Problem Gambling in Japan

Gambling is illegal in Japan. However, due to loopholes in the law and inconsistent policies, many forms of gambling are allowed to exist. Multiple government agencies are involved but none have legal responsibility for addressing the consequence of excessive gambling. There appears to be an increase in problem gambling among Japanese men who are alienated and frustrated by a deterioration in their work environment. One way Japanese cope with stress is by withdrawal, and gambling, especially pachinko and pachislot, offers an escape from work-related pressures and feelings of inadequacy. Gambling-related problems bring shame to the gambler and family members, who are afraid of public exposure and social exclusion. Gamblers Anonymous (GA), the self-help group for problem gamblers, started in the United States but has been adapted to meet Japanese needs. These include avoidance of confrontation and acceptance by nakama (one's fellows). GA members and their families regain healthy ways of living through mutual support and identification with their nakama.
 

Key Words

problem gambling; Japanese workers; alienation, social exclusion; Gamblers Anonymous; nakama

The personal and social effects of problem gambling often include serious financial difficulties, family problems, employment and legal difficulties, stress-related physical disorders, psychological distress, and suicide (Meyer et al., 2009; National Gaming Control Commission, 2010; Williams et al., 2007). That the Japanese government has done little to recognize this problem is not surprising since gambling is illegal in Japan, and the favored games, pachinko and pachislot, are not even considered gambling. To deal with the problems, Japanese gamblers and their families are forming self-help groups: Gamblers Anonymous (GA) for gamblers and Gam Anon for family members.

There is a rather narrow literature on problem gambling published in Japanese. There are three types of materials. First, there are books by psychiatrists intended for a lay audience (Hahakigi, 2004, 2010; Inami, 2007; Iwasaki, 1998; Tanabe, 2002). These inform the public about the seriousness of the problem and teach gamblers how to overcome it. Second, there are personal stories written by gamblers and their family members (Gamblers Anonymous Japan Information Center [GA JIC], 2010a; Nujumi, 2010; Oneday Port, 2004). Third, there is survey data about GA and treatment-seeking gamblers (GA JIC, 2009; Oneday Port, 2007; Recovery Support Network, 2008; Takiguchi, 2009, 2010). The first publicly funded study of Japanese problem gamblers was conducted by Tanaka (2010), who investigated co-morbid disorders and the applicability of an American screening test, the South Oaks Gambling Screen.

In English, there is more of a literature on Japanese gambling, albeit mostly concerned with its history, popularity and economic impact. A number of authors have focused exclusively on pachinko (e.g. Brooks et al., 2008; Manzenreiter, 1998; Tanioka, 2000; Thompson et al., 2005). They discuss its addictive nature and the necessity of categorizing it as gambling rather than as play or entertainment, and they call for more extensive investigation into problem gambling. Notably, there is little on how gambling problems are stigmatized differently from other countries or on how cultural values and beliefs have influenced treatment. Nothing in the literature examines how GA and Gam Anon have been adapted to meet the needs of people in Asia. Gamblers Anonymous has spread from its origins in the United States to become the most utilized form of treatment for problem gamblers in 55 countries. Yet there is little known about how different cultures have modified the program or about how those changes may have contributed to its effectiveness.

This paper reviews the current status of gambling in Japan, and addresses problem gambling among Japanese workers from a three-fold social perspective. First, the paper examines a sense of alienation experienced by workers caught up in economic and structural changes in the workplace. Many choose gambling as an escape method of coping. Second, the paper examines the role of cultural characteristics, such as the avoidance of confrontation, concerns about public exposure, and the threat of social exclusion, which affect not only gamblers but also their families. Third, the paper examines the sense of acceptance that gamblers and family members regain through participation in GA and Gam Anon.

In order to present an overview of gamblers in Japan, the paper uses data from the Leisure White Paper (Japan Productivity Center for Socio-Economic Development [JPC-SED], 2008) and the Survey of Pachinko Participation (Entertainment Business Institute, 2008). Data on problem gamblers were obtained from the Gamblers Anonymous (GA) Membership Survey (GA Japan Information Center [GA JIC], 2009; Takiguchi, 2009) and the Report of Oneday Port, No.3 (2007), a gambling-specific residential treatment center in Yokohama.

The paper also draws upon the first author's experience as a non-gambler observer at GA and Gam Anon meetings and conferences in nine cities in western Japan. The author attended the first GA meeting in Osaka in 1994. She attended weekly GA meetings in both Osaka and Kyoto (where GA started in 2000) until 2003, when she began holding monthly educational classes for family members. Since 2004 she has regularly attended regional GA and Gam Anon conferences, where she has been an invited speaker and has provided educational classes for family members. Respect for the confidentiality of the participants applies to the author's educational classes as well as the GA and Gam Anon meetings and conferences. Both GA and Gam Anon have policies against note taking or any mechanical recording at meetings and conferences. It is also not permitted for a guest or non-member to conduct systematic interviews or hand out questionnaires. The author adhered to the policy, but was afterwards able to meet informally with core participants to discuss some of the activities and to get to know them better. Personal stories of gamblers and their family members that appear in this paper are used either by permission of the individual or only after personal characteristics were sufficiently deleted to maintain anonymity.

