Brazilians bet R$20 billion per month online and the demand for addiction treatment is rising
João Montanaro
During her residency in forensic psychiatry at the Federal University of Rio Grande do Sul (UFRGS) in Porto Alegre, Dr. Gabrielle Foppa dealt with a complicated case. A 28-year-old man had taken a drug overdose in an attempt to end his own life. He had exhibited antisocial behavior from an early age, marked by a disregard for the consequences of his actions and the rights of others, and was a habitual user of alcohol and cocaine. While investigating the case, Foppa found that the man had attempted suicide impulsively after getting into debt as a result of online sports betting. His own mother had encouraged him to start playing after hearing in an advert that it was an easy way to make money. He began placing bets frequently and quickly ran up a debt of over R$10,000. “In this case, his gambling addiction was an expression of a more complex clinical picture, in which he felt the need for a lot of external stimulation and instant gratification,” says the psychiatrist, who described the case in the Brazilian Journal of Psychiatry in February.
What happened to Foppa’s patient is not an isolated event. People who have a problematic relationship with gambling are two to three times more likely to think about—and sometimes attempt—suicide than the rest of the population. One in three gambling addicts has thought about taking their own life and one in eight has made an attempt, according to an article published in the journal Psychological Bulletin in January by researchers from Norway and the United Kingdom, based on data from 4.6 million people.
Mental health experts fear that the problem will grow more widespread in Brazil as a result of the large number of online gambling platforms that have begun operating in the country since 2018, offering everything from sports betting to slot machines, such as the “Fortune Tiger” game. In December 2018, in the last weeks of his term, President Michel Temer passed Law No. 13,756, after approval by Brazilian Congress. The law provides for the use of money collected from lotteries and allows for the commercial exploitation of so-called fixed-odds betting, to be implemented by companies authorized by the Ministry of Finance. The result is legalized gambling on real or virtual (fictional) events for various sports (football, volleyball, and others). It is called fixed-odds betting because at the time the bet is placed, the player knows how much money they stand to win if they correctly predict the outcome of the event, which could be the final result of a match or a smaller part of it, such as who will commit the first foul. For example, someone who bets $2 on an event with a multiplying factor of 10 would end up with a balance of $20 if they guessed the correct result. If they get it wrong, they lose their bet and leave with nothing.
Since the law was passed, more than 2,000 betting sites have started operating in the country, according to a report published in the newspaper O Estado de S. Paulo on September 13. Most are based in other countries, some of which are tax havens, and operate in Brazil through a domestic partner or contracted company. “Online betting has existed since the 1990s, but in the early 2010s, with the rise of smartphones in Brazil, it became easier for users here to access gambling websites and apps. Because most of these companies are based abroad, they are not committing criminal offenses in Brazil by offering gambling services, which have been prohibited in the country since the 1940s,” explains Guilherme Klafke, professor of digital law at Fundação Getulio Vargas (FGV) in São Paulo. “It is also very difficult to monitor and supervise these websites and applications, which are generally based in locations where legislation is flexible and unregulated.”
A report released by Itaú bank in August, based on records of Brazil’s financial transactions with other countries, estimated how much money Brazilians have spent on online gambling between July 2023 and June 2024. It is an exorbitant amount: R$68.2 billion, or 0.6% of the country’s GDP. Of this total, R$24.2 billion was fees paid to betting sites. The players received a much smaller amount in prizes: just R$200 million. In a memo issued on September 23, Brazil’s Central Bank estimated that Brazilians have spent around R$20 billion per month on online gambling in 2024—in August alone, five million people on the Bolsa Família welfare program placed R$3 billion in bets. Of the total, 15% is taken by the companies and the rest is returned as prizes.
In the coming months, however, online gambling is expected to decline. On September 16, Brazil’s Ministry of Finance published an ordinance stating that from October to December of this year, only the 108 betting companies that have so far applied for authorization to run online lottery games will be able to continue operating in Brazil. The others, in principle, will be notified and blocked on October 11. After this type of gambling was established, the country took almost five years to define the rules for how betting companies must operate. “Brazil took a long time to adopt this procedure and the market ended up operating in a no-man’s land,” explains Helena Lobo da Costa, a professor of criminal law at the University of São Paulo (USP). According to Diogo Coutinho, a professor of economic law at USP, the delay made many problems worse, such as household debt, especially among those already in poverty, and money laundering. “An urgent and rigorous regulatory response is needed, taking into account the impacts of the surprising explosion of online gambling in Brazil,” he urges.
