‘A growing problem’: Rise in gambling addiction threatens bettors, athletes

Key takeaways:

• Searches for gambling addiction have greatly risen in recent years.
• Providers may lack education on identifying and treating such addiction.
• The rise in sports betting also has implications for athletes’ health.

As March Madness in men’s and women’s college basketball kicks off, millions will tune in to watch and bet — with the latter having major ties to the health of both the players and those making bets.

According to the American Gaming Association, Americans are projected to legally wager an estimated $3.1 billion on the tournaments, up from $2.7 billion in 2024.

This projection comes amid substantial increases over the last several years in both access to sports wagers and sportsbooks, as well as internet searches for gambling addiction, a recent analysis showed.

The observed rise in gambling addiction searches “was even more pronounced than we anticipated,” Kevin H. Yang, MD, a psychiatry resident physician at University of California, San Diego, told Healio. “These findings suggest that the convenience and 24/7 accessibility of online sports betting may pose unique risks that warrant special attention from health care providers.”

The results follow a Lancet Public Health commission calling for stronger policy and regulatory controls globally to reduce the impact that commercial gambling has on well-being and public health.

Gambling “is often overlooked in health research, clinical practice, and health policy development, with insufficient governmental efforts to prevent or mitigate harms,” Yang and colleagues wrote in JAMA Internal Medicine.

“This inadequacy in research may stem from the exclusion of gambling-related outcomes in standard health surveillance mechanisms but may also reflect a general blind spot to gambling,” they added.

A rise in gambling searches

In their longitudinal study, Yang and colleagues assessed the growth of sports gambling and its health effects following the U.S. Supreme Court’s 2018 decision in Murphy v. National Collegiate Athletic Association (NCAA), which allowed states beyond Nevada to legalize sports betting.

Specifically, they looked at internet searches per 10 million queries — made between Jan. 1, 2016, and June 30, 2024 — that mentioned “gambling” and “addiction,” “anonymous,” “addict” or “hotline.”

The researchers found that the number of states with operational sportsbooks rose from one to 38 from 2017 to 2024, while total sports wagers increased from $4.9 billion in 2017 to $121.1 billion in 2023.

Overall, 94% of total sports wagers made in 2023 had been placed online.

Study results also showed 23% (95% CI, 15%-30%) more searches nationally seeking help for gambling addiction after the Murphy v. NCAA decision, “with searches higher than expected for 55 of the 73 months during the post-period, including every month since September 2021,” the researchers wrote.

They also noted that several states, including Massachusetts (47%; 95% CI, 21%-79%), New Jersey (34%; 95% CI, 21%-45%), New York (37%; 95% CI, 26%-50%) and Pennsylvania (50%; 95% CI, 35%-66%), each had more searches than expected after the opening of any sportsbooks in each state.

The final estimate came in at 6.5 to 7.3 billion searches for gambling addiction nationally in the 73 months following Murphy v. NCAA.

“What particularly stood out was the stark contrast between retail and online sportsbook — when states introduced online betting, we saw significantly larger increases in gambling addiction-related searches compared to retail-only periods,” Yang said.

A need for education

Primary care providers “should recognize that gambling disorder shares many characteristics with substance use disorders and often co-occurs with other mental health conditions like depression and anxiety,” according to Yang.

“Given that sports betting is now legal in the majority of states in the U.S., PCPs should consider incorporating gambling disorder screening into their assessments for at-risk populations, including young adults who endorse other substance use and/or mental health symptoms,” he told Healio.

Many providers report limited training on identifying and treating gambling disorders, “which highlights the need for more education, such as through continuing educating units, on these topics,” Yang added.

The researchers identified some study limitations. They did not measure clinical outcomes like gambling disorder, while the findings may be confounded “as states with sportsbooks differ from states without sportsbooks,” they wrote.

Yang said that additional longitudinal studies “that track individual’s betting patterns and health outcomes over time” are warranted to continue assessing the full impact of gambling disorders.

