Tottenham Report: What is the matter with normal? By Andrew Tottenham, Managing Director, Tottenham & Co July 29, 2021 at 2:00 am One of the arguments for limiting the advertising of gambling products is that it “normalises” the activity. And I suppose the follow on is that normalisation will lead to an increase in gambling harms. The vast majority of more than 30 percent of the adult population in the UK regularly participate in gambling without suffering any harm or being at risk of suffering any harm. That, in my opinion, describes a normal activity. The fact that we try to “hide” this fact is not normal. It is true that a very small minority can become addicted to gambling and the consequences can be devastating. Gambling addiction is different than alcohol, in that the addiction often goes unnoticed, because the symptoms are hard to spot until it is too late and the harm has been done. The real question is whether “normalisation”, i.e., the public portrayal of gambling as normal, will cause an increase in addiction rates and/or gambling harms. Great Britain has one of the more liberal regimes when it comes to gambling, with all activities being legal and offered by the private sector. The country also has had one of the lowest rates of problem gambling in the world, even before the Gambling Commission started its recent mission to clamp down on high-risk products or gambling on credit for all. We need to be clear about the distinction between addicts, those who are at risk of addiction, and those who get into trouble gambling because they don’t know how easy it is to lose large amounts of money very quickly, i.e., chasing losses. The latter need to be addressed through a comprehensive educative program, such as those offered by YGAM, a charity concerned with educating young people about the risks involved in gambling. Most actions taken by regulators to reduce the harms from gambling are to remove access to “high-risk” products, as far as is possible. I am no expert, but am certainly more than an interested bystander. In my book, it is not the product (gambling game, drug, etc.) that causes the addiction, but rather something within the individual. I am not saying that all addicts are responsible for their own addiction. Far from it. An addict cannot help being an addict and should not be blamed or made to feel guilty. But we need to recognise that restricting everyone’s access to some gambling product because it is deemed to be “risky” is not the answer. A higher percentage of the prison population are gambling addicts than found in the general population, even after removing those whose crime was related to gambling addiction, such as stealing money, embezzlement, etc. Interestingly, a higher percentage of the prison population have been diagnosed with Attention Deficit Hyperactive Disorder (ADHD) than the general population and a higher proportion of addicts have been diagnosed with ADHD. There is also a thread of research and treatment that is looking at the relationship between experienced trauma, ADHD, and addiction — with some promising results. Parkinson’s disease tends to affect older people, causing a deficit of the neurotransmitter dopamine and some others, resulting in tremors, lack of muscle control, slurred speech, and rigidity; it also increases the risk of gambling addiction. Strangely, a class of drugs used to treat the disease, dopamine agonists (they imitate dopamine), can have the same effect, increasing the risk of addictions in about 7% of Parkinson’s sufferers. There have been a number of court cases around the world where groups of Parkinson´s patients have successfully sued the major pharmaceutical companies when they developed addictions, including gambling, after being treated with dopamine agonists. All of this would suggest that there is a biochemical nature to some people’s addictions. Is it nature or nurture or both? Is the cause of these biochemical changes genetic, life experience, or both and what does it mean for treatment? Without further research, we will not know. Does restricting access through banning something work to reduce addiction rates? Clearly not. The “war on drugs”, a prohibitive policy that targeted suppliers and users with draconian sentences, did nothing to reduce drug-addiction rates. Expecting an addict to just say “no” is entirely unrealistic. Drugs of choice for addicts vary over time according to price and availability. It is not the type of drug that causes the addiction. Alcoholics like spirits — whisky, vodka, etc. The stronger the better. Why? Because it gets them to where they want to be faster. If they cannot get spirits, they will find the next “best” thing, a slightly weaker form of alcohol and if they cannot get that … and so on and so on. A “high-risk” gambling product is, by definition, one that appeals to gambling addicts. If restricting access to “high-risk” gambling products is effective at making them disappear from the market, addicts will simply migrate to the next “best” thing. Before you know it, a “medium-risk” product will become a “high-risk” product and more gambling addicts will be found to be playing on this type of product. Loot boxes in video games became an item of interest to the media and regulators. There was concern, and rightly so, that some under the legal age for gambling were using them as a form of gambling. Why were they using loot boxes? Because it was the only thing that was available to them. If history can tell us anything, it is that prohibition does not work. Those who want to play a certain gambling game, if it is not available legally, will find it from an illegal supplier and will pay a premium to do so. This premium usually comes in the form of higher transaction fees, higher risks of not being paid out, etc. Addicts have by far the highest motivation to gamble at illegal products and they will migrate to illegal operators, making their addiction harder to identify. Instead of making gambling less interesting to over 90% of gamblers, regulators would best serve the public interest by working with the industry to create an environment that fosters the development of tools to identify those at risk and point them towards help, tools to help people manage their gambling and to ensure the availability of effective short- and long-term treatment.