Detecting At-Risk Gamblers: What One Study Did and Did Not Find

The Study This Page Reports, and Its Date

The paper behind this page exists and can be read on its publisher’s own site. It is “Markers of unsustainable gambling for early detection of at-risk online gamblers”, by Nicola Adami, Sergio Benini, Alberto Boschetti, Luca Canini, Florinda Maione and Matteo Temporin, in International Gambling Studies, volume 13, issue 2, pages 188 to 204. The publisher’s page records it as received 10 March 2012, accepted 28 November 2012 and published online 25 February 2013. It is a 2013 paper about a method of detection, and everything below is dated accordingly.

Its own summary of what it proposes is: “In this work we propose novel markers for identifying at-risk gamblers based on the concept of sustainability.” The first marker is the pattern an earlier version of this article described: “The first hypothesis here verified is that problematic gamblers oscillate between intervals of increasing wager size followed by rapid drops, probably because they exceed their economic sustainability limits.” Because those swings are irregular, the method looks for the shape rather than a period: “Due to the non-periodic nature of these fluctuations, the proposed marker detects a certain occurring feature, such as a rapid drop in wager size, over a wide range of fluctuation periods, drop sizes and shapes.” The second marker counts breadth of participation rather than money: “The second marker, counting the number of games the gambler is involved in, aims at predicting possible consequences of an exceeding amount of time dedicated to gambling, that ultimately causes social and relational breakdowns.” And the claim made for the result is a comparative one about classification: “In the experimental phase we demonstrate how the adoption of these markers allows for identifying larger segments of high- and medium-risk gamblers with respect to previous research on actual betting behaviours.”

Who Funded It, and Where the Data Came From

This matters more than it usually would, because the subject is a detection method applied to a gambling company’s own customers. The paper’s acknowledgements, on the same publisher page, state: “This research was partially supported by Gioco Responsabile srl.” They record the operator’s role: “We would like to thank bwin Interactive Entertainment AG for supporting the research by providing access to anonymized customer communication data.” They declare the authors’ position: “None of the supporters or any of the authors has personal interests in bwin and its associated companies that would suggest a conflict of interest.” And they name the research body that curated the dataset: “This paper utilized data from the Transparency Project (www.thetransparencyproject.org), Division on Addiction, Cambridge Health Alliance, a teaching affiliate of Harvard Medical School.” The Division on Addiction says of itself that “Cambridge Health Alliance is a Harvard Medical School teaching hospital.” So the Harvard connection in this story is the provenance of the data, which the authors disclose, and not a separate piece of work.

Three things the paper is therefore not. It is not a treatment, a prevention programme or anything a player can use; it is a classifier applied retrospectively to records. It does not describe a product, and no product named on this site or anywhere else treats or prevents a gambling disorder. And it is not a finding about slots: the material available on the publisher’s page describes wager size, number of games and “actual betting behaviours”, and does not identify the dataset as slot play.

Gambling Disorder Is a Diagnosis, Not a Marketing Problem

The World Health Organization’s fact sheet on gambling, dated 2 December 2024, places the condition: “Gambling disorder is described alongside substance use disorders in both the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM 5), and the International Classification of Diseases, eleventh revision (ICD 11).” It sets out the ICD-11 criteria as “impaired control over gambling;” “increasing priority given to gambling, taking precedence over other life interests and daily activities; and” “continuation of gambling despite negative consequences.” It gives the scale: “Standardized global estimation of gambling harms has been limited, but estimates suggest that 1.2% of the world’s adult population has a gambling disorder.” and “Around 5.5% of women and 11.9% of men globally experience some level of harm from gambling” It also records that harm begins below the clinical line: “Gambling harm also occurs well below clinical thresholds.”

The American Psychiatric Association describes the diagnosis in one sentence — “Gambling disorder is identified by a pattern of repeated and ongoing betting and wagering that continues despite creating multiple problems in several areas of an individual’s life.” — names the chasing behaviour among its features, as “After losing money gambling, often returning to get even.” and states the treatment position: “Several types of therapy are used to treat gambling disorders, including cognitive behavioral therapy (CBT), psychodynamic therapy, group therapy, and family therapy.” “There are no FDA-approved medications to treat gambling disorders.” and “Only one in ten people with gambling disorder seek treatment.” WHO puts the same point about efficacy: “A range of therapies exist for those with gambling disorder.” and “Treatment for gambling disorder has a low rate of uptake, with an estimated 0.14% of the population seeking formal and informal help for current problems.”

What Is Actually Known About Slot Design

The sourceable core of this subject is not the detection paper but the body of work on how slot games are built. A review in Philosophical Transactions of the Royal Society B describes the near miss: “Near-misses occur when an unsuccessful outcome is proximal to a win.” “They occur across all forms of gambling, such as when a slot-machine payline displays two cherries with the third cherry just coming into view.” and states what it is worth: “In games of chance, near-misses and the presence of control have no objective influence on the likelihood of winning.” “However, in gambling games, where winning outcomes are largely or purely determined by chance, near-misses provide no information on future success, and it is misleading for the brain to assign them value.” It also reports what near misses do to behaviour, drawing on an early experiment in which one group played a machine arranged to produce them and another did not: “Subjects in group 1 were seen to play for significantly longer than subjects in group 2.”

