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Luck and Fate: Cultural, Social and
Psychological Characteristics of
Asian Gamblers
Timothy Fong MD
UCLA Gambling Studies Program
New Horizons in Responsible Gambling
Conference
Vancouver, BC
February 2017
Objectives
• Discuss cultural attitudes and risk factors
regarding gambling among Asian Americans
• Discuss the impact of assimilation and
acculturation on gambling behavior and attitudes
towards treatment
• Identify culturally competent prevention,
intervention, and treatment programs for Asian
Americans
Definitions
Asian Pacific Islander
• A person with origins in any of the original
peoples of the Far East, Southeast Asia,
South Asia or the Pacific Island
Asian American
• Asian American Pacific Islander
• Asian American
• Asian Pacific American
• Asian or Pacific Islander
– ~5% US Population
– ~13% California
Asian Canadian
~26% British Columbia
Asian Canadian Population
• South Asian
• Southeast Asian
• Chinese
• Filipino
• Korean
• Japanese
APIs are Heterogeneous
Different languages & dialects
Different historical & trauma background
Different immigration histories
Different living, clothing & customs
Different family structure, inter-personal
relationships
Different cultural values
Different substance abuse preferences
Asians and Gambling
Stories from California
• BJL, a divorced Korean American from Fontana,
owed $200,000 in gambling debts in 2006. He
killed his 5-year-old daughter and then himself.
• TN, the Cambodian doughnut king of California,
gambled away his empire and, by 2005, wound
up living on the porch of a friend's trailer.
• KX, a Hmong father in North Sacramento,
argued with his wife over his gambling, shot
himself in the head and killed five of his seven
children in 1999.
California 2005-2016
• 2005 UGSP Founded
• 2007 Calls from API Non-Profits,
Conference presentations, letters to
legislature, meetings, grass-roots events
• 2007 First grants to examine API
Gambling
• 2009 CALGETS begins operations
Gambling Expansion in Asia
• Macau: No. 1 gaming market since 2006
• Singapore: Dropped its gambling ban
Opened Integrated Resorts 2009
• South Korea: >17 casinos;
• Taiwan and Japan: Considering allowing
casinos.
• The Philippines: Manila Bay
One Chinese proverb
demonstrates the culture’s
acceptance of gambling, at
the same time signaling a
warning to those who
overindulge: “A little gambling
is soothing and relaxing;
heavy gambling could affect
Asian Culture and Gambling
• Gambling has been a part of society
from the early Asian history (3,000
B.C.)
• Gambling as a part of social/family life
• New Year’s celebration and funerals
•
Cultural factors that
promote gambling
–Acceptable way to make money
–Inquire about one’s destiny
–“Honoring the Gods”
•Losses are sacrifice
–Equate gambling with self-worth
Cultural factors that
promote gambling
– Emphasis on numbers that have
power over life events
– Heavy peer involvement
– Gambling is family entertainment
– Gambling as a rite of passage
– Superstitions
Perceptions about Gambling
Chinese Western
Make money Entertainment
An investment
A harmless activity Involves risk
Limited sense of risk
Nancy Petry Study 2002
• Study on 96 Cambodian, Laotian and
Vietnamese refugees
–59% identified as pathological
gamblers. (1.5% California rate)
–95 % reported gambling in the
previous year, and 93% reported
gambling in the previous two
California Prevalence Study
(2006)
• Asians (504)
– Low response rate (47% overall, less APIs)
– 7% of survey sample
– Mostly English (1% translated)
– Problem Gambling: 2.3%
– Pathological Gambling 0.7%
Genes or Environment or
Something Else
• When national prevalence rates were
examined in countries such as Taiwan,
Hong Kong, and Korea, it was found that
the rates of problem and pathological
gambling were consistent from those
found in European and New World
countries (Taiwan – 5%, Hong Kong –
1.5%, and Korea – 1%).
Immigration?
• Asian immigrants in western countries
often yield much higher rates of problems.
– Montreal Chinese 5%
– Calgary, 8%
– Sydney, 8%.
Why Immigration?
• “Personality traits that make them greater
risk takers. Immigration for most involves
taking some risks . . Therefore. . .”
• To date there is no conclusive data to
show that Asian immigrants as a whole
exhibit personality traits that are correlated
to problem gambling.
Immigration
• The experience of immigration – including
any experience of trauma and subsequent
stresses of adaptation contribute to
greater likelihood of problem gambling.
– Loss
– Loneliness / isolation
– Status seeking
What about the gaming
industry?
• Gambling establishments frequently
shuttle potential patrons from communities
with large Asian populations (Chinatown,
Koreatown, etc.) to their facilities.
