Gambling disorder

Gambling disorder is a repeated pattern of gambling behaviour where:

• someone feels they have lost control over gambling
• someone continues to gamble or increase how much they gamble despite negative consequences
• gambling takes priority over other interests or activities.

Gambling disorder is also sometimes called gambling addiction, problem gambling and compulsive gambling.

Gambling disorder can have a big impact on your personal and family life, your work and education, and the things you enjoy.

In the UK, gambling is a relatively common activity. Many people who gamble experience negative consequences from it, and find it difficult to keep their gambling under control.

Roughly 2-3 in every 100 people have gambling disorder. 8-12 in every 100 people gamble in ways that are either harmful or at risk of becoming harmful in the future.

There are many different types of gambling behaviours. For example, most people are aware of gambling through electronic gaming machines or slots, scratch cards, the lottery, on sports betting or on casino games. However, some people can also gamble through betting on investment products or spending money to gain rewards in mobile or online games.

Often people don’t recognise that these are also a type of gambling and struggle to acknowledge that they have lost control.

As with all mental health problems, there is not one clear cause of gambling disorder. There are biological, genetic, environmental, and psychological reasons why someone might develop a gambling disorder.

Risk factors

Anyone can develop a gambling disorder. However, we know that in some people the problem may be more likely to develop. Some factors that might make you more likely to develop a gambling disorder include:

• Gender – If you are a man, you are four times more likely to have a gambling disorder, although the rate of women with a gambling disorder is steadily rising.
• Ethnicity and race – If you are from a Black, Asian or minority ethnic background you are seven times more likely to have a gambling disorder.
• Family history – If someone in your family has a history of gambling disorder or other addictions, particularly if they are your parents.
• Personal history of gambling – If you experienced or witnessed a big win at a young age or early on in your gambling.
• Drugs and alcohol – If you drink heavily or use illegal drugs.
• Mental health – If you have other mental health conditions, such as a mood disorder, anxiety disorder, or other types of addiction, such as alcohol dependence or substance use disorders.
• Place of work – If you work in a gambling premises, such as a casino, betting shop or arcade.
• Financial difficulties – If you are struggling financially or are unemployed.
• Physical health – If you have physical health problems or multiple physical health conditions.
• Medication – If you are taking some types of medication for your physical or mental health that affect dopamine, a chemical in our brains. Examples of these medications include pramipexole, ropinirole, rotigotine and aripiprazole. These medications are used to treat conditions like Parkinson’s disease, schizophrenia and bipolar disorder.

There are many types of harms associated with gambling disorder, and these can vary from person to person. For example, people with gambling disorder are more likely than other people to experience the following harms:

Financial harms

These include:

• overdue utility bills
• borrowing from family, friends or loan sharks
• large debts
• pawning or selling possessions
• eviction or repossession
• loan defaults
• committing illegal acts like fraud, theft or embezzlement to finance gambling
• bankruptcy
• a poor credit history.

Family harms

These include:

• being so preoccupied with gambling that normal family life becomes difficult
• increased arguments over money and debts
• emotional and physical abuse or neglect towards loved ones
• relationship problems, and separation or divorce.

Health harms

These include:

• low self-esteem
• stress-related disorders
• anxiety, worry or mood swings
• poor sleep and appetite
• substance misuse
• depression
• suicidal thoughts and attempts.

School, college or work harms

These include:

• poor school, college or work performance
• difficulty maintaining a job
• missing days, calling in sick or struggling to focus on or complete tasks
• expulsion or dismissal.

If you recognise any of these harms in your own behaviour, you should try to seek help.

If you think you might have a gambling disorder, the best thing to do first is to get help. Once you have done this, you can work out whether you are ready to stop or want to learn to control your gambling instead. Many people who want to control their gambling later decide to stop completely when they start to seek support.

Controlling gambling can be hard. We know that once gambling becomes a problem for someone it can be hard for them to maintain control and not return to gambling problematically. This is similar to other addictive behaviours, such as alcohol or substance use disorders.

Cognitive Behavioural Therapy (CBT)

CBT is a type of talking therapy. It helps people manage their difficulties by supporting them to find more helpful ways of thinking and behaving.

Evidence shows that if you have a gambling disorder, you will often think differently from other people about gambling. You might believe that:

• you are more likely to win than other people
• in a game with random numbers, like roulette, certain numbers are more likely to come up than others
• winning twice in a row means that you are on a 'winning streak'
• you are more likely to win at a game of chance if you are familiar with it
• certain rituals can bring you luck
• having lost, you can win back your losses by gambling more.

