{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T14:56:21Z","timestamp":1781880981944,"version":"3.54.5"},"reference-count":47,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2022,3,15]],"date-time":"2022-03-15T00:00:00Z","timestamp":1647302400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000236","name":"Ontario Trillium Foundation","doi-asserted-by":"publisher","award":["LP95159"],"award-info":[{"award-number":["LP95159"]}],"id":[{"id":"10.13039\/501100000236","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>The burden of harm from problem gambling weighs heavily on those experiencing poverty and homelessness, yet most problem gambling prevention and treatment services are not designed to address the complex needs and challenges of this population. To redress this service gap, a multi-service agency within a shelter setting in a large urban centre developed and implemented a population-tailored, person-centred, evidence-informed gambling addiction program for its clients. The purpose of this article is to report on qualitative findings from an early evaluation of the program, the first designed to address problem gambling for people experiencing poverty and\/or homelessness and delivered within a shelter service agency. Three themes emerged which were related to three program outcome categories. These included increasing awareness of gambling harms and reducing gambling behaviour; reorienting relationships with money; and, seeking, securing, and stabilizing shelter. The data suggest that problem gambling treatment within the context of poverty and homelessness benefits from an approach and setting that meets the unique needs of this community. The introduction of gambling treatment into this multi-service delivery model addressed the complex needs of the service users through integrated and person-centered approaches to care that responded to client needs, fostered therapeutic relationships, reduced experiences of discrimination and stigma, and enhanced recovery. In developing the Gambling Addiction Program, the agency drew on evidence-based approaches to problem gambling treatment and extensive experience working with the target population. Within a short timeframe, the program supported participants in the process of recovery, enhancing their understanding and control of their gambling selves, behaviours, and harms. This project demonstrates that gambling within the context of poverty requires a unique treatment space and approach.<\/jats:p>","DOI":"10.1371\/journal.pone.0264922","type":"journal-article","created":{"date-parts":[[2022,3,15]],"date-time":"2022-03-15T17:31:55Z","timestamp":1647365515000},"page":"e0264922","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["Filling the GAP: Integrating a gambling addiction program into a shelter setting for people experiencing poverty and homelessness"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0965-1048","authenticated-orcid":true,"given":"Flora I.","family":"Matheson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Hamilton-Wright","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7374-6979","authenticated-orcid":true,"given":"Tara","family":"Hahmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arthur","family":"McLuhan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guido","family":"Tacchini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aklilu","family":"Wendaferew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parisa","family":"Dastoori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,3,15]]},"reference":[{"issue":"1","key":"pone.0264922.ref001","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1186\/s12913-016-1583-3","article-title":"\u201cTalk with me\u201d: perspectives on services for men with problem gambling and housing instability","volume":"16","author":"SJ Guilcher","year":"2016","journal-title":"BMC Health Services Research"},{"issue":"2","key":"pone.0264922.ref002","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1007\/s11469-012-9409-y","article-title":"Untangling the complex needs of people experiencing gambling problems and homelessness","volume":"11","author":"L Holdsworth","year":"2013","journal-title":"International Journal of Mental Health and Addiction"},{"issue":"2","key":"pone.0264922.ref003","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1080\/14459795.2016.1172651","article-title":"Problem gambling, anxiety and poverty: An examination of the relationship between poor mental health and gambling problems