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Sports betting and gambling addiction

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Sports betting, which was largely illegal nationwide until a 2018 Supreme Court decision, is now allowed in most states, and billions of dollars are anticipated to be bet on this year’s Super Bowl alone. For some it’s entertainment, but for the many individuals who find it difficult to stop, the pervasive marketing and availability of sports gambling can be a ticket to financial and personal ruin. SciLine’s media briefing covered the current landscape of U.S. sports betting; the science of gambling addiction, including who is most at risk and impacts on physical and mental health; and evidence-based solutions to prevent problem gambling. Three panelists made brief presentations and then took reporter questions on the record.

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Introduction

[00:00:21]

RICK WEISS: Hello, everyone and welcome to SciLine’s Media Briefing on sports betting and gambling addiction. I’m SciLine’s director, Rick Weiss. And for those not familiar with SciLine, we are a philanthropically funded, editorially independent free service for journalists and scientists. We’re based at the nonprofit American Association for the Advancement of Science. And our mission is pretty straightforward. It’s just to make it as easy as possible for reporters like you to get more scientifically validated evidence into your news stories. And, as you’ll see, if you check us out at sciline.org, that means not just for stories about science but really any kind of story that you might be working on that can be strengthened by adding some scientific evidence which, in our view, is just about any kind of story you can think of. And that’s certainly true for the topic we’re covering today.

Billions of dollars are going to be wagered on this coming weekend’s Super Bowl just on that one event alone this year, and it’s not all about who wins. You can bet on how long the national anthem is going to go. You can bet on the color of a Gatorade that’s going to drench the coach. You can bet on how many times Donald Trump is going to tweet about Taylor Swift during the game. And that all sounds like a lot of fun. But, as we’ll learn today, it’s dangerous for many people. And that’s where you’re going to want to include some science in your sports or business stories about sports betting. So, whether you’re a sports journalist, business writer, an entertainment blogger, or a health reporter, this is a chance to get some scientifically validated facts into your stories. A couple of quick logistical details before we start. We’ve got three panelists who are going to make short presentations of up to seven minutes each before we open things up to Q&A. To enter a question during or after these presentations, just hover over the bottom of your zoom window. Select Q&A; and enter your name, the news outlet, and your question. If you want to pose that question to a specific panelist, be sure to note that. A full video of this briefing will be available probably by the end of the day today. But if you need something sooner, just let us know through that Q&A box; and we’ll send you something right off the bat at the end of the briefing.

I’m not going to take the time to do full introductions of our three speakers, their bios are on the SciLine website. I just want to tell you that we will hear first from Dr. Shane Kraus, an assistant professor of psychology and director of the Behavioral Addictions Lab at the University of Nevada in Las Vegas, an opportune location if you want to do field research in gambling, I guess. Dr. Kraus will give us an overview of the landscape of legal sports betting, some relevant demographics of the participants, and a bit about the advertising and recruitment that fuels this burgeoning marketplace. We’re going to hear second from Dr. Marc Potenza, a professor of psychiatry and neuroscience and director of the Center of Excellence in Gambling Research, all at the Yale School of Medicine. Dr. Potenza will clarify the ways in which gambling is an addiction with a lot of similarities, actually, to substance abuse, including how it affects the brain. And he’s going to describe some of the impacts of gambling addiction on physical and mental health. And, third, we’ll hear from Dr. Timothy Fong, a clinical professor of psychiatry at UCLA’s Institute for Neuroscience and Human Behavior. He’s going to talk about what’s known about the availability and efficacy of treatments and preventive measures, including psychological interventions, limits on advertising, and some of those rapid response helplines that I think some of you have seen out there. Okay. So, let’s just jump in and get started. And that means you’re up, Dr. Shane Kraus.

Sports betting and gambling addiction

[00:04:06]

SHANE KRAUS: Okay. So, thank you, everyone. So, I’m really excited to be here. I’m actually, as was said, I’m at University of Nevada in Las Vegas. I work in a phenomenal place to study gambling and problem gambling as well. So, I’m excited to be here, and thank you for having me. And let’s go ahead and do a quick overview. So, sports betting history has kind of evolved. So, originally, sports betting was previously illegal under the Professional and Amateur Sports Protection Act in 1992. However, Delaware and Montana, Nevada, and Oregon had preexisting lotteries, sports lotteries that were allowed to kind of be exempt from sports betting. However, in 2018, so about six years ago, the Supreme Court in Murphy and National Collegiate Athletic Association struck down this law in allowing states to legalize sports betting. And since then we’ve really had a really huge proliferation of sports wagering and sports betting throughout the country, which we’ll talk about. But just to give you an idea of scope of how big we’re talking, in six years, 306—over $306 billion has been handled, 25.3 billion in gross revenue; 4.5 billion in taxes has been generated so far. Again, I think 2024 is going to be even a bigger year than the prior years. Nevada alone is a big state for sports wagering, as well. We have—in six years, as well, we’ve handled 37, almost 37 million—billion, 2.1 billion in gross revenue, and 142 million in the Super Bowl last year, in 2023, which was very big. Nevada alone handled through our casinos, sports books here and $150 million was wagered for one game. I think that’s going to be much higher now that we have the Super Bowl here in Vegas.

So, this is a map of the current regulation. So, what you’re seeing is there’s 38 that are red, that those are states that have legal sports wagering or gambling in some capacity. Here, there are four states that are kind of this—I’m not sure, a brownish color. That is where we have four states that are in the process of trying to legalize it. And then we have seven states that were, in a sense, it’s not going to happen; or currently there’s no legislation and one that is not moving forward. So, you can really see we went from four that were kind of a small time to really proliferation, and this will continue to spread. So, the question that we always get is who bets on sports? And I think this is an evolving question. I would say that this is kind of what research and some of our research in this lab is also finding. But, generally, from a recent survey from last year, they found that, when we look at who’s sports—those who are sports bettors, they’re predominantly male. They’re more likely to be white, have higher income, and under 35. Again, I think as more and more people are engaging in sports wagering, I think these demographics should be—will be shifting, and we really want to be kind of evolving our understanding. But the question is also, you know, 84% of them are actually reported being a sports fan; 67% actually went to a live sporting event in the past year; 62% participate in a fantasy football league or sports leagues. These are things where people get together teams, and they create fantasy or, in a sense, not real teams. But they use players in the league, and you can gamble and wager money through them as well. And then 41% watch eSports, and this is like video games and betting on video games.

