It is clear that clinicians working in the field of problem gambling cannot afford to ignore the Internet. Psychological advice, help and treatment for gamblers are no exceptions with both counselling and psychotherapy entering the computer age. Such help comes under a variety of guises including Internet counselling, online therapy, webcounselling, cybertherapy, E-therapy, and cybercounselling (all on this partial list tend to get used interchangeably). Although there is no official description of how to define this activity, a common component of all these methods is that people logging into these Internet services are receiving psychological advice and/or 'treatment' at hundreds of websites. Predictably, the subject of Internet counselling is causing wide debate (especially on the Internet itself!). This paper overviews the main issues in the area and briefly examines 'telehealth', online therapy (and the various types currently available), the relative advantages and disadvantages of online therapy, a...

Online therapy: implications for problem gamblers and clinicians

Background: For highly stigmatized disorders, such as problem gambling, Web-based counseling has the potential to address common barriers to treatment, including issues of shame and stigma. Despite the exponential growth in the uptake of immediate synchronous Web-based counseling (ie, provided without appointment), little is known about why people choose this service over other modes of treatment. Objective: The aim of the current study was to determine motivations for choosing and recommending Web-based counseling over telephone or face-to-face services. Methods: The study involved 233 Australian participants who had completed an online counseling session for problem gambling on the Gambling Help Online website between November 2010 and February 2012. Participants were all classified as problem gamblers, with a greater proportion of males (57.4%) and 60.4% younger than 40 years of age. Participants completed open-ended questions about their reasons for choosing online counseling over other modes (ie, face-to-face and telephone), as well as reasons for recommending the service to others. Results: A content analysis revealed 4 themes related to confidentiality/anonymity (reported by 27.0%), convenience/accessibility (50.9%), service system access (34.2%), and a preference for the therapeutic medium (26.6%). Few participants reported helpful professional support as a reason for accessing counseling online, but 43.2% of participants stated that this was a reason for recommending the service. Those older than 40 years were more likely than younger people in the sample to use Web-based counseling as an entry point into the service system ( P =.045), whereas those engaged in nonstrategic gambling (eg, machine gambling) were more likely to access online counseling as an entry into the service system than those engaged in strategic gambling (ie, cards, sports; P =.01). Participants older than 40 years were more likely to recommend the service because of its potential for confidentiality and anonymity ( P =.04), whereas those younger than 40 years were more likely to recommend the service due to it being helpful ( P =.02). Conclusions: This study provides important information about why online counseling for gambling is attractive to people with problem gambling, thereby informing the development of targeted online programs, campaigns, and promotional material. [J Med Internet Res 2013;15(5):e99]

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Web-based counseling for problem gambling: exploring motivations and recommendations.

Although problem gambling is becoming more prevalent, research shows that many problem gamblers do not seek help. Online social support forums have become an increasingly popular option for receiving support for problem gambling. Few researchers have explored how participants within these forums interact, or what is supportive about participation in online communities. Melding netnography (ethnographic approaches online), discourse analysis, and ethnomethodology, we analyzed the discursive interactions of self-identified problem gamblers on an online forum. We report on the characteristics of this unique setting, the common discourses that members used, and how they discursively accomplished various interactional tasks, including constructing identities, and negotiating membership, legitimacy, and support. We conclude with recommendations for practitioners and researchers interested in better understanding people trying to overcome problem gambling and other behavioral concerns.

Doing Recovery Online

While the past decades have seen a dramatic increase in the number of women who gamble and develop consequent problems, treatment services are being underutilized in Ontario. This pilot study explores the feasibility of using web- and phone-based group interventions to expand services available for women who might not otherwise seek or be able to access treatment. Distinct treatment considerations for working with women, such as the value of a women’s group, advantages of phone counselling, and the implementation of modern web-based services, were reviewed. The study involved a clinician-facilitated group that used teleconferencing and webinar technology (Adobe Connect) for support and discussion, and a Tutorial Workbook (TW) developed specifically to address the issues and treatment needs of women who gamble at a problematic level. A mixed method analysis used to evaluate the results suggested that the group-based teleconference/webinar approach provided a much-needed means of treatment support for women. Participants reported that the program helped them to understand their gambling triggers, to improve their awareness, to feel better about themselves, to modify their mood and anxiety levels, to feel less isolated, to address their relationships, and to feel more hopeful for the future. The Tutorial Workbook, which was used to supplement the educational component of the group interaction, was highly rated.

