Contributed by Matthew Tsuda, MScOT, OT Reg. (Ont.), BEd, BA (Hons), Education Specialist and Therapist at the Gambling, Gaming and Technology Use Knowledge Exchange (formerly the Problem Gambling Institute of Ontario) at the Centre for Addiction and Mental Health
Take a few seconds to think about your vocation (i.e., your job, schooling or volunteering). How big of a role has vocation played in your life? What benefits has it brought?
There are often obvious benefits to vocation, such as generating income or a sense of productivity; however, it can also have the additional benefits of providing structure to your life, building confidence and feelings of accomplishment, and creating an opportunity to develop important skills. Our jobs, schooling and volunteering are often core tenants of who we are and how we identify ourselves. We tend to have a number of other life roles that shape our identity too, but vocation is often a big part of our lives.
Furthermore, employment and education are important social determinants of health (the social factors that affect a person’s overall health). For instance, poor working conditions can negatively influence our health. When our work/school is disrupted, our health can suffer and in turn, our health can affect our productivity at work/school.
Think about problem gambling―in what ways can gambling problematically disrupt work/school? How can it impact a person’s ability to focus and perform well? The impacts can surely be detrimental. This is exemplified in the
Diagnostic and Statistical Manual of Mental Disorders-V which lists “has jeopardized or lost a significant relationship, job or educational/career opportunity because of gambling” as one of the criteria for diagnosing Gambling Disorder.
As an Occupational Therapist, I see this commonly in practice. Clients have told me about how their preoccupation with gambling has affected their performance at work or their work attendance. It’s not uncommon for a client to report they were terminated from their job and/or have experienced difficulty finding employment. Some clients have also experienced legal issues (related to their gambling) that impact their ability to work. Clients who are in school report similar disruptions, in terms of missing class or not submitting assignments on time. At the same time, some clients find that their working/schooling conditions create stress, which can be a major trigger for gambling. In general, work and school can impact and be impacted by problem gambling, and these are important factors to consider when providing treatment.
As part of a client’s treatment and recovery plan, it can be helpful to explore (and support) their vocational goals. This can be an important motivator for a client and can tie in with their gambling goals. For example, I recently worked with a client who wanted to improve his performance at work. This client understood that maintaining his harm reduction gambling goal would help him get back on track at work, as he would have more time and energy to allocate to work efforts. As his work performance improved, so did his self-esteem, which positively reinforced his ability to stay on track with his gambling goals.
Using my Occupational Therapy (OT) lens, I’ve been able to provide vocational services to clients with problem gambling, supporting goals in the areas of work, school and volunteerism. As an adjunct service, I provide practical support to clients, such as goal planning, resume building, preparing for interviews, strategies for job searching, navigating work/school accommodations, etc. This is in line with current best practices within the areas of mental health and addictions, which emphasize the importance of supporting clients in their efforts to achieve meaningful employment in competitive jobs and capitalizing on clients’ motivation to return to work or school. There is an abundance of literature supporting the value of vocation in relation to supporting a person’s recovery process.
Although important, it can feel daunting at times to support a client with their vocational goals. Here are some brief tips from an OT perspective:
- Meet clients where they are at in terms of their readiness to return to work/school (see link to guideline below).
- Elicit relevant strengths, skills and work/school history.
- Help clients set a SMART vocational goal, creating a goal that is realistic and in line with their past experiences and skill set.
- Help clients identify the steps needed to accomplish their goal.
- Connect clients to employment services (e.g., an employment support agency).
- Discuss the potential of work/school accommodations as needed; many clients are unaware of this.
- Build on their motivation using motivational interviewing skills.
- Provide practical resources (e.g., how to build a resume, how to prepare for an interview, etc.).
- Provide education on the value of work/school in relation to recovery.
- Explore stress management strategies that can help clients effectively cope at work/school.
- If there are significant employment gaps, encourage them to consider volunteer work or to take a course to build recent experiences into their resumes.
Like navigating any behavioural change, it is important to tailor the strategy to the stage of change the client is in. In this case, it would be in terms of their readiness to return to work/school. Learn more
about strategies that can be implemented during each stage of change.
