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<td><a href="https://www.fiercehealthcare.com/providers/next-opioid-epidemic-gambling-addiction-grows-legalization-outpaces-public-health" style="font-family:Helvetica, sans-serif; letter-spacing:-1px;margin:0;padding:0 0 2px;font-weight: bold;font-size: 19px;line-height: 20px;color:#222;">Gambling addiction looms amid lagging public health response</a>
<div style="font-family:Helvetica, sans-serif; text-align:left;color:#999;font-size:11px;font-weight:bold;line-height:15px;">Apr 14th 2026, 13:45</div>
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<p><div class="col content" morss_own_score="5.948084054388134" morss_score="477.4376407973686">
<p>Mike Sciandra grew up around gamblers. It wasn’t long before he became one. </p>
<p>Born in Las Vegas, Sciandra’s earliest memories center on casino arcades—playing with rolls of quarters while his family gambled on the casino floor. By nine years old, Sciandra played cards for money. By 15, he placed bets at a Keno parlor, where staff knew him well enough to discreetly let him play as a minor. By 21, Sciandra gambled in the big leagues: casinos.</p>
<p>He didn’t stop for over 20 years. He played through graduate school, jobs, a marriage. Almost every night after his daughter went to bed, Sciandra gambled. On business trips around the Midwest, Sciandra would stop by his favorite machines, sometimes even using his corporate card. </p>
<p>The whole time, Sciandra kept his habit a secret. “It was truly a double life I was living,” Sciandra, now 47, said, “doing a lot of things that were really incongruent with my own personal beliefs.” </p>
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<img src="https://qtxasset.com/quartz/qcloud5/styles/thumbnail_200xauto/s3/media/image/Mike%20Sciandra.jpg?VersionId=926fKRppZ8REmbRCQIfAfArRooxVdaJj&itok=v5dBDHFI">
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Mike Sciandra, 47, Nebraska Council on Problem Gambling
(Mike Sciandra)
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<p>During the COVID-19 pandemic, the marketing business Sciandra ran took a serious hit. “I went back to the one thing that I kind of always knew, and that was gambling,” Sciandra said. With casinos closed, he started day trading. “I was finding any way possible to gamble. By the time I got to December of 2020, I was spiraling so bad that I knew I needed help.”</p>
<p>After leaving a parlor exhausted, Sciandra called the Nebraska Problem Gambling Helpline and got referred to treatment. “I guess you can say the rest is history,” Sciandra said. Today, Sciandra is a certified peer support specialist and executive director of the Nebraska Council on Problem Gambling. He hasn’t placed a bet in over five years.</p>
<p>Seven in 10 U.S. adults gamble, according to a survey from the National Council on Problem Gambling (NCPG). Commercial gaming revenue <a href="https://www.americangaming.org/commercial-gaming-revenue-hits-78-7-billion-in-2025-driving-record-18-1-billion-in-gaming-taxes-nationwide/">broke records</a> at $78.7 billion in 2025, with over $18 billion in tax revenue going into state and local coffers. All gaming segments, from casinos to sports betting to online games (iGaming), are growing. Throw in prediction markets, which allow users to speculate on the outcome of real-world events but are not legally considered gambling platforms, and the betting buffet becomes basically limitless. </p>
<div>We call it the next opioid epidemic.</div><div>Jody Bechtold, President, International Problem Gambling & Gaming Certification Organization</div>
<p>This menu of options is creating an addiction crisis yet to be widely recognized by the public, policymakers and the healthcare sector, experts caution. Current national problem gambling prevalence is unknown due to a lack of research and funding dedicated to the issue. States that measure and publish their own prevalence rates see anywhere from 1% to 6%. Those most at risk include young adults, men and online gamblers. Gambling-related harms can be dire, from financial stress to co-occurring behavioral health conditions to suicide, which a fifth of individuals with gambling addiction attempt.</p>
<p>To understand problem gambling, what’s driving it and efforts underway to address it, Fierce Healthcare talked to two dozen providers, researchers, advocates and regulators. This story is also based on a review of research, as well as exclusive data from Komodo Health analyzed on Fierce Healthcare’s behalf.</p>
<p>“It’s a small but mighty group of us that have been in this field, treating,” said Jody Bechtold, L.C.S.W., president of the International Problem Gambling and Gaming Certification Organization (IPGGC). “We call it the next opioid epidemic.” </p>
<h3>A decades-long gap in prevalence estimates </h3>
<p>Gambling addiction is known as gambling disorder, or persistent gambling that causes clinically significant impairment or distress. The condition was not recognized as an addiction in the Diagnostic and Statistics Manual (DSM) until 2013. Before then, it was considered an impulse control disorder, like kleptomania. </p>
<p>While to get diagnosed with gambling disorder, individuals must meet certain DSM criteria, many more individuals can experience gambling-related harms without a diagnosis, known as problem gamblers.</p>
<div>We are failing the people of America.</div><div>Brianne Doura-Schawohl, responsible gambling lobbiyst</div>
<p>Gambling, like substances, can be addictive because it activates the reward system in the brain. As a person gambles, or anticipates gambling, a release of dopamine activates areas associated with reward, pleasure, motivation and attention. The experience is so stimulating that gambling can become a habit, which creates changes in how people process gambling cues. Someone with gambling disorder may be triggered to gamble just by thinking about or seeing money.</p>
<p>“Gambling creates those pathways, it creates those positive memories and it’s really hard to reprogram those memories,” said Daniel Kaufmann, Ph.D., L.M.H.C., director of gaming services and program development at virtual provider Kindbridge Behavioral Health.</p>
<p>Winning is not necessary to experience a rush of dopamine, Kaufmann added. Just believing a win is possible is enough for the brain to stay hopeful. “That hope is intoxicating,” Kaufmann said. “That’s what the addiction is, with gambling. It is a rewiring and manipulation of hope.”</p>
<p>The last national prevalence study that used a validated measure was published in 1999. That Congress-authorized <a href="https://www.norc.org/content/dam/norc-org/pdfs/GIBSFinalReportApril1999.pdf">study</a> found a past-year prevalence rate of 1.3% when combining those with gambling disorder and problem gamblers. That equaled over 2.5 million adults at the time. The combined lifetime prevalence rate was 2.7%, equal to 5.5 million adults. Fifteen million were estimated to be at-risk gamblers.</p>
