The Trouble with Gambling Statistics

The Chief Executive of the Betting and Gaming Council, Michael Dugher, wrote in PoliticsHome on 9th January 2021:

When the Government announced before Christmas that it was kicking off the Review of Gambling, they did so with a “call for evidence” and they rightly said their determination to drive big changes will be “evidence-led”.  This is something I strongly support.  

Ministers made it clear that the percentage of problem gamblers in Britain stands at approximately 0.5 per cent of the adult population – comparatively low by many international standards – and that “this rate has remained broadly steady around or below one per cent for the past 20 years”.

The headline of his article calls for facts not fiction. He cites as facts that there is an ‘anti-gambling lobby’ who are ‘prohibitionists’ intent upon promoting ‘hysteria’ around gambling.

Facts are tricky things. So are statistics, data, ‘evidence’. Regarding the latter we published an article which raised some big questions about evidence during the campaigns to have the stake on Fixed Odds Betting Terminals reduced from £100 to £2. What was then the industry body, the Association of British Bookmakers, demanded ‘evidence that the machines were harmful with £100 stakes.

Evidence is not an innocent word. You can find or not find evidence for anything depending upon your perspectives and agenda. The big government and other machines for gathering evidence use models of gathering data. Interestingly, perhaps an admission of a failure of previous figures and ‘facts’:

This was in response to a recent House of Lords committee report on the gambling industry. Further, :

It would seem that neither the government nor the Gambling Commission have faith in the widely promoted ‘fact’ that ‘problem gamblers’ represent ‘only’ 0.7% of the population. A 2020 YouGov survey suggested that the figure is 2.7%. Quite a difference. When is a fact not a fact?

Aside, for a moment. The prevalence of the serious mental health condition called bipolar is estimated to be 2%. Should we say ONLY 2%? Not worth bothering about. Another fact to bear in mind in this aside is that with mental health diagnoses, three pyschiatrists may give three different diagnoses. And the diagnosing of mental health conditions varies between nations and different cultures. Further, it is clear that different sections of populations are more likely to receive particular diagnoses.

Returning to gambling harms:

So, even with current official figures, young people seem to represent a higher prevalence of harms than the general population. The young people of today are the adults of tomorrow and perhaps youth behaviour suggests worrying future trends in the near future.

While there are worrying indicators of increased exposure to gambling harms for women, the majority of people who face harm are men. Whole population figures do not remotely reflect the scale of the harms because they take an average which includes a gendered majority who face no harms.

Individual populations such as young people (which really needs breaking down to gender, ethnicity, social class, mental health conditions, educational attainment, religion, indices of poverty and deprivation) provide unuseful statistics as they don’t focus upon groupings within the individual population.

There are particular populations which require specific attention to them such as ethnic minorities, religious affiliates, LGBQT citizens. ‘Official’ attention to essential factors such as health, mental health especially, exclusion, exploitation, poverty, inequality and discrimination tends to be weakened by an institutionalised ‘whole population’ approach, the whole population being some vague collections of ‘normalised’ people. Of course, and it can’t be emphasised too much, that within ‘official’ institutions much progress is being made to remove this attentional blindness. What is most exciting is the ‘bottom up’ work of campaigning by minority groups, so often against the odds.

That report by the way shows that 4% of those surveyed were in prison because of gambling. Certainly, we have to move well beyond rather empty claims that the prevalence of gambling ‘disordered’ individuals in ‘the population’ is 0.5% (a figure which in any case is almost certainly a significant underestimate even using the outdated models previously used by the Gambling Commission and others). There are man, many populations within ‘the population’, and many individuals in each.

Stigma and the Invisible ‘Addiction’

We are currently working on a project around stigma and gambling. Stigma is the cause of much of the extra anguish to add to the pains of suffering from gambling harm. It leads to shame, guilt, and a fear of admitting to problems or seeking help.