Gambling in Japan

Inconsistent Japanese Policies Concerning Gambling

The policies of the Japanese government are contradictory and inconsistent concerning gambling. Gambling is prohibited by the Japanese Penal Code (2007, Articles 185, 186), which states: 'a person who gambles shall be punished by a fine of not more than 500,000 yen,' and 'a person who gambles habitually shall be punished by imprisonment with labor for not more than three years.' However, the law contains a loophole, as it also states: 'this shall not apply when the bet of a thing is made only for momentary amusement.' There are important exceptions in the form of state-regulated sports tracks (national and provincial horse racing, bicycle, motorboat, and motorcycle racing), 'Toto' (wagering on professional soccer), and a state-run lottery (Tanioka, 1997; Thompson, 2006). These public forms of gambling (Table 1) are regulated by the Racing Laws, the Law Concerning the Promotion of Sports Tickets (Toto), and the Law of Tickets with Prizes (lottery). The state run forms of gambling are allowed to operate because they promote 'the public good': they promote industry and sports and raise funds for local governments (Japan Lottery Association, 2009; JKA, 2009a, 2009b; Kyōtei Official Web, 2009; National Agency for the Advancement of Sports and Health, 2009; Japan Association for International Horse Racing, 2009; National Association of Racing, 2009).

The lottery ranks as the sixth most popular form of leisure activity, after restaurants, domestic trips, driving, karaoke, and watching videos at home. Thirty-eight percent of the population over the age of fifteen purchased lottery tickets, and annual spending per player was US$200 (at Yen100 = US$1). The second most popular form of gambling was national horse racing: 6.9 per cent of the population (legal age 20+), and annual spending per player was $717. Other forms of public gambling attracted fewer Japanese: participation rates and spending per player were 1.0 per cent and $183 for provincial horse racing; 0.7 per cent and $690 for bicycle racing; 1.1 per cent and $698 for motorboat racing; 0.3 per cent and $161 for motorcycle racing; and 4.2 per cent and $98 for Toto (JPC-SED, 2008). Participation rates and annual spending per player are summarized in Table 2.

The above data might lead one to conclude that excess gambling is not a major problem in Japan. However, the most significant form of gambling, the electronic gaming machines (EGMs), which in Japan consist of pachinko and pachislot, are considered games for amusement and are therefore not regulated by any gambling law. This is justified by having players win prizes, which can only be redeemed for cash outside of the pachinko parlor.

Most Significant Form of Gambling: Pachinko and Pachislot and Their Players

The pachinko game had been a popular Japanese children's game in the 1920s. One theory had it originating from an imported American pinball machine; another described its creation by Japanese soldiers who, at the end of the First World War, were left with a surplus of steel balls (Brooks et al., 2008; Kelly, 2007; Manzenreiter, 1998). It has developed into an increasingly sophisticated, interactive game. Pachislot, which was introduced in 1965 (Satō, 2007), more closely resembles American slot machines, British 'fruit machines,' and Australian 'pokies.' The player sets several reels of symbols spinning, then by hitting stop buttons attempts to line up a winning pattern. Advances in computer technology in the 1980s have led to the use of virtual reels, and a random number generator that determines the outcome. This has meant bigger payouts, as well as more ways to win (and lose). There is also more variability with regard to auditory feedback and visual displays, more interactive features, and the use of imagery and themes from popular culture. Both pachinko and pachislot games are found in pachinko parlors, most typically on separate sections of the floor; both games are collectively referred to as 'pachinko.'

Most impressive about these games is their ubiquity in Japan, in terms of the sheer number of machines, the amount of time and money spent on them, and the revenues they generate. Japan has by far the largest number of gaming machines in the world. In 2006, there were 4.9 million pachinko and pachislot machines in the country, which equates to one machine for every 26 people (TNS, 2006; see also Christiansen, 2007). By way of comparison, the United States has the largest number of machines outside of Japan, a total of 740,475 gaming machines in 2006, or one machine for every 404 people (TNS, 2006). Pachinko (including pachislot) is a huge US$230 billion industry (JPC-SED, 2008). Annual revenue dwarfs that of the Japanese automobile industry (Kelly, 2007). Japanese spend as much playing pachinko as they do on health care, and borrowing money to play is thought to account for almost half of consumer debt (Economist, 2006).