across socio-economic status","volume":"16","author":"M. van der Maas","year":"2016","journal-title":"International Gambling Studies"},{"issue":"2","key":"pone.0264922.ref004","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1007\/s10899-013-9435-0","article-title":"Problem gambling and homelessness: results from an epidemiologic study","volume":"31","author":"L Nower","year":"2015","journal-title":"J Gambl Stud"},{"issue":"1","key":"pone.0264922.ref005","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1037\/1064-1297.14.1.87","article-title":"Health Correlates of Pathological Gambling in a Methadone Maintenance Clinic","volume":"14","author":"J Weinstock","year":"2006","journal-title":"Experimental and Clinical Psychopharmacology"},{"issue":"9","key":"pone.0264922.ref006","doi-asserted-by":"crossref","first-page":"1112","DOI":"10.1176\/appi.ps.53.9.1112","article-title":"Gambling disorders among homeless persons with substance use disorders seeking treatment at a community center","volume":"53","author":"HJ Shaffer","year":"2002","journal-title":"Psychiatr Serv"},{"issue":"3","key":"pone.0264922.ref007","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1007\/s10899-012-9324-y","article-title":"Gambling participation and problem gambling severity among rural and peri-urban poor South African adults in KwaZulu-Natal","volume":"29","author":"A Dellis","year":"2013","journal-title":"Journal of Gambling Studies"},{"issue":"4","key":"pone.0264922.ref008","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1080\/09540121.2018.1499858","article-title":"Prevalence and potential predictors of gambling disorder among people living with HIV","volume":"31","author":"K Langan","year":"2019","journal-title":"AIDS Care"},{"issue":"11","key":"pone.0264922.ref009","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1177\/0706743716661990","article-title":"Gambling and Problem Gambling among Canadian Urban Aboriginals","volume":"61","author":"RJ Williams","year":"2016","journal-title":"Can J Psychiatry"},{"issue":"5","key":"pone.0264922.ref010","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1111\/j.1521-0391.2011.00166.x","article-title":"Association of substance use and VA service-connected disability benefits with risk of homelessness among veterans","volume":"20","author":"EL Edens","year":"2011","journal-title":"American Journal on Addictions"},{"issue":"2","key":"pone.0264922.ref011","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1556\/2006.5.2016.037","article-title":"Down and Out in London: Addictive Behaviors in Homelessness.","volume":"5","author":"S Sharman","year":"2016","journal-title":"J Behav Addict."},{"issue":"5","key":"pone.0264922.ref012","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1080\/01488376.2011.598716","article-title":"Housing Stability and Problem Gambling: Is There a Relationship?","volume":"37","author":"MN Gattis","year":"2011","journal-title":"Journal of Social Service Research"},{"key":"pone.0264922.ref013","first-page":"61","article-title":"Expansion of Gambling in Canada: Implications for Health and Social Policy","volume":"163","author":"DA Korn","year":"2000","journal-title":"Canadian Medical Association Journal"},{"issue":"9","key":"pone.0264922.ref014","doi-asserted-by":"crossref","first-page":"854","DOI":"10.3390\/ijerph13090854","article-title":"Gambling in the Landscape of Adversity in Youth: Reflections from Men Who Live with Poverty and Homelessness.","volume":"13","author":"S Hamilton-Wright","year":"2016","journal-title":"International Journal of Environmental Research and Public Health"},{"issue":"9","key":"pone.0264922.ref015","doi-asserted-by":"crossref","first-page":"1112","DOI":"10.1176\/appi.ps.53.9.1112","article-title":"Gambling disorders among homeless persons with substance use disorders seeking treatment at a community center","volume":"53","author":"HJ Shaffer","year":"2002","journal-title":"Psychiatr Serv"},{"key":"pone.0264922.ref016","article-title":"Problem gambling within the context of poverty: a scoping review","author":"T Hahmann","year":"2020","journal-title":"International Gambling Studies"},{"issue":"2","key":"pone.0264922.ref017","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1007\/s10899-014-9452-7","article-title":"Prevalence of gambling problems among the clients of a toronto homeless shelter","volume":"30","author":"FI Matheson","year":"2014","journal-title":"J Gambl Stud"},{"key":"pone.0264922.ref018","doi-asserted-by":"crossref","first-page":"285","DOI":"10.2147\/PRBM.S40883","article-title":"Psychological