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Why Not Harm Reduction for Problem Gambling?

Harmful gambling is a public health issue. As types of gambling products and accessibility to gambling have increased, so too have concerns as to the harm associated with this behavior. While there is evidence of the harm cause by some forms of land-based gambling such as electronic gambling machines (poker machines), much less is known about the impact of newer forms of gambling, such as online sports betting. With the development of a range of new gambling products, including the use of both traditional and social media platforms to promote and incentivize product use, children and adolescents are potentially exposed to gambling more than ever before (Pitt, 2017).

In 2016, 5.45 million individuals in the US were diagnosed as having a gambling disorder, with an estimated 1.2% of New York adults (186,475) believed to manifest a gambling problem in New York. Overall the gambling industry’s growth in 2016 exceeded the rate of inflation and established a new all-time high for consumer spending on gambling, at $154 billion (APGSA and Problem Gambling Solutions, Inc, 2016 Survey of Problem Gambling Service in the United States, 2016). In fact, in the United States, all states have some form of legalized gambling with the exception of Utah and Hawaii however, very little attention is given to problem gambling and its treatment. In the United States, treatment for problem gambling mostly focuses on the disease/abstinence model. While harm reduction approaches for drugs, alcohol and tobacco are gaining traction, the United States severely lags behind in harm reduction approaches for problem gambling compared to countries such as Canada and Europe (Blaszcynski, 2001).

Gambling related harms can be view in the following areas (Langham et. al., 2016):

  • Financial harm (to the person who gambles, the affected others, and/or the community)
  • Relationship disruption conflict or breakdown (with friends, family and community)
  • Emotional or psychological distress
  • Detriments to health
  • Cultural harm
  • Reduced performance at work or study Criminal activity.

Co-occurrence with Mental Health and Substance Use Concerns

Gambling disorders have been shown to have high comorbidity with substance use and mental health issues. In a national study, almost three quarter of pathological gamblers had an alcohol use disorder, 38% had a drug use disorder, and 60% were nicotine dependent. In terms of mental health comorbidity, personality disorder (60%), mood disorder (49.6%) and anxiety disorder (41.3%) were most prevalent (Petry, Stinson, & Grant, 2005).

Similar to what is seen in the mental health and substance use fields, shame and stigma are barriers to individuals seeking assistance for gambling related issues. Indeed, despite negative consequences for gambling, only 10% of individuals experiencing problems ever seek treatment and even when the treatment is sought, the presenting concern is often not identified as problem-gambling (Tanner et. al., 2017).

Treatment and Interventions

Treatment for problem-gambling usually involves either an abstinence-based model or a harm reduction approach with this latter being the least popular and researched of the two options. However, given that gambling is legal and available and has expanded with the availability and ubiquity of internet gambling sites and variety of betting games available, a harm reduction approach can prove very beneficial in having an impact on protecting vulnerable populations from the risk of developing a gambling disorder. Additionally, harm reduction approaches can be encouraging to individuals who do not see abstinence as an attractive or feasible option. This can include older adults who derive social benefits from gambling (Tanner et. al., 2017) along with young adults and college students in particular who are more at risk of pathological gambling than the general adult population (Lostutter et. al., 2014). Harm reduction initiatives are typically divided into three tiers of prevention (Blaszcynski, 2001). Primary prevention strategies are devised to protect gambling participants from developing problems. Such interventions include public education campaigns, promotion or responsible behavior and teaching the public about the risks associated with gambling. Such initiatives could also include clearly describing the odds and probabilities of winning and clarifying erroneous cognitions and misperceptions that might be associated with gambling and associated machines (Derevensky, Gupta, Dickson, & Deguire, 2004).

Secondary prevention techniques aim to minimize the harm of gambling once it has started. Given the rates comorbidity present with problem gambling, a key strategy is for addiction, mental health, and healthcare providers to screen for problem gambling among their patients. This provides an opportunity to identify opportunities for psychoeducation, intervention and referrals.

