annotated gambling bibliographies
Mutual aid: An annotated bibliography
Peter Ferentzy & Wayne Skinner, Centre for Addiction and Mental Health Toronto, Ontario, Canada. E-mail:
pferentzy@earthlink.net
A quick scan of this annotated
bibliography brings home one point: Gamblers Anonymous (GA) has not received
much scholarly attention in recent years. As well, the bulk of the
literature we have annotated deals mainly with other issues and not directly
with GA. Attention to GA peaked from the mid-1980s to 1994, with authors
such as Lesieur, Brown, Browne, Turner, and Saunders making significant
contributions. For a summary of GA-related literature, the reader could turn
to Ferentzy and Skinner (2003). Because little is known about GA, even
though it serves as an adjunct to most formal treatment programs, the
authors call for a more serious look at this mutual aid fellowship. It was
back in 1993 that Walker pointed out that given its cost effectiveness, GA
would likely figure prominently over the long run regardless of reservations
some may have about its effectiveness. So far, Walker's prediction has stood
the test of time. This alone suggests that a better understanding of GA's
workings is a research priority. As well, Ferentzy, Skinner, and Antze
(2004) in a more recent study have found much of the available information
to be dated. Whereas GA has earned a reputation, for example, as male
dominated and less focused upon the 12 Steps than Alcoholics Anonymous (AA),
these authors have found that this reputation, while still partly valid, is
less warranted than it once was. In short, the most up to date study
available suggests that GA is in transition and that much of the little
available knowledge at our disposal may be suspect. Many of the following
annotations should therefore be read with caution, as they may not
accurately reflect current reality.
A., Paul, Esq. (1988). Recovery,
reinstatement, serenity: The personal account of a compulsive gambler.
Journal of Gambling Behavior, 4, 312–315.
This is
an anonymous account of a successful individual who committed crimes,
received legal sanction, and lost his career due to gambling. He recounts
the way GA helped him recover both his life and his professional standing.
In court, some jurors felt that this man was too intelligent to really have
been a compulsive gambler.
Abt, V., & McGurrin, M. C.
(1991). The politics of problem gambling: Issues in the professionalization
of addiction counseling. In W. R. Eadington & J. A. Cornelius (Eds.),
Gambling and public policy: International perspectives (pp. 657–659).
Reno, NV: University of Nevada.
This is
a socioethical critique of the "addictions culture" that has helped to
foster GA and gambling treatment, as well as the entire self-help movement
and the addiction treatment industry. The authors argue that it is futile
(through treatment) to focus on one addict at a time and that this in fact
hides the social reality behind the addiction phenomenon. GA is discussed in
terms of its AA roots, as well as the extra lengths to which GA (due to the
seeming absence of physical determinants and consequences) had to go in
order to establish compulsive gambling as a legitimate ailment. The authors
see GA's rapport with certain professionals and institutions as symbiotic, a
"mutually validating" process that serves each party's interests. The
article advocates personal responsibility, for which the authors see medical
models such as the one applied to compulsive gambling as an abdication.
Adkins, B. J. (1988). Discharge
planning with pathological gamblers: An ongoing process. Journal of
Gambling Behavior, 4, 208–218.
The
author discusses the aftercare needs of gamblers, stating that while GA and
Gam-Anon are often sufficient for the maintenance of abstinence, other
aspects of a client's life (ranging from depression to housing and
employment) require professional involvement.
Allock, C. C. (1986).
Pathological gambling. Australian and New Zealand Journal of Psychiatry,
20, 259–265.
In this
overview of psychiatric treatments for pathological gambling, the author
concludes that behavioural interventions are the most successful. In a brief
discussion of GA, it is mentioned that only 10% of newcomers remain with the
fellowship for the long term. The author acknowledges, however, that GA
accepts anyone who walks through the door and probably receives many of the
most troubled cases. The author also mentions that even one GA meeting may
benefit a compulsive gambler, so dropouts need not be classified as cases of
pure failure.
Becoņa, E., Labrador, F., Echeburua,
E., Ochoa, E., & Vallejo, M. A. (1995). Slot
machine gambling in Spain: An important and new social problem. Journal
of Gambling Studies, 11, 265–286.
This
discussion of the gambling situation in Spain mentions how, in that country,
GA is less influential than other mutual aid programs sponsored through the
healthcare system. Despite some differences, these organizations use similar
therapeutic principles to those of GA.
Bellringer, P. (1999).
Understanding problem gamblers. London, New York: Free Association
Books.
This
book discusses problem gambling and its solutions in many aspects, from the
onset and nature of the affliction to the family's role. The one chapter
devoted to self-help groups focuses on GA and Gam-Anon. GA's history and the
12 Step program are discussed. The author endorses GA as a good means to
abstinence and believes lifetime membership to be beneficial. He does say
that for some gamblers GA is not enough and has reservations about the view
that lifelong abstinence is necessary for all problem gamblers.
Berger, H. L. (1988). Compulsive
gamblers: Relationships between their games of choice and their
personalities. In W. R. Eadington (Ed.), Gambling research: Proceedings
of the Seventh International Conference on Gambling and Risk Taking: Vol. 5
(pp. 159–179). Reno, NV: University of Nevada.
True to
its title, this article discusses the types of personalities associated with
different gambling activities pursued by problem gamblers. Common
attributes, such as propensities to deny reality or to blame others for it,
are also addressed. The author claims that card players and casino players
are particularly averse to GA attendance.
Blackman, S., Simone, R. V.,
Thoms, D. R., & Blackman, S. (1989). The Gamblers Treatment Clinic of St.
Vincent's North Richmond Community Mental Health Center: Characteristics of
clients and outcome of treatment. The International Journal of the
Addictions, 24, 29–37.
A
treatment program had some success, but GA involvement at termination of
treatment had little identifiable bearing on gambling behaviour at
termination. The authors suggest that a comparison should be made of these
clients and those for whom GA provides a successful alternative.
Blaszczynski, A. P. (2000).
Pathways to pathological gambling: Identifying typologies. The Electronic
Journal of Gambling Issues: eGambling, 1. Available at
http://www.camh.net/egambling/issue1/feature/index.html
The
author divides problem gamblers into three types: those whose problems are
rooted in biology, those whose problems are rooted in emotional
vulnerability, and those who are essentially "normal" save for the gambling
behaviour itself. The author recommends GA for the third group only.
Blaszczynski, A. P., & McConaghy,
N. (1994). Criminal offenses in Gamblers Anonymous and hospital treated
pathological gamblers. Journal of Gambling Studies, 10, 99–127.
Finding
no significant difference between the type and frequency of criminal
activity among GA members and pathological gamblers who received
hospital-based behavioural treatment, the authors discuss the role of
pathological gambling itself in the commission of nonviolent crimes against
property due to financial difficulties.
Blume, S. B. (1986). Treatment
for the addictions: Alcoholism, drug dependence and compulsive gambling in a
psychiatric setting—South Oaks Hospital, Amityville, New York. Journal of
Substance Abuse Treatment, 3, 131–133.
In this
brief description of a treatment program, the author emphasizes the common
features of compulsive gambling, alcoholism, and drug dependence. The author
also mentions loss of control, chronicity, progression, and "the utility of
the disease concept" and refers to addictions as "family diseases" that can
be addressed through combinations of professional and self-help approaches.
AA, GA, Cocaine Anonymous, Narcotics Anonymous, and other self-help meetings
are held on site.
Boston, M. D., Taber, J. I.,
Harris, R. L., Whitman, G. W., & Lougaris, I. A. (1988). Selective
perception in the diagnosis and treatment of addictive disorders. In W. R.
Eadington (Ed.), Gambling research: Proceedings of the Seventh
International Conference on Gambling and Risk Taking, Vol. 5 (pp.
78–94). Reno, NV: University of Nevada.
This
article was written to help move addiction treatment away from "a narrow
focus on specific addictions" and toward a perspective that takes into
account a broader range of potential concurrent addictions. The authors
mention, for example, that the inclusion of Narcotics Anonymous and GA in
addition to AA as part of a new program delivered promising results. The
authors do not see addiction as a mere symptom of neurosis but argue that a
holistic addiction concept would better serve the needs of many clients.
Brown, R. I. F. (1985). The
effectiveness of Gamblers Anonymous. In W. R. Eadington (Ed.), The
gambling studies: Proceedings of the Sixth National Conference on Gambling
and Risk Taking, Vol. 5 (pp. 258–284). Reno, NV: University of Nevada.
Primarily, this article discusses the difficulties associated with
evaluating GA's effectiveness. At the time of writing, the author could
claim that studies on GA's effectiveness as a therapy were "unknown."
