Problem Gambling Framework
The Research Centre Editor1
1The Centre
To download a pdf copy of the Problem Gambling Framework click here.
The goal of this Framework is to improve the consistency and precision of communication between the Ontario Problem Gambling Research Centre (OPGRC) and those seeking information or funding. It offers a conceptual overview of problem gambling by:
- identifying key sub-populations in relation to the study of gambling and related problems;
- describing the relationships and dynamics among these sub-populations;
- identifying influences on these relationships and dynamics;
- describing approaches to the study of gambling and gambling problems;
- identifying strategies for the prevention and treatment of gambling problems; and
- outlining a range of areas for research inquiry.
The Framework adopts an integrative perspective on gambling and problem gambling, suggesting there is no line or clear transition point between the two, and we are not dealing with discrete populations. Rather, it portrays a single population, comprised of non-gamblers, problem-free gamblers, and problem gamblers, all of whom are in constant movement in relation to risk exposure and the presence of problems.
To begin building the Framework, we locate the entire population along a continuum defined by two criteria: risk and problems. In relation to the risk criterion, we include four risk status categories.
Those who do not gamble are located in the no-risk category. Although people in this category do not develop gambling problems, it is possible for them to migrate to the right, where risk exposure progressively increases. Most of those in the low-risk category do not experience problems, although there is a real albeit remote likelihood. This likelihood or probability increases for those in the moderate-risk category, and is greatest among those in the high-risk category.
Note that the width of each category varies to suggest the relative size of the sub-populations. Keep in mind, however, that these variations are symbolic, and as yet do not reflect known values.
The second criterion for defining the continuum is problems. The shaded overlay represents the prevalence of gambling problems within each risk category. This gives a total of seven risk categories in what we now refer to as the problem gambling continuum.
Note that a very small proportion of people in the low-risk category will develop problems, despite the low probability. The prevalence increases through the moderate-risk category, and becomes substantial among those in the high-risk category. Note also that some people in the high-risk category do not develop problems despite the high probability. Why people in the same risk category do and do not develop problems is addressed later in the discussion of pathways and protective factors.
The problem gambling continuum can be used to locate and categorize all members of a population. Before developing it further, we explore the nature of risk and problems in greater detail.
In relation to gambling problems, risk can be direct or indirect. Direct risk has a primary causal relationship with the onset of problems such that, if it is not present, problems are highly unlikely to develop. In the problem gambling continuum, only direct risk is used to define risk status. In contrast, indirect risk, which is discussed later, is one step removed from the onset of problems.
As it applies to problem gambling, direct risk consists of: risk practices and risk cognitions.
Risk practices include a broad range of gambling behaviours that directly result in problems. Examples include persistently betting more than was planned or could be afforded, regularly spending more time gambling than intended, continually arranging schedules to include opportunities to gamble, chasing losses, borrowing money to gamble or acquiring it in unethical or illegal ways, and so on. These practices are causal, in that they are both necessary and sufficient conditions for the onset of problems.
Risk cognitions are thoughts and beliefs held by gamblers that support the adoption and maintenance of risk practices. They appear to play a more central role in gambling than for other behavioural problems such as alcohol, tobacco, or drug dependence. Examples of risk cognitions include beliefs about pre-ordained luck, superstitions related to winning, illusions of control, and serious misunderstandings about the nature of probability and randomness. For most people, such cognitions are necessary but not sufficient conditions for the development of gambling problems. Nonetheless, risk cognitions appear to be so highly integrated with the adoption and maintenance of risk practices that we include them as direct risk factors.
Levels of direct risk can increase in two ways: as a function of the number of risk practices and cognitions adopted, and as a function of the extent of involvement in each.
This diagram illustrates how some people will have adopted only a few risk cognitions and practices (Point A1), while others will have adopted many (Point A2). All else being equal, those in the former group are less likely to develop gambling problems than those in the latter. Similarly, some people might adopt a particular risk practice once in a while (Point B1) - for example, borrowing modest amounts of money every two or three months - while others borrow substantial amounts or do so more frequently (Point B2). Again, all else being equal, those who are more involved have a greater chance of developing problems than those who are less so. These principles may hold more strongly for risk practices than for cognitions, although evidence one way or the other is not available as yet.
