The drift of mass gambling during the pandemic. Implications for clinical social workers and psychiatric or mental health nurse practitioners.
by Fiasco M.

Keywords: gambling, addiction, compulsiveness, profitability

Abstract: Ten years have passed since the date of recognition by the Italian State that an important health problem is related to a mass diffusion of gambling practices. Today it appears necessary to arrive at a unified overview of the implications of the particular health risk. It is a question of examining the effectiveness of social regulation and the treatment of health aspects, while the compatibility of legalized gaming activities with reasons of public safety and health must be ascertained. Even the clinic professional is obliged to develop a multidisciplinary and multiprofessional reading that also includes numerous aspects albeit unrelated to his initial specialist preparation.

Apparently simple questions make it difficult to sufficiently understand the dynamics of addiction itself. It is necessary to understand how the various different games of chance work, what change the use of digital technologies has brought about, how the gambling majors manipulate the customer in online gambling, which is the mode that is prevailing over that in a space material. And in general, the effects of the daily presence of the always on, of the engagement of the person in a universal gamification, in a technological “gamification” that refers to the reward flow, at successive levels, to jingles that accompany the challenges, must be faced. , to new rewards expected.

Introduction

In the year 2012 only, the Italian Government classified the health risk related to gambling^[1], while the World Health Organisation has indicated this pathology since 1980. To understand this problem, we need to bring together as one a unified view of the situation.

Clinical therapy professionals have to demonstrate their scientific autonomy and demand the adoption of coherent institutional decisions. These decisions concern economic, legal, and other interrelated aspects as we are dealing with interconnected issues. First, it is necessary to assess whether legalised gambling activities are compatible with public safety and health. Therefore, we have to evaluate the actual functioning of the set of legal rules relating to the public concession contract.

In particular, practitioners in the clinical therapy area have to enrich their competencies with a multidisciplinary and multi-professional vision, including numerous aspects that nevertheless are not included in their initial specific preparation and specialisations. In other words, they need to acquire and use a contiguous set of additional knowledge in order to be able to obtain satisfactory results in their work. The questions to be asked are similar to those that concern the dynamics of pathological dependency. How do several and different forms of gambling work? How and to which extent the use of digital technologies has introduced and caused changes? How do online gambling businesses deal with their customers? Online gambling has been the prevailing form of gambling over land-based gambling in recent years.

We have to observe how long and in which ways gamblers remain online. The use of generalised technological gamification mechanisms hooks people in an all-encompassing gamification. Technology manages the flow of rewards. The player goes through successive levels while jingles come to their ears so as to stimulate challenges and induce them to new challenges and expected rewards. Clinical therapy professionals have to know how gambling, practised by vast masses of the population, works. New digital technologies have reorganised people’s biorhythms, codified and beat the times of emotions, and interpolated the paths of everyday life with the sequences of gratification and obliterable frustration.

Gambling as a prism

We can compare gambling to the figure of the prism. The prism is a figure of solid geometry composed of various faces, each of which is connected to the others. Each face of the prism determines the shape of the whole figure. In the field of wager, in the world of betting, in the game of “alea^[2]“, in the prism of gambling as a whole nothing is undetermined. The gambling machine does not leave out or hand over any detail to chance.

The prism keeps its faces strongly connected one-to-another. Its geometry implies many constitutive variables, each one of them is connected to the other ones. The prism of gambling in Italy has no equivalent if compared with other countries with a similar demographic and socioeconomic profile.

The world’s largest gambling corporation is headquartered in Italy. The oligopolistic Group “De Agostini” declares a volume of 4.1 billion euros in revenues coming from dozens of companies in the sector^[3]: the main one is the “International Gaming Technology” – IGT; other companies are all named “Lottomatica”. Building on the ROI from gambling and the collection of private savings, De Agostini Group manages hedge funds (for example, built from NPLs). In short, the economic crisis of the industrial and manufacturing production in the real economy has been counterbalanced by the performance of the gambling industry, with its related business and commercial chains.

Gambling in our day is an actual interdependent system, designed and governed through industrial planning methods and approaches. In the kingdom of “fortune”, no details are left to chance. The Corporations in the field choose their words to narrate gambling to the public, consumers, opinion leaders, policymakers, judicial institutions, and of course, local and regional administrations. Nothing is left to chance. The storytelling, the narrative, the chosen words and images, and the terminology used as a whole build a business able to get a tremendous amount of money with more than a hundred times nine zeros. The contemporary game of chance is totally different from the one described by F. Dostoevsky in his novel “The Gambler”.

