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March 2018

 Loot boxes; prevention and reducing harm; AARP gambling tips


The only non-substance-related addictive disorder in the American Psychiatric Association’s Diagnostic  and Statistical Manual, Fifth Edition (DSM-5), is Gambling Disorder.  Section III of DSM-5 includes conditions with a significant body of scientific evidence to suggest they warrant a specific diagnostic code  and formal inclusion in the DSM. However, further study  and evidence is required to fully include the condition as an official disorder.  One condition warranting further study is Internet Gaming Disorder.

In recognition of the 2018 Problem Gambling Awareness Month (PGAM) in its 14th year, this month’s Tips and Topics highlights an article on the convergence of Gaming and Gambling.

Jeffrey Beck was Clinical Director at the Maryland Center of Excellence on Problem Gambling.  Just at publication time, we learned that Jeff passed away on March 10, reminding us all of the fragility of life.  As one of Jeff’s last professional contributions,  Tips  and  Topics is honored to include an article that he wrote with Dan Trolaro, who is Assistant Director at the New Jersey Council on Compulsive Gambling ( With Dan, Jeff was a member of the National Council on Problem Gambling (NCPG) Emerging Trends Sub-committee. Together they wrote this article in January 2018.  With their permission, I have excerpted  and reformatted their article for  Tips  and  Topics.
Loot Boxes – The Convergence of Gaming  and Gambling
Note the context for concern about loot boxes within video games.
We all know digital media use is greatly expanding – from the playing of video games to the widespread consumption of technology  and movies. Today’s consumers demand from their digital media realism, action,  and more value for their dollar because of:
  • The improvement in graphics
  • The multiple forms of deliverable content
  • The integration between gaming and film as with the phenomenon of the new Star Wars movie, as well as a new Star Wars video game which came into the marketplace, titled Battlefront II.
This game had the unintended effect of raising questions as to the possible predatory practices of the game manufacturing industry.  When Electronic Arts (EA) created this game in connection with Disney, it brought the issue of loot boxes within video games to everyone’s attention.  Battlefront IItriggered a debate about gambling addiction,  and spoiled its launch  and threatened revenues.
Discover what you know (or don’t) about loot boxes.
Loot boxes (also known as crates, chests, cases, bundles  and card packs) contain digital goods allowing players the chance to obtain special items. They can be thought of as a ‘virtual grab bag.’
You can unlock a mystery box:
  • After earning a certain amount of experience or in-game currency.
  • Or after paying real world money.
What is in the loot box?
  • In some cases, this box (or crate) might contain cosmetic items that only make a weapon or item look ‘cooler’.
  • In other cases, loot boxes are directly integrated into the gameplay experience, are unavoidable and perhaps the only way to progress through the game.
  • It is a bit like opening a mystery box. You might get something cool or you might get a bunch of junk.
What is the difference between gaming and gambling in loot boxes?
  • Loot boxes allow players the ability to use real money to buy the chance to win prizes for in-game playing (gambling).
  • This randomized component introduced into a game that is widely skill-based (gaming), is muddying the waters between gaming and gambling.
Compare and contrast loot boxes and gambling.
Are ‘Loot Boxes’ Gambling?’
  • The buying of loot boxes appears to be gambling because players (often adolescents) are being asked to buy something of monetary value that could wind up being of lower financial value than the amount paid.
  • A key question in the determination of whether loot boxes are gambling is whether in-game items acquired within a game of chance can be considered of value. (e.g. a cosmetic item to make a weapon look ‘cooler’)
  • Thus, most legal experts agree that winning cosmetic items, for example, qualifies as gambling; and does not need to specifically involve only money or real currency.
According to prominent video game attorney, Mark Whipple, “typically, gambling is said to occur if it contains three important elements:
  • Consideration, which means you have to pay something to play.
  • Chance, which means there is something outside of a player’s control that determines the outcome of the game.
  • And a prize which is something or anything of value.”
More on ‘taking a chance’
  • When ‘taking a chance’, the participant may get a sense of satisfaction if he/she wins; anddisappointment with a loss.
  • But there is always the chance for a win next time!
  • It is similar to purchasing Pokemon cards – spending money on randomized card packs on the off chance you might get something valuable.
More on the prize inside the loot box
  • A consideration about the prize: Is there is a secondary market where the contents of loot boxes can be cashed out or exchanged?
  • To that end, over the years a myriad of third party websites have appeared where players can gamble, barter, buy, or sell the digital items for other digital items or, in some cases, real currency.
  • With these websites, the item of value is no longer confined to the game itself; rather, they can now exist within a third-party marketplace where supply and demand dictates a real-world currency value equivalent.
  • Any marketing strategy using psychology to reward players and encourage them to spend more on the game may be characterized as a predatory practice and should be reviewed further.
Understand how loot boxes are addictive or not.
Are ‘Loot Boxes’ Addictive?
  • Free to play developers are using push notifications, in-game notifications, special events and the like to draw attention to the product, which is, more often than not, at the end of a chain of real and in-game currencies.
  • Do these techniques encourage compulsive and addictive behaviors as a byproduct (an unintentional but avoidable side effect) of trying to make their product more appealing to players?
Consider the system as a sort of ‘weaponized behavioral psychology’, perfectly pitched to exploit the cognitive weaknesses which make people so susceptible to addiction  and compulsion:
  • It is set up as an intermittent reward system, like a slot machine. You believe the next loot box you open will be the lucky one.
  • While video games are typically thought of as skill-based, the EA Battlefront Star Wars game has random prizes generated by loot box reward systems.
  • The gambling element takes the game out of a pure skill category.
Psychological tricks game makers use to make loot boxes addictive:
  • Game makers now use psychological tricks to drive people toward acquiring and opening loot boxes.
  • Similar tricks have been used by casinos and gaming machines to keep people playing.
  • The opening of the loot box, the sirens, the noises, the way it slowly opens are all designed to stimulate your senses.
  • They are made to dazzle, delight and encourage repeat purchases. Further, game makers have access to much more information about the player then traditional casino style machines.
  • They know demographics of player, social interactions, data and habits. As a player keeps improving their level of achievement in the game, at a deeper brain level, this releases dopamine. This addictive cycle fuels learning and behavior. It perpetuates ongoing gameplay.
  • So what makes loot boxes addictive for the player is the preoccupation with the entire gaming and gambling experience and sense of immediate gratification that could develop into gambling habits.
References and Sources:
Holdren, Wendy    Herald Reporter “Problem gamblers program cautions parents on pay-to-win features in video games” 12/11/2017
Crecente, Brian Rolling Stone “State rep to video game industry: Regulate loot boxes before we are forced to legislate 11/28/2017
Responsible Gaming “Opinion: Dr Mark Griffiths- Kids are being turned into gambling addicts by loot boxes in popular video games” 12/20/2017
Johnson, Shauna Metro News “Loot boxes, other pay to win game features raise red flags for problem gambling group”12/28/2017
Lardieri, Alexa U.S. News “Excessive Gaming to be named a Mental Health Disorder by the WHO.” 12/27/2017
Schreier, Jason Kotaku “Apple says Apps must now disclose odds for loot boxes”12/22/2017
Hern, Alex The Guardian “Video games are unlocking child gambling, this has to be reined in:” 12/28/2017
Trolaro, Dan Pulse “The convergence of gambling  and gaming continues” 12/08/2017
Henry, Richard RISE Life Management Services “Practical Ways to Implement Responsible Gaming Principles.” June, 2015
Salmen, Andreas Business, Life, Science & Tech “Gambling  and loot boxes: What is gambling anyway7″12/23/2017
Griffiths, Mark       The Sun “Gambling with their futures: How your kids are being turned into gambling addicts by video game loot boxes right under your nose” 12/18/2017
Mason, Damien “UK Gambling Commission shifts away from defining loot boxes, explains how to help the situation” 12/11/2017


