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“Building on Success”. 12 th Annual Conference. Anthony Jennens. Chairman, GamCare. “Building on Success”. 12 th Annual Conference. Andrew McIntosh. President, GamCare. “Building on Success”. 12 th Annual Conference. Andrew Tottenham. Chair, The GREaT Foundation.

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Building on success l.jpg
“Building on Success”

12th Annual Conference


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Anthony Jennens

Chairman, GamCare


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“Building on Success”

12th Annual Conference


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Andrew McIntosh

President, GamCare


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“Building on Success”

12th Annual Conference


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Andrew Tottenham

Chair, The GREaT Foundation


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“Building on Success”

12th Annual Conference


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Baroness Neuberger DBE

Chair of the Responsible Gambling Strategy Board

Interim Chair of the Responsible Gambling Fund


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“Building on Success”

12th Annual Conference


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Professor Peter Collins

Director, Centre for the Study of Gambling, Salford


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Responsible Gambling: What it is, Why it matters and How to make it happen

Presentation by Prof Peter Collins

University of Salford

GamCare Conference

October 2009


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Overview make it happen

  • “Responsible Gambling”. A contradiction in terms or an unnecessary excuse for paternalism?

  • Consumer choice and consumer protection

  • “Informed choice,” – the core concept

  • Three ideal types: those with actual gambling-related problems; those at risk because they currently gamble; those who might gamble

  • Practical implications

  • Latest Developments


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What is “Responsible Gambling?”: A Contradiction in terms?

  • A contradiction like “responsible prostitution” or “responsible” indulgence in any “vice”? For many people “Yes” because indulgence in vice is always irresponsible

  • No matter what constraints are placed by governments on suppliers and consumers of commercial gambling services some people will always think that, at best, this is only preferable to complete prohibition because prohibition is impracticable even though prohibition is what would be the most desirable state of affairs

  • The essential fact about gambling, and what makes it exceptionally difficult to develop and implement sensible public policy for, is that it is widely thought of as a vice – i.e. an activity which typically many people enjoy a lot and many people (sometimes the same people) consider to be immoral.


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What is “Responsible Gambling?”: An Excuse for Paternalism

  • Compare “responsible gambling” with “responsible golfing” or any other leisure activity not considered a “vice” like eating cakes

  • A minority over-indulge and do harm to themselves and their families

  • But that’s not the government’s business

  • And we don’t think we need golf and cake “awareness days” or national responsible golf and cake strategies


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What is Responsible Gambling? A Political Compromise Paternalism

  • In societies where gambling is legal, some people wish it weren’t because they think it immoral or dangerous or both; others see no difference between gambling and any other form of entertainment which people may choose to spend time and money enjoying; most think it should not be wholly forbidden to those who enjoy it but also that it’s not as harmless as playing golf or eating cake

  • Therefore we should have some but not too much legal, commercial gambling and what there is should be:

    - regulated responsibly

    - supplied responsibly

    - consumed responsibly

  • This makes “responsible gambling” a concept which cannot be precisely, scientifically or otherwise objectively defined because what is to be meant by it in any particular context is open to negotiation and will express a political compromise or consensus

  • Because of this what counts as “responsible gambling” at any particular time is always unstable and never pleases everyone

  • So the main function of responsible gambling policies, programmes and practices, from the point of view of government and industry, is to sustain the support of public opinion for current policies and enable them to rebut publicly voiced criticisms of current or proposed policies


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So What Paternalism is “Responsible Gambling?”

  • “Responsible gambling” can usefully be used to refer to any set of policies, programmes and/or practices which maximally reduces the likelihood that people will harm themselves or others by spending too much time or money gambling, while minimally inhibiting the ability of those who wish to gamble harmlessly from doing so

  • This means that implementing responsible gambling measures is a matter of promoting not only consumer protection but also consumer choice (Budd, Eadington, Forrest, new proposed internet legislation in USA, “consumer surplus” and more fun)


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Relating the Two Principles Paternalism

  • Sometimes the principle of consumer choice conflicts with the principle of consumer protection and compromises must be made

  • E.g. How much should we curtail the freedom on non-problem gamblers in the hope of protecting problem gamblers from themselves? (Issues of availability, limits on stakes and prizes, responsible gambling features etc)

  • The principle of proportionality and other principles of good regulation are needed here (compare: speed limits)

