The association between gambling and financial, social and health outcomes in big financial data

Cluster analysis based on gambling variables and mental health in a clinical population of gamblers

BACKGROUND

Interest in characterizing individuals involved in addictive behaviors has been growing, which allows tailoring prevention and intervention strategies to the gambler's needs. The study aimed to 1) identify clusters of gamblers according to gambling-related characteristics and mental health; and 2) analyze differences in psychological variables between the clusters.

METHODS

A total of 83 participants undergoing treatment for gambling disorder (Mage = 45.52, 51.8 % female) completed a set of questionnaires. Hierarchical cluster analysis was performed to classify gambling based on gambling variables (i.e., gambling severity and gambling motives) and mental health (i.e., depression, anxiety, and hostility). Several ANOVAs were conducted to illustrate the distinguishing features of each cluster, encompassing both the variables included in the cluster analysis and other relevant psychological variables.

RESULTS

Findings suggest that gamblers can be classified into three clusters based on these variables: 1) "high gambling severity and good mental health," 2) "high gambling severity and poor mental health," and 3) "low gambling severity and good mental health." These clusters were differentiated as a function of psychological variables, such as emotional dependence, alexithymia, and stressful life events.

CONCLUSIONS

Classifying gamblers according to their profile provides a better understanding of their needs and problems, allowing for a more tailored approach in terms of prevention and intervention strategies.

Beyond 'single customer view': Player tracking's potential role in understanding and reducing gambling-related harm

BACKGROUND

Usage of electronic gaming machines (EGMs) and on-line gambling is strongly associated with gambling-related harm. Player-tracking systems can monitor a gambler's activity across multiple sessions and/or operators, providing a clearer picture of the person's risk of harm with respect to these gambling formats and enabling harm reduction efforts. The Finnish and Norwegian state monopolies have player-tracking systems in place, while the United Kingdom is implementing an operator-led system called 'single customer view' for on-line gambling, and Australian states are proposing similar 'player cards' for land-based EGMs.

ARGUMENT

Player tracking can advance harm reduction efforts in three ways. First, player tracking improves our understanding of gambling-related harm by providing data on how the population gambles, which can potentially be linked with operator, government and/or prevalence data sets. Secondly, player tracking can be used to implement harm reduction measures such as expenditure limits, self-exclusion and age verification. Thirdly, player tracking can provide a platform to evaluate harm reduction measures via gold-standard field trials. These potential benefits need to be weighed against various practical and ethical issues.

CONCLUSIONS

The potential benefits of player-tracking systems would be maximized via systems administered independently of the gambling industry and implemented universally across all gambling in a given jurisdiction.

Prevalence and Clinical Characteristics of Recreational and At-Risk/Problematic Gambling Among Low-Income U.S. Veterans: Results from the National Veteran Homeless and Other Poverty Experiences (NV-HOPE) Study

This study examined associations between recreational gambling (RG) and at-risk/problem gambling (ARPG), and clinical measures of mental illness and substance use, functionality, homelessness, in a nationally representative sample of U.S. military veterans. Data were analyzed from 781 veterans who participated National Veteran Homeless and Other Poverty Experiences (NV-HOPE) study conducted in 2021. Chi-square tests, analyses of variance (ANOVAs) and logistic regressions analyses were conducted to examine unadjusted and adjusted associations between gambling group status and sociodemographic, psychiatric, substance use, functioning, and homelessness measures. A significant minority of low-income U.S. veterans reported gambling, with 24.9% (95% confidence interval [CI] 95% CI 21.12-28.76%) exhibiting RG and 6.7% (95% CI 3.88-9.42%) screening positive for ARPG. The prevalence of ARPG was higher among younger, non-White veterans. ARPG was associated with greater symptoms of substance use and anxiety; poorer physical functioning; history of any mental illness; lifetime history of homelessness; and having any student or car loans relative to NG. Veterans who had RG were more likely to screen positive for drug use disorders relative to NG. Results of the current study provide an up-to-date estimate of the current prevalence of RG and ARPG among low-income U.S. veterans and underscore the importance of routine screening, monitoring, and development of interventions for problematic gambling severity, as well as interventions for ARPG in this population. These findings may inform targeted intervention strategies for this vulnerable subpopulation.

Problem gambling in psychotic disorders: A systematic review and meta-analysis of prevalence

INTRODUCTION

Problem gambling (PBG) is more common in people with mental health disorders, including substance use, bipolar, and personality disorders, than in the general population. Although individuals with psychotic disorders might be expected to be more vulnerable to PBG, fewer studies have focused on this comorbidity. The aim of this review was to estimate the prevalence of PBG in people with psychotic disorders.

METHODS

Medline (Ovid), EMBASE, PsycINFO (Ovid), CINAHL, CENTRAL, Web of science, and ProQuest were searched on November 1, 2023, without language restrictions. Observational and experimental studies including individuals with psychotic disorders and reporting the prevalence of PBG were included. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal for systematic reviews of prevalence data. The pooled prevalence of PBG was calculated using a fixed effects generalized linear mixed model and presented through forest plots.

RESULTS

Of 1271 records screened, 12 studies (n = 3443) were included. The overall prevalence of PBG was 8.7% (95% CI = 7.8%-9.7%, I2 = 69%). A lower prevalence was found in studies with a low risk of bias (5.6%; 95% CI = 4.4%-7.0%) compared with studies with a moderate risk of bias (10.4%; 95% CI = 9.2%-11.7%). Different methods used to assess PBG also contributed to the heterogeneity found.

CONCLUSION

This meta-analysis found substantial heterogeneity, partly due to the risk of bias of the included studies and a lack of uniformity in PBG assessment. Although more research is needed to identify those at increased risk for PBG, its relatively high prevalence warrants routine screening for gambling in clinical practice.

The relationship between gambling behaviour and gambling-related harm: A data fusion approach using open banking data

BACKGROUND AND AIMS

UK-based gambling policymakers have proposed affordability checks starting at monthly losses of £125. The present study combines open banking data with self-reports of the Problem Gambling Severity Index (PGSI) and other relevant information to explore the harm profiles of people who gamble at different levels of electronic gambling behaviour.

DESIGN, SETTING AND PARTICIPANTS

This was a data fusion study in which participants consented to share their bank data via an open banking application programming interface (API) and who also completed relevant self-report items. Hierarchical hurdle models were used to predict being an at-risk gambler (PGSI > 0) and being a 'higher-risk' gambler (higher PGSI scores among those with non-zero scores) using four specifications of electronic gambling behaviour (net-spend, outgoing expenditure, incoming withdrawals, interaction model combining expenditure and withdrawals), and by adding self-reported data across two additional steps. The study took place in the United Kingdom. Participants were past-year people who gamble (n = 424), recruited via Prolific.