For additional information on how to support clients with their vocational goals, please contact Matthew Tsuda at
Contributed by Lisa Pont, MSW, RSW, educator and therapist on the Gambling, Gaming & Technology Use team (formerly the Problem Gambling Institute of Ontario) at the Centre for Addiction and Mental Health
The decision by the World Health Organization (WHO) to include video gaming as a disorder in the International Classification of Diseases 11 (ICD-11) has generated a lot of discussion. As a clinician and educator in this area, this pleases me but I am also aware of some of the controversy and criticisms surrounding the decision. A few of the commonly held concerns are that it will:
- stigmatize video game players
- increase anxiety in parents
- dilute the meaning of the word addiction
- only affects a very small percentage of the population
Stigma and video gaming
Any time you label something, there is a risk of stigma and this needs to be weighed carefully. Having clearly defined criteria will make it easier to determine if someone has a diagnosable problem and hopefully, increase the likelihood they receive appropriate treatment. If having an official diagnosis leads to greater public awareness, informed prevention and treatment approaches, then the benefits may outweigh the potential harms. Addressing stigma in regards to mental health is ongoing work, but allowing the fear of stigma to prevent identifying a serious problem is shortsighted. For example, alcohol use disorder is an official diagnosis and, in my experience, has not resulted in falsely labelling social drinkers as having an addiction and/or being stigmatized by society.
Another criticism I have heard is that making gaming disorder an official diagnosis will cause parents to worry needlessly that their child who loves games is addicted or will become addicted. Parents are already worried. They see the impact that gaming and technology have on their kids and they don’t know what to do. If more and better research comes out of having official diagnostic criteria and this helps to clarify symptoms, parents will now know when they should be worried. The decision by WHO to include gaming was intended to increase awareness about this issue in order to promote prevention and early identification of the problem.
Is it really an "addiction"?
The idea that we will dilute the term "addiction" by including video gaming as a disorder due to addictive behaviours is contrary to what we know about behavioural addictions such as gambling. For years, skeptics maintained that gambling could not be addictive because it was not a psychoactive substance, but rigorous gambling research supported its inclusion as an official diagnosis. We know that gaming and gambling have structural similarities and that many video games contain elements of gambling. Research, along with clinical observation and first-person accounts of being addicted to video games, support the belief that video game disorder contains all of the hallmarks of addiction such as craving, loss of control and continuing the behaviour in spite of negative consequences.
What's the big deal?
Some argue that since video gaming disorder only affects a small percentage of the population, it should not be included as an official diagnosis and yet rare diseases that affect very few people are given an official diagnosis. How many people need to be impacted before labelling something as a disorder or a disease? My understanding is that one of the purposes of the ICD-11 is to record medical phenomena so that it can be identified and monitored for health management. Adolescence is a time when people are most at risk of developing video game disorder and mental health disorders. If problems go undetected and untreated during this time when youth are laying the foundation for their future, the negative effects can be far-reaching. In addition, for people experiencing problems with gambling, video gaming or technology use, there is a large percentage who also experience co-occurring mental illness.
Gambling, Gaming & Technology Use has just launched a Community of Interest on EENET Connect for addiction and mental health service providers to stay on top this emerging trend and share knowledge. I encourage you to join the community and share your thoughts there!
Contributed by Elaine Uskoski, SSW, C Ir, holistic health social service worker and certified iridologist, speaker, and author of the book
Seeing Through the Cracks
When I decided I wanted to become a mother it was important to me to be both committed and ready to do the work that was required to be the best parent I could be. Unlike applying for a job, no one was holding me accountable or interviewing me to see if I was a good fit. That responsibility fell solely on me. My background and experience were sorely lacking; I came from a dysfunctional childhood that included abuse and alcoholism, with poor role modeling. On paper, my resume revealed me as an unlikely candidate. But I had passion and desire, and I was intelligent. I had a good work ethic and was serious about taking on this new leadership role. I was determined to change my family’s history, and create a home of love and empathy, a place where my children would always feel safe and nurtured. And in 1991, I got the job, with the birth of my first child. In response, I studied, I learned, I shared my concerns and listened to other moms. I monitored, I set up boundaries and rules. I followed through with reasonable consequences. I provided, I played, and I was emotionally available. I thought I was doing a good job and my sons responded positively; I had raised decent human beings.
So, you can imagine my shock when I discovered that my son, at age 19, was addicted to video games so severely that he had stopped thriving. He was in full blown crisis. I believed I’d handled the arrival and progression of technology in my sons’ lives responsibly; I supervised to be sure they played age appropriate games, I had conversations with them both about keeping their personal information private to protect them from online predators, I spoke with them about the friendships they were developing through online video games. I believed both of my sons were safe from harm, but I was naive and ignorant.
Gaming and the internet were not things I was raised with; this was a new area for most of us parents during the nineties and into the new millennium. We were all seduced by its newness, excited about its possibilities, and we believed it was fun, educational, and safe. I wasn’t aware that my son was suffering social anxiety or that he had struggled since age twelve to feel like he fit in amongst his school peers. I later learned that he felt alone and ostracized after changing to a new school, leaving most of the friends he knew behind. I was unaware that he had turned to online gaming to escape school and social stresses, find his tribe, and create new online friendships in an arena of acceptance amid other gamers. I didn’t realize that he had chosen to look for solace and a form of interactive peer therapy, online, instead of coming to discuss his issues with me. And I was certainly blind to his emotional struggles as he navigated his entrance into university. There were signs; his grooming had slipped, his weight had dropped, he became visibly shaky, he communicated less, he was moodier, and he looked chronically tired. I asked him about these symptoms, as any concerned and loving mother would do, and he lied to cover up his secret. And I lied to myself. I didn’t know what I didn’t know, or what I should be looking for.
