One size doesn't fit all: experiences of family members of Indigenous gamblers.

Holdsworth, Louise ; Breen, Helen ; Hing, Nerilee 等

Abstract: This study explores help-seeking and help-provision by family members of Indigenous people experiencing gambling problems, a topic that previously has been ignored. Data are analysed from face-to-face interviews with 11 family members of Indigenous Australians who gamble regularly. The results confirm that substantial barriers are faced by Indigenous Australians in accessing formal help services and programs, whether for themselves or a loved one. Informal help from family and friends appears more common. In this study, this informal help includes emotional care, practical support and various forms of 'tough love'. However, these measures are mostly in vain. Participants emphasise that 'one size doesn't fit all' when it comes to avenues of gambling help for Indigenous peoples. Efforts are needed to identify how Indigenous families and extended families can best provide social and practical support to assist their loved ones to acknowledge and address gambling problems.

Introduction

Little is known about the experiences of family members of people with gambling problems (Patford 2009; Productivity Commission 2010), but existing research suggests their lives can be seriously disrupted (Patford 2009). Not only can the person experiencing the gambling problem be affected in various life domains, but family members may also experience financial, emotional, relationship and health problems (Volberg 2003). The Productivity Commission (2010) noted that for each person who gambles at problematic levels, several others are affected, including the spouse, children, parents and extended family. Although problem gambling may be seen as a personal difficulty, gambling problems can also impact on significant others and the wider community (Rogers et al. 2005). Additionally, while family members often provide help and support for the relative concerned, they may also need help themselves to cope with the situation.

Families differ in their willingness and capacity to both provide and seek help for gambling problems. Further, cultural factors, such as valuing collectivism, can influence how much family ties and collective interests are prioritised. One culture that emphasises collectivism is that of Indigenous Australian peoples (Fogarty and White 1994). In contrast to individualistic cultures, collectivist cultures are those in which people are integrated from birth into strong, cohesive in-groups, including extended family members, which continue protecting them in exchange for unquestioning loyalty (Hofstede 2012). Thus indigenous Australians are more likely than their non-Indigenous counterparts to see themselves in terms of their affiliation with their families and community (Yeo 2003). This may influence the ways they provide and seek help in relation to a loved one's gambling problem.

Limited knowledge is available about Indigenous Australian gambling in general (Young et al. 2007) and Indigenous gambling help-seeking in particular (Breen et al. in press). No prior research has been conducted into the role of Indigenous family and extended family members in both providing help to a loved one with a gambling problem or in seeking help and support for themselves. This paper presents a qualitative study involving 11 family members of Indigenous Australians who gamble regularly. The study explored the help-providing and help-seeking roles of Indigenous Australian families with a relative experiencing a gambling problem.

Background

Various terms have been used to describe people with gambling problems. 'Pathological' or 'compulsive' are terms often used in the North American, European and New Zealand literature (American Psychiatric Association 2000; Delfabbro 2009). However, explaining gambling as a pathology or obsessive-compulsive disorder has not been supported by Australian research (Delfabbro 2009). In Australia the term 'problem gambling' is generally used and defined as 'difficulties in limiting money and/or time spent on gambling, which can lead to adverse consequences for the gambler, others, or for the community' (Neal et al. 2005:125).

The Productivity Commission (2010) estimates that between 0.5 and 1.0 percent of Australian adults have problems with gambling, with a further 1.4 to 2.1 percent at moderate risk of problem gambling. However, these estimates are far higher among regular (at least weekly) non-lottery gamblers, where problem gambling rates are estimated at 8 percent, and combined problem and moderate risk gambling rates at around 22 percent (Productivity Commission 2010). Whether these estimates are applicable across cultural groups is not known. Among Indigenous Australians, who make up about 2.5 percent of Australia's population of 22 million people (ABS 2010), the proportion who gamble regularly, have gambling problems or seek help is also unknown. Yet, cultural differences may affect how gambling and gambling help are perceived (Productivity Commission 2010).

