GPs should routinely ask all patients who may be at risk of gambling-related harms about their habits, and guide affected patients to treatment services, according to a first-ever clinical guideline published today by NICE.
The new guideline, which was first published in draft in 2023, says GPs should target patients for discussion about gambling harm based on a number of risk factors. These include patients who attend appointments about depression, anxiety, or thoughts about self-harm or suicide; or in relation to a possible addiction such as alcohol or drug dependence.
Other patients who could be at risk of gambling-related harm include those suffering from post-traumatic stress disorder (PTSD), personality disorder, or attention deficit hyperactivity disorder (ADHD). GPs should also target patients who take medication that may affect impulse control, experiencing safeguarding issues or violence or a family history of gambling, NICE said.
Patients who have been identified as being at risk should be encouraged to assess the severity of their gambling-related harms by completing an NHS questionnaire based on the Problem Gambling Severity Index (PGSI). Patients with a score of eight or above should seek specialist gambling treatment, while those on lower scores may also benefit from support.
The NHS became the main commissioner of gambling treatment as a result of the new gambling levy brought in in 2023, raising £100m per year. So far there are 15 NHS gambling clinics across England, seven of which were opened last year, with a capacity for 3,000 patients a year.
According to NICE, GPs and other health and social care practitioners need to ‘take action’ to ensure patients at risk of gambling-related harms are not prevented from accessing support and treatment due to stigma, shame and fear of disclosure.
They should use a tailored approach to meet the needs of each person, including offering ‘vocation-specific services’ such as veteran’s groups or which take account of ethnic background and religion, NICE said. Gambling treatment services should consider involving partners or family members when working with patients, the guidance added.
NICE said it is ‘working closely’ with the Department for Culture, Media & Sport (DCMS), the Department for Health and Social Care (DHSC) and NHS England on the guideline’s implementation. However, it acknowledged in a statement that ‘implementation will not be immediate’.
NICE chief medical officer Professor Jonathan Benger said: ‘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.’
NHS England clinical director for primary care Dr Claire Fuller said: ‘We welcome NICE’s decision as gambling can have a massive impact on people’s lives and the lives of the people that care for them, and as healthcare professionals, we need the right tools to help tackle gambling-related harms.
‘Over the past few years, the NHS has made significant progress in expanding treatment for gambling addiction with the rollout of 15 specialist clinics across the country.’
The specialist clinics are in Sheffield, London, Milton Keynes, Thurrock, Bristol, Derby, Liverpool, Blackpool, Preston, Leeds, Newcastle, Manchester, Southampton, Stoke-on-Trent, and Telford. NHS England aimed for up to 3,000 people over the age of 13 to be treated across these clinics in a year.
NICE guidance: Asking about gambling
These recommendations are for healthcare professionals and social care practitioners in all settings including the criminal justice system.
1.1.2 Consider asking people about gambling (even if they have no obvious risk factors for gambling-related harm) when asking them about smoking, alcohol consumption or use of other substances (for example, as part of a holistic assessment or health check, when registering for a service such as with a GP or in contacts with social services).
1.1.3 Ask people about gambling in the following situations because they may be at increased risk of gambling-related harm:
- when they present in any setting 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 they are taking medicines that may affect impulse control, for example, dopamine agonists for Parkinson’s disease, or aripiprazole for psychosis; see NICE’s guideline on Parkinson’s disease for advice on managing and monitoring impulse control disorders as an adverse effect of dopaminergic therapy
- at each key contact with the criminal justice system (for example, with the police, liaison and diversion services, probation services, courts and prisons)
- when they present in any setting with problems relating to alcohol or substance dependence, especially use of cocaine
- when they are at risk of or experiencing homelessness
- when they share that they have financial concerns
- when there are concerns about safeguarding issues or violence, including domestic abuse
- when they share that there is a family history of gambling that harms or alcohol or substance dependence.
1.1.4 Consider asking people about gambling if they may be at increased risk of harm:
- because they have a neurological condition or acquired brain injury that leads to disinhibition or increased impulsivity
- because they are a young person who has recently left home for the first time
- because of their current or past occupation, for example, armed forces personnel, veterans, people working in the gambling or financial industry, and sports professionals.
1.1.5 Take into account that having multiple risk factors may have a cumulative effect and further increase the person’s chances of experiencing gambling-related harms.
1.1.6 Use direct questions to ask people about gambling, such as: ‘Do you gamble?’ or ‘Are you worried about your own or another person’s gambling?’. Be aware that some people may find it difficult to talk about gambling.
1.1.7 Encourage people who have concerns about gambling to assess the level of gambling-related harms by asking them to complete the questionnaire available on the NHS website
Source: NICE
A version of this story was first published on our sister title Pulse.
