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Inaguma T, Misumi S, Funatogawa T, Nemoto T, Harima H, Mizuno M. Does the loot box open the door to addiction? A case report of gaming disorder with high charges for loot box purchases. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2024; 3:e167. [PMID: 38868486 PMCID: PMC11114398 DOI: 10.1002/pcn5.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/19/2023] [Accepted: 12/27/2023] [Indexed: 06/14/2024]
Abstract
Background A loot box is a gaming term for an electronic lottery that randomly provides items that enhance the gaming experience. In recent years, loot boxes have been increasingly discussed as a risk factor of gaming disorder (GD). While they may be purchased for a few dollars at a time, the cumulative expenses resulting from their addictive use have become a social problem. Case Presentation This paper presents a case of GD involving a substantial financial burden incurred through the use of a Japanese loot box called Gacha. Conclusion The randomness in the selection of virtual items in loot boxes resembles gambling, triggering the reward system and contributing to an addiction to purchasing more loot boxes. For therapeutic purposes, understanding the motivations behind purchasing loot boxes and considering individual developmental characteristics are crucial to helping patients find satisfaction and a sense of achievement in activities besides gaming.
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Affiliation(s)
- Tokuya Inaguma
- Department of PsychiatryTokyo Metropolitan Matsuzawa HospitalTokyoJapan
- Department of NeuropsychiatryToho University Graduate School of MedicineTokyoJapan
| | - Sumiko Misumi
- Department of PsychiatryTokyo Metropolitan Matsuzawa HospitalTokyoJapan
| | - Tomoyuki Funatogawa
- Department of NeuropsychiatryToho University Graduate School of MedicineTokyoJapan
| | - Takahiro Nemoto
- Department of NeuropsychiatryToho University Graduate School of MedicineTokyoJapan
| | - Hirohiko Harima
- Department of PsychiatryTokyo Metropolitan Matsuzawa HospitalTokyoJapan
| | - Masafumi Mizuno
- Department of PsychiatryTokyo Metropolitan Matsuzawa HospitalTokyoJapan
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Close J, Spicer SG, Nicklin LL, Uther M, Whalley B, Fullwood C, Parke J, Lloyd J, Lloyd H. Exploring the relationships between psychological variables and loot box engagement, part 1: pre-registered hypotheses. ROYAL SOCIETY OPEN SCIENCE 2023; 10:231045. [PMID: 38126068 PMCID: PMC10731324 DOI: 10.1098/rsos.231045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023]
Abstract
Loot boxes are purchasable randomized rewards in video games that share structural and psychological similarities with gambling. Systematic review evidence has established reproducible associations between loot box purchasing and both problem gambling and problem video gaming, perhaps driven by a range of overlapping psychological processes (e.g. impulsivity, gambling-related cognitions, etc.) It has also been argued that loot box engagement may have negative influences on player financial and psychological wellbeing. We conducted a pre-registered survey of 1495 loot box purchasing gamers (LB cohort) and 1223 gamers who purchase other, non-randomized game content (nLB cohort). Our survey confirms 15 of our 23 pre-registered hypotheses against our primary outcome (risky loot box engagement), establishing associations with problem gambling, problem gaming, impulsivity, gambling cognitions, experiences of game-related 'flow' and specific 'distraction and compulsion' motivations for purchase. Results with hypotheses concerning potential harms established that risky loot box engagement was negatively correlated with wellbeing and positively correlated with distress. Overall, results indicate that any risks from loot boxes are liable to disproportionately affect various 'at risk' cohorts (e.g. those experiencing problem gambling or video gaming), thereby reiterating calls for policy action on loot boxes.
