According to Ferguson and Madara (1998), traditional face-to-face and new online self-help approaches share many of the same strengths. They list an additional 10 advantages of online groups not shared by face-to-face versions:

• More convenient access (individuals do not need to get dressed up to attend and when they want to leave, they simply click a button).
• It is easier to find groups for rare conditions.
• It is easier to locate both popular and technical information via online sources.
• Individuals experience more of an equal or collegial relationship with their health care provider (when this is available to them online).
• Individuals feel a greater sense of personal responsibility in the online version and therefore are more proactive regarding their health care.
• Health care providers are moved from a position of authority to that of a facilitator, which is easier for individuals to relate to.
• Health care providers improve their knowledge and skills as a result of participating in online discussion groups since they learn more about their patients’ needs. Discussions can be stored as archives for the benefit of others or as a refresher.
• Physical barriers are minimized (for example, bad weather, geography, shift work and so forth can be neutralized by online formats).
• Anonymity is safeguarded absolutely (unlike traditional face-to-face settings where anonymity is merely a function of the promise members make to one another).

Others have suggested additional benefits of online support groups, including:

• The fact that social status cues (for example, physical appearance) are minimized (Finn, 1996; Galinsky et al., 1997).
• Reluctant members might be more likely to participate if they are not called upon to verbalize in front of a live audience (Finn & Lavitt, 1994; Meier, 1997).
• Feelings of social isolation can be overcome (Dunham et al., 1998).
• Busy individuals who ordinarily might not have the time to travel to meet one another can still get together online (Anderson & Kanuka, 1997).

Tom Ferguson (1996b), a physician who also completed a doctoral thesis on self help in 1978 at Yale Medical School, described a very moving letter from “Jack in Utah” posted on a death and dying support group. Therein, “Jack” discussed his son’s accidental death by strangulation as he had been attempting to make a Halloween haunted house in the garage. The father’s anguish appeared to be overwhelming as he asked for help from those associated with the online group. Within the next two days, Jack received dozens of responses of support, empathy and advice. Sometime afterwards, Ferguson presented Jack’s story at a conference by way of illustrating the powerful possibilities of online self help. Following his address, he was approached by two very distinguished therapists who concluded that, had Jack come to them for help, although they [were] both very well trained, highly respected therapists, that they probably would not have been able to help him in nearly such an immediate, compassionate, practical and powerful way (Ibid., paragraph 34). This certainly sounds like the kind of endorsement that should be taken seriously, even if it is anecdotal.

It is important to be aware that there are some drawbacks:

• Access is often limited to those with the financial means to afford computer equipment and Internet access (Finn, 1996; Lacroix, 1997).
• People might become more socially isolated as they spend increasing amounts of their time with virtual friends as opposed to real-life friends and family (Finn, 1996; Kraut et al., 1998; Zimmerman, 1987) and this in turn might increase feelings of loneliness and depression (Kraut et al., 1998).
• Since membership cannot be assured, discussions may end up being unfocused and repetitive (Meier, 1997, page 43).
• People might become addicted to the Internet as a result of prolonged exposure (Morahan-Martin, 1998).
• Some concerns about liability have been noted in connection with advice being rendered in this format (Lacroix, 1997; Schwadron, 1997). With regard to liability issues, it has been reported that the American Psychological Association was planning to form a committee to examine online therapy in closer detail (Rice, 1997).

Is online help effective?

Many studies address the issue of the effectiveness of online groups. Such a comprehensive review is beyond the scope of this paper, but I will highlight three studies. One of the more detailed evaluations compared the impact of an online format with that of small face-to-face groups of emotionally disturbed adolescents.

Zimmerman (1987) found that the online format resulted in a greater expression of feelings and more frequent references to interpersonal issues than the face-to-face version. A total of 18 adolescents ranging in age from 13 to 20 years were involved in a computer project spanning several months; they learned basic skills and later became involved with a closed (in-house) discussion group with no constraints on their language or content. The data were analyzed both qualitatively and quantitatively. In the end, Zimmerman concluded that “computer-mediated communication may represent a new resource for eliciting emotionally rich, relationship-oriented verbal interaction among emotionally disturbed adolescents” (p. 837).

An interesting study from the Halifax area conducted pre- and post- tests of parental stress of 42 young (aged 15 to 20) single mothers who participated in a private (firewall-protected) online support group over six months (Dunham et al., 1998). A majority of the participants used the group consistently once they had been recruited and computer equipment supplied to them. The researchers found:

• a correlation between those who accessed the group and their level of participation with higher feelings of belonging and reduced stress levels
• that those who provided the most support to others also tended to receive the most support
• that the most socially isolated mothers tended to be the most likely to participate.

