Myth world: A brief look at some myths about Gaming Disorder

Earlier this year, the World Health Organisation announced that ‘Gaming Disorder’ (GD) was to be officially been included in the latest (eleventh) edition of the International Classification of Diseases (ICD-11). The announcement received worldwide media coverage alongside many debates as to whether its inclusion was justified based on the scientific evidence. The extensive media coverage raised many questions but also appeared to give rise to a number of myths. In this blog, I address these myths in the British context but some of these myths also have resonance outside the UK.

Myth 1 – Gaming Disorder equates to gaming addiction. Almost all of the worldwide press coverage for GD in June 2018 was equated with gaming addiction. However, the World Health Organization (WHO) does not describe GD as an addiction and the WHO criteria for GD do not include criteria that I believe are core to being genuine addictions (such as tolerance and withdrawal symptoms). Confusingly, the criteria for Internet Gaming Disorder (IGD) in the latest (fifth) edition of the Diagnostic Manual of Mental Disorders (DSM-5) does include all my core criteria of addiction. However, to be diagnosed with IGD, an individual does not necessarily have to endorse all the core addiction criteria. In short, all genuine gaming addicts are likely to be diagnosed as having GD and/or IGD but not all those with GD and/or IGD are necessarily gaming addicts.

Myth 2 – Gaming has many benefits so should not be classed as a disorder as it will create a ‘moral panic’: Predictably, the videogame industry has not welcomed the WHO’s decision to include GD in the ICD-11 and issued a statement to say gaming has many personal benefits and that GD will create moral panic and ‘abuse of diagnosis’. None of us in the field dispute the fact that gaming has many benefits but many other activities such as work, sex, and exercise can be disordered and addictive for a small minority, and is not a good basis for denying the existence of GD. The videogame industry also claims the empirical basis for GD is highly contested but then ironically uses non-empirical claims (i.e., that the introduction of GD will cause a moral panic and lead to diagnostic abuse by practitioners) as a core argument for why GD should not exist.

Myth 3 – Gaming Disorder is associated with other comorbidities so is not a separate disorder. In coverage concerning GD, those denying the existence of GD sometimes resort to the argument that problematic gaming is typically comorbid with other mental health conditions (e.g., depression, anxiety disorders, etc.) and therefore should not be classed as a separate disorder. However, such an argument is not applied (for instance) to those with alcohol use disorder or gambling disorder which are known to be associated with other comorbidities. In fact, we recently published some case studies in the International Journal of Mental Health and Addiction highlighting those attending treatment for GD included individuals both with and without underlying comorbidities. Consequently, diagnosis of disorders should be based on the external symptomatic behavior and consequences, not on the underlying causes and etiology.

Myth 4 – Gaming Disorder can now be treated for free by the National Health Service: Unlike many other countries, the UK has a National Health Service (NHS) whose treatment services can be accessed free of charge. A number of British newspapers reported that inclusion of GD in the ICD-11 meant that those with GD can now get free treatment. However, this claim is untenable and is unlikely to happen. All health trusts in the UK have a finite budget and allocate resources to those conditions considered a priority. Treating individuals with GD will rarely (if ever) be given priority over treatment for cancer, heart disease, schizophrenia, depression, etc. In countries where private health insurance is the norm, GD is likely to be a condition excluded for treatment on such policies even though it is now in the ICD-11. 

Myth 5 – The inclusion of Gaming Disorder as a mental disorder will lead to ‘millions’ of children being stigmatized for their videogame playing: This myth has been propagated by a group of scholars (mainly researchers working in the media studies field) but is completely unsubstantiated. The number of children who would ever be officially be diagnosed as having GD is extremely low and – as noted above – millions of children play videogames for enjoyment without any problems or stigma.

(Please note: This article is based on an editorial that I first published earlier this year: Griffiths, M.D. (2018). Five myths about gaming disorder. Social Health and Behavior Journal, 1, 2-3)

Dr Mark Griffiths, Distinguished Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Aarseth, E., Bean, A. M., Boonen, H., Colder Carras, M., Coulson, M., Das, D., … & Haagsma, M. C. (2017). Scholars’ open debate paper on the World Health Organization ICD-11 Gaming Disorder proposal. Journal of Behavioral Addictions, 6(3), 267-270.

Gentile, D.A., Bailey, K., Bavelier, D., Funk Brockmeyer, J., … & Young, K. (2017). The state of the science about Internet Gaming Disorder as defined by DSM-5: Implications and perspectives, Pediatrics, 140, S81-S85. doi: 10.1542/peds.2016-1758H

Griffiths, M.D.  (2005). A ‘components’ model of addiction within a biopsychosocial framework. Journal of Substance Use, 10, 191-197.

Griffiths, M.D. (2017). Behavioural addiction and substance addiction should be defined by their similarities not their dissimilarities. Addiction, 112, 1718-1720.

Griffiths, M.D. (2018). Conceptual issues concerning internet addiction and internet gaming disorder. International Journal of Mental Health and Addiction, 16, 233-239.

Griffiths, M.D., Kuss, D.J., Lopez-Fernandez, O., & Pontes, H.M. (2017). Problematic gaming exists and is an example of disordered gaming. Journal of Behavioral Addictions, 6, 296-301.

European Games Developer Foundation. Statement on WHO ICD-11 list and the inclusion of gaming. 2018 June 15. Available from: http://www.egdf.eu/wp-content/uploads/2018/06/Industry-Statement-on-18-June-WHO-ICD-11.pdf

Király, O., Griffiths, M.D. & Demetrovics Z. (2015). Internet gaming disorder and the DSM-5: Conceptualization, debates, and controversies, Current Addiction Reports, 2, 254–262.

Király, O., Griffiths, M.D., King, D., Lee, H-K., Lee, S-Y., Bányai, F., Zsila, A. Demetrovics, Z. (2018). An overview of policy responses to problematic videogame use. Journal of Behavioral Addictions, 7, 503-517.

Kuss, D.J., Griffiths, M.D. & Pontes, H.M. (2017). Chaos and confusion in DSM-5 diagnosis of Internet Gaming Disorder: Issues, concerns, and recommendations for clarity in the field. Journal of Behavioral Addictions, 6, 103-109.

Kuss, D.J., Pontes, H.M. & Griffiths, M.D. (2018). Neurobiological correlates in Internet Gaming Disorder: A systematic review. Frontiers in Psychiatry, 9, 166. doi: 10.3389/fpsyt.2018.00166

Griffiths, M.D., Van Rooij, A., Kardefelt-Winther, D., Starcevic, V., Király, O…Demetrovics, Z. (2016). Working towards an international consensus on criteria for assessing Internet Gaming Disorder: A critical commentary on Petry et al (2014). Addiction, 111, 167-175.

Rumpf, H. J., Achab, S., Billieux, J., Bowden-Jones, H., Carragher, N., Demetrovics, Z., … & Saunders, J. B. (2018). Including gaming disorder in the ICD-11: The need to do so from a clinical and public health perspective: Commentary on: A weak scientific basis for gaming disorder: Let us err on the side of caution (van Rooij et al., 2018). Journal of Behavioral Addictions, 7(3), 556-561.

Torres-Rodriguez, A., Griffiths, M.D., Carbonell, X. Farriols-Hernando, N. & Torres-Jimenez, E. (2018). Internet gaming disorder treatment: A case study evaluation of four adolescent problematic gamers. International Journal of Mental Health and Addiction, https://doi.org/10.1007/s11469-017-9845-9.

To err is to be human: A brief look at mistakes in poker playing

One of the most psychologically interesting questions concerning poker is ‘Why do so many people play so badly?’ It’s clear that most players know better, but they appear to make the same mistakes repeatedly. Given the hundreds of thousands of poker strategy books that are sold every year, we can only reach the conclusion that just a small percentage of poker players apply the skills they have read about. My hunch is that most people understand what they have read but when it comes to playing a competitive hand it’s simply more ‘fun’ to play badly than to play well. I’m not saying losing is more fun than winning (because quite clearly it isn’t), but the pursuit of profit maximization forces players to do things they don’t like doing. On a psychological level, maximizing profit makes extreme demands. Therefore, only a few, extraordinarily disciplined people play their best game most of the time – and nobody always plays it.

Most economists claim that gamblers are primarily driven by the profit motive. However, the psychological evidence is overwhelming that other desires affect gambling actions. Put simply, for most gamblers, our actions contradict the desire to maximize profits. Whilst I am no Freudian, there appear to be a whole range of unconscious factors at play in gambling situations.

One of the basic mistakes is playing too many hands. All the self-help books warn players against it but it is a common behaviour. In general, poker players find it boring to fold hand after hand. Players become more reckless and instead of folding, risk all in an attempt to get themselves out of a boredom rut. Even after losing, the poker player may ‘congratulate’ their play by defining it as ‘courageous’ when in the cold light of day, it was stupid. This type of adaptive thinking is common amongst gamblers who lose and should be avoided. Poker players often chase with weak hands for the same reason. Players will throw good money after bad in an effort to get even. Occasionally the strategy will pay off, but most of the time it won’t. In these situations, gamblers will invariably focus on the few times that chasing has got them out of a hole – but conveniently forget the many times that it didn’t.

Another common mistake is to playing too aggressively. Not only is this a male characteristic but is often the strategy of the game’s very top players. Again, such tactics occasionally pay off for the player in very tight games. However, in most gambling situations, playing aggressively is simply not called for yet players continue to do it. On the other hand, gamblers can sometimes play too passively. Gamblers constantly find good excuses to justify their playing styles. In these situations, gamblers simply remember the times they saved money by not betting or raising, ignoring the pots they lost by giving away free or cheap cards.

