Toronto casino would mean more problem gamblers, more “individual disasters”

With so much money to be made if a Toronto casino is built, it’s no surprise that the health effects of increased gambling receive short shrift in the media compared to news of intense lobbying activities.

Private investors, construction trades and companies, as well as the province and the city all stand to make money from a casino. The Ontario Lottery and Gaming Corporation (OLG), a crown corporation, is pushing hard for a casino in Toronto and said it would pay Toronto double the “hosting fees” it gives to other municipalities. However, Ontario Premier Kathleen Wynne rebuked the OLG for making that offer, and stated that all municipalities should be treated the same.

Meanwhile, a Toronto Public Health (TPH) report warns that building a casino in the city could “exacerbate social inequalities” and increase the frequency and severity of problem gambling in the city.

Problem gambling is not generally viewed as a health problem or, when it is severe, as a legitimate form of addiction, says Wayne Skinner, deputy clinical director of addictions programs with the Centre for Addiction and Mental Health (CAMH).

Partly as a result of this, and because gambling still carries a stigma, research indicates that a relatively small proportion of problem gamblers seek treatment, he says. “We have a longer understanding of  other substance abuse problems …yet neurobiology shows that it [gambling addiction] is a bit like being on stimulant drugs.”

Youth, seniors, relatively poor particularly vulnerable to problem gambling

Problem gambling is  “gambling behaviour that includes continuous or periodic loss of control over gambling; preoccupation with gambling and money with which to gamble; irrational thinking; and continuation of activity despite adverse consequences,” according to a Canadian Public Health Association definition.

Youth, seniors and those of lower socio-economic status are particularly vulnerable to problem gambling, as are newcomers and immigrants to Canada, according to research cited in the TPH report on the health impacts of gambling expansion. (Toronto Public Health has released four reports on the casino, including one that focuses on mitigating the negative effects of gambling.)

That gambling is regressive—it imposes a greater financial burden on lower socioeconomic groups— is evident in Statistics Canada’s latest report on gambling.

The poorest 20% of households spend a considerably higher proportion of their income on gambling than the highest 20% (2.7% compared to 0.5%), according to the households that reported to the federal agency.

The prevalence of problem gambling in Ontario (the term encompasses a continuum from those at moderate to severe risk) is between 1.2% and 3.4% of the population, according to Toronto Public Health.

Based on community surveys, the most severe form of problem gambling affects 11,000 people 18 years and over in the Greater Toronto Area (0.2% of the population) and another 129,000 GTA adults are deemed at-risk gamblers, the TPH document states.

In 2000, the CAMH established the Problem Gambling Institute of Ontario, which offers treatment to individuals and training for people who work in the gambling field (to help them identify problems).

Risk factors for serious gambling problems

CAMH researcher Nigel Turner says that Individuals at risk for serious gambling problems typically have one or more of the following risk factors: having had an early or big win, or a focus on money; erroneous beliefs about gambling, such as that “randomness corrects itself”; impulsivity or risk taking behaviour; and emotional vulnerability, such as anxiety or depression.

Turner has published widely on gambling issues and says gambling is often called “the most expensive addiction” because, compared to other addictions, much more money can be lost while in an “intensely stimulating gambling trance.”

But he also notes that the problems caused by gambling are “individual disasters which are not particularly public.” As a result, society at large is not particulary aware of some of the negative impacts of gambling.

Individuals who seek treatment for problem gambling at CAMH tend to also have other, concurrent, addictions, says Skinner. A recent systematic review, for example, concluded that more than 50% of problem gamblers have a substance use disorder.

The OLG aims to target younger gamblers

In its 2012 blueprint for modernizing gambling, the OLG makes clear its goals: to expand gambling in the province, maximize private sector involvement, and target a younger population in order to increase revenues.

Locating a casino in Canada’s largest city is particularly enticing to the OLG, which states in the blueprint document that “consumer interest” in gambling is not being met in the Greater Toronto Area.

More than 3 out of 4 “gamers” were 50 years old or older in 2008-09, the report states, and while slot machines are a major revenue source for the OLG, adults under 45 years of age prefer “black jack and poker” to slot machines, the report states.

And fully 88% of the Ontario Lottery and Gaming Corporation’s  “land based” revenue now comes from slot machines—a form of gambling that many researchers have shown is particularly addictive.

Slot machines particularly addictive

About 15% to 20% of slot machine players are deemed “problem players”, and 60% of slot machine revenue in Ontario comes from problem gamblers, according to Kevin Harrigan, a computer science professor with the University of Waterloo’s gambling research lab.

Slot machines can be set up to fool the human mind. For example, the Alcohol and Gaming Commission of Ontario permits slot machines to be programmed so that “near wins” occur 12 times more often than would be dictated by chance, Harrigan explains. Other jurisdictions, such as Australia, put stricter limits on the number of allowable near wins, he says.

Harrigan has co-authored extensive research on gambling, including a study showing that most “wins”, that slot machines flash to celebrate, are in fact losses (as when a person bets $1 but wins 20 cents), and that gamblers react physiologically as if these losses are wins.

Gambling activity in Canada increased substantially in the 1990s after a 1985 amendment to the Criminal Code of Canada allowed provinces to “manage and conduct” electronic forms of gambling. In 2000 the Canadian Public Health Association started to ring alarm bells when it issued its position paper Gambling Expansion in Canada, An Emerging Public Health Issue.

But growth has recently stalled, according to the OLG blueprint document, in part due to competition from other forms of entertainment.

