The workers hand out free luggage tags and travel-size tissues to encourage people to stop and chat. If they succeed, they give customers brochures displaying the state\u2019s gambling helpline number and website. They can even enroll them in a program called \u201cPlayMyWay,\u201d<\/a> which allows customers to set monthly spending limits on how much they gamble.<\/p>\n Outside the casinos, GameSense is marketed on social media and on sports betting apps<\/a> and websites. Meanwhile, the state\u2019s Department of Public Health puts its own moderation messages<\/a> on buses and billboards.<\/p>\n \u201cThat\u2019s a big movement in 12 years,\u201d said Mark Vander Linden<\/a>, who oversees the GameSense program in Massachusetts.<\/p>\n Massachusetts\u2019 first casino opened in 2015, and as the gaming industry grew, the state developed what it calls a \u201cresponsible gaming\u201d program, funded by a surtax on gambling industry profits.<\/p>\n At first, state regulators<\/a> tried various strategies to educate customers about the addictive nature of gambling, as well as the financial risks.<\/p>\n \u201cIt was much more about making sure that there are brochures that are available that explained the odds of whatever game it was,\u201d Vander Linden said.<\/p>\n Since then, Massachusetts has put in place additional regulations<\/a> on a booming industry that now includes widespread sports betting. For example, there\u2019s no betting on Massachusetts college teams, and no gambling by credit card. All gambling companies must allow customers to set voluntary limits and sign up for a \u201cvoluntary self-exclusion list\u201d that bans them from casinos or sports betting over various time intervals.<\/p>\n A Patchwork of State Policies<\/p>\n Some states have set similar limits to curb problem gambling, but others have very few. In the absence of a nationwide policy, or a national gambling commission to oversee the industry, each state is on its own.\u00a0<\/p>\n A growing number of addiction researchers and policymakers say it\u2019s time to take bolder \u2014 and more unified \u2014 steps to combat gambling disorders. They point to the explosion of the gaming industry since 2018, when the U.S. Supreme Court opened the door<\/a> for states to legalize sports betting<\/a> and unleashed an aggressive industry, now legal in 39 states. (Forty-eight states have legalized at least some form of gambling, including lotteries.)<\/p>\n Compared with the U.S., several other countries have gone much further in regulating<\/a> the gambling industry, and some experts in the U.S. are looking to them as potential models.<\/p>\n For example, Norway\u2019s government<\/a> has a monopoly on all slot machines so it can control the types of games offered, and every gambler in the country is limited to losing 20,000 kroner (about $2,000) a month.<\/p>\n In the United Kingdom<\/a>, most adults are limited to betting 5 pounds (about $7)<\/a> on every spin on a slot machine, and gambling companies are subject to a 1% levy that goes into a fund for treatment and prevention of gambling disorders.<\/p>\n Last year, a report published in the medical journal The Lancet<\/a> called on international health leaders to act quickly on regulations before gambling disorders become widespread and common \u2014 and that much harder to stop.<\/p>\n But policy leaders point out that the U.S. has less appetite for corporate regulation than many other countries, especially under the Trump administration. At the same time, they warn that doing nothing could pose a serious public health threat, especially now that sports betting apps allow people to gamble anywhere and anytime.<\/p>\n Even before the marriage of online gaming and cellphones, researchers had estimated 1%<\/a> to 2%<\/a> of Americans already had a gambling disorder, and an additional 8% of people were at risk<\/a> of developing one.<\/p>\n Some U.S. politicians fear the problem will only get worse.<\/p>\n \u201cThe sophistication and complexity of betting has become staggering,\u201d said Democratic U.S. Sen. Richard Blumenthal<\/a> of Connecticut. \u201cAnd that\u2019s why we need protections that will enable an individual to say no.