Cam Adair, in recovery from gaming disorder himself and founder of INTENTA (mission: to equip mental health professionals with resources on digital disorders to empower an intentional digital culture), provides some tips to help prevent gaming from becoming an addiction. He says it’s important to focus on maintaining key protective factors in the family, such as having a diversity of hobbies and interests (so gaming doesn’t become the only thing they do to fulfill their needs). He also encourages supporting well-being habits, such as sleep hygiene and physical activity, and to be consistent in your boundaries and limits.
As a gamer begins to play more excessively they will do all they can to increase the amount of time they can play. One strategy a gamer will implement is to remove barriers or obstacles that occupy time they could be gaming. They will stop doing sports, lose interest in other activities, manipulate your emotions and become the most effective lawyers in town to argue for maximum gaming time.
Stand strong and be firm in the values you hold for your family. It’s a lot easier to prevent gaming from becoming a problem than it is to turn the situation around once it’s become one.
In 2018, the World Health Organization (WHO) released the 11th revision of the International Classification of Diseases (ICD-11). This revision included a statement regarding gaming behavior as follows:
Gaming disorder is defined as a pattern of gaming behavior (“digital-gaming” or “video-gaming”) characterized by impaired control over gaming, increasing priority given to gaming over other activities to the extent that gaming takes precedence over other interests and daily activities, and continuation or escalation of gaming despite the occurrence of negative consequences.
For gaming disorder to be diagnosed, the behavior pattern must be of sufficient severity to result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning and would normally have been evident for at least 12 months.
The inclusion of gaming disorder in ICD-11 follows the development of treatment programs for people with health conditions identical to those characteristic of gaming disorder in many parts of the world, and will result in the increased attention of health professionals to the risks of development of this disorder and, accordingly, to relevant prevention and treatment measures.
Note: The WHO’s definition of gaming disorder intentionally omits games that have gambling elements built in.
A feature that has become part of the majority of popular video games threatens to become a gateway to problem gambling: loot boxes. Loot boxes are consumable virtual items in video games that can be redeemed to receive a randomized selection of further virtual items, or loot, ranging from simple customization options for a player’s avatar or character, to game-changing equipment such as weapons or armor.
Loot boxes are extremely profitable for video game companies. Payments are made through micro-transactions that may involve box purchases of 99 cents. However, repeated purchases of loot boxes can quickly escalate into thousands of dollars of purchases over time.
The National Council on Problem Gambling (NCPG) believes that many games with loot box systems already meet criteria for gambling, as players who make purchases of these boxes don’t know if the item they seek will actually be in the box.
Some loot boxes that have the same or similar characteristics of slot machines may not meet legal definitions of gambling but carry the same risks for addiction.
A legal definition of gambling is not required for a feature like a loot box to cause harm. The Diagnostic and Statistical Manual of Mental Disorders (DSM) and ICD (International Classification of Diseases) clinical criteria for gambling disorder do not require that rewards be “real money” or preclude a diagnosis if the client played with virtual coins or received several free plays before spending excessive amounts of time and money purchasing loot boxes.
Factors common to many loot boxes and slot machines:
random distribution of prizes
variable value of the prizes
visual and sound cues associated with participation and reward trigger urges to play along with increased excitement and
faster play
Consequences of gambling problems:
• financial harm
• emotional difficulties
• poor work or school performance
• poor mental and physical health
• higher rates of depression and substance abuse
Strong regulation is important, but it cannot be effective at reducing harm unless accompanied by equally robust prevention, education, treatment, recovery and research.
NCPG recommends addressing concerns around loot boxes and addiction with a multi-layered approach to users, parents, and communities to ensure an appropriate range of protections is put into place for youth and other vulnerable populations.
Key initiatives should include:
• creating better informed consumers
• preventing gambling-related problems
• encouraging treatment-seeking
• supporting recovery
• increasing research to enable evidence-based solutions
A major concern when it comes to youth addiction to gambling is the convergence of gaming and gambling. Many games now include gambling features and many gambling activities have gaming-like features.
