New research from UC San Diego provides the most comprehensive look yet at how the rapid expansion of sports betting venues, particularly online, is driving record increases in gambling addiction across the United States. (Photo by Areli Alvarez of Qualcomm Institute at UC San Diego)
States rake in millions from sportsbook gambling while addiction services struggle for scraps
In a nutshell
- Sports betting has grown from a $4.9 billion industry in 2017 to $121.1 billion in 2023, with 94% of bets now placed online through mobile apps and websites.
- Researchers found a 23% nationwide increase in searches for gambling addiction help since sports betting was legalized, with some states seeing increases of up to 67% after introducing online betting platforms.
- Despite collecting millions in tax revenue from sports betting, most states allocate less than $1 million annually to gambling addiction services, raising concerns about inadequate support for those affected.
SAN DIEGO — Sports betting has erupted into a $121 billion industry in America, transforming from a niche activity in Las Vegas to a ubiquitous form of entertainment. However, new research reveals a troubling parallel to this explosive growth: a significant surge in gambling addiction concerns across the nation. The study, led by researchers at the University of California San Diego, documents how the industry’s rapid expansion has coincided with record-breaking demand for addiction help-seeking resources.
Since the 2018 Supreme Court decision that opened the floodgates for legalized sports betting beyond Nevada, the landscape of American gambling has transformed dramatically. “When the Supreme Court legalized sportsbooks in Murphy v. NCAA, public health experts paid little attention,” says Dr. John W. Ayers, the study’s senior author and vice chief of innovation in the Division of Infectious Disease and Global Public Health at UCSD, in a statement. “Now, sportsbooks have expanded from a single state to 38 states, with hundreds of billions of wagers, mostly online, coinciding with record-breaking demand for help with gambling addiction as millions seek help.”
The new study, published in JAMA Internal Medicine, reports a 23% increase in online searches for gambling addiction help since the landmark decision. This surge in help-seeking behavior spans across multiple states and has shown particular intensity in areas where online betting platforms have been introduced.
The research team’s methodology involved analyzing Google searches that combined terms related to gambling with words like “addiction,” “addict,” “anonymous,” or “hotline.” This approach captured not just individuals struggling with gambling problems but also concerned family members and friends seeking help. At its peak in June 2023, these searches reached approximately 180,000 per month nationally.
What makes sports betting particularly insidious is its perception as a skill-based activity rather than pure gambling. Many bettors view themselves as sports experts making informed decisions rather than gamblers taking risks. This mindset, combined with the constant availability of betting opportunities through mobile apps, creates a perfect storm for addictive behavior.
“Sports betting has become deeply embedded in our culture,” says Matthew Allen, a third-year medical student who contributed to the research. “From relentless advertising to social media feeds and in-game commentary, sportsbooks are now everywhere. What was once a taboo activity, confined to the fringes of society, has been completely normalized.”
The researchers note these trends are projected to grow, driven largely by the industry’s strategic investment in sportsbooks as the future of gambling, evidenced by major rebranding efforts like Caesars Entertainment’s transition to Caesars Sportsbook and Casino.
Looking at the numbers reveals a staggering transformation. In 2017, before the Supreme Court’s decision, Americans wagered $4.9 billion on sports. By 2023, that figure had skyrocketed to $121.1 billion. Perhaps most notably, 94% of these bets were placed online, highlighting how digital accessibility has revolutionized the industry.
“Many people struggling with addiction don’t openly discuss it, but they do turn to the internet for answers,” explains Dr. Davey Smith, professor of medicine and director of the UC San Diego Altman Clinical and Translational Research Institute. “By analyzing search trends, we can gain real-time insight into the true scale of gambling addiction in the U.S.”
The study’s findings paint a particularly stark picture in states that have embraced online betting platforms. Massachusetts saw a 47% increase in gambling addiction-related searches after introducing sportsbooks. Ohio experienced a 67% surge. Pennsylvania witnessed a 50% rise. These numbers suggest that the convenience of mobile betting apps may be amplifying addiction risks.
Despite generating substantial tax revenue for states, the gambling industry’s contribution to addiction services remains surprisingly small. For example, New Hampshire allocated just $100,000 for gambling addiction services in 2023 while collecting $36.4 million in sports betting tax revenue. This disparity highlights a concerning imbalance between profit and public health considerations.
Healthcare systems appear unprepared for this growing crisis. Many medical practitioners report little to no training in handling gambling disorders. Unlike substance abuse, gambling addiction lacks FDA-approved medications for treatment, leaving healthcare providers with limited options beyond cognitive behavioral therapy and support groups.
The study’s findings have prompted calls for various interventions, from stricter advertising regulations to mandatory betting limits and enhanced addiction services. Some experts suggest following Australia’s example, which has banned “in-play” or “live” betting — wagers placed during ongoing games — to reduce continuous gambling opportunities.
“Sportsbook regulations are lacking because the Supreme Court, not legislators, legalized them,” concludes Dr. Ayers. “Congress must act now by passing commonsense safeguards. History has shown that unchecked industries—whether tobacco or opioids—inflict immense harm before regulations catch up. We can either take proactive steps to prevent gambling-related harms or repeat past mistakes and pay the price later.”
Paper Summary
Methodology
The research team conducted a longitudinal study examining internet search trends before and after the legalization of sports betting. They used Google Trends to analyze monthly search volumes for gambling-related terms combined with addiction-related keywords. The study covered the period from January 2016 through June 2024, allowing researchers to observe trends both before and after the 2018 Supreme Court decision. They also tracked the implementation of retail and online sportsbooks across different states, enabling them to study local impacts alongside national trends.
Key Results
National gambling addiction help-seeking searches increased by 23% following the Supreme Court decision. Individual states showed even more dramatic increases: Massachusetts (47%), Ohio (67%), and Pennsylvania (50%). The research revealed that online sportsbooks had a more significant impact than retail locations. For instance, New York saw minimal change with retail-only betting but experienced a 50% increase in searches after introducing online betting.
Study Limitations
The researchers acknowledge that search data cannot directly measure clinical outcomes or gambling disorder diagnoses. Additionally, some searches may reflect general curiosity rather than personal struggles with addiction. The COVID-19 pandemic may have influenced results during 2020-2021, as sports schedules were disrupted and pandemic concerns may have overshadowed gambling interests.
Discussion and Takeaways
The research suggests an urgent need for public health intervention in sports betting regulation. Key recommendations include developing preventive education programs, implementing advertising restrictions, raising the minimum betting age to 21, and requiring online platforms to include more robust safeguards against problem gambling. The study also highlights the need for better healthcare provider training and increased funding for addiction services.
Funding and Disclosures
The study received funding from the National Institutes of Health. Several researchers disclosed relationships with various healthcare and analytics companies, including Model Medicines, Hyundai Biosciences, Red Queen Therapeutics, and Gilead. These relationships were reported to maintain transparency but did not influence the study’s findings.
Publication Information
This research was published in JAMA Internal Medicine on February 17, 2025. The study was conducted by researchers from multiple institutions, including the University of California, San Diego; Bryn Mawr College; and other affiliated research centers. The paper underwent peer review and was accepted for publication on November 29, 2024.
