Exploring Mutual Aid Pathways to Recovery from Gambling Problems

Exploring Mutual Aid Pathways To Recovery From Gambling Problems

Peter Ferentzy, PhD Centre for Addiction and Mental Health

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

Paul Antze, PhD York University

1 Table of Contents

Acknowledgements 3

Abstract 4

Executive Summary 5

Introduction 8

Purpose and Goals 9

Literature Review 13

Research Design & Methodology 26

Research Sample 30

Findings 31

Interpretations 42

Conclusions and Implications 65

Future Research 66

References 68

Appendix 87

Project Report 91

2 Acknowledgements

We would like to thank the Ontario Problem Gambling Research Centre, not only for the initial grant, but for their extra support to allow us to complete this project when external events, including the SARS crisis of 2003, interfered with our work. The support and encouragement of the entire staff team at OPGRC is deeply appreciated.

We would like to thank Ines Moreira for her administrative support throughout the study.

Finally, we are deeply indebted to those who participated in our individual interviews. By sharing their stories they help us to understand how people can make and sustain positive change, and offer lessons of hope for people affected by gambling problems. To those who made us welcome at GA and NA meetings, we are indebted to their invitation into those moments of fellowship.

ABSTRACT:

This ethnographic study, involving participant observation at Gamblers Anonymous (GA) and Narcotics Anonymous (NA) meetings and interviews with subjects from both fellowships in the Toronto area, was designed to provide a more in-depth and empirically grounded account of GA’s recovery culture than what has been available so far. A secondary aim was to develop a better understanding of NA beliefs and practices and their use as a resource by problem gamblers with substance abuse issues. Not only has GA been understudied, with the literature providing more evaluation than description, this study has revealed that the little available information on GA is now largely dated. GA has earned a reputation for being an almost exclusively male fellowship, pragmatically focused on abstinence from gambling and on debts at the expense of discussions of emotional issues, and as a 12 Step fellowship in name only where the spiritual side of things is mostly ignored. Yet today in the Toronto area, the percentage of women in GA may be as high as 20 percent and rising, discussions of feelings and “life issues” are actively encouraged, and members have become far more focussed on the 12 Steps than in the past. Possible reasons for these changes – which seem to be taking place in GA throughout North America – are discussed, along with GA’s culture of recovery and its unique (among 12 Steps fellowships) emphasis on the virtue of patience. Our impression of NA as a potential resource for problem gamblers is also discussed.

Key Words: Gamblers Anonymous; Narcotics Anonymous; Self Help; Mutual Aid; Pathological Gambling.

4 Executive Summary

This project was preceded by the compilation of an annotated bibliography – funded by an OPGRC Incentive Grant – covering literature on Gamblers Anonymous and other material as it pertains to mutual aid options for gambling problems and co-occurring substance abuse problems. We were, therefore, fully acquainted with the available material on GA before embarking upon this inquiry.

Our investigation drew its rationale from two central premises, widely supported in the literature: 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. The literature on this organization was rife with controversy on such basic questions as whether GA is suited to the most troubled gamblers or those who are least troubled, whether it is the most effective approach or largely ineffectual, and whether its purported benefits stem from aspects of the “program” itself or are simply the function of group support. Our study was designed to be descriptive rather than evaluative: rather than pass sweeping judgement on GA, pro or con, we wanted to learn about whom, and in what way, GA is able to help.

We sought to uncover information about the following ways in which:

1. GA members perceive problem and pathological gambling. 2. GA members perceive and practice recovery. 3. gamblers reconstruct and describe their past experiences according to narrative formulas shared by GA. 4. their descriptions of their current lives “in recovery” conform to certain tenets which define the group’s understanding of what recovery means. 5. the lessons behind these stories are employed by members in managing their lives (choices, plans, etc.).

GA had earned a reputation for being an almost exclusively male fellowship, pragmatically focused on abstinence from gambling and on debts at the expense of discussions of emotional issues, and as a 12 Step fellowship in name

5 only where the spiritual side of things is mostly ignored. Commentators have claimed that GA is less effective as an overall therapy than AA which supposedly provides a broader conception of recovery.

By contrast, NA is strongly geared toward discussions of feelings. Partly because it deals with a range of drugs, NA has no substance specific physical addiction concept like the one used by AA but a broader, psycho-emotional conception of addiction. Regarding NA, the following questions guided us:

1. Whether NA’s broader addiction concept, which includes all drugs and emphasizes the notions of compulsion and obsession rather than physical addiction, may be more helpful to gamblers who may attend two fellowships than AA’s conception as gambling addiction involves no substances and is also understood in psychological rather than physical terms. 2. Whether NA’s emphasis on emotional issues may provide a counterweight to GA’s alleged exclusion of such matters for members attending both fellowships. 3. Whether many problem gamblers with substance abuse issues could find their recovery exclusively in NA.

Not only had GA been understudied, this inquiry has revealed that the little available information on GA is now largely dated. Today in the Toronto area, the percentage of women in GA may be as high as 20 percent and rising, discussions of feelings and “life issues” are actively encouraged, and members have become far more focussed on the 12 Steps than in the past. These changes seem to be taking place throughout North America.

We found that GA views pathological gambling in very strong terms, with most longstanding members perceiving themselves as potentially vulnerable to relapse and in need of avoiding gambling establishments. We have spoken to GA members who will not associate with persons who gamble, even those who only do so recreationally.

We have learned that GA’s culture of recovery is unique among 12 Step fellowships, and that this is 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 which 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 others 12 Step fellowships, it is pronounced more strongly in GA. For example, GA members tend to go through the 12 Step process at a slower pace on average than their AA and NA

6 counterparts. It is possible – with caution – to view the 12 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 12 Step fellowships, has at least some good cause to have evolved 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, 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 12 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 slow and measured paces.

While we have cause to believe that NA may be helpful to gamblers with co- occurring substance abuse disorders, we uncovered little evidence that NA in any way amounts to a better place for gamblers than AA. Further, GA has changed and is currently a far better place for discussions of emotions, throwing into question the need for any “compensation” NA may provide. With respect to the possibility that some gamblers with substance abuse issues could use NA exclusively, we found that NA is no substitute for GA due to a host of issues specific to gambling addiction which a substance oriented fellowship is poorly equipped to address.

7 1. Introduction

Founded in the 1950s, or a little earlier by some accounts (Browne, 1994), Gamblers Anonymous (GA) is a mutual aid fellowship based on 12-step principles. GA has groups in most North American communities, and has established itself worldwide as a resource for people struggling with gambling problems. GA has a unique culture of recovery that in certain ways distinguishes it from fellowships such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA). The most obvious difference may stem from the crippling financial difficulties many gamblers face: GA devotes much time and energy to counseling members on financial and legal challenges.

GA can be distinguished from formal treatment in that it involves peer support rather than professional intervention, yet its objectives are similar: to help members stop gambling and address character "defects," such as self- centeredness, which are purported to have led to the excessive gambling (Custer & Milt, 1985). However, what really distinguishes GA from formal treatment is not only the power of group dynamics, which institutions often provide, but that practitioners have no involvement. Since gamblers receive help only from other gamblers at GA, both the terms "self-help" and "mutual aid" are salient concepts for understanding this distinction. Part of a larger mutual aid and self-help movement based upon the 12 Steps of AA, and focussed upon a compulsive behavior that need not involve psychoactive substances, GA provides an excellent example of how the 12-step movement has been extended well beyond alcoholism to include other behaviors which can disrupt people's lives.

This ethnographic study involved participant observation at Gamblers Anonymous and Narcotics Anonymous meetings, and interviews with members of both groups in the Toronto area. Its primary objective was to develop a comprehensive understanding of GA beliefs and practices as experienced by individual members in order to place discussions about the group’s effects on a more firmly empirical footing. A subsidiary aim was to develop a better understanding of NA beliefs and practices and their use as an alternative resource by problem gamblers.

8 2. Purpose and Goals

2.1 Overview

Studies of GA had tended to be evaluative rather than descriptive, with conflicting assessments and little consensus. It seemed the confusion would continue until we gained a better understanding of what actually transpires in this organization as members absorb its precepts and apply them to their lives in various ways. Recent proliferation of legalized gambling venues in Ontario made this task more urgent, especially since it appeared to be bringing changes in the makeup of the problem gambling population. More knowledge was needed, not only about GA beliefs and practices, but also about which gamblers (for reasons ranging from gender and ethnicity to mindset and severity of gambling problems) were likely to remain and make successful use of GA. Our investigation drew its rationale from two central premises, widely supported in the literature: 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. The literature on this organization was rife with controversy on such basic questions as whether GA is suited to the most troubled gamblers or those who are least troubled, whether it is the most effective approach or largely ineffectual, and whether its purported benefits stem from aspects of the “program” itself or are simply the function of group support. In addition to providing the kind of basic knowledge needed to begin resolving such questions, this ethnographic study was designed to provide new hypotheses about the kinds of gamblers who attend GA, about those who remain and about the kinds of benefits they derive. This was the first serious study of GA in an Ontario context. Evidence that a significant number of gamblers had joined NA argued for a similar study of this group. Attention to gamblers in Narcotics Anonymous was meant to allow us to develop these hypotheses within a comparative perspective, especially as they bear on gamblers with co-occurring substance abuse problems.

Our primary goal - to establish a better understanding of GA beliefs and practices and the ways in which individual members perceive and experience them – entailed another: establish a stronger empirical foundation for further evaluative and descriptive studies. Some of the most widely cited studies of GA [Brown, 1986, 1987 A, B & C] had not involved direct observation and delivered findings that, however valuable, were highly speculative. While helpful, later observational studies [Browne, 1991,1994; Turner & Saunders, 1990] provided only rudimentary knowledge about the ways in which GA narratives are constructed, the effects they have on gamblers, and the kinds of gamblers most likely to accept them. We intended to investigate these issues directly. GA remained unknown in many respects [Petry, 2002]. It had been strongly endorsed [CFCG, 1996], and yet its methods, principles and effectiveness had been seriously challenged [Abt & McGurrin, 1991; Peele, 2001; Turner & Saunders, 1990]. There were also conflicting views about the types of gamblers for whom it is appropriate

9 [Blaszczynski, 2000; Brown, 1987 A]. Further, GA’s composition had surely been affected by the recent proliferation of legalized gambling venues throughout Ontario. It had been suggested that different games of chance produce different psychological processes and hence different types of compulsions [Dickerson, 1993], and also that some games of chance are more strongly associated with an aversion to GA than others [Berger, 1988]. Hence a more fine-grained observational study was warranted. It seemed that Ontario’s treatment community should know more about this society which it so often recommends to problem gamblers. Our secondary goal - to study gamblers attending NA for comparative purposes – was also designed to deliver knowledge about how GA can work in conjunction with another intervention, and to assess the relevance of our questions and hypotheses to gamblers with co-occurring substance abuse disorders. Preliminary ethnographic research suggested that a significant number of problem gamblers had turned to NA. While GA had been compared to AA [Browne, 1991, 1994; Murray, 1993], NA was (and is) understudied and had neither been compared properly to GA nor explored as a resource for problem gamblers with substance abuse problems. Wells [1994] commented that NA “contains an array of relatively untapped research material”. We wanted to explore how pertinent this may be to problem gambling research.

