Although Minnesota did not pass a bill legalizing sports gambling during the last session, many think it’s just a matter of time before it happens. With an eye toward the future – and an eye on the experiences of several other states who have legalized sports gambling – we talked to problem gambling leaders in Pennsylvania and Ohio for their observations and warnings. The next issue of Northern Light will highlight the sports gambling experiences of Michigan and New Jersey.
Pennsylvania
In Pennsylvania, retail sports betting debuted in November 2018, followed by the introduction of online and mobile options beginning in May 2019. What started as a relatively small piece of legislation to modernize the helpline ultimately grew to include online lottery games, fantasy sports and truck stop video gaming terminals (essentially small casinos). The bill also authorized airport gambling but that is not available yet.
Growth in sports gambling in the state has been astronomical. In 2019, the handle – the amount of money bet/put at risk – was $1.5 billion. By 2022, the handle was $7.25 billion, which represents roughly one percent of Pennsylvania’s gross domestic product. (Prior to sports gambling expansion, Pennsylvania gambling revenue (all forms) was $3.1 billion. By 2022, revenue passed the $5 billion mark, with the growth in sports gambling cited as a major reason.)
Helpline calls have also gone up markedly in Pennsylvania. In the first year, with just a few months of both brick-and-mortar and online sports gambling, there were 30 calls. In 2022, there were more than 300 calls specifically for sports gambling. Overall call volume (for all forms of gambling) has also increased, going from an average of about 1100 prior to gambling expansion to more than 1200 through the middle of 2023.
“In addition to the uptick in problems related to sports betting, this increase might also be related to wider advertising of the helpline number,” says Josh Ercole, executive director of the Council on Compulsive Gambling of Pennsylvania. “It’s possible that folks have been struggling for a while and just now are learning that help is available.”
In general, Josh was pleased with precautionary measures that accompanied Pennsylvania’s legalization of sports gambling. “We asked for a lot — and got close to everything.”
However, with the benefit of hindsight, Josh wishes that more attention was paid to the language of advertising, specifically the mention of “no-risk bets” that really aren’t. He also wishes that — at least in the beginning — consumers who opened accounts were made more aware of the capability of adding limits to their betting. However, as of several months ago, when new bettors sign up, they are made more aware of how they can govern their play.
Josh feels that the culture for the gambling industry has begun to change, and is at least partly attributable to the growth in sports gambling. “I think the industry sees that gambling problems are not sustainable and they want to address responsible gambling as part of the culture,” says Josh.
Josh also feels that it’s important for states to learn from other states. “In Pennsylvania we were able to look at other states with casinos and online regulations. We’re also fortunate that the Pennsylvania Gaming Control Board is always looking for new possibilities and regulations to implement to emphasize player protection.”
Ohio
A wide-ranging sports gambling bill was signed by Ohio Governor Mike DeWine in December 2021, and went into effect on January 1, 2023. Notably, the bill stipulated a universal start for all forms of sports gambling: mobile sports, brick-and-mortar sports books, and sports betting kiosks (primarily bars, restaurants and bowling alleys) licensed by the Ohio Lottery.
During the first month (January 2023), the handle for sports gambling was approximately $1 billion. It has since subsided but is expected to pick up again in the fall.
Gambling advertising blanketed all outlets. “It didn’t matter whether you were watching television, streaming a station or listening to the radio,” says Derek Longmeier, executive director of the Problem Gambling Network of Ohio.
Derek notes that one piece the Ohio legislation got right was having firm guidelines for marketing.Advertisers couldn’t promote risk-free bets unless they were truly risk-free, and every ad was required to detail a state or national gambling helpline clearly and conspicuously.
The Ohio bill set aside two percent of gambling tax revenue (which initially was set at 10 percent but later increased to 20 percent) for problem gambling efforts managed by the state gambling commission. The bill also allowed Ohio colleges and universities to collect data to analyze the impact of sports betting on student gambling. Ohio also prohibited gambling advertising on college and university campuses, the first state in the country to do so.
There has been a substantial increase in helpline calls in Ohio since the introduction of legalized sports gambling. In the first month (January 2023) of sports gambling, there were about 1500 calls, compared to under 500 calls in January 2022. The October-December 2022 period also saw a record high number of calls.
Derek says it’s not clear that the increase in helpline calls correlates directly with sports gambling. “Because of marketing, the helpline was more visible on all advertising, so it’s possible that more gamblers, not just sports gamblers, sought help for the first time.”
