When I was a little kid in Toronto, I used to be glued to the television watching Hockey Night in Canada. I would shriek with glee when my beloved Toronto Maple Leafs would score a goal, but then I'd be furious when they missed an empty net. Watching sports can be so emotional.
Decades later, I'm still obsessed with hockey and my Leafs, but now from my home in New York. And my home city isn't the only difference from my childhood hockey watching days. Today, I've noticed that every sports broadcast and commercial is teeming with sports ads for sports betting.
Sports betting is everywhere, and it's deeply embedded in our culture from televised football and baseball games to pro athlete endorsements. Gambling on sports has become completely normalized, and it's affecting children. Now, when a 10-year-old child goes to Madison Square Gardens, he or she sees a massive ad for BetMGM on the Jumbotron.
What's more normalized than that? And did you know that today's children are the first generation that has never watched sports without being invited to gamble on them? The stakes for children aren't just emotional like they were during my childhood.
They're financial, neurological, and increasingly addictive. As an addiction medicine physician, I treat patients with substance use disorders and behavioral addictions. Over the past few years, my colleagues and I have noticed a troubling trend.
Younger and younger patients are developing gambling-related harms, many of them linked to sports betting. Do you know what disturbs me the most? Three things.
One, many of the kids don't even realize they're gambling. They think they're just playing. Two, gambling addiction is similar to drug addiction, but it's more hidden.
There's no equivalent to an overdose that could then lead to treatment. And three, gambling addiction is strongly associated with suicide, and that's not going to help the growing child mental health crisis that we're facing. So, how did we get here?
Let's go back to 2018 when a Supreme Court ruling allowed states to legalize sports betting. As of 2026, 39 states and DC have some form of legal sports betting. Today, it's a multi-billion dollar conglomerate.
Betting ads are seamlessly integrated into uh sports broadcast, social media feeds, video games. For teenagers, sports betting isn't something they actively go looking for. It comes looking for them.
And it's affecting their most vulnerable body part, their brain. A child's developing brain is extraordinary. It's creative, curious, adaptive, and it's primed to learn.
But, it's also uniquely sensitive to reward. The reward center of the brain, driven by the neurotransmitter dopamine, matures before the prefrontal cortex, which oversees decision-making and impulse control. It's not play.
It's gambling. Let me tell you the story of Jimmy, a high-achieving 17-year-old high school student, excellent athlete, lots of friends. Life was grand on the outside.
Jimmy started placing small bets on baseball games with his friends. $5 here and there, sometimes 10. It was totally harmless.
It was social. It was bonding. Then Jimmy started using the apps and placing micro bets.
So, not just on what team was going to win the game, but on the number of home runs and the speed of the next pitch, all while watching odds change dynamically throughout the game. App-based betting engaged Jimmy in a way that I never was as a kid. Before he knew it, Jimmy was betting every day and it showed.
Within months, Jimmy's behavior started to change. He was anxious and irritable. His grades dropped.
And he was constantly lying to his parents about all of it, including his secret use of their credit card to pay off his escalating debts. By the time he came for help, Jimmy was overwhelmed financially, emotionally, mentally. He was depressed, ashamed, and afraid, and he had no idea how to stop.
Jimmy doesn't fit the stereotype of who most people think develops an addiction. He was smart, athletic. He had loving parents.
He was a good kid. Jimmy also had that perfect young brain that betting algorithms target. Historically, gambling required physical access to a casino or a a betting venue.
Restrictions were in place, travel, age verification, social oversight. Now? Gambling isn't just in your house.
It's in your pocket, accessible 24/7, and betting algorithms are optimized for the teenage brain. It's not just about gambling. It's about entertainment, financial aspiration, bonding.
But the betting industry frames it as strategic, skill-based, even entrepreneurial. But brain biology tells us differently. Sports betting hurts more than just finances.
It's strongly associated with substance use, depression, and suicidality. Binge drinking among young men who bet on sports has gone up up to 20%. Studies show that adolescents who gamble are more likely to experience anxiety, poor diet, poor sleep, and academic decline.
The brain biology of sports betting disorder, and gambling disorder more broadly, is strikingly similar to that of opioid and alcohol addiction. The same reward center of the brain is hijacked. Gambling, like heroin, activates the dopamine pathway.
And while most people think of dopamine as the feel-good or pleasure neurotransmitter, it's really about learning. Dopamine encrypts motivation, prediction, and repetitive learning. Gambling is uniquely powerful in that almost wins and near misses trigger dopamine surges.
