‘I'm Treating Guys Who Would Never Be Caught Dead in a Casino'

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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, and 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.
Article originally published at The Atlantic