Distinguishing between gaming and gambling activities in addiction research

Associations between Marketing Exposure, In-game Purchases, Problem Gaming, Simulated Gambling, and Psychological Distress among Adolescents

This study examined the relationships between marketing exposure, in-game purchase, problem gaming, online simulated gambling game playing, and psychological distress. Data were obtained from a sample of 2,595 seventh-grade students from 30 middle schools in Taiwan. A self-administered questionnaire was conducted in 2020. The results indicated that 94% of adolescents engage in online gaming, with 38% making in-game purchases, and 9% playing online simulated gambling games. The multiple regression results showed that adolescents who are exposed to higher levels of gaming marketing, influenced by advertising effects, involved in in-game purchases, and have lower levels of active parental mediation were more likely to experience problem gaming. Adolescents who have increased exposure to gambling game marketing, are influenced by advertising effects, are involved in in-game purchases, and who are experiencing problem gaming were more likely to engage in online simulated gambling game playing and token purchasing. Involvement in in-game purchases, problem gaming, and playing online simulated gambling games were associated with higher levels of psychological distress and poor sleep quality. In conclusion, the results of this study link adolescents' exposure to marketing with their involvement in in-game purchases, problem gaming, and engaging in online simulated gambling.

Problematic Gaming and Gambling: A Systematic Review of Task-Specific EEG Protocols

Even though gaming and gambling bear similar problematic behavioral aspects, there are no recognizable neurophysiological biomarkers or features characterizing and/or distinguishing these conditions. A systematic review of the literature with a focus on methods was performed in PubMed, Scopus, Web of Science (Web of Science Core Collection), EBSCOhost Research Databases (APA PsycINFO; APA PsycArticles; OpenDissertations; ERIC) databases. Following search terms were used to search the databases: ERP, "event related potential*", EP, "evoked potential*", SS, "steady state", EEG, electroencephal*; gam*. Data about the participants (total number, gender, age), main aim of the study and information about the experimental setup (experimental task description, stimuli used, ERPs measured (latency windows and placement of the electrodes), process evaluated) was extracted. A total of 24 studies were revised (problematic gaming - 16, pathological gambling - 8). The experimental protocols could be grouped into 3 main target domains (Cue-reactivity, General Information processing and Reward Processes & Risk Assessment). Sample-related limitations (small sample sizes, gender differences, differences between the groups regarding potential confounding variables) and heterogeneity regarding the experimental tasks, implementation and interpretation reviewed. Gambling-related research is highly focused on the investigation of the reward-related processes, whereas gaming-related research is mostly focused on the altered aspects of more general information processing. A vast heterogeneity regarding the ERP experimental paradigms being used and lack of clear guidelines and standardized procedures prevents identification of measures capable to reliably discriminate or characterize the population susceptible to addictive behavior or being able to diagnose and monitor these disorders.

Gambling and virtual reality: unraveling the illusion of near-misses effect

Introduction

Studying gambling behavior is a crucial element in reducing the impact of problem gambling. Nevertheless, most current research is carried out in controlled laboratory settings rather than real-life situations, which raises concerns about how applicable the findings are in the broader context. Virtual reality (VR) has proven to be a valuable tool and has been utilized in various experimental scenarios. A limited number of studies have employed VR to investigate gambling behaviors, and few have explored them in an older adolescent context.

Methods

This study examined the behavioral and physiological effects of gambling behavior, including problem gambling, gaming addiction, and risk-taking decision-making in a sample of 36 high-school students aged between 18 to 20 years using an ad-hoc constructed VR scenario designed to simulate a slot-machine platform.

Results

The behavioral results highlighted that participants reporting more problem gambling were sensitive to near-misses: i.e., they bet more after near-misses than after losses. This result may reflect the false belief that gamblers, after near-misses, are closer to winning. Physiological data showed that participants exhibited heart rate deceleration during the anticipation of the outcome, which has been suggested to represent a marker of feedback anticipation processing and hyposensitivity to losses.

Discussion

Overall, this study provides evidence for a new VR tool to assess gambling behaviors and new insights into gambling-related behavioral and physiological factors. Implications for the treatment of problem gambling are discussed.

The Price of Gambling: Examining Gambling Disorders

Gambling disorders are a serious public health problem. This manuscript will provide a comprehensive overview on this topic. Gambling disorder involves repeated patterns of gambling behaviors, that result in significant distress or impairment in a person's interpersonal relationships, employment, educational/career opportunities, and finances over a period of 12 months. Gambling is defined as an activity that involves risking something of value with the hopes of acquiring something of greater value. Comparable to substance use disorders, individuals with a gambling disorder may be unsuccessful in exercising control over their problematic behavior, engage in the behavior despite negative consequences, and have preoccupations/cravings to gamble. Gambling disorder has higher comorbidity rates of mental disorders including depression, anxiety, substance use, and personality disorders. Gamblers rarely seek treatment. Treatments must be tailored to the individual which may include psychological interventions, cognitive behavioral therapy, gamblers anonymous, and psychopharmacological agents such as selective serotonin reuptake inhibitors, mood stabilizers, and opioid antagonists to treat clinical symptoms.

Impaired Control Over Gaming Scale (ICOGS): Development, confirmatory factor validation, and psychometric evaluation

Background and aims

The concept of impaired control is central to addictive disorders, including gaming disorder in the DSM-5 and ICD-11. Impaired control refers to the recurrent inability to resist impulses to engage in certain activities or behaviours and the failure to limit or stop this engagement. Although numerous screening tools for gaming disorder symptoms have been developed, these instruments have limited capacity for measuring the nature and extent of impaired control. To address this limitation, the present study reports on the creation of the Impaired Control Over Gaming Scale (ICOGS), an 8-item screening tool to assess gaming-related impaired control.

Methods

A total of 513 gamers, including 125 gamers (24.3%) who met the DSM-5 criteria for gaming disorder, were recruited from Prolific, an online crowd-sourcing platform.

