Prevalence Estimates of Pathological Gambling in Quebec* ROBERT LADOUCEUR, Ph.D'
Pathological gambling was officially defined and recognized as a psychiatric illness by the American Psychiatric Association in 1980. This survey reports the results of a province-wide study in Quebec based on telephone interviews using standardized assessment instruments with 1,002 subjects. The current prevalence of pathological gambling is 1.2%. The results also show that 88% ofthe respondents have gambled at least once in their life. The implications of these results for the prevention and treatment of this debilitating disorder are discussed.
Klein's criteria (9). A study in England of 51 children showed similar results: 89% of them had gambled before, and they began to wager money at an average age of eight (11). Until recently, there have been few studies on the prevalence of pathological gambling. Results indicate the nature of needs related to problem gambling and justify the development of new treatment programs for pathological gamblers (12). Volberg (13) evaluated the prevalence of pathological gambling in three states (New York, New Jersey and Maryland). The prevalence of pathological gamblers varied from 1.4% to 1.5%. To our knowledge, no study of the prevalence of pathological gambling has yet been conducted in Canada. This survey evaluated the prevalence of pathological gambling in the adult population in the province of Quebec.
G
ambling has been practised among many cultures for thousands of years (1). The phenomenon is widespread; more than two-thirds of the adult population in the United States and Canada engage regularly in some form of gambling (2-5). While most people gamble occasionally, some become addicted. These gamblers become emotionally dependent on gambling and lose control of the personal, family, and vocational aspects of their lives (6,7). Clinical observations show that many pathological gamblers began gambling during adolescence (7,8). The age at which people have their first experience with gambling seems crucial in the development of gambling problems. The younger the age at which someone is exposed to gambling, the greater the risk that he or she may become addicted (3,9). Studies of the prevalence of pathological gambling among high school students confirm this hypothesis. In the United States, Lesieur and Klein (9) surveyed gambling behaviour and gambling problems in 892 adolescents. According to the authors, 91% of students had gambled at least once during the year preceding the study and 32% had gambled regularly. Additionally, 5.7% of them were considered to be pathological gamblers according to DSM-I1I criteria. Ladouceur and Mireault (10) surveyed gambling behaviour among high school students in the Quebec area, using a French version of the questionnaire developed by Lesieur and Klein (9). Threequarters (76%) ofthe 1,612 respondents had gambled at least once and 24% gambled at least once a week during the year preceding the survey. Furthermore, 3.6% of adolescents were identified as pathological gamblers according to Lesieur and
Method The South Oaks Gambling Screen (SOGS) was used, a telephone survey developed by Lesieur and Blume (14) and adapted by Volberg and her colleagues (15,16). This instrument is a 20 item scale derived from the DSM-I1I criteria for pathological gambling (6). (A copy of the SOGS is available from the author on request.) Respondents scoring 3 and 4 are classified as problem gamblers and those scoring more than 5 are classified as pathological gamblers. Weighted questions concern specific behaviours, such as hiding evidence of their wagering activities, arguments with family members over wagering, and borrowing money to gamble or to pay gambling debts. Lesieur and Blume (14) subjected a large pool of variables to discriminant analysis and verified the external validity of the instruments with assessments by independent counselors. Volberg and Bank (17) reported that SOGS was highly sensitive among the members of Gamblers Anonymous (99.5%) and with students (98.5%) and hospital workers (99.3%). Since most of the people in Quebec are French speaking, the instrument was translated into French. The sample was stratified to proportionally represent the population (over the age of 18) of each area in the province. Random selection of phone numbers from phone books and random selection of respondents within the households phoned were used (Kish grids). Only one person from each household was interviewed. One thousand and two interviews were completed. Respondents were contacted and interviewed by one of four research assistants trained by an employee of a survey research firm located in Quebec City. Interviews were conducted on weekdays between 4:00 pm and 9:00 pm and on Saturdays between noon and 6:00 pm.
