required in a contract. For this reason the self-exclusion process has to have some regulatory or legislative backing to meet the expectations of both parties that it can be enforceable. Because self-exclusion exists outside the familiar area of contract law it allows for considerable variation between jurisdictions.

Self-exclusion as Treatment

The use of self-exclusion or self banning as a treatment tool has received little attention in the literature on gambling to date. Using Lesieur and Blume’s (1987) SOGS screening tool, Ladouceur et al. (2000) examined 227 casino self-excluded gamblers and reported that 95% were probable pathological gamblers with a SOGS measurement of 5 or more. They reported that for this very problematic group of gamblers self banning was an effective treatment strategy, with 30% of gamblers reporting total abstinence for the duration of their self-exclusion period. They also noted that only 10% of their sample had used professional helping services and yet achieved a higher result than was reported in a contrasting study by Stewart and Brown (1988) where 8% of clients were abstinent after 1 year of attending Gamblers Anonymous meetings.

These results led Ladouceur to conclude that self-exclusion was a useful tertiary treatment tool that could be enhanced by promotion and better enforcement by gambling venues. A conclusion supported by the Australian Productivity Commission (1999) who suggest that “overall self-exclusion is a useful adjunct to responsible gambling policies” (p.16.67).

Both the value of self-exclusion and the observation from gamblers and gambling venues that it could be enhanced by better enforcement was noted in a report prepared by the South Australia Centre for Economic Studies (2003). This suggest that problem gamblers who used self-exclusion found it to be a useful self initiated treatment tool to “reduce the harmful effects that problem gambling can have on the individual and the community” (p.7). These authors also noted that self-exclusion derives its effectiveness from the integrity (either actual or perceived) of enforcement.

Self-exclusion in North America and New Zealand

While the availability of self-exclusion depends on the regulatory environment and the effectiveness of self-exclusion may vary on the basis of the effectiveness of its enforcement both these effects may be related to the implicit or explicit model of gambling and problem gambling held in that community. The contrast between self-exclusion regulations between the US, Canada and New Zealand demonstrate this.

In the United States (US) self-exclusion is left to states to regulate and consequently is not adopted by all states. Where self-exclusion does exist in the US it often is not implemented at the gambling venue. The gambler is required to apply in person to the local area gaming board and to provide them with a considerable amount of personal information. For example the Missouri Gambling Commission (2003) requires gamblers seeking self-exclusion to attend their office in person and supply the following information in their application:

  • The person’s full name and all aliases;

  • A physical description including height, weight, hair and eye color, skin color and any other noticeable physical characteristics;

  • The person’s occupation and current home and business addresses and phone numbers;

  • Social Security number;

  • Date of birth;

  • A statement that the applicant believes s/he is a problem gambler;

  • A photograph suitable for the commission and Class A licensees to use in identifying the person requesting to be placed on the List of Disassociated Persons; and

  • Other information as deemed necessary by the commission;

In the US the responsibilities on the parties to a self-exclusion, that is, the problem gambler and gambling venue are oriented towards the venue making reasonable efforts to detect and exclude the self-excluded gambler and encouragement of the gambler to honour their pledge to refrain from entry (Illinois Administrative Code 2005 p.8–9).

Whereas the National Council on Problem Gambling (2003) defines the prime responsibilities of the venue with respect to self-exclusion as to:

  • Make it clear that it is not the responsibility of the casino to prevent them from entering

  • Remove from all mailing lists and to revoke any slot or player’s cards.

  • Take reasonable steps to check identification before advancing cash

  • Take reasonable steps to identify self-excluded Persons who may be in a Gaming Facility

  • Promptly escort the self excluded Person from the Gaming Facility.

The responsibilities of the self-excluded gambler are for:

  • Self-excluders to [self] report violations to help to avoid the gambler trying to deflect blame for their relapse on gaming operators

  • Forfeiture of jackpots, chips in play and all money owed by the casino. They suggested that forfeited jackpots should be diverted into funds for gambling prevention and treatment.

The Canadian approach to self-exclusion is similar to that in the US but allows for more stringent consequences on the gambler who breaches the self-exclusion, for example the British Columbia Lotteries Corporation (BCLB) documents on self-exclusion allow for

  • Self-exclusion for: 6 months, 1, 2 or 3 years

  • Applies to all venues with slot machines, commercial bingo halls across BC and/or the PlayNow site

  • Refused admittance

  • [The gambler] may be liable for a $5,000 fine.

