J Gambl Stud https://doi.org/10.1007/s10899-018-9768-9 ORIGINAL PAPER

Patterns of Family and Intimate Partner Violence in Problem Gamblers Aino Suomi1 · Nicki A. Dowling1,2 · Shane Thomas3,4 · Max Abbott5 · Maria Bellringer6 · Malcolm Battersby7 · Jane Koziol‑McLain8 · Tiffany Lavis9 · Alun C. Jackson1

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Abstract  While the evidence about the statistical co-occurrence of family violence and problem gambling is growing, the mechanism by which the two behaviours are related is less clear. This study sought to clarify the dynamics of the problem behaviours, including * Aino Suomi [email protected] Nicki A. Dowling [email protected] Shane Thomas [email protected] Max Abbott [email protected] Maria Bellringer [email protected] Malcolm Battersby [email protected] Jane Koziol‑McLain jane.koziol‑[email protected] Tiffany Lavis [email protected] Alun C. Jackson [email protected] 1

Melbourne Graduate School of Education, University of Melbourne, Parkville, Australia

2

School of Psychology, Deakin University, Geelong, Australia

3

Centre for Research on Ageing Health & Wellbeing, Australian National University, Canberra, Australia

4

Shenzhen International Primary Health Care Research Institute, Shenzhen, People’s Republic of China

5

Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand



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the role of gender in victimisation and perpetration of violence in the family. Two-hundredand-twelve treatment seeking problem gamblers (50.5% females) were recruited for interviews about past year FV and IPV experiences. The interviews included questions about the types of FV and IPV using the HITS tool (Sherin et al. in Fam Med Kans City 30:508– 512, 1998). The questions addressed multiple family members, the temporal order of violence and gambling and the perceived associations between the two behaviours. The result show that well over half (60.8%; 95 CI = 54.1–67.2) of the participants reported some form of violence in the past 12 months, with no gender differences in relation to perpetration and victimisation. Bidirectional violence (43.9%; 95 CI = 37.4–50.6) was significantly more common than ‘perpetration only’ (11.3%; 95 CI = 7.7–16.3) or ‘victimisation only’ (5.7%; 95 CI = 3.3–9.6). Violence was mostly verbal, although considerable rates of physical violence also featured in the responses. ‘Participants’ own gambling preceded violence in a majority of the interviews but a small group of IPV victims reported that being a victim had led to their problematic gambling. These results can be used inform prevention, better treatment matching and capacity building in family violence and problem gambling services, where a significant focus should be on situational IPV. Keywords  Family violence · Intimate partner violence · Problem gambling · Bi-directional violence · Situational violence

Introduction There is now clear evidence about the statistical co-occurrence of family violence (FV) and problem gambling (PG) in a range of populations (Afifi et al. 2010; Dowling et al. 2014a, 2016a; Suomi et al. 2013; Korman et al. 2008; Muelleman et al. 2002). However, the mechanism through which these two problem behaviours are related is less clear (Dowling et al. 2014a, 2016a; Suomi et al. 2013). It is possible that PG results from FV or that FV is a consequence of the negative impacts of gambling in the family (Roberts et al. 2018; Dowling et al. 2016a, b). It may also be that these two problem behaviours do not share a direct causal relationship but are related through separate factor(s) indirectly related to both violence and gambling, such as alcohol abuse (Dowling et al. 2016a). In addition, there is a lack of clarity about the role of gender in the relationship between FV and PG and whether there are unique demographic patterns in violence victimisation and perpetration related to gambling (Dowling et  al. 2016a). Understanding these more in-depth dynamics between FV and PG has important implications for prevention and intervention efforts that can help target and improve service responses for the occurrence of the two behaviours.

Burden of Harm Associated with Gambling Problem gambling is a low-prevalence psychiatric condition with an average of 2.3% past year prevalence rate across countries, ranging from 0.5 to 7.6% (Williams et  al. 2012). 6



Gambling and Addictions Research Centre, Auckland University of Technology, Auckland, New Zealand

7



Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, Australia

8



Auckland University of Technology, Auckland, New Zealand

9



Flinders University, Adelaide, Australia

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Two to three times as many people experience sub-clinical problems (Dowling et al. 2016) and substantially more are negatively impacted by the behaviour of problem and at-risk gamblers (Goodwin et al. 2017). Recent Australian and New Zealand studies have found the burden of harm associated with gambling is somewhat similar in magnitude to major depressive disorder and alcohol misuse and dependence and substantially higher in comparison to drug use disorders and diabetes (Browne et  al. 2017). The burden is largely due to financial impacts, damage to relationships and health, emotional and psychological distress, adverse effects on education and work, high levels of conflict and poor relationship functioning in the families of problem gamblers (Bellringer et al. 2013; Dowling et al. 2009, 2016b; Hodgins et al. 2007; Kalischuk et al. 2006; Schluter et al. 2007). Given the wide range of negative impacts of gambling on family and relationship functioning, it is hardly surprising that family members themselves also experience reduced emotional and physical health and high rates of maladaptive behaviors that can further escalate conflict and tension in the families of problem gamblers (Dowling et  al. 2014b, 2016a; Hodgins et al. 2007; Vitaro et al. 2008).

