Addiction Data Bulletin 5

This bulletin provides an overview of the gambling risk environment, summarizing gambling policies, types and oversight of gambling activities, and the range of services available to reduce harm due to gambling in New York State (NYS). Following a brief overview of the social and health impacts of gambling, we provide a description of the approach that the NYS Office of Addiction Services and Supports (OASAS) is taking to reduce gambling harms and gambling disorder statewide. We also present data from 2024-25 surveys conducted among New Yorkers regarding gambling behaviors and perceptions of gambling harm.

• NYS developed a novel partnership between state agencies and external entities to ensure an integrated and responsive statewide system to prevent negative consequences associated with gambling.
• NYS has more types of legal gambling activities than any other US state.
• The adverse impact of gambling on health and well-being is more substantial than previously understood. 

Gambling risk environment includes the range of policies, gambling establishments and operators, services and supports, and individual family and social supports, that influence the likelihood and the severity of gambling harms. (Figure 1)

Legal gambling activities in NYS include lottery (e.g., Mega Millions, Lotto, scratch-offs), mobile sports betting, commercial casinos, tribal casinos, video lottery, horse racing, charitable activities (e.g., bingo, raffles). 

Gambling Disorder (DSM-5-TR)⁵ is a persistent and recurring pattern of problematic gambling behavior leading to significant distress or impairment. At least 4 of 9 criteria must be met in a 12-month period for a diagnosis. Gambling disorder is diagnosed as mild (4-5 criteria met), moderate (6-7 criteria met), or severe (8-9 criteria met).

Criteria include the following (in brief): 

• preoccupation with gambling
• need to gamble with increasing amounts of money to achieve desired excitement
• unsuccessful attempts to stop or control gambling
• restlessness or irritability when attempting to stop gambling
• gambles when feeling distressed
• chasing losses
• lying to conceal the extent of gambling involvement
• jeopardizing or losing important relationships, jobs, or educational/career opportunities
• relies on others to provide money to relieve desperate financial situations caused by gambling

Gambling Harms refers to negative consequences associated with gambling disorder.

At Risk for Gambling Disorder includes those who experience gambling harms such as financial problems and interpersonal difficulties. The Problem Gambling Severity Index is an instrument that is used to assess risk for gambling disorder.⁶  

Policies regarding the legality, availability of, and access to gambling are some of the components of the gambling risk environment. (Figure 1)

Legalized gambling has existed in NYS for decades. (Figure 2) Horse racing was the first form of gambling to be legalized in NYS (1939), followed by bingo and raffles (1957), and the establishment of the NYS lottery (1966). Tribal casinos were opened in 1988. Since then, additional types of gambling activities have been legalized in NYS. In 2013, the NYS Constitution was amended to permit the establishment of commercial casinos (in addition to pre-existing tribal casinos). In the ten years since commercial casino legalization, there has been a rapid expansion in the range and number of gambling establishments and operators. This includes an increase in the number of off-track betting corporations from five to ten and in the number of casinos to include four state-owned commercial casinos and three tribal casinos. The anticipated licensing of three new commercial casinos in NYC and Long Island in 2025 would increase the availability of gambling even further. Implementation of legalized mobile sports betting in 2022, NYS currently has more types of gambling activities than any other state, including New Jersey and Nevada. 

Currently, there is no source of US federal funding or federal oversight for services to address gambling harms and gambling disorder at the state level. This includes no federal funding for public health or monitoring gambling trends, or conducting research on gambling harms. This is in contrast to the federal funding and oversight provided to states by the Substance Abuse and Mental Health Administration (SAMHSA) for substance use disorder (SUD). Funds from SAMHSA cannot be used to support any addictions other than SUD. Therefore, funding for addressing gambling harms and gambling disorder comes exclusively from NYS through the NYS general fund and from gambling revenue. The lack of federal funding and oversight has resulted in a paucity of information on the impact of gambling on health and social outcomes. 

Additionally, NYS recently changed its Medicaid policies to expand reimbursement for treating gambling disorder. Previously, NYS Medicaid reimbursed treatment of gambling disorder only when it co-occurred with SUD. Currently, NYS Medicaid reimburses treatment of gambling disorder, with or without co-occurring SUD.

