Building a National Framework for Hope: Understanding the NICE Guidelines for Gambling Harms

When NHS England announced the commissioning of gambling harm support and treatment services across England, I knew that everything we do in the coming weeks will shape the future of gambling harm support in this country.

I also knew that is time to return to the NICE guidelines for identification, assessment and management of gambling harms with fresh eyes. Because if we’re about to build a new system, one finally free from all this talk about industry influence, then I want every part of our work to align with what the evidence actually tells us.

I had the privilege of being part of the NICE guideline committee that developed these recommendations. Over months of reviewing evidence, listening to people with lived experience, and wrestling with what the research tells us, we worked to create guidance that could genuinely transform how England responds to gambling harm. Now, as commissioners prepare to allocate the statutory levy funding, these guidelines offer a blueprint for the new system. Hopefully, a system worthy of the people who will depend on it.

In this week’s article, I’m breaking down what these guidelines actually mean for the people designing, funding and delivering gambling harm support services, and why they will shape every credible response to gambling harm in the years ahead.

Understanding NICE and why the gambling harm guidelines are important

For those unfamiliar with the process, NICE, the National Institute for Health and Care Excellence, has been developing clinical guidelines for the NHS since 1999. Their work ensures that healthcare decisions are grounded in the best available evidence rather than tradition, commercial interests, or postcode variation. The process is rigorous: independent committees of clinicians, researchers, people with lived experience, and other experts spend years systematically reviewing evidence, consulting widely, and translating findings into practical recommendations. The aim is always the same: to ensure that everyone in England has access to the best possible care, regardless of where they live or which service they approach.

The gambling harm guidelines took over three years to develop. Unlike alcohol or substance dependence treatment, where we have decades of established research and proven pathways, gambling harm has only recently begun to emerge from the shadows. The evidence base is newer, the service landscape more fragmented, and until now, much of the funding has come from the gambling industry itself, a fundamental conflict of interest that has shaped everything from research priorities to treatment availability.

The committee I served on reviewed hundreds of studies, heard testimony from people with lived experience, consulted with practitioners across different settings, and debated every recommendation with the seriousness it deserved. What emerged is guidance that reflects both the evidence and the human reality of gambling harm, the shame that keeps people silent, the complexity of overlapping mental health and social needs, the ripple effects on families, and the possibility of recovery when the right support is available.

As NHS England takes on the commissioning of gambling harm services, funded by the new statutory levy on gambling operators, the NICE guidelines offer crucial direction. They tell us not just what works, but how to build a system that can deliver it equitably, accessibly, and effectively.

A Whole-System approach to identification

The guidelines recognize that stigma, shame and fear of disclosure prevent people from seeking help. Too many people suffer in silence, their gambling escalating until crisis hits. Financial ruin, relationship breakdown, thoughts of suicide. By then, intervention is harder and the harm already severe.

The guidelines recommend that healthcare professionals and social care practitioners routinely ask about gambling, not just when obvious risk factors are present, but as part of holistic health checks, GP registrations, and contacts with social services. We normalized asking about smoking. We made it routine to discuss alcohol intake. It's time to do the same with gambling.

Certain situations should particularly trigger conversations: mental health presentations (especially thoughts of self-harm, depression, anxiety), criminal justice contacts, alcohol or substance dependence, financial concerns, safeguarding issues, homelessness, and when people are taking medications affecting impulse control like certain dopamine agonists.

For commissioners, this means investing not just in specialist treatment services, but in training across the health and social care workforce. GPs need to know what and how to ask. Mental health practitioners need to recognize the links between gambling and suicidality. Criminal justice workers need to understand gambling as both a driver and consequence of offending. This is prevention at scale, catching people earlier, before the harm compounds.

Tiered service provision that meets people where they are

The guidelines describe a comprehensive model with specialist gambling clinics for people presenting with severe harms or complex co-occurring needs (mental health conditions, substance dependence, trauma), and community-based gambling treatment services for those with lower-level harms or less complexity. Alongside these, gambling support services should provide information, advice, brief interventions and peer support.

This tiered approach matters because not everyone experiencing gambling harm needs the same intervention. Some people need intensive specialist therapy; others need brief support to interrupt an emerging pattern; still others need ongoing peer connection to sustain recovery. Commissioners must fund the full spectrum.

The guidelines are clear that services should allow for prompt risk assessment, deliver timely support, provide easy access for marginalized groups, and offer coordinated care across mental health, physical health, social care and criminal justice systems. They should be multidisciplinary, bringing together healthcare professionals, social workers, voluntary sector expertise, and crucially, people with lived experience.