As mentioned, indirect risks play a significant role in the development of gambling problems. They are secondary factors, however, as they do not cause problems directly. Rather, they increase the likelihood of adopting risk cognitions and practices. In so doing, indirect risks help to explain why some people make the transition from low-risk to moderate and high-risk categories.
In general, there are four types of indirect risk:
1. Social predisposition - children and adolescents acquire gambling related attitudes, beliefs, and behaviours from significant adults and peers in their lives; in the process, potentially harmful responses can be learned, ranging from a general acceptance or positive orientation toward gambling, to unhealthy ways of dealing with problems or negative emotions such as anger, depression, or loneliness;
2. Emotional predisposition - certain personal characteristics and conditions, such as social isolation, external locus of control, low self-efficacy, or low self-esteem may render some people vulnerable to inducements, incentives, or promotions to gamble, and susceptible to the adoption of risk cognitions or practices;
3. Biological predisposition - certain inherited biologically-based traits, such as impaired impulse control or hypersensitivity to endorphin-based stimulation, may increase the likelihood that people adopt risk cognitions or practices;
4. Environmental conditions - a range of contextual variables, such as the availability and accessibility of gambling, the nature of gambling related promotions, inducements and advertising, or the ethno-cultural significance of gambling, may increase the adoption of risk cognitions or practices;
The first three types of indirect risk are predisposing factors, while the fourth is more of a mediating or contextual factor. Another important distinction is that some indirect risks are modifiable, and therefore can be targeted for change, while others are difficult if not impossible to change, and are classified as non-modifiable. We explore these distinctions later in the section on response strategies.
As a group, indirect risk factors begin to explain much of why some people migrate from low-risk to the moderate and high-risk categories. What is less clear is why many people remain at low-risk despite the presence of indirect risk factors. This question is discussed in a later section dealing with protective factors.
Although the definition of gambling problems seems self-evident at first glance, some complexity is involved.
In general, gambling problems include the constellation of negative consequences that result from risk practices. They affect gamblers themselves, others in their social networks, and the community at large. Having said this, it has proven difficult to develop universally accepted criteria for defining gambling problems. In part, this is because most involve financial duress, a consequence often defined relative to a person's disposable income. Thus, losing $100,000 might be considered a problem for one person, but not for another. Another complication is that gambling problems often require responses from third parties, such as clinicians or significant others, in order to be defined. For a range of reasons, these people tend not to make the required judgements, and problems often remain unidentified.
The nature of gambling problems can be better understood when described along two axes: dependence and negative consequences.
The vertical axis is "dependence", which can be further divided into two types: psychological and physiological. Psychological dependence refers to learned patterns of behaviour that are reinforced over time, and exist in a stable state. When people attempt to modify these patterns by cutting down or quitting, they experience psychological distress. They can reliably relieve this distress by resuming the behaviour at previous levels.
Signs of psychological dependence include:
- preoccupation with gambling;
- repeated unsuccessful attempts to cut down or quit;
- gambling to cope with problems or unpleasant emotions;
- denying or minimizing losses;
- committing illegal acts to get money to gamble; and
- relying on others for money to gamble.
In general, clinicians assess levels of psychological dependence as mild, moderate, or severe based on the number of signs and the extent of involvement with each.
Physiological (or physical) dependence, on the other hand, is principally defined by two phenomena: tolerance and withdrawal. Tolerance refers to the need for people to increase their levels of gambling over time in order to achieve the same effects. Withdrawal is defined by physical symptoms such as irritability, restlessness, and agitation that people experience when they try to cut down or quit gambling.
In substance-related dependencies, the presence of physiological signs is often interpreted as indicating severe dependence. Although physiological dependence is cited in some literature, the extent to which it applies to problem gambling has yet to be established.
