Gambling addiction: Hidden harms

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.