Between 2018 and 2021 three events drastically changed the landscape of gambling in the United States.

The first was the rapid expansion of legal sports betting, the second event the jump in the number using the internet to gamble, and the third the COVID-19 pandemic. All coincided with a significant increase in potentially problematic play. The data—most notably the similarity in overall gambling behavior and problematic play between states with legal sports betting and states without—suggest that the pandemic had by far the greatest impact.

Prohibition of gambling or any particular form of gambling cannot be seen as an effective strategy for reducing excessive or disordered gambling, especially in an era where internet gambling is a few keystrokes away from anyone regardless of its legal status.

It does not negate the need for programs for the prevention, awareness, and treatment of problem gambling. At the same time, the data suggest that the diversion of gamblers from illegal offshore sites to legal facilities in-state by itself does not reduce problem gambling without effective programs and without regulation that goes beyond the gambling operator’s financial integrity.

Problematic play is clearly associated with age, the number of gambling activities in which one participates, and sports and fantasy sports betting.

While the data collected for this report do not permit an assessment of relative causality, they do suggest target audiences for efforts at awareness, prevention, and encouraging treatment.

Problematic play is also associated with measures of gambling literacy.

Problematic behavior, for example, is strongly linked to a belief that gambling is a good way to make money. Efforts to increase awareness of how gambling actually works may well be an effective strategy for the prevention of gambling problems.

In addition to having the highest level of problematic play of any demographic group, young adults are also the most likely to hold misconceptions about how gambling works and the likelihood of recovery from a gambling disorder.

A major collaborative effort between experts in problem gambling and communications professionals is essential.

The association of frequent investment trading with problematic gambling both bears further study and suggests the need for treatment and prevention professionals to incorporate questions about investment activity into their practice.

It also suggests a need for a mutually beneficial collaboration between those active in the problem gambling field and investment professionals.

The 2018 NGAGE survey report concluded that “Gambling disorders continue to be highly misunderstood and stigmatized. Both factors likely contribute heavily to a reluctance to seek or recommend treatment. In addition, awareness of treatment resources is low. Greater efforts need to be made to convey the realities of problematic gambling, the effectiveness of treatment, and its availability.”

This statement is every bit as true in 2021 as it was in 2018.

The continued high public participation in lotteries underscores their importance in problem gambling awareness and prevention.

This is not because lotteries carry an elevated level of risk, but because 90 percent of all gamblers play the lottery at some point. As such, lotteries have the potential to reach almost all Americans who choose to gamble.

Comparison of the 2018 and 2021 NGAGE studies reveals considerable change in the profile of gambling in America.

Our understanding of these changes is in its infancy and there is every reason to believe that we have not seen the last of them. Continued research is certainly essential, but so is increasing awareness that yesterday’s public policy is not an adequate response to today’s realities. Doing so will require a collaborative effort between governments, the gambling and gaming industries, non-governmental service providers, researchers, other affected industries, and the recovery community.

Americans gamble in many different ways.

Most Americans participate in gambling in some way, including residents of every state, young, old, white and people of color, and of every portion of the socio-economic status. And while some groups are more likely to experience problematic gambling than others, no age, income, socio-economic, or ethnic group is exempt.

Problem gambling is still too often seen as a personal or moral problem, and too much effort is still expended in attributing blame and denying responsibility.

It is a serious public health issue demanding a comprehensive solution that involves governments at all levels, the gambling industry, professions such as medicine, law, education and finance, the non-profit sector, and more.