Looking back on Ohio’s process, Derek thinks a phased-in approach might have been better than a universal start date. The state gambling commission was under considerable pressure to write rules while also doing compliance checks for numerous operators. Derek also feels that consumer access — which went from literally nothing to everything overnight — didn’t allow new consumers to become well educated about gambling.
Problem gambling advocates in Ohio sought to exclude sports betting ads on professional athlete’s jerseys but were not successful. (A compromise was a prohibition on youth jersey advertising.)
Derek also emphasizes that problem gambling advocacy organizations, such as MNAPG, should be aware of how little legislators might understand about sports gambling. “With legislators and in conversations, the response we often received was, ‘Wow, this was so much more complicated than we knew,’ says Derek. “Legislators often only hear from sports betting advocates about how great gambling will be.An important piece of work is to really showcase the importance of advocacy and having subject matter experts in the community share their thinking.”
Derek also encourages a focus on infrastructure so that all parts of a state are represented with certified gambling treatment counselors and to include appropriate telehealth options to communities challenged with identifying and cultivating counselors.
The Minnesota Alliance on Problem Gambling (MNAPG) received two national awards at the recent conference of the National Council on Problem Gambling. MNAPG received awards for the best affiliate newsletter and the best affiliate website.
“We have devoted considerable time and resources into both of these important communication tools, so we’re thrilled to see our work recognized at a national level,” says Susan Sheridan Tucker, MNAPG executive director. “I am grateful to my team for their contributions in making these useful resources.”
The 2023 Affiliate Website Award from the National Council on Problem Gambling recognizes an outstanding website that has increased awareness of problem gambling. MNAPG’s new website is the culmination of in-depth planning into MNAPG’s various audiences. MNAPG strives to be the central hub for all things Minnesota problem gambling-related, offering access to treatment information, research findings, recovery stories and podcasts.
The 2023 Affiliate Newsletter Award from the National Council on Problem Gambling recognizes an outstanding problem gambling-related newsletter. Northern Light, MNAPG’s quarterly newsletter, has earned several national awards since it was created in 2010. The newsletter seeks to educate visitors and readers about the latest trends in problem gambling, treatment and prevention, as well as provide updates on the organization’s outreach efforts and highlight stories of hope in recovery.
Video games have drawn the attention of activists and public health advocates since as early as the 1970’s. Many of these activists have focused on the intense depictions of violence in video games and suggest that these depictions may lead to real-life violence. One area that is often neglected, however, are depictions of substance use and gambling in video games. Although regulators have begun to investigate loot boxes and their relationship with problem gambling, other forms of gambling in video games have received less attention. For example, skin betting (i.e., exchanging virtual goods for digital gambling currency) — which was first popularized by the game Counter-Strike: Global Offensive — has evolved from betting on in-game matches to skins being used as currency in other games of chance such as roulette. Many of those involved in these underground gambling networks are adolescents who are unable to engage in traditional gambling. This week, the WAGER reviews a study by Nancy Greer and colleagues that examined links between esports, skin betting, and problem gambling.
What was the research question?
How does esports and skin betting relate to other forms of gambling and gambling harms?
What did the researchers do?
The researchers recruited participants through Amazon Mechanical Turk and social media posts in online gaming communities to participate in an online survey. All participants reported either esports cash or skin betting, or gambling skins on games of chance in the past 6 months. In total, 737 participants completed the survey. The survey itself focused on four broad categories: (1) video game involvement, (2) video game-related gambling (including betting on esports), (3) traditional gambling, and (4) problem gambling and gambling-related harms. The researchers used ordinal logistic regression to test the hypothesis that video game involvement increases the likelihood of engaging in video game-related gambling, which in turn increases the likelihood of engaging in traditional gambling and experiencing gambling harms.
What did they find?
Though video game involvement related to video game-related gambling, video game-related gambling was only slightly related to traditional gambling. Consider three different video game-related types of gambling: esports cash betting, esports skin betting, and skin betting on other games of chance. Of these, only esports cash betting frequency significantly predicted involvement in traditional gambling activities. Interestingly, although the sample overall reported high rates of problem gambling and gambling harms, neither esports cash betting nor esports skin betting significantly predicted problem gambling or gambling harms. When controlling for other forms of traditional gambling, only skin gambling on games of chance was predictive of problem gambling and gambling harms (see Figure).
Figure. This figure displays the odds of experiencing problem gambling and gambling harms based on video game-related gambling behaviors. Odds ratios above 1.00 indicate that for every one unit increase in the predictor variable (video game-related gambling behaviors) the odds of being one category higher in the outcome variable (problem gambling or gambling harms) increases by X times. An odds ratio below 1.00 indicates that the odds decrease by X times. For example, a one unit increase in esports cash betting frequency would mean a participant is 1.033 times as likely to experience a one unit increase in their problem gambling severity. Only skin betting on games of chance was significantly associated with either outcome variable. Click image to enlarge.
