The Problem with “Problem Gamblers”

In the bad old days,  among the cruel behaviours of teachers was to make a child sit facing a corner and wear a hat with ‘Dunce’ written on it. If that didn’t make  them learn and behave properly, a child could expect a thrashing for their irresponsible waywardness.

More progressive education renamed ‘dunces’ as ‘problem children’.

Now, of course, in more enlightened times we speak of ‘problem schools’ as the main reason for between a quarter and a fifth of school leavers being functionally illiterate after eleven years of education. It has been a great leap forward for  society to recognise that the ‘problems’ may have something to do with the education system itself.

This month (July 2020) has seen the UK government launch a ‘war on obesity’. Proposals include advertising bans, stopping two for one incentives on junk foods, public health campaigns, taxes on industry, education, more help from primary health care and so on. There are critics of all this. They say that people should be able to eat whatever they want to, they are free to make their own choices and shouldn’t have that freedom removed by the nanny state. Parents, they say, have the right to feed their children whatever they like. The fact that unhealthy, fattening food is cheap should not stop poor responsible people making sensible meals with basic nutritious items such as turnips: if they can afford widescreen televisions and smartphones , they can afford to eat well. But such is the devastating impact on health and the economy, the state is now proposing to get tough, go beyond voluntary industry actions and the good sense of consumers.

After decades of denial the tobacco industry accepted that their product was both addictive and highly detrimental to health. Stringent government action has seen a huge fall in the number of people smoking.  A total ban on advertising and marketing, removal of branding on cigarette packs along with reference to tar and nicotine content which some took to allow for a choice of ‘safer smoking’, severe annual rises in duty, a ban on smoking in public places, and the hiding from sight of tobacco products in shops. Alongside this, smoking cessation programmes are free to everybody. Individuals remain free to use tobacco if they so wish.

These days, at the tobacco counter in a shop, the tobacco products are screened from sight. (It’s worth noting that alcohol is still freely on display, but that’s a different story for now). At the front of the counter, inches from the customer are advertisements for the National Lottery and a range of scratchcards priced from £1 to £5 each. Like sweets placed at a supermarket till they make impulse purchases more likely. They’re also an indicator of how normalised respectable gambling has become. A website called casinoplay.com warns the public that ‘it can actually be quite hard to win one of the top prizes.’ It advises that to increase your chances you should buy scratchcards in bulk.

The Myth of the ‘Responsible’ v ‘Problem Gambler’

Unlike smoking and obesity, the risks associated with gambling aren’t associated with physical health (except in the many tragic cases of suicide). Gambling risks include financial ruin, turning to crime, family and relationships breakdown, mental illness. Many sources of information refer to the incidence of gamblers running into such conditions is ‘only’ 0.5% of the adult population (the same way as ‘only’ 0.5% of the the population are schizophrenic). There are other figures for children and young people, and for adults ‘at risk’ of being in the 0.5%. Data is never simple. It isn’t always available. It’s a snapshot of a previous period in time. It requires interpretation – and these interpretations differ. But if the 0.5% figure is taken as it is, given the personal suffering indicated above, plus the damage to immediate others such as family, plus societal costs is not that alone reason to give gambling damage the same weighting as a serious mental disorder such as schizophrenia? And unlike schizophrenia which, although it can be managed and treated well, in many cases very difficult to treat and manage, are not problems associated with gambling more easily attenuated using the approaches we have seen with tobacco, and beginning with junk food?

Yet it’s sometimes implied that if there are only 300,000 or so people in deep trouble because of gambling, that’s all right. They didn’t stop when the fun stopped. No one made them spend much more than they could afford: they were irresponsible. It was down to their having that much-cherished freedom to chose, but making the wrong choices. Many millions more enjoy the fun of a flutter. The appeal to the ‘millions who safely (and responsibly) enjoy a flutter’ is something of an industry catchphrase, and it needs unpicking.

Having placed the ‘problem gamblers’ into a sort of pathological ghetto, the logic goes that everybody else is a ‘responsible gambler’, enjoying a harmless flutter. This isn’t so.

In all our lives fortune rises and falls, and this is more nearly literal in the case of the regular happy flutterer. A regular bettor or gambler will win some, lose some, and for the great majority, over time will lose more than they win. Winning £25 on a £5 scratchcard won’t compensate for the many weeks of getting into debt with rent or power or council tax after buying four such cards each week. The strain on marriages and families will increase as essential money leaks into slots or online gambling. The wage packet won’t be spent on days out with the kids or new school clothes. Things will be pawned, payday loans become essential as credit is refused elsewhere and credit cards are maxed out. Loans from friends and family go unpaid. There may be catastrophic times, perhaps a threat of eviction or repossession, survived only by a hair’s width and that survival with ongoing negative financial consequences. (Sometimes, such a catastrophe can be the impetus to stop gambling). Anxiety, depression, arguments may go with the territory. The danger of becoming one of the statistics in that ‘problem gambler’ ghetto may increase. As it is, there are many whose quality of life is negatively affected by gambling, and they don’t show up in the statistics.

Now obviously, this is painting a bleak picture. Not everybody who enjoys a doughnut or two will incur an obesity-related illness. Most people do spend money responsibly and can enjoy a harmless flutter. There is, of course, even for them a risk of going beyond the harmless flutter. Even somebody new to betting and gambling can (not will) spiral down to dangerous levels.

What’s needed is research into the ‘twilight zone’ of gambling-induced harms. This is an area which has to involve personal testimonies of experience over time. It’s especially important in relation to young people who have been nurtured in a normalised gambling environment. It may lead to a more nuanced understanding of the scale and nature of gambling harms than that offered by dominant narratives of ‘problem gamblers’ versus the rest of us.

 

Where does GAMBLING EDUCATION fit in?

Article by Adrian Bailey, Director, The Machine Zone

This is a long post, sorry! Skip the preamble/disclaimer by all means.

PREAMBLE/Disclaimer

This post is a ‘light touch’ consideration of some of the questions arising around the idea of gambling education. The introduction below gives some background and points to some of the major questions.

It’s good to start, though, by stating firmly what this article isn’t. It doesn’t and couldn’t offer criticism of the many gambling education initiatives currently running. It doesn’t claim to be other than very tentative. It claims no expertise.

It does try to highlight questions underlying all approaches to gambling education. This highlighting is drawn from existing practitioners and theorists for whom such questions have always been basic.

I taught in secondary schools and then further education back in the 70s and 80s. During this time I was also engaged in educational research. I’ve never been a gambler but I have had a serious addiction and severe and enduring mental health problem. After teaching I worked in the mental health field, and in the last seven years of paid employment I worked with people recovering from various compulsive behaviours. Only in the past three years have I become familiar with the area of gambling.

Through work and personal experience I have ‘researched’ (as an ‘educated layperson’) mental health, and ‘addiction’. Like many of you I don’t like that word, ‘addiction’ but for convenience will use it here. Regard it as no more than a signpost to what we may prefer to call by less stigmatised words, and even these are only signposts to the area of personal experiences.