It’s also tempting to show your cards and most players will do it occasionally. If players make a successful bluff, it’s human nature to want to let people to know how smart they are. The golden rule in poker is never to give anything away but the human psyche works in such a way that we usually want to show off once in a while. Our psychological make-up also means that we let pride get in the way of minimizing losses. There are always games that should have been avoided but players end up staying in them long after they knew it was a mistake. None of us like to lose to who we think are weaker players, or admit that the game was too hard. How many times does a player continue playing because they want to try and get the better of a great player or show off because there is someone they are trying to impress? Although it’s a cliché, pride before a fall is commonplace. These short-term psychological satisfactions will almost always have a negative impact on long-term profits.

Because there are many non-financial types of rewards from many different sources while playing poker, some people view losses as the price of entry. To these players, winning may be a bonus. However, most of us don’t like losing – and we especially don’t like persistent losing, regardless of whether there are other types of reinforcement. In the cold light of day, we are all rational human beings. In the height of action, rationality often goes out the window. I’ve done it myself at the roulette table and standing in front of a slot machine. While gambling I have felt omnipotent (and wrote about this experience back in 1990 in an article on the dangers of doing observational research in amusement arcades). It is only after I walk away penniless that the non-financial rewards are short-term and not worth it.

Understanding our own psychological motives is clearly important while gambling. Most players know the strategies they should be adopting but fail to apply them in real gambling situations. Players do not lack the information. It is far more profitable to learn why we don’t apply the lessons we have already learned, then ensure that we apply them. Until we understand and control our own motives – including the unconscious ones – we cannot possibly play to our best ability.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Additional input from the writings of Alan Schoonmaker

Further reading

Biolcati, R., Passini, S. & Griffiths, M.D. (2015). All-in and bad beat: Professional poker players and pathological gambling. International Journal of Mental Health and Addiction, 13, 19-32.

Griffiths, M.D. (1990). The dangers of social psychology research. BPS Social Psychology Newsletter, 23, 20-23.

Griffiths, M.D., Parke, J., Wood, R.T.A. & Rigbye, J. (2010). Online poker gambling in university students: Further findings from an online survey. International Journal of Mental Health and Addiction, 8, 82-89.

McCormack. A. & Griffiths, M.D. (2012). What differentiates professional poker players from recreational poker players? A qualitative interview study. International Journal of Mental Health and Addiction, 10, 243-257.

Parke, A. & Griffiths, M.D. (2011). Poker gambling virtual communities: The use of Computer-Mediated Communication to develop cognitive poker gambling skills. International Journal of Cyber Behavior, Psychology and Learning, 1(2), 31-44.

Parke, A. & Griffiths, M.D. (2018). Identifying risk and mitigating gambling related harm in online poker. Journal of Risk Research, 21, 269-289.

Parke, A., Griffiths, M., & Parke, J. (2005) Can playing poker be good for you? Poker as a transferable skill. Journal of Gambling Issues, 14.

Recher, J. & Griffiths, M.D. (2012). An exploratory qualitative study of online poker professional players. Social Psychological Review, 14(2), 13-25.

Wood, R.T.A., Griffiths, M.D. & Parke, J. (2007). The acquisition, development, and maintenance of online poker playing in a student sample. CyberPsychology and Behavior, 10, 354-361.

Wood, R.T.A. & Griffiths. M.D. (2008). Why Swedish people play online poker and factors that can increase or decrease trust in poker websites: A qualitative investigation. Journal of Gambling Issues, 21, 80-97.

Shirty money: A brief look at football’s relationship with the gambling industry

A couple of days ago, Simon Stevens, the Chief Executive of the British National Health Service (NHS) said that foreign-owned betting companies who sponsor British football clubs should financially contribute to paying for gambling addicts’ treatment. I am all in favour of this, although I think some money should also be allocated to education, prevention, and (predictably) research. This is also an area that I have written about recently.

More specifically, I and my colleague Dr. Hibai Lopez-Gonzalez published a paper earlier this year entitled ‘Betting, forex trading, and fantasy gaming sponsorships – A responsible marketing inquiry into the ‘gamblification’ of English football’ in the International Journal of Mental Health and Addiction. Using data about sponsorship deals from English Football Premier League, we demonstrated that gambling marketing has become firmly embedded in the financial practices of many Premiership football clubs. We argued that these associations are not trivial, and that the symbolic linkage of sport and newer gambling forms may become an issue of public health, especially affecting vulnerable groups such as minors and problem gamblers.

A major preoccupation regarding gambling intersection with sports has been the marketing of betting as an experience inherently associated with the symbolic culture of sport. By emphasising its connections with sports, the marketing and advertising of betting has been theorised to pursue the ‘sanitation’ of gambling, transferring the health-related symbolic attributes of sport and physical exercise to betting behaviour. In this regard, of great concern is the effects that an excessive volume of betting marketing might have on vulnerable groups such as minors and young adults and individuals suffering or recovering from gambling disorder. Furthermore, additional issues might arise in the event that those new categories that extend the definition of sports gambling (i.e., trading, other gambling forms such as poker, and fantasy games) seeking to market their products in alignment with (or appropriation of) sports’ core values and positive attributes. Early examples of this marketing strategy can be found in the sport stars’ endorsement of poker brands such as the footballers Neymar Jr. and Cristiano Ronaldo, and the tennis player Rafael Nadal.

We asserted in our paper that football shirt sponsorship is arguably a good proxy to calibrate the volume of gambling marketing in English football. Table 1 shows the shirt sponsor evolution over a decade (from the 2007/2008 to 2016-2017 seasons). First team shirt sponsorship with gambling companies evolved from four deals in 2008, six deals in 2012, to ten deals in 2017, accounting for half of the 20 English Premier League teams. The saturation of shirt logos owned by gambling brands has evolved rapidly over a relatively short period of time. However, some industry voices have been anticipating a decline in the numbers of shirts being sponsored by gambling firms due to their incapacity to compete with other business sector, although such a decline has yet to materialise.

In the same vein, it has been noted that most of the football teams with shirts sponsored by gambling companies are among the less powerful in the league, both in terms of economic profitability and sporting success. Analysing the data from end of season table positions indeed demonstrates a bias of gambling companies sponsoring teams towards the bottom of the table. Thus, the four teams (out of 20 in the English Premier League) with gambling logos in 2007/08 finished the league 6th, 7th, 11th, and 15th. In 2011-12, the six teams sponsored by gambling companies finished 10th, 11th, 13th, 16th, 18th, and 20th. In 2016/2017 season, the ten teams with gambling sponsors showed an almost perfect inverse correlation between table position and gambling-origin shirt sponsor, ranking 9th, 10th, 11th, 13th, 14th, 15th, 16th, 17th, 18th, and 20th (19th being a money loan company).

This could be interpreted as a nuanced strategy. More specifically, gambling operators might believe they have enough global exposure that the league as whole offers, without needing to pay premium sponsorship deals to attach their brand to the most supported and successful teams (because all the lower ranked teams have to play all the upper ranked teams and therefore get equal advertising exposure during televised games).

Table 2 shows the breadth of the gamblification process by focusing on sponsorship deals running through 2016-17 season in the English Premier League. As can be observed, all teams secured at least one official betting partner, with some of them having multiple partners due to regional deals in strategic markets to provide so-called ‘geo-targeted’ betting experience. An illustration example is Arsenal club’s deals with 12Bet company in Asia, Betfair in Europe, SportPesa in Kenya, and Tempobet in Oceania. Altogether, the 20 English Premier League teams totalled 20 different betting brands, with 12 brands sponsoring only one team, five brands sponsoring two teams, and three brands sponsoring three different teams. Despite how fragmented the betting market might look, these brands represent only a small fraction of the actual number operating in association with the English football. In fact, betting brands are generally considered to offer poorly differentiated products in highly competitive markets. Consequently, marketing plays a significant part in artificially creating singular attributes that facilitate the acquisition and maintenance of customers.

Sponsorship deals with trading companies are not as prevalent as betting sponsorships. However, 14 out of 20 English Premier League teams have linked partnership deals with trading companies – most notably forex trading – for 2016/17 season. Only one trader (EZTrader) sponsors two different teams, while the rest are unique sponsors. Arguably, the same betting market attributes of low product differentiation and competitive environment also applies to trading firms.

Fantasy gaming is rapidly becoming a large component of sports appreciation, especially in the USA where fantasy sports appears to have partially absorbed the consumer base for online sports betting, an illegal activity in most states. Although still in its infancy in Europe, eight out of 20 English teams already have agreements in place with fantasy sports companies, some of which include a deal with DraftKings, the leading company along with FanDuel in USA’s fantasy gaming market. The concentration of brands here is slightly higher than in the case of betting and trading sponsorships, but six different brands still populate the growing fantasy gaming market in the English Premier League.

The detrimental effect on public health of an increase in the sports betting marketing volume is difficult to demonstrate. British data collected by the Gambling Commission is inconclusive due to the lack of definition of what constitutes gambling on sports. In general, research has found difficult to substantiate the causal association between gambling advertising exposure and behaviour, particularly when the effects of such exposure might take place weeks or months later. Despite the difficulties of finding empirical evidence of the real impact of marketing on betting behaviour, many authors have acknowledged that the association between marketing and gambling disorder is plausible, at least theoretically.

The sports betting marketing and advertising growth could be theorised to have two effects. First, an increase in gambling advertising exposure will lead to a higher prevalence rate of problem gambling. Many scholars have indicated that problem gamblers are usually more exposed to advertising (e.g., they visit more frequently gambling websites or watch more sport events), therefore it cannot be established whether they gamble more because they are exposed to more marketing instances or the are more exposed because they gamble more. However, a study I published with my Norwegian colleagues at the University of Bergen conducted among 6,034 Norwegian gamblers found that problem gamblers had a greater involvement with gambling advertising even when they were similarly exposed than regular non-problem gamblers.

Second, an overall rise in the consumption of gambling products following more aggressive marketing strategies, even while maintaining stable the percentage of people experiencing gambling-related harm, would lead to a rise in absolute numbers of people developing gambling problems. Simply put, keeping problem gambling rate constant, the more people that bet on sports, the more problem gamblers.

