Problem Gambling Services Research Articles

Operational status of mental health, substance use, and problem gambling services: A system-level snapshot two years into the COVID-19 pandemic.

The aim of this paper is to provide a system-level snapshot of the operational status of mental health, substance use, and problem gambling services 2years into the pandemic in Ontario, Canada, with a specific focus on services that target individuals experiencing vulnerable circumstances (e.g., homelessness and legal issues). We examined data from 6038 publicly funded community services that provide mental health, substance use, and problem gambling services in Ontario. We used descriptive statistics to describe counts and percentages by service type and specialisation of service delivery. We generated cross-tabulations to analyse the relationship between the service status and service type for each target population group. As of March 2022, 38.4% (n=2321) of services were fully operational, including 36.0% (n=1492) of mental health, 44.1% (n=1037) ofsubstance use, and 23.4% (n=78) of problem gambling services. These service disruptions were also apparent among services tailored to sexual/gender identity (women/girls, men/boys, 2SLGBTQQIA+individuals), individuals with legal issues, with acquired brain injury, and those experiencing homelessness. Accessible community-based mental health, substance use and problem gambling services are critical supports, particularly for communities that have historically contended with higher needs and greater barriers to care relative to the general population. We discuss the public health implications of the findings for the ongoing pandemic response and future emergency preparedness planning for community-based mental health, substance use and problem gambling services.

Patterns of Family and Intimate Partner Violence in Problem Gamblers.

While the evidence about the statistical co-occurrence of family violence and problem gambling is growing, the mechanism by which the two behaviours are related is less clear. This study sought to clarify the dynamics of the problem behaviours, including the role of gender in victimisation and perpetration of violence in the family. Two-hundred-and-twelve treatment seeking problem gamblers (50.5% females) were recruited for interviews about past year FV and IPV experiences. The interviews included questions about the types of FV and IPV using the HITS tool (Sherin et al. in Fam Med Kans City 30:508-512, 1998). The questions addressed multiple family members, the temporal order of violence and gambling and the perceived associations between the two behaviours. The result show that well over half (60.8%; 95 CI = 54.1-67.2) of the participants reported some form of violence in the past 12months, with no gender differences in relation to perpetration and victimisation. Bidirectional violence (43.9%; 95 CI = 37.4-50.6) was significantly more common than 'perpetration only' (11.3%; 95 CI = 7.7-16.3) or 'victimisation only' (5.7%; 95 CI = 3.3-9.6). Violence was mostly verbal, although considerable rates of physical violence also featured in the responses. 'Participants' own gambling preceded violence in a majority of the interviews but a small group of IPV victims reported that being a victim had led to their problematic gambling. These results can be used inform prevention, better treatment matching and capacity building in family violence and problem gambling services, where a significant focus should be on situational IPV.

Using Roadside Billboard Posters to Increase Admission Rates to Problem Gambling Services: Reflections on Failure.

Based on the stimulus-response model of advertising, this study sought to increase admission rates to a local problem gambling service (PGS) in Windsor, Ontario, Canada, by adding a series of locally based 10 foot by 20 foot roadside billboard posters to PGS's existing communications tools for a 24-week period. Using proof of performance reports, a pre-post survey of new callers to PGS, a website visit counter, and a media awareness survey, the findings showed that at least some individuals were influenced by billboard exposure, but admission rates continued to decline during the billboard campaign period. While one possible explanation for the communications failure was that the whole PGS communications campaign was below the minimal threshold for communications perception, another possible explanation is that the stimulus-response model of advertising used may not have been appropriate for such advertising that targets behavior change. Reflections on using an information-processing model instead of a stimulus-response model, and considerations of a two-step flow of communication, are provided. Recommendations are made regarding matching communications messages to stages of behavior change, use of online promotion, and strategies for future research.

