by: Alana Semuels | Time.com
Legalizing gambling can come with big health problems.
That’s the conclusion of a recent study out of Ontario, published in the American Journal of Preventive Medicine, which found that after the Canadian province legalized betting on individual sports events in 2022, emergency department visits for gambling disorders doubled. Most of the people who landed in the emergency department were men, and almost one third of the visits led to hospitalizations.
“This rise in severe presentations might be a bit of a warning signal of a wider increase in harms across the general population,” says Ryan Forrest, a public-health doctoral student at the University of Toronto and one of the authors of the study. “We think about things like financial distress, family and relationship problems, worsening mental health—and those things are not captured in the emergency department data.”
The authors of the Ontario study projected how many people would normally end up in an emergency department every year, and then compared that to what they saw after online betting on single sporting events became legal in Ontario. Emergency department visits were 154% higher than they would have been had the law not been changed, Forrest says. The visits were concentrated among men aged 10-44.
Many of the patients showed up at the emergency room with major depression and suicidality, and some had other mental-health or substance-abuse diagnoses, Forrest said. Doctors at the emergency department noted in patients’ records that gambling had contributed to those other issues.
A separate study by some of the same researchers also found that calls to ConnexOntario, Ontario’s free 24-hour mental health and addictions helpline, were 200% higher than they would have been had the law not been changed. That study found that the people reaching out for help were almost exclusively boys and men aged 15 to 44.
“There’s two data sources telling us there is a real health signal happening here,” Forrest says.
The mental-health consequences of expanding betting
The study is a warning to the U.S., which has seen sports gambling proliferate since 2018 after the Supreme Court struck down a law barring most state-authorized sports gambling, allowing states to decide for themselves whether to allow sports betting. Since then, dozens of states, including New Jersey, Tennessee, and New York, have legalized sports betting. Many states also allow online casino games. Gambling has spread in Canada, too, after the country legalized betting on single sports events in 2021.
Therapists in the U.S. say they are already seeing the mental-health consequences of the legalization of sport betting across the U.S., along with the results of more exposure to prediction markets. Birches Health, the largest provider specializing in the treatment of gambling disorder in the U.S., has seen the number of 18-to-34 year old clients grow more than twofold since 2024, according to Cynthia Grant, vice president of clinical for Birches Health.
“There’s more people gambling,” she says, “and when you have more people gambling, it simply means that there’s more people who are going to develop a problem.”
Grant says that clients are mentioning prediction markets 200% more often than they did last year, according to the company’s analysis of its initial clinical assessments. Prediction markets allow people as young as 18 to place wagers; sports betting is restricted to people over 21.
“It’s just not a regulated environment out there,” she says. “People’s lives are being ruined; their relationships are being destroyed, their retirement accounts are gone.”
One of the reasons younger people are seeking treatment may be that they are starting to gamble earlier, she says. It’s not just prediction markets: some kids are given lottery scratch tickets for gifts, she says, or they’ll participate in family fantasy sports wages. “Those are the memories that people talk about” in therapy, she says. Kids are also exposed to gambling with online games that encourage them to chase a reward, or through hobbies like collecting Pokemon cards, in which they are betting that they’ll get a valuable card in an anonymous pack.
The standard treatment for gambling disorder is cognitive behavioral therapy, Grant says, because people with a gambling addiction often have distorted thinking and believe that they can beat the system. But often, she says, people don’t even know that gambling disorder is a mental-health condition and that insurance can cover care. Studies show that suicidal ideation and suicide risk is 5 to 10 times higher in people with gambling disorders than in the general population.
An under-regulated betting landscape
Both Grant and Forrest say that the unregulated nature of gambling in both Canada and the U.S. leads to more people ending up with mental-health problems—but that there is little investment in tracking those problems. There has been no money set aside by the Canadian government to track whether it leads to more public-health problems, Forrest says.
“You compare that to something like when cannabis was legalized, there were huge amounts of grants given out to monitor these kinds of policy changes,” Forrest says.
Most apps don’t have automatic spending limits that prevent people from losing too much money gambling, and most take a hands-off approach to users who act in a way that suggests they have an addiction. In a recent ProPublica story, a reporter posed as a problem gambler and found that rather than flagging his behavior, the app tried to incentivize him to keep going.
“The way that online systems work right now do not protect people at all who are prone to behavioral addictions,” Grant says, “and that, to me, is very dangerous for my clients.”
“Bartenders have rules about how much they can serve someone,” Grant says. “Police can issue a DUI—there are efforts to stop people who are potentially causing harm. But that does not happen in the gambling space.”