NASW Social Work Talks - EP 147 - Understanding Gambling Disorder and How Social Workers Can Help

Episode Date: August 3, 2026

As sports betting, online gambling, and prediction market apps continue to grow, so does the risk of increased gambling addiction. In this episode of Social Work Talks, experts from the University of Maryland School of Social Work and its Center for Excellence on Problem Gambling discuss the warning signs of problem gambling, what drives gambling behavior, and how social workers can help through awareness, screening, and evidence-based treatment. Hosted by NASW Senior Practice Associate for Behavioral Health Makeba Royall Guests: Paul Sacco, Ph.D., MSW, Professor at University of Maryland School of Social Work, and Kristen Beall LCSW-C, Clinical Manager at University of Maryland, Center for Excellence on Problem Gambling

Navigating senior care options can feel overwhelming, but you don't have to do it alone. Oasis Senior Advisors provides compassionate, personalized guidance to help families nationwide find the right senior care solutions. This is Social Work Talks. I am your host, Makeba Royal, Licensed Clinical Social Worker and Senior Practice Associate for Behavioral Health. In today's episode, Understanding Gambling Disorder and How Social Workers Can Help, We will discuss what gambling addiction is, research related to motivation for gambling,

and how social workers can help with raising awareness, screening, and treatment. Joining us today is Dr. Paul Sacco and Kristen Bell. Dr. Sacco received his MSW from Arizona State University in 1995 and practiced for 10 years as a psychiatric social worker. In 2005, he returned to complete his PhD in social work at Washington University in St. Lewis and joined the faculty of the School of Social Work in 2009. His research focuses primarily on behavioral health and addictions with a focus on life course development, alcohol use disorders, problem gambling, tobacco use, and behavioral health integration. Sacco combines his behavioral

health research with an interest in the training of social work students and evidence-supported behavioral health interventions. He served as the project director of a SAMHSA-funded screening and Brief Intervention and Referral for Treatment Training Program and continues to provide training in this public health approach. He also directed the BHY's Lifespan Fellows Program, a HRSA-funded workforce development project focused on integrated behavioral health training. Socko teaches in the foundation and clinical practice areas. He also teaches structural equation modeling in the PhD program. As an educator, he endeavors to support students in learning the latest from research while helping them recognize the core elements of

effective social work practice. Kristen Bell has over 19 years of experience in the behavioral health field. She began her career with the University of Maryland's Methadone Treatment Program, working as a lead counselor and a patient advocate to increase awareness and reduce stigma of methadone treatment. Kristen was also employed at Johns Hopkins University as a health behavior specialist and at Baltimore Crisis Respond Incorporated as a mental health counselor where she worked alongside a registered nurse performing crisis interventions and assessments in Baltimore City. Currently, Kristen works as the clinical manager at the Maryland Center of Excellence on Problem Gambling. In this role, she assists providers integrating gambling screening

into their clinical practice, supports the five certified peer recovery specialists in their work with persons that are impacted by harms related to gambling, and provides clinical trainings. Kristen earned her master's degree in social work from the University of Maryland Baltimore School of Social Work and maintains an LCSWC. She's also certified as an international gambling counselor and certified associate for alcohol and drugs. Thank you both for joining us today. Thanks for having us. Yes, thank you. I think it would be a good way to start the podcast by letting the listeners know what inspired you to become a social worker.

And this question is for both of you. Thanks so much for the introduction. I had a bachelor's in psychology and, you know, I really wanted to help people was my goal. And social work, I just felt like gave a lot of opportunities and a lot of variation and ways to use our degree. And so that just is something that really appealed to me. Yeah, my background was in history. I have an undergraduate degree in history, so not exactly a natural transition, unlike Kristen's. I got involved in something called the Jesuit Volunteer Corps, which is kind of a VISTA volunteers for Catholics, and it's really steeped in Catholic social teaching. And I was inspired after I worked for a couple of years doing senior nutrition. I drove a Meals on Wheels truck and I thought I'd like to continue working with people.