Two months into first semester of second year, I learned that my son had never attended a single class in that time. Instead he’d gamed all night, every night, and slept through the days. At 6’2” tall his weight had dropped to 127 pounds, he had tremors, his hair was greasy, his body odour was pungent, his eyes dilated, and his skin a break out of acne. He was suffering with severe anxiety and depression, and he had stopped “living”. I was shocked that these alarming symptoms could occur from spending so much time gaming. I felt, as a parent, that I had failed him. I let go too soon and stopped parenting. This was a terrible mark on my work history, as a mother. And just as an employee makes a bad judgement and a poor decision on the job, I felt I needed to clean up this mess, or risk losing my job, or my son, or both.
I had more work to do. I was not finished parenting. I prepared myself to do whatever it took to support my son through recovery. I had no knowledge of what a video gaming disorder was or what it encompassed. I didn’t know where to turn for help, and I felt isolated. I still had the passion and desire to do what was best for my son even if it took enormous effort. And indeed, it did. I realized very quickly, when my son relapsed back into gaming, more than once, and when he continued to struggle with mental health problems, that he couldn’t tackle recovery without my undivided attention to his needs. Without my constant monitoring and his accountability to me, and without my unyielding conviction to put into place rules, restriction, boundaries, guidelines, and consequences, he would not beat this addiction. It was on me. I had an enormous role in his personal growth and success, and I could not take my foot off the gas, so to speak, at any time, even if I wanted to. It has taken the very same commitment and hard work, as a parent through the addiction recovery process as it took in raising my son to adulthood. It takes an incredible amount of love, empathy, grit, effort, and steely determination to support your child and/or your adult child through a mental health crisis. It is not a time to judge harshly, it is not a time to give up or quit the job of parenting. You dig deep and do whatever it takes to create an environment for success. You research and learn as much as you can in order to both understand and support your child. You must be willing to play hard at times, but you must also create a soft place of landing for the addict.
For me, personally, it was important to understand that Jake, in his determination to resolve his emotional pain, he looked online to others, instead of coming to me to ask for help. And that was okay. I couldn’t be upset with him for trying. He wanted to feel better, and gaming and chatting with his online gaming friends helped him to feel accepted, to experience some sense of success, and to escape from his feelings of anxiety. In the long run, this led to addiction and depression, so it was not a permanent fix. But it helped me to approach his recovery with empathy and sensitivity. This didn’t just assist Jake in creating a healthy shift, but it helped me to align, as a parent, with love and understanding rather than anger and frustration.
Today, after three years of battling through, working together, and reaching out for whatever help and reinforcements I could find, there has been much personal growth for both of us; our bond is stronger. There has been success, and there is still work to be done. My son now weighs 170 pounds; he has made valuable friendships outside of the virtual world, he has recently graduated from university and is working full time; he has found meaningful activities, sports, and clubs to engage in; he feels happy. He now celebrates one full year of being fully detoxed from video gaming. And although I know that he did the hard work that was required, he could not have done it without me doing my job, as his mother, or without all of the systems available to support both of us through this part of the journey.
Contributed by Aaron Diehr, PhD, CHES, Assistant Professor and Program Director for the Bachelor of Science in Public Health at Southern Illinois University and Marilyn Rule, MSW, Problem Gambling Program Director at Zepf Center in Toledo, Ohio
Researchers often choose to use health communication approaches (i.e., posters, videos, social media messages, and other materials containing images and text that attempt to educate and influence personal health decisions of targeted groups of people) because of their relative affordability in combination with their potential wide reach. Often, health communication campaigns also have the added benefit of increasing awareness about health concerns. To date, there are few studies featuring health communication approaches for gambling disorder among college students. As such, there remains a need to conduct message testing of gambling-related health communication materials with college students to first assess how effective they believe certain messages to be, whether they find the messages appealing, and if they understand the purposes of the messages. Information from this formative research can then be used to create more focused and effective materials.
Our recently published article in the
Journal of Gambling Issues entitled "A coordinated health communication campaign addressing casino and sports gambling among college students" used health communication techniques to assess undergraduate college students' reactions to two posters. One had a message targeted toward casino gambling (specifically slot machines) and featured a tagline of "What are the odds?" with three slot machine reels displaying the word "broke." The other poster's message focused on sports betting and included the catchphrase, "Having trouble rebounding from your losses?" These sorts of health communication techniques have often been used to address common health concerns among college students—such as alcohol, tobacco, and other drugs—but have rarely been used to impact students' gambling decisions. Accordingly, our project sought to examine college students' reactions to a health communication approach for gambling prevention.
