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Most high-stakes gambling used to happen at casinos. Now it’s as close as your palm. With smartphones and the internet, you can place a bet anywhere, anytime. The casino is right in your hand, whether it’s rolling the dice on traditional casino games or diving into the sportsbook, where you can bet on sports, elections, and stocks. You can even play video games with gambling components. But what are the health impacts of making online betting so accessible?

The U.S. Supreme Court rescinded the federal ban on sports betting in 2018, instead enabling individual states to legalize sports betting. Since then, 38 states, Washington D.C., and Puerto Rico have legalized sports wagering.

Gambling in some form is permitted in more than 80% of countries. According to the Lancet Public Health Commission on Gambling, global consumer losses are projected to exceed $700 billion by 2028.

The rise of online betting

Public health experts warn that the growth of the industry should be of concern to all of us. According to the National Council of Problem Gambling, about two million people in the U.S. are wrestling with gambling addiction, showing a growth of 30% in just the last three years.

The rapid growth of the global gambling industry, was discussed at a Harvard University forum recently. Panelists agreed that problem gambling is a public health issue and requires public health attention and intervention.

“We see the expansion of gambling activity not only on our phones, but in our real lives, to the point that gambling is not only endemic, but it’s so much a part of our daily lives that it has changed the fabric of what we do to our body, our brains, and our minds,” noted panelist Timothy Fong, an addiction psychiatrist and co-director of the UCLA Problem Gambling Studies Program.

Gambling is as old as humankind. It involves, Fong said, “putting something of value, usually money or time, on an event of uncertain outcome, in order to win a larger reward.” The impact of the gambling industry, enabled by the financial and technological industries, is expanding at an unprecedented pace. To its users, it promises instant gratification anywhere, anytime, at their fingertips.

It’s much more harmful than traditional gambling, up to 10 times more harmful, according to Shekhar Saxena, a panelist and professor of global health at the Harvard T.H. Chan School of Public Health. “It’s continuous, it’s intense, and it can be financially, physically, and mentally extremely harmful,” said Saxena.

Recreational gambling, for some people, can be an occasional indulgence without lasting harm. Online accessibility, however, makes it easier for recreational gambling to degenerate to “early problem gambling” with counterproductive consequences. Fong said that it can lead to behaviors like overspending and lying – similar to early signs of substance use disorders.

Gambling as a disorder

The medical community recognizes gambling as an addictive behavior with biological and psychological risks like other addictions. Fong describes gambling addiction as “ongoing, continued engagement in gambling activities, despite harmful consequences.”

Unlike traditional gambling which occurs in social situations, online gambling is more often done in isolation, hidden from those who could otherwise be observing and express concern about addictive behaviors emerging. It heightens anxiety and depression, and amplifies destructive behaviors. Research shows that online gamblers, especially those who use multiple sites, have the greatest risk of harm. Like other addictions, gambling addiction is not about willpower or morality. It can be a source of profound shame, harming the body, mind, and spirit, Fong said.

Who is at risk for problem gambling?

Teens and young adults are especially vulnerable to developing a disorder. They are often targeted by marketing that urges then into using social sports betting apps, where they are then channeled to sports wagering for money. In Massachusetts, about 46% of middle and high school students have gambled in the previous year. Parents are scared and seeking help.

Research consistently shows that there are two major risk factors among people who shift from social to problem gambling – low education and low socioeconomic status. With the rise of sports betting, however, people with higher education and socioeconomic status are now exposed to the same risks.

Help is available

Treatment of gambling addiction requires a multidimensional approach with biological, psychological, and social interventions.

As seen with other addictions, some medications can be effective in dampening gambling impulses, and psychotherapy helps managing urges to gamble. Restoring a sense of social connection and purpose also help. Fong said, “The longer you stay in professional treatment, the better you do.”

Research on gambling lacks the kind of attention other public health issues have received, such as alcohol and tobacco use. Advocacy groups are sparse, although there are an increasing number of Gamblers Anonymous groups, a familiar 12-step program. A significant issue is the considerable social stigma associated with gambling, causing families to hide the problem, and limiting public understanding.

State gambling regulations vary widely, and advertising is poorly regulated. The forum panelists advocate for stricter regulation of gambling ads. Regulations regarding gambling, however, struggle to keep up with the pace of emerging technology.

Congress is currently reviewing two gambling bills. The GRIT Act would allocate 50% of federal sports excise tax revenue to gambling addiction treatment and research. The SAFE Bet Act would require states with sports betting to enforce federal standards on advertising, affordability, and artificial intelligence.

” The public health framing is talking about the environment in which people live … and the kind of incentives that are there,” said Saxena. “Yes, people have some responsibility, but it’s the environment, it’s the technological environment, the social environment, and the economic environment in which people live.”

The gambling industry and tech companies invest heavily in trying to make the public believe that responsible gambling is possible. The Harvard panelists are skeptical. “Online gambling has to be regulated just like food safety, air quality, and water quality, because it is an issue of public health,” Fong said.