Julie Caillon

Les jeux de hasard et d’argent sur Internet présentent des caractéristiques addictogènes particulièrement à risque de perte de contrôle. Ainsi, en 2017, 13% des joueurs français sur Internet étaient considérés comme des joueurs excessifs ce qui était supérieur aux pratiques hors ligne. On assiste également à une augmentation de nouvelles pratiques de jeux d’argent sur Internet comme les activités de trading sur Internet. Pour protéger les joueurs les plus vulnérables, l’état en lien avec les opérateurs de jeu propose une politique dite de jeu responsable qui intègre plusieurs mesures de réduction des risques comme la mise en place de modérateurs de jeu sur Internet. Cependant, il existe très peu de preuves scientifiques démontrant l’efficacité de cette politique.L’objectif de notre travail était donc de faire le point sur la politique de jeu responsable menée en France, en s’intéressant plus particulièrement à la prévention des conduites à risque pour les jeux de hasard et d’argent en ligne et à l’efficacité des outils de réduction des risques.Les travaux de recherche présentés ont démontré que les modérateurs de jeu avaient un intérêt dans la réduction des risques associés à la pratique des jeux d’argent sur Internet. Leur efficacité semble varier en fonction du statut du joueur et du type de jeu pratiqué. Cependant, ils étaient sous-utilisés par les joueurs et de nombreuses pratiques sur Internet comme le trading ne rentrait pas dans le cadre de régulation actuel. Des modifications de la politique de jeu responsable en France doivent donc être discutées afin d’orienter la politique de jeu responsable de manière efficace.

Online gamblers are more likely to experience gambling problems. The main objective was to compare the frequency of recovery one (middle-term) and two (long-term) years after treatment initiation, according to the gambling medium (Internet vs. land-based gambling). The secondary objectives were (i) to compare online and offline gamblers at inclusion and (ii) to investigate whether the gambling medium was a predictive factor of recovery. Outpatients beginning treatment for a GD (n = 237) were assessed at inclusion (treatment initiation) and after 1 and 2 years. Bivariate analyses were performed to compare online and offline gamblers at inclusion and on the frequency of recovery at one and two years. Two multivariate logistic regressions were then performed to identify factors associated with middle- and long-term recovery. The majority of patients achieved middle (74.2%) and long-term (78.9%) recovery, with no difference between online and offline gamblers. The gambling medium was not a predictive factor of recovery. Patients with a higher perceived self-efficacy (OR = 1.04 [1.01–1.07], p = .046) and having no history of mood disorders (OR = 11.18 [2.53–49.50], p < .001) at inclusion were more likely to achieve middle-term recovery, while long-term recovery was associated with a lower level of sensation seeking (OR = 0.67 [0.48–0.92], p = .015) at treatment initiation. Online gambling did not seem to influence middle- and long-term recovery compared to offline gambling. Enhancement of perceived self-efficacy and treatment of mood disorders, and treatment strategies focused on sensation-seeking may represent helpful care strategies for favouring achievement of middle-term recovery and maintenance of long-term recovery, respectively. ClinicalTrials.gov NCT01248767, date of first registration: November 25, 2010.

