One of the biggest issues with problem gambling (Gambling Disorder/Compulsive Gambling/Pathological Gambling/Gambling Addiction) - apart from the fact that it clearly has way too many names - is the lack of understanding that exists about how a person can become addicted to a behaviour in the first place.  Because there is no addictive substance, like alcohol or nicotine, involved - most people believe that stopping gambling should be as easy as steering clear of the Betting Shop or deleting a gambling app from your phone.  The reality is that it's far more challenging and complicated than that.  

So, I've boiled down some of the reasons why so many people develop problems with gambling, in an effort to demystify and simplify things.

• Gambling Changes Your Brain Chemistry: Just like many stimulant drugs, gambling causes the release of the hormone and neurotransmitter, Dopamine, in the brain.  This occurs in the Reward Pathway of the brain - an area which serves the purpose of rewarding us when we eat certain foods or have sex (activities that are strongly linked to the survival of the individual and the species).  Gambling, just like many drugs, can 'hijack' the Reward Pathway - so that we 'feel' like we need to gamble (or smoke cigarettes; drink alcohol; use cocaine) in order to survive.  Just like with alcohol and other drugs, we develop a 'tolerance' to gambling, over time, and experience 'withdrawal' symptoms, when abstaining.  Tolerance and Withdrawal are the key elements of any addiction.  The good news is that the brain's chemistry will return to normal levels of Dopamine production, after a period of abstaining from gambling and persevering through withdrawal symptoms.  These often include: low mood, restlessness, irritability, difficulty sleeping, anxiety.  
• Gambling Taps Into 'Behavioural Conditioning':  Just as we can be conditioned into checking our smartphones for social media updates, text messages and emails - we can be conditioned into developing an unhealthy relationship with gambling.  There are two main types of behavioural conditioning: Classical and Operant.  Classical Conditioning is sometimes referred to as a 'Pavlovian Response' - referring to the famous 'Pavlov's Dog' behavioural experiment.  Basically, this experiment showed that an unconscious response can be 'paired' with a stimulus (trigger), over time, when the trigger is repeated.  A person who has developed a gambling problem will usually start out watching sports without gambling on the outcomes, but, over time, will come to associate watching sport with gambling.  The two separate behaviours have been 'paired' together, so that the person feels uneasy when not gambling during a sporting event (withdrawal symptoms).  The good news is, that, just like Pavlov's Dog, the conditioning can be broken (extinguished) over time and most people can return to watching sport without having strong urges to gamble or intense withdrawal symptoms.  Operant Conditioning works on reinforcing behaviours through rewards - or 'punishing' other types of behaviours - usually through the absence of a reward ("carrot and stick").  'Star Charts', such as those used in early education, are a form of Operant Conditioning.  The teacher rewards behaviours that they want to encourage and see repeated.  The Behavioural Psychologist, B. F. Skinner, developed the theory of Operant Conditioning, based on behavioural experiments with animals (the 'Skinner Box').  When he was trying to describe his theories to the public, he compared the Skinner Box to slot machines - because they operate on the same principles.  Skinner observed that the most addictive 'Reward Schedule' was  a 'Variable-Ratio Schedule'.  This means that we all become more compulsive in seeking a reward, when it is unpredictable - rather than when it is predictable.  For most people with gambling problems, it is the anticipation of a reward, which provides the excitement, stimulation and Dopamine - not the reward, itself.  If you are reading this, as a loved one of a person with a gambling problem, you might not be able to relate to this.  However, you may be exposed to exactly the same types of processes in Social Media.  You can't predict when you're going to see a post that you find interesting or entertaining - so you keep scrolling.  You can't predict how many people are going to like, comment or share your posts - so you keep checking and get a little hit of Dopamine when your notifications go off.  Most people who have developed gambling problems are trying to deal with rewiring their behaviours away from both Classical and Operant Conditioning, which, in many cases, has been going on for years - developing deeply engrained, subconscious habits.  If you are a loved one, reading this, and you are still struggling to understand what this might feel like - maybe consider staying off all social media for one week and see how you feel.  Most of us will struggle with this, as we are surrounded by 'triggers' which remind us that it's time to seek out our Dopamine reward.  
• 'Hopium': As my colleague, Tony O'Reilly, often says: "Nobody ever believes that they can drink their way out of an alcohol problem - but everyone believes that they can gamble their way out of a gambling problem".  The vast majority of people who have gone through our counselling service, or call our helpline, have had some 'big win' (or several big wins).  This presents the person with 'evidence' that they can 'dig their way out of the hole' that they have dug themselves into (using the same shovel).  Unfortunately, for a person with a gambling problem, this hope is pure 'Hopium' - an irrational belief; a delusion.  A person with a gambling problem will just keep gambling - even after a big win - because they are not addicted to winning money.  They are addicted to the process of gambling and money just allows you to keep gambling (stay 'in action') for longer.  Many people, who are desperate to pay off gambling-related debts, believe that gambling is the only option available to them.  Of course, this isn't true - as so many people who have learned the hard way, can attest to.  

