Betting on Recovery?
A discussion of paradox, client stigma, identity,
discourse, theoretical quandaries and personal
insights from therapeutic conversations about
addiction
Murray Anderson
Emily Doyle
Tanya Mudry
Introduction
Presenter backgrounds
Social construction of addiction
Paradox of addiction and recovery
Discourses of problem gamblers
Reflecting on your own practice
Think about your own practice and how you would
counsel someone with a gambling problem or another
“addiction”?
A little about us…
Murray Anderson
MA, PhD candidate counselling psychology
Emily Doyle,
MC, PhD candidate counselling psychology
Tanya Mudry
MSc, PhD student counselling psychology
Addiction is an abstract concept. It has no objective
existence and boundaries as would for example a chair or
an elephant. Furthermore, it is socially defined which
means that opinions can legitimately differ about what is
the most suitable definition; it cannot be said that one
definition is unequivocally correct and another one
incorrect, only that one is more useful or is generally
agreed upon by ‘experts’. Despite this, ‘addiction’ is one of
the most important concepts in behavioural and clinical
science.
(West, 2006, p. 9)
Addiction and Recovery as Social
Constructions
History
Attitudes
Events
Practices
Institutions
What is our role?
History, Attitudes & Events
Simply love to drink too much?
Industrialization and the need for self-control
Temperance movement (drunkard as a victim)
Addiction as a sign of weak character
Rediscovery of the “disease” model in the 1930’s – AA
Biological basis of addiction and taking an active role
in one’s recovery
Practices and Institutions
Medical Model
DSM-IV-TR
Sustained by social processes
What is OUR role?
Research from a social constructionist perspective
Practice from a social constructionist perspective
Therapeutic and Research
Experience
Project manager of various research projects involving
marginalized / stigmatized populations.
Worked as a clinician in psychiatric outpatient clinic.
Case Manager for early psychosis intervention clinic.
Social Program Officer for a multidiscipline crisis response
team.
Most 1:1, though a lot of group work in the past.
Reflection on Self & Practice –
Three Questions
How do I ensure there is cohesion in the way I practice
therapy and conduct research with the addiction/gambling
population?
How do I ‘bracket’ my own thoughts/views/ideas of
addiction/gambling to honor the voice/agency of those I
am working with?
How do I make room for emerging theory/therapies in my
work?
The Paradox of Addiction
Are gambling problems, shopping
compulsions and some forms of overeating
‘addictions’? Really? Are behavioral
addictions ‘real’, in the sense that they can
be understood as a family of medical
diseases that exist independently of culture,
history and politics? To my mind, there are
hardly less interesting questions
(Vrecko,2010, p.38).
What is the Paradox of
Addiction?
Throughout the addictions literature (Rockloff, & Schofield,
2004; Tavares, Martins, Zilberman, & el-Guebaly, 2002),
especially in the neuroscience realm (Keane & Hamill, 2010;
Vrecko, 2010) a widely held belief asserts that treating addiction
as a disease of the brain (White, 2000b) will reduce the
occurrence of shame and stigma.
The ‘addict’ is absolved of guilt, found not guilty by the moral
majority. However, with absolution comes the chance of shame;
now one carries a disease, an irreversible illness, never to be
cured - thus, the paradox.
What is the Paradox of
Addiction?
Such paradoxes are deeply embedded in both addiction
and problem gambling therapies.
If problem gambling is conceptualized as a disease
within the dominant addictions discourse, there is no
cure; from this perspective, addiction is a chronic,
debilitating disease that can be controlled, but not
dissolved.
This paradox has the potential to diminish the ability
of the field of addictions therapy to address associated
client experiences of shame and stigma (Buchman et
al., 2010).
The Paradox of Addiction –
Diagnosis of Problem Gambling
Attempting to conceptualize PG is a daunting task
(psychoanalytic, social learning, cognitive, and
neurotransmitter theory).
To date, no single model fully explains the complex and
heterogeneous nature of PG (Abbott & Clarke, 2005).
The lack of agreement on models has contributed, arguably, to
the lack of subscribed therapies outside of medical models
(Keane & Hamill, 2010).
Inconsistencies within such classification placed individuals
behavior on a continuum ranging from being socially
appropriate to socially catastrophic (Keane & Hamill, 2010).
