BEAT the FIX

No Such Thing as “AN ADDICT”

Since we live in a sea of shared meanings for words we have to accept that there is something called ‘addiction’. One problem is that the word comes loaded with negative implications. It is put out in the cold by mental health services, left to itself in ‘addiction services’. In reality though, a person identified with having an addiction is experiencing the most frighteningly awful mental and emotional agony. This agony is amongst the most pervasive woes in our society. But you’ll usually hear ‘experts’ say thigs like, ‘Addiction sometimes causes mental disorders’. Which is as daft as saying something like, ‘Schizophrenia may lead to mental disorders’.

Certainly, ~~addiction~~ does find its own sections in medical manuals, though it’s often dressed up with phrases such as ‘alcohol dependence syndrome’. These medical manuals are headed by the psychiatrists bible, the Diagnostic and Statistical Manual. (DSM). This has gone through many versions. We’re currently at DSM 5 (revised). Each new version has added hundreds of ‘new’ psychiatric illnesses. It’s put together by a team of psychiatrists who agree that these ‘disorders’ exist, and describe how to spot them. You may think you’re shy but if you check the manual you’ll discover that really you’re suffering from quite a list of disorders such as ‘social anxiety disorder’. If you are gay and checked for disorders up to 1973 versions of the manual you will find that homosexuality is categorically defined as a mental disorder, one of many such from a range of sexual ‘perversions’.

In practice, there are psychiatrists who specialise in ‘addiction’, along with many therapists (especially if you can afford them). As for treatment and diagnosis, you’re likely to get three different suggestions from three different psychiatrists. Treatment and diagnoses vary widely too across different countries and cultures. The chances are not good that you will meet up with a wise, kind psychiatrist who will treat you as a human being rather than treating you as something broken to be fixed with medications. In any case, the effect of the Tory government’s 2010 onwards policies around ‘addiction’ have seen both a savage cut in services and a cut in specialist doctors.

Commissioners (the people who dish out money for services) demand results, evidence of successful ‘outcomes’ within limited time frames. The whole tendency of mental health support to be characterised by cost analysis, quantifiable ‘recovery rates’, effectiveness and productivity means that a person becomes a unit on a conveyor belt. Many excellent charities and other third sector organisations have closed after losing funding because they could not meet the rigid requirements of evaluation. So, for instance, whereas anybody with the slightest understanding of human suffering knows that some people will need years of support including attention to social needs such as housing, each unit in the current model is expected to ‘get well’ in six weeks.

If you’re lucky and can survive the waiting list you may get a short course of cognitive behavioural therapy for anything from suicidal despair to mild depression. CBT is greatly over-hyped. It is very helpful for many people but utterly inappropriate for others. Similarly, medications such as ‘anti-depressants’ work no better than sugar pills for half the people prescribed (and that’s a lot of people). Even worse, despite years of denial from Big Pharma and psychiatrists, it can no longer be hidden that withdrawal from these medications can be devastating – and GPs are not yet aware enough of these dreadful withdrawal effects. Again, for some people medication helps (anti-depressants seem to be good for people with severe depression, not for the majority who suffer mild to moderate depression).

Given that commonly presented mental and emotional distress is diagnosed with one of the many types of depression and/or anxiety and treated with the conveyor belt approach of pills and/or talking therapy such as CBT (and there are 500 other talking therapies around as well as CBT), may we ask what has become of the unique individual, their unique feelings and expressed needs, their very humanity?

If this is the case for ‘respectable’ illnesses such as depression and anxiety, what hope for those seeking help with dirty ‘addiction’? What universal, abstract boxes do people find themselves put into? In the case of gambling, only 3% of those in need of support receive help although the NHS gambling clinics in England are a welcome development. Probably it is true that for the majority of people who are sad, traumatised, despairing, broken, maybe just totally flat and merely surviving, informal human support is best. Those with similar experiences (but never, never identical experiences) are, as throughout history, the greatest source of encouragement, support and hope. Groups like 12-steps and SMART Recovery, recovery cafes, groups for men or women suffering various mental and emotional distress, all of these work more than pills and experts for most people because they are community which means com-unity which means with unity which means all for one and one for all. You won’t find this in a syringe, a bottle, a bookies. Or a waiting room.

If you are seeking help, don’t exclude doctors but be aware of their limitations (which is not their fault of course) in terms of the above, and the tremendous pressures to wheel them in and get them out as fast as possible. You may have the good fortune to have a doctor who really does have the human factor and who somehow against tremendous odds finds time to share with you their common humanity. Some doctors will reach for the prescription pad perhaps too quickly; the best will often only prescribe pills as the very last resort, and support you to find much healthier ways to tackle distress than ingesting drugs. Like so much in life it’s down to luck. Many of us have had the good fortune to encounter a doctor, a teacher, a priest, just a human being, who has changed our life for the better.

Seek humanity first and foremost. But don’t forget the hugely supportive services that can address aspects of life that need support. Citizens Advice is an excellent place to start for many people. If you’re not comfortable in one GA or AA group find another. If you are a woman who doesn’t feel attracted to what tend to be male dominated groups go online and find others in your position – or start your own group. Doing something like starting your own group can be empowering for those who feel powerless. Avoid any service or group or individual that seems cocksure of itself as the only path to heaven. Avoid those who are constantly congratulating their own excellence, boasting about themselves. Look for those who are tentative, those who use words like ‘perhaps’, ‘maybe’ or ‘possibly’. Nobody can sell you a perfect future, and those who pretend they can are no better than snake oil merchants.

