Gambling and addiction

Updated: 2 days ago

The industry consistently emphasises that gambling addiction affects a small minority of individuals, benefitting from the fact that gold-standard prevalence surveys were stopped after 2010 due to funding cuts. The industry reflects on the estimates generated by data from self-completion forms included in health surveys or telephone surveys. On the other hand, more recent online studies have reported much higher gambling addiction rates, but the industry has dismissed these higher rates. Additionally, the industry fails to reflect that harmful gambling and gambling addiction should be viewed as a continuum. Moreover, more than half of the harm in individuals that gamble is expected to occur at the low-risk and moderate-risk harm levels.


Summary

The potential for addiction is influenced by intrinsic biological factors, extrinsic factors, and factors related to the addictive agent's ability to activate the brain's risk-reward areas. Like other addictions, dopamine has a crucial and well-documented role in developing and maintaining Gambling Disorder (GD). Gambling addiction is most prevalent among younger people. Other risk factors include a parent who suffered from a gambling disorder, poor mental health status, poor general health status, unemployment, and minority ethnic backgrounds.


GD is a behavioural addiction characterised by compulsive involvement in gambling activities, despite severe adverse consequences. GD is defined in the Diagnostic and Statistical Manual of Mental Disorders as "persistent and recurrent problematic gambling behaviour leading to clinically significant impairment or distress". GD has been recently included in the disorder class of "substance-related and addictive disorders".


It is essential to recognise that significant harms can occur in individuals who do not meet GD's clinical threshold as the diagnosis represents the most severe end of addiction and harm. According to research from Australia, gambling harm in individuals with GD makes up only 15% of the overall gambling harm suffered by those that gamble. Most of the harms on a population level are accrued by individuals who may be on the spectrum of addiction but not at GD's threshold. These findings are analogous to the scenario for alcohol harm, where harmful drinking in those without severe dependency is responsible for more significant amounts of harm. However, unlike alcohol harm, which is grouped into a single disorder on a continuum with mild, moderate, and severe sub-classifications, gambling-harm at mild and moderate levels are often treated with contempt.


Industry lobbyists often comment on prevalence statistics of those suffering the most severe harms from their gambling. Through this narrative, the industry can hide behind the idea that gambling affects only a tiny minority of the overall population, neglecting that more than half of the gambling harm in individuals that gamble is attributable to low-risk harm and moderate-risk harm. Moreover, adult prevalence statistics following 2010 are primarily limited to self-completion forms in health surveys due to a funding cut instead of the gold-standard bespoke gambling prevalence surveys.


What is known?

Genetics of gambling disorder

Twin studies investigating the genetics of pathological gambling have found that: 18

  • ‘heritability of pathological gambling is estimated to be 50–60%;

  • pathological gambling and subclinical pathological gambling are a continuum of the same disorder;

  • pathological gambling shares genetic vulnerability factors with antisocial behaviours, alcohol dependence and major depressive disorder;

  • genetic factors underlie the association between exposure to traumatic life‐events and pathological gambling’

Risk factors for gambling disorder (Odds Ratio): 19, 20

  • Parents regularly gambled but did not have a problematic relationship with gambling: 1.58

  • Current cigarette smoker: 2.46

  • ‘Other’ ethnic minority groups: 2.86

  • Unmanaged hypertension: 3.10

  • Asian/Asian British: 3.55

  • Black/Black British: 3.80

  • Unemployed: 4.02

  • Bad/very bad general health status: 6.17

  • Parents regularly gambled and had a problematic relationship with gambling: 7.32

  • A low Warwick-Edinburgh Mental Wellbeing score: 7.65

Prevalence of gambling harm from own gambling in adults across the world (past 12 months)

