Skip Ribbon Commands
Skip to main content

Youth Problem Gambling

​Problem gambling can affect people across their lifespan. Youth have higher rates of problem gambling than adults1–3 and different factors that affect their problem gambling risk.4 It is important to understand and apply developmentally appropriate screening, assessment and treatment practices for youth with problem gambling.8–10

illustration of therapist extending empathy to client


Gambling, Gaming & Technology Use
Knowledge Exchange

youth

In this section, the term youth refers to people aged 12 to 24 years, with slight variations based on the available evidence. Within this age range, youth differ in terms of developmental stage and whether they are legally allowed to gamble in Ontario. It is important to keep these differences in mind while reading and applying the evidence in this section. 

Young people aged 10 to 24 years have higher rates of problem gambling than adults.1–3 Youth with problem gambling also frequently experience co-occurring mental health problems.5 It is therefore crucial to provide early screening, assessment, and treatment for problem gambling tailored specifically for youth and their developmental stage.

This webpage looks at the evidence on screening, assessing, and treating youth with problem gambling, and shows you how to put it into practice. This information for mental health and addiction service providers is based on a review of the evidence and was reviewed by experts in the field of youth problem gambling.

About problem gambling in youth

Problem gambling is defined as repeated engagement in gambling activities that leads to significant negative impacts in a person's life.6

The Diagnostic and Statistical Manual of Mental Disorders (DSM), Fifth Edition―the primary tool used to classify and diagnose mental health disorders in North America―requires four or more of the following criteria to be met for a diagnosis of gambling disorder:6

  • frequent thoughts about gambling
  • unsuccessful attempts at controlling, quitting or cutting back on gambling
  • needing to spend increasing amounts of money to get the same level of excitement (i.e., tolerance)
  • being irritable when quitting or limiting gambling (i.e., withdrawal)
  • gambling when feeling distressed
  • lying to cover up gambling
  • chasing losses
  • relying on others for financial help after a gambling loss
  • risking or losing an important relationship, employment, or educational opportunity due to gambling.

Due to evolving definitions and classifications, terms such as pathological gambling and compulsive gambling are interchangeable with gambling disorder in the literature. However, we use the term "problem gambling" 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.7,8

youth-continuum.jpg

Although most gambling activities are illegal for adolescents, youth still engage in various types of gambling activities.9 For example, Ontario students in grades seven to 12 report gambling predominantly on dares or private bets (11.6 per cent), sports pools (9.8 per cent) and card games (9.4 per cent).1

Whereas adults are more likely to gamble for financial gain, adolescents are likely to gamble for entertainment, to escape negative emotions, to relieve boredom or loneliness, and to socialize or compete with others.9 Younger people are also more likely to take risks, which could lead to problem gambling.9

The worldwide prevalence of problem gambling in youth aged 10 to 24 years is 0.2 per cent to 12.3 per cent.3 In Canada, the problem gambling prevalence rate for youth aged 15 to 24 years is 2.2 per cent.3

In Ontario, a survey of students in grades seven to 12 found a similar prevalence rate.1 The survey also found that males are more likely to have low-to-moderate problem gambling than females.1

youth-OSDUHS.jpg

Research shows young people aged 10 to 24 years have higher prevalence rates of problem gambling than adults.1–3 While these findings may vary due to the context and the tools used to estimate prevalence4,10, the findings point to a need for more research and support services since behaviours formed in adolescence can contribute to problem gambling in adulthood.4

What does the evidence say?

A number of factors can put young people at risk for problem gambling, including:

  • having a parent or other family member with a gambling problem11
  • substance use4,12
  • alcohol use4,13,14
  • depression and anxiety4,13,15
  • trauma16
  • childhood abuse17
  • excessive video game playing18
  • impulsivity/attention-deficit hyperactivity disorder4,13,19
  • difficulty making friends4,13
  • not being connected or close to family members11
  • poor coping skills16
  • not having a sense of belonging at school11
  • being male.4,14

What about social casino games?

Use of free-to-play social casino games, offered through social media sites, apps, or websites, has been linked to problem gambling.10,38 These games typically introduce youth to gambling at an early age, and offer better odds of winning, which can lead to gambling for money.38 The distinction between gambling and gaming has also been blurred in other ways that make gambling more appealing and accessible to younger people. Examples include skill-based gambling and gambling elements within video games39, such as loot boxes.

