The recent article by Prof Henrietta Bowden-Jones OBE et al. (2022) provides a fundamental and comprehensive review of the needs for improving the knowledge of gambling disorder in the UK, although their recommendations could be extended to other countries.
Although gambling behavior without risk (recreational gambling) does not imply any affectation or impact on the functionality of the individual, it can become an addictive disorder with severe health consequences. From a recreational perspective, gambling can be considered a form of entertainment and a way of promoting social integration, in addition to the fact that it is a highly profitable business activity (especially in modalities such as online gambling).
Risk or problem gambling would imply the presence of behaviors that would cause some harm to the subject. However, when suffering from a Gambling Disorder (GD), gambling behaviour causes very significant disruptions in all the areas of the individual’s life (APA, 2013). GD has become part of the non-substance related addictive disorders in the DSM-5 (APA, 2013) and in the International Classification of Diseases (ICD-11; WHO, 2019), being the most prevalent behavioural addiction and the one that has generated more research.
From an epidemiological perspective, gambling has presented a very significant increase in Europe in the last decade, being one of the activities with the greatest expansion at the moment. Epidemiological studies show that rates of problem gambling in Europe range between 0.12-3.4% in adults (Calado & Griffiths, 2016), being even higher in the young population (0.2-12.3%) (Calado, Alexandre & Griffiths, 2017). This increase in gambling activity and, therefore, the increase of the harms associated with this behaviour have been related to the legalisation and popularisation of online gambling (Gainsbury et al., 2015; Mora-Salgueiro et al., 2021; Raybould et al., 2021).
Gambling activity has seen an important increase in Europe over the last decade, in particular among young people who often gamble online.
What do we know so far?
Although online gamblers appear to be a heterogeneous group, their profile tends to be male, young and single, with positive attitudes towards gambling and with several gambling preferences (i.e., preferences for different types of gambling and not just to one in particular). Likewise, it has also been observed that they present greater severity of gambling behavior (even if there is no coincidence between all the studies on this point), smoking, alcohol and substance use. However, although this would be the profile most frequently associated with online gambling, there are other highly vulnerable groups such as ethnic minorities, people with disadvantaged social and economic positions, people with low levels of education, women and elderly people, for whom gambling could be an escape mechanism to avoid negative emotions, feelings of loneliness and hopelessness in their lives (Hing et al., 2015; Castrén, Heiskanen, Salonen, 2018; Russell et al., 2021).
Online gambling is more prevalent among male, young and single individuals, but marginalised groups including ethnic minorities, people with socio-economic disadvantages and low educational level are also affected.
What is needed?
Both the characteristics described above and the potential damage associated with online gambling suggest the need to implement public health policies that control, protect and reduce the consequences of excessive gambling. Focusing efforts on preserving healthy habits related to gambling activity, as well as delving into the aetiology of the development of the disorder derived from it, are two fundamental research actions. Although there are currently still many aspects to be elucidated, several investigations have identified a series of risk factors associated with the appearance and maintenance of GD (Sharman et al., 2019). With a complex multifactorial aetiology, gambling disorder combines in its pathogenesis the interaction between biological (genetic, neuroendocrine, neuropsychological etc) and environmental (psychosocial, educational, social, cultural etc) factors. Its research, in association with the clinical (phenotypic) characteristics of the disorder, will allow a better understanding of the nosology of GD. This enables the development of diagnostic, prevention and treatment tools based on potential therapeutic targets, with the premise of promoting precision medicine.
We need to implement public health policies that control, protect and reduce the consequences of excessive gambling.
Illustrating research priorities in the gambling industry
Bowden-Jones et al. (2022) have published a public health piece, based on the consensus of a group of internationally recognised experts, many of whom belong to the National UK Research Network for Behavioural Addictions (NUK-BA), an organisation oriented to the promotion of knowledge and research in the field of behavioural addictions and also in gambling disorder. Thus, this article reviews the situation of GD in the UK and establishes the priority lines of research related to several aspects. The authors highlight the relatively limited research that has been carried out in the UK from the public health field and the interest to focus on research carried out in other countries. They also highlight the urgent need for the creation of research funds completely independent of the gambling industry.
This study reflects on the present and future of gambling activity in the UK, taking up the challenges that the scientific community must face in the field of behavioral addictions, but more specifically in the field of GD. Given the current situation, in which behavioral addictions have evolved over the last two decades, in terms of sociodemographic profiles, type of modalities (increasing through the Internet, especially during the pandemic), clinical characteristics (with progressively shorter evolutions), etc., it is of utmost importance to know where we are and where we are going in the field of GD.