We have also recorded a podcast episode  on this topic, where we discuss Tony O'Reilly and I discuss in more detail.  

Barry Grant: 
As a person working for an NGO, which advocates for safeguarding measures to be put in place to protect vulnerable adults and children from gambling related harm, I sometimes get the occasional snarky comment directed my way.  It's often something along the lines of, 'Won't somebody please think of the children?!' - a much-used quote from the Simpsons.  I respect everyone's opinions on these matters and I'm more than happy to debate my side of the street with anyone who is so inclined.  I'm very comfortable with my pearl-clutching, bleeding-heartedness - as I witness, first-hand, on a daily basis, the devastation which a lack of gambling regulation and harm-prevention services has on individuals, families and the wider community.  The vast majority of people who attend our gambling addiction treatment service, started gambling as children.  

Of all the massive gaps in problem gambling service provision, which I find utterly infuriating, the one that boils my blood the most, is the absence of any statutory intervention to "take appropriate measures to protect young people from gambling-related risks".  The reason that last section is in quotes, is that it comes from the National Policy Framework for Children and Young People, 2014-2020 (Better Outcomes, Brighter Futures).  The policy is in its final year and, to date, the only change which has the potential to have any positive impact on children and young people is the legislation enacted this year, which places an over-18s age restriction on Tote betting and on 'gaming' machines.  Previously there had been no age limit at the Tote and 'gaming' machines (such as slot machines - the most addictive form of gambling) had an age limit of 16.  

Government has completely ignored its duty of care to young people, when it comes to gambling-related harm.  We know, from the recent European School Survey (ESPAD) of 15-16 year old's in Ireland, that betting on sports or animals (horse and dog racing) is the most common gambling activity. This can only happen if gambling operators are failing to verify the age of their customers. We also know that when the Regulator of the Irish National Lottery performed a 'Mystery Shopper' test in July 2018, they found that over one-third of retail staff (37%) did not attempt to verify the young person's age.  A recent PQ reply from Minister for Health, Stephen Donnelly, showed that the State has never funded any harm-prevention interventions for gambling addiction.  

In the recently released ESPAD survey, they looked at problem gambling among 15-16 year old's for the first time.  While they did publish rates of problem gambling among those who gambled, they did not provide the prevalence rate, across all respondents.  As I am terrible at maths and get nose-bleeds when it comes to statistics, I reached out for help.  Doctoral Student, Conor Keogh (UCD) came to the rescue.  