The second axis for gambling problems is "negative consequences". The most common forms involve damage to important relationships, including spouses, family members, friends, and other significant people. Other consequences include damage to career and work relationships, arrest and legal sanction, and difficulties with lending institutions, debtors, or loan sharks. As with dependence, negative consequences can be classified as mild, moderate, or severe to reflect the extent of harm.
Figure 4 illustrates how both dependence and negative consequences can vary among gamblers. Levels of severity can be low for both dependence and negative consequences (Point A), high for dependence and low for negative consequences (Point B), or low for dependence and high for negative consequences (Point C). Finally, Point D shows someone who experiencing high levels of severity for both dependence and consequences. Each illustration has different implications for the effective prevention and treatment of gambling problems.
Although the problem gambling continuum has been portrayed thus far as static, it is in fact dynamic. People constantly move from one health status category to another in response to a broad range of influences.
Movement can occur between categories, or it can span two or more categories. For example, a non-gambler might begin to gamble and, from the outset, wager far more than he or she can afford and quickly fall into serious debt. This person would have skipped low-risk category and moved directly to moderate or high-risk. In the other direction, someone in the high-risk category who is experiencing problems might stop gambling altogether, thereby becoming a no-risk gambler. Movement occurs constantly among all risk categories and from problem to problem-free status.
Within these dynamics it is possible for the overall distribution to shift toward or away from higher risk and problems. These redistributions are seen in cross-sectional studies repeated over time, and reflect the cumulative influence of many variables, including cohort effects, gambling expansion, increased advertising, new inducements, expanded treatment services, and so on. As yet, we do not know how quickly such re-distribution occurs, nor do we know the specific effects of any single or combination of variables. However, experience with products such as alcohol and tobacco shows that distributions do shift over time, and it is reasonable to suggest that the same holds true for gambling.
Much more research is needed to measure migration rates throughout the Continuum and to identify the related influences.
As mentioned, two central questions for the field are:
- Why do some people migrate to higher risk categories, while others do not?
- Why do some people in a given risk category develop problems while others do not?
The simple response is that risk factors are simply statements of elevated probability, and not of certainty. For example, the rate for gambling problems might be 98 per 1000 for a high-risk population compared to 49 per 1000 for individuals in a lower risk category. While the rate is twice as high for the at-risk population - and warrants concern - it is nonetheless true that 902 out of 1000 people will not develop problems.
Reciting the probabilities is only part of the answer, however, as questions remain as to what causes some to make the transitions in question, while others do not. We are far from knowing all the answers, but some lie in what is known as pathways models, while others are related to the concept of protective factors.
Pathways models suggest that a number of contributing factors converge to result in gambling problems. These include: predisposing factors, environmental conditions, early gambling experiences, and the adoption of risk practices.
The first of these, predisposing factors, were identified as indirect risks in Section 4, and classified as social, emotional, or biological in nature. When present, these factors increase the likelihood of adopting risk practices and cognitions, all else being equal. Although they are found among most problem gamblers, it is nonetheless true that the majority of people so affected do not develop problems. It is the subsequent contribution of additional factors that accounts for the eventual onset of problems.
As mentioned in Section 4, environmental conditions are contextual factors located within the range of indirect risks. These include the availability and accessibility of gambling opportunities, the nature and extent of advertising, and the presence of inducements to gamble. When combined with predisposing factors, these conditions further contribute to the adoption of risk practices and cognitions.
Another set of contributing factors center around the early experience of gamblers. In particular, a large win or series of wins early in a gambling career may reinforce risk cognitions and the adoption of risk practices. In addition, new gambling associates or peers can exert considerable influence to consolidate potentially harmful cognitions and practices at this critical juncture.
The final set of factors that contributes to the development of problems is the adoption of risk practices. As mentioned in Section 3, these practices are portrayed as direct risks. Both the number of practices and the extent of involvement with each shape the behavioural patterns that define risk exposure. Ultimately, it is the level of exposure to direct risks that results in the onset of problems.
