I recently came across an insightful article in The New York Times discussing the diagnostic criteria for Attention-Deficit/Hyperactivity Disorder (ADHD), the rise in diagnoses, and the ongoing debate about whether a one-size-fits-all understanding of the “disorder” is appropriate.
One of the article’s key conclusions was that the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5)—despite being recognized as the gold standard—is a blunt instrument when it comes to diagnosing ADHD. The DSM-5 lists eighteen symptoms divided into two categories. Adults must exhibit five symptoms from either group within the past six months to be considered at high risk and referred for further evaluation.
This means that three individuals with completely different symptoms can all be flagged as high risk for the same disorder.
The article also referenced several studies showing no significant difference in academic performance between those medicated for ADHD and those who were not. Moreover, it proposed that ADHD may be contextual—where the ability to focus, or lack thereof, depends on the nature of the activity.
From personal experience with a relative severely affected by ADHD—who struggled to maintain jobs, relationships, or appointments but could spend hours immersed in drawing or playing guitar without distraction—I’ve seen firsthand that focus is not a fixed trait. This suggests that ADHD may not be a singular disorder, but rather a constellation of traits grouped under one label, manifesting differently depending on the individual and the context.
A similar issue arises in the DSM-5's criteria for gambling disorder. Of the ten listed symptoms, experiencing just four in the past year qualifies someone as being at high risk. As with ADHD, two individuals might meet entirely different criteria but still receive the same diagnosis.
As the article rightly noted, disordered gambling exists on a spectrum. On one end are compulsive gamblers, who are as unable to stop gambling as a heroin addict is to stop using. On the other are individuals who’ve stumbled into trouble—winning back losses a few times and mistakenly assuming they could always do so—until the inevitable happens. These people may meet the DSM-5 criteria, but that doesn’t necessarily mean they have a chronic disorder.
Most "disordered gamblers" fall somewhere between these extremes.
Regulators are striving to reduce gambling-related harm—either due to statutory requirements or a sense of moral duty. While their goals are commendable, it remains unclear whether the actions and regulations they implement are achieving their intended outcomes.
Too often, regulation takes a one-size-fits-all approach. But are disordered gamblers a uniform group? Possibly—but not necessarily. The prevalence of problem gamblers on online platforms does not automatically mean online gambling is the cause.
Consider this: alcoholics gravitate toward spirits for a quicker high. When spirits are unavailable, they’ll settle for wine or high-alcohol beer. Similarly, curbing spin speeds or lowering maximum stakes may do little to help disordered gamblers—they’ll simply seek the next best high.
We live in a world where volume often replaces evidence. Facts are increasingly subjective—defined by whoever speaks loudest.
Gambling regulators frequently defer to individuals with lived experience and public health advocates. While both offer important perspectives, they also carry biases. In the UK, public health experts are often far from impartial. Those with lived experience deserve a voice, but understandably, many will advocate for outright gambling bans.
A major opportunity was missed with the enactment of the 2005 Gambling Act in Great Britain. A comprehensive baseline study could have been conducted to measure the effectiveness of future regulations. Unfortunately, that didn’t happen. As a result, a flurry of rules—often implemented without thorough evaluation—makes it nearly impossible to assess the individual impact of each policy.
Scientific inquiry follows a clear path: hypothesize, predict, experiment, analyze, conclude. Gambling regulation, by contrast, is rarely this rigorous. Much of the so-called research used to justify regulations is riddled with flaws—cherry-picked data, weak methodologies, and biased conclusions—yet the media and policymakers take it at face value.
The anti-gambling lobby and segments of the public health industry are determined to do to gambling what they did to tobacco, despite the harms being significantly less severe.
This trend isn't isolated to Britain. It's spreading across Europe and now taking root in the United States.
The gambling industry must recognize what’s happening. If current trends continue, we will see increasingly stringent regulations, declining revenues, and a flourishing black market. It will be the 1920s all over again—only this time, the prohibition will be on gambling rather than alcohol.
So, what can be done?
We need to find our voice. The industry must proactively challenge flawed research, develop credible spokespeople who can engage with the media, and openly acknowledge the real harms gambling can cause. We must support robust, impartial research—even when it doesn’t serve our interests. And we should commission studies that assess the true impact of regulation—not only on players but on the sustainability of the industry.
With a united, multinational effort, perhaps we can push back the tide.