Elaine Nuske

The Public Stigma of Problem Gambling: Its Nature and Relative Intensity Compared to Other Health Conditions

Problem gambling attracts considerable public stigma, with deleterious effects on mental health and use of healthcare services amongst those affected. However, no research has examined the extent of stigma towards problem gambling within the general population. This study aimed to examine the stigma-related dimensions of problem gambling as perceived by the general public compared to other health conditions, and determine whether the publicly perceived dimensions of problem gambling predict its stigmatisation. A sample of 2000 Australian adults was surveyed, weighted to be representative of the state population by gender, age and location. Based on vignettes, the online survey measured perceived origin, peril, concealability, course and disruptiveness of problem gambling and four other health conditions, and desired social distance from each. Problem gambling was perceived as caused mainly by stressful life circumstances, and highly disruptive, recoverable and noticeable, but not particularly perilous. Respondents stigmatised problem gambling more than sub-clinical distress and recreational gambling, but less than alcohol use disorder and schizophrenia. Predictors of stronger stigma towards problem gambling were perceptions it is caused by bad character, is perilous, non-recoverable, disruptive and noticeable, but not due to stressful life circumstances, genetic/inherited problem, or chemical imbalance in the brain. This new foundational knowledge can advance understanding and reduction of problem gambling stigma through countering inaccurate perceptions that problem gambling is caused by bad character, that people with gambling problems are likely to be violent to other people, and that people cannot recover from problem gambling.

All in the family: help-seeking by significant others of problem gamblers

Problem gambling can significantly affect the lives of concerned significant others (CSOs) of problem gamblers, especially family members, but little is known about their help-seeking activities and experiences. This paper explores help-seeking by CSOs of problem gamblers and their related motivators and barriers. A telephone interview was administered to 48 CSOs who called an Australian gambling helpline seeking assistance for themselves and/or a person with gambling problems. Key motivators for seeking help (through helplines, non-professional sources, and self-help measures) were concerns the gambling might become a major problem, negative emotions, problems maintaining normal daily activities, concerns for dependents’ welfare, and health concerns. Barriers included wanting to solve the problem on their own, and shame. Findings highlight the need to better equip CSOs to assist both the person with gambling problems towards treatment and recovery and to protect their own physical, emotional, social and financial wellbeing.

Perceived stigma and self-stigma of problem gambling: perspectives of people with gambling problems

Abstract Minimal research has investigated the stigma associated with problem gambling, despite its major hindrance to help-seeking and recovery. This study explored perceived stigma and self-stigma to examine stigmatizing beliefs held, how they may be internalized, coping mechanisms, and effects on help-seeking. In-depth interviews with 44 people experiencing gambling problems were analysed using interpretive phenomenology. Results revealed an overwhelming perception that problem gambling attracts acute public stigma and is publicly viewed as caused by personal failings. Participants had serious concerns about being viewed as ‘a problem gambler’, fearing demeaning stereotypes, social rejection, hostile responses and devaluing behaviours. Many participants internalized perceived stigma as self-stigma, with deleterious reported effects on self-esteem, self-efficacy, perceived social worth, and mental and physical health. Deep shame was a near universal emotion and exacerbated by relapse. Secrecy was the main coping mechanism used, with perceived and self-stigma found to act as major barriers to disclosure and help-seeking. The findings can inform the development of a valid understanding and conceptualization of problem gambling stigma. This is a prerequisite for effective stigma-reduction strategies to reduce public stigma and discrimination, and to lower perceived and self-stigma and increase the use of treatment services and other interventions by people with gambling problems.

Impacts of gambling problems on partners: partners’ interpretations

Partners can be especially vulnerable to the negative effects of gambling problems, but little research has sought to understand partners’ experiences from their own unique perspectives. This qualitative interpretive study explored the impacts of gambling problems on partners. In-depth interviews were conducted with 18 partners and ex-partners of people with gambling problems to understand their experiences of gambling problems from their perspectives. The findings showed that partners experienced a wide range of negative effects, especially on their financial security, their emotional, mental and physical health, and on their relationships. The financial impacts of gambling problems on partners were substantial and far-reaching. Some partners were forced to take up extra employment to cover household expenses and pay off gambling-related debts. Others lost their savings, homes, belongings and established ways of life. While these impacts were extensive, partners also experienced a range of emotional impacts that were equally devastating. Their gambling partner’s lies, dishonesty and concealment of problems and gambling behaviour created considerable distress, loss of trust and a sense of betrayal. These experiences undermined these partners’ sense of self-identity, and created additional conflicts within their relationships. Along with accumulating mental and physical health impacts, these challenges lead to separation and/or divorce for many participants. These findings point to the need for greater understanding of partners’ experiences and public health initiatives that protect partners and their families from the harmful effects of gambling problems.