From the foregoing, a pathway can be seen as an accumulation of contributing factors, each of which further defines those who are likely to develop problems, and separates them from those who are less likely. There are many possible pathways, some of which are currently understood, and others that have yet to be discovered or fully described. Most important, however, is the perspective that gambling problems are neither the product of any single factor, nor develop through any single process or pathway. This understanding will keep the field from succumbing to the notion that there is a single "one size fits all" solution simply waiting to be discovered.
Apart from pathways models, protective factors further contribute to our understanding of why some people do and do not develop gambling problems. In general terms, protective factors function in a number of ways. First, their very presence can serve to decrease the likelihood of adopting risk practices and cognitions, and thereby reduce the onset of problems. Second, for those affected by social, emotional, or biological predispositions, they can play an insulating or buffering role that diminishes the negative impact. Finally, protective factors can function indirectly by supporting other actions or behaviours that promote, maintain, or protect health.
In general, two categories of protective factors are recognized: proximal and distal. Proximal factors are health-specific and, when applied to gambling, directly influence the adoption of risk practices and cognitions. They include: personal orientation to health, personal commitment to health, and perceived social support for engaging in healthy behaviour. Distal factors do not directly reference health, but nonetheless serve a protective function. They reflect an orientation to and involvement with institutions such as family, school, and church. In effect, they encompass broader measures of conventionality which, in turn, are aligned with the adoption of health protective behaviours.
Of late, researchers have started to identify gambling-related protective factors, and to explore the mechanisms by which they operate. Strengthening both proximal and distal factors may benefit young people in particular by steering them toward low-risk gambling and away from high-risk alternatives.
The problem gambling continuum sets the stage for the development of focused response strategies, consistent with the over-arching concepts of prevention and treatment. In general terms, prevention refers to the rate at which problems develop, known as the incidence rate, and endeavours to reduce it over time. By definition, therefore, prevention is aimed at people who have yet to develop problems. By contrast, treatment focuses on people with existing problems, as reflected by the prevalence rate, and endeavours to reduce these numbers over time. Often, treatment services are paired with rehabilitation services, which include measures to restore health to the extent possible.
Within the concepts of prevention and treatment, four response strategies can be identified: risk avoidance, risk reduction, brief intervention, and intensive intervention. Each is defined by three criteria: targeted risk status, problem status, and goals.
1. The Risk Avoidance Strategy
The Risk Avoidance strategy targets people in the no-risk category, along with those in the low risk category who have not developed problems. The goals are to:
- reduce the rate at which target group members adopt risk practices and cognitions; and
- insulate target group members from the influence of indirect risk factors.
For those in the no-risk category who are under the legal age for gambling, an additional goal may be to delay the onset of gambling activity. Whether this includes all gambling - for example, marbles or flipping sports cards - or be limited to gambling where there is an exchange of money remains a topic of debate. On another front, some argue to extend this goal to the prevention of gambling altogether - that is to create a group of young people who choose not to gamble at all as they enter adolescence and adulthood. As yet, there is little evidence to indicate whether such an outcome is desirable or achievable.
Initiatives within the Risk Avoidance strategy include program and policy interventions. In general, programs are used to introduce changes to target groups that reduce the adoption of risk practices and cognitions, and that insulate people from the effects of indirect risks. Policy initiatives are official positions or mechanisms adopted by governments, municipalities, gambling venues, and organizations such as school boards and employers. In general, their purpose is to impede the adoption of risk practices among members of identified target groups.
For reference purposes, Risk Avoidance initiatives are considered as primary prevention in the public health perspective.
2. The Risk Reduction Strategy
The Risk Reduction strategy targets people in the moderate and high-risk categories who have yet to develop problems. The goals of this strategy are to:
- replace risk cognitions among target group members with less harmful alternatives;
- reduce or eliminate risk practices among target group members; and
- reduce the extent of involvement with risk practices among target group members who are unable or unprepared to eliminate them.
