By Suzanne King, Kansas-Missouri Health Journalism Fellowship

Before Ted Hartwell became the Nevada Council on Problem Gambling's executive director, he was a founding cellist with the Las Vegas Philharmonic.

His career change came after Hartwell almost lost it all gambling.

"About 17 years ago, I was in the final few months of a gambling addiction that threatened to not only destroy me, but destroy my family's finances, impact multiple job sites, including my research institute and the Las Vegas Philharmonic," he said during his talk at Health Journalism 2024.

Since 2018, when the U.S. Supreme Court overturned the Professional and Amateur Sports Protection Act, which banned sports betting in most states, 38 states and Washington D.C. have legalized the passtime.

That new ubiquity, combined with technology that lets people place bets on smart phones in privacy and do so repetitively during games, have made sports gambling an emerging public health issue. Hartwell said stay-at-home orders triggered by COVID-19 made the problem even worse.

To be diagnosed with a gambling disorder - sometimes referred to as problem or compulsive gambling - someone must meet four of nine diagnostic criteria.

"But even meeting just one or two of those can be devastating in certain circumstances," Hartwell said.

People who bet on sports are more likely than others to frequently engage in additional risky behaviors like binge drinking. Addictive gambling often co-occurs with substance use disorders and other mental health conditions. In 90% of cases, Hartwell said, the brain biochemistry of someone with a gambling disorder matches that of someone with a substance abuse disorder.

Between 2018 and 2020, rates of self-reported problematic gambling behaviors approximately doubled, he said. The problem is of special concern among college students. An NCAA study last year found that two-thirds of 18-to-22-year-old men were involved with sports betting. Just over half of women in that age group said they were placing sports bets.

But as more states legalize sports betting, few are dedicating enough resources to awareness, prevention and research, Harwell said. The National Council on Problem gambling recommends that states allocate 1% of gambling revenue toward that effort.

Suzanne King covers health care for The Beacon in Kansas City.