Gambling disorder diagnoses rose 61% in US betting states: Study
A new study has found that diagnoses of gambling disorder rose by 61 per cent in US states that legalised sports betting between 2018 and 2026, while diagnosis rates fell by 29 per cent in states where sports betting has not been legalised.
The findings, published by Epic Research, are based on an analysis of electronic health records from more than 197 million US adults aged 18 and older who had at least one qualifying healthcare visit between January 2018 and March 2026. Researchers compared patients living in states that have legalised sports betting with those living in states that have not, while also analysing diagnosis trends by age group and sex.
Among adults living in states with legal sports betting, the quarterly rate of diagnosed gambling disorder increased from 3.0 per 100,000 patients in the first quarter of 2018 to 4.8 per 100,000 in the first quarter of 2026. In states that have not legalised sports betting, the rate declined from 3.1 to 2.2 per 100,000 over the same period.
Gambling disorder is recognised as a behavioural health condition in which a person continues to gamble despite financial, emotional or social harm. It was reclassified as an addictive disorder alongside substance use disorders in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013.
The study covers the period following the US Supreme Court’s decision in Murphy v. NCAA in May 2018, which struck down the federal Professional and Amateur Sports Protection Act and allowed individual states to legalise sports betting. By early 2026, sports betting was legal in 39 states and the District of Columbia. The researchers noted that national surveys and internet search data have indicated growing public interest in seeking help for gambling addiction since 2018, but population-level estimates of diagnosed gambling disorder in US clinical care have been limited.
Analysis of more than 197 million patient records
The researchers analysed records from adults aged 18 years and older who had at least one qualifying healthcare visit during the study period. Patients were grouped according to whether they lived in states that had legalised sports betting or states that had not. Results were also stratified by age group and sex.
The study found that diagnosis trajectories diverged sharply according to state legalisation status.
In the first quarter of 2018, when only Nevada had legalised sports betting, diagnosis rates were almost identical between the two groups, standing at 3.0 per 100,000 patients in states that had or would later legalise sports betting and 3.1 per 100,000 in states that had not.
By the first quarter of 2026, however, the diagnosis rate in states with legal sports betting had risen to 4.8 per 100,000 patients, while the rate in states without legal sports betting had fallen to 2.2 per 100,000.
Epic Research said the increase appeared to occur broadly in parallel across states that had legalised sports betting rather than following each state’s individual year of legalisation.
“One possible explanation is the parallel growth of online prediction markets such as Polymarket and Kalshi, which are not regulated as gambling at the state level and are accessible regardless of where a user lives,” the researchers said.
They added: “Because legalisation is staggered and gambling disorder is widely under-recognised in clinical care, these trends cannot be attributed to any single legal event and likely understate true population prevalence.”
The researchers also noted that the directional difference between legal and non-legal states was consistent with earlier national surveys and internet search trends.
“Even so, the directional contrast aligns with national survey and search-trend evidence of rising gambling-related help-seeking concentrated in states that have legalised sports betting,” the study said.
The study also noted that researchers did not identify a specific reason for the decline in diagnosis rates in states that had not legalised sports betting. It said changes in healthcare delivery, the expansion of telehealth during the COVID-19 pandemic, greater awareness among healthcare professionals and changes in diagnostic coding practices may have contributed to some of the differences observed between states.
Adults aged 30 to 49 recorded the highest diagnosis rates
Diagnosis rates varied by age group and sex. Adults aged 30 to 49 recorded the highest overall quarterly diagnosis rate throughout the study period, increasing from 4.1 per 100,000 patients in the first quarter of 2018 to 5.8 per 100,000 in the first quarter of 2026. Adults aged 50 to 64 recorded the second-highest rate, rising from 4.1 to 4.9 per 100,000 over the same period.
The largest proportional increase was recorded among adults aged 18 to 29, whose diagnosis rate more than doubled during the study period.
Among men in this age group, diagnosis rates rose from 3.2 per 100,000 patients in the first quarter of 2018 to 7.7 per 100,000 in the first quarter of 2026. For women, the rate increased from 0.5 to 1.0 per 100,000. Diagnosis rates among adults aged 65 years and older remained lower throughout the study but also increased over time.
The study found that diagnosis rates increased among both men and women, while remaining consistently higher in men across all age groups. The widest gap between the sexes was recorded among adults under 50.
According to the researchers, these findings are directionally consistent with previous survey-based research showing that men and younger to middle-aged adults are the groups most likely to participate in sports betting and to screen positive for problem gambling behaviours.
Large clinical dataset
The analysis used Cosmos, a dataset developed in collaboration with Epic health systems representing more than 304 million patient records from around 2,000 hospitals and more than 47,000 clinics across all 50 US states, Canada, Lebanon and Saudi Arabia.
