Gambling addiction: Hidden harms
This time, we're looking at gambling addiction and the associated harms. We hear from Bianca, a recovering gambling addict, about the deceit which characterised her experiences with betting, and why this is shared by many like her. Then, with Barbara Sahakian from the University of Cambridge, we learn about the biological and environmental factors which may lead to problem gambling, and hear from the perspective of the industry with Dan Waugh of Regulus. Finally, what treatments are out there for gambling addiction? Emma Ryan from the UK's first Primary Care Gambling Service tells us.
In this episode
01:24 - What does gambling addiction look like?
What does gambling addiction look like?
Bianca Colclough
The UK’s Gambling Commission, responsible for regulating the industry in this country, recently announced that it was making changes to “give people the opportunity to gamble safely, while protecting people from gambling-related harm.” The plans - which were set out in a white paper - include a mandatory levy on betting firms to pay for treatment of addiction, and new player protection checks to catch erratic betting activity. I’ll hear more about these proposals from a representative of the industry later on. But first, what is it like when gambling takes hold of your life? A “harmless” evening out launched Bianca Colclough down a slippery slope into a gambling addiction…
Bianca - I've never been somebody that's been particularly interested in gambling in any form. My first experience of gambling wasn't actually a choice that I made. I'd actually been on a night out with a good friend of mine, and we were having so much fun that we didn't want the night to end. And the only place that was open in my local town was the casino. I sat and watched him and was absolutely flabbergasted. I just found the whole thing really, really interesting. The fact that he'd been able to just put 20 pounds into a machine and then suddenly it was turning it into something else, I felt compelled to want to do the same. And as with so many other people who have experienced gambling addiction - they start their story the same way - of course, I won. So that 20 pounds became 100.
James - So far it sounds like the experience of many people, those who are able to gamble without it becoming a problem. What started to happen to make you think that something was different about your experience with gambling?
Bianca - I'd say initially I didn't because, I suppose, when you are still classing yourself as a social gambler, you're not seeing it as a problem because you're not spending outside of your means. You're not going into debt because of it, you're feeling the rush of it as something that's part of an enjoyment. But as time goes by, you start to up the stakes, you start to spend more time in the casinos. When you start to live outside of your means and you start to actually take out loans and you start to actually get into debt because of it, that's when I realised it was then becoming the problem. But by that time I was too far in and I couldn't get out of the problem. I was a fully fledged addict. There's an element of isolation that I chose because, being in a casino, you are isolated and you're sat in front of a machine, so there really isn't anybody else to share that you're struggling with.
James - Bianca, do you mind me asking how much you were losing?
Bianca - In the worst, darkest moments, I know I'd lost around 1000 pounds a week. It's the addiction and that sort of trapped cycle that you get yourself into where you feel you literally can't stop going. The money I was winning, I was still choosing to put it back into the machines when I actually could have been recognising that that was money that I could be using to pay off my debt or I could be using with my family, etc. I never really had an exact figure but I know, when I actually was too far gone, it was just under 30,000 pounds that I was in debt.
James - It's a vast sum of money. I imagine one of the hardest parts of this was the fact that you were keeping it a secret from the people close to you, your friends and family?
Bianca - Absolutely. Because gambling doesn't cause a physical symptom it's very easy for us as gamblers to spend a horrible amount of money and have the real depths of low, of losing. But then what I would have to do is drive home, and my husband at the time would come home from work, I would make his dinner, I would sit and ask him about his day. We would chat and he'd ask me about my day and I'd say I'd been busy, I'd been to work - and I hadn't done any of those things. I've been sat in the casino. So the deceit is the thread that runs through all of it. That, on top of the fact that you are losing money, you're also becoming a version of yourself that really isn't very nice. It's very, very difficult for people to understand, and that is why people do typically keep it a secret.