  • But sometimes the promotion of consumer choice and consumer protection reinforce each other as when people are addicted or ignorant of what they are doing


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Problem Gambling and Paternalism Informed Choice

  • Gambling is “problematic” in the sense of requiring action by governments, by industry and or by treatment and prevention specialists when:

    - Either the gambler is addicted in the sense that he or she would like to stop or cut down but can’t (for whatever reason)

    - Or the gambler would cut down or stop gambling if they knew relevant facts about the gambling they are engaging in but which they do not know

  • In these cases the consumer is neither able to exercise free choice nor is adequately protected by government from exploitation and deception by suppliers

  • Conversely, gambling is unproblematic when players are exercising informed choice, i.e. are genuinely free to choose because not behaving compulsively, and know what they are doing


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So who needs protection – and liberation? Three Ideal Types

  • Those who currently gamble and create problems for themselves and others much because they are addicted or ignorant of what they are doing

  • Those who currently gamble unproblematically but might develop problems in the future

  • Those who currently don’t gamble but might in the future and who, if they do will need to be able to avoid gambling problematically


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What responsible gambling measures need to be in place for the current problem gambler?

  • Information that there is such a thing as problem gambling (?50%+ of problem gamblers don’t. Most GPs and PCTs don’t)

  • Information that free, confidential and expert help is available

  • Information about how to access this easily and with minimum difficulty

  • Facilities for contacting a suitably sympathetic and knowledgeable counsellor – preferably immediately, i.e. on impulse

  • Facilities for accessing further free, confidential and expert help with gambling problems in one-on-one sessions, in groups, by telephone or internet

  • Facilities for accessing such help with related matters such as

    - comorbidities: other psychological disorders such as substance abuse, depression or anxiety disorders

    - employment issues

    - debt and money management

    - family and other personal relationships


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What responsible gambling measures need to be in place for the current non-problem gambler?

  • Reinforcement of the message that gambling ought to be a form of entertainment for which you pay by accepting the House Advantage

  • Understanding how games work and generate House Advantage

  • Not being exposed to features of games or the environment which mislead about the chances of winning or otherwise undermine the ability to exercise rational control (e.g. play for play on internet, columns with past numbers at roulette, encouragement to get intoxicated etc)

  • Access to warning signs about the possible onset of problem gambling

  • Access to information about what to do if you think you have a problem


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What responsible gambling measures need to be in place for the current non-gamblers?

  • Access to a general understanding that gambling can be dangerous

  • Access to information about what you can do to avoid getting into trouble if you do take up gambling (budgeting etc)

  • Access to information about how to identify and help someone else who is in trouble as a result of problem gambling


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What else needs to be done? Educating Professionals the current non-gamblers?

  • Most obviously, the professionals likely to encounter people, some or most of whose problems derive from excessive or compulsive gambling, need to be informed - as part of their continuing professional development - about the nature of problem gambling, how to identify it and what to do about it

  • The group of professionals at present most scandalously lacking in this knowledge is the medical profession

  • But social workers, law enforcement personnel, ministers of religion, bank managers etc all need to understand this phenomenon


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What else needs to be done? Developing an extensive and trustworthy knowledge base

  • Everyone, everywhere laments the absence of knowledge about how best to prevent and treat problem gambling, mainly because of inadequate scientific understanding of the causes, character and consequences of this phenomenon

  • This can only be remedied by growing the capacity for good research around the world, collating the efforts and findings of researchers and disseminating it to all interested parties

  • This requires centres of excellence in gambling studies which collaborate with each other to which scholars working on any aspect of gambling studies, nationally and internationally would be affiliated

  • This would mean that

    - all interested parties, including public officials (ministers, civil servants, parliamentarians, regulators, local councillors and officers), industry managers, the media, treatment and prevention professionals, other professionals and the general public could make inquiries about any aspect of gambling studies and

    - be confident of getting an answer which reflected the honest views of the best researchers in the area relying on the best available evidence

  • The alternative is to leave the shaping of public opinion to those who are unscrupulous in their use of evidence to further ideological, political, commercial or self-glorificatory agendas


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Some New Developments trustworthy knowledge base

  • Increasing investigation of the distinction between addicted and non-addicted problem gamblers

  • Increasing recognition of need to address comorbidities in treatment

  • Emphasis on Consumer Protection rather than on “Protecting the Vulnerable”

  • Increasing understanding by industry and government of the link between profits (and therefore taxability), public opinion and credible responsible gambling strategies

