Will sports betting legalization increase gambling addiction?

Experts believe that legalized sports betting is coming to the United States by 2020, if not sooner. Momentum is building to expand legal sports betting outside of Nevada. Led by NBA commissioner Adam Silver, some professional sports leagues (which have been long-standing staunch opponents of sports betting legalization) are starting to change their tune.

New Jersey's efforts to bring Las Vegas-style sports betting to Atlantic City casinos and the state's racetracks have, at a minimum, raised questions about the effectiveness of the 23-year-old federal ban on sports betting. Four more states -- Indiana, Minnesota, New York and South Carolina -- have introduced sports betting legislation in recent months, and two federal bills have been presented in Congress.

The question is beginning to appear as if it's when, not if, sports betting will be legalized in the U.S., but is the country mature enough as a gambling society to handle it?

Dr. Howard Shaffer, an associate professor of psychiatry at Harvard Medical School and a leading authority on the impact of gambling expansion, isn't sure.

"The more mature gambling environment, more mature gambling community, the less it's affected by expansion or changing of the characteristics of the gambling system," said Shaffer, who is also the director of the Division on Addictions at the Cambridge Health Alliance. "In the U.K., as an example, they're very mature as a gambling society. There's gambling everywhere. Although people expected an uptick there, when they expanded gambling, it didn't really happen. I think the question is: 'Is the sports gambling in America mature enough to tolerate expansion?'

"Sports betting in the United States is ubiquitous," Shaffer continued. "We have office pools, friendly wagers, it's not unusual when Super Bowl time rolls around for mayors of the competing cities to have a public bet. That's all sports betting. Now, is the community mature enough to tolerate legalized sports betting? Because when sports becomes legal, there will be some people who might not have bet on sports who will now jump in. Are those sports betting virgins, so to speak, going to be affected? I think the answer is 'yes.' But the real question is: 'How many are there and is there enough to influence the system?' "

When sports betting is legalized, young people who have never stepped in a casino or purchased a lottery ticket will try putting money down on a game, and some will develop gambling problems. Athletes are specifically at risk. Lives, families will be ruined. This risk can't be overstated.

Experts like Shaffer say that when legal gambling expands, there is an initial increase in problem gamblers known as the exposure effect. The more people who are exposed to gambling, the more people will gamble. A small percentage of them will develop a gambling problem. But evidence also suggests that mature gambling communities adapt to the increased exposure and are able to somewhat mitigate the initial spike in problem gamblers -- through revenue shares designated to social services, for example.

Ted Hartwell is one of those people who needed those social services.

In 2007, his addiction in full bloom, only one thing would get Hartwell up from the video poker machine -- his 2-year-old daughter. He'd always be there to pick her up from day care, albeit sometimes late. Living in Las Vegas, he found a spot with a poker machine five minutes away from the day-care center. If he hit a jackpot right before he needed to leave, he'd simply step outside the casino, call the day-care center and explain that he had a flat tire and would be a few minutes late.

"There's nothing rational about how an addict [does] things," Hartwell said.

A cellist and a research scientist, this was a successful, intelligent man in his early 40s, with family and friends. Yet he was living each day with the idea of getting a minimum amount of work done, leaving early and going to gamble. He'd burn through his available cash daily in the machines and began using sports betting almost as a savings account.

"This is going to sound screwy," he said, "but I would often make several sports bets, knowing that when I had pumped my available money into the video poker, I might still have some winning sports bets to get money and put into video poker again. It was just about having action, being numbed out. At this point, it wasn't a fun experience at all."

Hartwell estimates that during the last handful of years he was gambling, he lost between $150,000 and $200,000. It ended Sept. 14, 2007. That day, he arrived home after picking up his daughter and was confronted by his wife. She had found the mountain of credit-card debt he had accrued.

"I thought she was going to take our daughter and leave," Hartwell said. "It was the thought that I was going to lose my family potentially over this that finally made me turn the corner."