When your GP routinely asks you about your drinking habits you may lie, give a lower or much lower figure than your actual intake. You don’t want a lecture perhaps, but more than this you are ashamed about how your drinking is ‘out of control’. Ashamed, because only weak people are not in control of their behaviours. Ashamed because you are now outside the norms of decent society. Ashamed because, whatever the success of anti-stigma campaigns, you carry within you, have learned, that ‘addicts’ are bad, worthless, irresponsible. The felt stigma will vary between individuals but some groups will feel it more. A Muslim will have violated their religious and community codes for instance. A woman is likely to feel strongly the stigmas against female ‘drunks’ and ‘alkies’ and ‘lushes’: women are ‘supposed to be@ good mothers, home makers, protectors of children.

You can do all the high-poered, expensive, expert data gathering, analysis and statistical interpretation you like. You won’t be able to include figures for the unknown population of people suffering badly but who feel impelled to keep it to themselves.

Gambling Careers

There has been a welcome move towards valuing the voices of ‘Experts by Experience’ – in health generally and mental health specifically. (It is still not obvious to too many by the way that suffering from gambling harms is a mental health condition. We have a long way to go before health institutions not only stop talking about ‘mental health and addiction services’ but also incorporate a clear understanding into their core values and outlooks). Promisingly,Experts by Experience are involved in a dynamic involvement with health services, professionals from many fields, politics, shaping policy, media. Many individuals go on to find work in the ‘recovery’ field. Others volunteers support groups and peer to peer mentorships. Many are involved with campaigning – and some say that such involvement helps their own recovery.

There is another crucial point to focusing upon the individual. As we saw above, there are many different populations of gamblers, and no such thing as a blank-faced ‘problem gambler’ occupying a ghetto called ‘problem gamblers’. At individual level, the need to think of the whole-person should be obvious. Sensitivity to a woman’s experiences is useful with caution; but much greater sensitivity to that particular human woman is more important. We have to take away the boxes we put people into, the labels we use, the blinkered views our pre-judgments may entail. We have to be sensitive to life story, life situation, health, co-occurring harms such as substance dependence syndromes. What we can never do is think of AN addict. To label someone is to dehumanise them. To label someobody with the word ‘addict’ is horrible. It’s a word loaded with negative, highly stigmatising violence. If we have to use the word at all – as we will do as long as there are ‘mental health and addiction services’ – we should strike it through. ADDICT.

During an individual’s gambling career there will be enormous variations between people. Some may gamble only on certain occasions but do so in a way in which they can severely harm themselves and others. Some may go weeks, months, years without gambling and then ‘relapse’. Others gamble every day and lose every day. Some turn to crime to fund their gambling. A person who has rarely gambled may bet on a certainty one night and los etheir home. An old person may become ill with cold and malnutrition because she spends a good part of her meagre pension on scratchcards. Faced with trauma, redundancy, depression or just boredom someone may turn to gambling – for the experience of gambling is itself an escape into a sealed-off world where anxieties cease. A person with bipolar, in a manic or hypomanic phase may gamble recklessly. (It’s estimated that bipolar individuals have a 50% greater risk of gambling harms than the general population). A gang of of mates drinking and betting fiercely on their mobiles as a football game proceeds on television may introduce to gambling the new member of the group who wants to ‘fit in’. All the kids in school are gambling, your parents are gambling and you want to be grownup.

There is no typical career. But it should be said that a relatively casual ‘low risk’ gambler can hit the buffers at any time when conditions are there. Glasgow University Gambling Research Group is currently engaged in a three years project talking to many individuals about their ‘gambling careers’. The study does make use of the term ‘problem gamblers’ which is a phrase that carries with it some unfortunate negative connotations; however, it understands that there are very many gambling behaviours and harms, and degrees of harm, the crucial importance of individual life factors, so implicitly undermines any concept of a typical ‘problem gambler’:

Rather than viewing problem gamblers as a relatively small and distinct group, the study will look at problematic behaviour as a particular phase that can affect many more individuals at some point(s) in a gambling career, and will examine the way that behaviour waxes and wanes among this larger group.  It will focus on key moments and processes of change such as, for example, how people begin gambling, points when playing increases or decreases, when individuals realise they have a problem and decide to seek help – or not – and the circumstances that surround this. 

