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The convergence of gaming and gambling presents unique challenges for young people. The digital age means gambling is thriving, as technology can manifest in new ways with new intersections between gambling platforms and other digital media technologies. [1] What is simulated gambling? Simulated gambling is a common feature of many video games and involves an “interactive gambling activity which does not directly involve monetary gain but is otherwise structurally identical to a standard format of a gambling activity due to its wagering features and chance-determined outcomes of play”. [2] In short, the player experience is fundamentally the same as a real gambling application, except without real money being bet. In many mainstream video games, there are gambling elements, often in the style of in-game casinos one can visit. This has occurred in games across genres, including Grand Theft Auto, Fallout:New Vegas and even Pokémon. While not all representations of in-game gambling are purely positive, with more notable criticisms of casinos and gambling in some video games, such as Red Dead Redemption 2 exploring the consequences of gambling addiction on non-player characters, the game mechanics in these games where the player gambles are still designed to be “fun” for the player. To make these games of chance in otherwise skill-based games appealing, they may employ game mechanics such as a “Luck” statistic, or a minigame in which you must correctly time a button press, which can misrepresent real gambling as more skill-based than it really is. Often, the odds of winning a bet or a game in a video game are much higher than in real-life casinos or on gambling applications, which can skew player perception of gambling. In addition, in these games, players can save before each wager, and reset if they lose. Though not all representations of gambling in video games are equally addictive or positive for the player, all have the potential to cause a development in interest in gambling. Simulated gambling in video games extends to a whole genre of dedicated casino-style games, which involve no real-life transactions, but offer a similar experience to online casinos which do involve gambling. These include “free-to-play” online casinos. These simulated gambling apps are often hosted and advertised on social media, which plays into the exposure effect and social response aspect of gambling – people are more likely to engage if their peers are also involved. [3] According to Gambling Commission 2019 data using a sample of 2943 young people, 12% of 11-16 year olds have said they had played an online gambling-style game, almost half of which did so through an app. [4] These apps may be made by the same developers and owned by the same companies which develop real-money gambling applications, and indeed, the two may be one of the same, via the use of “demo modes”, a free “demonstration” of a gambling application which uses real money. Demo modes for online casinos are also a major form of youth gambling. In the same survey, 29% of young people who had gambled said they had previously used demo modes of online casinos. [5] Age checks are often not in place in online casino apps, and if they are, children may use their parent’s accounts or other methods to bypass the age restriction. Effects of simulated gambling According to research, simulated gambling exposure may be more likely to have negative consequences for youth gambling when different criteria are met. [6] Among other factors, if a simulated gambling application or game facilitates entry into a gambling subculture, providing social incentives to gamble, and encouraging covert gambling, the exposure is more likely to be considered harmful. Additionally, if the player experiences early wins, is enabled to engage in intense playstyles, and has misconceptions and false beliefs about the nature of gambling odds and skill levels, this is also harmful exposure. Simulated gambling may be beneficial as a part of gambling education if the player experiences normal win-loss outcomes and it is modelled as an educational experience with minimal extrinsic feedback. Based on these criteria, there are different levels of harmful exposure in video games; and the worst offenders are the dedicated casino-style gambling applications, which often exhibit skewed outcomes that favour the player and are designed to encourage players to keep playing in order to make money, either because they rely on making money through advertising or because they are closely linked to true gambling applications. Though the simulated gambling in more mainstream video games meets less of these criteria, and there are opportunities for gambling experiences to be more educational in these regards, we believe that exposure in some video games may have an overall negative effect. According to the ESRB‘s (Entertainment