Indigenous Australians have suffered, and continue to suffer, from postcolonial dispossession, racism and discrimination (Atkinson 2002; Martin 2008). They are more likely than non-Indigenous Australians to experience health and social problems, as well as structural disadvantages, including unemployment and poverty (ABS 2010). To highlight the ongoing impacts of post-colonialism resulting in many Indigenous people's vulnerability and disadvantage, Nicoll (2009) has drawn attention to a Northern Territory Government intervention which includes the quarantining of up to half of people's welfare payments for essential daily items such as food and rent, thereby reducing discretionary spending on optional services such as gambling. Nicoll (2009:57-8) argues that the intervention 'is supported ideologically through a focus on the Indigenous "other" as the subject of pathological difference'. From a neoliberal perspective that favours individual responsibilities over collective rights, the intervention is ostensibly seen to be required for 'practical reconciliation measures' or reducing collective cultural strength and structures. Similarly, Altman and Hinkson (2010:185) have stated that the intervention challenges Indigenous peoples' traditional values of community because its aim is to 'produce mobile, formally educated, individualized Aboriginal citizens who will embrace the values of the free market'. Addressing these arguments, a collective family perspective is recognised in this paper, whose authors include Indigenous and non-Indigenous Australians.

It is fundamentally important for gambling research concerning Indigenous people to consider potential relationships with other issues (Young et al. 2007). Addressing issues of poverty and disadvantage, Shaffer et al. (2002) have noted that poverty is often associated with greater financial risk-taking, which frequently has adverse results for the individual gambler, the family and for the wider community. While people from all socioeconomic backgrounds can develop gambling problems, people on low incomes experience gambling losses disproportionately to those on higher incomes; thus low income exacerbates the risk of negative consequences from gambling (Thomas and Jackson 2008). Hunter (1993:242) maintains that 'the poorest in society stand to lose most, even when losing less. At the bottom of the Australian economic ladder, Aborigines attract little contemporary attention to their gambling.'

Gambling is increasingly acknowledged as a public health issue for Indigenous Australians (AH&MRC of NSW 2007; McMillen and Donnelly 2008). From a public health perspective, gambling is viewed along a continuum, ranging from no gambling to a great deal of gambling, including problem gambling (Shaffer and Korn 2002). The Productivity Commission (2010) developed a problem gambling scale of increasing severity, from no risk or harm (recreational gamblers) to significant risk or harm (such as poverty, family breakdown and suicide). Those towards the problem gambling end of the continuum can be assisted through harm reduction strategies, including formal help, informal help and self-help strategies (Shaffer and Korn 2002).

If people with gambling problems and their family members seek formal help, they can attend treatment services such as general counselling, gambling-specific counselling, or addictions, relationship or financial counselling. They might also self-exclude from gaming venues or attend peer support groups such as Gambler's Anonymous, Gam-Anon or online mutual support groups. Alternatively, people may use informal sources of support provided by friends and family, or self-help strategies that do not necessarily involve other people, including budgeting, taking up alternative recreational activities or leaving debit cards at home. Yet these types of mainstream help services may not suit the cultural needs of Indigenous people. Concerns over language barriers, confidentiality issues, value conflicts and types of support may discourage attendance (CIRCA 2011; Dyall 2010; McMillen and Bellew 2001). For instance, a lack of Indigenous counsellors has been identified as a barrier to help-seeking (Breen et al. 2010) because Indigenous people may not be comfortable with the direct and open communication style that most counselling situations involve (Cultural Perspectives 2005). Gambling help-seeking may also be reduced for Indigenous people due to lack of awareness of problem gambling services, or lack of access to information and treatment (Raylu and Oei 2002). In New Zealand Bellringer et al. (2008) recommended greater Maori involvement in raising awareness of help services, de-stigmatising help-seeking behaviour, help service design and provision. Thus consideration of cultural attitudes, values and beliefs may be vital for underpinning professional help services for Indigenous groups.