So, this is—just came out to where it’s expected that about, you know, almost really 29 million people will intend to place an online wager for this year in Super Bowl. So, I think that is definitely—I think that’s an increase and reflecting of the popularity of this. One of the things that we need to be having a conversation—I know Dr. Potenza will speak more to this—is that what about problematic sports wagering? And, really, there’s not a lot of research yet. It’s an evolving area. But a couple of things that we know from the work we’ve done is that, worldwide, research generally suggests that sports betting is really—is associated with elevated risk for problem gambling across—and this is across countries and languages and cultures. Our work that we’ve done here recently is eSports wagering, daily fantasy football. In general, sports wagering are generally associated with more problem gambling or higher severity compared to those without. We’re also seeing more heavier substance use among those who engage in sports betting compared to those who do not, which has its own risk factors as we’ll hear soon.

And, again, people who really bet—so the takeaway here is people who bet on—who gamble on sports, I think they often might be a higher risk category. But it’s really important for—to look at two things. It’s people who bet more frequently in sports and also bet on two or more sports. So, as people bet on more sports across different sports, the risks for problem gambling will be shown to increase. So, the media is really everywhere, advertisements there. There’s lots of push, you know, a lot of excitement. The issue we’re having is there’s limited scientific data on sports wagering really in advertisement for youth despite massive proliferation, right, that we’re seeing in the U.S. and throughout the world. But what we know, though, what signals we’re getting is that sports betting advertisements so signup bonuses are related to at-risk behavior. So, when you look at the screen, you’ll see it says $200 bonus, you know, bet. Sign up. When we’re offering money or incentives for advertisement, that itself has been seeming to be in a risk factor for young adults, and this is prolific through the industry right now. So, I think it’s something further for consideration. We also know that sports betting advertisement through social media, which uses odds or other things, is more salient for men. And men are a risk factor, particularly between eight—under 30 years old. So, again, an area that we should be considering. And what we know is that responsible marketing codes or rules around language and being careful that we’re not using enticing or really problematic language is not being enforced in advertisement, nor is it being enforced across states.

So, these are some concerns. And I think with the Superbowl coming—I’ve heard there’s three odds—It’s going to be interesting to see what language is coming forward, you know, is moving forward through for marketing purposes. So, that’s all I have for my slides. So, thank you.

[00:10:19]

RICK WEISS: Great. Thank you, Dr. Kraus. Fantastic opener to get us a sense of the landscape and the edges of the problem here. Let’s move on to Dr. Marc Potenza for more.

Gambling disorder as an addiction

[00:10:31]

MARC POTENZA: I will share my screen and start my presentation. Thank you for having me here. I’ll be talking about gambling disorder as an addiction. So, it brings us to the question of what is addiction. And, historically, addictions have been viewed at least for the past several hundred years as involving excessive or problematic use of substances like alcohol or other drugs. From a societal perspective, addictions have been viewed from multiple perspectives as a sin, a vice, or as an addiction as a bad habit. And it’s only been more recently that even substance use disorders have been considered as mental disorders. And then, more recently, gambling disorder has been introduced into the main nomenclature systems that physicians use as the gold standard for considering mental health disorders.

So, what are addictions? What are the core elements? So, some may describe these as the C’s of addiction: compulsive engagement, a craving or an appetitive urge state that immediately precedes engagement in the behavior; poor control over the behavior; and then, importantly, continued participation in the behavior despite adverse consequences. And if we think about whether non-substance behaviors like gambling could fit with these core elements, then the answer is yes. And this has raised the question as to whether gambling disorder might be an addiction. And in the most recent editions of the Diagnostic and Statistical Manual that’s generated by the American Psychiatric Association and the International Classification of Diseases that’s generated by the World Health Organization, both of these books or entities categorize gambling disorder as a behavioral addiction.

So, what are some of the other ways that people might consider gambling disorder? There were multiple competing theories: as obsessive compulsive spectrum disorder, not being a disorder, that it’s secondary to other behaviors, or as an addiction. When initially introduced into the Diagnostic and Statistical Manual now over 40 years ago, the diagnostic term was pathological gambling. In going from the 4th edition to the 5th edition of the Diagnostic and Statistical Manual, it was felt that the term pathological was stigmatizing and was removed, and the term gambling disorder was—is now the formal condition. It was initially classified as an impulse control disorder not elsewhere classified, which was a heterogeneous grouping of conditions. And it was felt that this grouping given the heterogeneity and the additional information gained about the conditions, several disorders including gambling disorder were separated out. So, since 2013 in the Diagnostic and Statistical Manual and 2018 and 2019 when the 11th revision of the International Classification of Diseases was released, both of these entities now consider gambling disorder as a behavioral addiction.

So, what are the relationships between substance use disorders, the prototypical addiction, and gambling disorder? So, when the Diagnostic and Statistical Manual, DSM, workgroup met prior to DSM-5, I and another individual, Dr. Nancy Petry, were asked to look at gambling disorder and substance use disorders and look at similarities and differences in multiple domains, clinical aspects, epidemiological, phenomenological, genetic, and others. And based on the similarities, gambling disorder was reclassified together with substance use disorders as addictive disorders. Some of these phenomenological and clinical aspects include co-occurring disorders and the high prevalence within young—younger individuals, adolescents and young adults that we heard about from Dr. Kraus, as well as biological similarities that include, for example, how people process rewards. So, some of the brain regions and networks that are involved in processing of non-addiction-related rewards like money seem to be shared across substance use and gambling disorders.

