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Legacy Gambling Harms: What Happens Once the Gambling Stops?

Legacy Gambling Harms: What Happens Once the Gambling Stops? Purpose of Review Legacy gambling harm refers to adverse consequences that extend past the period where people are actively gambling at harmful levels. These harms can affect the gambler, people close to them and the wider community. This article reviews current research that investigates legacy harms; the types of legacy harm, how long they last and whether evidence suggests these harms are real or instead imagined injuries or reflections on past regrets. Recent Findings Legacy harms to individuals can be broadly categorised as including financial, relationship, emotional/ psychological, health, culture, work/study and criminal/deviance harms. In addition, legacy harms affect entire communi - ties by drawing funds and social capital away from vulnerable communities, leaving them socially, culturally and materially impoverished. Most legacy harms that accrue to gamblers have a half-life of 4 years, although financial harms last somewhat longer at 5 years. Greater distance in time from a past gambling issue is reliably and positively related to health and well-being indicators, including the Health Utility Index and the Australian Unity Wellbeing Index, which suggests that legacy gambling harms are real and have a lasting impact on well-being, rather than just imagined hardship from prior gambling difficulties. Summary These findings sugges t programme and policy development to support gamblers in reducing and managing their legacy harms, rather than focusing only on relapse prevention. Keywords Legacy · Harm · Gambling · Health · Utility · Well-being · Problem · Public Introduction behaviour meets clinical criteria for pathology. While these impacts may be less severe on an individual level, they are Gambling-related harm can profoundly affect both peo - not negligible; and include symptoms such as missing bill ple who gamble and people who are close to them [1, 2 ]. payments, deteriorating relationships with one’s family or Excessive time and money spent on gambling is the proxi- being late for work. In this way, gambling harm is increas- mal source of harm that takes resources away from impor- ingly recognised as being akin to the harm from alcohol tant obligations [3]. These observations are not controver- consumption, where people can drink too much and experi- sial. However, there are two important aspects of the harm ence adverse events, without necessarily having an alcohol emanating from gambling that have received recent atten- abuse disorder [5, 6]. Throughout this article, we use the tion. First, there is a growing recognition that gambling- term “harmful gambling” to refer to gambling that leads related harm extends to people who do not, and may never, to harm, even if it does not constitute a gambling disorder. meet the formal criteria for disordered gambling [4]. That is, The second area to receive increased attention, and most people can be harmed by virtue of spending too much time germane to this current report, is that gambling harm can or money gambling, regardless of whether their pattern of extend past the period where people are actively gambling at harmful levels [2 ]. This means that once someone stops gambling at problematic levels, they can still experience the This article is part of the Topical Collection on Gambling ongoing consequences of their prior episodes of harmful gambling. Likewise, the person’s gambling can have lasting * Matthew Rockloff •• effects on family, friends and communities [ 7 ]. In short, m.rockloff@cqu.edu.au excessive gambling can lead to psychosocial and economic Central Queensland University, Rockhampton, Australia Auckland University of Technology, Auckland, New Zealand 1 3 Current Addiction Reports (2022) 9:392–399 393 legacy consequences: The impact does not necessarily cease Having established some core definitions and distinc - when the gambling stops. tions, we will now review some key conceptual and empiri- Most of the research on gambling problems, and more cal milestones that, we shall argue, now enable a proper recent work on gambling harm, explicitly recognises only consideration of legacy gambling harms. harm that accrues directly from current gambling [8, 9 , 10–12]. This article, in contrast, reviews work that reflects on the legacy of harm that continues past the active period Foundational Research of gambling at harmful levels. We shall review the follow- ing: (1) the types of harm that constitute legacies from past It has long been recognised that a gambling disorder has gambling, (2) how long legacy gambling harms last for and profoundly negative effects on the person who gambles. It is (3) evidence for whether legacy harms have a real impact on not surprising, therefore, that most research in the gambling well-being, as opposed to simply being imagined injuries or field has focused on the prevalence, individual characteris - manifestations of regret. This work shows clear parallels to tics and treatment of people with a severe gambling problem the recognition that gambling harm extends beyond people [15, 16]. More recently, a public health view of gambling who are classified as disordered gamblers: It can persist over has been gaining traction to recognise and respond to the time, as well as being transmitted over social networks. broader effects of gambling on individuals, families and communities [17]. A public health perspective highlights that, although the financial, relationship, health and other What Are the Types of Legacy Harm? impacts of gambling are most acute amongst individuals with a severe gambling problem, gambling can harm gam- It is important to distinguish gambling harm from disor- blers across the entire risk spectrum [16], inclusive of low- dered gambling [13]. Disordered gambling refers to a mental risk and moderate-risk gamblers [18]. Importantly, a public health condition and behavioural features associated with health model also recognises the propagating effects beyond dependence and inability to control gambling behaviour. the person who gambles, to also include affected others and Likewise, problem gambling has a focus on behavioural the wider community [17, 19]. The focus of harm reduction indicators of excessive behaviour, such as feeling the “need efforts is extended from simply enabling gamblers to make to gamble with increasing amounts of money in order to informed choices, to instead promote the need for a multi- achieve the desired excitement” [14]. Gambling harms, in sectoral approach to reduce gambling harm across the popu- contrast, are negative consequences that people experience lation [17, 20, 