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| The Effect of Stressful Life Events on Problem Gamblers |
ABSTRACT
As most people make gambling a form of entertainment in their lives, the activities of problem and pathological gamblers clearly differ in some way from the social and recreational gambling of most adults. In pathological gambling, individuals create unpleasant consequences for themselves and their loved ones and for some, gambling can become a means of escape rather than a form of excitement. The link between trauma and pathological gambling was observed in O’Donnell’s (1993) study of dissociation and in many other studies conducted within the field of alcohol and drugs. The aim of the present study was to extend the research into the effects of stressful life events and unresolved trauma to pathological gambling. It was hypothesized that self-identified problem gamblers will be significantly more likely to report stressful and uncontrollable life events in comparison to social gamblers and that females will be more likely to report stressful life events in comparison to males. Forty four participants participated in the present study. All participants were asked to complete the Life Events Questionnaire – Social Readjustment Scale. The groups were rigorously tested to ensure randomisation had succeeded. The results supported the first two hypotheses, however, there was no significant difference among gender. The present study provides evidence that gambling to dysphoria or escape from life problems, characterise a large subset of persons affected by problem gambling in treatment and eclectic treatment modalities should be used. Methodological issues and limitations are also discussed.
ESCAPISM AS A REASON FOR GAMBLING
Escapism can be related to defensive patterns linked to pathological gambling, as it may be an attempt to avoid the recollection of past events, re-experiencing and undoing the past and becoming numb to other stimuli. Therefore, this pattern mirrors the existence of unresolved trauma related anxiety. The link between trauma and pathological gambling was observed in O’Donnell’s (1993) study of dissociation in pathological gamblers with and without identified trauma. He demonstrated a significant group difference in the level of dissociative phenomena, with gamblers who identified trauma reporting higher levels of dissociation than gamblers who did not report trauma. This accorded with Rosenthal’s (1986) description of gambling as an effort to control the uncontrollable, a concept that can be observed as the formulation for Post Traumatic Stress Disorder (PTSD).
Much of the available research suggests that escapism is an important factor in the likelihood of developing a problem gambling behaviour. Bujold, Ladouceur, Sylvain and Boisvert (1994) concluded that “gambling enables some individuals to escape reality, anxiety, and stress which result from personal, family and professional problems” (p. 276). Isaacs (2001) suggested that people with problem gambling behaviours strive to lose themselves in time. Problem gamblers rarely realise that they have been playing until the session is over and the excitement that is induced by gambling temporarily distracts the individuals uncomfortable feelings and stressful situations.
Isaac’s suggestion is also consistent with the findings of the Arizona council on compulsive gambling The predisposing factors for emotional escape included boredom, stress, grief, loss of finances/home, lack of leisure activities/hobbies, controlling or domineering spouse, loneliness, empty nest, abuse, depression, lack of identity, relationship difficulties, chronic pain, health problems, isolation, fear of death, and loss of youth. The council collated data from incoming calls and has concluded that 95% of women and 38% of men who called in relation to problem gambling behaviours have met the criteria for escape gambling. The large proportion of women may indicate the greater willingness of females to report stressful life events in comparison to males. This is consistent with recent research (The Wager, 2004) suggesting that women are more likely to report negative emotions and stressful life events as a consequence of gambling, whereas men are likely to cite the need to make money as a precipitant of a relapse.
THE IMPACT OF TRAUMATIC EVENTS
Dayton (2000) supported an anxiety based model as a significant etiological aspect of pathological gambling. He stressed that that pathological gambling is “a learned defense for anxiety” (p. 404) and that it becomes a problematic behaviour because of central nervous system information processing disrupted by traumatic events. Further, he identified trauma history as a vital clinical matter that should be investigated and treated with the intention of achieving successful treatment outcomes with pathological gamblers. He argued that pathological gambling develops because of unresolved trauma, similar to PTSD and that reduced gambling will occur only when that anxiety has been dealt with.
Greco-Gregory (2002) investigated the relationship between trauma history, dissociation and video poker gambling among adult 60 women in Nevada. All women completed the South Oaks Gambling Screen (SOGS), Dissociative Experiences Scale II (DES II), Trauma History Questionnaire (THQ), Child Abuse and Trauma (CAT) Scale, and a demographic questionnaire. Individuals who identified with a gambling problem indicated more trauma related experiences when they were not playing video poker and more dissociative experiences whilst they were playing this game. Furthermore, people with a problem gambling behaviour reported a strong attachment to the video poker and dissatisfaction with their interpersonal relationships. Pathological female video pokers with unresolved trauma may attain intimacy and support from gambling and that this experience may be fundamental in maintaining the gambling behaviour. Therefore, gambling may not only serve as an escape mechanism for unresolved trauma but it can also be perceived as a coping strategy for maintaining interpersonal relationships, albeit problematic ones.