Background. Impairment or distress caused by gambling disorder can be subjectively assessed via quality of life. The aim of this study was to develop a new patient-reported outcome instrument to explore the health-related quality of life (HRQoL) in gambling disorders, the Gambling quality-of-life scale (GQoLS), and to document its psychometric properties. Methods. A previous qualitative study had been conducted using focus groups of problem gamblers to identify areas of HRQoL impacted by gambling. The seven domains identified served as the basis for the hypothetical structure of GQoLS. Draft items were generated from the patient’s speeches to illustrate each of these domains. Cognitive debriefing interviews were realized to obtain a final hypothetical GQoLS. A validation study was then carried out to determine the final version of GQoLS and its psychometric properties (structural validity, construct validity, internal consistency). Results. The final GQoLS was composed of 21 items, with a total mean score of 38.3 (±13.6). Structural validity found a major dimension and four other minor dimensions. The five dimensions were: “emotion”, “lifestyle”, “loneliness”, “taboo” and “preoccupation”. GQoLS was moderately to strongly correlated with PGSI and EQ-5D visual analogic scale. Cronbach’s alpha coefficient was 0.92. Conclusion. GQoLS is the first HRQoL instrument specific to patients with a gambling disorder and developed from the patient’s perspective. GQoLS presents good psychometric properties. GQoLS can be used in clinical research to demonstrate the effectiveness of an intervention on outcomes that are relevant from the patient’s perspective.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Early detection in the prevention of addictive behaviours remains a complex question in practice for most first-line health professionals, despite its importance in terms of public health. Several prevention measures have successfully included a screening stage followed by a brief intervention in case of risk-related use or referral to an addiction centre for problematic use. Even though early detection is highly recommended by the WHO, it is not performed in practice. Objective: To assess acceptability and feasibility of a web-based application, “Pulsio Santé”, for health service users and first-line prevention professionals. Methods: A mixed-method prospective pilot study was conducted in 2017 in two departments: The Nantes occupational health department responsible for monitoring the health of salaried personnel across the region, and the university department of preventive medicine with a health unit dedicated to university students. In each department, all health professionals (physicians and nurses) were invited to participate in the study. Subjects 18 or older seen by a health professional from one of the departments were eligible. The study procedure comprised 4 phases: 1) inclusion of participants by health professionals face-to-face, 2) self-automated web-based assessment report filled in by participants on their substance use with “Pulsio Santé” based on ASSIST questionnaire. Participants received a text message on their smartphone or by email, 3) if participants agreed, they could transfer results to their health professional. If not, messages appeared allowing them to get in touch with their general practitioner, should the assessment detect a risk. Two levels of feasibility and acceptability criteria were assessed. Two focus group sessions with health professionals were performed, exploring their points of view on the acceptability and feasibility of the web-based application. A multi-category content analysis was done. Results: 1474 people were eligible and 44 health professionals participated in the study. The first level of acceptability (% of people who agreed to receive a text message or an email) was 79.2% (1167 out of 1474). The second level of acceptability (% of participants who click on the self-assessment link) was 60.2% (703 out of 1167). The first level of feasibility (% of participants who completed their self-evaluation entirely) was 76.2% (536 out of 703). The second level of feasibility (% of participants who shared the results with their health professional) was 79.5% (426 out of 536). Health professionals highlighted obstacles to carry out the recommended interventions for people at risk based on their online screening. Conclusions: Our pilot study on a large sample showed good acceptability and feasibility of “Pulsio Santé” by health service users and professionals. The need for further studies more directly focused on the limitations emerged.

Background: Many features of Internet gambling may impact problem severity, particularly for vulnerable populations (availability, anonymity, a convenience and ease of play, digital forms of payment, and a higher level of immersion). To prevent the risks associated with excessive gambling and to inform gamblers, we need responsible gambling strategies. Gambling-related warning messages are one possible strategy that can help minimizing gambling-related harm.Methods: Our experimental study aimed to evaluate the effectiveness of self-appraisal and informative pop-up messages compared to a control condition (blank pop-up messages), for both at-risk (ARG) and low risk/non-problem Internet gamblers (LR/NPG) according to their favorite type of game, in a semi naturalistic setting and with a 15-day follow-up. During the experimental session, participants were invited to gamble on their favorite website with their own money in the laboratory. Effectiveness was investigated through the impact of pop-ups on gambling behavior (money wagered and time spent), craving, cognitive distortions, and gambling experience, taking into account message recall. We analyzed data from 58 participants, playing preferentially either to skill and chance bank games (sports betting, horse race betting) and skill and chance social games (poker).Results: We observed a significant decrease in the illusion of control for ARG in the informative pop-up condition at the 15-day follow-up. A significant effect of self-appraisal pop-ups compared to blank pop-up messages was also demonstrated only for sport and horse bettors, with a decrease on time spent gambling and an increase of gambling-related expectancies at the follow-up. Finally, we also observed that a majority of the participants were disturbed and irritated by pop-ups during their gambling session.Conclusions: The results of our study demonstrated the limited impact of pop-up warning messages on gambling behavior and cognition in Internet gamblers according to the type of game and the status of gamblers. The limited impact of warning messages on gambling behavior and the inconvenience of the pop-ups for Internet gamblers lead us to only consider warning messages as one piece of a larger responsible gambling strategy.Trial Registration Number: NCT01789580 on February 12, 2013.

