Problem Gambling - Addiction or Disorder ?

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Terminology can be both empowering and constraining, especially when applied to situations where the vulnerabilities of human beings are being exposed. So, with regards to Gambling Related Harms (GRH), what are the phrases that crop up and what lies behind the 'labels'.

Problem Gambling refers to any act of gambling that is carried out in a way that generates problems for the individual engaging in it, or to others around them. While most people with direct experience of GRH can at least understand this phrase, they may not like it much, or actively use it themselves, due to it being perceived as having close associations with the term 'Problem Gambler', a phrase often identified as being coined and commonly used by the gambling industry in seeking to deflect responsibility for GRH from those promoting and profiting from gambling on to those experiencing harm while partaking in it. Describing a person as being a problem "anything" can be seen by those labeled in such a manner as being denigrating, belittling, and stigmatising. Having a [gambling] problem is entirely different from being a problem [gambler]. 

If gambling is indeed to be described as being a problem, then it has to be recognised as being a complex problem - i.e. one with complex causes which create diverse and complex harms, and which requires diverse and complex solutions. So a problem, yes, but one couched in the alternative, scientific, meaning of the word. A puzzle which we all have a role in taking ownership of, and vested interest in working together in seeking to find a workable solution for. 

Both the World Health Organisation (WHO - ref: ICD-11) and the American Psychiatric Association (APA - ref: DSM-V) now consider Gambling Addiction (also previously known as Pathological Gambling) to be a mental disorder. As such, the use of the terms Disordered Gambling, to refer to gambling that is carried out in a reckless and uncontrolled manner, and also Gambling Disorder, the mental illness which manifests in addictive aspects and behaviour around gambling activity, are gaining traction in the GRH community and are quickly becoming amongst the most widely adopted and generally acceptable terms for identification purposes.

It should also be noted that while someone can gamble in a disordered manner, it does not necessarily mean that they have developed a Gambling Disorder. It is, however, a distinct warning sign that they may be on the path to doing so.

Perhaps a more universal term is Harmful Gambling. This has the distinct advantage of covering all acts of gambling where harm is being actively caused and has the added benefit of having no inference as to characteristics or underlying disorders of the person engaging in those acts. It is also a term which recognises and encompasses all who are harmed by acts of gambling - whether they be the person engaging in gambling or those collaterally harmed by others - i.e. "affected others".

So, is it Gambling Addiction or Gambling Disorder, and is there a difference? People can and do become addicted to gambling and the mental process that occurs inside the brain is indicative of a mental disorder so, in effect, the two terms are interchangeable. A Gambling Addict is also a Disordered Gambler, and vice versa. The current APA and WHO approach is that Gambling Disorder is directly comparable with other more widely recognised addictions such as Alcohol and Substance Use Disorders. Those affected by Gambling Disorder share many characteristics and effects in common with sufferers of Alcohol and Substance Use addictions. This is also true of the closely linked but separate affliction of Gaming Disorder.

So which term is more appropriate for general use? Here at GamHarm we would opt for Gambling Disorder, simply because the terms 'addiction' and 'addicted' are so prevalent in every day language and idiom that they sometimes run the risk of becoming disassociated with their clinical meanings and, as such, 'watered down' in significance. For example, it is quite commonplace nowadays to hear someone claiming to be 'addicted' to a particular trending TV series or boxset. While it is the case that a very small percentage of those saying this might actually have a behavioural disorder whereby they can develop actual addiction to activities such as watching TV shows, the overwhelming majority are simply using those terms to emphasise their particular liking for such shows and are not expressing an irrational need to keep watching them to the detriment of other everyday activities and concerns. It is far less common to hear the term disorder being misappropriated for non-clinical usage and so we believe that by using Gambling Disorder we are making it very clear that we are talking about a mental disorder which has a defined basis in clinical psychiatry and is a diagnosable mental health condition.

As such, here at GamHarm, we would recommend using Harmful Gambling to describe acts of gambling where harm is being caused, Disordered Gambling to describe an act of gambling by an individual known to be suffering a disorder, and Gambling Disorder to describe the diagnosable condition by which individuals can become addicted to continuing engaging in uncontrolled and self-harming gambling behaviours. 

Some other terms that may be encountered include Pathological Gambler/Gambling, Compulsive Gambler/Gambling, and Obsessive Gambler/Gambling. While these are perfectly acceptable terms we do feel that they are more niche with regards their intended audience (Pathological == intra-clinical/medical use) and purpose (Compulsive/Obsessive == behavioural sub-category) and accordingly that Disorder/Disordered is a more generally acceptable use of terminology. 

Responsible Gambling is a term increasingly used by gambling operators to refer both to the act of gambling in a responsible and harm free manner and also to the collective tools and internal staffing sections employed to detect and prevent harmful gambling. GamHarm are happy to use the term Responsible Gambling but only in situations where it is clear that the onus of "responsibility" is recognised as applying to both sides of the transaction. In other words, where it clearly involves not only the responsibility of the customer not to harm themselves (and others) but also the responsibility of the operator not to allow customers to harm themselves.

As this equality of meaning is not always obvious in the context of usage we prefer the alternative term Safer Gambling. This not only removes confusion over precisely whose onus of "responsibility" is being referenced but also recognises the fact that any form of gambling can never by definition be "risk free" and therefore can never be fully "safe". We feel that "safer" acknowledges this.

Gambling Disorder is sometimes also known as the 'Hidden Addiction' for two good reasons. The first being that it is not widely publicised, in comparison with other addictions, and as such there is little endemic awareness of it amongst the general public. The second reason is that a common trait of sufferers is for them to try and hide their addiction from friends, colleagues, and family, due to feeling guilt and fearing stigmatisation as a result of the general lack of publicity or understanding about the disorder that currently prevails. This secrecy, combined with a common lack of any obvious external signs of physical harm, means that the prevalence of Gambling Disorder remains under recognised, under reported, and under the radar of public awareness.