With the aid of a community behavioral health organization with a robust gambling prevention and treatment program, the research team designed two posters and initially pilot tested them on undergraduate students in a classroom setting. Based on students' feedback and commentary from members of the research team, we revised the posters and placed the updated 20 posters for one week each (for a total of 40 posters) in prominent areas of residence halls at a large Midwestern US university. At the end of each week, research assistants approached students and asked them multiple questions about the particular message, including whether they noticed it, understood it and believed it, as well as collecting demographic variables about the students.
Overall, most students found the design of both posters to be appealing. They reported that they understood the messages were designed to raise awareness about disordered gambling and to link individuals with local treatment if needed. For the slot machine ad, more females than males liked the ad—consistent with research indicating more females gamble on slot machines—and individuals who started gambling at a younger age liked it more than those who had begun gambling more recently. One quite useful finding was that individuals who had lost more money to gambling than they had planned to lose displayed significantly greater understanding of the ad. Traditionally, college students do not have extra money to gamble, so the prevention message with the words "broke" on the slot reels may have possibly had an effect on their understanding, thus potentially influencing future decisions regarding their gambling spending habits. For the sports betting ad, the only major finding was that white students understood the message of the poster better than Hispanic/Latino students. Finally, in response to open-ended questions, students brought up some important potential concerns, such as whether the use of brightly colored images might inadvertently promote gambling or trigger individuals who suffer from a gambling disorder.
The posters being a trigger to fuel the desire for gambling may have been an unintended consequence. Although extensive research has not been conducted regarding gambling graphics or images, we know how brightly colored lottery tickets, slot machines and flashing lights can be attractive. Therefore, the research team decided not to use such images for future prevention messages. In treatment, this information can be used to assist the client in identifying triggers, with recognition that the makers of such machines have already researched the appeal.
The formative data that we gathered from conducting this study can be used to develop more targeted and effective health communication materials or to inform potential interventions related to gambling disorder among college students. Since universities often give priority to other pressing issues in college health (such as alcohol and substance abuse prevention), the approach described in our study represents a relatively inexpensive method of building awareness of gambling disorder on campuses.
Contributed by Thitapa Shinaprayoon, PhD, Department of
Psychology, University of Georgia
Around 2012, I had a chance to interview gamblers in Georgia, US as a part of a gambling study. Most common reasons these gamblers gambled were entertainment and winning money. I was curious to learn more about why people risk their money and invest so much of their time in gambling when most gamblers often lose more than they gain. Importantly, I wanted to know which gambling motives are likely to predict problem gambling. In 2014, my colleagues and I conducted a gambling study and found 2 gambling motives that significantly increase the risk of developing problem gambling.
Entertainment – Gambling is like gaming. It is fun and engaging. So, it not surprising that people sometimes gamble to cope with stress and anxiety. One of the reasons why enjoyment makes gambling addictive is the adrenaline rush and excitement that come with winning or the chance of winning. And, if gamblers keep relying on gambling as a source of entertainment and not addressing repercussions like accumulating debts, the cycle of using gambling to cope with stress continues until gambling becomes problematic. Casinos and gambling companies are aware of this motive. That is why they market their products as entertainment and design gambling games to be fun and engaging to reinforce gambling behavior.
Social reason – Gambling to socialize with friends or meet new people is also a risk of developing problem gambling because social gambling creates social circles of gamblers and reinforces gambling behavior. Gamblers also tend to have other gamblers in their circles rather than non-gamblers. This means that if gamblers go out together, they are likely to gamble together.
I hope that knowing these gambling motivations that are risks to developing problem gambling can help clinicians find suitable support for their patients. Clinicians could encourage their patients to substitute gambling with other entertaining activities that do not cause harm or could encourage their patients to find non-gambler friends, whether inside or outside of their circles.
For more information about Thitapa's study, please see the article The Modified Gambling Motivation Scale: Confirmatory Factor Analysis and Links With Problem Gambling published on the JGI website.
Contributed by Virve Marionneau, PhD, and Janne Nikkinen, ThD, University of Helsinki Centre for Research on Addiction, Control and Governance (CEACG), Faculty of Social Sciences
Our recently published
systematic review paper in
Journal of Gambling Issues focused on market cannibalization within and between gambling industries. In economics, cannibalization refers to a process in which a new product or service partly or completely substitutes for those in existing markets. In the field of gambling, this refers to substitution between different types of gambling games. We conducted an analysis of available studies regarding such cannibalization. The final data consisted of 58 original research articles. The results show that new gambling products substitute to a certain extent for existing gambling products, but examples of complete substitution are rare. In most cases, new products only partially cannibalize existing markets, thereby expanding the overall gambling offer. The sector in which the evidence is most convincing is the casino industry, which partially cannibalizes lotteries and pari-mutuel racing. There is also evidence that casinos partially substitute for other casinos and for non-casino electronic gaming machines. Lotteries partially substitute for casinos, other lotteries, sports betting, and pari-mutuel or racing industries. In some cases, market relationships are complementary. This appears to be the case in particular for online gambling which does not seem to reduce consumption in other gambling products, but directly expands the offerings and consumption of gambling games.
