Approaches to Recovery in Gamblers Anonymous

Peter Ferentzy, Ph.D. Centre for Addiction and Mental Health

Wayne Skinner, MSW, RSW Centre for Addiction and Mental Health University of Toronto

Paul Antze, Ph.D. York University

Final Report Submitted to the Ontario Problem Gambling Research Centre August 3, 2007

Disclaimer: Opinions expressed in this final report are those of the investigator(s), and do not necessarily represent the views of the Ontario Problem Gambling Research Centre (OPGRC). 2 Table of Contents

1. Acknowledgements ………………………………………………. 3

2. A b s t r a c t ………………………………………………. 4 3. Executive Summary ………………………………………………. 5 4. Introduction ………………………………………………. 7 5. Purpose and Goals ………………………………………………. 9 6. Literature Review ………………………………………………. 9 7. Research Design & Methodology ………………………………………………. 16 8. Research Sample ………………………………………………. 17 9. Findings from our Previous Study (EMAP) ………………………………………………. 18 10. Findings from Current Study ………………………………………………. 38 11. Interpretations, Conclusions and Implications ………………………………………………. 72 12. Future Research ………………………………………………. 73 13. References ………………………………………………. 74 14. Appendices ………………………………………………. 86

3 1. Acknowledgements

The authors want to acknowledge the support of the Ontario Problem Gambling Research Centre (OPGRC) for funding this project, which is the third in a line of work that they have sponsored in the under-researched domain of mutual aid in problem gambling recovery. In addition, circumstances among the research group necessitated an unexpected interruption in the work process. We wish to extend a special thanks to Judith Glynn and Rob Simpson for their support and understanding during that period. To our study participants who have opened up their personal worlds of recovery and through that provided a powerful view of Gamblers Anonymous, we owe many thanks. 4 2. Abstract

Designed to build upon knowledge generated by our original ethnographic inquiry into Gamblers Anonymous (GA), this qualitative, interview-based study explored common themes, as well as variations in recovery approaches among GA members. Of thirty-nine participants, twenty-six were men, thirteen were women. The average age was 56.5 years, with a range of 35-80 years. Some interviews were conducted in person, others over the phone as participants were drawn from all over North America. Interviews were open, semi-structured, and a grounded theory approach was used. Our primary focus was on the process referred to as “working the Twelve Steps”. Over the course of our previous study, we learned that the GA fellowship had changed significantly over the last 10-15 years, notably with respect to a greater emphasis on the Twelve Steps and psycho-emotional issues in general, as well as a greater involvement of women. Practically all the available literature had been published before these changes took hold, leaving the research community with a badly dated set of assumptions about GA’s recovery program. Building upon findings from our first study, which was designed in part to determine what happens at GA meetings, this study looked more closely at how GA members practise and work their programs on their own and in cooperation with their sponsors. Given the importance that members accord to the Twelve Steps, as well as our own findings associating Twelve Step work with abstinence and life satisfaction, it seemed likely that this would be a central element in the overall benefit GA offers problem gamblers. While acknowledging the overall recovery culture guiding the Twelve Step process in GA, we endeavoured also to look for internal variations. Not all GA members pursue their recovery in the same fashion. Knowledge generated by our first study has led us to hypothesize that certain approaches are associated with intra-personal and situational factors. One key finding involves the importance of GamAnon, a fellowship for spouses and significant others of GA members.

5 3. Executive Summary

We sought to identify and describe different approaches to recovery among members of Gamblers Anonymous (GA), and to determine whether these approaches were associated with issues such as gender, belief systems, affiliation with other Twelve Step fellowships, severity of problem gambling, debt load, comorbidity and levels of outside social support. We were also interested in associations between recovery styles and outcome measures such as abstinence and life satisfaction. Building upon the knowledge generated through our previous study – Exploring Mutual Aid Pathways to Recovery from Gambling Problems (EMAP; Ferentzy, Skinner, & Antze, 2004) – we explored the actual processes of recovery within GA, with a major emphasis on how GA members “work” the Twelve Steps (and how they report the Twelve Steps to work for people with gambling problems). Essentially, “working” the Twelve Steps entails practicing a set of moral and spiritual precepts originally put forward by Alcoholics Anonymous. During both meeting observations and in interviews, we had learned that many GA members feel that the “real” recovery program is not limited to meetings, and that a key to abstinence from gambling – and notably an emotional state that renders abstinence tolerable or even enjoyable – is the work members do on their own and with their “sponsors” (Ferentzy et al., 1004; Ferentzy, Skinner & Antze, 2006A). While acknowledging the overall recovery culture guiding the Twelve Step process in GA, we were also interested in internal variations. Not all GA members pursue their recovery in the same fashion, and knowledge generated by our first study had led us to hypothesize that certain approaches are associated with intra-personal and situational factors. We attempted to explore the reasons for these diverging recovery styles. In this study, we actually found that sponsorship is less active, or arguably more of a haphazard affair, than we had earlier understood. We also found that GA has been changing far more drastically than we had imagined. Notably, the role of GamAnon – GA’s sister fellowship for spouses and others affected by members’ gambling problems – has been declining. We put great effort into gauging the implications of this change, the importance of social support in general, and on how more members are now relying on the fellowship rather than their spouses to this end. To an increasing extent, personal recovery work involves the Twelve Steps (Ferentzy et al., 2006A). We explored the differences in the ways members work the Twelve Steps, and in how they practise other aspects of the GA program, such as sponsorship and meeting attendance. As mentioned, we investigated whether these variations are correlated with factors such as gender and belief systems, and also attempted to make preliminary determinations regarding which approaches are associated with better recovery outcomes. On this last matter, it was harder to reach firm conclusions. Ogborne (1995) has pointed out that since all accepted treatment approaches demonstrate successes and failures, it is best to avoid claiming simply that an approach works or does not work. Instead, we should ask for whom, and in what ways, an approach seems helpful. Our findings and objectives were consistent with Ogborne’s suggestion, as well as a logical extension of the work we had done so far. Our efforts were also governed by a brief study, preceding EMAP, involving a thorough review of the literature dealing with GA (Ferentzy & Skinner, 2003, 2006). We quickly learned that the attention GA had received from scholars fell short of reflecting its importance. Arguably most effective in conjunction with other interventions, GA’s practices were poorly understood (even though most North American treatment programs employed GA as an adjunct). As well, the information available on GA was largely dated, with recent changes within that fellowship receiving no attention at all. For example, though GA had rightly been identified as less focussed on spiritual and interpersonal issues than AA, and as opting, instead, for a more pragmatic focus on abstinence from gambling and debt- related issues, the extent to which this was changing had received no attention in the literature. Similarly, while GA had long been an almost exclusively male domain, this was also changing with little notice from the research community. Gender issues were therefore an important consideration in the EMAP study, with issues pertaining to spousal support a key area of inquiry in this one. 6 This was a qualitative, interview-based study employing a semi-structured format. Interviews were open, semi-structured, and a grounded theory approach was used. This method entails a radical empiricism, allowing subject matter to shape methodology throughout the process of an inquiry. For example, the interview protocol was consistently revised in response to the gathering of unanticipated information. Continuity was nonetheless maintained by adherence to guiding research questions, such as: How can we characterize the most important approaches members take to working the GA program and the Twelve Steps in particular? How do these approaches differ? Of thirty-nine participants, twenty-six were men, thirteen were women. The average age was 56.5 years, with a range of 35-80 years. Some interviews were conducted in person, others over the phone. While focused mainly on the Toronto area, telephone interviews were conducted with GA members from various North American regions in an attempt to provide a more complete picture of GA on this continent. Among other things, this report discusses GA’s seemingly unique approach to spirituality within the Twelve Step world. Long known to be guardedly secular, GA also advocates “spirituality” – and all but a very few members we interviewed agreed that atheists and agnostics can be spiritual. Inconsistencies notwithstanding, among GA members we interviewed those who were more secular were also more keen to make use of the Serenity Prayer (found on the cover of GA’s main text). As well, GA uses the so-called disease model of addiction as a therapeutic device, absolving guilt while at the same time ensuring that members do not treat circumstances (such as bad luck) as excuses for their plight. In many ways, GA’s application of this model is more stringent than that of other Twelve Step organizations: in short, GA takes the abstinence principle more to heart, with strong admonitions pertaining to potentially dangerous associations and behaviours. We also confirmed what many hail as mutual aid’s main virtue: social support. Members with fewer outside support networks cling more tenaciously not just to GA as a fellowship but also to its core beliefs. Perhaps the most interesting finding involves the shifting nature of spousal support within GA. GamAnon – a fellowship in principle for persons affected by someone’s gambling problems and in practice for wives of male GA members – is in decline, and as such the nature of recovery in GA has been changing. Furthermore, assumptions about spousal support that applied to GA’s traditionally male membership do not apply to the increasing percentage of female members – husbands of women in GA rarely join GamAnon. This report discusses the implications of these and other changes as GA struggles with new social and political realities.

7

4. Introduction

Traditionally, the research community has tended to treat mutual aid as monolithic, often overlooking the important differences between various organizations (Hurvitz, 1974; Lieberman & Borman, 1979; Rice, 1996). A notable example is Preston and Smith (1985) who discuss GA on the assumption that its program of recovery is virtually identical to that of Alcoholics Anonymous (AA). Later, Browne (1991, 1994) and Lesieur (1990) explored the differences between AA and GA, pointing to GA’s lesser emphasis on the Twelve Steps and spirituality compared to AA, and its more pragmatic focus upon gambling itself and issues such as debts. For this reason, Browne considers GA less effective as an overall therapy than AA, which is said to put more focus on the whole self. GA has also been criticized for attracting few women (Mark & Lesieur, 1992), and Browne (1991) has suggested that the absence of spiritual and inner-directed therapies may alienate women and certain minorities. Yet even here a uniformitarian bias prevails in the sense that GA is treated as largely monolithic, with little attention paid to internal variations. The same bias has tended to govern studies of AA (Antze, 1979; Miller & Kurtz, 1994; Valverde, 1998). Horstmann and Tonigan (2000) provide an exception to this rule, attempting to study Twelve Step work in AA in terms of different problem solving approaches to religion. Three coping types, borrowed from Pargament, Kennell, Hathaway, Grevengoed, Newman, and Jones (1988), are posited: self-directing, where individuals solve problems on their own; deferring, where individuals rely on God to solve their problems; and, collaborative, where problems are solved “jointly, by the individual and God” (p. 75). While also seeking internal variations, our approach differed in two key respects: first, we looked closely at Twelve Step processes, describing them in fine detail; second, rather than limiting ourselves to speculative typologies generated by us or the research community, we proposed that recovery approaches will emerge from the study itself (i.e., we wished to allow participants in GA to articulate, based on their experiences, the nature and variations of the recovery culture in GA). This was consistent with the approach taken in our previous study. Every effort was made to avoid presumptions about what may or may not be significant. We have found such a “grounded theory” (Glaser, 1978) approach to be the best way to avoid research bias, and opted to employ it further. While observers tend to discuss GA as though it were monolithic (Browne, 1991, 1994; Lesieur, 1990; Mark & Lesieur, 1992; Preston & Smith, 1985; Turner & Saunders, 1990), we have noticed a great deal of variability in the ways members work their recovery programs and apply GA principles to their lives. Perhaps the most obvious difference is that some members are more involved than others in every aspect of GA, from the Twelve Step process and meeting attendance to participation in group business meetings and events, such as conferences and social activities. We sought to gain a better appreciation of why some members associate with GA more strongly than others, and found a lack of outside social support to be a key indicator. With respect to recovery, some members put greater emphasis on psycho-emotional issues while others see recovery more in terms of cognitive restructuring. Some take a formal approach to the Twelve Steps, working the steps one at a time in their proper order. Others can rarely be said to be on any one step at a given moment, opting instead to learn, internalize, and practise the principles associated with the Twelve Steps simultaneously throughout their recovery. Despite what we had learned, our purpose was not to present typologies at the outset, but to generate them through an open-ended investigation of the ways GA members pursue their recovery. Nonetheless, some typologies had already emerged in our first study, Exploring Mutual Aid Pathways to Recovery from Gambling Problems (EMAP). As well, though our EMAP study was not quantitative, we compiled some information along these lines. We identified three – preliminary and admittedly broad – approaches to the Twelve Steps: 1. Working the Steps with a sponsor and attempting to do them in their suggested order; 2. Working the Steps by “osmosis”, meaning that a participant may take the Twelve Steps seriously enough to pay attention at meetings and try to apply 8 them to living, but without the assistance of another GA member, formal work on any one Step, or even much effort to focus on one step at a time; and, 3. Not working the Steps at all. Despite the small sample size, some of the data were striking. Eleven out of the 13 participants who worked the Twelve Steps with a sponsor said they did not miss gambling. Out of the four participants who worked the Twelve Steps by “osmosis”, two claimed to miss gambling. All of the five participants who paid no attention to the Twelve Steps admitted to missing gambling. Making allowances for ideological replies on the part of gamblers who worked the Twelve Steps and who tried to impress a listener with the efficacy of the GA program, we are still left with an impressive result (and the principal investigator [PI] sensed little deception on the part of these participants, many of whom he got to know quite well during the tenure of the study). Another measure, taken informally as direct questions were not asked on this topic, involved the PI’s perception of overall life satisfaction: disciplined Twelve Step work correlated with high life satisfaction, Twelve Step work by “osmosis” with fair life satisfaction, and no Twelve Step work with poor life satisfaction. With near unanimity, both in interviews and informal conversations, GA members (regardless of whether they had worked the Twelve Steps) were inclined to agree that members who had worked the Twelve Steps were better off emotionally and spiritually than those who had not. At a meeting, the PI heard mention of one member who had claimed that years ago, GA – and its then spiritually deficient recovery culture – drove him to drink. He therefore went to AA, found the Twelve Steps, and brought them back to GA. While glib, this story represents an important consideration: those who work the Twelve Steps seem more comfortable with abstinence from gambling, and for this reason may be less vulnerable to substitute disorders (including but not limited to substance abuse disorders). Our EMAP study found patience to be a key component of GA’s recovery program (Ferentzy, et al., 2004, 2006B). We also found that the theme of patience, while well intentioned, can in the view of some members lead to bad recovery outcomes or to newcomers leaving altogether. Supposedly, many new members “can’t seem to get to the steps, the Twelve Steps of recovery, fast enough.” (EMAP study, Interview #5). The idea is that without the emotional growth brought about by embarking on the Twelve Steps, the problems associated with early recovery from gambling are overwhelming. We hypothesized that this may be a weakness in GA’s approach to recovery: the emphasis on taking one’s time, while well intentioned, can at times be conducive to unhealthy procrastination. Other GA members have told us that Pressure Relief – a session wherein experienced GA members help a newcomer and his or her spouse to formulate plans for dealing with financial and legal matters – comes too late for many members. Here, the emphasis on taking one’s time, as practiced in GA, can apparently cause some newcomers to go back to gambling out of desperation in the hope of winning some sorely needed money. In GA, finding a balance along these lines seems to be an ongoing struggle, and the ways in which various GA members deal with the idea of patience can in many cases determine the quality of their recovery. This study explores the implications of procrastination in finer detail. Other variations, however, had to be taken into account before any understanding, let alone evaluation, of these processes was possible. Gender can serve as an example. Our fist study found that war stories – graphic and at times disturbing accounts of one’s gambling career – resonate differently among various members (Ferentzy, Skinner & Antze, 2003-2004). Some consider the retelling of tragic tales an excellent means to remind members why they should not gamble, and many consider the telling of their own stories to be therapeutic and necessary. Some, however, tire of the repetition while others consider the preoccupation with such tales as a means of staying in the past, avoiding the present, and circumventing emotional and spiritual growth. In our EMAP study, responses to the question, “How do you feel about war stories?” were divided into four categories: 1. positive, 2. positive with qualification, 3. negative with qualification, and 4. negative. Of the 12 men asked this question, 9 fell into the first category, and 3 into the second. Of the seven women asked this question, only one fell into the first category, three into the second, one into the third, and two into the fourth (Ferentzy, et al., 2004). Our findings are consistent with those of Mark and Lesieur (1992). Clearly, 9 there is a difference between the way male and female GA members relate to their past addictive episodes. Overall, the trend in GA seems to be vindicating women’s perspective on this question, as all longstanding members we asked agreed that war stories are far less frequent than 10-15 years ago. Even the positive endorsement given by many male members should be taken in the current context: these stories are appreciated today as a subset of GA discourse and no longer as the mainstay. As well, in this study we found that a newer breed of gambler – those playing slots and other electronic games – are less receptive to such stories and tend to gamble for different reasons than most of the older members (the latter are more likely to fall into the “action” gambler category). In short, our current study explored GA’s overall approach to recovery in terms of general themes, such as the emphasis on patience and, at the same time, sought out the internal variations in order to gain a sense of what seems to work for different types of gamblers. Our first study included meeting observations, yet we hypothesized that GA would remain a “black box” until a better grasp of the “real” recovery program is achieved, which seems to go on everywhere but at meetings. It includes working with sponsors, writing Step Four “moral and financial inventories”, the support of spouses, and applying the program to everyday living.

5. Purpose and Goals

As stated, we intended to investigate different approaches to recovery within GA and their relationship to: 1) prior characteristics that differentiate GA members (gender, severity of gambling problems, etc.) and 2) self-reports regarding abstinence from gambling and overall life satisfaction. The study was directed especially to the ways in which members engage in the Twelve Steps at the heart of the GA program. Its primary aim was to develop an accurate ethnographic account of “Step work” and its relationship to the recovery process in GA. We also expected it to throw light on changes arising in GA due to the increased emphasis members have placed on the Twelve Steps in recent years. An added goal, which we did not foresee, was to appreciate the role of GamAnon. As we learned more about the significance of this organization, it became necessary to reassess our objectives. Such shifts in emphasis are consistent with our stated approach: allowing GA members to tell us what is important, rather than presuming to know such things prior to investigation.

6. Literature Review1

6.1 GA's Effectiveness: How it Works

When discussions of GA were in their infancy, endorsements were often less guarded than in current assessments (Custer 1982b; Custer & Milt, 1985; Winston & Harris, 1984), though GA's inability to deal with certain psychiatric issues has long been acknowledged (Custer & Milt, 1985). Since then, more researchers have come to perceive GA as helpful, but incomplete and likely to be more effective in conjunction with other interventions (Petry, 2005). Such assessments are often based on three considerations: 1) greater attention to the significance of co-occurring substance addictions (Lesieur & Blume, 1991a); 2) more attention to GA's inability to address other special needs (Rosenthal, 1992); and, 3) concerns about the small percentage of gamblers who achieve abstinence after trying GA (Lesieur & Blume, 1991a; Petry, 2002). For example, Stewart and Brown (1988) found that out of a sample of 232 attendees, 8% had remained completely abstinent and active in the fellowship 1 year after their first meeting, and about 7% after 2 years.

1 Note: This is an updated version of the original literature review used in the EMAP study. 10 There are also questions pertaining to the type of gambler for which GA is effective. Blaszczynski (2000) has claimed that GA is suitable only for gamblers free of other compounding issues, meaning gamblers who are essentially "normal" save for the gambling problem itself. Yet Blaszczynski (2000) also claimed that such gamblers, being relatively well adjusted, are good candidates for moderation instead of abstinence goals, throwing into question their suitability for a program that insists on abstinence. Brown (1986, 1987a, 1987c) found that gamblers able to moderate their gambling activity were unlikely to stay for long at GA. Further, Brown argued that GA may suit only the most severe cases, as GA ideology involves the need to hit bottom (often called one's "personal low" in GA) and demands abstinence, which, as both Brown and Blaszczynski have stated, may not be necessary for less troubled gamblers. Brown (1987a, 1987b, 1987c) found that precisely those gamblers who perceived themselves as less troubled were more likely to leave GA. Stirpe (1995) also argued that GA is appropriate mainly for severe cases. In short, the ideology of hitting bottom insists that one must be at the brink – not just financially, but also emotionally – and tends to alienate those who simply cannot relate. Conversely, Blaszczynski’s point was that a compulsive gambler with pressing psychiatric difficulties may require a more serious intervention than a non-professional society can offer. Ferentzy et al. (2006B) found that, if nothing else, GA’s proscriptions pertaining to guarding against relapse suggest that the fellowship is targeting extreme cases, and that its collective experience is dominated by harder cases. Browne (1991, 1994) discussed GA's lesser emphasis on the Twelve Steps and spirituality than AA, and GA’s more pragmatic focus upon the gambling itself and issues such as debt. For this reason, Browne considers GA less effective as an overall therapy than AA, which puts more focus on the whole self. Browne (1991) also suggested that the relative absence of spiritual and inner-directed therapies may alienate women and certain minorities. Yet, according to Browne (1991), 12-Step consciousness can be found among GA members affiliated with other Twelve Step fellowships. Lesieur (1990) and Ferentzy et al. (2006A) have made similar observations. This adds weight to suggestions that GA is in many cases incomplete on its own (Lesieur & Blume, 1991a; Rosenthal, 1992; Petry, 2002, 2005) and should be judged on how it can complement other interventions. Many have argued that a program can be effective even if it reduces gambling activity without achieving long-term abstinence (Blaszczynski, McConaghy, & Frankonova, 1991), and despite philosophical discrepancies, there is no reason to presume GA could not play a role in such outcomes. It has long been recognized that GA may have a positive effect even on those who attend only once or twice (Allock, 1986). Yet, given the existing state of knowledge, GA's appropriate role is still open to speculation. While most North American gambling treatment programs use GA as an adjunct (Bensinger, DuPont, & Associates, 2006), a comprehensive understanding of GA's inner workings (i.e., its recovery culture and the types of narratives it employs) is lacking. There is no shortage of attempts to evaluate GA in various ways (Abt & McGurrin, 1991; Allock, 1986; Brown, 1985; Canadian Foundation of Compulsive Gambling (Ontario), 1996; Custer, 1982b; Petry, 2002; Potenza, 2002; Preston & Smith, 1985; Rosenthal, 1992; Steinberg, 1993; Stewart & Brown, 1988; Turner & Saunders, 1990; Walker, 1992). Petry (2002), however, grants that evaluations of GA's efficacy remain tenuous given the current state of knowledge, and argues that large-scale controlled studies of various interventions are necessary for a clearer grasp of what really works for pathological gamblers (though Brown [1985] has discussed some of the difficulties involved in attempting to assess an anonymous fellowship, such as GA). GA members have also been studied outside GA to gauge psychological and other issues (Getty, Watson, & Frisch, 2000; Kramer, 1988; Lorenz & Yaffee, 1986; Whitman-Raymond, 1988); however, little descriptive work has been done on the workings of GA itself. Livingston (1971) provided information that by today's standards would be introductory. Brown (1986, 1987a, 1987b, 1987c) has carried out some of the most useful work on GA, especially regarding the question of why some members drop out. As might be expected, he found that those who left were more likely to consider the talk at meetings to be "meaningless" and were more critical of GA 11 literature than those who remained (Brown, 1987b). Brown (1986) also found that those who were overly elated at their first meeting were more likely to become disenchanted later on than those with a more balanced initial impression. However, Brown’s studies relied upon interviews without accompanying observation of GA meetings, and no detailed account is given of exactly what was dismissed by some as meaningless. Further, since a solid descriptive base is lacking, we are left with speculative evaluation. For example, Brown (1987a, 1987c) found that only gamblers with the most severe problems, or at least those who perceived their problems as most severe, were likely to remain in GA. Possible explanations for this remain unverified. Brown (1987a) speculated that perhaps some members take pride (possibly competitive pride) in the extreme nature of their gambling careers, with the corollary that many members must either embellish their own stories or be unacknowledged and socially sidelined. Direct observation accompanied by interviews is needed to verify the existence of such a cultural dynamic and to describe its workings. Ferentzy et al. (2003-2004) have identified such a dynamic, and have found it to alienate many women who attend GA. McCormick and Brown (1988) provided an interesting account of parallels between GA’s approach and Christian conversion experiences. Still, beyond generalities and some admittedly interesting observations, only recently have discussions emerged that involve closer scrutiny of the ways in which GA members recover. Straus (2006) discussed how many GA meetings permit members to comment on what other members have said at meetings. Known as “cross-talk”, such feedback is generally discouraged at Twelve Step meetings. Ferentzy et al. (2006B) discussed how newer GA members are often asked the “20 Questions” (a diagnostic tool designed to determine whether they are compulsive gamblers) at their first meeting, so it is clear that GA differs from many other such fellowships when it comes to direct feedback. Ferentzy et al. (2006B) also discussed the process of recovery in GA, with special attention to the virtue of patience and its importance to recovering GA members. In short, theses authors point out that beyond the need to resist the urge to engage in the immediate thrill of practising one’s addiction of choice, gamblers must also be on guard against the impulse to solve problems quickly by means of winning money through gambling. They argue that GA’s entire culture of recovery cannot be understood without an appreciation of this facet. For example, they point out that even the Twelve Steps are worked at a slow pace for the purpose of teaching members to avoid trying to solve problems quickly (Ferentzy et al., 2006B). The study of GA's effectiveness is best described as a work-in-progress, with important advances identifying better research targets, but still haunted by gaps in available knowledge. When Brown began his studies, little observational work on GA had been done (Cromer, 1978; Livingston, 1971; Scodel, 1964), and both Cromer (1978) and Scodel (1964) delivered mainly interesting theoretical discussions and only brief empirical accounts of GA's workings. Preston and Smith (1985) claimed that AA is more effective with people with alcohol problems than GA is with gamblers, partly because AA's physical disease conception of an "allergy" to alcohol facilitates "re-labelling," thereby helping to deflect guilt and shame. While providing valuable insight into the importance of belief systems in mutual aid, Preston and Smith (1985) were nonetheless operating on the premise that the AA and GA programs were virtually identical. Later, Browne (1991, 1994) explored the differences between AA and GA. While this involved some discussion of GA "consciousness", such as the lesser importance attached to discussing one's feelings than in AA, little attention was paid to how much feelings are actually addressed in GA, because Browne's studies are, to a large extent, comparative. They are also more evaluative than descriptive, and contain (beyond criticisms already mentioned) a critical account of GA's version of its own history (Browne, 1994). Browne's work does contain some important descriptive material based on direct observation, but does not provide a detailed account of what transpires at GA meetings. Similar limitations apply to the account given by Turner and Saunders (1990) after a 1-year observational study. Critical of the medical model, these authors discussed the moral and emotional 12 implications of GA narratives and practises. They also mentioned GA's confrontational style as alienating to many newcomers (McCown & Chamberlain [2000] also described GA as more confrontational than AA, and Straus [2006] also discussed this matter). Still, Turner and Saunders (1990) discussed the narratives and practises primarily in terms of their negative implications rather than their actual content. It is possible to appreciate a commentary on the ways the medical model alienates those who do not conform to it, yet still question the validity of a critique that hinges largely upon the "ideal self" which is unattainable to most members (Turner and Saunders, 1990). The latter, after all, could be said of most spiritual and psycho-emotional endeavours. In any event, despite some significant descriptive observations, one is left mostly in the dark about how GA actually operates. Ferentzy et al. (2004, 2006A) argued that GA has become less confrontational than it once may have been. GA's own literature gives some vindication to Browne's (1991, 1994) contention that "GA consciousness" is pragmatic. The "Pressure Relief Group," for example, sets GA apart from substance use-oriented mutual aid societies, in that GA members take newcomers to talk over financial and other issues to help them “get honest” with their spouses and to get their affairs in order (Gamblers Anonymous National Service Office [GANSO], 1978). Browne (1991) discussed GA's "Page 17 consciousness", referring to a set of practical (rather than spiritual or psychological) principles found in GA's most important text (Gamblers Anonymous International Service Office [GAISO], 1999). However, Ferentzy et al. (2006A) argued that GA is now putting more emphasis on the Twelve Steps and life issues than it once did (though these authors agree that GA still puts less emphasis on these matters than AA or Narcotics Anonymous (NA), and that these changes are taking place slowly). Overall, the available literature does vindicate GA in other, less direct ways. GA's collective wisdom has demonstrated some scientific merit: the 20 Questions GA poses to assist gamblers in determining whether they need help has been found to compare favourably with other, professionally developed diagnostic instruments (Ursua & Uribelarrea, 1998). As well, commentators generally appreciate that GA provides social support that professionals could rarely imitate (Rugle & Rosenthal, 1994). Yet such endorsements of the mutual aid approach are not unique to GA, and stem partly from a growing awareness of the importance of social support in general (Gillian, Smith, Whitford, O’Shea, O’Kelly, & O’Dows, 2007; Helgeson & Cohen, 1996; Humphreys, 2004; Ilgen, McKellar, & Moos, 2007). Involvement in mutual aid has also been associated with better results with biological afflictions, such as breast cancer (Davison, Pennebacker, & Dickerson, 2000). Humphreys (2004) argued convincingly that, given their importance, mutual aid associations are understudied. In our previous study, we argued that little had been written about what, if anything, GA offers beyond peer support. Also, the literature has not adequately addressed whether GA's recovery program has merit in and of itself, and for which type of gambler (Ferentzy et al., 2004).

