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What is Stigma?
Stigma is a social phenomenon where certain characteristics, qualities or features of an identifiable group are regarded in a strongly negative light. Stigma against marginalised groups can lead to stereotypes, prejudice, and even discrimination. It occurs on a personal and institutional scale – stigma may make it harder for a single person affected by harm to speak out, or it may cause policymakers to underfund necessary prevention and treatment programmes.
Types of stigma:
Self-stigma: an individual’s self-discrimination from self-blame concerning their gambling and an accompanying sense of shame
Public stigma: widespread negative perceptions of people affected by gambling harm propagated by society
Structural stigma: political and policy approaches which discriminate against those affected by gambling harms
How does stigma affect people with gambling harm?
It is reported that stigma hinders or prevents treatment for individuals suffering from substance abuse and disordered gambling (Yang, Wong, Grivel and Hasin, 2017). Stigma can lead to policymakers underfunding necessary treatment programmes. Equally, stigma can dissuade individuals from speaking openly. If people who have a gambling disorder experience less stigma, they may feel more able to ask for help and take steps towards recovery. Studies have shown that people who suffer from gambling harm experience anxiety over how their disorder might be perceived and the potential negative consequences accompanying this. Because of this anxiety, other less healthy coping mechanisms are adopted, such as hiding and cognitive distancing (Dąbrowska and Wieczorek, 2020).
The Victorian Responsible Gambling Foundation make a distinction between self-stigma and public stigma. The former refers to stigma from the point of view of people with a gambling disorder and how they perceive themselves. The latter describes the point of view of others, perceiving individuals with a gambling disorder. Stigmatising beliefs can lead to people who gamble compulsively experiencing greater difficulties and further harm, such as increased self-blame and intensified feelings of guilt. Moreover, individuals with problem gambling experience high levels of fear regarding how others perceive them, despite experiences of direct discriminatory behaviours being relatively low (Hing, Nuske, Gainsbury and Russell, 2015).
Examples of stigmatising misconceptions surrounding those with gambling disorders:
Fixed nature of disorders: people affected by disordered gambling are framed as though they have no capacity or desire to change, which misrepresents gambling addiction
Personal responsibility: people affected by disordered gambling are framed as though they are making deliberate choices to gamble
Othering and dehumanisation: people affected by disordered gambling are described through addiction-first language that dehumanises them. People tend to keep a distance from them – thinking, “This could never happen to someone like me”.
Why is some language stigmatising?
It is important to think about why certain language is stigmatising. The choice of certain language and phrases over others can have far-reaching implications for the way in which topics, such as gambling harm, are discussed. Whether or not something is stigmatising often comes down to how the topic is framed. Subtle differences in the words we use, often chosen unconsciously, can create vastly different impressions. The language we use is important because of the non-explicit messages which are conveyed. Depending on how we phrase our words, we have the ability to avoid accidentally implying unnecessarily punitive attitudes and individual blame.
The most appropriate terminology is person-first and emphasises that this person has a problem – for example, “person with a gambling disorder” or “person who gambles compulsively” instead of “gambling addict” or “problem gambler”. In addition, language should be clinically accurate – “in recovery” rather than “clean”.
This language is non-stigmatising and centres the focus on the person, acknowledging them as an individual first and foremost, while also speaking about gambling in a clear and neutral way. It conveys the meaning that a person “has” a problem rather than that a person “is” a problem (Kelly, Saitz and Wakeman, 2016). When these ideas about stigmatisation are applied to all language used to discuss gambling harm, a far healthier environment is created.
Unfortunately, language like “problem gambler” is still common in research, policy and media despite these terms being found to negatively impact the sense of hope and self-efficacy of patients.
What are the stigmatising terms for gambling harm and drug use and what are the terms that they should be using?
The table below has been prepared to provide examples of non-stigmatising language alongside equivalent stigmatising language, based on a table provided for similar terms relating to drug addiction. On the right-hand side of the table are two columns. The first is a list of terms that can be used to describe Problem Gambling in a way which frames the conversation by putting individuals first. The second column is a list of terms that are often used yet stigmatise those who gamble compulsively. For reference, the two left-hand columns provide the original table of terms concerning drug usage.