Law No. 14,790, passed by President Lula on December 29, 2023, after being approved by Congress, establishes that betting sites must have their headquarters in Brazil and be run from within the country, as well as defining taxation rules. After deducting prize values, companies will keep 88% of their income obtained from bets and the federal government will take 12%, which will be allocated to education, security, border surveillance, and health. Of the government’s share, 1% will go to the Ministry of Health, “for measures aimed at preventing, managing, and mitigating the social damage of gambling on health.” The 2023 law also paves the way for the legalization of online casinos run by online betting companies, including slot machine games and other formats.
Alexandre Affonso / Pesquisa FAPESP
Regulating betting companies, however, does not always guarantee a reduction in the number of players or the amount of money being spent. A study led by Scott Baker, an economist from Northwestern University, USA, looked at the financial behavior of 230,000 American families between 2018 and 2023, a period in which 25 US states and Washington DC legalized online sports betting. The resulting article, uploaded to the preprint server SSRN on July 9 but not yet published in a scientific journal, indicates that both the number of players and the amounts they bet increased after the gambling sites were legalized.
The authors wrote that the move “led to an explosion in betting, with the total wagered amount rising from an average of US$1.1 billion per month in 2019 to US$14 billion in January 2024.” Three years after it was legalized, the average household was betting the equivalent of eight times the amount of their first bet. The proportion of income spent on gambling by less affluent households was 32% higher than the amount bet by the richest. Households with less savings started spending more on credit cards and using more of their overdrafts.
It may seem obvious, but not everyone who gambles has a gambling problem. In a recent review, a team led by psychologist and epidemiologist Louisa Degenhardt of the University of New South Wales, Australia, studied data on 3.4 million people from 68 countries, extracted from 366 articles published in the past 15 years. They found that 46% of adults—equivalent to 2.3 billion people—had gambled in the last year (online or in person). The percentage of children under 18 who had gambled was lower, but no less worrying, at 18% (almost 160 million people), despite there being age restrictions in many countries, including Brazil.
Among adults, 8.7% were involved in risky gambling behavior and occasionally experienced personal, social, or medical consequences related to gambling, while 1.4% were considered problem gamblers, who gambled in a way that caused problems in various areas of their life (financial, psychological, social, medical). When this behavior is persistent and repetitive, to the point that it causes harm and suffering, it is classified by the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Statistical Classification of Diseases and Related Health Problems (ICD) as a gambling disorder.
The forms of gambling most frequently associated with problematic behavior among adults were online casinos and slot machines, according to the study, which was published in The Lancet Public Health in August. After separating the data by time period, the researchers observed an increase in the number of players since 2016, when several countries began legalizing online gambling. According to estimates, 7.8% of adults and 10.3% of adolescents worldwide have used gambling sites, whose global revenue in 2030 is expected to reach US$205 billion. In the last year alone, however, these numbers rise to 13.3% of adults and a staggering 48.7% of adolescents. In both groups, around one in 10 players goes on to develop problematic behavior.
“The more that these forms of gambling are legalized and the opportunities to gamble increase, so too do the demand for mental healthcare and the prevalence of disorders associated with gambling,” says Daniel Spritzer, a psychiatrist from the São Pedro Psychiatric Hospital in Porto Alegre. Spritzer is part of a working group at the World Health Organization (WHO) that focuses on the problematic use of online gambling. He also heads Brazil’s Study Group on Technological Addictions (GEAT).
João Montanaro
Online gambling companies are now ubiquitous in Brazil. Their names are on the jerseys of almost every team in every major soccer championship—if not on your own team’s shirt, then on your friend’s. Betting sites run ads on broadcast and cable TV, radio, social media, and news websites. They use sports presenters, Olympic champions, and digital influencers to sell the idea that gambling is fun and could result in financial gain. Sometimes, they warn of the importance of gambling responsibly, something that may not be possible for people who have a problematic relationship with gambling.
The reality is that little is known about who is gambling in Brazil and how, which is fundamental to understanding the scale of the problem and planning how to address it. There are hopes that this lack of information will soon be remedied with the publication of the 3rd National Drug and Alcohol Survey, funded by the National Secretariat for Drug Policy and Asset Management (SENAD), which is run by the Ministry of Justice and Public Security (MJSP). In the survey, 16,600 Brazilians aged over 14 and from all regions of the country took part in interviews and answered questionnaires about their mental health. Set for release in the coming months, it will provide information on the consumption of alcohol and other drugs, as well as gambling behavior, including online betting.