  • Great Britain

  • British Gambling Prevalence Surveys 2007 and 2010 (Gold-standard) 19, 21

  • low-risk harm: 5.1 – 5.5%,

  • moderate-risk harm: 1.4% - 1.8%,

  • gambling disorder harm: 0.8% - 1.2%

  • Self-completion forms included in health surveys 2012 – 2018 20, 22-24

  • low-risk harm: 2.5% - 3.9%

  • moderate-risk harm: 0.8% - 1.1%

  • gambling disorder harm: 0.5% - 0.9%

  • Telephone surveys 2016 -2020 25

  • low-risk harm: 2.0% - 3.7%

  • moderate-risk harm: 0.9% - 1.9%

  • gambling disorder harm: 0.3% - 0.7%

  • Online surveys 2019 – 2020 26

  • low-risk harm: 7.0% - 7.2%

  • moderate-risk harm: 2.8% - 3.3%

  • gambling disorder harm: 2.6% - 2.7%

  • Isle of Man 27

  • Gambling Prevalence Survey 2017

  • 7.0% low-risk harm

  • 1.5% moderate-risk harm

  • 0.8% gambling disorder harm

  • Northern Ireland 28

  • Gambling Prevalence Survey 2010

  • 8.2% low-risk harm

  • 5.9% moderate-risk harm

  • 2.6% gambling disorder harm 28

  • Gambling Prevalence Survey 2016

  • 6.7% low-risk harm

  • 4.9% moderate-risk harm

  • 2.3% gambling disorder harm

  • Scandinavia 29

  • Denmark Gambling Prevalence Survey 2016

  • 3.6% low-risk harm

  • 1.2% moderate-risk harm

  • 0.4% gambling disorder harm

  • Finland Gambling Prevalence Survey 2015

  • 8.7% low-risk harm

  • 2.8% moderate-risk harm

  • 0.5% gambling disorder harm

  • Norway Gambling Prevalence Survey 2015

  • 7.7% low-risk harm

  • 2.3% moderate-risk harm

  • 0.9% gambling disorder harm

  • Sweden Gambling Prevalence Survey 2015

  • 4.2% low-risk harm

  • 1.3% moderate-risk harm

  • 0.4% gambling disorder harm 30

  • Italy

  • Problem Gambling Survey 2018

  • 4.1% low-risk harm

  • 2.8% moderate-risk harm

  • 3.0% gambling disorder harm 31

  • Victoria, Australia

  • Gambling Prevalence Study 2014

  • 8.9% low-risk harm

  • 2.8% moderate-risk harm

  • 0.8% gambling disorder harm 7

  • Gambling Prevalence Study 2019

  • 6.7% low-risk harm

  • 2.4% moderate-risk harm

  • 0.7% gambling disorder harm 32

  • New Zealand

  • Meta-analysis of survey results 2010 - 2016:

  • 3.1% low-risk harm

  • 1.5% moderate-risk harm

  • 0.5% gambling disorder harm 33

  • Health Survey 2012:

  • 2.0% low-risk harm

  • 1.0% moderate-risk harm

  • 0.2% gambling disorder harm 34

  • National Gambling Study 2012:

  • 5.0% low-risk harm

  • 1.8% moderate-risk harm

  • 0.7% gambling disorder harm 35

What the industry said?

Betting and Gaming Council 16

“Rates of problem gambling in Great Britain are stable and low by international standards and we are committed to doing more to ensure safer gambling”


The BGC omits consideration for the vast majority of individuals who suffer gambling-harm and instead focuses on the smaller population who suffer the most severe forms of harm. Moreover, the BGC states that gambling disorder harm rates are stable despite the absence of a gold-standard prevalence study since 2010 due to a funding cut.


Michael Dugher, CEO of the Betting Gaming Council 36

“I recognise the concerns people have when around 0.6 per cent of those who bet are classed as ’problem gamblers’.”


