a narrative analysis of help-seeking behaviour and critical change points for recovering problem...

The power of storytelling

1

Nuske, E., & Hing, N. (2013). A narrative analysis of help-seeking behaviour and critical change points for recovering problem gamblers: The power of storytelling. Australian Social Work,

66(1), 39-55.

Title of the Paper:

The power of storytelling: A narrative analysis of help-seeking behaviour and critical change

points for recovering problem gamblers

Short Running Head:


Authors

Dr Elaine Nuske (corresponding author)

Centre for Gambling Education and Research

Southern Cross University

PO Box 157 Lismore NSW Australia 2480

Email: [email protected]

Professor Nerilee Hing

Centre for Gambling Education and Research

Southern Cross University

PO Box 157 Lismore NSW Australia 2480

Email: [email protected]

Word count: 6,924


2

The power of storytelling: A narrative analysis of help-seeking behaviour and critical

change points for recovering problem gamblers

Abstract

Proportionately few problem gamblers seek formal help for gambling problems. However,

research into gambling help-seeking behaviour is limited, especially qualitative studies

capturing experiences of recovery. This paper conducted narrative analysis of in-depth

interviews relating the help-seeking behaviour of ten recovering problem gamblers. A

common temporal sequence moved from self-help, professional and non-professional help,

then returned to self-help, in a journey that emphasised the importance of their sharing of

narratives. Key themes in the plot structures were: self loathing/loss of identity; fear of

failure, of the loss of the gambling experience, and of being judged; negotiation of control,

being in control, and needing to be in control; changing based on insight, cognitive

behavioural interventions, or integrative interventions; and finally, the shared narrative. The

findings highlight the need for policy makers and practitioners to acknowledge the power of

narrative and to open the door to a broader community awareness of problem gambling.


3

The power of storytelling: A narrative analysis of help-seeking behaviour and critical

change points for recovering problem gamblers

Problem gambling is recognised as a serious public health issue in many countries (Korn &

Shaffer, 1999; Messerlian, Derevensky & Gupta, 2005; Shaffer & Korn, 2002). Problem

gambling prevalence rates are estimated at 2-5% of the adult population (Volberg, 2007) with

relatively few problem gamblers seeking treatment for their gambling (Cunningham, 2005;

Petry, 2005a; ; Slutske, 2006).). Australian estimates are that only 10% of problem gamblers

seek formal assistance for their gambling problems (Delfabbro, 2009). Untreated gambling

problems have significant personal and social costs, estimated in Australia to be at least

AU$4.7 billion annually (Productivity Commission, 2010).

Despite the severe impacts and significant costs of problem gambling, limited

qualitative research has explored the help-seeking behaviour of problem gamblers. To our

knowledge, this paper presents the first qualitative narrative analysis of critical change points

experienced by problem gamblers during recovery from gambling problems, while also

revealing a common temporal sequencing of help-seeking stages.

Considerable literature supports the importance of narratives within the lives of social

actors (Bruner, 1990; Hinchman & Hinchman, 1997). Narratives are particularly important at

times of change because they can provide a sense of continuity and the possibility of a new

narrative being created for the future. Additionally, the importance of narrative as a

therapeutic technique and general healing tool is well documented (Hanninen & Koski-

Jannes, 1999; Hyden, 1997; McGowan, 2003).

Similarly within the research environment, narrative analysis is recognised as a

powerful tool for qualitative enquiry (Mishler, 1995; Riessman, 2002). Thus, this study aimed

to provide a narrative analysis of the stories of problem gambling recovery, as told by ten

recovering problem gamblers, to illuminate the critical points and pathways in both their


4

help-seeking behaviour and journey towards recovery. Analysing these journeys and the

critical points of change may inform therapeutic practice and efforts to lower barriers and

enhance enablers to help-seeking for those affected by gambling problems.

Prior Research on Help-Seeking and Recovery

Before focusing on recovery, it is important to note that the predominant gambling activity

associated with gambling problems in Australia and many other jurisdictions is electronic

gaming machines (EGMs). This connection is evident for both pathological and recreational

gamblers. Dickerson’s research (2003) demonstrated that loss of control over expenditure of

time and money during a session of EGM play is integral to the pleasure players derived from

them. The Productivity Commission (2010) estimated that 15% of regular EGM players are

problem gamblers who account for about 40% of EGM revenue, with a further 15% being

moderate risk gamblers. The significance for social work and policy makers is evident in that

most people presenting with gambling problems express control problems associated with

EGMs.

Recovery is a disputed term. Nower and Blaszczynski (2008) advocate

conceptualising a spectrum of recovery from gambling that includes decreased time and

money spent on gambling, abstinence or controlled gambling that meets financial obligations,

absence of impaired control symptoms and cross-addicted behaviours, and absence of

negative consequences and improved quality of life over time. Clearly, recovery from

problem gambling can manifest in multiple ways.

