Research project Dilemmas of help-seeking
The responsibility to offer support and treatment for people with gambling problems and their significant others was clarified in Swedish legislation in 2018. The aim of this study was to explore barriers for and experiences of help-seeking among people with gambling and alcohol problems.
Interviews were held with 42 individuals experiencing such problems in 2018–2018, and with 16 representatives from governmental agencies, self-help organisations and treatment units in the gambling field (before the legislative change and two years later). The data collection also included available statistics concerning prevention, treatment and help-seeking over time.
The project is linked to the research program Responding to and Reducing Gambling Problems Studies (REGAPS) at the Department of Public Health Sciences ongoing until 2023.
Barriers for help-seeking presented by the interviewed were shame, guilt and fear of stigma, difficulties with acknowledging the problem to yourself and others, the intent to handle the situation on your own, lack of faith in the possibility to change the situation and that there are helpful treatment options available, potentially based on previous negative treatment experiences. When having built up the courage to seek help, often associated with drastic life events (e.g. family ultimatums), further barriers were often experienced: lack of available or adequate treatment options, unclear information on where to turn, caregivers referring the help-seeker back and forth, or not being taken seriously.
The interviewed had varying preferences of different help options based on their needs and experiences – internet or telephone support, social services, primary, addiction and psychiatric care, private psychologists and/or self-help groups. It was considered crucial that support and treatment are easily accessible when needs arise, that the care is flexible regarding relapse, and that caregivers have specific knowledge of gambling problems. Therefore, the support offered by self-help groups was often perceived as particularly important. Gamblers’ and substance users’ experiences of help-seeking were similar. But gamblers perceived that they to a greater extent needed to argue for the severity of gambling problems to be taken seriously. The gamblers had extensive experiences of trying to self-regulate their gambling through various responsible gambling tools. Despite the assurances of the gambling companies about their legislative compliance with duty of care, the gamblers described lack of consumer protection and advocated stricter regulation and supervision. The new Gambling Act as of 2019 has facilitated self-exclusion and decreased the amount of bonus offers. The essential paradox between the individual responsibility discourse of self-regulation and the prevailing medical discourse on the problem gambler’s incapability of self-control however remains. This implies an impossible equation that brings feelings of guilt and shame upon the individual gambler who concurrently is considered both responsible and incapable. To reduce harms gambling companies must be more proactive with coercive external control measures to fulfil the duty of care they claim to adhere to.
The following is recommended to improve prevention and treatment: Responsible gambling measures cannot be expected to be sufficient to prevent gambling harm. Economic support to self-help groups should be expanded considering how important they are considered by gamblers and significant others. Both biological, psychological, and social aspects of gambling and substance use problems need to be considered in the care system to meet the needs of the help-seekers. The availability of support and treatment for gambling problems has been improved during the study period, but the capacity of the care system to offer easily accessible, continuous and coordinated care should be improved. Resources, practical prerequisites, education and training of staff as well as development of integrated treatment measures are required to meet the needs of gamblers, with or without concurrent substance use problems, and their significant others.