Jim Orford

Sociodemographic Correlates of Internet Gambling: Findings from the 2007 British Gambling Prevalence Survey

This study provides the first analysis ever made of a representative national sample of Internet gamblers. Using participant data from the 2007 British Gambling Prevalence Survey (n = 9,003 adults aged 16 years and over), all participants who had gambled online, bet online, and/or used a betting exchange in the last 12 months (n = 476) were compared with all other gamblers who had not gambled via the Internet. Overall, results showed a number of significant sociodemographic differences between Internet gamblers and non-Internet gamblers. When compared to non-Internet gamblers, Internet gamblers were more likely to be male, relatively young adults, single, well educated, and in professional/managerial employment. Further analysis of DSM-IV scores showed that the problem gambling prevalence rate was significantly higher among Internet gamblers than among non-Internet gamblers. Results suggest that the medium of the Internet may be more likely to contribute to problem gambling than gambling in offline environments.

Coping with Alcohol and Drug Problems: The Experiences of Family Members in Three Contrasting Cultures

This is an invaluable resource from leading commentators. The experiences of family members living with alcohol and drug misusers are examined via the literature and a three-centre study in Australia, England and Mexico.

Social behaviour and network therapy: Basic principles and early experiences

The present paper reports on the basic principles of a treatment approach currently being used in a National Multicentre Randomised Controlled Trial of Alcohol Treatments in the United Kingdom (UK Alcohol Treatment Trial). The treatment: Social Behaviour and Network Therapy (SBNT) is novel as a package but has been developed by integrating a number of strategies found to be effective in other treatment approaches. The intervention is based on the notion that to give the best chance of a good outcome people with serious drinking problems need to develop positive social network support for change. A brief review of the evidence supporting social treatments for alcohol problems is followed by an outline of the feasibility work and the basic principles that guided the development of SBNT. Process data from the first 33 trial cases and 2 case vignettes are described and discussed. It is concluded that SBNT is a feasible and coherent treatment approach that can be delivered by a range of therapists in the alcohol field.

The experiences of affected family members: a summary of two decades of qualitative research

This article is based upon the collective findings of a number of studies conducted in a number of countries during the past 20 years. Female partners and mothers are the family members who have been most represented in the study samples, but the latter also included sizeable numbers of male partners, fathers, sisters, brothers and adult sons and daughters. Citing examples taken from the studies, the article describes some of the most prominent elements of the stressful experience of living with a relative who is drinking or taking drugs excessively, notably: the relationship with a relative becoming disagreeable and sometimes aggressive; conflict over money and possessions; the experience of uncertainty; worry about the relative; and home and family life being threatened. The reasons why family members may put up with substance misuse are described, and the ways in which family members may either withdraw and gain independence or stand up to substance misuse, as alternative ways of coping, are outlined. Examples of the strain experienced by family members are given. The kinds of social support valued by family members are explained, as is the finding that good quality social support for family members is often lacking. The article concludes by offering an integrated view highlighting the disempowered position in which family members usually find themselves and the importance of good social support for family members in their coping efforts. Although the picture is coloured by factors such as sociocultural group and the ages and genders of family members and their relatives, we believe the core experience for affected family members is a universal one.

Addiction in the family is a major but neglected contributor to the global burden of adult ill-health

This paper offers a conceptual overview of a neglected field. Evidence is presented to suggest that, globally, addiction is sufficiently stressful to cause pain and suffering to a large but uncounted number of adult affected family members (AFMs), possibly in the region of 100 million worldwide. A non-pathological stress-strain-coping-support model of the experience of AFMs is presented. The model is based on research in a number of different sociocultural groups in Mexico, England, Australia and Italy and aims to be sensitive to the circumstances of AFMs in low and middle income countries and in minority ethnic and indigenous groups as well to those of majorities in wealthier nations. It highlights the social and economic stressors of many kinds which AFMs face, their lack of information and social support, dilemmas about how to cope, and resulting high risk for ill-health. The public sector and personal costs are likely to be high. Attention is drawn to the relative lack of forms of help designed for AFMs in their own right. A 5-Step form of help aiming to fill that gap is briefly described. Family members affected by addiction have for too long been a group without a collective voice; research and action using the model and method described can make a contribution to changing that state of affairs.

Defining the online gambler and patterns of behaviour integration: evidence from the British Gambling Prevalence Survey 2010

This paper presents data from the British Gambling Prevalence Survey (BGPS) 2010, a large-scale random probability survey of adults (n = 7756), to examine how people gamble and ways in which online and offline gambling are integrated. Fourteen per cent of respondents were past year Internet gamblers (7% if purchase of lottery tickets online is excluded). The majority of online gamblers were also offline gamblers and a broader taxonomy of gambling subgroups was evident. This included those who chose different mediums of access for different activities and those who gambled online and offline on the same activity (mixed mode gamblers). These mixed mode gamblers had the highest rates of gambling involvement and higher problem gambling prevalence rates. Direct comparisons between Internet and non-Internet gamblers therefore ignore key questions of how people integrate online provisions with offline activities which may have important implications for our understanding of the relative risks associated with online gambling.