  • Increasing awareness of the need for all concerned with responsible gambling to collaborate rather than compete


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A Concluding Prediction trustworthy knowledge base

  • We have all over the world spent huge quantities of time and money over the past ten years trying to minimise the comparatively small amounts of harm caused when recreational gamblers for whatever reason lose control and to ensure that recreational gambling is strictly regulated so as to be crime-free, fair to players and protective of the vulnerable

  • Meanwhile through ideological naivety, political and commercial short-termism, incompetence and a culture of moral cynicism, we have deregulated the financial services industries so as to transform them into a giant global internet betting business which is neither crime-free, fair to players nor protective of the vulnerable

  • Some informal estimates (which merit proper research) suggest that at least half of all traders meet the criteria set out by the American Psychiatric Association for identifying probable pathological gamblers – they are obsessed with their “bets”, they sacrifice their personal lives to their betting, they spend far too much time betting, they chase their losses, they lie about their gambling, they steal in order to sustain their habit, and when it goes wrong they contemplate suicide

  • This is where those concerned with responsible gambling will need to focus their energies and attention in the future


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“Building on Success” trustworthy knowledge base

12th Annual Conference


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Andy McLellan trustworthy knowledge base

Chief Executive, GamCare


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Gamcare 12 trustworthy knowledge baseth Annual Conference 2009“Building on Success”

Andy McLellan, CEO, GamCare


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Agenda trustworthy knowledge base

  • What are we dealing with?

  • 2) What have we achieved?

  • 3) What could we be doing?


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What are we dealing with? trustworthy knowledge base

  • 68% of adult population gamble

  • Problem gamblers:0.5/0.6% = c 250,000 people

  • Dynamic snapshot

  • Family & friends x4 = 1.25 million

  • Further 1.4% - 660,000 people – at “moderate risk”

  • Cf problem drug users c327,000

  • And how much is spent on drugs?


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What are we dealing with? trustworthy knowledge base

  • But on the plus side:

  • A clear(er) regulatory framework

  • An industry that we can work with, and which takes its customers seriously

  • Partners around the country committed to working with us


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What have we achieved? trustworthy knowledge base

  • No levy

  • A fundraiser that looks like it will work

  • An industry increasingly conscious of responsible gambling, and increasingly equipped to encourage it

  • A developing and effective infrastructure for delivery


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What have we achieved? trustworthy knowledge base

  • FrontLine Services

  • HelpLine/NetLine calls up 21%

  • NetLine alone up 300%

  • Speaking to 100 callers every day

  • ChatRoom sessions doubled

  • 50% more new posts on Forum

  • 94% of callers rate service Excellent/VG


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What have we achieved? trustworthy knowledge base

  • Counselling

  • Sessions up by 30%

  • Problem gamblers:

    • - 88% at start of treatment

    • - 15% at end

  • More than 300 people in treatment at any one time

  • 4 new Partner areas

  • 60% of GB population in reach of GamCare counselling


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What have we achieved? trustworthy knowledge base

  • GamCare Trade Services

  • Trained 520 industry employees at 28 sessions since April 2008

  • Certification

    - 25 remote companies

    - 54 websites

    - 25 terrestrial companies

  • Income target 2009/10: £150k


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What have we achieved? trustworthy knowledge base

  • Developments

  • GamCare Salford

  • Online counselling

  • Gambling & Debt

  • Gambling in prisons


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What have we achieved? trustworthy knowledge base

  • Developments

  • Gambling in the Chinese community

  • Counselling for clients with hearing impairments

  • Training/certification for all GamCare staff


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What have we achieved? trustworthy knowledge base

  • GamCare International

  • GamCare Ireland

  • Training in Malta

  • Consultancy/training in Antigua


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What could we be doing? trustworthy knowledge base

  • Improving and extending FrontLine Services to meet demand

  • Extending counselling to the rest of GB

  • Evaluating and accrediting our services

  • Expanding online counselling


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What could we be doing? trustworthy knowledge base

  • Developing and piloting prevention work with young people - with partners old and new

  • Working with communities with special needs

    • - Turkish community

    • - Prisons

    • - Students

  • Developing coherent partnerships with Partners, NHS, Money Advice Trust etc etc across the country


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All this is possible trustworthy knowledge base

  • Now

  • Within funding proposed to be raised

  • By prioritising action

  • By working together


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“When you first suggested there was a reason for my gambling, I thought that was a mad idea. Now I’ve learnt there was a reason – I gambled to escape feeling sad and afraid. The choice was gambling or suicide. Now I’ve learned how to face my feelings I don’t need to escape. Thank you. GamCare has saved my life.”


