Gambling has swallowed American sports culture whole. Until early 2018, sports betting was illegal under federal law; today, it’s legal in 39 states and Washington, D.C. (and easy enough to access through backdoor channels even in the states where it isn’t). During NFL games, gambling commercials air more often than ads for beer. Commentators analyze not just whether a team can win, but if they might win by at least the number of points by which they’re favored on betting apps. Nearly half of men younger than 50 now have an account with an online sports book, and Americans spent about $150 billion on sports wagers last year. I regularly get ads on my phone offering me a complimentary $200 in sports bets, as long as I gamble $5 first.

As betting has overrun American sports, other forms of gambling are also on the rise. According to industry data, American casinos are more popular now than at any point on record. The age of their average patron had been crawling upward for years, but since sports betting was legalized at the federal level, it has plummeted by nearly a decade, to approximately 42. Some signs point to gambling problems increasing, too. No centralized entity tracks gambling addiction, but if its scale comes even close to matching the new scale of sports betting, the United States is unequipped to deal with it.

In its power to ruin and even end lives, gambling addiction is remarkably similar to drug dependency. Imaging studies show that pathological gamblers and people with substance addictions share patterns of brain activity. They are more likely to experience liver disease, heart disease, and sleep deprivation, whether it originates in the anxiety of concealing a gambling addiction or because someone is up wagering on contests, such as cricket and table tennis, that happen in faraway time zones. The best national survey available, which dates to well before the rise of sports betting, found that 2 million to 4 million Americans will experience a gambling disorder at some point in their life; one in six people with a gambling disorder attempts suicide. Even if their death certificate says differently, “I’ve had several patients who died because of the emotional pain from their gambling disorder,” Timothy Fong, a psychiatrist specializing in addiction treatment and a co-director of UCLA’s gambling-studies program, told me.

Fong, like the other researchers I spoke with, said that rapid forms of gambling, especially those that allow you to place multiple bets at one time, tend to be especially addictive. For decades, sports betting mostly involved wagers on who’d win a match, by how much, and total points scored—outcomes resolved over the course of hours. Now apps offer endless in-game bets decided in seconds. Last year, I watched the Super Bowl with a friend who bet on the national anthem lasting less than 90.5 seconds—the smart money, according to the analysts. He lost when Reba McEntire belted the song’s last words twice.

The ability to place one bet after another encourages a hallmark behavior of problem gamblers—when deep in the red, instead of walking away, they bet bigger. “Viewing sports gambling as a way to make money is likely to end badly,” Joshua Grubbs, a gambling researcher at the University of New Mexico, told me. “Gamblers that think that gambling is a way toward economic success or financial payouts almost always have far more problem-gambling symptoms.” And some apps actively blur the already hazy line between betting and other financial activities. For instance, the financial platform Robinhood, where millions of people trade meme stocks and manage their retirement accounts, began offering online sports “events contracts” (a type of investment whose payout depends on traders’ correctly predicting the outcome of a specified event) during March Madness this year through a partnership with the financial exchange Kalshi. (A Robinhood spokesperson told me this “emergent asset class” differs significantly from sports betting because users, not the house, set the prices, and can more easily exit their positions. But the experience of “investing” in an events contract is virtually indistinguishable from betting.) Financial markets have recently started offering services like this even in states where sports betting is illegal. State gambling regulators have called foul, but the federal government has so far made no move to stop the companies. As the courts sort out whether any of this is legal, Robinhood decided to let customers trade on the Indy 500 and the French Open.

Several recent trends suggest that problem gambling might be on the rise in the U.S. Calls to state gambling helplines have increased. (This might be partly explained by advocacy groups marketing their helplines more aggressively than ever; gambling companies also tack the numbers onto their ubiquitous ads.) Fong said that he was recently invited to speak to a consortium of family lawyers, whose divorce clients have started asking, “How do I protect my children from the damage of their father’s gambling?” Researchers and counselors are especially worried about single young men who play in fantasy sports leagues, bet on sports, day trade, and consider gambling a good way to make money. Gamblers Anonymous is rolling out groups for young people. “I’m treating guys who would never be caught dead in a casino,” James Whelan, a clinical psychologist who runs treatment clinics for gambling addiction in Tennessee, told me.