Meanwhile, surveys conducted by private institutions offer some clues, say gambling addiction experts. For a recent report, a team from the Locomotiva Research Institute, which specializes in analyzing behavior, consumption, and trends, conducted telephone interviews with 2,060 adults from 142 Brazilian cities. Based on the information they collected, they extrapolated results for the adult population nationwide, concluding that 52 million Brazilians have at some point placed sports bets online. Almost half of them (25 million people) are new players who started online gambling in 2024. Almost half (45%) of the players interviewed said they had suffered financial losses from gambling and 37% said they had gambled with money that should have been used for other important things.
“In the absence of data collected following a scientific methodology, these surveys give us some useful insight into the scale of the problem,” says psychiatrist Hermano Tavares of the University of São Paulo (USP). In 1997, Tavares founded one of the first specialist services for treating problems associated with gambling: the Pathological Gambling Outpatient Clinic (AMJO), based at USP’s Institute of Psychiatry (IPQ). He was also lead author of the first study to determine the proportion of people who gambled and had gambling problems in a representative sample of the Brazilian population.
In the study, 3,007 people aged over 14 from 143 cities were interviewed in person about their gambling habits. Published in the journal Psychiatry Research in 2010, more than a decade before betting sites really took off, the results paint a very different picture to the current situation.
At the time, 88.3% of Brazilians did not gamble. Just 9.4% were occasional gamblers, 1.3% had a gambling problem, and 1% fell into the category of pathological gamblers—people who continued to gamble despite having suffered financial or emotional harm and damaging family and social relationships. Initially, medical diagnostic manuals classified pathological gambling as an impulse control disorder, alongside pyromania (the urge to set fires), kleptomania (the desire to steal for no apparent reason), and intermittent explosive disorder, which causes outbursts of aggression. Over time, studies carried out in several countries, including at USP, showed that in terms of brain activation and the course of the disease, a problematic relationship with gambling is more similar to a chemical dependency than to impulse disorders. In 2013, this relationship began to be classified as a dependence induced by behavior—rather than by a chemical substance, as is the case with alcohol and other drugs—and was named gambling disorder, or ludomania.
The number of surveys being carried out and increased demand for treatment at AMJO in recent months suggest that online gambling is already affecting the mental health of a larger proportion of Brazilians. “If a gambler had come to AMJO last November, they would already be starting treatment in January. If you call today, you will only be seen in two years’ time,” says Tavares. Now part of a larger service called the Integrated Outpatient Program for Impulse Disorders (Pro-Amiti) at IPq, AMJO is one of the largest outpatient clinics specializing in problem gambling in the country, with the capacity to take on 80 new cases per year, in addition to those already undergoing treatment.
Alexandre Affonso / Pesquisa FAPESP
Patients at the clinic receive psychiatric monitoring, individual and group psychotherapy sessions, meditation and physical activity classes, talks with people who have suffered relapses, and help with organizing their personal finances. “It usually takes about two years for a patient’s condition to stabilize and they spend an average of about four years with us,” says Tavares.
The psychiatrist first became interested in gambling addiction in the mid-1990s, after a patient told him that she could not stop playing bingo. “When she argued with her husband, she went to play bingo. If her son was rude to her, she would go to play bingo,” he recalls. When he asked her more about the game, Tavares discovered that it was no longer the traditional game hosted by churches to raise funds. A 1993 law had authorized the commercial exploitation of bingo by sports companies, after which a number of large bingo halls were opened across the country. In the past, the cards had to be filled in by hand, but these were soon replaced by digital bingo cards controlled by computers: the players press a button and several virtual cards appear that are filled in automatically—and instantaneously—by numbers that appear on the screen. Then they just press the button again.
This behavioral pattern, identical to the way slot machines are used, is highly addictive. More importantly, this way of playing defeats the purpose of a game. Playing games is traditionally a pleasurable activity that humans enjoy throughout their lives. According to experts, games that follow certain rules are fundamental to our development and can serve as practice for real-life situations. Games help people learn skills and strategies, and in principle, playing games teaches people how to deal with victory and defeat. The problem is when the line between fun and pathology is crossed.