Software Rating Board) criteria, simulated gambling mechanics are considered appropriate for players aged 13 and up. We believe that this is unsatisfactory, as the links between simulated gambling and gambling behaviours with real money should not be downplayed. Gambling in real life situations has a much higher age limit, and exposure of adolescents, especially in situations where they feel compelled to gamble in these simulated environments, is likely to result in later issues for some people. [7] For more information on gambling in video games and its effects, please read our pieces on loot boxes and on online skin betting. [1]King D, Delfabbro P, Griffiths M. The convergence of gambling and digital media: Implications for gambling in young people. Journal of Gambling Studies. 2010 Jun 1;26(2):175-87. [2]King, D.L., Delfabbro, P.H., Kaptsis, D. and Zwaans, T., 2014. Adolescent simulated gambling via digital and social media: An emerging problem. Computers in Human Behavior, 31, pp.305-313. [3]Armstrong, T., Rockloff, M., Browne, M. and Li, E., 2018. An exploration of how simulated gambling games may promote gambling with money. Journal of Gambling Studies, 34(4), pp.1165-1184. [4]Young People Gambling Report 2019 (cliftondavies.com) [5]Wood RT, Griffiths MD. A qualitative investigation of problem gambling as an escape‐based coping strategy. Psychology and Psychotherapy: theory, research and practice. 2007 Mar;80(1):107-25. [6]King, D.L. and Delfabbro, P.H., 2016. Early exposure to digital simulated gambling: A review and conceptual model. Computers in Human Behavior, 55, pp.198-206. [7]Kushner, M., Thurus, P., Sletten, S., Frye, B., Abrams, K., Adson, D., Van Demark, J., Maurer, E. and Donahue, C., 2008. Urge to gamble in a simulated gambling environment. Journal of Gambling Studies, 24(2), pp.219-227.

The impact of gambling-harm on LGBT+ (lesbian, gay, bisexual/pansexual, transgender and other minority gender and sexual identity) communities is one which has been severely under-researched. Preliminary evidence suggests LGBT+ populations may be more vulnerable to experiencing gambling harm as they are 1.5-2x more likely to be diagnosed with anxiety or mood disorders, and have higher rates of substance use, which are considered risk factors with disordered gambling.[1] [2] LGBT+ people, particularly the trans and gender-nonconforming community, also experience employment and pay discrimination, which relates to gambling harm as economic deprivation is associated with gambling harm. [3] Why is understanding the effects of gambling on LGBT+ Populations important? Other minority groups, such as minority ethnic populations and veterans, are beginning to become more well-studied in the fields of gambling research. LGBT+ general health outcomes are also gaining greater study. However, there are only a handful of publications specifically investigating the ways in which LGBT+ people engage in gambling activity. Through the understanding of the ways in which sexual and gender identity affects patterns of gambling and gambling harm, standards of care can be improved and public health prevention efforts can be developed. The Minority Stress Model Many studies dealing with minority populations reference the minority stress model, which describes experiences which arise from a conflict between minority group members and the dominant social environment. It was initially designed to focus on sexual minorities but has been expanded in recent years to cover other minority groups. It proposes that factors such as social rejection, prejudice, hiding and concealing aspects of one’s true identity, and ameliorative coping processes leads to stress. This constant background stress coming from the outside world can lead to negatively impacted physical and mental health outcomes, including engaging in more risky behaviour. [4] Studies into gambling harm Sexual minority communities (LGBT+) Data on the prevalence of gambling in sexual minority communities is somewhat conflicting. Older studies conducted by the Kinsey Institute indicated that gay men gambled less than their heterosexual counterparts, but gay women gambled more than their heterosexual counterparts. [5] Moreover, a 2021 study on sexual minority men, which indicated that problematic gambling was less severe in sexual minority men than in heterosexual men. [6] Studies on the potentially elevated risk for lesbians and sexual minority women were difficult to find, and there were no studies found which were published specifically on this topic. One 2015 study on 605 individuals found there were no significant differences in gambling between heterosexual and homosexual and bisexual populations. [7] Instead, the study reported that sexual minority participants were more likely to engage in problematic gaming. However, participation in this study was through self-selection, and the survey was presented as a self-test for problematic