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Inside the brain of a gambling addict - BBC News

In a public health approach, the negative impacts of gambling can be assessed by health-related quality of life HRQL weights, known as disability weights DW , which measure the per-person burden of health state on quality of life [ 44 , 45 ]. Along this continuum, people can experience negative financial and social consequences, although harms tend to be more common among frequent gamblers [ 10 ]. Personal and interpersonal level costs are mostly nonmonetary in nature, including invisible individual and external costs that are general, costs of problem gambling and long-term cost. While quantifying the economic impacts is reasonably straightforward e. On the personal and interpersonal levels, financial impacts can be changes in financial situations. General impacts usually result from non-problematic recreational and at-risk gamblers gambling. In summary, a common and comparable methodology for evaluating the impacts of gambling is necessary [ 32 , 37 ], and none has been created. Problem and pathological gamblers are usually called problematic gamblers. This approach, however, presents a very biased view of the situation. They also defined that social cost must be social, rather than personal. Additionally, impact studies can be used when considering which gambling policies will reduce or increase costs or benefits the most [ 36 ]. Costs and benefits refer to overall negative or positive gambling impacts and not only those with monetary value. The impacts of gambling on societies is positive and negative and depends on a number of factors, including what type of gambling environments and games are available, how long gambling has been possible, whether gambling revenues are derived locally or outside the jurisdiction, and the effectiveness of gambling policy [ 32 , 33 , 34 , 35 ]. Peer Review reports. Financial harms are common, especially among problem gamblers. The Model emphasizes the public health perspective, which is somewhat different from the one in costing studies. Based on Williams et al. For example, gambling can be a leisure time option that takes time and money from other activities. Despite increased interest in gambling impacts, no consensus has been reached regarding the appropriate theoretical and methodological approach to studying them [ 32 ]. In the model, impacts can be divided into negative and positive. A theoretical model is still lacking, although some studies have created basic principles for conducting socioeconomic impact studies. Anielski and Braaten [ 39 ] also examined the impacts of gambling by using an approach they called full cost—benefit accounting, which attempts to overcome the obstacles of CBA. Gambling impact studies can help researchers and policymakers compare the health and social costs and benefits of different gambling policies and can be used when considering which gambling policies will reduce or increase costs or benefits the most. They have an influence on multiple levels: gambling-related harms restrict the gambler and their family, friends, workplace, community, and society [ 17 , 18 , 28 , 29 ]. All forms of gambling, even those typically considered to be more skill-based, like poker and sports betting, contain an element of luck [ 1 ]. However, impacts can simultaneously be both negative and positive. The temporal level refers to the development, severity and scope of the gambling impact. There are, however, much more people suffering from gambling-related harms. Gambling can be defined as betting money on an outcome of uncertain results to win money. Anielski and Braaten [ 39 ] also described many other approaches to study gambling impacts. The effects of gambling can be structuralized using a conceptual model, where impacts are divided into negative and positive; costs and benefits. From the public health perspective, it is not presumed that costs and benefits result only from problem gambling; instead we are interested in the whole spectrum of gambling behavior. This debate argues for a conceptual theoretical model based on the gambling impacts literature, where a public health perspective is applied. Individual impacts induce effects on a personal level to the gambler. Another common characteristic of gambling is that it is a zero-sum game: when one player wins, the other must lose [ 2 ]. Filling the gaps in knowledge is essential in forming a balanced evidence base on the impacts of gambling. In the model, benefits Fig. Overall, financial impacts contribute to economic activity and economic growth. For example, gambling is linked to increased criminality [ 44 ] but can also decrease illegal gambling [ 45 ]. Pathological gambling is a disorder included in both diagnostic manuals: International Classification of Disorders [ 13 ] and Diagnostic and Statistical Manual [ 14 ]. Temporal level refers to the development, severity and scope of the gambling impact. First, to demonstrate that gambling has major social and economic impacts. In the economic literature, gambling revenues and positive impacts on public services have been observed [ 32 ], but fewer studies have examined the positive impacts of gambling on gamblers or their significant others. The aim of this debate is to review complementing and contrasting views on the effects of gambling to create a conceptual model, where a public health perspective is applied. Labor impacts include gambling effects on work, such as changes in productivity, absenteeism, reduced performance, inability to work, job gains and losses, and unemployment. Financial impacts, for example, include gambling revenues, tourism, impacts on other industries, and infrastructure cost or value change. Individual impacts cause effects on a personal level to gamblers themselves. Thus, it is of utmost importance that impacts are examined on multiple levels. Similarly, tourism revenues are positive [ 46 ] but on the other hand tourism can increase crime [ 47 ]. According to the literature, harms can occur also among those classified as nonproblem gamblers [ 42 ]; however, examining only problem or pathological gambling and its impacts on society is still common in economic costing studies [ 43 ]. Most of the time, however, these costs remain unrecognized. We also state that impacts should be examined at the