Problem Gambling Education and Treatment in a Residential Setting ...

PROBLEM 

Education and Treatment 

in a Residential Setting 

GAMBLING 

Facilitator’s Guide

Problem Gambling 

Education and Treatment 

in a Residential Setting 

Facilitator’s Guide

ii 

Problem Gambling: Education and Treatment in a Residential Setting 


Facilitator’s Guide 

isbn: 978-1-77052-362-3 (PRINT) 

isbn: 978-1-77052-363-0 (PDF) 

isbn: 978-1-77052-364-7 (HTML) 

isbn: 978-1-77052-365-4 (ePUB) 

Printed in Canada 

Copyright © 2009 Centre for Addiction and Mental Health, Toronto ON 

Facilitators offering this program have permission to download the manual and 

copy and distribute the handouts for use by participants. Otherwise, no part of this 

work may be reproduced or transmitted (for profit or otherwise) in any form or 

by any means electronic or mechanical, including photocopying and recording, or by 

any information storage and retrieval system without written permission from 

the publisher—except for a brief quotation (not to exceed 200 words) in a review or 

professional work. 

4044/08-2009 

©2009 Centre for Addiction and Mental Health


iii 

Contents 

Introduction 

1 Why Is It Important to Talk about Gambling and Problem 

Gambling with Clients Who Have Mental Health and/or 

Substance Use Problems? 

2 How Is the Program Delivered? 

3 Screening for Problem Gambling 

3 Program Evaluation 

4 Acknowledgments 

Session-by-Session Guide 

7 Session 1: Gambling and Problem Gambling 

23 Session 2: Understanding Gambling 

35 Session 3: Goal Setting and Identifying High Risk-Situations 

41 Session 4: Developing Coping Strategies 

For High-Risk Situations 

49 References 


iv 


Appendices 

53 Appendix A: Problem Gambling Severity Index 

55 Appendix B: Sessions 1 and 2: Pretest/Post-test 

61 Appendix C: Problematic vs. Non-Problematic Gambling 

63 Appendix D: Reducing the Risk 

65 Appendix E: How to Choose Your Gambling Goal 

67 Appendix F: My Goal Statement 

69 Appendix G: Self-Monitoring Gambling or Urges to Gamble 

71 Appendix H: Gambling Triggers 

73 Appendix I: Facilitator’s Evaluation 


Problem Gambling: Education and Treatment in a Residential Setting 1 

Introduction 

The Problem Gambling Project at the Centre for Addiction and Mental Health 

(camh), in collaboration with the Georgianwood Concurrent Disorders Program at 

the Mental Health Centre Penetanguishene, is delighted to offer this problem 

gambling education and early treatment program for clients who are in a residential 

mental health and/or substance use setting. 

This program is intended to help clinicians inform clients with mental health and/or 

substance use problems about the potential risks associated with gambling and to 

provide some preliminary interventions for those clients already engaging in problematic 

gambling behaviour. 

Why Is It Important to Talk about Gambling and Problem 

Gambling with Clients Who Have Mental Health and/or 

Substance Use Problems? 

• Research shows a correlation between mental health problems, particularly depression 

and anxiety, and problem gambling. 

• Research also shows a correlation between substance use problems and problem 

gambling. 

• Gambling can be a potential trigger for substance use and/or mental health relapse. 

• People tend to be unaware of the risks associated with gambling. 


2 Problem Gambling: Education and Treatment in a Residential Setting 

How Is the Program Delivered? 

The program comprises four sessions delivered by clinicians in a group setting, and 

includes this facilitator’s guide, PowerPoint presentations and participant handouts, 

all available free for download at www.ProblemGambling.ca. You will also need a 

laptop computer, lcd projector, Internet access, flipchart and markers to deliver 

this program. 

Although a basic understanding of problem gambling is beneficial, it is not required 

to deliver this program. The facilitator’s guide offers clinicians all the information 

needed to deliver the program. The content from the PowerPoint slides appears in 

bold in this guide, and is accompanied by supporting notes for the facilitator. In 

certain areas, the facilitator is also provided with additional information or is 

directed to further readings. 

Depending on the number of participants and the amount of group discussion, each 

session will take between 60 and 90 minutes. 

Sessions 1 and 2 take a prevention and education approach toward gambling and are 

intended for all clients. They provide information about gambling that is suitable for 

everyone, regardless of their involvement in gambling. 

Session 1 focuses on introductory information including: 

• how gambling and problem gambling are defined; 

• what activities are considered gambling; 

• prevalence rates of gambling and problem gambling; 

• risk factors for developing a gambling problem; 

• the impact of problem gambling; 

• how gambling and substance use are connected; 

• how gambling and mental health are connected; and 

• a comparison of problematic and non-problematic gambling. 

Session 2 focuses on: 

• how games of chance work; 

• false beliefs and superstitions associated with gambling; and 

• strategies for reducing the risk of developing a gambling problem. 

Sessions 3 and 4, on the other hand, are intended for clients who are concerned about 

their gambling, or who have been identified as having problems related to their gambling. 

These sessions provide clients with a little more insight and awareness into 

their gambling difficulties, and help them to identify their personal triggers and learn 

new skills for how to deal with these triggers. 


• how to set realistic gambling goals; and 

• how to identify personal gambling triggers. 




• how to develop coping strategies to deal with gambling triggers; and 

• helpful resources. 

Sessions 3 and 4 offer clients support around gambling while they are in a residential 

treatment program for their substance use and/or mental health concerns. Once 

they leave residential treatment, however, clients should be encouraged to continue 

to get support around their gambling. 

Over 55 specialized problem gambling treatment services are available, free of 

charge, throughout Ontario. Clients should be strongly encouraged to follow up with 

their local treatment provider once they return home. To find out where services 

are available in specific regions, contact the Ontario Problem Gambling Helpline 

at 1 888 230-3505. 

Screening for Problem Gambling 

Because of the correlation between mental health problems and problem gambling, as 

well as between substance use problems and problem gambling, screening for problem 

gambling among mental health and/or substance use clients is very important. 

The Problem Gambling Severity Index (pgsi), which is included in this guide 

(Appendix A), is a simple and easy-to-use gambling screening tool. Participants can 

complete it: 

• prior to the delivery of this program: you may choose to screen all clients when they 

are initially admitted to your program; or 

• during Session 1: you may choose to screen clients after you present the “Continuum 

of Gambling Behaviour” (slide 19). 

Anyone who scores 3 or higher should be encouraged to attend Sessions 3 and 4. 

Program Evaluation 

This program was pilot tested and was evaluated using a pretest and a post-test. 

Results from the evaluations were: 

• pretest mean of 60% 

• post-test mean of 76%. 

The pretest/post-test is available in this guide (Appendix B), so that you can measure 

clients’ learning as a result of participation in this program. 

Also included is a Facilitator’s Evaluation form. Your feedback is important to us. 

Please take a few moments to complete the form (Appendix I). 



Acknowledgments 

Project leader: colleen tessier, senior project co-ordinator, Problem Gambling 

Project, camh 

Written by: chantal dubois, problem gambling therapist and trainer, Problem 

Gambling Project, camh, and dr. shari mckee, psychologist, Georgianwood 

Concurrent Disorders Program, Mental Health Centre Penetanguishene 

We would like to thank the following people for their contributions to the content: 

• gary hoskins, problem gambling therapist and trainer, Problem Gambling 

Project, camh 

• rena tennant, student, Georgianwood Concurrent Disorders Program, Mental 

Health Centre Penetanguishene 

We would also like to thank the following people for their support with this project: 

• dr. daniela lobo, psychiatrist, camh 

• stephen meredith, senior project coordinator, Problem Gambling Project, 

camh 

• lisa pont, problem gambling therapist and trainer, Problem Gambling Project, 

camh 

• janine robinson, problem gambling therapist and trainer, Problem Gambling 

Project, camh 



Session-by-Session 

Guide 



Session 1 

Depending on the number of participants and the amount of group discussion, this 


For this session you will need: 

• laptop computer and lcd projector 

• Session 1 PowerPoint presentation 

• participant handouts: 

- Problem Gambling Severity Index (Appendix A) 

- Problematic vs. Non-Problematic Gambling (Appendix C) 

- Session 1 PowerPoint presentation 

Slide 2 

Gambling and Problem Gambling 

This first session focuses on introductory information including: 

• how gambling and problem gambling are defined; 

• what activities are considered gambling; 

• prevalence rates of gambling and problem gambling; 

• the risk factors for developing a gambling problem; 

• the impact of problem gambling; 

• how gambling and substance use are connected; 

• how gambling and mental health are connected; and 

• a comparison of problematic and non-problematic gambling. 



Slide 3 

Why Is It Important to Talk about Gambling and Problem 

Gambling? 

People tend to be unaware of the risks associated with gambling. 

Unlike other high-risk activities, such as drinking and other drug use, smoking, 

impaired driving or unprotected sex, people are not always aware of the potential risks 

associated with gambling. As we will see throughout these sessions, gambling can 

lead to a variety of negative consequences such as financial troubles, relationship 

problems and physical and mental health issues, just to name a few. 

Gambling can be a potential trigger for substance use and/or mental health relapse. 

Because gambling can lead to a variety of issues such as financial loss, it may also 

trigger mental health problems like anxiety and depression. In addition, some individuals 

may turn to substances as a way of coping with negative feelings brought on 

by gambling. 

There is a link between mental health and substance use problems and problem 


Research shows that rates of mental health and substance use problems are higher 

among those experiencing problems related to gambling. In addition, rates of problem 

gambling are higher among those experiencing problems related to their substance 

use or mental health. 

There are some common biological factors shared by substance and gambling 

dependence. 

We all learn through reward and punishment, but for some people the reward system 

of the brain works a bit differently. These individuals are able to take more risks and 

are less sensitive to reward. As a result, it is believed that they are at increased risk 

for addictions (Chambers et al., 2003). 

Slide 4 

Gambling Definition 

Gambling is defined as risking something of value on an event that is determined 

mostly by chance. 

A person is gambling if: 

• he or she puts up something of value, such as money or property 

Although for the most part money is used for wagering, things such as jewelry, 

electronics and clothing can also be used. 

• the outcome has an element of chance beyond the person’s control 

We will focus on chance and how gambling games work in Session 2. 



• once the bet is made, it is irreversible. 

Irreversibility is an important part of the definition of gambling because if a bet were 

reversible, there would be no negative consequences. 

