Cultural Competency In Treating Problem Gambling

Cultural Competency In Treating Problem Gambling

As most people know, the American healthcare system has not treated people of color (POC) equitably. The pandemic has focused attention on the disparities between Whites and People of Color, as COVID fatalities are much higher for POC than Whites. Add in the racial unrest occurring in our own backyard — and around the country — and you get a sense of the stresses faced by POC. As a result, traditional counseling that White people might access is not the first choice for POC seeking help.

A virtual webinar conducted by Dr. Deborah Haskins, Ph.D., LCPC, ACS, MAC, ICGC-II, BACC, CEO, Mosaic Consulting and Counseling Services and President of the Maryland Council of Problem Gambling, highlighted some of the cultural interpretations among POC, examined some of the cultural considerations influencing gambling disorder, and introduced the cultural attunement model in her program Cultural Competency, Equity and Inclusion and Disordered Gambling Treatment and Prevention. Dr. Haskins stressed the need to understand cultural context when considering clients of color. Problem gambling is perceived as a “White man’s problem” because the approach to prevention seems only geared to Whites and POC do not see themselves represented.

Dr. Haskins provided overviews of various communities, including African American, Native American, Southeast Asians and Latinx. Each have very different views of gambling and how, when and where to seek help. Talk therapy is not the best fit for many communities and Dr. Haskins suggested we need to do more to shift the way in which we design and support problem gambling programs. She also described the cultural attunement model whereby counselors incorporate these five dimensions into a program:

1. Acknowledge the pain of cultural oppression.

2. Employ acts of cultural acceptance — ability to maintain a balanced perspective about one’s talents, successes and failures. Try to emphasize the positives to buoy their spirits since they have been so marginalized.

3. Act with cultural reverence. This requires that counselors think/listen/act from the heart and bring forth feelings of wonderment regarding how people bring meaning into their lives.

4. Engage in mutuality — cultural kinship — appropriate sharing of common experiences.

5. Possess the capacity to “not know” and be culturally open. The client is the true expert on their lives so tap into the expert knowledge they possess.

Overall, there needs to be new ways in which we approach treatment for POC. There must be real awareness of social and economic justice and understanding of past traumas (Adverse Childhood Experiences – ACES screening). Dr. Haskins stressed that we need to acknowledge the pathologies along with the resilience and keep stressing prevention.

NPGA To Launch Its Inaugural Clergy/Spiritual Training

NPGA To Launch Its Inaugural Clergy/Spiritual Training

This spring NPGA is offering its inaugural International Gambling Counselor Certification Board (IGCCB) clergy/spiritual leader training. We seek to expand outreach throughout Minnesota and among community groups that don’t necessarily see counseling/treatment as their first step towards help. The goal of the program is to increase the knowledge and equip influential community leaders with some basic understanding of problem gambling. The program provides spiritual leaders an opportunity to interact with each other as they seek to increase their community’s awareness of the issue of problem gambling, reduce any stigma related to problem gambling and facilitate discussions about ways in which harm can be minimized.

As part of this initial training, eight leaders from the Twin Cities Nigerian community will learn about gambling disorder, who it impacts, available resources, and how to engage in conversations that help those impacted as well as educating their congregations and community groups.

Each of the eight individuals will take 16 hours of online course work in the following eleven modules:

  1. Definitions and Diagnostic Criteria
  2. Special Populations and Gambling Disorders: Women and Multicultural
  3. Scope and Prevalence of Disordered Gambling
  4. Assessing Gambling Disorder
  5. Co-Occurring Disorders and Gambling Disorders
  6. Screening for Gambling Disorder and Impacts of Gambling
  7. Best Practices and Evidence-Based Strategies for Treatment of Gambling Disorder: Motivational Interviewing
  8. Family Intervention
  9. Financial Issues and the Meaning of Money
  10. Neurobiology and Psychopharmacology
  11. Special Populations and Gambling Disorders: Youth and Older Adults

In early May, the group convened on Zoom with a trained spiritual facilitator to discuss possible scenarios and ways they can engage their community member in a meaningful and resourceful way. Those who completed the full 24 hours will receive a certificate of completion. The IGCCB offers an actual certification that can be obtained by doing additional community project work, but for this inaugural program NPGA opted for the certificate. We will revisit this once we’re well past the restrictions of COVID.

