Loot box consumption by adolescents pre- and post- pandemic lockdown.

Loot boxes are virtual items that can be redeemed to receive randomly selected other virtual items, and have been criticized for being similar to gambling. The presence of loot boxes in video games has dramatically increased since 2010, with little evidence available for the current prevalence rate of loot box purchasing in the general population, particularly during and following the COVID-19 pandemic lockdowns. This study uses data from representative samples of American youth to estimate prevalence rates for video game play and loot box consumption before the pandemic (2019) and after the pandemic lockdowns (2022) to examine whether the pandemic has affected loot box usage in the general population and among gamers. The results suggest that youth loot box consumption has increased, rising from 24.9% in 2019 to 31.6% in 2022 among 8th grade (age 13-14) youth. The increase over this time period was larger for girls, though boys are still more likely to purchase loot boxes overall.

Gambling advertising on Twitter before, during and after the initial Australian COVID-19 lockdown.

Background and aims: COVID-19 resulted in the shutdown of almost all sporting competitions and most venue-based gambling opportunities. This study examines how wagering operators in Australia responded, by examining their advertising. Methods: The study compared Twitter activity during lockdown (March-May 2020) to the previous year for four major wagering operators. Results: Wagering operators continued to advertise in earnest, changing their marketing mix to include more race betting content, as races continued to operate. Most also promoted the only sports available, such as table tennis or esports. When sports resumed, sports betting advertising quickly returned to normal, or exceeded previous levels. Despite more content being available in the case of two operators, engagement from the public during lockdown was similar to or lower than previously. Discussion and conclusion: These results indicate that gambling operators can adjust quickly to major changes. These shifts appear to have been successful, with the increase in race betting during this period almost completely offsetting the decreases in sports betting. This is likely due in part to changes in advertising, which have been associated with increased betting activity, particularly amongst vulnerable people. Responsible gambling messages were virtually non-existent on Twitter, which contrasts with mandatory requirements in other media. The study highlights that regulatory changes to advertising, e.g., banning some content, are likely to be met with substitution of content, rather than reduction, unless advertising volume is also capped. The study also highlights the adaptive capacity of the gambling industry in the face of major disruption to supply.

Risk Factors for Gambling Disorder: A Systematic Review.

Gambling disorder is a common and problematic behavioral disorder associated with depression, substance abuse, domestic violence, bankruptcy, and high suicide rates. In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), pathological gambling was renamed "gambling disorder" and moved to the Substance-Related and Addiction Disorders chapter to acknowledge that research suggests that pathological gambling and alcohol and drug addiction are related. Therefore, this paper provides a systematic review of risk factors for gambling disorder. Systematic searches of EBSCO, PubMed, and Web of Science identified 33 records that met study inclusion criteria. A revised study acknowledges as risk factors for developing/maintaining a gambling disorder being a single young male, or married for less than 5 years, living alone, having a poor education, and struggling financially.

Neurocognitive Impulsivity in Opiate Users at Different Lengths of Abstinence.

The aim of the current study was to examine the effects of length of abstinence on decision making (impulsive choice) and response inhibition (impulsive action) in former opiate users (OU). Participants included 45 OU in early remission [0−12 months of abstinence], 68 OU in sustained remission [>12 months of abstinence], and 68 control participants. Decision making was assessed with the Iowa Gambling Task (IGT), the Cambridge Gambling Task (CGT), and the Monetary Choice Questionnaire (MCQ). Response inhibition was examined with the Stop Signal Task (SST), and the Go/No-Go Task (GNG). Results revealed group differences in decision making under risk (CGT) and ambiguity (IGT), where control participants displayed better decision making compared to OU in early remission. Both groups of former OU were also characterized by higher discounting of delayed rewards (MCQ). Regression analyses revealed minimal effects of length of abstinence on performance on decision-making tasks and no effects on delay discounting. In addition, both OU groups showed reduced action inhibition (GNG) relative to controls and there were no group differences in action cancellation (SST). Length of abstinence had no effect on response inhibition. Overall, our findings suggest that neurocognitive function may not fully recover even with protracted abstinence, which should be addressed by relapse prevention and cognitive remediation programs for OU.