gaming and gambling, which may lead to sampling errors such as lack of awareness or honesty. The total number of participants who were sexual minorities limiting the applicability of these findings to wider sexual minority populations. There are also multiple studies which do indicate that overall, sexual minority groups are at elevated risk of problematic gambling. A preliminary study by the University of New South Wales in Australia attempted to study patterns of play in the LGBTI+ community. It was limited by smaller sample size (69), but included a range of ages, with a mean of 32. Within this sample, 20.2% of participants met the diagnostic criteria for problematic gambling – far higher than in the general Australian population, which is between 0.5 and 1%. [8]The motivations for gambling were mostly to improve or elevate mood, for social reasons, or to cope with negative thoughts, and problematic gambling was linked with increased use of substances and less self-control. This study was obviously limited in the fact that it had a small sample size and marketed itself as a study on gambling specifically, which may lead to a higher participation with gambling problems. However, the data it collected on motivations is particularly valuable. [9] One of the largest studies - sample size of 23,533 - on gambling-harm in gay, bisexual and lesbian young people focused on symptoms of disordered gambling in collegiate athletes. Results for gay and bisexual people of each gender were combined, as it was found that these two groups did not differ from each other in gambling disorder symptomatology. The findings reflected an elevated presence of gambling disorder symptomatology in gay and bisexual student athletes, when compared to their heterosexual peers. The study found the highest rates of gambling in gay and bisexual men. These findings indicate that gambling rates are a significant risk for young gay, lesbian and bisexual people and that further research into the topic is required. Transgender and gender-nonconforming communities Transgender people (those whose gender is different to their sex assigned at birth) and gender-nonconforming (a broader term encompassing those who may not specifically identify as transgender but exist in ways outside of the gender binary) are a group which are particularly vulnerable to minority stress, with 99% of trans people in TransActual’s Trans Lives Survey experiencing social media transphobia, and over 71% experiencing transphobic street harassment. Trans rights are also the current focus of a media culture war, and transphobic hate incidents are becoming more common, which has the potential to amplify the findings of previous studies, and exert a great toll on transgender and gender-nonconforming mental health. A study on 80,929 students, 2168 of which identified themselves as transgender or “gender diverse” reported that trans people assigned male at birth (transfeminine) had elevated risks of screening positive for problem gambling, with had higher rates of participation in all gambling behaviours than the trans people assigned female at birth (transmasculine) and cisgender female participants, except that transgender men and cisgender men had similar rates of casino gambling. Transgender participants, particularly transfeminine participants, reported a much greater risk of screening positive for problem gambling, with 8.9% of transfeminine youth screening positive for problem gambling compared to rates of 1-2.1% for cisgender youth. Data for transmasculine youth indicated that the rates of problem gambling were higher, but this was not statistically significant, likely due to the small sample size. Transgender participants were also more likely to report having gambled via lottery tickets, casino, or online gambling, indicating potential patterns of play. The survey was limited due to its sampling of students, for several reasons, including that transgender participants are more likely to skip school and therefore likely to not be included, and the fact that not all students who will eventually understand themselves as transgender will report so on the survey. However, its large sample size make it a study which provides a lot of useful insights into the fields of youth and LGBT+ gambling research. Limitations of current studies and further research needs: The dearth of research involving LGBT+ stratification is an issue. Most studies into harm in sexual minorities also tend either to aggregate LGBT+ identities, limiting our understanding somewhat, or have small sample sizes. Many of the largest-scale studies carried out into the effects of gambling-harm are on adolescent or young adult populations. Adolescence is a time associated with a lot of difficulty for many LGBT+ people, as the differences between them and their peers become more evident, and as such diminishes the generalisability of research findings to older LGBT+ populations. Older LGBT+ people may be affected by trauma associated with the HIV/AIDS crisis, as well as having their identities treated as more of a pathological issue than the way most people view sexuality and gender identity today. [10] These stressors which are more common in older generations may or may not impact rates of mental health issues, or influence the ways in which they are dealt with. There has been little research into how LGBT+ people interact with recovery services for disordered gambling, and they are excluded from much analysis on patterns of play. Adding a single question on sexuality and gender identity in more widespread studies on these issues would allow for a lot of beneficial data to be obtained, even if LGBT+ identities are not the central point of research. Barriers to adequate care When seeking care or treatment for disordered gambling, LGBT+ people may face particular difficulties which their cisgender, heterosexual counterparts may not face. Poor conduct of mental health providers - Mental health care providers have been found to have the misconception that mental health disorders stem from sexual minority status, even when there is evidence indicating that simply being a member of a minority group has no effects on mental health. [11][12] In a literature review which studied 14 published works on the topic, a significant barrier to accessing these essential health services for the gay population, was the heteronormative attitudes imposed by health professionals. The LGBT+ population generally is more likely to self-medicate and seek support from non-professional sources due to discrimination, and fear assumptions about their sexual orientation. The fear of having your real health concerns dismissed or linked back to your sexual or gender identity is a very present one. In a recent survey of almost 700 UK-based participants by the group TransActual, 70% of participants reported being impacted by transphobia in non-trans-related healthcare settings. [13] This shows the rates at which poor conduct by health providers is impacting transgender and gender-nonconforming communities today. Transgender clients are often not referred to by their chosen names by providers, as well as treated in accordance with negative stereotypes around transgender people – i.e. that they are predatory, confused, or a danger to themselves. Better training for mental health providers, specifically those who deal with gambling harm, is something which would hopefully improve participation and engagement in mental health services overall. Stigma in group spaces: Many group therapy and support spaces, such as Gamblers Anonymous, are open to everyone, and in their statement, mention the inclusion and support of people regardless of their marginalised identity. However, stigmas which the general public in the form of other compulsive gamblers in the same group, or those who chair the groups, may hold, could be expressed to LGBT+ participants. In vulnerable spaces, such experiences may be potentially retraumatising. In a study which conducted interviews on members of Alcoholics Anonymous, a group which shares some structural similarities with Gamblers Anonymous, LGBT+ participants reported a generally heterocentrist language being used that they found alienating, as well being victim to passive-aggression from the group leaders. [14] Whether or not the groups themselves are welcoming, fear of engaging in spaces may cause LGBT+ participants to be reluctant to engage with them. Gendered recovery spaces: Many recovery spaces are gendered, either directly (through gender-specific rehabilitation programmes) or indirectly (through a group being composed largely of one specific gender). This is likely to have negative consequences for LGBT+ people, as many people report homophobic, biphobic or transphobic experiences in single-gender spaces. Many trans people would likely be afraid to enrol in these courses for fear of facing transphobia. Furthermore, if they did apply, they may be rejected on the basis of their gender identity. Across the world, many single-gender spaces reject transgender applicants. In other support spaces, such as homeless shelters, this has occurred, leading to individuals having to go back onto the streets, or seek shelter in the housing spaces for their assigned sex at birth, which can lead to higher rates of assault and sexual abuse. Negative health outcomes are also likely to occur if someone is rejected from a rehabilitation course. Residential courses are often intensive ones, and therefore people experiencing high levels of disordered gambling for whom they may be beneficial would be either actively excluded from engaging with this mental health resource through rejection on the basis of gender identity, or passively, by facing homophobia, biphobia or transphobia and therefore not getting the same benefits as a cisgender, heterosexual participant due to