A systematic review in the Journal of Gambling Studies covering 51 experimental studies published between 1991 and 2015 defines the second feature: “Losses disguised as wins (LDWs) occur when a player wins less money than they bet, resulting in an overall loss.” “Modern multiline slot machines celebrate LDWs in a similar or identical way to that of a true win.” Its findings were that “The systematic review revealed that near misses motivate continued play, but have varying effects on the emotional state or betting behaviour of the player.” and that “In contrast to near misses, the presence of LDWs was found to relate to an overestimation of how much a player is actually winning and was consistently viewed as an exciting event.” It attributes the effect to presentation rather than to the amount returned: “The effect of LDWs appears to be driven by the presence of visuals and sounds most often associated with a true win.” and “The EGM’s use of winning sounds and winning animations appear to have a strong influence on a player’s urge to continue playing, masking the overall loss”

WHO states the regulatory consequence bluntly: “EGMs can mislead users with design features that encourage extended use.”

The Design Features Are Now Regulated, Not Voluntary

In Great Britain the features described above are the subject of technical requirements. On a page recording “Last updated: 12 January 2026”, the Gambling Commission’s standards state the purpose first: “To ensure that products are designed responsibly and to minimise the likelihood that they exploit or encourage problem gambling behaviour.” The celebration of a losing spin is prohibited: “The gambling system must not celebrate a return which is less than or equal to the total stake gambled.” and “By ‘celebrate’ we mean the use of auditory or visual effects that are associated with a win are not permitted for returns which are less than or equal to last total amount staked.”

Speed is capped: “It must be a minimum of 2.5 seconds from the time a game is started until the next game cycle can be commenced.” with a longer floor for other casino games — “It must be a minimum of 5 seconds from the time a game is started until the next game cycle can be commenced.” — and it cannot be shortened by the player: “The gambling system must not permit a customer to reduce the time until the result is presented.” “Features such as turbo, quick spin and slam stop are not permitted.”

Simultaneous play is prohibited: “The gambling system must not offer functionality which facilitates playing multiple games at the same time.” And the product may not push the behaviour the clinical literature identifies: “Gambling products must not actively encourage customers to chase their losses, increase their stake or increase the amount they have decided to gamble, or continue to gamble after they have indicated that they wish to stop.” with the guidance that “written or graphical information should not encourage customers to try to win back their losses”

That last requirement names the clinical construct directly. A study in the Journal of Gambling Studies defines it: “Chasing, or continuing to gamble to recoup previous losses, is a behavioral marker and a diagnostic criterion for gambling disorder.”

The Tools an Operator Must Provide

Time has to be shown. The standards require that “The gambling system must provide easily accessible facilities that make it possible for customers to set a frequency at which they will receive and see on the screen a reality check within a gaming session.” and define it: “A ‘reality check’ means a display of the time elapsed since the session began.” A break has to be offered: a licence condition requires a time-out for “such other period as the customer may reasonably request, up to a maximum of 6 weeks.” which the Commission puts to players as “If you choose to take a timeout, you can block yourself from gambling for up to six weeks.” A longer block covers every licensed operator at once: “GAMSTOP is an online multi-operator self-exclusion scheme and has been available since April 2018.” “Self-exclusion is when you ask a gambling business to stop you from gambling with them for a certain length of time.” “All gambling businesses must participate in this scheme.” and “They must also update their lists of self-excluded consumers every 24 hours.” Credit is excluded altogether: “Gambling businesses must not accept credit card payments for gambling.” because “We are clear with gambling businesses that they must reduce the risk of harm from gambling and an important part of this is not allowing people to gamble with money that they may not have.”

None of these is a kindness. They are licence conditions, and the Commission states what happens when one is breached: “Compliance with these is a condition of licences; therefore any breach of them by an operator may lead the Commission to review the operator’s licence with a view to suspension, revocation or the imposition of a financial penalty and would also expose the operator to the risk of prosecution.” It has used that power against firms that failed to use the self-exclusion scheme: “We took action against a number of gambling businesses who had failed to use the system and will not hesitate to do so again.”

WHO is sceptical of the wider framework these tools sit inside, and says so in its own words: “Industry self-regulation is a common feature of gambling regulation.” “However, there are many examples of the failure of this approach.” “Responsible gambling interventions are typically ineffective, particularly where the uptake of measures is optional.” “Universal (also known as mandatory) systems are most effective.” “Voluntary systems have poor uptake and are non-enforceable.” and “Prevention is the most cost-effective strategy for minimizing gambling-related harm.” It also warns about one specific framing: “The preferred regulatory approach of the gambling industry – so-called responsible gambling – adds to this burden by effectively blaming those who experience harm.”

Where to Get Help

The NHS publishes a set of screening questions and a route to treatment on a page it dates “Page last reviewed: 8 December 2023”. Among the questions: “Do you bet more than you can afford to lose?” “Do you need to gamble with larger amounts of money to get the same feeling?” “Have you tried to win back money you have lost (chasing losses)?” and “Have you borrowed money or sold anything to get money to gamble?” Of the score it says: “If your total score is 8 or higher, you or those closest to you, are likely to be experiencing gambling-related harms.” and “If your total score is between 1 and 7, gambling might still be having a negative impact on your life.” On treatment: “You can go to a specialist gambling treatment clinic in England.” and “You can self-refer to a gambling clinic near you.”

The helpline numbers below are published by GambleAware on its own site. For England and Scotland: “If you live in England and Scotland and are worried about gambling, you can contact GamCare's free confidential helpline by phone or online chat, 24 hours a day, every day of the year.” and “Call 0808 8020 133” For Wales: “If you live in Wales and need to speak to someone about how gambling is affecting you or someone you care about, you can call the free NHS Wales helpline.” and “Call 0808 2819 265” The Gambling Commission prints the same two numbers in the footer of its own pages: “Call 0808 8020 133 in England and Scotland or 0808 2819 265 in Wales”