Experiences of treatment:  perceptions of its benefits, as well as relapses and reasons for leaving it, will also be explored. Given that the vast majority of problem gamblers never seek treatment, the research will focus in particular on the phase of ‘natural recovery’ in which problematic behaviour is resolved without formal intervention, and will explore shifts in social, demographic and personal circumstances that are associated with it.

This article has tried:

  • to demonstrate that the government and the Gambling Commission are seeking new ways to gather a better and more accurate view of the prevalence of gambling harms.
  • to suggest that calls for ‘evidence’ and ‘facts’ are based on innocent and naive misunderstandings, or else are being used as rhetoric against the ‘hysteria’ of ‘gambling prohibitionists’.
  • to sketch out some of the crucial differences between population studies versus the experiences of individuals.
  • to outline some of the issues around the term ‘evidence’ and show that it is by no means a simple ‘innocent’ word.

The Shills are Alive

CJCENTRAL

Many people die each year of gambling-related causes in the UK. This much is not only true but is the driving force behind this post. I’ve not lost anyone but I’m grateful that no-one lost me. Or maybe they did when I was lost in the fog. Who knows? But let’s get back looking forward.

We also have an increasing number of disordered gamblers. There is no report from any source that will shift that view. How can anyone tell me how many disordered gamblers there are when most, if not all, spend most of their time lying about it? If I’m not telling those closest to me my best kept secrets,then I’m hardly going to tell a stranger from Ipsos Mori or whoever else is feeding the Gambling Commission with pointless answers. You can just imagine…

“We asked 100 people, do you have a gambling disorder?”

So if we…

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Gambling and the Attention Economy

The gambling industry does not exist in a vacuum, nor does the consumer of products. Every business seeks to grab our attention – through advertising, social media and other ways. As individuals, we are saturated by claims on our attention. Our shared psychology in the digital age is marked by fragmented impulses, by accelerated time, by an imperative ‘normality’  that works against any hope of rest or peace.

The 24/7 stream of hooks on our attention is relentless. In the case of gambling, this is supplemented by products themselves which are designed to be addictive. They offer, paradoxically, a single point of attention which is, like any addiction, the release from the never-ending pressures of time, the chaos of information.

Drawing on fifteen years of field research in Las Vegas, anthropologist Natasha Dow Schüll shows how the mechanical rhythm of electronic gambling pulls players into a trancelike state they call the “machine zone,” in which daily worries, social demands, and even bodily awareness fade away.

Competition for our attention is intense and part of trillion dollars budgets of digital industries. If you have never made an impulse purchase from the internet you are very much the exception. We have to acknowledge the possibility that our growing restlessness is a digitally induced dis-ease with time. What are referred to as  clinical diagnoses, attention deficit disorder or hyperactive attention deficit disorder, may be now  normalised attributes of digitized citizens (to varying extents in individuals).

In practice, we are primed by digital technology to be restless and compulsive. It is not a question of individual responsibility or strength of character. The exploitation of this primed state is the core driver of the attention economy.

 

Digital Health: Dying?

Dying, facing our deaths and those near us, is something we all must do. Some of the greatest philosophers have concurred that to live is to prepare for death.

Yet we live in a death-phobic culture which – largely due to the digital environment – is incredibly fast, distracting, bright and shiny and ‘full of life’. In relatively recent history people accepted death as a normal part of life, inevitably to be faced with sadness and mourning but never as a sudden shock as if some malignant miracle had occurred.