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Affiliation(s)
- James Close
- Peninsula Medical School, Faculty of Health, University of Plymouth, Plymouth PL4 8AA, UK
- School of Psychology, University of Plymouth, Plymouth PL4 8AA, UK
| | - Stuart Gordon Spicer
- Community and Primary Care Research Group (CPCRG), ITTC Building, Davy Road, Plymouth Science Park, Derriford, Plymouth PL6 8BX, UK
| | - Laura Louise Nicklin
- School of Education, Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton WS1 3BD, UK
| | - Maria Uther
- Enterprise and Innovation, Faculty of Health, Education and Life Sciences, Birmingham City University, Seacole Building, Edgbaston Campus, Birmingham, UK
| | - Ben Whalley
- School of Psychology, University of Plymouth, Plymouth PL4 8AA, UK
| | - Chris Fullwood
- School of Natural, Sport and Social Sciences, University of Gloucestershire, Cheltenham, UK
| | | | - Joanne Lloyd
- Cyberpsychology Research Group, Department of Psychology, Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton WV1 1LY, UK
| | - Helen Lloyd
- School of Psychology, University of Plymouth, Plymouth PL4 8AA, UK
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Lee JK, Lee SB. Online Game Speculative Experiences and Problem Gambling among Adolescents in South Korea: Dual Mediation Effects of Irrational Beliefs and Gambling Attitude. Healthcare (Basel) 2023; 11:healthcare11091226. [PMID: 37174768 PMCID: PMC10177881 DOI: 10.3390/healthcare11091226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/21/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
This study aimed to test the effect of online gaming speculative experiences on problem gambling via irrational beliefs in and attitudes toward gambling. Data were obtained from the Korea Center on Gambling Problems, and participants comprised 386 adolescents (female 168, male 218) who currently play online games and have experience with betting games or gambling. The main findings are that (i) online game speculative experience positively influenced gambling attitude (B = 0.172, p < 0.001); (ii) online game speculative experience positively influenced irrational beliefs (B = 0.194, p < 0.001); (iii) online game speculative experience (B = 0.140, p < 0.001), gambling attitude (B = 0.294, p < 0.01), and irrational beliefs (B = 0.689, p < 0.001) was positively correlated with problem gambling. Also, the mediation effect was statistically significant. Policy and practical measures to assess the impact of gaming facilitating speculative experience and for intervening in gambling problems in adolescents are discussed. The results suggest the need to screen, educate, and provide short-term interventions to adolescents with online game speculative experience. Strict assessments, regulation, and surveillance of speculative elements can preserve online gaming as a healthy play culture for the adolescents.
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Affiliation(s)
- Jae-Kyoung Lee
- Department of Child Studies & Social Welfare, Andong National University, Andong-si 760-749, Republic of Korea
| | - Soo-Bi Lee
- Division of Social Welfare and Child Studies, Daejin University, Pocheon-si 487-711, Republic of Korea
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Delfabbro P, King D. The evolution of young gambling studies: digital convergence of gaming, gambling and cryptocurrency technologies. INTERNATIONAL GAMBLING STUDIES 2023. [DOI: 10.1080/14459795.2023.2171469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Paul Delfabbro
- School of Psychology, University of Adelaide, Adelaide, Australia
| | - Daniel King
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia
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Loot box purchases and their relationship with internet gaming disorder and online gambling disorder in adolescents: A prospective study. COMPUTERS IN HUMAN BEHAVIOR 2023. [DOI: 10.1016/j.chb.2023.107685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Primi C, Sanson F, Vecchiato M, Serra E, Donati MA. Loot boxes use, video gaming, and gambling in adolescents: Results from a path analysis before and during COVID-19-pandemic-related lockdown in Italy. Front Psychol 2022; 13:1009129. [PMID: 36237679 PMCID: PMC9551606 DOI: 10.3389/fpsyg.2022.1009129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/01/2022] [Indexed: 11/13/2022] Open
Abstract
Loot Boxes (LBs), i.e., virtual items embedded within video games with numerous features reminiscent of gambling, are increasingly widespread among adolescents. LB use is associated with problem gambling in youth, but few studies have been conducted on the association between LB use and gambling behavior considering adolescents. Thus, the mechanisms underlying this relationship are not clear. As LB use is a significant and positive risk factor for video gaming severity, and video gaming is associated with problem gambling, we hypothesized that LB use would be related to gambling frequency and problem gambling through the intermediary role of video gaming frequency and problem video gaming. We tested our hypothesis before COVID-19-pandemic-related lockdown and during COVID-19-pandemic-related lockdown, in Italy. Study 1 was conducted with 1,078 high school students (39% boys, mean age = 16.46, SD = 1.28) before COVID-19-pandemic-related lockdown, and Study 2 was conducted with 1,204 high school students (57% boys, mean age = 15.62, SD = 0.64) during COVID-19-pandemic-related lockdown. A path analysis was carried out to analyze the significance of indirect effects from LB use to gambling behavior and problem gambling through video gaming and problem video gaming. In both the studies, results showed that LB use exerted significant and positive direct effects on video gaming frequency, problem video gaming, and gambling frequency. Moreover, LB use had indirect significant and positive effects on problem gambling through video gaming frequency, problem video gaming, and gambling frequency. Findings attest that LB use can be related to problem gambling through a greater involvement in videogames. Thus, a specific subtype of young gamblers can develop Gambling Disorder symptoms from the use of LBs and through an intense use of video games. Practical implications for prevention and treatment are discussed.
