Gambling disorder is a medical condition that causes severe consequences for the individual and many people around the individual. Until 2013 gambling addiction was not considered worthy of classification as an addiction in classificatory systems, sitting in a category of ‘impulse control disorder’, with conditions such as pyromania. As the prevalence of online gambling in particular began to grow so too did converging lines of both clinical and research evidence supporting gambling disorder as an addiction. This led to the American Psychiatric Association reclassifying gambling disorder as an addiction with similar stature and importance of drug and alcohol addiction in May 2013.¹ The key features of gambling addiction are set out in Table 1.

Gambling Regulation Bill 

The new Gambling Regulation Bill, published on the December 2, 2022² is a much welcomed development. Minister of State at the Department of Justice and Equality with responsibility for Law Reform, James Browne, and his team deserve credit for seeing through comprehensive and wide ranging legislation in a challenging area. Rather than representing a finishing point for gambling regulation in Ireland, this legislation should be viewed more as a starting point, providing a framework through which the newly established Gambling Regulatory Authority of Ireland (GRA) will effect many of the necessary changes. 

Anxieties will remain for some time as to whether the GRA will have sufficient financial resources and political support to effect real change. The appointment of a new CEO Designate, Anne Marie Caulfield, is a positive step as is the establishment of a Programme Board within the Department of Justice to oversee and review developments in the area. I recently had the opportunity to meet with the newly appointed CEO Designate of the GRA and it was reassuring to note that recruitment for positions within the GRA covering a wide range of gambling regulation is underway. Provisions within the recently published Gambling Control Bill for the GRA to levy fines of up to €20 million or 10% of a gambling company’s total turnover is also encouraging, and suggests that the current government is serious about tackling gambling related harm. Another concern is the time it will take for the GRA to effect much needed change. Ireland already lags behind other European countries in terms of responding to the onslaught of online gambling offerings. Nearly two decades of political inertia around gambling legislation has left Ireland notably out of kilter with European counterparts with the only current Irish gambling legislation coming from the 1930s and 1950s. 

The new bill provides measures for the GRA to approach internet providers where standards are not being adhered to in the online space. It is encouraging to see that Minister Browne and colleagues included provision for limit setting within the new legislation. Limit setting is an evidence based approach to curbing excessive gambling. In effective limit setting, those with online accounts agree and adhere to pre-determined betting and loss limits over a set time period. The limit setting prevents financial damage occurring when problem gamblers chase losses. This compulsive state sometimes occurs when the individual is intoxicated with alcohol and/or drugs, but more often occurs when heavy losses are experienced and desperate attempts are made to win the losses back. The Bill specifies that providers must provide limit setting facilities and gamblers can then opt-in if they wish. Ideally once established, the GRA will mandate that all gamblers must limit set, rather than leaving it to choice.

The past decade has seen online gambling products developing at a ferocious pace with progressive sophistication of sports betting and online casino products, all on a background of poor regulation in Ireland. The gambling industry invested vast resources into sophisticated advert campaigns involving prominent celebrities. Sports fans will be familiar with the flurry of gambling advertisements before, during and after sports events, particularly football. Sadly, children are exposed to hundreds of these ads a year. Exposure likely supports not only initiation but also maintenance of gambling. Hope is on the horizon however for the restriction of such advertising in Ireland. The new Gambling Regulation Bill will ban gambling advertising from 5.30am to 9pm. In a position paper from the Irish College of Psychiatrists in 2020, we advised that there should be an entire ban on gambling advertising across television and radio.³

Progression of addiction

We have become familiar with the harrowing testimonies of those courageously publicly disclosing their gambling addiction illness with the intention of helping others. Gambling addiction compared with other addictions is a particularly pernicious disease, remaining hidden from loved ones until severe financial difficulties set in. The disease progresses by hijacking key brain risk processing centres. These dopamine rich areas are the same areas involved in alcohol and drug addiction. Gambling addiction however is silent whereas in alcohol and drug addiction loved ones are generally given clues as to the presence of problems through repeated intoxication and physical deterioration. 

Treatment services and supports

Gambling addiction treatment services in Ireland have been very thin on the ground. Some excellent statutory counselling services have struggled for their existence to this day, having to secure funding on a six monthly basis. Notwithstanding these deficits there are some helpful supports available at present. Gamblers Anonymous (gamblersanonymous.ie) is a huge support to many as is Gam-anon for family members affected (gamblersanonymous.ie/gam-anon). Local community addiction teams (CATs) generally do not have the resources to provide specific gambling addiction treatment but nevertheless in many cases do their best to accommodate those suffering from gambling addiction in a compassionate and effective way. The Money and Budgeting Service (MABS) provides helpful support with debt (mabs.ie; Helpline 0818 072000). Inpatient treatment programmes are most helpful in preventing access to further gambling and monitoring risk in the case of comorbid mental disorder. Gambling addiction is unfortunately associated with high levels of both reported suicidal ideation and completed suicide. Our own treatment facility at Saint John of God Hospital offers inpatient treatment as do Cuan Mhuire treatment centres.

What is really needed is the development of well-funded treatment services nationally. Inpatient rehabilitation programmes of at least three months are required, followed by intensive so called ‘step down’ care programmes in the community, for six months or more. The development of inpatient units will not require the same complexity and costs of a general medical hospital but nevertheless will be a substantial undertaking. If gambling addiction is to be treated effectively in the community, a network of outpatient clinics with associated services such as debt management agencies is required. Adequately resourced multidisciplinary specialist teams working in continuity with inpatient facilities are required. 

Funding service provision

It is obvious therefore that if we are serious about tackling problem gambling in this country it will come at a significant cost. The Gambling Regulation Bill specifies that a social impact fund will be developed by the GRA to address service provision and research. The GRA will have an important task in securing appropriate funds from the gambling industry to provide for these necessary treatment services. I have previously suggested that a 1% levy on gambling industry turnover is applied. This would be substantial and would ensure service provision is approached in a serious manner. Should this levy not be applied we will be looking at ongoing major deficits in service provision with tens of thousands of Irish problem gamblers suffering needlessly. 

Overall, the publication of this Bill should mark a turning point in gambling regulation in Ireland and provide a solid platform on which further positive changes can be achieved. 

References

1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders 5 (DSM5). Washington, DC: American Psychiatric Publishing; 2013
2. Houses of the Oireachtas. Gambling Regulation Bill 2022 (Bill 114 of 2022), Dec 2, 2022
3. The College of Psychiatrists of Ireland. Gambling Disorder Position Statement, 2020 (Apr)