Gambling Addiction and Sports Betting: How Does The Addiction Start?

Asim Shah, MD, discussed the increasing prevalence of sports and online gambling in the United States and its psychiatric implications. He noted that at least some form of gambling was legal in 48 states, normalizing gambling behaviors and increasing exposure, particularly through mobile apps and social media.¹ Shah explained that many individuals began with small, seemingly harmless bets but could progress to more problematic patterns, especially as accessibility increased.

Shah described 3 broad categories of gamblers: professional, social, and problem gamblers. Professional gamblers are characterized by self-control and rational decision-making, while social gamblers participated occasionally without significant consequences, Shah said. Problem gamblers, however, exhibit loss of control, compulsive betting, dishonesty, and significant financial, occupational, and interpersonal consequences.² He emphasized that individuals in the professional and social groups could transition into problem gambling over time.

Shah explained that gambling behavior was reinforced by the euphoric effects of dopamine release and the excitement associated with risk and reward. He noted that individuals often gamble on underdogs because they identified with them, which could increase emotional engagement. Early wins and peer encouragement could foster unrealistic confidence and false hope, leading to escalating bets and attempts to recover losses.

Shah also outlined 4 stages of gambling addiction: the winning stage, the losing stage, the frustration stage, and the hopelessness stage. In later stages, individuals often experienced severe financial losses, depression, substance use, and relationship or occupational impairment.

He highlighted clinical warning signs, including preoccupation with gambling, borrowing or stealing money, dishonesty, irritability, and attempts to chase losses. Shah stressed that gambling disorder could affect individuals across socioeconomic levels and might remain hidden for long periods. He concluded by emphasizing the importance of early recognition, patient education, and monitoring, particularly among adolescents with access to gambling apps.

References

1. Cohen E. US online casinos: here is where all 50 states currently stand on legalizing internet gambling, casino play. CBS Sports. February 4, 2026. Accessed February 11, 2026. https://www.cbssports.com/betting/news/u-s-online-casinos-here-is-where-all-50-states-currently-stand-on-legalizing-internet-gambling-casino-play/

2. Clark L, Averbeck B, Payer D, et al. Pathological choice: the neuroscience of gambling and gambling addiction. J Neurosci. 2013;33(45):17617-17623.