There is a wide consensus that sports betting marketing (and advertising) must be regulated, and is the case in most jurisdictions including the UK. However, there is no specific protection concerning the marketing of trading and fantasy gaming as a specific product category associated with sports. Finally, our paper noted that although there is no scientific evidence the marketing agreements between football clubs and the gambling industry are actually having a detrimental effect on the aforementioned vulnerable groups, it makes theoretical sense to think that they might potentially cause harm.

Note: This article was co-written with Hibai Lopez-Gonzalez

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Griffiths, M.D., Estévez, A., Guerrero-Solé F. & Lopez-Gonzalez, H. (2018). A brief overview of online sports betting advertising and marketing. Casino and Gaming International, 33, 51-55.

Lopez-Gonzalez, H., Estévez, A. & Griffiths, M.D. (2017). Marketing and advertising online sports betting: A problem gambling perspective. Journal of Sport and Social Issues, 41, 256-272.

Lopez-Gonzalez, H., Estévez, A. & Griffiths, M.D. (2018). Controlling the illusion of control: A grounded theory of sports betting advertising in the UK. International Gambling Studies, 18, 39-55.

Lopez-Gonzalez, H. & Griffiths, M.D. (2016). Is European online gambling regulation adequately addressing in-play betting advertising? Gaming Law Review and Economics, 20, 495-503.

Lopez-Gonzalez, H. & Griffiths, M.D. (2018). Betting, forex trading, and fantasy gaming sponsorships – A responsible marketing inquiry into the ‘gamblification’ of English football. International Journal of Mental Health and Addiction, 16, 404-419.

Lopez-Gonzalez, H. & Griffiths, M.D. (2018). Understanding the convergence of online sports betting markets. International Review for the Sociology of Sport, in press.

Lopez-Gonzalez, H. Guerrero-Solé, F., Estévez, A. & Griffiths, M.D. (2018). Betting is loving and bettors are predators: A Conceptual Metaphor Approach to online sports betting advertising. Journal of Gambling Studies, in press.

Lopez-Gonzalez, H., Guerrero-Sole, F. & Griffiths, M.D. (2018). A content analysis of how ‘normal’ sports betting behaviour is represented in gambling advertising. Addiction Research and Theory, 26, 238-247.

Remote control: ‘Cashing out’ in sports betting

“Cash Out lets you take profit early if your bet is coming in, or get some of your stake back if your bet is going against you – all before the event you’re betting on is over. Cash Out offers are made in real time on your current bets, based on live market prices. Whenever you are ready to Cash Out, simply hit the yellow button. Cash out is available on singles and multiples, on a wide range of sports, including football, tennis, horse racing, and many more! You can Cash Out of bets pre-play, in-play, and between legs” (Definition of ‘cash out’ betting on Betfair website, 2017).

Most European sports betting operators now feature ‘cash out’ functionalities in their online platforms. This means that bettors can withdraw their bets before the event bet upon has concluded, obtaining a smaller but guaranteed return if the outcome of the bet is going their way, or, conversely, cutting down the monetary impact of a foreseeable loss. The ‘cash out’ functionality has rapidly become popular among sports bettors that bet in-play (i.e., during the game on things such as soccer matches and horse races) as a way of maximising value on the bets they have made.

Industry voices such as David O’Reilly, from Colossus Bets, have identified four major benefits of cash out features for bookmakers: (i) reducing the volatility of the operator’s revenue; (ii) increasing the recycling of player returns, with more players banking smaller amounts; (iii) enabling players to avoid their ‘near miss’ frustration; and (iv) improving the player engagement with the platform by introducing a mechanism that promotes constant checking. However, for sports bettors, cashing out strategies might typically involve cutting down the profit while being ahead but rarely reducing the loss when going behind. In this regard, cashing out does not appear to differ greatly from other new internet-based betting forms (e.g. so-called ‘exotic’ or multiple bets), which have been found to possess, in general, higher expected losses for gamblers and greater profit margins for operators.

However, beyond the feature’s financial rationale, cash out affects the nature of sports betting in more meaningful ways. It is, arguably, a game-changer, that leads (along with other features such as ‘edit my acca’ features in which specific bets can be removed from ‘accumulator’ bets) to the transformation of sports betting from a discontinuous to a continuous form of gambling. Here, our contention is that cash out is a key component of the contemporary bettor-bookmaker interaction, and that the widespread adoption by devoted sports bettors merits a closer look into the implications of such an interaction from a problem gambling perspective. Such an examination also suggests that regulators and policymakers need to think about how to protect gambling consumers from the potential harm caused by this new type of betting.

Structural characteristics have been proposed as a determining factor that can influence problem gambling behaviour. Structural characteristics are those associated with the design of a gambling product that shape the way gamblers interact with it. Typical structural characteristics include, but are not limited to, bet frequency, bet duration, event frequency, near misses, stake size, jackpot size, probability of winning, and interface design (e.g., the use of music and colour stimuli in the design of slot machines).

The internet has altered significantly the structural characteristics of gambling and sports betting more specifically. For example, in a number of European countries, the football (soccer) pools used to comprise bets placed during a weekday on the outcome of a game played typically on a Saturday or Sunday (i.e., a once a week wager). This reward delay was a major protective factor against excessive gambling, which on a psychobiological level has been theorised as an imbalance in an individual’s dopamine receptors, and therefore, highly sensitive to shorter bet reward periods. Betting via the internet has reduced such delays in receiving rewards from gambling, thus modifying a major structural characteristic of betting from once a week to (in some instances) every few minutes.

In parallel to the increased uptake of Internet betting in many jurisdictions, a second dynamic, namely globalisation, has further widened the possibilities of betting across countries, sports, and time zones, ultimately transforming sports betting into a 24/7 activity where the bookmaker never closes the shop any day during the year. For the first time, if a gambler has a craving to bet, the market is able to respond to that demand anytime and anywhere via a range of Wi-Fi enabled portable devices (e.g., smartphone, tablets, laptops, etc.). Virtual sports have expanded the availability of betting options even more, eliminating the need to bet on real world sport events.

Although the time between bets (i.e., bet frequency) was effectively reduced to near zero, the time within bets (i.e., bet duration) changed little until cash out functionality was first introduced by the gaming operator William Hill in December 2012. With cash out features, sports betting has become a potentially continuous gambling activity, one that resembles the playing mechanics the stock market. As with investing in stocks, bet values in in-play sports betting are re-calculated seamlessly. The outcome of a sport event might not be as relevant for many bettors as the value their bet will acquire in the next few seconds, even if that bet turns out to be erroneous at the end of the game. As in stock market investing, betting becomes continuous because non-actions also qualify as actions in themselves. Every single second that a bettor decides not to cash out, a new bet takes place. Eventually, cash out features introduce the notion that it is the bet itself the commodity that is being traded in the sports betting market. This new continuous type of sports betting raises questions concerning the gambling-related harm that could be associated with it. It also suggests that the kinds of regulation found widely in the stock market investment sector might have some utility if applied to this new form of gambling.

From a marketing perspective, cash out functionality is often advertised as a control-enhancing mechanism for bettors. Given that cashing out is typically presented in television advertisements as a risk-free operation, the product is likely to be perceived as reimbursable if the client is not happy with it, arguably promoting less planned gambling behaviours. Some gaming operators use the alternative name of “edit my bet” to refer to cash out, focusing on the capacity of bettors to correct later possible errors of judgement. The problem is that (and as happens in stock market investing), cashing out is only possible at the current value of the stock (which may be inferior to the purchasing price). Additionally, and contrary to what happens in stock market investing, betting operators automatically devalue the bet price immediately after the purchase. For example, a bookmaker will typically offer to cash out for $0.95 or similar a $1 bet placed one second ago, a price devaluation unmotivated by any new information or event actually affecting the predicted value of such a bet.

Beyond its most apparent attributes, we have demonstrated that cash out within in-play gambling is a pivotal feature that has been introduced by the sports betting industry to transform sports betting from what was traditionally a discontinuous form of gambling into a continuous one. It is contended that, although cashing out presupposes more engaged gamblers that feel more in control of their bets, the emotionally charged context in which it is often used and the structural attributes of the product itself might actually make some bettors lose control over their gambling wagers. Consequently, gambling policymakers and regulators should be cognizant of the challenges of this transformation of sports betting and consider the implications for the protection of gambling consumers.

[Note: This article was co-written with Dr. Hibai Lopez-Gonzalez]

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Betfair (2017). Sportsbook: What is cash out and how does it work? Retrieved March 1, 2017, from: https://en-betfair.custhelp.com/app/answers/detail/a_id/4/~/sportsbook%3A-what-is-cash-out-and-how-does-it-work%3F

Gainsbury, S. M. (2015). Online gambling addiction: The relationship between internet gambling and disordered gambling. Current Addiction Reports, 2(2), 185-193.

Griffiths, M.D. (1993). Fruit machine gambling: The importance of structural characteristics. Journal of Gambling Studies, 9, 101-120.

Griffiths, M. D. (2005). A biopsychosocial approach to addiction. Psyke & Logos, 26(1), 9–26.

Griffiths, M.D. & Auer, M. (2013). The irrelevancy of game-type in the acquisition, development and maintenance of problem gambling. Frontiers in Psychology, 3, 621. doi: 10.3389/fpsyg.2012.00621.

Lopez-Gonzalez, H., & Griffiths, M. D. (2016). Understanding the convergence of online sports betting markets. International Review for the Sociology of Sport. http://doi.org/doi:10.1177/1012690216680602

Lopez-Gonzalez, H. & Griffiths, M.D. (2017). ‘Cashing out’ in sports betting: Implications for problem gambling and regulation. Gaming Law Review: Economics, Regulation, Compliance and Policy, 21(4), 323-326.

McCormack, A., & Griffiths, M. D. (2013). A scoping study of the structural and situational characteristics of internet gambling. International Journal of Cyber Behavior, Psychology and Learning, 3(1), 29–49.

Newall, P. W. S. (2015). How bookies make your money. Judgment and Decision Making, 10(3), 225–231.

