This article seeks to highlight the problems of gambling addiction and substance misuse among Jamaica’s adolescents and how RISE Life Management Services has been tackling these issues through our targeted prevention and intervention services over the past twenty-eight years. It also seeks to show how toxic masculinity and perceived gender norms result in the inability of “the forgotten boy” to address his emotional problems, which oftentimes are some of the underlying contributing factors to his addictive disorders.
RISE Life Management Services (RISE) is a nongovernmental organization established in Jamaica in 1989 as the “Addiction Alert Organization.” RISE operated the island’s first outpatient treatment center for addictive disorders. RISE delivers numerous community-based interventions targeting at-risk youth, families, and community members. The focus of these initiatives is the prevention and treatment of addictive disorders (including gambling addiction) as well as an island-wide telephone counseling lifeline and referral service for clients and family members.
However, over the years, the direction and focus of its programs were adjusted in order to meet the needs of the young at-risk population in Jamaica, particularly those living in inner-city communities. In order to reflect these developments, the organization changed its name to “RISE Life Management Services.” RISE is an acronym for “Reaching Individuals through Skills and Education.” Services offered by RISE include the prevention and treatment of addictive disorders; community-based health and education interventions, such as violence, drug, and HIV/AIDS prevention and testing programs for sex workers (SW) and men who have sex with men (MSM); life and pre-employment skills training, parenting programs, and capacity building for other civil society organizations (CSOs). These interventions take place in some of Jamaica’s most volatile inner-city communities.
RISE has unique and lengthy experience in the prevention and treatment of addictive disorders and as such is in an excellent position to speak to the same.
RISE carries out gambling prevention programs in elementary schools starting at age eight. Students are given information and encouraged on why they should not be involved in gambling until they are old enough to make choices for themselves. We also make presentations to community groups with regard to responsible gaming and gambling-related disorders.
In 2007, RISE commissioned a study to establish desired baseline measures for incidence, behavior, and relationships as it relates to gambling among adolescents aged ten to nineteen years old.
While gambling in the general population—in particular the problem of pathological gambling—is a concern, of even greater concern are the effects of gambling on the current generation of youth. The youth today in Jamaica are the first to have been raised in an environment of extensive legalized and government-sanctioned gambling. Studies done in the United States have found that correlates of gambling among youth include: poor academic achievement, truancy, being male, regular drug use, delinquency, progression to further problematic gambling behavior, and problematic parental gambling. Additionally, other studies have found that teens involved in problem gambling are more likely to be involved in aggressive behavior, stealing, school truancy, drug sales, and commercial sex work.
Gambling, defined here as games played for money, is pervasive in the society and virtually all youth aged ten to nineteen are aware of same. Of the sample, just over two-thirds (68 percent) reported having been exposed to such games, half (52 percent) actually had the opportunity to play, and the majority availed themselves of this opportunity, resulting in 45 percent of the sample having actually gambled at some stage. Having once gambled, the majority continue gambling and approximately two-thirds (67.1 percent) of this subgroup were identified as current gamblers, having played a game for money in the last twelve months. This high awareness and exposure to gambling is not surprising, as opportunities to gamble were reported as being at all the central places in their lives, whether at home, at school, or on the street. Generally, exposure to gambling, opportunities to gamble, and lifetime incidence of gambling were significantly higher in males, older youth aged fifteen to nineteen, at-risk youth.
Using factor analysis, four general views of gambling emerged, namely:
Games were played for money weekly, from as often as every day to less often (e.g., once or twice per week).
The amount of time spent gambling on specific games was heaviest (more than 3 hours) for arcade/video games, Bingo, computer games, and cards.
Over the last six-month period, ten- to nineteen-year-old youth spent heaviest at gaming establishments and on horse racing, reporting an average outlay of approximately $9 USD respectively. The maximum amount spent at gaming establishments was $134 USD, while a maximum of $100 USD was spent on horse racing.