Some people generalize the definition of gambling and say, for example, that getting 

married is a “gamble.” But would getting married meet our definition? It is true that 

people risk something of value when they get married and the outcome is uncertain. 

But is this decision irreversible? No. If after getting married a person decides that he 

or she is not satisfied with the outcome, the situation is reversible. 

Slide 5 

Types of Gambling Activities 

Note to facilitator: 

• If time allows, you could ask the group to brainstorm the various types of gambling activities. 

• For additional information on gambling games available in Ontario, visit the OLG website at www.olg.ca. 

• It’s important to stress that gambling is more than just casino games. In the same way that some people 

view different substances as more or less dangerous or serious, people may say the same of gambling. They 

may say things such as, “I don’t go to the casino, I just play bingo.” The reality is that, despite the fact 

that some gambling activities appear to cause more problems for people, all gambling has some 

degree of risk associated with it. 

Lottery, scratch, pull-tab and raffle tickets 

Lotteries are the most popular form of gambling among adults in Ontario. There are 

over 10,700 lottery retailers in Ontario. 

Bingo 

Bingo has changed a lot over the past few decades. New technology now allows bingo 

halls to “link” to each other. This means games are played at the same time, resulting 

in jackpots that are substantially larger. In addition, some locations now offer 

electronic terminals with touch screens that assist players in playing several bingo 

cards at once. 

Sports betting 

The Ontario Lottery and Gaming Corporation (olg) offers individuals the opportunity 

to bet on certain sports (hockey, football, baseball, soccer, college football and basketball) 

through Pro-line. In addition, some people may place bets with bookies or simply 

participate in sports pools with friends or co-workers. 

Slot machines 

Slot machines are the most problematic gambling activity for Ontario adults. In fact, 

60% of people experiencing gambling problems in Ontario have problems with the 

slots (Williams & Wood, 2004). In Ontario, slot machines are found in casinos as well 



as in racetrack venues. In other Canadian provinces, video lottery terminals (VLTs) 

are also available. 

Suggested reading: 

For more information on slot machines and VLTs, read “How Do Slot Machines and Other Electronic 

Gambling Machines Actually Work?” by Nigel Turner and Roger Horbay, available at: 

www.camh.net/egambling/archive/pdf/JGI-issue11/JGI-Issue11-turner-horbay.pdf 

Card and table games 

Table games include things such as craps and roulette, while card games include 

games such as poker and blackjack. In Ontario, card and table games can be played 

at casinos. Some people also engage in private games at home or in social clubs. 

Horse betting 

Betting on horse races has a long history in Canada. Before casinos and lotteries were 

introduced, horse racing was the only legal gambling activity available in Canada. 

These days, horse racing has expanded far beyond placing bets at a local track. 

Technology now gives people the opportunity to place bets on horse races happening 

anywhere in the world. 

Internet gambling 

Online betting opportunities are endless. For example, a Google search for “online 

gambling sites” produces tens of thousands of results. People can bet on casino 

games, sports activities or bingo. People can also gamble on activities such as who 

will be the next person voted off on Survivor, which movie will win “best picture” at 

the Oscars and whether a pregnant actress will have a boy or a girl. 

Stock market speculation 

This activity involves purchasing stock with the sole purpose of selling it to someone 

else at a higher price. This is different from investing in that the speculator takes 

higher risks in the hopes of making a profit, while an investor looks at the value that 

logically may accrue over time. 

Betting on other games 

People can also engage in less formal gambling activities such as betting on a game 

of golf, a new baby’s date of birth or the winner of a reality television program. 

Slide 6 

Problem Gambling Definition 

Gambling is a problem when it disrupts or damages your: 

• work, school or other activities; 

• mental or physical health; 

• finances; 



• reputation; 

• relationships with family or friends. 


It is important to note that problem gambling is not just about losing money—it can affect a person’s 

entire life. 

Another important issue to consider is language. The term that we use here is problem gambling. It is 

important for you to be familiar with the different terms used in the field, and why we chose this one 

in particular. 

The three most common terms used to describe over-involvement in gambling are compulsive gambling, 

pathological gambling and problem gambling. 

• Compulsive gambling is a term familiar to the general public and used by Gamblers Anonymous. The 

term is not entirely accurate because gambling is not a compulsive disorder. It is classified as an impulsecontrol 

disorder in the DSM-IV; however, there is disagreement in the field about whether gambling 

belongs in this category. 

• Pathological gambling is the diagnostic term used in the DSM-IV. Pathological gambling is defined as a 

maladaptive practice characterized by persistent and repetitive playing that is present when clients meet 

five or more of the following criteria: 

- they are preoccupied with gambling; 

- they need to gamble with increasing amounts of money to attain the desired state of excitement; 

- they have repeatedly and unsuccessfully attempted to control, cut back or stop gambling; 

- they are restless or irritable when attempting to cut down or stop gambling; 

- they gamble as a way of escaping from problems or relieving a dysphoric mood (e.g., feelings of helplessness, 

guilt, anxiety or depression); 

- after losing money gambling, they often return another day to get even; 

- they lie to family, a therapist or others to conceal the extent of their gambling; 

- they have committed illegal acts such as forgery, fraud, theft or embezzlement to finance gambling; 

- they have jeopardized or lost a significant relationship, job or educational or career opportunity because 

of gambling; or 

- they rely on others to provide money to relieve a desperate financial situation caused by gambling. 

Note: A person who meets five or more of the above criteria is not considered to be a pathological 

gambler if his or her actions can be explained by a manic episode. 

• Problem gambling is the term that is most commonly used throughout Canada. It is descriptive and is 

compatible with the notion that this problem can be very significant or very minor. People do not have to 

lose everything in their lives before getting help for “problem” gambling. Therefore, the term is broader 

and more inclusive. It is often used to describe gambling behaviour that involves some type of harmful 

consequence. Problem gambling includes, but is not limited to, compulsive and pathological gambling. 

It is the most effective term because it does not label or stigmatize the person with the problem in the way 

“pathological” or “compulsive” can. 



Why does it matter what we call it? The behaviour—gambling problematically—is the issue on which to 

focus. People have the problem, but they are not the problem. For example, calling someone a “problem 

gambler” can reduce him or her to one thing: a problem. Describing the situation rather than labelling the 

person—for example, “someone experiencing a gambling problem” or “someone affected by problem 

gambling”—reduces blame and stigma. 

Slide 7 

Gambling Prevalence Rates 

63.3% of Ontario adults have gambled in the past year. 

(Wiebe et al., 2006) 

Lottery tickets, raffle tickets and scratch tickets are the most common gambling activities 

engaged in by Ontario adults. 


Slide 8 

Problem Gambling Prevalence Rates 

3.4% of Ontario adults have moderate to severe gambling problems. 

Although the research indicates that 63% of adults in Ontario gamble, 3.4% experience 

moderate to severe problems with gambling. That is equal to approximately 

332,000 people (Wiebe et al., 2006). 

Another 5.8% are at risk of developing a gambling problem. 


Slot machines are the most problematic gambling activity engaged in by Ontario adults. 

Slot machines are the most problematic gambling activity because they provide 

intermittent reinforcement—a type of reinforcement that is very powerful because 

it is not continuous. 

Not only are slot machines the gambling activity with which adults in Ontario have the 

most difficulty, they are also the gambling activity that derives the most revenue from 

those who experience problems. 60% of the revenue derived from those experiencing 

gambling problems comes from slot machines (Williams & Wood, 2004). 



Slide 9 

Problem Gambling Prevalence Rates (continued) 

Men experience double the rates of gambling problems experienced by women. 

In Ontario, males are twice as likely as females to have a gambling problem (4.6% vs. 

1.4%) (Wiebe et al., 2006). 

Young adults aged 18 to 24 years have the highest rates of gambling problems. 

In Ontario, 6.7% of 18- to 24-year-olds experience moderate to severe gambling 

problems, compared to: 

• 4% for ages 25 to 34; 

• 3.2% for ages 35 to 49; 

• 2% for ages 50 to 59; and 

• 2.2% for those aged 60 years and over. 


Slide 10 

Some Risk Factors 

An early “big win” 

A big win early on can lead to false expectations about future wins. It is important to 

keep in mind that what is considered “big,” in terms of a win, is subjective and may 

vary from person to person. For example, while some people may see $100 as a big 

win, others might not consider this amount to be very significant. 

Not understanding the odds of winning 

As we will see in Session 2, people often have false beliefs about how gambling 

games work. These false beliefs (for example, believing that there is a system that will 

increase one’s chance of winning) put people at increased risk of developing a gambling 

problem. 

A history of alcohol and/or other drug problems 

As we will see in more detail in just a few moments, there is a link between substance 

use problems and gambling problems. 

A history of mental health problems, particularly depression, anxiety or trauma 

As we will also see, there is a link between mental health issues and problem gambling. 

In addition, research shows that rates of adult and childhood trauma are high among 

those experiencing gambling problems, and that problem gambling rates are higher 

among those who have experienced trauma (Boughton & Brewster, 2002; 

Ledgerwood & Petry, 2006; Biddle et al., 2005). 



A family history of problem gambling 

Research shows higher rates of problem gambling when a first-degree relative also 

has or had a gambling problem (Lobo & Kennedy, 2006). 

Loneliness, boredom or lack of leisure activities 

Gambling can easily alleviate feelings of loneliness or boredom. Also, since it is easily 

accessible and available and is promoted as “fun” and “exciting,” it is easy to see 

why someone may turn to this activity. 

Slide 11 

Some Risk Factors (continued) 

A habit of using gambling to cope with negative feelings or events 

The dissociative nature of gambling—the “escape” that it sometimes provides—may 

be very appealing to someone who is unable to cope with negative feelings. 

A tendency for impulsive behaviour 

As we will see in a few moments, those who struggle with impulse control have higher 

rates of problem gambling. 

Financial problems 

Some people who struggle financially may falsely believe that gambling is a solution 

to their financial problems. 

Note: The more factors that apply, the more likely a person is to develop a gambling 

problem. 


The reasons for developing a gambling problem are both wide-ranging and complex. According to the 

pathways model, developed by Alex Blaszczynski (1998), people experiencing gambling problems can be 

categorized into one of the following three groups or “pathways”: 

• Non-psychopathological or normal: For this group, problem gambling is linked to environment and learning. 

Problem gambling may stem from an early win or false beliefs about being able to win. These people 

do not necessarily have pre-existing psychological problems; they simply misunderstand the games, lose 

money and/or chase losses. (Chasing losses refers to continuing to gamble to try to win back money already 

lost, which almost always results in more losses.) According to Blaszczynski, with early intervention, these 

people may be able to control their gambling. 

