STUDY AIMS: This study sought to enhance understanding of: (1) Why and how people transition between gambling risk levels, (2) The inter-related behaviours for why people increase or decrease their gambling participation over time, (3) How transitions to lower gambling risk levels relate to recovery, (4) What assistance, if any, is received for gambling behaviours, (5) Harms experienced from gambling and what might exacerbate the harms, (6) Culturally associated traditions or behaviours that might intensify gambling behaviours or harms or protect against them, and (7) Strategies that are used to reduce gambling behaviour.

METHOD: Fifty participants recruited from National Gambling Study participants took part in indepth qualitative interviews. For analysis, participants were classified according to their overall gambling risk pattern: Stable high-risk, Transition into high-risk, Transition out of high-risk, Relapse and Stable low-risk. A qualitative thematic analysis of interview data was conducted.

RESULTS: (1) The reasons why and how participants transitioned between risk levels were complex; factors related to risk changes (increases and decreases) included winning money and financial perspectives, discovering online gambling, social influences and support, the availability of gambling opportunities, the experience of gambling related-harms, and life events and circumstances. Factors related to a relapse included a faded memory of gambling harms and not dealing with gambling urges; while avoiding gambling, lack of interest, loss-expectation, and not relying on the outcome of a bet contributed to maintaining a no-risk/low-risk status. (2) Inter-related behaviours were cognitions or emotions including co-existing mental health, wellbeing or addiction disorders, cognitive distortions and gambling supportive attitudes, boredom, and motivations to gamble and the investment or reliance on the outcome. (3) Transitioning to a lower risk level did not always result in recovery. Recovery from harmful gambling was an ongoing process involving multiple personal, contextual and temporal factors that enabled a person to gain, or regain, control over their gambling behaviour. (4) Professional services used by participants were found to be supportive and informative, contributing to recovery, although use of professional services was low. Many participants received nonprofessional or social support, which both preceded a reduction in gambling and supported recovery maintenance. Some participants self-excluded from venues. Help-seeking barriers included personal (e.g. shame), systemic (e.g. lack of awareness about services), and cultural (e.g. perceived language barrier) factors. (5) Gambling-related harms affected participants, family, whānau, friends and colleagues and included financial strain, mental health and wellbeing issues, physical health problems, poor work/study performance, and negative effects on others. Stable low-risk group participants did not experience gambling-related harms as a result of their gambling behaviour. (6) All participants were asked about their cultural background and possible influences on their gambling. Most migrant participants came from countries where gambling was illegal, heavily regulated or strongly opposed. Financial pressures, the value placed on money, and the prevalence of gambling whilst growing up were cultural factors that intensified, or protected against, gambling behaviours/ harms. No Māori participants discussed cultural factors. (7) Most participants had at some time attempted to control or reduce their gambling. The effectiveness of gambling management strategies was dependent on self-control and included monetary methods (e.g. limit setting), awareness of gambling behaviour and keeping busy, social support, and selfexclusion.

CONCLUSION: The nuances and experiences of gambling risk level transitions or stability, helpseeking behaviour and recovery were characterised with interaction, complexity and cyclical behaviour. Gambling behaviour was often context dependent with individual motivations based on personality, social, cultural and environmental factors. Factors that supported a reduction in gambling in one participant could facilitate an increase in another. Thus, it is not simply one factor or motivator that influenced gambling behaviour or supported recovery, rather it was the interaction of multiple personal, social and environmental factors. The influence of an individual’s context on increased or decreased gambling behaviour is important for understanding long-term gambling behaviour and recovery.