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Group Treatment for Women Gamblers Using Web, Teleconference and Workbook: Effectiveness Pilot

Ninety female gamblers identified barriers to gambling treatment. These data suggest that the women in this study are a homogeneous group: middle aged (M = 47 years), Caucasian (86%), married or living with their partner (46%), had children (77%), completed a post secondary education (53%), employed full or part-time (67%), with personal incomes less that $35,000 (61%), and household incomes between $35,000 to $79,999 (51%). Moreover, most were recruited by referral from the GA conferences or GA members (70%) and were living in Ontario, Canada (37%).The Gamblers Anonymous 20 Questions and the South Oaks Gambling Screen were the two instruments used in this study to measure gambling severity. The average score on the GA20 was 17 and the SOGS was 13. Almost the entire sample (99% for the GA20 and 98% for the SOGS) can be considered to be compulsive or probable pathological gamblers. The majority (81%) of women in this study received some type of formal help for their gambling problem. Forty-three percent received outpatient treatment, 41% received crisis help, and 27% received residential or in-patient treatment. All but one woman accessed informal help, including 91% who sought help from Gamblers Anonymous and 38% received help from the Internet support group CGHub. Eighty-four percent reported feeling seriously depressed; 74% related their depression to gambling. Thirty-three percent reported having attempted suicide; 57% related their suicide attempt to gambling. Almost half (47%) received treatment in adulthood for a mental health or addictive disorder other than gambling, of which 60% were treated for depression. Barriers to treatment were identified within 3 broad domains: individual, socio-environmental and programmatic issues. Correlations among the three barriers subscales were positive and statistically significant. Individual barrier items were identified most often and programmatic barriers were identified least often. The barrier item "gamble to deal with the stress of daily life" was most frequently endorsed. Respondents who received formal treatment reported statistically more barriers and had higher individual and socio-environmental barrier subscale scores than non-formal treatment seekers. These findings suggest that women gamblers in this study have sought help from both formal and informal help systems. Key barriers to treatment are psychological and emotional issues. The women disclose turbulent personal and family histories and significant issues of comorbidity and concurrent life stressors, which may have important clinical implications in providing appropriate and effective treatment to women addicted to gambling.

Identifying barriers to treatment among women gamblers

Despite an increasing prevalence of gambling problems, evidence suggests that most people do not receive help for their problems. The issue of stigma has been cited as a contributing factor. Technological advances have now made it possible for individuals who are concerned about stigma to seek help for their problems without making any personal disclosures. In this way, the inherent advantages of the Internet (privacy, convenience, safety and portability) help to ensure that assistance for problem gamblers is always available and that concerns about stigma are neutralized. Unfortunately, many who might benefit from Internet-based help are unaware of these possibilities, and treatment specialists and other health-care professionals may not direct problem gamblers to these services. This paper considers: 1. What is available to problem gamblers through the Internet? 2. What is known about the efficacy of such services?, and 3. Possible reasons why problem gamblers have not been referred to the Internet by point-of-entry personnel. Implications for future action will be discussed.

Online help for problem gambling: Why it is and is not being considered

I have always been fond of the comparison between social change agents and traditional farmers. That is, while farmers plant seeds and nurture crops to sustain the masses, leading thinkers cultivate ideas that help to enrich and advance us as a species. This brings to mind an amusing quip from one of my high school teachers many years ago: that a farmer is a person “out standing in their field.” With that as background, this article illustrates that Dr. Mark Griffiths, likely well known to most who consult this and peer-reviewed journals, is a contributor who is similarly “outstanding in his field.” By anyone’s criteria, he has “planted” far more than his fair share of ideas that will benefit many people for years to come. During the later half of the 1990s, a time when I was working on my doctoral thesis, there was very little published regarding the role of the Internet within the fields of mental health and addictions. In particular, the problem gambling arena, an area where I was hoping to explore Internet-based peer-support as an emerging trend, was especially plagued by a paucity of any published accounts in peer-review journals. This is not too surprising given that the Internet was still a very new phenomenon back then. At the time, I was working on a paper and cited NUA data regarding the number of people who were connecting to the Internet on a regular basis (early 1999). NUA estimated these numbers to be 159million worldwide and roughly 88million North Americans (NUA as cited in Cooper 2001). The NUA group appears to have stopped counting as of 2003, however, their estimates for that year still far surpassed the 1999 numbers: 600 million worldwide and 165 million in North America (NUA 2003a, b). Today, high volume traffic on the Internet (remember the term “information superhighway”?) is taken for granted; just a decade ago, however, it was quite a novelty. The Internet’s infancy is even more noteworthy because Griffiths was among the research pioneers, publishing papers on related themes during this period. For example, he was writing about “Internet Addiction” (Griffiths 1996a) and “Internet Gambling” (Griffiths 1996b; Int J Ment Health Addiction (2007) 5:103–105 DOI 10.1007/s11469-007-9059-7

Gerry Cooper

Papers

Online help for problem gambling: Why it is and is not being considered

Mark Griffiths, PhD: Planting Seeds and Cultivating Ideas for the World Community