Results

The ICOGS demonstrated promising psychometric properties. Exploratory and confirmatory factor analysis using two samples provided robust support for a 2-factor model and high internal consistency of the scale. ICOGS scores were significantly and positively associated with gaming disorder symptoms, gaming-related harms, gaming frequency, psychological distress, and neuroticism. Using receiver operating characteristic analysis, the ICOGS differentiated between non-problem gamers and those who met the criteria for GD.

Discussion and conclusions

Overall, the ICOGS appears to be a valid and reliable scale for use in studies of problem gaming, and may be useful for assessing outcomes of GD interventions that employ self-regulation and stopping techniques to reduce or eliminate problem gaming behavior.

Annual Research Review: Emergence of problem gambling from childhood to emerging adulthood: a systematic review

BACKGROUND

The risk for problematic gambling and associated high-risk behaviors is elevated during adolescence and emerging adulthood. Activities with gambling-like features and novel forms of gambling may place youth at an increased risk for problem gambling.

AIM AND METHOD

The aim of this review is to provide an overview of the association between both activities with gambling-like features and novel gambling activities and problem gambling among youth while examining the role of psychopathology and cognitive processes. Six databases (PsychINFO, MEDLINE, PubMed, Social Work Abstracts, Technology Collection, and Scopus) were searched in November 2021 for peer-reviewed articles investigating the association between the aforementioned variables among youth up to the age of 25 years. Risk of bias was assessed using the Observational Study Quality Evaluation.

FINDINGS

Forty-five articles were included in the review. Positive associations were observed between engagement in activities with gambling-like features (e.g., video games, social casino games, loot boxes) and problem gambling. Increased involvement with novel forms of gambling (e.g., online sports betting, fantasy sports, and esports betting) were also associated with a greater risk for problematic gambling. Males reported higher rates of engagement in these activities and a greater risk of problem gambling than females. Impulsivity, risk taking, cognitive distortions, and specific emotional vulnerabilities were associated with an increased risk of problem gambling.

CONCLUSIONS

Despite the need for additional longitudinal research controlling for relevant confounders, these findings underline how engagement in activities with gambling-like features are relevant in the developmental trajectory toward problem gambling.

Self-Generated Motives of Social Casino Gamers

Social casino games have achieved widespread popularity, and are accessed by more than 85 million people each day. Yet, why people play social casino games is largely unknown. To address this gap, an inductive approach was taken to better understand the motives for playing social casino games, as well as the motives for transitioning from social casino gaming to gambling and vice versa. To this end, 269 social casino gamers were asked to provide a ranked list of their motives for playing social casino games. Additionally, we asked participants their motivations for transitioning from gambling to social casino gaming (n = 202) or vice versa (n = 67). A total of 795, 605, and 201 unique responses describing motives for playing social casino games, transitioning from social casino gaming to gambling, and transitioning from gambling to social casino gaming, respectively, were analyzed using a thematic content analysis. The most frequently endorsed motive for playing social casino games was for enhancement (e.g., fun, challenge). Participants also noted playing to earn rewards, including money, and for social reasons. Several motives linked social casino game play to gambling. These included: to hone gambling-related 'skills', a desire to transition to gambling to win real money, and as a gambling harm-reduction strategy. Motives for playing social casino games did not differ significantly between those who first gambled and then transitioned to social casino gaming and vice versa, suggesting that once people begin playing social casino games, they have similar motives for continued engagement. The present study contributes to understanding the immense popularity of social casino games and their links to gambling.

Is there such a thing as gambling dual disorder? Preliminary evidence and clinical profiles

Patients with gambling disorder (GD) frequently present other mental disorders, such as substance use disorder (SUDs), attention deficit/hyperactivity disorder (ADHD), mood disorders, and impulse-control disorders. We propose that GD should not be conceptualized as a single nosological entity, but rather as a gambling dual disorder (GDD). This study aims to provide further evidence of the co-occurrence of GD and other mental disorders in routine clinical practice and to identify different clinical profiles of severity. This descriptive, cross-sectional, and observational study included 116 patients with GD who were undergoing treatment in a specialized center. The MULTICAGE-CAD 4 and South Oaks gambling screen questionnaires confirmed the presence of GD in 97.4% and 100% of the patients, respectively. Other addictive behaviors such as compulsive spending, Internet, video games, or SUD (59.5%, 27.6%, 11.2%, and 13.8%, respectively) were also identified. The most used substances were tobacco (42.2%) and alcohol (5.2%). Half of the patients suffered from ADHD, 30.2% showed moderate or severe depression, and 17.2% suffered from a social anxiety problem. The majority (76.7%) also presented a phenotype with high impulsiveness. The cluster analysis identified two different clinical profiles of severity in patients with GDD. One profile showed higher severity of other mental disorders (ADHD, depression, anxiety, SUD, or insomnia), impulsivity, general psychopathological burden, and disability. In conclusion, our study provides further evidence on the co-occurrence of GD and other mental disorders supporting the GDD existence, shows impulsiveness as a vulnerability factor for GD, and identifies two clinical severity profiles.

What’s in the box? Exploring UK players’ experiences of loot boxes in games; the conceptualisation and parallels with gambling

Loot boxes are a popular mechanic within many video games, but it remains unclear if some forms of loot boxes can be seen of as gambling. However, the perspectives of players are often neglected, such as whether they see them as ‘fair’ game elements and how closely they feel this aligns with gambling. In this paper, we synthesise a conceptualisation for loot boxes through players’ actual experience and explore if there are any parallels with gambling. Twenty-one participants who played video games took part in the research through either an interview or online survey. Thematic analysis suggested that six themes were core to exploring loot boxes: Random Chance Effects, Attitudes Towards Content, Implementation, Parallels with Gambling, Game Design, and The Player. The results suggested both indirect and direct parallels with gambling from the players experiences. Implications of game design and classifying loot boxes as gambling are discussed in relation to game design and risk factors of gambling and purchasing behaviour.

