Operational status of mental health, substance use, and problem gambling services: A system-level snapshot two years into the COVID-19 pandemic.

BACKGROUND: The aim of this paper is to provide a system-level snapshot of the operational status of mental health, substance use, and problem gambling services 2 years into the pandemic in Ontario, Canada, with a specific focus on services that target individuals experiencing vulnerable circumstances (e.g., homelessness and legal issues). METHODS: We examined data from 6038 publicly funded community services that provide mental health, substance use, and problem gambling services in Ontario. We used descriptive statistics to describe counts and percentages by service type and specialisation of service delivery. We generated cross-tabulations to analyse the relationship between the service status and service type for each target population group. RESULTS: As of March 2022, 38.4% (n = 2321) of services were fully operational, including 36.0% (n = 1492) of mental health, 44.1% (n = 1037) of substance use, and 23.4% (n = 78) of problem gambling services. These service disruptions were also apparent among services tailored to sexual/gender identity (women/girls, men/boys, 2SLGBTQQIA + individuals), individuals with legal issues, with acquired brain injury, and those experiencing homelessness. CONCLUSION: Accessible community-based mental health, substance use and problem gambling services are critical supports, particularly for communities that have historically contended with higher needs and greater barriers to care relative to the general population. We discuss the public health implications of the findings for the ongoing pandemic response and future emergency preparedness planning for community-based mental health, substance use and problem gambling services.

Brief Report: The Rise of Online Betting in Ontario.

In this paper we examine the nature of calls for the Ontario Problem Gambling Helpline from June 2021 to Jan 2023 to determine if the increased marketing of online and sports gambling has changed the nature of calls to the helpline. An interrupted time series model comparing the monthly calls before and after the expansion of online gambling and advertising (April 2023), found a significant effect. Calls related to the other games examined did not have a significant interrupted time series effect of from the expansion and advertising of online gambling. The results of this analysis clearly indicate an association between the expansion of legalized gambling and gambling advertising with the number of people who call the helpline for problem related to online gambling.

Increases in Serious Psychological Distress among Ontario Students between 2013 and 2017: Assessing the Impact of Time Spent on Social Media.

OBJECTIVE: The objective of the current research was to examine the association between time spent on social media and serious psychological distress between 2013 and 2017, a period when the rates of both were trending upward. METHODS: The current study analyzed population-based data from 3 waves of the Ontario Student Drug Use and Health Survey (N = 15,398). Multivariate logistic regression models were used to examine the association between time spent on social media and serious psychological distress controlling for theoretically relevant covariates. Interactions were tested to assess whether the association changed over time. RESULTS: The prevalence of serious psychological distress increased from 10.9% in 2013 to 16.8% in 2017 concomitantly with substantial increases in social media usage, especially at the highest levels. In the multivariate context, we found a significant interaction between social media use and the survey year which indicates that the association between time spent on social media and psychological distress has decreased from 2013 to 2017. CONCLUSION: Although both social media use and psychological distress increased between 2013 and 2017, the interaction between these variables indicates that the strength of this association has decreased over time. This finding suggests that the higher rate of heavy social media use in 2017 compared to 2013 is not actually associated with the higher rate of serious psychological distress during the same time period. From a diffusion of innovation perspective, it is possible that more recent adopters of social media may be less prone to psychological distress. More research is needed to understand the complex and evolving association between social media use and psychological distress. Researchers attempting to isolate the factors associated with the recent increases in psychological distress could benefit from broadening their investigation to factors beyond time spent on social media.

Efficacy of a Voluntary Self-exclusion Reinstatement Tutorial for Problem Gamblers.