Listing obstacles such as the tradition of anonymity, the author points out
that hard comparisons with other treatment options would be imprudent given
the lack of reliable data.
Brown, R. I. F. (1986). Dropouts
and continuers in Gamblers Anonymous: Life-context and other factors.
Journal of Gambling Behavior, 2, 130–140.
Perhaps
the first serious attempt to examine GA's effectiveness, this article
explores the reasons many drop out of the GA program. Controlling for
arguably unrelated issues such as "external practical considerations" that
may lead newer members to leave GA, the study attempts to gauge the appeal
and effectiveness of GA and to determine the types of gamblers for whom it
is best suited. Reasons for leaving include an immature character (those who
are completely elated and full of unrealistic expectations at their first
meeting leave more often than newcomers with a more "sober" attitude), as
well as the apparent ability to abstain without GA or simply to gamble more
moderately. Dropouts in general were also in less financial trouble than
"continuers."
Brown, R. I. F. (1987a). Dropouts
and continuers in Gamblers Anonymous: Part 2. Analysis of free-style
accounts of experiences with GA. Journal of Gambling Behavior, 3,
68–79.
Freestyle accounts suggest that one main difference among GA dropouts and
those who pursue the program is the propensity of dropouts to perceive
themselves as less troubled than longer-term GA members. Dropouts are said
overall to have made more "self-positive" statements. The author speculates
that this may vindicate GA's belief that gamblers must hit bottom before
embarking upon serious recovery. But other possible explanations are given.
It is speculated that many GA members may even look down at those with less
dramatic stories to tell, and also that some embellish their own past
troubles in order to make the newcomer feel at ease.
Brown, R. I. F. (1987b). Dropouts
and continuers in Gamblers Anonymous: Part 3: Some possible specific reasons
for dropout. Journal of Gambling Behavior, 3, 137–152.
The
author continues his study of these matters and finds that, though dropouts
and continuers share many complaints about GA, some notable differences
could be identified. These include a greater perception among dropouts that
GA members are too harsh in their treatment of those who slip, more
reservations about the GA handbook, and skepticism regarding the call for
complete abstinence. Dropouts were also less likely to have socialized with
other GA members.
Brown, R. I. F. (1987c). Dropouts
and continuers in Gamblers Anonymous: Part 4. Evaluation and summary.
Journal of Gambling Behavior, 3, 202–210.
The
author suggests that, overall, GA may be best suited for gamblers whose
problems have become most severe, and less so for gamblers who try to stop
before their gambling has reached critical stages. Though often effective in
helping gamblers achieve abstinence, GA is perhaps less helpful after a
relapse has occurred and hence possibly best suited for those who relapse
infrequently or not at all. Yet among those who dropped out, many believed
that their GA experience continued to be helpful and spoke highly of the
organization. The author cautions against generalizing from this sample,
which relied on one meeting only.
Brown, R. I. F. (1987d).
Pathological gambling and associated patterns of crime: Comparisons with
alcohol and other drug addictions. Journal of Gambling Behavior, 3,
96–114.
GA
members are compared to the general population and to various types of
substance addicts in order to gauge the extent and nature of crimes
associated with compulsive gambling. It was found that gamblers are prone to
committing nonviolent crimes for financial reasons, much like heroin
addicts. It is speculated that violent crime committed by gamblers is often
unrelated to gambling and associated with concurrent alcohol abuse. Most
criminal activity is said to be a product of gambling, with only a small
portion of problem gamblers having been criminals prior to the onset of
gambling pathology. Beyond purely financial motives, the author speculates
that long-term gambling can be conducive to a progressive "moral slippage"
due to circumstances associated with the activity.
Browne, B. R. (1991). The
selective adaptation of the Alcoholics Anonymous program by Gamblers
Anonymous. Journal of Gambling Studies, 7, 187–206.
Observations of AA and GA meetings indicate that GA differs from AA in
several respects, including a lesser focus on the 12 Steps, on spirituality,
and on the whole "self" as an issue to be tackled in recovery. Despite many
similarities, such as the principle of anonymity, the adherence to the
disease conception, and the insistence on abstinence, GA is said to differ
on three counts: organization, ideas about how to address addiction, and the
overall consciousness of members. The author also mentions that GA's
pragmatic approach, which focuses primarily on gambling and its consequences
rather than self-centredness and other issues addressed by AA, may render it
less helpful as an overall therapy. The "12 step consciousness" often found
among AA members is in the author's view most often seen in GA members
affiliated with other 12 Step fellowships. The author claims that GA's
negation of inner searching may alienate women and minorities.
Browne, B. R. (1994). Really not
God: Secularization and pragmatism in Gamblers Anonymous. Journal of
Gambling Studies, 10, 247–260.
The
author claims that GA is largely a 12 Step fellowship in name only, as it
has progressively become more secular and pragmatic in orientation. GA's
principles, practices, and evolution are discussed, along with a few
possible reasons for its turning away from God. One reason given is ethnic
composition. Jews and Italians are said to visit GA in large numbers. Jewish
culture is uncomfortable with what may appear to be Christian ideas about
God inherited from AA, as well as being averse to proselytizing. Italians,
though often religious, also tend to be skeptical of what may resemble
church authority.
Canadian Foundation of Compulsive
Gambling (Ontario). (1996). Vision of and role in the Province of
Ontario's comprehensive strategy for combating problem and compulsive
gambling. Toronto: Ontario Ministry of Health, Substance Abuse Bureau.
This
document addresses many pertinent issues ranging from demography to law.
GA's 12 Step approach is hailed as the most successful (and cost effective)
treatment for gambling problems, though inpatient options are recommended
for those in crisis. An increase in problem gambling rates is predicted, and
the Foundation recommends that GA and Gam-Anon be assisted in every way
possible to form more chapters. The foundation also promises to assist GA
members dealing with legal issues. Estimating that one third of compulsive
gamblers have substance abuse issues, the authors recommend integrated
interventions.
Castellani, B. (2000).
Pathological gambling: The making of a medical problem. Albany, NY:
State University of New York Press.
This
book discusses the emergence of a disease conception of problem gambling by
focusing on an early-1980s court case involving the misdeeds of a problem
gambler through the relevant discursive practices of diverging interests
including legal and medical and those of the gambling industry. One chapter
is devoted to GA.
Ciarrocchi, J. W., & Manor, T.
(1988). Profile of compulsive gamblers in treatment: Update and comparisons.
In W. R. Eadington (Ed.), Gambling research: Proceedings of the Seventh
International Conference on Gambling and Risk Taking, Vol. 5 (pp. 1–25).
Reno, NV: University of Nevada.
This
study of hospitalized compulsive gamblers finds both similarities and
differences between this group and GA members as reported in other studies.
Similarities include ethnic composition and suicidal history. Differences
include higher rates among hospitalized gamblers of criminal history,
parental alcoholism, and parental compulsive gambling. The authors note
that, while the hospitalized group is more "distressed and dysfunctional"
overall, this could in part be because GA samples are based mainly on
gamblers well into recovery. Still, the authors caution that the disparate
backgrounds of the two groups suggest that the hospitalized group represents
a type of problem gambler that requires special types of intervention.
Ciarrocchi, J. W., & Reinert, D. F.
(1993). Family environment and length of recovery
for married male members of Gamblers Anonymous and female members of
GamAnon. Journal of Gambling Studies, 9, 341–351.
This
study suggests that long-term abstinence through GA leads to an improved
satisfaction with family environment for the recovering gambler, but that
the gambler's spouse in Gam-Anon does not enjoy the same benefit.
Collins, A. F. (1996). The
pathological gambler and the government of gambling. History of the Human
Sciences, 9 (3), 69–94.
This
U.K.-focused historical account of legislation and attitudes surrounding
gambling describes the figure of the pathological gambler as a product of
the legalization of gambling and of changing perceptions. Past laws and
attitudes were prohibitive to the medicalization of problem gambling, a
"space" for which has recently been provided. GA's role in this process is
discussed, notably with respect to how gamblers themselves helped to
construct their own behaviour as pathological.
Cooper, G. A. (2001). Online
assistance for problem gamblers: An examination of participant
characteristics and the role of stigma. Unpublished Dissertation, OISE,
University of Toronto.
This
document discusses on-line support for individuals with gambling problems.
Noting that professional treatment and mutual aid approaches seem to reach
only a small percentage of those in need, the author discusses how many
gamblers use on-line help out fear of stigma and how people who have jumped
this hurdle are then more likely to seek face-to-face assistance. It is
suggested that on-line help is especially useful to problem gamblers
contemplating, but not quite ready for, a serious lifestyle change. Some of
the relevant literature on GA is discussed, as are other fellowships such as
AA and Narcotics Anonymous. The author is critical of GA's intolerance of
other recovery options and refers to texts suggesting that GA may be poorly
suited to women and minorities. Rather than dismiss GA, the author believes
that many options should be available and that safe and perfectly anonymous
on-line interaction may be a good start, especially for those less likely to
fit into available modalities.
