Abstract
This study’s results suggest that the potential exists for occupational therapists to use their expertise to help people with gambling problems engage in activities that are meaningful to them.
A person’s everyday activities can be broadly defined as activities of daily living (ADLs), which are often delimited into the categories of basic ADLs (BADLs) and instrumental ADLs (IADLs; James & Pitonyak, 2019). Consistent with occupational therapy theory and practice, the term “occupation” is an act of doing that is perceived as meaningful to the individual, whereas “activity” is an act of doing that may not involve meaning. For the purpose of this article, and for ease of reading, the terms occupation and activity are used interchangeably. Both BADLs and IADLs are types of occupations. BADLs are occupations related to self-care and survival (e.g., personal hygiene, eating), whereas IADLs are occupations that require comparatively higher levels of skill, such as the management of finances and health (American Occupational Therapy Association, 2020).
Living with addiction can shape occupational performance (Menezes & Pereira, 2019; Sy et al., 2021). Addictive behaviors are perceived as meaningful to the person, providing them with a temporal structure and an identity (Wasmuth et al., 2014) through which they organize their day-to-day activities to prioritize engagement in their addiction (Luck & Beagan, 2015). Addiction can create barriers to performing occupations that are unrelated to the addiction and, according to Sy et al. (2021), have been found to affect people’s participation in sleep as well as their eating patterns. These barriers constrain a person’s typical daily activities, a phenomenon linked to lower well- being (Hoxmark et al., 2012) and social isolation (Sy et al., 2021).
Gambling consists of three primary components: (1) the participation in an event of chance, (2) the occurrence of an initial stake (bet), and (3) the potential that this participation will result in reward (Macey & Hamari, 2024). Problem gambling (PG) is an addiction-like behavior characterized by excessive gambling (American Psychiatric Association, 2022; Ferris & Wynne, 2001). The prevalence of PG ranges from 2% to 5% in North America and varies between 0.12% and 5.8% worldwide (Calado & Griffiths 2016). Although most adults who gamble will not develop PG (American Psychiatric Association, 2013), those who experience persistent and recurrent PG behavior may develop gambling disorder, a recognized addiction that can result in significant distress or impairment (American Psychiatric Association, 2022). People with gambling disorder often face severe consequences, including poverty, homelessness, and depression (Hahmann et al., 2021; Matheson et al., 2021; Shaffer & Korn, 2002).
A few studies have indicated a possible relationship between PG and functional disability, defined as difficulty in ADL participation (Ellis et al., 2018; Jacob et al., 2022). For example, the partners of people experiencing PG report taking over household chores, child care, and financial responsibilities, suggesting people experiencing PG neglect their ADLs (Klevan et al., 2019).
People experiencing PG face significant stigma, leading them to hide their behavior, which contributes to feelings of isolation (Miller & Thomas, 2017). Public perception and debate tend to frame those experiencing PG as solely responsible for their situation, with the condition being a result of poor decision-making and character (Hing et al., 2016a; Marko et al., 2022; Miller & Thomas, 2017). Public messaging often reinforces these stereotypes, encouraging those experiencing PG to internalize them (Miller & Thomas, 2017). This internalization, or self-stigma, substantially influences a person’s self-image, contributing to decreased self-worth (Langham et al., 2016; Li et al., 2017) and a diminished sense of self-esteem, self-efficacy, and social worth (Hing et al., 2016a). Given that stigmatization of PG can lead to secrecy and impede help-seeking (Miller & Thomas, 2017), it is important to understand the narratives of these individuals so as to inform clinical practice.
There is a paucity of occupational therapy literature concerning the lived experience of people who demonstrate PG behaviors. Occupational therapists are professionals who assess individuals as holistic beings, identifying areas of occupational deprivation and dysfunction (Amorelli, 2016). They possess the necessary skills to address difficulties with occupations and promote healthy patterns of occupational performance (Thompson, 2007), such as through the use of lecture-based interventions (Ryan et al., 2023). Other forms of occupational therapy intervention related to addiction may include psychoeducational programs (Ryan et al., 2023), the creation of occupational profiles (Kitzinger et al., 2023), and motivational strategies (Doğu & Özkan, 2023), in an attempt to help the person re-engage in lost occupations (Bell et al., 2015). Although occupational therapists’ primary focus is on restoring functional independence through the use of meaningful occupations, a substance-dependent meaningful occupation may come in the form of a detrimental, adverse, and possibly lethal form of activity (Amorelli, 2016). Although a few studies have highlighted PG-related disruptions to daily lives (Jacob et al., 2022; Klevan et al., 2019), little is known about how these disruptions shape ADLs. Therefore, in this study we aimed to use a narrative inquiry approach with thematic analysis to understand how PG shapes a person’s ability to perform ADLs.
