Raising the stakes: Gambling harm awareness in medical education

Why is gambling harm such an important topic for medical students to learn about?

 

According to the World Health Organization, the burden of gambling-related harm appears to be of similar magnitude to harm attributed to major depressive disorder and alcohol misuse and dependence. It is substantially higher than harm attributed to drug dependence disorder. But how often do we ask about alcohol and substance misuse but not gambling harm?

The Office for Health Improvement and Disparities states there are almost 1.6 million adults in England who gamble who may benefit from treatment or support for harmful gambling. There are also over 900,000 children living in a household with an adult who gamble who might require treatment or support. These numbers do not include adult affected others, young people who suffer harm from gambling (approximately 4% of 11-16 year olds), and those affected by legacy harms from gambling in previous years. This highlights a significant part of the population who will be affected by gambling harm and, critically, a huge unmet safeguarding concern.

Less than 1% of those suffering gambling harm complete treatment and a significant contributor to this is the lack of screening for and identification of gambling harm. We are miles behind where we are with tobacco, alcohol and substance misuse. However, there is change on the horizon: in 2025, NICE published their first-ever guidelines on gambling harm. Medical school education provides an opportunity to teach all future doctors about gambling harm in a way that challenges the industry narratives of individual responsibility, highlights the vast scale of the concern and explores how gambling harm disproportionately impacts affected others who do not gamble themselves.

What are some common misconceptions about gambling addiction?

Probably the biggest misconceptions surround the stereotypes about who the “typical gambler” is. There are a lot of assumptions about the characteristics of someone who may gamble and whilst there are risk factors, it is a serious issue that really can impact anyone.

There is also a misconception that people might not recognise gambling as an addiction; while it is the first non-substance behavioural addiction recognised in the DSM, the underlying mechanism is broadly the same, namely activation of the brain reward system. There is a fascinating video where Professor David Nutt looks “inside the brain of a gambling addict” using an MRI:

I think another core misconception is that a decision to gamble is a fixed mindset that should not be considered/helped by clinicians. Whilst there are established treatment regimes for managing other types of addiction, for example alcohol or cigarettes, there remains a lack of understanding as to effective management for gambling harm and about the significance of harm to health on adults and children. Society still tends to view those who gamble as having made a deliberate choices to gamble with no desire to change.

With the support of Gambling Harm UK and Warwick Medical School, we have made some key additions to the WMS curriculum to assist students in understanding and managing gambling harm, as well as tackling the stigma surrounding gambling harm.

Firstly, we have incorporated gambling harm into the phase 1 (first year) Making Every Contact Count (MECC) teaching materials. MECC is a national initiative that aims to empower individuals to make healthier lifestyle choices through interactions with healthcare professionals. We have included information and suggested screening questions regarding gambling harm in the WMS Clinical History & Examination Sequences Set (CHESS) handbook.

I also created a gambling harm case study as part of the Case Based Learning (CBL) materials for phase 2 WMS students and we collated feedback from students as to how this can be developed for future cohorts.

In addition, I arranged an event with Warwick Medical School Psychiatric Society (PsychSoc) where two speakers involved with Gambling Harm UK discussed their personal experiences of gambling harm. One speaker was a gambler and one was an affected other. As well as hearing both speakers’ personal stories, students had an opportunity to discuss the impact gambling has had on all aspects of the speakers’ lives.

My aim was to weave gambling harm throughout the WMS curriculum so students revisit the topic with a view to embedding the learning and ensuring gambling harm remains in their minds when transitioning to clinical placements with patient exposure.

That sounds like really valuable work. Can you tell us more about the case study you've developed? Why do you feel CBL is such an effective approach for students to learn about this topic?

CBL is a core part of the MB ChB curriculum where students work through a patient scenario in small groups, taking an active role in identifying what they need to learn and how they can learn it. The aim is to create realistic case studies reflecting current clinical practice.

I thought this would be a great forum for students to learn more about gambling harm through active discussion and research, rather than passively hearing about the topic in a lecture format. It also provides an opportunity for students to explore how gambling harm impacts the patient and their loved ones.

The case study I prepared involves a patient presenting with signs of another (cardiac related) medical condition, which highlights the interplay between physical and mental symptoms. I also wanted to avoid any cliches or stereotypes by ensuring the patient was a mature female with no mental health history but who finds herself in challenging financial circumstances.

The case study provides students with an opportunity to consider what questions should be asked when taking a history for a patient who may be suffering from gambling harm and exploring why people gamble. Students are also asked to explore the impact of gambling harm on the patient as well as affected others, as we know gambling harm can have significant impacts on close contacts of the person who gambles. Finally the study explores treatment options and signposts resources for further reading on the topic so students can start to consider how gambling harm is managed in primary care.

We've had some great feedback from students. They enjoyed the discussions around the symptoms and the relationship between gambling addiction and financial pressures on health, as well as the increasing role that GPs/healthcare professions play in having difficult discussions surrounding non-clinical issues.

Students found the content surprising and thought it was a really helpful way of raising awareness of the topic, many of whom had not come across it before and felt this was therefore a positive learning experience.

There were extended discussions about gambling which highlighted how widespread the issue is, as well as questions on the responsibility of a GP to advise, especially when the stress has direct impact on health. We are looking to conduct focus groups with the phase 2 students to further delve into those themes and see how the case can be developed for future cohorts.

Essentially to ensure gambling harm is something all health professionals and medical students are aware of and consider when managing patients. I am so pleased that WMS have been receptive to including gambling harm in the MB ChB curriculum and it would be great to see all UK medical schools include teaching around gambling harm. Outside of medical education, better regulation of the gambling industry, in particular the huge advertising spend promoting gambling, and increased public awareness of gambling harm is key to tackling this fundamental health concern.

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