“High Stakes: Gambling Addiction, Beyond Borders” is a three-part series looking at the public health movement to address gambling in Massachusetts and the United States, and what can be learned from two countries with very different models of gambling regulation: Norway and the United Kingdom. This is part three of that series. Part one, about Norway, can be found here. Part two, about the U.K., can be found here.
A few hundred feet into the MGM Springfield casino floor, visitors can find the “GameSense” office, where, amid the loud clanging of slot machines and table games, an employee often stands alone at a desk.
They offer swag to get people to stop by — tissue boxes, luggage tags — and are happy to explain how gambling odds work. If anyone feels they need help reining in their gambling, brochures with the state’s helpline number are stacked on the counter.
The GameSense program has been a centerpiece of Massachusetts’ approach to reducing gambling problems, along with Play My Way, a program that allows people to set their own time and money limits in the state’s casinos and with online sportsbooks.
The programs focus on the 10% of the population that researchers at UMass Amherst estimate either has a gambling disorder or is at risk of one.
But with no national commission on gambling nor nationwide gambling policy, Massachusetts — like every state — is on its own to come up with ways to curb gambling disorders. And many addiction experts think the states could do better.
A growing number of health and policy makers say it’s time to take bolder — and more unified — action, especially since the U.S. Supreme Court legalized sports betting in 2018 and unleashed an aggressive new industry, now legal in 39 states. (Forty-eight states have legalized at least some form of gambling, including lotteries.)
“All (addictions) except gambling have some kind of intervention by the government to impose some constraints and provide some protection,” Democratic U.S. Sen. Richard Blumenthal of Connecticut said. “The sophistication and complexity of betting has become staggering. And that's why we need … protections that will enable an individual to say no.”
Blumenthal and U.S. Rep. Paul Tonko, a New York Democrat, have filed the Safe Bet Act, legislation that would impose federal standards on all sports betting companies. Among those regulations: no advertising during live sporting events, mandatory “affordability checks” on high-spending customers, limits on VIP schemes, a ban on A.I. tracking for marketing and the creation of a national “self-exclusion” database.
“Gambling is a nationwide activity. States are unable to protect their consumers from the promotions and pitches, the excessive and abusive offers — and sometimes misleading pitches — to gamblers from out of state,” Blumenthal said. “And [states] simply don't have the resources or the jurisdiction legally to provide the full protection that's necessary.”
The fallout, according to Jonathan Cohen, author of the book “Losing Big: America’s Reckless Bet on Sports Gambling,” is putting new generations at risk.
“The landmines are placed in front of young people,” Cohen said, “and if they don't know any better … they step on gambling as a landmine and it just blows up in their face and they don't even know what happened to them.”
“Responsible gaming” vs “public health”
The gambling industry has come out strongly against the Safe Bet Act.
Joe Maloney, a spokesperson for the American Gaming Association, calls the very concept of federal gambling standards a “slap in the face” to state regulators across the country.
“You have the potential to just dramatically, one, usurp the states’ authority and then, two, freeze the industry in place,” he said.
Maloney said the industry acknowledges that gambling is addictive for some people, but he said it has already developed its own solutions through a model called “responsible gaming.” That includes messages warning people to stop playing when it’s no longer fun and entertaining, public education about the low odds of striking it rich and supporting access to treatment for those with gambling disorders.
Maloney said there is no need for new federal rules on how companies can offer or advertise their products online or in casinos, which he said would only benefit the unregulated, illegal gambling market.
“There are certain stakeholders that are pretending to represent a certain type of player as a rationale for a one-size-fits-all protection,” Maloney said.
But proponents of the Safe Bet Act say the industry’s “responsible gaming” model has failed.
Harry Levant, the director of gambling policy at the Public Health Advocacy Institute at Northeastern University in Boston, calls the model “ethically and scientifically flawed.” He said it puts all the blame and responsibility on individuals with a gambling disorder.
Levant, who helped write the Safe Bet Act, was addicted to gambling himself. A former lawyer, he was convicted in 2015 for stealing clients’ money to fund his betting habit. He is also an addiction therapist. He explained that you can’t just tell a person struggling with addiction, “Just don’t do that anymore.”
“You need regulation when the industry has shown an inability and unwillingness to police itself,” Levant said. “It’s the moral equivalent of Big Tobacco saying, ‘Let us do whatever we want for our cigarettes, as long as we pay for chemotherapy and hospice.’ We wouldn't tolerate it with tobacco. We don't tolerate it with alcohol.”
Public Health Advocacy Institute Executive Director Mark Gottlieb said “responsible gaming” targets people who have already suffered great harm, while a public health approach, such as limiting what products can be offered and how, is “preventing people from experiencing that harm in the first place.”
But Gottlieb acknowledged that new federal regulations could be a hard sell in today’s political climate. If the Safe Bet Act doesn’t pass under this Congress, he is hoping states choose to take strong action on their own.