\u201d<\/p>\n Blumenthal has cosponsored the SAFE Bet Act<\/a>, legislation that would impose federal standards on sports betting companies.<\/p>\n The bill proposes a ban on gambling ads during live sporting events, mandatory \u201caffordability checks\u201d for high-spending customers, limits on VIP membership schemes, a ban on artificial intelligence tracking for marketing, and the creation of a national \u201cself-exclusion\u201d database, among other rules.<\/p>\n \u201cStates are unable to protect their consumers from the excessive and abusive offers, and sometimes misleading pitches,\u201d Blumenthal said. \u201cThey simply don\u2019t have the resources or the jurisdiction.\u201d<\/p>\n The gambling industry is strongly opposed to the SAFE Bet Act. Federal standards would be a \u201cslap in the face\u201d to state regulators, said Joe Maloney, a spokesperson for the American Gaming Association<\/a>.<\/p>\n \u201cYou have the potential to just dramatically, one, usurp the states\u2019 authority and then, two, freeze the industry in place,\u201d he said.<\/p>\n \u201cResponsible Gaming\u201d Versus the Public Health Approach<\/p>\n New regulations are also unnecessary, Maloney said. The industry acknowledges that gambling is addictive for some people, he said, which is why it developed an outreach\/awareness initiative known as \u201cresponsible gaming<\/a>.\u201d<\/p>\n That includes messages on buses and billboards warning people to stop playing when it\u2019s no longer fun and reminding them the odds of winning are very low.<\/p>\n \u201cThere\u2019s very direct messages, such as, \u2018You will lose money here,\u2019\u201d Maloney said.<\/p>\n He said his industry group does not collect data on whether such measures reduce addiction rates. But he said gambling restrictions are not the answer.<\/p>\n \u201cIf you suddenly start to pick and choose what can be legal or banned, you\u2019re driving bettors out of the legal market and into the illegal market,\u201d Maloney said.<\/p>\n Public health leaders argue that the industry\u2019s \u201cresponsible gaming\u201d model doesn\u2019t work.<\/p>\n \u201cYou need regulation when the industry has shown an inability and unwillingness to police itself,\u201d said Harry Levant<\/a>, director of gambling policy for the Public Health Advocacy Institute<\/a> at the Northeastern University School of Law in Boston.<\/p>\n One reason the industry\u2019s approach is \u201cethically and scientifically flawed\u201d is that it puts all the blame and responsibility on individuals with a gambling disorder, Levant said. \u201cYou can\u2019t say to a person who is struggling with addiction, \u2018Well, just don\u2019t do that anymore.\u2019\u201d<\/p>\n Levant comes to the issue from personal experience. He is in recovery from a gambling addiction. A former lawyer, Levant was convicted in 2015<\/a> for stealing clients\u2019 money to fund his betting habit. Since then, he not only has become an advocate for stronger regulations but also is a trained addiction therapist.<\/p>\n The American Gaming Association said it supports treatment for gambling disorders and helps pay for some referral and treatment services through state taxes. But Levant called that \u201cthe moral equivalent of Big Tobacco saying, \u2018Let us do whatever we want for our cigarettes, as long as we pay for chemotherapy and hospice<\/a>.\u2019\u201d<\/p>\n Instead, Levant advocates for a public health approach that would help prevent addiction from the get-go. That means putting limits on marketing and on the types, and frequency, of gambling \u2014 for everyone, not just those already in trouble.<\/p>\n To make his case, Levant opens his laptop and pulls up a corporate infomercial produced by Simplebet, a DraftKings subsidiary<\/a>.<\/p>\n In the video, the company boasts about getting more people to gamble on sports through what\u2019s called microbetting during live games. \u201cWe drive fan engagement by making every moment of every game a betting opportunity. Automatic, algorithmic, powered by machine learning and AI,\u201d the voiceover said.