Between 2018 and 2021, three major events transformed gambling in the United States: the expansion of legal sports betting, increased internet gambling, and the COVID-19 pandemic. These changes led to a rise in problematic gambling behavior, with the pandemic showing the most significant impact.

Key findings show that prohibition is ineffective at reducing gambling problems, especially with easy internet access. Instead, focus should be on prevention, awareness, and treatment programs, combined with proper regulation of legal gambling operations.

Risk factors for problematic gambling include:

• Young age
• Participation in multiple gambling activities
• Sports and fantasy sports betting
• Poor gambling literacy
• Misconceptions about gambling as a money-making method

Young adults represent the highest-risk demographic, showing both increased problematic play and misconceptions about gambling mechanics and recovery possibilities.

Important recommendations:

• Develop collaborative efforts between gambling experts and communications professionals
• Include investment activity screening in gambling treatment programs
• Strengthen partnerships between problem gambling specialists and investment professionals
• Utilize lottery networks for prevention and awareness campaigns, as 90% of gamblers play the lottery

The comparison between 2018 and 2021 NGAGE studies reveals significant changes in American gambling patterns, requiring updated public policy approaches. This demands collaboration between:

• Government bodies
• Gambling and gaming industries
• Non-governmental service providers
• Researchers
• Related industries
• Recovery communities

Problem gambling affects all demographic groups and requires recognition as a serious public health issue rather than a personal moral failing. A comprehensive solution must involve multiple stakeholders, including government, industry, healthcare, legal, educational, and financial sectors.

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