21]. This shift has recently catalysed research because of their or another person’s gambling involvement. in several key areas of gambling-related harm. These include Furthermore, these negative consequences may extend past its conceptualisation, measurement and prevalence. the period where people are gambling with great intensity, Based on a public health approach that measures impacts as defined in terms of the money and time they devote to it in terms of health-related quality of life, gambling harm has [3]. When these negative consequences persist past this time been conceptualised as the adverse consequences of gam- of intensive gambling involvement, the consequences are bling that lead to a decrement in the health or well-being of • • termed legacy harms [2 ]. There are additional sub-catego- an individual, family unit, community or population [9 ]. ries of legacy harms as well. For instance, life course harms This conceptualisation encapsulates a broad range of harms are consequences that substantially alter people’s life trajec- occurring across the spectrum of gambling risk that have tory, where those impacts may be of such significance that measurable impacts on health across the population. Based the person may never return to a state of full recovery [9 ]. on this reframing, researchers have developed public health When people lose a job due to their gambling, for example, frameworks outlining the risks and effects of gambling- they may never regain the same earnings or professional related harm to inform future research, policy and practice achievement. Divorce and bankruptcy are other severe con- [16, 21 e.g. 9 , 10, 11, 22–24]. These draw attention to fac- sequences that result in a fundamental change in the trajec- tors beyond the individual, such as product design, regula- tory of one’s life. Another sub-category of legacy harms is tion, policy and industry practices that have an impact on intergenerational harms [9 ]. For example, when children gambling harm. lose parental investment during critical points in their devel- Accompanying this public health reconceptualisation, opment due to parental gambling, their developmental out- recent research has focused on the measurement of gam- comes, including school performance, job prospects and life- bling-related harm, beyond tallying the prevalence of those time potential, may never fully recover. Significant parental with a diagnosable gambling disorder. Recently developed gambling losses may also mean they are unable to provide measures include the Harm Questionnaire [HQ: 25] and the support to their children later in life, such as in producing a Short Gambling Harms Screen [SHGS: 26]. The SGHS has deposit for buying a home. been psychometrically validated and is increasingly being 1 3 394 Current Addiction Reports (2022) 9:392–399 used [27]. Recent work has further evidenced its validity resolution of a gambling problem. Using UK banking when benchmarked against reductions in health and well- data on 6.5 million UK residents, Muggleton et al. [43] being [28–30]. Current work [31] has further validated found an association between gambling participation and the SGHS (renamed the Gambling Harm Scale-10), vali- indicators of financial distress, as well as negative health dated a 20-item measure (GHS-20) to elicit further detail and well-being outcomes. In addition, past gambling was on each domain of harm and validated measures of harm associated with negative future outcomes of unemploy- to affected others (GHS-10-AO, GHS-20-AO). This next- ment, disability and even premature mortality. Relatedly, generation suite of measures will further increase the public Swanton and Gainsbury [44, 45] and Oksanen et al. [46] health understanding of gambling-related harm. However, found that people with gambling problems have high con- although the integrated assessment of harm to gamblers and sumer debt, and that their debt stress relates to poor mental affected others is a welcome development, the authors rec - health. Thus, there is evidence that financial debt is an ognise that (1) their assessment is an “instantaneous” one, important component of legacy gambling harm that may which involves only a snapshot at the time the gambling is in turn be related to other harms. •• occurring, and (2) that have impacts on non-adult children of More recently, Rockloff et al. [ 7 ] suggested that leg- gamblers, typically not included in prevalence surveys and acy harms can also include social and cultural damage at are not currently incorporated. a community level, extending out from individual level With the availability of gambling harm measures, preva- harms that affect gamblers and people directly connected to lence studies are increasingly measuring harm from gam- them. Community level harm can therefore be understood as bling to better understand its nature, distribution and quan- multidimensional, referring to either the breakdown of the tum in the population. Recent prevalence studies in Australia relationship between the individual and their community, or [10, 32–37], New Zealand [8] and Finland [38] have admin- the impact of gambling on the community itself. Negative istered the SGHS. In nearly all these studies, 9–10% of consequences stemming from gambling in New Zealand, for adults report gambling harm-to-self in the past year, with instance, have been found to contribute to a dissolution of higher rates amongst males. Recent work has also measured traditional values and practices of some vulnerable commu- harm-to-others at the population level. Results indicate that nities, contributing to, and compounding, long-term health each person with a gambling problem affects up to six others and well-being inequities. Gambling can prevent some peo- [39], harming 5–11% of the adult population each year [19, ple from being involved in their communities, whereby cul- 33, 36, 40, 41]. Affected others experience severe adverse tural obligations may not be fulfilled, eroding social and cul - effects in numerous life domains and have reduced well- tural capital and increasing a sense of marginalisation. Time, being, and partners and women report the most harm [1, 19, money and energy spent on gambling are diverted away from 27, 41, 42]. Although affected others likely experience less community development activities, including volunteerism harm individually than the gambler themselves, the many- and the sharing of resources that enhance communities. to-one nature of the relationship means that the aggregate Moreover, gambling proceeds are a significant contributor impact may well be greater. to charitable organisations, but those revenues are often not From the above, it can be concluded that the field is in a distributed equitably with the