Overall, the results indicate that new gambling games do not completely substitute for existing products, but rather expand the market. This expansion of gambling has many direct consequences for consumers, governments and treatment professionals. Although evidence remains limited, the so-called total consumption model appears to apply to gambling. The model has been widely applied in fields such as alcoholism, and suggests that when the total consumption increases, so do the levels of problems. Gambling causes a wide range of harm to individuals, families and societies. Although clinicians face individual problem gamblers at the micro level, it is important to bear in mind these macro level developments to understand that problem gambling is not only an individual condition, but also a result of societal encouragement that some individuals are more vulnerable to. Concretely, this would mean taking into account the manifold gambling opportunities in treatment situations, and understanding how effective marketing strategies and enticing new gambling products may encourage players not only to try new games, but also to gamble more overall.
Our research on gambling at the Centre for Research on Addiction, Control and Governance (CEACG) at the University of Helsinki, Finland focuses on these societal and institutional problems of gambling provision, rather than on the individual gambler. We are currently conducting a European comparison on the use and dependencies of governments on gambling profits. These issues will be discussed in our forthcoming edited volume ‘Gambling policies in European welfare states: Current challenges and future prospects’ (edited by Egerer, Marionneau and Nikkinen; published by Palgrave McMillen in 2018). We are also continuing our research into cannibalization in gambling industries in a forthcoming systematic review paper that focuses on whether gambling industries cannibalize other sectors, such as entertainment and restaurant services. This study will shed further light on the impacts that gambling industries have on local economies, and whether gambling actually brings any additional financial benefit to the jurisdictions that introduce it or whether it merely displaces consumption away from other, less dangerous, commodities or reduces savings.
Contributed by Niri Talberg, MA,
Researcher at Fafo Institute for Labour and Social Research, Oslo, Norway
“If you stop winning, try your luck as a researcher”
I was quite proud and excited when I delivered the coupon in the kiosk that warm summer day in 1991. I was 10 years old and as always I spent the beginning of our summer holidays at my grandfather's house. That summer, to keep me occupied, I had been allowed to study the most prestigious form of gambling and the only form of sports betting available for Norwegians: “tippekupongen”. It was a weekly coupon that consisted of 12 soccer matches with three possible outcomes. After thorough analysis of the teams' injuries, current form, and history against their opponent, I started sweet-talking, nagging, and eventually persuading my grandfather and father into giving me enough money to purchase 8 half-hedges, to the cost of 256 Norwegian kroner [41 CAD]. Back then there was no age limit for gambling. For the first (and last) time in my gambling career, it went exactly as I had expected in all 12 games. I am quite sure that if I had won a million kroner (or even a million CAD) today, it would have felt like a lot less than the 2,688 CAD I won that day. With that, a passionate gambler was born.
When I started secondary education, the betting options had increased a great deal. I could try my luck on two betting coupons each week in addition to regular sports betting with matches every day. I was regarded as an experienced sports better and enjoyed some recognition from older peers. My systems had become more sophisticated; but to be honest, we were far from breaking even. I was used to a strictly regulated gambling market, however things were about to change. The old mechanical and fairly harmless slot machines were swapped out with highly aggressive electronical machines. Instead of wagering 6 kroner [1 CAD] in 10-15 seconds, it was now possible to wager 1000 kroner [160 CAD] in 10 seconds. I would see the new machines in almost all convenience stores and kiosks, and unlike the old machines, they were almost always occupied by adults and often retirees. The topic was hotly debated and the lobbyists managed to delay effective regulation until the end of 2006. I did not lose a lot of money on the slot machines, mostly because I never had much pocket money. However, I did experience losing track of time while playing and one time I forgot to collect my dog when going home from the kiosk. As for many others, this second part of my gambling career was less successful than the first.
In 2003, another form of gambling got my attention. Bookstores sold poker chips and there were often poker tournaments on TV. I watched James Bond playing Texas Hold’em at the movie theater (instead of baccarat) and even Coca Cola used poker to sell Cola light (Cola Zero) to us boys. I read several poker books and practiced with play money for at least one year before I started to gamble with real money. I had finally found a game where I made money in the long run after having tried multiple forms of gambling for the last 15 years. I started studying at the university and become increasingly interested in reading research on gambling while my own gambling became less frequent. I strongly felt that the Norwegian research literature did not understand the difference between poker and other games, and that questions used to diagnose gambling problems were unfit for a game like poker. I decided that I had to make my own survey and hand coded 953 surveys into the statistical program SPSS.