And then I was drawn to research after being a clinician for a number of years. And that's how I ended up here at the University of Maryland. So it sounds like the common thread is help, even though you didn't start out there, but you still found a way to want to help people in the profession. So that's great. Well, we're glad to have you both. In today's episode, we are discussing gambling. Let's level set, Dr. Sacco. What exactly is gambling considered? Gambling is putting something of value on an unknown outcome.

Basically, what you're doing is you're typically money. You're putting forward some money, buying a lottery ticket, and as you're scratching it, you don't know if you're going to win or not. It's that process, typically involving potentially some skill, but also a lot of luck as to whether you're going to receive more money or more of something else. Right. So gambling could include things like lottery tickets, horse racing. And now we're seeing expansions into new areas like sports betting and prediction markets. Yeah. And what are the criteria for gambling disorder and has that changed?

The criteria for gambling disorder look a lot like the criteria for substance use disorders. So we're talking about things like loss of control, something specific to gambling called chasing, which is this idea that people are going back to gamble or going back to the casino to make up their losses or even chasing winnings. Also engaging in other behaviors that are harmful to their professional, personal, or family circumstances. People also can experience craving related to gambling. One of the big transitions has been the notion that gambling has gone from being an impulse control disorder in DSM-5 to being a substance use or addictive disorder in DSM-5. Yeah, and you just answered the question because I was going to ask,

was it always considered an addictive disorder? But it sounds like at some point, it was considered more so about impulse control. Yeah, and I wonder what Kristen thinks about this too. I think there have been a lot of research and clinical areas that have led to this transition. And Kristen, I don't know if you wanted to say a little bit about that. Yeah, sure.

I think one of the big transitions and why it's now recognized as a substance use-related and addictive disorder is what happens in the brain. So addiction is not just always putting a chemical into your body, but the brain changes that happen And with that pleasure center, the reward system in our brain, research has shown that the brain is activated, right? When people are winning, right? We know that winning feels good, right?

Laughing feels good. Eating a good meal feels good. But even with those near misses, those intermittent rewards, the brain is still having some type of activation in the brain. And so it's those intermittent rewards that are keeping people engaged in the gambling activity. Right. So you're wanting something and you want to continually have that feeling of euphoria in some sense. When does gambling actually move from recreational activity to an addiction, though? Well, I was telling Paul, I always like to tell people, you know, if you work in addiction, you might be familiar with the 12 steps. And so I always refer people to step one, right? That's when we know it's a problem, when we're powerless over the gambling and our life has become unmanageable, when we're doing that activity despite the negative consequences. It's gambling more and more over the same time period. The notion of secrecy. A lot of times people are not talking about the amount of gambling that they're doing. Making

attempts to quit or stop or cut back on gambling and failing at that. And again, these mimic in very real ways other addictive disorders, like alcohol use disorder. So one of the reasons again, why gambling ends up making this transition to an addictive disorder is also because there's a lot of comorbidity. People who are experiencing gambling disorder are also tend to have other substance use disorders like alcohol use disorder. So phenomenologically, they look quite similar. When you think about gambling, almost think about it like a substance use disorder without a substance. I know gambling has changed over the years with, you know, social media platforms and things like that. What impact has those changes had on who gambles and the type of gambling people

engage in? Men gamble at higher rates than women. The research is still showing that, but women aren't too far behind. The access, though, has definitely changed. Now with sports betting, You don't even have to leave your house. I would concur on a lot of that. And I'm kind of old enough to remember when it was Las Vegas and Atlantic City. And so now it's gone from Las Vegas to Atlantic City, to Riverboat, to state legalized gambling casinos on Native American tribes. Now there's a casino in everyone's pocket.

That level of access, those policy changes have real impacts on what adults and youth are exposed to. So I think we may see expansions of risk for a new group, youth who play sports. Historically, gambling disorder has affected people of lower socioeconomic status disproportionately. It's often called like a reverse tax in that the poorest people in our society, the people who have the least resources engage in more gambling. I think what we may see with sports gambling is less of that educational gradient and more young men who have greater levels of education. I think we're going to see that prediction markets as well. I know you have also done research on motivation for gambling.