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“Building on Success” gambling, I thought that was a mad idea. Now I’ve learnt there was a reason – I gambled to escape feeling sad and afraid. The choice was gambling or suicide. Now I’ve learned how to face my feelings I don’t need to escape. Thank you. GamCare has saved my life.”

12th Annual Conference


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Clive Hawkswood gambling, I thought that was a mad idea. Now I’ve learnt there was a reason – I gambled to escape feeling sad and afraid. The choice was gambling or suicide. Now I’ve learned how to face my feelings I don’t need to escape. Thank you. GamCare has saved my life.”

Chief Executive, Remote Gambling Association


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  • http://www.morris-chapman.be/clients/RGA/flash/index.html gambling, I thought that was a mad idea. Now I’ve learnt there was a reason – I gambled to escape feeling sad and afraid. The choice was gambling or suicide. Now I’ve learned how to face my feelings I don’t need to escape. Thank you. GamCare has saved my life.”


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Industry Responsible Gambling Awareness Day gambling, I thought that was a mad idea. Now I’ve learnt there was a reason – I gambled to escape feeling sad and afraid. The choice was gambling or suicide. Now I’ve learned how to face my feelings I don’t need to escape. Thank you. GamCare has saved my life.”

What is it?

Why is it being held?

What does it involve?

The industry’s role in social responsibility?


What is it l.jpg

What is it? gambling, I thought that was a mad idea. Now I’ve learnt there was a reason – I gambled to escape feeling sad and afraid. The choice was gambling or suicide. Now I’ve learned how to face my feelings I don’t need to escape. Thank you. GamCare has saved my life.”

Origins

Who’s involved

objectives


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Why is it being held? gambling, I thought that was a mad idea. Now I’ve learnt there was a reason – I gambled to escape feeling sad and afraid. The choice was gambling or suicide. Now I’ve learned how to face my feelings I don’t need to escape. Thank you. GamCare has saved my life.”

To raise the profile of responsible gambling .

 Part of ongoing industry commitment to promoting responsible gambling and to the wider cause of social responsibility

Supplement all of the work being done within the industry and by key service providers such as GamCare.

Avoid the issue becoming background noise for consumer


What does it involve l.jpg

What does it involve? gambling, I thought that was a mad idea. Now I’ve learnt there was a reason – I gambled to escape feeling sad and afraid. The choice was gambling or suicide. Now I’ve learned how to face my feelings I don’t need to escape. Thank you. GamCare has saved my life.”

Gambling premises

Online

Within gambling companies

Externally


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The industry’s role in social responsibility gambling, I thought that was a mad idea. Now I’ve learnt there was a reason – I gambled to escape feeling sad and afraid. The choice was gambling or suicide. Now I’ve learned how to face my feelings I don’t need to escape. Thank you. GamCare has saved my life.”

Track record of industry support

Industry codes

Working with regulators

Working with treatment providers

Support for RIGT/GREaT Foundation


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Final thoughts………… gambling, I thought that was a mad idea. Now I’ve learnt there was a reason – I gambled to escape feeling sad and afraid. The choice was gambling or suicide. Now I’ve learned how to face my feelings I don’t need to escape. Thank you. GamCare has saved my life.”


Building on success63 l.jpg
“Building on Success” gambling, I thought that was a mad idea. Now I’ve learnt there was a reason – I gambled to escape feeling sad and afraid. The choice was gambling or suicide. Now I’ve learned how to face my feelings I don’t need to escape. Thank you. GamCare has saved my life.”

12th Annual Conference


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Jim Fearnley gambling, I thought that was a mad idea. Now I’ve learnt there was a reason – I gambled to escape feeling sad and afraid. The choice was gambling or suicide. Now I’ve learned how to face my feelings I don’t need to escape. Thank you. GamCare has saved my life.”

