Understanding Gambling Harm

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Conceptualizing gambling harm

Gambling harm is multifaceted, and isn't limited to just people who gamble. The types of harm and the severity of those harms can vary between gamblers and their affected others, and can occur at all levels of the continuum of gambling harm.

The continuum of gambling harm

Gambling harm severity is measured in different ways, but most commonly used scale is the Canadian Problem Gambling Severity Index, or PGSI.¹ This scale gauges a person’s gambling behaviour, and classifies it under one of four categories:

Non-problem gambling
Low-risk gambling behaviour
- Characterized by few, if any, identified consequences
Moderate-risk gambling behaviour
- Behaviour that begins to cause noticeable negative consequences
Problem gambling
- Characteristically, frequent negative consequences and possible loss of control over behaviour

Problem gamblers experience much more severe harms than lower-risk gamblers, but only a very small percentage of the population are problem gamblers, so they do not experience the majority of the harm to the population. A study by Browne et al.² found that harms experienced by problem gamblers only accounted for 15% of total gambling harms in the population of Victoria, Australia. Moderate-risk gamblers accounted for approximately 35% of gambling harms, and low-risk gamblers accounted for approximately 50%. Different prevention and treatment strategies should be targeted at different groups, depending on the types of harms they are experiencing, and the severity of those harms.

The themes of gambling harm

In order to understand gambling harm, it is helpful to break down the concept into core themes that define the dimensions that these harms operate within. The three dimensions are 1) who is experiencing the harms, 2) the types of harms being experienced, and 3) the timeframe the harms occur in.

"The Conceptual Framework of Gambling Related Harm", © Langham et al. 2016, is licensed under CC BY-4.0.

The persons affected

Gambling harms are not restricted to the person who gambles. While these individuals are most at risk for suffering the harms stemming directly from gambling behaviour, the friends and family of the gambler, also known as affected others, can suffer through indirect exposure. Beyond the immediate circle of friends and family that are at risk of suffering from gambling harms indirectly, the greater community with which the individual is engaged can be impacted.

The timeframe

In extreme or chronic examples of problematic gambling behaviour, harms from gambling can extend far beyond brief and immediate consequences. In some cases, these harms can stimulate long term life changes for the individual gambler, known as generational harms. Generational harms can irrevocably affect an individual’s life course and have lasting effects on many aspects of a person's life.

In extreme forms, these harms can extend to intergenerational disadvantages that continue to disrupt the lives of the person’s friends and family for many years. Intergenerational and lifecourse harms are of primary interest to population health advocates and policymakers, perpetuating legacy consequences that have major impacts as determinants of health and wellbeing.

The type of harm

Gambling harms can have multifaceted impacts to the individual, as well as to their friends, family, and the broader community. Erika Langham and colleagues³ have classified these diverse harms within the following areas:

Financial Harm

General	Crisis	Legacy
Additional costs due to lack of capacity of person who gambles to meet their costs or joint costs (minor to major items) Reduction or loss of capacity to purchase luxury items such as holidays, electronics Reduction or loss of discretionary spending such as nongambling related entertainment or other family members’ activities (i.e. children’s sports) Erosion of savings Activities to manage short term cash-flow issues: Additional employment or other forms of income generation Accessing more credit Use of credit cards (kite flying) Selling or pawning items Pay day loans Non-payment or juggling of large bills such as utilities or rates Cost of replacing items sold or pawned as part of short term cash strategies Reduction or loss of non-immediate consequence expenditure Insurance (health, home, car, income protection, business) Repairs or maintenance costs (home, car, business) Health promotion activities (check-ups, long term medications, allied health support) Household items Reduction or loss of expenditure on items of immediate consequence: Children’s expenses (education) Medication or health care Clothing Food (including use of food parcel) Housing or accommodation Needing assistance with bill payments from welfare organizations or inability to pay bills (e.g., utilities) Transport costs (gas, fares)	Loss of sources of additional funds (i.e. no further credit available) Loss of capacity to meet requirements of essential needs (food) Loss of normal accommodation requiring temporary accommodation or resulting in homelessness Loss of major assets (car, home, business) Bankruptcy	Reliant on welfare Restrictions due to bankruptcy or credit rating Ongoing financial hardship “Forced” cohabitation or involvement in unhealthy relationship due to financial constraint. Further financial harm from attempts to manage debt (i.e. Nonreputable finance providers for debt consolidation). Ongoing issues relating to financial security, poverty, or financial disadvantage. Higher costs associated with poor credit rating including premium cost of pay as you go services or increased security bonds.