Now, there are differences that also exist. There are differences that exist across substance use disorders. For example, withdrawing from alcohol, tobacco, cannabis all have different features. This is the same with gambling disorder where the withdrawal aspect tends to be more of an irritability or short temperedness of not being able to gamble when one wants to in the setting of having recently gambled. Another difference from a clinical perspective is the amount of financial debt that many people with gambling disorders experience, which is often substantially greater than for substance use disorders. As we heard from Dr. Kraus, young males, particularly those with sporting involvement or interests, appear to be particularly at risk. And we also heard about perhaps this perfect storm involving the overturning of the Protection of Amateur and Professional Sports Act, the sporting culture within the United States, the accessibility of the Internet to remove geographic and time boundaries—when people feel like gambling, they can do so relatively immediately—as well as advertising, media, and other factors may be contributing to a rise in sports gambling problems. Importantly, there’s been less attention given to gambling disorder relative to substance use disorders. There are data that indicate that many people see gambling as less harmful than substance use behaviors. There’s also a greater threshold needed for making a diagnosis of gambling disorder than there is for making a diagnosis of a substance use disorder.

And perhaps these are some factors that contribute to most people with gambling disorder not seeking or receiving treatment. Another factor is that there’s little—relatively little funding for problem gambling treatment and research. And this has been noted. And the GRIT Act has recently been introduced by a senator in the state of Connecticut, Sen. Blumenthal. And this GRIT Act is the Gambling Addiction Recovery, Investment, and Treatment Act, which seeks to set aside half of the federal sports excise tax revenue to fund programs for gambling addiction, prevention, treatment and research. Notably, this would not result in any increases in taxes and would utilize existing health and human services infrastructure to increase the resources that are available to help understand people with gambling problems and to provide treatment for the approximately 7 million U.S. citizens who are estimated to have gambling problems. So, some references of some articles are here, as well as information on the GRIT Act on the website of the National Council on Problem Gambling, as well as my contact information. And thank you for the time and opportunity to share this information.

[00:19:46]

RICK WEISS: Thank you, Dr. Potenza. And a reminder to reporters that these slides will be posted at the end of the briefing today, so you’ll be able to study those more closely and click on some of those links. And let’s move on to Dr. Timothy Fong.

The availability and efficacy of treatments for gambling addiction

[00:20:04]

TIMOTHY FONG: Thank you, Rick. And thank you, Dr. Potenza and Dr. Kraus for setting it up. And thanks for all the audience out there. I’m going to talk about some of the solutions and prevention and treatment. So, the real question is, what can we do? So, we know, again, about 1 to 2% of the population has this affliction of gambling disorder. What does treatment look like? This is a biological, psychological, social condition, biological and psychological social risk factors created. That means, for treatment, it’s biological, psychological, social treatments that we use.

The biological treatments are, in following category, number 1, medications. And we don’t have any FDA approved medications right now. But we do have a number of research medication that have been evaluated over the last 25 years. Medications like opioid antagonists and other things that we use for addictive disorders have been shown in the lab to be potentially effective for reducing the symptoms of gambling disorder. Number 2 with medication is treating the very more than likely co-occurring psychiatric conditions that come with gambling disorder: depression, ADHD, trauma, anxiety disorder. When we use those medications, that lays the groundwork for folks to be able to do recovery work in gambling disorder. I also think about other biological treatments, things like sleep hygiene; things like physical movement and exercise; and even nutrition, food as medicine. These are biological treatments that, although they sound very, very simple, are really, really crucial for restoring mental health and wellness in the brains and minds of men and women with gambling disorder.

Number 2, psychological treatments for gambling disorder, we borrow a lot from the other fields of addiction, mental health. We have, you know, dozens and dozens of types of psychotherapy that can be used. The thing that’s very interesting now in 2024 is the emergence of telehealth therapy for licensed therapy and counseling over the telehealth, just like we’re doing right now with Zoom. And we have specialized treatment providers across the nation and the globe who can provide these specialized types of psychotherapy through the Zoom platform and through telehealth. So, again, these psychotherapies identify the cognitive distortion, to identify an increased motivation to do recovery work to help people with gambling disorder reduce the emotional trauma, the emotional distress that they have from gambling. And, third, we have social treatments. And, of course, one would think about Gamblers Anonymous as a part of that social treatment that report for fellowship and support and recovery. But now we have some other newer ones, including things like software blockers, like Gamban that prevent you from logging on our or getting pop ups from gambling-related websites and gambling and things like that. We also have self-exclusion programs where, of course, you can be ban yourself from online as well as brick and mortar casinos and not actually have your players account active and not get teasers and emails moving forward. So, those are the some of the social treatments that have that are emerging.

We also are using more and more technology. Dr. Potenza has a very interesting use of computer-based cognitive behavior therapy, which means that you don’t always have to wait for your therapist to actually do work on recovery, to have that available 24/7 on your phone or on your laptop. That makes sense. If we’re going to make addiction available 24/7, we need to make recovery and solutions available 24/7. Bio, psychosocial treatments, how effective do all those work? They actually work quite well. And I think oftentimes people say, Well, how well? Well, we know they work well. I’ve roughly in our state of California, when people come into treatment, about 40 to 50% are able within just six months to have meaningful improvements in their signs and symptoms of gambling disorder, meaning their lives are better, meaning they can function better. They are engaging more in recovery activities. The trouble we have with gambling disorder treatment, it’s not a condition that most people run to go see their doctor or psychologist for. This is a hidden addiction this is a disorder that’s filled with shame and stigma. And in the early phases of this condition, you believe that, if I just keep gambling, I’m going to make all the problems go away. By the time men and women come into our state gambling treatment program in California, it’s very, very severe. Essentially, almost all the DSM criteria are met.

The average amount of debt that our gambler and gambling patients when they come into state treatment is about $40,000 in debt from just gambling; higher rates of co-occurring substance use; large amounts of distress and what I call lethal emotional pain, high rates of suicide attempts, high rates of suicide completion. So, put that all together. What do we do now is we have to figure out how do we spark the conversation to get men and women who are experiencing harm from gambling disorder at an earlier stage to come in. Many, many cancers, it’s the same thing. People have no symptoms whatsoever. But when they get screened for cancer, blood in your stool, weight loss, or blood marker that’s elevated, that usually then triggers an additional screening and assessment.

