“High Stakes: Gambling Addiction, Beyond Borders” is a three-part series looking at the public health movement to address gambling in Massachusetts and the United States, and what can be learned from two countries with very different models of gambling regulation: Norway and the United Kingdom. This is part two of that series. Part one, about Norway, can be found here.
If you walk around Blackpool, England — a one-time seaside resort on the west coast of England — you see carnival rides, a flashy boardwalk and a handful of neon-marketed casinos and arcades. Some call it the Las Vegas of Britain on the basis of betting opportunities per square mile.
I thought a weekend in Blackpool might serve as a trial-by-fire to learning about gambling in Britain. And within 15 minutes, I managed to lose my entire 20-pound budget on roulette machines at the Coral Island Casino.
But you don’t have to come to Blackpool to bet in the United Kingdom.
With an estimated 22 million people betting every month — and 2,000 gambling companies — researchers consider the U.K. one of biggest gambling markets in the world.
It’s also one of the places Massachusetts looked to when the state began regulating its own nascent gambling industry.
“I would describe it this way: that the wizened, haggard old man on the other side of the Atlantic is your future,” said Andrew Rhodes, the head of the U.K. Gambling Commission. “So every difficult experience we have had is going to happen in the U.S.”
While countries like Norway, for example, acted in the early 2000s to restrict gambling, the U.K. did the opposite. The National Gambling Act of 2005 liberalized and legitimized the gambling industry, which had previously been considered more of a seedy endeavor.
“Prior to then, gambling could best be described as something to be tolerated but not encouraged,” Rhodes said.
Today, almost every main street in every English town has a combination of betting shops and arcades where people can gamble. Major cities have brick-and-mortar casinos. And like the rest of the world, mobile and online betting is everywhere.
But with more places to gamble comes a higher risk of addiction, many health leaders say.
A government report from 2023 estimated almost 2 million people in the U.K. are either problem gamblers or at risk of becoming one. In response, the U.K.’s national Gambling Commission says it is putting in a number of new guardrails to help protect the population from gambling addiction, albeit balanced against the needs of the industry and limits of the law.
“The government is still very focused on the idea that it can simultaneously grow the industry and protect people from harms,” said Heather Wardle, a professor at the University of Glasgow. “We need a critical conversation.”
Wardle has been researching gambling policy and addiction for 20 years, including as a consultant for the Gambling Commission. She’s also an outspoken critic of the country’s gambling policy. So when I asked her if the U.K. should be a model for U.S. regulators, including those in Massachusetts, she hedged.
“I mean, certainly the U.K. is a model,” she said. “The question is, a model of what?”
“When the fun stops, stop”
Brixton is one of the most dense betting neighborhoods in London. It’s also one of the poorest.
Posters at each betting shop entrance have slogans meant to promote moderation, like “Take time to think” and “When the fun stops, stop.” (These are often next to another sign: “Best Odds Guaranteed.”)
Giving me a tour of the area, Wardle said those messages reinforce the idea that it’s each person’s responsibility to play in moderation — what’s known as the “responsible gaming” framework favored by the gambling industry — rather than the government’s job to help protect the population from addiction. She believes that’s only possible by scaling back the excessive promotion and availability of gambling.
We entered one betting franchise called William Hill, where a horse race was blaring on TV screens and several men were checking their score sheets. Nearby, a row of video machines were loaded with casino-style games.
Wardle slid a 10 pound note into a machine and chose an electronic roulette game.
“So if it's any number between 1 or 12, then we win,” she said, pressing the start button.
It was 14.
A man sitting next to us had been gambling for four hours and lost 800 pounds — around $1,100 — according to an employee who’d been watching with concern.
After five minutes, a message on the screen reminded Wardle she had set a time limit for herself. To override the reminder, all she had to do was press a button. And she did, winning the next game and then losing two, along with the rest of her cash.
How the United Kingdom got here
The U.K.’s National Gambling Act of 2005 set three key goals for regulating gambling: preventing crime, ensuring fairness and protecting people from harm.
Wardle said it also sent a message to the public that “we should stop being quite so puritanical. We want the industry to grow.”
And grow it did.
In addition to casinos in large cities and resort towns, betting shops in smaller towns started proliferating, offering a new kind of slot machine with preloaded games.