Newall, P. W. S. (2017). Behavioral complexity of British gambling advertising. Addiction Research & Theory. http://doi.org/10.1080/16066359.2017.1287901

Parke, J., & Griffiths, M. D. (2007). The role of structural characteristics in gambling. In G. Smith, D. Hodgins, & R. Williams (Eds.), Research and Measurement Issues in Gambling Studies (pp. 211–243). New York: Elsevier.

Sports Trading Life. (2015). Is “cash out” actually BAD for betting punters? Retrieved March 1, 2017, from http://sportstradinglife.com/2015/03/is-cash-out-actually-bad-for-punters/

Odds on: Ten ways to help prevent problem gambling

[Please note: The following article was written with Dr. Michael Auer]

Problem gambling has become a major issue in many countries worldwide. In this short article we provide ten ways to help prevent problem gambling.

Raise the minimum age of all forms of commercial gambling to 18 years – Research has consistently shown that the younger a person starts to gamble, the more likely they are to develop gambling problems. Stopping problem gambling in adolescence is a key step in preventing problem gambling in the first place. Any venue or website that hosts gambling games should have effective age verification procedures.

Restrict the most harmful types of gambling – Most research shows that gambling activities which can be gambled on continuously such as slot machines tend to be far more problematic than discontinuous games such as weekly lotteries. More harmful forms of gambling should be restricted to dedicated gambling venues rather than housed in non-dedicated gambling premises (such as supermarkets, cafes, and restaurants).

Educate players to pre-commit when engaging in the most harmful types of gambling – Ideally, the most harmful forms of gambling should have mandatory limit-setting options for players to set their own voluntary time and money limits when playing the games. Gambling operators can also use mandatory loss limits to keep gambling expenditure to a minimum.

Take responsibility for where problem gambling lies – While all individuals are ultimately responsible for their own gambling behaviour, other stakeholders – including the gambling industry – have control over the structural and situational characteristics of gambling products. Government policymakers and legislators have a responsibility to ensure that gambling products are tightly regulated and to ensure that any given jurisdiction has the infrastructure to keep gambling problems to a minimum. Gambling operators are responsible for all advertising and marketing and need to ensure that the content is socially responsible and promotes responsible gambling. Within gambling venues, all practices and procedures should be socially responsible (such as not giving free alcohol while gambling, and no ATM machines on the gaming floor).

Put social responsibility at the heart of gambling operating practice – The most socially responsible gambling operators always puts player protection and harm minimisation at the heart of their business. They need to provide all information about their products so that individuals can make an informed choice about whether to gamble in the first place. They should advertise their products responsibly and provide their clientele with tools to aid responsible gambling, and provide help and guidance for those who think they are developing a gambling problem or have one.

Raise awareness about gambling among health practitioners and the general public – Problem gambling may be perceived as a somewhat ‘grey’ area in the field of health. However, there is an urgent need to enhance awareness about gambling-related problems within the general public and the medical and health professions.

Identify at-risk players – Big Data and Artificial Intelligence are common approaches applied in behavioural analysis across many industries. Online gambling and personalized land-based gambling operators can detect harmful behavioural patterns such as chasing losses or binge gambling. Such players can be excluded from direct marketing, specific types of games, and/or contacted to prevent the development of problem gambling.

Use personalized feedback – Research across many areas such as sports, health behaviour, as well as gambling has shown that personalized feedback can effectively change behaviour. Using behavioural data available in online gambling and personalized land-based venues, gamblers can be informed in real-time about behavioural changes in order to make them more aware and use pre-commitment tools such as limit-setting and/or self-exclusion.   

Set up both general and targeted gambling prevention initiatives – The goals of gambling intervention are to (i) prevent gambling-related problems, (ii) promote informed, balanced attitudes, and choices, and (iii) protect vulnerable groups. The guiding principles for action on gambling are therefore prevention, health promotion, harm reduction, and personal and social responsibility. This includes:

• General awareness raising (e.g. public education campaigns through advertisements on television, radio, newspapers).
• Targeted prevention (e.g. education programs and campaigns for particularly vulnerable populations such as senior citizens, adolescents, ethnic minorities).
• Awareness raising within gambling establishments (e.g. brochures and leaflets describing problem gambling, indicative warning signs, where help for problems can be sought such as problem gambling helplines, referral service, telephone counselling web-based chatrooms for problem gamblers, and outpatient treatment).
• Training materials (e.g. training videos about problem gambling shown in schools, job centres).

Educate and training those working in the gambling industry about problem gambling – All gaming personnel in any gambling establishments from shop retailers to croupiers should receive ongoing training regarding responsible gambling and problem gambling.

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Auer, M. & Griffiths, M.D. (2013). Behavioral tracking tools, regulation and corporate social responsibility in online gambling. Gaming Law Review and Economics, 17, 579-583.

Auer, M. & Griffiths, M.D. (2013). Voluntary limit setting and player choice in most intense online gamblers: An empirical study of gambling behaviour. Journal of Gambling Studies, 29, 647-660.

Auer, M. & Griffiths, M.D. (2014). Personalised feedback in the promotion of responsible gambling: A brief overview. Responsible Gambling Review, 1, 27-36.

Auer, M., Malischnig, D. & Griffiths, M.D. (2014). Is ‘pop-up’ messaging in online slot machine gambling effective? An empirical research note. Journal of Gambling Issues, 29, 1-10.

Auer, M. & Griffiths, M.D. (2015). Testing normative and self-appraisal feedback in an online slot-machine pop-up message in a real-world setting. Frontiers in Psychology, 6, 339. doi: 10.3389/fpsyg.2015.00339.

Auer, M. & Griffiths, M.D. (2015). The use of personalized behavioral feedback for problematic online gamblers: An empirical study. Frontiers in Psychology, 6, 1406. doi: 10.3389/fpsyg.2015.01406.

Auer, M. & Griffiths, M.D. (2016). Personalized behavioral feedback for online gamblers: A real world empirical study. Frontiers in Psychology, 7, 1875. doi: 10.3389/fpsyg.2016.01875.

Griffiths, M.D. (2017). Evaluating responsible gambling tools using behavioural tracking data. Casino and Gaming International, 31, 41-45.

Griffiths, M.D. (2016). Gambling advertising, responsible gambling, and problem gambling: A brief overview. Casino and Gaming International, 27, 57-60.

Griffiths, M.D. & Auer, M. (2016). Should voluntary self-exclusion by gamblers be used as a proxy measure for problem gambling? Journal of Addiction Medicine and Therapy, 2(2), 00019.

Griffiths, M.D., Harris, A. & Auer, M. (2016). A brief overview of behavioural feedback in promoting responsible gambling. Casino and Gaming International, 26, 65-70.

Harris, A. & Griffiths, M.D. (2017). A critical review of the harm-minimisation tools available for electronic gambling. Journal of Gambling Studies, 33, 187–221.

Oehler, S., Banzer, R., Gruenerbl, A., Malischnig, D., Griffiths, M.D. & Haring, C. (2017). Principles for developing benchmark criteria for staff training in responsible gambling. Journal of Gambling Studies, 33, 167-186.

Wood, R.T.A. & Griffiths, M.D. (2015). Understanding positive play: An exploration of playing experiences and responsible gambling practices. Journal of Gambling Studies, 31, 1715-1734.

Wood, R.T.A., Shorter, G.W. & Griffiths, M.D. (2014). Rating the suitability of responsible gambling features for specific game types: A resource for optimizing responsible gambling strategy. International Journal of Mental Health and Addiction, 12, 94–112.

Every little ring: Another look at excessive smartphone use

Last week I did seven back-to-back BBC radio interviews concerning my thoughts on a new study on smartphone use carried out by Opinium Research for Virgin Mobile and reported in a number of papers including the Daily Mail. The company surveyed 2,004 British adults (aged 18 years and over) who own a smartphone as well 200 British teenagers and tweenagers aged between 10 and 17 years. The main findings were that:

• British adults receive an average of 33,800 mobile phone messages and alerts annually
• British adults spend the equivalent of 22 days a year checking messages on their smartphones (an average of 26 minutes a day)
• An average smartphone user gets 93 buzzes a day
• Those aged between 18 and 24 years have almost three times more messages receiving 239 messages and alerts a day on average (approximately 87,300 a year).
• On average, Britons are members of six chat groups, although a small minority (2%) are members of 50 groups or more, rising to 7% among those aged 18 to 24 years.
• One in four adults say they check a WhatsApp message instantly, with this increasing to almost one in three among 18 to 24-year-olds.
• Smartphone users receive 427% more messages and notifications than they did a decade ago
• Smartphone users sent 278% more messages than they did a decade ago

The survey found a contributing factor behind the surge in the number of messages received was the rise of group chats on platforms like WhatsApp and Facebook. In the press release, Dr Dimitrios Tsivrikos (consumer and business psychologist at University College London) said:

“The boom in smartphone use was a positive trend and allowed consumers greater control over their lives. In an age where we are constantly surrounded by endless tasks, always flooded with a sea of data, smartphones allow us to manage our lives in a way that suits us. From calendars and reminders, to emails and instantaneous access to an encyclopaedia of human knowledge, smartphones give us total control, right at our fingertips.”

There was nothing in the study that I found particularly surprising but I was hoping to see what survey had found from those under 18 years of age (but nothing was reported in the national newspapers and I’ve been unable to track down anything beyond the press release).

