A Vast Experiment With Legalized Gambling
The United States is in the middle of a vast experiment with legalized gambling. Sports betting is now legal in 39 states and Washington, D.C., with 30 states facilitating it through smartphone apps or websites advertised during nearly every live sports broadcast.
The proliferation of commercials loudly encouraging people to wager is more than just an annoyance. The bigger questions for the country are what legalized gambling will do to sports integrity and what sorts of mental and economic effects will surface over the longer haul. A new study offers one answer, and it is a sobering one.
The Core Finding: A 60 Percent Surge
In states that permit sports betting, gambling disorders surged more than 60 percent between 2018, when the Supreme Court freed states from a federal ban, and 2026. The data comes from Epic Research, a public benefit corporation that tracks public health phenomena using data from its parent company, the electronic healthcare record firm Epic Systems. The disorder is defined as continuing to gamble despite financial, emotional, or social harm.
Researchers examined medical records of 197 million American adults with at least one healthcare visit. The largest proportional increase occurred among adults aged 18 to 29, where the rate more than doubled. Young men were hit hardest of all.
The Numbers, State by State
The 60 percent increase figure actually understates the state-level impact, since the quarterly rate of gambling disorders rose sharply in states where sports betting was legalized while it dropped sharply in states that did not legalize it.
In legalizing states, the rate rose from 3.0 per 100,000 patients in the first quarter of 2018 to 4.8 per 100,000 in the first quarter of this year. States that have not legalized sports betting saw their gambling disorder rates fall from 3.1 per 100,000 in the first quarter of 2018 to 2.2 per 100,000 in the first quarter of this year, a 29 percent decrease.
Age and sex matter considerably. Americans aged 30 to 49 had the highest overall rates, climbing from 4.1 to 5.8 per 100,000 between 2018 and 2026. Those aged 50 to 64 saw an increase from 4.1 to 4.9 per 100,000. But the sharpest increase by far was among men aged 18 to 29, who saw their rate of problem gambling more than double, from 3.2 to 7.7 per 100,000, over the span of the study. Their female counterparts went from 0.5 to 1 per 100,000.
No Single Legal Event to Blame — But the Pattern Is Clear
Epic noted that adoption of legalized sports betting was staggered, with different states acting at different times. Because legalization is staggered and gambling disorder is widely under-recognized in clinical care, these trends cannot be attributed to any single legal event and likely understate true population prevalence, the researchers said.
In other words, this is the floor, not the ceiling. These results only capture cases where an addiction to gambling has progressed far enough to reach a doctor's office. Even so, the directional contrast aligns with national survey and search-trend evidence of rising gambling-related help-seeking concentrated specifically in states that have legalized sports betting. The data points overwhelmingly in one direction: legalization is driving this increase.
The Trade-Off Nobody Priced In
The legalization happened for a few clear reasons. State governments wanted the tax revenue. Sports leagues, once worried that widespread gambling would raise questions about the legitimacy of game outcomes, grew hungry for corporate sponsorship dollars instead.
But perhaps the single biggest factor is the technology itself. In 2026, a smartphone is a casino in your pocket. A person can act immediately on an impulse without spending time or money traveling to a sportsbook or finding a bookie. This near-frictionless access is precisely what makes legalized betting so different from anything that came before it, and precisely why the health consequences are showing up at this scale.
The Epic study underlines the trade-offs of this process. States got a tax-revenue windfall. But what does a 60 percent increase in gambling disorders mean for the health, both physical and financial, of their residents? And what will these disorders ultimately cost states in healthcare spending, lost productivity, and family disruption over the long run? Based on what this data shows, the cost is likely far greater than what was wagered on the upside.
Why This Matters for Underage Gambling
If gambling disorders are surging this dramatically among adults with legal access and at least some regulatory oversight, the risk to minors accessing offshore platforms with virtually no age verification is almost certainly more severe. Young men 18 to 29 already show the sharpest increase in this study — and offshore platforms like Bovada are reaching users even younger than that, with even fewer safeguards in place.