Overall, males were significantly more likely to have begun gambling at an earlier age, as too were youth in the ten- to fourteen-year-old age group and those classified as problem gamblers using the South Oaks Gambling Screen, a psychometric instrument widely used internationally to assess the presence of pathological gambling (Lesieur & Blume, 1986).
Interestingly youth do not identify their activities—whether the playing of jacks, “elastics,” marbles, or bottle-stopper football, all played for money—as gambling and see their own activities instead as fun and excitement. Hence while the negative view of gambling is the most pervasive one, they do not see this as even remotely relevant to their activities. In fact, the main motivator for their involvement was for the excitement and entertainment value of the activities as well as the prospect of winning money. Six in ten youth also found the skill factor of the activities appealing and gambled because they are “good at it.”
Harmless though the players think it is, similar to findings from a study in the United States (Mishra, Lalumière, & Williams, 2017), gambling was found in this study to be associated with antisocial and risk behavior, much of which are presenting as significant problems in Jamaica. These include aggression, stealing, school truancy, and substance use. Girls who gamble were also significantly more likely to report depression and suicidal ideation.
More specifically, persons who had played at least one game for money were also more likely to have thoughts of aggression as well as more likely to experience aggression and violence within the last twelve months. Specifically, they were more likely to have thoughts about hurting or killing someone, and to have been involved in a group fight within the last twelve months. Youth who had gambled were also more likely to report aggression, violence, and weapon carrying in school in the last twelve months.
These problems worsen as these individuals get more involved in gambling to the point of being classified as “problem gamblers.” Problem gambling was also associated with increased risk behaviors, including aggression, violence, and theft. Problem gamblers were more likely to report the following within the last twelve months: having stolen from a friend or family member, having been involved in a group fight, having injured someone seriously, and having deliberately damaged someone’s property. Problem gamblers, like youth who gambled, were also associated with aggression, violence, and weapon carrying in school. Specifically, they were more likely to report, within the last twelve months at school, having been in a physical fight, belonged to a gang, slapped or hit someone, and carried a knife or other weapon for protection.
Risk factors for gambling are those factors that, when present, increase the likelihood of youth engaging in gambling activities. Using correlation analysis, risk factors associated with gambling emerged as: age, gender, presence of a family member who gambles, age of gambling initiation, and accepting attitudes towards gambling activities. This profile was more likely to be male, aged fifteen to nineteen years old, having a family member who gambles, and perceiving gambling as fun, exciting, and a positive influence. This perception of gambling as fun, exciting, and a positive influence emerged as the strongest risk factor. Risk factors for problem gambling were similar, but with the addition of having a family member who gambles too much. Specifically, problem gamblers were significantly more likely to be males, have begun gambling at an earlier age, and have a family member who gambles, in addition to a family member who gambles too much. They were also more likely to view gambling as fun, exciting, and positive as well as endorse the notion that gambling gives a chance for a better life.
School connectedness and the presence of the external developmental assets of caring relationships, high expectations, and opportunities for meaningful participation within the school environment emerged as factors that protect against the initiation of gambling in youth. Youth who felt connected to schools and thus existed in a school environment rich in caring relationships, high expectations, and opportunities for meaningful participation were significantly less likely to engage in any gambling activity.
Marijuana, or “ganja” as its popularly called in the Caribbean, was introduced during the nineteenth century by indentured laborers from India (Rubin & Comitas, 1976). The herb is produced for local and foreign consumption with a high demand in tourist resort areas. Jamaica is one of the major suppliers to the other Caribbean countries, followed by St. Vincent and the Grenadines (Abrahams, 2000). Marijuana is used for a variety of reasons: relaxation, to heighten feelings and sensations, to relieve boredom, to cure illnesses, and to enhance spiritual experiences. It is also frequently used in combination with other drugs, mainly tobacco, alcohol, and crack cocaine.
