Reducing medicine-related gambling harms: identifying the link between aripiprazole and gambling harm in primary care

Primary Care Gambling Service

Project summary

The Primary Care Gambling Service (PCGS) is a primary care, NHS-integrated service that identifies and treats gambling-related harms within a primary care setting. This project focuses on an important medicines optimisation and patient safety issue: the recognised association between aripiprazole and addictive gambling or other impulse-control symptoms.

PCGS screens every person entering the service to identify whether they are currently taking, or have previously taken, aripiprazole. Where aripiprazole is identified, clinicians sensitively explore whether gambling behaviour, urges, spending, risk-taking or other impulse-control symptoms changed after starting the medicine or following a dose change. Patients are educated about the possible link in a non-blaming way, recognising that many people will not know medication can affect impulse control and may feel shame or stigma about disclosing gambling harm.

The project also educates the patient’s GP and psychiatrist, particularly where they are unaware of the association. This creates a direct safety feedback loop between specialist gambling harm care, primary care and mental health prescribing. The aim is not to stop medication abruptly, but to ensure that the responsible prescriber can review risks and benefits, consider safer alternatives if appropriate, and support shared decision-making.

The rationale is supported by national guidance. The MHRA reminded prescribers in December 2023 to be alert to addictive gambling and other impulse-control disorders with aripiprazole, and to advise patients, families and friends to watch for these symptoms. NICE NG248, published in January 2025, highlights stigma as a barrier to disclosure, recommends initial support and referral for gambling-related harms, and states that gambling-related harms can be a dominant risk factor for suicidal ideation and suicide attempts.

The project generates measurable evidence through routine recording of the number of patients screened for aripiprazole use, the number identified as taking it, the number reporting new or worsened gambling harms, and the number of GPs or psychiatrists contacted or educated. PCGS also uses outcome measures such as PGSI and CORE-10 where appropriate to monitor changes in gambling severity and psychological distress.

This work is innovative because it reframes gambling harm as a medicines optimisation, safeguarding and suicide prevention issue, not only a behavioural problem. It is simple to replicate, low cost, and can be embedded into routine medication reviews, severe mental illness reviews, pharmacy reviews and gambling harm assessments nationally. It supports earlier recognition of hidden harm, safer prescribing, improved professional awareness and more compassionate conversations with patients and families.