2.2 GA’s Role and Relevance

Our review of the relevant literature during the tenure of the Incentive Grant made two points clear: 1. Little was known about GA’s workings and effectiveness; 2. GA nonetheless played a central role in the treatment of problem gambling both as an adjunct to formal programs and as a potential solution on its own. GA had been hailed as a solution to pathological gambling [Custer & Milt, 1985; Winston & Harris, 1984] though more recent studies suggested that GA is most effective in conjunction with other interventions [Lesieur & Blume, 1991; Rosenthal, 1992; Petry, 2002]. Further, while Blaszczynski [2000] claimed that GA is suitable only for gamblers free of other compounding issues, Brown [1986, 1987 A, B & C] argued that GA may suit only the most severe cases, as GA ideology involves the need to “hit bottom” and insists on abstinence (which, as both authors stated, may not be necessary for less troubled gamblers). Despite disagreements over GA’s proper function, GA was (and still is) considered the most cost-effective option available [CFCG, 1996; Walker, 1993]. Walker [1993] argued that for this reason GA would likely continue to figure prominently even if other approaches were found superior. Most North American gambling treatment programs use GA as an adjunct, and GA provides social support that professionals could rarely imitate. Ogborne [1978] has argued that modalities are less important to success than the stability and support (such as family networks) a client brings to treatment, and gamblers with social support have been found to achieve longer-term abstinence than those without it [Stein, 1993]. Davison et al [2000] found that AA members lacking outside support adhere

10 more closely to AA’s program, and that alienation from one’s normal support networks can lead one to mutual aid. In short, mutual aid can alleviate isolation through peer support and encouragement. Walker [1992] claims that GA’s main strength lies in its collective belief that compulsive gambling can be beaten. While our Incentive Grant research confirmed GA’s relevance, we also found that GA’s approach (and thereby the role it could play) might be changing. For example, Browne [1991, 1994] had observed that GA was less focussed than AA on the 12 Steps and spirituality – with the corollary that, unlike AA, GA did not take the “whole self” into account. Browne considered GA effective for some in achieving abstinence, yet less effective than AA in addressing other issues that may accompany the primary addiction. Our exploratory fieldwork with GA confirmed Browne’s observations to a large extent, but we also learned that 12 Step-oriented meetings (“Step Meetings”) had recently been formed in the Greater Toronto Area, and that hence the picture may be more complex. When noting that the recent proliferation of legal gambling venues in Ontario should be considered as a potential cause of change in GA membership, greater GA attendance by women was one stated possibility. As well, the literature [Murray, 2001] was consistent with our own fieldwork in suggesting that GA had taken steps to better accommodate women. Either of these factors, or a possible shift in ethnic composition, could conceivably have affected GA’s approach to recovery and by implication the role it could play in the treatment of compulsive gambling.

2.3 GA Beliefs and Practices

Given GA’s significance, and the lack of consensus regarding just what it did and for whom, scrutiny of its beliefs and practices was in order. In framing our own approach to this task, we drew on the perceptive work of some earlier investigators, most notably Brown [1986, 1987 A, B, & C], Browne [1991, 1994], Lesieur [1990] and Turner and Saunders [1990]. What these studies did not provide was a comprehensive account of GA beliefs and practices, and of the specific ways in which GA members use these beliefs and practices in their own lives. This was just the kind of work that Antze [1976, 1979, 1982, 1987] had carried out in the case of AA and several other mutual help organizations. In this study, as in Antze’s earlier work, our concern was not with the truth or falsehood of the lessons that members learn from the group ( “compulsive gambling is a disease”, “once a gambler always a gambler,” etc.), but with the use they make of them in reorienting their lives. Antze [1979] and Cook [1988 B] had argued that mutual aid depends upon members internalizing the group’s belief systems. Our study would attempt to clarify how this happens. We were less concerned with members as isolated individuals than as representatives of a recovery culture characterized by distinctive beliefs, norms, practices and rituals – an anthropological approach which ideally could deliver a clearer idea about what was actually being accepted by some and rejected by others. Turner & Saunders [1990], claiming that the internalization of an addict identity was comparable to collective brain-washing, were critical of the way GA alienates those unwilling to go through this process.

11 While our own view was not so harsh, we agreed that the internalization of GA principles – re-labeling, assumption of “compulsive gambler” identities, adherence to codes of behavior (e.g. abstinence) and a new conception of self – would help some gamblers and alienate others.

2.4 Narcotics Anonymous

Our original decision to investigate NA was based on our Principle Investigator’s observation that in the Toronto area a significant number of gamblers with substance abuse issues made use of this society. While estimates of the percentage of problem gamblers with substance abuse problems vary, researchers were in agreement that problem gamblers had higher substance abuse rates than the general population and that more attention should be paid to this matter [Crockford & el-Guebaly, 1998; Lesieur & Heineman, 1988; Smart & Ferris, 1996; Wager, The, 2002]. NA is an understudied society and had not been compared seriously with GA or studied as a resource for gamblers. Yet the literature on GA and NA pointed to some interesting connections. According to Browne [1991] “12 Step Consciousness” – which entails a broader conception of recovery – could be found among GA members affiliated with other 12 Step societies. Lesieur [1990] had made similar observations. Further, NA offers gamblers a broad addiction concept: as NA deals with all drugs, unlike AA it has no substance-specific conception of physical addiction but a notion rooted in personality traits similar to an addictive personality concept [Peyrot, 1985; WSO, 1982]. It had been claimed that AA is more effective with alcoholics than GA is with gamblers, partly because AA’s physical disease conception (of an “allergy” to alcohol) facilitates “relabeling,” thereby helping to deflect guilt and shame [Preston & Smith, 1985]. To many, gambling is not a “legitimate” addiction. But heroin and cocaine addicts describing their afflictions in psycho-emotional terms (as most NA members do) might affect gamblers’ perceptions of their gambling problems. While most mutual aid movements cut from the AA mould are focused, like GA, on a single issue (alcohol, eating, gambling), NA promotes the more encompassing concepts of "addict" and "addiction". In NA, any compulsive behavior (including gambling) can qualify as “addictive”. Not only is NA focused more on underlying emotional issues rather than the addictive behavior itself, it tends to attract younger and more energetic members (including alcoholics with no other substance addictions) [Wells, 1994]. These observations raised the possibility that NA might offer a way of compensating for the limitations of GA’s allegedly narrower focus on gambling and debts. Lesieur [1988], aware of the many issues that often accompany compulsive gambling, lamented that most self-help societies discourage talk of multiple addictions, and even suggested that an anonymous society be created for that purpose. Despite its focus on drug addiction, NA often functions in just such a fashion. Whereas AA has been ambivalent toward problems other than alcohol, NA encourages members to discuss all their obsessions and compulsions [WSO, 1982]. We reasoned that a better understanding of this society would make possible a preliminary assessment of its potential value for problem gamblers with substance addictions. Possibly, NA may suit many gamblers more than AA or Cocaine

12 Anonymous, and possibly, we reasoned, many gamblers could use NA exclusively to deal with gambling as well as their substance addictions.

3. Literature Review

3.1 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. 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); 3. concerns about the small percentage of gamblers who achieve abstinence after trying GA (Lesieur and 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 one year after their first meeting, and about 7% after two years.)

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 claims 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) has found that gamblers able to moderate their gambling activity are unlikely to stay for long at GA. Further, Brown has 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 state, 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) has 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 is that a compulsive gambler with pressing psychiatric difficulties may require more serious intervention than a non-professional society can offer.

This brings to light why the term "effectiveness" often refers to more than just gambling cessation. Browne (1991, 1994) has discussed GA's lesser emphasis on the 12 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) has 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 12-step fellowships. Lesieur (1990) has made similar observations. This adds weight to suggestions that GA is incomplete on its own (Lesieur & Blume, 1991a; Rosenthal, 1992; Petry, 2002) 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 that 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, a comprehensive understanding of GA's inner workings — 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). Yet Petry (2002) 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 literature than those who remained (Brown, 1987b). Brown (1986) also found that those who were overly elated at their first meeting were more

14 likely to become disenchanted later on than those with a more balanced initial impression.

Yet Brown’s studies relied upon interviews without accompanying observation of GA meetings, and no detailed account is given of what, exactly, 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) speculates 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 would be needed to verify the existence of such a cultural dynamic and describe its workings. McCormick and Brown [1988] do provide an interesting account of parallels between GA’s approach and Christian conversion experiences. Still, beyond generalities and some admittedly astute observations, no one has provided a discussion of the ways in which GA members recover.

The study of GA's effectiveness is best understood as a work-in-progress, with important advances identifying better research targets yet still haunted by gaps in available knowledge. When Brown began his studies of GA, little observational work on GA had been done (Cromer, 1978; Livingston, 1971; Scodel, 1964), and both Cromer and Scodel 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 with gamblers, partly because AA's physical disease conception of an "allergy" to alcohol facilitates "re-labeling," 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’s "consciousness" (1991), 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, containing (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 one-year observational study. Critical of the medical model, these

15 authors discuss the moral and emotional implications of GA narratives and practices. They also mention GA's confrontational style as alienating to many newcomers (McCown & Chamberlain (2000) also describe GA as more confrontational than AA.) Still, the narratives and practices are discussed primarily in terms of their negative implications rather than their actual content. It is possible to appreciate a commentary on the ways in which the medical model alienates those who do not conform to it, yet still question the validity of a critique that hinges largely upon the unattainability of an "ideal self" to which members aspire (Turner and Saunders, 1990). The latter, after all, could be said of most spiritual and psycho-emotional endeavors. In any event, despite some significant descriptive observations, one is left mostly in the dark about how GA actually operates.

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 task over financial and other issues to help them to “get honest” with their spouses and get their affairs in order (GANSO, 1978). Browne (1991) discusses GA's "Page 17 consciousness," referring to a set of practical (rather than spiritual or psychological) principles found in GA's most important text (GAISO, 1999).

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 favorably 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). The importance of social support has already been discussed (please see 2.2 GA’s Role and Relevance; Davison et al, 2000; Ogborne, 1978; Stein, 1993; Walker, 1992).

Yet endorsements of the mutual aid approach are not unique to GA, and stem from a growing awareness of the importance of social support in general. Involvement in mutual aid has also been associated with better results with biological afflictions such as breast cancer (Davison et al., 2000). Little has been written about what, if anything, GA offers beyond peer support. Whether GA's recovery program has merit in and of itself, and if so, for which type of gambler, has yet to be addressed comprehensively in the literature.

To further complicate matters, questions concerning effectiveness are often laden with assumptions. For example, the answer to whether GA's insistence on abstinence is the best approach, good for some but not for others, or even potentially harmful, hinges upon ideas about the nature of compulsive gambling itself. We now turn to this issue.

3.2 The nature of problem gambling

Pathological gambling has been called a "pure" addiction because people feel compelled to pursue and continue the gambling activity even though no mind- altering drugs are involved (Rosenthal, 1992). GA uses the disease model, and the way GA is perceived is greatly affected by the extent to which this model is accepted. The most prominent view of pathological gambling, at least in North America, is the standard disease model of addiction, the so-called medical model. Even if the DSM IV (APA, 1994) calls pathological gambling an impulse control disorder, its description of the problem is quite compatible with (and indeed embedded in) the medical model.

The disease conception of addiction involves a few major tenets: 1. Addiction is a primary disease, the cause rather than the symptom of other difficulties. 2. Addiction is progressive, meaning that untreated it can only get worse. 3. Addiction is chronic, meaning that it can be arrested but never cured (hence, abstinent subjects must forever remain on guard). 4. Abstinence is the only solution (Alcoholics Anonymous World Services Inc., 1976; GAISO, 1999; Peele, 1989; World Service Office (WSO) Inc., 1982).

Despite the designation "primary disease," medical model proponents in the alcoholism field have pointed out that disease primacy need not involve chronological priority. Even if an addiction emerged due to other factors, it can be "primary" once it has taken effect, in the sense that alleviating the initial causes alone would not arrest the addiction (Flavin & Morse, 1991). According to this view, the main consideration is that active addiction is not merely a symptom of other difficulties. The disease model (and by implication GA) can, therefore, be compatible with psychodynamic, psychobiological and other explanations for the problem's onset.

A cursory glance at the literature could easily give the false impression that the medical model is out of favor: it would seem to have more critics than champions. This is mainly a sign of the model's dominance. Its adherents do not necessarily defend it directly, often preferring to vindicate all or most of its tenets explicitly or implicitly. Critics of this model rarely deny that it dominates, arguing instead that it should not (Abt & McGurrin, 1991; Peele, 1989, 2001; Sartin, 1988; Turner & Saunders, 1990). Also, it is common for researchers critical of aspects of the disease model to support other tenets and advocate co-operation with GA and its disease orientation. For example, Whitman-Raymond (1988), while at odds with the notion of disease primacy as it downplays the importance of psychoanalytic determinants, believes that psychoanalysts should collaborate closely with GA. Authors with more sympathy for the medical model of compulsive gambling have even pointed out that

17 newly abstinent gamblers can experience physical withdrawal (Rosenthal & Lesieur, 1992). Blume (1986, 1987) sidesteps questions concerning the disease model's scientific validity simply by claiming that it has proven useful for treatment.

Walker (1992) claims that problem gambling research has been overly reliant on data obtained from GA members and other gamblers in treatment who may have internalized the medical model and may, therefore, be likely to reconstruct their past experiences in accordance with its tenets. Moreyra, Ibanez, Liebowitz, Saiz-Ruiz and Blanco (2002) argue that most research suggests that pathological gambling more closely resembles a substance use disorder than an obsessive-compulsive disorder, but mention that the addiction and obsession-compulsion models are not mutually exclusive. They also mention that since most research on pathological gambling has come from the substance use treatment field, many findings could be biased in that direction. Given that substance addiction treatment in North American generally operates along disease model lines and that the late 20th-century trend was to view a host of psychobehavioral ailments in this fashion (often in reference to AA's alcoholism model) (Peele, 1989), it is not surprising that problem gambling theory and practice have followed suit. This trend has been challenged, of course, often because of its propensity to reduce all pathological gambling to one formula (Blaszczynski & McConaghy, 1989).