After submitting my Masters, I worked several years as an Educational and Psychological Counsellor. School refusal was among the topics I worked on. Gaming had become a lot more time-consuming since technology made it possible to play computer and video games online and cooperate with team mates from around the globe in different time zones. Games that continued even after the player had stopped playing were a new thing. As a counsellor, I experienced that it is quite hard to talk a pupil into going to school if he risks being kicked out of his team if he misses their practice. And chances are he won’t tell you about the game. Although I had completed my Masters, my survey had brought up more questions than it answered. I was eager to do more research to understand the poker players’ perspective.
In 2013, I finally got funding to become a PhD student at my university’s department of education. Although the quantitative data I had collected was a great stepping stone, it was crucial to talk to several players and listen to their histories. It lead to a qualitative trilogy where I study (1) their learning process, (2) how poker has affected their education and (3) the long-term effects (problems with relating to stigmatization from non-players and ethical dilemmas when playing against suspected problem gamblers). The article on long-term effects will be published in an upcoming issue of the
Journal of Gambling Issues (JGI) and the article on how gambling affects education is now available in JGI
2017:37. In the article currently in the JGI, you can meet several players that are considering dropping out of education to pursue careers as professional poker players and a few that already have. The competition among the players can be described like an arms race where investing more time than their opponents is essential to develop sufficient skills. I argue that the poker player base has become more homogenous and skilled. Since having a significant skill advantage over other players is necessary to make playing profitable, I believe that the players’ inclination to drop out of education is reduced.
Looking ahead, today March 5th, 2018 is a quite significant day for me. It is the due date for my first born, a son, and also the day I am expected to defend my PhD thesis at the University of Oslo. I am sure you all wonder; will I allow my son to gamble in 2028 when he turns 10? Probably not, however the games competing for his attention are likely to be almost unlimited.
Contributed by Sasha Stark, PhD, Manager, Special Research Projects and Lorelle Muller Lumsden, Senior Project Manager, PlaySmart Centres, both with the Responsible Gambling Council
Many Ontarians gamble. They play the lottery with the hope of cashing in on that big dream. They plan nights out at casinos and slots – and even have their favourite gambling spots. Some enjoy playing bingo and hanging out with their friends in between play sessions.
Since many Ontarians gamble, it only makes sense to ensure that those who choose to gamble have access to accurate information to help them make informed decisions about their play. And if anyone has a concern about their gambling, they should have access to assistance and support.
PlaySmart Centres are an onsite source for facts, tools, and advice about gambling for all levels of players. Whether someone’s new to gambling or more of a regular player, PlaySmart Centres provide gambling information in a fun and interactive manner. The Centres are designed to promote and encourage conversation.
- try a hands-on interactive slot demo
- participate in interactive educational events that have players popping a die to learn about gambling concepts or busting a popular gambling myth
- take a play break – chat with other players or a PlaySmart Centre staff.
And if someone is looking for ways to get help, the PlaySmart Centre and its staff are a good place to turn for support and information about help options.
The Responsible Gambling Council (RGC) has been managing and operating PlaySmart Centres (formerly Responsible Gambling Resource Centres) since 2005. PlaySmart Centres are located at casinos, slots, and charitable bingo and gaming centres across Ontario. RGC works collaboratively with Ontario Lottery and Gaming Corporation (OLG) to bring education, and assistance when needed, directly to people who are gambling.
What do clinicians in Ontario need to know about the services provided through PlaySmart Centres?
In January 2017, OLG and RGC began introducing a new generation of PlaySmart Centres, with the first of its kind at Shorelines Casino Belleville (pictured). The new PlaySmart Centres have decreased responsible gambling messaging stigma and moved towards being more integrated into the player’s overall experience – and here’s how:
- Continuing to place PlaySmart Centres in high traffic, highly visible locations
- Increasing PlaySmart Centre visibility off the gaming floor
- Introducing PlaySmart Centre staff presence on the gaming floor – interacting with interested players and gaming staff to increase awareness and build rapport
- Delivering interactive demos and activities to players on the floor – raising awareness about how gambling works, and bringing helpful tips and facts right to players
- Creating opportunities to promote and encourage conversation at the PlaySmart Centres with a “coffee house meets science centre” philosophy
- Broadening the PlaySmart message to speak to different levels of players – making PlaySmart Centre staff and the space friendlier for all players
This increased integration means that PlaySmart Centre staff are more readily accessible to players when they are needed – for information or for support – and that responsible gambling messages will reach more players.
How can a PlaySmart Centre help a person in distress at a gambling venue?
