Health 13 May 2019 Tom Watson: gambling may become a “public health emergency” The deputy Labour leader and gambling experts give their take on the industry that has created nearly half a million addicts. Getty Sign UpGet the New Statesman's Morning Call email. Sign-up Problem gambling, according the Labour Party’s deputy leader Tom Watson, represents a “hidden epidemic” in the United Kingdom. A report from the government’s Gambling Commission estimates that there are 373,000 people with an addiction to gambling in England, 30,000 in Scotland and 27,000 in Wales, with a further 2m people across these regions at risk of developing one. “This is a public health issue,” Watson warns. “We need far more research into problem gambling, and far more specialist treatment for an addiction that ruins lives.” The Institute for Public Policy Research’s Cards on the Table review found that nearly three quarters (73 per cent) of the UK’s adult population gamble to some degree. And the IPPR’s study into the cost of problem gambling to the UK’s overall economy highlights hospital inpatient services (up to £610m); mental health treatments including prescription medication and therapies (up to £150m); Jobseeker’s Allowance claims and lost tax receipts (up to £160m); gambling-related incarcerations (up to £190m); and statutory homelessness applications (up to £60m) as the most significant factors in an issue that it says could cost the UK up to £1.2bn per year. Professor Mark Griffiths, a chartered psychologist and director of the International Gaming Research Unit at Nottingham Trent University, says gambling should be viewed “in the same way you would any other social drug”, because it is a “mood modifier, much like alcohol”. Like alcohol, gambling offers “an opportunity to spend time with friends”, alongside its recreational appeal. “People might like the idea of an ostensibly inexpensive amount of money being turned into a life-changing sum” in games such as the National Lottery, he observes, and this type of gambling, “if contained and controlled responsibly, can be a perfectly legitimate form of leisure or entertainment. The problems start when it can’t be controlled and the urge to gamble starts to supersede everything else in someone’s life.” Watson has been, along with the shadow health secretary Jonathan Ashworth, one of the more vocal advocates of Labour’s policy on gambling. He says that the UK is struggling with a “culture” that risks exacerbating the rates of addiction, particularly as internet-based betting makes it faster and simpler to bet than ever before. Earlier this year, Watson suggested that current UK gambling laws were “unfit for the digital age” and highlighted the lack of regulation relating to gambling companies online. He has promised that under a Labour government, stricter limits would be placed on the stakes that online betters are able to make, and called for a limit on the speed at which games are allowed to be played. Griffiths explains why speed, as a “structural characteristic” of certain forms of gambling, can make a game more or less addictive. “I’ve never met anyone who’s addicted to a bi-weekly national lottery game,” he says, “but with slot machines, you might complete 12 games a minute. That’s not to say that lotteries are non-problematic. I could create a slot machine that limits you to bi-weekly plays, or I could create a lottery product that was run every two minutes. High-speed, high-frequency events are structurally problematic and more likely to be addictive.” Watson adds that the gambling industry must also face more robust regulation when it comes to advertising, especially around betting on sports. “We are bombarded by gambling adverts that tell us that we can’t enjoy football, for example, without betting some money. As new technologies emerge, so do new forms of gambling that are highly sophisticated, probably addictive, and often unregulated.” Griffiths points to the advent of “in-play” betting – opportunities to bet on a sports event while it is happening, on a gambling website or app – as one of the technological catalysts for more problem gambling. “In the past, betting on sport was structurally discontinuous. Now it’s different; you’re not waiting for the football results to come in on a Saturday afternoon. In-play betting means that every game has something like 70 different markets going on at any one time [including next goal scorer or correct score line, for example].” Dr Henrietta Bowden-Jones, the founder and director of the National Problem Gambling Clinic in Kensington, says that problem gambling is a “mental health problem in its own right”, but that it also has a correlative relationship with other conditions, such as stress, depression and anxiety. “We call this bi-directionality,” she explains. “It means that someone who suffers from an addiction to gambling could be more prone to suffering from other mental health conditions and someone with pre-existing depression or anxiety is more prone to becoming addicted to gambling.” According to the charity Gambling with Lives, between four and 11 per cent of UK suicides each year can be related to gambling addiction. Bowden-Jones, a psychiatrist who previously focused on alcohol and drug dependency, founded the NHS’s first, and currently only, specialist gambling clinic in 2008, with funding from the charity Gamble Aware and overseen by the Central and North West London NHS Foundation Trust. A second clinic, in Yorkshire, is due to open later this year. “I think that’s a sign that there is a national awareness and a growing acknowledgement that we need to treat gambling harm seriously.” In treating problem gambling, Bowden-Jones says that “abstinence” should be the end goal. “There is no way that a pathological gambler is going to be able to gamble responsibly. I think you’d find that is viewed as a universal truth amongst