Cordone, A. C. (1985). Two hats
but only one head: The dual role of a peer counselor. In W. R. Eadington
(Ed.), The gambling studies: Proceedings of the Sixth National Conference
on Gambling and Risk Taking, Vol. 5 (pp. 236–240). Reno, NV: University
of Nevada.
In
discussing his role as a peer counsellor at a treatment program for
compulsive gamblers, the author (a GA member) discusses many of the issues
pertinent to the distinction between peer and professional intervention.
Identification is key, but so is his own insight into the dishonesty of many
clients: he mentions that it is hard "to con a con artist" (something one is
just as likely to hear from AA and Narcotics Anonymous members). Considering
GA essential to recovery from compulsive gambling, he mentions how that
fellowship can be helpful with issues such as money management. Like other
GA members, he also understands the sensitive nature of this task: putting
too much financial pressure on gamblers can cause them to view their
gambling problem as a money problem. The many tensions between the author's
two worlds—formal treatment and GA—are colourfully discussed.
Cromer, G. (1978). Gamblers
Anonymous in Israel: A participant observation study of a self-help group.
International Journal of the Addictions, 13, 1069–1077.
While
pointing out that GA got started in Israel in 1976, this article is not
about the specifics related to that country. Arguing that "status
degradation" is more important to GA involvement than the loss of money, the
author sees the GA program as an example of differential association. One
learns to be deviant in association with others who reject society's norms
and unlearns it with the help of those who have reformed (or wish to
reform). This is not, in the author's view, unique to GA or even to mutual
aid groups in general, but occurs in all instances of "transformative
labeling." The old identity must first be destroyed, one must be subject to
the influence of peers, and the new identity requires time-consuming "ritual
involvement."
Custer, R. (1982a). Gambling and
addiction. In R. J. Craig & S. L. Baker (Eds.), Drug dependent patients:
Treatment and research (pp. 367–381). Springfield, IL:
Charles C. Thomas.
The
author provides a brief overview of compulsive gambling. In the discussion
of GA, seven reasons are given for its success: GA "(a) undercuts denial,
projection, and rationalization, (b) identifies the serious implications of
gambling, (c) demands honesty and responsibility, (d) identifies and
corrects character problems, (e) gives affection, personal concern, and
support, (f) develops substitutes for the void left by the cessation of
gambling, and (g) is non judgmental." The author considers GA the best
solution to compulsive gambling.
Custer, R. (1982b). An overview
of compulsive gambling. In P. A. Carone, S. F. Yolles, S. N. Kieffer, & L.
W. Krinsky (Eds.), Addictive disorders update: Alcoholism/drug
abuse/gambling. New York, London: Human Sciences Press, Inc.
The
author briefly discusses the causes, phases, and treatment of compulsive
gambling and mentions that GA is effective because it challenges the
gambler's dishonesty regarding the nature and consequences of his or her
condition. It is also mentioned that, at the time of writing, only 4% of GA
members were women. This chapter is followed by another with no stated
author as it contains the personal accounts of three GA members followed by
a panel discussion chaired by Dr. Custer involving experts as well as GA
members.
Custer, R., & Milt, H. (1985).
When luck runs out: Help for compulsive gamblers. New York, Oxford:
Facts on File Publications.
Compulsive gambling is defined and then discussed in terms of causes,
phases, diagnosis, and treatment. GA is highly endorsed, though mention is
made of how subjects with serious difficulties such as suicidal tendencies
require professional intervention (at least in the beginning). Similarities
between AA and GA members—such as desperation, disease progression, and the
activities of choice functioning as compensations for low self-esteem—are
mentioned as reasons for similar (though not identical) treatment
modalities.
Estes, K., & Brubaker, M. (1994).
Deadly odds: Recovery from compulsive gambling. New York:
Fireside/Parkside.
This is
a 12 Step–oriented self-help manual that strongly endorses GA. Topics
covered include various types of gambling, women's issues, and the GA
program. The book relies heavily on personal stories.
Ferentzy, P., & Skinner, W.
(2003). Gamblers Anonymous: A critical review of the literature.
Electronic Journal of Gambling Issues, 9. Available at
http://www.camh.net/egambling/issue9/research/ferentszy/
Authors'
abstract: "This study surveys existing literature on Gamblers Anonymous (GA)
and issues that help to contextualize our understanding of this mutual aid
association. While GA has been the subject of investigation by social
scientists, it is still understudied, with a notable shortage of research on
issues facing women and ethnic minorities. A need exists for large-scale
assessments of GA's effectiveness, more detailed accounts of GA beliefs and
practices, increased knowledge of the ways in which GA attendance interacts
with both formal treatment and attendance at other mutual aid organizations,
and a better understanding of the profiles of gamblers best (and least)
suited to GA, along with a clearer grasp of what GA was able to offer those
gamblers that it seems to have helped. This assessment of the current state
of knowledge underscores the embryonic state of our collective inquiry into
the nature of GA, and the authors emphasize that significant advances have
been made. Notably, important targets for study are being identified."
Ferentzy, P., Skinner, W., &
Antze, P. (2004). Exploring mutual aid pathways to recovery from gambling
problems. Toronto: Ontario Problem Gambling Research Centre. Available
at
http://www.gamblingresearch.org/download.sz/115-Ferentzy%20Final%20report%20PDF.pdf?docid=5990
Authors' abstract: "This
ethnographic study, involving participant observation at Gamblers Anonymous
(GA) and Narcotics Anonymous (NA) meetings and interviews with subjects from
both fellowships in the Toronto area, was designed to provide a more
in-depth and empirically grounded account of GA's recovery culture than what
has been available so far. A secondary aim was to develop a better
understanding of NA beliefs and practices and their use as a resource by
problem gamblers with substance abuse issues. Not only has GA been
understudied, with the literature providing more evaluation than
description, this study has revealed that the little available information
on GA is now largely dated. GA has earned a reputation for being an almost
exclusively male fellowship, pragmatically focused on abstinence from
gambling and on debts at the expense of discussions of emotional issues, and
as a 12 Step fellowship in name only where the spiritual side of things is
mostly ignored. Yet today in the Toronto area, the percentage of women in GA
may be as high as 20 percent and rising, discussions of feelings and 'life
issues' are actively encouraged, and members have become far more focused on
the 12 Steps than in the past. Possible reasons for these changes—which seem
to be taking place in GA throughout North America—are discussed, along with
GA's culture of recovery and its unique (among 12 Steps fellowships)
emphasis on the virtue of patience. Our impression of NA as a potential
resource for problem gamblers with substance abuse problems is also
discussed."
Frank, M. L., Lester, D., &
Wexler, A. (1991). Suicidal behavior among members of Gamblers Anonymous.
Journal of Gambling Studies, 7, 249–254.
This
survey of GA members suggests that histories of suicide attempts and
suicidal ideation are linked to the severity of gambling problems, starting
gambling early in life, and parental substance abuse.
Franklin, J., & Ciarrocchi, J.
(1987). The team approach: Developing an experiential knowledge base for the
treatment of the pathological gambler. Journal of Gambling Behavior, 3,
60–67.
The
authors discuss a "learning model" for the development of treatment
programs. Rather than simply imitate or ignore 12 Step approaches, it is
suggested that mental health professionals and peer counsellors learn from
each other and cooperate. Successful adaptation of—and cooperation with—AA
is discussed with an eye to achieving similar integration with GA and its
members. Recovering problem gamblers are said, for instance, to be adept at
detecting dishonesty in newcomers to treatment and capable of establishing
trust, thereby reducing resistance to treatment efforts. Professional
approaches, however, are said to make possible therapeutic advances that GA
could not accomplish on its own.
Franklin, J., Darvas, S.,
Robertson, R., & Knox, J. (1982). Therapeutic teamwork at the Johns Hopkins
Compulsive Gambling Counseling Center. In W. R. Eadington (Ed.), The
gambling papers: Proceedings of the Fifth National Conference on Gambling
and Risk Taking, Vol. 3 (pp. 109–116). Reno, NV: University of Nevada.
The role
of peer counsellors drawn from GA is discussed. The authors mention that
peer counsellors, because of empathy and identification, are especially
important during the initial phases of treatment.
G. A. Publishing Company (GAPC).
(1964a). Gamblers Anonymous. Los Angeles: Author.
An early
attempt by GA to produce a major text, this book discusses GA history and
the program at length. While still in use, this book has largely been
supplanted by the more recent GA: A new beginning (GAISO, 1989; see
below).