Social Marketing Strategies for Stigmatized Target Populations: A Case Example for Problem Gamblers and Family Members of Problem Gamblers

Advertising theory and accompanying research literature are in their infancy when it comes to advertising services to stigmatized populations. We know very little about what messages will impact potential clients of services and what messages could even be harmful to potential clients and to society’s shaping of social issues. The purpose of this qualitative study was to examine the views of problem gamblers and family members of problem gamblers in developing 10 foot by 20 foot billboards to promote a local problem gambling service. Participants identified issues such as photographs of money being a trigger to gamble, guilt and shame being emotions that would turn them off of the advertisement, and a fear of the advertisement leading to a scam or hoax. More research and theory development on stigmatized populations is necessary to better promote services to stigmatized populations and to avoid contributing negatively to social issues.

Suicidal ideation and familicidal-suicidal ideation among individuals presenting to problem gambling services: a retrospective data analysis.

Studies have consistently reported high rates of suicidal ideation (SI) among individuals with disordered gambling. None have explored gambling-related familicidal-suicidal ideation (FSI). This study examined the (1) prevalence of SI and FSI among treatment-seeking gamblers in Hong Kong, (2) characteristic profile of factors associated with SI and FSI, and (3) factors that predict SI and FSI. This is a retrospective analysis of data collected at initial clinical assessments from a specialized gambling counseling centre in Hong Kong. Participants were gamblers (N = 3,686) who sought treatment at the centre between 2003 and 2012. Information about socio-gambling demographics, physical and mental health status, current presenting problems, self-rated South Oaks Gambling Screen (SOGS, Chinese version), and occurrence of SI or FSI were examined. Descriptive analysis and ordinal regression analysis were used to investigate the characteristics of the gamblers and the association of variables. In our sample, 720 (20.0%) individuals reported SI, and 22 (0.6%) individuals reported FSI at the initial assessment. Individuals with SI and FSI differed from the nonsuicidal individuals in terms of their demographics, gambling experiences and severity, mental and physical wellbeing, and types of gambling-related problems. The adjusted ordinal regression model shows that participating in table games in casinos and having familial and financial problems seem to enhance the likelihood of having SI and FSI. While mental health issues are significantly related to SI and FSI among gambling treatment seekers, the impacts of physical, family, and financial strains should not be underestimated.

An Examination of a Proposed DSM-IV Pathological Gambling Hierarchy in a Treatment Seeking Population: Similarities with Substance Dependence and Evidence for Three Classification Systems

Toce-Gerstein et al. (Addiction 98:1661-1672, 2003) investigated the distribution of Diagnostic and Statistical Manual for Mental Disorders, 4th edition (DSM-IV) pathological gambling criteria endorsement in a U.S. community sample for those people endorsing a least one of the DSM-IV criteria (n = 399). They proposed a hierarchy of gambling disorders where endorsement of 1-2 criteria were deemed 'At-Risk', 3-4 'Problem gamblers', 5-7 'Low Pathological', and 8-10 'High Pathological' gamblers. This article examines these claims in a larger Australian treatment seeking population. Data from 4,349 clients attending specialist problem gambling services were assessed for meeting the ten DSM-IV pathological gambling criteria. Results found higher overall criteria endorsement frequencies, three components, a direct relationship between criteria endorsement and gambling severity, clustering of criteria similar to the Toce-Gerstein et al. taxonomy, high accuracy scores for numerical and criteria specific taxonomies, and also high accuracy scores for dichotomous pathological gambling diagnoses. These results suggest significant complexities in the frequencies of criteria reports and relationships between criteria.

Development of Culturally Appropriate Problem Gambling Services for Indigenous Communities

