Introduction
Gaming and gambling are generally perceived as unrelated activities in modern society and have traditionally been treated as distinct, both conceptually and legislatively. Digital or video-gaming, typically associated with younger generations, involves playing on consoles, computers, or mobile devices, while gambling is thought to mainly target adults in casino settings. However, both are considered forms of play, fundamental to human culture and development (Caillois, Reference Caillois2001).
Since its inception in the 1970s, thZe gaming industry has significantly expanded its global reach, accessibility, and economic impact (Goh et al. Reference Goh, Al-Tabbaa and Khan2023). In 2024, its market was projected to generate USD 282.30 billion (Statista, 2024). As game development costs rise, companies rely on novel monetisation strategies that often incorporate unregulated gambling-like features to secure steady revenue streams (McCaffrey, Reference McCaffrey2019). Numerous studies suggest these methods may act as a gateway to real-life gambling and/or contribute to excessive gaming (Spicer et al. Reference Spicer, Fullwood, Close, Nicklin, Lloyd and Lloyd2022).
In 2018, both gaming and gambling were recognised in the International Classification of Diseases, 11th Revision, under the section ‘Disorders due to substance misuse or addictive behaviours’, with diagnostic requirements framed in a similar manner (World Health Organization, 2025). Estimates suggest that 1.2% of the global adult population has a gambling disorder (World Health Organization, 2024). In contrast, prevalence studies of gaming disorder vary widely, ranging from 1.4% to 3.3% (Stevens et al. Reference Stevens, Dorstyn, Delfabbro and King2021; Kim et al. Reference Kim, Son, Roh, Ahn, Kim, Shin, Chey and Choi2022; Stevens et al. Reference Stevens, Dorstyn, Delfabbro and King2023).
The boundaries between these behavioural addictions are increasingly blurred by monetisation methods in gaming, such as microtransactions, that mimic gambling and exploit similar psychological reward mechanisms. This editorial explores these features, their potential mental health impact, and associated regulatory challenges.
Gaming economics and the gamble in microtransactions
Traditionally, gaming involved a single transaction: buying the game. Today, however, numerous forms of currency, value exchanges, and monetisation strategies are integrated into many gaming experiences, often becoming central to gameplay. Gambling-like and gambling-related practices have also emerged within games, including hyper-realistic worlds where characters gamble in virtual casino settings using in-game currency, as well as simulated gambling games involving real money (King et al. Reference King, Gainsbury, Delfabbro, Hing and Abarbanel2015).
Players now wager in-game tokens for rewards, bet on the outcome of multiplayer gaming competitions, engage with gamblified content on live streaming platforms, and purchase microtransactions (Zendle, Reference Zendle2020). Microtransactions are an umbrella term for various low-cost, in-game payments made with real-world money, typically for virtual items or unlockable content (Raneri et al. Reference Raneri, Montag, Rozgonjuk, Satel and Pontes2022). Often, players buy in-game currencies with real money, which are then spent within the game, creating a layer of abstraction that mirrors gambling’s exchange of cash for casino chips.
Certain gambling elements in games are not always immediately apparent. This is evident in ‘Freemium’ mobile phone games, which are advertised as ‘free to play’ but entice users to pay for ‘Premium’ features and bypass ‘paywalls’ to achieve uninterrupted progression (pay-to-win) (King & Delfabbro, Reference King and Delfabbro2018). A similar dynamic is seen with ‘loot boxes’, a type of microtransaction involving consumable virtual items that, when ‘opened’, yield a chance-based selection of rewards (Raneri et al. Reference Raneri, Montag, Rozgonjuk, Satel and Pontes2022). Loot boxes resemble collectible football stickers, where valuable items are often rare and usually require repeated purchases and substantial time and/or money to acquire. Players often receive duplicates or low-value loot, which incentivises continued spending in the quest for better rewards (McCaffrey, Reference McCaffrey2019). Microtransactions are highly profitable, surpassing traditional pricing models and accounting for over 70% of global gaming market revenue (Gibson et al. Reference Gibson, Griffiths, Calado and Harris2022).
This increased presence of gambling-related content in gaming contexts in order to realise desired outcomes is termed the ‘gamblification of gaming’. Gamblification can exploit psychological triggers to increase profitability by enticing frequent microtransactions and excessive playtimes through feelings of fun, as well as leveraging motivations like intellectual challenge and social rewards (Macey et al. Reference Macey, Hamari and Adam2024).
Addiction by design
Research indicates that structural and design aspects in gambling and gaming systems are crucial in the acquisition, development, and maintenance of problematic and addictive gaming and gambling behaviours (Griffiths & Nuyens, Reference Griffiths and Nuyens2017). According to operant conditioning theory, the method of delivering rewards is more influential than the rewards themselves, as it depends on factors such as their nature, magnitude, and frequency (Ferster & Skinner, Reference Ferster and Skinner1957). Like gambling, some games rely on variable ratio reinforcement schedules, which promote the most persistent behaviour and are the least likely to lead to extinction (Drummond & Sauer, Reference Drummond and Sauer2018). For instance, in certain role-playing games, rare items drop after defeating enemies at unpredictable rates, encouraging players to repeat the same actions for long periods in the hope of eventually being rewarded.