Media reporting on deaths due to suicide attributed to gaming in digital news: A case of misrepresentation and missed opportunities

INTRODUCTION

We aimed to study the attributes of the digital media reports on death due to suicide attributed to gaming. We also aimed to assess the overlap between the 'gaming' and 'gambling' activities in these media reports.

MATERIAL AND METHODS

The online media reports on the theme of deaths due to suicides attributed to digital gaming in India were retrieved using the Google News online platform. The news reports were searched in the tor browser using the keywords "gaming suicide India" or "gaming death India".

RESULTS

Gaming was identified as the direct reason for death due to suicide in an overwhelming majority (94.8%) of news reports. A large proportion of the reports failed to report death due to suicide in a responsible manner following the guidelines for responsible media reporting of suicide given by the World Health Organization (WHO). Stakeholders' views and opinions mentioned in the news reports included parents, caregivers or friends (17.5%), other gamers (3.1%), gaming industry (8.3%), and mental health professionals (5.2%). Around 24 per cent reports advocated a ban on 'gaming'.

CONCLUSIONS

Based on our observations we recommend responsible reporting on death due to suicide in the online news. Also, there should be a more rigorous and systematic attempt before reaching at the conclusion while attributing these deaths to gaming. Finally, the news reports should ensure that the boundaries between 'gaming' and 'gambling' do not get blurred.

Factors related to the dual condition of gambling and gaming disorders: A path analysis model

BACKGROUND AND AIMS

Gaming disorder has experienced rapid growth in the last decade among youth and adult populations, in parallel to the expansion of the videogame industry. The objective of this study was to explore the underlying process to explain the dual diagnosis of gaming with gambling disorder.

METHODS

The sample included n = 117 patients who met clinical criteria for gaming disorder, recruited from a tertiary care unit specialized in the treatment of behavioral addictions. Path analysis (implemented through structural equation modeling) assessed the direct and mediational mechanisms between the dual condition of gaming + gambling disorder and sociodemographic variables and personality traits.

RESULTS

The comorbid gaming + gambling disorder was met for 14.5% of the participants (additionally, 6.0% of the sample also met criteria for problematic gambling). The dual diagnosis was directly related to an older age at onset of the addiction problems, a higher level of the novelty seeking trait and being in active work. Employment status also mediated the relationship between persistence levels and chronological age. Greater psychopathological distress was related to females, higher levels of harm avoidance and persistence and lower levels of self-directedness.

CONCLUSIONS

The results of this study provide empirical evidence for the specific factors that increase the likelihood of the dual gaming + gambling disorder. Clinical settings should consider these features to improve gaming diagnosis and treatment. Preventive programs should also be focused on the most vulnerable groups to prevent onset and progression of this comorbid condition.

Profile of Treatment-Seeking Gaming Disorder Patients: A Network Perspective

The increasing presence of gaming disorder in recent years has led to major efforts to identify the specific predictors that have a high impact on the profile of people seeking treatment for this mental condition. The purpose of this study was to explore the network structure of the correlates of gaming disorder considering sociodemographic features and other clinical symptoms. Network analysis was applied to a sample of patients who met clinical criteria for gaming disorder (n = 117, of ages ranging from 15 to 70 yrs-old). Variables considered in the network included sex, age, socioeconomic position, global emotional distress, age of onset and duration of the gaming disorder, personality traits and the presence of other addictive behaviors (tobacco, alcohol and behavioral addictions). The central nodes in the network were global psychological distress, chronological age, and age of onset of gaming related problems. Linkage analysis also identified psychopathological status and age as the variables with the most valuable information in the model. The poorest relevance in the analysis was for the duration of gaming problems and socioeconomic levels. Modularity analysis grouped the nodes within four clusters. Identification of the variables with the highest centrality/linkage can be particularly useful for developing precise management plans to prevent and treat gaming disorder related problems.

Pay-to-Win Gaming and its Interrelation with Gambling: Findings from a Representative Population Sample

Pay-to-Win gaming describes a common type of video game design in which players can pay to advance in the game. The frequency and value of payments is unlimited, and payments are linked to players' competitiveness or progress in the game, which can potentially facilitate problematic behavioral patterns, similar to those known from gambling. Our analyses focus on assessing similarities and differences between Pay-to-Win and different forms of gambling. Based on a survey among 46,136 German adult internet users, this study presents the demographic and socio-economic profile of (1) Pay-to-Win gamers who make purchases in such games, (2) heavy users who conduct daily payments, and (3) gamers who are also gamblers. Motives for making payments were assessed and participation, frequency and spending in gambling by Pay-to-Win gamers are presented. To assess the similarity of Pay-to-Win gaming and gambling, we tested whether Pay-to-Win participation, frequency of payments and problematic gaming behavior are predictors for gambling and cross-tested the opposite effects of gambling on Pay-to-Win. We find that Pay-to-Win gamers are a distinct consumer group with considerable attraction to gambling. High engagement and problematic behavior in one game form affects (over)involvement in the other. Common ground for Pay-to-Win gaming and gambling is the facilitation of recurring payments.

The Role of Virtual Communities in Gambling and Gaming Behaviors: A Systematic Review

Gambling opportunities are facilitated by the growth of the Internet and social media platforms. Digital games also increasingly include monetary features, such as microtransactions, blurring the line between gambling and gaming. The Internet provides a variety of virtual communities for gamblers and gamers, but comprehensive research on these communities and their relevance in gambling and monetary gaming behaviors remains scarce. This paper summarizes research of online gambling and monetary gaming communities based on a systematic literature review. A systematic literature search was conducted from five databases: Scopus, Web of Science, PsycINFO, Social Science Premium Collection, and EBSCOhost. The search was limited to empirical articles that focused on gambling or gaming involving money and examined online interaction between gamblers or gamers. Preliminary search resulted in 1056 articles, from which 55 were selected for the analyses based on pre-determined criteria. According to results, online communities serve different functions in gambling and gaming behaviors. Gambling communities are typically forums for discussing and sharing gambling experiences, strategies, and tips as well as gambling problems, while gaming communities are inherently embedded inside a game being an essential part of the gaming experience. Identification with virtual communities influences gambling behavior and monetary gaming behavior through mechanisms of perceived norms, social influence, and community feedback. Whereas some gambling communities may provide protection from excessive gambling habits, gaming communities seem to solely motivate gaming behavior and purchase intentions. The role of online communities should be acknowledged in prevention and treatment of gambling and gaming problems.

