The University of Sydney Page 1

The role of culture in

problem gambling

treatment

Presented by

Dr Sally Gainsbury

Senior Lecturer, School of Psychology

Deputy Director, Gambling Treatment Clinic & Research Group

Adjunct Researcher, School of Business & Tourism

Southern Cross University

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Disclosures

– Research funded by Victorian Responsible Gambling Foundation – through grant to Cultural & Indigenous Research Centre Australia (CIRCA)

– I have worked on research projects that have received funding from gambling industry bodies, government departments, and organisations that are funded indirectly from taxes and/or contributions from the gambling industry.

– I have worked directly as a consultant to provide expertise to guide responsible gambling initiatives for gambling industry bodies, government departments, and organisations that are funded indirectly from taxes and/or contributions from the gambling industry.

– I have accepted funding to cover travel and expenses to attend and present at meetings on topics with the aim of enhancing the provision of responsible gambling strategies.

– Funding received directly and indirectly from: NSW Office of Liquor, Gaming and Racing; Australian Institute of Family Studies; British Columbia Lottery Corporation; Nova Scotia Provincial Lotteries and Casino Corporation; Australian Research Council; Australian Department of Social Services; Department of Broadband Communication & the Digital Economy; UK Responsible Gambling Trust; Ian Potter Foundation; Gambling Research Australia; Victorian Responsible Gambling Foundation; National Association for Gambling Studies; Manitoba Gambling Research Program; Ontario Problem Gambling Research Centre; Centre for Addiction and Mental Health; European Society for the Study of Gambling; Star Entertainment; Clubs NSW; Sportsbet; Techlink Entertainment; Gaming Technologies Association; Aristocrat Leisure Industry.

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The context of culture

“The concept of culture is complex and changes over time and between generations and within social contexts (Finno-Velasquez et al., 2015).”

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Cultural diversity in Australia

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Lower gambling participation

0

20

40

60

80

LOTE non-LOTELOTE – Language other than English

(Hare, 2015)

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Cultural attitudes towards gambling vary significantly

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Higher rates of gambling problems

0

1

2

3

4

5

6

7

8

9

10

Low-risk Moderate-risk Problemgamblers

LOTE

non-LOTE

LOTE – Language other than English

(Hare, 2015)

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• Low socio-economic status

• Stress related to cultural differences and migration

• Acculturation

• Cultural beliefs and attitudes

• Lack of alternative leisure options

• Low education

Gambling problems are related to cultural background

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• Reluctance to seek help

• Language barriers

• Understanding of mental health problems

• Impact on families - secrecy, shame, pride, stigma

• Concerns about confidentiality

• Mistrust of services

• Lack of culturally appropriate services

Responses to gambling problems

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Cultural competence better client outcomes

• Clinicians:

• Awareness of culture

• Build rapport

• Therapy:

• Compatible with cultural needs

Adapting gambling support programs

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• Skills-based models

• Clinician self-awareness & knowledge

• Adaptation models

• Systemic modifications to increase congruency with culture

• Process-oriented models

• Cultural meaning of dynamic treatment mechanisms

• Little evidence

• Few trials, limited data, rigorous research

Models of cultural competence

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Practical modifications

• Documentation translated

• Native-language speakers or interpreters

• Suitable location

Understanding cultural factors

• How culture impacts clinical symptoms & response

• Non-judgmental approach

• Consider wider family & community

Culturally relevant treatment

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Cultural matching

• Diversification of CALD workers

• Beyond translation

Families

• Initial approach

• Understand impact of families

• Involving families

Communities

• Encourage help-seeking

• Support recovery

Culturally relevant treatment

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Factors impacting cultural competence in treatment

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• Cultural competency can enhance treatment outcomes

• Unadapted interventions also efficacious

• Culturally neutral therapy –modified for clients

Cultural competency

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Discussion

– Should gambling treatment be tailored for CALD populations?

– What is the most effective way to achieve cultural tailoring?

– What is the least effective way to achieve cultural tailoring?

– What resources would assist cultural tailoring?

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Thank you

Reference

Gainsbury, S. (In Press). Cultural competence in the treatment of addictions: Theory, practice and evidence. Clinical Psychology & Psychotherapy.

Dr Sally Gainsbury

Deputy Director, Gambling Treatment Clinic & Research Group

Senior Lecturer, School of Psychology, University of Sydney

Editor, International Gambling Studies

Adjunct Researcher, School of Business & Tourism, Southern Cross University

Email: sally.gainsbury@sydney.edu.au

Website: http://sydney.edu.au/science/people/sally.gainsbury.php

@DrSalGainsbury