My older sister has three kids–a 12-year-old, an 11-year-old, and an 8-year-old. This Christmas, they got an Xbox One. When I found out about their gift, I got excited. The only other console they had at home was a Wii, meaning this was their chance to play some of my current favorites. I was dying to know what games they got and what accessories she grabbed them. And then I asked something I’d never thought to ask a parent before.

I’ve spent the last few weeks documenting stories I received online from folks who managed compulsive spending related to micro-transactions, gachapon/loot box mechanics, and skin gambling. I wanted to know if people were actually having problems with these systems already, and I got my answer quickly enough. There are people, probably more than we think, who have been seriously impacted by the consequences of impulsive spending in games.

In the world of video games, this kind of discussion is common. Writing about loot boxes focuses on the philosophical, the academic: What are the psychological mechanics behind in-game economies? How do these systems impact gameplay? What’s a “good” economy and what’s a “bad” economy? But when it came to talking to my sister about her kids’ first modern console, I grew immediately concerned about how in-game economies might draw them into a cycle of addiction.

One anonymous former Overwatch player shared with me what drew them into what they described as a loot box addiction. Opening a bunch of loot boxes at once, they said, “had a feeling of a continuous rush… like opening a bunch of Christmas presents.”

After spending a couple hundred dollars combined on Fire Emblem Heroes and Overwatch, 26-year-old Fennel told me she regretted ever getting into loot boxes in the first place. “I felt compelled to spend on loot boxes every time a limited time event started so I wouldn't miss out,” she said. “It warped my whole perception of the game into short periods of anxiety and stress where I had to spend money or play constantly on the hope of not missing out.”

The people I spoke to by-and-large described their spending on loot boxes as impulsive, shameful, and stress-inducing. The urge to buy loot boxes and try to get epic gear was driven by limited events and peer pressure. One respondent reported accruing several thousands of dollars in debt playing Neverwinter Online. A player who spent hundreds on loot boxes told me they were egged on by “the slow reveal, the soft glow, the visuals of the loot exploding out of the top of the box, the couple of frames where the light turns gold,” and the kinds of presentation elements that are baked in to continue the allure.

In trying to learn how gambling-like systems in games can harm people, I opened myself to a broad spectrum of stories and experiences. The individuals I spoke to ran a wide gamut of gaming contexts and age groups. They played across multiple platforms, from mobile to PC and console. Generally, these individuals had problems with one specific game rather than a problem spread across multiple titles. I did not observe a line between cosmetic economies, such as Overwatch, and economies that influence progression such as Battlefront II and Shadow of Mordor. The strongest common thread in all of these stories was a similar set of behaviors and impacts.

“The rush of pulling is addicting,” another player told me. “One failed attempt means an attempt closer to success.” Yet another, a FIFA player who spent upwards of £1000 on Ultimate Team, told me they were compelled by “the buzz of getting the player and... the need to have a good team to try and be competitive.”

Other players told me that loot boxes had tapped into old habits. Kyle, a player who managed problems with various Kabam titles, told me that he’d had a problem with online shopping in the past, but that loot boxes were a significantly larger issue. Matt, whose spending on Counter Strike loot boxes evolved into a skin gambling habit, reported that he’s struggled with casino gambling in addition to online betting and loot box purchases. In most cases, these issues exacerbated existing cases of anxiety and depression, or caused rifts in their marriages and families.

Many of these people emphasized that the feelings of regret and shame were accompanied by impact to their personal finances, relationships, and mental health. Some players were surprised by their own willingness to spend, like Fennel, who told me that she “never understood the appeal of traditional gambling.”

“A lot of the time afterwards,” said a former Marvel Heroes player, “I just sorta sat there with a dirty taste in my mouth.”

The ‘buzz’ of opening loot boxes and winning rare items inevitably was met by regret and shame afterwards. The anonymous Overwatch player told me they eventually felt “physically sick” when they logged in. “I woke up,” explained another, “realized what I had done, checked my bank account and wanted to throw up.”

