Combatting the Challenge of Gambling Harms

With 2.2m people participating in gambling in the UK, £1.7 billion contributions through the National Lottery and £417 million contributions to good causes from large society lotteries, one could believe that gambling has only positive benefits. [1]

However, in October the Gambling Commission’s own chief executive Andrew Rhodes delivered a speech at the 2022 IAGR Conference in Melbourne entitled “Time for change? Reflections on the policy landscape and developments in Great Britain.”[2] He stated that “in-person gambling participation rate had increased to 26% – up from 23% in year to March 2021”. “The last Health Survey for England found that 246,000 people were considered problem gamblers, with a further 1.6 million at risk of suffering harm. [3]

Gordon Moody

Gordon Moody are a registered charity that provides treatment for those whose lives have been severely affected by gambling addiction. They support adults, giving advice, education and therapeutic support to problem gamblers and those affected by gambling. This work is conducted through residential, online and outreach services. Paul Dent is the Strategic Engagement Lead at Gordon Moody, he is responsible for stakeholder management and is a Trauma and Addiction Therapist. He discusses the current landscape of gambling in the UK and some of the actions that can be made to help support problem gamblers.

Potential for a ‘Perfect Storm’

A BBC article followed this, highlighting the winter World Cup, the cost-of-living crisis and the run-up to Christmas having the potential to create a “perfect storm” for problem gamblers. [4] Sportradar, a company specialising in sports data, expected there would be more than £860m ($1.03bn) “wagered on each match” during the men’s World Cup. An estimated 129,000 gaming customers lost at least £2,000 in a year, more than the average home gas and electricity tariff, according to the analysis of 140,000 accounts with seven gambling firms. Zoe Osmond, chief executive of GambleAware, states that “As the cost-of-living crisis bites and people feel the pinch in the run-up to Christmas, this could create a perfect storm where fans resort to gambling as a way to cope.” [6]

Researchers from the National Centre for Social Research (NatCen) and the University of Liverpool has raised particular concerns about online gaming, a £4bn-a-year category dominated by virtual slots but that also includes online bingo and casino games. [7] It highlights that more than 420,000 British gamblers lose at least £2,000 a year. More worryingly, the report warns that losses on the most addictive products are “strongly skewed” towards deprived areas. The research underlines the losses incurred by the heaviest gamblers and raising “concern” at the low level of intervention by certain gambling companies to prevent them suffering harm.

Virtual slots were singled out for particular concern, with 50,000 individuals found to have played for the equivalent of eight full days in a year, losing £5,000 on average. While gambling is male dominated overall, this group was more likely to include women. This has further added to the calls for the imminent government review of gambling regulations, due shortly, to include tough affordability checks and stake limits on online slot machines. [8]

Government Review

Paul Scully, the Minister appointed to Department for Digital, Culture, Media and Sport (DCMS) with responsibility for Gambling speaking at the recent GambleAware conference, emphasised that viewing the issue through a public health lens was appropriate. “Our review of the Gambling Act will take action to help prevent these harms, with targeted, proportionate and effective reform”. “There are also specific rules for particular groups, like children”. “And for people suffering harm, who have greater needs, the rules require targeted interventions and particular support.” [9]

Is There a Need for a Public Health Approach?

The challenge to combat gambling harm through a public health approach has strong support from the medical fraternity. Outlined by the Lancet, many working in medicine feel that government policy “has employed discourses that align more closely with those of the gambling industry than with those of the individuals, families, and communities affected by the harms of gambling.” [10]

With most practitioners, support and treatment providers in agreement that a Public Health Approach would be the best way forward. This raises numerous questions though, namely dominated by the idea of who will pay. In terms of funding, the NHS has taken the stance that the gambling industry should pay a new multimillion-pound statutory “addiction levy” to fund the prevention and treatment of gambling-related harm. [11] The view being that it would be funded by a statutory levy on gambling revenues on the “polluter pays” principle, under which “the most harmful parts of the industry pay the most”. This would see a shift of control of funding away from the DCMS “to be overseen by “experts” at the Department of Health and Social Care.”

Treating Gambling Addiction with a Medical Model

This seems to overlook the risk of moving towards a “medical model – where the patient is there to be treated, fixed and cured in the shortest number of sessions (usually due to demands on resources). Problem gamblers and addicts, and they are different, demonstrate a great resistance to even seeking “help” whilst once “treated” have an unfortunate habit of relapsing as part of their recovery cycle. Perhaps a much more relevant discussion would be to focus on the needs of the person with problem gambling behaviours. Suicide and suicide ideation has been shown to be greatly elevated for both men and women with other mechanisms such as severity and multiplicity of harms experienced along with gambling to cope with life stressors.

