Sandy Thompson, programme lead for health and social care at Ygam, discusses the role community nurses can play in safeguarding young people against gaming and gambling harms.
Gambling harms have been recognised as a public health concern by the NHS, and gambling disorder has become the first non-substance behavioural addiction to be classified in the Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-V). In July 2023, the NHS recorded around 1,400 patients referred to NHS gambling addiction clinics, an increase of more than a third on the previous 12 months.
The NHS National Centre for Gaming disorders has seen a significant increase in people accessing the service since opening in October 2019, with numbers of gamers getting treated increasing by more than half from 2021 to 2022.
There are also growing concerns about the blurred lines between gambling and video games. Young people playing video games often spend real money or virtual currency to buy virtual goods or services that enhance the gaming experience. Many of these in-game purchases, such as loot boxes, can resemble gambling-like mechanisms and have been the subject of regulatory scrutiny and debate.
Yet, research published in the British Journal of General Practice revealed that patients are less likely to disclose gambling problems than substance use disorders, with approximately 25% of GPs thinking those experiencing gambling harms would spontaneously disclose this information. When asked to identify a care pathway for a problem gambler, some GPs didn’t view this kind of treatment as a general practice concern, and only 35% of GPs were able to identify a recognised gambling harm treatment or prevention service. Nurses in primary care are in an ideal position to support GPs in identifying signs of harm and make every contact count.
Gambling participation in young people
The Gambling Commission published the latest Young People and Gambling Report (November 2023) that revealed that over a quarter (26%) of 11- to 17-year-olds had spent their own money on any gambling activity in the last 12 months.
Nearly half of gamblers between the ages of 18 and 24 said they had risked more than they could afford to lose, with 42% revealing that they had taken financial risks to pay for their gambling, and 36% sharing that they had either borrowed money or sold possessions to place a bet.
In addition, 34% of young people aged between 11 and 17 had paid for in-game items in video games with their own money or virtual currency in the past 12 months, and 21% had spent money or virtual currency to unlock loot boxes, packs, or chests to acquire in-game items to advance the player through the game.
Gaming and young people
Globally, there are over 3 billion gamers, with the UK having the highest number of video gamers from across Europe. The Uswitch Online Gaming Statistics Report 2023 revealed that 91% of UK children between the ages of 3 and 15 play video games on some type of digital device, with more than two-thirds (68%) owning their own games console, and a further 9% having consistent access to one.
Influences on young people
Video gaming has surpassed being a pastime for many young people and has become a crucial way of learning for those growing up in a digital world.
The video games industry now also offers many and varied careers for young people, with The Data City estimating that UK gaming sector employment could rise to 60,000 by 2025 and could be worth approximately £29.5 billion by 2027.
The prospect of winning money is the main reason young people gamble. Nearly one-third (32%) of young people who had spent their own money gambling in the last 12 months said they gambled with the intention of winning money.
Family and parental influence can affect a young person’s gambling behaviour: 28% of young people had seen family members they live with gamble, with 12% sharing that gambling by a family member had helped to pay for things at home for example holidays, trips, or clubs.
This experience can create positive perceptions of gambling activity, allowing a young person to feel that gambling is an effective way to earn money quickly, that can then be spent on enjoyable experiences.
There is a correlation in 18-25-year-olds between peer pressure and their gambling behaviour too. The recent Annual Student Gambling Survey, commissioned by Ygam and GAMSTOP, revealed that over a third (36%) of student gamblers said they gamble for fun with their friends and peers, while the key influence for a student’s gambling was their friends (34%).
The exposure and effect of marketing messaging and social media can distort the social and financial rewards from gambling. Over half of young people have seen or heard gambling advertising via online or offline platforms (online: 53%; offline: 55%), having reported frequently seeing gambling advertising on television (47%) or on an app (45%).
A University of Bristol research project looked at 10 Premier League matches during the 2022/2023 season, and found that gambling logos appeared on average 16 times per minute (every 3.8 seconds) with a total of more than 15,500 appearances across all 10 matches.