You may find yourself one day sitting next to somebody very different than you. Much older or younger, a different gender, a Christian or Muslim or atheist, a criminal or a vicar. Somebody whose life, like yours, is totally unique, and whose character and inner experiences of woes and joys is so different than yours. That person may become your best friend. For whatever our differences we share a common core of humanity. You or they are not ‘addicts’: you are a vital spirit who may have lost sight of that because, for now, you and they and we suffer from what, for convenience only, we call addiction.

Beat the Fix: looking back and forwards

John who lost his son to gambling. A still from our forthcoming film ‘One Last Spin’

Quite some time since we set up The Machine Zone, our community interest company – which sounds la-di-da but has actually been two guys working hard to contribute a little bit to raising awareness about gambling damage, and campaigning to get harms reduced. It’s felt like the equivalent of a fulltime job with lots of overtime but we are just one of hundreds of similar individuals and small groups. We’re not remotely in the same area as those receiving millions in funding from the gambling industry and nor would we ever wish to be.

We started by focusing on the scourge of fixed odds betting terminals in bookies shops. Along with many other victims with lived experience we campaigned against this ‘crack cocaine’ of gambling. Many members of parliament, some newspapers, more than a few academics, social justice organisations, churches, city councils, British medical and psychiatry associations, and many prominent individuals were also campaigning and these machines had their maximum stake reduced from £100 to £2. So instead of being able to lose £300 in a minute of roulette, the most popular game, you could now lose ‘only’ £6 – or more than £300 in an hour. They continue to represent a cause of harm, especially in the most deprived communities where bookies cluster. The ARCHIVE section of this site contains stuff about these machines and the campaign.

Of course, the focus now is on the casino in your pocket, the saturation advertising and enticements to gamble 24/7, the grooming of children via loot boxes, the embedding of gambling into football and other sports, and the harms arising from scratch cards including those promoted by the National Lottery. While the latter does indeed fund many not only worthy but often life saving causes, there is growing concern that especially the poorest people are being harmed by its products. They also contributed to the £1 billion profit of the firm behind the lottery, Camelot, over the lockdown period. One may question also whether as a society we want vital services funded by gambling which disproportionally may harm the most vulnerable.

Anyway! We won’t be seeking funding from the National Lottery. We did get NHS funding this year, our first ever funding, for our anti-stigma work which includes a new website that features a compelling interview with Martin, the main man behind all our work. We’re now well into production of a film, One Last Spin, delayed by lockdown but scheduled for a premiere in December. Then in 2022 we will be doing screenings in community venues. These will initially be in Glasgow but we’re hoping to take it all over Scotland in the future. Looking forward to a trip to the Orkeny Isles!

The film features interviews with four people, including Martin, who have experienced dire harm from gambling. Complementing the interviews will be dramatised sequences to go with each story. Also in the film is Ronnie Cowan MP Inverclyde and Vice-Chair of the All Party Parliamentary Group on Gamblingg Harms, Professor Gerda Reith of Glasgow University who has many decades of research into gambling, and Will Griffiths who led the Alliance Scotland Health & Social Care) project to set up forums of lived experience throughout Scotland. He’s since left to take up a role as policy advisor with the Scottish government. We welcome his replacement, Georgina Charlton and greatly look forward to working with her.

We’d further like to welcome Fay Laidler who from October, as part of a PhD project, will be complementing the Alliance work by seeking to establish lived experience testimonies from women and Black, Asian & Minority Ethnicities.

Made up too to welcome Chris Lee as a Machine Zone Director. He’s building up a much-needed peer support service in Scotland called Chatter.

Our work over the past four and a half years has been hard and tiring, sometimes discouraging, but we’ve been surrounded by so many wonderful individuals and groups fired with passion to tackle a big source of distress and misery to so many. We’ll never walk alone, and we’ll carry on doing our little bit.

Stigma: Tell Your Story

Stigma, shame, guilt can be a heavy load to bear leading to a horrible sense of isolation with nowhere to turn.

We’re working on a project, to be delivered online by March 2021, which aims to reduce the stigma around gambling by awareness-raising, provide ideas for individuals to cope with stigma, and share lived experience of gambling stigma. How bad was it? Did it stop you – or does it stop you – from reaching for support? Did you find ways to handle internalised stigma and the deep sense of shame or guilt that went with it? Was stigma particularly worse for you because, for instance, you are a woman or member of a community which has strong condemnation of addiction?

We’d love to hear from you. A short piece of writing maybe, using a pen name if you like. Or a long piece. Would you be prepared to take part in a Zoom session to discuss various aspects of gambling stigma? In all cases we will respect requests for strict anonymity.

Sharing your story will help others immediately to see that they are not at all alone in their feelings of isolation and any shame or guilt, that these are further intense bad feelings that come with addiction. Any ways you found to cope with stigma will also help people greatly.

If you can take part please send us your thoughts. As said, short or long – and sometime one or two sentences can be powerful. Please indicate whether you’d be prepared to consider taking part in a Zoom event.

We’re also very keen to hear from organisations working in the gambling field which have experience of how damaging stigma is to people they work with.

Please respond by email to

themachinezone@planetmail.net

or DM us on our twitter handle, @themachinezone.

Get in touch too if you have any questions.

Some Statistics about Perceived Profits by Gamblers

Alarming UK Gambling Statistics, Sports Betting Data & Research 2020

Gambling and the Attention Economy

The gambling industry does not exist in a vacuum, nor does the consumer of products. Every business seeks to grab our attention – through advertising, social media and other ways. As individuals, we are saturated by claims on our attention. Our shared psychology in the digital age is marked by fragmented impulses, by accelerated time, by an imperative ‘normality’ that works against any hope of rest or peace.

