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While a harmless diversion for many, for some people gambling can mean losing everything – even their life. With treatment provision still sparse, Jody Lombardini and Danny Hames set out how one clinic has been providing much-needed help. Read this article in DDN Recent public debate regarding fixed odds betting terminals (FOBTs), the increasing density of betting shops – particularly in more deprived areas – and the prominence of gambling advertising on television has created a much needed spotlight on the blight of gambling for many of those affected. The Gambling Commission’s 2017 report indicated that 0.7 per cent of those who gambled in the past 12 months identified as problem gamblers (compared to 0.5 per cent in 2015), with 5.5 per cent identified as at-risk gamblers, and around 430,000 having a serious habit. How many of these are individuals who also experience problems with drugs and alcohol, and do we identify this in services – even if it is an unmet need that needs highlighting to our commissioners? Gambling is an addiction, and the NHS Substance Misuse Provider Alliance (NHSSMPA) hope that extra funding is provided to increase access to treatment for those affected. Why? Because we know it can be effective – one of the NHSSMPA members, Central and North West London NHS Foundation Trust (CNWL), has long been at the forefront of providing support to gamblers. Below, Jody Lombardini shares its story on the tenth anniversary of the CNWL National Problem Gambling Clinic (NPGC). MAKING A DIFFERENCE Thousands of patients have walked through the NPGC’s doors over the past decade. In that time its influence has been felt far and wide, and we are very proud of it – our internationally renowned facility is still the only NHS clinic designed to treat gambling disorders. We’re finding our services are required more than ever, with the numbers of people with gambling-associated problems having reached around half a million, while many millions more are impacted by the problems caused. The clinic treats problem gamblers living in England and Wales aged 16 and over. It assesses not just their needs, but also those of their partners and family members and provides a variety of treatments. It has also served an essential function since its inception in training mental health professionals in the treatment of problem gambling. The importance of our clinic was acknowledged by the government in June when health secretary Jeremy Hunt joined with a variety of guests in unveiling a plaque to mark its tenth anniversary. I was pleased to hear Mr Hunt acknowledge that the NHS needed to do more to help the types of patients we see, and pledge to work with Public Health England to carry out a review of services and the client group in order to inform action on how to prevent and treat this issue. I was struck by his words: ‘We want to remedy this.’ The clinic was founded by consultant psychiatrist Dr Henrietta Bowden-Jones at a time when knowledge of gambling addiction was limited and support was sparse. The basic ethos was that something was needed to help people in the grip of a gambling addiction – our chief executive, Claire Murdoch, bought into this vision and has supported it ever since. That was then, and now we have a long-term vision and hope for an expansion of dedicated services modelled on the NPGC across the country, combined with increasing awareness of problem gambling. At the unveiling of the plaque, Dr Bowden-Jones said, ‘We are optimistic that the next decade will bring what we have wished for from the day we started. This country needs to acknowledge problem gambling as an illness, as an addiction just like any other. In doing so it needs to accept responsibility for the treatment of the half a million patients currently suffering from this disease.’ As CNWL’s head of addictions I thoroughly endorse this vision. I have read and heard too many stories of patients whose families have been destroyed by gambling and heard too much about the numbers who have come to us having considered self-harm, or considered or attempted suicide. These are the lucky ones, however. We’ve all read about those who committed suicide having lost everything through gambling and had seen no way out. We offer hope and help – both to gamblers and to their families. Those who come to us will typically have had: A lengthy period of problem gambling, with little or no abstinence Previous unsuccessful structured psychological support for problem gambling Mental health difficulties Substance misuse or other compulsive behaviours Concerns about risk of harm to self or others Serious physical health difficulties Homelessness or unstable housing or chronic social isolation Frequent involvement with the criminal justice system or history of serious offending Developmental disorders such as attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD) or difficulties with cognitive or intellectual functioning Adverse experiences in childhood. To be treated at CNWL’s national problem gambling clinic, people can self-refer or be referred. If accepted for treatment, a proven and effective help is cognitive behavioural therapy (CBT), which is provided on an individual and group basis. Psychodynamic psychotherapy is another option and may be used with those who have failed to maintain abstinence using CBT methods, or for those who are clear that there are emotional reasons for their lapses. With the emphasis also on the family, the clinic offers behavioural couples therapy, while another option is medication, specifically naltrexone to suppress cravings. What’s clear is the gratitude of patients helped by the clinic, who through our help have managed to rebuild their lives. To mark its work, the clinic is also holding a conference at the Wellcome Collection in Euston Road on 8 October from 10am to 4pm. The NHSSMPA behaviour change conference also takes place at the Wellcome Collection, on 17 September where CNWL will be presenting its work to delegates. For more information, or for NHS providers to find out how to be part of the alliance visit www.nhs-substance-misuse-provider-alliance.org.uk. Jody Lombardini is head of addictions at CNWL Danny Hames is head of development at NHSSMPA *************** ALL BETS ARE OFF Are Britain’s betting problems getting out of hand? Gambling made national headlines with the government’s recent move to cut the maximum stake on highly controversial FOBTs from £100 to £2 (DDN, June, page 4), but how big is the UK’s gambling problem? It’s certainly large enough for PHE to launch an evidence review into its public health harms, and according to the Gambling Commission 45 per cent of people will have gambled in the last four weeks (although this includes activities like taking part in National Lottery draws or buying scratchcards). The industry’s marketing budget is also huge, with betting companies spending around £150m a year on TV advertising alone – research by the BBC last year found that around 95 per cent of advertising breaks during live UK football matches had at least one gambling advert. Using the Problem Gambling Severity Index (PGSI), 3.9 per cent of adults are categorised as ‘at-risk’ gamblers, while 0.8 per cent per cent of people over the age of 16 now identify as problem gamblers – defined as gambling ‘to a degree that compromises, disrupts or damages family, personal or recreational pursuits’. According to the Royal College of Psychiatrists’ 2014 report, Gambling: the hidden addiction, the harm doesn’t stop there. For every problem gambler there are between eight and ten other people who are ‘directly affected’ – children, friends, family members and spouses, some of whom will experience domestic violence. The same document pointed out that treatment services, funded ‘almost exclusively’ by the industry itself, remained largely ‘underdeveloped, geographically patchy, or simply nonexistent’. The Gambling Commission identifies the British gambling market as ‘one of the most accessible’ in the world, with a proliferation of betting shops on the high street and the internet bringing opportunities to gamble into ‘virtually every home’. While gambling is clearly something that many people will enjoy as an occasional pastime – having ‘a flutter’ on the World Cup, for example – for a minority it can lead to loss of their relationship, family, job, home and even life. Gambling participation in 2017: behaviour, awareness and attitudes at www.gamblingcommission.gov.uk Gambling: the hidden addiction at www.rcpsych.ac.uk

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