Gambling is a pastime that nearly half of the UK population do, ranging from occasionally purchasing scratch cards to regularly betting on sports events. People tend to engage in certain types of gambling (e.g., daily scratch card purchases) more frequently than others (e.g., playing slot machines or blackjack at the casino weekly); however, for most individuals, these forms of betting are harmless and fun. Many can enjoy placing a bet, even if it results in financial loss. This does not mean they have a gambling disorder, just as someone who is occasionally tipsy or hungover after a celebration does not necessarily have an alcohol use disorder. However, between 0.4% and 2.8% of the UK population (Public Health England, 2019) may develop a significant gambling disorder, leading to serious problems with their health, finances, or other types of social problems.
The defining feature of a gambling disorder is its persistence, along with the widespread harms and risks associated with placing bets. Deceit—both towards others and oneself—is also a key characteristic of a gambling disorder. The urge to gamble is so intense that individuals will go to great lengths to place the next bet, often involving lying to conceal their whereabouts, activities, and finances. They underestimate losses and overestimate gains, often engaging in magical thinking: “My horse came second; next time, it will win’.
Gambling and suicide are closely linked, particularly among men (Livingstone & Rintoul, 2021). Problem gambling significantly increases the risk of suicidal thoughts, attempts, and fatalities, with problem gamblers being three to four times more likely to attempt suicide, (Karlsson & Håkansson, 2018) especially when their addiction results in financial distress, relationship breakdowns or co-occurring mental health conditions such as depression and anxiety. Financial difficulties often play a central role, as problem gamblers frequently find themselves facing overwhelming debts that lead to feelings of hopelessness.
Furthermore, mental health issues, including depression and anxiety, amplify the risk, as does the social isolation that many gamblers experience due to stigma or strained relationships. Research shows that among treatment-seeking patients with gambling disorder, a majority suffered from a concurrent psychiatric disorder, including depressive disorder, anxiety and co-morbid drug or alcohol addiction (Sanju & Gerada, 2011). Gamblers report higher rates of emotions such as guilt, shame, loss of self-esteem, loneliness, sleep problems and poor self-care.
Gambling disorder poses a public health issue. Tackling this matter necessitates early intervention and integrated treatment for addiction.
Despite the harms caused by gambling, only one in five individuals seek help, the remainder suffering in silence (Bijker et al., 2022). Recommended treatments include cognitive behavioural therapy, self-help strategies, participation in support groups, and addressing co-occurring issues such as housing, financial difficulties, health concerns, and practical solutions such as gambling blocking apps on mobile phones. However, unlike other areas of mental health, there is a lack of robust evidence to ascertain the most effective treatment options, particularly research conducted in the UK.
Worsening social, health, and especially financial factors can lead to increased risk of mental health issues and suicide ideation in problem gamblers.
Methods
A recent paper (Seel et al., 2024) undertook a systematic analysis to identify which studies have been conducted for individuals seeking treatment in the UK. The authors examined the settings, research designs, outcome measures used to assess gambling treatments, and gaps in the research. The authors used a robust methodology, including searching key databases and publications involving research into gambling treatment conducted in the UK.
Studies were included if they evaluated the effectiveness of an intervention or treatment designed to improve symptoms of harmful or problematic gambling, reported outcomes of interventions on treatment adherence, gambling symptoms, or behaviours using standardised measures, were conducted in the UK, and were published since 2000 and ending 2023 (Seel et al., 2024).
Results
Their findings are very worrying.
Only eight studies in the reviewed literature met the authors’ inclusion criteria. These studies primarily employed retrospective reviews, case reports, or cross-sectional designs, and none utilised rigorous experimental methodologies such as randomised controlled trials (RCTs). The outcome follow-up periods for the studies ranged from 18 months to three years, except for one study examining the predictors of treatment dropout, which provided clinical data over 16 years. All but one of the studies were published within the last decade, and none were published after the COVID-19 pandemic.
Four studies employed the most frequently used retrospective chart review design. Additionally, one study utilised a retrospective case series, two focused on single-participant case reports, and one used a cross-sectional survey design. Case reports were then used to inform policy advice rather than encourage more rigorous research (Jones & George, 2011). No experimental research designs were identified in the review.