The actual percentage of Japanese playing these games has declined, from 25 per cent of the population in 1995-1997 to 14.5 per cent in 2005-07 (JPC-SED, 2008). However, during that same period, average annual per player spending increased while household income declined (JPC-SED, 2008). Brooks et al. (2008) observed that, despite the decline in popularity from 29.9 million players in 1989 to 17.1 million in 2005, revenue from the games has risen from 15.3 trillion yen in 1989 to 28.7 trillion yen in 2005. They note that this occurred during a period of flat inflation. How does one account for the fact that the number of people playing has decreased by nearly 11 million, but the revenue from pachinko has nearly doubled?

According to a recent survey, pachinko's declining popularity is partly due to the high cost of playing (Entertainment Business Institute, 2008). Another factor may be that tightened regulation of the consumer finance industry has made it more difficult for players to obtain money for gambling. It is also possible that pachinko players have discovered another form of gambling: the online casino. At present, no reliable data exist on Internet gambling, although there are anecdotal stories and reports of people winning large sums of money (e.g. Asahi Shimbun [Asashi Newspaper] February 5, 2005, as cited in Sugawara, 2005).

More pertinent to our topic is the implication that a smaller number of players is accounting for a larger amount of pachinko revenue. It would be extremely important to know what percentage of those who play regularly are problem gamblers, and the extent to which the pachinko industry's profits are dependent on them. Players can be seen lining up in front of every one of Japan's pachinko parlors, waiting for the 10 A.M. opening so they can race to claim their favorite machine (Kelly, 2007; Thompson et al., 2005). Some of these same players may be seen loitering at closing time, trying to see how machines are being adjusted, to determine which will offer more favorable odds.

Pachinko players are predominantly men between the ages of 20 and 59 (Kelly, 2007; Manzenreiter, 1998). Despite the loud, electronic sounds that are so overwhelming to someone entering a pachinko parlor for the first time, the experience of the players is a solitary one. Each is transfixed by the machine in front of him, alone in a pursuit from which all distractions, including those of reality, have been excluded (Iwasaki, 1998; Hahakigi, 2004).

Structural Changes in Work Environment and a Sense of Disconnectedness Among Workers

Recent structural changes in the work environment have driven many workers into a precarious state. In the early 1990s, Japan's economic bubble collapsed and a sweeping crash of stock and property prices caused a decade of economic depression. To revitalize the economy and respond to globalization, both the government and Japanese industry adopted 'neo-liberal' economic policies that emphasized individual competition and individual performance-based evaluations; secure employment was not guaranteed (Tachibanaki, 2006; Takenaka & Chida, 1998). The work environment, which used to emphasize open communication, group achievement, and mutual help (Pucik & Hatvany, 2000), became a field of competition and mistrust (Arai, 2007).

This radical change and the co-occurring economic depression have caused a massive deterioration of the work environment. Many workers do not have a sense of belonging to their companies or a connection with their fellow employees (Japanese Electrical Electronic and Information Union, 2001). This loss of a sense of belonging seems to have caused a deterioration in mental health. For instance, the male suicide rate increased from 23.6 per 100,000 in 1993 to 37.2 in 1998. This level of male suicide continues today (National Police Agency, 2008). The Survey of the State of Workers' Health by the Ministry of Health, Labor, and Welfare (2008) shows that 58 per cent of workers suffer significant mental stress and work-related anxiety. The stress rate is especially high among workers in managerial positions (61.8%), whose job includes mediating and managing personal relations. According to a Mental Health Research Institute (2008) survey, a majority of companies acknowledge a rise in mental illness among employees. The survey concludes that the rate is especially high in companies that do not provide a supportive environment, a sense of connectedness, and meaningful work.

Withdrawal Response to Stress

One way Japanese respond to stressful and uncomfortable situations is withdrawal (Lebra, 2004: Russell, 1989). Recently, a new form of social withdrawal has captured the attention of the public. A psychiatrist, Tamaki Saitō (1998), was the first to use the term hikikomori to describe predominantly young males from middle class families who withdraw from school, work, and from normal social relationships, and retreat to their rooms for months, years, even decades. Those who have written about the disorder have emphasized the role of social as opposed to individual factors (Dziesinski, 2003; Furlong, 2008; Ide, 2007; Jones, 2006; Zielenziger, 2006).

Teo (2010) finds this to be a quintessentially Japanese form of protest: no ostensible imposition is made on others. They refuse to participate in a society for which they feel ill suited or with which they disagree. Furlong (2008) relates hikikomori to the precarious status of young people in the current labor market and in a rigid social structure that does not provide alternative models of living. Younger Japanese in particular are very pessimistic about their future (Miyamoto, 2002;Yamada, 2004; Zielenziger, 2006). Ueyama (2001), a recovering hikikomori, has found similarities between hikikomori and the elite workers who achieve societal expectations, but who still feel alienated in the current occupational environment. This term, hikikomori, is sometimes used by young GA members to describe their withdrawal into pachinko and pachislot.

