processes of recovery from problem gambling a qualitative exploration

Glasgow Theses Service http://theses.gla.ac.uk/ theses@gla.ac.uk Christine, Lyle (2014) Processes of recovery from problem gambling: a qualitative exploration. MPhil(R) thesis. http://theses.gla.ac.uk/5470/ Copyright and moral rights for this thesis are retained by the author A copy can be downloaded for personal non-commercial research or study, without prior permission or charge This thesis cannot be reproduced or quoted extensively from without first obtaining permission in writing from the Author The content must not be changed in any way or sold commercially in any format or medium without the formal permission of the Author When referring to this work, full bibliographic details including the author, title, awarding institution and date of the thesis must be given Processes of Recovery from Problem Gambling: A Qualitative Exploration by Lyle Christine BA (Hons), MRes Submitted in fulfilment of the requirements for the degree of Master of Philosophy (MPhil) School of Social and Political Sciences College of Social Sciences University of Glasgow April 2014 Statement of Originality I hereby certify that I am the sole author of this thesis and that no part of this thesis has been published or submitted for publication. I certify that, to the best of my knowledge, my thesis does not infringe upon anyone’s copyright nor violate any proprietary rights. All ideas, techniques, quotations, or any other material from the work of other people included in my thesis, published or otherwise, are fully acknowledged in accordance with the standard referencing practices. Lyle Christine ii Abstract Gambling addiction (also referred to as ‘problem gambling’ or ‘compulsive gambling’’) is a phenomenon which has escalated in parallel to the continuing popularity of gambling activities in many countries. While studies have documented the growth of commercial betting culture, there remains uncertainty regarding the most effective way to treat individuals who have developed compulsive problems with gambling. It is not fully understood what motivates gamblers to engage with a recovery option, and so exploration is required of how people recognise problematic behaviour, and what determines their choice of formal support or a self- help journey. Using a series of in-depth qualitative interviews, this study examines the experiences of 6 individuals with the aim to understand the complex factors surrounding their participation with betting activities. Of interest are the triggers which influence their decision to seek help, and the strategies these individuals adopted in order to control their gambling and avoid relapsing. Using thematic analysis and critical theory, the research material is organised and analysed in three categories of social networks, identity, and money, which allowed the significant concepts within the interviews to be compared against relevant literature. The overall analysis from this project adds validity to the emerging perspective that recovery from problem gambling is not a linear route from problematic to controlled behaviour, but is instead cyclical and unpredictable. For example, during the recovery period, a gambler’s perception of their own identity is not always viewed positively which results in progression being hindered by low self-esteem. Similarly, individuals often enter and exit support programmes multiple times due to situations of relapse or changes in living arrangements which interrupts therapy schedules. This study concludes that the recovery routes of professional support and self-help should not be considered as a strict “either/or” choice for individuals – successful treatment can be achieved from a blend of formal group settings and informal social networks. Furthermore, while the recovery process is certainly not simple due to the complexities involved with people’s lives, there do appear to be simplistic erroneous perceptions held by gamblers and other members of the public with regard to what treatment involves, and which services are available. Subsequently, a recommendation can be made for greater public awareness of compulsive addiction as a condition, and how to choose a suitable recovery program. iii Acknowledgements I would like to thank Professor Gerda Reith & Dr Matthew Waites for their advice, support and guidance throughout the course of this research project. Their constructive input enabled this study to reach high standards of quality, and it was a pleasure working with such accomplished academics. Additionally, a great level of support and compassion was given during times of difficulty resulting from severe health issues I experienced, and so I would also like to express gratitude to all the members of the department who were involved in ensuring my progression. The project would not have been possible without the individuals who volunteered themselves as research participants, so I am very appreciative of their time and contributions to the study. Also, a huge thanks to the Responsible Gambling Trust who awarded me the scholarship to conduct the investigation and develop my academic abilities. iv Table of Contents 1. Introduction 1 2. Literature Review 4 2.1 Introduction 4 2.2 Defining problem gambling 5 2.3 Understanding recovery 7 2.4 Realising problems 9 2.4.1 Identity 9 2.4.2 Finance and debt 12 2.4.3 Social networks 15 2.5 Approaches towards control and abstinence 17 2.5.1 Formal treatment 18 2.5.2 Natural recovery 19 2.5.3 Responsibility 20 2.6 Individual and Social impacts of gambling 21 2.7 Conclusion 24 3. Methodology 27 3.1 Approaches to gambling studies 27 3.1.1 Philosophical perspective 28 3.2 Research methodology 30 3.3 Data gathering 31 3.3.1 Field of Study 