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Adolescent Problem Gambling

Adolescence (from 12 to 17 years of age) and young adulthood (from 18 to 24 years of age) denote times of increased emotional lability, impulsivity and independence from guardians, which puts these populations at a particularly high risk for problem gambling (Kourgiantakis et al., 2017).

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Adolescents have higher rates of problem gambling than adults and face a diverse set of risks and impacts. Adolescents with problem gambling commonly have mental health problems including substance use; however, they are often underrepresented in treatment. Given the multitude of risk factors facing adolescents, providing early screening, assessment and treatment for problem gambling are crucial. In this evidence-informed practice section, problem gambling in adolescent populations (12 to 17 years of age)—inclusive also of young adults (18 to 24 years of age)—will be discussed.

Key Concepts​

The term adolescent in this section is used to refer to a broad group of young individuals aged 12 to 24 years. These ages are highlighted here since this is when young people are most vulnerable to developing mental health challenges, including problem gambling (Kourgiantakis et al., 2017). Learn more about why this age group was selected.

A variety of risk factors, signs and consequences related to problem gambling affect young people. In addition, different developmental tasks, issues and rates of problem gambling are evident within the 12-to-24-year age group. For instance, experiences and stressors may be different for teenagers who are starting to become more independent from their guardians compared to young adults who are leaving home. These differences need to be considered when thinking about risks, signs, consequences and treatments. Learn more about different development tasks as they relate to problem gambling within this age group.

The social attitudes of teachers, mental health professionals and parents toward gambling can also impact adolescent gambling behaviour. Increasing awareness and understanding among professionals and parents can help reduce the risks and harms associated with adolescent problem gambling.


How are adolescents different from adults who gamble?

The characteristics below are specific to young people and can put youth at higher risk for problem gambling:

  • Adolescence is a time when people are most inclined to take risks.
  • Youth are less likely to foresee future negative consequences stemming from a pattern of problematic gambling. This may be explained by neurological development as well as limited lived experience.
  • Youth may have more disposable income because guardians may cover their expenses.
  • Youth who are financially supported by guardians or family members may be sheltered from some of the financial consequences of problem gambling, among other consequences, and may be unlikely to see the need for treatment.

In addition, youth may have compelling reasons to gamble that are related to their sense of self. Some of these reasons are:

  • to be included in a peer group that gambles
  • to complete a rite of passage once they are legally allowed to gamble
  • to forge a personal identity
  • to seemingly fast-track their way to financial independence and avoid dependence on minimum-wage jobs.

Adolescents are a diverse population, and so are people with gambling problems. For example, within the 12-to-24-year age group, different developmental tasks (milestones) exist that may affect or be affected by gambling behaviours. Below are some examples.

  • Developing an identity separate from parents and family―Adolescence marks a time when youth are becoming more independent and developing an identity separate from their parents and family, both behaviourally and cognitively. In the context of problem gambling, this may mean that youth who are not yet fully autonomous from their parents may not recognize their parents’ or family’s gambling involvement as problematic, normalizing the problem behaviours for the youth and possibly making them more likely to participate. Youth whose parents and family members discourage or forbid gambling may be less likely to gamble, as this has been shown to be a protective factor. However, if youth with restrictive parents do develop gambling problems, this can create distance and family conflict.

  • Identifying one’s own values and priorities―As adolescents begin to discover their values and priorities and select role models, an opportunity presents itself for the positive impact of others around them to influence their behaviours. This can include parents, family members and others who are older than the adolescents. Conversely, risk also exists when others of influence are not present or do not have a positive impact.

  • Negotiating and compromising within peer relationships―Negotiating and compromising within peer relationships starts in early to mid-adolescence and declines in later adolescence and young adulthood, when there is somewhat of a return to family. Adolescents who are at risk for gambling problems may be impressionable and susceptible to influence―particularly from peers who may be involved in risk-taking, impulsive, novel or experimental behaviours. This can lead the adolescent to socially driven forms of gambling (e.g., poker) as well as other risky behaviours that are commonly linked to problem gambling, including substance use.