<p>Though NCPG uses that research as the basis for its own present-day estimates, researchers caution that these are not reliable and surely an undercount. </p>
<p>"You can't update prevalence figures. You have to do a new study with a representative sample,” explained Lia Nower, Ph.D., director of Rutgers University’s Center for Gambling Studies who has served on NCPG committees and its board. </p>
<p>“We are failing the people of America,” responsible gambling lobbyist Brianne Doura-Schawohl said. “We truthfully have what I believe likely are very conservative estimates, and even those conservative estimates are very shocking.”</p>
<p>Whatever today’s true prevalence, a fraction of cases actually show up in clinical settings, Fierce Healthcare has found. Most providers are not screening for problem gambling, much less diagnosing gambling disorder. Claims data reflect this.</p>
<p>Komodo Health, a health analytics AI company with insight into 330 million de-identified patient journeys, analyzed its medical and pharmacy claims data across Medicare, Medicaid and commercial payers on behalf of Fierce Healthcare. The analysis, conducted using Komodo’s Marmot AI tool, looked at clinical diagnoses of gambling disorder from 2016 to 2024. </p>
<p>Though diagnosed cases increased by 47% during the period, they only amounted to 5.85 per 100,000 patients in 2024. That amounts to .006%. </p>
<p>“We are seeing a significantly lower rate compared to what we see in the literature,” Tabby Khan, M.D., M.P.H., senior director of analytics at Komodo, said. </p>
<p>There are several possible reasons for this discrepancy, with the crucial caveat that these data are not prevalence indicators. Mental health in general is under-captured in claims data, per Khan. Even when someone has gambling disorder, they may not seek formal treatment. And it’s possible that even if a diagnosis for gambling disorder was made, a provider didn’t know how to code it. </p>
<p>“This is a disease that we know impacts a lot of Americans. Why is it not part of this enhanced screening as part of primary care?” Khan said. Only 15% of Americans report ever being asked about their gambling behavior by a primary care provider, a recent NCPG<a href="https://www.ncpgambling.org/news/survey-finds-widespread-gambling-participation-before-age-21/"> survey </a>found. </p>
<p>“The problem is no one is catching this. No one is screening for this,” said Daniel Umfleet, founder and CEO of Kindbridge Behavioral Health.</p>
<p>Treatment for gambling disorder can range from cognitive behavioral therapy to motivational interviewing to peer support, or a combination. It may take place at outpatient, inpatient or residential programs. There is no FDA-approved drug for the condition, though opioid antagonists like naltrexone may help some patients.</p>
<p>Comorbidities appeared frequently in Komodo data, based on gambling disorder patients with at least one claim for a given condition during the period analyzed. Nearly 70% had anxiety disorders and 50% had major depression. Additionally, 42% had stress or adjustment disorders and 27% had bipolar disorder. </p>
<p>When it came to substance use, 36% had nicotine dependence; 31% had alcohol use disorders; 19% had cannabis use disorders and 14% had opioid use disorders. This reflects existing research that gambling disorder often co-occurs alongside other mental health conditions. </p>
<p>Indeed, Kindbridge sees comorbidities often. In patients who share their bank statements, providers spot spending habits that quickly add up: sports bets, video game transactions, subscriptions, Amazon purchases. “There’s a lot of mindless spending going on and people are not quantifying the amount they’re spending on these things,” Umfleet noted, “and that’s creating a lot of depression, anxiety and stress.”</p>
<p>Because other conditions like anxiety have significantly higher screening rates and more established treatment pathways, they are often recorded as one’s primary diagnosis instead of gambling disorder. “Gambling addiction is incredibly stigmatized and misunderstood,” NCPG’s Director of Public Affairs Cait Huble said. Substance use disorder treatment has over 300 times the public funding, she added, “so it’s just a really ignored issue.” </p>
<p>Payer executives say gambling addiction is not on their radar, Kevin Winters, co-founder and CEO of problem gambling support app Almond Digital Health, said. “There’s a comorbidity there that isn’t bubbling to the surface,” Winters said. “It ties back to the under-coding or miscoding of the issue.”</p>
<p>Gambling disorder is also excluded from the Americans with Disabilities Act, meaning there is no protection from employer discrimination based on the condition. This may discourage people from seeking a diagnosis. “People don’t often want to trust their employer with the knowledge that they’re gambling,” Winters said. “We’re finding a bigger increase in usage when [Almond is] referred to an individual through their trade union than through their employer.” Most users on Almond sign up anonymously.</p>
<p>Sciandra isn’t sure exactly how much money he spent playing, but he put himself in enough debt to declare bankruptcy twice. But more important for Sciandra is the time and energy he wasted that could’ve been spent trying to “be a better father, be a better husband, be a better Christian.” He believes gambling, and the lies he told to cover it up, contributed to the end of his marriage. </p>
<h3>Proliferating risk as legalization expands </h3>
<p>In 2018, the Supreme Court allowed each state to determine if they want to legalize sports betting. The “monumental decision” led to a flurry of legalization, Doura-Schawohl, the lobbyist, said. Today, 37 states, plus Washington, D.C., allow sports betting, according to the American Gaming Association. Additionally, 32 states and D.C. allow online sports betting, with Wisconsin legalizing just last week.</p>
<p>“Americans went in 2018 from having very limited options for sports betting to having it anytime, anywhere—it’s yours,” Doura-Schawohl said. “There are real implications to health and wellness when you put an addictive product on the most addictive device.” Research has <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4903302">found</a> that ease of access to sports gambling, particularly online, leads to increased levels of excessive debt.</p>
<p>“Everyone was interested in the gold rush, and nobody was interested in the downside,” Kindbridge Behavioral Health’s Umfleet echoed. </p>
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<img src="https://qtxasset.com/quartz/qcloud5/styles/half_body_width/s3/media/image/casino%20resized%201.jpg?VersionId=EWPCbr6DFBpciRMSUX7o2mUkV_nZLhu6&itok=pj-CZltU">
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Las Vegas casino
(Paige Minemyer)