These experiences are painful to individuals and their immediate networks. They relate to great social costs – economic costs, of course, but also serious negative repercussions upon the health and wellbeing of society. As such, they are public health issues in the widest sense. Because of this they are political issues too. Governments allocate funding for treatment, research and more; governments also, by attending – or not attending – to the issues raised suggest the priority – or lack of priority – of the issues raised and the allocation of resources.

Since it is a political issue, it is of concern to all citizens. In a democracy, a childless citizen has the right to be engaged with education. Someone who is young and healthy will engage with the health and social care policies of government, and provision for aging people. We may be materially well-off but have the right to challenge the existence in our own country of poverty and inequality. Concern for military horrors witnessed across the world gives every citizen the right to ask of the government’s foreign policy questions about arms sales it allows. So, you don’t have to be an ‘addict’, or mentally distressed or otherwise in pain to be involved, any more than you need to be a child in poverty to care about child poverty.

So, while having a specific interest in mental health and what is called addiction, by engagement with gambling education is as a concerned citizen. I can’t see any way of framing this as other than political.

Like most important issues, complexity encourages a wide variety of approaches and attitudes. As an interested citizen layperson I follow expert understandings of due humility.

As the philosopher William Irwin has written:

We ought to regularly and open-mindedly reconsider (alternative opinions and approaches) if only to remind ourselves why we believe what we believe.

 

INTRODUCTION

Gambling and gaming have been around since history began. Today we see a very wide spectrum. Truly, many millions do enjoy a ‘harmless flutter’ on a lottery or bet. Some buy scratch cards at £2 or £10 a time. It’s fun! Even without money we enjoy games of chance, the throw of a dice. Kids like me bet by throwing coins against a wall, then got into cards along with the cigarettes behind the bike shed. I’m sure kids still do. It’s something we learned in school but not from teachers. From our mates and the culture of kids passed on from one generation to the next.

If you’re on unemployment benefit or a low income, ten pounds can take a chunk out of basic living costs. Power, rent, food, council tax, presents for the kids. Even what looks like a small amount can have serious consequences. When people become hooked on gambling, often people in well-paid jobs or with good incomes, they can lose many thousands, even millions of pounds. Some – tragically – are driven to suicide. Others steal from their employers and end up in jail.

In the last ten years we’ve all become aware of the damage gambling can do. In response, a 2019 survey of the general public done by the Gambling Commission found that 27% of people think it would be best if ALL gambling were banned, while 82% agree that there are too many gambling opportunities today. The media regularly report on the often tragic impact of gambling on some individuals. For instance, in July 2020 The Guardian headlined a story: ‘How the Gambling Industry Got its Claws into Kids’. Former gamblers have initiated many organisations which document individuals’ stories; these are pressure groups, campaigners aiming to bring about fundamental changes in regulation, advertising and marketing, and the ‘addictive’ nature of some gambling products. Their work is mirrored in that of many academic researchers. Politicians from all parties have been and remain intent upon bringing about reform.

The industry, whose biggest members are represented by the Gaming and Betting Council, and its supporters point out that millions of people enjoy having ‘a harmless flutter’. It distinguishes between what it claims is a ‘small number’ of ‘problem gamblers’ from the vast majority of ‘responsible gamblers’. The industry also directly funds harm-prevention organisations such as Gamble Aware and thereby directs some of its 1% voluntary levy towards education and treatment. Against this, campaigners have claimed that concentrating upon education and treatment, while important areas (in particular, treatment which is greatly under-resourced or provided), can lead to neglect or disguising of vital systemic issues such as product design, marketing and advertising, regulatory issues and conscious exploitation of vulnerable psychological attributes of the human being. Such a claim is also made at various levels by academic researchers. Rather than develop this tension here, I’ve appended some web addresses at the end to give you an idea of such research.

Education about health, finance, citizenship, alcohol and other drugs, mental health and all the other things that relate to our wellbeing is not only confined to schools and other formal education settings. Nor is it limited to youth. Public Health campaigns mount many informal educational projects. The mental health sector provides very many sources of guidance, information and learning. And, of course, kids learn from their parents, their peer group and the culture they live in  – probably in some important ways far more than they learn in school. We also learn from social media. We learn from the mass media: in particular, popular music is a potent source of learning; so is television. Taking the latter, a ‘soap opera’ with a storyline about gambling or other mental health problems can provide more powerful learning than in formal settings. We also learn from advertisements and marketing. We learn, for instance, that Product X is fun, or will make us happy. Not all learning benefits us. Some addiction experts believe that an addiction is learned behaviour (as opposed to some sort of disease).

But here we’ll focus on school education, and in particular education about gambling. This is normally provided by what’s known in England and Wales as Personal, Social, Health and Economic education. This is a developing area. There is a very active PSHE association which, as well as providing resources and curriculum discussion, lobbies for greater weight and training to be given to the area. They have some excellent guidance for teaching about gambling,  The extract below demonstrates just one aspect of the theory and practice of gambling education and its complexity if it’s to be considered thoroughly. The extract also demonstrates some aspects of gambling education lacking in certain other current approaches:

 

Understanding of gambling industry strategies to draw people in and keep them gambling, including those that exploit natural human biases and errors

Dark nudges — a term used by researcher Philip Newall— describe the techniques gambling organisationsuse to encourage participation in gambling. Researchers suggest the gambling industry utilises arange of techniques including:

      • Normalisation of gambling behaviours, particularly bycreating a perception that it is a key part of enjoyingsport entertainment

      • Legitimisation through partnering with trusted organisations(to convey the impression that gamblingis accepted by those known to be ethical)

      • Extensive advertising with particular focus on vulnerablegroups

      • ‘Free bet’ promotions and ‘welcome back’ bonuses

      • Encroachment into gaming including throughnon-monetary forms, e.g. ‘loot boxes’

      • Over-emphasising a distinction between problem and responsible gambling — encouraging people to think of themselves as responsible gamblers

      • Adverts and encouragement to bet on highly specificevents where participants are less likely to win (e.g.first goal scorer or specific scoreline)

      • Additional techniques are used in online gambling:

      • Use of ‘near miss’ outcomes exploit the human bias to try again if someone has a near miss

      • Losses disguised as partial wins (with audio and visual prompts to support this)

      • Meaningless ‘bells, whistles and associations’ makeuse of the human tendency to search for meaning in patterns

It is plausible that helping young people to become   aware of these techniques can help them to be moreresilient to them.

Understanding of gambling risks and harms

Most gambling education programmes aimed at adolescents include a component on gambling’s risks and harms. This would seem an inherent part of enabling young people’s informed decision-making. Two caveats however merit highlighting: first, the recent review of school-based gambling education programmes concluded that ‘promoting a negative viewpoint of gambling and its associated consequences are not sufficient to prevent gambling problems’— therefore this should only be a component rather than the entirety of gambling education.

Second, some young people may find risks enticing rather than aversive, linked to developmental differences in perceptions and responses to risk42, so how risks are presented and discussed is important.

from How to address gambling through PSHE education

It’s important to note that the PSHE work with Gamble Aware (funded by the industry). Some have felt that any funding from industry is not permissible but the PSHE – and Gamble Aware itself – have shown repeatedly that this is not necessarily the case.

