A survey of 1,058 people attending GP clinics in Bristol, England, found that 0.9% were problem gamblers. That may not sound like much, but if you extrapolate that figure to the UK population, that’s around 600,000 people whose lives are blighted by this destructive addiction.
The survey also found that a further 4.3% had gambling problems that “were low to medium in severity”. That’s around 2.8m people potentially at risk of becoming problem gamblers.
This is a very big problem indeed – especially when you factor in the misery that it can inflict on their loved ones.
For many years, I have been arguing that GPs should be in the front line of screening people for gambling addiction. Back in 2004, I published an article in the BMJ arguing that the social and health costs of problem gambling are immense.
Personal costs can include irritability, extreme moodiness, problems with personal relationships (including divorce), absenteeism from work, neglect of family and bankruptcy. And health consequences for problem gamblers and their partners include depression, insomnia, intestinal disorders, migraine and other stress-related disorders.
In my BMJ article I also noted that analysis of calls to the GamCare, a national gambling helpline I co-founded, indicated that a small minority of callers reported health problems as a result of their gambling. These included depression, anxiety, stomach problems and thoughts of suicide. Clearly, many of these health issues are the consequence of the stress caused by gambling-related financial problems, but that doesn’t make it any less of a health issue for those suffering from severe gambling problems.
Research has also shown that health-related problems can occur as a result of withdrawal effects. For instance, one study found that at least 65% of pathological gamblers reported at least one physical side effect during withdrawal from a list that includes insomnia, headaches, loss of appetite, physical weakness, heart racing, muscle aches, breathing difficulty and chills.
Based on these findings, problem gambling is very much a health issue – and one which needs to be taken seriously by all medical professionals. GPs routinely ask patients about smoking cigarettes and drinking, but gambling is something that is not generally discussed.
Doctors need training in this problem
Problem gambling may be perceived as a grey area in healthcare, so it is very easy for medical professionals to overlook it. If the aim of GPs is to ensure the health of their patients, then an awareness of gambling and the issues surrounding it should be an important part of basic knowledge and should be taught in the curriculum while trainee doctors are at medical school. One of the reasons that GPs don’t routinely screen for problem gambling is because they are not taught about it during their medical training – as a result, it’s simply not on their radar.
As I recommended in a report commissioned by the British Medical Association, the need for education and training in the diagnosis, appropriate referral and effective treatment of gambling problems must be addressed within GP training. More specifically, GPs should be aware of the types of gambling and problem gambling, demographic and cultural differences, and the common health problems associated with problem gambling. GPs should also understand the importance of screening patients perceived to be at increased risk of gambling addiction. They should also be aware of the referral and support services available locally.
Still not listening
I also recommended that treatment for problem gambling should be provided under the NHS (either as standalone services or alongside drug and alcohol addiction services) and funded by a tax on gambling?. Back in 2011, I co-authored a study using freedom of information requests to ask NHS trusts whether they had ever treated pathological gamblers. Only 3% of the trusts had ever treated a problem gambler and only one trust said it had offered dedicated help and support. I’m sure if we repeated the study today, little will have changed.
It is evident that problem gambling is not, as yet, on the public health agenda in the UK. NHS services – including GP surgeries – need to be encouraged to see gambling problems as a primary reason for referral and a valid treatment option. Information about gambling addiction services, in particular services in the local area, should be readily available to gamblers and GP surgeries are a good outlet to advertise these services.
Although some gambling services (such as GamCare) provide information to problem gamblers about local services, this information is only provided to problem gamblers who have already been proactive in seeking help and information. Given that very few GPs have the specialist knowledge to treat a problem gambler, what they need most of all is the knowledge to refer their patients to someone who has.