Evaluation of Risk Behavior in Gambling Addicted and Opioid Addicted Individuals

Evidence suggests that both opioid addicted and gambling addicted individuals are characterized by higher levels of risky behavior in comparison to healthy people. It has been shown that the administration of substitution drugs can reduce cravings for opioids and the risky decisions made by individuals addicted to opioids. Although it is suggested that the neurobiological foundations of addiction are similar, it is possible that risk behaviors in opioid addicts may differ in detail from those addicted to gambling. The aim of this work was to compare the level of risk behavior in individuals addicted to opioid, with that of individuals addicted to gambling, using the Iowa Gambling Task (IGT). The score and response time during the task were measured. It was also observed, in the basis of the whole IGT test, that individuals addicted to gambling make riskier decisions in comparison to healthy individuals from the control group but less riskier decisions in comparison to individuals addicted to opioids, before administration of methadone and without any statistically significant difference after administration of methadone-as there has been growing evidence that methadone administration is strongly associated with a significant decrease in risky behavior.

Dorsal striatal functional connectivity changes in Internet gaming disorder: A longitudinal magnetic resonance imaging study

Internet gaming disorder (IGD) is a behavioral addiction involving excessive online game use despite negative psychosocial consequences. Unrestricted online gaming may lead to changes in striatal activity and the relationship between the striatum and other cortical regions. This study investigated structural and functional abnormalities involving the striatum through longitudinal follow-up magnetic resonance imaging (MRI) assessments. Eighteen young males with IGD (mean age: 23.8 ± 2.0 years) and 18 controls (mean age: 23.9 ± 2.7 years) were evaluated. Subjects were reassessed ≥1 year after the first visit (mean follow-up duration: 22.8 ± 6.7 months), using voxel-based morphometry and seed-based resting-state functional connectivity (FC) analyses in seed regions of the dorsal and ventral striatum. Subjects with IGD had smaller gray matter volume (GMV) in the anterior/middle cingulate cortex compared with controls during initial and follow-up assessments. They exhibited decreased FC between the left dorsal putamen and left medial prefrontal cortex (mPFC) compared with controls. They exhibited increased FC strength between the right dorsal putamen and right middle occipital gyrus (MOG) during follow-up. Subjects with IGD showed a significant correlation between changes in the dorsal putamen-MOG FC and gaming time per day. Young males with IGD showed an altered FC pattern in the dorsal striatum during follow-up. FC of the dorsal striatum in IGD increased in the mPFC and decreased in the MOG. These findings showed that IGD was accompanied by weakening of prefrontal control and strengthening of the sensorimotor network, suggesting that uncontrolled gaming may be related with functional neural changes in the dorsal striatum.

Risk Factors of Problem Gaming and Gambling in US Emerging Adult Non-Students: The Role of Loot Boxes, Microtransactions, and Risk-Taking

Video gaming and gambling have increasingly converged with one another (e.g., social casino games). For emerging adults (18-25 years old), who are already at an elevated risk for addictive disorders, this overlap in these activities may increase the likelihood of problematic involvement. At the moment, Internet gaming disorder (IGD) is being considered as a future medical diagnosis by the American Psychiatric Association. Therefore, the purpose of this study was to examine the potential comorbidity between IGD and gambling disorder (GD) in emerging adults, as well as explore if problematic engagement in gaming and gambling may be explained by recent trends in video game microtransactions (e.g., loot boxes) and risk-taking behaviors. An online survey was completed by 300 emerging adult non-students (M_age = 22.79, 49% male) from across the United States. The results revealed that compared to non-gamers, problematic gamers were 6.45 times more likely to problem gamble and compared to non-gamblers, problem gamblers were 5.62 times more likely to problem game. Microtransactions were the major mechanism for the relationship between IGD and GD. Participants with higher severity levels of either disorder demonstrated a greater likelihood of purchasing microtransactions, in addition to displaying significantly less aversion towards several domains of risk-taking. These findings suggest that emerging adults with probable IGD or GD may share common risk factors and patterns of behavior that transdiagnostic treatment approaches may better serve than syndrome-specific models.

Relationship of Internet Gaming Disorder with Psychopathology and Social Adaptation in Italian Young Adults

Internet addiction is currently considered a worldwide problem, with a possible impact on mental health. This study aimed to investigate the prevalence of internet gaming disorder (IGD) among Italian young adults and to explore its association with psychopathological symptoms. Our sample included 566 young adults (324 males/242 females; age: 22.74 ± 4.83 years). Participants were asked to state their favorite games and complete the following questionnaires: the Internet Gaming Disorder Scale Short Form (IGD9-SF); the APA symptom checklist, based on DSM-5 diagnostic criteria for IGD; the Symptom Checklist-90 Revised (SCL-90 R); and the Social Adaptation Self Evaluation Scale (SASS). Use of video games was common among study participants (95% of the sample). Thirty subjects (5.3% of the sample) matched criteria for a clinical diagnosis of IGD. Data showed a positive correlation between higher use of online games and higher levels of depression (r = 0.501), anxiety (r = 0.361) and psychoticism (r = 0.431), and lower family and extra-family relationships (r = −0.383). At linear regression analysis, somatization (p = 0.002), depression (p = 0.001) and sleep disturbances (p = 0.003) were predictors of IGD diagnosis. IGD was significantly associated to mental health distress. Healthcare professionals should be aware of the problematic consequences of online gaming.