Relationship Disruption

General

Crisis

Legacy

Dishonest communication within relationships with spouse, partner, children, family, friends or community
Unreliable or unavailable to spouse, partner, children, family, friends, or community
Reduced amount of time spent with spouse, partner, children, family, friends or community
Reduced quality of time spent with spouse, partner, children, family, friends or community
Disengagement or withdrawal from relationship responsibilities.
Increased levels of neglect of relationships
Pervasive neglect or disengagement from relationships
Reduced engagement in family or social events
Tension with spouse, partner, children, family, friends or community
Minor or occasional conflict due to increased involvement in gambling or suspicion of increased involvement with gambling
Serious or regular conflict due to increased involvement in gambling or suspicion of increased involvement with gambling
Major or constant conflict due to increased involvement in gambling or suspicion of increased involvement with gambling

Loss of trust from relationship with spouse, partner, children, family, friends or community
“Punishment” by spouse, partner, children, family, friends or community
Episodic distortion of relationship roles (infantilising the person gambling, others including children having to take parental type role)
Incidence or escalation of family violence or intimate partner violence

Threat of separation or rejection from relationship with spouse, partner, children, family, friends or community
Actual separation or rejection from relationship with spouse
Social isolation
Loss of relationship (temporary or permanent) with spouse, partner, children, family, friends or community
Distortion of relationship roles (infantilizing the person gambling, others including children having to take parental type role)
Incidence or escalation of family violence or intimate partner violence

Social isolation due to ongoing estrangement from relationships with spouse, partner, children, family, friends or community
Vulnerability to problematic gambling relapse due to isolation or relationship breakdown
Inability or reluctance to participate in social functions at gambling venues
Ongoing “punishment” or resentment from spouse, partner, children, family, friends or community
Relationship rebuilding or reconciliation
Ongoing involvement of family court in parenting or co-parenting
Long term damage or estrangement from relationship/s with spouse, partner, children, family, friends or community

Ongoing distortion of relationship roles (infantilising the person gambling, others including children having to take parental type role)
Loss of psychological development through lack of appropriate social interaction
Incidence or escalation of family violence or intimate partner violence

Emotional or Psychological Distress

General	Crisis	Legacy
Emotional and psychological distress caused by living outside of your value system Experience of distorted cognitions or erroneous beliefs Emotional or psychological distress of hiding gambling from others (including lying and creating alibis for lost time and money) Reduced feelings of self-worth and pride Increased feelings of shame Increased feelings of inadequacy or personal failing because of inability to control gambling to recreational levels Perceptions of being stigmatised Emotional or psychological distress of inability to control gambling Increased feelings of insecurity and vulnerability Emotional or psychological distress caused by other harms Emotional or psychological distress due to harm caused to others (guilt) Loss of “face” or reputation due to impact of other harms Desperation from not being able to recoup losses. Emotional or psychological distress of not wanting to accept problems with gambling Loss of sense of future or ability to get ahead Increasing feelings of powerlessness Fear and distress from follow up and harassment by creditors (legal and illegal)	Extreme emotional or psychological distress in relation to other harms Extreme emotional or psychological distress due to harm caused to others Extreme emotional or psychological distress caused by living outside of your value system Complete loss of feelings of self-worth and pride Extreme shame Extreme sense of hopelessness and powerlessness Suicidal ideation Loss of “face” or reputation (stigma) if problem with gambling becomes publicly known Shame from utilising responsible gambling measures such as exclusion or seeking treatment. Extreme fear and distress from follow up and harassment by creditors (legal and illegal)	Experienced, perceived and internal stigma Ongoing guilt and shame Emotional and psychological impacts of managing recovery or harm minimisation strategies including constant vigilance and behavioural adaptation Ongoing feelings of insecurity and vulnerability Ongoing emotional and psychological distress in relation to other harms Ongoing emotional or psychological distress due to harm caused to others Ongoing emotional or psychological distress caused by having lived outside of your value system Ongoing vulnerability to suicidal behaviours