[Behavioral (non-chemical) addictions and COVID-19]. / Povedencheskie (nekhimicheskie) zavisimosti i COVID-19.

The review examines the impact of the COVID-19 pandemic on the prevalence, manifestation, as well as the possibility of preventing and treating behavioral (non-chemical) addictions. Particular attention is paid to various manifestations of Internet addiction (IA): gaming, gambling, cybersexual and food addiction (FA). During the pandemic, Internet use increased significantly, leading to an increase in IA, mainly due to gaming, which correlated with the level of psychosocial problems. The increase in gambling occurred mainly in individuals with addiction or risk groups, while in the population the frequency of gambling decreased or did not change. Immediately after the start of the COVID-19 pandemic, the number of requests to porn sites increased dramatically, suggesting an increase in cybersex addiction. However, longitudinal studies in adolescents show a slight decrease in the interest in pornography in boys, and an increase from an initially low level in girls. The proportion of eating disorders and FA significantly increased. An increase in FA was associated with depression, anxiety, and also in obese individuals. In the era of COVID-19 prevention practices and general remedial activity should take into account the needs of the general population, emphasizing the importance of self-regulating and balanced lifestyles with moderate and sensible Internet use during the pandemic.

Gambling and COVID-19: Swedish national gambling data from a state-owned gambling sports and casino operator.

Background and aims: The lockdown of sports and gambling venues during the coronavirus disease 2019 (COVID-19) pandemic caused a fear of increased gambling on other online gambling types, with a risk for transfer to more addictive gambling than otherwise. This study aimed to estimate changes in gambling activity during COVID-19-affected periods among all gamblers at a Swedish state-owned gambling operator and to analyse observable sex differences. Methods: This study included gambling tracking data from the Swedish state-owned gambling operator Svenska Spel Sports & Casino (sports betting, online bingo, casino and poker). All individuals (n = 616,245) who gambled at least once from February 10 to July 19, 2020, were included. The study period was divided into four periods according to their expected level of COVID-19 impact on gambling opportunities: one pre-COVID period and three COVID-affected periods (sports cancellation, emerging return of sports, substantial return of sports). Results: Sports betting experienced an apparent decrease, followed by a gradual normalization and an end level substantially below prepandemic levels. For online bingo, gambling levels increased upon sports interruption and then decreased with the return to normality in sports events but remained higher than baseline levels. We observed a similar trend for online poker during the interruption of sports, but with a lower level than baseline levels when sports events normalized. We noticed a trend favouring online casinos during the sports interruption period regarding gambling intensity but not wagering levels. Discussion and conclusions: Dramatic changes in the content of the gambling market may divert some gamblers to other gambling types, but maintained effects could not be demonstrated.

COVID-19 and resultant restrictions on gambling behaviour.

Since the onset of COVID-19, studies suggest a significant increase in online gambling, potentially facilitated by increased time at home, social isolation and boredom. This study aimed to address what is known about the impact of the pandemic on gambling behaviour by conducting a mapping review. A systematic literature search was conducted using four online databases. Additional studies were identified using reference lists. Relevant studies were quality scored and their findings synthesised in terms of overall changes at the population level and potentially vulnerable groups. The weight of evidence from 35 relevant reports across 12 countries indicated reductions of gambling during the pandemic at the level of the general population. However, marked increases in gambling amongst vulnerable sub-populations including amongst young adults and people with pre-existing at-risk gambling were also noted. The impact of COVID-19 on gambling is highly contingent on context. If policy makers examine only population level data, this could overlook profound negative effects identified in those with at-risk gambling, gambling disorder, and amongst young adults.