Negative social attitudes and stigma that often accompany gambling problems can make seeking assistance difficult for people from all cultural backgrounds, deterring many people from seeking help when faced with life difficulties (Lipmann et al. 2004; Pulford et al. 2009; Tavares et al. 2002). For Indigenous Australians, shame has also been identified as a particular barrier to gambling help-seeking, sometimes leading to problem denial and concealment (AH&MRC of NSW 2007; CIRCA 2011). For Indigenous Australians, a gambling problem concerning a family member can also involve family shame, which is frequently associated with a loss of respect among community members (Cultural Perspectives 2005). Thus, when a family member's gambling becomes excessive, it may initially remain private and kept within the family. As a result, negative social, emotional and financial effects of problematic gambling on close family and friends can be far reaching (Hodgins et al. 2006; Petry 2005).

Given the barriers to formal help-seeking faced by Indigenous people, it might be expected that informal types of support are used instead. In north Queensland, people with gambling problems obtained support by turning to family for assistance, through traditional spirituality, and through relatedness and engagement with their collective culture (Breen 2012). Thus a combination of personal competence and social and cultural support from significant others appeared to foster resilience and recovery for some gamblers. However, no in-depth research has been conducted into how family members might assist themselves and the person with the gambling problem to deal with the gambling issue and its impacts (Breen 2012).

In summary, Indigenous Australians and their families appear to face particular barriers to obtaining help for gambling problems, but these issues and concerns are typically lost or diluted in population-level gambling research. Yet in-depth knowledge about gambling help-seeking could inform and underpin culturally relevant and practical measures for Indigenous people who are at risk or are experiencing gambling problems, as well as for their concerned family members.

Methods

Taking a qualitative approach was considered important for this study, given ethical and cultural considerations (Martin 2008; Steane et al. 1998). Allowing respectful co-operation, qualitative research is especially appropriate for gaining in-depth understanding, since it focuses on how people interpret their own situations, drawing from the interpretations and meanings people give to their experiences and lives (Denzin and Lincoln 2005). Qualitative research values each individual's perspective and experiences.

After the researchers' University Human Research Ethics Committee approved the study, 11 family members of people who gamble regularly were recruited though Indigenous community and health centres in Cairns and Darwin, as suggested by the local gambling help services. Darwin and Cairns are cities with large numbers of Indigenous residents plus many visitors from smaller, remote communities. All participants confirmed they had a close family member who gambled at least weekly, with some gambling almost daily. All except one felt that this person had a gambling problem. Family and extended kin relationships included parents, spouses, siblings, in-laws, cousins, children and aunties. Preferred gambling forms included poker machines (most popular), traditional card games, wagering and keno.

One author, an Indigenous Australian gambling counsellor and community educator, interviewed the 11 family members--six in Cairns and five in Darwin. An interview schedule was used (Appendix) because this assists in qualitative interviewing when 'the categories of response are focused but not necessarily pre-determined' (NHMRC 2007:26). Each interview lasted around 30 minutes and was conducted face-to-face in the community centres where the interviewees were recruited. Interviews were digitally recorded with each participant's permission (Charmaz 2005; Puchta and Potter 2004). A professional transcription service was used.

The interview data were analysed using thematic analysis (a method for identifying, analysing and reporting patterns (themes) within data), by organising and describing the data set in detail, and by interpreting the various aspects of the research topic (Braun and Clarke 2006). Thematic analysis also helps to protect participant anonymity, because results are grouped and presented by themes and sub-themes, rather than by case or narrative analyses of participants' individual accounts.

Results

Ten participants considered their family members had a gambling problem, evidenced by gambling their entire pay, seeking loans, having no food for their children, becoming angry when losing at gambling, lying about money and their gambling, gambling every day, and losing interest in other people and activities, including work. These ten participants had previously encouraged their family members to seek formal gambling help, while three had encouraged self-exclusion. However, they reported that their family members were extremely reluctant to access a service such as counselling, a gambling helpline, medical practitioner or other professional, or to self-exclude. Various reasons were given for this reluctance, as discussed below. All reasons involved cultural factors.

