Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Regulating Gambling-Like Video Game Loot Boxes: a Public Health Framework Comparing Industry Self-Regulation, Existing National Legal Approaches, and Other Potential Approaches

Regulating Gambling-Like Video Game Loot Boxes: a Public Health Framework Comparing Industry... Purpose of Review Loot boxes are gambling-like monetisation mechanics in video games that are purchased for opportunities to obtain randomised in-game rewards. Gambling regulation is increasingly being informed by insights from public health. Despite conceptual similarities between loot boxes and gambling, there is much less international consensus on loot box regulation. Various approaches to regulating loot boxes are reviewed via a public health framework that highlights various trade-offs between individual liberties and harm prevention. Recent Findings Many countries have considered regulation, but as yet only a few countries have taken tangible actions. Existing regulatory approaches vary greatly. More restrictively, Belgium has effectively ‘banned’ paid loot boxes and prohibits their sale to both children and adults. In contrast, more liberally, China only requires disclosure of the probabilities of obtain- ing potential rewards to provide transparency and perhaps help players to make more informed purchasing decisions. Most other countries (e.g., the UK) have adopted a ‘wait-and-watch’ approach by neither regulating loot box sales nor providing any dedicated consumer protection response. Industry self-regulation has also been adopted, although this appears to elicit lower rates of compliance than comparable national legal regulation. Summary Many potential public health approaches to loot box regulation, such as expenditure limits or harm-reducing modifications to loot box design (e.g., fairer reward structures), deserve further attention. The compliance and clinical benefits of existing interventions (including varying degrees of regulation, as adopted by different countries, and industry self-regulation) should be further assessed. The current international variation in loot box regulation presents opportunities to compare the merits of different approaches over time. Keywords Loot boxes · Video gaming regulation · Online gambling · Consumer protection · Interactive entertainment law · Video games · Public health Introduction ‘Loot boxes’ are gambling-like monetisation mechan- ics in video games that players can engage with to obtain This article is part of the Topical Collection on Gambling randomised rewards, which can provide cosmetic changes * Leon Y. Xiao •• • or gameplay advantages [1 , 2 ]. All loot boxes involve lexi@itu.dk ‘randomisation’ when deciding which rewards to provide 1 to players. However, depending on (i) whether or not the Center for Digital Play, IT University of Copenhagen, Rued player pays real-world money to become eligible to engage Langgaards Vej 7, Copenhagen 2300, Denmark 2 with the loot boxes and (ii) whether or not the rewards that School of Law, Queen Mary University of London, Mile End the players receive can be transferred to other players in Road, London E1 4NS, UK 3 exchange for real-world money [3] (the latter being a par- The Honourable Society of Lincoln’s Inn, Lincoln’s Inn, ticularly important distinction for regulatory purposes at London WC2A 3TL, UK 4 present), loot boxes have been divided into four catego- School of Psychological Science, University of Bristol, 12a •• ries by Nielsen and Grabarczyk [4 ], as summarised in Priory Road, Bristol BS8 1TU, UK Vol.:(0123456789) 1 3 164 Current Addiction Reports (2022) 9:163–178 Table  1. The existing academic literature and regulatory second categories of loot boxes that do not require purchase scrutiny have focused on so-called paid loot boxes (i.e., the appear less obviously harmful, although they might in con- shaded third and fourth categories described in Table 1) that trast lead to the player overspending time (in order to ‘grind’ the player spends fiat currency to purchase because these or repeatedly complete largely identical in-game tasks to might lead to the player overspending real-world money and achieve or receive something with only a small chance of thereby suffering potential financial harms [5 ]. The first and happening [6, 7]), rather than overspending money, and •• •• • Table 1 Nielsen and Grabarczyk [4 ]’s loot box categorization framework [4 ] (adapted from Xiao [5 ] and Xiao et al. [11]) 1 3 Current Addiction Reports (2022) 9:163–178 165 potentially lead to or exacerbate the World Health Organi- industry’s commercial interests, generally deem loot boxes zation’s (WHO’s) so-called gaming disorder or problematic to be suitable for implementation in children’s games and, engagement with video gaming as a form of behavioural by implication, suitable for children to purchase (e.g., the addiction. The degree of the ‘problematic-ness’ and level of Entertainment Software Rating Board (ESRB) in North potential harm for each category of loot boxes, as perceived America and Pan European Game Information (PEGI) in by the authors and generally understood by the literature, Europe, neither of which requires a minimum age rating are outlined in ascending order in Table 1. Hereinafter, this for games containing loot boxes as of May 2022, although article discusses paid loot boxes only and refers to them as imposing this would be within their self-regulatory powers loot boxes, unless otherwise specified, following colloquial [29]; this should be contrasted with how mere depiction of norms and the existing literature [11]. tobacco, alcohol and illegal drug use would generally render This article introduces loot boxes’ current prevalence in the game to be deemed as suitable only for older adolescents, video games and discusses why loot box regulation could be, e.g., ‘PEGI 16’ or suitable for players aged 16 and above and should be, conceptualised as a public health issue that [30]). Indeed, 58% of the highest-grossing UK iPhone games can be approached in many different ways. Then, existing deemed suitable for children aged 12 + contained loot boxes self-regulatory approaches from the video game industry, in 2019 [23 ], meaning that children are regularly exposed to and the legal regulatory frameworks for loot boxes in various loot boxes and can readily purchase them. The UK Gambling example jurisdictions, are summarised. Finally, both existing Commission found that 23% of young people aged between and potential loot box harm minimisation measures are con- 11 and 16 have paid real-world money to purchase loot boxes sidered in the context of the Nuffield public health interven- [31(p. 39)]; in contrast, only 7% have ever participated in tion ladder [12(pp. 41–42, paras 3.37–3.38)], with respect traditional online gambling [31(p. 33)]. to how they balance inherent trade-offs between individual liberties and harm prevention. Conceptual Similarities with Gambling Prevalence and Deemed Suitability to Children Purchasing loot boxes is conceptually similar to gambling both structurally and psychologically because the player vol- Loot boxes are presently frequently implemented in video untarily spends real-world money to engage in a randomised games, particularly on mobile phone platforms: in 2019, process whose results could be desirable or, more often, amongst the highest-grossing video games, 59% on the undesirable, given that most potential loot box rewards are Apple iPhone platform contained loot boxes in the UK, often contextually worthless to the player (either because as did 36% on the PC Steam platform [23 ]. Loot boxes they already have a duplicate copy or because they are remain an evolving issue as the prevalence rate was found already in possession of some other superior or effectively to have increased to 77% for UK iPhone games when it equivalent in-game item) [2 , 32]. Through purchasing loot was re-assessed in 2021 using a comparable sample [24]: boxes, players potentially either ‘gain’ by obtaining a valu- this appears to be due to multiple reasons including (i) a able and wanted item or ‘lose’ by obtaining a non-valuable greater number of popular games starting to implement loot and unwanted item [32]. This is even more evident in rela- boxes; (ii) difficulties with identifying well-hidden loot box tion to loot boxes that provide rewards possessing real-world implementations with complex purchasing procedures; and monetary value that the player can subsequently sell on the (iii) semantic and definitional ambiguities with what game secondary market, because many non-valuable rewards are mechanic exactly constitutes a loot box [25 ]. The preva- worth far less than the cost of purchasing the loot box, com- lence rate also differs across countries: 91% of the 100 high- pared to the potential large ‘jackpot’ wins from valuable est-grossing iPhone games contained loot boxes in China rewards [3], similar to the incentive structure of lottery tick- in 2020 [26], suggesting that the loot box situation might ets [24]. Certain particularly rare and highly sought-after be different across countries and cultures and that future loot box content is worth hundreds, and potentially over research should include the perspectives of non-Western one thousand, euros on the secondary market [33]. Indeed, countries and players [see 27]. opening ‘rare’ rewards from loot boxes elicits physiologi- Although some members of the public, e.g., some parents cal responses similar to participating in certain traditional [see 28], consider loot boxes to be unsuitable for children, gambling activities [34]. One adult player reportedly spent game companies and self-regulatory video game age rat- over US$10,000 on loot boxes in one game over a 2-year ing systems, which are financially supported by the industry period [35], and four children spent ‘nearly £550 in 3 weeks’ and therefore arguably conflicted from acting against the of their father’s money without permission and still failed to obtain the rare item that they were hoping for [36]. The debate on that issue is not addressed herein [8, 9] and has been addressed in other articles in Current Addiction Reports [e.g., 10]. 1 3 166 Current Addiction Reports (2022) 9:163–178 the UK Gambling Commission [63]) and 2.8% (by YouGov Differing Interpretations of the Loot Box ‘Harm’ Evidence Base: Allusions to Longstanding Debates on behalf of GambleAware) [64(p. 2)]. This suggests that ‘harm prevalence’ data may be subject to a range of meth- on the Evidence Base of Gambling Harms odological issues affecting their accuracy and validity that researchers are not fully aware of and cannot account for. Importantly, loot box expenditure has been found to be posi- tively correlated with self-reported problem gambling sever- More recently, Muggleton et al., relying instead on more objective transaction data from a high street bank, sug- ity in many cross-sectional studies across various Western countries, including the USA [37], Spain [38], Denmark [39] gested that even the higher, previously identified problem gambling prevalence rates (i.e., ~ 3.0%) have underestimated and Australia [40], amongst both adult and adolescent player samples [41]. Reviews and meta-analyses of these studies the extent of gambling-related harms and, importantly, failed •• to reflect the widespread associations between gambling have been conducted elsewhere [42 ]; [43–45]. However, the causal direction (if any) of this positive correlation is and various harms even amongst less engaged (supposedly, non-problem) gambling participants [65]. For loot boxes, not known [46], and there is debate as to how the current evidence base should be interpreted. McCaffrey has argued this suggests that the prevalence of loot box ‘harms’ might have been underestimated by prior studies and that research that, presently, there is insufficient evidence to demonstrate that loot boxes cause widespread harm and that regulatory collaborations with the industry using players’ actual (and, therefore, more objective) loot box spending data could pro- intervention is therefore not yet justified [47, 48]. In contrast, Drummond et al. have argued that there is already sufficient vide important insights [66]. However, in yet another strik- ing parallel with gambling research, the video game industry evidence demonstrating the potential harms of loot boxes (particularly, similarities with traditional gambling and the has hitherto been unwilling to share their data, similarly to how the gambling industry has been unwilling to share data involvement of real-world money) and that loot boxes should therefore immediately be regulated more stringently [2 , 3]. with independent researchers [67]. These diverging perspectives have similarly been present in the longer-standing debate in gambling. Collins et al. have Loot Boxes and Gambling Both Show a Trend Toward Pre‑emptive Industry ‘Self‑Regulation’ argued that existing harm reduction methods have been successful (as evidenced by stable or flat prevalence rates The video game industry has adopted certain pre-emptive of problem gambling), and that further regulation would unnecessarily reduce the (safe) enjoyment of gambling as a self-regulation purportedly to enhance transparency and reduce harms ahead of potential impending legal regulation. leisure activity by many people [49(p. 994)]. The gambling industry also echoes this interpretation [e.g., 50], perhaps For example, some companies have committed to making probability disclosures detailing the player’s likelihood of unsurprisingly given its commercial interests. In contrast, other researchers have argued that the problem gambling obtaining different randomised rewards voluntarily outside of Mainland China (where, uniquely, disclosures are required prevalence rate fails to reflect the full extent of the potential harms of gambling and that non- ‘problem gamblers’ would by law [26])[68]. Major app stores, such as the Google Play Store and the Apple App Store, also require probability dis- also potentially suffer harms, which is why a population- based public health harm minimisation approach might be closures globally [69, 70]. In addition, the two major self- regulatory age rating systems of North America and Europe, required to reduce the risk of harm amongst all gamblers [51–56]. the ESRB and PEGI, have introduced an ‘in-game purchases (includes random items)’ content descriptor to label and sig- The conflicting interpretations, in both the loot box and the gambling contexts, arguably arise partially from the nify the inclusion of loot boxes in a video game [71, 72]. However, this self-regulatory measure has been criticised as methodological weaknesses of a majority of the evidence base, which relied on retrospective self-reported data. Such being insufficiently detailed to truly inform potential custom- ers about the risks involved with loot boxes [29], and there data, derived either from a representative panel (such as a prevalence survey [57]) or from online convenience sam- is no evidence of these labels providing any tangible benefit. Loot box-related industry self-regulation mirrors many ples [58], might lack reliability due to the participants’ responses being intentionally dishonest (due to a desire attempts by the traditional gambling industry to self-regulate (seemingly in conflict with its own financial interests) argu- to hide one’s participation in gambling due to perceived stigma [59]) or unintentionally inaccurate (due to memory ably in order to fend off stronger (and likely more effec- tive) interventions from regulators and policymakers [73]. recall issues [60]; inconsistent interpretation of questions [61]; or incorrect estimations and calculations of expen- For example, the gambling industry has, for a long time, directed funds towards non-restrictive interventions, such ditures [62]). To illustrate, in the UK, gambling preva- lence studies have, in the 12 months prior to May 2022, as warning messages or education programmes about the risks of gambling, which do nothing to alter the properties recorded rates of problem gambling as varied as 0.2% (by 1 3 Current Addiction Reports (2022) 9:163–178 167 and availability of potentially harmful products [74]. In