Dr. James Sherer joins us to break down the sharp rise in gambling addiction fueled by online platforms and sports betting. From the mental health fallout to the addictive design of gambling apps, he unpacks what’s driving this crisis—and what can be done to stop it. Hear about the brain science behind the behavior, its impact on relationships, and where people can turn for real help.

Transcript for Audio

[00:00] Erin Connors: Welcome to Mental Health Pathfinders. As March Madness fuels a surge in sports betting, the growing accessibility of gambling through websites and apps is driving a rise in addiction. We'll discuss this issue with our guest today, Dr. James Shearer, Deputy Chief Medical Officer at Carrier Clinic, which is part of the Hackensack Meridian Health Network, and Chief Clinical Officer at Nostos.Health, offering online group-based treatment for tech addictions. Dr. Shearer served on the APA's Presidential Working Group on confronting addiction from prevention to recovery under past president Petros Lavounis. Dr. Shearer, thanks so much for joining us today. Really appreciate it.

[00:39] James Sherer: Thank you so much for having me, Aaron. It's a thrill to be here.

[00:42] Erin Connors: Right, we can jump right into it because gambling apps and these online games, they are everywhere right now. You see them on commercials and on social media ads. It seems like rewards or these constant notifications make it harder for people to stop. How can this affect their mental health in the long run?

[01:02] James Sherer: Well, I'll give you a really concrete example to start. You know, I've run intensive outpatient programs in the past that have focused on helping people with both substance use or addiction issues and mental health issues. And one really troubling thing that I've noticed in the past couple months or years is that some of the patients who are coming to these programs to get really intensive treatment, you know, group for multiple hours a day, they're finding it difficult to focus on the treatment that they're getting because they're actually on their phones in groups or while talking with their individual providers and gambling and betting. And it's so addictive that even when they know that they might even be, you know, paying to receive a high level of mental health care treatment, they can't seem to put these things down. And so that's kind of an example. That's a microcosm of the problem, you know, writ large. If you can't put the gambling app down to focus when you are getting treatment, how are you going to put the gambling app down when you're supposed to be focusing on spending time with your family or at your job or doing any of the other things that we need to do. These things have a way of kind of invading your normal life and really throwing things off balance.

[02:14] Erin Connors: And I would think the other end of this too, I guess a lot of people feel incredibly stressed and anxious when they're losing money and they feel pressure to keep playing.

[02:22] James Sherer: Yeah, chasing losses is a big problem when it comes to gambling addictions of any kind, whether it's old school gambling in a casino, gambling on an app, maybe even gambling as part of a video game like, like Roblox or Overwatch where there's loot boxes. You know, people feel the need to throw good money after bad. And it leads to people very quickly being in very large holes that they can't get out of, which then of course leads to despair and worsening of underlying chronic mental health symptoms.

[02:52] Erin Connors: And since they're so focused on these apps, do you have concerns that they're kind of putting their real life connections to the side, maybe sometimes even feeling lonely?

[03:02] James Sherer: Yeah, definitely. That's actually one of the major symptoms of gambling disorder as outlined in the DSM is kind of, you know, failing to fulfill major role obligations. As I mentioned before, you're not being the best father or mother that you could be. You're not being the best employee that you could be. You are not saving for retirement. You are not, you know, watching out for yourself. You're really kind of putting everything that you have financially, but also with regards to your attention and emotional energy into these apps and you kind of ride that wave of, you know, small wins if you have any, and then usually much larger losses emotionally as well. And that kind of follows you into your day. I've had patients tell me, you know, after major losses that they feel that, you know, for weeks or months, and they're not able to enjoy things like one of their children's recitals, for example, or a sporting event that they've been looking forward to or a concert that they saved up for, you know, those losses kind of taint their ability to enjoy life otherwise.

[04:05] Erin Connors: Yeah, people also talk about kind of getting a high from winning, you know, when they're on these apps. How does that work? And it must make it harder to step away from them when they are in that zone. yeah.

[04:16] James Sherer: Definitely.