treatments for gambling disorder","volume":"7","author":"CJ Rash","year":"2014","journal-title":"Psychology Research and Behavior Management"},{"issue":"8","key":"pone.0264922.ref019","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1177\/070674370404900803","article-title":"Assessing and treating problem gambling: Empirical status and promising trends","volume":"49","author":"T Toneatto","year":"2004","journal-title":"The Canadian Journal of Psychiatry"},{"key":"pone.0264922.ref020","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/S1077-7229(02)80049-9","article-title":"Cognitive therapy for problem gambling.","volume":"9","author":"T. Toneatto","year":"2002","journal-title":"Cognitive and Behavioral Practice"},{"issue":"3","key":"pone.0264922.ref021","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1192\/bjp.bp.108.062414","article-title":"Imaginal desensitization plus motivational interviewing for pathological gambling: randomised controlled trial","volume":"195","author":"JE Grant","year":"2009","journal-title":"British Journal of Psychiatry"},{"issue":"1","key":"pone.0264922.ref022","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1007\/s10899-010-9196-y","article-title":"Twelve-step facilitated versus mapping-enhanced cognitive-behavioral therapy for pathological gambling: A controlled study","volume":"27","author":"JC Marceaux","year":"2011","journal-title":"Journal of Gambling Studies"},{"issue":"4","key":"pone.0264922.ref023","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1080\/10550490802138830","article-title":"Effectiveness of community-based treatment for problem gambling: A quasi-experimental evaluation of cognitive\u2013behavioral vs twelve-step therapy","volume":"17","author":"T Toneatto","year":"2008","journal-title":"American Journal of Addiction"},{"issue":"6","key":"pone.0264922.ref024","doi-asserted-by":"crossref","first-page":"1204","DOI":"10.1007\/s10900-019-00706-w","article-title":"Evaluation of a Pilot Intervention to Reduce Mental Health and Addiction Stigma in Primary Care Settings.","volume":"44","author":"A Khenti","year":"2019","journal-title":"J Community Health"},{"issue":"12","key":"pone.0264922.ref025","doi-asserted-by":"crossref","first-page":"1926","DOI":"10.2105\/AJPH.91.12.1926","article-title":"Can public health researchers and agencies reconcile the push from funding bodies and the pull from communities?","volume":"91","author":"LW Green","year":"2001","journal-title":"Am J Public Health"},{"key":"pone.0264922.ref026","volume-title":"Guide to knowledge translation planning at CIHR: integrated and End-of-grant approaches.","author":"CIHR","year":"2012"},{"issue":"7212","key":"pone.0264922.ref027","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1136\/bmj.319.7212.774","article-title":"Participatory research maximises community and lay involvement","volume":"319","author":"AC Macaulay","year":"1999","journal-title":"British medical journal"},{"key":"pone.0264922.ref028","volume-title":"Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans","author":"Government_of_Canada","year":"2018"},{"issue":"4","key":"pone.0264922.ref029","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1007\/s10899-009-9135-y","article-title":"The NODS-CLiP: a rapid screen for adult pathological and problem gambling","volume":"25","author":"M Toce-Gerstein","year":"2009","journal-title":"J Gambl Stud"},{"issue":"2","key":"pone.0264922.ref030","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1007\/s10899-012-9300-6","article-title":"Validity of the Problem Gambling Severity Index interpretive categories.","volume":"29","author":"SR Currie","year":"2013","journal-title":"J Gambl Stud"},{"key":"pone.0264922.ref031","unstructured":"Ferris J, Wynne H. The Canadian problem gambling index: Final report. Submitted for the Ottawa: 2001."