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In the last couple of years, the world has become a kind of 24-hour casino. Anyone can place bets on anything at any time from the phone in their pocket. This shift hasn\u2019t been gradual. It\u2019s happened all at once. In the short time since a 2018 Supreme Court ruling took effect, roughly 38 states in the United States have legalized some kind of sports betting. At the same time, so-called predictive markets have taken off, with apps like Kalshi allowing regular people to place financial bets on everything from Venezuelan leader Nicol\u00e1s Maduro\u2019s capture, to Bad Bunny\u2019s Super Bowl halftime opener, to Greenland\u2019s fate, to whether it will snow in Salt Lake City this month.<\/p>\n That easy access spells trouble for many people. A recent investigation<\/a> in Jama Internal Medicine showed that online searches for gambling addiction help have ballooned: They\u2019re up 23 percent nationally since 2018. People in their 20s are the fastest growing group of gamblers, but many start as young as 12 years of age, often through online video games<\/a>. Many journalism outlets now have partnerships with predictive markets or sports betting sites, at least some of whom report feeling pressured<\/a> to normalize betting in their reporting. The more normal it seems, the more dangerous it becomes for at-risk groups, says Timothy Fong, addiction psychiatrist and co-director of the Gambling Studies Program at the University of California, Los Angeles.<\/p>\n I spoke to Fong about how the surge in online betting is reshaping gambling addiction and reality itself.<\/p>\n Has the nature of gambling disorder changed in the last few years, as betting on everything and anything has become more accessible?<\/p>\n No one, frankly, could have predicted, pardon the pun, how exponentially different our world would become in just a matter of years. Two years ago, prediction markets were a niche thing, but it\u2019s really exploded dramatically. I\u2019m an addiction psychiatrist. And for the last 25 years, I\u2019ve been in the business of helping people who call and say, \u201cI have a problem with drugs, alcohol, gambling. It\u2019s harmed my life. I need help.\u201d And these were people who would go to brick-and-mortar casinos, maybe use a bookie here and there\u2014you know, things like that.<\/p>\n But in the last four years, people began getting in trouble with online gambling apps. You can dress it up with different clothes and different makeup and different whatnot, but at the end of the day, what is it? It\u2019s an experience where you\u2019re putting something of value at risk, in this case money, on an event of uncertain outcome, in the hopes of winning a larger reward. Also knowing you can lose that. Any way you slice it, that\u2019s gambling.<\/p>\n ADVERTISEMENT<\/p>\n Nautilus Members enjoy an ad-free experience. They\u2019ll say prediction is based on your own research, it\u2019s a skill-based activity. These companies say, \u201cWe\u2019re not gambling, we\u2019re not gaming, we\u2019re investing, we\u2019re financial. We\u2019re allowing the little guy to get in on making money off his or her knowledge about human events. You can invest in anything you want and potentially be rewarded for it.\u201d But they don\u2019t talk about the risk of losing your investment. And these markets aren\u2019t regulated like casinos. The bottom line is, there\u2019s no doubt every single day we\u2019re starting to get more calls from men and women who are adversely impacted by these financially risky experiences.<\/p>\n Are your patients today different than a few years ago?<\/p>\n I saw a young man today, 19 years old, who has lost two years of his life with these various apps. A mixture of betting on sports, cryptocurrency stuff, meme and coin stuff, stocks, options, prediction markets. At the end of the day, this young man has spent over $180,000, and has tremendous guilt, shame, misery, emotional pain, financial damage. He\u2019s literally not left campus in a year because he\u2019s just been stuck on his phone and his laptop trying to play around with these financial apps. For him, the only reason he came to see me was that he spent everything. He told his parents, \u201cI\u2019m sorry, I don\u2019t know what else to do.\u201d And his parents said, \u201cYou need professional help. You\u2019re gambling.\u201d They googled gambling treatment, UCLA, they found me.<\/p>\n ADVERTISEMENT<\/p>\n Nautilus Members enjoy an ad-free experience. Are the kinds of people who are susceptible to gambling disorders different now versus a few years ago?<\/p>\n In the 1980s, crack cocaine came onto the market, and it created a whole new generation and legions of folks became addicted because it was a product that was much, much more potent and much stronger and much more addictive than cocaine. A similar thing has happened with gambling. The types of products that are out there now are way more addictive, faster, more potent, more accelerated. So for Generation X, if I wanted to invest in the stock market in the \u201990s, I had to physically go into an office, wait, put an order in, write a physical check, and wait for that thing to happen. Then E*TRADE came along, and you could do it from your home. And everyone was like, \u201cOh this is so cool!