Trends and patterns in UK treatment seeking gamblers: 2000–2015

doi:10.1016/j.addbeh.2018.09.009

Addictive Behaviors

Volume 89, February 2019, Pages 51-56

https://doi.org/10.1016/j.addbeh.2018.09.009 Get rights and content

Highlights

•
Forms of gambling identified as problem forms have changed over time.
•
Increases in Fixed Odds Betting Terminals, Poker, & Sports Betting.
•
Decreases in Horse and Dog Racing, and the National Lottery.
•
Gamblers more likely to have attempted suicide in recent years.
•
Gamblers more likely to report a co-morbid mental health disorder in recent years.

Abstract

Background and aims

Gambling is an activity that for some can become disordered, with severe negative consequences. Existing literature does little to inform us regarding changing gambling habits of treatment seeking gamblers; the current study sought to measure trends and patterns in UK treatment seeking gambler behaviour and demographics over a 15-year period.

Methods

Case files for 768 gamblers seeking residential treatment with the Gordon Moody Association (GMA) were analysed, collected between 2000 and 2015. Case files comprised initial assessment questionnaires, demographic data, current gambling behaviour, mental and physical health status, and a risk assessment. Chi-squared analyses were used to measure change in categorical distribution.

Results

Prevalence of different forms of gambling identified as problematic have changed over time: Fixed Odds Betting Terminals (FOBTs), sports betting, and poker have become more common; horse and dog racing, and the National Lottery have become less common. Online gambling has also increased over time. In more recent years, gamblers are also more likely to have attempted suicide, to report a co-occurring mental health disorder, and to start treatment having already been prescribed medication.

Discussion and conclusions

This is the first study to demonstrate that UK treatment seeking gambler behaviour has changed over time; major changes relate to the forms of gambling engaged in problematically, and the mental health of disordered gamblers. Whilst much media focus is directed towards one form of gambling, this should not detract focus from other forms and associated disorders, and the impact of the legislative environment.

Introduction

Gambling in the UK has been evolving since the implementation of the 2005 Gambling Act (2005 c 19). The 2005 act permitted marketing of gambling on TV and radio, increased betting shop opening hours, and increased the number of Fixed Odds Betting Terminals (FOBTs) allowed per shop to four. FOBTs are electronic gaming machines offering gambling at ‘fixed odds’, found in Bookmakers shops and casinos that offer high-stakes, high-speed gambling. Following implementation of these changes, exposure to gambling through adverts (Ofcom 2013) and other marketing ploys (Cassidy & Ovenden 2017) has dramatically increased, as has the number of FOBTs in bookmaker's shops (Gambling Commission 2018). However, past-year population gambling prevalence has remained relatively constant (Conolly et al. 2017; Wardle et al. 2011), yet gamblers are now spending record amounts of money. The gross gambling yield between April 2016 to March 2017 was £13.7 billion, a 1.8% increase on the previous year (Gambling Commission 2017). Past year gambling engagement since 2000 has increased in scratchcards, other lotteries, betting on other events and sports, FOBTs, and gambling on online bingo, casino or slot machine games, whilst betting on Football Pools has decreased (Wardle et al. 2011). The use of the internet to access gambling is also increasing (Conolly et al. 2017). Despite this, the prevalence of disordered gambling at population level in the UK has remained at <1% (Conolly et al. 2017; Wardle et al. 2011).

Disordered gambling is associated with adverse health outcomes. Kessler et al. (2008) reported that 96% of lifetime pathological gamblers met diagnostic criteria for at least one other psychiatric disorder. In the UK, elevated psychiatric comorbidity, and poor mental and physical health have been observed in both population level studies (Cowlishaw & Kessler 2015), and treatment seeking samples (Ronzitti, Lutri, Smith, Clerici, & Bowden-Jones 2016). Individuals with gambling disorders have been shown to experience elevated levels of mood and anxiety disorders (Petry, Stinson, & Grant 2005; Specker, Carlson, Edmonson, Johnson, & Marcotte 1996; Toneatto & Pillai 2016), and major depressive disorders (Zimmerman, Chelminski, & Young 2006).

