Gambling is the wagering of something of value on a random event where instances of strategy are discounted. It requires three elements: consideration, risk and a prize.
Problem gambling has been defined as any behavioural pattern that results in significant negative consequences for the person engaged in the behaviour, and/or for those who are affected by their actions. This definition has been used in the international literature to inform the development of measures to identify and measure gambling related harm. However, there are concerns that the definition is too narrow and does not capture all types of harm. Furthermore, it conflates the impact of gambling with the cause of the problem behaviour (i.e., symptoms), limiting its potential for use in screening and assessment instruments.
To address this, the current paper seeks to clarify and broaden the understanding of gambling harm by developing a conceptual framework that includes a catalogue of harms experienced, as well as a taxonomy of harms that can be measured at three levels: the person who gambles; their affected others; and the broader community. This framework is also based on public health principles to allow for the application of standard approaches for measurement of harm, including the influence of comorbidities.
The development of this framework has been informed by a review of the literature and four separate methodologies: a literature review; focus groups and interviews with professionals involved in the support and treatment of gambling problems; interviews with people who gamble and their affected others; and analysis of online discussion forums where people who gamble share their experiences. The framework is distinct from other measures of gambling harm, in that it defines harm as an outcome rather than a behavioural or clinical diagnosis; and it emphasises the significance of negative outcomes as opposed to the behaviour itself.
Interestingly, the framework was developed with an assumption that gambling related harm is a complex and subjective issue. However, capturing this subjectivity and complexity was determined not to be the primary function of this framework. Instead, the critical function was to establish a functional definition that could be operationalised and measured consistent with standard public health principles.
While it may seem counterintuitive that a seemingly harmless activity such as gambling can lead to serious problems, researchers have found that it shares many of the same neurobiological underpinnings as drugs and other addictive behaviors. In fact, studies of brain imaging have shown that playing casino games and performing certain laboratory tasks alter the same brain circuits as do cocaine, amphetamines and a host of other drugs. This evidence has led to the psychiatric community changing their definition of pathological gambling from a compulsion to an impulse control disorder, similar to kleptomania, pyromania and trichotillomania (hair pulling). Consequently, in its latest edition of the Diagnostic and Statistical Manual of Mental Disorders, the American Psychiatric Association moved it into the chapter on addictions. This is an important step forward in the recognition of the seriousness and scope of gambling related harm.