Nigel E Turner

• Ph.D
• Centre for Addiction and Mental Health

Background The aim of this paper is to provide a system‐level snapshot of the operational status of mental health, substance use, and problem gambling services 2 years into the pandemic in Ontario, Canada, with a specific focus on services that target individuals experiencing vulnerable circumstances (e.g., homelessness and legal issues). Methods...

In this paper we examine the nature of calls for the Ontario Problem Gambling Helpline from June 2021 to Jan 2023 to determine if the increased marketing of online and sports gambling has changed the nature of calls to the helpline. An interrupted time series model comparing the monthly calls before and after the expansion of online gambling and ad...

There has been increasing interest in problem Internet use in the past five years, particularly in the areas of video gaming and screen use. Social cognitive approaches to prevention are more common than those that target multiple stakeholder groups and take into consideration the geopolitical-cultural aspect of the problem behavior. Additionally,...

This paper examines the items of two scales, the Random Events Knowledge Test (REKT) and the Chance Test, and examines their relationship with problem gambling (N = 1375). Using exploratory and confirmatory factor analysis, the REKT was broken down into four sub-scales: Due to Win, Counterintuitive Nature of random chance, Odds Do Not Improve, and...

Voluntary self-exclusion programs allow gamblers to voluntarily be denied access to gambling venues for an agreed upon period. Many people who self-exclude decide to return to gambling venues after the exclusion period has ended, however people who reinstate may be at risk for the recurrence of gambling problems. This study was designed to determin...

A cross-validation of the factor structure of the Centre for Addiction and Mental Health Inventory of Gambling Situations (CAMH-IGS) is described. The CAMH-IGS is based on a cognitive-behavioural approach and is intended for use in treatment planning to help therapists determine the patterns of behaviour, thoughts or feelings which may trigger prob...

Problem gambling and gambling disorder are serious public health issues that disproportionately affect persons experiencing poverty, homelessness, and multi-morbidity. Several barriers to service access contribute to low rates of formal treatment-seeking for problem gambling compared with treatments for other addictions. Given these challenges to t...

The prevalence of problem gambling in the correctional system is about 10 times higher than in the general population, but programming for gambling problems in the correctional system is scarce. Examined barriers to treatment for problem gamblers in the correctional system, sex or gender differences, and options for program design. We conducted int...

Recognition of ADHD in the adult population is relatively recent. Epidemiological research examining the mental health impact of ADHD in adulthood is thus limited. The objective of this study was to examine whether adult ADHD symptoms are associated with psychological distress, hazardous drinking, and problem gambling, after controlling for traumat...

Purpose of Review The purpose of this review was to identify possible sources of bias in the study of gambling among older adults. These sources of bias included social desirability bias including issues of increased stigmatization of gambling behaviors in older adults, recall bias including deficits in the recall of negative experiences, and selec...

There is growing evidence of correlations between the amount of time spent using electronic devices in leisure and negative health outcomes. However, studies often lack indicators of problematic technology use, rarely investigate relationships between such problem use patterns and indicators of poor mental health, and use samples that are unreprese...

Objective The objective of the current research was to examine the association between time spent on social media and serious psychological distress between 2013 and 2017, a period when the rates of both were trending upward. Methods The current study analyzed population-based data from 3 waves of the Ontario Student Drug Use and Health Survey ( N...

Internet gambling has become a popular activity among some youth. Vulnerable youth may be particularly at risk due to limited harm reduction and enforcement measures. This article explores age restrictions and other harm reduction measures relating to youth and young adult online gambling. A systematic rapid review was conducted by searching eight...

As new types of problematic behaviors and new forms of online risk-taking emerge, forming collaborative relationships while understanding complexities of motivations may help to promote harm reduction and intervention. While it may be too early to form a stakeholder framework without first conceptually understanding the problematic behaviors involv...

Traumatic brain injury (TBI) is characterized by a change in brain function after an external force or sudden movement to the head. TBI is associated with risk-taking, impulsivity, psychological distress, substance abuse, and violent crime. Previous studies have also linked problem gambling to TBI, but these studies have not controlled for possible...

Griffiths and Pontes (2019) outlined a need for the video gaming industry to take responsibility in gamer protection in their paper titled, “The future of gaming disorder research and player protection: What role should the video gaming industry and researchers play?” To that end, they call for researchers to consider collaboration with the video g...

Background Although Internet-based interventions (IBIs) have been around for two decades, uptake has been slow. Increasing the acceptability of IBIs among end users may increase uptake. In this study, we explored the factors that shape acceptability of IBIs for problem gambling from the perspective of clients and clinicians. Findings from this qual...