Crisis, What Crisis? The Effect of Economic Crises on Spending on Online and Offline Gambling in Spain: Implications for Preventing Gambling Disorder.

(1) Background: In the period between 2008 and 2020, the world experienced two global economic crises that affected people's way of life and well-being: the financial crisis of 2008 and that precipitated by the COVID-19 pandemic. Despite the crises' radically different causes, their consequences for economic activity have been equally dramatic; (2) Methods: This article analyzes the consequences of both crises on gambling spending in Spain and compares traditional (offline) games with more recent online offerings. The data were collected from databases maintained by the Spanish government and gambling companies; (3) Results: The paper offers two main conclusions. The first is that, while traditional (offline) gambling has been significantly affected by economic crises, online gambling has exhibited consistent growth since its legalization. The second is that the measures implemented to resolve the two economic crises differed significantly and thus had different impacts on spending on the various types of gambling; (4) Conclusions: The key conclusion is that purchasing power (measured in terms of GDP) can only explain spending on less addictive gambling games, such as lotteries. However, the availability and accessibility of games are both directly related to spending on games of all types.

Experience of LGBTQIA2S+ populations with gambling during the COVID-19 pandemic: protocol for a mixed-methods study.

INTRODUCTION: Research undertaken since the beginning of the COVID-19 pandemic has provided us information about the impact of the pandemic on the gambling habits of the general population. However, very little is known about certain subgroups at increased risk of developing gambling disorder, such as the LGBTQIA2S+ population. The purpose of this study is to describe the impact of the COVID-19 pandemic on gambling behaviours among LGBTQIA2S+ individuals. In addition, we want to understand the experiences of the LGBTQIA2S+ population with gambling disorder and identify interventions that LGBTQIA2S+ people have found to be effective in addressing problem gambling during the COVID-19 pandemic. METHODS AND ANALYSIS: This study has a sequential explanatory mixed-method design in two phases over 2 years. The first phase is a correlational study. We will conduct a cross-sectional survey using a stratified random sampling among Canadian residents who are 18 years of age or older, self-identify as sexually and gender-diverse (ie, LGBTQIA2S+) and have gambled at least once in the previous 12 months. This survey will be administered online via a web panel (n=1500). The second phase is a qualitative study. Semistructured interviews will be conducted with LGBTQIA2S+ people with problematic gambling (n=30). ETHICS AND DISSEMINATION: This research project has been ethically and scientifically approved by the Research Ethics Committee and by the CIUSSS de l'Estrie-CHUS scientific evaluation committee on 3 March 2022 (reference number: 2022-4633-LGBTQ-JHA). Electronic and/or written informed consent, depending on the data collection format (online survey and online or in-person interviews), will be obtained from each participant. A copy of the consent form and contact information will be delivered to each participant.

Impacts of the COVID-19 pandemic on gamblers in Canada: qualitative analysis of responses to an open-ended question.

CONTEXT: Many stakeholders have expressed concerns about the impacts of the COVID-19 pandemic on gambling practices. These have historically increased during crises, potentially leading to deleterious effects on problematic gamblers, their families, and their communities. Primary care professionals need to better understand gamblers' experience during the pandemic to offer high level of care for this population. OBJECTIVE: draw up a portrait of the experience of gamblers regarding the impacts of the COVID-19 pandemic on their gambling practices. STUDY DESIGN: Qualitative analysis. SETTING: Content analysis of responses to a single open-ended question placed at the end of a cross-sectional survey which was online from February 16 to March 15 2021 in Quebec (Canada). Participants were recruited by a non-randomised online sampling. POPULATION STUDIED: 1529 individuals participated in the study, of whom 724 answered the open-ended question. Inclusion criteria were: (1) 18 years and older (2) living in the province of Quebec, Canada (3) has gambled at least once in the past year. RESULTS: Respondents' median age is 43 years, 54% are women and 57% are problem gamblers according to the Problem Gambling Severity Index. Three main themes were identified: (1) the changes in gambling practices during the pandemic as perceived by the respondents, (2) the impacts of these changes on their lives, and (3) the factors that influenced these changes. A significant proportion of gamblers felt that their gambling practices had increased during the pandemic, mainly due to boredom and increased free time. Many of them did not report deleterious effects of this increase whereas others reported being devastated. On the opposite, the pandemic was perceived by some participants as a unique window of opportunity to decrease their problematic gambling practices. CONCLUSIONS: The pandemic has created space to fill into many individuals' lives as usual leisure activities, hobbies and spending habits became out of reach. It led to increased gambling for many participants. While many did not report deleterious effects of this increase, others expressed being at great risk and therefore need primary care professionals to be equipped to support them.