In the extract above, young people are introduced to the role of industry in gambling harms. It’s noticeable too that the sort of education mooted here is not restricted to standalone sessions. As per government advice on all PSHE it can be integrated into the whole school curriculum. English/media education (analysing advertisements), mathematics (odds and risks) for instance. The PSHE experts are fully aware of age and development needs. One also has to consider learning disabled pupils. There is an emphasis (as there should be in all teaching) on teacher delivery. Research has shown what doesn’t work and may have effects opposite to what is intended. This includes being very careful about inviting former gamblers to speak: a totally unintentional outcome may be to make gambling risks attractive. The idea that most people can gamble without problems and only a few run into trouble is dangerous too. Scaring young people is very dangerous: many young people have ‘heard it all before’ about the terrible harms of alcohol, cannabis junk food: such scare stories conflict with their deeper learning from ‘real life’. Gambling educated should not be parachuted in to occupy a few sessions like a magic pill or injection: it should be part of a carefully integrated whole school developmental curriculum. Lessons should be participatory and interactive: few teachers these days (hopefully) talk at their students or expect them to magically absorb wisdom from texts.

The purpose of the foregoing has been to suggest that providing education about gambling is complex and requires expertise. Education cannot be some simple panacea that can be ‘injected’ into a young person’s mind. In a school it also requires commitment from senior management to PSHE generally to design a developmental curriculum. It seems unlikely at present that delivery is optimal in all schools. Elsewhere, after training about gambling education (often a one day or less session) teachers have felt unprepared – or faced with an only choice of delivering a handful of discrete session to students.

Implementing gambling education requires theory partly based on what has been learned about teaching about other risky behaviours. Such research has looked at other countries. In the UK, the Alcohol Education Trust which works with the PSHE Association, founded in 2010, provides a promising future for what gambling education may achieve. The AET has had the time needed to evaluate programmes – and give statistically significant indicators of positive impact on students’ drinking behaviours. The gambling education field is new. It is, therefore, difficult for evaluation of particular programmes (the AET does compare its own work with others’). Nevertheless, by virtue of existing at all, the importance of very enthusiastic and well-managed projects contributes to establishing gambling education ‘on the agenda’. Good work is being done in this area by DEMOS, EPIC and YGAM as well as the PSHE itself as ‘insiders’ with the power to link to other organisations and provide specific expertise. In Scotland, FastForward with its emphasis on peer group participatory workshops, theatre and a harm minimisation approach has a gambling hub to complement its work in health, risk and wellbeing. Many other projects continue to occur regionally, initiated by a range of organisations.

There are many obstacles to overcome and many contradictory approaches that need evaluating but education about gambling is growing and driven by enthusiasm and a wide, varied skills base.

HOWEVER!

There’s always a ‘but’! Here are some questions I think are important though I make no attempt to answer them.

    1. Within the context of all factors contributing to gambling harms is ‘gambling education’ emphasised too much and thus working to divert attention from other important factors?
    2. Given the current state of gambling education which offers promise but has many basic difficulties associated with it (as suggested above) is it likely to be a significant player in reducing gambling harm?
    3. How, when and by whom will gambling education programmes be evaluated and compared?
    4. How, when and by whom will gambling education within school curricula be evaluated?
    5. Which approaches to risky behaviours that have been evaluated in PSHE could potentially inform gambling education?
    6. Should gambling education be positioned and weighted within an integrated national policy for reducing harms?
    7. Given that a fifth of school leavers are ‘functionally illiterate’ is there scope for informal youth education to reach young people? (Functional illiteracy refers to minimal literacy, insufficient for full functioning in life such as ability to comprehend more than very basic texts).
    8. Given that 49% of the working age population have numeracy levels less that those expected of a primary school child (National Numeracy) is it realistic to assume that all pupils will be able to engage with such things as odds, percentages etc. in delivery of gambling education?
    9. Gambling problems can affect anybody but since there will be a demographic sector correlating with (7) and (8), hence less reachable by education and less capable of understanding fully the architecture of gambling, does such a group represent a vulnerable sector at risk of exploitation?

Some Links

Education Organisations

https://www.pshe-association.org.uk/content/gambling

www.YGAM.org

https://demos.co.uk/project/reducing-the-odds/

https://www.epicriskmanagement.com/

https://gamblingeducationhub.fastforward.org.uk/

https://alcoholeducationtrust.org/

Parliament

http://www.grh-appg.com/

https://www.parliament.uk/business/committees/committees-a-z/lords-select/gambling-committee/news-parliament-2019/lords-gambling-report-published/

 

Gambling Commission (3 year strategy for reducing harms)

https://www.reducinggamblingharms.org/asset-library/national-strategy-to-reduce-gambling-harms.pdf

 

Public Health

https://www.frontiersin.org/articles/10.3389/fpubh.2020.00320/full

https://www.bmj.com/content/365/bmj.l1807

https://www.gov.uk/government/publications/gambling-related-harms-evidence-review/gambling-related-harms-evidence-review-scope

Some Academics

https://www.gold.ac.uk/media/documents-by-section/departments/anthropology/Fair-Game-Web-Final.pdf

https://www.youtube.com/watch?v=TazssD6L7wc

http://eprints.gla.ac.uk/179965/

http://eprints.whiterose.ac.uk/148267/1/CHB_Loot_Box_Features_Accepted.pdf

Media

https://www.theguardian.com/lifeandstyle/2020/jul/11/my-son-would-be-shaking-trying-not-to-go-online-how-the-gambling-industry-got-its-claws-into-kids

https://www.reform-magazine.co.uk/2014/08/a-change-for-the-better/

https://www.theguardian.com/society/2020/jun/24/uk-betting-firms-move-to-redirect-problem-gambling-funds-raises-concerns

https://www.cypnow.co.uk/news/article/primary-schools-teach-pupils-about-gambling-risks

 

‘Personal Responsibility’ and Addiction

One of the hottest topics relating to addiction is the concept of personal responsibility. Do addicts bring it on themselves? Are addicts morally weak? Do addicts repeatedly fail in recovery because they refuse to take on responsibility?

On the other hand, it can be rightly claimed that all this emphasis on the individual is distorting an understanding of addiction. If, as some claim, addiction is a ‘disease’ how can people be responsible for it? Why is there virtually no alcohol addiction in Saudi Arabia (where alcohol is prohibited by law)? What social factors play a part in addiction? Do some commercial products – tobacco is an example – ‘hook’ some people in the right circumstances?

There is no such thing as an addict; there are only individuals suffering with addiction. Everybody is different, but some groups seem more prone to addiction to others. In the professions journalists, the police, doctors, entertainers, sportspeople and politicians have high rates of addiction. So too do people with multiple and complex disadvantages such as homelessness, poverty, lack of educational and cultural capital, mental illness, criminal background, adverse childhood experiences, trauma – or just one of these.

And people from different social backgrounds seem to be treated very differently when their addictions come to light. Newspaper readers will weep over the death of a pop idol through drugs; a politician will be praised for his ‘brave struggle’ against alcohol. In popular culture – films, books and television – we have come to expect our flawed heroes often to have an addiction problem as one of their flaws, a lonewolf cop bucking the rules and knocking back malt whisky while meditating on a case, a singer in rehab, a public figure making public penance.