We have to read the terminology, that is, the words used to name the games, to be able to understand and formulate the concepts of the economic analysis and propose technical models for clinical analysis. Words can enable or distance a correct knowledge of the phenomenon, the clinical framing of gambling-related addiction. Unambiguous messages or vice versa, “double” messages also influence therapeutic activity. Terminology is also essential when it comes to institutional aspects. Messages and technical words influence the therapeutic approach, that is, the work that the field specialist is conducting in order to help the recovery of the person.

The faces of the mass industrial gambling prism are the following ones:1. Existence of an industrial project and strategy; 2. Adoption of words tampering practices to prevent social concerns or alarm; 3. Adoption of very refined and innovative marketing, also using Gamification techniques; 4 Adoption of widespread Sponsorships for Cause-Related Marketing and advertising, if permitted by law; 5. Insertion of advertising messages in sports events; 6. Influencing the choice of intervention models for “substanceless” addiction therapy; 7. Interposing in a way that hinders or impedes the exercise of the power of local municipalities and regions; 8. Taxation with a “double link”, or tax addiction of the State; 9. Creation of a derivative finance; 10. Accentuation of the risk of money laundering and interference with democratic practices; 11. Incentive to the evolution of criminality; 12. Widespread feeling of insecurity in the territory and related phenomena of extortion and usury.

The prism has connected faces. Contemporary gambling is not as an aesthetic experience of the nineteenth century. At that time, casinos operated within the spa resorts. Casinos were elegant, they had rooms decorated with mirrors and stucco walls. Today we are in the era of industrial gambling. Industrial gambling is structured project, that adopts modern marketing techniques and gains the support of consumers. The gambling industry creates many consumer profiles (by age, social security, gender difference). The gambling industry follows and adopts an important scientific approach. Therefore it is necessary for social scientists to observe the “interna corporis” of the industrial project, so as to assess strengths and weaknesses, opportunities and traps.

An industrial project and a success story for universal consumption

We call it and define it as “mass industrial gambling” and propose a unitary, effective, and coherent framework at the same time. Here is the paradigm.

The key features are a) the combination of alea and advanced technologies; technologies have almost completely incorporated the “function of chance”; b) games that distribute prizes of a low monetary amount, but that reward many people, replace games that promise a prize of a lot of money, but very rarely; c) gratification with small amounts of money is repeated at very high frequency; d) this gratification has cancelled the magical compensatory function of the uncertain quest for Fortune; d) the large-scale and high-intensity use of neuroscience and behavioural acquisitions for operating “conditioning”; (f) a business linked to the financial market which results from the development of gambling profits.

A mass industrial game is, therefore, a low-threshold gambling experience. Gambling increasingly occupies the social time of life; gambling interpolates the itineraries of people’s daily life since it engages them for many hours of their day; Gambling is based on behaviour reinforcement techniques and induction to compulsive behaviours. In general, mass industrial gambling engages and blocks customer behaviour through a two-way system, both online and land based. Sequenza is “input – bet – expected reward”. With patient mosaic work, we observe the connections and systematic structure of mass industrial gambling.

Clinical therapy professionals assess the impact of the approximately 111 billion euros people spent in the second year of the covid-19 pandemic. Gambling impacts society and individuals. During the months of the pandemic, the authorities imposed social distancing health measures. With the lockdown, they have closed more than the access doors to the gambling halls closed. Nevertheless, gambling consumption in the year 2021 exceeded the consumption figure recorded in the year 2019.

We use appropriate terminology. In the habits of Italians, the volume of money and the corresponding portion of the social time of life spent by the population represent a vast “monetary flow of transactions”. The dynamic concept of “flow” refers to the number of sums wagered on gambling. The flow is a tumultuous, disorderly, overwhelming current. It is more appropriate to use the word “flow” than “collection”. The word “collect” suggests the idea of “participating” of collectively contributing to forming a prize pool that comes from subscribers. It is wrong to think that “luck” redistributes the “cumulation” depending on the outcome of events. This feature holds true for some traditional types of gambling. They are the types almost extinct (such as the “Totocalcio^[4]“), and the Superenalotto (a modern type of extraction game). The word “collection” is inappropriate for the set of fifty-one types of gambling that the majors distribute on the market. The algorithms, the proportions, and the combinations of collection and deposit are predetermined. The total amount of prizes is not variable but is regulated or rigidly. The technology predicts and guarantees the percentage of money paid at the “gambling bank”.

