Dr. Timothy Fong: Betting on sports and problem gambling

[0:00:19]

TIMOTHY FONG: My name is Dr. Timothy Fong, I’m a professor of psychiatry and the co-director of the UCLA gambling studies program.

[0:00:34]

TIMOTHY FONG: So, problem gambling, otherwise known as gambling addiction, or gambling disorder, has a prevalence rate of approximately 1% to 2% of the general population in the United States. That may sound rare, but it’s similar to the same prevalence rates of other major mental illnesses such as bipolar disorder or schizophrenia.

[0:01:04]

TIMOTHY FONG: So, gambling addiction, or gambling disorder, is, by definition, an addictive disorder. It has the same similarities and characteristics as substance use disorders, so it means it’s the same biological, psychological, and social risk factors. I get this question a lot. Who’s at risk? Who’s most vulnerable? And really, it’s a wide variety of folks, but the most significantly impacted folks are going to be people with active, co-occurring substance use disorders, untreated mental health conditions like depression and bipolar disorder and ADHD, and really, folks at the extreme ages of life. So, the adolescents and older adults, where financial losses can impact those individuals at a much quicker and rapid pace, then say, working professionals who have a little bit more financial reserve.

[0:02:04]

TIMOTHY FONG: I get asked this question a lot from patients and family to say, how do I know I have a “gambling problem?” Well, the first thing to recognize is that having problems from just gambling is part of the gambling experience. So, people lose money, they lose time. That doesn’t make you “having a gambling addiction.” That’s just part of gambling. You know, one of the risks of gambling is losing money. So, I usually say to folks, number one, gambling addiction, a gambling disorder, is very different. It’s continued, ongoing gambling, despite harmful, physical, emotional, social, financial, or spiritual consequences. Gambling disorder is oftentimes characterized by people looking at gambling as a solution to their problems, not entertainment, not a way to escape. It’s actually the thing or the activity that will solve all their problems. So again, like other forms of addictive behaviors—alcohol, tobacco, cannabis, substance use—it’s when harm becomes the norm. If the line is crossed and harm is created and people continue to engage in behavior despite harmful consequences, that’s the simple line that we use for gambling disorder.

[0:03:25]

TIMOTHY FONG: So, starting in 2018, the Supreme Court issued a ruling that basically allowed states to decide for themselves whether or not they were going to expand sports betting. And in the last seven years—now it’s 2025—we have over 38 states that have chosen to legalize sports betting. And so, it’s a rapid, rapid expansion of sports betting into the marketplace. But the real issue is the combination of legalizing sports betting, normalizing sports betting, and having sports betting on the phone. So, in 2025, the casino comes to us—the casino is on our phone. Compare that to 15-20 years ago, where you had to drive or fly, you know, the whole day just to get to a casino to place a bet on sports. So, the end result of that has been a tremendous wave of availability and access to gambling, normalization of gambling across all generations in America, saying, hey, this is an activity that everyone is doing, and you might as well do it yourself. So, you put that wave of more interest and more demand and more people gambling, inevitably, you’re going to—that wave is going to reach some people who have biological, psychological, and social vulnerabilities to gambling disorder. And we’ve seen that. So, we’ve seen that, unfortunately, in every state that has expanded sports betting, a rise in the number of people presenting to treatment for gambling addiction. We’ve also seen more interest in this topic of what gambling addiction is and is not. We’ve seen just more academic study. More media coverage like this. But the flip side of this, we’ve also just seen sports betting impact the public health in ways that people never anticipated. As an example, just financial health, sports integrity, abuse of athletes, harassment of athletes, because of just so much sports betting, a lot of online harassment.

So, a lot of things that have changed in our society because of the expansion of sports betting, not just gambling addiction, but just really how we look at sports, how we look at entertainment, and how we spend our entertainment dollar. You know, I do a lot of these talks, and I talk to a lot of people, and I’ll give you an example where a couple weeks ago, I was talking to a fraternity here at UCLA about sports betting. I asked, how many of you guys have sports betting accounts? And it was about 90% of the audience. I said, how many of you guys—what’s the average amount you spend per week on sports betting? And it was about $40 to $60 that these young men were saying, and I thought, what does that mean? They’re now spending $40 to $60 and less on other forms of entertainment, like going to a movie, going on dates, going to the bar, going to watch a sporting event. Or does that mean they’re just spending more and now they’re creating more debt than they ever had before? So, it’s an example where expansion of sports betting has consequences and implications, really, in every fabric of American life now.