In my radio interviews, most of the presenters wanted to know the extent to which individuals are now ‘addicted’ to their mobile phones. I then trotted out my usual response that ‘people are no more addicted to their smartphones than alcoholics are addicted to a bottle’ and said if there was anything addicting then it was the application (e.g., gaming, gambling, shopping, social networking, etc.) rather than the smartphone itself. I also went through the addiction components model and hypothesized what the behaviour of a smartphone addict would look like if they were genuinely addicted to their smartphone applications:

• Salience – This occurs when using a smartphone becomes the single most important activity in the person’s life and dominates their thinking (preoccupations and cognitive distortions), feelings (cravings) and behaviour (deterioration of socialised behaviour). For instance, even if the person is not actually on their smartphone they will be constantly thinking about the next time that they will be (i.e., a total preoccupation with smartphone use).
• Mood modification – This refers to the subjective experiences that people report as a consequence of using their smartphone and can be seen as a coping strategy (i.e., they experience an arousing ‘buzz’ or a ‘high’ or paradoxically a tranquilizing feel of ‘escape’ or ‘numbing’ whenever they use their smartphone).
• Tolerance – This is the process whereby increasing amounts of time on a smartphone are required to achieve the former mood modifying effects. This basically means that for someone engaged on a smartphone, they gradually build up the amount of the time they spend using a smartphone every day.
• Withdrawal symptoms – These are the unpleasant feeling states and/or physical effects (e.g., the shakes, moodiness, irritability, etc.), that occur when the person is unable to access their smartphone because they have mislaid or lost it, are too ill to use it, in a place with no reception, etc.
• Conflict – This refers to the conflicts between the person and those around them (interpersonal conflict), conflicts with other activities (social life, hobbies and interests) or from within the individual themselves (intra-psychic conflict and/or subjective feelings of loss of control) that are concerned with spending too much time on a smartphone.
• Relapse – This is the tendency for repeated reversions to earlier patterns of excessive smartphone use to recur and for even the most extreme patterns typical of the height of excessive smartphone use to be quickly restored after periods of control.

Using these criteria, I then went on to say that very few people would be classed as addicted to their smartphones. However, I did point out that such behaviour is on a continuum and that there may be a growing number of people that experience problematic smartphone use rather than being addicted. The examples I used included those individuals who would rather spend time on their smartphone than spending it with their partner and/or children, or individuals who spend so much time on their smartphone that it impacts on their job or their education (depending upon how old they are). Neither of these on their own (or together) necessarily indicate addictive use of smartphones but could be a sign that such individuals are at risk for developing an addiction to the applications on their smartphone. However, I would still argue that someone that spends all their time on social networking sites and social media (via their mobile phone) are a social media addict rather than a smartphone addict although others might see this as a semantic difference rather than a difference of substance. Whatever we call the behaviour, there does seem to be growing evidence that smartphones play a major role in people’s lives and that a small minority appear to have problematic use (as outlined in a number of studies that I have co-authored – see ‘Further reading’ below).

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Billieux, J., Maurage, P., Lopez-Fernandez, O., Kuss, D.J. & Griffiths, M.D. (2015). Can disordered mobile phone use be considered a behavioral addiction? An update on current evidence and a comprehensive model for future research. Current Addiction Reports, 2, 154-162.

Carbonell, X., Chamarro, A., Beranuy, M., Griffiths, M.D. Oberst, U., Cladellas, R. & Talarn, A. (2012). Problematic Internet and cell phone use in Spanish teenagers and young students. Anales de Psicologia, 28, 789-796.

Csibi, S., Griffiths, M.D., Cook, B., Demetrovics, Z., & Szabo, A. (2018). The psychometric properties of the Smartphone: Applications-Based Addiction Scale (SABAS). International Journal of Mental Health and Addiction. doi: 10.1007/s11469-017-9787-2

Griffiths, M.D. (2013). Adolescent mobile phone addiction: A cause for concern? Education and Health, 31, 76-78.

Hussain, Z., Griffiths, M.D. & Sheffield, D. (2017). An investigation in to problematic smartphone use: The role of narcissism, anxiety, and personality factors. Journal of Behavioral Addictions, 6, 378–386.

Lopez-Fernandez, O., Kuss, D.J., Griffiths, M.D., & Billieux, J. (2015). The conceptualization and assessment of problematic mobile phone use. In Z. Yan (Ed.), Encyclopedia of Mobile Phone Behavior (Volumes 1, 2, & 3) (pp. 591-606). Hershey, PA: IGI Global.

Lopez-Fernandez, O., Kuss, D.J., Romo, L. Morvan, Y., Kern, L., … Griffiths, M.D., … Billieux, J. (2017). Self-reported dependence on mobile phones in young adults: A European cross-cultural empirical survey. Journal of Behavioral Addictions, 6, 168-177.

Lopez-Fernandez, O., Männikkö, N., Kääriäinen, M., Griffiths, M.D., & Kuss, D.J. (2018). Mobile gaming does not predict smartphone dependence: A cross-cultural study between Belgium and Finland. Journal of Behavioral Addictions. doi: 10.1556/2006.6.2017.080

Richardson, M., Hussain, Z. & Griffiths, M.D. (2018). Problematic smartphone use, nature connectedness, and anxiety. Journal of Behavioral Addictions. doi: 10.1556/2006.7.2018.10

 

Eyes on the prize: Is the buying of loot boxes in videogames a form of gambling?

The buying of loot boxes takes place within online videogames and are (in essence) virtual games of chance. Players use real money to buy virtual in-game items and can redeem such items by buying keys to open the boxes where they receive a chance selection of further virtual items. Other types of equivalent in-game virtual assets that can be bought include crates, cases, chests, bundles, and card packs. The virtual items that can be ‘won’ can comprise basic customization (i.e., cosmetic) options for a player’s in-game character (avatar) to in-game assets that can help players progress more effectively in the game (e.g., gameplay improvement items such as weapons, armor). All players hope that they can win ‘rare’ items and are often encouraged to spend more money to do so because the chances of winning such items are minimal. Many popular videogames now feature loot boxes (or equivalents) including Overwatch, Middle-earth: Shadow of War, Star Wars Battlefront 2, FIFA Ultimate Team, Mass Effect: Andromeda, Fortress 2, Injustice 2, Lawbreakers, Forza Motorsport 7, and For Honor. In short, all of these require the paying of real money in exchange for a completely random in-game item. In an interview with Eurogamer, psychologist Jamie Madigan said:

“Whenever you open [a loot box], you may get something awesome (or you may get trash). This randomness taps into some of the very fundamental ways our brains work when trying to predict whether or not a good thing will happen. We are particularly excited by unexpected pleasures like a patch of wild berries or an epic skin for our character. This is because our brains are trying to pay attention to and trying to figure out such awesome rewards. But unlike in the real world, these rewards can be completely random (or close enough not to matter) and we can’t predict randomness. But the reward system in your brain doesn’t know that. Buying [loot boxes] puts them into the same category of packs of Pokémon cards or baseball cards. Unlike gambling in a casino, you’re going to get something out of that pack. Maybe just not the thing you wanted”.

Although there are many definitions in many disciplines defining gambling, there are a number of common elements that occur in the majority of gambling instances that distinguish ‘true’ gambling from mere risk-taking. These include: (i) the exchange is determined by a future event, which at the time of staking money (or something of financial value) the outcome is unknown, (ii) the result is determined (at least partly or wholly) by chance, (iii) the re-allocation of wealth (i.e., the exchange of money [or something of financial value] usually without the introduction of productive work on either side, and (iv) losses incurred can be avoided by simply not taking part in the activity in the first place. Added to this it could be argued that the money or prize to be won should be of greater financial value than the money staked in the first place. Based on these elements, the buying of loot boxes (or equivalents) would be classed as a form of gambling, as would other activities such as the Treasure Hunter and Squeal of Fortune games within the Runescape videogame and online penny auctions (which I have argued in previous papers – see ‘Further reading’).

In the UK Gambling Commission’s most recent (March 2017) position paper on virtual currencies and social casino gambling noted:

“One commonly used method for players to acquire in-game items is through the purchase of keys from the games publisher to unlock ‘crates’, ‘cases’ or ‘bundles’ which contain an unknown quantity and value of in-game items as a prize. The payment of a stake (key) for the opportunity to win a prize (in-game items) determined (or presented as determined) at random bears a close resemblance, for instance, to the playing of a gaming machine. Where there are readily accessible opportunities to cash in or exchange those awarded in-game items for money or money’s worth those elements of the game are likely to be considered licensable gambling activities [Section 3.17]…Additional consumer protection in the form of gambling regulation, is required in circumstances where players are being incentivised to participate in gambling style activities through the provision of prizes of money or money’s worth. Where prizes are successfully restricted for use solely within the game, such in-game features would not be licensable gambling, notwithstanding the elements of expenditure and chance [Section 3.18]”.

Consequently, the UK Gambling Commission does not consider loot boxes as a form of gambling because (they claim) the in-game items have no real-life value outside of the game. However, this is not the case because there are many websites that allow players to trade in-game items and/or virtual currency for real money. The Gambling Commission appear to acknowledge this point and claim that the buying of in-game loot boxes (and their equivalents) are not gambling but if third party sites become involved (by allowing the buying and selling of in-game items), the activity does become a form of gambling. As Vic Hood (in a 2017 article in Eurogamer) rightly notes, this appears to be a case of the law struggling to keep pace with technology. There are also issues surrounding age limits and whether games that offer loot boxes (or equivalents) should be restricted to those over the age of 18 years.

Predictably, those in the videogame industry do not view the buying of loot boxes as gambling either. For instance, Dirk Bosmans (from PEGI [Pan European Game Information], the European-based videogame rating organization) stated in a recent interview with Eurogamer that:

“Loot crates are currently not considered gambling: you always get something when you purchase them, even if it’s not what you hoped for. For that reason, a loot crate system does not trigger the gambling content descriptor. If something is considered gambling, it needs to follow a very specific set of legislation, which has all kinds of practical consequences for the company that runs it. Therefore, the games that get a PEGI gambling content descriptor either contain content that simulates what is considered gambling or they contain actual gambling with cash payouts. If PEGI would label something as gambling while it is not considered as such from a legal point of view, it would mostly create confusion. We are always monitoring such developments and mapping consumer complaints. We see a growing need for information about specific features in games and apps (social interaction, data sharing, digital purchases), but the challenge is that such features are rapidly becoming ubiquitous in the market, yet they still come in very different shapes and sizes.”

