Gambling: More than 'just a harmless flutter.’

‘Do you gamble?’ This is not a question that has been a routine part of my mental health consultations. Until recently, the sheer size and impact of problem gambling had completely gone under my radar. That has now changed having done some research for our Mental Health webinar earlier this month, and the publication of the new NICE guideline on gambling in January 2025 (NG 248). Reviewing this subject has been a real eye-opener for me, and has already changed my practice.

We summarise the NICE guidance, alongside practical resources for our patients who may be struggling with problem gambling, in the KISS below. But first, a few take-home points on this under-recognised issue:

1. Problem gambling is a big problem. Problem gambling and it’s related harms are common, significant, and generally under-recognised. The Gambling Survey of Great Britain found that 2.5% of adults participate in high risk gambling and a further 12% participate in gambling with an increased risk of harm. It is estimated that ~7% of people are (negatively) personally affected by others gambling. 
2. Beware industry influence. The fact that NICE in it’s guidance has had to stress the importance of giving ‘unbiased information’ on gambling tells you all you need to know…I cannot think of another NICE guideline that has had to do this. They note ‘The committee had concerns about the influence of the gambling industry on information provided to people experiencing gambling-related harms’. 
3. Stigma and shame. Gambling advertising is everywhere and gambling has been normalised within society as ‘a harmless bit of fun’. On top of this, industry influence has helped create the narrative that problem gambling is just seen in a very small minority of individuals who can’t control their addictive behaviour. This strategy is straight out of the oxycontin playbook with the message ‘our product is safe and it’s the individuals fault if they get addicted’, where as we know many gambling products have deliberately developed highly addictive algorithms. These factors result in a sense of shame and stigma with problem gambling. NICE highlight in the very first sentence of their guideline that shame and stigma with problem gambling (more so than substance or alcohol misuse) is a major barrier to people seeking help. 
4. A hidden addiction. Unlike alcohol or drug abuse, problem gambling is something that people can often successfully hide without any objective signs.
5. If you don’t ask you won’t know. Given points 3 and 4, it is not surprising that NICE are quite clear with their recommendation that we need to ask directly and proactively about gambling. ‘Do you gamble’ should become a routine question we ask, as we do with smoking, alcohol or drugs, particularly in the context of mental health problems. 
6. Be aware of the suicide risk. The Gambling Survey of Great Britain found that >10% of those that had gambled in the past 12 months had thoughts or attempts of suicide. Although the actual numbers of suicides from gambling are difficult to pin down, it is considered to be significant. We should ask about suicide risk at every opportunity.
7. Relapse is not a sign of failure. It’s really important we stress this when people are trying to tackle gambling and also be particularly aware of a heightened suicide risk if someone relapses into gambling after a period of abstinence. 
8. We can help. Whilst access to specialist treatment is still generally poor, there are loads of practical things we can recommend (e.g. blocking software for online gambling) and support services - see the KISS for more detail.