communities from which they relatively strong position regarding the assessment of harm came. Consequently, one legacy of gambling harm includes (or morbidity, in a public health framework) due to con- a transfer of wealth and resources from vulnerable com- current gambling problems, as experienced by the gambler munities, which can least afford to lose wealth and would and other adults with whom they have significant relation - benefit the most from charitable proceeds, and redistributes ships. But although there is growing consensus on concur- those funds to communities that are less vulnerable. This rent gambling harms, literature that specifically addresses observation parallels the more general regressive redistri- legacy gambling harm is sparse. Langham et al. [2 ] outlined butional effects of gambling, which is to channel money a comprehensive taxonomy of gambling harm that explicitly from the vulnerable people to corporations, investors and recognised the existence of legacy, lifetime and intergenera- the public purse. In comparison to the diverse groups and tional consequences. As part of this framework, the authors interests that make up communities, the gambling industry is identified that these ongoing harms, like immediate harm, well-connected, represented and heard at local and national can be broadly categorised into dimensions including finan - government levels in most Western democracies. Moreover, cial, relationship, emotional/psychological, health, culture, a member of a community that has been severely affected work/study and criminal/deviance. by gambling can feel the consequences, despite having no The financial consequences of gambling along with personal connection to the activity. Thus, it is important to time spent gambling are the proximal sources of gambling recognise that beyond the usual focus of gambling stud- harm [3]. The debt and other financial problems associ - ies on the harms or problems that accrue to individuals, ated with gambling do not automatically disappear with there is a larger story of legacy harms that accrue to entire 1 3 Current Addiction Reports (2022) 9:392–399 395 •• communities that leave them socially, culturally and materi- Rockloff et al. [ 7 ] calculated the half-life of gambling ally impoverished. harms from the regression probability model. The half-life of a harm is the time when it is 50% likely that the origi- nal harm experienced during the episode of harmful gam- How Long Do Legacy Harms Last? bling is no longer being experienced. The probability model suggested that for any randomly chosen single harm, the Despite a relative lack of information on the broader ques- half-life is 4 years. However, the length of harms varied tion of assessing legacy harm, contemporary research has somewhat by category. Financial harms, as a group, had the been able to understand the narrower issue of how long longest half-life at 5 years, and work/study harms and other gambling harm lasts after people transition out of an epi- harms (e.g. legal consequences) had the shortest half-lives •• •• sode of harmful gambling. Rockloff et al. [ 7 ] conducted an at 2.4 and 2.2 years, respectively. Rockloff et al. [ 7 ] also online survey looking at legacy harms of gamblers (N = 735, calculated the longevity of specific gambling harms (e.g. 43% female) that was administered between April 8th, 2020 increased credit card debt due to gambling), irrespective of and May 23rd, 2020. The survey included participants who harm category, and found that harms involving community admitted to having an “issue with gambling, no matter how relationships, church involvement and domestic and other minor” at some point in the past, but at least 1 year distant violence were shorter lived than other types of harm. from the year-end of 2019. The survey used the language of In sum, gambling harm can be surprisingly long-lived, a gambling issue rather than a gambling problem since peo- showing a 4-year half-life, but not all specific symptoms of ple would be less likely to admit to the latter due to concerns harm have the same lifespan. Financial harms are likely to about social desirability. Nevertheless, admitting to an issue last longer, whereas harm to community relationships tends was assumed to be indicative of past instances of harmful to be somewhat shorter. This is important information for gambling, regardless of whether respondents met criteria for treatment providers and policymakers in terms of setting problem gambling. realistic expectations for clients and making provisions for Participants in the survey were asked when their last issue follow-up support. People who experience harm from their with gambling had occurred and were given a checklist of gambling will likely want to know when they can expect 83 gambling harms that they might have experienced dur- some relief from the issues that are affecting them, and posi - ing this time. This 83-item checklist was derived from prior tively framed guidance can be helpful. Most of the harms research [9 ] and aimed to be a comprehensive and non- that people experience will begin to disappear quickly, redundant list of all harms that might occur due to gambling although some harms may still linger. Nevertheless, in gen- involvement. To see if the harms experienced during this eral, the financial devastation of gambling is not a life-long past period of problematic gambling were continuing (i.e. curse, and helpfully, community relationships are likely to legacy harms), participants were given a restricted list of recover faster than other issues. all the past harms they had reported, and asked to check off any harms that “still affect you at sometime within the last 12 months due to gambling that happened in the past.” Participants could add additional legacy harms as a fill-in- Imagined Injuries or Manifestations of Past the-blank, although few volunteered substantially new harms Regret? that were not previously chosen. The results showed that most gamblers in the sample had To verify the results of legacy gambling harm being a true continuing harms (n = 417, 56.7%). Importantly, and as pre- burden, rather than an imagined hardship from a past trau- dicted, gambling harms were less frequent with greater dis- matic experience, participants in Rockloff et  al.’s study tance in time from the past harmful gambling episode. The were surveyed on two measures of well-being, including the likelihood of gambling harms remaining after the end of a Health Utility Weight (HUW) and the Personal Wellbeing period of harmful gambling, with harm decreasing exponen- Index (PWI) [see 28,33]. As expected, people who reported tially with time since the problems ceased, and probability more continuing gambling harms also reported lower well- of reporting the harm modelled as a logistic model of the being on these indices, even though neither measure asked risk function. questions specifically about gambling, gambling problems Knowing that the underlying degree of experienced harm or gambling-related harm. The greater the number of legacy demonstrates exponential decay illustrates an important harms a participant had, the lower the well-being reported on property of gambling harm. Many harms drop-off quickly both indices (HUW and PWI). Moreover, well-being on both with distance from the past episode of harmful gambling; measures improved with increasing distance in time from the however, at least some harms are more long-lasting. To past gambling issue, at least suggesting that the reduction in determine the likely longevity of different types of harm, harm was responsible for increases in well-being. 