Previous research has established a relationship between smoking and gambling in adults (Mcgrath & Barrett 2009), and elevated levels of smoking amongst gamblers (Black, Shaw, McCormick, & Allen 2013). Additionally, tobacco dependence was found to be the most prevalent co-occurring psychopathology amongst disordered gamblers (Lorains, Cowlishaw, & Thomas 2011). Disordered gamblers also demonstrate an increased risk of alcohol use disorders (Cunningham-Williams, Cottler, Compton 3rd, & Spitznagel 1998; Welte, Barnes, Wieczorek, Tidwell, & Parker 2001) and are at increased risk of gambling relapse (Hodgins & El-Guebaly 2010) than gamblers without a co-morbid alcohol use disorder. Gambling is also associated with excessive substance use and substance use disorders (Barnes, Welte, Tidwell, & Hoffman 2015; Petry 2007). Lorains et al. (2011), report in their meta-analysis that 57.5% of gamblers had a co-occurring substance use disorder, whilst a recent meta-analysis of risk and protective factors identified cannabis use and illicit drug use as risk factors for gambling problems (Dowling et al. 2017).

Treatment seeking gamblers have also report high levels of suicidal ideation and suicide attempts (Battersby, Tolchard, Scurrah, & Thomas 2006; Ledgerwood & Petry 2004). Petry and Kiluk (2002) report suicidal ideation in 32%, and suicide attempts in 17% of a gambling treatment seeking sample and found that gamblers with suicidal ideation had higher SOGS scores. In the UK, a recent study utilising a large clinical sample indicated that 46% of individuals with gambling problems reported current suicidal ideation (Ronzitti et al. 2017).

The current paper analysed a large database of treatment seeking disordered gamblers, to identify behavioural trends and patterns both before and after implementation of the 2005 Gambling Act. Due to the changes in patterns of engagement in specific forms of gambling at population level, it is hypothesised that forms of gambling engaged in by treatment seeking gamblers will also vary. Although it would be expected that gamblers would drink, smoke and use substances more than the general population, there is no empirical evidence to suggest this will change over time. Thus, it is hypothesised that use of smoking, alcohol or drugs will not vary significantly over time in this treatment seeking population. Furthermore, although previous research suggests the study might observe elevated psychiatric disorders, there is no empirical evidence to justify a directional hypothesis regarding prevalence over a specific time. Therefore, an exploratory analysis will be conducted. This analysis represents, to the authors' best knowledge, the first analysis of treatment seeking gambler data over time, allowing novel patterns in demographic and behavioural patterns to be presented and discussed, significantly adding to the literature on treatment seeking gamblers in the UK.

Section snippets

Participants

The Gordon Moody Association provide the UK's only gambling-specific residential treatment facility, with two sites in South London and the West Midlands. Data was collected from all applicants to GMA between January 2000 and November 2015 (n = 768, M = 48 per year). Due to the residential nature of the treatment, GMA residents were until recently, all male. The age of applicants ranged from 17 to 70 (M = 34.82, s.d. 9.98). Of those who reported their ethnicity (n = 744), 88% (n = 654)

Forms of gambling

Analysis indicated that overall, forms of gambling identified as problematic at treatment start varied by intake year (χ² (90) = 582.99, p < .001), driven by significant increases in the proportion of gamblers identifying FOBTs (χ² (13) = 108.58, p < .001), Other Sports (χ² (15) = 69.68, p < .001), and Poker (χ² (10) = 35.28, p < .001) as problem forms (Fig. 1). Use of the internet as a means of accessing gambling increased significantly across intake year (Fig.1), (χ² (14) = 156.51, p < .001).

