This site is intended for UK healthcare professionals
Medscape UK Univadis Logo
Medscape UK Univadis Logo

Doctors Should Ask People About Gambling Habits, Says NICE

GPs and other health professionals in England should ask patients about gambling when they attend for a health check or attend with a mental health issue, the National Institute for Health and Care Excellence (NICE) said.

The question should be phrased in a similar way to how people are asked about their smoking habits and alcohol consumption.

The regulator said it had identified that when people seek help for depression, anxiety, or thoughts about self-harm or suicide due to a possible addiction such as alcohol or drug misuse, they may be at greater risk of harm from gambling.

Health professionals should be involved in identifying, assessing, and managing harmful gambling, the regulator said in new draft guidance.

Assessing Harmful Gambling

The guidance suggested that doctors talk to a patient about how to control their gambling habits and urges, including discussing talking treatment therapies such as cognitive behavioural therapy (CBT) as an option. Doctors should also discuss whether using blocking software tools to limit online gambling might be appropriate.

Patients should also be encouraged to fill in a questionnaire, based on the Problem Gambling Severity Index, to assess the severity of their gambling. A score of eight or more on the questionnaire, which is available on the NHS website, would indicate a patient might need support and treatment from gambling treatment services.

Harmful gambling is defined in the guideline as any frequency of gambling that results in people experiencing harm, that could include mental health problems, the breakdown of relationships or families, and financial consequences.

Rise in Problem Gambling

Earlier this year NHS England revealed that almost 1400 patients were referred for help in 2022-23, an increase of more than a third on the year before and up by almost 80% compared with 2 years ago.

Twelve gambling treatment clinics have been opened by NHS England in the last 4 years, with three more to open in coming months. The clinics, which are across England, are expected to see 3000 people a year.

Professor Jonathan Benger, chief medical officer and interim director of the centre for guidelines at NICE said, "Harmful gambling causes immense misery to all those who experience it. We want those needing help or who are at risk to be identified sooner and receive appropriate help." 

" The independent committee who made the draft recommendations included both clinicians and people with personal experience of harmful gambling. They scrutinised all of the available evidence to identify treatments and therapies that have been shown to work and offer good value for money. The result is this useful and usable advice to help NHS clinics as they develop their service," he added. 

"A Cruel Disease"

NHS mental health director Claire Murdoch, in an emailed response to Medscape News UK said: " We will work with NICE on this consultation process and while this new guidance will ensure the NHS can help even more people struggling with gambling addiction to receive evidenced based treatment, it is vital that the billion-pound industry also takes action in line with the Government's White Paper to stop people coming to harm in the first place."

In an emailed comment, Professor Kamila Hawthorne, chair of the Royal College of GPs, welcomed the consultation but warned that asking GPs to proactively ask patients about their gambling habits as part of every mental health consultation could prove counterproductive. "Some patients might choose not to disclose their gambling problems until they have built up a trusting relationship with their GP or member of the practice team over time, and any attempt to make them have these conversations before they are ready could make them more vulnerable," she said.

"Patients must not feel they are being interrogated when we ask them about their lifestyles as part of a mental health assessment," Professor Hawthorne added.

The proposals also raised practical issues. "With the current workforce and workload pressures in general practice, it's also hard to see how hard-pressed GPs could fit this into the standard 10-minute consultation when it is already too short and unfit for purpose," she said.

Gambling charities have welcomed the draft guidance. Zoe Osmond, CEO of GambleAware told Medscape News UK by email: "Gambling harms are a serious public health issue, which can affect anyone, and healthcare professionals are ideally placed to identify and help people experiencing them.

" We welcome the development of guidelines to further inform treatment for those seriously affected by gambling harm and will be responding to the consultation with our views."

A consultation on the draft guidelines, identification, assessment and management clinical guidance is open now and closes on Wednesday 15 November. 

For more news, follow Medscape on  Facebook, Twitter, Instagram, and YouTube 

Editor's note: This article was updated on 6 October to include comments from Professor Kamila Hawthorne, chair of the RCGP.