The rigidly withheld share of the money wagered is divided between the commercial companies (with their business partners) and the tax administration of the Italian State. Ina planned split, the gambling organization pays the prize money to the winners.

The so-called “instant lotteries” (scratch) follow a strict procedure. In the lottery entitled “White Christmas”, the “gambling desk” retains for itself 33.49 % of the margin of money bets, equivalent to nineteen million 291 thousand 400 euros (19,291,400), compared to 57.6 million euros expected. The lottery sold 19.2 million coupons (each coupon cost three euros). One ticket every 16 “reimburses” the amount equivalent to the ticket price; one every 16.7 pays as a “prize” a sum 66.6% higher than that of the cost of the ticket (so the effective price is equal to 2 euros); one for every 45.5 tickets pays the player a net balance of seventeen euros. For every 2400 tickets, there is a prize of fifty euros (47 euros, minus the cost of the ticket). Therefore, the margin is 7150 euros, compared to the disbursement of only 47 (see table 1). And so on.

Table n. 1

Source: Our elaboration on ADM prospectus (https://www.adm.gov.it/portale/-/bianco-natale)

Gambling companies sell a chance to get a reward from chance. In other words, companies sell the possibility of a prize obtained by chance; but the case is regulated by the algorithms compiled to build the structure of 51 different types of games. With these procedures, industrial gambling causes customers to continue even when they no longer perceive the euphoria of gambling. As is the case with people who consume alcoholic beverages or shop for goods (which they do not use) and go beyond the physical limit of “satiety”. Gambling, alcoholism, and smoking make us overcome the limitations of the physiological human capacity to consume a good.

With this key of interpretation, let us now look at the following figure graphic. In the first part, the graph describes the entire years from 2006 to 2014; the second part describes the period 2015-2021.

Figure n. 1 A – 2006 – 2010 Total volumes of money played, and shares of money obtained for the Treasury and the Concessionaire Companies

Source: ADM Data Extraction and Processing (Blue Book and More, 2008-2021)

The figure clearly shows the exponential increase in “gross” consumption. The increase doubles in volume over five years – between 2006 and 2011 – while tax revenues, as well as the revenues of the concessionaire companies, increase in a smaller proportion, with a linear trend. During the three-year period 2012-2014, the economic advantage for the gambling majors exceeds the tax advantage for the Italian State.

In the following seven years, however, a different phenomenon happens. With economic analysis, we interpret consumer behaviour. The recruitment of the population to gambling continues unstoppable: increased consumers commit increasing shares of their money and their social life to it.

However, both the State and the traditional gambling industry itself experience the beginning of the “losing phase^[5]“. In previous decades, they had obtained large margins of tax revenue and profit, but now the season of progressive reduction of revenue benefits begins and continues. This is evident from the following figures.

Figure n. 1 B – 2015 – 2021 Total volumes of played and shares obtained, distinguished between Treasury and the Concessionaire Companies

Source: ADM Data Extraction and Processing (Blue Book and More, 2008-2021)

The first information: to obtain the same marginal utilities – in absolute quantities – consumption must have an exponential growth: in fact, the percentage weight of the sum withheld by the State and of the sum obtained by commercial companies constantly decreases.

Let us look at the trend of the data corresponding to the red columns (tax revenues) and the green columns (revenues of commercial companies). Finally, the blue columns represent the flow of money, or the consumption of billions and billions of operations repeated each year: to bet money and to try to get back a multiple as a prize.

The chart describes how the trend in tax revenues and the trend in private commercial companies remain stable. Net revenues do not grow in proportion to the increase in money flow. It is the overwhelming confirmation that to obtain the same absolute quantities; one must counteract the “fall of marginal utilities” (according to the theory of the economist Leon Walras^[6] ). The relative prices of goods (in this of the “games”) are determined by the marginal utility consumers attribute to them, in a progressive fall for each unit purchased. The conspicuous confirmation is in the decreasing percentage that goes to remunerate (in this case) both the State and the private commercial company.