Voluntary self-exclusion programs allow gamblers to voluntarily be denied access to gambling venues for an agreed upon period. Many people who self-exclude decide to return to gambling venues after the exclusion period has ended, however people who reinstate may be at risk for the recurrence of gambling problems. This study was designed to determine the efficacy of a tutorial created with the intent of reducing the risk of harm to those who reinstate. People who wished to be reinstated were asked to complete a survey on gambling related issues and then watch the tutorial video. An online video-based tutorial designed to reduce gambling related harm and to provide information about treatment services was developed. The control group (N = 131) consisted of people who reinstated in the year prior to the implementation of the online tutorial. The experimental intervention group (N = 104) were those who reinstated after the implementation of the online tutorial. There was a significant decrease in gambling and problem gambling comparing pre-exclusion to during exclusion in both the experimental and control group. Furthermore, this drop in gambling problem was sustained for 6-months and 12-months after reinstatement. However, no main effect or interaction was found that supported the efficacy of the tutorial. Self-exclusion by itself was associated with a sustained reduction in problem gambling. There was no significant evidence that the educational tutorial had any additional impact on the reinstatement process.

Factors associated with social casino gaming among adolescents across game types.

BACKGROUND: With the proliferation of social casino games (SCGs) online, which offer the opportunity to gamble without monetary gains and losses, comes a growing concern regarding the effects of these unregulated games on public health, particularly among adolescents. However, given the limited research pertaining to SCG use, little is currently known about the manner in which adolescents engage with this new gambling medium. The present study aims to identify the factors that characterize adolescent social casino gamers, and to determine whether these factors differ by SCG type. Moreover, the study examines the extent to which social casino gaming is associated with monetary gambling and problem gambling in this cohort. METHOD: Data were obtained from students in Grades 9 to 12 (n = 10,035) residing in the Canadian provinces of Ontario, Saskatchewan, and Newfoundland and Labrador. Participants completed the Youth Gambling Survey (YGS), which is a supplementary instrument administered alongside the Canadian Student Tobacco, Alcohol and Drugs Survey (CSTADS). Logistic regression was used to assess the factors associated with SCG play. RESULTS: Overall, 12.4% of respondents reported having participated in SCGs in the past three months. Compared to adolescents who did not report playing SCGs, SCG players were typically more likely to participate in monetary gambling activities, and were more prevalently classified as problem gamblers of low-to-moderate severity or high severity. Although profiles of SCG players differed across SCG game types, factors significantly associated with the playing of SCGs were gender, weekly spending money, having friends and parents who gamble, and screen time. It was also shown that current smokers were significantly more likely to participate in simulated slots online relative to adolescents who did not play SCGs. CONCLUSION: Significant associations exist between SCG play, monetary gambling, and problem gambling among adolescents. Gambling intervention efforts directed at this population should aim to identify personal and environmental factors associated with social casino gaming, and should be tailored to different types of SCGs.

Cross Validation of the Gambling Problem Severity Subscale of the Canadian Adolescent Gambling Index (CAGI/GPSS) on a Sample of Ontario High School Students.

This paper reports on the cross validation of the Gambling Problem Severity Subscale of the Canadian Adolescent Gambling Index (CAGI/GPSS). The CAGI/GPSS was included in a large school based drug use and health survey conducted in 2015. Data from students in grades 9-12 (ages 13-20 years) derived from the (N = 3369 students). The CAGI/GPSS produced an alpha of 0.789. A principle component analysis revealed two eigenvalues greater than one. An oblique rotation revealed these components to represent consequences and over involvement. The CAGI/GPSS indicated that 1% of the students fell into the "red" category indicating a severe problem and an additional 3.3% scored in the "yellow" category indicating low to moderate problems. The CAGI/GPSS was shown to be significantly correlated with gambling frequency (r = 0.36), largest expenditure (r = 0.37), sex (more likely to be male) (r = -0.19), lower school marks (r = -0.07), hazardous drinking, (r = 0.16), problem video game play (r = 0.16), as well as substance abuse. The CAGI/GPSS was cross validated using a shorted version of the short SOGS, r = 0.48. In addition the CAGI/GPSS and short SOGS produced very similar patterns of correlations results. The results support the validity and reliability of the CAGI/GPSS as a measure of gambling problems among adolescents.