Background and Aims: Few studies have been conducted on the long-term evolution of gambling disorder (GD). The aim of this study was to identify factors that could predict GD relapse.Methods: Data were part of a dataset from a large 5-year cohort of gamblers who were assessed at inclusion and each year thereafter. Participants were recruited from an outpatient addiction treatment center, from various gambling places and through the press. For this specific study, inclusion criteria included (i) transitioning from GD to recovery at a follow-up time and (ii) undergoing at least one follow-up visit afterwards. Participants were evaluated using a structured clinical interview and self-report questionnaires assessing sociodemographic, gambling and clinical characteristics. “Relapse” was defined as the presence of GD (according to the DSM-5) at the N+1^th visit following the absence of GD at the N^th visit. A Markov model-based approach was employed to examine predictive factors associated with relapse at a subsequent follow-up visit.Results: The sample consisted of 87 participants, aged 47.6 years (sd = 12.6), who were predominantly male (65%). Among the participants, 49 remained in recovery, whereas 38 relapsed. Participants who reported not having experienced at least one month of abstinence and those with a low level of self-directedness at the previous follow-up visit were more likely to relapse.Conclusions: Our findings suggest the existence of factors that are predictive of relapse in individuals with GD who had previously achieved recovery. These results can inspire the development of measures to promote long-term recovery.

BACKGROUND Early detection in the prevention of addictive behaviors remains a complex question in practice for most first-line health care workers (HCWs). Several prevention measures have successfully included a screening stage followed by a brief intervention in case of risk-related use or referral to an addiction center for problematic use. Whereas early detection is highly recommended by the World Health Organization, it is not usually performed in practice. OBJECTIVE The aim of this study was to assess the acceptability and feasibility of a web-based app, called Pulsio Santé, for health service users and first-line prevention HCW and to carry out an exhaustive process of early detection of psychoactive substance use behaviors. METHODS A mixed methods prospective study was conducted in 2 departments: HCWs from the regional occupational health department and from the university department of preventive medicine dedicated to students were invited to participate. Participants 18 years or older who had been seen in 2017 by a HCW from one of the departments were eligible. The study procedure comprised 5 phases: (1) inclusion of the participants after a face-to-face consultation with an HCW; (2) reception of a text message by participants on their smartphone or by email; (3) self-assessment by participants regarding their substance use with the Pulsio Santé app; (4) if participants agreed, transfer of the results to the HCW; and (5) if participants declined, a message to invite them to get in touch with their general practitioner should the assessment detect a risk. Several feasibility and acceptability criteria were assessed by an analysis of a focus group with the HCW that explored 4 themes (usefulness and advantages, problems and limitations, possible improvements, and finally, integration into routine practice). RESULTS A total of 1474 people were asked to participate, with 42 HCWs being involved. The percentage of people who agreed to receive a text message or an email, which was considered as the first level of acceptability, was 79.17% (1167/1474). The percentage of participants who clicked on the self-assessment link, considered as the second level of acceptability, was 60.24% (703/1167). The percentage of participants who completed their self-evaluation entirely, which was considered as the first level of feasibility, was 76.24% (536/703). The percentage of participants who shared the results of their evaluation with the HCWs, considered as the second level of feasibility, was 79.48% (426/536). The qualitative study showed that there were obstacles on the side of HCWs in carrying out the recommended interventions for people at risk based on their online screening, such as previous training or adaptations in accordance with specific populations. CONCLUSIONS Quantitative results showed good acceptability and feasibility of the Pulsio Santé app by users and HCWs. There is a need for further studies more directly focused on the limitations highlighted by the qualitative results.

