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Today s agenda House Keeping Self-Medication, Trauma, and the Female Gambler * Sum of Not So Innocent Beginning s Beginner s luck, winning and enticement ... – PowerPoint PPT presentation

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Title: Self-Medication

  • Todays agenda
  • House Keeping
  • Self-Medication, Trauma, and the Female Gambler

  • 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?... Perhaps
    everything terrible is in its deepest being
    something helpless that wants help.

  • Rainer Maria

Hurt Cash Covering Nine inch Nails...
Nicotines the Worlds Antidepressant
  • 5 million premature deaths associated with
    tobacco use in 2000
  • It is estimated that between 2025 to 2050 there
    will be 300 million tobacco deaths
  • Why do we use it? Is it self-medication?

Effects on the brain
  • Dopamine, GABA, MAO
  • DiFranza (2008) suggests that it may only take a
    month to become hooked

Nicotine and Canadians
  • 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

Gender Differences in Alcohol Use
  • Men have higher lifetimes rates of alcohol
  • However, women appear to surpass men in alcohol
    related problems, such as
  • Deaths from suicide
  • Alcohol related accidents
  • Heart disease and stroke
  • Cirrhosis of liver

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Post-traumatic Stress Disorder Self-Medication
  • Early research centred trauma and PTSD as an
    effect of war, civil war - soldiers heart
    world wars - shell shock
  • 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

The Heart of PTSD and Trauma
  • According to Herman (1997) - Intense emotional
    reaction to an event - panic, terror, grief or
  • According to National Center for PTSD (2007)
    those most likely to develop PSTD

Reign over Me A Trauma Example
  • PTSD begins can begin intensely and can wane, and
    wax, and wane.
  • Psychological symptoms include
  • Re-experiencing (flashbacks, nightmares,
    intrusive memories)
  • Emotional Numbing (feeling detached, lack of
    emotions, loss of interests
  • Avoidance (activities, people, or places that
    are reminders of trauma)
  • Increase arousal (difficulty sleeping,
    irritability, hyper-vigilance, exaggerated
    startle response)

Psychological outcomes can include the following
  • Depression, major or pervasive
  • Anxiety disorders, phobias, panic, and social
  • Conduct disorders
  • Dissociation
  • Eating disorders

Psychosocial manifestations
  • Alcohol and substance abuse
  • Suicide attempts
  • Risky sexual behaviours
  • Self-injury
  • Interpersonal problems

PTSD and Substance Abuse
  • Kimmerling et al. (2004) report that
    approximately 30 to 50 of men and 25 to 30 of
    women with lifetime PTSD are also substance
  • Those with SUD and PTSD have poorer substance
    abuse outcomes (Brown, 2000)
  • 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 An
Interpretative Phenomenological Analysis
It takes two to speak the truth. One to
speak, and another to hear - Thoreau

  • Setting the Context
  • There is a paucity of research that addresses the
    connection between trauma and female pathological
    gambling (Boughton Brewster, 2002).
  • However, research has revealed that a large
    percentage of individuals with mental health
    problems report having experienced a traumatic
    event (Larkin Morrison, 2006).
  • Women in particular, are at a greater risk of
    being exposed to trauma that sometimes occurs in
    close relationships (Wolfe Kimerling, 1997)
    (i.e., incest, marital and date rape, and
    intimate partner violence).
  • Then again, it is not known whether pathological
    gambling development and its progression can be
    related to the latter kinds of traumas.

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.

Previous Research (contd)
  • In a more representative sample, Petry and
    Steinberg (2005) studied childhood maltreatment
    in male and female treatment-seeking pathological
    gamblers, recruiting participants from seven
    treatment sites (N 149 77 females and 72
  • The authors found that gender was specific to the
    intensity and types of childhood maltreatment
    experienced. It was revealed that female
    gamblers had higher scores related to
    sexual/emotional abuse and physical neglect.
  • 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).

What we know about Trauma and Gender!
  • Among survivors of abuse, research has
    consistently documented increased rates of
    psychiatric disorders (Kessler, Sonnega, Bromet,
    Hughes Nelson, 1995).
  • 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.