The existing literature does offer alternatives to the medical model. It has been argued that, since problem gamblers score high for both impulsivity and obsessionality, "obsessive-compulsive spectrum disorder" would be a better designation (Blaszczynski, 1999). Some have argued in favor of an overall propensity to addiction, insisting that problem gambling is simply a subset and should not be treated as an independent problem (Jacobs, 1987; Jacobs, Marston & Singer, 1985) while others have challenged that view (Blaszczynski & McConaghy, 1989; Briggs, Goodin & Nelson, 1996; Rozin & Stoess, 1993b). Pathological gambling has been associated with risky sexual behavior (Rozin & Stoess, 1993a) and with impulsivity (Blaszczynski, 1999; Castellani & Rugle, 1995), yet, at least, the latter view has been challenged (Allock & Grace, 1988). Many view compulsive gambling primarily in psycho-emotional terms (Sartin, 1988; Taber, Russo, Adkins & McCormick, 1986). Brown (1993) has argued that a non-substance addiction such as gambling requires more focus on purely psychological processes and, thus, could steer understanding of other addictions in similar directions.

Despite the medical model's primacy, there seems to be a trend toward identifying subtypes of problem and compulsive gamblers, with the connotation that the medical model — and by implication GA's approach — could not apply to all cases (Blaszczynski, 2000; Blaszczynski & Nower, 2002; Peele, 2001; Potenza, 2002). The emphasis on typology involves, among other things, the view that two individuals might exhibit similar behaviors for completely

18 different reasons. Blaszczynski (2000) can be taken as exemplary when he divides gamblers into three types: those whose gambling is rooted in genetic difficulties, those with underlying emotional difficulties, and those who are essentially "normal" save for the gambling problem itself. Brown (1986, 1987a, 1987b, 1987c) was already pointing to the importance of subtypes when attempting to determine what type of gambler is likely to remain in GA. Along these lines, some have argued that the complexities of problem gambling suggest that it is a syndrome rather than a single disorder (Griffiths, Parke & Wood, 2002; Shaffer & Korn, 2002). Berger (1988) has discussed different personalities attracted to different games of chance whereas Dickerson (1993) has argued that different games produce different types of compulsion.

Perhaps the most controversial implication of the different views on the nature of compulsive gambling is an issue that has haunted other addictions as well: is abstinence the only solution?

3.3 The abstinence principle

GA insists upon abstinence; hence, debates over this principle apply directly to evaluations of GA's program of recovery. Arguably the medical model's most important tenet, the abstinence principle has many critics. Some have argued that the call for abstinence has both positive and negative features (Murray, 2001) while others have been unequivocally critical (Peele, 2001; Rosecrance, 1988; Sartin, 1988). Most common is the claim that abstinence should not be considered the only solution (Blaszczynski, 2000; Blaszczynski et al., 1991; Blaszczynski & McConaghy, 1989; Peele, 2001; Walker, 1992, 1993), and it has long been argued that GA's call for abstinence may alienate those who do not have the same view (Brown, 1987b).

As a subset of the medical model, the abstinence principle might appear to have more detractors than supporters. Again, this perception would be inaccurate. As abstinence is the dominant solution, many in the field do not defend it explicitly; often success is simply measured, either primarily or exclusively, in terms of abstinence rather than the achievement of less harmful gambling patterns (Johnson & Nora, 1992; Maurer, 1985; Rosenthal & Rugle, 1994: Taber, McCormick, Russo, Adkins & Ramirez, 1987). McCown & Chamberlain (2000) provide a more up-to-date defense of abstinence as a goal in which they discuss reduced gambling activity, though primarily with reference to clients who target abstinence.

There is little in the gambling literature on the virtues or drawbacks of abstinence to distinguish it from more thoroughly developed discussions of these ideas related to substance use problems. Rankin (1982) has argued that since physical dependence is often the criteria for suggesting abstinence in cases of alcoholism, the application of this principle for gamblers is tenuous. Viets and Miller (1997) have pointed out that, in the problem gambling field,

19 even definitions of abstinence hinge upon definitions of gambling. For the most part, however, ideas about abstinence are not specific to gambling, and the gambling literature would benefit from greater attention to theoretical discussions of the abstinence principle's role in recovery.

Many 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, many 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 part of a larger belief system regarding the nature of, and solution to, the problem in question. Antze (1979) has discussed the ways in which mutual aid depends upon mutual identification and internalization of the group's belief system. Valverde (1998) has claimed that abstinence in AA is not so much a tyranny over desires but a pragmatic reconstruction of habits rooted in strands of 20th-century philosophy as well as ancient, pre-scientific wisdom. In their study of the 12-step–based (AA and NA) Minnesota Model, Keene and Rayner (1993) found the approach to favor those with compatible belief systems (e.g., agreement with the medical model, positive attitudes toward spirituality). Keene and Rayner recommended that clients be served by approaches and theories consistent with their own ways of thinking. There is some evidence for "cognitive profiles" applicable to many AA members (Ogborne & Glaser, 1981), 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.

Despite its popularity, many researchers are coming to the conclusion that while the abstinence principle may be helpful for some gamblers it could be harmful to others. Given that such questions are nowhere close to settled even in the substance addiction fields, we should not expect consensus among gambling researchers anytime soon.

3.4 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 that GA should have no place at all. As mentioned, GA's cost-effectiveness will ensure that it continues to play a role even if other approaches are found superior (Walker, 1993). Also, GA is recognized as the most widely available option for problem gamblers on this continent (Viets & Miller, 1997).

20 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 co-operation should replace ideologically rooted competition (Toneatto, n.d.). Some have argued for the compatibility of GA with cognitive and cognitive-behavioral approaches (Problem and Compulsive Gambling Advanced Workshop, 1986; Toneatto, n.d.). 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; and cognitive therapy, while diverging with 12- 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 that GA attendance in conjunction with professional therapy can yield positive outcomes. Lesieur & Blume (1991a), Russo, Taber and Ramirez (1984) and Taber et al. (1987) followed up clients who had completed such combined programs and each study found abstinence rates of over 50% among clients contacted at various points after discharge. While agreeing that these results suggest that GA in combination with professional therapy produces better results than GA alone, Petry (2002) claims that the studies contain methodological flaws: "One problem is therapy was not specifically described, so replication is not possible." Petry (2002) concludes 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 a recovery architecture built on the 12 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) do discuss 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. Lesieur (1988), aware of the many issues that often accompany compulsive gambling, laments the way most self-help societies discourage talk of multiple addictions, and even suggests 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), 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.

21 3.5 Gambling and co-occurring substance addictions

It is hard to tell what percentage of GA members have co-occurring substance use issues, though it is safe to assume that levels are considerably higher than in the general population. For example, a study of female GA members found their rate of substance use problems to be two to three times as high as that of the general female population (Lesieur & Blume, 1991b). Studies have suggested that slightly over half of GA members have abused either alcohol or other drugs at some point (Lesieur, 1988; Linden, Pope & Jonas, 1986). But work done so far has been preliminary (Linden et al., 1986; Lesieur & Blume, 1991a, 1991b) and, since there is good cause to believe that GA's membership has undergone recent changes, even the little available knowledge must be considered dated.

While estimates vary, researchers agree that problem gamblers have higher rates of substance use problems than the general population (Crockford & el- Guebaly, 1998; Canadian Foundation of Compulsive Gambling, (Ontario), 1996; Griffiths et al., 2002; Lesieur & Heineman, 1988; Spunt, Dupont, Lesieur, Liberty & Hunt, 1998). The only comprehensive study on drinking problems among problem gamblers in Ontario (Smart & Ferris, 1996) suggested that potential alcohol (and other drug) problems be taken into account when gamblers are being assessed. Yet this same study pointed to large discrepancies between different prevalence estimates. And even if varying definitions of substance use problems are taken into account to explain these discrepancies, some researchers have identified the need for harder data (preferably based on meta-analysis) of the overall prevalence of substance use problems among problem gamblers (The Wager, 2002). To be blunt, while everyone agrees that problem gamblers (and by implication GA members) are prone to substance use difficulties and that this fact should be taken into consideration during assessment, we are nowhere close to providing solid numbers. One short-term approach may be to take substance use findings and then work "backwards" in order to get a sense of the situation. For example, Steinberg, Kosten and Rounsaville (1992) found that 15% of cocaine users under study were pathological gamblers. Spunt et al. (1998) interpreted the available evidence to suggest that problem gambling rates among people with substance use problems are four to 10 times that of the general population, but they point to a shortage of research in this area as well

One can only speculate about the current prevalence of co-occurring substance difficulties among GA members. Yet Blaszczynski and Nower (2002) may provide a clue. They argue that problem gamblers without serious psychiatric and other difficulties are less likely to have substance use issues than more troubled gamblers, and claim that this kind of gambling pathology is almost entirely dependent upon availability and accessibility of gambling venues. Given the growing number of legal gambling options, one might expect a higher percentage of this type of gambler. Hence, it is at least possible that a growing

22 percentage of new GA members are free of compounding substance use problems.

3.6 GA and gender

GA has been described as a predominantly male fellowship, both in composition and in attitude (Mark & Lesieur, 1992). 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 four per cent of GA members were women. Yet, more recently, Strachan & 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 that GA remains predominantly male but that the number of women is increasing. 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 et al., 1998; Volberg, 1994). Further, an increasing sensitivity within GA to the concerns of women has been noted (Murray, 2001).

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) has suggested that GA's neglect of spirituality and interpersonal and psycho-emotional issues inhibits women's involvement. Lesieur (1988) has 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" (employment, legal) as important whereas women reported more concerns with physical and interpersonal issues. These results suggest that women may require more supportive counseling and psychotherapy whereas men seek information- sharing and cognitive restructuring. 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 that women were less likely

23 to have begun gambling for the thrill; instead, they were seeking ways to escape problems in their lives.

Despite the dearth of material on women who gamble, we are discovering that much of what we know about women with other addictions (and their differences from men) may apply to women who gamble. This is not a substitute for direct knowledge of female gamblers, but it permits us to extrapolate until further research takes place and should help to guide further research. Tavares, Zilberman, Beites and Gentil (2001) found that, as with other addictions, compulsive gambling progresses more quickly in women than men. Toneatto and Skinner (2000) found that, compared to males, female gamblers reported more use of psychiatric medications, notably antidepressants and sedatives. Further, whereas men were more likely to consume alcohol in the month prior to seeking treatment, there were no significant gender differences with illicit substance use. Toneatto and Skinner (2000) point out that overall these ratios are consistent with gender differences throughout the general population, even if the prevalence of use was higher. Mark and Lesieur (1992), critical of GA as male dominated, argue that its tendency to produce a "men's club atmosphere" 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 part because of how they affect women.

In fairness, 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 of 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 that these groups typically meet at the same time and location 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.

Significantly, female gamblers who attend GA have received 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.

24 3.7 GA and ethnicity

If GA's alienation of women also interferes with their likelihood of attending formal treatment (Spunt et al., 1998; Volberg & Steadman, 1989; Volberg; 1994) then this would apply to excluded ethnocultural groups as well.

The available literature is not very helpful on GA and ethnicity, though it has been discussed (Ciarrocchi & Manor, 1988; Custer & Milt, 1985; Livingston, 1971; Sagarin, 1969). Browne (1991) has suggested that GA's rejection of inner searching could alienate certain ethnocultural groups, and has commented (1994) on how many members of GA are either Jewish or Italian. While it has been argued that cultures where drunkenness is relatively uncommon (e.g., Jewish) have been more prone to gambling (Adler & Goleman, 1969), little work has been done on the implications of and reasons for GA's ethnocultural composition. Further, given that the world of gambling has been changing in recent years due to the proliferation of legal gambling venues, the available knowledge in these areas is probably dated.

