A man sits at a slot machine at three in the morning, feeding in money he cannot afford to lose, chasing the next win that will make up for all the losses, knowing somewhere in his mind that the math does not work, that the house always wins, that he is trapped in something he cannot control. He has told his wife he stopped months ago. He has borrowed from everyone he knows. He has considered suicide as the only way out of the debt and the shame. A woman plays online poker in her bedroom, her children asleep down the hall, the thrill of the game filling something she cannot name, the losses mounting on credit cards her husband does not know about. She started for fun and now she cannot stop. A young man bets on sports through his phone, the constant availability making every game an opportunity, the small bets that felt harmless becoming larger as tolerance grew and losses accumulated. A family discovers that their elderly parent has lost her retirement savings to lottery tickets and casino visits, her cognitive decline making her vulnerable to an activity that was always designed to take more than it gives. Gambling addiction receives less attention than substance addictions but can be equally devastating, destroying finances, relationships, and lives while operating through mechanisms that are increasingly understood but inadequately addressed.
The Case for Expanded Gambling Addiction Services
Advocates for expansion argue that gambling addiction is serious condition that deserves treatment infrastructure comparable to substance addictions. From this view, gambling addiction is undertreated and underrecognized.
Gambling addiction is recognized mental health disorder with significant prevalence. An estimated one to three percent of the population experiences gambling problems. The harms are serious, including financial devastation, relationship destruction, mental health crisis, and suicide. The scale of the problem warrants substantial response.
Treatment works. Evidence-based approaches including cognitive behavioral therapy, motivational interviewing, and self-exclusion programs can help people recover from gambling addiction. People do not have to remain trapped. Services that provide effective treatment should be available.
Gambling revenue creates obligation. Provincial governments profit from gambling while gambling harms some of those who participate. Revenue from gambling should fund treatment for gambling addiction. Those who profit have responsibility for the harms their product creates.
From this perspective, improving gambling addiction response requires: dedicated funding for gambling treatment services; integration of gambling treatment with mental health and addiction services; public education about gambling risks and available help; and recognition of gambling addiction as serious condition deserving serious response.
The Case for Integrated Addiction Approaches
Others argue that gambling addiction should be addressed within general addiction services rather than through specialized gambling programs. From this view, integration serves better than specialization.
Gambling addiction shares mechanisms with other addictions. The same reward pathways, the same loss of control, the same patterns of escalation and consequence characterize both substance and behavioral addictions. Treatment approaches overlap substantially. Integration makes clinical sense.
Separate gambling services may fragment an already fragmented system. People often have multiple addictive behaviors. Someone with gambling and alcohol problems should not need to navigate separate service systems. Integrated addiction services address whole-person needs.
Gambling-specific services may not be sustainable in smaller communities. Integrated services with capacity to address gambling alongside other addictions may be more feasible than separate gambling programs.
From this perspective, addressing gambling addiction requires: addiction services that include gambling expertise; training for addiction counselors in gambling-specific issues; integration rather than separation of gambling and substance addiction services; and recognition that behavioral and substance addictions share common ground.
The Online Gambling Challenge
Online gambling has transformed accessibility and raised new concerns.
From one view, online gambling dramatically increases exposure and risk. Twenty-four-hour availability, private access, and rapid play cycles make online gambling particularly dangerous. Regulation and intervention must address the online environment specifically.
From another view, online gambling also enables intervention. Operators have data on gambling patterns that could identify problem gambling. Self-exclusion can be enforced online. Technology that creates risk can also enable harm reduction.
How online gambling is addressed shapes prevention and intervention.
The Sports Betting Expansion
Legalization and expansion of sports betting has increased gambling accessibility.
From one perspective, sports betting expansion will increase gambling addiction. Making betting easier and more available will create more problem gamblers. The expansion is public health concern requiring response.
From another perspective, legal, regulated betting is safer than illegal alternatives. Regulation can include harm reduction requirements. Legal markets can fund treatment. Prohibition did not prevent sports betting and regulation may be preferable.
How sports betting expansion is managed shapes gambling addiction trajectory.
The Self-Exclusion Tool
Self-exclusion programs allow people to ban themselves from gambling venues.
