Aim: Control policies in the fields of alcohol and gambling show similarities across Nordic countries. The so-called Nordic model has consisted of strong state intervention and, in many cases, monopolistic provision. However, internal and external pressures pose challenges to the model. This article provides a comparative review of current policies on alcohol and gambling in the Nordic region. Methods: We analyse framings, implementation and outcomes of current alcohol and gambling policies in Denmark, Finland, Iceland, Norway and Sweden. We produce a review of legal documents and grey literature. We also analyse on-going and recent policy changes (2021–2024). Our focus is on policies related to World Health Organisation's evidence-based “best buys”: physical availability, taxation and marketing. While these best buys are designed for alcohol, we also apply these to gambling. Results: Control policies in the region take place on a spectrum from more restrictive to more market-oriented. Overall, alcohol policy is more restrictive than gambling policy. In comparison with gambling policy, alcohol policy was characterised by a stricter public health framing and consistent implementation based on the best buys. In terms of policy outcomes, more stringent alcohol regulations translated, to some extent, to lower consumption and prevalence, but not systematically. Recent policy developments suggest that alcohol policy may be heading towards increased de-regulation, whereas gambling policies are becoming stricter. Conclusions: The Nordic model continues to be visible particularly in alcohol control. However, the model is challenged by politics. To persist, the Nordic model needs political will and increased cross-country and cross-sectoral collaboration.

Policy coherence and integration have emerged as central concepts in policy scholarship in order to understand policy implementation. However, the majority of existing literature have applied these concepts into a multi-level context where addressing coherence is given: such as how member states translate doctrines of policy integration from the United Nations (UN) or European Union (EU) at the domestic level. This article extends these concepts by applying their relevance to a domestically oriented policy matter with cross-cutting elements that could impose policy integration, that of gambling policy. Relying on a qualitative deductive content analysis of gambling policy strategies, the article compares policy integration approaches in the Nordic countries of Denmark, Finland, Norway, and Sweden. The results exhibit two contrasting approaches to policy coherence. Finland explicitly approaches gambling policy from a coherence perspective and Sweden focus on coordination across sectors. Denmark and Norway rather adopt a sectoral approach in addressing gambling policy objectives. The findings underscores that the concepts are relevant in order to dissect cross-national policy differences in policy implementation and do not need to be connected to multi-level doctrines of addressing policy coherence.

Awareness and utilization of health interventions can be influenced by sociodemographic factors. These factors play a role in information processing, particularly regarding health messaging. The aim of this study is to analyze how different sociodemographic factors and gambling behaviors are associated with awareness of a (Swedish) gambling self-exclusion register. The study used data from the Swedish longitudinal gambling study (Swelogs) and analyzed n = 6720 participants from a stratified random sample of the Swedish population aged 18–84 years. Logistic regressions were conducted to analyze associations between sociodemographic characteristics, gambling behavior and awareness. Males with middle (OR = 1.70, 95% CI = 1.32–2.19) and high income (OR = 1.58, 95% CI = 1.19–2.09) and females with high (OR = 1.35, 95% CI = 1.03–1.76) and middle-level education (OR = 1.35, CI = 1.04–1.76), had higher awareness of Spelpaus.se. Online gamblers with problematic gambling behavior were three times (OR = 3.69, 95% CI = 2.15–6.37) more likely to be aware than non-gamblers. Online gamblers born in Sweden were twice (OR = 1.95, 95% CI = 1.19–3.19) as likely to be aware compared to those born outside of Europe. Males with high level of awareness had higher PGSI scores compared to women. Education could increase awareness of potential health risks and opportunities for intervention, particularly among women. Future interventions should be tailored to cater to the specific needs of individuals with lower levels of awareness, to facilitate enhancing their awareness and ultimately promoting a more equitable utilization of self-exclusion measures.