Discussion

The current research sought to analyse trends and patterns in the profile and behaviour of individuals seeking treatment for gambling problems at a UK residential treatment centre between 2000 and 2015. Overall, forms of gambling identified as problematic at treatment start varied by intake year, driven predominantly by increases in FOBT use, other sports gambling, and poker, and decreases in dog racing, horse racing, and the National Lottery. The use of the internet as a means of accessing

Conclusions

Results highlight two major areas of concern and interest. The changing patterns of forms of gambling identified as a problem form indicate that FOBTs, sports betting and poker, are increasingly being reported as problematic. Perhaps of more pressing concern is the rapid increase of the internet as the medium to access gambling; the increased availability of gambling afforded by the internet, aligned with more individually targeted marketing messages based on the individual's own browsing

Acknowledgment

The research was funded by an Internal University of Lincoln Research Investment Fund grant, awarded to Dr Roberts, REF: RIF2015-14.

References (44)

D.W. Black et al.
Pathological gambling: Relationship to obesity, self-reported chronic medical conditions, poor lifestyle choices, and impaired quality of life
Comprehensive Psychiatry
(2013)
N.A. Dowling et al.
Early risk and protective factors for problem gambling: A systematic review and meta-analysis of longitudinal studies
Clinical Psychology Review
(2017)
H. Pitt et al.
“It's just everywhere!” Children and parents discuss the marketing of sports wagering in Australia
Australian and New Zealand Journal of Public Health
(2016)
S. Ronzitti et al.
Current suicidal ideation in treatment-seeking individuals in the United Kingdom with gambling problems
Addictive Behaviors
(2017)
G.M. Barnes et al.
Gambling and substance use: Co-occurrence among adults in a recent general population study in the United States
International Gambling Studies
(2015)
M. Battersby et al.
Suicide ideation and behaviour in people with pathological gambling attending a treatment service
International Journal of Mental Health and Addiction
(2006)
R. Biolcati et al.
All-in and bad beat: Professional poker players and pathological gambling
International Journal of Mental Health and Addiction
(2015)
R. Cassidy et al.
Frequency, duration and medium of advertisements for gambling and other risky products in commercial and public service broadcasts of English Premier League football
(2017, Aug 10)
S. Christie
Gambling adverts feature in 95% of all televised football matches, researchers find
A. Conolly et al.
Gambling behaviour in Great Britain in 2015: Evidence from England, Scotland and Wales
(2017)

S. Cowlishaw et al.

Problem gambling in the UK: Implications for health, psychosocial adjustment and health care utilization

European Addiction Research

(2015)

R.M. Cunningham-Williams et al.

Taking chances: Problem gamblers and mental health disorders--results from the St. Louis Epidemiologic Catchment Area Study

American Journal of Public Health

(1998)

Department of Health

UK Chief Medical Officers' Low Risk Drinking guidelines

(2016)

J. Ferris et al.

The Canadian problem gambling index

(2001)

S. Gainsbury

The rise of internet gambling and its impact on addictive disorders

InPsych: The Bulletin of the Australian Psychological Society Ltd

(2015)

Gambling Act

Gambling Commission

M. Griffiths et al.

Online poker gambling in university students: Further findings from an online survey

International Journal of Mental Health and Addiction

(2010)

A. Harris et al.

The impact of speed of play in gambling on psychological and behavioural factors: a critical review

Journal of gambling studies

(2017)

N. Hing et al.

Sports-embedded gambling promotions: A study of exposure, sports betting intention and problem gambling amongst adults

International Journal of Mental Health and Addiction

(2015)

N. Hing et al.

Bet anywhere, anytime: An analysis of internet sports bettors' responses to gambling promotions during sports broadcasts by problem gambling severity

Journal of Gambling Studies

(2017)

Cited by (28)