the options that interfere less with the players’ ability and choice UK, the industry has agreed to partial restrictions around to purchase loot boxes and the companies’ commercial inter- advertising in professional sports (e.g., ‘whistle-to-whistle’ ests are available. The Nuffield public health intervention ban): however, this has not effectively reduced sports watch- ladder [12(pp. 41–42, paras 3.37–3.38)] is a tool that helps ers’ frequent exposure to gambling marketing via logos and to illustrate the acceptability of various measures on each website addresses shown on, for example, shirts and pitch- ‘rung’ by identifying, comparatively, how intrusive on per- side billboards in soccer [75]. Research has additionally sonal liberty each measure may be; how much justification critiqued the inadequacies of the main gambling warning may be required before they are adopted; and whether they message used by the UK industry from 2014 to 2021 (‘When are proportionate responses for achieving regulatory aims the Fun Stops, Stop’) [76, 77], and also its lack of effect (as shown in the first column of Table  2). on influencing gambling behaviour [78]. Many gambling The lowest rung of ‘do nothing’ or simply ‘monitor the researchers have therefore advocated for stronger interven- situation’ is technically a public health approach. This has tions, akin to the graphic health warnings or restrictions on the advantage of not restricting choice and does not remove availability adopted in tobacco contexts [79], but uptake of any of the potential (e.g., economic) benefits of the product. these approaches has been slow. Such an approach is likely appropriate when the potential for harm is deemed to be low or little information is available as to whether the product is, on balance, more harmful or ben- What Does Taking a Public Health Approach eficial to society. However, generally, the second lowest rung Mean? of ‘provide information’ is likely a superior approach when compared to ‘do nothing’, because ‘provide information’ Within the discourse surrounding loot box regulation, there can guide choice towards better alternatives and provides is substantial support for banning the mechanic entirely [80]: the same freedom of choice as ‘do nothing’. Many inter- for example, as advocated for by academics [e.g., 81(p. 40)], mediary approaches rest between the lower, non-restrictive gambling-related charities and other NGOs (non-govern- rungs and the highest, most restrictive rung of ‘eliminate mental organisations) [e.g., 82], and, indeed, members of choice’. Several different approaches might also be used in the legislature [e.g., 83(p. 115, para. 446)]. However, ban- relation to one subject matter simultaneously: for example, ning the product is only one potential approach amongst the UK public health approach to obesity works at multiple a spectrum of different approaches of varying degrees of levels, e.g., by providing information on nutrition (in super- restrictiveness. An indiscriminate ban is one of the most markets) and calories (in restaurants), whilst also restricting extreme approaches and is not strongly supported by the choice via new policies on the marketing and promotion evidence from, and the experience of, other public health of unhealthy foods (especially to children). Similarly, many domains given significant potential negative consequences approaches have been implemented in relation to tobacco: thereof. For example, the US ban on alcohol during the Pro- in addition to what has already been done in many Western hibition era (1920–1933) was not successful: consumption countries (e.g., age limits on purchasing the product (‘elimi- and alcohol-related harm was likely reduced, but demand nate choice’); restrictions on advertising (‘guide choice’); remained and caused the industry to shift towards a higher and warning messages on packaging (‘provide informa- risk illegal industry supplied by organised crime, thus incur- tion’)), many tobacco researchers have been advocating for ring ‘unacceptable social and economic [costs]’ that led to greater uptake of e-cigarettes and other generally less harm- support for the eventual repeal of the ban [84]. ful combustion-less tobacco alternatives [89, 90]. More sus- To ban or heavily regulate loot boxes as gambling is but tainable improvements to health may arise not from simply one potential regulatory approach that has dominated the banning the existing product (without providing alternatives discourse. Notably, in contrast, most countries have seem- and ignoring potential negative consequences thereof), but ingly decided not to regulate collectible card packs and by inventing, promoting and disseminating healthier alterna- other similarly gambling-like products (e.g., blind boxes) tives to the original product. [85], even though these products likely contravene existing These examples from other public health domains have gambling laws [86] and would constitute the most seem- been highlighted because, although loot boxes share strong ingly harmful fourth category of loot boxes (per Table 1) similarities with gambling (which itself is now seen as a had these been virtual, rather than physical, products [87]. public health issue [51–56]), there are also major differences Many video game players have identified this uncomfort- between loot boxes and gambling. Importantly, there are able incongruence between many countries’ strong desire to potential public health interventions for loot boxes that are regulate and ban loot boxes and regulatory inaction in rela- not possible in traditional gambling contexts. Commercial tion to other gambling-like products as deserving of some gambling relies on individuals losing money to be profitable, further consideration [88 ]. Indeed, a wider range of other and since a majority of gamblers spend very little money on 1 3 168 Current Addiction Reports (2022) 9:163–178 1 3 Table 2 Mapping loot box harm minimisation measures (non-exhaustive) onto the Nuffield public health intervention ladder [12(pp. 41–42, paras 3.37–3.38)] Range of intervention options Examples of specific measures As adopted by or as recommended by… Eliminate choice Prohibit the sale and, by extension, the purchase of loot boxes to all Belgium, which has effectively ‘banned’ the sale and purchase of both Regulate in such a way as to entirely eliminate choice, for example, players the third and fourth categories of loot boxes through applying existing through compulsory isolation of patients with infectious diseases Or less restrictively, prohibit the sale and, by extension, the purchase gambling law [13] of loot boxes to underage players Technically, Denmark [14], the UK [15] and many other countries through applying existing gambling law in relation to the fourth category of loot boxes, although this regulatory position has seemingly not been enforced in practice Restrict choice Maximum spending limits on loot boxes: i.e., that a player is only China, which only permits underage players to spend a certain amount Regulate in such a way as to restrict the options available to people allowed to spend up to a predetermined sum during a specified of money in online video games per month [120] with the aim of protecting them, for example, removing unhealthy period [115, 116 ] China, which also only permits underage players to play online video ingredients from foods, or unhealthy foods from shops or restaurants Less directly, maximum gameplay time limits: i.e., that a player is games on specific days during specific time periods [120, 121] only allowed to spend up to a predetermined length of time on video games during a specified period, which might dissuade purchase of loot boxes given that less time can be spent on enjoying their content Prohibit the implementation of specific types of loot boxes deemed to Japan, which prohibits the implementation of kompu gacha, which is be particularly problematic a type of loot boxes that provide a particularly valuable extra reward only after the player collects all other ‘regular’ potential rewards from the loot box (i.e., after the player spends a substantial sum of money) [98(pp. 314–315)] Guide choice through disincentives Institute an extra tax that is payable by players when purchasing loot None Fiscal and other disincentives can be put in place to influence people boxes, above and beyond usual sales taxes (if any) not to pursue certain activities, for example through taxes on Require video game companies to obtain and pay for a specific (non- cigarettes, or by discouraging the use of cars in inner cities through gambling) licence in order to sell loot boxes, which represents a cost charging schemes or limitations of parking spaces that is likely to be shifted onto the player-consumers Guide choices through incentives Require video game companies to provide players with the choice to None Regulations can be offered that guide choices by fiscal and other [posi- obtain all potential loot box rewards through direct purchase or some tive] incentives, for example, offering tax-breaks for the purchase of other form of non-randomised monetisation method at a price that bicycles that are used as a means of travelling to work would, on average, be lower than had the player attempted to obtain those rewards through purchasing loot boxes. (That it is generally cheaper to obtain the rewards through direct purchase should also be required to be prominently disclosed because ‘incentive’ in this con- text is difficult to control given that the randomisation could mean that some players might still be tempted to purchase loot boxes for a chance at obtaining all potential rewards even more cheaply.) Provide discretionary grants and tax relief to video game companies Not yet, but governmental funding is already available for the video based on their implementation of more ethical loot boxes or their game industry in many countries: these could be redirected, withheld decision not to implement loot boxes at all. These financial benefits and awarded on a basis that focuses on social responsibility in relation may also be shifted onto the player-consumers and make more ethi- to loot boxes, rather than on, e.g., the employment of citizens belong- cally designed video games more widely available ing to certain countries [119] Guide choices through changing the default policy Require video game companies to offer potential loot box rewards None For example, in a restaurant, instead of providing chips as a standard through direct purchase or some other form of non-randomised mon- side dish (with healthier options available), menus could be changed etisation method at a reasonable and comparable price by default, to provide a more healthy option as standard (with chips as an option such that the player must undertake extra effort in order to find available) the alternative option of attempting to obtain the rewards through purchasing loot boxes Current Addiction Reports (2022) 9:163–178 169 1 3 Table 2 (continued) Range of intervention options Examples of specific measures As adopted by or as recommended by… Enable choice Require video game companies to provide players with the choice of Some video games (e.g., Brawl Stars (Supercell, 2017)) currently offer Enable individuals to change their behaviours, for example, by offering either (a) purchasing loot boxes or (b) obtaining all potential loot box the option to purchase some potential loot box rewards directly, but participation in an NHS ‘stop smoking’ programme, building cycle rewards through direct purchase or some other form of non-ran- this is often confined to opportunities that are time-limited and do lanes, or providing free fruit in schools domised monetisation method at a reasonable and comparable price not include all possible rewards [22(p. 43)]. This option should be provided for all items on demand Promote ethical game design measures that are likely to minimise A variety of measures are available, some of which have been partially •• potential loot box harms: (i) encourage video game companies to implemented by certain video game companies [93 , 118, 119]. adopt them and (ii) encourage players to play and only spend money Promotion programmes directed at companies and players have not on games adopting them been forthcoming Provide information Require the expected, average real-world monetary cost of obtaining The UK advertising regulator attempted to require this [122], but has Inform and educate the public, for example as part of campaigns to potential rewards to be calculated and published by companies for since decided not to do so following consultation citing difficulties that encourage people to walk more or eat five portions of fruit and the player’s benefit companies would face in calculating this value given the complexity vegetables per day of in-game economies [123(pp. 9–10)] (which were arguably inten- tionally designed by companies to be that way and so the companies should be liable for any costs-related consequences thereof) Require probability disclosures as to the likelihood of obtaining poten- China by law [26] tial rewards to be published Nearly all other countries by industry self-regulation [24] Do nothing or simply monitor the current situation Continue to allow loot boxes to be sold without intervening In practice, the current position in Denmark, the UK and many other countries, given that existing gambling laws have not been enforced as interpreted and therefore no actions has been taken against the fourth category of loot boxes 170 Current Addiction Reports (2022) 9:163–178 the activity, gambling profits are driven by a small percent- not provided with the highest level of consumer protec- age of high-spending gamblers incurring high losses (so- tion uniformly, meaning that some players are more fre- called whales in land-based gambling environments) [91(p. quently exposed to potential harms than others, which does 21)]. The term ‘whales’ has also been used as a term for not appear to be ideal [22]. Cerulli-Harms et al.’s report high-spending loot box purchasers, and this small minority commissioned by the Committee on the Internal Market of players have been identified as effectively financing the and Consumer Protection of the European Parliament has video game containing the loot boxes (for the benefits of not argued that divergent regulation would also lead to increased only the operating company but also many non-paying play- compliance costs for companies (which might more unfairly ers) [92]. However, other loot box business models that rely affect smaller, newer companies, thus making it harder for on more players paying a reasonable amount of money (and them to compete with more established companies [48]) and no players spending extreme amounts) may also be com- is contrary to the principles of the European Single Market •• mercially viable [93 ]. [100]. Finally, public health has a ‘precautionary principle’ However, it should also be noted that, conversely, com- stating that the lack of scientific certainty cannot justify panies’ economic interests and players’ freedoms are less regulatory inactivity when potential harms are significant. restricted in the UK than in Belgium. In addition, there This principle has already been cited by the loot box lit- are also benefits to this divergent regulatory environment: erature [26] and by policymakers [94(p. 29)] to argue in specifically, data can be collected from multiple countries favour of regulating loot boxes, despite the absence of a as to the pros and cons of different public health-based strong evidence base. Given that this principle has already approaches, which can then be compared with each other been invoked in relation to loot boxes, it is important that and with data on industry self-regulation and also with stakeholders are aware of the full spectrum of approaches perspectives on other potential regulatory approaches that that could be used in a public health approach to regulating have been suggested but not as yet trialled. Multiple national loot boxes. In particular, the negative consequences of both policy experiments are effectively being conducted across an overly lenient and an overly restrictive approach should the world: taking advantage