31 3.3.2 Participants 32 3.3.3 Interviews 35 3.4 Analysis of data 37 3.4.1 Thematic extraction 37 3.4.2 Critical Theory 38 3.4.3 NVivo 39 v 3.4.4 Coding & thematic analysis 39 3.4.5 Presentation of data 42 3.5 Ethics 42 3.6 Summary 44 4. Analysis 46 4.1 Social Networks 47 4.2 Identity 63 4.3 Money 80 5. Conclusion 90 References 96 Appendix 105 vi 1. Introduction For individuals who develop a problem with gambling activity, recovery is considered to be the main goal of professional or informal treatment. Current gambling research demonstrates that there is uncertainty regarding which methods of recovery are the most effective, with a specific lack of understanding on what motivates people to regain control of their disordered gambling behaviour (Abbott, Volberg, Bellringer, & Reith, 2004). This thesis explores this gap in knowledge by examining in-depth interviews with recovering problem gamblers with the aim to understand why and how individuals change their relationship with betting activities. The field of study for this research project is centred on people who have encountered difficulties with gambling behaviour and their experience of tackling these issues via a formal or informal recovery method. Formal recovery refers to peer support organisations such as Gamblers Anonymous or professional services that offer private therapy. Informal recovery is a self-help approach whereby individuals attempt to regain control of their gambling with little more than their own determination and the encouragement from a small selection of friends and family. There is much research material on recovery processes from alcohol and drug addiction which has been accumulated over many years (Orcutt & Rudy, 2003; Stimmel, 1984), and due to the significant recent growth of a deregulated gambling industry, issues surrounding problem gambling are also now the focus of many studies. Understanding the experience of recovery for problem gamblers contributes to the academic fields of sociology and psychology in addition to informing policies regarding public health. The factors which are considered to influence the success or failure of a journey towards recovery include the role of social networks such as family and friend; the individual’s socio-economic status; the ease of accessing support services; and any circumstances which are unique to an individual (Blaszczynski & Nower, 2002; Reith, 2008b). An emerging view within sociology describes the recovery process as a journey comprised of ‘cycles’ rather than as a strict linear route, in which a person moves in and out of stages of change (Prochaska, Norcross, & Diclemente, 1994) while attempting to regain control of their problematic behaviour. These stages represent an individual’s movement towards a restructured life, and evaluates personal circumstances such as their readiness to initialize a recovery period, or the consequence of setbacks such as relapse. Subsequently, the character of this model cycles through phases related to an individual’s behaviour rather than sharply starts and stops. 1 Individuals who wish to tackle a gambling problem have the choice to involve themselves with a professional, established support service or instead choose to address their issues without the assistance of a formal recovery programme. Formal counselling services have proven to be successful for some individuals and can also treat comorbid issues (co-occurring disorders) regarding alcohol or drug misuse. However, the advantages of these services are limited and it is estimated that less than one fifth of problem gamblers in the U.K. have approached a formal recovery service (Sproston, Erens, & Orford, 2000). In contrast to professional counselling is the choice to regain control through ‘natural recovery’ whereby an individual commits to controlling their gambling behaviour only supported by the strength of their own will and perhaps also with encouragement from family or friends (National Research Council, 1999). Current literature on the ‘natural recovery’ method lacks detail due to the difficulty in recruiting research participants to be interviewed, but the reasons to decline formal rehabilitation programs include a firm belief that the individual can solve the problem alone, a desire to avoid the stigma created by attending recovery clinics and a lack of knowledge with respect to what help is available (Hodgins & el-Guebaly, 2000). For people who decide to participate with a formal recovery procedure, there are different types of treatment to choose from such as cognitive behavioural therapy (CBT), group therapy and face-to-face counselling, but little has been published on what is considered to be the most effective method of intervention. While there is general agreement that some form of counselling is beneficial for an individual rather than having none, there is an absence of certainty regarding which treatment has the most effective outcome and at which stage of their gambling an individual should receive therapy (Toneatto & Ladoceur, 2003). There are suggestions that a recovery plan which is tailored to the needs of the gambler will have the highest chances of success whereby elements of multiple forms of therapy are assembled to create a unique support program specific to every person (Anderson, Dobbie, & Reith, 2009). Following this introduction, a literature review is presented which examines how ‘problem gambling’ is defined, and how committed individuals are to addressing their gambling issues which is measured by the ‘stages of change’ model. Identity, finance and debt are discussed as important factors of how people realise their gambling has escalated out of control, which is followed by an explanation of the formal and natural recovery