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<p>Only eight states have legalized iGaming so far, though this is projected to grow. Those who gamble on smartphone apps are more likely to experience problem gambling, research shows. Experts liken it to putting a casino in your pocket. Apps also have a low barrier to entry, and how young someone is when they start gambling matters for risk. Gambling as a minor, like Sciandra did, is strongly correlated with the likelihood of being in a risk group. </p>
<p>Video games are another burgeoning concern for targeting youth and using well-documented predatory tactics to encourage overspending. Loot boxes, or virtual lotteries for in-game items, were <a href="https://www.juniperresearch.com/press/video-game-loot-boxes-to-generate-over-20-billion/">projected</a> to generate $20 billion for the industry in 2025. Paid loot boxes are banned in Belgium, where the Gaming Commission determined them to be “highly problematic” for exposing players, including kids, to gambling. While video gaming addiction is not yet an official diagnosis, the DSM-5 listed internet gaming disorder under Conditions for Further Study.</p>
<p>The more you gamble, the more likely you are to develop a problem. Data <a href="https://naadgs.org/wp-content/uploads/2022/06/NAADGS_2021_Survey_of_Publicly_Funded_Problem_Gambling_Services_in_the_United_States_v2.pdf">indicate</a> that as legal gambling expands, so does the number of people seeking help. </p>
<p>“It’s a very simple additive algorithm,” said Nower, with Rutgers University’s Center for Gambling Studies, who also is associate dean for research at the Rutgers School of Social Work.</p>
<p>New Jersey, which led the charge to legalize sports betting in the first place, is one of the few states that allows it all: casino gambling, sports betting, mobile sports betting and iGaming. Its overall rate of high-risk problem gambling, which best correlates to gambling disorder, is 6%, a 2023 study Nower worked on found. Among adults ages 18 to 24, that jumps to a whopping 19%.</p>
<p>The risks also apply to prediction markets, some believe. “Functionally, it is gambling,” NCPG’s Director of Government Relations Cole Wogoman said. “Our chapters are seeing folks on the ground that develop problems to prediction markets the exact same way they do with traditional sportsbooks.” </p>
<p>Prediction markets activity “carries substantially similar levels of risk to the consumer as traditional sports betting, including risks associated with chasing losses, impulsive behavior, financial harm and the development or escalation of gambling-related harm,” Huble added. “NCPG believes that all operators offering gambling-like products should take meaningful, visible steps to reduce harm and promote access to help resources as a public health best practice.”</p>
<p>Experts say coordinating a response to problem gambling is difficult because there is no cross-industry visibility into problem indicators. Banks can track transaction activity; providers can treat patients; gambling operators can focus on point-of-play behavior. But a holistic view of financial warning signs and clinical context doesn’t exist, making prevention difficult. Even when warning signs are there, the infrastructure to coordinate timely interventions is largely missing.</p>
<p>“We work in a space here where real-time data theoretically is available, any day, any night—but accessing that data is difficult,” noted Timothy Fong, M.D., professor of psychiatry and co-director of the Gambling Studies Program at the University of California, Los Angeles (UCLA). </p>
<p>Healthcare, finance and research stakeholders are starting to work together. “We're seeing people inside the gaming industry recognizing that there is harm,” Kaufmann said. The Financial Stability and Responsible Gambling Initiative is one cross-sector effort, coordinated by the Kindbridge Research Institute and UCLA, to prevent and intervene in gambling problems. The strategy borrows from Europe, where collaborative efforts are more mature. </p>
<p>“This is the first time in the space that we’ve ever actually had success in trying to corral public health strategy, gaming and gambling operations and banking operations into a single space,” Umfleet said. “The conversation just keeps getting a little bit more deep every time we connect.”</p>
<h3>Widespread underinvestment as states left to fill gaps</h3>
<p>Federal funding for gambling disorder has been all but nonexistent. Without resources, research is not feasible. That’s why there are fewer than two dozen researchers focused on gambling more than half their time in the entire country, per Fong. “Without federal support, it is incredibly difficult to do anything on a large scale to really get a good, clean picture of what’s happening nationally,” Fong said. “We can’t do research unless we get funding.”</p>
<p>Finally this year, a breakthrough: the Department of Defense received $370 million for its medical research program, which for the first time includes gambling disorder. Congress also recently introduced bipartisan legislation, the POINTS Act, that would redirect a portion of the existing federal excise tax on sports bets to gambling disorder resources. The bill is expected to generate $100 million annually for gambling services without creating any new taxes. </p>
<div>Every state needs more funding for gambling addiction.</div><div>Cole Wogoman, Director of Government Relations, NCPG</div>
<p>Prevention and treatment, like legalization, has thus far been up to states. And most states are doing the bare minimum. In 2023, states invested <a href="https://naadgs.org/wp-content/uploads/2024/06/2023-Budget-Update-of-Publicly-Funded-Problem-Gambling-Services-USA.pdf">$</a><a href="https://naadgs.org/wp-content/uploads/2024/06/2023-Budget-Update-of-Publicly-Funded-Problem-Gambling-Services-USA.pdf">134 million</a> in problem gambling services despite reeling in <a href="https://www.americangaming.org/resources/state-of-the-states-2024/">$14.67 billion</a> in gaming tax revenue. That means for every dollar generated from commercial gaming, less than one cent was invested in prevention and treatment. Yet NCPG estimates that every dollar spent to prevent and treat gambling problems would save states at least $2 in social costs.</p>
<p>“Anyone who profits from gambling has the economic and ethical obligation to dedicate a portion of the revenue to mitigating harm,” NCPG’s Huble said.</p>
<p>Funding for gambling services is usually tied to gambling tax revenue, meaning getting more money to address the problem requires expanding opportunities for the problem in the first place. Some might call that a conflict of interest, but the alternative is riskier, NCPG’s Wogoman argues.</p>
<p>“If you don’t use a percentage of gambling revenue, then you might not be on par with problems as they expand,” Wogoman said. It’s also important to direct a portion of tax revenue to treatment before legalization happens. “It’s very rare that a state will go back and fix that, because the money is already accounted for,” Wogoman said. </p>