Our screening tools for gambling are interviews, are self-questions, are things that are out there. If I’m working with a primary care audience, I have really one question I’ll say to a person. Does your gambling behavior increase your quality of life, or does it create problems, problems that can be wide-ranging from physical, social, psychological, and financial? If it creates problems, that’s something you should be concerned about. A more standard question is a two-item questionnaire we call the lie-bet question. Have you ever lied to anyone about the extent of your gambling? Have you ever had the need to increase your bet to get that same sense of thrill or action? A yes answer to one of those two questions should then alert the health care provider or the mental health provider do a thorough assessment and go through the diagnostic criteria. So, we don’t have a blood test. We don’t have a brain scan. We don’t have any fancy Star Trek tricorders that can tell us that you have a gambling issue. We wish we did. And that’s something the three of us had been working on for the last 25 years. But we don’t have any objective biological test. There really goes back to the central question there.

And the third part I’ll talk about, again, and about other issues of prevention. And it starts with, number 1, healthy and proper education of the risks of gambling, starting for young people, even in kindergarten, to talk about the risks of gambling and what gambling addiction looks like. Number 2, it’s enforcement. Very clear that this is an adult entertainment product. This is meant to be 21 and over, some states 18 and over. But we heard earlier from Dr. Kraus, very little enforcement of the regulation of the gambling that are set forth by state regulators. Number three, really looking at the gambling advertising and saying, if we’re going to regulate alcohol, tobacco, and cannabis advertising, what’s the reason that we don’t regulate gambling advertisement with the same full force, the same sense of seriousness, the same sense of scientific understanding that we do with those other conditions there as well. So, those are some of the areas that we look at with prevention. If I had one prevention message is to delay the onset of the very first bet combined with delaying the frequency of betting. We certainly know that the younger you are when you start gambling combined with the more frequent you start gambling, those are definitely concerning risk factors. And, of course, that’s why having access to the phone and 24/7 access to gambling is so concerning, because you talk about early access and frequent access. That’s the recipe that we have there. So, I didn’t have any fancy slides here today. I’ve been stuck in this rainstorm in LA. I can barely survive. But we have survived. But, absolutely, I do have some slides if people want to see them at a later time. But you can always reach out and find me on Twitter at Fongster98. Or check out our beautiful website at uclagamblingprogram.org.

Q&A


What is being done well in press coverage of these issues, and where is there room for improvement?


[00:28:15]

RICK WEISS: Fantastic. Thank you so much, Dr. Fong, for that super interesting closing part of our introductory materials. Such an interesting concept, that if gambling is going to be available, you know, every moment of every day, treatment ought to be as well. That’s a really interesting point. So, we’re going to get into the questions and answers now. I’ll remind reporters you can click on the Q&A icon at the bottom of your screen and enter your question. And, meanwhile, as those come in, I do typically start in these briefings with one question from the moderator. And that question is always the same. It’s basically can you three experts, as news consumers, speak to our reporters today and just say one or two things about something that you either appreciate about the way that media seems to be handling coverage of this issue, or give a critique or a suggestion of how the media could perhaps improve how it’s going about bringing this topic into the news? And I’ll start with you, Shane Kraus.

[00:29:14]

SHANE KRAUS: Yeah. I would say I think I really appreciate the last couple years has been more stories, more discussion on sports betting as it’s happening. So, I really—I’m really grateful. Just like this, I think we need more discussions. I think my suggestion would be to really dig deep. I think what—when I speak to a lot of journalists who are doing really, really great stories, they keep finding this disparity between wide access, increased access, and little funding for research, little funding for treatment. And that doesn’t really compare to other addictions. So, I think that’s a—be curious. Dig. And we should also be asking for some, you know, similar safeguards because I don’t really think they’re really set up right now. And despite the proliferation, and I think we’re going to break records today and even in Vegas, we’re going to break records for wagering. And that has risk, particularly for, as Dr. Fong mentioned. So, I think that’s—those are things to really consider.

[00:30:07]

RICK WEISS: Very interesting. It might be interesting for us a little later in this event to talk about whether some of the forces that have fought against closer regulation and so on in other areas like tobacco and oil might have—be playing a similar game in this domain. There’s a lot of money at stake. That’s for sure. Dr. Potenza, how about you?

[00:30:26]

MARC POTENZA: Yeah. I would echo what Dr. Kraus has mentioned. I appreciate the coverage of this important issue to communicate that gambling for some can be very devastating. And to cover this during times like prior to the Superbowl I think is a time when people are amenable to hearing about the potential risks that are associated with the behavior. So, grateful for the coverage. Similarly, I would say that digging deep and perhaps not oversimplifying some aspects like the neurobiology being dopamine solely. Go deeper than that would be my recommendation. But I’m really grateful for the important points that are being brought to the public attention about trying to make gambling a safe activity for all individuals and addressing the risks that—about the problems that some people experience and how to identify those people at earlier stages and get them the appropriate help that—from which they’re going to benefit, not only the identified individual but also the family members who—and others who may be affected indirectly.

[00:32:04]

RICK WEISS: Like other addictions, there’s more than one victim here. Dr. Fong.