the ongoing minority stress. Financial barriers. A higher percentage of LGBT+ people are unemployed, with a Stonewall report suggesting almost 1 in 5 LGBT+ people who were looking for work being discriminated against because of their sexual orientation or gender identity. [15] Issues around work also involve being fired for LGBT+ status, or experiencing workplace discrimination, including physical assaults. The TransActual 2021 study reported 63% of respondents had experienced transphobia while seeking employment, and there has been studies indicating a potential LGBT+ pay gap of up to 16%. [16] These statistics are generally also impacted by being part of a minority ethnicity in the UK, as well as disability. In countries which require specific health insurance for therapy, trans people are also less likely to be insured. [17] This means that paid-for services may be financially harder to access for LGBT+ people suffering gambling harm, making their inclusion in free services and therapies all the more critical. Recommendations for further study and improvement in standards of care Include questions about sexuality and gender identity in studies on gambling which are undertaken in the future Conduct more specific research into gambling disorders in LGBT+ communities Improve LGBT+ sensitivity training in recovery spaces, and include questions about sexuality and gender identity in intake for these spaces. Offer LGBT+ specific gambling harm reduction programmes. Include mentions of the LGBT+ specific increase in gambling risk and the potential increased risk when someone is multiple marginalised identities in early intervention and educational programmes [1] Bostwick, W. B., Boyd, C. J., Hughes, T. L., & McCabe, S. E. (2010). Dimensions of sexual orientation and the prevalence of mood and anxiety disorders in the United States. American Journal of Public Health, 100(3), 468–475 [2] Richard, J., Martin-Storey, A., Wilkie, E., Derevensky, J.L., Paskus, T. and Temcheff, C.E., 2019. Variations in gambling disorder symptomatology across sexual identity among college student-athletes. Journal of gambling studies, 35(4), pp.1303-1316. [3] https://www.mckinsey.com/featured-insights/diversity-and-inclusion/being-transgender-at-work [4] Dentato, M.P., 2012. The minority stress perspective. Psychology and AIDS Exchange Newsletter, 3. [5] Hershberger, S.L. and Bogaert, A.F., 2005. Male and female sexual orientation differences in gambling. Personality and Individual Differences, 38(6), pp.1401-1411. [6] Bush, R., Russell, A.M., Staiger, P.K., Waling, A. and Dowling, N.A., 2021. Risk and protective factors for the development of gambling-related harms and problems among Australian sexual minority men. BMC psychology, 9(1), pp.1-18. [7] Broman, N. and Hakansson, A., 2018. Problematic gaming and internet use but not gambling may be overrepresented in sexual minorities–a pilot population web survey study. Frontiers in psychology, 9, p.2184. [8] Gambling Statistics Australia February 2022: Do we have a gambling problem? (finder.com.au) [9] Birch, P., Ireland, J.L., Strickland, C. and Kolstee, J., 2015. Examining Gambling & Mental Health in LGBTI Communities: Executive Summary of Findings from a Preliminary NSW Study. [10] Gendron, T.L., Pendleton, T. and White, J.T., 2016. Mental health counseling of LGBT elders. In Handbook of LGBT elders (pp. 455-471). Springer, Cham. [11] Bockting, W., Robinson, B., Benner, A., & Scheltema, K. (2004). Patient satisfaction with transgender health services. Journal of Sex & Marital Therapy, 30(4), 277–294. doi:10. 1080/00926230490422467 [12] Ojeda-Leitner, D. and Lewis, R.K., 2019. Assessing health-related stereotype threats and mental healthcare experiences among a LGBT sample. Journal of prevention & intervention in the community, pp.1-15. [13] Trans lives survey 2021 — TransActual [14] "What Barriers to Treatment and Recovery Do LGBT Individuals with Alcoh" by April Smith (jefferson.edu) [15] LGBT in Britain - Work (stonewall.org.uk) [16] LGBT+ workers paid £6,700 per year less than straight workers, survey suggests | The Independent | The Independent [17] Full article: Healthcare Needs of the Transgender Homeless Population (tandfonline.com)

On the Monday 21st March 2022, I was humbled to deliver the 'Preventing Gambling Harm in Diverse Communities' initiative to Park Academy West London, a partner school of a previous workshop we had completed to River Academy West London. River Academy West London welcomed me with open arms, and the reception was matched from Park Academy West London. I was delighted to deliver our project to just over 390 students on the day ranging from the years 9-11. A lot was learnt on both sides, I was asked engaging and thoughtful questions, and I hope I provided the children with enough information to impact their lives. Thank you to each attendee, your efforts to grasp vital knowledge on this subject were appreciated.

