Some lessons from Las Vegas might benefit North Carolina as it prepares for the legalization of online sports betting next month. Public health researchers suggest that the experiences of Nevada, a hub of sports gambling, could be invaluable for states like North Carolina, which will soon allow online sports betting for those 21 and older.
Public health advocates in North Carolina are looking to places with established sports betting to understand the surge in problem gambling that often follows the launch of legalized sportsbooks.
“We’re ready. We know it’s coming. We understand what’s happened in other states, so that’s helped us prepare ourselves a little bit better,” Amanda Winters, program administrator for the NC Problem Gambling Program, told NC Health News. “But we’re waiting with bated breath to see how it plays out.”
Eight sportsbook operators are set to go live in North Carolina at noon on March 11, just in time for “March Madness.” The timing is expected to draw significant gambling activity, similar to events like the Super Bowl.
“We know that we’ll see an increase in helpline calls,” Winters said, though it may take some time for bettors to recognize their gambling as problematic and seek help.
In preparation, the NC Problem Gambling Program has provided additional training for clinicians and focused prevention programs on high-risk populations. They have ensured that the helpline is prepared for an expected influx of calls.
Funding and research
In 2023, the General Assembly designated $2 million annually from state tax revenue for the NC Problem Gambling Program, starting in the fiscal year beginning July 1. Meanwhile, the program has been operating on its annual budget of $1 million, unchanged since 2005.
“We are able to plan, and that’s a big part of the program that we run here,” Winters said. “Ensuring that the plans and the programs we have in place already are on a solid, concrete base and are strong so that when we do build on them, we know that we are starting from a good place.”
Michelle Malkin, a professor and director of the Gambling Research and Policy Initiative at East Carolina University, warned of unexpected consequences despite preparations. Malkin and her colleague Michele Stacey are conducting a study on gambling behaviors among 3,000 undergraduate students from community colleges and universities across North Carolina. Preliminary results from a survey of 1,661 students from 12 University of North Carolina System campuses show that 58 percent had gambled in the past year, with 13 percent gambling at least monthly.
The findings indicate that male students and athletes gamble more frequently than their peers, with about 5 percent of undergraduate students at risk for problem gambling, similar to the 5.5 percent of North Carolina adults.
“Preliminary results also show that over 60 percent of undergraduate students perceive gambling to be at least a minor issue on their campus,” according to Malkin. However, education on gambling behavior and risk is nearly nonexistent on college campuses.
Educating the youth
Alison Drain, a prevention coordinator for the NC Problem Gambling Program, expects an increase in problem gambling among younger college-age males, even those under 21. The program has been working since 2010 to educate middle and high school students about the risks of gambling.
“What we see is that kids have been gambling for quite some time on all kinds of things, including sports betting,” Drain said. “They engage in gambling amongst their friends just placing bets on sporting events or skill-based games, including video games.”
Drain likened gambling disorder to substance use disorders, noting that early engagement increases the risk of addiction later in life.
Research shows that gambling can trigger neural responses similar to addictive substances, with surges of dopamine, adrenaline, and serotonin, especially when winning or experiencing a near miss.
“Kids are developing at that time, and they engage in high-risk behaviors,” Drain said. “But they also need risk aversion, health education, and discussions with parents or trusted adults about whether a risk is worth taking.”
A public health approach
The NC Problem Gambling Program has focused on ensuring clinicians are trained to recognize sports gambling problems and relying on research for data-driven solutions.
“The point of funding (the ECU) research institute was to see where we are as a state as a baseline, and then monitor and look at emerging trends and special populations and effects of sports betting,” Winters said.
At a webinar sponsored by SciLine, researchers emphasized the importance of funding research on sports betting, noting that billions of dollars are wagered during events like the Super Bowl. Marc Potenza, a professor at Yale School of Medicine, noted that gambling is often perceived as less harmful than substance use behaviors, yet problem gambling receives relatively little funding for treatment and research.
Legislation has been introduced to create a federal funding source for research on gambling addiction, with aims to support the 7 million Americans estimated to have gambling problems.
Addressing the stigma
Winters and Drain advocate viewing problem gambling through a public health lens. “We do take a public health approach to this,” Winters said. “We’re data-driven. We want to do the best we can. We’re always trying to improve. We’re here to learn.”
Winters emphasized that there is no shame in having a gambling problem. “It’s a disease, not a decision,” she said, encouraging the use of software to block gambling apps, taking breaks from betting, and seeking help when needed.
Comparing problem gambling to a misunderstood character like Cookie Monster, Winters highlighted the importance of normalizing discussions about gambling issues to reduce fear and stigma.