3.8 Narcotics Anonymous

NA has received little scholarly attention, though studies not yet mentioned vindicate some of the points we have already made about its workings [Christo & Franey, 1995; Rafalovich, 1999]. To learn about NA, one can also refer to studies of the “Minnesota Model” which is AA and NA based [Cook, 1988 A & B; Keene & Raynoe, 1993], although such studies invariably blend the NA and AA programs and offer little about NA’s differences from AA. Still, NA’s unique recovery culture has been documented [Christo & Franey, 1995; O’Brien, 1998; Rafalovich, 1999; Wells, 1994], as has its all-encompassing addiction concept [Peyrot, 1985; Rafalovich, 1999] which is also discussed in NA literature [WSO, 1982]. Another poorly understood aspect of NA is that it is arguably less theocentric than AA. While one can debate the implications of AA’s conceptions of God and spirituality, NA goes as far as to include in its major text a personal recovery story written by an avowed atheist [WSO, 1982]. Wells describes it as a fellowship where spirituality can mean “Feelings of well-being engendered by the process of collective personal growth” [Wells, 1994]. Christo & Franey [1995] found that a lack of belief in standard conceptions of “God” or spirituality was not an inhibitor to NA membership. Yet nothing has been written on the effect this may have on secular minded problem gamblers, and no study has ever been directed at the overall effect NA’s unique approach may have on problem gamblers who make use of it

3.9 Conclusion

A review of the literature on Gamblers Anonymous points out the paucity of knowledge we have about this approach to recovery despite its pivotal role in our overall efforts to assist people with gambling problems. GA remains a black box about which we know too little. There would be real benefits to a detailed

25 and sophisticated understanding of the processes and events in GA that contribute to its success with some individuals and its lack of success with others. Such a knowledge base would require qualitative and ethnographic research methods, involving respect for GA as a positive social site of human interaction where meaning is constructed for and by those who participate. Large-scale, controlled studies of GA's efficacy (alone and in conjunction with other interventions) are also an important priority. Such studies could also provide knowledge of GA's ethnocultural and gender composition as well as rates (and implications) of substance use problems among GA members. Since formal treatment programs normally suggest (and often insist upon) GA attendance, the ways in which GA can compliment — or hinder — various types of treatment is an immediate concern.

Issues pertaining to overall effectiveness, co-ordination with other interventions, gender, substance use and appropriate GA member profiles have all been identified in the literature as key targets of inquiry. Surprisingly, the research community has had less to say about the need to explore GA's ethnocultural composition and the need to observe GA directly. Nonetheless, since major gaps in our current knowledge of GA have been identified, we can now point with more clarity to the ways in which future studies of this fellowship should proceed.

4. Research Design and Methodology

4.1 Overview/Research Questions This was a qualitative, ethnographic study with two components: participant observation and individual interviews. Larger research questions targeted: 1. ways in which GA members perceive problem and pathological gambling 2. ways in which GA members perceive and practice recovery 3. ways and extent to which gamblers reconstruct and describe their past experiences according to narrative formulas shared by GA 4. ways in which their descriptions of their current lives “in recovery” conform to certain tenets which define the group’s understanding of what recovery means 5. ways in which the lessons behind these stories are employed by members in managing their lives (choices, plans, etc.).

As we were dealing with more than one mutual aid society, comparisons were made. Concerning NA, the following question guided our study:

1. Whether NA’s broader addiction concept, which includes all drugs and emphasizes the notions of compulsion and obsession rather than physical addiction, may be more helpful to gamblers than AA’s drug specific conception as gambling addiction involves no substances and is also understood in psychological rather than physical terms 2. Whether NA’s emphasis on emotional issues may provide a counterweight to GA’s alleged exclusion of such matters

26 3. Whether many problem gamblers with substance abuse issues could find their recovery exclusively in NA.

We were also interested in who is alienated by GA, and why. Gender, ethnicity, intensity of gambling and other psycho-behavioral problems, belief systems and possibly even preferences for different games of chance – these were all theorized as potentially pertinent to GA affiliation, though at every step we resisted the temptation to presume. We sought to investigate mutual aid pathways to recovery in a preliminary, empirical fashion, to provide knowledge that would be immediately useful and also to set the stage for further qualitative and quantitative work in this area.

4.2 Participant Observation With consent from the groups involved, the PI attended and documented the activity and discourse at 42 GA and 29 NA meetings. Initial observations served to pilot and finalize observational strategies.

Data collection, while guided by the research questions already mentioned (see above, 4.1), consisted of descriptive observation and hence the parameters were defined by what had been observed. Since our goal was to understand mutual aid narratives from the perspectives of subjects rather than verifying their accuracy, and because our focus was also group interaction (the social organization, the social field), direct (participant) observation was better suited to this project than more formal approaches to data collection. One advantage of this method is that it permits a direct recursive link between theory and practice, so that data collected can be analyzed immediately and used to generate more focussed approaches to collection and subsequent analysis. The resulting “grounded theory” [Glaser, 1978] was geared to achieving significant observations and hypotheses about the meanings embedded in typical GA (and to a lesser extent NA) narratives and the ways members use them to make sense of their lives. Many interview questions, along with the choice of appropriate subjects, also hinged upon what had been uncovered through observation.

4.3 Individual interviews 32 interviews were conducted, four with NA members, 27 with GA members, and one with a professional in the gambling field we thought could shed some light on many aspects of GA. Of the GA members interviewed, 4 were interviewed twice, meaning that we interviewed 23 GA members in all. Individual interviews were audio-taped after obtaining written consent from the subjects, and interviewees were remunerated. Efforts were made to ensure that the resulting cohort was representative of group composition with respect to gender, race and social class. Yet our efforts were successful only in terms of gender. For example, while many GA members are Italian and Jewish, and our sample does justice to this fact, the small number of persons of African and Asian

27 descent in GA rendered recruitment difficult. We interviewed two African Canadians (one of whom is Muslim), an acceptable result, yet no subjects of Asian origin or ethnicity were interviewed (on two occasions, subjects who had agreed subsequently withdrew their consent). Subjects were also chosen according to theoretical sampling guidelines [Glaser, 1978]. Essentially, we began with more experienced members in order to learn as much as possible about GA’s core ideas. Subsequently, after more data had been accumulated and analyzed, subjects were chosen based upon the extent to which they seemed to represent various aspects of GA’s mutual aid culture. The last six interviews were, once more, conducted with experienced and knowledgeable members as these interviews were less about personal narratives than about specific (at times complex) questions pertaining to GA that the study had generated. The interviews were conducted in the same spirit as the participant observation: we wanted to facilitate the free emergence of subjects' own stories, within a semi-structured format. Our grounded theory approach entailed never presuming to know which questions are most pertinent, and the interview protocol was constantly revised and improved upon as newer ideas were presented or older ideas became more thoroughly understood. In fact, the interview protocol remained a work in progress right to the end of the study. Several informal (1-2 hour) discussions with members were also held, and highlights from four of these have been included in the field notes. With two exceptions (one interview over the phone and one online) the South Oaks Gambling Screen was used to determine the severity of each subject’s past or present gambling problem.

Interview Protocols can be found in the Appendix.

4.4 Limitations and Delimitations This study was explicitly exploratory and qualitative in its intention and design. Knowledge claims that emerge from such work are inherently limited, particularly from a quantitative research perspective. The sampling strategy is guided more by opportunity than prior design. There are risks of bias in perceiving and interpreting observed material. There is no way of compiling an audio-video record of GA groups, or of making notations in vivo in these sessions. While we are confident that much of the information delivered by this study will be useful on its own, our primary objective was to lay the groundwork for other endeavors, both qualitative and quantitative. For example, while we conducted no randomized trials of any kind, we have developed hypotheses that should help to shape other studies that do. We should also point out that in looking at a mutual aid society as a “social field” we treated subjects as reflective of a general culture of recovery and thus to some extent neglecting what may be unique to each account. Irvine [1999] has compared the search for “narrative themes” to the factors that arise in factor analysis: they are considered only if they meet predetermined statistical criteria. In the same vein, the approach here is to develop criteria through observation, and then target selected themes. We suspected that we might uncover more about why people stay in GA and NA than about why they leave (which turned out to be the case). Nonetheless, the former

28 issue already sheds light (by contrast) on the latter, and our open-ended approach to data collection – which includes scrutiny of groups as well as social processes outside the groups – was designed to develop useful observations on both counts. Another limit involved the type of GA meetings the PI was able to attend. Most GA meetings are “closed” meaning that they are open to problem gamblers only. The PI was able to attend only a few closed meetings, and for the most part was limited to “open” meetings. We originally had no reason to expect this limit (please see Project Report), and had to rethink our research strategy. One meeting, held monthly, was a speaker meeting. While informative, it involved no interaction, for example, between old-timers and newcomers (who would simply sit and listen). One open meeting was indeed interactive as it involved members taking turns speaking, a so-called “therapy meeting”, and as such did represent a more typical GA meeting. But this meeting was poorly attended and eventually closed down. Instead, the PI attended many “pinnings” –- meetings where one or more members celebrate one or more years of abstinence – as all meetings are open to the public when celebrating a member’s abstinence. While such meetings involve discussion of the GA program and of what members consider essential to success, and also enable an observer to learn about the ways in which GA members interact (the meetings are normally followed by small parties), they provide few opportunities to observe disenchanted newcomers. In short, the PI was able to learn much more about why people stay in GA than about why they leave. Other meetings the PI could attend, more interactive and participatory, took place at a two day GA “Marathon”. While informative in many ways, this was also an event better suited to learning about why GA members stay and less suited to learning about why members drop out (it was attended almost exclusively by experienced members). Given the limitations to our observational strategy, the interviews overall were perhaps more informative than the observations (though the observations did help in guiding the ongoing evolution of the interview protocol itself). Again, though, when asked why some do not succeed in GA, members will usually respond with statements consistent with GA ideology: “they’re not ready”, “they can’t get honest”, “they don’t want it badly enough”, etc. So once more, this project was better suited to delivering information about the positive things that GA has to offer, and less well suited to a comprehensive discussion of the ways in which it may fall short for many. Thoughts on the latter, while offered, are unavoidably more speculative in nature. Our unforeseeable difficulty in attending closed meetings presented another problem: the types of meetings we were able to attend did not necessarily provide as many “typical” GA narratives as we were hoping to find at closed meetings. While interviews were helpful on this score, we had to accept the fact that any hope of conducting “pure” discourse analysis would have been illusory. To some extent, this drawback mattered less than one might suppose. We learned early in the project that GA had changed dramatically since the bulk of the available literature had been published, and that in many ways we were dealing with an unexplored culture of recovery requiring some basic description. GA seemed to be in transition to such an extent, that we even had to wonder whether a search for

29 “typical” stories might have been premature. Fortunately, our entire methodology was premised on readiness for the unanticipated.

5. Research Sample

Interviewee Sample

5.1 Totals 23 GA members and 4 NA members (one of who was a former GA member) were interviewed

5.2 Age Ranged from 26 to 70+ years

5.3 Gender GA: 15 male, 8 female; NA: 2 male, 2 female

5.4 Time Abstinent GA: one week to 35 years (including one very recent arrival and one member unable to stop) NA: (From Drugs) 3 to 12 years; (from gambling) time indefinite: two interviewees still gambling, one abstinent from gambling for three years, one abstinent form bingo (her game of choice) for two years.

5A. Observational Sample

5A.1 GA: 42 meeting observations in total – 37 open meetings, 5 closed meetings Of the open meetings 11 observations took place at the same speaker meeting held once per month; 14 were pinnings (celebrations of a gambler’s abstinence) held at various locations throughout the GTA; 5 were “workshop” meetings held at a “GA Marathon”; the rest were mostly speaker meetings though some interactive open meetings were briefly available. All five closed meetings were “therapy meetings” rather than speaker meetings.

5A.2 Ages ranged from late teens to 70+ (this figure applies to GA members only and does not include children of members who may attend the “pinnings” and other relatives) with 40-45 being the average age. Gender breakdown was approximately 20% women, though at many pinnings there would be GamAnon (spouses and loved ones on GA members) members present so this approximation of actual female GA members present is rough.

5A.3 NA: 29 meeting observations in total— open meetings only One main meeting was attended 23 times – it was a “sharing” meeting (NA parlance for “therapy meeting”) though 10 minutes were also allotted to a speaker; the rest were open meetings help at various locations throughout the

30 GTA. Ages ranged from late teens to 60, with an average age of 30-35. Gender Breakdown was 30-35% women.

6. Findings

6.1 Recent Changes within GA

GA currently has about 21 weekly meetings in the Greater Toronto Area (GTA), and approximately 22 more in the rest of Ontario. Exact numbers cannot be given because meetings can close down while new ones are formed. Overall, though, the fellowship is growing: a 2001 meeting list identifies 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 an exclusively male domain, GA’s female membership in the Toronto area now stands at perhaps 20% and rising. This estimate is based partly upon meeting observations, but primarily upon information gathered from the interviews with members (answers ranged from 10% to 30%). Long considered a 12 Step fellowship in name only – with members focussing primarily on abstinence and debts with little regard for the 12 Step process – GA is fast becoming more “spiritual” with a greater emphasis on the 12 Steps and a range of psycho-emotional issues. One might even suggest that a process of “feminization” has taken place: most women we have interviewed insist that their influence has helped to increase awareness of a broader conception of recovery.