GAPC. (1964b). The GA group.
Los Angeles: Author.
This
document describes the format and service structure of GA groups.
Gam-Anon International Service
Office, Inc. (1986). Gam-A-Teen. Whitestone, NY: Author.
This is
a GA-sanctioned pamphlet describing the program for children and family
members of compulsive gamblers.
Gam-Anon International Service
Office for Gam-Anon Family Groups. (1988). The Gam-Anon way of life.
Whitestone, NY: Author.
This is
a GA-sanctioned pamphlet describing the Gam-Anon program for spouses, other
relatives, and friends of compulsive gamblers.
Gamblers Anonymous International
Service Office (GAISO). (1989). GA: A new beginning. Los Angeles:
Author.
Other
versions of this text have appeared under the title Sharing recovery
through Gamblers Anonymous. Next to the "Combo Book" (GAISO, 1999), this
is probably the most important GA publication. It outlines the fellowship's
history and the recovery program and also discusses Gam-Anon.
GAISO. (1999). Gamblers
Anonymous. Los Angeles: Author.
This is
a pamphlet describing the GA program, with a few words on the organization
itself and its history. This is the first document one is likely to see at a
GA meeting, and members read from it during the first part of the meeting.
It is known as the "Combo Book."
Gamblers Anonymous National
Service Office (GANSO). (1978). The pressure group meeting handbook.
Los Angeles: Author.
The
"pressure group" is designed to enable gamblers to get honest with their
spouses about their condition and its ramifications and to deal with
financial and other matters. This document describes the process.
Getty, H. A., Watson, J., &
Frisch, G. R. (2000). A comparison of depression and styles of coping in
male and female GA members and controls. Journal of Gambling Studies, 16,
377–391.
This
study finds that GA members have higher depression rates and poorer coping
skills than controls. Female GA members reported higher rates of depression
than male members. Therapeutic suggestions are made.
Heineman, M. (1987). A
comparison: The treatment of wives of alcoholics with the treatment of wives
of pathological gamblers. Journal of Gambling Behavior, 3, 27–40.
The
author discusses how the wives of pathological gamblers in recovery face
difficulties that rarely burden the wives of alcoholics. These include
financial problems such as the need to deal with debts they have cosigned.
With husbands attending GA meetings and often working more than one job to
repay debts, wives of gamblers are generally in greater need of social and
treatment networks. The author considers Gam-Anon the best option, yet
claims that there are not enough of these groups available and that
professional help is also scant.
Heineman, M. (1992). Losing
your shirt: Recovery for compulsive gamblers and their families.
Minneapolis, MN: CompCare.
This is
a self-help book for gamblers and their families with an entire chapter
devoted to the 12 Steps. GA and Gam-Anon are discussed at length, and
personal stories are provided. Co-occurring disorders are also addressed.
Horodecki, I. (1992). The
treatment model of the Guidance Center for Gamblers and Their Relatives in
Vienna/Austria. Journal of Gambling Studies, 8, 115–129.
The
first GA group in Vienna was formed in 1982. GA soon developed into a
"guidance centre" for gamblers and their relatives funded partly by the
state. The author discusses the treatment program, essentially a blend of
applications based upon conceptions of neurosis as well as a pure addiction
model. Clients receive formal therapy but also partake in group activities
where only clients and no professionals are present.
Hudak, C. J., Varghese, R., &
Politzer, R. M. (1989). Family, marital, and occupational satisfaction for
recovering pathological gamblers. Journal of Gambling Behavior, 5,
201–210.
A study
at a private gambling treatment centre found that job satisfaction was more
likely to reduce the chances of relapse than positive feelings pertaining to
marital and family issues. GA meetings were an important adjunct to the
program, which had recovering gamblers on staff. The authors argue that,
regardless of whether recovery leads to benefits such as job satisfaction or
vice versa, "multi-interventive" services should be offered to gamblers in
recovery so that many issues can be addressed simultaneously.
Humphreys, K., & Ribisl, K. M.
(1999). The case for a partnership with self-help groups. Public Health
Reports, 114, 322–329.
This
article discusses many reasons for professionals to cooperate with mutual
aid societies. Since such societies are free, they can help alleviate
disparities in access to health care rooted in economic disparity. Such
cooperation would also enhance interaction between professionals and their
communities at large. Major issues discussed include cost effectiveness,
mutual identification, and choice (for example, people with drinking
problems could choose between AA and a mutual aid group emphasizing
moderation, such as Moderation Management).
Jacobs, D. F. (1985). Research
findings comparing gamblers in treatment with recovering Gamblers Anonymous
members: Implications for rehabilitation planning. In W. R. Eadington (Ed.),
The gambling studies: Proceedings of the Sixth National Conference on
Gambling and Risk Taking, Vol. 5 (pp. 101–108). Reno, NV: University of
Nevada.
The
author compares the attitudes toward recovery of gamblers currently in
treatment and gamblers in GA. The latter group was more focused on life and
recovery issues while the former was still more occupied with simply
maintaining abstinence. GA members were more likely to claim to have found
activities to replace gambling and less likely to favour hospital treatment.
Hospitalized gamblers were likely to view GA as important to their long-term
recovery.
Johnson, E. E., & Nora, R. M.
(1992). Does spousal participation in Gamblers Anonymous benefit compulsive
gamblers? Psychological Reports, 71, 914.
This
study suggests that spousal involvement in GA may contribute to longer
periods of abstinence, yet the authors caution that their findings at this
point are not statistically significant.
Kramer, A. S. (1988). A
preliminary report on the relapse phenomenon among male pathological
gamblers. In W. R. Eadington (Ed.), Gambling research: Proceedings of the
Seventh International Conference on Gambling and Risk Taking, Vol. 5
(pp. 26–31). Reno, NV: University of Nevada.
Based on
the testimonies of gamblers known to the researcher through outpatient
treatment (most of whom were experienced GA members), this brief report
discusses some of the issues pertinent to the onset and aftermath of
relapse. It is mentioned that little work has been done on how relapsers
respond to, and feel about, facing their GA peers after a fall.
Lehmkuhl, V. (1982). Reflections
of a peer counselor on professional treatment of pathological gambling. In
W. R. Eadington (Ed.), The gambling papers: Proceedings of the Fifth
National Conference on Gambling and Risk Taking, Vol. 3 (pp. 140–147).
Reno, NV: University of Nevada.
A peer
counsellor and GA member discusses his original antipathy to professional
treatment and his subsequent change of heart. Noting that GA members in his
vicinity also tend to mistrust professionals, the author also tells how he
and other gamblers affiliated with the same treatment centre helped to
change the attitudes of many in GA toward the facility. The author advocates
cooperation between GA and professionals, noting that GA need not be "the
sole answer."
Lesieur, H. R. (1984). The
chase: Career of the compulsive gambler. Rochester, NY: Schenkman.
Based on
a central theme in the lives of compulsive gamblers—the chase, trying
desperately to regain money one has lost, a compulsion to "get even"—this
book addresses a range of pertinent themes from the relation between
pathological gambling and crime to abstinence-relapse cycles and recovery.
With colourful description well grounded in facts, the author also tries to
bring the reader right into the gambler's world and to allow the reader see
things through the gambler's eyes. GA is often discussed in positive terms.
For example, the author credits GA with helping to dispel the once prevalent
notion that pathological gamblers have masochistic personalities.
Lesieur, H. R. (1986).
Understanding compulsive gambling (Rev. ed.). Center City, MN: Hazelden
Educational Materials.
The
author discusses different theories of compulsive gambling and several
stories of successful recovery through GA. The text ends with GA's 20
Questions.
Lesieur, H. R. (1988). The female
pathological gambler. In W. R. Eadington (Ed.), Gambling research:
Proceedings of the Seventh International Conference on Gambling and Risk
Taking, Vol. 5 (pp. 230–258). Reno, NV: University of Nevada.
This
article discusses the issues facing female pathological gamblers from
several perspectives. The sample used includes women who attend Narcotics
Anonymous, AA, and other self-help groups. The author laments the way most
self-help operations focus, perhaps stubbornly, on the target addiction and
discourage talk of multiple addictions. He suggests that an anonymous
fellowship that deals with multiple compulsions should be formed and
recommends that existing fellowships be more receptive to discussions of
other addictions haunting their members. The author discusses how a
predominantly male operation such as GA often alienates women and considers
female pathological gamblers in need of better outreach assistance.
Lesieur, H. R. (1990). Working
with and understanding Gamblers Anonymous. In T. J. Powell (Ed.), Working
with self-help (pp. 237–253). Silver Spring, MD: NASW Press.