The social aspects and normalisation of gambling

That gambling is normalised and is a socially accepted activity in many Indigenous communities was highlighted by all participants. For example, one participant reported that social aspects of gambling were a barrier for the family member to seek help: 'He sees going to the venue as a social thing and a place to have a yarn, they all eat there and there's family there. He wouldn't stop gambling; it's because of the social side of things.'

Others spoke about gambling being seen as a normal social activity and how this prevents their family members from seeing that gambling is a problem for them. One participant, when talking about her son, said, 'He thinks because he goes gambling and that all his friends are there gambling that he doesn't have a problem with it. That he just does it as a social thing to do. Until he sees it as a problem he won't go and get help.'

As indicated above, social acceptance of gambling can hinder recognition that a gambling problem exists. One family member expressed this simply: 'If they're all doing it they don't see it as a problem'. Similarly, another participant said that, although he/she had spoken to the family member about seeking professional help, he did not believe gambling was a problem for him: We always tell him we know he has a problem with it [gambling] but he doesn't listen and I don't think he'd ever go to professional help. He just thinks there's nothing wrong with it [his gambling behaviour]. He says that [his gambling] is his lifestyle and what he does. Our advice falls on deaf ears.

One interviewee pointed to social aspects of gambling that discouraged self-exclusion because gaming venues are a social meeting place that people were reluctant to bar themselves from.

Cultural respect

Other cultural concerns that related to respectful relationships were highlighted by family members. One was the inappropriateness of suggesting the need for help to an Elder because this would indicate lack of cultural respect. The following comments reflect this situation: It's like that cultural thing too. The other siblings, they're the Elders now in our age group because our grandparents have passed away, we wouldn't ... I wouldn't even be game enough to say that. With the kids, yeah it would be important to encourage avoiding venues, organising support, but not the Elders. Given the culture side of things, it's not appropriate for me to do that to him as an Elder ... to say you have a problem; you need to go and see a counsellor. It would show no respect.

Lack of service awareness and culturally appropriate services

Most family members said the Indigenous people they know are unaware of available gambling help services, as highlighted in the following response: 'People really don't know where they could go for help because it's not widely publicised. Services need to be out in the community and more visible.'

The lack of culturally appropriate services was an important issue raised by many participants.

The following interview quotes highlight this concern: For Indigenous people that's the biggest problem out there, access to services ... access to culturally applicable services out there. They're flat out just getting normal government services ... and basic counselling services let alone culturally applicable ones. At the moment there's nothing. But it's important that Indigenous people have somewhere to go where the environment's right, the cultural aspect's right, the venue ... so people can approach a comfortable place to say--I'm struggling with this part of my life.

Shame, along with a lack of confidence and self-esteem, also appeared as a major reason that family members' encouragement to seek formal help was largely ignored. For example, some participants noted: There are cultural influences in addressing those issues, and probably a lot of the delay in addressing those issues is the shame factor. They knew what it [counselling service] was all about and knew what to expect, but they wouldn't go to it because of the shame. A lot of Indigenous people don't have the confidence or the self-esteem to go to counselling.

Confidentiality and trust were considered vital to the cultural appropriateness of services. For instance, one respondent believed that 'It's important that there is confidentiality and trust in the service ... because that's one of the big issues for Indigenous people. It's about feeling comfortable with confiding.' A similar view was taken of mutual support groups for gambling problems as they usually lack other Indigenous participants. One interviewee asked rhetorically, 'How many black people have you seen in Alcoholics Anonymous or Gamblers Anonymous?'

Likewise, another participant believed joining a mutual support group such as Gamblers Anonymous would be helpful for the family member if other Indigenous people attended: 'It would definitely be a very good help mechanism for him. If there were other Indigenous people that he could associate with to go to those sort of forums. He'd probably feel more relaxed and comfortable.'