From one view, self-exclusion is valuable harm reduction tool. It provides mechanism for people to act on their own recognition of problem. Enforcement should be strengthened to make self-exclusion effective. Programs should be easy to access and difficult to circumvent.
From another view, self-exclusion has limitations. Enforcement is imperfect. Online gambling makes exclusion harder. Self-exclusion addresses access but not underlying addiction. It should be one tool among many, not primary intervention.
What role self-exclusion should play shapes harm reduction approaches.
The Industry Responsibility Question
Gambling industry responsibility for addiction prevention and treatment is contested.
From one perspective, industry should bear substantial responsibility. Gambling products are designed to be engaging in ways that can become addictive. Those who profit from gambling have obligation to address harms. Industry-funded treatment and prevention should be mandatory.
From another perspective, industry-controlled programs may not serve public interest. Independent programs funded by industry levies but not controlled by industry may be more appropriate. Treatment should not depend on those whose products cause the problem.
How industry responsibility is structured shapes funding and independence.
The Prevention Gap
Prevention of gambling problems receives less attention than treatment.
From one view, prevention should be prioritized. Education about gambling risks, especially for youth, could prevent problems before they develop. Restrictions on gambling advertising would reduce exposure. Prevention investment would reduce future treatment needs.
From another view, prevention effectiveness for gambling is uncertain. Resources may be better spent on treatment for those already affected. Prevention should be evidence-based rather than assumed effective.
How prevention and treatment are balanced shapes resource allocation.
The Comorbidity Challenge
Gambling addiction often co-occurs with other mental health and substance use conditions.
From one perspective, comorbidity is the norm rather than exception. Treatment must address co-occurring conditions together. Gambling-only treatment that ignores depression, anxiety, or substance use will not succeed.
From another perspective, treating everything at once may not be feasible. Sequenced treatment addressing most urgent problems first may be necessary. Gambling-focused treatment can be first step even when other conditions exist.
How comorbidity is addressed shapes treatment design.
The Financial Counseling Need
Gambling addiction creates financial devastation that requires specific response.
From one view, financial counseling should be integrated with gambling treatment. Addressing the gambling behavior without addressing the financial consequences leaves people in crisis. Debt management, bankruptcy counseling, and financial recovery should be part of gambling addiction services.
From another view, financial counseling is separate expertise from addiction treatment. Referral to financial services rather than integration may be appropriate. Gambling treatment programs cannot provide all needed services.
How financial consequences are addressed shapes comprehensive response.
The Suicide Risk
Gambling addiction carries elevated suicide risk.
From one perspective, suicide prevention must be central to gambling treatment. Routine screening, crisis response capacity, and connection to mental health services are essential. The shame, desperation, and hopelessness of gambling addiction create serious suicide risk.
From another perspective, suicide risk reflects mental health conditions that often co-occur with gambling. Treating underlying mental health addresses suicide risk. Gambling-specific suicide prevention may be less important than comprehensive mental health care.
How suicide risk in gambling addiction is addressed shapes treatment design.
The Canadian Context
Canadian provinces operate or regulate gambling and vary in how they fund and provide gambling addiction services. Some provinces have dedicated gambling treatment programs while others address gambling within general addiction services. Online gambling expansion and sports betting legalization are increasing gambling accessibility across the country.
From one perspective, Canada should strengthen gambling addiction services proportional to gambling revenue and harm.
From another perspective, integration of gambling within broader addiction services may serve better than separate gambling programs.
How Canada addresses gambling addiction shapes response to a growing problem.
The Question
If gambling addiction is recognized disorder with serious consequences including financial ruin, relationship destruction, and suicide, if treatment exists that can help people recover, if governments profit from the gambling that causes these harms - why are gambling addiction services often inadequate? When someone loses everything to gambling while the province that enabled their gambling profits, who bears responsibility? When gambling is promoted through advertising while treatment remains underfunded, what does that contradiction reveal? When online and sports betting expansion increases accessibility while services do not expand proportionally, who is making those choices and in whose interest? And when someone trapped in gambling addiction cannot access help, is that personal failure or system failure?