\u201d The problem is, we\u2019ve accelerated two things: The speed at which you can make financial transactions combined with the addictive nature of some of these products that are expressly designed to get you to spend more money. It offers an incredible experience and lots of things to choose from. Super cheap to get into, powerful advertising, normalization of this behavior so that it\u2019s seen as, \u201cOh, everybody\u2019s doing it.\u201d And if you don\u2019t get in on it, you\u2019re missing out.<\/p>\n Who\u2019s most vulnerable?<\/p>\n The core is gonna be young people who aren\u2019t fully formed adults. We know it\u2019s people with untreated mental-health conditions that make emotional regulation difficult. So people with ADHD, major depression, bipolar disorder, active substance use disorder, people with head injuries. And we know disproportionately it\u2019s gonna be people from lower socioeconomic classes and minority populations that are already behind the eight ball. But on the flip side, who comes into the clinic at UCLA? White guys, 18 to 24. That\u2019s it. That\u2019s all we see. The last 20 calls I\u2019ve had for help were 18- to 24-year-old white guys with good families, who were highly educated, tech savvy, but had run into some trouble. I haven\u2019t seen a single female in the last two years. At a conference two weeks ago, not a single audience member had a woman that showed up for help. But we know women are doing this. They\u2019re just not coming in.<\/p>\n ADVERTISEMENT<\/p>\n Nautilus Members enjoy an ad-free experience. How do you know women are gambling on the apps?<\/p>\n Because when I ask women in my world, \u201cAre you gambling on sports?\u201d They say, \u201cYeah.\u201d And in the gambling industry, when we ask them how many users identify as women on your apps, they say 20-30 percent. Even the national surveys say that. I saw a really interesting ad for the predictive market Kalshi the other day. I wasn\u2019t sure whether it was an ad or a social media influencer they were paying, but it was a female in pajamas on a couch. The idea was basically, \u201cHey, get into Kalshi. This could be your side gig. Get paid for your opinions.\u201d It was couched as a job, as a safe work-from-home alternative.<\/p>\n So did you not used to see 18- to 24-year-old white men in your practice for gambling addiction?<\/p>\n ADVERTISEMENT<\/p>\n Nautilus Members enjoy an ad-free experience. I think they\u2019re trending younger. If you look at the profiles of people who call gambling helplines, compared to five or six years ago, there are definitely more younger men calling. But it\u2019s a tricky profile. Is this a brand new population of gambling-disordered people we created from thin air? Yes and no. We\u2019ve created an environment that\u2019s driving these young men to seek help. We can\u2019t say it\u2019s affecting them more than say, older Black men in their 70s or something like that. But we\u2019re definitely seeing that age group, which is very vulnerable to all kinds of addictions. This young man from today, if he doesn\u2019t get into these apps, he doesn\u2019t develop a gambling problem. He\u2019s just a normal sophomore.<\/p>\n And are most of them coming to you having trouble with sports gambling, or all kinds of prediction market stuff?<\/p>\n It\u2019s a mixture usually of five or six different apps, five or six different types of gambling. Sports tends to be number one followed by stocks and meme stocks and crypto. But the vast majority of what we\u2019re seeing is betting on sports. And it\u2019s not traditional sports betting, like my team versus your team. It\u2019s very exotic types of bets on sports they know nothing about, like table tennis from Taiwan or Hungarian soccer leagues. Sports betting used to be about enjoying action and watching a game with friends. Now it\u2019s essentially like a lottery. You\u2019re just using random number generators and you\u2019re hoping the numbers go your way.<\/p>\n ADVERTISEMENT<\/p>\n Nautilus Members enjoy an ad-free experience. Read more: \u201cAre Fantasy Sports Really Gambling?<\/a>\u201d<\/p>\n So they\u2019re not betting on global events like, you know, Maduro\u2019s capture in Venezuela, things like that?<\/p>\n That\u2019s part of the problem. A lot of the gamblers that come in, that\u2019s not kind of a standard thing that clinicians ask, because many clinicians don\u2019t even know about it. I ask, and most of the clients I have are like, \u201cThat\u2019s not really a thing yet for me.\u201d<\/p>\n Does the normalization and pervasiveness of gambling change the kinds of neurological or psychological hooks that get people into it?