approaches. Lastly, the social impacts of gambling are discussed which considers problems associated with family relationships, crime, and health. Following a review of significant literature, a methodology section explains the research approach used within the study and the rationale for these choices. The strategies for data 2 gathering are described which focuses on how participants were selected for the study, and the procedures involved with conducting qualitative interviews. The methodology chapter finishes with the details of how the research data was organised and analysed through thematic extraction, and the ethical considerations involved with conducting this type of project. Next, the analysis section focuses on the three main categories of social networks, identity and money which applies aspects of critical theory to passages from the interview transcriptions in order to make comparisons between the extracted themes and relevant literature. This precedes the final conclusion chapter in which the most important revelations from the study are presented, and suggestions for further investigation are made. 3 [...]... possibly attributed to cultural differences regarding approval of, and ease of access to, betting services (Alegr a et al., 2009) Raylu & Oei (2004) draw attention to several studies in which Maori of New Zealand, American Indians of North Dakota and Aboriginal groups in Canada all showed higher figures of problem gambling compared to the Caucasian population Also, betting habits of college students in America... America provided evidence that Asians have a rate of gambling participation approximately 3 times higher than that of African Americans and Caucasians with a similar figure produced from a study on Chinese gamblers in the general population (Raylu & Oei, 2004:1090-1092) Furthermore, The British Gambling Prevalence Survey (Wardle et al., 2011) revealed that problem gambling in the UK had increased from. .. unlikelihood of winning a jackpot large enough to lift anyone out of poverty The gambling industry relies on a customer base that lacks a full understanding of statistical risk and mathematical probability so that individuals become regular gamblers without developing a cynical opinion of betting (Collins, 2003) The mass popularity of gambling, and the delusional, irrational beliefs of players are aspects... insomnia, anxiety, headaches and stomach problems, which may also contribute to absenteeism” (Reith, 2006:43) 21 Such disharmony within a person’s state of mind can lead to suicidal thoughts and attempts to self-harm While higher than average rates of suicidal ideation are present among pathological gamblers, current research does not suggest that inherent characteristics of gambling activity are the... combinations and exact title queries, refined searches were Gambling Studies; Addiction Journal; American Journal on Addictions; The British Journal of performed digitally which returned the information required to assemble an accurate impression of the factors associated with gambling problems Location and dates were included as search criteria in order to compare a breadth of information, and an author’s... model has resonance with the emerging view of the recovery process from gambling addiction as cyclical rather than linear Thirdly, the realisation of gambling problems are considered from the areas of identity, debt and social networks: a duality of the ‘self’ can occur whereby an individual perceives their identity in terms of a gambling side and their ‘normal’ side; debt is often a trigger for gamblers... many years which demonstrates an instilled self-perception of the adage ‘once an addict, always an addict’ (Reith & Dobbie, 2012:518) It appears that some individuals embrace the aspect of their self as a gambler and feel this defines a core aspect of their identity regardless of how much time has passed since they last actually placed a bet Conversely, some people are not keen to affirm a status as... psychological view of problem gambling is a recent change in perspective which attempts to understand gambling within social and cultural structures, and how an individual’s behaviour is affected by such frameworks An article by Alex Blaszczynski and Lia Nower (2002) agrees that problem gambling presents an impairment of control for an individual but the journal contribution is also critical of the simplistic... methods of how the data is analysed with respect to organising and interpreting the interview material, attaching codes to and extracting themes from the data, and the role of how analytical software coordinates the information Ethical procedures and considerations constitute part five of this chapter which is then followed by a summary of the methodological perspective of the thesis 3.1 Approaches to gambling. .. While counsellors and healthcare advisors felt that attitudes towards and awareness of gambling addiction had improved over the last 15 years, gambling participants of the Downs & Woolrych (2006:77) study felt that there were still some social structures which lacked a comprehensive understanding of problem gambling such as in the criminal system Additionally, the fear of stigma is a reason given for . by an explanation of the formal and natural recovery approaches. Lastly, the social impacts of gambling are discussed which considers problems associated with family relationships, crime, and. & Zorland, 2007:8-9). Problem gambling does not have an entry in the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1980) but ‘pathological gambling . compared against relevant literature. The overall analysis from this project adds validity to the emerging perspective that recovery from problem gambling is not a linear route from problematic