On Monday 21st February 2022, Joshua Palmer and Ben Jones from Red Card were welcomed by Aldenham School in Borehamwood. We were invited to speak to pupils from the school years of Year 7 through to Year 13 by Jos Perris, the Reverend of the Chapel attached to the school to deliver the 'Preventing Gambling Harm in Diverse Communities' programme. A wonderful, with thought-provoking questions, attentive students, and engaged teachers, which saw us deliver to just under 680 students. Thank you, Aldenham School, for your support in our programme, for recognising the significance of gambling harm on young people and allowing us to come in to deliver our free specialist workshops to the students.

What is Stigma? Stigma is a social phenomenon where certain characteristics, qualities or features of an identifiable group are regarded in a strongly negative light. Stigma against marginalised groups can lead to stereotypes, prejudice, and even discrimination. It occurs on a personal and institutional scale – stigma may make it harder for a single person affected by harm to speak out, or it may cause policymakers to underfund necessary prevention and treatment programmes. Types of stigma: Self-stigma: an individual’s self-discrimination from self-blame concerning their gambling and an accompanying sense of shame Public stigma: widespread negative perceptions of people affected by gambling harm propagated by society Structural stigma: political and policy approaches which discriminate against those affected by gambling harms How does stigma affect people with gambling harm? It is reported that stigma hinders or prevents treatment for individuals suffering from substance abuse and disordered gambling (Yang, Wong, Grivel and Hasin, 2017). Stigma can lead to policymakers underfunding necessary treatment programmes. Equally, stigma can dissuade individuals from speaking openly. If people who have a gambling disorder experience less stigma, they may feel more able to ask for help and take steps towards recovery. Studies have shown that people who suffer from gambling harm experience anxiety over how their disorder might be perceived and the potential negative consequences accompanying this. Because of this anxiety, other less healthy coping mechanisms are adopted, such as hiding and cognitive distancing (Dąbrowska and Wieczorek, 2020). The Victorian Responsible Gambling Foundation make a distinction between self-stigma and public stigma. The former refers to stigma from the point of view of people with a gambling disorder and how they perceive themselves. The latter describes the point of view of others, perceiving individuals with a gambling disorder. Stigmatising beliefs can lead to people who gamble compulsively experiencing greater difficulties and further harm, such as increased self-blame and intensified feelings of guilt. Moreover, individuals with problem gambling experience high levels of fear regarding how others perceive them, despite experiences of direct discriminatory behaviours being relatively low (Hing, Nuske, Gainsbury and Russell, 2015). Examples of stigmatising misconceptions surrounding those with gambling disorders: Fixed nature of disorders: people affected by disordered gambling are framed as though they have no capacity or desire to change, which misrepresents gambling addiction Personal responsibility: people affected by disordered gambling are framed as though they are making deliberate choices to gamble Othering and dehumanisation: people affected by disordered gambling are described through addiction-first language that dehumanises them. People tend to keep a distance from them – thinking, “This could never happen to someone like me”. Why is some language stigmatising? It is important to think about why certain language is stigmatising. The choice of certain language and phrases over others can have far-reaching implications for the way in which topics, such as gambling harm, are discussed. Whether or not something is stigmatising often comes down to how the topic is framed. Subtle differences in the words we use, often chosen unconsciously, can create vastly different impressions. The language we use is important because of the non-explicit messages which are conveyed. Depending on how we phrase our words, we have the ability to avoid accidentally implying unnecessarily punitive attitudes and individual blame. The most appropriate terminology is person-first and emphasises that this person has a problem – for example, “person with a gambling disorder” or “person who gambles compulsively” instead of “gambling addict” or “problem gambler”. In addition, language should be clinically accurate – “in recovery” rather than “clean”. This language is non-stigmatising and centres the focus on the person, acknowledging them as an individual first and foremost, while also speaking about gambling in a clear and neutral way. It conveys the meaning that a person “has” a problem rather than that a person “is” a problem (Kelly, Saitz and Wakeman, 2016). When these ideas about stigmatisation are applied to all language used to discuss gambling harm, a far healthier environment is created. Unfortunately, language like “problem gambler” is still common in research, policy and media despite these terms being found to negatively impact the sense of hope and self-efficacy of patients. What are the stigmatising terms for gambling harm and drug use and what are the terms that they should be using? The table below has been prepared to provide examples of non-stigmatising language alongside equivalent stigmatising language, based on a table provided for similar terms