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On a Skype call after the news broke, Sauer, a psychological scientist and coexecutive director of the International Media Psychology Laboratory, talked with his collaborator, psychological scientist Aaron Drummond, PhD, of Massey University in New Zealand, about Belgium’s decision. Because loot boxes represent a financial risk with an unknown reward, Belgian policymakers had categorized them as a form of gambling, and those policymakers were not the only ones. Countries and states that have passed or considered regulations on loot boxes include Australia, the Netherlands, and Hawaii. But those regulations were contentious.

Researchers are now working to refine their understanding of the psychological principles that underlie the drive to gamble and the neurological underpinnings of what happens in the brains of gamblers who struggle to stop. Counter to simplistic assumptions about the role that the neurotransmitter dopamine plays in addictions (Nutt, D. J., et al., Nature Reviews Neuroscience, Vol. 16, No. 5, 2015), research is showing variations in the volume and activity of certain areas of the brain related to learning, stress management, and rewards processing that might contribute to problematic gambling.

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Gambling problems, previously called pathological gambling, were considered an impulse control disorder until 2013, when the DSM-5 classified them as an addictive disorder. That made gambling addiction the first, and so far the only, defined behavioral addiction in the clinical section of DSM-5 (with some hints that video gaming disorder might ultimately follow, experts say). Like addictions to alcohol and drugs, gambling addictions are characterized by an increasing tolerance that requires more gambling as time goes on to feel satisfied. People with the disorder can also experience withdrawal that causes irritability when they try to quit.

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As evidence accumulates, it is important to examine the risks without overreacting before the data are in, said Marc Potenza, PhD, MD, director of Yale University’s Center of Excellence in Gambling Research. When casinos enter a region, he said, the area may experience a transient bump in gambling problems followed by a return to normal. Given how quickly gambling is evolving with digital technologies, only time will tell what their impact will be. "We don’t want to be overly sensationalistic, but we do wish to be proactive in understanding and addressing possible consequences of legalized gambling expansion," he said.

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New strategies for treatment would be welcome, experts say, as gambling is a particularly tricky addiction to treat, in part because it is easy to hide. As many as 90% or more of people with gambling problems never seek help (Bijker, R., et al., Addiction, Vol. 117, No. 12, 2022).

Charles Gillespie, a Charlotte native and co-founder of Gambling.com, spoke to CBJ in a video call interview from his home in Monaco. His co-founder and Providence Day and UNC Chapel Hill classmate, Kevin McCrystle, also previously lived overseas but now resides in Charlotte, home to the company’s North american online casino headquarters.