Provincial governments may be glossing over the societal and health costs of problem gambling, including depression and suicide, because of the significant income they gain from gambling, claim several public advocacy and mental health organizations. They are calling for more research into the prevalence of depression and suicide among problem gamblers. (For more, see the Public Health column on page 1208.)
“The normal system that provides checks and balances around this area is compromised because government in every province is responsible for alcohol and gaming regulation of the industry — and the welfare of those with gambling problems,” says Neasa Martin, a researcher at the Mood Disorders Society of Canada. “Their revenues are closely tied to the gambling industry, putting a pall on normal advocacy around the issue.”
Rob Simpson, CEO of the Ontario Problem Gambling Research Centre (OPGRC), similarly decries government's “direct financial conflict of interest” as the recipients of gambling revenue. “Effective treatment implies reduction of users, bringing down revenue,” he says. “Why would you put government in the position of choosing between health and profit?”
Gambling-related revenues constituted 5.1% of provincial revenues in 2003, or $11.8 billion, according to Statistics Canada's 2003 Canadian Community Health Survey.
Martin says 35% of those revenues come from problem gamblers. “The number one area of generation of income is video lottery terminal (VLT) slots and that's where most problem gamblers are.”
The Toronto-based Centre for Addiction and Mental Health defines problem gambling as a “pattern of gambling behaviour that causes harm to an individual's personal or family life, work, finances or health.”
Provincial governments do provide services for people with gambling problems. The Ontario government, for example, allocates 2% of gross revenues ($36 million in 2003–04) from slots in charity casinos and racetracks to problem gambling prevention, research and treatment, including a help-line. In fact all the provinces and the Yukon Territory have help-lines for problem gamblers.
But programs in general vary across Canada and it's difficult to know if they are sufficient, given the paucity of data on the addiction's cost to the individual and society. The Canada Safety Council advocates quantifying such factors as medical care, policing, courts, prisons, social assistance and business losses. It has linked gambling addiction to depression and suicide, bankruptcy, family breakup, domestic abuse, assault, fraud, theft and homelessness.
There are also various data on the prevalence of the problem. The National Survey of Gambling Problems in Canada (Can J Psychiatry 2005;50:213-7) estimates 2% of Canadians aged 15 or more are considered to have gambling problems. The Demographics of Gaming Revenue cites a prevalence of 3.8%. And Simpson says if nongamblers are eliminated from the sample, 4.7%, or 1 in 20 people, are problem gamblers. This translates to 559 187 Ontarians, where 83% of the population gambles.
The Canadian Health Network states that 1 in 4 moderate or severe problem gamblers report being under a doctor's care for emotional or physical problems due to stress, and more than 1 in 3 report feeling depressed at times. Researchers estimate the annual cost associated with a compulsive gambler ranges from $20 000 to $56 000, including loss of work, and court and treatment costs.
The National Survey of Gambling Problems in Canada concludes that the highest prevalence of gambling problems “emerged in areas with high concentrations of VLTs in the community combined with permanent casinos.”
VLTs have been shown to be highly addictive and are marketed to young people — the same segment of the population with the highest incidence of suicide. Suicide accounts for 24% of all deaths among Canadians aged 15 to 24, according to the Mood Disorders Society of Canada.
Young people are twice as likely as their adult counterparts to develop serious gambling problems, reports the Centre for Addiction and Mental Health.
But Ontario's Chief Coroner, Dr. Barry McLellan, says that problem gambling as a contributor to suicide is difficult to measure. “Family and friends may be reluctant to talk about problem gambling and coroners don't always pose the question. So we are not necessarily capturing all the information.”
There are some data. In Alberta, gambling was listed “in the files” of suicides about 10% of the time; 46 out of a total of 482 suicides in 2001, and 54 out of 430 suicides in 2000.
A Nova Scotia study by the non-profit research group GPI Atlantic released in October 2004 showed problem gambling as a factor in 6.3% of suicides. In addition, Nova Scotia's Office of Health Promotion, Focal Research Consultants found that almost 50% more residents in that province are at potential risk for gambling problems than 10 years ago.
Nova Scotia is now conducting Canada's first study of the socioeconomic costs of gambling, due for completion in September 2007. Australian and US federal governments are conducting similar studies.
In a June 2004 paper (Psychol Addict Behav 2004;18:49-55) on the tendency to suicide and depression among youth gamblers, authors Lia Nower and colleagues analyzed the incidence of suicide, depression and problem gambling among middle and high school students in Ontario and Quebec.
Among 3941 students in a 1996 study in Quebec, 49.2% of the problem and pathological gamblers had thoughts of suicide, as compared to 28.4% of non-gamblers, and 29.9% of social gamblers. A 2001 Ontario study of 2142 students showed that the 4.8% classified as problem gamblers, and that pathological gamblers had significantly higher levels of depression and suicidal tendencies (28.2%). That number jumped to 60% among females, with a significantly high proportion of suicide attempts (13.6%).
Nower, an associate professor at Rutgers University, says, “Canada does more than any other country in the world about problem gambling and treatment. The only thing that will help long-term will be to take ATM and credit card machines out of the gambling venues and to launch campaigns to deglamourize gambling, especially among adults. Most kids who gamble, started at home and clearly, the adults facilitate this.”
Nower has divided problem gamblers into 3 types, one of which is predisposed to anxiety, depression and gambling (Addiction 2002;97[5]:487-99). “This group, which we suspect is the largest,” Nower says, “is prone to the risk-taking behaviour and superstitious beliefs that escalate the gambling addiction.”
Nower is developing screening instruments to more easily identify problem gamblers for treatment. “Right now, everyone is being treated with a broad brush,” she says.