Like most problems, gambling addiction is a complex issue that doesn’t have just one solution.
Treatment for problem gambling can be as diverse of an issue as the people facing it.
As Gambling Awareness Month draws to a close, advocates are spotlighting the importance of diversity, equity and inclusion in treatment methods.
A focus on Diversity, Equity and Inclusion in problem gambling treatment
According to Deborah G. Haskins, Owner and Chief Consulting Counselor of MOSAIC Consulting, less than 5% of community members actually seek gambling disorder treatment.
Approximately 100,000 people in the state have struggled with a gambling disorder, but not all seek treatment for various reasons.
For people of color, or within minority communities, those reasons are amplified by a lack of trust or belief that the system can work for them.
“My mission statement is always going to say, ‘how are we reaching the other 95%?,’” Haskins said. “That is what I want us to think about moving forward. It may mean we have to change everything we have done so far.”
Haskins is stressing the importance of DEI (diversity, equity and inclusion) in the approach for gambling addiction treatment.
- Diversity: Treatment staffs should reflect the diversity of a community to create an inclusive environment for those seeking help.
- Equity: Different than equality, equity stresses that different communities may require more or different resources for successful treatment.
- Inclusion: Making sure all communities feel heard and know they belong.
Equity may be the biggest piece of this puzzle, as Haskins illustrates.
“What we want to strive for with equity is the recognition that not everybody starts out in the same place. In order to provide access and provide health wellness, we have to recognize in our mission that different community members are going to need different accommodations,” she said. “We think that people have equality, that everyone has the same playing field, that they can access health equity in the same way, and they have the same resources even with the Affordable Care Act, but that is not the case.”
ACEs play a key role in risk for gambling addiction
As was touched on during our look at youth gambling concerns, Adverse Childhood Experiences play a role in the world of gambling disorder and diversity.
There are 10 commonly researched ACEs and their connection with frequency of gambling. They are:
- Physical abuse
- Sexual abuse
- Verbal abuse
- Physical neglect
- Emotional neglect
- A family member who is depressed or diagnosed with other mental illness
- A family member who is addicted to alcohol or another substance
- Family member who is in prison
- Witnessing a mother being abused
- Losing a parent to separation, divorce or death
The 2018 Nevada Behavioral Risk Factor Surveillance System data showed that odds of frequent gambling was 69% higher among those exposed to three or more ACEs compared to those who had none.
The Adverse Childhood Experiences often are accompanied by Adverse Community Environments. Those include:
- Community Disruption
- Lack of economic opportunities
- Poor housing quality or affordability
These challenges create a greater threat of problem gambling, and have impacted minority communities at a greater rate.
Haskins identified more direct issues within the different communities.
Verbiage is important for the black community, according to Haskins.
She says gambling is perceived as a solution for many within the community, not a problem. So, when treatment identifies with the words “problem” and “addiction”, that can deter them from seeking help right away.
“If we are branding all of our awareness as ‘problem gambling’, we are not going to reach some people. As soon as they see problem, they are going to feel it doesn’t relate to them because they don’t see themselves as having a problem,” she said.
Haskins also pressed the living conditions, social needs, and laws and policies as other key factors standing in the way of proper treatment for people of color.
“We have to, from the beginning, include the race and cultural context in approaches to treatment,” Haskins said. “You have to able to articulate right out the gate that you understand, even though you may not know what it’s like to be a black or brown person and living in these experiences, but you have empathy culturally and you are learning about it more and want to provide a safe place. If you can’t do that, most of these community members are not going to access your services. We have been very shy as a discipline, professionally, to really talk about race. Many times it’s not an easy conversation, but guess what? By not addressing it, it sends a message to a person that we don’t see that their living conditions are true and valid.”
According to the 2016 Journal of Gambling Studies, almost 80% of Latino mental wellness patients said they had gambled in the past month.
Trust was an issue for many in seeking treatment, as they would first seek help from a close family member before looking for clinical help.
Those that have immigrated to the U.S. face additional challenges as they feel greater pressure to provide for their family when earning low wages.
“People who immigrate to the United States, English is one of the hardest languages to master. It can be hard for English-native speakers, let alone someone coming into a new land,” Haskins said. “You have to learn the language, then you have to figure out how you are going to work. You may have had a vocational identity in your native land, but now you come here and may not be able to access that same occupational status. All these things create a lot of acculturation stress that creates psychological challenges, spiritual challenges, financial challenges and family challenges.”
The Native American community has exposure to the harms of problem gambling due to their connections with the industry.
While the industry has been successful for many tribes across the country, it can come at a high cost for some in regard to developing addiction.
However, most guides on treatment don’t specify the best approach within their community.
Haskins highlights the lack of holistic approaches to treatment, something that the Native American community feels is important.
“Even in 2022, how do the theories and techniques and prevention that we use match the cultural communities?” Haskins asked. “Right now if you look for a practitioner guide on diversity, equity and inclusion on problem gambling disorder, it doesn’t exist.”
How to make gambling addiction services more inclusive
According to Haskins, there are three crucial strategies that should be implemented to improve the services for all people.
- Know, really KNOW the community: This means treatment options need to include people that have investments in the community and understand the limitations of that community.
- Use a health equity/social justice lens: Identify the strengths and weakness of the community and build a long-term approach to sustain wellness plans. Those focuses might include transportation, land use, recreation and housing.
- Develop a strategic DEI plan for wellness: Multiple members planning with a commitment to DEI as a central priority to their agency/unit and having an understanding of the community culture. They know proper messaging for their community and are good problem-solvers.
Haskins also stressed the need for treatment services to evaluate how they operate and provide more options to their patients. Those can include:
- Available options for those that don’t speak English
- Home-based therapy for those with transportation issues or limited access to resources
- Further options for deaf patients
- Further options for the LGBTQ community
- More boots on the ground within the community
- Improved verbiage when discussing the issue
“Are you really meeting people where they are? Because if you really are meeting them, you understand that using the term problem gambling, disordered gambling is very deficient-focused. It focuses on pathology, and people feel more stigmatized,” Haskins said. “We have to be very sensitive. We have to use different messaging.”
For more information on equity in problem gambling prevention, check out the Our Voices Matter study done in May of 2021.
If you or anyone you know needs help with their gambling-related issue, call the Michigan Department of Health and Human Services Problem Gambling Helpline at 1-800-270-7117.