2.23 Gambling Reabilitation Services Introduction Figure 1 Since 1995 provincial revenues from gambling activities ave increased over 56% from $69.2 million in 1995 to $108 million in 2004. Te majority of sanctioned gambling witin te Province is managed by te Atlantic Lottery Corporation (ALC). ALC is te primary organization autorized to develop and market gaming products trougout Atlantic Canada. ALC is jointly owned by te governments of te four Atlantic provinces. According to ALC, since commencing operations in 1976 it as paid te Government of Newfoundland and Labrador $1.132 billion. Figure 1 sows te Provincial revenues from gambling for te past 10 years. Province of Newfoundland and Labrador Lottery Revenue For te Year Ended 31 Marc ($ Millions) GAMBLING REVENUE 120 100 80 60 40 20 0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 YEAR VLT Oter Year Total 1995 69.2 1996 73.5 1997 75.5 1998 78.4 1999 89.6 2000 100.6 2001 93.6 2002 101.9 2003 106.0 2004 108.0 Source: Public Accounts In addition to ALC, te Province allows religious, caritable and oter specified groups to raise funds troug various games of cance suc as bingo, sale of break-open tickets, games of cance or ticket draws. According to te Department of Government Services, in 2003 tese groups ad gross revenues of $55 million. None of te revenue from tese games accrues to te Province. A Statistics Canada report issued in December 2003 indicated tat, wile no trend data exists on problem gambling rates, researc as sown tat increased access to gambling contributes to an increase in te prevalence of gambling related ealt problems along wit socio-economic problems. Te researc also sows tat individuals wit a gambling addiction are also more likely to ave mental ealt issues tan tose wit oter types of addictions. Auditor General of Newfoundland and Labrador 379
2.23 Gambling Reabilitation Services Officials at te Department of Healt and Community Services indicated tat approximately $4.1 million is spent annually by te four ealt and community services boards, te two integrated ealt care boards, and te Healt Care Corporation of St. Jon's to deliver all addiction programs (alcool, drugs, tobacco and gambling). Tere are approximately 50 staff trougout te Province responsible for delivering tese addiction programs. Scope and Objective We completed our review of gambling reabilitation services in Marc 2004. Te objectives of our review were to determine: wat revenues are received by te Province from gambling and ow tis is used to fund te services offered by te Province for problem gambling issues; weter te extent of problem gambling in te Province is known; and wat services are available for te education, prevention and treatment of problem gambling. Conclusions In 2004 te Province received $108 million from te Atlantic Lottery Corporation (ALC), an increase of $38.8 million or 56% from te $69.2 million received in 1995. Of tis amount, $76 million was from Video Lottery Terminals (VLT), an increase of $44 million or 137% from te $32 million received in 1995. A Statistics Canada report issued in December 2003 indicated tat one in four gamblers, wose playing includes VLTs, are at risk to become or are already problem gamblers. Te report went on to state tat VLTs are te 'crack cocaine' of gambling. Furtermore, correspondence from five of te six ealt boards providing addiction services in te Province indicated tat te vast majority of individuals being treated for problem gambling were addicted to VLTs. Tere are a number of significant issues relating to Government s involvement wit te identification and treatment of gambling addiction. For example: Newfoundland and Labrador is te only Province in Canada tat as not conducted its own prevalence study to determine te extent of te gambling problem. Statistics Canada as indicated tat in 2002, 330,000 individuals in Newfoundland and Labrador over 380 Auditor General of Newfoundland and Labrador
2.23 Gambling Reabilitation Services te age of 15 participated in and spent money on some form of gambling activity. Furtermore, Statistics Canada as indicated tat 6.3% of tese individuals are at risk or are already problem gamblers. Tis equates to some 20,800 Newfoundlanders and Labradorians wo are at risk or are already problem gamblers. Newfoundland and Labrador as te igest percentage in Atlantic Canada of individuals wo gamble and wo are at risk or are already problem gamblers. Te four ealt and community services boards and te two integrated boards carged wit administering te gambling addiction program are unable to provide complete or comparable statistics on te numbers of clients wit gambling addictions wo were referred, treated and waitlisted. Furtermore, te boards do not ave systems in place to capture information on te costs