- Kishan Patel
Gambling research, education, and treatment
Updated: Feb 11
Donations to gambling-harm research, education, and treatment efforts are made voluntarily. RET funding targets are currently based on an arbitrary percentage of net losses, and minimum funding targets have been consistently missed. Some operators have maintained their status as voluntary contributors in reducing and preventing gambling harm by donating as little as £5 across a year. Therefore, unsurprisingly, UK RET funding is also drastically lower than countries, including Canada, New Zealand, and Australia, that hold a public health approach to preventing gambling harm. Chronic underfunding and a lack of independence from the industry have meant that steps to tackle and prevent gambling harm have been woefully limited. Firstly, there is a lack of understanding of the significance of gambling harms on the population's health.
Additionally, there is an absence of dedicated studies, education, and treatment efforts to prevent and tackle disproportionate gambling harm in ethnic minority communities. At the time of writing, gambling-harm is also poorly recognised in health and social care, with gambling absent from guidelines and curriculums for health care professionals. Lastly, current safer gambling initiatives place the onus on the customer and are widely criticised as thin-veiled attempts to advertise brands.
Investment into gambling-harm research, education, and treatment (RET) is currently made voluntarily. At present, minimum funding targets are not set on need and are based on an arbitrary percentage of net losses. However, due to donations' voluntary nature, the minimum funding targets have been missed for the past two consecutive years. Meanwhile, operators have maintained their status as voluntary contributors to RET efforts by donating as little as £5 across a period of 12 months.
RET funding in the UK is significantly lower than in other countries where a public health approach to gambling harm has been enacted. Notably, RET funding shortfalls reflect a disparity between the industry’s purported commitments to reducing gambling harm and their lack of actions in delivering meaningful change. Moreover, some of the more substantially funded RET initiatives have been criticised for industry ties and a lack of independent and critical evaluations evidencing their effectiveness.
The UK is relatively far behind in terms of research into gambling-related harms relative to some other countries. Research evaluating the significance of harm to health on the UK population through measurements of disability-adjusted life years, and studies measuring the costs of impact, are desperately needed as part of a public-health approach. Despite being the primary funding source of research, the industry has created an atmosphere of doubt and regularly calls for more research.
For over a decade now, research has consistently reflected that individuals from ethnic minority backgrounds are several times more likely to be affected by gambling harm. However, dedicated studies to explore this phenomenon further have been limited and largely absent. Furthermore, treatment statistics reflect that individuals from ethnic minority backgrounds are far less likely to receive specialist help and support. Similarly, despite significant evidence of the effect of gambling-harm on health, gambling is yet to feature in medical education curriculums for medical students, speciality curriculums for Psychiatry and General Practice, or NICE guidelines for health care practitioners. Instead, gambling-harm specialist services reach a fraction of the harmed population, which is relatively far fewer than the results achieved by substance use treatment services.
Gambling education was recently introduced into the PSHE statutory guidance; however, the framework does not apply to independent schools and is only statutory for years 10 and 11. Additionally, gambling features as one of the learning objectives in "internet safety and harms" contrastingly, "drugs, alcohol, and tobacco" are covered as a separate topic with their distinct learning objectives.
Safer gambling initiatives and awareness campaigns organised or funded by the industry place the onus for safe gambling on the consumer. Such campaigns are in stark contrast to the evidence, which reflects a significant genetic component to addiction. Thus, responsible gambling messages have been widely criticised as being thinly veiled advertisements.
What is known?
