As a therapist who treats people with gambling problems, I've noticed a shift over the past few years - not only in the profile of the typical clients I treat, but also in the way their gambling problems develop.
In 2018, the U.S. Supreme Court made the landmark decision to allow states to legalize sports wagering. Tennessee, where I am studying clinical psychology, took advantage of this ruling, and in late 2020, the state legalized online and mobile sports betting.
With most sportsbooks offering betting apps, my clients are finding it more difficult to quit gambling than ever before. Unlike other forms of gambling, such as playing roulette or slots at a casino, these apps are on their phones and in their pockets, accompanying them wherever they go.
This availability makes it that much harder to resist any urges that might arise - and presents unique challenges for helping clients reduce their gambling.
A new type of client emerges
When I first started treating people for gambling disorder in 2019, my clients were usually older and gambled in casinos, with slot machines and card games among their favorite forms of gambling. They also tended to be poorer and often talked about how they began gambling to make some side money, viewing it as a second job. Many of them had retired and would say things like, "Going to the casino gets me out of the house" or "The casino is like my 'Cheers'" - a nod to the popular watering hole in the eponymous sitcom.
That all changed when sports betting was legalized in Tennessee in November 2020.
Since then, I've noticed that my average client has started to look different. I'm now providing therapy to younger men, mostly in their 20s, who are seeking treatment for problems with sports betting. These clients tend to earn more money and be wealthier than my previous clients - a pattern that sports betting researchers have observed.
Several of them reported being avid sports fans or having a competitive streak. And they thought they could "beat the system" due to their extensive sports knowledge.
Many of them started betting on sports after hearing promotions for various betting companies. Even if you're a casual sports fan with no interest in betting, you can't miss these ads, which regularly air during televised sporting events. For example, some ads for FanDuel, one of the more popular sports betting apps, highlight a "No Sweat First Bet," with new users eligible for a risk-free bet of up to $1,000.
There's also a social element to sports betting. One client talked about betting on sports as a way to bond with relatives who also gambled. Similarly, a few college students I have treated told me that they started betting because they wanted to fit in with their fraternity brothers.
The apps don't make it easy to set limits
But once gambling issues begin, it can be hard for these clients to stop. Most of them started by placing smaller bets on a single outcome. Over time, they start to bet more to recoup their losses. Before they knew it, their bets had increased, with many not realizing how this change even happened.
Betting apps are available on any smartphone and are connected to clients' bank accounts, making it quick and easy to deposit more funds. This often leads clients to lose track of how much money they have lost. As one client told me, "It's easier to spend money on these apps because you never really see it. The transactions are all done electronically."
These apps do not make it easy for those with gambling problems to sign up for cool-off periods or self-exclusion. Cool-off periods allow the user to set a time frame - from a few hours to several months - where they will be unable to log into their betting account. Self-exclusion allows the user to ban themselves from the app for longer periods of time. Specific exclusion lengths differ by state. In Tennessee, there are one-year, five-year and lifetime ban options.
While many apps have these features, my clients often have to search online for this information, and even when they do find it, they can't figure out how to put these guardrails in place. If they wish to set a cool-off period or ban themselves from all sports betting apps, they must do so from each app, one at a time, which can be tedious.
It's impossible to avoid sports and smartphones
Sports betting presents unique challenges for treating gambling problems.
In addiction treatment, therapists, like me, often encourage clients to fill their time with activities that aren't connected to gambling or to avoid situations where they may be likely to gamble. But when gambling is available at the touch of a button, it becomes harder to determine what situations may lead to gambling, which makes it harder to figure out what to avoid.
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Before the apps, clients had to make plans for how and when to gamble. Now, all they have to do is pick up their phone and open an app. It is also incredibly difficult, if not impossible, to ask a client to stop using their smartphone or stop watching sports.
This is why I often tailor treatment to each client's needs and circumstances. Some may wish to quit altogether, while others may simply want to cut back on their gambling. This has forced me to consider other possible alternatives, such as showing them how to set screen time limits for sportsbook apps or talking about strategies to watch less sports.
Most people who bet on sports don't develop gambling problems. But with so few regulations in place - advertising or otherwise - those who are the most at risk are especially vulnerable to developing problems.
Tori Horn, PhD Student in Clinical Psychology, University of Memphis
