Gambling addiction, like any dependency, can worsen in times of stress. Data commissioned by the regulator the Gambling Commission showed virtual online betting in Great Britain went up 88% between March 2019 and the month lockdown started, March 2020. Gambling operators’ gross yield for gambling on real events, such as football games, went up 115% (to £217.5m) between May and June this year. Charity GambleAware writes here about ‘gambling harms’ – where an individual’s health, or that of their family’s, is being harmed by gambling – and how nurses can signpost patients to help.
Gambling harms have only recently started to gain much-needed attention as a significant contributor to poor well-being and the ways in which they accentuate inequalities in society. The country is now starting to take this issue more seriously and adopt a public health approach to tackling it. Nurses have an important role to play in helping to identify people who are experiencing gambling harms, respond appropriately and develop care pathways to match individuals to the help that they need.
Gambling disorder is sometimes described as a hidden addiction, as the more visible indicators of intoxication or disintegration common to other addictions are often missing. But it is also hidden in another way. Some forms of gambling, including online, can be done discreetly in the presence of others, who often remain totally unaware of this behaviour and its impacts (poor mental health, relationship problems, and debt can all be indicators of a gambling problem).
Although the issue may be hidden, nurses are ideally placed to assess a patient’s needs and build supportive relationships to help identify if gambling is contributing to their problems. For mental health nurses, it is important to note that some mental health problems frequently co-occur with gambling harms. For example, those who have problems regulating emotions may use gambling to dissociate from their distress. We also frequently see people with social anxiety, ADHD, depression, impulse control problems, PTSD, and personality disorder. It is also worth looking out for those who may complain of anxiety or depression, where this can be best explained by the distress that comes with a chronic gambling problem.
For nurses in physical health settings, it is worth noting that stress-related physical health problems co-occur with gambling harms, such as hypertension and gastrointestinal problems.
Gambling problems can affect people of all ages and from all walks of life. The stereotype of a gambler might be a young man, but the first-time mum stuck at home with a new child might also be a gambler, or the newly-retired single person who misses the social aspect of the workplace. People from some BAME communities may be less likely to gamble, but more likely, if they do gamble, to suffer gambling harms. Parkinson’s patients can be vulnerable due to dopamine agonist medication (which can induce excessive gambling). The effect of Covid-19 has had something of a downward effect on gambling participation due to closure of land-based venues and reduction in sports participation, but has made things worse for some people with gambling disorder.
People with gambling problems can experience high levels of stigma and shame, so might be reluctant to seek help for their gambling. This is why it is so important that agencies with which they come into contact for other reasons help identify them, by non-judgementally asking, listening to their response, showing you care and supporting them into specialist treatment. The good news is that treatment is readily available, with short waiting times, and can make a real difference to an individual’s wellbeing.
Just as much gambling takes place online, especially with Covid-19 restrictions, so too, people with gambling problems may prefer to access help remotely, as many are keen that help is not just confidential, but also anonymous. GamCare operates the National Gambling Helpline which provides telephone and on-line support, offers advice on stimulus control and is where many people’s treatment journey starts. The helpline is accessible by telephone and online 24 hours, 365 days a year.
As well as the helpline, there is a network of locally-based providers across Britain designed to deliver a range of treatment services, including brief intervention, short and longer term support, and residential programmes. Normally much of this treatment is provided face-to-face but during Covid-19 restrictions, treatment continues remotely.
There are also several specialist NHS out-patient clinics based in Leeds, London, Salford and Sunderland for people whose gambling problems are more severe or may co-occur with other mental health problems. For those whose gambling addiction is so severe that community-based treatment is not sufficient, twelve-week residential rehabilitation is also available.
As well as existing services and treatment options, more work is always being done to understand how best to treat those with gambling disorder. For example, a recent innovation in London has been the launch of the Primary Care Gambling Service, which is exploring how to treat gambling problems in a primary care setting.
There is also the National Gambling Treatment Service (NGTS), a network of organisations, that can help find the most appropriate package of care for individual.
Whatever the patient’s needs and circumstances, the NGTS should be able to provide them with the help they need. It is an important resource for nurses in identifying the best route to recovery.
Key helplines to refer people to:
National Gambling Helpline: 0808 8020 133
NHS Northern Gambling Service: 0300 3001490
London Problem Gambling Clinic: 020 7381 7722
Primary Care Gambling Service: 0300 0300 111