For those who become addicted, the gambling aspect is what leads them across that line. Placing a bet with the hope of winning back a greater amount activates parts of the brain associated with feelings of gratification and reward. This cerebral circuit involves almost a dozen surface and deep structures, the functioning of which is fundamental to our survival. The same network is activated by pleasurable acts, such as eating or having sex. In people with gambling disorder, however, it does not seem to function properly. According to a review article published in Nature Reviews – Disease Primers in 2019, some components become too sensitive, leading people to act without thinking, feel stressed, or become uninhibited and spend more.
“The greater a game’s capacity to continuously excite this brain network, the more enticing and addictive it is to the player,” explains the USP psychiatrist. This generally occurs in two ways: through actions that maintain prolonged tension before the outcome, such as the fast and intense narration of a horse race; or when the time between the action and the response is extremely short, such as when pulling the lever of a slot machine.
“Over time and with repeated stimulation, the body adapts and begins to require increasingly intense or frequent stimulation to produce the same effect,” explains AMJO psychologist Maria Paula Tavares de Oliveira. For years, she was head of the first Brazilian outpatient clinic for gambling addicts, created in 1993 by psychiatrist Dartiu Xavier da Silveira as part of the Orientation and Care Program for Addicts (PROAD) at the Federal University of São Paulo (UNIFESP). One consequence of becoming accustomed to the effects of gambling is that people feel like they have to play more often or bet higher amounts.
Just like drug addicts who stop taking drugs or alcoholics who stop drinking, people with a gambling disorder often experience cravings if they stop gambling. Defined as an uncontrollable urge to repeat pleasurable acts and made worse by any impediment to doing so, these cravings grow until they become unstoppable. They are the leading cause of relapses.
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The USP group made an important contribution to our understanding of the craving experienced by gamblers. During a postdoctoral fellowship at the University of Calgary, Canada, in the early 2000s, Tavares compared the intensity and types of craving experienced by 49 chronic gamblers who had abstained for a few weeks with 101 alcoholics in a similar situation. The conclusions he reached helped to redirect treatment.
In the first few weeks of abstinence, gamblers experience much more intense cravings than alcoholics. If they can manage to stay away from gambling for about 90 days, however, the intensity decreases and treatment is more likely to be successful.
The results, published in Alcohol: Clinical and Experimental Research in 2005, and another study that Tavares carried out after returning to Brazil (published in Addictive Behaviors in 2007) also confirmed that gamblers and drinkers suffer cravings for different reasons. For gamblers, the cravings begin to grow during withdrawal because the person stops feeling the positive emotions provided by gambling (feeling active, enthusiastic, happy, a part of something). For alcoholics, it increases when the person stops drinking because they begin to experience negative sensations that they would prefer to avoid, such as anxiety, fear, sadness, anger, or anguish.
More recently, in a paper published in the Journal of Gambling Studies in 2020, Tavares and his team found evidence that the reward system might not be the only thing altered in those with gambling disorder. The problem may also be affected by a complementary and opposing system: the non-reward system, which is sensitive to negative results and leads an individual to stop performing a certain task when it is not going well.
At AMJO, psychologist Raquel Berg subjected two groups of people—habitual gamblers and nongamblers—to two tests: one with a solution and one without. In the first test, participants sitting in front of a computer had to discover which two-digit number formed by a combination of the numbers 1, 2, or 3 would interrupt an unpleasant noise. Every time they got it wrong, the screen would flash red to signal the error. The nongamblers quickly adopted a strategy of testing possible combinations (1 and 1, 1 and 2, 1 and 3, 2 and 1, and so on). The gamblers, however, appeared to choose numbers at random. In the second test, there was no correct number and it was impossible to stop the noise. The nongamblers quickly gave up. The gamblers, meanwhile, persisted until the end of the test.
“This result made us think that in addition to being more sensitive to wins, gamblers may also be insensitive to error signaling,” says Tavares. The signaling of an unpleasant outcome, such as a failure, is registered by a deep brain structure called the habenula, which acts to prevent repeat occurrences of frustrating experiences. “It is the balance between the reward and non-reward systems that allows us to make better decisions. In gamblers, there seems to be a high tendency to overestimate their winnings and underestimate their losses,” he explains.
João Montanaro
With each new cycle of game releases, health experts say there is a sudden increase in the number of people seeking help for problem gambling. This number drops again after a while, but always settles at a higher level than before. “This is true in Brazil and worldwide,” says Tavares, from USP.
But significant differences have arisen in recent years, one of which is ease of access. Until a few years ago, you had to go to a specific place—a bingo hall or an illegal gambling den—to place a bet. The fixed-odds games legalized in 2018 are available on websites or cellphone apps, within everyone’s reach.