*This study was conducted in part by a grant from the Conseil de la recherche en sciences humaines du Canada (410-88-0676) and from the Conseil quebecois de la recherche sociale (RS-1280). Manuscript received August 1990, revised January 1991. 'Ecole de Psychologie, Universite Laval, Ste-Foy, Quebec.
Can. J. Psychiatry Vol. 36, December 1991
732
December, 1991
733
PREVALENCE OF PATHOLOGICAL GAMBLING
Up to five attempts were made to contact each number. The response rate was 68%; it was higher among urban respondents. Results The overall results indicated that 2.6% of the Quebec sample were problem gamblers and 1.2% were pathological gamblers. Confidence intervals determined at the .05 level for problem and pathological gamblers revealed that between 61,000 and 136,000 of the 3.8 millions adults in Quebec are problem gamblers and 20,000 to 71,000 adults are pathological gamblers. The next step in our analysis was to identify significant differences between the overall sample and the respondents who were identified as problem and pathological gamblers. In order to carry out this analysis, the responses of the problem and pathological gamblers were combined and compared with responses given by those without gambling problems. Significance was statistically determined using a chisquare analysis. Significant differences between the total sample and the problem and pathological gamblers on sex, age of onset, education, income and marital status were found (p < .05) (see Table I). The interval between the age at which problem and pathological gamblers began wagering and the age at which they became preoccupied with the amounts they were wagering was 8.8 years. A small percentage (11.5%) of the problem and pathological gamblers had already sought help for gambling. Most respondents who had received help for gambling were those who were identified as pathological gamblers (8.9%), while only 2.9% of those who were identified as problem gamblers had sought help from a health care professional or from a self-help group. During the year preceding the survey, 52.2% ofthe respondents had wagered money. Since lotteries are the most popular form of legalized gambling in Quebec, it is not surprising that 88.3% of the respondents had purchased a lottery ticket
at some time, leaving only 11.5% who had never participated in a lottery. Discussion The study showed the current prevalence of pathological gamblers in the province of Quebec to be 1.2%. Another 2.6% of the population are problem gamblers. The results also showed that 88.3% of the respondents had gambled at least once in their life and 55.2% of them had gambled more than once during the year preceding the survey. These results suggest that gambling is widespread in Quebec. These figures are similar to the ones reported by Volberg and Steadman (15,16). In New York and New Jersey they found that 2.8% of the sample were identified as problem gamblers and another 1.4% of the sample were identified as pathological gamblers. In Maryland, 2.4% of the sample were identified as problem gamblers and another 1.5% of the sample were identified as pathological gamblers. Since lotteries, horse-races and bingo constitute the only legalized forms of gambling, we can assume that many gamblers engage at some time or another in some form of illegal gambling. The majority of the respondents who developed a gambling problem were male and most of them began to wager at an earlier age than other gamblers. These results are consistent with clinical observations which show that pathological gamblers are men who began to wager during their adolescence (7,8). As mentioned before, a substantial number of students who gamble on a regular basis can already be classified as pathological gamblers (9,10). Volberg (13) found that the problem and pathological gamblers were more likely to be under the age of 30 and to have household incomes under $25,000 than non gamblers. In our survey, the problem and pathological gamblers were more likely to be under the age of 30 or between 40 and 49 years of age. These gamblers were more likely than non gamblers to have household incomes between $15,000 and $25,000 or between $35,000 and $50,000. In what way may gamblers under 30 be distinguished from those between 40 and 49? In what way could the gamblers with household
Table I Comparison of Individual Characteristics of Gamblers and Non Gamblers on Individual Characteristics
31.0 17.5 42.2
46.1 33.6 58.4
19.6 24.0 53.7 10.0
38.0 43.8 36.7 26.0
734
incomes between $15,000 and $25,000 be different from those who earn between $35,000 and $50,OOO? They may not engage in gambling for the same purposes. Gamblers who earn between $15,000 and $25,000 may wager mainly to win large amounts of money because their household incomes are low. We can also assume that gamblers who earn between $35,000 and $50,000 began to gamble primarily for entertainment and not necessarily to win large amounts of money. In this survey, only 11.5% ofthe problem and pathological gamblers sought professional help for their gambling problems. Many gamblers are probably not aware of their gambling problems or do not know where to seek help. In fact, it seems that very few people know about pathological gambling and its consequences. This suggests that people need more information on the nature of pathological gambling and the resources available to help them cope with the problem. Acknowledgement The author wishes to thank Dr. Rachel Volberg for her helpful suggestions.