This research team concluded that “the development of close bonds between individuals with shared interests and problems tended to be the rule, not the exception. Our data indicate that the technology does not suppress socioemotional content” (Ibid, p. 300-1). In the end, the mothers themselves insisted on a continuation of their support network beyond the study!

Finally, a survey of group practitioners was conducted to learn of their experience, knowledge and comfort levels with computer groups (Galinsky et al., 1997). Of 213 usable surveys, the authors found that the most frequently cited purposes for computer-mediated-communication (CMC) were education and support. They also noted that the ability to master the technology itself can be an empowering process.

Online Assistance for Problem Gamblers

Self-help groups
The growing body of literature describing the successful use of online support groups for a variety of other health problems leads to the logical conclusion that such groups may also be of some help to individuals seeking to resolve their gambling problems. Unfortunately, there appear to be little if any published accounts to date of how problem gamblers are using online support groups as part of their therapeutic journey.

One unpublished observational study does suggest, however, that problem gamblers do make good use of online self-help communities (Cooper, 1998). In this study, postings to GAweb (a popular asynchronous online self help support group for problem gamblers) were analyzed for one year. Participants (100 males and 100 females randomly selected from postings during 1997) stated that they logged on from many different parts of the world including Australia, Canada, England, Germany, Ireland and the United States. Key findings include:

• Women’s participation increased over the course of the year to 44 per cent of the posts by year’s end, and as individuals, they posted as often and as extensively as men.
• Women also tended to seek help more often than men, to start a new thread more often and to report themselves as being new to the group.
• Men were more likely to provide an e-mail address and to identify themselves as having attained one year of abstinence from gambling.
• Most of the postings came during the evening hours.

Clearly, more research on this emerging form of social support is required.

Problem Gambling Information and Assistance

Aside from self-help support groups, many Internet sites provide easy access to problem gambling information and assistance. However, not all information posted on the Internet is necessarily accurate. For the same reason that consumers of information can also be its producers in this dynamic environment, recipients of information and advice need to take proper precautions that they are receiving credible information and advice. Take a few moments to check the accuracy of such information (for example, verifying by comparing with information posted at other sites where there is an affiliation to well-known institutions such as hospitals or universities).

That being said, there are many helpful locations that you and/or your clients might want to visit. The quickly changing nature and overwhelming size of the Internet does not permit an adequate description of all that is available. What follows, though, is a partial listing of Internet sites with problem gambling-specific information current to October 2000. Even if these sites change or disappear over time (since this book might long outlive some of the Web sites), you can get an appreciation for the kinds of information that are easily obtained through the Internet. In addition, it is very likely that Internet-based information concerning problem gambling will grow even more comprehensive in the coming years.

Using the Internet

Even if you or your clients do not have access to the Internet, you should know that public libraries often provide free Internet connections for their patrons. Staff will be only too happy to show you what you need to know to find information (for example, how to obtain information about the Canadian Foundation on Compulsive Gambling by using a search engine — you simply type in the key word and a number of hits will appear: these are hypertext links that you click on and then transport yourself to that location).

When copying down a url (the characters in between the triangular parentheses ), make sure to be exact since any alterations will result in an inability to locate the site you want: for example, do not type a letter as lowercase if it is listed as upper-case (and vice versa); periods, commons, colons and semicolons (and so forth), all need to be entered as shown in order to be successful at locating a specific site.

Build Your Own Web Site: A How-to Guide

It is relatively easy to start your own e-mail discussion list or to establish your own Web page on the Internet. Indeed, a growing number of people are doing just that — individually and collectively, from service providers to consumers.

List Serves

Starting an e-mail list is as easy as finding a few individuals who share a particular interest (for example, persons who concurrently have depression and vlt problems), and organizing them into a group in the address book of your electronic mail software. Next, decide what information and/or materials you would like to send to the members of this group and how often; you might also invite members to send notes and articles to you to be compiled and later distributed to the larger group. In an effort to attract more members to the group, you could find similar interest news groups on the Internet and post a note on your special topic with information on how anyone interested in subscribing could receive your newsletter. Ferguson’s Health Online (1996a) provides excellent examples of how many divergent mailing lists and news groups got started.

Web Pages

Publishing a Web page on the Internet is only a little more challenging. If I can do it anyone can! Nowadays, the software packages that are available for this purpose make experts out of novices. Any electronic file that you might want to post to the Internet can be uploaded from your computer to the main computer at your Internet Service Provider (isp — in order to interact with the Internet, it is necessary to have an ISP). To upload files, you simply need to have the software (known as a file transfer protocol or ftp) to facilitate the exchange. ftp software is frequently available free of charge on the Internet (to find out where, simply go to a search engine and type in the key words). Adding more elaborate features to your electronic file (like hypertext links and graphics) is possible by either knowing how to instruct the computer using html language (hypertext markup language), or by using the features of Web page design software packages (again, many of these are available free of charge on the Internet).

