Vol. #14, No. 12
Welcome to the March edition of Tips and Topics. March is Problem Gambling Awareness Month. March means it’s time to #HaveTheConvo during Problem Gambling Awareness Month (#PGAM)!
NEW this month – There are now links to social media at the end of Tips & Topics (see at the end)
David Mee-Lee M.D.
March is Problem Gambling Awareness Month, a local and national campaign to heighten awareness to the issue of problem gambling with this year’s theme being “Have the Conversation.”
In the April 2016 edition of Tips and Topics, I wrote about Gambling Disorder – why consider it; getting real about screening and assessment, health coverage, staff credentials and competence, and filling treatment gaps. You can see more at: April 2016 Tips & Topics
In honor of Gambling Awareness Month, two guest writers are leading the conversation on gambling in Tips and Topics this month: Daniel J. Trolaro who is the Assistant Executive Director and George Mladenetz, Treatment Coordinator for the Council on Compulsive Gambling of NJ (CCGNJ).
George writes first about the impact of stigma with respect to Gambling Disorder and other addictive disorders.
What is stigma; and why it is important to know about stigma when working with gambling disordered individuals.
- A mark or sign of a perceived deviation from the norm; entails shame and discreditation.
- Stigma comes from within, from the public, even from the Recovery and Treatment communities.
Why it is important to know about stigma:
- Most experts agree the biggest barrier to addiction treatment faced by individuals is stigma. This serves as a major barrier to problem acknowledgement, disclosure, treatment-seeking and recovery (Hing, N. Russell, A., Gainsbury, S., Nuske, E. Journal of Gambling Studies 2016; 32:847-864).
- For 6-9 million Americans, gambling is a damaging behavior which can harm relationships, family life and careers (SAMHSA). Blog on Gambling Disorder
- It is estimated only about 9% of individuals with gambling disorder ever make it to treatment. It is believed stigma has much to do with this.
- Many individuals experiencing gambling disorder say the stigma they face is often worse than the disorder.
- People with gambling problems feel ashamed and stupid and believe other people perceive them as stupid, selfish, people who hurt their families (Dr. Annie Carrol, Australian National University, Center for Gambling Research).
- Research indicates problem gambling is not well understood by the community in the way substance use disorders are; this also contributes to stigma associated with having a gambling problem.
Be mindful of stigma and words. Here are some examples of stigma in Gambling and Substance Use Disorders.
Stigma and Words
- Stigmatizing words often devalue, discourage, isolate, misinform, shame and embarrass.
- Better language can advance people’s understanding of gambling disorder as a public health issue, a psychological disorder, which is treatable.
- Words have power – “they have the power to teach, the power to wound, the power to shape the way people think, feel and act towards others.” (Otto Wahl)
Examples of Gambling and Substance Use Disorder Stigma
- Defining individuals by their disorder, e.g., gambling addict; degenerate gambler; gamblerholic; alky; junkie; pothead
- Hurtful words and comments, e.g., “You are a degenerate gambler!”
- Sensationalizing gambling addiction, e.g., National Enquirer stories about Ben Affleck, Michael Jordan, Pete Rose and Charles Barkley gambling excessively.
Combat stigma by changing our language to recovery terminology.
Combating Stigma – Watch our language!
- The term “addict” is frequently used with individuals suffering from gambling disorder or other types of addiction.
- It is not for counselors and others to define how individuals who have gambling disorder and/or substance use disorder or those in recovery choose to identify themselves.
- For many people in early recovery, the term “addict” is a helpful way of identifying symptoms and issues and finding a way to connect in a healthy way to promote change.
- However, the “addict” label suggests the whole person is the problem rather than the problem being the problem.
We can take a stand against stigma by changing the way we think, talk about and treat people with gambling addiction.
Language of Recovery
“The most respectful way of referring to people is as people.” (ATTC Southeast HHS Region 4, 2012)
Current – Alex is a gambling addict.
Alternative – Alex is a person with gambling disorder.
Reasoning – Put the person first; avoid defining the person by his/her disease.
Current – Jennifer is in denial about her gambling disorder.
Alternative – Jennifer hasn’t internalized the seriousness of her gambling disorder.
Reasoning – Remove the blame and stigma from the statement.
Current – Mark has to attend Gamblers Anonymous and other self-help groups while in treatment.
Alternative – Mark has to attend Gamblers Anonymous and other mutual aid groups while in treatment.
Reasoning – Removing the stigma and using a strength-based term (ATTC Southeast HHS Region 4, 2012)
How to create “Gambling Stigma Reduction Initiatives”
Here’s what it takes to create “Gambling Stigma Reduction Initiatives”:
- Understand the “whys” problem gambling is stigmatized.
- Gain knowledge of how characteristics of gambling disorder and individuals suffering from gambling disorder are publicly perceived.
- Implement the theme of this year’s National Problem Gambling Awareness Month – “Have the Conversation.” Engage clients experiencing substance use disorders and/or mental health disorders to determine if they also might be involved in problem gambling.
- Use de-stigmatizing language in order to help them feel more at ease in disclosing their gambling habits and possible gambling related problems.
- Communicate positive stories of people with gambling disorder to address the social stigma of gambling addiction.
- At a structural level, implement training and education programs targeting community partners, professionals, social workers, substance use disorder professionals, teachers and even medical school students to change gambling stigma.
- At a personal level, talk about gambling addiction amongst our friends and family members to hopefully address the misperceptions about gambling disorder, treatment options and long term recovery.