To strengthen the right to support for people with gambling problems in Sweden, legislative changes were enacted in 2018. This study aims to critically examine how problems and solutions are represented in 69 appeals concerning gambling treatment within the general administrative court (2014–2022) and to assess how these representations have evolved following the legal amendments. The study employs Bacchi’s WPR approach to scrutinize court judgments. The results reveal that gambling problems are unequivocally recognized as severe issues requiring intervention, with both explicit and implicit notions of the problem rooted in the concept of loss of control. Prior to the legal amendments, rulings primarily focused on identifying the responsible actor for providing care, often framed within a medical discourse. Post-amendment, the focus shifted to how treatment needs should be met, emphasizing an evidence-based discourse. These varying representations produce discursive, subjectifying, and material consequences, significantly affecting access to different welfare interventions. The new legislation has solidified the responsibility of social services to provide treatment for gambling problems. However, as the study demonstrates, responsibilization of gamblers occurs not only in policy and treatment frameworks, but also within the court system.

On January 1st, 2019, a license-based system allowing online commercial companies to operate and advertise in the Swedish market was introduced. According to the Gambling Act, advertising should be ‘moderate’. Legislative changes are windows of opportunities where stakeholder interpretation and adaption may result in new agenda-setting based on conflicting interests. This article examines how stakeholder groups initially perceived and interpreted this key concept of moderation. Data from semi-structured interviews, seminars and press conferences, as well as policy documents and statements, were analyzed using a framework method approach. Contrary to what is stated in the legislation, stakeholders defined ‘moderation’ in terms of both content and volume. Although industry and media representatives requested further guidance for interpreting ‘moderation’, they favored self-regulation and allowing market consolidation. There was a notable ambivalence within and between stakeholder groups concerning balancing freedom of expression, market protection, consumer protection and public health. In conclusion, legislation is a blunt steering instrument when key concepts are largely left to stakeholders, with opposing interests, to interpret. Our study shows the incremental and interactive character of policy-making, where new legislation resulted in new policy responses. Case law and market consolidation take time and regulatory interventions need to take this into account. 

Aims: Voluntary self-exclusion (VSE) programmes are intended to minimise gambling-related harm. They are considered effective for the individual but several weaknesses have been reported that deter individuals from enrolment. The present paper summarises opinions about and experiences with VSE strategies and assesses gaps and needs with regard to the current self-exclusion regulations and programmes in seven jurisdictions. Methods: A total of 102 representatives from various sectors (research community; addiction help and care services; prevention; regulatory bodies; gambling providers) in Finland, Germany, Italy, Massachusetts (USA), Norway, Sweden, and Victoria (Australia) were surveyed about their experiences with and opinions about VSE strategies, as well as gaps and needs of the current VSE regulations in their jurisdiction. Results: The respondents agreed on the need for and importance of VSE programmes. However, in all participating jurisdictions, VSE regulations at the time of the survey were considered insufficient, and the respondents suggested potential improvements to facilitate the exclusion process, increase utilisation and reduce gamblers’ breaching VSE. Representatives of the gambling industry also emphasised the individual's responsibility. Conclusions: Individuals with gambling disorder require effective VSE programmes to cope with their addictive behaviour. To effectively reduce breaches, technical and legal solutions are necessary. This includes access controls based on complete nationwide registries, strict enforcement and preventing excluded gamblers from accessing unlicensed online operators.

Background Given low utilization by individuals experiencing gambling problems the potential of self-exclusion (SE) might be not fully exploited in Germany. This paper aims to gain insight into different actors’ perceptions and reflections on the problems and difficulties in the process of self-exclusion to delineate which specific attitudes hamper a successful implementation of SE.

Methods 13 individual and four group interviews with individuals experiencing gambling problems and governmental or commercial gambling providers were examined. A Grounded Theory Approach was used to portray the opinions of these different actors on existing regulations of SE and to delineate potentially diverging interests between the distinct groups.

Results The interviewees agreed on the usefulness of SE and consented that it is important to early recognize individuals experiencing gambling problems. They also considered the present practice insufficient but for different reasons. Individuals experiencing gambling problems and providers particularly disagreed on addressing individuals experiencing gambling problems. While individuals experiencing gambling problems stated that they had hardly ever been approached, providers argued that help offers were mostly rejected. Especially commercial providers also regarded insufficient German language skills and rapid fluctuation of guests as strong barriers to approaching individuals experiencing gambling problems. Interviewees from governmental venues furthermore suspected that commercial providers took addressing individuals experiencing gambling problems less seriously.