Gambling treatment clinics were the most frequently reported settings, appearing in five studies. The other three studies took place in locations such as Gamblers Anonymous (GA) meetings, residential care facilities, or unspecified sites.
Cognitive-behavioural therapy (CBT) is the most extensively studied intervention for gambling harm. While CBT has shown promise in tackling gambling-related issues, the review highlighted the significant lack of research into alternative approaches, including pharmacological treatments, self-guided internet interventions, and broader psychosocial interventions.
The review found no evidence that interventions for harmful gambling followed recognised best-practice experimental designs, such as randomised controlled trials. Instead, they overrelied on retrospective reviews of outcomes, standard data, or subjective case reports.
Additionally, even the definition of gambling disorder was inconsistent. Most researchers inferred severity using the Problem Gambling Severity Index (PGSI) scoring criteria or from self-reports. However, the PGSI does not provide a formal diagnosis of gambling disorder, and its accuracy and validity in identifying issues can vary. Self-reporting is often also inconsistent and, as with the PGSI, does not offer a formal diagnosis of gambling disorder suitable for research purposes. Seel et al. recommend utilising more robust criteria, such as the DSM-5 or ICD-11. Only one of the studies employed the latest DSM-based diagnostic instrument.
Studies rarely offered details about recruitment criteria and often consisted solely of secondary analysis of internal clinical audits. Only one study noted conflicts of interest, and funding information was presented in only two.
The review found no gambling intervention studies using randomised controlled trials, raising concerns about the lack of rigorous, evidence-based treatment research in this field.
Conclusions
This review highlights the urgent need for comprehensive research to build a strong evidence base for effective gambling harm interventions in the UK.
Without research, clinicians are working in the dark, extrapolating from the treatment of other non-behavioural addictions or from international research, which might not be immediately applicable to a UK cohort of patients. By adopting a more methodologically rigorous approach, the field can more effectively address gambling-related harms’ complex and far-reaching impacts.
The authors say there is:
an urgent need to establish new research priorities to support the treatment of harmful gambling.
Without robust UK-based research, clinicians are left navigating gambling harm treatment in the dark, relying on limited or non-applicable international data.
Strengths and limitations
There are several limitations which the authors acknowledge in their review. For example, they did not conduct a risk of bias assessment, as this is not typically part of standard practice for scoping reviews aimed at mapping evidence. However, such an assessment might have been beneficial in evaluating the robustness of each included study in terms of their methodological and reporting quality. Additionally, the small number of included studies limited the possibility of a more detailed examination of potential biases.
Moreover, the review focused exclusively on UK-based treatment literature, as the primary objective was to explore this area for the first time, particularly in developing the NICE guidelines for harmful gambling treatment. Consequently, it excluded studies from countries with different policy and legislative frameworks on gambling treatment.
Future research would benefit from examining the global literature to identify common approaches, practical strategies, and potential gaps in treating harmful gambling across various settings. Expanding the scope to include international studies could offer a broader perspective and enhance the generalisability of findings, ultimately leading to the development of more comprehensive treatment frameworks.
However, the limitations arise not primarily from the paper itself, a thorough analysis and well-conducted scoping review, but rather from the content of what they were exploring: the lack of quality studies originating from the UK. The authors suggest that this may stem from issues related to funding for research, which has come mainly from voluntary levies imposed by the gambling industry and fines levied by the Gambling Commission on gambling providers. This funding source could have discouraged researchers from applying for funds due to concerns about being perceived as under the influence of the industry or potential conflicts of interest.
The imposition of the gambling industry may have impaired the growth of research on gambling.
Implications for practice
The authors recommend a comprehensive overhaul of the UK research approach to gambling harm interventions. This includes more significant investment in experimental research, developing standardised treatment protocols, and broader recruitment strategies to ensure representative samples. They also emphasise the importance of addressing systemic barriers, such as limited funding and insufficient collaboration among researchers, clinicians, and policymakers. The good news is that the UK government’s introduction of a statutory levy on gambling operators is poised to enhance research into gambling-related harms significantly. Aiming to start in April 2025, this levy is expected to generate approximately £100 million annually, with 20%—around £20 million—explicitly allocated for research purposes. With this levy in place, research efforts can be more strategically planned and executed, fostering a deeper understanding of gambling behaviours, the effectiveness of interventions, and the development of evidence-based policies.
