A Phenomenological Study of Problem Gambling: Types, Risk Factors, and Consequences.

Mehari, Getahun

dc.contributor.author	Mehari, Getahun
dc.date.accessioned	2018-01-15T04:26:22Z
dc.date.available	2018-01-15T04:26:22Z
dc.date.issued	2018-01-14
dc.identifier.uri	http://hdl.handle.net/123456789/8483
dc.description.abstract	i A Phenomenological Study of Problem Gambling: Types, Risk Factors, and Consequences. M.A Thesis By: Mehari Getahun A Thesis Submitted to the Department of Psychology, College of Educational and Behavioral Sciences Presented in Partial Fulfillment of the Requirements for the Degree of Master of Arts in Social Psychology Bahir Dar University Bahir Dar, Ethiopia May, 2017 APPROVAL SHEET This is to certify that the thesis prepared by Mehari Getahun, entitled A Phenomenological Study of Problem Gambling: Types, Risk Factors, and Consequences in Bahir Dar City submitted in partial fulfillment of the requirements for the Degree of Master of Arts in social psychology complies with the regulations of the University and meets the accepted standards with respect to originality and quality. Signed by the Examining Committee: Examiner (External) ____________________Signature __________ Date _________ Examiner (Internal) ____________________Signature __________ Date _________ Advisor ______________________________Signature___________Date ________ ____________________________________________ Chair of Department or Graduate Program Coordinator i ACKNOWLEDGMENTS My heartfelt gratitude goes to my entire family, my mother Kassaye Mullu and my sister Hiwot Getahun for taking care of the entire household and for your continuous support during that challenging time. My special thanks go to my advisor Mr. Koye Kassa, for his continuous and thoughtful guidance throughout the preparation of this thesis My gratitude extends to my darling brothers Gizew Layew, and Gizachew Getu. Thank you so much for your significant contribution in the entire data collection process which without your guidance I wouldn‘t be able to find the research sites. Thank you all for making this possible. ii iii LIST OF ACRONYMS OR ABBREVIATIONS APA American Psychological Association BGPS British Gaming Prevalence Survey CSA Central Statistics Agency IPA Interpretive and Thematic Phenomenological Analysis NGB National Gambling Board NGISCR National Gambling Impact Survey Commission Report NORC National Opinion Research Center SHORE Social and Health Outcomes Research and Evaluation VCGA Victorian Casino and Gambling Authority TABLE OF CONTENTS ACKNOWLEDGMENTS ...................................................................................................................... ii LIST OF ACRONYMS OR ABBREVIATIONS ............................................................................................... iii TABLE OF CONTENTS ........................................................................................................................ ii LIST OF TABLES ................................................................................................................................. iv LIST OF FIGURES ...................................................................................................................................... v ABSTRACT ............................................................................................................................................... vi CHAPTER ONE: INTRODUCTION ..................................................................................................... 1 1.1. Background of the Study ......................................................................................................... 1 1.2. Statement of the Problem ........................................................................................................ 4 1.3. Research Questions ................................................................................................................. 6 1.4. Objectives of the Study ........................................................................................................... 6 1.4.1. General objective ............................................................................................................ 6 1.4.2. Specific objectives .......................................................................................................... 6 1.5. Significance of the Study ........................................................................................................ 6 1.6. Delimitation of the Study ........................................................................................................ 7 CHAPTER TWO: REVIEW OF RELATED LITERATURES .............................................................. 8 2.1. Understanding Problem Gambling .......................................................................................... 8 2.2. Major Gambling Categories .................................................................................................... 9 2.2.1. What are the most harmful types of gambling? ............................................................ 10 2.3. Who Gambles ........................................................................................................................ 10 2.3.1. Gambling Participation by age ...................................................................................... 10 2.3.2. Gambling participation by population group ................................................................ 11 2.4. Major Theoretical Approaches to Understanding Problem Gambling.................................. 12 2.4.1. Addiction Model ........................................................................................................... 12 2.4.2. Learning theory ............................................................................................................. 13 2.4.3. Cognitive models .......................................................................................................... 13 2.4.4. Integrative Model .......................................................................................................... 14 2.5. Impacts of Gambling ............................................................................................................. 19 2.5.1. Personal health .............................................................................................................. 19 2.5.2. Interpersonal relationships ............................................................................................ 19 2.5.3. Financial problems ........................................................................................................ 20 2.5.4. Employment problems .................................................................................................. 20 2.5.5. Legal problems .............................................................................................................. 21 ii CHAPTER THREE: RESEARCH DESIGN AND METHODOLOGY .............................................. 23 3.1. Research Design .................................................................................................................... 23 3.2. Sample and Participants ........................................................................................................ 23 3.3. Data Gathering Tool ............................................................................................................. 23 3.4. Data Collection Procedure .................................................................................................... 24 3.5. Method of Data Analysis ...................................................................................................... 24 3.6. Ethical Consideration ............................................................................................................ 25 CHAPTER FOUR: FINDINGSAND DISCUSSIONS ...................................................................................... 26 4.1. Demographic Characteristics of Participants ........................................................................... 26 4.2. Types of Problematic Gambling Practices ............................................................................. 27 4.3. Risk factors/ Causes for problematic gambling behavior ..................................................... 28 4.3.1. Personal factors ............................................................................................................ 28 4.3.2. Social factors ................................................................................................................. 31 4.3.3. Economic factors........................................................................................................... 33 4.3.4. Environmental ............................................................................................................... 34 4.4. Consequences of Gambling Behavior ................................................................................... 34 4.4.1. Personal impact ............................................................................................................. 35 4.4.2. Social Impact ................................................................................................................ 36 4.4.3. Economic (Financial) impact ......................................................................................... 41 CHAPTER FIVE: SUMMARY, CONCLUSSION, AND RECOMMENDATION ............................................... 42 5.1. Summary .................................................................................................................................... 42 5.2. Conclusion .................................................................................................................................. 43 5.3. Recommendations ..................................................................................................................... 43 REFERENCES .......................................................................................................................................... 45 APPENDIX .............................................................................................................................................. 51 iii LIST OF TABLES Table 1. Participation in gambling by gambling mode and population group ...................................... 11 Table 2. Participant characteristics and problematic gambling forms .................................................. 26 iv LIST OF FIGURES Figure 1. Integrated model of problem gambling, Pathway 1. Source: Blaszczynski&Nower, 2002. . 16 Figure 2. Integrated model of problem gambling, Pathway 2. Source: Blaszczynski&Nower, 2002. . 17 Figure 3. Integrated model of problem gambling, Pathway 3. Source: Blaszczynski&Nower, 2002. . 18 v vi ABSTRACT This study was a qualitative phenomenological study that explored the types of gambling activities, personal, social and environmental risk factors and consequences of problematic gambling in selected kebeles of Bahir Dar city, Ethiopia. Six participants were sampled using snow ball sampling method. Data was analyzed by interpretative and thematic phenomenological analysis. Among the identified types of gambling activities, the most common ones were carambolla followed by playing cards and pool gambling while playing cards was the most harmful reported gambling activity. Results from the study showed that personal factors (socializing and relieving boredom, to escape, and addictive behaviors), social factors (peer influence, relationship problems, and social acceptance), economic (being unemployed and chasing) and environmental factors predominantly accessibility of gabling houses were the major reported risk factors of problematic gambling. The study also revealed that problem gambling has an impact on personal (health and emotional wellness), social (family, interpersonal relations, work and crime) and economic (indebtedness, losing savings and assets) aspects. The study concluded that the problem needs critical public awareness, research and initiatives from different institutions. Finally the study recommended different stakeholders to work cooperatively and collaboratively in order to raise public awareness, promote informed choice, research and take legal measures. Keywords: Types Risk Factors, Consequences, Gambling, Problematic Gambling CHAPTER ONE: INTRODUCTION 1.1. Background of the Study According to the National Research Council (1999), gambling can be defined as betting money on games of chance. The UK Gambling Act 2005 describes it more specifically in terms of gaming (i.e. playing a game of chance for a prize); betting and participating in a lottery. It usually involves risk taking and in some cases requires particular knowledge or skills. There is considerable debate over the nature and cause of problem gambling. This is understood by Wong (2009), Lesieur and Rosenthal (1991) as to involve an uncontrollable urge to gamble, such that the persons involved cause significant harm to themselves and to others. In the latest British Gambling Prevalence Survey (BGPS 2007, p.72), problem gambling is defined as ―gambling to a degree that compromises, disrupts or damages family, personal or recreational pursuits. Whereas American Psychological Association (APA, 1994) defines problem gambling as ‗persistent and recurrent maladaptive gambling behavior is characterized by an inability to control gambling, leading to significant deleterious psychosocial consequences: personal, familial, financial, professional and legal. According to the Australian Medical Association (1998), approximately 0.5 percent of the adult Australian population has a severe gambling problem, while another 0.6 percent are described as ―at risk‖ for gambling problems. Based on criteria developed by the American Psychiatric Association, the National Opinion Research Center (NORC) (1999) estimated that approximately 2.5 million adults (0.8 percent) are pathological gamblers and 3 million adults (1.3 percent) are problem gamblers in United States. Gambling is generally divided into three categories: (1) Wagering and betting, placing a bet or wager on the outcome of an event such as a sporting event or race; (2) Gaming, which involves placing bets on games that are constrained by mathematically pre-determined rules and theoretical returns of players (gaming machines and casino table games); and (3) Lottery style games, including Cross-Lotto, Powerball, Pools, scratch tickets and Keno, all of which award prizes based on the selection of winning symbol or number combinations (Rickwood, Blaszczynski, Delfabbro, and Dowling, 2010). 