A selection from Stockholm University publication database

• Reaching Out to Big Losers: Exploring Intervention Effects Using Individualized Follow-Up

  2023. Jakob Jonsson (et al.). Psychology of Addictive Behaviors

  Article

  Objective: Previous research suggests that a brief duty-of-care telephone call to high expenditure customers was associated with lower gambling over the subsequent year. The current aim was to assess effects on individual trajectories rather than overall group effects reported previously. The objective was to identify different patterns of individual change over the follow-up year and explore differential responses of subgroups of individuals. Method: A matched pair design contrasting the outcome for telephone intervention with a no-intervention control condition. Five hundred and ninety-six statistical pairs randomly drawn from the top 0.5% of customers based upon annual expenditure at Norsk Tipping, Norway. Primary outcome measure was gambling theoretical loss (TL), derived from the Norsk Tipping gambling data warehouse. Player trajectories across time were identified using growth mixture modeling to assess differential intervention effects on homogenous subgroups of individuals. Results: Relatively low, medium, and high TL subgroups were identified. The telephone intervention was associated with greater reductions than the control condition for all three subgroups but showed the strongest effect for the subgroup with the highest TL. The intervention was most effective for casino and sport gamblers, male, young, and middle-aged. Conclusions: A brief duty of care telephone contact with high expenditure customers showed sustained effects over 12 months, in particular for individuals showing the highest level of TL. Examining trajectories using advanced statistical models identified customer characteristics most strongly associated with reduced TL. These findings can guide prevention strategies with evidence-based knowledge about differential effects.Public Health Significance StatementA brief contact intervention with high expenditure customers showed sustained positive effects, in particular for individuals showing the highest level of expenditure. Findings about differential effects for individuals with specific profiles can guide evidence-based knowledge prevention strategies to provide duty of care for gambling customers.

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• In search of lower risk gambling levels using behavioral data from a gambling monopolist

  2022. Jakob Jonsson (et al.). Journal of Behavioral Addictions 11 (3), 890-899

  Article

  Background and aims: Lower-risk recommendations for avoiding gambling harm have been developed as a primary prevention measure, using self-reported prevalence survey data. The aim of this study was to conduct similar analyses using gambling company player data.

  Methods: The sample (N = 35,753) were Norsk Tipping website customers. Gambling indicators were frequency, expenditure, duration, number of gambling formats and wager. Harm indicators (financial. social, emotional, harms in two or more areas) were derived from the GamTest self-assessment instrument. Receiver operating characteristics (ROC) curves were performed separately for each of the five gambling indicators for each of the four harm indicators.

  Results: ROC areas under the curve were between 0.55 and 0.68. Suggested monthly lower-risk limits were less than 8.7 days, expenditure less than 54 €, duration less than 72–83 min, number of gambling formats less than 3 and wager less than 118–140€. Most risk curves showed a rather stable harm level up to a certain point, from which the increase in harm was fairly linear.

  Discussion: The suggested lower-risk limits in the present study are higher than limits based on prevalence studies. There was a significant number of gamblers (5–10%) experiencing harm at gambling levels well below the suggested cut-offs and the risk increase at certain consumption levels.

  Conclusions: Risk of harm occurs at all levels of gambling involvement within the specific gambling commercial environment assessed in an increasingly available gambling market where most people gamble in multiple commercial environments, minimizing harm is important for all customers.

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• Reaching Out to Big Losers

  2021. Jakob Jonsson (et al.). Journal of Gambling Studies 37, 387-401

  Article

  Telephone and letter-based motivational interventions with high expenditure gamblers have significant short and long term positive effects on gambling and use of responsible gambling tools. This report examines how different subtypes of gamblers, based upon patterns of play, are differentially affected. A randomized controlled trial design with three conditions (n = 1003 in each): feedback intervention by letter, telephone or a no-contact control condition. Subtypes of gamblers were derived by latent class analyses (LCA) based upon gambling behavior pre intervention. The participants were customers of Norsk Tipping gambling platforms. 1003 statistical triplets from the top 0.5% of customers based upon annual expenditure, matched on sex, age, and net losses. Primary outcome measure was gambling theoretical loss (TL), derived from the Norsk Tipping customer database. The LCA identified six subtypes: High Casino, High Sport, High Lottery, High Video lottery terminal (VLT), Lottery/Mix and Bingo/Casino. There were almost no differences in change in TL between the six subtypes of gamblers receiving the letter or telefone interventions respectively. However, the choice of contact by letter or telephone did have different effects for the different gambling subtypes. Sending a letter seems like a cost effective alternative to telephone contact for the High Lottery type, but telephone contact performs better for High Casino, High Sport and High VLT customers. Responsible gambling interventions can be improved by subtyping of gamblers.