6.2 The Abstinence Principle

Ferentzy et al. (2004, 2006B) discussed the way GA takes abstinence perhaps even more seriously than similar Twelve Step fellowships, such as AA. They argue that GA members are doubly concerned, partly because there are, in principle, no limits to how much one can gamble (while there are physical tolerance limits to substance abuse), and also because GA members perceive themselves as particularly vulnerable to triggers. Hence, while AA leaves decisions pertaining to whether one may safely enter a bar up to the individual, GA admonishes members not to enter, or even to go near gambling establishments (GAISO, 1999). Many researchers perceive the abstinence principle in terms of its ideological function. While critics such as Turner and Saunders (1990) consider GA members' internalization of the medical model to be comparable to collective brainwashing, the designation "ideology" need not be derogatory. Rather than attacking or defending the belief in abstinence, some researchers prefer to study the ways in which the principle operates. The acceptance of abstinence by a person with an addiction has been viewed as 13 part of a larger belief system regarding the nature of, and solution to, the problem in question (Ferentzy et al., 2006B). Antze (1979) discussed the ways mutual aid depends upon mutual identification and the internalization of the group's belief system. Valverde (1998) claimed that abstinence in AA is not so much a tyranny over desires, but a pragmatic reconstruction of habits rooted in strands of twentieth- century philosophy, as well as ancient, pre-scientific wisdom. In their study of the Twelve Step-based (AA and NA) Minnesota Model, Keene and Rayner (1993) found the approach favoured those with compatible belief systems (e.g., agreement with the medical model and positive attitudes toward spirituality). They recommended clients be served by approaches and theories consistent with their own ways of thinking. There is some evidence for "cognitive profiles" and other characteristics applicable to many AA members (Ogborne & Glaser, 1981; Tonigan, Bogenschutz, & Miller, 2006), suggesting that similar work could be done on the personality and cognitive profiles of GA members: Are they field-dependent? Do they demonstrate authoritarian attitudes and an often accompanying need for simple, clear answers, such as abstinence? Work already done on AA members could help researchers in the gambling field move ahead more quickly than AA research pioneers were able to in this area.

6.3 GA in Conjunction with Other Interventions

Despite the range of opinions about GA's effectiveness and appropriate function, one would be hard-pressed to find critics claiming GA should have no place at all. GA's cost-effectiveness will ensure it continues to play a role, even if other approaches were found superior (Walker, 1993). More recent studies have been confirming this with respect to mutual aid in general (Humphreys & Moos, 2007). Also, GA has long been recognized as the most widely available option for problem gamblers on this continent (Viets & Miller, 1997). This may help to explain why many efforts have been made to demonstrate GA's compatibility with certain professional approaches. This is not to suggest that compatibility studies are simply self- serving. Often such studies are guided by a belief that cooperation should replace ideologically rooted competition (Toneatto, n.d.). Some have argued for the compatibility of GA with cognitive and cognitive-behavioural approaches (Problem and Compulsive Gambling Advanced Workshop, 1986; Toneatto, n.d.; Petry, 2005). Arguments have also been made regarding GA's compatibility with psychoanalytic methods (Maurer, 1982; Rosenthal & Rugle, 1994; Rugle & Rosenthal, 1994; Whitman-Raymond, 1988). Overall, compatibility studies have raised points worthy of further exploration. For example, denial has long been the main target of both addiction treatment and psychoanalysis. Cognitive therapy, while diverging with Twelve Step recovery in some respects, also involves deference to higher principles, and shares the disease model's emphasis on rooting out self- destructive thought patterns (Toneatto, n.d.). Overall, studies have suggested GA attendance in conjunction with professional therapy can yield positive outcomes (Petry, 2005). Lesieur and Blume (1991a), Russo, Taber, and Ramirez (1984), and Taber, McCormick, Russo, Adkins and Ramirez (1987) followed up with clients who had completed such combined programs and each found abstinence rates over 50% among clients contacted at various points after discharge. While agreeing that these results suggest GA in combination with professional therapy produces better results than GA alone, Petry (2002) claimed the studies contained methodological flaws: "One problem is therapy was not specifically described, so replication is not possible (p. 192)." Petry (2002) concluded that more work needs to be done in this area. Because some other mutual aid groups share a common grounding in the disease model and recovery architecture built on the Twelve Steps, GA's potential interaction with these groups emerges as an issue for consideration. Unfortunately, little work has been done on GA members who also attend AA, and NA has received even less attention, though Lesieur and Blume (1991a) discussed a treatment program that made use of client-specific combinations of GA, AA, and NA. Both Browne (1991) and Lesieur (1990) have mentioned that concurrent attendance at other mutual aid groups can have a positive effect on some gamblers. Ferentzy et al. (2006A) have also written to this effect. Lesieur 14 (1988), aware of the many issues that often accompany compulsive gambling, lamented the way most self-help societies discourage talk of multiple addictions, and even suggested that an anonymous fellowship be created for that purpose. Since researchers have argued that GA works best in conjunction with other interventions (Lesieur & Blume, 1991a; Rosenthal, 1992; Petry, 2002, 2005), since most treatment programs make use of GA, and since some researchers (Browne, 1991, 1994; Lesieur, 1990) have criticized GA’s lack of attention to emotional issues, the ways in which GA attendance interacts with other approaches presents itself as a research priority.

6.4 GA and Gender

GA has been described as a predominantly male fellowship, both in composition and attitude (Mark & Lesieur, 1992; Ferentzy et al., 2003-2004). Research on GA has, perhaps unintentionally, reflected this bias, as little work has been done on female GA members. Twenty years ago, Custer (1982a) reported that only about 4% of GA members were women. A decade later, Strachan and Custer (1993) noted that, at least in Las Vegas, more than half of GA members were women. While available information is probably dated, there is enough in the literature to suggest GA remains predominantly male, but the number of women is increasing. Ferentzy et al. (2003-2004) reported that in the Toronto area, the percentage of women in GA stands at about 20% and is rising. This is partly due to demographics. While most pathological gamblers have traditionally been male, the number of female pathological gamblers has been growing (McAleavy, 1995; Spunt, Dupont, Lesieur, Liberty, & Hunt 1998; Volberg, 1994). Further, an increasing sensitivity within GA to the concerns of women has been noted (Murray, 2001; Ferentzy et al., 2003-2004). While GA plays a major role in the treatment of problem gambling, its approach to gender issues has been identified as especially significant. Since many (possibly a majority) of clients are referred to gambling treatment through GA, it has been argued that GA's alienation of women has inhibited women's participation in formal gambling treatment as well (Spunt et al., 1998; Volberg & Steadman, 1989; Volberg, 1994). Browne (1991, 1994) suggested that GA's neglect of spirituality and interpersonal and psycho- emotional issues inhibits women's involvement. Lesieur (1988) argued that the opportunity to discuss a host of compulsions (rather than merely the targeted addiction) is important to women. Since then, studies have confirmed these suspicions. Crisp et al. (2000) found that male gamblers were more likely to report external concerns (e.g., employment, legal) as important whereas women reported more concerns with physical and interpersonal issues. These results suggest women may require more supportive counselling and psychotherapy whereas men seek information-sharing and cognitive restructuring. Ferentzy et al. (2003-2004, 2004) have confirmed these findings. Hraba and Lee (1996) found that whereas alcohol was more likely to trigger problem gambling in men, women were more influenced by social issues, such as estrangement from conventional lifestyles and immersion in social settings that involve gambling. While one can argue that GA's effectiveness is limited to clients without "special needs" (Rosenthal, 1992), to whatever extent women's needs are considered special is simply a measure of their exclusion. Differences have been noted between male and female GA members. Getty et al. (2000) found that women in GA have higher rates of depression than men. In a study of women from GA, Lesieur and Blume (1991b) found women less likely to have begun gambling for the thrill; instead, they were seeking ways to escape problems in their lives. Mark and Lesieur (1992), critical of GA as male dominated, argued that its tendency to produce a "men's club atmosphere" (p. 1) should be taken into account by researchers. They suggest, for example, that war stories (graphic and often disturbing recollections of one’s addictive career), usually shared by male GA members, may alienate women. This suggestion is clearly indebted to our experience with the treatment of other addictions. Many drug treatment settings, along with a number of NA and AA groups, have long discouraged war stories, "drunk-alogues", and the like - at least in 15 part because of how they affect women. Ferentzy et al. (2003-2004) support the observations of Mark and Lesieur (1992) regarding gender based differences in responses to war stories, yet found that such monologues no longer dominate as they once did, likely due in part to the influence of women. Ferentzy et al. (2003-2004) also reported that, while still concerned with a “men’s club atmosphere”, many women in GA claim the situation is improving. GA has a history of acknowledging women's needs in at least one respect. GA's recovery culture reflects the template that originated with AA through the emergence GamAnon, a support fellowship for spouses, family members, and other individuals whose lives have been negatively affected by someone with gambling problems. A review of the GA meeting list for Ontario indicates these groups typically meet at the same times and locations as GA groups. This format of double meetings suggests that GA and GamAnon might be more interdependent than similar mutual aid groups in other domains. On a related note, male AA members whose wives attend Al-Anon have demonstrated superior abstinence rates (Humphreys, 2004), Female gamblers who attend GA have received significantly less attention than female members of GamAnon, which deals with (predominantly female) spouses or partners of GA members (Adkins, 1988; Bellringer, 1999; Canadian Foundation of Compulsive Gambling [Ontario], 1996; Ciarrocchi & Reinert, 1993; Heineman, 1987, 1992; Lorenz & Yaffee, 1985, 1986, 1988, 1989; Maurer, 1985; Moody, 1990; Steinberg, 1993; Zion, Tracy, & Abell, 1991). As it stands, from a research perspective, women have received more attention as wives and partners of GA members than as GA members themselves.

7. Research Design/Methodology

7.1 Research Questions

This study was designed to address the following questions. We should note, however, that its open-ended methodology allowed us to pursue additional unanticipated questions that arose as we began to gather data. 1. What are the common features that best describe GA’s approach to recovery? The study looked closely at the ways members work the Twelve Steps, and other aspects of the GA program in an effort to identify features that seem to be inherent to practically all successful recoveries in GA. In this respect, it built upon the results of our previous study, which identified some general features of GA’s approach to recovery without examining them in detail. 2. Which of these features are uniformly valued by members? Which are sources of controversy? For example, while patience is a virtue often emphasized in GA, some members feel this emphasis can encourage procrastination and sabotage recovery by delaying important steps. Not getting to the Twelve Steps, or Pressure Relief, soon enough presented themselves as areas of concern. In addition to identifying the core features of GA most members see as essential, our study sheds light on some of these contested aspects of the program. 3. How can we characterize the most important approaches members take to working the GA program and the Twelve Steps in particular? How do these approaches differ? 4. To what extent do different ways of engaging with GA reflect prior differences in subject characteristics? This aspect of the study examines the idea that differences in background may explain some differences in the ways members work the Twelve Steps and the overall GA program. While gender would be an obvious area for scrutiny, we also considered the role of age, severity of gambling problem, types of gambling pursued, comorbidity, debt-load, and outside support, both informal and professional. 5. What relationship, if any, can be found between client characteristics and modes of engagement with GA on the one hand, and recovery outcomes on the other? This was the most ambitious and inherently difficult question posed by our study, and here we had few illusions about 16 finding definitive answers. The aim at this stage was rather a heuristic one: to determine which hypotheses are most plausibly supported by our data. We must emphasize this study made no claim to assess “outcome” in the strong sense of the word. We were, however, interested in the relationship between client characteristics, ways of working the program, and self-reports regarding success in abstinence and current life-satisfaction.

7.2 Overview of Methodology

This was a qualitative study that drew most of its data from open-structured interviews with GA members, based on a protocol that was refined as the study developed. Analysis of the data sought to identify general patterns in the ways members engage in the Program and its Twelve Steps, as well as significant differences. We attempted to correlate some of these differences with specific background characteristics of GA members and with differences in self-reported outcomes.

7.3 Individual Interviews

While we planned to (and did) conduct 40 interviews, the more substantive goal of interviewing to saturation governed our efforts. Every effort was made to ensure that women were properly represented. Remuneration was given to volunteers. With participants’ written consent, the interviews were audio taped.

7.4 Sample Recruitment

As a result of our previous study, we had extensive GA contacts in Toronto and elsewhere in Southern Ontario. Most of those interviewed in our first study indicated a willingness to be interviewed again, and others had also indicated a willingness to participate. We began with close to 50 potential informants – a substantial base that was expanded through word-of-mouth referrals. Participants were also chosen according to theoretical sampling guidelines (Glaser, 1978). We began with more experienced members in order to learn as much as possible about GA’s core ideas and practises before moving to a more representative sample; in doing so, we tried to ensure that a wide range of demographic and situational factors were represented. Toward the end of the study, a number of participants were chosen for background characteristics or approaches to recovery deemed to warrant special scrutiny. The interviews were conducted in a fashion designed to facilitate the free emergence of participants' own ideas within a semi-structured format.

7.5 Interview Protocol Development

Our interview protocol consisted of three parts, corresponding to the three fields of information bearing on our study: 1. Participants’ background characteristics, 2. Participants’ experience in applying the Twelve Steps and GA’s program more generally, and 3. Participants’ self- reports of current success in abstinence and overall life satisfaction. An initial draft of this protocol is presented in Appendix A. However, we made significant changes to this during the course of protocol development as a result of testing and consultations with other experts in the field, as well as with GA members. The final version is presented in Appendix B. Severity of gambling problems and types of games pursued were covered by the Canadian Problem Gambling Index which was given to all participants. Subjects also filled out a brief paper-and- pencil survey covering such demographic characteristics as gender, age, ethnicity, religious background, education, form of employment, current income, marital status, and number of children.

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7.6 Ethical Approval

The research proposal was submitted to the Ethics Committee of CAMH and the University of Toronto, and approved on March 17, 2005.

8. Research Sample

Forty semi-structured interviews were conducted with 39 participants. Twenty-six participants were men, thirteen were women. The average age was 56.5 years, with a range of 35-80 years. About half of participants were married (n = 20), and 11 were divorced (9 men, 2 women). One man and 2 women were separated, 2 women were windows, and 2 men described themselves as single. Seven participants reported they were childless, and 32 reported being parents. For women, the average was 1.3 children, with a range of 0-2, and for the men the average was 2, with a range of 0- 5. Reported income ranged from $0 to 220,000, with an average of $60.7. This domain presents the most striking difference between men and women in the sample. Men reported an average income of $82,700 (range: $12,000 - 220,000), and women reported an average income of $25,600 (range: $0 - 50,000). Half (n = 21) of our sample reported no other 12-Step involvement. Of the other 18 who did, 3 reported two other affiliations. Six reported involvement with Overeaters Anonymous (OA). AA was identified by six participants. Two participants mentioned NA. One respondent each mentioned AlAnon, Adult Children of Alcoholics (ACA), All Addictions Anonymous (AAA), Synanon, or Codependents Anonymous (CODA). By region, 13 lived in the Toronto area, 6 in other Ontario communities, 2 in other Canadian provinces, and 18 in the United States. It should be noted an effort was not made to probe, but to allow respondents to answer demographic questions in their own way. This led to difficulties in organizing responses to occupation, ethnicity, and education. More than half participants (n = 22) indicated no religion, while 5 indicated Judaism, 1 Islam, and 11 Christianity (1 Anglican, 4 Christian, 2 Protestant, and 4 Roman Catholic). Ethnically, the sample was diverse, although hard to characterize. The majority (n = 23) identified themselves as European in various ways (e.g., Caucasian, Norwegian, Irish, French, English, and Italian). Eleven said they were Jewish. One identified as Jamaican, another as East African. Two identified as Canadian, another as white. Eleven participants reported having a high school education. The remainder reported education beyond that level, with 7 reporting bachelor degrees, 3 Master level degrees, and one doctoral degree. CPGI scores for the sample averaged 19.2 (men: 18.6; women: 20.1). The range was 7-26.

9. Findings from Previous Study (EMAP)

The current study was essentially a continuation of a previous, 16-month (i.e., Feb 2003 - May 2004) inquiry into the nature of GA. The original study (EMAP) was ethnographic in orientation, involving interviews with GA members and participant observation at GA meetings. The goal was to generate the most empirically grounded account of GA’s recovery culture to date. Prior to engaging in that endeavour, two of us (Ferentzy and Skinner) compiled an annotated bibliography comprising 18 literature dealing with GA, mutual aid, and co-occurring substance abuse problems. With extensive knowledge of what had been written about GA at the time, EMAP was founded upon two key premises: first, GA is an influential movement (and, in fact, a standard adjunct to many gambling treatment programs in North America). Second, the actual functioning of GA – how it works, how it affects the lives of members – was still poorly understood (Ferentzy et al., 2004). We had found no consensus on whether GA was appropriate for the most or the least troubled problem gamblers, whether it was the most or the least effective of approaches, or even whether the agreed upon benefits stemmed solely from group support rather than the GA program itself. Our study was meant to describe rather than evaluate GA, with a specific focus upon whom it may help and in what way.

9.1 Overview

Some of the most notable findings involved the ways GA differs from other Twelve Step fellowships, notably AA and NA. We learned that GA members tend to view pathological gambling as an overwhelming addiction, and that even longstanding members consider themselves vulnerable. AA, for example, does not tell its members whether they can enter bars safely, whereas GA makes it clear that one should not enter – or even go near – a gambling establishment. Many GA members will not associate with people who gamble, even if the gambling is merely recreational. We learned that GA’s culture of recovery is unique among Twelve Step fellowships, partly because pathological gamblers are perhaps unique among addicts in that beyond the quick fix provided by one’s substance or activity of choice, gamblers must be on guard against another quick fix: the real possibility of huge winnings that could, conceivably, solve many problems immediately. For a gambler, any urge to solve problems quickly can conceivably lead to relapse. For this and other reasons specific to gambling, GA’s overall culture of recovery seems to be geared towards teaching patience to its members. While the latter is emphasized in other Twelve Step fellowships, it is pronounced more strongly in GA. For example, GA members tend to go through the Twelve Step process at a slower pace on average than their AA and NA counterparts. It is possible (with caution) to view the Twelve Steps of GA as an exercise in learning patience. We found that GA, long known to be more secular in orientation than AA, NA, and many other Twelve Step fellowships, has at least some good cause to have evolved in this way. Anything associated with the mystical can be reminiscent of the mystification endemic to a problem gambler’s mindset with respect to odds, hunches, and good luck charms. Further, the type of quick conversion experience often mentioned in AA’s Big Book is far too similar to a quick solution – akin to winning fast money – and in some ways the opposite of what recovery in GA seems to be. GA’s Twelve Steps do not mention a “spiritual awakening”. There may be other reasons for GA’s aversion to religious proselytizing, but from the perspective of recovery, this may be the most important. While many GA members seem to experience legitimate spiritual awakenings, and GA is keen to emphasize the importance of spirituality while insisting that this need not involve a deity, they tend to occur at a slow and measured pace.

9.2A Recent Changes within GA

We found that GA had about 21 weekly meetings in the Greater Toronto Area (GTA), and approximately 22 more in the rest of Ontario. Exact numbers could not be given because meetings can close down while new ones are formed. Overall, though, the fellowship seemed to be growing: a 2001 meeting list identified only 17 meetings in the GTA. Over the last 15 years (since the bulk of available literature on GA was published), GA has experienced dramatic changes. Described by the research community as an almost exclusively male domain, at the time of the EMAP study GA’s female membership in the GTA was at 20% and rising. Long considered a Twelve Step fellowship in name only – with members focusing primarily on abstinence and debts with little regard for the Twelve Step process – GA was fast becoming more 19 spiritual, with a greater emphasis on the Twelve Steps and a range of psycho-emotional issues. One might even suggest that a process of “feminization” had taken place: most women we interviewed insisted that their influence helped to increase awareness of a broader conception of recovery.

9.2B GA as it Once Was (as described by the research community and long-time GA members) i. Not Twelve Step Focused The Twelve Steps involve spirituality, and GA has long been very guarded about its status as a secular organization. While this has served to prevent conflicts over religious matters often experienced in AA and NA, GA has been said to lack precisely the spiritual foundation that many AA and NA members consider essential to the contentment accompanying their sobriety. Conversely, in GA there has been a pragmatic focus on abstinence from gambling, as well as debts and legal matters. One commentator, Basil Brown, said that as opposed to Twelve Step Consciousness, most GA members have what could be called “Page 17 Consciousness” (Browne, 1991, 1994). ii. Page 17 The last, and probably most important page in GA’s main text (GAISO, 1999), is a list of dos and don’ts for gamblers to follow (e.g., attend meetings regularly and don’t go in or near gambling establishments). Page 17 reflects GA’s no-nonsense approach to recovery. It is a summary of an already brief Combo Book. Whereas AA uses its so-called Big Book (AAWS, 1974), and other fellowships, such as NA, employ lengthy texts as well, recovery in GA revolves around a 17-page pamphlet. GA members have told us that, until quite recently, much of the recovery in GA could almost be reduced to members telling their stories, abstaining from gambling, and following the instructions on Page 17. iii. Not Dealing with Feelings and Life Issues These first two points tie into one another: GA has earned a reputation for not being keen on discussions of one’s feelings or of life-issues in general, and stories told revolved almost exclusively around gambling. According to one long-time member (a resident of Florida):

When I first came to GA and attended meetings in ‘68, if you dared talk about anything other than gambling or war stories, there was a knock on the table. And they would say, ‘Sorry’. You could never, ever say my life is better, my kid is born and I when out to the circus with him. You weren’t allowed to do that in those days. (Interview #32)

For this reason, critics consider GA less effective as an overall therapy than AA, which traditionally has put more emphasis on the whole self (personality, emotions) as the proper target of recovery. Commentators have also suggested that the absence of “inner-directed” therapy has served to alienate many women. Our own interviews give much support to this observation. iv. Male Dominated GA has been criticized in the literature as maintaining a boys’ club atmosphere, and has traditionally been an almost exclusively male domain. In fact, the characteristics mentioned so far – not discussing one’s feelings, a single minded focus on a few clear goals (e.g., abstinence) – could be viewed as stereotypically masculine in orientation. v. War Stories A good example of what may be called a hyper-masculine recovery culture is the preponderance of so-called war stories. Essentially, such stories involve the retelling of one’s addictive 20 career – often with an emphasis on the disturbing and the tragic – in order to impress upon the audience the devastating consequences of active addiction. War stories, while possibly therapeutic for the speaker and obviously a good means to warn others away from gambling, can be seen as a tough-love approach: members, especially new members, are kept in line through fear. While few would suggest that such tales are unimportant, a preoccupation with these stories for the most part precludes discussions of positive emotions associated with healthy recovery, with the latter representing a gentler, and perhaps kinder, approach. Our communications with GA members have confirmed that up until quite recently monologues at GA meetings were primarily (and in some cases, exclusively) war stories. Again, commentators have suggested that these stories can alienate many women, and our own interviews also provide some confirmation for this observation. vi. Confrontational Approach Lastly, GA has been identified in the literature as host to a confrontational recovery culture. One member recounts:

When I came to GA I was 30 years old…one of the first people I saw, he grabbed me up by the neck and pulled me about two inches off the ground. And here’s what he said to me at the end of the meeting: ‘Kid, you’re two f---ing young. You didn’t suffer enough. You’ll never make this program. (Interview #32)

Our own findings indicate that, at least in the GTA, GA never practised confrontation to such extremes (the quote above is from a resident of Florida). For the most part, it would seem that a culture of politeness governed GA in the GTA. Still, it is safe to say that GA in this area favoured curt communication, did not involve discussions of life issues at meetings, and the “rooms” were not as keen on sensitivity as they are today.

