1 in 3 States Now Allow Sports Betting

By VirentaNews Staff — May 10, 2026

Executive summary — the rapid expansion of legal gambling across the United States is outpacing the development of public health safeguards, creating conditions for a potential behavioral health crisis. While 38 states and Washington, D.C. now permit some form of legal sports betting, fewer than 10 have allocated dedicated funding for gambling addiction treatment. This imbalance between commercial growth and public health preparedness mirrors early phases of the opioid epidemic, when regulatory oversight lagged behind pharmaceutical marketing and prescription practices, leading to widespread dependency and overdose deaths. Without coordinated intervention, experts warn that problem gambling could exact similar social and economic tolls, particularly among youth, low-income populations, and individuals with co-occurring mental health disorders.

Explosive Growth in Legal Gambling Markets

The legal gambling landscape in the U.S. has transformed dramatically since the Supreme Court’s 2018 decision in Murphy v. NCAA, which struck down the federal ban on sports betting. In the six years since, legal sports wagering has expanded from two states to 38, with online platforms like DraftKings, FanDuel, and BetMGM investing over $1 billion in advertising in 2023 alone. According to the American Gaming Association, legal sports betting generated $12.4 billion in revenue in 2023, up from just $380 million in 2018. Meanwhile, the National Council on Problem Gambling estimates that 2% to 3% of U.S. adults—roughly 7 million people—meet clinical criteria for gambling disorder, with another 5 million exhibiting at-risk behaviors. Yet, only 11 states direct any portion of gambling revenue toward treatment and prevention programs, and federal funding for gambling addiction research remains minimal, with the National Institutes of Health allocating less than $10 million annually—less than 0.01% of its total budget.

Key Players: Industry, Legislators, and Public Health Experts

The primary drivers of gambling expansion are commercial operators and state governments seeking revenue without raising taxes. Companies like FanDuel and DraftKings spend heavily on celebrity endorsements and real-time ad placements during live sports, normalizing betting behavior. State legislatures, facing budget pressures, have welcomed the influx: in 2023, New York collected over $500 million in taxes from sports betting, while Illinois took in $300 million. However, public health advocates, including the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO), have raised alarms about the lack of safeguards. The National Council on Problem Gambling has called for a federal excise tax on gross gaming revenue to fund treatment, similar to tobacco control models, but legislative action remains stalled. Meanwhile, some states, like Colorado and Maryland, have begun integrating gambling disorder screening into primary care settings, but such initiatives remain isolated and underfunded.

Trade-Offs: Revenue Gains vs. Social Costs

The economic benefits of legalized gambling are clear: states gain new tax revenue, create jobs, and reduce reliance on illicit markets. However, the social costs of unchecked expansion are substantial. Problem gambling is strongly linked to bankruptcy, family breakdown, depression, and suicide. A 2022 study published in JAMA Psychiatry found that individuals with gambling disorders are twice as likely to attempt suicide compared to the general population. Moreover, the digitalization of gambling—accessible 24/7 via smartphones—increases the risk of compulsive use, particularly among adolescents. While industry-funded initiatives like Gamblers Anonymous and self-exclusion lists exist, critics argue they are insufficient without mandatory responsible gambling features, such as deposit limits and algorithmic monitoring for risky behavior. The absence of federal oversight allows wide variation in consumer protections, creating a patchwork system vulnerable to exploitation.

Why Now: Digital Access and Shifting Social Norms

The current surge in gambling legalization coincides with two critical shifts: the proliferation of mobile technology and the normalization of betting in sports culture. Mobile apps allow users to place bets in real time, often during live games, leveraging psychological triggers like near-misses and instant rewards that reinforce addictive behavior. Simultaneously, sports leagues like the NFL and NBA have partnered with betting companies, integrating odds into broadcasts and social media. This cultural endorsement, combined with aggressive marketing during major events like the Super Bowl and March Madness, has eroded historical stigma. Unlike opioids, which faced public backlash as overdose deaths mounted, gambling’s harms are often hidden—manifesting as financial ruin or emotional distress rather than visible physical decline—making it harder to mobilize policy responses.

Where We Go From Here

In the next 6 to 12 months, three scenarios could unfold. First, a ‘business-as-usual’ path where more states legalize gambling without robust safeguards, leading to rising addiction rates and increased strain on mental health systems. Second, a regulatory shift where federal or state governments impose mandatory funding for treatment, adopt standardized responsible gambling practices, and require warning labels—similar to alcohol and tobacco. Third, a public backlash triggered by high-profile cases of gambling-related harm, potentially prompting emergency legislation or lawsuits against operators for predatory design. The trajectory will depend on whether public health voices can gain traction in policy debates dominated by economic interests.

Bottom line — without urgent investment in prevention, treatment, and regulation, the U.S. risks normalizing a potentially devastating addiction under the guise of entertainment and fiscal pragmatism.

Source: Fiercehealthcare