Leveraging Partnerships with Other Government Agencies and External Partners 

The Responsible Play Partnership is a novel collaboration between the New York Council on Problem Gambling, the NYS Gaming Commission and OASAS. The New York Council on Problem Gambling is a not-for-profit independent corporation funded by OASAS dedicated to increasing public awareness about gambling harms and gambling disorder and advocating for support services for those adversely affected by gambling harms. The NYS Gaming Commission regulates all aspects of legal gaming activity in the State, including horse racing, commercial and tribal casinos, the NYS lottery (including video lottery), mobile sports betting and fantasy sports betting, and charitable gaming (see Definitions section). OASAS oversees the prevention, treatment, harm reduction, and recovery services for those affected by gambling harm. 

NYS developed the Responsible Play Partnership to ensure an integrated and responsive statewide system to prevent gambling harms, to establish relationships between local service providers and gambling establishments and operators, and to ensure that establishments and operators comply with NYS Gaming Commission rules and regulations.

Adverse impacts from gambling on health and well-being are more substantial than previously understood. Gambling harms, including gambling disorder, are associated with serious and long-lasting financial consequences, and social consequences (see Definitions box). Financial consequences can include debt, asset loss, and bankruptcy; social consequences can include loss of trust, interpersonal conflict, and impaired relationships.^1,2 Additionally, those who experience gambling harms, including gambling disorder, have a higher prevalence of anxiety, depression, insomnia and substance use disorders, and suicidal ideation and attempts than those who do not experience gambling harms including gambling disorder.^3,4

GAMBLING HARMS PARADOX While anyone who gambles is potentially at risk for experiencing gambling harms, there is emerging evidence of “a gambling harm paradox”, in which specific groups may be as likely, or even less likely, to gamble than others, but are more likely to experience harms if they do.¹ Certain groups may be more likely to experience harms related to use than others due to social and economic determinants of health.⁴

Gambling harms can also occur among people who do not develop or have gambling disorder.¹ A higher prevalence of gambling harms occur among those who:

• Reside in under-resourced areas (compared to high-resourced areas)
• Identify as non-Hispanic Black, Native American or Asian populations (compared to non-Hispanic White or Hispanic)
• Earn low incomes (compared to high incomes)
• Have low educational attainment (compared to high education attainment)
• Are unemployed (compared to employed)

Gambling harms are also experienced by significant others, families and friends of those who gamble¹: 

• For every one person experiencing a gambling harm at least six other people experience harms
• Increased rates of substance use exist among family members of the person who gambles

OASAS services to reduce gambling harms are focused on strategies to reduce risk during four points in time (states of gambling) for those who currently engage or have previously engaged in gambling. (Table 1) Services span the continuum prevention, treatment, harm reduction, and recovery. OASAS also offers services for significant others, families and friends affected by those who gamble.

^a Voluntary self-exclusions are maintained by the NYS Gaming Commission and include exclusions from both mobile sports betting operators and brick and mortar establishments.

In 2024-25, OASAS conducted three surveys in NYS: 

1. to understand public perceptions of gambling harm,
2. to assess which types of public messaging on gambling were perceived to be the most likely to initiate action among those with personal experience of addiction, and
3. to assess gambling behaviors among people who may have thought they were experiencing harms from gambling.  

Perceptions of Gambling Harms 

The first survey was conducted in September 2024 among a convenience sample of New Yorkers. The survey assessed New Yorkers’ perceptions of gambling harm, including perceived harmfulness by gambling activity. 

We asked attendees at the 2024 Annual NYS Fair to complete a paper- or online-based survey on the OASAS website—the latter which was also available to the general public. 