Head of Research & Policy,

Money Advice Trust


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Debt advice and gambling, I thought that was a mad idea. Now I’ve learnt there was a reason – I gambled to escape feeling sad and afraid. The choice was gambling or suicide. Now I’ve learned how to face my feelings I don’t need to escape. Thank you. GamCare has saved my life.”gambling counselling services working together

Jim Fearnley

Head of Research & Policy

Money Advice Trust


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Where we are now gambling, I thought that was a mad idea. Now I’ve learnt there was a reason – I gambled to escape feeling sad and afraid. The choice was gambling or suicide. Now I’ve learned how to face my feelings I don’t need to escape. Thank you. GamCare has saved my life.”

  • Debt advisers do not routinely ask about gambling

  • Sensitivity of subject matter makes this a difficult area to discuss

  • The level of debt caused by problem gambling is an unknown quantity

  • There is a need to understand the problem better


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What is to be done? (i) gambling, I thought that was a mad idea. Now I’ve learnt there was a reason – I gambled to escape feeling sad and afraid. The choice was gambling or suicide. Now I’ve learned how to face my feelings I don’t need to escape. Thank you. GamCare has saved my life.”

  • Debt advice agencies should visit gambling support organisations and vice versa to better understand each others’ ethics and mode of operation.

  • Advice agencies need to be made more aware of the nature and extent of gambling-related debt, eg, by contacting GamCare to support staff training, and expanding MAT wiseradviser training content.

  • The display of GamCare posters and leaflets in public areas of advice centres may help encourage client disclosure.

  • Awareness raising might include liaising with other organisations such as Gamblers Anonymous and GamAnon.*

  • *These recommendations are in part based on independent research commissioned by MAT and GamCare


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What is to be done? (ii) gambling, I thought that was a mad idea. Now I’ve learnt there was a reason – I gambled to escape feeling sad and afraid. The choice was gambling or suicide. Now I’ve learned how to face my feelings I don’t need to escape. Thank you. GamCare has saved my life.”

  • Process of referral for people with gambling and debt problems to gambling support services and advice agencies should be reciprocal so that both debt and gambling problems are treated simultaneously (breaking the cycle).

  • A short screen (standard set of questions) to diagnose gambling and debt problems in non-specialist settings is key. MAT and GamCare have agreed to liaise in order to pilot such a screen.

  • Alerting family members to the need to control problem gamblers’ access to money/credit could improve outcomes medium-term.

  • Managed bank accounts, (eg, by Credit Unions or POCA), could be a practical longer-term solution.


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“Building on Success” gambling, I thought that was a mad idea. Now I’ve learnt there was a reason – I gambled to escape feeling sad and afraid. The choice was gambling or suicide. Now I’ve learned how to face my feelings I don’t need to escape. Thank you. GamCare has saved my life.”

12th Annual Conference


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Henrietta Bowden-Jones gambling, I thought that was a mad idea. Now I’ve learnt there was a reason – I gambled to escape feeling sad and afraid. The choice was gambling or suicide. Now I’ve learned how to face my feelings I don’t need to escape. Thank you. GamCare has saved my life.”

Lead Clinician,

CNWL NHS National Problem Gambling Clinic


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WORKING TOGETHER….. gambling, I thought that was a mad idea. Now I’ve learnt there was a reason – I gambled to escape feeling sad and afraid. The choice was gambling or suicide. Now I’ve learned how to face my feelings I don’t need to escape. Thank you. GamCare has saved my life.”TO GET THE JOB DONE.

Dr H. Bowden-Jones MD, MRCPsych, BA (Hons) DOccMed.

Consultant Psychiatrist, Addictions Directorate,Central North West London NHS Foundation TrustLead Clinician, National Problem Gambling Clinic, LondonRoyal College of Psychiatrists Spokesperson on Problem GamblingHonorary Senior Lecturer, Imperial College, Dept of Neurosciences and Mental Health


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NATIONAL PG CLINIC & GAMCARE gambling, I thought that was a mad idea. Now I’ve learnt there was a reason – I gambled to escape feeling sad and afraid. The choice was gambling or suicide. Now I’ve learned how to face my feelings I don’t need to escape. Thank you. GamCare has saved my life.”

  • This is the 3rd year of working together towards the shared goal of bringing a high quality, evidence-based treatment to problem gamblers across the UK.

  • NPGC began treating patients in Sept 2008 but the collaboration with Gamcare started well before that.


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CERTIFICATION COURSE gambling, I thought that was a mad idea. Now I’ve learnt there was a reason – I gambled to escape feeling sad and afraid. The choice was gambling or suicide. Now I’ve learned how to face my feelings I don’t need to escape. Thank you. GamCare has saved my life.”

