Gambling-related harms

Introduction

Gambling has existed in some form for millennia across different cultures and societies. Modern commercial gambling has snowballed since the mid-1980s and has more recently been accelerated by advancements in online advertising and the accessibility of gambling products.

In Great Britain, after adjusting for inflation, the overall net losses by gamblers totalled £10.9 billion and £14.4 billion in 2010 and 2019, respectively. As the number of adults who gamble has fallen over this period, the average net losses per gambler per year have risen from £302 to £502.

According to the World Health Organisation, “The gambling-related burden of harm appears to be of similar magnitude to harm attributed to major depressive disorder and alcohol misuse and dependence. It is substantially higher than harm attributed to drug dependence disorder”.

Gambling causes direct health problems, such as reduced level of self-care, self-harm, and physiological distress. However, gambling harm can uniquely impact individuals via a multitude of means simultaneously:

• Financial harm
• Relationship disruption
• Emotional distress
• Cultural harm
• Reduced performance at work
• Criminal activity

Epidemiology

The most recent well-designed gambling prevalence study was conducted in 2010 through the British Gambling Prevalence Survey (BGPS).

BGPS 2010 found that 8.5% of adults (16+) suffer significant harm from gambling. 5.5% were considered to suffer low-risk (LR) harm, 1.8% as moderate-risk (MR) harm, and 1.2% as problem gambling (PG) harm.

When these proportions are considered with the available evidence from disability-weight studies and mortality studies, an estimated 1.05 million years of healthy life are lost in the vulnerable gambling population every year.

A conservative estimate would lead to an extra 1500 deaths and 56,000 years of life lost (YLL). Of this, an extra 725 suicides every year (or 12% of the total suicides in the UK) are estimated to occur in the problem gambling population in Great Britain. Although significance has often been placed on problem-gambling, population-level harm from gambling is mostly owing to low-risk and moderate-risk gambling instead of problem gambling.

In the Young People Gambling Report from 2019, 31.5% of 11-16-year-olds were social non-problem gamblers, 2.7% suffered low to moderate risk harm, and a further 1.7% were reported to be problem gamblers.

Despite the expected significance, no research measures the extent of gambling-related harm in underage gamblers and indirect harm in the loved ones of vulnerable gamblers.

Risk factors

Disproportionately affected groups include:

• Individuals with a low Warwick-Edinburgh Mental Wellbeing score
• Black, Asian, and other minority ethnic (BAME) groups
• Males
• Individuals living in areas of deprivation
• Individuals with unmanaged hypertension

Diagnosis

A diagnosis of gambling disorder requires at least four of the following DSM-V criteria during the past year or a score of more than eight on the PGSI screen.

Help and support

Efforts to mitigate gambling harm are expanding. Funding for charities that support gamblers has been limited by shortfalls associated with a voluntary levy by the gambling industry. Operators have pledged larger sums to meet their commitments due to mounting pressure from experts by experience (EbE) campaigners.

Useful organisations for gamblers or those around gamblers who may have experienced gambling harm (such as family members) include GamCare, Gamblers Anonymous, Betknowmore, Gordon Moody Association, Samaritan’s, Gam-Anon, GamFam and Gambling Therapy.

Additionally, there are four NHS Gambling Clinics, and up to 12 further clinics have been proposed.

These NHS clinics are in South West London (opened in 2008), Leeds (opened in 2019), Sunderland (opened in 2020) and Salford (opened in 2020).

Public health perspective

Ultimately, prevention is better than a cure. To support gamblers in recovery and reduce harm rates, lessons need to be learned from efforts within Tobacco and Alcohol harm. From a public health perspective, meaningful action urgently needs to take place in two main ways:

1. Addressing gambling advertisements
2. Passing accountability to betting operators

Actions for clinicians

At present, there are no NICE guidelines on gambling. However, there are a plethora of opportunities for self-referral for gambling harm. Sadly, for many, gambling harm is a silent addiction. So it is not unusual for vulnerable gamblers to walk away with anti-depressant prescriptions without mentioning gambling harm.

Research has found that 46% of those experiencing severe gambling harms (problem gamblers) had not used any treatment or support, with 17% believing their gambling was not harmful, and 27% saying they were likely to experience stigma or shame.

One way to raise awareness and tackle barriers to treatment would be for clinicians to ask patients about gambling routinely. In social history-taking, asking about smoking, drinking and drug use is common. Appropriate questions on gambling become routine practice.