Despite the fact that marijuana is illegal, its use is widely tolerated in many of the Caribbean territories, and its reputation of high quality and potency makes it a sought-after commodity by North Americans and Europeans. In Jamaica, the heaviest users are the Rastafarians, a religious group that uses marijuana as part of their religious doctrine (Abrahams, 2000). Use of the herb is also widespread and traditional in rural areas and glamorized by music stars like Bob Marley and Peter Tosh. Jamaica recently decriminalized the use and possession of marijuana for amounts not exceeding 2 grams. It is unclear if this legislation will increase usage in the general population or influence underage usage.
A concern for all health personnel working in drug treatment and prevention is the increased potency of marijuana and the mixing of the herb with crack cocaine or other substances. In order to compete with United-States-grown marijuana, with their technologically advanced cultivation methods, selective breeding of the herb today can result in a product which contains ten to twenty times more THC (i.e., delta-9-tetrahydrocannabinol, one of the psychoactive compounds found in marijuana) than that which was used in the 1960s and 1970s (Abrahams, 2000). This has implications for treatment and prevention, and could be a factor in the noticeable increase in patients admitted to psychiatric units with a dual diagnosis such as “cannabis-related psychotic episode” or “ganja-induced psychosis.”
Our 2017 data from our Telephone Lifeline recorded a total of 272 calls for the one-year period, with 54.4 percent of these requesting assistance for substance abuse problems, 6 percent for gambling, and 40 percent solicited information. Consistently, the cohort recording the highest abuse was the twenty to thirty-five age group (41 percent) with the number one drug of choice being marijuana (64 percent), followed by alcohol (25 percent), tobacco (3 percent), gambling (6 percent), crack (4 percent), powdered cocaine (2 percent), and prescription drugs (0.8 percent). Also consistent with previous years was the male to female ratio: 90 percent male, 10 percent female. Among callers, 44.5 percent were unemployed, 25.6 percent were employed, 20.7 percent were students, 6.7 percent were self-employed, 1.3 percent were retired, 0.7 percent were incarcerated, and 0.6 percent were not recorded.
One of the difficulties encountered in conducting effective prevention programs is dealing with the perception of the youth who grow up in a culture where the acceptance of marijuana use is widespread. In Jamaica, the practice exists in some rural and urban inner-city communities where marijuana is brewed as tea or cooked in food, with the belief that this practice will make the children “wise.”
RISE has been operating an adolescent, outpatient, drug treatment program since 2014 with adolescent boys referred from the adolescent drug treatment court. These youth enter the judicial system for drug-related charges and are placed in a twelve-week, nonresidential treatment program. This program involves psychoeducational sessions, life skills workshops, family day activities, and recreation. There is also a behavior-modification system and incentive program. Clients are required to participate in the program for a minimum of twelve weeks and present four negative drug screens the month prior to graduation. The program is divided into three phases with the requirement of attendance, participation, and negative urine screens for promotion through the phases.
RISE’s 2017 program evaluation revealed that (62.5 percent) of those who attended more than five sessions reported that they had stopped using marijuana; at least one-third of respondents (31.6 percent) reported smoking less since graduating the program; the more sessions attended the more likely respondents reported that their lives were better after attending the program, with 79.2 percent of those who attended more than five sessions reporting that their lives had improved since graduating.
In our experience of addressing marijuana use in adolescent boys, all clients have a unique history which influenced their drug use and delinquency, but all have the common trait of the inability to properly process the emotions associated with whatever trauma they experienced. In essence, the majority of these boys self-medicate their symptoms of emotional distress.
These are phrases often directed towards our boys and men. On the other hand, we hush and coddle our girls when they so much as bump their knees. We encourage our boys to be rough and tough while maintaining that our girls must be soft, gentile, and emotionally expressive. All this is usually done without a true understanding of the fundamental differences between boys and girls. This kind of socializing of the concepts of masculinity and femininity is contributing to the breakdown of the mental health of our boys and men. The notion that boys and men must be strong and devoid of emotion has been present for many generations, much to the demise of both genders. Both men and women suffer due to this norm of hypermasculinity. Without emotional intelligence and channels for emotional release, our males bottle up emotions they cannot identify, much less know how to process.
