Abstract
Aims: People with gambling as well as substance use problems who are exposed to public stigmatization may internalize and apply it to themselves through a mechanism known as self-stigma. This study implemented the Progressive Model for Self-Stigma which consists four sequential interrelated stages: awareness, agreement, application and harm on three groups of individuals with gambling, alcohol and other substance use problems. It explored whether the two guiding assumptions of this model (each stage is precondition for the following stage which are trickle-down in nature, and correlations between proximal stages should be larger than correlations between more distant stages) would differentiate people with gambling problems from those with alcohol and other substance use problems in terms of their patterns of self-stigma and in terms of the stages in the model.Method: 37 individuals with gambling problems, 60 with alcohol problems and 51 with drug problems who applied for treatment in rehabilitation centers in Israel in 2015–2016 were recruited. They completed the Self-stigma of Mental Illness Scale-Short Form which was adapted by changing the term “mental health” to gambling, alcohol or drugs, and the DSM-5-diagnostic criteria for gambling, alcohol or drug disorder.Results: The assumptions of the model were broadly confirmed: a repeated measures ANCOVA revealed that in all three groups there was a difference between first two stages (aware and agree) and the latter stages (apply and harm). In addition, the gambling group differed from the drug use and alcohol groups on the awareness stage: individuals with gambling problems were less likely to be aware of stigma than people with substance use or alcohol problems.Conclusion: The internalization of stigma among individuals with gambling problems tends to work in a similar way as for those with alcohol or drug problems. The differences between the gambling group and the alcohol and other substance groups at the aware stage may suggest that public stigma with regard to any given addictive disorder may be a function of the type of addiction (substance versus behavioral).
Highlights
One of the important changes in the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5: American Psychiatric Association [APA], 2013) was to include Gambling Disorder under the section on Substance-Related and Addictive Disorders for the first time (Straussner, 2013)
For the purposes of this study, only individuals who met at least one item of the DSM-5 criteria related to gambling/alcohol or other substance use disorders were included in the analyses
Significant age difference was found [F(2,147) = 5.86, p < 0.01, η2 = 0.074]; namely, participants with gambling problems were younger than participants with alcohol problems (Bonferroni post hoc test, p < 0.005), whereas the age of participants with substance use problems did not differ from either group
Summary
One of the important changes in the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5: American Psychiatric Association [APA], 2013) was to include Gambling Disorder under the section on Substance-Related and Addictive Disorders for the first time (Straussner, 2013). Hing et al (2016b) asked a sample of 2000 adult residents of Victoria, Australia to read five vignettes about recreational gambling, problem gambling, alcohol use disorder, schizophrenia, and a subclinical distress control. They found that problem gambling was less stigmatized than alcohol use. Based on a sample of 270 American university students who read case histories describing individuals with 40 mental disorders, they found that out of the addictive disorders, cocaine dependence was rated as the most stigmatized disorder (rated 6th), more than alcohol dependence (rated 10th) whereas pathological gambling was rated 13th. In Israel, where the current study was conducted, an earlier study indicated that mental health professionals perceived the issue of adolescent gambling as less severe than alcohol or drug use (Sansanwal et al, 2016)
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