Feature

Gambling with our health

Government moves to loosen controls on gambling will have knock-on effects for public health, warns Mark Griffiths

The recent government white paper, A Safe Bet For Success, signals the widespread deregulation of gambling in the UK. On the face of it, gambling may seem to have little to do with health care, but there are many related health issues which the government is going to have to face.

Traditionally, gambling has not been viewed as a matter of public health and research into its health, social and economic impacts is at an early stage. In August 1995, a special issue of the British Medical Journal argued that gambling was a health issue because it widened inequalities of income and because there was an association between inequality of income in industrialised countries and lower life expectancy.

But there are many more specific reasons why gambling should be seen as a health issue. It is estimated that one to three per cent of the adult population has a gambling problem. This is characterised by unrealistic optimism on the gambler’s part; all bets are made in an effort to recoup their losses. But instead of ‘cutting their losses’, gamblers get deeper into debt and become more preoccupied with gambling, believing that a big win will repay their loans and solve their problems.

This puts pressure on personal relationships, and can lead to illegal borrowing and other criminal activities in an effort to find money. At this point, family or friends may ‘bail out’ the gambler.

Alienation from those closest to them characterises the final phase of desperation for problem gamblers. In a last-ditch effort to repay their debts, gamblers’ criminal behaviour reaches its height and, when there are no more options left, they may suffer severe depression and have suicidal thoughts.

The costs of problem gambling are high both to affected individuals and to society. Personal costs can include irritability, extreme moodiness, problems with personal relationships (including divorce), absenteeism from work, family neglect, and bankruptcy. There can also be adverse health consequences for both the gambler and their family, including depression, insomnia, intestinal problems, migraines, and other stress-related disorders.

Attempts to stop gambling can also lead to health problems. Research in the US found that at least 65 per cent of problem gamblers reported one or more physical side-effects during withdrawal, including insomnia, headaches, upset stomach, loss of appetite, physical weakness, racing heart, muscle aches, breathing difficulty and/or chills.

Preliminary analysis of the calls to the UK’s gambling helpline, run by GamCare, indicates that a significant minority of the callers report health problems as a consequence of their problem gambling. These include depression, anxiety, digestive problems, other stress-related disorders and suicidal ideation.

Problem gambling is very much the ‘hidden’ addiction. Unlike alcoholism, for example, there are no outward signs of addiction such as slurred speech. Obvious signs of a problem often do not occur until well into the problem gambler’s career.

But gambling is an addiction that can destroy families and have medical consequences – so health professionals need to be aware of its adverse effects in the same way that they are familiar with the consequences of other potentially addictive activities such as drinking and smoking.

GPs routinely ask patients about their smoking and drinking, but not about gambling. It may be seen as a ‘grey’ area in health care, and it is easy to deny that health professionals should get involved. But if the main aim of practitioners is to ensure the health of their patients, then it is clear that an awareness of the issues surrounding gambling should be an important part of GPs’ basic knowledge.

There is no doubt that opportunities for gambling will increase as a result of the measures outlined in the government’s white paper. Evidence from other countries shows that where access to gambling is increased, there is an increase not only in the number of regular gamblers but also in the number of problem gamblers.

Not everyone is susceptible to gambling addiction, but the more gambling opportunities, the more people with a gambling problem. There is an urgent need to increase awareness among health professionals about gambling-related problems and to develop effective strategies to prevent and treat them.

It is inevitable that a minority of people will become casualties due to the deregulation of gambling. The government has announced that £3m a year will be put aside for research into, and treatment of, problem gambling. But with an estimated 300,000 problem gamblers already, £10 for each of them is clearly inadequate.