Background: Although Internet-based interventions (IBIs) have been around for two decades, uptake has been slow. Increasing the acceptability of IBIs among end users may increase uptake. In this study, we explored the factors that shape acceptability of IBIs for problem gambling from the perspective of clients and clinicians. Findings from this qu...

The increasing popularity of gambling as a leisure activity among older adults (+ 55) coupled with the rapid aging of the population makes it increasingly important to understand what divides problem and non-problem gambling for this age group. This study investigated the association of different types of motivations to visit a gambling venue with...

Although Internet-based interventions (IBIs) have been around for two decades, uptake has been slow. Increasing the acceptability of IBIs among end users may increase uptake. In this study, we explored the factors that shape acceptability of IBIs for problem gambling from the perspective of clients and clinicians. Findings from this qualitative stu...

Background Although Internet-based interventions (IBIs) have been around for two decades, uptake has been slow. Increasing the acceptability of IBIs among end users may increase uptake. In this study, we explored the factors that shape acceptability of IBIs for problem gambling from the perspective of clients and clinicians. Findings from this qual...

The purpose of this paper is to explore the differences in adolescent problem video gaming in a large urban area (Toronto) compared to a non-urban region of Ontario (Northern Ontario). The results of this study showed that 76.6% of adolescents in the urban region and 80.3% of adolescents in the non-urban region played video games in the past year (...

This paper offers a cursory account of the use of technology and online services by 12-Step peer support groups with a particular focus on support services for problem gamblers. We examine the history of peer support groups and examine the extent to which they have embraced newer technologies. Gamblers Anonymous (GA) has little direct involvement i...

Currently, a full appreciation of how problem gaming impacts the daily lives of gamers is lacking. This study aims to gain a more holistic understanding of the activities in the daily lives of problem gamers; particularly, what is important to them, what motivates gaming, and what supports/constraints engagement in other life activities. Semi-struc...

Traumatic brain injury (TBI) is a common injury characterized by a change in brain function after an external blow to the head and is associated with substance abuse, psychological distress, risk-taking, and impulsivity. Convenience and clinical samples have also linked TBI to problem gambling, but have not ruled out confounding variables such as h...

Background With the proliferation of social casino games (SCGs) online, which offer the opportunity to gamble without monetary gains and losses, comes a growing concern regarding the effects of these unregulated games on public health, particularly among adolescents. However, given the limited research pertaining to SCG use, little is currently kno...

The purpose of this research and development project was to describe the complete gambling experience and to develop best practices for the prevention of problem gambling among older adults (55 years and over) in Ontario. The challenging task of developing best practices involved integrated research and development, as well as knowledge translation...

This study examined the rate of gambling problems among Ontario older adults at gambling venues. Herein we describe an intercept survey that took place at casinos and horse racing tracks with slot machines or other forms of casino games (racinos) in southwestern Ontario, Canada. This method provided a significant opportunity to obtain a large sampl...

As the proportion of Canadians over the age of 55 continues to rise, it accordingly becomes increasingly important to understand the implications that their leisure activities have for their physical and mental health. Gambling is a form of leisure that presents relatively high risk for its participants and remains a popular leisure pursuit among o...

Gambling is a popular leisure activity for older adults (55+), and existing research suggests that overall older adults are less prone to problem gambling compared to younger cohorts. People born after World War II are now beginning to reach retirement age. The purpose of this article was to explore age-related cohort differences between people bor...

RÉSUMÉ Les personnes âgées constituent, en proportion, la population la plus importante parmi les joueurs (Ontario Lottery and Gaming Corporation [OLG], 2012). Les joueurs célibataires seraient plus isolés socialement et solitaires (Dykstra & de Jong Gierveld, 2004), et plus susceptibles de s’engager dans le jeu, présentant ainsi des risques accrus...

The use of mindfulness meditation (MM) in the treatment of problem gambling (PG), has been used effectively for over five years. However, the neural mechanisms responsible for the improvements are unknown. The literature describes healthy individuals with an increase in alpha power and a decrease in alpha frequency after eight weeks of mindfulness...

This paper reports on the cross validation of the Gambling Problem Severity Subscale of the Canadian Adolescent Gambling Index (CAGI/GPSS). The CAGI/GPSS was included in a large school based drug use and health survey conducted in 2015. Data from students in grades 9–12 (ages 13–20 years) derived from the (N = 3369 students). The CAGI/GPSS produced...

We greatly appreciate the care and thought that is evident in the ten commentaries that discuss our debate paper, the majority of which argued in favor of a formalized ICD-11 gaming disorder. We agree that there are some people whose play of video games is related to life problems. We believe that understanding this population and the nature and se...

