Gambling motivation and involvement: A review of social

lem gambling is not uncomplicated, which is shown by the seemingly contradictory
results of some studies mentioned. For instance, as the REM model suggests [132],
when viewing gambling as a public health toxin, not only is dose (number and
size of gambling establishments) important, but also potency (types of gambling)
and duration (time since established). Furthermore, a positive correlation between
gambling opportunities and a high frequency of problem gamblers in an area says
nothing about cause and effect. Opportunity may cause gambling problems, but it
may also be, as suggested above, that populations with certain demographic profiles,
which tend to cluster in socio-geographical space, have relatively high rates of
problem gambling. Gambling opportunities tend to be more plentiful in the areas
with such populations, since gaming operators realize that the demand for gambling
is higher there than elsewhere.
Longitudinal studies are needed to clarify issues about cause and effect. Such
studies may also provide insight into the effects that exposure and adaptation to
gambling opportunities have on the population in a certain geographical area [132].
Increased exposure is likely to initially increase the incidence of problem gambling,
but over time adaptation processes may reduce the incidence and prevalence to
previous levels. For instance, if a new form of game with a high risk of problem
gambling is introduced, some people who were not problem gamblers earlier are
likely to become so. After a time, however, at least some of these people will realize
the dangers of the game and develop methods to cope with them. Furthermore,
responsible gaming measures implemented by gaming providers and preventive
and treatment efforts by public agencies may also reduce the problems connected
with the game in question. According to Shaffer and colleagues [132] it is likely
that “exposure and social adaptation models represent twin pillars in explaining
dynamic epidemiological gambling-related trends” ( p. 46).
Prevalence studies conducted in communities where gambling opportunities have
increased significantly, e.g. through the establishment of a large casino, may use
a longitudinal “before and after” design [134]. Such studies may thereby reveal
relationships of cause and effect with respect to gambling availability and problem
gambling: the sudden increase in availability constitutes a natural experiment on
the determinants of problem gambling. The weakness of such studies, however, is
that they are limited to one or a few cases, the generalizability of which is unclear.
Geographical studies based on a multitude of locations promise results with greater
applicability.
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