Abdallah Ahmed, Fariha Mahbub, Mosabbih Tanvir, Abdullah Rafi

Group A Final Research Essay

27 November 2022

The Effects of Gambling Via Traditional and Online Loot Box Mediums on Adult and Adolescent Populations 

Introduction

Gambling, both traditional and now online and accessible to any age group via loot boxes, has different effects on adult and adolescent physical and mental health. While many individuals gamble responsibly, for a considerable fraction of the population, it may get out of hand and become a problem. Dowling et al’s (2015) study found that adults who have been diagnosed as problem-gamblers (gamblers with behavior patterns that compromise or damage their personal, social, and/or financial life) displayed mental health problems such as major depressive disorder as well as alcohol abuse and dependence disorders. Floros’s (2018) study also came to a similar conclusion finding that adults involved in gambling activities suffer increased levels of anxiety, depression, and an unhealthy addiction to gambling. There is no doubt that gambling is a major issue across the globe. Gambling has grown in popularity throughout the years as consumers spend large amounts of money for the chance of winning even more money. Clark (2005) mentions that “the average gambler visits a casino nearly six times a year–almost twice as often as he did a decade ago. At least 6 million Americans will click a bet on one of 2,300 online gaming sites. Altogether, gamblers will lose more than $80 billion…”. Despite the fact that gamblers are at a net loss of more than eighty billion dollars annually, gambling continues to grow at great rates, and as Clark reports, “A record 73 million Americans, up nearly 20 million from just five years ago, will patronize one of the nation’s more than 1,200 casinos, card rooms, or bingo parlors this year.”  Gambling is meant to be a pastime in which the consumer can have fun and win, but the average consumer is not winning, they are losing. This is mainly because while the initial allure of gambling is to have fun and potentially make big bucks, gambling quickly becomes addictive and therefore damaging in many aspects of life. 

These effects do not limit themselves to adults either–adolescents suffer similar affects from gambling, albeit their form of gambling is quite different. Adolescents do not attend casinos or play high-stakes poker, but they do play games riddled with non-age-restricted loot boxes. Loot boxes are virtual, in-game items that contain a chance at getting one of many in-game items and/ or skins for in-game items. They usually contain many common in-game items within the loot box, and very few rare items, which are ones that the user would want more. Loot boxes typically come at a cost, typically a dollar to three dollars depending on the type of loot box; some loot boxes are always available and therefore cost less, and some are seasonal and limited-time deals, making them cost much more. According to Zendle et al. (2019), the loot box industry is predicted to generate up to thirty billion dollars in 2018 alone, so it is a popular form of gambling, one that adults and also adolescents frequent across various platforms. Lootboxes are considered gambling because it costs money to open them, and the user only gets a chance at the particular item they want, rather than any guarantee. Thus, users can spend a lot of money opening boxes, hoping to get the rare chance item that may considerably improve their gameplay or in-game fashion (similar to hitting a jackpot), and continuously getting common items they have absolutely zero desire for (similar to losing money on undesirable outcomes when gambling via traditional methods). 

As a form of gambling, these loot boxes lead to damaging affects on younger users. Rockloff et al’s (2021) study found that individuals who bought and sold loot boxes aged 18-24 were associated with higher gambling frequencies over a 12-month period in these individuals. These adolescents also experienced more gambling-related harms which included symptoms such as depression, poor academic performance, and addiction to gambling activities. Ford et al. (2020) found a significant association between a positive screen for a lifetime history of problem gambling and younger age, male gender, lower level of education, and single marital status. Thus, there are many factors that contribute to gambling as a pastime and facing gambling harms, and of those prime factors is the age of the user. Zendle et al. (2019) discuss that adolescents are susceptible to problem gambling due to their impulsivity stemming from immature neurodevelopment.  

