Summary

• Stigma Of Pathological Gambling Addiction
• Stigma Of Pathological Gambling Disorders
• Stigma Of Pathological Gambling Definition
• Stigma Of Pathological Gambling Addiction
• Pathological Gambling Disorder

The foundation commissioned this research to determine the nature of problem gambling stigma, including perceptions of its intensity, how it is created and maintained, and who it affects and how.

The study examined stigma from two perspectives: from the point of view of people with gambling problems (self-stigma), and from the point of view of others (public stigma).

Over 95 per cent of Victorians believe problem gambling is an addiction. Nature and intensity of stigma. The most common self-stigmatising beliefs held by people with gambling problems include feeling disappointed in themselves, ashamed, embarrassed, guilty, stupid, weak and a failure. Gambling as perceived by the general public, (2) compare the stigma-related dimensions of problem gambling to those for other health conditions, and (3) determine whether the publicly perceived dimensions of problem gambling predict its public stigmatisation.

The researchers from the Centre for Gambling Education and Research, Southern Cross University, also considered how stigma may impede treatment and interventions among first-time and relapsed help-seekers, and how it may influence recovery from problem gambling.

How was the research conducted?

The researchers collected insights into gambling-related stigma via quantitative surveys of:

Stigma Of Pathological Gambling Addiction

• the Victorian adult population (2000 participants)
  
• people with gambling problems (203 participants).
  

Stigma Of Pathological Gambling Disorders

The researchers used the survey results to compare levels of perceived stigma for five conditions:

1. problem gambling
   
2. alcohol use disorder
   
3. schizophrenia
   
4. sub-clinical (general) gambling
   
5. sub-clinical distress.
   

There were differences in perception of stigma for these conditions between the general population and recent problem gamblers.

Qualitative, in-depth interviews with 44 recent problem gamblers and nine counsellors added depth to the survey findings. They also explored attempts at help-seeking, self-exclusion and the effects of stigma on relapse and recovery.

Limitation

The two surveys were online, which restricted respondents to those with online access.

What were key findings of the research?

The key findings of the research include:

Perceptions of problem gambling

• The majority of Victorians believe problem gambling is a noticeable and disruptive condition caused by stressful life circumstances, although one that is recoverable. However, many also assign blame for the problem to the individual affected, seeing them as impulsive, irresponsible, greedy, irrational, anti-social, untrustworthy, unproductive and foolish.
  
• A vast majority (95.6 per cent) believe problem gambling is an addiction, while half (51.6 per cent) believe it is diagnosable. One in three (34.4 per cent) believe problem gambling is a mental health condition.
  
• Although willing to socialise with people with gambling problems in incidental ways, Victorians are reluctant to form more enduring or personal relationships with them. Public devaluation and discrimination against them in employment is also evident.
  
• Less than 25 per cent of Victorians think people with gambling problems are likely to be violent towards others but just over 40 per cent think they are likely to be harmful to themselves.
  

Over 95 per cent of Victorians believe problem gambling is an addiction.

Nature and intensity of stigma

• The most common self-stigmatising beliefs held by people with gambling problems include feeling disappointed in themselves, ashamed, embarrassed, guilty, stupid, weak and a failure.
  
• Victorians are generally more likely to pity a person with a gambling problem than they are to feel anger or fear. However, a minority reported feeling annoyed, apprehensive, angry or uncomfortable.
  
• The stigma attached to problem gambling by the Victorian community is higher than for sub-clinical distress or gambling in general, but lower than for alcohol use disorder or schizophrenia.
  

Perception and experience of stigma

• Recent problem gamblers believed their condition to be more publicly stigmatised than alcoholism, obesity, schizophrenia, depression, cancer, bankruptcy and recreational gambling, but not more so than drug addiction. They also perceived greater stigma from others than was actually the case.
  
• Most recent problem gamblers perceived being negatively judged by others because of their gambling, although direct experiences of demeaning and discriminatory behaviours were rare, possibly due to many being reluctant to disclose their gambling problem. Expectations and fear of being devalued and discriminated against were strong deterrents to problem gambling disclosure and helpseeking.
  

Recent problem gamblers perceived greater stigma from others than was actually the case.