“These studies should examine the progression from casual betting to problematic gambling, investigate whether specific betting types — like in-play betting or parlays — carry higher risks and explore the relationship between betting patterns and mental and physical health symptoms,” he said.

Athletes face harassment

According to Yang, a further consequence of the rise of sports gambling is its impact on the health of athletes.

“Players across multiple sports have reported receiving death threats and hostile messages on social media when their performance affects betting outcomes,” he said. “This concerning trend highlights how real-time betting can have unintended consequences beyond gambling addiction itself.”

Jeffrey L. Derevensky, PhD, professor emeritus and director of the International Center for Youth Gambling Problems and High-Risk Behaviors at McGill University in Canada, highlighted recent NCAA research that showed athlete harassment related to betting is prevalent across all collegiate levels.

For example, a study including 21,000 student athletes revealed that 21% of Division I men’s tennis participants reported experiencing harassment from sports bettors, along with 17% of Division I men’s basketball athletes.

“The same thing was true for Division II [men’s tennis], but to a lesser degree — 6%,” Derevensky, who was a co-author of the NCAA report, told Healio.

These student-athletes can experience various negative outcomes as a result, including “performance problems, depression, anxiety [and] other mental health issues,” he added.

Meanwhile, the bettors harassing players “are either obviously upset about their losses or trying to influence future tournaments,” Derevensky said.

He pointed out that college athletes are especially vulnerable to harassment for several reasons.

Specifically, “they’re younger... and they tend to have fewer social supports around them," he said.

Gambling disorder also affects athletes

Derevensky said that education on and screening for mental health and gambling disorders are both “really important,” as well as treatment — which can be difficult in some cases, especially for college athletes.

The NCAA report showed that the percentage of student athletes who bet on sports once or more a month has increased in recent years. This percentage among men in Division III grew from 12% to 17% from 2016 to 2024.

In 2024, this percentage across several men’s sports individually ranged from 15% to 25% in Division III and from 2% to 8% in Division I.

A press release noted that another notable finding from the report was that the percentage of male student-athletes who reported gambling alone rose from 6% to 15% from 2016 to 2024, suggesting their gambling behaviors “may remain unknown to the bettor's family, friends, teammates and coaches.”

“The problem with treatment for collegiate athletes is the notion of eligibility,” Derevensky explained. “If an athlete has a gambling disorder and goes to his coach and says, ‘I have a gambling disorder,’ he or she may become ineligible to continue playing.”

He underlined that the rise of sports betting and its far-reaching effects on both bettors and athletes “[is] going to become a growing problem.”

“We know that the amounts of money being bet, for example, on March Madness are going to be extraordinary,” he said. “The concern is that we have to keep athletes healthy, that they don't get involved in gambling, and that there have been a number of recent cases where athletes have become either suspended, or they're now looking into suspension of athletes for gambling on their own teams or gambling on themselves. I think we have to be really concerned.”

For more information:

Kevin H. Yang, MD, can be reached at kevinyang@health.ucsd.edu.

Jeffrey L. Derevensky, PhD, can be reached at jeffrey.derevensky@mcgill.ca.

References:

• Americans to legally wager estimated $3.1 billion on March Madness. Available at: https://www.americangaming.org/americans-to-legally-wager-estimated-3-1-billion-on-march-madness/. Published March 13, 2025. Accessed March 20, 2025.
• NCAA study: Education shows promise in changing sports betting behaviors; harassment from bettors prevalent in DI. Available at: https://www.ncaa.org/news/2025/1/14/media-center-ncaa-study-education-shows-promise-in-changing-sports-betting-behaviors-harassment-from-bettors-prevalent-in-di.aspx. Published Jan. 14, 2025. Accessed March 20, 2025.
• Trends in NCAA student-athlete gambling and sports betting behaviors: Full report. Available at: https://ncaaorg.s3.amazonaws.com/research/wagering/2025RES_WageringReport.pdf. Accessed March 20, 2025.
• Yeola A, et al. JAMA Intern Med. 2025;doi:10.1001/jamainternmed.2024.8193.