The Gambling Harms Scale Index (GHSI): Holistic Framework and Measurement of Gambling Related Harm and Recovery
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Speaker:
Dr James Close is Associate Professor in Medicine and Psychology at the University of Plymouth. His research has spanned biomedical, health and psychological sciences. With a keen interest in both videogames and games of chance, his current research interests include how psychological heuristics and biases are exploited for monetisation by gaming, gambling and social media companies, and the subsequent impacts on individuals and society.
Abstract:
Gambling-related harms are increasingly recognised as a major public-health issue, yet they remain poorly integrated with broader health-economic and policy frameworks. Existing measures often focus narrowly on clinical definitions of “problem gambling”, underplaying lived experience, harms to affected others, and the cumulative social and health impacts. Our work addressed these shortcomings via four, discrete stages.
(1) Development of a holistic framework of gambling harms and recovery, for people who gamble and affected others. With gambling policy shifting towards a public-health model, we developed a clear, lived-experience account of how harm actually manifests, derived from literature reviews plus in-depth interviews with gamblers and affected others. The framework foregrounds stigma – both social and self-stigma – alongside the nature of cascading, overlapping harms, such as financial stress spilling into relationships and mental health issues.
(2) Development of the Gambling Harms Severity Index (GHSI-10) and the GHSI for Affected Others (GHSI-AO-10). We translated the framework into the GHSI and GHSI-10, co-developing items with stakeholders for non-judgmental language, clearer response codes, and reduced biases related to denial and social desirability. In a large survey of over 3,000 gamblers and 3,000 affected others, the GHSI showed strong psychometric performance and stronger associations with wellbeing than PGSI. The measures can be obtained from: gamblingharms.org
(3) Benchmarking against other conditions and behaviours. Using health-utility and capability measures, we show that increasing gambling harm is associated with clinically meaningful decrements in quality of life. In terms of impact, these decrements place high-severity gambling alongside other long term health conditions and substance based addictions (i.e. alcohol and drugs), challenging assumptions that gambling harms are comparatively “minor” or transient. These tools can be used to benchmark changes in harm over time, and associated health economic benefits that are realised via interventions and service delivery.
(4) Comparative harm and policy appraisal. Finally, we triangulated such findings via Multi-Criteria Decision Analysis (MCDA) – a structured, expert-led decision-making method that integrates evidence and explicit value judgements across multiple harm domains – to compare gambling with alcohol and drugs. This approach shows that high-risk gambling generates harms comparable to high-risk alcohol, underscoring the need for proportionate, evidence-led regulation rather than exceptional treatment.