Research, Education, and Treatment spending and investment
Research, Education, and Treatment (RET) spending in Great Britain is comparable to that of some states in the US, and is relatively a fraction of what is spent in Canada, Australia, and New Zealand
GambleAware (the charity responsible for managing and distributing RET efforts and funding in Great Britain) asks all those who profit from the gambling industry in Great Britain to donate a minimum of 0.1% of their annual Gross Gambling Yield (GGY) directly to GambleAware
2017 - 2018: 0.07% (£9.5m/£14.4bn) 73
2018 - 2019: 0.07% (£9.6m/£14.3bn) 74
2019 - 2020: 0.07% (£10.1m/£14.2bn) 75
A review by the Gambling Commission in 2018, which drew on input from GambleAware and the Advisory Board for Safer Gambling (RSGB), reported that hypothetical RET scenarios could cost between £21.5m to £67.0m 76
The Gambling Commission compared RET spending in Great Britain with other countries in 2018 76
RET Spend (£m)
Number of individuals with a GD
RET spend per GD (£)
Nova Scotia Scotia
Prince Edward Island
New South Wales
Specialist treatment services
Source of referrals into treatment services
Self, family, and friends: 92%
Health services and social care: 3%
Criminal justice: 1%
Substance misuse services: 0%
Alcohol only 78
Self, family, and friends: 66%
Health services and social care: 22%
Criminal justice: 6%
Substance misuse services: 3%
Non-opiate and alcohol 78
Self, family, and friends: 64%
Health services and social care: 17%
Criminal justice: 10%
Substance misuse services: 3%
Non-opiate only 78
Self, family, and friends: 66%
Health services and social care: 15%
Criminal justice: 10
Substance misuse services: 2%
Opiate only 78
Self, family, and friends: 56%
Health services and social care: 9%
Criminal justice: 25%
Substance misuse services: 7%
Percentage of populations reached by National Gambling Treatment Services 77
0.02% of individuals who gamble and suffer low-risk harm
0.03% of affected others completed treatment
0.30% of individuals who gamble and suffer moderate-risk harm
1.00% of individuals who gamble and suffer gambling disorder harm in Great Britain completed treatment
Disproportionately affected population groups 79
Observed = % of population receiving treatment in 2019/20, Expected = % of population affected by gambling disorder harms from the last British Gambling Prevalence Study)
16-24 year olds: Observed: 11% & Expected: 30%
25-34 year olds: Observed: 42% & Expected: 26%
White: Observed: 89% & Expected: 66%
Asian or Asian British: Observed: 5% & Expected: 19%
Black or Black British: Observed: 3% & Expected: 9%
Other: Observed: 3% & Expected: 7%
Research gaps in the literature
Population health measures of loss of healthy life have never been conducted in the GB population (discussed in more detail in chapter 1: gambling and health)
Prevalence of affected other harms were not measured at all prior to 2019
Great Britain has only had one cost of impact studies, and this has been limited to some of the direct costs to the government.
Cost of impact studies for gambling disorder gambling in Sweden and Czech Republic have reported that costs are approximately twice the amount of tax revenue generated 80, 81
The last gold-standard prevalence study was conducted in 2010
The only dedicated quantitative study of gambling-harm in ethnic minority communities was published in 2020 using secondary data following a consistent picture of disproportionate harms in ethnic minority communities across prevalence studies since 2007 82, 83
Out of 116 registered clinical studies, only one is in the UK 84
The Adult Psychiatry Morbidity Survey (APMS) 2014 omitted gambling despite finding a significant relationship between gambling and suicidal harm in 2007
Gambling Commission spending on prevalence studies research 86–94
2009/10: < £446,000
2010/11: < £368,000
Issues with education
PSHE Curriculum (updated September 2020 to include gambling) 94
Internet safety and harms
the similarities and differences between the online world and the physical world, including: the impact of unhealthy or obsessive comparison with others online (including through setting unrealistic expectations for body image), how people may curate a specific image of their life online, over-reliance on online relationships including social media, the risks related to online gambling including the accumulation of debt, how advertising and information is targeted at them and how to be a discerning consumer of information online.
how to identify harmful behaviours online (including bullying, abuse or harassment) and how to report, or find support, if they have been affected by those behaviours.
Drugs, alcohol and tobacco
the facts about legal and illegal drugs and their associated risks, including
the link between drug use, and the associated risks, including the link to
serious mental health conditions.
the law relating to the supply and possession of illegal substances.
the physical and psychological risks associated with alcohol consumption and what constitutes low risk alcohol consumption in adulthood.
the physical and psychological consequences of addiction, including alcohol dependency.
awareness of the dangers of drugs which are prescribed but still present serious health risks.
the facts about the harms from smoking tobacco (particularly the link to lung cancer), the benefits of quitting and how to access support to do so.
What the industry said?
Betting and Gaming Council 36
“Importantly, the largest BGC members are committing an additional £100 million to research, education and treatment (RET) over the next four years.”
The BGC announced a voluntary commitment to increase RET funding following calls for a statutory levy that would mean independence between the industry and prevention and treatment efforts. At the end of the four years, funding will increase ten-fold, demonstrated the industry’s ability to fund RET despite it chronically underfunding it for several years. This voluntary commitment also signals the industry’s acceptance that existing RET measures are insufficient.