• Emotionally vulnerable: For this group, gambling problems are due to difficulty in managing stress or crisis 

in their life. They use gambling as a way of avoiding underlying issues and current stresses. These people 

can even be vulnerable during times of “good” stress, such as the birth of a child. Blaszczynski believes 

that abstinence, as well as learning anxiety reduction techniques, is the best option for these people. 



• Biologically influenced or impulsive: This group comprises individuals who tend to have an impulse 

disorder, such as attention-deficit/hyperactivity disorder (ADHD). For this small percentage of people, 

gambling can trigger other binge behaviours. According to Blaszczynski, these people should receive 

counselling to deal with impulse control. People in this pathway will require intervention by a psychologist 

or psychiatrist. 

The pathways model demonstrates that people develop gambling problems for different reasons. The model 

might not, however, account for all the factors that lead people into gambling problems. 

Slide 12 

Impact of Problem Gambling 

Significant financial loss 

The most common negative impact of problem gambling is financial loss. Savings, 

property or belongings may be lost and excessive spending on gambling may also 

mean that bills are not paid, utilities are cut off and money for necessities such as 

groceries is in short supply. 

Higher rates of relationship and family breakdown 

Because gambling can be hidden for a long time, many families are shocked when 

the full impact of the gambling is discovered. While some families are able to recover, 

not all are able to survive gambling problems. 

Higher rates of emotional and health problems 

The stress of problem gambling can cause health issues such as anxiety, depression 

or other stress-related issues such as poor sleep, ulcers, bowel problems, headaches 

and muscle pains. 

Work-related difficulties 

Once gambling problems begin, preoccupation with gambling or gambling-related 

debt may lead to neglected work responsibilities or increased absenteeism. 

Legal problems 

Some individuals may turn to theft, fraud or embezzlement to finance their gambling 

or to deal with gambling-related debt. 

Higher rates of suicide 

Suicide attempts are more frequent among those who are experiencing problems 

related to gambling, compared with the general population. In addition, suicide 

attempts are more common among people experiencing problems related to gambling 

than among those experiencing problems with any other types of addictions 

(National Council of Welfare, 1996). As a result, it is important to screen those who 

are struggling with this issue for suicidality. 



Slide 13 

Concurrent Substance Use and Gambling Problems 

There are higher rates of alcohol, other drug and nicotine dependence among those 

who are experiencing gambling problems. 

In both treatment and general population samples, research shows higher rates of 

alcohol, other drug and nicotine dependence among those who are experiencing 

gambling problems (Kennedy et al., 2008; Petry et al., 2005; Welte et al., 2001; 

Crockford & el-Guebaly, 1998; Smart & Ferris, 1994; Bland, et al., 1993; 

Cunningham-Williams et al., 1998; Toneatto et al., 2002; Feigelman et al., 1998). 

There are also higher rates of problem gambling among individuals with substance 

use problems. 

In addition, research shows higher rates of problem gambling among individuals 

with substance use problems (Daghestani et al., 1996; Giacopassi et al., 1998; 

Lejoyeux et al., 1999; Crockford & el-Guebaly, 1998; Lesieur et al., 1986; Stinchfield 

et al., 2005). 

Slide 14 

Possible Links between Gambling and Substance Use Problems 

Gambling is falsely viewed as a safer alternative. 

Because gambling is promoted as a fun activity, and because people are not as aware 

of its potential risks, people who make changes to their substance use sometimes 

engage in gambling, believing it is safer than drinking or using other drugs. 

Gambling is falsely viewed as a way to finance substance use. 

Someone needing money for drugs, for example, may turn to gambling, believing 

that this is an easy way to make money. 

Using substances can lead to poor judgment in gambling activities. 

Gambling while under the influence is particularly risky, as it may lead to poor 

decision making. 

Substances may be used to cope with negative consequences of gambling. 

Someone struggling with, for example, significant financial losses because of gambling 

may turn to alcohol or other drugs to cope with negative feelings. 

There are some common biological factors shared by substance and gambling 

dependence. 

As already mentioned, we all learn through reward and punishment, and for some 

people the reward system of the brain works a bit differently. These individuals are 

able to take more risks and are less sensitive to reward. As a result, it is believed that 

they are at increased risk for addictions (Chambers et al., 2003). 




These are some possible connections between gambling and substance use. You may want to ask participants 

if they can think of additional connections. 

Slide 15 

Mood Disorders and Problem Gambling 

Mood disorders are very common among those who are experiencing gambling 

problems. 

Mood disorders such as major depressive disorder and dysthymic disorder, as well as 

manic and hypomanic episodes, are common among those who experience gambling 

problems (Petry et al., 2005). 

Also, according to a study conducted by Kennedy et al. (2008), there is more than 

twice the Canadian average rate of problem gambling in people seeking help for 

major depressive disorder. Further, this study found that more than 70% of people 

experiencing gambling problems reported that their mood disorder came before 

their gambling problem. 

In addition, according to a Canadian study by McIntyre et al. (2007), individuals who 

have been diagnosed with bipolar disorder have double the rates of problem gambling 

experienced by the general population. 

In some cases mood disorders can lead to the development of a gambling problem; 

in other cases, gambling problems can lead to a mood disorder. 

In some cases, the mood disorder is a contributing factor to the development of the 

gambling problem, while in other cases, it is the result of the gambling problem. For 

example, someone who struggles with depression may turn to gambling because it 

helps to alleviate depressive symptoms. Or, because of financial losses due to gambling, 

a person may start experiencing mood-related problems. 

In some cases, the mood and gambling problems may be cyclical—the mood disorder 

leads to a gambling problem which in turn leads to more mood issues, and so on. 

Being aware of the connection between gambling and mood problems is important 

as it will have an impact on treatment for both of these issues. 

Slide 16 

Anxiety Disorders and Problem Gambling 

Anxiety disorders are very common among those who are experiencing gambling 

problems. 

Anxiety disorders such as panic disorder (with or without agoraphobia), social phobia, 

specific phobias, generalized anxiety and obsessive-compulsive disorder are common 



among those who are experiencing gambling problems (Petry et al., 2005; Crockford 

& el-Guebaly, 1998). In fact, according to a study conducted by Kennedy et al. (2008), 

people with gambling problems reported higher rates of anxiety disorders than the 

Canadian average. 

In some cases anxiety disorders can lead to the development of a gambling problem; 

in other cases, the gambling problem can lead to an anxiety disorder. 

Similar to mood disorders, in some cases the anxiety disorder is a contributing factor 

to the development of the gambling problem, while in other cases, it is the result 

of the gambling problem. For example, people who are having difficulty dealing with 

anxiety may turn to gambling because the sometimes dissociative nature of gambling 

helps to alleviate their anxiety symptoms. Or, some people may struggle with anxiety 

resulting from the many lies they have told to conceal their gambling problem. 

In some cases, the anxiety and gambling problems may be cyclical—the anxiety disorder 

leads to a gambling problem which in turn leads to more anxiety, and so on. 

Being aware of the connection between gambling and anxiety problems is important 

as it will have an impact on treatment for both of these issues. 

Slide 17 

Impulsivity and Problem Gambling 

Impulsivity in general is common among those experiencing gambling problems. 

Research shows that impulsivity as a trait—as well as disorders that include aspects 

of impulsivity, such as attention-deficit/hyperactivity disorder, antisocial personality 

disorder and substance-related disorders—are common among those experiencing 

gambling problems (Rodriguez-Jimenez et al., 2006; Petry et al., 2005; Crockford & 

el-Guebaly, 1998). Pathological gambling is classified as an impulse-control disorder 

in the DSM-IV. 

The person’s lack of impulse control can make self-restraint difficult. 

Slide 18 

Psychosis and Problem Gambling 

Rates of pathological gambling are higher among individuals who have been diagnosed 

with schizophrenia than in the general population. 

There is not a lot of research on gambling and psychotic disorders. The research that 

exists, however, suggests that rates of pathological gambling (this term is discussed 

ina moment) are higher among individuals who have been diagnosed with schizophrenia 

than in those who have not been diagnosed (Borras & Huguelet, 2007). 



Psychosis is not as common among those experiencing gambling problems as are 

mood and anxiety disorders or impulsivity. 

Although psychosis is not as common as other mental health disorders among those 

experiencing gambling problems, it remains an issue for some. For some, psychotic 

symptoms such as auditory hallucinations may be a contributing factor to gambling. 

For example, a person may hear voices telling him or her to gamble. In addition, for 

those who already struggle with psychosis, the stress of problem gambling may be a 

trigger for psychotic symptoms. 

Slide 19 

Continuum of Gambling Behaviour 


Explain the continuum to the group. Be sure to clarify that a person can be at more than one place on the 

continuum. For example, you may place yourself at “occasional gambling” for your bingo play and “regular 

gambling” for your lottery use. 

Once you’ve described the continuum, ask participants where they “fit” on the continuum in terms of their 

own gambling behaviours. Depending on people’s comfort level, this activity can either be done as a group 

or individually. 

For those who fall into the “No Gambling,” “Occasional Gambling” and “Regular Gambling” categories of 

the continuum, prevention and education is recommended. This is the purpose of Sessions 1 and 2. 

For those who fall into the “Problem Gambling” and “Pathological Gambling” categories of the continuum, 

changes related to their gambling behaviour are recommended. This can mean either reducing or quitting 

some or all gambling activities. These clients should also participate in Sessions 3 and 4, where gambling 

problems are addressed in more detail. 

At this time, if you have not already done so, have participants complete the “Problem Gambling Severity 

Index” screening tool (Appendix A). Anyone who scores a 3 or higher should be encouraged to attend 

Sessions 3 and 4. 

No gambling 

With no gambling, there is no risk of developing a problem. 

Occasional gambling 

A person who gambles occasionally is someone who may, for example, go to the casino 

for an evening of entertainment once in a while. Gambling is not this person’s 

main leisure activity. 

Regular gambling 

A person who gambles regularly may dedicate considerable time to gambling but not 

to the point where it is damaging to other areas of his or her life. This person may, 

for example, buy weekly lottery tickets or go to weekly bingo. 



Problem gambling 

As already defined, problem gambling is a pattern of gambling that disrupts or damages 

one’s health, finances, reputation, relationships or vocational/academic pursuits. 

The problems can range from mild to severe. 