of this opportunity would facili- be recognised. Indeed, a non-restrictive or less restrictive tate the improvement of existing policies and the adoption approach might be more appropriate at present when regula- of better policies in all countries. To assist in visualising tion is imposed based on the precautionary principle. and comparing the array of harm minimisation measures that have either been adopted or proposed in relation to loot boxes (either as (i) industry self-regulation or (ii) national A Public Health Framework Comparing legal regulation), these are non-exhaustively mapped onto Industry Self‑Regulation, Existing the Nue ffi ld public health intervention ladder [ 12(pp. 41–42, National Approaches, and Other Potential paras 3.37–3.38)], as shown in Table 2; some (iii) additional Approaches approaches that have not previously been suggested are also summarised therein. The perceived urgency of the loot box regulation issue and the divergent interpretations of the emerging evidence base Industry Self‑Regulation on potential loot box harms have meant that various coun- tries (including those that are otherwise ideologically quite As mentioned under “Loot Boxes and Gambling Both aligned, e.g., Western European countries) have taken very Show a Trend Toward Pre-emptive Industry ‘Self-Regula- different policy approaches, as previously comprehensively tion’” section, the video game industry self-regulates loot collated by the legal literature [95–98]. Players, including boxes through mandating probability disclosures. However, children, in different countries are therefore provided with importantly, the motivations for the industry to self-regulate varying degrees of consumer protection: players in Belgium should be viewed with an appropriate degree of scepticism (where all paid loot boxes have effectively been ‘banned’ because established research from traditional addictive [13]) are provided with the highest degree of protection, domains, such as gambling, alcohol and tobacco, have all whilst players in the UK are provided with no dedicated suggested that, when their industries have purported to act loot box consumer protection measures (because, although in socially responsible ways, those self-regulatory efforts paid loot boxes that contain rewards that can be transferred have in fact been self-interested and suboptimal and have to other players and therefore possess real-world monetary therefore failed to maximally advance the public interest value technically contravene gambling law according to the [101–103]. Indeed, industry self-regulation might not have national gambling regulator [15], no enforcement actions been adopted by companies for purely altruistic purposes have been taken against known illegal implementations (e.g., improve public welfare at the cost of its own commer- [5 , 85]). Players from different countries are therefore cial profits) and may instead have been adopted to placate 1 3 Current Addiction Reports (2022) 9:163–178 171 public concern, dissuade stricter legal regulation, and main- to enter the Chinese game’s settings menu and chat with tain control over whether and how much the product is regu- the customer support bot in English in order to access the lated [104]. disclosure [26]. Further, the effectiveness of probability dis- This cynical view is justified in relation to the self-reg- closures at reducing overspending and harm is unproven and ulation of loot boxes. The Apple App Store requires loot doubtful, even when they are easily accessible and have been box probability disclosures for all video games on the plat- seen by the player: only a small minority of Chinese players form. However, when the 100 highest-grossing UK iPhone (16.4%) self-reported spending less money after seeing loot •• games were examined in 2021, only 64.0% of those games box probability disclosures [93 , 105]. Thus, it is important containing loot boxes actually complied with industry self- not to treat the adoption of only one consumer protection regulation and disclosed probabilities [24]. Additionally, measure as a ‘solution,’ given that the measure might not many UK probability disclosures were found to have been be complied with fully and that the measure itself might implemented using methods that were difficult for players to not effectively reduce harm even if it has been effectively •• access (e.g., requiring multiple buttons to be pressed before adopted [93 ]. the disclosure is shown) [24]. Despite this unsatisfactory In other countries, although a consumer protection law level of compliance (which is likely reflected also in other approach to loot box regulation (e.g., using the Unfair Com- countries adopting industry self-regulation), the industry’s mercial Practices Directive 2005 and national implemen- adoption of probability disclosure self-regulation has been tations thereof in the European Union and the UK [106, widely promoted: however, this measure’s effectiveness 107 , 108, 109]) and other approaches might be tenable, (particularly in relation to children) is not even known, the focus has been to apply gambling law to regulate loot and research from other risk communication domains and boxes in light of the apparent similarity and relationship self-reported evidence would suggest that it is unlikely to between loot boxes and gambling, and the ease and prompt- •• reduce loot box spending on a broad scale [93 , 105]. This ness with which existing gambling law could be applied to perfunctory and unsatisfactory state of affairs is reminis- immediately address the issue [22]. This assessment has cent of similarly suboptimal information disclosure-based already been completed by the national gambling regula- industry self-regulation in gambling [78] and other addictive tors of many countries, inter alia, the UK [15], the Neth- domains, e.g., tobacco [101]. erlands [16] (which has since been found to be incorrect [19, 20]), Belgium [13], France [110], and Denmark [14]. Existing National Approaches The national gambling regulators would attempt to fit vari- ous implementations of loot boxes within the pre-existing In contrast to how probability disclosures have been required national gambling law framework, meaning that the legal in other countries through industry self-regulation, China definitions of ‘gambling’ differ from the common sense has imposed this measure by law [26]. A direct comparison understanding of gambling. National gambling laws also of the loot box probability disclosure rates amongst the 100 differ across countries: specifically, the various legal ele- highest-grossing iPhone games in China and in the UK has ments that must be satisfied for a product to constitute gam- been conducted: the compliance rate with Chinese law was bling are not the same [5 , 22]. This means that different 95.6% in 2020 [26], which was significantly higher than the national regulators may easily arrive at different conclu- compliance rate with UK industry self-regulation at 64.0% sions as to whether a specific type of loot box legally con- in 2021 [24]. This demonstrates that legal regulation appears stitutes gambling under the national laws of any particular to have been more effective at ensuring compliance than country. This also means that the conclusion reached by industry self-regulation (cultural differences between the any one national regulator (one way or the other) is not two countries as to companies’ willingness to comply with necessarily reflective of, or relevant to, the decision that law and regulation notwithstanding) [24]. However, Chinese a different country’s regulator might arrive at [20]. The law gave discretion to companies as to how they can comply: decision-making processes are separate and based solely any disclosure, however difficult for the player to access, is on how that country’s gambling law was originally drafted. deemed compliant [106]. For this reason, many disclosures Finally, national gambling regulators generally cannot in China were also found to have been published by video change the law (from how it was originally drafted by the game companies using methods that were not prominent and legislature) or make new laws: they merely pronounce an difficult for players to access: even though companies could interpretation; express a desire to enforce that interpreta- have displayed the probability disclosure on the in-game tion; and potentially take enforcement actions against prod- page where loot boxes could be purchased, so that play- ucts that are deemed to be contravening the law (with the ers can easily view them and perhaps make more informed proviso that the regulators’ interpretation of the law might purchasing decisions, only 5.5% of games containing loot be legally wrong and therefore remains challengeable in boxes did so [26]. In one extreme example, the player had court by video game companies, as has been successfully 1 3 172 Current Addiction Reports (2022) 9:163–178 done by Electronic Arts against the Dutch gambling regula- affected by the Belgian ban. The effectiveness of Belgium’s tor’s previously published interpretation [19, 20]). blanket ‘ban’ of loot boxes remains to be assessed, although Briefly put, Belgium, due to the distinctiveness of its this measure appears to have not perfectly achieved the elim- national gambling law, has deemed the third and fourth ination of paid loot boxes from that market [99]. categories of loot boxes (as described in Table 1; both of which require payment of real-world money to engage in a Other Potential Approaches process that provides randomised rewards) to legally con- stitute gambling [13] and therefore effectively ‘banned’ all Many regulatory measures that may be taken in relation implementations of the product from the country [22, 100]. to loot boxes are presented on Table 2. Notably, many are In contrast, most other countries (e.g., the UK [15], France phrased as an intervention that can be imposed on players. [110], and Denmark [14]) concluded that only loot boxes This framing seemingly places the burden on individuals to that both require payment of real-world money to purchase change their loot box purchasing behaviour, which perhaps is and provide players with rewards that can be transferred to inequitable because it is the video game companies that are other players in exchange for real-world money (i.e., only providing a potentially harmful product, so it is their behav- the fourth category of loot boxes per Table 1) legally con- iour that policy should aim to influence. A public health stitute gambling. Notably, although the countries adopting approach to gambling regulation has recognised the impor- this latter position agreed as to which category of loot boxes tance of moving past the ‘blame-the-victim’ framing that is legally constitute gambling under their laws, the national inappropriately preoccupied with the gamblers’ individual regulators’ enforcement actions have differed in relation to responsibility [54]. Therefore, the loot box regulatory meas- the same games that arguably contravene the gambling laws ures could also be rephrased as interventions against video of multiple countries. Indeed, only the Dutch gambling regu- game companies, e.g., prohibiting the ‘sale’ of loot boxes lator was known to have enforced the law [16–18], whilst by companies, instead of prohibiting the ‘purchase’ of loot the regulators of many other countries have chosen not to boxes by players, or restricting the amount of money that act despite having issued compliance advice suggesting that ‘companies are allowed to receive’ from each player, rather such loot boxes would be illegal [e.g., 15]. However, a recent than limiting the amount of money ‘players are allowed to Dutch judicial decision overruled the Dutch gambling regu- spend.’ This would more accurately reflect that the policies lator’s interpretation of the law [19] and instead effectively are aimed at targeting the product availability that companies affirmed the legality of the fourth category of loot boxes in provide, rather than restricting players’ ability to purchase, the Netherlands [20]. although practically the two might be identical. The respon- Accordingly, no country, besides Belgium, is actively sibility should rest with the companies to do less harm, regulating loot boxes using gambling law at present. Some rather than for players to protect themselves, and the fram- companies quickly sought to comply with Belgian law by ing of any regulation should more accurately reflect with changing the design of the national version of the game, whom that onus lies. specifically removing the possibility of purchasing loot In addition, there are other potential ways of minimis- boxes with real-world money [111, 112]. Doing so allowed ing loot box harms that emulate examples from public these games to continue to be available to Belgian players: health issues other than gambling. For example, promoting importantly, the games were not banned, and only the loot the use of e-cigarettes in smoking is a way of reformulat- box monetisation method was. These corporate actions also ing the delivery of nicotine in a way that is fundamentally suggest that (i) it is possible to rapidly remove the loot box less harmful than combustible tobacco [89, 90]. Similarly, functionality if required to do so and (ii) these games were less harmful and fairer loot boxes could be implemented by still deemed to be commercially sound even without the loot increasing the likelihood of obtaining the rarest rewards; box revenue stream. This might be due to these games being limiting how many different loot boxes may be offered able to generate revenue through the sale of the software or within a single game and how many different potential other non-randomised in-game product offerings, or because rewards may be obtainable from a single type of loot box; maintaining strong brand awareness amongst the player base and not providing players with useless (or significantly •• in Belgium was deemed as being worth the loss in revenue devalued) duplicate rewards [93 ]. Importantly, such design and operating costs. However, in contrast, other compa- changes are plausible because of one fundamental difference nies instead removed their games from the Belgian market between loot boxes and traditional gambling: gambling pro- entirely [113], rather than to only remove the loot box fea- viders profit only when gamblers lose money and so harm to ture, likely because it was no longer commercially viable to gambling participants is inherent to the profitability of that operate those games. This shows that some genres of video industry; however, loot box providers profit from each loot games (so-called gacha games [114]) whose monetisation box sale regardless of whether the video game player has •• models rely heavily on loot boxes were likely more severely ‘won’ a valuable reward or not [93 ] and so profitability 1 3 Current Addiction Reports (2022) 9:163–178 173 is not dependent on the player ‘losing’ money and harm one of many different potential approaches. A whole range is not inherent to the loot box monetisation model. Video of harm minimisation measures of varying levels of restric- game companies’ commercial interests might be negatively tiveness are available to both policymakers and video game affected by the adoption of the aforementioned measures, companies. A broader public health perspective allows the as players would now only need to buy fewer loot boxes loot box issue to be viewed more holistically: specifically, before becoming satisfied with their rewards. However, the by comparing the pros and cons of different approaches business model would still in theory be potentially profit- and by balancing the interests of different groups of play - able (and previously non-spending players may now be more ers (e.g., on one hand, those who benefit from having con- willing to spend small amounts of money on the game as tinued access to cheaper entertainment due to loot boxes the chance of obtaining a valuable item would be higher, and who appreciate this more flexible monetisation model thereby unlocking a new source of revenue for video game [88 ] and, on the other hand, those who may be in need of companies). Similar