[00:32:09]

TIMOTHY FONG: So, you know, 15, 20 years ago when we first started, almost all the media inquiries were about, like, Who do you like to win the Superbowl? You know, who do you have your money on? Things like that. And there was a lack of seriousness. So, I think, number one, I really encourage media not to glamorize gambling stories, right, not to celebrate, Here’s an average Joe who put $5 down and now he won, you know, $10,000. And you know, that really, I think, is not—that’s a disservice to kind of what we see here. That’s just advertising. Number 2, I don’t like stories that generate a lot of fear. So, much about the media criticisms about fear, fear, fear, fear, fear, fear, right? And, you know, we see a lot of stories of this is Joe, and he lost his shirt. And he’s terrible. And it’s really horrible stuff. And it’s really hard. But it’s—it creates fear at the idea that everyone’s going to develop a gambling disorder. And that’s not true, either. Instead, I’d like to see stories of recovery. Stories of inspiration of folks who have gone through it. And we do see some of that but then also for them to share their message of what got them into treatment. That’s the missing part. You always hear them say, Yeah, I’m better now because of treatment, blah, blah, blah. But you don’t hear, well, what really got you into treatment. What was the motivating factor? And I think, when you put it all together and really highlight what this is, gambling should be viewed in the media as a public health topic, no different than air quality, water quality, food safety. It should be treated as such. And the connection that you operate in, there’s going to be a connection with gambling, gambling disorder, and whatever you look at, whether it’s mental health, sociology, economics, sports reporting, and things like that. The thing I’ll say, I think the vast majority of sports reporters who do report on Gambling do it from the gambling line and do it from the gaming perspective, and I think that that’s really where I challenge a lot of sports reporters to do more and talk about, well, it’s part of our job to talk about the whole story, not just the betting line and whether that line is accurate, what you think about how it impacts the sport better and things like that.


How could adding a responsible gambling program to school curriculums impact teen behavior?


[00:34:21]

RICK WEISS: Great. Thank you all very much for that. And let’s get into some reporter questions. I’ll start with this one from Ellen Rolfes, who’s a reporter at Marketplace. Some states are considering adding a responsible gambling curriculum to teach teens about gambling, as many young people are starting to make bets. When it comes to the scientific research, how could this impact teen behavior? Does anyone want to jump on that, know what the scientific basis is of whatever trainings are starting to get created?

[00:34:55]

TIMOTHY FONG: Marc should jump in on that, and I’ll—

[00:34:57]

MARC POTENZA: I’m happy to jump in.

[00:34:58]

TIMOTHY FONG: What Marc doesn’t say, I’ll say the opposite.

[00:35:03]

MARC POTENZA: Yeah. So, teaching youth about risk behaviors is an important effort. And gambling is often omitted from risk behaviors taught to children and adolescents. So, I think it’s a welcome addition to try to educate children and adolescents and young adults about the potential risks associated with gambling. Now, how best to do that. What are the programs that have empirical support for behaviors like substance use, that’s a challenge because how—you know, part of the developmental process of children moving into adulthood, adolescence is a period of risk taking. And even with education about the risks of smoking and alcohol use and cannabis use, youth engage in these behaviors? So, how do we mitigate the harm? How do we try to promote healthier behaviors is a challenge that is going to exist, even with educational efforts. So, I think what Dr. Fong had mentioned about things like how do we limit advertising, how do we limit the glorification of a potentially risky behavior is, I think, an important way to have an affect on a broad range of individuals, including youth, who may be watching different forms of media, seeing these advertisements of people who they admire, Hollywood celebrities, sports figures who are advocating for gambling on sports. And it is also how these sports advertisements are being portrayed, like get X number of dollars in free bets. It may also be misleading, particularly to youth who may not understand some of the complexities. So, there are ways I think where we can do better. And it’s going to take multifaceted approach to try to protect the public health and protect developing individuals, youth navigate a complex environment.

[00:37:40]

TIMOTHY FONG: And I’ll just add to that. What we know does not work is to just say no. That does not work. We also know that getting forced curriculum into schools is very difficult to get school, you know, approval to do that. In California, we did have a project that showed that did work where we had a youth-led project where the young people created gambling public service announcements themselves, and then we track their own gambling behavior over time. And it turned out that they were much less likely than other teenagers to engage in gambling behavior at a younger age. So, again, it’s educating youth. It’s empowering youth to start off earlier on. And, again, under these responsible gambling curriculum, it’s not about teaching math. It’s not about teaching the odds. It’s about teaching resilience. It’s about teaching how to deal with loss. It’s about how—teaching how to deal with fear of missing out. These are the themes that we now know are much more science based that work not just for gambling but for tobacco, alcohol, and substance use prevention.


What has been the effect of the NFL’s partnership with sports betting companies?


[00:38:40]

RICK WEISS: Fascinating. Here’s a question that maybe it’s up your alley, Dr. Kraus. This is from Craig Miller, a freelancer based in New York. What’s the effect of the NFL reversing itself and going all in on this, even becoming an official partner with the big bet companies, including more betting parameters in their game broadcast stats, etc.?

[00:39:03]

SHANE KRAUS: Yeah. So, I think—again, I think the big issue is, again, that expansion that we’ve seen, I mean, I don’t—there’s nothing else that compares, such wide expansion across for—you know, we haven’t seen cannabis go from 4 to 38 states overnight. There’s so much money, so much advertisement. And I think—you know, so we know where the most ads for sports wagering are during NFL games, right. So, I think it’s a money decision. I think it’s problematic from my perspective that we’re not—we don’t understand what we don’t know. And when you ramp up really quickly, there’s a lot of risk factors. And I think there hasn’t been enough discussion around mitigating harm and outreach and understanding. And the youth, I mean, there’s a lot of people who don’t understand there’s risk with gambling. And, again, there are young people who are gambling and doing lots of things. So, I’m not sure. I really think it—I don’t know that—I think it’s going to be problematic, I think, because there’s going to be three odds. There’s at least three odds now for the Superbowl and what does that mean? And, again, people, often young people don’t understand the risk associated with it. And I think it’s a big issue. So, I mean, I don’t know. I think we’ll see how it turns out. And they may—they might find themselves in the industry in a position they’re going to have a really hard time getting out of, you know, as research and more comes out. Yep.


Does the fact that education and other public services receive funding from gambling counter against efforts to limit sports betting?


[00:40:18]

RICK WEISS: You know, if I can add an addendum onto that question, though. Isn’t it important that more and more public services, I think education, among other things, is dependent upon this funding? Does that create a counter force against efforts to limit things?