Initiatives within the gambling industry involve training casino staff to detect and employ sensitive approaches in dealing with potential problem gamblers, reducing the amount of alcohol or cigarettes available near gaming areas, removing ATM machines from gambling areas, self-exclusion programs, expenditure limits connected to time-intervals and restricting the amount of wins and/or restricting wins to checks rather than cash.

Lastly, the goal of tertiary interventions is to reduce the gravity of gambling problems once they have commenced and helping prevent relapses of gamblers in treatment. Such measures include therapy for problem gambling and particularly therapies that focus on creating individualized controlled gambling plans rather than full abstinence (Ladouceur, 2005).

New York State has made significant strides in utilizing harm reduction initiatives around problem gambling. In 2013, the New York State Gaming Commission, the Office of Alcoholism and Substance Abuse Services (OASAS) and the New York Council on Problem Gambling announced the formation of the Responsible Play Partnership (OASAS website, 2018). This Partnership is aimed at regulating gambling venues and exploring ways to prevent and treat problem gambling. The Responsible Play Partnership has taken components such as the implementation of a statewide self-exclusions law, improving the way gambling facilities identify gamblers at risk, improving responsible gambling, enforcing age restriction laws and enhancing outreach and awareness. Through OASAS, New York State is also expanding the presence of Problem Gambling Resource Centers across the state to increase awareness of, and access to, various types of gambling treatment services.

Often viewed as cornerstones of problem gambling systems, helplines were among the first services established by many US states. Telephone and chat helplines are confidential and easily accessible, and may be an ideal vehicle for individuals, including youth, to ask questions, obtain information and acquire referrals to services. Helplines such as the HOPEline (1-877-8-HOPENY), the statewide 24/7 helpline that offers support, education as well as treatment referrals to New Yorkers struggling with substance use and problem gambling, and NYC Well (1-888-NYC WELL) which offers connection to mental health supports to New York City residents, can cut across the three tiers of harm reduction. This can include providing education around responsible gaming to its callers and break some misconceptions around winning and losing at gaming facilities, education around concepts such as self-exclusion or cash limits on gambling. Should an individual develop a problem gambling disorder, helplines are there to destigmatize the shame around problem gambling, provide emotional support to the person at risk and/or their family members and guide the individual to appropriate referrals for the treatment of problem gambling.

Nada Touma is Director of Specialized Services at the Mental Health Association of New York City. Kelly Clarke is Director of NYC Well at the Mental Health Association of New York City. Contact them at or


Derevensky, J. L., Gupta, R., Dickson, L., and Deguire, A. (2004). Gambling problems in youth: Theoretical and applied perspectives, McGill University, Penguin Publishing.

Ladouceur, R. (2005). Controlled Gambling for Pathological Gamblers, Journal of Gambling Studies, 21 (1) 49-57.

Langham, E., Thorne, H., Browne, M., Donaldson, P., Rose, J., & Rockloff (2016). Understanding gambling related harm: A proposed definition, conceptual framework, and taxonomy of harms, BMC Public Health,16 (80)1-23.

Lostutter, T. W., Lewos, M. A., Cronce, J. M., Neighbors, C., Larimer, M.E. (2014). The use of protective behaviors in relation to gambling among college students, Journal of Gambling Studies, 30 (1) 27-46.

Office of Alcoholism and Substance AAbuse Services website (2018) NYS Gaming Commission, OASAS & NY Council on Problem Gambling Form Responsible Play Partnership to Address Problem Gambling Issues,

Petry, N. M., Stinson, F. S., & Grant, B. F., (2005). Comorbidity of DSM-IV pathological gambling and other psychiatric disorders: Results from the national epidemiologic survey on alcohol and related conditions, Journal of Clinical Psychiatry, 66(5) 564-74.

Pitt (2017). Factors that influence children’s gambling attitudes and consumption intentions: Lessons for gambling harm prevention research, policies and advocacy strategies, Harm Reduction Journal, 14 (11) 1-12.

Tanner, J., Drawson, A. S., Mushquash, C. Muchquash, A. R., & Mazmanian, D. (2017). Harm reduction in gambling: A systemic review of industry strategies. Addiction Research & Theory, 25, 485-494.

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