This article is available in: HTML PDF jgi: p. 5

Journal Information
Journal ID (publisher-id): jgi
ISSN: 1910-7595
Publisher: Centre for Addiction and Mental Health
Article Information
© 1999-2001 The Centre for Addiction and Mental Health
Publication date: June 2009
First Page: 5 Last Page: 30
Publisher Id: jgi.2009.23.1
DOI: 10.4309/jgi.2009.23.1

An evaluation of two United Kingdom online support forums designed to help people with gambling issues
Richard T.A. Wood Affiliation: GamRes Limited, Montreal, Quebec, Canada Email: Richard@GamRes.org
Sabrina A. Wood Affiliation: GamRes Limited, Montreal, Quebec, Canadaa

For correspondence: Dr. Richard T.A. Wood, CPsychol, Web site: www.GamRes.org, e-mail: Richard@GamRes.org
Contributors: Richard Wood designed the studies, administered the content analysis, interviews and questionnaire, conducted the analysis, and wrote the final report. Sabrina Wood assisted with the design, administration, and analysis of the three studies.
Competing interests: There were no competing interests for either author.
Funding: This research was entirely funded by The Responsibility in Gambling Trust (RiGT) in the UK.
Ethics approval: The ethics of the project were examined and approved by the Research Committee of the Responsibility in Gambling Trust. All research was carried out in accordance with ethical guidelines from The British Psychological Society.
Summary findings of the research were presented at The Nova Scotia Gaming Corporation's Responsible Gambling Conference, Halifax, Nova Scotia, October 2008.
Dr. Richard Wood is a Chartered Psychologist and the Director of GamRes Limited, an independent research and consultancy company specialising in international responsible gaming initiatives. He has authored over 50 gaming-related publications, presented his findings at conferences and seminars around the world, and undertaken numerous responsible gaming consultations for both the gaming industry and regulatory sectors. Dr. Wood's research focuses on both the underlying causes of problem gambling and the structural and situational characteristics of games that can influence the behaviour of vulnerable players. He also examines the use of technology to help support people with gambling problems (e.g., forums and online guidance) and recently developed — following this study's completion — the first national Canadian forum to help people with gambling issues (www.GamTalk.org).
Sabrina Wood has many years of experience managing online forums, organising electronic databases, and developing Web-based materials. Sabrina also worked as a healthcare professional in both Canada and the UK, giving her an excellent understanding of the issues related to unhealthy behaviour patterns and vulnerable populations. Sabrina coordinates all of the online resources and activities that GamRes undertakes and is the chief moderator of www.GamTalk.org.
Acknowledgements: We would like to thank The Responsibility in Gambling Trust (RiGT) for funding this research and all the participants who took part. The authors would like to thank all the forum staff for their assistance in conducting this study, and also many thanks to all the forum members who took part, without which this study would not have been possible.

Abstract

The study examined two United Kingdom online forums designed to support people with gambling problems and people affected by problem gambling (e.g., partners, relatives, and friends). The methods utilised were content analysis of 60 forum posts, online semi-structured interviews (n = 19), and an online survey (n = 121). The study found that the forums helped members to better understand and cope with their own gambling problems or with those of others. A lack of other alternative support, ease of access and availability, need for additional support, insight gained through posting and hearing other's stories, help in resisting urges to gamble, and perceived anonymity were all given as benefits of the forums. The forums were most popular with online gamblers, and had a higher ratio of females to males (with gambling problems) than any other comparable service. Significantly more females than males suggested that the forums helped them to cope better with their gambling problem. The utility of online forums for helping people dealing with gambling problems is discussed.


Background

To date, there has been only one empirical study (world-wide) that has specifically investigated the utility of online forums for helping people with gambling problems, and that study focused on the international, although predominantly North American, Gamblers Anonymous (GA) web forum. Cooper (2004) collected both quantitative and qualitative responses to an online survey received from 50 people with gambling problems who used the forum. Cooper found that the majority of clients (70%) had previously avoided seeking face-to-face treatment because of an unwillingness to disclose information about themselves. This appeared to relate to a perceived high level of stigma associated with having a gambling problem. Several studies have found that the issue of stigma has caused some people with gambling problems to avoid seeking treatment (Gupta & Derevensky, 2000; Hodgins & el-Guebaly, 2000; Marotta, 2000).

Cooper (2004) also found that lurking (i.e., visiting but not registering a presence to other users) at a problem gambling support group Web site made it easier for many people to consider seeking further help, including face-to-face services. Cooper observed that this was particularly true for the female clients in the study. A similar finding was also noted by Wood and Griffiths (2007a), who found that the one-to-one online guidance and support service GamAid, where a client chats directly to an advisor, was used by far more females with gambling problems (relative to males) than any other comparable United Kingdom (UK) service. Wood and Griffiths (2007a) speculated that this was due to females perceiving problem gambling as more stigmatising than their male counterparts do. This may be because gambling has traditionally been seen as a largely male pursuit in the UK, with the exception of bingo.

Cooper (2004) noted that 20% of the sample in his study reported that they used GAweb as the exclusive means for helping them deal with their gambling problems. Cooper suggests that for some people, online forums may be the only support that they can receive because of financial, geographical, transportational, and/or emotional constraints. Given that Internet gambling is the fastest growing form of gambling, online support may prove to be an extremely useful way of helping those who develop problems with online gambling. Wood and Griffiths (2007a) found that the GamAid service was used by more Internet gamblers than any other comparable UK service. This is perhaps not surprising considering that Internet gamblers have access to, and are usually comfortable using, online services more generally.