Conclusion Our results emphasize the dilemma of conflicting interests in both individuals experiencing gambling problems and providers. Rather than acting against the economic interests of employers, venue staff blame individuals experiencing gambling problems for lack of problem recognition. Conversely, individuals experiencing gambling problems blame the providers for not offering help. To address individuals experiencing gambling problems appropriate staff training is required, and SE regulations need to be controlled by an independent body rather than by the providers themselves.

This study explored the characteristics and consequences of criminogenic problem gambling in Sweden. All verdicts (N = 283,884) delivered by Swedish general courts between 2014 and 2018 were subjected to a key word search for the term ‘problem gambling’ and its synonyms. Verdicts that met the search criterion (n = 1,232) were inspected manually and cases in which problem gambling clearly was the main cause for committing crime (n = 282) were analyzed quantitatively. The most common types of crimes were fraud and embezzlement (67%). Each year around 400 individuals, companies, and organizations became victims of gambling-driven crimes, with nonprofit organizations being the most severely affected. Those convicted for such crimes were older, and to a greater extent female and first-time offenders, compared to national statistics on crimes in general. This suggests that in Sweden, middle-aged women are a high-risk group for severe gambling problems that should be monitored particularly closely by gambling companies for indications of problematic gambling. We conclude that although crimes driven by problem gambling are relatively rare in the justice system, they bring considerable harm to victims and the perpetrators themselves.

While there is evidence for self-exclusion (SE) as an individual-level harm reduction intervention, its effects on reducing harm from gambling at the population level remain unclear. Based on a review of national legal frameworks and SE programs, including their utilization and enforcement in selected high-income societies, the present analysis aims to explore the reach and strengths of SE in the protection of gamblers in these jurisdictions. It places particular emphasis on SE programs' potential to prevent and minimize gambling harm at the population level. The overview examined SE in Finland, Germany, Italy, Massachusetts (USA), Norway, Sweden, and Victoria (Australia). These jurisdictions differ considerably in how gambling is regulated as well as in how SE is implemented and enforced. The reach and extent of enforcement of SE apparently vary with the polity's general policy balance between reducing gambling problems and increasing gambling revenue. But in any case, though SE may benefit individual gamblers and those around them, it does not appear to be capable of significantly reducing gambling harm at the population level. To render SE programs an effective measure that prevents gamblers and those linked to them from financial, social, and psychological harm, utilization needs to be substantially increased by reforming legal regulations and exclusion conditions.

The gambling market is a complex field of conflicting stakeholders and interests involving dimensions, such as economy, health, social inequality and morals. The division of responsibility between gamblers, the gambling industry and the regulating state for limiting the harmful effects of this activity, however, are unclear. The aim of this study was to explore how gamblers in the Swedish market attribute responsibility to various actors within the gambling field. Qualitative interviews were conducted with 37 gamblers experiencing extensive gambling problems. Based on a discourse analytical approach, five ideological dilemmas were identified, highlighting the tension between the, often contradictory, values that the participants need to relate to. On the individual level, the gamblers emphasize their own responsibility for their problem, thereby showing accountability in relation to themselves, their significant others and their peers as agents in recovery. On the corporate- and state levels however, the participants argue for a stronger public health approach, where the gambling companies should take further responsibility by living up to the legal regulations and where the state should ensure compliance and safeguard funding for treatment and research. The essential paradox between the individual responsibility discourse of self-regulation and the prevailing medical discourse of the gambler's incapacity for self-control signifies an impossible equation that imposes feelings of guilt and shame upon an individual who is concurrently considered as both responsible and incapable. In order to reduce harm, the gambling industry must be more proactive with coercive external control measures to fulfill the duty of care they claim to adhere to, and the regulating state must ensure its compliance.