Initially, the funds were to be allocated to Action Against Gambling Harms. However, with little notice, the BGC revoked this and instead changed the recipient to GambleAware. Researchers have stressed their concerns to decision-makers and highlighted the need for a levy that funds prevention and treatment while being free from real or perceived industry influence. The researchers also reflected that the unilateral decision-making in funding allocations is one way of the industry exerting influence. 95
Peter Jackson, CEO of Flutter Entertainment PLC 96
“GambleAware has a long track record in commissioning treatment services and working with providers for the benefit of problem gamblers. Through the provision of this unprecedented level of financial support, we aim to achieve a step-change in the treatment and counselling available to those experiencing gambling-related harm.
Through the provision of this unprecedented level of financial support, we aim to achieve a step-change in the treatment and counselling available to those experiencing gambling-related harm.”
Jackson focusses on the need for a step-change in treatment services, implying that most of the incoming funds for RET will be spend on treatment. Worryingly, public health monitoring of gambling-harm is still limited to counting the numbers of individuals affected in the past-year. To allow gambling-harm to be considered in the context of other issues and for efforts to tackle gambling-harm to be monitored appropriately, there is a desperate need for research that evaluates the significance of harms instead of simply the numbers affected.
Nigel Huddleston, Minister for Sport, Tourism and Heritage 97
“We have been clear that the gambling industry has a responsibility to protect people from gambling-related harm and support those who have been affected. I welcome the Betting and Gaming Council now outlining how it will deliver on leading operators’ pledges to bolster research, education and treatment. We will monitor closely the progress of these new measures and continue to encourage the wider industry to step up”
Huddleston reports on the industry's need to keep up with the Gambling Commission’s licensing objectives and reflects trust that the industry will now tackle and prevent gambling-harm voluntarily.
Betting and Gaming Council 16
“The vast majority of gambling activity in Great Britain is carried out in a fair and transparent fashion”…”most people who gamble in this country do so with companies licensed by the regulator.”
The BGC take the minority view as only about a third of the population agree that gambling is carried out in a fair and transparent fashion.
Ian Proctor, Chairman of Flutter UK & Ireland 98
“We believe the way forward is taking a risk-based approach founded on evidence. This means not considering affordability in isolation, but in the context of many other data points including frequency of bets and deposits, personal circumstances, time, products used and, crucially, changes in usual patterns of behaviour for each customer. When all these inputs are considered together, we can take an impactful approach to player protection.”
Proctor identifies the need to be evidence-led and for affordability to be judged alongside other data points, implying that such basic measures are not utilised already in player protection.
Responsible Gambling Fund 99
“RGF said the funding partnership with the Great Foundation was unworkable thanks to increasing interference from gambling industry stakeholders pressuring the Great Foundation as to how to spend the money. A spokesman for the RGF said the gambling industry “has much stronger interest in funding treatment than it does in funding research”.
The RGF reported that the industry had a substantial interest to interfere and disrupt RET efforts.
Martin Lycka, Senior VP of US Regulatory Affairs & Responsible Gambling at Entain Group 100
“Our approach, Advanced Responsibility and Care (ARC), will combine the best academic research and life experience with industry-leading data science and AI to create what we believe is the first pro and personalised approach to player protection. And we'll be trialling this in the UK this summer.”
Lycka associates the ARC with academic research and other technologies to suggest that emerging player protections efforts will be more meaningful.
73. GambleAware. Annual Review 2016/17. 2017. Available from: https://about.gambleaware.org/media/1628/gambleaware-annual-review-2016-17.pdf [Accessed: 9th November 2019]
74. BeGambleAware. 2018/19 supporters. Available from: https://www.begambleaware.org/201819-supporters [Accessed: 30th March 2021]
75. BeGambleAware. 2019/20 supporters. Available from: https://www.begambleaware.org/201920-supporters [Accessed: 30th March 2021]
76. Gambling Commission. Reviewing the research, education and treatment (RET) arrangements. Gambling Commission; 2018. Available from: https://www.gamblingcommission.gov.uk/PDF/Review-of-RET-arrangements-February-2018.pdf [Accessed 31st March 2021]
77. GambleAware. Annual Statistics from the National Gambling Treatment Service (Great Britain). GambleAware. 2020.
78. Public Health England. Adult substance misuse treatment statistics 2019 to 2020: report. GOV.UK; 2020.
79. Gambling Harm UK. Treatment Statistics from 2018-2020 in context. Available from: https://www.gamblingharm.com/post/treatment-statistics-in-context [Accessed: 31st March 2021]
80. Hofmarcher T, Romild U, Spångberg J, Persson U, Håkansson A. The societal costs of problem gambling in Sweden. BMC Public Health. 2020;20(1): 1921. Available from: doi:10.1186/s12889-020-10008-9
81. Winkler P, Bejdová M, Csémy L, Weissová A. Social Costs of Gambling in the Czech Republic 2012. Journal of Gambling Studies. 2017;33(4): 1293–1310. Available from: doi:10.1007/s10899-016-9660-4
82. Gunstone B, Gosschalk K. Gambling among adults from Black, Asian and Minority Ethnic communities: a secondary data analysis of the Gambling Treatment and Support study. GambleAware; 2019.