A better evidence base for treating individuals suffering from gambling-related harms ensures that interventions are effective and account for a diversity of needs, including different patient populations. This is especially evident due to the social, psychological, and financial effects that families, communities, the broader society, and the individual can subsequently experience. For example, an important area for research is whether different treatment approaches might need to consider gender. Due to stigma and stereotypes primarily associating gambling with men, it’s possible that gambling-related harms in women may go unrecognised. Women may not seek gambling treatment due to many reasons, including stigma, shame, fear of judgment, childcare responsibilities, co-occurring mental health issues, or distrust in treatment. Addressing these requires women-centric, trauma-informed, accessible services, reducing stigma, and offering flexible, affordable, and supportive interventions (Hing et al., 2016). Effective solutions require ongoing research.
Furthermore, prisoners represent a high-risk group for problem gambling, with engagement often exacerbating substance misuse, mental health issues, and recidivism. Evidence-based interventions within correctional settings can address underlying causes, helping to break the cycle of harm and thus increase the likelihood of rehabilitation.
There are many unique challenges faced by minority groups that add complexity to developing these evidence-based treatments, such as cultural stigmas, discrimination, and barriers to accessing necessary treatment. These complexities are crucial to consider providing culturally sensitive and inclusive care.
Without strong evidence to support the development of these treatments, the risk of ineffective care is heightened, leading to an increased likelihood of harm and the perpetuation of inequalities. Therefore, employing this rigorous research can ensure that relevant interventions tackle the root causes of gambling-related harms while reducing stigma and remaining person-centred. Developing these strategies is vital for improving treatment outcomes for individuals and addressing health disparities between demographics, which would foster healthier communities. This is truly an area where “more research is needed”.
A better evidence base for treating individuals suffering from gambling-related harms ensures that interventions are effective and account for a diversity of needs, including different patient populations.
Statement of interests
Both RW and CG are funded to deliver care via the Primary Care Gambling Service through a grant from Gamble Aware.
Links
Primary paper
Seel, C. J., Jones, M., Christensen, D. R., May, R., Hoon, A. E., & Dymond, S. (2024). Treatment of harmful gambling: A scoping review of United Kingdom-based intervention research. BMC Psychiatry, 24(1), 392. https://doi.org/10.1186/s12888-024-05843-8
Other references
Bijker, R., Booth, N., Merkouris, S. S., Dowling, N. A., & Rodda, S. N. (2022). Global prevalence of help-seeking for problem gambling: A systematic review and meta-analysis. Addiction (Abingdon, England), 117(12), 2972–2985. https://doi.org/10.1111/add.15952
Hing, N., Russell, A., Tolchard, B., & Nower, L. (2016). Risk Factors for Gambling Problems: An Analysis by Gender. Journal of Gambling Studies, 32(2), 511–534. https://doi.org/10.1007/s10899-015-9548-8
Jones, H. B., & George, S. (2011). ‘You never told me I would turn into a gambler’: A first person account of dopamine agonist – induced gambling addiction in a patient with restless legs syndrome. BMJ Case Reports, 2011, bcr0720114459. https://doi.org/10.1136/bcr.07.2011.4459
Karlsson, A., & Håkansson, A. (2018). Gambling disorder, increased mortality, suicidality, and associated comorbidity: A longitudinal nationwide register study. Journal of Behavioral Addictions, 7(4), 1091–1099. https://doi.org/10.1556/2006.7.2018.112
Livingstone, C., & Rintoul, A. (2021). Gambling-related suicidality: Stigma, shame, and neglect. The Lancet Public Health, 6(1), e4–e5. https://doi.org/10.1016/S2468-2667(20)30257-7
May-Chahal, C., Humphreys, L., Clifton, A., Francis, B., & Reith, G. (2017). Gambling Harm and Crime Careers. Journal of Gambling Studies, 33(1), 65–84. https://doi.org/10.1007/s10899-016-9612-z
Public Health England. (2019). Gambling Related Harms Evidence Review.
Sanju, G., & Gerada, C. (2011). Problem gamblers in primary care: Can GPs do more? The British Journal of General Practice,61(585), 248–249. https://doi.org/10.3399/bjgp11X567027