9.2C GA Today i. More Focused on the Twelve Steps We found that a strong majority of GA members in the GTA now insist the Twelve Steps are crucial to healthy recovery. Interviews and informal communications suggest this change seems to have taken place throughout North America. Abstinence from gambling is no longer enough. The Twelve Steps are seen as a way to change your personality, make you a better person, and render abstinence from gambling enjoyable rather than a burden. While still ardently secular, GA puts more emphasis on spirituality than it once did. Spirituality is often described as involving traits such as kindness, tolerance, and generosity. At least three GA meetings devoted entirely to the Twelve Steps have been formed in the GTA – and once more, interviews and informal communications with GA members suggest the number of Step Meetings has been increasing throughout North America. ii. Page 17 – What it Means Today While Page 17 is definitely a set of practical principles, it does, for example, mention the Twelve Steps. The difference now is that more members are paying attention to this aspect of Page 17. The theme of patience is one way to understand the significance of Page 17. “Don’t try to solve all your problems at once” (GAISO, 1999) is taken from Page 17, and is preceded by an old recovery slogan in bold upper case letters: “ONE DAY AT A TIME”. Further down the page, another admonition receives an exclamation mark: “be patient!” Patience is key to a gambler’s recovery. To start, many gamblers come to GA deeply in debt and may spend well over 10 years paying off creditors. GA prepares new members for such realities with an emphasis on patience. Further, gamblers are perhaps unique among addicts in that beyond the quick fix provided by one’s substance or activity 21 of choice, gamblers must be on guard against another quick fix, namely, the possibility of huge winnings that could conceivably solve many problems immediately. The urge to solve problems quickly can easily lead to relapse. GA’s entire culture of recovery seems to have been geared towards patience. So while Page 17 is indeed a practical guide to recovery in GA, it also reflects an entire philosophy of recovery, and is not as shallow as Brown (1991, 1994) seemed to suggest. Recovery in GA today could, with caution, be viewed as a complex interaction between the Twelve Steps and Page 17. Of course, there is more to it, and this is addressed in the Interpretations segment. iii. Life Issues Not only are life-issues discussed at meetings, today most meetings begin with a “How was your week?” segment. Essentially, members are asked to tell the group how their week went, or to discuss whatever may be on their minds (or in their hearts). While such discussions were suppressed in the past, they are now not only encouraged, but given formal sanction. However, a small minority still feel that talk at meetings should be restricted to gambling-related issues. iv. Greater Involvement of Women While an almost exclusively male domain 15 years ago, women in the GTA now represent as much as 20% of GA’s overall membership. GA seems to have taken measures to better accommodate women, and relationships between the genders seems very amicable. Still, some women complain about the preponderance of a “boys club” atmosphere. Also, overall, men and women tend to perceive gender issues quite differently (see 9.9 ii, below). While things are improving for women in GA, most members (both male and female) agree that overall women are more likely than men to drop out. v. War Stories War stories no longer dominate as they once did, though they are still told and appreciated by many – especially newcomers who need to hear such horror stories in order to enhance their resolve to quit gambling for good. Consistent with suggestions in the literature, men tend to perceive war stories in a more positive light than women. vi. Beyond Confrontation As mentioned previously, it is questionable whether GA in the GTA was ever very confrontational. Interviews and informal communications have led us to conclude that GA has been very confrontational in other regions, and is still in some regions. However, across the continent GA seems to be moving away from a confrontational culture of recovery.

9.3 The GA Meeting

While formats vary, a typical GA meeting starts with members taking turns reading from the “Combo Book” (GAISO, 1999), which is really a pamphlet (9 by 14cm) and only 17 pages long. Though GA does have a larger text (comparable to AA’s Big Book) called Sharing Recovery Through Gamblers Anonymous (GAISO, 1984), it is rarely used or even mentioned. Less textual in orientation than AA or NA, GA must put greater emphasis on its oral culture. However, the Combo Book is a masterly exercise in concision, and thereby reflects GA’s traditional no-nonsense approach to recovery. As mentioned, GA has tended to take what could be called a very pragmatic approach. The last, and possibly most important, page in the text, Page 17, can be viewed as a summary of the Book – another exercise in concision. Our interaction with GA members revealed some consensus on one point: gamblers are an impatient lot, and GA’s main text might reflect this. However, the Combo Book addresses psycho-emotional issues, and more recently GA has been doing justice to this end of its 22 program. Normally, the readings are followed by the “How was your week?” segment. If newcomers are present, they may be asked GA’s 20 Questions (a diagnostic tool designed to determine whether someone is a compulsive gambler) or asked simply to read the questions and think about them during and after the meeting. If several newcomers are present, and especially if many ask for feedback, such interaction may dominate the rest of the meeting. Usually, however, the Chair will propose a topic, with themes such as regaining one’s family’s trust, abstinence, a particular step, or helping newcomers. Members will share on the given topic, or something else if they choose, for the duration of the meeting. At “Step Meetings”, the focus is on the Twelve Steps, with the group remaining on a single step for possibly a month or longer. At these meetings, the “How was your week?” segment may or may not be in the format, and newcomers (while welcome) are told respectfully that their recovery should begin at a regular GA meeting (partly because the 20 Questions are central to a new member’s initiation). As with other Twelve Step fellowships, in GA members give their first names and acknowledge their addiction before speaking; however, there is a difference. In AA or NA, a member might simply say, “My name is Sue and I’m an alcoholic/addict”. In GA, one is more likely to hear: “My name is George, and I fully admit and accept the fact that I’m a compulsive gambler.” The admission is more adamant. Further, in GA the identification will usually be followed by an account of one’s time abstinent (which is rare in AA and NA). Despite recent changes, GA still puts more emphasis on pure abstinence than many other Twelve Step fellowships.

9.4 Reasons for Leaving GA

Only by attending many closed meetings could we have observed for ourselves the traits associated with dropping out of GA after a brief stay. Most of the information we have comes from members themselves. Such reports are clearly suspect given that GA ideology states that GA is appropriate for all compulsive gamblers. Members have told us that some gamblers are simply not ready - the idea being they have not hit, in Twelve Step jargon, their “bottom”. Only after one has suffered enough will there be willingness to face the problem and address it. Some gamblers were described as looking for excuses (which they inevitably find). Others were said to have received financial bailouts – something GA warns against emphatically – and then perceive their problem as being solved. GA emphasizes in very strong terms that people have a gambling problem and not a money problem. Therefore, those who perceive their problem as primarily financial would, in most cases, either change their view or eventually leave GA, with or without a bailout, simply because they did not identify with the GA program. Women were said to leave more readily than men, but most members (male and female) were unwilling to blame sexism, a “boys club”, or things of that nature. We found, though, that most successful GA members seemed to have strong family support for their recovery. War stories are another possible reason for leaving GA. Graphic tales may cause some members to think that since their misfortunes were not so extreme, they do not need help or are not true compulsive gamblers. Money can also be an issue, especially for women. On average, male GA members bet larger amounts, and we have been told that some men undermine the seriousness of smaller bets (even in cases where these bets were made by someone with less money at their disposal). For this reason, there is a strong tendency in GA to emphasize that the amount of money gambled is relative and not an absolute indicator of the seriousness of someone’s gambling problem. Another stated reason for dropping out was that many new members “can’t seem to get to the steps, the Twelve Steps of recovery, fast enough” (Interview #5). The idea is that without the emotional growth brought about by embarking on the Twelve Steps, the problems associated with early recovery from gambling are overwhelming. This may represent a dilemma in GA’s approach to recovery: the 23 emphasis on taking one’s time, while well intentioned, can at times be conducive to unhealthy procrastination. In GA, finding a balance along these lines seems to be an ongoing struggle. Along similar lines, we have been told that Pressure Relief (see 9.5 below) often comes too late, making it hard for newer members to deal in a measured fashion with their gambling-related financial difficulties (Interview #32). Again, GA’s emphasis on moving slowly towards recovery, while certainly understandable, may have some drawbacks.

9.5 Pressure Relief

A Pressure Relief Group meeting is often held for newer members (though old-timers sometimes make use of this service). Experienced GA members, some of whom may be accountants or lawyers, will help new members and their spouse formulate strategies for paying off debts, dealing with legal matters, and other related issues. We found that currently few Pressure Relief sessions are held in the GTA. Some GA members do not know why this is. Two members told us a few of the individuals on the Pressure Relief Committee are too controlling and intolerant. We have cause to believe that Pressure Relief is practised less in other regions as well. Another GA member said younger people today are less willing to share their financial information. We also speculate the system was designed for traditional couples, and has yet to adjust to situations where the gambler is not the sole, or even the major, breadwinner, and where the spouse may be less dependent (for more on this topic, see section 10).

9.6 How New Members Are Perceived

Many new members enter GA believing the fellowship might actually pay their debts. Perhaps with good reason, GA members perceive the newer members as “sick” and troubled souls, with huge egos and outrageous feelings of entitlement. New members are also said to express outrage at not being trusted by their spouses after a week of abstinence from gambling, despite having pursued the destructive behaviour for many years. Many GA members told us they were also in this state of mind when they were new to the program, and one told us he would not have remained if not for his mistaken belief that GA would eventually pay his debts (we found several more claiming to have been in this state of mind; see section 10). New members are also perceived as impatient – a huge obstacle to recovery in GA. Therefore, patience is one of the first things new members are taught. Often, experienced members make a comparison with AA, referring to a myth that seems common in GA: it is said that in AA newcomers are told to “shut up and listen” (i.e., they are told not to speak at meetings). Conversely, it is said that in GA a new member could be chairing a meeting or functioning as treasurer within 2 weeks. In fact, in AA newer members usually need 90 days of abstinence before playing the role of speaker at a meeting, but can certainly share at meetings where members take turns talking. Further, it is unlikely that a new GA member could function as treasurer (though we have heard of one case where a recently relapsed member served in this capacity).There is a 6 month abstinence requirement by which most groups (but not all) abide, so the story is meant to emphasize the way gamblers have huge egos and want to control things – the latter, of course, is said to apply even more to those yet to embark upon recovery. In GA, control issues among members are often discussed, with newcomers often serving as favourite targets.

9.7 Spiritual Awakening/Conversion

GA puts less emphasis on the spiritual awakening than other fellowships, such as AA and NA. GA’s Step 2, for example, speaks of a restoration to a “normal way of thinking and living” (GAISO, 1999), rather than a “restoration to sanity”, as is the case with other Twelve Step fellowships. In GA, 24 Step 2 is less melodramatic. GA’s Step Twelve speaks of carrying the GA message to other gamblers, but unlike AA and NA, there is no mention of a “spiritual awakening”.

9.8 Bankruptcy

GA officially frowns on bankruptcy, since “bailouts” of any kind are considered harmful to recovery. Nonetheless, more and more members are opting for bankruptcy. Many, though, are unable to exercise this option for a host of legal reasons, and many owe money to family and friends and sincerely want to make amends. There are those, as well, who are indebted to underground elements and do not have this option.

9.9 Recent Changes in GA: Causes and Implications i. Influence of AA Members: Twelve Step Consciousness Even back when GA was not as focused on the Twelve Steps, commentators pointed out that an appreciation for the Twelve Steps could be found among members with experience in other Twelve Step fellowships (Brown, 1991; Lesieur.1990). The difference now is that such members seem to have had a larger impact. We heard of one member who claimed GA – and its spiritually deficient recovery culture – drove him to drink. He therefore went to AA, found the Steps, and brought them back to GA (Field Notes). At first, there was some conflict over this. It is said, for example, that some members would mock the process by taking steps up and down a staircase, and making derisively humorous comments about the “Steps” while doing so. Still, it would seem the “Steppers” have won out. There is reason to believe that GA will continue to head in a similar direction, putting greater emphasis on the Twelve Steps with each passing year. ii. Influence of Women

As the women came in and they brought a sense of sensitivity to the rooms – there’s some guys that were sensitive, and this allowed them to come out a little bit more, you know? (female member, Interview #4)

In the conferences and things like that I find more women taking leadership role, in running events. And nurturing events – always making sure there’s food there and things like that. So I think it has added a bit of a feminine touch. I think sometimes things are a little more emotional in the meetings, which is also very good. (female member, Interview #17)

Have women added a “feminine touch”? Most women interviewed seem to think so. Most women insisted their influence had the effect of bringing more sensitivity, awareness of feelings, and a broader conception of recovery to GA. One woman (Interview #2) said the “How was your week?” section, now at the start of most meetings, was first introduced by women. Another woman, more experienced and far more knowledgeable about GA, said this was untrue (Interview #4). It could be that women may sometimes exaggerate the impact they have had. Further, women interviewed stated the atmosphere – levels of acceptance, types of issues discussed, and ways issues are discussed – has become more accommodating to women. Still, women mention the preponderance of a “boys club”. The difference in perception is notable. For example, women interviewed stated that the increased participation of women had brought more awareness of feelings into the rooms of recovery, and “life-issues” (issues not directly related to gambling) were now more commonly discussed by men, as well as women, due to greater female influence. Conversely, with one exception, male members interviewed were unable to identify any serious effect the increased number of women has had on GA’s culture of recovery. 25 The above results apply to open-ended questions about the influence of women. When asked directly about whether women have helped to bring more talk of feelings and life issues into the rooms, male members were inclined to grant this as possible or even likely. Without prodding, however, only one male member said so. The men may mention that men are now inclined to watch their language, or at least to apologize after using a profanity. They may even be sensitive to the fact that many women may not wish to discuss some things in front of men, such as having engaged in prostitution to support their gambling. For this reason, some men suggested that meetings for women only should be formed. (In fact, at least one women only meeting was formed in the GTA, but it was poorly attended and eventually closed down.) Beyond such observations, men had little to say about the influence women have had on GA’s recovery culture. Therefore, while the relations between the sexes tend to be highly amicable, there seem to be some differences in how these relations are perceived. The men we have interviewed talked about the women as kindred spirits – fellow problem gamblers who in this respect are no different – while the women were likely to qualify this association with issues they consider specific to gender. The men at times took a defensive posture when responding to questions pertaining to the influence of women. The idea they often conveyed was that there is nothing wrong with having women in GA. Some men still seemed to think the presence of women required justification, which in turn suggests some men are uncomfortable with women being at the meetings. According to one male member,

And when the women came in, they made the room a very comfortable place to share and talk about gambling issues. I don’t think they lessen the group at all. And I think that the group is doing well. (Interview #6)

Issues pertaining to gender seemed to matter more to women than to men. An interview with a male member, very active in every aspect of the program and among the most knowledgeable in the GTA, produced this insight:

PI: Are issues related to gender often discussed? #16: Only by a female. PI: I see. #16: I mean that I recall. (Interview #28)

There is good reason to believe women have had an influence along the lines they claim, even if some may be inclined to exaggerate the extent. First, when asked directly, even the men were inclined to agree. Also, changes to GA’s recovery culture seem to have taken place at about the same time more women began to attend. Also, there is the simple fact that many of the changes are consistent with the needs of women. As discussed in the Literature Review:

Browne (1991, 1994) suggested that GA's neglect of spirituality and interpersonal and psycho-emotional issues inhibits women's involvement. Lesieur (1988) argued that the opportunity to discuss a host of compulsions (rather than merely the targeted addiction) is important to women. Since then, studies have confirmed these suspicions. Crisp et al. (2000) found male gamblers were more likely to report external concerns (e.g., employment, legal) as important whereas women reported more concerns with physical and interpersonal issues. These results suggest that women may require more supportive counselling and psychotherapy whereas men seek information-sharing and cognitive restructuring. Ferentzy et al. (2003-2004, 2004) have confirmed these findings.

Our interviews with women in GA have given some confirmation to these generalizations about gender. The many recent changes in GA’s recovery culture could have been tailor made for the 26 accommodation of women. This is not to suggest these changes are due solely to the influence of women. For example, The Twelve Steps on their own entail a broader conception of recovery, and we have found no evidence to suggest men are any less active than women in bringing Twelve Step awareness to GA. Further, some of the changes are consistent with cultural trends throughout North America. It is now far more acceptable for men to discuss their feelings, admit weaknesses, and even cry (see iii, below). Women have also had an impact on the way different forms of gambling are perceived. There is a strong tendency in GA to emphasize that any form of gambling is legitimately worthy of GA’s attention. Bingo, for example, played mainly by women, is not perceived as serious by some (mostly male) card players or horse betters. Due to constant reinforcement of GA principles, this attitude is changing. However, old habits die hard, as explained by one woman:

Even though I am a woman, I’m sort of more accepted by the men in the room because the gambling that I did was more of what used to be termed the “male” gambling. I played craps and card games and that. I wasn’t, you know, what they refer to a women’s games. (Interview #19)

The amount of money bet is also an issue. Clearly, the implication of the amount one bets is relative to how much one can afford. This is emphasized constantly at meetings, suggesting a lack of awareness among some members. While the latter is often directed at newcomers, it might not explain everything. Interviews have confirmed that war stories are sometimes delivered in a competitive fashion, not only in terms of tragedy but in dollar figures. As women in GA are far less likely to have been high stake gamblers, they are often made to feel less significant or deserving to be at GA. This usually happens without intent, but not always. Hence, many GA members, male and female, emphasize that the amount bet is not, on its own, an indicator of compulsion, as amounts must be measured against a gambler’s situation (i.e., what they can afford). The presence of women has probably had an important effect with regards to this aspect of problem gambling. There now seems to be a more general awareness of this aspect. Lastly, war stories resonate differently among various members and gender is a key determinant. Some consider the retelling of tragic tales an excellent means to remind members why they should not gamble, and many consider the telling of their own stories to be therapeutic and necessary. Some, however, tire of the repetition, while others even consider the preoccupation with such tales as a means of staying in the past, avoiding the present, and circumventing emotional and spiritual growth. Responses to the question, “How do you feel about war stories?” were divided into four categories: 1. positive, 2. positive with qualification, 3. negative with qualification, 4. negative. Of the 12 men asked this question, 9 fell into the first category, 3 into the second, and none into the third and fourth. Of the seven women asked this question, only one fell into the first category, three into the second, one into the third, and two into the fourth. Our finding is consistent with that of Mark and Lesieur (1992) who noted that war stories can alienate women. Clearly, female GA members tend to relate to their past addictive episodes, and those of others, differently than men. Overall, the trend in GA seems to be vindicating the women’s perspective on this question, as all longstanding members we asked agreed that war stories are far less frequent than 10-15 years ago. Some meetings explicitly discourage war stories, not so much because they shouldn’t have a place, but because they are now perceived as the type of monologue that should occur only once in a while. So even the “positive” endorsement given by many male members has to be taken in the current context: these stories are appreciated today as a subset of GA discourse and not, like before, as the mainstay. Given that this change is consistent with the sensibilities of many women in GA, and, as mentioned, that the timing of the change seems to have coincided with the increase in female participation, it is safe to assume that women must have had at least some influence.

27 iii. Cultural Changes Throughout North America Other possible reasons for many of GA’s recent changes are some recent changes in North American culture. First, a greater awareness of addiction and recovery has come in the wake of a greater awareness of the Twelve Steps, and also the need to become more cognizant of (and closer to) one’s emotions. It is now more acceptable for men to discuss their fears and insecurities, show their feelings, and cry. These changes have affected most segments of society, and it seems GA has been no exception. iv. GA’s Original Recovery Culture Unsatisfactory Another reason, perhaps the most important, for the recent changes in GA is simply that a large number of members found GA’s original approach unsatisfactory. Browne (1991) mentioned how it was common in GA for members to reach a “stage of recovery” where they conclude GA is insufficient for dealing with many emotional issues, and that GA even provided an “informal referral network to professional help” for such individuals. Further, it would seem many who deemed themselves satisfied with early GA approaches have been converted. One can, with caution, say GA has changed for the better.

9.10 The Twelve Steps of GA i. The Essence of Twelve Step Recovery Perhaps the most telling feature – whether for gambling, alcohol, or illicit drugs – is that the vice in question, in this case gambling, is mentioned only in the First Step. The Twelve Steps are not about addiction. Rather, they are about recovery. In a sense, working the Steps is the opposite of telling a war story – the latter is about the past, while the former is more about the present and future. The Twelve Steps deal with the past, but only in order to move beyond it. A popular ritual among Twelve Step programs is the burning of one’s Fourth Step inventory (and maybe any other writing that went with the Twelve Steps) after the process has been completed. The Twelve Steps are not psychological. The First Step is an admission of powerlessness and unmanageability, and from the perspective of someone in Twelve Step recovery, it is a purely empirical endeavour. The person simply admits what is true, and the reasons for it are irrelevant. The AA Big Book treats any attempt to explain why a person became an alcoholic as making excuses, and states the only honest answer an alcoholic can give is that he or she does not know (AAWS, 1976). The GA Combo Book says that discovering why one became a compulsive gambler may be important, but does not insist that it is, and points out that abstinence is possible without such knowledge (GAISO, 1999). This has something to do with the essential mystery associated with the disease conception of addiction. Any explanation could render the condition situational rather than absolute. The First Step involves what is, and not why – a statement of “being” best understood as the start of an ontological journey that can render the psychological irrelevant. To say one is an alcoholic or a compulsive gambler is to make an inviolable claim. There are no degrees of illness according to the disease model - one either is or is not an alcoholic or a compulsive gambler. It involves an absolute statement of “being”. Step Four follows a similar tack. It is a “moral” inventory (in GA, a financial one as well). The “moral” is about right and wrong. There is no mention of a “psycho” inventory, or anything of that nature. Step Four was designed to get one’s moral house in order, and not to reveal any truth about why one became addicted (though some have tried to use it for that purpose). To turn one’s life and will over to the care of a higher power can involve putting one’s feelings, and psyche, aside. GA members are not required to deny the existence of the psychic world (although many Twelve Steppers do) in order to render it mostly irrelevant by means of a process designed to change one’s personality through prayer, meditation, and commitment to kindred sufferers. Twelve Step recovery was designed to get past “self” (i.e., self-centeredness, self-will, self-seeking), although this may be difficult for those who participate in a self-obsessed, therapeutic culture to accept or even comprehend. The Big Book states 28 that all knowledge and insight in the world cannot help the alcoholic. What can help is a journey designed to render knowledge and insight marginal. ii. GA’s Adaptation of AA’s Twelve Steps

Step1. Admitted we were powerless over gambling – that our lives had become unmanageable.

GA’s first Step is the same as AA’s, though gambling has been substituted for alcohol. In practise, GA has adopted a different approach to powerlessness. GA takes the concept more seriously. For example, while AA takes no official stand on whether an alcoholic in recovery can go to bars, thereby leaving it up to the individual, Page 17 of the Combo Book (GAISO, 1999) instructs members not to go in, or even near, gambling establishments. The best way to understand Step One in GA is through its interaction with the suggestions on Page 17, which is discussed below in section 9.11 ii.

Step 2. Came to believe that a power greater than ourselves could restore us to a normal way of thinking and living.

The second Step has been changed from the AA original, and sets GA apart from most other Twelve Step fellowships. Instead of the standard restoration “to sanity”, GA members are restored to “a normal way of thinking and living”. First, GA is less inclined to perceive its membership as “insane”. Second, the transition is less sensationalistic: GA members, for the most part, seek normalcy rather than earth shattering conversion experiences. This is partly due to GA’s secular orientation. As well, there is good reason to believe GA avoids the sensational because it resembles big wins while gambling.

Step 3. Made a decision to turn our will and our lives over to the care of this Power of our own understanding.

Unlike AA and most other Twelve Step fellowships, GA’s third Step does not refer to “God as we understood Him”. This is a secularized approach to a spiritual process.

Step 4. Made a searching and fearless moral and financial inventory of ourselves.

Note that beyond a moral inventory, GA members are responsible for a “financial” inventory.

Step 5. Admitted to ourselves and to another human being the exact nature of our wrongs.

Unlike other Twelve Step fellowships, GA does not suggest members admit their wrongs to God, but only to themselves and another human being.

Step 6. Were entirely ready to have these character defects removed.

Again, GA changes the step by not mentioning God as the one who removes these defects.

Step 7. Humbly asked God (of our understanding) to remove our shortcomings.

Here, interestingly, GA does mention God, whereas AA and other such fellowships do not. In the original AA version, this step refers to “Him”. GA adds in brackets “(of our understanding)” in order to emphasize that God could indeed be the group, or anything else the gambler chooses.

29 Steps 8 through 11 are the same as those for AA:

Step 8. Made a list of all persons we had harmed and became willing to make amends to them all.

Step 9. Made direct amends to such people wherever possible, except when to do so would injure them or others.

Step 10. Continued to take personal inventory and when we were wrong promptly admitted it.

Step 11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of his will for us and the power to carry that out.

Step12. Having made an effort to practise these principles in all our affairs, we tried to carry this message to other compulsive gamblers.