Research has shown that CBT can help you find more helpful ways to think and behave. It can also get you to think about a life outside of gambling, and:

• reduce the number of days you spend gambling
• reduce the amount of money you lose and
• help you to stay away from gambling for longer once you have stopped.

CBT for gambling is typically provided over a number of sessions, either individually or in a group. In CBT, you will:

• learn strategies to reduce your opportunities to gamble
• manage your cravings and triggers
• challenge some of your gambling-related thoughts.

There are often tasks to complete in between the sessions to help build on the topics covered in therapy.

Therapy for gambling can include techniques such as:

• motivational interviewing - this helps people to identify and act on their own reasons for wishing to change
• imaginal desensitisation – this is a technique that involves individuals imagining being exposed to triggers for gambling, but not acting on them
• cognitive restructuring – this is a strategy to identify, evaluate, and modify inaccurate or otherwise unhelpful thinking associated with gambling.

Medication

Naltrexone is a type of medication commonly used to treat alcohol and opioid addiction. We now know that there is good evidence that it can be helpful in managing a gambling disorder. Naltrexone can be particularly helpful for people who:

• have tried psychological therapy previously but have been unable to stop gambling or
• still experience a strong urge to gamble or
• experience repeated relapses of gambling.

It can help people to reduce their gambling and to stay away from gambling. There are other medication options for gambling disorder, but naltrexone is the only one listed in current NICE guidelines. The NICE guidelines also have a link to the national prescribing guidelines for naltrexone in gambling disorder.

Medication for gambling disorder is typically started by a specialist, such as a consultant psychiatrist working in an NHS Gambling Treatment Service. GPs do not usually initiate naltrexone, but they may be able to take over monitoring and prescribing after the initial titration has been undertaken by the specialist and a safe and effective dose has been established. 

Other mental health conditions are common in people with a gambling disorder. If this is the case, medication such as antidepressants can be prescribed. Once the mental health condition is better managed, the gambling disorder can also improve.

Additional support

You may also need practical help, such as:

• managing your debts
• support from people who have themselves experienced gambling problems
• dealing with family problems or
• treating other psychological/psychiatric problems.

You might be able to get help for these things from your GP or from a voluntary or community organisation. 

About 1 in 3 people with a gambling disorder will recover on their own, without treatment. About 2 in 3 will continue to have problems, which tend to get worse.

There are many reasons why someone might not get help for their gambling disorder.

Often people with gambling disorders can struggle to recognise their gambling as a problem or may focus more on the positive aspects, such as winning money or socialising. Even if someone recognises their gambling as a problem, the following things might get in the way of them getting support:

• stigma
• being embarrassed
• not wanting others to find out
• being in debt and worrying about the consequences.

Women, people from poorer backgrounds and people from Black, Asian and minority ethnic backgrounds are thought to be less likely to seek support for their gambling disorder. Research suggests this can be due to:

• not knowing where to get support
• stigma
• the cost or time taken to access or travel to a treatment centre.

It is important to ask for professional help if you have a gambling disorder. In the meantime, here are some simple and practical measures to reduce gambling:

1. Limit the amount of money you spend gambling

• Set a limit from the start on how much you are willing to spend in a session or in a week, and stick to it.
• Leave credit/cash cards at home when you go out to gamble.
• Set withdrawal limits on your bank account.
• On pay day, aim to pay all your bills first or transfer money out of your account to a savings account.
• Sign up to a bank that offers a gambling block on your bank account, such as Barclays or Monzo.

2. Sign up to a self-exclusion service

When you have unlimited access to gambling services it is hard to resist the temptation to gamble. Online and in-person gambling services make it possible for people to block their access to gambling. Below are some examples:

Online
GAMSTOP – GAMSTOP lets you put controls in place to restrict your online gambling activities.

Gamban – Gamban helps you block access to online gambling on all your devices.

Betting shops
Multi-Operator Self-Exclusion Service (MOSES), Tel: 0800 294 2060 – MOSES allows people to self-exclude from betting shops.

Casinos
Self Enrolment National Self Exclusion scheme (SENSE) – SENSE allows people to self-exclude from casinos in the UK. You can also speak to the manager at your local casino.

Bingo
Bingo Association – The Bingo Industry Self-Exclusion Scheme allows people to self-exclude from bingo halls in the UK. You can also speak to the manager at your local bingo hall.

Arcades
You can call 020 7730 644 to self-exclude from amusement arcades or speak to the manager at your local arcade.

Lottery
National Lottery – The National Lottery offers ways to control your gambling, including limiting your spending and play, sessions reminders, and keeping track of or pausing your play.

You can also self-exclude from other local lottery services, such as the Postcode Lottery, which you can find out more about on their websites.