Method
Study Design
This study was conducted as a course requirement for a master of science in occupational therapy for two of the authors (Jazmin Carranza and Noelle Fossella). We chose a narrative inquiry design (Gail & Jasna, 2016) to facilitate our understanding of the participants’ everyday experiences and contexts (Caine et al., 2019).
Participants and Recruitment
After receiving ethics approval from the Unity Health Toronto Research Ethics Board (REB 22-263) and the University of Toronto (Protocol 43285), we posted a recruitment flyer with our contact information in online forums, including a Gambler’s Anonymous group on Facebook, GamTalk, and the r/problemgambling forum on Reddit. Participant eligibility criteria included the following: self-identify as experiencing PG, participate in online and/or land gambling, be of legal age to gamble in their region, comfortable interviewing in English, and have access to email. Participants provided verbal informed consent over Zoom before the interview. After the interview, participants received a $10 e-gift card of their choice.
Of the 60 people who responded to the recruitment flyer, 12 participated in this study. Individuals were excluded if they did not meet the inclusion criteria. Moreover, because of the time limitations of this study, the inclusion of any additional participants would not have been realistic. At the conclusion of each interview, we collected sociodemographic information through a questionnaire. We used convenience sampling, in which participants are selected on the basis of convenient accessibility (i.e., online forums), and purposive sampling, in which participants are selected on the basis of the need for expert opinion (i.e., personal experience of PG; Martínez-Mesa et al., 2016).
Data Collection
We conducted 60-min semistructured virtual interviews using Zoom for Healthcare. We uploaded audio recordings to a secure server at Unity Health Toronto and transcribed them verbatim. During the interviews, Carranza and Fossella typically alternated taking the interviewer role, and a research assistant served in an administrative capacity to record and save the audio to a secure server.
Data Sources
The guide for the eight-question semistructured interviews explored participants’ typical daily activities, activities they enjoyed, challenges with activities, gambling involvement, and how gambling may have changed their daily activities. The Problem Gambling Severity Index (PGSI; Ferris & Wynne, 2001) was administered to discriminate between participants with nonproblematic gambling and those categorized as having a low, moderate, or severe risk of PG (Perrot et al., 2022). The PGSI is a self-assessment measure that has good internal consistency (α = .84), adequate test–retest reliability (r = .78), and very good construct validity (Ferris & Wynne, 2001). It consists of nine questions, each of which allows for a score of 0 to 3 (Currie et al., 2013; Perrot et al., 2022), with a respondent needing to receive a score between 8 and 27 to be within the range of PG (Ferris & Wynne, 2001). Sociodemographic information was collected at the end of each interview (Table 1).
Participant Sociodemographic Information
Note. In Canada, college and university are distinct and not used interchangeably. Typically, college is considered to be practical based, as opposed to university which involves theoretical based learning. Additionally, participants were given the choice to select between high school diploma, college, and university.
Data Analysis
Carranza and Fossella conducted a thematic analysis of the data (Braun & Clarke, 2006). Following the six phases outlined by Braun and Clarke (2006), they individually became familiar with the data by transcribing, rereading, and noting ideas before they generated codes and searched for themes. They each generated initial codes for one-half of the transcripts, after which they individually reviewed and created additional codes for the other half. Once the individual review process was complete, they conducted a joint review of the total 248 generated codes, resolving discrepancies through careful deliberation before generating themes together. Together, they reviewed and refined each theme to establish names and definitions (Braun & Clarke, 2006). Throughout, they engaged in reflective discussions about their positionality and used audit trails.
Results
As shown in Table 1, participants’ ages ranged 23 to 32 yr, the majority identified as male, as having a Black identity, as being college or university educated and employed, and with an income ≥CAD$40,000. Eleven identified as African American or African Canadian, and one identified as South Asian. All participants were found to be within the range of PG on the PGSI, as seen in Table 2, with scores ranging between 12 and 20. From the qualitative analysis, we identified four primary themes (11 subthemes) from participant interviews: the activity of gambling, social influence, gambling overtakes all ADLs, and mental health.