The role of family and extended family members in providing informal help

With some lack of trust in mainstream services, many participants said that people would be more likely to trust a family member or close friend. For instance, two interviewees said: When he discussed his gambling problems with people that he trusted, family members, friends, it went alright. It was obvious at that time that he gave up gambling because be was coming home quite regularly, waiting for his wife at my place. He could trust us. People talk with family members they know because in a small community there's confidentiality [concerns] and shame. Shame stops people getting help.

The capacity of family members to assist the person with the gambling problem appeared to vary widely. For example, one interviewee seemed well equipped: 'I just try and give her my support and talk to her because I guess I know a bit about gambling. 1 could talk her through some of the stuff and give her information and where to get help.' Another felt that he/she would have to get advice first, and would 'Get some education of a support group if it was available that would enable me to gain more knowledge and understanding so that I could make ]family member] aware of the difficulties and risks that are associated with gambling.'

Most family members tried talking to the relative with a gambling problem as reflected here: 'We tell him that all the time. Like "if you take all your money tonight then you'll have nothing left for tomorrow night". So we try and educate him and let him make the choice himself.' Others used practical strategies, such as one participant who reported that his family helped to feed the children of a relative with a gambling problem: 'My cousins would come over and sleep at our house when there was no food in theirs.'

However, such practical strategies were not always well received. One participant related efforts to 'Try to hide the wallet and try and hide the cardkey but that just makes him react ... He gets volatile because of that.' One female participant had left her partner temporarily because of his gambling and noted that 'It stopped him for a little while ... and then he went back'.

Others had tried some 'tough love', such as: Just saying no to her when she rings for money for food and stuff. We just cut her off altogether and just say no, She doesn't actually ring us for one month or two months because she's angry we didn't give her the money but it's for her own good.

However, some felt that family members were sometimes more of a hindrance than a help to the person with a gambling problem: 'Her other siblings are just as bad as what she is, so when they gamble they gamble together. That's what they do when they go out together ... the other siblings, well they reinforce that behaviour to gamble.'

A few interviewees considered that informal help was better coming from someone outside the immediate family. For example, one person had tried pointing out how gambling was affecting the gambler's family: 'I'd say to him this is how you're affecting your sister, your mother, your father and in turn it even affects me too being outside the immediate family group.' Similarly, another noted: 'We've asked his aunty to go and speak to him [but] if anybody speaks to him, family members, it falls on deaf ears. [So] help would have to come from an outside influence because speaking to family goes in one ear and out the other.'

The role of family and extended family members in encouraging self-help

The participants discussed trying to help their family members through encouraging self-help strategies. One strategy was budgeting, as the following interviewee explained: 'I always try to encourage budgeting ... I suggested we try things like, if you're going to go to the casino you're only allowed to go there with a $100 strategy and I told them to leave the keycard at home.' Another had offered to help manage her son's money to prevent him spending it all: 'I even said to him "give me money to hold so when you've got nothing then I will give you some bit by bit".'

Some participants actively encouraged take-up of other activities to replace gambling, particularly those that encourage social connectedness and wellbeing. For instance, one participant stressed the importance of health and wellbeing and discussed the issue of loneliness for the family member, saying, 'Yes we did gardening. She was also into yoga. She's on a diet now. So she has a go at trying to do everything but given that she's home by herself most of the nights she does tend to be very lonely.'

Two other participants were less specific but clearly thought it important to divert the person's focus away from gambling: I've been in this situation myself. The biggest thing is to take yourself away from the situation ... the environment. After a while you don't miss it. As humans I think we're very habitual so if we can do something for a while we get into the habit of it but if we don't do it for a while you don't miss it. All you can do is try to put something else in place to cater for their needs. It is important that we are supporting each other and being there for each other. It's been a support mechanism to say 'There's more to life than this gambling on pokies, there's a beautiful world out there'.