Epic Research said the study was conducted independently by two separate teams, each comprising a clinician and a research scientist, with both teams reaching similar conclusions.
The researchers also said diagnosed gambling disorder remains widely under-recognised in clinical care, meaning the findings are likely to understate the true prevalence of gambling-related harm in the wider population.
Experts weigh in on the findings
Speaking to NBC News, several experts said the study adds to a growing body of evidence examining the relationship between expanded sports betting and gambling-related harm, while cautioning that diagnosed gambling disorder likely represents only a small proportion of those affected.
Mark van der Maas, a social work professor at Rutgers University who studies the relationship between gambling and suicide and was not involved in the Epic Research study, said the findings were consistent with what has been observed following the expansion of gambling opportunities.
“You increase access, you increase problems,” van der Maas said.
He noted that the age groups showing the largest increase in diagnoses were also the groups most likely to use online betting platforms.
“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,” he said.
Harry Levant, director of gambling policy at the Public Health Advocacy Institute, said the findings highlighted the risks associated with online gambling platforms.
“This is extremely important evidence that speaks to not only the impact of legalisation but the inherently dangerous nature of how online gambling is fundamentally different than anything we’ve seen before,” Levant said.
“You’re introducing younger and more vulnerable people to a highly addictive product.”
Industry response
The American Gaming Association said the study reflected greater awareness and diagnosis of gambling disorder rather than an increase in underlying addiction rates.
“While problem gambling is a serious condition for those impacted, this study does not indicate an increasing rate of addiction,” the association 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 added that the industry invests around US$500 million annually in education, research and support for people experiencing problem gambling.
Diagnosed cases may represent only a fraction of gambling harm
Experts also said the number of diagnosed cases captured in the study is likely to represent only a small proportion of people experiencing gambling-related harm.
Although several states have conducted recent studies into problem gambling prevalence, the last federally funded national study in the United States was carried out in 1999.
Access to treatment also varies significantly between states, as does public funding for gambling prevention, education and treatment services, much of which is financed through gambling tax revenue.
Healthcare professionals do not routinely screen patients for gambling disorder, and even recognised cases are not always recorded using the diagnostic code for the condition.
Experts also noted that many people experiencing gambling-related harm do not recognise the symptoms themselves or seek help through formal healthcare services. Instead, some turn to peer support groups such as Gamblers Anonymous or online support forums.
Rachel Volberg, a gambling researcher who previously found increases in financial, emotional and relationship harms among gamblers in Massachusetts after the state legalised sports betting in 2022, said treatment rates remain low.
“Typically no more than 3 to 10 per cent of people who would be diagnosed with disordered gambling actually access treatment services for a gambling problem,” Volberg said.
Steven Heim, outpatient supervisor at New Hope Integrated Behavioral Health Care in New Jersey, which legalised sports betting in 2018, said the organisation had observed an increase in people seeking help.
“We’ve seen definitely an increase in related referrals and diagnoses,” Heim said.
Gambling disorder and addiction
According to the Diagnostic and Statistical Manual of Mental Disorders, symptoms of gambling disorder include persistent preoccupation with gambling, needing to gamble increasingly larger amounts of money, repeated unsuccessful attempts to stop gambling, lying to family members or others about gambling activity and relying on others for financial assistance because of gambling losses.
Levant, who has previously spoken publicly about recovering from gambling addiction, said gambling disorder often remains hidden until significant harm has occurred.
“It is an addiction that for many people is silent. There are no visible manifestations,” he said.
“By the time it is diagnosed, the amount of pain and suffering and misery on the person and their loved ones is enormous.”
Dr Anthony Comerford, chief executive of New Hope Integrated Behavioral Health Care, said gambling disorder shares similarities with substance addiction.
“It affects the brain in the same way that heroin or any other psychoactive drug does,” Comerford said.
“It works through the same mechanisms. Those same cravings come into play.”
Wider concerns
NBC News also noted that other recent studies have linked the expansion of legal online sports betting with increases in bankruptcies, debt and credit card delinquencies, alongside declines in credit scores and savings.
The report said differences between states that have legalised sports betting and those that have not may narrow over time because of the growth of online prediction markets, which allow people to place wagers on sporting events regardless of whether online sports betting is legal where they live.
Prediction market platforms are not regulated by states as gambling companies and generally have minimum age requirements of 18 rather than 21. The platforms describe themselves as trading platforms rather than gambling operators and say they provide responsible trading tools.
Former New Jersey Attorney General Matthew Platkin, who previously oversaw gambling enforcement, said the long-term effects of expanded gambling may take time to emerge.
“It’s going to take a few years for us to recognise these harms, because it doesn’t show up on day one,” Platkin said.
“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.”
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