College health professionals have a unique opportunity to help young people with gambling problems early on – before they progress into deeper, more difficult problems.

A national study of U.S. colleges and universities found that 75 percent of college students gambled during the past year, wagering on the lottery, card games, small-stakes gambling (such as office pools and raffles), and sports.

Many college students assume gambling is a risk-free activity; however, perception does not match reality. Research has shown that for a small segment of college students, gambling for fun can turn into a serious preoccupation that adversely affects their lives.While most college students who gamble do so responsibly, the most recent research estimates that 6 percent of college students in the U.S. have a serious gambling problem that can result in psychological difficulties, unmanageable debt and failing grades. Students who admit to having a problem sometimes find a lack of support on campus.

Gambling Disorder and Health Implications

Most college students are able to make responsible decisions about gambling, but for some, gambling can turn into a serious problem. Having problems as a result of gambling doesn’t mean he or she necessarily have a gambling disorder but could signal future problems.

Gambling disorder can be associated with numerous negative consequences and are highly correlated with other risky behaviors. Students who use tobacco, drink heavily or binge drink, smoke marijuana or use other illegal drugs, drive under the influence or have a low GPA are more likely to gamble.

Recent trends have raised concerns that today’s college students might be more susceptible to risky behaviors, such as gambling, than previous generations. For example, gambling opportunities, once only available in a few states, have proliferated nationwide during the past 30 years with the expansion of lotteries, casinos and Internet gambling, especially online sports wagering.


Advances in psychoactive medications have made it possible for many more young people with psychiatric problems to attend college. Research has shown that most individuals with gambling problems have co-occurring psychiatric problems. Although the field of research on gambling disorders is young, recent studies continue to confirm the relationship between gambling disorder and substance-use disorders, citing high rates of their co-occurrence in many different types of studies.

A 2008 study by Harvard Medical School’s Department of Health Care Policy analyzed the gambling data included in the National Comorbidity Survey Replication (NCS-R), a landmark study of mental health in America that conducted face-to-face interviews with 9,282 individuals who were 18 years and older. The ICRG-funded study of the gambling data found that, among those who developed a gambling disorder, 23.5 percent developed a gambling disorder before any other psychiatric problem, 74.3 percent of respondents developed pathological gambling after experiencing other psychiatric problems, and 2.2 percent developed pathological gambling and other psychiatric problems at about the same time. The bottom line: respondents with any other psychiatric disorder are 17.4 times more likely to develop a gambling disorder than those without such problems.


Kessler, R. C., Hwang, I., LaBrie, R., Petukhova, M., Sampson, N. A., Winters, K. C., et al. (2008). DSM-IV pathological gambling in the National Comorbidity Survey Replication. Psychological Medicine, 38(9), 1351-1360.

Public Awareness of Gambling Disorder

Public understanding of gambling disorder as a mental health problem continues to lag behind the awareness of problems with alcohol and other drugs. Conventional wisdom about excessive gambling as a sign of weakness or lack of moral fiber still dominates public discourse about the issue. Several consequences can result from an outmoded view of gambling problems. First, it is vital for college health care providers to recognize that excessive gambling can be a sign of a serious mental health problem. Second, students who are not aware of the risks of excessive gambling might not take the necessary precautions. A study conducted at a large public university found that 90 percent of the students in the sample disagreed with the assertion that “gambling could lead to serious problems.” Third, students who have a problem might not seek help if they are unaware that a gambling disorder is treatable.

It is important for college health professionals to promote understanding of disordered gambling behavior as a treatable mental health disorder with bio-behavioral roots that frequently co-occurs with other addictive behaviors and psychiatric disorders.

For more information about a public health approach to gambling, see the following:

Korn, D.A., & Shaffer, H.J. (1999). Gambling and the health of the public: Adopting a public health perspective. Journal of Gambling Studies, 15(4), 289-365.

Shaffer, H.J. (2003). A public health perspective on gambling: The four principles. AGA Responsible Gaming Lecture Series, 2(1), 1-27.

Shaffer, H.J., & Korn, D.A. (2002). Gambling and related mental disorders: A public health analysis. Annual Review of Public Health, 23, 171-212.

Internet Gambling

Internet gambling--especially the expansion of online sports wagering--has gained increasing public scrutiny affecting policy, regulations, and public concern about its safety.

Because it is often a solitary activity that can provide instant or rapid gratification, online gambling has been perceived as riskier than land-based forms of gambling. Until recently, there has been little peer-reviewed research on Internet gambling, and the available research has relied on gamblers’ self-descriptions of past Internet gambling behavior. Newer research on Internet gambling in Europe suggests that such fears are unfounded. However, the applicability of these findings to the United States is unknown.

A Harvard Medical School study tracked the betting transactions of 40,499 subscribers to a European Internet sports gambling service over an eight-month period. The results suggest that although the majority of the sample demonstrated moderate gambling behavior (e.g., a median loss of 33 Euros over eight study months), approximately 1 percent of the online bettors showed more excessive gambling behaviors. Future research on these gamblers is necessary to determine whether the gambling patterns of these very involved bettors are clinically relevant.

The ICRG is currently funding a national survey of sports wagering in the United States. This study will answer many questions about the prevalence and health risks of sports betting.


LaBrie, R.A., LaPlante, D.A., Nelson, S.E., Schumann, A., & Shaffer, H.J. (2007). Assessing the playing field: A prospective longitudinal study of Internet sports behavior. Journal of Gambling Studies, 23, 347-363.)

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