The Intersection Between Problem Gambling and Family Violence In contrast to problem gambling, there are no consistently reported prevalence estimates for perpetration and victimisation of FV in the general population. Most estimates focus on physical and/or sexual Intimate Partner Violence (IPV), whereby victimisation rates range between 15 and 34% for ever-partnered women (Garcia-Moreno et al. 2006), and a prevalence estimate for past year physical IPV perpetration for ever-partnered men is 22% (Desmarais et al. 2012). FV shares a number of common risk factors with PG, including male gender, young age, impulsivity, cognitive distortions, illegal acts, antisocial behavior, nicotine dependence, alcohol and substance use disorders, mood and anxiety disorders, and personality disorders (Dowling et  al. 2015a, b, 2017; Field et  al. 2004; Johansson et  al. 2009; Leone et al. 2016; Lorains et al. 2011, 2014; Scholes-Balog et al. 2014; Suomi et al. 2013). The actual mechanism through which FV and PG are related, however, remains open to speculation. Some evidence shows that victimisation precedes gambling problems, whereby victims of violence physically escape violent behaviours by attending gambling venues or use gambling as means to mentally cope with traumatic experiences (Afifi et al. 2010; Cunningham-Williams et al. 2007; Dowling et al. 2016a; Echeburúa 2011; Korman et  al. 2008). It has also been proposed that stress resulting from PG is a catalyst for the perpetration of violence by the problem gambler against family members or by a family member against the gambler (Afifi et al. 2010; Dowling et al. 2016a; Echeburúa 2011; Korman et al. 2008; Muelleman et al. 2002; Suomi et al. 2013). In addition, a small number of empirical studies have examined rates for both victimisation and perpetration in problem gamblers (Afifi et  al. 2010; Dowling et  al. 2014a; Korman et  al. 2008), and only one of these (Dowling et al. 2014a) reported the rates of bi-directional violence where the victim is also a perpetrator of violence. They found that overall rate of FV was 34%, whereby 11% reported ‘victimisation only’, 7% reported ‘perpetration only’ and the largest group, 16% of respondents, reported both victimisation and perpetration.

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Gambling and Intimate Partner Violence Of all forms of FV related to gambling, IPV is the most thoroughly documented. Dowling et  al.’s (2016a) systematic review on IPV and PG revealed a significant relationship between PG and both victimisation and perpetration. The review included a series of metaanalyses showing that over one-third of problem gamblers report being victims of physical IPV (38%) or perpetrators of physical IPV (37%); and that PG was over-represented in perpetrators of IPV (11%). The review also synthesised other types of violence (psychological, emotional) but the inconsistency of measures used across samples did not allow for conclusive reporting of types of violence in relation to gambling other than physical IPV.

The Role of Gender in the Intersection Between Gambling and Violence There are mixed research findings about gender differences between perpetrators and victims in PG samples (Bellringer et  al. 2016; Dowling et  al. 2014a; Korman et  al. 2008). Some evidence, for example, shows that gender does not play a role in the relationships between gambling severity and any forms of IPV (Afifi et  al. 2010). However, Korman et al. (2008) found that female problem gamblers were more likely than their male counterparts to report physical IPV perpetration. In contrast, Dowling et al. (2014a) found that female gamblers were significantly more likely to report ‘victimisation only’ and bi-directional IPV (being both a victim and perpetrator) than male gamblers. Finally, Bellringer et al. (2016) reported that males were at higher risk of FV perpetration than females, but that the gender effect became non-significant after controlling for a range of other health and wellbeing factors. From this available evidence, it remains unclear whether the association between FV and gambling varies depending on individuals’ gender, other demographics or whether the gambler is the perpetrator, the victim, or both.

Current Study There is a clear need for research that more fully examines the nature of the association between PG and violence, including violence that extends beyond intimate partners. Understanding the relationship between the two problem behaviours has important public health implications in terms of intervention efforts, as well as responsible gambling and violence prevention policies. Based on the available literature, the current study aimed to answer the following questions: (1) What are the rates of FV and IPV in treatment-seeking gamblers by form (perpetration, victimisation, bi-directional)? (2) Which family members are perpetrators and victims as reported by treatment-seeking gamblers? (3) Are there significant gender differences between victims and perpetrators of violence? (4) What are the rates of different types of violence perpetration and victimisation (physical, verbal) between family members? (5) What is the perceived temporal order of violent behaviour and gambling as reported by treatment-seeking gamblers?

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Method Procedure The current article reports data from a large-scale study investigating the prevalence of PG and FV in help-seeking populations; the full method has been reported elsewhere (Dowling et al. 2014a; Suomi et al. 2013, 2014). The study was approved by the University of Melbourne Human Research Ethics Committee (project 0838146) and the Victorian Department of Justice Human Research Ethics Committees (project 1119644). The larger study includes sites in Hong Kong (Chan et al. 2016) and in New Zealand (Bellringer et al. 2016), but this article reports on the 212 participants who were recruited at PG services in three states in Australia (Victoria, Tasmania and South Australia). All 212 participants were first screened for FV victimisation and perpetration (Phase 1) and as a part of the screen they were invited to take part in more in-depth interviews about the potential cooccurrence of PG and FV (Phase 2).

