Year: 2021

What are gambling and gambling problems?

Most Canadians play games of chance for money or other prizes. Popular gambling activities include lottery and raffle tickets, scratch tickets, casino games, slot machines, video lottery terminals (VLTs), bingo, sports betting and informal card games. In Canada and around the world, people have had more and more opportunities to gamble over the past 30 years.

Although most Canadians are recreational gamblers, about 5% of the adult population develops gambling-related problems. These problems can range from the person who over spends on one occasion to the person who has a longer-term problem controlling his or her gambling activity.

At the extreme end of the scale is Gambling Disorder which is continued and extreme gambling that is maladaptive because of its negative effects on family, personal and work life (APA, 2013). About 1% of adults experience this severe form of the disorder.

Indicators[1] may include: repeated unsuccessful attempts to control, cutback or stop gambling, restlessness or irritability when making these attempts, needing to gamble with increasing amounts of money to achieve the desired excitement, preoccupation with gambling, gambling to escape from problems or emotions such as depression or anxiety, lying to family members or others about the extent of gambling,  jeopardizing relationships, jobs or career opportunities because of gambling, and relying on others to provide money to relieve the financial consequences of gambling. Chasing losses (returning to gamble on another day to win back lost money) is considered a key feature.

There is no one cause of gambling problems and it is clear that biological, psychological and social factors all play a role. Gambling problems tend to run in families and people who have or have had problems with other addictions such as alcohol are at an increased risk of developing a gambling problem.

Gambling problems can also be related to clinical depression but we do not yet fully understand whether gambling problems lead to depression, whether depression contributes to gambling problems, or both. People who are impulsive (for example, people who make decisions without thinking about consequences) are also more likely to have gambling problems. Most gambling also occurs in a social context. People gamble because their friends and family are gambling.

What can psychologists do to help people who have gambling problems?

Researchers have been active in examining k how successful we are at treating people with gambling problems. In most areas of the country, programs and counsellors use treatment approaches that are similar to those used for drug and alcohol problems. These approaches can be provided individually or in groups and for inpatients and outpatients. Most cities have chapters of Gamblers Anonymous which offer mutual support groups that operate on a twelve-step, spiritual model.

Research supports psychologists’ use of cognitive and behavioural treatments with problems gamblers. Cognitive treatments help people understand and change thinking that maintains maladaptive gambling.

For example, problem gamblers try to predict the outcome of their next bet by considering the outcomes of earlier bets.

This kind of thinking is false and risky. A certain outcome is not more likely because it has or has not occurred on earlier bets – the chance of a certain outcome remains the same for each bet. With behavioural treatments, people change their behaviours and environment in order to make it harder for them to gamble. For example, people will often limit their access to cash.

Research also highlights the importance of motivation in overcoming gambling problems. Motivational enhancement techniques help people to understand how gambling effects their lives and the mixed feelings they might have about stopping gambling.

To date, there are no medications which have been proven to be effective in treating problem gambling.

Where do I go for more information?

The website for the Responsible Gambling Council, http://www.responsiblegambling.org has a comprehensive list of links to Canadian treatment programs, Gamblers Anonymous and provincial help lines.

You can consult with a registered psychologist to find out if psychological interventions might be of help to you. Provincial, territorial and some municipal associations of psychology often maintain referral services. For the names and coordinates of provincial and territorial associations of psychology, click https://cpa.ca/public/whatisapsychologist/ptassociations/.

This fact sheet has been prepared for the Canadian Psychological Association by Dr. David Hodgins, a faculty member in the Clinical Psychology Program at the University of Calgary, Calgary, Alberta. He is affiliated with the Alberta Gaming Research Institute http://www.addiction.ucalgary.ca.

Revised: October 2020

Your opinion matters! Please contact us with any questions or comments about any of the Psychology Works Fact Sheets:  factsheets@cpa.ca

Canadian Psychological Association

Tel: 613-237-2144
Toll free (in Canada): 1-888-472-0657

[1] Based on the diagnostic criteria of gambling disorder as found in the Diagnostic and Statistical Manual of Mental Disorders (5^th Ed.) of the American Psychiatric Association (2013).

Why does pain from needle procedures matter?

Needle procedures are used to prevent, diagnose, monitor, and treat various health conditions. For example, insulin injections and finger pokes are a common experience for people with diabetes while bone marrow aspirations and lumbar punctures are experienced by people with cancer. Immunizations/vaccinations are the most common source of needle pain in childhood. For example, the Canadian Immunization Schedule recommends over 20 needles, not including yearly flu vaccinations, before a child reaches the age of 18. While vaccinations are a critical part of health care that have made a major difference in the prevention of infectious diseases, pain can be a consequence of these procedures. If the pain from needle procedures is not properly managed, there are short and long term consequences including longer procedure times, increased risk of fainting and injuries, negative memories, fear and avoidance of future procedures.

Why does pain from needle procedures matter?

The good news is that there are many ways that pain and distress during needle procedures can be managed. Types of strategies include:

• procedural – how the clinician performs the procedure (e.g., no aspiration for immunizations)
• physical – across ages, sitting upright is usually helpful unless the person has a history of fainting. If there is a history of fainting, a technique called muscle tension can be helpful.
• pharmacological – topical anesthetics or other medications for more invasive procedures.
• psychological strategies. More on these below for preschoolers and older.