• Bilingual staff in order to increase comfort
and ease of their Asian patrons.
• Targeted events, lounges, facilities, offers
Prevalence of Asian Gambling
in Casinos
Results
Gender N=180
Male 75%
Females 25%
Ethnicity
Asians 37%
Chinese, Filipino, Korean,
Japanese
Non-Asians 63%
Results
Screening Score APIs Non-APIs
SOGS >5 42% 36%
NODS >5 35% 26%
PG Alliance San Jose
Community Survey 2011
• Gender:
– Male-574 (40%),
– Female-828 (57%), N/A 61 (3%)
• Race:
– Vietnamese-374 (27%),
– Filipino-201 (14%),
– Chinese-145 (10%),
Results
• PG Prevalence (%)
• San Jose (Gen Pop)
– At Risk: 6.5
– Problem 2.4
– Pathological 1.4
• San Jose (API)
– At Risk: 6.5
Help Seeking Behaviors & Barriers
(PG Alliance San Jose Community Survey
2011)
• APIs reported > non-APIs
– Very Difficult to talk about
– I Would not discuss my problems
• Barriers to Treatment
– No Money
– Shame
– No idea where to go
Community Awareness
• 84% said PG is an addiction
• 40% had not heard of treatment resources
• Likely sources
– Media
– Friends / Family
– Helpline
APIs and Treatment
Barriers to Treatment
• Underestimation of the extent of the problem
– Lower does not mean zero
• Lack of dependable statistics & research data
– Lack of funding, dedicated resources
• Underutilization of treatment services (delaying
or not seeking treatment)
– shame
– stigma
Barriers to Treatment
• Lack of cultural & language appropriate
treatment programs
• Lack of evidence based practice
• Myth Debunked:
– Treatment retention, duration and outcome
similar for API vs. Non-API
California Gambling Education
and Treatment Services
(CALGETS)
problemgambling.ca.gov
Treatment Options
• Prevention
• Self-help
• Telephone Interventions
– Helpline services
• Office-based treatment
• Group treatment
• Intensive Outpatient
Gambling Helplines
Problem Gambling
Telephone Interventions (PGTI)
• 1-800-GAMBLER
• 1-888-968-7888 (Chinese Languages)
• Free (or no cost)
• Weekly sessions over the phone
• Staffed by trained therapists
• Problem Gamblers and Affected Individuals
• Helpline staff fielded 187 calls for 2015
• 24 / 7
1-888-968-7888
• Dedicated, Asian Language Helpline
• Separate from 1-800-GAMBLER
• Helpline staff fielded 187 calls for 2015
• 24 / 7
• Media sources: #1 referral
– Radio , Print, Internet
• Referred by human ~15%
Gamblers
• 40% male
– married, 36-45 years old, Cantonese-
speaking, and residing in the San Francisco
Bay Area (where helpline is headquartered).
– Gambler callers most often reported strained
family relations and finances as the most
negative impacts to their lives.
Venue for Gambling
• 60% Card Rooms
• 30% Tribal Casinos
• 10% Internet
– What happened to underground gambling?
AI API Callers
• “Affected individual” callers
– female, married, age 26-45, Cantonese-
speaking and calling from the San Francisco
Bay Area or San Gabriel Valley area.
– Affected individuals were most often the friend
or spouse of a problem gambler, or child
Freedom From
Problem Gambling Workbook
Available Languages for WB
Arabic Hmong Russian
Armenian Japanese Samoan
Cambodian Korean Spanish
Chinese Laotian Tagalog
English Lu Mien Thai
Farsi Punjab Vietnamese
Where to Get the Workbook
California Department of
Public Health
Office of Problem Gambling
www.problemgambling.ca.gov
Cultural Issues in Office
Based Treatment
Cultural Issues
• API PG
– redeem losses, peer influence, thrill,
emotional problems, stress and boredom
• (Teo et al. 2007)
– claim that they are winning even when they
are losing a lot of money.
– illusion of control than the Caucasians
• (Loo et al. 2008
Impact of Family on GD
• Familial socialization may have impacted
Chinese gamblers’ familiarity with and
preference for certain forms of gambling
and may have passed on the values and
beliefs about gambling to the next
generation (Loo et al. 2008).
• Second, Chinese families has a strong
Cultural Influences
• Collectivistic (Goodwin and Tang 1996)
mindset leads to strong sense of guilt and
shame because they have brought
disgrace to their families and have let their
families down.