of providing eac of te various addiction programs and te amount of time spent by staff on eac program. As a result, information required by te Department and te boards to adequately plan and monitor addiction programs is not readily available. Boards indicated tat tey did not ave sufficient resources to meet te demand for gambling addiction reabilitation and as a result several boards ad waitlists. Tis is significant in tat it was indicated by one Board tat Researc indicates tis population group [individuals requiring gambling reabilitation] does not usually follow troug wen tey are waitlisted. Tere is no centralized resource at te Department of Healt and Community Services to assist te regional boards in developing standard programs for gambling reabilitation including a strategy for te delivery of a Provincial education and awareness program. Altoug Government is required to matc a 1% VLT fee received from retailers, officials at te Department of Healt and Community Services were not aware of tis requirement. As a result, te Department did not budget for tis matcing amount. Te Department of Healt and Community Services provides approximately $4.1 million annually for all addiction programs (alcool, drugs, tobacco and gambling); owever, it cannot readily demonstrate tat te amount available for gambling addiction programs was in fact used for tis purpose. Auditor General of Newfoundland and Labrador 381
2.23 Gambling Reabilitation Services Findings and Recommendations Gambling Revenues Te Province receives significant revenues from te ALC wic manages several forms of gambling on bealf of te Province. For te fiscal year ending 31 Marc 2004 te Province received $108 million in revenue from te ALC. Of te revenue tat is provided to te Province from ALC tere are two main gaming categories. Tese categories are traditional games (includes games suc as Lotto 6/49, Super 7, scratc tickets and breakopen tickets) and Video Lottery Terminals (VLTs). Te VLT category exclusively refers to video lottery terminals wic may emulate one or more games suc as a slot macine, keno, and/or poker. Figure 2 provides a breakdown of te revenues generated between te two categories for eac of te ten years to 2004. Figure 2 Atlantic Lottery Revenue Breakdown Years Ended 31 Marc ($000 s) Year Traditional Games VLT Amount % of Total Amount % of Total Total 1995 37,161 54% 32,012 46% 69,173 1996 35,618 48% 38,499 52% 74,117 1997 34,619 46% 40,419 54% 75,038 1998 34,580 44% 44,330 56% 78,910 1999 32,801 36% 57,083 64% 89,884 2000 35,233 37% 58,927 63% 94,160 2001 31,703 33% 63,062 67% 94,765 2002 34,188 34% 67,402 66% 101,590 2003 35,529 33% 70,916 67% 106,445 2004 31,870 30% 75,716 70% 107,586 Source: Atlantic Lottery Corporation As Figure 2 sows, tere as been a significant increase in te amount received from ALC since 1995. In 2004 te Province received $108 million from ALC, an increase of $38.8 million or 56% from te $69.2 million in 1995. 382 Auditor General of Newfoundland and Labrador
2.23 Gambling Reabilitation Services As te Figure also sows, te increased revenues are attributable to te increased gaming activity in te VLT category. In 2004 te Province received $76 million from te VLT category, an increase of $44 million or 137% from te $32 million received in 1995. In 1995 VLT revenue represented 46% of total revenues from ALC wile in 2004 VLT revenue accounted for 70% of te total revenue from ALC. In contrast, during tis 10 year period, te revenues from te traditional gaming category ave declined by $5.3 million or 14%. A Statistics Canada report issued in December 2003 indicated tat one in four gamblers, wose playing includes VLTs, are at risk to become or are already problem gamblers. Te report went on to state tat VLTs are te 'crack cocaine' of gambling. Furtermore, correspondence from five of te six ealt boards providing addiction services in te Province indicated tat te vast majority of individuals being treated for problem gambling were addicted to VLTs. Video Lottery Terminal (VLT) Identification of Problem Gamblers Given te significant increase in VLT revenues over te last ten years and te associated correlation wit addiction problems, it would be expected tat te Province would be proactive in determining te prevalence of problem gambling in order to develop appropriate reabilitation services. Our review indicated tat te Province is not doing a good job in determining te prevalence of problem gambling. Auditor General of Newfoundland and Labrador 383
