By Claire Dunbar | Mental Health | 15 March 2026 | 6 min read
Key Takeaways:
- Problem gambling is classified as a behavioural addiction in both the ICD-11 and DSM-5, placing it firmly within the scope of mental health services.
- Mental health charities in Scotland regularly encounter clients whose anxiety, depression, or suicidal ideation is rooted in gambling harm, often without the client disclosing it directly.
- Understanding how bookmakers and betting platforms operate helps support workers have informed conversations with affected individuals and their families.
- Early identification and a non-judgemental approach significantly improve outcomes for people experiencing gambling-related distress.
Across Scotland, community mental health organisations work with people navigating depression, anxiety, isolation, and crisis. Within that caseload, a growing number of individuals present with psychological distress that traces back to disordered gambling. The link between gambling and mental health is not peripheral. The World Health Organization's ICD-11 classifies gambling disorder alongside substance dependence as a disorder due to addictive behaviours, and the American Psychiatric Association's DSM-5 lists it as the only recognised behavioural addiction. For mental health charities operating in communities like Lanarkshire, where deprivation and limited access to specialist services compound the issue, understanding the gambling landscape is becoming a practical necessity. Resources such as SharkBetting document how the modern betting industry operates, providing the kind of factual context that helps support workers and families understand what a person with a gambling problem is actually dealing with.
Why Gambling Disorder Belongs in Mental Health Services
Gambling disorder shares neurological mechanisms with substance addiction. Functional MRI studies have demonstrated that the anticipation of a gambling win activates the same dopamine reward pathways triggered by drugs and alcohol. The 2013 reclassification in the DSM-5, which moved pathological gambling from the impulse control category to the substance-related and addictive disorders chapter, reflected two decades of neuroscience evidence confirming this overlap.
For frontline mental health workers, the clinical reality is that gambling disorder rarely presents in isolation. A 2019 study in The Lancet Psychiatry found that 75% of people seeking treatment for gambling disorder met criteria for at least one co-occurring mental health condition, most commonly major depression, generalised anxiety, and alcohol use disorder. In practice, this means mental health services are already seeing gambling-affected clients. The question is whether those services are equipped to recognise and respond to the gambling component.
The Scale of the Problem in Scotland
Public Health Scotland's 2021 estimates suggest that between 0.7% and 1.2% of the adult population meets criteria for problem gambling, with a further 3.5% classified as at-risk. In absolute numbers, that translates to approximately 30,000 to 50,000 people with a gambling disorder and roughly 150,000 more experiencing some level of harm. These figures likely undercount the true prevalence, as gambling disorder is among the most under-reported behavioural health conditions.
The distribution is not uniform. Areas of higher deprivation show elevated rates of gambling harm. Fixed-odds betting terminals, before their stake reduction in 2019, were disproportionately located in the most deprived communities. The shift to online gambling has not corrected this inequality. It has removed the last geographic friction that made gambling marginally less accessible.
Recognising Gambling Harm in Clients
Most people experiencing gambling-related distress do not present to a mental health service and say they have a gambling problem. They present with depression, with anxiety, with relationship breakdown, with debt-related stress, with suicidal thoughts. Gambling harm is frequently the root cause but rarely the stated reason for seeking help.
There are practical indicators that support workers can learn to recognise. Unexplained financial crisis in someone previously stable. Secretive phone use. Mood swings that correlate with sporting events or specific times of day. Withdrawal from social activities. Repeated borrowing from family or payday lenders. None of these are diagnostic on their own, but in combination they warrant a gentle, direct question.
The Problem Gambling Severity Index (PGSI) is a validated nine-item screening tool that can be incorporated into existing assessment processes. A shorter alternative, the Brief Biosocial Gambling Screen, uses just three questions and takes under two minutes to administer.
How the Betting Industry Works
Effective support requires a basic understanding of what the person is involved in. The modern betting industry is vastly different from the high-street bookmaker of thirty years ago. Online platforms operate around the clock, offer hundreds of markets per football match alone, and use sophisticated algorithms to personalise promotions and maximise engagement.
