Problem gambling can affect people throughout their life. Problem gambling in adulthood can lead to psychological, physiological, social, financial and criminal consequences (Shaw et al., 2007; Moghaddam et al., 2014; Battersby et al., 2006; Petry & Kiluk, 2002; Morasco et al., 2006). Therefore, it is crucial to understand and apply evidence-informed screening, assessment and treatment practices for adults with problem gambling.
According to a 2017 CAMH survey, about 1.2 per cent of Ontario adults are at moderate to high risk of experiencing gambling problems (Ialomiteanu et al., 2018). Worldwide, studies have found about 0.1 to 7.6 per cent of adults have gambling problems (Lorains et al., 2011; Williams et al., 2012)
Problem gambling can have many negative consequences in a person’s life (Shaw et al., 2007; Moghaddam et al., 2014; Battersby et al., 2006; Petry & Kiluk, 2002; Morasco et al., 2006) and it can co-occur with substance use and other mental health problems (Lorains et al., 2011). It is therefore, 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 is also important to provide treatment approaches tailored for this population.
This page features information on screening, assessment and treatment approaches for problem gambling in adults (18 years of age and older) and includes ways to apply these treatment approaches in your clinical practice. The content on this page is based on a review of the evidence and was reviewed by an expert in the field of problem gambling.
About problem gambling in adults
Problem gambling is defined as the act of repeatedly engaging in gambling activities that have significant negative impacts (American Psychiatric Association, 2013).
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 (American Psychiatric Association, 2013):
- 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 (Moghaddam et al., 2014; Gambling Research Exchange Ontario, 2017).
What does the evidence say?
In a 2017 Ontario survey, 69.2% of adults said they had participated in one or more gambling activities in the past year (Ialomiteanu et al., 2018). Of these adults, 62.5 per cent gambled most frequently on lottery tickets, while 23.4 per cent gambled on slots or table games at a casino. The remaining 3.7 per cent gambled online (Ialomiteanu et al., 2018).
Adults who gamble report doing so for fun, to win money, to socialize, to support causes and/or to escape (Williams & Volberg, 2013).
Although many engage in gambling activities without developing a problem, about 1.2 per cent of Ontario adults have moderate to high risk of gambling problems (Ialomiteanu et al., 2018).
Cultural factors, social factors and age-related factors can play a role in an adult’s participation in gambling and development of problem gambling (Gambling Research Exchange Ontario, 2017; Raylu & Oei, 2004; Subramaniam et al., 2015). Some of these key risk factors include:
- being male (Hing et al., 2016)
- being a young adult or an older adult (Hing et al., 2016; Subramaniam et al., 2015)
- experiencing mental health problems such as substance use, depression, anxiety, personality disorders or bipolar disorder (Hodgins et al., 2012; Kennedy et al., 2010; Turner et al., 2006)
- having attention-deficit/hyperactivity disorder (Grall-Bronnec et al., 2011)
- experiencing stressful life event(s), including trauma (Hing et al., 2016; Kausch et al., 2006; Turner et al., 2006)
- having problems at school/work (Turner et al., 2006)
- lacking supportive friendships or a romantic relationship (Turner et al., 2006)
- having access to gambling venues and/or activities (Turner et al., 2006)
- experiencing a big win due to gambling (Turner et al., 2006)
- having cognitive distortions or faulty beliefs about gambling (e.g., having a poor understanding of odds, probability and randomness) (Cunningham et al., 2014; Sharpe, 2002; Turner et al., 2006).
Some risk factors may also present as concurrent disorders in adults with problem gambling.
Adults with problem gambling often face various negative consequences, including:
- financial problems (Moghaddam et al., 2014)
- relationship problems (Shaw et al., 2007)
- physical and mental health problems (Morasco et al., 2006)
- work/school difficulties (Moghaddam et al., 2014)
- criminality (Moghaddam et al., 2014)
- suicidality (Battersby et al., 2006; Petry & Kiluk, 2002).
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 (Cowlishaw et al., 2012).