1 The Scottish center for social research (2006) found that, certain features of games are strongly associated with problem gambling. These include games that have a high event frequency (i.e. that are fast and allow for continual staking), that involve an element of skill or perceived skill, and that create ‗near misses‘ (i.e. the illusion of having almost won). Size of jackpot and stakes, probability of winning (or perceived probability of winning), and the possibility of using credit to play are also associated with higher levels of problematic play. Games that meet these criteria are electronic gaming machines and casino table games. According to Derevensky(2004),problematic gambling is governed by a complex set of interrelated factors, causes and determinants ranging from biology and family history to social norms and existing statutes encompassing ecological, psycho-physiological, developmental, cognitive, and behavioral components. Among the personal (psychological) risk factors, Tang and Oei (2011) reported that life stress was being associated with erroneous gambling cognition, while Dickson (2008) revealed that trait anxiety, risk propensity and ineffective coping were found to be positively correlated with gambling problems. Gillespie (2007) also reported that problematic and pathological gamblers engage in gambling to escape problems, to alleviate depression, to cope with loneliness, to relax, and to interact socially with others. At the social level, Carlson and Moore (1998) found problematic gambling to be associated with familial and community factors such as family gambling history, and lax or laissez-faire social regulation on gambling. Clarke (2007a) argues, like substance abuse, gambling is initiated, normalized and reinforced by family and peers. Clarke (2005, 2007b) further argues, Low socioeconomic status has also been found to be a key indicator in the transition from social to problem gambling. This is supported by research showing urges or beliefs that gambling can provide big financial rewards, and solves money problems were more likely in individuals with a low socioeconomic status. Dervensky and Gupta, (1998) also relate disruptions of relationships with family, peers and family gambling history to the problem. Another study by Clarke, Tse, Abbott, Townsend, Kingi, & Manaia, (2007a) suggests that problem and non-problem gamblers have similar motivations to gamble but the motivational strength differs for problem gamblers. In particular, winning money (chasing losses) and relieving tension, stress and emotional distress are implicated in promoting continued gambling. 2 According to the ministry of health in New Zealand, (2008) the vast majority of problem gamblers are in touch with health professionals and the evidence is clear that they tend to suffer from a range of co-morbidities such as hazardous drinking, cigarette smoking and suicidality. Studies have shown there are strong relationships between risky gambling and both hazardous alcohol use and smoking. It also shows a clear positive relationship between problem gambling level (none, low risk, moderate risk/problem) and measure of psychological distress. In addition, the level of gambling risk is associated with decreases in self-rated health across numerous domains. In addition to this, Bellringer and Abbott (2009) identified a range of crimes in New Zealand. These included financial, benefit/social security, physical, family, community, workplace, directly related to gambling and legal but undesirable behaviors like prostitution. Moreover legalization of gambling can give rise to different social problems. Other studies by Rule and Sibanyoni(2000) reported that the legalization of the gambling industry in South Africa was associated with increases in societal problems among which prostitution, theft, rape, robbery, and assault. According to a report of Nzimande, Louw, and Mannya (2010), in their overview of gambling literatures indicated that the prevalence of problematic gambling in South Africa fluctuated between 4.2 and 6.8 % from 2001 to 2005.Overall; the three most popular forms of gambling are casino gambling, the lotto and scratch cards, irrespective of race or income group. It would appear that levels of participation correlate closely with income. Persons in lower income groups are less likely to gamble than persons in higher income groups, with 71% of the lowest income cluster abstaining from gambling, while 58% and 65% in the two highest income clusters do not participate in gambling at all. In the context of Ethiopia, Tariku, Robert, Ruiter and Tamirie (2013) have conducted a crosssectional study on personal, social and environmental risk factors of problematic gambling among high school adolescents in Addis Ababa, Ethiopia. Their cross-sectional survey showed that personal feelings (e.g., self-esteem, false perceptions about winning, drug abuse), social factors (e.g., peer influence, parental gambling), and environmental factors (e.g., accessibility of gambling venues, advertisements) were significant correlates of problematic gambling. The study also revealed that men were more at risk for severe problematic gambling than females. Among the identified types of gambling activities, the most prevalent ones were playing cards followed by flipping coin and pool gambling while internet gambling was among the least reported gambling activities. 3 1.2. Statement of the Problem After analyzing many literatures related with social and economic costs of gambling, Williams and Rehm (2011) conclude that there are both monetary and social/nonmonetary costs associated with problem gambling. The monetary costs include money spent on a) treatment and prevention; b) policing, prosecution, incarceration, and probation for gamblingrelated crime; c) child welfare involvement for gambling-related family problems; and d) unemployment and welfare payments and lost productivity because of gambling-related work problems. However, because only the minority of problem gamblers seek or receive treatment, and only a minority typically have police/child welfare/employment involvement, the bulk of the impacts tend to be social/nonmonetary in nature. The study by Ciarrocchi & Reinert, (1993); Dowling (2009) found that the family environments of people with gambling problems are characterized by high levels of anger and conflict as well as low levels of clear and effective communication, less independence, less engagement in intellectual and cultural activities, a lack of commitment and support, little direct expression of feelings, and less participation in social and recreational activities. Dowling (2009) further argued that these family environments are comparable to those of people with drinking problems. Moreover, Darbyshire, Oster, & Carrig (2001) commented on the children of people with gambling problems are exposed to a range of family stressors, including financial and emotional deprivation, physical isolation, inconsistent discipline, parental neglect/abuse and rejection, poor role modeling, family conflict, and reduced security and stability. The children of problem gambling parents are also at risk of developing gambling problems themselves. The findings across four independent studies exploring the intergenerational and familial transmission of gambling by Dowling, Jackson, Thomas, & Frydenberg, (2010) revealed that people who had a parent or sibling with a gambling problem were two to ten times more likely to experience gambling problems than people without a parent or sibling with a gambling problem. The National Prevalence Study (2010a, p.2) found that whilst 7% of the sample gambles only in legal casinos, a full 13% gambled only in informal venues. This is especially stark in the East Rand, South Africa where 3% of the sample gambles in casinos as compared to 17% in informal gambling venues that points to the growing significance of informal (and hence 4 illegal) gambling in South Africa, which has an especially pernicious impact on problem gambling behavior. The criminal code of the federal democratic republic of Ethiopia article 789. - Violation of Provisions Regarding Lotteries, Gambling and Betting states that gambling activity without having obtained an authorization from the competent authority is illegal. Despite of the above stated proclamation with respect to the context of Ethiopia, gambling is not technically illegal. Regarding this issue, Tariku, Robert, Ruiter and Tamirie (2013) described the situation as the following: ―In the streets of the capital city Addis Ababa, there are plenty of gambling activities played for money with state-owned lotteries, play stations, pool houses, and table football being the most prevalent ones‖ (p. 62).In their conclusion, they indicated that the risk factors found in the study are culture specific such as life styles and care should be taken in generalizing the results outside the study area. They also suggested that the study should be replicable in other settings and populations. Borrell (2005, 2008) also comments on the need to connect individual experiences and daily realities with analysis of the socialcollective situation in which they occur –through the medium of a broad concept of culture. Until the researcher‘s knowledge, the study by Tariku, Robert, Ruiter andTamirie (2013) is the only one study conducted in the Ethiopian context and this study does not consider the psycho social impact of gambling practices on adults. In addition we can‘t certainly take those findings to other part of regions in Ethiopia because of the above mentioned age and cultural factors. In the city of Bahir Dar, the researcher has observed that the form of gambling and the environment in which it is conducted is conducive to social interaction and this adds substantially to its inherent enjoyment. Within these contexts, gamblers can readily meet, interact socially, and test their luck and skill in pleasant and safe surroundings leading to enhanced social integration and stimulation, self-esteem, and a positive sense of recreation/leisure without considering its harm. Hotel, club, carambolla, pool, cards and oncourse venues are recreational locations by which many adults devote their time. There is a lack of adequate data on the lived experience of problematic gambling behavior in Ethiopia. The present study will try to assess the types, pushing factors and consequences of problematic gamblers in Bahir Dar city, Ethiopia from their own life experience. 5 1.3. Research Questions [ In order to have a clear understanding of the phenomena the researcher brings the following research questions; 1. Which type of problematic gambling practices is/are common in Bahir Dar? 2. What are the risk factors for problematic gambling behavior? 3. What are the impacts of problem gambling on gamblers bio-psychosocial wellness? 1.4. Objectives of the Study 1.4.1. General objective To this end the overall objective of this study is to gain a comprehensive understanding on different forms of gambling activities as well as the risk factors, its impact on bio psycho social wellness of gamblers and their involvement on risk taking behaviors due to their gambling problem. 