<p>Massachusetts, which allows everything but iGaming, by far invests the most in problem gambling services, putting up over $30 million in 2024. Of the states that had positive funding that year, 16 states <a href="https://naadgs.org/wp-content/uploads/2024/06/2023-Budget-Update-of-Publicly-Funded-Problem-Gambling-Services-USA.pdf">committed</a> $1 million or less, according to the National Association of Administrators for Disordered Gambling Services (NAADGS). Another 14 states hovered around or below the average state allocation of $3.6 million. Only nine states committed between $5 and $10 million. Problem gambling services may include helplines, awareness programs, problem gambling treatment, counselor training and prevention.</p>
<p>"States are all on different playing fields, but every state needs more funding for gambling addiction,” Wogoman said. </p>
<p>Like other states, Massachusetts has a regulatory body overseeing gambling. What’s unique is a legal mandate to ensure the appropriate safeguards are in place. The Massachusetts Gaming Commission has a responsible gaming division overseeing player health and an annual research agenda that has resulted in 90 published studies so far. </p>
<p>“We have to, at times, have hard conversations with the operators to get them where we need them,” Gaming Commission Chair Jordan Maynard said. “And then other times, they’re ahead of us on things and then we learn from them.” </p>
<p>The state’s problem gambling prevalence was <a href="https://massgaming.com/wp-content/uploads/Gambling-and-Problem-Gambling-in-Massachusetts-Results-of-a-Follow-Up-Population-Survey-Report-4.3.24.pdf">1.4%</a> in 2021, with an additional 8.5% of adults identified as engaging in risky gambling behavior. Treatment in the state is reimbursed by commercial payers and Medicaid, while the Department of Public Health funds the problem gambling helpline, workforce development, public awareness, screening and treatment resources.</p>
<p>Credit cards for sports betting are banned in Massachusetts. Some operators, like DraftKings and FanDuel, have taken that policy national. The idea is to add friction and give bettors a breaking point, Maynard said. It’s the same reason Massachusetts requires ATM machines to be at least 15 feet away from gaming areas. The state also prohibits operators from issuing credit to patrons who self-identify as problem gamblers, are on a self-exclusion list or are on public assistance. </p>
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<img src="https://qtxasset.com/quartz/qcloud5/styles/half_body_width/s3/media/image/casino%20resized%202.jpg?VersionId=rx2k__RskwI7WIx.c3PAkN3GJdp8jxCK&itok=yYrAsqwK">
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Las Vegas casino
(Paige Minemyer)
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<p>There is no national self-exclusion list, meaning players must fill out a different form for each state they want to be banned from betting in. It can be a helpful tool, but research has found that casinos don’t do a good enough job telling customers about the option. Still, self-exclusion has become a key resource in Massachusetts. Maynard has seen the number of people on the list grow. “We want voluntary self-exclusion to be there for the people who would find it to be a helpful resource,” Maynard said. </p>
<p>Many responsible gambling tools, like self-exclusion, require players to voluntarily opt in. Nower pointed to website cookies, which U.S. users are opted into by default and are given the option to opt out of. In the same way, limits should be the default: “You have to take the step to opt-out or change. I think that would protect an enormous amount of people going in,” Nower said.</p>
<h3>Provider constraints: Inconsistent training, screening challenges</h3>
<p>Nearly 20 million Americans reported experiencing at least one sign of problematic gambling behavior “many times” in 2024, according to an NCPG survey on gambling attitudes. But experiencing problem gambling is not the same as recognizing it. </p>
<p>Sciandra was on the severe end of the spectrum, meeting the criteria for gambling disorder. But until he sought help, he was convinced he was bipolar because of the highs he felt when he was gambling and the lows he felt when he was not. He also suffered from anxiety and depression. </p>
<p>“In the past, I had always thought that it was a mental health concern. Didn’t really think about the behavior as being addictive,” Sciandra recalled. When his gambling counselor recommended he avoid placing bets and see how he feels, Sciandra felt better. Suddenly, it made sense. “My mental health concerns really started to wane,” Sciandra said. </p>
<p>As with many things in healthcare, if you don’t ask, you won’t see it. Providers are not asking about financial hardship and are unaware of the scale of the problem. Many medical schools don’t go in-depth on addictions in general, let alone gambling. There is also no mandated national credentialing program for gambling providers. </p>
<p>IPGGC, the International Problem Gambling and Gaming Certification Organization, offers a voluntary certification for counselors. By its own count, it has only been taken by about 300 people globally. Some states require IPGGC’s certification, or have their own. As a result, a region may have dozens of trained providers, or only a handful. Some states, including Alabama and Idaho, appear to have none at all. </p>
<p>“You really do need to be trained if you’re going to be a competent provider of gambling treatment,” Nower said. </p>
<p>Rutgers offers 30 hours of training to prepare students for the IPGGC certification and has trained about 600 people to date. Kindbridge also offers courses to prepare people for the IPGGC certification. It is doing outreach to med schools and seeing strong demand. “We’re going to try like hell to educate as much as we possibly can,” Umfleet said. </p>
<p>Developing new education on gambling disorder is a priority for the American Society of Addiction Medicine (ASAM).</p>
<p>"The rise in people seeking help for gambling addiction is concerning, especially with easy access to sports gambling mobile apps,” Michael Fingerhood, M.D., chair of ASAM's Medical Education Council, told Fierce Healthcare in an email. </p>
<p>Given how diverse those affected are, Fingerhood added, “it makes it increasingly important to not only provide advanced training for addiction specialists, who may handle more complex cases, but also non-specialists who are increasingly likely to encounter patients with new onset gambling addiction in their day-to-day practice.” </p>
<p>Screening, when it is done, can present its own challenge given how stigmatized gambling is. Standardized tools exist to flag potential problems, like the BBGS and PGSI. Both explicitly refer to gambling. The problem is that using the term can scare people off. </p>