- Motivational interviewing is a counselling approach that addresses a client’s ambivalence toward change and has been studied extensively in adults with problem gambling. Motivational interviewing has been shown to decrease gambling frequency (Toneatto, 2016; Yakovenko et al., 2015), money spent on gambling (Cowlishaw et al., 2012; Toneatto, 2016; Yakovenko et al., 2015) as well as depression and anxiety symptoms (Cowlishaw et al., 2012) after treatment. Gambling frequency is also reduced in the longer term, at nine to 12 months after treatment (Cowlishaw et al., 2012; Sharpe, 2002). It has also been effective in reducing gambling urges, behaviour and symptoms when combined with a relaxation-based practice called imaginal desensitization that helps people control their impulses when faced with gambling triggers (Grant et al., 2009). Motivational interviewing appears to reduce money and days spent on gambling as well as psychological distress in adults even after a single session (Diskin & Hodgins, 2009).
- 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 (Schuler et al., 2016). However, they may be effective in conjunction with CBT or motivational interviewing (Schuler et al., 2016).
- Mindfulness-based approaches teach clients to become aware of and to accept their moment-to-moment thoughts, body sensations and emotions. These approaches appear to reduce the frequency, severity and duration of gambling, in addition
to reducing urges and money spent by adults with problem gambling (Maynard et al., 2018). When combined with CBT, these approaches also appear to reduce gambling behaviours and improve the quality of life of adults with problem gambling (Mcintosh et al., 2016).
- Medications have been studied for the treatment of problem gambling, although no drug is currently approved for this purpose. Opioid antagonists have shown the most promise to date (Menchon et al., 2018).
How do I put 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.
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 (Lorains et al., 2011). Learn more about concurrent disorders.
Use a trauma-informed approach throughout the screening, assessment and treatment process, taking into consideration the influence that past or current experiences of trauma may have on the person’s gambling and their response to treatment (Lorains et al., 2011). 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 barriers.
You can use the following approaches to address problem gambling in your adult clients, either alone or in combination. These treatments can be effective for people at all stages along the continuum of gambling severity.
To help your client with their problem gambling, your CBT practice should include cognitive restructuring, problem solving and relapse prevention components (Cowlishaw et al., 2012; Menchon et al., 2018). Learn more about implementing CBT in your practice.
Incorporating elements of motivational interviewing will allow you to help your client address their ambivalence toward change and remain in treatment (Yakovenko et al., 2015). Important elements of motivational interviewing 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 (Schuler et al., 2016).
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.
Depending on the severity of your client’s 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.
- Offer to involve family members or other loved ones in treatment sessions depending on their relationship. You can also offer to provide support separately to their family members or loved ones (Kourgiantakis et al., 2013).
- Refer them to a local financial or credit counsellor if their gambling has resulted in financial difficulties.
- Online self-help tools are available for people with gambling problems and their family and friends. These include resources and interactive exercises to learn about gambling and how to help.
- CAMH GGTU trainings and webinars are available for professionals working with individuals who are experiencing problems related to gambling, gaming and technology use.
- Gambling Research Exchange Ontario provides knowledge exchange products and information related to gambling.
- ConnexOntario is an information and referral service focusing on mental health, addiction and problem gambling services in Ontario.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: Author.
Battersby, M., Tolchard, B., Scurrah, M. & Thomas, L. (2006). Suicide ideation and behaviour in people with pathological gambling attending a treatment service. International Journal of Mental Health and Addiction, 4 (3), 233–2. Available: https://- doi.org/10.1007/s11469-006-9022-z. Accessed March 26, 2021.
Cowlishaw, S., Merkouris, S., Dowling, N., Anderson, C., Jackson, A. & Thomas, S. (2012). Psychological therapies for pathological and problem gambling. Cochrane Database of Systematic Review, 2012 (11). Available: https://doi.org/10.1002/14651858.CD008937.pub2. Accessed March 26, 2021.
Cunningham, J.A., Hodgins, D.C. & Toneatto, T. (2014). Relating severity of gambling to cognitive distortions in a representative sample of problem gamblers. Journal of Gambling Issues, 29, 1–6. Available: https://doi.org/10.4309/jgi.2014.29.2. Accessed March 26, 2021.
Diskin, K.M. & Hodgins, D.C. (2009). A randomized controlled trial of a single session motivational intervention for concerned gamblers. Behaviour Research and Therapy, 47 (5), 382–383. Available: https://doi.org/10.1016/j.brat.2009.01.018. Accessed March 26, 2021.
