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Problem gambling

CALD Child and Adolescent Mental Health Resource

eCALD Supplementary Resources

“Pathological gambling” refers to a condition in which individuals meet five or more Diagnostic and Statistical Manual V (DSM-V) criteria (APA, 2013a). A person suffering from pathological gambling shows persistent and recurrent maladaptive gambling behavior, resulting in dysfunctions in the areas of work, studies, and social and family relationships. Whereas “problem gambling” refers to a condition in which a person meets three or four DSM-V criteria, and the person has the following problems: high rates of gambling-related fantasy, lying, using gambling to escape, and preoccupation about gambling, “disordered gambling” is used to describe the combination of problem and pathological gambling. Disordered gambling is associated with substantial interpersonal, financial, and legal difficulties, coupled with increased levels of substance abuse, mood and anxiety disorders, and suicidality in some cases (Alegria, 2009).

International studies show that Asian families are disproportionately affected by problem gambling (Blaszczynski, et al., 1998; Cultural Partners Australia Consortium, 2000; Loo et al., 2008; Petry, Armentano, Kuoch, Norinth, & Smith, 2003; Sobrun-Maharaj et al., 2012, Tse et al., 2010). Among Asian groups, Asian people from refugee backgrounds (Marshall, et al., 2009; Petry, et al., 2003) and international students (Gambling Research Australia, 2011; Li, 2008; Li, 2006) are more vulnerable to gambling related disorders (Marshall, et al., 2009; Petry, et al., 2003). In New Zealand, Asian groups from refugee backgrounds include South-East Asians: Laotians, Vietnamese, Cambodian and Burmese groups.

Asian youth gambling behaviours

The New Zealand Youth ’12 survey included youth gambling behaviours (Rossen, et al., 2013). The results for Asian youth are drawn from the nationally representative survey of secondary school students conducted in 2012. Youth’12 surveyed a large randomly-selected sample of secondary school students. The following results are based on the 1051 Asian students in the study in comparison with the 4024 New Zealand European students. Asian young people included students who identified as Filipino, Chinese, Indian, Japanese, Korean, Cambodian, or ‘Other Asian’. As Asian students constitute a range of ethnic groups, there may be meaningful differences in relation to gambling between the various Asian ethnic groups.

The Youth’12 survey showed that (Rossen, et al., 2013):

  • About one-quarter (23%) of Asian students had gambled in the last year, and 9% had gambled in the last four weeks. Of those who had gambled in the past year, very few (5%) spent more than $20 per week or more than 30 minutes a day gambling.
  • Rates of gambling in the last 12 months were similar amongst Asian and NZ European students (23% and 24% respectively), as were rates of gambling in the last 4 weeks (9% for both groups).
  • Asian students were much more likely to be worried about their gambling than NZ European students (24% of Asian and 6% of NZ European students who had gambled in the past year).
  • 57% of Asian students reported that their parent(s)/caregiver(s) gamble and 11% were worried about their parent(s)/caregiver(s) gambling. A number of Asian young people and/or their family encounter problems due to gambling.

Xu (2014) examining the role of social and cultural connectedness in the gambling behaviour of Asian youth found that family, friends and school connectedness scales were not found to be protective towards unhealthy gambling behaviours (p>0.05). However, cultural connectedness was found to be significantly protective against unhealthy gambling behaviours (p<0.05). The finding suggests that prevention and treatment programmes consider encouraging Asian youth to explore cultural connectedness as a form of prevention or treatment.

The following tables identify the variables associated with an increased risk of “unhealthy gambling” (Rossen et al., 2013) and culturally competent assessment and intervention for teenage problem gambling (Tse et al., 2004).

Risk factors for unhealthy gambling in Asian youth populations

(Adapted from Rossen et al., 2013, p.104).

Risk: Variables associated with an INCREASED risk of “unhealthy gambling.”
  • Worrying about the amount of time/money spent on gambling.
  • Worrying about other peoples’ gambling (ie family members).
  • Experiencing the following impacts of someone else’s gambling (ie family members):
    • Arguments or fights.
    • Had to go without things.
    • Bills weren’t paid.
    • People had done things that could have got them in serious trouble.
  • Gambling with:
    • ‘Other’ people they know (ie not family or friends).
    • People they don’t know (eg people online).
  • Having more accepting attitudes towards gambling.
  • Gambling on:
    • Pub or club EGMs/casino EGMs or tables, TAB betting.
    • the internet/mobile phone/0900 phone games.
  • Drinking alcohol weekly or more often.
  • Smoking cigarettes weekly or more often.
  • Depression.
  • Having attempted suicide (in the last 12 months).
  • Poor wellbeing.
  • Experiencing violence or bullying:
    • Witnessed violence in the home.
    • Been hit or physically harmed in their own home.
    • Has been bullied (weekly or more often).
  • Truancy.
  • Using the internet for 3+ hours per day.
  • Playing computer games for 3+ hours per day.
  • Demographic characteristics:
    • Maori, Pacific and Asian students.
    • Refugee background.
    • Sexbeing male.
  • Socioeconomic statusliving in neighbourhoods with higher levels of socioeconomic deprivation.