MEASUREMENTS

Self-report measures were used of gambling-related harm (PGSI), depression [Patient Health Questionnaire 9 (PHQ-9)], age and gender; bank-recorded measures of income and electronic gambling behaviour.

FINDINGS

Unharmed gamblers had an average monthly gambling net-spend of £16.41, compared with £208.91 among highest-risk gamblers (PGSI ≥ 5). Being an at-risk gambler (PGSI > 0) was predicted significantly by all four types of gambling behaviour throughout all three steps [1.08 ≤ odds ratios (ORs) ≤ 2.92; Ps < 0.001), with only outgoing expenditure being significant in the interaction model (2.26 ≤ ORs ≤ 2.81; Ps < 0.001). Higher PHQ-9 scores also predicted at-risk gambling in steps 2-3 (1.09 ≤ ORs ≤ 1.10; Ps < 0.001), as did lower age (0.95 ≤ ORs ≤ 0.96; Ps < 0.001) and male gender identity in step 3 (2.51 ≤ ORs ≤ 2.95; Ps < 0.001). Being a higher-risk gambler was predicted significantly by gambling behaviour only in the expenditure-only (1.16 ≤ ORs ≤ 1.17; Ps ≤ 0.048) and withdrawal-only (1.08 ≤ ORs ≤ 1.09; Ps ≤ 0.004) models, and was not predicted by income (0.98 ≤ ORs ≤ 1.14; Ps ≥ 0.601), age (0.98 ≤ ORs ≤ 0.99; Ps ≥ 0.143) or male gender identity (1.07 ≤ ORs ≤ 1.15; Ps ≥ 0.472).

CONCLUSION

The UK government's proposed affordability checks for gamblers should rarely affect people who are not experiencing gambling-related harm. At-risk gambling is predicted well by different types of gambling behaviour. Novel insights about gambling can be generated by fusing self-reported and objective data.

Towards an Active Role of Financial Institutions in Preventing Problem Gambling: A Proposed Conceptual Framework and Taxonomy of Financial Wellbeing Indicators

The transformation of gambling into a largely digital commodity has created a need for online payment technologies to facilitate online gambling, thereby also raising the question of what role these actors can play in the promotion of Responsible Gambling (RG). With the means and access they maintain, financial institutions are in a unique position to alleviate financial pitfalls, yet their role in the gambling context has thus far received little scrutiny. The objective of this study was to conduct an extant literature review to develop an initial set of financial indicators tailored for financial institutions, enabling them to engage in the RG initiatives. We conducted a two-step narrative literature review to identify both general Financial Well-Being (FWB) indicators across financial research disciplines, and one specific to gambling. A literature search over the past 20 years was performed across the following academic databases: Medline (Ovid), Sociological Abstracts (ProQuest), Web of Science (Clarivate), and PsycInfo (EBSCO). Manifest content analysis was used in step one to review general financial well-being, yielding a general FWB conceptual framework. In step two, we applied latent content analysis to the gambling-specific literature, linking essential concepts of gambling-related financial harms to the broader FWB literature. This resulted in a tentative taxonomy of indicators applicable to financial institutions with gambling customers. In tandem with the FWB conceptual framework, the preliminary taxonomy could provide a foundation for financial institutions catering to gambling customers to engage in the duty of care agenda, potentially broadening player protection beyond the current operator-focused RG measures.

The risk and development of work disability among individuals with gambling disorder: a longitudinal case-cohort study in Sweden

BACKGROUND

This longitudinal register study aimed to investigate the association between gambling disorder (GD) and work disability and to map work disability in subgroups of individuals with GD, three years before and three years after diagnosis.

METHODS

We included individuals aged 19-62 with GD between 2005 and 2018 (n = 2830; 71.1% men, mean age: 35.1) and a matched comparison cohort (n = 28 300). Work disability was operationalized as the aggregated net days of sickness absence and disability pension. Generalized estimating equation models were used to calculate adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for the risk of long-term work disability (>90 days of work disability/year). Secondly, we conducted Group-based Trajectory Models on days of work disability.

RESULTS

Individuals with GD showed a four-year increased risk of long-term work disability compared to the matched cohort, peaking at the time of diagnosis (AOR = 1.89; CI 1.67-2.13). Four trajectory groups of work disability days were identified: constant low (60.3%, 5.6-11.2 days), low and increasing (11.4%, 11.8-152.5 days), medium-high and decreasing (11.1%, 65.1-110 days), and constant high (17.1%, 264-331 days). Individuals who were females, older, with prior psychiatric diagnosis, and had been dispensed a psychotropic medication, particularly antidepressants, were more likely to be assigned to groups other than the constant low.

CONCLUSION

Individuals with GD have an increased risk of work disability which may add financial and social pressure and is an additional incentive for earlier detection and prevention of GD.

Skill-Based Electronic Gaming Machines: Features that Mimic Video Gaming, Features that could Contribute to Harm, and Their Potential Attraction to Different Groups

New gambling products have been developed over time as technology permits. For example, early mechanical slot machines were later replaced by electronic gaming machines (EGMs), which enabled a faster speed of play and more immersive experience. EGMs have in the decades since their invention become one of the main drivers of gambling expenditure worldwide and are one of the gambling products most strongly associated with harm. This literature review considers research relevant to a new subcategory of EGM, 'skill-based' EGMs, termed 'SGMs' here. SGMs can be highly varied in content, with some representing a minimal departure from EGMs, where the typical bonus round is replaced by some skill-based activity, such as a simple video game, which could increase the machine's appeal. Other SGMs feature more radical departures from conventional EGMs, such as multiplayer games using intellectual property from popular TV shows or video games. These skill-based elements could tap into common gambling fallacies such as the illusion of control, and therefore facilitate harmful engagement. SGMs could also be less harmful than current EGMs, if skill-based elements break the dissociative states associated with EGM gambling. The intellectual property used in SGMs may increase their appeal among people who generally do not gamble, and the skill-based elements could increase their interest among gamblers who predominately prefer skill-based gambling formats such as sports betting. The novelty and varied content of SGMs present many open questions, which research should aim to address in future.