With so many of us in the rich countries living longer than ever, longevitiy for the majority bringing with it pain and suffering, dementia and deadly diseases, how do we prepare for death? Do we expect the incredible medical advances and technology to keep us going for ever? Is that our goal – to squeeze as many years and days out of life as we can? Has technology in this as many other other cases further removed use from nature and being a human rather than a machine?

In any case, what, if anything, can ‘digital health do to address the truth of our mortality? Lots of big questions here but as you and I will die we need to think of our own deaths. As a society, the birth rate is falling quickly at the same time as the older population is greatly increasing. Who will look after the old, who will pay for that care?

Perhaps we need to understand that technology has little part in our dying, apart from its role as a tool to alleviate pain and enable diagnoses. Certainly, there is a small number of enthusiastic scientists who believe that in this century that not only all disease but death itself will be defeated. We’ll look at these claims in later posts but for us here and now, dying is the truth of our lives.

With luck, and perhaps some forethought, we will have a ‘good death’, one that is peaceful and pain -free. The stark evidence, however, suggests that the majority, especially the poor, may face death unprepared, bewildered, frightened. Some – about 5% of the population – will receive palliative care; most will die in busy hospital wards or nursing homes.

To end on a bright note, here is Dr Kathryn Mannix who has 40 years experience as a consultant palliative care physician. She’s written a lovely book called With the End in Mind. There has been a growth in recent times of interest in death: academically it’s called thanatology. In most UK cities there are ‘death cafes’ where ordinary folk meet to talk about dying – not only people with a terminal diagnosis but anybody who believes that one day they will die.

We will all die as unique individuals, in different circumstances. Some will die suddenly but most of us will die more slowly (in fact, from the age approximately of 21 we are all in the process of dying). Digital technology can provide huge swathes of data about populations but the individual alone is a unique human being, and part of that unique being is unique dying. As laypeople we may be able to ease and support someone’s dying: most of us can’t. We are frightened and adrift in the face of death. Some of us will demand of doctors futile medical treatment. Doctors and nurses themselves, in addition to their expertise, don’t always have the time and, especially, the understanding to help the dying. At this important point of a person’s life what is needed most of all is kindness. Kindness is also the most important part of living, something we forget in the full flood of youth and health.

In the area of digital health we should never forget that it is but a series of technical tools, perhaps as sharp as a scalpel, that in no way is as essential as the human touch. ‘Health’ comes from the word ‘whole’ and our whole being is our unique full personhood with all the fears and joys, memories and loves, body and soul. We should always put people before data, and before people we should put the unique individual human person.

Digital World

In the coming year The Machine Zone is broadening its scope to examine how digital technology is affecting our lives and wellbeing. We look ahead to possible futures in the next couple of years and beyond.

We continue our work around digital gambling at beatthefix.com . In many ways the subject of digital gambling is an encapsulation of the wider social and cultural impact of digital technology. Like so much in rapid technological development it has shown the inadequacy of old ways of thinking. Governments and regulators are ‘catching up’ with an unanticipated development (unseen, for instance, in the liberalising framework of the 2005 Gambling Act). More broadly, Professor Rebecca Cassidy argues in her 2020 book, Vicious Games: Capitalism and Gambling :

An experiment which began in the 1980s ((financial deregulation, neoliberalism)), to shift the burden of risk from the state to the citizen, has increased inequalities and changed the ways in which we imagine wealth is created and shared. Gambling has been at the heart of these shifts: in the City as it deregulated and embraced riskier, increasingly complex and opaque ways to make money, becoming less and less accountable as a result, and in government itself, which encouraged citizens to become self-sufficient individualists.

Vicious Games: Capitalism and Gambling

We now live in a world where we are strongly encouraged, ordered, commanded to see ourselves as self-sufficient individualists’. Thus, our ill or well being is seen as a matter solely of personal responsibility and choices. We are seen as isolated atoms, disconnected from not only each other but also disconnected from the power of business (for instance products, marketing and advertising), immune from vast social inequalities, disallowed from understanding that things like poverty or poor education may influence who we are. We must ‘stand on our own feet’.

