Gambling problems can go unnoticed for years without screening
Across Quebec, thousands of people living with gambling disorder have access to free, specialized treatment — and most use it only once. A thirteen-year McGill University study of more than 2,300 patients reveals not a failure of will, but a failure of system design: chronic conditions require sustained care, and a culture that still treats gambling problems as invisible or self-contained leaves many to suffer in silence. As online betting expands across Canada, the question is whether provinces will build the infrastructure of care before the need overwhelms it.
- A thirteen-year study finds that despite free treatment, people with gambling disorder average fewer than two visits — a chronic condition met with episodic, insufficient care.
- Online gambling is accelerating the crisis: the frictionless tap of an app removes every barrier between impulse and harm, driving a 15% higher rate of treatment admissions among digital bettors.
- Comorbid mental health conditions are quietly crowding gambling disorder off the clinical agenda — depression and anxiety get treated while the gambling problem, invisible and unsmelling, goes undetected.
- Ontario's regulated online betting market is already live; Alberta's launches this month — and nearly three in ten Canadians already fear someone they know is addicted to sports betting.
- Researchers point to one fragile thread of hope: patients who sought help on their own terms were more likely to return, suggesting that early recognition and honest clinical screening could change the trajectory.
Marie-Josée Fleury, a McGill University psychiatrist, has spent years watching people with gambling problems move through Quebec's addiction system — or, more often, never return to it. Her team's thirteen-year study of more than 2,300 people diagnosed with gambling disorder found something troubling: despite free access to specialized care, patients averaged fewer than two treatment visits over the entire period. Nearly six in ten who sought help came once and never came back.
Fleury frames gambling disorder the way addiction specialists increasingly do — not as a problem solved in a single session, but as a chronic condition requiring sustained support, much like diabetes or substance-use disorders. The current pattern of sparse, episodic contact suggests most people simply aren't getting what they need.
One finding sharpened the concern: people who gambled online showed roughly 15% higher treatment admission rates than those using traditional venues. Postdoctoral researcher Ovidiu Tatar explained the logic — online platforms remove all friction. A person can act on impulse instantly, through an app, without leaving the couch. That ease appears to accelerate relapse and the need for repeated care.
The research also identified a quieter barrier. Patients with comorbid mental health conditions were more likely to return for multiple treatments — but often for depression or anxiety, not gambling. Clinicians tend to prioritize the more visible disorder. Gambling leaves no smell, no physical trace. Without active screening, the problem can persist undetected for years.
One encouraging signal: patients who sought treatment on their own initiative were more likely to return. Personal motivation matters — but it depends on visibility. It requires doctors asking about gambling, public awareness of the real consequences, and a system robust enough to receive people when they do come forward.
As Ontario's regulated online betting market goes live and Alberta prepares to follow, the McGill study lands as a quiet warning: the infrastructure of care is not keeping pace with the expansion of risk, and the window for prevention may be closing.
Marie-Josée Fleury has spent years watching people with gambling problems cycle through Quebec's addiction treatment system—or, more often, not cycle through it at all. The McGill University psychiatrist and her colleagues at the Douglas Research Centre recently completed a thirteen-year study of more than 2,300 people diagnosed with gambling disorder, and what they found was troubling: despite free access to specialized treatment, patients averaged fewer than two visits to addiction services over the entire span.
The numbers alone suggest a system failing to meet a chronic need. Among those who did seek treatment, about 42 percent returned for multiple admissions. That means the majority—nearly six in ten—came once and didn't come back. Fleury frames gambling disorder the way addiction specialists increasingly do: not as a discrete problem to be solved in a single intervention, but as a condition requiring sustained, long-term care, much like substance-use disorders or diabetes. For some patients, that means years of support. The current pattern of sparse, episodic contact suggests most people aren't getting it.
The research team analyzed provincial health records from addiction treatment centers and cross-referenced them with other healthcare data to understand not just who was using services, but what patterns emerged. One finding stood out: people who gambled online showed about 15 percent higher rates of treatment admission than those who gambled through traditional channels. Ovidiu Tatar, a postdoctoral researcher on the study, explained the mechanism plainly—online platforms remove friction. A person can act on impulse instantly, through an app, without leaving home. That ease of access appears to accelerate the cycle of relapse and the need for repeated treatment.
The timing of this research matters. Online betting is expanding rapidly across Canada. Ontario launched a regulated online gambling market, and Alberta is set to follow in July. Meanwhile, a recent poll from the Angus Reid Institute found that nearly three in ten Canadians worry someone they know may have a sports betting addiction, and 69 percent believe problem gambling will increase as betting options proliferate. The McGill study suggests those concerns are well-founded—and that the treatment infrastructure may not be ready.
The researchers also identified a secondary barrier: people with comorbid mental health conditions were significantly more likely to return for multiple treatments, but not necessarily for gambling. Depression, anxiety, and other psychiatric disorders often take clinical priority. A patient might receive treatment for their mental illness while their gambling problem, less visible and less immediately dangerous in the clinician's view, goes unaddressed. Tatar noted that gambling issues are fundamentally harder to detect than substance use. There's no smell, no physical signs. Without active screening and patient disclosure, the problem can persist unnoticed for years.
One encouraging signal emerged from the data: people who sought treatment on their own initiative were more likely to return. Personal motivation matters. That finding points toward a prevention strategy—encouraging people to recognize the problem early and come forward. But that requires visibility. It requires doctors asking about gambling, not just assuming it's not happening. It requires public awareness that gambling disorder carries real consequences: high suicide risk, severe social disruption, financial ruin. And it requires a treatment system robust enough to handle the people who do show up.
As online betting becomes easier and more normalized, Quebec and other provinces face a choice: invest now in screening, early intervention, and sustained treatment capacity, or manage the consequences later. The McGill study suggests the window for prevention is closing.
Notable Quotes
Gambling disorder often requires sustained, long-term care and should be approached as a chronic condition, comparable to substance-related disorders.— Marie-Josée Fleury, McGill University psychiatry professor
Online gambling makes it easier to act on impulse, which can increase the risk of relapse and repeated treatment.— Ovidiu Tatar, postdoctoral researcher
The Hearth Conversation Another angle on the story
Why would people with free access to treatment use it so rarely? That seems counterintuitive.
Access isn't the only barrier. Many people don't recognize they have a problem, or they're ashamed to admit it. Doctors don't routinely ask about gambling the way they might ask about drinking or drug use. It's invisible.
So it's a screening problem, not a resource problem.
Partly. But it's also that gambling disorder is chronic. People need to come back repeatedly, and most don't. They might come once, feel better temporarily, then relapse alone.
What changes with online gambling?
It removes every obstacle between impulse and action. You're sitting at home, you open an app, you bet. There's no friction, no moment to reconsider. That speed seems to feed the cycle.
And the mental health connection—why does that matter?
When someone has depression and a gambling problem, clinicians treat the depression first. It feels more urgent. But the gambling keeps feeding the cycle, and nobody addresses it.
So what would actually work?
Early identification, sustained follow-up, and treating gambling as seriously as we treat substance addiction. Right now we're doing none of those things well.