Conduct problems and depressive symptoms in association with problem gambling and gaming: A systematic review

BACKGROUND AND AIMS

Behavioral addictions such as gambling and gaming disorder are significant public health issues that are of increasing importance to policy makers and health care providers. Problem gambling and gaming behaviors have been identified as being associated with externalizing and internalizing problems, with theoretical models suggesting that both conduct problems and depressive symptoms may be significant risk factors in the development of problem gambling and gaming. As such, the purpose of this systematic review is to provide an overview of research identifying the relationship between conduct problems, depressive symptoms and problem gambling and gaming among adolescents and young adults.

METHODS

Systematic literature searches in accordance with PRISMA guidelines found 71 eligible studies that met the inclusion criteria, 47 for problem gambling, 23 for problem gaming and one for both problem behaviors.

RESULTS

Based on cross-sectional evidence, both problem gambling and gaming are consistently concurrently associated with conduct problems and depressive symptoms. Longitudinal evidence appears to be clearer for conduct problems as a risk factor for problem gambling, and depressive symptoms as a risk factor for problem gaming. However, both risk factors appear to increase the risk for these problem behaviors.

DISCUSSION AND CONCLUSIONS

Results from the literature review suggest that problem gambling and gaming are associated with the presence of conduct problems and depressive symptoms, with the potential of sharing common etiological factors. Additional research is necessary to confirm these longitudinal relationships with an emphasis on investigating the interaction of both early conduct problems and depressive symptoms.

Online Survey of Gambling Participation and Problem Gambling in Chiba City: Problem Gambling Rates May be Strongly Influenced by the Administration Mode

Prevalence studies on gambling participation and problem gambling in Japan have been limited. To obtain data showing the current status of gambling in Japan, we conducted an online survey on gambling participation and problem gambling among residents in Chiba City. The online data collection was conducted through an Internet research firm. Questionnaires were consisted of personal demographics, past-year gambling participation and severity of gambling risks. The Problem Gambling Severity Index (PGSI) was used as a survey instrument. Males (51.5%) were significantly more likely than females (25.5%) to have gambled in the past year. Problem gamblers (PGSI score ≧ 8) were 7.2% among males and 1.2% among females. Problem gambling was strongly correlated with frequent gambling, preference for Pachinko/Slot and smoking habit. The gambling participation rates were roughly lower than those reported in many overseas jurisdictions, whereas the problem gambling rates were considerably higher than those reported in the same jurisdictions. According to the total consumption model, it would be reasonable to consider that gambling participation rates show a positive correlation with problem gambling rates. The high levels of problem gambling may be due to the administration mode using online sampling, by which answers admitting unapprovable behaviors like problem gambling tend to increase. This suggests that the previous studies using conventional face-to-face or telephone methods may have underestimated problem gambling rates.

Excessive Spending in a "Free-to-Play" Smartphone Game

BACKGROUND AND OBJECTIVES

Although gaming disorder is increasingly recognized, there has been limited consideration of the impact of free-to-play games with in-game purchases, also called microtransactions.

METHODS

Case report (n = 1).

RESULTS

A patient with posttraumatic stress disorder, major depressive disorder in remission, polysubstance use disorders in remission, and opioid use disorder on buprenorphine/naloxone developed gaming disorder (based on International Classification of Diseases, 11th revision) and spent up to 40% of his monthly income on microtransactions within a smartphone game. Treatment consisted of relinquishing access to electronic payment mechanisms, motivational interviewing, and couples therapy.

DISCUSSION AND CONCLUSIONS

The case highlights how in-game purchases may cause patients with gaming disorder to experience financial consequences, and the need for further characterization of the clinical ramifications of microtransactions.

SCIENTIFIC SIGNIFICANCE

To the best of our knowledge, this is the first report in the medical literature of a patient with gaming disorder developing excessive in-game spending from expenditures on microtransactions. (Am J Addict 2020;29:528-530).

Treatments for internet addiction, sex addiction and compulsive buying: A meta-analysis

BACKGROUND AND AIMS

Internet addiction, sex addiction and compulsive buying are common behavioral problems, which share similarities with gambling disorder and substance use disorders. However, little is known about the efficacy of their treatments. The objective of this meta-analysis was to examine the efficacy of the treatments of such problem behaviors, and to draw parallels to gambling disorder and substance use disorders in terms of treatment response.

METHODS

Literature search yielded 91 studies totaling 3,531 participants to provide a comprehensive evaluation of the short-term and long-term efficacy of psychological, pharmacological and combined treatments for internet addiction, sex addiction, and compulsive buying.

RESULTS

Psychological, pharmacological, and combined treatments were associated with robust pre-post improvements in the global severity of internet addiction (Hedges's g: 1.51, 1.13, and 2.51, respectively) and sex addiction (Hedges's g: 1.09, 1.21, and 1.91, respectively). For compulsive buying, psychological and pharmacological treatments were also associated with a large-sized pre-post reduction in global severity (Hedges's g: 1.00 and 1.52, respectively). The controlled pre-post and within-group pre-follow-up effect sizes were in the similar range, with few exceptions. Moderator analyses suggest that psychological interventions are effective for reducing compulsive behaviors, especially when delivered face-to-face and conducted over extended periods of time. Combinations of cognitive-behavioral approaches with medications showed an advantage over monotherapies.

DISCUSSION AND CONCLUSIONS

The results suggest that treatments for common behavioral addictions are effective in the short term, similar to those implemented for gambling disorder and substance use disorders, but more rigorous clinical trials are needed.