design changes would be impossible consumer protection from potential financial harms) and the for traditional gambling as the industry would be rendered commercial interests of video game companies. Intrusive •• unprofitable (the house edge would be lost) [93 ]. Such measures might be more immediately effective at reducing design-based approaches are, in the authors’ opinion, the harm but may lead to negative consequences, whilst less best regulatory proposal at present because it balances the intrusive measure better respect all stakeholders’ interests interests of all stakeholders: the potential harms of loot but might not provide sufficient consumer protection to the boxes would be effectively curtailed, but players and com- most vulnerable players. Existing legal and self-regulatory panies would still gain from the economic benefits of the responses to loot boxes (whose effectiveness should be sub- loot box monetisation model. ject to empirical assessment) must be viewed critically and The video game industry and individual companies not seen as ultimate ‘solutions’ that have successfully and should be encouraged to self-regulate and adopt so-called effectively removed all potential harms from those coun- ethical game design measures (even potentially through tries. Consideration should be given as to which measure granting tax incentives for making more ‘ethical’ games would be the most appropriate for different types of players or placing tax disincentives on loot box purchases) [119]. (e.g., young children, as compared to adults) in different However, any one particular measure on its own should not countries. be deemed as sufficient consumer protection. The effective- ness of self-regulation should be continually monitored, and Funding L.Y.X. is supported by a PhD Fellowship funded by the IT some legal intervention (e.g., banning certain problematic University of Copenhagen (IT-Universitetet i København), which is aspects of loot boxes) might be appropriate, if voluntary publicly funded by the Kingdom of Denmark. measures are shown to be merely performative and ineffec- tive. Similarly, any legal regulatory measures that have been Declarations adopted (e.g., Belgium’s ban on paid loot boxes and Chi- na’s probability disclosure requirements) should also not be Human and Animal Rights and Informed Consent This article does not assumed to be an ultimate and effective ‘solution’ that other contain any studies with human or animal subjects performed by any of the authors. jurisdictions should immediately emulate without question: the differing cultural contexts should be considered. Which Conflict of Interest L.Y.X. was employed by LiveMe, a subsidiary of approach a certain jurisdiction decides to take is a policy Cheetah Mobile (NYSE:CMCM) as an in-house counsel intern from decision for the people of that jurisdiction to make (national July to August 2019 in Beijing, People’s Republic of China. L.Y.X. was loot box research would allow for evidence-informed regu- not involved with the monetisation of video games by Cheetah Mobile lation) [80]. Consumer protection regulation can always be or its subsidiaries. L.Y.X. was the recipient of an AFSG (Academic Forum for the Study of Gambling) Postgraduate Research Support improved upon and must continue to adapt, as loot boxes Grant that was derived from ‘regulatory settlements applied for social- continue to be designed and implemented in newer ways by ly responsible purposes’ received by the UK Gambling Commission video game companies. and administered by Gambling Research Exchange Ontario (GREO) (March 2022). L.Y.X. has accepted conference travel and attendance grants from the Socio-Legal Studies Association (February 2022), the Current Advances in Gambling Research Conference Organising Conclusions Committee with support from Gambling Research Exchange Ontario (GREO) (February 2022) and the International Relations Office of the Conceptual similarities between loot boxes and gambling Jagiellonian University, the Polish National Agency for Academic Ex- change (NAWA; Narodowa Agencja Wymiany Akademickiej) and the and the potential harms of loot boxes have been high- Republic of Poland (Rzeczpospolita Polska) with co-financing from lighted. A public health approach to gambling regulation the European Social Fund of the European Commission of the Euro- can inform a similar approach for loot box regulation. How- pean Union under the Knowledge Education Development Operational ever, attempting to regulate loot boxes as gambling is only Programme (May 2022). L.Y.X. was supported by academic scholar- 1 3 174 Current Addiction Reports (2022) 9:163–178 ships awarded by The Honourable Society of Lincoln’s Inn and The from Nielsen and Grabarczyk’s framework might infringe City Law School, City, University of London. L.L.H. and R.K.L.N. national gambling laws, with specific reference to the differ - declare no conflict of interest. P.W.S.N. is a member of the Adviso- ing approaches of Belgium, the Netherlands, and the UK. ry Board for Safer Gambling – an advisory group of the Gambling 6. Karlsen F. Entrapment and near miss: A comparative analysis Commission in Great Britain, and in 2020 was a special advisor to of psycho-structural elements in gambling games and massively the House of Lords Select Committee Enquiry on the Social and Eco- multiplayer online role-playing games. Int J Ment Health Addict. nomic Impact of the Gambling Industry. In the last 5 years, P.W.S.N. 2011;9(2):193–207. has contributed to research projects funded by the Academic Forum 7. Woods O. The economy of time, the rationalisation of resources: for the Study of Gambling, Clean Up Gambling, GambleAware, Gam- Discipline, desire and deferred value in the playing of gacha bling Research Australia, NSW Responsible Gambling Fund and the games. Games and Culture. 2022;4:15554120221077728. Victorian Responsible Gambling Foundation. P.W.S.N. has received 8. Aarseth E, Bean AM, Boonen H, Colder Carras M, Coulson M, travel and accommodation funding from the Spanish Federation of Re- Das D, et al. Scholars’ open debate paper on the world health habilitated Gamblers, and received open access fee grant income from organization ICD-11 gaming disorder proposal. J Behav Addict. Gambling Research Exchange Ontario. 2016;6(3):267–70. 9. Kiraly O, Demetrovics Z. Inclusion of gaming disorder in ICD has more advantages than disadvantages. J Behav Addict. Open Access This article is licensed under a Creative Commons Attri- 2017;6(3):280–4. bution 4.0 International License, which permits use, sharing, adapta- 10. Billieux J, Flayelle M, Rumpf HJ, Stein DJ. High involvement tion, distribution and reproduction in any medium or format, as long versus pathological involvement in video games: a crucial dis- as you give appropriate credit to the original author(s) and the source, tinction for ensuring the validity and utility of gaming disorder. provide a link to the Creative Commons licence, and indicate if changes Curr Addict Rep. 2019;6(3):323–30. were made. The images or other third party material in this article are 11. Xiao LY, Henderson LL, Nielsen RKL, Grabarczyk P, Newall included in the article's Creative Commons licence, unless indicated PWS. Loot boxes, gambling-like mechanics in video games. In: otherwise in a credit line to the material. If material is not included in Lee N, editor. Encyclopedia of computer graphics and games the article's Creative Commons licence and your intended use is not [Internet]. Springer; 2021 [cited 2022 Jul 3]. (Springer Nature permitted by statutory regulation or exceeds the permitted use, you will Living Reference). Available from: https://doi. or g/10. 1007/ 978- need to obtain permission directly from the copyright holder. To view a 3- 319- 08234-9_ 459-1. copy of this licence, visit http://cr eativ ecommons. or g/licen ses/ b y/4.0/ . 12. Nuffield Council on Bioethics. Public health: ethical issues. Lon- don: Nuffield Council on Bioethics; 2007. 191 p. 13. Belgische Kansspelcommissie [Belgian Gaming Commis- sion]. Onderzoeksrapport loot boxen [Research Report on Loot References Boxes] [Internet]. 2018 Apr [cited 2020 Apr 14]. Available from: https:// web. archi ve. org/ web/ 20200 41418 4710/ https:// www . g amin gcomm ission. be/ openc ms/ e xpor t/ sites/ def au lt/ Papers of particular interest, published recently, have jhksw eb_ nl/ docum ents/ onder zoeks rappo rt- loot- boxen- final- been highlighted as: publi catie. pdf. • Of importance 14. Spillemyndigheden [Danish Gambling Authority]. Statement about loot boxes / loot crates [Internet]. 2017 [cited 2021 Mar •• Of major importance 3]. Available from: https:// www . spill em ynd ighed en. dk/ en/ news/ state ment- about- loot- boxes- lootc rates. 1.•• Xiao LY. Loot boxes. In: Grabarczyk P, Aarseth E, Jorgensen 15. UK Gambling Commission. Virtual currencies, esports and IKH, Debus MS, Vozaru M, Houe NP, et al., editors. Encyclo- social gaming — position paper [Internet]. 2017 Mar [cited pedia of ludic terms [Internet]. IT University of Copenhagen; 2022 Mar 10]. Available from: https:// web. archi ve. org/ web/ 2022 [cited 2022 Apr 25]. Available from: https://eolt. or g/ar tic 20210 11107 5348/ http:// www. gambl ingco mmiss ion. gov. uk/ les/ loot- boxes. An open access introduction to loot boxes PDF/V irtual- cur rencies eSpor ts- and- social- casino- g aming.pdf . that summaries game studies (ludology), psychology and 16. Kansspelautoriteit [The Netherlands Gambling Authority]. legal research. Onderzoek naar loot boxes: Een buit of een last? [Study into 2.• Drummond A, Sauer JD. Video game loot boxes are psycho- Loot Boxes: A Treasure or a Burden?] [Internet]. 2018 Apr logically akin to gambling. Nat Hum Behav. 2018;2(8):530–2. A [cited 2022 Mar 10]. Available from: https:// web. archi ve. org/ consideration of how the loot box mechanic in specic fi games web/20190 50323 2356/ https:// k ansspelau t oriteit. nl/ publi sh/ libr a satisfy various criteria of ‘gambling’ and therefore are con- ry/6/o nderz oek_na ar_l oot_b oxes_-_e en_bu it_of _e en_l ast_-_nl . ceptually and structurally similar to traditional gambling. pdf. 3. Drummond A, Sauer JD, Hall LC, Zendle D, Loudon MR. Why 17. Kansspelautoriteit [The Netherlands Gambling Authority]. loot boxes could be regulated as gambling. Nat Hum Behav. Imposition of an order subject to a penalty on Electronic Arts 2020;4:986–8. for FIFA video game [Internet]. 2020 [cited 2021 Mar 11]. 4.•• Nielsen RKL, Grabarczyk P. Are loot boxes gambling? Random Available from: https:// web. archi ve. org/ web/ 20201 12722 2346/ reward mechanisms in video games. ToDIGRA. 2019;4(3):171– https://k ansspelau t oriteit. nl/ nieuw s/nieuw sber ic hten/2020/ okt ob 207. A framework separating loot boxes into four categories er/ impos ition- an- order/. that assist in helping to distinguish various implementations 18. Electronic Arts Inc & Electronic Arts Swiss Sarl v Kansspe- and their differing levels of potential harms to players, which lautoriteit (2020) Rechtbank Den Haag [District Court of The potentially justifies each category to be regulated to different Hague] [Internet]. 2020 [cited 2021 Mar 11]. Available from: degrees. https://uitsp r aken.r echtspr aak.nl/ inzie ndocu ment? id= ECLI: NL: 5.• Xiao LY. Which implementations of loot boxes constitute gam- RBDHA: 2020: 10428. bling? A UK legal perspective on the potential harms of random 19. Afdeling Bestuursrechtspraak Raad van State [Administrative reward mechanisms. Int J Ment Health Addict. 2022;20(1):437– Jurisdiction Division of the Council of State (The Netherlands)]. 54. A consideration of how each category of loot boxes Uitspraak [Ruling] 202005769/1/A3, ECLI:NL:RVS:2022:690 1 3 Current Addiction Reports (2022) 9:163–178 175 (9 March 2022) [Internet]. Raad van State; 2022 [cited 2022 Mar 34. Larche CJ, Chini K, Lee C, Dixon MJ, Fernandes M. Rare 10]. Available from: https://www .r aadvans tate. nl/ actue el/ nieuw loot box rewards trigger larger arousal and reward responses, s/@ 130150/ 20200 5769-1- a3/. and greater urge to open more loot boxes. J Gambl Stud. 20. Xiao LY, Declerck P. Video game loot boxes are NOT gambling 2021;37:141–63. under Dutch gambling regulation? Shifting the goalpost in Elec- 35. Yin-Poole W. FIFA player uses GDPR to find out everything tronic Arts v Kansspelautoriteit [Internet]. OSF Preprints. 2022 EA has on him, realises he’s spent over $10,000 in two years [cited 2022 Apr 26]. Available from: https:// osf. io/ pz24d/. on Ultimate Team [Internet]. Eurogamer. 2018 [cited 2020 Aug 21. Sinclair B. EA fined €10m o ver loot boxes as Dutch court sides 3]. Available from: https://www .eur ogamer .ne t/ar ticles/ 2018- 07- with gambling authority [Internet]. Games Indus try. biz. 2020 23-fif a-pla yer-uses- gdpr -t o-find- out- e veryt hing-ea- has- on- himr e [cited 2021 Mar 11]. Available from: https://ww w. games indus alises-hes- spent- o ver-usd10- 000- in- tw o-y ears-on- ultim ate- team . try. biz/ artic les/ 2020- 10- 29- ea- fined- 10m- over- loot- boxes- as- 36. Kleinman Z. ‘The kids emptied our bank account playing Fifa’ dutch- court- sides- with- gambl ing- autho rity. [Internet]. BBC News. 2019 [cited 2020 Aug 3]. Available from: 22. Xiao LY. Regulating loot boxes as gambling? towards a com-https:// www. bbc. co. uk/ news/ techn ology- 48908 766. bined legal and self-regulatory consumer protection approach. 37. Zendle D, Cairns P. Loot boxes are again linked to problem gam- Interactive Entertainment Law Rev. 2021;4(1):27–47. bling: Results of a replication study. PLoS One. 14(3):e0213194. 23.• Zendle D, Meyer R, Cairns P, Waters S, Ballou N. The preva- 38. Gonzalez-Cabrera J, Basterra-Gonzalez A, Montiel I, Calvete lence of loot boxes in mobile and desktop games. Addiction. E, Pontes HM, Machimbarrena JM. Loot boxes in Spanish ado- 2020;115(9):1768–72. An assessment of the prevalence of loot lescents and young adults: Relationship with internet gaming boxes amongst video games on various hardware platforms, disorder and online gambling disorder. Comput Human Behav. which importantly should be read in conjunction with the 2021;107012. updates provided in [25]. 39. Kristiansen S, Severin MC. Loot box engagement and problem 24. Xiao LY, Henderson LL, Newall P. What are the odds? Lower gambling among adolescent gamers: Findings from a national compliance with Western loot box probability disclosure indus- survey. Addict Behav. 2019;103:106254. try self-regulation than Chinese legal regulation [Internet]. OSF 40. Rockloff M, Russell AMT, Greer N, Lole L, Hing N, Browne M. Preprints. 2021 [cited 2021 Oct 1]. Available from: https:// osf. Young people who purchase loot boxes are more likely to have io/ g5wd9/. gambling problems: An online survey of adolescents and young 25.• Xiao LY, Henderson LL, Newall PWS. Loot boxes are more adults living in NSW Australia. J Behav Addict [Internet]. 2021 prevalent in United Kingdom video games than previously con- [cited 2021 Apr 6];Advance Online Publication. Available from: sidered: Updating Zendle et al. (2020). Addiction [Internet]. https://a kjour nals.c om/v iew/j ourna ls/2 006/a op/a rticl e-1 0.1 556- 2022 [cited 2022 Feb 9];Advance online publication. Available 2006. 2021. 00007/ artic le- 10. 1556- 2006. 2021. 00007. xml. from: https:// onlin elibr ar y . wile y . com/ doi/ abs/ 10. 1111/ add. 41. Wardle H, Zendle D. Loot boxes, gambling, and prob- 15829. The world’s first attempt at empirically assessing the lem gambling among young people: results from a cross- effectiveness of a form of loot box regulation, specifically sectional online survey. Cyberpsychol Behav Soc Netw. legally-required probability disclosures in China. 2021;24(4):267–74. 26. Xiao LY, Henderson LL, Yang Y, Newall PWS. Gaming the sys- 42.•• Spicer SG, Nicklin LL, Uther M, Lloyd J, Lloyd H, Close tem: suboptimal compliance with loot box probability disclosure J. Loot boxes, problem gambling and problem video gam- regulations in China. Behavioural Public Policy. 