Howard Jeffrey Shaffer

Harvard Medical School | HMS · Department of Psychiatry

Confronted with criticisms focused on the nature of Responsible Gambling (RG), this article suggests that Positive Play (PP) is a conceptual subset of Responsible Gambling and not a fully developed and independent harm prevention or reduction framework. To advance public health initiatives and focus public policy. This article reviews and clarifies...

‘Responsible drinking’ remains a poorly defined construct despite decades of use among diverse stakeholders including industry, academics, governmental agencies, and addiction advocacy groups. To move the field closer to a consensus definition of responsible drinking that is useful for educational and research purposes, we describe five primary bar...

To mitigate alcohol-related harm, various stakeholders have advanced the construct of ‘responsible drinking.’ However, clarity regarding ‘responsible drinking’ in evaluation research is limited. Additionally, the alcohol industry often uses the term without any mention of clear limits or meaning. At this point it is unclear whether stakeholders are...

Despite its widespread use, the concept of “responsible gambling” lacks a clear definition. Consequently, debate and confusion surround the respective government, regulator, industry operator, individual, and community accountability as these stakeholders attempt to develop strategies, policies, and procedures that will protect consumers by minimiz...

This article describes the construct of “behavioral addiction” and its place within addiction nosology. To accomplish this goal, we will begin by considering the idea of addiction in general (e.g., the etiology and epidemiology of the disorder), and we will use the addiction syndrome model to guide this discussion (Shaffer et al., 2004, 2012a,b). T...

In this comment, we suggest there has been a crusade among some gambling stakeholders to move the field away from personal responsibility influences and toward social setting effects. This perspective disproportionally attributes gambling-related negative consequences to the social setting rather than the gambler. We argue that personal responsibil...

Alors qu’une pandémie dévastatrice affecte le monde entier, il est essentiel que les décideurs tiennent compte des problèmes de méthodologie et de mesure qui pourraient être associés aux indicateurs de santé publique de la maladie à coronavirus 2019 (COVID-19). Ce commentaire comprend quatre variables principales pour illustrer les questions de mes...

As people around the world experience a devastating pandemic, it is critical that policy-makers consider the methodological and measurement issues that might be associated with coronavirus disease 2019 (COVID-19) public health indicators. This commentary uses four primary variables to illustrate measurement and methodological issues that can compli...

Unfortunately, the original publication contains errors. The authors would like to correct the errors.

Purpose of review Posttraumatic stress disorder (PTSD) commonly co-occurs with substance use disorder (SUD) and is challenging to treat. We review all behavioral therapy models with at least one randomized controlled trial in a current PTSD/SUD population. We identify factors in selecting a model for clinical use, emphasizing a public health framew...

During the past few decades, response rates have declined across social science research. Although some researchers are willing to accept this state of affairs, in this comment, we argue that low response rates weaken the value of social science research, thereby jeopardizing science research and associated knowledge. We describe the case of a Hong...

Many people worry that exposure to Internet gambling will overpower individuals’ self-control, stimulate addictive behavior patterns, and provide the context to sustain addiction once it emerges. Though many researchers have attempted to evaluate this proposition, they have been limited by their methodological approaches—specifically, their use of...

This paper discusses the relationship between investigative credibility and the sources of funding associated with gambling research. Some researchers argue against accepting funding from gambling industry sources; similarly, they decline to participate in activities directly or indirectly sponsored by gambling industry sources. In contrast, these...

Some critics of the Reno model appear to have misinterpreted its fundamental tenets by expressing the belief that the model is incompatible with the public health model. Both the public health and Reno models attempt to influence policies and strategies designed to promote responsible gambling and the reduction of gambling-related harms. In this ar...

Public health groups, researchers, the beverage alcohol industry, and other stakeholders have promoted and applied the concept of “responsible drinking” for the past 50 years. However, little is known about the state of the existing responsible drinking evaluation research and its application to policy and practice. This project provides a scoping...

This comment corrects erroneous and misleading statements about gambling control and public health. In addition, it avoids tilting at windmills. This comment focuses on four primary issues: (1) the politics of public health initiatives, (2) gambling as a determinant of adverse health, (3) the nature and prevalence of gambling addiction, and (4) the...

A recent systematic review of the responsible gambling research suggests that there are no significant differences between gambling industry and non-industry funded research with regard to research design and outcomes. This study empirically synthesizes the outcomes of a larger sample of the scientific gambling literature to determine the generaliz...

Robert Ladouceur and Alex Blaszczynski convened this working group and established the early agenda and direction for the International Group on Responsible Gambling and our scholarly publications. The Reno Model provided the seminal architecture for understanding, creating, and implementing responsible gambling activities and programs. This model...