2.23 Gambling Reabilitation Services Figure 3 Gambling Statistics for 2002 Jurisdiction Newfoundland and Labrador is te only Province in Canada tat as not conducted its own prevalence study to determine te extent of te gambling problem. Statistics Canada as indicated tat in 2002, 330,000 individuals in Newfoundland and Labrador over te age of 15 participated in and spent money on some form of gambling activity. Furtermore, Statistics Canada as indicated tat 6.3% of tese individuals are at risk or are already problem gamblers. Tis equates to some 20,800 Newfoundlanders and Labradorians wo are at risk or are already problem gamblers. Figure 3 provides a comparison by province of te number of citizens wo gamble and te percentage of tese gamblers wo are eiter at risk to develop a gambling problem or wo already ave a gambling problem. Total Gamblers (000s) % at Risk or Already a Problem Gambler Total Number at Risk or Already a Problem Gambler (000s) Newfoundland and Labrador 330 6.3 21 Prince Edward Island 83 4.8 4 Nova Scotia 588 5.7 33 New Brunswick 463 5.3 24 Quebec 4,787 4.6 220 Ontario 7,213 6.5 468 Manitoba 642 9.4 60 Saskatcewan 575 9.3 53 Alberta 1,731 7.8 135 Britis Columbia 2,474 6.9 170 Total for Canada 18,886 6.3 1,188 Source: Statistics Canada 384 Auditor General of Newfoundland and Labrador
2.23 Gambling Reabilitation Services As te Figure indicates, in Newfoundland and Labrador te average of 6.3% of individuals wo gamble and wo are at risk or wo are already problem gamblers is te igest percentage in Atlantic Canada. Gambling Reabilitation Programs Given te significant increase in te number of individuals wo are at risk or wo are already problem gamblers, it would be expected tat te Province would ave programs in place to address tis problem. Normally, suc programs would include education, prevention and treatment. Furtermore, we would expect tat tere would be systems in place to provide statistical information on te number of individuals referred, treated and waitlisted. We would also expect tat information on te amounts budgeted and actually spent on gambling reabilitation programs would be readily available. Te Province s current treatment for gambling addiction consists of, in most cases, out-patient counselling by te six Boards; owever, tere are also two residential centres - a detoxification centre (Recovery Centre) operated by te St. Jon s Regional Healt and Community Services Board and a treatment centre (Humberwood) operated by te Western Regional Healt and Community Services Board. Out-patient counselling consists of individual and group counselling sessions witout an overnigt stay wile te residential centres provide similar counselling along wit a required stay of six days for te Recovery Centre and nineteen days for Humberwood. Our review indicated tat, altoug te Province as taken some action to address te issue of problem gamblers, tere are weaknesses as follows: Te four ealt and community services boards and te two integrated boards carged wit administering te gambling addiction program are unable to provide complete or comparable statistics on te numbers of clients wit gambling addictions wo were referred, treated and waitlisted. Some boards specifically identified te inability to compile statistics as a problem. A contributing factor in tis lack of information relates to a Client Referral Management System module wic, altoug as been in development for te last 5 years, is still not available to track individuals receiving addictions services. Officials at te Department of Healt and Community Services indicated tat te addictions module as not been a priority of te Department. Auditor General of Newfoundland and Labrador 385
2.23 Gambling Reabilitation Services Te four ealt and community services boards and te two integrated boards do not ave systems in place to capture information on te costs of providing eac of various addiction programs and te amount of time spent by staff on eac program. Terefore, information required by te Department and te boards to determine ow muc money and time is being spent to deliver gambling reabilitation programs is not readily available. Te following cart provides information on budgeted costs and staffing levels for all addiction programs (alcool, drugs, tobacco and gambling) by board. Budget St. Jon s Regional Healt and Community Services Board $1.1M 21 Eastern Healt and Community Services Board $0.5M 6 Central Regional Healt and Community Services Board $0.4M 4 Staff Western Regional Healt and Community Services Board $1.3M 15.5 Grenfell Regional Healt Services Board $0.1M 1 Healt Labrador Corporation Total $0.4M $3.8 M No Response Received Source: Department of Healt and Community Services, community services boards, and integrated ealt boards In addition to te $3.8 million provided to te four ealt and community services boards and te two integrated boards, $0.3 million was provided to te Healt Care Corporation of St. Jon s relating to an addictions program. Boards indicated tat tey did not ave sufficient resources to meet te demand for gambling addiction reabilitation and as a result several boards ad waitlists. Tis is significant in tat it was indicated by one Board tat Researc indicates tis population group [individuals requiring gambling reabilitation] does not usually follow troug wen tey are waitlisted. As a result, tere are likely individuals wo, altoug sougt elp for teir gambling addiction, did not get te elp tey needed. At 30 September 2004, te boards ad te following waitlists: St. Jon s (not available), Eastern - 6, Central - 20, Western - 17, Grenfell - nil, and Labrador (no response). 386 Auditor General of Newfoundland and Labrador