While a spectrum of gambling recovery has yet to gain wide acceptance, it is

generally agreed that abstinence is not a necessary condition of recovery, but that even

though urges to gamble may remain, control of these urges and resistance to a return of the

problematic behaviour are crucial (Nower & Blaszczynski, 2008). It is thus not appropriate to

say that recovery is ever “final” and it is not possible to know if anyone has ever fully

https://www.researchgate.net/publication/23480419_Recovery_in_Pathological_Gambling_An_Imprecise_Concept?el=1_x_8&enrichId=rgreq-2dbc1153-980f-4377-bc33-95d74fe3ee66&enrichSource=Y292ZXJQYWdlOzI2MzEwMzQ3ODtBUzoxMTc1MDk0NDk1ODg3MzdAMTQwNTAyNzg0NDQ3OA==


5

“recovered”. Nevertheless, the element of behavioural control appears crucial for

understanding the progression of individuals toward recovery.

Most research related to problem gambling recovery has focused on help-seeking.

One focus has been on outcomes from formal treatment, with a meta-analysis of 22 outcome

studies concluding that research has generally found efficacious short- and long-term

outcomes for those completing formal gambling treatment (Pallesen, Mitsem, Kvale, Johnsen

& Molde, 2005). However, while these studies demonstrate that people can change their

behaviour to resolve a gambling problem, they do not illuminate how people change, the

sequence of their help-seeking activities and the critical points of change involved.

Another line of research has been into barriers and enablers to help-seeking. Overseas

and Australian reviews have concluded that the primary motivating factors to seek

professional help are psychological distress, and financial and relationship breakdown, while

the main barriers are shame, embarrassment, unwillingness to admit the problem, issues with

treatment itself and false hope in regaining control or winning back losses (Delfabbro, 2009;

Suurvali, Hodgins & Cunningham, 2010). These studies provide insights into what facilitates

or hinders movement towards actioning change, but as snapshot findings they fail to consider

movement in help-seeking. Very few studies have considered the role of informal help in

problem gambling recovery, such as from family, friends and community organisations.

Research has identified social support as beneficial in the recovery of substance abusers

(Booth, Russell, Soucek & Laughlin, 1992; Hogan, Linden & Najarian, 2002). However,

little is known about the role it plays in problem gambling recovery, although one study of 60

problem gamblers in treatment found that emotional support influenced self-efficacy for

treatment and motivation for change (Gomes & Pascual-Leone, 2009). Studies into the

benefits of support groups such as Gamblers’ Anonymous (GA) have shown mixed results

(Petry, 2005a; 2005b), with one finding that GA involvement was associated with a readiness

https://www.researchgate.net/publication/6600135_Social_support_-_do_they_interventions_work_Clin_Psychol_Rev_22_381-440?el=1_x_8&enrichId=rgreq-2dbc1153-980f-4377-bc33-95d74fe3ee66&enrichSource=Y292ZXJQYWdlOzI2MzEwMzQ3ODtBUzoxMTc1MDk0NDk1ODg3MzdAMTQwNTAyNzg0NDQ3OA==

https://www.researchgate.net/publication/232535849_Pathological_Gambling_Etiology_Comorbidity_and_Treatment?el=1_x_8&enrichId=rgreq-2dbc1153-980f-4377-bc33-95d74fe3ee66&enrichSource=Y292ZXJQYWdlOzI2MzEwMzQ3ODtBUzoxMTc1MDk0NDk1ODg3MzdAMTQwNTAyNzg0NDQ3OA==


6

for change, but not with any other facilitator of change (Gomes & Pascual-Leone, 2009).

Few studies have examined self-help measures in changing gambling behaviour

(Cooper, 2001; Marlatt, 2002; Petry, 2005a). However, comparing self-help efficacy is

difficult given its wide variation, reliance on case studies (Marlatt, 2002; Toneatto, Vettese &

Nguyen, 2007) and use of samples also undergoing other interventions (Townshend, 2007;

Tremblay, Boutin & Ladouceur, 2008).

Studies specifically on problem gambling recovery have been of two main types.

Recovery rates have been estimated from prevalence studies comparing lifetime and current

measures of problem gambling (Shaffer & Hall, 1997) and from prospective designs

(LaPlante, Nelson, LaBrie & Shaffer, 2008). Only one prospective study of gambling

recovery has been conducted in Australia, with 63 problem gamblers undergoing treatment

(Blaszczynski, McConaghy & Frankova, 1991). This study, involving a two and nine year

follow up, reported that abstinence is not the only outcome of successful treatment, and that

controlled gambling does not necessarily result in a return to problem gambling. However,

overall recovery rates remain unknown in Australia.