Exploring the Complex Dynamics: Examining the Influence of Deviant Personas in Online Gambling

The widespread use of computers and the Internet has substantially changed the gaming environment during the past ten years. The gambling industry is no longer exclusive to land-based gaming establishments (such as casinos and racetracks). Today, a few keystrokes on a computer are all it takes to access gaming operations. Social media platforms like Facebook, Instagram, Snapchat and various other platforms constitute a particular form of access that has drawn more attention from academics in gambling studies. This increasing focus is partially attributable to the fact that social media sites have gained popularity as a means of accessing online gambling websites via hyperlinks hidden inside adverts. Users of social networking platforms can play free-to-play virtual gambling games using programmes. Virtual gaming platforms are the new name for these free-to-play simulation games of gambling. However, there is evidence to suggest that playing social casino games may serve as a "gateway" to real money gambling. The purpose of this study is to investigate the influence of deviant personas on online gambling behavior. By examining the relationship between deviant personas and online gambling, we seek to enhance our understanding of the factors that contribute to problematic gambling behaviors in virtual environments. Employing a robust methodological approach, this research amalgamates the analytical power of PLS-SEM (Partial Least Squares Structural Equation Modeling) to explore the factors influencing the intention to adopt online gambling services. The data for this study were obtained by administering an online survey questionnaire to a sample of 325 aware customers of online gambling. The study's discerning insights have notable implications for the academic community, brand strategists, online game designers, and online gambling platform providers, offering valuable guidance for decision-making and strategy formulation within the burgeoning online gambling industry.

A Double-Edged-Sword Effect of Overplacement: Social Comparison Bias Predicts Gambling Motivations and Behaviors in Chinese Casino Gamblers

Overconfidence, a widely observed cognitive bias, has been linked to increased gambling motivations and behaviors. However, previous studies have largely overlooked overconfidence under a social comparison context, known as overplacement, i.e., the tendency of individuals to believe that they are better than their similar peers. In the present study, we tested the effect of overplacement on gambling motivations and behaviors though a Pilot Survey of Chinese college students (N = 129) and a Field Survey of Chinese Macao casino gamblers (N = 733). Our results revealed a double-edged sword effect of overplacement: Serving as a risk factor, evaluating one self's earning ability as higher than others was linked to more gambling motivations (β = 0.18, p = .005) and frequency (β = 0.18, p = .004); Serving as a protective factor, evaluating oneself as happier than others was linked to less gambling motivations (β = - 0.32, p < .001) and problem behaviors (β = - 0.26, p < .001). These findings expand the relationship between overconfidence and gambling from a cognitive bias perspective to a social comparison perspective. Our study not only revealed a typical profile of gambling motivations and behaviors among different demographic groups in Chinese casino gamblers, but also highlighted the importance of considering social factors in the study of the psychological mechanisms of gambling.

Against the odds: exploring individuals' pushback mechanisms against commercialized football gambling

Introduction

The need for money, the pursuit of pleasure, and the liberalized access to gambling have been documented in several pieces of literature as the drivers of gambling. Such drivers are predicated on commercialized gambling, leading to the growth of the gambling industry and constituting a structural influence that normalizes the activity among young people.

Methods

Through a qualitative inquiry, this study investigates the social agentic factors of individuals who are susceptible to gambling. Fifteen non-gamblers were recruited across three commercial cities in Africa, namely Nairobi, Lagos, and Johannesburg. We first established the gambling susceptibility of the participants: their need for money, their passion for football, ownership of a smartphone, access to the internet, and exposure to football gambling marketing.

Results

Consequently, we probed for their agency, which is indicative of why they do not gamble, despite being susceptible to engaging in the activity. Four major agentic factors were identified from the participants; knowledge of the industry's business model, conserving the integrity of football, identity of self, morality and/or religion model.

Discussion

As such, these factors may be utilized to develop an intervention program for gamblers within the geographical context.

Gambling among indebted individuals: an analysis of bank transaction data

BACKGROUND

Gambling is connected to important financial harms, including debt. Most existing research has investigated the relationship between gambling and debt using self-reported data. Only a few studies have used objective data. The current study focuses on the gambling of indebted individuals. It investigates the amounts and types of gambling consumed by indebted individuals, and the amounts of unsecured debt among heavy gamblers.

METHODS

We use past-year banking data of Finnish individuals (N = 23 231) collected between 2018 and 2021 among applicants to a debt consolidation service. The transactions consist of deposits to, and winnings paid by gambling operators, distinguished by type of gambling (sports betting, casino, lottery) as well as active loans divided into secured and unsecured loans.

RESULTS

Gambling is widespread among indebted individuals in Finland. In terms of gambling types, casino-type gambling is the most popular among indebted individuals. Gambling spending is highly concentrated. Nearly half (49.5%) of all gambling deposits are concentrated among the highest spending 5% of indebted individuals. Individuals with unsecured loans have higher median losses than those without unsecured loans.

CONCLUSIONS

The results suggest that gambling and indebtedness are strongly linked. The connection is stronger for individuals with unsecured debt. This has implications for prevention and treatment. Easy access to unsecured credit is likely to worsen gambling harms. Debt counselling services routinely encounter gambling-related harms and need to be equipped to manage these issues.

Treatment seeking for gambling disorder in nationwide register data - observations around a major shift in legislation

Background

Treatment seeking for gambling disorder is known to be low and there has been a lack of longitudinal research regarding treatment opportunities. The present study aimed to assess possible changes in treatment uptake after a formal introduction of gambling disorder in social services and health care legislations, by using register data, including patient characteristics with respect to socio-demographics and comorbidities.

Methods

Nationwide register data were collected for the years 2005-2019, describing diagnoses in specialized out-patient health care and in in-patient hospital care. Numbers and characteristics of patients with gambling disorder were followed longitudinally. Also, a new legislation for treatment by public institutions was introduced in 2018, and data were compared for the years before and after the shift in legislation, both nationally, for each of the three major urban regions, and for the rest of the country. Comparisons were made with respect to concurrent mental health comorbidities, age and gender.

Results

The number of out-patient gambling disorder diagnoses increased over time, but without any significant step changes around the shift in legislation. Over time, patients were younger, became more likely to have gambling disorder as their primary diagnosis, and less likely to have mental health comorbidities, whereas gender distribution did not change. Among the smaller group of patients diagnosed in in-patient settings, mental health comorbidity increased over time. Despite gradual changes over time, no changes in demographics were seen around the actual shift in legislation, although the psychiatric comorbidity appeared to increase after this change.