Linking Trauma to Women Gamblers
  • Interestingly, among 365 females gamblers from
    across the province in Ontario, Boughton and
    Brewster (2002) found that 46 of women reported
    experiencing physical abuse as adults and 28
    reported experiencing sexual abuse as an adult,
    while another 30 of married participants
    reported current physical abuse in their
  • 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
    self-reported having a traumatic history and
    whose scores on the NORC DSM-IV gambling screen
    indicated a severe problem with gambling.

Method Interpretative Phenomenology (IPA)
  • IPA endeavours to provide a descriptive account
    of a participants world that is both critical
    and conceptual leading to a life text that
    supports participant claims and feelings about a
    lived experience (Smith, 1996).
  • 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).

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Name Age Ethnicity Gambling Onset Gambling Type Trauma Experience
Kathy 65 Caucasian 58 EGM Childhood Sexual Abuse Childhood Bereavement Raised in Alcoholic Home
Barb 58 Caucasian 50 EGM Childhood Sexual Abuse
Liz 48 Caucasian 46 EGM / Cards Childhood Physical Abuse Adult Physical Abuse Breavement (violent death) Raised in Alcoholic Home
Martha 60 First Nations 38 Bingo/EGM Residential School Abuse Racial Discrimination Adult Physical Abuse
Matty 42 First Nations 22 EGM Childhood Sexual Abuse Childhood Physical Abuse Racial Discrimination Adult Bereavement
Eve 58 Asian 45 EGM Childhood Physical Abuse Childhood Multiple Bereavement
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
  • 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).
  • Hypothetical grouping
  • Condensation
  • Elimination
  • Reconstructing
  • Final deconstruction

Terms and Terminology
  • Using Object-Relations theory to define the Ego,
    the authors refer to theorist Frank Summers
    (2002), who states that ego is, the part of the
    psyche charged with the responsibility of
    mastering competing pressures while maintaining
    the functional capacity of our organism (p.
    235). Object-relations theory states that human
    beings experience essentially two births a
    physical and a psychological (Almaas, 1988
    Mahler, Pine, Bergman, 1975).
  • 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.
  • Predominated by feeling of anxiousness,
    loneliness and emptiness, or loss 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

Matty speaks about Emptiness
  • I dont think it ever goes away honestly, to tell
    you the truth. The emptiness. Its like, youre
    dying its like a continuation of that over and
    over and over again Because youre on that train
    and youre going so fast that if you jump youre
    gonna die anyway. Well, you dont really want to
    die. You just want those parts of your life to
    stop. Its like somebody standing there with the
    light flickering on and off. So what do you do?
    You end up going to a corner you learn how to
    block it out, right?
  • Corner and space is gtgtgt Gaming Venue.
  • It appeared that emptiness could be blocked out
    or denied, but not forever.
  • Emptiness was altered somewhat effectively by
    moments of psychic inflation (charge of energy)
    that fills up the holes in ones being via a win
    and admiration during gambling.

Theme 2 Not So Innocent Beginnings
  • The experience of trauma whether in childhood
    or later in life for all of the participants
    seems to have left them in-the-world already
    searching for something to soothe traumas
    numbing effects on the psyche/self.
  • 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.

Eves First Time in
  • 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.

Sum of Not So Innocent Beginnings
  • Beginners luck, winning and enticement
  • Downplaying effect of affect
  • Begin to learn how gambling can be an escape

Seduction IntoxicationTheme 3 Seduction and
My family would drop me off at one of the
casinos and go shopping and not come for five or
six hours. It was fascinatingcause when you did
win, it would come out, and you put it right back
as well. And the first day we were down there
and they dropped me off about four o-clock and
they didnt pick me up until midnight. And I just
had pots and pots of money but I didnt want to
cash them in, I wanted to take them back to the
hotel (Barb).
  • The Archetype is loosely defined as a
    representation of powerful psychic energy
    organized around basic forms and pathways that
    are enacted through human behaviour that appear
    to have been ever present in various forms in all
    cultures (Jung, 1971).
  • 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.
  • There is a progression financially and
  • I found something that feels right.... I
    feel right

Theme 4 Opening the Doorway to Oblivion
  • Oblivion - A state of forgetting?
  • Participants existence could be said to be
    tied up in an eternity of forgetting about the
    past and future...
  • Paradox here...
  • 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
  • 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
  • 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.