Minimal studies have qualitatively explored the process of recovery to understand

how people change their gambling behaviour. One study (Hodgins & el-Guelaby, 2000)

provided powerful insights into the reasons 43 “resolved” problem gamblers had changed

their gambling behaviour, actions taken, factors maintaining these changes, the role of life

events and reasons that some had not sought treatment. The focus was significant life events,

with general emotional and financial factors precipitating behavioural change. Those with

severe problems in terms of overall life events gravitated toward professional or self help

processes, whereas those with less severe problems “naturally recovered”. McGowan (2003)

also used a qualitative approach to examine narrative discourses constructed in an online

https://www.researchgate.net/publication/247501619_Counter-story_resistance_and_reconciliation_in_online_narratives_of_women_in_recovery_from_problem_gambling?el=1_x_8&enrichId=rgreq-2dbc1153-980f-4377-bc33-95d74fe3ee66&enrichSource=Y292ZXJQYWdlOzI2MzEwMzQ3ODtBUzoxMTc1MDk0NDk1ODg3MzdAMTQwNTAyNzg0NDQ3OA==

https://www.researchgate.net/publication/223275294_Buddhist_philosophy_and_the_treatment_of_addictive_behavior?el=1_x_8&enrichId=rgreq-2dbc1153-980f-4377-bc33-95d74fe3ee66&enrichSource=Y292ZXJQYWdlOzI2MzEwMzQ3ODtBUzoxMTc1MDk0NDk1ODg3MzdAMTQwNTAyNzg0NDQ3OA==

https://www.researchgate.net/publication/232535849_Pathological_Gambling_Etiology_Comorbidity_and_Treatment?el=1_x_8&enrichId=rgreq-2dbc1153-980f-4377-bc33-95d74fe3ee66&enrichSource=Y292ZXJQYWdlOzI2MzEwMzQ3ODtBUzoxMTc1MDk0NDk1ODg3MzdAMTQwNTAyNzg0NDQ3OA==


7

group for women seeking support for recovery from gambling problems, providing insights

into the gendered nature of their experiences and the role of narrative in problem resolution.

The current study uses an alternative approach, namely narrative analysis of

participant interviews, to provide additional insights into the gambling recovery process. We

were specifically interested in understanding the sequence of help-seeking behaviours used

and any commonalities in the critical points experienced during the journey of recovery, as

well as the therapeutic role of the participants’ involvement in a project that enables them to

tell their stories to the wider community. Importantly, we wanted the participants’ voices to

be heard rather than reduce their narratives to numerical reporting of the results. We also

wanted to capture a more holistic view of recovery than previous studies examining single

steps in help-seeking and recovery have done.

Methods and Procedures

Participants

Research participants were recruited through the Consumer Voice Project, an ongoing project

of the Gambling Help Service, Relationships Australia (South Australia) which aims to raise

community awareness about problem gambling. Consumer Voice comprises recovering

problem gamblers and family members of problem gamblers who, after appropriate training,

share their experiences of gambling problems in forums such as gaming venues, community

services, and counselling sessions of people affected by problem gambling. Thus, in this

context, the participants self-defined as “recovering problem gamblers”. On our behalf,

Relationships Australia (South Australia) contacted potential participants, then provided us

with contact details of ten who had agreed to be interviewed.

Six women and four men were interviewed. Eight interviewees had experienced

problems with EGMs, and two (both men) with wagering on horse and greyhound races. The


8

length of time they considered their gambling to be problematic ranged from 1-35 years,

while the time period they had been problem-free ranged from one to several years.

Procedure

Ethics clearance was obtained from the researchers’ university. Semi-structured interviews of

30-40 minutes were conducted that followed the journey of recovery for the participants.

Interviewees were asked to expand on the sequence and issues in the help they had sought

and received. Thus, they were asked about professional help (e.g., through counselling,

professional group counselling services, general practitioners); non-professional help (e.g.,

family, friends, religious, spiritual or community leaders, mutual support groups); and self-

help (e.g., budgeting, taking up new interests, avoiding gambling venues or friends who

gamble). Interviewees were asked about which type of help they used in a time sequence,

motivators and barriers to seeking each type of help, and suggestions about ways to improve

each category of help. Interviews were recorded and transcribed prior to analysis.

Data Analysis

The interview analysis followed the method highlighted by Wong, Leung & Lau (2009), who

emphasised that narrative allows understanding to unfold based on the interplay of socio-

economic, cultural and emotional elements. According to Wong Leung & Lau (2009),

narrative analysis occurs in two stages. Firstly, the composing of a temporal sequence follows

similarities across individual trajectories. Following this, plot structures are layered upon

these sequences that indicate how emotional, cultural and social belief systems are integral

components of these experiences.

In the current study, the stories told were examined firstly to explore movement of

help-seeking behaviours. This was assisted by the method of questioning which directly

asked about which type of help was accessed first, second and third. Similarities in these


9

movements across the stories were identified. Secondly, thematic analysis was employed to

draw out plots appearing within the stories.

Within qualitative narrative research there are no claims to generalisability. However,

to ensure validity, the researchers utilised the conceptual elements determined by

Sandelowski (1986) in response to Lincoln & Guba (1985) who called for rigor and

trustworthiness in qualitative research. Firstly, credibility was determined by sharing of ideas

and rereading of transcripts by all members of the research team. Secondly, applicability was

determined by ensuring that each participant’s story represented a valid representation of the

group, and that all participants met the criteria for engagement in the project. Thirdly,

consistency was observed by the researchers’ clear provision of an “audit trail” through the

research process to allow for replication. Finally, neutrality was maintained as the researchers

remained true and focused to the words of the participants as the analysis is described below.

