Loaded dice?

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Loaded diceThe estimated 450,000 people in the UK with a gambling problem are at a distinct disadvantage when it comes to getting access to treatment. DDN reports 

Earlier this year no less an organisation than the Royal College of Psychiatrists (RPsych) called on the government to dramatically increase the level of support for people struggling with problem gambling (DDN, May, page 5), which it defines as ‘gambling that disrupts or damages personal, family or recreational pursuits’.

‘These adults deserve the same access to treatment services as those with alcohol and drug addictions,’ said the college’s Faculty of Addiction Psychiatry. It also pointed out that not only was current service provision ‘under-developed, geographically “patchy” or simply nonexistent’, it was also funded almost exclusively by the gambling industry itself.

For problem gamblers looking for support there’s Central and North West London NHS Trust’s (CNWL) National Problem Gambling Clinic, which offers one-to-one and group therapy, family services and referral to appropriate aftercare, as well as Gamblers Anonymous – which is holding events to mark its 50th birthday this month – and a network of just under 20 local services partnered with industry-funded support service GamCare.

As Broadway Lodge chief executive Brian Dudley told DDN last year, however, among the only residential centres offering treatment for gambling addiction are his organisation and the Gordon Moody Association, both GamCare-funded (DDN, November 2013, page 17). ‘It’s funded by the gambling industry because there’s no other funding,’ he said. ‘The need is there, but the money doesn’t follow it.’

RCPsych’s report, Gambling: the hidden addiction, called for the government to ‘recognise gambling disorder as a public health responsibility’, to allow treatment to be provided by existing drug and alcohol services. Lack of government action, however, alongside the ‘increasing availability and public visibility of gambling’ would provide ‘the perfect conditions for a new generation of problem gamblers – a future trend in addictions that we are ill-equipped to treat’, said the report’s co-author and consultant addiction psychiatrist, Dr Sanju George.

And that ‘availability and public visibility’ does seem to be increasing all the time, with an explosion in online gambling, gambling apps and more, much of it backed by well-funded advertising campaigns. Earlier this year there was a high-profile controversy around fixed odds betting terminals (FOBT) – frequently referred to as ‘the crack cocaine of gambling’ – installed in bookmakers, with MPs calling for a reduction in the maximum amount it was possible to gamble on them in one go, from £100 to £20.

There were 33,000 of these terminals in betting shops in the UK in 2013, accounting for more than half of the shops’ net takings, according to regulator the Gambling Commission. The Campaign for Fairer Gambling, meanwhile, claimed that a staggering £1.6bn was lost on FOBTs last year – up £89m in 2012 – and that almost £500m of those losses occurred in 55 of England’s most deprived boroughs. Even where money isn’t at stake, however, as in the case of ordinary online gaming, there’s real potential for addictive behaviour and negative consequences, with people becoming so obsessed that their health and relationships can suffer dramatically (DDN, February 2013, page 8).

As another RCPsych report in partnership with Alcohol Concern Cymru – A losing bet? Alcohol and gambling – illustrated, while there may be fewer people struggling with gambling problems than with alcohol, ‘often people with alcohol problems participate in unhealthy gambling, and vice versa’. Both industries have seen the rules governing them in the UK liberalised in recent years, it points out, along with an expansion of female-targeted marketing. One in six of those interviewed for the report who had sought help for alcohol misuse also admitted to problems with gambling.

‘There’s a lot of comorbidity,’ said Brian Dudley. ‘Someone will come in with a drug or alcohol problem but when we actually start working with them we might well find their primary addiction is gambling, but they’d never have got funded.’

So is there a real role for the treatment sector here? ‘Expert and experienced in the medical treatment of addictions, these services could play an important role in tackling adult gambling disorder,’ said the RCPsych report, with the basic service infrastructure and staff already in place. ‘Incorporating gambling disorder within this structure provides a method to meet a critical and growing need, and one which not only needs to be seriously considered by the government, but also acted on.’

Derek Irwin, a psychotherapist and counselling services manager at GamCare, which currently offers counselling through a partnership with 18 local agencies, says his organisation would definitely ‘support the same access for services related to gambling addiction’ as for drugs and alcohol. ‘Even though gambling as an addiction does not exhibit physical or health symptoms in the same way, the behavioural process is similar to other addictions and the consequences are often just as serious,’ he tells DDN.

‘The NHS is committed to treating people with other forms of addiction, but not gambling, and so the onus is on the third sector to provide the services necessary to support those who suffer as a consequence of their gambling behaviour,’ says Marc Etches, chief executive of the Responsible Gambling Trust (RGT), a charity which exists to help ‘minimise gambling-related harm’ via voluntary donations from the gambling industry – around £6m per year.

From March 2013 to March 2014, 80 per cent of this money was spent on treatment, he points out, including the cost of running GamCare’s National Gambling Helpline. However, there is ‘scope to spend more on support for people with gambling problems and the RGT has plans to do so – but I’ve little doubt that nationwide provision of additional support through the NHS, including training for GPs on how to spot and treat gambling addiction, would greatly help problem gamblers’, he states.

So could gambling be incorporated into the existing treatment sector, as RPsych’s report advocates? ‘Working with addictions in a treatment context would utilise similar skills, but training regarding gambling-related problems would be essential in order to deal with this specific problem,’ says Irwin.

The report acknowledges additional resources would need to be identified – and ring-fenced – with the most significant cost likely to be training existing staff, and potentially employing more. Much could also be achieved by improving non-specialist care, however, with RCPsych calling for better screening for problem gambling by GPs and other professionals and the use of low-cost brief interventions to try to stop people moving from being ‘at risk’ to developing a full disorder, particularly with clients who are unsuited to – or unwilling to access – more intensive treatment.

Screening and brief interventions are indeed ‘useful and important’ says Irwin, as people ‘would benefit from early intervention just like any other problem or condition’. 

Meanwhile, the RGT’s funding plan for 2014-15 has set aside £4.3m for the provision of services to treat problem gambling, stresses Etches. ‘This includes £2.4m for GamCare to provide treatment services, either directly or via its network of partners, to gamblers and others adversely affected by gambling via free and confidential counselling, one-to-one or in groups, face-to-face and online.’ The RGT has also made grants to CNWL to fund CBT-based counselling at the National Problem Gambling Clinic, he points out, as well as residential services at the Gordon Moody Association and GamCare’s National Gambling Helpline. ‘There is no national, publicly funded alternative to these services,’ he states.

And what about RPsych’s warning that without dramatically upscaled action now there could be a whole new generation of problem gamblers? ‘It depends how you look at problems causally,’ says Irwin. ‘A parallel could be made with legislation, advertising and availability around alcohol. It is the case, we feel, that other problems and issues lead to addictive behaviours, so addressing these other issues would be our priority. Of course, legislation and advertising need always to be monitored, but it’s not the solution.’  DDN

Gambling: the hidden addiction at www.rcpsych.ac.uk

A losing bet? Alcohol and gambling: investigating parallels and shared solutions at www.alcoholconcern.org.uk

A major London conference on 13 November will look at the level of gambling-related problems in the UK, the links with drug and alcohol misuse, and opportunities for the treatment sector. For more information, visit: Weighing up the odds

From debts to bets