A major problem

Although rates of youth gambling in Maryland dipped to 15.3% during the COVID-19 pandemic, they climbed to 17.5% during the 2022-23 school year, driven primarily by teenage boys, according to the center. In that same school year, a quarter of high school-age males gambled, while about 10% of their female classmates did.

In Maryland high schools, 18-year-olds are most likely to gamble. They’re also the only students legally able to do so. In Maryland, it’s legal for 18-year-olds to purchase lottery tickets, and wager on horse races and fantasy sports betting. But it’s not legal for Maryland 18-year-olds to enter casinos, play poker, or participate in sports betting. Those venues and activities require participants to be 21.

Despite this, more than 17% of younger teens gamble, according to the center’s data.

Although many online gambling venues have terms of service that bar underage use, some teens use deceitful methods to sidestep state law. According to Hinman, he’s encountered children as young as 15 using offshore betting sites, while others have forged legitimate online profiles by using an older person’s identification — sometimes with their permission.

“A lot of times, the parents are thinking it’s a harmless activity,” Hinman said. “I think it’s a family member, in a lot of cases, that help those underage kids … open up accounts.”

Even seemingly innocuous actions, like gifting lottery tickets as stocking stuffers on Christmas or letting them pick horses during the Preakness Stakes, can introduce children to dangerous gambling behaviors, Hinman said.

Eshleman characterized gambling as similar to addictive substances, such as alcohol. Many can control their consumption, but for a small population, it spirals out of control, destroying lives in the process. The earlier someone starts gambling, the more likely they are to become addicted, Eshleman said.

Since 2020, helpline calls at the Maryland Center of Excellence on Problem Gambling have more than doubled, and many callers are seeking help for more than just a gambling problem. When the center analyzed its helpline callers in April 2024, about a third reported depression, 16% reported alcohol problems and 14% reported drug use. Nearly two-thirds had financial problems and almost a third struggled with their mental health.

While alcohol and drug abuse have long been the targets of Maryland’s health curricula, gambling addiction has never seen the same focus.

“There needs to be more education around it,” Hinman said. “We’re seeing it start to become a real serious problem. Let’s take some action before it becomes a major, major problem.”

North Carolina’s solution

Youth gambling in North Carolina could have looked similar to Maryland.

North Carolina legalized sports betting in March 2024, three years after Maryland. However, state gambling prevention experts identified another worrying trend growing among the state’s youth: gambling mechanics within online gaming and digital media.

“What we’ve realized is this convergence of media — gambling, gaming, two very popular things to do, two very socially normal things to do, …  we needed to talk about all of it together,” said Alison Wood, the youth prevention coordinator for the North Carolina Problem Gambling Program.

Video games like Hogwarts Legacy, Madden NFL 24, and Marvel’s Spider-Man 2 — all of which were in the top five best-selling games of 2023 — feature loot boxes, chance-based blind boxes that can be purchased with in-game or real currency for a chance at rare prizes or rewards.

The widespread implementation of these mechanics within video games has even led to a proposed addition to the fifth edition of the “Diagnostic and Statistical Manual of Mental Disorders” — internet gaming disorder. It would be just the second diagnosable behavioral addiction after gambling.

To combat the growth in gambling behaviors in high school-aged North Carolinians, Wood worked with Stacked Deck, a gambling addiction education package and grant program, beginning in 2010. A 2022 report from the company showed the curriculum resulted in a 25% increase in students believing gambling’s risks far outweigh its benefits, as well as an overall reduction in reported gambling activities within the high school age group.

Last year, Wood worked to introduce a new program, Choice Led Health, a variation of which has also been recently implemented in Virginia. This program was placed within existing health and physical education curricula, starting with over 10,000 seventh graders in Charlotte-Mecklenburg schools. The North Carolina Department of Health and Human Services reported the program resulted in a 20% decrease in gambling activities after just a single school year.

Wood is focused on expanding the state’s gambling addiction curricula, both to other counties and to other educators. North Carolina’s next evolution will open gambling risk education to any educator, as not all schools in the state have health educators.

“Health education should be just as important as math class, as science class,” Wood said. “What are the tools that [students] need to practice healthy coping strategies, as opposed to what we call maladaptive coping strategies, which can lead to addictions?”

What’s the hold-up?

Maryland is behind on gambling addiction education, but not for a lack of trying.

Sen. Bryan Simonaire, a Republican representing northern Anne Arundel County, has worked for years to implement a statewide problem gambling curriculum, spurred by his own experiences with disordered gambling. His father was an addict, which was exacerbated by gambling’s legalization in his home state.

“I’ve seen the personal side of addiction for that, and I try to do everything I can to help other families not to have to go through that,” Simonaire said.

Despite his best efforts, the legislation has stalled since its original introduction in 2020, just before the pandemic shut down that year’s legislative session early.

When the Maryland Senate reconvened, Simonaire’s proposal found opposition from the Maryland State Department of Education,  county boards of education,n and the Public School Superintendents’ Association of Maryland. These organizations pushed back due to Simonaire’s proposal for an additional mandated curriculum, which can increase a teacher’s required workload. The bill was declared dead in April 2021.

A different story played out in Virginia’s state legislature.

Del. Sam Rasoul, a Democrat representing Roanoke in Virginia’s lower house, successfully pushed through similar legislation in 2022, facing little opposition. Unlike Simonaire’s bill, Rasoul’s legislation inserted problem gambling content into existing mandated addiction curricula, effectively sidestepping the resistance encountered by Simonaire a year prior.

“There was already instruction time allocated to addiction, and we just ensured that we were revising those guidelines to inform on the extreme dangers of addiction gambling,” Rasoul said.

Rasoul created the legislation alongside the Virginia Department of Behavioral Health and Developmental Services, just as Simonaire worked with Eshleman and the Maryland Center of Excellence on Problem Gambling on his bill. Virginia’s curriculum takes inspiration from both MD-Smart Choices and Stacked Deck, said Anne Rogers, Virginia’s responsible gambling promotion coordinator.

According to Rogers, Virginia finalized its first draft of the updated curriculum in January, which is set to be followed by a final draft in March and implementation of the revisions at the start of the 2025-26 school year.

While Virginia moves ahead with its successful legislation, Simonaire is working to replicate Rasoul’s success.

His new legislation in Maryland follows a similar pattern to Rasoul’s bill, adding new information about problem gambling to existing health curricula. Simonaire is targeting the Maryland youth suicide prevention school program, as gambling addiction, especially addiction that results in severe debt, can be a risk factor for suicidal behaviors. It would be the first revision to the program since 2008.

About half of disordered gamblers in the United States have reported suicidal ideations, according to statistics from the American Psychiatric Association. Nearly one in five have attempted suicide.

That being the case, Simonaire said the state must act.

“This is not a mandated curriculum that says every county has to do it. This is an overarching guideline as far as how to handle suicide,” Simonaire said. “What we’ve done is we’ve included gambling in it to show from the legislative standpoint, we want this included in those discussions.”

The bill’s fate will be decided during Maryland’s 2025 legislative session, which began on Jan. 8 and runs until April 7. Despite past setbacks, Simonaire said he is confident, both in the legislation’s chances and its mission. Simonaire said health professionals, education specialists and casino operators all back the bill, which had its first Senate hearing Feb. 12.

“An ounce of prevention is worth a pound of cure,” Simonaire said.