Gambling distracts one from problems, and seemingly provides an escape from helplessness, shame, and other intolerable feelings (American Psychiatric Association, 1994). It holds out the possibility of financial success, while indulging fantasies of being accepted, validated, and loved; it allows the gambler to feel powerful and in control (Iwasaki, 1998; Lesieur & Rosenthal, 1991; Rosenthal & Rugle, 1994; Toneatto & Nguyen, 2007). Thus gambling provides a withdrawal from problems, while also offering a sense of identity and purpose.

Escape Seekers: Heavy and Problem Gamblers

Consistent with the view that EGMs are closely connected with gambling problems (Williams et al., 2007), a majority of treatment-seeking gamblers are pachinko and/or pachislot players. For instance, among the 196 participants who chose to fill out the survey questionnaire at the 2008 GA National Conference in Japan, 77 per cent stated that their first gambling choice was pachinko, pachislot, or both (GA JIC, 2009; Takiguchi, 2009). The Report of Oneday Port shows the same tendency; among 52 residents (from August 2005 to December 2006), 78.8 per cent stated that either pachislot or pachinko was their first choice (Oneday Port, 2007). Males significantly outnumber females. Hahakigi (2004), a psychiatrist who specializes in treating problem gamblers, stated that at his hospital 90 per cent of the patients were men. Most GA members are men, and of 115 GA groups in Japan (as of September 2010), only five are specifically for women (GA JIC, 2010b).

What is known about why Japanese men gamble? The Survey of Pachinko Participation (Entertainment Business Institute, 2008) shows that 'heavy' players (defined by the survey as those gambling twice a week or more) play to cope with stress. Asked to indicate the reasons they play, 'heavy' pachinko players answered as follows: (1) because pachinko is 'easily accessible and solitary' (53.1%), (2) 'to cope with stress' (47.4%), and (3) 'to have fun' (43.5%). 'Light' (once a month or less) players' responses were (1) 'to pass the time' (50.4%), (2) because pachinko is 'easily accessible and solitary' (39.0%), and (3) 'to win jackpots' (35.4%). Only 28.9 per cent of 'light' players and 20.7 per cent of 'rare' (once in 4 months or less) players gave stress as a reason for playing. A similar pattern is seen with pachislot players: 43.3 per cent of 'heavy' players named stress as a reason for playing while just 28.4 per cent of' light' players and 16.7 per cent of 'rare' players did so (Entertainment Business Institute, 2008). Heavy and problem gamblers in Japan appear to be predominantly men who play EGMs because they are easily accessible, solitary, and are thought to reduce stress. Another survey study of treatment-seeking gamblers (Tanaka, 2010) shows the same tendency. Asked to indicate the triggering incidents for gambling, they most commonly named job-related stressors; family-related problems came second.

Problem Gambling: Vice or Disease?

How is problem gambling perceived in Japanese society? Recently, the media has begun to present gambling problems as a health issue. For instance, one TV show explained the American Psychiatric Association's (1994) Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for pathological gambling and showed GA meetings and therapy sessions at a hospital. The show also interviewed GA members and their families, solicited expert opinions, and appealed for awareness and understanding of gambling problems (OHK, 2008). Contradicting the above presentation, the media depicts gamblers who commit crimes as morally corrupt. When seemingly solid citizens are caught embezzling to fund a gambling habit, they are characterized as double-faced: behind their honest appearance they stole money and cheated their colleagues and society. It is their employers who publicly apologize for the gamblers' deplorable conduct, and pledge to tighten discipline and improve moral standards. Neither the employers nor the media mention gambling as an addiction, mental disorder, or illness (e.g., MSN Sankei News, April 5, 2008).

Fear of Public Exposure and Social Exclusion

Japanese are afraid of 'uncontrolled leakage of their undesirable selves in front of others' (Lebra, 2004, p.66). Uncontrolled gambling selves, obviously 'undesirable selves,' have to be kept hidden from others. There is a progression of desperate measures in their 'further attempt(s) at self-wrapping' (Lebra, 2004, p.66). Gamblers may attempt suicide (Tanaka, 2010), so that they do not have to face angry or disappointed family members or risk being ostracized.