This volume reflects the perspectives of a diverse group of primary stakeholders interested in responsible gambling activities and programs. It also marks a watershed moment in the activities of the International Group on Responsible Gambling. The Reno Model, introduced by Blaszczynski, Ladouceur, and Shaffer in 2004, has provided the seminal archi...

Objective To help mitigate potential gambling harm, responsible gambling information centres are launching across casino venues in North America. The launch of the first such centre in the USA provided an opportunity to achieve three goals: (1) document the centre’s reach among casino patrons, (2) generate a comprehensive description of services pr...

Driving under the influence of alcohol or other substances is a serious public health concern. Previous research has shown that psychiatric comorbidity is more prevalent for repeat offenders than the general population, and that first-time offenders exhibit elevated rates of psychiatric comorbidity, but few studies have directly compared first-time...

Daily fantasy sports (DFS), a rapidly growing industry, allows players to create fantasy teams of real-life players and potentially win cash prizes, derived from entry fees. Some stakeholders have expressed concern that DFS’s accelerated nature and other features might promote excessive play and related harm. We conducted the first descriptive summ...

This article describes a collaborative research project between the Division on Addiction, Cambridge Health Alliance, a Harvard Medical School Teaching Hospital, and the Integrated Centre on Addiction Prevention and Treatment (ICAPT) of the Tung Wah Group of Hospitals (TWGHs) in Hong Kong. The goal of this research is to better understand the syndr...

Aim: Despite significant reductions in Driving Under the Influence (DUI) in the United States during recent decades, DUI continues to be a major public health threat. The current study investigated the intersection of two domains known to influence DUI: criminal history and psychiatric comorbidity. Methods: DUI recidivists (N = 743) attending a...

This brief report examines whether there are differences in aspects of different characteristics, including design/methodologies of responsible gambling (RG), between studies funded by industry as compared to other sources. To investigate this, the authors used those studies included in a recent meta-analysis focusing on the empirical basis of RG i...

During 2011, the Governor of Massachusetts signed a bill to allow casino gambling in the state (Commonwealth of Massachusetts 2011). As a result, two resort casinos will begin operations during 2018 and 2019; a smaller slots parlor began operations during June 2015. Prior to this expansion, gambling was widely available in Massachusetts, through th...

Objectives. Emerging adulthood remains a critical period in the participation of risky behaviors, including alcohol and substance use as well as gambling. College students are at greatest risk for participation in these risky behaviors because they are continuously exposed to multiple, drinking, substance use and gambling environments without the s...

Investigators have observed that college-age students have the highest prevalence rates of problem gambling among adults. Problem/disordered gambling has been associated with increased risks for personal, social, academic, behavioural, and criminal problems. From a prevention perspective, previous studies have suggested that prohibitive college gam...

This article describes the construct of ‘behavioral addiction’ and its place within addiction nosology. To accomplish this goal, we consider the idea of addiction in general (e.g., disorder etiology and epidemiology). We use the syndrome model to focus our consideration on a shared etiology of substance and behavior based addiction by examining the...

Many jurisdictions around the world have implemented Responsible Gambling (RG) programs for the purpose of preventing gambling-related harms. Using a research synthesis strategy, this paper examines the extant peer-reviewed empirical evidence underpinning RG strategies. Instead of reporting all available studies and then discarding many on the grou...

In their review of Internet gambling studies, Auer and Griffiths (J Gambl Stud 30(4), 879–887, 2014) question the validity of using bet size as an indicator of gambling intensity. Instead, in that review and in a response (Auer and Griffiths, J Gambl Stud 31(3), 921–931, 2015) to a previous comment (Braverman et al., J Gambl Stud 31(2), 359–366, 20...

As rates of Internet gambling participation increase worldwide, so too does the need to understand how people engage in this form of gambling. This study represents the first examination of actual Internet gambling records within Iceland, a Nordic country with an active Internet lottery market that imposes strict regulations on gambling operator li...

As rates of Internet gambling participation increase worldwide, so too does the need to understand how people engage in this form of gambling. This study represents the first examination of actual Internet gambling records within Iceland, a Nordic country with an active Internet lottery market that imposes strict regulations on gambling operator lic...

This study examined patterns of problematic internet use (PIU) among South Korean internet users to investigate the association between PIU and dissociative experiences. Five hundred and eight participants between 20 and 49 years old were recruited through an online panel survey. Using logistic regression analysis with PIU as the dependent variable...

The RENO Model, first published during 2004, described a science-based framework of responsible gambling principles for a range of industry operators, health service providers, community and consumer groups, and governments. These strategic principles serve as a guide for the adoption and implementation of responsible gambling and harm-minimization...