  • Together we devised the first National Certification course for professionals working with PGs. All of Gamcare staff have been through the course.

  • The next course will see NHS professionals and others attending.


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CONFERENCES gambling, I thought that was a mad idea. Now I’ve learnt there was a reason – I gambled to escape feeling sad and afraid. The choice was gambling or suicide. Now I’ve learned how to face my feelings I don’t need to escape. Thank you. GamCare has saved my life.”

  • Together we have spoken in shared workshops and seminars across the US and UK putting forward our shared vision of a Tier 3/ Tier 2 service.


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TOGETHER gambling, I thought that was a mad idea. Now I’ve learnt there was a reason – I gambled to escape feeling sad and afraid. The choice was gambling or suicide. Now I’ve learned how to face my feelings I don’t need to escape. Thank you. GamCare has saved my life.”

  • We see the NHS as providing PSYCHIATRIC and PSYCHOLOGICAL input for specific patient groups with complex and severe presentations.

  • This equates to a small number of patients with severe pathological gambling and/or co-morbid disorders such as depression, anxiety, alcohol or drug problems.


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FUTURE VISION gambling, I thought that was a mad idea. Now I’ve learnt there was a reason – I gambled to escape feeling sad and afraid. The choice was gambling or suicide. Now I’ve learned how to face my feelings I don’t need to escape. Thank you. GamCare has saved my life.”

  • Our hope is to see successful collaborative work in other parts of the UK between Gamcare partners and NHS units.

  • Together we are stronger, PARTNERSHIP is the way forward for the wellbeing of problem gamblers in this country.


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[email protected] gambling, I thought that was a mad idea. Now I’ve learnt there was a reason – I gambled to escape feeling sad and afraid. The choice was gambling or suicide. Now I’ve learned how to face my feelings I don’t need to escape. Thank you. GamCare has saved my life.”


Building on success79 l.jpg
“Building on Success” gambling, I thought that was a mad idea. Now I’ve learnt there was a reason – I gambled to escape feeling sad and afraid. The choice was gambling or suicide. Now I’ve learned how to face my feelings I don’t need to escape. Thank you. GamCare has saved my life.”

12th Annual Conference


Annette dale perera l.jpg
Annette Dale-Perera gambling, I thought that was a mad idea. Now I’ve learnt there was a reason – I gambled to escape feeling sad and afraid. The choice was gambling or suicide. Now I’ve learned how to face my feelings I don’t need to escape. Thank you. GamCare has saved my life.”

Addictions & Offender Care,

CNWL NHS Foundation Trust


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Treatment for problem gambling: gambling, I thought that was a mad idea. Now I’ve learnt there was a reason – I gambled to escape feeling sad and afraid. The choice was gambling or suicide. Now I’ve learned how to face my feelings I don’t need to escape. Thank you. GamCare has saved my life.”working with the NHS

Annette Dale-Perera

Strategic Director of Addiction and Offender Care

Effective treatment, changing lives


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Gambling and the NHS gambling, I thought that was a mad idea. Now I’ve learnt there was a reason – I gambled to escape feeling sad and afraid. The choice was gambling or suicide. Now I’ve learned how to face my feelings I don’t need to escape. Thank you. GamCare has saved my life.”

  • Some Trusts interested (eg CNWL)

  • Some NHS professional groups interested eg psychologists

  • No central ownership of problem gambling as one the state is responsible for

  • Problem Gambling a health/social issue or a lifestyle choice

  • What is the impact (positive and negative)

  • Which Government department has lead responsibility

  • If cross government issue – who plays ringmaster


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Drug Treatment gambling, I thought that was a mad idea. Now I’ve learnt there was a reason – I gambled to escape feeling sad and afraid. The choice was gambling or suicide. Now I’ve learned how to face my feelings I don’t need to escape. Thank you. GamCare has saved my life.”

National Strategy: political will

Evidence treatment cost effective

Public Service Agreement PSA + Vital Signs (NHS) target

Ring-fenced Budget

National Framework (Models of Care for Drug Misusers)

Evidence-based guidance (NICE)

Robust performance management framework

Rapid consistent expansion of treatment over past 7 yrs

Alcohol Treatment

National strategy: political will

PSA and target focus with on brief intervention NOT treatment

National funding of BI pilots

DH give local commissioners guidance to invest in treatment but funding local choice

National framework (MOCAM)

NICE guidance forthcoming

Very patchy implementation

In policy terms, how does Gambling compare to other addictions?