Figure n. 2 – Percentage breakdown of the played in “Prize Pool” – “Treasury receipts” – “Dealers’ margin”

Source: ADM Data Extraction and Processing (Blue Book and More, 2008-2021)

What is the impact of this obligatory operation? The exponential increase in gross consumption, the recruitment of the gambling population to gambling. The aim is to balance with the increase in absolute quantities (i.e., “gross consumption”) the constant and dramatic decrease in relative profit margins. For example: in the year 2000 in Italy, gambling bets had a monetary volume of eleven billion euros (at current prices); The Italian State obtained 38% of the amount of money from the bets. The private commercial companies (in charge of the distribution of the Lotto game and lotteries) received an income almost equal to that of a tax collector.

In the year 2021, the average state levy of taxes did not exceed 7.5 percentage points (of the approximately 111 billion money flow played). The trend – already noticeable over the last seven years – has now become irreversible.

State tax addiction from gambling vices

If the behaviour of the gambler is “psychologically conditioned,” public administrations also decide and act under strong conditioning. The taxes obtained from a trade that is related to damage to the health of the person cause a paradoxical consequence, as already happened with smoking. The State suffers a pathological dependence mirroring the pathological dependence of the consumer. A symmetric condition: is a tax addiction, which manifests itself in the compulsive search for new tax revenues: the compulsion to seek money to pay for the growing expenditure of the administrative systems^[7].

A similar fiscal device acts both in pathological gambling and in smoking. Is the tax revenue created by cigarettes EUR 14 billion per year? What if the financial burden of healthcare is greater than the revenues of taxes on the sale of tobacco^[8]?

Every year the health administration in Italy records ninety-three thousand deaths from tobacco smoke. The costs, direct and indirect, for treatment and related effects are much higher: over twenty-six billion euros^[9]! The State does not calculate the algebraic sum of the two items (revenues and costs); cash emergencies are constantly faced by entering in the budget the forecast of new revenues from additional taxation on tobacco. The demand for this “good” is, in fact, rigid, and the 11.5 million smokers will continue to consume what the smoking industry offers under the umbrella of the state monopoly^[10]. The increase in the price of smoking does not influence the propensity to inhale burnt tobacco (as well as in the hi-tech variant of tobacco heated by an electronic device for inhaling nicotine vapours^[11]).

For betting, slot machines and lotteries, the spiral of state induction to gamble therefore causes a new symmetry between bureaucratic decisions and gambler behaviour. The latter, when he loses money, seeks revenge and continues to bet increasing amounts. Immersed in the swamp of debts, the State also suffers a fiscal crisis: due to increasing expenses and insufficient revenues. Even the administration of the State suffers the chasing, the chase of losses: the State wants to “redo” (loss-chasing) to find the money necessary to cover the current expenditure of the administrative systems.

As happens to the gambler, the public administration (all bureaucratic and political decision-makers) refuses to adopt a systemic vision. Here, instead, is the paradigm of a rational decision: “if the production of goods and services increases, not only will there be more jobs, but more economic growth will be achieved. As a result, the flow of taxes will be greater.” In short, what will no longer result from the taxation of gambling will be balanced by taxes on other and consumer goods. Households will have more significant sums of money available for consumption; the State will get more taxes from the consumption of goods and services.

The public administration is a prisoner of dullness. And so does a cognitive shortcut, otherwise called heuristic: under pressure to stock up on money, bureaucracies seek taxes where it is easier to obtain it from citizens. Conclusion: The abnormal expansion of gambling consumption has become a further structural factor in both the deficit and the State’s debt. In the pursuit of losses (and in the escape from responsibilities), the government and parliament project each other into Pathological Gambling or in an endless spiral.

It is a spiral that is difficult to master when an industrial gaming system is sustained by the continuous expansion of the number of gambling participants. The “emancipatory” premise is restoring the ethical-political conditions of guaranteeing the rule of law.

With the same flow of sums entered and exited from the game, the resounding prevalence of consumption through online platforms confirms the total impossibility for the State to recover absolute quantities of “revenue” and to return to the values of the year preceding the covid-19 pandemic.

“Dual” pathology: in the person and the State

We insist on the paradox because the evidence continues to be denied. It can be dryly formulated as follows: the government promotion of gambling cannot achieve any significant “monetary” recovery, but on the other hand, it exacerbates gambling addiction in the population.