FaHCSIA commissioned the Cultural and Indigenous Research Centre Australia to further develop knowledge in this area by identifying service and resource needs for Indigenous communities; exploring current delivery frameworks for problem gambling help services; identifying culturally appropriate approaches for addressing problem gambling in Indigenous communities; exploring mechanisms for attracting Indigenous problem gamblers to services; identifying appropriate approaches to addressing problem gambling in Indigenous communities; and developing a rationale as to why service frameworks are deemed to be good practice. The research involved a literature review to draw on existing knowledge and help set the overall context for the research. Telephone-based stakeholder consultations were also conducted to further understand service and resource needs in the area, and gather information about culturally appropriate approaches for addressing problem gambling in Indigenous communities. Forty-seven stakeholder consultations were conducted with representatives from state and territory governments, problem gambling services, alcohol and drug treatment services, Indigenous-specific services, financial counseling services, emergency relief organizations, and academics and researchers in this area. This research also provides a number of key principles for culturally appropriate service development for those working with Indigenous problem gamblers. These include viewing problem gambling as less of a social and more of an issue related to public health, thus placing more emphasis on primary prevention. Other principles identified in the research include supporting existing problem gambling help services to build stronger links and networks with the local Indigenous community, adopting a more community development-type approach when working with Indigenous communities, helping to develop the capacity to tackle the issue at a ‘grassroots’ level and placing a greater focus on workforce development in the future.

A Proof of Concept for Using Brief Dialectical Behavior Therapy as a Treatment for Problem Gambling

Fourteen ‘treatment resistant’ problem gamblers received 9 weeks of Dialectical Behavior Therapy (DBT) at specialist problem gambling services delivered in Melbourne, Australia. This study is the first to investigate the effectiveness of a brief DBT treatment for problem gambling, with a focus on measuring change in the four DBT process skills (mindfulness, distress tolerance, emotion dysregulation, and negative relationships). Although there were no statistically significant improvements in measures of gambling behaviour, 83% of participants were abstinent or reduced their gambling expenditure pre- to post-treatment. Participants also reported statistically and clinically significant improvements in psychological distress, mindfulness, and distress tolerance. Moreover, there were no increases in alcohol or substance use. These results are discussed in the context of focusing on a single DBT process skill, and the benefits of using group-based approaches.

Epidemiology of Problem Gambling in a Canadian Community

Pathological gambling became a public health concern in most countries in the 1990s, shortly after the liberalization of gambling policies and practices. Various communitywide surveys have examined population-level gambling behaviours, the prevalence of gambling problems, their antecedents, and their correlates. Early studies suggest that approximately 3–5 % of a given population have some level of gambling problems and that this prevalence is relatively stable across communities and among most countries (Doiron and Nicki 2001). However, there is evidence of changing patterns of gambling behaviour across communities and possibly a change in prevalence rates (Stucki and Rihs-Middel 2007). Saskatchewan is a prairie province in Canada with a population estimate of 1.04 million (Saskatchewan Bureau of Statistics 2010). Gambling revenues suggest that gaming activities are popular in Saskatchewan, with residents having multiple gambling options available. The provincial gaming net revenues from wagers on government-controlled games have steadily increased from $62 million in 1992 to $641 million in 2008. Saskatchewan’s gambling revenue per capita was the second lowest in Canada after the northern territories in 1992 ($86), but increased to the highest per capita revenue in 2008 ($825); the national average was $528 (Statistics Canada 2006, 2007, 2009). These increases are likely due to increases in and better access to gambling venues and similar to gambling revenue increases in other parts of Canada. The government of Saskatchewan earmarked 0.5 % of gambling revenues for allocation to problem gambling initiatives in 2010. Problem gambling services include programs that promote responsible use of Video-LotteryTerminals, training to gambling industry employees, a problem gambling helpline, and funding of various organizations that work to raise awareness and offer support programs in prevention, treatment, public policy, and public resources (Problem Gambling.ca 2010). A limited number of empirical studies have reported the incidence of gambling in Saskatchewan. In 1994, a government sponsored study (N = 878), using the South Oaks Gambling Screen (Lesieur and Blume 1987), estimated an upper limit of 29,100 adults as problem or probable pathological gamblers, representing 2.9 % of the population (Volberg 1994). In 2002, 1,848 adults were administered the Canadian Problem Gambling Index (CPGI) (Ferris et al. 1998) in a telephone survey. Reported prevalence of all levels of gambling problems was 15.15 % (Wynne 2002). The report estimated an upper limit of 135,400 adults at risk or already exhibiting serious gambling problems. Past year participation in gambling activities had risen from 53 % in 1994 (Volberg 1994) to 86 % in 2002 (Wynne 2002). Data from Statistics Canada’s CCHS cycle 1.2 (2001–2001) with 2,032 Saskatchewan residents in face-to-face interviews also using the CPGI, reported lower rates of past year gambling engagement at 75.4 %, with an estimated combined rate of 7.1 % of the population having gambling problems (Faregh 2009). Given the use of different instruments and methodologies, a direct comparison N. Faregh (&) McGill University Health Centre, Montreal, Canada e-mail: nedafaregh@gmail.com

