Background

Problem gambling is a considerable burden on society as well as on persons who gamble and those around them. In Ireland, about one-half of the population (49%) gambles in some form, while 0.3% (or 12,000 people) engage in problem gambling and tens of thousands more are deemed at risk.1

In 2022, legislation was introduced in Ireland to provide for the establishment of a new regulatory body – the Gambling Regulatory Authority of Ireland (GRAI) – with a focus on public safety and wellbeing and including an addiction specialist within its members.2

Coinciding with the establishment of the GRAI, the Economic and Social Research Institute (ESRI) was commissioned to review relevant policy issues.3

Among the report’s conclusions was that the societal burden of gambling is substantial and likely due to the large number of people with less problematic gambling behaviour. However, some groups are disproportionately affected by problem gambling, notably males and younger people, as well as those with other addictions and mental health problems.3

Much of what is known about problem gambling comes from population surveys; however, these are likely to underestimate the extent of harm, owing to the secretive and stigmatised nature of problem gambling and difficulties people can have in recognising their own problem gambling behaviour.3 Another source of data is addiction services, which routinely collect information on persons seeking help for their gambling. These kind of data provide important evidence on the demand for treatment and the characteristics of those seeking help, and can be an indicator of trends in the wider population.

In Ireland, data on treatment for problem gambling are collected by the National Drug Treatment Reporting System (NDTRS) hosted by the Health Research Board (HRB).4 In 2022, the NDTRS published data profiling cases treated for gambling from 2008 to 2019.5 This was the first study using routine surveillance data to characterise cases treated for problem gambling in Ireland. This article extends the analysis by including data for 2020 to 2022.

Methods

A subset of NDTRS data (n=3898) was analysed in order to describe the demographic and treatment characteristics of cases treated for problem gambling from 2008 to 2022. With client consent, gambling treatment data are routinely collected by service providers and voluntarily returned to the NDTRS using a standardised data collection form.6 As a unique health identifier number has not yet been implemented in Ireland, the data reported are case-based, representing episodes of treatment rather than individuals.7

Included in this study were cases where gambling was the only presenting problem (n=1988) and cases where gambling occurred with another addiction issue (n=1190). Chi-square analyses examined differences between the two groups in key psychosocial and treatment variables.

Key findings

The following findings were based on the 3,988 cases treated for problem gambling:

• Males were in the majority (93.1%).
• The median age entering treatment was 34 years.
• One-half started gambling before the age of 18 years.
• Over one-half (55.2%) had completed upper post-primary (Leaving Certificate) or third-level education.
• Over one-third (36.7%) were in paid employment.
• Most (85.5%) were living in stable accommodation.
• At least 7 in 10 (70.8%) were living with other people.
• One in five (20.8%) were living with children aged 17 years or under.
• Most were treated in inpatient (55.2%) or outpatient (39.1%) settings.
• Almost one-half (48%) self-referred to treatment.
• Fewer than 1 in 10 were referred by general practitioners (GPs) (7.5%) or by mental health professionals (4.4%).

Gambling with and without additional problems

Almost one-half of cases (49%) reported gambling as their only problem. Compared to cases reporting gambling with other addictions, these cases were more likely to be in paid employment (41% vs 32.1%), to have completed third-level education (16.8 vs 10.3%), and to be living with dependent children (24.7% vs 16.6%).

These cases were also more likely to be seen in outpatient settings (45% vs 33%) and to be referred by GPs (8.6% vs 6.4%) or mental health professionals (5.8% vs 4.4%).

Just over one-half of cases (51%) reported gambling plus an additional problem involving drugs and/or alcohol. The most common substances reported were alcohol (83%), cocaine (33.6%), cannabis (32.4%), and benzodiazepines (11.2%). Compared to cases with gambling only, these cases were slightly younger when starting gambling (17 vs 18 years) and entering treatment (33 vs 35 years).

They were also more likely to have left school before the age of 16 years (20.8% vs 14.6%), to be homeless (10.2% vs 5.8%), and to be unemployed (58.3% vs 46%). These cases were more likely to be treated in inpatient settings (60.8% vs 49.7%) and to have been referred through other addiction services (11.2% vs 5%), or the legal system (5% vs 1.5%).

Discussion

This analysis has profiled cases accessing gambling treatment in Ireland, including those whose only problem is gambling and those who have additional addiction issues. About one-half of cases appeared more complex, reporting problems with substances, especially alcohol. Compared to those with gambling only, these cases also had a differing psychosocial profile and pathway to treatment. There was little difference between the groups in the age they started gambling, but notably, one-half of all cases started gambling before the age of 18 years. Issues relevant to children and adolescents have been noted by the ESRI, including the need for further research on loot boxes in video games and social casino games and their association with problem gambling.3

Due to the voluntary nature of reporting gambling data to the NDTRS, the true level of treatment need and demand is likely greater than described. An unmet treatment need in the population is also possible, as some may not be accessing help for reasons including stigma and cost. Nonetheless, these data provide important insights into those accessing treatment for problem gambling in Ireland and can inform policy and planning. They also demonstrate the value and potential of routine monitoring of problem gambling treatment. A unique health identifier would facilitate the understanding of those impacted by problem gambling, their interactions with health services, and outcomes of interventions. This, together with increased routine surveillance, would ensure high-quality evidence to inform the design and delivery of early intervention and prevention programmes at population level and services for those whose gambling has progressed to a problem.

1    Mongan D, Millar SR, Doyle A, Chakraborty S and Galvin B (2022) Gambling in the Republic of Ireland: results from the 2019–20 National Drug and Alcohol Survey. Dublin: Health Research Board. Available from: https://www.drugsandalcohol.ie/35305/

2    Houses of the Oireachtas (2022) Gambling Regulation Bill 2022 – No. 114 of 2022.
Dublin: Houses of the Oireachtas. Available from: https://www.oireachtas.ie/en/bills/bill/2022/114/

3    Ó Ceallaigh D, Timmons S, Robertson D and Lunn P (2023) Problem gambling: a narrative review of important policy-relevant issues. ESRI Survey and Statistical Report Series No. 119. Dublin: Economic and Social Research Institute. Available from: https://www.drugsandalcohol.ie/39018/

4    The NDTRS is the national public health surveillance system that reports on treated problem drug and alcohol use in Ireland. Established in 1990, the NDTRS is maintained by the HRB on behalf of the Department of Health. While the primary purpose of the NDTRS is to collect data on drugs, it also provides for the collection of data on behavioural addictions such as gambling.

5    Condron I, Lyons S and Carew AM (2022) Gambling in Ireland: profile of treatment episodes from a national treatment reporting system. Ir J Psychol Med, Early online. Available from: https://www.drugsandalcohol.ie/36419/

6    NDTRS data collection complies with the European Treatment Demand Indicator (TDI) Protocol. Available from: https://www.emcdda.europa.eu/publications/manuals/tdi-protocol-3.0_en

7    Individuals may appear more than once in the dataset if they return to treatment in a treatment service, or if treated in multiple services in a calendar year.