Games that include gambling-like features are most concerning. Unfortunately, these gaming sites are both very accessible and unregulated. They include social casino gambling, which is considered gambling without risking money. However, these sites typically include virtual currency, and thus can be seen as a “training ground” for future gambling with real money when participants are of age.
An example of gambling-like gaming is a video game that features mini-games one can bet on in a simulated casino. There are also many opportunities to participate in social casino games through social media.
Another example of “gambling” is a video game that features loot boxes, where players can spend money for access to unknown game features. According to Gambling Research Exchange Ontario, free gambling-like games are now more popular than online gambling for money. In recent years, there has also been an increase in the number of people who bet on different outcomes of video games.
Studies show that young adults and adults who are exposed to these types of games may be more likely to develop gambling problems.
Electronic gaming machines (EGMs) are gambling devices that offer a variety of games. They may have the same theme as popular television game shows. EGMs are found at casinos, on cruise boats, at racetracks, at local bars, and even at corner stores. EGMs may have an element of skill or a feature that makes it seem that skill plays a role. Researchers believe that features such as these help to attract young participants and keep them gambling.
Today’s youth are the first generation to grow up with electronic gambling, such as video poker and video slots. Electronic gambling is considered to be the most addictive type of gambling because games can be played rapidly, there’s easy access to money (through credit cards), the activity takes place in isolation and there is no potential for human intervention to monitor the gambler’s behavior.
Evidence shows that the age group most affected by gaming disorder is adults between the ages of 25-40. However, given that this is a relatively new platform and online access is far more readily available today than just ten years ago, monitoring minors’ activities in gaming and creating appropriate prevention messaging will be important.
Children and teens have little awareness that regularly partaking in these types of activities may lead to problem gambling issues later in life. In fact, most individuals, whether minors or adults, have little awareness that these unregulated sites are, in fact, designed to be more predatory than regulated sites.
Youth problem gambling is a growing public health concern. While parents may think gambling is less of a problem than drugs, smoking or drinking, there’s still reason to be concerned. Gambling can become an addiction — and is statistically more likely to occur the younger a person first gambles.
Gambling problems have long-term, severe consequences on a teenager’s life and on the life of those close to him or her. Some of the adverse effects of a gambling problem can be seen on various levels of individual functioning (cognitive, social and academic) and on both mental and physical health.
Despite the fact that gambling activities are legally restricted to adults in many jurisdictions —and have traditionally been viewed as an adult activity — there is clear evidence that underage youth actively participate in gambling. According to the most recent Minnesota Student Survey completed in 2019, 30 percent of middle school and high schoolers gambled in the last year, seven percent gambled frequently (more than once a week) and half of one percent (2,000 students in Minnesota) indicated signs of gambling disorder.
In addition to anecdotal and empirical evidence of the dangers of youth gambling, there’s also a physiological explanation. Recent advancements in brain development research indicate that the frontal lobe — the decision-making part of the brain — is not fully developed until age 25.
Thus, youth are less likely to make fully considered decisions about gambling and the risks that they take. This supports the reason why gambling is not allowed until the age of 18 in Minnesota and 21 in many other states.
Youth gambling is also a concern because the lines between “gaming” and “gambling” are becoming increasingly blurred. Problem gambling prevention efforts should really be addressing problem behavior with respect to “gaming” as much as gambling. Video games often have gambling-like features incorporated in them, and there are real opportunities to gamble using features within video games (e.g., skins, or in-game virtual decorative weapons/materials) that meet the definition of gambling in prize, chance and consideration.
There are many overlapping indicators for video gaming disorder and gambling disorder and there is increasing evidence that social casino gaming may cause increased gambling behavior in youth as well as eventual gambling problems. This contention is bolstered by information provided by the U.K. Gaming Commission, which reported that 31 percent of youth age 11 to 16 have paid or used in-game items to open loot boxes while three percent had bet with in-game items. Further, a study (Zendle & Cairns, 2018) also noted that the amount of money spent on loot boxes by those playing video games have been linked to severe gambling problems.