Pathological gambling 

For a small but significant number of people, gambling seriously harms all aspects 

of their lives. People with gambling problems this severe are unable to control the 

urge to gamble, despite the harm it causes. 

Slide 20 

Problematic vs. Non-Problematic Gambling 


Give participants a copy of the “Problematic vs. Non-Problematic Gambling” handout (Appendix C) and 

review it with them. If time allows, prior to distributing the handout, you can also do a brainstorm with the 

group to come up with examples of problematic and non-problematic gambling. 

Financial limits 

Non-problematic: Individuals who gamble non-problematically only lose money 

that they can afford to lose. Money is budgeted for this activity in the same way that 

money is budgeted for other social activities. When the funds are spent, the gambling 

stops. 

Problematic: Individuals who gamble problematically lose more money than they 

can afford to lose and often make the situation worse by trying to win back what they 

have lost. 

Time limits 

Non-problematic: Individuals who gamble non-problematically control the amount 

of time they spend gambling. 

Problematic: Individuals who gamble problematically often lose track of time and 

spend more time gambling than they intend. 

Entertainment 

Non-problematic: Individuals who gamble non-problematically enjoy gambling as a 

form of social or recreational activity in which they engage periodically. Gambling 

meets personal social needs such as getting out of the house and seeing other people. 

Problematic: Individuals who gamble problematically are more likely to see gambling 

as a form of income or a game of skill that they can conquer. 



Other activities 

Non-problematic: Individuals who gamble non-problematically enjoy gambling as 

one of many social activities in a balanced lifestyle. 

Problematic: Individuals who gamble problematically often spend a great deal of 

time gambling while missing family functions and skipping other activities that they 

used to enjoy. They often think about gambling even when they are not gambling. 

Relationships 

Non-problematic: Individuals who gamble non-problematically do not allow their 

gambling to disrupt their personal, social and professional relationships. 

Problematic: Individuals who gamble problematically find that gambling disrupts 

personal, social and professional relationships. 

Personal control 

Non-problematic: Individuals who gamble non-problematically have control over the 

amount of money they spend gambling. 

Problematic: Individuals who gamble problematically lose control over the amount of 

time and money they spend gambling. 





Session 2 






• Internet access 

• flipchart and markers 


- Reducing the Risk (Appendix D) 


Slide 21 

Understanding Gambling 

This second session focuses on: 

• how games of chance work; 

• false beliefs and superstitions associated with gambling; and 

• strategies for reducing the risk of developing a gambling problem. 



Slide 22 

The Slot Machine: What Every Player Needs to Know 


Most people are unaware of how games of chance actually work, and false beliefs are particularly common 

with slot machines. “The Slot Machine: What Every Player Needs to Know” is a 10-minute video that was 

co-developed by the Ontario Problem Gambling Research Centre and OLG. This video challenges many of 

the myths associated with slot machines and clearly shows how they really work. 

To view the “The Slot Machine: What Every Player Needs to Know” video, go to the www.KnowYourLimit.ca 

website. The link to the video is available at the bottom of the home page. 

This video is intended as a prevention tool. It is not meant to encourage anyone who has quit gambling to 

resume. Be sure to inform participants of this prior to showing the video. In addition, although the focus 

of this video is slot machines, it describes a number of important concepts that are relevant to all games 

of chance. 

After the group watches the video, ask participants what they thought: 

• Was this new information? 

• Did they know the odds would always be the same for each play of the slot machine? 

Or did they believe the odds changed based on when the machine last paid out? 

• Were they surprised that past wins/losses have no impact on current or future wins? 

• If they do occasionally gamble on slot machines, will this information change how 

they play? If so, how? 

Slide 23 

The Coin Toss: Activity 1 


Explaining important concepts about how games of chance work (for example, randomness, independent 

outcomes, odds) can be particularly challenging. The following coin toss activities are intended to help you 

demonstrate these concepts in a simple way. Some participants may question whether this activity is considered 

gambling. Because no one is risking anything of value, it is not. 

Activity 1: 

• Flip a coin five times and write the five outcomes (“heads” or “tails”) on the board. 

• Now flip the coin another five times, but before each flip ask participants what they 

think the outcome will be. Record each outcome. 

• Once you’ve completed all 10 coin tosses, ask participants what made them pick 

heads or tails. What was their reasoning? 

Debrief: 

• Guessing heads or tails is just that—a guess. There is no sure way to know what will 

come up. It is random. 



• People often mistakenly look for patterns, lucky streaks or what is “due to come up” 

when they gamble. All games of chance have an element of randomness that affects 

the outcome. There is no way to predict what the outcome will be. (We will go into 

more detail about randomness in a moment.) 

Slide 24 

The Coin Toss: Activity 2 

Activity 2: 

• For this second activity, ask participants which of these three patterns is the most 

likely to occur and why they picked the pattern they did. 

Heads or tails? 

H H H T H H H T T T 

T T T T T H H H H H 

T T T T T T T T T T 

Debrief: 

• People are likely to choose the first pattern. 

• As mentioned for the previous activity, however, there is no pattern that is more likely 

to come up. People choose the first pattern because it appears to be more random; that 

is, it looks more like what we would expect. The second and third patterns seem too 

ordered to occur naturally. However, since each independent flip of the coin has a 50% 

chance of landing on heads or tails, all three series of 10 flips are equally likely to occur. 

Slide 25 

Randomness 

Most gambling games are based on randomness, meaning they occur without reason, 

aim or pattern. This means: 

• no one can predict the outcome; 

• there is no connection between results; 

• all outcomes are equally likely. 


When gambling, people often mistakenly try to assign patterns. For example, someone may believe that a 

slot machine is “due for a win” because it has lost several times in a row. But, since each spin activates a 

random number generator, there is no way of knowing when a machine is due to win—each spin is random. 



Another example to consider is the lottery. Whether you buy a quick pick ticket or you select the numbers 

yourself has no impact on the outcome. All outcomes are equally likely. 

(Turner & Powel, 2007) 

Slide 26 

Independent Outcomes 

Most gambling games involve independent outcomes. 

Random events are independent from each other; in other words, gambling games 

have no memories. 

For example, a spin of the roulette wheel is in no way affected by the previous spin. 


What happened on previous plays has no impact on current or future play. If we consider our coin toss 

example again, a coin toss has no effect on the next coin toss. The coin doesn’t “remember” what the 

last outcome was and is not capable of “balancing” the overall outcome so that it is 50/50 (Turner & 

Powel, 2007). 

Slide 27 

The House Edge 

The “house” is the organization that sponsors the games. 

Examples include the casino, bingo hall, racetrack and lottery commission. 

The house edge is what the house “charges” the player to play the game. 

When people gamble on casino or lottery games, for example, they are always playing 

at a mathematical disadvantage, because the odds are set up in favour of the 

house. Even in games that involve some skill (for example, poker, sports betting) the 

game is set up to guarantee a profit for the house. 

Over time, no amount of skill can beat this house edge. 

Although people may win in the short term, because of this built-in advantage, over 

time they will likely lose more than they will win. This is what makes casinos and lotteries 

so profitable. 

(Turner & Fritz, 2007) 

Examples of the house edge: 

• Blackjack: When both the player and the dealer go over 21 (technically a tie), the 

player loses. 



• Roulette: The wheel has 38 slots but only 36 have numbers and are either red or 

black. The two remaining slots are 0 and 00 and both green. Therefore, when the 

marble lands on either 0 or 00, all the players who bet on red or black lose their bets. 

Slide 28 

Odds 

The odds are your chances of winning. 

For example, in a coin toss your chance of accurately predicting the outcome is two 

to one (50%). 

In gambling, the odds are always against the person placing the bet. 

The house (the casino, bingo hall, racetrack, lottery commission, etc.) is absolutely 

guaranteed mathematically to win over time. This is how they make their money. 

The longer you gamble, the more likely it is you will lose. 

Because the house has a mathematical advantage, the longer you gamble, the more 

likely it is you will lose. 

The house always has the edge. 

This is because the odds are set up in favour of the house. 

(Turner & Powel, 2007) 

Slide 29 

What Are Your Chances? 

Say that my brother lived somewhere in Ontario but I did not know his phone number. 

If I were to randomly dial any Ontario residential phone number, what do you think 

the odds are that I would reach him? 

Most people would say that this is impossible! And yet so many people play Lotto 

6/49 and believe they have a good chance of winning. 


According to Statistics Canada, in 2008, the Ontario population was approximately 12,900,000. If you consider 

that not every single Ontarian has a residential telephone number, you can see that the chances of 

reaching my brother by telephone are better than my chances of winning the Lotto 6/49 (which are approximately 

one in 14 million)(Statistics Canada, 2009). 



Slide 30 

Games of Chance—No Skill 

These games are based only on chance, randomness and independent outcomes. 

Examples: 

• lottery/scratch tickets 

• roulette 

• bingo 

• dice games 

• slot machines 


Slide 31 

Games of Chance—Some Skill 

These games involve some skill, but so much randomness is involved that the 

chances of winning are still very low. 

The house advantage is lower than games that require no skill, but although players 

may win in the short term, it is mathematically likely that over time, they will lose 

more than they win. 

Examples: 

• card games 

By following a basic strategy, skilled players may have more opportunity to minimize 

their losses, or play for longer with the same amount of money. It is important to 

remember, however, that card games still have a random element (there are only so 

many cards and you don’t know which cards will be dealt) and that players can lose 

many times consecutively regardless of how well they play. 

• sports betting 

There is still a great deal of uncertainty in sports betting (for example, weather conditions, 

health of the players, etc.). For Pro-line, for example, you have to make the 

point spread and/or choose the three winning teams in order to win. 

• horse betting 

There is also a great deal of uncertainty in horse betting (for example, health of the 

horse or the jockey, track conditions, etc.). In addition, the odds are based on how 

many bets have been placed on a certain horse. 




Slide 32 

Cognitive Distortions 

False and superstitious thoughts, ideas or beliefs 

As we will see, cognitive distortions are of particular importance when it comes to 


Common in all societies 

For example, in North American culture, the following superstitions and beliefs are 

common: 

• walking under a ladder = bad luck 

• crossing the path of a black cat = bad luck 

• groom seeing the bride before the wedding = bad luck 

• breaking a mirror = seven years of bad luck 

• opening an umbrella in the house = bad luck 

• a rabbit’s foot = good luck 

• blowing out candles on a birthday cake = good luck (your wish will come true, but 

only if you do not tell anyone what you wished for!) 