Shame is observed among the gambler's family members (wives and mothers). Government and industry have supported and validated a household arrangement in which husbands invest their time and energy on work, while wives (mothers) do domestic chores, manage the family budget, and address their needs (Borovoy, 2005; Iwao, 1993). Good wives are expected to take care of family problems (Borovoy, 2005; Iwao, 1993) and their self-esteem derives from the competency with which they manage the household (Iwao, 1993). Public exposure of problems indicates serious failure on the part of wives (and mothers). For this reason, the members of the gamblers' family, but especially wives and mothers, will do their best to fix the problem and keep it within the family. Parents, but especially mothers, not only blame themselves, but are blamed by others for failing to raise their children properly (Iwao, 1993). A sense of self-reproach is intensified among the mothers of adult gamblers who had some illness or had special needs as children. The mothers feel they are responsible for protecting their children by all means necessary, and continue their bailout even after joining Gam Anon and being told by others not to do so.

It was 60 years ago that the American anthropologist, Ruth Benedict (1946/2005), wrote of 'the great importance of being accepted by [one's] fellows' (p. 287), and stated that, in Japan, 'ostracism is more dreaded than violence' (p. 288). Social exclusion is an issue for the families of gamblers indebted to loan sharks or arrested for illegal acts. For example, when a father's debt to loan sharks was disclosed, his daughter's husband divorced her, and her gambler father was never again allowed to see his grandchildren. Aware of reactions such as these, gamblers and their relatives worry that disclosure will bring disaster to the whole family. If there is an arrest, and especially if the gambler's name appears in the local newspaper, families are known to move to another city where the gambler's arrest is unknown. Their feelings of hopelessness and fears of humiliation and social exclusion are conveyed by the following statements, which are typical family reactions:

'I am very afraid that my friends will find out that this gambling woman is my mother. I feel I am a 100 per cent shameful being. If my mother's gambling problem is exposed, none of my friends will talk to me anymore. I will lose all of my friends.'

'If my (gambling) son commits a crime, my husband will have to resign from his job. I will be disqualified as a mother.'

Shameful feelings and fears of being ostracized drive gambling problems into the shadows. Even though there has been a significant increase in the number of GA meetings, most problem gamblers fail to seek help or to attend.

Available Resources and Treatment for Gambling Problems in Japan

Alcoholism is recognized as a disease, and there are hospitals and clinics that specialize in its treatment; the cost is covered by the national health insurance system. Although the Ministry of Health, Labor and Welfare recognizes the diagnosis of 'pathological gambling,' as defined by the World Health Organization's (1992) International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10), it is not covered by the national health insurance. What resources then are available in Japan?

There is no nationwide advocacy organization. However, the Council on Credit and Consumer Loan Problems launched a task force in 2008 to formulate a policy for dealing with problem gambling. There is a helpline, the Recovery Support Network (2010; see Brooks et al., 2008), funded by the All-Japan Cooperative Association of Pachinko Operators. The helpline telephone number is posted in the pachinko parlors and callers are given information on GA and Gam Anon and on mental health centers in their area.

Japan has one gambling specific residential treatment center for male gamblers, Oneday Port, which opened in 2000, and one gambling specific outpatient treatment center for female gamblers, Nujumi, which opened in 2007. Both are in Yokohama. The programs are run by peer counselors, recovering gamblers who owe their recovery to GA. Group meetings form the main activity and patients are taken to Gamblers Anonymous. The centers also offer educational seminars for family members. These are delivered by psychiatrists, social workers, and lawyers. Among the topics covered are co-dependency and enabling of the gambler's behavior.

Several Japanese hospitals and alcoholism clinics also treat gamblers, and some private practitioners (therapists) provide treatment. Diagnosis is based on the criteria in the American Psychiatric Association's (1994) Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) or the World Health Organization's (1992) International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10). They utilize essentially the same programs that they use for alcoholics. Since problem gambling is considered an addiction akin to alcoholism, 'gamburu izon [Japanese translation of gambling dependence]' rather than ' byōteki gamburingu [pathological gambling defined in DSM-IV or ICD-10]' is the term used to refer to problem gambling (Hahakigi, 2004; Tanabe, 2002). Treatment programs at these facilities include educational and group meetings, and abstinence is the goal (Hahakigi, 2004, 2010). A few hospitals and clinics also incorporate cognitive behavioral therapy (CBT) and self-reflection methods in their treatment programs, as well as such activities as sports, cooking, and gardening (Kikuyo Hospital, 2009; Kōryō Hospital, 2009). All these clinics and hospitals urge gamblers to attend GA.

Recently, for the first time the government funded a project concerning gambling problems. The Ministry of Health, Labor & Welfare funded a gambling study in 2007, which investigated the applicability of a gambling screening test, the South Oaks Gambling Screen (SOGS), and also investigated co-morbidity among treatment-seeking gamblers (Tanaka, 2010).