Overall, there is a paucity of empirical data that assesses the efficacy and feasibility of online forums for helping people with gambling problems and those affected by people with a gambling problem. Consequently, the present study is the first to examine an online peer support programme for people with gambling problems within the UK.

Currently, there are two national forums in the UK for persons with gambling problems and both of these were examined in the present study. Both forums have been operating for several years and are run by organizations that provide several other types of support service for people with gambling problems. These services include telephone help lines and face-to-face counselling, and one organization also provides residential treatment facilities. At the time this study was conducted, there were approximately 8,000 registered members across both forums. Around half of those members were considered “active” in that they had logged on to the forum at least once in the last 6 months. However, it is difficult to determine how many members visit the forum on a more regular basis and also how many members only read posts as opposed to write their own posts.

The project aimed to investigate both the features of UK support forums and the communication processes that may facilitate or hinder users in abstaining from, or controlling, their gambling behaviour. The research examined the nature of problem gambling support forums through content and thematic analysis, as well as the experiences and motivations of those clients who use those services through interviews and a questionnaire. Participants were self-defined as persons with gambling problems rather than being identified with screening tools such as the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association). For the purpose of this project, it was felt that if a participant believed that they had a problem with their gambling behaviour, then it was highly likely that this was actually the case. Also, these forums offer support to those getting over gambling problems who may no longer meet the criteria for pathological gambling.


Ethical considerations

The researcher was introduced to the online communities by the respective moderators and made clear the research intentions before any data were gathered. The researcher answered questions about the project, via the forums, for 2 weeks before the study began in order to ensure that the forum members were fully informed. There were no objections registered to the research taking place. The names of all participants remain confidential and were known only to the researcher for the purpose of arranging the online interview procedures. All references to persons in the analysis and subsequent reports were made by using pseudonyms that were different from their actual usernames. It has been argued that online identities should be afforded the same guarantee of anonymity as physical identities (Wood, Griffiths, & Eatough, 2004). To ensure informed consent, the researcher fully advised the participants about the nature of the study and the use of the subsequent findings and reassured them that they were free to withdraw their consent at any time during or after the study if they so wished. Contact details for follow-up questions were provided.

The study was designed and carried out in accordance with The British Psychological Society Code of Conduct, Ethical Practises and Guidelines. All participants were required to indicate that they were over 18 years of age as part of the (informed) consent procedures. However, it is important to note that there was no independent means of verifying the age of participants. Online, people largely define who they are through text, and as a result the study relied on people telling the truth about who they were. Every care was taken to verify age, given these limitations. See Wood et al. (2004) for a more detailed discussion of ethics in online research.

The ethics of the project were examined and approved by the Research Committee of the Responsibility in Gambling Trust.


Study 1: A content analysis of 60 posts

The purpose of this phase of the project was to gather secondary data in order to both broadly define the usage of the forums and to give an indication of the content of the discussions that take place. By defining the content of the forums, it was possible to show how they were mostly used. More important, this phase of the research process helped identify the areas that needed to be discussed in more detail during the interviews conducted during Study 2.


Method
Participants

Participants were all members of one of two UK-based forums set up to help people who are dealing with either their own gambling problems or the gambling problems of partners, relatives, or friends. The data gathered were secondary in that they were derived from previous posts on the forums. Therefore, it is not possible to give demographic information such as age and gender, as this was not known. Actual usernames are also not given in order to respect the anonymity of those forum members whose posts were selected as examples.

Design and procedure

In order to gauge a basic understanding of the types and content of posts on the forums, a brief microanalytic content analysis was conducted of 60 posts by randomly selecting 15 posts on 4 separate days. New posts and subsequent responses are often qualitatively different from each other. For example, a new post may be a question or a request for help, whereas a response is more likely to be an answer to a question or a message of support. Therefore, half of the posts selected represented the first post of a new forum topic and the other half were randomly selected responses to previous posts. Each topic (sub-forum) across both forums was equally represented in the analysis.

Analysis

Emergent coding procedures were followed (Stemler, 2001) and two researchers independently read through all of the selected posts (with all usernames removed) and compiled a list of global thematic categories. Comparison of the lists showed a high level of initial similarity (92% agreement). A composite list of categories was collapsed into a final set of coding categories that were then applied to the selected posts. Two of the researchers coded all of the questionnaires independently. Inter-coder agreement was high, with kappa values ranging from 0.77 to 0.87 across the categories identified. Landis and Koch (1977) report that kappa values of 0.61 to 0.81 show a substantial strength of agreement, and values of 0.81 and above can be considered almost perfect.


Results

The analysis of forum posts identified that the forums contained a variety of different types of messages that were utilised to support both members with gambling problems and members seeking help for others with problems. Results show the percentage of categories that appeared in all 60 posts; several categories could appear in a single post.

Forum members providing advice or information to another member (38% of posts)

How to deal with an issue relating to problem gambling was the most frequently occurring category of post on the forums. Sometimes these posts were in response to a specific question or request for help from another member. For example:

The answer to your question is only if she is willing. The two things a compulsive gambler needs is opportunity and means. Self exclusion limits the opportunity, and it's a good idea if you can handle the finances in order to limit her means.

