Gambling addiction – a public health issue?

This article was originally published on 29 March 2017. It is being reposted ahead of the Short Debate on Problem gambling on 19 July 2017.

Darllenwch yr erthygl yma yn Gymraeg | View this post in Welsh

Gambling is an activity that a lot of people in the UK engage in, and while many may enjoy it responsibly, some people develop an addiction, also referred to as problem gambling. According to an October 2016 report by the Gambling Commission 1.1 per cent of people in Wales can be identified as problem gamblers. A recent report published by the Institute for Public Policy Research (IPPR) provides an in-depth analysis of data for Great Britain as a whole and suggests that problem gambling constitutes costs to government of between £260 million and £1.16 billion per year, of which the costs for Wales are estimated to be between £40 million and £70 million a year.

Current policy and future direction

The image shows stacks of casino chipsRegulation of gambling is not devolved and is governed by the Gambling Act 2005, which provides a regulatory framework for the industry. The Department for Culture, Media & Sport is currently undertaking a Review of Gaming Machines and Social Responsibility Measures, which aims to determine what changes, if any, are needed ‘to strike the right balance between socially responsible growth and the protection of consumers and wider communities’. The areas of the review include maximum stakes as well as numbers of gaming machines permitted. A recent report (PDF 958 KB) by the Fixed Odds Betting Terminals (FOBT) All Party Parliamentary Group has called on the UK Government to substantially lower the maximum stake from the current level of £100 to £2. The House of Commons Library has recently published a briefing paper on fixed odd betting terminals, which summarises the issues associated with this one specific gambling outlet.

Section 58 of the Wales Act 2017 devolves legislative competence in relation to gaming machines authorised by a new betting premises licence where the maximum charge for a single play is more than £10. This was the result of a Government amendment moved at Lords Report stage. During the House of Lords debate, the new powers were welcomed although some Lords expressed the opinion that the changes did not go far enough and competence should be given for machines with a maximum stake of £2. In evidence to the Assembly’s Health, Social Care and Sport Committee during scrutiny of the Public Health (Wales) Bill, public health representatives described FOBTs as the ‘crack cocaine’ of the gambling industry. It is important to remember, however, that is only one form of gambling among many. For instance, calls have been made to exercise greater control over football bets. Online gambling is also on the increase, and it’s acknowledged that this is harder to regulate.

While Wales may have limited powers in terms of gambling regulation, addiction to gambling is increasingly being recognised as a public health concern.

For example, Aneurin Bevan University Health Board has identified gambling addiction as one of the issues on the horizon. Its report New and Emerging Threats to the Health of the Gwent Population PDF 4.9 MB), published in 2014, suggests that health professionals working in primary care services, alongside mental help and social care services, can all play an important role in diagnosis and referral for help. Similarly, the aforementioned IPRR report lists amongst its recommendations taking more opportunities to screen for problem gambling when individuals come into contact with frontline services, and training professionals to identify problem gambling whenever possible.

Diagnosis and treatment

General information about addictions can be found on the NHS Direct website. The NHS Choices website offers some information about gambling addiction and its treatment. Recognition of the problem is crucial in starting treatment, which can then be accessed using one of four routes:

  • Self-referral;
  • Referral by GP;
  • Private clinics; and
  • Court referrals.

Although most cases are self-referred, the role of GPs in screening for the condition is an important one. Availability of training in identifying problem gambling is even more important given that the profile of the traditional gambler has changed. Although men tend to engage in gambling more than women, the gap in participation between men and women has been narrowing in recent years, with 63 per cent of men and 59 per cent of women reporting gambling participation in Wales in 2015. Similarly, more and more young people are affected by problem gambling.

Often gambling addiction co-occurs with other addictions, such as alcohol (PDF 1.1 MB). There is also evidence that suggests that gambling can be associated with the presence of mental health problems.

There are a number of possible treatment options, as set out in a major review published by the British Medical Association (PDF 358 KB):

  • Counselling;
  • Psychotherapy;
  • Cognitive-behavioural therapy;
  • Residential care;
  • Pharmacotherapy; and
  • Combinations of the above.

Current provision is often regarded as insufficient. Currently most treatment is provided by private and charitable organisations, such as GamCare, Gamble Aware, Gamblers Anonymous, among others. In Wales, the charity Beat the Odds Wales offers support to people who have been affected by problem gambling. There is only one NHS National Problem Gambling Clinic in the UK, which is located in London. It accepts patients from England and Wales. In 2013 the clinic’s director, Dr Henrietta Bowden-Jones, called on the Welsh Government to fund a designated clinic in Wales.

What is being done?

The issue of gambling was debated in Plenary in the 4th Assembly, calling the Welsh Government to develop and implement strategy to tackle the social and health consequences of gambling. In an answer to a question on what is done to tackle gambling, the First Minister said on 28 June 2016 that

it’s hugely important that people see gambling as an addiction, which it is—in the same way as people see alcohol as an addiction, the abuse of certain drugs as an addiction, it’s hugely important with gambling as well. We are looking at ways in which we can ensure, via our education system, that people understand the dangers of gambling.

A number of responses to the Assembly’s Health, Social Care and Sport Committee’s consultation on its priorities highlighted the fact that gambling addiction has received too little attention, and that this issue should be looked at from a public health perspective. In the US, some researchers called for adopting such a perspective 20 years ago, and for instance the Ministry of Health in New Zealand has a statutory duty to co-ordinate problem gambling services. It may be the case that, here in Wales, there is scope for the health sector to play a greater role in tackling the issue.

Article by Piotr Wegorowski, National Assembly for Wales Research Service.
The Research Service acknowledges the parliamentary fellowship provided to Piotr Wegorowski by the Arts and Humanities Research Council, which enabled this blog post to be completed.

This post is also available as a print-friendly PDF: Gambling addiction – a public health issue? (PDF, 210KB)