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Photo Collage of a stack of hundred dollar bills with a stack of casino chips, a pair of dice and some playing cards
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Ted Hartwell has been gambling since childhood.

Growing up in Texas, his dad took him to the horse tracks often; always sliding a $20 bill his way before the races began.

“By the age of 10,” Hartwell says, “I knew how to read the history of the horses in the program and tell my father which horses to place a bet on.”

In college, Hartwell played a lot of high-stakes poker, eventually winning enough money to quit his job and move into his own apartment. By the time he was in his mid-20s, he was living in Las Vegas, with big plans to enter the prestigious World Series of Poker.

But the tournament’s entry fee was $10,000, and Hartwell—who also had a habit of playing video poker, and regularly losing thousands of dollars at a time—never managed to keep a bank balance that high. Within a few years, he started skipping work to gamble, and hiding his growing debt from his wife.

“I started to chase my losses,” he says, referring to the frantic pattern of trying to recoup the money he was losing with more frequent (and oftentimes, bigger) bets.

Hartwell, who’s 57 now, works as an educator for problem gamblers — the umbrella term for people with gambling behaviors that disrupt their personal, family and work life. He estimates that he lost about $250,000 in the flurry of years leading up to his recovery, but notes, “People with a gambling problem are notoriously bad at estimating the amount of money and time they’ve lost.”

Gambling disorder is a diagnosable, chronic mental health disorder, much like drug or alcohol abuse, though it’s rarely talked about as such. Most people have a better understanding of (and sympathy for) the struggle that comes with drug and alcohol addiction, and tend to view problem gambling as something of a lesser evil — one that’s far easier to control. In reality, the symptoms of problem gambling and substance abuse disorder are very similar: both come with higher-than-average rates of depression, anxiety and suicidal behavior. According to the National Association of Addiction Professionals, problem gambling actually has the highest suicide attempt rate (up to 20%) of all addictions.

Most studies say problem gambling affects about 1% of the U.S. population, but the research is outdated and underfunded. And since most people with this type of addiction don't self-report or seek treatment, experts say, the research that does exist only provides a cursory look at the situation.

What is clear, though, is the problem is only getting worse, thanks in part to the growing popularity of online gambling and sports betting at in-person casinos and websites like FanDuel and DraftKings.

This Sunday, U.S. football fans will bet an estimated $16 billion on the 2023 Super Bowl, according to the American Gaming Association (AGA) — an all-time record and more than double the figure the group projected in the runup to last year's Super Bowl.

The stakes are higher than ever, and the consequences — for individuals, their families and society as a whole — could be dire.

"The stigma is profound"

Keith Whyte, executive director of the National Council on Problem Gaming (NCPG), calls problem gambling a “ticking time bomb.”

As of this writing, no federal funds are earmarked for problem gambling research or treatment, unlike drug, alcohol, and tobacco addiction, which get billions of federal dollars each year.

Gambling revenue, on the other hand, is soaring.

U.S. commercial gaming revenue, which includes sports betting, online gambling, slots and table games, reached $49.9 billion in the first 10 months of 2022, up 14.7% from the same period in 2021, according to the AGA. Year-over-year revenue reached an all-time high in 2022, due in large part to gambling expansion and pent-up demand from the pandemic.

Gambling is also more accessible today than ever before — including lotteries, it's now legal in some form in most states. And thanks to a Supreme Court decision that struck down a law banning sports betting in 2018, the practice is now up and running in Massachusetts, Illinois, and 31 other states (plus Washington, D.C.).

After that ruling, NCPG estimates that the risk of gambling addiction grew by 30% in just three years.

“We didn't have a good problem gambling infrastructure in place prior to the expansion of sports betting, and we still don't,” Whyte says.

Today, access to prevention and treatment services is uneven.

Hartwell, for one, got treatment for his addiction in 2007, which involved outpatient therapy and joining a 12-step program. But most people with the disorder don’t seek help.

Timothy Fong, co-director of the Gambling Studies Program at the University of California, Los Angeles, says many people avoid treatment for financial reasons (rehab isn’t cheap, after all). Others are too ashamed to even admit they have a problem.

“It’s hard to seek help and tell a stranger, ‘I spent $30,000 or drained my wife’s bank account.’ Or, ‘I spent all my retirement savings.’ The stigma is profound,” Fong says.

Many people who visit casinos, host poker nights or participate in office Superbowl pools can do so without slipping into a pattern of addiction, Fong adds. To be diagnosed with gambling addiction, the American Psychiatric Association says, you have to demonstrate set characteristics, like putting an increasing amount of money towards gambling or trying unsuccessfully to control it.

“It becomes an addiction when there’s impaired functioning or just a tremendous amount of emotional pain and distress,” Fong says.

When that happens, he says, “It can be really destructive and horrific."

"Watching in slow motion"

The impact of problem gambling stretches beyond the individual struggling to overcome it. Gambling addiction also has an inherent “social cost,” experts say, driven by criminal justice and health care expenses paid by American taxpayers.

NCPG puts that cost at about $7 billion annually, but Doug Walker, an economics professor at the College of Charleston who’s studied the social and economic impact of gambling, says that's an undershot. Researchers may be able to measure the crime rates and treatment costs associated with problem gambling, but how it impacts people's careers, family finances and general well-being is harder to quantify.

Further complicating matters is the fact that betting does provide some social good. Casinos, for one, bring tax revenue, jobs and recreation to many of the communities in which they operate. But without robust data showing the full scope of problem gambling in the U.S., or evidence on how to treat and prevent it, it's hard to see the growing number of Americans participating in legalized betting as a net positive.

“That's kind of the tragedy of it,” Whyte says. “We're watching in slow motion a lot of people start to slide down a path into a devastating need and life-threatening addiction.”

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