1.4.2. Specific objectives The specific objectives of this study are to:  Identify in which type of gambling practices problematic gamblers are engaging.  Explore the possible risk factors for problematic gambling behavior.  Reveal the impacts of problem gambling on gamblers bio-psychosocial wellness. 1.5. Significance of the Study The results of the study may help various stakeholders such as local and international NGO‘s, social psychologists, and social workers in public education campaigns and increasing community contact with people with gambling problems. Public health approaches do not require abstinence from gambling, but promote consumers‘ informed choice. Thus, the results of this study may be used by those stake holders as a potent source for informed choice of the public by informing the various negative multi-facets of problematic gambling. The output of this study and the recommendations to be drawn particularly will have multiple benefits either directly or indirectly in fostering the philosophy of Bahir Dar University, which aims at strengthening bond between the university and the community. This study may contribute to the understanding of important variables of problematic gambling in Ethiopia. This might be taken us a pioneering work and may provide a core list of possible intervention targets by identifying relevant correlates of problematic gambling. By doing so, it may provide invaluable information for the systematic design and evaluation of evidence-based 6 educational interventions to prevent problematic gambling in Ethiopia in the feature. Accordingly this condition pave ways for the university to take part in intervening problems pined by the study. It is plausible to think that such problem gamblers will respond well to education of various sorts: about the way gambling works, the nature of odds, the truth about luck etc. The study might help as a stepping stone for those experts who want to carry out further investigation in similar arena or for those who want to design and implement intervention action. This study can be also taken as an introductory about the various aspects of the problem gambling in the selected study area. The results of the study can inform policy and decision makers to enact further considerations of the gambling problem such as development of legal frameworks and necessary restrictions on the gambling activities of the selected area. 1.6. Delimitation of the Study This study is concerned on types, inter and intra-personal consequences, responsible factors, as well as associated risky behaviors of problem gambling in Bahir Dar city, Ethiopia. The study is conducted in kebeles of 4, 6 and 12 sites of gambling houses in Bahir Dar city, Ethiopia. The study focuses on mid adult population because these groups are believed to be holding many social responsibilities of managing their family, participating in community, and working in and leading organizations and are also models for adolescents. In the eyes of the researcher this groups are special in many ways, thus targeting those groups can enable the research to broaden his outlook of the problem and yield in-depth information of the phenomena. The study is not concerned with the socio-economic and cost-benefit analysis of the gambling industry at the macro level in Bahir Dar city, Ethiopia and the perception (the moral judgment) of the public towards gambling practice and for those who have a problem with gambling. In addition to this, this study is not targeted to show the prevalence rate of problem gambling in the study area. The study is a cross-sectional qualitative research. 7 CHAPTER TWO: REVIEW OF RELATED LITERATURES In this chapter various literatures written by different authorities on the subject are reviewed and summarized. This review includes conception of problem gambling by different writers, models to understand major types of gambling activities, the etiology of problem gambling, and its interpersonal impact. 2.1. Understanding Problem Gambling Historically, the terms ‗compulsive gambler‘ and ‗pathological gambler‘ have been used interchangeably to denote individuals who report uncontrollable urges to gamble. More recently, alternative terms have been employed: ‗problem‘, ‗at-risk‘, ‗in-transition‘, ‗disordered‘, ‗excessive‘ and ‗Level 2‘ gamblers. Each utilizes different criteria and classification schemes. For example, Abbott, Palmisano & Dickerson (1995) classify gamblers as either ‗excessive‘ or ‗normal‘, based on amount of time, expenditure and number of trips to gambling venues. In contrast, Winters, Stinchfield & Fulkerson (1993) employed a complicated classification scheme based on symptom count and frequency of gambling. Others likeGupta&Derevensky1998b use symptom count alone and differing categories a ssocial/problem/pathological and Shaffer (1994) (non-pathological/in-transition/ pathological); Vitaro, Arseneault & Tremblay, 1997 (recreational/low problem/high problem). The Victorian Casino & Gaming Authority (VCGA) 1997) argued that the presence of harm rather than symptom count should be used to define problem gambling. This position is exemplified by the VCGA‘s consensus definition: ‗―Problem gambling‖ refers to the situation when a gambling activity gives rise to harm to the individual player, and/or to his or her family, and may extend into the community‘ (VCGA 1997; p. 106), and by the definition advanced by Ferris(1998): ‗Problem gambling is excessive gambling behavior that creates negative consequences for the gambler, others in his/her social network, and for the community‘ (p. 58). 8 Blaszczynski & Nower (2006), define gambling problem and try to distinguish it from problem gambling as ‗problem gambling may be defined as a friction or difficulty in any area of functioning that result from some element of gambling behavior. Typically, gambling problems may arise as a result of differences of opinion regarding amounts potentially risked or time spent away from home/family in the absence of any excessive financial losses relative to disposable income, preoccupation with gambling absent impaired control or other adverse consequences. In contrast, the defining feature of a problem gambler is not only the emergence of negative consequences but also the presence of a subjective sense of impaired control, construed as a disordered or diseased state that deviates from normal, healthy behavior. Impaired behavioral control defined by repeated, unsuccessful attempts to resist the urge in the context of a genuine desire to cease, is the central, diagnostic and foundational feature of pathological gambling‘ (p. 488). 2.2. Major Gambling Categories Table 1. Description of major gambling categories Game Category Card games Unregulated Restaurant casinos Casino Slot machines EGMs Bingo Bingo Football pools Sport pools Horse races Horse betting Fast lotteries Instant lotteries National lotteries Lotteries Bingo-Loto Lotteries Local lotteries Lotteries Data from Swedish prevalence study, Rönnberg, et al.(1999). The forms of gambling appearing in the table from the prevalence survey were often well- known categories, such as EGMs, bingo, and sports betting. The prevalence study further describes each category as follows:  Bingo—bingo in a bingo parlor  Casino—in some studies, casino gambling includes slot machines and EGMs in casinos, sometimes these are excluded  EGMs—includes traditional slot machines and all other devices that resemble slot machines 9  Horse betting—includes betting on dog races  Instant lotteries  Internet gambling—all kinds of Internet gambling; data in the studies appear primarily to concern Internet poker, casino, and sports betting  Lotteries—national and local lotteries; lotto, keno, and other number games  Sports pools—usually football pools; in some studies, football pools are included in sports betting  Sports betting—some studies include sports pools in sports betting, while others list sports pools separately  Unregulated gambling—this broad category includes card games and betting with friends, illegal gambling at clubs, and betting with non-licensed bookmakers, as well as all other gambling, legal or illegal, in private and without the supervision of authorities  A game typical to Ethiopia is Carambolla. Carambolla is very closely similar with the Italian game of Bocette (http://billiardtraveler.blogspot.com/201110/billiards-inhottest-inhabited-village.html) 2.2.1. What are the most harmful types of gambling? Eighteen national prevalence surveys of problem gambling, most of them from Europe, were analyzed by Center for Public Research Center (2011) to assess the relative harmfulness of various forms of gambling. It was found that interactive Internet gambling, casino gambling, electronic gaming machines, and high-stakes unregulated/illegal gambling are often relatively closely associated with problem gambling, while lotteries and instant lotteries appear relatively harmless. Other forms of gambling (sports pools, bingo, horse betting, and sports betting) are typically relatively moderately associated with problem gambling. 2.3. Who Gambles 2.3.1. Gambling Participation by age The average time of first gambling experience has been reported by Jacobs, (2004) as twelve years of age, an age considerably younger the first use of alcohol, tobacco or other drugs. Initiation of gambling in youth has been associated with an increased likelihood of a substance use problem to begin during young adulthood (Lynch, Maciejewski, Potenza, 2004). Further study by Winters, Stinchfield, Botzet, (2002) pointed that age of onset has been suggested to predict more severe problems later in life. 10 2.3.2. Gambling participation by population group The table below is taken from the 2009 NGB survey of gambling behavior, and shows the propensity to gamble by population group and mode. The African population group is the most active in gambling activities followed by Whites, Asians, and Coloureds. Table 2.Participation in gambling by gambling mode and population group [ The participation in the different gambling modes indicates the following: Coloureds showed the lowest propensity to gamble on the lotto (17.1%), while Africans were the most active participants (31.7%). Casino gambling is the most popular among Whites (11.5%) and Asians (8.5%) and the least popular among Africans (5.6%) and Coloureds (3.7%). Among other things, these figures indicate the relative affluence of players. Africans (1.3%) and Asians (1.3%) were the most active at horse betting, while Africans (2.1%) and Coloureds (1.0%) were fairly active sports betting participants. Scratch cards were the most popular among Africans (7.8%) and Asians (5.3%) while this mode attracted only (1.3%) of the White population. Fahfee and dice were played predominantly by Africans (3.3%) and Coloureds (1.6%) while it was totally absent among Asians and Whites. The data shows that Africans and Coloureds, representing the highest percentage of low-income people, are 11 primarily affected by the lottery, scratch cards, horse racing, fahfee, dice and gaming competitions (usually illegal lotteries). Thus, low cost gambling forms are most prevalent among poorer population groups. Overall, however, the three most popular forms of gambling are casino gambling, the lotto and scratch cards, irrespective of race. 2.4. Major Theoretical Approaches to Understanding Problem Gambling Currently, there is no widely accepted causal explanation or single theoretical model that adequately accounts for why individuals develop a gambling problem. Here are some of the more common models of gambling. 2.4.1. Addiction Model As it is defined by American Psychiatric Association, (2000) the term addiction was restricted to the recurrent use of external drugs characterized by the presence of excessive preoccupations, cravings, overwhelming compulsive urges to consume the substance, negative consequences associated with its use, withdrawal following cessation and tolerance—features of neuro-adaptation. The above understanding to the term addiction is being challenged in the contemporary perspective. The definition of this term is now come to broadened and includes a non- substance behavioral addictions including gambling (Holden, 2001). Thus addiction model proposes that problem gamblers are addicted to gambling just like individuals with a drug and alcohol addiction. According to this model gamblers are thought to experience tolerance (the need to bet more and more in order to obtain the same excitement), cravings (a strong physiological desire to gamble), and also withdrawal symptoms (anxiety, physiological symptoms) if they do not gamble (Tamminga & Nestler, 2006). Contributing to this model is data suggesting that problem gamblers also have high rates of substance use and alcohol dependence, which has led to the common perception that gamblers are prone to addiction. Scholars try to justify this by using epidemiological survey data and clinical studies describing high rates of comorbidity between pathological gambling and substance abuse, Similarities in neurobiological activity and genetic abnormalities found among gamblers and those who are substance dependent involving cortico-meso-limbic brain 12 structures suggest common molecular pathways (Goudriaan, Oosterlaan, de Beurs, & Van den Brink, 2004). 