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• Reaching out to big losers leads to sustained reductions in gambling over 1 year

  2020. Jakob Jonsson (et al.). Addiction 115 (8), 1522-1531

  Article

  Background and aims: A previous randomized controlled trial demonstrated that telephone‐ and letter‐based motivational interventions with high‐expenditure gamblers had significant short‐term positive effects on gambling and use of responsible gambling tools. This post‐trial follow‐up examined outcomes in gambling expenditure over 12 months.

  Design: Observational study following a three‐arm randomized controlled trial.

  Setting: Customers of Norsk Tipping (NT) gambling platforms, Norway.

  Participants: A total of 1003 statistical triplets from the top 0.5% of customers based upon annual expenditure, matched on sex, age and net losses. Mean age was 53.4 years; 19% were women, mean yearly loss for 2016 was 88 197 NoK.

  Interventions and comparator: Feedback intervention by telephone, letter or a no‐contact control condition.

  Measurements: Primary outcome measure was gambling theoretical loss, derived from the NT customer database. Secondary outcomes were responsible gambling customer actions and whether or not the participant was retained as an NT customer.

  Findings: Per‐protocol analyses of triplets who received the telephone call or letter as randomly assigned (n  = 596) showed a positive and sustained effect over 12 months: the telephone group showed a 30% reduction in theoretical loss (d  = 0.44) and the letter group 13% (d  = 0.18), both outperforming the control group with a 7% reduction (d  = 0.11). The telephone condition was superior to both the letter and control conditions in per‐protocol (P  < 0.001) and to control condition in intention‐to‐treat analyses (ITT) (P  < 0.001). Individuals in the telephone condition took more responsible gambling actions. The letter condition had better outcomes than the control in the ITT‐only analysis (P  < 0.001). More than 93% were still customers a year after the intervention.

  Conclusions: Personal contact with high‐expenditure gambling customers in Norway that provided individualized feedback on expenditures was associated with reduced theoretical losses and greater use of responsible gambling tools over a 12‐month period, compared with no contact. Telephone intervention with customers had a larger impact than a mailed letter.

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• Transitioning Between Online Gambling Modalities and Decrease in Total Gambling Activity, but No Indication of Increase in Problematic Online Gambling Intensity During the First Phase of the COVID-19 Outbreak in Sweden

  2020. Philip Lindner (et al.). Frontiers In Public Health 8

  Article

  Introduction: The COVID-19 outbreak will likely have a public health impact beyond immediate disease transmission. Little is known about whether social distancing and other societal changes has provoked an increase in gambling, whether decreased betting opportunities due to paused sports events spurred gamblers to transition to online casino gambling, or whether any of these factors have had an impact on problem gambling.

  Methods: Data on lookup queries against the Swedish Gambling Paus registry, logging all initiated gambling sessions by all licensed gambling providers, from 2019-01-01 (start of registry) to 2020-04-08 (well into the first phase of the outbreak) were analyzed using TBATS time series forecasting to estimate trends after the first domestic COVID-19 death. Obfuscated data on daily total wagered and deposited amounts, split by modality (casino or betting, and low and high intensity, respectively) for the equivalent period were supplied by a licensed online gambling provider.

  Results: Total gambling activity decreased by 13.29% during the first phase of the outbreak compared to forecast. Analyses of online gambling data revealed that although betting decreased substantially in synchrony with a slight increase in online casino gambling, there was no increase in likely problematic, high-intensity gambling and neither did total online gambling increase.

  Conclusions: This first, preliminary study revealed no increase in Swedish gambling activity, total or specifically online, in the first phase of the COVID-19 outbreak. Future research should examine whether pandemic-induced transitioning between gambling modalities and/or increased participation in gambling, leads to long-term effects on prevalence of problem gambling.

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• Preventing problem gambling: Focus on overconsumption

  2019. Jakob Jonsson (et al.).

  Thesis (Doc)

