Diagnoses of gambling disorder rose more than 60% since 2018 in states that have legalized sports betting, with the biggest increase among young men, according to a new study of electronic health records across the U.S.
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Gambling disorder is a recognized mental health condition in which patients often cannot stop gambling, despite the growing distress and harm they experience.
Sports betting has exploded across the U.S. following a landmark Supreme Court ruling that paved the way for states to legalize online sportsbooks in 2018. Experts say the findings offer more evidence of potential fallout from the decision — at a time when more online betting sites, like prediction markets, are taking off.
The rate of gambling disorder in states with legalized sports betting rose from 3.0 per 100,000 to 4.8 per 100,000, according to Epic Research, a private firm known in the medical field for its research on public health trends.
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The group also found that diagnoses of gambling disorders fell in the 11 states that did not legalize sports betting, with cases dropping by about 30% from 2018 to March 2026.
Epic’s researchers did not identify a specific reason for the drop. But they noted that changes in health care and the growth of telehealth during the Covid pandemic, as well as greater awareness among health care clinicians and changes in coding practices, may have contributed to some of the differences between states.
Epic Research analyzed records from more than 197 million U.S. adults from January 2018 to March 2026 using data from its parent company, an electronic health software platform used by thousands of hospitals and clinics across the U.S.
Adults ages 30 to 49 had the highest overall rate of gambling disorder, but the biggest increase was among those ages 18 to 29, who were also disproportionately male.
Epic’s researchers said the trends “cannot be attributed to any single legal event,” such as a state’s decision to legalize sports betting, but they added that the findings were in line with other research showing that more people are looking to get help for gambling problems in states that have done so.
“You increase access, you increase problems,” said Mark van der Maas, a social work professor at Rutgers University who has studied the link between gambling and suicide and was not involved in the research.
He noted that the age groups with the biggest increases in diagnoses were also those likeliest to use the online betting platforms that have been at the heart of the sports gambling boom.
“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,” van der Maas said.
Harry Levant, director of gambling policy at the Public Health Advocacy Institute, a legal research group with a mission of reducing harm caused by for-profit products, said the findings spoke to how online platforms were increasing the risk of addiction.
“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,” said Levant, who is in recovery from gambling addiction. “You’re introducing younger and more vulnerable people to a highly addictive product.”
The American Gaming Association, a trade group that represents sportsbooks and other gambling companies, said the study reflected greater awareness of gambling addiction, not a growing underlying problem.
“While problem gambling is a serious condition for those impacted, this study does not indicate an increasing rate of addiction,” it 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.”
A spokesperson for the association said the industry invests around $500 million annually in education, research and support for those struggling with problem gambling.
Experts, however, stressed that problem gambling is much more common than what Epic Research’s analysis was able to capture.
While a few states have conducted recent studies to examine the prevalence of problem gambling, the last federally funded national study was conducted in 1999.
Access to treatment still varies widely depending on location even as online betting has erupted across the U.S. So does state funding for gambling prevention, education and services — which is often drawn from state tax revenue collected from gambling companies.
But some providers who specialize in treating gambling addiction told NBC News they have observed an influx of patients seeking help.
“We’ve seen definitely an increase in related referrals and diagnoses,” said Steven Heim, outpatient supervisor at New Hope Integrated Behavioral Health Care, a treatment center in New Jersey, which legalized sports betting in 2018.
In fact, experts said, only a small fraction of those with gambling disorders will end up being diagnosed in medical settings. Health providers typically do not screen for gambling problems, and even known cases do not always get labeled with the diagnostic code for gambling disorder.
People who develop gambling problems also may not be willing or able to recognize their symptoms of addiction, which are often invisible to loved ones, as well, expert researchers and clinicians said. And those who do seek help often do so outside of formal health care settings, through peer-support groups like Gamblers Anonymous or online forums.
“Typically no more than 3 to 10% of people who would be diagnosed with disordered gambling actually access treatment services for a gambling problem,” said Rachel Volberg, a leading gambling researcher who found a significant increase in financial, emotional and relationship harms reported by gamblers in Massachusetts after the state legalized sports betting in 2022.
Symptoms of gambling disorder include an ongoing preoccupation with gambling, a need to gamble increasingly large amounts of money, repeated unsuccessful attempts to stop gambling, lying to family members and others about the extent of gambling and relying on others for a financial bailout linked to gambling, according to the Diagnostic and Statistical Manual of Mental Health Disorders.
“It is an addiction that for many people is silent — there are no visible manifestations,” said Levant, who stole close to $2 million from his clients, friends and family members to fund his gambling habit more than a decade ago. “By the time it is diagnosed, the amount of pain and suffering and misery on the person and their loved ones is enormous.”
Gambling disorder is now classified in the same section in the DSM as substance abuse disorders because of the similarities in clinical presentation and treatment.
“It affects the brain in the same way that heroin or any other psychoactive drug does,” said Dr. Anthony Comerford, New Hope’s CEO. “It works through the same mechanisms — those same cravings come into play.”
Other recent studies have linked the legalization of online sports gambling to an increase in bankruptcies, debt and credit card delinquencies, as well as a decrease in credit scores and savings. The differences between the states that legalize sports betting and those that do not may be becoming smaller amid the rise of new platforms like prediction markets, which allow residents to place wagers on sports events regardless of whether online sports betting is legal where they live. The platforms are not regulated by states as gambling companies and typically have minimum ages of 18 instead of 21. (Prediction markets say they are trading platforms, not gambling companies, and have their own “responsible trading tools.”)
“It’s going to take a few years for us to recognize these harms, because it doesn’t show up on day one,” said former New Jersey Attorney General Matthew Platkin, who oversaw gambling enforcement. “It takes a while for problematic gambling behaviors to appear, and I will bet anything that three years from now, we’re going to see a spike.”