In everyday terms, this strategy targets people who are "problems waiting to happen", and endeavours to reduce levels of risk exposure before the fact. It is noteworthy that, in many instances, the profile of risk practices and cognitions in this group may be similar to those among people who have developed problems, further underscoring the futility of trying to draw a line between people with problems and those without.
Initiatives within the Risk Reduction strategy include both program and policy interventions. In general, programs endeavour either to change risk practices and cognitions among target group members, or to insulate people from the effects of indirect risks. Policies within this strategy include measures adopted by governments and organizations to encourage the adoption of low and no-risk practices among target groups whose current practices place them at risk.
The Risk Reduction strategy is usually combined with Brief Intervention and classified as secondary prevention in the public heath perspective.
3. The Brief Intervention Strategy
The Brief Intervention strategy targets people in the low and moderate-risk categories who are experiencing problems of mild-to-moderate severity. The goals of this strategy are to:
- eliminate risk practices and cognitions; and
- eliminate problems that have resulted from gambling.
In general, research suggests that the targeted population responds well to less intensive treatment interventions, which usually range from one to eight sessions in length. Moreover, moderate gambling outcomes can be achieved by many people who are suitable for brief interventions, and can be considered as an alternative to abstinence. Some evidence suggests that the very availability of moderation as a treatment option will, in itself, improve overall recruitment rates. Finally, those who are unable to succeed with moderation are more likely to accept an abstinence goal in successive efforts to resolve their problems.
Note that, regardless of whether abstinence or moderate gambling outcomes are selected, the goal is to eliminate harm resulting from excessive gambling - neither specifically adopts the reduction of harm as its primary goal. Abstinence-based approaches address this goal by eliminating gambling altogether, while moderation-based approaches address it by eliminating risk practices and cognitions. In the former, successful treatment moves clients to no-risk status while, in the latter, it moves them to low-risk, problem-free status.
Increasingly, brief interventions are being aligned with the Transtheoretical Model, with specific offerings for problem gamblers in the pre-contemplation, contemplation, and preparation stages of change. These program variants recognize that readiness to change is a key determinant of treatment success, and that imposing treatment on someone who is not ready to change is often futile.
As mentioned, brief interventions are usually classified as secondary prevention in the public health perspective. Such programs may be delivered in a several formats, including self-help or "self-directed", group and individual counselling delivered face-to-face, and telephone-based counselling. In addition, these formats potentially lend themselves to internet-based applications. Some evidence suggests that allowing clients to choose their preferred format yields superior rates for program completion which, in turn, are associated with better outcomes.
4. The Intensive Intervention Strategy
The intensive intervention strategy provides treatment to people in the high-risk category who are experiencing severe gambling problems. On occasion, people in the moderate-risk category will also develop severe problems, and be appropriate for intensive treatment. The goals for this strategy are:
- eliminate all gambling and risk cognitions; and
- restore healthy functioning.
As indicated, the clinical goal for this strategy is abstinence, although the related research does not preclude moderate gambling goals for some. Intensive treatment programs usually extend from two to twelve months in duration, and include outpatient or community-based counselling, day treatment, and inpatient or residential care. Often treatment and rehabilitation services are integrated into a phased model that offers stabilization, behaviour modification, cognitive restructuring, debt management, and relapse prevention.
An increasing body of evidence identifies a high degree of co-morbidity among problem gamblers who are appropriate for intensive treatment. Co-existing problems include alcohol and other drug dependencies, depression and anxiety disorders, and attention-deficit/hyper-activity disorders, among others. As treatment models evolve, they will have to address the question of how best to effectively manage concurrent disorders.
The relationships among the response strategies described above and the problem gambling continuum are depicted in Figure 6.
Although we have aligned response strategies with health status categories, this does not suggest that all people within any one category are the same. In fact, evidence from related fields suggests that discrete groups or segments exist within each category. Commercial interests, such as the producers of beverage alcohol and tobacco, and even organizations that operate lotteries and casinos, have long been aware of this, and undertake market segmentation studies to define the various groups they wish to engage.