Psychiatric comorbidity has emerged as a key element distinguishing DUI offenders from others, and, in some cases, distinguishing repeat offenders from first-time offenders. This paper utilizes a prospective design to determine whether the comorbid disorders identified among repeat DUI offenders can predict recidivism. Seven hundred forty-three rep...

Social networks play important roles in mental and physical health among the general population. Building healthier social networks might contribute to the development of self-sufficiency among people struggling to overcome homelessness and substance use disorders. In this study of homeless adults completing a job- and life-skills program (i.e., th...

The current study examines the perceived differences of stress and stress coping strategies between smoking and nonsmoking South Korean casino workers. Casino employees (N = 621) were grouped into two groups (i.e., smokers and nonsmokers). Using logistic regression analysis with cigarette smoking as the dependent variable, investigators observed th...

Gaming industry employees are at higher risk than the general population for health conditions including gambling disorder. Responsible gambling training programs, which train employees about gambling and gambling-related problems, might be a point of intervention. However, such programs tend to use a "one-size-fits-all" approach rather than multip...

In this article, we consider behavioral addiction by examining the psychiatric aspects of disordered gambling. In particular, we illustrate these considerations with examples based on the growing evidence base associated with Internet-based gambling. We begin our review by focusing on gambling, the epidemiology of gambling disorders, and the place...

This study is the first to compare the accuracy of self-reported with actual monetary outcomes of online fixed odds sports betting, live action sports betting, and online casino gambling at the individual level of analysis. Subscribers to bwin.party digital entertainment's online gambling service volunteered to respond to the Brief Bio-Social Gambl...

Using records of Internet gambling subscribers (n = 1,384), this study tested the Pareto principle: about 20% of customers, “the vital few,” are responsible for about 80% of the activity, while 80%, “the trivial many,” are responsible for the remaining 20%. Participants completed the Brief Biosocial Gambling Screen (BBGS) and had a history of betti...

As rates of Internet gambling participation increase worldwide, so too does the need to understand how people engage in this form of gambling. This study represents the first examination of actual Internet gambling records within Iceland, a Nordic country with an active Internet lottery market that imposes strict regulations on gambling operator li...

In their review of Internet gambling studies, Auer and Griffiths (Soc Sci Comput Rev 20(3):312-320, 2013) question the validity of using bet size as an indicator of gambling intensity. Instead, Auer and Griffiths suggest using "theoretical loss" as a preferable measure of gambling intensity. This comment identifies problems with their argument and...

Using actual gambling behavior provides the opportunity to develop behavioral markers that operators can use to predict the development of gambling-related problems among their subscribers. Participants were 4,056 Internet gamblers who subscribed to the Internet betting service provider bwin.party. Half of this sample included multiple platform gam...

Research indicates that specific types of gambling, such as electronic gaming machines (e.g., Video Lottery Terminals (VLTs), slot machines, virtual gaming machines), are associated with increased odds of experiencing gambling problems. Recent findings suggest that to advance our understanding of gambling-related problems scientists need to focus l...

Background: Prescribing benzodiazepines during buprenorphine treatment is a topic of active discussion. Clinical benefit is unclear. Overdose, accidental injury, and benzodiazepine misuse remain concerns. We examine the relationship between benzodiazepine misuse history, benzodiazepine prescription, and both clinical and safety outcomes during bup...

As the worldwide popularity of Internet gambling increases, concerns about the potential for gambling-related harm also increase. This paper reports the results of a study examining actual Internet gambling behavior during 10 years of play. We examined the electronic gambling records of subscribers (N = 2,066) who triggered a responsible gaming ale...

A growing literature is addressing the nature of the relationships among gambling activity, gambling involvement, and gambling-related problems. This research suggests that among the general population, compared to playing any specific game, gambling involvement is a better predictor of gambling-related problems. To date, researchers have not exami...

Two studies conducted in Massachusetts and Nevada evaluated the efficacy of a self-help toolkit for problem gambling. Individuals concerned about gambling-related problems, in response to public notices and newspaper advertisements, volunteered for a randomized trial of the self-help toolkit, Your First Step to Change: Gambling. Participants were r...

This study examines the impact of a work-skills program grounded in an integrated services approach on both employment and related life domains among homeless individuals. Six hundred thirty-eight participants in a 14-week work-skills program at a large day center in New England completed assessments at intake between 1999 and 2007; a subsample of...

The major purpose of the present study was to examine the application of more precise inoculation procedures to the problem of smoking prevention. In addition, this project was conducted to demonstrate the feasibility of carrying out smoking inoculation with seventh grade students in the Cambridge public schools, develop a manual to standardize met...

