Legal Sports Betting Linked to 10% Rise in Binge Drinking Among Young Men

Study published in Health Economics (Wiley). Co-authored by Keshar M. Ghimire, PhD, University of Cincinnati.

Legalizing online sports betting appears to come with an unintended side effect: more binge drinking among young men. That is the central finding of a study published in Health Economics that compared substance use patterns across U.S. states with and without legal sports gambling.

The numbers are specific. Among men aged 35 and younger who already reported binge drinking, the frequency of heavy drinking sessions rose by roughly 10% in states where online sports betting became legal after 2018. Smoking rates, by contrast, showed no comparable shift.

The gambling-drinking connection

The researchers used national survey data and modern policy-evaluation methods -- essentially treating the staggered legalization of sports betting across states as a natural experiment. Some states moved quickly to legalize after the U.S. Supreme Court struck down the federal ban on sports betting in 2018. Others held off. That patchwork created comparison groups the researchers could exploit.

The design is important because it allows the team to isolate the effect of legalization itself, rather than simply observing that people who gamble also drink more. The staggered rollout across states provides a stronger basis for causal inference than a simple cross-sectional survey would.

The connection between gambling and alcohol is not new to behavioral researchers. Casinos have long offered free drinks to patrons, and the two activities share overlapping psychological reward pathways. But the rise of mobile sports betting introduces a new dynamic: gambling that follows people home, to bars, to sporting events -- anywhere a phone goes.

Why young men specifically

The effect concentrated among younger men tracks with what we know about both sports betting demographics and binge drinking patterns. Men under 35 are the primary market for sports betting apps, which are heavily marketed during live sporting events. They are also the demographic most likely to report binge drinking in national surveys.

The study found no significant effect on women or on older men, suggesting the link is not about gambling legalization broadly altering social norms around drinking. Instead, it appears to operate within a specific population that is simultaneously the heaviest user of both products.

The mechanism is likely behavioral rather than chemical. Sports betting is a social activity, often embedded in watching games with friends -- an environment where alcohol consumption is already elevated. As betting becomes legal and more accessible through phone apps, more of these social occasions may involve gambling, and the associated drinking may intensify.

The self-reporting problem

The researchers acknowledged a significant limitation: all substance use data came from self-reports. People systematically underreport alcohol consumption in surveys. If heavy drinkers in gambling-legal states are underreporting at the same rate as those in non-legal states, the true effect could be larger than the measured 10%.

There is also the question of whether legalization changes reporting behavior itself. If sports betting normalizes certain social environments where drinking occurs, participants in legal states might actually be more forthcoming about their drinking -- which would mean the measured effect is closer to reality. The study cannot distinguish between these possibilities.

The data also cannot capture the full spectrum of gambling activity. Illegal sports betting existed before legalization, and some portion of the apparent effect of legalization may simply reflect a shift from unregulated to regulated gambling. If people were already betting and drinking before legalization, the measured increase in binge drinking may overstate the true behavioral change.

A public health dimension to gambling policy

The findings arrive at a moment when states are still deciding how to regulate -- or whether to legalize -- online sports betting. The policy debate has largely centered on gambling addiction, tax revenue, and the integrity of sporting events. Alcohol consumption has received less attention.

Keshar M. Ghimire of the University of Cincinnati, a co-author on the study, emphasized the public health dimensions, noting that as sports betting continues to spread across states, policymakers should consider the broader behavioral impacts of gambling liberalization.

The practical implications are not straightforward. A 10% increase in binge-drinking frequency among people who already binge drink is clinically meaningful -- binge drinking is associated with liver disease, cardiovascular events, accidents, and violence. But it is not clear what policy lever would address it. Restricting alcohol advertising during sporting events, requiring gambling apps to include health warnings about alcohol, or funding treatment programs with gambling tax revenue are all possibilities, but none have been tested.

What remains unknown

The study covers the early years of legalization, from 2018 through the study period. Long-term effects remain uncertain. It is possible that the initial novelty of legal sports betting drives a temporary spike in both gambling and associated drinking that fades over time. It is equally possible that as betting becomes more embedded in sports culture, the effect grows.

The researchers did not examine other substances beyond alcohol and tobacco, leaving open questions about whether legal gambling might influence cannabis use, prescription drug misuse, or other behaviors. They also did not examine gambling disorder itself, focusing solely on substance use as an outcome.

For now, the data offer a clear signal: legalizing online sports betting did not occur in a behavioral vacuum. It changed drinking patterns among the people most likely to use it. Whether policymakers choose to act on that signal is another matter entirely.