Gambling addiction explained
Barbara Sahakian, University of Cambridge
Problem gamblers often report a loss of agency over their betting, where huge financial losses and the compulsion to cover them up can contribute to severe mental health difficulties and, in some cases, even suicide. But it goes deeper than just the money: gambling changes the way our brain’s reward system functions addicting players to the rush that comes with risk taking. Barbara Sahakian is professor of clinical neuropsychology at the University of Cambridge and a leading expert on gambling addiction…
Barbara - Addiction has to do mainly with the loss of control over your behaviour. So when you aren't allowed to do something, for instance, if it's a substance of abuse like cocaine or amphetamine, you're not allowed to take it anymore, you get symptoms of withdrawal and you get cravings. The same thing actually happens in gambling. So you get irritable and crave gambling. And basically what happens is it frequently starts with a level of impulsivity, when somebody impulsively tries something, and then they slowly become more and more addicted to it, such that it becomes the focus of control. That's an important thing in gambling, that they only want to gamble. They lose their own ability to stop gambling. But their interest is really only in that to the neglect of other areas of life.
James - I suppose the critical difference with gambling, as opposed to the substances you listed there, is that there's nothing physically being ingested into the body which we can point to and directly to the harms that it causes. Is that possibly the reason why it's taken quite a long time for awareness of gambling as an addiction to really become mainstream?
Barbara - Originally, it was classified differently in the Diagnostic and Statistical Manual of the American Psychiatric Association, but now it's basically been reclassified as substance related and addictive disorders. So it's actually considered in that category now. And I think you're right, it's because it was a behavioural addiction. But that has a lot of benefits too because as I said, the sort of addictive triangle is the loss of control, the craving and withdrawal aspects, and then the neglect of other areas of life. And with the addictive behaviour that you might have to gambling, you can study that in a pure way. So you don't have alcohol problems, you don't have other substances of abuse problems such as cocaine or amphetamine. It's purely looking at the behaviour
James - As I understand it, it often goes hand in hand. I know Bianca mentioned at the top of the program alcohol as a factor as to how she started gambling, and that's quite common across the board.
Barbara - It is quite common across the board. And unfortunately some places use this. So if you go to a place like Las Vegas, they will often, in the casinos or hotels where there's gambling, they'll allow you to have free alcohol because of course it disinhibits you and it allows you to gamble more freely. But there are also some strong relationships with alcohol and gambling. And of course in a lot of the addictions there's a predisposition for impulsive behaviour which prompts them all. At Yale University, Marc Potenza and others have pointed out that there's a very strong family association and that genetics is very important as well.
James - I imagine the answer will be, it's a bit of both, but whether it's the person or the exposure to gambling which can cause these gambling related harms. If we start with the exposure, what factors are there to bear in mind?
Barbara - Well, there's people who are very interested in risky behaviour and they go into areas where there's a lot of excitement and risky behaviour going on. So it used to be that footballers would get involved in a lot of use of alcohol. I mean, they're more protective about that now because they realise that it's important to keep fit, but they still probably go into gambling. And as you know, it's advertised very strongly on TV and so forth when there's football matches on. So there's a lot of things to do with advertisements. We're also finding that internet gaming games that are proposed for children and adolescents have a lot to do with the sorts of activities that you would do while you were gambling. So it's almost like training them or grooming them to gamble in the future. So that's another problem. And then it's quite common that in families where there's gambling, then other people, younger people will start to gamble as well. So there's environmental factors like that. There's also other environmental factors. I mean, we know that socioeconomic status can affect gambling because obviously people who don't have money are looking for money and how you respond to stress, whether you can emotionally regulate yourself when something negative happens to you and that kind of thing. So the sort of stresses in the environment can promote gambling as well. And we do know that there's changes, for instance, in the hippocampus and amygdala areas involved in emotional regulation as well as your top-down control of emotion in gamblers. And so it could be that the impact of stress from various environmental sources can affect them as well.
