Rachel Volberg remembers her run-in with a persistent ad campaign.

She would go to play a puzzle app on her iPad, only for actor and comedian Kevin Hart to pop up over and over. He was encouraging her to set up an account with DraftKings, one of America’s largest sportsbook providers, in the lead-up to Massachusetts’ sports betting launch last year.

“I was completely taken aback every time,” Volberg said.

Since the Supreme Court overturned a de facto ban on sports betting in 2018, it’s become a multi-billion-dollar industry. Major companies like BetMGM, FanDuel and DraftKings are now advertising mainstays around sports events like March Madness, but that’s not where they stop.

Volberg, who describes herself as a “middle-aged, slightly older” woman, realized how far-reaching it had become once it took over her puzzle game.

“It was very clear to me that there was literally no demographic niche in the Massachusetts population that was not getting bombarded with advertising,” she said.

Volberg is a research professor at the University of Massachusetts-Amherst and president of the gambling consulting firm Gemini Research. She’s studied gambling since the 1980s, when much of it was illegal and research about it was scarce, she said.

“In the early years of my career, a majority of people objected to gambling on the basis of a moral argument,” Volberg said.

By 2018, a Gallup poll showed public opinion had shifted. Because the federal government doesn’t set broad gambling regulations, most states today have legalized gambling to varying degrees and in different forms, like lotteries, casinos and sports betting.

In Kentucky, legal sports wagering launched in September. Residents can now bet online and at brick-and-mortar venues like horse racetrack facilities, no longer needing to cross state lines.

However, some experts say the wide legalization and promotion of sports betting could present risks, especially around addiction. The American Psychiatric Association recognizes gambling disorder and defines it as someone showing at least four deeply harmful habits in a year. Those can include constantly thinking about gambling, trying to recoup lost money by gambling more, and being unable to quit.

Kentuckians at risk

In March, around a dozen members of an anonymous gambling support group in Kentucky discussed how gambling had negatively affected their lives. They discussed the toll it had taken on their emotions, their financial stability and their relationships with family.

And while some said it had been hard to quit gambling, they were all seeking to stop permanently. Some had placed their last bet months ago, others years ago and a few others decades ago.

RonSonlyn Clark is a licensed gambling counselor and the president of the Kentucky Council on Problem Gambling, an advocacy group that connects people struggling with gambling to resources like therapy.

She said the accessibility of sports betting can cause a gambler to fall “deeper and deeper into trouble”, and Kentuckians who live far from other states where gambling has been legalized are now at greater risk.

“You can sit in the comfort of your home, while your family is sitting there watching TV at night — most people are playing on their phones — and you can be placing sports bets at any time,” Clark said.

The International Gambling Counselor Certification Board lists Clark as just one of three active counselors in Kentucky, and her organization is looking to boost that number by hosting training sessions. She said she treats patients “from across the state.”

“Because there are so few of us, I do use some telehealth resources,” said Clark, who’s based in Owensboro.

The council lists several other certified counselors in the state. Mike Stone, the group’s executive director, said that’s because some earned certification before a merger between the American and International boards.

Calls in Kentucky to a national gambling helpline, answered at RiverValley Behavioral Health in Owensboro, have increased since the Commonwealth launched sports wagering in September. Gerrimy Keiffer, who works at RiverValley, said in an email that during the first two months of 2024, there were 101 calls seeking help or information on harmful gambling.

Stone attributed the rise in calls to the emergence of sports betting ads that include the helpline number. He added that legalization has coincided with a shift in what callers say is their preferred method of gambling.

“It has been for years back and forth between lottery scratch-offs and slot machines at casinos… For the first time in January, the preferred game of choice was sports betting,” Stone said.

An analysis by the council released in 2022 estimated that at least 47,000 Kentuckians could have a gambling addiction, which studies have shown correlates with a high risk of suicide. The council’s analysis also found that at least 102,000 more residents could be at risk of addiction.

Clark said the state has been late in addressing the harms connected to gambling.

“I think we should have been focused on problem gambling 25 years ago, when we started [the council],” Clark said.

Guardrails and gaps

Kentucky’s approval of sports betting included a goal to support the state’s permanent pension fund. Revenue from wagers placed at brick-and-mortar venues is taxed at 9.75%, a rate that jumps to 14.25% for online bets.

While some Republicans in the GOP-dominated legislature objected to it on moral grounds, others framed it as a way to regulate an underground industry and prevent residents’ money from going into neighboring states that had already legalized the practice.

Jim Whelan, the executive director at the Tennessee Institute for Gambling Education and Research, said that when states legalize the practice, they’re able to better mitigate longstanding risks linked to gambling.

“Before the lottery, the idea that you would do public awareness about gambling harms, legislators [and] regulators wouldn’t touch,” he said.

Kentucky’s law to legalize sports betting also gave regulatory powers to the Kentucky Horse Racing Commission, an independent state agency.

Through an emergency amendment last year, the commission set some rules on sports wagering advertisements — including banning them at grade schools — and set up a self-exclusion list that residents can opt into if they believe they have a gambling problem. Sports betting providers can’t offer wagering to people who self-exclude from their product for a set amount of time.

In Kentucky, sports betting runs through horse racetrack associations like Churchill Downs and Keeneland, which can then partner with sportsbook providers. Under current regulations, the associations have to regularly report self-exclusions they receive to the commission, which shares the full list with all of them.

But in those regulations, the state doesn’t say if associations and sportsbooks must prohibit everyone on the list from their sports betting services. The Kentucky Horse Racing Commission did not respond by deadline to a request for comment seeking clarification on its policies.

The rules also don’t specify how long Kentuckians should be able to self-exclude from gambling beyond at least a 72-hour “break.” Sports betting providers offer those short cutoffs alongside longer self-exclusion periods.

At least several providers that operate in Kentucky let residents self-exclude for up to five years, and they don’t reopen accounts unless a user requests it. But the majority don’t say they allow for permanent self-exclusion.

Sharon Custer is concerned that people who opt out temporarily could redevelop unhealthy habits once that period is over. She’s a faculty member at the Institute for Responsible Gaming, Lotteries and Sport at Miami University in Ohio, which makes policy recommendations for gambling industries.

Custer said she likes that Kentucky has a shared self-exclusion list, but wants to see more regulations in place.

“It should make it a little bit hard to [re-enter], so that someone really has to think twice, ‘Is this really what’s best for me?’” Custer said.

Some states like Ohio and New Jersey have government programs that allow residents to self-exclude from all sports wagering services, and from other forms of gambling, but Kentucky does not.

Volberg, with the University of Massachusetts-Amherst, said that a “strong, independent regulator” is necessary to oversee the gambling industry.

She pointed to the Massachusetts Gaming Commission, a public agency that hired her more than a decade ago to lead an ongoing research project into gambling’s social and economic impacts on the state.

“Gambling regulation is increasingly being viewed as not just about making sure the operators follow the rules to offer a product in a fair and transparent way,” Volberg said, “but also preventing those operators from behaving in ways that are going to cause harm to residents.”

State lawmakers are considering a new measure, Senate Bill 299, that would replace the Kentucky Horse Racing Commission and the Department of Charitable Gaming with a new regulatory group to oversee most forms of legal gambling.

The Kentucky law legalizing sports wagering also established a fund that provides money for people and groups seeking to address unhealthy gambling behaviors. Those funds can be used for activities like public awareness campaigns, gambling counselor trainings and addiction treatment cost support.

The fund receives 2.5% of the collected tax revenue from sports betting. According to the Kentucky Horse Racing Commission, nearly $900 million had been placed on wagers from Sept. to Dec. 2023. That produced more than $15.5 million in tax revenue, on pace to exceed officials’ expectations of $23 million in year one.

Brice Mitchell, a spokesperson for the Cabinet of Health and Family Services, said this month that there is around $630,000 deposited in the gambling assistance account after about half of a year of legal sports betting.

A need for resources

The federal government provides funding, resources and training toward addressing substance abuse and mental health issues. But that doesn’t include support for unhealthy gambling.

Whelan, with the Tennessee Institute for Gambling Education and Research, said there aren’t enough resources to treat unhealthy gambling behaviors.

“There’s not a lot of education being done out there for health service providers, on how to provide treatment, or even how to screen for this,” Whelan said. “The issue really comes back to money.”

While some research has shown that medicine, such as opioid antagonists, can address people’s symptoms from a gambling disorder, the U.S. Food and Drug Administration has yet to approve any drugs for treatment. Whelan said that behavior-based solutions that target gambling work.

“[Gamblers are] fundamentally different,” Whelan said, referencing a common belief that they can solve their issues by having “one big win.”

“That cognitive behavioral treatment needs to be tailored to the culture and the kind of processes that happen for people when they gamble,” Whelan said.

The Kentucky Council on Problem Gambling’s Clark said her group hasn’t decided if they will apply for money in the state fund. They hosted a certification session for about 20 people in January.

“This is the first time we’ve had this much interest in becoming a gambling counselor… in a very long time,” Clark said.

She stressed that her group is neutral on gambling itself, and that it can be a healthy practice in moderation.

“Gambling is supposed to be fun and entertaining. Take some money that you would use for a night of any other entertainment … That can be the gambling money,” Clark said.

But she said that people shouldn’t double down on making a profit from it.

“Places like Las Vegas, and the casinos and the racetracks, they’re all beautiful, beautiful venues. They didn’t build those places off of people’s winnings. They built those off of people’s losses in those communities.”

Note: If you or someone you know is at risk of problems related to gambling, the national helpline 1-800-GAMBLER can provide resources.

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