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Todays agenda
House Keeping Self-Medication, Trauma, and the Female Gambler
Self-Medication
Drugs push aside suffering
How should we be able to forget those ancient myths... about dragons that at the last minute turn into princesses who are only waiting to see us once and beautiful and brave?... [P]erhaps everything terrible is in its deepest being something helpless that wants help.
It is estimated that between 2025 to 2050 there will be 300 million tobacco deaths
DiFranza (2008) suggests that it may only take a month to become hooked
45,000 Canadians die each year from smoking related deaths each year
For long-time smokers, the chance of dying from a smoking-related cause is 50%
Smoking is the single most preventable cause of cancer (Lung Cancer Canada, 2008) Check this out
Deaths from suicide Alcohol related accidents Heart disease and stroke Cirrhosis of liver
Today in the aftermath of 911 and closer to home residential school aftermath, trauma and PTSD is becoming more recognized
We have now beginning to challenge the etiological diagnosis where the traumatic event is thought to be outside the normal range of experience - to realize that rape, battery, sexual and domestic abuse, are so common that they can hardly be outside the range of normal experience
According to Herman (1997) - Intense emotional reaction to an event - panic, terror, grief or disgust
According to National Center for PTSD (2007) those most likely to develop PSTD
DIRECTLY EXPOSED SERIOUSLY INJURED IN THE EVENT LONG LASTING AND SEVERE
PTSD SYMPTOMS
PTSD begins can begin intensely and can wane, and wax, and wane.
Psychological symptoms include
Re-experiencing
(flashbacks, nightmares, intrusive memories)
Emotional Numbing
Avoidance
Dissociation
Eating disorders
Psychosocial manifestations
Alcohol and substance abuse
Suicide attempts
Risky sexual behaviours Self-injury Interpersonal problems
Meanwhile those with PTSD relaspe more quickly, drink more on days when they drink, have greater % of heave drinking days and more consequences due to non-PTSD substance abusers (Brown, 2000)
Women are more likely to develop addictions after exposure to traumatic event and symptoms of PTSD, with approximately 65% to 84% of women experiencing PTSD before developing addictive dependencies (Milkman & Sunderwirth, 2008)
Meanwhile, men appear to develop PTSD symptomology during their addictive careers (Kimmerling et al. 2004)
Trauma, its Role and Trajectory in the Development of Female Pathological Gambling
It takes two to speak the truth. One to speak, and another to hear - Thoreau
Previous Research
Based on a Canadian study involving both males and females living in 22 families, Grant Kalischuk and Cardwell (2004) developed a grounded theory that situated trauma as being a factor implicated in problem gambling for both males and females. Afifi, Brownridge, MacMillan & Sareen (2010) sought to understand the relationship between problematic gambling and family violence. Results from their study suggested problem gambling may be directly associated with dating violence, marital violence and child abuse.
In a sample of 111 pathological gamblers, Kausch, Rugle, and Rowland (2006) identified a relationship between gambling and trauma, however the role that trauma played in development of these 111 pathological gamblers was not determined. With respect to gender, the sample was comprised of only 9 female participants and yet all 9 reported emotional, physical or sexual abuse or multiple abuses.
An important consideration pointed out by the authors was that the study did not address whether childhood maltreatment leads to pathological gambling (Petry & Steinberg, 2005, p. 228).
According to Strachan and Custer (1989) and Lesieur and Blume (1991) as well as others, gambling has been categorized as a means for dealing with trauma and trauma-related abuse (via escape), especially among females.
Half of Canadian women (51%) have experienced at least one incident of physical or sexual violence since the age of 16 (Statistics Canada, 2006). Moreover, the World Health Organization (WHO, 2006) have recognized that gender is a well known determinant in a variety of health-related problems and that differences exist between male and female treatment utilization, substance use, and mental health-related symptoms and diagnoses.
However, despite determining that gambling was a means by which the individual was able to escape from life stressors, the mechanism by which trauma played a role in the development of problem gambling continues to remain under-investigated (Boughton & Brewster, 2002).
Todays Presentation
This presentation will focus on essences drawn from a phenomenological interpretative investigation of 6 women (taken from a larger grounded theory study of 40 women) (Kalischuk, Nixon, Hagen, & Solowoniuk, in press) who selfreported having a traumatic history and whose scores on the NORC DSM-IV gambling screen indicated a severe problem with gambling.
What makes IPA unique from other qualitative methods is its position on constructing an interpretation derived from investigated experiences (Larkin, Watts, & Clifton, 2006).
Tappan (1997) asserts that an interpreter understands by constant reference to her own perspective, which shapes her understanding of the world based on her expectations, preconceptions, biases, and assumptions that rest fundamentally on her lifestyle, life experiences, culture, and tradition.
