Adverse Childhood Experiences (ACEs), including abuse, neglect, and household dysfunction, are recognised as key determinants of long-term health and behavioural outcomes (Felitti et al., 1998). Defined as potentially traumatic events occurring before the age of 18, ACEs are associated with increased risks of substance use, depression, and suicidal ideation in adulthood (Leza et al., 2021), and may contribute to gambling-related harm, though this is underexplored.

Gambling is increasingly prevalent and normalised as a form of leisure in the UK (Campbell et al., 2011, McGee, 2020), with around 50 % of adults reporting past-year gambling (NHS England, 2023). For some, gambling can lead to significant harm, defined as adverse consequences negatively affecting health and wellbeing of individuals, families, and communities (Langham et al., 2016). These harms may include financial hardship, relationship breakdown, and mental health challenges, including suicidality (Wardle et al., 2018, Public Health England, 2023).

Gambling is legal and widely available in the UK. The industry is regulated under the Gambling Act 2005, which liberalised gambling laws, introduced a comprehensive licensing system, and established the UK Gambling Commission, to regulate gambling and protect vulnerable people. Yet, the ubiquity of gambling marketing, and ease of access via digital technology such as smart phones, has contributed to the normalisation of gambling as a leisure activity (Rossi & Nairn, 2024).

While the relationship between childhood trauma and substance use or other mental health problems is well documented, its connection to gambling is less understood (Horak et al., 2021). Research suggests maltreatment, such as emotional or physical abuse is associated with greater gambling severity (Afifi et al., 2010, Black et al., 2012, Sharman et al., 2019). Gambling may serve as a maladaptive coping mechanism for emotional pain and psychological distress resulting from early adversity (Felsher et al., 2010, Grant and Kim, 2002). However, this needs further exploration to fully understand this relationship. Furthermore, the role of broader household dysfunction, such as parental mental illness or substance abuse, remains under-investigated in gambling contexts. Finally, familial transmission is relevant, with children of individuals experiencing gambling problems at higher risk themselves (Dowling et al., 2018, Dowling et al., 2021). These patterns may overlap with, but are not always captured within, the standard ACEs framework.

In England, an estimated 1.6 million adults may benefit from support for gambling-related harm that considers past trauma (Office for Health Improvement and Disparities, 2024). Yet, little is known about the prevalence and relevance of ACEs among treatment-seekers. This study addresses this gap by exploring how ACEs shape the experiences of treatment-seekers, to inform more effective and trauma-informed responses to gambling harm. Our aims were to explore among treatment-seekers:

Prevalence of ACEs.

Perceptions of how ACEs may link to gambling.

Experiences of treatment that may have implications for consideration of ACEs within treatment.