There is no one profile of a ‘typical’ person who suffers gambling harms. Not everybody reaches ‘rock bottom’ for instance, and problems that arise for some gamblers may be relatively easy to address. The right support, especially from family, friends and employers is invaluable.

Nevertheless, for the many who fall deeper into gambling addiction, the harms can be immense and difficult to unravel.

The four brave people who tell of the devastation gambling brought to their lives in our film, One Last Spin provide powerful testimony of the harms that can befall anybody. There can be little doubt after watching the film that gambling addiction is itself a serious mental and emotional agony. The inner experiences which are shared with us are unquestionably signs of a severe illness.

Below, we outline the surrounding complexities which surround the illness.

There are many good reasons to attend to the voices of ‘experts by experience’ in improving mental health care. Often we are entranced, ‘in the zone’ of, familiar and safe with, figures, numbers, data, models, impressive power point presentations. These things are important. Yet as GP Roger Jones reminds us (British Journal of General Practice)

One of the targets of Charles Dickens’ Hard Times is the 19th century equivalent of the bloodless, box-ticking bureaucracy that many people feel is now strangling the NHS. Mr Gradgrind demands facts, facts unadorned by sensitivities, emotions, or other human foibles. And facts we have — league tables, performance indicators, Care Quality Commission inspection scores, 2-week waiting time performance — facts coming out of our ears. Measuring the cost of everything and the value of practically nothing.

There is a need to employ quantitive thinking where, as so frequently, it’s appropriate. But quality, value can get lost. Addiction, the extreme negativity of gambling harms, is a pervasive mental illness than can be considered beyong the context of gambling. It’s a conceptual quagmire. The person with an addiction cannot articulate what’s going on, how or why they feel forced to do things they know are bad for them and others. So much harder then for others to understand. Perhaps the best we can do is acknowledge without a shred of doubt that we are dealing with a genuine illness, baffling as it is. As a society we are uneasy talking or thinking about this pervasive illness that may affect directly perhaps ten per cent of the population plus the knock-on distress of between 60 and 100 per cent of affected others. Perhaps society is not only stigmatising addiction but actively repressing it as at some level it represents a symptom of a deep distress spread throughout the population.

Therefore it is vital to hear cleary the voices of those most obviously affected for they have the qualititative insights into the illness. This is, of course, true of all health conditions. Listening to individuals talk about depression, for instance, convinces us tha there is no neat ‘box’ that defines it: it is different for everybody, varies widely in its manifestations, the severity of its impact, its centrl role at the heart of a person’s self-identity. Voices suggest too ways of recovery, journeys from darkness to light. So too with gambling related mental health issues. Apart from the extreme of addiction, these will often be seen as depression and anxiety, suicidal ideation, deteriorating physical health. These need addressing as they would be for anybody. Harmful gambling behaviour too is often preceded by mental and emotional distress such as depression and anxiety. Certain conditions such as ‘bipolar disorder’ make people far more likely to practise risky behaviours.

Add to this the negative factors of high debt, family breakdown, possibly crime, unemployment and the complexity of supporting and treating the more severe cases of individual mental and emotional distress becomes evident. Further, there are social and economic factors which no doctor, therapist or ‘method’ can ‘cure’. An NHS Scotland report (health-inequalities-what-are-they-how-do-we-reduce-them-mar16) states:

Health inequalities are the unfair and avoidable differences in people’s health across social groups and between different population groups.They represent thousands of unnecessary premature deaths every year in Scotland, and for men in the most deprived areas nearly 24 fewer years spent in ‘good health’

Life expectancy between the most deprived and wealthiest communities in Glasgow varies by more than twenty years. (It is in those deprived areas – or ‘data zones’ as the new terminology has it – that there is a clustering of gambling outlets (and retailers of fast food and alcohol). Hence, whatever treatment and support is given to people with mental and emotional distress in deprived areas, for many individuals it will remain insufficient. Addressing inequality, poverty and injustice requires a public health approach backed by political will. Nevertheless, many people overcome great obstacles to achieve wellbeing; many initiatives really do help people away from health problems; the value of peer support can never be underestimated: those who have been through and survived a problem are in the best position to help others. We need to avoid stigmatising a whole community as ‘deprived’. Only those familar, by residence or work, with the communities most battered by inequality and injustice can appreciate the enormous reservoir of mutual care and support and strong commitment to life-enhancing actions. In these communities there is no deprevitation of the best of humanity despite there being higher levels of ill health than in the leafy suburbs.

 Gambling’s Contribution to Society

It’s frequently pointed out by the gambling industry that it satisfies customer demand for a fun and harmless leisure activity. It acknowledges that there is work to be done to reduce harms to people who run into difficulty with gambling, and points out its record of funding education and treatment.

It also says rightly that it provides employment to tousands of people, and makes significant tax payments in the billions of pounds.

For some, gambling business is an example of others like the fast food industry. While some people may gamble irresponsibly or feed their children junk food, this should not be a concern of the state. What is generally meant by a ‘libertarian’ position includes emphasis upon personal autonomy and responsibility for choices. It is argued that it is unfair to the vast majority who enjoy products without detrimental effects should be penalised by heavy-handed laws and regulations that restrict personal choice.

Such points have merits when taken separately, and can be discussed one by one. Taken together they tend to establish a ‘dominant narrative’ whereby relatively very few people suffer from gambling. Phrases used beyond industry such as ‘pathological gambler’ also reinforce the narrative of individuals suffering from a rare illness or disease. This emphasis upon a small group of ‘pathological’ individuals serves to shift attention from industry’s practices and social responsibility with the latter addressed by the small amount of profits voluntarily donated towards research, education and treatment.

Some issues here, of course, are not restricted to gambling. The balance between public health ephasis, business and personal freedoms and responsibilities, is evident in many other cases. A current debate for instance is about the legalisation and regulation of (some or all) recreational drugs. Tobacco was involved in decades-long arguments, claims and counter-claims before the ‘balance’ swung towards severe restrictions such as the banning of advertising, public health campaigns and universally available free NHS treatment for cessation, hiding of products from view, draconian annual increases in duty.

Any attempt to examine the costs and benefits  of gambling need to avoid ideology (such as a central belief in personl freedom and responsibility) and then to engage in democratic arguments with all stakeholders.

Anticipating reforms arising from the current Gambling Act Review,The Social Market Foundation concludes in a March 2021 report, Double or nothing? acknowledging a total contribution of £8 billion from gambling, ‘it seems very unlikely that this economic contribution is truly additional to what would have taken place if gambling did not exist. Indeed, with most other parts of the economy having more extensive supply chains, and thus higher economic multipliers, reductions in gambling expenditure would almost certainly be a net economic benefit as households instead spendmoney elsewhere.’ The report states stridently, ‘Far from being acase for timidity, the economics of gambling – presented in this report – are in fact a case for bold, robust and significant regulatory reform. Done right, there is scope to both reduce the societal costs of problem gambling, and realise economic gains.’ This represents one line of thinking among the many we’ll witness as the Gambling Act review unfolds.