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As it stands, the National Institutes of Health has agencies dedicated to problem alcohol use and drug use, but there are no official efforts aimed at problem gambling, and there are no federal regulations against advertisements for sports betting, said social worker Lia Nower, JD, PhD, director of the Center for Gambling Studies at Rutgers University in New Jersey. That means kids can see ads, often featuring their sports heroes promoting gambling, at any time of day or night. "It’s the wild, wild west with regard to gambling," Nower said.

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Vulnerability is high in people with low incomes who have more to gain with a big win, added psychologist Shane Kraus, PhD, director of the Behavioral Addictions Lab at the University of Nevada, Las Vegas. Young people, especially boys and men, are another susceptible group. Up to 5% of adolescents and young adults who gamble develop a disorder. And men outnumber women at a ratio of about 2 to 1 among people with gambling addictions, although there are a growing number of women with the disorder.

As evidence accumulates, it is important to examine the risks without overreacting before the data are in, said Marc Potenza, PhD, MD, director of Yale University’s Center of Excellence in Gambling Research. When casinos enter a region, he said, the area may experience a transient bump in gambling problems followed by a return to normal. Given how quickly gambling is evolving with digital technologies, only time will tell what their impact will be. "We don’t want to be overly sensationalistic, but we do wish to be proactive in understanding and addressing possible consequences of legalized gambling expansion," he said.

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Illinois surpassed $2 billion in tax revenue last year from all types of gambling and the state lottery – a record bolstered by continued growth in video gambling, sports betting and the opening of several new casinos.

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Gambling.com remains bullish, citing internal data that show growth of 30% last year without the additional states. North american online casino revenue grew to $60 million from $7 million between 2021 and 2023, according to the company.

In March, Gambling.com reported full-year 2023 results. Revenue increased to $108.7 million, or 42% higher than 2022. Net income rose to $18.3 million from $2.4 million, while earnings before interest, taxes, depreciation and amortization (EBITDA) grew to $36.7 million from $24.1 million.