As Seen on Intenta Newsletter

As Seen on Intenta Newsletter

.Worth Reading This Month

·         ​Link between loot boxes and problem gambling has been “robustly verified” in new research.

·         ​Gaming the system: legally-required loot box probability disclosures in video games in China are implemented sub-optimally

·         ​Leaked recording captures discussion of Counter-Strike match fixing

April Spotlight – Monetization tactics in video games

This month, we’re highlighting the tactics used in video gaming and the links to problem gambling.

The gaming and gambling industries have converged, borrowing sophisticated techniques from each other to engage and profit from players – now games are increasingly monetized and gambling is more game-like.

Loot boxes – virtual items in video games that contain randomized rewards – is one such technique borrowed from the gambling world that has become profitable for the gaming industry. For example, YouTuber Mr Beast recently posted a video of himself opening loot boxes, ranging from $100 to $250,000, with a total value of $500,000. Within two weeks of posting, the video had been viewed over 40 million times.

Although the gaming industry claims that loot boxes are unproblematic, non-gambling activities, this claim is refuted by the evidence.

Recent research by GambleAware reports that 12 out of 13 studies have established ‘unambiguous’ linking of loot boxes to problematic gambling behavior (Close & Lloyd, 2021).

There are a number of other emerging trends in gaming:

·         Increased access to risky games through mobile adoption and free-to-play models.

·         Using real money for virtual currency leading to a warped perception of value.

·         More opportunities to gamble with faster-paced action and random rewards.

·         More ‘real-life’ loot boxes, virtual skins and character customization.

·         More data for companies to leverage.

Using behavioral analysis, the gaming industry adjusts game mechanisms to increase spending by gamers.

Gaming companies also use AI to predict, identify and hunt down ‘whales’ – individual gamers who will spend thousands of dollars on a single platform (Handrahan, 2019).

However, gamers are taking notice of the monetization tactics within games. A survey of 1100 gamers in the UK found players reported over 35 different types of ‘predatory’ techniques perceived by gamers to be misleading, aggressive or unfair. The practices were often seen by gamers to be pressuring them to spend money. (Petrovskaya, Elena & Zendle, David, 2021).

Research indicates that harms from gambling-like mechanics in games disproportionately affect adolescents and young people.

Given the concern “that gambling is now part of everyday life for children and young people” through video games (BBC News, 2021), understanding these predatory tactics will increase our effectiveness at safeguarding the psychological and financial well-being of gamers.

Clinicians need to be equipped to deal with problematic gaming behavior. Get started today by registering for our Gaming Disorder Clinical Training.


BBC. Loot boxes linked to problem gambling in new research. 02 April 2021.

Close, James and Joanne Lloyd. (2021). Lifting the Lid on Loot-Boxes Chance-Based Purchases in Video Games and the Convergence of Gaming and Gambling. Report Commissioned by Gamble Aware.

Handrahan, M. (21st October 2019). Yodo1’s AI-driven whale hunt is a bad look for the games industry: Opinion. Retrieved from

Petrovskaya, Elena & Zendle, David. (2021). Predatory monetisation? A categorisation of unfair, misleading, and aggressive monetisation techniques in digital games from the perspective of players.

Recovered Video Game Addict Creates Support Community for Professionals and Players

Recovered Video Game Addict Creates Support Community for Professionals and Players

Cam Adair, a video gamer in recovery, has made his life’s purpose to prevent others from reaching the same depths as he did. Cam’s life took a dramatic turn at the age of 11 when he began to experience intense bullying, leading him to drop out of high school and escape into gaming. He never graduated, and while all of his friends were off to college, Cam was playing video games up to 16 hours a day.

