Twenty million people in the U.S. reported at least one problematic gambling behavior in the last year. Thirty-nine states and DC have legalized sports betting. And 28% of adults are now gambling daily online.
Those numbers come from the National Council on Problem Gambling and Birches Health. They are not projections. They describe what is happening right now.
Most treatment centers have no program for it.
The Demand Is Already Here
Andrew DiGiacomo, SVP of Strategy at Birches Health, said it plainly in a recent Behavioral Health Business podcast: the treatment infrastructure is already falling behind. The speed at which online gambling has expanded is outpacing everything the industry built to respond to it.
It is not just adults. Rebecca Schechter, a senior advisor at McKinsey who has worked on the payer side, noted that gambling is now the highest-growth problem behavior schools are tracking for middle schoolers in Massachusetts, after the state expanded gambling access. Middle schoolers.
That is the pipeline. The clients coming through your door in five years are already being shaped by the environment they are growing up in today. If your facility cannot treat gambling disorder, you will not be equipped to serve them.
The Clinical Model Is Different. Build Yours Now.
A common reason treatment operators have not moved on gambling is that it does not fit neatly into existing clinical infrastructure. Gambling disorder does not require detox. There is no medication-assisted treatment protocol. The clinical path looks different from what most residential and IOP programs are built around.
DiGiacomo described the current state as a bit of a Wild West. The clinical model is still being defined across the industry.
That is the window. The centers that build their approach now, before standards get set, will have a head start that is very difficult to close. The ones that wait will spend years trying to match what the early movers already know how to do. Investors have noticed: one gambling-focused provider raised $20 million this year specifically to build out the clinical model and grow the provider population.
There is also a workforce gap. Schechter and DiGiacomo both noted a shortage of clinicians specialized in gambling disorder, the same pattern the industry saw in substance use treatment coming out of COVID. Demand accelerated before the clinical workforce could catch up. That is exactly where gambling addiction sits right now.
Payers Are Already Running the Numbers
Schechter laid out how insurers evaluate emerging specialized programs. They look at four things: whether the clinical model is valid, whether outcomes are actually measured, whether the program reduces the cost of care, and whether it can scale.
This matters for operators because payer interest follows clinical credibility. A gambling disorder program without measurement infrastructure will not get payer buy-in. One built with outcomes tracking from the start speaks the language insurers need to hear before they write a contract.
Payers are already asking about this space. The treatment centers that can answer those four questions with data will get referrals. The ones that cannot will watch them go elsewhere.
What to Do Before This Gets Expensive
You do not need to build a full gambling disorder program tomorrow. But there are things you can start now that will matter later:
- Find out if your intake process captures gambling behavior at all. Most standard intake forms do not ask. That means you are missing co-occurring gambling disorder in clients presenting for substance use, every time.
- Talk to your clinical team about what a gambling disorder track would require. The model is still forming, which means your clinicians have input into how it gets built. That opportunity closes once the field standardizes.
- Identify one or two clinicians interested in specialized training. The workforce gap is real, but it is also a chance to develop internal expertise before the market drives up the cost of finding it externally.
- Start tracking outcomes for any gambling-adjacent presenting issues, even informally. Measurement is what payers ask for first, and the baseline takes time to build.
The Gap Is the Point
Treatment infrastructure has always lagged behind the addiction it is meant to treat. It lagged behind opioids. It lagged behind meth. It lagged behind fentanyl. Each time, the centers that moved early built census, referral networks, and clinical reputations that the late movers spent years trying to replicate.
Gambling addiction is at that same point now. The demand exists. The clinical path is open. The payer interest is building. The workforce is short.
This is not a trend to monitor. It is a decision to make.