Theme 5 Trauma and Ties that Bind Us
  • Exposure to trauma and its effects are unique to
    each individual and its repercussions can be felt
    in all areas of life, i.e. (emotionally,
    mentally, physically, socially, and spiritually)
    (Levine, 2005).
  • Trauma arising from childhood and adulthood
    (especially within families) echoed from the past
    thru to our participants relationships in the
  • 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).

Trauma Bonds and Unfinished Business
  • Martha provides an illumination of this
    phenomenon When win, especially
    big...and people are coming to me, trying to
    borrow and all that...I felt big. And I thought,
    well at least Im somebody today because Ive got
  • 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.

  • 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
  • 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
  • Barb concludes Ties that Bind Us, stating
  • Well I hated him and I think it was there for a
    long, long time and I had to get away from that
    hate. Because it was a bad feeling. And it
    wasnt right to hate my dad. It wasnt right for

Theme 6 What Trauma Does Introspection into
  • Participants report that trauma freezes their
    capacity to feel and it appeared that it also
    arrested ego development
  • Creates feelings of inadequacy
  • Overt need for mirroring
  • Push into the unconscious (I acknowledge / I
    dont )
  • Shame bonding
  • Trauma and gambling become intertwined

Loss of Being
Trauma and its link to Gambling
  • Deep down I think I do equate early childhood
    losses to gambling because they didnt see me
    go through all my tribulations and the
    graduation, all the highlights that would have
    been in my life. Yeah, they died too young
    parents. In a way, even though they were
    really strict and that, you still have a loss of
    being And then something triggers it her
    gamblingI kind of try to figure it out myself,
    too, because Ive gone to a psychologist. Ive
    gone to the mental health they said, geez, 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 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

Gambling, Trauma, and the Need To Be Seen.
  • Wounding in childhood or wounds in adulthood
    compounded the feeling of not okay-ness.
  • Hence, as stated previous, participants reported
    feeling not good enough, frozen, and emotionally
    cut-off, it is no wonder then that winning and
    receiving admiration fuels a continued desire to
  • 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!

Theme 7 Gambling Becomes Trauma
  • The gambler becomes like Sisyphus rolling the
    boulder up the hill... (were our participants
    happy playing again and again).
  • Jungian analyst and author Linda Schierese
    Leonard (1989) parallels mythic literature and
    provokes a deep question about the experience of
  • Is addiction, then, the act of giving 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?

(No Transcript)
Conclusions Trauma and Gambling
  • Trauma in early childhood impinges ego
  • Creating deep rooted feeling of not good enough
  • Creates hunger and drive need to be seen
  • Cuts us off from essence / vitality (emotional
  • Prone to periods of emptiness throughout life
  • Trauma lies in wait
  • Gambling
  • I can feel or I learn how to escape (mood
  • I can be seen / or disappear
  • I can be important
  • Cycle of gambling triggers and reinforces old
    feelings of not good enough
  • Gambling becomes traumatic

Primer for Addiction
Recovery From Trauma
  • According to Herman (1997) recovery from
    traumatic events unfold in three
  • Establishing Safety
  • Remembrance and mourning
  • Reconnection with ordinary life

  • 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
  • Trusting Therapeutic Relationship

Remembrance and Mourning
  • Tell the whole story
  • Repeat until story is part of survivors
    experience rather than focus
  • Memory coherent linked to feeling
  • Grief and other symptoms retract / less

  • Create new self / new future
  • I know have myself - basic trust
  • New relationship or old re-established
  • Understands damage becomes person she / he wants
    to be
  • Imagine, fantasy, desire, and initiative