  A proportion of gamblers experience problems. The role of overconsumption in developing gambling problems is sparsely described in the literature and there is little scientific knowledge about the prevention of gambling problems. There are some promising results regarding personalized feedback on gambling habits, and there is a need for more research. The overall aim of this thesis was to explore the role of overconsumption in problem gambling and target it in a preventive intervention. The preventive intervention was to give gambling consumption feedback to high consumers in order to make them reflect upon their gambling habits and enhance their motivation for change. Study I aimed to explore the dimensionality of GamTest, an online test of gambling behaviour, and validate it against PGSI and the gambler’s own perceived problems. Data came from four Nordic gambling sites, n = 10,402. In an ESEM analyses, GamTest had a high degree of correspondence with the players’ own perceived problems and with the PGSI. In an EFA, GamTest captured five dimensions of problematic gambling (i.e. overconsumption of money and time, and negative financial, social and emotional consequences). A bifactor approach showed a general factor and four specific residual factors, negative emotional consequences contribute to the dominant part of the general factor. Study II aimed to examine both the psychometric properties of the Jonsson-Abbot Scale (JAS) and its predictive validity with respect to increased gambling risk and problem gambling onset. The results are based on repeated interviews with 3,818 participants within the Swedish longitudinal gambling study. The results indicate an acceptable fit of a three-factor solution in a CFA, with ‘Overconsumption (OC),’ ‘Gambling fallacies (GF),’ and ‘Reinforcers (RI)’ as factors. When controlled for risk potential measured at baseline, GF and RI were significant predictors of gambling risk potential, and GF and OC were significant predictors of problem gambling onset at 12-month follow up. Study III’s primary objective was to investigate the effects of providing personalized feedback on gambling intensity among high consumers in Norway. An RCT design was used to evaluate how behavioural feedback by telephone or letters affects subsequent gambling expenditure. A sample of 1,003 statistical matched triplets, from the top 0.5 % of customers, were randomly assigned to telephone, letter, or a no-contact control condition. Over 12 weeks, theoretical loss decreased 29 % for the telephone, and 15 % for the letter, conditions, compared with 3 % for the control group. Study IV was a 12-month follow-up of Study III, aimed to investigate the relative effects over twelve months. The telephone group showed a 30 % reduction in theoretical loss, the letter group 13 %, both outperforming the control group with a 7 % reduction. Less than 1% in all groups stopped playing at Norsk Tipping. These four studies indicate that overconsumption of gambling plays different roles in problem gambling. The role of overconsumption in preventing gambling problems is discussed. Contacting high consumers about their gambling expenditure appears to be an effective method for gambling companies to meet their duty of care for customers. Technical evolution has made it possible for gambling companies to fulfil their duty of care, but this has to be regulated and mandatory if it is to be effective.

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• Reaching Out to Big Losers

  2019. Jakob Jonsson (et al.). Psychology of Addictive Behaviors 33 (3), 179-189

  Article

  Gambling disorder is a public health issue in many countries, and expectations that the gambling industry protects individuals from harm are increasing. The primary objective of this study was to investigate the effects of providing personalized feedback on gambling intensity among high consumers of venue-based and online gambling in Norway. A randomized controlled trial design was used to evaluate how behavioral feedback by telephone or letters sent via surface mail affects subsequent gambling expenditure and use of responsible gambling tools and whether a follow-up contact increases the effect. Gambling expenditure, the primary outcome, was measured using theoretical loss, which is the actual cost to the player, adjusted for the house advantage. From the top .5% of customers based upon annual expenditure, a sample of 1,003 statistical triplets, matched on sex, age, and net losses, were randomly assigned to the feedback intervention by telephone, letter, or a no-contact control condition. Participants assigned to the phone call or letter were also randomly assigned to receive or not receive a subsequent follow-up contact. The results showed that over 12 weeks, theoretical loss decreased 29% for the phone and 15% for the letter conditions, compared with 3% for the control group. A positive effect of the follow-up contact was limited to participants who at the initial call indicated an interest in receiving a follow-up call. Contacting high consumers about their gambling expenditure appears to be an effective method for gambling companies to meet their duty to care for customers.

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• GamTest

  2017. Jakob Jonsson (et al.). Journal of Gambling Studies 33 (2), 505-523

  Article

  Recent increases in the number of online gambling sites have made gambling more available, which may contribute to an increase in gambling problems. At the same time, online gambling provides opportunities to introduce measures intended to prevent problem gambling. GamTest is an online test of gambling behavior that provides information that can be used to give players individualized feedback and recommendations for action. The aim of this study is to explore the dimensionality of GamTest and validate it against the Problem Gambling Severity Index (PGSI) and the gambler's own perceived problems. A recent psychometric approach, exploratory structural equation modeling (ESEM) is used. Well-defined constructs are identified in a two-step procedure fitting a traditional exploratory factor analysis model as well as a so-called bifactor model. Using data collected at four Nordic gambling sites in the autumn of 2009 (n = 10,402), the GamTest ESEM analyses indicate high correspondence with the players' own understanding of their problems and with the PGSI, a validated measure of problem gambling. We conclude that GamTest captures five dimensions of problematic gambling (i.e., overconsumption of money and time, and monetary, social and emotional negative consequences) with high reliability, and that the bifactor approach, composed of a general factor and specific residual factors, reproduces all these factors except one, the negative consequences emotional factor, which contributes to the dominant part of the general factor. The results underscore the importance of tailoring feedback and support to online gamblers with a particular focus on how to handle emotions in relation to their gambling behavior.