• less likely to seek outside or professional
help than other cultural groups despite
Treatment Principles
Prevention Ideas
• Effective early intervention strategies
much address the culture of acceptance,
in order to reshape social norms and
learned behaviors
– Teaching the odds
– Building up coping skills
– Demystifying gambling as a sport
Prevention Ideas
• Strengthening family and community can
be a powerful tool to help Asian gamblers.
Service providers working with Asian
gamblers often have to act as a liaison,
linking gamblers to other services such as
ESL classes, job training, public benefits
assistance, and financial counseling.
What Clinicians Can Do
• Willing to work with client who are not ready for
total abstinence; need a longer time of
engagement; to start with, cut down use
• Avoid traditional reflective, non-directive
approach
• Focus on external stresses in the early stage,
offer crisis intervention & tangible help
• Respect family secrets and confidentiality
• Accommodate client’s work & family
What Clinicians Can Do
• Proficient in client’s language/dialect,
using interpreter only as last resort
• Avoid extensive questioning, assessment
& evaluation; clarify and explain all
procedures
• Help client develop measurable and
tangible short-term treatment goals
• Receptive to Somatic Approach &
Focus on the Family
• In many Asian traditions, it is natural for
family and community members to help
one another – by lending money for debt
relief, vouching for a loan, etc.
• Asian families may have to get assistance
in setting firm boundaries, avoiding
codependency, and encouraging
Make Treatment Acceptable
• St. Mary’s Center in San Francisco,
framed services in the context of a
teahouse.
• Clients are invited over to “chat over tea”
rather than for “counseling”.
• Services called “improving finances”
Thoughts on GA
• Gamblers Anonymous – a voluntary, 12‐
step support group for gamblers currently
only has one Asian language meeting in‐
the entire state of California.
• Unknown effectiveness and even less
availability
• One-on-one “mentorship” more powerful
Medication Principles
• Target co-occurring disorders
• No data on API-specific responses
• Concepts of medications to impact
behaviors is tough to grasp
• Therapeutic power of the pill
Eastern Treatment Options
• Acupuncture
– Used to be part of residential treatment
programs
– No clear data
• Eastern philosophies of balance,
restoration
– Flushing out negative energy
Fables of Fortune (South Philly)
Innovative Ideas
• Partner with casino buses / tour junkets
• Create more online tools / apps for APIs
• Tie-in with API dining establishments
• Partnerships with churches
• Establish community “warning networks”
• Encourage casinos to play more active
role in outreach
Q and A
Contact Information
Timothy Fong MD
310-825-4845
tfong@mednet.ucla.edu
www.uclagamblingprogram.org

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Dr. Tim Fong

  • 1. Luck and Fate: Cultural, Social and Psychological Characteristics of Asian Gamblers Timothy Fong MD UCLA Gambling Studies Program New Horizons in Responsible Gambling Conference Vancouver, BC February 2017
  • 2. Objectives • Discuss cultural attitudes and risk factors regarding gambling among Asian Americans • Discuss the impact of assimilation and acculturation on gambling behavior and attitudes towards treatment • Identify culturally competent prevention, intervention, and treatment programs for Asian Americans
  • 4. Asian Pacific Islander • A person with origins in any of the original peoples of the Far East, Southeast Asia, South Asia or the Pacific Island
  • 5. Asian American • Asian American Pacific Islander • Asian American • Asian Pacific American • Asian or Pacific Islander – ~5% US Population – ~13% California Asian Canadian ~26% British Columbia
  • 6. Asian Canadian Population • South Asian • Southeast Asian • Chinese • Filipino • Korean • Japanese
  • 7. APIs are Heterogeneous Different languages & dialects Different historical & trauma background Different immigration histories Different living, clothing & customs Different family structure, inter-personal relationships Different cultural values Different substance abuse preferences
  • 9.
  • 10. Stories from California • BJL, a divorced Korean American from Fontana, owed $200,000 in gambling debts in 2006. He killed his 5-year-old daughter and then himself. • TN, the Cambodian doughnut king of California, gambled away his empire and, by 2005, wound up living on the porch of a friend's trailer. • KX, a Hmong father in North Sacramento, argued with his wife over his gambling, shot himself in the head and killed five of his seven children in 1999.
