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

Chapter 1: Introduction

1.1 Background and policy context

Gambling harm is increasingly recognised as a significant public health issue in Scotland, associated with a wide range of social, economic and health impacts ^[1]. Harms extend beyond individuals to affect families, communities, wider society, and are unevenly distributed, disproportionately affecting more deprived populations and those experiencing multiple forms of disadvantage.

A comprehensive epidemiological assessment of gambling harms in Scotland has recently been undertaken by Public Health Scotland (PHS)^[2]. A brief overview set out in below presents an update to this using the latest data from the Gambling Survey for Great Britain (GSGB).

Epidemiological snapshot: Gambling participation, harm and service use in Scotland

Gambling participation remains widespread in Scotland. In 2024, 48.7% of adults (52.9% men; 44.7% women) reported gambling in the past four weeks. Excluding National Lottery participation, rates remained substantial at 32.0% overall, including 36.1% of men and 28.0% of women. There is evidence of socioeconomic patterning, with 50.9% of those living in the most deprived areas gambling in the past four weeks compared with 41.4% among those living in the least deprived.

The GSGB measures a range of adverse consequences and harms from gambling. It includes the Problem Gambling Severity Index (PGSI). The PGSI asks nine questions which represent a mix of behavioural symptoms of gambling disorder and adverse consequences from gambling. Combined, the PGSI gives a total score ranging between 0 and 27. A PGSI score of 0 represents people who do not gamble or may gamble (including heavily) but do not report experiencing any of the nine gambling related symptoms or adverse consequences included in the index. A PGSI score of 1-2 represents people who gamble and who experience a low level of problems with few or no identified negative consequences; a PGSI score of 3-7 represents people who gamble and experience a moderate level of problems leading to some negative consequences; and a PGSI score of 8 or more represents people gambling who experience negative consequences and a possible loss of control.

The PGSI estimates suggest that 8.6% of adults living in Scotland (9.8% of men; 6.9% of women) have a score of 1–2; 3.3% of Scottish adults (4.8% men; 1.9% women) have a PGSI score of 3–7, and 2.5% (3.3% men; 1.5% women) have a PGSI of 8+. Strong socioeconomic patterning is also evident in the distribution of harm, with 9.7% of adults living in the in the most deprived areas having PGSI scores of 8+, compared with 0.7% of those who live in the least deprived areas.

Severe gambling-related harms (losing something of significant financial value, experiencing relationship breakdown, abuse, or committing crime to fund gambling) from one’s own gambling are reported by 1.8% of Scottish adults, and by 2.8% of Scottish adults in relation to someone else’s gambling.

Socioeconomic patterning of severe harms is also pronounced (5.4% of those living in the most deprived quintile report experiencing severe harms from their own gambling compared with 0.8% of those living in the least deprived areas; 5.5% vs. 1.7% for harms from someone else’s gambling). While these categories capture more severe forms of harm, they represent only part of a wider spectrum of adverse consequences associated with gambling, affecting both those who gamble and those affected by others’ gambling.

Despite this level of need, engagement with formal support remains very limited. Only 0.55% of Scottish adults report use of specialist gambling support services, with 2.1% reporting use of any support service for gambling (including mental health services, food banks, welfare organisations, and relationship counselling). This also indicates that specialist gambling support services are not the primary point of contact for people experiencing gambling harms in Scotland.

Taken together, these data point to a substantial gap between population-level need and service utilisation, with gambling harms concentrated among more disadvantaged groups but only a small proportion of those affected accessing support. This provides important context for interpreting the scale and reach of current service provision discussed in this report (see Section 4.4).

There is a growing emphasis on adopting a public health approach to gambling harm, shifting focus away from individual responsibility and towards structural determinants, including the availability, accessibility and regulation of gambling, as well as broader social and economic conditions. Within a public health approach, making support and treatment available for all people at-risk of or experiencing gambling harms remains a priority ^[3].

Scotland’s Population Health Framework^[4] explicitly adopts a public health approach to gambling harms by recognising gambling as a health-harming product. It prioritises a comprehensive approach across prevention and early intervention, treatment and support services, as well as research, and commits to support actions across these areas via the Gambling Levy.

The development of treatment and support services in Scotland remains limited. As noted in PHS’s 2025 Healthcare Needs Assessment, provision has been largely concentrated in the third sector, with limited integration into statutory health services and no comprehensive national system of care^[5].

At the time of this study, the system for providing treatment and support for gambling within Scotland was undergoing a significant transition. The introduction of a statutory levy on gambling operators has increased funding for research, prevention and treatment, and has reshaped commissioning arrangements. However, this ongoing transition introduced uncertainty with many organisations operating under short-term funding arrangements or awaiting decisions about future commissioning.

This context is important for interpreting the findings of this report. While not always explicitly articulated by participants, funding uncertainty and anticipated system change form a key backdrop to current service provision and inter-organisational dynamics.

1.2 Purpose of the study

This study was commissioned by the Scottish Government to:

• provide a comprehensive understanding of gambling harm treatment and support services in Scotland to inform the engagement with the sector, resilience, development of future services, and to promote a more coordinated and collaborative landscape;
• to update understanding of evidence for the effectiveness of gambling harm prevention, treatment and recovery support services.

To achieve these aims, the study set out the following objectives:

RO1: Undertake a rapid literature review on the effectiveness of interventions designed to address and support those affected by gambling harms, building from the Lancet Public Health Commission on gambling^[6].

RO2: Map the provision of gambling support services across Scotland.

RO3: Provide understanding of co-ordination and collaboration between different gambling specific services, exploring their understanding and links with each other and wider, indirect services that may also exist.

RO4: Capture data on service provider; location and geographical coverage; type of service; service users (intended and actual); referral routes (where applicable); contact details; number accessing support (with demographic details if available); any evaluation data of effectiveness of service (completed, current or planned) or other research by services; source of financial support and future financial plans.

RO5: Identify geographical, population group and service type gaps in service provision and how Scotland’s current service provision relates to our understanding of what is effective.

RO6: Capture any challenges the services face.

The report builds on existing work, including the PHS Healthcare Needs Assessment^[7], by providing a detailed, system-level analysis of service provision and operation.

1.3 Analytical approach

The report adopts an analytical framework grounded in priorities identified by PHS^[8] for the development of gambling harm services within Scotland. These priorities emphasise that services should:

8. Be provided locally and integrated with existing trusted services

9. Be flexible to ensure equitable, person-centred care

10. Have clearly defined pathways to access services

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

12. Be evidence-generating through robust data and evaluation

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

14. Be free from the influence of the gambling industry

These priorities are used in this report as a framework for analysing current provision, allowing for an assessment of the extent to which the existing system aligns with a public health model of care envisioned for Scotland.

In addition, the report draws on an updated review of the evidence on the effectiveness of gambling harm interventions. This provides a basis for assessing whether current provision reflects what is known to be effective.

1.4 Structure of the report

The report is structured as follows:

• Chapter 2 outlines the methods and analytical approach
• Chapter 3 presents the evidence on effective interventions
• Chapter 4 maps current provision and describes how services operate
• Chapter 5 analyses gaps and challenges in relation to the PHS priorities and the evidence on intervention effectiveness, and considers implications for the future development of services