Of the 349 respondents from 37 counties who completed the survey, 15.2% reported lived experience of gambling harms. The gambling activities that most New Yorkers perceived as being the least harmful were the categories of lottery, scratch-off, raffle and bingo (35.1%) and stock/commodities market (28.1%). In contrast, gambling activities that most New Yorkers perceived as being the most harmful were horse or other animal racing (66.8%) and casino games (65.5%). A majority of respondents perceived any form of legal gambling to be harmful (64.9-87.3%). (Figure 3)

Meaningful Public Messaging  

The second survey was conducted in September-October 2024 among New Yorkers with lived experience of addiction, including gambling harms and gambling disorder, and asked for perceptions regarding meaningful public messaging on reducing gambling harm. The survey was posted on the OASAS website, disseminated through recovery groups, and offered at various NYS gambling and mental health conferences. The survey asked respondents to share their opinion regarding effective public messaging campaigns about the harms of gambling during a paper- and online-based survey.

Of the 152 respondents from 39 counties who completed the survey, 97.6% thought that gambling could become an addiction like use of substances such as alcohol, nicotine, cannabis or opioids. The public campaign approach that respondents reported would be the most likely to initiate action was messages of individuals sharing their stories and/or experiences of gambling harm (34.3%). (Figure 4)

Gambling Self-Assessment

The third survey was conducted in January-March 2025 among a convenience sample of New Yorkers who had participated in any gambling activity in the prior 12 months. The purpose of the survey was to assess gambling behaviors among people who may have thought that they were experiencing harms from gambling using the validated Program Gambling Severity Index (PGSI) self-assessment tool.^5,6 The PGSI identifies individuals with various degrees of potential harms from gambling. At the end of each survey, participants were given individualized feedback on their gambling behaviors and additional support options.

The survey was made available through a QR code on both the OASAS website and a public service announcement that ran on various media outlets including television and social media.

Of 3,470 responses, 65.2% reported experiencing consequences from gambling that may indicate that they are experiencing gambling harm(s) or gambling disorder. (Figure 5) 

The gambling risk environment has changed in NYS, particularly since 2013 when commercial casinos were legalized and off-track betting expanded, and in 2022 when mobile sports betting was legalized. The impact of gambling on health and well-being is more substantial than previously understood. 

OASAS recently implemented a series of surveys to better understand a range of gambling-related experiences of New Yorkers, including perceptions of gambling harms and gambling behaviors. In a convenience sample of New Yorkers, a majority of respondents perceived any form of legal gambling to be harmful (64.9-87.3%). In a survey of those with lived experience of addiction, nearly all respondents reported perceptions that gambling could become an addiction similar to substances such as alcohol or opioids (97.6%). 

OASAS operates and oversees help lines, provides harm reduction services, and treatment and recovery services for New Yorkers experiencing gambling harm. Please see below for gambling-related resources. Please also see Addiction Data Bulletin No. 2025-06 Gambling Harms and Gambling Disorder Service Utilization in New York State.

1. Wardle H, Degenhardt L, Marionneau V, et al. The Lancet Public Health Commission on Gambling. The Lancet Public Health. 2024;9(11):e950-e994. doi:10.1016/S2468-2667(24)00167-1
2. Muggleton N, Parpart P, Newall P, Leake D, Gathergood J, Stewart N. The association between gambling and financial, social and health outcomes in big financial data. Nature Human Behaviour. 2021;5(3):319-326.
3. Mestre-Bach G, Potenza MN. Pharmacological management of gambling disorder: an update of the literature. Expert Rev Neurother. Apr 2024;24(4):391-407. doi:10.1080/14737175.2024.2316833
4. Kristensen JH, Pallesen S, Bauer J, Leino T, Griffiths MD, Erevik EK. Suicidality among individuals with gambling problems: A meta-analytic literature review. Psychological Bulletin. 2024;150(1):82.
5. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. American Psychiatric Association; 2013.
6. Ferris JA, Wynne HJ. The Canadian Problem Gambling Index. Canadian Centre on Substance Abuse; 2001.

Suggested Citation

Rebecca Cooper, Grace Hennessy, Shawna Black, Tracy Stickle, Jennifer Farrell, Nina Gargon, Shuo Chen, Andrew Heck, Greg Meyer, Chinazo O Cunningham, Ashly E Jordan. The Gambling Risk Environment and Public Perceptions of Gambling Harms in New York State. Addiction Data Bulletin (No. 2025-05). Mar 2025.