Teenage problem gambling: culturally competent assessment and intervention

(Tse et al., 2004)
  • Engage the client:
    • When working with Asian youth, explore the meaning of gambling in their home culture. This approach removes personal blame or stigma.
    • Match the therapist: Where possible it is helpful to have a gender and culture match between the client and therapist.
    • The counsellor’s self-disclosure of their struggle to adjust to a new culture will communicate empathy to the client.
  • It is important to explain counselling confidentiality to the client (and adherence to the code of ethics).
  • It may be necessary to use an interpreter. There are several strategies which make this successful: (a) involve them as part of the treatment team; (b) inform the client about the interpreter’s name and seek the client’s permission before the interpreter arrives; (c) require the interpreter to sign a confidentiality agreement before meeting the client, and clarify the interpreting expectations with the interpreter
  • Identify the presenting problems: In addition to assessing the extent and severity of gambling-related problems (eg type and frequency of gambling, amounts of money lost), a thorough assessment should cover: potential harm to oneself, family and property; and risk from other psychiatric or medical conditions, such as depression, the use of illicit drugs, and excessive consumption of alcohol
  • Problem gambling is often just the ‘tip of the iceberg.’ It is important to inquire about all the types of problems and challenges faced by Asian youth, including financial hardship, language barriers, and intergenerational conflicts.
  • Asian groups from refugee backgrounds have suffered from civil unrest, political persecution, or war, and the loss of family and community. Mental health disorders such as posttraumatic stress disorder (PTSD), depression and anxiety should be identified by the therapist. For some, gambling and other addictions provide an escape from pre-migration traumas
  • During counselling, it is important to identify the strengths and resources that the client (and potentially their family) can contribute to the effective management of their gambling problem. This may help the young person improve their self-esteem and sense of control.
  • Cultural/religious beliefs may assist with this process. Therapists should find out about the client’s hopes for themselves and for their families. It is also useful to ask how the client coped with adversity before coming to New Zealand (ie what works for them).
  • Metaphor can offer a powerful therapeutic tool for counselling. Appropriate use of metaphor may prompt Asian clients to reconnect with their cultural traditions. Using familiar images or folk stories may help clients gain a better understanding of their problem gambling and help them focus on recovery.1
  • Identify whether support systems are in place for Asian young people and to build up extra support or resources if necessary.
  • Help the young person navigate the services they need to access: Crucial settlement issues are English proficiency, educational achievement and developing support systems. Counsellors/ therapists need to make special efforts to ensure that clients know where to go for help, and that they will be referred to a culturally competent service provider (eg legal services; settlement support etc).
  • Power-distance: Asian clients may have a different expectation of the therapeutic alliance. Asian clients are very conscious of social status and power. Therapists, counsellors, social workers, or other professionals are seen as people in authority. Clients may be uneasy if they are asked to work in partnership with the therapist. They tend to expect the therapist to take an authoritative position and to provide a ‘quick fix.’
  • Practical approach: Asian clients prefer a pragmatic, practical approach in dealing with problem gambling. They usually welcome the idea of completing ‘homework’ or having a handbook to help them deal with problems in between appointments and to prepare for the next session.
  • Be directive: Being directive means giving the client a limited number of informed choices, rather than leaving it entirely to the client.
  • Working with families: It is crucial for the counsellor/therapist to discuss with young people any family involvement (obtaining their agreement and protecting their privacy). It is important to run separate sessions for family members in the initial phase of family intervention. If this is not done, the session can be chaotic, humiliating, and superficial and may be dominated by senior family members. When the young person’s parents are involved in counselling, it is particularly important to assure the client that the counsellor will not disclose their details to their parents. Typically in Asian cultures, parents assume the right to know everything about their children.

1 For example, the cultural metaphor “山不轉路轉 ; 路不轉人轉 ; 人不轉心轉” illustrates the importance of ordering and the emphasis on multiple cultural values. This saying literally means if the mountain doesn't turn the road turns, if the road doesn't turn the person turns, if the person doesn’t turn then the heart and mind turns. Figuratively, it means that no matter how hard things get, there is always a solution. If you can't find a way past the mountains (obstacle), then find a road around it. If there is no road around it, then make your own path. If you have done your best and still can't change the situation or find a solution, then you need to change the way you think and feel about it. This type of saying can be incredibly healing, and could potentially be utilized in problem and solution-focused therapies (e.g., let's figure out how to solve the problem), mindfulness and acceptance-based therapies (e.g., it looks like we can’t change the other person or the situation, let's figure out how to make the most of it and put our mind at peace), as well as cognitive-behavioral therapy (e.g., now that we tried to resolve the problem, what's the most helpful and effective way to think about it) (Hwang, 2011).