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Building a critical mass: ideal components of a treatment system

  • Acknowledgement of (cost of ) a problem and of the role of the State

  • The Political “will” and prioritisation of the issue

  • An national strategy: government department ownership

  • Agreed need (nationally & Local)

  • Agreed evidence-based

  • National Service Framework and/or national standards

  • National “Clinical Guidelines”

  • Clear local commissioning with jointly owned plans

  • Resources and/or targets

  • National monitoring system

  • Performance management system and inspection framework

Took years to get this re drugs and longer still with alcohol

Addiction client groups often seen as undeserving

Historically national funding only given when to combat negative impact on others


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NHS and Gambling: context and conclusions system

  • NHS financially compromised – facing cuts of 20%+ in next 3 years

  • General election + change in Govt: unlikely to get change now

  • NHS via DH is non-directive – localism rules – priority issues are outlined in Vital Signs for commissioners to purchase against local need

  • Local budgets will shrink over next 3 years

  • Garner political support for incoming government

  • Addiction treatment need to show it saves money on public services

    Investment in addiction treatment only has come when impact on society is seen as large and political will is strong enough to cope with potential public backlash


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“Building on Success” system

12th Annual Conference


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Jane Rigbye system

Head of Education Development, GamCare


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Young People: Attitudes to Gambling system

Jane Rigbye

International Gaming Research Unit

Nottingham Trent University

[email protected]


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Overview system

  • Prevalence of gambling and problem gambling

  • Attitudes to gambling

  • Internet gambling

  • Education and prevention

  • The role of GamCare


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Adolescent Gambling: A Brief Overview system

  • Prevalence

    • Past year gambling – 60% - 80%

    • Past week gambling – 21% (Ipsos Mori/NLC 2009)

  • Participation

    • Mainly slot machines (9%) and private betting (7%)

    • Increase in participation in ‘money free gambling’

    • Decrease in participation since previous study (26% in 2005-6)


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Problem Gambling system

  • Problem Gambling Prevalence

    • 3% - 8% problem gamblers, 10% - 15% ‘at risk’ (Derevensky and Gupta, 2007)

    • 2% problem gamblers (Ipsos Mori/NLC 2009)

    • Measured using the DSM-IV-MR-J

  • Measurement issues

    • Canadian Adolescent Gambling Index (CAGI)

  • Higher than adult problem gambling rate

  • Lower than in many other jurisdictions

  • Fallen since previous study (3.5% in 2005-6)


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Attitudes to Gambling system

  • Survey, n=2583, 10-22 year olds

  • Types of gambling activity: awareness of gambling activities generally in line with the participation levels: slot/fruit machines (65%) and private betting (44%) being the most common responses.

  • Indicators of problem gambling in a friend:

    • Money problems, 34%; frequency of activity, 33%; asking to borrow money, 23%.

  • Problems that may arise:

    • Money problems/debt, 43%; addiction, 24%; emotional and social problems.

  • What would they do to help: distraction, 29%; speak to someone else, 13%; impose financial control, 11% .


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Internet Gambling amongst Children and Adolescents system

Past Year Internet Gambling Prevalence Rate Among Adolescents = 2% (Welte et al, 2009)

Past Year Internet Gambling Prevalence Rate Among Adolescents = 4% (Meerkamper, 2006)

Past Year Internet Gambling Prevalence Rate Among Adolescents = 4% (Byrne, 2004)

Past Year Internet Gambling Prevalence Rate Among Adolescents = 4% (Poulin and Elliot, 2007)

Lifetime Internet Gambling Prevalence Rate Among Adolescents = 20-24% (Olasson, 2009)

Past Year Internet Gambling Prevalence Rate Among Adolescents = 8% (Gendron et al, 2009)

Past WEEK Internet Gambling Prevalence Rate Among Adolescents = 1% (Ipsos Mori, 2009)

Past Year Internet Gambling Prevalence Rate Among Adolescents = 9% (Derevensky and Gupta, 2008)


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Internet Gambling: system

Some Preliminary Observations

  • Adolescent Internet gamblers were significantly more likely to be problem gamblers (e.g. Gendron et al, 2009; Olason 2009)

    • Not straightforward and no evidence of causal relationship

  • Friends and family play significant role in youth’s experience

    • 2% of adolescents play alone (Brunelle et al., 2009)