Seeking help for themselves

The participants were more focused on providing help for their family members than on seeking help for themselves. However, one participant had sought both formal and informal help for himself in relation to a close relative's gambling. This participant had previously gambled nearly every night with the relative but had since cut back. He reported that he first spoke informally to a local person 'about my feelings towards gambling. I didn't raise the concern of my [family member] gambling. I talked about what was impacting on me. The advice I was given was "that person doesn't want to change, why do you hang around with them?"' Following this, an Aboriginal health service visited the participant's community and advised both the participant and his relative as follows: 'He just basically said, if you encourage one another and keep one another strong, he encouraged us to continue to do that.' This advice reportedly convinced the relative to stop gambling for six weeks, although he started again but in a more controlled fashion.

The other participants had not sought formal help for themselves, but had pursued various strategies to help them deal with the family member's gambling. For one participant, this involved relaxation and diversions: 'I refuse to stress out over other people's problems. To relax I'll go for a walk, I'll go to the internet cafe and get on the computers and just play solitaire. Just time out to myself. Take my mind off my problems.'

Some found support from other family members: It's been good to talk about it because sometimes as a family you go through trauma. You don't necessarily get that time to de-brief. Or have a yarn about what's happening. Yeah. Just recognising that they're going through the same thing and see if there's anything we can talk about how to help that person.

One person felt that becoming more informed about gambling problems and the impacts on other people had helped him to better cope with his family member's gambling, so he had been 'just trying to look at the research, the statistics and what signs you see with family members, how it affects them'.

Suggested improvements

All participants agreed that avenues for gambling help for Indigenous people could be significantly improved. Suggestions included raising awareness about the effects of gambling through education and community campaigns geared specifically to Indigenous peoples; education about financial management; attending to concerns about confidentiality and trust; addressing gambling as one of a range of complex issues and needs; raising awareness of services; instilling self-esteem and confidence; and amendments to government policy to prioritise gambling reform.

Discussion

Before discussing the results of this study, its main limitation is the small non-representative sample of 11 Indigenous interviewees. As such, the findings cannot provide significant evidence that can be attributed to overall populations. However, qualitative research does not claim to, or indeed aim to, do this. Rather, qualitative research aims to understand, in depth, people's experiences of a situation rather than finding out what is generally true of many (Merriam 1998). Despite this, the study has provided substantial insights into how some Indigenous Australian family members attempt to provide help for a relative with a gambling problem and to cope with the impacts of gambling-related problems on themselves. Further research will be important to verify and extend this study, with larger sample sizes and in different communities. In support, Young et al. (2007:341) state, 'Information is critically needed on the consequences for culturally distinct minorities who are exposed to globalized gambling cultures'.

The study raises three broad issues for discussion about the role of Indigenous family members in providing and seeking help for a relative's gambling problem. First, the Indigenous gamblers discussed by their family members were clearly very reticent to use mainstream gambling help services and measures, including counselling, self-exclusion and mutual support groups. This was despite encouragement to do so by concerned family members. This reluctance to access services has been noted in previous research (AH&MRC of NSW 2007; Breen et al. in press; CIRCA 2011) and so is not distinctive to the current sample. Indeed, the current study supports previous findings that the social aspects of gambling, and the acceptance of gambling as a leisure activity among many Indigenous Australians, can mask gambling problems (Breen 2012; Breen et al. 2010).

Low use of formal services appeared to be further exacerbated in the current study if an Elder had a gambling problem. Cultural respect dictated that the Elder should not be confronted about the problem. Elders are custodians of knowledge and are chosen, accepted and highly respected by their own communities (Martin 2008) and, as such, are regarded as role models and teachers to young people because of their wisdom and knowledge (Atkinson 2002). When there is a possibility of the community thinking that an Elder is acting inappropriately, then the continuing respect of the community may be withdrawn (Stiegelbauer 1996). Yet, in this study, participants were apprehensive about approaching Elders who showed signs of a gambling problem. They did not withdraw respect, confirming that the traditional social structure in Aboriginal society as an organising principle for relationships between people (Altman and Hinkson 2010) was very important for these participants.