Bio: George Mladenetz has worked in the field of substance use disorder and mental health for over thirty years within the New Jersey Department of Human Services, Division of Mental Health & Addiction Services. George possesses a Master’s degree in Counseling from Trenton State College (currently The College of New Jersey). He has been licensed as a Clinical Alcohol and Drug Counselor (LCADC) since 2005 and is an International Certified Gambling Counselor (ICGC- I). As Treatment Coordinator for the Council on Compulsive Gambling of NJ (CCGNJ), he monitors the operations of eight (8) subcontracted treatment providers who serve disordered gamblers and/or family members/significant others. George’s experience in working in the addiction treatment field has helped him realize how important it is that individuals entering treatment for any type of disorder be screened for gambling disorder as too often the “hidden illness” of gambling disorder goes undetected.
- Central East Addiction Technology Transfer Center Network. Anti-Stigma Toolkit: A Guide to Reducing Addiction-Related Stigma, 2012.
- CSAT, Substance Use Disorders: A Guide to the Use of Language, revised April, 2004
- Hing,N., E.Nuske, S. Gainsbury, A. Russell. Perceived Stigma and Self-Stigma of Problem Gambling: Perspectives of People with Gambling Problems. International Gambling Studies, Vol. 16, Issue 1, 2016.
- Livingston, J.D., T. Milne, M.L. Fang, E. Amari. The Effectiveness of Intervention for Reducing Stigma Related to Substance Use Disorders: A Systematic Review. Addiction (Abington, England) 107 (1) 39-50, 2012.
- Massachusetts.gov The Official Website of the Office of Health and Human Services. State Without Stigma. Retrieved from “Stop Addiction; State Without Stigma,” 2012.
- Mee-Lee, D. Tips and Topics, Vol. 14, No. 1, April, 2016. https://www.changecompanies.net/blogs/tipsntopics/2016/04/
- Petry, N.M. Pathological Gambling. American Psychological Association, 2006.
- Office of National Drug Control Policy. Changing the Language of Addictions. Announcement for Public Comments, 2016.
- Southeast Addiction Technology Transfer Center Network. The Most Respectful Way of Referring to People is as People, 2016.
Daniel echoes the theme for this year’s Problem Gambling Awareness Month for having the conversation about gambling.
Because gambling is considered an invisible addiction, addiction and mental health counselors are encouraged to screen for gambling disorder.
Why an “invisible” addiction?
- There are no smells or track marks easily identifiable.
- There are no blood tests, urine screens or hair follicles to detect gambling disorder.
- Gambling Disorder is officially classified in DSM-5 by the American Psychiatric Association as an addictive disorder, though gambling problems can easily be camouflaged as ordinary and unremarkable behavior.
When clinicians and counselors screen for gambling disorder, this leads them to “have the conversation” with their clients; otherwise, it may go undetected.
Family members can “have the conversation” with those who show signs of gambling disorder.
Problem gambling is a public health issue. It affects relationships, families, businesses and communities. Because Gambling Disorder can be camouflaged as other problems, families and communities might not see gambling as the problem in:
- Health issues (physical and emotional)
- Increased risk of suicide
- Increased domestic violence
- Financial losses and bankruptcies
- Workplace issues
Individuals who find gambling is causing negative consequences in their life can “have the conversation” with gambling helplines to direct them to valuable resources that can help.
If you or someone you care about has a gambling problem, call 800-GAMBLER or visit us on the web at www.800gambler.org for additional information and resources. Support, treatment, and hope is available 24 hours a day.
Legislators and the gambling industry can “have the conversation” with each other and with State Gambling Councils, to better understand how to minimize harm while identifying and employing responsible gaming strategies. Gambling problems are too devastating to individuals and society to allow them to go unnoticed and unattended. We all need to have the conversation!
Bio: Daniel J. Trolaro is the Assistant Executive Director for the NJ Council on Compulsive Gambling. He graduated from The College of New Jersey with a BS in Finance and a concentration in Economics. He also holds his MS in Psychology from California Coast University. Dan has spoken around the state and country about internet and mobile device gambling, emerging trends and the warning signs for disordered gambling. Whether speaking on treatment options, prevention strategies, responsible gaming or recovery resources, Dan discusses the concept of addiction switching, co-occurrence, and behaviors associated with this devastating addiction.
A couple of months ago, I ran into a new neighbor who had just moved next door. We exchanged neighborly greetings. When he heard my work focused on addiction, he told me of an article he had just read in the December 2016 issue of The Atlantic, “How Casinos Enable Gambling Addicts”.
It is a comprehensive article and you may not get time to digest it all in one sitting. But it is well worth the education on the not-so-innocent big gaming industry. At the very least, follow Scott Stevens’ story.
“On the morning of Monday, August 13, 2012, Scott Stevens loaded a brown hunting bag into his Jeep Grand Cherokee, then went to the master bedroom, where he hugged Stacy, his wife of 23 years. “I love you,” he told her…….” Don’t miss the rest of the story at The Atlantic article on compulsive gamblingThe Atlantic December 2016
Addiction is such a devastating illness. For so many, those afflicted by addiction themselves or as family and friends, it just seems bad behavior that they should just stop. If only it were that simple.
We’re becoming a little better at empathy and understanding for people with addiction manifested as a substance use disorder. When it come to gambling disorders, we are not there yet….it’s just as cunning and baffling and devastating as substance-related disorders.
Ask the family of Scott Stevens.
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