Feature

Taking a chance with our health

Could the National Lottery and scratchcards lead to widespread pathological gambling? Mark Griffiths examines the evidence

Within months of its introduction on 14 November 1994, the National Lottery appeared to be part of British culture. In August 1995, the British Medical Journal published an editorial titled ‘Gambling with the nation’s health?’ which argued that gambling (and more particularly the National Lottery) was a health issue because it widened inequalities of income and that there was an association between inequality of income in industrialised countries and lower life expectancy. The editorial also pointed out there would be a reduction in donations to medical charities as more people spent their disposable income on lottery tickets.

More recently both Paddy Ashdown (Liberal Party) and Chris Smith (Labour Party) have called for instant scratch cards to carry a health warning. I constantly get calls asking whether Lottery Rage or Lottery Disappointment Syndrome are bona fide medical conditions. Whether they are or not, gambling — and more particularly pathological gambling — is undeniably a health issue for some people.

Pathological gambling affects only a small proportion of the adult population and is characterised by unrealistic optimism on the gambler’s part. All bets are an effort to recoup losses (often referred to as ‘the chase’). The result is that, instead of cutting their losses, gamblers get deeper into debt, pre-occupying themselves with gambling and determined that a big win will repay their loans and solve all their problems. Family troubles begin and illegal borrowing and other criminal activities usually start in an effort to get money. At this point, family and/or friends may ‘bail out’ the gambler. Alienation from those closest to them characterises the appearance of the final desperation phase. In a last-ditch, frenzied effort to repay debts, illegal criminal behaviour reaches its peak and when there are no more options left, the gambler may suffer severe depression and feel suicidal.

Over 60 per cent of the adult population now gambles every week on the National Lottery. Most people I know speak very positively about its introduction and I have little negative to say about the National Lottery in itself. But that does not mean that the health issues should be ignored. The lottery’s association with good causes has softened (or at least is beginning to soften) people’s attitudes towards gambling in general and may start to erode the social stigma surrounding other gambling (eg betting or casino gambling). An insidious message is getting through that the National Lottery is a good thing and therefore ‘gambling is good’.

Should we be worried? I think so, as gambling on the Lottery appears to be mirroring the initiation of other socially acceptable, socially condoned but potentially addictive behaviours like drinking (alcohol) and smoking (nicotine). Addictions — of whatever kind — are a health issue.

Perhaps the major health concerns about the introduction of the National Lottery have nothing to do with the Lottery in itself but more to do with possible future legislation. Most parts of the gambling industry (eg football pools, bingo, betting shops and amusement arcades) have already lost some of their custom to the National Lottery and scratchcards. All areas of the gambling industry now want to be on a level playing field and are lobbying for change. As gambling laws relax and gambling becomes another product that can be more readily advertised, there will naturally be an increase in gambling. This will lead to more people who experience gambling problems. Since the introduction of the National Lottery, calls to Gamblers Anonymous have increased by 17 per cent. This is not to say that all of these callers are ‘addicts’ but it does suggest that there a large minority of people who are spending more than they can afford.

Camelot’s Instants scratchcards have also established themselves as a cultural phenomenon since their introduction on 21 March 1995. Scratchcards are not new to the UK but the fact they are now heavily advertised and a have a potential £50,000 jackpot prize has meant they have quickly become very successful. Should they carry a health warning? Scratchcards are potentially addictive because they contain characteristics which give psychological rewards at little overall cost to the person gambling. Showing the existence of these characteristics is of great practical importance. Not only could potentially ‘dangerous’ forms of gambling be identified, but effective and selective legislation could be formulated. In 1978, the Royal Commission said casino gambling came closest to incorporating the largest number of gambling inducing characteristics. This was because it included a high pay-out ratio (ie jackpots) and had a rapid event frequency (ie the opportunity for repeated gambling). These characteristics are also true of scratchcards.

Scratchcards are effectively ‘paper fruit machines’ because manufacturers build ‘near misses’ into them. Near misses encourage future play, inducing continued gambling. The potential danger of the near miss element of scratchcards was first documented in the 1970s and they were dubbed ‘heartstoppers’ because they gave the illusion of coming close to a big prize.

Many people consider scratchcards little more than a harmless flutter. But the Home Office’s definition of ‘hard’ gambling refers to ‘those forms of gambling which are considered to carry greater potential risks than others, usually because of the high or rapid staking associated with them’ (my emphasis). Scratchcards are therefore a ‘hard’ form of gambling by the Home Office definition. With their integrated mix of conditioning effects — short pay-out intervals, capacity for continued gambling (high event frequency) and psychological rewards (the near miss), coupled with the fact that scratchcards require no skill, are deceptively inexpensive, highly accessible and sold in respectable outlets — it is not hard to see how scratchcard gambling could become a repetitive habit.

Reviewing the structural characteristics of gambling activities provides insights into the potential ‘addictiveness’ of both the National Lottery and instant scratchcards. Evidence suggests that the National Lottery as a weekly draw was unlikely to be addictive because there was a week’s gap between knowing the result of each gamble, whereas scratchcards could potentially promote repetitive habit patterns and should perhaps carry some kind of government health warning.

But Camelot’s second weekly Lottery draw, which began in February 1997, effectively decreases the event frequency and could easily make gambling more addictive. It is not hard to imagine the UK facing the situation in Spain (a daily lottery draw) or in some American and Canadian states (instant lottery draws in the shape of video lottery terminals) in which the event frequencies are sufficiently high to induce the repetitive gambling patterns found in horse race betting.

There are many other issues surrounding the National Lottery which need to be debated and investigated further. My own major recommendations would include

• no rollover jackpot
• the capping of jackpot pay-outs
• an increase in the minimum age for playing the Lottery to 18
• detailed research to discover the extent of problematic Lottery gambling
• restrictions on TV advertising (particularly in relation to scratchcards)
• an increase in the percentage of Lottery funds going to charities
• the Lottery being run on non-profit lines
• significant strengthening of the powers of Oflot, the regulatory authority.

Some of these recommendations are fairly uncontroversial and already happening (detailed empirical research is being carried out) and others would probably have support from the general public (eg the Lottery being run on a non-profit basis and Oflot’s powers being strengthened). But others would require further debate. In my view, the one recommendation that the government should seriously consider is raising the minimum age for gambling to 18 in line with other commercial gambling activities. It has consistently been shown that the earlier a child starts gambling the more likely they are to have gambling problems later in life.

It is inevitable that a small minority of people will become gambling casualties directly as a result of the deregulation of gambling and help should be provided for problem gamblers. Since the National Lottery is here to stay, and is effectively state-sponsored, the government should consider giving priority funding (from taxes raised from gambling revenue) to organisations providing advice, counselling and treatment for people with severe gambling problems. This may appear controversial (and some might say self-serving) but there seems to be a legitimate argument for such a policy.