Participants The participants were 212 new clients of the participating PG agencies resulting from screening of consecutive cases for Phase 1 (as reported in Dowling et al. 2014b). Over half (51%) were female, with a mean age of 43.6 (SD = 13.0) years. In reporting the results, we use the term ‘participant’ to refer to the help-seeking problem gamblers who acted as the informants for this study; the term ‘family member’ to refer to family members of the informant; the term ‘family violence victim’ to refer to participants who are victims of FV, and the term ‘family violence perpetrator’ to refer to participants who are perpetrators of FV. We also use terms IPV and FV to refer to intimate partner violence (IPV) from violence involving other family members (FV), respectively.

Measures Family Violence The four-item HITS Scale (Sherin et  al. 1998) asks how often partners or family members physically Hurt, Insulted, Threatened with harm or Screamed at them. The four-item HITS was used to examine different types of violence separately for perpetration and victimization which could be reported in relation to unlimited number of family members and they were provided with a comprehensive list of the relevant immediate or extended family members including partners and ex-partners. The four types of violence were (1) physically hurt; (2) insulted or talked down; (3) threatened with harm; and (4) screamed at, and response options for the four types of violence were ‘never’, ‘sometimes’, ‘most of the time’, and ‘almost always’. For the purposes of this study, we identified the participant as a victim or a perpetrator for each type of violence if they endorsed any of the four types of violence in the last 12 months in relation to a family member. The HITS tool displays high internal consistency (α = .80) and good concurrent and construct validity (Sherin et al. 1998). The HITS was selected due to its brevity, good psychometric properties, and its ability to measure violence beyond intimate partners (see Thompson et al. 2006). For the

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purposes of the current study, Family Violence (FV) refers to any endorsement of HITS items in relation to family members other than intimate partners and Intimate Partner Violence (IPV) refers to HITS items endorsed in relation to intimate partners.

Relationship Between Gambling and Family Violence The interviews included three questions concerning the relationship between gambling and FV for those who endorsed FV in relation to one or more family members: (1) “Do you think the aggressive behaviours or gambling are related?” with the answer options yes/ no. Participants who answered ‘yes’ were also asked: (2) “Which one do you think came first, aggressive behaviours or gambling?” with the options of ‘gambling’ and ‘aggressive behaviours’. The last question was about the nature of the relationship between violence and gambling: (3) “In what way do you think the aggressive behaviours and your gambling are related?” The responses from the last question about the ways aggressive behaviours and gambling were related were categorised into recurring themes consistent with relevant gambling and FV literature (e.g., Dowling et  al. 2016a) and crosschecked between two researchers to avoid bias.

Data‑Analysis No missing data treatments were required for the scale measurements as participants answered all items before progressing to subsequent questions. Descriptive statistics were used to describe the rates for different forms and types of violence (with 95% confidence intervals [CIs]) reported in relation to overall sample estimates. Crosstabulations were employed to examine any demographic differences between the violence groups for categorical data; and a series of one-way ANOVAs were used to examine for continuous variables (age). Significance (alpha) levels are reported at p ≤ 05; p ≤ .01; and p ≤ .001.

Results The first part of the results reports the rates of different forms and types of FV and IPV in the past 12  months (research questions 1–4). For the clarity of reporting, we will use the term ‘form’ to refer to three forms of violence: (1) perpetration only; (2) victimisation only; and (3) both perpetration and victimisation (bi-directional); and the term ‘type’ for the four types of FV and IPV as measured by the HITS four-item screen. The second part reports findings from the questions regarding the perceived relationship between gambling and FV (research question 5) including the temporal order and causal explanations for the two problem behaviours.

Forms of Violence Victimisation and Perpetration Table  1 reports the demographics of our sample by form of FV and Table  2 reports the demographics of the sample by form of IPV. Forms of violence for Tables 1 and 2 were divided in three groups: (1) perpetration only; (2) victimisation only; and (3) both perpetration and victimisation; which all add up to (4) any form of violence. As shown in Table 1, around third of the participants reported some form of FV, with only 5.1% reporting perpetration only, 11.3% reporting victimisation only and 17.0%

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* = p < .05, ** = p < .01

50.0

45.5

34.2 (10.6) 100 90.9 20.0 11 (5.1)

Females

Age M (SD)** Born in Australia* English as first language In a live-in relationship* n (%) of the total sample (n = 212)

44.1 (15.7) 79.2 87.5 19.0 24 (11.3)

(2) FV vict. only (%)

(1) FV perp. only (%)

Table 1  Four FV groups by demographics

37.7 (10.2) 91.7 77.8 24.2 36 (17.0)

52.8

(3) FV perp. and vict. (%)

