Gambling-Related Harms: A Care Staff Guide to NICE NG248

Gambling harm is often hidden. People rarely volunteer it, and it can sit behind debt, relationship breakdown, low mood or suicidal thoughts. NICE guideline NG248, published in January 2025, is aimed at identifying, assessing and treating gambling-related harms in adults, and at supporting people of any age affected by someone else's gambling. For care and health staff, its clearest message is simple: ask.

Why asking matters

NICE recommends asking about gambling as part of routine questions about smoking, alcohol and other substances, even when there are no obvious risk factors. Direct questions work best, such as asking whether the person gambles. The guideline also directs people to the NHS self-assessment questionnaire. Stigma and shame are strong, so ask in private and without judgement.

When to ask specifically

NICE advises asking specifically when someone presents with:

• mental health problems, including suicidal thoughts, depression, anxiety, psychosis, bipolar disorder, post-traumatic stress disorder, personality disorder or ADHD
• medicines that affect impulse control, such as dopamine agonists or aripiprazole
• alcohol or substance problems, especially cocaine
• contact with the criminal justice system
• homelessness, financial worries, safeguarding concerns, violence or domestic abuse
• a family history of gambling harm or addiction

It also suggests considering the question when a neurological condition or acquired brain injury causes impulsivity, when a young person has recently left home, and for higher-risk occupations such as the armed forces, veterans, gambling or finance industry workers and sports professionals. Multiple risk factors have a cumulative effect. Our guide to Parkinson's disease care is relevant because dopamine agonists, used in Parkinson's, are on NICE's list of medicines that can affect impulse control, and our guide to dual diagnosis covers co-occurring substance misuse.

Suicide risk

NG248 states that gambling can be a dominant risk factor for suicide, even where there are no other risk factors. Staff should ask directly about suicidal thoughts and intent. If risk is present, NICE recommends explaining the link with gambling, noting that risk may peak after a gambling episode, creating a safety plan, assessing social support, considering involving family or friends, and referring urgently if risk is immediate. Our guide to suicide and self-harm awareness explains how to respond.

Initial support

• Tell the person that support is available and that recovery is possible.
• Offer information, encouragement to seek help, signposting, including to the national gambling helpline, and referral. Brief motivational interviewing can help if the person is reluctant.
• Discuss ways to limit harm, such as blocking software, blocking marketing, self-exclusion schemes, payment blocks and limiting access to money.
• Consider advice about debt, housing, employment, legal issues and domestic abuse.
• Consider referral to an NHS triage service, and tell the person that self-referral through triage or the helpline is an option.

NICE reminds practitioners that severity can change over time and that recent onset or reduced gambling can still cause severe harm.

Treatment

Under NG248, the main treatment is cognitive behavioural therapy (CBT). Group CBT is offered to reduce severity and frequency, starting as soon as possible after diagnosis, with individual CBT where the person prefers it, a group is unavailable or a group is unsuitable. NICE says CBT should be delivered by practitioners trained in gambling, follow evidence-based protocols, usually run for about 8 to 10 group sessions or 6 to 8 individual sessions, and include relapse prevention. Motivational interviewing can build engagement but is unlikely to be effective on its own. Peer support should be offered to those who want it.

The guideline says naltrexone may be considered if psychological therapy has not worked after an appropriate course or if relapse is repeated. It was off-label in the UK as of January 2025 and should be started by or under a qualified specialist. Staff should never advise starting or stopping medicines themselves.

Recording and confidentiality

Record what the person says about their gambling, any debts or safeguarding concerns, and what support you have offered, in factual and non-judgemental language. Explain what will be shared and with whom. NICE notes that services are usually free and confidential, with exceptions where safety is at risk, and being honest about those limits helps people trust you. Make sure that any money-related concerns, such as access to bank accounts or possible financial abuse, are raised through the right safeguarding or financial processes.

Affected others

NG248 also covers family members and friends. Offer them information on how to support the person and how to get help for themselves, and consider support individually or jointly if both agree. Gambling services should be free of gambling industry influence.

Supporting staff learning

Asking about gambling is a skill. Short briefings and role-play on difficult conversations build confidence. Learnsignal's CPD courses can help teams plan wider learning.

Frequently asked questions

Should we ask everyone about gambling? NICE recommends including a question about gambling in routine questions about smoking, alcohol and other substances, and asking specifically where risk factors are present.

What treatment works? According to NICE, group or individual CBT delivered by trained practitioners, with peer support, and sometimes naltrexone under specialist care.

Can a family member get help? Yes. NG248 recommends offering support and information to people affected by someone else's gambling.