Less favourably are seen the ‘scagheads’, the ‘junkies’,  the street addicts, the working class addicts. Although victims all their lives of unequal and unjust social conditions, turning to drugs or drink or gambling to escape if only for a moment, it is they who are most harshly blamed and despised for their lack of responsibility – while those with a lifetime of advantages are treated with adulation and sympathy.

In his remarkable book, Good Cop Bad War, former undercover cop Neil Woods charts his journey of increasing knowledge through the ‘low life’ of desperate addicts (in contrast to the venomous gangster business cartels that bring drugs to market). He grow increasingly sympathetic to the friends he makes while pretending to be himself an addict. Apart from their addiction, most are essentially decent, often intelligent, kind and caring. One such friend , Cammy, tells him his heart-felt news that he has heard a good friend has died. Neil asks whether he will go to the funeral to say goodbye and Cammy replies, ‘I’m not going to the funeral. I wouldn’t do that to the family. The last thing they want is some dirty junkie turning up and ruining everything.’ As Woods observes, ‘No matter how society may condemn and look down on the addict, it is never, ever as low a view as he has of himself.’

That internalisation of social attitudes and stigma is something all addicts have to deal with. Part of them remains ‘clean’ and is a constant accusing voice; the addict hates themself. Guilt and shame alone can maintain an addiction – that belief of such utter worthlessness that there is no point in trying to stop, instead seeking that absurd temporary negation of inner torment with a fix.

Of course, those with a lot going for them tend to do better. Not everybody, of course: the nature of every individual addiction, while having common attributes, is unique in the complexities of an individual. It’s probably easier on the whole if you’re, say, a teacher to have three months leave on full pay to attend rehab, or just to get your life together, than if you are without any money, any support, any care, any love, surviving in brutal conditions. Though yes, many who seem to have well insulated lives with all the support in place do succumb, grow sick and die. And yes, too, some at the very bottom recover and flourish.

There are as many as 40% of addicts who recover spontaneously, relatively painlessly, without any intervention by ‘experts’ or support organisations. A well known example of this is ‘maturing out’ whereby young people who have addictive or risky tendencies literally grow out of them when they settle into employment, get married, start a family. Another famous example is how 80% of American soldiers deemed heroin addicted in Vietnam lost their addiction when they returned to the States and their families. Against this, many others in recovery are certain that addiction is a disease for life and that the only way to manage it is by faithfully following a programme such as a 12-steps one.

A word is needed here too about dependence versus addiction. Through force of habit, culture, lifestyle, many drinkers, for instance consume not only health-damaging amounts but quantities which make them physically dependent. The withdrawal from physical dependency can be life- threatening and ideally requires medical supervision. Yet many heavy drinkers then go onto just stop or greatly limit consumption: they were heavy drinkers, not alcohol addicts. There is an additional dependence which is separate from addiction – psychological dependence. Partly this is just the force of habit, neural correlates in the brain ‘speaking’ loudly to perform an action when certain triggers arise. Usually one can become psychologically dependent on a substance or activity to avoid stress, negative feelings or often an undiagnosed mental disorder such as anxiety and depression. Dependence can, and often does, lead to addiction but it’s still possible to recognise a dependence and take responsibility for halting it with acceptance of necessary effort and suffering which will vary greatly in terms of time and intensity according to unique individuals in unique circumstances.

Addiction by its very nature, the heart of addiction, disowns the individual’s core self. It disowns the possibility of being responsible for one’s destiny, for making deep choices. No addict will be able to understand what is going on. They are fully aware of the misery they leave in their wake, of their loss of pride, reputation, money, health, relationships, status, children. They desperately want to stop. But they can’t. In the old days people spoke of a demon inside that controlled them. The demon took them over. This degree of inner torment varies from individual to individual. It’s certainly true that there are many ‘highly functioning addicts’ in all walks of life, folk nobody begins to suspect as being an addict, and, of, course, another core attribute of addiction is the addict’s propensity to deny their addiction. It’s for this reason that common wisdom has it that people must ‘hit rock bottom’ before they can start to recover. This is, fortunately, a myth. It may be true that a secret gambler’s addiction only comes to light when the bailiffs arrive to take the family home and he or she spirals into heavy debt, bankruptcy, prison or failed suicide attempts. But in many cases – often in consort with worried others – many are lucky enough to address their addiction before absolute calamity.

The foregoing suggests just a few of the strands in the complexity of an individual’s addiction. If there is a common attribute of addiction it is that to take responsibility for recovery one must already have made a vital move. This vital move, this perception that one is not only the addicted self, is the precursor of recovery. For some, this vital move is totally unconscious and involves little pain and effort, for others it is a lifelong process.

To conclude, to return to the topic of addiction and responsibility. All of us are a product of our environments, probably more so than products of our genes. Children have been sold drugs from icecream vans (dealers do not ask for age verification or advise responsible use of their products) so 12= year-olds have become heroin addicts. The vans are part of the environment, behind the vans are networks of the drugs business, also part of the environment. People continue to smoke cigarettes but on the packets is written ‘smoking kills’, and tobacco is more and more restricted by government policies: it’s recognised that tobacco addiction is not the result of weak responsibility in individuals. Campaigns to restrict and limit junk food (itself addictive), sugar, salt, fat are not controversial. People argue about minimum pricing for alcohol, but the argument is not seen as being around any bizarre claims. In short, government and industry are seen as having a major role in addressing the damage that harmful products may do to individuals and society, including addictive products.

Current debate about addiction is skewed towards a focus on individual responsibility. Just as a parent is deemed responsisible for feeding their children high doses of sugar and fat (These being by far the cheapest foods to buy for those in poverty), so the addict is held reponsible for choosing their addiction (even if this was motivated by a need to escape misery and despair into 20 minutes of arificial paradise). There are no jackpots, magic fixes that will ever beat the scourge of addiction but government and industry have to stop denying their role in attenuating it.

 

One Last Spin: Update

We’ve suspended filming for One Last Spin for now. This is in common with most but essential working as Coronavirus continues. Planned interviews with people in different parts of the UK will be rearranged.

The time won’t be wasted as it will afford us an ongoing opportunity to research subject matter. We’ve taken note of an increased emphasis by campaigners and academics upon the supply side of gambling, including product design. This has been a focus of research for some experts for many years, and something that often lone voices of ‘ordinary’ people have been expressing for a very long time. There are now organisations such as Gamvisory, a user-level group which seeks to involve ‘experts by experience’ in representing a vitally important but to date virtually absent role in influencing gambling policy.

Similarly, the Health and Social Care Alliance Scotland are taking the lead in the three years National Strategy to Reduce Gambling Harms which will take a public health and population approach which ‘will put the voice of lived experience at the heart of the process.’ In fact, today an event to discuss ways forward of such involvement had to be postponed (and some of our potential interviewees were thereby unavailable).

One Last Spin will add to the growing media of ‘experts by experience’. For instance, check out the videos at Gambling with Lives, a wonderful yet tragically based user-led organisation discussing bereavement of those who have lost loved ones through gambling suicide.

It’s encouraging too to see the interaction going on between academics and the people whose voices matter so much and have been often unheard. As in all generalisations this hides the truth that many UK politicians and academics have long met with individuals badly hurt, sometimes ruined, by contemporary gambling.