most psychologists. You could compare the situation to someone with alcohol dependency; they’ll never really feel comfortable drinking in moderation because they’ll always be on edge.” The clinic, Bowden-Jones says, offers a “range of services”, including cognitive behaviour therapies, psychological assessments and education-based lifestyle training. “There are lots of different pathways to gambling addiction. We try and get to the root cause of a patient’s problem… we explore the triggers and causes, which could include a childhood trauma. A classic example would be the death of a parent, which might have left someone with a pressure to provide [money for the rest of their family]. As for lifestyle changes, we can introduce patients to ways of controlling external stimuli. This could include blocking gambling companies’ apps from their online banking accounts. I know that Monzo and Starling offer this service. There’s software called ‘gamban’, which blocks access to all gambling-related apps on a given device.” For patients who do not respond well to therapies, the clinic has prescribed drugs that suppress cravings, such as naltrexone, though Bowden-Jones clarifies that medication is considered a “last resort” when other interventions are not successful. Patients at the clinic exist on a scale, she says, but all could be considered to have “serious” problems with gambling. “One of my patients lost £3m recently through gambling. I treat people who are gambling up to ten times their annual income.” All things considered, does the prevalence of problem gambling strengthen the case for prohibition? Mark Griffiths, who describes himself a “recreational gambler”, worries that such an extreme measure could “create more problems than it solves” in terms of crime rates, and would ignore the gambling industry’s contributions to employment and tax revenue. The Gambling Commission claims that over 100,000 people work in the UK’s gambling industry, and that HMRC took nearly £3bn in betting and gaming tax receipts in the last financial year. Nevertheless, gambling’s health risks cannot be overlooked. “I’m pro-responsible gambling,” Griffiths says, “but we need to have the infrastructure in place that helps the casualties of when there is overspill.” So, who’s footing the bill? “The NHS,” Griffiths admits, “has a great many things to worry about beyond problem gambling. I’m in favour of gambling companies leading by example. They should have a duty of care to their customers. I’m in favour of health warnings on gambling products. I think gambling companies should be paying [into a central pot] to fund the treatments and services that deal with the casualties of the industry. And if you can’t adequately exercise your duty of care to your customers, you should lose your operating license.” Bowden-Jones also favours tighter regulation over prohibition, and feels that the gambling industry should be more “proactive” in protecting its customers. She suggests that a more “interventionist” use of “data science” could help companies to keep a better track of people who were betting beyond their means. “I think if gambling companies have a record of their customers’ ages, their incomes, the frequency with which they are betting and how much they are betting, then they should take the steps to intervene when it’s necessary.” Ben Wright, Sky Betting and Gaming’s head of safer gambling, says the more established bookmakers – Sky has around 2m UK customers – are already taking these precautions. Sky, Wright says, has developed an “interaction strategy”, which uses technology to intervene “at scale across all of our products” to reduce the risk of problematic behaviour. “We do not want to generate any revenue from someone with a gambling problem. If we have concerns about a customer’s patterns of play, based on their data, then we contact them to discuss this. If we are unable to make contact with a customer, where we have concerns, we freeze their account until they have spoken to a trained member of our customer care team. In addition, we have significantly improved our range of simple-to-use and effective player protection tools such as ‘cool-off periods’, deposit limits and a profit and loss tool which allows customers to be kept informed of their betting balance and spend over a period of time they choose.” Gambling companies in the UK already pay a voluntary £10m per year levy to help fund the Gamble Aware charity and its activities, but this figure is dwarfed by the £1.5bn annually that they spend on advertising. Research by the firm Regulus Partners found that gambling companies spent roughly £747m on direct online marketing in 2018, £301m on “affiliate” media such as tipster websites, £149m on social media and £234m on televised ads. “While £10m paid into the levy is a lot,” Bowden-Jones says, “it could definitely stand to be more. There are nearly half a million people suffering from problem gambling in the UK, but only around 8,000 are seeking treatment at any one time… funding is a big part of the reason for that.” Tom Watson says that problem gambling risks becoming a “public health emergency” without action. The 2005 Gambling Act, he points out, “has more mentions of the postal service than it does of the internet” as he underscores the need for modernised legislation. Labour’s plans, as laid out in the party’s Gambling Review last year, include a “whistle-to-whistle” ban on advertising betting during live sport and a ban on using credit cards to place stakes in person or online. “The UK needs new gambling legislation,” Watson says firmly, “that can curb the worst excesses of the industry and, importantly, keep pace with innovation.” › The US-China trade war is another sign that protectionism is here to stay Rohan Banerjee is a Special Projects Writer at the New Statesman. 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