Yeah, I mean, these things are still coming into focus, but what we suspect is that neurobiologically, neurochemically, the pathways involved in gambling are similar to those involved in other substance use disorders. And that is to say that there's a quote unquote final common pathway, which is mediated by dopamine. And that pathway is old. It's in a deep part of the brain. And when you win, you get a spike in that dopamine pathway, analogous to that which you might receive if you were to eat a really good meal or have sex or do some sort of illicit substance. The neurobiological pathways that are involved are similar. Because they're similar, those pathways can be hijacked by gambling the same way that those pathways can be hijacked by something like alcohol or opioids or so on and so forth. And it becomes this thing that's hard to break.

The more you do it, the more it of gets entrenched in your brain and the harder it is to disrupt that. It gets to the point where people really need an intensive level of treatment to try to get through that and normalize their life again.

[05:29] Erin Connors: Is there any documented effect on sleep caused by these kind of using these kind of apps?

[05:36] James Sherer: That's a really good question. You know, to be quite frank, I'm not sure off the top of my head. I'm sure there is. And just from my personal clinical experience, yes, because much like video games, much like social media, you know, these are things that are available 24 seven. These are things that we find ourselves reaching for 24 seven. We were all familiar with that phantom buzz sensation where you feel something buzzing in your pocket. You reach down, there's nothing there. Maybe your phone is on the table, that doesn't stop when you go to bed. So whether it's social media addiction or gambling or video game addiction or online porn addiction or what have you, I have patients that are reaching for their phones, reaching for their tablets, reaching for their laptops way into the night, completely disrupts their sleep schedule. Now as to what that is exactly doing on like a scientific level, what segments of the sleep cycle are disrupted, I'm not sure offhand, but I'm sure that research is out there.

[06:34] Erin Connors: And I'm sure the financial end of this puts people in desperate situations often. Do you often worry about your patients harming themselves?

[06:41] James Sherer: Yes, definitely. I can give you a recent example of a patient I saw who came into the hospital experiencing suicidal ideation with a plan after losing $100,000 on a single bet on a gambling app. And this is someone who was a father who was able to hold down a job. He actually worked in investment banking, very successful at his career and his life otherwise.

And even when it came to kind of gambling in the market, so to speak, he was very prudent and very cautious. But when it came to gambling on apps, on, you know, betting on sports, that caution was kind of thrown to the wind. And he was shocked that he lost a hundred thousand dollars in a single bet in a single day. And that required him to come into the hospital, receive emergency treatment, and eventually become hospitalized for a psychiatric reason. That patient, you know, these are,

These are stories with happy endings. That patient is doing much better now. But, you know, it's really easy to kind of blink and then realize that you've lost maybe more money than you have.

[07:49] Erin Connors: And that's a great segue to talk about prevention and ways to get support. What can help people who are struggling with gambling or gaming addiction or what some of the tools and resources that you have for some of these patients?

[08:01] James Sherer: Sure. So I think the most common one and probably the best place for most people to start is Gambler's Anonymous. Gambler's Anonymous is analogous to Alcoholics Anonymous or Narcotics Anonymous in that it's a peer-led system with groups all across the country that allow people to kind of approach healing through the lens of camaraderie in a non-judgmental kind of place, along with accessing Gambler's Anonymous, a really great resource can be calling the Gambler's Hotline and putting yourself on a block list, you know, disallowing yourself from going to casinos in a certain state, or perhaps even disallowing yourself from accessing gambling apps. If you're younger or, so for example, if your parents are willing to do this, or if maybe you are in a relationship and your significant other is willing to do this, you can also ask them to activate the parental controls on your phone and prevent you from accessing these applications. If you've tried all that and that doesn't seem to be working, that's really when you should be seeking the counsel of someone who's professionally, has professional experience treating this. That can be an addiction psychiatrist who can help you with maybe medications or specific types of therapies to address these underlying concerns or a higher level of group-based care, such as an intensive outpatient program, or even online professionally-led groups like we offer at no-stose.health to help you get through some of the toughest parts of getting through this.

[09:44] Erin Connors: James Scherer. We really appreciate you being here today. Very timely information for everyone.

[09:49] James Sherer: Thank you so much, I really appreciate the opportunity.

[09:52] Erin Connors: And to our listeners, you can find more episodes like this on a range of mental health topics on APA's Medical Mind Channel, available on all major podcasting platforms.