To prevent risks associated with online gambling, many jurisdictions propose self-exclusion strategies as a part of a responsible gambling policy. To protect online gamblers, French law provides for a 7-day temporary non-reducible and voluntary self-exclusion measure that applies only to select websites. The objective of our study was to evaluate the effectiveness of this self-exclusion measure for at-risk online gamblers. It was an experimental randomized controlled trial targeted at risk prevention. The main outcomes were the money wagered and time spent gambling assessed 15 days (short-term) and 2 months (medium-term) after the implementation of the self-exclusion measure. The effectiveness of self-exclusion was also compared according to the gambling type (pure chance games, such as lottery or scratch tickets, skill and chance bank games such as sports betting or horserace betting, and skill and chance games such as poker). Sixty participants were randomly assigned to the experimental condition (n = 30; with the implementation of a self-exclusion measure) or control condition (n = 30). The randomization was stratified according to their favorite game [pure chance games (n = 20), skill and chance bank games (n = 20), and skill and chance social games (n = 20)]. The results revealed that self-exclusion had no short-term impact—but did have a medium-term impact—on gambling habits. After 2 months, the gambling-related cognitions (“illusion of control” and “the perceived inability to stop gambling”) and the subscale “desire” of the Gambling Craving Scale (GACS) have decreased. Participants’ opinions about the impact and effectiveness of self-exclusion were discussed. To conclude, it appeared that temporary self-exclusion is an interesting tool to protect online gamblers from excessive practices, but several modifications have to be made to improve its effectiveness and use.

In Europe, the prevalence of gambling disorders in the general population ranges from 0.15 to 6.6%. Professional athletes are known for having risk factors for addictive behaviors, such as young age or sensation seeking, though no study has yet tried to evaluate the prevalence of gambling and gambling disorders among this specific population. The goals of this study were to estimate the prevalence of gambling, problematic or not, among European professional athletes and to explore the factors that are associated with gambling practice and gambling problems in professional athletes. A self-completion questionnaire was specifically designed for this study. The questionnaires were distributed by European Union athletes to professional ice hockey, rugby, handball, basketball, football, indoor football, volleyball, and cricket teams in Spain, France, Greece, Ireland, Italy, Sweden, and the United Kingdom. Socio-demographic variables (age, sex, education, marital and parental status, sport, country of birth, and country of practice), variables linked to gambling (gambling habits, screening of gambling problems with the Lie/Bet questionnaire, and gambling related cognitions), and impulsive behavior data (urgency, premeditation, perseverance, and sensation seeking [UPPS]-Short Form questionnaire) were gathered. There were 1,236 questionnaires filled out. The percentage of professional athletes that had gambled at least once during the previous year was 56.6%. The prevalence of problem gambling, current or past, was 8.2%. A certain number of variables were associated with the gambling status. In particular, betting on one's own team (OR = 4.1, CI_95% [1.5–11.5]), betting online (OR = 2.9, CI_95% [1.6–5.4]), gambling regularly (OR = 4.0, CI_95% [2.1–7.6]), and having a high positive urgency score (OR = 1.5, CI_95% [1.3–1.7]) were associated with gambling problems, current or past, among professional athletes. Professional athletes are particularly exposed to both gambling and problem gambling.

Online gambling has been legalized in France in 2010. Licenses are issued to gambling operators who demonstrate their ability to respect the legal framework (security, taxation, consumer protection, etc.). The preventive measures to protect vulnerable gamblers include an obligation to provide online gambling moderators. These moderators should allow gamblers to limit their bets, exclude themselves from the website for 7 days, and consult the balance of the gambler’s account at any time. However, there are only a few published reports of empirical research investigating the effectiveness of Internet-based protective measures implemented by French law. Moreover, no empirical research has yet studied the impact of bonuses on gambling behaviors. This research is an experimental randomized controlled trial, risk prevention targeted. The research is divided into four sub-studies depending on the studied moderator: limiting bonuses, self-exclusion, self-limitation and information. The study sample consists of 485 volunteers. For each experimental condition and the control groups, the sample is composed of gamblers equally recruited from gamblers having preferences in each of the three major forms of games (lottery and scratch tickets, sports and horserace betting, and poker). For each form of gambling, the gamblers are recruited in order to obtain as many problem gamblers as non-problem gamblers. According to the randomization, the experimental session begins. The experimental session is a gambling situation on a computer in our research center. The gambler is invited to play on his favorite gambling site as usual, with his own gambler account and his own money. Data collected comprise sociodemographic characteristics, gambling habits, an interview about enjoyment and feeling out of control during the gambling session, moderator impact on gambling practice, statement of gambling parameters and questionnaires (BMIS, GRCS, CPGI, GACS). Moderator efficiency is assessed based on the two major characteristics of gambling behavior: money wagered and time spent in gambling. The results of this research will be important to prevent online problem gambling and influence policy-makers. NCT01789580 . Registered 8 February 2013