Gambling disorder cannot be resolved in a single treatment.
Across Quebec, a thirteen-year study has quietly documented a paradox at the heart of public health: free, specialized care for gambling disorder exists, yet the people who need it most rarely return for more than a single visit. Researchers at McGill University followed over 2,300 patients and found that the disorder—one that hides without visible symptoms and carries a genuine risk of suicide—remains largely unseen by a system that has not yet learned to look for it. As online betting expands across Canada and the threshold for placing a wager shrinks to a tap on a screen, the distance between available care and those suffering grows wider, not narrower.
- A thirteen-year study found that gambling disorder patients in Quebec averaged fewer than two treatment visits despite services being entirely free—a sign that cost is not the barrier.
- The disorder conceals itself: no physical symptoms, no standard screening, and patients who rarely disclose the problem mean years can pass before anyone in the healthcare system notices.
- Online gambling is accelerating the crisis—users show 15% higher treatment admission rates, suggesting that frictionless, app-based betting intensifies the cycle of relapse and help-seeking.
- Nearly 3 in 10 Canadians already worry someone they know has a sports betting problem, even as Alberta prepares to launch a new regulated online market following Ontario's lead.
- Researchers are calling for gambling disorder to be managed as a chronic condition—like substance addiction—rather than a one-time clinical encounter, given its links to suicide and financial ruin.
Marie-Josée Fleury, a psychiatry professor at McGill University, has spent years watching a healthcare system fail to reach people it technically serves. Her thirteen-year study of more than 2,300 Quebecers with gambling disorder, published in the Journal of Gambling Studies, found that despite free specialized treatment, patients averaged fewer than two visits over the entire study period. Only 42 percent of those who sought care returned for additional sessions.
The research, conducted with colleagues at the Douglas Research Center, drew on health records from addiction treatment centers across Quebec, cross-referenced with provincial data to trace how patients moved—or didn't—through the system. What emerged was a portrait of profound underuse, one that points to barriers far more complex than access or cost.
Gambling disorder is uniquely invisible. Unlike substance addiction, it leaves no physical trace. Patients often carry competing diagnoses—depression, anxiety, substance use—that overshadow the gambling entirely. Clinicians rarely screen for it, and patients rarely volunteer the information. Postdoctoral researcher Ovidiu Tatar noted that years can pass before the problem surfaces at all. One meaningful exception: patients who sought treatment on their own initiative were significantly more likely to return, underscoring how much motivation shapes outcomes.
Online gambling adds another dimension. Those who gambled digitally showed 15 percent higher treatment admission rates—a reflection of how easily apps and websites convert impulse into action, and how readily that cycle drives people back toward help. The finding arrives at a fraught moment: Alberta is preparing to launch a regulated online betting market, and a recent Angus Reid poll found that nearly 3 in 10 Canadians worry someone they know may already have a sports betting problem.
Fleury's conclusion is direct: gambling disorder must be treated as a chronic condition requiring sustained management, not a single clinical encounter. The suicide risk is real, the social and financial consequences severe. Yet the system continues to treat it as something people will address if they happen to find their way to a clinic door—leaving the gap between available care and those who need it quietly, steadily wider.
Marie-Josée Fleury has spent years watching people struggle with something the healthcare system barely acknowledges. A professor of psychiatry at McGill University, she recently completed a thirteen-year study of more than 2,300 Quebecers with gambling disorder—and what she found is troubling: despite free access to specialized treatment, these patients averaged fewer than two visits over the entire span. The research, published in the Journal of Gambling Studies, reveals a system that exists on paper but fails to reach the people who need it most.
The study itself was methodical. Fleury and her team at the Douglas Research Center combed through health records from addiction treatment centers across Quebec, then cross-referenced them with provincial health data to track how patients moved through the system and what patterns emerged. What became clear was a picture of underuse so pronounced it suggested something deeper than simple inconvenience. Among those who did seek treatment, about 42 percent returned for additional sessions—a figure that hints at the chronic nature of the disorder. But the majority never came back at all.
The reasons are layered. People with gambling disorder often carry other diagnoses—depression, anxiety, substance use—and those competing health crises can eclipse the gambling problem entirely. A patient might show up for treatment of their mental illness and never mention the betting, or mention it only in passing. Doctors, for their part, don't always ask. Gambling addiction lacks the visible markers of substance abuse. There are no track marks, no slurred speech, no obvious physical deterioration. It hides. Ovidiu Tatar, a postdoctoral researcher on the project, noted that many people never disclose their gambling at all, and without screening protocols in place, years can pass before anyone realizes there's a problem.
One pattern did stand out: those who sought treatment on their own initiative were significantly more likely to return. Motivation matters. So does the form the addiction takes. People who gambled online showed about 15 percent higher rates of treatment admission than others—a finding that makes sense given how the technology works. An app on your phone, a website open in a browser, the ability to place a bet in seconds on a sporting event: these remove friction from impulse. They make relapse easier, and relapse drives people back to treatment.
The timing of this research is not incidental. Online gambling is booming across Canada. Alberta is preparing to launch a regulated online betting market, following Ontario's lead. Apps and websites have made wagering as accessible as checking email. A recent poll from the Angus Reid Institute found that nearly 3 in 10 Canadians worry someone they know may have a sports betting problem, and 69 percent believe problem gambling will worsen as betting options proliferate.
Fleury is clear about what needs to change. Gambling disorder cannot be treated as an acute condition—something you fix in one session and move on. It requires the same sustained, long-term approach used for substance-related disorders, the same recognition that some patients will need chronic disease management. The stakes are high. Gambling disorder carries a significant risk of suicide and cascades into social and financial ruin. Yet the system treats it as optional, as something people can address if they happen to walk through a clinic door.
The gap between what exists and what's needed is widening. As online betting becomes more normalized and more accessible, the people struggling with it remain largely invisible to the healthcare system—not because treatment isn't free, but because the system itself hasn't learned to see them.
Citas Notables
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
La Conversación del Hearth Otra perspectiva de la historia
Why would someone with free access to treatment use it so rarely? That seems counterintuitive.
Because access isn't the same as reach. The services exist, but people don't know about them, don't recognize their own problem, or are too ashamed to walk through the door. And doctors aren't trained to ask.
So it's a visibility problem.
Partly. But it's also that gambling doesn't look like addiction the way heroin does. There's no physical crisis that forces someone to seek help. You can hide it for years.
The study found online gamblers return for treatment more often. Why would that be?
Because online betting is frictionless. You can act on an impulse instantly, from anywhere. That makes relapse faster and more frequent, which pushes people back into treatment. It's almost like the technology itself creates a cycle.
And the people with mental health conditions—why are they more likely to return?
Because they're already in the system for something else. They have a relationship with a doctor or clinic. But that doesn't mean the gambling gets addressed—it often gets buried under the other diagnosis.
So the real problem is that gambling disorder isn't being treated as a chronic illness.
Exactly. It's being treated as something you fix once, if you fix it at all. But for many people, it's lifelong. It needs the same sustained care we give to diabetes or depression.