  • Expanding intellectual interests―As adolescence merges into young adulthood, youth begin to expand their intellectual interests and knowledge. This in part requires a focus on school achievements. However, if youth are participating in problematic behaviours such as gambling, this can lead to poor academic performance and problems at school.

  • Developing the ability to delay gratification―Developing the ability to delay gratification and think about the implications of one’s behaviour (e.g., continued gambling, stealing money, etc.) are other developmental tasks that occur in adolescence. If youth experience a reinforcing “big win” early on in their gambling, this can lead to a greater need for instant gratification and affect the ability to reach this developmental milestone.

Source: Clinical examples and information on developmental tasks provided by Rob Bancroft, advanced practice clinical leader with the Child, Youth and Emerging Adult program at the Centre for Addiction and Mental Health.

Prevalence

Adolescents are at a particularly high risk for problem gambling, typically having higher rates of problem gambling than adults. Overall, males are at higher risk than females, with males having rates of gambling that are two to three times higher (Ferris & Wynne, 2001).

According to research from the Centre for Addiction and Mental Health’s Ontario Student Drug Use and Health Survey (2015), below are the prevalence rates for past-year gambling participation and problem gambling among Ontario high school students:


Gambling & problem gambling rates for Ontario high school studnets


How does this compare to prevalence rates worldwide? According to St-Pierre and Derevensky (2016), approximately 0.9% to 8.1% of adolescents and 7.2% to 12.3% of college students worldwide met the diagnostic criteria for disordered gambling.

As gambling activities become more readily available through the Internet, the prevalence of gambling and problem gambling will likely increase.

Risk factors

Many factors can put someone at risk for developing gambling problems. Many adolescents with a gambling problem are also coping with mental health problems, including depression and substance use.

The following realities, behaviours and experiences increase the risks of developing a gambling problem in adolescence:

  • having a parent or other family member with a gambling problem
  • gambling in several different ways
  • abusing or misusing alcohol or other drugs
  • selling drugs
  • having depression and/or anxiety
  • having mental health problems and/or a high level of distress
  • experiencing suicidal ideation and/or suicidal behaviour
  • having experienced abuse in childhood
  • facing major negative life events or traumatic experiences
  • stealing
  • playing video games excessively
  • getting into fights
  • having attention-deficit/hyperactivity disorder or impulsive behaviours
  • having difficulties with friends and lacking social support
  • not having a sense of belonging at school
  • not being connected or close to family members
  • being male
  • having poor coping skills or coping by escaping or avoiding.

Gambling behaviours

Many adolescents are gambling offline as well as online, despite the age restrictions. Today there are many different ways adolescents and young adults can gamble offline, including:

  • playing casino games
  • betting with cards
  • betting with dice games
  • betting on skill-based games, such as golf or pool
  • betting on sports (including sports pools and sports lotteries)
  • betting on races, such as horse races
  • playing lottery tickets or raffle games, such as Keno or tombola
  • playing slot machines
  • using scratch-and-win or pull-tab tickets, such as Nevada tickets.

Although not an exhaustive list, this can also include bets or wagers made with friends (e.g., betting with friends on the outcome of a soccer game).

The ubiquity of technology and access to the Internet has created more opportunities for youth to gamble online. Sports pools are the most common form of online gambling among students in grades 7 to 12 in Ontario (Boak et al., 2015). Some youth start with free online gambling games, known as social casino games, available through social media sites. This can be risky, as it normalizes gambling for youth. These games often have better odds as well, which gives youth the impression they are more skilled at the game and/or that their odds of winning when participating in gambling games are better than they actually are.

As mentioned, adolescents who play a greater variety of games have an increased risk of problem gambling. Online gambling, Internet use and video games are also associated with higher rates of problem gambling in youth.

Online gambling can include:

  • online sports betting
  • playing Internet poker and other card games
  • using virtual casinos and slot machines
  • video-game betting (e.g., betting on outcomes, in-game betting, etc.)