2.4.2. Learning theory Anderson & Brown, 1984; Dickerson, 1979; McConaghy, 1980, describe gambling as a behavior governed by contingencies of reinforcement operating under operant and classical conditioning paradigms. Both positive and negative reinforcement increase the probability of a gambling response being elicited and explain persistence in gambling. Skinner (1953) proposed that problem gambling is a function of previous reinforcement history. Support for this comes from the fact that problem gamblers often had enjoyed a big win the first time they gambled. Empirical evidence suggests that the schedule of reinforcement is also a crucial factor. For example, Ch´oliz (2010) demonstrated that the perseverance of problem gamblers depends on the immediacy of reinforcement. Further research by Dickerson, (1984) has suggested that rewards are provided not only by money but also by environmental stimuli producing arousal. Griffiths, (1995) describe the limits of behavioral theories are that they appear to oversimplify problem gambling and do not explain why gamblers come back to gambling after prolonged abstinence. Thus, although offering some explanation for persistence in gambling and insights into treatment interventions (stimulus control, imaginal desensitization), pure learning theories is incomplete as a conceptual framework for problem and pathological gambling. 2.4.3. Cognitive models The cognitive approach to gambling assumes that people hold faulty beliefs in relations to their understanding of the odds of gambling, the concept of randomness, and skilled versus chance determined events. Due to these faulty beliefs and assumptions, individuals over‐estimate the extent to which they can predict and influence outcomes based upon their own knowledge and skills, which leads to a subjective expectation of success that is higher than the objective odds would dictate. Langer (1975); Joukhador, Blaszczynski, & MacCallum, (2004); Walker, (1992)listed common cognitive biases such as the gamblers fallacy (losses interpreted that a win is imminent), probability bias (incorrect beliefs about randomness which inflates beliefs in relation to winning), magnified gambling skill (overrated their ability to win despite persistent losing and various superstitious rituals like praying, acting on hunches which they believe increase the likelihood of winning, cognitive regret (regret over ceasing prematurely and missing out on the next win, and entrapment 13 (where one is motivated to maintain a course of action having already invested so much to date. Although the origin of irrational and erroneous cognitive beliefs and schemas remains unknown, Blaszczynski & Nower, (2007); Griffiths (1994) suggested social learning experiences, vicarious and participatory exposure to familial and peer-related gambling, media representations, religiosity and cultural influences, and personal experiences have all been hypothesized to play significant roles. Delfabbro (2004) has criticized cognitive theories, arguing that some of the evidence is invalid. In addition, while cognitive theories provide reasonable explanations of why people keep gambling, they do not explain why they started gambling. 2.4.4. Integrative Model Recently, several models have aimed to provide a comprehensive explanation of problem gambling, spanning traditional disciplines. In addition to biological and psychological evidence, these models use socio-demographic and cultural data, and include risk factors such as age, gender, income and family environment (Abbott et al., 2004; Orford, Sproston, Erens, White, &Mitchell, 2003; Raylu&Oei, 2002). Blaszczynski and Nower (2002) propose a pathways model which describes how problem gambling develops in three types of problem gamblers. Behaviorally conditioned problem gamblers follow a pathway characterized by the availability of gambling, acquisition mechanisms based on classical and operant learning, a period of habituation and the presence of chasing (i.e., keeping playing to recoup losses). Emotionally vulnerable problem gamblers follow a similar pathway, but also present emotional and biological pre-morbid vulnerability. Finally, antisocial impulsive problem gamblers also present impulsive traits linked to neurological and neurochemical dysfunction. The study will be guided by the integrative model to problem gambling which is a comprehensive model for problem gambling. The researcher has reasons to guide the study in the lens of integrative model to problem gambling. The reason is other theoretical models to understand problem gambling are not comprehensive and sufficient and are one dimensional. Rather than taking a broader psycho-social and environmental approach they focus on the individual as a responsible agent for the development and maintenance of the problem. For example cognitive theories provide faulty and erroneous beliefs as the underlying causes to problem gambling while biological and personality factors blame the internal individual 14 characteristics for the development and continuity of problem gambling without giving greater concern for factors outside the individual such as cultural and ecological factors. As it is echoed by many scholars in the area there is a need to consider problem gambling from a multi perspective outside the individual. Integrative model is holistic and shows us how this situation is evident by using two explicit socio-cultural ―ecological factors‖ – ―increased availability‖ and ―increased accessibility‖ – which at a basic level causally influence the other factors in different groups as shown in the figures below. More over as we have a collective culture blaming individuals as a solely responsible agent for the problem is not optional rather, considering socio-cultural influences with more emphasis than individual characteristics and the interaction between the two should be our concern to have a detailed understanding of the phenomena. 15 Figure 1. Integrated model of problem gambling, Pathway 1. Source: Blaszczynski&Nower, 2002. 16 Figure 2. Integrated model of problem gambling, Pathway 2. Source: Blaszczynski&Nower, 2002. 17 Figure 3. Integrated model of problem gambling, Pathway 3. Source: Blaszczynski&Nower, 18 2002. 2.5. Impacts of Gambling The study by Francis and Lubbe (1999) laments the lack of adequate data specifically in South Africa and in Africa in general and that might substantiate preconceptions that gambling results in an increase in crime and other evils. They also point out that ―the social implications of gambling are much more difficult to measure than the economic implications since many of the possible impacts of gambling, such as on the work ethic of a society, are difficult to measure‖ (p. 13). The paragraphs that follow outline briefly the social and other pathologies to which gambling has been shown to be linked globally, although not necessarily in a relationship of causality. 2.5.1. Personal health The Productivity Commission (1999) asserts that many studies find a connection between problem gambling and mood disorders, such as depression, anxiety, guilt, restlessness, preoccupation with gambling and loss of control. A recent United States survey concluded that pathological gamblers had an ―incidence of poor health 2.2 times higher than low risk gamblers‖. Furthermore, it has been found that many pathological gamblers have other dependencies, such as alcohol and drugs (Productivity Commission, 1999).The SHORE study, (2008) found a direct relationship between high participation in gambling and lower physical health, lower mental wellbeing, worse feelings about themselves, and lower overall life satisfaction.. 2.5.2. Interpersonal relationships The NGISCR (1999) argues that despite the scarcity of research on the impact of compulsive gambling on interpersonal relationships, the available literature suggests that compulsive gambling may have a severe impact on the family of a pathological gambler. The increase in the number of problem and compulsive gamblers implies that the number of affected non gamblers is also high. Another study by Dowling, Smith, & Thomas, (2009a) pointed that Problem gambling can have significant effects on many aspects of the gambler‘s life, including their relationships. The study further argues that many problem gamblers report intimate relationship and family difficulties or having lost or jeopardized relationships as a result of gambling. 19 It is estimated that the activities of most compulsive gamblers affect the lives of between six and 12 people, particularly members of the family and friends (Looney, 1998). Compulsive gambling leads to family disruption, child abuse and neglect. Also, children of problem gamblers are more likely to adopt delinquent habits such as smoking, drinking and using drugs, and have a high risk of becoming compulsive gamblers (NGISCR, 1999). For example Jacob 1989, found that the children of problem gamblers have a higher than normal involvement with addictive substances, more psycho-social problems, and more problems at school than others. Hing, Russell, Nuske & Gainsbury, (2015) widen their scope of the problem and investigate the power of Problem gambling to attract high levels of public stigma, similar to other mental health disorders and addictive behaviors. The above scholars added Through a process of labeling, people with gambling problems may come to be defined by their problem, and as a group are assigned a range of negative stereotypes including being irresponsible, impulsive, compulsive and greedy. Differences between ‗us‘ and ‗them‘ can then be accentuated through a process of separating or social distancing, which reflects a loss of social acceptance. 2.5.3. Financial problems There are many areas of social costs to society such as high insurance costs due to illegal acts, due to fraud, embezzlement, white-collar crimes, bank fraud, credit card debt and bankruptcy, police costs, judicial (both civil and criminal) and corrections (prisons) are increased due to compulsive gambling. Compulsive gambling leads to financial devastation for the problem gambler and family members (Looney & O‘Neill, 1999; Productivity Commission, 1999). Looney & O‘Neill, 1999; NGISCR, 1999demonstrates there is a correlation between the rapid growth and availability of legalized gambling and a recent surge in personal bankruptcies. Moreover there are 2.5 million compulsive gamblers in the United States—about 3% of the adult population that gambles—and more than 20% of compulsive gamblers said they had filed for bankruptcy as a result of their gambling losses. 2.5.4. Employment problems The National Gambling Impact Survey Commission Report (NGISCR) (1999) and Productivity Commission (1999) estimates that a quarter to one-third of gamblers in treatment in gamblers anonymous state that they lost their jobs as a result of gambling. Also, 20 compulsive gambling is said to be responsible for poor work performance, lost time at work or study and resignation. Other studies by Ladouceur 1994 have found that problem gamblers report higher than average incidences of job loss, and those who remain in work report lost productivity through lateness, non-attendance and preoccupation with gambling. Productivity Commission, (1999) and Gerstein (1999) come to conclude that problem gamblers tend to suffer greater ill-health than the general population, including conditions such as depressive moods, insomnia, anxiety, headaches and stomach problems, which may also contribute to absenteeism. 