The Profiles of Gamblers Seeking Counseling Services Evidence from Chinese Gamblers in Hong Kong

This study maps the demographic profiles of 4,480 clients of ten problem gambling services in Hong Kong. It attempts to identify help-seekers' characteristics associated with gender, adolescent onset of gambling, and suicidal thoughts/attempts. This aggregation of data to form a gambler service user profile among Hong Kong Chinese is the first of its kind. Service and research implications are discussed.

Tiered Frameworks for Planning Substance Use Service Delivery Systems: Origins and Key Principles

It is well known that only a relatively small proportion of people in the community who experience substance use problems seek assistance from the specialized sector of services that have been commissioned to provide treatment and support for these problems. Going back to seminal reports from the early 1990s there has been a call for a systems approach to “broaden the base of treatment” in order to achieve wider coverage and yield positive outcomes at a population level. In some jurisdictions conceptual models referred to as “tiered models” have been advanced to support planning, system design and performance monitoring. This paper traces the evolution of such tiered models for substance use services and describes a recent model advanced in Ontario Canada for design of an integrated system of mental health, substance use and problem gambling services and supports. The paper concludes by highlighting key features and principles of the tiered approach that are critical for its actual operationalization. Some challenges operationalizing such a comprehensive system design framework are also noted.

Problem Gambling Treatment Within the British National Health Service

According to the latest British Gambling Prevalence Survey, there are approximately 300,000 adult problem gamblers in Great Britain. In January 2007, the British Medical Association published a report recommending that those experiencing gambling problems should receive treatment via the National Health Service (NHS). This study examines the extent to which this recommendation has been taken up by NHS Trusts. In August 2009, a total of 327 letters were sent to all Primary Care Trusts, Foundation Trusts and Mental Health Trusts in the UK requesting information about problem gambling service provision and past year treatment of gambling problems within their Trust under the Freedom of Information Act. Results showed that 97% of the Trusts did not provide any service (specialist or otherwise) for treating those with gambling problems (i.e., only nine Trusts provided evidence of how they deal with problem gambling). Only one Trust offered dedicated specialist help for problem gambling. There was some evidence that problem gamblers may get treatment via the NHS if that person has other co-morbid disorders as the primary referral problem. Current provision for problem gamblers in Great Britain is delivered overwhelmingly by the third sector. There is still a long way to go if the aim is to provide localised, problem specific treatment to problem gamblers within the NHS system.

Significant Others and Gambling Treatment Outcomes

This study investigates the effect of significant others on treatment outcomes among treated pathological gamblers. This is a cohort study of individuals who received gambling treatment. Oregon Problem Gambling Services (OPGS) for gamblers and their family members. 4,410 adult gamblers who were discharged from treatment between August, 2001 and April, 2007. OPGS enrollment forms provided gambler gender, age, ethnicity, education level, employment status, gambling-related debt, and whether the gambler had a significant other at the time of enrollment. Termination forms provided information on the type of discharge (successful/unsuccessful) and treatment length (in days). Participation of the gambler's significant other in the family treatment program was identified. Results showed that age, ethnicity, gambling debt, and having a significant other are associated with the odds of successful treatment. Education level moderates the effect of having a significant other on treatment success. Age, ethnicity, education, employment, and having a significant other participate in treatment significantly impacted gamblers' length in treatment. These findings indicate that there may be a benefit to integrating significant others in gambling treatment methods. Significant others may act as social supports for gamblers seeking treatment, and involving loved ones in gambling treatment models may positively affect gambler treatment outcomes.