James - And then when we think about it from maybe the more biological perspective or the psychological perspective, I guess that necessitates us having a better grip on the actual mechanisms of what's going on inside the brain when someone's suffering from gambling addiction. Is that an exact science at this point?
Barbara - We still need a lot of research on what starts the gambling process and then how it continues. We do know quite a lot about other addictive behaviours as you pointed out, and we do know that many of them start with a kind of impulsive act. You're sort of excited or your friend takes you into the environment and then you get hooked by the excitement of the whole thing. We found that in our studies with the Cambridge gambling task, which I've been involved in inventing, that in some of the studies that have been done with that task, that people actually are poorer decision makers. So when the odds are against them, they will still bet and they might bet quite highly, whereas a healthy person wouldn't do that. They would notice that the probability is against them and then they wouldn't take that option or they would go for a much smaller bet with that option. So we can see that there's also some more risky decision making that goes on in these people who gamble.
13:20 - The gambling industry and problem gambling
The gambling industry and problem gambling
Dan Waugh, Regulus
What does the gambling industry have to say about gambling, and what measures are being put in place to make sure they’re taking a more active role in helping problem gamblers? Dan Waugh is a partner at gambling consultants Regulus. He previously worked as a director at the Rank Group - which is the UK’s leading operator of casinos and bingo clubs…
Dan - Placing bets on betting websites is perfectly legal. I don't think the activity is to stop people doing it. The focus of activity has to make sure that people are doing it, they're fully informed of what they're doing, and the protections are in place to prevent vulnerable people from suffering harm.
James - How do you answer the challenge that the relevant demographic here when it comes to the gambling industry are these problem gamblers? A huge amount of their revenues are derived from people who suffer harms related to gambling, and so it's not in their interests to address gambling related harms, and we need to force them with stricter regulations?
Dan - I would say any industry that is not focused on the wellbeing of its consumers will not last as an industry for very long. I think it'd be incredibly shortsighted and misguided if the industry was focusing on problem gamblers. I don't think they are, and I think we've seen various claims about the proportion of revenue that comes from problem gamblers. I think they are demonstrably unreliable. We would expect some people with problem gambling to spend more than the average, but I think the idea that the industry is dependent upon revenues and problem gamblers is unsupported by any hard data.
James - According to research from the University of Liverpool, when it comes to online gambling, 86% of profits come from 5% of customers. And I put it to you that those are people who are likely to be suffering from harms of gambling and it is not necessarily in the industry's interest to deal with problem gamblers, they are very reliant on them to make themselves viable businesses.
Dan - Well, that figure is from a very high quality study of about 140,000 online betting accounts. It relates to online sports betting alone. An important point has to be made here when you're looking at these distributions which is that, unlike most other activities, a meaningful proportion of people who bet will end up in profit. And in that particular study, I think 23% of the accounts they studied were actually in profit over the course of the year, so that automatically skews the distribution. I think from memory it was about 83 pounds a month to be included in that top 5%, so I don't think the fact that a large proportion of revenues are coming from a small proportion of customers is necessarily an issue. A bigger issue is whether the industry is generating large amounts of revenue from people who are experiencing harm. I don't think that study at the University of Liverpool would be able to inform you one way or the other about that.
James - Okay. But let's talk about the people who are daily spending hundreds or even thousands of pounds using online betting websites. What's being done to curtail that and to stop the related harms?
Dan - So, under the regulations, online operators have a requirement to monitor customer activity in order to identify potentially harmful behaviour. The government has consulted and the Gambling Commission consulted on bringing in what are called affordability checks. Thresholds will be set across the industry which indicate at what levels operators have to interact with consumers.
James - What are the proposed thresholds on those affordability checks?
Dan - Yes, the proposed thresholds are that anybody spending more than 1000 pounds within a 24 hour period, or more than 2000 pounds over a 90 day period, would be subject to extra checks to ensure that the money they were spending was theirs and was affordable.