Conclusion

After the introduction of gambling disorder in the responsibility of social services and health care settings in Sweden, the number of patients diagnosed with gambling disorder increased only modestly. Likely, further implementation of gambling disorder treatment is required in the health care services. Also, longer longitudinal studies are needed in order to understand to what extent patients not seeking health care treatment are received by municipal social services or remain outside the treatment system.

Motivational telephone intervention to risk gamblers by a state-owned gambling operator in Sweden

Background and aims

Few studies have tested the effect of a motivational telephone intervention from a gambling operator to clients with high-risk gambling practices. This study aimed to study subsequent limit setting, self-exclusions and gambling post-intervention, compared to controls.

Methods

The study assessed a motivational, personalized telephone intervention by the state-owned Swedish gambling operator AB Svenska Spel within its subsection of sports, poker, online casino and bingo gambling. Clients successfully reached with the telephone intervention (n = 1,420) were compared to clients who could not be reached (n = 1,504). Gambling practices during 8 weeks pre-intervention were assessed, and outcome measures limit setting, self-exclusion, and gambling 4 weeks post-intervention.

Results

The telephone intervention was associated with increased limit settings (10 vs. 5 percent, p < 0.001), self-exclusions (11 vs. 8 percent, p < 0.01), lowered theoretical losses (p < 0.001), but not significantly associated with gambling abstinence (18 vs. 15 percent, p = 0.07). In unadjusted analyses of sub-groups, significant associations of the intervention with full gambling abstinence were seen in people who gamble on online casino/bingo (19 vs. 14 percent, p < 0.01), but not in sports bettors. In logistic regression, the intervention was not associated with full week 1-4 abstinence.

Conclusion

A personalized motivational telephone intervention to people displaying high-risk gambling, delivered by a gambling operator, is promising, and effects were seen on the uptake of responsible gambling tools post-intervention. Effects may be more pronounced in users of chance-based, online games, than in sports bettors.

Gambling-related suicide in Victoria, Australia: a population-based cross-sectional study

Background

Gambling is associated with serious harms to health, including suicide. Yet public health systems for recording the role of gambling in suicide deaths are relatively underdeveloped. This study contributes to the understanding of this relationship.

Methods

A population-based cross-sectional study of suicides reported to the Coroners Court of Victoria between 2009 and 2016 was performed to identify the incidence and characteristics of gambling-related suicides (GRS).

Findings

From 2009 to 2016 there were 4788 suicide deaths in Victoria. Of these, 184 were identified as direct GRS and a further 17 were GRS by 'affected others'. Together, these GRS comprise 4.2% of all suicides in Victoria over this eight-year period. Direct GRS account for an annual average rate of 5.13 GRS per million Victorian adults. GRS were significantly more likely to be male (n = 153, 83%), than the Victorian population of total suicide deaths and significantly more likely to occur among those most disadvantaged. Family members and friends were more likely than clinicians to know about the deceased gambling.

Interpretation

Given that gambling is not routinely investigated by coroners and may be hidden from family, friends, and health professionals, this is an underestimate of the true scale of the GRS in Victoria. A range of measures should be introduced to prevent, screen, support, and treat gambling harm. Family members and friends should also be provided with help services. Preventing gambling-related harm through public health measures could significantly reduce suicidality and suicide, both in Australia and globally.

Funding

Federation University Australia, Coroners Court of Victoria, Suicide Prevention Australia.

Using geospatial mapping to predict and compare gambling harm hotspots in urban, rural and coastal areas of a large county in England

BACKGROUND

Disordered gambling is a public health problem with interconnections with health and social inequality, and adverse impacts on physical and mental health. Mapping technologies have been used to explore gambling in the UK, though most were based in urban locations.

METHODS

We used routine data sources and geospatial mapping software to predict where gambling related harm would be most prevalent within a large English county, host to urban, rural and coastal communities.

RESULTS

Licensed gambling premises were most concentrated in areas of deprivation, and in urban and coastal areas. The aggregate prevalence of disordered gambling associated characteristics was also greatest in these areas.

CONCLUSIONS

This mapping study links the number of gambling premises, deprivation, and risk factors for disordered gambling, and highlights that coastal areas see particularly high density of gambling premises. Findings can be applied to target resources to where they are most needed.

US Taxation of Gambling Winnings and Incentives to Bet

Sports betting is growing rapidly in the US after its legalization by the Supreme Court in 2018. This paper describes the treatment of gambling winnings and losses in the federal tax code and shows how the system may incentivize some gamblers to substantially increase the scale of their betting in order to have a chance to win. This incentive stems from the fact that gambling losses can only be deducted if taxpayers are filing for itemized deductions, meaning the scale of gambling losses has to be large enough to push a taxpayer's eligible deductions over the standard deduction. This incentive to engage in large-scale betting applies mostly to lower and middle-income households.

The lived experience of financial harm from gambling in Australia

The financial consequences associated with harmful gambling create significant health and social stressors for individuals, their families, and communities. However, there has been limited research exploring how people impacted by gambling harm conceptualise and experience the financial impacts on their lives. To help fill this gap, this study used in-depth qualitative interviews with gamblers harmed by their own gambling and affected others harmed by someone else's gambling. Reflexive thematic analysis was used to interpret the data. The study had three key findings. First, prior to experiencing harm, gamblers and affected others did not consider the financial risks associated with gambling and only recognised the risks once the financial losses negatively impacted other areas of their lives. Second, gamblers and affected others managed the day-to-day financial impacts of gambling by adjusting their financial priorities, reducing spending in other areas, or accruing debt. Finally, the financial impacts of gambling and the associated financial management strategies led to broader and long-term problems for gamblers and affected others. This study demonstrates that financial harms from gambling are complex and contribute to the stigmatisation of people who experience harm. Current educational messages and tools simplify this complex issue and may legitimise gambling as a leisure activity which can be managed by making 'responsible' financial decisions. Public health and health promotion initiatives must recognise this complexity, developing approaches that are independent from the gambling industry and informed by lived experience.