Segment members share key characteristics, including essential values, beliefs, personality traits such as self-efficacy and locus of control, sources of influence, self-image, and so on. Identifying segments within a larger population allows actions to be tailored to particular characteristics of the segment. This knowledge can be used to improve engagement rates, and to develop more effective interventions that are matched to segment characteristics.
As developed to this point, the Framework is able to accommodate a range of research strategies. These can be divided into five general categories: descriptive, explanatory, predictive, prevention, and treatment.
1. Descriptive Research
The purpose of this type of research is to describe the gambling-related status of populations by:
- enumerating the distribution of non-gambling, problem-free gambling, and problem gambling cases at specific time points;
- describing or comparing gambling status in various sub-populations or target groups; and
- identifying important trends in these distributions over time.
2. Explanatory Research
The purpose of this type of research is to explain the etiology of problem gambling by:
- identifying direct and indirect risk factors that move people through risk categories and increase the onset of problems;
- identifying protective factors that reduce the incidence of direct risks and problems;
- identifying protective factors that insulate those affected from indirect risk factors;
- identifying the mechanisms by which risk and protective factors operate; and
- identifying or specifying pathways by which people migrate through risk categories and develop problems.
3. Predictive Research
This type of research endeavours to project future gambling status among populations, sub-populations, and target groups by:
- assessing trends, current conditions, and other factors, and projecting rates for risk status and gambling problems over time;
- identifying outcomes among problem-free gamblers that cause reductions in the incidence of risk practices and cognitions, or gambling problems;
- identifying outcomes among people with gambling problems that cause reductions in problems and restore healthy functioning;
- identifying the impact of contributing factors on rates for risk status and problem gambling; and
- identifying and describing gambler segments within risk status categories.
4. Prevention Research
The purpose of this type of research is to contribute to reductions in rates at which people migrate to risk and problem status by:
- identifying methods and approaches to reduce the likelihood that target group members will adopt risk practices and cognitions;
- identifying methods and approaches that reduce the prevalence of risk practices and cognitions among target groups that have yet to develop problems; and
- identifying methods and approaches that insulate those affected from the influence of indirect risks.
5. Treatment Research
The purpose of this type of research is to contribute to reductions in prevalence rates for problem gambling by:
- identifying methods and approaches that enhance readiness for change among problem gamblers;
- identifying methods and approaches that improve treatment take-up rates among problem gamblers;
- identifying clinical protocols that help treatment clients reduce or eliminate gambling problems; and
- identifying interventions that sustain treatment effects over the long term.
As mentioned at the outset, the purpose of the Framework is to improve communications between the Ontario Problem Gambling Research Centre and those wishing funds of information from it. To this end, those who have reviewed the Framework, either in its dynamic format or as a downloaded document, will find that its terms and concepts are applied throughout the web site. For example, current priorities for funding are built directly on the Framework, and assume familiarity with the core concepts.
As the web site evolves over the coming months and years, the integration will become even more apparent. The e-courses on proposal writing will not only be predicated on the Framework, but will show how the concepts are applied to the application process. Similarly, indexes for literature searches, funding priorities, solicitations for proposals, and guidelines for funding requests will all employ terminology and concepts from the Framework. Over time, we hope that communications will become more precise and rigorous, and will allow for greater levels of understanding among those who are dedicated to the study and amelioration of gambling problems in Ontario and elsewhere.
Research Topics Arising from the Framework
Note: The following examples illustrate a range of research topics that can be aligned with the five categories of research. The lists are by no means exhaustive. Each identified topic uses concepts and terms introduced in the framework.
1. Descriptive Research
- Developing and testing instruments or tools by which people can be assessed and assigned to risk status categories;
- Developing and refining criteria or measures by which direct risk, indirect risk, or gambling problems can be defined;
- Measuring various populations, sub-populations, and target groups to determine the distribution of members across risk status categories;
- Refining various approaches used to measure the distribution of populations and sub-populations across risk status categories, and comparing approaches in terms of consistency, under-reporting, or bias;
- Comparing the distribution of specific populations, sub-populations, or target groups across risk status categories over time in order to identify trends or other changes;
- Exploring and further specifying the nature of psychological and physiological dependence as in relation to problem gambling;
- Further specifying or quantifying the nature of risk and relative risk as manifested in relation to problem gambling;
- Examining risk status categories to determine whether discrete segments exist within each and, if so, determining whether segment characteristics suggest specific strategies to engage or influence members;
- Introducing or extending the contribution of various disciplines to understanding gambling and problem gambling among various sub-populations and target groups.