Here are the headline figures from Conor's analysis of the ESPAD Survey (2019) and a comparison with the National Advisory Council on Drugs and Alcohol (NACDA) problem gambling prevalence rates from 2014/15:

• The problem gambling prevalence rate among Irish males, aged 15-16, is 1.7%
• The problem gambling prevalence rate among Irish males aged 15-17 was 0.8% in 2014/15
• The problem gambling rate among male teens in Ireland has more than doubled in the last 4-5 years
• The problem gambling prevalence rate among Irish females, aged 15-16, is 0.2%
• The problem gambling prevalence rate among Irish females aged 15-17 was 0.7% in 2014/15
• Based on the most recent census figures, this means that there are roughly 1,200 (1,184) problem gamblers (aged 15-16), in Ireland.  
• There are roughly 2,200 (2,244) Irish schoolchildren , aged 15-16, who gamble  excessively.  
• There are, roughly, 3,400 (3,428) Irish schoolchildren, aged 15-16, who gamble either problematically or excessively.  

I will hand you over to Conor, now, to give you his full analysis of the ESPAD and NACDA data.  

Conor Keogh: 
It is firstly important to consider that the above figures are not a statistical aberration and are generally in line with trends that are being seen all over Europe. Indeed, the ESPAD results found that of all those respondents across the full European sample who had gambled in the last twelve months, around 5% of respondents met the criteria for problem gambling. This 
equates to a rate of around 1.4% across the total sample in Europe. As has been in the case in various previous research 
findings, the ESPAD report also points to a very prominent gender discrepancy that exists in respect to problem gambling. 
In every country surveyed in the ESPAD report, boys were more likely to be problem gamblers than girls (boys had an 
average of 29%, compared to 15% amongst girls).   
 
Going back to the Irish context, the 2014 / 2015 Drug Prevalence Survey carried out by the National Advisory Committee on Drugs and Alcohol (NACDA) was amongst the first prevalence surveys carried out in the country to gauge gambling 
behaviours across the population. The report estimated that 0.8% of the male population aged between 15 and 17 fit 
the criteria for being problem gamblers (based on the DSM-IV classification framework).  For females of the same age bracket, the figure was slightly lower, estimated to be around 0.7%.  Overall, male adolescents were more likely to have gambled at least once over the past 12 months (29.9%) compared to adolescent females (20.6%).  
 
The recently released ESPAD statistics surrounding underage gambling in Ireland paint a highly dangerous picture. The 
ESPAD survey report (which covers a wide range of adolescent behaviours including alcohol, drug, and technology use) 
suggests that the problem gambling rate amongst Irish adolescent males has in fact risen to 1.7%, compared to the 0.8%  
found in the NACDA report. This represents nearly a doubling of problem gamblers amongst this demographic. 15 – 16-year-old females were estimated to have a lower rate, estimated to be at around 0.2%. This is in line with the average across all age-groups in the female population (0.2%), based on the NACDA 2014/15 study. In line with 
the other European states, boys who gambled had a higher problem gambling rate (7.6%) than the girls who gambled 
(2.8%). Of the students who gambled in the last 12 months, 26.3% (around 1 in 4) felt they needed to bet and spend more, 
and 12.2% (around 1 in 10) had lied to those close to them about their gambling behaviours.  
 
In the UK, we see a similar situation. The Gambling Commission’s 2019 report that investigated gambling behaviour 
amongst 11–16-year olds found that 1.7% of this demographic fit the criteria for being problem gamblers. 
In terms of total figures, this means that approximately 55,000 children are classified as problem gamblers in England, 
Scotland, and Wales. In addition to this, another 2.7% presented as being ‘at-risk’ gamblers, presenting 
with signs that they could be at risk of developing a more serious problem. Overall, 39% of the full cohort of respondents
aged 11 – 16 have admitted gambling with their own money recently, with the most popular form of gambling being 
fruit machines at arcades and pubs (incidentally, slot machines were the least favoured form of gambling amongst Irish 
adolescent gamblers, according to the ESPAD data).  
 
Gambling amongst adolescents: new forms of gambling 
Decades of technological advance have meant that gambling has spread into various diverse forms of media, which has 
meant that the lines which demarcate what exactly constitutes “gambling” have become blurry in recent years. Such 
recent technological advancements have meant that gambling can be seen in increasingly common places, exposing 
children to it on a very regular basis, via television, mobile phones, and increasingly, in video games. One of the most 
notable places we can see this is through the increasingly popular “loot boxes” in video games. Indeed, recent research 
published by Central Queensland University found that of the 82 best-selling video games available, 62% (51 of them) 
had loot box mechanisms  in them.  
 