Read: How casinos enable gambling addicts

These imperfect proxy measures, along with incomplete data trickling out of a few states, are the best indicators that researchers have about the extent of gambling addiction. Experts are also unsure how long any increase in problem gambling might last: Some studies suggest that the prevalence of gambling problems tends to equalize after a spike, but those findings are usually limited to physical casinos and remain debated within the field. According to researchers I spoke with, no study has established the prevalence of gambling addiction in the U.S. since sports betting became widespread. Federal agencies dedicated to alcoholism and substance abuse allocate billions of research dollars to American universities every year. Yet for decades, the federal government—the largest funder of American research—has earmarked zero dollars for research on gambling activity or addiction specifically, despite collecting millions annually from gambling taxes. (The Substance Abuse and Mental Health Services Administration, which collects national data on behavioral health and funds research into it, declined to comment.)

Gambling-addiction treatment is “50 years behind where we are with drugs or alcohol or any other substance,” Michael Sciandra, the executive director of the Nebraska Council on Problem Gambling, told me. Doctors and therapists, even those who specialize in treating addiction, rarely screen for issues with gambling, he said. Among the handful of dedicated gambling-addiction treatment providers around the country, many deploy cognitive behavioral therapy, which studies suggest can at least temporarily improve patients’ quality of life and reduce the severity of their gambling problem. But discrepancies in treatment approaches and tiny trial sizes make it difficult to say exactly how many patients the therapy helps. Two medications used to treat alcoholism and opioid addiction have also been found to reduce the severity of gambling addiction across a handful of small clinical trials. But the evidence needed for FDA approval would require large and expensive clinical trials that no one seems eager to fund, Marc Potenza, the director of Yale’s Center of Excellence in Gambling Research, told me.

Because the federal government doesn’t fund gambling-addiction treatment, each state decides what resources to make available. A Tennessee caller to the national helpline 1-800-GAMBLER might be put through to their state’s helpline and then connected to the network of government-subsidized clinics Whelan runs across the state. But in states with bare-bones offerings, workers typically refer callers to peer-support groups such as Gamblers Anonymous, or to online resources on budgeting, says Cole Wogoman, a director at the National Council on Problem Gambling, which runs the helpline. Studies have found that each of these strategies is less effective than therapy.

Charles Fain Lehman: Legalizing sports gambling was a huge mistake

Texas could be an example of how unprepared the U.S. is to deal with any increase in problem gamblers. The state’s gambling laws are among the strictest in the country, yet it still sends the second-highest number of callers (behind California) to 1-800-GAMBLER. This November, Texans might vote on a constitutional amendment to allow sports betting. The state of more than 30 million has no funding for gambling treatment and only three certified gambling counselors, according to Carol Ann Maner, who is one of them. The state’s official hub for gambling help, which Maner leads, was founded just this spring.

Once they find the money, Maner and her colleagues plan to finally set up the state’s own helpline. But first, they need to recruit and train more therapists for a job that, thanks to a lack of state and federal funding, might require turning away uninsured clients. That’s a daunting task. Finding the apps Texans can use to get around gambling restrictions is easy.

Gambling prevalence studies provide a snapshot of gambling behaviour, problems and harm in our communities. They are typically conducted about every five years.

In some Australian states and territories, four or five have been conducted over the past 20 or so years. These have provided a snapshot into how gambling has changed – and how it has not.

So, how has gambling in Australia changed in the past two decades or so, and where may we be heading?

The intensification of gambling

In 1997-98, the Productivity Commission found about 82% of Australians had gambled in the previous 12 months.

Almost all further prevalence studies show the proportion of adults gambling has declined substantially over time.

The 2024 NSW prevalence survey, for example, found 54% reported gambling in the previous 12 months, down from 69% in 2006.

While fewer people are gambling, the proportion of people experiencing problems has not changed much, nor has gambling turnover.

In some states, gambling turnover has increased, even when you take inflation into account.

So while a smaller proportion of people are gambling, those who do gamble are doing so more frequently, and spend more money – a phenomenon we have described as the “intensification” of the industry.

As figures from the Grattan Institute show, the vast majority of gambling spend comes from a very small proportion of people who gamble.

What’s the problem?

Typically, the focus in gambling studies has been on “problem gamblers”, a term we now avoid because it can be stigmatising.

This refers to those experiencing severe problems due to their gambling, which is typically about 1% of the adult population, and around 2% of people who gamble.