References 1. Abt V, Smith JF, Christiansen EM. The business of risk: com-
2. 3.
4. 5. 6. 7.
Vol. 36, No. 10
CANADIAN JOURNAL OF PSYCHIATRY
mercial gambling in mainstream America. Lawrence KS: University of Kansas Press, 1985. Gallup G. 78% des Canadiens aiment parier. La Presse, Montreal, November 29, 1980. Kallick M, Suits D, Dielman T, et al. A survey of American gambling attitudes and behaviour. Survey Research Center, Institute for Social Research. The University of Michigan, 1979. Olivier A, Gagnon C. Etude de la penetration des loteries dans le marche montrealais : "Penetration VIII". Montreal QC: Multi-Reso Inc, 1984. Skolnick JH. The social risks of casino gambling. Psychology Today 1979; 7: 52-64. Diagnostic and statistical manual of mental disorders, third edition. Washington DC: American Psychiatric Press, Inc., 1980. Custer RL. An overview of compulsive gambling. In: Carone PA, Yolles SF, Kieffer SN, Krinsky LW,eds. Addictive disorders update New York: Human Science Press, 1982: 107-124.
8. Dell U, Ruzicka ME, Palisi AT. Personality and other factors associated with gambling addiction. The Intemational Journal of Addictions 1981; 16: 149-156. 9. Lesieur HR, Klein R. Pathological gambling among high school students. Addictive Behaviors 1987; 12: 129-135. 10. Ladouceur R, Mireault C. Gambling behaviour among high school students in the Quebec area. Journal of Gambling Behavior 1988; 4: 3-12. II. Ide-Smith SG, LeaSEG. Gambling in young adolescents. Journal of Gambling Behavior 1988; 4: 110-118. 12. Volberg RA, Steadman HJ. Policy implications of prevalence estimates of pathological gambling. In: Shaffer HJ, Stein SA, Gambino B, Cummings TN, eds. Compulsive gambling. Toronto ON: Lexington, 1989: 163-174. 13. Volberg RA. Prevalence rates of problem gambling in three states. Remarks presented at the Fourth National Conference on Compulsive Gambling, Des Moines, Iowa, June 1-3, 1989. 14. Lesieur HR, Blume S. The South Oaks Gambling Screen (SaGS): a new instrument for the identification of pathological gamblers. Am J Psychiatry 1987; 144: 1184-1188. 15. Volberg RA, Steadman HJ. Refining prevalence estimates of pathological gambling. Am J Psychiatry 1988; 145: 502-505. 16. Volberg RA, Steadman HJ. Prevalence estimates of pathological gambling in New Jersey and Maryland. Am Psychiatry 1989; 146: 1618-1619. 17. Volberg RA, Banks SM. A review a two measures of pathological gambling in the United States. Journal of Gambling Studies 1990; 6: 153-163.
Resume En 1980, I'American Psychiatric Association a defini et reconnu officiellement la passion dujeu comme une maladie psychiatrique. On rapporte les resultats d' un sondage telephonique mene au Quebec aupres de 1002 personnes, au moyen d' instruments d' evaluation normalises. La prevalence de la passion du jeu se chiffre actuellement a 1,2 %. Les resultats revelent egalement que 88 % des sujets interreges se sont livres ades jeux d' argent au mains une fois dans leur vie. On examine la signification de ces resultats dans le contexte de La prevention et du traitement de cette maLadie debilitante.