39.3 (12.3) 88.7 83.1 21.9 71 (33.5)

50.7

(4) Any form of FV (%)

43.6 (13.0) 77.8 85.4 39.4 100

50.5

Of the whole sample (%)

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44.5 (8.9) 75.0 75.0 100.0 4 (1.9)

*** = p < .001

100

Age, M (SD) Born in Australia English as first language In a live-in relationship*** n (%) of the total sample (n = 212)

(1) IPV perp. only (%)

Females

Table 2  Four IPV groups by demographics

44.3 (14.4) 57.1 71.4 71.4 7 (3.3)

42.9

(2) IPV vict. only (%)

40.3 (12.0) 81.2 92.8 76.6 69 (32.6)

55.1

40.1 (12.1) 78.8 90.0 77.3 80 (37.7)

56.2

(3) IPV perp. and vict. (4) Any form of IPV (%) (%)

43.6 (13.0) 77.8 85.4 39.4 100

50.5

Of the whole sample (%)

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reporting bi-directional FV (where the participant was both the perpetrator and victim). Of the demographic factors, age, country of birth and relationship status varied significantly across the FV groups. Compared to the rest of the sample, participants reporting FV perpetration only were older, more of them had been born in Australia and fewer were in a livein relationship. In all the groups reporting some form of FV, there were fewer participants living with a partner and more participants who were born in Australia than the sample average. There were no significant gender differences between the FV groups. Table 2 shows that nearly all IPV was bi-directional (32.6% of the whole sample); relatively small proportions reported IPV perpetration only (1.9%) or IPV victimisation only (3.3%). Of the demographics, only relationship status was significantly related to IPV. Expectedly so, there were more participants living with a partner in all IPV groups, in comparison to the sample average. While the gender differences for the IPV groups were not statistically significant, it should be noted that everyone who reported IPV ‘perpetration only’ (n = 4) were females and there were more females who reported bidirectional IPV than males in the sample. To examine the full scale of violence in the sample, it was important to examine both FV and IPV together as many who reported IPV did not report FV (and vice versa). Table 3 shows the rates of the four forms of FV by the four forms of IPV: (1) no violence, (2) perpetration only; (3) perpetration only; (4) both perpetration and victimisation (bidirectional violence). The rate of any form of violence reported by the participants in the sample was 60.8%. Over half of the sample (62.3%) did not report any IPV; of these, one-third reported some form of FV, mostly bidirectional. An even larger proportion (66.5%) of the sample did not report any FV; of these, around two-thirds reported some form of IPV. Only 22 participants (14.4%) reported both IPV and FV. The overall rates of violence perpetration and victimisation, as well as bidirectional violence, are at the bottom half of Table 3. Table 3  IPV by FV, rates of perpetration, victimisation, bi-directional, and any violence as reported by 212 gamblers No IPV n (%; 95 CI) No FV 83 (39.2; 32.5–46.1) FV perp. 8 (3.7; 0.1–0.7) FV vict. 17 (8.1; 4.7–12.5) FV 24 perp and vict (11.3; 7.4–16.4) Total 132 (62.3; 55.4–68.8)

IPV perp. only n (%; 95 CI) 3 (1.4; 0.1–4.1) 1 (< 0.1; 0–2.6) 0 0 4 (1.9; 0.5–4.8)

IPV vict. IPV perp and vict. Total only n n n (%; 95 CI) (%; 95 CI) (%; 95 CI) 6 49 141 (2.8; 1.0–6.1) (23.1; 17.6–29.4) (66.5; 59.7–72.8) 0 2 11 (0.1; 0–3.4) (5.2; 2.6–9.1) 1 6 24 (< 0.1; 0–2.6) (2.8; 1.0–6.1) (11.3; 7.4–1.6) 0 12 36 (5.7; 3.0–9.7) (17.0; 12.2–22.7) 7 69 212 (3.3; 1.3–6.7) (32.5; 26.3–39.3) (100)

RATES OF PERPETRATION, VICTIMISATION, BIDIRECTIONAL, AND ANY VIOLENCE ACROSS IPV AND FV n (%;95CI) Perpetration only Victimisation only Bidirectional violence

n = 24 (11.3; 7.4–1.6) n = 12 (5.7; 3.0–9.7) n = 93 (43.9; 37.1–50.8) Any perpetration n = 105 (49.5; 42.6–56.5) Any victimisation n = 117 (55.2; 48.2–61.9) Any violence n = 129 (60.8; 53.9–67.4)

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Table 4  Overall rates of FV and IPV victimisation and perpetration reported by 212 gamblers HITS items

Perpetration n (%)

Physically hurt you Insulted or talked down to you Threatened you with harm Screamed or cursed at you Any of the above

Table 5  The number of family violence victims and perpetrators reported by 212 gamblers

Victimisation n (%)

35 (16.5)

38 (17.9)

87 (41.0) 30 (40.2) 95 (44.8) 105 (100)

108 (50.9) 45 (21.2) 102 (48.1) 117 (100)