• an itchy palm = money will come your way 

• number 13 = unlucky (most large buildings in North America do not have a 13th 

floor—the elevator numbers go from 12 to 14!) 

Risk factor for problem gambling 

Although cognitive distortions are common to us all, when it comes to gambling, 

they are of particular concern. 

Slide 33 

Common Gambling-Related Cognitive Distortions 


This slide looks at a number of gambling-specific cognitive distortions. You can go into as much or as 

little detail as needed, depending on the time available and the interest of the group. 

Control over luck 

Luck as a variable: Actively trying to manipulate luck through superstitious behaviours, 

such as wearing a lucky bracelet. 

Luck as a trait: Believing that you are naturally lucky with certain games and unlucky 

with others. 

Aligning with luck: Believing that, since luck cannot be manipulated directly, it is 

important to wager strategically, waiting for periods of good luck (streaks) and avoiding 

periods of bad luck. 



Luck as a contagion: Believing that success in other areas of one’s life will bring success 

at gambling, or that other people bring either good or bad luck (for example, 

leaving a blackjack table because the dealer is unlucky). 

Superstitious behaviours 

Talismanic superstitions: Believing that possessing a certain object, such as a shirt, 

hat or doll, increases one’s chances of winning. 

Behavioural superstitions: Believing that certain actions or rituals increase the 

chance of winning. These are usually non-verbal behaviours, such as sitting in a preferred 

seat at bingo, holding the cards a specific way or pulling the arm on a slot 

machine instead of pressing the button. 

Cognitive superstitions: Believing that one’s mental state can influence the chance of 

winning. Examples include praying, hoping, thinking optimistically and maintaining 

a positive state of mind. 

Magnification of skills 

Overrating one’s ability to win and exaggerating self-confidence, despite persistent 

losses. 

Selective memory 

Recalling wins, especially large ones, but not losses. 

Attribution biases 

Attribution errors: Explaining wins by overestimating the importance of dispositional 

factors (e.g., skills and abilities) and underestimating situational factors (e.g., luck 

and probability); losses are interpreted as near wins, and wins are interpreted as a 

sign of skill. 

Anthropomorphism: Attributing human characteristics to gambling objects, by 

giving names to slot machines, for example. Also crediting these objects with wins 

or blaming them for losses, assuming a relationship can exist with the game or 

its objects. 

Gambler’s fallacy: Interpreting losses as an indication that a win is imminent. This 

often leads to chasing—when someone tries to make up previous losses through 

more gambling. Chasing usually involves taking greater risks and/or making larger 

bets. The goal may be not only to regain the money that was lost, but also to reexperience 

the feeling of how great it was to win. 

Over-interpretation of cues 

Over-interpreting ambiguous stimuli, such as bodily sensations, intuitions or unusual 

events, to guide gambling decisions, such as whether to continue playing. In this 

case, feelings equal knowledge. 

(Toneatto, 2000) 



Slide 34 

Reducing the Risk 


Give participants a copy of the “Reducing the Risk” handout (Appendix D). If time allows, prior to giving 

out the handout you can do a brainstorm with the group to come up with strategies to reduce the risk of 

developing a gambling problem. 

Set a limit on time and money. 

Spend only what you can afford to lose. Leave your bank and credit cards at home. 

When your budget is gone and your time is up, walk away! Do not try to win back 

your losses or use rent or grocery money to continue to gamble. Keep a diary of how 

much time you play and record your wins and losses—memory is selective in 

remembering only the wins. 

Think of gambling as entertainment and not as a way to make money. 

Play knowing that you will almost certainly lose. Go with friends who do not have 

gambling problems and ask them to support you in staying within your pre-set limits. 

See the money lost as part of your entertainment budget. 

Understand the odds. The house always has the edge. 

Make your gambling decisions based on an accurate understanding of your odds of 

winning. Expect to lose. Accept that you have no control over the outcome of gambling. 

It is truly random. You cannot change the outcome, there are no winning 

strategies and you cannot influence luck. The odds are stacked against you and 

always in favour of the house. 

Recognize risk factors. 

Do not gamble when you are feeling vulnerable, bored, lonely, anxious or angry. Be 

careful not to use gambling as a way to escape problems or to avoid difficult feelings 

or situations. Mixing alcohol or other drugs with gambling is risky and should also 

be avoided. 

If you choose to gamble, keep it as part of a balanced lifestyle. 

If you choose to participate in gambling, see it as an enjoyable part of a balanced 

lifestyle. Have other meaningful activities in your life—not just gambling. 

Listen to the concerns of others. 

If others express concern about your gambling, listen to them! They may see something 

you don’t. People who do not have gambling problems do not let their gambling 

behaviours negatively affect relationships in their personal, social or professional lives. 



Slide 35 

Helpful Resources 

Ontario Problem Gambling Helpline 

1 888 230-3505 

www.opgh.on.ca 

If you are concerned about your own gambling or the gambling behaviour of someone 

close to you, free and confidential help is available in Ontario. To find treatment 

services near you, contact the Ontario Problem Gambling Helpline (ConnexOntario). 

www.ProblemGambling.ca 

This website about gambling and problem gambling is geared toward the general 

public, people concerned about their own gambling or someone else’s gambling, and 

professionals. 

www.KnowYourLimit.ca 

This website provides information about how gambling works, myths and facts, and 

helpful tips to reduce the risk of developing a gambling problem. 

Slide 36 

Preventing Problem Gambling: Take-Home Messages 

People with a history of substance use problems are at higher risk of developing 

a gambling problem. 

People with a mental health problem are at higher risk of developing a gambling 

problem. 

People who have problems with gambling are at higher risk of suicide. 

Slide 37 

Take-Home Messages (continued) 

The house edge ensures that over time, you will likely lose more money than you win. 

Gambling games are mostly based on randomness and independent outcomes, and 

your chances of winning are smaller than your chances of losing. 

Luck is really just a cognitive distortion and many people get into trouble because of 

a lack of understanding about how games of chance work. 



Slide 38 

Take-Home Messages (continued) 

The casinos and lottery corporations are billion-dollar industries. 

Gambling is a problem when it damages your finances, work, health, relationships 

or reputation. 

You can reduce your risk of developing a problem by setting limits on time and 

money, and viewing gambling as entertainment and not as a way of making money. 





Session 3 








- How to Choose Your Gambling Goal (Appendix E) 

- My Goal Statement (Appendix F) 

- Self-Monitoring Gambling or Urges to Gamble (Appendix G) 

- Gambling Triggers (Appendix H) 

- Inventory of Gambling Situations (igs) tool 


Note: The Inventory of Gambling Situations tool is not included in this guide. A copy 

of this tool is available in the Inventory of Gambling Situations User’s Guide 

(pages 18-21). You can access this guide from the following link: 

http://www.problemgambling.ca/EN/Documents/InventoryGambUserGuide2009 

FinalProtected.pdf 



Slide 39 

Goal Setting and Identifying High-Risk Situations 

This third session focuses on: 

• how to set realistic gambling goals; and 

• how to identify personal gambling triggers. 

Slide 40 

Goal Setting 

Different goals are appropriate for different people: 

• abstinence; or 

• reduced gambling 

Some people might choose to abstain from gambling, while others may set themselves 

a goal of reduced gambling. 

Reduced gambling can include reducing involvement in gambling, or quitting some 

forms of gambling but continuing to engage in others. As we will see in the next slide, 

you should take many factors into consideration when choosing a gambling goal. 

However, an initial period of abstinence is recommended for everyone. 

For many reasons, even if you choose a goal of reduced gambling, a period of abstinence 

is recommended because: 

• It may bring some relief from the pressures you are experiencing as a result of gambling. 

• It may help you recognize hidden motivations for, or attractions to, gambling not 

obvious to you now. 

• It gives you time to come up with a concrete and realistic plan for reduced gambling. 

• It proves to yourself that you are able to abstain from gambling. 

• It helps put gambling into perspective with other life responsibilities and activities. 

This initial period of abstinence may vary from person to person depending on 

circumstances. For example, some people may feel they simply need a few days or 

weeks to come up with a realistic plan, while others may feel they need a longer period 

to allow them to address their financial problems. 


Historically, most addiction treatment programs were abstinence-based. Over the past few decades, however, 

there has been a shift toward a harm reduction approach. 

When applied to problem gambling, harm reduction means reducing the harm associated with gambling. 

This can include reducing involvement in gambling, quitting some forms of gambling or abstaining from 

all forms of gambling. Talking a harm reduction approach allows clinicians to support clients at all stages 

of change. As well, it respects the rights of clients to set their own goal. 



Slide 41 

Choosing Your Gambling Goal 

Abstinence is recommended when: 

• you are experiencing significant financial problems; 

• you continue to see gambling as a solution to financial problems; 

• you gamble to escape and/or cope with negative situations and moods; 

• your gambling is related to an impulse disorder; 

• you have been mandated to by the legal system; 

• you have already made unsuccessful attempts to reduce your gambling; or 

• your relationships or employment may be at risk if you continue to gamble. 

(Toneatto et al., 2003) 


Give participants a copy of the “How to Choose Your Gambling Goal” questionnaire (Appendix E) and 

have them fill it out. 

This tool is helpful when deciding between abstinence and reduced gambling. It has eight questions that 

focus on the person’s previous gambling behaviour and it recommends a gambling goal based on his or 

her responses. A “yes” answer to any of the questions indicates that cutting down may not be the best 

choice and a goal of abstinence is recommended. Despite this, the ultimate decision is the client’s. 

A “no” answer to all eight questions indicates that the client may succeed at reduced gambling. If the person’s 

choice is reduction, it is important to establish clear guidelines and discuss the following issues: 

• which gambling activities the client will and will not engage in; 

• how frequently the client will gamble; 

• how much money and time the client will spend on gambling; and 

• the times when the client will not gamble (for example, when he/she is feeling sad or has consumed alcohol 

or taken other drugs). 

Another point to consider is that of wins. If clients choose a goal of reduced gambling, it is important for 

them to think about how they will address possible wins. A win might, for example, be seen as a change 

in luck. And, in trying to duplicate the win, the client may find himself or herself experiencing further problems. 

In addition, without careful planning, a win can easily lead clients into believing they no longer have 

a gambling problem. As such, it is important for clients to plan for this situation, in case it should arise. 

Otherwise, a win may trigger clients to return to gambling activities they have been abstaining from; or, for 

activities they are still engaged in, it may trigger them to exceed the limits they have set for themselves. 