The 24/7 stream of hooks on our attention is relentless. In the case of gambling, this is supplemented by products themselves which are designed to be addictive. They offer, paradoxically, a single point of attention which is, like any addiction, the release from the never-ending pressures of time, the chaos of information.

Drawing on fifteen years of field research in Las Vegas, anthropologist Natasha Dow Schüll shows how the mechanical rhythm of electronic gambling pulls players into a trancelike state they call the “machine zone,” in which daily worries, social demands, and even bodily awareness fade away.

Competition for our attention is intense and part of trillion dollars budgets of digital industries. If you have never made an impulse purchase from the internet you are very much the exception. We have to acknowledge the possibility that our growing restlessness is a digitally induced dis-ease with time. What are referred to as clinical diagnoses, attention deficit disorder or hyperactive attention deficit disorder, may be now normalised attributes of digitized citizens (to varying extents in individuals).

In practice, we are primed by digital technology to be restless and compulsive. It is not a question of individual responsibility or strength of character. The exploitation of this primed state is the core driver of the attention economy.

Digital Health: Gambling

If you were recovering from drinking alcohol too much, it wouldn’t be a good idea to carry a bottle of booze around with you. These days, even carrying a mobile phone would be risky as in most cities you can order drink to be delivered 24/7 – for a lot of cash true, but when you’ve ‘got a habit’ any financial sense is the last thing that will protect you.

With gambling the problem is much worse. Unless you get rid of your phone and every other digital device you constantly have a casino in your pocket or near at hand on your other devices, 24/7 – in bed, at work, driving, on the bus or train, watching sports on television. And you’ll be assailed by precisely designed marketing to ‘enjoy’ playing ‘games’ precisely and scientifically designed to be potential instruments of addiction. Or instruments of torture.

You have choices with alcohol. Pour it down the sink. Avoid socialising with drinkers, at least early on in your recovery. Don’t carry it with you. Obviously.

But with gambling, unless you completely cut yourself off from the digital world, the supply is there by default. It follows you wherever you go. Younger people are ‘digital natives’. To them gambling is a completely normal and fun activity, especially associate with sport and sporting heroes. Loot boxes and other ‘games’ blur the boundary between childhood behaviour and adult ‘fun’. Every kid wants to grow up and act like the adults. Immersed in constant usage of digital devices – for good or ill – the ease of quick-thrill access to gambling, pornography and drugs (the latter just a text message away for quick delivery) puts many – not all – young people in harm’s way. What age checks may officially exist are easily circumnavigated. In the digital world you are not a thirteen-year-old you are a bundle of data. Very profitable data.

On our main site, The Machine Zone, we have begun to examine the huge area of what is known as Digital Health. This phrase is riding like a juggernaut through health services including the NHS and is already a multi-trillion dollar corporate industry. It is heavily promoted as A.Very.Good.Thing. In many ways it is and will be: there can be no doubt about that. But we’ll be looking at some more precautionary views. While data sharing can speed up and enhance healthcare, for instance, there are concerns about privacy. There’s also the question of whether a consultation with a human doctor may be more beneficial than diagnosis and treatment via remote apps and algorithms.

Well, it’s also the case that digital health should, in the interests of prevention, consider the digital causes of illness and ill-being. There are, in the case of gambling, many apps which prevent digital bank transactions – and credit card transactions are now illegal. One may ask, and be certain to be fiercely argued against, whether a truly effective preventive method may see the complete banning of all digital online gambling and hence marketing. Such a radical move, even the proposal, is enmeshed in the fundamental political questions around business and personal freedom, business and personal responsibility, loss in tax revenue, and – of course – the deprivation for millions who enjoy a little flutter responsibly and safely. Even tobacco regulation hasn’t gone nearly so far, and surely tobacco causes far more illness and death than gambling. All true.

It is hard to see where treatment for people with gambling-related distress may develop. ‘Addiction services’ in the UK have been decimated since the government transferred responsibility to local councils reeling under budget cuts. Stigmatising attitudes in all mental health care are institutionalised. Medical professionals, through no fault, do not have the knowledge and experience to help. Stigma prevents many people admitting to problems and seeking what help there may be. That help is there in some geographical regions (although in Scotland there are no dedicated gambling services). Anti-stigma projects around mental health are proving of some success: people generally are willing to identify their own issues, such as depression, and seek help. Perhaps one way forward to destigmatising gambling issues is to launch an ongoing social media campaign – the very social media that have proved their weight in gold to businesses of every shade. Funding for such a campaign is unlikely; less so a willingness to see the need for such a campaign.

The weight of prevention of gambling harms has been given over to schools and social enterprises funded ultimately by voluntary donations from the gambling industry. There is much good work being done – along with some not so good work. The big problem is that educational initiatives have behind them a paucity of evidence, research and effectiveness evaluation. Whether by design or not, the weight given to education repeats the dominant ideology of modern capitalism: individuals are responsible for their choices and behaviour; individuals identified as ‘pathological’ or ‘failing’ should be given support but ultimately everything is down to them. The responsibility of industry is thereby de-emphasised – in the case of gambling, the industry’s social responsibility to ensure harm minimisation by discontinuing harmful products, marketing and willingness to reduce profits in the name of rigorous procedures to monitor and prevent individual disasters. Not everybody will agree with this; some will vigorously disagree. That’s life, that’s politics, and no one anywhere can press a magic button to produce a win-win. The savage legal restrictions faced by the tobacco industry, the negative social perception of tobacco, emerged after more than 50 years of furious debate. While it’s true that the comparison between gambling and tobacco is often too heavily simplified and overstated, from a health perspective there remains a good deal to learn good lessons.

