dr. tim fong

Luck and Fate: Cultural, Social and Psychological Characteristics of

Asian GamblersTimothy Fong MD

UCLA Gambling Studies ProgramNew Horizons in Responsible Gambling

ConferenceVancouver, BCFebruary 2017

Objectives• Discuss cultural attitudes and risk factors regarding

gambling among Asian Americans• Discuss the impact of assimilation and acculturation

on gambling behavior and attitudes towards treatment

• Identify culturally competent prevention, intervention, and treatment programs for Asian Americans

Definitions

Asian Pacific Islander

• A person with origins in any of the original peoples of the Far East, Southeast Asia, South Asia or the Pacific Island

Asian American• Asian American Pacific Islander• Asian American• Asian Pacific American• Asian or Pacific Islander

– ~5% US Population– ~13% California

Asian Canadian~26% British Columbia

Asian Canadian Population • South Asian• Southeast Asian• Chinese• Filipino• Korean• Japanese

APIs are HeterogeneousDifferent languages & dialectsDifferent historical & trauma background Different immigration historiesDifferent living, clothing & customsDifferent family structure, inter-personal relationshipsDifferent cultural values Different substance abuse preferencesDifferent help seeking patterns

Asians and Gambling

Stories from California• BJL, a divorced Korean American from Fontana,

owed $200,000 in gambling debts in 2006. He killed his 5-year-old daughter and then himself.

• TN, the Cambodian doughnut king of California, gambled away his empire and, by 2005, wound up living on the porch of a friend's trailer.

• KX, a Hmong father in North Sacramento, argued with his wife over his gambling, shot himself in the head and killed five of his seven children in 1999.

California 2005-2016• 2005 UGSP Founded• 2007 Calls from API Non-Profits,

Conference presentations, letters to legislature, meetings, grass-roots events

• 2007 First grants to examine API Gambling• 2009 CALGETS begins operations

Gambling Expansion in Asia

• Macau: No. 1 gaming market since 2006• Singapore: Dropped its gambling ban

Opened Integrated Resorts 2009• South Korea: >17 casinos; • Taiwan and Japan: Considering allowing casinos. • The Philippines: Manila Bay• Mainland China: ?

One Chinese proverb demonstrates the culture’s acceptance of gambling, at the same time signaling a

warning to those who overindulge: “A little gambling

is soothing and relaxing; heavy gambling could affect

your mental health”.

Asian Culture and Gambling

• Gambling has been a part of society from the early Asian history (3,000 B.C.)

• Gambling as a part of social/family life• New Year’s celebration and funerals• Superstition regarding fate and luck associated

with gambling

Cultural factors that promote gambling

–Acceptable way to make money–Inquire about one’s destiny–“Honoring the Gods”

•Losses are sacrifice–Equate gambling with self-worth and ability to move up classes

Cultural factors that promote gambling

– Emphasis on numbers that have power over life events

– Heavy peer involvement– Gambling is family entertainment– Gambling as a rite of passage– Superstitions

Perceptions about Gambling

Chinese Western

Make money EntertainmentAn investment A harmless activity Involves risk Limited sense of risk

Nancy Petry Study 2002

• Study on 96 Cambodian, Laotian and Vietnamese refugees–59% identified as pathological gamblers.

(1.5% California rate)–95 % reported gambling in the previous

year, and 93% reported gambling in the previous two months.

California Prevalence Study (2006)

• Asians (504)– Low response rate (47% overall, less APIs)– 7% of survey sample– Mostly English (1% translated)

– Problem Gambling: 2.3%– Pathological Gambling 0.7%– Less aware of helpline

Genes or Environment or Something Else

• When national prevalence rates were examined in countries such as Taiwan, Hong Kong, and Korea, it was found that the rates of problem and pathological gambling were consistent from those found in European and New World countries (Taiwan – 5%, Hong Kong – 1.5%, and Korea – 1%).

Immigration?• Asian immigrants in western countries

often yield much higher rates of problems.– Montreal Chinese 5% – Calgary, 8%– Sydney, 8%.