Evidence-Based Treatment

The guidelines reviewed all available evidence on psychological and pharmacological treatments. What emerged was clear guidance on what should be offered first-line:

Group cognitive behavioral therapy (CBT) is recommended as the primary psychological intervention, delivered by trained practitioners with gambling-specific competence, typically over 8-10 sessions, including relapse prevention components. Individual CBT should be offered when group therapy isn't suitable or available, usually over 6-8 sessions.

Motivational interviewing can strengthen people's confidence and commitment to change, particularly for those who are ambivalent about treatment.

Peer support should be offered as an integral part of any treatment pathway. The guidelines recognize what those of us in recovery communities have always known: there's something powerful about discussing aspects of recovery with others who've been through similar experiences, hearing what worked for them, and finding community in what can feel like an isolating struggle.

For people whose gambling hasn't improved despite psychological therapy, or who have repeated relapses, naltrexone (an opioid receptor antagonist) can be considered. This represents the first time pharmacological treatment for gambling harm has been included in national guidance, a significant development.

Crucially, the guidelines emphasize that treatment should be gambling-specific, not included as a part of generic addiction services. People experiencing gambling harm value interventions that address the unique characteristics of their struggle, the cognitive distortions around probability and control, the relationship with money and debt, the accessibility of online platforms, the triggers in the endless advertising. Generic approaches miss these specifics.

Support for Affected Others

One of the most important aspects of the guidelines is the explicit recognition that families and affected others experience severe gambling harms and require their own support. An estimated 3.8 million people in Great Britain, including children and young people, are affected by someone else's gambling.

Services should offer help both independently and jointly with the person gambling, including techniques to manage distress, prioritize their own needs, and engage in non-judgmental communication. And this mustn’t be done as an add-on, but as core provision.

A call for true collaboration

Here's what keeps me awake at the moment: we could receive historic levels of funding, commission excellent services, build state-of-the-art clinics, and still fail to reduce gambling harm at the population level if we don't work together.

The NICE guidelines aren't a prescription for any single organisation to follow in isolation. They're a framework for a system. One where GPs feel confident asking about gambling, where crisis teams understand the link between gambling and suicidality, where community services can make warm referrals to specialist clinics, where clinical treatment and peer support and debt advice and housing support all coordinate around the person's needs.

To commissioners: fund the full spectrum of provision, from prevention through aftercare. Don't create competition where collaboration is needed. Value lived experience as expertise, not just as consultation. Build in time and resources for partnership-working, because integration doesn't happen by accident. Make decisions based on the NICE guidance and the evidence that underpins it, not on historical relationships or organisational size.

To service providers: let go of territorial instincts. Share what works. Refer to each other generously. Remember that we're not competing for people's care, we're collaborating for their recovery. If the NICE guidelines recommend peer support, make space for it. If they recommend gambling-specific CBT, ensure your staff have that competence. Excellence requires humility about what we can and cannot provide alone.

To policymakers: sustain this investment. Gambling harm didn't emerge overnight, and it won't be solved in a single funding cycle. Give services time to build trust in communities, to develop their workforce, to demonstrate outcomes. Hold us accountable to evidence-based practice, but also trust the expertise of those doing the work.

To people with lived experience: your voices shaped these guidelines. Keep speaking. Keep telling us when services miss the mark. Keep reminding us that behind every statistic is a human story, and that recovery is possible when the right support exists.

The work begins now

The NICE guidelines estimate that excess costs to the NHS, wider public sector, and society from gambling harm are between £1.05 to £1.77 billion annually. Between 117 and 496 people die by suicide each year as a result of gambling. An estimated 2.5% of adults in Great Britain engage in problem gambling, with another 12% at some level of risk.

These aren't just numbers. They're mothers, fathers, siblings, friends. They're people who started gambling for entertainment and got trapped. They're families torn apart by debt and deception. They're lives lost to despair.

But they're also the people who will recover when we get this right. When we build services aligned with evidence. When we reduce stigma and increase access. When we coordinate care and sustain funding. When we bring together clinical expertise and lived experience wisdom.

The NHS England commissioning of gambling harm services represents an unprecedented opportunity to create something worthy of the people who need it. The NICE guidelines give us the roadmap. The statutory levy provides the resources. Now we need the collective will to build it. Together.

We all share the same mission: to reduce the harm caused by gambling and to help people reclaim lives of meaning, connection, and hope.

The work begins now. Let's make it count.