What have you found in your research as it relates to motivation for gambling? Yeah, a doctoral student of mine, Jiung Jung, and myself, we wrote a paper specifically on gambling motivation among people who play the lottery. So we worked with a state lottery board and they provided some data on people's gambling. And what we learned was that people who gamble to cope tend to be at higher risk of developing gambling-related problems. There are other reasons why people gamble as well. Sometimes people gamble for social reasons. My grandfather used to go to the horse track periodically and he never had a gambling-related problem, but I think it was a way as an older person that he got out of the house. I think he enjoyed his

time there. So social related gambling tends to be associated with lower risk. Sometimes people also gamble for financial reasons. And we had kind of mixed findings. There are some studies that have found that people who gamble believe they're gambling to make money tend to be at higher risk. We did not find financial motivation to be particularly problematic. The main thing we found was that people with high general motivations to gamble had higher risk. Okay. And what are some of the risks that we're finding with gambling? Like, has there been an increase in suicide rates? What are we finding as it relates to that? The DSM does say that those that meet the criteria for severe gambling disorder, about 50%

have contemplated suicide. And the research shows 17 to 20% have made an attempt. There's not a lot of research, right, on completions. There is some research that came out of Rutgers University that looked at the National Violent Death Reporting System on a national level, just to kind of look at the rates of suicide and helping people, because it's all like self-report, right? Was there like gambling paraphernalia found on that individual? Were they in treatment for gambling disorder? And then it's also hard to predict, like, depression was that there first, and then the gambling, or was the gambling there first, and then the depressive symptoms, it's often not spoken about, right? It's not something that you hear about in the news,

but I definitely hear it anecdotally. You know, I heard somebody jumped off the garage at the casino, and unfortunately, it's not something that gets highlighted. Otherwise, you know, maybe more public health awareness would be put on this issue. You're bringing up a good point here, though, that it's something that's not talked about. And I'm wondering, what would you say in terms of screening, right? Like, should social workers be screening for both? Should social workers be screening for both SUD, gambling, and suicide risk? What are your thoughts about that? I mean, that's kind of my job at the center, too, is really to, you know, help providers integrate that screening and assessment, like start asking an evidence-based question, not just

do you gamble, right? Because as Paul started out, there's so many different variations of what gambling could be. But if we just bring people back to that definition, it's wagering something of value on that unknown outcome. You can start having more conversations. For social workers in particular, there's, I think, an importance to screen in mental health settings. So this is a group of people that gambling is a relatively low prevalence problem. It's not that common in the general population. Where it becomes much more common is in addiction treatment settings. So if you're a social worker working in addiction, I think you have to have one eye fixed on the potential that someone also has a gambling-related problem. We used to use the term cross-addiction,

double trouble. I think those are all fine words to describe the idea that people who have substance use disorders may be at higher risk for gambling. In addition to that, I think people who work in community mental health settings, private therapy settings, should also be mindful of and screening for gambling-related problems. We know that people who have depression, people who live with a personality disorder, specifically those cluster B personality disorders, are at much higher risk. So what happens is I think what you find is that these small groups of people who should probably be screened more commonly than they are. And it's something I think that can be missed. I think looking at those populations in particular, and social workers are well

situated to do that because we're already working with these populations. What screening tools or resources would you recommend to social workers who might want to start incorporating this into their work, especially those who might be in private practice as well? The brief bio-social gambling screen is one that's highly recommended, particularly during Gambling Disorder Screening Day. It's a very brief three-question, yes or no questionnaire asking about the last 12 months, and then a yes to any one of those questions would prompt further assessment. Another one we often recommend is also the Problem Gambling Severity Index, which is a nine-question, so it's a little bit longer,

but it does use a Likert scale, so it gives you a score at the end to let you know if you're low, moderate or high risk. Now, obviously, here's the million dollar question. Often you screen and then it's what do you do after and where is treatment and what does treatment look like? Is it a team approach? Who's on the team? Can you tell us a little bit about that, Kristen? Well, here in Maryland, Maryland offers no cost treatment through the Problem Gambling Fund. So I help oversee a directory of providers that offer that service. And I do that in collaboration with our peer staff. So our peers are often the boots on the ground, connecting with help seekers who are interested in treatment, and then making that referral process. But we have individual, you