However, some of these posts provided more general information to all forum members on strategies for dealing with gambling issues. For example:

It is not the experience of today that drives people mad — it is the remorse or bitterness of something which happened yesterday and the dread of what tomorrow may bring. Let us, therefore, LIVE BUT ONE DAY AT A TIME.

A supportive statement (37% of posts)

A supportive statement was another frequently occurring category of post. Such messages usually related to a specific forum member, but sometimes messages were aimed at forum members in general. For example:

Keep posting and reading, we are all here to help you. God Bless

Personal stories (25% of posts)

Personal stories accounted for a quarter of the content of all the posts examined. Such stories usually detailed how the member had developed either a gambling problem of their own or had to deal with a partner, relative, or friend's problem. Such complete personal stories were usually accompanied by an introductory statement. For example:

It all started for me last year when I was in a bad bout of severe depression…

Other personal stories related to a particular incident in the member's (usually) recent history, such as an incident where a relapse occurred. For example:

I looked forward to the Cheltenham festival more than Christmas as a child and in fact I had been off gambling for 8 weeks until Cheltenham came around this year and I felt that I couldn't miss out on the carnival atmosphere that takes over my family for that week. Needless to say, I took a hammering over the week but never mind as I got stuck in again and again after it until I stopped 3 days ago.

Requests for help and answers to specific questions (24% of posts)

Requests for help and answers to questions were present in almost a quarter of all the posts examined. Therefore, more than half of the posts contained either an answer to a forum member's question or a request for help or information. For example:

Keep reading time and time again about partners taking over credit cards and monetary matters. Is that a good thing in the long run? Surely taking responsibility is the best. Won't feel like you own decision if it feels like it is being enforced by a loved one. I just think it would only work short time, feeling like your doing it for someone else. You can only really control yourself? Am I wrong?

Personal statements (10% of posts)

Personal statements were concerned with a particular belief or view, often relating to a specific gambling operator or a particular treatment provider. For example:

I think for every one new member of GA [Gambler Anonymous] there must thousands waiting to reach their rock bottoms, before they have to admit they have lost, and can never ever win.

Introductions by new members (8% of posts)

An introduction was the final category of post identified and simply provided a means by which new members could introduce themselves and receive a welcome response from the other forum members.

The categories identified helped to formulate the topic areas for the interview guide that aided the dialogue in Study 2.


Study 2: Online interviews with forum members

This study was designed to gain a more in-depth understanding not only of the experiences and motivations of forum members, but also the utility of the forums in helping members to gain better control over their gambling behaviour. In addition, the interviews provided the information that was needed to construct the survey for Study 3.


Method

Participants Nineteen participants took part in the study in response to posts placed on dedicated threads on both forums over a period of 2 weeks. Ten participants were female and 9 were male; age was not ascertained, as the majority of interviews were conducted on the forum, and it was considered that asking age could compromise anonymity. Seventeen of the participants had or were experiencing gambling problems. Two participants were married to someone with a gambling problem (see Table 1 for a full list of participants). All 19 participants were self-selected and represented everyone who responded to a request to participate in this part of the study.

Design and procedure

The aim of the study was to examine the role of the forums in helping participants with a gambling problem, as well as those with a partner, relative, or friend with a gambling problem. There was a specific focus on the communication processes that could facilitate or hinder users in abstaining from, or controlling, their gambling behaviour. One researcher undertook all of the interviews, and an interview guide was used to ensure that certain topics were covered, as identified in the literature and in response to the content analysis in Study 1. Participants were also encouraged to raise any other topics that they considered pertinent.

Discussions focussed on the following areas:

  1. The experience of communicating with other people who have had similar experiences
  2. Sharing personal experiences
  3. Reading other people's stories
  4. The difference between posting online and interacting via phone or face-to-face
  5. The meaning behind usernames
  6. Perceived benefits and drawbacks of using a forum
  7. Suggestions for change and improvement
  8. The times when the forum helped most
  9. The extent to which the forum has helped with a gambling problem or a problem experienced by a partner, relative, or friend

An e-mail address was given for those who did not want to discuss issues in a public arena, and 5 participants responded in this way. Responses were analysed using thematic analysis, and exemplar quotes are provided to illustrate the findings using pseudonym usernames.


Results
Feeling less alone through sharing personalexperiences

One of the most universally reported benefits was the ability of the forums to help members feel less alone with their problems. The discovery that other people were experiencing similar difficulties was for many participants a revelation that was expressed as an intense relief. Prior knowledge of others with gambling problems was often sparse or completely absent, and when members realised that they were not alone, it made the possibility of recovery seem more attainable for them. Gambling problems were often kept hidden away from partners, friends, and family, as the symptoms were not usually directly observable. A person experiencing gambling problems must often make a conscious decision to confide in others. Taking the first step towards admitting a problem to others was reported as extremely difficult, and the forums appeared to help their members to move towards a situation where talking to others was possible.

As this is called the hidden addiction, talking to others and finding out you are not alone in this addiction has helped me so much. I feel their pain when I read their stories. We are from different walks of life, different countries, their story is my story. We are all at different levels of recovery, but in away [sic] we are like one big family. (Helen, female, has experienced gambling problems)

There is some comfort in knowing that you are not the only one, this is some sort of phenomenon and you are not a ‘freak’, if you will…. When people come here hurting, I *know* what that feels like. (Jill, female, has experienced gambling problems)

To begin with the prospect of telling anyone was daunting, but once out in the open it felt like a huge weight had been lifted. (Sally, female, has experienced gambling problems)

The revelation that others were suffering similar problems was also reported as a relief by a participant who was helping her partner with a gambling problem.