We greatly appreciate the care and thought that is evident in the ten commentaries that discuss our debate paper, the majority of which argued in favor of a formalized ICD-11 gaming disorder. We agree that there are some people whose play of video games isrelated to life problems. We believe that understanding this population and the nature and sev...

This paper describes the pilot evaluation of an Internet-based intervention, designed to teach counselors and problem gamblers about how electronic gambling machines (EGMs) work. This study evaluated the tutorial using assessment tools, such as rating scales and test of knowledge about EGMs and random chance. The study results are based on a number...

Background This study seeks to give an overview of academic research on internet-based interventions that are used to address problem gambling. The rate of treatment seeking has been demonstrated to be low across several research environments. This is in part because of the systemic barriers that treatment seekers face to accessing traditional face...

BACKGROUND This study seeks to give an overview of academic research on internet-based interventions that are used to address problem gambling. The rate of treatment seeking has been demonstrated to be low across several research environments. This is in part because of the systemic barriers that treatment seekers face to accessing traditional face...

The prevalence rates of problem gambling in the adult correctional population are 5 to 10 times higher than those found in the general population. Yet little has been published about dealing with problem gamblers in correctional settings. We conducted a literature review and interviewed 16 key informants who provide services to clients experiencing...

Past research has shown that treatment services for problem gambling are being underutilized in Ontario, especially by women. Our pilot study involves the development of a Tutorial Workbook (TW) designed specifically to address the special issues and treatment needs of women who gamble and develop consequent problems. Investigators tested the effec...

Past research has shown that treatment services for problem gambling are being underutilized in Ontario, especially by women. Our pilot study involves the development of a Tutorial Workbook (TW) designed specifically to address the special issues and treatment needs of women who gamble and develop consequent problems. Investigators tested the effec...

Background and aims: Little research has examined the relationship between incentives used by gambling venues to attract customers and the experience of gambling related harm. Organized and subsidized bus tours are a common example of such incentives. The aim of this study was to examine whether bus tour patronage was associated with increased odd...

Background: With the development of new gambling technology, and increased internet accessibility, online gambling has rapidly emerged as a new gambling market. Governments in numerous jurisdictions have moved to legalize online gambling, yet little is known about the impact of online gambling availability particularly for adolescents. To date, few...

Introduction Self-efficacy is the belief or personal confidence related to the own ability to perform a specific action necessary to obtain a certain result. Its use refers to the application of validated instruments. Aims Describe the process of cross-cultural adaptation of the drug-taking confidence Questionnaire (DTCQ-8) drugs’ version and to v...

This study’s aim was to identify characteristics with higher odds of distinguishing a group of pathological gamblers (PG) from (1) a group of gamblers without a gambling problem (NP) and 2) a sub-clinical group (SP). An additional aim was to investigate those characteristics as risk/protective factors along the continuum of problemgambling severity...

Objective: This paper describes the patterns of self-reported driving under the influence of alcohol (DUIA) and driving under the influence of cannabis (DUIC) among licenced Ontario students in 2009, and examines their associations with graduated licencing, risk taking, and substance use problems for understanding DUIA and DUIC behaviours. Ontario'...

Given the preponderance of Gamblers Anonymous (GA), there has been relatively little effort to explore the existing evidence base on its effectiveness as a recovery approach for problem gambling. To remedy this gap in the literature we conducted a scoping review of the literature on mutual aid for individuals experiencing problem gambling published...

While the past decades have seen a dramatic increase in the number of women who gamble and develop consequent problems, treatment services are being underutilized in Ontario. This pilot study explores the feasibility of using web- and phone-based group interventions to expand services available for women who might not otherwise seek or be able to a...

As older adults continue to make up a greater proportion of the Canadian population, it becomes more important to understand the implications that their leisure activities have for their physical and mental health. Gambling, in particular, is a form of leisure that is becoming more widely available and has important implications for the mental heal...

The DSM-5 was published in 2013 and it included two substantive revisions for gambling disorder (GD). These changes are the reduction in the threshold from five to four criteria and elimination of the illegal activities criterion. The purpose of this study was to twofold. First, to assess the reliability, validity and classification accuracy of the...

Background: Predicting time to relapse provides an opportunity for the development of relapse prevention interventions in drug users. Objectives: The aim of the present study was to describe the development of the Persian version of the 9-item Time to Relapse Questionnaire (TRQ) and to evaluate its psychometric properties in an Iranian sample of...