<p>“There is just this stigma associated with self-identifying as a gambler, so if you’re using that word, it’s going to be underreported,” IPGGC's Bechtold said. </p>
<p>In the early stages of gambling disorder when they are still mostly functional, bettors see gambling as a solution to their problem, explained Fong, with UCLA’s Gambling Studies Program. This is why he likens the condition to a silent cancer: not caught until it’s far along. By the time Fong gets a referral, patients are in a very acute state. One of Fong’s recent patients was a woman who spent over $600,000 on a social casino app. </p>
<p>“By the time they come to see me, it’s metastasized, it’s very severe,” Fong said. </p>
<p>At Rutgers, Nower helped develop an initial <a href="https://socialwork.rutgers.edu/sites/default/files/2022-05/nower_clinical_gambling_screen.pdf">screener</a> that is deployed before the BBGS and PGSI. Her questionnaire asks patients in a factual manner what activities they engaged in over the past year, from buying lottery tickets to betting on horse racing to playing daily fantasy sports. By the time the final screen, the PGSI, is introduced, patients have been gradually exposed to the idea that their behavior may be gambling. This leads to more honesty, per Nower, but most places do not have such a systematic screening protocol.</p>
<p>Stigma is particularly acute for military service members and veterans, who are at higher risk for gambling disorder. Though slots are banned from domestic bases, the military operates <a href="https://www.wired.com/story/us-military-on-base-slot-machines-gambling-addiction/?utm_brand=wired&utm_social-type=owned&utm_source=twitter&utm_medium=social&utm_campaign=aud-dev">over 1,800</a> of them overseas. There were 185 active-duty service members with a gambling-related diagnosis in FY24, according to a Government Accountability Office (GAO) <a href="https://www.gao.gov/assets/gao-25-107700.pdf">report</a>, a number that’s been growing for years. Gambling disorder in service members is typically secondary to issues like PTSD or drug or alcohol misuse, GAO found. Among veterans seeking treatment for gambling disorder, <a href="https://pubmed.ncbi.nlm.nih.gov/40987457/">over 40%</a> have attempted suicide. </p>
<p>A Colorado military base had to turn away a recruit because of how much debt they had, according to Umfleet. Kindbridge is embedded with half a dozen Colorado bases, with plans to expand to several more states. Kindbridge also works with TRICARE International, providing treatment for soldiers abroad. The partnership came about at the behest of an overseas base “because they’ve seen such an increase in this in overseas deployments,” Umfleet said.</p>
<h3>Tech augments a tenuous safety net </h3>
<p>Incoming traffic to the National Problem Gambling Helpline, run by NCPG, peaked last year at 54,606 calls, texts and chats. This doesn’t mean each inbound request resulted in care. Based on 24 states with the relevant data, 42% saw more people enrolled in treatment than called for help in 2021, according to <a href="https://naadgs.org/wp-content/uploads/2022/06/NAADGS_2021_Survey_of_Publicly_Funded_Problem_Gambling_Services_in_the_United_States_v2.pdf">NAADGS.</a> The national helpline is made up of 24 contact centers providing local resources and referrals to care across all 50 states, with inbounds routed based on a caller’s area code. </p>
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<img src="https://qtxasset.com/quartz/qcloud5/styles/full_body_width/s3/media/image/Incoming%20Traffic%20%281%29.png?VersionId=Eq9vEtVsKYTV0znnsJm_J8LnUSVhq2Zz&itok=c5ZfLljh">
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NCPG Helpline dashboard
(National Council on Problem Gambling)
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<p>California has by far the greatest incoming volume, followed by Texas. But while California funds no-cost inpatient and intensive outpatient treatment programs, as of late 2025, Texas remained one of seven states without any funding for problem gambling services, according to NCPG. In states that don’t fund treatment or have certified gambling counselors within a caller’s proximity, individuals may be referred to Gamblers Anonymous instead of professional treatment, per NAADGS.</p>
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NCPG Helpline dashboard
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<p>NCPG has long advocated for states to allow gambling operators to include the national helpline number 1-800-MY-RESET (previously 1-800-GAMBLER) in their ads. It’s a lot easier for people to remember one number, as opposed to state-specific ones. “Could you imagine if 911 changed numbers depending on which state you were in?” Huble said. “It just puts a big burden on the consumer.”</p>
<p>The national helpline offers referrals to treatment and support groups, guidance on self-exclusion and financial counseling. But without real investment in care, these resources can only go so far. When gamblers are in what’s known as a hot state, they need immediate triage. “We expect people to call a hotline and somehow end up cured. No, we’ve got to establish the transport system,” Nower said. “You have to have frameworks to move people.”</p>
<div>Gambling industry [regulators] in most countries actually ask their players to play without safety systems.</div><div>Rasmus Kjaergaard, CEO, Mindway AI</div>
<p>Gambling operators, which have incentive to keep customers healthy long-term, are establishing provider partnerships around responsible play resources and referrals to treatment. For instance, Birches Health, a virtual gambling addiction provider, is working with Penn Entertainment, while Kindbridge is working with online sportsbooks BetMGM and DraftKings.</p>
<p>Tech companies are also supporting gaming establishments. Denmark-based software company Mindway AI works with operators, including fantasy sports giant PrizePicks, to identify player risk based on transaction data. Mindway’s platform GameScanner reviews the actions of nearly 15 million players a month globally, tracking 13 risk indicators like loss chasing, cancelled withdrawals and payment methods. </p>
<p>Mindway’s algorithm was built alongside gambling addiction experts, researchers and psychologists, who analyzed several thousand player gambling patterns to train the model. GameScanner detects at least 87% of at-risk and problem gambling cases that human experts detect, the company claims.</p>
<p>“We do not want to provide software for this very sensitive matter that actually can go rogue by learning from itself,” Mindway AI CEO Rasmus Kjaergaard said. “You cannot yet rely on algorithms only.” </p>