It is vital as the wife of a compulsive gambler. I didn't know where to turn when I found out the extent of the problem/illness. When you find out, you feel a mixture of emotions and it helped me so much to find that my mixed up hurt and pain was shared by others and was ‘normal’. There was no judgement by those who had similar experiences. (Dancer, wife of a person with gambling problem)

Community and friendship

Not only was the discovery of others in similar situations often a revelation, but it also provided a means of mutual support. Forum members supported each other and suggested that they could be more honest and open with other forum members than they had been with their family and friends. This support was ongoing and helped to build a sense of community.

We are here for ourselves to get help, but also by posting and telling our stories, we are helping others. Also I have made some wonderful friends on this forum, who have helped me and pulled me through some rough times. (Helen, female, has experienced gambling problems)

You may not know them by face but a lot of times you get to know them better than their family do. You can feel their pain when they first post and being a gambler yourself your heart goes out to them. (Marg, female, has experienced gambling problems)

Many life issues connect back to gambling which is why the diaries on here work so well. You can visit people you feel a little more connected to in their diary space and vice-versa. (Bill, male, has experienced gambling problems)

Support did not just relate to issues directly concerned with gambling, but also extended to other aspects of participants’ lives. For some, the opportunity to talk about non-gambling issues was seen as important and there was a sense that gambling problems went deeper than just the actual activity. For these people, talking about other things was a vital step in their recovery and necessary in order to fill the gap that appeared when their gambling behaviour ceased. However, some participants did not feel that there was any need to talk about non-gambling matters. In this respect, the participants were fairly evenly split; although no one objected to the presence of non-gambling posts, some did not see them as relevant to themselves.

I think talking about non gambling matters can sometimes help us, when we are down and feeling low, a smile or hug, or a joke, can make you have a laugh. When we were in the throws [sic] of gambling I never laughed or smiled. (Helen, female, has experienced gambling problems)

I personally find it helps me a lot to get my feelings into my diary, a lot of which do not have a direct relation to gambling (e.g., my relationship). Although initially this was linked directly to the gambling, as time passes this link is getting less and less, but my need to write about it still remains. (Fantasy, male, has experienced gambling problems)

Talking about non-gambling matters is very important, as life is not just about gambling, and it brings a smile to my face as it can be so much fun. (Sparky, female, has experienced gambling problems)

Self-discovery and insight

The realisation that other people were experiencing similar problems invariably led to a journey of personal self-discovery. By discussing personal issues and by reading the posts of other forum members, participants reported that it helped them to better understand the nature of their own problem and the possibility of recovery. Insight appeared to work in two ways. One way was through reading other people's posts.

Reading so many personal testimonies has changed my perception about my own relationship to gambling and allowed me to be more objective about my approach to recovery. I am very heartened and grateful for the sharing that takes place here. (Bill, male, has experienced gambling problems)

It has helped me a lot, it helps me to stay focused as I log on and read something every day, as I have done for about a year now. (Sparrow, male, has experienced gambling problems)

Another way that insight was achieved was through the process of writing thoughts down. This helped some participants to gain more clarity about what they were thinking and enabled them to make their thoughts more concrete. This process was also reported by the wife of a person with a gambling problem, who found the clarity gained useful in dealing with her husband's problem:

Posting on the forum you can write to your hearts content and then edit your reply, so it is helping to organise your thoughts in a way you cannot do on the phone or face-to-face. Also, you can take the time to reflect on what you read before replying. Looking at written words I think you process the information slightly differently. (Dancer, wife of a person with gambling problem)

Posting gives me a real opportunity to ‘see’ what I am thinking. I often have difficulty in sorting out my thoughts if I am just ‘thinking’ them so by posting I can take my time to sort out my thoughts. Essentially, it's very therapeutic for me. (Bin, female, has experienced gambling problems)

Accountability to self and other forum members

Regularly posting on the forum, sometimes in the form of a diary, increased feelings of accountability, both to the individual themselves and to other forum members. Having to report a relapse was seen as letting other forum members down, as well as a personal failure.

Being able to post and put something on the record and thereby make myself accountable for my actions in respect to my gambling addiction has been helpful for me. (One step, male, has experienced gambling problems)

Writing about my experience and how I actually felt after the latest binge was a lifesaver. Compulsive gamblers forget how they felt when at the bottom of each cycle of binging. Having a permanent record has been extremely helpful. (New Me, male, has experienced gambling problems)

Reminders of how bad it can get

Reading other members’ accounts was seen as a deterrent to a potential relapse. Sometimes, these accounts would be older archived posts, or they would represent the posts of new members who were just starting their own voyage of recovery. Occasionally, they might also come from established members who had relapsed. As 2 participants put it:

Hearing others share THEIR stories is a deterrent…sharing MINE is healing. (Jill, has experienced gambling problems)

It is nice to have reminders of what can happen if I was to return to my gambling ways, and it allows me to think on a logical level, unlike the illogical reasoning that occurs when in gambling ‘mode’. (Fantasy, male, has experienced gambling problems)

Resisting urges

Such reminders also helped the participants to resist urges to gamble. By logging on and reading other members’ posts or conversing with other forum members more directly, participants found that the urge to gamble often subsided. In this way, the forum appeared to act, for some members at least, as an effective relapse prevention strategy. The efficacy of the forums for reducing urges appeared to be particularly true for those participants who predominantly gambled online, as it was convenient for them to go to a forum when they were online and feeling vulnerable and/or tempted to gamble. However, other types of gamblers, and ex-gamblers, also found the forum useful for resisting urges.