Problem gambling within sexual and gender minorities: A systematic review
2023, Addictive Behaviors
A body of literature now suggests that sexual and gender minorities (SGMs) experience a distinct set of stressors in the form of minority stress, which may function as a risk factor for the development of negative psychological and behavioral health outcomes. A systematic review of the literature was conducted through June 1st, 2022. Inclusion was limited to peer-reviewed publications in academic journals, with prospective and retrospective studies of a quantitative nature included for synthesis. Articles were required to contain an empirical measure of gambling cognitions, behaviors, motives, or outcomes. Studies that did not include sexual minorities within the sample or did not provide quantitative results which shed light on gambling in sexual minorities were excluded from the present review. In total, 12 eligible studies were identified for the current review. In general, this review highlighted methodological weaknesses within the literature and suggested that little is known about gambling in this population. Given conflicting findings across studies, further research is necessary to understand gambling in sexual and gender minorities. From a methodological standpoint, there is a need for clearer conceptualization and standardized measurement of gambling-related variables in vulnerable populations. Further, longitudinal research would be beneficial to understand the nuances of gambling disorder across sexual orientations and gender identities, as well as aid in the development of holistic intervention options that meet the needs of these more vulnerable groups.
Gambling disorder in the UK: key research priorities and the urgent need for independent research funding
2022, The Lancet Psychiatry
Citation Excerpt :
Moreover, studies have tended to be ad hoc rather than longitudinal in their design. Data from UK treatment settings indicate that the nature of gambling has changed markedly over time (eg, growing use of online applications and other forms of online gambling33), and gambling is now accessible to a large proportion of the population irrespective of time and place. This is also likely to be the case in the general population but has not been addressed by prevalence surveys.
Gambling in the modern era is pervasive owing to the variety of gambling opportunities available, including those that use technology (eg, online applications on smartphones). Although many people gamble recreationally without undue negative effects, a sizeable subset of individuals develop disordered gambling, which is associated with marked functional impairment including other mental health problems, relationship problems, bankruptcy, suicidality, and criminality. The National UK Research Network for Behavioural Addictions (NUK-BA) was established to promote understanding of, research into, and treatments for behavioural addictions including gambling disorder, which is the only formally recognised behavioural addiction. In this Health Policy paper, we outline the status of research and treatment for disordered gambling in the UK (including funding issues) and key research that should be conducted to establish the magnitude of the problem, vulnerability and resilience factors, the underlying neurobiology, long-term consequences, and treatment opportunities. In particular, we emphasise the need to: (1) conduct independent longitudinal research into the prevalence of disordered gambling (including gambling disorder and at-risk gambling), and gambling harms, including in vulnerable and minoritised groups; (2) select and refine the most suitable pragmatic measurement tools; (3) identify predictors (eg, vulnerability and resilience markers) of disordered gambling in people who gamble recreationally, including in vulnerable and minoritised groups; (4) conduct randomised controlled trials on psychological interventions and pharmacotherapy for gambling disorder; (5) improve understanding of the neurobiological basis of gambling disorder, including impulsivity and compulsivity, genetics, and biomarkers; and (6) develop clinical guidelines based on the best contemporary research evidence to guide effective clinical interventions. We also highlight the need to consider what can be learnt from approaches towards mitigating gambling-related harm in other countries.
Predictors of suicide attempts in male UK gamblers seeking residential treatment
2022, Addictive Behaviors
Citation Excerpt :
In the period during which data was collected, the UK gambling landscape underwent significant change, primarily due to implementation of the Gambling Act of 2005, and the advent of online gambling; leading to the emergence of newer forms of gambling, including Fixed Odds Betting Terminals and in-play sports betting. Trends and patterns in gambling behavior of GMA residents over the stated time frame are discussed elsewhere (Sharman et al., 2019). GMA is a registered UK charity that has been helping rehabilitate compulsive gamblers through its residential treatment programme since 1971.
Disordered gambling can have serious negative consequences for the individual and those around them. Previous research has indicated that disordered gamblers are at an increased risk of suicidal thoughts, ideation and attempts. The current study sought to utilise data from a clinical sample to identify factors that are associated with prior suicide attempts.
The sample included 621 patients entering a gambling-specific residential facility in the UK. A series of Chi-Square analyses and binary logistic regressions were run to identify clinical and sociodemographic variables associated with suicide attempts.
Of the 20 variables analysed using Chi-square statistics, five were significantly associated with the outcome variable (lifetime attempted suicide): loss of family relationships, loss of home, prior depression, prior suicidal thoughts, and medication use. Regression analysis showed that individuals were more likely to have reported suicide attempts if they had experienced loss of family relationships (1.65 times), loss of a home (1.87 times), prior depression (3.2 times), prior suicidal thoughts (6.14 times), or were taking medication (1.95 times) compared to those not reporting such individual events.