Results

Critical Points and Pathways in Help-Seeking Behaviour

To understand the participants’ help-seeking journey, it is necessary to acknowledge critical

points within this process. The significance of these critical points serves to demonstrate how

each type of help serves, or not, the participants in their recovery. Both elements of help-

seeking and recovery are discussed within the following results. Initially, the ten narratives of

the recovering problem gamblers were examined in terms of the sequence of their help-

seeking behaviours, and subsequently the journey of recovery is followed through the use of

plot structures. Critical points within each element are interjected within the analysis.

Narrative analysis does not have a primary aim of discovering common sequences but instead

reveals the meanings ascribed to experiences by participants. However, given the

commonalities in the help-seeking sequence as described by participants, this sequence is


10

presented here as a backdrop to the more in-depth analysis which utilises themes to illuminate

understanding.

Narratives of Help-Seeking Behaviour

Figure 1 depicts sequence similarities in the participants’ narratives of recovery.

INSERT FIGURE 1 ABOUT HERE

Figure 1 shows that, in the retold stories, all ten participants moved from self-help

behaviours, through either professional or non-professional help from family and/or friends,

before all ten experienced relapse. The types of self-help used in these earlier stages included

writing down all the reasons not to gamble and referring to these when tempted, reading

personal development books, “self-talk”, limiting the amount of money carried and self-

exclusion. This self-help proved useful in the short term, and indeed may be sufficient for

some problem gamblers to resolve the issue. However, for those interviewed, these strategies

were not sustained or sufficient to change their behaviour. They then moved toward seeking

support from family and friends (non-professional help). This was a negative experience for

one participant who felt “intimidated and bullied” by her partner. It was hard for many to

approach family and friends due to fear of being judged, as discussed further below, but

others who used non-professional help at later stages appreciated the ongoing support from

family and friends. Early experiences of professional help were generally positive but

nonetheless ended in relapse. It seemed that those who did benefit from professional help also

needed to incorporate their own self-help strategies and activate non-professional support

networks to sustain change.

Thus, following relapse, the participants’ stories told of gaining more professional

help and then utilising self-help strategies (six stories), or using self-help strategies

immediately following the relapse experience (four stories). An integrated approach is what

seems significant for those interviewed. In addition, what was important in all ten stories was


11

their current place, that of being able to share their narrative with others through the

Consumer Voice Project. These “others” included current gamblers, gaming venue workers,

counsellors, and the general community. Those interviewed saw their work for Consumer

Voice as the best way they had of helping themselves to sustain their transition away from

gambling. This activity was clearly extremely powerful for all those interviewed and was the

defining component of their journey to rid themselves of their gambling addiction. It seems

that the telling of their stories to others is both therapeutic to them and extremely helpful to

those listening.

The important role that Consumer Voice had for participants is reflected in the

comment below:

It’s not normally like me to talk in front of groups of people. Well it certainly did. It

certainly helped me and it helped me to accept some of the things that I did when I

was gambling. It was so shameful. It’s helped me to accept that they weren’t quite as

bad as I built them up to be.

And most vividly:

I talk to venues and I talk to the industry and I go to gaols and talk to prisoners now.

It’s mainly just talking and spreading the word and helping educate. It still does,

definitely does [help to control my gambling]. It’s like if you’ve got a bad infection

you take antibiotics and if you never take them again, eventually that infection might

come back. I use all my talks as ongoing medicine for me because I always say that

with a gambling addiction, you’re never cured. You’re only in remission.


12

Thus, involvement in Consumer Voice was the most significant time and place for the

recovery to be cemented, and this remained the continuing story for the research participants

at the time of their interviews.

Critical Points and Pathways Toward Recovery

Overlaying the sequential narrative discussed above is the composite plot structure

that emerged through the narratives. This composite plot structure comprises the emotional

content of the stories plus underlying values and beliefs within the social and cultural

elements of the narratives. The plot structures show movement and the creation of new

stories. The themes within the plot structure are represented in Figure 2 using the words of

the research participants. The themes, as discussed below, are designated as: self

loathing/loss of identity; fear of failure, of the loss of the gambling experience, and of being

judged; negotiation of control, being in control, and needing to be in control; changing based

on insight, cognitive behavioural interventions, or integrative interventions; and finally, the

shared narrative.

INSERT FIGURE 2 ABOUT HERE

Theme 1: Self Loathing / Loss of Identity

The participants recounted how they seemed to lose any sense of normality in their life as

they moved into “the zone” of heavy gambling. They began to feel distaste for themselves

and to question who they really were. The activity of gambling seemed to be outside of their

personal sense of self. This led them to build barriers around themselves, and to feel they had

let themselves and others down. As some recounted:

I was very sick, I was lost in another world for a long time and I feel like I lost my

40’s and 50’s basically because I was just so … like I was on a path of self

destruction.


13

I thought about my life and I had stopped playing my music, I’d stopped doing … I’d

lost interest in lots of things. The gambling had taken all the interest away.

I couldn’t work out what it was I wanted anymore because I had completely lost my

identity, for me.

Thus, the participants described how they began acting in a ways foreign to their

sense of themselves, and that these changes in their sense of self and associated behaviour

had caused them distress and anxiety. This loss of identity led to an emotional response of

fear. This was critical for the participants, who alongside feeling stuck, were also led to a

deeper acknowledgment that they needed to reach out for help.