  • 11. California 2005-2016 • 2005 UGSP Founded • 2007 Calls from API Non-Profits, Conference presentations, letters to legislature, meetings, grass-roots events • 2007 First grants to examine API Gambling • 2009 CALGETS begins operations
  • 12. Gambling Expansion in Asia • Macau: No. 1 gaming market since 2006 • Singapore: Dropped its gambling ban Opened Integrated Resorts 2009 • South Korea: >17 casinos; • Taiwan and Japan: Considering allowing casinos. • The Philippines: Manila Bay
  • 13. One Chinese proverb demonstrates the culture’s acceptance of gambling, at the same time signaling a warning to those who overindulge: “A little gambling is soothing and relaxing; heavy gambling could affect
  • 14. Asian Culture and Gambling • Gambling has been a part of society from the early Asian history (3,000 B.C.) • Gambling as a part of social/family life • New Year’s celebration and funerals •
  • 15. Cultural factors that promote gambling –Acceptable way to make money –Inquire about one’s destiny –“Honoring the Gods” •Losses are sacrifice –Equate gambling with self-worth
  • 16. Cultural factors that promote gambling – Emphasis on numbers that have power over life events – Heavy peer involvement – Gambling is family entertainment – Gambling as a rite of passage – Superstitions
  • 17. Perceptions about Gambling Chinese Western Make money Entertainment An investment A harmless activity Involves risk Limited sense of risk
  • 18. Nancy Petry Study 2002 • Study on 96 Cambodian, Laotian and Vietnamese refugees –59% identified as pathological gamblers. (1.5% California rate) –95 % reported gambling in the previous year, and 93% reported gambling in the previous two
  • 19. California Prevalence Study (2006) • Asians (504) – Low response rate (47% overall, less APIs) – 7% of survey sample – Mostly English (1% translated) – Problem Gambling: 2.3% – Pathological Gambling 0.7%
  • 20. Genes or Environment or Something Else • When national prevalence rates were examined in countries such as Taiwan, Hong Kong, and Korea, it was found that the rates of problem and pathological gambling were consistent from those found in European and New World countries (Taiwan – 5%, Hong Kong – 1.5%, and Korea – 1%).
  • 21. Immigration? • Asian immigrants in western countries often yield much higher rates of problems. – Montreal Chinese 5% – Calgary, 8% – Sydney, 8%.
  • 22. Why Immigration? • “Personality traits that make them greater risk takers. Immigration for most involves taking some risks . . Therefore. . .” • To date there is no conclusive data to show that Asian immigrants as a whole exhibit personality traits that are correlated to problem gambling.
  • 23. Immigration • The experience of immigration – including any experience of trauma and subsequent stresses of adaptation contribute to greater likelihood of problem gambling. – Loss – Loneliness / isolation – Status seeking
  • 24. What about the gaming industry? • Gambling establishments frequently shuttle potential patrons from communities with large Asian populations (Chinatown, Koreatown, etc.) to their facilities. • Bilingual staff in order to increase comfort and ease of their Asian patrons. • Targeted events, lounges, facilities, offers
  • 25. Prevalence of Asian Gambling in Casinos
  • 26. Results Gender N=180 Male 75% Females 25% Ethnicity Asians 37% Chinese, Filipino, Korean, Japanese Non-Asians 63%
  • 27. Results Screening Score APIs Non-APIs SOGS >5 42% 36% NODS >5 35% 26%
  • 28. PG Alliance San Jose Community Survey 2011 • Gender: – Male-574 (40%), – Female-828 (57%), N/A 61 (3%) • Race: – Vietnamese-374 (27%), – Filipino-201 (14%), – Chinese-145 (10%),
  • 29. Results • PG Prevalence (%) • San Jose (Gen Pop) – At Risk: 6.5 – Problem 2.4 – Pathological 1.4 • San Jose (API) – At Risk: 6.5
  • 30. Help Seeking Behaviors & Barriers (PG Alliance San Jose Community Survey 2011) • APIs reported > non-APIs – Very Difficult to talk about – I Would not discuss my problems • Barriers to Treatment – No Money – Shame – No idea where to go
  • 31. Community Awareness • 84% said PG is an addiction • 40% had not heard of treatment resources • Likely sources – Media – Friends / Family – Helpline
  • 33. Barriers to Treatment • Underestimation of the extent of the problem – Lower does not mean zero • Lack of dependable statistics & research data – Lack of funding, dedicated resources • Underutilization of treatment services (delaying or not seeking treatment) – shame – stigma
  • 34. Barriers to Treatment • Lack of cultural & language appropriate treatment programs • Lack of evidence based practice • Myth Debunked: – Treatment retention, duration and outcome similar for API vs. Non-API
  • 35. California Gambling Education and Treatment Services (CALGETS) problemgambling.ca.gov
  • 36. Treatment Options • Prevention • Self-help • Telephone Interventions – Helpline services • Office-based treatment • Group treatment • Intensive Outpatient
  • 38. Problem Gambling Telephone Interventions (PGTI) • 1-800-GAMBLER • 1-888-968-7888 (Chinese Languages) • Free (or no cost) • Weekly sessions over the phone • Staffed by trained therapists • Problem Gamblers and Affected Individuals • Helpline staff fielded 187 calls for 2015 • 24 / 7
  • 39. 1-888-968-7888 • Dedicated, Asian Language Helpline • Separate from 1-800-GAMBLER • Helpline staff fielded 187 calls for 2015 • 24 / 7 • Media sources: #1 referral – Radio , Print, Internet • Referred by human ~15%
  • 40. Gamblers • 40% male – married, 36-45 years old, Cantonese- speaking, and residing in the San Francisco Bay Area (where helpline is headquartered). – Gambler callers most often reported strained family relations and finances as the most negative impacts to their lives.
