Shawn Kelly is a pediatrician in Ottawa who specializes in adolescent addiction medicine. Because he’s one of the few doing this work in his part of Canada, teenagers come to him with a host of problem behaviors, from opioid abuse to compulsive video gaming. A few years ago, patients started coming to him with gambling issues. Sometimes these issues were comorbidities with drug addiction. But now, he’s seeing gambling in his general pediatrics practice, too, and among younger teens without other issues.
A parent will say at the end of a pediatric well visit, “Are you going to tell Dr. Kelly what you did?” And it turns out the tween surreptitiously took his dad’s credit card and blew over a thousand Canadian dollars in one weekend on sports betting and online casinos. As these incidents became more common in his practice, Kelly (the consummate Canadian) also noticed that betting terminology had been fully integrated into the ice hockey highlights he was watching with his young son. His 7-year-old was asking him what “over-under” meant.
Of course, not every teenager who throws a few dollars into a fantasy football pool is going to develop a problem, and not all problem gamblers will destroy their lives, but in the past decade or so, sports betting and prediction markets have become totally, unavoidably mainstream across the world. Gambling dominates sports now to the extent that a recent Washington Post analysis of 50 hours of televised professional and college hockey, football and basketball games found that “a gambling reference, promotion or commercial occurred every four minutes on average.”
Even though we are surrounded by enticements to gamble, and despite the growing evidence that there has been an increase in addictive gambling behavior since sports gambling became broadly legal in the United States in 2018, there is a dearth of research about diagnosis and treatment compared with that for other addictions. In a 2024 investigation published in JAMA Internal Medicine, academics described the paucity of data, writing that “gambling is often overlooked in health research, clinical practice and health policy development, with insufficient governmental efforts to prevent or mitigate harms.” An estimated two-thirds of 18 – 22-year-old men surveyed by the N.C.A.A. in 2023 had bet on sports, and 16 percent of men and women had engaged in at least one risky gambling behavior.
Kelly told me that the lack of actionable, evidence-based guidance on how to treat youth gambling keeps him up at night, because multiple studies have found a link between suicide, suicidal ideation and gambling disorder. “We need to be doing something and evaluating efficacy so that we are in a position to actually deal with this problem, rather than waiting for the wave of young male suicides,” Kelly told me. (While young men are more likely to gamble than young women, women may progress to problem gambling faster than men do.)
Lia Nower, the director of the Center for Gambling Studies at the Rutgers School of Social Work, is at the forefront of the kind of research that Kelly would like to apply in his practice. She told me that because of the lack of organized governmental or private funding for research into gambling, “a lot of what we want to know, we can’t answer.” Like Kelly, she said that she’s seeing gambling issues begin in elementary school.
Nower and her colleagues found that if other family or household members gamble, that is a risk factor for kids becoming problem gamblers, and that many parents are unaware that gambling in front of their kids is bad. According to a Common Sense Media survey, over half of boys who have gambled in the past year did so with family members. She believes we’re currently thinking about gambling the way we thought about cigarettes and alcohol in the mid-20th century, when these substances were treated as benign, many more smoked, and “everybody had a bar in their office and no one thought anything about driving drunk or driving their kids around in the car while they were drunk.”
Still, researchers have started to develop frameworks and theories for identifying problem gamblers and treating them. There is a widely used screening test called the Problem Gambling Severity Index — but scoring high on that index tells us only so much about what’s behind a person’s excessive gambling or how to ameliorate it. Nower and her colleagues, based on their clinical experience, have identified three different subtypes of problem gambling.
People in the first and largest group, the “behaviorally conditioned,” have no other significant emotional problems and develop issues with gambling because they are exposed to it through socialization. Everyone is doing it, so they do it, and then they start chasing their losses. Those in the second group, the “emotionally vulnerable,” are more likely to struggle with depression and anxiety and to have had adverse childhood experiences. The third group, “antisocial impulsivist,” is somewhat self-explanatory: Its members are antisocial and impulsive, and they’re also more likely to engage in risky sexual behavior and substance use.
Each group should have a different treatment, Nower told me. The first group benefits from more of a cognitive behavioral approach, which involves education about gambling and help finding alternative social activities. The other two groups need help managing their other mental health and substance struggles, whether it’s through medication or talk therapy, though the third group is the most difficult to treat.
As I was reporting this newsletter, I spent some time talking to parents and loved ones of young men with gambling problems, and it did make me wonder if there is another, yet more profound societal element at work. The world feels especially precarious right now, and growing up is always uncertain, too. Parents told me that their sons felt that a gambling win was a concrete gain — they won this round of a rigged game, and that gave them a sense of agency.
I asked Kelly what he thought about my observations, and he said he had similar notions about the psychological motivations behind why some young people are drawn to problematic bets. He said that adolescence is the time when a sense of uncertainty about life comes to the fore, and he explained, “being able to bet on everything that we are unsure about seems like a very pathological approach to this space and time where we’re supposed to be learning how to tolerate that uncertainty.”
Earlier this year, Kelly recommended in in AAP News, the American Academy of Pediatrics’s news outlet, that gambling should be treated like other risky behaviors among youths, calling on pediatricians to start asking their patients about it. “Questions about screen time and gaming can open the door to conversations about gambling exposure,” he noted. Parents should be initiating conversations with their teenagers about gambling — so much can happen on apps that you don’t even know exist.
I can’t help feeling that, once again, parents are outmanned by a predatory industry that spends millions of dollars to influence elections through super PACs — that’s just one example of how difficult legislation to curb its power might be. Mark Zuckerberg, who I guess is not rich enough, wants to create a prediction markets app. In a newsletter from earlier this year, my colleague David French had a number of policy suggestions about gambling, including raising the age of gambling to 25 and better regulating prediction markets. I want these things to happen, but the wheels of our legislature move slowly.
How many young people’s lives will be damaged in the meantime?
End Notes
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In November, The Cut published an article in which four women talked about how gambling had destroyed their relationships, and it has haunted me to this day. One woman said she “had no idea which signs to look out for when her husband was gambling away around $300,000 on DraftKings and FanDuel. ‘Being addicted to casino gambling is completely different,’ she says. ‘Sports betting is so easy to hide.’”
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Another true crime book recommendation from me: I started reading “The Other Dr. Gilmer: Two Men, a Murder, and an Unlikely Fight for Justice,” by Benjamin Gilmer. The author, a family medicine doctor in rural North Carolina, takes over a clinic that was once run by Vince Gilmer (no relation), who murdered his own father. It’s a wild story, filled with darkness, medical mysteries and almost unbelievable coincidence, told sensitively.
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