Case Study Demonstration of the Potential Acceptability and Effectiveness of a Novel Telehealth Treatment for People Experiencing Gambling Harm.

The evidence base for internet therapies is building but little is known yet about the acceptability and effectiveness of providing telehealth online in a group format for the treatment of gambling disorders. Therefore, this uncontrolled, real-world study aimed to evaluate the feasibility and effectiveness of providing evidence-based treatment in a group format using an online platform. This innovative approach to treatment of people experiencing gambling harm was developed during the COVID pandemic so that gamblers could access evidence-based treatment from their homes. A closed group treatment program was developed using telehealth, enabling gamblers to come together weekly to engage in a treatment program based on behavioral therapy using cue exposure. Four online gamblers who met the criteria for Gambling Disorder were recruited from a gambling help service. A case report evaluation methodology was used to gain an in-depth understanding of the effectiveness of this approach to treatment. Treatment was conducted weekly over 12 months. All participants engaged with the program and after completing treatment participants no longer met the criteria for a Gambling Disorder, were abstinent for 12 months post treatment and achieved improved life functioning. This program provides preliminary evidence that providing treatment online in a group setting can be an acceptable and effective model in the delivery of treatment for clients unable to attend face-to-face clinics or preferring telemedicine as an option for treatment delivery. These findings warrant further exploration through a larger randomized controlled study.

Gamblers' Perceptions of the Impact of the COVID-19 Pandemic on Their Gambling Behaviours: Analysis of Free-Text Responses Collected through a Cross-Sectional Online Survey.

The COVID-19 pandemic has brought drastic changes to the lives of a substantial portion of the world's population. Many stakeholders have expressed concern about the impact of the pandemic on gambling practices, which have historically increased during times of crisis. The purpose of this study was to provide a snapshot of the impact of the pandemic on gambling practices, focusing on the lived experiences of people who gamble. An online cross-sectional survey was conducted between 16 February and 15 March 2021. An open-ended question allowed the participants to describe in their own words the impact of the COVID-19 pandemic on their gambling practices. A qualitative analysis was conducted based on 724 responses to this question. Among the participants, 57% were problem gamblers, according to their Problem Gambling Severity Index score. Three themes were identified: (1) changes in gambling practices perceived by the respondents during the pandemic, (2) the impacts of these changes, and (3) the factors that influenced the changes in their gambling practices. A meaningful proportion of the sample of gamblers felt that their gambling practices had increased during the pandemic. Many of them did not report the deleterious effects of this increase, whereas others were devastated. Thus, variations in gambling practices during the pandemic must be interpreted with caution, as they may reflect a variety of realities.