2.5.5. Legal problems Problem and pathological gamblers are often involved in criminal activities, such as embezzlement, fraud and default on their financial obligations (NGISCR, 1999). In the United States about 85% of compulsive gamblers say that in some instances they steal from their employers to finance their gambling habit. Nicholas, Asimacopoulos, Dimouski and Haydon (1997) assert that there is a relationship between pathological gambling and crime. Report from Criminal Justice Commission, 1991 also argued that an increase in the number of legal casinos would probably lead to an increase in the number of compulsive gamblers and gambling-related crimes. Evans, and Topoleski(2003) found a result consistent with the notion that increases in crime are partly attributable to increased numbers of problem gamblers, most studies have found increases primarily in property offences, particularly fraud, embezzlement, theft, and larceny.Barthe & Stitt, (2007) also showed that certain forms of gambling offer increased opportunities for illegal activity to occur (i.e., passing counterfeit money, money laundering, loan-sharking, cheating-at-play, race fixing, theft, fraud). The above reviewed literatures show us the negative impacts of problem gambling from the different global contexts. As the researcher has observed there are many issues that could be listed out about the stressful situations in Bahir Dar city by which problem gamblers are facing. It‘s not argumentative that there is such kind of problem and peoples are affected by it. Its usual to see peoples spent many hours in gambling houses like carambolla, pool, and casino houses, betting huge money in games, drinking alcohol to stay involved or chewing chat to stay active for the whole night, and etc. Such activities can certainly bring conflict during play like escalated arguments, fighting, and being indebted so that they can finance 21 their gambling activities. In addition there are many individuals who have interpersonal relationships which is full of conflict because of their inability to pay back, and managing their own family, and missing important life events. In common sense we know its existence (problem gambling) but understanding through common sense is not scientifically valid and acceptable. Thus this research is aimed to prove the nature of the problem by using scientific investigation so that we can have a detailed understanding of the problem. 22 CHAPTER THREE: RESEARCH DESIGN AND METHODOLOGY 3.1. Research Design This study was an exploratory study which concerned to seek broader based information on the nature, inter and intra-personal consequences, responsible factors, as well as associated risky behaviors of problem gambling in the selected area of the study. A qualitative approach which sought to interpret, understand and explain the meanings of participants‘ experiences (Neuman, 2007) was used. Qualitative methods were considered as the most appropriate approach in this instance because they yield rich in-depth data about the participants‘ experiences of problem gambling. Thus, in order to reflect the gambler‘s lived experiences of the negative multi-facets of problem gambling phenomenology was employed to generate rich and thick descriptions through in-depth interviews (Geertz 1983). Phenomenology is the study of shared meanings of experiences of a phenomenon for a range of people (Creswell, 2007). 3.2. Sample and Participants The target groups were individuals who practice gambling in major sites of Bahir Dar City, Ethiopia. Hence gambling houses are places where problem gamblers could be found, 10 participants were recruited from gambling sites of kebele 4, 6 and 12 using snow ball sampling method. Snow ball sampling was appropriate because as the study design was qualitative, sever cases could be investigated in greater emphasis and would help in choosing participants who have the experience of problem gambling. 3.3. Data Gathering Tool A rich study keeps asking and answering questions like when, why, how, and under what circumstances the phenomenon occurs. Thus, a semi-structured interview was used to uncover the different forms of gambling activities, how gamblers were influenced, affected and involved in to unwanted risky behaviors. The researcher developed the interview guide questions from the objectives or research questions of the study. The interview guides were going to be prepared in the form of open-ended questions which allowed focused, conversational, two-way communication. 23 The interview began with warm-up questions to make participants feel comfortable and document the participants profile about gambling activities. The second section was prepared to ask interviewees about the types of gambling activities. The third section of the interview included questions asking for the reasons for starting gambling. Here, participants were going to be asked to give in depth explanations about why and how they were motivated to such an activity. Thus they were expected to give underlying causes from personal, social and ecological considerations. The four sections of the interview included questions on the negative impact of problematic gambling on personal and familial as well as its burden on social relationship and gambler‘s career. This section also asked participants to give their experience of having any hazardous situations and risk taking behaviors because of problem gambling including the criminal activities. Probing questions were used in questions under section two and three as necessary as needed. 3.4. Data Collection Procedure After securing the letter of support from college of educational and behavioral sciences, and the consent of the participants, and mentioning the objective of the study to participants throughout the research process, the interview has taken place. The interviews were taperecorded, with permission of the participants, and then the tapes were transcribed. The researcher gathered data as lengthy interviews describing the shared participants‘ experiences and then reduces these data to a central meaning, or essence of the experience. 3.5. Method of Data Analysis Data analysis consisted of interpretative and thematic phenomenological analysis (IPA), which is a framework for analyzing qualitative research data to bring about deep insights and understandings into how individuals make sense of a phenomenon (Smith, 1999). The aim of IPA is to explore in detail how participants make sense of their personal and social world, and the meanings and perceptions they placed on their particular experiences. Themes were identified from the participants‘ accounts, and connections between themes were made in order to group them in a meaningful way. The researcher used narration, direct quotation and paraphrasing and this information has been written up, with an emphasis on anchoring the participants‘ accounts of the phenomenon in the research, thus providing meaningful insights. 24 3.6. Ethical Consideration Ethics was one of the most crucial areas of the research. In this research there was strong positive interaction between the researcher and population sample. The researcher mentioned the objectives of the study to participants throughout the research process. The researcher was highly conscious to respect the dignity of participants of free choice and insured informed consent before collecting any relevant data. The participants were informed that their identities will remain anonymous, that they were free to withdraw from the study at any point should they wish to do so. The permission of the participants was also sought and obtained before the audio recording of the interviews. The researcher assured that participants‘ information would be kept confidential and used for only the research purpose required for the partial fulfillment of Master of Arts in social psychology. Participants were to be debriefed once when they have completed their participation / acknowledgement/ by indicating that the success of the paper was due to their full cooperation. 25 CHAPTER FOUR: FINDINGSAND DISCUSSIONS This chapter presents results from interviews with six people with the experience of having a gambling problem. It was supposed to have a total of ten participants but the researcher could find only six voluntary participants. The participants were interviewed to provide first-hand perspectives on the types of gambling activities they are engaging and about the different causes for starting and continuing gambling activities. Deep investigation on the consequences of problem gambling and the associated risk behaviors as part of a consequence of problem gambling is also one and the very expected objective of the study. An interpretive approach to data analysis was used, with thematic analysis providing the foundation to identify, analyze and report themes emerging from the data. The following analysis provides rich data from the individual stories told by participants. As is appropriate with qualitative research, numbers of responses are not reported here, but the use of ‗most‘ ‗about half‘ and ‗a few‘ is used to indicate the strength and range of responses. This chapter also elucidates the connections between some of the results and the literature, 4.1. Demographic Characteristics of Participants Table 3. Participant characteristics and problematic gambling forms Name Age Sex Current Occupation 26 Age of Onset of Gambling Demeke 37 Male Waiter 19 Uncertai n Period of Addictio n Mekonin 52 Male Driver 23 12 Carambolla, Pool & Card Abay 43 Male Unemployed 25 Uncertai n Woldu 47 Male Unemployed 20 Uncertai n Haylemariam 40 Male Unemployed 16 13 Carambolla& Card Desalegn 58 Male Police man 31 10 Carambolla& Card Problematic Gambling Forms Carambolla& Pool Carambolla& Pool Carambolla& Card All participants were male. The researcher tried to include a female participant but couldn‘t find any female participant due to the absence of female gambler in gambling houses. All participants were men middle adults. Half of the participants were not currently active in the activity. These peoples are those who seize to gamble and are now social gamblers. The rest Active/ Inactive Active Inactive Active Active Inactive Inactive half are still active, i.e., they are problem gamblers and find it difficult to stop their habit even if they want to do so. Participants were asked about the onset of the activity and the period of addiction by which they thought gambling is causing a problem but is unable to quit. Only one participant had started to gamble during adolescence the rest of the participants began to play during young adulthood. Almost all of the participants were sure about the onset but were quite confused about the addiction period. Especially almost all active gamblers were uncertain. This is due to the uncontrollable characteristics of the activity that gamblers do not know what they are doing and unknowingly are driven by the attractive feature of the game for a long period of time. But in contrary, inactive gamblers were sure about their addiction time hence they know the time where they jump from ‗a social gambler‘ to ‗a problematic gambler‘. In addition, they were very experienced and were free to tell the case deeply than active gamblers. This can be best explained by one of the inactive gambler as: It is quite difficult to tell you the exact time you know? I didn‘t think for a second that I‘m in trouble for many years while I was a gambler. It feels like I am a new gambler even if I played for many decades. But after I get the insight I come to exclude myself…… to be honest with you I didn‘t think I‘m addicted until I stop it. From this we can understand that active gamblers are highly dragged in by the activity and cannot be specific and are unconscious while inactive gamblers are best in explaining the situation. Most of the literatures have linked the onset of the activity with the age of adolescence (for example Jacobs, 2004). Lynch, Maciejewski, Potenza, (2004) associate the initiation of the activity with an increased likelihood of a substance use problem to begin during young adulthood. In this study only one participant started to gamble in adolescence by the increased likely hood of substance use. The rest of them have started during young adulthood which was not initiated by an increased likelihood of a substance use problem. 4.2. Types of Problematic Gambling Practices Participants were asked to report the types of gambling that had caused them the most gambling related problems. Carambolla was the most common type of gambling activity for all participants while playing Card was listed by most participants and Pool was reported by a 27 few participants. Even though Carambolla was commonly reported by all participants, in terms of harm Carambolla is reported in a second position next to playing Cards which is the most dangerous forms of gambling activity. Rönnberg, (1999), has classified games in to ten categories by which card games were under unregulated category. This category was characterized as illegal gambling at clubs, and betting with non-licensed bookmakers, as well as all other gambling, legal or illegal, in private and without the supervision of authorities. As it was investigated the above mentioned characteristics were totally the same in the context of Bahir Dar city, Ethiopia. Whereas Carambolla, a game typical to Ethiopia which is very closely similar with the Italian game of Bocette was found to be a legally established means of gambling. In this case gamblers feel secured and freely bet money as long as they want but in case of playing cards hence it is illegal, gamblers always do it by hiding from others in protected and unthinkable houses. In terms of harm, the study supports a report by Center for Public Research Center (2011). Illegal gambling was closely associated with problem gambling and found to be harmful. In this study, playing card which is one form of unregulated (illegal) gambling was reported by participants as harmful and thus causing different problems. Another form of gambling that was reported as harmful next to playing cards was Carambolla. Pools were listed by center for public research center (2011) as relatively moderately associated with problem gambling but in case of the current study the researcher found the effect of playing Pools as insignificant in comparison to playing cards and Carambolla. 