During a routine visit, clinicians ask about alcohol, drugs, depression, and personal safety. A question about gambling rarely follows, even as wagering moves into the sports and financial apps people carry in their pockets.

Until recently, I assumed World Cup pools and fantasy football in my own social circles were friendly competitions with a few dollars at stake. Then I learned that some people had hundreds or thousands riding on a game. I originally thought that behaviors like frequently checking apps, tracking injuries, or recalculating matchups reflected my friends’ enthusiasm, but I was surprised to learn that they hinged on real financial stakes. Although placing bets is not evidence of a gambling disorder, I began to sense that gambling had become embedded in familiar social activities so seamlessly that I had barely recognized it as gambling at all.

Medicine already understands this distinction with alcohol. We do not diagnose alcohol use disorder from a drink; we ask about the amount, frequency, and effects. A similarly open question about gambling gives patients room to say whether betting remained entertainment or began to affect sleep, finances, or relationships. We already ask about many of gambling’s consequences. We rarely ask about gambling itself.

The DSM-5 places gambling disorder among addictive disorders [1]. A meta-analysis of 107 studies found that people with gambling problems had 2.17 times the odds of lifetime suicidal ideation and 2.81 times the odds of a suicide attempt [2]. Another analysis estimated that only about one in five people with problem gambling had sought help [3]. A patient who comes in for depression or insomnia may say nothing about betting unless someone asks.

For Asian American, Native Hawaiian, and Pacific Islander (AANHPI) communities, the research remains sparse. In a study of 813 college students, Asian American and White students reported similar rates of gambling initiation. Among those who had gambled, 28.9% of Asian American students and 16.8% of White students met the study’s threshold for problem-gambling symptoms [4]. Conducted at one university before today’s mobile betting market, the study raises concern but cannot establish current prevalence in AANHPI communities.

The national figure often used to fill that gap hides the differences we need to understand. A 2001-2002 survey reported disordered gambling in 2.3% of a combined Native American and Asian American group, compared with 1.2% of White adults [5]. A 2025 American Psychiatric Association resource presents 2.3% as an AAPI gambling-disorder rate [6]. The matching study used a broader measure and pooled those two populations. It provides no separate rate for Asian Americans and no data on Native Hawaiian or Pacific Islander people. With numbers this blunt, how can we tell whom prevention reaches?

Researchers in Greater Boston interviewed 40 Khmer, Chinese, Korean, and Vietnamese immigrants in their preferred languages. Participants described poverty, stressful work, isolation after immigration, limited culturally accessible recreation, and casino marketing [7]. Their accounts show why ‘Asian gambling culture’ is a poor substitute for understanding how circumstances and neighborhoods shape risk.

Care must also be reachable. Among 431 Asian American adults, self-stigma about seeking help was associated with less willingness to pursue mental-health care [8]. A gambling-treatment program run by the NICOS Chinese Health Coalition received 140 inquiries; 19 people expressed interest in language-concordant telephone counseling and eight enrolled [9]. These findings leave clinics with a practical question: how easily can someone who asks for help actually receive it?

Meanwhile, access to betting keeps expanding. State-regulated sportsbooks handled $166.94 billion in wagers in 2025, according to the industry’s trade group [10]. Kalshi offers sports-event contracts using the language of trading. Dr. Timothy Fong, co-director of UCLA’s Gambling Studies Program, told the Associated Press that clinicians are seeing prediction-market use among patients more often [11]. The clinical literature is still thin, but a patient can lose money on a game through an app that never uses the word ‘bet.’

Clinicians can begin by asking about gambling when warning signs appear: depression, sleep loss, unexplained debt, family conflict, or suicidal thoughts. The three-question NODS-CLiP asks about loss of control, lying, and preoccupation [12]. A systematic review found screening feasible in several health settings, while acknowledging limited evidence on outcomes [13]. Screening must also lead to a plan. One pilot identified the referral pathway as a major barrier [14]. A positive answer should prompt attention to immediate safety and a connection to care the patient can use.

APAMSA’s policy compendium already recognizes online gambling as a public-health concern and calls for research on AANHPI health [15]. Medical schools should teach trainees when and how to ask about betting. Health systems should map gambling-specific referrals in the languages their patients speak before adding a screen. Researchers should publish subgroup-specific findings so communities can help design and evaluate outreach. A translated brochure alone will not help a patient who cannot get through intake.