Loot box engagement and problem gambling among adolescent gamers: Findings from a national survey

Loot boxes represent a form of microtransaction in many video games that have some resemblance with gambling. Research on this subject is still in its infancy, and particular there are few studies involving young people. Using cross-sectional survey data from a representative sample of 1,137 participants aged 12-16 years, this study examined loot box engagement patterns and links with problem gambling severity. Nearly half (45.6%) of the participants that were involved in gaming in the past year engaged in loot box activities at some level, and loot box users were predominantly male. The vast majority of the males (93%) had earned, bought, or sold items from a loot box whereas 15% of the females reported engagement with loot boxes. There was a significant positive correlation between loot box engagement and problem gambling severity when controlling for core demo-graphic factors. Compared to participants with no engagement or participants who solely obtained a loot box, the proportions of at-risk and problem gamblers were higher among those, who had purchased or sold items from a loot box. The findings provide new insights into the links between loot box engagement and problem gambling among adolescent populations. Specifically, the study provides new knowledge on different engagement patterns among loot box users and their implications. On this basis, different measures to reduce loot box purchases and reduce marketplace structures are discussed.

The mediating effect of motivations between psychiatric distress and gaming disorder among esport gamers and recreational gamers

Research examining the relationship between gaming disorder, gaming motivations, and mental health is increasing, but the types of gaming use, such as recreational gaming and esports are not commonly distinguished. The present study compared recreational gamers and esport gamers (N = 4284) on a number of variables including game time, gaming motivations, severity of gaming disorder, and psychiatric symptoms. Additionally, the mediating effect of gaming motivations among esport and recreational gamers between psychiatric distress and problematic gaming was examined. Results showed that esport gamers spent significantly more time playing video games both on weekdays and weekend days than recreational gamers. Moreover, esport gamers had higher scores on social, competition, and skill development gaming motivations than recreational gamers. The mediation model demonstrated a significant positive direct and significant mediated effect via escapism (i.e., gaming excessively to avoid real life problems) between the higher levels of psychiatric distress and gaming disorder. However, esport and recreational gamers showed no significant differences in the model. The escapism motive appeared to be the common predictor of problematic gaming among both esport and recreational gamers. Future studies should focus on exploring escapism's mechanism in different subgroups of gamers in relation to problematic gaming to help the development of prevention, intervention, and treatment programs.

An Assessment of the Validity of the Gamblers Belief Questionnaire

Cognitive distortions in gambling are irrational thoughts that cause an individual to overestimate their level of control over the outcome of the game and diminish the role of chance. Due to their strong relation to gambling disorders, they are a particularly important characteristic to assess and understand in gamblers. Although numerous measures of gambling-related cognitive distortions exist, studies assessing criterion validity are scarce. In this study, we develop several tests of the Gamblers Belief Questionnaire (GBQ), a versatile and widely used scale. A sample of 184 U.S. adults was recruited through Amazon Mechanical Turk to complete an online study that included measurement of the GBQ and an assessment of the perceived role of skill and chance in various gambling and non-gambling activities. In addition to a confirmatory factor analysis of the scale, three novel validation tests were developed to understand whether the GBQ subscales can identify and discriminate measures of illusion of control and gambler's fallacy distortions. Our validation tests demonstrate that the scale does measure both distortions, providing information about gamblers' cognition that is unexplained by gambling problems, frequency of play, and demographics. Conversely, our analysis of the factor structure does not show good fit. We conclude that the GBQ measures gambling-related cognitive distortions, but there may be an opportunity to reduce the number of scale items and further refine precision of the two subscales.

Online gaming and gaming disorder: more than just a trivial pursuit

Gaming disorder is set to be included in the International Statistical Classification of Diseases and Related Health Problems alongside other behavioural addictions (gambling disorder) and substance-related addictions. Given the popularity of online gaming, this is set to become an increasingly common presentation to general mental health professionals, addiction specialists, and general practitioners. This article briefly examines online gaming and describes the characteristics of gaming disorder. Some features of online gaming that have addictive potential and similarities to other addictive behaviours such as gambling disorder are discussed. Finally, the article examines treatment options available for gaming disorder and treatment going forward from an Irish perspective.

The Psychology of Esports: A Systematic Literature Review

Recently, the skill involved in playing and mastering video games has led to the professionalization of the activity in the form of 'esports' (electronic sports). The aim of the present paper was to review the main topics of psychological interest about esports and then to examine the similarities of esports to professional and problem gambling. As a result of a systematic literature search, eight studies were identified that had investigated three topics: (1) the process of becoming an esport player, (2) the characteristics of esport players such as mental skills and motivations, and (3) the motivations of esport spectators. These findings draw attention to the new research field of professional video game playing and provides some preliminary insight into the psychology of esports players. The paper also examines the similarities between esport players and professional gamblers (and more specifically poker players). It is suggested that future research should focus on esport players' psychological vulnerability because some studies have begun to investigate the difference between problematic and professional gambling and this might provide insights into whether the playing of esports could also be potentially problematic for some players.

Gambling Behavior and Risk Factors in Preadolescent Students: A Cross Sectional Study

Although gambling was initially characterized as a specific phenomenon of adulthood, the progressive lowering of the age of onset, combined with earlier and increased access to the game, led researchers to study the younger population as well. According to the literature, those who develop a gambling addiction in adulthood begin to play significantly before than those who play without developing a real disorder. In this perspective, the main hypothesis of the study was that the phenomenon of gambling behavior in this younger population is already associated with specific characteristics that could lead to identify risk factors. In this paper, are reported the results of an exploratory survey on an Italian sample of 2,734 preadolescents, aged between 11 and 14 years, who replied to a self-report structured questionnaire developed ad hoc. Firstly, data analysis highlighted an association between the gambling behavior and individual or ecological factors, as well as a statistically significant difference in the perception of gambling between preadolescent, who play games of chance, and the others. Similarly, the binomial logistic regression performed to ascertain the effects of seven key variables on the likelihood that participants gambled with money showed a statistically significant effect for six of them. The relevant findings of this first study address a literature gap and suggest the need to investigate the preadolescent as a cohort in which it identifies predictive factors of gambling behavior in order to design effective and structured preventive interventions.