Struggling with depression he reached rock bottom when he wrote a suicide note, and it was this night when he made a commitment to change.


The stated goal of INTENTA is to equip mental health professionals with resources on digital disorders to empower an intentional digital culture. It provides internationally accredited training that covers a comprehensive overview of problem and disordered gaming, allowing mental health professionals to understand the context, dynamics, mechanisms and special issues that present with gaming clients.

According to INTENTA’s website, professionals lack the tools and training to effectively screen clients, which greatly increases the risk of misdiagnosis and ineffective treatment. Without training, professionals cannot effectively communicate nor relate to clients who engage primarily in digital spaces.

Distraught family members of loved ones with gaming issues may seek help from mental health professions, who lack the training to assess and counsel families to provide effective interventions. Without comprehensive education, these professionals can cause harm by
making ineffective and counterproductive interventions.

Another challenge is the rapid rate of change and evolution in video game technology. INTENTA helps professionals stay current with ever-increasing game innovations and their client’s struggles.

After completing the INTENTA training, professionals will:

  • The bullet list is messed up. Should read:
  • Improve quality of care and reduce potential risk of harm for clients
  • Understand the psychology of gaming and recent innovation trends
  • Have validated screening tools to identify at-risk clients
  • Be abel to implement practical strategies for prevention, treatment and recovery
  • Be a valuable source of knowledge among colleagues
  • Be an international recognized specialist in gaming disorder

For more information about INTENTA, visit


Game Quitters is the world’s largest support community for video game addiction, which currently serves members in 95 countries. The Game Quitters website ( provides a wealth of information, including more than 200 videos about video gaming addiction and a list of ideas to replace gaming. The site also provides an addiction test for gamers, lists of resources and support groups, and other information to help those with a video game addiction as well as parents and concerned others.

What’s In a Name: Might the Renaming of Massachusetts’ Council Be the Way of the Future?

What’s In a Name: Might the Renaming of Massachusetts’ Council Be the Way of the Future?

In September, after nearly 40 years, the Massachusetts Council on Compulsive Gambling (MCCG) changed its name to the Massachusetts Council on Gaming and Health (MACGH). Northern Light discussed this change and its implications with Marlene Warner, executive director of MAGH.

Q: Why was the organization renamed?


bio photo of massachusetts council on gaming and health

Marlene Warner

A: We started talking about this around four years ago. For starters, the term “compulsive gambling” was antiquated. We also became involved with GameSense, which meant we were more focused on the full spectrum from prevention to recovery rather than just intervention. We also heard increasingly from people at casinos and on social media, helplines, etc., about the blurring of lines between gaming and gambling. Since iGaming takes place on the casino floor it made sense to talk about “gaming,” which is more of an all-encompassing term. The “health” aspect of our name reflects that we do more than just intervention — we also want to look at the larger public health implications. The intention of the name is to not only expand our mission but also to designate what we’re truly doing as an organization.


Q: Was there a tipping point in the decision to change the name?


A: It was a gradual thing but in the last two years as we’ve realized the blurred lines between gaming and gambling, so have gaming commissions. Congress has even held hearings on gaming. It became clear to us that this was the next wave and we didn’t want to miss it.


Q: What has the response been to the name change?


A: For the most part, everyone has been incredibly supportive. They thought it was appropriate and future-focused.


Q: Have you made any changes to your training since the name change?


A: The very first thing we did was to work on a certificate program and clinical training program to broaden counselor and clinician knowledge of video gaming in a clinical setting. We want to make sure they’ve been prepared so that when someone presents with a gaming problem, they know how to respond.


Q: How is Massachusetts handing gaming disorder? Are counselors encouraged to take the INTENTA training? (INTENTA is the first approved training provider for the new International Gaming Disorder Certificate (IGDC) by the International Gambling Counselor Certification Board).


A: The training that we’re putting together is sort of a competitor to INTENTA. It’s another option that is a little shorter and less expensive. We are collaborating with the Evergreen Council on Problem Gambling and the course is called Foundations in Gaming Disorder. As with INTENTA, it will qualify for international board certification.