Protecting children and young people from contemporary marketing for gambling

Around the world, children are being exposed to intensive marketing for gambling products. This normalizes perceptions that gambling is essentially a harmless form of entertainment, despite mounting evidence of the harms it causes. Young people and their parents are supportive of strategies to protect children from being exposed to gambling marketing. Yet existing regulatory efforts are inconsistent and inadequate, and have not protected children from exposure to the many forms of marketing now being developed and exploited by the gambling industry. We outline existing knowledge about strategies used by the gambling industry to market its products, with a specific focus on the potential impact of gambling marketing on young people. We provide a definition of gambling marketing and outline the different forms of promotion that are currently used to market gambling, current regulatory responses, and the impact of marketing on children and young people. We then argue that a comprehensive public health approach to gambling is urgently required, which must include effective action to limit the influence of marketing for gambling products, while recognizing that it is never possible to insulate children entirely from their reach.

Designing Improved Safer Gambling Messages for Race and Sports Betting: What can be Learned from Other Gambling Formats and the Broader Public Health Literature?

Safer gambling messages are one potential input to a public health approach toward reducing gambling-related harm, and yet there is no strong evidence supporting current messages such as "gamble responsibly" or "keep the fun in the game". Furthermore, sports betting is increasing in popularity in multiple jurisdictions, such as Australia and the US, increasing the need to design effective messaging campaigns for race and sports betting. Compared to other gambling formats, such as electronic gambling machines, the level of potential skill involved in race and sports betting may raise unique issues regarding the design of effective messages. This review first highlights research from the related public health domains of alcohol and tobacco. Then, five potential areas for further messaging-based research in race and sports betting are discussed: teaching safer gambling practices, correcting gambling misperceptions, boosting conscious decision making, norm-based messages, and emotional messages. A broad approach to message design is encouraged, given the potential for individual differences in message receptivity, and for frequently-repeated messages to be ignored or cause negative psychological reactance.

Drug-Induced Gambling Disorder: Epidemiology, Neurobiology, and Management

Problematic gambling has been suggested to be a possible consequence of dopaminergic medications used mainly in neurological conditions, i.e. pramipexole and ropinirole, and possibly by one antipsychotic compound, aripiprazole. Patients with Parkinson's disease, restless legs syndrome and other conditions potentially treated with dopamine agonists, as well as patients treated for psychotic disorders, are vulnerable patient groups with theoretically increased risk of developing gambling disorder (GD), for example due to higher rates of mental ill-health in these groups. The aim of the present paper is to review the epidemiological, clinical, and neurobiological evidence of the association between dopaminergic medications and GD, and to describe risk groups and treatment options. The neurobiology of GD involves the reward and reinforcement system, based mainly on mesocorticolimbic dopamine projections, with the nucleus accumbens being a crucial area for developing addictions to substances and behaviors. The addictive properties of gambling can perhaps be explained by the reward uncertainty that activates dopamine signaling in a pathological manner. Since reward-related learning is mediated by dopamine, it can be altered by dopaminergic medications, possibly leading to increased gambling behavior and a decreased impulse control. A causal relationship between the medications and GD seems likely, but the molecular mechanisms behind this association have not been fully described yet. More research is needed in order to fully outline the clinical picture of GD developing in patient groups with dopaminergic medications, and data are needed on the differentiation of risk in different compounds. In addition, very few interventional studies are available on the management of GD induced by dopaminergic medications. While GD overall can be treated, there is need for treatment studies testing the effectiveness of tapering of the medication or other gambling-specific treatment modalities in these patient groups.

How can implementation intentions be used to modify gambling behavior?

Problem gambling can cause significant harm, yet rates of gambling continue to increase. Many individuals have the motivation to stop gambling but are unable to transfer these positive intentions into successful behavior change. Implementation intentions, which are goal-directed plans linking cues to behavioral responses, can help bridge the gap between intention and many health behaviors. However, despite the strategy demonstrating popularity in the field of health psychology, its use in the area of gambling research has been limited. This mini review illustrates how implementation intentions can be used to facilitate change in gambling behavior. Adopting the strategy could help reduce the number of people with gambling problems.

“These People Had Taken Advantage of Me”: A Grounded Theory of Problematic Consequences of Player Interaction with Mobile Games Perceived as “Designed to Drive Spending”

Many games which incorporate microtransactions—uncapped, repeated in-game purchases—are described by players as having had their 'dynamics designed to drive spending'. Such games are perceived by players as designed primarily to encourage spending, rather than with the improvement of the player experience in mind. However, it is unknown how playing these games affects players. We addressed the research question of “What consequences might there be of interaction with games perceived as having had their dynamics designed to drive spending?” considering adult players. We conducted semi-structured interviews and used a grounded theory method of analysis. Our findings revealed five life areas of problematic consequences: financial issues, problems at work and education due to distraction and lack of productivity, emotional consequences for self-perception, problems sleeping, and social consequences. These outcomes emerge from the interaction of players with certain vulnerability traits with these game mechanics. We discuss these findings in the context of gaming disorder and the gamblification of games.

Legacy Gambling Harms: What Happens Once the Gambling Stops?

Purpose of Review

Legacy gambling harm refers to adverse consequences that extend past the period where people are actively gambling at harmful levels. These harms can affect the gambler, people close to them and the wider community. This article reviews current research that investigates legacy harms; the types of legacy harm, how long they last and whether evidence suggests these harms are real or instead imagined injuries or reflections on past regrets.

Recent Findings

Legacy harms to individuals can be broadly categorised as including financial, relationship, emotional/psychological, health, culture, work/study and criminal/deviance harms. In addition, legacy harms affect entire communities by drawing funds and social capital away from vulnerable communities, leaving them socially, culturally and materially impoverished. Most legacy harms that accrue to gamblers have a half-life of 4 years, although financial harms last somewhat longer at 5 years. Greater distance in time from a past gambling issue is reliably and positively related to health and well-being indicators, including the Health Utility Index and the Australian Unity Wellbeing Index, which suggests that legacy gambling harms are real and have a lasting impact on well-being, rather than just imagined hardship from prior gambling difficulties.

Summary

These findings suggest programme and policy development to support gamblers in reducing and managing their legacy harms, rather than focusing only on relapse prevention.