One of the dangers around ‘digital health’ is that it is embedded in wider ideological worship of data and algorithms. Buzz-words are efficiency, cost-saving, productivity. Unsurprisingly, the same words are almost holy icons in business. It can tend to work at a population level, seeking to insert a living human individual into a categorised ‘box’. It was the philosopher Kierkegaard who said, ‘To label me is to dehumanise me’. Sadly, in our ordinary lives we do tend to label people: ‘waster’, ‘junkies’, ‘alkies’. Big Data takes labelling into the realms of a high art, an ethereal cloud of digital bits totally disunited from the hearts and souls of a whole, living individual with all that means. The word ‘whole’ is where we get the word ‘health’ from. In seeking and recognising the unique wholeness of a person we have to go beyond statistics, data and ‘evidence’. That’s why it’s greatly to be welcomed that far below the data clouds the voices of individuals are being heard more and more. In health generally, perhaps most visibly, ‘Experts by Experience’ are coming to the fore. In what relatively little gambling research there is, there is a turn away from quantitative data-crunching towards qualitative research focused on individual human experiences, the voices of whole individuals. Such approaches may, of course, be appropriated by powerful stake-holders, including the researchers themselves, to ultimately hide those voices. Yet it cannot be denied that the gathered voices of ordinary people have been successful in so many ways in ‘bottom-up’ challenges to policy making so often driven drom the ‘top-down’.

We live in a digital world, breathe it, an air as invisible and taken-for-granted as the sea is by the fish that swim there. But we aren’t bits of cork bobbing about and carried this way and that by environments over which we have no control. We are not bits of data, we are human beings rich with the powers of solidarity and more power than we sometimes realise to make a better world just by being who we are.

The Problem with “Problem Gamblers”

In the bad old days, among the cruel behaviours of teachers was to make a child sit facing a corner and wear a hat with ‘Dunce’ written on it. If that didn’t make them learn and behave properly, a child could expect a thrashing for their irresponsible waywardness.

More progressive education renamed ‘dunces’ as ‘problem children’.

Now, of course, in more enlightened times we speak of ‘problem schools’ as the main reason for between a quarter and a fifth of school leavers being functionally illiterate after eleven years of education. It has been a great leap forward for society to recognise that the ‘problems’ may have something to do with the education system itself.

This month (July 2020) has seen the UK government launch a ‘war on obesity’. Proposals include advertising bans, stopping two for one incentives on junk foods, public health campaigns, taxes on industry, education, more help from primary health care and so on. There are critics of all this. They say that people should be able to eat whatever they want to, they are free to make their own choices and shouldn’t have that freedom removed by the nanny state. Parents, they say, have the right to feed their children whatever they like. The fact that unhealthy, fattening food is cheap should not stop poor responsible people making sensible meals with basic nutritious items such as turnips: if they can afford widescreen televisions and smartphones , they can afford to eat well. But such is the devastating impact on health and the economy, the state is now proposing to get tough, go beyond voluntary industry actions and the good sense of consumers.

After decades of denial the tobacco industry accepted that their product was both addictive and highly detrimental to health. Stringent government action has seen a huge fall in the number of people smoking. A total ban on advertising and marketing, removal of branding on cigarette packs along with reference to tar and nicotine content which some took to allow for a choice of ‘safer smoking’, severe annual rises in duty, a ban on smoking in public places, and the hiding from sight of tobacco products in shops. Alongside this, smoking cessation programmes are free to everybody. Individuals remain free to use tobacco if they so wish.

These days, at the tobacco counter in a shop, the tobacco products are screened from sight. (It’s worth noting that alcohol is still freely on display, but that’s a different story for now). At the front of the counter, inches from the customer are advertisements for the National Lottery and a range of scratchcards priced from £1 to £5 each. Like sweets placed at a supermarket till they make impulse purchases more likely. They’re also an indicator of how normalised respectable gambling has become. A website called casinoplay.com warns the public that ‘it can actually be quite hard to win one of the top prizes.’ It advises that to increase your chances you should buy scratchcards in bulk.

The Myth of the ‘Responsible’ v ‘Problem Gambler’

Unlike smoking and obesity, the risks associated with gambling aren’t associated with physical health (except in the many tragic cases of suicide). Gambling risks include financial ruin, turning to crime, family and relationships breakdown, mental illness. Many sources of information refer to the incidence of gamblers running into such conditions is ‘only’ 0.5% of the adult population (the same way as ‘only’ 0.5% of the the population are schizophrenic). There are other figures for children and young people, and for adults ‘at risk’ of being in the 0.5%. Data is never simple. It isn’t always available. It’s a snapshot of a previous period in time. It requires interpretation – and these interpretations differ. But if the 0.5% figure is taken as it is, given the personal suffering indicated above, plus the damage to immediate others such as family, plus societal costs is not that alone reason to give gambling damage the same weighting as a serious mental disorder such as schizophrenia? And unlike schizophrenia which, although it can be managed and treated well, in many cases very difficult to treat and manage, are not problems associated with gambling more easily attenuated using the approaches we have seen with tobacco, and beginning with junk food?

Yet it’s sometimes implied that if there are only 300,000 or so people in deep trouble because of gambling, that’s all right. They didn’t stop when the fun stopped. No one made them spend much more than they could afford: they were irresponsible. It was down to their having that much-cherished freedom to chose, but making the wrong choices. Many millions more enjoy the fun of a flutter. The appeal to the ‘millions who safely (and responsibly) enjoy a flutter’ is something of an industry catchphrase, and it needs unpicking.