societal, individual, and interpersonal levels. The reviewed empirical work largely concentrated on the costs of gambling, especially costs on the community level. Impacts can be individual or external. Ideally, this evidence could be the starting point in formulating public policies on gambling. Compared with existing models, this model combines aspects from costing studies [ 32 , 39 ] and from gambling harm literature [ 18 , 33 , 34 , 35 ] making the present model more comprehensive and up to date. Harms caused by gambling can co-occur with other difficult situations in life, usually intensifying along with crises and continuing even after the problematic behavior comes to an end [ 17 , 18 ]. Personal level refers to the gamblers themselves and interpersonal level to people close to the gambler: friends, family and work colleagues. Additionally, in a public health approach, the positive effects associated with gambling are recognized [ 17 ]. Gambling-related harm can affect multiple domains of life [ 17 ], including financial [ 19 , 20 ] and health problems [ 21 , 22 ], psychological and emotional distress [ 23 , 24 ], and impaired social and cultural relationships [ 25 , 26 , 27 ]. By doing this, Williams et al. For some consumers, the motivation for gambling is influenced by social interactions because gambling venues offer social settings to meet people [ 6 , 7 ], whereas others are mainly motivated by the dream of winning money [ 8 ]. By contrast, some use gambling to escape their problems, and this is especially common among problem gamblers [ 9 ]. Several limitations of earlier gambling impact studies have been highlighted [ 37 , 40 ], but one major concern has been how to capture and quantify the social impacts [ 32 , 46 ]. Financial problems can range from escalating harms, such as diminishing savings and borrowing money, to major harms, such as bankruptcy or loss of all valuable possessions [ 17 ].{/INSERTKEYS}{/PARAGRAPH} For most individuals, gambling is a form of entertainment [ 4 , 5 ]. The Model can be used to identify areas where research is scarce. These classes manifest on personal, interpersonal, and societal levels. Costs and benefits are categorized into three classes: financial, labor and health, and well-being. These include general impacts, impacts of problem gambling and long-term impacts of gambling. However, like Williams, Rehm and Stevens [ 32 ] stated, figures obtained by this approach are not reliable and somewhat arbitrary, and it is not clear how the monetary values for some variables are created. These classes manifest in personal, interpersonal, and societal levels. In our study, rather speaking of social impacts, we use the term nonmonetary impacts i. Thus, studies have mostly ignored social impacts, choosing to measure only the economic costs or benefits that are quite easily quantifiable. There are no established ways to define the social impacts of gambling. The conceptual model offers a base on which to start building common methodology for assessing the impact of gambling on the society. Based on harms experienced because of gambling, gamblers are usually divided to recreational, at-risk, and problem and pathological gamblers [ 11 , 12 ]. In a public health approach, the impacts of gambling, negative and positive, are assessed across the entire severity spectrum of the activity [ 41 ]. Different approaches have been used to study the impacts of gambling. Health and well-being impacts include the effects that gambling has on physical, psychological, and social health and well-being. Economic cost—benefit analysis CBA measures changes in well-being in common units dollars [ 38 ] and attempts to discover whether increased gambling opportunities are positive for society [ 39 ]. Gambling is typically viewed as a continuum, with most people gambling only occasionally or not at all and some gambling more frequently. In this approach, monetary value is also assigned to intangible harms harms not necessarily monetary in nature, e. Although some studies have created basic principles for conducting impact studies, a theoretical model is currently lacking. In a public health approach, the impacts of gambling, negative and positive, are assessed across the entire severity spectrum of the activity. Studies have usually concentrated on impacts of problem gambling while ignoring the entire continuum of gambling. These long-term effects of problem gambling can materialize even if the person no longer gambles; it can create a change in the life course of an individual, and even pass between generations [ 18 ]. Impact studies can also help researchers and policymakers compare the impact of different health and social problems and benefits; for example, gambling impacts can be weighed against alcohol impacts. While measuring monetary impacts is not always straightforward, the main issue is how to measure the social impacts, which are typically ignored in calculations, as are personal and interpersonal impacts. Walker and Barnett [ 40 ] stated that social costs must aggregate societal real wealth, that is, cause harm to someone in the society and benefit no one. Since the expansion of the gambling market, the question of gambling impacts has piqued researchers and policymakers interest [ 37 ]. According to these definitions, when a gambler becomes ill because of excessive gambling, their suffering should not be counted as a social cost as long as someone in society gains from this excessive gambling and gamblers do not demand any treatment that would cause costs to society. This approach, however, has been criticized because an arbitrary monetary value is applied to these intangible harms [ 37 , 40 ]. Gambling creates costs and benefits that others must pay for or can exploit. When concentrating solely on problematic gambling, only the tip of the iceberg is observed and gambling harms and its costs to society are underestimated [ 42 ]. Research into the socioeconomic impacts of gambling can be conducted from a cost of illness perspective, commonly used in alcohol and drug research; however, this approach neglects the benefit side [ 37 ]. {PARAGRAPH}{INSERTKEYS}Metrics details. Overall, there are several main purposes for conducting impact studies on gambling. The model includes a temporal dimension, which refers to the development and severity of gambling behavior.