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Adult Problem Gambling

​Problem gambling can affect people across their lifespan. Problem gambling in adulthood can lead to psychological, physiological, social, financial, and criminal consequences.1–5 Therefore, it’s important to understand and apply evidence-informed screening, assessment, and treatment practices for adults with problem gambling.




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According to a 2017 CAMH survey, about 1.2% of Ontario adults had moderate to high risk of gambling problems.6 Worldwide, studies have found about 0.1 to 7.6 per cent of adults have gambling problems.7,8

Problem gambling can have many negative consequences in a person’s life1–5 and it can co-occur with substance use and other mental health problems.7 Therefore, it’s crucial to provide early screening and assessment for adults who may have problem gambling or who have a mental health problem that may put them at risk for problem gambling. It’s also important to provide treatment approaches tailored for this population.

This webpage features information on screening, assessment, and treatment approaches for problem gambling in adults (18 years of age and older) and ways to apply treatment approaches in your clinical practice. The content on this webpage is based on a review of the evidence and was reviewed by an expert in the field of problem gambling.

For more information on youth problem gambling, including information specific to young adults (aged 18 to 24), click here.

About problem gambling in adults

Problem gambling is defined as the act of repeatedly engaging in gambling activities that leads to significant negative impacts.9

The Diagnostic and Statistical Manual of Mental Disorders (DSM), Fifth Edition―the primary system used to classify and diagnose mental health problems in North America―requires that a person exhibit four or more of the following criteria to be diagnosed with gambling disorder:9

  • Has frequent thoughts about gambling.
  • Has made unsuccessful attempts at controlling, quitting, or cutting back on gambling.
  • Needs to gamble more money to get the same level of excitement (i.e., tolerance).
  • Is irritable when quitting or limiting gambling (i.e., withdrawal).
  • Gambles when feeling distressed.
  • Lies to cover up gambling.
  • Chases losses.
  • Relies on others to help with financial distress that results from gambling losses.
  • Risks or loses an important relationship, job, or educational opportunity due to gambling.

Due to evolving definitions and classifications, terms such as “pathological gambling” and “compulsive gambling” have become interchangeable with “gambling disorder”. The term “problem gambling” will be used in this section because it implies that gambling lies along a continuum from no gambling to gambling disorder, with harms being possible even when gambling is not problematic (see the image below).2,10

youth-continuum.jpg

What does the evidence say?

In a 2017 Ontario survey, about 69.2% of adults said they participated in one or more gambling activities in the past year.6 Of these adults, 62.5% gambled most frequently on lottery tickets, while 23.4% gambled on slots or table games at a casino, and 3.7% gambled online.6

Adults who gamble report doing so for fun, to win money, to socialize, to support causes, and/or to escape.11

Although many engage in gambling activities without developing a problem, about 1.2% of Ontario adults had moderate to high risk of gambling problems.6

Cultural factors, social factors, and age-related factors can play a role in an adult’s participation in gambling and development of problem gambling.10,12,13 Some of these key risk factors include:

  • male gender14
  • being a young adult14 or an older adult13
  • mental health problems such as substance use15, depression16, anxiety16, personality disorders16, and bipolar disorder17
  • attention-deficit/hyperactivity disorder18
  • stressful life event(s),15 including trauma14,19
  • problems at school/work15
  • lack of supportive friendships or a romantic relationship15
  • access to gambling venues and/or activities15
  • experiencing a big win due to gambling15
  • having cognitive distortions or faulty beliefs about gambling (e.g., having a poor understanding of odds, probability, and randomness)15,20,21.

Some risk factors may also present as concurrent disorders in adults with problem gambling. Learn more about concurrent disorders.

Adults with problem gambling often face various negative consequences, including:

  • financial problems2
  • relationship problems1
  • physical and mental health problems5
  • work/school difficulties2
  • criminality2
  • suicidality.3,4

The list below describes the treatment options available for adults experiencing gambling problems and related harms.