We thus note a “dual” pathological addiction: the first deriving from rampant gambling disorder within a conspicuous “habitual” population (in 2018, it was estimated at 5.1 million adults and 130 thousand minors); the second, on the side of the State, what we have just called with “tax addiction”.

The following table describes dual addiction. It is paradoxical and brutal: to obtain unchanged amounts of tax revenue and profit, the only leverage is that of the general volume of money flows played.

Figure 3 – Trend of games of chance. Comparison of forms on the physical territory and on online channels

Source: ADM data extraction and processing (Blue Book and more, 2008-2021). For the year 2021, Senate Commission of Inquiry into Legal Gaming Dysfunctions etc.

A “dual” pathology (or a dualism of pathology) links medical observation to the financial calculation of gambling. However, there is more. With the boom in online gambling, there is also a severe problem for national cyber security: an annual flow of sixty-seven billion euros of online transactions creates a risk for public safety and the integrity of computer networks.

The figure (fig.3) shows us how the breadth of consumers is expanding, and by a lot, with the transition to digital gambling. Let us look at the distribution of registered “gaming accounts” by age group. The youth age groups prevail because the extremely high frequency of the bets that follow one another allows the retention of the person to the gaming device. In the so-called “physical game” modes, the repetitiveness of the input and output gestures is also recorded there. However, the structure of the material system comes to cause the gambler’s budget to be exhausted in four, maximum five rounds of play.

Figure n. 4 – Distribution of the withheld shares of online gambling between the Treasury and the Concessionaires

Figure 4a – Percentage ratios between tax revenue and dealers’ margins in online gambling

Source: ADM Data Extraction and Processing (Blue Book and More, 2008-2021). For the year 2021, Senate Commission of Inquiry into Legal Gaming Dysfunctions etc.

Gambling practised in cyberspace tends to replace gambling practised “in physical space”. However, the consequence is that the proportions between tax revenues and profits of the gambling industry are different. When the state collects only one euro, the commercial gambling companies collect three euros. The state gets a quarter of the margin (i.e., the amounts lost by the people who bet); the private commercial companies get three-quarters of the money made from the players’ losses. The question is: what is the public interest? What is the advantage for the state?

The game played using the digital channel erases the physical limit of the hourly frequencies of gambling. The various modes of online gambling result in the total loss of the player’s budget with about twenty rounds of bets. In short: online gambling makes you bet money with a remarkably high frequency of game rounds. The fundamental structure of advanced technology gambling is this. This is a paradox which nevertheless affects the medical therapies for Gambling disorders.

The state and private commercial companies need to get more outcomes, but they collect less (relative) income. In short, while gambling consumption presents a tremendous increase, the relative advantage of the State and commercial companies decreases. For both parties, the balance (with the sum of “physical” gaming and online gaming) is decreasing.

Does online attract the lowest income population?

The exponential increase in the amount of money gambled also shows a paradoxical trait in the transition to online gambling. The Italian regions endowed with the most developed economy have a greater diffusion of services through the internet for many activities and needs. During the months of the covid-19 pandemic, digital tools have gained more users. Mass literacy has reduced the digital divide in the population. However, the northern and southern regions of Italy have not diminished the difference in their economic development. There is still a clear gap in computer literacy between the south and north of Italy. According to Istat, in the Lombardy Region, two out of three people use the internet with competence and continuity^[12].

On the contrary, in the Region of Calabria and the Region of Campania, the spread of digital services still excludes 50 % of the population. The numbers in Sicily are even smaller (43.3%). One could imagine that the spread of the internet among households would correspond to a lower prevalence of online betting. However, in web gambling, the opposite happens.

Observing the actual data, in the year 2020 in Campania, more than two and a half million online gaming accounts were active (two million and 526 thousand, to be exact).) In Lombardy, the active accounts were “only” one million and 556 thousand, that is, over 38 percent less than in the other region. Lombardy shows lower data than the Sicily Region (for 280 thousand accounts). In short, there are more online gaming accounts in Campania, Sicily, Calabria and Puglia than in Piedmont, Lombardy, Veneto and Emilia and Romagna. These latter regions of Italy have greater economic wealth since they have more manufacturing industries and more modern agriculture. If you compare the data with the size of the population, the suspicion arises that there is a delinquent influence.

