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Problem gambling has a compounding cost not just for individuals but also for their families and their communities, write Professor Steve Robson and Associate Professor Jeffrey Looi.
Australians have long been recognised as the world’s biggest losers – in terms of gambling.
The Australian Institute of Health and Welfare (AIHW) has reported that Australians lose around $25 billion each year from legal gambling.
That equates to annual per capita losses of close to $1500 each year. From the industry itself: “When it comes to gambling on an individual scale, Aussies’ currently lead the way. In 2014, Australians gambled over $916 per person, with Singaporeans coming a close second on $891.16. Singapore only recently legalized casino gambling, and the per-head spend isn’t a surprise”.
Gambling expenditure per person is the highest in New South Wales, with $1508 spent on gambling per capita in 2019–20.
Whereas individual Australians are the clear “winners” in the global stakes for the biggest gambling losers, our state and territory governments are living off the ill-gotten proceeds, raising around $6.6 billion in 2018–19.
Despite the coronavirus disease 2019 (COVID-19) pandemic putting a dent in gambling activity, Australians bet around $175 billion in the financial year 2019–20 — before the pandemic, that figure was well over $200 billion a year.
It’s clear that Australians like a bet, but traditional ways of gambling in person are substantially disrupted by online gambling.
The amount spent through internet-based gambling in 2022 was estimated to be close to $7 billion (US$4.5 billion), and ongoing profitability may contribute to advice to investors to consider shares in the gambling industry.
Estimates suggest that as many as one in ten Australians participated in online gambling in 2022, an increase from 8% in 2020.
In the privacy of your own home
Australia has one of the most “normalised” gambling environments in the world, with socially and culturally valued organisations endorsing gambling, such as pubs, clubs, sporting teams and codes.
However, due to the COVID-19 pandemic, online gambling has become firmly established in Australia.
Gambling online seems to pose much greater risks for problem behaviours due to a number of unique factors.
Online gambling is commonly done in isolation, without interruption, and access is constant and easy.
The design of websites and smartphone applications influences behaviour through push notifications of time-limited promotional offers, or the elimination of natural breaks in play, or nudge messages (eg, “people like you bet on …”).
There are also potentially new gateways for young people to be encouraged to gamble online, such as the controversial practice of “pay-to-play” online video-gaming involving microtransactions to progress levels or achievements and the inclusion of features such as “loot boxes”. These “loot boxes” were the subject of an Italian study that hypothesised that their inclusion in video games may result in problem gambling.
Harm
There is overwhelming evidence that, for many people, gambling is harmful, not only to individuals but potentially to their loved ones and others around them.
These harms form a spectrum, ranging from mildly negative experiences to full-blown crises, some of which can leave a legacy of ill-effects for years.
There also the substantial opportunity costs to work, personal interactions, personal development and life experiences due to time consumed by gambling instead of more holistic living.
Problem gambling can hurt an individual’s relationships.
The partners and family members of people with gambling problems can be involved in financial and material losses.
Relationships with people affected by problem gambling can be characterised by psychological and social stresses, conflict both in home life and other relationships, and by having to fulfill roles and responsibilities neglected by the affected partner.
Problem gambling is associated with health effects including depression, sleep disorders, even hypertension and cardiovascular disorders.
Beyond the physical, problem gambling is associated with mental health conditions such as depression and anxiety.
It is now recognised that people with gambling problems pose harm to themselves and others in the workplace: they can be distracted, with lower productivity and resulting safety risk-proneness.
Dealing with the health issues of online gambling
Although most Australians gamble at levels unlikely to lead to any harms, there is still a strong uptake, with estimates that almost 7 million Australians gamble regularly in some form or another.
Of those, the AIHW has estimated that 1.33 million Australians, just over 7% of the population, gamble at levels that are potentially harmful – that is a very large number of Australians.
Data from the Productivity Commission suggest that as many as 170 000 Australians are problems gamblers.
Because online gambling has the potential to ensnare a new generation of people, the Australian Government is completing an inquiry into online gambling and its impacts on those experiencing gambling harm.
The inquiry has received almost 150 submissions, including one from the Australian Medical Association and a joint submission from the Royal Australasian College of Physicians and the Royal Australian and New Zealand College of Psychiatrists.
One of us (Stephen Robson) gave evidence to the inquiry in Canberra recently.
The data tell us that Australians have a big issue with gambling, and because governments and gambling providers make such enormous amounts of money from gambling, reform is not going to be easy.
This is especially so now that sports and gambling are becoming intertwined.
There are increasing concerns about how gambling advertising affects young people who are exposed to it during sporting events.
As David Gallant and Sean Cowlishaw from the University of Melbourne warn us: “… the gambling industry in Australia today is now so connected to our sport that it’s now almost impossible to enjoy a sporting event without being exposed to gambling”.
Gambling advertising has become synonymous with sport.
To deal with this threat to Australians, particularly the new generation of young Australians who seem to be taking up online gambling — increasingly via online gaming — urgent action is needed.
The data tell us that many Australians are potentially affected, making awareness of our patients’ gambling important to screen for. Excellent screening resources have been developed for Australian settings and are readily available.
New resources will need to be developed to support young people with online video-gaming-related gambling gateways such as pay-to-play microtransactions and loot boxes, as well as limiting excessive play and spending.
In Belgium and the Netherlands, and more broadly in the European Union, there have been legislative measures to protect young people in relation to online video-gaming, such as the outlawing of loot boxes as illegal gambling.
More importantly, dealing with the root causes of online gambling is the key to protect our community in the long term.
One of the major issues is advertising and the linking of gambling with sport.
We support the Australian Medical Association’s call for bans on these forms of advertising and sponsorship because of the effects these corrosive practices can have on the next generation of Australians.
There also needs to be similar awareness and, potentially, regulation of gambling-gateway features of online video games that target players, especially children and youth.
With the current parliamentary inquiry, we have an opportunity to wrest back the initiative when it comes to protecting Australians.
Gambling is always a losing hand for individuals and the community.
It won’t be a “lay down misère”, but without doubt it is the right thing to do.
Professor Steve Robson is the President of the Australian Medical Association.
Associate Professor Jeffrey Looi is a clinical academic psychiatrist and Head of the Academic Unit of Psychiatry and Addiction Medicine at the Australian National University School of Medicine and Psychology.
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the Australian Medical Association, the MJA or InSight+ unless so stated.
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