Step Twelve is telling in that there is no mention of a “spiritual awakening”. Beyond GA’s secular orientation, there is an aversion to the kind of quick conversion experience some (though not all) of the first AAs underwent. We have already discussed the theme of patience and the aversion to solving problems quickly. An overnight conversion would be akin to winning $100,000 at a casino. GA’s entire culture of recovery turns against such aspirations. In GA, there may indeed be a spiritual awakening, but it would likely proceed at a slow, measured pace. iii. The Twelve Steps in Practice As practised in GA, the Twelve Steps are, to a large degree, geared towards teaching patience. For reasons already discussed, GA treats this virtue as key to a gambler’s recovery. A recurring warning among GA members is not to move from Step One (admission of powerlessness) immediately to Step Twelve (passing on the message to other gamblers). While a warning not to overstep one’s ability in the enthusiasm of early recovery is common to other Twelve Step fellowship’s – moving from Step One immediately to Step Twelve is called “two-stepping” – in GA, this warning also involves an emphatic call for patience. To quote a longstanding (i.e., 35 years) GA member:

You know some people, some people, and thank God, can be on step one for a year. It’s only when you jump from step one to step twelve, and forget about all the one’s in between, that there’s a problem – a very serious problem. (Interview #1)

If members were to spend an entire year on each step, it would be more than a decade before they were “ready” to spread the word, sponsor people, and so on. The latter might actually happen after one year of abstinence (and the person may then be working on steps three or four), but the point is that newcomers are consistently warned against impatience, and much less often, against procrastination. There are many reasons for this. When asked which item on Page 17 he considered most important, another member (over 7 years abstinent) replied:

One day at a time, don't try to solve all your problems at once was very helpful to me as I had to face the chaos that I created but without # 1 - attending meetings – I wouldn't have ever understood how someone could take their problems one day at a time. (Interview #31)

Even meetings are treated primarily as a means to achieving patience. Like most GA members, the person who provided the quote above had huge debts to pay. Gamblers, more so than many other addicts, must understand that it may take time to set things right. 30 For obvious reasons, an attitude of avoiding quick fixes can be important to recovery from drugs and alcohol. It is simply more pressing to the GA member. Gambling is not only a quick fix in the sense that it may provide an escape or thrill, it can (conceivably) be a source of quick revenue. This temptation can spell death for a gambler. It may also take a gambler longer to earn the trust of family members. Not only has more money been wasted (possibly misappropriated or stolen from family members), the newly abstinent gambler is not as “obviously” abstinent as a sober alcoholic or cocaine addict might be: it is much harder to tell whether a gambler has indulged in the addictive behaviour. For these and other reasons, some GA members – even after 20 years of abstinence – are in a position where their spouses refuse to let them control more than nominal amounts of money. While the timelines vary, the latter scenario is something for which the new GA member may have to prepare. Again, patience is key. Recovery in GA can be seen as a complex interaction between the Twelve Steps and messages (primarily concerning patience and abstinence) in Page 17. Normally, recovery would begin with Step One, the admission that one is a compulsive gambler, aided by GA’s 20 Questions, and then turn quickly to the instructions on Page 17 (some of which could be perceived as parts of, or additions to, the First Step; for Page 17, see section 9.11 ii). GA, however, is not a monolithic entity, and there are many variations in the ways in which members recover. It is also clear to us that the Twelve Steps are often integral to healthy recovery in GA, and that a better understanding of this process holds the key to why GA is able to assist a recognizable segment of the problem gambling population. Though our study was not quantitative, we did compile some information along these lines. We identified three – preliminary and admittedly broad – approaches to the Twelve Steps: 1) Working the Steps with a sponsor and attempting to do them in the suggested order; 2) Working the Steps by “osmosis”, meaning a person may take the Twelve Steps seriously enough to pay attention at meetings and try to apply them to living, but without the assistance of another GA member, formal work on any one Step, or much effort to focus on one step at a time; and 3) Not working the steps at all. Despite the small sample size, some of the data were striking. In response to the question, “Do you miss gambling?”, 11 out of 13 participants who worked the Twelve Steps with a sponsor replied they did not. Two out of four who worked the Twelve Steps by “osmosis” claimed not to miss gambling. The five who paid no attention to the Twelve Steps all admitted to missing gambling. Making allowances for ideological replies on the part of gamblers who have worked the Twelve Steps and who may wish to impress a listener with the efficacy of the GA program, we are still left with a stunning result (the PI sensed little deception on the part of these participants, many of whom he got to know quite well during the tenure of the study). Another measure, taken informally as direct questions were not asked on this topic, involved the PI’s perception of overall life satisfaction. Disciplined Twelve Step work seemed to be correlated with high life satisfaction, Twelve Step work by “osmosis” with fair life satisfaction, and no Twelve Step work with poor life satisfaction. With near unanimity both in interviews and informal conversations, GA members, regardless of whether they had worked the Twelve Steps or not, tended to think that those who worked the Steps were more likely to be better off in a number of respects than those who had not done the work. Though life satisfaction itself could conceivably lead to a willingness to practise the Twelve Steps, it would be imprudent to suggest this approach has no causal bearing on life satisfaction. Another important variation involves the pace at which members proceed. One member who was asked why some do not succeed in GA responded:

Well because they can’t seem to make the transformation from the initial rush, the initial excitement, of finding a lot of people like themselves that had gone through the same experiences. And you know the stories – all the rush that we get when we first come into GA. And they can’t seem to get to the steps, the Twelve Steps of recovery, fast enough. You know there seems to be a lag between… some people get the excitement of the program when they first come in. And they get the power of example and the hope and everything, but they can’t 31 seem to get to the steps soon enough. And they fall off before they start looking, and working the steps. I think that’s where we lose a lot of people. (Interview #5)

This statement is striking for two reasons: first, there in an implicit critique of GA’s slow paced approach; and second, it is consistent with Brown’s (1986) observation that those who are overly elated at their encounter with GA may be less successful in the long run. In any case, we found that many GA members procrastinate – seemingly taking full advantage of GA’s suggestion pertaining to not rushing into things.

9.11 The GA Combo Book i. General Discussion

You know – every time you read the Combo Book you get one step closer to understanding it. And every time you read it there’s a different meaning to it. There’s a different understanding. There’s something that speaks to you, you know, depending on your frame of mind, depending on how the page is being read, or even who’s reading the page. You know, because it’s kind of a magical book. (Interview #2)

One of GA’s most striking features is the length of its main text. The Combo Book, as mentioned, is really just a pocket sized, 17-page pamphlet. At an AA or NA meeting, one might be introduced to one of several lengthy books published by the fellowship, or to one of several pamphlets. Any of the texts may be read from at a meeting. While GA has a larger book called Sharing Recovery Through Gamblers Anonymous (GAISO, 1984), it is not normally read at meetings. It seems that only at a designated Step Meeting will segments pertaining to the Twelve Steps be read from that text. GA does have some pamphlets and brochures, yet these also receive little or no attention at meetings. GA is grounded almost exclusively in the Combo Book. A first glance at the Combo Book would not likely vindicate our interviewee’s claim of it being profound and magical. It may appear quite simple and even shallow. Concision involves the ability to determine what is essential, and the authors of the pamphlet must have had a clear grasp of precisely what compulsive gamblers need to hear; otherwise, the Combo Book would not be so dominant. More than a few gamblers have told our PI that after reading the Combo Book, they got the feeling it was written about them personally. They reported feelings of shock and awe that anyone could understand them so perfectly. The Combo Book speaks to gamblers with more finality than even the famous Big Book speaks to alcoholics. In AA, there is some disagreement (at times heated) as to which AA literature is best. Some prefer the so-called “12 by 12” (AAWI, 1981), which can infuriate traditionalists who prefer the Big Book. Some AA members prefer other AA literature, and a vast majority prefer some variety. Such divisions are not apparent tin GA: practically everyone endorses the Combo Book. The book begins with a history followed by a brief description of GA. By pages four and five, one is already reading the Twelve Steps of Recovery. Since they are only listed without explanation, which would require a longer text, GA members must rely very heavily on GA’s oral culture in order to learn about the Twelve Steps. They may also go to Step Meetings for more textual assistance and deeper discussion. But such meetings are only recently becoming more prominent, and at the time of this writing, there are only three in the GTA. Pages six and seven contain The Unity Program, GA’s version of AA’s Twelve Traditions, which (for reasons the PI could not fathom) are often called the “12 Steps of Unity”. Pages eight and nine discuss compulsive gambling along disease model lines. These pages deal with the need for acceptance of one’s condition, qualified by an endorsement of self-diagnosis: 32 only you can decide whether or not you are a compulsive gambler. This is also where it is mentioned that insight into the reasons for one’s condition may, or may not, be important. Page 10 discusses three characteristics associated with being a compulsive gambler: 1) inability or unwillingness to accept reality; 2) emotional insecurity; and 3) immaturity. Page 11 discusses “the dream world of the compulsive gambler”, which may include things such as yachts and servants. However, the dream will never materialize because the gambler will use any money won to “dream still bigger dreams”. For this reason, many GA members perceive themselves as compulsive dreamers. Pages 12 to 14 further discuss gambling along disease model lines, making it clear that even a penny ante game or office sports pool is sufficient to activate the addiction. Perhaps most importantly, page 12 explains that compulsive gambling is not a financial problem. Pages 15 and 16 contain GA’s “Twenty Questions”, which help new members decide whether or not their gambling has been compulsive and also help experienced members confirm their status as compulsive gamblers. The book states that most compulsive gamblers will answer, “yes” to at least seven of these questions. In practice, however, GA members insist that you are definitely compulsive if you answer seven positively – a contradiction of the previous statement on page eight that self- diagnosis is the only valid criterion. This paradox is not specific to GA, and has long haunted Twelve Step/disease model approaches. Two legitimate concerns are involved: first, compulsion, marked by “craving” of any kind, is an experiential phenomenon that only the person in question can identify with certainty; second, experienced addicts are often able to identify a kindred spirit who may be practising some denial. A balance between these two legitimate concerns is integral to any healthy rapport with newcomers. After these sparsely worded 16 pages, one turns to what is probably the most important page of all. ii. Page 17 Many GA members say Page 17, on its own, can ensure abstinence from gambling if a person takes all the instructions seriously. Others say Page 17 along with the two pages containing the Twelve Steps are sufficient reading material for healthy recovery. One cannot understand GA without understanding Page 17. How could one short page resonate in such a powerful fashion? Page 17 contains seven suggestions, or admonitions. Despite their apparent simplicity, the suggestions reflect a philosophy of recovery, as well as ideas about the nature of compulsive gambling. The page begins with bold, upper case lettering:

TO ALL GAMBLERS ANONYMOUS MEMBERS, PARTICULARLY THE NEW GAMBLERS ANONYMOUS MEMBERS

And then the first admonition:

1. Attend as many meetings as possible, but at least one full meeting per week. MEETINGS MAKE IT.

All Twelve Step fellowships stress the importance of meeting attendance. However, in most the suggestion for newcomers is normally 90 meetings in 90 days (e.g., AA, NA, and Cocaine Anonymous [CA]). So why does GA consider one weekly meeting sufficient for new members? GA was smaller when the Combo Book was first written, and there were not enough meetings in most (maybe all) regions for a more ambitious suggestion. Some of the older GA members in the GTA recall when the city had only one weekly meeting. One may also speculate that a fellowship dominated by war stories with little discussion of life issues, emotions, or other matters – as GA was until recently – would not provide enough variety to entice members to attend with more frequency. There is more to 33 it, however. When first achieving abstinence, many compulsive gamblers are very busy dealing with debts, legal issues, or both:

When I came in… the concept was the guy goes out and gets two, three, four jobs if he has to. (Interview #32)

Our experience with GA members suggests that, in general, they are an ambitious lot, keen to earn good incomes. However, regardless of how we explain it, even today when there are plenty of meetings in the GTA that offer much variety, we have yet to meet a GA member who claimed to attend a full meeting a day for a span 90 days, although a few have claimed upwards of 60 during early recovery. Normally, a newcomer who attends three meetings per week is considered a good candidate for recovery. Conversely, we have found it is far more common in NA for newer members to attend considerably more than three meetings a week, with many attending a meeting every day (or more than one per day when possible) well beyond the first 3 months. It would seem that, for most GA members, such goals are simply unrealistic. However, Page 17 is well thought out, as the second admonition seems designed to compensate for the relatively less frequent meeting attendance.

2. Telephone other members as often as possible. Use the Telephone List!

While all Twelve Step fellowships make such suggestions, we have found that GA members put a very high emphasis on phone contact. Several members interviewed made a point of discussing the amount of time they spend on the phone with other GA members. To whatever extent meeting attendance is less frequent, GA seems to provide a strong telephone culture as a corrective.

3. Don’t test or tempt yourself. Don’t associate with acquaintances who gamble. Don’t go in or near gambling establishments. DON’T GAMBLE FOR ANYTHING. This includes the stock market, commodities, options, buying or playing lottery tickets, flipping a coin or entering the office sport pool.

The reader may be impressed with the vehemence: Don’t, don’t, don’t, and DON’T. GA takes these matters very seriously. This exhortation contains two parts. The first provides a very broad notion of what gamblers need to avoid, and the second provides a broad definition of gambling. Page 17 applies to all GA members, not just newcomers. One may find it strange that even after years of abstinence, a gambler should not enter – or even go near (!) – a casino. AA, for example, does not tell its members that they will never be able to enter, or work, in bars. The first explanation is that, up until recently, gambling venues were few, so contact with them was not integral to normal social interaction. Conversely, alcohol is everywhere. Today, however, most variety stores are “gambling establishments” because they sell lottery tickets. For this reason, some members have suggested to us that this section may require revision. Still, this does not explain it all. Most longstanding GA members we have spoken to would not enter a casino or a racetrack. Most would, if need be, go near such a place (e.g., they would not take a detour in order to avoid walking past the track). Somehow, GA members perceive themselves as perennially vulnerable to relapse. Before discussing this further, here is another consideration:

P: So what you’re saying to me is that a relapse is more dangerous for a gambler than maybe for an alcoholic. #1: No, as far…when you come to the relapse part… if an alcoholic goes out drinking, the problems … all his problems are still …come back. Same thing with the …only difference is the amount of money. I mean an alcoholic goes back to drinking, he may drink for a month 34 and then go back to AA. He may use up a couple of hundred dollars. If he’s not gambling on the side. But a compulsive (gambler) goes back, they go back with a vengeance. P: They do? #1: Worse than ever. (Interview #27)

This participant’s words are important, as he is a longstanding GA member (35 years, 29 years abstinent) and among the two or three most respected figures among GA members in the GTA. The perception in GA is that members who relapse usually make up for lost time. The point he makes is that while there are limits to how much one can drink, there are in principle no limits to how much one can gamble. While it is possible that an alcoholic who slips for a few days may, for example, cause tragedy from behind the wheel of a car, it is more than likely that when the binge is over, a little bit of money (and health) will have been spent and the option to resume recovery will present itself. In the same amount of time, the gambler may have played away the family home or a child’s college fund. GA members avoid potential triggers with a passion, and one reason for this is that there are few limits to how much money they could gamble away. Yet this does not explain everything. Gambling seems to call GA members in a very strong way, so that it is not only the intensity of the relapse that is a concern, but also a greater likelihood. One member, abstinent since 1968, will enter casinos because his work requires it. However, even for work related reasons, he would not go to a racetrack (horseracing was his game of choice).

#28: But the fact is I go in and near gambling establishments. But I wouldn’t dare go to a racetrack. P: You wouldn’t? #28: No. I never gambled in a casino. Maybe that’s the answer, I don’t know. But when they show the news on, and they showed the last 15 seconds … during the sports they show like the last 15 seconds of a feature race. I have to shut that off. I still, after all these years get anxiety, or my mind right away picks the outside horse, or the inside horse, or the gray horse. (Interview #32)

At one meeting, an older member with over 25 years of abstinence, told the room he still will not visit relatives in Nevada due to the proximity of Las Vegas. The admonition goes even further: members are told not to associate with acquaintances who gamble. While some GA members apply this only to those who gamble compulsively, and others ignore it altogether for the sake of family members who gamble compulsively, there are many who adhere to this warning. They may say hello or engage in a brief conversation, but they simply will not associate with someone who gambles, even if the person only gambles recreationally. So, rightly or wrongly, GA perceives gambling addiction as a practically all-powerful demon. Moreover, while GA is becoming more spiritual in orientation, its Step Twelve still has no mention of a spiritual awakening. We have discussed possible reasons for this, but here is another possible reason that GA members are vulnerable. The AA Big Book states that only after such a conversion experience can an alcoholic safely go anywhere regardless of how much alcohol is consumed. One can speculate over the power of such experiences, and perhaps the prophecies – both in AA concerning one’s invulnerability to relapse and in GA concerning one’s vulnerability – are to an extent self-fulfilling. Either way, the distinction is not lost on at least a few GA members:

P: …Now, all of these suggestions in item three imply that gambling addiction is a very serious illness. Now AA for example has no official policy on whether or not members can go to bars, you know, even if different AA members have their opinions. The AA message seems to be that once in recovery and free of alcoholism, an alcoholic can go anywhere. 35 #28: Well because they supposedly have a spiritual awakening… in some shape or manner. (Interview #32)

While there certainly are GA members who work at casinos and are not bothered by it, our observations are only meant to reflect generalities. It is at least conceivable that as GA becomes more attuned to the spirituality associated with the Twelve Steps, it may modify its stance on the suggestions contained in Item 3. Still, we should not take this for granted: GA members we spoke to, who are also alcoholics and attend AA, have said that while they are not bothered by people drinking around them, they would feel uneasy in a gambling environment. Could these individuals be less spiritual in the face of one addiction than with the other, or could it simply be that gambling is more likely to present stronger urges? Currently we have no answer to this puzzle. The second part of Item 3 deals with the definition of gambling, which for GA includes even the smallest, seemingly insignificant bets, and stock market activity or risky investments, such as commodities or options. There seems to have been much conflict over including what many consider legitimate investments in the definition, and this is only a recent addition. There have been conflicts in the GTA over whether someone who plays the stock market should be able to receive a pin and a special meeting designed to celebrate that person’s abstinence. As it happened, they cannot. One might suspect that more than a few GA members simply refrain from sharing that aspect of their lives with the fellowship. This broad definition of gambling reflects GA’s uncompromising stance toward what is and is not dangerous. We should recall that members are told not to associate even with recreational gamblers. One participant (Interview #7) was mainly involved in the buying and selling of real estate, and questioned his status as a compulsive gambler. GA guards heavily against such developments, and Item 3 of Page 17 reflects just how guarded GA can be about the dangers of compulsive gambling. This certainly helps to explain why GA members, rather than simply stating that they are compulsive gamblers when identifying themselves at meetings, prefer a more vehement admission, which sometimes can be as adamant as the following: “My name is Betty. I fully and completely accept and admit the fact that I am a compulsive gambler”. This, in GA, can be taken as part of Step One, which involves powerlessness over compulsive gambling and an admission that one’s life cannot be “managed”. Step One run through page 17, and GA takes this step more seriously than any other Twelve Step fellowship of which we are aware.

4. Live the Gamblers Anonymous Program ONE DAY AT A TIME. Don’t try to solve all your problems at once.

Again, the theme of powerlessness: one cannot simply force reality to comply; things will change at their pace, not yours. Acceptance of this is integral to healthy recovery in GA. That is partly why the Serenity Prayer is so central to GA: God grant me the serenity to accept the things I cannot change, courage to change the things I can, and the wisdom to know the difference. While also very important in other Twelve Step fellowships, this prayer rings even more loudly in GA: many members we spoke to consider this prayer one of the three or four most important components of their recovery. When Browne (1991) claimed that GA (as opposed to AA) does not focus on self- centeredness as a problem in recovery, and Page 17 is not about that at all, he missed a key point: to tell a gambler things will not go his way overnight is to tell him to cease being self-centered. There are many slogans associated with Twelve Step recovery used by members to deal with a host of issues. It is no accident that “One Day at a Time” receives a special mention on Page 17. While this slogan can be used as a means to help members struggling with abstinence (it is easier to say one will not drink, use drugs or gamble today, rather than imagine an entire future without one’s addictive behaviour), the stress is immediately placed upon patience, which is another legitimate interpretation of this slogan. “Don’t try to solve all your problems at once” has, as we explained, a special meaning for 36 those suffering from an addiction geared towards reaping financial benefit. As mentioned by one GA member, who is also a recovering alcoholic:

Gambling certainly presents a dream world that seems to be something I have to constantly guard against, perhaps made more alluring by my memories of the times I actually won gambling, and the false hope I could win again reinforced by industry and government agency advertising "Millions Win". I can't imagine harbouring such delusions about drinking again, perhaps because I have no memories of "winning" when I was drinking. (Interview #31)

5. Read the RECOVERY and UNITY steps often and continuously review the Twenty Questions. Follow the steps in your daily affairs. These steps are the basis for the entire Gamblers Anonymous Program and practicing them is the key to your growth. If you have any questions, ask them of your trusted servant and sponsors.

Page 17 can be viewed as a tool book for staying abstinent, and is therefore a practical guide. However, members read more into it. We have given some reasons for why this is so. Here, the Twelve Steps of recovery are mentioned, along with the Unity Steps, as the foundation of the GA program. While it is true that these aspects of the program are reduced to one item that also deals with the 20 Questions, Page 17 does acknowledge them: first, the Steps of Recovery, and second, the Steps of Unity, with the latter being a political as well as spiritual set of rules. However, Page 17 has already tried to explain the importance of patience to the GA member, and the seriousness of avoiding triggers has been addressed. Browne (1991, 1994) may have viewed Page 17 as simply a practical set of rules, but as we explained, it involves a philosophy of recovery along with a theory about compulsive gambling. Here, another point must be clarified: Page 17 is more than just practical:

P: One thing that struck me is that page 17 is a set of practical principles, it seems just pragmatic, how to avoid gambling and so on. But to some members it’s a lot more than just a practical guide. Do you have any thoughts on this? #16: I think it paraphrases the necessity for someone to utilizing the tools of the book. It talks about read the Twelve Steps often, read and review the Unity Steps. It encompasses every highlight of the book that I think is necessary. So I think it’s way more than practical. I think it’s practical and spiritual. (Interview #16)

6. When you are ready, the Trusted Servants will conduct a Pressure Relief Group meeting, or evaluation for you and your spouse (if married), and adherence to it will aid in your recovery.

We already discussed Pressure Relief (see section 9.5). Here, the most telling words, consistent with the rest of Page 17, are “when you are ready”. Normally, members must demonstrate some commitment to the program, at least in the form of meeting attendance, before Pressure Relief becomes an option. This is consistent with the overall message of Page 17 and GA regarding not rushing into solving problems. Some GA members have been critical of this, stating that without early, immediate Pressure Relief many gamblers return to gambling out of desperation. This critique, coming from GA members themselves, seems convincing enough, even though it may not apply to all new members:

What happens is that there are people in GA that have the concept that says ‘We shouldn’t give a guy or a woman a budget meeting or a pressure group, whatever you want to call it, until we know that they’re for real, until we know they’re not gambling. Until we know they’re in recovery.’ And there’s a lot of advocacy that says six to eight weeks. Which to me is stupid because the pressure, the financial pressure is so great, that sometimes you gotta do it right 37 away or they can’t recover cause they think that the only way to pay the bills is to go back to gambling and get a big win. (Interview #32)

This may be an example of when GA’s recovery culture runs into a snag. Could the emphasis on patience, in this and perhaps other cases, be taken too far? In any case, despite its collective genius, Page 17 runs into a paradox, as can be seen from our discussion of the seventh and last admonition.

7. Be Patient! The days and weeks will pass soon enough, and as you continue to attend meetings and abstain from gambling your recovery will really accelerate.

Necessary for successful recovery from compulsive gambling, our meeting observations and interviews suggest that patience may be the most difficult virtue for many new members to acquire. The tension between waiting for Pressure Relief and perhaps finding it impossible to get patient until some plan for dealing with problems has been created is exemplary, even if Pressure Relief is not currently practised as often as before. This last and most difficult suggestion on Page 17 highlights the fact that this page is not merely a starting point for recovery in GA: it is also an endpoint. Members will say it takes time to “get 17”, which may surprise a casual reader who found the page quite simple. What is required is a profound grasp of, among other things, what patience entails, along with an emotional state amenable to such wisdom. According to one of the most longstanding and knowledgeable GA members in the GTA:

Be patient. That is…there’s our magic. That’s so hard. But you see, you can’t…I can say to you the first day you come in, “be patient”. What the hell are you talking about? Here I’ve got problems up to my, you know? So that’s why you don’t come to page 17 for quite a while. (Interview #27)

There really is some “magic” to it, as another interviewee explained at the start of this section on the Combo Book. Here is another segment from Interview #27:

P: So because page 17 tells you to be patient and stuff like that, that takes – #1: They’re not at that stage. P: Right. It takes a long time. #1: Like I say I gambled compulsively for 30 years. I come in I got troubles, whatever it is. Be patient. I don’t even know what the word means. (Interview #27)

10. Findings from Current Study

This study was designed to learn about GA, primarily (though not exclusively) from the perspective of GA members. For this reason, this section relies heavily on quotations from our interviews – we want to let GA speak for itself. The point is not that this is the only way to approach such a topic. It is simply the way we have chosen. While addressing many of the questions originally laid out in our grant proposal, it became clear to us that our original agenda was more ambitious than we had first believed (e.g., outcome and life satisfaction issues are even harder to assess than we had imagined). As well, the importance of social support, primarily through GamAnon, became clearer during the course of our study, throwing into question many of our original assumptions: often, it seems to matter less whether a new member is ready or motivated than whether the member receives the necessary support and encouragement. Many male GA members insisted that, if not for the efforts of their spouses in GamAnon, they would never have stopped gambling. In fact, many attended originally just to please their wives, the courts, or because of the mistaken belief GA would pay their debts. It seems that willingness need not always be 38 present at the outset, and that the very first step on the road to recovery is simply showing up (Moyer, Finney, Swearingen, & Vergun, 2002). Another consideration that caused us to rethink our agenda involved the ways in which GA has been changing, even more drastically than we had originally imagined. These and other issues are addressed in this section, which places special emphasis on the importance of social support and encouragement in the pursuit of recovery. The reader should note that, in this study, many interviews were conducted by phone with GA members from different North American locales. While still focused on the GTA, many of our findings can, with caution, be treated as applicable to GA in North America.