Theme 2: Fear

As indicated above, as part of this loss of self-identity, fear became increasingly apparent.

Fear was characterised within three elements: fear of failure, fear of the loss of the gambling

experience, and fear of being judged.

Fear of Failure

Most interviewees felt they had control over most areas of their lives. They were successful

in many ways and could not accept this was one area where they may fail. Thus, they felt

they could not fail to win and they could not face being unsuccessful in breaking the habit –

thus they avoided seeking help for fear of failure.

According to one respondent:

I think you feel that you should be able to control it yourself. You feel that you

should be able to have that control and take charge of your life and then you feel like,


14

it’s a little bit … not being successful, you’ve failed. That’s got to account when you

failed badly.

This was echoed by another, who said:

And all I kept thinking of was I’ve overcome cancer so many times against the odds,

how the heck can I do this? So it’s a sign of failure. And no one wants to admit

they’re failing and I certainly didn’t want to admit that I needed help.

Fear of Loss of the Gambling Experience

Although recognising that they needed to stop gambling, the experience itself was meeting a

need that they feared to lose. As some recounted:

I’m sure now looking back, I was terrified that I would have to stop gambling and

then I wouldn’t be able to cope.

This particular participant expressed how she used gambling as an escape mechanism.

In gambling she found a way of forgetting factors in her life that were causing her anxiety. If

she did not gamble she would have to face these anxieties and that “terrified” her.

It was always a relief when I slipped back into those habits as well

The “relief” for this participant related to his a sense of “comfort” that he found in

gambling. While gambling he did not have to think about whether the behaviour was

problematic; he just entered his gambling experience. If he stopped then he would have to

look at his behaviour from the outside and that scared him.


15

I think the addiction had been so strong that I didn’t really want to give it up. It had

been such a big part of my life ... The thought of having to give that away was like a

drug addict trying to give up drugs. You think you’re going to but then you go a day

without it and you just have to get it back.

The behaviour, identified here as an addiction, had become such a normal element of

the participant’s life that he could not imagine being without it.

Fear of Being Judged

Society’s judgment was a real issue for many. They felt that most people do not understand

the gambler’s addiction, thus making it hard for the gambler to admit to family and friends

that they have a problem. Non-judgmental attitudes of counsellors were noted by many as so

important to their recovery. If societal attitudes and values could be modified, many felt that

they would have been more willing to seek help earlier, as reflected in the following

comments:

I hear people say “I can’t believe they’d do that”. They’re so judgmental about it and

they don’t understand the fact that it’s an addiction, an illness really and I think that’s

because it’s also an entertainment so it’s … I don’t think people can see that you can

be doing it one minute and the next minute you’ve got a problem.

I can’t stress how much we need to take the stigma off the whole thing.


16

Fear is shown above as a powerful emotion that seemed to stimulate the participants

to move toward taking control over their lives in different ways. The manifestation of the

critical point of negotiating control is considered within the following theme.

Theme 3: Negotiation of Control

Having moved through fear, it was necessary to consider the role of control in the gambler’s life.

Some considered that early on, they felt in control (albeit this was later seen as fallacious).

Ultimately it was important to acknowledge the need to be in control oneself. Thus, change was

not possible without a sense of personal control.

Being in Control / No Problem

The following comments reflect the feelings of some participants who felt they were in

control or had no gambling problem:

I can control this, I can control this and then I’d do really well for a while and then

I’d fall back off.

I was completely in control and really presenting the image of me that I have learned

to do over the years and that is Miss Perfect. That’s how my family and friends see

me. I’ve always dressed a certain way, I’ve always looked a certain, I’ve always

behaved a certain way.

Need to Take Control

However, participants reached a point where they needed to take control if they were going to

achieve change. Thus, some reflected that:

I said no, I want control of my life and I admit I’ve got a problem.

I don’t want to live this life I’m living but I do want to live and I’ve got to get help.


17

Taking back control was central to the movement of the participants in allowing for

change to occur. The different ways in which change was addressed by the participants is

expanded upon below.

Theme 4: Change

Ultimately, change was achieved based on insight, cognitive behavioural interventions or

integrative interventions.

Insight Based Change

Different types of help privilege different elements within the person and support system. All

interviewees acknowledged the importance of insight as a therapeutic tool. For some it was

more significant than others, but all commented on the power of understanding past history

and relationships. However, this in itself was not sufficient for any of those within this study,

as indicated in these comments:

Even going back to childhood and a death in the family, empty nest syndrome, all that

sort of thing that had all built up in time that I hadn’t really dealt with properly.

She [the counsellor] brought things out of my psyche that I’d forgotten about, which

were buried and I’d always think because of the things that had happened, I worked it

out from her that I had a self hatred thing where I didn’t think I deserved anything

that I’d got.