The Paradox of Addiction –
Diagnostic Tools
Three main identification tools predominate in gambling
epidemiology:
South Oaks Gambling Screen (SOGS; Lesieur & Blume,
1987) - by far the most widely used;
DSM-IV-TR (APA, 2000);
Canadian Problem Gambling Index (CPGI: Wynne, 2003);
Although the SOGS is the tool most commonly used by
practitioners to screen gamblers, the DSM-IV-TR is the
primary text used to ascertain treatment protocols (Slutske,
2006). Such discrepancies further complicate treatment for
PG.
The Paradox of Addiction – Diagnostic
Complications
The term PG is not defined within the DSM-IV-TR (APA, 2000).
Despite attempts to unite PG and pathological gambling under the
heading disordered gambling, at present, no gambling screening tools
(Petry, 2009) endorse such distinctions.
Evidence suggests that clinicians do not use the DSM protocol
uniformly for diagnosis, particularly with marginalized or oppressed
populations (Lowe, & Widiger, 2009; Overmars, 2010).
Inclusion of PG as an extension of pathological gambling leads to
confusion as to what treatment approaches are appropriate. According
to these medical screening tools (CPGI, 2003; SOGS, 1987), the term
problem gambler describes people who do not meet the criteria for
diagnosis of pathological gambler. Such fuzzy descriptions only add to
the problem of PG being treated as an addiction.
Emerging Research
Spoiled Identity: Problem Gamblers and the Moral
Management of Stigmatized Identities through
Conversational Agency.
Stigma greatest barrier in addiction treatment (Hinshaw,
2006; Horch, 2008)
Spoiled Identity (Goffman, 1963)
Identity Work (Wortham, 2000)
Moral Management (Avdi, 2005; Rapley, Kiernan &
Antaki, 1995)
Conversational Agency (Strong, 2012; Zidjaly, 2009)
Outline of Research Initiative
Action Research Initiative (Lewin, 1948; Fals-Borda,
1982).
Situational Analysis (Clarke, 2005).
Three focus groups with addiction counsellors.
Two – 60 minute, semi-structured interviews with six
problem-gamblers.
Why this investigation?
Whether in academia or among practitioners, there is
little agreement on the constructs of addiction
(gambling).
There is a movement afloat (Bailey, 2005; Marie, 2004)
that suggests the social identity of being a “problem
gambler” and its management in talk is far more fluid
and dynamic than the static characteristic of “having a
disease” or “being an addict.”
Impact of possible changes to the DSM-V from both a
clinician and client perspective.
Research Question
How do clients agentively manage or negotiate their moral identities
while in therapeutic conversation?
Focusing on what has been described as conversational ethics
(Strong and Sutherland, 2007) a secondary branch of research
questions emerge: How is this process of negotiation facilitated or
hindered by therapists?
How do therapists infer the stated (or unstated) aims clients have in
coming to therapy?
How do therapists rationalize, understand, and maneuver around
potentially stigmatizing topics (e.g., Holmes, Murray, Perron, & Rail,
2006; Porter & O’Halloranan, 2009)?
Context of Study
Agency – conditionally defined as the socioculturally mediated
capacity to act (Ahearn, 2001) is a loose concept with a lengthy,
vague history.
Conversational Agency - invented term that orients us to ways
in which clients participate in therapeutic dialogues (Massfeller
& Strong, 2012).
One purpose of the study is to demonstrate a way of
conceptualizing agency as a collaborative, and interactive
achievement (Zidjaly, 2005), a conjoint action involving specific
linguistic strategies (footing shifts, format roles, alignments,
claiming, ratifying, and expertise) social actors draw upon in
therapeutic interactions.
Initial Findings
Therapists
Not all therapists agreed
that clients were agentive
in session.
Some therapists reported
frustration with clients
that didn’t follow
treatment protocol.
High level of interest in
hearing from clients –
how sessions could be
improved.
Gamblers
Strong use of recovery
discourse.
Noted lack of agreement
related to addiction
language (“once an addict,
always an addict”).
Subjective nature gambling
often ignored (story).
Stronger indicator of
success in support group
situation.
Paradox of Addiction – Final
Thoughts
Problem Gambling is a highly- contested topic.
Paradox of addiction confounds the recovery process.
Addiction as disease models do not work for everyone.
Postmodern theory and therapeutic approaches are
gaining credibility within the field of addictions
(Diamond, 2012; Mitchell, 2006) and in particular
problem gambling (Suissa, 2007).
We take addiction to be a category, a concept and a
discourse rather than an unchanging historical entity
Keane and Hamill, 2010, p. 53).
