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In the last couple of years, the world has become a kind of 24-hour casino. Anyone can place bets on anything at any time from the phone in their pocket. This shift hasn’t been gradual. It’s happened all at once. In the short time since a 2018 Supreme Court ruling took effect, roughly 38 states in the United States have legalized some kind of sports betting. At the same time, so-called predictive markets have taken off, with apps like Kalshi allowing regular people to place financial bets on everything from Venezuelan leader Nicolás Maduro’s capture, to Bad Bunny’s Super Bowl halftime opener, to Greenland’s fate, to whether it will snow in Salt Lake City this month.

That easy access spells trouble for many people. A recent investigation in Jama Internal Medicine showed that online searches for gambling addiction help have ballooned: They’re up 23 percent nationally since 2018. People in their 20s are the fastest growing group of gamblers, but many start as young as 12 years of age, often through online video games. Many journalism outlets now have partnerships with predictive markets or sports betting sites, at least some of whom report feeling pressured to normalize betting in their reporting. The more normal it seems, the more dangerous it becomes for at-risk groups, says Timothy Fong, addiction psychiatrist and co-director of the Gambling Studies Program at the University of California, Los Angeles.

I spoke to Fong about how the surge in online betting is reshaping gambling addiction and reality itself.

Has the nature of gambling disorder changed in the last few years, as betting on everything and anything has become more accessible?

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No one, frankly, could have predicted, pardon the pun, how exponentially different our world would become in just a matter of years. Two years ago, prediction markets were a niche thing, but it’s really exploded dramatically. I’m an addiction psychiatrist. And for the last 25 years, I’ve been in the business of helping people who call and say, “I have a problem with drugs, alcohol, gambling. It’s harmed my life. I need help.” And these were people who would go to brick-and-mortar casinos, maybe use a bookie here and there—you know, things like that.

But in the last four years, people began getting in trouble with online gambling apps. You can dress it up with different clothes and different makeup and different whatnot, but at the end of the day, what is it? It’s an experience where you’re putting something of value at risk, in this case money, on an event of uncertain outcome, in the hopes of winning a larger reward. Also knowing you can lose that. Any way you slice it, that’s gambling.

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They’ll say prediction is based on your own research, it’s a skill-based activity. These companies say, “We’re not gambling, we’re not gaming, we’re investing, we’re financial. We’re allowing the little guy to get in on making money off his or her knowledge about human events. You can invest in anything you want and potentially be rewarded for it.” But they don’t talk about the risk of losing your investment. And these markets aren’t regulated like casinos. The bottom line is, there’s no doubt every single day we’re starting to get more calls from men and women who are adversely impacted by these financially risky experiences.

Are your patients today different than a few years ago?

I saw a young man today, 19 years old, who has lost two years of his life with these various apps. A mixture of betting on sports, cryptocurrency stuff, meme and coin stuff, stocks, options, prediction markets. At the end of the day, this young man has spent over $180,000, and has tremendous guilt, shame, misery, emotional pain, financial damage. He’s literally not left campus in a year because he’s just been stuck on his phone and his laptop trying to play around with these financial apps. For him, the only reason he came to see me was that he spent everything. He told his parents, “I’m sorry, I don’t know what else to do.” And his parents said, “You need professional help. You’re gambling.” They googled gambling treatment, UCLA, they found me.

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Are the kinds of people who are susceptible to gambling disorders different now versus a few years ago?

In the 1980s, crack cocaine came onto the market, and it created a whole new generation and legions of folks addicted because it was a product that was much, much more potent and much stronger and much more addictive than cocaine. A similar thing has happened with gambling. The types of products that are out there now are way more addictive, faster, more potent, more accelerated. So for Generation X, if I wanted to invest in the stock market in the ’90s, I had to physically go into an office, wait, put an order in, write a physical check, and wait for that thing to happen. Then E*TRADE came along, and you could do it from your home. And everyone was like, “Oh this is so cool!” The problem is, we’ve accelerated two things: The speed at which you can make financial transactions combined with the addictive nature of some of these products that are expressly designed to get you to spend more money. It offers an incredible experience and lots of things to choose from. Super cheap to get into, powerful advertising, normalization of this behavior so that it’s seen as, “Oh, everybody’s doing it.” And if you don’t get in on it, you’re missing out.

Who’s most vulnerable?

The core is gonna be young people who aren’t fully formed adults. We know it’s people with untreated mental-health conditions that make emotional regulation difficult. So people with ADHD, major depression, bipolar disorder, active substance use disorder, people with head injuries. And we know disproportionately it’s gonna be people from lower socioeconomic classes and minority populations that are already behind the eight ball. But on the flip side, who comes into the clinic at UCLA? White guys, 18 to 24. That’s it. That’s all we see. The last 20 calls I’ve had for help were 18- to 24-year-old white guys with good families, who were highly educated, tech savvy, but had run into some trouble. I haven’t seen a single female in the last two years. At a conference two weeks ago, not a single audience member had a woman that showed up for help. But we know women are doing this. They’re just not coming in.