Gambling Research Exchange Ontario. (2017). Applying a public health perspective to gambling harm. Available: https://www.greo.- ca/en/programs-services/resources/Applying-a-public-health-perspective-to-gambling-harm---October-2017.pdf. Accessed March 26, 2021.
Grall-Bronnec, M., Wainstein, L., Augy, J., Bouju, G., Feuillet, F., Vénisse, J.L. et al. (2011). Attention deficit hyperactivity disorder among pathological and at-risk gamblers seeking treatment: A hidden disorder. European Addiction Research, 17 (5), 231–2. Available: https://- doi.org/10.1159/000328628. Accessed March 26, 2021.
Grant, J.E., Donahue, C.B., Odlaug, B.L., Suck, W.K., Miller, M.J. & Petry, N.M. (2009). Imaginal desensitisation plus motivational interview- ing for pathological gambling: Randomised controlled trial. The British Journal of Psychiatry, 195 (3), 266–272. Available: https://- doi.org/10.1192/bjp.bp.108.062414. Accessed March 26, 2021.
Hodgins, D.C., Schopflocher, D.P., Martin, C.R., el-Guelbaly, N., Casey, D.M., Currie, S.R. et al. (2012). Disordered gambling among higher-frequency gamblers: Who is at risk? Psychological Medicine, 42 (11), 2433–2444. Available: https://- doi.org/10.1017/S0033291712000724. Accessed March 26, 2021.
Hing, N., Russell, A., Tolchard, B. & Nower, L. (2016). Risk factors for gambling problems: An analysis by gender. Journal of Gambling Studies, 32 (2), 511–515. Available: https://doi.org/10.1007/s10899-015-9548-8. Accessed March 26, 2021.
Ialomiteanu, A.R., Hamilton, H.A. & Mann R.E. (2019). CAMH Monitor 2018: Metadata User’s eGuide. Toronto, ON: Centre for Addiction and Mental Health. Available: https://www.camh.ca/camh-monitor. Accessed March 26, 2021.
Kausch, O., Rugle, L. & Rowland, D.Y. (2006). Lifetime histories of trauma among pathological gamblers. The American Journal on Addictions, 15 (1), 35–43. Available: https://doi.org/10.1080/10550490500419045. Accessed March 26, 2021.
Kennedy, S.H., Welsh, B.R., Fulton, K., Soczynska, J.K., McIntyre, R.S., O’Donovan, C. et al. (2010). Frequency and correlates of gambling problems in outpatients with major depressive disorder and bipolar disorder. Canadian Journal of Psychiatry, 55 (9), 568–575. Available: https://doi.org/10.1177/070674371005500905. Accessed March 26, 2021.
Kourgiantakis, T., Saint-Jacques, M.-C. & Tremblay, J. (2013). Problem gambling and families: A systematic review. Journal of Social Work Practice in the Addictions, 13 (4), 353–563. https://doi.org/10.1080/1533256X.2013.838130. Accessed March 26, 2021.
Lorains, F.K., Cowlishaw, S. & Thomas, S.A. (2011). Prevalence of comorbid disorders in problem and pathological gambling: Systematic review and meta-analysis of population surveys. Addiction, 106 (3), 490–494. https://doi.org/10.1111/j.1360-0443.2010.03300.x. Accessed March 26, 2021.
Maynard, B.R., Wilson, A.N., Labuzienski, E. & Whiting, S.W. (2018). Mindfulness-based approaches in the treatment of disordered gambling. Research on Social Work Practice, 28 (3), 348–353. Available: https://doi.org/10.1177/1049731515606977. Accessed March 26, 2021.
Mcintosh, C.C., Crino, R.D. & O’Neill, K. (2016). Treating problem gambling samples with cognitive behavioural therapy and mindful- ness-based interventions: A clinical trial. Journal of Gambling Studies, 32 (4), 1305–1313. Available: https://doi.org/10.1007/s10899-016-9602-1. Accessed March 26, 2021.
Menchon, J.M., Mestre-Bach, G., Steward, T., Fernández-Aranda, F. & Jiménez-Murcia, S. (2018). An overview of gambling disorder: From treatment approaches to risk factors. F1000Research, 7 (0), 4. Available: https://doi.org/10.12688/f1000research.12784.1. Accessed March 26, 2021.
