*Article* **Self-Exclusion among Online Poker Gamblers: E**ff**ects on Expenditure in Time and Money as Compared to Matched Controls**

**Amandine Luquiens 1,2,3,4,\*, Aline Dugravot 3, Henri Panjo 3, Amine Benyamina 1, Stéphane Gaï**ff**as 2,5 and Emmanuel Bacry 2,6**


Received: 4 September 2019; Accepted: 6 November 2019; Published: 11 November 2019

**Abstract:** *Background:* No comparative data is available to report on the effect of online self-exclusion. The aim of this study was to assess the effect of self-exclusion in online poker gambling as compared to matched controls, after the end of the self-exclusion period. *Methods:* We included all gamblers who were first-time self-excluders over a 7-year period (*n* = 4887) on a poker website, and gamblers matched for gender, age and account duration (*n* = 4451). We report the effects over time of self-exclusion after it ended, on money (net losses) and time spent (session duration) using an analysis of variance procedure between mixed models with and without the interaction of time and self-exclusion. Analyzes were performed on the whole sample, on the sub-groups that were the most heavily involved in terms of time or money (higher quartiles) and among short-duration self-excluders (<3 months). *Results:* Significant effects of self-exclusion and short-duration self-exclusion were found for money and time spent over 12 months. Among the gamblers that were the most heavily involved financially, no significant effect on the amount spent was found. Among the gamblers who were the most heavily involved in terms of time, a significant effect was found on time spent. Short-duration self-exclusions showed no significant effect on the most heavily involved gamblers. *Conclusions:* Self-exclusion seems efficient in the long term. However, the effect on money spent of self-exclusions and of short-duration self-exclusions should be further explored among the most heavily involved gamblers.

**Keywords:** online gambling; self-exclusion; responsible gambling; comparative study; poker

### **1. Introduction**

Harmful gambling behaviors are widespread and treatment-seeking is still very low among problem gamblers. Self-exclusion processes could be seen as an accessible tool for problem gamblers who are not ready to seek treatment. In France, gamblers can apply for online self-exclusion per website, for the length of their choice from one week to three years. During this period, they cannot access their gambling account on the website and receive no commercial offer from the gambling service provider. At the end of the period, they can gamble back on the website with no additional procedure. No help is provided nor any counselling during the self-exclusion period.

#### *Int. J. Environ. Res. Public Health* **2019**, *16*, 4399

It has been consistently demonstrated that most self-excluders were indeed heavy gamblers and probably problem gamblers [1,2]. A recent meta-analysis describing gamblers who self-excluded highlighted that this tool, perceived as one of the main "responsible gambling" tools, is still considerably under-used [3]. Main barriers for self-exclusion has been described: complicated enrollment processes, lack of complete exclusion from all venues, little support from venue staff, and lack of adequate information on self-exclusion programs. The proportion of self-excluders could be particularly low among problem internet gamblers [4]. Regulators have reached the conclusion that this tool should be promoted to increase its use. Promoting the use of a potentially therapeutic tool needs to rely on robust efficacy data and not only on empirical data or mere common sense. A recent systematic review of the literature demonstrated that the impact of responsible gambling tools is still poorly supported by scientific evidence [5]. In particular, efficacy data for the effect of self-exclusion on gambling behaviors remains scarce [5]: several studies have shown reduced gambling after a self-exclusion period on both online and offline environments, with variable durations of follow-up, sometimes including the self-exclusion period itself [1,6,7]. Follow-up after online self-exclusion has been reported in only two studies [7,8]. The first one included a limited sample of 20 gamblers, with no control group, and assessed psychosocial outcomes [8]. The other one reported that the majority of online self-excluders returned to gambling after the self-exclusion period expired (*n* = 1996) [7], and that most of them self-excluded a second time, after another period of more intensive gambling than the first [1]. Only one study has reported follow-up data from matched controls with a comparative research design (*n* = 86) [5]. One study reported that gambling outcomes did not differ between self-exclusion alone vs self-exclusion combined with counseling or counseling only [9]. No study has reported efficacy data on spontaneous voluntary self-exclusion as compared to no intervention (i.e., no self-exclusion). One experimental study randomized volunteering problem gamblers (but not pathological gamblers, who were excluded) to either a very short 7-day period of self-exclusion or no self-exclusion [10]. The authors reported no significant between-group differences in terms of changes regarding money and time spent gambling at two months.

Skills are important in poker gambling and poker gamblers have been demonstrated to have particular thoughts about their own gambling behavior and to be particularly sensitive to feedbacks on their own practice [11]. Illusion of control could be high in poker gamblers [12] and perception of their own skills could be amplified [13]. The prevalence of problem gambling among online poker gamblers is particularly high, consistently reported between 15% and 20% of active gamblers [14,15]. Several factors predicting excessive gambling in poker gamblers were identified: stress, internal attribution, dissociation, boredom, negative emotions, irrational beliefs, anxiety, and impulsivity [16], lower performance in the emotional intelligence competences (Emotional Quotient inventory Short) and, in particular, those grouped in the Intrapersonal scale (emotional self-awareness, assertiveness, self-regard, independence and self-actualization). Classical financial moderators' relevance have been consistently discussed in poker gambling as financial involvement of problem gamblers can be very low and time involved is critical to take into account [14]. No time moderator is mandatory for online gamblers in France [17]. Self-exclusion could then be one of the most relevant tools currently available for poker online gamblers in France. Poker gamblers are then a particularly interesting population to study to assess the efficacy of self-exclusion.

The aim of the present study was to document the long-term effects of self-exclusion from a poker website as compared to no self-exclusion, using matched controls. Our hypothesis was that self-exclusion would have an effect on time and money spent after the exclusion ended compared to no self-exclusion.