The most severe mental health impacts resulted in deep depressions and thoughts of self-harm. A player who had developed a problem with spending on mobile rhythm games like Idolm@ster and Love Live described their breaking point. “I ended up calling a suicide hotline that night. I felt distraught, pathetic, that I had just blown so much money on nothing but virtual jewels. I felt like I deserved to die for letting it get so bad and for wasting this much money.”

In the Diagnostic and Statistical Manual of Mental Disorders, the American Psychiatric Association defines gambling disorder through its impacts. People with gambling disorders become preoccupied with the action and the rush associated with gambling. They try to win back their losses, they experience depression and anxiety related to their gambling, they’re pushed to gamble by external forces like social situations and stress, and they experience withdrawal when they’re not gambling. The DSM-5 has tentatively defined a new disorder, “Internet gaming disorder,” with an almost identical set of criteria.

Psychiatrist Richard Freed, who works with families struggling with digital addiction, explained that the psychiatric community recognizes that gambling disorders and even gaming addiction can have the same kind of personal impacts as substance abuse. “Behaviors can also be addictive,” Dr. Freed told me. Multiple psychiatric studies corroborate the idea that gambling disorders trigger the same areas of the brain as drug and alcohol addictions, and recent studies claim that game addictions may do the same (though that is still disputed territory and the science is far from settled).

Casino experts like GameCo’s Blaine Graboyes, whose company builds arcade-like game experiences for casinos, recognize gambling industry tactics being emulated in the games industry. “The games industry should understand the underlying human behaviors and mechanics that they are tapping into,” Graboyes told me. “The loot box phenomenon builds on the slot machine experience,” he explained. “They are the best and most optimized product in the casino.”

"...the slow reveal, the soft glow, the visuals of the loot exploding out of the top of the box, the couple of frames where the light turns gold..."

Dan Trolaro, the Assistant Executive Director of the Council on Compulsive Gambling of New Jersey, explained, “The mechanics within a loot box look and feel like a gamble.” Trolaro leads a subcommittee exploring emerging issues for the National Council on Problem Gambling.

Keith Whyte, the executive director at the NCPG, explained that problem gambling experts see gambling as a spectrum of risk, intensity, and possible harms. “One of the ways we think about this,” he said, “is whether or not someone can experience harm, be that defined as emotional or financial, as a result of the gambling-like mechanics in a game.”

Whyte explained that gambling experts are looking at games because of a phenomenon they call “convergence.” Addictive behaviors become a shared language because traditionally separate kinds of gaming—casino gaming and video gaming—are coalescing. “You can do two things,” Whyte explained. “You can make a slot a lot more like a video game, by adding some skill and some choice and controllers, or you can take a video game and you can ‘gamblify’ it and make it a lot more like a slot machine.” The question facing the psychiatric community and experts on problem gambling is where to draw the line between “gaming addiction” and “gambling disorder.” Though the systemic consequences of habitual impulsive spending in games are remarkably similar to the impacts of traditional gambling disorder, current psychological understanding would not classify loot box addictions as gambling disorder.

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The hesitation to call systems like loot boxes “gambling” has led to a lack of understanding within the games community and the psychiatric community alike. Cam Adair, a self-professed former game addict who now runs a community support group called GameQuitters, told me that members of his community have attempted to seek support only to be faced with lack of insurance coverage or, worse, a lack of understanding from mental health professionals. “The debate over classification”, he said, “ignores people with that struggle.”

There is a tacit recognition within the gambling industry that gambling disorder exists. Casinos advertise hotlines in their marketing and on-premises and fund research of gambling disorders. GameCo’s Blaine Graboyes went as far to say that the gambling industry has a financial incentive to support recognition and addiction research. In his words, acknowledgement of problematic behavior creates sustainable business.

There are systems in today’s games that prey on vulnerabilities in our psychology.

For its part, the games industry has resisted attempts to label and regulate gambling-like systems. The ESRB outright refused to acknowledge loot boxes as gambling. However, when casino industry insiders are telling us that these systems are just like slot machines, we need to take the threat of addiction and psychological manipulation seriously. If the industry continues to refuse oversight, it could very well lead to marketplace crackdowns and regulatory intervention.