Pathological gambling was officially defined and recognized as a psychiatric illness by the American Psychiatric Association in 1980. This survey reports the results of a province-wide study in Quebec based on telephone interviews using standardized assessment instruments with 1,002 subjects. The current prevalence of pathological gambling is 1.2%. The results also show that 88% ofthe respondents have gambled at least once in their life. The implications of these results for the prevention and treatment of this debilitating disorder are discussed.
Klein's criteria (9). A study in England of 51 children showed similar results: 89% of them had gambled before, and they began to wager money at an average age of eight (11). Until recently, there have been few studies on the prevalence of pathological gambling. Results indicate the nature of needs related to problem gambling and justify the development of new treatment programs for pathological gamblers (12). Volberg (13) evaluated the prevalence of pathological gambling in three states (New York, New Jersey and Maryland). The prevalence of pathological gamblers varied from 1.4% to 1.5%. To our knowledge, no study of the prevalence of pathological gambling has yet been conducted in Canada. This survey evaluated the prevalence of pathological gambling in the adult population in the province of Quebec.
G
ambling has been practised among many cultures for thousands of years (1). The phenomenon is widespread; more than two-thirds of the adult population in the United States and Canada engage regularly in some form of gambling (2-5). While most people gamble occasionally, some become addicted. These gamblers become emotionally dependent on gambling and lose control of the personal, family, and vocational aspects of their lives (6,7). Clinical observations show that many pathological gamblers began gambling during adolescence (7,8). The age at which people have their first experience with gambling seems crucial in the development of gambling problems. The younger the age at which someone is exposed to gambling, the greater the risk that he or she may become addicted (3,9). Studies of the prevalence of pathological gambling among high school students confirm this hypothesis. In the United States, Lesieur and Klein (9) surveyed gambling behaviour and gambling problems in 892 adolescents. According to the authors, 91% of students had gambled at least once during the year preceding the study and 32% had gambled regularly. Additionally, 5.7% of them were considered to be pathological gamblers according to DSM-I1I criteria. Ladouceur and Mireault (10) surveyed gambling behaviour among high school students in the Quebec area, using a French version of the questionnaire developed by Lesieur and Klein (9). Threequarters (76%) ofthe 1,612 respondents had gambled at least once and 24% gambled at least once a week during the year preceding the survey. Furthermore, 3.6% of adolescents were identified as pathological gamblers according to Lesieur and
Method The South Oaks Gambling Screen (SOGS) was used, a telephone survey developed by Lesieur and Blume (14) and adapted by Volberg and her colleagues (15,16). This instrument is a 20 item scale derived from the DSM-I1I criteria for pathological gambling (6). (A copy of the SOGS is available from the author on request.) Respondents scoring 3 and 4 are classified as problem gamblers and those scoring more than 5 are classified as pathological gamblers. Weighted questions concern specific behaviours, such as hiding evidence of their wagering activities, arguments with family members over wagering, and borrowing money to gamble or to pay gambling debts. Lesieur and Blume (14) subjected a large pool of variables to discriminant analysis and verified the external validity of the instruments with assessments by independent counselors. Volberg and Bank (17) reported that SOGS was highly sensitive among the members of Gamblers Anonymous (99.5%) and with students (98.5%) and hospital workers (99.3%). Since most of the people in Quebec are French speaking, the instrument was translated into French. The sample was stratified to proportionally represent the population (over the age of 18) of each area in the province. Random selection of phone numbers from phone books and random selection of respondents within the households phoned were used (Kish grids). Only one person from each household was interviewed. One thousand and two interviews were completed. Respondents were contacted and interviewed by one of four research assistants trained by an employee of a survey research firm located in Quebec City. Interviews were conducted on weekdays between 4:00 pm and 9:00 pm and on Saturdays between noon and 6:00 pm.
