Ever since casino gambling was legalized in Massachusetts more than a decade ago, government leaders and regulators have pledged to both support the industry and address the risks of gambling addiction. They say it’s a challenging balance that became even more intense after the U.S. Supreme Court legalized online sports betting in 2018.
NEPM’s Karen Brown has been following these efforts for years, and earlier this spring, she received a fellowship to look at two countries with very different models for gambling regulation – Norway and the United Kingdom.
This week, the first wave of her project is out on our website. It’s called “High Stakes: Gambling Addiction, Beyond Borders.” She spoke with NEPM’s Nirvani Williams.
Nirvani Williams: What does gambling addiction look like?
Karen Brown: Gambling addiction is a behavioral addiction. People have described it as being in a bubble or being in a prison, or where nothing else matters to you. And this inability to stop gambling, to stop chasing winnings or losses, has been described as leading to depression, to anxiety, to suicide, and of course, also to financial ruin – for some people.
And why did you choose to visit Norway and the UK?
I wanted to understand what other countries are doing to try and address gambling addiction. Norway is one of the most regulated countries in the world when it comes to gambling. There's a state monopoly. So the two main companies that oversee all gambling are owned by the government. And they say their main focus is essentially to prevent gambling harms. I should note there are no casinos in Norway, but there are plenty of slot machines in convenience shops. There's horse betting. Of course there's online gambling on people's phones. All the profits from the government run gambling go to charities, which is different than most countries, where the industry makes all the money.
And the UK is almost the opposite of Norway. Unlike one government monopoly, like they have in Norway, there are 2000 gambling companies in the UK, and while there is a national commission there that's meant to help prevent problem gambling, many say the industry is just simply too big to rein in at this point. But they are nevertheless putting in piecemeal regulations to try to do that.
So the question I had was, are there aspects of both of these countries, both of these models, that regulators in the United States can learn from, either as models or as cautionary tales?
And what are some of the specific things those countries have tried to bring down the rates of gambling addiction?
Well, as I said, Norway is very tightly controlled. So they set some mandatory limits on both online and in-person games. So every person in the country can only lose a maximum of about $2,000 a month, which, of course is not nothing. I mean, that's a lot every month to lose. But as one of my sources said, it acts as a sort of airbag. So the financial effects of compulsive gambling are not necessarily going to take your house or completely ruin your family's finances.
They also limit the kinds of games. So they make them slower, they have lower stakes the odds are different. There's fewer loud sounds. All of these are the kinds of ways that gambling targets the brain's dopamine reward systems. That's what the experts say. So Norway is trying to do the opposite.
And you said the UK has a less controlled approach?
Well, there are betting shops on almost every main street in every city, along with arcades and casinos in the big cities, and there's lots and lots of advertising for phone apps and for sports betting. So some of the health leaders I talked to, including many addiction specialists, they say the sheer availability of gambling is what's driving addiction.
But the National Commission says they are putting in some guardrails. They lowered the maximum stake on slot machines from 100 pounds a spin, which is what it used to be, to five pounds a spin. And it's a little bit different for young adults, younger people. They've also just enacted a tax, a levy, on every gambling company, which they're expecting will lead to 100 million pounds a year for independent research and prevention. That's considered major progress because up until now, many of the measures were voluntary efforts by the gambling companies.
And you talk about how the US has been dealing with big changes in the gambling landscape on a much shorter timeline than both Norway and the UK in your series. How does that affect what is likely to happen here?
So the U.S. Supreme Court legalized sports betting in 2018. That's less than ten years ago. So while several states, including Massachusetts and tribal communities, already had some forms of gambling, the industry really exploded in the last five, six, seven years. And now almost 40 states allow sports betting, but there are no national standards. So every state is on its own to come up with guidelines to protect players. And the industry lobbies in every one of those states to keep regulation at a minimum. So it's challenging.
And who’s trying to change that?
Nationally, there's a movement of public health leaders and lawmakers who are pushing for a federal law that would standardize the rules across the country. This legislation would also ban advertising during live sporting events. There would be no more VIP schemes which encourage extra gambling. It would restrict the way the industry tracks gamblers using AI as a way to get them to play more.
So what about taking action on a state level like in Massachusetts?
The Mass Gaming Commission says they're already using tools at their discretion. So they allow people to set their own gambling limits already or put themselves on a self exclusion list. But some legislators think there should be even more tools. So one bill, which is co-sponsored by state Rep Lindsay Cardoza of Western Mass. It would ban prop bets. So that's when you can gamble on the incremental things that happen in a game, like who's up first to bat?, or even what color outfit is the umpire wearing. And Sabato says giving people more and more ways to gamble like that is just encouraging dangerous, compulsive behavior. The legislation would also put in affordability checks, just like the federal law, because not everyone can afford to spend the same amount of money, she points out. I should note that that's actually something that has been pretty controversial in the United Kingdom, where they are piloting affordability checks.
And what does the industry think about all of these new efforts to slow down gambling?
Well, for the most part, they do not like it. They especially say there's no need to get the feds involved. Better to leave it to individual states to come up with their own rules. And they also claim that the more you regulate how people can play, how they can gamble, what they can play and gamble, even for their own protection, the more likely people are likely to turn to illegal companies, to the unregulated black market. But as state representative Sabadosa said, she does not buy that argument. She says there's no point really having a legal, regulated industry if you can't actually regulate it.
“High Stakes: Gambling Addiction, Beyond Borders” was funded by a grant from the Association of Health Care Journalists, with support from The Commonwealth Fund.