James - So they kick in at 1000 pounds a day, 2000 pounds across 90 days, would this just be for that one particular website the customer is using or is this tracked across all betting sites? So, to put it another way, could someone lose 900 pounds across three days on three different websites, which I would argue is a strong sign of problem gambling, and slip through the net of these checks?
Dan - Yes, that could certainly happen. The operators' checks take place at the level of the operator. If somebody's betting with Paddy Power and also betting with William Hill, the operators wouldn't see the full picture. That's certainly the case. I don't know whether necessarily somebody spending 3000 pounds across three operators is necessarily a sign of problem gambling. It would certainly indicate elevated risk. This is the only form of consumer activity where these tests are applied, so there's always got to be a balance between these things, and generally consumers don't like providing things like bank statements and tax returns in order to spend their money. So I think it's important to recognise there is a balance here, and this is quite a unique system that's being proposed.
James - There really seems to be no shortage of gambling companies and ways of gambling out there. Half the Premier League teams have one company or another on their shirts as of fairly recently, and with all the signup offers that are very attractive to new customers, that's why I wanted to raise this point.
Dan - I think all bar one maybe of the Premier League sponsors are overseas gambling websites that nobody in this country would use. They're being marketed to people in Asia or Africa. Also, the Gambling Commission is taking action as a result of the government's white paper on things like sign up bonuses. So the idea that there is no regulation around this stuff or ‘it's very light touch regulation’ started to change somewhat, and if you look at the full range of measures that are coming out of the white paper, I think the environment for the gambling consumer is changing into a very much more restrictive one. These things should be borne into mind when you're thinking about what is appropriate regulation and what are the balances between protecting some people and allowing freedom to others. You could, for example, make a similar argument that pub companies should track alcohol consumption because some people do experience negative consequences in that domain. So I think we've always got to balance what is appropriate and proportionate in a free society.
19:47 - How do we treat gambling addiction?
How do we treat gambling addiction?
Emma Ryan, Primary Care Gambling Service & Bianca Colclough
Part of the new plans from the UK government to tackle problem gambling forces betting companies to help fund treatment for people suffering from the associated harms. But where is that money going? What sort of help is on hand? Emma Ryan who is a lead GP at the UK’s first Primary Care Gambling Service - which is a free confidential NHS service for adults who experience problems with gambling. She also works with the charity Gamble Aware...
Emma - In the UK, for those experiencing gambling harms, only 5% are in treatment. So, I suppose the message we're trying to get across is that we need to raise awareness that if you're experiencing gambling harm you can get help because there is support out there. But we need to identify individuals to get them into the support and treatment services.
James - That chimes really strongly with what Bianca was telling us at the top of the programme. The fact that she felt that so few people around her understood or could even comprehend the idea that gambling could be an addiction.
Emma - Gambling is quite unique compared to other addictions because it's often referred to as a hidden addiction. When we speak to patients that come through our service, I think that's one of the issues that people don't come forward early, they present late. Our overall aim is to really raise awareness to everyone to think about gambling in people that are unwell early so that we can get them into support and treatment early.
James - When someone does come to you, when you've got through that first hurdle, the hardest one it sounds like, of getting them into treatment, what are the first steps there?
Emma - What we have to do initially is to stress that it's confidential, stress that there's no judgement and really work on explaining that this is an addiction because of the products and the exposure that individuals are getting to it. A 'no blame' assessment. In terms of treatments, there's lots and lots of options. The mainstay of treatment for gambling harms is cognitive behavioural therapy. When we do the initial assessment, there's often a pattern where people have been through significant childhood trauma. If that's the case where we assess someone and they've been through the system maybe more than two or three times, we would put them with a psychotherapist. That's much longer: 20 sessions. That's the mainstay of clinical treatment.
James - And I imagine given the way other addictions are treated, is there also scope for group therapies, opportunities to speak to people with similar experiences?