It is apparent, therefore, that gambling is a harmful and addictive pastime for both adults and adolescent gamblers. Despite being at a net loss of money, and also developing problem gambling behaviorism and addictions, many continue to gamble. Similar to adult gamblers who gamble via traditional methods such as casinos (and therefore face a host of physical and mental health problems like anxiety and addiction), adolescents, now likely to gamble as a pastime through chance loot boxes, also experience the same increase in physical and mental health problems such as anxiety and depression, as well as face an increase in their likelihood of becoming problem gamblers due to differences in their neurobiology. 

Methods

Ford et al’s (2020) study used a survey to analyze the relationship between problem gambling and other health conditions such as substance abuse, mental health, and behavioral addictions. The survey was distributed by the company Userneeds to a pre-existing panel of online survey respondents. This survey was only distributed to individuals in Sweden, data collection ceased once 2000 responses were received but there were 2038 included responses in the end. All participants were 18 or above as that is the legal gambling age in Sweden, anyone younger was excluded from recruitment. The survey was distributed in Swedish. Age brackets consisted of 18-24-year-olds, 25-29, 30–39, 40–49, 50–59, and 60 or older. Gender was categorized as male, female, transgender, and prefer not to answer. The first category of health examined was the participants’ physical health. This was done by asking about the participants’ BMI, and physical activity, and asking questions such as how many days a week the participants are involved with heart-pounding activities. The Alcohol Use Disorders Identification Test was used to measure alcohol consumption by identifying those with hazardous alcohol behaviors, substance and alcohol abuse disorders, and alcohol dependence. This consisted of a 3 question screening that asked about alcohol consumption and patterns of use in the last 12 months. Drug use was measured by asking whether participants’ used an illegal drug in the past year. A list of illegal drugs was provided to ensure validity. Next, the Kessler Psychological Distress Scale was used with the intention to assess the risk of serious mental health issues. Each question addressed whether the individual had a specific emotion in the past 30 days. This section included questions about being nervous, hopeless, restless or fidgety, so depressed that nothing could cheer you up, that everything was an effort, and worthless. The responses were coded as 4 (all of the time), 3 (most of the time), 2 (some of the time), 1 (a little of the time), and 0 (none of the time). Participants were also asked whether they had been prescribed medication as treatment for mental illness. The NORC DSM-IV Screen for Gambling Problems was used to screen for a history of possible pathological gambling. Yes or no questions such as whether the individual lied to family members or friends about how much money was lost gambling. Lastly, behavioral addictions were assessed using three screenings. First, the 3-item Problematic and Risky Internet Use Screening Scale asked about anxiety and internet use. The 7-item Bergen Shopping Addiction Scale was used to assess shopping addiction which participants answered on a scale from 0 (completely disagree) to 4 (completely agree). Finally, the Gaming Addiction Scale was used to assess participants’ potential addiction to games. Questions such as did you think about playing a game all day long and have you neglected other important activities (e.g., school, work, sports) to play games were answered on a scale from 1 (never) to 5 (very often).