This doesn’t sound like much, until you remember 1% of adults in Australia is more than 200,000 people. That’s a lot of people struggling with severe problems.

Based on recent prevalence surveys in Australia, these gamblers spend about 60 times as much as people who do not experience problems.

However, that’s just the most severe cases.

How gambling harms people

When most people think of gambling harm, they think about financial harm. But gambling can cause problems with relationships, work and study, emotional and psychological harm, and even cause health issues.

Some degree of gambling harm is experienced by around 10-15% of people who gamble.

Some groups are overrepresented: young men typically experience very high levels of harm compared to others. Other overrepresented groups are:

those who have not completed tertiary education

people who speak a language other than English

people who identify as Aboriginal or Torres Strait Islander.

Harm isn’t just experienced by people who gamble, though – it impacts the people around them.

While young men are more likely to experience harm from their own gambling, women, particularly young women, are most likely to experience harm from someone else’s gambling.

When we take all of these sources of harm into account, we get a much better picture of gambling harm in our community: around 15-20% of all adults (not all gamblers) experience harm.

That’s very different to the figure of 1% we’ve focused on in the past.

We’re still missing some accounting, though: we don’t know how much harm is experienced by people under 18, for example, because prevalence studies typically only include adults.

Where does the harm come from?

The most problematic form in Australia is pokies, responsible for about 51-57% of problems.

Casinos are responsible for another 10-14%, although fewer people have been gambling in casino games in recent years.

Read more: Whatever happens to Star, the age of unfettered gambling revenue for casinos may have ended

Sports betting and race betting together account for about another 19-20% of harm.

Between them, pokies, casino games and sports and race betting account for about 90% of harm to Australian gamblers.

Availability is an issue

This widespread availability of pokies is the biggest single driver behind gambling harm in Australia.

In other countries, pokies are limited to venues that are specifically used for gambling, like casinos or betting shops.

We have pokies in a huge number of our pubs and clubs, except in Western Australia.

A couple of years ago, we used national prevalence data to compare gambling problems in WA to the rest of the country.

A higher percentage of adults in WA gamble, but mostly on the lotteries which are typically not associated with much harm.

Gambling on pokies is far less prevalent in WA because they’re only available in one casino. Gambling problems and harm are about one-third lower in WA, and our analysis shows this can be attributed to the limited access to pokies.

This also tells us something important. If pokies are not available, people will typically not substitute them with other harmful forms. It points to the role of the availability of dangerous gambling products in gambling harm, rather than personal characteristics.

Online gambling has also become a lot more available. Most of us now have a mobile phone almost surgically implanted onto our hand, making online gambling more accessible than ever. Not surprisingly, online gambling continues to increase.

An obvious solution to try

Governments have taken increasingly proactive measures to help address gambling harm, such as the National Consumer Protection Framework for Online Gambling, strategies for minimising harm such as NSW’s investment into gambling harm minimisation, Victoria’s proposed reforms on pokies including mandatory precommitment limits, Queensland’s Gambling Harm Minimisation Plan and the ACT’s Strategy for Gambling Harm Prevention.

Voluntary limits have been trialled to help people keep their gambling under control, but have had virtually no uptake.

For example, the recent NSW Digital Gaming Wallet trial was conducted in 14 venues. Only 32 people were active users, and 14 of these were deemed genuine users. Another study found only 0.01% of all money put through machines in Victoria used the voluntary YourPlay scheme.

The problem with voluntary limits is, no one volunteers.

Mandatory limits though are almost certainly necessary, just like we have mandatory limits for how fast you can drive, or how much you can drink before the bartender puts you in a taxi.

There will almost certainly be push back against this, just like the introduction of mandatory seatbelts in the 1970s, or the introduction of random breath testing.

Now, we accept them as important public health measures.

History tells us the same will happen with mandatory gambling limits, even if we’re a bit uncomfortable about it at first.

Join Daily Faceoff’s Andy MacNeil as he handicaps Monday’s matchup between the Nashville Predators and Philadelphia Flyers.

Predators vs. Flyers Odds

Nashville Predators Moneyline: +100

Philadelphia Flyers Moneyline: -120

Puck Line: Predators +1.5 (-250), Flyers -1.5 (+200)

Game Total: 5.5 (Over -110, Under -110)

Game odds via Sports Interaction.

