The impact of responsible gambling framing on people with lived experience of gambling harm

Substantiating policy recommendations for reducing gambling-related harms with perspectives from individuals with lived experience

PURPOSE OF REVIEW

Changes in gambling regulation have been linked to public health concerns, with system- and population-level approaches suggested to prevent and reduce gambling-related harms in societies. This review utilizes recent qualitative studies on individuals with lived experience of gambling-related harms to substantiate and inform refinement of current policy-level recommendations.

RECENT FINDINGS

Recent policy recommendations are well poised to address issues faced by individuals with lived experience of gambling-related harms, as reflected in several recent qualitative studies. Pertinent topics include increased accessibility to gambling via digitization, limitations of self-exclusion, and difficulty adhering to self-imposed financial limits. A range of barriers, including stigma, aggressive advertising by gambling operators, and gambling opportunities in video games, may undermine the effectiveness of some policies (e.g., self-exclusion, deposit limits, and age restrictions, respectively).

SUMMARY

The perspectives of individuals with lived experience of gambling-related harms can be invaluable in complementing, strengthening, and contextualizing quantitative results to substantiate policy recommendations and provide insight into potential limitations of the recommendations to refine population-level strategies. Individuals with lived experience should be involved in future research involving monitoring of the gambling industry and assessing the impact of regulatory measures to strengthen the process of evaluating and adapting policies.

Addressing gambling harm to affected others: A scoping review (Part I: Prevalence, socio-demographic profiles, gambling profiles, and harm)

Awareness is growing that gambling harm can affect social networks, including family members and friends. This scoping review broadly aimed to examine contemporary research on gambling harm to adult affected others, covering prevalence, socio-demographic profiles, gambling profiles, and harm (Part I); and coping strategies, assessment, and treatment (Part II). A systematic search of electronic databases identified 121 studies published from 2000, 88 of which related to prevalence (9.9 %), socio-demographic profiles (6.6 %), gambling profiles (4.1 %), and harm (71.9 %). Prevalence estimates in the general population ranged from 4.5 %-21.2 %, though these may overstate direct harm by focusing on exposure to problem gambling. Socio-demographic profiles are mixed, but women are more often affected family members and men are more often affected close friends. Affected others also have higher gambling participation and problems than non-affected individuals. Gambling problems harm an average of six others, who experience an average of seven harms, many of which persist beyond problem resolution, resulting in reduced quality of life. Studies consistently identified harm across multiple domains of harm, with emotional and relationship harms the most common, followed by financial and health harms. Harms were consistently identified using measures with and without direct reference to gambling, but equivocal findings were most evident in research employing standardised measures that did not directly reference gambling. There was some discordance in harm perceptions between gamblers and affected others, suggesting differing family experiences. These findings highlight the need for targeted action by governments, industry, researchers, and service providers to protect affected others from gambling-related harm.

Addressing Gambling Harm to affected others: A scoping review (part II: Coping, assessment and treatment)

Public health definitions of gambling-related harm include risks to family members and friends. This scoping review broadly aims to identify recent research on addressing gambling harm to adult affected others, focusing on prevalence, socio-demographic profiles, gambling profiles, and harm (Part I); and coping strategies, assessment, and treatment (Part II). A systematic search of electronic databases identified 121 studies published from 2000, with 82 focusing on coping strategies (22.3 %), assessment (21.5 %), and treatment (39.7 %). Findings revealed affected others employ various coping strategies, which can be gambler- or family-focussed, before accessing other forms of support. Common strategies include financial strategies and informal support but few studies have assessed their effectiveness. Few brief fit-for-purpose instruments with adequate psychometric evaluation are available to assess affected other status, harm, coping, social support, and help-seeking. Affected others are under-represented in treatment (8 % in general practices, 15 %-26 % in online gambling services, 30 %-43 % in gambling helplines), largely due to various barriers, including a lack of service awareness and shame. Low-intensity internet-delivered interventions show promise and can reach affected others who would not otherwise receive professional help. Other affected other interventions, which can be gambler- and/or family-focused, demonstrate good acceptability but somewhat limited efficacy, while couple interventions demonstrate some promising outcomes, although more rigorous evaluations are needed. The diverse treatment needs and preferences of affected others, coupled with the relatively limited efficacy of current treatments, highlight the need for the development of tailored interventions. The findings of this review can be used to inform clinical, research, and policy decision-making.

Involving lived experience in regional efforts to address gambling-related harms: going beyond 'window dressing' and 'tick box exercises'

BACKGROUND

Lived Experience (LE) involvement has been shown to improve interventions across diverse sectors. Yet LE contributions to public health approaches to address gambling-related harms remain underexplored, despite notable detrimental health and social outcomes linked to gambling. This paper analyses the potential of LE involvement in public health strategy to address gambling-related harms. It focuses on the example of a UK city-region gambling harms reduction intervention that presented multiple opportunities for LE input.

METHODS

Three focus groups and 33 semi-structured interviews were conducted to hear from people with and without LE who were involved in the gambling harms reduction intervention, or who had previous experience of LE-informed efforts for addressing gambling-related harms. People without LE provided reflections on the value and contributions of others' LE to their work. Data analysis combined the Framework Method with themes developed inductively (from people's accounts) and deductively (from the literature, including grey literature).

RESULTS

Four themes were identified: (1) personal journeys to LE involvement; (2) the value added by LE to interventions for addressing gambling-related harms; (3) emotional impacts on people with LE; and (4) collective LE and diverse lived experiences. Two figures outlining LE involvement specific to gambling harms reduction in the UK, where public health efforts aimed at addressing gambling-related harms coexist with industry-funded programmes, are proposed.

CONCLUSIONS

Integrating a range of LE perspectives in a public health approach to gambling harms reduction requires local access to involvement for people with LE via diverse routes that are free from stigma and present people with LE with options in how they can engage and be heard in decision-making, and how they operate in relation to industry influence. Involving LE in gambling harms reduction requires enabling people to develop the affective and critical skills necessary to navigate complex emotional journeys and a challenging commercial and policy environment.

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.