Problem Gambling in a Sample of Older Adult Casino Gamblers.

As older adults continue to make up a greater proportion of the Canadian population, it becomes more important to understand the implications that their leisure activities have for their physical and mental health. Gambling, in particular, is a form of leisure that is becoming more widely available and has important implications for the mental health and financial well-being of older adults. This study examines a large sample (2103) of casino-going Ontarian adults over the age of 55 and identifies those features of their gambling participation that are associated with problem gambling. Logistic regression analysis is used to analyze the data. Focusing on types of gambling participated in and motivations for visiting the casino, this study finds that several forms of gambling and motivations to gamble are associated with greater risk of problem gambling. It also finds that some motivations are associated with lower risk of problem gambling. The findings of this study have implications related to gambling availability within an aging population.

An examination of internet and land-based gambling among adolescents in three Canadian provinces: results from the youth gambling survey (YGS).

BACKGROUND: With the rapid proliferation of new gambling technology and online gambling opportunities, there is a concern that online gambling could have a significant impact on public health, particularly for adolescents. The aim of this study is to examine online and land-based gambling behaviour among adolescents in 3 Canadian provinces (Ontario, Newfoundland and Labrador, Saskatchewan) prior to the implementation of legalized online gambling. METHODS: Data are from 10,035 students in grades 9 to 12 who responded to the 2012-2013 Youth Gambling Survey (YGS) supplement, a questionnaire administered as part of the Canadian Youth Smoking Survey (YSS, 2012) in 3 provinces: Newfoundland and Labrador (n = 2,588), Ontario (n = 3,892), and Saskatchewan (n = 3,555). RESULTS: Overall, 41.6% of adolescents (35.9% of females and 47.4% of males) had gambled in the past 3 months. 9.4% of adolescents had gambled online in the past 3 months alone (3.7% of females and 15.3% of males). The most popular form of online gambling was online sports betting. Adolescents also engaged in online simulated gambling including internet poker (9.1%) and simulated gambling on Facebook (9.0%). Few adolescents participated in online gambling exclusively and online gamblers were more likely than land-based gamblers to engage in multiple forms of gambling. A higher proportion of adolescent online gamblers scored "high" or "low to moderate" in problem gambling severity compared to land-based only gamblers. CONCLUSIONS: Despite restrictions on online gambling at the time of the study, adolescents were engaging in online gambling at a significantly higher rate than has been previously found. Adolescents were also using technology such as video games to gamble and free online gambling simulations.

Endorsement of Criminal Behavior Amongst Offenders: Implications for DSM-5 Gambling Disorder.

The fifth edition of the diagnostic and statistical manual (DSM) has changed the scoring threshold for a gambling disorder (GD) from five criteria to four and eliminated the illegal acts criterion. The impact of these changes was examined with data from a correctional population (N = 676) in Ontario, Canada. The offenders completed a self-report survey that included the Canadian problem gambling index, the South Oaks Gambling Screen and the DSM-IV criteria. Changing the threshold from 5 to 4 improved the convergent validity for GD and resulted in an increase in the percentage of offenders diagnosed with a GD from 7.4 to 10.2 %. The results also indicate that the illegal acts criterion contributes to the convergent validity of GD. The evidence supports the change in the threshold from five to four, but also reinforces the importance of examining illegal acts when dealing with an offender population. The incorporation of illegal acts into the "lying to others" criteria appears to make up, to some extent, for the removal of the illegal acts criterion.

Gamblers Anonymous as a Recovery Pathway: A Scoping Review.

