When we think about any addiction, we tend to focus on people who are utterly consumed by it — those whose lives are visibly falling apart. Yet gambling challenges our usual assumptions about addiction and risk, as its harms extend far beyond the most severe cases.
Consider a young man from my therapy practice, a former college athlete, who isn’t bankrupt or in crisis but feels stuck in a cycle of unhealthy online sports betting. He repeatedly deletes the betting app from his phone, only to reinstall it days later at the prompting of a well-timed email, a group bet with friends or simply the ads plastered across every sports arena. He does fine at work and mostly keeps to the dollar limits he sets, but his internal preoccupation, restlessness and chasing of losses just feel bad. He wouldn’t call himself addicted, but he doesn’t feel healthy, either. At the very least, he has the creeping sense that he’d feel better if he put his attention and energy toward something more meaningful.
Serious gambling addiction is devastating. Beyond financial ruin, it increases the risk of physical health problems, domestic violence and family rupture. Every year, 2.5 million American adults suffer from severe gambling problems. Many suffer invisibly, silently wagering away their lives on cellphones, perhaps in the very same room as their family and friends.
These severe cases demand attention, but focusing only on them obscures something important. As a physician and someone in recovery from alcohol and stimulant addiction myself, I’m concerned by how we have been conditioned to see addiction in all-or-nothing terms. Beyond the millions of Americans who meet the criteria for gambling disorder, five million to eight million more have a mild to moderate gambling problem that still affects their lives — like my patient. Since the federal ban on sports betting was struck down in 2018, sports gambling in the United States has exploded, with annual wagers now approaching $150 billion.
Today’s surge of sports betting — supercharged by technology and unfettered industry practices — shows how everyone can struggle with self-control to varying degrees. No longer a simple matter of putting money down on which competitor will win, modern technology has transformed sports betting into a high-speed, continuous stream of wagers throughout the game. For Sunday’s Super Bowl, people can place bets on things from the result of the coin toss to the yardage of the next drive, from Kendrick Lamar’s halftime guests to how many times Taylor Swift is mentioned.
Online gambling companies collect troves of personalized data to guide betting variables and marketing to match each user’s patterns and preferences. (The Athletic, which is owned by The New York Times, has a partnership with BetMGM, online sports betting and gaming company.) Subscription plans and automated deposits further erode the friction between impulse and action.
Technological advances are also blurring the lines between gambling, video games and financial speculation. Prediction markets, crypto and meme coins like $TRUMP and $PEPE have introduced gambling dynamics to larger audiences. Children now routinely encounter gambling in video games, through casino-style simulations, pay-to-win features and other random rewards. When gambling-like features become part of everyday life, it becomes harder for everyone to maintain healthy boundaries.
The gambling industry actively shapes our perception of normal versus addictive behavior. Companies promote gambling as harmless entertainment while portraying addiction as an extreme condition afflicting only a vulnerable few. This playbook — refined over decades by the tobacco, opioid and alcohol industries — frames harm as a result of personal choices rather than a problem to do with their products.
We desperately need more resources for the most severely affected; the National Council on Problem Gambling reports that states currently invest just 0.0009 cents in gambling addiction support services for every dollar generated from commercial gambling. Parents should educate themselves about gambling-like features in their children’s apps and games, remove gambling from shared devices, have open conversations about risks and, perhaps above all, be mindful of what they are modeling.
We need common-sense regulations that address gambling as not just a financial but also a public health issue. In Europe, it is more common to see partial limits on advertising, such as restricting sports celebrity endorsements or stadium advertising. Other moderating forces could include limiting bet sizes, curbing in-game betting speed and intensity, and restricting partnership deals (for example, between gambling companies and college athletic departments).
Critics might argue that I’m being alarmist about an activity most people enjoy safely. But this misses the point. While it’s true that most gamblers don’t develop severe addictions, we should regulate potentially harmful products based on their full spectrum of impacts, not just their most extreme outcomes.
In my study of the cultural history of addiction, the earliest documented case I found was a gambling addiction described in the Rig Veda, probably dating to before 1000 BCE. The pull of gambling on human psychology is timeless, and is most likely to persist as long as we have some form of money to put at risk. What’s different now isn’t the underlying susceptibility, it’s that technology and concentrated commercial power have made these vulnerabilities impossible to ignore.
As millions gather to watch the Super Bowl, many will place bets through apps on their phones. Others will binge on ultraprocessed foods or drink more than they intended. Some will be on the road to serious problems, while others will wake up the next morning with no more than mild regret. Most will not qualify as having true addictions. But many will feel a glimmer of diminished control, which reminds us that addiction, in an important sense, is in all of us.
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