Having placed the ‘problem gamblers’ into a sort of pathological ghetto, the logic goes that everybody else is a ‘responsible gambler’, enjoying a harmless flutter. This isn’t so.

In all our lives fortune rises and falls, and this is more nearly literal in the case of the regular happy flutterer. A regular bettor or gambler will win some, lose some, and for the great majority, over time will lose more than they win. Winning £25 on a £5 scratchcard won’t compensate for the many weeks of getting into debt with rent or power or council tax after buying four such cards each week. The strain on marriages and families will increase as essential money leaks into slots or online gambling. The wage packet won’t be spent on days out with the kids or new school clothes. Things will be pawned, payday loans become essential as credit is refused elsewhere and credit cards are maxed out. Loans from friends and family go unpaid. There may be catastrophic times, perhaps a threat of eviction or repossession, survived only by a hair’s width and that survival with ongoing negative financial consequences. (Sometimes, such a catastrophe can be the impetus to stop gambling). Anxiety, depression, arguments may go with the territory. The danger of becoming one of the statistics in that ‘problem gambler’ ghetto may increase. As it is, there are many whose quality of life is negatively affected by gambling, and they don’t show up in the statistics.

Now obviously, this is painting a bleak picture. Not everybody who enjoys a doughnut or two will incur an obesity-related illness. Most people do spend money responsibly and can enjoy a harmless flutter. There is, of course, even for them a risk of going beyond the harmless flutter. Even somebody new to betting and gambling can (not will) spiral down to dangerous levels.

What’s needed is research into the ‘twilight zone’ of gambling-induced harms. This is an area which has to involve personal testimonies of experience over time. It’s especially important in relation to young people who have been nurtured in a normalised gambling environment. It may lead to a more nuanced understanding of the scale and nature of gambling harms than that offered by dominant narratives of ‘problem gamblers’ versus the rest of us.

‘One Last Spin’: Production Begun

Great that after months of delay because of coronavirus, filming has started on One Last Spin

Brilliant to welcome Kelly and John up from Merseyside and Tony Franklin (from everywhere!) for first three interviews. Powerful stuff. Lit up Glasgow on the wettest day of the year.

More to follow soon.

Where does GAMBLING EDUCATION fit in?

Article by Adrian Bailey, Director, The Machine Zone

This is a long post, sorry! Skip the preamble/disclaimer by all means.

PREAMBLE/Disclaimer

This post is a ‘light touch’ consideration of some of the questions arising around the idea of gambling education. The introduction below gives some background and points to some of the major questions.

It’s good to start, though, by stating firmly what this article isn’t. It doesn’t and couldn’t offer criticism of the many gambling education initiatives currently running. It doesn’t claim to be other than very tentative. It claims no expertise.

It does try to highlight questions underlying all approaches to gambling education. This highlighting is drawn from existing practitioners and theorists for whom such questions have always been basic.

I taught in secondary schools and then further education back in the 70s and 80s. During this time I was also engaged in educational research. I’ve never been a gambler but I have had a serious addiction and severe and enduring mental health problem. After teaching I worked in the mental health field, and in the last seven years of paid employment I worked with people recovering from various compulsive behaviours. Only in the past three years have I become familiar with the area of gambling.

Through work and personal experience I have ‘researched’ (as an ‘educated layperson’) mental health, and ‘addiction’. Like many of you I don’t like that word, ‘addiction’ but for convenience will use it here. Regard it as no more than a signpost to what we may prefer to call by less stigmatised words, and even these are only signposts to the area of personal experiences.

These experiences are painful to individuals and their immediate networks. They relate to great social costs – economic costs, of course, but also serious negative repercussions upon the health and wellbeing of society. As such, they are public health issues in the widest sense. Because of this they are political issues too. Governments allocate funding for treatment, research and more; governments also, by attending – or not attending – to the issues raised suggest the priority – or lack of priority – of the issues raised and the allocation of resources.

Since it is a political issue, it is of concern to all citizens. In a democracy, a childless citizen has the right to be engaged with education. Someone who is young and healthy will engage with the health and social care policies of government, and provision for aging people. We may be materially well-off but have the right to challenge the existence in our own country of poverty and inequality. Concern for military horrors witnessed across the world gives every citizen the right to ask of the government’s foreign policy questions about arms sales it allows. So, you don’t have to be an ‘addict’, or mentally distressed or otherwise in pain to be involved, any more than you need to be a child in poverty to care about child poverty.

So, while having a specific interest in mental health and what is called addiction, by engagement with gambling education is as a concerned citizen. I can’t see any way of framing this as other than political.

Like most important issues, complexity encourages a wide variety of approaches and attitudes. As an interested citizen layperson I follow expert understandings of due humility.

As the philosopher William Irwin has written:

We ought to regularly and open-mindedly reconsider (alternative opinions and approaches) if only to remind ourselves why we believe what we believe.

INTRODUCTION

Gambling and gaming have been around since history began. Today we see a very wide spectrum. Truly, many millions do enjoy a ‘harmless flutter’ on a lottery or bet. Some buy scratch cards at £2 or £10 a time. It’s fun! Even without money we enjoy games of chance, the throw of a dice. Kids like me bet by throwing coins against a wall, then got into cards along with the cigarettes behind the bike shed. I’m sure kids still do. It’s something we learned in school but not from teachers. From our mates and the culture of kids passed on from one generation to the next.

If you’re on unemployment benefit or a low income, ten pounds can take a chunk out of basic living costs. Power, rent, food, council tax, presents for the kids. Even what looks like a small amount can have serious consequences. When people become hooked on gambling, often people in well-paid jobs or with good incomes, they can lose many thousands, even millions of pounds. Some – tragically – are driven to suicide. Others steal from their employers and end up in jail.