[00:40:35]

SHANE KRAUS: Well, I think what we need, as we mentioned, Dr. Potenza mentioned, we need a much robust system for funding. The industry funding is pretty limited. I think, yes. There’s some money, 6 million, but I think would you say $6 million amount is sufficient for alcohol use wide issues during the Super Bowl, which we know will be very high. So, the answer is it’s really—it’s one of—we need many, much larger players to have funding to do the research with youth outreach, public health. We need to treat it as a public health thing. But we also need federal and state and industry support, which is really not happening. The Bill mentioned was struck down at Congress and it’s dead. So, I think right now—so I think, you know, we’re in this position where we’re ramping up but really not thinking through, I think, tomorrow, I would say we’re not really thinking about tomorrow.

[00:41:22]

RICK WEISS: Any other comments, Marc, or Timothy, before we move on?

[00:41:26]

TIMOTHY FONG: Yeah. You know, I’ve been a big sports fan for a long time. And what we’re seeing now is combining of football and gambling, two things that never once were in the same lane. They were always meant to be opposite. And now you’re going to have a brand new generation of people who only know football and gambling together as the product. NFL has also gotten into the slot machine business. You know, they have NFL slots. And I think what I see at least in the discussions, you know, Americans, don’t like, quote, hypocrisy. They don’t like this idea of you do one thing, and you need to do it this opposite. So, I think if I were advising NFL, I’d say, you know, you need to come out a little stronger to say, you know, what and how is your entertainment product, benefited by partnering with gambling operators. You know, for—they’re a private company. Should they be mandated to pour more money into responsible gambling work and problem gambling research? They’re a private company. But they’re a private company that is the biggest visible company in the world, right. And they do a lot of wonderful social things there as well. They do support some problem gambling efforts there as well. So, I think, again, for me as just a consumer, it’s always about how is the product that I’m watching on the field, how do I make sure it’s really actually true, that the game integrity is true? And I think this is a big question and topic that people are saying. Well, now that the NFL is, quote, partnering with gambling operators, the game must be rigged. Isn’t that fascinating that this is the first year I see more and more and more discussion. It’s rigged. It’s totally rigged, you know. And that, I think, is a fascinating commentary that comes because of this combo of gambling and football together.


What can colleges and universities do to address problem gambling?


[00:43:15]

RICK WEISS: That’s fascinating and part of a much bigger social movement about disinformation these days that I’m sure we could get diverted onto, but we won’t right now. Here’s a question from Tyler Dukes from the Raleigh News & Observer. What should colleges and universities be doing? What’s their responsibility for college students to reduce problem gambling? Anyone want to pick that up?

[00:43:39]

MARC POTENZA: I’m happy to get the ball rolling. So, I think that universities should address this in multiple ways. Part of it would be not to promote gambling so things like casino nights that some universities have sponsored should not be supported by the University or college. And education about the potential harms of gambling by college students would be something to introduce into the colleges. I think what Dr. Fong had said about not scaring people but also informing people is very relevant. And, oftentimes, youth hear things well from peers with lived experience, and perhaps having people who have recovered from gambling problems that they experienced while in college would be an effective way to educate individuals in a way that people can hear it from someone about their own age who has gone through an experience and can be there to engage in and dialogue in a question-and-answer fashion. So, these are ways. There are different ways in which colleges and universities can act proactively to try to help protect their student bodies. And these could be incorporated into times where students may be gambling more heavily, like during March, which is Problem Gambling Awareness Month but also is the time of the NCAA Tournament, and many colleges engage in the NCAA Tournament. And/or it can be done during an orientation for all incoming students or both. There are different ways in which these colleges and universities can think about trying to get the message out in a way that is heard by their students.

[00:46:11]

RICK WEISS: Dr. Kraus, you’re at a university campus where one needs only walk across the street to find a bunch of casinos. Is this something that you see being addressed?

[00:46:21]

SHANE KRAUS: So, I think that I would say the short answer is no. I mean, I think here at UNLV, we have—I think universities minimally should have their mental health clinics. We know there’s comorbid people of gambling have mental health issues. So, screening in all mental health settings will be important. I do think that universities are not taking it seriously. Even UNLV, there’s—recently they partnered with an organization that sent out stuff on sports, March Madness out. And I just thought that’s not—I think universities should not be soliciting or actually just putting out any advertisement for gambling to their student body or in any capacity. I also think we need to be educating more about alcohol use, substance use while gambling, which I think for younger people that’s definitely a risk factor. But, again, I think education is amazing and goes a long way. I think we just have a conversation. But I think we need to work with administrators because I think—and leadership at universities that, you know, we know that young people, you know, college age are gambling online, and that that’s ticking up pretty quickly. So, I think, you know, let’s get ahead of it. Let’s educate. Let’s provide knowledge, as Dr. Potenza mentioned so, you know, to really be in front of that. And I think that’s—we’re still not there. I don’t think so.

[00:47:27]

TIMOTHY FONG: There was a recent NCAA survey that showed that 60% of college students did, in fact, bet on sports, you know. So, it is absolutely a major activity. Again, 18 and up in only a few states. Vast majority of states it’s 21 and up. So, I encourage a lot of college and universities to generate a gambling policy that’s related to their code of conduct. They have alcohol policy. They have substance policies. But I’m not aware of any university that actually has a gambling policy in terms of code of conduct for students who actually do that inside university housing or various things like that. So, that’s definitely an area of growth, and that should be done.


What are some warning signs to look for to assess whether someone has crossed over from normal gambling behavior into problem gambling?


[00:48:08]

RICK WEISS: Very interesting. Here’s a question that’s come in that’s asking for some practical information that I think you all can help with. What are some of the warning signs to look for to assess whether someone, a friend or family member has crossed over from normal gambling behavior into problem gambling? Dr. Fong, I think you’ve touched on some of these signs. You want to start with a few warning signs there.