know, outpatient, IOP, residential levels of care that people can go to at no cost. Okay. And what has been some of your challenges in keeping people in the program? Well, sometimes it's just getting them in the door. It's the first step. I think a lot of persons, what I'm finding just, again, anecdotally is in working with our peer staff is they might feel pressure from outside family members to go into treatment where they may not be necessarily ready themselves. They may have never gone to treatment before. And sometimes the misconception of a person with a gambling disorder, they might just believe that they have a money problem. Like if I just hit this one big win, all these problems would go away. And they might do that

while they're getting that referral to treatment and then that might fall through? A couple of things. I think one is the complexity of sometimes the patients who are clients who have gambling disorders and that they may be dealing with a comorbid, what we used to call access one disorder, like major depression,

but then also may have problems with impulsivity, problems with antisocial behavior as well. So like addictions, there are real challenges in terms of treatment. I think the other piece that my colleagues at places like the Maryland Center tell me is what stigma and shame there is associated with these disorders. So it's a hard thing to admit. And it leaves this kind of complete wreckage in a way that others addictive or substance use disorders don't. Like if someone goes on a bender,

they can really ruin their own life. But you can ruin the lives of your family and loved ones pretty quickly if you have a gambling disorder in terms of spending your money, but then also spending your family wealth. So that ties it back, I think, to the suicide piece as well, is that there's this really powerful role for shame. So I know that my colleagues at the Maryland Center have sometimes said to me, well, maybe you want to screen people when they first come in, but then also kind of keep an eye out and potentially screen again, because sometimes people aren't truthful up front. So it's like screening throughout the treatment process, not just at the beginning. Yeah, being mindful of it throughout.

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I think it's very important, right, because when we send people to treatment, they're coming back to the same environment. And if the family hasn't made any changes, it can just recreate that process again, that cycle again, where maybe they relapse or aren't doing the best. I think it's a good idea if you can involve the family to involve the family. There's, I think, a lot of challenges there. sometimes I would guess families want nothing to do with the person. There's been some bridge burning. I think another element is that family may need to be involved in terms of supporting the person through the process, either that's in a 12-step kind of model and a cognitive behavioral model in terms of recognizing, for want of a better term, cues or triggers to gambling behavior.

I think another thing that is really challenging and an area that I know less about and really fascinates me is this idea of how do you support people to clean up that financial wreckage? We have a financial social work program here at University of Maryland. I know that there's a lot of national organizations working on programs to help people to kind of pick up the pieces. Yeah. I mean, because you have to touch money in some form or fashion every single day. So I would imagine the urge is something that's there to constantly have to deal with on a daily basis. for both the family and the person. Yeah, one of our peers in his recovery, right,

that was part of it was handing his finances over to his wife and she was managing the money, right? So that way he didn't have any access. So he kind of jokes that he got like a $5 allowance for a period of time. But those things, yeah, the family sometimes really does need to be involved in that high level of managing and taking over the finances to help that person recover.

We've kind of talked about gambling from a broad sense and probably from an adult perspective, but with gaming apps and social media, we also know that teen gambling is on the rise. Are there any safeguards social workers can recommend to parents who may be dealing with this issue with their children, adolescents, and teens? Set boundaries as early as possible when it comes to gaming. I just want to remind parents as well about bet-blocking apps, that there are opportunities to actually block gambling apps. BetBlocker is a service that's free, and as long as you download what they provide you, you'll be able to block them. Gamban is a subscription service.

I believe once you add that one, you're locked in and onto that subscription and are able to be blocked from any gambling websites, legal or illegal. Also, thinking about gambling is not benign. I know Kristen and her team at the Maryland Center very much encourage people to not buy their children lottery tickets. I mean, I think it's also connected to families who are deeply connected to gambling as well, is the grandparents, the parents, and then the kids might gamble more typically. And I think to be mindful of that in terms of I would not encourage my child to gamble on sports or in any way enable that early because it's almost like early drinking as well. Early access is not good. So monitoring, putting more boundaries on phones, limits on phones, things of that nature. Yeah, they've done a lot of things to make games like video games more addictive. There's these things called loot boxes, which as at my tender age, I'm not very familiar with, but it's basically like a little bit of gambling inside of a video game, trying to think about how much time is my child sitting on video games. And it's like anything else, having a conversation with your kids, right? So there was, I think, NIAAA or SAMS had this thing, like, talk to your kids about their alcohol use, about alcohol. But I think also having a conversation with your kids about gambling and the harms associated with that and encouraging parents to do that.