Q: Do you plan to measure the impact of the name change, whether through changed attitudes or diminished stigma around gambling disorder?


A: For now, we’re just collecting anecdotal feedback. But a year from now, we’ll want to know we’ve done the right thing. I think we’re gaining a lot of traction. We’re also in the process of putting together a major national study with gambling and gaming stakeholders with major universities. That, alone, has been well received.


Q: Do you think other state councils will make similar name changes?


A: Several fellow state councils have asked us how to do it. Many of us were trained on the idea of calling it “gambling” rather than “gaming” so it takes some fresh thinking. It’s not a change to be done lightly.

NCPG Conference Roundup

NCPG Conference Roundup

I (virtually) attended the annual conference of the National Council on Problem Gambling in July. Here is a recap of some of the presentations. – Susan Sheridan Tucker

Industry Trends

The conference featured a considerable focus on responsible gambling, particularly in light of the expansion of gambling. This includes sports betting and igaming, along with esports and the continued blurring of lines between gambling and video gaming.

Operators, regulators and players are all part of the multichannel platform growth. Technology and an apparent pent-up demand for wagering have hastened the need for increased legalization and regulatory rules that address the desire for operators to make a profit, for states to collect revenue and, most importantly, to protect consumers with comprehensive responsible gambling tools. In Minnesota, no new legislation has passed yet, but it’s just a matter of time. It will be critically important to ensure the legislative language provides for funds to cover prevention, treatment and research, and to insist on best regulatory practices and sharing the aggregate data with the state.

COVID-19 has presented financial challenges to operators and states, who have already seen profits and tax revenues plummet due to brick and mortar closings and the tanking of other sectors of the economy. For the few states that had already passed online gambling legislation, the transition from land-based to online sites was fairly smooth. Early indications show that existing customers and new ones found and used the online alternatives. However, in states without legalized online gambling, players were lured to offshore, unregulated sites which present a myriad of unethical practices; this is one of the arguments for legalizing more forms of gambling. Several states are not only jumping to pass sports betting, but also igaming so they can create an omni-channel market for consumers. If land-based casinos need to shut down for a pandemic or natural disaster, operators can continue to offer their products to customers online, reducing the hit on profits and state tax revenue.

Another trend that’s emerging internationally and creeping into the U.S. is a move to go cashless. The industry prefers this because it minimizes the amount of cash they need to secure on the premises, more consumers are accustomed to using less cash and, with COVID-19, eliminating handling of cash is more sanitary. Cashless systems present opportunities to closely monitor customers’ playing habits and to build in responsible gambling tools during play that may deter players from taking too much risk. However, there are also disadvantages with cashless systems. The availability of on-demand access to digital payments means consumers may increase their spending beyond their means. These new systems also shift more risk to the player and remove protective factors, such as the need to pause the game to replenish cash. If cashless systems are to be adopted, specific consumer protections must be part of the plan.

Some operators are beginning to realize they have a greater responsibility to identify problem gamblers and to talk with them when gambling patterns indicate troubling behavior. In some European casinos, operators are using data to have conversations with players about the risks they’re taking and recommending they take a break, discussing self-exclusion or suggesting they seek help from a professional. The NCPG has developed Guidelines for Payment Processing as a guide to the industry as they begin to adopt these tools and minimize the incidence of gambling addiction.

Generation Z

Those working to prevent gambling disorder need to be aware of the generational characteristics of Generation Z, which consists of people born between 1997 and 2017. This is the first genuine digital generation and is redefining what “winning” means. For this generation, a win equates to a good experience, engagement and bragging rights, but not necessarily winning money. They enjoy games of skill, not chance. It’s expected that esports will explode with this generation because it’s popular with both males and females.

The exposure to online gaming and apparent attraction to “trying out” a game — plus the strategic use of game bonuses — are considered a priming of the pump for gambling once these players are in a position to spend money.

