Gambling Legalization Linked to Increased Emergency Room Visits for Disorders, Study Finds

Legalizing gambling, particularly sports betting on individual events, is associated with a significant increase in emergency department visits for gambling disorders, according to a recent study from Ontario. The research, published in the American Journal of Preventive Medicine, found that after Ontario legalized betting on individual sports events in 2022, emergency department visits related to gambling disorders doubled.

Most individuals presenting at emergency departments were men, and nearly one-third of these visits resulted in hospitalizations. Researchers project that emergency department visits were 154% higher than they would have been without the policy change. These visits were concentrated among men aged 10 to 44.

“This rise in severe presentations might be a bit of a warning signal of a wider increase in harms across the general population,” said Ryan Forrest, a public-health doctoral student at the University of Toronto and a study author. “We think about things like financial distress, family and relationship problems, worsening mental health—and those things are not captured in the emergency department data.”

Many patients sought emergency care due to major depression and suicidality, with some also having other mental-health or substance-abuse diagnoses. Doctors noted in patient records that gambling had contributed to these issues.

A separate study by some of the same researchers indicated a similar trend in helpline calls. Calls to ConnexOntario, a 24-hour mental health and addictions helpline, increased by 200% after the legalization of single-sports event betting. This study found that individuals reaching out for help were almost exclusively males aged 15 to 44.

“There’s two data sources telling us there is a real health signal happening here,” Forrest stated.

Mental Health Consequences of Expanded Betting

The study serves as a potential warning for the U.S., where sports gambling has rapidly expanded since the Supreme Court struck down a federal ban in 2018, allowing states to legalize and regulate their own sports betting markets. Dozens of states, including New Jersey, Tennessee, and New York, have since legalized sports betting, with many also permitting online casino games. Canada also saw an increase in gambling after legalizing betting on single sports events in 2021.

Therapists in the U.S. report observing mental health consequences linked to the proliferation of sports betting and prediction markets. Birches Health, a provider specializing in gambling disorder treatment, has seen its number of clients aged 18 to 34 more than double since 2024, according to Cynthia Grant, vice president of clinical for Birches Health. "There’s more people gambling, and when you have more people gambling, it simply means that there’s more people who are going to develop a problem."

Grant noted that clients are mentioning prediction markets 200% more often in initial clinical assessments compared to the previous year. Prediction markets allow individuals as young as 18 to place wagers, while sports betting typically has a minimum age of 21.

“It’s just not a regulated environment out there,” Grant said. “People’s lives are being ruined; their relationships are being destroyed, their retirement accounts are gone.”

Younger individuals seeking treatment may be starting to gamble at earlier ages. Grant attributes this partly to early exposure through activities like lottery scratch tickets received as gifts, family fantasy sports wagers, and online games that encourage chasing rewards. Hobbies such as collecting trading cards, where the value of a pack is uncertain, can also contribute to early exposure to gambling-like mechanisms.

Cognitive behavioral therapy is the standard treatment for gambling disorder, as individuals with the addiction often exhibit distorted thinking patterns. However, Grant pointed out that many are unaware that gambling disorder is a treatable mental health condition covered by insurance. Studies indicate that suicidal ideation and suicide risk are five to 10 times higher in individuals with gambling disorders than in the general population.

An Under-Regulated Betting Landscape

Both Grant and Forrest highlighted concerns regarding the largely unregulated nature of gambling in both Canada and the U.S., suggesting it contributes to increased mental health problems with limited investment in tracking these issues. Forrest noted that the Canadian government has not allocated funds to monitor the public health impacts of gambling policy changes, unlike the significant grants provided for monitoring changes after cannabis legalization.

Many gambling apps lack automatic spending limits to prevent excessive losses, and some adopt a passive approach to users exhibiting signs of addiction. A ProPublica investigation found that one app, rather than flagging problematic behavior, incentivized continued play.

“The way that online systems work right now do not protect people at all who are prone to behavioral addictions, and that, to me, is very dangerous for my clients,” Grant said. She drew a parallel to other regulated industries, stating, "Bartenders have rules about how much they can serve someone. Police can issue a DUI—there are efforts to stop people who are potentially causing harm. But that does not happen in the gambling space."