One such researcher is Professor Rebecca Cassidy, whose fieldwork included working in a bookies as a cashier. Her recent book, Vicious Games: Capitalism and Gambling is a gem. We have written a short review of it here. It covers many areas of gambling but one thing that stands out for us is her attention to the paucity of much gambling research and the need to move towards qualitative research involving the neglected voices at the heart of the matter.

It’s in this sort of spirit that One Last Spin is being made.

 

 

Vicious Games: Capitalism and Gambling. A Review

Below is a review of this very good book.  We’ll be adding to this in forthcoming posts.

Vicious Games: Capitalism and Gambling. A Review

Wide-ranging and precisely researched. Professor Cassidy’s fieldwork as an anthropologist provides a fascinating insight into the actuality of the gambling industry in opposition to surface statistics and ‘evidence’. She shows the nexus comprising industry practice, government policies, regulation, academic research, technology, marketing and gamblers. Importantly, she removes any idea of a global approach: each state or region of the world has very varying practices involving many different factors.

 

A history of UK gambling from 1960 legalisation of betting shops through to the present online practices via the introduction of electronic gambling machines on the high street is contextualised within contrasting and complementing histories in other parts of the world. Personal work as a cashier in betting shops reveals the inherent violence in many and the risks to staff – a stark contrast to the stated industry policies of staff and customer protection. Cassidy’s experiences at gambling industry conferences and in headquarters of  major gambling companies captures not a monolithic perspective but multiple, often contradictory aspects of individual roles, the views of individual workers and, rather than a neat linear introduction of business responses to new models based around potentiating profit opportunities afforded by regulatory and technological developments, a fragmented, sometimes chaotic, ‘catching up’ by the industry.

The book demands that we stop thinking simply about the world of gambling. However, there is a strong advocatory impulse which. almost imperceptibly, draws to a conclusion. In many ways this conclusion was reached in Cassidy et al’s 2013 report ‘Fair Game: Producing gambling research’ at Goldsmiths, University of London, which you’ll find online. In the report, as in the book, the status of academic research is interrogated. Not only is it an ‘unpopular’ academic research interest, hence a paucity of good quality investigations, it has been used by the industry on occasions, paid for by the industry, as a rhetorical weapon. The sense is that the mantra of governments for ‘evidence’, industry claims that there is ‘no evidence’ that gambling provision causes no harm to the vast majority of players, is something of a fig leaf.  The research approach of Cassidy, an anthropologist, is in total contrast to what, in any case, is fairly febrile data-driven approaches (for one, data is incredibly difficult to come by). In sum, the great weaknesses of gambling research are unearthed. And in any case, at the end of the day governments, legislators, policy makers, regulators and industry do not make decisions based upon ‘evidence’.

 

As well as the excellent insights afforded by Cassidy’s conversations with a range of stakeholders from industry CEOs to people who have been grievously harmed by modern gambling products, where the book excels is in Cassidy’s placing gambling in the context of neoliberal capitalist ideology. At a simple level this can be charted in the Thatcher-Reagan turn to market freedom and an emphasis on ‘personal responsibility.’ There’s no such thing as society, only individuals who have the power to shape their life, the responsibility and freedom to do so. If a person runs into trouble with gambling (or any legal product) it’s their own fault. They are weak, flawed, bad. Although Cassidy discusses a public health approach (in theory) to gambling problems, I think it would have been helpful to put this in the wider context of mental health ideology, since gambling or any other ‘addiction’ is a mental health issue (though in practice the medical establishment sometimes has difficulty dealing with this, although individual professionals do their very best to change such practice and underlying assumptions). Concentration on individual ‘pathology’ is endemic in all branches of mental health research and society: one senior gambling executive claimed that ‘problem gamblers had ‘brain diseases’ to start with. There is, of course, resistance to the dominant ideology, resistance which asserts the centrality of ‘problem’ environments – inequality, poverty, exploitation by clever marketing and so on.

 

Cassidy argues that this dominant focus upon the individual reinforces and reproduces the emphasis on ‘responsible gambling’. In fact, ‘An experiment which began in the 1980s ((financial deregulation, neoliberalism)), to shift the burden of risk from the state to the citizen, has increased inequalities and changed the ways in which we imagine wealth is created and shared. Gambling has been at the heart of these shifts: in the City as it deregulated and embraced riskier, increasingly complex and opaque ways to make money, becoming less and less accountable as a result, and in government itself, which encouraged citizens to become self-sufficient individualists.’

 

The promotion of ‘responsible gambling’ reflects this ideological construction of ‘self-sufficient individualists’. Dominant narratives around gambling are based upon this attitude, an attitude taken as something as natural and realistic as the way things really are, as natural as nature. Cassidy’s book is a powerful challenge to these dominant narratives. The last line of the book is optimistic. I won’t repeat it here but comment that its an excellent coda.

 

As a layperson I want to add that the book is very accessible, and short, while remaining academically rigorous. It has so much in it, so many interweaving levels, that the only way to do justice to it is to urge people to read it.

Adrian Bailey

Busy, Busy

Our documentary is coming along nicely. A fair bit of pre-production done and a few weeks before we start filming.

After many delays it’s looking like there is a good chance we can get our drama piece about digital gambling into Barlinnie Prison. Yup! We’re trying to get into prison!

Martin’s been especially busy adding to his already great network of contacts, including a trip to Westminster last week and meeting up socially with Gambling with Lives / The Big Step who completed the long walk from Reading FC to Wembley. Check out the Gambling with Lives website.

Grassroots campaigns are driven by the dreadful suffering caused by some aspects of the gambling industry. Others, who have no personal experience of gambling, are joining them as awareness grows. Politicians from all sides, academics, addiction workers, psychologists and the media are raising their voices all over the world.

Nobody who hasn’t known it can presume to imagine the pain of losing a loved one to suicide brought on by gambling. A countless number have had life ruined by less tragic losses. It’s a public health issue that should have far more awareness and treatment facilities, but it must begin with prevention.

one last spin

Our present project is the production of a high-quality documentary about issues around gambling in the world today. A highly professional and experienced production team is currently engaged in research and planning. The film will centre around the gambling life of Martin Paterson who many of you will recognise as one of the most vocal campaigners demanding urgent and radical reforms to the gambling industry. We’ll also hear from other campaigners and people whose lives have been seriously affected by digital gambling devices. Adding their voices will be academics who specialise in gambling research. There is a new page on this site for the documentary, and we’ll be posting regular updates.

 

 

Addiction and Society

The worldwide misery caused by addiction is immense, striking millions of people. Not only the ‘addict’ but those close to them are devestated. In addition, there are huge economic costs to society and billion pounds costs from crime.

Also, beyond the identification of the most extreme forms of addiction, millions more are affected by less intense effects (including those on a ‘slippery slope’). For example, there is a tremendous toll on those who drink too much without being recognised as ‘addicts’. One unlucky bet from a regular gambler could result in financial ruin and its implications.

For those who seek recovery there are many sources of help (and it is worth remembering that many recover without intervention). Some succeed, some succeed partially, some die. In the wider social and political, medical and support spheres, ‘addiction’ continues to be a central focus of debate and research.