For example, “FIFA packs” (as one example of many more) have been a notable demonstration of the muddied definitional 
lines between what is a harmless, fun feature of a game, and what is considered gambling. In many ways, the process of 
opening a pack (or any other similar loot box) is very much psychologically akin to a gamble and involves stimulating the 
brain in the same way that any other gamble does. As Macdonald (2018) says; “the dopamine hit is enjoyable, but 
potentially addictive, and hard to resist”. Whilst technically the reward being received by the player is not physically 
tangible (one might ‘pack’ a Lionel Messi in FIFA, yet this Messi has little to no value outside the game world), the 
overarching mechanism remains the same – it is a game of chance, of risk and reward, and is ultimately psychologically
 akin to real-life gambling that provides a “‘ripe breeding ground’ for the development of problem gambling among 
children”(Drummond and Sauer, 2018).  In a recent Oireachtas report, Hurley (2020) mentions that at the time of writing, 
Ireland does not have a “gambling regulator, a digital safety commission or any other independent expert body responsible for determining whether loot boxes ought to be regulated as a form of gambling” and argues that there is a “growing 
consensus” that such regulation is required in Ireland to regulate for such practices.  
 
For many adult problem gamblers, their first exposure to gambling was in childhood. Testimonies from gamblers tell us 
that this first exposure can range from anything like buying a scratchcard, betting on the Grand National, sneaking into a 
casino, or perhaps playing cards with friends. Now, the number of opportunities available to would-be adolescent 
gamblers is enormous. This, combined with a very-liberal approach to gambling advertisement (noticeably during 
live sports), a prominent “gambling culture”, and the emergence and popularisation of gambling-simulator type practices 
in more common forms of media (such as video games), has led to a situation where children and adolescents have become at great risk to the harms associated with gambling, and the recent ESPAD statistics are a distinct testament to this.   
 
Problem gambling comes with a devastating personal, economic, psychological, and social cost. The figures that we see 
​here from ESPAD are a result of an industry that has been continually under-legislated for in Ireland, and are a stark 
indictment of the Government’s failure to implement any meaningful legislation or solutions in order to counterbalance 
the devastating personal, financial and social cost of a gambling addiction. They also act as a timely reminder (and warning) that not enough has been done to protect children and adolescents from the harm associated with gambling, and that 
there is an urgent need for the development and implementation of proper channels of gambling prevention education, 
support, and treatment in Ireland, along with re-emphasising the urgent need for across-the-board legislation.  

The results of our Strategic Planning Survey are now available.  The full document (PDF) can be downloaded here.  I would like to thank everybody who took the time to give their views.  It makes for very interesting reading and certainly challenged some of my own views on key topics.

As much as possible, I attempted to balance my own bias when creating the questions.  One example is Q14: "I am happy with the amount of gambling advertising on Irish media (including social media)".  This is not my position, but I did not want to "lead" survey respondents by posing the question, based on my own biased view.  It was interesting that, in the case of this question, over 92% of respondents either disagreed (24.29%) or strongly disagreed (68.57%) with the statement.  

Other interesting results include:  

• "I feel that I have a problem with controlling my gambling" - 13% Agree
  
• "I feel that a family member or friend may have a gambling problem" - 28% Agree
  
• "Problem Gambling support services should be funded by a government levy on Gambling Industry income" - 78% Agree
  
• "Regulation of the gambling industry in Ireland would be a 'Nanny State' approach" - 75% Disagree
  
• "In Ireland, the positive aspects of gambling outweigh the negatives" - 87% Disagree

The survey was sent to addiction workers, listed on the www.drugs.ie website, was shared on social media and was available on our website.  While we are not claiming any statistical significance, the survey makes for interesting reading and has been invaluable in preparing our Strategic Planning for the next three years.  

Barry Grant, CEO & Founder, Problem Gambling Ireland.