Family Members Affected by a Close Relative's Addiction: the Stress-Strain- Coping-Support Model

This article outlines the stress-strain-coping-support (SSCS) model which underpins the whole programme of work described in this supplement. The need for such a model is explained: previous models of substance misuse and the family have attributed dysfunction or deficiency to families or family members. In contrast, the SSCS model assumes that having a close relative with a substance misuse problem constitutes a form of stressful life circumstances, often longstanding, which puts affected family members at risk of experiencing strain in the form of physical and/or psychological ill-health. Coping and social support are the two other central building blocks of the model. Affected family members are viewed as ordinary people faced with the task of coping with such stressful life circumstances. It is an assumption of the model that, difficult though the coping task is, family members need not be powerless in maintaining their own health and helping their relatives. Good quality social support, in the form of emotional support, good information and material help, is an invaluable resource for affected family members, supporting their coping efforts and contributing positively to their health. The 5-Step Method, to be described later in the supplement, is based on the SSCS model. It can be seen as a way of increasing the positive social support available from professional sources.

PGSI and DSM-IV in the 2007 British Gambling Prevalence Survey: reliability, item response, factor structure and inter-scale agreement

Data from the 2007 British Gambling Prevalence Survey were used to examine the psychometric properties of the two problem gambling scales used in the survey: the Canadian Problem Gambling Severity Index (PGSI) and a DSM-IV-based scale. Analysis was based on those who reported any gambling in the past 12 months (between 5483 and 5528 participants for most analyses). The PGSI gave evidence of high internal reliability, uni-dimensionality, and good item-response characteristics. Several PGSI items showed extreme male to female endorsement ratios and a possible conclusion is that the PGSI is under-estimating the prevalence of problem gambling among women. The DSM-IV-based scale showed only satisfactory internal reliability, evidence suggesting bi-dimensionality, and poor performance of at least two items: those relating to gambling-related crime and ‘chasing losses’. The results also suggest that, for population survey purposes, problem gambling/non-problem gambling might best be viewed as lying on a continuum.

Negative public attitudes towards gambling: findings from the 2007 British Gambling Prevalence Survey using a new attitude scale

A new 14-item scale of general attitudes towards gambling (the Attitudes Towards Gambling Scale: ATGS) was developed for use in the 2007 British Gambling Prevalence Survey. The development of the scale is described. Based on the responses of a representative sample of 8880 people of 16 years of age or more, evidence is presented of good internal reliability and statistically significant associations with a range of socio-demographic, own and family gambling and lifestyle variables. Overall, and in all sub-groups except the heaviest gamblers, attitudes were found to be negative: more people believed that gambling is foolish and dangerous, and of greater harm than benefit to families, communities and society as a whole, than the reverse. The majority, however, were against prohibition of gambling. Public opinion appears to be out of line with the view of gambling in Britain that lay behind the 2005 Gambling Act. It will be of interest to see whether attitudes change in the forthcoming years. The ATGS is a suitable measure for use in future surveys in the UK and in other English speaking countries.

The relative efficacy of two levels of a primary care intervention for family members affected by the addiction problem of a close relative: a randomized trial

OBJECTIVES A randomized trial to compare two levels of an intervention (full versus brief) for use by primary health-care professionals with family members affected by the problematic drug or alcohol use of a close relative. DESIGN A prospective cluster randomized comparative trial of the two interventions. SETTING A total of 136 primary care practices in two study areas within the West Midlands and the South West regions of England. PARTICIPANTS A total of 143 family members affected by the alcohol or drug problem of a relative were recruited into the study by primary health-care professionals. All recruited family members were seen on at least one occasion by the professional delivering the intervention and 129 (90 %) were followed-up at 12 weeks. MAIN OUTCOME MEASURES Two validated and standardized self-completion questionnaires measuring physical and psychological symptoms of stress (Symptom Rating Test) and behavioural coping (Coping Questionnaire) experienced by the family members. It was predicted that the full intervention would show increased reduction in both symptoms and coping when compared to the brief intervention. RESULTS The primary analysis adjusted for clustering, baseline symptoms and stratifying variables (location and professional group) showed that there were no significant differences between the two trial arms. The symptom score at follow-up was 0.23 [95% confidence interval (CI): -3.65, +4.06] higher in the full intervention arm than in the brief intervention arm, and the coping score at follow-up was 0.12 (95% CI: -5.12, +5.36) higher in the full intervention arm than in the brief intervention arm. CONCLUSIONS A well-constructed self-help manual delivered by a primary care professional may be as effective for family members as several face-to-face sessions with the professional.