Another change is that people can now place multiple bets and gamble continuously. “I have patients who play three games simultaneously,” says psychologist Elizabeth Carneiro, one of the founders of the Outpatient Clinic for Impulse Disorders and Behavioral Addictions at Santa Casa do Rio de Janeiro Hospital, who now runs a private rehabilitation center. “Even in sports betting, the reward can be almost immediate if a bet is made during the match. High-speed, high-intensity stimulation is available 24 hours a day.”
“The problem is now in the palm of your hand,” warns a member of the Gamblers Anonymous (GA) group in Jabaquara, a neighborhood in the south of São Paulo. The man says he started betting on horses during a visit to the São Paulo Jockey Club in 2013, before venturing into other sports and realizing he was trapped in an addiction. Within a decade his gambling cost him two cars, his store, and his family’s apartment. He returned to GA meetings in 2020 after being treated at AMJO and has not gambled for three and a half years. He says he has noticed an increase in demand for the support group.
In addition to concerns about the potential increase in adults with gambling disorder, mental health experts are worried about the future for children and adolescents. Well before betting sites began their rise, Spritzer observed in the national survey from the 2000s that the frequency of teenagers who gambled in Brazil was 6.9%, lower than in countries where gambling was legal. However, the proportion of young people who developed a problematic relationship with gambling was the same (1.6%), according to an article published in the Journal of Gambling Studies in 2011. Using data from the same survey, Carneiro found that the problem progresses much faster among younger people: less than two years after their first bet, they already had a pathological relationship with gambling. This took an average of 12 years for people over 35 years old, as reported in Psychiatry Research in 2014.
“Teenagers’ brains are still maturing, making them more vulnerable to advertising. They find it more difficult to control their impulses and consider the long-term consequences of their decisions,” says Spritzer. “What we are seeing now is like a social experiment with these new forms of gambling,” says Carneiro. “It will take a few years to discover the scale of the problem, but it certainly will not be small.
The twists and turns of gambling legalization This is not the first time that gambling has been legalized in Brazil. The country has a long history of prohibition and permission that has swung from one side to the other depending on the interests of the state and pressure from society, dating back to the colonial period (see timeline). In the last 100 years, the only forms of gambling that have never been banned are horse racing and lotteries. Poker is considered a game of skill rather than chance, although it is not free from a certain degree of randomness.
“In the colonial period, gambling took place in so-called betting houses, which offered various types of games, such as cards, víspora [a type of bingo], and billiards,” says Marcelo Pereira de Mello, a sociologist from Fluminense Federal University (UFF) and author of the book Criminalização dos jogos de azar: A história social dos jogos de azar no Rio de Janeiro (1808-1946) (The criminalization of gambling: The social history of gambling in Rio de Janeiro), published by Juruá in 2017. In the 1830s, the Criminal Code of the Empire of Brazil attempted to put an end to the practice of gambling and its exploitation by private individuals by establishing penalties for people who ran or frequented betting houses. “Despite this, gambling continued at full steam,” says Mello.
Something similar happened with the century-old jogo do bicho (a popular Brazilian lottery-type game). In 1892, seeking to raise funds for the Vila Isabel Zoo in Rio de Janeiro—the first zoo in Brazil—the owner, João Baptista de Vianna Drummond (1825–1897), Baron of Drummond, launched a new lottery. The entrance tickets purchased by visitors included an image of an animal. The first draw took place on July 3, a Sunday. “At around 5 p.m., an engraving of one of the 25 possible animals, which included a cow, a butterfly, and a crocodile, was pulled from a wooden box. That day it was an ostrich, and 23 people took home the cash prize,” says historian Felipe Magalhães of the Federal Rural University of Rio de Janeiro (UFRRJ), author of the book Ganhou, leva!– O jogo do bicho no Rio de Janeiro (1890–1960) (You win, take it! – The jogo do bicho lottery in Rio de Janeiro; Editora FGV/FAPERJ, 2011).
The idea was a success and draws began to take place from Tuesday to Sunday. A short time later, the baron set up a stall in the city center, and many people bought tickets just to gamble. In 1895, the local authorities prohibited the zoo’s lottery, but the trend had already spread throughout the city. The game later underwent various transformations until it arrived at the format that remains to this day. It became a criminal offense nationwide for individuals to run the game following the passing of Law 3,688 on October 3, 1941.
The story above was published with the title “The harmful effects of online gambling” in issue 344 of October/ 2024.
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