This is a generation that creates and follows influencers – not necessarily the traditional influencers, such as sports figures or Hollywood personalities. Innovative social media (not Facebook) apps rule the way they communicate and, like most generations, they have created their own style of communication that is vastly different than past generations.

Relevant responsible gambling materials/prevention need to reflect this rising generation, educating them early on about potential risks in gaming/gambling.

Why Responsible Gambling Programs Are Essential

Ultimately, responsible gambling programs make good business sense. While the gambling industry seeks to provide an entertaining experience for all who partake, some are clearly unable to do so without causing significant harm to themselves and their loved ones. By adopting robust responsible gambling programs, the industry plays its role in keeping all players healthy, helping to flag issues before customers crash.

Properly designed, a responsible gambling program extends to the regulator, operator, its staff and the player. This shared responsibility helps combat the stigma of gambling disorder that blames the player and leaves them struggling in isolation.

Responsible gambling programs:

  1. acknowledge the risks up front,
  2. provide the rules and odds of each game,
  3. incorporate intervention tools that enable a player to pause and reset, and
  4. create a mutually beneficial and nonjudgmental relationship to ensure a player’s experience is positive.

The purpose of responsible gambling programs is to create opportunities for safer sustained play. This requires a multi-pronged approach involving understanding the needs of players (from new players to serious players to those who appear in trouble), producing positive messages that invite open discussion of prevention, making materials readily available and knowing when to deliver messaging and/or other resources to a troubled player. A robust responsible gambling program also helps gaming staff enjoy their jobs because it offers them more tools to assist and it builds empathy for their customers.

Ultimately, a responsible gambling program requires a commitment from top leadership with an understanding of the long-term benefit. It also requires regulatory bodies be willing to insist on best practices and enforcement when needed.

Racism in Gambling Disorder/Healthcare

Each day of the conference, a small segment was dedicated to reminding attendees that systemic racism exists in the problem gambling arena, as it does in so many other aspects of our healthcare and economic systems.

Some statistics:

  • Black, indigenous and people of color (BIPOC) experience gambling disorder at twice the rate of whites.
  • Generational trauma is real, and quite apparent in the African American community.
  • Blacks represent 13.4% of the U.S. population, but very few are seeking treatment due to roadblocks, such as mistrust of the system, shame, privacy issues, lack of information and financial concerns.
  • COVID-19 has clearly shown that BIPOC are more vulnerable and experience more serious symptoms due to the lack of access to good healthcare throughout their lives.

NCPG has formed a Diversity Equity and Inclusion Committee that advises on issues affecting the Black community, additional communities of color and other marginalized groups. We expect there will be recommendations made in time.

(As a side note, NPGA is reexamining all of its collateral material to ensure it reflects Minnesota’s diversity. In the past year, we have made a concerted effort to portray that diversity in our public service announcements.)

Call For One National Problem Gambling Helpline

NCPG is appealing to states to join its national gambling helpline. Twenty-two states have separate problem gambling helplines, in addition to the national number used by NCPG. These helplines were established over the decades for various reasons. The question is whether it makes sense for each of these states to have separate numbers. Minnesota has its own helpline, which is managed by the Minnesota Department of Human Services and operated through a contractor. While there would be costs with transitioning to a national number — including changing printed and online materials —there are advantages to having one number. A single helpline provides centralized data collection and the assurance that training is consistent and meets best practices.

Oregon Core Competencies For Treatment Providers

In Oregon, a public health authority teamed up with researchers at Lewis & Clark College to develop new guidelines for gambling counselors. The publication, A Guide to Core Competencies for Problem Gambling Treatment Counselors, was created over the course of a year through surveys conducted across the country and the world to compile best practices in treatment counseling.

After consultation with advanced problem gambling counselors, a total of 166 core competencies were identified. These competencies were organized around five primary domains:

  1. knowledge of problem gambling
  2. psychoeducation
  3. basic problem gambling treatment skills
  4. case management and ethical practice and
  5. sociocultural awareness and competence.

The full report can be found on our website at under Professional Resources. The state of Oregon intends to use this document as a way to improve the training it provides to gambling counselors.

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