Features

The realities of addiction: a dangerous game

22 July 2022

In the second of our series on addiction, journalist John Windell looks at the billion-pound industry that is enjoyed by millions in the UK, but exacts a huge cost on some players and their families.

The extent of Britain’s fixation on gambling was laid bare with the publication in March of GambleAware’s latest Annual GB Treatment and Support Survey. As many as 2.8% of adults – the equivalent of 1.4 million people – are experiencing harm as a result of their gambling (Gunstone et al, 2020). They would score 8 or more (out of 27) on the Problem Gambling Severity Index (PGSI), meaning their behaviour has ‘negative consequences and a possible loss of control’.

That behaviour also has reverberations for their families and friends, whether the addiction is to gambling online (most prevalent), at the bookmakers or in a casino. Six per cent of the population (around 3.4 million people) say they have been negatively affected by another’s gambling (Gunstone et al, 2020). It can take a heavy toll on relationships, family life, employment and education.

The Royal College of Psychologists describes a gambling disorder (also sometimes known as a compulsion or addiction) as a repeated pattern of behaviour where the person ‘feels they have lost control, continues to gamble despite negative consequences, and sees gambling as more important to them than any other interest or activity’ (RCPsych, 2021). This broad description is formally codified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5: American Psychiatric Association, 2013) and the International Statistical Classification of Diseases and Related Health Problems (ICD-11: WHO, 2019), which health professionals refer to when making a formal diagnosis of a gambling disorder.

But as with other addictive disorders, problem gambling covers a wide spectrum of behaviour, and certain people may be more prone towards developing harmful behaviour than others.

Over the limit

Rob Mabbett, head of growth at the gambling charity Gordon Moody, says there is a range of responses to gambling. ‘Some people wake up feeling terrible after a heavy night’s drinking, but think it was worth it because they had a good night, and some people do that with gambling. They go to the races or the casino, they may gamble more than usual, but next time they are able to bring it back to a limit they’re comfortable with. It becomes a problem when that doesn’t happen, and reaching that point can depend on a lot of individual factors.’

When gambling begins to have an impact on their lives, it’s not always immediately apparent, says Becky Harris, a family therapist and area manager for Central and North West London NHS Foundation Trust Addiction Services: ‘It can be hard to miss compared with the early stages of some other kinds of addictions. Many people can keep a gambling disorder secret for a long time. They may have been gambling for years and years and it’s only when they have lost a lot of money that it becomes too much to handle and they can’t hide it any more. They may be at the point of losing their marriage, house or job, and it causes huge pressure and stress.’

As well as creating problems, gambling can be a way of avoiding them. ‘It might be financial or emotional issues, or a previous trauma,’ says Rob. ‘People often gamble to escape difficult thoughts and bad places.’

For spouses or partners, the revelation of a gambling disorder and the related harm it causes can come as a huge shock. In extreme cases, they suddenly face the collapse of a life they had thought was secure. ‘In my experience, it’s the lying that has such a terrible impact on partners,’ says Becky.

Children can also feel the effects. Though they may not fully understand what is happening, they are often highly sensitive to their parents’ stress, tension, arguments and lack of money. Older children may even have their own gambling issues. ‘We hear about it, but we don’t see many people younger than about 17,’ says Becky. ‘It seems to be a recreational activity, often sports betting, and done on a smartphone. For a small percentage it will become problematic.’

Treatment and results

Any gambling disorder carries the risk of mental health issues, such as high levels of anxiety and depression. ‘It’s different to other addictions in that the best solution feels like it’s to carry on with the problem,’ says Becky. ‘If you’re in heavy debt, part of your brain tells you that more gambling is the way to get out of that debt. You dig yourself deeper and deeper, and it becomes incredibly preoccupying and stressful. I’ve worked in the addictions field for a long time, and when I started working in gambling I was shocked at how many people feel suicidal when they came into treatment. They get so desperate, they can’t see a way out. But once they’re in treatment, they can get on top of it and feel very different very quickly.’

The core NHS treatment for addiction disorders is cognitive behavioural therapy. A specific programme has been developed to address the particular challenges of gambling disorder, which also includes motivational interviewing and other psychotherapeutic approaches, as well as psychiatrists who assess and help those who are struggling with their mental health. Another facet is family work.

A useful range of practical interventions are also available, such as blocking the ability to gamble from a phone or voluntary exclusion from bookmakers. ‘These steps can give people the space they need from being in the gambling moment,’ says Becky. The good news is that the prospects for those who stay in treatment are good. ‘Plenty of people stop and stay stopped. But as with most addictive behaviour, it can take more than one go, and you can’t always predict when it will be successful,’ she adds.