Are Video Games a Gateway to Gambling? A Longitudinal Study Based on a Representative Norwegian Sample

The scope and variety of video games and monetary gambling opportunities are expanding rapidly. In many ways, these forms of entertainment are converging on digital and online video games and gambling sites. However, little is known about the relationship between video gaming and gambling. The present study explored the possibility of a directional relationship between measures of problem gaming and problem gambling, while also controlling for the influence of sex and age. In contrast to most previous investigations which are based on cross-sectional designs and non-representative samples, the present study utilized a longitudinal design conducted over 2 years (2013, 2015) and comprising 4601 participants (males 47.2%, age range 16-74) drawn from a random sample from the general population. Video gaming and gambling were assessed using the Gaming Addiction Scale for Adolescents and the Canadian Problem Gambling Index, respectively. Using an autoregressive cross-lagged structural equation model, we found a positive relationship between scores on problematic gaming and later scores on problematic gambling, whereas we found no evidence of the reverse relationship. Hence, video gaming problems appear to be a gateway behavior to problematic gambling behavior. In future research, one should continue to monitor the possible reciprocal behavioral influences between gambling and video gaming.

Gambling expenditure by game type among weekly gamblers in Finland

BACKGROUND

Excessive expenditure and financial harms are core features of problem gambling. There are various forms of gambling and their nature varies. The aim was to measure gambling expenditure by game type while controlling for demographics and other gambling participation factors. A further aim was to find out how each game type was associated with gambling expenditure when the number of game types played is adjusted for.

METHODS

Using data from the 2015 Finnish Gambling survey on adult gamblers (n = 3555), multiple log-linear regression was used to examine the effects of demographics, gambling participation, and engaging in different game types on weekly gambling expenditure (WGE) and relative gambling expenditure (RGE).

RESULTS

Male gender, lower education level, higher gambling frequency and higher number of game types increased both WGE and RGE, while younger age decreased WGE but increased RGE. Furthermore, seven specific game types increased both WGE and RGE. Weekly horse race betting and non-monopoly gambling had the strongest increasing effect on expenditure. Betting games and online poker were associated with higher expenditure even when they were played less often than weekly. Among weekly gamblers the highest mean WGE was recorded for those who played non-monopoly games (146.84 €/week), online poker (59.61 €/week), scratch games (51.77 €/week) and horse race betting (48.67 €/week). Those who played only 1-2 game types a week had the highest mean WGE and RGE on horse race betting and other betting games.

CONCLUSIONS

It seems that overall gambling frequency is the strongest indicator of high gambling expenditure. Our results showed that different game types had different effect sizes on gambling expenditure. Weekly gambling on horse races and non-monopoly games had the greatest increasing effect on expenditure. However, different game types also varied based on their popularity. The extent of potential harms caused by high expenditure therefore also varies on the population level. Based on our results, future prevention and harm minimization efforts should be tailored to different game types for greater effectiveness.

Gamers' insights into the phenomenology of normal gaming and game "addiction": A mixed methods study

In response to calls for further research into the phenomenology of Internet gaming disorder (IGD), we used a community-engaged consensus development approach to evaluate how members of the "gamer culture" describe problematic gaming and the relationship of these descriptions to the proposed IGD criteria. Two focus groups of gamers were recruited at a video game convention. Participants were asked to submit suggestions for signs of game "addiction". Participants discussed and ranked the criteria in order of conceptual importance. The rankings were analyzed quantitatively, and then a multidisciplinary team compared the ranked criteria to the DSM-5 IGD proposed criteria. The strongest agreement between participants' rankings and IGD symptomatology was found for harms/functional impairment due to gaming, continued use despite problems, unsuccessful attempts to control gaming, and loss of interest in previous hobbies and entertainment. There was less support for other IGD criteria. Participants also offered new content domains. These findings suggest that collaborative knowledge-building approaches may help researchers and policymakers understand the characteristics and processes specific to problematic video game play and improve content validity of IGD criteria. Future efforts may benefit from multi-stakeholder approaches to refine IGD criteria and inform theory, measurement and intervention.

The Candy Crush Sweet Tooth: How 'Near-misses' in Candy Crush Increase Frustration, and the Urge to Continue Gameplay

Like many gambling games, the exceedingly popular and lucrative smartphone game "Candy Crush" features near-miss outcomes. In slot machines, a near-miss involves getting two of the needed three high-paying symbols on the pay-line (i.e., just missing the big win). In Candy Crush, the game signals when you just miss getting to the next level by one or two moves. Because near-misses in gambling games have consistently been shown to invigorate play despite being frustrating outcomes, the goal of the present study was to examine whether such near-misses trigger increases in player arousal, frustration and urge to continue play in Candy Crush. Sixty avid Candy Crush players were recruited to play the game for 30 min while having their Heart Rate, Skin Conductance Level, subjective arousal, frustration and urge to play recorded for three types of outcomes: wins (where they level up), losses (where they don't come close to levelling up), and near-misses (where they just miss levelling up). Near-misses were more arousing than losses as indexed by increased heart rate and greater subjective arousal. Near-misses were also subjectively rated as the most frustrating of all outcomes. Most importantly, of any type of outcome, near-misses triggered the most substantial urge to continue play. These findings suggest that near-misses in Candy Crush play a role in player commitment to the game, and may contribute to players playing longer than intended.

The relationship between gaming disorder and addiction requires a behavioral analysis

In their position paper, Aarseth et al. (2016) bring to light several timely issues concerning the categorization of gaming disorder as a form of addiction and as a discrete mental disorder. In our commentary, we welcome their caution toward this move and their discussion of the equivocal scientific data in its support and the potential negative consequences for gamers. We suggest that a more heterogeneous approach is required for understanding any behavioral addiction, as concepts from gambling appear to be more relevant for aspects of mobile gaming than for video games more generally. In addition to a greater need for clinical research, we argue that studying gaming at a different level of analysis than the epidemiological study is required to gain a meaningful understanding of the harm video games may or may not entail.

