The Centre for Urban Health Solutions

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Overview

This guide is for peers and professionals who work with people who are experiencing homelessness, precarious housing or extreme poverty, and who may also be experiencing problems with gambling. This guide has been developed to:

. increase your knowledge of problem gambling

. give you information and tools to identify when a person has gambling problems

. provide you with tips for talking to clients about gambling

. give you strategies that will help you to support people with gambling problems

. increase your knowledge of community supports and services for people with gambling problems.

Abstract

Engaging peer-interviewers in qualitative inquiry is becoming more popular. Yet, there are differing opinions as to whether this practice improves the research process or is prohibitively challenging. Benefits noted in the literature are improved awareness/acceptance of disenfranchised groups, improved quality of research, and increased comfort of participants in the research process. Challenges include larger investment in time and money to hire, train, and support peer-interviewers, and the potential to disrupt peer recovery. We illustrate, through case study, how to engage peer-interviewers, meet potential challenges, and the benefits of such engagement. We draw upon our experience from a qualitative study designed to understand men's experiences of problem gambling and housing instability. We hired three peers to conduct semi-structured qualitative interviews with 30 men from a community-based organization. We contend, that with appropriate and adequate resources (time, financial investment), peer-interviewing produces a positive, capacity building experience for peer-interviewers, participants and researchers.

Abstract

Background: Problem gambling and homelessness are recognized as important public health concerns that significantly impact individuals, their friends and families, communities and broader society. We aimed to explore the experiences with health and social services of men who had histories of problem gambling and housing instability in Toronto, Ontario.

Methods: We used a community-based participatory approach with a multi-service agency serving low-income individuals. We conducted qualitative interviews with men (n = 30) who had experienced problem gambling and housing instability. Our interviews employed open-ended questions to elicit men's perceptions of services related to housing instability, problem gambling and other comorbid conditions (e.g., mental illness, substance use). We reviewed relevant themes related to experiences with services (e.g., Use of and feedback on: health and social services, housing services, justice/legal aid services, substance use services, gambling services; stigma; goals; triggers; physical health; coping strategies; finances; relationships; barriers to services and recommendations for services).

Results: The concept of person-centred engagement was identified as a main overarching theme, and seemed to be lacking in most of the men's experiences of services. Person-centred engagement for these men entailed empowerment and autonomy; empathy, compassion and sincerity; respectful communication; and tailored and holistic life plans. While there was a strong emphasis placed on independence, the men identified the importance of positive therapeutic relationships as being critical aspects of the recovery process. Based on our analyses, several recommendations were identified: 1) Increasing general awareness of services for problem gambling; 2) Delivering integrated services in a one-stop-shop; 3) Addressing mental health with psychotherapy and pharmacotherapy; 4) Providing timely access to prevention and recovery services; and 5) Enhancing life skills with peer support.

Conclusions: Our study highlighted that most of the men we interviewed were not having their health and social needs met. Services need to address the intersection of problem gambling, housing instability, and other comorbidities. Ensuring services are grounded in person-centred engagement appears to be critical for optimal service delivery

Abstract

Most of the research on gambling behaviour among youth has been quantitative and focused on measuring prevalence. As a result, little is known about the contextual experiences of youth gambling, particularly among those most vulnerable. In this paper, we explore the previous experiences of youth gambling in a sample of adult men experiencing housing instability and problem gambling. We present findings from a qualitative study on problem gambling and housing instability conducted in Toronto, Canada. Thirty men with histories of problem or pathological gambling and housing instability or homelessness were interviewed. Two thirds of these men reported that they began gambling in youth. Five representative cases were selected and the main themes discussed. We found that gambling began in early life while the men, as youth, were also experiencing adversity (e.g., physical, emotional and/or sexual abuse, neglect, housing instability, homelessness, substance addiction and poverty). Men reported they had access to gambling activity through their family and wider networks of school, community and the streets. Gambling provided a way to gain acceptance, escape from emotional pain, and/or earn money. For those men problematic gambling behaviour that began in youth, continued into adulthood.

Abstract

Background: Men and women differ in their patterns of help-seeking for health and social problems. For people experiencing problem gambling, feelings of stigma may affect if and when they reach out for help. In this study we examine men's and women's perceptions of felt stigma in relation to help-seeking for problematic gambling.

Methods: Using concept mapping, we engaged ten men and eighteen women in group activities. We asked men and women about their perceptions of the pleasurable aspects and negative consequences of gambling; they generated a list of four hundred and sixteen statements. These statements were parsed for duplication and for relevance to the study focal question and reduced to seventy-three statements by the research team. We then asked participants to rate their perceptions of how much felt stigma (negative impact on one's own or family's reputation) interfered with help-seeking for gambling. We analyzed the data using a gender lens.

Findings: Men and women felt that shame associated with gambling-related financial difficulties was detrimental to help-seeking. For men, the addictive qualities of and emotional responses to gambling were perceived as stigma-related barriers to help-seeking. For women, being seduced by the 'bells and whistles' of the gambling venue, their denial of their addiction, their belief in luck and that the casino can be beat, and the shame of being dishonest were perceived as barriers to help-seeking.

Conclusions: Efforts to engage people who face gambling problems need to consider gendered perceptions of what is viewed as stigmatizing.

Abstract

Given the preponderance of Gamblers Anonymous (GA), there has been relatively little effort to explore the existing evidence base on its effectiveness as a recovery approach for problem gambling. To remedy this gap in the literature we conducted a scoping review of the literature on mutual aid for individuals experiencing problem gambling published between 2002 and 2015. We searched 13 databases and reviewed reference lists and websites of relevant organizations. We reviewed records for eligibility and extracted relevant data from eligible articles. Three reviewers independently assessed the methodological quality of the included studies using the Mixed Methods Appraisal Tool. We identified 17 studies in 25 publications that were eligible for inclusion. Most studies were conducted in the United States, were cross-sectional in design, and involved both male and female adult participants. Results indicate that the evidence for the effectiveness of GA either as a control condition or in conjunction with formal treatment or medication is inconsistent. An emphasis on patience, using the Serenity Prayer as a way to gain acceptance of financial matters and reality, and absolute assertion of identity as a ''compulsive gambler'' were identified as important aspects of GA's recovery culture. There is a need for large-scale randomized controlled trials to determine GA's effectiveness, as well as research exploring the mechanisms through which GA works, barriers to GA as a recovery approach, and the status of women in the fellowship.