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How do you know women are gambling on the apps?

Because when I ask women in my world, “Are you gambling on sports?” They say, “Yeah.” And in the gambling industry, when we ask them how many users identify as women on your apps, they say 20-30 percent. Even the national surveys say that. I saw a really interesting ad for the predictive market Kalshi the other day. I wasn’t sure whether it was an ad or a social media influencer they were paying, but it was a female in pajamas on a couch. The idea was basically, “Hey, get into Kalshi. This could be your side gig. Get paid for your opinions.” It was couched as a job, as a safe work-from-home alternative.

So did you not used to see 18- to 24-year-old white men in your practice for gambling addiction?

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I think they’re trending younger. If you look at the profiles of people who call gambling helplines, compared to five or six years ago, there are definitely more younger men calling. But it’s a tricky profile. Is this a brand new population of gambling-disordered people we created from thin air? Yes and no. We’ve created an environment that’s driving these young men to seek help. We can’t say it’s affecting them more than say, older Black men in their 70s or something like that. But we’re definitely seeing that age group, which is very vulnerable to all kinds of addictions. This young man from today, if he doesn’t get into these apps, he doesn’t develop a gambling problem. He’s just a normal sophomore.

And are most of them coming to you having trouble with sports gambling, or all kinds of prediction market stuff?

It’s a mixture usually of five or six different apps, five or six different types of gambling. Sports tends to be number one followed by stocks and meme stocks and crypto. But the vast majority of what we’re seeing is betting on sports. And it’s not traditional sports betting, like my team versus your team. It’s very exotic types of bets on sports they know nothing about, like table tennis from Taiwan or Hungarian soccer leagues. Sports betting used to be about enjoying action and watching a game with friends. Now it’s essentially like a lottery. You’re just using random number generators and you’re hoping the numbers go your way.

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Read more: “Are Fantasy Sports Really Gambling?”

So they’re not betting on global events like, you know, Maduro’s capture in Venezuela, things like that?

That’s part of the problem. A lot of the gamblers that come in, that’s not kind of a standard thing that clinicians ask, because many clinicians don’t even know about it. I ask, and most of the clients I have are like, “That’s not really a thing yet for me.”

Does the normalization and pervasiveness of gambling change the kinds of neurological or psychological hooks that get people into it?

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It’s like other forms of addiction—cannabis, alcohol—when you normalize the activity, you decrease perception of harm. When you promote engagement, that’s when you get folks who are vulnerable or financially illiterate or just unaware, more likely to participate. We don’t see a lot of ads on TV about using cannabis. There are strict advertising laws against cannabis for anyone under 21. But when it comes to gaming, these markets, laws like this aren’t really enforced. Kalshi is gonna have an ad in the Super Bowl. I can’t think of a more publicly endorsed form of advertising than the Super Bowl. Then you have peer pressure, and you imagine what it does. This 19-year-old I saw today, he’s in a frat. I asked him, how many of the guys in your frat are betting on sports? He’s like, “110 percent plus the other 20 percent who are lying that they’re not.” So if he doesn’t bet on sports, he’s an outcast.

And people in their teens and early 20s are already more vulnerable to this kind of addiction?

Anyone whose brain isn’t fully grown is vulnerable when it comes to decision making. They’re vulnerable to impulsivity, understanding the biological urges of wanting something versus needing something: drugs, sexual images, financial reward, images of power, things that are associated with acquisition.

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I understand that in gambling disorder, what really hooks people, when it starts to become destructive, is after their first big win.

It’s similar to what happens with substances. If you don’t get a rewarding experience the first time you use cocaine or heroin, you’re probably not likely to do it again. But what also is super rewarding is the near win, or the almost win—the near miss. It’s been shown through some neuroscience imaging that this is as rewarding as actually winning, and almost even more reinforcing. It’s like, “Oh my gosh, I almost won. If I stick at it, eventually I’m going to win.” Which is why that game ParlayPlay is so attractive. It lets you place multiple bets at once, if you get all of them right, you can get a massive win, which creates the opportunity for a lot of near-misses. These are the powerful kinds of reinforcing mechanisms that we see.

So these betting sites are set up to use our specific psychological vulnerabilities against us?

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People in the casino and gambling industry have been doing this for years. No clocks, free drinks. They do this for engagement and retention. The betting apps also use tricks. They have algorithms that know what kind of bets you like, what kind of sports you like, what kinds of numbers draw you in. So when I log onto these apps, I notice that “Oh, wow, they already pre-made a bet for me. This is great. I don’t even have to do my own research.” It’s like, “Click here if you want in on it.” They have a lot of other tricks, reward systems, mini competitions, track your progress, refer a friend and get a nice jacket. So a lot of it is the standard stuff, but I’ve had a few behind-the-scenes talks with gambling operators, and they’re like, “You know what we get frustrated with? When people sign up, they deposit money, they make one bet, and then the next day they pull their money out. That’s the worst kind of customer.”