2021;Advance ing: A systematic review and meta-synthesis. New Media Online Publication:1–27. Soc. 2021;17:14614448211027176. A meta-analysis of the 27. Henrich J, Heine SJ, Norenzayan A. The weirdest people in the relationships between loot box purchasing and problem world? Behav Brain Sci. 2010 Jun;33(2–3):61–83. gambling which has been highly consistently found and 28. Zaman B, Mechelen MV, Cock RD, Huyghe J. Perceptions of between loot box purchasing and problem video gaming and exposure to games of chance, gambling, and video gam- which has been less consistently identified. ing: self-reports of preadolescents and parents. J Gambl Issues 43. Yokomitsu K, Irie T, Shinkawa H, Tanaka M. Characteris- [Internet]. 2020 Dec 1 [cited 2021 Dec 19];46. Available from: tics of gamers who purchase loot box: a systematic literature https:// jgi. camh. net/ index. php/ jgi/ artic le/ view/ 4096. review. Curr Addict Rep. 2021;8(4):481–93. 29. Xiao LY. ESRB’s and PEGI’s self-regulatory ‘includes random 44. Montiel I, Basterra-Gonzalez A, Machimbarrena JM, Ortega- items’ labels fail to ensure consumer protection. Int J Ment Baron J, Gonzalez-Cabrera J. Loot box engagement: A Health Addict. 2021;19(6):2358–61. scoping review of primary studies on prevalence and asso- 30. Pan European Game Information (PEGI). What do the labels ciation with problematic gaming and gambling. PLoS One. mean? [Internet]. [cited 2020 Apr 14]. Available from: https:// 2022;17(1):e0263177. pegi. info/ what- do- the- labels- mean. 45. Garea SS, Drummond A, Sauer JD, Hall LC, Williams MN. 31. UK Gambling Commission. Young people and gambling survey Meta-analysis of the relationship between problem gambling, 2019: A research study among 11-16 year olds in Great Britain excessive gaming and loot box spending. Int Gambl Stud. [Internet]. 2019 [cited 2021 Jun 29]. Available from: https:// 2021;21(3):460–79. web.ar chiv e.or g/w eb/20210 12912 3612/ https:// www .g amblingco 46. Sidloski B, Brooks G, Zhang K, Clark L. Exploring the asso- mmiss ion. gov. uk/ PDF/ Young- People- Gambl ing- Report- 2019. ciation between loot boxes and problem gambling: are video pdf. gamers referring to loot boxes when they complete gambling 32. Xiao LY. Conceptualising the loot box transaction as a gamble screening tools? Addict Behav. 2022;29:107318. between the purchasing player and the video game company. Int 47. McCaffr ey M. The macro problem of microtransactions: The J Ment Health Addict. 2021;19(6):2355–7. self-regulatory challenges of video game loot boxes. Bus 33. Yin-Poole W. FIFA 21 rocked by ‘EAGate’ scandal after com- Horiz. 2019;62(4):483–95. pany employee is alleged to have sold coveted Ultimate Team 48. McCaffr ey M. A cautious approach to public policy and loot cards for thousands of pounds [Internet]. Eurogamer. 2021 [cited box regulation. Addict Behav. 2020;102:106136. 2022 Apr 19]. Available from: https:// www. eurog amer. net/ fifa- 49. Collins P, Shaffer HJ, Ladouceur R, Blaszszynski A, Fong D. Gambling research and industry funding. J Gambl Stud. 21-r ocked-b y-ea- g ate-scand al- as- com pan y-em ploy ee-alleg ed- t o- 2020;36(3):989–97. have-soldc o veted-ultim ate- team- car ds-f or-t housands- of- pounds . 1 3 176 Current Addiction Reports (2022) 9:163–178 50. Betting and Gaming Council. Betting and gaming council artic le- 10. 1556- 2006. 2022. 00016/ artic le- 10. 1556- 2006. 2022. pledges to ‘keep up the momentum’ as new report suggests 00016. xml. problem and at-risk gambling rates are falling [Internet]. Bet- 67. Cassidy R, Pisac A, Loussouarn C, editors. Qualitative research ting & Gaming Council. 2021 [cited 2022 Mar 12]. Available in gambling: Exploring the production and consumption of risk. from: https:// web. archi ve. org/ web/ 20220 31214 3711/ https:// London: Routledge; 2013. 288 p. betting andg amingcoun cil. com/ ne ws/be tting- and- g amingcoun 68. Entertainment Software Association (ESA). Video game indus- cil- pledg es- to- keep- up- the- momen tum- as- new- report- sugge try commitments to further inform consumer purchases [Inter- sts- probl em- and- at- risk- gambl ing- rates- are- falli ng. net]. ESA Official Website. 2019 [cited 2021 Mar 12]. Available 51. Abbott MW. The changing epidemiology of gambling disorder from: https:// www. theesa. com/ persp ectiv es/ video- game- indus and gambling-related harm: public health implications. Public try- commi tments- to- furth er- inform- consu mer- purch ases/. Health. 2020 Jul 1;184:41–5. 69. Google. Monetisation and ads – payments [Internet]. Google 52. Livingstone C, Rintoul A. Moving on from responsible gam- play developer policy centre. 2019 [cited 2021 Jun 30]. Available bling: a new discourse is needed to prevent and minimise harm from: https://suppo r t.goog le.co m/goog le play/andr oid- de veloper/ from gambling. Public Health. 2020 Jul 1;184:107–12.answer/ 98587 38. 53. Price A, Hilbrecht M, Billi R. Charting a path towards a public 70. Apple. App store review guidelines [Internet]. Apple developer. health approach for gambling harm prevention. J Public Health 2021 [cited 2020 Aug 3]. Available from: https:// devel oper . (Berl). 2021 Feb 1;29(1):37–53.apple. com/ app- store/ review/ guide lines/. 54. van Schalkwyk MCI, Cassidy R, McKee M, Petticrew M. Gam- 71. Entertainment Software Rating Board (ESRB). Introducing a bling control: in support of a public health response to gambling. new interactive element: In-game purchases (Includes Random The Lancet. 2019;393(10182):1680–1. Items) [Internet]. ESRB Official Website. 2020 [cited 2020 Apr 55. van Schalkwyk MCI, Blythe J, McKee M, Petticrew M. Gam- 13]. Available from: https:// www. esrb. org/ blog/ in- game- purch bling Act review. BMJ. 2022;376:o248.ases- inclu des- random- items/. 56. Wardle H, Reith G, Langham E, Rogers RD. Gambling and 72. Pan European Game Information (PEGI). PEGI introduces public health: we need policy action to prevent harm. BMJ. notice to inform about presence of paid random items [Inter- 2019;365:l1807. net]. PEGI Official Website. 2020 [cited 2020 Apr 14]. Available 57. Young M. Statistics, scapegoats and social control: A critique from: https:// pegi. info/ news/ pegii ntrod uces- featu re- notice. of pathological gambling prevalence research. Addiction Res 73. Fiedler I, Kairouz S, Reynolds J. Corporate social responsibil- Theory. 2013;21(1):1–11. ity vs. financial interests: the case of responsible gambling pro- 58. Pickering D, Blaszczynski A. Paid online convenience samples grams. J Public Health (Berl). 2021;29(4):993–1000. in gambling studies: questionable data quality. Int Gambling 74. Schull ND. Addiction by design [Internet]. Princeton University Stud. 2021;0(0):1–21. Press; 2012 [cited 2021 May 17]. Available from: https://doi. or g/ 59. Harrison GW, Lau MI, Ross D. The risk of gambling problems 10. 1515/ 97814 00834 655. in the general population: a reconsideration. J Gambl Stud. 2020 75. Purves RI, Critchlow N, Morgan A, Stead M, Dobbie F. Examin- Dec 1;36(4):1133–59. ing the frequency and nature of gambling marketing in televised 60. Wood RT, Williams RJ. ‘How much money do you spend on broadcasts of professional sporting events in the United King- gambling?’ the comparative validity of question wordings dom. Public Health. 2020 Jul 1;184:71–8. used to assess gambling expenditure. Int J Soc Res. Methodol. 76. Schalkwyk MC, van Maani N, McKee M, Thomas S, Knai C, 2007;10(1):63–77. Petticrew M. “When the fun stops, stop”: An analysis of the 61. Blaszczynski A, Ladouceur R, Goulet A, Savard C. ‘How much provenance, framing and evidence of a ‘responsible gambling’ do you spend gambling?’: ambiguities in questionnaire items campaign. PLoS One. 2021;16(8):e0255145. assessing expenditure. Int Gambl Stud. 2006;6(2):123–8. 77. Newall PWS, Weiss-Cohen L, Singmann H, Walasek L, Ludvig 62. Heirene RM, Wang A, Gainsbury SM. Accuracy of self-reported EA. Impact of the “when the fun stops, stop” gambling message gambling frequency and outcomes: Comparisons with account on online gambling behaviour: a randomised, online experimen- data. Psychol Addict Behav. 2021. tal study. The Lancet Public Health. 2022;7(5):e437–46. 63. UK Gambling Commission. Statistics on participation and 78. Newall P, Weiss-Cohen L, Singmann H, Walasek L, Ludvig E. problem gambling for the year to March 2022 [Internet]. Gam- No credible evidence that UK safer gambling messages reduce bling Commission. 2022 [cited 2022 May 4]. Available from: gambling [Internet]. PsyArXiv; 2021 [cited 2022 Apr 20]. Avail- https:// www. gambl ingco mmiss ion. gov. uk/ stati stics- and- resea able from: https:// psyar xiv. com/ hv6w9/. rch/ publi cation/ stati stics- on- parti cipat ion- andpr oblem- gambl 79. Livingstone C, Rintoul A, Lacy-Vawdon C de, Borland R, Dietze ing- for- the- year- to- march- 2022. P, Jenkinson R, et al. Identifying effective policy interventions to 64. Gunstone B, Gosschalk K, Zabicka E, Sullivan-Drage C, You- prevent gambling-related harm [Internet]. Melbourne: Victorian Gov. Annual GB Treatment and Support Survey 2021 On behalf Responsible Gambling Foundation; 2019 [cited 2021 Apr 24]. of GambleAware [Internet]. YouGov; 2021 [cited 2022 May 4]. Available from: https:// respo nsibl egamb ling. vic. gov. au/ docum Available from: https:// www. begam bleaw are. org/ sites/ defau lt/ ents/640/ Livin gs tone-ident ifying- effec tiv e-policy -inter v entions- f iles/ 2022- 03/ Annual% 20GB% 20Tr e atment% 20and% 20Sup June- 2019. pdf. port% 20Sur vey% 20Rep ort% 202021% 20% 28FIN AL% 29. pdf. 80. Xiao LY. Reserve your judgment on “draconian” chinese video 65. Muggleton N, Parpart P, Newall PWS, Leake D, Gathergood gaming restrictions on children. J Behav Addict [Internet]. 2022 J, Stewart N. The association between gambling and financial, [cited 2021 Dec 16];Advance online publication. Available from: social and health outcomes in big financial data. Nat Hum Behav. https:// doi. org/ 10. 1556/ 2006. 2022. 00022. 2021 Mar;5(3):319–26. 81. Close J, Lloyd J. Lifting the lid on loot-boxes: Chance-based 66. Macey J, Cantell M, Tossavainen T, Karjala A, Castren S. How purchases in video games and the convergence of gaming and can the potential harms of loot boxes be minimised?: Proposals gambling [Internet]. GambleAware; 2021 Apr [cited 2021 for understanding and addressing issues at a national level. J Apr 7]. Available from: https:// www . beg am blea w ar e. or g/ Behav Addict [Internet]. 2022 20 [cited 2022 Apr 26];1(aop). sites/def ault/ f iles/2021- 03/ Gaming_ and_ Gambl ing_ R eport_ Available from: https://akjou r nals.com/ vie w/jour nals/ 2006/ aop/ Final. pdf. 1 3 Current Addiction Reports (2022) 9:163–178 177 82. Mason L. Video gaming – taking a gamble with young peo- 96. Honer P. Limiting the loot box: overview and difficul- ple’s health and wellbeing? Perspect Public Health. 2021 Jan ties of a common EU response. Interact Entertain Law Rev. 1;141(1):5–6. 2021;4(1):63–83. 83. Select Committee on the Social and Economic Impact of the 97. Schwiddessen S, Karius P. Watch your loot boxes! – recent Gambling Industry of the House of Lords (UK). Report of Ses- developments and legal assessment in selected key jurisdictions sion 2019–21: Gambling Harm— Time for Action [Internet]. from a gambling law perspective. Interact Entertain Law Rev.. 2020 Jul [cited 2020 Jul 2]. Report No.: HL Paper 79. Available 2018;1(1):17–43. from: https:// w eb. ar c hi ve. or g/ w eb/ 20200 70219 5336/ https:// 98. Derrington S, Star S, Kelly SJ. The case for uniform loot box publi catio ns. parli ament. uk/ pa/ ld5801/ ldsel ect/ ldgamb/ 79/ 79. regulation: a new classification typology and reform agenda. J pdf. Gambl Issues. 2021 Feb;46:302–32. 84. Hall W. What are the policy lessons of National Alcohol 99. Xiao LY. Breaking Ban: Assessing the effectiveness of Bel- Prohibition in the United States, 1920–1933? Addiction. gium’s gambling law regulation of video game loot boxes. Stage 2010;105(7):1164–73. 1 registered report recommended by peer community in regis- 85. Xiao LY. Blind boxes: opening our eyes to the challenging regu- tered reports [Internet]. 2022 [cited 2022 Apr 13]; Available lation of gambling-like products and gamblification and unex- from: https:// osf. io/ 8fvt2/. plained regulatory inaction. Gaming Law Rev. 2022;26:255–68. 100. Cerulli-Harms A, Munsch M, Thorun C, Michaelsen F, Hause- 86. Elliott SA, Mason DS. Emerging legal issues in the sports indus- mer P. Loot boxes in online games and their effect on consumers, try: are trading cards a form of gambling? J Legal Aspects Sport. in particular young consumers [Internet]. Policy Department for 2003;13(2):101–20. Economic, Scientific and Quality of Life Policies (EU); 2020 Jul 87. Zendle D, Walasek L, Cairns P, Meyer R, Drummond A. Links [cited 2020 Jul 29]. Report No.: PE 652.727. Available from: between problem gambling and spending on booster packs in https:// www. europ arl. europa. eu/ RegDa ta/ etudes/ STUD/ 2020/ collectible card games: A conceptual replication of research on 652727/ IPOL_ STU(2020) 652727_ EN. pdf. loot boxes. PLoS One. 2021;16(4):e0247855. 101. Hiilamo H, Crosbie E, Glantz SA. The evolution of health 88.• Macey J, Bujić M. The talk of the town: community perspec- warning labels on cigarette packs: the role of precedents, and tives on loot boxes. In: Ruotsalainen M, Torhonen M, Karhu- tobacco industry strategies to block diffusion. Tobacco Control. lahti VM, editors. Modes of esports engagement in overwatch 2012;23(1):e2. [Internet]. Cham: Springer International Publishing; 2022 102. Blackwell AKM, Drax K, Attwood AS, Munafo MR, Maynard [cited 2022 Mar 11]. p. 199–223. Available from: https:// doi. OM. Informing drinkers: Can current UK alcohol labels be org/ 10. 1007/ 978-3- 030- 82767-0_ 11. A paper that begins to improved? Drug Alcohol Depend. 2018;192:163–70. consider the player perspectives on loot boxes and regula- 103. Newall PWS. Dark nudges in gambling. Addict Res Theor. tion thereof. 2019;27(2):65–7. 89. Balfour DJK, Benowitz NL, Colby SM, Hatsukami DK, 104. Pantani D, Sparks R, Sanchez ZM, Pinsky I. ‘Responsible drink- Lando HA, Leischow SJ, et al. Balancing Consideration of the ing’ programs and the alcohol industry in Brazil: killing two Risks and Benefits of E-Cigarettes. Am J Public Health. 2021 birds with one stone? Soc Sci Med. 2012;75(8):1387–91. Sep;111(9):1661–72. 105. Leon Y. Xiao, Fraser TC, Newall PWS. Opening Pandora’s loot 90. Levy DT, Borland R, Lindblom EN, Goniewicz ML, Meza R, box: Weak links between gambling and loot box expenditure in Holford TR, et al. Potential deaths averted in USA by replac- China, and player opinions on probability disclosures and pity- ing cigarettes with e-cigarettes. Tobacco Control. 2018 Jan timers [Internet]. Vol. Forthcoming, J Gambl Stud. 2022 [cited 1;27(1):18–25. 2021 May 28]. Available from: https:// psyar xiv. com/ 837dv/. 91. Forrest D, McHale IG. Exploring online patterns of play: Interim 106. Xiao LY. Drafting video game loot box regulation for dummies: report [Internet]. NatCen Social Research; 2021 Mar [cited 2022 a chinese lesson. Inform Commu Technol Law. 2022;31(3). Apr 25]. Available from: https://w ww.b egamb leawa re.o rg/s ites/ 107.• Petrovskaya E, Zendle D. Predatory monetisation? a categori- defau lt/ files/ 2021- 03/ PoP_ Inter im% 20Rep ort_ Short_ Final_0. sation of unfair, misleading and aggressive monetisation tech- pdf. niques in digital games from the player perspective [Internet]. 92. Close J, Spicer SG, Nicklin LL, Uther M, Lloyd J, Lloyd H. J Business Ethics. 2021 [cited 2021 Oct 21]. Available from: Secondary analysis of loot box data: Are highspending “whales” https:// doi. org/ 10. 1007/ s10551- 021- 04970-6. A study on how wealthy gamers or problem gamblers? Addictive Behaviors. other aspects of video game monetisation, beyond loot boxes, 2021 Jun 1;117:106851. are potentially also deemed as unfair, misleading, or aggres- 93.•• Xiao LY, Newall PWS. Probability disclosures are not enough: sive by players. Reducing loot box reward complexity as a part of ethical video 108. Spence-Jones G, Xiao LY. Loot Boxes – Video gaming indus- game design [Internet]. Vol. Advance online publication., Jour- try’s hidden treasure or a Pandora’s Box that misleads consum- nal of Gambling Issues. 2021 [cited 2021 May 3]. Available ers? Gough Square Chambers Website. 2020;8. from: https:// cdspr ess. ca/?p= 5602. A reasoned proposal of 109. Cartwright P, Hyde R. Virtual coercion and the vulnerable con- four simple ethical game design changes to loot boxes that sumer: ‘loot boxes’ as aggressive commercial practices. Legal are tangible and actionable. Making these changes to loot Studies. 