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Affiliation(s)
- Caterina Primi
- NEUROFARBA Department, University of Florence, Florence, Italy
| | | | - Marta Vecchiato
- Addictions Department, Azienda ULSS n. 4 Veneto Orientale, Venice, Italy
| | - Emilia Serra
- Addictions Department, Azienda ULSS n. 4 Veneto Orientale, Venice, Italy
| | - Maria Anna Donati
- NEUROFARBA Department, University of Florence, Florence, Italy
- *Correspondence: Maria Anna Donati,
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Duan Y, Xu S, Wang Y, Zhang Y, Wang Y, Chen R. Blind box over-engagement and suicide risk among adolescents and young adults: Results of a large-scale survey. EClinicalMedicine 2022; 51:101575. [PMID: 35875818 PMCID: PMC9304904 DOI: 10.1016/j.eclinm.2022.101575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/01/2022] [Accepted: 07/01/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Gambling appears to be an independent risk factor for suicide among the young population worldwide. Blind boxes are collectable toys packed randomly in the box, which share certain similarities with gambling and are popular among the young population. This is the first study that examined the association between blind box engagement and suicide risk in the young population, the leading consumption group of blind boxes. METHODS This study is part of a large-scale, cross-sectional study using convenience sampling conducted Oct 26 to Nov 18, 2021, which covered all the university and college students in the Jilin province, China. A total of 73,206 participants completed the survey with valid data for the current study (male: N = 28,762; female: N = 44,444; Mean age = 19·59). Participants' blind box engagement, suicide risk, depression, anxiety, alcohol use, smoking habit, and sociodemographic characteristics were assessed. First, we used univariate and multivariable binary logistic regression models to examine the relationship between blind box engagement and suicide risk in all participants. Second, we tested whether depression and anxiety would mediate the association between blind box engagement and suicide risk. Third, we analysed the association between "Frequency (i.e., frequency of blind box engagement)," "Bet (i.e., expenditure on the blind box that exceeds affordability)," "Tolerance (i.e., level of addiction)," "Borrowed (i.e., the amount of money borrowed for blind box engagement)," and suicide risk in the group with blind box engagement history. FINDINGS 4,195 participants (5·73%) have engaged in blind boxes, with 3,255 females (77·59%) and 940 males (22·41%). In the univariate models, binary logistic regression showed that blind box engagement was associated with suicide risk in both male and female participants (male: OR = 2·21, 95% CI = 1·86-2·63; female: OR = 1·64, 95% CI = 1·50-1·78). In the multivariable models, after controlling age, subjective socioeconomic status, per capita disposable income, alcohol use, and smoking habit, blind box engagement still was associated with suicide risk across genders (male: OR = 2·25, 95% CI = 1·89-2·68; female: OR = 1·58, 95% CI = 1·45-1·73). Depression (male: indirect effect = 0·31, SE = 0·04, p < 0·001; female: indirect effect = 0·20, SE = 0·02, p < 0·001) and anxiety (male: indirect effect = 0·26, SE = 0·03, p < 0·001; female: indirect effect = 0·13, SE = 0·02, p < 0·001) mediate the association between blind box engagement and suicide risk. Within the blind box engagement group, forward binary logistic regression revealed that "Tolerance" was associated with participants' suicide risk in both males (p = 0·001) and females (p < 0·001); "Borrowed" (p = 0·019) alone was associated with the male participants' suicide risk. INTERPRETATION Our findings showed that blind box over-engagement is positively associated with suicide risk in both young males and females, and this association persisted after adjusting for influencing factors. In spite of the limitations in this study (e.g., cross-sectional, convenience sampling), current findings can assist policymakers in developing regulations for such a prosperous youth-dominant consumption industry while protecting youth's mental health worldwide. FUNDING None.
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Affiliation(s)
- Yinan Duan
- Vanke School of Public Health, Tsinghua University, 100084 Beijing, China
| | - Shicun Xu
- Northeast Asian Research Center, Jilin University, Changchun 130012, China
- Department of Population, Resources and Environment, Northeast Asian Studies College, Jilin University, Changchun 130012, China
- China Center for Aging Studies and Social-Economic Development, Jilin University, Changchun 130012, China
- Corresponding authors.
| | - Yinzhe Wang
- Vanke School of Public Health, Tsinghua University, 100084 Beijing, China
| | - Yanwen Zhang
- Vanke School of Public Health, Tsinghua University, 100084 Beijing, China
| | - Yuanyuan Wang
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, China; School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou 510000, China
- Corresponding authors.
| | - Runsen Chen
- Vanke School of Public Health, Tsinghua University, 100084 Beijing, China
- Institute for Healthy China, Tsinghua University, 100084 Beijing, China
- Corresponding authors.