Prediction markets are different from sports betting because they’re dealing with real-world events. They claim to aggregate wisdom, the wisdom of crowds, to reveal truth. But does this end up becoming a self-referential loop? With reporting of the odds in turn influencing behavior, which amplifies the odds and so on? Particularly given the cozy relationships that exist and are developing between prediction markets and journalism outlets.

I think it goes back to again, what are these products? An investment or financial tool that’s meant to preserve wealth? A more accurate polling device? Financial tools that hedge against risks? Like if you run a restaurant and you bet on it closing, then you’re protected from, let’s say, a wildfire shutting it down. But I play around with these apps a lot, and all I know is that when I put money in a prediction market, really into sports, it feels exactly like gambling. I have an expectation I’m gonna get paid out. If it were a true investment, I wouldn’t get paid out for 10 years or 20 years like a CD or a six-month treasury. Right?

I think this whole wisdom of the crowd, that’s very useful for certain things. But is the crowd leading the money, or is the money leading the crowd? And it could be driven by insider trading by someone who had an agenda and you’re completely unaware of it, which ends up shaping how you think. I think that’s probably the scariest thing. Someone force-feeding you an idea so that they could benefit from the outcome of that idea.

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Just a few weeks ago, federal prosecutors charged over two dozen people in a college basketball scheme for fixing gains. And then there’s the Polymarket trader who placed the wager on Maduro and made $400,000. And the crazy rumors about Karoline Leavitt, Trump’s press secretary, ending her briefing early in response to a bet on one of the apps. What happens when the corruption and “fixing” extends beyond sports into global politics and everyday events?

You get more distrust in everything. People start believing that everything is rigged. There is a faceless, authoritarian figure or corporation behind every move. Alternative facts become the norm. And conspiracy theories dominate. And any sort of faith that you have in anything is eroded. Do we as humans need faith in order to sustain ourselves? Or can we live in an environment where literally everything we do is constantly questioned by everyone? I see profound distrust in institutions just getting worse, which, in turn, obviously impacts everyone’s mental health, because that creates more fear, anxiety, emotional pain, doubt, pessimism, and well, addiction. But in the patients that come in for addiction right now, it’s a very different story. They’re like, “I just know I could get back to even.”

I had a policy guy at a think tank say to me the other day, “I see no value in gambling ever.” And I said to him, “I see no value in alcohol as a product in the world. Humans don’t need alcohol to live.” And he’s like, “You’re right. I don’t see any value in that either.” So what do we do with things in our world that we know provide no immediate benefit to the survival of the species?

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Do existing frameworks for understanding and treating gambling disorders fit what’s emerging now? Or do you have to rewrite them given how quickly things are changing?

We have to evolve. Standard treatment protocols are about biological, psychological, and social treatments for addiction. A biological treatment is getting a good night’s sleep. It’s eating three meals a day. It’s physical movement. So that stuff is always there. We have certain medications for urges and cravings. No problem.

Psychologically, when it comes to the actual gambling, there’s a lot of cognitive distortions that fuel ongoing gambling addiction. In traditional gambling, it’s like, “Oh, I’ve lost 20 hands in a row at Blackjack, I’m due to win, therefore I should triple my bet.” Or: “You can’t lose on your birthday, so I’m gonna take a higher bankroll to the casino on my birthday.” But it’s a different set of distortions when it comes to online financial gambling. “The Bulls never beat the Knicks on Mondays.” So there’s some similarity, but there are also some different expectations, such as a lot of folks come in and tell me, “No, these things aren’t rigged, and I really believe I have a skill in picking stocks.” Or: “Everyone I see online is making money hand-over-fist, so it’s just a matter of time before I do, too.” And a lot of times people don’t view this stuff as gambling. They see gambling as slot machines.

The social treatment for addiction is things like 12-step support groups—Gamblers Anonymous, connecting with others, learning new skills. This is one of the hardest parts when you have generations now that are really struggling with loneliness. I say, “You need to go out, meet people, do stuff, get out there in real life,” and there’s this resistance. “No, I’m not doing that.” It’s fear of rejection. A lot of these young folks will not go to a GA meeting in person because they’re like, “That sounds so scary.” But they’ll do a GA meeting online. Or they’ll say, “I won’t go to church ‘cause church is full of pedophiles.” Or: “I won’t go get a job because why should I get a job? Because why should I stay for 10 hours making $150 bucks when I can gamble in two seconds and make a thousand dollars.” Even in fraternities, they’re like, “Why should we go out? It’s just too much of an effort.” So that social treatment is about finding real-life activities that are more meaningful. That’s what draws you away from the compulsion to gamble.

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If you have a full life and you’re super busy and you have a lot of interests, you’re probably not on your phone a thousand hours a day. But these people have very different views on real-world experiences. I’ve had a few who are really uncomfortable coming in to see me in person because they don’t know how to be in person with anybody. They’re only used to the digital world.

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How Gambling Addiction Is Changing in a Polymarket World