STUDIES ON YOUNG PEOPLE
Ste-Marie (2003) examined gambling behaviour among youth and provided preliminary support for a self-medicating model of gambling behaviour among adolescents. Questionnaires administered comprised of the Gambling Activities Questionnaire (GAQ), Diagnostic and Statistical Manual -4th Ed.- Multiple Response - Juvenile (DSM-IV-MR-J), the State Trait Anxiety Inventory (STAI), and the Behavioural Assessment for Children (BASC). Participants were categorised into one of four groups; no to all items (non gamblers, 28.6%), 0 to 1 items out of 9 domains (social gamblers, 57.2%), 2 or 3 items out of 9 domains (at risk for problem gambling, 9.7%), and 4 or more items out of 9 domains (probable pathological gamblers, 4.5%).
Ste-Marie's (2003) results showed that correlation coefficients revealed significant, with modest positive correlations between total DSM-IV-MR-J and state anxiety, trait anxiety and the Behaviour Assessment System for Children (BASC) Social Stress Scale. A close relationship between anxiety and gambling was found and the higher the state anxiety, trait anxiety and social stress scores, the higher the reported gambling problems (on the DSM-IV-MR-J).
DRUG AND ALCOHOL STUDIES
Although limited research has been conducted within the PTSD and gambling arena, empirical evidence (Baker, 2001; Clark, Masson, Delucci, Sharon & Sees, 2001) has awakened the drug and alcohol field to a complicated interaction among unresolved trauma challenges and addiction. A qualitative analysis (Streicher & Lyn, 2001) investigated the association between female perceptions of their heroin addiction and their histories of childhood nothing abuse. This study gathered information from 3 adult women recovering from a heroin addiction via the use of semi-structured interviews. Two of these women identified as Caucasian and one as Hispanic. All three revealed that drug-use was a means of coping with painful feelings from both childhood nothing abuse and later trauma. Heroin was their way to escape from reality and helped them feel “normal.” The small sample size and the non-examination of the severity of the women’s life stressors were two major limitations of this study.
Ouimette and colleagues (Ouimette, Kimerling, Shaw, Moos, 2000) focused on the relationship between physical and nothing abuse with psychological symptoms and functioning among substance abuse disorder (SUD). The sample consisted of 24,959 patients seeking treatment for SUD who were assessed with the Addiction Severity Index (ASI). Abuse history was related to alcohol, drugs, psychiatric, medical, social, legal, family and employment problems. A high proportion of patients had experienced traumatic events with more women reporting experiencing dual abuse (physical and nothing) than men. Although it was concluded that abuse history was related to more social and medical problems including drug and alcohol addiction it was also observed that abuse was connected to comorbid psychiatric diagnosis including PTSD.
A German study assessed the prevalence of traumatic experiences and PTSD among substance dependent persons. Participants were asked to complete a questionnaire about their trauma experiences and substance use. Over a quarter (26%) of participants were diagnosed with PTSD and 42% had at least one traumatic life experience with women reporting more traumatic experiences than men and in most cases, victimization occurred during childhood (Teegen & Zumbeck, 2000). This study emphasised childhood traumas and stressors and no account was taken into more recent life events that may have contributed to addictive behaviours.
Although the studies described above indicate a possible link between uncontrollable life events and problem gambling, it is also evident that there is a need for a comprehensive investigation within this field as most of the studies cited reveal major methodological limitations.
AIM and HYPOTHESES
The aim of this study was to extend the research into the effects of stressful life events and unresolved trauma to the field of problem gambling.
It was hypothesized that self-identified problem gamblers (individuals receiving treatment/support through Gambler’s Help) are significantly more likely to report stressful life events in comparison to social gamblers (people not seeking help for a gambling problem).
The second hypothesis was that self-identified problem gamblers are significantly more likely to report experiences of uncontrollable life events in the previous 12 months in comparison to the control group.
Further, it is hypothesized that females, in both groups, are significantly more likely to report stressful life events in comparison to males.
