The total consumption model applied to gambling: Empirical validity and implications for gambling policy

The total consumption model (TCM) originates from studies of the distribution of alcohol consumption and posits that there is a strong association between the total consumption and the prevalence of excessive/harmful consumption in a population. The policy implication of the TCM is that policy measures which effectively lead to a reduction of the total consumption, will most likely also reduce the extent of harmful consumption and related harms. Problem gambling constitutes a public health issue and more insight into problem gambling at the societal level and a better understanding of how public policies may impact on the harm level, are strongly needed. The aim of this study was to review the literature pertaining to empirical validity of the TCM with regard to gambling behaviour and problem gambling and, on the basis of the literature review, to discuss the policy implications of the TCM. The study is based on a literature mapping through systematic searches in literature databases, and forward and backward reference searches. The literature searches identified a total of 12 empirical studies that examined the total consumption model or provided relevant data. All but one of these studies found empirical support for the TCM; that is, a positive association between population gambling mean and prevalence of excessive or problem gambling. Such associations were found both with cross-sectional data and with longitudinal data. There is a small but fairly consistent literature lending empirical support to the total consumption model. An important policy implication is that interventions which are successful in reducing overall gambling are likely also to reduce problem gambling incidence