THE NEW YORK TIMES (February 9, 2025); By Carl Erik Fisher
When we think about any addiction, we tend to focus on people who are utterly consumed by it — those whose lives are visibly falling apart. Yet gambling challenges our usual assumptions about addiction and risk, as its harms extend far beyond the most severe cases.
Consider a young man from my therapy practice, a former college athlete, who isn’t bankrupt or in crisis but feels stuck in a cycle of unhealthy online sports betting. He repeatedly deletes the betting app from his phone, only to reinstall it days later at the prompting of a well-timed email, a group bet with friends or simply the ads plastered across every sports arena. He does fine at work and mostly keeps to the dollar limits he sets, but his internal preoccupation, restlessness and chasing of losses just feel bad. He wouldn’t call himself addicted, but he doesn’t feel healthy, either. At the very least, he has the creeping sense that he’d feel better if he put his attention and energy toward something more meaningful.
Serious gambling addiction is devastating. Beyond financial ruin, it increases the risk of physical health problems, domestic violence and family rupture. Every year, 2.5 million American adults suffer from severe gambling problems. Many suffer invisibly, silently wagering away their lives on cellphones, perhaps in the very same room as their family and friends.
These severe cases demand attention, but focusing only on them obscures something important. As a physician and someone in recovery from alcohol and stimulant addiction myself, I’m concerned by how we have been conditioned to see addiction in all-or-nothing terms. Beyond the millions of Americans who meet the criteria for gambling disorder, five million to eight million more have a mild to moderate gambling problem that still affects their lives — like my patient. Since the federal ban on sports betting was struck down in 2018, sports gambling in the United States has exploded, with annual wagers now approaching $150 billion.
Dr. Fisher is an addiction physician and bioethicist at Columbia University. He’s the author of “The Urge: Our History of Addiction.”