Yeah, we've talked about gambling is not being addressed as often as we would like. And at the same time, it's also increasing. What skills can social workers develop to work with gambling addiction if they have an interest? We have to be not afraid to talk to our clients about money because that can often open up a doorway or a bridge to discover if people are gambling. Right. And are they using that as a financial solution? Are they chasing losses? Are they increasing the amounts that they wager? Are they becoming irritable and upset? And then we can also discover if it's impacting the family members as well, if we're just kind of having those conversations, because we want to help the affected others also. So I would start with maybe some conversations about money. And Chris and I, when we talked about this podcast, we had a conversation about the connection between addiction treatment and gambling treatment. So these look a lot alike, right? So now we're talking about things like understanding the 12-step model, I think is a good idea for clinicians. So if you're already working in addiction, a lot of this is going to look pretty familiar. Areas like motivational interviewing, relapse prevention for gambling

does not look a lot different than relapse prevention for alcohol and other drug use. There's a lot of strong evidence for cognitive behavioral treatments for gambling disorder, because in some ways, like it's how do you break a habit? So you think about removing things from your house that are related to gambling. You think about recognizing triggers. You think about finding other activities to engage in that can replace gambling so that gambling isn't like the only thing that you do to have fun. It's about engaging the family so that they're not reinforcing these problematic behaviors and they're reinforcing the other behaviors. So I think getting a good background in addiction will help you. I think the big thing for me, again, like that makes

gambling a little bit different is the financial piece. And I think we're going to see a lot more focus on that. Things like apps that limit financial access. I know there's been over the period of time, a lot of programs have specifically focused on the financial element. Great. Well, this brings us to the end of our podcast. But before we go, are there any final thoughts that you want our listeners to take away from this conversation? Yeah. So many of the social workers who may listen to this are clinical social workers. But also, I would ask everyone in the social work profession to be mindful of the policy element here in terms of the ways that we've expanded gambling and not really thought very much about, hey,

nothing could possibly go wrong after we do this, right? When you make something easier to do and expand access, more people will do it. And some of those people will be vulnerable. My opinion is that we have completely gotten ahead. You know, we've thought a lot about the potential funding elements in terms of tax funding to fund schools and other things like that. What we haven't thought are the harms related to gambling. Like we don't even know that much compared with things like alcohol and drugs about the harms associated with it. There is no National Institute of Gambling. NIDA and NIAAA do not fund gambling-related studies. So a lot of us are in a position where we're being funded by gambling-related foundations or other

groups. And every year or so at the federal level, there has been a gambling-related treatment and research funding proposal or legislative bill that's been put forward. And I think social workers should support those. And I think we need to think about as things like prediction markets unfold, what kind of harms are we putting out there that could affect youth and adults both? Yeah. So it sounds like more research needs to be done. And definitely we need to make sure that we continue to have a pulse on the policies that may come out as they pertain to gambling to use that as a way to safeguard society overall as well. It's hard to put the horse back in the barn is what I'm saying. You know, now the picture marks out there, we're all responding. Kristen and her

team are getting new calls in and you're kind of trying to get that horse back in the barn. But I think it's easier if we think about like, what are the implications of gambling expansion and how are those going to affect families in our communities? And, you know, I hope NASW and other organizations related to social work will support those kinds of pieces of legislation that expand treatment, that expand research, and then also that put reasonable limitations on gambling so that it doesn't become such a serious public health and social problem. All right. Well, thank you to our listeners for tuning into this episode of Social Work Talks as we engage in our conversation on understanding gambling disorder and how social workers can help. Links to the screening tool

and other resources can be found in the show notes section of our website. You may Google NASW Social Work Talks to find it. Again, thank you so much for listening. Have a great day.