Thus, IPA is collaborative research approach that requires the researcher to share meanings and understandings with ones participants toward generating an insiders perspective (Larkin, Watts, & Clifton, 2006).
PARTICIPANT PROFILES
Name Age Ethnicity Gambling Gambling Onset Type
58 EGM
Trauma Experience
Childhood Sexual Abuse Childhood Bereavement Raised in Alcoholic Home Childhood Sexual Abuse Childhood Physical Abuse Adult Physical Abuse Breavement (violent death) Raised in Alcoholic Home
Kathy
65
Caucasian
Barb
58
Caucasian
50
EGM
Liz
48
Caucasian
46
EGM / Cards
Martha
60
First Nations
38
Residential School Abuse Bingo/EGM Racial Discrimination Adult Physical Abuse Childhood Sexual Abuse Childhood Physical Abuse Racial Discrimination Adult Bereavement Childhood Physical Abuse Childhood Multiple Bereavement
Matty
42
First Nations
22
EGM
Eve
58
Asian
45
EGM
Interview Procedure
The interview procedure began by restating and answering participants questions related to the purpose and goals for the study. Afterwards empathic listening and paraphrasing were employed by the interviewer to help participants feel safe and comfortable in sharing intimate stories of how trauma and experiences of a traumatic nature associate with the development of a gambling problem.
While the interview process was unstructured, the interviewer probed and prompted his participants to sit inside their experiences of gambling and trauma (Solowoniuk & Nixon, 2009).
This appeared to help amplify interpretations of experiencing and together the interviewer and interviewee expanded their understanding of how trauma affects personhood and how this then influenced the origin, progression, and complete loss of control of ones gambling behaviours.
Theme Construction
Theme construction involved five processes (van Kaam, 1966; Solowoniuk, 2009).
1. Hypothetical grouping 2. Condensation
3. Elimination
4. Reconstructing 5. Final deconstruction
The implication here is that there is no inherent, separate sense of self from birth, it is constructed through, in part, by our early experiences with our caregivers; fashioning a blue print for relationships later on in life.
Thus, if a child does not have a nurturing environment that is essentially, good enough, the ego does not develop normally; and in turn psychological pathology can result (Summers, 2002). The latter point here is important to keep in mind as all of our participants grew up in conditions that seem to have impinged ego development through early childhood trauma.
Interpretative Analysis
Theme 1: Early Life Trauma and the Not Good Enough Self
Effect of trauma in earlychildhood created a visceral state of being.
The developing sense of self (ego) appeared to be bitterly cut off from its own ground of being (Almaas, 1988, 1997). Dampening of affect.
Lizzy Stated:
I started hanging out with older guys in the pool hall, and kind of wanting attention all the time and my Dad had a real reaction to that. He thought I should be a good girl, instead of a bad girl So I guess thats why he only beat me... Only me... And then their was, well my Mom and Dad didnt like each other either... My mom was a nasty drunk... I always looked for a time when they were happy together, you kind of seek that, I mean when you know your parents have some kind of harmony or connection. I mean what other reference point do you have when youre a kid.
Mirroring from parents is natural, but not receiving it was a predominant experience shared by our participants (we then seek is elsewhere).
By the age of 12, Lizzy tried to pacify herself through substance use and years later by binge gambling.
Left raw and empty from past trauma, it may interpreted that all participants were already primed for an addiction.
Thus, no matter how innocent the beginnings may seem, it appeared that our participants compulsions lay dormant.
Some participants experienced addictions and behavioural compulsions years before the development of pathological gambling.
I got introduced to Vegas. And of course my interest was not in Vegas, because my brother had a time share thing there. It was pure innocence because his son couldnt make it oh yeah Ill join you! Well that was my first exposure. When I got there it was like, glitz! And I thought, is this me? Im looking around, sweating it out there. Looking at the strip. And of course you throw in a few coins and of course, ding, ding, ding and outcome the quarters...I enjoyed it, I had funnothing happened, it was okay.
Intoxication
The high or rush associated with the game and the gambler is well documented across all cultures throughout history. Lady Luck with her spinning wheel of fortune beckons (Currie, 2007, p. 17).
Seduction Summation
Seductive nature of gambling and its phenomenal affects both sooth (sense of emptiness) while heightening gambling experience(s).
For some participants accumulation of stressors added to the drive to gamble more.
Yet there would appear to be a very cognizant pursuit to get the stuff to continue to gamble or
Secure time necessary to gamble wantonly... Thus is it really about escape!