The
author discusses many aspects of GA, from its focus on gambling as the
primary problem rather than on gambling's purported root causes, to the
nature of the recovery program beginning with identification with other
members and leading to a reconstruction of one's self-image. Differences
with AA are explained, the most obvious being the lesser emphasis on God and
spirituality in GA's 12 Steps, as well a lesser emphasis on the Steps. The
frequency of GA members involved in other operations such as AA and
Narcotics Anonymous is also discussed, and the author mentions that GA
members who also attend AA are more amenable to the 12 Steps and more likely
to discuss emotional issues.
Lesieur, H. R. (1998). Costs and
treatment of pathological gambling. In J. H. Frey (Ed.), The
Annals of the American Academy of Political and Social Science, Vol. 556,
Gambling: Socioeconomic impacts and public policy (pp. 153–171).
Thousand Oaks, London, New Delhi: Sage Periodicals Press.
The
author discusses the nature and social (and financial) costs of compulsive
gambling and concludes that certain parties should be spending more on
research (notably governments and the gambling industry). GA is addressed in
terms of issues such as its hostility to controlled gambling treatment,
relabelling of gamblers from evil/stupid to sick, and identification with
other GA members. Other treatment methods, and combinations of methods, are
discussed.
Lesieur, H. R., & Blume, S. B.
(1991). Evaluation of patients treated for pathological gambling in a
combined alcohol, substance abuse and pathological gambling treatment unit
using the Addiction Severity Index. British Journal of Addiction, 86,
1017–1028.
The
results of a study indicate that combined treatment for people suffering
from combinations of alcoholism, drug addiction, and problem gambling is
effective. The article refers to different studies of GA members and is
based upon a treatment program that made use of client-specific combinations
of GA, AA, and Narcotics Anonymous.
Lesieur, H. R., & Custer, R. L.
(1984). Pathological gambling: Roots, phases, and treatment. The Annals
of the Academy of Political and Social Science, 474, 146–156.
This
article was written when far less was known about problem gambling issues.
In it, two pioneers in the field discuss the rise of the medical model as
well the sociocultural roots of pathological gambling, the phases (winning,
losing, desperation) of the gambler's career, and methods of treatment. GA
is hailed as a means by which problem gamblers can get over guilt, achieve
self-honesty, and, it is hoped, recover. The authors mention that GA's
retention rate seems to compare poorly with the rates of other self-help
groups and add that without public acceptance of pathological gambling as an
illness, gamblers themselves are less likely to accept the medical model
employed by GA. A suggestion that outside consultants could help GA on this
score is balanced by an understanding of GA's resistance to external
influence of any kind.
Lesieur, H. R., & Puig, K.
(1987). Insurance problems and pathological gambling. Journal of Gambling
Behavior, 3, 123–136.
GA
members were surveyed in order to assess the cost of problem gambling to the
insurance industry, which is estimated at almost $100 billion. The behaviour
leading to these costs was not only reversed for many through GA attendance,
subjects even began to make restitution.
Livingston, J. (1971).
Compulsive gamblers. Lafayette, IN: Purdue University.
This
book is the product of a 2-year observational study of GA. Interviews were
conducted with gamblers and their wives. The author's samples include male
gamblers only, and the study delivers some information that by now is
commonplace (for example, that many GA members are either Italian or
Jewish). The author found that gamblers are narcissistic and fearful of
strong interpersonal ties. The author believes that whereas psychiatry tends
to overlook the sociological dimensions of lifestyle change, self-help
groups unduly ignore the need for introspection. The author considers GA's
effectiveness at the very least equal to that of other available
interventions.
Lorenz, V. C., & Yaffe, R. A.
(1985). Pathological gambling: Medical, emotional
and interpersonal aspects. In W. R. Eadington (Ed.), The gambling
studies: Proceedings of the Sixth National Conference on Gambling and Risk
Taking, Vol. 5 (pp. 101–108). Reno, NV: University of Nevada.
This
study of GA and Gam-Anon members suggests that the medical and emotional
needs of gamblers and their spouses could be better addressed if properly
focused professional therapy were available at gambling treatment centres,
community centres, and GA conferences. The findings also indicate that
spouses of compulsive gamblers in recovery face similar physical and
psychosomatic illnesses and are less satisfied than the gamblers are with
the interpersonal situation at home.
Lorenz, V. C., & Yaffe, R. A.
(1986). Pathological gambling: Psychosomatic,
emotional and marital difficulties as reported by the gambler. Journal of
Gambling Behavior, 2, 40–49.
Surveys
were distributed at GA conferences—both to GA and Gam-Anon members—in order
to gauge the extent of medical, emotional, and marital difficulties during
the final ("desperation") phase of the gambling career and some time after
abstinence had been achieved. Among the authors' conclusions, based upon
answers from the gamblers themselves, are that more research should be done
on the physical ailments that often accompany long-term compulsive gambling
and that psychosomatic and sexual issues also require more attention.
Lorenz, V. C., & Yaffe, R. A.
(1988). Pathological gambling: Psychosomatic,
emotional and marital difficulties as reported by the spouse. Journal of
Gambling Behavior, 4, 13–26.
Based
upon a survey of the spouses of GA members, the authors discuss many of the
emotional, financial, and other problems confronting the wives of problem
gamblers at the last ("desperation") phase of the gamblers' careers and also
following abstinence. Wives are said to suffer from many of the physical
ailments experienced by gamblers, such as headaches and stomach problems.
The authors argue that a gambler's behaviour could be less important than a
spouse's insufficient coping skills and that professionals should work in
concert with GA and Gam-Anon to assist in this area.
Lorenz, V. C., & Yaffe, R. A.
(1989). Pathological gamblers and their spouses:
Problems in interaction. Journal of Gambling Behavior, 5, 113–126.
Couples
at GA conferences were surveyed on their thoughts and feelings about issues
during the final desperate phase of the gambler's career and the time after
recovery had begun. The results suggest, for instance, that Gam-Anon is more
helpful with financial recovery and less so with family and sexual issues.
Gamblers along with their spouses felt poorly understood by mental and
medical health practitioners and by each other. The authors state that
mental health and other professionals should work more closely with GA and
Gam-Anon.
Lyons, J. C. (1985). Differences
in sensation seeking and in depression level between male social gamblers
and male compulsive gamblers. In W. R. Eadington (Ed.), The gambling
studies: Proceedings of the Sixth National Conference on Gambling and Risk
Taking, Vol. 5 (pp. 76–100). Reno, NV: University of Nevada.
Referring to research that views addictive behaviours as resulting from a
process wherein potential growth produces anxiety, which in turn is assuaged
by depression, the latter then becoming a defence mechanism that inhibits
growth, in turn entailing the need for extreme sensations to (temporarily)
alleviate depression, the author discusses similarities between AA and GA
members. He claims that while GA and AA work for similar reasons, they may
also fail for similar reasons in many cases. A large number of depressed
individuals may simply leave these fellowships after a brief trial.
Regardless of their respective addictions, some of these individuals may
have more in common with each other than with others who share the same
addiction and continue with mutual aid. Not all alcoholics, or compulsive
gamblers, face the same issues. GA is said to be insufficient for people
suffering certain types of depression.
Mark, M. E., & Lesieur, H. R.
(1992). A feminist critique of problem gambling research. British Journal
of Addiction, 87, 549–565.
The
authors are critical of the male-oriented nature of most gambling research.
Subjects tend to be male, gender-related issues are ignored, and even the
gambling sites investigated are usually male dominated. Recommendations are
made on how to alter the situation. GA is discussed as male dominated, and
the authors suggest that its tendency to produce a "men's club atmosphere"
should be taken into account by researchers. "War stories," often shared by
male members, are an example of something that may work to alienate women.
The authors suggest that GA hold women-only meetings. Other questions are
raised. For example, GA suggests that gamblers hand over control of their
assets to their spouses. While this may work well for men, the authors
question the wisdom of many women who are already subordinate and
financially dependent handing over even more power to their husbands. The
marginalization of women in GA is also compared to that of minorities.
Martey, H., Zoppa, R. M., &
Lesieur, H. R. (1985). Dual addiction: Pathological gambling and alcoholism.
In W. R. Eadington (Ed.), The gambling studies: Proceedings of the Sixth
National Conference on Gambling and Risk Taking, Vol. 5 (pp. 65–75).
Reno, NV: University of Nevada.
A survey
of patients at an alcoholism and drug abuse treatment centre found that
almost 35% were also pathological gamblers. The authors also found aversion
to GA to be correlated with denial: the more acceptance clients had of their
gambling problem, the more GA meetings they attended.
Maurer, C. D. (1982). Challenges
in dealing with pathological gambling in outpatient psychotherapy. In W. R.
Eadington (Ed.), The gambling papers: Proceedings of the Fifth National
Conference on Gambling and Risk Taking, Vol. 1 (pp. 136–144), Reno, NV:
University of Nevada.