  • Cognitive-behavioural therapy (CBT) is a time-limited form of psychotherapy that helps clients shift how they think, behave, and respond to gambling urges. It is the most well-established treatment for adults with problem gambling.22 Learn more about CBT.
  • Motivational interviewing is a counselling approach that addresses a client’s ambivalence towards change and has been studied extensively in adults with problem gambling. Motivational interviewing has been shown to decrease gambling frequency23,24, money spent on gambling22–24, as well as depression and anxiety symptoms22 after treatment. Gambling frequency was also reduced in the longer term, at 9 to 12 months after treatment.22,23 It has also been effective in reducing gambling urges, behaviour, and symptoms when combined with imaginal desensitization, a relaxation-based practice that helps people control their impulses when faced with gambling triggers.25 Motivational interviewing appears to reduce money and days spent on gambling as well as psychological distress in adults even after a single session.26
  • Peer support groups (e.g., Gambler’s Anonymous), which bring people with similar problems together to support each other, have had mixed results for people with problem gambling.27 However, they may be effective in conjunction with CBT or motivational interviewing.27
  • Mindfulness-based approaches, which teach clients to become aware of, and accept, their moment-to-moment thoughts, body sensations and emotions, appear to reduce gambling frequency, severity, and duration, as well as urges and money spent by adults with problem gambling.28 When combined with CBT, these approaches also appear to reduce gambling behaviours and improve quality of life of adults with problem gambling.29
  • Medications have been studied for the treatment of problem gambling, although no drug is currently approved for this purpose.30 Opioid antagonists have shown the most promise to date.30

Putting the evidence into practice

Screening and assessment

It is crucial to screen and assess clients to identify problem gambling behaviours and any co-occurring mental health problems. Learn more about screening and assessment practices for problem gambling in adults.

Treatment

Once you have identified your client’s needs and goals, work with them to develop a treatment plan that will address their problem gambling as well as any addictions or other mental health problems they may have.7 Learn more about concurrent disorders.

Throughout the screening, assessment, and treatment process, use a trauma-informed approach, taking into consideration the influence that past or current experiences of trauma may have on the person’s gambling and their response to treatment.7 Learn more about trauma-informed care.

It is also important to remain conscious of potential inequities in the quality and access to care that your client may experience as a result of their cultural or social context, and consider ways to mitigate or remove these inequities.

To address problem gambling in your adult clients, you can use the following approaches, either alone or in combination. These treatments can be effective for people at all stages along the continuum of gambling severity.

CBT

To help your client with their problem gambling, your CBT practice should include cognitive restructuring, problem solving, and relapse prevention components.22,30 Learn more about implementing CBT in your practice.

Motivational interviewing

Incorporating elements of motivational interviewing will allow you to help your client address their ambivalence towards change and remain in treatment.23 Important elements of motivational interviewing will include open-ended questions, active and reflective listening, and acknowledging their efforts to change. You can also incorporate imaginal desensitization with your motivational interviewing techniques, so that your client can use this relaxation-based practice to control their urges whenever they are exposed to gambling situations.

Peer support groups

Discuss with your client whether they might be interested in joining a local peer support group (e.g., Gambler’s Anonymous) to help them build their coping skills and social support network.27

Mindfulness

You can incorporate elements of mindfulness into your client’s treatment plan or refer them to a local mindfulness group.

You can learn more about how to implement mindfulness practices, including those for relapse prevention, with your clients here. You can also teach your clients short mindfulness exercises, such as the Three-Step Breathing Space and Urge Surfing, to help them unhook from the automatic thoughts, feelings and body sensations they experience whenever they feel triggered to gamble.

Other considerations

Depending on the severity of your clients’ problem gambling and concurrent disorders, they may also benefit from these additional supports:

  • Conduct regular suicide risk assessments to determine whether your client needs specialized supports to reduce their risk of harming themselves. Learn more about suicide and gambling.
  • Depending on their relationship, you can offer to involve family members or other loved ones in treatment sessions. You can also offer to provide support separately to their family members or loved ones.31
  • If your client’s gambling has resulted in financial difficulties, you can refer them to a local financial or credit counsellor.

Resources for clinicians

  • Problem Gambling: A Guide for Helping Professionals is a handbook for professionals who may come in contact with people with gambling problems, including mental health and addictions service providers, social and health care providers, workers in the criminal justice system, clergy, and employee assistance program counsellors. This resource is available in both English and French.
  • Problem Gambling: Working with Parents is a pamphlet for professionals working with parents who have a problem with gambling.

Resources for clients and families

References

Last modified: July 17, 2019

This information is intended to help clinicians in their use of evidence-informed practice (EIP) when screening, assessing, and treating clients with behavioural addiction(s). Evidence-informed practice, sometimes called evidence-based practice, is a client-centred approach to clinical decision making. It’s a way to solve problems by integrating the best available research evidence with the clinician’s experience, the client’s preferences and values, and the organizational and cultural context.1,2,3,4

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Disclaimer: Information on this site is not to be used for diagnosis, treatment or referral services and CAMH does not provide diagnostic, treatment or referral services through the Internet. Individuals should contact their personal physician, and/or their local addiction or mental health agency for further information.