In the most populous northern region, Lombardy, the inhabitants are twice as many as those of Campania. However, in the latter, for every hundred residents, there were 13.3 open accounts. Furthermore, in the other territories – such as Sicily (10 accounts per hundred inhabitants), Calabria (9.3) and Puglia (8.9) – it is confirmed that online gambling thrives much better in the south than in the north. The result of this simple analysis is that the first four regions in the ranking – precisely those of the south – were followed at a great distance by Lombardy, which has only 5.3 active accounts, always per one hundred residents. In short, a reverse dualism in the digital divide of gambling.

Table 2 – Diffusion of accounts for betting, casinos, and other digital modes

Source: Elaborazione di dati di ADM (Blue Book and more, 2008-2021).

Therefore, not only concerning the number of the resident population (one in six Italian citizens lives in Lombardy), but the gambling accounts also active in Lombardy are fewer than that of Campania, despite its population being equal to half that of Lombardy. In online gaming, the “poor” South is much more projected into online gambling than the “advanced” and industrialized North.

Let us move directly to the subject of clinical care. The question concerns the social impact and consequences on the individual person’s health. The Italian State has recognized that gambling is related to pathologies in health. This was decreed in 2012, with a law concerning the National Health Service. In 2017, the Government also issued a decree of the Essential Levels of Health Care (LEA). Since 2017, the Italian State has been organizing the therapy service. In turn, the Regions’ governments have decided to implement regional health plans. However, the Ministry of Health does not yet collect epidemiological data and does not include them in the National Information System of Addictions (SIND). The Court of Auditors (the judiciary that oversees the use of the state budget) has criticized the failure to include these data in the SIND.

The survey of the Istituto Superiore di Sanità

However, the Higher Institute of Health conducted epidemiological research in 2018. The research results show that about eighteen and a half million adults and about 700,000 minors have gambled at least once in a year. Within a population of eighteen and a half million adults and 700 thousand minors, there are 5.1 million individuals who play habitually (data referring to the year 2018). Finally, within the subset of habitual gamblers, there are about one and a half million “problem gamblers”.

Digging into the information mine of the ISS survey, we discovered how consumption is distributed by concentrating precisely on a cluster of population. Well, eighty per one hundred of gross consumption (in 2018, it was around 100 billion euros) is attributable to the subset of habitual players, and among them to the further subset of “problem” players. We specify that in Italian, the term “problematic” refers to a dimension of theory, to a logical problem. English means not a question, but a structural and important knot, connected to a difficulty or a social danger.

With the selection of the subset of the habitual and therefore of the “problematic”, we obtain the qualitative-quantitative image of social behaviour within which the pathology is born. Consequently, the cut-off can be established: the threshold separating the “playful” game and the “pathological” game. The combination of the amount of money spent and the amount of social lifetime spent indicates the appropriate measure: from the population of 32% of habitual gamblers, we find a population of 29.4% of extreme habitual-pathological gamblers.

The ISS Report reports these data: out of a resident population of over-eighteen (fifty million and 680 thousand people, according to ISTAT 2016), there are five million “habitual” (divided into “problematic”, “moderate risk”, “low risk”). Therefore, just under a third of the habitual are problematic: 1 million and 526 thousand people, to which to add about 150 thousand student minors (between eighty thousand “at risk” and sixty-nine thousand “problematic”), among the 670 thousand detected by a spin-off of the Institute’s survey^[13].

Table n. 3 – Evidence from ISS Research

(Survey conducted in 2018)

In the year examined (2018), the volume of money played online, and the number of “remote” players were less than half of those of 2021 (see above, Figure 3.).

We arrive at a paradigm on how users are formed for the services of taking charge of people who have a gambling disorder (or, in any case, from problem gambling). All addiction workers know that the threshold for access to therapeutic services that treat the person’s suffering is often exceedingly high, a threshold that people have difficulty overcoming. In practice, the person who suffers from a gambling addiction (or for other addictions) should take the following steps: a) recognize that he has his own pathology; b) be informed about the procedures to avoid the stigma of this pathology that is attributed to him; c) take the steps to access a care system. The therapeutic program should therefore be “personalized;” concern both him and his family group; continue for a long time.

It is, therefore, necessary to offer a comprehensive and diversified range of therapies; therapies must be placed near the person; the times of access to the places of therapy must be fixed. Care services and ways of accessing care incentivize or discourage people from seeking help for their illness.