It is generally recognised that more needs to be done. There are insufficient facilities that provide recovery options. Mental health services often relegate ‘addiction’ to being of less than primary concern. In society at large, while things like smoking addiction are accepted as important, the many other killers are less thought about, or thought about very differently. Often, for instance, heroin addiction is thought by many to be associated with moral and character defects. A key right-wing philosophy puts all the emphasis on ‘individual responsibility’. It is, sadly, very common to hear people say things like, ‘It’s their own fault. Nobody made them drink, take drugs, gamble etc.’

Anybody who has made the barest inspection of addiction studies knows that the end result of addiction is the product of many factors. Some of these include:

  • Individual susceptibility via genetics,  peer group behaviour, mental health, poverty, cultural capital, education.
  • Availability of harmful products.
  • Multiple and complex needs including the first group above, housing, unemployment, prison and crime, lack of family support.
  • Normalisation by industry and culture as a whole of harmful behaviours.
  • Lack of support services and lack of effective strategies for many people.
  • Stigmatisation. This hangs like a dark cloud over all discussion. Even recovered addicts themselves, usually unaware of how fortunate they are not to have faced any of the difficulties mentioned above, have been known to ‘blame the addict’ (while promoting their own self-satisfied moral strength).
  • Education has been recognised as an important factor in ameliorating future harms. Alcohol and gambling industries present themselves as concerned about that high percentage of people who are addicts (and from whom most of their profits come), supporting charities and research. They stress that their products are to be enjoyed as ‘fun’ (‘When the fun stops, stop’ is the gambling industry’s slogan). In educational institutions, there have been initiatives in recent years but these tend to be very patchy and under-evaluated: some amount to little more than a few lessons, or a lecture.
  • Advertising, especially for football gambling, has come in for criticism and many argue that it should go the way of tobacco advertising. Promotion by famous paid sports personalities has also been criticised especially for its effect on young people.
  • While the psychology of addiction is extremely complex, it is fairly simple to understand why so many people turn to drugs (and, remember, alcohol is a hard drug) to alleviate misery, to numb the pain. While it’s not surprising that this connection is found strongly in people who have the least going for them, it’s very important to remember that there are many varieties of psychic suffering, and addiction curses many high up on the social pecking order.
  • There is an increasing worry that something in culture and society is causing a stark rise in unhappiness and mental health disorders. Such conditions are breeding grounds for addiction. Many people are ‘self-medicating’ to escape misery, depression and anxiety.

I’ve purposely included in the above some value judgments because these are, like stigma, very common within any discussion of addiction. If you believe that the scourge of addiction and its devestating effects on millions of people can best be addressed by emphasising the responsibility of individuals to change their ways, I’d only disagree 90%. There is, and should be, a role for personal responsibilty, powerless people have to be given that power. But along with that, and along with intense attention to recovery, we need to address as well as possible the factors which encourage addiction in the first place. It’s not one or the other, that would be silly. Neither is it rocket science. If society regulates our food and medicines, the air we breathe, health and safety, then we can ask whether the regulatory frameworks in place for alcohol and gambling are adequate.

It’s not a question of banning or being anti-industry or anti-anything. Regulation is not a very exciting word but it’s crucial. There is a growing movement, for instance, including police officers and politicians, to legalise and regulate street drugs. Such a policy has been found to lessen drugs harm in countries like Portugal. But that’s a different story, and mentioned here only to throw in an other factor to what should be an ongoing debate.

 

 

 

 

Response to DCMS Gambling 2017/18 Consultation

The following is from the response of The Machine Zone Community Interest Company‘s response in January 2018 to the Department of Culture, Media and Sports final consultation prior to decisions about FOBT stakes and othe rgambling related issues such as advertising.

 

For relative brevity, we here comment analytically on aspects of connected issues. A few representative sources of evidence are cited but it is assumed that previous consultation evidence is familiar.

While there has been a great deal of attention from many individuals and sectors to B2 machines, it is usually implicitly understood that Fixed Odds Betting Terminals cannot be seen in isolation but figure in complex relationships with the rest of the gambling and betting landscape. Whether terms of reference allow or not, the FOBT debate has become an ongoing discussion about gambling as a whole, particularly about all electronic gambling machines, digital devices and online gambling, gambling promotion, gambling harm, regulation and control versus business and personal freedom, and so on.

 

One important reason that FOBT gambling relates to the wider field is that many of the features of FOBT machines and their availability are common across gambling devices. We believe that much is to be learned from the research into FOBTs for applying to other areas. In any case, like many people with an interest in the issues, we implicitly identify FOBTs with concerning aspects of the present and developing gambling and betting industries.

 

EVIDENCE

 

The term ‘evidence-based’ when attached as a modifier to policy or practice has become part of the lexicon of academics, policy people, practitioners and even client groups. Yet such glib terms can obscure the sometimes only-limited role that evidence can, does, or even should, play.

http://www.ruru.ac.uk/pdf/Rhetoric%20to%20reality%20NF.pdf

While we recognise the crucial role of evidence, we see the term as problematic.

  1. Evidence gathering includes access to data, and this is by no means complete.
  2. It is unrealistic to expect many responding to the consultation to engage at a level deemed by terms of reference as ‘evidential’ or ‘analytic’. This raises the question of methodologies of evidence seeking, and more importantly, the basic assumptions, values, attitudes and orientations unerlying the evidence-seeking process. One aspect of this is that a hierarchy of evidence may pertain with quantative, statistical, academic discourses dominating rather than being part of the process. There is a lack of good qualitative research. Most concern about electronic gambling machines arises from user experiences yet this is perhaps written off as ‘merely’ anecdotal. This should be a prime research focus. Nancy Dow Schull who spent 13 years on site in Las Vegas looking at gambling behaviour and machine design argued that there is a need for in depth inte rviews etc to provide evidence impossible to collect quantitatively (Nancy Dow Schull, Addiction by Design: Machine Gambling in Las Vegas). We recognise necessary caution in looking at evidence from other cultures and environments but nevertheless beieve there is much to be learned, particularly from Australian research. In particular, to date there has been at best only very scant phenomenological/anthropological research at the sitse of gambling practice. Clearly there are many difficulties to such an approach, but this simply signals the possibility that research to date is far from complete in arriving at adequate understandings and much more needs to be done in the future.

 

  1. With regard to the present enquiry/consultation, there is no agreed or well formulated definition of what counts as evidence. Who will analyse and interpret a wide range of submission based on ‘evidence’; what basis will such analysis and interpretation be taken upon, with what expertise, peer review, avoidance of preconceived ideas etc?

 

Often, calls for evidence in politics are rhetorical. Look out for calls for ‘robust evidence’ or ‘rigorous evidence’, phrases used by committees, indivudaul parliamentarians, interest groups, industry. As noted above, there will be different understandings of what sort of evidence is appropriate. This is not peculiar to the FOBT consultation process. For instance, many educational charities boast solid evidence bases, yet when they are examined, it is found that this conceals more than it reveals; in ‘gambling education’ in school aged students, the complexities are often ignored and the ‘evidence’ is spurious or based on very limited ambitions.