Number of family members reported by gamblers 1 2 3 4 Don’t know/refused Total (participants) Total family members reported by the participants

Perpetration by the gambler n (%)

Victimisation of the gambler n (%)

81 (77.1)

86 (73.5)

15 (14.3) 4 (3.8) 3 (2.8) 2 (2.9) 105 (100) 135 (100)

18 (15.4) 7 (6.0) 3 (2.5) 3 (2.5) 117 (100) 155 (100)

Types of Victimisation and Perpetration The next section of the results examines the breakdown of HITS responses for the 105 (49.5%) participants who reported ‘any perpetration’ and 117 (55.2%) participants who reported ‘any victimisation’ as shown in Table 3. This allows for examination of different types of violence, as recorded by HITS, that the participants had experienced in the past 12 months. We combined both IPV and FV for these overall rates of perpetration and victimisation. As shown in Table 4, the most common types of violence were verbal in nature (‘insulting or talking down’ and ‘screaming or cursing at’) for both perpetration and victimisation. Physical violence was the least common type of the four, also for perpetration and victimisation.

The Victims and Perpetrators of Violence The participants were able to report perpetration and victimisation for up to five family members although most of them only reported being a victim (73.5%) or perpetrator (77.1%) in relation to one family member, as shown in Table 5. However, over one quarter reported being victimised by more than one family member and nearly a quarter of them reported that they had perpetrated violence towards more than one family member. The last two rows of Table  5 show that 105 participants reported perpetration of

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J Gambl Stud Table 6  Family members identified as victims of family violence by 212 gamblers Family member

Physically hurt n (%)

Insulted or talked down n (%)

Threatened with harm n (%)

Screamed or Total n (%) cursed at n (%)

Current partners

8 (11.0)

57 (58.1)

4 (5.5)

65 (89.0)

73 (100)

Parents Former partners Siblings Children In laws Refused/DK Total

4 (20.0) 1 (7.1) 0 6 (35.3) 1 (100)

21 (87.5) 12 (85.7) 7 (77.8) 16 (94.1) 1 (100)

2 (8.3) 3 (21.4) 1 (14.3) 6 (35.5) 0

19 (79.2) 14 (100) 6 (85.7) 15 (88.2) 1 (100)

20 (14.5)

114 (84.4)

16 (11.9)

120 (88.9)

24 (100) 14 (100) 9 (100) 17 (100) 1 (100) 3 (100) 135 (100)

Table 7  Family members identified as perpetrators of family violence against 212 gamblers Family member

Physically hurt n (%)

Insulted or talked down n (%)

Threatened with harm n (%)

Screamed or Total n (%) cursed at n (%)

Current partners

9 (11.8)

63 (82.9)

9 (7.9)

64 (84.2)

76 (100)

Parents Former partners Siblings Children In laws Refused/DK Total

2 (10.0) 5 (26.3) 0 3 (15.7) 0

15 (75.0) 19 (100) 15 (100) 19 (100) 6 (75.0)

2 (10.0) 9 (47.4) 3 (20.0) 3 (15.7) 2 (25.0)

18 (90.0) 16 (84.2) 13 (86.7) 16 (84.2) 4 (50.0)

19 (12.2)

137 (88.4)

20 (100) 19 (100) 15 (100) 19 (100) 8 (100) 17 (100) 155 (100)

28 (18)

131 (84.5)

violence in relation to 135 family members and 117 participants reported victimisation in relation to 155 family members. The victims by type of violence perpetration are shown in Table  6. Current partners were most likely to be victims (n = 73), followed by parents (n = 24), children (both adult and dependent minors; n = 17), former partners (n = 14) and siblings (n = 9). The most common type of violence was ‘screaming or cursing at’ (89%) the family member and that was the case for all family members for whom the participants reported to have perpetrated against. ‘Insulting and talking down’ (84.4%) was the second most common type of perpetration. ‘Physically hurting’ (14.5%) was the least common type of perpetration and it was reported in relation to current partners, parents, children, formers partner and one in-law, but not in relation to siblings. The perpetrators of violence by type of violence are shown in Table  7. Similar to Table 6, current partners were the largest groups of perpetrators (n = 76). Dissimilar to victims (Table  6), parents (n = 20), former partners (n = 19) and children (n = 19) displayed similar rates of perpetration. While ‘insulting or talking down to’ (88.4%) was the most common type of violence, ‘screaming or cursing at’ was the most common type of perpetration by current partners and parents but for other family members it was ‘insulting or talking down’ to the participant. ‘Physically hurting’ (12.2%) was the least common form

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Table 8  Proportion of sample identifying a link between gambling and family violence by family member

J Gambl Stud Family member

Perpetration n (%)

Victimisation n (%)

Parents

19 (79.2)

17 (85.0)

Current partners Former partners Siblings Children In laws Any family member

44 (97.8)* 11 (78.6) 8 (88.9) 12 (70.6) 1 (100) 95 (73.7)

16 (84.2) 12 (80.0) 11 (57.9) 4 (50.0) 104 (67.1)

*Substantial amount of missing data—this question was asked only from 45 participants in intimate partnerships and without separating victimisation and perpetration

Table 9  The temporal order of violence victimisation and perpetration and gambling Form of violence

Valid responses Gambling n first n

Violence first n

Other* n

FV victimisation of the gambler

46

41

0

5

FV perpetration by the gambler IPV vict. and perp.