However, there is a vast potential for needing management, which we can calculate even with the “theorem of definite proportions”. If in a given “compound” where two or more elements react to form it, their subsets are always combined according to defined and constant mass proportions: in the “compound” gambling, we find three elements: a) the totality of the population that in the course of a year reports at least one contact with one or more of the “games”; b) the population habit in complex “at risk” (low, moderate, high); (c) the population exposed to high risk or the population of problem gamblers ).

Therefore, it is necessary to intercept the population of problem gamblers (a subset of “habitual” players), so that the “need” for care is transformed into a “demand” for health and is taken over by the services. All this requires active promotion by the National Health Service. But this is currently starting very slowly.

These are the reasons why gambling-related pathological addiction therapy professionals must also address, albeit indirectly, institutional, and legal issues.

References

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Bobbio, L, (1996), La democrazia non abita a Gordio: studio sui processi decisionali politico-amministrativi, Milano, Ed. Franco Angeli

Custer, Robert L. – Milt, H, (1985), When Luck Runs Out: Help for Compulsive Gamblers and Their Families, in Facts on File; 1st edition

Fiasco, M, (2015), Azzardo virtuale e vita quotidiana. Anatomia d’una impostura, in Giochi di Stato, a cura di Coccia B., Edizioni Apes

Fiasco, M, (2019), La complessa sociologia del gioco d’azzardo contemporaneo, in Corti Supreme e Salute, n. 3 del 2019

Grinols, EL, – Mustard, DB, (2001), Business profitability vs. social profitability: Evaluating the social contribution of Industries with externalities and the case of the casino industry, in Managerial and Decision Economics, n. 22

ISTAT, (2019, Report Cittadini e Ict, anno 2019

Istituto Superiore di Sanità, (2019), Il Gioco d’azzardo in Italia, Ricerca realizzata nell’ambito dell’Accordo di Collaborazione tra Agenzia delle Dogane e Monopoli (ADM) e Istituto Superiore di Sanità (ISS) Anni 2016-2019.

Lesieur, H, – Custer, RL, (1984), Pathological Gambling: Roots, Phases, and Treatment, in The Annals of the American Academy of Political and Social Science 474(1):146-156, July

Motterlini, M, (2011), “Neuroeconomia” e “Teoria del prospetto” in Enciclopedia dell’economia Garzanti, Milano, Garzanti

Sukhwinder Singh Sohal, Mathew Suji Eapen, Vegi G.M. Naidu, Pawan Sharma, (2018), IQOS exposure impairs human airway cell homeostasis: direct comparison with traditional cigarette and e-cigarette, Published Online by European Respiratory Society, ISSN 2312-0541, 2019 5: 00159-2018.

Walras, Marie-Esprit-Léon, (1874), Éléments d’économie politique pure, ou théorie de la richesse sociale, 1874, trad. it. Elementi di economia politica pura, Torino, UTET 2013