The
author discusses difficulties he experienced ranging from client resistance
to legal matters. He also discusses his experiences attending GA. He found
the program "remarkably similar to A.A.," and was soon invited by members to
participate by reading some program material (as GA members do at each
meeting). Yet many suspected his motives, and one member offended by the
"outsider's" presence threatened him physically. Yet members also asked him
to facilitate tensions between them and another member. The author discusses
how he eventually established a strong rapport with GA and Gam-Anon.
Maurer, C. D. (1985). An
outpatient approach to the treatment of pathological gambling. In W. R.
Eadington (Ed.), The gambling studies: Proceedings of the Sixth National
Conference on Gambling and Risk Taking, Vol. 5 (pp. 205–217). Reno, NV:
University of Nevada.
The
author describes an outpatient approach involving GA (and Gam-Anon or AA
where appropriate), where success (1 year of abstinence) is achieved in 20%
of cases. He believes that a process that at least began with inpatient
treatment would be more successful.
McCormick, A., & Brown, R. I. F.
(1988). Gamblers Anonymous as medicine, as religion and as addiction
recovery process. In W. R. Eadington (Ed.), Gambling research:
Proceedings of the Seventh International Conference on Gambling and Risk
Taking, Vol. 5 (pp. 343–364). Reno, NV: University of Nevada.
The
authors describe the unique mixture of a medical model of behaviour and
religious notions inherent to 12 Step recovery. Referring to AA's (and by
implication GA's) debt to the Oxford Group, the article discusses the
similarities between the conversion experiences of Christians and GA
members. They consider GA's approach to rest, in part, on a secular
rendition of the forgiveness of sin.
McCown, W. G., & Chamberlain, L.
L. (2000). Best possible odds: Contemporary treatment strategies for
gambling disorders. New York: John Wiley & Sons.
This
book discusses many approaches to treating gambling problems and contains a
very positive account of GA despite a few criticisms. The authors discuss
GA's debt to AA as well as some of the differences between these two
fellowships. Compared to AA, GA is said to be less focused on spirituality,
more pragmatic (for example, it helps members address financial issues), and
more confrontational. The latter is said to possibly account for higher
attrition rates in GA than in AA and Narcotics Anonymous. The authors claim
that people with experience in AA are sometimes disappointed by GA's lesser
emphasis on spirituality. On the whole, GA is said to be more receptive to
medical and clinical assistance than AA and also more ready to allow access
to its members for research purposes. The authors consider abstinence the
best goal for problem gamblers and describe GA as "the heart of
abstinence-based programs." While recognizing that GA is not for everyone,
the authors believe that all problem gamblers should at least try it.
McGowan, V. (2003).
Counter-story, resistance and reconciliation in online narratives of women
in recovery from problem gambling. International Gambling Studies, 3,
115–131.
This study analyzes discourse
at an on-line gender-specific support group established by two female GA
members and examines the narratives through which women tell their stories
of problem gambling and recovery. Given the dominance of male discourse,
women create both on-line and off-line symbolic communities. One important
theme is the undermining of women's experiences at GA (for example, they are
sometimes told that their gambling losses do not qualify them as compulsive
gamblers). GA's oral tradition and that of other 12 Step groups is
replicated. Shared suffering provides women with a "symbolic community." The
result is an on-line forum wherein women's experiences are made visible and
transformative. This group is an indicator of dissatisfaction with GA's
male-dominated approach, and further study into gender interaction and the
needs of women in recovery from problem gambling is recommended.
Miller, W. (1986). Individual
outpatient treatment of pathological gambling. Journal of Gambling
Behavior, 2, 95–107.
This
article discusses the issues leading up to quitting gambling and more
notably the sense of loss after quitting, the latter being treated as
similar to other grieving processes. GA is mentioned first as a good
substitute for former social ties, yet the emotional benefits of gambling
are said to run more deeply, and the ensuing sense of loss is the main
target of the treatment program discussed by the author. The latter is a
four-phase program, the first phase being consistent with GA's first step,
involving acknowledgement of lack of control over gambling and overall
unmanageability. While the author is at odds with GA's belief that gamblers
must hit bottom before embarking upon recovery, he considers GA a useful
complement to the treatment program.
Moody, G. (1990). Quit
compulsive gambling: The action plan for gamblers and their families.
London: Thorsons.
Written
for popular consumption, this self-help book describes the nature and
treatment of compulsive gambling along GA lines. GA (and Gam-Anon) is
discussed extensively and in very positive terms.
Moody, G. (n.d.). Wheel of
misfortune: Compulsive gambling. Gamblers Anonymous/Gam-Anon [U.K.].
Available at http://www.gamblersanonymous.org.uk/wheel.htm
In the
author's words: "This present publication is the result of the author's
combination, with minor revisions, of his two leaflets, Gamblers Anonymous,
and Wheel of Misfortune. These were first published by 'Crucible' and
'Interface' respectively. The author developed these themes further in 'Quit
Compulsive Gambling' published by Thorsons in February 1989 and available
from Gamblers Anonymous." Compulsive gambling is discussed along disease
model lines. The gambler can be helped by GA, and family problems can be
addressed with Gam-Anon. The two organizations are discussed briefly.
Murray, J. B. (1993). Review of
research on pathological gambling. Psychological Reports, 72,
791–810.
This
article discusses the state of literature at the time of writing with an eye
to questions such as the personality profiles of pathological gamblers and
the extent to which such gamblers can control their behaviour. On these and
other questions, the author concludes that answers should be taken as
preliminary. The similarities and differences between GA and AA are
discussed. The author says that both operations have proven successful, but
points out that controlled gambling (as well as drinking) has also
demonstrated successes. Some of the difficulties in studying GA are also
mentioned.
Murray, R. D. (2001). Helping
the problem gambler. Toronto: Centre for Addiction and Mental Health.
This is
a comprehensive collaborative effort, addressing issues ranging from the
nature of compulsive gambling and the different types of treatment to family
issues and the need for cross-cultural awareness. This document discusses
many topics pertinent to understanding and evaluating GA and 12 Step
approaches in general, such as the positive and negative features of the
call for abstinence. A section on GA and Gam-Anon is included. The programs
are described, along with important themes such as GA's increasing
(admittedly recent) sensitivity to the needs of women and the importance of
professionals working together with this fellowship.
Nora, R. M. (1989). Inpatient
treatment programs for pathological gamblers. In H. J. Shaffer, S. A. Stein,
B. Gambino, & T. N. Cummings. Compulsive gambling: Theory, research, and
practice (pp. 127–134). Lexington, MA: Lexington Press.
The
author argues that some gamblers require inpatient treatment. One program
discussed works closely with GA, whose members (with financial expertise)
are sometimes invited to advise clients on financial difficulties. Treatment
staff are encouraged to attend GA conferences.
Petry, N. M. (2002). Psychosocial
treatments for pathological gambling: Current status and future directions.
Psychiatric Annals, 32 (3), 192–196.
This
article discusses several treatment approaches to compulsive gambling, and
the author points out that there is still little consensus on which method
is most effective. Mentioning that, to the best of our current knowledge, GA
on its own achieves abstinence in only a small percentage of those who try
it, the author says that GA in combination with professional therapy may be
more effective. Still, she adds that it is hard to generalize from existing
studies that suggest this. The author recommends large-scale controlled
studies of all treatment options as necessary for a clearer grasp of what
really works for pathological gamblers.
Petry, N. (2003). Patterns and
correlates of Gamblers Anonymous attendance in pathological gamblers seeking
professional treatment. Addictive Behaviors, 28, 1049–1062.
Many GA
members eventually opt for professional treatment. This study compares
gambling and psychosocial problems in GA members seeking treatment and in
treatment seekers who are not GA members. In all, GA members were older,
with higher incomes and greater likelihood of being married. They also had
higher South Oaks Gambling Screen scores, bigger debts, longer problem
gambling histories, greater family conflicts, and fewer serious drug
problems. Two months after treatment began, GA members were more likely to
be abstinent. These findings suggest that there may be important differences
between people entering treatment with histories of GA attendance and those
without, with implications for treatment recommendations and results.
Preston, F. W., & Smith, R. W.
(1985). Delabeling and relabeling in Gamblers Anonymous: Problems with
transferring the Alcoholics Anonymous paradigm. Journal of Gambling
Behavior, 1, 97–105.
Interviews with GA and AA members as well as other data suggest that AA has
higher rates of abstinence. The authors argue that belief in a strong
medical model permits AA members to deflect shame and stigma more easily,
which in turn facilitates recovery.