Why Immigration?• “Personality traits that make them greater risk

takers. Immigration for most involves taking some risks . . Therefore. . .”

• To date there is no conclusive data to show that Asian immigrants as a whole exhibit personality traits that are correlated to problem gambling.

Immigration• The experience of immigration – including

any experience of trauma and subsequent stresses of adaptation contribute to greater likelihood of problem gambling. – Loss– Loneliness / isolation– Status seeking

What about the gaming industry?

• Gambling establishments frequently shuttle potential patrons from communities with large Asian populations (Chinatown, Koreatown, etc.) to their facilities.

• Bilingual staff in order to increase comfort and ease of their Asian patrons.

• Targeted events, lounges, facilities, offers

Prevalence of Asian Gambling in Casinos

ResultsGender N=180

Male 75% Females 25%

EthnicityAsians 37%

Chinese, Filipino, Korean, Japanese

Non-Asians 63%

Results

Screening Score APIs Non-APIs

SOGS >5 42% 36%

NODS >5 35% 26%

PG Alliance San Jose Community Survey 2011

• Gender:– Male-574 (40%), – Female-828 (57%), N/A 61 (3%)

• Race: – Vietnamese-374 (27%), – Filipino-201 (14%), – Chinese-145 (10%), – Mexican-278 (19%)

Results• PG Prevalence (%)• San Jose (Gen Pop)

– At Risk: 6.5– Problem 2.4– Pathological 1.4

• San Jose (API)– At Risk: 6.5– Problem 0.7– Pathological 3.4

Help Seeking Behaviors & Barriers (PG Alliance San Jose Community Survey

2011) • APIs reported > non-APIs

– Very Difficult to talk about– I Would not discuss my problems

• Barriers to Treatment– No Money– Shame– No idea where to go

Community Awareness• 84% said PG is an addiction• 40% had not heard of treatment resources• Likely sources

– Media– Friends / Family– Helpline

APIs and Treatment

Barriers to Treatment • Underestimation of the extent of the problem

– Lower does not mean zero• Lack of dependable statistics & research data

– Lack of funding, dedicated resources• Underutilization of treatment services (delaying or not seeking

treatment) – shame– stigma– lack of knowledge,– Lack health insurance

Barriers to Treatment • Lack of cultural & language appropriate

treatment programs• Lack of evidence based practice• Myth Debunked:

– Treatment retention, duration and outcome similar for API vs. Non-API

California Gambling Education and Treatment Services

(CALGETS)

problemgambling.ca.gov

Treatment Options• Prevention• Self-help• Telephone Interventions

– Helpline services• Office-based treatment• Group treatment• Intensive Outpatient• Residential Treatment

Gambling Helplines

Problem Gambling Telephone Interventions (PGTI)

• 1-800-GAMBLER• 1-888-968-7888 (Chinese Languages)• Free (or no cost)• Weekly sessions over the phone• Staffed by trained therapists• Problem Gamblers and Affected Individuals• Helpline staff fielded 187 calls for 2015• 24 / 7• Media sources: #1 referral

– Radio , Print, Internet• Referred by human ~15%

1-888-968-7888• Dedicated, Asian Language Helpline• Separate from 1-800-GAMBLER• Helpline staff fielded 187 calls for 2015• 24 / 7• Media sources: #1 referral

– Radio , Print, Internet• Referred by human ~15%

Gamblers• 40% male

– married, 36-45 years old, Cantonese-speaking, and residing in the San Francisco Bay Area (where helpline is headquartered).

– Gambler callers most often reported strained family relations and finances as the most negative impacts to their lives.

Venue for Gambling• 60% Card Rooms• 30% Tribal Casinos• 10% Internet

– What happened to underground gambling?

AI API Callers• “Affected individual” callers

– female, married, age 26-45, Cantonese-speaking and calling from the San Francisco Bay Area or San Gabriel Valley area.

