'Playing to extinction': the commercial determinants of gambling-related harm, suicidality and suicide.

This paper presents a model of the commercial determinants of health in the context of gambling-related harm, suicidality and suicide. It outlines the ways the gambling ecosystem undermines suicide prevention efforts by driving harmful engagement with gambling. Using the dominant, orthodox discourse of 'responsible gambling', the ecosystem relies on the effects of addiction to underpin, sustain, and grow its power. Attempts to introduce effective interventions to prevent gambling-related harms are often blocked by the gambling ecosystem actors, using an evidence base that is biased by its focus on individual level causation and the attendant 'responsible gambling' responses. This emphasis on individual responsibility diverts attention from the practices of the industry, generates stigma and shame for those harmed, downplays serious harms caused by gambling, and contributes to the suicide toll. As most gambling activity is unrecorded, and systems for monitoring harms are underdeveloped, the true extent of these consequences have been largely invisible. This makes it more difficult to hold governments to account to regulate and prevent gambling-related harms, including suicidality and suicide. With growing evidence of harms linked to gambling, including suicide and increasing public concern, we present measures that could be adopted to disrupt these determinants and improve accountability to prevent harms and save lives.