 

  1. ‘Evidence based policy’ has become a government mantra in recent decades. It has also become a subject to be researched in academic and professional contexts, as well as internally in parliament. It is certainly not ‘transparent’ although claims based around it implicitly or explicitly attach unwarranted authority. Very many policies stemming from evidence based research and consultations have proved to be ingenuous, wrong and dangerous. We believe too, with the Goldsmith Fair Game (2013) report, that in any case, government policy is not decided by evidence alone.

 

 

  1. Confusion around, and rhetorical usage of ‘evidence’, leads to competing narratives. For instance, from the BMJ:

bmj

http://jech.bmj.com/content/early/2017/09/29/jech-2017-209710

  1. As with tobacco, the deleterious harmful effects of FOBT gambling were discovered not by academics but by human consequences. (It was insurance actuaries who made the links in the case of tobacco). There has been a countless number of individual stories of the dreadful consequences following use of electronic gambling machines. Since research is lacking, and since a great stigma around gambling addiction prevails so that the number of people ‘going public’ is small, we may legitimately assume that the actual human consequences are unseen across populations. Bankruptcy, mental health problems, relationship breakdown, suicide may be attributed to other factors than gambling to ‘protect’ reputation.

 

  1. Underlying values led to liberalisation of gambling by the Labour government. Some of these values pertain today. These values include, partly, a dependence upon growth in the sector for tax revenues. There are also libertarian values around personal freedom, minimal state intervention, and light-touch regulation. Central to the values which generate policy and research is the commitment to business freedom.

We believe that the deleterious impact of modern gambling is a public health issue. We think that gambling should be treated every bit as stringently as alcohol, tobacco and illegal drugs. The underlying values of welfare and health protection need promotion. This will lead to a rearrangement of foci in evidence seeking.

 

 

 

 

CONTEXTS

 

  1. The digital revolution has taken everyone by surprise. All aspects of society are affected. In every sector, adaptation and future orientation are challenging. In the case of the gambling and betting industries, adoption of digital products seems ‘ahead of the game’. This is coupled with legal and regulatory liberalisation, and associated responses from public, government, regulators, researchers and public health.

 

We are concerned that in examining the content and discourses of relevant political and regulatory bodies in terms of the current debate, responses and forward planning seem to be reactive. Further, there seems to be a dominant narrative of future monitoring, postponement of core policy and an expectation that the gambling and betting industries will develop as they will, and the preferred response is to take ‘action’ upon singular cases of excess (such as FOBTs).

We would prefer to hear a much stronger sounding set of policies and strategies for the future, which demonstrate awareness of, and set out proposals to tackle, the growing problems associated with gambling and betting.

 

  1. While weight is properly given to business freedom, personal choice and responsibility and economic factors, the public health approach to problem gambling seems unduly relegated as of lesser importance.

 

  1. It is probably the dominant narrative in public thinking that ‘addicts’ are responsible for their plight, and/or ‘addicts can/should receive treatment. Although the present process of consultation examines other factors such as machine design, convenience and accessibility, clustering, our analysis suggests that such factors do not presently receive sufficient attention, and that their is undue and unhelpful focus upon the ‘pathology’ of the individual.

 

  1. The acronym RET (research, education and treatment) is frequently mentioned as a monolith, hence the acronym, and we understand this block signifies various important and potent approaches to minimising ‘problem gambling’. We say more about RET below, but point out here that the random lumping together of three highly important and distinct areas both minimises their importance by becoming a passing reference and acts to reinforce the diversion of attention from the contexts of machine design, promotion, marketing, convenience and accessibility, cross-industry corporatism etc.

 

  1. There is a strong public distaste for the harms done by FOBTs. This has translated into an equally strong distaste for all gambling with the Gambling Commission reporting that 23% of the public believing it would be better if gambling were banned altogether. http://www.gamblingcommission.gov.uk/PDF/survey-data/Gambling-participation-in-2016-behaviour-awareness-and-attitudes.pdf

 

‘ADDICTION’

 

Sometimes called addiction, problem gambling, pathological gambling. An objection is that such terms summon up negative stereotypes. What is certainly true is that they delineate the individual subject. The player, gambler, person becomes the sole bearer of ‘something wrong’. As the Goldsmith Report (Fair Game, 2012) claims:

By categorising a small minority of people as

‘problem gamblers’, the state and the industry are

able to continue to promote gambling as a safe

and legitimate form of leisure and entertainment

for the ‘normal’ majority. Images of problem gamblers

in our data are many. They include those

labelled as losers, weirdos or simply those who

don’t gamble well, but most are flattened out and

decontextualised accounts of problematic people.

Industry’s views of problem gamblers, in particular,

are often deterministic and derogatory. They are

seen as people who are unable to control their behaviour.

Some described treatment as a waste of

money, and people with gambling problems as

‘problem people’.

Problem gamblers are problem people. They

are drug addicts, criminals, they are unable to

control their impulses and this is why it is impossible

and pointless trying to prevent them from harming themselves.

 

Much research, acknowledging this reservation, sees ‘addiction’ as occurring on a continuum. While the results of gambling may be severe for those with a problem, those around them and society at large, the compulsion to gamble is better seen in terms of strength so that an individual may at some times resist, at other times be overwhelmed. This is important because environmental cues obviously are key to eliciting responses, attenuating inhibitory power. A visual representation of ‘problem gambling’ such as that below suggests that there are largely ignored populations who are at great risk, and individuals who can move between levels.

toronto

Centre for Addiction and Mental Health, Toronto, 2005

 

We suggest that conceptualising gambling behaviour on such a spectrum alerts us more precisely to the scale of gambling harms with different intensities, and prevents us from imagining that ‘the problem’ is with a minority population of pathological gamblers.

Yet dominant narratives, certainly from the industry, continue to emphasise that levels of harm are very low, and that those who suffer are ‘ill’ (and would suffer whatever forms of gambling and betting are available). The percentage of the population cited as ‘pathogical gamblers’ hovers around 1% in the UK although this disguises variations. In Northern Ireland, for instace, the figure is quoted as 2.3%.

The industry and others say that these figures are stable over time. This suggests that many years of research, education and treatment have had little or no effect in tackling the ‘problem of problem gambling’.

More seriously, the figures quoted refer to the national adult populations. Yet:

 

           Industry apologists argue that no more that 1 or 2 percent of the population  meets the diagnostic criteria for pathological gambling, with perhaps 3 or 4   percent qualifying  for the less severe “problem gambling.” But, as Schüll points out, those figures are for the general population. “The percentage of  pathological and problem gamblers among the gambling population is a good  deal higher, and higher still among regular(or “repeat”) gamblers—20 percent, by some estimates.”

As the APPG’s consultations showed, there is much evidence that a very high number from this revised figure are characterised as multiply disdvantaged,  and betting companies appear to cluster their premises where the most vulnerable live.

 

PUBLIC HEALTH

 

Even if one accepted the 1% figure as meaningful, one has to factor in the number of people affected such as family, economic detriment and health service uptake. As a matter of fact, when some politicians and industry spokespeople talk of the economic implications (tax revenue, profits, employment etc) of curtialing gambling opportunities, these wider costs are often ignored. These factors are well rsearched (with accompanying differences of interpretation) and already figure in the consultation process.

It may, nevertheless, be instructive to compare ‘problem gambling’ rates with other mental health disorders, using the more conservative figures.