4.3. Risk factors/ Causes for problematic gambling behavior Identifying the risk factors for starting and continuing to gambling is the second objective of this study. In these section four themes namely; personal, social, economic and ecological (environmental) factors are identified. Each will be elaborated deeply as follows. 4.3.1. Personal factors a) To socialize and relieve boredom Most gamblers stated that they began the activity because it can be away to socialize as a means of interacting with friends, or to meet new people. Gambling was also stated as a means for enjoyment and a way to have fun. 28 You see you came here and you like the social atmosphere like the jokes. Then I moved to the next step. For the first time, I didn‘t know how to play. So I began by playing for time and then when I got the skills I began bet money and gradually the amount of the bet increased from time to time. Others also forwarded their motivation to gambling in relation with their need to interact and socialize as:“I play because for enjoinment or just to have fun… to have a good time. It‟s enjoyable you know and it‟s fun‟‟. Experiences varied and others stated that through time gamblers develop a sense of competition and so that they compete one another and upgrade their skills as part of excitement. This was best explained by participants with the following phrases as ‗show skills‟, „learn games‟ and „practice strategies‟, „to beat someone else‟, and „it‟s challenging‟. Others say they gamble to occupy time and to have something to do or to alleviate boredom. This refers to filling a gap in the person‘s life either through alleviating boredom or through providing a means of socializing that was otherwise missing from their lives. Many of the gamblers reported that gambling was their only available social outlet. For instance one participant said ―Often I choose gambling to pass time and bored‟‟. b) Gambling to escape Analysis of the data shows that all of the participants also gambled because of the need to escape or to cope with problems, stress full life events, loneliness, depression, or anxiety. Escape served as the central reason to continue gambling despite the realization that further gambling would not solve their long-term problems. Gambling was undertaken for the experience that it provided, and the ability that it had to enable the person to block out their problems while engaged in the behavior. According to the participants, gambling was used as an escape mechanism from the depressing realities of their lives, loneliness, stress or sometimes grief. All of the participants made reference to gambling as an escape, either directly or indirectly. The term escape was offered freely by a number of participants as an explanation for their behavior, and the interviewer took great care not to lead subsequent participants to respond in further accordance. A participant who is a diabetic adult stated that he was a business man and things were not going fine. The business bankrupted and that time he was much stressed. Due to this reason he began to play with his friends in order to release from the stress. He further 29 explained the situation as ―during that time I found it as a best way to avoid responsibility and to shut the world out‖. Another interviewee commented: My wife passed away during labor. It was the darkest part of my life. My children‘s were living abroad and after work I go to home and nobody was there. It‘s terrible to be alone. I feel lonely and I really need someone else or something to be there for me….. Gambling was definitely an escape where I could just forget, all it was it just me and nothing else mattered. Not the family, not my job, nothing. Nothing mattered. Gambling is an escape from reality. Because when you are gambling you didn‘t think of anything else. You totally blank all your problems or anybody else‘s around you. You don‘t give a thought for anybody. As echoed by scholars in the area (for example Gillespie, 2007), the study support the idea that problematic and pathological gamblers engage in gambling to escape problems, to alleviate depression, to cope with loneliness, to relax, and to interact socially with others. In this study the above stated personal factors were also exactly motivating participants to visit gambling houses. Beyond the need to relax and have fun, the gamblers tendency to view gambling as an escape mechanism to stressful occasions was found to be a central reason in explaining why gamblers are personally motivated to visit gambling houses. c) Addictive Behaviors Engaging in other addictive behaviors such as smoking, drugs or alcohol were also cited as a possible reason for starting and continuing the behavior. One of the interviewees replied as: It was not only to win back that make me to stay in gambling life but it‘s also because my addiction for smoking cigarette and chewing chat becomes higher and higher day after day so I had to gambled more as I need more. According to participants, this is a rarely noticed phenomena but also the most hazardous. It is said that certain forms of games were purposely used in addictive activities while others don‘t. Typically playing card while chewing chat was a common phenomenon. Lynch, Maciejewski, Potenza, (2004) also concluded that Initiation of gambling in youth has been associated with an increased likelihood of a substance use problem to begin during young adulthood. The researcher also found this finding interesting. Playing card and using drugs were associated in two ways. One is playing card and addictive drugs have a mutual relationship. To make clear for readers, playing cards were used or served as a stimulant while chewing chat. At the same time chewing chat or using other drugs help to increase their concentration 30 during play. According to participants‘ explanation, playing cards were used as a stimulant. Gamblers said (believed) that playing cards while chewing chat can enable them to reach the state of euphoria quickly. It‘s like drinking coffee or tea while using drug to reach euphoric state quickly. 4.3.2. Social factors a) Peer Influence The influence of the people around them particularly friends also encourage gambling among individuals. Friends were found to influence gambling behavior in two ways both by initiating the gambling and by normalizing it. It‘s typically stated as: It‘s because of my friends. My friends took me in. After the business bankrupted, I often spent my time with my friends. Unfortunately those of my friends had addictive behaviors. They smoke, drink, chew chat and gambled. They convinced me that using drugs can help me to heal from the tension that comes from both the business and the family pressure. After a time I began to play cards while using drugs but soon after I found my self-trapped in addiction. Clarke (2007a) argues, like substance abuse, gambling is initiated, normalized and reinforced by family and peers. At the social level, Carlson and Moore (1998) found problematic gambling to be associated with familial and community factors such as family gambling history. Similarly, Tariku, Robert, Ruiter and Tamirie (2013) mentioned social factors (e.g., peer influence, parental gambling) as a responsible agent. Also in this study, problem gambling was found to be encouraged by peers both by initiating and normalizing it. Parental history of gambling was not reported by participants as a possible reason to begin the activity. Thus the gambling and other addictive behavior of peers could influence participation in such behavior. b) Relationship Problems Many of the participants reported that they would gamble most heavily when they were experiencing some kind of problem, conflict, or stress in their family and in organizational responsibility. Financial debts and further conflict with partners and relatives were mentioned as the possible reasons to continue the behavior. Participants were trapped in a cycle whereby gambling created problems, but at the same time, gambling created the solution by allowing them to dissociate and forget those problems. Many of the literatures relate relationship problems with the beginning of problem gambling during adolescence, for example disruptions of relationships with family, peers and family gambling history (Dervensky and Gupta, 1998). But in this study the way interpersonal 31 relationship problem as a cause to problem gambling was explained in different context. First participants are matured enough (have already established their own family, i.e. it was not related with being an adolescent). So, their urge to gamble comes after family engagement. Second, many literatures including the above scholars have a narrowed lens of this factor (relationship problems) to the problem which is specific to family relationships. But here, relationship problems outside family such as with relatives, neighbors, communities were also cited. Third, the explanation by different literatures was not found to be culturally sound to the present study findings in such a way that participants are living in a collective society. Meaning, social burdens and conflicts beyond familial level are evident so that would have the power to influence individuals to fall under the problem. c) Social acceptance According to participants explanation, the interacting effect of the sense of competition together with the need to improve skills and the satisfaction from winning the best gambler would satisfy or fulfill the gamblers need to be respected, appreciated and recognized. Some said skilled gamblers have funs (followers) and so whenever they play they will get social support as a reward. Being able to bet huge money and win the best gambler was considered to produce a social support in the form of admiration, moral, respect, and pride, etc. This is a special phenomenon in Carambolla houses by which peoples can meet together and freely participate. In one way or another it would make gamblers to feel safe and smash the previous loss with pride and would be morally energizing. In playing cards, there is one social event that is very interesting for readers but very shameful. A gambler who lost everything at play may bet on his queen in Amharic (this doesn‟t refer to a sexual deal). If he loses the game, then the winner is socially rewarded. Skinner (1953) proposed that problem gambling is a function of previous reinforcement history. Further research by Dickerson, (1984) has suggested that rewards are provided not only by money but also by environmental stimuli producing arousal. In this study, the environmental stimuli were expressed in the form of social support and acceptance such as pride in ones skill, admiration and etc. indeed influencing individuals to continue the behavior. 32 4.3.3. Economic factors This category is perhaps one of the most major underlying themes founded in the study while investigating key reasons to problematic gambling. The following descriptions were vastly shared by most of the respondents. a) Being unemployed (to win money) Most participants said they gambled because they expected to win money. The main reason to begin gambling was poverty or low socioeconomic status. Interviewees felt that people start gambling to win money, to help their family and so in general to ease financial problems. Being unemployed were the major reason to participate in gambling. They believed that people start gambling to win money for the family. They viewed it as an easy activity that could lead to financial gain or that served as a time-out from family. People who were unemployed had more free time than those who worked, and so they would get bored and become tempted to gamble. Most of the participants were directly or indirectly and strictly reporting the long lasting effect of being unemployed in their gambling life. Those who were unemployed have given their confession as: “I don‟t think I will be here if I have something to do with a good capital. Like if something that I could work by myself, I could assure you that you wouldn‟t found me here”. Being unemployed was also clearly marked as the major factor to start the activity as: “As I understand nobody needs to be called a gambler. It‟s not because of peers or availability of gambling houses that brought me here. It‟s because I don‟t have a job”. Others also magnify the issue as; ―Of course I gambled to relieve boredom but most importantly absence of job”. The other participant reported his and his friends experience as “Even if we don‟t have anything to bet, there are many cases that we seat down here and earn money just simply by judging the game. And by that we can finance our family‖. Clarke (2005, 2007) indicated Low socioeconomic status to be a key indicator in the transition from social to problem gambling. This is supported by the present study that urges or beliefs that gambling can provide big financial rewards, and solves money problems were more likely in individuals with a low socioeconomic status. Participants have clearly reported that ‗being unemployed‘ and at the same time the need ‗to win money‘ as a major reasons so that they can finance themselves and their families while explaining their behavior. 