This study will provide insight into the mechanisms that shape the medicalization of problem gambling. It will examine how counselors construct racial and gender differences in problem gambling behavior. It will also examine the ways counselors construct and understand race and gender in their everyday discussions of clients and client behavior. Using Conrad's (1992) definition of medicalization, the process by which social problems are redefined as medical problems mandating the intervention and control of licensed medical professionals, this project will demonstrate how social and historical factors shape the construction of illness. And it will bridge the theoretical work on medicalization with research on the "policy making" of street level bureaucrats (Lipsky 1980), and on clinical decision-making processes (Hays et al. 2010, Gushue 2004).

Data collection through participant observation and interviews will address three themes: (1) the types of racial and gender discourses counselors use when discussing clients, (2) the kinds of legitimating evidence counsellors provide in these discourses, and (3) the meanings counselors attach to the differences which have been constructed. Data collection strategies include interviews with counselors and managers of problem gambling programs and a multi-site ethnographic study of gambling addiction training workshops, conferences, and call centers. Very few qualitative studies closely examine the role of counselors and managers in shaping definitions of mental illness and even fewer seriously examine their subjectivity. Combining interviews and ethnographic approaches, this study will advance understanding of the complex processes of medicalization.

Project Report

This project, a study of the significance of race and gender in problem gambling counseling, has yielded important findings. Through qualitative methods this study has revealed how racialized and gendered discourses operate in counselor education to create and maintain stereotypes. The focus of this study was problem gambling, a mental disorder added to the Diagnostic and Statistical Manual of Mental Disorders in 1980. As a newer mental disorder, research on problem gambling is still growing, although racialized and gendered diagnostic patterns have emerged that are consistent with other disorders. Research indicates that African American men are more likely than any other group to be diagnosed as problem gamblers. This is consistent with a large body of research indicating minority groups receive more serious mental health diagnoses at disproportionate rates, but contradicts findings that indicate woman, like minorities, are more likely to receive similarly patterned diagnoses. Audit studies of counselors suggest that this disparity is the result of racial and gender bias in clinical decision-making. Researchers have suggested that a bias does exist, but have struggled to identify how – through what processes – gender and racial biases are constructed and operate. What my study produces is an analysis of how, through counselor education, race and gender stereotypes are used to shape counselors understandings of problem gambling behavior. The intellectual merit of this project is two-fold: it contributes original qualitative data to the growing literature surrounding problem gambling, and provides insight into the mechanisms that produce racial and gender disparities in mental health. Further, this project has made a broader impact by contributing to the sociological literature on race, gender, mental health, and qualitative methodology. Findings from this study have been shared with various research communities both locally and nationally. As such, this study has advanced the theoretical knowledge of the mechanisms through which race and gender stereotypes shape constructions of deviant behavior.

National Science Foundation (NSF)
Division of Social and Economic Sciences (SES)
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Saylor Breckenridge
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Duke University
United States
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