Is gambling like a virus?: A conceptual framework based on empirical data for the prevention of gambling addiction (preprint)

Objective. The objective of this study is to present a conceptual framework for the prevention of gambling disorder and try to corroborate some of its postulates. The assumption of gambling as if it were acting like a virus may have important considerations in terms of preventing gambling disorder in society and, therefore, it could be a relevant public health issue.  Study Design. This research is a quasi-experimental investigation aimed to evaluate the effects of anti-COVID measures on the frequency of gambling and evolution of gambling disorder. The present study analyzed gambling patterns and the problems caused by gambling in 2,903 people, including those who were at-risk gamblers or had a gambling disorder. Results. In general terms, restrictive measures to combat COVID-19 worked to prevent the consolidation of gambling habits and the appearance of gambling disorder, but they did not seem to be sufficient for people who already had this disorder. The most affected games were those that took place in public places (gambling halls, bars, etc.), with online gambling being affected to a much lesser degree.  Conclusions. The findings of this work support the hypothesis that, just as the SAR-CoV-2 virus is responsible for the global pandemic of COVID-19, which can only be stopped with vaccines and social distancing, in the case of gambling, the absence of an effective vaccine for "gambling virus" can lead to an epidemic of gambling disorders in societies, if the environmental conditions that are favorable for the spread of such virus are not modified.

Risk-Taking Behavior in Recovered COVID-19 Patients.

BACKGROUND: The aim of this study is to investigate risk-taking behavior and decision-making processes in recovered COVID-19 patients. SUBJECTS AND METHODS: Twenty patients recovered from COVID-19 as confirmed by polymerase chain reaction (PCR) tests and twenty-one healthy individuals were recruited. A computerized version of the Iowa Gambling Test (IGT) for measuring risk-taking behavior tendencies as a decision-making process and State-Trait Anxiety Inventory (STAI), Beck Depression Inventory (BDI), and WMS-R Digit Span Forward Test (DSFT) for clinical assessments included. The assessments of the recovered patients were applied on the initial phase that the tests of the patients were negative and on the 4-week follow up phase. RESULTS: The results showed that the anxiety scores were significantly higher in the healthy control group than in the group of recovered patients. The IGT-Net 4 scores were significantly and IGT-Net total scores were marginally significantly lower in the group of recovered patients. In other words, recovered patients showed higher risk-taking behavior tendencies. This tendency difference is consistent with the anxiety levels of the groups. These IGT scores showed to be persistent in the 4-week follow up phase. CONCLUSIONS: Our findings indicate that recovered patients show higher risk-taking behavior tendencies than healthy controls and this may be the result of overcoming the COVID-19 threat.

An interrupted time series analysis of gambling behavior based on gambling operator revenue-based taxation during the COVID-19 pandemic in Sweden.

OBJECTIVES: The impact of COVID-19 on gambling behavior and the gambling industry itself has been widely speculated. Prior studies have shown how boredom, social isolation, poor mental health, and financial hardships, all of which have been associated with COVID-19, can aggravate problem gambling behaviors in patients with gambling disorders while also luring newcomers. Few studies have used methods other than self-report to assess longitudinal behavioral changes in gambling behavior before versus during the pandemic. STUDY DESIGN: The present study addresses this gap by using an interrupted time series approach on data obtained from the Swedish Gambling Authority measuring taxation on gambling vendors' revenue between January 2019 and November 2021. METHODS: March, June, and October 2020 were chosen as interruption points as they correspond to the pandemic's commencement, the return of elite sports, and the second wave of cases in Sweden, respectively. We hypothesized that the pandemic would be associated with both temporary changes for select gambling types and long-term increases in online gambling. RESULTS: Results revealed the pandemic's onset was associated with transient effects at each point of interruption, as well as long-term upward trends in total gambling and commercial online gambling, excluding horse betting and the state-owned operator for online casinos and betting. CONCLUSIONS: The present study's findings, although consistent with the theory that gambling activity could increase during the pandemic, contradict previous studies that found no changes or a decrease from pre-COVID-19 levels. Findings indicate that the pandemic and Sweden's reaction to it were associated with increased use of some gambling products.

Advances in problematic usage of the internet research - A narrative review by experts from the European network for problematic usage of the internet.