Disordered gamblers are vulnerable to suicide; a number of factors have been identified in the current study that predict an increased likelihood of attempted suicide. The factors mainly revolve around loss: not financial loss, but rather disintegration of an individual’s support network and deterioration in the individual’s mental health. Findings indicate that isolation and negative affect associated with gambling are most influential in attempted suicide and should therefore be more strongly considered when creating and providing the legislative, educational and treatment environments for those experiencing gambling related harm.
Individual differences in learning during decision-making may predict specific harms associated with gambling
2020, Addictive Behaviors
Problem gambling has been linked to impairments in decision-making under uncertainty. Problem gamblers are more likely to favor high-risk, high-reward, and short-term gains over more advantageous choice alternatives, and this preference has been linked to impaired learning about decision outcomes. In this paper we link specific learning processes in decision-making to specific harms related to problem gambling. We asked a group of 140 casual gamblers to 1) perform a canonical decision-making task (the Iowa Gambling Task) online, and 2) to complete a self-report survey (the GamTest) designed to measure self-perceived harm caused by their gambling. We used a reinforcement learning model to explain individual differences in the decision task, and related individuals’ model parameters to the specific problem areas reported using the questionnaire. We found that people who learned more from gains than from losses on the task were more likely to report overall gambling problems, and problems specifically related to money. We also found that people whose learning was more driven by the frequency of rewards were more likely to report problems related to the amount of time spent gambling, as well as social problems. We discuss possible psychological and neural processes mediating learning and gambling related harms, and we discuss the relevance of our approach to the diagnosis of problem gambling and its consequences.
Gambling-related harms attributable to lotteries products
2020, Addictive Behaviors
Citation Excerpt :
Costes et al.’s (2018) two-country (France and Canada) study of gamblers who only use lotteries products found evidence of gambling-related harm, especially among participants who were male, younger, less educated, unemployed, of lower socio-economic status, excessive alcohol consumers, and illicit drug users. Some pathological gamblers cite their lottery and scratch ticket use as their primary reason for seeking help (Papoff & Norris, 2009; Sharman et al., 2019). The proportions and profiles of at-risk lotteries-only gamblers in Costes et al.’s (2018) study varied between Canada and France, highlighting the need to examine how issues resulting from these products differ between countries.
Lotteries products (lottery tickets and scratch tickets) are the most popular forms of gambling worldwide, however little research has investigated whether these products are associated with gambling-related harm. The limited available research suggests these products are linked to problematic gambling behaviors and a range of resulting negative outcomes, with certain sub-groups appearing to be more vulnerable to experiencing harms. The present study examined risk of gambling-related harm (measured by the Problem Gambling Severity Index) from lotteries products use in an Australian sample of lotteries-only gamblers (n = 540). Additionally, the study investigated whether risk varied according to a range of sociodemographic and behavioral characteristics (age, gender, household income, location (rural vs. metropolitan), employment status, alcohol consumption, smoking status, frequency of e-cigarette use, frequency of scratch ticket use, frequency of lottery ticket use, expenditure on scratch tickets, and expenditure on lottery tickets). Almost one-third of the sample was found to be at some level of gambling-related risk due to their use of lotteries products. Younger respondents, males, current smokers, e-cigarette users, and those who purchase scratch tickets more frequently were more likely to report problematic use of lotteries products. Policy makers should enact strategies to prevent and reduce harms resulting from lotteries products, especially among the identified at-risk groups.
Problem gambling and suicidality in England: secondary analysis of a representative cross-sectional survey
2020, Public Health
Citation Excerpt :
Problem gamblers who seek treatment have long been recognised as a high-risk group for suicidal ideation and behaviours.4,5 These associations have been replicated among treatment populations in various jurisdictions, including Spain, France, Britain, Sweden and America.6–11 While the factors that underpin these associations are poorly understood, some studies note a history of depression or anxiety disorder as a risk factor for suicidality among gamblers seeking treatment,6,10,7,12 pointing to a range of mechanisms that might explain this relationship.
Problem gamblers in treatment are known to be at high risk for suicidality, but few studies have examined if this is evident in community samples. Evidence is mixed on the extent to which an association between problem gambling and suicidality may be explained by psychiatric comorbidity. We tested whether they are associated after adjustment for co-occurring mental disorders and other factors.
Secondary analysis of the Adult Psychiatric Morbidity Survey 2007, a cross-sectional national probability sample survey of 7403 adults living in households in England.
Rates of suicidality in problem gamblers and the rest of the population were compared. A series of logistic regression models assessed the impact of adjustment on the relationship between problem gambling and suicidality.
Past year suicidality was reported in 19.2% of problem gamblers, compared with 4.4% in the rest of the population. Their unadjusted odds ratios (OR) of suicidality were 5.3 times higher. Odds attenuated but remained significant when depression and anxiety disorders, substance dependences, attention-deficit/hyperactivity disorder, and other factors were accounted for (adjusted OR = 2.9, 95% confidence interval = 1. 1, 8.1 P = 0.023).
Problem gamblers are a high-risk group for suicidality. This should be recognised in individual suicide prevention plans and local and national suicide prevention strategies. While some of this relationship is explained by other factors, a significant and substantial association between problem gambling and suicidality remains.