BCLC (2002) information online for the self-excluded gambler stresses that “it is your responsibility to honor the commitment you made to yourself.”

From this analysis it is possible to characterise the implicit model of problem gambling in North America as a personal weakness model and the approach to self-exclusion as aiming to help a vulnerable individual.

The gambling environment in New Zealand is very different. In New Zealand 88.2% of all problem gamblers using gambling helping services cite VGMs as their primary mode of gambling. Of the total number seeking help 79.3% access VGMs outside of casinos (MOH 2005). New Zealand has 1,721 gambling venues outside casinos; each can have up to 18 VGMs with the average number being 12.9. There are 21,206 VGMs outside casinos with a machine to total population of 1:180 (DIA 2006)

The fundamental approach to gambling and problem gambling in New Zealand is defined in legislation with a public health approach, within the Gambling Act 2003. As a result the self-exclusion provisions of the Act have a product safety approach.

A problem gambler in New Zealand can self-exclude themselves from a venue by identifying themselves as a problem gambler to the venue licensee or manager and asking to be excluded. This approach can be by mail making it possible for problem gambling treatment services to facilitate the self-exclusion of clients through a mail out to all venues in the relevant geographical area. A self-exclusion can last for any nominated period up to 2 years, applies only to the gambling area of the venue, that is restaurants and other facilities can still potentially be used, and once in place cannot be revoked.

The consequences of breaching a self-exclusion are shared between the venue and the problem gambler. If a self-excluded gambler breaches a ban they commit an offence and can be fined up to $500, the venue that allows them to gamble also commits an offence and can be fined up to $10,000. In addition as this would be an offence under the Gambling Act the venue may not meet the requirements for their annual licence renewal. The consequences of breaches of self-exclusion bans have made the venue operators very wary of allowing self-excluded problem gamblers into their venues. Gambling Harm Prevention and Minimisation Regulations (2004) require all venues to have staff trained in harm minimisation strategies on duty at all times. It is suggested that both the consequences of breaches and staff training have contributed to the effectiveness of self-exclusion for problem gamblers in New Zealand. Between 2004 and 2005 there were 593 self-exclusions from casinos with only 188 exclusions were initiated by the casinos (DIA 2006).

A Follow-up Study of Self-excluded Problem Gamblers

This is a description of a small study following the clients of a single community problem gambling treatment service.

Sample

All clients of the treatment service who had used the self-exclusion option between July 04 (when self-exclusion regulations came into effect) and July 06 were followed up in August 06, n = 35, all had VGMs as their primary mode of problem gambling. As the treatment service involved has an assertive follow-up policy despite several of the clients having left the area 32 were contacted at follow-up and one was deceased. At the time of follow-up the clients had been self-excluded for between 2 and 24 months (Table 1).

Table 1 The Sample of Self-excluded Clients Contacted
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Materials and Methods

The clients had a comprehensive mental health/addiction assessment on entry to the service and were treated as outpatients for an average of six sessions (range 3–12). The assessment included the South Oaks Gambling Screen, a client estimate of dollars lost in the last four weeks, a clinician judgment of the number of DSMIV pathological gambling criteria met, and a client judgment of degree of control over gambling on a 4 point scale where 1 is totally in control of my gambling and 4 gambling completely out of control.

The treatment approach was Cognitive Behavioural Therapy (CBT) oriented with emphasis on education about gambling, in vivo desensitization to VGMs, planning around access to money, time and access to machines and problem solving.

Results

Table 2 shows the before and after data from a sample of self-excluded problem gamblers.

Table 2 Before and After Data of Self-excluded Problem Gamblers
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Limitations of this Study

This was a small scale study involving the follow-up of clients from a single service who had self-excluded with the help of this service by the service itself. This lack of independence may have affected the self-report of the clients and the small sample and the lack of control over the duration of the self-exclusion means these results should be interpreted with caution.

Discussion

The public health approach to gambling and problem gambling are defined in legislation and reflected in all aspects of the management and treatment of problem gamblers in New Zealand. This approach has lead to a product safety approach to self-exclusion which places some of the responsibility for problem gambling and the effectiveness of self-banning on gambling venues.

Initial results from a small scale study give rise to optimism that in a public health environment that self-exclusion may be more effective than has been reported in other jurisdictions.