Gamblers Anonymous (GA) and Gam Anon

Since almost all the hospitals and clinics emphasize the importance of the self-help group for the recovery of problem gambling (Hahakigi, 2010), GA is the largest treatment resource for Japanese gamblers. According to the GA survey, the typical GA member is a male over thirty years of age, who is a university graduate with a full-time job. He is a pachinko or pachislot player and started gambling in his late teens (GA JIC, 2009; Takiguchi, 2009). GA and Gam Anon started in Japan in 1989 (GA JIC, 2001). For the first decade their growth was slow, but recently they have been growing more rapidly. Currently (September 2010), GA has 115 groups (GA JIC, 2010b), and Gam Anon has 93 groups (Gam Anon Japan Information Center [Gam Anon JIC], 2010b). Each year in October, GA holds a national conference; over 400 participants (GA members and their families) attended the 2010 conference (Personal communication with GA JIC, 27 October, 2010). Regional GA and Gam Anon groups also host annual conferences. Gam Anon holds its national conference every June; the 2010 conference drew 400 participants from various areas of Japan (Gam Anon JIC, 2010a).

GA and Gam Anon members relate to each other as equals and respect each individual's anonymity. In the US members use their given (first) names to identify themselves and when addressing other members, as it is a rule that family (last) names cannot be used in 12-step groups. Japanese, however, generally use given names only among family members and close friends, and so to use given names in a 12-step group would feel odd to new members. To solve this problem, new members are advised to create their own nicknames, or 'anonymous names' as they are called in Japan, to reflect their desire and determination to recover. For instance, one gambler chose Kame (Turtle) as his 'anonymous name,' as he wanted to be humble and to step forward slowly but steadily. A turtle moves in a low position, which to this man symbolizes humbleness (Personal communication, November 20, 2008).

Both GA and Gam Anon conduct meetings according to the '12 steps of recovery and unity.' Both use the official international GA and Gam Anon literature translated into Japanese. As in the United States, they hold regular meetings, step meetings, and business meetings. At a typical regular meeting, a chairperson, chosen from regular attendees, asks several participants to read a selection from the GA or Gam Anon literature, and then suggests a theme, for instance, 'stealing.' The members take turns identifying themselves by their 'anonymous names,' then talk about their experiences. Regular meetings may be either open or closed; anyone can attend open meetings but non-members are not allowed to speak and only gamblers can attend the closed meetings, which allow them to speak more frankly about their feelings and 'wrongdoings.' For instance, some members may emphasize their regret about stealing gambling money from their children, and their eagerness to stop gambling, when non-GA members are present. The same members may disclose their daily frustrations and continuing cravings to gamble in the closed meeting.

Confrontation is avoided in Japanese GA meetings and this might show 'a Japanese distaste for confrontation' (Doi, 2005, p.153). Participants are prohibited from commenting on others' statements so that no member need feel embarrassed or ashamed within the group. When disagreement does occur, disgruntled members tend to leave the group and create a new GA group rather than discuss the points over which there is disagreement. The step meetings are conducted to study and work each of the 12 steps and the business meetings are held to discuss how to operate group activities, for example, preparation for the anniversary conference.

Financial advisory meetings (called 'pressure relief meetings'), where gamblers fully disclose their financial situations and work with others to devise and implement get-out-of-debt plans, are rarely conducted by GA in Japan. Members instead prefer to go to lawyers or to the Victims Association of Consumer Loan and Credit.

Another difference between GA and Gam Anon in Japan and in the US is that, in Japan GA and Gam Anon meetings tend to be held separately – at different times and locations. (In the US, by contrast, GA and Gam Anon meetings are typically held at the same time and location but in separate rooms.) In September 2010, only 13 Japanese GA groups schedule GA and Gam Anon meetings at the same time and location; 11 of them are in western Japan (GA JIC, 2010b; Gam Anon JIC, 2010b). One reason for scheduling separate meetings is childcare; using babysitters is uncommon in Japan and someone has to stay home to attend the children. Another reason may be the difficulty of finding two available meeting rooms in the same location. One might wonder whether anger on the part of family members toward the gambler is also a reason, but core Gam Anon members deny this, stating that family members are supportive of gamblers and their recovery efforts (Personal communication, February 20, 2009).

Mutual Support and Unity Among GA Members

GA activities are based upon mutual support among members, as this is critical in helping members maintain abstinence (Oei & Gordon, 2008). Japanese society has often been depicted as being vertically organized (Nakane, 1967), yet egalitarian and horizontal relationships and mutual help among group members are also important, especially in western Japan where mutual cooperation and gift exchange have long been (and still are) critical to maintaining egalitarian relationships among community members (Befu, 2000). A Japanese cultural anthropologist, Yoneyama (1976) argues that the most important relationships in the everyday lives of Japanese are those with nakama, which can be translated as peers, comrades, mates, or one's circle of friends. Although 30 years have passed since Yoneyama conceptualized nakama relationships, this concept is useful for understanding relationships among GA members. It is noteworthy that nakama is the word most often used among GA (and other 12-step group) members to define their relationships with each other. They say, for instance, 'We are nakama,' or 'Without nakama compulsive gamblers cannot recover,' or 'I have always been protected by nakama.' Many GA members feel confused when they read about 'God' or 'a power greater than ourselves' in the translated literature. This is a key concept in the 12-step recovery program, which enables gamblers and their family members to regain healthy lives. Most Japanese, although nominally Buddhists, do not lead religious lives, and have difficulties with the concept of 'God' or 'a power greater than ourselves.' When new members are told that their 'Higher Power' can be their deceased mothers, the sun (Otentosama), or anything they can trust, they feel relieved, and for many GA and Gam Anon members, their 'Higher Power' resides in their nakama.