Finally, although we do not impose specific goals on clients, you may choose to recommend a goal based on 

your knowledge and expertise. If you recommend a goal of abstinence, however, it is important to reassure 

clients that your support is not conditional on their agreeing to this goal, or on their success at abstaining. 

Use language like the following: “You have the right to choose your own goal, and I will support you no 

matter what you choose. However, based on what you are telling me, I feel I have to recommend that you 

abstain from gambling.” At this point provide details about why you are recommending abstinence; for 



example, the client’s serious financial situation, the risk to his or her employment or unsuccessful past 

attempts to reduce gambling. Conclude by reassuring the client, “If you choose to work on a goal of 

reduced gambling, I will continue to support you.” 

Slide 42 

My Goal Statement 


Give participants a copy of the “My Goal Statement” handout (Appendix F) and have them complete it. 

• In the Gambling Activity column, they should indicate every gambling activity they have been involved in. 

If participants are engaging in numerous activities, a second copy of this handout may be necessary. 

• In the Gambling Goal column, participants should indicate what their goal will be for each gambling 

activity. If they choose a goal of reduced gambling, they should include as much detail as possible (see 

example on handout). 

Tell participants that you will be reviewing this handout in Session 4 and ask them to bring it to the 

next session. 

Slide 43 

Triggers 

Personal triggers 

What triggers one person to want to gamble is not necessarily what will trigger another. 

For example, watching a sporting event on television may be a trigger for some people 

who’ve had problems with sports betting, but it may not be a trigger for others who’ve 

had similar problems. 

Identifying one’s personal triggers is very important and can be done in a number of 

ways. For example, through self-monitoring, a person may begin to recognize what 

triggers gambling urges, in addition to identifying patterns over time. 

Multiple triggers 

People who experience problems related to gambling usually have more than one 

trigger. To simply focus on one trigger and neglect others sets a person up for relapse. 

Occasional triggers 

Occasional triggers (less frequent triggers) also need special attention, because they 

may take the person by surprise. For example, someone who is doing well with his 



or her gambling goal while at home may find that an unexpected work trip triggers 

strong urges to gamble. Identifying periodic triggers, such as a sports season or holidays, 

is also strongly encouraged. 


At this time, give participants a copy of the “Self-Monitoring Gambling or Urges to Gamble” handout 

(Appendix G) and review it with participants. Encourage them to start using this tool to keep track of gambling 

urges and/or actual gambling occurrences. 

Tell participants that you will be reviewing this handout in Session 4 and ask them to bring it to the next 

session. 

Slide 44 

Identifying Triggers 

Triggers: 

• situations (people, places and things) 

Situational triggers could be people you used to gamble with, places such as corner 

stores or sporting events or things such as receiving bills in the mail or pay day. 

• thoughts 

Thoughts such as “Just one more time,” “I am due to win” or “Today is my birthday 

so it has to be lucky” can be triggers. 

• moods (positive and negative) 

Negative moods such as anger, desperation, loneliness or grief and positive moods 

such as joy, confidence or excitement can be triggers. 

How are these triggers connected to each other? 

For example, getting a bill in the mail may lead to feelings of desperation, which may 

lead to thoughts of “Just one more time.” 


Give participants a copy of the “Gambling Triggers” handout (Appendix H). Depending on the time or the 

number of people in the session, either: 

• have them complete the worksheet on their own and then have a group discussion about it; or 

• do this exercise as a group by writing the headings “Situations”, “Thoughts” and “Moods” on the board 

or on a flipchart and then doing a brainstorm for triggers and placing them in the appropriate columns. 

Note that at this time, participants are only filling in the triggers for Situations, Thoughts and Moods. They 

are not completing the Action Plan section yet (this will be done in the final session). 

Tell participants that you will be reviewing this handout in Session 4 and ask them to bring it to the 

next session. 



Slide 45 

Inventory of Gambling Situations (igs) Tool 


The IGS tool, developed by Littman-Sharp & Turner (1999), is a 61-item questionnaire that identifies an 

individual’s risk situations for gambling. It is based on the Inventory of Drinking Situations (IDS) tool, which 

has been used for many years for the same purpose with people experiencing problems with alcohol. 

Have each participant complete the IGS tool. To score the tool manually, read the directions in the Inventory 

of Gambling Situations User’s Guide (http://www.problemgambling.ca/EN/Documents/ 

InventoryGambUserGuide2009FinalProtected.pdf), pages 10-12. 

You can also score this tool electronically by inputting the data in the electronic IGS tool at: 

http://www.problemgambling.ca/EN/ResourcesForProfessionals/Pages/InventoryofGamblingSituations 

Questionnaire.aspx 



Session 4 








- participants’ scored Inventory of Gambling Situations (igs) tool 


Slide 46 

Developing Coping Strategies for High-Risk Situations 

This fourth session focuses on: 

• developing coping strategies to deal with gambling triggers; and 

• helpful resources. 



Slide 47 

Reviewing Gambling Goals, Triggers and Self-Monitoring 

In the previous sessions, we focused on setting goals and identifying triggers. Have 

participants pull out the following handouts: 

• My Goal Statement (Appendix F) 

• Self-Monitoring Gambling or Urges to Gamble (Appendix G) 

• Gambling Triggers (Appendix H) 

Review the worksheets with participants. 

• How did they do with their goal(s)? 

• Do they want to add anything to their list of triggers? 

• Do they want to make any changes around any of their gambling goals? 

Debrief as necessary. 

Slide 48 

Reviewing Your IGS Results 


Hand out each participant’s scored IGS results. Let them know that each subscale has a number between 

0 and 100 and that the higher numbers are an indication that this subscale is a high-risk situation for them. 

Give them a few moments to review the results and ask if there are any surprises and/or questions about 

the results. 

You should also briefly explain each subscale to the group. Point out that while the IGS focuses on their 

past gambling behaviour and under what circumstances they gambled the most, it makes sense that those 

same circumstances or situations are their highest-risk times to relapse in the future. So, the IGS provides a 

kind of priority list of high-risk situations that clients can anticipate and plan for in the future. 

Negative emotions 

Gambling to escape from, or cope with, negative emotions such as sadness, anger, 

guilt or stress. 

Conflict with others 

Gambling to cope with conflict with others. 

Need for excitement 

Gambling for the thrill or excitement of it. 

Testing personal control 

Gambling to test imposed limits on self or one’s ability to gamble without negative 

consequences. 



Pleasant emotions 

Gambling to celebrate or when feeling happy and content. 

Social pressure 

Gambling when pressured to or when in a social situation where gambling is expected. 

Worried about debts 

Gambling to relieve financial pressures. 

Winning and chasing 

Gambling to recoup gambling loses, or believing that one more try is needed or that 

this time the outcome will be profitable. 

Confidence in a skill 

Gambling when confident, or believing that this time it will be a sure thing. 

Urges and temptations 

Gambling when the urge comes, out of habit, when reminded of gambling or when 

gambling is available. 


The participants could also compare their IGS results to their “Identifying Gambling Triggers” handouts. 

Are they similar or different? Some clients are already aware of their worst triggers and may already be 

addressing them. They may be unaware, however, of less intense or less frequent triggers, which can just 

as easily lead to a relapse. For instance, clients who have dealt with some temptations, such as availability 

or friends gambling, may be less aware of their vulnerability to cognitive distortions, such as confidence 

in skill. 

Based on these results, participants may also want to make some changes to their gambling goals. For 

example, if they scored highly on Negative Emotions and they chose a goal of reduced gambling, they may 

want to make it a goal to not gamble when they feel sad, mad or frustrated. 

Slide 49 

Developing Coping Strategies 

Match strategies to your triggers. 

Once you identify specific triggers, you must develop specific strategies to cope with 

them. Not all strategies work for everyone, so be specific about your own needs. 

Use: 

• action strategies; 

• thinking strategies; and 

• feeling strategies. 



As with triggers, it is helpful to divide the strategies into action, thinking and feeling 

strategies; for example, avoiding going to sports bars (action), using positive self-talk 

(thinking), or dealing with negative emotions (feeling). 

If one plan doesn’t work, try another. 

You should never have just one plan to deal with triggers. Come up with a plan A, B, 

C and even D so that you are prepared to address whatever challenges may come up. 

Don’t simply focus on avoidance. 

Although it’s good to focus on avoiding triggers at the beginning, over time, you 

should focus on engaging in healthy replacement behaviours, rather than simply 

avoiding old harmful ones. For example, some people may need to develop better 

connections with family and friends to feel a greater sense of belonging and have a 

wider variety of activities to take part in. 

Slide 50 

Examples of Strategies 

Avoid things/places that trigger the urge to gamble, for example: 

• the corner store where you can buy lottery tickets; 

• the sports pages of the newspaper; 

• sports or poker tournaments on TV. 

Avoid people who will trigger the urge to gamble, for example: 

• friends or family you used to gamble with. 

Slide 51 

Examples of Strategies (continued) 

Avoid drinking or other drug use during high-risk times. 

Reduce the withdrawal limit on your debit card. 

Reduce the limit on your credit card. 

Carry limited amounts of cash. 

If you go somewhere that gambling will be available, leave your credit and debit cards 

at home. 



Slide 52 

Examples of Strategies (continued) 

Tell friends and family that you no longer gamble. 

If you find yourself in a place/situation where you are feeling triggered to gamble, 

leave. 

Associate yourself with supportive people. 

Attend a support group for people who also struggle with gambling. 

Slide 53 

Some Recommended Strategies 

Self-exclusion 

Some people with gambling problems find it helpful to create an extra barrier to prevent 

them from going to casinos or slot machine venues at raceways. Self-exclusion, 

or “banning” oneself from casinos and slot machine venues, is a voluntary program 

offered by olg to people who would like to stay away from gambling facilities. 

To self-exclude, clients should go to their local olg gambling facility or to a designated 

off-site location for a voluntary interview with security staff. Their photograph will be 

taken and they will be asked to sign a self-exclusion form. This information is then 

forwarded to all other olg gambling sites in Ontario. For example, if clients selfexclude 

at Woodbine Racetrack in Toronto, they are not only banning themselves 

from this venue, but from all olg casinos and olg slot machine venues within 

the province. 

Self-exclusion contracts are irrevocable for the time period covered and are enforced 

by casino security personnel. If someone who is on the self-exclusion list is found in 

a casino or slot machine venue, he or she may be asked to leave, or may be subject to 

a trespassing charge and/or fine. 

After a minimum of six months, clients can ask to have their self-exclusion overturned. 