This appears somewhat hardline given that PEGI’s descriptor of gambling content is used whenever any videogame “teaches or encourages” gambling. Such a descriptor would arguably cover gambling-like games or activities and the buying of loot boxes is ‘gambling-like’ at the very least. The same stance has been taken by the Entertainment Software Rating Board (ESRB) which rates videogames in Canada and the USA. A spokesman for the ESRB told Eurogamer that:

“ESRB does not consider [the buying of loot boxes] to be gambling because the player uses real money to pay for and obtain in-game content. The player is always guaranteed to receive something – even if the player doesn’t want what is received. Think of it like opening a pack of collectible cards: sometimes you’ll get a brand new, rare card, but other times you’ll get a pack full of cards you already have. That said, ESRB does disclose gambling content should it be present in a game via one of two content descriptors: Simulated Gambling (player can gamble without betting or wagering real cash or currency) and Real Gambling (player can gamble, including betting or wagering real cash or currency). Neither of these apply to loot boxes and similar mechanics.”

At present, there are a number of countries (mainly in South East Asia such as China and Japan) who do view the buying of loot boxes as a form of gambling and have incorporated such activities into their gambling regulation. However, most countries have either not considered regulating the buying of loot boxes at all, or (like the UK) have ruled out that buying loot boxes does not currently meet their regulatory definition of gambling. Although there has been little published in academic journals on loot boxes, a number of articles in the trade press have claimed that the buying of loot boxes can be problematic and/or addictive because they are designed using highly similar reward schedules to those used in the design of slot machines. This is something that have also pointed out in relation to similar activities to the buying of loot boxes where individuals play for points rather than money. Personally, I view the buying of loot boxes as a form of gambling particularly because the ‘prizes’ won are (in financial terms) often a lot less than that of the price paid. Obviously I am out of step in relation to the regulators in my own country, but if third party websites continue to host services where in-game virtual items can be bought and sold, the activity definitely constitutes a form of gambling by almost any definition of gambling currently used in the field of social sciences.

(N.B. This article uses material from a paper I recently published in Gaming Law Review)

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Alexandra, H. (2017). Loot boxes are designed to exploit us. Kotaku, October 13. https://kotaku.com/loot-boxes-are-designed-to-exploit-us-1819457592

Avard, A (2017). Video games have a loot box fetish, and it’s starting to harm the way we play. Games Radar, October 10. Located at: http://www.gamesradar.com/loot-boxes-shadow-of-war/

Gambling Commission (2017). Virtual currencies, esports and social casino gaming – position paper. Birmingham: Gambling Commission.

Griffiths, M.D. (2015). Adolescent gambling and gambling-type games on social networking sites: Issues, concerns, and recommendations. Aloma: Revista de Psicologia, Ciències de l’Educació i de l’Esport, 33(2), 31-37.

Griffiths, M.D. (2017). Is the buying of loot boxes in videogames a form of gambling or gaming? Gaming Law Review, 22(1), 52-54.

Griffiths, M.D. & Carran, M. (2015). Are online penny auctions a form of gambling? Gaming Law Review and Economics, 19, 190-196.

Griffiths, M.D. & King, R. (2015). Are mini-games within RuneScape gambling or gaming? Gaming Law Review and Economics, 19, 64-643.

Hood, V. (2017). Are loot boxes gambling? Eurogamer, October 12. Located at: Located at: http://www.eurogamer.net/articles/2017-10-11-are-loot-boxes-gambling

Lawrence, N, (2017). The troubling psychology of pay-to-loot systems. IGN, April 23. Located at: http://uk.ign.com/articles/2017/04/24/the-troubling-psychology-of-pay-to-loot-systems

Perks, M. (2016). Limited edition loot boxes: Problematic gambling and monetization. Cube, October 11. Located at: https://medium.com/the-cube/limited-edition-loot-boxes-problematic-gambling-and-monetization-756819f2c54f

Wikipedia (2017). Loot box (2017). Located at: https://en.wikipedia.org/wiki/Loot_box

Wiltshire, W. (2017). Behind the addictive psychology and seductive art of loot boxes. PC Gamer, September 29. Located at: http://www.pcgamer.com/behind-the-addictive-psychology-and-seductive-art-of-loot-boxes/

To see or not to see: A brief look at hallucinations in virtual reality applications

As a teenager I was fascinated with LSD purely as a consequence of my love of The Beatles and its alleged association with songs such as ‘Lucy in the Sky with Diamonds‘ (I say ‘alleged’ because all Beatle fanatics know that this song got its’ title from a drawing by John Lennon’s son Julian and that lyrically the song was inspired by the writings of Lewis Carroll, the creator of Alice in Wonderland [AIW], a book which gave its’ name to AIW Syndrome that I examined in a couple of previous blogs).

When I first started teaching my ‘Addictive Behaviours’ module back in 1990, almost all my lectures concentrated on drug addictions (as opposed to behavioural addictions which now take centre stage in my teaching), and it was my session on hallucinogenic drugs (also known as psychedelic drugs) that was always the most fun to teach and the topic that students appeared to be most engaged in. Like many of my students, I have always been interested in altered states of consciousness both in my own research into addiction and the topic more generally.

The reason why I mention all these things as that I did a media interview on the hallucinogenic effects of virtual reality products. The interview was based on comments by Microsoft researcher Mar Gonzalez Franco, who said that virtual reality will soon replace the need for hallucinogenic drugs. More specifically, she was quoted as saying:

“By 2027 we will have ubiquitous virtual reality systems that will provide such rich multi-sensorial experiences that will be capable of producing hallucinations which blend or alter perceived reality. Using this technology, humans will retrain, recalibrate and improve their perceptual systems…In contrast to current virtual reality systems that only stimulate visual and auditory senses, in the future the experience will expand to other sensory modalities including tactile with haptic devices“.

Claims that VR products have the potential to induce hallucinogenic experiences have already started appearing in the media. A recent story in the Daily Mail reported that there was already a VR app (SelfSound) that claimed it can reproduce the effects of hallucinogenic drugs and “plays on the neurological phenomena known as synaesthesia” and that a “program is used to promote mediation through creating abstract reality [and] plays face-melting music with synesthetic DMT-style visualizations uniquely generated in response to [a person’s] voice”. (DMT is an abbreviation for dimethyltryptamine, a powerful hallucinogenic drug).

Over the last seven years, I have published a series of studies with Dr. Angelica Ortiz de Gotari (some of them listed in the ‘Further reading’ section below) showing that hallucinations are common among video gamers in our working examining Game Transfer Phenomena (GTP). Therefore, it’s no surprise that VR games can do the same thing. We have reported that visual and auditory hallucinations are commonly experiences by regular videogame players.

For instance, one of our studies published in the International Journal of Human-Computer Interaction found that some video gamers experience altered visual perceptions after playing (e.g., distorted versions of real world surroundings). Others saw video game images and misinterpreted real life objects after they had stopped playing. Gamers reported seeing video game menus popping up in front their eyes when they were in a conversation, or saw coloured images and ‘heads up’ displays when driving on the motorway. Our study analysed 656 experiences from 483 gamers collected in 54 online video game forums. Visual illusions can easily trick the brain, and staring at visual stimuli can cause ‘after-images’ or ‘ghost images’ among videogame players. We found that GTP were triggered by associations between video game experiences, and objects and activities in real life contexts. Our findings also raised questions about the effects of the exposure to specific visual effects used in video games.

We also reported that in some playing experiences, video game images appeared without awareness and control of the gamers, and in some cases, the images were uncomfortable, especially when gamers could not sleep or concentrate on something else. These experiences also resulted in irrational thoughts such as gamers questioning their own mental health, getting embarrassed or performing impulsive behaviours in social contexts. However, other gamers clearly thought that these experiences were fun and some even tried to induce them.

Visual experiences identified in GTP show us the interplay of physiological, perceptual and cognitive mechanisms and the potential of learning with video games even without awareness. It also invites us to reflect about the effects of prolonged exposure to synthetic stimuli and the challenges that the human mind affront due to the technological advances that are still to come. However, because we collected our data for most of our published studies from online video game forums, the psychological profile of the gamers in our studies are unknown. However, different gamers reported similar experiences in the same games. This highlights the relevance of the video games’ structural characteristics but gamers’ habits also appear to be crucial. Some gamers may be more susceptible than others to experience GTP. The effects of these experiences appear to be short-lived, but some gamers experience them recurrently. It goes without saying (but I’ll say it anyway) that more research is needed to understand the cognitive and psychological implications of GTP. Most of these GTP experiences are viewed positively but a small minority of players find them detrimental.

Whether such hallucinations – either in typical videogames or VR videogames – can be induced on demand is debatable. Very few players in our own research said they were able to induce hallucinations. At present, we simply don’t know what the long-term effects of VR gaming will be and that goes for VR-induced gaming hallucinations too. It may be the case that VR induced hallucinogenic states will be ‘safer’ than ones induced by psychedelic drugs as there is no ingestion of a psychoactive substance, but that’s just speculation on my part.

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Cawley, C. (2016). Virtual Reality could make you hallucinate; Don’t freak out. Tech Co, December 15. Located at: http://tech.co/virtual-reality-hallucinate-dont-freak-2016-12

Hamill, J. (2016). Windows of perception: Microsoft says virtual reality will soon have same mind-bending effects as LSD. The Sun, December 7. Located at: https://www.thesun.co.uk/news/2347705/microsoft-says-virtual-reality-will-soon-have-same-mind-bending-effects-as-lsd/

Liberatore, S. (2016). That’s trippy! Watch the VR app that claims to be able to reproduce the effects of a hallucinogenic drug. Daily Mail, May 4, Located at: http://www.dailymail.co.uk/sciencetech/article-3572184/That-s-trippy-Watch-VR-app-claims-able-reproduce-effects-hallucinogenic-drug.html

Ortiz de Gortari, A.B. & Griffiths, M.D. (2012). An introduction to Game Transfer Phenomena in video game playing. In J. Gackenbach (Ed.), Video Game Play and Consciousness (pp.223-250). Hauppauge, NY: Nova Science.