6.2 GA as it Once Was (as described by the research community and longtime GA members) i. Not 12 Step Focussed The 12 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 12 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, the 17 page Combo Book [GAISO, 1999], Page 17 is a list of dos and don’ts for gamblers to

31 follow. E.g., attend meetings regularly and don’t go in or near gambling establishments. Page 17 in fact 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 Narcotics Anonymous 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 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 longtime 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 proper targets 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 that observation.

iv. Male Dominated GA has been criticized in the literature as maintaining a boys’ club atmosphere, and it 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 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 such stories for the most part precludes discussions of positive emotions associated with healthy recovery –

32 the latter representing a gentler, and perhaps a kinder, approach. Our communications with GA members have confirmed that up until quite recently monologues at GA meetings were primarily – some have even said exclusively – war stories. Again, commentators have suggested that war stories can alienate many women, and our own interviews provide some confirmation for this observation as well. vi. Confrontational approach Lastly, and perhaps not surprisingly, GA has also 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 too fucking young. You didn’t suffer enough. You’ll never make this program’”. (Interview #32)

Our own findings indicate that, at least in the Toronto area, GA never did practice 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 nonetheless favored curt communication, life issues were not often discussed at meetings, and that the “rooms” were not as keen on sensitivity as they are today.

6.3 GA Today

i. More Focussed on the 12 Steps We have found that, today, a strong majority of GA members in the Toronto area insist that the 12 steps are crucial to healthy recovery. Interviews and informal communications suggest that this change seems to have taken place throughout North America. Abstinence from gambling is no longer enough. The 12 Steps are seen as a way to change your personality, to make you a better person, and render abstinence from gambling enjoyable rather than a burden. One longstanding member recalls how, once abstinent,

“I was able to take care of my family needs, my business needs. Myself. I didn’t face …what I did to my three daughters. Or to my wife. I just hid from that… Once I was able to accept … and start to listen. Then all of a sudden, the steps of recovery meant something… I was partners with my father-in-law and I would have killed him… Cause [he] was such a person that I couldn’t stand. But…all of a sudden we became good friends…abstinence alone is just a pimple.” (Interview #27)

According to another:

33 “Come in and you’re a compulsive liar and an asshole and a compulsive gambler. Stop gambling well, guess what? If you’re not putting anything into it to make changes, you’re still an asshole” (Interview #7)

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 12 Steps have been formed in the Toronto Area – and once more, interviews and informal communications with GA members suggest that the number of “Step Meetings” has been increasing throughout North America.

ii. Page 17 – What it Means Today While definitely a set of practical principles, Page 17 does for example mention the 12 Steps – the difference now is that more members are paying attention to that 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 ten 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 of choice, gamblers must be on guard against another “quick fix”: the real possibility of huge winnings which 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] seems to suggest. Recovery in GA today could – with caution – be viewed as a complex interaction between the 12 Steps and Page 17. Of course there is more to it, and that 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 how their weeks went, or to discuss whatever may be on their minds (or hearts). Far from suppressed as in the past, talk of life-issues is not only encouraged but given formal sanction. While some members still feel that talk at meetings should be restricted to gambling related issues, they are now a small minority. According to the same member who said that once you could not discuss your feelings:

34 “I was at a meeting last Friday… There were ten of us in there. There was not one word, not one word, of gambling mentioned… every single person talked about love, where they are in their life, their relationship, their kids, their family. There was nothing about gambling. It was just totally about living and life. And it blew me away. It was the best meeting I’ve ever been at in all the time I’ve been in GA.” (Interview #32). iv. Greater Involvement of Women While an almost exclusively male domain even 15 years ago, women in the Toronto area now represent as much as 20% of GA’s overall membership. GA seems to have taken measures to better accommodate women, and relations between the genders seems very amicable. Still, some women complain about the preponderance of a “boys club” atmosphere and, overall, men and women tend to perceive gender issues quite differently [please see Interpretations]. While things are improving for women in GA, most members, 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, it is questionable whether GA in the Toronto area was ever very confrontational. Of interest is that interviews and informal communications have led us to conclude that it has indeed been very confrontational in other regions, that it still is in some regions, but that all over the continent GA seems to be moving away from a confrontational culture of recovery. Possible reasons for this and other changes are given in the Interpretations section.

6.4 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. While 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 traditionally “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

35 important page in that text, Page 17, can be viewed as a summary of the Book – another exercise in concision. Our interaction with GA members has revealed some consensus on one point: gamblers are an impatient lot, and GA’s main text might reflect this (even if one may not wish to push this generalization about problem gamblers to the hilt). Yet the Combo Book does address psycho- emotional issues, and more recently GA has been doing justice to this end of its program. Normally, the readings will be followed by a section called “How was your week” wherein each member briefly answers that question and possibly elaborates on his or her state of mind. 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 to 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 – possible themes include regaining one’s family’s trust, abstinence, a particular step, helping newcomers (the options are countless) – and 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 obviously on the 12 Steps, with the group remaining on a single step for possibly a month or longer – here “how was your week” may or may not be in the format, and newcomers, while welcome, would be 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 12 Step fellowships, in GA members give their first names and acknowledge their addiction before speaking. Yet 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.” So the admission is more adamant. Further, in GA the identification will usually be followed by an account of one’s time abstinent (which is much more rare in AA and NA). Despite recent changes, GA still puts more emphasis on pure abstinence than many other 12 Step fellowships.

6.5 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, therefore, from members themselves. Such reports are clearly suspect given that GA ideology states that GA is appropriate for all compulsive gamblers. As mentioned, we were able to learn more about why members stay in GA than about why they leave. Members have told us that some gamblers are simply not ready, the idea being that they have not hit, in 12 Step jargon, their “bottom” – only after one has suffered enough will there be willingness to face the problem and address it. Some gamblers are said to be looking for excuses (which they inevitably find), and others are said to receive financial bailouts – something against

36 which GA warns emphatically – and then perceive their problem to be solved. GA emphasizes in very strong terms that one has a gambling problem and not a money problem. So those who perceive their problem as primarily financial will in most cases either change their view or eventually leave GA, with or without a bailout, simply because they do not identify with the GA program. Women are 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 have found, though, that most successful GA members seem to have had strong family support for their recovery. While grateful for such support, only a few GA members we spoke to attributed their success in recovery to that source: 12 Step ideology stresses the importance of an individual’s determination and willingness, and guards against “excuses” of all kinds – “I have no family support” would qualify as an unjustified excuse. War stories are another possible reason. Graphic tales often cause some members to think that, since their misfortunes were not so extreme, maybe they do not need help or are not true compulsive gamblers. Money can be an issue, especially for women. On average, the 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 12 steps of recovery, fast enough.”. [Interview #5] The idea is that without the emotional growth brought about by embarking on the 12 Steps, the problems associated with early recovery from gambling are overwhelming. This may in fact represent a dilemma in GA’s approach to recovery: the 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. This last matter is discussed in the Interpretations (7.3). Along similar lines, we have been told that Pressure Relief (6.7) 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 present some drawbacks (Please see 7.4).

6.6 GA’s Fear of Triggers GA is more guarded about potential relapse triggers than many other 12 Step fellowships. AA, for example, does not tell members to refrain from entering bars, whereas on Page 17 GA members are told not even to go near gambling establishments. Even longstanding GA members tend to view themselves as vulnerable to relapse and hence in need to take precautions.

6.7 Pressure Relief A Pressure Relief Group meeting is often held for newer members. Experienced GA members, some of whom may be accountants or lawyers, will help the new member and his or her spouse to formulate strategies for paying off debts, dealing with legal matters, and other related issues. We Have found that currently few Pressure Relief sessions are held in the Toronto area. Some GA members do not know why this is. Two told us that a few of the individuals on the Pressure Relief Committee are too controlling and intolerant. Yet we have cause to believe that Pressure Relief is practiced less in other regions as well. Another GA member said that younger people today are less willing to share their financial information. We also speculate that 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.

6.8 Secrets “You are only as sick as your secrets” is a statement one will hear throughout the world of 12 Step recovery, yet it seems to ring even more strongly in GA. While all 12 Step recovery involves openness, confession and honesty with others and oneself, in GA the urgency of this matter is enhanced by financial issues. During a Pressure Relief session, all debts and assets must be disclosed. Beyond the attraction of gambling as an addiction, undisclosed financial matters can, according to GA members, trigger a relapse. A secret debt, for example, may create a temptation to settle it by winning some fast cash. Hidden money could also be a temptation. So, while addicts of all stripes are required to open up emotionally and in other ways, GA members must also open up financially.

6.9 Gambling as Escape Versus Gambling as Thrill When asked whether their motivation for gambling had been the thrill or the escape, most members said that it was both. In some cases, it is questionable whether the gamblers were really escaping at all even though they reported it. Possible therapeutic suggestion – from counselors, GA members, or both – often rendered these accounts suspect. The following statement by a woman, currently estranged from GA, is telling:

“And now that I’ve been in treatment programs, I see that maybe it was an escape for me – from what I’m not really sure… I really don’t know what I was escaping from.” [Interview #10]

6.10 Sponsorship and Group Sponsorship Sponsorship has long been central to recovery in AA, NA, GA and other 12 Step fellowships. The idea is that a (usually) more experienced member will guide a

38 newer one through the 12 Steps and other recovery related matters. Sponsors often give advice and support, and lead by example. In GA, a common complaint is that sponsorship is not widely practiced. AA is often referred to as an example of how widespread sponsorship should be – and AA is often referred to as an example to follow in other matters as well. Efforts are being made to ensure that more members find sponsors in GA. Group sponsorship – where the group provides a new member with a temporary sponsor – is becoming more common according to some members.

6.11 Social Support Our interviews indicate that family support has been helpful to many successful GA members.

6.12 GamAnon This is the association for spouses and family members of GA members. While GA is growing in the Toronto area, GamAnon is shrinking – and this seems to be the case in other regions of North America as well. Two possible reasons are worthy of consideration. First, with the increasing number of female GA members, there are more male spouses who do not seem too interested in joining a group such a GamAnon (practically all GamAnon members are women). Second, the typical wife of a male GA member is now far less likely to be a traditional homemaker – and it could be that career women are less likely to want, or need, the kind of support offered by GamAnon.

6.13 How New Members Are Perceived Many new members enter GA believing that 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. Newer members are also said to express outrage at not being trusted by their spouses after a week of abstinence from gambling, despite having pursued that destructive behavior for many years. Quite a few GA members told us that they were also in this state of mind when new to the program, and one told us that he would not have remained if not for his mistaken belief that GA would eventually pay his debts. Newer members are also perceived as impatient – a huge obstacle to recovery in GA. So patience is one of the first things newer 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”, that they are not to speak at meetings. Conversely, it is said that in GA a new member will be chairing a meeting or functioning as treasurer within two 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. This once more reflects the way some GA members often use AA as a model to follow – to the point of constructing myths about that fellowship. Further, it is unlikely that a newer GA member could function as treasurer (though we have heard of one case

39 where a recently relapsed member served in this capacity), and in fact there is a six month abstinence requirement by which most groups (though 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 a favorite target.

6.14 AA as a Model AA is often used as a model of how a good fellowship should be run. GA members often claim that AA is more spiritual, that it puts more emphasis on sponsorship and the 12 Steps, that life issues are dealt with in greater depth – all examples of the way in which GA, according to most members, should be heading. We learned of one unofficial GA meeting – not officially a GA meeting because a few GA members use AA’s Big Book for Step study -- in the Toronto area.

6.15 Members Forced to Attend Our interviews suggest that many new GA members are there due to coercion, either from courts or from family.

6.16 Spiritual Awakening/Conversion GA puts less emphasis on the spiritual awakening than do 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 12 Step fellowships. In GA, Step 2 is less melodramatic. GA’s Step 12 speaks of carrying the GA message to other gamblers, but unlike AA and NA, there is no mention of a “spiritual awakening”.

6.17 Serenity Prayer The Serenity Prayer is on the Cover of the GA Combo Book [GAISO, 1999] and plays an extremely important role in the lives of GA members. Many link it strongly with the theme of patience.