Rockloff et al’s (2021) study aimed to find whether playing games with loot boxes caused adolescent individuals to experience gambling harms and problems. This study was also done to analyze what were the effects of long-term exposure to loot boxes on gambling harms in comparison to short-term exposure. The study was conducted through a survey of 12-24-year-old individuals from New South Wales, Australia. Of the 2,650 people participating in the survey, 59.9% were female and the remainder of the participants were male. Of the 1,035 adult respondents in the survey, “3.9% were married and a separate 18.9% stated that they were living with a partner. 47% of the adult participants stated that they had secondary education as their highest form of education and 24.4% stated that they had a bachelor’s or a postgraduate degree”. Adolescent participants did not answer questions related to commercial forms of gambling, only on their experience with loot boxes. The remainder of the participants aged 18-24 were asked about both their experience with loot boxes and that of commercial gambling since they were legally allowed to be involved with such activities. The survey consisted of multiple screening questions. Participants were asked questions on the Problem Gambling Severity Index (PGSI), “a nine-item screening for gambling problems that asks about behaviors and perceptions around gambling” (Rockloff et al, 2021). Responses to each question stem from 0 (never) to 3 (almost-always) with a total score of 8 or higher indicating problem gambling. The PGSI was used here to assess participants’ gambling activities in the last 12 months. The questions were:Next, participants were asked nine questions from the DSM-IV-MR-J screening. The DSM-IV-MR-J is a revised version of the PGSI that is only validated for use in a juvenile population. “The nine-item screen is based on the clinical criteria for problem gambling drawn from the Diagnostic and Statistical Manual of the American Psychiatric Association (revision IV) with one point for each qualifying positive response summed to a score 0 through 9” (Rockloff et al, 2021). The total points for these questions were 9, with a score of 4 indicating gambling problems. The next section was on the Short Gambling Harms Screen, a screening used only among the 18-24 year old participants of the study. These participants were asked about a checklist of behaviors that are commonly related with gambling harms such as whether the individual sold their own personal belongings to fund their gambling activities and if they felt distressed about their gambling. Finally, participants were asked about their attitude towards gambling and loot boxes as well as their involvement with loot boxes and gambling.

Zendle et al’s (2019) study was a survey that aimed to come to a conclusion on whether or not loot box spending is positively correlated with the development of gambling problems in adolescents. Participants were recruited via posts on the Internet bulletin board Reddit through posts made to 100 different subreddits. These participants were then asked a series of questions regarding their loot box spending and gambling activities. 1,155 responses from participants aged 16 to 18 were collected. 88% of participants described themselves as male, 9% as female, and 3% as non-binary. 26.4% were aged 16, 26.6% were aged 17, and 47% were aged 18. First, participants were asked if they paid for a loot box in the past month, and they responded with either yes or no. Next, participants were asked how much they spent on loot boxes in the past month and the amount of their spending on other microtransactions. Problem gambling was measured via the Canadian Adolescent Gambling Inventory’s Problem Gambling subscale, a nine-item instrument that asked questions on the participants’ frequency of their problem-gambling-related behaviors by having them answer questions on a scale from 0 (never) to 3 (almost always). Impulsivity was measured by five yes-or-no questions related to impulsive behaviors. How quickly the participants became involved with loot boxes was measured by asking the following question. “Approximately how long had you played this game for before paying real-world money for your first loot box in it”. Answer choices were “(i) less than 15 min; (ii) more than 15 min but less than an hour; (iii) more than an hour but less than a day; (iv) more than a day but less than a week; (v) more than a week but less than a month; (vi) more than a month”. Finally, motivation to buy loot boxes was measured by asking the open-ended question, “why would you say that you buy loot boxes”.

Results

In their cross-sectional web survey, Ford et al’s (2020) report indicated that age, gender, the highest level of education achieved, and marital status were all significant associations of being a problem gambler or not. In the age category, based on the number of respondents that fit each separate category, 5% of those who were problem gamblers were 18-24, as well as 11% of those in the 25-29 subcategory, 22% in the 30-39 subcategory, 29% in the 40-49 subcategory, 13% in the 50-59 subcategory, and 20% in the 60+ subcategory. In the gender category, 35% of respondents who were problem gamblers were women, and 65% of respondents who were problem gamblers were male. In the highest level of education achieved category, 6% of problem gamblers were at elementary school completion, a whopping 45% of problem gamblers were with a high school degree, 16% were with an incomplete university degree, and 26% of problem gamblers were with a completed university degree. However, in the highest level of education achieved category, 5% of non-problem gamblers were at elementary school completion, 36% of non-problem gamblers were with a high school degree, 15% were with an incomplete university degree, and 39% of non-problem gamblers were with a completed university degree. In the marital status category, 35% of problem gamblers were single, 59% were married, and 6% of problem gamblers were divorced/ separated. Furthermore, Ford et al’s (2020) report also indicated a significant finding that 9% of problem gamblers have used a prescription medication for non-medical reasons while only 2% of non-problem gamblers have used a prescription medication for non-medical reasons. Furthermore, when asked if the respondent smoked or took snuff (powdered tobacco) daily, a significant finding was that 31% of problem gamblers responded yes, while only 16% of non-problem gamblers responded yes. Also, when asked if a doctor has ever prescribed the respondent medication or therapy as a treatment for mental illness, 39% of problem gambler respondents said yes, while only 26% of non-problem gamblers responded no. Finally, for the Kessler Psychological Distress Scale, for problem gambler respondents, 32% said they have no psychological distress, 48% said they had moderate distress, and 20% said they had severe distress. However, again for the Kessler Psychological Distress Scale, for non-problem gambler respondents, 61% reported no psychological distress, 32% reported moderate distress, and only 7% reported severe distress. 