Ortiz de Gortari, A.B. & Griffiths, M.D. (2014). Altered visual perception in Game Transfer Phenomena: An empirical self-report study. International Journal of Human-Computer Interaction, 30, 95-105.

Ortiz de Gortari, A.B. & Griffiths, M.D. (2014). Auditory experiences in Game Transfer Phenomena: An empirical self-report study. International Journal of Cyber Behavior, Psychology and Learning, 4(1), 59-75.

Ortiz de Gortari, A.B. & Griffiths, M.D. (2014). Automatic mental processes, automatic actions and behaviours in Game Transfer Phenomena: An empirical self-report study using online forum data. International Journal of Mental Health and Addiction, 12, 432-452.

Ortiz de Gortari, A.B. & Griffiths, M.D. (2015). Game Transfer Phenomena and its associated factors: An exploratory empirical online survey study. Computers in Human Behavior, 51, 195-202.

Ortiz de Gortari, A.B. & Griffiths, M.D. (2015). Auditory experiences in Game Transfer Phenomena: An empirical self-report study. In: Gamification: Concepts, Methodologies, Tools, and Applications (pp.1329-1345). Pennsylvania: IGI Global.

Ortiz de Gortari, A.B. & Griffiths, M.D. (2016). Prevalence and characteristics of Game Transfer Phenomena: A descriptive survey study. International Journal of Human-Computer Interaction, 32, 470-480.

Ortiz de Gortari, A.B., Pontes, H.M. & Griffiths, M.D. (2015). The Game Transfer Phenomena Scale: An instrument for investigating the non-volitional effects of video game playing. Cyberpsychology, Behavior and Social Networking, 18, 588-594.

Rothman, P. (2014). Virtual Reality and Drugs – Yes, you should get high before using VR. H Plus Magazine, July 31. Located at: http://hplusmagazine.com/2014/07/31/virtual-reality-and-drugs-yes-you-should-get-high-before-using-vr/

Levy settle: A statutory gambling levy is needed to help treat gambling addicts

At the most recent Labour Party conference, the Party’s deputy leader Tom Watson said that if they formed the next Government they would introduce legislation to force gambling operators to pay a levy to fund research and NHS treatment to help problem gamblers deal with their addiction. This is something which I wholeheartedly support and is also something that I have been calling for myself for over a decade

The most recent statistics on gambling participation by the Gambling Commission in August 2017 reported that 63% of the British population had gambled in the last year and that the prevalence rate of problem gambling among those 16 years and over was 0.6%-0.7%. While this is relatively low, this still equates to approximately 360,000 adult problem gamblers and is of serious concern.

At present the gambling industry voluntarily donates money to an independent charitable trust (GambleAware) and most of this money funds gambling treatment (with the remaining monies being used to fund education and research). In the 12 months prior to March 2017, the gambling industry had donated £8 million, an amount still 20% below the £10 million a year I recommended in a report I wrote for the British Medical Association a number of years ago.

A statutory levy of 1% on all gambling profits made by the British gambling industry would raise considerably more money for gambling education, treatment and research than the £8 million voluntarily donated last year and is the main reason why I am in favour of it. Gambling has not been traditionally viewed as a public health matter. However, I believe that gambling addiction is a health issue as much as a social issue because there are many health consequences for those addicted to gambling including depression, insomnia, intestinal disorders, migraine, and other stress related disorders. This is in addition to other personal issues such as problems with personal relationships (including divorce), absenteeism from work, neglect of family, and bankruptcy.

There are also many recommendations that I would make in addition to a statutory levy. These include:

• Brief screening for gambling problems among participants in alcohol and drug treatment facilities, mental health centres and outpatient clinics, as well as probation services and prisons should be routine.
• The need for education and training in the diagnosis and effective treatment of gambling problems must be addressed within GP training. Furthermore, GPs should screen for problem gambling in the same way that they do for other consumptive behaviours such as cigarette smoking and alcohol drinking. At the very least, GPs should know where they can refer their patients with gambling problems to.
• Research into the efficacy of various approaches to the treatment of gambling addiction in the UK needs to be undertaken and should be funded by GambleAware.
• Treatment for problem gambling should be provided under the NHS (either as standalone services or alongside drug and alcohol addiction services) and funded either by gambling-derived revenue (i.e., a ‘polluter pays’ model).
• Given the associations between problem gambling, crime, and other psychological disorders (including other addictions), brief screening should be routine for gambling problems should be carried out in alcohol and drug treatment facilities, mental health centres and outpatient clinics, as well as probation services and prisons.
• Education and prevention programmes should be targeted at adolescents along with other potentially addictive and harmful behaviours (e.g., smoking, drinking, and drug taking) within the school curriculum.

As I have tried to demonstrate, problem gambling is very much a health issue that needs to be taken seriously by all in the medical profession. General practitioners routinely ask patients about smoking and drinking, but gambling is something that is not generally discussed. Problem gambling may be perceived as a grey area in the field of health. If the main aim of practitioners is to ensure the health of their patients, then an awareness of gambling and the issues surrounding it should be an important part of basic knowledge in the training of those working in the health field.

Gambling is not an issue that will go away. Opportunities to gamble and access to gambling have increased due to the fact that anyone with Wi-Fi access and a smartphone or tablet can gamble from wherever they are. While problem gambling can never be totally eliminated, the Government must have robust gambling policies in place so that potential harm is minimized for the millions of people that gamble. For the small minority of individuals who develop gambling problems, there must be treatment resources in place that are affordable and easily accessible.

(N.B. This is a longer version of an article that was originally published in The Conversation)

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Auer, M. & Griffiths, M.D. (2013). Behavioral tracking tools, regulation and corporate social responsibility in online gambling. Gaming Law Review and Economics, 17, 579-583.

Griffiths, M.D. (2003). Problem gambling. The Psychologist: Bulletin of the British Psychological Society, 16, 582-584.

Griffiths, M.D. (2004). Betting your life on it: Problem gambling has clear health related consequences. British Medical Journal, 329, 1055-1056.

Griffiths, M.D. (2006). The lost gamblers: Problem gambling. Journal of the Royal Statistical Society, 3(1), 13-15.

Griffiths, M.D. (2007). Gambling Addiction and its Treatment Within the NHS. London: British Medical Association

Griffiths, M.D. (2017). Gambling regulation from a psychologist’s perspective: Thoughts and recommendations. In Gebhardt, I. (Ed.), Glücksspiel – Ökonomie, Recht, Sucht (Gambling – Economy, Law, Addiction) (Second Edition) (pp. 938-944). Berlin: De Gruyter.

Meyer, G., Hayer, T. & Griffiths, M.D. (2009). Problem Gambling in Europe: Challenges, Prevention, and Interventions. New York: Springer.

The born identity: Can online gaming help people with gender dysphoria?

About a year ago, my colleagues and I published what we believe is the very first study of the helping role that video gaming can play in the lives of transgender individuals. Before I get to that, it’s probably worth noting that there have been studies of how gamers and fans play with sexuality, gender, and the video game Minecraft on YouTube as well as papers discussing whether the gaming industry should cater for marginalized groups and develop games for groups where there is little representation within games (e.g., gay and transgendered characters). For instance, there is now a short autobiographical game by Auntie Pixellante called Dys4ia. This is a WarioWare-style game, played only with the arrow keys, chronicling the experiences of a trans woman rectifying her own gender dysphoria. Such videogames raise interesting questions about how those individuals with gender dysphoria utilize gaming as part of their identity.

In a previous blog I briefly looked at gender swapping in online video games including some of my own research. For instance, in 2003 I published a paper in the journal CyberPsychology and Behavior using secondary poll data from online gaming forums. The paper reported that of 10,350 players at the Everlore fan site, 15% had swapped the gender of their main in-game playing character. We also reported a similar finding among 8,694 players at the Allakhazam fan site with 15.5% reporting that they had gender swapped their main in-game character (and more specifically, 14.5% males and 1% were females who had changed the gender of their lead character). In a 2004 follow-up survey among 540 Everquest gamers (again in the journal CyberPsychology and Behavior) my colleagues and I reported that 60% had swapped their online in-game characters. The prevalence of gender swapping was probably much higher in this study because the question related to the gender swapping of any online game character not just their main playing character.

In a small exploratory study I published in 2008 with Dr. Zaheer Hussain in the International Journal of Mental Health and Addiction, we examined why people engaged in gender swapping in a self-selecting sample of 119 online gamers (mean age of 28.5 years). We reported that 57% of gamers had engaged in gender swapping (any character not just their main character), and that males adopting an online female persona believed there were a number of positive social attributes to becoming female characters in male-oriented gaming environments. The study also reported that significantly more females than males had gender swapped their character – mainly to prevent unsolicited male approaches on their female characters. Some females appeared to gender swap purely out of interest to see what would happen in the game (as a personal experiment), while others claimed that they were treated more favourably by male gamers when they played as a male character. Others reported that gender swapping enabled them to play around with aspects of their identity that would not be possible to explore in real life. Other reasons for gender swapping were that (i) female characters had better in-game statistics, (ii) some specific tools were only available with female characters, (iii) the class of character was sometimes only available in one gender, (iv) they played for fun, and/or (v) they did it to so something that they would not normally do in the game (i.e., they did it for a change in their usual playing behaviour).

Outside of online gaming, a 2002 paper by Hegland and Nelson in the International Journal of Sexuality and Gender Studies noted that the Internet more generally can be used as a tool for expressing gender identity because it allows identities to cross cultural boundaries instantly and without regard for real physical space. They examined 30 cross-dressing websites and argued that for most cross-dressers that visited such websites, the online forum was their primary medium of expression. The users of the website used the Internet to nurture the ability to create a feminine identity, and helped them to pass as a woman in the offline public world. More generally, cross-dressers used the Internet to participate in the larger cultural dialogue of gender.