Moghaddam, J.F., Yoon, G., Campos, M.D. & Fong, T.W. (2014). Social and behavioral problems among five gambling severity groups. Psychiatry Research, 230 (2),143–151 Available: https://doi.org/10.1016/j.psychres.2015.07.082. Accessed March 26, 2021.
Morasco, B.J., Pietrzak, R.H., Blanco, C., Grant, B.F., Hasin, D. & Petry, N.M. (2006). Health problems and medical utilization associated with gambling disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Psychosomatic Medicine, 68 (6), 976–979. Available: https://doi.org/10.1097/01.psy.0000238466.76172.cd. Accessed March 26, 2021.
Petry, N.M. & Kiluk, B.D. (2002). Suicidal ideation and suicide attempts in treatment-seeking pathological gamblers. Journal of Nervous and Mental Disease, 190 (7), 462–464. Available: https://doi.org/10.1097/00005053-200207000-00007. Accessed March 26, 2021.
Raylu, N. & Oei, T.P. (2004). Role of culture in gambling and problem gambling. Clinical Psychology Review, 23 (8), 1087–1111. Available: https://doi.org/10.1016/j.cpr.2003.09.005. Accessed March 26, 2021.
Schuler, A., Ferentzy, P., Turner, N.E., Skinner, W., McIsaac, K.E., Ziegler, C.P. et al. (2016). Gamblers Anonymous as a recovery pathway: A scoping review. Journal of Gambling Studies, 32 (4), 1261–1312. Available: https://doi.org/10.1007/s10899-016-9596-8. Accessed March 26, 2021.
Sharpe, L. (2002). A reformulated cognitive-behavioral model of problem gambling: A biopsychosocial perspective. Clinical Psychology Review, 22 (1), 1–25. Available: https://doi.org/10.1016/S0272-7358(00)00087-8. Accessed March 26, 2021.
Shaw, M.C., Forbush, K.T., Schlinder, J., Rosenman, E. & Black, D.W. (2007). The effect of pathological gambling on families/marriages, and children. CNS Spectrum, 12 (8), 615–616. Available: https://doi.org/10.1017/S1092852900021416. Accessed March 26, 2021.
Subramaniam, M., Wang, P., Soh, P., Vaingankar, J.A., Chong, S.A., Browning, C.J. et al. (2015). Prevalence and determinants of gambling disorder among older adults: A systematic review. Addictive Behaviours, 41, 199–202 Available: https://doi.org/10.1016/j.add- beh.2014.10.007. Accessed March 26, 2021.
Toneatto, T. (2016). Addictive behaviors single-session interventions for problem gambling may be as effective as longer treatments: Results of a randomized control trial. Addictive Behaviors, 52, 58–65. Available: https://doi.org/10.1016/j.addbeh.2015.08.006. Accessed March 26, 2021.
Turner, N.E., Zangeneh, M. & Littman-Sharp, N. (2006). The experience of gambling and its role in problem gambling. International Gambling Studies, 6 (2), 237–242 Available: https://doi.org/10.1080/14459790600928793. Accessed March 26, 2021.
Williams, R.J. & Volberg, R.A. (2013). Gambling and Problem Gambling in Ontario. Report prepared for the Ontario Problem Gambling Research Centre and the Ontario Ministry of Health and Long Term Care. Available: http://hdl.handle.net/10133/3378. Accessed March 26, 2021.
Williams, R.J., Volberg, R.A. & Stevens, R.M.G. (2012). The population prevalence of problem gambling: Methodological influences, standardized rates, jurisdictional differences, and worldwide trends. Available https://opus.uleth.ca/bitstream/han- dle/10133/3068/2012-PREVALENCE-OPGRC%20(2).pdf. Accessed March 26, 2021.
Yakovenko, I., Quigley, L., Hemmelgarn, B.R., Hodgins, D.C. & Ronksley, P. (2015). The efficacy of motivational interviewing for disordered gambling: Systematic review and meta-analysis. Addictive Behaviors, 43, 72–82. Available: https://doi.org/10.1016/j.addbeh.2014.12.011. Accessed March 26, 2021.