Like substance use disorders, gambling addiction impairs that prefrontal cortex, which manages decision-making and impulse control. Like cocaine, gambling is strongly associated with intense cravings that are driven by the brain. Another overlooked consequence is emotional volatility.
Sports evokes intense emotions at baseline, and I get it. During the NHL playoffs, my heart is pounding with excitement every time my Leafs get a penalty shot. Now, bring money into the equation.
A win feels euphoric, but a loss can feel catastrophic. So, what does this mean for educators? First, exposure to betting is happening earlier, as young as on average age 17.
And so, why does that matter? It's because it's impacting students before their brains' executive function, their prefrontal cortex, is fully developed. In fact, teenagers who gamble are up to four times more likely to develop problem gambling later.
And I want to be clear about something here. Students aren't the ones failing. These betting systems are highly sophisticated, and they use a lot of the same behavioral design strategies as gaming and social media platforms.
And if this sounds familiar, it's because it is. You've all seen this pattern before with tobacco, marijuana, and opioid painkiller pills. History has repeatedly shown us that when profit-driven industries intersect with vulnerable groups, public health professionals need to intervene, as do educators.
We need to act. We need innovative and effective approaches to combat this growing public health problem of sports betting among youth. And we need a multi-layered approach that integrates behavioral, digital, educational, and regulatory methods.
One innovative action could be behavioral vaccines. So, instead of warning young people about gambling harms, why don't we inoculate them psychologically against manipulation? This time the disease isn't a contagious viral infection like measles, but rather rapidly spreading misinformation.
And instead of building up antibodies against a virus, we would be building up pre-bunking tools for betting. So, what would that look like? We could develop interactive modules where teenagers experience simulated betting platforms that intentionally manipulate uh odds displays and trigger emotional nudges.
Then the simulation would reveal the manipulation in real time. Studies show that what once people recognize behavioral exploitation, they're less likely to be manipulated later. The take-home point here is let's teach young people to identify manipulation cues automatically, similar to a cognitive immune response.
A second innovative action is digital interventions. Smartphone-based cognitive behavioral therapy, motivational interviewing, and personalized normative feedback have been shown to reduce gambling frequency and harm among college students. Digital tools leverage technology for scalability and accessibility, and they can include pop-up messages that prompt time limits and mandatory breaks.
A third innovative action is educational campaigns. Modeled after anti-tobacco strategies, sports betting educational uh programs provide information about risks, as well as social and emotional consequences. Young people need to be involved in in the design and delivery of educational tools in order to enhance their relevance and impact.
A fourth innovation is regulatory and policy interventions. This is critical. Restricting sports betting advertising, especially to youth, has been shown to lower gambling harm.
And And why? It's It's because marketing exposure is a strong predictor of problem gambling among young people. Other policy changes that I think will keep kids safe include raising the legal bait age limit and enforcing credit card bans.
As an addiction medicine doctor who treats a lot of mental illness, I'm going to add another key action point. We need to integrate mental health support and screening for gambling behaviors into routine medical care for young people. Annual visits to the pediatrician need to ask about betting given the strong connection between gambling and adverse mental health outcomes, including suicide.
So, what happened to Jimmy? Well, I first thanked him and his parents for coming in and asking for help. With behavioral therapies, medication, recovery, and family support services, Jimmy regained control of his life.
He His grades improved. He's back to running track. He is in recovery.
Jimmy once said something that that struck me. He said, "Placing bets made me feel warm and cozy. I thought I was just playing a game.
I didn't know the game was playing me. Those wise teenage words capture the essence of the highs and lows of modern sports betting. Here's my message to young people.
Your brain is one of the most powerful machines on the planet. But it's uniquely sensitive to reward and forming habits during adolescence. And that's not a weakness, it's biology.
These betting systems were built by data engineers, neuroscientists, and behavioral economists whose primary goal is to keep you betting because that's how they make money. So, what's the most radical thing you can do? Protect your brain because that will protect your time, attention, and mental well-being.
Here's my message to adults. If you're a an educator, parent, policy maker, healthcare professional, or simply someone who just cares about young people, please recognize that sports betting is not just gambling. It's about how digital industries interact with developing young brains.
In closing, I believe that sports has and always will bring people together. Sports teaches teamwork, resilience, joy, and connection. Right now, we have an opportunity and a responsibility to ensure that the sports betting business does not mutate positive sports experiences into addictive mental poisons for young people.
Because when we nurture adolescent brain health, we're not just preventing disease, we're fostering the freedom to enjoy sports for what it was always meant to be, a game. Thank you.