Emma - Absolutely. They are as important as the clinical therapy and often, where the patient wants it, we offer that at the same time. What we find is that, when patients arrive, they're extremely isolated because they're just focused on the gambling: they've lost their friends, their family aren't speaking to them, they've lost their colleagues at work. It's really important that they're ready to link them in if possible with a lived experience advisor, someone that's been through this and is now better. That gives hope and gives real understanding and empathy for the person going through it. The other thing with GPs that we're trying to raise awareness around is the use of social prescribers. They're local to where people live and they can advise on activities which take up the gambling space if you like. So, if somebody's spending hours gambling each day, they're now free if they're trying to stop. We are able to link them into communities in the local area where they live, whether that be walking groups, art classes, we've given cookery courses. It's really trying to move the mindset of the person experiencing harm to start living again really.
James - And in terms of drug treatments, are there any of those that are applicable in the case of gambling addiction?
Emma - Well, historically and currently, the main one that you'll hear doctors and clinical workers talk about is Naltrexone. We did discuss this in the NICE guidelines and it's not widely used. In order to use it, you would need to know the full medical history of the individual because it can have effects on the kidney and the liver and it also needs blood monitoring. When it's considered it is if someone has relapsed two or three times with psychological therapy and they really need something else. It would be used in a specialist setting. It's off-license and off-label, so it's not to be used in clinics where there's not a specialist input from a consultant psychiatrist. So it is there in the NICE guidelines, we have mentioned it, but it's in the recommendation for further research because what's interesting about it is that we don't know which people it's going to work on. Some people do improve and no longer gamble and don't get the urge to gamble, whereas for others it doesn't work at all.
Earlier in the programme we heard from gambling addict Bianca Colclough. She did seek help and now regards herself as “in recovery”...
Bianca - There have been a few points during my life through addiction where I've realised that it was overtaking my life and my mental health. At those points I had self excluded, but the regulations in the industry do make it very easy for you to go back until you find that inner strength. I was very fortunate to become a first and second time mum during lockdown which, a woman in my forties, James, I never expected to happen. So I was so grateful for children. Even at that point, I was still gambling. I'd moved to online because it was lockdown so that that hit was still there, it just wasn't physically in the casinos. What I realised was that I actually had purpose outside of the casino. I didn't want to be in there, and I started to feel guilt. That's nothing against anybody that was previously in my life before my children, because that's not to say I love them any less, but they gave me a sense of purpose that I think I'd always longed for in my life where gambling suddenly started to seem somewhat dirty, and I started to feel ashamed of myself and embarrassed to be there.
James - But did you get any help from outside while you've been in recovery?
Bianca - I didn't actually go through a traditional therapy route until more recently because I'm quite a headstrong person and I felt like, if I'm going to do this, I'm going to do this myself, which I don't advocate, I think it's just my personality. So I completely banned myself from any form of gambling that's based in the United Kingdom. I also registered with the West Midlands Gambling Recovery Service who have been fantastic. So there are a lot of tools out there, but in my own personal opinion, not enough.
James - How are things now? You're in recovery. Is it still very much a prominent thing in your mind, the drive to gamble? Or has it subsided somewhat since you've stopped doing it? How is it day to day?
Bianca - I am a realist, James. Although I'm a year into my recovery journey, this is part of me that took over my life for 12, 13 years. I would be lying if I said there wasn't a day that went by that I didn't think about gambling. The urges that I have are really, really strong. The ability to break a habit that you've had that's been part of your daily life for such a long time isn't going to happen overnight. I strongly feel proud to say that I will be in recovery for the rest of my life, but I am no longer an addict. I don't yet feel that there are enough people around me that understand my addiction fully, and I do believe that there should be more support out there for affected others. But I believe from my own boundary perspective, I am able to manage that. I haven't set foot in a casino, I haven't gambled now for over a year, which is something that I'm very, very proud of. But yeah, absolutely, to answer your question, I still think about it every day.
Comments
Add a comment