1 3 396 Current Addiction Reports (2022) 9:392–399 communities may recover. This knowledge is important Discrete Periods of Harm in understanding the pervasive effects of gambling on communities, rather than the usual focus of psychologists There are important assumptions built into the conceptuali- regarding the effects of gambling on individuals. sation of legacy harms as it has been studied so far. First, There are clear implications for this work in how ser- people were asked about a past gambling issue, no matter vices should be changed. Much work by treatment services is how minor, that affected them at some time in the past, and organised around supporting recovery and protecting people to indicate when “most” of those issues had resolved, or against relapse. However, there is less consideration around conversely whether they were ongoing. This forces a discrete how people might be supported in recovery to ameliorate conception of gambling issues that is somewhat artificial. their ongoing experiences of harm. Support services can Some people may have discrete periods where they gamble be resourced to provide a more holistic offering, such as heavily and experience gambling harms, whereas there are financial, relationship and mental health counselling, to other times when they either do not gamble or gamble at a improve upon people’s situation past the end of harmful low and affordable level. However, it is possible, and perhaps gambling involvement. Self-help groups, such as Gamblers probable, that gamblers also move smoothly through times of Anonymous, are explicitly concerned with positive growth greater and lesser gambling involvement. That is, gambling and community reconnection during recovery, yet they are harm may not only occur as a result of discrete episodes of limited in the provision of formalised interventions. “problem” or “non-problem” gambling, but instead gamblers Funders of gambling treatment services need to rec- experience varying levels of harm in line with varying levels ognise the importance of legacy gambling harms so that of involvement. Consequently, some harm identified in past comprehensive long-term support can be provided to those work on legacy harms, such as that by Rocklo ff et al., may be who need it. This recognition may have a knock-on effect of low-level immediate harm from continuing gambling rather reducing the high rates of gambling relapse. Explicit support than true legacy harm that emanates from past gambling. could be provided to recovering gamblers that recognises the Similarly, it is unclear as to how low-level immediate harms burdens of legacy harms, not just as potential triggers for occurring from continued gambling may impact the inten- relapse, but also to address ongoing harm and improve peo- sity and longevity of legacy harms resulting from previous ple’s lives during recovery. For instance, bolstering people’s episodes of harmful gambling. Further research can help use of and access to recovery capital [47] may improve their address this limitation by understanding what proportion of long-term welfare. People experiencing legacy harms could the harms might stem from continuing gambling. also be encouraged to seek support from non-gambling ser- vices, since their period of harmful gambling has ceased. Relationship, financial counselling, health and mental health services could assist in this regard. Self-help resources are Implications also needed to support people to cope with and address the legacy harms from their gambling. For gamblers, research on legacy harms provides a realistic basis for understanding what to expect with the cessation of harmful gambling. That is, gamblers can be informed Conclusion that (a) the consequences of gambling do not resolve when the harmful gambling stops; (b) continuing to gamble in a Research into legacy gambling harms is nascent, but some way that causes harm can mean longer lasting harm; and clear findings are now available. Legacy harms extend well that (c) harms typically have a shelf life. Greater insight beyond harmful episodes of gambling. On average, these into the longevity of gambling harm, but also the knowl- lingering effects can have a half-life of around 4 years, with edge that harms do usually resolve over time, may help to financial harms lasting longer with a half-life of 5 years. As break relapse cycles where people return to gambling as a these figures reflect the half-life of the harm, there are some means to cope with the lasting consequences of previous people who will experience harms far longer. These legacy harmful gambling episodes. harms are not just regrets or remembrances of past harm, but It is difficult to know how long the legacy of harm to instead have been shown to be reliably related to reductions social capital and the environment continues because most in well-being using two different measures: HUW and PWI. communities are persistently exposed to harm. There is Moreover, many harms fall away quickly after the resolu- little prospect for recovery when harmful gambling is per- tion of most issues, whereas other harms disappear more vasive within the community. Future research may be able slowly. The pattern of reduction in harm can be described to understand those rare cases in which gambling opportu- by a decreasing logistic curve. There is a manifest need for nities are removed from communities to track how entire greater thought and investment into how to support gamblers 1 3 Current Addiction Reports (2022) 9:392–399 397 10.1186/ s12889- 016- 2747-0 . This article is important because in recovery. Services need to be resourced to provide con- it outlines an influential theory and taxonomy describing tinued support for clients beyond recovery from a gambling legacy gambling harms. problem to help them cope with and address the ongoing 3. Neal PN, Delfabbro PH, O’Neil MG. Problem gambling and experience of legacy harms. harm: towards a national den fi ition. hekyll.services.adelaide.edu. au; 2005; Retrieved June 3rd, 2022, from https://heky ll.ser vices. In the future, knowledge must be developed on the legacy adela ide. edu. au/ dspace/ handle/ 2440/ 40558.  of gambling harms that accrue to affected others, including to 4. Browne M, Rawat V, Greer N, Langham E, Rockloff M, Hanley C. 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Abstract