Cognitive Behavioural Change

The power of thoughts and behaviours was evident for those interviewed. Cognitive

behavioural treatment seemed to strike a strong cord, linking closely to the need for control

and subsequent self-esteem:


18

When she said to me “at the end of this you’re going to be able to sit in front of a

pokie machine and put $1 and not push a button.” She said the look on my face was

just priceless. I was like “you want me to do what?” So the first week I took home a

picture of the pokie machines. The second time was a DVD. The third time was

actually going into a venue but my worker came with me. The next time was going in

by myself. I couldn’t have any money on me though.

Combination/Integrative Change

It is evident that there is no simple process for those moving through gambling problems and

that a combination of treatments reaches the core of many. This is a cyclical process and

links closely to self-help and use of the narrative, as is shown in the following comment:

But I just say to you, everything that I have done I believe has got me where I am

now and that is not gambling so no one thing has succeeded.

Moving through critical points of loss of identity, the resulting fear, movement to take

control and initiate change for themselves, the participants were well along their journey of

recovery at the time of the interviews. The culminating and most significant and illuminating

moment came when they were able to tell their stories to others. This is not an end point for

the participants, but is an ongoing and vital point in their recovery process.

Theme 5: The Shared Narrative

Having moved through the emotive narrative of help-seeking, alongside the values, beliefs

and interplays of culture and community, the recovering problem gamblers interviewed

shared how the defining moment for them came when they were able to lift their heads high

and share their stories with both other problem gamblers and the general community. There

has been much discussion within the literature that highlights the importance of life stories as


19

healing tools. Here we can see this reflected in the narratives of storytelling related by the

participants:

I think there are different things that touch different people. I remember doing one

talk and this lady came up to me and she was a gambler and she help my hand and

she said “I know exactly how you feel because that’s how my grief of the father

dying ...”. There are certain things in people’s stories that you can take out and “ah-

ah” and connect to them that way. It’s problematic for me as well because the more I

get to tell my story the more I feel that I’m actually getting better day by day.

They say “I just feel like I want to cuddle you” when they hear your story.

Listening to their stories and then telling mine, it helped me to understand.

One participant talked about the empowering experience that she had as her story

grew and she grew in confidence through its telling:

I was quite honest about how bad I was behaving and everything and saying it out

there and having these people looking back at me and really being touched by the fact

that I was doing these things but not judging. I didn’t feel like they were judging me.

Here is seen the connection to a feeling of being judged that has been expressed

earlier in this analysis. The participant clearly developed a more conducive and positive self-

image as a result of the acceptance received in telling her story.

Similarly another recounted how her story is constantly changing, the process of

recovery is continuous and moves in parallel with a developing sense of self:


20

As I grow, my story changes and I’ve got to talk next week and I’m going to be able

to say I haven’t gambled for 6 months now and being really pleased with that. I get

people giving me really good feedback as well on how well I’m doing and how far

I’ve come and how brave I am to stand up and tell them my story and to see that

they’re listening too is really good.

Thus, it is evident that in retelling and sharing of their stories, the

participants’ recovery is a journey that travels in relation to their reconstructed

identity.

Discussion

Those interviewed for this research talked about their pathways to recovery as an ongoing

and dynamic process. Narrative analysis was used to analyse the in-depth interviews with

these recovering problem gamblers to discover the sequence and plot structures of their

help-seeking behaviour. In terms of sequence, interviewees had a journey of movement that

began with self-help, moved through professional and non-professional help, and then

relapse. After returning to self-help and/or professional help, sometimes with the non-

professional support of family and friends, the help-seeking process culminated at the time

of the interviews with retelling their stories and sharing their narratives with others as the

crucial point of recovery.

Also apparent from the sequence of help-seeking identified in the current study is the

use of multiple forms of help by the research participants. This confirms previous research

findings. For example, an Australian study focused mainly on self-help (National Centre for

Education & Training on Addiction, 1998) found that their 30 problem gamblers not only

used a variety of self-help measures, but some also attended GA meetings and formal

counselling. Similarly a large New Zealand study found that 46% of respondents recruited


21

through their calls to a gambling helpline had also used formal or informal assistance for a

gambling problem (Bellringer, Pulford, Abbott, DeSouza & Clarke, 2008). The study

concluded that specialist help-seeking may be motivated by a failure to achieve the required

assistance elsewhere and may be one of the final, rather than first, steps, in the help-seeking

process.

Our analysis of plot structures in the research participants’ stories highlighted

several themes. One was self-loathing and loss of identity accompanying descent into

problem gambling, which have been reported elsewhere. For example, McGowan

(2003:121) identified “shame and self-loathing” accompanying “chaotic descent into

despair” as a key theme in her narrative analysis of women’s postings to an online group..

Fear, another of our themes, was also frequently endorsed by Hodgins’ study (2001), but he

referred to fear of the strength of the individual’s gambling and of the situations they had

found themselves in as a result of their gambling. In contrast, our participants experienced

fear of failure at addressing their gambling problem, fear of giving up gambling and fear of

being judged by others, which appear to reflect barriers to help-seeking rather than a process

of change. Nonetheless, greater community education might reduce stereotyping and blame

being placed upon those caught in the addictive cycle.

