A sweeping new analysis of Quebec’s public health system reveals that specialized treatment programs for gambling disorder are being dramatically underused, even as online betting platforms fuel a surge in addictive behaviour. The study, led by researchers at McGill University and the Douglas Research Centre, tracked the treatment trajectories of over 2,300 people diagnosed with gambling disorder across 13 years. Despite the availability of free, publicly funded services, patients accessed treatment an average of fewer than two times over the entire follow-up period, a pattern that scientists say mirrors the kind of chronic, relapsing course seen in substance use disorders.
“Gambling disorder is not something that can be resolved in a single treatment. It often requires sustained, long-term care,” explained Marie-Josée Fleury, senior author and professor in McGill’s Department of Psychiatry. “We need to approach it as a chronic condition for some patients, comparable to substance-related disorders.” The disorder carries a markedly elevated risk of suicide, bankruptcy, family breakdown, and psychiatric comorbidities, yet the window during which individuals engage with formal care remains perilously narrow. The team’s findings, published in the Journal of Gambling Studies, underscore a stark disconnect between the escalating public health toll of gambling and the actual use of evidence-based interventions.
To construct the longitudinal picture, the researchers linked individual-level records from addiction treatment centres across Quebec with provincial health administrative databases, creating a comprehensive dataset that captured repeat admissions, referrals, and clinical diagnoses from 2009 onward. The statistical analysis focused on identifying which demographic, clinical, and behavioural factors were associated with frequency of treatment re-entry. A key metric was the number of treatment admissions per patient, which the team modeled using zero-inflated negative binomial regression—a technique well-suited for count data with excess zeros—allowing them to parse both the likelihood of returning at all and the intensity of repeat use.
Among the most striking predictors, patients who gambled online exhibited approximately a 15 percent higher rate of treatment admissions compared with those whose gambling occurred exclusively in land-based venues. Ovidiu Tatar, a postdoctoral researcher and co-author, noted that the architectural design of online platforms amplifies impulsivity. “Online gambling makes it easier to act on impulse, which can increase the risk of relapse and repeated treatment,” he said. The near-constant availability, rapid bet settlement, and algorithm-driven prompts that characterize digital betting ecosystems create a behavioural feedback loop that erodes self-control more aggressively than traditional casino or lottery settings. This finding lands at a critical moment, as Alberta prepares to follow Ontario in launching a regulated online gambling market this July, and as a recent Angus Reid Institute poll indicates that nearly three in ten Canadians worry someone they know may be addicted to sports betting.
The study also revealed that co-occurring mental health conditions—mood disorders, anxiety disorders, and personality disorders—were strong independent predictors of multiple treatment admissions. The researchers interpret this as evidence of a clinical hierarchy in which psychiatric symptoms often eclipse gambling problems during brief clinical encounters. When a patient presents with simultaneous depression and gambling urges, the former tends to take precedence in consultation, meaning the underlying behavioural addiction may remain unaddressed for long stretches. Only when mental health symptoms are partially stabilized does the gambling disorder resurface as a target, contributing to a pattern of episodic treatment over many years.
Notably, individuals who initiated treatment on their own volition—rather than through family pressure, legal mandates, or employer referrals—were significantly more likely to return for subsequent episodes of care. This self-referral effect points to intrinsic motivation as a powerful lever that could be harnessed in early intervention campaigns. “Many don’t disclose gambling issues, and doctors don’t always ask,” Tatar added. “Because gambling problems are less visible than substance use, they can go unnoticed for years without screening.” The absence of routine screening in primary care settings likely contributes to the long latency between symptom onset and first treatment, which averaged over four years in the cohort.
From a neurobiological standpoint, chronic gambling disorder shares features with drug addiction, including sensitization of dopaminergic reward pathways and impaired prefrontal control systems. Each relapse episode further entrenches these circuits, which is why the McGill team advocates for a chronic disease management model that employs continuous monitoring, proactive outreach, and flexible re-entry into care. The current data suggest that, on a population level, patients are cycling through the system in an erratic fashion that falls far short of the recommended stepped-care approach.
The researchers caution that their analysis is limited to publicly funded addiction services in Quebec, meaning it does not capture private therapy, peer support groups, or unassisted recovery attempts. Nonetheless, the 13-year retrospective design provides one of the most detailed portraits yet of long-term service use patterns in gambling disorder. Fleury emphasized that health systems must adapt by integrating gambling screening into routine mental health and primary care visits, training clinicians to recognize digital markers of problem gambling, and destigmatizing repeated treatment seeking. As legal online gambling expands across North America, the gap between need and care will likely widen unless proactive strategies are embedded within the very same digital infrastructure that is accelerating the addiction.A sweeping new analysis of Quebec’s public health system reveals that specialized treatment programs for gambling disorder are being dramatically underused, even as online betting platforms fuel a surge in addictive behaviour. The study, led by researchers at McGill University and the Douglas Research Centre, tracked the treatment trajectories of over 2,300 people diagnosed with gambling disorder across 13 years. Despite the availability of free, publicly funded services, patients accessed treatment an average of fewer than two times over the entire follow-up period, a pattern that scientists say mirrors the kind of chronic, relapsing course seen in substance use disorders.