Purpose of Review Legacy gambling harm refers to adverse consequences that extend past the period where people are actively gambling at harmful levels. These harms can affect the gambler, people close to them and the wider community. This article reviews current research that investigates legacy harms; the types of legacy harm, how long they last and whether evidence suggests these harms are real or instead imagined injuries or reflections on past regrets. Recent Findings Legacy harms to individuals can be broadly categorised as including financial, relationship, emotional/ psychological, health, culture, work/study and criminal/deviance harms. In addition, legacy harms affect entire communi - ties by drawing funds and social capital away from vulnerable communities, leaving them socially, culturally and materially impoverished. Most legacy harms that accrue to gamblers have a half-life of 4 years, although financial harms last somewhat longer at 5 years. Greater distance in time from a past gambling issue is reliably and positively related to health and well-being indicators, including the Health Utility Index and the Australian Unity Wellbeing Index, which suggests that legacy gambling harms are real and have a lasting impact on well-being, rather than just imagined hardship from prior gambling difficulties. Summary These findings sugges t programme and policy development to support gamblers in reducing and managing their legacy harms, rather than focusing only on relapse prevention. Keywords Legacy · Harm · Gambling · Health · Utility · Well-being · Problem · Public Introduction behaviour meets clinical criteria for pathology. While these impacts may be less severe on an individual level, they are Gambling-related harm can profoundly affect both peo - not negligible; and include symptoms such as missing bill ple who gamble and people who are close to them [1, 2 ]. payments, deteriorating relationships with one’s family or Excessive time and money spent on gambling is the proxi- being late for work. In this way, gambling harm is increas- mal source of harm that takes resources away from impor- ingly recognised as being akin to the harm from alcohol tant obligations [3]. These observations are not controver- consumption, where people can drink too much and experi- sial. However, there are two important aspects of the harm ence adverse events, without necessarily having an alcohol emanating from gambling that have received recent atten- abuse disorder [5, 6]. Throughout this article, we use the tion. First, there is a growing recognition that gambling- term “harmful gambling” to refer to gambling that leads related harm extends to people who do not, and may never, to harm, even if it does not constitute a gambling disorder. meet the formal criteria for disordered gambling [4]. That is, The second area to receive increased attention, and most people can be harmed by virtue of spending too much time germane to this current report, is that gambling harm can or money gambling, regardless of whether their pattern of extend past the period where people are actively gambling at harmful levels [2 ]. This means that once someone stops gambling at problematic levels, they can still experience the This article is part of the Topical Collection on Gambling ongoing consequences of their prior episodes of harmful gambling. Likewise, the person’s gambling can have lasting * Matthew Rockloff •• effects on family, friends and communities [ 7 ]. In short, m.rockloff@cqu.edu.au excessive gambling can lead to psychosocial and economic Central Queensland University, Rockhampton, Australia Auckland University of Technology, Auckland, New Zealand 1 3 Current Addiction Reports (2022) 9:392–399 393 legacy consequences: The impact does not necessarily cease Having established some core definitions and distinc - when the gambling stops. tions, we will now review some key conceptual and empiri- Most of the research on gambling problems, and more cal milestones that, we shall argue, now enable a proper recent work on gambling harm, explicitly recognises only consideration of legacy gambling harms. harm that accrues directly from current gambling [8, 9 , 10–12]. This article, in contrast, reviews work that reflects on the legacy of harm that continues past the active period Foundational Research of gambling at harmful levels. We shall review the follow- ing: (1) the types of harm that constitute legacies from past It has long been recognised that a gambling disorder has gambling, (2) how long legacy gambling harms last for and profoundly negative effects on the person who gambles. It is (3) evidence for whether legacy harms have a real impact on not surprising, therefore, that most research in the gambling well-being, as opposed to simply being imagined injuries or field has focused on the prevalence, individual characteris - manifestations of regret. This work shows clear parallels to tics and treatment of people with a severe gambling problem the recognition that gambling harm extends beyond people [15, 16]. More recently, a public health view of gambling who are classified as disordered gamblers: It can persist over has been gaining traction to recognise and respond to the time, as well as being transmitted over social networks. broader effects of gambling on individuals, families and communities [17]. A public health perspective highlights that, although the financial, relationship, health and other What Are the Types of Legacy Harm? impacts of gambling are most acute amongst individuals with a severe gambling problem, gambling can harm gam- It is important to distinguish gambling harm from disor- blers across the entire risk spectrum [16], inclusive of low- dered gambling [13]. Disordered gambling refers to a mental risk and moderate-risk gamblers [18]. Importantly, a public health condition and behavioural features associated with health model also recognises the propagating effects beyond dependence and inability to control gambling behaviour. the person who gambles, to also include affected others and Likewise, problem gambling has a focus on behavioural the wider community [17, 19]. The focus of harm reduction indicators of excessive behaviour, such as feeling the “need efforts is extended from simply enabling gamblers to make to gamble