39 44

31 27

2 17

6 0

*No clear sequential order/order varies

of violence and was reported in relation to current partners, parents, and children but not in relation to siblings or in-laws.

The Perceived Relationship Between Gambling and Violence All participants who reported any HITS perpetration or victimisation were also asked “Is this aggressive behaviour related to your gambling?” Table 8 shows the breakdown of those who responded that gambling was linked to perpetration and victimisation of violence by family members. A majority of all violence was reported to be related to gambling: 73.7% of perpetration and 67.7% of victimisation. The participants who reported that gambling and aggressive behaviours were related then indicated which one of the behaviours occurred first. Table 9 shows the break-down for FV perpetration, FV victimisation and IPV (combined perpetration and victimisation). Most participants reported that gambling preceded aggressive behaviours for FV victimisation and FV perpetration as well as for IPV. None of the participants reported that violence preceded FV victimisation and only two reported that violence preceded FV perpetration. Some participants also reported that there was no clear sequential order between gambling and violence. In contrast to FV, a significant proportion of participants (n = 17) who reported IPV reported that violence preceded gambling behaviours. The participants also responded to an open-ended question ‘How are these two behaviours related?” The answers, where the respondent had elaborated on the relationship, were coded according to four separate recurring themes that emerged which were also consistent with the relevant literature. Table 10 shows all the responses for FV perpetration and FV victimisation and IPV where gambling preceded violence and they were: (1) fight about gambling without further elaboration (e.g., ‘Fighting about gambling” OR “she talks down

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J Gambl Stud Table 10  Elaboration on the relationship between gambling and violence victimisation and perpetration

Gambling → violence

FV victimisation, n

FV perpetration, n

IPV, n

Fight about gambling

13

9

11

Money Stressed/upset/worried Anger Trust Total

11 6 11 0 41

6 12 4 0 31

7 3 3 3 27

to me because of gambling, she doesn’t like it”); (2) fight about money (e.g., “She can’t understand how I could just throw money away. She can’t comprehend how I could do that.” OR “Yes, my gambling created a lot of financial problems (…) that meant we fought about it (…) a lot”); (3) stressed, upset, worried about gambling (e.g., “It causes frustration that effects the relationship. People don’t know how to bring it up and they don’t know what to do and it makes them anxious and creates stress and tension in the relationship, that impacts in a big bad way on it”; (4) family member’s anger over gambling (e.g., “She gets severely angry when I’m gambling” OR “Out of concern they get angry for doing it [gambling]). The four reasons for FV perpetration by the gambler were similar: (1) fight about gambling; (2) fight about money; (2) stressed, upset, worried over own gambling; (3) anger over own gambling and losses (e.g., “Home from bad loss, got angry at mum who is a volatile person” OR “Losing, taking out my anger”). The explanations in relation to IPV were similar to those in relation to FV with the addition of ‘trust’ issues (e.g., “I had been dishonest and the mistrust that I created because of the gambling” OR “…when the gambling started, there was distrust because I lied about gambling and I had the guilt, and that would lead to arguments”) that did not emerge in the answers in relation to other family members. Also for IPV, the ‘fight about gambling’ theme was the most common answer, followed by the ‘fight about money’ theme.

Aggression First Open‑Ended Accounts for IPV Of the 17 respondents who answered that IPV preceded gambling, eight individuals either could not or chose not to elaborate on the open-ended question: ‘How are aggressive behaviours and gambling are related?’ Eight respondents who reported that IPV preceded gambling were females, and one was male. All valid answers (n = 9) are as shown in Table 11. As shown in Table 11, a majority of these personal accounts are consistent with gambling as means of coping with stress in the home or physically escaping the conflict or violent environment. Although the number of responses is low and cannot be generalised to the general population, it does paint a consistent picture of the ways aggressive behaviour in the intimate partnership can lead to problematic gambling.

Discussion The current study set out to explore the co-occurrence between FV/IPV and PG, and increase the understanding how this co-occurrence could be explained by examining the following: (1) the rates of FV and IPV in treatment-seeking gamblers by form (perpetration, victimisation, bi-directional); (2) family members who were perpetrators and victims;

13

13

Gender, age

F, 52

F, 52 F, 66 F, 46 F, 31

F, 64

M, 52

F, 36 F, 69

#

1

2 3 4 5

6

7

8 9

I feel the need to gamble to cope with his behaviour Stress [from violence]. Makes me want to gamble Conflict–pressure–frustration anger—gambling Gambling was my only outlet because he took my life away. I didn’t even exist. He had all the control and I just wanted to get a bit of my own money so I could have some control over my life. He would give me money and I would go to TAB on the weekends and gamble away. His behaviour, control and violence was always the real issue not my gambling. Since we separated I have no reason to gamble The aggressive behaviour was there and I gambled to feel a bit better. It’s a place to go when I didn’t want to be at home and around him I think the two go hand in hand they’re related. After heated discussions with my wife I would feel I needed to gamble the next day Violence leads to gambling Cause of it [gambling]

