Key findings

• Gambling harms are broad, interconnected, and extend well beyond money. Harms affect wellbeing, relationships, and resources, often reinforcing each other over time, and they impact not only people who gamble but also partners, families, and other affected others. Recovery is similarly multi-dimensional and not reducible to simply “stopping gambling”.
• New, robust tools now measure gambling harm directly — for both people who gamble and affected others. The Gambling Harms Severity Index (GHSI-10) and GHSI-AO-10 are co-designed, non-stigmatising measures that reliably capture the full spectrum and severity of real-world harm, outperforming older diagnostic tools focused on “problem gambling”.
• Gambling harms cause large, clinically meaningful reductions in quality of life and capability. In Great Britain, increasing harm is associated with substantial losses in wellbeing and life capability, with severe gambling harm producing impacts comparable to — or greater than — depression and opiate dependence. Affected others experience harms of similar magnitude.
• When assessed holistically, gambling harms are comparable to alcohol and cocaine. Using a multi-criteria decision analysis, high-risk gambling was rated as equally harmful overall as high-risk alcohol use and more harmful than cocaine once mental wellbeing, financial strain, and relationship harms — including harm to others — are fully accounted for.