I spoke on BBC Radio Wales recently to discuss my former addiction to FOBTs. I was joined by ex-Wales international footballer John Hartson, who has shown considerable courage by telling the story of his addiction publicly. Hearing the stories of those that have become addicted to gambling has been crucial in challenging any prejudices people might have about gambling addiction.
The Diagnostic and Statistical Manual of Mental Disorders is a leading authority on the categorisation of mental illness. The latest edition, the DSM-V, put gambling addiction on a par with drug and alcohol addiction, as there are similarities in brain activity between gambling and cocaine use. Therefore, gambling addiction should be treated with the same urgency, particularly when it has the highest suicide rate of any addiction.
On BBC Radio Wales, I was asked what listeners should do if they thought they might have a gambling addiction. I said it is best to go to your GP and get referred to the National Problem Gambling Clinic if you’re in the London vicinity, which is an NHS-run, but industry-funded service. Alternatively, I suggested listeners are referred for Cognitive Behavioural Therapy (CBT) if London is too far to travel. CBT is the most effective treatment for gambling addiction, and is central to the treatment offered at the National Problem Gambling Clinic.
At this point, Mr. Hartson intervened and argued that a doctor cannot help you stop gambling, and that the best place for gambling addicts is Gamblers Anonymous (GA). I am very happy that GA is working for Mr. Hartson, but unfortunately the statistics do not reflect his enthusiasm for an approach which, unfortunately, is recognised as having limited efficacy. Professor Lance Dodes estimates that the “12 Steps” used by GA is effective for between just 5% and 8% of people – which is no better than the success rate for people who are able to quit on their own.
The 12 Steps were developed in 1935, when knowledge of the brain was very limited, and its path to recovery through abstinence has the potential to do more harm than good. Those who are addicted and abstain without psychiatric treatment are putting themselves at risk of a relapse, which would lead to even heavier gambling as a result. This is reinforced by the GA mantra of “one bet might as well be 100”.
Because of the lack of treatment provision available in the UK, GA is often the only option for gambling addicts. We are more likely to hear from someone who has been successful in their recovery, and like Mr. Hartson, attribute that to GA. But we rarely hear from those who are unsuccessful, and if we do the perception is that they have failed rather than the treatment has failed them. There is no one size fits all approach to treatment, everyone is different. But we know that CBT is effective, so it is scandalous that a country that has chosen to liberalise gambling to the extent of the UK has not met that with an adequate treatment infrastructure.
Treatment relies on industry-funding through the Responsible Gambling Trust, which supports just one National Problem Gambling Clinic, the Gordon Moody residential rehab centre with just 24 spaces a year, and GamCare, which pays their “trained counsellors” just £26 per patient.
GA says that if you’re addicted to gambling then it is because you are “an addict” and you must admit defeat. But gambling addiction, or gambling-related harm, is not binary – it is more of a spectrum. GA also fails to take into consideration the impact of certain gambling products and their accessibility on gambling related harm, which contemporary addiction science acknowledges has a role. GA attributes the blame for the addiction to the individual alone, and if they fail using the 12 Steps then it is because they are “incapable of being honest with themselves”.
So whilst it is important that we have an adequate treatment infrastructure in place that treats addicts medically rather than spiritually, it is also necessary to impose some restrictions on the most addictive gambling products like Fixed Odds Betting Terminals. Reducing the maximum stake from £100 a spin to £2 would limit the harm caused by this product by eliminating the addictive roulette content thereby reducing disordered gambling.