with increasing amounts of money in order to informed choices, to instead promote the need for a multi- achieve the desired excitement” [14]. Gambling harms, in sectoral approach to reduce gambling harm across the popu- contrast, are negative consequences that people experience lation [17, 20, 21]. This shift has recently catalysed research because of their or another person’s gambling involvement. in several key areas of gambling-related harm. These include Furthermore, these negative consequences may extend past its conceptualisation, measurement and prevalence. the period where people are gambling with great intensity, Based on a public health approach that measures impacts as defined in terms of the money and time they devote to it in terms of health-related quality of life, gambling harm has [3]. When these negative consequences persist past this time been conceptualised as the adverse consequences of gam- of intensive gambling involvement, the consequences are bling that lead to a decrement in the health or well-being of • • termed legacy harms [2 ]. There are additional sub-catego- an individual, family unit, community or population [9 ]. ries of legacy harms as well. For instance, life course harms This conceptualisation encapsulates a broad range of harms are consequences that substantially alter people’s life trajec- occurring across the spectrum of gambling risk that have tory, where those impacts may be of such significance that measurable impacts on health across the population. Based the person may never return to a state of full recovery [9 ]. on this reframing, researchers have developed public health When people lose a job due to their gambling, for example, frameworks outlining the risks and effects of gambling- they may never regain the same earnings or professional related harm to inform future research, policy and practice achievement. Divorce and bankruptcy are other severe con- [16, 21 e.g. 9 , 10, 11, 22–24]. These draw attention to fac- sequences that result in a fundamental change in the trajec- tors beyond the individual, such as product design, regula- tory of one’s life. Another sub-category of legacy harms is tion, policy and industry practices that have an impact on intergenerational harms [9 ]. For example, when children gambling harm. lose parental investment during critical points in their devel- Accompanying this public health reconceptualisation, opment due to parental gambling, their developmental out- recent research has focused on the measurement of gam- comes, including school performance, job prospects and life- bling-related harm, beyond tallying the prevalence of those time potential, may never fully recover. Significant parental with a diagnosable gambling disorder. Recently developed gambling losses may also mean they are unable to provide measures include the Harm Questionnaire [HQ: 25] and the support to their children later in life, such as in producing a Short Gambling Harms Screen [SHGS: 26]. The SGHS has deposit for buying a home. been psychometrically validated and is increasingly being 1 3 394 Current Addiction Reports (2022) 9:392–399 used [27]. Recent work has further evidenced its validity resolution of a gambling problem. Using UK banking when benchmarked against reductions in health and well- data on 6.5 million UK residents, Muggleton et al. [43] being [28–30]. Current work [31] has further validated found an association between gambling participation and the SGHS (renamed the Gambling Harm Scale-10), vali- indicators of financial distress, as well as negative health dated a 20-item measure (GHS-20) to elicit further detail and well-being outcomes. In addition, past gambling was on each domain of harm and validated measures of harm associated with negative future outcomes of unemploy- to affected others (GHS-10-AO, GHS-20-AO). This next- ment, disability and even premature mortality. Relatedly, generation suite of measures will further increase the public Swanton and Gainsbury [44, 45] and Oksanen et al. [46] health understanding of gambling-related harm. However, found that people with gambling problems have high con- although the integrated assessment of harm to gamblers and sumer debt, and that their debt stress relates to poor mental affected others is a welcome development, the authors rec - health. Thus, there is evidence that financial debt is an ognise that (1) their assessment is an “instantaneous” one, important component of legacy gambling harm that may which involves only a snapshot at the time the gambling is in turn be related to other harms. •• occurring, and (2) that have impacts on non-adult children of More recently, Rockloff et al. [ 7 ] suggested that leg- gamblers, typically not included in prevalence surveys and acy harms can also include social and cultural damage at are not currently incorporated. a community level, extending out from individual level With the availability of gambling harm measures, preva- harms that affect gamblers and people directly connected to lence studies are increasingly measuring harm from gam- them. Community level harm can therefore be understood as bling to better understand its nature, distribution and quan- multidimensional, referring to either the breakdown of the tum in the population. Recent prevalence studies in Australia relationship between the individual and their community, or [10, 32–37], New Zealand [8] and Finland [38] have admin- the impact of gambling on the community itself. Negative istered the SGHS. In nearly all these studies, 9–10% of consequences stemming from gambling in New Zealand, for adults report gambling harm-to-self in the past year, with instance, have been found to contribute to a dissolution of higher rates amongst males. Recent work has also measured traditional values and practices of some vulnerable commu- harm-to-others at the population level. Results indicate that nities, contributing to, and compounding, long-term health each person with a gambling problem affects up to six others and well-being inequities. Gambling can prevent some peo- [39], harming 5–11% of the adult population each year [19, ple from being involved in their communities, whereby cul- 33, 36, 40, 41]. Affected others experience severe adverse tural obligations may not be fulfilled, eroding social and cul - effects in numerous life domains and have reduced well- tural capital and increasing a sense of marginalisation. Time, being, and partners and women report the most harm [1, 19, money and energy spent on gambling are diverted away from 27, 41, 42]. Although affected others likely experience less community development activities, including volunteerism harm individually than the gambler themselves, the many- and the sharing of resources that enhance communities. to-one