6.18 12 Steps as Key to Healthy Recovery We have found that almost all GA members, even those who do not work the 12 Steps, agree that those who do work the Steps are better off spiritually and emotionally. We have found a strong association between 12 Step work and life satisfaction as well as not missing gambling at all. GA also seems to gear 12 Step Work to recovery needs associated with gambling. As mentioned, in GA patience is key; and the 12 Steps are treated to a large extent as an exercise in patience. On the whole, GA members take considerably more time on each

40 Step than their AA and NA counterparts. (GA members with experience in AA agreed with this statement, and the PI knows enough about recovery in both NA and AA to confirm it as well.) So the theme of not solving problems quickly is actually practiced while members go through the 12 Steps. GA has also rewritten the 12 Steps in places to suit its needs, and this is explicated in the Interpretations.

6.19 Different approaches within GA While observers tend to discuss GA as though it were monolithic [Browne, 1991, 1994; Lesieur, 1990; Mark and Lesieur, 1992; Preston and Smith, 1985; Turner and Saunders, 1990] we have noticed a great deal of variability in the ways in which members work their recovery programs and in the ways they 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 12 Step process and meeting attendance to participation in group business meetings and events such as conferences and social activities. 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 12 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 practice the principles associated with the 12 Steps simultaneously and throughout their recovery. Some pay little or no attention to the 12 Steps at all. With respect to life satisfaction, not missing gambling and likelihood of relapse, we have found working the 12 Steps formally to yield the best results, and not working them at all to yield the poorest results.

6.20 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 of course many owe money to family and friends and sincerely want to make amends.

6.21 Narcotics Anonymous Our interest in NA was guided by three hypotheses: 1. That NA’s broader addiction concept, which includes all drugs and emphasizes the notions of compulsion and obsession rather than physical addiction, may be more helpful to gamblers than AA’s drug specific conception as gambling addiction involves no substances and is also understood in psychological rather than physical terms; 2. More importantly, we hypothesized that NA’s emphasis on emotional issues may provide a counterweight to GA’s alleged exclusion of such matters; 3. Possibly many problem gamblers with substance abuse issues could find their recovery exclusively in NA.

41 With respect to the first hypothesis, we have found while NA may be helpful to gamblers with co-occurring substance abuse disorders, we have uncovered little evidence that NA in any way amounts to a better place for gamblers than AA. With respect to the second, GA has changed and is currently a far better place for discussions of emotions, throwing into question the need for any “compensation” NA may provide. With respect to the third, we have found that NA is no substitute for GA due to a host of delusions specific to gambling addiction which a substance oriented fellowship is poorly equipped to address. One limit was that we were unable to find members who currently attend both GA and NA. We did find gamblers with substance abuse problems who attend NA exclusively (three of whom we interviewed), and NA members who had once attended GA (one of whom we interviewed). NA is treated in more detail in the Interpretations section.

7 Interpretations

7.1 Recent Changes in GA: causes and implications

i. Influence of AA Members: 12 Step consciousness

Even back when GA was not so focussed on the 12 Steps, commentators pointed out that an appreciation for the 12 Steps could be found among members with experience in other 12 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 claiming that GA – and its spiritually deficient recovery culture – drove him to drink. He therefore went to AA, found the Steps, and then 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 that the “Steppers” have won out. As mentioned, one striking feature of GA in the Toronto area is that members often refer to AA as an example of the ways in which GA should be heading: AA is said by many to be more spiritual, to deal with newcomers more wisely, and above all to be more inclined to practice sponsorship and to focus on the 12 Steps. There is reason to believe that GA will continue to head in similar directions, putting greater emphasis on the 12 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. As already mentioned, most of the women we have interviewed insist that their influence has had the effect of bringing more sensitivity, awareness of feelings, and a broader conception of recovery to GA. One woman [Interview #2] said that 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 that this is untrue [Interview #4]. So it could be that women may sometimes exaggerate the impact they have had. Further, women interviewed have stated that the atmosphere – levels of acceptance, the types of issues discussed and the ways in which issues are discussed – has become more accommodating to women. Still, the preponderance of a “boys club” is mentioned – by the women, not by the men. The difference in perception is notable. For example, women interviewed have stated that the increased participation of women has brought more awareness of feelings into the rooms of recovery, and that “life-issues” (issues not directly related to gambling) are now more commonly discussed by men as well as women due to greater female influence. Conversely, with one exception, male members interviewed so far have been unable to identify any serious effect that the increased number of women has had on GA’s culture of recovery. This applies to open 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 that this is possible or even likely. Without prodding, however, only one male member said so. The men may mention that men are more 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, for example 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’s meeting has been formed in the Toronto area, but it was poorly attended and eventually closed down.) But beyond such observations, men have little to say about the influence women have had on GA’s recovery culture. So 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

43 the women were likely to qualify this association with issues they consider specific to gender. The men at times take a defensive posture when responding to questions pertaining to the influence of women: the idea they often convey is that there is nothing wrong with having women in GA, so some men still seem to think that the presence of women requires justification, which in turn suggests that some, maybe more than a few, 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)

And issues pertaining to gender matter more to the women than to the men. One interview with a male member, very active in every aspect of the program and among the most knowledgeable in the Toronto area, produced this insight:

“P: Are issues related to gender often discussed?

#16: Only by a female.

P: I see.

#16: I mean that I recall.” [Interview #28]

There is good reason to believe that 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 are inclined to agree. Also, changes to GA’s recovery culture seem to have taken place at about the same time that more women began to attend. And there is the simple fact that many of the changes are consistent with the needs of women. As we discussed in the Literature Review:

“Browne (1991, 1994) has suggested that GA's neglect of spirituality and interpersonal and psycho-emotional issues inhibits women's involvement. Lesieur (1988) has 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" (employment, legal) as important whereas women reported more concerns with physical and interpersonal issues. These results suggest that women may require more supportive counseling and psychotherapy whereas men seek information- sharing and cognitive restructuring.”

44 Our interviews with women in GA have given some confirmation to these generalizations about gender. So the many recent changes in GA’s recovery culture could have been tailor made for the accommodation of women. This is not to suggest that these changes are due solely to the influence of women. The 12 Steps, for example, on their own entail a broader conception of recovery – and we have found no evidence to suggest that men are any less active than women in bringing 12 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, to admit weaknesses, and even to cry (see next subsection: iii.)

But 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 perceived as not serious by some of the (mostly male) card players or horse bettors. Due to constant reinforcement of GA principles, this attitude is changing. But old habits die hard, as one woman explains.

“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. Yet this is emphasized constantly at meetings, suggesting a lack of awareness among some members. While the latter is often directed at newcomers, that might not explain everything. Interviews have confirmed that “war stories” are sometimes delivered in a competitive fashion, not only in terms of tragedy but also 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 – usually this 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 (what they can afford). The presence of women has probably had an important effect this way: there seems now to be more general awareness of this aspect of problem gambling.

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

45 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, three 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 said 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 only ten or fifteen years ago. Some meetings explicitly discourage war stories, not so much because they should have no 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 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 that, as mentioned, 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 on this score.

iii. Cultural changes throughout North America.

Another possible – and likely – reason for many of GA’s recent changes is some of the 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 12 Steps, and also of 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, to show their feelings and to cry – a change that has affected most segments of society, and it would seem that 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 that 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 that many who deemed themselves satisfied with early GA approaches have been “converted”. One can, with caution, say that GA has simply changed for the better.

46 7.2 Why these Changes did not Come Sooner: Issues specific to gambling as a potential obstacle

One may wonder why, up until quite recently, GA was very different from kindred 12 Step fellowships with respect to feelings, life issues, as well as the 12 Steps and spirituality. Did issues specific to gambling prevent GA from achieving these changes sooner? More to the point, why did GA go the way it did in the first place? One can only speculate. It is true that GA has had a high percentage of Jewish and Catholic members and hence a lower percentage of Protestant members, which may have entailed from the start an aversion to the type of religious proselytizing often found in AA. This may at least help to explain why GA has been so ardently secular. Yet it cannot explain the aversion to – let alone the prohibition of – discussions one’s feelings at GA meetings. Nor does it explain why the 12 Steps were ignored for so long in a purportedly 12 Step fellowship – notably because GA’s 12 Steps are a secularized version of AA’s, designed expressly to appease those with secular sensibilities or with an aversion to proselytizing. Better explanations come from the world of gambling itself. First, mystification of odds and a belief in things such as good luck charms are often a key aspect of gambling addiction. It could be that a culture of recovery geared to demystification was at the same time less receptive to anything even remotely associated with the mystical, be that God, Higher Power, or any other spiritual conception. Further, this may also entail a “no nonsense” approach to thinking, which in turn favors goal directed processes such as a direct focus on gambling and debts rather than “feelings”, hunches, or anything associated with one’s emotional side. There is also the issue of gender – and only recently, with the proliferation of legal gambling venues, has the percentage of female compulsive gamblers begun to rise. GA began as an almost exclusively male domain. Many of the traits which governed GA till recently – from the neglect of feelings to a somewhat confrontational recovery culture – can be perceived as stereotypically masculine. We have no reason to believe that the average male pathological gambler is more macho than the average male alcoholic. But maybe things change in recovery. Are difficulties associated with problem gambling conducive to a hyper-masculine consciousness? If it is true that male gamblers are more likely to favor logo-centric approaches and place more emphasis on “external” concerns such as legal matters and earning money (Crisp et al, 2000), and less importance on the emotional, inter-personal and spiritual, a fellowship such as GA may have provided (and may still provide) the type of environment where these sensibilities are vindicated. Our speculation involves the huge debts and legal challenges many gamblers face by the time they arrive at GA. When persons are subject to loosing their homes, and are faced with legal repercussions, it may be perceived as “natural” to sideline other concerns. This could create a culture of recovery wherein certain sensibilities are consistently vindicated while others are shoved aside. As well,

47 the urgency of legal and financial problems may also help to justify a confrontational attitude, giving credence to a certain conception of recovery.

7.3 The 12 Steps of Gamblers Anonymous

i. The Essence of 12 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 once in the First Step and then no more. The 12 Steps are not about addiction. 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 12 Steps deal with the past, but only in order to move beyond it. A popular ritual among 12 Step proponents of all stripes is the burning of one’s Fourth Step inventory (and maybe any other writing that went with the 12 Steps) after the process has been completed. In themselves, the 12 Steps are not psychological even if they can be bent in such directions. The First Step is an admission of powerlessness and unmanageability, and from the perspective of someone in 12 Step recovery, it is a purely empirical endeavor: one is simply admitting what is true, and the reasons for it are irrelevant. The AA Big Book treats any attempt to explain why one became an alcoholic as making excuses, and states that the only honest answer an alcoholic can give is that he 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 which as such can render the psychological irrelevant. To say that 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 (and in GA’s case 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 (even if 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. One need not deny the existence of the psychic world – though many 12 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. 12 Step recovery was designed to get past “self” – self-centeredness, self-will, self-seeking – even if this is difficult

48 for those who participate in a self-obsessed, therapeutic culture to accept or even comprehend. The Big Book states clearly that all the 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 12 Steps.

1. We admitted we were powerless over gambling – that our lives had become unmanageable.

GA’s first Step is the same as AA’s, though of course gambling has been substituted for alcohol. In practice, though, GA has adopted a different approach to powerlessness. In short, GA takes the concept more seriously. For example, while AA takes no official stand on whether an alcoholic in recovery can go to bars, leaving it up to the individual, Page 17 of the Combo Book (GAISO, 1999) contains an admonition regarding gambling establishments: members are told not to go in, or even near. The best way to understand Step One in GA is through its interaction with the suggestions on Page 17, which is discussed in the next subsection (7.4 The GA Combo Book).

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 12 Step fellowships. Instead of the standard restoration “to sanity”, GA members are restored simply to “a normal way of thinking and living”. First, GA is less inclined to perceive its membership as “insane” to begin with. 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 that GA avoids the sensational because it resembles big wins while gambling.

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 12 Step fellowships, GA’s third Step does not refer to “God as we understood Him”. This is a secularized approach to a spiritual process.

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

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

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

Unlike other 12 Step fellowships, GA does not suggest that members admit their wrongs to God, but only to themselves and another human being.

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

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

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, though, this step does refer to “Him”. Again, though, GA adds in brackets “(of our understanding)” in order to emphasize that God could indeed be the group, or anything else a gambler chooses.

Steps 8 through 11 are unchanged from the AA original.

8. Made a list of all persons we had harmed and became willing to make amends to them all. 9. Made direct amends to such people wherever possible, except when to do so would injure them or others. 10. Continued to take personal inventory and when we were wrong promptly admitted it. 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.