<p>After GameScanner’s analysis, Mindway suggests interventions to operators. Depending on company policies and local laws, operators may choose to exclude a player or close their account altogether. Mindway is conducting research to understand what messaging and channels are most effective in terms of interventions. At-risk players are also referred to Kindbridge for treatment.</p>
<p>A separate Mindway tool, Gamalyze, draws on insights from neuroimaging to assess a player’s betting tendencies in a simulated online card game. The goal is to help players develop self-awareness of their strategy and sensitivity to wins and losses. It also offers individualized advice to reduce escalation of compulsive behavior. The game is integrated in DraftKings’ Responsible Gaming Center. </p>
<p>“We see ourselves as lane-keeping assistance,” Kjaergaard said. “We would never fly an airplane if we knew there were no safety systems, but gambling industry [regulators] in most countries actually ask their players to play without safety systems.” </p>
<p>Recognizing the inevitable influence of artificial intelligence, Massachusetts has an AI task force to understand AI in gaming and develop regulations accordingly. The Gaming Commission could, for instance, regulate how licensees should use the technology. Possible use cases identified by the state include detecting financial risk. “The algorithms can be trained for good, and that’s to help players that are having an issue,” Maynard said.</p>
<p>Tech can also be a powerful way to expand peer support, particularly important between treatment visits. CHESS Health makes a peer support and digital resource app that can be deployed by states, payers and providers. The app—originally built for substance use disorder—offers skills building tools, community engagement and crisis support. Peer recovery support specialists moderate discussion groups and virtual support meetings. In multiple studies, use of CHESS has been linked to increased adherence to treatment in substance use disorder patients.</p>
<p>“What we’re trying to serve is the gap between treatment visits, which is really when individuals have a return to use or in this case recurrence of problem gambling,” Hans Morefield, CEO of CHESS, said.</p>
<p>The app recently expanded into problem gambling through a contract in West Virginia. First Choice Services, the local helpline operator, developed the problem gambling-specific app content and curated the provider network. First Choice also moderates the problem gambling discussion forums and is alerted to anyone in distress.</p>
<p>“One of the things that differentiated CHESS from the other apps is our ability to monitor,” said Maricel Bernardo, program director of the Problem Gambling Help Network of West Virginia at First Choice. “Instead of waiting for them to contact the helpline, ... this allows us to reach out to them immediately, and for me that was a very important feature.” </p>
<p>Both the substance use and problem gambling versions of CHESS survey users weekly about whether they have relapsed and evaluates them on seven measures, including confidence in their recovery, supportive relationships and feelings of depression. Results get compared to a user’s baseline over time. Providers also get access to the app, which can integrate with electronic health records, while CHESS clients can see the data in aggregate to understand population patterns and identify valuable providers. North Carolina plans to roll out the problem gambling version of the app.</p>
<p>Almond Digital Health, whose clients include universities, gambling operators, employers and states, aims to help people build and maintain healthy gambling habits early on. The app, free to users, offers an initial screener, suggests a risk level and presents educational tools. Users can also connect with peers or be referred to local treatment. “It’s kind of a light-touch way to get people reflecting on their behavior for gambling,” Winters, Almond’s CEO, said. </p>
<p>The startup is currently working with Medicaid managed care plans to deploy its screener. This has been easier than with commercial payers because there are fewer Medicaid plans per state with less fragmented member cohorts. Once the effort establishes that there is an under-reporting problem, Winters explained, the hope is commercial payers will follow. Medicaid also has a more urgent, practical interest: “Managed care plans are the ones kind of incentivized to keep these complex mental health patients out of the high-cost primary care or downstream care venues.” </p>
<h3>A long road ahead </h3>
<p>At the national level, it’s difficult to definitively pin down the state of reimbursement for problem gambling services. This is likely tied to a state’s own level of investment, some suggest. “If the government’s not even paying [for] it, what incentive is there for private insurers to pay?” NCPG’s Huble said. </p>
<p>In a statement, a spokesperson for payer trade group AHIP said, “Health plans are deeply committed to expanding access to affordable, effective behavioral health care.” Many commercial plans recognize treatment for gambling disorder as a behavioral health service, the spokesperson said, and “plans determine which medical necessity or appropriateness criteria to use when evaluating treatment options.” When coverage is offered, treatment is “available in accordance with mental health parity rules.” </p>
<p>Last summer, the New York Senate introduced <a href="https://www.nysenate.gov/newsroom/press-releases/2025/joseph-p-addabbo-jr/addabbo-introduces-bill-mandate-insurance-coverage">a bill</a> that would require insurers to cover outpatient problem gambling treatment. Currently, services offered through the state Office of Addiction Services and Supports are not reimbursed by most payers unless a substance use disorder is also diagnosed.</p>
<div>It is unlikely that protections are going to be legislatively forced.</div><div>Daniel Kaufmann, Director of Gaming Services & Program Development, Kindbridge Behavioral Health</div>
<p>At Northwell’s Zucker Hillside Hospital, which launched its gambling treatment program in 2025, services including individual and group therapy, psychiatry and family care are reimbursed by commercial and government payers. Northwell also has some funding available for under- or uninsured patients. </p>
<p>IPGGC’s Bechtold runs a group practice in Pennsylvania that accepts all commercial plans and Medicare for problem gambling services. She believes that since gambling disorder was recognized as an addiction in the DSM-5, reimbursement has improved. Kindbridge accepts insurance across 40 states, and Birches Health contracts with private payers and Medicaid.</p>
<p>When the Affordable Care Act (ACA) was finalized, full coverage for mental health and substance use disorder was guaranteed as one of the 10 essential health benefits. Gambling disorder was not explicitly listed. Advocates question whether it is legal to only cover substance use disorder and not gambling disorder, given it is also an addiction. The Centers for Medicare and Medicaid Services (CMS) did not respond to multiple requests for comment.</p>