Digital machinery turns us into data which is controlled and manipulated by powerful bodies. Increasingly, decisions of public welfare make appeal to population-level data and rarely to actual, living human beings. There are, fortunately, dissidents. (Staying with gambling, for instance, real individuals campaign about real human stories). ‘People not Data’ could be a battlecry. We see a healthy increase in citizens working together to bring the voices of real people to the fore.

Big Data follows us wherever we go. Algorithms keep us under constant surveillance. Facial and other biometric technology turns our bodies in real time into data. Data is bought and sold for enormous sums.

One huge expansion of digital technology is ‘digital health’. This is being promoted as ‘A Very Good Thing’ – not only by companies vying with each other for huge profits, but within the NHS, governments and Third Sector health organisations. We’ll look more closely in the coming months at what ‘digital health’ means. It ranges from record keeping to mental health apps, from thousands of ‘nano robots’ introduced into the body to fight disease to personal monitoring equipment. At its most spectacular it merges with the visions of such futurists as Ray Kurzweil who prophecy the end of illness and the defeat of death. (At one time in recent history ‘genomics’, the manipulation of genetic material, made similar wonderful claims that sadly failed to materialise).

We’ll examine digital health as part of the digital world, but we can only do this in a cursory way. There is an enormous number of academic research bases devoted to digital life and digital futures. Many universities have new departments devoted. Military and medical corporations are big players. Everything we touch these days is connected to digital machinery. Education, health, leisure, shopping, the ‘internet of things‘. Yesterday (28 August 2020) Elon Musk announced the successful implantation of a chip into a pig’s brain: the research is related to enabling control for people with a brain damaged, for instance, by stroke. (There’s a backround paper by Musk here). Others, with much broader enthusiasms, think on the possibility of ‘uploading’ a human mind into digital storage.

The digital world is invisible, like gravity. We only see its effects. At the level of a person, stripped of much personhood and what makes for a healthy and flourishing life, digital infrastructures become an extension of the nervous system. Even without wires and brain transplants, many are ‘hooked’ into digital social media, digital friends, digital games, digital scrolling, digital addiction, digital shopping, digital entertainment, digital distractions, a careless giving of information to digital surveillance. Digital gambling is but one manifestation and the purveyors are happy to take not only money but minds.

 

 

 

 

The Problem with “Problem Gamblers”

In the bad old days,  among the cruel behaviours of teachers was to make a child sit facing a corner and wear a hat with ‘Dunce’ written on it. If that didn’t make  them learn and behave properly, a child could expect a thrashing for their irresponsible waywardness.

More progressive education renamed ‘dunces’ as ‘problem children’.

Now, of course, in more enlightened times we speak of ‘problem schools’ as the main reason for between a quarter and a fifth of school leavers being functionally illiterate after eleven years of education. It has been a great leap forward for  society to recognise that the ‘problems’ may have something to do with the education system itself.

This month (July 2020) has seen the UK government launch a ‘war on obesity’. Proposals include advertising bans, stopping two for one incentives on junk foods, public health campaigns, taxes on industry, education, more help from primary health care and so on. There are critics of all this. They say that people should be able to eat whatever they want to, they are free to make their own choices and shouldn’t have that freedom removed by the nanny state. Parents, they say, have the right to feed their children whatever they like. The fact that unhealthy, fattening food is cheap should not stop poor responsible people making sensible meals with basic nutritious items such as turnips: if they can afford widescreen televisions and smartphones , they can afford to eat well. But such is the devastating impact on health and the economy, the state is now proposing to get tough, go beyond voluntary industry actions and the good sense of consumers.