PGSI Scores and Average Number of Years Spent Gambling
Note. PGSI = Problem Gambling Severity Index.
The Activity of Gambling
Gambling is a meaningful activity that people engage in with others or alone using online and in-person modalities. The modalities most commonly reported to be engaged in by participants included sports, horse track, and casino betting. The participants, many of whom had been engaged in gambling for up to 10 yr (see Table 2), spoke of how the activity of gambling is a cycle of wins and losses.
A Part of Their Typical Routine
Participants gambled 4 to 7 days/wk, with more time spent gambling on weekends compared with weekdays: “The weekend is more extreme … less … work and more … gambling” (Participant [P]3). Participants often checked their bets immediately upon waking and found that more and more of their time was dedicated to gambling, resulting in neglect of other activities: “I feel like I neglect my family because … the weekends are for families … but on the weekends is when I spend a lot of time in the casinos” (P5). Gambling was a distraction from other activities, with participants frequently checking bets or searching for opportunities to bet: “Gambling distracted me from other activities, because … I’d have to keep on checking … looking for possible opportunities” (P7).
Substance use was commonly part of the routine when gambling: “I started drinking ’cause, that’s a thing between people who gamble and drinking.… When you start gambling, you start drinking … there’s that connection” (P6). Consuming substances occurs before, during, and after gambling. It occurs after wins and especially after losses. “I drink in both cases because after a loss … you drink to just, you want to forget about the loss. But, after the win, you drink to celebrate, so, that’s a bit funny, you drink to celebrate, you drink after a loss, the end results are the same, you’re just drunk” (P6) Participants linked the combination of substance use and gambling to difficulty with ADLs and, as Participant 10 noted, the cause of poor decisions while gambling: I can say maybe … doing drugs and making decisions especially while gambling, maybe like most of the times I go to the casino with my friends we’re usually wasted[,] maybe we had some drinks or [got] high a bit.… I think that mostly … makes me make some choices that really I wouldn’t have made otherwise.
Some participants believed their daily routine was not normal; others felt they themselves were not normal: I experience … a lot of challenges because, basically, [as] a normal human being … you have to provide for your family.… I go to work, but most of the money, I devoted in gambling … so I end up spending less … money on my family. (P5)
Still, the activity of gambling had become a meaningful part of all participants’ daily routines, providing both enjoyment and displeasure.
Enjoyment of and Displeasure With Gambling
Participants described various motivators to continue gambling, including winning a bet, socializing with friends, and financial gain. A few participants described gambling as a “good” or “special kind” of feeling. Displeasure with gambling related to financial losses, gambling alone, losing the bet, and losing against friends. They described feeling “heartbroken” and “down” upon losing a bet. Participant 9 expressed regret for spending long periods of time gambling, and Participant 2 described how feeling addicted affected their enjoyment: “I find that I am addicted to it; I can’t say that I really enjoy doing that.” The relationship between gambling and ADLs was also evident through social influence.
Social Influence
Participants spoke of the social influence they faced, both positive and negative, with respect to their participation and engagement in gambling; specifically, close friends influenced gambling behaviors. Not only did social networks encourage gambling, but also gambling influenced close relationships, primarily those with friends and family.
Friends Play a Key Role in Gambling
Friends introduced participants to gambling—“They’re friends that I found in the, like, they basically introduced me to gambling” (P8)—and, in some cases, pressured them to gamble: “I was pressured daily by a friend … to get involved in it … so that’s how it started” (P12). One of the biggest changes related to gambling that participants identified were the friends they acquired: “The only people you will meet there are people of the same kind, they’re not any good ones.… The best will [encourage] you to follow him one day, even if you don’t want to” (P12). Friends sometimes encouraged participants to place bets: I was introduced to online gambling because … one of those friends that I have right now … saw … I loved soccer … there was this joke that, you love this and … cannot get [onto] a team.… What if you place a bet on the thing you love the most and maybe you might win? (P5)
Participants sought connection and belonging through gambling: You can’t just be somewhere and everyone is doing something, like you want to participate. Even if … the thing is bad or … it doesn’t match your belief, you just want to stay engaged in it.… [You find] yourself continuously doing it. (P12)
Although participants clearly described how others shape their gambling, they also described how gambling shaped their relationships.