nature of the relationship means that the aggregate Moreover, gambling proceeds are a significant contributor impact may well be greater. to charitable organisations, but those revenues are often not From the above, it can be concluded that the field is in a distributed equitably with the communities from which they relatively strong position regarding the assessment of harm came. Consequently, one legacy of gambling harm includes (or morbidity, in a public health framework) due to con- a transfer of wealth and resources from vulnerable com- current gambling problems, as experienced by the gambler munities, which can least afford to lose wealth and would and other adults with whom they have significant relation - benefit the most from charitable proceeds, and redistributes ships. But although there is growing consensus on concur- those funds to communities that are less vulnerable. This rent gambling harms, literature that specifically addresses observation parallels the more general regressive redistri- legacy gambling harm is sparse. Langham et al. [2 ] outlined butional effects of gambling, which is to channel money a comprehensive taxonomy of gambling harm that explicitly from the vulnerable people to corporations, investors and recognised the existence of legacy, lifetime and intergenera- the public purse. In comparison to the diverse groups and tional consequences. As part of this framework, the authors interests that make up communities, the gambling industry is identified that these ongoing harms, like immediate harm, well-connected, represented and heard at local and national can be broadly categorised into dimensions including finan - government levels in most Western democracies. Moreover, cial, relationship, emotional/psychological, health, culture, a member of a community that has been severely affected work/study and criminal/deviance. by gambling can feel the consequences, despite having no The financial consequences of gambling along with personal connection to the activity. Thus, it is important to time spent gambling are the proximal sources of gambling recognise that beyond the usual focus of gambling stud- harm [3]. The debt and other financial problems associ - ies on the harms or problems that accrue to individuals, ated with gambling do not automatically disappear with there is a larger story of legacy harms that accrue to entire 1 3 Current Addiction Reports (2022) 9:392–399 395 •• communities that leave them socially, culturally and materi- Rockloff et al. [ 7 ] calculated the half-life of gambling ally impoverished. harms from the regression probability model. The half-life of a harm is the time when it is 50% likely that the origi- nal harm experienced during the episode of harmful gam- How Long Do Legacy Harms Last? bling is no longer being experienced. The probability model suggested that for any randomly chosen single harm, the Despite a relative lack of information on the broader ques- half-life is 4 years. However, the length of harms varied tion of assessing legacy harm, contemporary research has somewhat by category. Financial harms, as a group, had the been able to understand the narrower issue of how long longest half-life at 5 years, and work/study harms and other gambling harm lasts after people transition out of an epi- harms (e.g. legal consequences) had the shortest half-lives •• •• sode of harmful gambling. Rockloff et al. [ 7 ] conducted an at 2.4 and 2.2 years, respectively. Rockloff et al. [ 7 ] also online survey looking at legacy harms of gamblers (N = 735, calculated the longevity of specific gambling harms (e.g. 43% female) that was administered between April 8th, 2020 increased credit card debt due to gambling), irrespective of and May 23rd, 2020. The survey included participants who harm category, and found that harms involving community admitted to having an “issue with gambling, no matter how relationships, church involvement and domestic and other minor” at some point in the past, but at least 1 year distant violence were shorter lived than other types of harm. from the year-end of 2019. The survey used the language of In sum, gambling harm can be surprisingly long-lived, a gambling issue rather than a gambling problem since peo- showing a 4-year half-life, but not all specific symptoms of ple would be less likely to admit to the latter due to concerns harm have the same lifespan. Financial harms are likely to about social desirability. Nevertheless, admitting to an issue last longer, whereas harm to community relationships tends was assumed to be indicative of past instances of harmful to be somewhat shorter. This is important information for gambling, regardless of whether respondents met criteria for treatment providers and policymakers in terms of setting problem gambling. realistic expectations for clients and making provisions for Participants in the survey were asked when their last issue follow-up support. People who experience harm from their with gambling had occurred and were given a checklist of gambling will likely want to know when they can expect 83 gambling harms that they might have experienced dur- some relief from the issues that are affecting them, and posi - ing this time. This 83-item checklist was derived from prior tively framed guidance can be helpful. Most of the harms research [9 ] and aimed to be a comprehensive and non- that people experience will begin to disappear quickly, redundant list of all harms that might occur due to gambling although some harms may still linger. Nevertheless, in gen- involvement. To see if the harms experienced during this eral, the financial devastation of gambling is not a life-long past period of problematic gambling were continuing (i.e. curse, and helpfully, community relationships are likely to legacy harms), participants were given a restricted list of recover faster than other issues. all the past harms they had reported, and asked to check off any harms that “still affect you at sometime within the last 12 months due to gambling that happened in the past.” Participants could add additional legacy harms as a fill-in- Imagined Injuries or Manifestations of Past the-blank, although few volunteered substantially new harms Regret? that were not previously chosen. The results showed that most gamblers in the sample had To verify the results of legacy gambling harm being a true continuing harms (n = 417, 56.7%). Importantly, and as pre- burden, rather than an imagined hardship from a past trau- dicted, gambling harms were less frequent with greater dis- matic experience, participants in Rockloff et  al.’s study tance in time from the past harmful gambling episode. The were surveyed on two measures of well-being, including the likelihood of gambling harms remaining