Changes in Work Status, Couple Adjustment, and Recovery Capital: Secondary Analysis of Data From a Congruence Couple Therapy Randomized Controlled Trial

Purpose

Employment and family/social relationships are 2 of the highest priorities among those in substance use recovery. This study examined the relationship of work status with couple adjustment and other recovery capital treatment outcomes among symptomatic alcohol, substance use, and gambling participants (N = 38) using data collected in a randomized trial comparing a systemic Congruence Couple Therapy (CCT) and individual-based Treatment-as-Usual (TAU).

Method

Change scores and associations between work status and couple adjustment together with 8 other recovery outcome variables at post-treatment (5 months from baseline) and follow-up (8 months from baseline) in TAU (n = 17) and CCT (n = 21) were analyzed.

Results

Number of those working increased with both CCT and TAU but without reaching significance in either CCT (Cochran's Q = 5.429, P = .066) or TAU (Cochran's Q = 2.800, P = .247). Relative to those not working in the combined sample, those working showed significantly improved scores in post-treatment and follow-up in addictive symptoms, couple adjustment, psychiatric symptoms, depression, and life stress. Separating the CCT and TAU groups, similar trend was found in the CCT group but was inconsistent in the TAU group.

Conclusion

Significantly greater improvement in addictive symptoms and recovery capital of couple adjustment, mental health, and life stress was found in the working vs not-working group. Compared to individual-based TAU, exploratory findings indicate that the systemic treatment of CCT showed a clearer and more consistent difference in improved working days, addictive symptoms and recovery capital. Replication with larger samples is needed to generalize these results.

Employment Stress and Couple Adjustment among Clients With Disorders of Gambling and Alcohol Use: Themes of Transfers in Congruence Couple Therapy

Background

Individuals with problematic gambling, alcohol and substance use commonly report lower employment rates and more employment-related problems such as job loss, work conflicts and poor performance.

Method

A thematic qualitative analysis was conducted to extract employment-related themes from 21 sets of addiction counselors' case notes of couple therapy sessions (average 10 sessions per case) from a randomized controlled trial of Congruence Couple Therapy (CCT). Case notes were examined for the types of employment issues to answer the research question: What are the interconnections of employment, couple adjustment and addictive behaviors as revealed in the CCT counselors' case notes?

Results

Five key areas of employment-related stress were identified: (1) unemployment, (2) financial concerns, (3) history of crime, (4) overworking and workaholism, and (5) workplace conflict. These themes interacted negatively with couple adjustment and addictive behaviors. Using CCT as an intervention, clients gained skills in 4 areas transferred to employment: (1) awareness of self, other and family of origin, (2) congruent communication, (3) work-family balance, and (4) enlisting spousal support. These themes intersected with enhanced work functioning and reduced stress, alcohol use and gambling.

Conclusion

Employment problems negatively impacted addictive behaviors, couple adjustment and well-being of partners and clients. Skills and awareness gained in CCT promoted changes in addicted clients' employment functioning and coping with employment stress. The domains of work and couple adjustment are mutually influential in increasing or reducing stress with implications for addiction recovery. CCT as a viable intervention for enhancing employment function should be further studied.

Risk of problem gambling among occupational groups: A population and registry study

Aims:

To identify which occupational groups have elevated levels of regular gambling participation and at-risk and problem gambling, and to explore job-specific factors associated with elevated levels.

Methods:

Statistical analyses were performed on data from the 2015 Swedish population study on gambling and health. The principal registry variable was occupation, classified according to the Swedish version of the International Standard Classification of Occupations (ISCO-08). Two gambling variables were studied: regular gambling participation and at-risk and problem gambling, as measured by the Problem Gambling Severity Index (PGSI). For statistical regression analyses, socio-demographic data were used such as gender, income, and country of origin.

Results:

We found significant differences between occupational groups with regard to the two gambling variables. In general, manual jobs with predominantly male workers scored high, especially when there was no fixed workplace. Several significant differences remained when we controlled for gender. We also found support for three types of workers having elevated levels on the gambling variables: (1) building, construction and service, mobile, (2) vehicle drivers, and (3) monotonous manual indoor work. These results were confirmed by comparisons with propensity score matched controls.

Conclusion:

A policy implication of this study is that some occupational groups should be prioritised in the prevention of problem gambling. Theoretically, the study shows that occupational categories represent real-life cultures and contexts of gambling and non-gambling as distinct from the abstract socio-demographic factors that are usually considered in relation to gambling participation and problem gambling.