This is the purpose of this consensus paper that portrays the current situation of gambling in the UK, highlighting the insufficiency of independent resources for research, the limitation of available care resources (in which evidence-based treatments are applied) and outlining the need to join efforts at international level to advance in priority lines of research.
Considering the current empirical evidence of GD there are many questions about the genetic, epigenetic, neurobiological, hormonal, psychological and social factors involved in the development and maintenance of the disorder. But we also do not know in depth the protective factors. In this way, what mechanisms contribute to maintaining gambling behaviour with control? What treatments are most effective? How can we improve the intervention programs (psychological, pharmacological, based on new technologies, etc.) that are currently available?
Thus, the authors of this interesting article defined several key research lines including the implementation of longitudinal studies on the prevalence of risk gambling and GD (especially in vulnerable populations), valid and reliable assessment instruments, identification of risk and protective predictors of GD in recreational gamblers, randomised controlled trials (RCTs) of psychological and psychopharmacological interventions, research on biomarkers (neurological and genetic) of GD and its relationship with impulsivity and compulsivity and the development of effective clinical evidence-based treatment guidelines. Indeed, the increase of knowledge in these fields will definitely help to provide better care for this devastating disorder.
Research can pave the way to develop appropriate and effective prevention and treatment tools for people who are at risk or are diagnosed with gambling disorder. What should be prioritised?
Links
Primary paper
Bowden-Jones, H., Hook, R.W., Grant, J.E., Ioannidis, K., Corazza, O., Fineberg, N.A., Singer, B.F., Roberts, A., Bethlehem, R., Dymond, S., Romero-Garcia, R., Robbins, T.W., Cortese, S., Thomas, S.A., Sahakian, B.J., Dowling, N.A., Chamberlain, S.R. (2022) Gambling disorder in the UK: key research priorities and the urgent need for independent research funding. Lancet Psychiatry. S2215-0366(21)00356-4. doi: 10.1016/S2215-0366(21)00356-4
Other references
American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders (5th edn) (DSM 5). (2013). American Psychiatric Association. Arlington, USA.
Calado, F., Griffiths, M.D. Problem gambling worldwide: An update and systematic review of empirical research (2016). Journal of Behavioral Addictions, 5(4), 592-613. doi: 10.1556/2006.5.2016.073.
Calado, F., Alexandre, J., Griffiths, M.D. (2017). Prevalence of Adolescent Problem Gambling: A Systematic Review of Recent Research. Journal of Gambling Studies, 33(2), 397-424. doi: 10.1007/s10899-016-9627-5.
Castrén, S., Heiskanen, M., Salonen, A.H. (2018). Trends in gambling participation and gambling severity among Finnish men and women: cross-sectional population surveys in 2007, 2010 and 2015. BMJ Open, 8(8):e022129. doi: 10.1136/bmjopen-2018-022129
Gainsbury, S.M. (2015). Online Gambling Addiction: the Relationship Between Internet Gambling and Disordered Gambling. Curr Addict Rep., 2(2), 185-193. doi: 10.1007/s40429-015-0057-8
Hing, N., Russell, A.M., Gainsbury, S.M., Blaszczynski, A. (2015). Characteristics and help-seeking behaviors of Internet gamblers based on most problematic mode of gambling. J Med Internet Res., 17(1), e13. doi: 10.2196/jmir.3781
Mora-Salgueiro, J., García-Estela, A., Hogg, B., et al. (2021). The Prevalence and Clinical and Sociodemographic Factors of Problem Online Gambling: A Systematic Review. Journal of Gambling Studies, 37(3), 899-926. doi: 10.1007/s10899-021-09999-w.
Raybould, J.N., Larkin, M., Tunney, R.J. (2021). Is there a health inequality in gambling related harms? A systematic review. BMC Public Health., 21(1)-305. doi: 10.1186/s12889-021-10337-3.
Russell, A.M.T, Browne, M., Hing, N., Visintin, T., Begg, S., Rawat, V., Rockloff, M. (2021).Stressful Life Events Precede Gambling Problems, and Continued Gambling Problems Exacerbate Stressful Life Events; A Life Course Calendar Study. J Gambl Stud. doi: 10.1007/s10899-021-10090-7.
Sharman, S., Butler, K., Roberts, A. (2019). Psychosocial risk factors in disordered gambling: A descriptive systematic overview of vulnerable populations. Addictive Behaviors, 99, 106071. doi: 10.1016/j.addbeh.2019.106071.
World Health Organization (WHO). (2019). International Classification of Diseases, 11th Revision (ICD-11). International Classification of Diseases 11th Revision (ICD-11).
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