33 b) Chasing Financial reasons include the need for money to pay a debt or the potential of winning a big prize with a small amount of money. All the gamblers reported that they had at some point chased their losses to try and win back their money. The cognitive regret of losing money motivated them to continue, often with the belief that their luck eventually change. This usually leads to larger and larger bets in order to try and pay off the debts. One of the interviewees replied that: Suddenly I lose huge money in short duration of play. It was 3000 birr. It was from loan (in Amharic Ekub). I had to get it back. Then I gambled heavily and repeatedly to win back but it has not been as such easy. Similar to previously reported findings by different scholars (for example Clarke, Tse, Abbott, Townsend, Kingi, & Manaia, 2007), the need to Solve financial problems and later covering gambling losses (chasing ones losses) was also found to be another main reason that contribute to the development of problem gambling. 4.3.4. Environmental Environmental (ecological) reasons found in the study included being brought up in an environment of gambling or being around people who gambled. The variety of gambling facilities or the abundance or types of gambling was linked to the beginning of gambling. Different scholars (for example Carlson and Moore 1998; Derevensky, 2004) have mentioned the role of the ecology or environment in shaping the adaptation of the activity. Tariku, Robert, Ruiterand Tamirie, (2013) also mentioned two environmental factors such as accessibility of gambling venues and advertisements. In the current study the role of advertisements was not indicated by participants but largely accessibility of gambling houses. 4.4. Consequences of Gambling Behavior This section will uncover the impact of problem gambling in individuals‘ lives. To show this the researcher found three major themes of personal, social, and economic consequences. Each theme is classified in to sub sections. The personal impact comprises emotional and health related aspects. The social problems are described with four sub themes of impact on families, relationships, work, finance and criminal activities. The economic consequence namely the financial impact is also presented. Each will be discussed in details. 34 4.4.1. Personal impact a) Impact on Emotional Wellbeing Gamblers often reported a strong emotional response of distress because as time passes they realize that problems are intensified and efforts to address them become more difficult. This directly can affect their emotional wellbeing. In most cases this become more apparent after the discovery that gamblers found themselves in serious trouble or commented by others for their problematic gambling behavior. All of the participants feel feelings of unworthiness, anger, resentment, guilt, shame and most importantly negative sense of self and self-esteem. It was said that through time they came to realize they haven‘t done anything good for themselves and their families or other significant persons even though they tried unsuccessful attempts to quit gambling. So, they understood that they are living a miserable or meaningless life. It was commented by one of the inactive gambler as; ―It reaches up to identity (moral) crisis”. As a human, from birth to death we have things you think to fulfill like having a job, engage in marriage, raising children and so on. But you may even believe doing such social issue is not your responsibility and you don‘t give a concern for anything. During that time the important thing to worry about was how can I get money for today and satisfy my needs for drug and gambling. b) Impact on Health In relation to the emotional distress participants responded that they have experienced stress, depression and other chronic disease like diabetes. Almost all of the participants have experienced stress in their lives while a few participants experienced chronic and other physical diseases because of the negative emotional experiences. These negative emotional experiences were found to be directly or indirectly influencing participants‘ wellness. In addition to the negative emotional experiences, due to the uncontrollable urge to gamble, gamblers didn‘t give adequate time for their entire body functioning. They couldn‘t observe and take immediate action for the psychological and physiological changes. From the participants‘ stand point, the pain they didn‘t gave attention reached at the boiling point and exposed them for extra health expenses. 35 Moreover, it was said they are often in depressing mood state or mood swing. They became extremely happy when they win and feel stressed, guilt, angry when they lose. Exceptionally only one participant was certain that the state of depression was medically diagnosed and confirmed. Regarding this, one interviewee stated as: As I said it before, chewing chat with playing cards can create really high state of euphoria. It made me not to listen to the diabetes symptom soon. And it‘s because I didn‘t check myself for long time that now I‘m almost totally blind. If I could follow up early it would not be in a critical stage. I had also suffered from diabetic related depression. The impact of gambling on gamblers emotional wellbeing is perhaps one of the least cited and explained issue by scholars while its impact on health was widely explained. Due to scarcity of resources in the area, the researcher presented the report by Productivity Commission (1999) and the SHORE, (2008) study to strength the data. Those studies asserts that many studies find a connection between problem gambling and mood disorders, such as depression, anxiety, guilt, restlessness, preoccupation with gambling and loss of control. In Addition there is a direct relationship between high participation in gambling and lower physical health, lower mental wellbeing, worse feelings about themselves, and lower overall life satisfaction. The present study is also in the same boat with the above studies but has unique faces. The above studies since they are quantitative they presented the relationships in between the volume of gambling behavior and the self-reported health relationships. The present study since it‘s qualitative it does not only conceal that problem gambling has an impact on gamblers emotional and health wellbeing but also explained how these consequences influence one another. In this study a deteriorated emotional state was found to bring further impact on health. In another words many of the health problems were due to a growing sense of negative emotional wellbeing. 4.4.2. Social Impact a) Impact on Family All participants have confessed the fact that their gambling behavior have paused a black shade in their familial relationship. Their marriage life was found to be full of conflict, debate, dishonest, unfaithfulness, and lies. Problem gambling was found to cause a growing sense of disconnection and isolation with their family members. Accordingly, participants 36 have also pointed that their children were victimized by their laziest house hold management. Some Interviewees‘ found themselves as unfaithful hence they break the bond of trust with their spouses. One reported the problem as: I don‘t go home early. You see when I am late my wife may be suspicious. My support and care for my children‘s became degraded. For example, I couldn‘t follow up their academic progress. There were a lot of cases that I have lied my wife and when I failed again there were many cases that she wanted to break up. Some have also cheated on their wife hence they break the bond of trust; one replied that “I had a sexual relationship with another woman. I did this both when the relationship becomes escalated and after I separated with her.‖ According to participants, divorce was the final and extreme manifestation of gambling problem. Their spouses have repeatedly given a chance to improve their habit and to be faithful. Despite the chances, because of the uncontrollable gambling urges, many of the respondents said they have experienced relationship break down and ended up with divorce or separation. The marriage life of some respondents is also in unsafe situation hence if they are busted again things may get serious. There is a bulky of research resources on the impact of problem gambling on family wellness. Similarly, the study provides further support for the study by Ciarrocchi & Reinert, (1993); Dowling (2009) that the family environments of people with gambling problems are characterized by high levels of anger and conflict as well as low levels of clear and effective communication, less independence, less engagement in intellectual and cultural activities, a lack of commitment and support, little direct expression of feelings, and less participation in social and recreational activities. In addition to the above points, the present study also dealt with the climax manifestations of the problem such as its impact on children, breaking the bond of trust (cheating on their wives), separation and finally divorce. b) Impact on Inter personal Relationship In this sub theme the researcher tries to uncover relationship beyond gamblers‘ home. A gambler‘s social relationship is influenced by problem gambling. Many of them said they have experienced stigma related with their behavior. Even though this study doesn‘t aimed to study the public perception on problem gamblers, but while talking about the impact of problem gambling on their social interaction participants have touched or reflected their own 37 belief about the public by stating on how others viewed their capacity to be trusted on taking social roles and obligations. According to participants, they were not trusted in many social situations and often are underestimated. They explained that: If you spent many of the days in gambling houses, there are many things you are going to lose. Firstly your social acceptance will become zero! For example if you are in trouble I mean a real trouble and you ask someone to borrow you money, they will not give you because they believe you need it for gambling. Morally it hurts you when people point their fingers and call you a gambler. Furthermore, because of the time and resources they spent on gambling, they couldn‘t fulfill the social obligations and roles such as visiting the ill, going to church, and enjoying social ceremonies like wedding. Together with the cohesiveness and collective culture of the society, such situations can exacerbate the social stigma. They elaborated it as ―It takes your time so much. Just you don‟t want to quit playing. If you are tolled someone close to you is seriously ill or gets injured, you are unwilling to quit and go for help‖. Others have mentioned about the social interaction within the gambling house. One said “the social interaction of this house is very bad. We insult each other and easily get bull. For example because you are emotional so you may even insult someone you respect and that is very shameful”. Additionally it was said they don‘t tolerate and respect each other. Many of the literatures presented in the current and out of this study explained interpersonal relationship problems in terms of frizzed communication, escalated and jeopardized cooperation, within the scope of familial level. For example, A study by Dowling, Smith, & Thomas, (2009a); Looney, 1998; and NGISCR, (1999) pointed that Problem gambling can have significant effects on many aspects of the gambler‘s life, including intimate relationship and family difficulties or having lost or jeopardized relationships as a result of gambling. In this discussion the researcher is not interested to state about the interpersonal problems at a familial level because it has already been discussed in previous topic. Here readers are granted to see the interpersonal problems outside home. The present study strengthen the idea by Hing, Russell, Nuske & Gainsbury, (2015) about the power of problem gambling to attract high levels of public