METHOD
Forty four participants participated in the present study. Participating organisations included Goulburn Valley Family Care-Gambler's Help West Hume, The Salvation Army-Gambler's Help City and Bentleigh Bayside Community Health Centre-Gambler's Help Southern.
The experimental group was comprised of 22 adults who received treatment/support through Gambler’s Help. Just over half of this sample (52.9%) comprised of males and the mean age was 43 years (SD=10.711) with a range of 29 to 63 years old.
The non-gambling group was comprised of 22 adults who work in community health in Victoria. Approximately half the sample was male (47.1%) and the mean age was 43 years (SD12.7) with a range of 23 to 66 years old.
All participants were asked to complete the Life Events Questionnaire – Social Readjustment Scale (Rahe, 1995). This Questionnaire contains 43 events, with their value in ‘life-change units’ that ranges from 123 (death of spouse) to 22 (minor violations of the law). Participants were asked to tick the items they had experienced in the last twelve months without being aware of the value of each item. The life-change values of the ticked items were then summed up to yield a total score that indicated how much stress each participant had experienced. Demographic information, including age, gender, country of birth, and education level and marital status were also collected.
Controllable life events refer to the reasonable predictable events that normally occur to many individuals at specific times during their lives and are expected, such as school transitions, marriage, childbirth, retirement, death of parents and others. In contrast, uncontrollable life events pertain to rare or unexpected events, such as accidents and disasters (Schwarzer & Schulz, 2001).
Ethical clearance from SCERH and piloting of the instrument occurred prior to the commencement of the study.
RESULTS
Table 1 shows the mean, median and standard deviation for age, uncontrollable life events, controllable life events, and the total life event score.
Table 1
Mean, median and standard deviation of age, reported uncontrollable and controllable life events.
AGE Uncontrollable Life Events Controllable Life Events Total Life Event Score
N Valid
Missing 44
0 44
0 44
0 44
0
Mean 43.34 82.1591 150.3182 232.4773
Median 44.00 60.5000 108.5000 151.0000
Std. Deviation 11.642 89.22429 134.81663 205.55749
In the table above the overall mean for controllable life events is almost twice as high as the mean for uncontrollable life events (150.3 and 82.1). Further, the overall median for controllable life events is approximately twice as high compared to the overall median of the uncontrollable life events (108.5 and 60.5). The participants could be described as a middle aged group with a mean age of 43.34 years.
Table 2
Mean, standard deviation and standard error of mean for reported life events among the two groups.
Group N Mean Std. Deviation Std. Error Mean
AGE Experimental
Control 22
22 43.36
43.32 10.711
12.759 2.284
2.720
Uncontrollable Life Events Experimental
Control 22
22 138.2727
26.0455 87.05892
46.09150 18.56102
9.82674
Controllable Life Events Experimental
Control 22
22 226.1818
74.4545 152.20026
44.64220 32.44920
9.51775
Total Life Event Score Experimental
Control 22
22 364.4545
100.5000 216.24055
57.14039 46.10264
12.18237
In Table 2, the mean age for the experimental group (M=43.36, S.D.= 10.7, n=22) is very similar to that of the control group (M=43.32, S.D.=12.7, n=22). The mean score for uncontrollable life events of the experimental group (M=138.2, S.D.=87.0, n=22) was, however, four times greater than that of the control group (M=26.0, S.D.=46.0, n=22). Generally, these descriptive statistics suggested higher life event scores for the experimental group for uncontrollable as well as controllable reported life events. The overall total life event score for the experimental group was approximately four times greater than the control group (M=100, S.D.=57, n=22).
The control and experimental groups were rigorously tested to ensure matching had succeeded. Participants of the experimental and control groups were the same age and similar proportions of men and women were recruited.
Table 3
Mean, standard deviation and standard error of the mean for gender on reported life events.
Gender N Mean Std. Deviation Std. Error Mean
Uncontrollable Life Events Male
Female 17
27 69.8824
89.8889 105.50171
78.46034 25.58792
15.09970
Controllable Life Events Male
Female 17
27 126.1176
165.5556 148.93282
125.64092 36.12151
24.17961
Total Life Event Score Male
Female 17
27 196.0000
255.4444 239.20885
182.34800 58.01667
35.09289
In Table 3, the mean age for males and females was very similar that resulted in similar standard deviations (M=45, S.D.=11.4, n=17; M=41.7, S.D.=11, n=27). In relation to uncontrollable and controllable life events, females reached a slightly higher (M=89.8; M=165.5) score compared to males (M=69.8; M=126.1), and the overall life events score also had a slightly higher mean for females as compared to males (M=255; M=196).
