Gambling addiction in young people - an issue for social work

Professional Social Work magazine - 8 October, 2019

The tragedy of Jack Ritchie, who committed suicide aged 24 after struggling with gambling addiction, highlights a problem that must be taken seriously by social workers and other agencies working with young people.

Beginning when he was at school, his addiction quickly grew into a serious problem. Particularly significant was his addiction to fixed odds betting terminals, which have come into the public’s focus in recent times.

Gambling is not often considered a child-protection concern on its own and even when present in children with complex emotional and behavioural issues, isn’t normally high on practitioners’ agendas. This must change. It is well known that emotional wellbeing and environmental factors are key indicators of addiction issues and that means children in need and looked after children are especially vulnerable in this arena.

In June this year the NHS announced plans for the first dedicated gambling addiction service for young people.

Simon Stevens, the chief executive of NHS England, said: “The links between problem gambling and stress, depression and mental health problems are growing and there are too many stories of lives lost and families destroyed. This action shows just how seriously the NHS takes the threat of gambling addiction, even in young people, but we need to be clear – tackling mental ill health caused by addiction is everyone’s responsibility – especially those firms that directly contribute to the problem.”

The clinic has just opened in Leeds and will be followed quickly by 13 others including facilities in Sunderland and Liverpool.

Claire Murdoch, NHS England’s national director for mental health, said: “This has the potential to be a major turning point and it is all about making sure the NHS does everything it can to help people of all ages, who are seriously addicted to gambling. There is already a big push to transform mental health services across the board for children and young people and the specific focus on gambling related addiction is the logical next step, particularly given the explosion of online gambling.”

Once referred to a clinic, psychiatrists and clinical psychologists will work with patients who could have a range of complex gambling related difficulties, including:

• A lengthy period of problem gambling with little or no abstinence.
• Mental health difficulties, compulsive behaviours, risk of self-harm or substance misuse.
• Developmental disorders such as ADHD, ASD or difficulties with cognitive or intellectual functioning.
• Adverse experiences in childhood that might underlie the gambling problem.

The Gambling Commission's recently published annual report on Young People and Gambling shows the following areas of concern:

• 14 per cent of young people gamble regularly and this figure is higher than those who smoke, drink or take drugs
• This number equates to over 450,000 young people and is two per cent higher than in 2017
• Of this number 55,000 young people have been labelled as problem gamblers
• Six per cent of respondents had gambled on gambling premises while seven per cent had gambled privately with friends and five per cent had played a National Lottery game

This research also points to a near doubling of at risk and problem gamblers since 2014 and although there may be technical reasons for some of this increase it still represents a significant concern. It does not include recent concerns on gaming and loot boxes which is suggesting that young people are being drawn into gambling by this methodology. With one single game, Fortnite, grossing over two billion dollars annually from such revenue streams, experts appear right to have such concerns.

Research in the United States is compelling. It points out that gambling has a massive impact on the reward centres in the brain and that these are the same reward centres impacted by alcohol and other substance use.

The other part of the brain that is often implicated in gambling and substance use disorders is the prefrontal cortex. This region is involved in decision-making, controlling impulsivity, consequential thinking and cognitive control. Several studies have shown that problem gamblers and drug addicts both showed less activation of the prefrontal cortex in response to gambling.

Research commissioned by a leading UK gambling charity, GambleAware, found that problem gamblers were six times more likely to have suicidal thoughts or try to take their own life – and could be 15 times more likely to do so.

The elevated risk remained even when correcting for other contributing factors that might be linked to suicidal thoughts, such as depression, substance abuse and financial problems.

What practitioners have identified is that addiction resources need to include a multiplicity of interventions that are user friendly and allow young people to work with their parents and services that work with them.

These include social, psychological and pharmacological solutions that bear on the knowledge of addiction and treatment options and an understanding of talking therapies such as motivational interviewing, cognitive behavioural therapy, dialectical behavioural therapy and Prochaska and Di Clemente’s theory on the cycle of change.

Some practitioners are likely to minimise the corrosive emotional impact of gambling to focus on more obvious addiction and emotional issues. Resources need to address this. Giving social workers a set of tips and tools they can use to engage with and empower young people who are wrestling with gambling issues would be a good place to start.

This needs to include the intersection of motivational interviewing and the cycle of change. An understanding of this will allow parents and practitioners to engage in ‘change talk’ which is a vital component of the motivational interviewing model. This can happen very easily by using methodologies like looking back and looking forward. These are specific tools to allow young people to explore how their lives looked like before problematic gambling became an issue. This allows them to explore what their life looked light and what were the strengths they had that they could draw on now. In addition, it allows young people to explore the future and how their lives could look like if they decide to change.

Practitioners are beginning to look at neurological models, specifically ones that focus on the development of the reward system of the brain. The connection between the limbic system and the frontal cortex will be explored and this will allow parents and worker to replace the rewards offered by gambling in other ways. These will include more controllable positive risks like sport and outward bounds activities. These offer high rewards with achievement and self-esteem building activities.

From the research that has been published and using my 30 years’ experience of working with young people who have addiction issues these are some tips for practitioners:

• Make connections with young people. Workers cannot change behaviour without understanding the young people that they work with

• Change is not easy, and workers need to work with established change models and look to understand why young people are gambling

• Understand the young person’s motivation to gamble and work with that. Find out why they want to do this and explore avenues that will allow them to get a similar buzz in a less harmful way

• Do not minimise the damage being done by gambling. Practitioners are often fixed on abuse and neglect and that may lead them to miss other damaging behaviours, particularly with young people with multiple need

• Try and understand how the world of gaming is developing and how this can lead young people into addictive behaviours. Read about loot boxes and the like

• Be aware of your own thoughts and feelings about gambling and reflect on how that may impact on your interventions

Ian Butler is gambling expert at The Training Hub (www.thetraininghub.co.uk), which provides specialist training courses across education, and health and social care

This article is published by Professional Social work magazine which provides a platform for a range of perspectives across the social work sector. It does not necessarily reflect the views of the British Association of Social Workers