    • 59% of adults play alone (Valentine and Hughes, 2008)

  • Challenges for parents preventing underage internet gambling:

    • Appropriate attitudes, awareness and intentions to prevention

    • Educating and enabling parents should be a key priority


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Internet Gambling: system

Some Preliminary Observations

  • Money free gambling is pervasive among adolescents

    • 1 in 3 have tried (Byrne, 2004, Gendron et al, 2009);

    • 28% played in the last week (Ipsos Mori/NLC, 2009)

  • Money free gambling: link to PG is complex and unclear

    • Strong predictor - problem gambling (Forrest, McHale & Parke, 2009)

    • ‘Social networking mode’ versus ‘demo’ mode – quite different

    • Money free gambling needs to be better understood before regulatory measures are put in place


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Education and Prevention: system Some Observations

  • Significant amount of investment worldwide into education and prevention of problem gambling in young people

  • Too often, initiatives have been quickly introduced in response to policy changes without thorough research, theory development, testing and evaluation

  • Wider issue of acceptance of problem gambling as ‘a problem’

  • In the UK we must learn from others experiences


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GamCare’s Approach to system Education and Prevention:What should we ensure we get right?

  • Research

  • Evidence

  • Evaluation

  • Working in partnership, both with young people and their carers/educators and with problem gambling experts in both design and delivery

    • Accessible teaching tools that fit into the curriculum

    • Delivering prevention programmes in partnership


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Figure 1. Money-free gambling in the last 7 days (n=8,598) system

(adapted from Ipsos MORI 2009)


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“Building on Success” system

12th Annual Conference


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Cath Groves system

Services Director,

CIC (GamCare Partner)


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Young People: Extending the Partnership system

Catherine Groves

Director for Addictions and Homelessness Services, CIC


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Partnership Working system

  • Background in substance misuse services

  • Context

  • Explore and develop ideas on how the provider/Gamcare partnership might be developed

  • Building on existing partnerships and collaboration

  • What skills are there already and what works?


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The Context of Services for People with Dependency Problems system

  • Existing addictions marketplace

  • Well developed systems of working and governance

  • Wholesale not piecemeal

  • Integrating with primary care

  • Integrating with YP services – schools YOT and Connexions


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What do we have already? system

  • Mainly adults

  • Paid per session delivered or DNA’d

  • Paid admin attendance to prevent lone working

  • Paid contribution towards clinical supervision

  • Vulnerable


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What are the gaps? system

  • Corporate and clinical governance

    • Line management supervision

    • Organisational systems

    • Young Person-specific

  • Contribution to non-staff costs such as accommodation and travel

  • Networking and development

  • Non-counselling interventions

  • Non-client-contact time


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How might Provider/Gamcare Partnerships be developed? system

  • Consider an alternative model to share the costs/risks of development

    • Substantive workers with a remit to develop and network as well as provide client contact

    • Release opportunities for extending the reach of services and finding harder to help clients

    • Integration of teams and streamlined ways of working


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Existing Partnerships and Collaboration system

  • Funders such as PCT’s, DAAT’s, CSP’s, Police, NOMS, local authorities

  • Partner agencies providing wraparound services – housing, CAB, parenting and family support, debt support and advice

  • Service users and the community


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What skills are there already and what works? system

  • Skilled and experienced staff in multi-disciplinary teams

  • Written protocols

  • Co-location and outreach

  • Joint working and case conferences

  • Peer supervision

  • Evidence-based alternative therapies such as Black Box treatment

  • Key working


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Next Steps system

  • Whole systems-based thinking

  • Specific consideration to serving young people and deliberately developing services

  • Capacity building

  • Piggyback on longer established provision

  • Partnership in risk and governance

  • Focus on hard-to-reach

  • Communities and service users in education and prevention


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In Summary system

  • Complex political environment

  • Demand for services

  • Good start

  • Alignment with and piggy-backing on mainstream longer established systems

  • Infiltrate systems of treatment, criminal justice and education

  • Pioneer education and prevention


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“Building on Success” system

12th Annual Conference


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Clive Hawkswood, Remote Gambling Association system Cherry Hosking, Bingo Association Andy Lyman, Association of British BookmakersViv Ross, National Casino Industry ForumSue Rossiter, BACTA


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“Building on Success” system

12th Annual Conference


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