In a couple of weeks, Las Vegas, Nevada will play host to the Super Bowl for the first time. It wasn’t all that long ago that Nevada was the only state in the country where you could legally bet on the outcome of sports contests like the Super Bowl. But that changed nearly six years ago, when the U.S. Supreme Court opened the door for all states to legalize sports gambling.

Since then, 38 states, plus Washington, D.C. and Puerto Rico, have done so. Most of them allow betting through mobile apps, including saturation advertisers DraftKings and FanDuel.

Those apps allow gamblers to bet not just on the outcome of a game, but on individual players’ performances and specific events within a game, on all kinds of sporting events all over the world, at any hour of the day or night.

Some advocates fear this rapid expansion of sports wagering is fueling a rise in gambling addiction in the U.S., and that the state-by-state approach to treatment isn’t keeping up.

Any type of gambling can be addictive. Say you’re at a casino and you hit a jackpot at a slot machine, or you win a hand of poker. According to Dr. Timothy Fong, a professor of psychiatry at UCLA and co-director of the school’s Gambling Studies Program, that does something to your brain.

“When you win a reward, when you win money, that feels naturally good,” Fong said. “That’s baked into our DNA.”

That surge of dopamine is thrilling, and you’ll probably want to feel it again. So you play another round. If you lose, chances are you’ll eventually walk away. But a small percentage of people feel like they can’t.

“I’ve had patients just tell me, ‘I just know that when I’m gambling, and when I win money, it does something to my body and brain, and I feel alive, I feel joy, I feel safe, I feel pleasure,’” said Fong.

Losing money by chasing that feeling long enough, he said, can have devastating consequences: Bankruptcy, divorce, even suicide.

Addiction has always been a side effect of legalized gambling. But up until a few years ago, legal gambling looked really different, said Diana Goode, head of the Connecticut Council on Problem Gambling.

“In order to gamble you had to put clothes on,” said Goode. “You had to get up, you had to go out, and now you don’t.”

Goode’s organization, funded in part by tax revenue from the state’s gambling operators, has been around since 1980. It runs a helpline, which connects people who have gambling problems with treatment.

“We’ve seen a huge increase in calls,” she said.

A 91% increase in 2022, the first full year mobile sports betting was legal in the state, to be exact.

If you listen to a lot of podcasts, you may well have heard the number for Connecticut’s helpline, alongside a bunch of others, in ads for online sportsbooks. These long lists of helpline numbers in different states are usually read at a frantic pace at the end of ads for companies like FanDuel, DraftKings and BetMGM, which have flooded podcast ad breaks in the last few years. They’re all over sports shows, but also on others too, including some Marketplace podcasts as recently as last summer. And ads for gambling are now ubiquitous in pro sports broadcasts. 

But why do they have that long, frantic list of helpline numbers? Look to the way in which sports betting has been legalized across the country.

“For our nation’s history, gambling has been approached on a state-by-state basis, and so too have responsible gambling and problem gambling services,” said Keith Whyte, head of the National Council on Problem Gambling (NCPG).

The NCPG operates its own helpline, 1-800-GAMBLER, that some states use. Whyte said calls to the line nearly doubled between 2020 and 2023, and texts and chats both grew at a significantly faster rate. 

Since sports betting is now legal in all but twelve states, Whyte thinks the state-based approach to treatment is outdated.

“Just as we don’t look at cancer, or diabetes, or substance abuse state-by-state, we really need to recognize that gambling too is something that you have to look at on a national basis,” he said.

To do that, Whyte said, the whole system needs more funding. Between January and November of last year, Americans bet $106 billion on sports, according to the American Gaming Association (AGA). But bookmakers paid less than one-tenth of one percent of that in state taxes earmarked for problem gambling treatment, a spokesperson for the AGA said. 

Whyte argues treatment funding needs to increase more than tenfold. He thinks the federal government needs to step up, and it already has a way to raise the funds.

“There is an additional excise tax on every single sports bet place in the United States,” Whyte explained.

A bill introduced in the Senate earlier this month would give half of the money from that federal tax to gambling addiction treatment and research. Whyte’s council supports that bill. But some advocates want to see the feds go much further.

“I think there needs to be uniform protections for consumers across the nation,” said Mark Gottlieb, executive director of the Public Health Advocacy Institute (PHAI) at Northeastern University.

PHAI led litigation against the tobacco industry over the last few decades. Now, it has its sights set on sports betting. Late last year, PHAI sued DraftKings in Massachusetts over what it alleged were deceptive advertising practices. DraftKings has pushed back on the group’s claims.

Gottlieb thinks Congress should limit the frequency and types of bets that can happen on sports gambling apps.

“Things like affordability checks, limits on the types of bets, the number of bets that can be placed during a game,” he said, listing examples of ways lawmakers could regulate the industry.

A spokesperson for the American Gaming Association said in an interview that the gambling industry flatly rejects the idea of federal regulation. 

But one thing the industry, public health advocates, and treatment leaders agree on? Those helpline disclosures need to be simplified. They’re working on it.