relating to drug addiction. On the right-hand side of the table are two columns. The first is a list of terms that can be used to describe Problem Gambling in a way which frames the conversation by putting individuals first. The second column is a list of terms that are often used yet stigmatise those who gamble compulsively. For reference, the two left-hand columns provide the original table of terms concerning drug usage. Theories for understanding stigma Just World Theory: Refers to the cognitive fallacy that people tend to believe that the world is orderly and fair, and that people’s actions will bring morally just consequences. Good will be rewarded, and “evil” will be punished. Some people, for example, may wrongly think people who are in debt “deserve” it, for being affected by compulsive gambling, or some other perceived misdeed. Attribution error: the assumption a person’s actions are dependent on what “kind” of person they are – people who do “bad” things must be “bad” people. This attribution can be applied retroactively. Labelling theory: The understanding that when somebody has been given a label that differentiates them as “other”, they will be treated differently and worse than “normal people.” Intersectional stigma: is a way of understanding how multiple stigmatised identities affect a person or group. These may be various addictions, health issues or demographic factors (from an ethnic minority, lower-income community, or marginalised sexuality/gender background). Intersectionality exacerbates the effect of certain types of stigma. What has been done to combat stigma? The traditional approach to combatting addiction stigma has been the disease model of addiction. This approach has been traditionally applied to problematic drug and alcohol usage and more recently to gambling harm, with compulsive gambling introduced as a disorder in the DSM. Although the disease model might reduce some aspects of social stigma, it has issues as it fails to consider some of the social factors contributing to gambling harm. Anonymity is a strategy used in treatment, such as Gamblers Anonymous. Anonymous support allows people to talk openly without fear of the stigma of gambling affecting them so deeply and helps people access support, but it is also limited, and may contribute to self-stigma in some people as they perceive themselves as less honest. Emerging ways of combatting stigma As mentioned, one of the ways in which we as individuals and organisations can combat stigma is through utilising person-first language. This can help reduce marginalisation through depersonalisation. Destigmatisation can also come through storytelling and narrative psychology, involving changing the ways in which people suffering from gambling harm are spoken about, as well as contact theory, which posits that intermingling of people affected by gambling harm and those who are not affected will decrease stigmatisation. Contact theory is sometimes considered at odds with anonymity, although there is ample room for both in a plan to reduce stigma. Similar to the disease model is defining compulsive gambling and addictions in general as health problems. The two are not synonymous, however. In addition to increasing understanding of mechanisms of addiction, gambling addictions should also be understood as public health issues. Therefore, the societal conditions which contribute to gambling harm, such as targeted advertising, the minority stress model, and socioeconomic inequality, must be meaningfully addressed. In addition, harm that comes to “moderate” and “low-risk” gamblers must be taken seriously. Empowerment through co-production and creation of services by those who have lived experience of gambling harms is something that can empower people to channel these lived experiences to positive personal and social change. Social change can also be directly campaigned for through formal objection to negative portrayals of those with gambling harm or structural stigma limiting the support given to those with gambling disorders. A method of gaining support from political and social figures is rational compassion – fighting discrimination by appealing to the rational benefits of the desired approach, such as via health economics, as gambling harms cost the economy more than prevention and improved treatment would. Suggestions for tactics that could help to reduce stigma Research and report production to detail the causes and effect of gambling harms Educational outreach programmes for youth Storytelling through various forms of media to increase empathetic understanding and compassion Increasing opportunities for contact between those with gambling disorders and those without which will combat otherisation Direct campaigning against discriminatory policies or media which frames those with gambling addictions in a stigmatising way Social media campaigns dispelling stigma References Dąbrowska, K. and Wieczorek, Ł. (2020) ‘Perceived social stigmatisation of gambling disorders and coping with stigma’, Nordic Studies on Alcohol and Drugs, 37(3), pp. 279–297. Hing, N., Nuske, E., Gainsbury, S. and Russell, A., 2015. Perceived stigma and self-stigma of problem gambling: perspectives of people with gambling problems. International Gambling Studies, 16(1), pp.31-48. Kelly, J., Saitz, R. and Wakeman, S., 2016. Language, Substance Use Disorders, and Policy: The Need to Reach Consensus on an “Addiction-ary”. Alcoholism Treatment Quarterly, 34(1), pp.116-123. Yang, L., Wong, L., Grivel, M. and Hasin, D., 2017. Stigma and substance use disorders. Current Opinion in Psychiatry, 30(5), pp.378-388.