Long time members are called 'saki yuku nakama' (one who stepped into the path of recovery earlier) and unofficially take a leadership role. 'Saki yuku nakama' is a wise elder and an ideal model for new members, as often stated, 'I want to become like this saki yuku nakama and I will follow him.' When a new member chooses a particular saki yuku nakama to ask for his advice, their relationship becomes that of a sponsor and sponsee. The sponsor guides those whom he is sponsoring to work the steps, gives suggestions for dealing with slippery or risky situations, and even gives practical advice about such things as the buying of new clothes. The terms sponsor and sponsee are unfamiliar to Japanese members; nakama or saki yuku nakama and atarashi'i (new) nakama are the terms used.

Certain regional differences exist. Members living in urban areas are fairly isolated, while in countryside areas, a stronger sense of nakama helps new members to interact actively with older members, and strengthens the members' sense of connectedness and belonging. The following contrasting cases of GA activities, all from western Japan, illustrate different ways that GA members relate to each other.

Case A: GA in a large city

City A, with a population of over a million, was the cultural center of Japan for more than 1000 years, and residents are proud of this heritage. Residents tend to respect individual privacy and do not like to interfere in others' affairs (Yoneyama, 1976). Newcomers to the city describe residents as being rather distant (Naitō, 1998).

In January 2009 there was one GA group in the city. It had been formed in 2000 and met once a week. Usually around 15-20 members participated. One member achieved five years of abstinence and another two years, but neither attended regularly. Most of the members are men who work full-time. They attend only this one Friday night meeting. They do not interact with each other outside the meeting nor do they go to GA meetings in neighboring cities nor attend the national and regional GA conferences.

It was the first author's observation that there was an absence of leaders willing to invest energy in GA activities; for instance, no one has suggested that the group host a regional conference. Another impression was of how closed the group was. Members have no interaction with other GA groups or with other self-help groups in City A. For the past four years, the first author has provided a monthly educational seminar for family members, but there are still no Gam Anon meetings.

Case B: GA in a middle-sized city

City B is a middle-sized city – population 420,000 – in a regional area. The city is historically a pilgrimage site and welcomes many visitors. Hospitality is a tradition. The city's GA group, founded in 2004, holds three meetings a week. Members host an annual conference and also attend the national and other regional conferences. In March 2008 the group had several core members who had been abstinent for more than two years, and more than 25 gamblers were regularly attending meetings.

Group members interact actively outside meetings. They call each other and go hiking together. When one young man lost his job, another member invited him to work in his field. There is also a Gam Anon group, which has a small number of core members. One is a woman in her late 50s whose husband is a core member of GA. The couple is actively involved in helping newcomers and regularly invites members to their home. Members do not seem to be afraid of revealing their identities, at least among themselves. Socializing and visiting each other's homes helps to build trust.

The city also has an active chapter of the Victims Association of Consumer Credit and Loan, a semi-self-help organization started thirty years ago to help those indebted to consumer finance companies. Client members work together with the assistance of lawyers and counselors to pay off their debts and lead financially responsible lives. The chapter's financial counselor (a non-GA member) is extremely supportive of GA and Gam Anon; when he meets new clients with gambling issues he strongly encourages them to attend GA, and he occasionally attends GA meetings and the annual regional conference.

Cities C and D: GA groups in smaller regional cities

City C, with a population of 180,000, has one GA group (formed in 2003) and holds four different meetings: two meet every week, one meets 3 times a month, and one meets twice a month. The city has a hospital that specializes in treating alcoholics. Recently the hospital began accepting gamblers, and patients have come from various parts of western Japan. This hospital has strongly promoted patient participation in AA; it is an established rule that local AA leaders take new patients to AA meetings and conferences. This rule has been extended to the gamblers in treatment being taken to GA meetings by GA volunteers.

Neighboring City D, with a population of 280,000, has a GA group (formed in 2001), unofficially led by a very energetic leader. This man organizes regional conferences, takes newcomers to conferences in other cities, attends the national conference, welcomes visiting GA members from other parts of Japan, and invites members to stay at his home. City D's GA group has 3 meetings a week. Gamblers living in the area of cities C and D, if they drive 30 minutes, can attend GA meetings almost every day. GA members in these cities also associate actively with each other outside of meetings; for instance, they go to karaoke together.