My husband is violent and I need to gamble. I gamble and it makes him pick a fight with me and then he’s violent

Personal account on how aggressive behaviour leads to gambling

Table 11  Personal accounts of the relationship between gambling and IPV by nine gamblers

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(3) any gender differences between victims and perpetrators of violence; (4) the rates of different types of violence perpetration and victimisation (physical, verbal) between family members; and (5) the perceived temporal order of aggressive behaviours and gambling as reported by treatment-seeking gamblers. In relation to the first question and consistent with previous research (Afifi et al. 2010; Dowling et al. 2014a, 2016a; Korman et al. 2008; Muelleman et al. 2002), the current data shows high rates of family- and intimate partner violence in help-seeking gamblers. Over half of the sample (60.8%) reported some form of violence (including both IPV and FV) in the past 12 months. Bidirectional violence (43.9%) was significantly more common than ‘perpetration only’ (11.3%) or ‘victimisation only’ (5.7%). Just over half of all violence was by or against intimate partners; this violence was mainly bi-directional, whereby the gambler was both a victim and a perpetrator. There was little overlap between FV and IPV, with only a small group (~ 14%) of the sample reporting both IPV and FV. The second research question examined the victims and perpetrators of violence as reported by the current sample. A clear majority of the perpetrators and victims were current partners and other immediate family members (parents, children, siblings), although a handful of in-laws and former partners were also reported as perpetrators and victims of violence in the past 12 months. While most participants reported victimisation and perpetration only in relation to one family member, around one quarter of the gamblers reported being a victim or perpetrator of violence in relation to multiple family members. These findings are important as current evidence of violence other than IPV in gamblers is limited (Dowling et al. 2016a; Suomi et al. 2013). In relation to the third question about demographic factors related to the violence groups, we found no significant differences in victimisation or perpetration rates between males and females, and that seems to be consistent with some studies (e.g., Afifi et  al. 2010; Korman et al. 2008) but not with others (Echeburúa 2011). These current findings, however, are in line with general population studies of FV, whereby men and women are as likely to be victims and perpetrators of violence (Archer 2002; Fiebert 2010). In addition, gamblers who reported FV were less likely to be living with a partner than those who reported IPV. This seems logical as individuals outside co-habiting relationships may rely more on immediate family members for support that may, in turn, exacerbate or create conflict in the context of gambling problems. Of the other demographic factors, only age was related to violence perpetration and the small group that only reported FV perpetration were older than the rest of the sample. The fourth question sought to examine the types of violence reported in the sample. The violence (both FV and IPV) reported by participants was mostly verbal but physical violence also featured in the responses. Physical violence was most common in relation IPV victimisation and perpetration but was also reported in relation to children, parents and ex-partners (both perpetration and victimisation). Children were more likely to be victims than perpetrators, of physical violence, and ex-partners were more likely to be perpetrators than victims, of physical violence. The verbal violence as measured by HITS included screaming or cursing at, insulting or talking down to the victim. In relation to the last question on the temporal order of violence and gambling, most gamblers who reported FV also reported that the violence, both perpetration and victimisation, was related to their own gambling. For the clear majority who reported that the two behaviours were related, it was more likely that gambling preceded violence and that the conflict that led to violence was about gambling: financial losses, or anger, stress and anxiety related to the losses. Similar results have been previously reported by family members of problem gamblers (Suomi et al. 2013) and the reasons for gambling-related conflict are