This morning I appeared on BBC Radio Lincolnshire for the second time in the past fortnight. Previously it was part of the BBC Upload programme, and the presenter gave out details of the All Bets Are Off podcast and aired a section from our Gambling Harm Among The Student Population episode. However, I was invited to the Mid-morning show with Melvyn Before talking about my own gambling addiction story. Due to the breaking news of the coronavirus tiered system update, we got to cut a little bit short otherwise, we would have spoken more about industry exploitation and the podcast itself. Below you will find the discussion in its entirety.

A huge thanks to John Cossee (Twitter - @JohnCossee) for asking me to participate in this news piece about the realities of gambling addiction in lockdown. It’s always a privilege to be asked to share my experiences, and the way John pulled this together is fantastic. Also, listen out for Ray Gritt, who also takes part. Ray is the husband of our very own Angel of the North Tracey. Click here to watch on YouTube.

As a Monzo account holder myself, I was delighted to share my experiences with Kate Hollowood (Twitter - @katehollowood). We hurried up the blog's release to make sure it was published as early as possible during the lockdown. In the blog, I share my gambling and recovery experiences and highlight how Monzo has helped me rebuild my financial independence. Monzo was one of the first banks to introduce a gambling blocker, and I regularly recommend them to others. Click here to read the full article.

Callum Room (Twitter - @CallumRSport) got in touch during the first Covid-19 lockdown, having listened to the All Bets Are Off podcast. He was interested in writing an article about gambling-related harm and what the return of football might mean. I shared my addiction and recovery experiences, including starting the All Bets Are Off Podcast with Ryan, Kish, and Kelly back then. Then I spoke about gambling in football, how it is so normal now, and the ultimate risk, suicide! Click here to read more.

Matt Zarb-Cousin writes in the Independent A video by Coalition Against Gambling Ads

When TES (the Times Educational Supplement) approached me about an article about how to educate students about the dangers of gambling, I felt compelled to lend a hand and share my lived-experience in and among the expert opinion and analysis. Stopping gambling-related harm is what it's all about, I wouldn't wish for any youngster to go through the same. Unfortunately, the article is behind a paywall and so to read the full article you will need to subscribe (click here). That said, I've shared my involvement below:- "I cry myself to sleep sometimes," he says. "I look back, and I'm ashamed and I'm guilty. I've ruined many, many relationships. I should be in prison, to be honest." "I didn't go to further education. I got kicked out of home, then for 15 years, I was gambling like it was a full-time job. I'm 33 now and I haven't been able to accomplish any of the things I would have hoped at the age of 15, 16, 17. Everything came second to gambling and I wouldn't want any young person to be in the same position." On the possible introduction of a monthly soft-cap: "We hear horror stories where kids are spinning roulette wheels at hundreds upon hundreds of pounds a go, and it's linked to their father's or mother's account," he says. "It's really, really scary just how simple that is. I was speaking to someone the other day who signed on and deposited £6,000 very quickly without any verification at all," says Pitcher. "We don't know how old the person is, we don't know how much money they've got - it's ridiculous. The proposed affordability checks in the gambling review will help stem that."