Signs

The signs of problem gambling in adolescents can look similar to other problem behaviours, such as substance use. It is therefore important for professionals to ask specific questions about gambling. The signs of problem gambling in adolescents can be similar to those in adults, but there are some important differences to consider. School-related issues and possession of fake identification (ID) in order to gamble at age-restricted venues are issues specific to adolescents. Additional signs of gambling include:

  • skipping school
  • being preoccupied with Internet gambling sites, sports results and/or TV poker
  • missing money without an adequate explanation
  • borrowing or stealing money from friends and family
  • selling or losing possessions
  • having large, unexplained amounts of cash
  • having fake ID(s), casino entry card(s) or racetrack receipt(s) among belongings
  • leaving an Internet trail.

Adolescents are more independent from guardians and family members and place great importance on relationships and activities outside the home. These common features of this developmental stage when paired with worry, shame and secrecy about gambling behaviours can make recognizing the signs and symptoms of problem gambling in youth particularly difficult for families.

Consequences

Problem gambling can hurt both the person who is gambling and the people around them. In fact, for each person with a gambling problem, between eight and 10 other people are directly affected in some way.

The severity levels of problem gambling and its consequences are on a continuum. When problem gambling is severe, more consequences tend to be present. However, adolescents can experience consequences of gambling behaviours even if they are not gambling problematically—for instance, getting caught participating in age-restricted gambling activities while underage. Consequences for youth and their families can include:

  • financial problems
  • problems with stealing or other legal/criminal issues
  • secretiveness and lying
  • school issues, such as attendance, academic, behavioural, social and interpersonal concerns
  • mood swings or irritability
  • problems related to mental and physical health
  • suicidality
  • substance use problems
  • excessive time spent playing video games or using technology such as a computer or phone
  • parenting difficulties and/or disagreements between parents on how to deal with the gambling problem
  • arguments between family members
  • physical, verbal and emotional abuse between family members
  • discomfort talking about the gambling problem with other family members or friends
  • loneliness and isolation.

Social attitudes toward gambling

Marketing and advertising for gambling is ubiquitous, with 61% of young people reporting that gambling advertisements have been sent directly to their email as spam and 96% having seen gambling advertisements on television (Derevensky et al., 2010). The advertisements not only depict gambling as a highly exciting and entertaining activity but also make winning look easy and frequent. These advertisements may influence youth to gamble and engage people who are already having difficulty with gambling.

The attitudes of parents, teachers and mental health professionals toward gambling can also impact the gambling behaviour of adolescents. Many parents do not think gambling is a risky activity and may introduce their children to gambling by purchasing a lottery ticket for them or involving them in games like poker. Many teachers and mental health professionals see gambling as a less risky and less serious behaviour than drug use or other addictive behaviours; therefore, they do not address it to the same extent. For example, Derevensky and colleagues (2014) surveyed Ontario public and private high school teachers and found that out of 10 adolescent high-risk behaviours, problem gambling was ranked as the least important—with only 20% of teachers indicating it to be a serious problem. These beliefs could impact not only their discussions around problem gambling but also the supports provided to students who may be at risk. The promotion and normalization of gambling, attitudes and role modelling of parents as well as the perception of gambling as less risky than other behaviours impact the way adolescents view gambling.

Barriers to treatment

Gambling is often referred to as a “hidden addiction.” In addition to it being easier to hide than a substance use problem, youth are often gaining increased independence from family and spending more time with peers, which means parents may have fewer opportunities to identify or deal with the problem. Gambling is not typically on the radar of parents, teachers and mental health professionals, so youth are often not educated or asked about their gambling.

Furthermore, few treatment options are tailored to adolescents, which may deter some youth from attending treatment.

Prevention

Addressing the issues early can help reduce the harm and additional risks related to problem gambling. Unfortunately, gambling is not seen as a serious issue in the same way substance use and other social problems are. Raising awareness among parents and mental health professionals about adolescent problem gambling is an important way to help prevent it and reduce the risks.

Currently there is a paucity of prevention programs for adolescent problem gambling, and the ones that do exist focus on raising awareness and do not address protective factors such as school belonging and family cohesion. More needs to be done to improve the awareness and perceptions of problem gambling as a serious issue that requires prevention measures.