Through their survey, Rockloff et al. (2021) found that adult men or women who either bought or sold loot boxes also gambled more frequently and had more gambling-related problems. Also, women who simply opened loot boxes gambled more frequently and spent more on gambling, thus experiencing more gambling-related harms. Rockloff et al. (2021) also found that for adolescents aged 12-17, both girls and boys who bought loot boxes more often had gambling-related problems, especially female adolescents, who additionally had more positive attitudes towards gambling as a pastime. Interestingly, the authors also found that for adults (both men and women) there was no evidence that having a long experience with loot boxes correlated to key outcomes and associated problems, but for adolescent girls, in particular, the more recent first openings of loot boxes were associated with last 12-month gambling problems. Therefore, Rockloff et al. (2021) found that adolescent girls who opened a loot box were therefore at a higher predisposition to continue gambling for the rest of the year, and face gambling-associated problems. 

In their large online survey, Zendle et al. (2019) found that there was a significant positive correlation between loot box spending and problem gambling; they also found that there is a significant relationship between whether a player pays for loot boxes and having different severity of gambling-related problems. As seen in the figure below, according to Zendle et al.’s (2019) study, in the response of “no” on the x-axis of whether a player pays for loot boxes or not, the median problem gambling severity was an associated 1.5 out of 5, meaning low to moderate severity. However, when a player pays for loot boxes, meaning a response of “yes” on the x-axis, the median problem gambling severity is an associated 4.3 out of 5.0, meaning high problem gambling severity. Thus, paying for loot boxes increases problem gambling severity and likelihood. Zendle et al. (2019) also found that when loot box contents were only available for a limited time and also games were giving away free loot boxes, there was a significantly strengthened link between adolescent loot box spending and problem gambling. Thus, games that only give the contents of the loot box within a loot box and for only a short time are also the games in which adolescents are purchasing more loot boxes and therefore gambling at an increased risk. 

Discussion

Findings from Ford et al. (2020) and Zendle et al.’s (2019) studies showed the deteriorating consequences of betting on Americans’ social and economic life. Although gambling is considered a means of relaxation, it was found that people were losing more money than they were getting from this process. Since the psychological mindset of a gambler is to make money, one can be frustrated and even depressed when the conditions or the outcomes of the process are unfavorable. Furthermore, Clark’s (2005) study found that Casino executives hire scientists and techno-wizards to manipulate the conditions of casinos to get more money from adult gamblers, such as having no windows in the casino parlor so people lose track of time, and also giving free alcoholic beverages to gamblers. Under the influence of alcohol and participating in a behavior in which the gambler is tirelessly chasing a potential “big win,”  many adults leave the casino with less money than when they entered, making them more vulnerable to social and psychological breakdowns such as stress, depression, and intra-familial conflict. 