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

Step 12 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 12 Steps in Practice

As practiced in GA, the 12 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 12 (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 12 Step fellowship’s – moving from Step One immediately to Step 12 is called “two-stepping” – in GA this warning also involves an emphatic call for patience. To quote a longstanding (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] Clearly, 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 seven 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] Here, even meetings are treated primarily as a means to achieving patience. Like most GA members, this person had huge debts to pay – gamblers, more so than many other addicts, must understand that it may take time to set things right. 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 a thrill, it can (conceivably) be a source of quick revenue – and 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 “obviously” abstinent as a sober alcoholic or cocaine addict might be: it is much harder to tell whether or not a gambler has indulged that day in the addictive behavior. 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 12 Steps and the messages (primarily concerning patience and abstinence) found in Page 17. Normally – and this is discussed in the next section (7.4 The GA Combo Book) – recovery would begin with Step

51 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). 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 12 Steps are 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 12 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 subject may take the 12 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 even much effort to focus on one step at a time; 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?, out of 13 subjects who worked the 12 Steps with a sponsor, 11 replied that they did not, and only 2 admitted to missing gambling. Out of 4 who worked the 12 Steps by “osmosis”, 2 claimed not to miss gambling and 2 claimed to miss it. The 5 who paid no attention to the 12 Steps all admitted to missing gambling. Making allowances for ideological replies on the part of gamblers who have worked the 12 Steps and who may wish to impress a listener with the efficacy of the GA program, we are still left with a stunning result (and the PI sensed little deception on the part of these subjects, 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 12 Step work seemed correlated with high life satisfaction, 12 Step work by “osmosis” with fair life satisfaction, and no 12 Step work with poor life satisfaction. With near unanimity both in interviews and informal conversations, GA members – whether they had worked the 12 Steps or not – tended to the view that those who worked the steps were more likely to be better off in a number of respects than those who had not done that work. Though it is conceivable that life satisfaction could itself lead to a willingness to practice the 12 Steps, it would be imprudent to suggest that this approach has no causal bearing on life satisfaction at all.

Another important variation involves the pace at which members proceed. One member, when asked why some do not succeed in GA, had this to say:

“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 12 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 seem to get to the steps soon enough. And they fall off before they

52 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; second, it is consistent with Brown’s (1986) observation that those who are overly elated at their encounter with GA may in fact be less successful in the long run. In any case, we have found that many GA members do procrastinate – seemingly taking full advantage of GA’s suggestion pertaining to not rushing into things.

7.4 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 these texts may be read from at a meeting. While GA does have a larger book called Sharing Recovery Through Gamblers Anonymous, it is not normally read at meetings. It seems that only at a designated Step Meeting will segments pertaining to the 12 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. But concision involves the ability to determine what is essential, and the authors of this 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 that 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 in fact 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 prefers

53 some variety. In GA, there seem to be no such divisions: practically everyone loves the Combo Book. The book begins with a history and then a brief description of GA. By pages four and five, one is already reading the 12 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 12 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 Toronto area. Pages six and seven contain The Unity Program, GA’s version of AA’s 12 Traditions, which (for reasons the PI could not fathom) are often called the “12 Steps of Unity”. We discuss the Unity Program in the next subsection (7.5). 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: 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 ten discusses three characteristics associated with being a compulsive gambler: inability or unwillingness to accept reality; emotional insecurity; immaturity. Then, page eleven discusses “the dream world of the compulsive gambler” which may include things such as yachts and servants. Yet the dream will never materialize, because the gambler will use any money won to “dream still bigger dreams” – so GA members perceive themselves as compulsive dreamers. Pages twelve to fourteen further discuss gambling along disease model lines, making it clear that even a penny ante game or an office sports pool are sufficient to activate the addiction. Most importantly, perhaps, on page twelve it is explained that compulsive gambling is not a financial problem. Pages fifteen and sixteen 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 says that most compulsive gamblers will answer, “yes” to at least seven of these questions. In practice, however, GA members insist that you definitely are compulsive if you answer seven positively – a contradiction of the previous statement on page eight that self-diagnosis is the only valid criteria. This paradox is not specific to GA, and has long haunted 12 Step/disease model approaches. Two legitimate concerns are involved: first, compulsion, marked by “craving” of any kind, is an experiential phenomenon that only the subject in question can identify with certainty; second, experienced addicts are often able to identify a kindred spirit who may be practicing some denial. A balance between these two legitimate concerns is integral to any healthy rapport with newcomers. After these sparsely worded sixteen pages, one turns to what is probably the most important page of all.

54 ii. Page 17

Many GA members say that page 17, on its own, can ensure abstinence from gambling if a person takes all the instructions seriously. Others say that page 17, along with the two pages containing the 12 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 12 Step fellowships stress the importance of meeting attendance. Yet in most – AA, NA, CA, for example – the suggestion for newcomers is normally ninety meetings in ninety days. So why does GA consider one weekly meeting sufficient for new members? When the Combo Book was first written, GA was smaller and there were not enough meetings in most (maybe all) regions for a more ambitious suggestion. Some of the older GA members in the Toronto Area recall when that 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. But there is more to it. 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 also suggests that, in general, they are an ambitious lot, keen to earn good incomes. But regardless of how we explain it, even today when there are plenty of meetings in the Toronto Area and the meetings do offer much variety, we have yet to meet a GA member who claimed to attend a full meeting a day for a span ninety days, though a few have claimed upwards of sixty during early recovery. Normally, a newcomer who attends three meeting per week is considered a good candidate for recovery. Conversely, we have found that it is far more common in NA (and in AA – the PI looked into this) for newer members to attend considerably more

55 than three meetings a week, with many attending a meeting every day – or more than one per day when possible – well beyond the first three months. It would seem that, for most GA members, such goals are simply unrealistic. But 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 12 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. 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 that, 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

56 back to drinking, he may drink for a month 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 subject’s words are important, for 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 Toronto area. The perception in GA is that members who relapse usually make up for lost time. And 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 the fact that there are few limits to how much money they could gamble away is one reason. 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. But 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 twenty-five years of abstinence, told the room that he still will not visit relatives in Nevada due to the proximity of Los Vegas.

And 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

57 members who gamble compulsively, there are many who adhere to this warning. They may say “hello” or engage in 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. But there is more: while GA is becoming more spiritual in orientation, its Step 12 still has no mention of a spiritual awakening. We have discussed possible reasons for this, yet here is another possible reason that GA members are vulnerable. The AA Big Book mentions that only after such a conversion experience can an alcoholic go safely 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.

#28: Well because they supposedly have a spiritual awakening… in some shape 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 12 Steps, it may modify its stance on the suggestions contained in Item 3. Still, we should not take this for granted: GA members we have spoken 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 also 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 Toronto area 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

58 suspect that more than a few GA members at this point 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 non-compulsive recreational gamblers. One subject (Interview #7) was mainly involved in the buying and selling of real estate – and currently questions 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 12 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 12 Step fellowships, this prayer rings even more loudly in GA: many members we have spoken to consider this prayer one of the three or four most important components of their recovery.

When Browne [1991] claims that GA (as opposed to AA) does not focus on self- centeredness as a problem in recovery, and that Page 17 is not about that at all, he misses a key point: to tell a gambler that things will not go his way overnight, is precisely to tell him to cease being self-centered.

We have discussed aspects of the above admonition already (6.3 ii., 7.3 iii). There are many slogans associated with 12 Step recovery used by members to deal with a host of issues. It is no accident the “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 that one will not drink, use drugs or gamble today, rather than imagining an entire future without one’s addictive behavior – here the stress is immediately placed upon patience (another legitimate interpretation of this slogan). “Don’t try to solve all your problems at once” has, as we explained, a special meaning for those suffering

59 from an addiction geared towards reaping financial benefit. As one GA member, who is also a recovering alcoholic, put it:

“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 harboring 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. So it is a practical guide. Yet, members read more into it. We have given some reasons for why this is so. Here, the 12 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 which also deals with the 20 Questions, Page 17 does acknowledge them. First, the Steps of Recovery and then the “Steps of Unity” – the latter being a political as well as a spiritual set of rules (discussed farther down: 7.5). Yet 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 have 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 12 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.”

Pressure Relief is discussed elsewhere (6.7, 6.8) and 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 Gamblers Anonymous regarding not rushing into the solving of 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 if 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 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.”

So 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 today Pressure Relief is not practiced 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 tell you that 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.

61 According to one of the most longstanding and knowledgeable GA members in the Toronto area:

“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]

7.5 The Unity Program

Borrowed from AA’s 12 Traditions, the GA Unity Program is a set of 12 rules meant to govern the fellowship. In GA, they are often referred to as the 12 Steps of Unity. The document addresses important themes such as the decentralization of authority, though Browne [1994] has discussed the way GA has to a degree strayed from this. While GA has made fewer changes to the original than in the case of the 12 Steps of Recovery, it has continued to pursue its secular agenda. AA’s Second Tradition reads: “For our group purposes there is but one ultimate authority – a loving God as he may express himself in our group conscience. Our leaders are but trusted servants; they do not govern.” [AAWS, 1976] The GA version is simply: “Our leaders are but trusted servants; they do not govern.” [GAISO, 1999] Still, for the most part the original AA version has been left unchanged. The Unity Program has been designed to ensure that groups are self-governing and that a nonjudgmental acceptance of all kindred sufferers is practiced. So the Third Unity Step reads: “The only requirement for Gamblers Anonymous membership is a desire to stop gambling”. The Unity Steps also ensure that GA groups remain autonomous and unaffiliated with any other organization. Outside financial contributions are prohibited, and GA is not to express opinions on “outside issues” which include, but are not limited to, politics, religion, and even legislation governing

62 gambling establishment. Individual GA members who do speak on such matters should do so as private citizens and without identifying themselves as GA members. This brings us to the final, and perhaps most important, aspect of this legalistic document: anonymity. When a GA member speaks as a GA member, he or she should reveal a first name only. This is not only to protect the person from stigma, but also to ensure that no individual achieves fame or prominence through GA. As the final Unity Step states, “Anonymity is the spiritual foundation of the Gamblers Anonymous program, ever reminding us to place principles before personalities.”

The Unity Program was of course designed to strengthen GA unity. Some members we spoke to referred (as is quite common to GA in the Toronto area) to AA as a model for how the Unity Program should work. AA is said by some to do much better on “unity” than GA. It is, however, highly questionable whether AA could provide a model. Given the size of GA’s membership in the Toronto Area, it is fair to assume that, on average, a GA member puts far more into the fellowship than his AA counterpart. The Toronto fellowship is quite small, and our PI was more than a little impressed with the number of individuals willing to deal with functions such as phone lines and conferences (drawn as they were from such a small pool). Some of the older members recall that there was “really good unity” 20 or 30 years ago. Of course, back then GA in Toronto was so small (in the late 1960s there was only one meeting in Toronto) that it was a tightly knit group. That kind of “unity” is no longer realistic, and the challenge for GA in Toronto is to grow to a large enough size for a stronger service structure to emerge. Members sometimes mention GA in Montreal as a model, and some do point out that in Montreal GA may be twice as large (there is a casino right in the city).

7.6 Narcotics Anonymous

The study of NA was a subset of this project, and was based on a few hypotheses that did not pan out as we had proposed (please see 2.4, 6.21). On the idea that maybe NA could function as a place for problem gamblers with substance abuse problems to deal with both issues without the help of GA, we had to conclude that this is not the case. While all addictions can at times be associated with delusional thinking, gamblers participate in beliefs that a substance oriented fellowship seems poorly equipped to deal with. One woman with over ten years in Narcotics Anonymous, quite self aware and highly intelligent (working on a Masters Degree) still demonstrated some difficulties in looking clearly at her gambling (she had not yet crossed over to serious compulsion, but had demonstrated the early signs).

“P: At the time you really thought that you could still start winning money –

63 24: Yeah. Eventually, one day, I would get that thousand dollars that I’d been trying to win and that the money that I was spending would get me to win. A thousand bucks!

P: And how do you feel about that now? What do you think?

24: I feel like I could go there and chances are one time that I will win that thousand bucks.

P: Do you not think that you would probably lose more than a thousand before you actually won that thousand?