After your Web page is operational, you can promote its existence by informing other Web page operators of your url and requesting that they provide a link to your page; that way, visitors to their site can learn of yours at the same time. Before you know it, you will be receiving e-mail messages from interested parties from around the world!

A few last words

The scenarios of Tamara, Joe and Kevin at the start of this section present challenges to the more traditional methods of providing assistance. After reading countless stories at GAweb and elsewhere in cyberspace, I have full confidence that individuals like these will increasingly find information, support and help from their use of Internet-aided forms of assistance.

The extent to which therapists should facilitate these contacts remains a matter of personal perspective and perhaps debate. It can be argued that those whose first experience with help-seeking is via specialized counselling, deserve, at a minimum, to be informed by the therapist of other potentially helpful approaches. This is particularly true if the approaches have as many advantages as do online support groups. Ideally, therapists will routinely inform and refer their clients to such programs in the very near future. To be sure, therapists themselves may benefit from listening in on the discussions of problem gamblers in this kind of open forum. Happy surfing!

Click here for a list of online resources

References

Anderson, T. & Kanuka, H. (1997). On-line forums: New platforms for professional development and group collaboration [40 paragraphs]. Journal of Computer Mediated Communication [On-line serial], 3 (3). [http://www.ascusc. org/jcmc/vol3/issue3/anderson.html]

Carey, E. (1999, April 24).Web taking over home life. The Toronto Star, p.A18.

Cooper, G. (1998). On-line assistance for problem gambling: Who’s participating? (Unpublished manuscript, available from ).

Dunham, P.J., Hurshman, A., Litwin, E., Gusella, J., Ellsworth, C. & Dodd, P.W.D. (1998). Computer-mediated social support: Single young mothers as a model system. American Journal of Community Psychology, 26 (2), 281-306. Ferguson, T. (1996a). Health Online. Reading, MA: Addison-Wesley Publishing Company.

Ferguson, T. (1996b,May). A guided tour of self-help cyberspace (A Keynote Presentation from “Partenerships for Networked Consumer Health Information”) [140 paragraphs] DocTom’s Online Self-Care Journal [On-line serial]. [Internet address: <http://www.healthy.net/welcome/>]  

Ferguson, T. & Madara, E.J. (1998). 25 Lessons from online support networks [26 paragraphs]. DocTom’s Online Self-Care Journal [On-line serial]. [Internet address: <http://www.healthy.net/scr/article.asp?Id=992>]

Finn, J. (1996). Computer-based self-help groups: On-line recovery for addictions. Computers-in-Human Services, 13 (1), 21-41.

Finn, J. & Lavitt, M. (1994). Computer-based self-help groups for sexual abuse survivors. Social Work With Groups, 17 (1/2), 21-46.

Galinsky, M.J., Schopler, J.H. & Abell, M.D. (1997). Connecting group members through telephone and computer groups. Health and Social Work, 22 (3), 181-188.

Gilder, G. (1994). Life After Television: The Coming Transformation of Media and American Life. New York:W.W. Norton & Company.

Kraut, R., Lundmark, V., Patterson, M., Kiesler, S., Mukopadhyay, T. & Scherlis, W. (1998). A social technology that reduces social involvement and psychological well-being? American Psychologist, 53 (9), 1017-31.

Lacroix, S. (1997). Internet discussion lists in substance abuse: Impact on consumer health, recovery and support. Bibliotheca Medica Canadiana, 18 (4), 137-140.

McGuigan, P.P. (1998). Internet gambling. Computer Law & Security Report, 14 (2), 112-115.

Meier, A. (1997). Inventing new models of social support groups: A feasibility study of an online stress management support group for social workers. Social Work With Groups, 20 (4), 35-53.

Morahan-Martin, J. (1998, September). Caught in the Net: Can Internet use become abusive? Paper presented at the Addictions ’98 Conference, Newcastle upon Tyne, uk.

NUA Internet Surveys. (2000a). How Many Online? [1 paragraph]. [On-line serial]. [http://www.nua.ie/surveys/how_many_online/EN/Pages/default.aspx]

NUA Internet Surveys. (2000b). How Many Online: US & Canada? [1 paragraph]. [On-line serial]. [http://www.nua.ie/surveys/how_many_online/n_america.htm]

Rice, V. (1997, May 29) Cyberpsychology: Therapy for the 1990’s. The Site (msnbc tv). [On-line serial]. []

Schwadron, T. (1997, March 31), Postcard from cyberspace: Not all therapy may be net-worth. Los Angeles Times. [On-line serial]. [Internet address: <http://www.metanoia.org/imhs/latimes.htm>]

Zimmerman, D.P. (1987). A psychological comparison of computer-mediated and face-to-face language use among severely disturbed adolescents. Adolescence, xxii (88), 827-840.

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