Research shows that more than $80 billion is lost through traditional gambling, and over $30 billion is spent on loot boxes in online methods of gambling. This figure covers all financial resources lost through betting, including traditional adult gambling and adolescents’ loot box. Second, much time is also spent at these traditional adult gambling sites and adolescents’ loot boxes. Although it can be argued that the amount of money gamblers spend in Casinos, and online gambling platforms is higher than that spent in adolescents’ loot boxes and traditional adult gambling sites, the effect of losing money is the same irrespective of the gambling method employed. It is, therefore, safe to conclude that the financial and psycho-social damages from high-end casinos and online betting sites are similar to conventional sites such as adolescents’ loot boxes and traditional adult gambling sites.

According to Ford et al.’s (2020) study, gambling, both via traditional and online loot boxes, is associated with a decrease in overall educational achievement, using prescription medication for non-medical reasons, smoking or taking snuff at higher rates, and reporting overall higher rates of moderate and severe distress. In the highest level of education achieved category, 6% of problem gamblers were at elementary school completion, a whopping 45% of problem gamblers were with a high school degree, and 26% of problem gamblers had a completed university degree. On the other hand, 5% of non-problem gamblers were at elementary school completion, a whopping 36% of non-problem gamblers were with a high school degree, and 39% of non-problem gamblers had a completed university degree. Thus, problem gamblers are more likely to only complete a high school degree than non-problem gamblers, and non-problem gamblers are much more likely to have a completed university degree. This could be a reason why gamblers are gambling, pointing to the fact that they want more money than their degree can afford, but also there are problem gamblers who have higher education completed and are still problem gamblers. This could mean that problem gambling can impact anyone, even those who are likely financially stable. Ford et al.’s (2020) report also indicated a significant finding that 9% of problem gamblers have used a prescription medication for non-medical reasons while only 2% of non-problem gamblers have used a prescription medication for non-medical reasons. Furthermore, when asked if the respondent smoked or took snuff (powdered tobacco) daily, a significant finding was that 31% of problem gamblers responded yes, while only 16% of non-problem gamblers responded yes. Finally, in Ford et al.’s (2020) report, of problem gambler respondents, 32% said they have no psychological distress, 48% said they had moderate distress, and 20% said they had severe distress. However, of the non-problem gambler respondents, 61% reported no psychological distress, 32% reported moderate distress, and only 7% reported severe distress. This is significant because it illustrates that problem gamblers are abusing prescription drugs, smoking more cigarettes, or taking snuff more on average, and also battling distress both moderate and severe on a higher scale. It is unclear whether each of these other factors is caused by gambling, if these factors cause gambling, or if they have a causal relationship at all, however, one thing for certain is that problem gambling is associated with the aforementioned factors because problem gamblers are statistically (based on Ford et al. (2020)), more likely to also have lesser education, abuse prescription drugs, smoke more cigarettes/ take snuff, and battle higher levels of moderate and severe distress.

  It should now be clear that there is a direct correlation between loot boxes and gambling addiction. Composed of 12-24-year-old individuals from New South Wales, Australia, Rockloff et al. (2021) derived the conclusion that adult men or women who either bought or sold loot boxes tend to gamble more frequently, and women who simply opened loot boxes gambled more frequently and spent more on gambling, and also experienced more gambling-related harms. This is portraying the direct correlation between traditional adult gambling with loot box gambling. Of the 1,035 adult respondents in the survey, 3.9% were married and a separate 18.9% stated that they were living with a partner. 47% of the adult participants stated that they had secondary education as their highest form of education and 24.4% stated that they had a bachelor’s or a postgraduate degree Adolescent participants did not answer questions related to commercial forms of gambling, only on their experience with loot boxes. The remainder of the participants aged 18-24 were asked about both their experience with loot boxes and that of commercial gambling since they were legally allowed to be involved with such activities. The survey consisted of multiple screening questions. Participants were asked questions on the Problem Gambling Severity Index in relation to their activities in the last 12 months. Thus, games that only give the contents of the loot box within a loot box and for only a short time are also the games in which adolescents are purchasing more loot boxes and therefore gambling at an increased risk. According to Zendle et al. (2019), games that also give away free loot boxes encourage adolescents to open a loot box, making them engage in the activity, and then spend additional real money on loot boxes for a chance to gain an item they suddenly now desire. This is important because it highlights that loot boxes are a direct pathway to gambling addiction and problems. Furthermore, it represents that even adults are at risk of the dangers from loot boxes and their associated risks, which dawns a harrowing reality of what can happen to adolescents who begin to buy and open loot boxes as a pastime in video games.