A commonly mentioned barrier to formal help-seeking included shame associated with having a gambling problem. Experiencing shame may impact negatively on people's self-esteem. While previous studies have noted this barrier among non-Indigenous populations (Bellringer et al. 2008; Evans and Delfabbro 2005; McMillen et al. 2004), shame appears an even stronger deterrent to formal help-seeking among Indigenous people due to the prevalence of low self-esteem, as reported by the AH&MRC of NSW (2007); shame acts as a barrier to accessing gambling help.

A lack of culturally appropriate services and little trust in mainstream services, along with the absence of Indigenous counsellors and other Indigenous people attending support groups, have also been noted in prior research (AH&MRC of NSW 2007; Breen 2012; Breen et al. in press; Cultural Perspectives 2005) and confirmed in the current study. These factors all contribute to the low rates of formal help-seeking activity reported in this and prior research (Breen et al. 2010; McMillen and Bellew 2001; Moore 2008; Rush et al. 2002). Thus participants in the current study advocated for improved avenues of prevention and support, including culturally appropriate education and treatment programs, a more holistic approach to addressing gambling and related complex needs, and gambling reform.

The second prominent issue highlighted by our research is the commitment by family and extended family members to try to help the person with a gambling problem with informal support and safety measures. These measures included emotional support, practical advice, money management and budgeting advice, provision of food and shelter, various forms of 'tough love' and encouragement to take up alternative leisure activities, particularly those that promote social connectedness and wellbeing. The importance of being socially connected for health and wellbeing was highlighted in Stevens and Young's (2009) study concerning gambling problems among Indigenous people in the Northern Territory.

Family members reported that their loved ones were much more likely to turn to family and friends for help with their gambling problem than to formal help services. Collective support from family and friends was clearly significant for Indigenous gamblers (Cultural Perspectives 2005; McMillen and Bellew 2001). Extended family support through kin group and cultural relatedness was similarly considered a protective factor for Indigenous gamblers by Breen (2012). This is especially significant for Indigenous gamblers because informal help-seeking from friends and family sits comfortably within Indigenous collective traditions of cultural reciprocity and meeting kinship obligations (Fogarty and White 1994). However, results here suggest that family members may not know how best to assist a relative with a gambling problem and that, in any case, their attempts to help had often failed. Research is needed to investigate successful strategies used by family members. This valuable knowledge could then be disseminated through Indigenous community education activities.

The third key finding from this study was the low priority placed by extended family on seeking help for themselves. Only one of the 11 participants sought formal assistance to help deal with the negative impacts of the relative's gambling. Informal measures such as talking with other families in similar situations and undertaking diversionary pastimes to take their minds off the problem were the only other measures discussed. Thus there is an opportunity to raise Indigenous community awareness of avenues of help available for family members affected by those with a gambling problem. These can include counselling services, mutual support groups and practical measures to protect the family's assets, avoid or cope with the associated stress, and manage relationship difficulties.

Conclusions

This study has provided some insights into the help-providing and help-seeking encounters of family members of Indigenous gamblers experiencing gambling problems. The results have confirmed that substantial barriers are faced by Indigenous Australians in accessing formal help services and programs, whether for themselves or a loved one. These barriers include problems being masked due to the wide acceptance of gambling as a social activity, the shame and trust concerns that go hand-in-hand with help-seeking, the need for cultural respect to Elders, and the lack of service awareness and of culturally appropriate services. Participants emphasised that 'one size doesn't fit all' when it comes to avenues for gambling help for Indigenous peoples. Given the apparent preference for using informal sources of help, efforts are needed to identify how Indigenous families can best provide social and practical support to assist their loved ones to acknowledge and address their gambling problems. Such an approach would sit far more comfortably with the collectivist nature of Indigenous Australian culture than existing mainstream counselling services can hope to do.

Appendix: Interview schedule

A. About you

A.1 Can you please confirm for us that you have a close family member who gambles at least once a fortnight?

A.2 Can I please ask what relative you are to this person? (e.g. husband, mother, etc).

A.3 And just to keep us on track during this interview, can I please have the first name of this person?

B. Their

B.1 Can you please tell us about (name's) involvement in gambling over the 12 months?