[00:48:34]

TIMOTHY FONG: Yeah. I mean, all of us, this is our core. And I think if you take 100 men and women with gambling disorder issues, right, and you said what did they look like in the first few months they started to have problems, it’s going to be 100 different stories. It’s going to be all sorts of possibilities from changes in personality, more depression, loss of sleep, not doing your responsibility, more anxiety, financial difficulties, you know, lying, and things like that. So, that’s why gambling disorder is so unique because every history is not the same. But the themes are the same, and that’s the gambling continued. Despite these harmful consequences, biological, psychological, social consequences happening, they keep doing it. The warning signs, and that’s our task to make those connections. Oftentimes, I’ll see folks who are not gambling disorder clients, and they’ll come to me. Oh, I’m depressed. I can’t sleep. You know, I don’t like my spouse. And they think it’s an issue with depression or an issue with the marriage, and it turns out what’s driving that distress is gambling.

[00:49:38]

RICK WEISS: Great.

[00:49:39]

MARC POTENZA: And I’ll add a few other things. So, one common behavior among people with gambling problems is chasing losses so going back to a place of gambling to win back money that was recently lost. So, if people are chasing losses and this may involve people asking others for money. They may not be honest about what the money is for. So, if people begin asking multiple people for money or once you’d have a suspicion of, perhaps this may be related to gambling, if people are not functioning well in different capacities, be it work or for students at school, keeping in mind that there may be behaviors like gambling where there are not visible signs of intoxication. So, keep this in mind and be open to asking people. And people may deny it, may become upset. There may be tension. But, ultimately, it’s trying to care for people around them. And these are also signs that people can take. One is not being honest about their gambling behavior. Begins to hide or conceal or lie about their gambling behavior. That’s concerning. Or experiencing psychological distress about gambling is another concern.

[00:51:21]

SHANE KRAUS: The only thing I would add to that is escapism. So, particularly when we look at U.S. veterans, you know, people with trauma histories, military backgrounds we see sometime this escapism, using gambling to escape kind of where they’re at in their experiences in the moment. So, you know, if you’re really going—if you’re gambling to kind of escape your current stressors or escape, that’s also kind of, I think, something I’d think about. Someone’s like, Oh, I’m going to go because I just can’t handle the whole week, and I’m going to just go blow off steam. But that’s really their reason to do that. That’s also I think, kind of a red flag, like, hey. Let’s talk about that escapism. Gambling should not be an escape, right. And so that gets a little worrisome so.


Within the realm of regulated sports betting, are there any constraints on what people can do—such as how much or how often they can bet?


[00:51:58]

RICK WEISS: Great. Very helpful. We’ve got a few more questions here. I just want to mention to reporters on the line that, as we start to wrap up, when you do log off, you will be prompted for a very short survey. It’s just three or four questions that will take about a half a minute. These surveys are very helpful to us as we plan these media briefings and come up with topics and experts who can help you in your reporting. So, I ask that you do take that extra half a minute or so and fill out the survey for us so we can keep these really informative briefings going for you.

We’ve got a question here that asks, Within the realm of legal sports betting, are there any guardrails, limitations, or constraints on what people can do, for example, maximum amounts one can wager in a single bet or maximum number of wagers that can be placed on a given event?

[00:52:51]

SHANE KRAUS: I’ll just jump in really quickly. I think the—one of the issues we have is we don’t have—we need more access—researchers need access to player data to really understand what’s happening from real people. Some of the research is a bit limited. But I think some of the research now and I think what we’re studying here, as well, in our research is I think some really—I think that—we’re looking at, as well, is live betting. So, once the game started, betting while the game, I think that is incredibly risky, knowing that probably 50% of the people, 40, 50% are actually using substances. So, then prompting and sending advertisement, if someone did that, why they’re probably drinking is likely a poor decision for—or it’s likely related to risk. And I also think using things like overdraft we published or using things like looking at overdrafts, overcommitments, you know, five or six counts to deposit money to different—I think there are ways that, you know, we don’t have all the information, but we need to do something. There should be some safeguards. And there’s really pretty limits—pretty limited, you know. And again, showing someone psychoeducation. Oh, you know, set a limit. Well, someone with problem gambling, they would set a limit if they could. But because they have a problem, they can’t. So, psychoeducation works well for people without the issue. But once you’re on the problem gambling train, psychoeducation, responsible gambling strategies are really ineffective. So, you need to have higher, more direct cut-offs. And that’s still limited. And I think without industry support and without really funding, we might have to take really harsh cut-offs or decisions with play and that. So, we really want to get it right, but we really need more support from industry, as well as, you know, from funding and research perspective so.

[00:54:26]

TIMOTHY FONG: And I’d highlight a couple of facts here that are really interesting, that, you know, of all the mobile online bets, from what I understand, the same game parlay now is the dominant form of sports betting wager, a small amount that you put on multiple outcomes of one game to win a much larger reward. That in my mind is like a slot machine bet. That’s not like a single bet on a winner or loser. So, that’s the dominant form.

The second thing is none of this applies to unregulated sports betting websites. So, that’s the problem, that we really have no idea how many of those are out there unregulated, how to stop them, how to put them down. I’ve had a number of patients that say, I prefer to play on the unregulated sites because they’re faster, they’re quicker, they have more offerings, and it’s completely anonymous. I don’t have to pay taxes or worry about my employer finding out that I’m gambling on unregulated websites. We have a colleague who advocates for the idea that, when you—the first year that you sign up for a mobile sports betting that you have almost like a gambling license, that you have a maximum amount that you can spend per year on your first year or while you learn how to gamble. Well, that’s like a driver’s license. That doesn’t—I don’t think that’s going to work in America. But those are the sorts of things that we’re kind of interested in. And, lastly, how do you do this when a lot of states have multiple gambling operators? It isn’t just one, you know. For instance, like certain states will have—like Ohio has like six gambling mobile sports operators. Other states will have as many as 17. So, if you just put the restrictions on one site, it’s just—guy just logs off and gets on another site that is giving them a teaser. Anyway, just a few ideas. Dr. Potenza I know has a few comments to back that up too.

[00:56:14]

RICK WEISS: Anything you want to add, Marc, on limitations?

[00:56:16]

MARC POTENZA: Well, I am mindful of the time that we have and want to make sure that we get to all the questions. So, I’ll pass on this.


What can healthcare providers do to screen for problem gambling?