10.1 GA and Social Support – The Fellowship as a Substitute Community

It is no secret that mutual aid fellowships provide much needed peer support for those in recovery. Even an observer with little faith in any or all aspects of the program would be hard pressed to deny the importance of this one attribute. Rarely, if ever, can professionals compete on this score with organizations such as AA and GA (Rugle & Rosenthal, 1994; Humphreys, 2004). In our last study, we took a cue from Ogborne (1978) who, after extensively studying AA and professional therapies for substance addiction, argued that choice of modalities is likely less important to the achievement of treatment goals than stability and the social support to which a client has access. Since then, evidence has amply confirmed this observation (Humphreys, 2004; Kwame, Whitley, & Weich, 2002; Moos & Moos, 2006). Not only did we find that this also applies to gamblers, with those who have social support achieving longer-term abstinence than those without it (Stein, 1993), already during the course of our original EMAP study (Ferentzy et al., 2004) we learned something in the literature about the functioning of mutual aid: AA members lacking outside support adhere more closely to AA beliefs and behaviours, and alienation from one's regular support networks may lead one to mutual aid (Davison et al., 2000). In NA, it is often said that “an addict alone is in bad company” (Field Notes, EMAP study). Mutual aid has been designed for many purposes, one of which is to alleviate isolation. Our study was designed not only to discover general information about recovery in GA, but also to explore variations in approaches. Early on, we hypothesized that GA members with less outside support would identify more tenaciously with the fellowship and its precepts. Our interviews have given more than a little confirmation to this premise (this theme is examined in the following subsection). We also found that GA is unique in the world of Twelve Step recovery with the ways in which spouses of GA members participate in the recovery process through the sister fellowship, GamAnon (addressed below in 10.3).

10.2 Issues Influencing Degrees of Involvement in GA

10.2A. Social Support as a Factor in GA Involvement

The following is from an interview with a longstanding GA member who at first received little or no outside support:

PI: What kind of support for your recovery did you receive from family and friends? 28: My wife was very pissed off and angry for about three-four years. Got herself an ulcer because she wanted to get even with me. I didn’t get too much support from anybody. My mother didn’t get it. She thought that… I remember one time we had taken her to some GamAnon meeting and on the way home from the meeting we were in about a year at the time, my wife said ‘Would you ever lend him any more money for gambling?’ She said, ‘No, not for gambling’. So you could con her out of money still, and she didn’t understand it. My mother in 39 law & father in law were pissed off at me. My brother thought I was a scumbag and basically told me that for a long time. My sister was in another world in her head and she couldn’t care. She told my wife – actually I shouldn’t say it like that – she told my wife to leave the son of a bitch. (#28, male member)

This man went on to become one of the most active and committed GA members in North America:

PI: What are the most important things that you do for your recovery? 28: Well, I have a sponsor. And I feed everything off my sponsor. Have a wife that’s very supportive at this point. And she’s very sharp and in tune, you know, what recovery’s all about. She ran a treatment center, for a lot of years with drugs, alcohol and gambling. I stay very involved in GA. Actually you asked me about hours I spent (on gambling), I spend that many hours a day involved with compulsive gambling issues. I wake up in the morning, first thing I’m doing is on the computer answering emails. I probably answered 20 this morning. WS: 20 hours a day! 28: I would say, 15 for sure. (#28, male member)

His comments can be contrasted with the responses of a member who received love and support from family and many friends:

PI: And what are the most important things you do for your recovery? 12: I keep myself active in various aspects of my life. As far as hobbies are concerned, I’ve looked at other ways of entertaining myself. I read books, I golf now. I’m more involved in my work. I do quite a bit of extensive research in the gambling area. The illness part. The recovery part. As well as the kinds of programs that are out there, preventative awareness and so on. So I’ve taken keen interest in finding out… basically what goes on with people that have a gambling problem. And how best to continue to recover. PI: Do you go to many other GA events, such as conferences? 12: I go to conferences when I can. I enjoy them. I don’t particularly enjoy going to functions, parties and Christmas parties, and bowling outings and that kind of stuff. I don’t particularly like those. PI: Do you associate with many GA members in your private life? 12: No I don’t. (#12, male member)

It should be noted that for this member, recovery took place outside of GA, and involved activities that had nothing to do with the fellowship. The following is taken from an interview with another member who received good support from family members:

PI: And today what are the most important things you do for your recovery? 27: I work to try to have balance in my life, you know. I mean I’m a compulsive person. I recognize the tendency to be compulsive about many things is within me. I’m always you know continually wrestling with my week, you know… when I was 35, 22 years ago. I smoked three packs a day… I’ve done everything like that in my life. I work in… work and eating I can’t quit, you know. So I have to try to create some balance…positive stuff. But I, you know, I go to the gym, you know, I work out. I work. I create more variety in my life and work so I’m not obsessed with any one thing. PI: Do you go to many other GA events, such as conferences? 27: No, not really. (#27, male member)

40 The term recovery, used constantly in GA, clearly means different things to different members. Its location, which can be inside or outside the rooms of GA, seems to be determined on a case by case basis. Support from friends and family is clearly central to this question. The following is taken from an interview with a woman who received good support from family members:

PI: What are the most important things you do for your recovery? 74: Importantly I remind myself every morning…I still wake up every morning and I feel pain and misery over what I’ve done, over what brought me to where I had… my downfall, more or less. And I thank God that I’m waking up in own bed, and with my husband. (#74, female member)

For this woman, recovery takes place in the home. Notably, intimacy with her partner is key. Her approach to Pressure Relief speaks to the same experience:

PI: What experience have you had with Pressure Relief? 74: I have utilized the Pressure Relief program within GA mainly because I was facing a lot of legal and financial issues. Revenue Canada being one of them. So a lot of the people gave me advice, legal advice and whatever, freely. But I never had a real sit down Pressure Relief group, because I always had family members I could call upon to help me out. (#74, female member)

Beyond simple encouragement, social support is not just something one is given, but also something one must take up, employ, and make use of. In this sense, social support involves being willing to accept and receive what one has been offered or given. A person takes responsibility for the faith and time others have invested. Often one does not, after receiving assistance – be it moral, financial, spiritual, or another type – wish to disappoint one’s supporters. While such loyalty involves bonds that develop over years in normal situations, GA seems to generate them quite quickly.

You know I wanted to do it. At the beginning I wanted to do it more for the other members and for the program. Because they reached to me and they gave me love… (#5, male member)

Though his parents were still behind him, he received very little outside support at the beginning. Having lost the trust and respect of almost everyone he knew, he had to rely almost exclusively on support from the fellowship. The quotation above represents what was at first his main motivation for recovery. We might pause briefly and consider this: when asked to state a primary motive, he offers neither debt relief nor hope for a decent life; almost overnight, GA can generate overwhelming loyalty and, with it, commitment: “They reached me, and they gave me love.”

5: Well the first thing I did was grab onto a few of the members, or…more correctly I should say they grabbed onto me. They kind of held me up, where I wasn’t in good enough shape to raise my head. They gave me support and they gave me love before I even knew I needed love… I guess getting a sponsor was the next thing. And coming to meetings on a regular basis, and being … just being available because I was the lone ranger when I was in action. And I didn’t… you know, when I wanted someone, I would call them. But don’t bother calling me or don’t look for me to be there for you… (In GA) I made myself available because I could feel that these people really cared about me. (#5, male member)

Similarly, for this person, the meaning of recovery is consistent with GA’s own stated definitions:

PI: What are the most important things you do for your recovery? 41 5: I reach out to my Higher Power each day, every morning. And I talk to my sponsor on a regular basis. And the steps…I mean I don’t do the steps on a regular basis but I’m constantly reminded of where I am in the fourth step inventory. (#5, male member)

A GA member and abstinent since 1974, this man still pursues the Twelve Step program with remarkable zeal. While it would be unwise to attribute this entirely to his early situation and lack of outside support, our findings suggest quite strongly that members in such situations tend to latch onto the fellowship and its precepts with more tenacity than others. GA need not be the sole solution along these lines. The following words come from an individual who had to overcome an inordinate amount of self pity, yet received support from a formal treatment setting as well as GA. The Centre for Addiction and Mental Health (CAMH) offers solutions with a greater cognitive emphasis, and this man participated in individual counselling as well as group therapy at CAMH:

PI: What kind of support for your recovery did you receive from family and friends? 71: Initially not as much as I would have liked, but I was very needy and I transferred. I believe I transferred the issue to be all about me, and I had some very serious health problems. And I felt an abandonment as opposed to me being the generator of the issues. Since then, I’ve become more patient. And I understand that each of the individuals that I’ve affected have to go through their own recovery. And I have to try to be supportive of them, and what they’re going through. Cause they were the recipients of my actions and its given me more of a clarity one things. And I don’t feel the anxieties that I had before. This realization is coupled with some restoration of health, cause I was basically blind until the second week in September of this year. So I wasn’t able to work. I was feeling sorry for myself. I was living in recovery houses, halfway house, almost on the street. For better or worse I grew up in privilege, and I felt a sense of abandonment… (#71, male member)

What differentiates this man from possibly every other GA member interviewed is a highly cerebral conception of recovery. This is possibly due to his nature, yet identification with the treatment centre also seemed to play a role:

PI: What are the most important things you do for your recovery right now? 71: Developed a very strong support system. I go, I believe in the meetings. I believe in the contact with therapists – CAMH, GA, the specialists.

PI: Now please tell me what recovery means to you. 71: Good question. I think recovery is dealing with the basic concept of addiction. And since I understand… I have not been an emotional individual. I have become more so. A person that’s always thought… that has had trouble dealing with emotions and feelings. What recovery means to me is dealing with the impulse control disorder and recognizing certain stimulus at the time, that evoke certain emotions or feelings. And what I’m trying to do right now is …with all the therapy is engage in cognitive thinking and rational reason. By doing that, try to say what is really happening here, what is the reason that I’m reacting to whatever the comment is…take a step back, see if I can turn something that might create anxiety and stress into a more productive action and more constructive thinking. So I think it’s a whole issue of dealing with my history, with my emotions, my feelings, and translating that into positive action so the recurrence of whatever has happened over the years and built up, and my defence mechanisms, will not recur. (#71, male member)

42 Surely, there are many ways to explain the answer that came to this person’s mind: recovery means dealing with the “basic concept of addiction”. Yet identification, and the support that goes with it, is central to his stated needs:

PI: What aspects of GA do you find most helpful? And which are least helpful? 71: I find sharing very helpful. I’m also an individual that is easy in groups, and relates to people well. And while I felt abandoned by my family, and it was a distorted feeling and I accepts that, I was looking for support. And so I do a lot of phoning. I phone at least 5 people a day in GA.

While this study lacks the type of quantification required to make hard conclusions, our findings have been consistent with that of similar inquiries into the nature of social and peer support and the ways mutual aid can figure along these lines (Gillian et al., 2007; Humphreys, 2004; Humphreys & Moos, 2007). We consistently found levels of social support to be an excellent predictor of commitment to, and involvement in, GA. Predictably, many cases fall into grey areas. Some who get little direct support from family for their recovery may still be on good terms with them. This is different from those who are alienated, often resulting in mixed levels of commitment. Geography can also play a role:

PI: What kind of support for your recovery did you receive from family and friends? 70: I would say, prior to … OK when I first went into GA I would say that I had not bad support, actually. PI: And then later? 70: Later, no support. Because people in family were of the understanding that …. PI: They didn’t like the idea of you going to meetings on an ongoing basis? 70: Right. They didn’t see that I had a problem. They didn’t know the severity of my addiction. My family was two provinces away. Now one province, but at that time they were two provinces away. (#70, female member)

In this case, the woman ended up leaving GA and returning to gambling. Upon her second entry, family and friends were more supportive. While very committed to the Twelve Steps and other aspects of GA’s program, her conception of recovery is nonetheless external to the fellowship:

PI: And what was your main motivation for recovery? 70: My main motivation? PI: Yeah. 70: My son. PI: Alright. Please tell me what recovery means to you. 70: Living in a nice, even keeled world. (#70, female member)

PI: What are the most important things you do for your recovery? 70: Oh, I buy myself a People magazine once a week. You know. All things to …it’s the money aspect. So where I would never spend any money on myself, everything went into the machines. Important thing I do now is make sure I treat myself. (#70, female member)

Some gamblers may get much needed support from one person only. In the following case, the man received encouragement from his wife and no one else:

PI: When you came into GA, what was the very first thing you did for your recovery? 43 73: Well, a member drove me home that night. I told my wife at that time I would never gamble again. I’m very committed, and I got involved. I got definitely involved. Stopped buying newspapers. Stopped watching certain things on television. And again, got involved. PI: Got involved – you mean in GA. 73: Yeah. And made as many meetings as I can. PI: And what did you do after that? 73: I kept… got really involved in the program. Would not carry money around. I ripped up my credit cards. I cut off all my supplies of money.

Note that another participant (#5) claimed to have been motivated mainly by loyalty to the GA members who had stood by him. The significance of such bonds should not be underestimated. In following case, a spouse played this role:

PI: Alright now, what was your main motivation for recovery? 73: To prove, number one, that I could do it. I’m a committed person. I make a commitment, I do it. I didn’t want to live this life anymore. Just got the best of me. I was depressed with this. When I would lose I was depressed. When I won I was the happiest guy in the world. But I got tired of living the lie. PI: And you said “prove”. Prove to who? 73: Prove to myself. Prove to my spouse.

Related to the theme of support from GA members is the simple matter of whether one is able to remain on good terms with other members. To the question, “Which aspects of GA do (did) you find the least helpful?”, many members answered “politics” (usually meaning interpersonal conflicts) and identified issues such as feelings of betrayal (statements made in confidence, possibly at meetings, and then blurted out elsewhere being a major irritant). One woman, who no longer attends GA and claims to gamble now without negative repercussions, also claims to receive strong support from friends and family. It is at least conceivable that, without outside support, a move to moderation of gambling behaviour would have been much more difficult or even unthinkable. Her partner and many of her friends gamble, and have been supportive of her efforts to moderate. In such a situation, someone will find it easier to leave GA. In this case, the decision was unequivocal:

PI: Tell me something. You felt that you could leave GA and still do OK with your gambling? 10: At that time, yes. PI: If you would have felt that you actually needed GA in order to manage the gambling, would you have stuck it out despite the interpersonal conflicts? 10: No. (#10, female member)

Another woman who had consented to an interview 2 years prior for our first study was also willing to participate in this study. With a supportive husband, friends, and relatives, this woman is also able to manage without GA. While still attending “pinnings” (celebrations of years abstinent) of members with whom she has bonded, she no longer attends regular GA meetings. She had been an active member with over 2 years of abstinence. Interpersonal conflicts alienated her from the fellowship, and since then, she has decided to gamble on occasion. Her conception of addiction merits attention:

13: I was abstinent until April or May 2005. I have been to the casino a few times. Like I said, I can count on…I have been any more than what you can count on two hands since then. If that. Certainly it hasn’t been a problem for me. PI: I see. So you’re gambling on occasion now, but it’s not running away like it used to. 44 13: Well, no. In a way yes, and in a way no. OK? I don’t know if you’re gonna understand me when I explain this. It’s still very difficult to know when to leave. That’s the addiction part. It’s still very difficult not to spend every penny I have in my purse. That’s the addiction part. However, good common sense does come into play. I mean I can make common sense come into play here. And leave where I couldn’t have left before, without draining everything I could get my hands on with my debit card and credit card and stuff like that. Don’t do that anymore. (#13, female member)

The point is not that she denies being an addict, but that addiction can be managed. This woman answered each of GA’s 20 questions in the affirmative, and has no qualms about admitting she is an addict. Better off emotionally and financially than when she first entered GA, she has simply moved on, in thought as well as deed. Still, it seems GA left its mark:

PI: In your view, what is compulsive gambling? 13: Not being able to stop. Going constantly, spending all your money. Threatening relationships, health, work everything. That sort of thing. PI: Do you view it as a disease? 13: yes. (#13, female member)

10.2B Other Factors Influencing GA Involvement

The following account of issues influencing involvement in GA is based on interviews conducted during the course of our study, and should not be taken as exhaustive. Our interviews suggest that one strong, and possibly unsurprising, indicator of commitment to GA involves money. Most new GA members are in desperate financial straights. Those who are not are also less inclined to cling tenaciously to the fellowship and its tenets:

PI: Alright, so you have done some step nine work. You tried to make amends to your ex. Anybody else? 76: As far as I’m concerned, nobody else was affected by my gambling. (#76, male member)

In such situations, a person may have fewer regrets over gambling-related behaviours. Typically, a Twelve Step commitment involves a reassessment of one’s personality, with the corollary that harm to others requires a broader definition. However, as the above case suggests, in the absence of a strong initial motivator one may never acquire such Twelve Step consciousness. Another case involves a woman who still gambles on occasion, and only attends GA meetings sporadically:

PI: And When you first entered GA, what was your financial situation? 18: I had some stocks. I had savings, And I was OK. I was OK. PI: And What kind of support for your recovery did you receive from family and friends? 18: None. PI: What kind of relationship did you have with family members when you first entered GA? 18: Always have good relations with family. PI: And they didn’t support your recovery? Why is that? 18: I guess. I guess they figured I would handle it sooner or later because the …. relationship I had with my estranged husband is what I was escaping from. It was horrific. (#18, female member)

Despite seeing herself as a compulsive gambler, this woman still chooses to gamble on occasion. She is not beholden to solutions based on GA’s disease conception of problem gambling 45 (which entails that abstinence is the only solution). She considered her main issue to be an unhealthy relationship, and her family network also supported this position. While this study was not meant to generate evidence that would stand up to quantitative scrutiny, we were able to uncover strong connections between certain determinants and someone’s willingness to believe, or not to believe, many of GA’s precepts. The following quotation is from an interview with a man who, despite a lack of outside support for his recovery, was in a financially stable position when entering the fellowship:

PI: What does a gambler need to do to recover? 90: He needs a hell of a lot of support. Needs willpower. I know the GA program says that it’s not willpower alone. And that is very…. You still have to have one ton of a lot of willpower. And I think by going to meetings… You know, meetings aren’t for everybody. You have to find something that works for you. Whether it’s reading, whether it’s going to meetings, whether it’s going to church, whether it’s doing individual counselling – everything you can do to put a roadblock between you and your gambling, you gotta do it. (#32, male member)

He claims to work on recovery mostly in ways that are independent of GA:

PI: What are the most important things you do for your recovery? 90: Not gamble. Don’t think about it. You… I had three different casinos, gaming rooms in my territory. And when I first started, you know I didn’t go near any of them. But you know eventually Casinorama’s actually a customer of mine. I do it on my phone, so I don’t have to go on to the property. But you know, it’s just… it was being away from the ….thinking of something else, I had to… I had to find something to fill that time… And so I read. PI: Do you go to many GA events, such as conferences? 90: No. PI: Do you associate with many GA members in your private life? 90: No. (#32, male member)

Another indicator of attachment to GA and its precepts involves one’s perception of formal treatment, and notably, whether one’s experiences with it are perceived as having been helpful. Recall that participant #71 (see 10.2 a), while committed to GA, was nonetheless influenced by his positive experiences at CAMH. Now, consider the following:

PI: What kind of professional therapy did you receive either before or during GA? 79: I went to a psychiatrist only to appease my wife and friends. And obviously it turned out to be a total … it was a flop. I had no reason…, I had no desire to be there and I only went to…at their coaching. PI: When you first entered GA, what was your financial situation? 79: Destitute. PI: What kind of support for your recovery did you receive from family and friends? 79: From my wife basically I got….our support was just an (unclear) to who I was, no recriminations, never a bad word, and I didn’t have any support from friends. All my support came from a few people in the program that I met. (#79, male member)

PI: What is compulsive gambling in your view? 79: It’s …for myself it’s just an activity that once I start I have absolutely no control over. It continues to get worse, and it can only lead to my destruction. PI: Do you see it as a disease? 79: Absolutely. (#79, male member)

46 Such statements are often sufficient for speculation about a person’s loyalties: “absolutely” is a stronger word than “yes”. In this case, however, we need not speculate. The interviewee makes his loyalties quite clear:

PI: In your view, what does a gambler need to do to recover? 79: First thing to accept that he has this illness. Accept the fact that there’s no way he or she alone can have the willpower to overcome it. And accept the fact he or she has to follow the GA program. And to me there’s absolutely no other way. (#79, male member)

Our interviews uncovered another – perhaps unsurprising – predictor for GA involvement: members also affiliated with other Twelve Step fellowships, such as AA and NA, are often less inclined to devote themselves to GA. One male participant attends AA and NA, and for geographical reasons attends GA less often. As well, these fellowships were more formative than GA, even in his conceptualization of compulsive gambling:

PI: Has viewing compulsive gambling as a disease helped your recovery? 91: You know, at the time I came into GA I didn’t. It wasn’t until I began to understand, talking about the recognition of compulsive gambling as a disease in the Diagnostic and Statistics Manual. I didn’t look at it. I always viewed it as a lack of control, or a moral problem. Probably four or five years in, I thought it was just a matter of willpower or, you know, there was something wrong with me and…. But it wasn’t until I actually got involved in other Twelve Step programs that I began to make a connection between the disease concept, the disease of addiction and that gambling, even though it wasn’t putting a chemical in lour body, that it was very similar to what alcoholics and drug addicts went through. (#91, male member)

As mentioned, we have found that members affiliated with AA or NA are generally more inclined to practice the Twelve Steps:

PI: Do you have any thoughts on why some people leave GA? 91: Well I think the recidivism is high because of… you know lack of…. I don’t know how to put this. Lack of commitment to a Twelve Step program. I think they have this huge ego and they think after attending meetings for so long long that they’re fixed. Now they can go back out and get control of the gambling. And now they know … they’ve heard all the horror stories at the GA meetings and they know what not to do. They don’t understand the it’s not the … it’s the first bet that is the problem. It’s not the last bet, it’s the first bet. So and that what I think that that would probably answer that question. (#91, male member)

Perhaps more interesting is the way some GA members who have never had a substance addiction rely on AA literature, with some even attending open AA meetings. The following participant prefers AA meetings to GA:

69: A little bit about myself? I coach hockey games. I’ve always been involved in coaching hockey. I guess you might say I would be a religious person. I follow my faith (RC)... I’m very dedicated to the program I’m involved in. I’m attending a step meeting with… we use the 12 and 12 … of Alcoholics Anonymous. We just change it from alcohol to gambling. PI This is in a GA meeting? You Use AA literature? 69: Yes, yes. It’s a GA step meeting. PI: Does the fellowship not object to that? 69: They do. (#69, male member) 47

He explained that although this meeting is no longer on the local GA meeting list (the use of outside literature being the reason), he considers it a proper GA meeting. He is a religious man (RC) whose higher power is “God.” One aspect of the way GA has changed over time involves the revision of it’s basic text (GAISO, 1984; GAPC,1964). Given that GA relies mainly on the shorter Combo Book (GAISO, 1999), this did not strike us as a major consideration. But to this participant, it is key.

PI: What aspect of GA do you find most helpful? Which are least helpful? 69: Well, I find that, interestingly enough, the way they work the Twelve Steps …. Not very helpful at all. I got the real substance of the program. What has happened over the years…. We had a book that was …. I think it was really taken from the Big Book of Alcoholics Anonymous and the 12 & 12, and over the years people kept on pushing it out the door. Kept on changing it. I just couldn’t stand this here. Because I could see what was happening. The real program was disappearing. And that’s why I felt that I had to really grab on to the AA program. Just for my own personal benefit. And what I was telling you about the 12 & 12, you ask if they approved it, well they didn’t approve of the original book that we hadn’t changed so how could they approve of what the Twelve Steps of recovery from Alcoholics Anonymous were about? That’s where the original came from. I could show you the difference of what we had – the literature we have today and the one we had previously. That there’s such a close relationship with the AA program and GA program. And what has happened it’s separated so much down the years. So the original founders of the GA program, they just took copies of the book, the Big Book, and changed it around. They’ve got a certain amount of good things in it. They didn’t believe in God, they were members of AA, and they couldn’t handle the God part of the program, so they went and started their own program in GA, and tried to take God out of the program as much as they possibly could. (#69, male member)

Essentially, the original GA book was based – perhaps in some ways uncritically – on AA literature. So, this participant and a few others operate a “renegade” GA meeting. Dedicated to recovery and GA (he claims to have five sponsees), he is nonetheless alienated from GA, and at this point, rarely attends conferences and other activities. One of his sponsees, #75, who attends the above mentioned meeting exclusively, had been off gambling for almost 5 years when participating in this interview, yet knew very little about GA outside of that one – arguably non-GA – meeting. Both #69 and #75 have one thing in common: alcoholic fathers with whom they had poor relationships. #69’s father was an AA member, and #75’s attended ACA for “4 or 5 years”.