[0:06:38]

So right now, in America, sports betting, again, is available legally in about 38 states. We don’t have any convincing data right now to say that one region of America has more availability than any other. I basically think of it this way: every household in America today can access sports betting over their phone, whether it’s legal, illegal, regulated, or unregulated. And there are a lot of different forms of sports betting. You know, there’s, again, at least 40 different apps I can think of that essentially are the same, where you’re putting money on an event, on sports, hoping to win more money. That’s, by definition, sports betting. So, I think other areas where it’s more popular, again, yes, we know it’s been marketed much more toward men ages 18 to 30, but we have to remember this is a 21 and up activity. It’s not meant for high schoolers. It’s not meant for anyone under the age of 18. So, we do see, unfortunately, more underage sports betting gambling than we’d like, in part because it’s very difficult to enforce on the phone underage exposure. Other regional differences I don’t think really exist, but what we know is that when every state opens up, you see a big rush in gambling activity in that state for a little while. I came across a very interesting story last week between, I believe Nebraska and I think it’s Kansas, where in one state sports betting is legal, in the other state it’s not, and there was a surge of cell phone activity in this cornfield that happens to be right at the state border. So, what they determined was there’s a lot of folks leaving Nebraska to go into the state that has sports betting, and so you see the surge of activity. So, you get some funny stories like that from time to time. But I think what most folks don’t recognize is how available sports betting remains in every household in America today.

[0:08:56]

TIMOTHY FONG: So, for probably the last 60-70 years, there’s been kind of a rhythm in the gambling world where major sporting events like the Super Bowl or March Madness or the World Series would draw more business to the sports books. And it kind of makes sense, you know, it’s the big sporting event—more people are watching, more excitement. Now that’s changed, where sports betting is available 24/7. Every day there’s a Super Bowl. Every day there’s a different thing to bet on. And in fact, one of the really interesting things are like real esoteric sports, like table tennis from Taiwan or Hungary, happen to be very—a lot of revenue generated, and action placed on these sports even though they’re not traditional mainstream sports here in America. So, you back it up and say, well, what does that mean? When we have these major sporting events, we still see surges of interest from people, you know, gambling, because it’s a major sporting event. And then even more so, you have a lot of advertisement and a lot of, like, what we call kind of offerings from sports betting companies, you know, enticements and, you know, risk-free bets and various things that happen during these things. Unfortunately, our men and women with gambling disorder, it does represent a vulnerable time, because when there’s so much attention to gambling, it can oftentimes trigger gambling urges and cravings. For other folks who then gamble heavily during a heightened sporting event, that could then create the problems and consequences that follow them after the event is over. So traditionally, like in years past, calls at gambling helplines oftentimes would go up the first one or two weeks after the Super Bowl, in part because oftentimes people lost a lot of money betting on a major, major sporting event. But again, things have changed, and that’s why I tend to think that every day is just a different sporting event. It’s a Super Bowl every day because there’s just so almost an infinite number of sporting betting opportunities.

[0:11:11]

TIMOTHY FONG: So, the way I think about it, it’s an addictive disorder, which means its consequences again affect the body, the brain, the mind, the spirit, and the finances. If we had 100 men and women with gambling disorder and they told their stories, you’re going to have 100 different stories of different impacts. Some might have profound impacts financially, to the point that they generate generational debt. Others would have commit crimes and create chaos and drama in their lives. Others will have difficulty sleeping and will have neglected their physical care to the point where they have health- related, stress-related problems from gambling disorder. The common theme I see again is harm and suffering. So, when people are experiencing harm and suffering from gambling disorder, just like any other addictive disorder, there’s impact on their quality of life. They don’t sleep as well. They lose time. They lose productivity. They have conflicts. And they have real world problems that are difficult to solve—financial debt, financial strain, not advancing up, you know, their job at work, relationship difficulty. I’ll give you a quick example. I saw a man last week, you know, who’s in his late 20s, and he’s working remote, making over $200,000 working from home, but that’s a substantial amount. But the gambling was taking up significant amounts of time. He was hiding it from his girlfriend, and although he had no financial debt. He had difficulty sleeping. He wasn’t exercising. He was spending a good amount of time thinking about gambling, which was—and the thoughts about gambling were not pleasant. They were obsessional. They were compulsive. They were painful to think about gambling so much. Neglecting time with his friends, again, at the age of 29, not developing other life skills, like cooking, like seeing the world, like, you know, all the things that we learn how to do in life in the early 20s. So, it’s a perfect example where you talk to him, he looks healthy. He’s verbally fluent. He’s a smart guy. You would not be able to detect that there was “anything wrong with him,” but internally, he was experiencing a lot of suffering from ongoing gambling activities.

