The language we use in public health matters. How we describe an issue, and the people affected by it, in turn shapes how we perceive it and the types of actions we consider appropriate. For instance, in the drugs domain, guidance for medical professionals in the US advises against using the term ‘drug addict’ or ‘drug abuser’, and instead to talk about a ‘person with substance use disorder’ or a ‘person with opioid addiction’. The effect of this change in language is to emphasise that the person has a problem, rather than is the problem.
Is it likewise time to reconsider our use of the term ‘problem gamblers’? While the term ‘problem gambler’ has fewer negative associations than ‘drug addict’ or ‘drug abuser’, it still can convey an unhelpful notion that gambling is a fundamental characteristic of the individual’s identity. If we instead talk about an ‘individual with a gambling disorder/gambling problem’, we foreground the idea that a gambling problem can be changed, rather than being a permanent characteristic of a person.
Making this change is worthwhile because it better represents the reality of how people experience gambling harms. Phil Mackie, Lead Consultant at Public Health Scotland, spoke at the recent UKPHN 5 Nations Roundtable of the need to recognise that people move in and out of risk, with half of all Scottish problem gamblers ‘new’ to problem gambling, and also that gambling harms may be temporary or accumulate across the life course. At the same event, keynote speaker Dr Maria Bellringer spoke on how New Zealand takes a preventative approach, which recognises that people experience varying levels of harm before reaching the problem gambling stage. If we accept that problem gambling affects a more fluid demographic, it is unhelpful and inaccurate to use language which conveys the sense of there being a fixed, unchanging demographic of ‘problem gamblers’. Our language should change to reflect how we address the problem: we should be taking actions to prevent those at risk of harm, and to prevent casual gamblers from moving into problematic gambling activity.
Additionally, talking instead about ‘people suffering from a gambling problem’ opens the opportunity for us to think about victims other than the person who is actually gambling. For every gambler that experiences harm, approximately six other people in their life will be negatively affected – these people are also ‘suffering from a gambling problem’, even if it is not caused by themselves. It is of course important to target those who are most at risk, but it is also worth recognising that those affected by the gambling of others experience four times as much harm as problem gamblers.
If we reframe the language we use about problem gambling, we can also help to reduce stigma around the issue, through emphasising that individuals are affected by a problem, rather than themselves problematic. Of course, much more needs to be done beyond this alone to address the stigma of problem gambling, but the language we use is important – and the way media in particular talks about gambling has an important role in shaping the public discussion of the issues.
While it may be true that some people are more likely to be psychologically predisposed to problematic gambling, this does not detract from the harms produced by the gambling environment itself: the ease of access to high-risk gambling products, and the lack of preventative policies in place to limit their activity. To talk of ‘problem gamblers’ places the onus on the individual – of being themselves the ‘problem’ – rather than thinking more broadly about how their vulnerability is exploited and enabled. Indeed, as proposed by Twitter user Steve Ramsey @steviejbramsey, maybe it is time to talk about ‘problem operators’ – shifting the onus away from people who gamble towards the gambling companies who create the unsafe environment.
Finally, it is ultimately important to recognise that different people will find different kinds of language helpful, and that for some, the term ‘problem gambler’ will be felt to best reflect their own lived experiences, while others will find ‘individual with a gambling problem’ more relevant. We would be keen to hear your own perspectives on this topic, so please consider emailing Freddie on [email protected].