Help-seeking for gambling problems following expansion of Ontario's online gambling market and legalization of single-event sports betting.

BACKGROUND

Online gambling and sports betting have recently been legalized and expanded in North America. We aimed to evaluate long-term changes in the frequency of gambling-related helpline contacts in the province of Ontario following the launch of a government-operated online gambling platform (PlayOLG) in January 2015 and the expansion of private online gambling, including single-event sports betting, in April 2022.

METHODS

We conducted an interrupted time-series analysis of contacts with Ontario's free 24-hour mental health and addictions helpline (ConnexOntario) between January 2012 and September 2025. We used segmented linear regression to compare immediate, gradual, and overall changes in monthly rates of gambling-related contacts after gambling expansion in January 2015 and April 2022 overall and by age and gender subgroups.

RESULTS

Over 13 years, ConnexOntario received 745 716 contacts, including 37 087 (5.0%, mean age 39 yr, 68.2% men) related to gambling. The mean monthly rate of gambling-related contacts per 1 000 000 individuals aged 15 years and older was stable over time before the launch of PlayOLG (13.4); the rate increased after Play-OLG's launch (17.0) and further increased following privatization (26.2). Compared with the scenario in which PlayOLG never launched, the estimated effect was 9.3 (95% confidence interval [CI] 1.04 to 17.5) additional monthly contacts per million individuals aged 15 years and older in February 2022 (an approximately 80.7% increase). Compared with the scenario in which neither PlayOLG nor private online gambling was allowed, the estimated effect was 20.8 (95% CI 8.5 to 33.2) additional monthly contacts per million individuals aged 15 years and older in September 2025 (an approximately 198.3% increase). Increases in gambling-related contacts occurred almost exclusively in adolescent boys and men aged 15 to 44 years. Compared with no private online gambling, and no private online gambling or PlayOLG, gambling-related contacts in adolescent boys and men aged 15 to 24 years were estimated to have increased by 144% and 337.8%, respectively.

INTERPRETATION: The introduction of online gambling and subsequent privatization with single-event sports betting were each associated with substantial increases in gambling-related helpline contacts, specifically in adolescent boys and young men, suggesting increased gambling problems, care-seeking, or both. This underscores the need to strengthen preventive measures and treatment access.