States love March Madness. That’s a problem for many.

This story was originally reported in February. It's been updated and we are resurfacing it amid the March Madness men's and women’s college basketball tournament, which Americans are expected to wager more than $2.72 billion on this year.

March Madness is underway, with one weekend down and two to go. In years past, office pools—sometimes under-the-table—were most common. Today, 38 states, Washington, D.C., and Puerto Rico all allow people to bet on the NCAA games and other sports events via online betting apps. Six more are debating the issue.

As a result, sports betting revenue has “achieved new records,” according to the American Gaming Association. “Nationwide sports betting revenue grew by 44.5% year-over-year in 2023, increasing to $10.92 billion from $7.56 billion in 2022.”

States have fueled this massive uptick in online and in-person wagering on sporting contests, even though they have received relatively modest revenue increases and have seen dramatic increases in reports of people struggling with gambling addiction.

Sports betting was shunned for decades because league commissioners worried that gambling on games could undermine the integrity of their sports, which would, in turn, drive away fans. And, of course, betting had led to major scandals that people talk about decades later, from the 1919 Black Sox to Pete Rose.

That all changed when the Supreme Court sided with New Jersey as it challenged Nevada’s exclusive legal right to allow sports gambling, which Congress put in place in 1992. Suddenly, any state could allow sports betting, and almost all of them jumped at the chance. Lobbyists from gaming companies like DraftKings and FanDuel swarmed state capitols to legalize the new form of gaming and to secure favorable conditions.

The speed of the about-face was remarkable. As Religion News Service points out, it took nearly 60 years for 40 states to adopt government-run lotteries, following New Hampshire’s decision to set one up in 1964. It only took five years for sports betting to spread that far.

One reason for the enthusiasm: States could collect taxes from the new services. Last year, states took in $2.1 billion from sports betting, up from $1.5 billion in 2022. While that is certainly significant, it is also a relatively small piece of the revenue picture for operations as big as state governments. The $2.1 billion in nationwide sports betting taxes from 2023 is less than Idaho received in sales taxes in its last fiscal year. What’s more, the vast majority of new gaming revenues have been concentrated in a few states: New York, New Jersey, Pennsylvania and Illinois.

On the other hand, the impact on people reporting problems with gambling addiction have been widespread. Advocates estimate that nearly 7 million Americans experience gambling addiction.

Calls to Kentucky’s gambling addiction hotline have tripled since the state first allowed sports bets in September. Ohio saw a 55% jump in its first year of sports betting. In Connecticut, calls nearly doubled.

The legal changes came at the same time that technological advances made it possible for people to make a bet at any time from nearly anywhere using their phones. That lowers the barriers for people who experience gambling addiction, Diana Goode, the head of the Connecticut Council on Problem Gambling told Marketplace recently.

“In order to gamble you had to put clothes on,” said Goode. “You had to get up, you had to go out, and now you don’t.”

Technology is also used to keep people hooked once they place their bets. Using massive data mining operations and artificial intelligence, gaming companies can tailor their offerings to keep customers wagering on anything from the outcome of a current drive in an NFL game to the winner of an obscure collegiate tennis match, 60 Minutes reported.

Young men are the most likely to gamble and the most likely to experience problems with gambling addiction.

Even before sports betting became legal in North Carolina, for example, surveys found that a majority of college students had gambled in the prior year. Advocates worry that the age restrictions in the new law, which limits gambling to people 21 or older, won’t be enough to prevent addiction among younger residents.

“They’re more prone to take risks than older adults. They may also be less aware of the concept that, regardless of if there’s skill involved, it’s still gambling,” Amanda Winters, the head of state’s Problem Gambling Program, told The (Raleigh) News & Observer. “You can never out-skill chance.”

Advocates who want to prevent gambling addiction have called for many changes in state sports betting laws. Those include limits on promotions like free bets that gaming companies use to lure new users; prohibiting the use of credit cards for gambling; making state-run support for people affected by a gambling problem more widely available and easier to access, and, of course, more funding for those treatment services.

But state regulators were caught flat-footed by the surge in responsibilities that they already have been given, often allowing practices that lawmakers specifically outlawed, according to a 2022 investigation by The New York Times.

Other advocates are pushing for more federal involvement in treating gambling addiction. In Congress, two lawmakers introduced legislation in January to redirect federal tax revenues on sports wagering to fund treatment for gambling addiction.

Keith Whyte, the head of the National Council on Problem Gambling told Marketplace that a state-by-state approach to treating gambling addiction is outdated.

“Just as we don’t look at cancer, or diabetes, or substance abuse state-by-state, we really need to recognize that gambling too is something that you have to look at on a national basis,” he said.

It’s unclear when or whether other states will join the sports betting frenzy. Georgia lawmakers are considering a constitutional amendment to allow sports betting there, even though a similar effort failed last year. Other states face headwinds because of relations with Native American tribes, opposition from religious conservatives or high legal hurdles: Alabama, Alaska, California, Georgia, Hawaii, Idaho, Minnesota, Missouri, Oklahoma, South Carolina, Texas and Utah.

But even in places like Missouri, where sports betting is not legal, residents often find a way to wager anyway. More than 81,000 people from Missouri had accounts and were using betting apps, according to GeoComply, a geolocation company. At one highway interchange near the Kansas-Missouri border, The Kansas City Beacon reported, GeoComply recorded 24,000 transactions during the Chiefs playoff run, as Missouri residents pulled over to the side of the road to make their bets.

Gambling has a powerful allure and offers people something intoxicating that drugs or alcohol cannot provide, Scott Anderson, a problem gambling specialist in the Department of Mental Health and Addiction Services in Ohio, told The New York Times.

“Gambling is the only mood-altering thing that has hope involved,” he said. “I’m not going to sit in the crack house and hope I can catch up on my child support.”