Recognizing that gambling has associated risks, it’s important that those who are concerned about their own or someone else’s gambling have access to support. The PlaySmart Centre is a place where someone can find ways to get help right onsite – be it through a brochure about local counselling or a PlaySmart Centre staff who helps get them connected to the support they need. PlaySmart Centre staff do not provide ongoing counselling to individuals, but are trained to provide immediate support and explore appropriate help options.
PlaySmart Centres continue to be a support to anyone wishing to self-exclude or reinstate at casino and slot venues. When someone is self-excluding, PlaySmart Centres offer helpful contacts to local problem gambling and credit counselling, along with helplines for mental health and drug and alcohol concerns. PlaySmart Centre staff can walk someone through the help options to see what might best suit the immediate needs of the individual.
At the time of reinstatement, PlaySmart Centres provide tips on how to keep play low-risk and information on warning signs to look for that would tell someone that their gambling may be becoming a problem.
More recently, PlaySmart Centre staff have been working with gaming staff to effectively respond to players on the floor, who may be experiencing problems with gambling.
What is new and emerging from RGC?
The RGC’s Centre for the Advancement of Best Practices recently developed best practices for youth gambling prevention. These best practices are based on evaluations of youth prevention programs, the experiences of those who work with youth with gambling problems, and a quantitative survey of youth in Ontario. Insights from this work will be used to inform RGC’s ongoing youth prevention programs,
GameBrain – an educational game show about the risks of youth gambling – and
Know the Score 2 – an interactive problem gambling awareness display and social media campaign for college and university students.
The Centre regularly conducts Insight projects, which examine a particular problem gambling issue in detail. The current Insight project focuses on video lottery terminal play in Canada and Keno play in British Columbia. It looks at how people play these games, what risky and responsible play looks like, and the available responsible gambling resources. The final Insight report will be publicly available in March 2018.
Results from the Insight project, and many other interesting topics, will be covered at this year’s Discovery conference April 11th and 12th in Toronto. RGC has organized sessions on a variety of topics including the impact of gambling on Indigenous communities, the differences between gaming and gambling, and the psychology and biology behind risk taking. You can register now or submit a poster presentation to be part of this engaging two-day conference.
Deirdre Querney, Registered Social Worker with the City of Hamilton’s Alcohol, Drug & Gambling Services and Instructor at the McMaster Centre for Continuing Education
Does this scenario sound familiar? You have a client in front of you who is trying to change her gambling behaviour but she is plagued by strong urges, demoralized by how difficult the change process is and feels betrayed by her brain that seems to tell her that gambling is still desirable, even in the face of terrible consequences. The client says to you “What’s wrong with my brain? What is happening to me??”
Your heart sinks a little bit at the question. After all, the brain is complicated. You want to answer her question but the answer is not all that clear, even to you. So, you take a deep breath and weave together an answer that is a patchwork of ideas from the last conference you attended, an article you read, something a learned colleague said and your own anecdotal evidence. You hope that what you are saying makes sense to the client and helps her feel less frustrated and ashamed. You also hope that what you have said is accurate, but you’re not entirely sure.
I have been a problem gambling counsellor at the Alcohol, Drug & Gambling Services (ADGS) in the City of Hamilton for 17 years and I have been asked questions about the neurobiology of problem gambling hundreds of times. My answers have changed over the years as I have picked up new information from various sources but what hasn’t changed is my worry that what I was saying was not completely evidence-informed. As the consulting psychiatrist for our program once told me “Deirdre, you tell a good story and it probably is helpful to your clients. I just don’t know if it’s actually true.”
In an effort to correct my “patchwork quilt” approach to answering these important questions, I became involved in a project funded by the Gambling Research Exchange Ontario (GREO) called
Brain Connections. My team included Dr. Iris Balodis and her graduate student, Fiza Arshad from the Peter Boris Centre for Addictions Research as well as my ADGS colleague and fellow problem gambling counsellor, Andrea Strancaric. Together, we set out to answer five of the most often-asked questions about the brain and problem gambling and then to turn those answers into clinical handouts designed to enhance treatment sessions with clients.
The five questions are:
- How is problem gambling like an addiction to alcohol or drugs from my brain’s point of view?
- Why do people keep gambling even when it’s not fun anymore?
- Why is it hard to say “no” to an urge?
- When I’m not gambling, why does it feel like nothing else―even activities I used to enjoy―will ever be fun again?
- Why do people sometimes switch from gambling to another addiction?
We are very excited to unveil the result of
Brain Connections, which is five high quality, person-centered and visually appealing clinical handouts.
Each handout has four parts to it: (1) a summary of the research to answer the question at hand, (2) an activity to help clients understand the information in the handout, (3) a discussion question to help clients think about how the information might personally apply and (4) a take-home message summarizing the main ideas in the handout. We have also developed a single summary sheet of all the information for people who just want to hear the bottom line without reading all the handouts.