I know a lot of people find it useful if they are tempted to gamble, but it's usually the online gamblers that find this (they come on here instead of the gambling site). My temptation comes when I am not in my home (fruit machines). (Steph, female, has experienced gambling problems)

When I have the urge to gamble I log on and read the postings, and I feel like I have friends who understand and don't judge, and by the time I have done that the urge is gone. I feel good about myself instead of the pain that I put myself through when I gamble. (Mel, female, has experienced gambling problems)

If I get an urge [to gamble], I log on and read the posts, just to remind myself why I cannot gamble ever again. (Helen, female, has experienced gambling problems)

However, several participants noted that it would also be good if there were some more positive stories on the forum. Although reading about other people's problems was a reminder of how bad things could get, it was also important that there were examples of how recovery was possible.

THINGS CAN GET BETTER, YOU ARE NOT ALONE, YOU ARE WORTH IT, THIS IS DOABLE. Those are all things that I *really* needed to hear and now I can help others by telling them -THERE IS HOPE. (Jill, female, has experienced gambling problems)

To read there is hope and others have stopped gambling and so can you is so important to a compulsive gambler. (Marg, female, has experienced gambling problems)

The majority of the time it makes me feel quite sad [reading other people's stories], as there is ‘nothing’ positive with long term gambling. (Fantasy, male, has experienced gambling problems)

Choices and the option to try different approaches and strategies

The forums offered a chance to learn about problem gambling and to find out about different strategies for dealing with problems. Several participants reported that they were not comfortable with the idea of attending face-to-face services or using a telephone service. For other members, the forums offered an alternative to Gamblers Anonymous groups, which was sometimes the only other support available to them.

I haven't tried a phone call but I know I could not handle GA meetings. I was very aware that I did not want to tell strangers about my problem. In addition, the twelve steps, while usual to many, seems way too rigid and unthinking too me. (New Me, male, has experienced gambling problems)

Perhaps in a way this site assesses your personality for free by offering lots of different types of motivation and lots of different types of suggestions and maybe that's why it has helped me. (One step, male, has experienced gambling problems)

Being anonymous, you can't get that anywhere else. People are a lot more honest here. Not that they lie in GA meetings but you don't always feel comfortable when it's live and in person. I think both have their advantages. (Bruce, male, has experienced gambling problems)

I'm not interested in counting the number of days since I last gambled and taking one day at [a] time forever on end, I don't want to have to attend a meeting on a regular basis for the rest of my life, I just want to stop gambling and forget about it, I want it to be like a type of fruit I can't eat. (One step, male, has experienced gambling problems)

Convenience and accessibility

Convenience and accessibility were reported as essential reasons for forum use by participants who were either geographically remote, or who could not attend other services because of commitments such as child care. The forums offered these people a lifeline where no other service was accessible.

I know I would not have come this far without it. I have a long way to go and it's been a bumpy road. This has been my only form of group support due to my location and I would still be gambling, miserable and ill had I not found this site. (Steph, female, has experienced gambling problems)

To some of us there is no other support available, the forum is all I have living in a rural area. (Marg, female, has experienced gambling problems)

For me posting on this forum, is like having a helpline available 24/7, there is usually someone around most times whether it is early hours of the morning or late at night. With all the different time zones, help is here when you need it. Gambling isn't a 9 to 5 problem. Also, there are a lot of people out there that cannot get to meetings, they have other problems which prevent them leaving their houses or interacting with people. (Helen, female, has experienced gambling problems)

I am supported at anytime day and night and I don't need babysitters. (Sparky, female, has experienced gambling problems)

The fact that the forums were always available, and did not require a one-to-one dialogue, was reassuring for those who did not want to feel as though their problem could be an imposition on others.

GA tells me to use my phone list…I never do. Calling someone, I have no idea what's going on in that persons life, and honestly I have a family and there aren't many occasions where someone could call me and it wouldn't be an inconvenience. I don't want to do that to anyone, but I can come online ANYTIME and the folks here they can read and respond ONLY if they want to and AT THEIR convenience so I don't feel like I'm burdening anyone by coming here, here, people will only give if they have the time and the inclination, that works for me. (Jill, has experienced gambling problems)

The significance of usernames

For half of the participants interviewed, their username held no significance other than it was actually their real name or something they picked simply because they liked it. For others, usernames helped to maintain anonymity and allowed participants to speak freely and openly about their problems without incriminating themselves or their partners, friends, and relatives. For some participants, their username was reported as symbolic of their state of recovery or their hopes for their future life beyond gambling. Several participants reported that their username had changed over time to reflect the positive changes that had occurred since joining the forum. It would not be ethical to divulge the specific usernames as examples, although similar pseudonyms are given below as examples:

Down and out changed to Back on track Big Loser changed to New me Hopeless case changed to One step forward


Study 3: An online survey of forum members

Themes that were developed from Study 2 were used to construct an online questionnaire in order to quantitatively examine the extent to which those themes appeared to be universal across a larger sample of forum members.


Method
Participants

A total of 126 participants submitted the online evaluation questionnaire. Five surveys were excluded from the study, as they were only partially completed, leaving a total of 121 participants (53 male; 52 female; 16 unknown).