<p>In 2024, Congressman Paul Tonko (D-NY) <a href="https://tonko.house.gov/news/documentsingle.aspx?DocumentID=4072">called</a> on the Department of Health and Human Services to clarify that gambling addiction should be covered under the ACA. It appears there was no response. Last year, Tonko also introduced a bill that would create nationwide consumer protections and standards for mobile sports betting. Tonko recently told <a href="https://www.theatlantic.com/magazine/2026/04/online-sports-betting-app-addiction/686061/?gift=66OeTwjwIWd7-zlTK2lFDi3Q8DuxbBUQfdARMQEcv-Y&utm_source=copy-link&utm_medium=social&utm_campaign=share">The Atlantic</a> he is under no illusions about the uphill battle ahead to try to get the bill passed, citing the sports betting industry’s powerful lobby. </p>
<p>Kaufmann of Kindbridge does not see regulators leading the way on responsible gambling efforts. “Because of the prioritization of freedom of choice in the cultural fabric of the United States, it is unlikely that protections are going to be legislatively forced,” Kaufmann said. “But the industry itself … [is] interested in the vision of these tools from companies like Kindbridge.”</p>
<p>“There has to be a cultural shift,” Nower said. “We are where cigarettes were in the 40s and alcohol was in the 50s.” Anyone who screens for substance use should also screen for gambling. “We have to get buy-in from the medical, mental health communities,” Nower said.</p>
<p>It took three decades to regulate tobacco, noted Doura-Schawohl, the lobbyist. “Until it hits the home of a lot of legislators, you very rarely see action on an issue,” Doura-Schawohl said. “We’re so blind to issues if it doesn’t impact us. It’s one of my biggest frustrations.”</p>
<p>Sciandra remains neutral on legal gambling. He’s not naive about the reality that it’s here to stay. “It’s 2026. I know that we’re not going to put away everything back into Pandora's box. I just want people to know about the resources available to help,” Sciandra said. “The big thing is just letting people know that there is help, that there is hope.”</p>
<p>To support a loved one, it's important to start a conversation in a non-stigmatizing way, Sciandra recommends. Problem gambling is not simply a bad habit. And it’s crucial to be persistent in compassion and concern.</p>
<p>“Your message might not resonate the first time, but just like … all the promotion out there around gambling, you hear it enough times, it becomes normalized,” Sciandra said.</p>
<p><em>If you or someone you know is struggling, contact 1-800-MY-RESET for the National Problem Gambling Helpline.</em></p>
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<p><em>Editor's Note: This story was updated to clarify a quote from Mindway's Kjaergaard. He meant gambling industry regulators, not the gambling industry, often ask players to play without safety systems.</em></p>
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<td><a href="https://www.fiercehealthcare.com/health-tech/webmd-ignite-rolls-out-program-help-providers-get-rural-health-transformation-efforts" style="font-family:Helvetica, sans-serif; letter-spacing:-1px;margin:0;padding:0 0 2px;font-weight: bold;font-size: 19px;line-height: 20px;color:#222;">WebMD launches 'shovel-ready' digital services for RHT program</a>
<div style="font-family:Helvetica, sans-serif; text-align:left;color:#999;font-size:11px;font-weight:bold;line-height:15px;">Apr 14th 2026, 13:45</div>
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<p><div class="col content" morss_own_score="5.523747560182173" morss_score="107.7232277421185">
<p>The federal government will begin doling out funds this fall to states and providers as part of the $50 billion Rural Health Transformation Program. But many organizations face challenges deploying digital health infrastructure fast enough to get programs off the ground by later this year.</p>
<p>WebMD Ignite launched a new program that provides a "shovel-ready" platform to help states, health systems and rural networks stand up patient engagement, prevention and access programs in just weeks, without requiring major system replacements or extensive IT investment. </p>
<p>The company's Health Education and Access for Rural Transformation (HEART) platform is built for statewide or multi-provider rollouts and pulls together education, risk assessment, outreach and navigation into a single front door for rural populations. It also includes AI-powered education tools and Centers for Medicare and Medicaid Services (CMS)-aligned reporting, according to WebMD Ignite executives.</p>
<p>The HEART platform is designed to help organizations get RHT programs off the ground quickly and demonstrate measurable progress.</p>
<p>The Rural Health Transformation Program fund, authorized last summer under the One Big Beautiful Bill Act, will <a href="https://www.fiercehealthcare.com/providers/cms-opens-state-applications-50b-rural-health-transformation-program">allocate $10 billion</a> annually between fiscal years 2026 and 2030. Half the money will be split evenly, with the remaining half distributed by CMS based on how well states' pitches met its goals of strengthening rural health prevention, standing up sustainable access, developing a rural workforce and introducing innovative care delivery and technology, as Dave Muoio <a href="https://www.fiercehealthcare.com/providers/cms-opens-state-applications-50b-rural-health-transformation-program">reported</a>.</p>
<p>The funding was intended to offset concerns about the <a href="https://www.kff.org/medicaid/a-closer-look-at-the-50-billion-rural-health-fund-in-the-new-reconciliation-law/">outsized fallout</a> anticipated in rural communities from OBBBA/H.R. 1, which is expected to slash Medicaid spending by nearly $1 trillion over a decade. The $50 billion in funding is designed to be used to expand access, modernize infrastructure, rebuild the workforce and develop care models. </p>
<p>CMS has made it clear that Rural Health Transformation funds can be used to support things like health IT, interoperability, telehealth and cybersecurity, but it cannot be used to fund new buildings or major technology equipment. There's a 10% cap on funding for direct and indirect administrative purposes, as well as percentage-based limitations around certain electronic health system replacements.</p>
<p>First-year funding awards range from $281 million (for Texas) to $147 million (for New Jersey).</p>
<p>"The average funding amount is about $200 million. If you look at some of the states, maybe they were spending half a million to $2 million in their rural populations that were funded by various state initiatives. This is a massive increase of dollars flowing into the states, and they have to deploy it quickly, and they have to deploy it in ways that can show impact and be immediately measurable," Ann Bilyew, EVP, Health and President of the Healthcare Solutions Group at WebMD Ignite, told Fierce Healthcare in an interview.</p>