A written request must be submitted to an olg casino or olg slot machine 

venue. Requests are not considered until six months after the initial date and there 

is a 30-day waiting period before reinstatement is granted. 

For more information about self-exclusion, visit www.KnowYourLimit.ca. 

GamBlock: Blocks access to all online gambling. 

For those who gamble online, GamBlock is an excellent tool. It is easily downloadable 

from the following website: www.GamBlock.com. Once this program is installed 



on the person’s computer, it will block access to all gambling sites. 

Because the cost for a one-year subscription is approximately US $75, however, it may 

not be a realistic option for everyone. 

Address financial issues by: 

• dealing with debt 

Debt is often a big trigger for gambling, since some people falsely believe that the 

only way to pay off their debt is by winning at gambling. Putting an end to this cycle 

is crucial, and there are financial experts who can help. For example, the Ontario 

Association of Credit Counselling Services can assess a person’s finances and make 

recommendations specific to his or her situation and needs. Contact information for 

the Ontario Association of Credit Counselling Services is available on the final slide of 

this session. 

• considering temporarily handing over control of your finances. 

During the early stage of treatment, limiting access to money is often essential to 

reducing or stopping gambling in the short term. Family members and friends can be 

enlisted for support if they are willing; most families are relieved to take this on. If a 

client chooses this option, it can be helpful for the clinician to assist in negotiating 

these limits. Generally speaking, it is better in the long run if the arrangements are 

decided collaboratively, as part of a helping plan, rather than imposed on the client. 

Slide 54 

Gambling Triggers: My Action Plans 


At this time, have participants go back to the “Gambling Triggers” handout (Appendix H) that they completed 

in the previous session, and have them fill in the Action Plan section for Situations, Thoughts and 

Moods. Depending on time and the number of participants, you may ask them to do it individually, in pairs 

or in the larger group. 

Optional role-playing activity: 

It may be particularly beneficial for clients with both gambling problems and a major mental illness to have a 

chance to role-play how to effectively handle some of the suggestions in this session. 

Some suggestions for client role-playing include: 

• Practise asking a family member to temporarily take over control of your finances. 

• Practise telling a family member that, at family gatherings, you would rather not play cards for money 

any more. 

• Practise going into a casino and telling security staff that you would like to self-exclude. 

• Practise telling your family and friends that you no longer gamble. 

• Practise the steps you would take to get out of a high-risk situation (e.g., you are at a friend’s house, and 

an impromptu game of poker starts up—how would you get out of there without gambling?) 



You have just had an argument with a family member. You are frustrated and angry—which is usually 

when you feel the urge to gamble. Practise different ways of handling your negative emotions more effectively 

(such as taking a long, warm shower; going for a walk; focusing on your breath; listening to music; or doing 

a thought record). 

Slide 55 

Some Final Thoughts 

Think ahead. 

Prevent or avoid triggers by identifying the processes that lead to gambling. 

Plan healthy alternatives to gambling and rewards for not gambling. 

Healthy, positive alternatives and rewards are essential. You need to acknowledge 

your hard work and progress. 

Identify barriers and plan to overcome them. 

There will be barriers and rough spots—you should anticipate these and plan for 

them. For example, if family gatherings involve playing cards for money, you have to 

come up with a plan that will work for you. You may decide to: 

• avoid family gatherings for a certain period of time; 

• tell family about your difficulties and ask them to plan alternative activities during 

family get-togethers; or 

• ask if the wagering aspect of card games can be omitted. 

Slide 56 

Some Helpful Resources 

Ontario Problem Gambling Helpline 

www.opgh.on.ca 

1 888 230-3505 

Problem gambling can be overcome, and although these sessions are important first 

steps in addressing this issue, clients should be encouraged to continue to get support. 

Over 55 specialized problem gambling treatment services are available, free of 

charge, throughout Ontario. Clients should be strongly encouraged to follow up with 

their local treatment provider once they return home. To find out where services are 

available in specific regions, contact the Ontario Problem Gambling Helpline. This 

service is free, confidential, anonymous and available 24 hours a day. 

www.ProblemGambling.ca 

This bilingual website, developed by the camh Problem Gambling Project, is intended 

for the general public, for those concerned about their own gambling or someone 



else’s gambling, and for professionals. It contains information about gambling and 

problem gambling, screening tools, printable handouts and self-help resources. 

Some client resources are available in an additional 20 languages. 

Ontario Association of Credit Counselling Services 

www.oaccs.com 

1 888 204-2221 

Anyone who has financial problems related to gambling should be encouraged to 

contact this service. This not-for-profit provincial organization provides information 

and referral to 26 member credit counselling services throughout Ontario. Their 

services include budgeting, dealing with creditors, paying off debt at a rate that is 

manageable, and restoring credit. 



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Appendices 


Problem Gambling: Education and Treatment in a Residential Setting Screening Tool · 53 

Appendix A 

Problem Gambling Severity Index 

Thinking about the last 12 months . . . 

Have you bet more than you could really afford to lose? 

0 Never 1 Sometimes 2 Most of the time 3 Almost always 

Still thinking about the last 12 months, have you needed to gamble with larger 

amounts of money to get the same feeling of excitement? 

o Never 1 Sometimes 2 Most of the time 3 Almost always 

When you gambled, did you go back another day to try to win back the money you lost? 


Have you borrowed money or sold anything to get money to gamble? 


Have you felt that you might have a problem with gambling? 


Has gambling caused you any health problems, including stress or anxiety? 


Have people criticized your betting or told you that you had a gambling problem, 

regardless of whether or not you thought it was true? 


Has your gambling caused any financial problems for you or your household? 


Have you felt guilty about the way you gamble or what happens when you gamble? 


scoring 

0: Non-problem gambling. 

1 or 2: Low level of p0roblems with few or no identified negative consequences. 

3 to 7: Moderate level of problems leading to some negative consequences. 

8 or more: Problem gambling with negative consequences and a possible loss of control. 

Reference: Ferris, J., & Wynne, H. (2001). The Canadian problem gambling index: 

Final report. Submitted for the Canadian Centre on Substance Abuse. 





Appendix B 

Sessions 1 and 2: Pretest/Post-Test 

1. Why is it important to talk about gambling, even if you’ve never gambled before? 

a. Because everyone gambles 

b. Because people who have substance use and/or mental health problems are at risk 

for developing gambling problems 

c. Because gambling can be a trigger for substance use or mental health relapse 

d. All of the above 

e. b and c 

2. Which of the following elements is not part of the definition of gambling? 

a. Something of value is risked 

b. It is a social activity 

c. The outcome has an element of chance 

d. Once the bet is made, it is irreversible 

3. Which of the following would be considered gambling activities? 

a. Slot machines 

b. Horse betting 

c. Bingo 

d. Lotteries 

e. Getting married 

f. All of the above 

g. All except e 

4. Lots of people gamble without it becoming a problem. You know it has become a 

problem when it damages your: 

a. Finances 

b. Work 

c. Relationships 

d. Reputation 

e. All of the above 

5. What percentage of adults in Ontario have gambled in the past year? 

a. 90% 

b. 74% 

c. 63% 

d. 29% 



6. What is the most common gambling activity among adults in Ontario? 


b. Lottery tickets 

c. Bingo 

d. Horse betting 

7. What percentage of adults in Ontario have a moderate to severe gambling problem? 

a. 31.2% 

b. 19.8% 

c. 9.5% 

d. 3.4% 

8. Which of the following statements best describes those who are experiencing problems 

with gambling? 

a. Many struggle with mood disorders 

b. Many struggle with anxiety disorders 

c. Many struggle with psychosis 


e. a and b 

9. Which of the following is not a risk factor for problem gambling? 

a. An early big win 

b. Mistaken beliefs about the odds of winning 

c. Having a family member who has had a big lottery win 

d. A history of substance use and/or mental health problems 

10. Why is gambling especially problematic for people who have a substance use problem? 

a. They may believe, in error, that it is a safer activity 

b. If they gamble when intoxicated, they can get into financial trouble 

c. They may believe, in error, that gambling would be a good way to finance their substance 

use 

d. If they lose money while gambling, they are more likely to use substances to cope 


11. People who are considered to gamble non-problematically would be people who: 

a. See gambling as one of many types of recreational activities and realize that gambling 

can be a way of increasing their income 

b. Only gamble what they can afford to lose and enjoy the fun of gambling so much 

that they lose track of time 

c. Do not allow gambling to interfere with their personal relationships and make sure 

that they stay long enough to win back what they have lost 

d. Control the amount of money they spend on gambling and see gambling as one of 

many types of recreational activities 

12. Which of the following are characteristics of something that is random? 

a. All outcomes are equally likely 

b. No one can predict the outcome 

c. There is no connection between results 




13. Which phrase best illustrates the idea of independent outcome? 

a. “The house always wins.” 

b. “Gambling games have no memories.” 

c. “This slot machine is due for a payout.” 

d. “I never gamble on a Sunday.” 

14. Which of the following statements is true? 

a. You should keep playing the same lottery numbers—it increases your chances 

of winning. 

b. When looking for a slot machine to play, you should try to find one that hasn’t paid 

out in a while. 

c. The lottery numbers drawn this week have no effect on the numbers that will be 

drawn next week. 

d. If a fair coin is tossed five times and you get “tails” each time, the sixth time the 

coin is more likely to turn up “heads.” 

15. Which are examples of the house advantage? 

a. If I flip a coin four times and it lands on heads each time, the chance that I flip 

heads on the fifth flip remains 50%. 

b. In casino blackjack, when both the dealer and the player go over 21, the player loses 

his or her money. 

c. In roulette, the wheel has 38 slots but only 36 have numbers and are either red or 

black. The two remaining slots are 0 and 00 and both green. Therefore, when the 

marble lands on either 0 or 00, all the players who bet on red or black lose their bets. 