Materials

A 41-item questionnaire was designed containing questions that related to previous literature, data from the content analysis in Study 1, and analysis of the interviews in Study 2. The questionnaire went through five modifications, with two stages of input from the project advisory group.

Online survey procedure

The online survey was posted on both forums, and moderators once again introduced the researcher to the forum and requested that members help the project by completing it. The survey was posted on the forums for a period of 1 month. The researcher made it clear that the survey was completely anonymous and voluntary. The online data collection software automatically coded all responses into a format ready for analysis.


Results
Demographic information

Demographic information was requested as an entirely optional part of completing the survey, as the researchers did not want to exclude participants who did not feel comfortable divulging this sort of information.

Age

The participants were aged between 18 and 61 years and had a mean age of 41 years (SD = 11 years). The males’ ages ranged between 18 and 61 years (mean = 39 years; SD = 12 years) and the females’ ages ranged between 24 and 61 years (mean = 42 years; SD = 9 years).

Ethnicity

The participants were mostly white in ethnic origin (96%). The remaining participants’ ethnic origins were black Caribbean (n = 1), Chinese (n =1), and mixed parentage (n = 2).

Nationality

Data were also collected on which country the client was accessing the forums from. Two thirds of the participants (66%) were from the UK. However, a significant minority of participants (33%) accessed the forums from other (mostly) English-speaking countries and jurisdictions, including the United States (14%), Australia (11%), Canada (7%), Sweden (1%), and Finland (1%).

Finding a forum

The majority of the participants (62%) found one of the forums by searching for help on the Internet. The next most frequently reported way that a forum was found was through referral from a gambling Web site (15%), followed by referral from a Web site for problem gambling issues (10%), from a friend or relative (6%), from a telephone helpline (3%), from a professional such as a counsellor or doctor (3%), and from a sticker on a gambling machine (1%).

Membership duration and forum usage

Most participants had been a member of one of the forums for several months (40%) or for a year or more (31%). Just under a third of participants reported that they had been a member for 1 month or less (30%). Half (50%) of the participants reported that they used one of the forums every day, and over a third (39%) reported using a forum a few times a week. Those who reported using a forum a few times a month or a few times a year accounted for 12% of the participants. There was no significant association between gender and frequency of forum use (c2= 3.29, df = 3, p =.349). The amount of time that participants reported spending on the forums during an average session varied, with the most frequent duration being 11 to 30 min (45%), followed by 31 min to 1 hr (43%), then several hours (9%), and then less than 10 min (4%). Again, there was no significant association between gender and the amount of time spent during an average forum session (c2= 3.97, df = 3, p =.271).

Reason for first using one of the forums

Most participants went to one of the forums because they were personally experiencing some kind of gambling problem (67%; n = 81). The remainder of the participants went to one of the forums because they no longer experienced gambling problems and wanted some support (17%), or because they were seeking help for a partner, relative, or friend (16%).

There was a significant overall association between gender and the reported reasons for using the forum (c2= 24.17, df = 2, p >.005). Female participants (15%) were more likely to be seeking help for a partner, relative, or friend than were males (1%). Males (15%) were also much more likely than females (2%) to be no longer experiencing a gambling problem and seeking support. However, there was no significant gender difference between the percentage of males (34%) and females (32%) seeking help for a current gambling problem.

Participation in other problem gambling services

Just over half of the participants had contacted another support service at some time in the past (58%). The most frequently reported other service was a face-to-face support group such as Gamblers Anonymous (30%), followed by a telephone helpline service (27%), face-to-face counselling (17%), their own doctor (9%), and then residential treatment (3%). There was no overall significant association between gender and preferences for seeking other forms of help (see Table 2).

For those who had used another service (n = 73), there were a variety of reasons given for why they also used one of the online forums. The most frequently given reason was that they specifically wanted help online (56%). This was closely followed by the assertion that the forum was used as additional help (48%). Reasons of convenience and accessibility meant that 17% could either not travel to attend another service or did not have time to attend another service. Although 15% suggested that they were not satisfied with another service that they had tried, 9% wanted a second opinion.

Almost half of the total participants (49%) suggested that it would be either fairly difficult or extremely difficult for them to get alternative help instead of the forum, whereas just under a third (31%) reported that it would be fairly easy to get other help and 9% that it would very easy. However, 11% did not know how easy it would be for them to get another form of help.

Specific reasons for using the forums

Participants were able to rate the importance of a variety of reasons as to why they decided to use one of the forums. Some of these responses related to aspects such as the ease of access (80%) and that the service was available 24 hr a day, 7 days a week (70%). Other reasons related to the fact that participants could talk to others in the same situation as themselves (73%) and that they felt on an equal footing with everyone else (46%). Anonymity was cited as an important factor for around half of the participants (49%). Just under a third of participants (27%) suggested that they did not like talking about gambling issues on the phone, and 21% did not like talking about gambling issues in a face-to-face setting.

Reported utility of the forums

Participants were very positive about the efficacy of the forums in helping them with their problems (see Table 3). Almost all of the participants suggested that the forum helped them to feel less alone (98%), including both those with a gambling problem and those seeking support for others. Similarly, most participants either agreed or strongly agreed that the forum (a) helped them to understand their own thoughts by writing them down (82%); (b) helped them to vent or offload their feeling (84%); (c) served as a reminder for how bad things could get (91%); (d) provided a sense of community and/or friendship (89%); (e) provided new ideas on how to cope (92%); (f) helped to reduce the impulse to gamble (60%); (g) helped them plan for the future (52%); (h) made them more confident about seeking other forms of help (50%); (i) made them more positive about the future (69%); (j) gave them a sense of satisfaction from helping others (66%); and (k) helped them to gain better control over their gambling behaviour (72%).