Continuing with the plot structure, our study found that admitting that they needed to

seek help led the research participants to admit to a lack of control in their lives and to

consider taking back control. McGowan (2003) also identified losing control as a key

feature of the descent into problem gambling as expressed in online postings to a women’s

support group, while Hodgins’ study of resolved problem gamblers (2001) found that self-

liberation was a frequently reported process of change, involving committing oneself to

action and reminding oneself that success is possible.



22

For our recovering problem gamblers, the road to change was not easy but seemed

greatly facilitated by their involvement in the Consumer Voice Project. While not the

intention of this study to rigorously evaluate the therapeutic benefits of this program, the

ability to retell and share their stories clearly marked a critical stage in our participants’

recovery and signalled their transition from problem saturated stories to problem free

stories. This aligns with the literature that recognises narratives as a powerful tool when

used effectively as a therapeutic intervention. Narrative shapes action because it not only

reveals the experiences that have transpired, but also the experiences that are actively

pursued and created by the narrator (McGowan, 2003). In relation to gambling, Strong

(2011) provided examples of how narrative therapy might reframe a client’s original

understanding of problem gambling as a disease or addiction to help them move towards an

alternative interpretation that better assists them to change. The stories told in our study

clearly show the strength of the individual in the need to take personal control using their

own self as the change agent.

In conclusion, implications of this research can be identified for research, practice

and policy. For research, this study has added evidence that using narrative analysis to

understand the experience of the gambler can open discourses that allow social, cultural and

personal understanding to emerge. These understandings present a sequential view that

incorporates past, present and future possibilities for change. As such, this style of analysis

would lend itself to a longitudinal study of gambling experiences to allow the researcher

entry into the ongoing world of the problem gambler and their struggle to move from

problem saturated stories to problem free stories. In terms of practice, this study emphasises

the benefits of narrative as therapy and the role that shared narratives can have in the

recovery journey. Social workers might therefore consider increased emphasis on

storytelling as a therapeutic tool, combined with tools for self-help and multilayered



23

therapeutic offerings. Policy-makers could enhance community education to focus on the

social and cultural values and beliefs surrounding problem gambling to break down

judgmental attitudes and belief systems that appear at the root of such paralysing fear

experienced by our study participants.

Naturally, this study is subject to several limitations. Only ten recovering problem

gamblers were interviewed and the findings cannot be generalised beyond the sample.

Nevertheless, there were many parallels within each story and both the sequences of

behaviour and plot structures had clearly visible similarities. However, our sample

comprised only recovering problem gamblers who had used professional help. Different

results may be obtained for a non-treatment sample. Also, because our sample comprised

only Consumer Voice participants, we were unable to explore alternative roads to recovery

that did not involve the publicly shared narrative. Our study also relied on retrospective

accounts which may suffer from recall and interpretation biases. Thus, we acknowledge this

research provides only a beginning to understanding and presents the researcher with new

ways of viewing and exploring help-seeking behaviour and recovery from gambling

problems.

Acknowledgements

Financial support for this research was provided by Gambling Research Australia. We also

thank Relationships Australia (SA) and the research participants they recruited.

References

Bellringer, M., Pulford, J., Abbott, M., DeSouza, R., & Clarke, D. (2008). Problem

gambling: Barriers to help-seeking behaviors. Final report for the Ministry of Health.

Auckland: Gambling and Addictions Research Centre, Auckland University of

Technology.


24

Blaszczynski, A., McConaghy, N., & Frankova, A. (1991). Control versus abstinence in the

treatment of pathological gambling: A two to nine year follow-up. British Journal of

Addiction, 86, 299-306.

Booth, B.M., Russell, D.W., Soucek, S., & Laughlin, P.R. (1992). Social support and

outcome of alcoholism treatment: An exploratory analysis. American Journal of Drug

and Alcohol Abuse, 18, 87–101.

Bruner, J. (1990). Acts of meaning. Harvard University Press: Cambridge.

Cooper, G.A. (2001). Online assistance for problem gamblers: An examination of participant

characteristics and the role of stigma. Toronto: University of Toronto.

Cunningham, J.A. (2005). Little use of treatment among problem gamblers. Psychiatric

Services, 56, 1024–1025.

Delfabbro, P.H. (2009). Australasian gambling review (4th ed.). South Australia: Independent

Gambling Authority.

Dickerson, M. (2003). Exploring the limits of ‘responsible gambling’: Harm minimisation or

consumer protection?. In Coman, G., Walker, M., Jackson, A. & Thomas, P. (Eds).

Proceedings of the 12th Annual Conference of the National Association for Gambling

Studies, Melbourne, 187-202.

Gomes, K., & Pascual-Leone, A. (2009). Primed for change: Facilitating factors in problem

gambling treatment. Journal of Gambling Studies, 25(1), 1-17.

Hanninen, V., & Koski-Jannes, A. (1999). Narratives of recovery from addictive behaviours.

Addiction, 94(12), 1837-1848.

Hinchman, L.P., & Hinchman, S.K. (1997). Introduction. In L.P. Hinchman & S.K.

Hinchman (Eds.), Memory, identity, community: The idea of narrative in the human

services (pp. xii-xxxii). New York: State University of New York.


