Last week, Dr. Scott Wooder, a family physician from Stoney Creek, reported the story of someone who had lost much of their family’s money through problem gambling. In a question to me, he noted that we don’t spend enough time talking about the impact of gambling on people’s and families’ health. I agree with him, and because of my concern that gambling is the fastest growing addiction among Canadian youth, I decided to write about the resources that are available and outline some policies that could be strengthened.
To begin, these are the signals I look for when considering whether a patient may have a problem gambling:
• Money often arises in conversation as an issue. Needing money for bills or other debts may be a trigger for gambling. Also, though, having extra money may also be a trigger for someone with a compulsive need to gamble.
• Extreme changes in mood is another impetus to gambling.
• For many, but especially for young men, boredom can lead to gambling.
• The availability of gambling promotes it, which means that the introduction of online gambling by government is a particular risk since this could make gambling readily accessible, anytime, anywhere, to anyone.
Having access to good information about gambling is important for health care professionals and there are two excellent documents that can be used as resources about gambling. One is the Canadian Paediatric Society’s Position Statement, Gambling in Children and Adolescents. The second resource is the Citizen Brief published by the McMaster Forum in February 2018, Strengthening Collaboration to Optimize Efforts Addressing Gambling-related Harm in Ontario. Both are excellent resources, with up-to-date information. The latter focuses on Gambling-related harm in general, while the first considers gambling in children and adolescents.
While most health care providers are aware of the mental health problems associated with problem gambling, many are surprised to learn that some physical health conditions are also linked to these behaviours. Conditions such as chronic headaches, chronic bronchitis and cardiovascular conditions have all been found to have an association with problem gambling. Problem gambling is linked to personality disorders, mood disorders and substance-use disorders. In the Youth Psychiatry Program at my clinic, we are now routinely screening for problem gambling.
For any person seeking assistance for themselves or a family member with problem gambling, the Canadian Safety Council’s Gambling Helplines are one of the best resources available. These are open 24 hours a day and are completely confidential. Having someone call one of these helplines right from your office and allowing them to experience the compassionate, nonjudgmental advice that they offer, can help a troubled gambler realize that they are not alone and that there is support any time of day or night.
Another resource for schools or for your own practice is the material available through the International Centre for Youth Gambling Problems and High-Risk Behaviors. The Centre has tools proven to promote prevention of gambling problems in young people. These products are innovative and provocative enough to generate discussion among youth.
All the information you review on problem gambling will remind you that further research is still required to better understand the links between problem gambling and its impacts. You can see that, in many of the statements I’ve made regarding problem gambling, associations between problem gambling and other conditions have been found, but clarity as to the meaning of those associations is lacking.
Finally, it’s important to remember that another addiction that needs to be addressed is governments’ addiction to gambling revenues. Gambling raises a lot of money for governments around the world and investments made by the government agencies that manage gaming are not enough to offset the impacts caused by problem gambling. For example, at casinos run by the Ontario Lottery and Gaming Corporation, credit is offered to patrons. Intuitively, that does not seem like a good way to encourage “responsible gambling” (an oxymoron, if I’ve ever heard one).
To address governments’ addiction to gaming, many of the references that I’ve cited suggested policies that would constitute public health measures to limit the harmful effects of gambling. These included:
• Government gaming agencies should completely fund programs aimed at educating the public about problem gambling and providing good access to that information.
• A warning could be given whenever a person begins to use a gaming machine or venue. The information should come up, the way the warning on a cigarette package needs to be evident.
• Government gaming agencies should only operate under those conditions proven to deter problem gambling: e.g. no 24-hour venues, restrictions on the amount of time a person can gamble, restrictions on the money they can spend, etc.
• Governments should stop advertising their gaming operations.
• Government gaming agencies should be accountable for the policies they implement. This would mean that they would do an impact assessment before implementing any new program, like online gaming for example.
As an adolescent psychiatrist, I’ve known youth who gambled away their savings or educational grants for the year. I am confident that every doctor has had patients who’ve lost much more money than this. These individuals develop emotional distress, but their gambling can completely disrupt their work and cost them their relationships. Governments addicted to gaming revenues should not be preying on these poor people to balance their own budgets.