10.3 GamAnon and Social Support – A Unique Approach to Recovery

Our previous study explored how GA has developed a recovery culture unique within the larger world of mutual aid (Ferentzy, et al., 2004, 2006B). Financial issues represent an obvious point of reference, and one obvious reason for GA to treat family matters differently than is the practice in other Twelve Step fellowships. Regardless of how we explain it, GA has managed to set itself apart in its approach to family. Affiliated with GA, GamAnon is a mutual aid organization for spouses and others affected negatively by someone’s compulsive gambling. Rather than shutting out spouses and other significant contacts, as is often the practice in Twelve Step fellowships, GA invites their participation and acknowledges their needs in a fashion unmatched – at least in a North American context – by any other such organization of which we are aware. Though modeled upon (even in its name) the AA affiliate, Al-Anon, GamAnon assumes a much more active role in the recovery of GA members. While in its earlier days, Al-Anon was more closely affiliated with AA, today each fellowship pursues its agenda separately (Humpreys, 2004). It is different with GamAnon and GA. 48 The vast majority of GamAnon members are women, spouses of male GA members. Despite its reputation of being male-centered, GA has a history of acknowledging women’s needs, at least in this respect. A review of the GA meeting list for Ontario indicates these groups typically meet at the same time and location as GA groups, usually in an adjacent room. While GamAnon meetings are held next to GA meetings, the latter are mainly for gamblers only. A few GA meetings in the GTA have been designated as “open” (to the public), and all meetings wherein members celebrate years of abstinence from gambling (pinnings) are open to interested observers. In our first study, we found that GamAnon members were well represented at pinnings, and that they were often asked to speak. As well, conferences and many other GA sanctioned events tend to involve GamAnon. Even before the original EMAP study, we theorized that the format of double meetings suggests GA and GamAnon are more interdependent than similar mutual aid groups in other domains. Not only did our assumption prove accurate, during the course of this study we learned that one cannot understand GA without a serious grasp of GamAnon’s role. First, if GA has traditionally been less program-focused than AA, a good way to explain how recovery in GA proceeds is with reference to the support that GamAnon members provide. We are dealing with a very different conception of recovery than that found in most Twelve Step mutual aid organizations. Whereas the traditional Twelve Step philosophy has rested upon an individualistic conception of motivation, GA has long encouraged prodding from people who, in many circles, would today be considered co-dependent (even if GamAnon works in some ways to free members from such dependency). Given that the benefits of social support have more recently received scientific vindication (Helgeson & Cohen, 1996; Humphreys, 2004; Kwame, Whitley, & Weich, 2002; Moos & Moos, 2006), one might say GA has long been ahead of its time. However, this same support, coming as it does from traditional spouses (almost exclusively from wives of male GA members) is becoming less common with the greater acceptance of divorce and the newer generation of women who are more independent and less keen to stand by husbands who waste their fortunes and cannot be relied upon. One can speculate that with the decline of such support for GA members, substitutes are needed, and that hence the greater appreciation of spirituality and the Twelve Steps (evidenced more recently within GA; see section 9) serves, in part, to fill the void. In many ways, we are currently dealing with a different Gamblers Anonymous, operating as it does in a very different world. For the longest time, however, GA pursued an approach consistent with twentieth century social realities and the gender roles that came with them. Though waning, this approach still operates. While self-motivation is considered important, it is often perceived as insufficient, which suggests a type of dependency on family members that fellowships such as AA and NA would rarely acknowledge. AA especially has, at least in its literature, insisted upon a personal relation with one’s God and an accompanying spiritual conversion. Belief in the absolute power of spiritual experiences would clearly preclude the acknowledgement of dependency on significant others. As explained in our previous report (Ferentzy et al., 2004), GA has traditionally put less emphasis on such conversions, making possible a more human-centered and socially based conception of recovery. Seeking normalcy rather than earth-shattering spiritual change (see section 9.10 ii), many GA members have traditionally been willing to rely on normal, day-to-day, prodding from their spouses. From a member who first joined in 1966:

83: Most compulsive gamblers, male or female, come in with a partner, husband and wife, boyfriend and girlfriend. And if they don’t have that support basically from that partner, they’re almost doomed to fail whatever good intention they may have at the time. (#83, male member)

While possibly consistent with more recent studies vindicating the importance of social support over and above motivation, the above perspective is anathema to a traditional Twelve Step lore 49 (AAWS, 1976; WSO, 1982). The centrality of active spouses often has another effect: social support, in general, can at times be reduced to this factor. From a GA member who first joined in 1962:

PI: And What kind of support for your recovery did you receive from family and friends? 89: My wife frequently attended GamAnon for the first 13 years. (#89, male member)

Unlike other Twelve Step fellowships, GA has long understood that pressure from family can help in the achievement of abstinence, even when the addict in question demonstrates what may appear to be insufficient motivation. We have found that such pressure can be integral to recovery in GA, with many longstanding members insisting that, at first, they attended meetings mainly to satisfy family members (often their wives who would soon join GamAnon). However, as already mentioned, the interpersonal realities making this possible have been changing:

PI: In your view, has GA changed significantly over the years? 89: Sure. …. Number one, the spouses were more involved. Very much more involved. Also …the current situation…now these companies that come in and say well they got easier credit…. And the people turn to them rather than turn to something has the stigma …And they don’t want their spouse to know what’s going on. You can’t have success that way. (#89, male member)

#89 is a longstanding GA member who, in fact, helped to design the Pressure Relief system (see section 10.6). In his view, the new approach is inferior to the one he and his peers practised in the mid-twentieth century. The older GA philosophy seemed to be that one’s spouse had to be aware of every financial detail. While honesty is often central to Twelve Step recovery in general, such complete disclosure, achieved through a Pressure Relief session where one’s spouse’s attendance is mandatory, has been unique to GA. This often leads to situations that are almost unheard of in the larger world of Twelve Step recovery:

PI: Do you have a sponsor? 93: Yes. PI: Could you describe your relationship? 93: It’s just very cordial. I don’t lean on my sponsor very heavily. I think probably because my wife goes to GamAnon, and we can talk about the whole thing. She’s more like my sponsor than he is, because I use her more that way. Cause she understands better. (#93, male member)

Yet the support of a spouse need not always be pleasant. As discussed in our previous report (Ferentzy et al., 2004), some GA members are prevented (mainly by their spouses) from controlling more than nominal amounts of money even after several years of abstinence from gambling. Despite the cooperation, there has long been an uneasy tension between GA and GamAnon:

PI: How has GamAnon been doing in your view? 96: Well I don’t attend their meetings. There’s some women that go there that swear by it. There’s some guys married to those women that wish they’d never gotten involved in it. But you know it’s like…if you got somebody over top of you that …. I mean maybe they’re supporting you, but in other ways they’re constantly being like a policeman watching everything you do… (#96, male member)

As mentioned, the society in which GA operates is changing:

50 PI: In your view, has GA changed significantly over the years? 79: Yes. PI: How so? 79: …When I first came in, the marriage ethic back then was that the man was the breadwinner, the woman sort of you know, maybe the homemaker or sort of you know, was not that independent and relied a lot on the male figure. And today when young couples come in it’s been totally…not totally, but very significantly different. The women married to compulsive gamblers today are much more fast to say, you know, hey, he doesn’t stop, I’m outa here. Very rarely would I hear that back then. And I believe that the person …I’ll go back to the man. The man who comes into GA with a spouse is so much more apt to hang around and do well than the man who doesn’t have a spouse in GamAnon. Today there are not that many younger women married to gamblers who are that interested in coming to GamAnon. Hey, you know, that’s his problem and he wants to continue to gamble you know, I don’t need him. But that’s so different from the way it used to be. (#79, male member)

Also, the interpersonal conflicts are often more complex than one might first imagine:

79: I don’t believe that there are many men in GamAnon. I know a few, but it’s very unusual. I truly believe that the women in GA have a resentment, a strong resentment to GamAnon. And I see it, and it’s very disturbing. And I’m getting into why, but I’m a member of the BLT, the Board of Trustees. And I put on the agenda for GA …a motion that in each starting kit (for new groups) we put in a piece of paper telling them of the existence of GamAnon if they’re interested and the number to call…. And it was a huge discussion and it came down to a vote. I was able to see how the vote went. And there were 21 women on the board of trustees, out of about 90. 19 of them voted against it. And I couldn’t believe it…. I think that when they see all these women in GamAnon and then they see themselves in GA, something must happen. And I don’t want to get into the psychology of it. I think I might, you know, have an inkling. of…it must be disturbing to them. WS: Is it that their men don’t back them up the way that… 79: I don’t know. I think that they see GamAnon as a women’s organization and here they are in men’s organization… (#79, male member)

Essentially, we are witness to a format that was initiated by male gamblers, and for male gamblers, with their wives playing a supportive role. In the process, women are often left in the lurch, as the same formula does not always translate when gender roles are reversed. One possible alternative would be a well-developed system of sponsorship. However, at the time of this writing, GA has yet to develop a strong culture of peer support through sponsorship (see section 10.4). In the decades to come, GA will surely struggle with changing realities:

PI: And How has GamAnon been doing in your view? 85: I believe that GamAnon is today – and I hope this will turn around – I believe that GamAnon today is a dying fellowship. And I believe that it’s based on the following statistic. At least in part. 80% when the male gambler presents for treatment the spouse is still present. 80% when the female gambler presents for treatment, the spouse is gone. So as the female percentage rises, the GamAnon percentage drops. (#85, male member)

To highlight the significance of this transition, we will end this subsection with a claim that is by no means unusual:

If my wife didn’t come into GamAnon, I wouldn’t be here today. (#79, male member) 51

10.4 Sponsorship in GA – A Haphazard Affair

Initiated by AA, the sponsorship system in Twelve Step fellowships involves more experienced members guiding newer members through their recovery. Members of such fellowships who are more beholden to the program will often insist that a sponsor is primarily (or exclusively) a guide through the Twelve Steps. Typically, it is suggested that even someone with 20 years of abstinence should have a sponsor (presumably, someone with even more clean time). Many GA members interviewed have complained that, unlike in AA, the sponsorship system in GA is poorly developed. In part, this can be attributed to the role GamAnon has long played. From another member who leans on his spouse in ways already described:

PI: Now, in step 5, #28, did you share these things with an individual? 28: Yes. PI: Would that be a sponsor? 28: It was a sponsor and it was also my wife. PI: Your wife was your sponsor? 28: S’ --- got something very special. She…. in the house today and said, “You know, your f--- ing ego’s running away”. She knows it, she… catches it, and I get pissed off when she does it but, you know, if you hold back and you look at it from…you can really get it. She really knows what’s going on with me. (#28, male member)

It is worth noting that this person is one of the most active GA members in North America. Despite lacking a formal sponsor, few in GA would question the legitimacy of his recovery. Abstinent since the late 1960s, he entered GA when there was little sponsorship to speak of. Since then, GA has moved somewhat in a direction that resembles other such fellowships more closely. In its formative years, however, GA did things its own way. At least, this is what our interviews suggest. There was, however, a support system in effect wherein more experienced members helped to guide newer ones. From a member who, at the time of the interview, had been with GA for 41 years:

9: When I came in there was no such thing as a sponsor. Never heard the word I think for 15 years in the program. But I know that I two significant people who are…I guess today you would call them sponsors though they didn’t work the steps. But looked over me like... And really were very concerned about my wellbeing and how I was doing. They literally called me every single day, and maybe two or three times a day. PI: Do you have any sponsees? 79: Yes. But you know something, I don’t. because when people ask me would you be my sponsor, my response is I’m not sure what that means because I didn’t grow up in GA with one. But I will be as involved with you as much as you want me to. And I’m there for you 24 hours a day. And if you want me …to label me as a sponsor, that’s fine. But I don’t need a label, and I’m very close with a bunch of people in the program. (#79, male member)

As this member points out, to some extent the distinction may be semantic, but it is also more than that. First, as mentioned, GA has been able to downplay the role of the designated peer-guide through recovery by offloading much of the related tasks onto spouses. Second, as we discuss in the following subsection (section 10.5), other features of Twelve Step recovery, such as the Twelve Steps themselves, have traditionally received less attention in GA than in other Twelve Step fellowships. This last point has been confirmed in the literature (Browne, 1991, 1994; Lesieur, 1990) and in our own observations and interviews, both in this study and our previous one (Ferentzy et al., 2004, 52 2006B). As the quotation above, and the one to follow, suggest, there is often some ambiguity about the nature of sponsorship in GA:

PI: Do you have a sponsor? 27: Do I have a sponsor? No, I don’t think I do. Maybe …I have ---- in Toronto if I need him. But I haven’t talked to him in years. You know, I have other, older members, that I speak to… but I don’t …particularly call anybody my sponsor. PI: And how many sponsees do you have? 27: Right now I’ve got…Oh I don’t know…I’ve got two that are in good shape… and they’re celebrating one and five years. I’ve got one that’s retired I guess, in the sense that he doesn’t come to meetings anymore. He moved away …but I think he’s OK. (#27, male member)

It would, nonetheless, be a mistake to perceive GA as a haphazard, undisciplined society. While some aspects of the program are taken lightly, others are emphasized more stringently than in AA or NA. In our last study, we discussed GA literature with special attention to page 17 of the Combo Book (GAISO, 1999; Ferentzy et al., 2004, 2006B; see also section 9.11). Some of the features that make GA successful in the achievement of its goals include: proscriptions concerning entering, or even going near, gambling establishments; a stringent focus upon abstinence; and a pragmatic willingness to address financial and legal matters. With certain issues receiving more attention, it stands to reason that others suffer neglect. The following quotation shows how, aside from the support offered by GamAnon, GA members supported each other back when sponsorship was a much less formal affair. From a member who joined GA in the early 1970s:

P: Did a sponsor guide you through the steps? #1: Every person that has been successful in our program has had a sponsor. And that’s the one thing that we lack – that we’re just going after and now stronger – that AA has, that we do no approach properly. In the beginning, my God, there was eight or ten of us, and we led each other. We sponsored each other. We lived off each other. You know what I mean? There weren’t a day went by that five or six of us never spoke together and met together. Even though we had no money, we had nothing. But we’d be together, and talk on the phone. And we tell people now, (about) sponsorship. And I say “call me to say ‘hello’. Doesn’t have to be with a problem. Just keep in touch, and if there is a problem I’ll tell you how I handled it. You know what I mean? Or if there’s something you’re asking me a question about, I will answer. And get together. Quite often we’d get together over a cup of coffee. And in the beginning sometimes our meeting would be, let’s say, from 7:30 to 9:30 and then we would talk, we’d talk in the room till 12 or 1 o’clock. Our wives thought that we were out, either killed somewhere or gambling somewhere. That’s a fact, and that’s something we’ve sort of lost a little bit of. But we are now working – and we still have a lot of it, but not as much as we should have. Very, very important – sponsorship. Don’t be without it. (#1, male member, Interview #1 from EMAP study)

A key to grasping the current process is an awareness that it is in flux, and forming itself as these words are being written. As the Twelve Steps also become more important to GA, the approach has been distinct: many members seem to go through the Twelve Step process by attending designated Step Meetings rather than by working privately with sponsors. The following subsection deals with the Twelve Steps as practised in GA.

10.5 GA and the Twelve Steps in Practice

53 The first thing to keep in mind is that GA has been changing. For reasons discussed in this and our previous report, there is now more attention given to the Twelve Step aspect of GA’s program:

PI: Tell me, do you think that the Twelve Steps of recovery are getting less attention or more attention than they did say 20 years ago? 79: Much more. PI: Much more? 79: When I came in the program, there was hardly any mention of Steps 2 through 11. It was always One and the Twelve. And was for a long, long period of time. When I first came in the program the people, almost everyone, just talked in their therapy about Step One, and very rarely did you hear – at least the meetings I went to – any discussions of, you know, the spirituality of the program. And that’s dramatically changed, I believe, in the last 20 years and continues to do so. (#79, male member)

The member is referring to Step One (admission of one’s addiction) and Step Twelve (working with others). In our EMAP study, we discussed how members went straight from one end of this journey to the other, neglecting the steps in between (Ferentzy et al., 2004, 2006A). Today, however, this is less common than in the past. Yet even to this day, perhaps the most striking aspect of GA’s approach to the Twelve Steps hinges on a practical consideration: debt load. Given the financial pressure confronting members in early recovery, debt is usually the first issue that must be addressed. Recall that GA’s fourth step involves a financial and moral inventory (see section 9.10), and that this is where recovery (out of necessity) normally begins. While the Twelve Steps were originally designed to be worked in their proper order, with the first three steps involving admission of one’s addiction along with the need for hope, faith, and surrender, in GA these considerations tend not to precede the addressing of financial issues. Nonetheless, the latter contains a moral dimension, given that debts must be paid and hence obligations must be met. In GA, the process rarely follows a linear sequence of steps one through twelve. To be sure, the first step is often addressed at one’s first meeting with GA’s 20 Questions leading members to unmistakable conclusions. From there, however, the member will likely address what is essentially a part of the fourth step, often in conjunction with Pressure Relief. This entails work on what amounts to step Five (admission to another person), Eight (identifying those we have wronged), and Nine (making amends – in this case, paying debts). All the while, a gambler may be working on (or perhaps not even starting) Steps One or Two. The following is an example:

PI: What did you do for step four? Did you right it down, or… 5: Oh yes! Oh yes! At the beginning it was really just a financial inventory. PI: Ah! Ok, you started with that. 5: Yeah. And it wasn’t until my second step – my second time through doing Step Four that I actually started looking at character defects and… PI: And who you had hurt? 5: Oh yeah. PI: And that happened the second time around only. 5: Well actually that’s more of what I got into in steps 8 and 9. (#5, male member)

Only the second time through the process did this person have enough freedom from material concerns to get on with the moral and spiritual aspects of the program:

And I thought at the time I wasn’t quite willing and courageous enough to look at the emotional or the moral side of Step Four. But I did the Step Four financial because I had asked for a Pressure Relief meeting. (#5, male member) 54

PI: How did you do Step Eight, was it written? 5: Oh, yes. And that was you know, that came out in drips and drabs. I… for whatever reason I wasn’t ready to be completely honest or I wasn’t and… my mind was blocking out certain people that I had harmed. I remember doing step 8 in a couple of pieces, you know, 2 or 3 at a time just before I finally I think got everybody… And yet you know there are, years later, I’d still remember more people that I had harmed. (#5, male member)

The following is quite common:

PI: And, how did you go about working step four? 72: I didn’t in the beginning cause it wasn’t encouraged to make a personal, moral inventory like there was in AA. But I did have a personal financial inventory after I was in the program three weeks when I had the budget meeting. So that happened. And I kind of followed that. I did what they said and amazingly it worked. PI: And later, did you do a moral inventory? 72: Yes I did. I did a written moral inventory. (#72, male member)

However, moral or interpersonal dividends often come immediately with financial honesty. As one woman explains:

Being single back then, it wasn’t like I took too many people down with me. What I did is… I took a lot of money from the credit cards. So the financial Pressure Relief took care of those ends. And what was interesting, it took me probably three months then I told my parents that I was in GA. As a result of that a pretty exciting thing happened. I was in GA and I finally let all my guard down in GA and got off of this ‘don’t let anyone know that you have any weakness, any problems at all’. In GA I could be really open about all that and figure out how it wasn’t working. I …was able to share all my problems and foibles, and also with a spiritual councilor in addition to that once a week….. But what I found, which was interesting, is I could go to a meeting and after the meeting I could hug somebody and say ‘have a good week’. But I never hugged my dad in my whole life. I never told him verbally that I loved him . He never told me, either. And after 90 days in the program, I went down to my brother’s house in Florida and told them at the hotel that … what had happened, what I was doing. I was finally for the first time able to hug my dad and tell him I loved him, verbally. (#23, female member)

While each case is different, it is safe to say that, overall, financial concerns are pressing for most new GA members. Often, they have no time to recover in peace by putting these matters off:

I was working Four and Nine before I even looked at Step One. I had to… I had four bookies… You can’t compare an AA or an NA. These are real things you have to address. You don’t address them, you may not be walking the earth. (#85, male member)

PI: … Pressure Relief was important. You told me, it helped you. 83: Yeah., it was a frightening thing, once I disclosed myself. The first thing that I did was disclose all my money that I owed… They (creditors, not GA members) wrapped a chain around my neck, in front of my wife! You don’t borrow $10,000 from the neighborhood bank. This was a criminal element. A chain around my neck! (#83, male member)

55 Note that in Twelve Step recovery, Step Four is often considered the courage step. In GA, Pressure Relief (facing your financial situation without any denial) often takes more courage than anything else. The following quotation comes from someone only 90 days into the program, yet already in the process of confronting harsh reality and dealing with aspects of steps Eight and Nine:

PI: And What was your main motivation for recovery? 94: Tired of being, tired of living a lie. That’s probably the… the money, I mean I, shit. A year ago I knew I was in a financial mess. I just kept… you know. And I mean, standing here talking to you, I’m in the same financial mess I was in, you know. You don’t recover from this in 90 days. So, yeah, I’ve paid a few bills off, but I got a few people not phoning me anymore cause they know what’s going on and we’re working on putting a program together. But I’m not living a lie anymore. I’ve come clean with the people that I need to come clean with. There’s a few people that I should come clean with, but I don’t need to. I have… I’m not bragging or patting myself on the back, but I’ve done a lot of house cleaning in the last 90 days. (#94, male member)

Here, we also run into one of the purported weaknesses in GA’s approach to Twelve Step recovery. Commentators, such as Brown (1991, 1994) and Lesieur (1990), made observations that quite a few GA members have vindicated in our interviews:

PI: And can you tell me how you went about working the steps? 91: Well, actually when I started in GA the focus was on the financial, most of it was on the financial restitution. I mean you had to do Step One, obviously. The powerlessness. But the emphasis of my first year or actually my first year and a half, was on the financial… it’s very difficult because it’s unlike the alcohol and the drug situation in AA and NA. Because the financial problems are so much greater than they would be in the other programs. But I really feel wholeheartedly, I really think … I don’t think I truly understood recovery until I did a good second and third step and then ten, eleven and twelve, those maintenance steps became part of my every day life. But two and three, I think that’s where GA loses a lot of our people… They go from one, admitting they’re powerless and their life’s unmanageable, and jump right to four and do the financial restitution. (#91, male member)

When asked whether he saw a way out of this dilemma, #91 had no answer, and simply said that, in a sense, he was fortunate that his experience in AA and NA got him to a better understanding and practice of the Twelve Steps. This is quite typical: members with experience in other Twelve Step fellowships are often more keen on the Twelve Steps and are often responsible for changing attitudes within GA (see section 9.9). We have found that this translates into positive responses with respect to life satisfaction measures (see section 9.10). Working the Twelve Steps seems to improve people’s lives. Ironically, another addiction may be a boon to many GA members. With the need for financial peace identified as crucial to most GA members, it is worth exploring the many ramifications of this reality. One interviewee, who actually made an effort to work the steps in their proper order, claimed to have had no experience with Pressure Relief (#70, female member). Despite dire financial circumstances when first coming to GA, this woman worked her steps in the proper order (with allowances made for paying off certain debts, which is technically a Step Nine endeavour). Pressure Relief, while often necessary, seems at times to inhibit a concerted effort in the Twelve Step process. Also, as mentioned, members tend to work the Twelve Steps at Step Meetings rather than with their sponsors (a notable difference from the norm in AA and NA):

PI: OK, and Step Three. Did you turn your will and your life over? 56 73: Somewhat. Not too much. PI: Not too much. Did you do a step four? Moral inventory? Financial inventory? 73: Yeah, when I was in the pressure group, yes. PI: In the pressure group you did a financial inventory. Did you ever sit down and write up a moral inventory? 73: I never did the written part of it. PI: But you did…did you do something like a step nine? Making amends to people that you’ve wronged? 73: ‘Make amends to people that we’ve hurt, except when to do so would injure them or others’. PI: You did that? 73: Off the top of my head. PI: But you never really go into the steps in a big way. 73: No I never… really into the step meetings . I’ve been to some meetings where you walk in and …step meeting…they all talk, if they want to, about that step. I’ve never really…into the steps. (#73, male member)

We found that Step Meetings often stay on a certain step for 1 month, and then move on to the next one. This can make for a haphazard approach for members who rely upon them:

And they have step meetings, and you have to work on that step that month. And some people may not be caught up to that step or whatever and not be at that… you know they may be new into the program and they’re coming in June. (#87, male member)

With a sponsorship system still in its formative stages, replies such as the following are common:

PI: Did you write a (fourth) step? 96: Yeah. I did fourth step work, with therapists along the way. (#96, male member)

There is often a lack of awareness of what working a step might mean, as well as ambiguity pertaining to one’s own efforts in this regard:

PI: Did you work Step Three? 27: I think so, yeah…” (#27, male member)

PI: And did you work the steps? Do you work the steps? 89: I think I do. (#89, male member)

PI: Do you work the Twelve Steps, #71? 71: I don’t say I work it as diligently as I should. But when I review the steps, there are some that you can take in order. And there are some that you can be working at the same time. PI: Have you written a fourth step, for example? 71: I have, I believe I have. PI: You believe you have? 71: I mean I don’t remember… the fourth step is to make amends? (Note that the fourth step is a “searching and fearless moral and financial inventory, and that amends are made in Step Nine; #71, male member)

PI: Did you work the Twelve Steps? 57 83: Yeah I guess at some point I did. (#83, male member)

Financial questions are not the only reason for this seemingly lax approach to Twelve Step work. In our previous study, we explored the theme of patience and why this virtue is likely even more important to gamblers than to substance addicts in recovery (Ferentzy et al., 2004, 2006B; see also section 9.11). Beyond the need to avoid the temptation of enjoying a quick thrill or release the addictive behaviour may offer, gamblers must also be on guard against the temptation to solve many problems quickly by means of winning large amounts of money while gambling. The latter temptation does not haunt alcoholics or drug addicts, and the need for a concerted focus on the virtue of patience sets GA apart from other Twelve Step fellowships. Arguably, GA’s entire recovery program is geared towards teaching patience, entailing a slow paced approached even to the Twelve Steps. Things are done slowly (perhaps necessarily), which can lead to procrastination or even neglect. The following statement comes from a GA member after 1.5 years in recovery, and beyond Step Two (and the inescapable need to pay some debts):

I haven’t gotten…no, it’s really slow. You have to be really patient. I mean, I may (have) gone ahead and realized… like there’s the one about the financial and moral inventory. (#74, female member)

Recall the importance of Page 17, particularly the admonitions pertaining to behaviours and attitudes to avoid (see section 9.11), and this matter becomes clearer:

PI: And what has Page 17 meant to your recovery? 74: It’s meant that it’s not instant. It’s meant that it does take time. (#74, female member)

Still, Pressure Relief, along with the entire issue of money, is key to understanding GA. We now turn to this issue.