* What type of gambling did they do?

* How often did they gamble on the various types?

* Which was the most often?

B.2 Do you feel that (name) has a problem with their gambling? Why or why not?

B.3 What signs would alert you that (name) had a gambling problem, if they were to develop one?

C. Your role in helping the gambler If (name) developed a gambling problem that was impacting on you or the family, we're interested to know what you might do to try to help them?

C.1 Would you encourage them to seek professional help, such as counselling, relationship or legal advice, the Gambling Helpline or going to a GP or other professional? Why or why not?

C.2 Would you encourage them to join a self-help group, like Gamblers Anonymous or an online forum? Why or why not?

C.3 Would you encourage them to turn to other people, maybe family, friends, church minister, community leader or Elder? Why or why not?

C.4 Would you encourage them to use self-help strategies, such as better budgeting, taking up different interests, or avoiding other people who gamble? Why or why not?

C.5 Would you encourage them to avoid or bar themselves from the gambling venues they go to? Why or why not?

C.6 Is there anything else you would do that we haven't already talked about?

D. Help for yourself

If (name) developed a gambling problem that was impacting on you or the family, we're interested to know what you might do to cope with this yourself.

D.1 Would you seek professional help for yourself, such as counselling, relationship or legal advice, the Gambling Helpline or going to a GP or other professional? Why or why not?

D.2 Would you join a self-help group, like Gam-Anon or an online forum? Why or why not?

D.3 Would you turn to other people, maybe family, friends, church minister, community leader or Elder? Why or why not?

D.4 Would you use self-help strategies, such as managing family finances differently, taking up new interests together, or just talking to the gambler about bow the gambling is affecting you?

Why or why not?

D.5 Would you approach the gambling venues they go to, to see if they can do anything? Why or why not?

D.6 Is there anything else you would do to help you better cope with (name's) gambling that we haven't already talked about?

E. Motivators and barriers to help-seeking

We'd like to know at what point you would seek help in the ways we've talked about.

E.1 Would you seek help at the first signs of a problem or would you wait till things got pretty bad?

E.2 What specific problems or triggers would lead you to seek these types of help?

E.3 Are there any reasons or barriers that would delay you from seeking these types of help?

F. Improvements

F.1 How might avenues for gambling help for Indigenous people be improved?

F.2 What could be done to encourage Indigenous people to seek help at an earlier stage of a gambling problem?

F.3 What could be done to encourage Indigenous family members to seek help for themselves to deal with the impacts of someone's gambling?

G. Any other comments

G.1 Are there any other comments you'd like to make about help-seeking for Indigenous people for a gambling problem?

Acknowledgments

We acknowledge the Indigenous people who took part in this research for their insightful responses and co-operation. Financial support for this project was provided by Gambling Research Australia.

References

ABS (Australian Bureau of Statistics) 2010 The Health and Welfare of Australia's Aboriginal and Torres Strait Islander People, ABS, Canberra (Catalogue 4704.0).

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Louise Holdsworth, Helen Breen, Nerilee Hing and Ashley Gordon

Centre for Gambling Education and Research, Southern Cross University

Louise Holdsworth, PhD, is a researcher at the Centre for Gambling Education and Research, School of Tourism and Hospitality Management, Southern Cross University.

<louise.holdsworth@scu.edu.au>

Helen M Breen, PhD, is a Senior Lecturer at the School of Tourism and Hospitality Management, Southern Cross University, and an Australian Research Council Postdoctoral Research Fellow at the Centre for Gambling Education and Research.

<helen.breen@scu.edu.au>

Nerilee Hing, PhD, is a Professor at the School of Tourism and Hospitality Management at Southern Cross University, and the Director of the Centre for Gambling Education and Research, Southern Cross University, New South Wales.

<nerilee.hing@scu.edu.au>

Ashley Gordon, BEd, is an Indigenous researcher, a gambling counsellor and gambling community educator with lengthy experience in Indigenous community engagement.

<agconsultant@optusnet.com.au>