View all citing articles on Scopus

View full text

Trends and patterns in UK treatment seeking gamblers: 2000–2015

Highlights

Abstract

Background and aims

Methods

Results

Discussion and conclusions

Introduction

Section snippets

Participants

Forms of gambling

Discussion

Conclusions

Acknowledgment

Comprehensive Psychiatry

Clinical Psychology Review

Australian and New Zealand Journal of Public Health

Addictive Behaviors

Gambling and substance use: Co-occurrence among adults in a recent general population study in the United States

International Gambling Studies

Suicide ideation and behaviour in people with pathological gambling attending a treatment service

International Journal of Mental Health and Addiction

All-in and bad beat: Professional poker players and pathological gambling

International Journal of Mental Health and Addiction

Frequency, duration and medium of advertisements for gambling and other risky products in commercial and public service broadcasts of English Premier League football

Gambling adverts feature in 95% of all televised football matches, researchers find

Gambling behaviour in Great Britain in 2015: Evidence from England, Scotland and Wales

Problem gambling in the UK: Implications for health, psychosocial adjustment and health care utilization

European Addiction Research

Taking chances: Problem gamblers and mental health disorders--results from the St. Louis Epidemiologic Catchment Area Study

American Journal of Public Health

UK Chief Medical Officers' Low Risk Drinking guidelines

The Canadian problem gambling index

The rise of internet gambling and its impact on addictive disorders

InPsych: The Bulletin of the Australian Psychological Society Ltd

Online poker gambling in university students: Further findings from an online survey

International Journal of Mental Health and Addiction

The impact of speed of play in gambling on psychological and behavioural factors: a critical review

Journal of gambling studies

Sports-embedded gambling promotions: A study of exposure, sports betting intention and problem gambling amongst adults

International Journal of Mental Health and Addiction

Bet anywhere, anytime: An analysis of internet sports bettors' responses to gambling promotions during sports broadcasts by problem gambling severity

Journal of Gambling Studies