For an adult to meet current criteria for a diagnosis of transsexualism, the World Health Organisation’s International Classification of Diseases (ICD) reports they must express the desire to live and be accepted as a member of the opposite sex, usually accompanied by the wish to make his or her body as congruent as possible with the desired sex through surgery and cross-sex hormones. This transsexual identity must have been present persistently for a minimum of two years and not be a symptom of another mental disorder or a chromosomal abnormality. The latest (fifth) edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) of the American Psychiatric Association uses the term gender dysphoria to describe people who are uncomfortable and/or distressed regarding their assigned gender, their physical sex characteristics and/or their associated social roles. Depending upon the intensity of this distress, some individuals may wish to transition from one point on a notional gender scale to another. The most common direction is from a man to a woman (individuals known as trans women), or from a woman to a man (individuals known as trans men). The distress intrinsic to gender dysphoria may be focused around anatomy, physiology, and/or being perceived and treated as someone of a gender with which the person does not identify. However, these diagnostic labels do not apply to all trans individuals for a multitude of reasons because some people will not identify themselves as a man or as a woman

The World Health Organisation working group has recommended that the latest ICD replace the term Transsexualism with Gender Incongruence) and remove it from the mental and behavioural disorders chapter. Gender incongruence denotes the incongruence between a person’s gender identity and their assigned sex and/or congenital primary and secondary sex characteristics. The terminology in this field has changed over the years and the terms ‘transgender’ and ‘trans’ have been used in the literature as umbrella terms to cover a wide variety of atypical gender experiences and expressions which may lead to permanent change of social gender role but does not necessarily involve treatment with cross-sex hormones or surgical intervention. A recent study has reported an prevalence for transsexualism of 4.6 in 100,000 individuals; 6.8 for trans women and 2.6 for trans men, which is primarily based on studies looking at individuals attending clinical services. (However, it should be noted that recent population studies have reported a significantly higher prevalence rate of atypical gender experiences and expressions).

The study we published in the journal Aloma originated from initial observations made by Dr. Jon Arcelus that a number of gender dysphoric clients presenting at the national (UK) gender dysphoria clinic admitted that they gender-swapped while playing online games. After I met with Dr. Arcelus I suggested he revisit his case files and and to write them up as case studies (as no study in the gaming field has ever examined online gaming among those with gender dysphoria). The main objectives of our study were to use exemplar case studies to highlight that gaming – in some circumstances – appears to be a functional way of dealing with gender identity issues, and that gender swapping in gaming may help such individuals to come to terms with their gender dysphoria.

Our paper featured four case studies who attended an assessment at the National Centre for Gender Dysphoria in Nottingham. All four individuals described in our paper were given pseudonyms and the content of their histories were anonymised (and included ‘Mary’ a 26-year old natal male who fully transitioned to the female social role six months prior to our study; ‘Mark’ a 20-year old natal female who first attended for an assessment in the female role; ‘Paul’ a 31-year old natal male who would like to be female, but still living full-time as a male; and ‘Harry’ a 23-year old natal male who presented for an assessment as a male). If you want to read about each case in detail, the paper can be downloaded for free from here).

The four case studies outlined in our paper are only a selected sample of the number of cases attending a national clinic for people with gender dysphoria. However, they were in no way unusual to the other clients that have sought help at the Centre. However, these individual accounts were specifically selected to demonstrate the different ways that video gaming may help people with gender dysphoria come to terms with their gender identity. For example, gaming can be used among trans people as a psychological tool to increase one’s awareness of gender identity and/or as part of the self. Gaming may therefore be a useful way to express one’s experienced gender identity in a safe, non-threatening, non-alienating, non-stigmatizing, and non-critical environment. This appears to mirror other the findings of other studies outside of the online gaming environment.

Articles published in the mass media have reported that online games such as World of Warcraft provide a creative space that allows gamers that might be questioning aspects of their identity to explore their lives as different individuals. Some have even gone as far as to argue that this could help gamers transform their ‘offline’ identity, as is the case with some trans gamers. This was also demonstrated in the case studies described in our study. Other authors have asserted that the online medium offers an infinite space for development and resistance to traditional gender roles, and that online interaction enables a transgression of the dichotomous categories of male and female, constructing trans (or even genderless) social identities and relationships. However, although such anonymous online communities may provide trans individuals with the power to subvert their physical sex.

Our case studies also demonstrated the different functions of gaming in trans people (e.g., the function of “testing out” their gender feelings). For instance, using gaming to ‘come out’ to other people, by initially coming out in the online community, which is perceived as a safe environment, and then gradually coming out in real life. Gaming, as for many non-trans individuals, can derive psychological benefits and a sense of escapism. This is even more relevant among trans people as it may be the only time that they feel they can be themselves, allowing them to feel happy, relaxed, and achieving a sense of completeness. This could develop into a powerful coping skill substituting unhealthy behaviours, such as self-harming behaviour. This is particularly important in this population as research shows a strong association between being trans and mental health problems, particularly depression and self-harm as a way to manage one’s trans feelings. This is not surprising as the discomfort and distress about assigned gender and body dissatisfaction may lead to a sense of hopelessness, which can bring low mood, self-injury and even suicide.

Although gaming appears (at least initially) to be a positive and beneficial activity for many trans people, there is also the risk that staying in the game becomes too much of a secure and safe environment. This can create a vicious circle where the trans person does not wish to move out of the secure online world, and back into reality. Spending an increasing amount of time in online gaming carries the risk of developing a gaming dependence or addiction. This may not only affect one’s personal relationships, work and/or study, but may also impair real life social gender role transition, as in many cases, the individual is expected to socially transition before they can be considered for treatment.

Obviously our paper only included four participants and may be perceived by some researchers as ‘anecdotal’ because the data were not collected for this specific study but were retrospectively collated. However, our findings showed that for a trans individual, the online gaming environment was perceived as “safe” but further research is needed to establish what the distinctive elements of online gaming are that help to raise gender awareness (or not as the case may be). With the rates of gender dysphoria attending clinical services increasing significantly, future research should investigate (i) the rates and severity of gaming among this population as well as its function, and (ii) the rates of gender dysphoria among game addiction as coming out may help their addiction. The game industry may also want to consider how they can use games as a way of helping trans people being more accepted within society by developing game industry may want to co-observe how their games can prepare and assist individuals to socially transition. Online games also provide a safe environment that provides people access to a platform where individuals can discuss and experiment with gender identity.

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Arcelus, J., Bouman, W. P., Witcomb, G. L., Van den Noortgate, W., Claes, L., & Fernandez-Aranda, F. (2015). Systematic review and meta-analysis of prevalence studies in transsexualism. European Psychiatry, 30, 807-815.

Arcelus, J., Jones, B., Richards, C., Jimenez-Murcia, S., Bouman, W.P. & Griffiths, M.D. (2017). Video gaming and gaming addiction in transgender people: An exploratory study. Journal of Behavioral Addictions, 6, 21–29.

Dale, L. K. (2014, January 23). How World of Warcraft helped me come out as transgender. The Guardian. Retrieved from http://www.theguardian.com/technology/gamesblog/2014/jan/23/how-world-of-warcraft-game-helped-me-come-out-transgender

Griffiths, M.D., Arcelus, J. & Bouman, W.P. (2016). Video gaming and gender dysphoria: Some case study evidence. Aloma: Revista de Psicologia, Ciències de l’Educació i de l’Esport, 34(2), 59-66.

Griffiths, M. D., Davies, M.N.O. & Chappell, D. (2003). Breaking the stereotype: The case of online gaming. CyberPsychology and Behavior, 6, 81-91.

Griffiths, M.D., Davies, M.N.O. & Chappell, D. (2004). Demographic factors and playing variables in online computer gaming. CyberPsychology and Behavior, 7, 479-487.

Griffiths, M. D., Kiraly, O., M. Pontes, H. M. & and Demetrovics, Z. (2015). An overview of problematic gaming. In Starcevic, V. & Aboujaoude, E. (Eds.), Mental Health in the Digital Age: Grave Dangers, Great Promise (pp.27-55). Oxford: Oxford University Press.

Fahs, B., & Gohr, M. (2012). Superpatriarchy meets cyberfeminism: Facebook, online gaming, and the new social genocide. MP: An Online Feminist Journal, 3(6), 1-40.

Hegland, J. E., & Nelson, N. J. (2002). Cross-dressers in cyber-space: Exploring the Internet as a tool for expressing gendered identity. International Journal of Sexuality and Gender Studies, 7(2-3), 139-161.

Huh, S., & Williams, D. (2010). Dude looks like a lady: Gender swapping in an online game. In Online worlds: Convergence of the real and the virtual (pp. 161-174). London: Springer.

Hussain, Z., & Griffiths, M. D. (2008). Gender swapping and socialising in cyberspace: An exploratory study. CyberPsychology and Behavior, 11, 47-53.

Lewis, A., & Griffiths, M. D. (2011). Confronting gender representation: A qualitative study of the experiences and motivations of female casual-gamers. Aloma: Revista de Psicologia, Ciencies de l’Educacio i de l’Esport, 28, 245-272.

McLean, L., & Griffiths, M. D. (2013). Female gamers: A thematic analysis of their gaming experience. International Journal of Games-Based Learning, 3(3), 54-71.

Osborne, H. (2012). Performing self, performing character: Exploring gender performativity in online role-playing games. Transformative Works and Cultures, 11. doi:10.3983/twc.2012.0411.

Potts, A. (2015). ‘LOVE YOU GUYS (NO HOMO)’ How gamers and fans play with sexuality, gender, and Minecraft on YouTube. Critical Discourse Studies, 12(2), 163-186.

Shaw, A. (2012). Do you identify as a gamer? Gender, race, sexuality, and gamer identity. New Media and Society, 14(1), 28-44

Taylor, T. L. (2003). Multiple pleasures women and online gaming. Convergence: The International Journal of Research into New Media Technologies, 9(1), 21-46.

Todd, C. (2012). ‘Troubling’ gender in virtual gaming spaces. New Zealand Geographer, 68(2), 101-110.