After multiple failed attempts with counseling in the past, Hartwell found success through a six-week outpatient program with the Las Vegas Problem Gambling Center. He hasn't bet since that September day. Now Hartwell, 49, has emerged as one of the few public faces of problem gambling.

"It's one of my missions, really, to be public about it," he said. "I want people to hopefully feel more comfortable talking about it themselves and maybe help someone get into treatment sooner than they might otherwise."

More can certainly be done to spread awareness, though. According to a survey conducted by the National Council of Problem Gambling, only 1 percent of compulsive gamblers enter state-funded treatment annually. That's a problem, because treatment is often effective. The NCPG compiled a study based on three states with well-established public services and found that problem gamblers who complete treatment improve significantly. In Arizona, for example, 97 percent of patients reduced their participation in gambling. Post-treatment clients in Iowa reduced their gambling debt by an average of $13,000.

"I get calls from people who are down in the range anywhere between $15,000 to $100,000," said Victor Ortiz, a senior director at the Massachusetts Council on Compulsive Gamblers. "For sports bettors, it's somewhere between maybe $10,000 and $25,000, at the most. The people at the high end are the people that have been gambling the longest."

Ortiz has been working in social services for 20 years. He says that when it comes to calls to the gambling help line regarding sports betting, April is by far his busiest month.

"Guys play through football season, then try to keep it going or catch up during March Madness," Ortiz said. "Then, when the NCAA tournament is over, I think it kind of hits them. For most people, there's March Madness. In my world, it's April Sadness."

Sports betting is already deeply ingrained in American culture, yet is mostly illegal in 49 states. That's not stopping many from betting, though. A 2008 Gallup Poll found that one in six Americans gamble on professional sports, either in an office pool or by betting on specific games. A 2012 NCAA study showed 18.7 percent of male Division I athletes wagered on sports.

"One of the things that make sports betting so interesting is that it is probably by far the most widely participated form of illegal gambling," said Keith Whyte, executive director for the National Council for Problem Gamblers. "Illegal gambling is one of the factors that's associated with gambling addiction. We know that people with gambling problems are more likely to gamble on illegal forms and that very much tends to be guys gambling on sports."

Hundreds of billions of dollars are wagered on sports annually. The American Gaming Association estimates $9 billion will be wagered on the NCAA tournament alone. And once legalized, the sports betting pool is expected to increase.

In a March 17, 2009 letter to Delaware Gov. Jack Markell, NFL commissioner Roger Goodell protested the state's attempt to bring back its pro football sports lottery and wrote: "By legalizing sports betting, it will be in Delaware's interest to create ever-larger numbers of new gamblers as the state attempts to maximize any revenue found in this promotion. The negative societal impact of additional gambling cannot be minimized in a community."

Goodell was right about the growth. Delaware re-started the sports lottery in 2009 and has seen significant growth. In 2009, $10.81 million was wagered on the sports lottery, which features only NFL games. In 2014, $37.8 million was bet in the lottery.

The negative societal impact Goodell predicted, however, has not been glaringly obvious. Despite the growth of the Delaware lottery -- nearly 2 million more bets were placed in 2014 than in 2009 -- the state's council on problem gambling says it has not seen a noticeable uptick in calls from problem gamblers regarding sports betting.

In 2014, less than 1 percent of callers to the Nevada Council on Problem Gambling Helpline identified sports betting as their most problematic form of gambling. Six percent of calls to New Jersey's problem gambling hotline are related to sports betting. Calls regarding lotteries scratch-off tickets and, where legal, video poker and slots, are much more common.

Overall, gambling addiction in the U.S. peaked at about 2.7 percent in the late 1990s and early 2000s, Whyte said.

"It's been going down since then, even in the face of expansion," Whyte said.

While an increase in problem gamblers after the legalization of sports betting is a concern, there isn't overwhelming evidence to support the fact that it will be a big issue. Until it's legalized, though, all the gaming industry can do is plan and attempt to dispel the stigma attached to betting.