No significant differences were found between experimental and control groups on gender, country of birth and marital status. A significant difference was, however, found in level of education X2(2) = 18.579, p < 001.
Significant differences were found between overall life event scores (t(42) = 5.34,
p < 001) and controllable and uncontrollable life events (t(42) = 4.48, p <001) between the experimental and control groups.
DISCUSSION
TRAUMATIC EVENTS
Life events were not only shown to have a significant association with persons who have a problem gambling behaviour, but a significant relationship was also observed between uncontrollable and controllable life events among self-identified problem gamblers and social gamblers. This finding supported the first two hypotheses of this study. Similarly to Jacob's (1987) General Theory of Addictions, the addiction of choice, which in this study was gambling, was probably reinforced and maintained by permitting the individual with the problem gambling behaviour to escape from painful realities arising from uncontrollable life events.
The findings of the present study are further supported by empirical research conducted by Blaszczynski & McConaghy (1989). Blaszczynski and McConaghy (1989) suggest that pathological gamblers gamble to reduce or avoid "noxious physiological states" and gambling increases as a way of distracting and escaping from everyday problems and stress. Blaszczynski & McConaghy (1989) concluded that pathological gamblers are likely to exhibit anxiety or depression when stressed and were found to have higher state and trait of anxiety scores.
YOUNG PEOPLE
Studies revealing a connection between problem gambling and uncontrollable life events have also been found in younger age groups. Although the present study focused on self-identified problem gamblers who were over the age of eighteen, Gupta and Derevensky (1998) came to a similar conclusion when studying youth gambling, as it was concluded that adolescents who engage in excessive gambling do so to dissociate and escape from reality.
This is in accord to Ste Marie’s (2003) study of gambling among adolescents. It was concluded that possible pathological gamblers experience more anxiety (state and trait) compared to non-gamblers and social gamblers. Moreover, the negative life events from which adolescents were trying to escape may have been the cause of their heightened levels of state and trait anxiety.
Taber, McCormick and Ramirez (1987) discovered similar results with a group of pathological gamblers, aged 23-73 years seeking hospital treatment. The participants were compared with groups of gambling patients who had experienced insignificant, low, or moderate amounts of life trauma. Major traumatic events were discovered in the histories of 10 of 44 pathological gamblers whilst less traumatic events were associated to problem gamblers. Rates of depression, anxiety and avoidance in personality style were also found to be higher in pathological gamblers who had experienced more traumas in their lives.
Moreover, Hodgins and el-Guebaly (2000) suggested that even though life events do not play a significant role in precipitating recovery from problem gambling, they may be important in maintaining recovery. It was observed that life for recovered gamblers improved after experiencing an increase in positive events and decrease in negative events, as well as positive financial and health events. Participants also reported that engaging in new activities, accessing general support and remembering negative consequences were vital variables in maintaining changes.
AGE
As described in the results, the participants of the present study were mostly middle aged with an overall mean of 43 years. Although some investigators have concluded that young males are likely to be problem gamblers when compared to young females (Abbott & Volberg, 1996; Griffiths, 1995), other researchers noted that gender differences are not evident or decrease with time (Fisher, 1993; Lopez Viets, 2001).
GENDER
This supports the findings of the third hypothesis of this study as no differences were observed between gender and stressful life events among the two groups as women did not report more life events than males. By reviewing the literature concerning trauma and its relationship to gender, results are incongruent. For example, research conducted in the United States (Resnick, 1993 cited in Broffman, 2000) exploring the differences in traumatic events among the two nothing, concluded that more women (69%) had experienced at least one traumatic event with 32% of women being victims of nothing assault and meet PTSD criteria. This is consistent with McLean & Woody's (1998) supporting evidence of women being likely to experience 'dual abuse' and that 60% of women with depression have a reported childhood history of nothing abuse. Carmen and colleagues (Carmen, Masson, Delucci, Hall, Sees, 2001) on the other hand, revealed no gender differences in the prevalence of traumatic events.
