Helen Suurvali

Barriers to seeking help for gambling problems: A review of the empirical literature

This literature review summarizes recent empirical research on obstacles preventing problem gamblers from seeking treatment for their gambling problems. Relevant databases and bibliographies were searched for English-language papers and reports published since 1998. The only methodological requirement was that gamblers themselves be asked about reasons for not seeking help. Nineteen studies conducted in five countries were identified. All except one targeted adults. Despite differences in methodology, many of the same barriers to treatment were identified. Most commonly reported barriers were: wish to handle problem by oneself; shame/embarrassment/stigma; unwillingness to admit problem; and issues with treatment itself. The authors of the review argue that unwillingness to admit to the problem may be even more prevalent than is typically indicated by the results of barriers studies. Other frequently reported barriers included lack of knowledge about treatment options and practical issues around attending treatment. More research is needed on barriers to treatment-seeking experienced by subgroups of gamblers defined by culture, ethnicity, gender, age. Open-ended questioning methods can help provide insights into what barrier categories mean to different groups and individuals. Input directly from gamblers can be combined with information from other kinds of studies to devise better ways of reaching problem gamblers, especially those in underserviced populations.

Motivators for Resolving or Seeking Help for Gambling Problems: A Review of the Empirical Literature

This literature review summarizes recent empirical research on the reasons disordered gamblers try, through treatment or otherwise, to resolve or reduce their gambling problems. Relevant databases and bibliographies were searched for English-language studies, published since 1998, that asked gamblers themselves about motivators for action. Found were ten studies addressing reasons for trying to resolve or reduce gambling problems, five addressing reasons for seeking help and four addressing reasons for requesting self-exclusion from casinos. Help-seeking occurred largely in response to gambling-related harms (especially financial problems, relationship issues and negative emotions) that had already happened or that were imminent. Resolution was often motivated by the same kinds of harms but evaluation/decision-making and changes in lifestyle or environment played a more prominent role. Self-exclusion was motivated by harms, evaluation/decision-making and a wish to regain control. Awareness and educational materials could incorporate messages that might encourage heavy gamblers to make changes before harms became too great. Intervention development could also benefit from more research on the motivators leading to successful (vs. failed) resolution, as well as on the ways in which disordered gamblers are able to overcome specific barriers to seeking help or reaching resolution.

Hesitation to seek gambling-related treatment among Ontario problem gamblers.

Objectives:This study aimed to examine barriers in seeking help for gambling problems. Methods:A random digit dialing telephone survey was conducted among adults in Ontario, Canada. Respondents meeting criteria for possible past year gambling problems were asked an open-ended question on why they might hesitate once they had decided to seek help. Results:Of 556 eligible respondents, 47% asserted they would not hesitate to seek help. The most frequently identified possible reasons for hesitation were shame, difficulty acknowledging the problem, and treatment-related issues. Younger gamblers and those with higher problem severity, self-perception of a gambling problem, and past treatment experience were more likely to volunteer shame and treatment-related issues. Gamblers with lower problem severity, no self-perception of a gambling problem, and no history of help seeking more frequently said they would not hesitate to seek help. However, among problem/pathological gamblers, 49% did not self-perceive even a moderate gambling problem; they were more likely than self-perceived problem gamblers in this high severity group to predict no hesitation. Conclusions:In addition to revealing perceived and objective factors that impede help seeking for gambling problems, the identification of possible barriers may indicate, among some disordered gamblers, awareness of gambling problems and consideration given to possible actions. Both tackling barriers and enhancing problem awareness are necessary components of strategies to provide accessible and timely assistance to those with gambling problems.

Drinking-driving fatalities and consumption of beer, wine and spirits

Drinking-driving is a leading cause of preventable morbidity and mortality in Canada. The purpose of this paper was to examine factors that influenced drinking driver deaths in Ontario. We examined the impact of per capita consumption of total alcohol, and of beer, wine and spirits separately, on drinking-driving deaths in Ontario from 1962 to 1996, as well as the impact of the introduction of Canadas per se law and the founding of People to Reduce Impaired Driving Everywhere - Mothers Against Drunk Driving (PRIDE - MADD) Canada. We utilised time-series analyses with autoregressive integrated moving average (ARIMA) modelling. As total alcohol consumption increased, drinking driving fatalities increased. The introduction of Canadas per se law, and of PRIDE-MADD Canada, acted to reduce drinking driving death rates. Among the specific beverage types, only consumption of beer had a significant impact on drinking driver deaths. Several factors were identified that acted to increase and decrease drinking driver death rates. Of particular interest was the observation of the impact of beer consumption on these death rates. In North America, beer is taxed at a lower rate than other alcoholic beverages. The role of taxation policies as determinants of drinking-driving deaths is discussed.

The relationship between alcohol use and mortality rates from injuries: a comparison of measures.

Per capita consumption of alcohol has traditionally been considered to be the leading indicator of population levels of alcohol problems. However, some recent research suggests that this relationship may be weakening, and that drinking pattern measures may be preferable to per capita consumption as problem-level indicators. We compared the ability of per capita alcohol consumption and survey-based measures of alcohol use to predict deaths from injuries in Ontario, Canada, for the period 1977–1996. Per capita consumption and percentage of daily drinkers were significantly related to injury mortality, but percentage of drinkers and percentage of episodic heavy drinkers (those who drank five or more drinks on a drinking occasion) were not. Of the measures we examined, per capita consumption was the strongest indicator of mortality rates from injuries. However, the survey-derived measure of percentage of daily drinkers was similar to per capita consumption in ability to predict problem levels.

Work-Induced Risks to Mental Health: Conceptualization, Measurement and Abatement

The proposition that the organization of work is a strong influence on mental health is supported by both scientific and legal evidence. In this context, we explore and discuss the use of a metric called the Mental Safety Risk Reduction Potential as a means of isolating organization of-work-related risks to mental health at a local, site-specific level. The implications of using this metric are discussed in the framework of intervention examples familiar to the authors. The relevance of the exercise lies in the appropriate allocation of responsibility for reducing the burden of mental health problems on society.

Do Increased Levels of Drug Abuse Treatment Lead to Fewer Drug-Related Problems?

It has been argued that increased levels of treatment for drug abuse are effective in reducing the levels of drug problems. During the 1980s in Ontario levels of treatment increased considerably. More treatment facilities were opened, and the number of drug abuse cases increased by a factor of about seven. It was expected that drug-related problems (mortality, morbidity, and convictions) would decrease, as happened for alcohol problems when alcohol treatment levels increased. However, the results were inconsistent. Hospital separations for drug problems decreased in the late 1970s and then increased in the 1980s. However, deaths from drug psychoses and drug dependency showed an opposite trend. Convictions for cocaine offences increased while those for narcotics, LSD, and hallucinogenic drugs showed a substantial decline from the early 1980s to the present. Significant negative correlations (suggestive of a beneficial impact) were found between treatment rates and three drug-problem measures (deaths rates from drug psychoses and drug dependence, other drug-related deaths, and convictions under the Food and Drug Act); however, a significant positive correlation was found between treatment rates and Narcotic Control Act convictions. Thus, although some of the predicted negative relationships between treatment rates and drug problems were observed, the correlations did not provide a consistent picture of the effects of increased drug treatment. More research is needed to identify better indicators of drug problems and monitor the factors that influence them.