After decades of denial the tobacco industry accepted that their product was both addictive and highly detrimental to health. Stringent government action has seen a huge fall in the number of people smoking.  A total ban on advertising and marketing, removal of branding on cigarette packs along with reference to tar and nicotine content which some took to allow for a choice of ‘safer smoking’, severe annual rises in duty, a ban on smoking in public places, and the hiding from sight of tobacco products in shops. Alongside this, smoking cessation programmes are free to everybody. Individuals remain free to use tobacco if they so wish.

These days, at the tobacco counter in a shop, the tobacco products are screened from sight. (It’s worth noting that alcohol is still freely on display, but that’s a different story for now). At the front of the counter, inches from the customer are advertisements for the National Lottery and a range of scratchcards priced from £1 to £5 each. Like sweets placed at a supermarket till they make impulse purchases more likely. They’re also an indicator of how normalised respectable gambling has become. A website called casinoplay.com warns the public that ‘it can actually be quite hard to win one of the top prizes.’ It advises that to increase your chances you should buy scratchcards in bulk.

The Myth of the ‘Responsible’ v ‘Problem Gambler’

Unlike smoking and obesity, the risks associated with gambling aren’t associated with physical health (except in the many tragic cases of suicide). Gambling risks include financial ruin, turning to crime, family and relationships breakdown, mental illness. Many sources of information refer to the incidence of gamblers running into such conditions is ‘only’ 0.5% of the adult population (the same way as ‘only’ 0.5% of the the population are schizophrenic). There are other figures for children and young people, and for adults ‘at risk’ of being in the 0.5%. Data is never simple. It isn’t always available. It’s a snapshot of a previous period in time. It requires interpretation – and these interpretations differ. But if the 0.5% figure is taken as it is, given the personal suffering indicated above, plus the damage to immediate others such as family, plus societal costs is not that alone reason to give gambling damage the same weighting as a serious mental disorder such as schizophrenia? And unlike schizophrenia which, although it can be managed and treated well, in many cases very difficult to treat and manage, are not problems associated with gambling more easily attenuated using the approaches we have seen with tobacco, and beginning with junk food?

Yet it’s sometimes implied that if there are only 300,000 or so people in deep trouble because of gambling, that’s all right. They didn’t stop when the fun stopped. No one made them spend much more than they could afford: they were irresponsible. It was down to their having that much-cherished freedom to chose, but making the wrong choices. Many millions more enjoy the fun of a flutter. The appeal to the ‘millions who safely (and responsibly) enjoy a flutter’ is something of an industry catchphrase, and it needs unpicking.

Having placed the ‘problem gamblers’ into a sort of pathological ghetto, the logic goes that everybody else is a ‘responsible gambler’, enjoying a harmless flutter. This isn’t so.

In all our lives fortune rises and falls, and this is more nearly literal in the case of the regular happy flutterer. A regular bettor or gambler will win some, lose some, and for the great majority, over time will lose more than they win. Winning £25 on a £5 scratchcard won’t compensate for the many weeks of getting into debt with rent or power or council tax after buying four such cards each week. The strain on marriages and families will increase as essential money leaks into slots or online gambling. The wage packet won’t be spent on days out with the kids or new school clothes. Things will be pawned, payday loans become essential as credit is refused elsewhere and credit cards are maxed out. Loans from friends and family go unpaid. There may be catastrophic times, perhaps a threat of eviction or repossession, survived only by a hair’s width and that survival with ongoing negative financial consequences. (Sometimes, such a catastrophe can be the impetus to stop gambling). Anxiety, depression, arguments may go with the territory. The danger of becoming one of the statistics in that ‘problem gambler’ ghetto may increase. As it is, there are many whose quality of life is negatively affected by gambling, and they don’t show up in the statistics.

Now obviously, this is painting a bleak picture. Not everybody who enjoys a doughnut or two will incur an obesity-related illness. Most people do spend money responsibly and can enjoy a harmless flutter. There is, of course, even for them a risk of going beyond the harmless flutter. Even somebody new to betting and gambling can (not will) spiral down to dangerous levels.