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Research Snapshot​

The term adolescent in this section is used to refer to a broad group of young individuals aged 12 to 24 years. This age range was selected based on the available research literature. No studies were included that focused on people over 25 years of age, and research on 12-year-olds was included because it is important to prevent gambling problems as early as possible. In addition, these ages also represent the period when youth are most vulnerable to developing mental health problems, including problem gambling (Kourgiantakis et al., 2017).

Important to note is that current literature does not delineate differences among youth aged 12 to 24 years involved in gambling. Further research is needed to speak to this issue, which will help to inform future supports and treatments for adolescent problem gambling.

Access to gambling

Once believed to be an activity mainly for adults, gambling has engaged increasing numbers of adolescents with each passing year. Adolescents manage to find ways to gamble despite age restrictions, laws and regulations (Derevensky & Gilbeau, 2015).

All Canadian provinces offer some form of gambling in the hopes of increasing gambling-related revenues through technologically delivered games (e.g., gambling using mobile devices and/or the Internet). The rise in technologically delivered games has resulted in an increase in availability, easier accessibility and larger variations in gambling alternatives. All these factors have enabled greater access to gambling activities for underage youth (Derevensky & Gilbeau, 2015). In spite of legal restrictions placed on gambling activities, adolescents have managed to participate in almost all forms of social, regulated and unregulated gambling (Gupta & Derevensky, 1998; Volberg et al., 2010).

Protective factors

In addition to considering the risk factors and consequences of problem gambling for adolescents, it is also important to consider the protective factors they may possess. These factors can help with strength-based counselling and treatments as well as with the set-up of prevention programs. Protective factors for adolescent problem gambling include:

  • being female (Gavriel-Fried & Ronen, 2015)
  • using little or no alcohol (Edgerton et al., 2015)
  • exercising social control (Cheung, 2014; Gavriel-Fried & Ronen, 2015)
  • having the ability to delay gratification (Cheung, 2014; Gavriel-Fried & Ronen, 2015)
  • experiencing few stressful life events (Bergevin et al., 2006)
  • having supportive relationships without conflict (Gori et al., 2015)
  • having parents with restrictive gambling attitudes (Gori et al., 2015)
  • having a cohesive family (Dickson et al., 2008; Goldstein et al., 2013; Leeman et al., 2014)
  • having regular parental monitoring (Goldstein et al., 2013; Hanss et al., 2015; Jonkman et al., 2013)
  • having positive relationships with parents and strong emotional supports (Gori et al., 2015).

Treatment

Although best practices for the treatment of adolescent problem gambling have not yet been established, various treatment modalities have been used for adolescents, many of which are based largely upon treatment approaches for adults (Derevensky & Gilbeau, 2015). These include but are not limited to:

  • psychoanalytic/psychodynamic approaches
  • behavioural approaches
  • cognitive and cognitive-behavioural approaches
  • pharmacological treatments.

While cognitive-behavioural therapy remains the treatment of choice for both adults and adolescents with problem gambling, more attention needs to be given to the underlying motivations that drive adolescent problem gambling. Understanding the underlying problem gambling motivations, personal and social factors, and treatment barriers for adolescents is necessary before best practices in treatment can be established (Derevensky & Gilbeau, 2015). For example, one of the main barriers for determining appropriate treatment(s) for youth is the fact that only a small number of adolescents with gambling problems seek treatment (Derevensky et al., 2011; Hardoon et al., 2003; St-Pierre & Derevensky, 2016). This may be due to a variety factors, including feelings of shame, stigma, denial or failure to recognize that a problem exists and thinking it can be managed without supports―factors that need to be addressed in treatment (Derevensky & Gilbeau, 2015).

St-Pierre and Derevensky (2016) outlined a number of promising interventions for the treatment of adolescent problem gambling in their recent review, including motivational interviewing, personalized feedback and online-based services. They posit that these novel approaches appropriately address a number of common barriers currently facing adolescents, such as accessibility and availability. The evidence bases for motivational interviewing and personalized feedback intervention are discussed below.

Motivational interviewing

The main objective of motivational interviewing is to change client ambivalence and facilitate the transition toward behaviour change through the enhancement of self-efficacy. Motivational interviewing is believed to be particularly appealing to adolescents due to the emphasis on personal autonomy (St-Pierre & Derevensky, 2016). Preliminary research investigating the use of motivational interviewing in adolescents with problem gambling has demonstrated significant reductions in gambling severity, frequency and expenditure at nine-month follow-ups (Petry et al., 2009).