Gambling disorder (GD) doesn’t get the respect it deserves. We aren’t taught enough about it; we don’t all screen for GD;  and we’re not all sure how to treat GD.  As Internet Gaming Disorder is a potential new diagnosis in the  Substance-Related and Addictive Disorders chapter of DSM, the convergence of gaming  and gambling makes it all the more important to develop prevention  andtreatment SKILLS.
Develop steps for prevention of harmful effects of loot boxes within video games.
It’s imperative consumer protection, transparency  and education are available to address the preoccupation  and instant gratification that could encourage or discourage gambling behavior. Ultimately, parents must develop an understanding of the loot box phenomenon  and talk to their children about their behavior.
The following are steps the industry, public, parents or caregivers could take to help limit the potentially harmful effects of loot boxes within video games:
  • Future research must examine the role gaming plays, plus its connection with gambling.
  • Game makers must be required to reveal the win rate of loot boxes, to give players more knowledge about what they are playing for.
  • Through legislation, the gaming industry should have restrictions on gambling-like mechanics in games that are marketable to youth and adolescents.
  • The ratings agency governing gaming could place an 18+ rating with a message on any games which “contains gambling-like themes.”
Richard Henry from Rise Life Services shares his thoughts on  responsible gaming, which applies, as well, to the expansion within video games of gambling-like themes:
Responsible Gaming describes a situation where all stakeholders within the gaming industry uphold agreed-upon principles and standards that ensure safe and fair gaming experiences that protect customers and the wider society from the possible adverse effects of disordered gaming.
Responsible gaming in a regulated environment exists when consumers can make informed decisions and can exercise rational and sensible choices based on their circumstances.
Responsible Gaming means a shared responsibility with collective action by the gaming industry, government, individuals and communities. The aim is to achieve outcomes that are socially responsible and responsive to community concerns. The principles that govern responsible gaming are grounded in science and driven by collaboration.”
Put protections in place to minimize the harm to youth from loot boxes.
Early age is a major risk factor
The introduction of gambling-like activities at an early age is a major risk factor  and gateway for gambling with real money with a potential for problem gambling later in life.
  • Youth display the typical responses adults have to gambling in these situations: anger, disappointment, and the urge to spend again- without any of the impulse control andawareness most adults have.
  • When gambling themes and mechanics are introduced at an early age, this can lead to normalization of spending and miscalculation of risk and reward.
  • This may lead to excessive time spent on games or money spent within the games themselves.
  • Additionally, youth can develop chasing behavior. They often lack the necessary judgment and self-control since those features typically develop last in the brain, often not complete until age 25.
  • These in-game ‘micro-transactions’ are reinforcing youth needs for instant gratification. It can groom them for future tendencies towards problem gambling.
Regulatory bodies
Many regulatory bodies have shifted the discussion from defining what loot boxes are to harm-minimization  and protection of young people.
Many parents are simply not interested in whether an activity meets the legal definition of gambling.
  • Their main concern is whether there is a product out there that could present a risk to their children.
  • If an activity meets the gambling test, we want to insure children are protected.
  • If it does not meet the test but could cause harm to children, parents will expect proper protections to be put in place by those who create, sell and regulate the products.
  • When the marketing, mechanics, and concepts all contain elements of gambling-like mechanisms within video games, this becomes a concern for youth