<\/p>\n ADVERTISEMENT<\/p>\n Nautilus Members enjoy an ad-free experience. It\u2019s like other forms of addiction\u2014cannabis, alcohol\u2014when you normalize the activity, you decrease perception of harm. When you promote engagement, that\u2019s when you get folks who are vulnerable or financially illiterate or just unaware, more likely to participate. We don\u2019t see a lot of ads on TV about using cannabis. There are strict advertising laws against cannabis for anyone under 21. But when it comes to gaming, these markets, laws like this aren\u2019t really enforced. Kalshi is gonna have an ad in the Super Bowl. I can\u2019t think of a more publicly endorsed form of advertising than the Super Bowl. Then you have peer pressure, and you imagine what it does. This 19-year-old I saw today, he\u2019s in a frat. I asked him, how many of the guys in your frat are betting on sports? He\u2019s like, \u201c110 percent plus the other 20 percent who are lying that they\u2019re not.\u201d So if he doesn\u2019t bet on sports, he\u2019s an outcast.<\/p>\n And people in their teens and early 20s are already more vulnerable to this kind of addiction?<\/p>\n Anyone whose brain isn\u2019t fully grown is vulnerable when it comes to decision making. They\u2019re vulnerable to impulsivity, understanding the biological urges of wanting something versus needing something: drugs, sexual images, financial reward, images of power, things that are associated with acquisition.<\/p>\n ADVERTISEMENT<\/p>\n Nautilus Members enjoy an ad-free experience. I understand that in gambling disorder, what really hooks people, when it starts to become destructive, is after their first big win.<\/p>\n It\u2019s similar to what happens with substances. If you don\u2019t get a rewarding experience the first time you use cocaine or heroin, you\u2019re probably not likely to do it again. But what also is super rewarding is the near win, or the almost win\u2014the near miss. It\u2019s been shown through some neuroscience imaging that this is as rewarding as actually winning, and almost even more reinforcing. It\u2019s like, \u201cOh my gosh, I almost won. If I stick at it, eventually I\u2019m going to win.\u201d Which is why that game ParlayPlay is so attractive. It lets you place multiple bets at once, if you get all of them right, you can get a massive win, which creates the opportunity for a lot of near-misses. These are the powerful kinds of reinforcing mechanisms that we see.<\/p>\n So these betting sites are set up to use our specific psychological vulnerabilities against us?<\/p>\n ADVERTISEMENT<\/p>\n Nautilus Members enjoy an ad-free experience. People in the casino and gambling industry have been doing this for years. No clocks, free drinks. They do this for engagement and retention. The betting apps also use tricks. They have algorithms that know what kind of bets you like, what kind of sports you like, what kinds of numbers draw you in. So when I log onto these apps, I notice that \u201cOh, wow, they already pre-made a bet for me. This is great. I don\u2019t even have to do my own research.\u201d It\u2019s like, \u201cClick here if you want in on it.\u201d They have a lot of other tricks, reward systems, mini competitions, track your progress, refer a friend and get a nice jacket. So a lot of it is the standard stuff, but I\u2019ve had a few behind-the-scenes talks with gambling operators, and they\u2019re like, \u201cYou know what we get frustrated with? When people sign up, they deposit money, they make one bet, and then the next day they pull their money out. That\u2019s the worst kind of customer.\u201d<\/p>\n Prediction markets are different from sports betting because they\u2019re dealing with real-world events. They claim to aggregate wisdom, the wisdom of crowds, to reveal truth. But does this end up becoming a self-referential loop? With reporting of the odds in turn influencing behavior, which amplifies the odds and so on? Particularly given the cozy relationships that exist and are developing between prediction markets and journalism outlets.<\/p>\n I think it goes back to again, what are these products? An investment or financial tool that\u2019s meant to preserve wealth? A more accurate polling device? Financial tools that hedge against risks? Like if you run a restaurant and you bet on it closing, then you\u2019re protected from, let\u2019s say, a wildfire shutting it down. But I play around with these apps a lot, and all I know is that when I put money in a prediction market, really into sports, it feels exactly like gambling. I have an expectation I\u2019m gonna get paid out. If it were a true investment, I wouldn\u2019t get paid out for 10 years or 20 years like a CD or a six-month treasury. Right?<\/p>\n I think this whole wisdom of the crowd, that\u2019s very useful for certain things. But is the crowd leading the money, or is the money leading the crowd? And it could be driven by insider trading by someone who had an agenda and you\u2019re completely unaware of it, which ends up shaping how you think. I think that\u2019s probably the scariest thing. Someone force-feeding you an idea so that they could benefit from the outcome of that idea.