2022 Mar;7:1–21. boxes is likely to reduce harm whilst also maintaining the 110. Autorite de regulation des jeux en ligne (ARJEL) [Regulatory economic benefits of this monetisation model. Authority for Online Games (France)]. Rapport d’activite 2017- 94. Digital, Culture, Media and Sport Committee of the House of 2018 [Activity Report 2017-2018] [Internet]. 2018 Jun [cited Commons (UK). Immersive and addictive technologies: fifteenth 2021 Jun 29]. Available from: https:// w eb. ar c hi ve. or g/ w eb/ report of session 2017–19 [Internet]. 2019 Sep [cited 2021 Jun 20200 41418 4944/ http:// www . ar jel. fr/ IMG/ pdf/ r appo r t- activ 20]. Report No.: HC 1846. Available from: https:// web. archi ve. ite- 2017. pdf. org/w eb/2 02106 09191 037/h ttps://p ublic ation s.p arlia ment.u k/p a/ 111. Blizzard Entertainment. Paid loot boxes and loot chests disabled cm201 719/ cmsel ect/ cmcum eds/ 1846/ 1846. pdf. for players in Belgium [Internet]. Official Overwatch Forums. 95. Moshirnia A. Precious and worthless: a comparative per- 2018 [cited 2021 Mar 12]. Available from: https:// eu. forums. blizz ar d. com/ en/ over w atch/t/ paidl oo t- boxes- and- loo t- ches ts- spective on loot boxes and gambling. Minn JL Sci & Tech. disab led- for- playe rs- in- belgi um/ 8139. 2018;20(1):77–114. 1 3 178 Current Addiction Reports (2022) 9:163–178 112. 2K Games. Statement Belgium [Internet]. 2K Games Official 120. Xiao LY. People’s Republic of China legal update: the notice Website. 2018 [cited 2021 Mar 12]. Available from: https:// on the prevention of online gaming addiction in juveniles (Pub- www. 2k. com/ mytea minfo/ be/. lished October 25, 2019, Effective November 1, 2019). Gaming 113. Nintendo. Belangrijke informatie voor gebruikers in Belgie Law Rev. 2020;24(1):51–3. [Important Information for Users in Belgium] [Internet]. Nin- 121. Xiao LY. People’s Republic of China legal update: the notice tendo Belgium. 2019 [cited 2020 Aug 3]. Available from: https:// on further strictly regulating and effectively preventing www.ninte ndo. be/ nl/ Nieuw s/2019/ mei/ Belan g rijke-inf ormatie- online video gaming addiction in minors (Published August voor- gebru ikers- in- Belgie- 15619 11. html. 30, 2021, Effective September 1, 2021). Gaming Law Rev. 114. Woods O. The affective embeddings of gacha games: Aesthetic 2021;25(9):379–82. assemblages and the mediated expression of the self. New Media 122. Committee of Advertising Practice, Broadcast Committee of Soc. 2022 Jan;7:14614448211067756. Advertising Practice. Consultation on new guidance to explain 115. Drummond A, Sauer JD, Hall LC. Loot box limit-setting: a how the Advertising Codes apply to the marketing of in-game potential policy to protect video game users with gambling purchases in apps and video games [Internet]. 2020 [cited 2021 problems? Addiction. 2019;114(5):935–6. Jan 14]. Available from: https:// web. ar c hi ve. or g/ web/ 20210 116.• King DL, Delfabbro PH. Loot box limit-setting is not sufficient 11411 5545/ https:// www. asa. org. uk/ uploa ds/ assets/ 8039d 7d7- on its own to prevent players from overspending: a reply to drum-cac3- 4603- 8c752 e16c2 7aaa84/ In- game- Purch asing- Consu ltati mond. Sauer & Hall Addiction. 2019;114(7):1324–5. A paper sug-on. pdf. gesting many potential ways for loot box harms to be reduced, 123. Committee of Advertising Practice, Broadcast Committee of many of which are borrowed from the gambling context. Advertising Practice. Practice statement on new guidance to 117. Rossow I, Hansen MB. Gambling and gambling policy in Nor- explain how the Advertising Codes apply to the marketing of way—an exceptional case. Addiction. 2016;111(4):593–8. in-game purchases in apps and video games [Internet]. 2021 118. King DL, Delfabbro PH. Video game monetization (e.g., ‘Loot [cited 2022 Mar 23]. Available from: https:// www. asa. org. uk/ Boxes’): a blueprint for practical social responsibility measures. static/ 21e9a 90d- a7ac- 4499- a57c6 6729c d5c3e1/ In- game- purch Int J Ment Health Addiction. 2019;17(1):166–79.asing- state ment. pdf. 119. Xiao LY, Henderson LL. Towards an ethical game design solu- tion to loot boxes: a commentary on King and Delfabbro. Int J Publisher's Note Springer Nature remains neutral with regard to Ment Health Addiction. 2021. jurisdictional claims in published maps and institutional affiliations. 1 3 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Current Addiction Reports Springer Journals

Regulating Gambling-Like Video Game Loot Boxes: a Public Health Framework Comparing Industry Self-Regulation, Existing National Legal Approaches, and Other Potential Approaches

Loading next page...
 
/lp/springer-journals/regulating-gambling-like-video-game-loot-boxes-a-public-health-5CT2R1Mdxf
Publisher
Springer Journals
Copyright
Copyright © The Author(s) 2022
eISSN
2196-2952
DOI
10.1007/s40429-022-00424-9
Publisher site
See Article on Publisher Site

Abstract

Purpose of Review Loot boxes are gambling-like monetisation mechanics in video games that are purchased for opportunities to obtain randomised in-game rewards. Gambling regulation is increasingly being informed by insights from public health. Despite conceptual similarities between loot boxes and gambling, there is much less international consensus on loot box regulation. Various approaches to regulating loot boxes are reviewed via a public health framework that highlights various trade-offs between individual liberties and harm prevention. Recent Findings Many countries have considered regulation, but as yet only a few countries have taken tangible actions. Existing regulatory approaches vary greatly. More restrictively, Belgium has effectively ‘banned’ paid loot boxes and prohibits their sale to both children and adults. In contrast, more liberally, China only requires disclosure of the probabilities of obtain- ing potential rewards to provide transparency and perhaps help players to make more informed purchasing decisions. Most other countries (e.g., the UK) have adopted a ‘wait-and-watch’ approach by neither regulating loot box sales nor providing any dedicated consumer protection response. Industry self-regulation has also been adopted, although this appears to elicit lower rates of compliance than comparable national legal regulation. Summary Many potential public health approaches to loot box regulation, such as expenditure limits or harm-reducing modifications to loot box design (e.g., fairer reward structures), deserve further attention. The compliance and clinical benefits of existing interventions (including varying degrees of regulation, as adopted by different countries, and industry self-regulation) should be further assessed. The current international variation in loot box regulation presents opportunities to compare the merits of different approaches over time. Keywords Loot boxes · Video gaming regulation · Online gambling · Consumer protection · Interactive entertainment law · Video games · Public health Introduction ‘Loot boxes’ are gambling-like monetisation mechan- ics in video games that players can engage with to obtain This article is part of the Topical Collection on Gambling randomised rewards, which can provide cosmetic changes * Leon Y. Xiao •• • or gameplay advantages [1 , 2 ]. All loot boxes involve lexi@itu.dk ‘randomisation’ when deciding which rewards to provide 1 to players. However, depending on (i) whether or not the Center for Digital Play, IT University of Copenhagen, Rued player pays real-world money to become eligible to engage Langgaards Vej 7, Copenhagen 2300, Denmark 2 with the loot boxes and (ii) whether or not the rewards that School of Law, Queen Mary University of London, Mile End the players receive can be transferred to other players in Road, London E1 4NS, UK 3 exchange for real-world money [3] (the latter being a par- The Honourable Society of Lincoln’s Inn, Lincoln’s Inn, ticularly important distinction for regulatory purposes at London WC2A 3TL, UK 4 present), loot boxes have been divided into four catego- School of Psychological Science, University of Bristol, 12a •• ries by Nielsen and Grabarczyk [4 ], as summarised in Priory Road, Bristol BS8 1TU, UK Vol.:(0123456789) 1 3 164 Current Addiction Reports (2022) 9:163–178 Table  1. The existing academic literature and regulatory second categories of loot boxes that do not require purchase scrutiny have focused on so-called paid loot boxes (i.e., the appear less obviously harmful, although they might in con- shaded third and fourth categories described in Table 1) that trast lead to the player overspending time (in order to ‘grind’ the player spends fiat currency to purchase because these or repeatedly complete largely identical in-game tasks to might lead to the player overspending real-world money and achieve or receive something with only a small chance of thereby suffering potential financial harms [5 ]. The first and happening [6, 7]), rather than overspending money, and •• •• • Table 1 Nielsen and Grabarczyk [4 ]’s loot box categorization framework [4 ] (adapted from Xiao [5 ] and Xiao et al. [11]) 1 3 Current Addiction Reports (2022) 9:163–178 165 potentially lead to or exacerbate the World Health Organi- industry’s commercial interests, generally deem loot boxes zation’s (WHO’s) so-called gaming disorder or problematic to be suitable for implementation in children’s games and, engagement with video gaming as a form of behavioural by implication, suitable for children to purchase (e.g., the addiction. The degree of the ‘problematic-ness’ and level of Entertainment Software Rating Board (ESRB) in North potential harm for each category of loot boxes, as perceived America and Pan European Game Information (PEGI) in by the authors and generally understood by the literature, Europe, neither of which requires a minimum age rating are outlined in ascending order in Table 1. Hereinafter, this for games containing loot boxes as of May 2022, although article discusses paid loot boxes only and refers to them as imposing this would be within their self-regulatory powers loot boxes, unless otherwise specified, following colloquial [29]; this should be contrasted with how mere depiction of norms and the existing literature [11]. tobacco, alcohol and illegal drug use would generally render This article introduces loot boxes’ current prevalence in the game to be deemed as suitable only for older adolescents, video games and discusses why loot box regulation could be, e.g., ‘PEGI 16’ or suitable for players aged 16 and above and should be, conceptualised as a public health issue that [30]). Indeed, 58% of the highest-grossing UK iPhone games can be approached in many different ways. Then, existing deemed suitable for children aged 12 + contained loot boxes self-regulatory approaches from the video game industry, in 2019 [23 ], meaning that children are regularly exposed to and the legal regulatory frameworks for loot boxes in various loot boxes and can readily purchase them. The UK Gambling example jurisdictions, are summarised. Finally, both existing Commission found that 23% of young people aged between and potential loot box harm minimisation measures are con- 11 and 16 have paid real-world money to purchase loot boxes sidered in the context of the Nuffield public health interven- [31(p. 39)]; in contrast, only 7% have ever participated in tion ladder [12(pp. 41–42, paras 3.37–3.38)], with respect traditional online gambling [31(p. 33)]. to how they balance inherent trade-offs between individual liberties and harm prevention. Conceptual Similarities with Gambling Prevalence and Deemed Suitability to Children Purchasing loot boxes is conceptually similar to gambling both structurally and psychologically because the player vol- Loot boxes are presently frequently implemented in video untarily spends real-world money to engage in a randomised games, particularly on mobile phone platforms: in 2019, process whose results could be desirable or, more often, amongst the highest-grossing video games, 59% on the undesirable, given that most potential loot box rewards are Apple iPhone platform contained loot boxes in the UK, often contextually worthless to the player (either because as did 36% on the PC Steam platform [23 ]. Loot boxes they already have a duplicate copy or because they are remain an evolving issue as the prevalence rate was found already in possession of some other superior or effectively to have increased to 77% for UK iPhone games when it equivalent in-game item) [2 , 32]. Through purchasing loot was re-assessed in 2021 using a comparable sample [24]: boxes, players potentially either ‘gain’ by obtaining a valu- this appears to be due to multiple reasons including (i) a able and wanted item or ‘lose’ by obtaining a non-valuable greater number of popular games starting to implement loot and unwanted item [32]. This is even more evident in rela- boxes; (ii) difficulties with identifying well-hidden loot box tion to loot boxes that provide rewards possessing real-world implementations with complex purchasing procedures; and monetary value that the player can subsequently sell on the (iii) semantic and definitional ambiguities with what game secondary market, because many non-valuable rewards are mechanic exactly constitutes a loot box [25 ]. The preva- worth far less than the cost of purchasing the loot box, com- lence rate also differs across countries: 91% of the 100 high- pared to the potential large ‘jackpot’ wins from valuable est-grossing iPhone games contained loot boxes in China rewards [3], similar to the incentive structure of lottery tick- in 2020 [26], suggesting that the loot box situation might ets [24]. Certain particularly rare and highly sought-after be different across countries and cultures and that future loot box content is worth hundreds, and potentially over research should include the perspectives of non-Western one thousand, euros on the secondary market [33]. Indeed, countries and players [see 27]. opening ‘rare’ rewards from loot boxes elicits physiologi- Although some members of the public, e.g., some parents cal responses similar to participating in certain traditional [see 28], consider loot boxes to be unsuitable for children, gambling activities [34]. One adult player reportedly spent game companies and self-regulatory video game age rat- over US$10,000 on loot boxes in one game over a 2-year ing systems, which are financially supported by the industry period [35], and four children spent ‘nearly £550 in 3 weeks’ and therefore arguably conflicted from acting against the of their father’s money without permission and still failed to obtain the rare item that they were hoping for [36]. The debate on that issue is not addressed herein [8, 9] and has been addressed in other articles in Current Addiction Reports [e.g., 10]. 