Background The Drug-Taking Confidence Questionnaire evaluates a drug user’s confidence in his or her ability to resist the urge to consume psychoactive substances in high-risk situations. This study’s objective was to develop a cross-cultural adaptation of the eight-item version of the Drug-Taking Confidence Questionnaire (DTCQ-8) for all drugs exc...

Background With the rapid proliferation of new gambling technology and online gambling opportunities, there is a concern that online gambling could have a significant impact on public health, particularly for adolescents. The aim of this study is to examine online and land-based gambling behaviour among adolescents in 3 Canadian provinces (Ontario,...

Yoga may be effective in the reduction of PTSD symptomology. The purpose of this study was to evaluate the impact of a Kundalini Yoga (KY) treatment on PTSD symptoms and overall wellbeing. To supplement the current field of inquiry, a pilot randomized control trial (RCT) was conducted comparing an 8-session KY intervention with a waitlist control g...

Both films have short scenes of classroom lectures, but the scenes in the original seem more relevant to the plot of the film. In the 1974 version, Professor Freed quotes Dostoyevsky’s Notes from the Underground (1992[1864]) about making 2 + 2 equal 5 by an act of free will. He appears to embrace magical thinking in general as a defiant act of free...

The fifth edition of the diagnostic and statistical manual (DSM) has changed the scoring threshold for a gambling disorder (GD) from five criteria to four and eliminated the illegal acts criterion. The impact of these changes was examined with data from a correctional population (N = 676) in Ontario, Canada. The offenders completed a self-report su...

To identify correlates related to retention time of a cohort study of the opioid-dependent patients participating in the Methadone Maintenance Treatment (MMT) program offered by a major addiction treatment clinic in Tehran, Iran between April 2007 and March 2011. Several parametric Survival models assuming Weibull, Log-normal and Log-logistic distr...

Mindfulness originated from Buddhist contemplative practice 2500 years ago. Mindfulness has increasingly been integrated into a variety of health care programs to address issues such as chronic pain, mental health problems, and addictions. The purpose of this study was to evaluate the feasibility of teaching problem gamblers about mindfulness medit...

Background: Although it is well established that sex is a risk factor in acquiring a traumatic brain injury (TBI) among adolescents, it has not been established whether it also moderates the influence of other TBI psychological health correlates. Methods and findings: Data were derived from a 2011 population-based cross-sectional school survey,...

This paper describes gambling problems among Ontario students in 2009 and examines the relationship between gambling problems and substance use problems, mental health problem indicators, and delinquent behaviors. Data were derived from the Ontario Student Drug Use and Health Survey of Ontario students in grades 7-12. Gambling problems were measure...

Objective Excessive video gaming may represent a behavioural addiction among adolescents. The objective of this study was to identify and describe the taxonomy of problem gamers based on responses to the Problem Video Game Playing (PVP) scale. Methods Data based on 3338 Ontario high schoolers sampled from 103 schools (aged 11–20; male = 51 %) who c...

In this paper we will examine advances in gambling game design taking into account previous research, simulations of games, interviews with gamblers. We will first describe the technology of gambling machines; discuss changes in game design and major innovations in games parameters over the past 40 years that have made gambling machines into the mo...

The development and evaluation of the Centre for Addiction and Mental Health Inventory of Gambling Situations (CAMH-IGS) is described. The CAMH-IGS is based on a cognitive-behavioural approach to addiction that sees excessive gambling as a pattern of behaviour which is learned, and which can be changed. The CAMH-IGS is designed to determine the pat...

Inventory Drug-Taking Situations (IDTS) is a universal instrument used to determine high-risk situations resulting in drug abuse. The aim of this study was to translate this questionnaire to Farsi, and to assess its validity and reliability by applying it to Iranian drug users. As a psychometric study, 300 drug users participated in a treatment pro...

This book documents the history of ideas about problem gambling and its link to addictive disorders. The book uses a combination of literature review and conceptual and linguistic analysis to explore the way ideas about problem gambling gave changed over time. It examines the religious, socio-cultural, and medical influences on the development of t...

To examine characteristics of treatment-seeking outpatients from a clinic for co-occurring disorders within an urban psychiatric hospital. Patients (n = 131) completed six self-report scales including the Brief Symptom Inventory and Toronto Alexithymia Scale. The most common substance use disorders were: alcohol (62%), tobacco (50%), cannabis (22%)...

In this chapter, we examine early conceptions of pathological gambling from the ancient world up until the early twentieth century, with a special emphasis on the early nineteenth century. In particular, we examine how the concept of addiction as a disease, with roots in the notion of sin, emerged during this time period. Popular as well as scienti...