24: That was starting to occur to me, yes.” [Interview #24]

We need to consider the words “starting to occur”. This woman had demonstrated a very sophisticated grasp of her substance addiction, had over ten years of experience in NA, and was still struggling with a delusion that four weeks in GA would have quashed. While this woman did stop her gambling of choice, bingo, due to the birth of her child (she could not afford to play), she continued to purchase lottery tickets and had little awareness of the potential danger playing bingo in the future could pose. Our assessment is that she was able to stop playing bingo largely because her addiction had not become too out of hand – the point being that a more serious compulsive gambler might not have found the NA program sufficient. We found only one gambler able to use NA exclusively to refrain from both gambling and drugs, but this man had in fact attended GA during early recovery and it was drugs, not gambling, that were his primary addiction. Others (two of whom we interviewed) we have found to be struggling with their gambling while in NA, even though they had successfully stopped using drugs. Much of what the literature said about NA, along with our initial impressions about this fellowship, we found to be accurate. Yet it would seem that gamblers require a certain approach to their delusions, along with the type of recovery culture that GA has developed. In short, we both overestimated NA’s potential and, perhaps more importantly, underestimated GA – only after a careful look at GA’s recovery culture were we able to appreciate the ways in which it was tailor made for gamblers. Another reason for inquiring into the benefits of NA involved that fellowship’s stronger emphasis (compared to AA) on feelings and the emotional undercurrents of addiction as a counterweight to GA’s suppression of such matters. Yet GA itself has changed on this score. So while NA may still be potentially beneficial for a gambler with substance abuse issues, this hypothesis was based on dated information. While we have no trouble recommending NA to GA members with substance abuse problems, we found little cause to view it as the potential panacea we were hoping to find.

64 8. Conclusions and Implications

Gamblers Anonymous is a neglected but vital resource for people seeking help for gambling problems. Using qualitative methods, our project sought to draw attention to the value of mutual aid for problem gamblers. Overall, we have learned that GA has a unique culture of recovery designed specifically for pathological gamblers – an approach that in many ways sets it apart from traditional 12 Step fellowships such as AA and NA. While originally we considered the possibility that many compulsive gamblers with substance abuse problems could benefit from attending a substance oriented fellowship exclusively, we are no longer of that view. While such a choice may work for some, GA’s approach appears to be uniquely, and very intelligently, designed for the specific dilemmas facing problem gamblers. Further, GA is changing rapidly: with the growing influence of women, and a greater emphasis on the 12 Steps and on the emotional side of recovery, it might be that GA has only recently begun to incorporate cultural changes that have marked North America during the second half of the twentieth century. We explore some possible reasons for why GA remained as it did for so long, but they are speculative. More importantly, these changes are also a comment on earlier recovery process in GA: without the 12 Steps, many members simply found GA’s approach unsatisfactory despite their abstinence. Terms such as “dry drunk” in AA reflect what many members of 12 Step fellowships have long understood: abstinence is not enough. In keeping with this claim, our research has found a strong association between 12 Step work and recovery from gambling. It may be that the 12 Steps render abstinence far more tolerable. Since GA serves as an adjunct to most formal treatment options in North America, members of the treatment community should be aware of GA’s strengths and limitations. GA is still more secular than AA, NA, CA and many other kindred mutual aid associations. It is less male-dominated fellowship than it once was. Other changes GA has experienced, all described in this study, should be made known to those in the business of helping problem gamblers. It is important to acknowledge the limitations of this study. A limited sample of GA participants took part in a semi-structured interview. We were able to attend and observe open GA meetings, but were disallowed from attending closed meetings. Still, the findings we report open a line of research that merit further study. And given the continuing importance of GA as a resource for problem gamblers, we hope such work rekindles scholarly interest in mutual aid as a pathway to recovery that problem gamblers themselves continue to explore.

65 9. Future Research

Overall, our most significant observation is directed at the 12 Step process itself: given its apparent benefits for members, we find it surprising that the research community has yet to examine it closely. While much has been written on AA and other such fellowships, the actual process of “Step work” remains largely unknown. So while we consider a close study of the ways in which GA members work the 12 Steps as key to a fuller understanding of how and why GA works for many, this recommendation would apply to the study of 12 Step/mutual aid fellowships in general. Talk to GA, AA, or NA members, and many of them will tell you that this 12 Step process is “where the real program is”. For too long, these claims have been neglected.

The following is a list of topics we recommend as further areas of inquiry.

Features that best describe GA’s approach to recovery. A study might look closely at the ways in which members work the 12 Steps, or at why they do not (and what they might be doing instead), and try to identify features that seem to be inherent to practically all successful recovery in GA. The present study has already identified some general features of GA’s approach to recovery, and it would be useful to build upon that knowledge.

The advantages, and disadvantages, these features present. For example, we have discussed the importance of patience to GA members and the reasons for it, along with some potential drawbacks associated with procrastination stemming from a slow and measured approach to recovery. Clearly, members need to find a balance, and those who fail in this regard may well return to gambling. Not getting to the 12 Steps, or to Pressure Relief, soon enough have been identified as potential areas of concern.

Sources and effects of greater engagement with GA activities. Potential reasons for closer affiliation with GA are endless, yet some clarity on this matter would be helpful. Gender, for example, would be an obvious area for scrutiny. Ethnicity, which this project was unable to address properly, could also figure. Other areas of interest could include, but would not be limited to: severity of gambling problem, types of gambling pursued, debt-load, belief systems, outside social support and personality type. The effects of these factors on outcomes along a number of a number of psychosocial dimensions, including overall quality of life, merit closer study.

Characterizing different approaches to 12 Step work in GA. Beyond the three approaches identified here, it may be possible to identify other salient differences. Such differences lead to questions about which of these approaches are more effective. Are certain approaches simply more effective in general? Or are some approaches better suited to particular subpopulations?

66 Social and personal determinants of different recovery approaches. Potential factors may well include: gender, belief systems, links with other fellowships, severity of gambling, debt load, comorbidity, levels of outside support, participation in professional treatment.

Emerging directions in GA. If GA’s female membership continues to grow, this could have significant implications. The trend itself merits further study, as do the possible effects of more women on GA culture. Also, there are many potential implications to GA’s increased emphasis on the 12 Steps and their associated spiritual transformation.

There are then, a number of topics that have been identified in this study that merit further investigation. As gambling expansion continues to be the policy of most western governments, GA remains the most widely available resource for problem gamblers seeking help in North America. The importance of understanding this therapeutic movement will continue to grow.

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11. Appendix

Original Interview Protocol For GA members:

1. Why don’t we start with an introduction. Could you please tell me a little about yourself? 2. Every gambler’s story is unique. How did you first get started in gambling? 3. What did you like about gambling? 4. What didn’t you like about gambling? 5. What brought you to GA? 6. What has GA been for you? What has it meant to you? 7. Do you miss gambling? 8. GA has helped you stop gambling. How has it helped you not to want to gamble? 9. How important are the 12 Steps for you? 10. How important is page 17 for you? 11. Why, in your view, do some succeed in GA and others not? 12. GA now has more women than it once did. How did this change take effect? And what effect has the greater involvement of women had on GA? 13. I’ve heard that GA in this region doesn’t hold many Pressure Groups. Why is that? 14. In your view, is GA very confrontational with newcomers? 15. In your opinion, is GA primarily a secular or a religious organization? Or, do these words really apply? What does spirituality mean to GA (and to you)?

Finalized Interview Protocol:

1. Why don’t we start with an introduction. Could you please tell me a little about yourself? 2. When you first entered GA and took the 20 questions, how many “yes” answers did you give? 3. How did you first get started in gambling? 4. What did you like about gambling? 5. Why do you think you gambled? Was it a thrill, a means of alleviating pain or fear or tension, or something else entirely? 6. What didn’t you like about gambling? 7. Have you ever had any substance addictions, including tobacco? 8. How did the experience and feelings surrounding gambling compare to some of your substance addictions? 9. How has your gambling affected your friends and loved ones? 10. Aside from GA, what kind of support have you received for your recovery? 11. Did you liquidate assets because of gambling?

87 12. Which assets did you liquidate first, and which ones did you liquidate only when there were no other options? 13. Can you give reasons for these priorities? 14. What brought you to GA? 15. What has GA been for you? What has it meant to you? 16. Do you miss gambling? 17. Do you ever get urges to gamble? [If yes] How do you deal with these urges? 18. Not gambling isn’t the same as not wanting to gamble. Has GA helped you not to want to gamble? 19. How important are the 12 Steps of Recovery to you? 20. How does one work the steps? 21. Have you noticed that if two people have been off gambling for a similar amount of time, that the one who has worked the steps is a little better off – emotionally, spiritually – than the one who hasn’t? 22. How important is page 17 to you? 23. Page 17 is a set of practical principles, but to some GA members it’s much more than that. Do you have any thoughts on this? 24. Please tell me about the Unity Program. 25. How important is sponsorship to you. And, in your experience, what role does it play in the lives GA members in general 26. Why, in your view, do some succeed in GA and others not? 27. GA now has more women than it once did. Can you describe how this transition took place in the rooms: the conflicts, surprises, levels of acceptance? 28. And what effect has the greater involvement of women had on GA? 29. I’ve heard that new women in the program are less likely to stick around, is that true in your opinion? 30. [If so] Why do you think that is? 31. In your view, what percentage of active GA members are women? 32. Not only is GA mostly male, it is also mostly white. Do you have any thoughts on the reasons for GA’s ethnic composition? 33. How do you feel about War Stories? 34. I’ve heard that some, maybe many, GA members discourage talk of feelings, life- issues and so on, in the belief that GA should focus more closely on issues directly related to gambling. Do you think that many people in the program feel this way? 35. What are your views on this question? 36. I’ve heard that GA in this region doesn’t hold many Pressure Relief Groups. Do you know why that is? 37. What does spirituality mean to GA (and to you)? 38. What do you do to help other members in the program? 39. If you could change, or improve, anything about GA, what would it be? 40. Do you feel that there is an onus on the government, or the gambling establishments, to have a duty of care? 41. Could governments or gambling establishments have done something in order to get you to a GA meeting earlier, or get you to stop gambling earlier? 42. How did you feel about the interview? 43. Can you think of other questions I could have asked?

Special, In-depth Protocol for Experienced Members (used in the later stages of the study):

1. Please tell me what happens at a GA meeting. 2. Are the meetings very interactive? 3. Is cross-talk discouraged? 4. Do members find ways to get around the prohibition of cross-talk? 5. Could you please tell me about what happens when someone takes the 20 questions? 6. Do people often discuss substance addictions, including tobacco? 7. Is this discouraged? 8. Do some members get annoyed when people discuss life-issues without reference to gambling? 9. Do people often discuss their urges to gamble, and how they deal with these urges? 10. Are the 12 Steps of Recovery discussed very often? 11. What’s said about the steps? 12. Do people talk about how to work the steps? 13. Do members discuss the Unity Program? 14. What do they say? 15. How about page 17, is it discussed often? 16. What do people say about page 17? 17. Out of the three – recovery steps, unity program, page 17 – which receives the most attention? 18. Are issues related to gender often discussed? 19. Have you noticed any differences between the things men and women like to talk about? 20. I’m interested in the ways that men and women tend to interact. Does gender have much bearing on the overall flavor of a meeting? 21. Do you think that the presence of women affects the way men express themselves? 22. Does the presence of men affects the way women express themselves? 23. Does ethnicity have any bearing on what goes on at meetings? 24. Do you hear many war stories? 25. Are war stories discouraged, either explicitly or in other ways? 26. Do you think that some members tell war stories just to be defiant? 27. Is spirituality discussed very often? 28. What kinds of things are said about spirituality? 29. How are newcomers dealt with? 30. How do old-timers deal with each other? 31. Do people often talk about the gambling establishments, duty of care, and things like that?

Interview protocol for NA members:

*If applicable.

1. Why don’t we start with an introduction. Could you please tell me a little about yourself? 2. When you first entered GA and took the 20 questions, how many “yes” answers did you give?* 3. How did you first get started in gambling? 4. How did you first get started in drugs? 5. What did you like about gambling? 6. What did you like about drugs? 7. What didn’t you like about gambling? 8. What didn’t you like about drugs? 9. How did the experience and feelings surrounding gambling compare to some of your substance addictions? 10. What brought you to GA?* 11. Please tell me about your experiences in GA, what it has meant to you.* 12. What brought you to NA? 13. Please tell me about you NA experiences, what does this fellowship offer? 14. Why do (don’t) you still go to GA meetings?* 15. Why do you still go to NA meetings? 16. In your view, what are the main differences and similarities between these two fellowships?* 17. Do you miss gambling? 18. Do you miss drugs? 19. NA/GA has helped you stop gambling and using drugs. How has NA/ GA helped you not to want to pursue these activities? 20. How important are the 12 Steps for you? 21. How important is page 17 for you?* 22. Why, in your view, do some succeed in GA and others not?* 23. How do you feel about War Stories? 24. What does spirituality mean to you? 25. How did you feel about the interview? Can you think of other questions I could have asked?