1 3 166 Current Addiction Reports (2022) 9:163–178 the UK Gambling Commission [63]) and 2.8% (by YouGov Differing Interpretations of the Loot Box ‘Harm’ Evidence Base: Allusions to Longstanding Debates on behalf of GambleAware) [64(p. 2)]. This suggests that ‘harm prevalence’ data may be subject to a range of meth- on the Evidence Base of Gambling Harms odological issues affecting their accuracy and validity that researchers are not fully aware of and cannot account for. Importantly, loot box expenditure has been found to be posi- tively correlated with self-reported problem gambling sever- More recently, Muggleton et al., relying instead on more objective transaction data from a high street bank, sug- ity in many cross-sectional studies across various Western countries, including the USA [37], Spain [38], Denmark [39] gested that even the higher, previously identified problem gambling prevalence rates (i.e., ~ 3.0%) have underestimated and Australia [40], amongst both adult and adolescent player samples [41]. Reviews and meta-analyses of these studies the extent of gambling-related harms and, importantly, failed •• to reflect the widespread associations between gambling have been conducted elsewhere [42 ]; [43–45]. However, the causal direction (if any) of this positive correlation is and various harms even amongst less engaged (supposedly, non-problem) gambling participants [65]. For loot boxes, not known [46], and there is debate as to how the current evidence base should be interpreted. McCaffrey has argued this suggests that the prevalence of loot box ‘harms’ might have been underestimated by prior studies and that research that, presently, there is insufficient evidence to demonstrate that loot boxes cause widespread harm and that regulatory collaborations with the industry using players’ actual (and, therefore, more objective) loot box spending data could pro- intervention is therefore not yet justified [47, 48]. In contrast, Drummond et al. have argued that there is already sufficient vide important insights [66]. However, in yet another strik- ing parallel with gambling research, the video game industry evidence demonstrating the potential harms of loot boxes (particularly, similarities with traditional gambling and the has hitherto been unwilling to share their data, similarly to how the gambling industry has been unwilling to share data involvement of real-world money) and that loot boxes should therefore immediately be regulated more stringently [2 , 3]. with independent researchers [67]. These diverging perspectives have similarly been present in the longer-standing debate in gambling. Collins et al. have Loot Boxes and Gambling Both Show a Trend Toward Pre‑emptive Industry ‘Self‑Regulation’ argued that existing harm reduction methods have been successful (as evidenced by stable or flat prevalence rates The video game industry has adopted certain pre-emptive of problem gambling), and that further regulation would unnecessarily reduce the (safe) enjoyment of gambling as a self-regulation purportedly to enhance transparency and reduce harms ahead of potential impending legal regulation. leisure activity by many people [49(p. 994)]. The gambling industry also echoes this interpretation [e.g., 50], perhaps For example, some companies have committed to making probability disclosures detailing the player’s likelihood of unsurprisingly given its commercial interests. In contrast, other researchers have argued that the problem gambling obtaining different randomised rewards voluntarily outside of Mainland China (where, uniquely, disclosures are required prevalence rate fails to reflect the full extent of the potential harms of gambling and that non- ‘problem gamblers’ would by law [26])[68]. Major app stores, such as the Google Play Store and the Apple App Store, also require probability dis- also potentially suffer harms, which is why a population- based public health harm minimisation approach might be closures globally [69, 70]. In addition, the two major self- regulatory age rating systems of North America and Europe, required to reduce the risk of harm amongst all gamblers [51–56]. the ESRB and PEGI, have introduced an ‘in-game purchases (includes random items)’ content descriptor to label and sig- The conflicting interpretations, in both the loot box and the gambling contexts, arguably arise partially from the nify the inclusion of loot boxes in a video game [71, 72]. However, this self-regulatory measure has been criticised as methodological weaknesses of a majority of the evidence base, which relied on retrospective self-reported data. Such being insufficiently detailed to truly inform potential custom- ers about the risks involved with loot boxes [29], and there data, derived either from a representative panel (such as a prevalence survey [57]) or from online convenience sam- is no evidence of these labels providing any tangible benefit. Loot box-related industry self-regulation mirrors many ples [58], might lack reliability due to the participants’ responses being intentionally dishonest (due to a desire attempts by the traditional gambling industry to self-regulate (seemingly in conflict with its own financial interests) argu- to hide one’s participation in gambling due to perceived stigma [59]) or unintentionally inaccurate (due to memory ably in order to fend off stronger (and likely more effec- tive) interventions from regulators and policymakers [73]. recall issues [60]; inconsistent interpretation of questions [61]; or incorrect estimations and calculations of expen- For example, the gambling industry has, for a long time, directed funds towards non-restrictive interventions, such ditures [62]). To illustrate, in the UK, gambling preva- lence studies have, in the 12 months prior to May 2022, as warning messages or education programmes about the risks of gambling, which do nothing to alter the properties recorded rates of problem gambling as varied as 0.2% (by 1 3 Current Addiction Reports (2022) 9:163–178 167 and availability of potentially harmful products [74]. In the options that interfere less with the players’ ability and choice UK, the industry has agreed to partial restrictions around to purchase loot boxes and the companies’ commercial inter- advertising in professional sports (e.g., ‘whistle-to-whistle’ ests are available. The Nuffield public health intervention ban): however, this has not effectively reduced sports watch- ladder [12(pp. 41–42, paras 3.37–3.38)] is a tool that helps ers’ frequent exposure to gambling marketing via logos and to illustrate the acceptability of various measures on each website addresses shown on, for example, shirts and pitch- ‘rung’ by identifying, comparatively, how intrusive on per- side billboards in soccer [75]. Research has additionally sonal liberty each measure may be; how much justification critiqued the inadequacies of the main gambling warning may be required before they are adopted; and whether they message used by the UK industry from 2014 to 2021 (‘When are proportionate responses for achieving regulatory aims the Fun Stops, Stop’) [76, 77], and also its lack of effect (as shown in the first column of Table  2). on influencing gambling behaviour [78]. Many gambling The lowest rung of ‘do nothing’ or simply ‘monitor the researchers have therefore advocated for stronger interven- situation’ is technically a public health approach. This has tions, akin to the graphic health warnings or restrictions on the advantage of not restricting choice and does not remove availability adopted in tobacco contexts [79], but uptake of any of the potential (e.g., economic) benefits of the product. these approaches has been slow. Such an approach is likely appropriate when the potential for harm is deemed to be low or little information is available as to whether the product is, on balance, more harmful or ben- What Does Taking a Public Health Approach eficial to society. However, generally, the second lowest rung Mean? of ‘provide information’ is likely a superior approach when compared to ‘do nothing’, because ‘provide information’ Within the discourse surrounding loot box regulation, there can guide choice towards better alternatives and provides is substantial support for banning the mechanic entirely [80]: the same freedom of choice as ‘do nothing’. Many inter- for example, as advocated for by academics [e.g., 81(p. 40)], mediary approaches rest between the lower, non-restrictive gambling-related charities and other NGOs (non-govern- rungs and the highest, most restrictive rung of ‘eliminate mental organisations) [e.g., 82], and, indeed, members of choice’. Several different approaches might also be used in the legislature [e.g., 83(p. 115, para. 446)]. However, ban- relation to one subject matter simultaneously: for example, ning the product is only one potential approach amongst the UK public health approach to obesity works at multiple a spectrum of different approaches of varying degrees of levels, e.g., by providing information on nutrition (in super- restrictiveness. An indiscriminate ban is one of the most markets) and calories (in restaurants), whilst also restricting extreme approaches and is not strongly supported by the choice via new policies on the marketing and promotion evidence from, and the experience of, other public health of unhealthy foods (especially to children). Similarly, many domains given significant potential negative consequences approaches have been implemented in relation to tobacco: thereof. For example, the US ban on alcohol during the Pro- in addition to what has already been done in many Western hibition era (1920–1933) was not successful: consumption countries (e.g., age limits on purchasing the product (‘elimi- and alcohol-related harm was likely reduced, but demand nate choice’); restrictions on advertising (‘guide choice’); remained and caused the industry to shift towards a higher and warning messages on packaging (‘provide informa- risk illegal industry supplied by organised crime, thus incur- tion’)), many tobacco researchers have been advocating for ring ‘unacceptable social and economic [costs]’ that led to greater uptake of e-cigarettes and other generally less harm- support for the eventual repeal of the ban [84]. ful combustion-less tobacco alternatives [89, 90]. More sus- To ban or heavily regulate loot boxes as gambling is but tainable improvements to health may arise not from simply one potential regulatory approach that has dominated the banning the existing product (without providing alternatives discourse. Notably, in contrast, most countries have seem- and ignoring potential negative consequences thereof), but ingly decided not to regulate collectible card packs and by inventing, promoting and disseminating healthier alterna- other similarly gambling-like products (e.g., blind boxes) tives to the original product. [85], even though these products likely contravene existing These examples from other public health domains have gambling laws [86] and would constitute the most seem- been highlighted because, although loot boxes share strong ingly harmful fourth category of loot boxes (per Table 1) similarities with gambling (which itself is now seen as a had these been virtual, rather than physical, products [87]. public health issue [51–56]), there are also major differences Many video game players have identified this uncomfort- between loot boxes and gambling. Importantly, there are able incongruence between many countries’ strong desire to potential public health interventions for loot boxes that are regulate and ban loot boxes and regulatory inaction in rela- not possible in traditional gambling contexts. Commercial tion to other gambling-like products as deserving of some gambling relies on individuals losing money to be profitable, further consideration [88 ]. Indeed, a wider range of other and since a majority of gamblers spend very little money on 1 3 168 Current Addiction Reports (2022) 9:163–178 1 3 Table 2 Mapping loot box harm minimisation measures (non-exhaustive) onto the Nuffield public health intervention ladder [12(pp. 41–42, paras 3.37–3.38)] Range of intervention options Examples of specific measures As adopted by or as recommended by… Eliminate choice Prohibit the sale and, by extension, the purchase of loot boxes to all Belgium, which has effectively ‘banned’ the sale and purchase of both Regulate in such a way as to entirely eliminate choice, for example, players the third and fourth categories of loot boxes through applying existing through compulsory isolation of patients with infectious diseases Or less restrictively, prohibit the sale and, by extension, the purchase gambling law [13] of loot boxes to underage players Technically, Denmark [14], the UK [15] and many other countries through applying existing gambling law in relation to the fourth category of loot boxes, although this regulatory position has seemingly not been enforced in practice Restrict choice Maximum spending limits on loot boxes: i.e., that a player is only China, which only permits underage players to spend a certain amount Regulate in such a way as to restrict the options available to people allowed to spend up to a predetermined sum during a specified of money in online video games per month [120] with the aim of protecting them, for example, removing unhealthy period [115, 116 ] China, which also only permits underage players to play online video ingredients from foods, or unhealthy foods from shops or restaurants Less directly, maximum gameplay time limits: i.e., that a player is games on specific days during specific time periods [120, 121] only allowed to spend up to a predetermined length of time on video games during a specified period, which might dissuade purchase of loot boxes given that less time can be spent on enjoying their content Prohibit the implementation of specific types of loot boxes deemed to Japan, which prohibits the implementation of kompu gacha, which is be particularly problematic a type of loot boxes that provide a particularly valuable extra reward only after the player collects all other ‘regular’ potential rewards from the loot box (i.e., after the player spends a substantial sum of money) [98(pp. 314–315)] Guide choice through disincentives Institute an extra tax that is payable by players when purchasing loot None Fiscal and other disincentives can be put in place to influence people boxes, above and beyond usual sales taxes (if any) not to pursue certain activities, for example through taxes on Require video game companies to obtain and pay for a specific (non- cigarettes, or by discouraging the use of cars in inner cities through gambling) licence in order to sell loot boxes, which represents a cost charging schemes or limitations of parking spaces that is likely to be shifted onto the player-consumers Guide choices through incentives Require video game companies to provide players with the choice to None Regulations can be offered that guide choices by fiscal and other [posi- obtain all potential loot box rewards through direct purchase or some tive] incentives, for example, offering tax-breaks for the purchase of other form of non-randomised monetisation method at a price that bicycles that are used as a means of travelling to work would, on average, be lower than had the player attempted to obtain those rewards through purchasing loot boxes. (That it is generally cheaper to obtain the rewards through direct purchase should also be required to be prominently disclosed because ‘incentive’ in this con- text is difficult to control given that the randomisation could mean that some players might still be tempted to purchase loot boxes for a chance at obtaining all potential rewards even more cheaply.) Provide discretionary grants and tax relief to video game companies Not yet, but governmental funding is already available for the video based on their implementation of more ethical loot boxes or their game industry in many countries: these could be redirected, withheld decision not to implement loot boxes at all. These financial benefits and awarded on a basis that focuses on social responsibility in relation may also be shifted onto the player-consumers and make more ethi- to loot boxes, rather than on, e.g., the employment of citizens belong- cally designed video games more widely available ing to certain countries [119] Guide choices through changing the default policy Require video game companies to offer potential loot box rewards None For example, in a restaurant, instead of providing chips as a standard through direct purchase or some other form of non-randomised mon- side dish (with healthier options available), menus could be changed etisation method at a reasonable and comparable price by default, to provide a more healthy option as standard (with chips as an option such that the player must undertake extra effort in order to find available) the alternative option of attempting to obtain the rewards through purchasing loot boxes Current Addiction Reports (2022) 9:163–178 169 1 3 Table 2 (continued) Range of intervention options Examples of specific measures As adopted by or as recommended by… Enable choice Require video game companies to provide players with the choice of Some video games (e.g., Brawl Stars (Supercell, 2017)) currently offer Enable individuals to change their behaviours, for example, by offering either (a) purchasing loot boxes or (b) obtaining all potential loot box the option to purchase some potential loot box rewards directly, but participation in an NHS ‘stop smoking’ programme, building cycle rewards through direct purchase or some