Problem gambling ignored by the NHS
“The NHS is severely impaired in its ability to address new pathologies such as problem gambling, because it is having to spend all its money on drug and alcohol treatment” says psychiatrist Henrietta Bowden-Jones.
Possibly half a million UK ‘problem gamblers’
Problem gambling is one of the many secret addictions that doesn’t seem to be given as much credence or attention as other more ‘mainstream’ dependencies. Unjustifiably so, because gambling addiction is a very real problem that can have devastating effects on the user’s life and the life of their family and loved ones, just as drug addiction or alcoholism can.
The difference with gambling addiction, though, is that it can often be better hidden. In a society with effortless access to numerous online gambling sites, with enticing incentives of free first time bets intended to draw customers of all ages in, the prevalence of addiction is rising.
Official numbers vary, with gamblingaddiction.co.uk estimating there to be around 350,000 problem gamblers in the UK, while the NHS suggests there could be as many as 593,000. The most recent statistical publication from the National Centre for Social Research on behalf of The Gambling Commission was conducted back in 2010, and estimated that while around 73% of the British adult population had participated in some form of gambling in the previous year – around 35.5 million adults – the number suffering from problem gaming was thought to be round 450,000.
The diagnostic criteria
But what exactly constitutes “problem gambling”. At what stage does it turn from an impulsive bit of fun to a reckless, life-consuming addiction that demands rehabilitation? The DSM-5 — the diagnostic statistical manual used universally in the diagnosis of mental disorders — requires at least four occurrences of the following symptoms to be present over the period of a month, for a diagnosis of problem gambling:
- The individual needs to gamble with increasing sums of money in order to achieve the same pleasure response.
- The individual is restless or irritable when attempting to cut down on gambling.
- The individual has made repeated unsuccessful attempts in the past to cut back on the gambling.
- The individual is preoccupied with thoughts of past, present and future gambling.
- The individual often gambles when feeling distressed (e.g depressed, anxious or guilty).
- After losing money, the individual often returns the next day to try and win it back.
- The individual lies to conceal the extent of their gambling.
- The individual has jeopardised or lost a significant relationship / job / vocational pursuit as a result of gambling.
- The individual relies on others to provide money to relieve desperate financial situations caused by their gambling.
NHS needs to catch up
But while problem gambling was recognised as a disorder and added to the DSM way back in 1980, the NHS doesn’t seem to have caught up yet. When comparing the wealth of detailed supportive information available on the NHS website for alcoholism and drug addiction, the comparable pages for gambling addiction are sparse. It lists only two national charities / helplines and a single specialist gambling addiction clinic in the whole of the UK.
“The NHS is severely impaired in its ability to address new pathologies such as problem gambling, because it is having to spend all its money on drug and alcohol treatment” says psychiatrist Henrietta Bowden-Jones, founder of The National Problem Gambling Clinic, established in 2008.
The prognosis for gambling addicts is again difficult to ascertain due to the lack of research in the area. The little research that has been conducted, both epidemiological and clinical, demonstrates that problem gambling is highly co-morbid with other psychiatric conditions – conditions which could affect likelihood of relapse vs. successful rehabilitation.
Most published studies have employed relatively small sample sizes, are of limited duration and involve possibly non-representative clinical groups (e.g. those without co-occurring psychiatric disorders). That said, some studies have indicated that treatment can be successful in the long term, with mindfulness-based and CBT focused treatments.
The particular issue with treating gambling addiction is that, unlike drugs, money is not an illicit substance. It needs to be handled every day, making stimulus control in recovering gambling addicts extremely difficult. Due to the lack of available treatment, the trends would seem to indicate that more and more patients are turning to private therapy and seeking bespoke care outside of the oversubscribed NHS, in order to connect with a specialist on a deeper and more personal level to promote the likelihood of successful lifetime rehabilitation.