Gambling Shaped Relationships
Social networks were highly important, with about half of participants identifying socializing as a meaningful ADL. Whereas some reported socializing with friends and family, others acknowledged that gambling filled time previously spent socializing: “I would spend much time with my family.… That’s what it was like before gambling” (P3). Five participants reported that their friend network completely changed after they began gambling: “I used to have different type of friends, like, they were just grounded, not like these ones that I have right now” (P5). Participants frequently reported that the length and type of interactions with friends and family changed after they began gambling. Gambling could cause contention, “when you realize you’re going to lose a close friend … due to the disputes that arise in terms of gambling” (P3). Others noted that the lack of time to socialize with family affected their relationships: I neglect my family … my brothers, I can’t remember the last time that we talked.… I can’t remember the last time that I [visited] my mother. But I can vividly remember the last time I was in a casino.… I can remember the last time that I saw my friends, I can remember the last time that I placed a bet. (P5)
Family members could be supportive, “I started seeing this therapist … recommended to me by my sister, yeah, she saw … I’m losing a lot of money and time” (P2), or unsupportive: My sister, my mother … they know that I’m into gambling so sometimes I … shy off from meeting them because … they just cancel me out.… That’s what makes it difficult for me … to go and visit them, apart from me not having that time. (P8)
Half of the participants reported issues maintaining social relationships with friends, romantic partners, and family because of gambling. Relationships that were not lost were primarily described as “distant” and “awkward” because they spent less time socializing with them in order to gamble: “Certain interactions with people [are] not quite the same” (P3). This loss could be worrisome, as Participant 3 described: “You … sit down without gambling and … realize that you lost some people.… It sometimes invokes a fear that those might be the last people that you are counting on.”
Overall, participants found that the relationships they had with the people around them shaped, or were shaped by, their gambling and that gambling became a priority over other ADLs.
Gambling Overtakes All ADLs
For most participants, gambling behaviors overtook all ADLs, changing and challenging their ADL participation. Although some noted that they maintained participation in meaningful ADLs, others reported that none of their ADLs remained the same after they began gambling. Similarly, participants described how gambling was a distraction from fully engaging in non-gambling–related ADLs, especially after a gambling loss.
Time Management
A few participants said they organized their schedule to gamble without significantly interfering with non-gambling activities, and all spoke of challenges related to participating in ADLs because of time spent on gambling. For example, as Participant 2 explained, planned ADLs were dismissed when the opportunity to gamble is presented: “The main agenda is that we want to … have an experience of life, but we just find that, when we go to these places, we discover a casino.”
Participants noted that gambling adversely affected their lives by leading them to allocate more time to gambling than other ADLs: “Gambling has changed my life.… I … put a lot of my focus and my time into it, and it’s made me become more distant with the activities than I was” (P7). Many participants highlighted the loss of time for family-related ADLs: The biggest change, and it affects me always, is … I used to hang a lot with my family … spending … lots of time together; like, this thing has robbed me of my time. I spend a lot of time in the casinos.… I haven’t seen my mother in many years.… We just communicate through the phone.… I haven’t talked to my brother for like, six months. (P5)
Some participants described being unaware of time passing while gambling, which occasionally caused them to miss scheduled ADLs. Even the accomplishment of long-term goals, Participant 8 reflected, were hindered by gambling. Yet the lack of time to participate in non-gambling activities was noted by participants to be just one of the issues they faced in relation to engaging in ADLs because of gambling.
Loss of Energy
About half the participants spoke of gambling-related energy loss that made it difficult to engage in ADLs: “When it’s late, I come back home, like, I’m tired, maybe I do some cooking sometimes, sometimes I don’t” (P6). Gambling-related activities (e.g., partying) exacerbated this energy loss: You’re too exhausted.… You not just gambled but even ended up maybe … partying with friends and you know sometimes drinking with friends and … you know, the morning-like stuff, like you can’t even do anything. (P3)
Similarly, participants also spoke of a loss of motivation to engage in non-gambling ADLs.