Theories for understanding stigma
Just World Theory: Refers to the cognitive fallacy that people tend to believe that the world is orderly and fair, and that people’s actions will bring morally just consequences. Good will be rewarded, and “evil” will be punished. Some people, for example, may wrongly think people who are in debt “deserve” it, for being affected by compulsive gambling, or some other perceived misdeed.
Attribution error: the assumption a person’s actions are dependent on what “kind” of person they are – people who do “bad” things must be “bad” people. This attribution can be applied retroactively.
Labelling theory: The understanding that when somebody has been given a label that differentiates them as “other”, they will be treated differently and worse than “normal people.”
Intersectional stigma: is a way of understanding how multiple stigmatised identities affect a person or group. These may be various addictions, health issues or demographic factors (from an ethnic minority, lower-income community, or marginalised sexuality/gender background). Intersectionality exacerbates the effect of certain types of stigma.
What has been done to combat stigma?
The traditional approach to combatting addiction stigma has been the disease model of addiction. This approach has been traditionally applied to problematic drug and alcohol usage and more recently to gambling harm, with compulsive gambling introduced as a disorder in the DSM. Although the disease model might reduce some aspects of social stigma, it has issues as it fails to consider some of the social factors contributing to gambling harm. Anonymity is a strategy used in treatment, such as Gamblers Anonymous. Anonymous support allows people to talk openly without fear of the stigma of gambling affecting them so deeply and helps people access support, but it is also limited, and may contribute to self-stigma in some people as they perceive themselves as less honest.
Emerging ways of combatting stigma
As mentioned, one of the ways in which we as individuals and organisations can combat stigma is through utilising person-first language. This can help reduce marginalisation through depersonalisation.
Destigmatisation can also come through storytelling and narrative psychology, involving changing the ways in which people suffering from gambling harm are spoken about, as well as contact theory, which posits that intermingling of people affected by gambling harm and those who are not affected will decrease stigmatisation. Contact theory is sometimes considered at odds with anonymity, although there is ample room for both in a plan to reduce stigma.
Similar to the disease model is defining compulsive gambling and addictions in general as health problems. The two are not synonymous, however. In addition to increasing understanding of mechanisms of addiction, gambling addictions should also be understood as public health issues. Therefore, the societal conditions which contribute to gambling harm, such as targeted advertising, the minority stress model, and socioeconomic inequality, must be meaningfully addressed. In addition, harm that comes to “moderate” and “low-risk” gamblers must be taken seriously.
Empowerment through co-production and creation of services by those who have lived experience of gambling harms is something that can empower people to channel these lived experiences to positive personal and social change. Social change can also be directly campaigned for through formal objection to negative portrayals of those with gambling harm or structural stigma limiting the support given to those with gambling disorders. A method of gaining support from political and social figures is rational compassion – fighting discrimination by appealing to the rational benefits of the desired approach, such as via health economics, as gambling harms cost the economy more than prevention and improved treatment would.
Suggestions for tactics that could help to reduce stigma
Research and report production to detail the causes and effect of gambling harms
Educational outreach programmes for youth
Storytelling through various forms of media to increase empathetic understanding and compassion
Increasing opportunities for contact between those with gambling disorders and those without which will combat otherisation
Direct campaigning against discriminatory policies or media which frames those with gambling addictions in a stigmatising way
Social media campaigns dispelling stigma
References
Dąbrowska, K. and Wieczorek, Ł. (2020) ‘Perceived social stigmatisation of gambling disorders and coping with stigma’, Nordic Studies on Alcohol and Drugs, 37(3), pp. 279–297.
Hing, N., Nuske, E., Gainsbury, S. and Russell, A., 2015. Perceived stigma and self-stigma of problem gambling: perspectives of people with gambling problems. International Gambling Studies, 16(1), pp.31-48.
Kelly, J., Saitz, R. and Wakeman, S., 2016. Language, Substance Use Disorders, and Policy: The Need to Reach Consensus on an “Addiction-ary”. Alcoholism Treatment Quarterly, 34(1), pp.116-123.
Yang, L., Wong, L., Grivel, M. and Hasin, D., 2017. Stigma and substance use disorders. Current Opinion in Psychiatry, 30(5), pp.378-388.