Handicapping the Predators (27-36 SU, 30-43 ATS, 28-45-0 O/U)

Monday’s game in Philadelphia is the start of a three-game road trip for Nashville. The Predators will look to avoid losing their third game in a row, which would be their eighth loss in their last 10 games. Nashville is coming off back-to-back losses versus the St. Louis Blues and Vegas Golden Knights.

Offense continues to be a huge problem for the Predators, who have scored two or fewer goals in seven of their last nine games, but it’s been a problem all season. No team has scored fewer goals per 60 minutes than Nashville, despite ranking among the top-10 teams in expected goals and shot attempts. Only two players, Filip Forsberg (28) and Steven Stamkos (23) have scored more than 20 goals, and only Forsberg has registered more than 50 points.

BAM AD

Nashville also ranks among the bottom-10 teams in goals against per 60. Juuse Saros, Scott Wedgewood, and Justus Annunen have all allowed more goals than an average goaltender would have based on shot quality, according to Evolving Hockey’s goals saved above expected metric, and Saros has been among the worst goalies in the league over the last month. That said, the team has been average defensively in the month of March.

From a betting perspective, no team has underperformed more than the Predators, and as a result, they have been the worst moneyline bet this season by far. If a bettor had bet on the Predators to win every game this season, they’d be down 22.3 units.

Nashville is also still without star defenseman Roman Josi, who has not played since Feb. 25.

BAM AD

Handicapping the Flyers (30-45 SU, 37-38 ATS, 36-37-2 O/U)

Philadelphia fired head coach John Tortorella on Thursday following a 7-2 loss at the hand of the Maple Leafs. Tortorella wasn’t able to help the Flyers qualify for the playoffs in his time as head coach and this season, he had guided them to the worst record (28-36-9) in the Metropolitan Division.

In the two games since then, however, the Flyers’ offense has exploded for 13 goals. First, Philadelphia defeated the Montreal Canadiens 6-4, and then dominated the Buffalo Sabres by a score of 7-4. The Flyers only scored six goals or more in four games under Tortorella this season.

Additionally, the Flyers had gone 13 games without a power play goal, but they have scored three goals on the man advantage in those two games. Now, Philadelphia will look to earn its third victory in a row in the final game of a three-game homestand against the Predators.

BAM AD

Of course, defense is still an issue for this team. Only four teams have allowed more goals on a per-60 minute basis this season, and they’ve allowed eight goals in the last two games. That might not be a big concern against a Predators team that is inept offensively, but it’s something that the team will have to improve if they want to make the playoffs next season.

I mean, this isn’t a bad hockey team. According to Evolving Hockey, the Flyers rank fourth in expected goals percentage at five-on-five, and only one team has allowed fewer expected goals per 60 minutes. Moreover, while the Flyers do rank among the 10 least profitable moneyline bets this season, they’ve almost managed to break even on home ice. Philadelphia is 18-19-1 at home this season.

BAM AD

Best bets for Predators vs. Flyers

Matvei Michkov Anytime Goal (+195) at Sports Interaction

The Flyers are finally having fun again, and no player has benefited more than rookie Matvei Michkov, who has looked more dangerous than ever. In two games since the coaching change, Michkov has scored four goals on 11 shots and he also registered three assists. The 20-year-old had only played 19:59 or more six times in his first 70 games under Tortorella, but in two games under interim head coach Brad Shaw, Michkov has played 19:59 and 20:29.

Follow Andy’s hockey bets on the Action App!

“Gambling is generally marketed as entertainment, and for most gamblers, it’s just that,” said Dan Cassino, a professor of government and politics at Fairleigh Dickinson, and the executive director of the survey. “But there’s always some chance of gambling turning into problem behaviors, and online gambling is proving to be much more dangerous than other kinds.”

He said the risks “are closely related to online betting on sports and online slot machines.”

Ohio is one of 39 states that permits sports betting, and while it’s an economic windfall, it can be a big issue for those with gambling problems, which includes 6% of college students who reported losing more than $500 in a single day, according to a recent study.

In Ohio, sports betting tax revenues in 2024 totaled $180.8 million, up $133 million in 2023.

Around 60% of college-age students bet on sports, according to the responsible gaming organization Pause Before You Play, and a lot of that is done in March, which is known as Problem Gambling Awareness Month and March Madness, named for the unpredictability of the early rounds of the NCAA Men’s College Basketball Tournament.