Given the preponderance of Gamblers Anonymous (GA), there has been relatively little effort to explore the existing evidence base on its effectiveness as a recovery approach for problem gambling. To remedy this gap in the literature we conducted a scoping review of the literature on mutual aid for individuals experiencing problem gambling published between 2002 and 2015. We searched 13 databases and reviewed reference lists and websites of relevant organizations. We reviewed records for eligibility and extracted relevant data from eligible articles. Three reviewers independently assessed the methodological quality of the included studies using the Mixed Methods Appraisal Tool. We identified 17 studies in 25 publications that were eligible for inclusion. Most studies were conducted in the United States, were cross-sectional in design, and involved both male and female adult participants. Results indicate that the evidence for the effectiveness of GA either as a control condition or in conjunction with formal treatment or medication is inconsistent. An emphasis on patience, using the Serenity Prayer as a way to gain acceptance of financial matters and reality, and absolute assertion of identity as a "compulsive gambler" were identified as important aspects of GA's recovery culture. There is a need for large-scale randomized controlled trials to determine GA's effectiveness, as well as research exploring the mechanisms through which GA works, barriers to GA as a recovery approach, and the status of women in the fellowship.

Reliability, Validity, and Classification Accuracy of the DSM-5 Diagnostic Criteria for Gambling Disorder and Comparison to DSM-IV.

The DSM-5 was published in 2013 and it included two substantive revisions for gambling disorder (GD). These changes are the reduction in the threshold from five to four criteria and elimination of the illegal activities criterion. The purpose of this study was to twofold. First, to assess the reliability, validity and classification accuracy of the DSM-5 diagnostic criteria for GD. Second, to compare the DSM-5-DSM-IV on reliability, validity, and classification accuracy, including an examination of the effect of the elimination of the illegal acts criterion on diagnostic accuracy. To compare DSM-5 and DSM-IV, eight datasets from three different countries (Canada, USA, and Spain; total N = 3247) were used. All datasets were based on similar research methods. Participants were recruited from outpatient gambling treatment services to represent the group with a GD and from the community to represent the group without a GD. All participants were administered a standardized measure of diagnostic criteria. The DSM-5 yielded satisfactory reliability, validity and classification accuracy. In comparing the DSM-5 to the DSM-IV, most comparisons of reliability, validity and classification accuracy showed more similarities than differences. There was evidence of modest improvements in classification accuracy for DSM-5 over DSM-IV, particularly in reduction of false negative errors. This reduction in false negative errors was largely a function of lowering the cut score from five to four and this revision is an improvement over DSM-IV. From a statistical standpoint, eliminating the illegal acts criterion did not make a significant impact on diagnostic accuracy. From a clinical standpoint, illegal acts can still be addressed in the context of the DSM-5 criterion of lying to others.

Problem Gambling Among Ontario Students: Associations with Substance Abuse, Mental Health Problems, Suicide Attempts, and Delinquent Behaviours.

This paper describes gambling problems among Ontario students in 2009 and examines the relationship between gambling problems and substance use problems, mental health problem indicators, and delinquent behaviors. Data were derived from the Ontario Student Drug Use and Health Survey of Ontario students in grades 7-12. Gambling problems were measured as 2 or more of 6 indicators of problem gambling. In total 2.8% of the students surveyed endorsed two or more of the problem gambling items. The odds of problem gamblers reporting mental distress was 4.2 times higher than the rest of the sample and the odds of problem gamblers reporting a suicide attempt were 17.8 times greater than the rest of the sample. In addition compared to the rest of the students, delinquent behaviors were also more common among problem gamblers, including theft (OR = 14.5), selling marijuana (OR = 19.6), gang fights (OR = 11.3) and carrying a handgun (OR = 11.2). In a multivariate analysis, substance-use problems, mental health problems, and the participation in a variety of delinquent behaviors remained significantly associated with youth problem gambling behavior. Students who report problem gambling behaviors show increased substance abuse, mental health, and delinquency/criminal problems that are similar to those seen among adult problem gamblers. The association between these problems suggests that these problems could be addressed in a unified manner.

Characteristics of outpatients in an addictions clinic for co-occurring disorders.