Why young people are more at risk
A recent study published in the Journal for Gambling Studies suggests young people are more vulnerable to the risks associated with gaming and gambling due to cognitive immaturities and brain underdevelopment. Between the ages of 10 and 25, the brain undergoes changes that have important implications for behaviour.
Development in the limbic system plays an important role in determining rewards and punishments and processing emotional experience and social information, while the prefrontal cortex is involved in decision making and cognitive control. This makes young people far more impulsive and generally more likely to participate in risk taking activities.
This is evidenced through data that shows that 11- to 17-year-olds who had participated in gambling in the last 12 months had also participated in other risk activities, with 67% of them drinking alcohol and 20% of them taking illegal drugs. This lack of self-regulation can manifest in impulsive decision making, especially in activities like in-game sports betting with added time pressure, in-game purchases to advance to the next level while playing a video game, or any activity that requires immediate decision making.
‘Putting gambling in the same category as drug and alcohol harm is an eye-opener for me’
Child health screener, Newham
For the past few years, researchers have highlighted how online games and social media platforms are using the same techniques as gambling operators to create psychological dependencies and ingrain their products in the lives of their young users.
Ofcom has recently introduced tighter rules for internet companies and how they can interact with children within the connect of the Online Safety Act. Seriously harmful content, including that relating to suicide, self-harm and eating disorders, will now need to be kept off children’s feeds entirely, but the topics of gaming and gambling have faced lesser restrictions.
This has created safeguarding concerns within the NHS around the monitoring, regulation, and exposure of gaming and gambling advertising, as young people are still left substantially unprotected against these dangers, without the cognitive maturity or grasp of consequence to help them make more informed decisions.
‘I found this really useful, will definitely be incorporating gaming/gambling into health assessments as I never really ask about it when discussing sleep problems with young people’
School nurse, Stockport
NHS guidance and what to look out for
When struggling with their mental health, few young people feel comfortable enough to turn to nurses and medical staff for help, with many feeling isolated or ashamed due to the stigma that exists around the topic.
The Gambling Commission’s recent analysis of NHS services (March 2024) revealed that gaming and gambling harms often coexist with other comorbidities that in turn impact a young person’s mental and physical wellbeing. This can make it even more difficult to identify signs of harm.
‘Having worked in addiction services previously I am aware of the lack of support and resources around gambling specifically’
Clinical lead, primary care, Devon
Despite the hidden nature of gaming and gambling harms, nurses are in a unique position to identify signs of potential harm. While routine screening for gaming or gambling harms is not compulsory in the NHS, it is important that all healthcare professionals are vigilant and have conversations with the patient if they have any concerns.
NICE draft guidelines, due to be finalised next month, advise that all healthcare professionals should ask people about gambling in the way they are asked about drugs, alcohol, and smoking.
‘I will be adding some questions around gambling/gaming to the vulnerability/exploitation part of my risk assessment with young people’
Mental health practitioner, Bolton
Although there’s currently no NICE guidance on the topic of gaming harms, the NHS has regularly highlighted the addictive systems that some video games use to encourage young people to gamble, reiterating the negative relationships between excessive video gaming and gambling. For more information on the signs to look out for and ICD 11 criteria, please visit the National Centre for Gaming Disorders website.
Nurses in primary care are vital in acting as a first line of harms prevention for children and young people. Comprehensive education and support initiatives are imperative to equip professionals with the necessary tools to intervene effectively.
By integrating more rigorous routine screening into healthcare assessments and adopting a holistic approach to care, we can safeguard more young people against gaming and gambling harms.
Ygam is an award-winning charity with a mission to prevent children and young people from experiencing gaming and gambling harms through awareness raising, education, and research. If you have care or influence over a child or young person and want more information about gambling harms and how to prevent them, you can register for a free online workshop here.
Our City & Guilds accredited workshop enables nurses in primary care to have meaningful conversations about gaming and gambling and be able to risk assess participation and know how to respond. You will receive a resource pack to use in your practice along with available signposting information.
If you’re worried about your own or someone else’s gambling, the National Gambling Support Network provides free help and support, 24 hours a day, 7 days a week.
