Diagnoses of gambling disorder have surged by over 60% in U.S. states where sports betting has been legalized, contrasting sharply with a decline in non-legalized states. This trend is a critical concern for those in recovery, as the shift toward digital, high-frequency gambling platforms often mirrors the compulsive patterns seen in substance use disorders.
What the study found: Key results
Analysis of over 197 million patient records revealed a significant divergence in clinical diagnoses of gambling disorder based on state legislation. [1] Between the first quarter of 2018 and the first quarter of 2026, the quarterly rate of diagnosed gambling disorder in states that legalized sports betting rose from 3.0 to 4.8 per 100,000 patients—a roughly 61% increase. Conversely, states that have not legalized sports betting saw a 29% decrease in these diagnoses, with rates falling from 3.1 to 2.2 per 100,000 patients. [1]
These findings suggest that the widespread availability of legal sportsbooks is associated with a higher clinical identification of gambling disorder. Importantly, these trends did not appear to be staggered by each state’s specific legalization year but rather rose in parallel, potentially driven by the nationwide rise of unregulated digital platforms that allow users to wager on the outcomes of future events. [1]
States included
The study stratified patients based on their residence in states that had legalized sports betting (39 states and the District of Columbia) versus those that had not (Alabama, Alaska, California, Georgia, Hawaii, Idaho, Minnesota, Oklahoma, South Carolina, Texas, and Utah) as of early 2026. [1]
Who appears most at risk
While rates rose across all demographics, the most striking trajectory was observed among young adults aged 18 to 29, whose diagnosis rates more than doubled. Adults aged 30 to 49 maintained the highest overall quarterly rates of diagnosed gambling disorder by 2026. Across all age groups, men showed higher rates of diagnosis than women, with the gender gap being particularly pronounced in those under the age of 50. [1]
Why gambling disorder diagnoses might be increasing
The rise in diagnoses is likely multifactorial. Beyond the immediate accessibility of mobile betting apps, there is a growing clinical recognition of gambling as an addictive disorder. Reclassified in the DSM-5 in 2013, gambling disorder is now categorized alongside substance use disorders, reflecting shared neurological underpinnings such as the dysregulation of reward pathways in the brain. [1]
What the numbers do and do not prove
It is important to note that these figures represent diagnosed cases in clinical settings and likely undercount the true population prevalence. While the data show a strong correlation between legalization and medical diagnosis, it cannot definitively prove causation due to variables like "coding-practice drift," where clinicians have become better at identifying and documenting these disorders over time. [1]
Signs you may need to seek help
For individuals in recovery from substance use, the brain’s reward system remains sensitive. Signs that gambling may be transitioning into a disorder include:
- Feeling an uncontrollable urge to bet despite financial or emotional distress or its interference with household responsibilities, work duties, and other areas of life.
- Chasing losses by increasing the frequency or size of wagers.
- Using gambling as a way to escape or cope with stress, anxiety, or post-acute withdrawal symptoms.
- Lying to loved ones about the extent of betting activities.
Public health implications
The rapid expansion of sports betting poses significant public health challenges. Online sports betting is both a public policy and a public health concern, requiring integrated strategies to mitigate harm. [2] When access to addictive products—whether substances or digital betting—outpaces the implementation of preventative health measures, the burden on the healthcare system grows. [3]
For those who have experienced brain trauma, such as that caused by opioid-induced hypoxia, the vulnerability to new compulsive behaviors may be heightened. [4] Opioid overdoses can lead to cognitive impairment due to restricted oxygen to the brain, which may impact executive function and decision-making, potentially making it harder to resist the impulsive nature of modern sports betting. [4]
Prevention and recovery options
Recovery is a lifelong process. If the patterns described here resonate, utilizing the SAMHSA National Helpline (1-800-662-HELP) can connect individuals with local resources for both substance and behavioral health. Peer support groups and cognitive behavioral therapy (CBT) remain the gold standard for treating addictive behaviors by helping to rewire the reward-seeking patterns in the brain. [5]
