When Diana Gabriele started working as a counsellor at Ontario’s only in-patient treatment for problem gamblers a decade ago, her clients were mostly trying to break free of their addictions to slot machines and other games at casinos.

Their profiles fit neatly with the original raison d’être of the Centre for Problem Gambling and Digital Dependency at Hôtel-Dieu Grace Healthcare in Windsor, a program established in 1994 when the border city was granted the first casino in Ontario.

But in recent years, there has been a sea change in the nature of the addictions that send people to the provincially funded, three-week in-patient recovery program and its related outpatient program.

Today’s clients, Ms. Gabriele said, tend to be hooked on online casinos and sports betting. Some have even tried to sneak smartphones into the device-free recovery program by sewing them into the lining of their suitcases.

“It’s a nightmare,” Ms. Gabriele said, singling out online sports betting as a particular challenge because of the tsunami of advertisements that portray it as a natural part of fan culture.

“With the merging of online activity with gambling activity, the lines have become so incredibly blurred,” she added. “Online activities have become so normalized, that, for the most part, people are not recognizing how incredibly detrimental it is” – until they find themselves broke and alienated from their families.

It’s not yet clear how the rise of legal online betting in Canada – a phenomenon supercharged by Ontario opening its market to commercial casino and sports-betting websites in 2022 – has affected rates of problem gambling. Earlier this week, the Canadian Centre on Substance Use and Addiction called for a national strategy to curb gambling advertisements and to monitor harms such as betting-related suicides, bankruptcies and divorces.

The group also urged governments to offer more counselling for gamblers whose vice is always a swipe away. For advice on how to do that, health leaders could look to the programs at Hôtel-Dieu Grace, which have pivoted to treating smartphone-addicted gamblers while still helping those hooked on real-world casinos and video games.

Clients’ underlying problems are often similar, regardless of their preferred game of chance, Ms. Gabriele said. Betting can offer a dopamine-fuelled escape from trauma, loneliness, depression and other ills.

“It was always emotional,” Lesley, 41, said of her addiction to online slot machines. “I never really wanted to go and play [online] slots if I was in a happy mood. Then it became emotional every day because I had this cloud over me over losing this money.”

Lesley joined Hôtel-Dieu Grace’s outpatient program last October. (To protect her privacy, The Globe and Mail is not using her last name.) A remote tech worker with a husband and three kids, she was staying awake for hours every night playing slots on websites such as Party Poker, Jackpot City and BetRivers.

She found she couldn’t manage her bankroll the way she had as a former poker professional at real tables. Once she switched to online slots, “the difference was, the logic and my brain just kind of shut down. I was just escaping and pressing buttons.”

At one point, she won a $100,000 jackpot from a slots website that, as far as she could tell, only allowed her to withdraw $10,000 of her winnings a week. After collecting the first instalment, she gambled most of the rest away on the same site. She played more, hoping to recoup her losses, but fell deeper into debt.

Lesley’s husband worried she might hurt herself. He urged her to call Hôtel-Dieu. As a Windsorite, she was able to live at home while attending one-on-one counselling and group therapy sessions during which counsellors explain addiction theory, and teach clients to set boundaries, communicate with their families and face the emotional struggles that led them to gamble in the first place.

They gave her practical tips, too, such as subscribing to services that block gambling websites on all devices with passwords held by friends or family.

Lesley has abstained from gambling since joining the program. The most recent one-year follow-up data found that 75 per cent of participants achieved the same success, Ms. Gabriele said.

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The outpatient program at Hôtel-Dieu Grace treated 119 patients in 2023-24, 87 of them male and four of them 17 or younger. That total is up from 93, 70, 37 and 85 in the four previous years.

The in-patient program, which welcomes five or six clients at a time for three-week cycles, treated 57 patients in each of the past two fiscal years, up from 41 and 40 in the worst years of the pandemic. In 2019-20, the last year before COVID-19 struck, the in-patient program treated 85 clients and often had a wait-list.

Clients entering the in-patient centre on Hôtel-Dieu’s verdant grounds are met by a gratitude board with sticky notes from past clients reading “I’m grateful for a second chance” and “I’m grateful to fully understand that the past does not equal the future.”

Each patient has his or her own simple bedroom for the three-week cycle, with access to a kitchen and common room. Every day, participants take part in group therapy sessions that include preparing for Family Day, when relatives and friends confront participants in often searing ways about the damage their gambling inflicted on people they love.

For Wayne Ladouceur, now 38, checking into the digital dependency stream of the in-patient program allowed him to break free from the dawn-to-dusk video-game habit he developed after a childhood in and out of foster care.

Living at the centre “was like the complete opposite of my whole life up to that point,” Mr. Ladouceur said. The staff were firm about structure and routine. They taught him to be open with others and to fill his days with satisfying in-person activities.

“This was the first time in my life that I knew what it felt like to be unconditionally loved,” he said.