Amid the clanging slot machines and flashing lights of a Massachusetts casino, state workers attempt something that might seem contradictory: promoting moderation and financial discipline inside a gambling facility.
These employees, wearing distinctive green polo shirts, staff a small office just off the main gaming floor at MGM Springfield. Above them, a sign reads “GameSense”—Massachusetts’ signature program aimed at curbing problem gambling.
A digital display cycles through messages like “Keep sports betting fun. Set a budget and stick to it.” Workers hand out promotional items—luggage tags and travel tissues—hoping to start conversations with patrons. When successful, they provide brochures featuring the state’s gambling helpline and website, and can enroll customers in programs allowing them to set monthly spending limits.
Massachusetts’ Approach
Outside casino walls, GameSense appears on social media, sportsbook applications, and company websites. Meanwhile, the state’s Department of Public Health places its own moderation messages on buses and billboards.
“That represents significant progress over twelve years,” says Mark Vander Linden, who oversees GameSense for Massachusetts.
The state’s first casino opened in 2015. As the gaming industry expanded, Massachusetts developed what officials call a “responsible gaming” program, funded through a surtax on gambling industry profits.
Initially, regulators experimented with various strategies to educate customers about gambling’s addictive nature and financial risks. Early efforts focused on making informational brochures available explaining game odds.
Since then, Massachusetts has implemented additional regulations on the booming industry, which now includes widespread sports betting. Examples include: no betting on Massachusetts college teams, no gambling via credit card, and mandatory options for customers to set voluntary limits and add themselves to self-exclusion lists that ban them from casinos or sports betting for specified periods.
No National Framework
While some states have implemented similar limits to address problem gambling, others have enacted very few. Without a nationwide policy or national gambling commission to oversee the industry, each state creates its own approach.
An increasing number of addiction researchers and policymakers now argue it’s time for bolder, more unified action against gambling disorders. They point to the industry’s explosive growth since 2018, when the Supreme Court permitted states to legalize sports betting, unleashing an aggressive new sector now legal in 39 states. (Forty-eight states have legalized at least some gambling form, including lotteries.)
International Comparisons
Compared to the United States, several other nations have gone much further in regulating gambling. Some American experts view them as potential models.
Norway’s government, for instance, maintains a monopoly on all slot machines, allowing control over available game types. Every Norwegian gambler faces a monthly loss limit of approximately $2,000.
In the United Kingdom, there’s a roughly $7 limit on every slot machine spin, and gambling companies now face a 1% levy funding treatment and prevention of gambling disorders.
Earlier this year, a report published in the medical journal The Lancet urged international health leaders to act quickly on regulations before gambling disorders become widespread and common—making them much harder to address.
The Challenge in America
Policy leaders acknowledge that the United States has less appetite for corporate regulation than many other countries, particularly under the current administration. Simultaneously, they warn that inaction could pose serious public health threats, especially now that sports betting apps enable gambling anywhere, anytime.
Growing Concerns
Even before online gaming merged with smartphones, researchers estimated 1% to 2% of Americans already had gambling disorders, with another 8% at risk of developing them.
Some politicians fear the problem will worsen.
“The sophistication and complexity of betting has become staggering,” says U.S. Senator Richard Blumenthal of Connecticut. “That’s why we need protections enabling individuals to say no.”
Blumenthal has co-sponsored the SAFE Bet Act, legislation that would impose federal standards on sports betting companies. Proposed rules include:
- Banning gambling advertisements during live sporting events
- Mandatory “affordability checks” for high-spending customers
- Limits on “VIP” membership schemes
- Prohibition on AI tracking for marketing purposes
- Creation of a national self-exclusion database
“States lack the ability to protect their consumers from excessive and abusive offers, and sometimes misleading pitches,” Blumenthal explains. “They simply don’t have the resources or jurisdiction.”
Industry Opposition
The gambling industry strongly opposes the SAFE Bet Act. Federal standards would be a “slap in the face” to state regulators, according to an industry spokesperson.