There were two significant associations between gender and what participants reported that they got out of using the forums. Females (32%) were more likely than males (20%) to agree or strongly agree that the forum helped them to reduce the impulse to gamble (c2= 11.18, df = 5, p >.05). Similarly, more females (39%) than males (23%) reported that they agreed or strongly agreed that the forum helped them to gain better control over their gambling behaviour (c2= 17.60, df = 4, p >.05).

Reported utility of specific forum features

Participants were very positive about the utility of various features of the forum (see Table 4). The vast majority of participants found the following features either somewhat useful or very useful: (a) being anonymous (90%); (b) writing a continuous personal diary (57%); (c) telling their own story (88%); (d) asking for help from other members (81%); (e) getting professional advice (56%); (f) reading other people's stories (98%); (g) having 24-hr, 7-days-per-week access to the forum (97%); (h) having a specific section to discuss non-gambling issues (40%), although 30% were not sure; (i) discussing Gamblers Anonymous matters (42%), although 30% were not sure; and (j) writing responses to other forum members (87%). There were no significant gender differences in relation to the utility of any of the forum features.


Discussion

Both of the forums appear to provide a good deal of support for people experiencing gambling problems, as well as for those who were no longer experiencing gambling problems. The support offered on the forums was also utilised by partners, friends, and relatives of people with gambling problems. Foremost, the forums provided a means of mutual peer-based support that allowed the members to feel less alone with their problems. This support is in line with findings from previous studies of support forums in other health-related settings (e.g., Buchanan & Coulson, 2007; Coulson, 2005; Coulson & Knibb, 2007; Finn, 1999). Furthermore, by reading other members’ posts and by engaging in a dialogue with other members, participants reported that a better insight and understanding of gambling problems was achieved. The mutual peer support that the forums offered helped members to consider how they might take steps towards confronting their problems. These findings both support and extend the evidence presented in the pathways disclosure model developed by Cooper (2004).

The anonymity of the forums appeared to help the members to express themselves openly, and for some members, this was the first time that they had ever talked about their problems. Gambling problems are frequently accompanied by other psychological problems such as anxiety and depression. Although these other problems may be a symptom of the gambling problem and/or a contributing factor, the need to talk openly to others is an essential step in dealing with the gambling problem. Furthermore, it was found that for some members, the process of reading and posting helped them to resist urges to gamble and to more effectively control their gambling behaviour on a day-to-day basis. In this respect, non-gambling topics were considered important by around half of the participants as an essential way of moving beyond their gambling problem. Filling the “void” that can appear when gambling ceases is an important part of the recovery process (Wood & Griffiths, 2007b). Developingnon-gambling sub-forums may be a useful strategy to help those who wish to go in that direction. Having specific areas where discussion does not focus on gambling would be one way to achieve that goal.

The forums also helped some members to consider various options and strategies for dealing with their problems. These options ranged from simply writing down and organising their thoughts to considering other treatment options and/or day-to-day strategies for coping. For a number of members, the forums were used in conjunction with other services as an extra form of support that was available whenever they felt that they needed further help.

Reading other members’ posts served to remind forum members of how bad things could get and served as a deterrent to further gambling. However, some participants noted that these posts could also be quite depressing and that more positive stories would be useful to provide hope. Developing a sub-forum dedicated to success stories might be helpful for those who cannot face reading about examples of failure to stop gambling. Similarly, providing a sub-forum dedicated to successful strategies for dealing with gambling problems may be helpful for those specifically looking for such information.

Access was also seen as an important reason for using the forums and was linked to the use of the forums in reducing urges. This may be particularly true for online gamblers who can divert their attention to the forum when they are online and feel a strong urge to gamble. The peer-based nature of the forums means that they are available 24/7, even though some participants still felt alone when few (if any) people were actually online. Sometimes this problem related to different time zones and it was interesting to observe that a third of the participants were based outside of the UK in other (mostly) English-speaking countries. The concept of a UK-based forum appears to be a misnomer, given that the forums are available internationally and that this is reflected in their membership. This is despite the fact that both of the forums are based in the UK and do not actively advertise their services internationally. Most participants found the forums through search engines such as Google and, as a result, international memberships are probably inevitable. It is worth noting that no member complained about the presence of international members, and several members cited the involvement of international members as a positive aspect of the forums.

Similar to the findings of Cooper (2004), the present results indicate that, for around half of the participants, a forum appeared to be the only possibility for them to receive any help for their problem. This was due to geographical location and lack of transport, or lack of opportunity because of time constraints such as childcare considerations. It may also be the case that some participants would not consider other help services because of fears of attending face-to-face encounters or telephone services. The role that forums can play for people who fear other forms of help is an interesting area that warrants further in-depth investigation.