Medicine does not wait for alcohol use to become liver failure before asking about drinking. We should not wait for a betting app to surface as debt, depression, or a suicide attempt before we ask about gambling.

References

1. Jeremiah Weinstock and Carla J. Rash, ‘Clinical and Research Implications of Gambling Disorder in DSM-5,’ Current Addiction Reports 1, no. 3 (2014): 159-165. DOI: 10.1007/s40429-014-0026-7
2. Joakim H. Kristensen et al., ‘Suicidality among individuals with gambling problems: A meta-analytic literature review,’ Psychological Bulletin 150, no. 1 (2024): 82-106. DOI: 10.1037/bul0000411
3. Rimke Bijker et al., ‘Global prevalence of help-seeking for problem gambling: A systematic review and meta-analysis,’ Addiction 117, no. 12 (2022): 2972-2985. DOI: 10.1111/add.15952
4. Alan Ka Ki Chan et al., ‘Personal Gambling Expectancies among Asian American and White American College Students,’ Journal of Gambling Studies 31, no. 1 (2015): 33-57. DOI: 10.1007/s10899-013-9397-2
5. Analucía A. Alegría et al., ‘Disordered gambling among racial and ethnic groups in the US: Results from the National Epidemiologic Survey on Alcohol and Related Conditions,’ CNS Spectrums 14, no. 3 (2009): 132-142. DOI: 10.1017/S1092852900020113
6. American Psychiatric Association, Healthcare Professional’s Resource Guide: Addressing Gambling Disorder in Asian American and Pacific Islander (AAPI) Communities, June 2025. Read source
7. Mia Han Colby et al., ‘Unpacking the root causes of gambling in the Asian community: Contesting the myth of the Asian gambling culture,’ Frontiers in Public Health 10 (2022): 956956. DOI: 10.3389/fpubh.2022.956956
8. Qian Li and James P. Whelan, ‘Behavioral Addiction from the Asian Americans Perspective: Exploration of Public and Help-Seeking Stigma,’ Journal of Gambling Studies 40, no. 1 (2024): 367-385. DOI: 10.1007/s10899-023-10210-5
9. Iman Parhami et al., ‘The Implementation of a Telephone-Delivered Intervention for Asian American Disordered Gamblers: A Pilot Study,’ Asian American Journal of Psychology 3, no. 3 (2012). DOI: 10.1037/a0029799
10. American Gaming Association, ‘Commercial Gaming Revenue Hits $78.7 Billion in 2025,’ February 26, 2026. Read source
11. Associated Press, ‘Prediction markets say they’re different from sportsbooks. Gambling addicts say it’s all the same,’ April 2026. Read source
12. Marianna Toce-Gerstein, Dean R. Gerstein, and Rachel A. Volberg, ‘The NODS-CLiP: A Rapid Screen for Adult Pathological and Problem Gambling,’ Journal of Gambling Studies 25, no. 4 (2009): 541-555. DOI: 10.1007/s10899-009-9135-y
13. Lindsay Blank et al., ‘Should screening for risk of gambling-related harm be undertaken in health, care and support settings? A systematic review of the international evidence,’ Addiction Science & Clinical Practice 16 (2021): 35. DOI: 10.1186/s13722-021-00243-9
14. Andrew Reid et al., ‘Exploring the feasibility of a gambling harm screening model in general practice and community service settings in Fairfield: a pilot study,’ Australian Journal of Primary Health 30 (2024): PY23208. DOI: 10.1071/PY23208
15. Asian Pacific American Medical Student Association, ‘40.014 Recognizing Harmful Impacts of Gambling and Supporting Investigation of Gambling Impacts on AANHPI Health,’ APAMSA Policy Compendium, updated March 2026. Read source

Author Bio

Hayoung Ahn is a medical student at the David Geffen School of Medicine at UCLA and serves as the APAMSA Neurology Student Representative. She earned her A.B. in Neuroscience from Harvard College and an M.A. in Education from UCLA. She is interested in neurology, medical education, and AANHPI health equity. She is passionate about storytelling at the intersection of medicine and media and enjoys creative writing, photography, hiking, and exploring new cities.