Oblivious Accounts
Liz reported... Its all about changing the way you feel, its all about not wanting to deal with things that are painful. I think to me, that has been my experience. Matty remarked... Pawning I lost every single one of my rings. It wasnt 24 hours but I mean, Id go to work right? I mean, as soon as we got paid we wouldnt even go home after. It got to the point where we just went straight from work to the bank to the bar and yeah [Laughter]. And I would be dipping into the rum and coke and hed be drinking his beer. And then wed be like, okay! And at that point in time, too, you gotta remember, those vlts ummm you had to wait for them. Because everybody would be on them at that time. So wed be bouncing all over the place. It was almost like a panic if we didnt get on a machine. Barb reiterates... I started going for an hour after work, and then it got, then I couldnt get the work done fast enough to get back to the casino to gamble. I played for twelve hours straight. Because by this time I had let bills go, and I was kind of trying to gain the money, I hid the bills as they came in and when [my husband] wasnt around, and then he started ignoring me. [Feelings]?... Well, I didnt care. I just wanted to get back to the machines. It was like easy money.
A Sanctuarious Space
Fecundity of the case (Gadmer, 1975) Arising from Oblivion....
We are not talking about the classic escape gambler!
We are talking about direct impingement upon the psyche from a traumatic or traumatic events.
Sanctuarious narratives...
It seemed the less absorbed you were with it [grieving], that your generally up winning, I cant remember trying to win. It always just seemed like it was a place I could go and hide from the world, and I didnt have to do anything or talk to anybody.... It was a space for me to just be... (Kathy).
Kathy was able to contain psychic energies within herself and the pain she was feeling... A return to the wellspring of Being?
I could comprehend more and feel more of what was happening and accept that fact that my husband wasnt there and he wasnt coming back [Alzheimers disease] and he wasnt getting better and people kept on telling me you have to go on with your life and you have to stay healthy for him, and it just automatically starts to heal. I dont know what the hell I would have done to fill those hours; I dont know if I would have gotten really mentally ill.
Trauma arising from childhood and adulthood (especially within families) echoed from the past thru to our participants relationships in the present.
When support was needed during gambling addiction - their was a difficulty in our participants asking for help or in trusting oneself or others.
Frozen in time - both the body of trauma and the (personal) relationships that are connected to them (Levine, 2005).
Chase ideals, both socially via relationship and financially; both of which are not born from our own being.
Matty sadly remarked: Through the abuse that Ive gone through, I would say that yeah, I have a very addictive personality. I can cling onto things pretty quickand the really good people that I run into, I throw them as far away as I possibly can; because Im going to end up being the one hurting them. Theyre not going to hurt me or maybe I subconsciously think that they will hurt me; because their lives are too perfect and Im kinda not in that category of perfect.
Resurfacing
I went to my pastor and we went through six sessions with him, and he told me that the only way that I would get that out of my system [sexual abuse] is to forgive. You know it went on for five years. Id try to block it out and then it would come back, I would block it out and it would come back. Then a lot of times when my Dad was still alive him and my Mom would come to visit it just about drove me drinkingAnd I hated my Dad, but I mean I done it for my mom. My mother is still in denial that my father abused me and my sister and we just put that behind us (Barb).
Traumatic memories or associations appeared to resurface for our participants And once gambling becomes a learned panacea... It makes is easy to want to regulate feelings of not being okay Resurfacing coincided with relaspe(s) and gambling binges
you seem to be pretty even-keeled. Youre outgoing, youre this and that. But I said, but theres something underlying it. You know, theres something deeper. And I havent got to that deep part (Eve).
For participants, first their was trauma and then gambling acted, Like a camouflage. It wasnt really...an answer. Yeah, it wasnt an answer but yet I still went to it. Because it didnt talk back. It was one on one. But Eves mind would come back to gambling again and again trying to find one.
Such a phenomena was first delineated by Freud (1938) - the classic corrective emotional experience.
My other part of our life was rejected, because I couldnt, I didnt feel like a wife anymore it was. When you win at the machine and everybody comes around and you are very special and everybodys looking at you and saying hey, you won! Good for you!
Jungian analyst and author Linda Schierese Leonard (1989) parallels mythic literature and provokes a deep question about the experience of addiction:
oneself over to something as ones master be it a substance, object, person, or activity so totally that ones entire being becomes possessed by it?
1. I can feel or I learn how to escape (mood regulator) 2. I can be seen / or disappear
Primer for Addiction
2.
3.
3. I can be important 4. Cycle of gambling triggers and reinforces old feelings of not good enough
5. Gambling becomes traumatic
4.
5.
SAFETY
Establish Safety (regain control) Feeling safe in relation to others Support Letting go of addictive behaviours Name the demon Make connection with abuse and symptoms and behaviours Trusting Therapeutic Relationship
Reconnection
Create new self / new future I know have myself - basic trust