The Medical Minute: More than a bet: Know the signs of online gambling addiction
August started gambling when she was just 21. Back then, she says, “It was always just for fun.”
But in 2015, a casino opened near her job. Juggling work stress and anxiety, the casino became “a place to hide from the world.” Credit card companies kept raising her limits, and soon her wins and losses devolved into a vicious cycle: make bets, lose money, pay down cards, wait for a paycheck. Rinse, repeat.
“You don’t cash out when you hit the jackpot,” says August, a New Cumberland resident who asked that her real name not be used, “because your brain is messed up. You constantly think that you’re going to get the bigger one. Everybody always tells you to have hope, but that’s not a good thing in gambling.”
She eventually lost her house, drained her 401(k) and filed for bankruptcy.
When online gambling arrived in Pennsylvania, her last guardrails – the drive to the casino, the chance someone might notice she wasn’t home – disappeared.
“When gambling comes into your home, you can do it on your phone anytime,” she says.
A Growing Problem in Pennsylvania
Pennsylvania legalized online gambling in 2017. Sports betting launched two years later, followed by online casino games in July 2019.
Growth has been staggering. iGaming revenue jumped from $241 million to $897 million between 2020 and 2021 as the pandemic pushed people online. By 2022, 11% of Pennsylvania adults reported gambling online.
The state now ranks among those with the highest rates of gambling problems. Up to 6.4% of adults are classified as current problem gamblers, while nearly 30% fall into at-risk categories. Sports betting tax revenue is expected to hit $1 billion this year.
“You can’t even sit down to watch a TV show without one or two online sports betting ads popping up,” says Autumn Cessna Rothman, a counselor at Penn State Health Psychiatry and Behavioral Health’s Advancement in Recovery program.
Rothman notes young men are especially vulnerable to sports betting addiction because it taps into existing interests like fantasy sports and gaming. But she is also seeing more women like August, in their 40s and 50s, seeking help, a pattern researchers are studying for potential links to menopause and hormonal changes.
If you or a loved one recognizes the signs of gambling addiction, call 1-800-GAMBLER.
Why is It So Addictive?
Gambling disorder is a process addiction, not a chemical one, explains Elizabeth Ward, clinical manager of the Advancement in Recovery program.
“You’re still getting that dopamine hit, just like from marathon running or extreme sports,” Ward says. “But there isn’t a medication that fills that void the way some treatments can help manage drug or alcohol addiction.”
What drives someone to keep playing isn’t winning – it’s the chase.
“They’re always trying to get that same high from hitting,” Rothman says, “whether it’s a small amount, a large amount, getting a payday or getting extra credits for spins.”
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Recognizing the Risks and Signs
Risk factors for gambling addiction include a family history of addiction, impulsivity, depression, anxiety and loneliness. “Gambling mostly centers around trying to fill some sort of need or void,” Rothman says.
Sports betting is particularly insidious because it blends into social activities. “People think, ‘I’m doing it with six friends I go bowling with, and it’s only a $10 buy-in. That’s nothing,’” Rothman explains.
“If you’re a problem gambler, you have no control,” Rothman says. “The behavior turns into lying to family about money or where they’ve been, hiding money, or being restless and irritable when they can’t gamble.”
For August, the breaking point came after she maxed out her mother’s credit cards. During a session meant to work out a repayment plan, a counselor warned the arrangement sounded like elder abuse. Terrified and panicked, August attempted suicide and spent three days unconscious in a hospital.
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Breaking the Cycle
During outpatient care, August learned Penn State Health’s Advancement in Recovery program had launched a specialized gambling addiction treatment service in August 2026.
Rothman helps patients like August map the pathways that led to gambling and work on closing the door to each one. Patients also keep “feelings journals” and rediscover activities they enjoyed before the addiction that provide healthy rewards.
With Rothman’s guidance, August uses an app that blocks gambling sites while learning to recognize her triggers. After years of feeling helpless, she’s finally receiving help for the addiction that cost her so much.
Asked what she’d tell someone considering their first bet, August doesn’t hesitate. “I would say just stay away,” she says. “Don’t do it.”
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