10.6 Pressure Relief

Over the course of this study, we were fortunate to interview two longstanding GA members who were active in the development of the Pressure Relief system:

PI: What experience have you had with Pressure Relief? 89: I started it. Myself and…. wrote the thing…We did not start the concept of Pressure Groups… as a matter of fact… a multi-millionaire…was willing to lend the money to compulsive gamblers… And that fell through. First they were called pressure groups, not Pressure Relief. (#89, male member)

PI: So Pressure Relief is now about 42 years old. 89: Formally, yes. PI: Formally. And in what ways has GA’s approach to Pressure Relief or Pressure Groups changed over the years. 89: Oh basically its the same but… back then, money was the thing. Going bankrupt, that was unheard of. Bankruptcy was not as easily (achieved). (#89, male member)

PI: And what experience have you had with Pressure Relief? 79: Enormous. I was part of writing the Pressure Relief… And I believe it‘s one area of the program, outside of New York that’s truly lacking. And to me it’s an essential part of getting started in this program. (#79, male member) 58

To this day, GA frowns upon bankruptcy. It is perceived by many as a bailout, an abdication of responsibility destined to thwart someone’s recovery. As well, bankruptcy can fortify the perception that one really has a money problem rather than a gambling problem. In our last study, we were told by some members that many gamblers enter GA mainly because of the mistaken belief that the fellowship might somehow pay their debts (Ferentzy et al., 2004). This study has confirmed this observation. Such attitudes speak to the many delusions that often haunt compulsive gamblers, especially in the later stages of an addictive career. This belief represents a sense of entitlement that is especially rampant among those with an addiction involving the illusion one is destined to get rich without labour and live indefinitely in luxury. The Combo Book (GAISO, 1999) devotes some space to the compulsive gambler’s dream world. These attitudes not only hinder an individual’s recovery, but they seem at times to poison the atmosphere for others:

PI: What aspects of GA do you find the least helpful? 76: Would say that there are members have quite …there are members that aren’t quite ready to admit they’re own problem. They come in basically for that half hour or that hour that they’re in the meeting room. ‘I’ve got a problem and I need some help’. And trying to reach out the that person, welcome them into the fold, understand and then they disappear. Or they have other problems and you realize that they’re trying to ask you for loans. They’re coming in because they’re financially destitute. PI: I see. So you have known many people who go there hoping that GA will help them out financially? 76: There have been some, yes. (#76, male member)

85: One, I absolutely believed at my first, and even second meeting, that when I told other gamblers who was looking for me – organized crime people – that somebody in the fellowship was gonna write me a check to get ‘em off my back. (#85, male member)

Pressure Relief helps to dispel such illusions, while providing newer members with workable solutions. Still, in such a setting, moral and spiritual issues can be treated in a cavalier fashion, or simply put off. One member explains her journey through Step Four, which only on subsequent attempts involved a moral inventory:

The financial again for me was a no-brainer. It was the moral that I the difficulty with. (#19, female member)

Still, as our previous study already discovered, GA is changing. There is more focus on the Twelve Steps than before. There are more women. The advent of legalized gambling venues has even affected the type of gambler likely to attend GA meetings, many of whom are less likely to identify with the dream world. As mentioned, the ways in which people approach their debts has also changed over the last few decades:

PI: What experience have you had with Pressure Relief? 27: None. Other than you know we started a couple of times to try to establish a committee here in Ottawa. PI: You mean you don’t have a Pressure Relief committee in Ottawa? 27: No we don’t. PI: I see. 27: And we’ve tried a couple of ways, you know, starting it. But it kind of always fell through. The demand for Pressure Relief within Gamblers Anonymous, at least in my experience, isn’t 59 as high as maybe it was a long time ago. You know so much of it relates around debt counselling. And there’s probably so much professional debt counselling that goes on. People go that route. And by the time they get to GA or get to…they’ve already been bankrupt, you know, gone that route, and stuff like that anyway. So what are you gonna tell them? You gotta get help? (unclear) bankrupt now (#27, male member)

While financial issues are still important, they are perhaps less pressing than in the past. This may partly explain the increasing willingness among many members to address spiritual and psychosocial matters. Regardless of how one explains it, there is clearly a shift in perception that is, at least in part, generational. The other member, #79, who was instrumental in starting the Pressure Relief system, told us he considers it an essential part of the program, and does not understand how some are able to do without it. It should be discussed, preferably, “at the first meeting”. But as mentioned, it is not available everywhere:

That’s why I’m going to Kansas City where it’s nonexistent. And now I’m working with someone in Colorado who just started introducing it, and …in Boston they don’t do it. And in California it’s really weak. (#79, male member)

This member also identifies a paradox that has haunted GA from the start. As a Twelve Step fellowship employing a disease conception of addiction, GA must impress upon its members that their primary problem is not money but the addiction. The internalization of this belief is, according to many members we interviewed, imperative to healthy recovery within GA (see sections 9.4, 9.9, & 9.11). This, however, has not always been easy for many new members to accept:

The expression, you know, ‘Money’s not your problem. Gambling’s your problem’. But very few people call me up…. I’m calling because they have financial difficulties. No money. And if people come in to program, the first night and they have these huge financial problems…. And they give their therapy and everybody hugs them and “we love you and come back” and they leave and they wake up the next morning and their home’s gonna be foreclosed. And the credit card companies are calling. What are they supposed to do if they’re not told what to do? How do they get through that? (#79, male member)

This member also “never” did the Twelve Steps, because when he started, GA was a different fellowship, similar to the one Browne (1991, 1994) identified:

PI: Did you work the steps? 79: No. Unheard of when I came in program. PI: And after that you never bothered …. 79: No. PI: Why? 79: When I came in there was no such thing as a sponsor. Never heard the word I think for 15 years in the program. But I know that I (have) two significant people who are…I guess today you would call them sponsors though they didn’t work the steps. But looked over me…. And really were very concerned about my wellbeing and how I was doing. They literally called me every single day, and maybe two or three times a day. (#79, male member)

He is a more traditional GA member. He reported that he is keen on Page 17, and even suggested adamantly that fellowships such as AA could benefit from Pressure Relief. As he explains it, in his day, one might work Step One and then immediately move to Step Twelve (helping newcomers). As he said, the word “sponsor” meant nothing to him for many years, despite attending GA meetings. 60 Given that sponsorship and the Twelve Steps have long been considered central to recovery in other Twelve Step fellowships, this study has attempted to uncover how GA members achieved any recovery at all up until recently when these approaches started to receive more attention. We can now witness a different attitude, and one may cautiously state that it is ascendant. The following statement may qualify as a caricature of this perspective:

I don’t think there’s any, any place in recovery for Pressure Relief. I think you could ask for help, but to make it an absolute part of a program…. There’s nowhere in the Twelve Steps that that should be a part of the program. (#78, male member)

Having come to GA less than a year ago (despite a brief appearance back in 1981), this man has also had experience in AA and NA. He sees recovery primarily as a journey through the Twelve Steps. Unsatisfied with GA’s approach to recovery, he attends GA less often than the other fellowships, and even mentioned that he is not too keen on Page 17:

PI: What has Page 17 meant to your recovery? 78: Again, I think page 17…there’s no basis in recovery for that page. It’s not spiritually based. It’s more this is what you have to do, you know. It’s OK. It’s common sense, but like…it’s basically talking about abstinence. PI: Interesting. AA doesn’t take a stand on whether or not a member can go to bars or things like that, whereas page 17 is pretty clear: don’t go to gambling establishments. 78: Right. PI: Do you have any views on that? 78: Yeah, I mean actually, you know in the Big Book of Alcoholics Anonymous, and I read it recently, it says, we’re not gonna tell you not to go to a bar. If you have a legitimate reason to go to a bar, or a restaurant or a wedding or somewhere where alcohol is being served, then go. What are your intentions? if I had a conference in Las Vegas for business, I would probably go… I’d be in constant contact with somebody. But if I was there for a legitimate reason, I would go. (#78, male member)

Even the edict concerning not entering gambling establishments is questioned by this member, who perceives Pressure Relief as inconsistent with spiritual-based recovery. Our world is changing, and the following quotation provides an example of how old approaches to Pressure Relief do not always apply, and can even cause harm:

PI: Did you have any experience with Pressure Relief? 10: Yes. That was a disaster. PI: It was a disaster. 10: Because one of the…when my sponsor set me up with one person. And I had to call this person and I did. PI: Oh, I remember what happened! I remember from the last interview (from our previous study). 10: Yeah. PI: They insisted that your partner come and you said no. 10: I didn’t want that. And so he (the person providing Pressure Relief) was kind of nasty with me. PI: So then it never happened? 10: Oh no. PI: They wouldn’t budge on that one, eh? 61 10: No. And I think my sponsor was disappointed with me. She didn’t say a lot, but could read between the lines. (#10, female member)

This woman’s male partner was gambling, though not compulsively. Financially, their arrangement was that money matters were kept separate. While living together common law, older conceptions of common property and financial destiny simply did not apply. This woman believed that there was no reason to include her partner in the Pressure Relief session. This led to conflict with GA members who were set in their ways, and to longstanding resentments. For this and other reasons, the woman no longer attends GA.

10.7 The Serenity Prayer: Secularism and Spirituality in GA – An Uneasy Tension

PI: What role has the Serenity Prayer played in your recovery? 88: I say that a million times a day. It’s been invaluable in my life. (#88, female member)

Our EMAP report discussed how GA seems, overall, more guardedly secular in its orientation than other Twelve Step fellowships of which we are aware (Ferentzy et al., 2004, 2006A). Reasons identified include the need to overcome some of the mysticism that often accompanies problem gambling, and GA’s ethnic composition. Other scholars have discussed how GA, with a strong representation of Italian and Jewish members, could, for this reason alone, be adverse to religious proselytizing (Browne, 1994; Livingston, 1971). We also have reason to believe that issues specific to gambling might inhibit the spiritual process. If nothing else, members’ own experiences may lead to suspicion of such endeavours:

So I became an agnostic and I said if God was there God will show himself to me, you know. But I can tell you this now and I smile when I say this. In 9th grade at the racetrack when I put my last $8 on a horse, I said God let me win this... So who knows, you know… ten months after I came to GA I was on a business trip in California. And I wound up going to a conference that was there that weekend. And I know the person who said it but I don’t know what she said, she talked about…it was the spirituality workshop on Sunday morning and I heard something there. They got a connection. And I started developing a belief in a higher power. (#72, male member).

One way to unravel the complex mix of secularism and spirituality in GA is through the role of the Serenity Prayer, found on the cover of GA’s Combo Book: God grant me the serenity to accept the things I cannot change, courage to change the things I can, and the wisdom to know the difference (GAISO, 1999). Elsewhere, we have discussed how the theme of powerlessness (a Step One Issue) seems more poignant in GA than in similar, substance-related fellowships (Ferentzy, et al., 2006B; see sections 9.10 & 9.11). GA members perceive their addiction as an all-powerful force, and financial issues render the theme of unmanageability very real in the eyes of most members. There is also the sense of entitlement haunting many problem gamblers, with a prayer pertaining to acceptance of reality providing an important corrective. As well, there is the issue of just how God-centered such fellowships choose to be. While the Serenity Prayer does invoke God, it is less doctrinaire and less obviously monotheist than the Lord’s Prayer. The latter is popular at many AA and CA meetings in the GTA, and seemingly nonexistent in NA (which relies exclusively on the Serenity Prayer). In our earlier study, we found only one GA meeting that ever ended with the Lord’s Prayer. While contradictions are easy to identify, one might nonetheless appreciate why secular GA members may find solace in a prayer that is short, expresses sensible hopes, and is clearly nondenominational. Many problem gamblers seem to have spiritual needs, even if they take issue with anything even remotely mystical. 62 The popularity of this prayer speaks to this tension, and can often resolve it in the one way that matters most: it helps. The following quotation comes from a more religious GA member:

71: The Serenity Prayer becomes much more significant to me as time goes by. And that whole first section “Grant me the wisdom to accept the things I cannot change”, means that I don’t have some God granted power of insight to make all decisions. And that I …the serenity issue itself, and the calmness, you’re dealing with situations and the acceptance of things, something that I’ve been able to glean from senior individuals. At the beginning I was in such turbulence. And I had absolutely no serenity. And to see the individuals that had been through a story similar to mine, different than mine, but you know, there was a root cause that was very similar. To be able to have a certain perspective, and to allow events to unfold, knowing I can’t change them. That’s all with the patience and the serenity and part of spirituality and introspection. So I do... I’m getting more of a handle on that. The courage to change the things I can, is I believe about myself. And I am trying to work on character changes and expectations, where I had to be the decision maker and you know, do things my way. Now because of health, and because of opportunity and age, and maybe a little more realism, my expectations of myself are not as high. The expectations of my family, my immediate family, that’s my wife and children, were never as high as what I had of myself. So that’s something that’s an evolutionary process and that’s gonna take a lot of time, probably the rest of my life. (#71, male member)

The Serenity Prayer is central to the life of this fairly religious GA member (who brought up the prayer before we had a chance to ask about it). This in itself may not seem surprising, but below is what a very religious (Christian) member had to say:

PI: What role has the Serenity Prayer played in your recovery? 77: There have been times when I spent, you know, like a grasp, you know, get a hold of…there have been times when I had to draw on it heavily. I would say, then it kind of tapered off. I haven’t felt that kind of desperation in a while. It’s still a handy tool. I consider it a handy tool to have. (#77, male member)

Also, consider the member whose views on spirituality were so strong that he had issues with Pressure Relief and was not to keen on Page 17:

PI: What role has the Serenity Prayer played in your recovery? 78: It’s just another piece of it. You know. That makes sense to me. (#78, male member)

A theme that kept resurfacing was how more secular members seemed to rely on this prayer more heavily:

87: I have no views on religion. I don’t believe in it. I believe in a higher power. I believe in … and not that I’m against religion. But I just feel I don’t care what it is you believe in – be it Jesus, God, Buda, Moses, whoever it is – just as long as you believe in it. I always tell people I don’t care if it’s a pet rock. As long as you have belief then you have some spirituality. If you believe that thing or that person can help you, and I think anything religious is just a bunch of malarkey. Because all they’re looking for is money. (#87, male member)

PI: What role has the Serenity Prayer played in your recovery? 87: I gotta repeat it probably 10 times a day. I preach it to my children in a basic way, as far as you know when they have problems. You can accept what you can. Just the principles of 63 that I try to teach them. Can you do anything about it? No. Then you can’t worry about it. (#87, male member)

PI: Would you mind telling me your views on religion, or spirituality? 23: Yeah I’m a person who believes that all of us are one, that there’s not one person who is more important than another. And that there’s good in all of us. And with the GA program, with the higher power, for me I just look at it as higher power because don’t follow structured religion. For me it’s just a matter of surrendering to what is. And realizing it’s beyond what I can control. (#23, female member)

PI: What are the most important things you do for your recovery? 23: I say the Serenity Prayer every morning and I keep in touch with other GA members on a daily basis. (#23, female member)

The prayer was mentioned, without prodding, as possibly the most important aspect of her recovery.

Even where there is less enthusiasm, secular GA members tend to make use of this prayer. From a self-described agnostic:

PI: What role has the Serenity Prayer played in your recovery? 79: I think it’s a significant role when I can follow through on it. It’s hard for me to assert…to accept that. But you know I certainly think I understand it. (#79, male member)

We discussed how legal, financial, and at times, life-threatening issues can affect recovery in GA. Recall interviewee #74 (see sections 10.2 & 10.5), who at the time of the interview had been in GA for just under 2 years. It is easy to understand why such a person might still not be ready for a serious rapport with the Twelve Steps, yet be very reliant on the Serenity Prayer:

PI: What role has the Serenity Prayer played in your recovery? 74: Oh, it’s big. It’s really…it’s the thing that puts it all into perspective when I have legal issues. I mean, things just haven’t stopped for me. Unfortunately I’m still suffering fallout. But there are things that I can’t control. There are only things that I can deal with. And as long as you know you can’t control them, then you don’t waste time on them. Things that you can control, you can control your abstinence, you can control how you feel about certain situations, you can have a thought and realize it’s the wrong thought and change it around to being the right thought. And that is within your control. So the Serenity Prayer is very big. (#74, female member)

Similarly, the Twelve Steps are often worked via the Serenity Prayer. When asked how he had gone about working Step Three (turning over one’s will to a higher power), one member replied:

I had accepted that in that I accepted the Serenity Prayer that GA has, which is very powerful. And you know, I accepted the things that I cannot change. And I have the courage to change the things that I can, and I have and will continue to do. And I now have the wisdom to know the difference between what I can change and what I can’t. And that’s helped me immensely, because there are a couple of individuals that don’t particularly care for me. Or, I was trying to kind of convince them that, you know, this disease…this is this…this is that…that I’m not really bad person. I’m a good person, you know. And they just didn’t want any part of it. (#12, male member)

64 In this case, the financial wreckage was huge. While he had received solid support from family and many friends, in some cases forgiveness and understanding remained elusive. Elsewhere, we discussed how many GA members never really regain the trust of loved ones, and how many are prevented from controlling all but nominal amounts of money even after years of abstinence (see sections 9.10 & 10.3). Given that the dollar amounts are specific to gambling, we have no reason to believe that the same is true for AA and NA members. The Serenity Prayer begins with a plea for the ability to accept what cannot be changed, and it is not hard to understand why this message resonates so strongly in GA. From a woman who claims to have little use for spirituality and who no longer attends GA:

I say that (Serenity Prayer) all the time now, even at work. (#10, female member)

While spirituality has long been a hallmark of Twelve Step recovery, other commentators have noted how it is often imported by GA members with experience in other fellowships (Browne, 1991, 1994; Lesieur, 1990). We have found much the same (Ferentzy et al., 2006A). From a longstanding GA member:

Well when I first came into recovery I didn’t buy it, to be honest with you. And I used go all the spiritual workshops, fight with everybody that was doing it. M----- would be there. And I would wait to ask questions and my questions would be like “How come young people die?” And “Why do good people die?” and “Why do things happen?”. You know that kind of stuff. And I remember I was 8 or 10 years into the program, and M---- grabbed me and said “Kid, if you stick here long enough you’ll get it”. And what happened was my daughter had a drug and alcohol problem, and I ended up in Al Anon, and through Al Anon I got the spiritual part of the recovery program. (#28, male member)

To highlight the nebulous tension between religion, spirituality, and secularism in GA, we end this section with a quotation that speaks both to a member’s spiritual needs and to her suspicious attitude towards religion:

PI: Would you mind telling me your views on religion, or spirituality? 80: To me religion is following a bunch of rules that were made up by men. Spirituality is a relationship with God. PI: You call yourself a Christian. Do you go to Church? 80: I do. (#80, female member)

10.8 The Disease Model of Addiction – Its Role in GA

We are certainly not the first to explore the ways in which a disease conception of addiction can function in the lives of recovering addicts. We have, arguably, been the first to discuss this in depth with respect to GA. Other efforts, while significant, did not delve into this matter in ways that distinguish GA significantly from kindred Twelve Step fellowships (Cromer, 1978; Lesieur, 1998; Preston & Smith; 1985; Turner & Saunders, 1990). Though not the first to identify GA as especially keen in its focus on abstinence, we are likely the first to discuss the reasons for it (Ferentzy et al., 2004, 2006B; see also sections 6.2, 9.10 iii, & 9.11). In our EMAP study, we discussed how themes, such as abstinence and avoiding dangerous locations, seem more pressing in GA than in AA and NA, for example (Ferentzy et al., 2004). While we certainly were not the first to point out how these other fellowships may be more keen on spirituality as opposed to abstinence in comparison to GA (Browne, 1991, 1994; Lesieur, 1990), in our last study we made the following statement: “GA’s first Step is the same as AA’s, though of course gambling has been substituted for alcohol. In practice, though, GA has 65 adopted a different approach to powerlessness. In short, GA takes the concept more seriously” (see section 9.10 ii). In this study, we explored this thought, with extra attention to how it might play out in a fellowship that targets what is, after all, a non-pharmacological addiction. How, given that the very existence of gambling addiction is often contentious, can the concept resonate in such a powerful fashion? One of the first questions that comes to mind is whether, and to what extent, such disease conceptions help to alleviate guilt in healthy and productive ways rather than serving as a means to abdicate responsibility. Overall, our findings suggest the effect is positive:

PI: Now please tell me what recovery means to you. 12: Recovery means to me being serene, having some serenity. Recovery means not gambling anymore. Recovery means not even having thoughts of gambling. Recovery means forgiving myself for the kinds of things that I experienced. And I didn’t realize that this was an illness. And then I was …I quickly realized this was a disease. And that’s why I could accept the fact that I was addicted and that I had become powerless over this, over this addiction. I’d come to realize…that I am a compulsive gambler and I will die a compulsive gambler. And GA has….now helped me with the living issues. They helped with facing the tremendous fallout of gambling – all the destruction, all the serious consequences that come with recovery. (#12, male member)

However, the language used can at times be passive, suggesting a perennial victim status. #12 also said the following:

There isn’t a day that goes by that I don’t regret what happened to me. (#12, male member)

This, however, is often connected to the nebulous status with which the problem gambling world still struggles. In this case, the participant was a public figure who was vilified in the media. While one can only speculate, we suspect he would have received more understanding had his problem involved a substance addiction. Either way, the disease concept can, ironically, involve the acceptance of responsibility. Once the condition has been accepted, issues outside of oneself are harder to identify as the root of one’s tragedies:

WS: You mentioned you see it as a disease and that helped. Can you tell us a bit about what’s advantageous to that view? 79: It made me understand that I couldn’t do it alone. As long as I never viewed it as a disease, when I went through… I always believed you know it was just a bad habit, or luck would change. And once I saw it as a disease, and once I understood the connection between this disease and gambling, you know it made it so obvious to me that I couldn’t do this by myself. That I you know I … I put gambling in the same category as diabetes or cancer. It makes that simple to me to know that. (#79, male member)

One should not underestimate the power of these ideological assertions. Consider the following from a woman who reports having moderated her gambling after first achieving abstinence through GA:

PI: In your view, #10, what is compulsive gambling? 10: Oh, I guess it’s the way I was. You have to go and…you know you can’t stop yourself. PI: Would you consider yourself no longer compulsive, or less compulsive? 66 10: Um… less compulsive. But I think it’s like, I’ve never been an alcoholic but I’ve had a couple in my family and I think it’s like…alcoholism I think it’s always there. (#10, female member)

While agreeing with GA on compulsive gambling being a permanent (chronic) condition, this woman views the affliction along a continuum. This view is consistent with the position of harm reduction advocates, and inconsistent with a stricter disease conception that identifies the condition in absolutist terms (one either is, or is not, a compulsive gambler). Such absolutes are often key. This is the First Step in GA:

PI: What does a gambler need to do to recover? 76: First and foremost is the Step One, admit that you’re powerless over it. So if you choose to gamble, it’s gonna take you away. It’s gonna take you down with it. And so I would say understand that it is not something that you can control and choose not to. (#76, male member)

Nonetheless, we have discussed how recovery often proceeds slowly in GA, and have given many reasons for this (Ferentzy, et al., 2006B; see also sections 9.2, 9.11, & 9.10). We can surmise that with an addiction involving no ingested substance, the denial phase may also be extended for this reason:

PI: Has viewing compulsive gambling as a disease helped your recovery? 74: It did. It took me about six months to accept the fact that I was a compulsive gambler. I’m someone that needs things documented. I need proof. And I’ll never forget, at Belwoods one day, I was just about to hit my six months of abstinence... And I started getting more urges and I used to call them flutters inside, like would think of the gambling and then it would trigger a flutter inside of me that …oh if I went it would be really bad because I’ve been court ordered not to go, and just that kind of stuff would get me going….I accepted it at that moment, that I have this addictive disease inside myself and, yeah, it’s a disease. And I accepted it then. (#74, female member)

PI: What must a gambler do to recover? 74: A gambler first has to admit that they’re a gambler. And I think that’s the first step. (#74, female gambler)

PI: Please tell me what recovery means to you. 74: Recovery means to me that I …I will always have the addiction. (#74, female gambler)

Our investigation found that, overall, GA members are likely to view their affliction more in psycho-emotional terms than one would expect from other advocates of the disease conception. The latter holds, albeit inconsistently in practice, that addiction is a primary disease (i.e., a cause rather than an effect of other ills). The AA Big Book, for example, makes it clear that it is counterproductive to ask why one drinks to excess (AAAW, 1976). Such explanations are dismissed as hypothetical at best and, at worst, as making excuses. Conversely, the GA Combo Book discusses this matter in a noncommittal fashion. While discovering why one became a problem gambler may be important to some, recovery is often achieved without such awareness; essentially, the importance of such inquiries are left up to the individual (GAISO, 1999). While it is understandable that a fellowship struggling with a non- pharmacological addiction would be more open to psychological perspectives, this fact leaves an undeniable stamp on the ways GA members perceive their disease, and, by implication, how they recover. Many GA members insist on the significance of causal insight: 67

PI: And what does a gambler need to do to recover? 80: First of all stop gambling. And second of all be willing to dig deep within oneself and try to admit the pain maybe that they had earlier in their lives and work through that with someone who can help them do that. You know, recognize my emotions, what’s causing them and realize that their just feelings and it’s not something that I have to allow to control me. I think the biggest problem that I had was feeling stuck in my life and feeling helpless to do anything about it. It’s why I resorted to gambling. (#80, female member)

