A Holistic Framework of Gambling Harms and Recovery, Derived from a Rapid Evidence Assessment and Qualitative Interviews with People who Gamble and Affected Others.

IntroductionGambling-related harms affect people’s finances, their health and wellbeing, personal relationships, and community life. They impact not only people who gamble but their families and others around them. Public health models require a harm-based approach that moves beyond clinical thresholds and recognises the wider determinants and distributions of harm across populations. Existing gambling harms frameworks are somewhat generic in scope, have rarely involved lived experience and affected others, and generally equate recovery with abstinence. This study developed a holistic, empirically grounded framework of gambling harm and recovery, rooted in lived experience and tailored to the cultural and policy context of Great Britain.MethodsThe study proceeded in two stages. Stage 1 comprised a Rapid Evidence Assessment (REA) of academic and grey literature on gambling-related harm and recovery, supplemented by analysis of harm and recovery frameworks from adjacent sectors (alcohol and other drugs). Stage 2 involved 40 semi-structured qualitative interviews with people who had experienced gambling harms directly or as affected others. Reflexive thematic analysis was used to identify, refine and validate components of harm and recovery that were brought together in a new holistic framework. Stakeholder co-production and iterative validation informed each stage of framework development. ResultsThe new holistic framework encompasses three broad components of harm—resources, wellbeing, and relationships—each comprising sub-components reflecting financial, emotional, relational, and community-level impacts. The framework also captures how identity, culture, and context can shape harm experiences. It conceptualises recovery as a multidimensional process involving financial stability, identity repair, and social connection, all underpinned by support networks alongside control, insight, behaviour change, and ownership of gambling behaviours. ConclusionsThis holistic framework advances gambling harms research by integrating lived experience, acknowledging affected others, and embedding recovery. It provides a foundation for more inclusive harm reduction strategies, recovery-oriented interventions, and person-centred measurement tools.