83. Gambling Harm UK. Gambling in BAME & Risk Factors. Available from: https://www.gamblingharm.com/post/gambling-in-bame-and-other-risk-factors [Accessed: 31st March 2021]
84. ClinicalTrials.gov. Search of: Gambling - List Results - ClinicalTrials.gov. Available from: https://clinicaltrials.gov/ct2/results?recrs=&cond=Gambling&term=&cntry=&state=&city=&dist= [Accessed: 31st March 2021]
85. Gambling Commission. Annual report and accounts 2009/10: keeping gambling fair and safe for all. 2010. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/247697/0199.pdf [Accessed: 25th March 2020]
86. Gambling Commission. Annual report and accounts 2010/11: keeping gambling fair and safe for all. 2011. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/247408/1115.pdf [Accessed: 25th March 2020]
87. Gambling Commission. Annual report and accounts 2011/12: keeping gambling fair and safe for all. 2012. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/247021/0253.pdf [Accessed: 25th March 2020]
88. Gambling Commission. Annual report and accounts 2012/13: keeping gambling fair and safe for all. 2013. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/246662/0344.pdf [Accessed: 25th March 2020]
89. Gambling Commission. Annual report and accounts 2013/14: keeping gambling fair and safe for all. 2014. Available from: https://www.gamblingcommission.gov.uk/PDF/Annual-report-and-accounts-2013-14.pdf [Accessed: 25th March 2020]
90. Gambling Commission. Annual report and accounts 2014/15: keeping gambling fair and safe for all. 2015. Available from: http://www.gamblingcommission.gov.uk/PDF/Annual-report-and-accounts-2014-15.pdf [Accessed: 25th March 2020]
91. Gambling Commission. Annual report and accounts 2015/16: keeping gambling fair and safe for all. 2016. Available from: http://www.gamblingcommission.gov.uk/PDF/Annual-report-and-accounts-2015-16.pdf [Accessed: 25th March 2020]
92. Gambling Commission. Annual report and accounts 2016/17: keeping gambling fair and safe for all. 2017. Available from: https://www.gamblingcommission.gov.uk/PDF/Annual-report-and-accounts-2016-2017.pdf [Accessed: 25th March 2020]
93. Gambling Commission. Annual report and accounts 2017/18: keeping gambling fair and safe for all. 2018. Available from: https://www.gamblingcommission.gov.uk/PDF/Annual-report-and-accounts-2017-2018.pdf [Accessed: 25th March 2020]
94. Department for Education. Relationships Education, Relationships and Sex Education and Health Education. Department for Education. 2019.
95. Wardle H, Banks J, Bebbington P, Blank L, Bowden Jones Obe H, Bramley S, et al. Open letter from UK based academic scientists to the secretaries of state for digital, culture, media and sport and for health and social care regarding the need for independent funding for the prevention and treatment of gambling harms. [Online] The BMJ. BMJ Publishing Group; 2020. Available from: doi:10.1136/bmj.m2613
96. Betting & Gaming Council. Support for the Treatment of Gambling Harm. Available from: https://bettingandgamingcouncil.com/commitments/safer-gambling-increasing-support-for-the-treatment-of-gambling-harm [Accessed: 29th March 2021]
97. Betting & Gaming Council. COMMITMENT 2: Increasing support for the treatment of gambling harm. Available from: https://bettingandgamingcouncil.com/safer-gambling-initiatives/research-education-treatment [Accessed: 29th March 2021]
98. Proctor I. Flutter: Gambling industry is listening, and responding, to addiction concerns. CityAM. 12 February 2021. Available from: https://www.cityam.com/flutter-gambling-industry-is-listening-and-responding-to-addiction-concerns/ [Accessed: 29th March 2021]
99. Mason T. Gambling charities solve dispute by merging. Civil Society News. 15 December 2011. Available from: https://www.civilsociety.co.uk/news/gambling-charities-solve-dispute-by-merging.html [Accessed: 29th March 2021]
100. Lycka M. Martin Lycka: The age of responsible gambling. SBC Americas. 11 March 2021. Available from: https://sbcamericas.com/2021/03/11/martin-lycka-the-age-of-responsible-gambling/ [Accessed: 30th March 2021]