Gambling as a recreational activity continues to expand, driven by the constant availability of online platforms. Sports betting, casino-style games, and real-time micro-betting are now accessible on smartphones at any hour, turning what was once occasional into a continuous presence shaped by artificial intelligence, big data, and app designs that permit bets before, during, and after events.

Gambling disorder is recognized in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and is classified with substance-related and addictive disorders due to shared clinical features, brain mechanisms, comorbidities, and treatment approaches. Online formats amplify risk through intermittent reinforcement, near-misses, sensory cues, and instant rewards that engage dopamine pathways in ways comparable to certain drugs. Brains continue developing into the mid-20s; during this window, reward sensitivity is high while impulse control remains incomplete, making early exposure particularly consequential.

Offshore online gambling companies operating from jurisdictions with limited oversight have built models that prioritize access over safeguards. Age verification is frequently limited to a self-attestation checkbox. Minors commonly circumvent these measures with false birthdates, borrowed credentials, or VPNs, while cryptocurrency deposits reduce traceability. Regulated domestic operators typically employ stronger Know Your Customer processes, biometrics, facial recognition with liveness detection, geolocation, and periodic re-verification. The gap leaves many young people exposed.

Documented health consequences are substantial. Problem gambling rates among youth are several times higher than among adults. Studies link early online exposure to elevated lifetime addiction risk, anxiety, depression, sleep disruption, declining academic performance, and family financial strain. Gambling disorder carries one of the highest suicide risks among addictive disorders; meta-analyses show markedly elevated odds of suicidal ideation, attempts, and mortality. Comorbidity is the rule rather than the exception: Roughly four-fifths of individuals with gambling disorder also meet criteria for another mental disorder, with particularly high rates of substance-use, mood, and anxiety disorders. Emergency-department visits related to gambling have risen sharply in jurisdictions that expanded access, especially among males under 30, often accompanied by co-occurring substance use or suicidal thoughts. Families report discovering hidden accounts, depleted savings, eroded trust, and secondary physical effects of chronic stress such as insomnia, migraines, and blood-pressure changes. These patterns echo the early trajectory of the opioid crisis: rapid market growth, insufficient protections, and delayed recognition of population-level harm.

Government regulation can reduce these harms through clearer standards and stronger enforcement. Proposed measures such as California’s AB 2617 seek to prohibit platforms from offering real-money gambling or sports-style wagering to those under 21, restrict marketing directed at minors, and require robust age assurance rather than self-attestation. Effective age-verification systems should include government-issued identification, biometric checks with liveness detection, ongoing behavioral monitoring, and third-party verification services comparable to those used in banking. Payment-processor blocks, app-store removals, and coordinated cease-and-desist actions against offshore operators further limit access. The United Kingdom’s framework (mandatory identity verification before any deposit or real-money play, marketing restrictions, and meaningful penalties) provides a practical reference point.

Banking systems offer an additional lever. Existing rules under the Bank Secrecy Act and related regulations already require financial institutions to know their customers and to block or report certain unlawful transactions. Policymakers can strengthen these tools by mandating that banks and payment platforms flag and report gambling-related transactions linked to accounts of minors or known teenagers to their parents or legal guardians, while preserving appropriate privacy safeguards for adults. Such reporting would complement age-verification reforms, close the loophole of shared or borrowed adult accounts, and give families earlier warning before debts and behavioral problems escalate. Combined with school-based education, expanded counseling capacity, and self-exclusion registries, these measures create layered protection without eliminating adult recreational play.

The high-profile case of Thomas Goldstein, an attorney who cofounded SCOTUSblog, taught at leading law schools, and later faced a multi-count tax indictment connected to gambling-related financial activity, illustrates that vulnerability is not limited to adolescents. Cultural normalization, heavy advertising, and continuous mobile access have reduced stigma while increasing exposure.

DSM-5 criteria require at least four of the following behaviors within a 12-month period: preoccupation with gambling, need to gamble with increasing amounts, unsuccessful efforts to control or stop, restlessness or irritability when attempting to cut back, gambling to escape problems or relieve dysphoria, chasing losses, lying to conceal the extent of involvement, jeopardizing relationships or opportunities, and relying on others to relieve financial consequences. Primary-care physicians are well positioned to screen, particularly when patients present with depression, anxiety, or substance concerns. A family history of gambling problems further elevates risk.

Treatment centers on harm reduction, identification of the most damaging activities, psychotherapy, peer support such as Gamblers Anonymous, concurrent management of co-occurring mental-health conditions, and restoration of supportive relationships and daily structure. Recreational gambling that does not generate harmful consequences for the individual, family, or community remains a legitimate form of risk-taking. A simple practical test is whether gambling is improving or diminishing the overall quality of life.

Help is available through 1-800-GAMBLER and state self-exclusion programs that allow individuals to bar themselves from both land-based and online platforms. Stronger age-verification standards, accountable banking reporting for underage or teenage accounts, and consistent enforcement against offshore operators can limit preventable damage while preserving adult choice. Early, evidence-based regulation is the most reliable path to protecting developing brains and the families.

Regulators and advocates argue that this knowingly exposes teens, whose brains are highly reward-sensitive to addiction. This fuel calls for stronger federal action and supports watchdog efforts documenting harms.

Kayvan Haddadan is a physiatrist and pain management physician, and president and medical director of Advanced Pain Diagnostic & Solutions, a multidisciplinary pain management practice in California that he founded in 2012. A physician and surgeon licensed by the Medical Board of California, he is double board-certified in pain medicine and physical medicine and rehabilitation. He is also certified in controlled substance registration through the DEA and serves as a qualified medical examiner through California’s Department of Industrial Relations Division of Workers’ Compensation.

Dr. Haddadan earned his Bachelor of Science degree from the College of Alborz in Tehran, Iran, and his medical degree from Shahid Beheshti University of Medical Sciences. He later received his Educational Commission for Foreign Medical Graduates certification in Philadelphia, completed an internship in medical surgery at Loyola University Medical Center’s Stritch School of Medicine in Illinois, and finished his residency in physical medicine and rehabilitation at the same institution. He completed his fellowship in pain medicine at California Pacific Medical Center’s Pacific Pain Treatment Center and also trained in medical acupuncture for physicians at the University of California, Los Angeles David Geffen School of Medicine.

Dr. Haddadan has contributed to 29 research publications across multiple specialties, including pain management, cardiology, pulmonology, endocrinology, gastroenterology, and infectious disease. His work has examined topics such as hyperlipidemia in high cardiovascular risk patients, hyperuricemia and gout management, type 2 diabetes and hypertension, chronic obstructive pulmonary disease and asthma therapies, influenza treatment, irritable bowel syndrome, and opioid related complications in chronic pain care. His research has also included clinical outcome studies in spinal cord stimulation and award-winning presentations on neuropathic pain management and neuromuscular disorders.