Furthermore, it represents that even adults are at risk of the dangers from loot boxes alongside traditional gambling and their associated risks, which dawns a harrowing reality of what can happen to adolescents who begin to buy and open loot boxes as a pastime in video games, which causes havoc in both adults and adolescents due to their neurobiology. Floros (2018) found that adolescents, due to differences in neurobiology and their brains being underdeveloped, have a bias toward immediate gains rather than long-term ones. Floros (2018) reported that between 4% and 8% of adolescent gamblers are experiencing significant gambling-related problems… various psychosocial issues, poor academic performance, intrafamilial conflict,… increased rates of suicide ideation and attempts, [and] drug and alcohol use.” Thus, adolescent gambling through the online loot box medium is not only increasingly prevalent but also terribly dangerous. Adolescents who gamble face a host of psychosocial and familial issues and suffer as a result of them gambling as a pastime. Rockloff et al. (2021) also found that for adolescents aged 12-17, both girls and boys who bought loot boxes more often had gambling-related problems, especially female adolescents, who additionally had more positive attitudes towards gambling as a pastime. This is important to take note of because similarly to traditional gambling, which starts as a pastime activity, it slowly starts to endanger the consumers’ mental health, draining them and causing them stress which stops them from performing daily life activities. Based on the findings of Zendle et al. (2019), most noteworthy, it deepens the importance of the confirmation that if adults are at risk of loot box addictions, so are adolescents. Interestingly, the authors also found that for adults (both men and women) there was no evidence that having a long experience with loot boxes correlated to key outcomes and associated problems, but for adolescent girls, in particular, the more recent first openings of loot boxes were associated with last 12-month gambling problems. Therefore, adolescent girls who opened a loot box were therefore at a higher predisposition to continue gambling for the rest of the year, and face gambling-associated problems. Finally, paying for loot boxes, rather than getting them for free which is what video games initially do to draw in their consumers to buy loot boxes after trying them, increases problem gambling severity and likelihood. Thus, Zendle et al. (2019) found that games that also give away free loot boxes serve as a stepping stone for adolescents to open a loot box, engage in the activity, and then spend money on loot boxes for a chance to gain an item they suddenly now desire.

Works Cited

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Floros, Georgios D. “Gambling disorder in adolescents: prevalence, new developments, and treatment challenges.” Adolescent Health, Medicine and Therapeutics, vol. 9, 2018, p. 43+. Gale Academic OneFile, link.gale.com/apps/doc/A574314818/AONE?u=cuny_statenisle&sid=AONE&xid=38c0b071. Accessed 18 October 2022

Ford, M., & Håkansson, A. (2020). Problem gambling, associations with comorbid health conditions, substance use, and behavioural addictions: Opportunities for pathways to treatment. PLOS ONE. Retrieved October 24, 2022, from https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0227644

Rockloff, M., Russell, A. M. T., Greer, N., Lole, L., Hing, N., & Browne, M. (2021).Young people who purchase loot boxes are more likely to have gambling problems: An online survey of adolescents and young adults living in NSW Australia. Journal of Behavioral Addictions, 10(1), 35–41. https://doi.org/10.1556/2006.2021.00007

Zendle, David, et al.“Adolescents and Loot Boxes: Links with Problem Gambling and Motivations for Purchase.” Royal Society Open Science, 19 June 2019, https://royalsocietypublishing.org/doi/10.1098/rsos.190049