Information, training and research on problem gambling has been increasingly available in the last few years, in response to the rapid expansion of legalized gambling and consequent concerns about problematic gambling behaviour. There is now a large and growing body of information and experience for new practitioners to access. This chapter introduces the assessment and treatment of people with gambling problems. Although substance use counsellors will find a great deal that is familiar, and will have a head start in this area, there are significant differences in working with this population.

Gambling in a Societal Context

There has been a remarkable proliferation of legal gambling opportunities around the world in recent years, representing an increasing source of revenue for governments and charities. The first commercial casino in Canada opened in Winnipeg in 1984. Since then, over 50 permanent casinos have been added. By 2000, there were 44 permanent horse racetracks and about 60,000 video lottery terminals (VLT's) and slot machines in Canada (Korn, 2000). From 1992 to 2000, net gambling revenues from casinos increased by 573 per cent, and revenue from VLT's and slots increased by 1,369 per cent (Azmier, 2001). There have also been expanding opportunities for bingo, off-track betting, Internet gambling and many other games of chance.

Governments’ reasons for expansion in this area become very clear when revenues are examined. The Province of Ontario anticipates net earnings from gambling of $2.3 billion in 2002–03, representing about 3.5 per cent of total revenues (Ontario Ministry of Finance Quarterly Update, September 2002). Across Canada, the proportion of provincial revenues coming from gambling have on average increased considerably (see Figure 30-1). Provincially run gambling across Canada, consisting of commercial casinos, VLT's and lotteries, produced gross revenues in 2000 of $9.04 billion. The average net loss per Canadian adult was $394.26 (Azmier 2001).

Source: Canadian Centre on Substance Abuse (1997); Azmier (2001).Used by permission.

In addition to government revenues, advantages cited for increased gambling include job creation, economic expansion, increased tourism, support for Aboriginal communities, prevention of illegal gambling, and enhanced revenues for charities. Ontario, for instance, guarantees $100 million of gambling revenue to charities annually through the Ontario Trillium Foundation.

Gambling as a pastime is now far more accepted than it was a decade or two ago, and attracts a broader portion of the population. For instance, a trip to the casino is now a commonplace and respectable outing for women or seniors. Lottery tickets, illegal prior to the Olympic lottery held in 1970, are now a normal part of everyday life. Eighty-three per cent of Ontario adults engaged in some form of gambling in the past year, according to a 2001 study (Wiebe et al., 2001). Gambling is now highly accessible, not just in casinos or racetracks, but also in convenience stores, by phone and on the Internet. In many parts of Canada, VLT's are or have been available in bars and corner stores. Gambling advertising is also ubiquitous, and its messages further normalize gambling behaviour.

Messages from the gambling industry do not typically include the real odds of winning. It is probably a rare gambler who thoroughly understands the odds and makes his or her bets consistent with that knowledge. Cognitive distortions associated with problem gambling will be discussed later in this chapter. However, mistaken beliefs about gambling are part of the current social fabric. For instance, in a survey by the Consumer Federation of America (1999), 27 per cent of respondents believed their best plan for financing their retirement was through lottery winnings rather than through saving and investing.

There is some movement to balance the weight of explicit and implicit pro-gambling messages. All provinces provide funding to promote responsible gambling and to support prevention, research and treatment. For instance, in Ontario two per cent of slot machine revenues are earmarked for this purpose. Such initiatives include training for casino staff, self-exclusion programs, 24-hour helplines, prevention packages for youth, and treatment services.

Along with the upswing in gambling opportunities has come an increase in the number of people seeking treatment for problem gambling. Callers to the Ontario Problem Gambling Helpline seeking treatment resources increased by 49 per cent between 1998 and 2002 (Ontario Problem Gambling Helpline statistics, 2003). A 2001 survey on gambling and problem gambling in Ontario found that 3.8 per cent of individuals 18 years or older reported moderate or severe gambling problems (Wiebe et al., 2001). This translates into about 340,000 Ontarians with such problems. Another 9.6 per cent report minor problems with gambling that indicate some risk. Studies consistently find that levels of problem gambling in youth are about double that of adults (AADAC, 2000; Shaffer et al., 1999).

The downside to gambling expansion can be found in damage to individuals, families and communities affected by problem gambling. Excessive gambling affects people’s finances, employment, relationships, and physical and mental health, and these effects can range from mild to extreme. The results may include chronic poor levels of functioning, bankruptcy, job loss, legal trouble, family breakups or child neglect. A gambling problem generally affects a number of people in a widening circle of stress and loss.