2. Explanatory Research
- Identifying and further specifying indirect risk factors, describing the sub-populations or target groups they influence;
- Describing how various risk or protective factors influence the adoption of direct risks and the onset of problems;
- Introducing or extending the contribution of traditional and non-traditional disciplines to understanding why people migrate through risk status categories and develop gambling problems;
- Identifying and comparing the impact of various direct and indirect risk factors on different sub-populations and sub-groups;
- Examining or specifying the mechanisms by which indirect risk factors affect people in various risk status categories;
- Further specifying the mechanisms and relationships that link faulty cognitions, risk practices, and the onset of problems;
- Exploring and further specifying the relative impact of the number of direct risks adopted as opposed to the extent of involvement in those adopted;
- Describing the conditions and mechanisms that initiate and support spontaneous or self-directed recovery from gambling problems;
- Exploring whether the phenomena of tolerance and withdrawal apply to problem gambling and, if so, specifying their role in the in the maintenance of risk practices;
- Examining the effects of changes in the gambling environment on rates for direct risks and problem gambling.
3. Predictive Research
- Examining the mathematical properties that predict the distribution of gamblers across all risk status categories, and the impact of key variables (such as the mean) on this distribution;
- Elaborating existing and identifying new pathways that explain or predict the onset of gambling problems among members of various sub-populations and target groups;
- Developing and testing evidence-based models that specify outcomes and processes which reduce the adoption of direct risks and onset of gambling problems;
- Developing and testing evidence-based models that specify outcomes and processes which reduce the prevalence of direct risks and gambling problems;
- Conducting prospective studies that identify and refine the understanding of direct and indirect risk factors, and the processes by which people become at risk and develop gambling problems;
- Exploring or specifying how resilience and other protective factors insulate some people from developing problems despite the presence of direct or indirect risk factors;
- Identifying the factors and motivators that initiate movement through the stages of change as problem gamblers decide to address their difficulties.
4. Prevention Research
- Determining which types of change, when introduced to various target groups, will reduce the onset of direct risks in those groups;
- Determining whether the types of change found to reduce the onset of direct risks can be achieved through program interventions;
- Testing new interventions to reduce levels of direct risk among members of various sub-populations or target groups;
- Testing new interventions to insulate members of various sub-populations or target groups from the effects of indirect risk factors;
- Determining whether selected local policy initiatives have beneficial impact on the incidence or prevalence of direct risks and gambling problems;
- Determining whether selected provincial policy initiatives have beneficial impact on the incidence or prevalence of direct risks and gambling problems.
5. Treatment Research
- Determining which outcomes, when achieved in various target groups, will reduce gambling problems among members of those groups;
- Developing and testing new instruments and protocols to identify individuals in non-gambling treatment settings who are experiencing mild-to-moderate gambling problems;
- Developing and testing new instruments and protocols to identify individuals in non-gambling treatment settings who are experiencing severe gambling problems;
- Identifying the barriers that prevent people with gambling problems from seeking treatment or other forms of help;
- Identifying techniques or approaches intended to increase treatment engagement rates among members of various target groups experiencing gambling problems;
- Identifying and testing interventions intended to move individuals experiencing gambling problems toward engaging in treatment or other forms of help;
- Testing new interventions intended to eliminate gambling problems among members of various sub-populations or target groups;
- Testing new interventions intended to reduce the range or severity of problems among members of various sub-populations or target groups;
- Testing new delivery formats for interventions intended to reduce or eliminate gambling problems among members of various sub-populations or target groups.