EDUCATION
An unexpected finding that was observed was in relation to the participants education. Level of education was significantly different amongst self-identified problem gamblers and social gamblers. The higher the level of education, the less likely the probabilities of developing a problem gambling behaviour. Whilst this finding supported Abbott and Volberg’s (1999) conclusions, other researchers (e.g., Aasved, 2003) dispute it, suggesting that education and income are not consistently related to the prevalence of problem gambling. Future research is required to clarify inconsistencies.
MARITAL STATUS
Marital status of the participants resulted in some interesting findings as most participants (66.7%) from the control group were married but only one third (33%) of the experimental group. It is not clear whether marriage is protective against problem gambling or problem gamblers’ marriages are more likely to break down. This finding, however, is consistent with past research as is indicated that the prevalence of problem gambling is lower for persons who are married than for persons who are single or divorced (Aasved, 2003).
ETHNICITY
Although previous research (Aasved, 2003) shows that at risk gambling occurs at a higher rate among African-Americans and Caucasians, whilst Hispanics have the lowest rate of pathological and problem gambling but the highest rate of at-risk gambling, the present study found no significant relationship between ethnicity and problem gambling.
This may be due to the geographical regions that participants derived from as most rural regions have a greater Anglo-Australian population.
LIMITATIONS and METHODOLOGICAL ISSUES
A basic limitation of this study was that self-identified problem gamblers were not assessed on the severity of their gambling behaviour. Therefore, the distinction of problem and pathological gamblers cannot be made for this study. Furthermore, by relying only on the life events questionnaire (Rahe, 1995), the results were limited to the use of average weights for events, disregarding that dissimilar persons may have a different view of the similar event.
Moreover, coping processes and changes in social support were not examined. Social support and networks may have assisted to gain a better understanding of gambling patterns and its relevance to life events. In this study, self-identified problem gamblers were not asked to provide any information about their social and support networks. However, the degree to which the objective nature of the stressor should be stressed contrary to its subjective interpretation continues to be under debate (Hobfoll, 1998; Schwarzer & Schulz, 2001).
One issue that has to be taken into consideration is the small number of participants that were included in this study. This limited number was partly due to the fact that a very similar study was conducted at the same time by a Masters student from LaTrobe University. Therefore, an insufficient number of Gambler’s Help organisations were willing to take part in the present project as they already commited themselves to another study.
Stigma and shame are vital factors to consider when examining a sample of individuals with a problem gambling behaviour. Stereotypes of irrationality are often part of community attitudes towards problem gambling, with the perception that those affected are “weak willed”, “irresponsible” or even “stupid” (Gambling Research Panel, 2003). These perceptions make seeking, getting help and participating in various projects all the more difficult.
Further, the association between depression and problem gambling has been demonstrated in many studies (Abbott & Volberg, 1996; Fisher, 1993; Grffiths, 1993). Due to this association, it is unclear whether individuals with a problem gambling behaviour are likely to experience more symptoms of depression than others, because the experience of losing can be perceived as a negative experience. Another explanation of this may simply be that individuals who are depressed are likely to perceive experiences and life events as being more negative rather than positive.
This notion is further supported by Roy and colleagues (Roy, Custer, Lorenz, & Linnoila, 1988) who conducted a study that appears to contradict the hypothesis that individuals gamble to self-medicate or escape. Roy et al. focused on major depressive episodes and examined depressed pathological gamblers who reported on life events preceding the onset of depression. Their results indicated that during the 6-month period before the onset of depression, individuals with problem gambling behaviours had more negative life events related to gambling than did the control group. Their research suggested that individuals with problem gambling behaviours may have become depressed as a consequence of the negative impacts of gambling but it cannot rule out the possibility that depressed individuals recall more negative events than nondepressed people.
Besides the limitations and methodological issues raised above, there appears to be an interactive effect between problem gambling and stressful life events that may lead to escapism and self-medicating. The excitement induced by gambling, distracts the person with a gambling problem from uncomfortable feelings and stressful situations, that may also be related to unresolved trauma from critical life events.
Health compromising behaviours constitute a major pathway to persons who are under stress. People under stress may want to relieve their tension by consuming more alcohol, illicit drugs, or, in this instance, gambling as a means to escape from reality. In accord with drug and alcohol studies, the results of the present study suggest that gambling to escape dysphoria or life problems, characterise a large subset of persons affected by problem gambling. Treatment modalities for problem gambling should include a range of strategies as underlying factors such as unresolved trauma due to stressful life events can serve as a catalyst for problem gambling behaviours.
http://www.gamblershelp.org/index.cgi?tid=1172
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