<p>Even with federal dollars soon in hand, many rural healthcare organizations struggle with executing programs at scale due to a lack of tech infrastructure.</p>
<p>WebMD Ignite's HEART platform is designed to work without heavy IT lift or multi-year builds. The company designed a rapidly deployable solution that enables organizations to activate prevention programs, improve patient engagement and measure outcomes aligned with CMS accountability requirements. </p>
<p>WebMD is well known for offering medical and health information to consumers, and it launched the Ignite brand several years ago to develop tech solutions for providers and health plans.</p>
<p>"As more details about the five-year Rural Health Transformation Program started to come up last fall, we realized that it was very much in our sweet spot of engagement, education, activation and thinking about how to reach these harder-to-reach communities, and harder to reach for many reasons, including the obvious one of geographic dispersion. There's also trust barriers, language barriers and in some cases, access to communication infrastructure," Bilyew noted.</p>
<p>WebMD's patient education and engagement solutions are already used by hundreds of healthcare organizations nationwide, including more than 650 health systems and 80 health plans, supporting millions of patient education interactions each year, according to executives.</p>
<p>"When we looked at the CMS and how they had crafted the program, we realized it wasn't about big-time infrastructure. Only 10% of funds can be used for major software initiatives like electronic medical record (EMR) systems. It wasn't about building out physical infrastructure. It really was about creating new services, creating new access points and creating new communication streams or channels to reach people, inform them, educate them, and get them actively in the system and actively receiving care. That's exactly what we do," Bilyew said. "We figure out ways and strategies and channels to reach people, to give them the right information so that they can make good health decisions and get them engaged with health professionals. It's a perfect fit in terms of our capabilities."</p>
<p>WebMD Ignite's HEART platform brings together several of the company's capabilities – along with new features – into a unified program. It features a health hub that serves as a centralized entry point for prevention, education and care navigation across rural communities. </p>
<p>"The health hub delivers clinically validated, consumer-oriented content tailored to specific rural populations within a state—the languages, the tribal languages, the targeted high propensity disease states, those sorts of things tailored to a region's particular rural population. It's really focused on lower health literacy in some communities and limited access to specialists for even basic education, and it really gives patients a trusted source instead of relying on fragmented or low-quality information," Bilyew said.</p>
<p>On top of the health hub, WebMD Ignite layered a HealthAdvisor feature, which offers evidence-based health risk assessments that help identify prevention opportunities and connect individuals to appropriate care pathways.</p>
<p>"That enables individuals to assess their own health risks and get directed to appropriate resources in their community. It provides the ability for people to understand their own unique set of circumstances and understand what options are available for them to take a next step, such as schedule a telehealth appointment or sign up for a virtual course, and take a next action that's tailored to their particular set of circumstances," Bilyew noted.</p>
<p>WebMD Ignite also developed omnichannel engagement programs designed to reach rural populations in their preferred channel through digital outreach, community engagement and accessible print resources. The HEART platform also offers AI-powered interactive education tools that allow individuals to explore sensitive or complex health topics through conversational guidance.</p>
<p>"These are interactive AI-based avatar tools that people can access and ask questions about anything that pertains to their particular health status. We're doing some beta tests with some nationally known institutions across the country and what we're finding is that people really enjoy engaging with the AI-based tools because they don't feel judged," Bilyew said.</p>
<p>WebMD Ignite also tracks engagement to help organizations assess progress.</p>
<p>"We track how many people are coming to the site, accessing educational materials, taking a health risk assessment, booking an appointment as a result of the engagement, using one of the self-guided AI education tools. We track who we're reaching, and who's engaging, and who's taking action as a result of the engagement," she said.</p>
<p>She added, "What the HEART program is meant to do is reach out to these communities and get them access to healthcare professionals, either virtually or in-person or get them signed up for remote patient monitoring, whatever it might be that's the right answer for them. An organization or a community or a state could stand up the best telehealth or remote patient monitoring programs and can send out mobile health vans, but if people don't know that those resources exist, if you don't engage them and get them to take that first step, it doesn't matter."</p>
<p>The platform also offers outcome dashboards aligned to CMS reporting requirements, enabling states and providers to measure engagement, prevention activity and care-seeking behavior.</p>
<p>WebMD Ignite designed the HEART platform to require a low technical lift, allowing integration with existing systems through APIs, FHIR connectors or standalone digital hubs. And it's designed for long-term sustainability, with a cost model designed to support continued operation after federal funding cycles conclude, company executives said.</p>
<p>"Our goal is to help organizations move quickly from funding to transformation,” said Bilyew. “States and providers need solutions that are proven, measurable, and ready to deploy today—not multi-year technology projects.”</p>
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<p><strong>Forwarded by:<br />
Michael Reeder LCPC<br />
Baltimore, MD</strong></p>
<p><strong>This information is taken from free public RSS feeds published by each organization for the purpose of public distribution. Readers are linked back to the article content on each organization's website. This email is an unaffiliated unofficial redistribution of this freely provided content from the publishers. </strong></p>
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