Deconstructing the Modern Slot Machine: Psychological
Ingredients and Personal Vulnerabilities
Dr Luke Clark
New Horizons in Responsible Gambling
22 February 2017

Disclosure Statement
The Centre for Gambling Research at UBC is
supported by the British Columbia Lottery
Corporation (a Crown Corporation) and the Province
of BC government.
Honoraria: Svenska Spel (Sweden), Victorian
Responsible Gambling Foundation (Australia),
National Center for Responsible Gaming (US)
Consultancy: Cambridge Cognition Ltd (UK)

Objectives
• Psychiatry and neuroscience has focussed on personal vulnerability
factors to gambling addiction, neglecting the role of the gambling
product.
• Modern slot machines are among the most harmful gambling
products. These games contain many psychological ingredients that
may underlie their addictiveness.
– Near Misses
– Immersion (as a net result)
– Cash vs credit-based payment
• RG initiatives should respond to, and consider regulating, specific
features.

Who Develops Gambling Problems?
• “Medical Model” (psychiatry &
neuroscience) places Gambling
Disorder alongside the substance
addictions
• “Addiction is a brain disease” (Leshner,
1997 Science)
• Uneven playing field in who develops
addictions

Impulsivity: the Addictive Personality
0
5
10
15
20
25
30
35
40
Neg
Urgency
Pos
Urgency
Lack of
Premed
Lack of
Persev
Sens
Seeking
UPPS-PSubscaleScore
PG Controls
UPPS-P Scale Effect
Size (d)
Negative Urgency 1.8
Positive Urgency 1.5
Lack of Premeditation 0.8
Lack of Perseverance 0.6
Sensation Seeking 0.2
“mood-related
impulsivity”
“narrow”
impulsivity
** **
Michalczuk et al (2011)
*
*

Early Predictors

0
1
2
3
4
D2 in Overall Striatum
Controls Gamblers Clark et al (2012 NeuroImage)
Con Gam
1.5
2
2.5
3
10 20 30 40 50
BPNDLimbicStriatum
Negative Urgency
GD
Controls
11C-raclopride PET of dopamine transmission
in Gambling Disorder

Individual Vulnerabilities
0.6
0.7
0.8
0.9
1
9 8 7 6
ProportionMajority
Choice
Majority Colour
PG
Controls
Neuropsychological Markers
1.5
2
2.5
3
30 35 40 45
D2BPinOverall
Striatum
Negative Urgency
Neurochemistry (PET)
Personality Traits
0
10
20
30
40
Neg
Urgency
Pos
Urgency
Lack of
Premed
Lack of
Persev
Sens
Seeking
UPPS-PSubscaleScore
PG Controls
Brain Responses (fMRI)

A Public Health Approach to
Gambling Harm
GAMBLERGAME
GAMBLING
ENVIRONMENT
Impulsivity
Dopamine
Brain structure
Near-misses
Speed of play
Jackpot size
Korn & Shaffer 1999
Murch & Clark 2015
Venue size
Age restrictions
Opening hours

Revenues & problems by different forms
Maclaren 2015: revenue
from different forms,
across all provinces
• BC: Most popular forms of gambling: lottery (44%), charity raffle
(16%), casino (11%), private games (11%), sports betting (3%)
• Forms most associated with PG: casino (42%), private games
(39%), stocks & shares (27%), bingo (14%), internet gambling
(13%)
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
0
100
200
300
400
500
600
Fiscal year
RevenueperCanadianadult
(CAD)
VLTs
Slots
Lottery
Horse
All other

Treatment Services
• In treatment services, the most common preferred /
problematic form of gambling are slot machines (25 of 51
in our Vancouver study; Dawn Kennedy’s poster)
• (in UK, 40-50% at London clinic have electronic Roulette as
preferred form)
• More rapid progression from initial use to problematic
gambling (Breen & Zimmerman 2002)

Early Slot Machines
1895 Charles Fey invents
the ‘Liberty Bell’
1938 Bally’s
‘Double Bell’
1973 Bally’s
‘Circus’

The Modern EGM
Ice Impress (WMS Games)

Game Features
Speed / Continuity
Pay-out features: Jackpot Size, Max
Bet, Return to Player
Mode of Payment (bill acceptors)
Sensory Feedback / ‘Losses Disguised
as Wins’
Illusory Control (e.g. stopper buttons)
Near-Misses

Slot Machine
Simulations
Pick a shape
Choice
No win
Full-miss outcome
Anticipation
Win outcome
Win 5€
No win
Near-miss outcome
Rating
Win 5€
How much do you want to
continue gambling?

