The United Kingdom’s National Institute for Health and Care Excellence (NICE) has issued clinical guidelines on gambling-related harms, urging GPs and social care practitioners to ask patients about their gambling habits routinely.
Should the recommendations be adopted in practice, it would see gambling addiction screening aligned with checks for smoking and alcohol consumption in the UK.
The NICE guidelines recommend that GPs and social care professionals “consider asking people about gambling” even if they have no apparent risk factors for gambling-related harm when asking about smoking, alcohol, or the use of other substances. The questions could come as part of a complete health assessment or when registering for a GP or social services.
NICE’s Gambling Screening Guidelines: Who Will Be Asked?
The language changes from ‘consider asking’ to ‘ask’ when assessing certain people, as under the guidelines, they ‘may be at increased risk of gambling-related harm.’
The guidelines outline the following situations in which people will be asked:
- Patients with a mental health problem or concern, in particular thoughts about self-harm or suicide, depression, anxiety, psychosis and bipolar disorder, post-traumatic stress disorder (PTSD), personality disorder or attention deficit hyperactivity disorder (ADHD);
- When a patient is taking medication that may impact impulse control. Examples provided in the guidelines include dopamine agonists for Parkinson’s disease and aripiprazole for psychosis;
- At each contact with the criminal justice system, including but not limited to police, probation services, courts, prisons, and liaison and diversion services;
- People presented in any setting with problems relating to alcohol or substance dependence, with specific mention of cocaine use;
- When a person is at risk or is experiencing homelessness;
- When concerns over financial stability are expressed;
- Where there are concerns around safeguarding issues or violence, with specific mention of domestic abuse;
- If a professional is made aware of a family history of gambling-related harm or alcohol and substance dependence.
It offers more lenient language around young people who have recently left home for the first time, people with a neurological condition or acquired brain injury that leads to increased impulsivity, and those who have formerly worked in the armed forces or gambling and financial industry and sports professionals. The groups mentioned above ‘may be at increased risk of harm.’
The guidelines also ask healthcare professionals to take into account that ticking multiple ‘at risk’ boxes can have a cumulative effect and make it significantly more likely that someone will experience gambling-related harm.
Professionals are told to use direct questions to ask people about gambling and to be aware that some people ‘may find it difficult’ to speak about the topic. Guidelines suggest using questions such as “Do you gamble?” and “Are you worried about your own or another person’s gambling?”
How Will Healthcare Professionals Screen for Gambling Addiction?
Anyone with concerns about gambling will be encouraged to complete the Problem Gambling Severity Index (PGSI) questionnaire available on the NHS website, which will be used to evaluate the severity of the gambling-induced harm. Those who score above eight will be advised to seek specialist gambling treatment services, while professionals are free to recommend support intervention where considered pertinent.
NICE’s chief medical officer, Professor Jonathan Benger, commented. “Gambling-related harm has a devastating impact on those who experience it and the people close to them. Our useful and usable guideline will help healthcare professionals and others to identify those needing help earlier and ensure they get the treatment and support they need.”
Baroness Fiona Twycross, Minister for Gambling, welcomed NICE’s guidelines, stating, “This guidance will support those experiencing harmful gambling to get access to the right support. We know that clinical treatment is not necessarily right for everyone, but it is important that there is a full spectrum of support as we strengthen treatment options.”
The 2023 Gambling Survey for Great Britain found that 2.5% of the adults surveyed were classified as problem gamblers (PGSI score of 8+), while 12% were at an elevated risk of harm (PGSI score 1–7).
Baroness Twycross continued, “The Government’s plans to introduce a statutory levy, which will generate £100 million each year, will provide the investment needed to further expand the support and treatment on offer for those in need.”