Loss of Motivation
Issues completing ADLs were frequently linked to a loss of motivation, especially after a gambling loss: “When you remember … you … feel like not doing anything” (P10). It was especially impactful for leisure- and productivity-based ADLs: If I have placed a bet … before I go to work … then … I have lost a lot of money. When I start working, I will be discouraged.… I won’t be that productive in my work. (P2)
Participants often described their low mood after a loss as the driving force behind their lack of motivation: “My moods are very low.… I tend to find it difficult to engage in swimming[,] and it is no longer fun after losing a bet” (P11). This loss of motivation, in combination with other factors, can lead to vocational challenges related to lost productivity and interest in leisure activities that were previously enjoyable.
Vocational Challenges
Gambling was linked to a loss of work productivity. Approximately half the participants spoke of missing work and a lack of time, concentration, and motivation to spend on work tasks: “Gambling has made me, like, a bit unproductive.… There are the things that I have to do” (P2). Similarly, they spoke about changing the type and amount of work they did to continue gambling. Participant 12 noted that their use of substances and gambling resulted in loss of employment: “due to the way I waste when I gamble.… I can even take the weeks of leaving my work just to go to gamble if I have a little cash on me … I have [now] … lost my job.”
Although not necessarily linked to their vocational challenges, participants also described how their gambling activity shaped their financial management.
Financial Management
One-quarter of participants reported allocating money toward gambling rather than other ADLs. Participants also spoke of the financial loss they experienced with gambling, including aspects of homelessness and taking out loans to continue gambling. Participant 12 remarked that “any little money which you have you want to use it to go gamble.” To continue gambling, a few participants stole money from their family: “I can even go to the extent of stealing my mom’s money just to make sure that … I make some bets” (P12). Moreover, the financial loss from gambling made it difficult to save money and participate in other ADLs: I’m not earning a lot of money, and a lot of my finances go into betting so, um, most of the time I go bankrupt because I don’t have enough money to spend on myself.… I have a limited number of activities that I can do. (P11)
On the other hand, gambling was also considered a source of financial gain and a way to finance non-gambling ADLs: “I focus on quick money.… I want to double this money that I have 1,000, I want to get 2,000, have this 10,000.… So, when I gamble, I just want this quick success” (P5). Thus, participants’ ability to engage in financial management was shaped by their quick gains and losses through gambling. As PG overtook non-gambling–related ADLs, molding participants’ lives, they described a cyclical relationship whereby their gambling activities affected their mental health, and in turn their mental health affected their non-gambling–related ADLs.
Mental Health
Although participants often experienced gambling as an enjoyable ADL, it could also come to dominate all other ADLs and considerably change their social networks. Participants spoke of how PG shaped their mental health, which led to challenges in their ability to participate and engage in non-gambling–related ADLs.
Psychological Distress
Many participants spoke about how the ADLs they identified as meaningful were also a means of alleviating feelings of psychological distress caused by gambling activities. After a gambling loss, participants would ruminate on the loss, how they could have invested the money elsewhere and wondered “why, why, why, why am I doing [this?]” (P12). As described in the “Gambling Overtakes All ADLs” section, participants reported physically taking in their activities without mentally engaging. Although such mental dissociation can occur with the desire to be engaging in gambling activities, it also occurs when participants thought of their gambling activities in a negative light. Participant 10 described how gambling-related psychological distress affected his ability to engage at work: At times maybe I can go like to work with a sick feeling … I don’t feel like doing a lot and … it’s my dad’s workshop so maybe like when I’m not feeling myself … sometimes I can go to work and just stay there … half the day doing like … not [doing] anything constructive.… Sometimes it just affects how you feel and how you do your activities.
Participants further described how experiencing psychological distress regarding monetary loss from gambling activities can hinder meaningful engagement in valued ADLs, as Participant 2 explained: Losing money paralyzes me, paralyzes my activity. Losing money, being charted to the wrong directions, that just scares me.… Traveling, you need cash … so, like, losing money, it paralyzes, it paralyzes me, paralyzes my activities, like, I want to travel on the weekends, just go out and feel the fresh air. It just paralyzes me.