An Enhanced Sense of Connectedness in GA and Gam Anon Conferences

GA conferences (national and regional) are occasions for GA members and their families to experience an enhanced sense of solidarity and connectedness. The atmosphere at conferences is celebratory. Visiting members bring their local sweets, which are shared by all the participants. Long-time members are delighted to see old friends and exchange gifts with each other; newcomers are welcomed by older members; family members enjoy seeing families of other gamblers. Those who are absent from regular meetings may participate in the conference. Minor conflicts within the groups are, even if temporarily, overcome and enhance the sense of unity of the entire GA and Gam Anon groups. The recovery stories of old timers, some of whom have over ten years of abstinence (according to the 2008 GA Survey, 18 years is the longest), are especially appreciated and newcomers witness members who have regained healthy and productive lives.

Problem gambling is a shameful conduct in Japan, therefore, minimum participation in GA and Gam Anon, as seen in City A, seems to be a natural consequence. Why then are some groups eager to host conferences, and why would some members reach out to newcomers even outside the group meetings? Those who have less to lose by public disclosure sometimes take the lead in promoting GA and Gam Anon activities. Someone who does not have family in his area, for example, or who is close to retirement, would have less concern about disclosure. Another factor, and one of crucial importance, is the example set by others. Cities B, C, and D already had active, established self-help groups (Victims Association, AA), which provided models for GA leaders to adopt. As a third factor, the sense of connectedness and joy experienced by the attendees seem to outweigh their sense of shame. Many attendees state, 'The conferences give us power; I feel invigorated.' This empowerment motivates them to attend other conferences and to host their own conference.

Members' Strong Identification with GA and Gam Anon Groups

The nakama relationship has a powerful effect on GA and Gam Anon members. A sense of belonging to their nakama becomes the foundation upon which Japanese gamblers and their family members regain their sense of rootedness and identity. Although Japanese cultural studies represented by such scholars as Lebra (1976, 1992) and Nakane (1967) have been criticized (Befu, 2000; Lebra, 2004; Mouer & Sugimoto, 2000), the educational system, starting with preschool, still 'foster(s) in each child an identity as a member of a group' (Tobin, 1992, p.32) and 'promote(s) a desire in young children for social connection' (Hayashi et al., 2009, p.32). Elementary school in Japan appeals emotionally to each child's need to conform to their group and participate in the group's activities (Tsuneyoshi, 1992). Threat of disruption, or disconnection from, one's set of relationships could seriously damage the individual (Markus & Kitayama, 1991, p.246); this is observed in the intense fear of social exclusion on the part of gamblers and their family members. As Yoneyama (1976) indicates, nakama means not just one's friends, but the reference group with whom one identifies. For active members, GA and Gam Anon are their reference groups and they develop a strong identification, which is consolidated by their participation in meetings and conferences.

Conclusion

We discussed problem gambling among Japanese workers from a three-fold social perspective. First, we addressed the sense of helplessness experienced by employees caught up in economic and structural changes in the workplace. Many turned to gambling, specifically pachinko, as an avoidant method of coping. Second, we considered the role of cultural characteristics, such as the avoidance of confrontation and concerns about public exposure, and the powerful threat of social exclusion, which affect not only gamblers but also their families. Third, we looked at the sense of acceptance that gamblers and family members regain through GA and Gam Anon.

Our intent was to raise some of the issues having particular importance for Japanese male gamblers. A future paper will look at the nature of social interaction and support among Japanese women attending female-specific GA groups. We hope to continue looking at problem gamblers, male and female, who seek professional treatment and /or GA, and compare them to those who do not. Not dealt with here but of concern to us is the relationship between problem gambling and suicide, which in Japan has a particular historical, literary, and sociological tradition that puts gamblers at special risk. Also in need of further study is the impact of gambling on young people, as part of the Japanese 'withdrawal syndrome' (Lebra, 2004), and especially in relation to co-occurring dependence on video games and computer technology.

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About the Authors

Naoko Takiguchi, PhD is Professor of Anthropology in the Department of Sociology at Otani University, Kyoto, Japan. She teaches anthropology and sociology. She provides educational classes for family members of gamblers in Kyoto and Osaka and for gamblers in the correction facilities in Japan.

Richard J. Rosenthal, MD is Clinical Professor of Psychiatry and Co-Director of the UCLA Gambling Studies Program. He co-authored the diagnostic criteria for pathological gambling, was co-investigator on the first genetic study, and has published articles and book chapters on the phenomenology, course, complications, and treatment of gambling disorders. He has also published a number of literary studies, most notably on Dostoevsky.

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