Then came online gambling and sports betting, matched by a rush of advertising and sponsorship campaigns.
“If I wanted to generate harm amongst a population, this is pretty much how I would do it,” said Matt Gaskell, an addiction specialist who runs six gambling treatment clinics for the country’s National Health Service.
Gambling products are designed to “exploit reward pathways [in the brain], affect our decision making, and have an influence on the way that we think and act,” Gaskell said. “My patients gamble in the bathroom, they gamble on their way to work, they gamble at work.”
According to GamCare, a charity organization that offers counseling and referrals, 2024 saw the highest number of calls on record to the U.K.’s national gambling helpline, largely due to sports betting and online casino games.
Gambling treatment has expanded in the U.K. in recent years, going from one nationally funded clinic to 15. But by the time people come into a clinic, Gaskell said, the damage has been done.
While about 1,500 people seek gambling treatment a year, Gaskell believes that’s only a tiny fraction of the number who have gambling disorders. Using a public health analogy, he said the system is trying to rescue people after they’re already drowning.
“We're able to pick one or two out of the river,” he said, “while the industry is throwing in thousands further upstream.”
“I couldn’t enjoy anything except gambling”
Matt Zarb-Cousin was 16 in 2010 when he placed his first bet. He was waiting for a friend near a betting shop while a soccer match was underway.
“I’m an Arsenal fan, and I just put some money in and just thought I'd pass a bit of time,” he said. “And then I won in the first attempt, and I thought, ‘Well, this is easy.’”
Within a few months, he couldn’t stop. Sometimes he won, which made him feel powerful. Sometimes he lost, which made him want to win the money back.
“I was sort of trapped in a prison that the gambling had sort of created around me, where I couldn't enjoy anything except gambling,” he said.
He used student loans and bank overdrafts to fund his bets. In one afternoon, he lost several thousand pounds. “And it took me to a very, very dark place.”
Zarb-Cousin said he made plans to take his own life until his parents intervened. It took him a lot of therapy, and a few relapses, to stop gambling entirely.
During that period, he went to a Gamblers Anonymous support group. “And what I really didn't like about the culture around gambling addiction recovery was the focus on blaming the individual,” he said.
“That only serves the industry's interests, in my view,” he said. “Because they're sort of saying, ‘Well, OK, we're going to cause all of this harm and profit from it. But the people that get impacted by it, they're sort of embarrassed and ashamed and they're going to be quiet.’”
The push for stronger regulations came as people like Zarb-Cousin, now 35, began to call on legislators to protect all players, not just the most vulnerable. He and others successfully lobbied to reduce the maximum stake on slot machines from 100 pounds a spin to 5 pounds. (They were unsuccessful in changing the speed of play, which goes as fast as two seconds a turn.)
“We never understood what a deep and complex addiction it was,” said Charles Ritchie, whose 24-year-old son Jack took his own life in 2017 after years of gambling led to anxiety, depression and overwhelming debt.
Ritchie and his wife Liz founded the organization Gambling With Lives, which is made up of people who have lost a family member to gambling-related suicide. They are pushing for more limits on the industry, as well as research and education on the risks of gambling.
“All the young people who died, these were nice young people and they were … being told, ‘It's your fault, it's something wrong with you,’” Ritchie said. “‘Everybody else is fine. You're the problem here. You need to solve it.’”
Gambling with “minimum friction” while identifying risks
Andrew Rhodes said he takes seriously the need to protect the public from gambling harms. But, as head of the U.K. Gambling Commission, he also has to take the industry’s needs into account.
“What we're trying to do is make sure that people who want to engage in gambling can, with as minimum friction as possible,” he said. “But we make sure that operators identify those who are at risk because it isn't in the industry's best interests, after all, for people to be harmed by gambling.”
Many public health advocates say that’s not actually true. Research shows that about 90% of the gambling industry’s profits come from about 10% of the highest-spending customers, including people with gambling disorders.
Rhodes said strict regulations, like the mandatory spending limits in Norway, would not be politically or socially acceptable in the U.K.
“The more you restrict people, the more you do run a risk of driving people to the illegal market … where there are no safeguards at all,” he said, echoing a common argument from the gambling industry.