An Examination of the Relationship Between Social Casino Gaming and Gambling: The Bad, The Ugly, and The Good

Social casino games (i.e., free-to-play online gambling-themed games) are now ubiquitous on social network platforms such as Facebook. Their popularity and similarity to gambling games has raised concern that, among other things, social casino games will normalize gambling behaviour, which may contribute to gambling participation and to a rise in the rate of disordered gambling (see Gainsbury, Hing, Delfabbro, & King, 2014; Kim, Wohl, Salmon, Gupta, & Derevensky, 2015; Parke, Wardle, Rigbye, & Parke, 2013). Herein, we review theory and research that address potentially bad (migration to gambling) and ugly (increased rate of problem gambling) consequences of social casino gaming. We also outline the limits and boundaries of this presupposition. Specifically, we outline contexts in which social casino games may yield positive consequences when played, including the use of such games as a proxy for gambling among disordered gamblers. Drawing on these discussions, we offer a path model for gambling behaviour that places social casino gaming at its core. Although we, like others, present some pessimism regarding the outcome of social casino game play, this paper points to situations and motivations that may yield positive effects.Les jeux de casino sociaux (à savoir, les jeux de hasard gratuits en ligne) se retrouvent maintenant sur les plateformes de réseaux sociaux comme Facebook. Leur popularité et leur ressemblance avec les jeux d’argent soulèvent des inquiétudes que les jeux de casino sociaux aient entre autres pour effet de normaliser les comportements de jeu, lesquels peuvent contribuer à une participation aux jeux de hasard et à une augmentation du taux de jeu compulsif (voir Gainsbury, Hing, Delfabbro, et King, 2014; Kim, Wohl, Salmon, Gupta, et Derevensky, 2015; Parke, Wardle, Rigbye, et Parke, 2013). Dans le présent article, nous analyserons la théorie et les travaux de recherche qui traitent des conséquences potentiellement néfastes (engouement pour les jeux d’argent) et horribles (augmentation du taux du jeu compulsif) des jeux de casino sociaux. Nous définissons également les limites de cette affirmation. Plus particulièrement, nous présentons une vue d’ensemble des contextes dans lesquels les jeux de casino sociaux peuvent avoir des conséquences positives lorsqu’on s’y adonne, notamment l’utilisation chez les joueurs pathologiques de ces jeux comme substitut pour les jeux de hasard. En nous inspirant de cette analyse, nous proposons un modèle de cheminement pour les comportements de jeu où les jeux de casino sociaux occupent la place centrale. Bien que nous soyons un peu pessimistes, et nous ne sommes pas les seuls, en ce qui a trait aux répercussions des jeux de casino sociaux, cet article cite des situations et des motivations qui peuvent amener des effets positifs.

Gambling and Video Game Playing Among Youth

Gambling and video game playing represent two leisure activities in which adolescents and young adults participate. There are psychological and behavioural parallels between some forms of gambling (e.g., slot machines, video lottery terminals, electronic gambling machines) and some types of video games (e.g., arcade games). Both activities operate on behavioural principles of variable reinforcement schedules in order to reward and prolong play and use exciting and stimulating sound and light effects within game play. Additionally, both activities have similar negative effects associated with excessive play (e.g., poor academic performance, moodiness, loss of interest in activities previously enjoyed, and interpersonal conflict). Thus, there is concern that children and adolescents who are attracted to video games, for both psychological rewards and the challenge, may be at greater risk to gamble. We examined the gambling and video game playing behaviour among 1,229 adolescents and young adults. Results indicate that gamblers, relative to non-gamblers, were more likely to play video games. Video game players were more likely than non-players to gamble. Both social and problem gamblers had higher rates of video game playing than did non-gamblers, and addicted gamers had higher rates of gambling than did social and non-gamers. Results from the current study suggest significant overlap in youth participation in both gambling activities and video game playing. These results have implications for future research and the treatment of problem gambling and video game addiction.Les jeux de hasard et les jeux vidéo sont deux loisirs auxquels s’adonnent les adolescents et les jeunes adultes. Il existe des parallèles psychologiques et comportementaux entre certaines formes des jeux de hasard (p. ex., les appareils à sous, les appareils de loterie vidéo, les machines de jeux électroniques) et certains jeux vidéo (p. ex., les jeux d’arcade). Ces deux types de jeux exploitent les principes comportementaux du programme variable de renforcement pour récompenser le joueur et l’amener à jouer plus longtemps et utilisent des effets lumineux et sonores stimulants et excitants pour accroître l’attrait de l’expérience de jeu. De plus, ces deux activités entraînent des effets négatifs similaires chez les joueurs excessifs (p. ex., mauvais résultats scolaires, instabilité émotive, perte d’intérêt pour des activités qui autrefois procuraient du plaisir, conflits interpersonnels). On craint donc que les enfants et les adolescents qui sont attirés par les jeux vidéo, en raison des défis qu’ils proposent et des récompenses psychologiques qu’ils procurent, soient plus à risque de s’adonner aux jeux de hasard. La présente recherche a examiné les comportements de jeu de 1229 adolescents et jeunes adultes relativement aux jeux de hasard et aux jeux vidéo. Les résultats indiquent que les joueurs de jeux de hasard, par rapport aux non-joueurs, étaient plus susceptibles de jouer à des jeux vidéo, et que les joueurs de jeux vidéo étaient pareillement plus susceptibles de s’adonner aux jeux de hasard que les sujets ne jouant pas aux jeux vidéo. Le groupe des joueurs sociaux et celui des joueurs à problèmes présentaient tous deux un taux plus élevé de pratique des jeux vidéo que celui des non-joueurs, et les sujets ayant une dépendance aux jeux vidéo s’adonnaient également en plus forte proportion aux jeux de hasard que les sujets ne pratiquant par les jeux vidéo ou les pratiquant de manière sociale uniquement. Les résultats de la présente étude donnent à croire qu’il y a un chevauchement important entre la pratique des jeux de hasard et celle des jeux vidéo chez les jeunes. Ces résultats ont des incidences sur les futures recherches et le traitement de la dépendance aux jeux de hasard et aux jeux vidéo.