Even when taking part in their valued activities, participants continued to experience psychological distress in anticipation of financial losses due to gambling. Now, even when I’m traveling, I have to worry about my finances because I know that where I’m going I’m going to use a lot of money. Because I know these boys, they just take us to the casinos, the gambling spots. (P2)
Sleep is an essential ADL for everyone; inadequate sleep is detrimental to one’s mental health. A few participants noted gambling-related sleep problems caused by lack of time and anxiety. You [have] a lot of things on your mind, you won’t have some good rest.… there might be some nights … you’re thinking about life.… You will search for sleep the whole night and you will find that you won’t. (P12)
Many participants spoke about feelings of self-blame and negative self-image because of their gambling activities, and one participant spoke of how these negative self-perceptions prevented them from re-engaging in ADLs in which they had previously participated: [You’re] having a good name, you’ve been a good person[,] and all of a sudden everyone is seeing you as a different person, you know, everyone sees you as a … some kind of street dog or something[,] but that wasn’t how it was.… So, the other thing is, back then … I do [activities] and I’m not doing them now and sometimes I wish if I could but … I feel that this is [it], I can’t go back any longer, you know. So, you just have this kind of bitterness in your heart and it makes you feel depressed. (P12)
Such common instances of psychological distress among participants had led some of them to seek ways of coping through activity, such as reading and exercise.
Ways of Coping
About one-quarter of the participants mentioned using coping strategies related to completing ADLs. A few used distraction to cope: “I tend to read novels because they separate me from the reality world into the fantasy world, which is very accommodating at that time after losing a bet” (P11). Seven participants dissociated from reality and themselves to cope, often identifying this as a meaningful ADL: “Even after it [comes to your] mind, just the fact that you’re [feeling] enjoyment, you want to leave the serious thoughts that you have waiting for you just to satisfy yourself” (P12). Others used alcohol to cope with gambling-related stress. I’d say, drinking … to cope with stress … after a big loss … ’cause I want to disconnect from reality ’cause I lost the little amount of money that I had[,] so I drink as a form of coping with my emotions. (P11)
Three participants used physical exercise to manage their gambling-related stress: “I do love going to the gym because … my frustrations[,] I can, I channel them” (P8). Additional coping mechanisms identified by participants included movies, yoga, discipline, positive self-talk, talking with family, socializing with friends, gaming, reading, and mindfulness. Three participants sought assistance from a health care professional: “I have been going to a therapist.… It’s gradual but I can feel a difference … talking to someone, opening up … to like, avoid this addiction … of any kind, to talk to someone” (P2).
Whereas some participants reported the use of strategies as helpful in managing challenges, others reported multiple attempts to use strategies without success. I tried following the schedule. Like, even if I’m betting, I would do this in this time … and this amount of money.… I just followed it two days and I was back to default.… I can say I tried planning on my time but … I failed myself and I failed my family. (P5)
Discussion
The primary aim of this study was to explore the lived experiences of people with PG and how PG shapes their ability to engage in ADLs. Participants shared how their gambling ultimately changed their relationships with close others and how their psychological distress interfered with ADL participation and engagement. Nearly all participants indicated that psychological distress hindered their occupational engagement. Participants also indicated that mental health problems from PG affected their occupational performance.
Research suggests that continued participation in gambling is correlated with involvement in relationships with others who gamble, which normalizes gambling behaviors and harms (Russell et al., 2018) and is a risk factor for PG (Williams et al., 2023). Accordingly, the social influence experienced by participants in this study likely contributed to their continued gambling behaviors. Stigma associated with PG presents a barrier to help-seeking and treatment (Hing et al., 2016b) and can adversely affect racial-ethnic minority, youth, and male populations (Clement et al., 2015). Normalization of harms associated with PG, as well as self- and societal stigmatization, may work to reduce help-seeking behavior.
Occupational balance, a concept advocated for by occupational therapists (Yazdani et al., 2018), is defined as the right amount of, and variation between, occupations as subjectively perceived by a person (Wagman et al., 2012). Eklund et al. (2017) suggested that to achieve balance, the right mix of occupations, resources, and ability to manage one’s occupations, as well as engaging in meaningful occupations, is important. Occupational balance provides structure to daily life and is linked to better well-being, happiness, health, satisfaction, and quality of life (Yazdani et al., 2018). Conversely, occupational imbalance is associated with an absence of daily life structure, significant stress on the mind and body, poor mental health, and negative consequences for quality of life (Sangster Jokić & Jokić-Begić, 2022; Yazdani et al., 2018). Our findings indicate that the study participants were likely experiencing occupational imbalance because they all reported considerable issues engaging in non-gambling ADLs, such as leisure and self-care activities, because of PG. Ryan et al. (2023) suggested that decreased participation in health-promoting activities leads to occupational imbalances. Thus, it is likely that gambling-related occupational imbalances contributed to participants’ described psychological distress.