Measuring the social and economic impacts

OLG-sponsored gambling contributed $2 billion to the province in 2010/11, according to the corporation’s annual report. But attempts to measure the risks and benefits of the activity in terms of overall public good is a complicated pursuit, as is evident from The Social and Economic Impacts of Gambling, an extensive 2011 report written for the Canadian Consortium on Gambling Research.

The overall impact of gambling depends on a number of variables, including where the casino is located, and when the impacts are examined. For example, while destination casinos in economically challenged areas can have economic benefits for the host city, positive economic effects are “muted or mixed” in more economically robust areas.

Casinos have the greatest potential to increase crime and, because they offer continuous forms of gambling, have a greater addiction potential than other types of gambling such as lotteries, it states.

Problem gambling, which is associated with bankruptcy, divorce, suicide and treatment issues, is the health effect that gets the most attention. The OLG spends $49 million a year, according to its latest annual report, to support problem gambling prevention, treatment and research.

Only a minority of problem gamblers seek or receive treatment and “only a minority have police/child welfare or employment involvement,” states the Social and Economic Impact report.

Robert Williams, a leading gambling researcher at the University of Lethbridge, co-authored a 2012 document, prepared for the Ontario Ministry of Health and Long Term Care, titled Prevention of Problem Gambling: A Comprehensive Review of the Evidence and Indentified Best Practices.

CAMH’s Turner says education about how games work, and about coping skills, are two major approaches to preventing gambling problems, but their long term efficacy is difficult to measure.

One tool for mitigating problems (for those who have developed them) is when gamblers “self exclude” from casinos. But the OLG has a poor record of enforcing such self exclusion and a $3.5-billion class action suit has been launched against the OLG on behalf of 10,000 gamblers, according to a 2009 Globe and Mail feature.

The city’s Board of Health opposes a casino, several Toronto Public Health documents outline the public health concerns, and a citizen’s group, No Casino Toronto, has been bringing attention to reports of community health impacts.

Public Health Ontario held grand rounds to address the issue of the expansion of casinos in Ontario, but has not taken a position on the matter. But many medical officers of health, such as Dr. Rosana Pellizzari in Peterborough, have raised concerns about the downside of casino expansion.

Toronto City Council will soon vote on whether or not the city should have a casino.

Do you support a casino in Toronto?

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  1. Tony Culyer

    What a biased account! What a poor summary of the evidence! Where is the good measure of what you call the ‘economic value’? What about other valued benefits? How is the asserted negative (but not quantified) harm (net harm?) to public health to be evaluated? What paucity of evidence about cause and consequence! Where is a careful exposition of the ethics? Where the comparison between gambling and other activities that give pleasure and also carry risks to the individual and to society as a whole?

    In short – %featured%what advantages to be compared with what disadvantages?And whose values are to count? Or is the whole discussion to be conducted in a ‘dirty commerce vs clean public health’ playing field?%featured%

  2. Stephen Jones

    %featured%This is where public health falls out of being scientific or objective and engages in social engineering.%featured%

    Where is the evidence that more people will become individual disasters? Since gambling already exists, how do we know that a single casino in Toronto will create more addicted gamblers? perhaps it will just redistribute them around.

    In any event, who cares? Why should the fact that harm will come to some people prevent other people from engaging in gambling if they choose to do so? The harms from gambling can be addressed through treatment if need be.

    I have no interest in the casino and think that it should not be built because it involves public land and money. I am highly skeptical of that the economic benefits will materialize. But if MGM Casinos wanted to build on private land and was prepared to pay for the infrastructure that goes with it, then I’d say let them take the risk.

  3. Irfan Dhalla

    Thanks Stephen and Tony for your comments. We value criticism as we feel it helps us improve.

    We didn’t set out to cover all aspects of the casino issue. Our goal, as indicated in the opening paragraph, was to focus on the potential health effects, which have not received much attention in the mainstream media.

    It is well accepted that addiction is a function of both predisposition and exposure. (A lifelong teetotaller cannot become addicted to alcohol.) So we can probably be reasonably confident that the addition of a large casino in Toronto will increase the number of Torontonians who are addicted to gambling. It’s difficult to know how large the increase will be, but the current prevalence of gambling addiction, as well as research examining the addition or removal of gambling opportunities, suggests that a new casino in Toronto would likely result in thousands more people developing problem gambling or gambling addiction. The evidence is less clear on whether these individuals will also become addicted to alcohol or other drugs.

    Should any of this matter to those of us who aren’t going to become addicted to gambling? I suppose that depends mostly on one’s own values and beliefs, but there are also ‘externalities’ to consider. People who develop gambling addiction sometimes end up receiving social assistance, or requiring publicly funded treatment.

    Whether the costs of a casino, borne both individually and publicly, outweigh the benefits (e.g., from the potential increase in jobs, from the entertainment value and from the increase in government revenue) is a question that probably cannot be definitely answered given the data that are currently available. But of cours%featured%e politicians must often make decisions in the absence of definitive data, and we believe it would be useful for them to consider the potential health effects when they are making their decision%featured%.

  4. Scott Wooder

    I’m sorry that I missed this piece when it was first published. It makes the excellent point that poorer families suffer disproportionately when a casino is placed in the midst of their community.

    The Hamilton Academy of Medicine and many other health and social groups made a very similar argument when we lobbied against a downtown Hamilton casino.

    I hope that the Government of Ontario and the new OLG Board listen.

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