GPs Should Screen Patients for Problem Gambling, Says NICE

Healthcare professionals and social care practitioners should consider asking certain patients about gambling during routine health checks or GP appointments. The National Institute for Health and Care Excellence (NICE) recommended addressing gambling alongside questions about smoking, alcohol consumption, or use of other substances, even in the absence of clear risk factors for gambling-related harm. The recommendation extends to practitioners working in the criminal justice system.

The guideline comes amid growing concern over the scale of gambling problems in the UK, which has been estimated to cost up to £1.77 billion annually in England and is linked with hundreds of suicides each year.

Harms Associated with Gambling

In final guidance, the health regulator highlighted the broad impact of gambling-related harm, including financial difficulties, relationship breakdowns, and mental health issues. The effects extend to families, communities, and society, impairing overall health and wellbeing. 

NICE identified several risk factors for gambling harm, including:

Early identification is crucial, NICE stated, to prevent escalation of harm.

Other risk factors include a family history of gambling, post-traumatic stress disorder, personality disorders, attention deficit hyperactivity disorder, medications that affect impulse control such as dopamine agonists for Parkinson’s disease and aripiprazole for psychosis, and experiencing safeguarding issues or violence.

Screening Tools and Referrals

NICE said that people should be encouraged to assess the severity of their gambling-related harms by completing the questionnaire on the NHS gambling website, which is based on the Problem Gambling Severity Index (PGSI). Individuals scoring eight or more on the PGSI should seek support from specialist gambling clinics. Referrals can be made by healthcare professionals or through self-referral. Those with lower scores could be at an elevated risk and may also benefit from support services, depending on need.

Professor Jonathan Benger, NICE’s chief medical officer, emphasised the importance of early intervention. “Gambling-related harm has a devastating impact on those who experience it, and the people close to them,” he said in a press release. “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.”

The guidance stressed the need for healthcare professionals and social care practitioners to combat stigma, shame, and fear of disclosure, which often deter people from seeking support and treatment. NICE also recommended that gambling treatment services remain in separate settings from those for alcohol or substance dependence. 

Expansion of Gambling Treatment Services

Fifteen NHS England-funded gambling treatment clinics have opened across the country since 2019, including seven last year. NICE said these clinics are expected to treat around 3000 people each year. 

The NHS gambling webpage provides details of other free support services, which include gambling helplines, local support groups, software and apps to block access to gambling websites, debt support, and urgent mental health support.

According to the Royal College of Psychiatrists, treatment for gambling disorders may include cognitive behaviour therapy, 12-step programmes such as Gambler’s Anonymous, and sometimes medication. 

The College says there is “good evidence” that naltrexone, used to treat alcohol and opioid addiction, can also be helpful in managing gambling disorders, particularly when people have been unable to stop and still experience a strong urge to gamble despite psychological therapy. The NICE committee described the evidence as “limited” and “not convincing enough” to consider the drug for first-line use, but nevertheless agreed that it should be available as a treatment option, even though it is not approved in the UK for this indication.

Naltrexone treatment must be started by a psychiatrist, but prescriptions can continue from a GP. In addition, treatment for other mental health conditions where present – for example with antidepressants – may also improve gambling problems.

New Levy on Gambling Operators to Fund Services

A statutory levy on gambling operators, set to be introduced in April this year, is expected to generate £100 million annually, with the money used for research, prevention, and treatment of gambling-related harms. Half of this funding will be directed to NHS England and appropriate bodies in Scotland and Wales to develop a comprehensive NHS-led gambling support and treatment system, to include referrals and triage through to recovery and aftercare.

Introducing the levy, Baroness Twycross, the minister responsible for gambling at the Department for Culture, Media and Sport, said in a press release that “prevention is a crucial part of the government’s efforts to tackle gambling harm”. She explained that 30% of levy funding would go towards preventive efforts, which could include national public health campaigns and training for frontline staff. The remaining 20% will be directed to UK Research and Innovation and the Gambling Commission to develop bespoke research programmes on gambling to inform future policy and regulation.

Dr Sheena Meredith is an established medical writer, editor, and consultant in healthcare communications, with extensive experience writing for medical professionals and the general public. She is qualified in medicine and in law and medical ethics.