Gambling Harm Reduction Outcomes; a Rapid Evidence Review

Recent NICE guidance (NG248) for gambling-related harms recommends that future research investigates the “effectiveness and cost-effectiveness of care pathways and models of care for people who experience gambling-related harms”. As gambling-related harms are increasingly recognised as a public health issue, it is important to understand the routes to protection, prevention, and recovery from harm (herein referred to collectively as “harm reduction”), in which there is a paucity of literature concerning evidence-based approaches to harm reduction - especially around outcomes, measurement and evaluation of intervention. Wardle and colleagues offer a framework for the costs of gambling-related harms across different domains with associated metrics, providing researchers and policy makers a range of potential outcomes to track. Similarly, Marionneau and colleagues present a systematic review of harm prevention and reduction, offering potential tools for assessing the success of preventative work, again well aligned with policy. However, neither framework seeks to align these with interventions and treatment outcomes are measured inconsistently, and recovery is often poorly operationalised. This measurement inconsistency is concerning. Measurement science has advanced beyond ad hoc scale construction, with many older scales failing fundamental psychometric requirements like unidimensionality and temporal measurement invariance. Robust measures are essential for tracking meaningful change, comparing interventions, and ensuring that observed improvements reflect genuine recovery.