“You’ve got to know when to hold ‘em, know when to fold ‘em, know when to walk away, and know when to run.” – Kenny Rogers, The Gambler

Online sports betting is skyrocketing. And the population at greatest risk for use, misuse, and possible future gambling addiction is Gen Z youth, ages 18-29. The American Gaming Association estimates that “Americans will wager $3.3 billion on the NCAA Division I Women’s and Men’s Basketball Tournaments” in 2026. While many young adults have been betting online for years, the ability to bet continuously and in the moment has escalated with the advent of many new sports betting apps.

The increase in online sports gambling is likely due to:

• Smartphone betting: with instance access anywhere, anytime
• Micro-bets and live betting: betting on each play or possession
• Integration with social media: influencers posting bets, sharing their “best picks,” and bragging about their winnings
• Advertising during game: including celebrities promoting betting
• Peer influence: many young people are encouraging others to jump in

All this adds up to the promotion and pressure to join in the fun. But this fun can be dangerous. It may include risk factors that could lead to compulsive gambling. Some of these influences include:

• Continuous betting
• Push notifications on smart phones indicating that you “almost won” (stimulating increased engagement in betting)
• Impulses to chase losses
• Apps with free bets and sign-up bonuses
• Parlay betting: the ability to bet small stakes with a pool of others, adding up to potential big wins. However, the house usually wins, and odds are stacked against participants

Recent research has demonstrated that the explosion of online sports betting leads to gambling addiction. The rate of gambling addiction in sports gambling is twice as high as other forms of gambling. The same research indicates that young adults are significantly at risk, particularly men.

What can physicians do about this? For one, physicians should be aware of national support resources for those who may be in need of help with problem gambling, including the National Council on Problem Gambling, Gamblers Anonymous, and 1-800-GAMBLER. Other resources that physicians can inform their patients include GamTalk, an online peer support program through Envive, and Gam-Anon, a self-help organization related to the 12-step program for family and friends of compulsive gamblers.

For another, physicians can become familiar with the DSM-5 criteria for gambling disorder, as well as the ways in which compulsive gambling may be thwarted. They should offer the following guidelines for preventing or at least containing online sports betting:

• Do not gamble if you are in a distressed emotional state
• Beware of gambling if under the influence of substances
• Use limit setting tools that are part of online gaming apps, such as
• Deposit limits
• Spending limits
• Time limits
• Cooling off or time-out checks
• Turning off push notifications
• Refrain from parlay gambling
• Use third party apps that help you control your online gambling

Finally, physicians can encourage patients’ family members and caregivers to provide the following support:

• Have ongoing and frequent conversations about gambling, including focusing on the financial risks and game design leading to addiction, rather than moral lectures
• Ask about the experience of online betting. What is your experience? What do you find so compelling? What have you learned about it? What do you think are its dangers? And be sure to address these open-ended questions with curiosity, empathy, and lack of judgment. We cannot help our young people if we do not understand the appeal of their use of digital media.
• Encourage your young people that they should monitor their payment systems, and offer to help with this (be aware of using PayPal, Venmo, credit cards or crypto transactions)
• Encourage watching sports for entertainment, rather than possible income
• Enlist siblings, peers, mentors, trusted family friends, and relatives to participate in the dialogue

Online sports betting is very different from what Kenny Rogers is singing about. You can walk away or run from a gambling table but try and walk away or run from your smartphone! Few of us can do this anytime, no less than when we are caught up in a betting frenzy.

The problem of online betting is yet another side of digital media we all need to be aware of. This major frontier has not simply invaded our lives but has been moving so quickly that few of us can truly understand how to be media literate and take control of it before it takes control of us.

Let’s add online betting to our understanding of the use and misuse of social media, apps, and the internet.

Dr. Gene Beresin is Executive Director of the Clay Center for Young Healthy Minds, and Director of Education for the Division of Professional and Public Mental Health Education at The Massachusetts General Hospital. He is professor of psychiatry at Harvard Medical School.

This article is part of the Medical Insights vertical on Op-Med, which features study breakdowns, resources, and insights from Doximity members on popular topics in medicine. Want to submit to Medical Insights? See our submission guidelines here; note that we are especially interested in articles covering oncology, dermatology, or rheumatology.

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