As expected, and consistent with previous research, the Stacked Deck program produced significant and sustained changes in gambling attitudes, knowledge, and fallacies. At follow-up, students in the intervention schools demonstrated significantly more negative attitudes toward gambling, greater knowledge of both gambling and problem gambling, and greater resistance to gambling fallacies. This is an important result, indicating that the content of the Stacked Deck program was appropriate and delivered in a fashion that allowed for retention of this material. It is also likely the case that changes in these attributes are preconditions for actual changes in gambling behavior.
In addition, the present program also produced significant improvements in applied decision making and problem solving, a decrease in the percentage of gamblers, decreased overall gambling frequency, and, most importantly, some evidence of decreased rates of problem gambling (i.e., significantly lower rates of problem gambling at follow-up compared to the control group).3 To our knowledge, this is the first time that a school-based problem gambling prevention program has produced actual behavioral changes.
An argument can be made that decreased gambling participation may not be an appropriate goal of problem gambling prevention, when gambling is a normative activity in western society as well as a non-problematic activity for the large majority of people who engage in it (including high school students). However, as seen in the present study, gambling is not a normative activity among adolescents (only 41% of students gambled at baseline), and some types of gambling they report engaging in are illegal for their age group. Second, a decrease in gambling may well be appropriate outcome when considering that our primary goal was for students to decrease any behavior that can be construed as a bad gamble (i.e., when the odds are not in your favor and when the advantages of engaging in the behavior are less than the disadvantages). Finally, a decrease in the rate of problem gambling is definitely an appropriate measure of effectiveness, and it is hard to imagine this occurring without a concomitant decrease in overall gambling involvement.
The program was also found to be equally effective for all ages, genders, grades, schools, and communities. Furthermore, it also appears to be useful for students with high baseline levels of gambling frequency and/or symptoms of problem gambling. This is partly due to regression to the mean as well as these individuals having more "room for improvement." However, what this also speaks to is the instability of gambling and problem gambling in young people. As seen in Table 3, only a minority of problem gamblers at baseline were still problem gamblers at follow-up, including problem gamblers in the control group who received no intervention at all.
Other variables related to an enhanced outcome were more positive attitudes toward gambling at baseline, later date of program administration, higher baseline involvement in high-risk activities, and which trainer delivered the program. A more positive attitude is related to better outcome likely because the program had an impact on changing these attitudes, which presumably led to decreases in gambling behavior. Receiving the Stacked Deck program later in the study probably reflects the trainers' greater fluency in administering the program with greater practice. A lower rate of involvement in high-risk activities is related to better outcome perhaps because it reflects a less entrenched pattern of behavior more amenable to change. Finally, it comes as no surprise that there should be individual variability in the effectiveness of different trainers.
There are several important differences with previous programs that may explain why behavioral change was obtained in this study and not in others.
The focus on improving decision making and problem solving was somewhat different, as was the reported improvement in these skills. However, the failure of this improvement in decision making and problem solving to decrease other high-risk behaviors (e.g., substance use) makes it uncertain about their role in decreasing gambling behavior.
The orientation of the Stacked Deck program in advocating smart gambling/risk taking is different.
Targeting entire cohorts of students so as to include most of their peers was unique to the present study.
The average age of the students (16) is older than in other studies. Other problem gambling prevention programs have modeled themselves after tobacco and illicit drug use programs where the intervention is delivered to elementary school students who have not yet engaged in the behavior that is the target of prevention. This makes sense for prevention of tobacco and illicit drug use where total noninvolvement is the goal. However, noninvolvement in gambling is not a realistic (or appropriate) goal. Furthermore, some of the important concepts (e.g., odds, probabilities, independence of random events, law of large numbers) require a degree of mathematical and intellectual sophistication that may be beyond the grasp of many elementary school students. A stronger case can be made for intervening prior to the typical onset of problem gambling, which, admittedly, does appear to be present in high school students. However, as seen earlier, problem gambling does not appear to be a very stable or well-formed entity in this age group. Furthermore, the ability of the Stacked Deck program to change the behavior of heavily involved gamblers is evidence of its utility in this age group.4
Perhaps the most important difference from previous studies is the much heavier emphasis on the development and retention of skills, accomplished by making the program much longer (up to 600 min over 6 sessions), by spaced administration of lessons, and by its interactive and skill-oriented content. The superiority of the Booster Program over the Standard Program in some areas supports the notion that length and spacing is a contributing factor to the program's effectiveness. However, the comprehensiveness of the program is also likely important, as the authors have implemented other, even more substantive prevention initiatives in focused areas (i.e., mathematics of gambling) to university students that have failed to produce behavioral change (Williams and Connolly 2006). The authors appreciate the difficulty in incorporating multisession programs into already tight high school curriculums. However, it is important to recognize that the limited effectiveness of most current problem gambling educational and policy initiatives have to do with the fact that the ones that are implemented tend to be those that cause the least inconvenience, and consequently, have the least actual impact (Williams et al. 2007, 2008). We believe that problem gambling prevention needs to aspire to avoid the situation found in the substance abuse area, where the most commonly used (and entrenched) prevention and treatment interventions tend to be the less effective ones (e.g., Miller et al. 2003). Efficiencies may be obtained if the Stacked Deck program were administered in conjunction with prevention modules for tobacco, illicit drugs, and other substances because of potentially common content with respect to improving decision making, social problem solving, and coping skills.
J Prim Prev. 2010;31(3):109-125. © 2010 Springer
Springer Science+Business Media
Cite this: Stacked Deck: An Effective, School-based Program for the Prevention of Problem Gambling - Medscape - May 01, 2010.