 

Problem gambling                             1-3%

Bipolar 1                                                1%

Schizophrenia                                     1.1%

Alcohol Dependence (England)      1.4%

 

 

We suggest that major mental health disorders are not all treated equally in terms of research, priority and treatment. The connotative weight of ‘addiction’ may play a part but it seems ironic that with so much focus on the ‘pathological individual’, research, the state, the industry, and health services offer much less attention and support to what is clearly a major health issue.

The move to make problem gambling a public health is issue is backed, of course, by the Royal Society for Public Health, may health professionals and researchers. The Royal College of Psychiatrists and the British Medical Association as organisations back the move as do countless doctors.

As a public health issue, prevention is seen as crucial to ameliorating gambling harm, and this health strategy involves the full cognisance of the harmful nature of gambling products such as electronic gambling machines. In a piece in The Lancet (January 2018), several researchers argued that

The harms of habitual and disordered gambling are many, and adversely affect   individuals, families, employers, and communities. While the development of  gambling disorder by players of electronic gambling machines (EGMs) involves   complex interactions between multiple factors (eg, decision-making processes,  availability of gambling outlets), there is growing recognition of the role of  machine design in the progression of the disorder.1,2 We allege that EGMs are                            intentionally designed with carefully constructed design elements (structural characteristics) that modify fundamental aspects of human decision-making and  behaviours, such as classical and operant conditioning, cognitive biases, and dopamine signals.

In other words, the industry exploits human psychological attributes. They conclude:

lancet

As a public health issue where we witness threats to health and wellbeing through dangerous products, we expect the same attention to gambling as has been given to tobacco, alcohol and other industries. This entails strong curtailment of specifically identified dangerous products (here electronic gambling machines); the tackling of ‘normalisation’ that follows from promotions, advertising, opportunity and convenience; facilitating independent research with no financial input from industry, this to build on the growing body of research which is highlighting product design, industry strategies, etc.

Public health should not in any way be funded by industries which damage public health. John Catford draws attention to why:

 

Receiving alcohol and gambling funding is particularly compromising for health and social agencies, sport and fitness organisations, universities and research groups. The time has come for those values-based organizations that already have agreed not to accept funding from Big Tobacco to extend this to Big Booze and Big Bet. And for those who have not done so—to do the same.

  1. compromise the objectivity and independence of the research and the maintenance of integrity and standards by creating a conflict of interest for researchers;
  2. foster poor quality or compromised research which may then produce biased and erroneous results favourable to the interests of these industries;
  3. create a dependence on this form of research funding which may then inhibit other independent research and inquiry;
  4. reduce the ability of researchers to publish the outcomes of research in reputable, high-quality journals which may have policies which preclude industry-funded research;
  5. restrict groups from receiving other funding from reputable funding bodies, which will then damage and restrict growth of research performance;
  6. indicate to the public, professional groups, and government—by associating with these industries—that organization endorses the activities and products of these industries;
  7. create a more favourable climate for these industries so that regulators will not need to enforce or further restrict the promotion of alcohol and gambling to youth and vulnerable people;
  8. compromise the organization’s reputation, mission, core commitments and values.

https://academic.oup.com/heapro/article/27/3/307/754330/Battling-Big-Booze-and-Big-Bet-why-we-should-not

 

As with every aspect of the ‘debate’, however, framing ‘problem gambling’ as a public health issue can make for neat concepts but it is not straightforward and by no means guarantees a significant leap forward (and no more do monolithic concepts such as Research, Education and Treatment).

 

RESEARCH, EDUCATION AND TRAINING

 

 

 

As noted above ‘RET’ is often bundled into a convenient concept of its own, and often mentioned only in passing.

Or prime concern is that all three areas, each of which is crucial, are too frequently conceived in terms of ‘the pathological individual’.

This reinforces the diversion of attention from the impacts of machine design, environments, convenience and availability, targeting by industry of the mos vulnerable, promotion, marketing and advertising. The reliance upon funding from the gambling and betting industries is no more acceptable than research, education and treatment accepting funding from alcohol and tobacco industries.

There has been a solid output from concerned academics and professionals about how industry funding skews agenda for research. We would wish to see levies and some taxation from the industry ringfenced to contribute to totally independent research initiatives.

Treatment for gambling disorders is woeful, this exacerbated by funding cuts which impac on local authority comissioning services. A much deeper reason for treatment neglect is that, despite its evidentially manifested severity and prevalance, it simply does not figure highly in any government priorities. Ongoing debates about the paucity of mental health services are amplified in the case of gambling disorder.

Education includes campaigns comparable with other public health projects. There is limited evidence that ‘teaching’ players greater awareness about machine features, odds risk etc reduces harmful play in laboratory conditions. Very little evidence suggests that public education has any beneficial effect.

In schools and other educational institutions there is a very chequered history of drugs and alcohol education. These days, such education is seen as part of personal, social, health and economic education (PSHE) but this itself lacks national coherence and delivery. Research has shown what works best in such education. As importantly, it shows what is ineffective or counterproductive: alarmingly such latter education which includes scare tactics, lecturing, talks from ‘recovered’ addicts continues. In the case of gambling education, as in ‘treatment’, there is a low awareness of gambling. However, with state encouragement and initiative, coupled with developments in PSHE, we believe it possible and desirable to include gambling education in state funded education. In whatever case, educational initiatives relating to, or funded by, the industries are unacceptable because the powerful implicit message is that the gambling environment is a safe source of entertainment for the many and that it is the ‘few’ who already have problems who run into danger: as noted above, such messages, combined with that of ‘social responsibility’, may act as good PR for industry, but in any case contriutes to the continuing obfuscation about reality.

 

FUTURES

 

FOBT issues are well documented, but internet and app platforms are increasing access to gambling due to the exponential increase in smart phone and tablet computers across Wales. These technological changes are leading to change in social regulation of gambling as a public behaviour, as well as facilitating targeted and unregulated advertising to potentially vulnerable individuals. Trends indicate that these may include older adults and underage children.

An Investigation into the Social Impact of Problem Gambling in Wales (2017) https://pure.southwales.ac.uk/en/publications/an-investigation-of-the-social-impact-of-problem-gambling-in-wales(8b5df31f-4e41-4308-ad28-90617ba9d3ec).html

 

As we introduced our response, the digital environment has taken us by surprise. There are many opportunities and many dangers. The use of the word ‘exponential’ in the above quotation is precise. FOBTs are just one example of exponential digital gambling growth. Betting shops are beginning to install Self Service Betting Terminals, digital facilities which provide an ‘all in one experience’. Such terminals mirror the micro-environment of the digital phone, tablet or other device. In an increasingly promoted gambling environment, young people especially are at great risk.

Clamping down on FOBTs, reduing maximum stake to £2, adjusting machine designs such as removing ‘replay’ button, lengthening time between bets etc will be of benefit to some users; more importantly it will send out a strong message of intent about the dangers of digital gambling. This should be backed up with what are currently very inadequate areas of research, education and treatment.

There have been many things to learn from the FOBT debates, not least the need to be alert proactively to the future of digital gambling and the need for far more solid bases for regulation and harm prevention across the coming gambling industry’s products.