Problem Gamblers show increased
brain responses to near-misses
CONTROLS GAMBLERS
GAMBLERS > CONTROLS
fMRI:
near-miss >
full-miss
Sulpiride
Percentsignalchange
Near-miss
Full-miss
T
6.7
11
CONTROLS
Sescousse
et al, 2016
GAMBLERS

The UBC ‘Casino Lab’
0
1000
2000
3000
4000
5000
6000
5 10 15 20 25 30
Credits
Minutes
Slot-Tracker algorithm

Lost in the Game
• During play, some gamblers enter a ‘trance-
like’ state (immersion, flow, dissociation)
• This state may provide a means of escape from
stress, low mood, boredom
• Particularly common during slot machine
gambling; slot machine design has served to
“smooth the play experience”
Spencer Murch

Measuring Immersion
3X 0
5
10
15
20
0 3 6 9 12 15 18 21 24 27
DQScore
Problem Gambling Symptoms
Dissociation
0
3
6
9
12
15
0 3 6 9 12 15 18 21 24 27
Targets
Problem Gambling Symptoms
Targets Detected
Murch et al, 2017

Shattering the Zone: RG Implications
3X
$17.50
GS-$2.50
3X
GS
$17.50

Sensory Feedback in the Rat Casino
https://www.youtube.com/watch?v=0Mw50JsaESY
stimulus
lights on
nosepoke in lit
hole
5s time out
(p = 0.1)
P1: 1 pellet
(p = 0.9)
P4: 4 pellets
(p = 0.4)
P2: 2 pellets
(p = 0.8)
P3: 3 pellets
(p = 0.5)
40s time out
(p = 0.6)
10s time out
(p = 0.2)
30s time
out (p = 0.5)
Trial
rewarded
Trial
punished
OR
Cued rGT:
Uncued rGT:
Profitability 295 99 411 135
Barrus & Winstanley (2016)

The Plastic Trap
• In a ‘cashless’ society, should
we be able to play slot machines
using credit cards / app-based
payment?
• In consumer psychology, people
make more risky & excessive
purchases when paying on credit
(the ‘pain of paying’ hypothesis)
• Current practices are a hybrid:
cash in, ticket out
Chua et al, New Horizons poster

Cash vs Credit
0
50
100
150
PERSISTENCE (MEAN # TRIALS)
0
100
200
300
400
500
BETTING (MEAN PER MINUTE)
CASH CREDIT CASH CREDIT
Chua et al, New Horizons poster

Conclusions
 Clinical emphasis on vulnerability to gambling addiction should not
trivialize the impact of the gambling product.
 Slot machines are psychologically complex games with many
ingredients. Are the ingredients that make a game fun the same
ingredients that make it addictive?
 From an RG perspective, initiatives to encourage limit setting are
important, but by themselves may be insufficient.
 The next phase of research will describe how specific game
features interact with personal vulnerability to shape gambling
harms.

CGR People
Dr Luke Clark
Director
Dawn Kennedy
Research
Assistant
Spencer Murch
Dr Tilman
Lesch
Dr Eve Limbrick-
Oldfield
Graduate Students
Mario Ferrari Ke ZhangGabriel Brooks
Post-Doc Fellows
Cindy Chang Candy Chua
Undergrad RAs
Keni Ng

Email luke.clark@psych.ubc.ca
Web www.cgr.psych.ubc.ca
Twitter @LukeClark01 @CGR_UBC

The Modern EGM
27

Limbrick-Oldfield et al 2017: brain areas hyper-reactive to gambling cues and
correlated with cravings in problem gamblers
2.3 4.5
Z = -4 X = -2

-12
-10
-8
-6
-4
-2
0
2
4
6
Carfentanil Displacement by Amphetamine
(Opioid Release)
PG Con
* * * **
Carfentanil PET imaging of mu-opioid receptors
and opioid release in Gambling Disorder
Oral amphetamine (0.5 mg/kg)
releases endogenous opioids,
displacing ligand from receptors
(lower BP)
Opioid release blunted in PGs (no
diff in baseline receptors)
BASELINE POST-AMPH
Mick et al (2016 Neuropsychopharm)

Genes or Environment?
31
Slutske et al 2000: 6744 Vietnam era twins.
Rate of lifetime Path. Gambling: 1.4%, subclinical: 6.2%
Rate of lifetime Alcohol Dependence: 35%
PG genetics: 40-50% (from MZ-DZ disparity)
Overlap between PG genes and AD genes: 12-20%

PlayNow.com: Game category breakdown