25

Hodgins, D.C. (2001) Processes of changing gambling behavior. Addictive Behaviors, 26(1),

121-8.

Hodgins, D.C., & el-Guebaly, N. (2000). Natural and treatment-assisted recovery from

gambling problems: A comparison of resolved and active gamblers. Addiction, 95(5),

777–789.

Hogan, B.E., Linden, W., & Najarian, B. (2002). Social support interventions: Do they work?

Clinical Psychology Review, 22, 381–440.

Hyden, L.C. (1997). Illness and narrative. Sociology of Health & Illness, 19(1),48-69.

Korn, D., & Shaffer, H. (1999). Gambling and the health of the public: Adopting a public

health perspective. Journal of Gambling Studies, 15(4), 289-365.

LaPlante, D.A., Nelson, S.E., LaBrie, R.A., & Shaffer, H.J. (2008). Stability and progression

of disordered gambling: Lessons from longitudinal studies. Canadian Journal of

Psychiatry, 53(1), 52–60.

Lincoln, L.S., & Guba, E.G. (1985). Naturalistic inquiry. Newbury Park: Sage.

Marlatt, G.A. (2002). Buddhist philosophy and the treatment of addictive behavior. Cognitive

Behavioral Practice, 9(1), 44-49.

McGowan, V. (2003). Counter-story, resistance and reconciliation in online narratives of

women in recovery from problem gambling. International Gambling Studies, 3(2),

115-131.

Messerlian, C., Derevensky, J., & Gupta, R. (2005). Youth gambling problems: A public

health perspective. Health Promotion International, 20, 69-79.

Mishler, E. (1995). Models of narrative analysis: A typology. Journal of Narrative and Life

History, 5, 87-123.

National Centre for Education and Training on Addiction (1998). Gambling and self-help.

Adelaide: Department of Human Services.


26

Nower, L., & Blaszczynski, A. (2008). Recovery in pathological gambling: An imprecise

concept. Substance Use & Misue, 43, 1844-1864.

Pallesen, S., Mitsem, M., Kvale, G., Johnsen, B.H., & Molde, H. (2005). Outcome of

psychological treatments of pathological gambling: A review and meta-analysis.

Addiction, 100(10), 1412–22.

Petry, N.M. (2005a). Pathological gambling: Etiology, comorbidity, and treatment.

Washington, DC: American Psychological Association.

Petry, N.M. (2005b). Gamblers Anonymous and cognitive-behavioral therapies for

pathological gamblers. Journal of Gambling Studies, 21(1), 27-33.

Productivity Commission (2010). Gambling, Report No. 50. Canberra: Commonwealth of

Australia.

Reissman, C.K. (2002). Narrative analysis. In A.M. Huberman (Ed.), The qualitative

researcher’s companion (pp. 217-270). London: Sage.

Sandelowski, M. (1986). The problem of rigor in qualitative research. Advances in Nursing

Science, 8(3), 27–37.

Shaffer, H., & Korn, D. (2002). Gambling and related mental disorders: A public health

analysis. Annual Review of Public Health, 23, 171-212.

Shaffer, H.J., & Hall, M.N. (1997). The natural history of gambling and drinking problems

among casino employees. Journal of Social Psychology, 142, 405-24.

Slutske, W.S. (2006). Natural recovery and treatment-seeking in pathological gambling:

Results of two U.S. national surveys. American Journal of Psychiatry, 163(2), 297–

302.

Strong, T. (2011). Approaching problem gambling with a discursive sensibility. Journal of

Gambling Issues, 25, 68-87.


27

Suurvali, H., Hodgins, D.C., & Cunningham, J.A. (2010). Motivators for resolving or seeking

help for gambling problems: A review of the empirical literature. Journal of

Gambling Studies, 26(1),1-33.

Toneatto, T., Vettese, L., & Nguyen, L. (2007). The role of mindfulness in the cognitive-

behavioural treatment of problem gambling. Journal of Gambling Issues, 19, 91-100.

Townshend, P. (2007). Self-exclusion in a public health environment: An effective treatment

option in New Zealand. International Journal of Mental Health & Addiction, 5(4),

390-395.

Tremblay, N., Boutin, C., & Ladouceur, R. (2008). Improved self-exclusion program:

Preliminary results. Journal of Gambling Studies, 24(4), 505-518.

Volberg, R.A. (2007). Population surveys. In Smith, G., Hodgins, D.C., & Williams, R.J.

(Eds.), Research and measurement issues in gambling studies (pp. 33-54). Burlington:

Elsevier.

Wong, Y.L.R., Leung, Y.K.T., & Lau, C.W.D. (2009). Behind the allure of gambling: A

qualitative exploration of the existential yearnings of Chinese men with gambling

problems in Hong Kong. International Gambling Studies, 9(3), 189-205.


28

Figure 1: Sequence Similarities in Narratives of Help-Seeking Amongst 10 Recovering

Problem Gamblers


29

Figure 2: Figure 1: Composite Plot Structure in Narratives of Help-Seeking Amongst 10

Recovering Problem Gamblers

a narrative analysis of help-seeking behaviour and critical change points for recovering problem...

Documents