The opportunity to gamble has moved from a trip to Vegas, to a drive to a local casino, to a phone in your pocket. And if you are a sports fan, the nudges to place a bet are almost impossible to ignore, with sports gambling ads and promos regularly appearing on TV, social media, sports radio and in the arena.
The astonishing expansion of sports wagering after decades of casino expansion certainly gives rational people reason to pause.
For most bettors, gambling is an occasional form of entertainment – a Powerball ticket when the jackpot swells to $1 billion, a Super Bowl box with co-workers, a birthday trip to the casino.
But for others, the possibility of developing a gambling disorder looms.
How much should Americans worry?
Gamble is being human
A nuanced answer begins with the fact that gambling has been popular for a long, long time.
Evidence of gambling has been found in ancient cultures around the world. Archaeologists have found dice marked with pips, or dots, in Mesopotamia dating back to 1300 BC.
In North America, one Navajo myth tells of Noqoìlpi, or “the gambler.” Informal gambling games and lotteries were common in the American Colonies, including lotteries to fund the Continental Army.
In the US, sports and gambling have long been intertwined. In the decades after the Civil War, pool halls were set up near Western Union stations so that gamblers could easily place bets on horses. And sports like baseball and boxing became very popular in the 19th century, in part because they attracted bettors.
As long as there is gambling, there is also gambling problem.
Some writers in ancient India highlighted the consequences of habitual gambling. Over 150 years ago, Dostoyevsky famously wrote “Crime and Punishment” to pay off gambling debts. And in the 20th century, sports betting imploded the careers of baseball legends “Shoeless” Joe Jackson and Pete Rose.
When problems arise
I describe this history because it shows that humans always seem to find ways to gamble, whether it’s legal or not. And, of course, some bettors will experience harm or gambling disorder.
I direct the Institute of Gambling Education and Research, where we focus on the treatment of gambling disorders and gambling problems.
Psychologists have only recently begun to see problem gamblers as a form of addictive behavior, in which gambling urges, tolerance and withdrawal are similar to how the disorder uses the core. Researchers have found that brain imaging data and symptom patterns of problem gamblers are similar to people who are addicted to drugs or alcohol. Gamblers can build a tolerance, which means they have to gamble more and bet in greater amounts to maintain the same level of excitement. And attempts to cut back or quit can lead to emotional struggles.
There are also financial and social ramifications for gambling disorder.
Money problems are the most common reason people start asking if they have a problem. But other symptoms include damage to relationships, deterioration in mood and the physical cost of this distressing situation. Problem gamblers often lie or hide gambling, which can make it difficult for loved ones to identify.
The best prevalence research shows that somewhere between 1% and 2% of the US adult population, or 2 to 4 million adults, will experience a gambling disorder in their lifetime. Another 3% to 5%, or 5 to 9 million people, will, at some point in their lives, report subclinical problems, which means that some symptoms of gambling disorder are present but a psychiatric diagnosis is not guaranteed.
Despite some hand-wringing over the expansion of sports betting, I believe that any increase in the level of problems is likely to be temporary. A review of 30 years of research on the prevalence of gambling problems and gambling disorders shows a pattern. More availability of gambling tends to lead to a spike in the number of people reporting gambling problems in the short term. However, populations tend to adapt over time; the level of gambling problems decreases accordingly.
It will be interesting to see what the same pattern plays out for sports betting.
Barriers to treatment
My team also operates an outpatient clinic where we treat people with gambling disorders. Our research and therapy sessions revealed some encouraging news, as well as some obstacles.
The good news is that treatment, especially when it includes cognitive behavioral techniques, significantly reduces gambling disorder symptoms and psychological distress. While long-term treatment is recommended, effective treatment is about eight to 10 sessions.
But there are still roadblocks. People are often hesitant to try treatment; people who often go out.
People often do not know that they have a gambling problem, even when they report having symptoms of problem gambling. We don’t know why. The impact, though, is substantial. Only about 10% of individuals with gambling problems ever seek treatment. By comparison, help-seeking rates among people with substance use disorders are between 10% and 50%. It is lower than those with depression and anxiety, 70% to 90% of which will seek treatment.
We also know that gambling disorder is one of the most stigmatized mental health concerns. We find that people tend to blame people who have developed gambling problems, and see people as dangerous or untrustworthy. In contrast, people with depression and anxiety are less likely to be blamed for their problems.
Another challenge is the rate at which people stop treatment before completing standard therapy. For most mental health problems, 20% of those who start psychological treatment fail to continue with it. By comparison, the dropout rate for gambling harm is almost double: 39%.
We believe that the dropout rate is not explained by people who do not want to put in the work to change. However, the relationship with the therapist and ambivalence about the progress being made tends to undermine treatment. Finances are also a real problem. Patients may not be able to make an appointment, or insurance does not cover the diagnosis of gambling disorder.
Gaps in knowledge and funding
About a decade ago, a friend who is an alcohol researcher observed that thinking and research about gambling was about forty years behind where it is for alcohol. Gaps in knowledge were evident. We still do not have a good model of how problem gambling develops, or how to conceptualize addiction without substance. We do not know the long-term effects of gambling problems and gambling disorders. And we don’t fully understand the treatment improvements that are being made.
While researchers around the world are chipping away at this knowledge gap, there are still huge challenges – not least that gambling laws are changing and new forms of gambling are always developing.
More importantly, there is little funding available to learn more about gambling disorder – and almost no funding from the US government. By 2022, the National Institutes of Health is investing more than $570 million to study alcohol use problems.
How much is the NIH budgeted to study gambling?
zero.
James P. Whelan is a research professor of Clinical Health, University of Memphis
Learn how to navigate and strengthen trust in your business with The Trust Factor, a weekly newsletter that examines what leaders need to succeed. Log in here.