Can Positive Social Perception and Reduced Stigma be a Problem in Sports Betting? A Qualitative Focus Group Study with Spanish Sports Bettors Undergoing Treatment for Gambling Disorder

The way society perceives problem gambling, and its effects on how problem gamblers perceive themselves have significant consequences on the wellbeing of people experiencing gambling disorder. Associated with social perception, stigma and other social perception-related features have an impact on the way problem gamblers identify themselves, seek for help, and recover. However, not all gambling types are identically perceived by the society. The present paper examines the case of the social perception of sports betting in the context of Spain. A total of 43 male sports bettors undergoing treatment for gambling disorder were interviewed within seven focus group discussions. Using a qualitative thematic analysis technique, participants reported two fundamental characteristics of sports betting social perception: (1) the absence of negative connotations associated with sports betting comparative to other gambling forms; and (2) the presence of positive connotations that sanitised sports betting as a harmless practice. The study reports aspects such as the lack of stereotypes, the low-involvement of betting as a product, the novelty of online sports betting, the social construction of the normal bettor, and the workplace gambling normalisation as elements that could lead to an increase in gambling-related harm. This is the first study to explore the social perception of sports betting in a subgroup of problem sports bettors and suggests that policymakers should be cognizant of these perceptions in order to inform responsible gambling regulation .

A national public health programme on gambling policy development in New Zealand: insights from a process evaluation

Background

In New Zealand, a public health programme on gambling policy development is part of a national gambling harm reduction and prevention strategy mandated by the Gambling Act 2003. Funded by the Ministry of Health, the programme directs workplace/organisational gambling policies, non-gambling fundraising policies, and local council policies on electronic gaming machines (EGMs). We carried out a process evaluation of this programme to identify practical information (e.g. advocacy approaches; challenges and ameliorating strategies) that can be used by programme planners and implementers to reinforce programme effectiveness and serve to guide similar policy-focused public health initiatives elsewhere.

Methods

Evaluation criteria, based on the programme’s official service specifications, guided our evaluation questions, analysis and reporting. To identify informative aspects of programme delivery, we thematically analysed over 100 six-monthly implementer progress reports (representing 3 years of programme delivery) and transcript of a focus group with public health staff.

Results

Identified output-related themes included purposeful awareness raising to build understanding about gambling harms and the need for harm-reduction policies and stakeholder relationship development. Outcome-related themes included enhanced community awareness about gambling harms, community involvement in policy development, some workplace/organisational policy development, and some influences on council EGM policies. Non-gambling fundraising policy development was not common.

Conclusions

The programme offers an unprecedented gambling harm reduction approach. Although complex (due to its three distinct policy focus areas targeting different sectors) and challenging (due to the extensive time and resources needed to develop relationships and overcome counteractive views), the programme resulted in some policy development. Encouraging workplace/organisational policy development requires increased awareness of costs to employers and society and appreciation of policy value. Although encouraging non-gambling fundraising policies will likely remain challenging, public debate on ethical aspects could stimulate policy consideration. Influencing council EGM policy decisions will remain important for minimising EGM accessibility among vulnerable communities. Public involvement in EGM policy decisions has strong implications for policy effectiveness. Given the expanding range of gambling activities (including online gambling) presently accessible to communities worldwide, both organisational and public policies (as advocated through the programme) are needed to minimise gambling harms.

Preventing and responding to gambling-related harm and crime in the workplace

Aims

Problem gambling, even if it occurs in leisure time, can cause harm in the workplace. Problem gamblers are preoccupied with gambling and often suffer from psychiatric and psychosomatic symptoms caused by their excessive gambling. This may lead to inefficiency at work and absenteeism. Severe gambling problems typically lead to a constant need for money, which may result in theft of money or goods from the workplace and in embezzlement. This paper outlines measures to prevent and respond to gambling-related harm and crime in the workplace.

Methods

A review of the literature and qualitative interviews with therapists specializing in problem gambling treatment, peer counsellors from mutual support societies, recovered problem gamblers who have embezzled, and professionals working in workplace crime security and the prevention of alcohol, drug and gambling harm.

Results

Important measures in preventing and responding to gambling harm in the workplace include: substance use and gambling policy, problem gambling awareness, attention to signs of gambling-related harm, control functions, appropriate responses to harmful gambling, and rehabilitation.

Conclusion

The workplace should play a greater role in the universal, selective and indicated prevention of problem gambling.