In the last ten years we’ve all become aware of the damage gambling can do. In response, a 2019 survey of the general public done by the Gambling Commission found that 27% of people think it would be best if ALL gambling were banned, while 82% agree that there are too many gambling opportunities today. The media regularly report on the often tragic impact of gambling on some individuals. For instance, in July 2020 The Guardian headlined a story: ‘How the Gambling Industry Got its Claws into Kids’. Former gamblers have initiated many organisations which document individuals’ stories; these are pressure groups, campaigners aiming to bring about fundamental changes in regulation, advertising and marketing, and the ‘addictive’ nature of some gambling products. Their work is mirrored in that of many academic researchers. Politicians from all parties have been and remain intent upon bringing about reform.

The industry, whose biggest members are represented by the Gaming and Betting Council, and its supporters point out that millions of people enjoy having ‘a harmless flutter’. It distinguishes between what it claims is a ‘small number’ of ‘problem gamblers’ from the vast majority of ‘responsible gamblers’. The industry also directly funds harm-prevention organisations such as Gamble Aware and thereby directs some of its 1% voluntary levy towards education and treatment. Against this, campaigners have claimed that concentrating upon education and treatment, while important areas (in particular, treatment which is greatly under-resourced or provided), can lead to neglect or disguising of vital systemic issues such as product design, marketing and advertising, regulatory issues and conscious exploitation of vulnerable psychological attributes of the human being. Such a claim is also made at various levels by academic researchers. Rather than develop this tension here, I’ve appended some web addresses at the end to give you an idea of such research.

Education about health, finance, citizenship, alcohol and other drugs, mental health and all the other things that relate to our wellbeing is not only confined to schools and other formal education settings. Nor is it limited to youth. Public Health campaigns mount many informal educational projects. The mental health sector provides very many sources of guidance, information and learning. And, of course, kids learn from their parents, their peer group and the culture they live in – probably in some important ways far more than they learn in school. We also learn from social media. We learn from the mass media: in particular, popular music is a potent source of learning; so is television. Taking the latter, a ‘soap opera’ with a storyline about gambling or other mental health problems can provide more powerful learning than in formal settings. We also learn from advertisements and marketing. We learn, for instance, that Product X is fun, or will make us happy. Not all learning benefits us. Some addiction experts believe that an addiction is learned behaviour (as opposed to some sort of disease).

But here we’ll focus on school education, and in particular education about gambling. This is normally provided by what’s known in England and Wales as Personal, Social, Health and Economic education. This is a developing area. There is a very active PSHE association which, as well as providing resources and curriculum discussion, lobbies for greater weight and training to be given to the area. They have some excellent guidance for teaching about gambling, The extract below demonstrates just one aspect of the theory and practice of gambling education and its complexity if it’s to be considered thoroughly. The extract also demonstrates some aspects of gambling education lacking in certain other current approaches:

Understanding of gambling industry strategies to draw people in and keep them gambling, including those that exploit natural human biases and errors

Dark nudges — a term used by researcher Philip Newall— describe the techniques gambling organisationsuse to encourage participation in gambling. Researchers suggest the gambling industry utilises arange of techniques including:

- - Normalisation of gambling behaviours, particularly bycreating a perception that it is a key part of enjoyingsport entertainment

- - Legitimisation through partnering with trusted organisations(to convey the impression that gamblingis accepted by those known to be ethical)

- - Extensive advertising with particular focus on vulnerablegroups

- - ‘Free bet’ promotions and ‘welcome back’ bonuses
  - Encroachment into gaming including throughnon-monetary forms, e.g. ‘loot boxes’
  - Over-emphasising a distinction between problem and responsible gambling — encouraging people to think of themselves as responsible gamblers
  - Adverts and encouragement to bet on highly specificevents where participants are less likely to win (e.g.first goal scorer or specific scoreline)

- - Additional techniques are used in online gambling:
  - Use of ‘near miss’ outcomes exploit the human bias to try again if someone has a near miss
  - Losses disguised as partial wins (with audio and visual prompts to support this)
  - Meaningless ‘bells, whistles and associations’ makeuse of the human tendency to search for meaning in patterns

It is plausible that helping young people to become aware of these techniques can help them to be moreresilient to them.

Understanding of gambling risks and harms

Most gambling education programmes aimed at adolescents include a component on gambling’s risks and harms. This would seem an inherent part of enabling young people’s informed decision-making. Two caveats however merit highlighting: first, the recent review of school-based gambling education programmes concluded that ‘promoting a negative viewpoint of gambling and its associated consequences are not sufficient to prevent gambling problems’— therefore this should only be a component rather than the entirety of gambling education.

Second, some young people may find risks enticing rather than aversive, linked to developmental differences in perceptions and responses to risk42, so how risks are presented and discussed is important.

from How to address gambling through PSHE education

It’s important to note that the PSHE work with Gamble Aware (funded by the industry). Some have felt that any funding from industry is not permissible but the PSHE – and Gamble Aware itself – have shown repeatedly that this is not necessarily the case.