Gordon Moody provides a 14-week residential programme for the most severe cases. Besides psychotherapy, it offers intensive peer support. Residents are also required to surrender any access to cash and the internet, which amounts to a gambling detox. ‘We see really successful outcomes,’ says Rob. ‘People normally start our programme with a PGSI score in the mid-20s. By the end, they are down to single digits.’

While the outlook for individuals can be positive, the big question is whether the gambling issue is getting worse at a societal level. The prevalence of advertising and round-the-clock opportunities means that gambling is more visible and easier to partake in than ever, but Gambling Commission figures for the year to March 2022 show that the overall headline problem gambling rate remained stable at 0.2% of participants (Gambling Commission, 2022). However, the experience at Gordon Moody is the opposite; Rob says the charity has seen a definite increase in those most affected. ‘The number of people reaching out to us with severe issues rose by 123% in the last year. This may be linked to mental health issues and other things going on such as Covid-19, living costs and so on.’

Hidden problem

It’s also an issue that community practitioners may encounter more often, though it may not be apparent at first. ‘Because of the secrecy aspect, it can difficult to spot,’ says Becky. ‘If somebody seems down or is being secretive about money, and is on their phone a lot, it doesn’t necessarily mean they are gambling, but it could.’

Rob agrees it can be a hidden issue: ‘There are many instances where people’s mental health clearly isn’t right, but one of the last questions asked is whether it might be gambling. So first and foremost, ask the question.’

If there is a problem, help is at hand for you to signpost clients towards. ‘Gambling treatment is readily available,’ says Becky. ‘Google “NHS gambling treatment” and you’ll find it. We’re a national service and can take referrals from anywhere in the country. The referral process is very straightforward.’

The NHS London Problem Gambling Clinic and the NHS Northern Gambling Service are part of the National Gambling Treatment Service. Run by GambleAware, it offers a range of other services, from brief interventions all the way to Gordon Moody’s residential care. ‘You can call the National Gambling Helpline, many charities run their own help desks, have lots of information on their websites, and there are leaflets and advice in betting shops,’ says Rob. ‘The focus is on getting people the right support at the right time.’ 


Resources

NHS information and links to support nhs.uk/live-well/addiction-support/gambling-addiction

GambleAware – the hub for national support begambleaware.org

GamCare – support for anyone affected by gambling harm, including the National Gambling Helpline gamcare.org.uk

Gordon Moody – charity that offers counselling and residential treatment gordonmoody.org.uk

Living with Gambling – charity that supports affected families gamblingwithlives.org


References

American Psychiatric Association. (2013) Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). American Psychiatric Publishing: Arlington, VA. 

GambleAware. (2021) Annual statistics from the National Gambling Treatment Service. See: www.begambleaware.org/sites/default/files/2021-11/FINAL_GA_Annual%20stats_report_2020-21_English.pdf (accessed 6 June 2022).  

Gambling Commission. (2022) Statistics on participation and problem gambling for the year to March 2022. See: gamblingcommission.gov.uk/statistics-and-research/publication/statistics-on-participation-and-problem-gambling-for-the-year-to-march-2022 (accessed 6 June 2022). 

Gambling Commission. (2020) Young people and gambling 2020. See: gamblingcommission.gov.uk/statistics-and-research/publication/young-people-and-gambling-2020 (accessed 7 June 2022). 

Gambling with Lives. (2020) The number of gambling-related suicides each year in the UK, GwL 2020. See: gamblingwithlives.org/research/the-number-of-gambling-related-suicides-each-year-in-the-uk-gwl-2020/ (accessed 6 June 2022). 

Gunstone B, Gosschalk K, Zabicka E et al. (2021) Annual GB treatment and support survey 2021: on behalf of GambleAware. YouGov. See: www.begambleaware.org/sites/default/files/2022-03/Annual%20GB%20Treatment%20and%20Support%20Survey%20Report%202021%20%28FINAL%29.pdf (accessed 6 June 2022).

Karlsson A, Håkansson A. (2018) Gambling disorder, increased mortality, suicidality, and associated comorbidity: A longitudinal nationwide register study. Journal of Behavioral Addictions 7(4): 1091-099.

Muggleton N, Parpart P, Newall P et al. (2021) The association between gambling and financial, social and health outcomes in big financial data. Nature Human Behaviour 5(3): 319–26.

Royal College of Psychiatrists. (2021) Gambling disorder. See: rcpsych.ac.uk/mental-health/problems-disorders/gambling-disorder (accessed 6 June 2022).

WHO. (2019) International Statistical Classification of Diseases and Related Health Problems (10th Revision). See: https://icd.who.int/browse10/2019/en (accessed 7 June 2022).


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