3. Reduce the amount of time that you gamble

• Set yourself a limit on how many times a week you will gamble.
• Avoid those "I'll just have a quick go" scenarios.
• Set an alarm on your watch or phone to remind you to stop.
• Walk away once you have reached your agreed time spent gambling.

4. Don't view gambling as a way of making money

• Always remember that you are buying entertainment.
• Always be prepared to lose. If you win, know that it will happen by chance.
• Never spend your savings or investments on gambling.
• Ask friends and family not to lend you money even if you ask them.

5. Spend time doing other activities

• Spend more quality time with family or friends.
• Take up a new hobby or interest, or revisit one that you enjoyed before gambling took over.
• Join a social group or organise events with friends who do not gamble.
• Talk to others about your worries or concerns.

Being close to someone with a gambling disorder can be very difficult. You might have lots of different feelings, including hurt, mistrust, sadness and worry about the future. You might have been financially impacted too and feel anxious about how to manage.

Depending on your relationship, conversations about gambling can feel tricky or unsafe. Sometimes the person you care about won’t want or be able to talk about how they are coping and whether they are still gambling. Or you might find that your feelings, for example anger, get in the way of having a helpful conversation.

If you know someone with a gambling disorder, you can:

• get help for your feelings and give yourself the opportunity to talk through the dilemmas you may be facing
• increase your knowledge of gambling and its treatment
• get support to think about the different ways of responding to the person you care about
• protect your finances and get support if you are struggling financially
• get support for other members of your family who might also be impacted, such as children.

By getting support for yourself, you will be in a better position to support the person in your life who is gambling. You might find it helpful to get support from:  

• peer support groups
• counselling sessions
• family support groups, which can offer information and be a way for you to get emotional and practical support
• family and couples therapy, to help you think about how your relationships have been affected and find a way forward.

Some of the services in the next section can offer support to people who know someone with a gambling disorder, as can some voluntary and community organisations. 

Do not wait until things get worse. By reaching out for help, you can take the first steps to managing your gambling and start to feel more in control.

The NHS Gambling Services can be accessed by anyone experiencing harm from gambling through self-referral, or referral by a health and care professional. This can be done through the services’ website links included below.

National Gambling Clinic – The National Gambling Clinic, established in 2008, supports people who are experiencing harm from gambling aged 13 to 18 years from anywhere in England, and 18 or over in London.

Northern Gambling Service – The Northern Gambling Service is an NHS service that offers specialist support to people with a gambling disorder, covering the North West, North East, and Yorkshire & Humber regions.

Southern Gambling Service – The Southern Gambling Service offers high quality assessment and evidence-based treatments for people with gambling-related harms or gambling disorder. The service is open to people aged 17 and older who live in or are registered with a GP in the South East of England.

West Midlands Gambling Harms Service – The West Midlands Gambling Harms Service provides specialist addiction therapy, treatment and recovery to people affected by gambling addiction and gambling problems across the West Midlands region.

East Midlands Gambling Harms Service – The East Midlands Gambling Harms Service provides specialist therapies, treatment and recovery to those affected by gambling addiction and gambling problems in the East Midlands region.

East of England Gambling Service – The East of England Gambling Service is an NHS service offering specialist treatment and support to individuals and families experiencing the negative impact of gambling in the East of England region.

South West Gambling Service – The South West Gambling Service provides free confidential specialist support to people living in the South West affected by gambling addiction.

Domestic violence resources

If you or someone you know is experiencing domestic violence as a result of a gambling disorder, or if you think your gambling is leading you to take part in abusive behaviours, here are some useful resources:

Respect Phoneline – Respect is a charity for people who think that they might be taking part in abusive behaviours and want to get help.

Domestic abuse: how to get help, Gov.uk – This website offers useful resources for people experiencing domestic violence across the UK.

Reporting child abuse, NSPCC – If you are concerned that a child is experiencing abuse or neglect, the NSPCC can provide you with advice. 

• Breaking Free: How To Stop Gambling by Henrietta Bowden-Jones
• Overcoming compulsive gambling by Alex Blaszczynski
• The Girl Gambler: A young woman's story of her escape from gambling addiction by Stacey Goodwin
• Tony 10: The astonishing story of the postman who gambled €10,000,000 … and lost it all by Declan Lynch and Tony O'Reilly

This information was produced by the Royal College of Psychiatrists’ Public Engagement Editorial Board (PEEB). It reflects the best available evidence at the time of writing.

Expert authors: Professor Henrietta Bowden–Jones OBE, Professor Sam Chamberlain, Jenny Cousins, Zoe Delaney, and Dr Konstantinos Ioannidis

Expert by experience: Owen Baily, Peer Support Worker at the National Problem Gambling Clinic.

Full references available on request.