*This study was conducted in part by a grant from the Conseil de la recherche en sciences humaines du Canada (410-88-0676) and from the Conseil quebecois de la recherche sociale (RS-1280). Manuscript received August 1990, revised January 1991. 'Ecole de Psychologie, Universite Laval, Ste-Foy, Quebec.
Can. J. Psychiatry Vol. 36, December 1991
732
December, 1991
733
PREVALENCE OF PATHOLOGICAL GAMBLING
Up to five attempts were made to contact each number. The response rate was 68%; it was higher among urban respondents. Results The overall results indicated that 2.6% of the Quebec sample were problem gamblers and 1.2% were pathological gamblers. Confidence intervals determined at the .05 level for problem and pathological gamblers revealed that between 61,000 and 136,000 of the 3.8 millions adults in Quebec are problem gamblers and 20,000 to 71,000 adults are pathological gamblers. The next step in our analysis was to identify significant differences between the overall sample and the respondents who were identified as problem and pathological gamblers. In order to carry out this analysis, the responses of the problem and pathological gamblers were combined and compared with responses given by those without gambling problems. Significance was statistically determined using a chisquare analysis. Significant differences between the total sample and the problem and pathological gamblers on sex, age of onset, education, income and marital status were found (p < .05) (see Table I). The interval between the age at which problem and pathological gamblers began wagering and the age at which they became preoccupied with the amounts they were wagering was 8.8 years. A small percentage (11.5%) of the problem and pathological gamblers had already sought help for gambling. Most respondents who had received help for gambling were those who were identified as pathological gamblers (8.9%), while only 2.9% of those who were identified as problem gamblers had sought help from a health care professional or from a self-help group. During the year preceding the survey, 52.2% ofthe respondents had wagered money. Since lotteries are the most popular form of legalized gambling in Quebec, it is not surprising that 88.3% of the respondents had purchased a lottery ticket
at some time, leaving only 11.5% who had never participated in a lottery. Discussion The study showed the current prevalence of pathological gamblers in the province of Quebec to be 1.2%. Another 2.6% of the population are problem gamblers. The results also showed that 88.3% of the respondents had gambled at least once in their life and 55.2% of them had gambled more than once during the year preceding the survey. These results suggest that gambling is widespread in Quebec. These figures are similar to the ones reported by Volberg and Steadman (15,16). In New York and New Jersey they found that 2.8% of the sample were identified as problem gamblers and another 1.4% of the sample were identified as pathological gamblers. In Maryland, 2.4% of the sample were identified as problem gamblers and another 1.5% of the sample were identified as pathological gamblers. Since lotteries, horse-races and bingo constitute the only legalized forms of gambling, we can assume that many gamblers engage at some time or another in some form of illegal gambling. The majority of the respondents who developed a gambling problem were male and most of them began to wager at an earlier age than other gamblers. These results are consistent with clinical observations which show that pathological gamblers are men who began to wager during their adolescence (7,8). As mentioned before, a substantial number of students who gamble on a regular basis can already be classified as pathological gamblers (9,10). Volberg (13) found that the problem and pathological gamblers were more likely to be under the age of 30 and to have household incomes under $25,000 than non gamblers. In our survey, the problem and pathological gamblers were more likely to be under the age of 30 or between 40 and 49 years of age. These gamblers were more likely than non gamblers to have household incomes between $15,000 and $25,000 or between $35,000 and $50,000. In what way may gamblers under 30 be distinguished from those between 40 and 49? In what way could the gamblers with household
Table I Comparison of Individual Characteristics of Gamblers and Non Gamblers on Individual Characteristics
31.0 17.5 42.2
46.1 33.6 58.4
19.6 24.0 53.7 10.0
38.0 43.8 36.7 26.0
734
incomes between $15,000 and $25,000 be different from those who earn between $35,000 and $50,OOO? They may not engage in gambling for the same purposes. Gamblers who earn between $15,000 and $25,000 may wager mainly to win large amounts of money because their household incomes are low. We can also assume that gamblers who earn between $35,000 and $50,000 began to gamble primarily for entertainment and not necessarily to win large amounts of money. In this survey, only 11.5% ofthe problem and pathological gamblers sought professional help for their gambling problems. Many gamblers are probably not aware of their gambling problems or do not know where to seek help. In fact, it seems that very few people know about pathological gambling and its consequences. This suggests that people need more information on the nature of pathological gambling and the resources available to help them cope with the problem. Acknowledgement The author wishes to thank Dr. Rachel Volberg for her helpful suggestions.