  • 41. Venue for Gambling • 60% Card Rooms • 30% Tribal Casinos • 10% Internet – What happened to underground gambling?
  • 42. AI API Callers • “Affected individual” callers – female, married, age 26-45, Cantonese- speaking and calling from the San Francisco Bay Area or San Gabriel Valley area. – Affected individuals were most often the friend or spouse of a problem gambler, or child
  • 44. Available Languages for WB Arabic Hmong Russian Armenian Japanese Samoan Cambodian Korean Spanish Chinese Laotian Tagalog English Lu Mien Thai Farsi Punjab Vietnamese
  • 45. Where to Get the Workbook California Department of Public Health Office of Problem Gambling www.problemgambling.ca.gov
  • 46. Cultural Issues in Office Based Treatment
  • 47. Cultural Issues • API PG – redeem losses, peer influence, thrill, emotional problems, stress and boredom • (Teo et al. 2007) – claim that they are winning even when they are losing a lot of money. – illusion of control than the Caucasians • (Loo et al. 2008
  • 48. Impact of Family on GD • Familial socialization may have impacted Chinese gamblers’ familiarity with and preference for certain forms of gambling and may have passed on the values and beliefs about gambling to the next generation (Loo et al. 2008). • Second, Chinese families has a strong
  • 49. Cultural Influences • Collectivistic (Goodwin and Tang 1996) mindset leads to strong sense of guilt and shame because they have brought disgrace to their families and have let their families down. • less likely to seek outside or professional help than other cultural groups despite
  • 51. Prevention Ideas • Effective early intervention strategies much address the culture of acceptance, in order to reshape social norms and learned behaviors – Teaching the odds – Building up coping skills – Demystifying gambling as a sport
  • 52. Prevention Ideas • Strengthening family and community can be a powerful tool to help Asian gamblers. Service providers working with Asian gamblers often have to act as a liaison, linking gamblers to other services such as ESL classes, job training, public benefits assistance, and financial counseling.
  • 53. What Clinicians Can Do • Willing to work with client who are not ready for total abstinence; need a longer time of engagement; to start with, cut down use • Avoid traditional reflective, non-directive approach • Focus on external stresses in the early stage, offer crisis intervention & tangible help • Respect family secrets and confidentiality • Accommodate client’s work & family
  • 54. What Clinicians Can Do • Proficient in client’s language/dialect, using interpreter only as last resort • Avoid extensive questioning, assessment & evaluation; clarify and explain all procedures • Help client develop measurable and tangible short-term treatment goals • Receptive to Somatic Approach &
  • 55. Focus on the Family • In many Asian traditions, it is natural for family and community members to help one another – by lending money for debt relief, vouching for a loan, etc. • Asian families may have to get assistance in setting firm boundaries, avoiding codependency, and encouraging
  • 56. Make Treatment Acceptable • St. Mary’s Center in San Francisco, framed services in the context of a teahouse. • Clients are invited over to “chat over tea” rather than for “counseling”. • Services called “improving finances”
  • 57. Thoughts on GA • Gamblers Anonymous – a voluntary, 12‐ step support group for gamblers currently only has one Asian language meeting in‐ the entire state of California. • Unknown effectiveness and even less availability • One-on-one “mentorship” more powerful
  • 58. Medication Principles • Target co-occurring disorders • No data on API-specific responses • Concepts of medications to impact behaviors is tough to grasp • Therapeutic power of the pill
  • 59. Eastern Treatment Options • Acupuncture – Used to be part of residential treatment programs – No clear data • Eastern philosophies of balance, restoration – Flushing out negative energy
  • 60. Fables of Fortune (South Philly)
  • 61. Innovative Ideas • Partner with casino buses / tour junkets • Create more online tools / apps for APIs • Tie-in with API dining establishments • Partnerships with churches • Establish community “warning networks” • Encourage casinos to play more active role in outreach
  • 63. Contact Information Timothy Fong MD 310-825-4845 tfong@mednet.ucla.edu www.uclagamblingprogram.org