Stigma as an impediment to treatment and interventions

• Used by over 80 per cent of respondents, secrecy was the main mechanism used to cope with stigma, meaning family and friends are typically unaware of someone’s gambling problem. This secrecy is grounded in fear of rejection and being stereotyped, judged and discriminated against.
  
• Fear of disclosing a gambling problem means self-help is the most common form of help used, followed by support from family and friends. Shame and fear of being exposed as a problem gambler are the major deterrents to self-exclusion from gambling venues due to photos being visible to staff. By comparison, online self-exclusion is considered less likely to result in shame.
  
• Episodes of relapse were reported to worsen self-stigma, eliciting feelings of shame and self-loathing. Survey respondents who had relapsed had significantly higher levels of self-stigma compared to those who had not relapsed.
  

Fear of disclosing a gambling problem means self-help is the most common form of help used.

How this research might be useful

This research provides an account of how the Victorian community views people with gambling problems, and how stigma can play out, with some people preferring a degree of social distance from those with gambling problems.

The study highlights some misconceptions held by the community about problem gambling. While many recognise it as an addiction, fewer see it as a mental health condition. Further, most believe it is a recoverable condition, despite it being common for people with gambling problems to experience relapse. Community education specifically challenging the misconceptions that feed stigma could be beneficial.

On the flipside, given people with gambling problems overestimate the amount of stigma they face, providing them with a more realistic view of the sympathy they can expect would be helpful.

Stigma is seen by both gamblers and counsellors as a significant barrier to the uptake of help services, suggesting a need for further research to develop ways to reduce perceived and self-stigma among people with gambling problems. Likewise, minimising stigma is important for improving uptake of self-exclusion programs.

Citation

Hing, N, Russell, A, Nuske, E & Gainsbury, S 2015, The stigma of problem gambling: Causes, characteristics and consequences, Victorian Responsible Gambling Foundation, Melbourne.

Stigma Of Pathological Gambling Definition

Gambling and Mental Health
Instructor: Dr. Dawn-Elise Snipes
Executive Director: AllCEUs.com Counselor Education & Training

CEUs/OPD/CPDs are available for this presentation at https://www.allceus.com/member/cart/index/product/id/664/c/ for clinicians in the US and https://australia.allceus.com/member/cart/index/product/id/664/c/ for clinicians in Australia.