after the end of a Health Utility Weight (HUW) and the Personal Wellbeing period of harmful gambling, with harm decreasing exponen- Index (PWI) [see 28,33]. As expected, people who reported tially with time since the problems ceased, and probability more continuing gambling harms also reported lower well- of reporting the harm modelled as a logistic model of the being on these indices, even though neither measure asked risk function. questions specifically about gambling, gambling problems Knowing that the underlying degree of experienced harm or gambling-related harm. The greater the number of legacy demonstrates exponential decay illustrates an important harms a participant had, the lower the well-being reported on property of gambling harm. Many harms drop-off quickly both indices (HUW and PWI). Moreover, well-being on both with distance from the past episode of harmful gambling; measures improved with increasing distance in time from the however, at least some harms are more long-lasting. To past gambling issue, at least suggesting that the reduction in determine the likely longevity of different types of harm, harm was responsible for increases in well-being. 1 3 396 Current Addiction Reports (2022) 9:392–399 communities may recover. This knowledge is important Discrete Periods of Harm in understanding the pervasive effects of gambling on communities, rather than the usual focus of psychologists There are important assumptions built into the conceptuali- regarding the effects of gambling on individuals. sation of legacy harms as it has been studied so far. First, There are clear implications for this work in how ser- people were asked about a past gambling issue, no matter vices should be changed. Much work by treatment services is how minor, that affected them at some time in the past, and organised around supporting recovery and protecting people to indicate when “most” of those issues had resolved, or against relapse. However, there is less consideration around conversely whether they were ongoing. This forces a discrete how people might be supported in recovery to ameliorate conception of gambling issues that is somewhat artificial. their ongoing experiences of harm. Support services can Some people may have discrete periods where they gamble be resourced to provide a more holistic offering, such as heavily and experience gambling harms, whereas there are financial, relationship and mental health counselling, to other times when they either do not gamble or gamble at a improve upon people’s situation past the end of harmful low and affordable level. However, it is possible, and perhaps gambling involvement. Self-help groups, such as Gamblers probable, that gamblers also move smoothly through times of Anonymous, are explicitly concerned with positive growth greater and lesser gambling involvement. That is, gambling and community reconnection during recovery, yet they are harm may not only occur as a result of discrete episodes of limited in the provision of formalised interventions. “problem” or “non-problem” gambling, but instead gamblers Funders of gambling treatment services need to rec- experience varying levels of harm in line with varying levels ognise the importance of legacy gambling harms so that of involvement. Consequently, some harm identified in past comprehensive long-term support can be provided to those work on legacy harms, such as that by Rocklo ff et al., may be who need it. This recognition may have a knock-on effect of low-level immediate harm from continuing gambling rather reducing the high rates of gambling relapse. Explicit support than true legacy harm that emanates from past gambling. could be provided to recovering gamblers that recognises the Similarly, it is unclear as to how low-level immediate harms burdens of legacy harms, not just as potential triggers for occurring from continued gambling may impact the inten- relapse, but also to address ongoing harm and improve peo- sity and longevity of legacy harms resulting from previous ple’s lives during recovery. For instance, bolstering people’s episodes of harmful gambling. Further research can help use of and access to recovery capital [47] may improve their address this limitation by understanding what proportion of long-term welfare. People experiencing legacy harms could the harms might stem from continuing gambling. also be encouraged to seek support from non-gambling ser- vices, since their period of harmful gambling has ceased. Relationship, financial counselling, health and mental health services could assist in this regard. Self-help resources are Implications also needed to support people to cope with and address the legacy harms from their gambling. For gamblers, research on legacy harms provides a realistic basis for understanding what to expect with the cessation of harmful gambling. That is, gamblers can be informed Conclusion that (a) the consequences of gambling do not resolve when the harmful gambling stops; (b) continuing to gamble in a Research into legacy gambling harms is nascent, but some way that causes harm can mean longer lasting harm; and clear findings are now available. Legacy harms extend well that (c) harms typically have a shelf life. Greater insight beyond harmful episodes of gambling. On average, these into the longevity of gambling harm, but also the knowl- lingering effects can have a half-life of around 4 years, with edge that harms do usually resolve over time, may help to financial harms lasting longer with a half-life of 5 years. As break relapse cycles where people return to gambling as a these figures reflect the half-life of the harm, there are some means to cope with the lasting consequences of previous people who will experience harms far longer. These legacy harmful gambling episodes. harms are not just regrets or remembrances of past harm, but It is difficult to know how long the legacy of harm to instead have been shown to be reliably related to reductions social capital and the environment continues because most in well-being using two different measures: HUW and PWI. communities are persistently exposed to harm. There is Moreover, many harms fall away quickly after the resolu- little prospect for recovery when harmful gambling is per- tion of most issues, whereas other harms disappear more vasive within the community. Future research may be able slowly. The pattern of reduction in harm can be described to understand those rare cases in which gambling opportu- by a decreasing logistic curve. 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Journal

Current Addiction ReportsSpringer Journals

Published: Dec 1, 2022

Keywords: Legacy; Harm; Gambling; Health; Utility; Well-being; Problem; Public

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