Opening Pandora’s Loot Box: Weak Links Between Gambling and Loot Box Expenditure in China, and Player Opinions on Probability Disclosures and Pity-Timers

Loot boxes are quasi-gambling virtual products in video games that provide randomised rewards of varying value. Previous studies in Western contexts have identified a positive correlation between loot box purchasing and problem gambling severity. A preregistered survey of People’s Republic of China (PRC) video game players (N = 879) failed to replicate this correlation. We observed statistically significant but weak positive correlations between loot box expenditure and past-year gambling participation, and between loot box expenditure and impulsiveness. This study cannot prove that loot boxes are not disproportionately purchased by people with problem gambling symptomatology in the PRC or that PRC players are not potentially at risk of loot box-related harms. Instead, the evidence suggests that the relationship between loot boxes and gambling might be weaker in the PRC than in Western countries. We identified multiple unique factors about the PRC that might be affecting this relationship. For example, the lotteries are the only legally permitted form of gambling. More gamified electronic gambling products are unavailable. The limited availability of gambling meant that a low level of gambling participation (n = 87) was observed, which is a limitation of this study. Additionally, the PRC is presently the only country to legally require loot box probability disclosures as a consumer protection measure. Most loot box purchasers (84.6%) reported seeing loot box probability disclosures, but only 19.3% of this group reported consequently spending less money. Most loot box purchasers (86.9%) thought that pity-timers, which increase the winning probabilities of obtaining rarer rewards, are appropriate for implementation. Future loot box research should give greater consideration to differing cultural contexts and novel consumer protection measures.

Regulating Gambling-Like Video Game Loot Boxes: a Public Health Framework Comparing Industry Self-Regulation, Existing National Legal Approaches, and Other Potential Approaches

Purpose of Review

Loot boxes are gambling-like monetisation mechanics in video games that are purchased for opportunities to obtain randomised in-game rewards. Gambling regulation is increasingly being informed by insights from public health. Despite conceptual similarities between loot boxes and gambling, there is much less international consensus on loot box regulation. Various approaches to regulating loot boxes are reviewed via a public health framework that highlights various trade-offs between individual liberties and harm prevention.

Recent Findings

Many countries have considered regulation, but as yet only a few countries have taken tangible actions. Existing regulatory approaches vary greatly. More restrictively, Belgium has effectively ‘banned’ paid loot boxes and prohibits their sale to both children and adults. In contrast, more liberally, China only requires disclosure of the probabilities of obtaining potential rewards to provide transparency and perhaps help players to make more informed purchasing decisions. Most other countries (e.g., the UK) have adopted a ‘wait-and-watch’ approach by neither regulating loot box sales nor providing any dedicated consumer protection response. Industry self-regulation has also been adopted, although this appears to elicit lower rates of compliance than comparable national legal regulation.

Summary

Many potential public health approaches to loot box regulation, such as expenditure limits or harm-reducing modifications to loot box design (e.g., fairer reward structures), deserve further attention. The compliance and clinical benefits of existing interventions (including varying degrees of regulation, as adopted by different countries, and industry self-regulation) should be further assessed. The current international variation in loot box regulation presents opportunities to compare the merits of different approaches over time.

The Gamblification of Investing: How a New Generation of Investors Is Being Born to Lose

Investing and gambling share key features, in that both involve risk, the coming together of two or more people, and both are voluntary activities. However, investing is generally a much better way than gambling for the average person to make long-run profits. This paper reviews evidence on two types of “gamblified” investment products where this advantage does not hold for investing: high-frequency stock trading and high-risk derivatives. This review defines a gamblified investment product as one that leads most investors to lose, that attracts people at risk of experiencing gambling-related harm, and that utilizes product design principles from gambling (either by encouraging a high frequency of use or by providing the allure of big lottery-like wins). The gamblification of investing produces novel challenges for the regulation of both financial markets and gambling.

Gambling, Gaming, and Internet Behavior in a Sexual Minority Perspective. A Cross-Sectional Study in Seven European Countries

Background

Addictive behavior of gambling, gaming and internet activity is partly a new research domain and has not been well investigated with regard to sexual minority populations. Although health disparities between sexual minorities and the general population are well documented, there is a lack of inclusion of sexual minorities in both research and clinic. Among lesbian, gay and bisexual populations certain features could be present that play a role for the development of addictive behaviors, such as social isolation and increased risk of other psychiatric problems. The aim of this study was to investigate problem gambling, problem gaming and problematic internet behavior in a European context and if it is affected by sexual orientation status.

Methods

An online web-survey was distributed among web-panels in England, Poland, Switzerland, Italy, Spain, Denmark, and Sweden in 2017-2018.

Result

10 983 complete answers were collected. 7.1% of the participants had a sexual minority status (n = 774). Regression models found that there was no difference in gambling, gaming and internet behavior among heterosexual and sexual minority men. Sexual minority women were associated with problematic gambling and gaming behavior, when also controlling for age and nationality. When also controlling for psychological distress, women defining as having another sexual minority status than lesbian and bisexual remained significant for having a problematic gaming behavior (AOR = 2.3).

Conclusion

An awareness of female sexual minority perspectives is relevant in facilities treating behavioral addiction as well as in future research in behavioral addiction. More research is needed in problematic gambling and gaming behavior in different sexual minority populations with regard to psychiatric comorbidity and living conditions. An inclusion of sexual minority groups defining as other than gay and bisexual is needed in future research. No significant differences were found between heterosexual and sexual minority men in adjusted analysis in this study.

Gambling disorder in the UK: key research priorities and the urgent need for independent research funding

Gambling in the modern era is pervasive owing to the variety of gambling opportunities available, including those that use technology (eg, online applications on smartphones). Although many people gamble recreationally without undue negative effects, a sizeable subset of individuals develop disordered gambling, which is associated with marked functional impairment including other mental health problems, relationship problems, bankruptcy, suicidality, and criminality. The National UK Research Network for Behavioural Addictions (NUK-BA) was established to promote understanding of, research into, and treatments for behavioural addictions including gambling disorder, which is the only formally recognised behavioural addiction. In this Health Policy paper, we outline the status of research and treatment for disordered gambling in the UK (including funding issues) and key research that should be conducted to establish the magnitude of the problem, vulnerability and resilience factors, the underlying neurobiology, long-term consequences, and treatment opportunities. In particular, we emphasise the need to: (1) conduct independent longitudinal research into the prevalence of disordered gambling (including gambling disorder and at-risk gambling), and gambling harms, including in vulnerable and minoritised groups; (2) select and refine the most suitable pragmatic measurement tools; (3) identify predictors (eg, vulnerability and resilience markers) of disordered gambling in people who gamble recreationally, including in vulnerable and minoritised groups; (4) conduct randomised controlled trials on psychological interventions and pharmacotherapy for gambling disorder; (5) improve understanding of the neurobiological basis of gambling disorder, including impulsivity and compulsivity, genetics, and biomarkers; and (6) develop clinical guidelines based on the best contemporary research evidence to guide effective clinical interventions. We also highlight the need to consider what can be learnt from approaches towards mitigating gambling-related harm in other countries.

