Millions Of Americans Are Problem Gamblers. So Why Do So Few People Ever Seek聽Treatment?
Legal sports betting is spreading and legislators have put forward two types of bills that seek to legalize betting on sports in Hawaii.
The opportunity to gamble has moved from a trip to Vegas, to a drive to a local casino, to the phone in your pocket. And if you鈥檙e a sports fan, nudges to place bets have become nearly possibly to ignore, with sports gambling ads and promos routinely appearing on TV, social media, sports radio and in arenas.
following certainly gives any rational person reason to pause.
For most bettors, gambling is an occasional form of entertainment 鈥 Powerball tickets , with co-workers, a birthday trip to the casino.
But for other people, the possibility of developing a gambling disorder looms.
To what extent should Americans be worried?
To Gamble Is To Be Human
A nuanced answer begins with the fact that gambling has been popular for a long, long time.
Evidence of gambling has been found . Archaeologists have unearthed dice marked with pips, or dots, in Mesopotamia that date back to 1300 B.C. Historians have located records of dice games in Greek and Indian cities before 400 B.C.
In North America, one Navajo myth tells , or 鈥渢he gambler.鈥 Informal gambling games and lotteries were common in the American Colonies, including .
In the U.S., sports and gambling have long been intertwined. In the decades after the Civil War, pool halls were set up near Western Union stations so gamblers . And sports like baseball and boxing became hugely popular in the 19th century, in part .
For as long as there鈥檚 been gambling, there has also been problem gambling.
Several writers in ancient India . Over 150 years ago, Dostoyevsky famously wrote 鈥淐rime and Punishment鈥 . And in the 20th century, sports betting imploded the careers of baseball legends and .
When Problems Arise
I describe this history because it shows that humans have always seemed to find a way to gamble, whether it鈥檚 legal or not. And, inevitably, some bettors will experience harm or a gambling disorder.
I direct , where we focus on the treatment of and gambling problems.
Psychologists have only recently begun to view problem gamblers as a form of addictive behavior, in which gambling urges, tolerance and withdrawal are akin to how substance use disorders unfold. Researchers have found that brain imaging data and symptom patterns of problem gamblers are similar to those of people who are addicted to drugs or alcohol. Gamblers can build a tolerance, meaning that they need to gamble more and bet in higher amounts in order to maintain the same levels of excitement. And attempts to cut back or stop can lead to emotional struggles.
There are also financial and social ramifications to gambling disorder.
is the most frequently cited reason people start questioning whether they have a problem. damage done to relationships, deterioration in mood and the physical costs of this distress. Problem gamblers often lie about or hide their gambling, which can make it difficult for loved ones to recognize.
The shows that somewhere between 1% and 2% of the U.S. adult population, or 2 to 4 million adults, will experience a gambling disorder in their lifetime. Another 3% to 5%, or 5 to 9 million people, will, at some point in their lives, report a subclinical problem, which means that some gambling disorder symptoms are present but the psychiatric diagnosis is not warranted.
Despite some hand-wringing over the expansion of sports betting, I believe any increase in the rate of problems is likely to be temporary. on the prevalence of problem gambling and gambling disorder reveals a pattern. More gambling availability tends to lead to a spike in the number of people reporting gambling issues in the short term. However, populations tend to adapt over time; the rate of gambling problems decreases accordingly.
It will be interesting to see whether the same pattern plays out for sports betting.
Barriers To Treatment
My team also operates an outpatient clinic where we treat people with gambling disorder. Our research and therapy sessions have pointed to some encouraging news, along with a few barriers.
The good news is that treatment, particularly when it includes , significantly reduces gambling disorder symptoms and psychological distress. While long-term treatment is recommended, an effective is about eight to 10 sessions.
Yet there are still roadblocks. People are often hesitant to try treatment; those who do frequently drop out.
People are often unaware they have gambling problems, even when they report having symptoms of problem gambling. We don鈥檛 exactly know why. The impact, though, is substantial. Only about 10% of . As a comparison, the among those with substance use disorders runs somewhere between 10% and 50%. It鈥檚 considerably lower than those experiencing depression and anxiety, 70% to 90% of whom will seek treatment.
We also know that gambling disorder is . We find that people tend to blame someone who has developed gambling problems, and view them as dangerous or untrustworthy. By contrast, someone experiencing depression and anxiety is less likely to be blamed for their problems.
The other challenge is the rate at which people discontinue treatment before completing the standard course of therapy. For most mental health concerns, 20% who start a psychological treatment . By comparison, the is nearly double: 39%.
We believe that dropout rate is not explained by people not wanting to put in the work to change. Instead, the relationship with the therapist and ambivalence about the progress being made tend to derail the course of treatment. Finances are also a real problem. Patients might not be able to afford their appointments, or a diagnosis of a gambling disorder.
Gaps In Knowledge And Funding
About a decade ago, a friend who is an alcohol researcher observed that the thinking and research about gambling was about four decades behind where it is for alcohol. The gaps in knowledge were evident. We still don鈥檛 have good models for how a gambling problem develops, or how to conceptualize an addiction without a substance. We don鈥檛 know the long-term effects of experiencing gambling problems and gambling disorder. And we don鈥檛 fully understand the extent to which improvements from treatment are maintained.
While researchers around the world are chipping away at these knowledge gaps, there continue to be huge challenges 鈥 not the least of which is that gambling regulations keep changing and new forms of gambling are always emerging.
More importantly, there is little funding available to learn more about gambling disorder 鈥 and almost no funding from the U.S. government. In 2022, the National Institutes of Health to study alcohol use problems.
The amount the NIH budgeted to study gambling?
Zero.
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