BACKGROUND AND OBJECTIVES: To examine characteristics of treatment-seeking outpatients from a clinic for co-occurring disorders within an urban psychiatric hospital. METHODS: Patients (n = 131) completed six self-report scales including the Brief Symptom Inventory and Toronto Alexithymia Scale. RESULTS: The most common substance use disorders were: alcohol (62%), tobacco (50%), cannabis (22%), cocaine/stimulants (18%). The most common psychiatric disorders were: mood (65%), psychotic (24%) and anxiety disorders (24%). Many of the scales correlated with the global psychiatric severity score. Patients with mood disorders had superior interpersonal functioning global scores and reported reduced drug use and reduced advice seeking. Patients with psychotic disorders had higher global psychiatric severity scores and reported higher advice seeking. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: This preliminary study indicates that among a heterogeneous sample of patients with co-occurring disorders the more symptomatic patients may present with a wider range of impairments along with some specific differences based on psychiatric diagnosis.

Problem gambling inside and out: the assessment of community and institutional problem gambling in the Canadian correctional system.

This paper reports on the results of a multi-site survey of gambling behaviour and gambling problems amongst offenders in correctional institutions in Ontario, Canada, conducted between 2008 and 2011. A total of 422 (completion rate 61.5 %) incarcerated offenders (381 male and 41 female) took part in the study including 301 federal offenders and 121 provincial offenders. Based on the Problem Gambling Severity Index of the Canadian Problem Gambling Index (CPGI/PGSI) the prevalence rate of severe problem gambling was 8.9 prior to incarceration and 4.4 % during incarceration. These numbers are substantially higher than rates found among the general public. Thirty-four percent of the sample reported gambling in prison. Half of those who suffered from gambling problems before incarceration continued to have gambling problems during incarceration. People with problems related to slot machines prior to incarceration reported fewer gambling problems during incarceration compared to other problem gamblers.

The use of tobacco as gambling currency by federal offenders in Canada before and after a tobacco ban.

In 2008 tobacco was banned in federal correctional institutions in Canada. In this paper we compare the use of tobacco as currency for gambling in two studies that we conducted, one before and one after the tobacco ban. The data from two studies were compared. The questionnaires were administered to offenders in federal and provincial institutions in Ontario. Study 1 included 254 male offenders and study 2 included 395 male offenders. The focus in this paper is on one questionnaire about the type of wager made while incarcerated. It was found that the use of tobacco as a currency in gambling went from 28.6% of those offenders who gamble to 2.3% of those offenders who gamble. In addition, there was an overall decrease in the number of federal offenders who reported gambling while incarcerated. However, information gained from the questionnaire and from interviews with incarcerated offenders suggests that there has been a shift to money wagers and that gambling inside has become more serious since the tobacco ban. The results suggest that the ban on smoking has resulted in a change in the type of currency used for gambling inside correctional institutions in Ontario Canada.

Exploring the Gaps in Programming for Men and Women with a Gambling Disorder in the Correctional System in Canada.

The prevalence of problem gambling in the correctional system is about 10 times higher than in the general population, but programming for gambling problems in the correctional system is scarce. Examined barriers to treatment for problem gamblers in the correctional system, sex or gender differences, and options for program design. We conducted interviews with 16 experts who had worked with problem gamblers in the correctional system and analyzed the data in terms of themes. For barriers, the experts discussed a lack of awareness about problem gambling, as well as stigmatization and lockdowns. Experts described the content of current programs as equally applicable to both men and women, but that emotional components were more important for women. Finally, the experts had mixed views on whether programming should be integrated with other programs such as substance abuse. Programming implications for this population are discussed.

Volatility, house edge and prize structure of gambling games.