“Gambling disorder is not something that can be resolved in a single treatment. It often requires sustained, long-term care,” explained Marie-Josée Fleury, senior author and professor in McGill’s Department of Psychiatry. “We need to approach it as a chronic condition for some patients, comparable to substance-related disorders.” The disorder carries a markedly elevated risk of suicide, bankruptcy, family breakdown, and psychiatric comorbidities, yet the window during which individuals engage with formal care remains perilously narrow. The team’s findings, published in the Journal of Gambling Studies, underscore a stark disconnect between the escalating public health toll of gambling and the actual use of evidence-based interventions.
To construct the longitudinal picture, the researchers linked individual-level records from addiction treatment centres across Quebec with provincial health administrative databases, creating a comprehensive dataset that captured repeat admissions, referrals, and clinical diagnoses from 2009 onward. The statistical analysis focused on identifying which demographic, clinical, and behavioural factors were associated with frequency of treatment re-entry. A key metric was the number of treatment admissions per patient, which the team modeled using zero-inflated negative binomial regression—a technique well-suited for count data with excess zeros—allowing them to parse both the likelihood of returning at all and the intensity of repeat use.
Among the most striking predictors, patients who gambled online exhibited approximately a 15 percent higher rate of treatment admissions compared with those whose gambling occurred exclusively in land-based venues. Ovidiu Tatar, a postdoctoral researcher and co-author, noted that the architectural design of online platforms amplifies impulsivity. “Online gambling makes it easier to act on impulse, which can increase the risk of relapse and repeated treatment,” he said. The near-constant availability, rapid bet settlement, and algorithm-driven prompts that characterize digital betting ecosystems create a behavioural feedback loop that erodes self-control more aggressively than traditional casino or lottery settings. This finding lands at a critical moment, as Alberta prepares to follow Ontario in launching a regulated online gambling market this July, and as a recent Angus Reid Institute poll indicates that nearly three in ten Canadians worry someone they know may be addicted to sports betting.
The study also revealed that co-occurring mental health conditions—mood disorders, anxiety disorders, and personality disorders—were strong independent predictors of multiple treatment admissions. The researchers interpret this as evidence of a clinical hierarchy in which psychiatric symptoms often eclipse gambling problems during brief clinical encounters. When a patient presents with simultaneous depression and gambling urges, the former tends to take precedence in consultation, meaning the underlying behavioural addiction may remain unaddressed for long stretches. Only when mental health symptoms are partially stabilized does the gambling disorder resurface as a target, contributing to a pattern of episodic treatment over many years.
Notably, individuals who initiated treatment on their own volition—rather than through family pressure, legal mandates, or employer referrals—were significantly more likely to return for subsequent episodes of care. This self-referral effect points to intrinsic motivation as a powerful lever that could be harnessed in early intervention campaigns. “Many don’t disclose gambling issues, and doctors don’t always ask,” Tatar added. “Because gambling problems are less visible than substance use, they can go unnoticed for years without screening.” The absence of routine screening in primary care settings likely contributes to the long latency between symptom onset and first treatment, which averaged over four years in the cohort.
From a neurobiological standpoint, chronic gambling disorder shares features with drug addiction, including sensitization of dopaminergic reward pathways and impaired prefrontal control systems. Each relapse episode further entrenches these circuits, which is why the McGill team advocates for a chronic disease management model that employs continuous monitoring, proactive outreach, and flexible re-entry into care. The current data suggest that, on a population level, patients are cycling through the system in an erratic fashion that falls far short of the recommended stepped-care approach.
The researchers caution that their analysis is limited to publicly funded addiction services in Quebec, meaning it does not capture private therapy, peer support groups, or unassisted recovery attempts. Nonetheless, the 13-year retrospective design provides one of the most detailed portraits yet of long-term service use patterns in gambling disorder. Fleury emphasized that health systems must adapt by integrating gambling screening into routine mental health and primary care visits, training clinicians to recognize digital markers of problem gambling, and destigmatizing repeated treatment seeking. As legal online gambling expands across North America, the gap between need and care will likely widen unless proactive strategies are embedded within the very same digital infrastructure that is accelerating the addiction.
Subject of Research: Factors associated with treatment admission frequency among patients with gambling disorder
Article Title: Factors Associated with the Frequency of Treatment Admissions Over A 13-year Period Among Patients with Gambling Disorder
News Publication Date: 22-Apr-2026
Web References: https://pubmed.ncbi.nlm.nih.gov/42014609/; https://angusreid.org/sports-betting-addiction/
References: 10.1007/s10899-026-10490-7
Image Credits: Not provided
Keywords: gambling disorder, treatment admissions, online gambling, mental health, chronic disease management, relapse, health services research, impulsivity, longitudinal study, public health