Betting exchanges add another layer of complexity. Unlike traditional bookmakers where the customer bets against the house, exchanges allow users to bet against each other. One person backs an outcome while another lays it, effectively taking the bookmaker's role. These platforms charge a commission on net winnings rather than building a margin into the odds. The commission structures vary and can be opaque. Understanding what a betfair expert fee involves, for instance, helps demystify the financial mechanics that clients may describe in vague or confused terms during support sessions.
This is not about support workers becoming gambling experts. It is about having enough literacy to ask the right follow-up questions and to understand the answers.
Approaches That Work
The evidence base for treating gambling disorder within mental health settings is growing. Cognitive behavioural therapy adapted for gambling (CBT-G) has the strongest evidence, addressing the cognitive distortions that sustain gambling behaviour: the belief in hot streaks, the illusion of control, the selective memory of wins over losses.
Motivational interviewing is effective as a first-stage intervention, particularly for clients who are ambivalent about change. It aligns well with the person-centred, non-judgemental approach that characterises good mental health practice in the third sector.
Peer support programmes, modelled on those used in addiction recovery, have also shown promising results. GamCare and the National Gambling Helpline provide specialist referral pathways, and Gamblers Anonymous operates groups across Scotland including in the Lanarkshire area.
What Mental Health Charities Can Do Now
Organisations do not need to become specialist gambling treatment providers. What they can do is integrate gambling awareness into their existing practice. This means training staff to screen for gambling harm as part of routine assessment, building referral relationships with specialist services, and creating an environment where clients feel safe disclosing gambling problems without fear of judgement.
It also means recognising that gambling harm extends beyond the individual. Partners, children, and parents of people with gambling disorders experience what researchers call affected other harm: financial instability, emotional distress, and broken trust. Family support should be part of the response.
Scottish Government funding through the Public Health Priority framework has begun to recognise gambling harm as a public health issue rather than an individual failing. Mental health charities are well positioned to contribute to this shift, bringing their expertise in community-based support to a problem that has been under-served for too long.
Frequently Asked Questions
Is gambling addiction a mental health condition?
Yes. Gambling disorder is classified as a behavioural addiction in both the WHO's ICD-11 and the APA's DSM-5. It shares neurological mechanisms with substance addiction and frequently co-occurs with depression, anxiety, and other mental health conditions.
How common is problem gambling in Scotland?
Public Health Scotland estimates that between 30,000 and 50,000 Scottish adults meet criteria for gambling disorder, with approximately 150,000 more classified as at-risk gamblers. Prevalence is higher in areas of socioeconomic deprivation.
What should I do if I think a client has a gambling problem?
Ask directly but without judgement. Use a validated screening tool such as the PGSI or Brief Biosocial Gambling Screen. If gambling harm is identified, offer to refer to the National Gambling Helpline (0808 8020 133) or GamCare for specialist support, while continuing to address co-occurring mental health needs.
Can mental health charities treat gambling disorder?
Charities with trained counsellors can deliver CBT-based and motivational interviewing interventions for gambling harm. For more complex cases, referral to NHS or specialist gambling treatment services such as the National Gambling Treatment Service is appropriate. The key role for community organisations is early identification and supported referral.
About the author: Claire Dunbar is a mental health writer and researcher with a focus on behavioural addictions and community-based intervention models. She has contributed to policy consultations on gambling harm for Scottish Government working groups and writes on the intersection of public health, mental health services, and gambling regulation.
Sources: World Health Organization, ICD-11 (2019), 6C50 Gambling Disorder. American Psychiatric Association, DSM-5 (2013). Dowling, N.A. et al., "The prevalence of comorbid personality disorders in treatment-seeking problem gamblers," Journal of Personality Disorders, 29(6), 2015. Wardle, H. et al., "Gambling and public health: we need policy action to prevent harm," BMJ, 365, 2019. Public Health Scotland, Gambling-related harms: evidence review, 2021. Cowlishaw, S. et al., "Psychological therapies for pathological and problem gambling," Cochrane Database of Systematic Reviews, 2012.