Problem and Compulsive Gambling
Advanced Workshop (ARF). (1986). Cognitive treatment for compulsive
gambling. Sault Ste. Marie, ON: Addiction Research Foundation.
Although
a document on cognitive therapy for gambling problems, this text attempts to
show that cognitive treatment for gambling is in many ways consistent with
the 12 Steps of GA.
Rosecrance, J. (1988a). Active
gamblers as peer counselors. The International Journal of the Addictions,
23, 751–766.
The
author questions the efficacy of GA attendance and the goal of complete
abstinence, at least for many gamblers, and suggests a format where
controlled gambling treatment is assisted by peer counsellors who themselves
gamble. Arguing that problem gambling can be rooted in defective wagering
strategies, the author suggests that active gamblers could help clients
gamble properly (just as abstinent GA members are effective in helping
others achieve abstinence).
Rosecrance, J. (1988b).
Gambling without guilt: The legitimation of an American pastime. Pacific
Grove, CA: Brooks/Cole.
This is
essentially a book on the history and pervasiveness of gambling in America.
While providing accounts of his own experiences with gambling, as well as
ethnographic discussions of gambling environments, the author argues that
gambling has become more acceptable because of changing middle class
attitudes toward it. The author is critical of the medical/compulsion model
of problem gambling and the call for abstinence, and argues, for example,
that it is easier for GA members to accept the notion of compulsion than to
seriously scrutinize and discuss the real motives behind allowing gambling
to cause one to forsake one's family, loved ones, and responsibility in
general.
Rosecrance, J. (1989). Controlled
gambling: A promising future. In H. J. Shaffer, S. A. Stein, B. Gambino, &
T. N. Cummings, Compulsive gambling: Theory, research, and practice
(pp. 147–160). Lexington, MA: Lexington Press.
The
author argues that problem gambling in the United States can to a large
degree be attributed to a lack of knowledge and sophistication regarding the
risks associated with gambling. Defining problem gambling as "the losing of
an excessive amount of money," the author questions disease conceptions
involving notions such as compulsion. Critical of GA and of medicalization
in general, the author argues that controlled gambling involves good betting
strategy along with rational financial management. He recommends that active
gamblers function as counsellors. The author does concede that controlled
gambling is not feasible for some.
Rosenthal, R. J. (1992).
Pathological gambling. Psychiatric Annals, 22 (2), 72–78.
This
article discusses definitions and treatments of pathological gambling, with
a recommendation that more efforts should be made to identify this
underdiagnosed affliction. Similarities to alcohol and substance dependence
are discussed, with mention of how some investigators have called compulsive
gambling a "pure" addiction given the absence of any ingested substance. The
importance of comorbidity and the shortage of women in GA are discussed, as
is GA's effectiveness, which, in the author's view, is limited to clients
without special needs. Many would do better with a psychodynamic approach in
tandem with GA.
Rosenthal, R. J., & Rugle, L. J.
(1994). A psychodynamic approach to the treatment of pathological gambling:
Part 1. Achieving abstinence. Journal of Gambling Studies, 10, 21–42.
The
authors argue that a psychodynamic approach to gambling treatment is
compatible with an addiction model approach, including 12 Step solutions.
In their discussion of the decline in
the popularity of psychoanalysis among professionals, the authors argue
that, with the addictions, many proponents of alcoholism and drug dependence
as primary diseases have been dismissive of psychological approaches because
of the emphasis on issues considered secondary at the expense of the
addiction itself. By implication, this same
attitude dominates many approaches to compulsive gambling, which is also
viewed as a primary disease by GA and many of its supporters. Yet the
authors point out, for example, that 12 Step recovery owes the term "denial"
to psychoanalysis, even if the term's meaning has changed in some respects
over the years. They claim that GA and psychotherapy should be viewed as
complementary.
Rugle, L. J. (1993). Initial
thoughts on viewing pathological gambling from a physiological and
intrapsychic structural perspective. Journal of Gambling Studies, 9,
3–16.
This
article attempts to harmonize the perspectives of different disciplines on
the theoretical and practical treatment aspects of compulsive gambling. The
author hypothesizes that addicts (including gamblers) are deficient in
"internal structures," leading to dysfunction in emotional, cognitive, and
coping capacities. The article discusses the ways in which the author's
integrated "structural perspective" is compatible with 12 Step approaches
(GA and AA are the focus).
Rugle, L. J., & Rosenthal, R. J.
(1994). Transference and countertransference reactions in the psychotherapy
of pathological gamblers. Journal of Gambling Studies, 10, 43–65.
This
article discusses the psychoanalytic themes of transference and
countertransference as they apply to the treatment of pathological gamblers.
Supportive of GA, the authors caution the therapist against potential
countertranference reactions to that fellowship. Therapists may feel
threatened by GA and may compete with GA for credit if a client gets better,
and for reasons such as this they may downplay GA's effectiveness. GA is
said to provide supports that therapists cannot imitate, and a therapist's
negative reactions could jeopardize the recovery process.
Sagarin, E. (1969). Odd man
in: Societies of deviants in America. Chicago: Quadrangle Books.
This
book contains a history of GA, along with some harsh criticisms of GA's
account of its own history.
Scodel, A. (1964). Inspirational
group therapy: A study of Gamblers Anonymous. American Journal of
Psychotherapy, 18, 115–125.
The
author studies GA from a sociopolitical perspective, on the assumption that
alienation leads people to seek out this kind of association. It is argued
that the alienated are learning to achieve identity through mutual aid, and
at the same time they are becoming insular and depoliticized. The author
also sees gambling as a counterproductive attempt by men to attain
independence from their wives, who themselves unconsciously wish to see the
gambling continue.
Stein, S. A. (1993). The role of
support in recovery from compulsive gambling. In W. R. Eadington & J. A.
Cornelius (Eds.), Gambling behavior and problem gambling (pp.
627–637). Reno, NV: University of Nevada.
This
study attempts to validate the importance of social support to recovery from
problem gambling. Compulsive gamblers who feel that they have social support
for their attempts to change are likely to remain abstinent for longer. GA
is discussed, notably as evidence of the need for gamblers to discuss their
feelings and thoughts and to refrain from isolating themselves.
Steinberg, M. A. (1993). Couples
treatment issues for recovering male compulsive gamblers and their partners.
Journal of Gambling Studies, 9, 153–167.
The
author takes to task an essentially individualistic approach to the
treatment of gamblers and their spouses. Spouses, and even children, should
be brought into treatment early on in order to complement the GA/Gam-Anon
approach, which involves changes within the self but excludes a direct focus
upon the interpersonal realm (for example, the Gam-Anon member is expected
to heal independently of the gambler's behaviour). Conversely, a "family
systems" approach focuses on relations between family members rather than on
individuals in isolation.
Stewart, R. M., & Brown, R. I. F.
(1988). An outcome study of Gamblers Anonymous. British Journal of
Psychiatry, 152, 284–288.
A sample
of 232 GA attenders revealed that about 8% remained abstinent after 1 year,
and about 7% did after 2 years.
Stirpe, T. (1995). Review of
the literature on problem and compulsive gambling. Toronto: Addiction
Research Foundation, Problem and Compulsive Gambling Project.
This is
a book-length document that addresses the problem gambling issue with regard
to themes ranging from definitions, prevalence, and history to outreach,
treatment, and comparisons with other addictions. The section on
disease-model treatment suggests that GA may be best suited to gamblers with
the most severe problems. The reference section is broken down by topic and
could be an excellent resource for those seeking to combine their research
with areas not addressed in this bibliography.
Strachan, M. L., & Custer, R. L.
(1993). Female compulsive gamblers in Las Vegas. In W. R. Eadington & J. A.
Cornelius (Eds.), Gambling behavior and problem gambling (pp.
235–239). Reno, NV: University of Nevada.
In Las
Vegas, more than half of GA members are women. Based upon responses from 52
female GA members, the authors list some significant findings: 42% of
subjects had at least one alcoholic parent, 42% had at least one parent who
gambled excessively, 33% had been physically abused by parents, 29% had
experienced childhood sexual abuse, 69% had contemplated suicide, and 33%
belonged to 12 Step fellowships other than GA. The authors consider this
study a wake-up call: female pathological gambling is a grossly understudied
yet serious problem compounded by many other issues. Further, as legalized
gambling spreads, such high numbers of female gamblers will not be limited
to places like Las Vegas.
Taber, J. I., & Chaplin, M. P.
(1988). Group psychotherapy with pathological gamblers. Journal of
Gambling Behavior, 4, 183–196. (Previously, Taber delivered a much
longer talk with the same title, which can be found in W. R. Eadington
(Ed.), The gambling papers: Proceedings of the Fifth National Conference
on Gambling and Risk Taking, Vol. 1 (pp. 1–88). Reno, NV: University of
Nevada (1982).)