PI: Now 71, you mentioned one thing as we were walking over here. You told me that it is important for you to understand why you became a gambler. Some people care about that and some people don’t. In the Twelve Step approach they don’t put too much emphasis on that. But you do want to know why. 71: Oh, definitely. PI: Have any ideas? 71; Oh I believe it’s an emotional problem and I suppress the … let’s say the normal way of dealing with issues. And I blocked out what would have been normal decisions. Part of it is my own feeling of self-worth, my own ego, inability to accept any kind of failure. And really, right now, I find myself less critical of myself. I stopped… I can’t say I forgave myself yet for what I did to my family. But I’m not beating myself up like I did. I found that the counsellors at GA…or CAMH, the GA program, my addiction specialist and the psychiatrist have all been necessary components to my understanding myself. And what I was terrified with initially, and why it’s important to me, is if I just suppress gambling through just not gambling, abstinence, and I don’t go through real recovery I’m afraid it might surface in some other form of addiction. And I lived in two houses of recovery… So I‘ve seen people with cross addictions and I’ve spoken to many of them, and very few of them have gambling addiction. But they have very similar issues in their formative stages. And some of them were abused and… but the feeling of self worth, I found very, very common. (#71, male member)

While GA has typically been single-minded in its focus on abstinence at the expense of life issues, there is also a counter-tendency brought on (we suspect) by the very non-pharmacological nature of problem gambling. In a similar vein, though it might not be hard to understand why a problem gambler, focusing on issues underlying the condition, would have little difficulty identifying with other types of addicts in a lucid fashion, there is still a certain ambiguity that often haunts the efforts of GA members trying to make sense of this seemingly mysterious condition:

PI: Has viewing compulsive gambling as a disease helped your recovery? 80: Oh, yes. I think the most wonderful thing about coming into recovery was finding out that I’m not the only person who does it. You know, but it is a…it is an affliction of some sort. And you know, I do think a lot of it is emotional. (#80, female member)

PI: Do you see it as a disease? 94: Oh definitely. I’m, like, to me, you know I honestly compare it, like I don’t understand it. It’s emotional, it’s something inside me, but it’s a cancer inside eating me. (#94, male member)

Such confusion is certainly not universal, however, and GA members often demonstrate impressive levels of sophistication in these matters. This is especially true of GA members who have experienced serious substance addictions, as with the following two examples:

68 I got the same high from gambling as I did from cocaine. So there’s a physical effect on my brain chemistry when I gamble. (#78, male member)

Compulsive gambling is an addiction. And I absolutely have the view that it’s also a substance addiction, just like alcohol, just like chemical dependency. The difference of course being that we manufacture the substance in our brain rather than ingesting it. (#85, male member)

Even though #85 is an addiction treatment professional, we have found the experiential dimension, on its own, sufficient for inducing an inclusive grasp of addiction. There is also, in many cases, a lack of dogma: members are willing to consider many explanations:

PI: In your view, what is compulsive gambling? 19: Now I do believe that it is an illness. I don’t know if it is a physical illness or just an emotional illness. I think the school’s still out on that. But there may be some physical connection, but I do definitely believe that it’s an emotional illness. (#19, female member)

This, however, need not detract from the perceived emergency pertaining to acceptance of a disease model of some sort:

PI: What does a gambler need to do to recover? 19: They need to accept that it’s a disease. They need to want to recovery, to really want – they have to be done with gambling to accept that this has ruined their life and they want to recover. (#19, female member)

As mentioned, GA members we interviewed tended to demonstrate an affinity with addicts of all stripes:

Compulsive gambling…it’s an emotional problem that drives us to …it could be an escape, it could be seeking euphoria… I’ve always said that we take our poison, whether it’s gambling, eating, sex, alcohol, drugs ….very similar in nature, just poisons is all. (#76, male member)

Well I think that we all have addictive personalities. We all seem to do things to excess no matter what it is we’re doing. Whether it be gambling, drinking, working – everything seems to be excessive. And that is…I don’t really know what that … I mean it’s a personality fault of some sort. (#13, female member)

Essentially, the two statements above represent the most common view we found in GA: that of an addictive personality or disposition. While this does not seem to affect members’ views on their ability to consume alcohol (most non-alcoholic GA members seem to drink, and without incident), members tend to be guarded about an affliction that may assume other forms – this despite GA’s purportedly single-minded focus on abstinence from gambling. Clearly, we can speak of counter- tendencies in operation. In all, members tend to demonstrate some sophistication in their understanding of the affliction. Many explanations are given:

Compulsive gambling is an insanity that comes out of my character defects. (#5, male member)

I see it was a symptom of a larger spiritual problem. (#77, male member)

69 I absolutely believe that this is an emotional spiritual disease that demands and emotional spiritual solution. (#85, male member)

I think it’s an emotional disorder and disease. When I first came into GA I thought it was a financial problem. And today I realize that that’s not the case. (#88, female member)

Perhaps the last quotation speaks to the most important matter: members no longer view their affliction in terms of normal reality. Specifically, they no longer see their problems as stemming from external circumstances, but rather from within themselves. Ironically, this is precisely what can alleviate guilt and overcome the need to keep fighting with the world around them:

PI: Steps six and seven are about character defects. Did you work on those? How did you play it if you did? 19: I did work on those. It seems like simple words, ‘entirely ready’, but I wasn’t entirely ready until I fully believed that it was an illness. And that I could get myself off the hook. And the more I came to this belief, and this realization, the more ready I became. (#19, female member)

One can perhaps guess at how, and why, many GA members come to see their addiction as a blessing in the long run. For example, one can speak of:

Getting my life back and becoming the person that, or even a better person than I used to be. (#19, female member)

And from my consequences from doing what I did, I have a better life now. I don’t think I’ve had the life that is half as good now, the marriage that is half as good now, I would if I haven’t gotten into all this trouble. (#74, female member)

PI: And what kind of relationship do you have with family members today? 80: Really good. It’s better than I ever envisioned it would be. (#80, female member)

In the end, many GA members perceive their affliction as a call to a higher morality. Minor misdeeds, which normal people can perhaps afford, could take compulsive gamblers down a path they desperately wish to avoid:

If I was to do something that was wrong, and maybe feel very bad about myself, I would probably go to gambling again. Cause I see gambling as a punishment. (#96, male member)

…and I get down to the bottom… And until I get to the part where it says there’s the theory about wanting to punish ourselves, that’s me. That is me. First time I ever read it, the first night, first meeting I ever went to, somebody else was reading it. But I was following along. And that’s one of the few things that really grabbed my attention my first meeting. (#94, male member)

10.9 Recent Changes in GA

This subsection is delivered in no particular order. It simply presents findings that are worthy of note, and perhaps of exploration for further study.

70 i. Members report that, overall, newer members are younger than in past. Over 20 years ago, it was rare to find newer members under the age of 30.

The average age of people coming into the program in the last ten fifteen years has dramatically changed... When I came in I was the youngest person at a meeting of 60 people. When I first came in I was 25 or 26. And everybody was old enough to be my father. (#79, male member) ii. The percentage of women has increased. This matter has been discussed both in this report and the previous one (Ferentzy et al., 2003, 2004). iii. This last point ties into another. The often discussed distinction between action and escape gamblers, while arguably simplistic, has some bearing according to the interviews we conducted. Many members reported that a new breed of GA member has been on the increase. Different types of gamblers are becoming more common. The distinction between escape and action gamblers seems applicable to the data we uncovered:

PI: How do you feel about war stories? 82: That’s a good question. I would say that it effects different people differently. The people that are into GA and still involved in GA are willing to talk war stories constantly. But there’s a different set of people that have come into GA. Maybe video poker addicts – that war stories bring out inside of them… depressing feelings. Whereas people like myself, who thrived on the excitement and the action, the adrenalin rush of gambling in a lot of ways, love to talk about war stories… But that was what created that little common bond in that box. But there are a lot of people coming into GA now that don’t thrive on talking about war stories. They don’t like coming to the meetings cause there’s too many stories …which brings back all the, elicits all the old memories and makes them feel bad about themselves. That’s turning off a big set of people. And I think that’s probably not that much discussed or investigated. I think that’s why so many people don’t keep coming back. (#82, male member)

Some gamblers spoke of the excitement that gambling provided, while others mentioned the escape from lives that were dreary, meaningless, or unpleasant. While many researchers have been critical of this distinction, our findings suggest that there is some validity to it, even if the categories are imperfect and require qualification. Gender is one marker to be considered. Our EMAP study found that war stories are far less popular among women than men (Ferentzy et al., 2003, 2004; see also sections 6.4, 9.2, 9.4, & 9.9). Other scholars have reached similar conclusions (Mark & Lesieur, 1992). In general, women are more likely to fall into the escape category, and the dream world of the compulsive gambler is something to which they are less likely to relate (see section 10.6):

PI: Well, you mentioned for example that the dream world wasn’t really a big part for you, where it is for most of them. 80: Well that’s true. Women …I really relate with women gambling because I think most of us gamble for escape. We weren’t in it for the action we’re in it to zone out. (#80, female member)

PI: Do you miss gambling? 19 I would have to say I miss the solitude. I know it sounds strange cause I’m a casino gambler, but when I was gambling I was alone. I wasn’t responsible. Didn’t have to listen to anybody. I was on my own. (#19, female member)

71 11. Interpretations, Conclusions, and Implications

Our findings confirm the importance of social support to recovery from addictions in general, and problem gambling in particular. Often, such support seems more important than a new member’s alleged motivation for recovery. Perhaps a key lesson pertains to clinical procedures as a whole: often sociological issues cannot be ignored, and a broader conception of recovery is required. In the case of GA, changing family and gender roles have drastically affected the recovery process, with GamAnon’s role declining and other aspects of the program becoming more important, at least in part to fill that void. If, as our findings would suggest, a lack of outside social support is the best predictor of attachment to GA and to its precepts, this may also apply to why many become attached to psychiatrists and other treatment professionals. We are, after all, social beings, and the unhealthy behaviours many of us pursue must, to some degree, be seen in a social light. Social isolation, whether obvious or of a more subtle, psychological nature, is likely to have some causal bearing upon the onset of PG and other troublesome behaviours. It stands to reason that the solutions are also social. Our findings also pertain to the unique needs of problem gamblers. While similar in many ways to substance addicts, GA members have created a recovery culture suitable to their needs. The issue of debt load affects the way every aspect of the Twelve Step program is pursued. Alternatively, it may inhibit the pursuit of the Twelve Steps entirely. It may take GA members much longer to embark upon, and subsequently complete, a Twelve Step journey than AA or NA members, and we explored the reasons for this in detail. While any mutual aid fellowship, or treatment institution for addicts of any kind, will be affected by a changing world, this is doubly true for GA (and possibly for those treating gamblers). First, with the role of spouses accentuated in GA, changing gender roles have affected GA in ways that are arguably unique. Second, with the nature of gambling itself changing so quickly (e.g., newer, different forms of gambling are becoming more popular), along with the recent proliferation of legal gambling venues, GA has had to face challenges that are arguably greater than those faced by other mutual aid organizations. One thing that makes GA so difficult to study is that it is changing quickly and drastically. The so called dream world of the compulsive gambler, for instance, is discussed in the Combo Book (GAISO, 1999). However, today a greater number of new members cannot relate to this dream. Our findings suggest many slot players, and many women, do not think this way while gambling. From the nature of marriage and spousal support to the nature of problem gambling itself, the ground upon which GA once stood firmly has been starting to shift. Despite all of this, we can point to two constants that apply both to GA and the larger world of mutual aid. First, interpersonal, peer support continues to function positively. Second, the disease conception of addiction serves to alleviate guilt and shame while – perhaps ironically – discouraging members from looking outside of themselves for the cause of their ills, thereby leading to an assumption rather than an abdication of responsibility. These two features are unlikely to change, and will ensure that GA continues to play an important role in our overall efforts to assist problem gamblers with their recovery.

12. Future Research

Our findings are consistent with those of more recent studies suggesting that social and peer support are key predictors in the achievement of treatment goals (Gillian et al., 2007; Humpherys, 2004). Fresher approaches to studying the entire recovery process, such as some of the more recent discussions surrounding social capital, may offer the most promising venues (Kwame, Whitley, & Weich, 2002). Further exploration of GamAnon’s role is consistent with this endeavour. Given the shifting gender roles our culture is witnessing, is GamAnon on its last legs or, eventually, will more 72 male partners be willing to participate? Given that we found a lack of outside social support to be a good predictor of a gambler’s need to affiliate strongly with GA, it is fair to ask whether social isolation is an important cause of many gambling problems in the first place. Again, studies surrounding social capital seem promising to such inquiries. Theoretical preferences aside, we would recommend anyone studying GA to devote special attention to the overall role of spousal support in recovery patterns and outcomes. Such knowledge would also enhance our understanding of recovery from gambling problems outside of GA. We suggest strongly that some of the ground we have broken in this study be addressed with quantitative tools. The connection between spousal support and recovery outcomes would, for example, be an obvious target for such an unquiry. Our findings suggest that affiliation with other Twelve Step organizations affects the ways GA members pursue their recovery. The effects of such cross-affiliation – whether or not the other organization is based upon AA’s Twelve Step model – warrants further scrutiny. The role of the often berated disease conception of addiction should be explored in greater detail. Its veracity may be less pertinent than its therapeutic effect, and GA and other Twelve Step fellowships have seemingly made good use of it in two ways: first, the model alleviates guilt and shame, making self-esteem (along with healthy recovery) a possibility; and second, the model precludes laying blame upon externals, thereby permitting members to take responsibility for their behaviour. These findings have serious clinical implications and warrant further scrutiny. We also recommend that GA’s highly creative approach to spirituality receive some attention. Since our study found that GA has been changing, and that many of these changes – from gender roles, to financial issues and the types of gamblers now entering the fellowship – can be attributed to issues outside of GA, sociological inquiries would also be appropriate. The decline of GamAnon and the proliferation of legal gambling venues are two reasons GA has likely been changing far more drastically than other fellowships, such as AA and NA. Implications and future directions should be explored. While we rarely deal in certainties, the following conclusion is unavoidable: GA will continue to play an important role in our overall efforts to assist problem gamblers. Cost-effectiveness alone will ensure that formal treatment centres use it as an adjunct. As well, given North America’s tradition of reliance upon mutual aid in so many spheres of life, GA will continue to be important. The findings from this study suggest that changes within this fellowship render it perhaps even less well known than when our original inquiries began in 2002 (and we complained back then that GA was understudied). Understanding GA, its nature and its role, needs to be considered a research priority.

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Appendix A. Original Interview Protocol

Note that severity of gambling problem and types of games pursued was covered by the Canadian Problem Gambling Index which was given to all participants. Subjects also filled out a brief paper-and- pencil survey covering such demographic characteristics as gender, age, ethnicity, religious background, education, form of employment, current income, marital status, and number of children.

Part One: 1. Why don’t we start with an introduction? Could you please tell me a little bit about yourself? 2. When you first entered GA and took the 20 Questions, how many “yes” answers did you give? 3. Have you ever had any substance addictions? 4. What kind of professional therapy did you receive either before or during GA? 5. Would you mind telling me your views on religion, or spirituality? 6. In your view, what is compulsive gambling? 7. When you first entered GA, what was your financial situation? 8. What kind of support for your recovery did you receive from family and friends? 9. What kind of relationship did you have with family members when you first entered GA?

Part Two: 10. When you came into GA, what was the very first thing you did for your recovery? What did you do after that? 11. Please tell me what recovery means to you. 12. How many meetings do you go to in an average week? 13. What aspects of GA do you find most helpful? Which are least helpful? Why? 14. What are the most important things you do for your recovery? 15. Do you go to many other GA events, such as conferences? 16. Do you associate with many GA members in your private life? 17. What kind of service work are you involved in?* 18. Do you have a sponsor? 19. How many sponsees do you have? 20. What has Page 17 meant to your recovery? 21. What did you, and do you, do to work Step One? (“…” Step Two, Step Three, etc.)

Part Three: 22. What is your financial situation like today? 23. Do you miss gambling? 24. How successful have you been in maintaining abstinence? 25. How content are you with your life as it is? 26. How well do you like your work? 27. What kind of relationship do you have with family members today?

* “Service” refers to any activity on behalf of GA, from helping to make coffee at meetings to helping arrange conferences and working on the GA phone line.

86 Appendix B. Final Interview Protocol

Note that severity of gambling problem and types of games pursued was covered by the Canadian Problem Gambling Index which was given to all participants. Subjects also filled out a brief paper-and- pencil survey covering such demographic characteristics as gender, age, ethnicity, religious background, education, form of employment, current income, marital status, and number of children.

Interview #: Interviewee #:

Demographic Information

Please note that you have the right not to answer any or all of these questions if you so choose.

1. Age ______

2. Gender______

3. Occupation______

4. Ethnicity______

5. Do you practice any religion? If so, which one?______

6. Have you ever belonged to any other 12 Step Fellowships? If so, which one’s?

7. Education ______

8. Marital Status______

9. Number of children______

10. Current Income______

11. City (town) of residence ______

Interview Protocol

Note that severity of gambling problem and types of games pursued will be covered by the CPGI (Canadian Problem Gambling Index) which will be given to all participants. Subjects will also fill out a brief paper-and-pencil survey covering such demographic characteristics as gender, age, ethnicity, religious background, education, form of employment, current income, marital status, and number of children

Part One: 1. Why don’t we start with an introduction? Could you please tell me a little bit about yourself? 2. When did you first enter GA? 3. How long have you been abstinent? 4. When you first entered GA and took the 20 Questions, how many “yes” answers did you give? 5. Have you ever had any substance addictions? 6. What kind of professional therapy did you receive either before or during GA? 7. When you first entered GA, what was your financial situation? 87 8. What kind of support for your recovery did you receive from family and friends? 9. What kind of relationship did you have with family members when you first entered GA? 10. Would you mind telling me your views on religion, or spirituality? 11. In your view, what is compulsive gambling? (Do you see it as a disease?) 12. Has viewing compulsive gambling as a disease helped your recovery? 13. What are compulsive gamblers like, in your view? What is a gambler? 14. What does a gambler need to do to recover? 15. Do you have any thoughts on what you have in common with other compulsive gamblers? 16. Any thoughts on how you may differ from other compulsive gamblers? 17. Do you have any thoughts on why some people leave GA? 18. In your view, has GA changed significantly over the years? (In what way?) 19. How do you feel about war stories? (Has their importance diminished or increased over the years?) 20. How has GamAnon been doing in your view? 21. The Combo Book talks about the “dreamworld” of the compulsive gambler. Does this apply to all compulsive gamblers?

Part Two: 1. When you came into GA, what was the very first thing you did for your recovery? What did you do after that? 2. What was your main motivation for recovery? 3. Please tell me what recovery means to you. (After, ask about “normalcy” or sanity). 4. How many meetings do you go to in an average week? 5. Has this changed over time? 6. What aspects of GA do you find most helpful? Which are least helpful? 7. What are the most important things you do for your recovery? 8. What aspects of your recovery are dealt with outside of GA, and in what way? 9. Do you go to many GA events, such as conferences? 10. Do you associate with many GA members in your private life? 11. (if so) please describe the activities. 12. Is GA your main social support for recovery? 13. (if not) What is your main social support? 14. What kind of service work are you involved in?* 15. What experience have you had with Pressure Relief? (has GA’s approach to Pressure Relief changed over the years?) 16. Could you describe the role that phone contact with other GA members plays in your recovery? 17. Do you use a phone list? 18. Do you call more often than you are called? 19.Do you have a sponsor? 20. Could you describe your relationship? 21. How many sponsees do you have? 22. How do you help your sponsees, how does the relationship work? 23. What role has the Serenity Prayer played in your recovery? 24. What has Page 17 meant to your recovery? 25. And can you tell me how you went about working the steps?

Part Three: 1. What is your financial situation like today? 2. Do you miss gambling? 3. How successful have you been in maintaining abstinence? 4. How content are you with your life as it is? 88 5. How well do you like your work? 6. What kind of relationship do you have with family members today?

* “Service” refers to any activity on behalf of GA, from helping to make coffee at meetings to helping arrange conferences and working on the GA phone 89 Appendix C. Canadian Problem Gambling Index (CPGI)

1. Have you ever spent money on

Card Games Yes ____ No____

Horse races, dog races, other activities involving animals Yes ____ No____

Sports Yes ____ No____

Dice Games Yes ____ No____

Casinos Games Yes ____ No____

Numbers or Lotteries Yes ____ No____

Bingo Yes ____ No____

Stocks, or Commodities Market Yes ____ No____

Slot machines, poker machines, or other gaming machines Yes ____ No____

Bowling, pool, golf or some other game of skill Yes ____ No____

Pull tabs or paper games other than lotteries Yes ____ No____

Any gaming no listed above (please specify) Yes ____ No____

Activity: Card Games: Daily____ 2-6 times/week____ about once a week___ 2-3 times/month___ about once a month___ between 6-11 times/year___ between 1-5 times/year___ never in the past year ___

Activity: Horse races, dog races, other activities involving animals Daily____ 2-6 times/week____ about once a week___ 2-3 times/month___ about once a month___ between 6-11 times/year___ between 1-5 times/year___ never in the past year ___

Activity Sports: Daily____ 2-6 times/week____ about once a week___ 2-3 times/month___ about once a month___ between 6-11 times/year___ between 1-5 times/year___ never in the past year ___

Activity Dice Games Daily____ 2-6 times/week____ about once a week___ 2-3 times/month___ about once a month___ between 6-11 times/year___ between 1-5 times/year___ never in the past year ___

Activity_ Casinos Games Daily____ 2-6 times/week____ about once a week___ 2-3 times/month___ about once a month___ between 6-11 times/year___ between 1-5 times/year___ never in the past year ___

Activity_ Numbers or Lotteries Daily____ 2-6 times/week____ about once a week___ 2-3 times/month___ about once a month___ between 6-11 times/year___ between 1-5 times/year___ never in the past year ___

90 Activity__ Bingo: Daily____ 2-6 times/week____ about once a week___ 2-3 times/month___ about once a month___ between 6-11 times/year___ between 1-5 times/year___ never in the past year ___

Activity_ Stocks, or Commodities Market: Daily____ 2-6 times/week____ about once a week___ 2-3 times/month___ about once a month___ between 6-11 times/year___ between 1-5 times/year___ never in the past year ___

Activity Slot machines, poker machines, or other gaming machines: Daily____ 2-6 times/week____ about once a week___ 2-3 times/month___ about once a month___ between 6-11 times/year___ between 1-5 times/year___ never in the past year ___

Activity__ Bowling, pool, golf or some other game of skill: Daily____ 2-6 times/week____ about once a week___ 2-3 times/month___ about once a month___ between 6-11 times/year___ between 1-5 times/year___ never in the past year ___

Activity__ Pull tabs or paper games other than lotteries: Daily____ 2-6 times/week____ about once a week___ 2-3 times/month___ about once a month___ between 6-11 times/year___ between 1-5 times/year___ never in the past year ___

Activity______Daily____ 2-6 times/week____ about once a week___ 2-3 times/month___ about once a month___ between 6-11 times/year___ between 1-5 times/year___ never in the past year ___

3. Activity__ Card Games Minutes and/or hours______

Activity Horse races, dog races, other activities involving animals Minutes and/or hours______

Activity__ Sports: Minutes and/or hours______

Activity_ Dice Games: Minutes and/or hours______

Activity_ Casinos Games: Minutes and/or hours______

Activity__ Numbers or Lotteries: Minutes and/or hours______

Activity__ Bingo: Minutes and/or hours______

Activity__ Stocks, or Commodities Market: Minutes and/or hours______

Activity Slot machines, poker machines, or other gaming machines: Minutes and/or hours______

Activity__ Bowling, pool, golf or some other game of skill: Minutes and/or hours______

Activity_ Pull tabs or paper games other than lotteries: Minutes and/or hours______

Activity______Minutes and/or hours______

Activity__ Card Games: dollar amount______

Activity Horse races, dog races, other activities involving animals dollar amount______

Activity___ Sports: dollar amount______91

Activity__ Dice Games: dollar amount______

Activity__ Casinos Games: dollar amount______

Activity___ Numbers or Lotteries: dollar amount______

Activity___ Bingo: dollar amount______

Activity__ Stocks, or Commodities Market: dollar amount______

Activity_ Slot machines, poker machines, or other gaming machines: dollar amount______

Activity__ Bowling, pool, golf or some other game of skill: dollar amount______

Activity__ Pull tabs or paper games other than lotteries: dollar amount______

Activity______dollar amount______

Activity Card Games: dollar amount______

Activity Horse races, dog races, other activities involving animals: dollar amount______

Activity__ Sports: dollar amount______

Activity__ Dice Games: dollar amount______

Activity__ Casinos Games: dollar amount______

Activity__ Numbers or Lotteries: dollar amount______

Activity___ Bingo: dollar amount______

Activity__ Stocks, or Commodities Market: dollar amount______

Activity__ Slot machines, poker machines, or other gaming machines: dollar amount______

Activity__ Bowling, pool, golf or some other game of skill: dollar amount______

Activity__ Pull tabs or paper games other than lotteries: dollar amount______

Activity______dollar amount______

6. Never___ sometimes___ most of the time___ almost always___

7. Never___ sometimes___ most of the time___ almost always___

8. Never___ sometimes___ most of the time___ almost always___

9. Never___ sometimes___ most of the time___ almost always___

10. Never___ sometimes___ most of the time___ almost always___ 11. Never___ sometimes___ most of the time___ almost always___

92 12. Never___ sometimes___ most of the time___ almost always___

13. Never___ sometimes___ most of the time___ almost always___

14. Never___ sometimes___ most of the time___ almost always___

15. Never___ sometimes___ most of the time___ almost always___

16. Never___ sometimes___ most of the time___ almost always___

17. Never___ sometimes___ most of the time___ almost always___

18. Strongly agree_____ Agree____ Disagree____ Strongly disagree____

19. Strongly agree_____ Agree____ Disagree____ Strongly disagree____

20. Yes___ No___

21. Yes___ No___

22. Yes___ No___

23. Yes___ No___

24. Yes___ No___

25. Yes___ No___

26. Yes___ No___

27. Yes___ No___

28. Yes___ No___

29. Yes___ No___

30. Yes___ No___

31. Yes___ No___

32. Yes___ No___

33. Yes___ No___