<\/p>\n That\u2019s the kind of constant engagement that promotes addiction, Levant said. (Contacted by KFF Health News and NPR, DraftKings declined to comment, instead sending a link to its \u201cresponsible gaming\u201d program<\/a>.)<\/p>\n Lawmakers Want To \u201cStop the Worst Excesses\u201d Before the Next Gambling Trend<\/p>\n Some of those gambling mechanisms would be limited by the SAFE Bet Act, which Levant and his colleagues at the Public Health Advocacy Institute helped write.<\/p>\n But if the legislation doesn\u2019t get through the current regulation-averse Congress, then states need to take strong action on their own, Levant said.<\/p>\n The Massachusetts Legislature is currently considering the \u201cBettor Health Act<\/a>,\u201d which would impose additional rules on sports betting companies.<\/p>\n \u201cThe goal is not to stop gambling entirely,\u201d said Massachusetts state Rep. Lindsay Sabadosa<\/a>, a cosponsor of the bill. \u201cIt\u2019s to stop the worst excesses of online sports betting.\u201d<\/p>\n The Massachusetts bill includes components of the federal legislation, such as mandatory \u201caffordability checks.\u201d Those would cap how much money some gamblers can lose. Affordability checks are modeled on a pilot program<\/a> in the United Kingdom.<\/p>\n \u201cIf you\u2019re only allowed to have two drinks, we know that you\u2019re not going to get drunk, right?\u201d Sabadosa said. \u201cIf you\u2019re only allowed to gamble $100 a day because that\u2019s an affordable amount, you\u2019re not going to go broke. You\u2019re still going to be able to pay the rent.\u201d<\/p>\n The Bettor Health Act would also ban \u201cprop\u201d bets, which are wagers placed during a live game, such as who makes the first shot in basketball, or who hits the first home run in baseball.<\/p>\n But state tax revenue<\/a> from sports betting rose to $2.8 billion in 2024 \u2014 a welcome source of funding for struggling state budgets. Because of that potential boost, Levant fears that state legislatures will shy away from further regulation.<\/p>\n States may even be tempted by the promise of additional revenue from new types of gambling, such as \u201ciGaming.\u201d That refers to online versions of roulette, blackjack, and other casino-style games, playable at any hour, from the comfort of home.<\/p>\n IGaming is currently legal in seven states, but pending legislation in other states, including Massachusetts<\/a>, could expand its markets.<\/p>\n \u201cWe have empathy for how hard it is for states to balance their budgets in this current political environment,\u201d Levant said, \u201cbut states are starting to recognize that the answer to that problem is not to further push a known addictive product.\u201d<\/p>\n \u00a0<\/p>\n This article is part of a partnership with NPR<\/a> and New England Public Media<\/a>.<\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\n Subscribe<\/a> to KFF Health News\u2019 free Morning Briefing.<\/p>\n This article<\/a> first appeared on KFF Health News<\/a> and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License<\/a>.![\"A](\"https:\/\/www.newsbeep.com\/ca\/wp-content\/uploads\/2025\/10\/Gambling_01-500x334.jpg\")
A slot machine on the floor of the MGM Springfield casino, in Springfield, Massachusetts. (Karen Brown\/New England Public Media)<\/p>\n![\"An](\"https:\/\/www.newsbeep.com\/ca\/wp-content\/uploads\/2025\/10\/gambling-500x309.jpg\")
An ad for GameSense, a \u201cresponsible gaming\u201d program for Massachusetts residents, appears on a screen at the MGM Springfield casino. (Karen Brown\/New England Public Media)
\nFears That More Gambling Means More Addiction<\/p>\n![\"Harry](\"https:\/\/www.newsbeep.com\/ca\/wp-content\/uploads\/2025\/10\/Gambling_03-500x333.jpg\")
Harry Levant (left) and Mark Gottlieb, both of the Public Health Advocacy Institute at the Northeastern University School of Law in Boston, are advocating for stronger gambling regulations nationwide. (Karen Brown\/New England Public Media)<\/p>\n![](\"https:\/\/www.newsbeep.com\/ca\/wp-content\/uploads\/2025\/10\/kffhealthnews-icon.png\"\/){kind=icon}
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