A speed-of-play limit reduces gambling expenditure in an online roulette game: Results of an online experiment

UK online casino games are presently not subject to any limitations on speed-of-play or stakes. One recent policy proposal is to ensure that no online casino game can be played faster than its in-person equivalent. Another policy proposal is to limit the maximum stakes on online casino games to £2, to match the current stake limit on electronic gambling machines. This research experimentally investigated the speed-of-play proposal subject to a £2 stake limit, in an online experiment using incentivized payouts based on £4 endowments and a commercial online roulette game, which was slowed-down in one condition to enforce a speed-of-play limit of one spin every 60 seconds. UK residents, aged 18 years and over and with experience in playing online roulette (N = 1,002), were recruited from an online crowdsourcing panel. In the slowed-down condition there was a credible reduction in the amount gambled. This effect occurred via a credible reduction in the mean number of spins which outweighed any potential increases in bet sizes. Speed-of-play limits may be effective in reducing gambling expenditure for online roulette.

Associations between financial gambling motives, gambling frequency and level of problem gambling: a meta-analytic review

BACKGROUND AND AIMS

Money is central to psychological definitions of gambling, but contemporary accounts are ambiguous regarding the role of financial motives in disordered gambling. The aims of the current research were to obtain meta-analytic weighted effect sizes for zero-order associations of financial motives against gambling frequency and level of problem gambling, as well as partial associations after controlling for other motives (e.g. coping).

METHODS

A meta-analysis of the literature through February 2021 was undertaken. Studies were identified from multiple sources (e.g. database search, other researchers). PRISMA standards were followed when screening identified records and extracting relevant data. The data analytic plan was pre-registered. We included 44 cross-sectional studies that involved student, community and clinical samples of people who gamble (sample sizes ranged from 22-5666), using validated self-report measures of financial gambling motives alongside measures of either gambling frequency and/or problem gambling.

RESULTS

Financial gambling motives were positively associated with gambling frequency, r = 0.29, 95% CI = [0.21, 0.37], n = 22 738, and level of problem gambling, r = 0.35, 95% CI = [0.31, 0.38], n = 38 204, with moderate effect sizes. Partial associations after controlling for overlapping variance with other gambling motives were also positive (gambling frequency: β = 0.14, 95% CI = [0.05, 0.22], n = 13 844; level of problem gambling: β = 0.18, 95% CI = [0.13, 0.22], n = 28 146), with small-to-moderate effect sizes. Effect sizes were heterogeneous and the extent of heterogeneity was high. Analyses of the zero-order association involving gambling frequency indicated that gambling motives measure (greater for Gambling Motives Questionnaire-Financial) and sample mean age (greater for younger samples) were moderators. No other moderators were statistically significant.

CONCLUSIONS

Financial gambling motives appear to be reliably and positively associated with both gambling frequency and level of problem gambling.

Employment Stress and Couple Adjustment among Clients With Disorders of Gambling and Alcohol Use: Themes of Transfers in Congruence Couple Therapy

Background:

Individuals with problematic gambling, alcohol and substance use commonly report lower employment rates and more employment-related problems such as job loss, work conflicts and poor performance.

Method:

A thematic qualitative analysis was conducted to extract employment-related themes from 21 sets of addiction counselors’ case notes of couple therapy sessions (average 10 sessions per case) from a randomized controlled trial of Congruence Couple Therapy (CCT). Case notes were examined for the types of employment issues to answer the research question: What are the interconnections of employment, couple adjustment and addictive behaviors as revealed in the CCT counselors’ case notes?

Results:

Five key areas of employment-related stress were identified: (1) unemployment, (2) financial concerns, (3) history of crime, (4) overworking and workaholism, and (5) workplace conflict. These themes interacted negatively with couple adjustment and addictive behaviors. Using CCT as an intervention, clients gained skills in 4 areas transferred to employment: (1) awareness of self, other and family of origin, (2) congruent communication, (3) work-family balance, and (4) enlisting spousal support. These themes intersected with enhanced work functioning and reduced stress, alcohol use and gambling.

Conclusion:

Employment problems negatively impacted addictive behaviors, couple adjustment and well-being of partners and clients. Skills and awareness gained in CCT promoted changes in addicted clients’ employment functioning and coping with employment stress. The domains of work and couple adjustment are mutually influential in increasing or reducing stress with implications for addiction recovery. CCT as a viable intervention for enhancing employment function should be further studied.

A Normative Feedback Intervention on Gambling Behavior-A Longitudinal Study of Post-Intervention Gambling Practices in At-Risk Gamblers

BACKGROUND

In problem gambling, normative personalized feedback interventions have demonstrated promising effects. Given the widespread increase in online gambling in recent years, internet-delivered normative feedback may serve as a promising intervention. This study aimed to examine whether such an intervention, delivered by a gambling operator and aiming to help problem gamblers decrease their gambling, may in fact be associated with lower gambling practices post-intervention.

METHODS

Online questions on norms and beliefs about one's own and peers' gambling habits, derived from the Gambling Quantity and Perceived Norms Scale, were followed by personalized feedback, delivered online by the Swedish state-owned gambling operator. A total of 1,453 gamblers consented to participate in a pre-post measure of wagering levels.

RESULTS

Wagering decreased significantly post-intervention (28 days) compared to pre-intervention (28 days prior). The decrease was significantly more pronounced in younger and online casino gamblers. In an 84-day follow-up, the decrease remained significant, although less pronounced.

CONCLUSIONS

An online normative intervention delivered by a state-owned gambling operator, addressing norms and beliefs about gambling levels, may lower risky gambling in the short term. Implications and further research needs are discussed.

Social disadvantage and gambling severity: a population-based study with register-linkage

Background

Studies have found an association between problem gambling and poverty. However, there is relatively little research on social inequalities and problem gambling using population representative data.

Methods

A population-representative self-report web-based and postal survey with register-based linkage was conducted in the three geographical areas of Finland. Participants (n = 7186, aged 18 or older) were randomly selected from the population register. Sociodemographic factors and social welfare benefits were studied among gambling groups and their statistical difference were examined by χ² test. Seven logistic regression models were calculated, where unemployment, social security benefits and low income were treated as dependent variables and where sex, age, family structure and education were controlled as covariates. The results were presented as odds ratios (OR) with 95% confidence intervals (CIs).