In this final chapter, we summarize the main themes of the book. Topics covered include (but are not limited to) the history of gambling, technological and scientific innovations that facilitated both problem gambling and chronic drunkenness, and the long-standing similarities between our understandings of problem gambling and substance addiction....

This chapter was written to clarify the basics of problem or pathological gambling (PG) as an idea and also to establish its existence. Controversies over the reality of mental disorders are especially poignant when behavioral addictions are at issue. We discuss evidence for PG based upon harm, prevalence, and its relationship to other psychiatric...

This chapter begins with an account of early psychoanalytic theories about PG. These involve themes such as masochism (deep down, the gambler wants to lose) and, unsurprisingly, looked to early childhood determinants and the unconscious. From there, however, we quickly turn to narcotic addiction, which in the early twentieth century came to set the...

In this chapter, we offer a brief history of gambling and then discuss the intersection of pathological gambling with technology, religion, and science. While technological innovations, assisted by the development of probability theory helped to make gambling a more profitable industry, other historical currents were at work. Substance use and abus...

This chapter brings us up to the late twentieth century. Early twentieth-­century conceptions, such as the unscientific though popular notion of alcoholism as an allergy, are discussed with an eye on how negative portrayals of addicts continued to influence discussions of all addictions (including PG) in tandem with more benign approaches to medica...

This chapter deals with the current situation and offers some thoughts on future prospects. Issues raised throughout the book are revisited, and accounts are given of seemingly ascendant perspectives such as the public health and the biopsychosocial models. The ongoing role of metaphors, exemplified by the development of “vaccines” against addictio...

Video game playing has become a very popular activity among adolescents. Its impact on the mental health and well-being of players is just beginning to be explored. This paper reports on the prevalence of problematic gaming in a representative sample of 2,832 Ontario students in grades 7 to 12. The survey included questions about the school grade,...

This article examines the relationship between problem gambling, mental health, and criminal behavior in a sample of incarcerated Canadian male federal offenders (N = 254). In particular, the study compared correlates of problem gambling in the offender population with the correlates of problem gambling in a nonoffender population from a previous s...

Over the past 200 years, society has come to accept the idea that addictions such as alcoholism and pathological gambling (PG) are a type of disease that is chronic, progressive, and somewhat mysterious in terms of etiology. This conception has been most strongly associated with organizations such as Alcoholics Anonymous and Gamblers Anonymous. The...

This paper reports on the results of a multi-site survey of gambling behaviour and gambling problems amongst offenders in correctional institutions in Ontario, Canada, conducted between 2008 and 2011. A total of 422 (completion rate 61.5 %) incarcerated offenders (381 male and 41 female) took part in the study including 301 federal offenders and 12...

In 2008 tobacco was banned in federal correctional institutions in Canada. In this paper we compare the use of tobacco as currency for gambling in two studies that we conducted, one before and one after the tobacco ban. The data from two studies were compared. The questionnaires were administered to offenders in federal and provincial institutions...

This study used simulations to examine the effect of prize structure on the outcome volatility and the number of winners of various game configurations. The two most common prize structures found in gambling games are even money payoff games (bet $1; win $2) found on most table games and multilevel prizes structures found in gambling machine games....

Cluster analysis was used to define subpopulations of youth involved in drugs, alcohol, and gambling. Data from a 2001 cross-sectional survey of Ontario grade 7 to 13 students (N = 2,243; mean age 15 years; 51% males) were examined. The analysis suggested four clusters: Mainstreamers (66.0%), Party Goers (26.2%), Drug Takers (5.9%), and Heavy Gambl...

This paper is a review of the Global Gaming Expo, November 17 to 19, 2009. A number of new innovations in gambling equipment are described, including multi-game slots, multi-player electronic games (e.g., competitive bonus rounds), advances in card-based bonusing systems, and the explosive growth of new electronic table games. In addition, the conf...

In the story below, David describes the personal challenges he has faced in controlling his on-line stock market investing. Following David's account, Nigel Turner presents some general observations that tie David's story to the research literature on problem gambling. The viewpoints in David and Nigel's sections reflect the ideas and opinions of t...

The study examined the perception of random lines by people with gambling problems compared to people without gambling problems. The sample consisted of 67 probable pathological gamblers and 46 people without gambling problems. Participants completed a number of questionnaires about their gambling and were then presented with a series of random and...

Many gamblers believe that it is possible to find a strategy to beat the lottery including selecting numbers that are due to come up or looking for a bias in past numbers. In this paper, we examine sales figures and variations in the number of winners for the various prize levels of a popular Canadian lottery to detect lottery ticket preferences. I...