We invited clients from ADGS to tell us what they thought about the handouts. What they told us is that these handouts can serve many purposes. They can:
- Be comforting when it feels like the brain is on auto-pilot and working against the treatment goal
- Help prevent relapses by providing information about urges and substitutions
- Prepare people to have a realistic sense of what to expect from the brain as it heals from a gambling addiction
- Give hope that change is possible.
To download the handouts, please go to
You can also see
GREO’s promotional video about
Sign up for one of our webinars hosted by the CAMH Problem Gambling Institute of Ontario on
May 16th or May 28th, 2018 when we will be discussing how to best use the handouts in your clinical practice.
Thank you for taking the time to learn more about
Brain Connections. If you try our handouts and want to give us feedback about your experience, we would love to hear from you! Please see our
contact information on our website.
Toula Kourgiantakis, Assistant Professor and Coordinator of the Simulation Program at the Factor-Inwentash Faculty of Social Work at the University of Toronto and a Registered Couple and Family Therapist
What was the rationale for creating Adolescent Problem Gambling: A Prevention Guide for Parents?
Adolescent Problem Gambling: A Prevention Guide for Parents was developed after discussions between the writers highlighted some of the gaps we were observing in our work with adolescents and emerging adults with gambling concerns. The first concern was that despite the fact that statistics showed problem gambling to be much higher among adolescents and young adults, we were seeing few young people with gambling problems in the clinic. That was surprising considering the results of the Ontario Student Drug Use and Health Survey (OSDUHS) completed by students in grades 7 to 12 across Ontario. This survey showed that 24% of grade 7 students are gambling and by grade 12, this jumps to 41%. Among students who are gambling, almost 5% state that they have a problem, of which 1% report that the problem is severe. This represents 7,500 adolescents in Ontario (Boak et al., 2015).
Our clinical work and research in this area also indicated that a large proportion of the youth with gambling problems are coping with other difficulties such as substance use, problem technology use, depression, anxiety, conflict with parents, as well as academic and social difficulties.
In consulting other experts and the research on this topic, we started formulating hypotheses about why adolescents were not seen in higher numbers in clinical settings. This may be due to not having services specifically adapted for this age group. It may be challenging for an adolescent to fit in to a group treatment program with most participants being in an older age bracket. It may also be connected to the fact that many addiction treatment centres do not offer family-centred services that support parents, enhance treatment entry for youth, prevent youth from dropping out of treatment and improve outcomes when youth complete treatment.
We also noted that while there has been a lot more research on adolescent problem gambling, very little has been done to promote problem gambling prevention. There are a few prevention programs delivered through schools, but they are not offered in a uniform manner across all schools. The work on substance use programming has demonstrated that prevention programs offered in schools have much greater impact in reducing risks or harm to children and adolescents when parents are involved. Yet, there have been no problem gambling prevention programs reported to date that involve parents (Kourgiantakis et al., 2016).
Another possibility discussed by our team on why adolescents and their families were not getting professional help was that perhaps the professionals were unfamiliar with problem gambling and were not asking the right questions. A gambling research team in Montreal surveyed teachers (Derevensky, et al., 2014) and mental health professionals (Dickson & Derevensky, 2006;
Temcheff et al., 2014) working in schools and found that gambling was unknown and not viewed as an area of priority by professionals.
Considering all of these hypotheses, we wondered whether some of these youth are not getting any help and whether others are getting help, but not for problem gambling. Perhaps some of these youth who may be seen in children’s mental health centres are presenting with other concerns, and so problem gambling is not being screened, assessed and/or reported. This led us to develop this guide that we hope will be disseminated in children’s mental health centres, schools, hospitals, community centres, and adult addiction treatment centres. It is important to raise awareness in order to reduce risks. For an adolescent with higher risks, early intervention is key to reducing the likelihood that problem gambling will become more severe and/or will contribute to the onset of other problems.
Based on your clinical experience and research, what new forms of gambling are youth engaging in? Does this change how treatments and supports are offered/tailored for youth?
We know that most youth are engaging in some form of online gambling and that there is a connection with problem video gaming or problem technology use. While the services addressing problematic technology use among youth have increased in addiction and mental health treatment centres, there are still important gaps in policy and services. There is a need for well-defined best practices. Experts have recommended doing more around prevention and ensuring parents are involved.
We know that children who have a parent with a gambling problem are at much greater risk of developing a gambling problem. For clinicians who are working with parents with problem gambling, it is important to discuss ways they can reduce harm to their children. We previously developed
Problem Gambling: A Guide for Parents to help parents learn ways they can prevent the intergenerational transmission of problem gambling.
Where can clinicians access the handbook?
The guide is free and available now on CAMH Problem Gambling Institute of Ontario’s professionals website