In the extract above, young people are introduced to the role of industry in gambling harms. It’s noticeable too that the sort of education mooted here is not restricted to standalone sessions. As per government advice on all PSHE it can be integrated into the whole school curriculum. English/media education (analysing advertisements), mathematics (odds and risks) for instance. The PSHE experts are fully aware of age and development needs. One also has to consider learning disabled pupils. There is an emphasis (as there should be in all teaching) on teacher delivery. Research has shown what doesn’t work and may have effects opposite to what is intended. This includes being very careful about inviting former gamblers to speak: a totally unintentional outcome may be to make gambling risks attractive. The idea that most people can gamble without problems and only a few run into trouble is dangerous too. Scaring young people is very dangerous: many young people have ‘heard it all before’ about the terrible harms of alcohol, cannabis junk food: such scare stories conflict with their deeper learning from ‘real life’. Gambling educated should not be parachuted in to occupy a few sessions like a magic pill or injection: it should be part of a carefully integrated whole school developmental curriculum. Lessons should be participatory and interactive: few teachers these days (hopefully) talk at their students or expect them to magically absorb wisdom from texts.

The purpose of the foregoing has been to suggest that providing education about gambling is complex and requires expertise. Education cannot be some simple panacea that can be ‘injected’ into a young person’s mind. In a school it also requires commitment from senior management to PSHE generally to design a developmental curriculum. It seems unlikely at present that delivery is optimal in all schools. Elsewhere, after training about gambling education (often a one day or less session) teachers have felt unprepared – or faced with an only choice of delivering a handful of discrete session to students.

Implementing gambling education requires theory partly based on what has been learned about teaching about other risky behaviours. Such research has looked at other countries. In the UK, the Alcohol Education Trust which works with the PSHE Association, founded in 2010, provides a promising future for what gambling education may achieve. The AET has had the time needed to evaluate programmes – and give statistically significant indicators of positive impact on students’ drinking behaviours. The gambling education field is new. It is, therefore, difficult for evaluation of particular programmes (the AET does compare its own work with others’). Nevertheless, by virtue of existing at all, the importance of very enthusiastic and well-managed projects contributes to establishing gambling education ‘on the agenda’. Good work is being done in this area by DEMOS, EPIC and YGAM as well as the PSHE itself as ‘insiders’ with the power to link to other organisations and provide specific expertise. In Scotland, FastForward with its emphasis on peer group participatory workshops, theatre and a harm minimisation approach has a gambling hub to complement its work in health, risk and wellbeing. Many other projects continue to occur regionally, initiated by a range of organisations.

There are many obstacles to overcome and many contradictory approaches that need evaluating but education about gambling is growing and driven by enthusiasm and a wide, varied skills base.

HOWEVER!

There’s always a ‘but’! Here are some questions I think are important though I make no attempt to answer them.

1. Within the context of all factors contributing to gambling harms is ‘gambling education’ emphasised too much and thus working to divert attention from other important factors?
2. Given the current state of gambling education which offers promise but has many basic difficulties associated with it (as suggested above) is it likely to be a significant player in reducing gambling harm?
3. How, when and by whom will gambling education programmes be evaluated and compared?
4. How, when and by whom will gambling education within school curricula be evaluated?
5. Which approaches to risky behaviours that have been evaluated in PSHE could potentially inform gambling education?
6. Should gambling education be positioned and weighted within an integrated national policy for reducing harms?
7. Given that a fifth of school leavers are ‘functionally illiterate’ is there scope for informal youth education to reach young people? (Functional illiteracy refers to minimal literacy, insufficient for full functioning in life such as ability to comprehend more than very basic texts).
8. Given that 49% of the working age population have numeracy levels less that those expected of a primary school child (National Numeracy) is it realistic to assume that all pupils will be able to engage with such things as odds, percentages etc. in delivery of gambling education?
9. Gambling problems can affect anybody but since there will be a demographic sector correlating with (7) and (8), hence less reachable by education and less capable of understanding fully the architecture of gambling, does such a group represent a vulnerable sector at risk of exploitation?

Some Links

‘Personal Responsibility’ and Addiction

One of the hottest topics relating to addiction is the concept of personal responsibility. Do addicts bring it on themselves? Are addicts morally weak? Do addicts repeatedly fail in recovery because they refuse to take on responsibility?

On the other hand, it can be rightly claimed that all this emphasis on the individual is distorting an understanding of addiction. If, as some claim, addiction is a ‘disease’ how can people be responsible for it? Why is there virtually no alcohol addiction in Saudi Arabia (where alcohol is prohibited by law)? What social factors play a part in addiction? Do some commercial products – tobacco is an example – ‘hook’ some people in the right circumstances?

There is no such thing as an addict; there are only individuals suffering with addiction. Everybody is different, but some groups seem more prone to addiction to others. In the professions journalists, the police, doctors, entertainers, sportspeople and politicians have high rates of addiction. So too do people with multiple and complex disadvantages such as homelessness, poverty, lack of educational and cultural capital, mental illness, criminal background, adverse childhood experiences, trauma – or just one of these.

And people from different social backgrounds seem to be treated very differently when their addictions come to light. Newspaper readers will weep over the death of a pop idol through drugs; a politician will be praised for his ‘brave struggle’ against alcohol. In popular culture – films, books and television – we have come to expect our flawed heroes often to have an addiction problem as one of their flaws, a lonewolf cop bucking the rules and knocking back malt whisky while meditating on a case, a singer in rehab, a public figure making public penance.

Less favourably are seen the ‘scagheads’, the ‘junkies’, the street addicts, the working class addicts. Although victims all their lives of unequal and unjust social conditions, turning to drugs or drink or gambling to escape if only for a moment, it is they who are most harshly blamed and despised for their lack of responsibility – while those with a lifetime of advantages are treated with adulation and sympathy.