Global concern about problematic usage of the internet (PUI), and its public health and societal costs, continues to grow, sharpened in focus under the privations of the COVID-19 pandemic. This narrative review reports the expert opinions of members of the largest international network of researchers on PUI in the framework of the European Cooperation in Science and Technology (COST) Action (CA 16207), on the scientific progress made and the critical knowledge gaps remaining to be filled as the term of the Action reaches its conclusion. A key advance has been achieving consensus on the clinical definition of various forms of PUI. Based on the overarching public health principles of protecting individuals and the public from harm and promoting the highest attainable standard of health, the World Health Organisation has introduced several new structured diagnoses into the ICD-11, including gambling disorder, gaming disorder, compulsive sexual behaviour disorder, and other unspecified or specified disorders due to addictive behaviours, alongside naming online activity as a diagnostic specifier. These definitions provide for the first time a sound platform for developing systematic networked research into various forms of PUI at global scale. Progress has also been made in areas such as refining and simplifying some of the available assessment instruments, clarifying the underpinning brain-based and social determinants, and building more empirically based etiological models, as a basis for therapeutic intervention, alongside public engagement initiatives. However, important gaps in our knowledge remain to be tackled. Principal among these include a better understanding of the course and evolution of the PUI-related problems, across different age groups, genders and other specific vulnerable groups, reliable methods for early identification of individuals at risk (before PUI becomes disordered), efficacious preventative and therapeutic interventions and ethical health and social policy changes that adequately safeguard human digital rights. The paper concludes with recommendations for achievable research goals, based on longitudinal analysis of a large multinational cohort co-designed with public stakeholders.

Telehealth treatment for gambling disorder in the COVID-19 era: seismic shifts and silver linings.

PURPOSE OF REVIEW: Gambling disorder is a serious mental health condition and the only behavioral addiction currently recognized by the American Psychiatric Association. Though prevalence and treatment seeking for gambling disorder have been stable for decades, the global COVID-19 pandemic has created a seismic shift in societal factors that influence gambling disorder and treatment availability. At the same time, the increasing availability of telehealth therapy for gambling disorder offers a new way to provide specialized treatment nationwide. RECENT FINDINGS: The present review discusses the seismic shifts in underlying risk factors, gambling availability, and reduced access to treatment. It also covers the emergence of telehealth treatment for gambling disorder, including its benefits and pitfalls. SUMMARY: In separate commentaries, several experts hypothesized that the pandemic was likely to increase mental health risk factors in society such as social isolation, job loss, and stress. In addition, access to online gambling also increased, while countries that locked down more strictly (like Singapore) saw a reduction in terrestrial gambling, countries that did not lock down strictly (like Sweden) did not see changes in gambling behavior. Telehealth was almost universally recommended as a good option for treatment in the studies we reviewed, though proper training and staffing are needed for telehealth to prove effective. Gambling disorder was only included in nationwide addiction telehealth programs in two countries.

Addressing gambling harms by reducing the supply of electronic gambling machines: a comparative study of Italy and Finland.

BACKGROUND: Electronic gambling machines (EGMs) are amongst the most harmful forms of gambling. The high availability of EGMs is also linked to increased consumption. To reduce the burden of EGMs on public health, policies to reduce their numbers have recently been introduced in Italy and Finland. This study compares the aims and justifications of these legislative changes, as well as their overall impacts on total consumption. METHODS: The objectives and justifications of policies to reduce the number of EGMs were based on qualitative media analysis. The impacts on total consumption were measured using financial figures provided by gambling providers in Italy and Finland. RESULTS: Results show that the reductions in EGM numbers were justified in terms of public health concerns in both countries, but the amplitude of policies varied. In Italy, the reductions were more ambitious than in Finland, and included reductions in the number of gambling locations. The financial data nevertheless indicated that the reductions may not have been significant enough. CONCLUSIONS: Public health concerns were initially highlighted in the media discussions, but eventually in both countries reduction policies were less ambitious due to industry lobbying and state revenue interests. The reductions therefore do not appear to have been effective in reducing total consumption and the burden on public health.