There were some noticeable gender differences in how the forums were used, with far more females than males seeking help for others, and more males than females seeking support while no longer experiencing gambling problems. However, when it came to members seeking help for their own problems, there were virtually no gender differences in the frequency of those seeking help. This is unusual, considering that more males than females are usually identified as experiencing gambling problems, a finding that was reconfirmed (for the UK at least) in the latest prevalence study (Wardle et al., 2007). The conclusions drawn from the results of the present study suggest that females are more likely than males to seek help online and/or more females than males have online gambling problems and prefer to use the media of online help. The latest UK prevalence study found that more males than females bet online with a bookmaker (6% vs. 1%) and that more males than females participate in online gambling (4% vs. 1%; Wardle et al.). However, a recent world-wide investigation that focused exclusively on online gamblers noted that more females than males reported playing online casino games (Parke et al., 2007). Similarly, the GamCare services report for 2006 (GamCare, 2007) noted that more females than males called the helpline to report personal problems related to online gambling.

A recent evaluation of GamAid (Wood & Griffiths, 2007a), a UK-based online help service that provides one-to-one chats with an advisor, suggested that the GamAid service appealed to women more than other comparable services did (i.e., telephone helplines and face-to-face counselling). Why this was the case was not altogether certain. However, the authors put forward several speculative reasons. For instance, women may favour online gambling, as it is more gender neutral than more traditional modes of gambling, which (on the whole) are male oriented (with the exception of bingo halls). The same logic could also be applied to the use of online help forums. Women experiencing gambling problems may feel more stigmatised than men and less likely to approach other support services, which tend to be predominated by men (e.g., face-to-face support groups). If this is the case, then the high degree of anonymity offered by online help services such as forumsmay also be one of the reasons that they are preferred by women.

There is also some evidence to suggest that women's expressive styles may be more suited to e-mail communication than are those of men. For instance, Boneva, Kraut, and Frohlich (2001) collected both quantitative and qualitative data relating to gender differences in e-mail communication over a 4-year period. They found that women were more likely than men to use e-mail to keep in touch with people who lived far away and that their messages contained more personal content, exchanged in short bursts.

Despite the lack of certainty about the prevalence of women who have problems with online gambling, the present study identified that the ratio of females to males seeking help on the forums was higher than for any other comparable service (i.e., telephone helplines and face-to-face counselling). Furthermore, female participants reported higher levels of satisfaction with the forums on two important aspects. Females were more likely than males to report that the forums had helped them to resist urges to gamble, and females were more likely than males to report that the forums helped them to control their overall gambling behaviour. Given that females appear to derive more benefit from online help services than males do, this could also explain why these services are the preferred mode of help for females. This assertion is of course speculative and further research is needed to explore these issues further.


Strengths and weaknesses of the study

Before the study commenced, we observed that one of the forums had 1,783 registered members and the other forum had 2,295 registered members. On the basis of response rates from a similar study evaluating GamAid (another online service dealing with gambling problems; Wood & Griffiths, 2007a), we estimated that 200 to 400 responses might be expected. However, after a month of posting the survey, only 126 responses were collected (121 completed surveys). There are several reasons that this may have occurred. First of all, there is no way of telling how many of the registered forum members regularly use the forum. Indeed, some members may have posted only once or twice in order to ask a specific question or to find that the forum did not suit their needs. This would be particularly true of a person who was seeking some specific information such as the location of face-to-face services in their area. Some members may no longer use, or feel the need for, the forum once they perceive that their gambling problem is resolved. Furthermore, the survey identified that the majority of the members who responded suggested that anonymity was very important to them. Therefore, it is conceivable that some forum members would be concerned about maintaining their anonymity to the extent that they decided not to fill out the survey.

Despite the lower than anticipated response rate for the survey phase, it is worth noting that the response rate for the interview phase was almost double the proposed estimate of 10 interviewees. Therefore, what the study may have lost in frequency of responses it may have gained in depth of understanding ascertained from the interviews. One of the key strengths of this evaluation was that it used a variety of methods to collect data and information, including secondary data, online interviews, and an online survey. Furthermore, although it could be argued that the number of participants in the online survey was relatively small (n = 121), the data were fairly consistent and came from one of the largest ever UK samples of people with gambling problems in one study (i.e., the survey study, n = 81). For instance, the UK's latest national prevalence study identified only between 45 and 54 problem gamblers from a sample of 9,003 participants (see Wardle et al., 2007).

Although there are clearly issues surrounding self-selection in this kind of study, relatively large numbers of participants can take part with no increased consequences in terms of expenses. Online questionnaires are particularly useful for the discussion of sensitive issues that participants may find embarrassing in a face-to-face situation (such as problem gambling). The nature of this medium means that a relatively high degree of anonymity can be maintained, and participants may feel more comfortable answering sensitive questions on their computer than in a face-to-face situation. The disadvantages of online methods (e.g., potentially biased samples, validity issues) are in many ways no different than those encountered in more traditional research approaches. For a more detailed discussion of the advantages and disadvantages of online research methods, see Wood et al. (2004).


Conclusion

Overall, it appeared that the forums examined in this study provided useful support for the people who used them, whether they were personally experiencing gambling problems, getting over gambling problems, or seeking help or coping with others with gambling problems. Currently, there are only a handful of similar forums world-wide despite the fact that they are extremely cost effective to run compared with more traditional helping services. Given the positive findings of this project, and the ever-growing proliferation of Internet-based gambling, it is hoped that the long-term utility of forums for supporting people with gambling problems becomes an area for continued investigation and development.


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Tables
Table 1 

Participant details from Study 2


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Table 2 

Reported participation in other problem gambling helping services


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Table 3 

Participants’ views on what they got out of using the forum (n = 121)


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Table 4 

Reported views about specific forum features (n = 121)


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Article Categories:
  • research

Keywords: online forums, problem gambling, online gambling, female gamblers, coping.
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