Why do these findings matter?
These findings suggest that buying skins and esports gambling are not risk factors for problem gambling in and of themselves. Rather, skin gambling on games of chance appears to increase the risk of gambling harms. It remains unclear whether individuals who gamble skins on games of chance do so because they have exhausted other financial resources, or if skin gambling on games of chance directly increases the risk of problem gambling and other gambling harms. Regardless, these findings suggest that regulatory bodies should consider focusing on gambling operators who facilitate skin gambling on games of chance, rather than other more traditional esports focused operators.
Every study has limitations. What are the limitations in this study?
This study has significant limitations in terms of its generalizability. Participants were required to have gambled either on esports or via using skins in the past six months, so the results likely do not represent video game players as a whole. The study also failed to include anyone under the age of 18 despite the fact that many people who gamble using skins are adolescents. Additionally, due to the study’s limited sample size, the researchers were unable to conduct path analysis, an analytical technique that allows for estimating causal effects instead of only statistical associations.
For more information:
Individuals who are concerned about their gambling behaviors or simply want to know more about problem gambling may benefit from visiting the National Council on Problem Gambling. Others who want to learn more about video game addiction can find information via the Cleveland Clinic. Additional resources can be found at the BASIS Addiction Resources page.
Editor’s Note: Today’s review is part of our month-long Special Series on Asian American/Pacific Islander (AAPI) Addiction Research. Throughout May, The BASIS is examining forms of addiction among AAPI communities.
Emerging research indicates that the Asian American community is at greater risk for problem gambling than the general population. However, research often fails to include or accurately capture the realities of gambling and problem gambling within this community, particularly the experiences of Asian American working-class immigrant communities. This week, as part of our Special Series on Asian American/Pacific Islander Addiction Research, The WAGER reviews a study by Mia Han Colby and colleagues that investigated the systemic issues that contribute to gambling in the Greater Boston Asian American community.
What was the research question?
What are the systemic issues that contribute to gambling in the Asian American community of the Greater Boston area?
What did the researchers do?
The authors conducted forty semi-structured interviews with adult members of Asian1 immigrant communities in the Greater Boston area who had a family member, friend, neighbor, or coworker who gambled. Using a community-based participatory research approach, bilingual/bicultural community fieldworkers who had experience working in their respective communities interviewed participants. Participants were asked about their perceptions of gambling in their community, as well as impacts of gambling on families and the community more generally. The researchers analyzed the interviews for common themes pertaining to systemic issues related to gambling and problem gambling in the Asian community in the Greater Boston area.
What did they find?
The interviews revealed how the underlying issues of poverty and social and cultural loss due to immigration contribute to gambling in this community (see Figure). Many participants spoke about the challenges of making a decent living as an immigrant while working low-wage and stressful jobs. Gambling was viewed as a way to make money and improve a family’s financial situation. For example, one participant expressed that gambling gave them “hope that they can have freedom of money.” It was also seen as a way to relieve work-related stress.
Participants also spoke about the challenges of integrating into American society due to cultural and linguistic barriers. Many discussed the lack of appropriate and accessible social and recreational activities, which contributed to experiences of social isolation, loneliness, and boredom. Gambling—especially within casinos—was viewed as a means of socializing and connecting with other Asian community members. Many participants spoke about the ways that casinos targeted Asian clientele, including busing directly to casinos from Asian communities (e.g., from Boston’s Chinatown neighborhood), creating an Asian-friendly casino environment (e.g., employees speak Asian languages, concerts and events featuring Asian artists), and incentives (e.g., free food and discounts).
Figure. Reasons for gambling in Asian communities in the Greater Boston area, by percentage of respondents who identified each reason for gambling (n = 40). Click image to enlarge.
Why do these findings matter?
These findings illustrate the complex and systemic issues that contribute to gambling in Asian communities in the United States, including social and cultural isolation due to challenges integrating into American society, and struggles working low-wage and stressful jobs. Asian CARES (Center for Addressing Research, Education, and Services) of Boston created actionable recommendations for change based on these findings. They recommend investing in neighborhoods where Asian immigrants live and work to create inclusive spaces that facilitate social and recreational activities other than gambling. Additionally, Asian CARES recommended increasing funding to trusted community-based organizations (e.g., Boston Chinatown Neighborhood Center) that provide culturally and linguistically responsive problem gambling, mental health, and social services (e.g., services that help individuals find and maintain employment).
Every study has limitations. What are the limitations of this study?