In his remarkable book, Good Cop Bad War, former undercover cop Neil Woods charts his journey of increasing knowledge through the ‘low life’ of desperate addicts (in contrast to the venomous gangster business cartels that bring drugs to market). He grow increasingly sympathetic to the friends he makes while pretending to be himself an addict. Apart from their addiction, most are essentially decent, often intelligent, kind and caring. One such friend , Cammy, tells him his heart-felt news that he has heard a good friend has died. Neil asks whether he will go to the funeral to say goodbye and Cammy replies, ‘I’m not going to the funeral. I wouldn’t do that to the family. The last thing they want is some dirty junkie turning up and ruining everything.’ As Woods observes, ‘No matter how society may condemn and look down on the addict, it is never, ever as low a view as he has of himself.’

That internalisation of social attitudes and stigma is something all addicts have to deal with. Part of them remains ‘clean’ and is a constant accusing voice; the addict hates themself. Guilt and shame alone can maintain an addiction – that belief of such utter worthlessness that there is no point in trying to stop, instead seeking that absurd temporary negation of inner torment with a fix.

Of course, those with a lot going for them tend to do better. Not everybody, of course: the nature of every individual addiction, while having common attributes, is unique in the complexities of an individual. It’s probably easier on the whole if you’re, say, a teacher to have three months leave on full pay to attend rehab, or just to get your life together, than if you are without any money, any support, any care, any love, surviving in brutal conditions. Though yes, many who seem to have well insulated lives with all the support in place do succumb, grow sick and die. And yes, too, some at the very bottom recover and flourish.

There are as many as 40% of addicts who recover spontaneously, relatively painlessly, without any intervention by ‘experts’ or support organisations. A well known example of this is ‘maturing out’ whereby young people who have addictive or risky tendencies literally grow out of them when they settle into employment, get married, start a family. Another famous example is how 80% of American soldiers deemed heroin addicted in Vietnam lost their addiction when they returned to the States and their families. Against this, many others in recovery are certain that addiction is a disease for life and that the only way to manage it is by faithfully following a programme such as a 12-steps one.

A word is needed here too about dependence versus addiction. Through force of habit, culture, lifestyle, many drinkers, for instance consume not only health-damaging amounts but quantities which make them physically dependent. The withdrawal from physical dependency can be life- threatening and ideally requires medical supervision. Yet many heavy drinkers then go onto just stop or greatly limit consumption: they were heavy drinkers, not alcohol addicts. There is an additional dependence which is separate from addiction – psychological dependence. Partly this is just the force of habit, neural correlates in the brain ‘speaking’ loudly to perform an action when certain triggers arise. Usually one can become psychologically dependent on a substance or activity to avoid stress, negative feelings or often an undiagnosed mental disorder such as anxiety and depression. Dependence can, and often does, lead to addiction but it’s still possible to recognise a dependence and take responsibility for halting it with acceptance of necessary effort and suffering which will vary greatly in terms of time and intensity according to unique individuals in unique circumstances.

Addiction by its very nature, the heart of addiction, disowns the individual’s core self. It disowns the possibility of being responsible for one’s destiny, for making deep choices. No addict will be able to understand what is going on. They are fully aware of the misery they leave in their wake, of their loss of pride, reputation, money, health, relationships, status, children. They desperately want to stop. But they can’t. In the old days people spoke of a demon inside that controlled them. The demon took them over. This degree of inner torment varies from individual to individual. It’s certainly true that there are many ‘highly functioning addicts’ in all walks of life, folk nobody begins to suspect as being an addict, and, of, course, another core attribute of addiction is the addict’s propensity to deny their addiction. It’s for this reason that common wisdom has it that people must ‘hit rock bottom’ before they can start to recover. This is, fortunately, a myth. It may be true that a secret gambler’s addiction only comes to light when the bailiffs arrive to take the family home and he or she spirals into heavy debt, bankruptcy, prison or failed suicide attempts. But in many cases – often in consort with worried others – many are lucky enough to address their addiction before absolute calamity.

The foregoing suggests just a few of the strands in the complexity of an individual’s addiction. If there is a common attribute of addiction it is that to take responsibility for recovery one must already have made a vital move. This vital move, this perception that one is not only the addicted self, is the precursor of recovery. For some, this vital move is totally unconscious and involves little pain and effort, for others it is a lifelong process.

To conclude, to return to the topic of addiction and responsibility. All of us are a product of our environments, probably more so than products of our genes. Children have been sold drugs from icecream vans (dealers do not ask for age verification or advise responsible use of their products) so 12= year-olds have become heroin addicts. The vans are part of the environment, behind the vans are networks of the drugs business, also part of the environment. People continue to smoke cigarettes but on the packets is written ‘smoking kills’, and tobacco is more and more restricted by government policies: it’s recognised that tobacco addiction is not the result of weak responsibility in individuals. Campaigns to restrict and limit junk food (itself addictive), sugar, salt, fat are not controversial. People argue about minimum pricing for alcohol, but the argument is not seen as being around any bizarre claims. In short, government and industry are seen as having a major role in addressing the damage that harmful products may do to individuals and society, including addictive products.

Current debate about addiction is skewed towards a focus on individual responsibility. Just as a parent is deemed responsisible for feeding their children high doses of sugar and fat (These being by far the cheapest foods to buy for those in poverty), so the addict is held reponsible for choosing their addiction (even if this was motivated by a need to escape misery and despair into 20 minutes of arificial paradise). There are no jackpots, magic fixes that will ever beat the scourge of addiction but government and industry have to stop denying their role in attenuating it.

The Myth of the ‘Responsible’ v ‘Problem Gambler’

PREAMBLE/Disclaimer

INTRODUCTION

HOWEVER!

Some Links

Education Organisations

Parliament

Gambling Commission (3 year strategy for reducing harms)

Public Health

Some Academics

Media