Even so, Rhodes said the gambling commission has already banned many practices that encourage excessive play, including most VIP schemes, misleading messages that present a loss as a win and “slam stops” that give the false illusion of controlling a slot machine’s outcome.
And Rhodes said the commission is now calling on all operators to intervene in a “meaningful” way when customers are showing signs of trouble or losing large sums of money in a short span of time.
Several betting shop managers told me they do their best to comply. An arcade manager in Blackpool named Mary, who declined to give her last name, said she looks at customers’ “body language, signs they're exhibiting to see if they're in sort of internal distress.”
But Mary said most people just want to be left alone. “Real gamblers, they'd walk through snow, wouldn't they? Because it's an addiction, isn't it?”
And while she hands out brochures with the national gambling helpline number, she said most people leave them behind.
Another recent change is a new levy on gambling operators in the U.K. Enacted in April, the 1% tax on profits is expected to raise about 100 million pounds ($140 million) a year towards prevention, research and treatment.
“Money will now go untainted by the gambling companies who cannot dictate how their money is spent,” said Don Foster, a member of Parliament who heads a legislative group called Peers for Gambling Reform.
In one of the commission’s more controversial measures, operators are now asked to conduct “affordability checks” to determine whether players can afford to lose as much as they are betting. Some critics say that’s an invasion of customer privacy and hard to enforce.
“There's lots of debates around this, how it should be done, what the limit should be,” Foster said. “But the principle … has been established and that's a major victory.”
Foster would still like to see a cap on what he considers excessive advertising for sports betting and online casino games, but Rhodes said that’s not in the Gambling Commission’s jurisdiction.
The most encouraging sign, Foster said, is a shift in the national conversation, as more politicians treat gambling as a public health issue. But he’s still concerned the new Labour Party government is under pressure to grow the economy, and by extension, the gambling industry.
“The notion that you can increase the profits of the gambling companies without it having an impact on gambling harm is clearly, in most people's view, nonsensical,” Foster said.
What the United States – and Massachusetts – can learn
Britain has been developing regulations over the course of 20 years, as the gambling industry has rolled out online games, smartphone apps and sports betting. In contrast, Rhodes pointed out, “all of those things are arriving at the same time in the U.S.”
And with no nationwide gambling policy, each state is on its own to regulate the options.
“It will be a very long journey for the states to get to grips with this, unless they are able to get real political clout over this very, very quickly,” said Matt Gaskell, the gambling addiction clinician for the National Health Service. “It's always harder to draw things back once they've gotten way out of control.”
U.S. gambling experts are watching the U.K.’s moves closely, including Jonathan Cohen, who wrote the new book “Losing Big: America’s Losing Bet on Sports Gambling.”
“What's happening in England is a great test case for us,” he said.
Cohen said there’s still time for most states to outlaw online casino games — a style of gambling that experts consider especially addictive. So far, only seven states allow them and Massachusetts isn’t one of them.
Affordability checks, as the U.K. is piloting, have also caught the eyes of U.S. public health leaders.
“It may or may not be doing what they set out to do, but I think the concept struck us as a very solid one,” said Mark Gottlieb, the executive director of the Public Health Advocacy Institute at Northeastern University in Boston.
Gottlieb helped write the Safe Bet Act, a pending federal bill that would make gambling operators do a financial check on any customer betting more than $1,000 in a 24-hour period, or $10,000 in a 30-day period. A pending Massachusetts gambling bill makes a similar proposal.
And while the Safe Bet Act stops short of creating a national gambling commission, as the U.K. has, it would create minimum federal standards for advertising, affordability and artificial intelligence — an approach the industry strongly resists.
Public health advocates in both countries acknowledge that adding new restrictions on betting could lead to a smaller gambling industry. But researcher Heather Wardle said that may be a worthwhile tradeoff.
“Do you want a smaller industry that produces less harms that arguably could be more sustainable going forward?” she asked.
Next up in the series: As sports betting expands across the United States, states are on their own to make the rules. A growing movement of U.S. health leaders and legislators want to strengthen and standardize the way gambling is regulated. But they are facing opposition from the betting industry.
This project was supported by a grant from the Association of Health Care Journalists, with funding from The Commonwealth Fund. It was edited by Dusty Christensen, with help from Elizabeth Román.