Whether it’s basketball, football, or any other sport, watching your favorite team play each week is a classic pastime—but alongside expert commentary and exciting plays, you’ve probably noticed that sports gambling ads have become a pervasive part of game day.

Companies such as DraftKings and BetMGM have run advertisements featuring Kevin Hart, LeBron James, Tom Brady, and other celebrities. The companies have made deals to become official sports betting partners of the WNBA and X (formerly known as Twitter), respectively. These and other companies sponsor teams and are promoted by sports commentators.

And using these companies’ apps has made placing a bet before and during games easier than ever.

In the years since a 2018 U.S. Supreme Court decision ended federal prohibition of sports betting, the industry has exploded. Currently, 38 states and Washington, D.C., have legalized sports gambling, and legislation to allow it is pending in other states, too.

Now, new research is investigating just how significantly sports betting has changed the economic and public health landscape in the U.S.

A study published on Feb. 17 in JAMA Internal Medicine found that, between 2017 and 2023, sports gambling wagers grew from $4.9 billion to $121 billion. And online searches for help with gambling addiction rose 23% since sports betting was legalized.

“We have a national problem affecting millions of people, and we can link the occurrence of these problems with the opening of sports books, specifically online sports books,” senior study author John Ayers, PhD, an epidemiologist and associate adjunct professor of medicine at the University of California San Diego, told Health.

Ayers first became interested in studying sports betting after chatting with an employee at his local golf course who was asking to borrow some money. He had lost a significant amount on online sports gambling despite living in a state where it was supposed to be illegal.

Ayers wondered about the scope of the problem—particularly because health agencies don’t regulate sports gambling and because in the years since it’s been legalized, only a couple dozen studies have looked into the issue, he said.

So using Google Trends, Ayers and his colleagues looked at how often people in the U.S. were searching online using phrases such as gambling and addiction, addict, anonymous, or hotline. For example, searches such as “gambling addiction hotline” or “am I a gambling addict?” were included in their analysis.

After quantifying the volume of these searches before and after sports betting became legal, the researchers found that queries for help with gambling addiction rose by 23% nationally. This represented between 6.5 million and 7.3 million searches for gambling help nationwide in the years since sports betting was legalized.

Their analysis also showed that certain states were hit harder than others. Ohio saw a 67% increase in searches for gambling help, Pennsylvania saw a 50% increase, and Massachusetts saw a 47% increase, the results showed.

Compared to in-person betting, states that opened the door to online sports gambling showed larger increases in searches.

The findings do “seem to fit with what we are seeing, for example, in call lines for people seeking help for gambling problems,” Marc Potenza, PhD, MD, psychiatrist and director of the Center of Excellence in Gambling Research at the Yale School of Medicine, told Health.

A 2023 survey of over 2,800 Americans found that people who engaged in sports gambling were also more likely to engage in other kinds of gambling.

At the most basic level, problem gambling can stem from the unpredictability of whether someone will win money or some other reward. But the circumstances around gambling can make it more or less addictive.

For one, increased access makes people gamble more. This could be an issue with sports betting in particular, since the majority of wagers happen online.

“The smartphone…makes gambling readily available, 24 hours a day, seven days a week, and betting on just about anything is available online,” said Potenza.

Not only is sports betting accessible, but it’s also become normalized in our culture, he pointed out.

“We’ve seen legislative changes that have legalized the behavior, making the public perception of such behaviors perhaps [seen] as more endorsed by the government,” said Potenza.

In addition, sports betting companies spend hundreds of millions to advertise during sporting events. Research on how these ads affect people’s wager habits is mixed. However, some data suggest they might perpetuate risky gambling behaviors.

Not everyone who sports bets develops a gambling addiction, experts agreed. But some people certainly can—this usually manifests with three components, David Hodgins, PhD, professor of psychology at the University of Calgary, told Health.

First, “you continue to gamble despite the fact that it’s causing you negative consequences,” Hodgins explained. Secondly, you might experience impairments in impulse control, meaning you can’t stop yourself from gambling. If you have an issue with betting, you may also miss out on social activities to gamble, he said.

“For folks experiencing gambling disorders, they oftentimes don’t realize that what they have is an addiction,” Timothy Fong, MD, clinical professor of psychiatry at UCLA, told Health. “They think, ‘Oh, I just have a problem with luck,’ or ‘I have a problem with not enough money.’”

Some additional signs of problem gambling, Fong and Hodgins said, include:

• Anger and personality changes
• Trouble paying rent
• Lying to friends and family members about the extent of losses
• Losing out on social, work, or educational opportunities to gamble
• Being unable to cut back on gambling
• Increased levels of stress or depression
• Needing to bet larger sums of money to experience a thrill

Anyone can develop a gambling addiction, but Potenza said young adolescents and adult men, as well as former amateur athletes, tend to be at a higher risk.

“They may be more engaged in viewing sporting events and may have competitive risk-taking elements that then may link to their gambling behaviors,” he said. “It’s an area that we need to understand better.”

Drinking alcohol while watching sports may contribute, but more research is needed.

It’s essential to continue monitoring the impact of sports betting and to allocate more resources for addiction prevention and treatment efforts, experts agreed. Sports betting companies also need more regulations to safeguard consumers.

That means a greater awareness of the issue among physicians and therapists, too, said Fong. 

“It’s not standard of care right now for most providers to ask for that, and they oftentimes don’t make the connection between, say, depression or irritability, and gambling problems,” he said.

According to Ayers, the following five public health measures could help curb addiction among sports betters:

• Use more of the taxes imposed on sports betting to pay for addiction services. Currently, states invest just 0.0009 cents in gambling addiction support services for every dollar generated from the taxes.
• Regulate advertisements and restrict companies from making misleading claims, such as offering “risk-free” sports betting.
• Institute safeguards for online betting, such as mandatory breaks for users and banning the use of credit cards.
• Invest in public awareness campaigns and more research into sports betting.
• Invest in public health more broadly to address the problem.

“Even though we fueled the rapid growth of sports books over the last seven years, we did not make similar investments in our public health and medical and scientific infrastructure to meet those that have problems with sports gambling,” said Ayers. “That investment needs to start now.”