U.S. — A new study of electronic health records indicates that diagnoses of gambling disorder increased by more than 60% since 2018 in states where sports betting has been legalized. In contrast, states that did not legalize sports betting saw a 30% decrease in gambling disorder diagnoses during the same period.

The study, conducted by Epic Research, analyzed records from over 197 million U.S. adults from January 2018 to March 2026. The rate of gambling disorder in states with legalized sports betting rose from 3.0 per 100,000 to 4.8 per 100,000. Epic's researchers noted that these trends cannot be attributed to any single legal event, such as a state's decision to legalize sports betting.

Mark van der Maas, a social work professor at Rutgers University, stated that increased access leads to increased problems. "You increase access, you increase problems," van der Maas said. "As soon as you introduce a new form of gambling or dramatically increase the availability of gambling, you will be increasing the number of people that are experiencing harm because of that gambling," he said.

Harry Levant, director of gambling policy at the Public Health Advocacy Institute, characterized the evidence as significant regarding the impact of legalization. "This is extremely important evidence that speaks to not only the impact of legalization — but the inherently dangerous nature of how online gambling is fundamentally different than anything we've seen before," Levant said. "You're introducing younger and more vulnerable people to a highly addictive product," he said. "It is an addiction that for many people is silent — there are no visible manifestations," Levant added.

The American Gaming Association indicated that the study reflects a greater awareness of gambling addiction rather than an increase in the underlying problem. "While problem gambling is a serious condition for those impacted, this study does not indicate an increasing rate of addiction," the association said in a statement. "Increased screening and greater awareness of available resources can often lead to more diagnoses, while decades of research have found no increase in problem gambling rates as legal gaming has expanded," the association said.

Adults aged 30 to 49 had the highest overall rate of gambling disorder, while the largest increase in diagnoses occurred among adults aged 18 to 29, who were disproportionately male. Steven Heim, outpatient supervisor at New Hope Integrated Behavioral Health Care, confirmed seeing an increase in related referrals. "We've seen definitely an increase in related referrals and diagnoses," Heim said. A spokesperson for the American Gaming Association said the industry invests around $500 million annually in education, research, and support for individuals struggling with problem gambling.

Why It Matters

The findings from Epic Research provide data on the correlation between the legalization of sports betting and the rates of gambling disorder diagnoses. These developments follow a 2018 Supreme Court ruling that allowed states to legalize online sportsbooks, leading to states like New Jersey and Massachusetts legalizing sports betting in 2018 and 2022, respectively. The data offers an updated perspective on problem gambling, as the last federally funded national study on its prevalence was conducted in 1999.

Gambling disorder is classified in the Diagnostic and Statistical Manual of Mental Health Disorders in the same section as substance abuse disorders due to similarities in clinical presentation and treatment. Symptoms include preoccupation with gambling, a need to gamble larger amounts, repeated attempts to stop, deceiving others about gambling, and relying on financial bailouts due to gambling.