Decrements to Health

General	Crisis	Legacy
Increased sedentary behaviour during time spent gambling Biological manifestation of emotional and psychological distress (e.g. increased blood pressure, loss of sleep, etc.) Reduced levels of self-care: Nutrition Hygiene Sufficient sleep Compliance with medical care Physical activity Reduced quality of living circumstances (i.e. cannot afford heating) Incidence of disease or injury due to reduced levels of self-care Increased risk due to gateway effect, interaction with, or exacerbation of other health risk factors (drinking, smoking, illegal substances) Increased risk due to gateway to, interaction with, or exacerbation of comorbidities (depression, anxiety, biophysical chronic disease) Increased experience of family violence due to involvement in gambling Incidence of self-harm Minor health ailments (headache migraine) relating to focusing on a screen for long periods of time with particular gambling products	Physical impacts of living rough due to homelessness, including increased risk of disease, violence and impact of poor living conditions Experience of violence due to involvement in gambling Medical emergency (including mortality) due to onset, exacerbation, or failure to diagnose condition due to gambling Serious self-harm Attempted (or completed) suicide	Ongoing disability or decrement to health through attempted suicide or other forms of self-harm Ongoing increased risk of disease or decrement to health due to legacy effects of risk factors or poor self-care Ongoing disability or decrement to health due to other medical conditions exacerbated or advanced due to involvement with gambling

Cultural Harm

General	Crisis	Legacy
Reduced engagement in cultural rituals Culturally based shame in relation to cultural roles and expectations Reduction of contribution to community and cultural practices of the community Reduction of cultural practices Reduced connection to cultural community Harm to individual through reduced connection to community and culture in terms of increased social exclusion or isolation	Extreme cultural shame in relation to culturally based roles and expectations Loss of ability to contribute to community Impact (loss) on cultural practices Damaged or lost connection to community and culture Harm to individual through reduced or lost connection to community	Ongoing cultural shame in relation to roles and expectations Ongoing reduction or loss of contribution to community Ongoing reduction or loss of cultural practices Ongoing loss of connection to community Ongoing harm to individual through reduced connection to community Harm to individual through reduced or lost connection to community

Reduced professional or academic performance

General	Crisis	Legacy
Reduced performance due to tiredness or distraction Increased absenteeism due to time spent actually gambling, tiredness, ill health or lack of transport due to gambling Workplace or educational institution consequences of use of work or educational institution resources for gambling activity Reduced availability to contribute to the community through volunteer work	Loss of job due to theft or fraud involving employment or educational institution Loss of job, suspension or exclusion from educational institution due to poor performance Exacerbation or contribution to other harms due to job loss (including loss of wage) Rejection from volunteer work	Reduced opportunity for employment or enrolment due to past poor performance or criminal activity Ongoing impact in participation in volunteer work (linked to reputation and restriction of activities)

Criminal activity and deviance

General	Crisis	Legacy
Vulnerability to illegal activities that can provide fast access to funds Engagement in crimes of negligence - acts such as child neglect (leaving children unsupervised) Engagement in crimes of opportunity - petty theft including from family members Engagement in crimes of opportunity - property crimes for funds, illicit lending, fraudulent efforts to attain funds Engagement in crimes of duress - relating to repaying debt such as drug trafficking and prostitution	Arrest and/or conviction of criminal activity of opportunity Arrest and/or conviction of criminal activity of duress Arrest and / or conviction of criminal activity of negligence	Impact of criminal record on future employment opportunities, voluntary and community opportunities, travel restrictions Disruption to relationships of custodial sentence Ongoing impact on spouse, partner, child, family and friends due to impact of criminal record or custodial sentence through other mechanisms Trans-generational impact of criminal record or custodial sentence Shame and stigma of criminal conviction or involvement in criminal activity

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