Introduction
The nature and scope of gambling in the province of Ontario and our country has changed dramatically over the past few years. For a generation too young to have lived it, it is probably difficult to imagine a time when the church bingo and horse tracks were the only legal gambling available. Now gambling opportunities are ubiquitous. The gaming industry has grown to become a multi-billion-dollar sector of the economy. In Ontario, it is an eight billion dollar enterprise — bigger than revenues from cinema showings, movie rentals, sporting event admissions and live theatre combined. There is every indication that this rapid and widespread expansion will continue into the foreseeable future.
Most jurisdictions provide an assortment of legal gambling opportunities, which may include casinos, state-sponsored gambling (lotteries, instant scratch-off tickets, pull-tabs, and sports betting), bingo and horse tracks. All this is in addition to the informal gambling activity and illegal betting that has always existed. Other activities that have not traditionally been defined as gambling, such as real estate speculation and some forms of stock market investing, are also problematic for some individuals. Add to this list gambling done over the Internet, or “cybergambling,” which some view as the next major focus of gambling expansion.
The public persona of gambling has also undergone a significant metamorphosis. Rather than being viewed as an illegal and disreputable activity, gambling is being promoted as an attractive form of entertainment that is fun, exciting and potentially lucrative to the player. Given the millions who engage in this activity, it is obvious that people like to gamble.
Why Write this Guide?
While it is important to keep in mind that most people who gamble do so without harming themselves or others, a minority do experience serious personal, social and financial problems as a result of their gambling. This harm also extends to the gambler’s family and to the community in which they live. Determining accurate prevalence rates is problematic; however, studies into the prevalence of problem gambling have shown that in most countries where research has been conducted, three to five per cent of the population show signs of some gambling-related problem. It is also important to note that the prevalence rates of problem gambling for certain groups, such as youth, are much higher. People affected by problem gambling also experience higher rates of other health problems, such as substance abuse and mental illness.
Many parts of the world have witnessed an emotionally charged debate over the costs and benefits of gambling. Whatever arguments are put forth by either side of this important discussion, one fact remains: increasing access to gambling opportunities increases the number of people who experience harm associated with this behaviour. And while there is a general agreement that gambling is here to stay and will likely expand, there is also growing acknowledgment that all levels of government, the gaming industry, health care and social service providers, and other allied professional groups have a responsibility to help those people who are negatively affected by gambling.
This guide has been written to address the need for practical information on the nature and dynamics of gambling problems and how to help affected people and their families. It is intended not only for counsellors who work in Ontario’s designated problem gambling treatment system, but also for clinicians in this province’s addiction treatment system who want to help clients on their caseload who are experiencing gambling-related problems.
The approach we take
This guide does not embody an anti-gambling bias. Gambling is a social reality that is here to stay and it bears repeating that most people gamble without doing harm to themselves or others. However, there is a continuum of risk for, and harm from, problem gambling. The intention of this publication is to support the development of specialized support and treatment services for the minority of people whose gambling behaviour has negative consequences.
This guide has been written with the understanding that people who are affected by gambling problems require helpers to have specialized knowledge, skills and approaches. Historically, the tendency has been to treat people affected by problem gambling as if they had a chemical dependency. Many people affected by problem gambling have been admitted to mainstream addiction treatment programs and told to simply think of gambling whenever they heard “alcohol” or “drugs.” Research and experience has shown, however, that gambling problems are different from substance use problems.
Problem gambling is often a complex phenomenon. Consider the following examples of individuals who experience gambling-related problems:
- an adolescent male with an attention deficit disorder who is “cyber gambling” over the Internet to the extent that he is becoming socially isolated and piling up debts on his unknowing parent’s credit cards
- a man with a long history of criminal behaviour who frequents racetracks on a daily basis and who is stealing to support his habit
- an elderly woman whose frequent trips to casinos, and consequent erosion of her retirement savings, were precipitated by the death of her husband and resulting depression.
This brief list of affected individuals demonstrates the multi-faceted nature of this entity that we call “problem gambling.” It also suggests that this population is a heterogeneous group.
By extension, the above list also suggests that it would be unrealistic to expect that one approach, a single magical therapeutic bullet, would effectively treat this diverse group of people. This handbook does not promote one particular approach to the treatment of problem gambling. Rather, we take the view that the assessment and treatment planning process should unfold based on the characteristics, needs and preferences of the individual client. As a consequence, you will find that this publication has been influenced by many treatment paradigms and approaches — the biopsychosocial model, the transtheoretical model of change (stages of change), motivational interviewing, cognitive-behavioural treatment, solution-focused brief therapy, 12-step approaches, psychodynamic therapy and the social learning model — just to name a few.
Whenever possible, information and recommendations are research based. This handbook has been highly influenced by the international literature on gambling and every effort has been made to incorporate existing scientific data on the etiology, process and treatment of problem gambling. However, systematic research into problem gambling is a quite recent development and many facets of problem gambling have not been examined in a scientifically rigorous manner. Consequently, the knowledge and wisdom gained from the experience our authors have had with people affected by gambling problems are also reflected in this publication.
Our emphasis is on providing practical information and best advice. This handbook has been designed to increase your understanding and empathy regarding the personal experience of people affected by gambling problems, and to help you develop relevant counselling skills aimed at reducing or eliminating the harm caused by gambling. Our hope is that this publication will be a valued resource that provides you with the information and tools you need to meet the unique challenges involved in working with people affected by problem gambling and their families.
Acknowledgments
This publication could not have been produced without the help and support of many individuals. First, I would like to express my sincere indebtedness to all of the contributors and reviewers who shared a common commitment to producing a resource that would make a positive contribution to the field. Second, I am immensely grateful for the financial support provided by the Ontario Substance Abuse Bureau of the Ministry of Health and Long-Term Care. Scott Macpherson, who is now the Co-ordinator of the Bureau, deserves special mention for his keen interest in seeing that this guide was created. There are a number of other specific individuals who deserve acknowledgment for the substantive role they played in the production of this handbook. Caroline Hebblethwaite of CAMH’s Communications, Education and Community Health Program was a valued collaborator on this project. Her expertise and wise counsel is reflected throughout this handbook. In addition, Phil Lange made many important contributions as my Research Associate through the initial planning and shaping of this resource. Finally, Laurie Dickson, my Research Associate through the development of much of this publication, was tremendously supportive to our contributors and provided essential organizational work during the many phases of its production.
Robert D. Murray
December 2000
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