[00:56:26]

RICK WEISS: Well, I was just about to wrap up with a last question from me. So, if you want to say something quickly on this topic, we’ll, you know.

[00:56:34]

MARC POTENZA: Well, yeah, I think that one thing that I would like to bring up that is separate from this topic, just briefly, because I do see in the chat about healthcare providers screening. I do think that this is very important like physicians asked about tobacco use and alcohol use, to add gambling. But I would also add cannabis use to that list of what healthcare providers ask about, given the changing landscape with cannabis use, as well, with cannabis.


How have gambling apps changed the landscape of sports betting?


[00:57:14]

RICK WEISS: Yeah. I’m sorry we didn’t—we’ve got just two minutes left. But we did have a question that I had missed here about how betting apps have changed betting. This is from Nick Lehr at The Conversation. And do they actually screen out users who are under 18 or 21? Are their push notifications to encourage betting or live betting? Anyone wanted to quickly weigh in on that?

[00:57:40]

SHANE KRAUS: I don’t—again, because there’s unregulated, regulated, I don’t think there’s really good—we know that push using—push updates are used. I mean, that’s used for all social media, right. So, I think that’s happening. I think that’s not—it’s just the degree and how aggressiveness and the marketing saying, Oh, we’ll match $20. You know, you don’t go to the store and you’re buying a bottle wine and say, oh, we’re going to give you 3 bottles because you bought the one. So, again, I think there’s some of that happening, again, because it’s so many companies, so unregulated and all varying. There really has to be oversight and kind of like kind of understanding a better landscape. We just don’t know, which is really why I think it’s concerning.

[00:58:19]

TIMOTHY FONG: It’s incredibly difficult to have online compliance of gambling operators. I mean, it’s not like a brick and mortar where you have controlled space. And I hold the operators responsible. But I also hold the states who authorize and regulate them responsible because it’s got to be a shared partnership. So, I’ve so many patients that have used VPNs who have gone on under age, you know, onto legal regulated websites, and they just didn’t know. Vice versa, again, the technology is there. It’s just how do we find the will and the ability to actually have healthier compliance in accordance with the regulations to which they were legalized.


What is one key take-home message for reporters covering this topic?


[00:59:00]

RICK WEISS: Great. Great way to wrap up. I like to end these briefings with just a real quick pithy comment from each of the three of you. Often these are most helpful, succinct things that reporters can go with. One take-home message that you want every reporter to walk away with today who have been on this briefing, and what would that be. Shane.

[00:59:19]

SHANE KRAUS: I think it’s going to be dig deep to look at your area, your community. So, again, if everyone’s looking within their community, in their areas, in their states, I think that’s a really good thing for us.

[00:59:30]

RICK WEISS: Great. Marc.

[00:59:31]

MARC POTENZA: Most people gamble. Most people gamble develop—without developing problems, but a small percentage develop problems that can be very severe. And making sure that we protect vulnerable individuals, including developing youth. Is really important.

[00:59:49]

RICK WEISS: And Timothy.

[00:59:50]

TIMOTHY FONG: Gambling is a public health issue. And it’s important for us to continue having conversations about all the aspects of how it impacts body, brain, minds, and communities.

[01:00:04]

RICK WEISS: I want to thank our excellent panel of presenters today. A lot of great information on a very timely topic. I also want to encourage reporters who are online here to fill out the survey as you leave us today. We’ll keep you informed about other upcoming briefings. Thank you all for participating and for educating the public through your various ways about this important public health issue. See you at the next SciLine Media Briefing.

Dr. Timothy Fong

University of California Los Angeles

Dr. Timothy Fong is a clinical professor of psychiatry, board-certified in addiction psychiatry, at the Semel Institute for Neuroscience and Human Behavior at the University of California Los Angeles. Dr. Fong’s primary research interest is understanding the neurobiological mechanisms that contribute to pathological behavior.  He is also the co-director of the UCLA Gambling Studies Program, with the goal of examining the underlying causes and clinical characteristics of gambling disorder in order to develop effective, evidence-based treatment strategies.

Declared interests:

None.

Dr. Shane Kraus

University of Nevada, Las Vegas

Dr. Shane Kraus is an assistant professor of psychology at University of Nevada, Las Vegas. Dr. Kraus is a licensed clinical psychologist and expert in psychopathology, sexual trauma, substance use disorders, gambling disorders, and compulsive sexual behavior disorder. Dr. Kraus uses behavioral, epidemiological, and neurobiological methods to assess factors that contribute to the development of addictive behaviors and other co-occurring psychiatric disorders among at-risk groups (e.g., U.S. military veterans, young adults). His research on gambling is also exploring effective screening approaches for identifying individuals with problem gambling.

Declared interests:

None.

Dr. Marc Potenza

Yale School of Medicine

Dr. Marc Potenza is a professor of psychiatry and professor in the Child Study Center and of neuroscience, and the director for the Center of Excellence in Gambling Research at Yale School of Medicine. Dr. Potenza is a board-certified psychiatrist with sub-specialty training and certification in addiction psychiatry. His research focuses on how non-substance (“behavioral”) addictions are similar to and different from substance addictions. In his lab, they use brain imaging, genetic, clinical, pharmacological, behavioral and epidemiological approaches to study this topic. Dr. Potenza is also interested how individual differences related to impulsivity and gender, for example, influence non-substance and substance addictions.

Declared interests:

Dr. Potenza has consulted for Opiant and Idorsia Pharmaceuticals, Game Day Data, Baria-Tek, and the Addiction Policy Forum and has been involved in a patent application with Yale University and Novartis. He participates on boards for multiple non-profit groups, including the National Council on Problem Gambling and Children and Screens. He has received research support (to Yale) from Mohegan Sun Casino, Children and Screens, and the Connecticut Council on Problem Gambling and has participated in surveys, mailings, or telephone consultations related to internet use, addictions, impulse-control disorders or other health topics. He has consulted for and/or advised gambling and legal entities on issues related to impulse-control/addictive behaviors/internet use.

Dr. Shane Kraus presentation

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Dr. Marc Potenza presentation

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