Results

Problem and at-risk gambling (ARG) was more common among people who were unemployed [PG: χ²=6.4 (1), P < 0.01, ARG: χ²=12.4 (1), P < 0.001] or had received social security benefits [PG: χ²=41.6 (1), P < 0.001, ARG: χ²=22.9 (1), P < 0.001]. The OR for problem gambling was high as 5.6 (CI: 3.22–9.61) among respondents who had received social assistance even when covariates were taking into count. Almost a third of those experiencing problem or at-risk gambling received at least one form of social security benefit.

Conclusions

The most important task of gambling policy should be reducing gambling-related harms and diminishing social inequality. However, even in government organized system where gambling profits are used for common good, profits come from the most socially disadvantaged people thereby exacerbating inequality.

Prevalence of Suicidal Behavior and Associated Clinical Correlates in Patients with Behavioral Addictions

Addictive disorders are characterized by severe consequences, including suicidal events, but most studies investigating the association between addiction and suicidal risk have focused on substance use disorders and gambling disorder at the expense of the rest of behavioral addictions. This study examined the prevalence and the associated clinical correlates of suicidal ideation and suicide attempts in a sample of patients with a diagnosis of behavioral addiction. The total sample consisted of 4404 individuals: 4103 of these patients with gambling disorder, 99 with gaming disorder, 44 with sex addiction, and 158 with buying–shopping disorder. All of them were assessed consecutively at a specialized hospital unit for the treatment of behavioral addictions. Participants attended two clinical interviews and completed self-reported questionnaires to explore clinical features of behavioral addictions, personality traits, psychopathological symptomatology, suicidal behavior, and sociodemographic variables. The highest prevalence of suicidal ideation was found in patients with gambling disorder (22.9%), followed by buying–shopping disorder (18.4%), sex addiction (18.2%), and gaming disorder (6.1%). The highest prevalence of suicide attempts was registered for sex addiction (9.1%), followed by buying–shopping disorder (7.6%), gambling disorder (6.7%), and gaming disorder (3.0%). Female gender and unemployment constituted two relevant sociodemographic factors associated with suicidal risk in gambling disorder, gaming disorder, and buying–shopping disorder. Lack of family support appeared as a relevant risk factor, except for gaming disorder. These results pointed out that suicide is a prevalent behavior in behavioral addictions, and clinicians and researchers need to pay particular attention to the specificities of each behavioral addiction when assessing suicidal risk.

Internet-based treatment of gambling problems: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND AND AIMS

The effect of internet-based psychological treatment for gambling problems has not been previously investigated by meta-analysis. The present study is therefore a quantitative synthesis of studies on the effects of internet-based treatment for gambling problems. Given that effects may vary according to the presence of therapist support and control conditions, it was presumed that subgroup analyses would elucidate such effects.

METHODS

A systematic search with no time constraints was conducted in PsycINFO, MEDLINE, Web of Science, and the Cochrane Library. Two authors independently extracted data using a predefined form, including study quality assessment based on the Cochrane risk of bias tool. Effect sizes were calculated using random-effects models. Heterogeneity was indexed by Cochran's Q and the I 2 statistics. Publication bias was investigated using trim and fill.

RESULTS

Thirteen studies were included in the analysis. Random effects models at post-treatment showed significant effects for general gambling symptoms (g = 0.73; 95% CI = 0.43-1.03), gambling frequency (g = 0.29; 95% CI = 0.14-0.45), and amount of money lost gambling (g = 0.19; 95% CI = 0.11-0.27). The corresponding findings at follow-up were g = 1.20 (95% CI = 0.79-1.61), g = 0.36 (95% CI = 0.12-0.60), and g = 0.20 (95% CI = 0.12-0.29) respectively. Subgroup analyses showed that for general gambling symptoms, studies with therapist support yield larger effects than studies without, both post-treatment and at follow-up. Additionally, on general gambling symptoms and gambling frequency, there were lower effect sizes for studies with a control group compared to studies without a control group at follow-up. Studies with higher baseline severity of gambling problems were associated with larger effect sizes at both posttreatment and follow-up than studies with more lenient inclusion criteria concerning gambling problems.

DISCUSSION AND CONCLUSIONS

Internet-based treatment has the potential to reach a large proportion of persons with gambling problems. Results of the meta-analysis suggest that such treatments hold promise as an effective approach. Future studies are encouraged to examine moderators of treatment outcomes, validate treatment effects cross-culturally, and investigate the effects of novel developments such as ecological momentary interventions.

A scoping review of hard systems and tools that restrict money and cash for gambling

BACKGROUND

Gamblers engage in a range of "soft" financial options to limit access to money or cash for gambling (e.g., family looks after cash). Such barriers are easily overturned, resulting in a demand for financial systems and tools that offer "hard" restrictions on access to money and cash in a gambling context. The aim of this scoping review was to determine the attitudes and preferences of gamblers and their families on systems or tools to restrict access to money and cash, as well as the effectiveness of systems and tools that can be used to accomplish that goal.

METHODS

A systematic search of articles related to financial restrictions and gambling was conducted. Eligibility criteria included samples of gamblers or affected others and interventions targeted at money or cash restrictions in a gambling context. Soft financial barriers such as family involvement were excluded, as were limit-setting systems which focused on gambling expenditure in gambling venues.

RESULTS

Nine studies met the eligibility criteria, with three focused on financial systems (e.g., ban on credit betting) and six focused on removal of cash machines from gambling venues. The included literature was generally of low quality, with just two pre-post studies and seven cross-sectional or qualitative ones.

CONCLUSIONS

The included studies provided strong support for financial mechanisms to support gamblers and their families. Future studies need to involve multiple stakeholders to provide this type of support as well as to evaluate the holistic impact that such hard barriers can have on gambling and gambling-related harms.

A public health approach to gambling regulation: countering powerful influences

Often portrayed as a harmless leisure activity in the UK, gambling is being increasingly recognised as a public health concern. However, a gambling policy system that explicitly tackles public health concerns and confronts the dependencies and conflicts of interest that undermine the public good is absent in the UK. Although there is a window of opportunity to change the gambling policy system, with the UK Government's launch of a review of the Gambling Act 2005, the adoption of a comprehensive and meaningful public health approach is not guaranteed. Too often, government policy has employed discourses that align more closely with those of the gambling industry than with those of the individuals, families, and communities affected by the harms of gambling. In view of the well described commercial determinants of health and corporate behaviour, an immense effort will be needed to shift the gambling discourse to protect public health. In this Viewpoint, we seek to advance this agenda by identifying elements that need challenging and stimulating debate.