Personalized feedback intervention

Personalized feedback is a brief intervention that focuses on correcting misperceptions of adolescent gambling behaviours, which is believed to lower gambling frequency and in turn reduce negative consequences associated with gambling (St-Pierre & Derevensky, 2016). The feedback is based on questions related to their gambling behaviour, such as frequency, type of gambling activity, money wagered and lost, and any problems associated with gambling. It may also include using gambling screening tools such as the Canadian Problem Gambling Index.

Personalized feedback may be done online or in person and involves getting unbiased information about how an adolescent’s gambling compares with that of their peers. Personalized feedback is not necessarily meant to replace counselling, but studies have found that the increase in awareness and social comparison resulted in changes to gambling behaviour. It can also be useful for age groups that are less likely to attend counselling, such as college-age young adults. Research has demonstrated the efficacy of this approach in decreasing gambling frequency among adolescents (Larimer et al., 2003; Larimer et al., 2012) as well as decreasing co-occurring mental health symptoms (e.g., depression, anxiety and hostility) (Geisner et al., 2015).



Putting it Into Practice

Screening

Screening for problem gambling can be done either formally or informally. You can ask clients a few questions about gambling behaviour, and if any concerns emerge about their gambling, you can move on to using a formal screener. Screening tools can also be helpful in increasing awareness around clients’ behaviour and monitoring progress. Screeners are available that were originally developed for youth; however, screening tools adapted from adult screeners are seen as the best tools for adolescents:

When asking young people about their gambling, it can be helpful to use presuppositional language such as “How often do you gamble?” and “How much do you spend on gambling?” in order to normalize the activity and decrease any fears about being judged. You can also change your language from “gambling” to “betting with money or material belongings on events or outcomes,” using examples like a sporting event or a challenge with a friend. Young people may not relate to the word gambling as it may conjure up images of traditional casino games.

Assessment

Assessing gambling behaviours can happen in a variety of contexts. According to the Canadian Paediatric Society’s position statement on gambling in children and adolescents (2012), to screen for a gambling problem, health care providers should ask:

  • about the frequency of their clients’ gambling, with at least once per week being the threshold for a gambling problem
  • if clients gamble more than planned
  • if clients present with behaviours that indicate they are hiding their gambling from others.

You can include specific questions about gambling within a mental health and/or addictions assessment, asking questions relating to:

  • how long they have been gambling
  • where they gamble
  • when they gamble
  • who they gamble with
  • how much they spend
  • how much money they owe/how much debt they have
  • what type of gambling games they play
  • what they like about gambling
  • if anyone has expressed concern about their gambling
  • what the negative impacts of gambling are on the various aspects of their life.

It can also be helpful to get collateral information from family members, particularly when youth are still living with their parents/guardians and siblings.

Using a motivational interviewing approach can elicit information about clients’ mental health history, including addictions, and can be helpful when offering feedback. Asking permission before providing impressions and information can promote an environment of respect. Ensuring confidentiality, even when parents are involved in the program, is also important in fostering trust and comfort.

Treatment

Since problem gambling is not typically at the forefront of concerns for parents, teachers and mental health professionals, adolescents with problem gambling are unlikely to be referred for or seek out treatment. Currently there is also a lack of research on effective treatment options for adolescents with problem gambling and no clear guidelines on best treatment practices.

In addition, few specialized treatment options exist for adolescents. Given the low numbers of youth in most gambling treatment programs, they may be referred to groups with adults. However, youth-specific services are more effective than mixing young people with adults in a single treatment group. Depending on the age and maturity level of the clients and the lack of others close to their age within the treatment group, it may be more beneficial to treat younger clients individually.

Many of the treatment approaches for youth have been adapted from problem gambling treatments for adults. This can be problematic because it does not consider the diverse developmental aspects and challenges of adolescence. However, there is some evidence to support the effectiveness of cognitive-behavioural therapy (CBT) and motivational interviewing with this population. Motivational interviewing has an emphasis on autonomy, which may lend itself well to this particular age group.