What’s needed is research into the ‘twilight zone’ of gambling-induced harms. This is an area which has to involve personal testimonies of experience over time. It’s especially important in relation to young people who have been nurtured in a normalised gambling environment. It may lead to a more nuanced understanding of the scale and nature of gambling harms than that offered by dominant narratives of ‘problem gamblers’ versus the rest of us.

 

‘Personal Responsibility’ and Addiction

One of the hottest topics relating to addiction is the concept of personal responsibility. Do addicts bring it on themselves? Are addicts morally weak? Do addicts repeatedly fail in recovery because they refuse to take on responsibility?

On the other hand, it can be rightly claimed that all this emphasis on the individual is distorting an understanding of addiction. If, as some claim, addiction is a ‘disease’ how can people be responsible for it? Why is there virtually no alcohol addiction in Saudi Arabia (where alcohol is prohibited by law)? What social factors play a part in addiction? Do some commercial products – tobacco is an example – ‘hook’ some people in the right circumstances?

There is no such thing as an addict; there are only individuals suffering with addiction. Everybody is different, but some groups seem more prone to addiction to others. In the professions journalists, the police, doctors, entertainers, sportspeople and politicians have high rates of addiction. So too do people with multiple and complex disadvantages such as homelessness, poverty, lack of educational and cultural capital, mental illness, criminal background, adverse childhood experiences, trauma – or just one of these.

And people from different social backgrounds seem to be treated very differently when their addictions come to light. Newspaper readers will weep over the death of a pop idol through drugs; a politician will be praised for his ‘brave struggle’ against alcohol. In popular culture – films, books and television – we have come to expect our flawed heroes often to have an addiction problem as one of their flaws, a lonewolf cop bucking the rules and knocking back malt whisky while meditating on a case, a singer in rehab, a public figure making public penance.

Less favourably are seen the ‘scagheads’, the ‘junkies’,  the street addicts, the working class addicts. Although victims all their lives of unequal and unjust social conditions, turning to drugs or drink or gambling to escape if only for a moment, it is they who are most harshly blamed and despised for their lack of responsibility – while those with a lifetime of advantages are treated with adulation and sympathy.

In his remarkable book, Good Cop Bad War, former undercover cop Neil Woods charts his journey of increasing knowledge through the ‘low life’ of desperate addicts (in contrast to the venomous gangster business cartels that bring drugs to market). He grow increasingly sympathetic to the friends he makes while pretending to be himself an addict. Apart from their addiction, most are essentially decent, often intelligent, kind and caring. One such friend , Cammy, tells him his heart-felt news that he has heard a good friend has died. Neil asks whether he will go to the funeral to say goodbye and Cammy replies, ‘I’m not going to the funeral. I wouldn’t do that to the family. The last thing they want is some dirty junkie turning up and ruining everything.’ As Woods observes, ‘No matter how society may condemn and look down on the addict, it is never, ever as low a view as he has of himself.’

That internalisation of social attitudes and stigma is something all addicts have to deal with. Part of them remains ‘clean’ and is a constant accusing voice; the addict hates themself. Guilt and shame alone can maintain an addiction – that belief of such utter worthlessness that there is no point in trying to stop, instead seeking that absurd temporary negation of inner torment with a fix.

Of course, those with a lot going for them tend to do better. Not everybody, of course: the nature of every individual addiction, while having common attributes, is unique in the complexities of an individual. It’s probably easier on the whole if you’re, say, a teacher to have three months leave on full pay to attend rehab, or just to get your life together, than if you are without any money, any support, any care, any love, surviving in brutal conditions. Though yes, many who seem to have well insulated lives with all the support in place do succumb, grow sick and die. And yes, too, some at the very bottom recover and flourish.

