Twenty-nine thousand Iowans struggled with a gambling addiction in 2015, but only 600 called the state's hotline, 1-800-BETS OFF.
That's a "huge disparity," said Eric Preuss, program manager for the Iowa Gambling Treatment Program through the Iowa Department of Public Health.
Preuss, who has worked in substance abuse treatment since the late 1980s, said the stigma surrounding a gambling habit is higher than other addictions. The rate of suicide is higher, too, he said.
"There is an extreme amount of shame and guilt," Preuss said. "They suffer in silence. These are people that are hurting. It takes courage to pick up the phone."
About 68 percent of Iowans, or 1.6 million people, have gambled in the past 12 months, statistics show. Of those, 85 percent stay within their means and very rarely or never exhibit problem behaviors.
"They seem to just have fun with it," Preuss said.
The 29,000 who struggle with a gambling addiction represent 1.2 percent of the state's population. Preuss said another 13 percent are considered "at risk," because they have exhibited at least one of nine criteria for determining problem gambling. That could include losing a large sum of money in one bet or lying to your spouse about where you were.
Blair Brown, a problem gambling counselor in Davenport, said where she often sees the addiction beginning to form is when the person is trying to duplicate the high he or she felt after winning the first time.
"They had a big win the first time gambling," Brown said. "They're chasing that high over and over again."
She is concerned that as gambling continues to become more available the risk of relapse will grow among those who already are struggling with the addiction.
Preuss shares the concern, too.
In 1991-92, the Quad-Cities went from zero to three riverboat casinos. Today, Iowa has 22 casinos and 2,400 Iowa Lottery outlets, and the state issues more than 2,800 social and charitable gaming licenses, such as for a church bingo event.
"Gambling has always existed," Preuss said. "Poker always existed. But now with the stuff you can do on smartphones, and there is talk of fantasy sports being legalized, what existed 25 years ago looks much different today."