Stigma Of Pathological Gambling Addiction

Objectives
~ Post-traumatic stress symptoms in pathological gambling: Potential evidence of anti-reward processes
~ Problem gambling in bipolar disorder
~ Alexthymia and Pathological Gambling
~ Food addiction in gambling disorder
~ Gambling, domestic violence and trauma
~ Understanding stigma
Post Traumatic Stress and Gambling
~ When the number of traumatic events were controlled for, individuals with pathological gambling disorder had significantly higher PTS scores
~ “Anti-reward” gambling provides momentary relief from PTS but contributes to the “spiraling distress cycle”
~ In a study of pathological gamblers, gambling behavior significantly decreased upon completion of PTSD treatment (Najavits et al., 2013)
~ People with a history of trauma should be counseled about their increased risk for developing gambling problems
Bipolar Disorder
~ People who met criteria for Bipolar 1 (full manic) and pathological gambling were identified
~ The general population had a 3.8% prevalence of problem gambling
~ The group with bipolar disorder had a 11.6% prevalence of problem gambling
~ Of all psychiatric categories examined, respondents screening positive for a manic episode had the highest risk of pathological gambling
~ Selective serotonin reuptake inhibitors may be effective for some patients with pathological gambling
Bipolar Disorder
~ Sustained release lithium appears to produce significant positive results in gambling behaviors and affective stability after 8 to 10 weeks as measured by the
~ Clinical Global Impression (CGI) pathological gambling improvement scale
~ Clinician-Administered Rating Scale for Mania
Alexthymia
~ Individuals with high levels of alexithymia become prone to addictive behavior via emotional dysregulation
~ Alexithymia
~ difficulty in describing feelings
~ distinguishing one’s feelings from bodily sensations
~ having restricted imaginative processes
~ a stimulus-dependent, externally oriented cognitive style
~ challenges in emotional processing and coping with stressful feelings/ emotional regulation
~ Alexithymic individuals
~ attempt to regulate their emotions through compulsive behaviors.
~ show addictive behaviors due to their lack of self-knowledge and insight.
Alexthymia
~ Emotional dysregulation was measured using the Difficulties in Emotion Regulation Scale (DERS)
~ Difficulties in emotion regulation and alexithymia are positive, significant predictors of pathological gambling
Gambling and Domestic Violence
~ 25-50% of spouses of compulsive gamblers have been abused
~ Odds ratio of intimate partner violence increased 10.5 times when partner was problem gambler
~ Children of problem gamblers are 2 to 3 times more likely to be abused by a parent
~ For many women gambling venues are refuge from violence and gambling becomes a method of escape
~ Family violence and addiction have several common features including loss of control, continuation despite adverse consequences, tolerance and withdrawal, involvement of the entire family, preoccupation or obsession and defenses of denial, minimization and rationalization
Gambling and Trauma
~ In a twin cohort study, experiencing traumatic events increases the risk of having a gambling problem by up to 453%
~ Problem gamblers are 620% more likely to develop PTSD
~ Soldiers who are returning from deployment tend to have a greater propensity for risk taking and often have experienced trauma putting them at greater risk for the development of PG
Food Addiction in Gambling Disorder
~ Recent research supports the notion that food may have addictive potential in some individuals due to the increased potency of certain nutrients, palatability, or natural reward (i.e. dopamine and serotonin)
~ Palatable foods can mimic the neurophysiological and behavioral effects of addictive drugs
~ Systematic reviews confirm commonalties between GD and other behavioral addictions (including FA)
~ Impulsivity and compulsivity
~ Structural and functional abnormalities of networks involved in reward processing and top-down control
~ Alterations in neurochemical-neuroendocrine systems
~ Increased negative urgency, disinhibition and novelty seeking
~ Familial diathesis (history)
Food Addiction in Gambling Disorder
~ Distinct subtypes of GD patients described the as “disorganized and emotionally unstable”
~ The co-occurrence of FA in treatment-seeking GD patients is related to poorer emotional and psychological states
~ Higher ratio of FA was found in women
~ There was a higher risk of a FA diagnosis in patients with
~ High scores for
~ Harm avoidance (escape)
~ Self-transcendence: Unconventional, illogical, suspicious, and immature
~ Low scores in cooperativeness
Stigma
~ As a result of stigma, people with gambling problems attracted substantial negative stereotypes, social distancing, emotional reactions, and status loss/discrimination
~ Stigmatizing attitudes held toward people experiencing problem gambling
~ Impulsive
~ Irrational
~ Irresponsible
~ Untrustworthy
~ Unproductive
~ Greedy
~ Antisocial
Stigma
~ Stereotypes of “problem gamblers” are socially constructed from transmitted cultural beliefs rather than cognitively derived from direct interactions.
~ Culturally constructed stereotypes are more resistant to contradictory evidence and education campaigns, but increased contact with the stigmatized population appears to reduce stigma
~ Desired social distance increased with perceptions that problem gambling is caused by bad character, is perilous, non recoverable and disruptive, but decreased with perceptions that it is due to stressful life circumstances or a chemical brain imbalance
~ Individuals experiencing gambling problems have expressed aversion to being pitied, wanting instead to be treated like everybody else
Summary
~ Anti-reward processes, or the immediate, short term escape followed by worsening of the condition is very common in people with PTS.
~ People with pathological gambling disorder have higher PTS scores
~ Gambling is a high-risk behavior that people with bipolar disorder may undertake to escape depressive mood states or for excitement during manic states
~ Time-released lithium was found to improve gambling urges as well as emotional lability
~ People with alexthymia have difficulty identifying and therefore regulating their emotions. Gambling can provide an escape/numbing of unpleasant physiological or emotional states.

Pathological Gambling Disorder

Summary
~ Similar to other addictions, there is a high correlation between food addiction and gambling disorder.
~ In families where someone has pathological gambling disorder, there are significantly higher rates of domestic violence and child abuse.
~ Stigma often causes people to refuse to seek help.
~ Stigma regarding gambling appears to be largely culturally created
~ Exposure to people who have pathological gambling disorder to reduce othering shows the greatest promise for the reduction of stigma.