The recommended strategies can change depending on the age of the person getting the needle. For example, infants benefit from kangaroo care (<1 month) or being closely held by the caregiver, breastfeeding, and/or sugar water for more minor procedures such as immunizations or venipunctures.

Research shows that the psychological techniques listed below help to reduce immunization pain, and can help for other needle pain in children as well as adults. They are all relatively easy to use and low in cost, if not free. Each technique can be adjusted as needed, depending on a person’s age and the specific procedure they are having.

• Education and Preparation – everyone deserves to know what procedure they are getting, why, and what will be done to make it comfortable (what they can do and what others will do). Provide choice when possible: for example, do they want to look at or away from the needle? What coping strategies will they use? Do they want a caregiver or other trusted individual to be present?

  Before a needle procedure:

• • Answer any questions people have in a way that is honest but appropriate for their age
  • Tell very young children about the needle only a little while before the procedure
  • Tell older children, adolescents, and adults about their procedure before the day in question so they can prepare coping strategies

• Communication to the individual immediately before and during the procedure. For all ages:
  • Speak calmly, clearly, with simple wording.
  • Signal the start of the procedure in a neutral way (e.g., “1, 2, 3, here we go”).
  • Do not say “it won’t hurt”. That does not help and it is not necessarily true so could led to mistrust.
  • Do not reassure (e.g., say “it’s okay” or “almost done”) over and over again. It does not help.

• Distraction – these are strategies that involve taking a person’s attention away from the procedure. Use age-appropriate distraction techniques such as:
  • Talking about things other than the procedure (e.g., holidays, favourite movie)
  • Toys
  • Videos (with adult coaching to engage for younger children)
  • Singing
  • Video games
  • Books

• Deep breathing or blowing – this strategy involves the person taking slow, deep, regular breaths, which can help with feeling relaxed. Using a toy is recommended for school-aged children and adolescents (e.g., pinwheel or bubble wand) which then also includes distraction. Children (and adults) can be instructed to take a calm and slow breath from their diaphragm (e.g., “take a deep breath in from your tummy. When you breathe in, your tummy should fill up like a balloon. Then breathe out pushing out all the air.”). Adults may also find coughing or taking a deep breath in and holding it (for brief injections such as immunizations) helpful.

What if a high level of needle fear is present?

Needle fear is present in about 2/3 of children and 1/4 of adults and can range from mild to severe levels. The strategies listed above are helpful for people with low to moderate needle fear. Across the lifespan, about 10% of individuals have high levels of needle fear that can interfere with their willingness to undergo needed medical procedures. At the most severe end of the spectrum, ~4-5% of individuals have a phobia related to needles which is characterized by extreme fear and anxiety and called blood injection injury phobia. People who have high levels of needle fear require different strategies than are listed above – they need to undergo exposure-based therapy in which they face their fear in a controlled, hierarchical manner. After their fear reduces, they can then benefit from the traditional pain and distress management strategies.

Where do I go for more information?

• Recently, the HELPinKids&Adults Team, a group of many different types of health professionals, including psychologists, published a pain management guideline for childhood immunizations. https://helpkidspain.ca/
  • The full HELPinKids&Adults team Clinical Practice Guideline can be found at: https://www.cmaj.ca/content/cmaj/187/13/975.full.pdf
    • The appendices contain age based algorithms and other tools
  • The CARD^TM system for school based immunizations is also based on this work: https://www.aboutkidshealth.ca/card
• Solutions for Kids in Pain: https://www.kidsinpain.ca/
• Itdoesnthavetohurt social media campaign and resources (e.g., videos) are available here https://itdoesnthavetohurt.ca/
• For needle fear:
  • CANVax Podcast on needle fear (see episode 3): https://canvax.ca/emerging-topics-podcast
  • Clinical Practice Guideline on treating high levels of needle fear (extra info in the supplementary material): https://www.tandfonline.com/doi/full/10.1080/16506073.2016.1157204
• Resources and videos on helping infants specifically:
  • Be Sweet to Babies: https://www.cheo.on.ca/en/clinics-services-programs/be-sweet-to-babies.aspx
  • Reducing pain from vaccinations in babies: https://www.youtube.com/watch?v=5Oqa1Fag5eQ&feature=youtu.be

You can consult with a registered psychologist to find out if psychological interventions might be of help to you. Provincial, territorial, and some municipal associations of psychology often maintain referral services. For the names and coordinates of provincial and territorial associations of psychology, please visit:   https://cpa.ca/public/whatisapsychologist/ptassociations/

This fact sheet has been prepared for the Canadian Psychological Association by Dr. C. Meghan McMurtry, University of Guelph. The current version is based on the 2011 version written by Dr. C. Meghan McMurtry, Dr. Christine T. Chambers, Dalhousie University, and Dr. Anna Taddio, University of Toronto.  

Updated: May 2020

Your opinion matters! Please contact us with any questions or comments about any of the Psychology Works Fact Sheets:   factsheets@cpa.ca

Canadian Psychological Association

Tel: 613-237-2144
Toll free (in Canada): 1-888-472-0657