Gambling Harm Treatment and Support in Scotland: Current provisions and future directions

Executive Summary

Introduction

Gambling harm is increasingly recognised as a public health issue in Scotland, with impacts extending beyond individuals to affect families, communities and public services. Whilst it is estimated that around one in forty adults living in Scotland experience harms from their own gambling (2.6%), only one in two hundred (0.55%) seek specialist treatment or support for gambling.

This study was commissioned by the Scottish Government to provide a comprehensive, system‑level understanding of gambling harm treatment and support services in Scotland, and to update the understanding of the evidence on the effectiveness of gambling harm prevention, treatment and recovery support services to inform sector engagement, resilience and the development of a more coordinated and collaborative service landscape.

To achieve this, the study combined desk‑based service mapping, a survey of providers, qualitative interviews with service leads and stakeholders, analysis of geographic accessibility and an updated review of evidence on intervention effectiveness based on the findings of the Lancet Public Health Commission on Gambling. The resulting findings were subsequently analysed using the Public Health Scotland (PHS) priorities for future service development as an interpretive lens to assess system alignment.

Current provision of gambling harm treatment and support in Scotland

Gambling harm treatment and support in Scotland is delivered across specialist treatment providers (i.e., those who primarily offer gambling-focused treatment), non-specialist support providers (i.e. those who address gambling harms alongside interconnected social and health issues, such as homelessness, mental health, etc.), peer support networks, and a small number of system-level organisations that enable the development of this ecosystem through research and public health advocacy work. Provision is diverse but limited in scale and coherence.

The most effective forms of treatment and support are cognitive behavioural therapies and other psychological interventions. The provision of these services across Scotland is limited and is concentrated within a small number of specialist treatment providers who tend to offer online rather than face-to-face support. The main form of treatment and support available is via peer support networks. Whilst these are recognised as useful, they offer a particular type of support programme which may not be suitable for everyone and have more limited evidence of efficacy.

Overall service reach remains low relative to the estimated population‑level need. While most people in Scotland (81%) live within 10 miles driving distance of an in‑person service, the most accessible provision for many is peer support rather than specialist treatment.

Alignment with Public Health Scotland priorities and the evidence base on intervention effectiveness

In 2025, Public Health Scotland published a set of priorities for the development of an integrated and equitable model of care to address gambling harms in Scotland. We assessed progress towards these priorities.

Public Health Scotland recommended that treatment and support should:

1. Be provided locally and be integrated within existing trusted services

We found that local support mainly comes from peer support networks and community-based non-specialist organisations. Other forms of local support remain limited across many parts of Scotland. Specialist treatment is mainly delivered remotely, and NHS involvement remains extremely limited.

2. Be flexible to ensure equitable, person‑centred care

Our study suggests that many services, particularly non-specialist and peer support organisations, provide personalised and ongoing support that can be adapted to people’s wider social and health needs. However, despite this, overall use of gambling support services remains low, provision is uneven across different population groups, and much specialist treatment continues to be delivered remotely, which may perpetuate existing inequalities in access.

3. Have a clearly defined pathway to access services

We found evidence of multiple ways for people to access gambling treatment and support, including specialist services, community-based organisations, peer support networks, and the national helpline. However, links between services are often informal and inconsistent, which may make it harder for people to move between services or access more intensive support when needed.

4. Be evidence-based and follow up-to-date clinical guidance (including NICE Guidelines)

There appears to be a systematic mismatch between the evidence base and service provision across Scotland, with interventions such as cognitive-behavioural therapy concentrated within a very small number of specialist treatment providers. Lower‑intensity and peer‑based interventions with comparatively weaker evidence base for effectiveness dominate the system.

5. Be evidence-generating through robust data collection and evaluation

We found little evidence of a shared framework for data collection or outcome measurement across the system. While specialist treatment providers typically collect more structured data, practices are variable and limited among non-specialist support providers and peer support networks, constraining system learning.

6. Be designed and provided with meaningful involvement from people with lived experience

Our study showed that adherence to this priority varies substantially across different types of services. Lived experience underpins governance and delivery within peer support networks, representing a structurally embedded model of involvement. In contrast, within specialist treatment providers and non-specialist support providers, lived experience is more often consultative and not consistently embedded in decision‑making.

7. Be free from the influence of the gambling industry

Historically, service configuration has been shaped by industry‑linked funding arrangements, influencing system dynamics and collaboration. The transition to statutory levy funding marks an important structural shift, but its effects on system behaviour are not yet fully realised.

Future directions for system development

Our findings highlight several areas that may be important for the future development of gambling treatment and support services across Scotland.

• Strengthening pathways and coordination
• Improving alignment with evidence-based interventions
• Developing workforce capacity and competency frameworks
• Expanding early intervention, especially for underserved groups, and improving awareness of support pathways
• Building data and evaluation infrastructure
• Clarifying roles across the ecosystem
• Embedding lived experience structurally
• Stabilising funding and commissioning arrangements