16. Which of the following is a game of pure chance? 


b. Card games 

c. Sports betting 

d. Horse betting 

17. Cognitive distortions are: 

a. False and superstitious thoughts, ideas or beliefs 

b. Common in all societies 

c. A risk factor for problem gambling 


e. a and c 

18. To reduce the risk associated with gambling, you should: 

a. Set a limit on time and money 

b. Think of gambling as entertainment, not a way to make money 

c. Remember that the house always has the advantage 






Sessions 1 and 2: Pretest/Post-Test Answers 

1. Why is it important to talk about gambling, even if you’ve never gambled before? 


2. Which of the following elements is not part of the definition of gambling? 

b. It is a social activity 

3. Which of the following would be considered gambling activities? 

g. All except e 

4. Lots of people gamble without it becoming a problem. You know it has become a 

problem when it damages your: 


5. What percentage of adults in Ontario have gambled in the past year? 

c. 63% 

6. What is the most common gambling activity among adults in Ontario? 

b. Lottery tickets 

7. What percentage of Ontario adults have a moderate to severe gambling problem? 

d. 3.4% 

8. Which of the following statements best describes those who are experiencing problems 

with gambling? 

e. a and b 

9. Which of the following is not a risk factor for problem gambling? 

c. Having a family member who has had a big lottery win 

10. Why is gambling especially problematic for people who have a substance use problem? 


11. People who are considered to gamble non-problematically would be people who: 

d. Control the amount of money they spend on gambling and see gambling as one of 

many types of recreational activities 

12. Which of the following are characteristics of something that is random? 


13. Which phrase best illustrates the idea of independent outcome? 

b. “Gambling games have no memories.” 



14. Which of the following statements is true? 

c. The lottery numbers drawn this week have no effect on the numbers that will be 

drawn next week. 

15. Which are examples of the house advantage? 


16. Which of the following is a game of pure chance? 


17. Cognitive distortions are: 


18. To reduce the risk associated with gambling, you should: 



Problem Gambling: Education and Treatment in a Residential Setting Session 1 Handout · 61 

Appendix C 

Problematic vs. Non-Problematic Gambling 

life non-problematic problematic 

areas gambling gambling 

Individuals who gamble non-problem- Individuals who gamble problem- 

atically only lose money that they can atically lose more money than 

afford to lose. Money is budgeted they can afford to lose and often 

for this activity in the same way that make the situation worse by 

money is budgeted for other social trying to win back what they 

activities. When the funds are spent, have lost. 

the gambling stops. 

Financial 

limits 

Time Individuals who gamble non- Individuals who gamble 

limits problematically control the amount problematically often lose track 

of time they spend gambling. of time and spend more time 

gambling than they intend. 

Entertain- Individuals who gamble non- Individuals who gamble 

ment problematically enjoy gambling problematically are more likely 

as a form of social or recreational to see gambling as a form of 

activity in which they engage peri- income or a game of skill that 

odically. Gambling meets personal they can conquer. 

social needs such as getting out of 

the house and seeing other people. 

Other Individuals who gamble non- Individuals who gamble 

activities problematically enjoy gambling problematically often spend a great 

as one of many social activities deal of time gambling, while 

in a balanced lifestyle. 

missing family functions and 

skipping other activities that they 

used to enjoy. They often think 

about gambling even when they 

are not gambling. 

Relation- Individuals who gamble non- Individuals who gamble 

ships problematically do not allow their problematically find that gambling 

gambling to disrupt their personal, disrupts personal, social and 

social and professional relationships. professional relationships. 

Personal Individuals who gamble non- Individuals who gamble 

control problematically have control over problematically lose control over 

the amount of money they spend the amount of time and money 


they spend gambling. 

Reference: Problem Gambling Project, camh 





Appendix D 

Reducing the Risk 

All gambling has potential risks. If you are experiencing financial, emotional or physical 

health problems because of your gambling, you should consider taking a break 

to fully understand its impact on your life and to help you gain control. If you do 

choose to gamble, consider the following strategies to limit your risk: 

Set a limit on your time and money. 

Spend only what you can afford to lose. Leave your bank and credit cards at home. 

When your budget is gone and your time is up, walk away! Do not try to win back 

your losses or use rent or grocery money to continue to gamble. Keep a diary of how 

much time you play and record your wins and losses—memory is selective in 

remembering only the wins. 

Think of gambling as entertainment and not as a way to make money. 

Play knowing that you will almost certainly lose. Go with friends who do not have 

gambling problems and ask them to support you in staying within your pre-set limits. 

See the money lost as part of your entertainment budget. 

Understand the odds. The “house” always has the edge. 

Make your gambling decisions based on an accurate understanding of your odds of 

winning. Expect to lose. Accept that you have no control over the outcome of gambling. 

It is truly random. You cannot change the outcome, there are no winning 

strategies and you cannot influence luck. The odds are stacked against you and 

always in favour of the house. 

Recognize risk factors. 

Do not gamble when you are feeling vulnerable, bored, lonely, anxious or angry. Be careful 

not to use gambling as a way to escape problems or to avoid difficult feelings or situations. 

Mixing alcohol or other drugs with gambling is risky and should also be avoided. 

If you choose to gamble, keep it as part of a balanced lifestyle. 

If you choose to gamble, see gambling as an enjoyable part of a balanced lifestyle. 

Have other meaningful activities in your life—not just gambling. 

Listen to the concerns of others. 

If others express concern about your gambling, listen to them! They may see something 

that you don’t. People who do not have gambling problems do not let their gambling 

behaviours negatively affect relationships in their personal, social or professional lives. 






Appendix E 

How to Choose Your Gambling Goal 

To help you choose the best goal for you, you might find it helpful to ask yourself the 

following questions. A “yes” answer to any of the questions indicates that cutting 

down may not be the best choice and a goal of abstinence is recommended. 

YES 

NO 

1. Is my gambling considered to be a severe problem? 

2. Have I already made an attempt(s) to moderate my gambling 

but did not succeed? 

3. Will any gambling hurt me financially? 

4. Have I been mandated to seek treatment by my employer 

or by the criminal justice system? 

5. Are my personal relationships at risk (that is, friends or family) 

if I continue to gamble? 

6. Do I want to continue gambling so that I can win back lost money? 

7. Am I always thinking about gambling and ways to win? 

8. Am I using gambling to escape other problems or feelings? 

(Toneatto et al., 2003) 





Appendix F 

My Goal Statement 

Decide what goals you will follow over the next several weeks/months and indicate 

your choice by completing the following goal statements. Be specific and set a goal for 

every gambling activity that you have been involved in (for example, lottery tickets, 

scratch tickets, cards, horse betting, bingo, slot machines, Internet betting, etc.). An 

example is included below. 

Date: _____________________________ 

Signature: _________________________ 

gambling 

activity 

gambling goal 

Example: Poker ■ Abstinence 

■✓ 

Reduced gambling 

This means I will gamble: 1 time(s) per ■ day, ■ week, or ■✓ 

month. 

I will wager a maximum of $50 per gambling occasion. 

additional information: I will not play poker in casinos or 

online—only at home with friends. I will not play if I have 

been drinking or using drugs and I will not play if I am feeling 

lonely, angry or sad. 

gambling 

activity 

___________ 

gambling goal 

(check one) 

■ Abstinence 

■ Reduced gambling 

This means I will gamble: ___ time(s) per ■ day, ■ week, or ■ month. 

I will wager a maximum of $_____ per gambling occasion. 

additional information: _______________________________ 

______________________________________________________ 

______________________________________________________ 




___________ 






______________________________________________________ 

______________________________________________________ 

___________ 






______________________________________________________ 

______________________________________________________ 

___________ 






______________________________________________________ 

______________________________________________________ 

___________ 






______________________________________________________ 

______________________________________________________ 




Appendix G 

Self-Monitoring Gambling or Urges to Gamble 

Learning to understand and control gambling urges is an important step in regaining 

control over gambling behaviour. Recording urges to gamble, as well as actual 

gambling situations, can help you to discover gambling patterns, triggers and coping 

strategies that are working for you. 

Date Time Type Where With Mood Gambled? Time Net 

whom spent win/loss 

Comments: ____________________________________________________________ 

Consequences if you gambled: ____________________________________________ 

Coping strategies if you did not: ___________________________________________ 



Comments: ____________________________________________________________ 



Reference: Nina Littman-Sharp, Problem Gambling Service, camh 





Comments: ____________________________________________________________ 





Comments: ____________________________________________________________ 





Comments: ____________________________________________________________ 



Reference: Nina Littman-Sharp, Problem Gambling Service, camh 



Appendix H 

Gambling Triggers 

situations 

action plan 

thoughts 

moods 





Appendix I 

Facilitator’s Evaluation 

Your feedback is important to us. Please take a few moments to complete this evaluation. 

Thank you for taking the time to complete this evaluation form. Please fax it to: 

Problem Gambling Project, camh 

416 260-4185 

facilitator’s guide 

strongly strongly 

disagree 

agree 

The facilitator’s guide was easy to use. 1 2 3 4 5 

The facilitator’s guide was clear and concise. 1 2 3 4 5 

The facilitator’s guide provided enough 

information for me to deliver this program. 1 2 3 4 5 

powerpoint slides 

strongly 

disagree 

strongly 

agree 

The information is presented in a way that is easy 

for participants to understand. 1 2 3 4 5 

The language level used in the slides is at an 

appropriate level. 1 2 3 4 5 

The concepts presented are easy for participants 

to understand. 1 2 3 4 5 

participant handouts 

strongly strongly 

disagree 

agree 

The handouts are helpful to the participants. 1 2 3 4 5 

The handouts are clear and concise. 1 2 3 4 5 

The language used in the handouts is at 

an appropriate level. 1 2 3 4 5 



additional information 

strongly 

disagree 

strongly 

agree 

The 60- to 90-minute suggested timeframe is 

suitable to deliver each session. 1 2 3 4 5 

The preparation time needed to deliver each 

session is reasonable. 1 2 3 4 5 

“The Slot Machine: What Every Player Needs 

to Know” video via the Internet is accessible 

and easy to use. 1 2 3 4 5 

The Inventory of Gambling Situations (igs) 

tool is easy to administer to clients. 1 2 3 4 5 

“The Slot Machine: What Every Player Needs 

to Know” video and Inventory of Gambling 

Situations (igs) tool are useful components 

of this program. 1 2 3 4 5 

Was anything missing? ___________________________________________________ 

______________________________________________________________________ 

______________________________________________________________________ 

Additional comments: ___________________________________________________ 

______________________________________________________________________ 

______________________________________________________________________ 

I have used the following sessions with clients: 

■ Sessions 1 and 2 

■ Sessions 3 and 4 

Number of times delivered: _________________________ 

Average number of participants per session: ___________ 

Number of times delivered: _________________________ 

Average number of participants per session: ___________ 

I work in the following field: 

■ Addiction 

■ Mental health 

■ Concurrent disorders 

■ Other (Specify): 

Date evaluation form was completed: ______________________________________

Problem Gambling Education and Treatment in a Residential Setting ...

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