The Self-Exclusion Experience for Problem Gamblers in South Australia

Abstract Increased prevalence of problem gambling has accompanied the spread of gaming venues in many parts of the world. One intervention to minimise the impact of harmful patterns of gambling behaviours is self-exclusion, where patrons can elect to ban themselves from a gaming venue or its gaming facilities for a specified time period. While self-exclusion programs are widely available, little research has been conducted into their operations and efficacy, particularly from the self-excluders’ perspective. This paper presents findings from 35 survey responses and 23 interviews with gamblers who had self-excluded through a centralised service in South Australia. They identified key program shortcomings as low publicity, limits on how many venues they could self-bar from, and inadequate venue monitoring for breaches of self-barring orders. Nevertheless, the centralised service, staffed by trained psychologists and located away from gaming venues, which allows multiple venue barring in one application, appeared advantageous over programs that require people to self-exclude directly from individual gaming venues. Most respondents (85%) had ceased or lessened their gambling in the 12 months following self-barring. Nevertheless, some continued to struggle to manage their gambling, reflected in breaches of their orders and gambling in venues from which they were not excluded.

All mixed up together: women’s experiences of problem gambling, comorbidity and co-occurring complex needs

While there has been minimal recent gendered gambling research conducted in Australia and elsewhere, there is some evidence to suggest that gender differences do exist in various ways including gambling motivations such as gambling used as a coping strategy to alleviate or ‘escape’ from stress and anxiety, help-seeking and prevalence of comorbidity. In this Australian qualitative study we explored the experiences and concerns of 20 women electronic gaming machine players through in-depth interviews. Ten women self-identified as recreational gamblers and 10 had received help for their gambling. We present findings as they relate to specific issues of comorbidity and complex needs. For the 10 women who had received gambling help the range of comorbid issues was extensive. Greater understandings of the range of complex issues often involved for women who gamble problematically will assist in the identification of moving from recreational to problem gambling and in the implementation of effective treatment strategies.

Balancing contradictions: the experiences of biological children of foster families

This paper presents findings from a recent research project that provided an opportunity for the voices of a special group of young people to be heard. The biological children of foster families have rarely been the focus of foster care research. Their stories are used in this study to highlight individual experiences and, ultimately, to inform the practice of offering support to foster families. Twenty-two young people between the ages of nine and thirty-two were interviewed. Their stories told of life in a confusing and contradictory world of foster care. This paper presents, through the words of the young people, four essential themes that highlight these contradictions. These are: sharing and losing; being responsible and escaping; caring and resenting; shouting and keeping quiet. Recommendations are made to improve training and support to foster families.

Responding to problem gamblers in the venue: role conflict, role ambiguity, and challenges for hospitality staff

In this article the authors explore the challenges experienced by gaming venue employees in Queensland Australia in responding to patrons with gambling problems. Forty-eight in-depth interviews were analyzed using thematic analysis. Challenges identified include embarrassment for both staff and patrons, emotional labor for employees, difficulties in identifying problem gamblers, and concerns about invading the patrons privacy, losing the patrons business, getting in trouble with their manager, and receiving an angry patron response. Aligning their responsible gambling obligations with the expectations of management, patrons, significant others, and their own capabilities can potentially cause substantial role conflict and role ambiguity for frontline venue staff.

Assisting problem gamblers in the gaming venue: a counsellor perspective

Governments now recognise gambling as a social and public health issue that invites a collaborative approach to responsible gambling and help-seeking involving the gambling industry, gambling help agencies and the wider community. In this paper, we report on findings from interviews with 23 counsellors working in Queensland Gambling Help agencies in Australia based on their own and their clients’ experiences of the processes and practices involved in help seeking in gaming venues. An aim of this study was to establish how venues interact with local gambling help agencies to provide assistance to patrons with gambling problems and the way that venue staff respond. It identified gaps in relevant staff skills and responsible gambling training, particularly the barriers to providing appropriate assistance to problem gamblers, and best practice examples. The barriers to seeking assistance included: patrons feeling shame; issues of confidentiality; and lack of awareness of help available at gaming venues.

A Process Evaluation of a Self-Exclusion Program: A Qualitative Investigation from the Perspective of Excluders and Non-Excluders

This paper draws on a process evaluation of Queensland’ self-exclusion program to examine how people use the program, motivations for self-excluding, barriers to use, experiences and perceptions of program elements, and potential improvements. Detailed, reflective, first-person accounts were gathered through interviews with 103 problem gamblers, including excluders and non-excluders. Identified strengths include the program’s widespread availability. Many self-excluders reported positive experiences with responsive, knowledgeable, respectful venue staff. Major weaknesses include low publicity, limited privacy and confidentiality, the need to exclude individually from venues, and deficiencies in venue monitoring for breaches, which hinder the program’s capacity to meet harm minimisation objectives. While the program reaches some problem gamblers, others are delayed or deterred from self-excluding by low awareness, shame and embarrassment, difficulties of excluding from multiple venues, and low confidence in venue staff to maintain confidentiality and provide effective monitoring. Potential improvements include wider publicity, off-site multi-venue exclusion, and technology-assisted monitoring.