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Regulating Gambling-Like Video Game Loot Boxes: a Public Health Framework Comparing Industry Self-Regulation, Existing National Legal Approaches, and Other Potential Approaches. CURRENT ADDICTION REPORTS 2022. [DOI: 10.1007/s40429-022-00424-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Abstract
Purpose of Review
Loot boxes are gambling-like monetisation mechanics in video games that are purchased for opportunities to obtain randomised in-game rewards. Gambling regulation is increasingly being informed by insights from public health. Despite conceptual similarities between loot boxes and gambling, there is much less international consensus on loot box regulation. Various approaches to regulating loot boxes are reviewed via a public health framework that highlights various trade-offs between individual liberties and harm prevention.
Recent Findings
Many countries have considered regulation, but as yet only a few countries have taken tangible actions. Existing regulatory approaches vary greatly. More restrictively, Belgium has effectively ‘banned’ paid loot boxes and prohibits their sale to both children and adults. In contrast, more liberally, China only requires disclosure of the probabilities of obtaining potential rewards to provide transparency and perhaps help players to make more informed purchasing decisions. Most other countries (e.g., the UK) have adopted a ‘wait-and-watch’ approach by neither regulating loot box sales nor providing any dedicated consumer protection response. Industry self-regulation has also been adopted, although this appears to elicit lower rates of compliance than comparable national legal regulation.
Summary
Many potential public health approaches to loot box regulation, such as expenditure limits or harm-reducing modifications to loot box design (e.g., fairer reward structures), deserve further attention. The compliance and clinical benefits of existing interventions (including varying degrees of regulation, as adopted by different countries, and industry self-regulation) should be further assessed. The current international variation in loot box regulation presents opportunities to compare the merits of different approaches over time.
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Hing N, Rockloff M, Russell AMT, Browne M, Newall P, Greer N, King DL, Thorne H. Loot box purchasing is linked to problem gambling in adolescents when controlling for monetary gambling participation. J Behav Addict 2022; 11. [PMID: 35385397 PMCID: PMC9295209 DOI: 10.1556/2006.2022.00015] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 03/10/2022] [Accepted: 03/15/2022] [Indexed: 12/04/2022] Open
Abstract
Background and aims Purchasing loot boxes in digital games is akin to gambling as it involves risking money for a chance-based reward of uncertain value. Research has linked buying loot boxes to problem gambling amongst adolescents, but has not examined co-occurring gambling participation. This study examined links between loot box purchasing and problem gambling amongst adolescents while controlling for monetary gambling participation. Methods Two survey samples of Australians aged 12-17 years were recruited through advertisements (n = 843) and online panels (n = 826). They included n = 421 and n = 128 adolescents, respectively, who met criteria for problem gambling. Results Past-month loot box purchasing was significantly related to gambling problems in bivariate analyses. When including age, gender and past-month monetary gambling, loot box purchases were still associated with at-risk and problem gambling in both samples. As expected, these other predictors attenuated the predictive value of recent loot box purchases in relation to gambling problems. The odds-ratios, nevertheless, were still in the predicted direction and remained significant. When controlling for monetary gambling, age and gender, recent loot box purchasing increased the odds of problem gambling 3.7 to 6.0 times, and at-risk gambling 2.8 to 4.3 times. Discussion and conclusions While causal relationships between loot box purchasing and problem gambling remain unclear, the results indicate that loot boxes disproportionately attract adolescents experiencing gambling problems, adding to the financial stress already caused by gambling. Consumer protection measures, youth and parental education, and age restrictions on loot box games are needed to protect young people.
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Affiliation(s)
- Nerilee Hing
- Experimental Gambling Research Laboratory, School of Health, Medical and Applied Sciences, CQUniversity, Australia
| | - Matthew Rockloff
- Experimental Gambling Research Laboratory, School of Health, Medical and Applied Sciences, CQUniversity, Australia
| | - Alex M. T. Russell
- Experimental Gambling Research Laboratory, School of Health, Medical and Applied Sciences, CQUniversity, Australia
| | - Matthew Browne
- Experimental Gambling Research Laboratory, School of Health, Medical and Applied Sciences, CQUniversity, Australia
| | - Philip Newall
- Experimental Gambling Research Laboratory, School of Health, Medical and Applied Sciences, CQUniversity, Australia
| | - Nancy Greer
- Experimental Gambling Research Laboratory, School of Health, Medical and Applied Sciences, CQUniversity, Australia
| | - Daniel L. King
- College of Education, Psychology, and Social Work, Flinders University, Australia
| | - Hannah Thorne
- Experimental Gambling Research Laboratory, School of Health, Medical and Applied Sciences, CQUniversity, Australia
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