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consistent with the literature on gambling-related stressors and the negative family impacts of gambling (Dowling et al. 2009, 2016b; Hodgins et al. 2007; Kalischuk et al. 2006). The majority of FV and IPV reported in the sample is consistent with ‘situational’ type of violence whereby men and women are equally likely to be victims and violence is reciprocal (Gilchrist and Hegarty 2017; Kelly and Johnson 2008), the violence is mostly verbal in nature and triggered by gambling or other contextual stressors (Carlson and Dayle Jones 2010; Friend et al. 2011; Jacobson and Gottman 1998; Johnson and Ferraro 2000). However, a small group of female victims of IPV in the sample reported using gambling as a coping mechanism to deal with past or current violence—some of it severe and traumatising. Similar results have been previously reported in relation to trauma and gambling (Hodgins et al. 2010; Nixon et al. 2013). This type of violence seems more consistent with ‘characterological’ type violence that is more likely to involve controlling and coercive behaviours, tends to be asymmetrical and involves a clearly identifiable perpetrator and victim (Carlson and Dayle Jones 2010; Friend et  al. 2011; Jacobson and Gottman 1998; Johnson and Ferraro 2000). The number of women reporting this type of violence in the current sample is not high enough to make any conclusive comments, but these qualitative accounts can provide some direction to future research on female victims of IPV who experience gambling problems. This study provides the first level of evidence of the mechanisms by which FV and PG could be related. The next step in understanding the relationship is to explore these temporal and potentially causal relationships through robust prospective research designs. In particular, the potential pathway in which violence victimisation manifest in problematic gambling warrants more in-depth investigations using a longitudinal methodology. Focusing on the most vulnerable groups to gambling and violence, including indigenous populations and those suffering from mental health issues, should be of priority in designing such studies. The relationships found in this study should also be tested in general populations as well as in representative samples of help-seeking victims and perpetrators of family violence. Future investigations, with prospective methodology, are also needed to deepen our understanding of the intersection of PG, FV, and a range of psychiatric comorbidities (Dowling et al. 2016a). One of the novel contributions of this study is the examination of FV beyond IPV, including members of immediate and extended families. The study found high levels of FV, particularly for those gamblers who were not in a live-in relationship. Given that supportive family network may act as a protective factor against escalation of gambling problems (e.g., Scholes-Balog et  al. 2015), maintaining family relationships and reducing conflict should be routinely implemented as part of treatment plans for gamblers who seek help. A vast majority of current interventions for FV and IPV focus on gendered treatments where the male is perceived as the perpetrator and the female as the victim, largely based on the feminist approach (Bartholomew and Cobb 2012), although evidence from community-based samples consistently indicates that men and women perpetrate violence at similar rates (Archer 2002; Fiebert 2010) particularly in relation to IPV (Low et al. 2017). Other studies have highlighted that not only are these types of treatments ineffective but also that there is a real gap between existing intervention efforts and empirically driven approaches considering bi-directional IPV (Low et  al. 2017). The main findings of this study point to high levels of bi-directional and situational violence, particularly in cohabiting relationships. The types of violence related to gambling have significant implications for treatment matching and should be further explored. Some appropriate couplebased treatments include conjoint couple treatments where the focus is on the relationship dynamic and other forms of family therapy (Friend et al. 2011).

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While this study only scratches the surface of the complex relationship between FV and gambling, the notion of the strong co-occurrence of the two problem behaviours should be reflected in routine practice and policy concerning both problem behaviours. For example, treatment of victims and perpetrators of family and intimate partner violence should include screening for gambling (and vice versa) (Dowling et al. 2016a). Treatment services for FV and gambling would greatly benefit from having well-developed response and identification mechanisms and referral pathways to serve clients who report the two problem behaviours, especially for those who seek help in relation to a family member’s gambling. Despite the obvious strengths of the current research in exploring the dynamics of FV and PG, some caution should be taken as to how these results can be used and interpreted. The limitations of the study are related to the research methodology, cross-sectional design, self-reports by gamblers and a purposeful sampling through gambling treatment services. These apparent methodological constraints will not allow for generalisations of the results to a wider population of gamblers or to individuals who are victims of violence or who use violence against others. In addition, the measure of violence used in this study (HITS; Sherin et al. 1998) only focused on four types of violence and did not cover sexual, psychological or economic abuse or gendered forms of violence including coercive control. However, the HITS tool could be easily employed to ask questions about other family members than intimate partners and allowed for inclusion of more minor forms of conflict and violence that were important to capture for the purposes of the study. As evidenced by the small number of female victims of IPV in the study who used gambling as means of coping with violence, there is clearly a need for future research to employ a contextualised, more gendered approach to the measurement of violence in the gambling context. Finally, it was out of the scope for this study to address the implications of mental health problems or substance abuse in the relationship between violence and gambling, both of which are likely to play a significant role in the co-occurrence of FV and PG (Dowling et al. 2014a, 2016a). This paper sheds light on the well-established relationship between FV and PG. The article reports the first findings on how gamblers, who also experience violence, perceive the relationship between the two behaviours. While these personal accounts provide insights on how co-occurring violence and gambling could be treated or prevented, more work is needed on testing and confirming these relationships with more robust methodologies, larger samples and longitudinal designs. In addition, the research on and treatment of violence and its comorbidities should acknowledge the high rates of bi-directional and situational violence related to IPV and the shift from the traditional focus on women as victims and men as perpetrators. Given that a large body of evidence points to men and women being equally likely to be victims and perpetrators of violence, interventions, where appropriate and safe, could include both partners and possibly focus on the relationship dynamics, in addition to targeting the violent and aggressive behaviours. Funding  This research was funded by the Australian Research Council (Linkage Grant LP 0989331) with the Office for Problem Gambling, South Australia and Drummond Street Services, Victoria as industry partners; and the Problem Gambling Research and Treatment Centre at the University of Melbourne. Compliance with Ethical Standards  Conflict of interest  The authors declares that they have no conflict of interest. Ethical Approval  The study is compliant with the Australian Ethical Standards and the study protocol was approved by the University of Melbourne Human Research Ethics Committee (project 0838146) and the

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Victorian Department of Justice Human Research Ethics Committees (project 1119644) that are compliant with the Australian National Health and Medical Research Council guidelines for conducting research on human participants.

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