A recent study published in the American Journal of Preventive Medicine indicates that the legalization of gambling is associated with significant public health consequences. Researchers in Ontario found that emergency department visits related to gambling disorders doubled following the province’s 2022 decision to allow betting on individual sports events.
The majority of patients presenting to emergency rooms were men, with nearly one-third of those visits resulting in hospitalization. Ryan Forrest, a public health doctoral student at the University of Toronto and a co-author of the study, noted that the surge in severe cases may signal broader harms within the general population, including financial distress, relationship breakdowns, and deteriorating mental health—issues often absent from hospital records.
By comparing projected baseline emergency visit rates against actual data post-legalization, researchers determined that visits were 154% higher than they would have been had the law remained unchanged. These incidents were concentrated among men aged 10 to 44. Many patients arrived with diagnoses of major depression and suicidality, while others struggled with substance abuse. Medical records frequently cited gambling as a contributing factor to these conditions.
Corroborating these findings, a separate analysis by the same research team examined calls to ConnexOntario, the province’s free 24-hour mental health and addictions helpline. The data showed a 200% increase in calls compared to projections, with the vast majority of callers being males between the ages of 15 and 44.
“There’s two data sources telling us there is a real health signal happening here,” Forrest said.
The findings serve as a cautionary tale for the United States, where sports gambling has expanded rapidly since the Supreme Court struck down a federal ban in 2018. Dozens of states, including New York, New Jersey, and Tennessee, have since legalized sports betting, and many also permit online casino games. Canada followed suit by legalizing single-event sports betting in 2021.
U.S. therapists are already observing the mental health impacts of this proliferation. Cynthia Grant, vice president of clinical services at Birches Health, the country’s largest provider of gambling disorder treatment, reported that the number of clients aged 18 to 34 has more than doubled since 2024.
“There’s more people gambling, and when you have more people gambling, it simply means that there’s more people who are going to develop a problem,” Grant said.
Grant highlighted a notable rise in discussions surrounding prediction markets, which allow individuals as young as 18 to wager, unlike sports betting restricted to those over 21. According to an analysis of initial clinical assessments, mentions of prediction markets have increased by 200% compared to the previous year.
“It’s just not a regulated environment out there,” Grant said. “People’s lives are being ruined; their relationships are being destroyed, their retirement accounts are gone.”
She attributed the trend partly to younger generations beginning to gamble earlier in life. Exposure often starts through gifts such as lottery scratch tickets, family fantasy sports pools, online games that reward chasing prizes, or collectible card hobbies like Pokémon.
Cognitive behavioral therapy remains the standard treatment for gambling disorder, addressing the distorted thinking patterns that lead individuals to believe they can overcome the odds. However, Grant noted that many sufferers are unaware that gambling disorder is recognized as a mental health condition covered by insurance. Research indicates that suicidal ideation and risk are five to ten times higher among those with gambling disorders than in the general population.
Both experts criticized the lack of regulatory oversight and investment in monitoring health outcomes. Forrest pointed out that unlike the legalization of cannabis, which came with substantial grants for tracking policy impacts, the Canadian government has not allocated funds to monitor the public health effects of sports betting.
Grant emphasized that most gambling applications fail to implement automatic spending limits or intervene when users display addictive behaviors. Citing a ProPublica investigation, she noted that some platforms actively incentivize continued play rather than flagging problematic patterns.
“The way that online systems work right now do not protect people at all who are prone to behavioral addictions,” Grant said. “And that, to me, is very dangerous for my clients.”
She drew a parallel to other industries, noting that while bartenders face restrictions on serving intoxicated individuals and police enforce DUI laws, comparable safeguards do not exist in the gambling sector.
My dad lost our savings to sports betting. I am glad someone is finally studying the real cost.
Correlation doesn’t always equal causation. Maybe other factors like economic stress drove these numbers up?
Do you think prediction markets for under-21s will face stricter regulation soon? The article mentions this loophole.
Why are we still surprised by this? Gambling addiction ruins lives, and now the data proves it publicly.
I knew betting was popular, but doubling ER visits? That is genuinely alarming and needs more attention.