},{"issue":"9","key":"pone.0264922.ref032","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.1177\/1049732305276687","article-title":"Three approaches to qualitative content analysis","volume":"15","author":"HF Hsieh","year":"2005","journal-title":"Qual Health Res"},{"issue":"2","key":"pone.0264922.ref033","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1111\/hex.12640","article-title":"How to practice person-centred care: A conceptual framework","volume":"21","author":"MJ Santana","year":"2018","journal-title":"Health Expectations"},{"issue":"2","key":"pone.0264922.ref034","first-page":"40","article-title":"Borderline Intellectual Functioning and Lifetime Duration of Homelessness among Homeless Adults with Mental Illness","volume":"14","author":"A Durbin","year":"2018","journal-title":"Healthcare Policy"},{"issue":"1","key":"pone.0264922.ref035","doi-asserted-by":"crossref","first-page":"1110","DOI":"10.1186\/s12889-016-3768-4","article-title":"The effectiveness of a Housing First adaptation for ethnic minority groups: findings of a pragmatic randomized controlled trial","volume":"16","author":"V Stergiopoulos","year":"2016","journal-title":"BMC Public Health"},{"key":"pone.0264922.ref036","doi-asserted-by":"crossref","DOI":"10.4309\/jgi.2019.42.4","article-title":"Reflections on Poverty, Homelessness and Problem Gambling: Discoveries from a World Cafe","volume":"42","author":"EH Wright","year":"2019","journal-title":"Journal of Gambling Issues"},{"issue":"1","key":"pone.0264922.ref037","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1151\/ascp074145","article-title":"Managing addiction as a chronic condition","volume":"4","author":"M Dennis","year":"2007","journal-title":"Addict Sci Clin Pract"},{"issue":"2, Supplement","key":"pone.0264922.ref038","doi-asserted-by":"crossref","first-page":"S63","DOI":"10.1016\/j.jsat.2004.09.006","article-title":"Pathways in the relapse\u2014treatment\u2014recovery cycle over 3 years","volume":"28","author":"CK Scott","year":"2005","journal-title":"Journal of Substance Abuse Treatment"},{"issue":"6","key":"pone.0264922.ref039","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1177\/0193841X07307771","article-title":"An Eight-Year Perspective on the Relationship Between the Duration of Abstinence and Other Aspects of Recovery","volume":"31","author":"ML Dennis","year":"2007","journal-title":"Evaluation Review."},{"issue":"3","key":"pone.0264922.ref040","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1007\/s10899-009-9129-9","article-title":"Barriers to seeking help for gambling problems: A review of the empirical literature","volume":"25","author":"H Suurvali","year":"2009","journal-title":"Journal of Gambling Studies"},{"issue":"11","key":"pone.0264922.ref041","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.1176\/ps.2008.59.11.1343","article-title":"Treatment seeking among Ontario problem gamblers: Results of a population survey","volume":"59","author":"H Suurvali","year":"2008","journal-title":"Psychiatric services"},{"key":"pone.0264922.ref042","volume-title":"A developmental evaluation primer","author":"JAA Gamble","year":"2008"},{"key":"pone.0264922.ref043","article-title":"Charting a path towards a public health approach for gambling harm prevention","author":"A Price","year":"2021","journal-title":"Journal of Public Health: From Theory to Practice."},{"issue":"2","key":"pone.0264922.ref044","first-page":"190","article-title":"The Conceptual Framework of Harmful Gambling: A revised framework for understanding gambling harm","volume":"9","author":"M Hilbrecht","year":"2020","journal-title":"J."},{"key":"pone.0264922.ref045","doi-asserted-by":"crossref","first-page":"68","DOI":"10.4309\/jgi.2016.33.5","article-title":"Addressing the needs of problem gamblers with co-morbid issues: policy and service delivery approaches","volume":"33","author":"K Martyres","year":"2016","journal-title":"Journal of Gambling Issues"},{"issue":"6","key":"pone.0264922.ref046","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1089\/pop.2015.0147","article-title":"Bridging the silos of service delivery for high-need, high-cost individuals","volume":"19","author":"M Sherry","year":"2016","journal-title":"Population Health Management"},{"issue":"3","key":"pone.0264922.ref047","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1111\/hsc.12909","article-title":"Factors related to screening for problem gambling among healthcare and social service providers in Ontario, Canada: A concept mapping study","volume":"28","author":"SJ Guilcher","year":"2020","journal-title":"Health Soc Care Community"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0264922","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,15]],"date-time":"2022-03-15T17:33:00Z","timestamp":1647365580000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0264922"}},"subtitle":[],"editor":[{"given":"Marc","family":"Potenza","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,3,15]]},"references-count":47,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,3,15]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0264922","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,15]]}}}