“Stop the worst excesses of sports betting”
Massachusetts gambling regulators declined to comment on any legislation — neither the Safe Bet Act nor a pending state bill that would limit gambling options.
But they say they have come a long way since the state legalized casinos in 2011, when the approach to problem gambling was “much more about making sure that there are brochures that are available that explained the odds of whatever game it was,” according to Mark Vander Linden, who runs the responsible gaming division of the Massachusetts Gaming Commission.
The commission says 64,000 people are currently signed up for a Play My Way account, though only a small percentage choose to set personal limits on time and money spent gambling. About 2,300 people have put themselves on a statewide “self-exclusion” list that bans them from one or all forms of legalized betting for a period of time.
Vander Linden said his office is now adapting to the new risks of online sports betting, which lawmakers legalized in Massachusetts in 2022. His team is seeking technology that gives gamblers more ways to curb their play, including software that disables gambling apps on phones and methods to track any uptick in gambling habits.
He said they are also designing research to learn “the science of being able to identify triggers or patterns of risky gambling behavior,” as well as which interventions would change that behavior.
State Rep. Lindsay Sabadosa, D-Northampton, wants to give regulators even more tools.
Sabodosa is co-sponsor of the Bettor Health Act, which, like the federal Safe Bet Act, would require affordability checks and advertising limits. It would tax gambling companies at a higher rate and direct additional money to the Massachusetts’ public health trust fund for treatment and prevention.
The law would also ban “prop” bets, which are wagers placed during a game on a variety of game-related events — who makes the first shot in basketball, for example, or who hits the first home run in baseball.
“It's encouraging excessive gambling,” Sabadosa said. “You can win and lose, like, from one second to the next.”
Sabadosa also thinks affordability checks, like those that exist in the United Kingdom, can act as a financial safety net.
“If you're only allowed to have two drinks, we know that you're not going to get drunk, right?” she said. “If you're only allowed to gamble $100 a day because that's an affordable amount, you're not going to go broke.”
The American Gaming Association declined to give its position on affordability checks but did say it opposes a ban on prop bets.
“A prop bet is a very, very popular form of betting. It provides for an increased level of engagement,” Maloney, the American Gaming Association spokesperson, said. “If you suddenly start to pick and choose what can be legal or banned … you're driving bettors out of the legal market and into the illegal market.”
Sabadosa doesn’t accept that position.
“We've heard that argument from the cannabis industry, too. ‘Don't regulate us because then people will go to the black market,’” Sabadosa said. “But at the end of the day, if you're going to have a legal market, it does need to be protected. That is the whole point of having this legal market.”
She added that the goal is not to stop gambling entirely. “It's to stop the worst excesses of online sports betting.”
Many public health advocates say passing any legislation that restricts the growth of gambling won’t be easy — not least due to industry lobbying. The watchdog organization OpenSecrets reports gambling companies spent almost $40 million nationally on lobbying in 2024. In Massachusetts, 30 gaming-related companies spent a combined $2.7 million lobbying state lawmakers last year, according to state lobbying disclosures.
“The sportsbooks really benefited from the diffuse nature of sports betting and from the fact that we have 50 states and 50 laws about gambling,” Cohen said, “because they were able to show up at every different legislature and sort of run roughshod over them with their money, their lobbying, to get the sort of laws they wanted on the books.”
At the same time, many state legislators are tempted by the promise of new revenue from expanded gambling, said Harry Levant of the Public Health Advocacy Institute. He’s concerned that could launch the “i-gaming” industry — online roulette, blackjack and other casino-style games — which is currently legal in only seven states.
“We have empathy for how hard it is for states to balance their budgets in this current political environment,” he said, “but states are starting to recognize the answer to that problem is not to further push a known addictive product.”
What could convince lawmakers to restrain the gambling market, Mark Gottlieb said, is a groundswell of advocacy from friends and family of people with gambling addiction, the same way that Mothers Against Drunk Driving pushed for blood alcohol limits on the road.
“That is really the thing that has been missing from this movement,” Gottlieb said.
Meanwhile, industry critics are not waiting for legislation to pass; they are also turning to the courts. In June, the Public Health Advocacy Institute sued Caesars Online Casino and Harrah’s Philadelphia casino over what it calls a “predatory” promotion designed to “snare” consumers into more gambling. The city of Baltimore is suing several sportsbooks for their aggressive marketing practices.
And Cohen said simply publicizing the risks of gambling — in a way that young people will notice — can work too.
“So whatever sort of counter programming that can be provided to Jamie Foxx playing piano and telling you that gambling is cool, I think that would be the place to start,” Cohen said. “We don't have to wait for government to do that.”
This project was supported by a grant from the Association of Health Care Journalists, with funding from The Commonwealth Fund. It was edited by Dusty Christensen, with help from Elizabeth Román.