This study used simulations to examine the effect of prize structure on the outcome volatility and the number of winners of various game configurations. The two most common prize structures found in gambling games are even money payoff games (bet $1; win $2) found on most table games and multilevel prizes structures found in gambling machine games. Simulations were set up to examine the effect of prize structure on the long-term outcomes of these games. Eight different prize structures were compared in terms of the number of winners and volatility. It was found that the standard table game and commercial gambling machines produced fairly high numbers of short term winners (1 h), but few long term winners (50 h). It was found that the typical even money game set up produced the lowest level of volatility. Of the multilevel prize structures examined, the three simulations based on commercial gambling machines were the least volatile. The results are examined in terms of the pragmatics of game design.

Adult attention-deficit hyperactivity disorder symptoms and psychological distress, hazardous drinking, and problem gambling: A population-based study.

Recognition of ADHD in the adult population is relatively recent. Epidemiological research examining the mental health impact of ADHD in adulthood is thus limited. The objective of this study was to examine whether adult ADHD symptoms are associated with psychological distress, hazardous drinking, and problem gambling, after controlling for traumatic brain injury and sociodemographic characteristics. We analyzed data from a population-based survey administered in 2015 and 2016 to adults aged 18 years and over in Ontario, Canada (N = 3,817). Logistic regression was used to construct unadjusted and multivariable models for each of the three focal relationships. In the unadjusted models, ADHD symptoms were significantly related to psychological distress (OR = 9.3; 95% CI:6.1, 14.0) and hazardous drinking (OR = 2.1; 95% CI: 1.3, 3.4), but not to problem gambling (OR = 1.5; 0.5, 4.3). After adjustment, ADHD symptoms were significantly related to psychological distress (OR = 7.1; 95% CI: 4.6, 11.1), but not hazardous drinking (OR = 1.4; 95% CI: 0.8, 2.5) or problem gambling (OR = 0.6; 95% CI: 0.2, 2.5). This study further highlights the importance of clinicians assessing for concomitant ADHD and psychological distress in adults.

Lottery ticket preferences as indicated by the variation in the number of winners.

Many gamblers believe that it is possible to find a strategy to beat the lottery including selecting numbers that are due to come up or looking for a bias in past numbers. In this paper, we examine sales figures and variations in the number of winners for the various prize levels of a popular Canadian lottery to detect lottery ticket preferences. It was determined that the lottery outcomes conformed well to a random outcome. No evidence of either a bias myth or due to come up myth was found. However ticket popularity indicated a marked preference for the number 7 and low numbers, and the avoidance of high numbers and adjacent numbers. In addition we found a linear and a quadratic relationship between past frequency of the numbers and ticket popularity indicating a belief in both the due to come up and the bias myths. The findings suggest strong non-random preferences in the selection of lottery numbers.

A Perspective on Age Restrictions and Other Harm Reduction Approaches Targeting Youth Online Gambling, Considering Convergences of Gambling and Videogaming.

Internet gambling has become a popular activity among some youth. Vulnerable youth may be particularly at risk due to limited harm reduction and enforcement measures. This article explores age restrictions and other harm reduction measures relating to youth and young adult online gambling. A systematic rapid review was conducted by searching eight databases. Additional articles on online gambling (e.g., from references) were later included. To place this perspective into context, articles on adult gambling, land-based gambling, and substance use and other problematic behaviors were also considered. Several studies show promising findings for legally restricting youth from gambling in that such restrictions may reduce the amount of youth gambling and gambling-related harms. However, simply labeling an activity as "age-restricted" may not deter youth from gambling; in some instances, it may generate increased appeal for gambling. Therefore, advertising and warning labels should be examined in conjunction with age restrictions. Recommendations for age enforcement strategies, advertising, education, and warning labels are made to help multiple stakeholders including policymakers and public health officials internationally. Age restrictions in online gambling should consider multiple populations including youth and young adults. Prevention and harm reduction in gambling should examine how age-restriction strategies may affect problem gambling and how they may be best enforced across gambling platforms. More research is needed to protect youth with respect to online gambling.