stigma and through a process of labeling, people with gambling problems may come to be defined by their problem, and as a group are assigned a range of negative stereotypes including being irresponsible, impulsive, compulsive, and greedy. The 38 present study also provide depth analysis and found social stigma and failure in fulfilling social obligations and its negative effect in trust and social acceptance as a major impacts of problem gambling on participant‘s interpersonal relationship. c) Impact on work The above stated interpersonal problems were also found to be similar in gamblers working environment. According to participants, once co-workers discover their gambling behavior, then it will totally affect their trust, acceptance, reliability and loyalty. In other words this behavior causes conflicts and arguments in their working environment so that they can‘t function properly. The other discovery of the study was the capacity of problem gambling to kill work motivation. As participants stated they believe they could get thousands in a minute while gambling and they compare and contrast this to their monthly salary. So this can affect their work motivation because they believe their monthly salary will not bring change in their existence. It was said: Here you get huge money in a minutes or may be in a seconds and you also lose it at the same time. I mean you don‘t give that much value for money. My salary here is invaluable because it‘s something I can get in a minute. So you don‘t care for the job. I had a job. I was a hotel manager. I didn‘t do my job well. Often I was not present in work and I didn‘t have a good relationship with others. My interest and motivation to work becomes to decline from time to time and finally I resigned. Another impact of problem gambling is unemployment. Half of the participants were unemployed. Because gamblers give little concern for work, are not punctual and in most cases are not present, and gamble in working hours, they were repeatedly warned, penalized and finally get fired. There are also some participants who were warned, penalized and finally get fired because they were caught while doing unethical activities. This will be discussed in the next sub topic. As it was justified by different scholars and national reports in the area (NGISCR, 1999; Productivity Commission, 1999; Ladouceur, 1994 and Gerstein, 1999) problem gambling has a direct influence on work such as absenteeism, poor work performance, job loss and etc. The present study findings were all in all similar with the above stated consequences. Moreover, the impact of work place social stigma on individuals was not adequately discussed by previous studies. This study found a connection between the power of work 39 place stigma in directing the whole work motivation and interpersonal interaction of participants‘. d) Crime Crime was another gambling problem among the respondents. Together with their uncontrollable urge to play and the need to finance the activity, they said they used any options available like a financial crime, cheating at play and fraud. Even though this kind of situation was reported by a very few of participants, it definitely show us how much this activity is dangerous. One of them reported he had committed a financial crime by breaking ethical rules and regulations of his organization. He also added his career was directly affected by such kind of offenses and finally get fired after repetitive warning and penalty. He further explained it as: Because my salary was not enough, I was forced to commit criminal acts. For example, when I arrest robbers or thieves, I made a deal with them that I forced them to give me money and then I set them free…. Finally, other police officers heard this and I get fired. Experiences varied and another participant said he had participated on fraud documents and/or being middle men in such works. According to him, this all was to finance his gambling urge. Interviewees concealed the fact that they cheat at paly most commonly during playing cards. They said there is a term called ‗Wug‟ meaning, while playing cards they make symbols, scratches, points, or something that helps them to identify the most important numbers on cards. In this study a problem gambling was found to expose gamblers in to criminal activities. The two major criminal acts were fraud and financial crime. These findings were also echoed by different national research reports and scholars (NGISCR, 1999;Nicholas, Asimacopoulos, Dimouski and Haydon, 1997;Barthe&Stitt, 2007). Barthe & Stitt, (2007) also showed that certain forms of gambling offer increased opportunities for illegal activity to occur (i.e., passing counterfeit money, money laundering, loan-sharking, cheating-at-play, race fixing, theft, fraud). The present study also revealed that certain forms of gambling namely playing card offer opportunities to cheat at play. 40 4.4.3. Economic (Financial) impact Participants have mentioned their dire financial situation and the difficulties of coping family and other social responsibilities. Because gamblers spent much of their time, money and other resources to pay debts, so they face difficulties in coping familial and other social responsibilities. In return this situation brings conflict and will narrow their social relationship. Some also lost their savings, assets, homes and or belongingness. Generally they experienced disruption and deterioration of their established way of life and their sense of stability and security. The present study result agrees with the research findings done by (Looney & O‘Neill, 1999; Productivity Commission, 1999) that Compulsive gambling leads to financial devastation for the problem gambler and family members. 41 CHAPTER FIVE: SUMMARY, CONCLUSSION, AND RECOMMENDATION 5.1. Summary The main objective of this study was to gain a comprehensive understanding on the different forms of gambling, responsible factors to begin and continue gambling and its consequences on the bio psychosocial wellness of individuals. With these objectives in view, the following three research questions were raised. 1. Which type of problematic gambling practices is/are common in Bahir Dar? 2. What are the pushing factors/risk factors/ for problematic gambling behavior? 3. What are the impacts of problem gambling on gamblers bio-psychosocial wellness? The study was a phenomenological study and data was analyzed by using interpretive thematic analysis method. The major findings of the study with respect to the above research questions are summarized as follows:  Carambolla, playing cards and pool respectively were predominant reported types of gambling practices by research participants. In terms of harm playing card was reported to be the most harmful and dangerous than carambolla, whereas pool was found to have insignificant and harmless.  There were personal, social, economic, and environmental reasons to start and continue gambling. Personal factors include socializing and relieving boredom, to escape, and addictive behaviors. Social factors include peer influence, relationship problems, and social acceptance. Economic factors include being unemployed (to win money) and chasing. Lastly, Environmental factors include accessibility of gambling sites.  Consequences of problematic gambling in this study were personal, social and economic. Its personal impacts are effect on emotional and health wellness. Socially, problem gambling has a negative impact on family, interpersonal relationship, work, and criminal acts. The reported economic impacts of problem gambling were indebtedness, losing savings, assets, homes and or belongingness. 42 5.2. Conclusion In this study, problem gambling is one of an identified social problem that has posed personal, social and economic consequences. The study revealed the fact that problem gamblers are in devastating psychological condition by which they are trapped in this social problem and in relation to the absence of help line services participants are experiencing different negative burdens. Thus the problem needs critical focus on creating public awareness, research and initiatives from different institutions. 5.3. Recommendations Based on the present study of results, the following recommendation could be forwarded.  Problem gambling is one of the least investigated and unrecognized social problems. Various stakeholders such as local and international NGO‘s, social psychologists, and social workers in public education campaigns should give undue emphasis on the importance of raising public awareness of the risk factors and consequences of excessive gambling. Problem gambling awareness campaigns targeting adults can lead to measurable increases in awareness of community services so that consumers informed choice could be promoted.  In addition to risk factors it‘s important to identify protective factors that moderate or mediate the effects of exposure to risk factors. The issue of problem gambling is one of the least investigated social problems in Ethiopia, so it is imperative to conduct both applied and evaluative research predominantly from research sites.  As a first step in development of broad public awareness campaigns aimed at preventing the development of gambling problems among at risk groups in the population, the researcher believe there is a merit in conducting further qualitative focused research on the social and cultural meanings of gambling to these groups. A modest initial investment in research on views of gambling and problem gambling and on the most effective methods to convey messages to these groups will have long term impacts on the later effectiveness of large media campaigns to prevent gambling problems nationally. So, a collaborative and cooperative work is advisable among mass Media, research institutions, and other community development organizations. 43  The criminal code of the federal democratic republic of Ethiopia article 789 states that unregulated forms of gambling are illegal. The study also proves the fact that there are illegal forms of gambling in Bahir Dar city, Ethiopia. So, legal measure should be taken to control such illegal activities and individuals who are found in such activity should be legally accountable. To do so enforcement should come first from different stake holders primarily from Bahir Dar University and both governmental and nongovernmental organizations (NGOs)so that the concerned bodies mainly legal institutions and social affairs could get an insight to the problem and can take further measures. 44 REFERENCES Abbott, M., Palmisano, B. & Dickerson, M. 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Journal of Gambling Studies, 9,63–84. 50 51 APPENDIX Appendix A: Semi structured Interview Items (English Version) Warm up questions 1. Age Gender Occupation 2. When and in what situation you started the activity? 3. For how long do you think you are addicted to the activity? Questions on types 4. What are your most favorite types of gambling activities? 5. From the before mentioned types, which of them do you think are highly causing a problem in your life? Questions on causes 6. Can you explain about your personal, social and environmental reasons to start and continue gambling? 7. What purposes do you consider while playing the game? Questions on consequences 8. In relation to your excessive preoccupation with gambling, can you explain its influence on your personal wellness, and family relationship? 9. Can you tell me its further impact on your social relationship ad vocational progress? 10. In relation to your excessive preoccupation with gambling, how do you explain the risk of experiencing unwanted gambling related behaviors? 11. In relation to being financial deficient and your need to satisfy your gambling urge, please explain about your experience of occupying in criminal activities? Appendix A: Semi structured Interview Items (Amharic Version) አ ነ ሳ ሽ ጥያ ቄዎች 1. ዕ ድሜ ፆታ የ ስ ራ ዓይነ ት 2. የ እ ድል ጨዋታዎችን መጫዎት መቼ እና በ ምን ሁኔ ታ ጀመር ክ? 3. ከመቼ ጀምሮ ነው ወደ ሱስ ነ ት የ ተቀየ ረ ው? 4. አ ብዝተህ እና አ ዘ ውትረ ህ የ ምትጫወታቸው የ እ ድል ጨዋታ አ ይነ ቶች ምን ምን ና ቸው? 5. ከዘ ረ ዘ ር ካቸው ውስ ጥ የ ትኞቹ የ ጨዋታ አ ይነ ቶች ና ቸው ተፅ ዕ ኖ የ ፇጠሩብህ ? የ ችግሩ መነ ሻ ምክያ ቶች 6. ጨዋታውን እ ን ድትጀምር ና እ ን ድትቀጥል ያ ደረ ጉህ ግላ ዊ፣ ማህ በ ራዊ እና አ ካባ ቢያ ዊ ምክያ ቶች ምን ምን ና ቸው? 7. ጨዋታውን የ ምትጫወተው ምን ጥቅም አ ገ ኝበ ታሇ ሁ ብሇ ህ በ ማሰ ብ ነው? የ ችግሩ ጥልቀትና መገ ሇ ጫዎች 8. ጨዋታውን አ ብዝተህ በ መጫወትህ ምክን ያ ት በ ግል እና በ ቤተሰ ብህ ላይ እ ያ ሳ ደረ ያሇው ጫና ዎች ምን ምን ና ቸው? 9. በ ማህ በ ራዊ ግን ኙነ ቶች /መስ ተጋብር / እና በ ስ ራ አ ሇ ም እ ን ቅስ ቃሴ ላይ እ ያ ሳ ደረ ብህ ያ ሇ ው ጫና ስ ምን ይመስ ላ ል? 10. አ ብዝተህ ከመጫወትህ ጋር በ ተያ ያ ዘ አ ላ ስ ፇላ ጊ ሇ ሆኑ ድር ጊ ቶች ተጋላ ጭነ ትህ ን እ ን ዴት ትገ ልፀ ዋሇህ? 11. ከዚህ ጋር በ ተያ ያ ዘ የ ጨዋታ ፍላ ጎ ትህ ን ሇ ማር ካት የ ገ ን ዘ ብ እ ጥረ ት ሲያ ጋጥምህ በ ወን ጀል ድር ጊ ቶች ተሰ ማር ተህ ታውቃሇ ህ ? በ ዝር ዝር ግሇ ጽ፡፡ 52	en_US
dc.language.iso	en	en_US
dc.subject	psycology	en_US
dc.title	A Phenomenological Study of Problem Gambling: Types, Risk Factors, and Consequences.	en_US
dc.type	Thesis	en_US