Gambling is now more accessible than ever. Once limited to casinos in places like Las Vegas and Atlantic City, it now includes lotteries, online games, and video games with gambling elements available to both adults and children.
According to early 2023 data from the American Gaming Association, sports betting is legal in 37 states and Washington, DC, with six more considering legislation. This means people can gamble at any time and place, and this includes teenagers and even young children who are under the legal gambling age.
The expansion of gambling access has raised concerns among psychologists and other experts about the potential increase in gambling problems. Early evidence suggests that young people, especially boys and men, are particularly vulnerable to gambling addiction. This demographic is also the primary participant in the newest forms of gambling, such as sports betting and video game-based gambling. Recent research shows that people in their early 20s are the fastest-growing group of gamblers. A 2018 Canadian survey of over 38,000 youths found that nearly two-thirds of adolescents aged 12 to 18 had gambled or played gambling-like games in the previous year. Starting young can lead to significant psychological distress and increased chances of developing problems.
Researchers are studying the psychological principles and neurological mechanisms underlying the drive to gamble and the difficulties gamblers face in stopping. Contrary to simplistic views on the role of the neurotransmitter dopamine in addictions, research is uncovering variations in the volume and activity of brain areas related to learning, stress management, and reward processing that might contribute to problematic gambling.
Understanding what makes certain people more susceptible to gambling problems could lead to better prevention and treatment strategies and provide insight into the health impacts of gambling, the consequences of early exposure, and the potential role of government regulation.
Currently, the National Institutes of Health have agencies dedicated to alcohol and drug abuse, but no official efforts target problem gambling, nor are there federal regulations against sports betting advertisements. This means children can see ads, often featuring their sports heroes, at any time. “It’s the wild, wild west with regard to gambling,” said Lia Nower, JD, PhD, director of the Center for Gambling Studies at Rutgers University.
Examining the risks
Most adults and adolescents in the United States have placed some type of bet without issues. However, a significant subset develops gambling disorder, defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a persistent, recurrent pattern of gambling associated with substantial distress or impairment.
Gambling problems, previously called pathological gambling, were classified as an impulse control disorder until the DSM-5 reclassified them as an addictive disorder in 2013. This made gambling addiction the first, and so far the only, defined behavioral addiction in the clinical section of DSM-5. Like addictions to alcohol and drugs, gambling addictions are characterized by increasing tolerance and withdrawal symptoms when attempting to quit.
Researchers have refined their understanding of the prevalence and risk factors for gambling addiction. Among adults, the estimated prevalence of gambling problems ranges from 0.4% to 2%, depending on the study and country. Rates are higher for those with other addictions and conditions. About 4% of people being treated for substance use and nearly 7% of psychiatric inpatients have gambling disorder. Approximately 96% of people with gambling problems have at least one other psychiatric disorder, with substance use disorders, impulse-control disorders, mood disorders, and anxiety disorders being particularly common.
Vulnerability is higher among people with low incomes and young people, especially boys and men. Up to 5% of adolescents and young adults who gamble develop a disorder. Men outnumber women in gambling addiction cases by about 2 to 1, though the number of women with the disorder is growing.
Despite concerns, scientists have yet to document a consistent rise in gambling problem rates in recent years. However, more access to gambling suggests that overall numbers of problems may have increased. For example, after Ohio legalized sports betting, the number of daily calls to the state’s gambling helpline more than doubled.
From gaming to gambling
Loot boxes in video games have become a controversial topic. These digital containers, which players can buy for a small amount, might reveal valuable game items or be worthless. In 2018, Belgium became the first country to ban loot boxes, categorizing them as a form of gambling due to their financial risk and unknown reward.
Researchers James Sauer, PhD, and Aaron Drummond, PhD, studied loot boxes in popular games and found that nearly half met the definition of gambling. Their research indicated that loot boxes exploit psychological principles similar to slot machines, leading to rapid adoption of the behavior.
Studies show that people who spend more on loot boxes are often at higher risk of developing gambling problems, especially during adolescence. Some evidence supports the idea that buying loot boxes can act as a gateway to other forms of gambling.
Early exposure
Loot boxes are not the only avenue to gambling for kids. Online games that simulate gambling without financial risk are available to very young children, normalizing gambling and increasing the risk of developing problems later. Studies suggest that teens who play simulated gambling games are at higher risk of having gambling problems. Early exposure to gambling through family members or online games increases the likelihood of developing severe gambling issues.
The brain of a problem gambler
Scientists are studying the brain to understand why early exposure makes a difference and why some people develop gambling addictions. Research links gambling disorders to variations in brain regions involved in reward processing, emotional learning, and stress regulation. Genetic factors also play a significant role, explaining over half of individual differences in gambling problems.
Brain research suggests that teenagers are particularly susceptible to gambling due to the late development of the prefrontal cortex, which regulates impulsivity and decision-making, especially in boys. New treatments, including targeted brain stimulation, could eventually help people with gambling problems.
Cognitive behavioral therapy is currently the most common treatment for gambling addiction, with different pathways leading to gambling problems. These include habitual gambling, escape from stress, and impulsive personalities.
Betting on the game
Sports betting is the newest frontier for young adults, who have grown up with video games and online gambling. Legal in many states, sports betting has exploded in popularity, with young people being the fastest-growing group of sports gamblers. Early signs suggest that sports betting may lead to higher rates of gambling problems and associated mental health issues.
To address these issues, simple steps like setting spending limits and education about gambling risks are crucial. Prevention programs exist but are often not widely implemented. Parents should talk to their children about gambling risks and the psychological mechanisms that make them appealing.
In conclusion, as gambling becomes more accessible, it is vital to understand its impact on the brain and who is most vulnerable to addiction. This knowledge can lead to better prevention and treatment strategies, helping to mitigate the risks associated with gambling.