Manaakitia Te Rawa Kore—Supporting the Disempowered

As part of its service to reduce harm from problem gambling, Ngāti Porou Hauora (a New Zealand indigenous-led health service provider) aims to reduce the number of non-casino gambling machines (pokies) legally able to operate in the Gisborne district of the North Island’s East Coast. This case study summarises, from the Ngāti Porou Hauora perspective, its problem gambling service’s journey of working with others between 2003 and 2005 to achieve a local government ‘sinking lid’ policy for pokies as part of the council’s class 4 gambling venues policy. New Zealand’s Gambling Act 2003 and Local Government Act 2002, and the expansion of the Ngāti Porou Hauora problem gambling service team in 2003, set the scene for this local policy action. How the team learnt about and negotiated their way through local government policy-making processes and community interest groups and issues is documented. In conclusion, reflections are shared on the critical factors that contributed to achieving this policy outcome—knowledge and use of the community empowerment opportunities arising from recent legislation, the qualities and skills of the team, and the community relationships and collaborations they established.

Clients' perspectives of, and experiences with, selected Australian problem gambling services

Although there continues to be interest in documenting the evidence base for problem gambling interventions, little has been published on service users' perspectives on services provided to them. To gain a greater understanding of this issue, group interviews were held with present and past users of two services in Victoria, Australia-the government-funded state-wide Gambler's Help program and the privately funded self-help Free Yourself Program. Service users articulated a range of views about factors leading to the propensity to gamble, causes of problem gambling, the action that they would take to protect problem gamblers, the effectiveness of self-exclusion from venues, the features of a good problem gambling counselling service, unhelpful service characteristics, and the issue of abstinence or control as desired endpoints of intervention.

Change and continuity in a help-seeking problem gambling population: A five-year record<xref ref-type="fn" rid="fn3">*</xref>

This paper provides an overview of some trends among problem gamblers seeking help through the BreakEven/Gambler's Help problem gambling counselling services in Victoria, Australia, between July 1995 and June 2000. Data presented are drawn from details collected on clients at registration, assessment, and all other client contacts to form a Problem Gambling Services minimum data set (MDS). Analysis of the MDS shows a number of noteworthy trends towards continuity or change. A major element of continuity is the ability of the service to attract women, who constitute around 50% of the clients for the period. Major changes include the increasing trend towards presentation of clients at an earlier stage in their "career" as problem gamblers. Also identified is persistence or change in client characteristics, such as gender differences in gambling activity and problem type and level. In addition, a range of other factors are explored, such as level of debt and its associated characteristics, the characteristics of people committing crimes to finance their gambling, and the differences between people presenting for counselling and problem gamblers in the community.

Oregon's Problem Gambling Services: Public health orientation in a stepped-care approach [H2

Oregon's Problem Gambling Services: Public health orientation in a stepped-care approach [H2

Oregon's Problem Gambling Services: Public health orientation in a stepped-care approach

Oregon's Problem Gambling Services: Public health orientation in a stepped-care approach

Development of an Instrument for the Analysis of Problem Gambling Counselling Practice

This article provides an overview of the development and validation of a Counsellor Task Analysis (Problem Gambling) [CTA (PG)] instrument undertaken in order to document the activities of counsellors in problem gambling services. The CTA (PG) aims to provide a broad overview of the complexity of the counsellor's role; specify the range of tasks they perform; and document the relationship between the frequency of task performance and the counsellor's beliefs about the importance of the tasks performed. The CTA (PG) instrument addresses nine dimensions of practice activity through nine subscales, all of which demonstrate internal consistency. It appears to be a strong instrument in terms of its measurement error characteristics for recommending its use with counsellors engaged in the field of gambling. The CTA (PG) gives counsellors the opportunity to document their practice and theories in use when dealing with a problem gambler, a member of the problem gambler's family and the community at large. The psychometric findings reported in this article should be viewed as the preliminary results of an ongoing research effort and further psychometric testing is anticipated.