1. Con the so-called Balduzzi decree (DL 13 September 2012, n. 158). ↑
2. “Alea”, in ancient Rome, was the dice of gambling, synonymous with chance, luck, the random prize. ↑
3. The Group operates in Italy in games through Lottomatica, in publishing through De Agostini Editore and in finance through Dea Capital. It informs a press release of July 2019, that shareholders have approved a Consolidated one-to-another Financial Statements with net revenues of almost 4.5 billion euros (4,497 million) with a gross margin of 34 percent (1 billion and 546 million). The positive delta came from gambling for 1 billion and 482 million, therefore for 95.9 percent. On the other hand, the profitability of the original, traditional publishing activities fell: only 1.6 percent, equal to 25 million out of 333 million in turnover. From gambling to finance, which was Under Management for “almost 12 billion”, including the volumes of intervention on so-called non-performing loans – NPLs. An interesting passage of the widespread note: in Italy “the company has positioned itself at its best to continue on the path of growth of this business sector “; but abroad the gambling business is not like this: “both of North America and of the International; the results are still partly below expectations”. In short it is confirmed that Italy – now in the twelfth year of general economic stagnation – is the territory of a continuous expansion of the alea affair. ↑
4. Play predictions on the results of the matches of a day of the championship of the football game. ↑
5. We use a bold analogy with the third phase – precisely the “losing phase” – career of the player, well described by Robert L. Custer (Midland, Pennsylvania, 1927 – 1990) American psychiatrist, pioneer in the study and treatment of the game of gambling addiction. ↑
6. Marie-Esprit-Léon Walras (Évreux 1834 – Clarens, Lausanne, 1910) is cited here for having identified as relative prices (of a good, of a service) are determined by the marginal utility that consumers attribute to goods. In the case of industrial gambling, to correct the constant disaffection to pay an invariant price to a chance – which is configured excessively remote – to get a prize (from a lottery, from a bet, from a coin inserted in the slot machine etc.) the “bank” reduces more and more the profit margin to split, increasing it progressively, as much as possible the prize pool ↑
7. Between the identification of a problem (i.e. the “birth certificate” of a matter sanctioned by an agenda) and the arrival of results, a cognitive and deliberative process takes place according to a succession of prospects and frameworks that condition the choices. However, if you put the lens towards the “actual conditions” of decision-making, you can be baffled by the succession, very often, of erroneous simplifications, of crude shortcuts (even verbal) that characterize the way of interacting of the personal holder of public power.Writes Luigi Bobbio, in Democracy does not live in Gordio: study on political-administrative decision-making processes (Milan, Ed. Franco Angeli, 1996) that when deliberating one looks at “a linear and rational model of decision that does not adapt to the complexity of the institutions and the problems they are called to face” (p.8). In this dress we see, for our part, one of the matrices of persistent obtuseness, or of the “operant conditioning” that under the pressure of the urgency of financial revenues pushes to “terrible simplifications” in matter of tobacco, alcohol and gambling. “Obtuseness” to be understood as a synonym for “Tax Addiction”. ↑
8. Between VAT (3.4 billion) and excise duties (10.6) the State collects fourteen billion euros from the consumption of tobacco (all the various products) (final balance for the year 2020, from the “Blue Book” of the ADM, October 2021) ↑
9. From the institutional website of the ministry: “In Italy it is estimated that over 93,000 deaths are attributable to tobacco smoke (20.6% of the totaof all deaths among men and 7.9% of all deaths among women) with direct and indirect costs of over EUR 26 billion (Tobacco Atlas sixth edition). As far as cancers are concerned, tobacco is the risk factor with the greatest impact to which at least 43,000 deaths per year are attributable” (last update 31 May 2021). ↑
10. In 2015, according to ISTAT data, smokers, among the population aged 14 and over, are just under 10 million.The prevalence is 18.4%. There are strong gender differences: among men smokers are 22% and among women 15.1%. Tobacco smoke was more prevalent in the 25-34 age group (24.2%). ↑
11. It should be noted carefully how this mode is presented, both to induce people to make it their own without health alarm and to obtain the “boiling” of the state authorities on the non-responsibility of the industry, if health data were still detected. On the eve of the opening of the industrial plant in Italy, in Crespellano (Bologna), the president of Philip Morris, Calantzopoulos, magnifies the tobacco sticks to be heated as products with “potential mitigated risk”. Nor is the risk admitted, but only the possibility of a “potential” risk. Cunning subtlety to evade the contestation of a civil liability for the diseases procured by the new business. Nevertheless the lithote (neither risk nor danger, but only a “potential risk”: “attenuated”) has failed to absolve the “heated and unburned” tobacco by the European Respiratory Society, a prestigious research institute on lung cancer with offices in Lausanne, Brussels and Sheffield. The dangers would be there, and many. Cf. Sukhwinder Singh Sohal, Mathew Suji Eapen Car Hire, Vegi (Italy) G.M. Naidu, Pawan Sharma, IQOS exposure impairs human Airway Cell homeostasis: direct comparison with traditional Cigarette and e-Cigarette, Published Online by European Respiratory Society, ISSN 2312-0541, 2019 5:00159-2018. ↑
12. ISTAT, Citizens Report and Ict, year 2019: “… there are strong differences between the Centre-North and the South (70.6% against 62.5%). Puglia and Calabria are the regions with the lowest share of Internet users (59.7% and 60.1% respectively) …Compared to 2018, there were appreciable increases for Sicily (+6.6 percentage points) and Campania (+3.5 percentage points)”. ↑
13. Istituto Superiore di Sanità, Gambling in Italy, Research carried out under the Collaboration Agreement between the Customs and Monopolies Agency (ADM) and the Istituto Superiore di Sanità (ISS) Years 2016-2019. ↑