This is in line with recent research [12] on public health implications caused by changing epidemiology of gambling-related harm which whilst acknowledging the rise in at-risk and problem gambling prevalence rates, states that most harm arises from non-problem gamblers. The logic is that the harm is substantial and impacts most on marginalised populations and mainly due to financial problems, damage to relationships and health, psychological distress and adverse effects on work and education. Recommendations include that any public health policies should focus on reducing exposure to more ‘toxic’ gambling forms as well as increasing the availability of interventions to assist at-risk and problem gamblers and prevent relapse”

An Example Intervention

One such intervention is the Primary Care Gambling Service (PGCS) and is the first of its kind in the country [13]. Funded by a regulatory settlement from the Gambling Commission between October 2019 and March 2022 with GambleAware then taking over the funding role. The Hurley Group – an NHS Partnership led by practising GPs in London – developed and delivers the PCGS in partnership with GamCare and Gordon Moody. The service integrates primary care and third-sector support to provide accessible, consistent, and whole patient-focused support to gamblers. The PCGS service aims are to:

Treat gamblers through pharmacological, psychological and peer group interventions.
Improve primary care practitioner awareness of how problem gamblers can present and knowledge of available support, and;
Support practitioners to identify gamblers using validated questionnaires.

An evaluation was carried out to understand how well each of the referral pathways has been working, to explore the patient journey and emerging patient outcomes, and to make recommendations for improving the future delivery of PCGS.

Most patients were quickly contacted following referral to complete their assessment, and in 53% of cases, the target waiting time of seven days was met. The patients very positively received this, especially when compared to experiences of waiting times for other NHS services. Patients were also broadly positive about their experiences in terms of the personalised and welcoming approach which was possible due to the relatively small number of patients supported compared to the service size. However, nearly a third of patients had disengaged with the PCGS at some point during their service use. The service obviously needs more time and throughput of patients to deliver its aims for both practitioners and clients.

Long-term Rehabilitation and Recovery

Gordon Moody, who were also involved in the previous intervention, was founded originally in 1971 as a hostel for men left homeless and destitute as a result of their gambling. Gordon Moody provides support for those for whom an all-consuming compulsion to gamble at any cost has left them with nowhere else to turn. For those whose gambling has led to difficulties affecting employment, family relationships, finances, mental and physical health as well as their overall quality of life. Gambling addiction does not just impact the individual either – it is estimated that for every addictive gambler six to ten other family members, friends and colleagues are also directly affected, leading to a significant negative impact on the wider society.

Dealing with gambling addiction can be daunting and providing a safe space is key to starting the journey to recovery as well as staying with people from the first point of contact. Collaboration and innovation are key along with working with the right partners helps to support a vision that those most affected by gambling-related harm will have access to the right help, in the right place, at the right time, and to ensure that people can reclaim and rebuild their lives.

Women and Co-morbidity:

Women, face unique issues around gambling. There was a 54% increase in the number of women gambling online compared to 28% for men. Only 2,000 women accessed treatment for disordered gambling across the UK last year. This figure is thought to be only 3% of the actual number that needs treatment. Many clients present with co-morbidities of trauma, mental health, and drug and alcohol issues, it is through working with other organisations that it is possible to coordinate care plans, so the client receives the right treatment in the right order without being lost in a system when at their most vulnerable.

Both forms of intervention are equally valuable but operate at completely opposite ends of the spectrum. Many people who realise they have a gambling problem with seek help from a GP. Those with no other solutions (or their partner is threatening to leave) will seek help from Gordon Moody, on average 12.5 years for men / 11.5 for women since they started gambling. To design a public health policy that encompasses all aspects of gambling harm would seem to indicate that sensible collaboration between all parties is needed.

Divided Opinions on Gambling Harms

Therefore, returning to the issue in question – what is the harm in gambling? This question has never been more important in terms of the political and future direction of treatment for those most affected. According to whatever set of data you use to demonstrate your case, the regulator and to a large degree, the gambling industry would plea that current controls are sufficient and that monies raised for research, education and treatment are being wisely used to bring down numbers. The “Lived Experience” group, now a very valued, vocal voice would pertain that gambling in its many forms (including advertising) is responsible for many suicidal deaths each year.

Treatment providers, it would seem, are split in how a public health model should be delivered, either completely under the auspices of the NHS or in collaboration with the existing non-profit apparatus that can possibly best deal with the long lead times before effective treatment is sort, relapses that are part of any addiction and the recovery resources that need to be in place once “treatment” is complete. The Government’s own position or at least which way it leans will perhaps become a little clearer once the White Paper is published.

Around 7% of the population are found to be negatively affected by someone else’s gambling, according to the 2021 Public Health England review. In this article Paul Dent, Strategic Engagement Lead at Gordon Moody, discusses the current landscape of gambling and the challenges organisations face when supporting problem gamblers.

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