Online support needs and experiences of family members affected by problem gambling
The harms associated with problem gambling are significant, and not only affect the person with problem gambling, but also their family and friends. Recent research suggests gambling harms occur at the individual, family and community level across seven broad domains. Family members (inclusive of partner, parent, child, sibling, other relative or friend) infrequently seek help but when they do, it is most frequently prompted by emotional distress and financial concerns, and worry that the problem will worsen. In an attempt to increase rates of help-seeking more broadly, a number of low-intensity and self-directed treatment options have been developed in Australia and internationally.
Low-intensity interventions delivered by a professional variously replicate traditional talk therapy and may involve counselling, support, information or referral. Until recently, the most frequent low-intensity option was telephone counselling but, in Australia, e-therapy has become widely available and accessible. In Australia, the most frequent types of e-therapy accessed by family members are chat and email counselling provided by the national online help service Gambling Help Online. Family members also access self-help information provided on the Gambling Help Online website as well as community peer support forums. Although these low-intensity and self-help options have been offered to family members for more than five years in Australia, there has not as yet been any examination of the specific experiences of family members seeking help online or indeed their treatment and support needs more broadly.
The current study aimed to describe the experiences of family members seeking help online. Quantitative and qualitative analyses were applied to describe the characteristics of family members seeking help, the effect of gambling on the family member and the types of low- and high-intensity services previously accessed. The study also described the types of e-therapy accessed and the reasons for help seeking. Given the limited literature currently available the five aims were exploratory and included:
- Describe the characteristics of family members, including age, gender, relationship to the gambler and length of time the gambling has impacted on the family member.
- Describe the impact of gambling on family members including their functioning, coping and levels of social support.
- Describe the types of low- and high-intensity services accessed by family members prior to e-therapy.
- Describe the types of e-therapy accessed (i.e., what was accessed and in which combinations) and the degree to which the intervention was perceived to be sufficient.
- Explore reasons for seeking help, expectations of treatment and what family members ideally want from services.
Sixty-two family members were recruited from Gambling Help Online. Family members were most often female, younger than 35 years of age and also most often the partner of a person with a gambling problem. Over half of family members had found out about the gambling problem in the past 12 months and over two-thirds currently lived with the person with the problem.
Family members reported a wide range of serious effects to their mental and physical health. Almost 80% reported that they often experienced feelings of sadness, anxiety, stress or anger due to another person's gambling and two-thirds reported that gambling often affected the quality of their relationship with the person with the problem.
Family members reported accessing a wide range of low-intensity (e.g., chat, email, forums, telephone) and high-intensity (e.g., face-to-face) services prior to this contact with e-therapy. Over two-thirds of family and friends had engaged with at least one low-intensity option and viewed website content.
Family members accessed all of the e-therapy options including chat, email, forums and self-help information on the Gambling Help Online website. On average, two different services were accessed, and over half of family members said that the services they accessed were sufficient at that time to meet their needs.
Help was sought for four main reasons: psychoeducation about gambling, approaching the person with the gambling problem, how to encourage help seeking and how to support change. There were also 57 resource needs identified, which were thematically grouped into improving coping skills/self-efficacy and social support.
The findings of this research suggest family members experience a significant range of gambling-related harms and access help for a variety of reasons. The vast majority of family members in this study reported that their experiences of e-therapy were positive and the services that they accessed were sufficient. However, caution should be applied to these findings given the sample size and self-selection into the study. Furthermore, the survey administered was intentionally brief. It included questionnaires that were developed for the current study and also some not previously widely administered. This was because in multiple instances no validated instruments were available.
While the findings from this research are positive, they also highlight multiple areas where gambling service systems could be enhanced to better support family members. As indicated above, family members make contact most frequently for help managing a specific issue (i.e., recent awareness of a gambling problem). This means family issues are likely ongoing, and while a single session of e-therapy was sufficient for many family members, resources need to be available for family members to access over the longer term and across the multitude of situations they will likely encounter.
For these reasons, programs and services need to be developed that are tailored to the needs of family members. The measures used in the current study suggest these needs are very similar to those described in the Mental Health First Aid Guidelines for gamblers (i.e., information for family members on how to identify gambling problems, approach someone with a problem, encourage help seeking and change, and how family members can help someone that does not recognise that there is a problem) (Bond et al., 2016, Appendix E). These guidelines urgently need to be adapted to a training program for counselling staff working with family members, and also provided to family members via Australian websites or other self-directed modalities. The impact of providing family members with evidence-informed information should then be evaluated.