References 1. Abt V, Smith JF, Christiansen EM. The business of risk: com-
2. 3.
4. 5. 6. 7.
Vol. 36, No. 10
CANADIAN JOURNAL OF PSYCHIATRY
mercial gambling in mainstream America. Lawrence KS: University of Kansas Press, 1985. Gallup G. 78% des Canadiens aiment parier. La Presse, Montreal, November 29, 1980. Kallick M, Suits D, Dielman T, et al. A survey of American gambling attitudes and behaviour. Survey Research Center, Institute for Social Research. The University of Michigan, 1979. Olivier A, Gagnon C. Etude de la penetration des loteries dans le marche montrealais : "Penetration VIII". Montreal QC: Multi-Reso Inc, 1984. Skolnick JH. The social risks of casino gambling. Psychology Today 1979; 7: 52-64. Diagnostic and statistical manual of mental disorders, third edition. Washington DC: American Psychiatric Press, Inc., 1980. Custer RL. An overview of compulsive gambling. In: Carone PA, Yolles SF, Kieffer SN, Krinsky LW,eds. Addictive disorders update New York: Human Science Press, 1982: 107-124.
8. Dell U, Ruzicka ME, Palisi AT. Personality and other factors associated with gambling addiction. The Intemational Journal of Addictions 1981; 16: 149-156. 9. Lesieur HR, Klein R. Pathological gambling among high school students. Addictive Behaviors 1987; 12: 129-135. 10. Ladouceur R, Mireault C. Gambling behaviour among high school students in the Quebec area. Journal of Gambling Behavior 1988; 4: 3-12. II. Ide-Smith SG, LeaSEG. Gambling in young adolescents. Journal of Gambling Behavior 1988; 4: 110-118. 12. Volberg RA, Steadman HJ. Policy implications of prevalence estimates of pathological gambling. In: Shaffer HJ, Stein SA, Gambino B, Cummings TN, eds. Compulsive gambling. Toronto ON: Lexington, 1989: 163-174. 13. Volberg RA. Prevalence rates of problem gambling in three states. Remarks presented at the Fourth National Conference on Compulsive Gambling, Des Moines, Iowa, June 1-3, 1989. 14. Lesieur HR, Blume S. The South Oaks Gambling Screen (SaGS): a new instrument for the identification of pathological gamblers. Am J Psychiatry 1987; 144: 1184-1188. 15. Volberg RA, Steadman HJ. Refining prevalence estimates of pathological gambling. Am J Psychiatry 1988; 145: 502-505. 16. Volberg RA, Steadman HJ. Prevalence estimates of pathological gambling in New Jersey and Maryland. Am Psychiatry 1989; 146: 1618-1619. 17. Volberg RA, Banks SM. A review a two measures of pathological gambling in the United States. Journal of Gambling Studies 1990; 6: 153-163.
Resume En 1980, I'American Psychiatric Association a defini et reconnu officiellement la passion dujeu comme une maladie psychiatrique. On rapporte les resultats d' un sondage telephonique mene au Quebec aupres de 1002 personnes, au moyen d' instruments d' evaluation normalises. La prevalence de la passion du jeu se chiffre actuellement a 1,2 %. Les resultats revelent egalement que 88 % des sujets interreges se sont livres ades jeux d' argent au mains une fois dans leur vie. On examine la signification de ces resultats dans le contexte de La prevention et du traitement de cette maLadie debilitante.
