Abstract
The burden of harm from problem gambling weighs heavily on those experiencing poverty and homelessness, yet most problem gambling prevention and treatment services are not designed to address the complex needs and challenges of this population. To redress this service gap, a multi-service agency within a shelter setting in a large urban centre developed and implemented a population-tailored, person-centred, evidence-informed gambling addiction program for its clients. The purpose of this article is to report on qualitative findings from an early evaluation of the program, the first designed to address problem gambling for people experiencing poverty and/or homelessness and delivered within a shelter service agency. Three themes emerged which were related to three program outcome categories. These included increasing awareness of gambling harms and reducing gambling behaviour; reorienting relationships with money; and, seeking, securing, and stabilizing shelter. The data suggest that problem gambling treatment within the context of poverty and homelessness benefits from an approach and setting that meets the unique needs of this community. The introduction of gambling treatment into this multi-service delivery model addressed the complex needs of the service users through integrated and person-centered approaches to care that responded to client needs, fostered therapeutic relationships, reduced experiences of discrimination and stigma, and enhanced recovery. In developing the Gambling Addiction Program, the agency drew on evidence-based approaches to problem gambling treatment and extensive experience working with the target population. Within a short timeframe, the program supported participants in the process of recovery, enhancing their understanding and control of their gambling selves, behaviours, and harms. This project demonstrates that gambling within the context of poverty requires a unique treatment space and approach.
Highlights
Problem gambling (PG) is associated with an array of complex social problems and public health issues [1,2]
Prior to detailing how the Gambling Addiction Program (GAP) program was received by participants and Gambling Addiction Case Workers (GACWs) in the findings, we describe the study participants
For agencies that currently do not provide gambling addiction services, Gamblers Anonymous (GA) may offer an opportunity to meet some of the needs of these clients without the added costs of program development and delivery. This evaluation illuminated the complex nature of the lives of people experiencing problem gambling, homelessness and poverty
Summary
Problem gambling (PG) is associated with an array of complex social problems and public health issues [1,2]. PG is associated with multiple measures of poverty, including low income [3–5], precarious employment [6,7], and unemployment [4,8,9]. The relationship between PG, poverty, and housing instability is a significant and growing public health concern [1,12,13]. Research has documented multiple comorbidities and challenges among people experiencing PG, homelessness, and poverty [3,4], including mental illness, substance use, criminalization, poor coping skills, relationship loss, employment instability, financial insecurity, experiences of discrimination and stigma [2], and histories of trauma [14]. Effective responses to complex co-occurring health and social issues among this population require awareness of the relationship between PG and poverty/homelessness, widespread screening for PG among service agency clients, as well as population-targeted and agency-coordinated PG prevention and recovery services [1,2,11,15]
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