Our findings supplement the literature addressing how PG disrupts daily life. Although it is known that people experiencing PG demonstrate functional disability (Jacob et al., 2022) and difficulty participating in ADLs (Klevan et al., 2019), research describing the lived experiences of these persons has been limited. We addressed this gap by using narrative inquiry and thematic analysis to identify common themes among our participants, including how gambling overtook other ADLs, the social influence of gambling, and mental health.
The literature has discussed how occupation-focused psychoeducational programs for addiction may improve occupational balance by helping people re-engage in self-care and leisure activities (Ryan et al., 2023). With the help of occupational profiles, occupational therapists can assess the habits and routines of people with addictions, working with them to determine whether their behaviors act as facilitators of or barriers to recovery (Kitzinger et al., 2023). Evidence-based occupational therapy interventions specific to substance use include motivational strategies, cognitive–behavioral therapy, goal-setting, and 12-step recovery programs (Doğu & Özkan, 2023). Other occupational therapy interventions with roots in substance use recovery include skill training and leisure exploration strategies to restore and maintain previously lost roles (Bell et al., 2015). The recovery of meaningful roles was found to be a significant motivator for abstinence by people who were reintegrating into the community (Bell et al., 2015). Although these studies are specific to substance use recovery, there is potential for such occupational therapy interventions to be an effective approach to PG recovery given that participants in our study highlighted the loss of meaningful occupations in which they had previously engaged. However, further research is warranted to determine whether these occupational therapy interventions are effective with this population or if a new approach is necessary.
It is important to note that our study has some limitations. First, our sample lacked diversity in both gender and racial identity, which may affect the extent to which our findings represent the population of people experiencing PG. These disparities may be explained in part by current PG statistics, which indicate that men are at a higher risk of experiencing PG (Rotermann & Gilmour, 2022). Second, although Black Canadians are just as likely as White Canadians to gamble (Rotermann & Gilmour, 2022), the frequency with which they use online forums—our primary recruitment source—could differ between racial-ethnic groups. Third, we lack an understanding of the context of participants’ social environments, including cultural beliefs and views, which can influence occupational values and how people cope with issues related to PG. Finally, there was an age disparity in our participants, which limits our findings with respect to differences in ADLs and PG across the life course. It would be beneficial for future research to seek to understand the relationship between PG and ADLs for people under the legal gambling age, in the middle of their life span, and older adults who have retired. Although our sample was small, this study provides a unique look into how gambling affects people’s ADLs.
Implications for Occupational Therapy Practice
Occupational therapists are well positioned to help people with addictive behaviors by providing life skills and education and advocating on their behalf for program development. Our study may provide additional insights into explaining how occupational therapists can be involved in supporting those with PG. This study has the following implications for occupational therapy practice: ▪ Occupational therapy interventions can be used to restore occupational balance in people experiencing imbalances with respect to their ADL participation. ▪ Interventions can be reframed through an occupational therapy lens so that they are specific to addiction behaviors. ▪ Education about the valuable role that occupational therapy can play in helping people who are experiencing PG can be advanced.
Conclusion
In this article, we have highlighted the voice of people experiencing PG, who spoke about their mental health as it relates to gambling activities and how these activities ultimately came to overshadow non-gambling ADLs. Participants described how their social networks influenced the start of gambling and how their close relationships irrevocably changed. These findings suggest an occupational imbalance in this population that is contributing to psychological distress. Because occupational therapists play an important role in addiction, further research is warranted to explore whether current addiction interventions are appropriate or if a new approach is needed to address PG.
Footnotes
Acknowledgments
The work was supported by the Master of Science in Occupational Therapy program at the University of Toronto, Toronto, Ontario, Canada, and the MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada.
We thank both Madison Ford and Shahroze Zafar for their on-going assistance and support. We are grateful to the participants, who openly shared their experiences of gambling. In addition, we honor and thank the traditional land of the Huron-Wendant, the Seneca, and the Mississaugas of the Credit First Nation, where this research was conducted.