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• Measuring Gambling Reinforcers, Over Consumption and Fallacies

  2017. Jakob Jonsson (et al.). Frontiers in Psychology 8

  Article

  Traditionally, gambling and problem gambling research relies on cross-sectional and retrospective designs. This has compromised identification of temporal relationships and causal inference. To overcome these problems a new questionnaire, the Jonsson-Abbott Scale (JAS), was developed and used in a large, prospective, general population study, The Swedish Longitudinal Gambling Study (Swelogs). The JAS has 11 items and seeks to identify early indicators, examine relationships between indicators and assess their capacity to predict future problem progression. The aims of the study were to examine psychometric properties of the JAS (internal consistency and dimensionality) and predictive validity with respect to increased gambling risk and problem gambling onset. The results are based on repeated interviews with 3818 participants. The response rate from the initial baseline wave was 74%. The original sample consisted of a random, stratified selection from the Swedish population register aged between 16 and 84. The results indicate an acceptable fit of a three-factor solution in a confirmatory factor analysis with ‘Over consumption,’ ‘Gambling fallacies,’ and ‘Reinforcers’ as factors. Reinforcers, Over consumption and Gambling fallacies were significant predictors of gambling risk potential and Gambling fallacies and Over consumption were significant predictors of problem gambling onset (incident cases) at 12 month follow up. When controlled for risk potential measured at baseline, the predictor Over consumption was not significant for gambling risk potential at follow up. For incident cases, Gambling fallacies and Over consumption remained significant when controlled for risk potential. Implications of the results for the development of problem gambling, early detection, prevention, and future research are discussed.

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• Gambling Motives in a Representative Swedish Sample of Risk Gamblers

  2016. Kristina Sundqvist, Jakob Jonsson, Peter Wennberg. Journal of Gambling Studies 32 (4), 1231-1241

  Article

  Motives for gambling have been shown to be associated with gambling involvement, and hence important in the understanding of the etiology of problem gambling. The aim of this study was to describe differences in gambling motives in different subgroups of lifetime risk gamblers, categorized by: age, gender, alcohol- and drug habits and type of game preferred, when considering the level of risk gambling. A random Swedish sample (n = 19,530) was screened for risk gambling, using the Lie/Bet questionnaire. The study sample (n = 257) consisted of the respondents screening positive on Lie/Bet and completing a postal questionnaire about gambling and motives for gambling (measured with the NODS-PERC and the RGQ respectively). When considering the level of risk gambling, motives for gambling were not associated with gender, whereas younger persons gambled for the challenge more often than did older participants. Card/Casino and Sport gamblers played to a greater extent for social and challenge reasons then did Lotto/Bingo-gamblers. EGM-gamblers played more for coping reasons than did Lotto/Bingo gamblers. However, this association turned non-significant when considering the level of risk gambling. Moderate risk gamblers played for the challenge and coping reasons to a greater extent than low risk gamblers motives for gambling differ across subgroups of preferred game and between gamblers with low and moderate risk. The level of risk gambling is intertwined with motives for gambling and should be considered when examining gambling reasons.

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• Spelberoende

  2013. Per Carlbring, Jakob Jonsson. KBT inom psykiatrin, 337-353

  Chapter

  Här beskrivs hur KBT kan tillämpas vid de vanligaste psykiatriska tillstånden. I denna uppdaterade och utvidgade utgåva har nya kapitel tillkommit, bland annat om fallformulering, spelberoende, internetbehandling samt KBT och psykofarmaka. (Från baksidestexten.)

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• Reaching out to big losers

  Jakob Jonsson (et al.).

  Article

  Background and aims: We previously demonstrated that phone and letter-based motivational interventions with high expenditure gamblers had significant short term positive effects on gambling and use of responsible gambling tools. This report examines outcomes over twelve months.

  Design: A randomized controlled trial design with three conditions: feedback intervention by telephone, letter, or a no-contact control condition.

  Setting: Customers of Norsk Tipping gambling platforms.

  Participants: 1,003 statistical triplets from the top .5% of customers based upon annual expenditure, matched on sex, age, and net losses.

  Measurements: Primary outcome measure was gambling theoretical loss, derived from the Norsk Tipping customer database. Secondary outcomes were responsible gambling customer actions and whether the participant was retained as a NT customer.

  Findings: The results showed a positive and sustained effect of the phone and letter interventions over 12 months - the telephone group showed a 30% reduction in theoretic loss (d =0.44) and the letter group 13% (d =0.18), both outperforming the control group with a 7% reduction (d =0.11). The phone condition was superior to both the letter and control conditions in per protocol (p<0.001) and intention to treat analyses (ITT) (p< 0.018 and 0.001). Individuals in the phone condition took more responsible gambling actions. The letter condition had better outcomes than the control in the ITT only (p<0.001). Over 99% in the intervention groups were still customers during the follow-up year.

  Conclusions: A targeted telephone intervention with high expenditure customers effectively reduced theoretical losses over a 12 month period. Gambling companies can utilize this type of intervention as a response to their duty to care for customers.

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Show all publications by Jakob Jonsson at Stockholm University