About a week ago, I got an invoice from the AARP. You don’t have to be that old to join the nearly 38 million members of the AARP, which is “dedicated to empowering Americans 50  and older to choose how they live as they age.” They wanted me to renew my membership. What a deal…just $63 for five years… and that includes both me  and my wife.
$63 membership for two for 5 years
Better still, I was due to visit my dentist for an annual checkup  and X-rays. I had just read on page 9 of the March edition of AARP Bulletin an article on “ You probably don’t need annual X-rays“. Ask your dentist said the article, so I did. My dentist agreed I could wait to do X-rays every two years. That saved me unnecessary x-rays  and paid for my 5-year membership fee more than twice over.
By the way, if you noticed in this month’s edition the revamped photo in the  Tips &  Topics banner, you’ll see I am embracing my age  and letting my hair go natural grey. It’s been going grey since my 30s.  But I figured since I am now twice that age, it was time to go with the flow of nature …………. ……gracefully.
So back to the AARP.
In this same March edition, besides the dentist  tips, there were some gambling  tips.  So in keeping with March Problem Gambling Awareness Month, here are  tips from a casino gambling expert ( Tips on Gambling):
  • Go to a casino expecting to have fun, not to win. The odds are against you. So short of being extremely lucky, the only way to leave a casino with a small fortune is to arrive with a
    large fortune.
  • Leave the ATM and credit cards at home, and bring just the amount of money you are comfortable losing.
  • Slot machines are like “electronic crack” to beginners because they are so easy to play. But they have the worst odds. If you can’t resist the slots, play machines near the entrance or other high-traffic areas – casinos set these machines to pay more often, to draw in passersby.
  • Roulette is a bad bet. If you must play roulette, look for a wheel with only one zero on it – you have a better chance of winning (not great, but better).
  • Learn to play craps. The game looks intimidating because there is so much going on. Nevertheless it can be exciting. There is even one bet where the casino has no advantage of taking your money – the only time this happens in a casino.
Since I don’t have a large fortune  and hate losing money, I won’t be taking his advice.  But if you don’t have a gambling problem, enjoy the  tips  and have fun.
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