Data were self-reported and based on past experiences, so the results might be subject to recall bias. Findings from this study might not be generalizable to other geographic areas or to other immigrant populations.
For more information:
Do you think you or someone you know has a gambling problem? Visit the National Council on Problem Gambling for screening tools and resources. For individuals in Massachusetts looking for culturally and linguistically relevant problem gambling services, call the Massachusetts Problem Gambling Helpline (800-327-5050) or visit the Boston Chinatown Neighborhood Center website.
1. Interviews were conducted with members of the Khmer, Chinese, Korean, and Vietnamese immigrant communities in the Greater Boston area.
The first time I gambled, when I was 18, I considered it simply entertainment. I might spend $20-$40 and go with some friends. It never occurred to me that gambling could become a debilitating addiction.
However, while I was in college, the impact of several events unsettled me. First, my mother’s longtime partner left her, leaving emotional wounds for all of us to deal with. And not long after that, I learned that a young girl who I had mentored died by suicide. I tried to focus and managed to graduate, but I never had a chance to truly grieve these losses while in school.
After graduating, I eventually moved back to Minnesota in 2017 and got engaged. That’s when I started to explore gambling. By the time I got married in July of 2018, I was living a double life with gambling. I remember telling my husband at the time that I felt more married to slot machines than to him.
I had been looking forward to marriage and the opportunity to be part of his family, as I was adopted and longed to be loved and experience a sense of belonging. Unfortunately, although I initially felt accepted by my husband’s family in the beginning, I eventually found it hard to be myself.
All of these struggles — rejection, abandonment, not feeling I belonged or was loved — drove me to gamble as an escape. Gambling offered a “fake happy place” for me to numb my pain and just be. I felt emotions on the outside but had deep pain inside myself. When I gambled, it felt fun, but as time progressed, I was exhausted. I felt like a robot with an altered mind and body
At first, I gambled for just a few hours. But before long, I was gambling for longer periods of time, spending $300-$500 two to three times a month. Things progressed quickly. Within a year, I was losing $1,000- $2,000 two to three times a week.
I would drive to Mystic Lake no matter what the weather was like. As I drove, I’d constantly hear a voice telling me that everything would be fine — but it was hard to numb that voice.
My gambling escalated even more. I spent a lot of my inheritance from my grandparents, approximately half a million dollars in two years
My health started going downhill. I stopped taking important medications and stopped eating, losing 30 pounds over two years. I let go and didn’t care, as if I wanted to die that way.
Well into my addiction my morals became very foggy and distorted. My socializing with friends became more isolating. I lied, I stole from my fiancé, used my inheritance and other forms of getting money (annuities, life insurance), and sold my most prized possessions. In the end, the last things I sold were my flute from childhood and a camera my grandma had bought me. I was desperate and needed money, it was my fix.
I lost my job in December 2019 and had a mental breakdown on January 2, 2020. I knew I wanted to get help and be in a safe place. My mom grabbed my childhood blanket and bear to help comfort me. I told her to take me to the ER. I had suicidal thoughts. I was done living.
I told my mother all about my gambling. She said my eyes were a different color during my breakdown and wanted to protect me from the kitchen knives. Eventually, she got me to a safe place, the hospital. I ended up celebrating my 33rd birthday in the hospital, and my mom, aunt and husband came to celebrate. I never thought I’d be where I was, but I needed to feel safe and heard in a protected environment.
It was during my hospital stay that we found a program for inpatient care for gambling addiction, the Vanguard Center at Project Turnabout in Granite Falls. I went there shortly after leaving the hospital. It was the hardest thing I’ve ever done in my life.
As we drove, I noticed an eagle flying next to the car. For me, it was a symbol of a higher power. I know that a “higher power” can push some people away, but for me it’s about nature
At Vanguard, I learned a lot about addiction in general but also gambling addiction. I related to the 20 questions in the GA yellow combo book and, more and more, realized I did have a gambling problem.
Being in treatment for five weeks, I learned that gambling addiction doesn’t define me, even if it happened in my life. I learned more about how much more pain I had endured in life and its impact on my self-esteem and self-confidence. In treatment, I have a relapse prevention plan, and support has helped me continue to make my recovery number one. I learned how to advocate for myself and what I need, knowing my toolbox of coping skills when things get overwhelming and learning to be kind and gentle to my new self. Recovery is challenging but I tell myself I do the best I can do in that day and give myself credit. It’s truly okay to ask for help. I’m not alone anymore.
Sharing my story is part of the healing I do every day, part of my recovery. I hope that sharing my story can help others and be a reminder that there is help out there.