Controversial loot boxes subject players to heightened anticipation, much like slot machines, through sensory elements such as bursts of colour and acoustic references. These features positively reinforce wins, encouraging further purchases and increasing playtime (King &Delfabbro, Reference King and Delfabbro2019). Additionally, ‘near misses’ (losses perceived as close wins) are frequently displayed, which have been found to increase the desire to continue playing, activating the same psychological reward process as actual wins (Parke & Griffiths, Reference Parke and Griffiths2004). This can lead to cognitive distortions akin to the ‘gambler’s fallacy’, where repeated unsatisfactory loot box openings are viewed as a sign that a rare item is near, leading gamers to overestimate their chances despite the outcome being random (King et al. Reference King, Delfabbro and Griffiths2010).
Intrinsic loot box characteristics, such as frequent in-game events, rapid betting cycles, short event duration, and minimal payout intervals, are often designed to promote impulsive behaviours. These mechanics minimise opportunities for reflection during loss periods, effectively trapping players in a cycle of reinvestment of rewards into the game (Griffiths & Auer, Reference Griffiths and Auer2012). They may also exploit players’ fear of missing out on valuable social interactions and competitive advantages in online games (Karlsen, Reference Karlsen2011). Furthermore, research into pay-to-win microtransactions revealed that the frequency of payments, rather than the total amount spent, served as a stronger predictor of engagement in other forms of gambling-like gameplay (Steinmetz et al. Reference Steinmetz, Fiedler, von Meduna and Ante2021). This reinforces the concept that the design choices underlying microtransactions are more likely to lead to problematic behaviours rather than merely the financial outlay.
Game developers have presented microtransactions as a way to fund content updates, reduce upfront costs, and enhance gameplay through optional customisation. In response to concerns, the industry introduced self-regulatory measures like content classification and age rating systems to inform customer choices (McCaffrey, Reference McCaffrey2019).
Mental health impact
Studies on the interplay between microtransactions, problem gaming, and problem gambling are limited. Despite this, existing research suggests that loot box spending is positively associated with problem gambling severity. In addition, loot box purchasers are more likely to be young males and report higher levels of video game engagement (Gibson et al. Reference Gibson, Griffiths, Calado and Harris2022; Zendle, Reference Zendle2020).
Comorbid psychiatric disorders can serve as both risk factors for and consequences of gaming disorder. However, the lack of longitudinal studies makes it difficult to establish the directionality of these associations (Mihara & Higuchi, Reference Mihara and Higuchi2017). A literature review on Gaming Disorder identified significant correlations with various presentations, with anxiety showing the strongest association, followed by depression, attention deficit hyperactivity disorder or hyperactivity symptoms, and social anxiety/phobia and obsessive–compulsive symptoms (González-Bueso et al. Reference González-Bueso, Santamaría, Fernández, Merino, Montero and Ribas2018).
Given the overlap between gaming and gambling behaviours, further research is needed to explore both in conjunction. This would help improve understanding of their combined impact on well-being and their relationship with comorbid mental health disorders, including any reciprocal effects.
Legislative framework
Loot boxes remain largely unregulated because they do not align with traditional gambling definitions, reflecting how legal frameworks often lag behind technological advancements (Griffiths, Reference Griffiths2018). While some regions have acted, no clear global consensus exists, highlighting the need for greater transparency in game design and stricter age restrictions to safeguard impressionable players. The Belgian Gaming Commission is the only European authority to have outlawed paid loot boxes since 2018 (McCaffrey, Reference McCaffrey2019). The Dutch government advocates for a microtransaction ban under European Union law, while Finland proposed a bill in 2022 to regulate loot boxes as gambling (Pour, Reference Pour2024). In the United Kingdom, the Gambling Act 2005 does not cover loot boxes. As a result, the industry adopted a self-regulatory approach and published ‘Principles and Guidance on paid Loot boxes’ in 2023 (UKIE, 2023). The UK government indicated that it is monitoring these practices and considering future legislative action (Woodhouse, Reference Woodhouse2024). In Ireland, the Gambling Regulatory Authority of Ireland (GRAI) was established under the recent Gambling Regulation Act 2024 (Government of Ireland, 2024), which focuses on traditional gambling activities and does not address loot boxes. Meanwhile, China has shifted from lifting a console ban to prohibiting loot boxes from being purchased with real currency, mandating drop rate disclosures, and requiring player-spending reports (Pour, Reference Pour2024).
Conclusion
The escalating integration of gambling-like features in gaming demands urgent action from researchers and policymakers. There is a pressing need to include gambling within gaming under existing legislations in the European Union and across the world. This should be followed up by legislation focused on Gaming Regulation, with the gambling aspects taken into consideration.
The manipulation of microtransactions capitalises on the same psychological triggers that fuel gambling addiction, often with a disturbing focus on underage players who may lack understanding of the consequences. As the gaming industry expands, clearly defining what constitutes gambling within games becomes even more critical. Policymakers should also consider measures like the Irish Social Impact Fund (Government of Ireland, 2024), introduced under the Gambling Regulation Act 2024, to address the long-term impact of gambling within gaming. Furthermore, services for Gaming Disorder need to be developed and interlinked with those for Gambling disorder. Recent pilot services in some parts of Ireland, which combine Gambling and Gaming Disorders and are funded through the public health service, are a step in the right direction. If left unchecked and without adequate support for gamers, these practices will only increase the risks of financial harm, gambling-related behaviours, and serious co-occurring mental health issues.
Funding statement
This editorial received no specific grant from any funding agency, commercial or not-for-profit sectors.
Competing interests
The authors declare none.
Ethical standards
The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committee on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008.