Research Interests
Common discourses of problem gamblers
Problem gambling and online support
Communities of practice (Wenger, 2004)
Discursive accomplishment of interactional tasks
Co-constructing identities
Negotiating membership
Establishing legitimacy
Providing and receiving support
Method
“Netnography” (Kozinets, 2010)
Discourse analysis (Wetherell, Taylor, & Yates, 2001)
Ethnomethodology (Garfinkel, 1967)
Data from a free Canadian 24/7 support forum
Forum
Discourse Analysis
Shame and Guilt
Now here I am again, crying, fretting, stressed out and wondering where I will
find the money to fix my car, buy groceries and buy food. It’s not just that I feel
like a failure -- I am a failure.
Causality
My Mom and her parents were/are as I know today compulsive gamblers and
gambling was a normal way of living for me. I placed my first bet at [the] Race
Track when I was 10 and was betting with a bookie at 16 . . . I truly believe that
I missed the chaos of the family life I grew up in and set about creating my own
chaos in my life with both drinking and gambling.
People gamble for many different reasons, and it can become an issue when they
gamble to escape from problems in their lives, if they chase losses, and/or get
hooked on the buzz of winning (or almost winning).
Nature of Gambling
Personally I don’t believe there is a thing as “Responsible Gambling” . . . people
go to casino’s for fun and to lose their daily responsibilities. Casino’s are
businesses and sell dreams and thrills for cold hard cash, nothing more. Anyone
trying to be responsible wouldn’t be there in the first place.
Gambling as an Addiction or
Illness
Compulsive gambling needs to be treated like other addictions. Cocaine, alcohol,
heroin, are all the same as compulsive gambling. All of these addicts need help
to break free from their addictions, they cannot just walk away and quit.
This addiction has the ability to put [people] out on the streets with nothing but
the clothes on [their] back . . . Gambling addicts are like drug addicts . . . only
takes one “hit” and we’re back on the dark path destroying ourselves
Control and Responsibility
Are you aware of the self-exclusion process? You can [ask] to be voluntarily
banned from the premises and should you show up they have the ability to
charge you with trespassing. There are other options such as handing over all
your finances to a loved one for the time being until you are back in control of
your behaviour.
Recovery as a Process
Getting over a gambling problem is not easy but it can be done. Recovery is like
a journey and there are going to be ups and downs but the important thing is to
keep moving forward even if you have a few setbacks. You have made a good
start by coming here and deciding to talk about what is going on in your life.
Talking about the problems is an important step towards understanding the
problem.
Identity Co-Construction
“I am ill”
“I am an
addict, I
want to
recover”
“I am in
recovery”
•Introduction as a “problem gambler” (gambling as an addiction/illness)
•Category entitlement
•Establishing legitimacy as a “real addict”
•Understanding PG
•Sharing stories (shame and guilt, causality, nature of gambling)
•Seeking advice (control and responsibility, recovery as a process)
•Establishing legitimacy as in “recovery” (recovery as a process)
•Demonstrating recovery efforts (control and responsibility)
•Providing support
•Celebrating abstinence
Example
I just signed up here, I’m not even sure I know what I aim to
accomplish except to quit gambling. I have been gambling all my
life and it has eaten away at everything I try to achieve. I am in
debt over my head and many people are very upset with me.
Since I have made my choice and also acknowledged the need to
change I have been 5 weeks now without any sort of gambling
and it feels very good to say that. I even had money to buy a new
pair of jeans today.
Welcome to the site! Many people experience big wins in the first
little while of gambling and end up in the same situation.
Admitting the issue is an invaluable step - congratulations!
Socialization
Introduction section
This is the place to start on the GamTalk Forum. Say “Hi” to everyone
and maybe say what you want to get out of the forum. Please keep your
intro brief and then move on to another area…
Socialization of the introduction
Maybe you could tell us a bit about your story in the
"introductions" section. Writing about your situation can
help give ourself a clearer picture of what is going on, and
the rest of us can have a better idea of suggestions that
might help you.
Reflecting on Practice
• Members discursively co-construct their understandings of PG and their
identities as a gambler or gambler in recovery through their interactions.
• Understandings about identity transformation may be of use to
practitioners as an approach to recovery efforts, using identity coconstruction in their work with clients.
• Discourses of CoPs that are different from the clients might dissuade them
away from interacting on such forums. Other barriers might include the
requirement to disclose painful details, not being “ill enough” to
participate, and the challenge of establishing a legitimate position in the
group (Sandaunet, 2008).
• Similar barriers to participation might also be evident in counselling or
healthcare settings, highlighting the importance of practitioners being
aware of the common discourses and norms of illness and recovery.