– Affected individuals were most often the friend or spouse of a problem gambler, or child

Freedom From Problem Gambling Workbook

Available Languages for WBArabic Hmong Russian

Armenian Japanese Samoan

Cambodian Korean Spanish

Chinese Laotian Tagalog

English Lu Mien Thai

Farsi Punjab Vietnamese

Where to Get the Workbook

California Department of Public Health

Office of Problem Gamblingwww.problemgambling.ca.gov

Cultural Issues in Office Based Treatment

Cultural Issues• API PG

– redeem losses, peer influence, thrill, emotional problems, stress and boredom

• (Teo et al. 2007) – claim that they are winning even when they are losing a lot of

money. – illusion of control than the Caucasians

• (Loo et al. 2008 – hold more strongly onto the beliefs in fate and luck than other

cultural groups

Impact of Family on GD• Familial socialization may have impacted Chinese

gamblers’ familiarity with and preference for certain forms of gambling and may have passed on the values and beliefs about gambling to the next generation (Loo et al. 2008).

• Second, Chinese families has a strong tendency to conceal the presence of a family member with problem gambling and to rescue him/her by paying his/her debts.

Cultural Influences• Collectivistic (Goodwin and Tang 1996) mindset

leads to strong sense of guilt and shame because they have brought disgrace to their families and have let their families down.

• less likely to seek outside or professional help than other cultural groups despite having higher unpaid debts and financial problems (Victorian Casino and Gambling Authority 2000).

Treatment Principles

Prevention Ideas• Effective early intervention strategies much

address the culture of acceptance, in order to reshape social norms and learned behaviors – Teaching the odds– Building up coping skills– Demystifying gambling as a sport– Using technology to promote resilience

Prevention Ideas• Strengthening family and community can be

a powerful tool to help Asian gamblers. Service providers working with Asian gamblers often have to act as a liaison, linking gamblers to other services such as ESL classes, job training, public benefits assistance, and financial counseling.

What Clinicians Can Do• Willing to work with client who are not ready for total

abstinence; need a longer time of engagement; to start with, cut down use

• Avoid traditional reflective, non-directive approach• Focus on external stresses in the early stage, offer crisis

intervention & tangible help• Respect family secrets and confidentiality• Accommodate client’s work & family responsibility when

scheduling appointment

What Clinicians Can Do• Proficient in client’s language/dialect, using

interpreter only as last resort• Avoid extensive questioning, assessment &

evaluation; clarify and explain all procedures• Help client develop measurable and tangible

short-term treatment goals• Receptive to Somatic Approach &

Pharmacological Treatment

Focus on the Family• In many Asian traditions, it is natural for family

and community members to help one another – by lending money for debt relief, vouching for a loan, etc.

• Asian families may have to get assistance in setting firm boundaries, avoiding codependency, and encouraging gamblers to take responsibility.

Make Treatment Acceptable• St. Mary’s Center in San Francisco,

framed services in the context of a teahouse.

• Clients are invited over to “chat over tea” rather than for “counseling”.

• Services called “improving finances”

Thoughts on GA• Gamblers Anonymous – a voluntary, 12‐step

support group for gamblers currently only has one Asian‐language meeting in the entire state of California.

• Unknown effectiveness and even less availability

• One-on-one “mentorship” more powerful

Medication Principles• Target co-occurring disorders• No data on API-specific responses• Concepts of medications to impact

behaviors is tough to grasp• Therapeutic power of the pill

Eastern Treatment Options• Acupuncture

– Used to be part of residential treatment programs

– No clear data• Eastern philosophies of balance, restoration

– Flushing out negative energy

Fables of Fortune (South Philly)

Innovative Ideas• Partner with casino buses / tour junkets• Create more online tools / apps for APIs• Tie-in with API dining establishments• Partnerships with churches• Establish community “warning networks”• Encourage casinos to play more active role in outreach• Tell more stories through media / change the conversation

Q and A

Contact InformationTimothy Fong MD

310-825-4845tfong@mednet.ucla.edu

www.uclagamblingprogram.orgwww.lasbirt.com