2.23 Gambling Reabilitation Services Te Department of Healt and Community Services does not play a coordinating role to assist te regional boards in developing standard programs for gambling reabilitation including a strategy for te delivery of a Provincial education and awareness program. Te Department does not currently ave a resource person to provide a coordinating role. We note tat officials at te Department indicated tat promoting awareness of problem gambling as not been considered a Government priority due to te relatively low proportion of problem gamblers and te Department's oter priorities. As a result, tere may be inconsistencies in te gambling reabilitation programs offered by eac of te boards. Furtermore, everyone in te Province is not necessarily receiving a consistent and clear message as to te symptoms of problem gambling and te gambling reabilitation services available. Altoug Government, in accordance wit a Cabinet Directive in 1995, is required to matc a 1% VLT fee received from retailers, officials at te Department of Healt and Community Services were not aware of tis requirement. As a result, te Department did not budget for tis matcing amount. Furtermore, tere is no separate budget item for te 1% retailer fee wic is to be used specifically for te prevention and treatment of problem gambling. Since te 1% fee was first collected in 1995-96, retailers ave contributed approximately $2 million. In 1995-96, retailers contributed $142,000 wile in 2003-04, tis amount ad increased to $313,000, an increase of 120%. Altoug te Department of Healt and Community Services provides approximately $4.1 million annually for all addiction programs (alcool, drugs, tobacco and gambling), it cannot readily demonstrate tat te amount available for gambling addiction programs was in fact used for tis purpose. Recommendations Te Department of Healt and Community Services sould: Undertake a prevalence study to determine te full extent of problem gambling in te Province. Auditor General of Newfoundland and Labrador 387
2.23 Gambling Reabilitation Services Ensure tat tere is adequate information available to adequately plan and monitor te addiction programs. Te information sould include statistics on te number of clients wit gambling addictions wo were referred, treated and waitlisted as well as information on te costs of providing eac of te various addiction programs and te amount of time spent by staff on eac program. Ensure tat tere are standard programs for gambling reabilitation and a strategy for te delivery of a Provincial education and awareness program. Ensure tat te 1% Video Lottery Terminal retailer fee is matced and included in a separate budget wic can be monitored to ensure tat te funds are spent for te purpose intended. Department s Response Te Department accepts te need for te completion of a gambling prevalence study. It is expected te study will occur in 2005 and take approximately six monts to complete. Wit respect to te Auditor General's comments on te availability of adequate information te Department notes te Client Referral & Management System (CRMS) - Addictions Module became operational in 2004. Currently 5 of 6 regional ealt boards are registering teir addictions clients. Tis will significantly improve te Department's capability to manage addictions services. An additional investment in information tecnology will be required in 2005 to fully integrate and implement te new module. Te Addictions Program is provided trougout te province. Tere is a standard protocol for intake for Addiction Services wic is used by te regional ealt boards. Te initial assessment identifies te addiction treatment needs wic may include multiple addictions. If a gambling addiction is identified, a treatment plan is developed tat is customized to meet te needs wic are presented. Wit respect to matcing te VLT operator contributions te Department will seek matcing funding troug government's budget process. Te Department will also review its budget metodology for allocating and monitoring funding to improve its ability to track expenditures related to gambling addictions. 388 Auditor General of Newfoundland and Labrador