This story is part of our mental health series. Find out more here.

Gambling is legal in 48 U.S. states now, and sports betting apps like DraftKings and FanDuel have made it increasingly more accessible to the public.

Though most apps and advertisements feature warnings about the risks of gambling, problem gambling is growing rampant. About 7 million American adults are suffering from some form of problem gambling, according to the National Council on Problem Gambling.

Heather Hugelmeyer, senior director of behavioral health at Northwell Health in New York, says that research shows that adults ages 18 to 35 are most at risk for developing problem gambling behaviors.

Hugelmeyer warns that problem gambling could swell into a crisis akin to the opioid epidemic because it’s been so normalized in the mainstream.

“You can’t turn on a sports program now without seeing betting lines throughout the entire event. You can bet on every play,” Hugelmeyer says. “Now everybody has smartphones, which are essentially little casinos, in their pocket. So the access and normalization that’s happening with gambling is really putting us at risk for a ballooning crisis.”

8 questions with Heather Hugelmeyer

What is a gambling addiction? How does it compare to something else like an addiction to alcohol or drugs or even sex?

“When we talk about gambling addiction or problem gambling, we’re talking about a strong or uncontrollable urge to continue gambling despite negative consequences. That’s a very basic definition.

“It is very similar to other addictions. It does impact the similar reward center of the brain. The consequences, symptoms, and treatment approaches are all very similar across addictions. One of the main issues that’s a little bit different when we talk about problem gambling or gambling addiction as opposed to a substance use disorder is really, there’s no physiological dependence on an actual substance.”

What are the signs that might indicate gambling addiction?

“One of the major ones is continuing to gamble despite having negative consequences and having negative impacts on areas of your life, whether that’s family, relationships, finances, work.

“Finding yourself having consuming or obsessive thoughts about gambling, failed attempts to try and stop is a big warning sign and — very similar to other addictive processes — hiding or lying about gambling behavior.

“One that’s very specific to gambling is really the idea of what we call chasing losses, which is trying to win back money that’s previously been lost.”

What does treatment look like for gambling addiction?

“Treatment for gambling is very similar to that it is for other addictive processes: things such as individual therapy, group therapy, medication management to deal with anxiety depression or other mental health symptoms that come with this.

“One of the things that are really very specific if we’re talking about that online gambling issue is really the idea of how you can limit access. So, with gambling, you might be looking at limiting access to funds. This could be help by family members monitoring. There are very specific debit cards, or different cards that look like debit cards, that put limits on spending. There’s blocking software that’s available to limit access to certain sites.”

How can people limit access to online gambling when their phone is with them all day?

“There’s three things that you can do specifically in this area. One is the blocking software that does exist. You can also self-exclude from gambling platforms. Now that’s a little bit harder and certainly requires a good amount of motivation from the individual. You basically indicate and make your own access to a specific site.

“The other thing that we talk about — which is much harder in this day and age — is to consider, at least in those early days, the idea of moving away from a smartphone and using a non-smartphone.”

Do the disclaimers that play during gambling advertisements and on apps help people struggling with problem gambling?

“I think that the messages are important, but I think the problem is that while we have those PSAs, we are normalizing this in so many other ways.

“When we talk about video games that have loot boxes and paid currency to scratch-offs to, again, you cannot watch a sporting event in the United States without watching betting lines across the bottom for the entire duration of the sports event. And now you even have the commentators commenting on it.

“So while I believe it’s helpful and I think these education initiatives are important, we also need to look at the fact that we are really normalizing this for an entire generation.”

Most states only allow gambling for people over 21, but some teenagers are able to get around that restriction. What’s the impact on children?

“Research shows that the introduction of harmless betting by age 12 increases your risk of engaging in problem gambling later on by four times.

“Right off the bat, having conversations and engaging, educating your kids about the risks and consequences of gambling is really important. While as parents we don’t always feel that way, our voice is the strongest voice of influence in our kids lives. So those conversations happening at home are really important. It also opens the door and the opportunity for your kids to come to you if there is an issue if you’re willing to engage in those conversations.

“I would also say we have to be careful about, again, normalizing that within our own homes. Don’t give scratch-off tickets as gifts or encourage underage gambling behaviors.

“And we do have to watch out for those video games, those loot boxes, the paid currency.”

What can parents look for that might indicate a gambling addiction in their teenager?

“So when we’re looking for signs with teen gambling, certainly looking for any noticeable change in your adolescent. Of course, that could mean anything in adolescence.

“Does your teenager all of a sudden start to have a noticeable interest in competition, in having to win, in being right? That’s an indicator that they could be gambling. Also, missing household cash or finding stashes of money being kept by your teen that really are unexplained.

“Again, these things could be related to other issues. They’re certainly a sign potentially of gambling and an indication that you need to start to have a conversation with your teenager about what’s happening.”

What kind of legislation would help ensure this doesn’t become an epidemic?

“One of the things we know is that there is a clear intersection between gambling and other public health issues: substance use disorders, anxiety, depression, and other mental health disorders.

“So coming from a public health approach that includes increased money for research, youth education and prevention, the implementation of screening tools across settings, looking to develop frameworks or treatment practices that we know are effective towards gambling, messaging to de-stigmatize treatment around gambling are really important.

“It’s important that we’re proactively putting these interventions and approaches in place so that we can prevent an emerging epidemic.”

Samantha Raphelson produced and edited this interview for broadcast with Micaela Rodríguez. Grace Griffin adapted it for the web.