The social norms we teach our boys to adhere to encourages them to not share their emotions, to be emotionally self-reliant, failing to acknowledge their emotional needs or seeking the help or support of others. How we teach our boys to manage and regulate their emotions affects their quality of mental health in adolescence and adulthood. Though we try to teach boys to manage their anger, we generally allow the free expression of the same (within reason) and discourage expression of emotions such as sadness and fear. As a result, boys are more likely to express anger and fail to acknowledge, much less express, other emotions. Subsequently, they can experience poorer mental health outcomes.
However, the reality is that the average Jamaican man grows up in female-led household without a father, and as soon as he hits puberty is expected to step up and be a man, even though he has not been taught what that means. He is taught from an early age not to cry or express “girly” emotions and to man up. The man is expected to be the leader, provider, breadwinner, bedroom stallion, and the protector; our boys grow up with these messages and expectations. This hypermasculine man is now the gold standard that our boys strive toward. After all this, he often experiences an existential crisis when he realizes that he has not really been taught how to meet these false expectations, which may be in opposition to what he really wants for himself.
The main perpetrators of violence are men and men have higher rates of “successful” suicide and lower rates of health-seeking behavior (WHO, 2002). As it relates to mental issues and illnesses, men are more likely to externalize emotions, which leads to aggressive, impulsive, coercive, and noncompliant behavior.
As a result of toxic masculinity, which is characterized by excessive self-reliance, restriction of emotions, and dominance, men experience a range of issues from mental health problems to substance misuse, violence, and in extreme cases, injuries and suicide.
During our group therapy sessions, we challenge our boys to come face-to-face with the issues they have been avoiding and trying to drown. They come face-to-face with feelings of abandonment because their fathers are absentee, feelings of resentment toward their mothers who have pushed them to be “hustlers” as a way to provide of the family, feelings of shame and/or guilt due to their lack of educational attainment, and feelings of confusion surrounding the mixed messages they receive about who they should be.
During these sessions, we see the raw emotion that was hidden for years—tears, anger, frustration, and revelation. It is after this that they are ready to confront and resolve their underlying issues before they can fix the broken pieces and move toward starting a drug-free life. Then, from a programmatic standpoint, we provide the transitional support needed for school re-enrollment, job preparation, and program graduation.
Male empowerment does not seek to further widen the gender gap, but to allow men to fully actualize in a wholesome way so that they see women as equals and that violence in any form is not seen as an option. These interventions need to focus on the social, mental, and emotional needs of the modern man.
The following elements were found to be common to successful Latin American and Caribbean prevention programs, according to a review of international programs for at-risk youth by the World Bank in 1996 (Cunningham, Cohan, Naudeau, & McGinnis, 2008): early intervention, small school size, individualized attention, sustained counseling and monitoring of youth; program autonomy and flexibility; and parental involvement. The survey also indicated the following ingredients for success: proper case management; community-wide, multiagency collaborative approaches; a mix of public/private funding; youth participation in the design; implementation and evaluation of programs; replicability; and sustainability. Recommendations highlighted the importance of constructive occupation and educational attainment as the two most important factors for empowering and assisting at-risk youth, especially when these interventions are combined with individual and group counseling or other interventions that meet the personal development and psychosocial needs of these at-risk youth.
Jamaica needs more interventions geared towards the empowerment of boys and men that goes further than equipping them with a skill and/or trade and placing them in jobs. We need more programs to address issues such as substance misuse, delinquency, low academic performance, and crime and violence that go deep under the surface and confront underlying issues, defying toxic masculinity and allowing for full emotional healing, because our boys have feelings too and deserve the opportunity to express them.