Personalized feedback intervention (PFI) is a type of brief intervention that involves correcting misrepresentations of youth gambling behaviour by comparing their behaviours to normative behaviours of a peer group. Youth who believed their friends gambled more frequently, spent more money and thought that important people in their lives approved of their gambling were more likely to experience negative consequences related to gambling. Geisner and colleagues (2015) showed that one session of PFI was associated with less gambling and fewer mental health symptoms six months after the session. This could be related to the importance of peer relationships and self-image at this developmental stage.

Young people regularly use the Internet to access help and look for information related to mental health problems. Emerging evidence suggests that providing online services for youth with problem gambling is advantageous and effective. An example of this was a pilot project by McGill University’s International Centre for Youth Gambling Problems and High-Risk Behaviors called gamtalk4teens. It was a real-time chat line for teens and young adults using instant-messaging software. Anecdotal evidence indicated that it was helpful for users of the service.

The lack of youth representation in problem gambling treatment has made it difficult to study treatment efficacy. The research that has been done endorses CBT, motivational interviewing and PFI as showing some benefit. Given the comfort that youth have with technology and the likelihood they will look for help and information online, this could be a promising way to support youth with problem gambling. In addition to these modalities and delivery methods, helping youth develop good coping skills and providing support for families in treatment on improving relationships can reduce risks and help support recovery.


Responding to co-occurring issues

Youth with problem gambling are more likely to have other mental health problems―including addictions to substances and/or behaviours (e.g., gaming, etc.)―when compared to the general population. It is important to ask about any mental health diagnoses or problem behaviours they may be experiencing. They may not have a diagnosis when they come to treatment, but you may suspect the presence of other issues such as depression and/or anxiety. Screening tools can help identify co-occurring problems your client may be experiencing. An example of a screener that has been validated for use with adolescents is the Global Appraisal of Individual Needs Short Screener (GAIN-SS; page 23). Learn more about additional screeners for concurrent disorders.

Screening can help identify the need to refer your client for psychiatric consultation or to a specialized mental health clinic. It is important to work with these professionals and organizations to provide integrated care for your client’s problem gambling and concurrent disorder(s).

Offering education about the link between problem gambling and co-occurring mental illness can also be helpful in normalizing their experience and decreasing stigma. Learn more about concurrent disorders.

Other issues such as finances, legalities, housing and family conflict may also need to be assessed and included in a treatment plan. Often, if the issues connected to gambling are not addressed, it can be hard to recover.


Involving families

Problem gambling impacts all families, including those of adolescents. Families can also have an impact on the person with problem gambling; therefore, whether or not they are involved in treatment will impact their loved one’s recovery. Parenting issues and family conflict are both linked to adolescent problem gambling. Involving family in treatment will not only provide support and information to impacted family members but may also help address conflict and parenting issues. In situations where parents have insisted the youth present for treatment, focusing on familial issues may take priority over gambling behaviours.

Families can be involved in a number of ways, such as receiving psychoeducation, being invited into session(s) with their loved one, having their own counsellor, attending a group for families and/or engaging in family therapy. It can be helpful to let the youth and their loved ones know how family involvement in treatment can positively impact recovery from problem gambling.

It can be common for parents to “bail out” their youth when they find out about gambling debts. It is important that families know what they can do to support change and how minimizing consequences for the person with a gambling problem can negatively impact motivation and recovery. Involving parents in treatment may include discussions about limit setting, communication strategies and rebuilding trust with their child.


Important considerations

Role of technology

Young people have always known a world with Internet access and technology such as Smartphones, computers and tablets. They often have a great deal of comfort with these media and spend a lot of leisure time online. In addition to comfort, the level of access and pervasiveness of the Internet and technology has increased availability of online activities, including gambling. Adolescents can access online gambling sites more easily than other gambling venues because they can pass the age verification more easily.

In addition to online gambling, gambling games exist that can be played online for points (known as social casino games) as well as online video games with gambling elements embedded within them, which may prime youth for gambling at a later age.