During the 2024 tournament, it was reported that $2.72 billion was legally wagered on tournament games, and nearly 5.7 times that, or $15.5 billion, were illegal bets, like office pools, according to BetfFirm.com.

While gambling in and of itself is not a problem, Kristina Latta-Landefeld, Envision Partnerships chief operating officer, said the problem comes when it becomes commercialized, like with sports betting apps and websites, which became legal in Ohio as of January 2023.

“What’s happened in the last couple of years is this massive expansion (of gambling) at one time, and Ohio had the biggest expansion of regulated gambling at one time versus any of the other 38 states that have legalized sports betting right now,” she said. “Part of it is, it’s like anything else, and it’s got a potential for harm, it’s got a potential for addiction.”

The National Council on Problem Gambling defines gambling addiction as “gambling behavior that is damaging to a person or their family, often disrupting their daily life and career.”

Gambling addiction is a recognized mental health diagnosis, and the group says anyone who gambles can be at risk for developing a problem.

Its symptoms include thinking about gambling all the time; feeling the need to bet more money more often; going back to try to win money back, known as “chasing losses;” feeling out of control; and continuing to gamble despite negative consequences.

Ohioans bet almost $8.9 billion in 2024, which was $1.1 billion more than in 2023. And sports betting, Latta-Landefeld said, is just as easy as scrolling on social media apps on one’s phone, saying 98% of sports bets in Ohio were made online.

“We all know it’s easy,” she said. “Just like we know it’s easy to lose an hour scrolling through videos, it’s also easy to lose times making sports bets.”

Gaming in Ohio made a big jump in 2009 when voters passed a constitutional amendment legalizing casinos and racinos. The first Ohio casino opened in May 2012 in Cleveland, and today there are four casinos and seven racinos, which are racetracks with casino gaming.

A 2022 Ohio gambling survey reported 41.4% of Ohioans did not gamble, which decreased to 25.1% five years later. In 2022, 17.2% of Ohioans reportedly did not gamble. Over that same time, problem gamblers were reported to be 0.4% of the state’s population in 2012, which jumped to 2.8% in 2022.

When sports betting in Ohio became legal two years ago, problem gambling increased.

Ohio for Responsible Gambling, which is part of the state’s Department of Mental Health and Addiction Services, reported a 55% increase in helpline calls from 2022 to 2023, and data showed there was a 67% increase of Ohioans seeking clinical hair for gambling over that same timeframe.

“With nearly 1 in 5 Ohio adults considered to be ‘at risk’ for problem gambling, the month serves as a prime opportunity to raise awareness, educate the public, and highlight critical prevention and treatment resources,” said LeeAnne Cornyn, director of the ODMHAS, citing that more than 1.8 million adult Ohioans can be categorized as at risk for problem gambling.

One of the biggest concerns with gambling addiction, Latta-Landefeld said, is suicide.

“Gambling is mostly tied to suicide, one of the reasons it’s so important for us to have (gambling) treatment providers is because oftentimes it’s not flagged in an assessment,” she said. “It’s oftentimes thought of the silent disease. It’s very easy to hide. It doesn’t show up in physical symptoms.”

Gambling addiction is an American Psychiatric Association-recognized disorder, though not all who have problems with gambling are diagnosed with addiction. But it doesn’t mean they’re not at risk.

“At any point in time, we have access to potentially addicting behavior,” said Latta-Landefeld said. “There’s an awareness factor. If we choose to engage in those, we need to be aware what the potential harms are, and really how to recognize that in ourselves.”

The Associated Press contributed to this story.

FIND HELP

Resources for problem gambling and addiction:

National Problem Gambling Helpline: 800-426-2537 (GAMBLER) is a one-stop hub connecting people looking for assistance with a gambling problem to local resources.

Make The Call: 800-589-9966 provides assistance for anyone who is struggling or has a loved one struggling due to gambling.

TimeOutOhio.com: This site offers people the ability to ban themselves from casinos, racinos and sports gaming.

MORE: Visit casinocontrol.ohio.gov/responsible-gambling

RISKS FACTORS AND WARNING SIGNS

Problem Gambling Risk Factors:

Early big win

Availability & Accessibility

Family History

Co-occurring substance misuse

Viewing gambling as a safer alternative

Gambling to cope or finance

Problem Gambling Warning Signs: