Deborah G. Haskins, Ph.D., LCPC, NCGC-II, BACC New Faces of Problem Gambling: Cultural Competency and Problem Gambling For my remarks, I want to focus on what I do—helping practitioners learn how to infuse treatment to reflect cultural identities and values.

Objectives The cultural landscape of our neighborhoods/communities are changing; therefore, problem gambling treatment and prevention must change too. Participants will: 1. Briefly learn the cultural competency Multicultural Awareness (Attitudes) Knowledge and Skills (MAKS) model to use for counseling problem gamblers. 2. Learn specific cultural knowledge about racial and ethnic problem gamblers. As you saw in the description, read above.

Cultural Competency: What is this? Individual Cultural Competence: “The state of being capable of functioning effectively in the context of cultural differences.” Organizational Cultural Competence: A set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals and enable that system, agency, or those professionals to work effectively in cross-cultural situations. Culturally Competent Mental Health Care: Will rely on historical experiences of prejudice, discrimination, racism, and other culture-specific beliefs about health or illness, culturally unique symptoms and interventions with each cultural group to inform treatment (Cross, Bazron, Dennis, & Issacs, 1989; Pope-Davis, Coleman, Liu, & toporek, 2003) Notice that cultural competency can function at many levels, including individual and organizational. It is important for us as addictions professionals to understand that cultural competence operates at an individual level, and organizational level, and specific mental health competency levels. One psychologist, Dr. Carolyn Turner identified conducts a research program in Georgia at one of the state hospitals where they ask consumers of hospital and psychiatric services to themselves identify what are culturally competent services.

Cultural Competency Clinicians have Multicultural: Awareness of importance of his/her own identity, socialization experiences, and influence of culture on functioning and therapeutic relationship Knowledge base of cultural factors and how treatment and prevention must incorporate what we understand about tailoring interventions/awareness to meet diversity of consumers Skills to translate this to the therapeutic relationship So as Addictions Professionals, what should we aspire to acquire for cultural competency? This is what the MAKS model identifies.

Cultural Research Volberg (1994) found great majority of pathological gamblers entering treatment are White, middle-aged men Ethnic minorities were seriously underrepresented among pathological gamblers entering treatment, even on Native American tribal governments So 16 years later, have things changed? Who is seeking treatment now?

Problem Gambling and Cultural Diversity Research Minorities were much more likely than Whites to be problem gamblers (Weite, Barnes, Wieczorek, & Tidwell, 2004) Their study found that Race was the most potent predictor of pathological gambling symptoms per person: Blacks and American Indians have more symptoms per person, Hispanics and Asians in the West had more symptoms than those outside the West The sample size was 2168 respondents who gambled in the past year. Among female gamblers, the group comprised of Blacks/American Indians/Women of unknown race gambled more frequently (70 times) than the group containing Whites, Hispanics, and Asians (42 times); Among married or never married men, Whites and Asians gambled less often (55 times) than men of other races (93 times/year) In the Michigan Survey of Gambling Behaviors (Hartmann, 2006), the author noted that as in earlier reports, age and race appeared to have some correlation to incidence of higher SOGs scores but it is clear that no age, race, gender, education or income group is immune to the risk of gambling problems. Dr. Hartmann noted also that in this survey, youth and poverty are related to low survey response. So how do we reach these persons. Many materially poor persons don’t trust govt, institutions/places they feel have contributed to their experiences of poverty and unempowerment—how do we engaged these persons and get their involvement ultimately in treatment and prevention.

Cultural Research Materially poor persons may see gambling as an escape from poverty, making them more at risk to gambling pathology U.S. minorities have a much lower net worth than Whites, even at similar income levels (U.S. Dept. of Commerce, 2001); therefore, lower wealth means the same gambling losses will cause more financial hardship, and more pathology (Schissel, 2001) So how do we change this? We may not be able to just as practitioners—more complex, we’re talking about dealing w/generational poverty, multiple areas where racial, ethnic, and materially poor persons are not privileged in our society

Cultural Research In a study examining gender-related differences in the characteristics of problem gamblers using a gambling hotline (n=562, 349 males; 213 females ) in southern New England found: disproportionately fewer calls received from minorities, especially Hispanic and African American men, compared with estimated rates of problem gambling in these groups Issue: How do we make gambling helpline services more available or attractive to minority groups? Potenza, M. N., Steinberg, M. A., McLaughlin, S. D., Wu, R., Rounsaville, B. J., & O’Malley, S. (2001). Are we doing public education in the places where persons hang out?: For example, with AIDS/HIV education, regular citizens like barbers, hairstylists, etc. are being trained to provide information. Have we taken our Helpline info, etc. to these places, schools, churches, religious/spiritual institutions. We have to get out into the community. We need folks willing to do this grass roots work.

Culture and Addictions Research More understanding of the contextual factors surrounding race, ethnicity, and culture when working with trauma survivors from diverse backgrounds (Hien, Litt, Cohen, Miele, & Campbell, 2009).

Summary: So What Needs To Change? 1. More research needed to understand cultural context and relationship with addictions and problem gambling. 2. Patterns of alcohol & drug use and medical co- morbidities have affected cultural & ethnic groups in similar and divergent ways. Prevention and treatment involve medical, public health, and changes in minority community attitudes and mores, law enforcement, education, media, technology (Westermeyer, J. & Dickerson, D., 2008). 1. We need to be willing to design our interventions to respect culture—be willing to modify treatment and prevention to include cultural context.

Summary/Recommendations 3. Perceived barriers to care within a minority group can impede treatment seeking, even when services are available (Westermeyer, J. & Dickerson, D., 2008). Question: How do we reduce the barriers that impede minorities from seeking treatment and/or connection to our public awareness efforts such as National Problem Gambling Awareness Week? How do we develop more culturally relevant treatment?