“You have the potential to dramatically usurp states’ authority and then freeze the industry in place,” the representative argues.
Beyond “Responsible Gaming”
New regulations are also unnecessary, industry representatives maintain. They argue the sector acknowledges gambling’s addictive nature for some people, which is why it developed an outreach/awareness initiative called “responsible gaming.”
This includes messages on buses and billboards warning people to stop playing when it’s no longer enjoyable and reminding them that winning odds are very low.
Industry groups don’t collect data on whether these measures reduce addiction rates. However, they argue gambling restrictions would be counterproductive.
“If you suddenly start picking and choosing what can be legal or banned, you’re driving bettors out of the legal market and into the illegal market,” industry representatives claim.
The Public Health Perspective
Public health leaders counter that the industry’s “responsible gaming” model simply doesn’t work.
“You need regulation when the industry has shown an inability and unwillingness to police itself,” says Harry Levant, director of gambling policy for the Public Health Advocacy Institute at Northeastern University.
One reason the industry’s approach is “ethically and scientifically flawed” is that it places all blame and responsibility on individuals with gambling disorders, Levant explains.
“You can’t say to a person struggling with addiction, ‘well just don’t do that anymore,'” Levant notes.
Levant brings personal experience to the issue. A recovering gambling addict himself, he was convicted in 2015 for stealing clients’ money to fund his betting habit. Since then, he’s become both an advocate for stronger regulations and a trained addiction therapist.
While the gambling industry says it supports gambling disorder treatment and helps fund some referral and treatment services through state taxes, Levant calls this “the moral equivalent of Big Tobacco saying, ‘Let us do whatever we want with our cigarettes, as long as we pay for chemotherapy and hospice.'”
Instead, Levant advocates for a public health approach that prevents addiction from the outset. This means limiting marketing and controlling the types and frequency of gambling for everyone, not just those already in trouble.
The AI Threat
To illustrate his concerns, Levant displays a corporate video from a major betting company subsidiary. The video boasts about increasing gambling engagement through “micro-betting” during live games.
“We drive fan engagement by making every moment of every game a betting opportunity. Automatic, algorithmic, powered by machine learning and AI,” the voiceover proclaims.
This constant engagement promotes addiction, Levant argues.
Some of these gambling mechanisms would face limitations under the SAFE Bet Act, which Levant and his colleagues helped draft.
State-Level Action
If the legislation doesn’t pass through the regulation-averse Congress, then states need strong action on their own, Levant contends.
Massachusetts legislators are currently considering the Bettor Health Act, which would impose additional rules on sports betting companies.
“The goal isn’t to stop gambling entirely,” says State Representative Lindsay Sabadosa, a bill co-sponsor. “It’s to stop the worst excesses of online sports betting.”
The Massachusetts bill includes components of the federal legislation, such as mandatory “affordability checks” that would cap losses for some gamblers. These are modeled on a pilot program in the United Kingdom.
“If you’re only allowed two drinks, we know you’re not going to get drunk, right?” Sabadosa explains. “If you’re only allowed to gamble $100 daily because that’s an affordable amount, you’re not going to go broke. You’ll still be able to pay rent.”
The Bettor Health Act would also ban “prop” bets—wagers placed during live games, like who makes the first shot in basketball or who hits the first home run in baseball.
The Revenue Dilemma
However, state tax revenue from sports betting reached $2.2 billion in 2023—a welcome funding source for struggling state budgets. Because of this, some advocates fear state legislatures will avoid further regulation.
States may even be tempted by promises of additional revenues from new gambling types, such as “i-gaming”—online versions of roulette, blackjack, and other casino-style games, playable any time from home.
I-gaming is currently legal in only seven states, but pending legislation in others, including Massachusetts, could expand its markets.
“We have empathy for how hard it is for states to balance budgets in this current political environment,” Levant acknowledges, “but states are starting to recognize that the answer to that problem isn’t to further push a known addictive product.”
If you or someone you know is struggling with gambling addiction, help is available through the National Problem Gambling Helpline at 1-800-GAMBLER.
