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
Contributed by Dr. Richard Wood, Founder & Director at GamTalk and Owner at GamRes Ltd.
What is gamtalk?
Gamtalk is an online community for anyone who has questions or concerns about gambling behaviour. Maybe it's their own gambling, or that of a family or friend. Or maybe it's someone in treatment who needs a little extra support, or someone in recovery who wants to share with others. At gamtalk, they can chat with people all over the world who are facing or have faced that same situation—24 hours a day, seven days a week.
It's a place where someone struggling with the shame and stigma that comes with addiction can join in anonymously, or someone who isn't sure if they're ready for formal treatment can seek advice and find out about options. People in treatment might need some encouragement to avoid a relapse, while someone else might look for advice on how to talk to a family member about their gambling. Someone needing encouragement to overcome their gambling problems can find inspiration in the stories of others who have walked the same road. And in addition to peer support, they can ask questions of qualified experts in gambling treatment and recovery.
Gamtalk is a non-profit organization providing services across North America and beyond. We are not a substitute for local helpline or treatment services. Rather, we provide encouragement to make that call, and we're there for people who for whatever reason can't make it to a traditional treatment program. We're also there for people who may believe their gambling is getting out of control, but are not yet in need of an intensive treatment program. We were founded and are managed by Dr. Richard Wood, an internationally recognized expert with almost 20 years of experience in the field of problem gambling.
What do visitors get from peer support?
One thing that we have learned at gamtalk, through talking and listening to people who have experienced gambling problems, is that they needed to hear positive recovery stories. Reading such stories shows that that there is hope—it can be done! Many people with gambling problems feel very alone, particularly if they have never talked to anyone about it before. Finding out that others have beaten a gambling problem can be the boost needed to begin the road to recovery. Such stories can also provide practical ideas and strategies that have worked for others. There is no one-size-fits-all approach, so having lots of different options to try is extremely useful. To this end, gamtalk developed the "Stories of Hope" project. The aim is to gather together as many personal stories as possible about successfully managing a gambling problem. To date, we have 27 detailed recovery stories published. Each personal story is published anonymously as a free resource available to everyone.
Last year more than 200,000 people visited gamtalk, and we have found that it has the following advantages:
- many people now turn to Google first to find answers and gamtalk is right there to help.
- provides information and referral to other support and treatment services (local and national).
- particularly popular with women.
- provides hope, reassurance and support from a community of members in similar situations.
- gives support and information to concerned friends, relatives, parents etc.
- is free to use for anyone with concerns or requiring information.
- is easy and convenient to access; available 24/7.
- particularly helpful for people in remote areas and people with mobility issues or other restrictions such as child care considerations.
- provides a high level of anonymity for people who are not yet ready or willing to commit to face-to-face or telephone-based services.
- can be used as additional support in conjunction with treatment services (e.g., counselling).
- can be used to share a variety of strategies for coping with gambling issues.
- provides hope for people who are experiencing problems and highlight warning signs for those in danger of developing problems.
- can help people in recovery to abstain or cut back on their gambling behaviour and reduce impulsive decisions to gamble through accessing the service instead.
What advice would we give for setting up online peer support?
You can build the slickest website in the world and nobody will visit it unless you get the word out. Promoting your service is an essential part of the process. One way to do this is to buy advertising using Google Adwords, so that anyone searching in Google for terms related to problem gambling will see your website link and a description. You can specify the key search words and you can define where (geographically) you want the advert to be displayed (e.g., just Ontario).
Another paid promotion service that works really well is Facebook. Almost everyone has an account now and your ad can be targeted just to people who have visited gambling support groups, have liked gambling-related posts and other relevant criteria. Whilst you can also have a free Facebook page for your service, in our experience this doesn't attract many new visitors to your site. The key difference between a paid Facebook ad and a free Facebook page is that the ad is an anonymous experience for the visitor, whereas visiting or liking the free page is not and may be seen by the visitor's friends.
Sharing links with other relevant websites is one effective and free way to promote your online peer support service. Giving wallet cards with your website link to physical support services (e.g., counsellors, casino support staff) can also be a low-cost way to attract more visitors.
Also, don't expect to build a website and a community to evolve by itself. At first, there will be nobody around to talk to, so expect to have moderators respond to new visitors and have them pose questions and topics to get the conversations flowing. Once you start to get established, try to get people involved. Once you have some regular and trusted visitors, you can try letting them do some supervised moderating. Eventually, the community starts to take on a life of its own, but it takes time and perseverance.
Also, expect to completely redesign your website every four or five years. Websites age incredibly quickly and before you realize it your website is looking very tired and dated.
Finally, be prepared to deal with constant spammers and trolls who will try to disrupt your community. Having good technical support is critical here and it is essential to back up all of your precious community dialogues. One time, gamtalk was held hostage by hackers who demanded money to return our site back to us. Thankfully, we had backups of the entire site and were able to get back online with only minimal downtime and no ransom payments!
Running online peer support services can be very rewarding and we get lots of positive feedback from our visitors, many of which visit gamtalk for ongoing support whilst they also get help from traditional treatment and support services. Overall, it's a lot of work, but it's totally worth it.
Welcome to your NEW blog! We are so excited to curate monthly blog articles contributed by experts from across Canada and around the world. We'll cover important, emerging topics and best practices in problem gambling and technology use prevention and treatment. We hope this blog provides you with new ideas, knowledge and things to consider in your practice.
We also encourage you to ask questions and post comments about your own experiences and insights. Your contributions may help others who are new or seasoned professionals in the field.
Our goal is to provide professionals with opportunities to share and learn from each other about best practices in treatment and prevention of gambling- and technology-related concerns. We know that you're here because providing the best possible care for your clients matters to you.
If you would like to contribute to this blog, please contact us: email@example.com.
The ECR Team
Problem Gambling Institute of Ontario, Centre for Addiction and Mental Health