The next major health epidemic in the U.S. will not come from a pathogen. This plague has a potential patient population in the tens of millions, limited effective treatments, and is not widely studied in the medical community.

I’m referring to sports gambling, an activity that deeply alarms me as a physician who specializes in addiction. Problem gambling can increase the incidence of depression and anxiety and can lead to bankruptcy, homelessness, or suicide.

My field has made immense strides in treating various substance use disorders thanks to years of research, new medications, and the full force of top medical institutions. In comparison, the rising risk of gambling disorder looks like a runaway train with little blocking the tracks.

The Supreme Court’s 2018 ruling to overturn sports gambling bans eliminated guardrails and created an environment that could fuel a major health crisis. That decision lowered the barrier to entry for a first-time bettor. With a few taps on a smartphone and a bank account, anyone can place a bet legally by reaching in their pocket. For people susceptible to addiction, that ease of access poses major problems. Also, the marketing campaigns for online sportsbooks are staggeringly ubiquitous and indiscriminate, with promotions so thinly veiled to encourage betting that they feel predatory.

But my greatest concerns come from what we don’t know yet. Public health initiatives to treat substance use disorder, or diabetes, or cancer start with answering basic questions. Who are the patients impacted? How many of them are there? What therapies are available? We simply don’t know these answers with excessive gambling.

The National Council on Problem Gambling estimates only 1 percent of adults in the U.S. meet the criteria for “a severe gambling problem.” I find that number dubious at best, as problem gambling lacks published studies in peer-reviewed medical journals relative to other diseases.

Some existing data suggest a much more widespread issue, particularly in young people. An anonymous poll of college-aged students found six in ten respondents had placed a sports wager, and 16 percent of that group engaged in high-risk behaviors like betting too much for their budget or betting daily.

Law enforcement in Iowa became so concerned with illegal gambling among college athletes there, it brought criminal charges against 35 athletes and staff in 2023. The Iowa Department of Criminal Investigations found a lack of oversight from sportsbooks and regulators led to a level of illicit gambling that was impossible to ignore, including bets placed at local high schools (the legal gambling age in Iowa is 21).

Attempts to rein in betting activity have largely focused on litigating against behavior that compromises the outcomes of games, such as when the University of Alabama’s head baseball coach provided a tip on his injured starting pitcher. A comparatively tiny amount of attention has been paid to actually identifying and treating problem gambling. Like other behavior-based addictions, excessive gambling stems from a complex medical condition that deserves more research and understanding.

Available resources today include the legally mandated 1-800 hotlines visible in all sportsbook advertisements. Patients who call can speak with mental health professionals who specialize in gambling disorder, but those of us who treat addiction every day know the importance of continuity of care and an ongoing rapport with our patients.

Cognitive behavioral therapy is a clinically validated, psychology-based treatment for anxiety and depression that has shown promise in treating gambling addiction. General CBT programs are widely available through psychologists at major health systems and clinics, but programs tailored specifically for gambling are harder to find.

The best treatment for addiction leverages a multi-layered approach that combines psychological therapy with proven medications, but the same interdisciplinary model does not exist in gambling addiction today.

Recent gains in treating substance use disorders have come from having more tools at our disposal, particularly from new pharmaceuticals. The FDA recently approved a non-addictive, opioid alternative painkiller, and we have saved millions of lives by prescribing suboxone and naltrexone for opioid and alcohol use disorders. Another potential avenue emerged from a study in the journal Addiction, which found GLP-1 receptor agonists for diabetes and obesity (Ozempic, Mounjaro) could also control addictive behaviors.

To avoid the same horror script that has played out with opioid use disorder, we need to establish a layered clinical treatment model for gambling addiction. Congress needs to pass legislation that awards grants for gambling addiction medication and research, such as the recently introduced Gambling Addiction, Recovery, Investment, and Treatment Act.

Most critically, we must protect young people from the harms of gambling addiction and limit their exposure. To do that, we need to curb the onslaught of sportsbook ads with another version of The Federal Cigarette Labeling and Advertising Act of 1966, which ended radio and TV ads for tobacco. Lawmakers must crack down on sportsbooks that do not enforce minimum age requirements as they are fueling a health crisis. The surgeon general recently advocated for warning labels on social media platforms to flag their addictive properties. The same logic should apply to gambling platforms.

Without these coordinated, purposeful actions to address gambling as a threat to public health, we will face yet another avoidable epidemic.

Safina Adatia is an addiction medicine physician.