2) Social Inequalities & Treatment

what is there an emphasis on in gambling

on gambling harms

gambling harms (2)

• modern public health approaches to gambling emphasise harms over symptoms

• a gambling harm is any measurable negative outcome that can be attributed to gambling

7 dimensions of harm

• financial harms

• relationship disruption

• physical health

• occupational harms

• cultural harms

• emotional distress

• crime related harms

how are harms different (3)

• they affect significant others beside the person who gambles

• often they do not disappear with long term abstinence from gambling

• they can have inter generational consequences

is gambling involvement event distributed (2)

• no they are not evenly distributed across society

• gambling outlets are often located in more disadvantaged neighbourhoods

geospatial analysis of socio economic status

found that slot machine venues/ losses are denser and greater in neighbourhoods of lower SES

where is gambling revenue often concentrated among

concentrated among a vital few, that is more likely to include people with gambling problems

gambling revenue from people with gambling problems (3)

• calculations use prevalence estimates of problem gambling rate

• questionnaire estimates of typical monthly spend on gambling

• 20-40% of gambling revenue come from gambling problems but hard to calculate and people are very inaccurate in reporting this

indigenous gambling and problem gambling (3)

• relative popularity of gambling participation among indigenous canadians is fairly similar to non indigenous canadians

• the rate of problem gambling is much higher among indigenous canadians

• highest of any racial and ethic group in canada

cultural and economic context in indigenous culture (3)

• lahal is a ceremonial gambling game played by coast salish

• this game meets the standard legal definition of gambling

• but 75% of indigenous participants did not consider these traditional games to be gambling

BC youth data (5)

• 21% of BC youth aged 12- 18 gambled for money in the past year

• youth employment 20 hours per week is linked to gambling for money

• involvement in sports on weekly basis associated with sports betting

• monthly gambling leads to sedentary lifestyle, less social connection, excessive technology use

• gambling problems in 3% of those who gambled, highest in non binary youth

gambling and gender identity

youth identifying as non binary showed higher rates of problem gambling, especially in transgender youth assigned male at birth

intersectional identities

intersectionality refers to how identification with multiple under represented and/ or marginalised groups can create unique experiences of disadvantage or discrimination

resources in BC for gambling problems (7)

• telephone helpline

• voluntary self exclusion program

• other responsible gambling tools such as limit setting options

• psychological treatment

• financial support

• family therapy

• there is no residential facilities for gambling in BC

psychological treatments (2)

• cognitive behavioural therapy

• motivational interviewing

cognitive behavioural therapy (3)

• involves two separate components when looking at gambling problems

• cognitive involves testing and restructuring false beliefs and distortions

• behavioural involves exposure and desensitisation

motivational interviewing (4)

• enhancing motivation to change, exploring ambivalence, pros and cons of gambling

• discussing in an open and non judgemental way

• goal is to be more aware of gambling problem and cons of gambling

• often used in combination with other therapies

questions about CBT and motivational interviewing

question of whether it is effective in a group setting or individual, in person or online delivery, abstinence or controlled gambling

biggest issue with treatment

few people with addictions actually seek help

what did they find in a systematic review and meta analysis on prevalence of help seeking for gambling (2)

• seeking help in moderate risk gamblers are 3.7%

• seeking help in problem gambling are 20.6%, 1/5 seek help

pharmacotherapy for gambling disorder

have a dopamine centric view on dopamine but found that it is not as effective as other medications

which medications are most effective for gambling disorder

from placebo controlled trials, the most promising meds are opioid antagonists which reduce urge and cravings

fMRI of reward in problem gambling (4)

• study looking at playing a card game where there is a positive EV

• looked at brain response after wins vs losses

• found reduced striatum and vmPFC reward activity in problem gambling participants compared to healthy participant

• results correlated with gambling severity, supporting reward deficiency hypothesis