In recent years, the gambling industry has used technology to develop more online games and gambling sites that are accessible, affordable and more attractive to younger audiences. This “gamification of gambling” includes but is not limited to adding gambling elements to games on social media and adding social/video gaming features to online gambling sites. There are growing concerns surrounding the blurred lines between gaming and gambling, as this could increase the risk of developing problem gambling.

Motivation and engagement

Youth that present in treatment may have been forced to be there by their parents and may be reluctant to engage. Time should be spent working on engagement, building an alliance and gaining trust. Many adults that attend treatment for gambling do so because they are dealing with serious financial and relationship consequences. They may be at risk of losing their spouse/partner, their job and/or their housing. Youth are not likely to be dealing with the same consequences as adults and as a result may be less motivated to get treatment. Building a relationship with a young client and being curious and non-judgmental about their gambling behaviour can help create opportunities to explore why gambling has become problematic for them and how they can minimize risks in the future.

Working with clients through a health equity lens

Social factors can play a crucial role in our overall physical and mental health. These can include one’s education, income, job security/working conditions, childhood development, food insecurity, housing, health services, Indigenous status, gender, race and disability status. These social factors, known as the social determinants of health, can affect how people―including clients seeking problem gambling treatment―view their symptoms, what symptoms they report, when and what treatments they seek and who may be involved in their care. Social factors of both the client and the health care practitioner can also lead clients to experience systemic disparities in the quality of health care received as well as access to services. For instance, the rate of hospitalization for mental illness among people in the lowest income level is two times higher than the rate in the highest income level.

Health equity is an important perspective with which to evaluate our health care practices to reduce or remove the avoidable, unjust and unfair disparities that exist for specific populations. In providing care, it is essential to consider all factors that may affect your clients’ health, including their gambling problems, concurrent disorders and social determinants of health.

Social factors can play a role in the development, assessment and treatment for adolescent problem gambling. Below are a few examples.

  • Given that most adolescents are often still living with and dependent upon their caregivers, the social determinants of health must be considered for both the adolescents and their caregivers when assessing and treating youth with problem gambling. For example, caregivers who have to work multiple jobs may not be able to see their adolescent child as often, thereby making it more difficult to identify a problem as quickly. Socioeconomic status, location, access to transportation and other factors may also mean that caregivers are unable to attend treatment with their child and/or that the youth may be unable to attend extra-curricular activities or other treatments recommended for their gambling problems. It is crucial to learn more about your client and how the social determinants of health may apply to them.

  • Social factors can also play a role in why youth gamble. Gambling is more prevalent in certain cultures and may be embedded in how they socialize and celebrate, which may have implications for the detection of the problem, youth’s comfort level of telling someone they have a problem and the potential for relapse if exposure to gambling is ongoing. Adolescents who grow up in cultures where gambling is a highly normalized activity may be at increased risk of developing problem gambling.

  • Conversely, gambling is prohibited or frowned upon in certain religious and cultural communities, which can be protective for youth. However, if a young person does develop a problem with gambling, this can create distance and isolation from their parents, family and community.

  • Cultural background, among many other factors, can influence help-seeking behaviour as well as beliefs about addiction and mental illness. Adolescents might be fearful about their family finding out they have a gambling problem. They may also have been given strong messaging about dealing with things within the family as opposed to seeking outside professional help. It is important to have some cultural awareness and responsiveness when responding to adolescent problem gambling.

  • First Nations, Inuit and Métis youth face additional social factors that may put some at higher risk for problem gambling. According to a review by Wardmann and colleagues (2001), prevalence rates of problem gambling for Indigenous adolescents in North America commonly range from 10.1% to 21%, with an additional 25% of youth being at risk. Subsequent studies have examined why problem gambling prevalence may be elevated in Indigenous youth in Canada, including youth living in urban settings, and social factors such as low family income, stress, abuse, intergenerational trauma, feelings of isolation, racial discrimination and exposure to one or both parents who gamble have been linked to problem gambling. Therefore, it is important for treatments, programs and services to consider these social determinants of health as they pertain to Indigenous youth as well as the diversity of peoples, cultures, languages, histories and experiences of Indigenous youth in Canada.




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Handouts for clients​​​​


Additional Resources

You can also access these websites for more information on youth gambling: