By Anne Blythe

It might be better if some things that happen in Vegas don’t stay there.

Public health researchers say the betting mecca could share valuable lessons about the effects of sports gambling with states that are just now legalizing it. North Carolina will be one of those states next month, when online sports betting becomes legal for people 21 and older.

Many public health advocates here have been looking to Nevada’s desert oasis — and to other places with legalized sports betting — hoping to better understand the problem gambling that typically surges shortly after sanctioned sportsbooks go live.

“We’re ready. We know it’s coming. We understand what’s happened in other states, so that’s helped us prepare ourselves a little bit better,” Amanda Winters, program administrator for the NC Problem Gambling Program, told NC Health News this week. “But we’re waiting with bated breath to see how it plays out.”

As of Wednesday, eight sportsbook operators were on track to go live here at noon March 11, marking a shift in law that many expect to contribute to more problem gambling.

The go-live date is just in time for “March Madness,” when college basketball fans are cheering for and betting on their teams to go deep into postseason play. The ACC and NCAA tournaments, magnets for all that fan mania, are expected to be big draws for gambling — similar to the Super Bowl.

“We know that we’ll see an increase in helpline calls,” Winters said, while also acknowledging that it could take a while for bettors to realize their gambling has become problematic and reach out for help.

“We know that people do experience greater harms when it comes to sports betting, so we’ve provided additional trainings for our clinicians,” Winters added. “We’ve focused … our prevention programs on high-risk populations. We’ve ensured that the helpline is well prepared. They’re aware that there will be an influx of calls, and they’ve prepared to adjust for that.”

Studying the numbers 

In 2023, when the General Assembly adopted new legislation for legalized sports betting, the lawmakers designated that $2 million annually from the projected state tax revenue stream go to the NC Problem Gambling Program, which is housed in the state Department of Health and Human Services.

The program won’t see any of that funding until the coming fiscal year, which begins July 1, Winters said. So the preparation for the launch of legalized sports betting had to be done within the program’s $1 million annual budget, which it has received since the inception of the lottery in 2005, she added.

“We are able to plan, and that’s a big part of the program that we run here …  ensuring that the plans and the programs we have in place already are on a solid, concrete base and are strong so that when we do build on them, we know that we are starting from a good place,” Winters said.

Michelle Malkin, a professor and director of the Gambling Research and Policy Initiative at East Carolina University, said there likely will be unexpected consequences when online sports betting apps and limited on-site gambling become available to North Carolina residents — despite the best efforts at preparation.

“I have yet to see a state fully ready to take on what is an unknown,” Malkin told NC Health News in a recent interview.

The Gambling Research and Policy Initiative that Malkin leads is in the ECU Department of Criminal Justice and Criminology. Malkin and another ECU professor, Michele Stacey, have been engaged in a study that eventually will pull in data about the gambling behaviors of 3,000 undergraduate students from community colleges and universities across the state. The state Division of Mental Health, Developmental Disabilities and Substance Use Services, where Winter’s program is housed, contributed $750,000 toward the research.

Preliminary results from a survey of 1,661 students from 12 University of North Carolina System campuses show that 58 percent of those they polled had gambled over the past year. Thirteen percent of those respondents reported gambling at least monthly.

The findings also showed that male students gambled more than their female peers. Athletes in the mix gambled slightly more frequently than non-athletes.

In keeping with what other researchers have found about gamblers in the general population, the ECU professors reported that about 5 percent of the undergraduate college students were at risk for problem gambling — similar to the 5.5 percent of all North Carolina adults with the same prospect.

“Preliminary results also show that over 60 percent of undergraduate students perceive gambling to be at least a minor issue on their campus,” according to a preliminary summary of the study that Malkin shared with NC Health News. “However, education concerning gambling behavior and risk and screening for gambling risk are practically non-existent on college campuses and the vast majority of students (over 97 percent) do not know if there is a gambling behavior policy on their campus.”

Educating the youth

Alison Drain, a NC Problem Gambling Program prevention coordinator, told NC Health News that younger college-age males are among the populations they expect to have an uptick in problem gambling, despite many of them being younger than 21. 

Long before the planning for legalized sports gambling began, her program was providing prevention programs for youth. Since 2010, they’ve been working with middle schools, high schools and community organizations to educate young people about the potential for risky behavior. Data they get from program evaluations has been enlightening.

“What we see is that kids have been gambling for quite some time on all kinds of things, including sports betting,” Drain said. “They engage in gambling amongst their friends just placing bets … on sporting events or skill-based games that they’re engaged in, including video games. 

“I don’t have the data right here in front of me to be able to speak to every single thing that they do, but in terms of legally available — and illegally available — kids are doing all of it.”

Gambling disorder, Drain added, is similar to substance use disorders.

“The earlier that you engage in the activity, the greater the chances are of you becoming addicted to it later in life because it deals with that brain structure and development,” Drain said. 

Research has shown that gambling can trigger neural responses similar to using such addictive substances as cocaine or alcohol. Gamblers can experience surges of dopamine, adrenaline and serotonin when placing a bet — especially when they win or even have a “near miss.”

“Kids are developing at that time, and they engage in high-risk behaviors — which is … great because we want them to try new things,” Drain said.”But they also need some of that risk aversion where they’re provided health education or they’re talking to parents or other trusted adults about whether a risk is worth taking or not and how that will play out in the long term.”

The DHHS program has been providing substance use disorder grants to colleges for a while, Drain added. More recently they started working with an organization that provides retired athletes with lived sports betting experience, who go to campuses to speak with athletes who can be at risk for problematic gambling behaviors, in part, because of their competitiveness.

“We hope to build on that, as well as find some other avenues to reach parents who are very concerned about their kids at college who are engaging in sports betting in terms of education online and other ways to reach out to them as we continue to develop the program,” Drain said.

Sports gambling in North Carolina will go live just in time for the annual “March Madness” basketball tournament. Researchers say young people and young athletes could be at risk for sports gambling addiction. Credit: adamglanzman/ Flickr

A public health issue

In addition to the programs aimed at younger people, the NC Problem Gambling Program has focused on ensuring that clinicians are well trained to recognize sports gambling problems and looking to research for data-driven solutions.

“The point of funding (the ECU) research institute was to see where we are as a state as a baseline, and then monitor and look at emerging trends and special populations and effects of sports betting,” Winters said. “We’ve seen other states do a fantastic job with their research agendas, but they had looked at casino gambling or at lottery. This is new.”

At a webinar in early February about sports betting and gambling addiction sponsored by SciLine, a nonprofit based at the American Association for the Advancement of Science, three researchers from across the country spoke with reporters before Super Bowl LVII between the Kansas City Chiefs and the San Francisco 49ers. They stressed the importance of funding research on sports betting.

Billions of dollars of bets are placed during Super Bowl weekends, and they are much more wide-ranging than which team will be the victor. It can take weeks to find out how many of those bets might have led to a hotline call seeking help, but researchers expected an increase after the game.

Marc Potenza, a professor of psychiatry and neuroscience and director of the Center of Excellence in Gambling Research at the Yale School of Medicine, told reporters during the SciLine webinar that data indicate “many people see gambling as less harmful than substance use behaviors.”

Beyond that, he added, there is a “greater threshold needed for making a diagnosis of gambling disorder than there is for making a diagnosis of a substance use disorder,” which could lead to fewer people seeking or receiving treatment.

Another factor, Potenza said, “is that there’s little — relatively little funding for problem gambling treatment and research.”

Richard Blumenthal, a Democratic senator from Connecticut, and Andrea Salinas, a Democratic congresswoman from Oregon, introduced the Gambling, Addiction, Recovery Investment and Treatment Act in January to create a federal funding source for research on gambling addiction.

The act would set aside half of the federal sports excise tax revenue to fund programs for gambling addiction, prevention, treatment and research, Potenza said, for the 7 million people in the United States estimated to have gambling problems.

Shane Kraus, an assistant professor of psychology and director of the Behavioral Addictions Lab at the University of Nevada in Las Vegas, and Timothy Fong, a clinical professor of psychiatry at UCLA’s Institute for Neuroscience and Human Behavior, also stressed the need for more research funding options, including calling on the National Football League and other sports franchises to share more of the load.

“[W]e need many, much larger players to have funding to do the research with youth outreach, public health,” Kraus said. “We need to treat it as a public health thing. But we also need federal and state and industry support, which is really not happening.”

‘No shame’ 

Back in North Carolina, Winters and Drain echoed the sentiment that problem gambling should be looked at through a public health lens.

“We do take a public health approach to this,” Winters said. “We’re data driven. We want to do the best we can. We’re always trying to improve. We’re here to learn.”

There is at least one lesson Winters would like the people of North Carolina to learn as the state embarks on legalized sports betting: “There’s no shame in having a problem.  Anybody can. Not everybody does. It’s a disease, not a decision.”

It’s OK to use software to block gambling apps or to take a break from betting or to reach out for help, Winters stressed.

Winters shared a story about how some people unfamiliar with Cookie Monster might fear the blue Muppet from Sesame Street if they had never been immersed in the culture of the chocolate chip cookie lover.

“If I didn’t know who Cookie Monster was, and he came running up in front of me, I’d be like, ‘Oh my god,’ ” Winter said. “It’s the same thing with problem gambling. It’s not a big scary monster. It is a monster, but it’s something that the more we talk about, the more it is normalized.”