There are as many as 40% of addicts who recover spontaneously, relatively painlessly, without any intervention by ‘experts’ or support organisations. A well known example of this is ‘maturing out’ whereby young people who have addictive or risky tendencies literally grow out of them when they settle into employment, get married, start a family. Another famous example is how 80% of American soldiers deemed heroin addicted in Vietnam lost their addiction when they returned to the States and their families. Against this, many others in recovery are certain that addiction is a disease for life and that the only way to manage it is by faithfully following a programme such as a 12-steps one.

A word is needed here too about dependence versus addiction. Through force of habit, culture, lifestyle, many drinkers, for instance consume not only health-damaging amounts but quantities which make them physically dependent. The withdrawal from physical dependency can be life- threatening and ideally requires medical supervision. Yet many heavy drinkers then go onto just stop or greatly limit consumption: they were heavy drinkers, not alcohol addicts. There is an additional dependence which is separate from addiction – psychological dependence. Partly this is just the force of habit, neural correlates in the brain ‘speaking’ loudly to perform an action when certain triggers arise. Usually one can become psychologically dependent on a substance or activity to avoid stress, negative feelings or often an undiagnosed mental disorder such as anxiety and depression. Dependence can, and often does, lead to addiction but it’s still possible to recognise a dependence and take responsibility for halting it with acceptance of necessary effort and suffering which will vary greatly in terms of time and intensity according to unique individuals in unique circumstances.

Addiction by its very nature, the heart of addiction, disowns the individual’s core self. It disowns the possibility of being responsible for one’s destiny, for making deep choices. No addict will be able to understand what is going on. They are fully aware of the misery they leave in their wake, of their loss of pride, reputation, money, health, relationships, status, children. They desperately want to stop. But they can’t. In the old days people spoke of a demon inside that controlled them. The demon took them over. This degree of inner torment varies from individual to individual. It’s certainly true that there are many ‘highly functioning addicts’ in all walks of life, folk nobody begins to suspect as being an addict, and, of, course, another core attribute of addiction is the addict’s propensity to deny their addiction. It’s for this reason that common wisdom has it that people must ‘hit rock bottom’ before they can start to recover. This is, fortunately, a myth. It may be true that a secret gambler’s addiction only comes to light when the bailiffs arrive to take the family home and he or she spirals into heavy debt, bankruptcy, prison or failed suicide attempts. But in many cases – often in consort with worried others – many are lucky enough to address their addiction before absolute calamity.

The foregoing suggests just a few of the strands in the complexity of an individual’s addiction. If there is a common attribute of addiction it is that to take responsibility for recovery one must already have made a vital move. This vital move, this perception that one is not only the addicted self, is the precursor of recovery. For some, this vital move is totally unconscious and involves little pain and effort, for others it is a lifelong process.

To conclude, to return to the topic of addiction and responsibility. All of us are a product of our environments, probably more so than products of our genes. Children have been sold drugs from icecream vans (dealers do not ask for age verification or advise responsible use of their products) so 12= year-olds have become heroin addicts. The vans are part of the environment, behind the vans are networks of the drugs business, also part of the environment. People continue to smoke cigarettes but on the packets is written ‘smoking kills’, and tobacco is more and more restricted by government policies: it’s recognised that tobacco addiction is not the result of weak responsibility in individuals. Campaigns to restrict and limit junk food (itself addictive), sugar, salt, fat are not controversial. People argue about minimum pricing for alcohol, but the argument is not seen as being around any bizarre claims. In short, government and industry are seen as having a major role in addressing the damage that harmful products may do to individuals and society, including addictive products.

Current debate about addiction is skewed towards a focus on individual responsibility. Just as a parent is deemed responsisible for feeding their children high doses of sugar and fat (These being by far the cheapest foods to buy for those in poverty), so the addict is held reponsible for choosing their addiction (even if this was motivated by a need to escape misery and despair into 20 minutes of arificial paradise). There are no jackpots, magic fixes that will ever beat the scourge of addiction but government and industry have to stop denying their role in attenuating it.