Dugher demonstrates a lack of understanding of gambling harm by stating that 0.6% of those who bet suffer from a gambling disorder. Contrastingly, the most recent gold-standard study in 2010 reflected that approximately 1.6% of individuals that gambled in the past year suffer from the most severe form of addiction. After excluding individuals who exclusively play on the lottery and those who do not gamble regularly, this rate would be far higher. Moreover, the harms suffered by non-adults are entirely omitted. Notably, the gambling disorder harm rate is much higher in 11-16 year olds where 5.1% of individuals who gambled in the past year or 1.9% of the overall population affected by gambling disorder.


“Of those problem gamblers, a smaller but still significant number are ‘disordered’ or addicted gamblers.”


Dugher also demonstrates a confused understanding of addiction, as the most severe form of harm is at the gambling disorder level. As ever and despite the evidence, the industry refuses to embed an understanding of addiction and gambling-harm as being on a continuum and thus ignore the harms suffered by individuals who gamble and experience low-risk harms and moderate-risk harms.


“That might be a tiny fraction – and we shouldn’t forget of course that millions of people gamble safely – but the effect of addiction on these individuals and their families can be devastating.”


Here the CEO of the BGC, quite unusually, recognises that family members can suffer devastating harms but omits the statistic that between 6% to 7% of adults have reported suffering affected other harms in Great Britain.


Michael Dugher, CEO of the Betting Gaming Council 37

“For millions of people, it is a carefree leisure activity, and they do so perfectly safely and perfectly responsibly.”


Dugher uses the term “millions of people” to describe the number of individuals who gamble with no significant consequences while neglecting that millions of people suffer significant harm from gambling.


“But we recognise, as do the Government, as do campaigners and others that there is a small group of people who can have a problem with this, and in some cases it can be very, very severe.”


Dugher suggests that there is only a small group of people who suffer harm from gambling. Furthermore, Dugher and colleagues often implies that campaigners wanting reform are prohibitionists and have an issue with gambling as a leisure activity, despite evidence from lived experience campaigners showing that this claim is not valid. 38


“What we're saying is you've got to get the regulation right because what we don't want is to drive customers away from safer gambling on the regulated high standard sites to the illegal black market offshore companies.”


Paradoxically, Dugher highlights the concern of black market offshore companies while failing to recognise that before 2014, a large number of remote operators were not regulated, and the vast majority of companies continue to base offshore to avoid the UK’s corporation tax. Moreover, remote operators are global by nature and thus have customers in the black market in other countries.

Brigid Simmonds, Chair of the Betting and Gaming Council 39

“Just as we intervene with our customers so banks should as well:”


Simmonds deflects responsibility for safer gambling to banks, such that just like operators, banks should intervene to prevent gambling-harm. However, operator interventions are often limited to safer gambling messages as operators seldom close accounts that are profit-making for the industry.


“We take our responsibility to our customers incredibly seriously and we are determined to raise standards and improve safer gambling,”


Simmonds then repeats vague commitments to raising standards and improving safer gambling.


Brigid Simmonds, Chair of the Betting and Gaming Council 40

… "we have worked together on BetRegret"…


Simmonds comments on her role in developing the “BetRegret” campaign, which has been widely criticised for furthering stigma by placing responsibility on customers, potentially increasing self-blame, and for being drowned out by the sheer volume of contradictory betting advertisements.


Michael Dugher, CEO of the Betting Gaming Council 41

Place you bets now please… #RouletteBoy

"I thought you liked casinos, young Matt?"


Dugher uses social media to mock someone who is now abstinent; in doing so, he demonstrates his contempt for those who have suffered gambling-harm, the legacy effects of those harms, and the chronic nature of addiction.


References

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40. @BrigidSimmonds. ‘Many congratulations Zoe, we have worked together on BetRegret & your knowledge & expertise in advertising, marketing & how charities can work with other partners & industry will be vital to your new role @GambleAware’. [cited 14 January 2021] Available from: https://twitter.com/BrigidSimmonds/status/1349755154640347137 [Accessed: 30th March 2021] ]

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