Alcohol identity is the extent to which an individual perceives drinking alcohol to be a defining characteristic of his or her self-identity. Although alcohol identity might play an important role in risky college drinking practices, there is currently no easily administered, implicit measure of this concept. Therefore we developed a computerized i...

Gaming industry employees work in settings that create personal health risks. They also have direct contact with customers who might engage in multiple risky activities (e.g., drinking, smoking, and gambling) and might need to facilitate help-seeking by patrons or co-workers who experience problems. Consequently, the empirical examination of the pr...

This article presents findings from the first taxometric study of actual gambling behavior to determine whether we can represent the characteristics of extreme gambling as qualitatively distinct (i.e., taxonic) or as a point along a dimension. We analyzed the bets made during a 24-month study period by the 4,595 most involved gamblers among a cohor...

Many international jurisdictions have introduced responsible gambling programs. These programs intend to minimize negative consequences of excessive gambling, but vary considerably in their aims, focus, and content. Many responsible gambling programs lack a conceptual framework and, in the absence of empirical data, their components are based only...

Objective: To identify patterns of sports gambling that discriminate sports bettors with self-reported gambling-related problems from sports bettors without such difficulties. Methods: Secondary data analysis of the actual betting behavior observed during the first 2 years of a longitudinal study of 47,134 subscribers to an Internet sports gambling...

Recent studies indicate that posttraumatic stress disorder (PTSD) is one of the most common psychiatric comorbidities among driving-under-the-influence (DUI) offenders in treatment. Investigation of DUI offenders' PTSD and clinical characteristics could have important implications for prevention and treatment. This prospective study examined the de...

This paper investigates the similarity or difference in cognitive bias on a poker task between experienced poker players (EPPs) and inexperienced poker players (IPPs). EPPs were compared with IPPs on probability estimation (estimation bias) and choice (decision bias). It was hypothesized that EPPs would have lower estimation bias and lower decision...

Internet gambling is one of the fastest growing gambling-related industries (Christian Capital Advisers 2006). As the Internet gambling industry expands, many stakeholders have created, or are in the process of creating, gambling-related policy. Policy makers promulgating these regulations rely on professional opinions and/or conventional wisdoms r...

Outpatient-based opioid treatment (OBOT) with buprenorphine is an important treatment for people with opioid dependence. No quantitative empirical research has examined rationales for use of illicit buprenorphine by U.S. opioid-dependent treatment seekers. The current study sequentially screened OBOT admissions (n = 129) during a 6-month period in...

Gambling-related research has advanced rapidly during the past 20 years. As a result of expanding interest in pathological gambling (PG), stakeholders (e.g., clinicians, regulators, and policy makers) have a better understanding of excessive gambling, including its etiology (e.g., neurobiological/neurogenetic, psychological, and sociological factor...

Cognitive measurement techniques, such as self-reports of behavior and reaction time measures, largely dominate the field of psychological research. It is uncommon for researchers to examine a phenomenon of interest by observing actual behavior within natural settings. To illustrate the existence of this methodological trend for gambling research,...

Gambling is an important public health concern. To better understand gambling behavior, we conducted a classroom-based survey that assessed the role of the theory of planned behavior (TPB; i.e., intentions, subjective norms, perceived behavioral control, and attitudes) in past-year gambling and gambling frequency among college students. Results fro...

To develop a pathological gambling (PG) screen for efficient application to the household population and for clinicians to use with treatment seekers. We applied a series of multivariate discriminant functions to past-12-month Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR)-based, gambling-related pr...

The goal of this study is to identify betting patterns displayed during the first month of actual Internet gambling on a betting site that can serve as behavioural markers to predict the development of gambling-related problems. Using longitudinal data, k-means clustering analysis identified a small subgroup of high-risk gamblers. Seventy-three per...

Gli studi sul gioco d’azzardo sono un’area “giovane” sospesa al confine con il “regno” della Sanità Pubblica. In questo capitolo, viene anticipato il punto d’arrivo delle ricerche sul gioco d’azzardo e incoraggiato l’uso di un approccio integrato collegato con la Sanità Pubblica e finalizzato alla comprensione di questo quadro patologico. In manier...

The purpose of this study was to examine the relationships between types of gambling and disordered gambling, with and without controlling for gambling involvement (i.e. the number of types of games with which respondents were involved during the past 12 months). We completed a secondary data analysis of the 2007 British Gambling Prevalence Survey...

For more than a decade, casinos around the world have offered self-exclusion programs (SEPs) to gamblers seeking help with their gambling behavior. Despite the proliferation of SEPs, little is known about the long-term outcomes for gamblers who utilize these programs. The current study assessed the experiences of a sample (N = 113) of Missouri self...