Many of these risk factors can also co-occur with problem gambling in adolescents, including substance use disorders and mood or anxiety disorders.5

Youth with problem gambling can face a number of negative consequences, including:

  • substance use problems12
  • mental health problems9,12
  • problem video gaming20
  • criminal behaviour9,21
  • family problems (e.g., parenting difficulties, family conflict)9,11
  • social/interpersonal difficulties9,22
  • difficulties in school9,22
  • financial problems.9,23

 In Ontario, students in grades 7 to 12 with problem gambling have been found to have higher rates of suicidal ideation and attempts.21

Currently, there are no universal best practices for the treatment of youth with gambling problems.24 Since few youth get referred to or access treatment, there is little research in this area and most treatments used in practice are based on what has been proven effective for adults.24 The following approaches have shown some promise for the treatment of youth problem gambling:

  • Cognitive-behavioural therapy (CBT) is a time-limited form of psychotherapy that teaches clients to shift their thoughts and behaviours related to gambling and respond to their urges in a more healthy way. CBT was found to improve gambling outcomes and illusions of control up to six months after treatment when offered as weekly, one-on-one sessions over three months to youth aged 17 to 19 years25 and as weekly group sessions over four or six weeks to college students aged 19 to 25 years.26
  • Motivational and personalized feedback approaches, either offered separately or together, have shown some promise for addressing problem gambling in college students aged 18 years and older.26–29 A motivational approach (i.e., motivational interviewing or motivational enhancement therapy) is a person-centred counselling style that addresses ambivalence towards change and emphasizes personal autonomy, while personalized feedback focuses on correcting perceived norms about gambling.24 Two studies examined brief interventions with both motivational and personalized feedback elements and found an improvement in gambling outcomes.26,27 Other studies have found that personalized normative feedback or becoming aware of the gambling norms of peers can help prevent problem gambling in college-aged students.28,29

Parental gambling increases the likelihood of gambling participation30 and problem gambling in youth.31 On the other hand, parental monitoring, connectedness, and involvement in a youth's life leads to fewer gambling problems, although this may be age- and situation-specific.11,32 Therefore, it may be beneficial to involve parents and family in treatment as appropriate.


Putting the evidence into practice

When providing clinical care to a young person who may have a gambling problem, it is important to consider their developmental stage, needs, and goals. The following screening, assessment, and treatment approaches can be effective for youth at any point along the continuum of gambling severity.

It is also important to know Ontario's age of medical consent as well as confidentiality requirements detailed in the Personal Health Information Protection Act and by your regulatory college.

Screening and assessment

Although most screening tools for youth have been adapted from adult versions24, the following have been validated for use in adolescents33:

If you determine that your client has a gambling problem, an assessment will help you understand their gambling behaviours and any co-occurring mental health problems, medical conditions, or environmental factors that may be contributing to the problem.24 For instance, you should screen your clients for bipolar disorder because they may gamble excessively during periods of mania and may benefit from treatment of the underlying condition.5,6 Learn more about screening and assessment

Treatment

Cognitive-behavioural therapy

When offering CBT sessions to your young client, whether individually or in a group, focus on functional analysis, correcting cognitive distortions, identifying and coping with triggers, addressing illusions of control, developing social skills (such as assertiveness), and preventing relapse.25–27 In addition, offer brief interventions as these may be more suitable for younger clients.24 Learn more about CBT.

Cognitive-behavioural therapy handouts are available for clients 18 years of age or older and may be helpful for your younger clients. These handouts focus on topics such as understanding gambling, cognitive restructuring, dealing with urges, and preventing slips and relapses.

Motivational and/or personalized feedback approaches

You may wish to include motivational interviewing and/or personalized feedback in sessions with your young client, as these have been effective for college-aged students26,27 and may also have benefits for younger clients.

When engaging in motivational interviewing with youth coping with addictions, it is important to use the spirit of motivational interviewing, which employs elements of partnership, acceptance, compassion, and evocation (i.e., drawing out what your client already has within themselves to address their needs).34,35 There are a few important skills that can help you engage, explore, evoke, and plan, which can be remembered by the acronym OARS:34

  • Open-ended questions engage your client in a conversation. Use questions that begin with "What," "How," or "Tell me about…" For example: 
    • "What do you think your friends' parent(s) say to them about gambling?"
    • "What are some of your mom or dad's worries about your gambling?"
    • "What worries you most about your gambling?"
    • "What have you tried in the past that has worked?"
    • "What do other people who are concerned about you say to you when you talk about this with them?"
    • "What would make this session most helpful for you?"
  • Affirmations highlight the positive and help your client feel supported and encouraged. For example, "I'm glad you were able to make it here today."
  • Reflections are ways to paraphrase what your client says. For example, "It sounds like your parents are worried about you, but they may not always use an approach that is helpful."
  • Summaries are reflections that touch on different topics that your client has discussed during a session. For example, "What I have heard you say is that you have concerns about school, feeling anxious, and gambling." Summaries can also be expressed as affirmations.

Learn more about motivational interviewing.

In conjunction with motivational interviewing, you can also provide your client with personalized feedback about peer norms to stimulate discussions about their goals and to promote behaviour change.26,27  

Other considerations

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

  • If your client is experiencing co-occurring mental health problems, it is important to address these alongside their problem gambling.5 It is also important to work together with your client's other healthcare provider(s) to ensure they receive coordinated care.
  • If your client expresses suicidal thoughts, it is crucial to address these immediately. Learn more about suicide and problem gambling.
  • If your client consents, consider involving family members in treatment sessions and/or providing supports to family members separately, as is done with adults.36,37 Parents can benefit from information about youth problem gambling, including ways to address it and engage the youth in treatment.

Resources for clients and family members

The following websites provide additional information about youth gambling:


References





Last modified: May 22, 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