The
authors discuss their group-therapeutic techniques with an eye to both
positive and negative attitudes and behaviours often exhibited by clients.
Negative attitudes toward GA are listed as threats to recovery. The authors
state that even if a member dislikes GA meetings, the act of going is
paramount. They see such "surrender" as an aid to the development of impulse
control and argue that a program is likely to work if the gambler simply
believes that it can.
Taber, J. I., & McCormick, R. A.
(1987). The pathological gambler in treatment. In T. Galski (Ed.), The
handbook of pathological gambling. Springfield, IL: Charles C. Thomas.
The
authors discuss many approaches to the treatment of pathological gambling
and consider peer counselling the most important tool available. Though peer
counsellors should not be confused with professionals, the authors consider
the process of identification extremely helpful. Despite being keen
advocates of GA, they present a few criticisms: GA meetings (local ones, at
the time of writing) are poorly organized, often with little attention paid
to the sensibilities of many newcomers. Interestingly, the authors have
urged many of their gambling patients to attend AA simply to learn some
things from this more experienced fellowship. They say, however, that
gamblers often have little respect for alcoholics and are not receptive to
adopting AA practices. Nonetheless, the authors believe that GA will mature
as a fellowship, just AA has had to do.
Taber, J. I., McCormick, R. A.,
Russo, A. M., Adkins, B. J., & Ramirez, L. F. (1987). Follow-up of
pathological gamblers after treatment. American Journal of Psychiatry,
144, 757–761.
A
structured inpatient treatment program, modelled on programs for alcoholics
and other substance abusers, shows promising results. GA attendance was
associated with higher odds of success.
Taber, J. I., Russo, A. M.,
Adkins, B. J., & McCormick, R. A. (1986). Ego strength and achievement
motivation in pathological gamblers. Journal of Gambling Behavior, 2,
69–80.
Stating
that pathological gamblers tend to be deficient in ego strength and in some
areas of achievement motivation, the authors argue that abstinence is in
such cases insufficient to address issues that probably preceded the
addictive behaviour itself. A tendency among many GA and AA members to view
abstinence as a solution on its own is taken to task. Conversely, a program
such as GA is said to be beneficial for many reasons, provided that
emotionally underdeveloped individuals are able to adapt and stick it out.
The article comments on an awareness within GA of the narcissistic
characteristics of many problem gamblers and points out that in the (lay)
parlance of the fellowship, "ego" often refers to such traits.
Turner, D. N., & Saunders, D.
(1990). Medical relabelling in Gamblers Anonymous: The construction of an
ideal member. Small Group Research, 21, 59–78.
Participant observation of GA leads the authors to some highly critical
conclusions. Beyond their scepticism about the medical model of pathological
gambling, the authors claim that the internalization of an addict identity
functions through a process comparable to collective brainwashing, which
leaves out those unwilling to go through it (even though many such people
are in dire need of help) and causes addiction to other group members in
those who comply. Further, the ideal GA identity for which members strive is
never achieved, casting doubt on the overall therapeutic benefits of this
process.
Ursua, M. P., & Uribelarrea, L.
L. (1998). 20 Questions of Gamblers Anonymous: A psychometric study with
population of Spain. Journal of Gambling Studies, 14, 3–15.
This
study reveals that GA's 20 Questions compare favourably to other,
professionally developed, diagnostic instruments.
Viets, V. C. L., & Miller, W. R.
(1997). Treatment approaches for pathological gambling. Clinical
Psychology Review, 17, 689–702.
This
study examines outcome literature on various modalities. The authors say
that no properly controlled outcome research exists on psychodynamic and 12
Step approaches. Where multimodal approaches have been tested, it is hard to
determine the efficacy of each modality. Cognitive, behavioural, and
cognitive-behavioural approaches have been studied extensively enough to
indicate positive results. While allowing for bias in favour of publishing
positive reports, the authors claim that evidence indicates that
pathological gambling is treatable. GA is still the most widely available
solution, yet the authors point out that its retention rates seem to be low.
Still, the authors say that there is a strong need for studies on GA's role
in treatment outcomes. The authors suggest some often ignored themes be
taken into account by new studies on treatment modalities, including the
situation of dropouts some time after treatment. Specifics that should be
addressed include the following: in some cases gambling may be a secondary
addiction that could be relieved by addressing other problems, definitions
of "abstinence" hinge upon definitions of gambling, and client
characteristics (such as gender and age) may help predict responses to
certain treatments.
Walker, M. B. (1992). The
psychology of gambling. Oxford: Pergamon Press.
This
book promotes the notion that excessive gambling is rooted mainly in
irrational or at least incorrect beliefs maintained by the gambler. Critical
of explanations involving excitement and stimulation in general, the author
offers a "sociocognitive" model. GA is discussed extensively, both in
positive and negative terms, yet the author believes that its overall
effectiveness is hard to measure. The author says that GA's main strength
rests in the collective belief that compulsive gambling can be beaten. While
critical of GA's insistence on abstinence for all problem gamblers, the
author is perhaps even more critical of many of his colleagues who have
researched compulsive gambling with an overreliance on data obtained from GA
members and other gamblers in treatment (usually based on similar medical
models): such samples are, first, not representative and, second, possibly
biased since subjects who have internalized the medical model are likely to
reconstruct their past experiences in accordance with its tenets.
Walker, M. B. (1993). Treatment
strategies for problem gambling: A review of effectiveness. In W. R.
Eadington & J. A. Cornelius (Eds.), Gambling behavior and problem
gambling (pp. 533–536). Reno, NV: University of Nevada.
The
author discusses and evaluates the major treatment approaches to problem
gambling. While cautious in appraising GA's effectiveness, the author points
out that even if other measures are found to be more successful, GA's cost
effectiveness will ensure that it continues to play an important role.
Controlled gambling is a valid option for certain treatment strategies, and
while the feasibility of long-term controlled gambling is suspect, the same
can be said of long-term abstinence. In either case, long-term success rates
are low.
Walters, G. D. (1994). The
gambling lifestyle: II. Treatment. Journal of Gambling Studies, 10,
219–235.
A
"lifestyle" model of treatment is discussed. Despite this model's opposition
to the disease conception, the author considers GA a good aftercare option
(though not necessarily the best).
Winston, S., & Harris, H. (1984).
Nation of gamblers: America's billion-dollar-a-day habit. Englewood
Cliffs, NJ: Prentice-Hall.
This
book discusses the scope and the economic, social, and personal costs of
gambling in America. Personal accounts are included. GA is strongly endorsed
as the best solution to compulsive gambling and the problems incurred by
families. Advice (consistent with GA's message) is given to compulsive
gamblers and family members.
Zion, M. M., Tracy, E., & Abell,
N. (1991). Examining the relationship between spousal involvement in
Gam-Anon and relapse behaviors in pathological gamblers. Journal of
Gambling Studies, 7, 117–131.
This study found no serious
differences between the relapse rates of gamblers with spouses in Gam-Anon
and those without. Yet the study did show that those with past addictive
behaviours (whether involving food, drugs, or alcohol) were, perhaps
counterintuitively, less likely to relapse. The authors speculate that the
latter were more driven to make larger overall changes in their lives. The
authors suggest that interventions should put more focus on possible
multiple addictions.
Manuscript history: Submitted August
19, 2005.
This article was not peer-reviewed.
For
correspondence: Peter Ferentzy, PhD, Centre for Addiction and Mental Health,
240 Northcliffe Blvd. #204, Toronto, Ontario, Canada
M6E 3K7. Phone: 416-651-8094,
e-mail:
pferentzy@earthlink.net
Contributors: PF
compiled and annotated the texts. WS suggested texts for consideration, and
made editorial as well as substantive contributions to many of the
annotations.
Competing interests: None declared.
Funding: This study was funded by
the Ontario Problem Gambling Research Centre.
Peter Ferentzy (PhD, social and political thought, York
University) is a research scientist at CAMH and has been studying GA since
2002. He has published on GA as well as the history of addiction.
Wayne Skinner (MSW, RSW, University of Toronto) is
clinical director of the Concurrent Disorders Program and the Problem
Gambling Service of the Centre for Addiction and Mental Health in Toronto,
Canada. He has over 25 years' experience as a clinician, supervisor,
researcher, consultant, and educator. Wayne is an assistant professor in the
Department of Psychiatry at the University of Toronto. He also directs and
teaches in the Addiction Studies certificate program in Continuing Education
at the University of Toronto. He has studied at the doctoral level at York
University, where he is an adjunct faculty member of the School of Social
Work. He is editing a clinical handbook on the treatment of co-occurring
addiction and mental health problems. He is co-investigator on several
research studies on problem gambling.
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