<\/p>\n ADVERTISEMENT<\/p>\n Nautilus Members enjoy an ad-free experience. Just a few weeks ago, federal prosecutors charged over two dozen people in a college basketball scheme for fixing gains. And then there\u2019s the Polymarket trader who placed the wager on Maduro and made $400,000. And the crazy rumors about Karoline Leavitt, Trump\u2019s press secretary, ending her briefing early in response to a bet on one of the apps. What happens when the corruption and \u201cfixing\u201d extends beyond sports into global politics and everyday events?<\/p>\n You get more distrust in everything. People start believing that everything is rigged. There is a faceless, authoritarian figure or corporation behind every move. Alternative facts become the norm. And conspiracy theories dominate. And any sort of faith that you have in anything is eroded. Do we as humans need faith in order to sustain ourselves? Or can we live in an environment where literally everything we do is constantly questioned by everyone? I see profound distrust in institutions just getting worse, which, in turn, obviously impacts everyone\u2019s mental health, because that creates more fear, anxiety, emotional pain, doubt, pessimism, and well, addiction. But in the patients that come in for addiction right now, it\u2019s a very different story. They\u2019re like, \u201cI just know I could get back to even.\u201d<\/p>\n I had a policy guy at a think tank say to me the other day, \u201cI see no value in gambling ever.\u201d And I said to him, \u201cI see no value in alcohol as a product in the world. Humans don\u2019t need alcohol to live.\u201d And he\u2019s like, \u201cYou\u2019re right. I don\u2019t see any value in that either.\u201d So what do we do with things in our world that we know provide no immediate benefit to the survival of the species?<\/p>\n ADVERTISEMENT<\/p>\n Nautilus Members enjoy an ad-free experience. Do existing frameworks for understanding and treating gambling disorders fit what\u2019s emerging now? Or do you have to rewrite them given how quickly things are changing?<\/p>\n We have to evolve. Standard treatment protocols are about biological, psychological, and social treatments for addiction. A biological treatment is getting a good night\u2019s sleep. It\u2019s eating three meals a day. It\u2019s physical movement. So that stuff is always there. We have certain medications for urges and cravings. No problem.<\/p>\n Psychologically, when it comes to the actual gambling, there\u2019s a lot of cognitive distortions that fuel ongoing gambling addiction. In traditional gambling, it\u2019s like, \u201cOh, I\u2019ve lost 20 hands in a row at Blackjack, I\u2019m due to win, therefore I should triple my bet.\u201d Or: \u201cYou can\u2019t lose on your birthday, so I\u2019m gonna take a higher bankroll to the casino on my birthday.\u201d But it\u2019s a different set of distortions when it comes to online financial gambling. \u201cThe Bulls never beat the Knicks on Mondays.\u201d So there\u2019s some similarity, but there are also some different expectations, such as a lot of folks come in and tell me, \u201cNo, these things aren\u2019t rigged, and I really believe I have a skill in picking stocks.\u201d Or: \u201cEveryone I see online is making money hand-over-fist, so it\u2019s just a matter of time before I do, too.\u201d And a lot of times people don\u2019t view this stuff as gambling. They see gambling as slot machines.<\/p>\n The social treatment for addiction is things like 12-step support groups\u2014Gamblers Anonymous, connecting with others, learning new skills. This is one of the hardest parts when you have generations now that are really struggling with loneliness. I say, \u201cYou need to go out, meet people, do stuff, get out there in real life,\u201d and there\u2019s this resistance. \u201cNo, I\u2019m not doing that.\u201d It\u2019s fear of rejection. A lot of these young folks will not go to a GA meeting in person because they\u2019re like, \u201cThat sounds so scary.\u201d But they\u2019ll do a GA meeting online. Or they\u2019ll say, \u201cI won\u2019t go to church \u2018cause church is full of pedophiles.\u201d Or: \u201cI won\u2019t go get a job because why should I get a job? Because why should I stay for 10 hours making $150 bucks when I can gamble in two seconds and make a thousand dollars.\u201d Even in fraternities, they\u2019re like, \u201cWhy should we go out? It\u2019s just too much of an effort.\u201d So that social treatment is about finding real-life activities that are more meaningful. That\u2019s what draws you away from the compulsion to gamble.<\/p>\n ADVERTISEMENT<\/p>\n Nautilus Members enjoy an ad-free experience. If you have a full life and you\u2019re super busy and you have a lot of interests, you\u2019re probably not on your phone a thousand hours a day. But these people have very different views on real-world experiences. I\u2019ve had a few who are really uncomfortable coming in to see me in person because they don\u2019t know how to be in person with anybody. They\u2019re only used to the digital world. Enjoying\u00a0 Nautilus<\/a>? Subscribe to our free newsletter<\/a>.<\/p>\n Lead image: Visual Generation \/ Shutterstock<\/p>\n ADVERTISEMENT<\/p>\n Nautilus Members enjoy an ad-free experience. Kristen French <\/p>\n
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