[0:13:38]

TIMOTHY FONG: Well, the good news is that over the last 25 years, we’ve learned a lot about treating men and women with gambling disorders. And again, because we classify it as an addictive disorder, we use the same kind of principle. So that means we do have some medications that are effective for urges and cravings and reducing the impulsivity around gambling. We have psychotherapies that are very, very effective in helping men and women manage the emotional pain and suffering that comes with it, teaching skills and how to manage the thoughts about gambling, repairing the damage that they’ve done. And we have social support systems like Gamblers Anonymous and residential treatment programs that work very, very, very well. We even have now a lot of digital therapeutic options. We have gambling software blockers, so you can’t go on gambling software on your phones. We have gambling recovery apps that are very useful, that give you lessons and inspirations, messages of support. So, there’s a lot of things that we’re learning from the principles of recovery that also work into gambling addiction treatment. And again, I think a lot of people are wondering, well, what could you possibly say to me that would actually help me stop gambling, other than stop gambling? But there’s a lot, again, psychotherapy techniques that we use to kind of help people deal with the guilt, deal with the shame, and develop understandings and insights around gambling and money that they never had considered before oftentimes are very, very useful for them.

[0:15:17]

TIMOTHY FONG: So, we’ve really evolved where we’ve gone from saying, okay, if you know you have a problem with gambling, go get help, because we realize that many, many folks who are experiencing gambling disorder don’t even know they have a gambling disorder. So, I think I would start with the most severe cases where if you know for certain that gambling is creating harm, either in your family or for yourself or for someone you’re worried about. Absolutely, there should be consider that, almost like a medical emergency, like a heart attack, where you really want to get professional help right away to figure out what’s the next step in treatment. Along the way, though, I think for anyone who’s just curious about gambling and how to protect themselves from developing a gambling addiction before it starts. It’s worthy of having one or just two sessions with a gambling treatment specialist to figure out and how to prevent that from happening. I think again, oftentimes, people don’t even realize, like for instance, that they start having problems financially, or they start feeling guilty about their gambling—that’s an early sign of concern. That is a time to maybe download a gambling recovery app or go to a Gamblers Anonymous meeting. That doesn’t mean you have a gambling addiction or problem, but it means that you should be curious about gambling behavior to see how do I make sure I don’t evolve into something worse than it is right now. And as a corollary to that, people oftentimes well, how do I find a gambling addiction treatment specialist? Well, most states in America, there are gambling helplines that can link you directly to a gambling treatment provider. Here in California, we use 1-800-Gambler. Many states use the same number, and you call that number 24/7, that will get to a directory of therapists that are trained to treat gambling disorder. Secondly, oftentimes, just starting with your mental health provider that’s either in your health insurance network or maybe already in your circle of your world and saying, hey, you know, I have a concern about gambling. I’m worried about my husband’s gambling, or my son’s gambling, that’s a great way to start that conversation where that mental health provider can either provide services right away or find someone else who can.

[0:17:44]

TIMOTHY FONG: I think the vast majority of people, when they think about gambling, still misunderstand what it is. You know, this is a form of entertainment. The vast majority of people who do it on a regular basis are able to do it without long-lasting harm. It’s enjoyable. It’s fun. And at its core, gambling and sports betting is supposed to make your life better. It’s supposed to bring you closer to family and friends. It’s supposed to give you some entertainment, and even if it costs you money, if you’re spending money on entertainment, that’s the whole point of entertainment. So, I think sometimes people forget that, and they think of gambling as a reliable way of making money. They think of it as a job. They think of it as a can’t lose investment or can’t miss proposition, and it’s none of those things. So, think about the language we use with gambling. We say, oh, I lost $50 gambling. We don’t say I spent $50 gambling. It’s a very subtle distinction. We don’t say I lost $50 going to the movies. I lost $50 going to dinner. I lost $50 at the bar. We say I spent $50 at dinner. There’s a weird implicit thing where we think if we spend money on gambling, we should be getting money back. I think oftentimes people miss that concept, and they tend to create something that is not and that sets themselves up for disappointment or frustration or anger or a sense of competitiveness and say, oh, I don’t like it that somebody took my money. I want; I want my money back. You know, again, we might go to the worst movie and be upset, but we don’t say to the movie theater, I want my money back because this movie was so horrible, right? So, there’s just some subtleties there. And I think that’s what we’re trying to change, that narrative to say that’s how I think people can stay in the lane of gambling that’s not problematic or doesn’t cause problems by really viewing what the expectation of gambling really is.