other form of non-ran- this is often confined to opportunities that are time-limited and do lanes, or providing free fruit in schools domised monetisation method at a reasonable and comparable price not include all possible rewards [22(p. 43)]. This option should be provided for all items on demand Promote ethical game design measures that are likely to minimise A variety of measures are available, some of which have been partially •• potential loot box harms: (i) encourage video game companies to implemented by certain video game companies [93 , 118, 119]. adopt them and (ii) encourage players to play and only spend money Promotion programmes directed at companies and players have not on games adopting them been forthcoming Provide information Require the expected, average real-world monetary cost of obtaining The UK advertising regulator attempted to require this [122], but has Inform and educate the public, for example as part of campaigns to potential rewards to be calculated and published by companies for since decided not to do so following consultation citing difficulties that encourage people to walk more or eat five portions of fruit and the player’s benefit companies would face in calculating this value given the complexity vegetables per day of in-game economies [123(pp. 9–10)] (which were arguably inten- tionally designed by companies to be that way and so the companies should be liable for any costs-related consequences thereof) Require probability disclosures as to the likelihood of obtaining poten- China by law [26] tial rewards to be published Nearly all other countries by industry self-regulation [24] Do nothing or simply monitor the current situation Continue to allow loot boxes to be sold without intervening In practice, the current position in Denmark, the UK and many other countries, given that existing gambling laws have not been enforced as interpreted and therefore no actions has been taken against the fourth category of loot boxes 170 Current Addiction Reports (2022) 9:163–178 the activity, gambling profits are driven by a small percent- not provided with the highest level of consumer protec- age of high-spending gamblers incurring high losses (so- tion uniformly, meaning that some players are more fre- called whales in land-based gambling environments) [91(p. quently exposed to potential harms than others, which does 21)]. The term ‘whales’ has also been used as a term for not appear to be ideal [22]. Cerulli-Harms et al.’s report high-spending loot box purchasers, and this small minority commissioned by the Committee on the Internal Market of players have been identified as effectively financing the and Consumer Protection of the European Parliament has video game containing the loot boxes (for the benefits of not argued that divergent regulation would also lead to increased only the operating company but also many non-paying play- compliance costs for companies (which might more unfairly ers) [92]. However, other loot box business models that rely affect smaller, newer companies, thus making it harder for on more players paying a reasonable amount of money (and them to compete with more established companies [48]) and no players spending extreme amounts) may also be com- is contrary to the principles of the European Single Market •• mercially viable [93 ]. [100]. Finally, public health has a ‘precautionary principle’ However, it should also be noted that, conversely, com- stating that the lack of scientific certainty cannot justify panies’ economic interests and players’ freedoms are less regulatory inactivity when potential harms are significant. restricted in the UK than in Belgium. In addition, there This principle has already been cited by the loot box lit- are also benefits to this divergent regulatory environment: erature [26] and by policymakers [94(p. 29)] to argue in specifically, data can be collected from multiple countries favour of regulating loot boxes, despite the absence of a as to the pros and cons of different public health-based strong evidence base. Given that this principle has already approaches, which can then be compared with each other been invoked in relation to loot boxes, it is important that and with data on industry self-regulation and also with stakeholders are aware of the full spectrum of approaches perspectives on other potential regulatory approaches that that could be used in a public health approach to regulating have been suggested but not as yet trialled. Multiple national loot boxes. In particular, the negative consequences of both policy experiments are effectively being conducted across an overly lenient and an overly restrictive approach should the world: taking advantage of this opportunity would facili- be recognised. Indeed, a non-restrictive or less restrictive tate the improvement of existing policies and the adoption approach might be more appropriate at present when regula- of better policies in all countries. To assist in visualising tion is imposed based on the precautionary principle. and comparing the array of harm minimisation measures that have either been adopted or proposed in relation to loot boxes (either as (i) industry self-regulation or (ii) national A Public Health Framework Comparing legal regulation), these are non-exhaustively mapped onto Industry Self‑Regulation, Existing the Nue ffi ld public health intervention ladder [ 12(pp. 41–42, National Approaches, and Other Potential paras 3.37–3.38)], as shown in Table 2; some (iii) additional Approaches approaches that have not previously been suggested are also summarised therein. The perceived urgency of the loot box regulation issue and the divergent interpretations of the emerging evidence base Industry Self‑Regulation on potential loot box harms have meant that various coun- tries (including those that are otherwise ideologically quite As mentioned under “Loot Boxes and Gambling Both aligned, e.g., Western European countries) have taken very Show a Trend Toward Pre-emptive Industry ‘Self-Regula- different policy approaches, as previously comprehensively tion’” section, the video game industry self-regulates loot collated by the legal literature [95–98]. Players, including boxes through mandating probability disclosures. However, children, in different countries are therefore provided with importantly, the motivations for the industry to self-regulate varying degrees of consumer protection: players in Belgium should be viewed with an appropriate degree of scepticism (where all paid loot boxes have effectively been ‘banned’ because established research from traditional addictive [13]) are provided with the highest degree of protection, domains, such as gambling, alcohol and tobacco, have all whilst players in the UK are provided with no dedicated suggested that, when their industries have purported to act loot box consumer protection measures (because, although in socially responsible ways, those self-regulatory efforts paid loot boxes that contain rewards that can be transferred have in fact been self-interested and suboptimal and have to other players and therefore possess real-world monetary therefore failed to maximally advance the public interest value technically contravene gambling law according to the [101–103]. Indeed, industry self-regulation might not have national gambling regulator [15], no enforcement actions been adopted by companies for purely altruistic purposes have been taken against known illegal implementations (e.g., improve public welfare at the cost of its own commer- [5 , 85]). Players from different countries are therefore cial profits) and may instead have been adopted to placate 1 3 Current Addiction Reports (2022) 9:163–178 171 public concern, dissuade stricter legal regulation, and main- to enter the Chinese game’s settings menu and chat with tain control over whether and how much the product is regu- the customer support bot in English in order to access the lated [104]. disclosure [26]. Further, the effectiveness of probability dis- This cynical view is justified in relation to the self-reg- closures at reducing overspending and harm is unproven and ulation of loot boxes. The Apple App Store requires loot doubtful, even when they are easily accessible and have been box probability disclosures for all video games on the plat- seen by the player: only a small minority of Chinese players form. However, when the 100 highest-grossing UK iPhone (16.4%) self-reported spending less money after seeing loot •• games were examined in 2021, only 64.0% of those games box probability disclosures [93 , 105]. Thus, it is important containing loot boxes actually complied with industry self- not to treat the adoption of only one consumer protection regulation and disclosed probabilities [24]. Additionally, measure as a ‘solution,’ given that the measure might not many UK probability disclosures were found to have been be complied with fully and that the measure itself might implemented using methods that were difficult for players to not effectively reduce harm even if it has been effectively •• access (e.g., requiring multiple buttons to be pressed before adopted [93 ]. the disclosure is shown) [24]. Despite this unsatisfactory In other countries, although a consumer protection law level of compliance (which is likely reflected also in other approach to loot box regulation (e.g., using the Unfair Com- countries adopting industry self-regulation), the industry’s mercial Practices Directive 2005 and national implemen- adoption of probability disclosure self-regulation has been tations thereof in the European Union and the UK [106, widely promoted: however, this measure’s effectiveness 107 , 108, 109]) and other approaches might be tenable, (particularly in relation to children) is not even known, the focus has been to apply gambling law to regulate loot and research from other risk communication domains and boxes in light of the apparent similarity and relationship self-reported evidence would suggest that it is unlikely to between loot boxes and gambling, and the ease and prompt- •• reduce loot box spending on a broad scale [93 , 105]. This ness with which existing gambling law could be applied to perfunctory and unsatisfactory state of affairs is reminis- immediately address the issue [22]. This assessment has cent of similarly suboptimal information disclosure-based already been completed by the national gambling regula- industry self-regulation in gambling [78] and other addictive tors of many countries, inter alia, the UK [15], the Neth- domains, e.g., tobacco [101]. erlands [16] (which has since been found to be incorrect [19, 20]), Belgium [13], France [110], and Denmark [14]. Existing National Approaches The national gambling regulators would attempt to fit vari- ous implementations of loot boxes within the pre-existing In contrast to how probability disclosures have been required national gambling law framework, meaning that the legal in other countries through industry self-regulation, China definitions of ‘gambling’ differ from the common sense has imposed this measure by law [26]. A direct comparison understanding of gambling. National gambling laws also of the loot box probability disclosure rates amongst the 100 differ across countries: specifically, the various legal ele- highest-grossing iPhone games in China and in the UK has ments that must be satisfied for a product to constitute gam- been conducted: the compliance rate with Chinese law was bling are not the same [5 , 22]. This means that different 95.6% in 2020 [26], which was significantly higher than the national regulators may easily arrive at different conclu- compliance rate with UK industry self-regulation at 64.0% sions as to whether a specific type of loot box legally con- in 2021 [24]. This demonstrates that legal regulation appears stitutes gambling under the national laws of any particular to have been more effective at ensuring compliance than country. This also means that the conclusion reached by industry self-regulation (cultural differences between the any one national regulator (one way or the other) is not two countries as to companies’ willingness to comply with necessarily reflective of, or relevant to, the decision that law and regulation notwithstanding) [24]. However, Chinese a different country’s regulator might arrive at [20]. The law gave discretion to companies as to how they can comply: decision-making processes are separate and based solely any disclosure, however difficult for the player to access, is on how that country’s gambling law was originally drafted. deemed compliant [106]. For this reason, many disclosures Finally, national gambling regulators generally cannot in China were also found to have been published by video change the law (from how it was originally drafted by the game companies using methods that were not prominent and legislature) or make new laws: they merely pronounce an difficult for players to access: even though companies could interpretation; express a desire to enforce that interpreta- have displayed the probability disclosure on the in-game tion; and potentially take enforcement actions against prod- page where loot boxes could be purchased, so that play- ucts that are deemed to be contravening the law (with the ers can easily view them and perhaps make more informed proviso that the regulators’ interpretation of the law might purchasing decisions, only 5.5% of games containing loot be legally wrong and therefore remains challengeable in boxes did so [26]. In one extreme example, the player had court by video game companies, as has been successfully 1 3 172 Current Addiction Reports (2022) 9:163–178 done by Electronic Arts against the Dutch gambling regula- affected by the Belgian ban. The effectiveness of Belgium’s tor’s previously published interpretation [19, 20]). blanket ‘ban’ of loot boxes remains to be assessed, although Briefly put, Belgium, due to the distinctiveness of its this measure appears to have not perfectly achieved the elim- national gambling law, has deemed the third and fourth ination of paid loot boxes from that market [99]. categories of loot boxes (as described in Table 1; both of which require payment of real-world money to engage in a Other Potential Approaches process that provides randomised rewards) to legally con- stitute gambling [13] and therefore effectively ‘banned’ all Many regulatory measures that may be taken in relation implementations of the product from the country [22, 100]. to loot boxes are presented on Table 2. Notably, many are In contrast, most other countries (e.g., the UK [15], France phrased as an intervention that can be imposed on players. [110], and Denmark [14]) concluded that only loot boxes This framing seemingly places the burden on individuals to that both require payment of real-world money to purchase change their loot box purchasing behaviour, which perhaps is and provide players with rewards that can be transferred to inequitable because it is the video game companies that are other players in exchange for real-world money (i.e., only providing a potentially harmful product, so it is their behav- the fourth category of loot boxes per Table 1) legally con- iour that policy should aim to influence. A public health stitute gambling. Notably, although the countries adopting approach to gambling regulation has recognised the impor- this latter position agreed as to which category of loot boxes tance of moving past the ‘blame-the-victim’ framing that is legally constitute gambling under their laws, the national inappropriately preoccupied with the gamblers’ individual regulators’ enforcement actions have differed in relation to responsibility [54]. Therefore, the loot box regulatory meas- the same games that arguably contravene the gambling laws ures could also be rephrased as interventions against video of multiple countries. Indeed, only the Dutch gambling regu- game companies, e.g., prohibiting the ‘sale’ of loot boxes lator was known to have enforced the law [16–18], whilst by companies, instead of prohibiting the ‘purchase’ of loot the regulators of many other countries have chosen not to boxes by players, or restricting the amount of money that act despite having issued compliance advice suggesting that ‘companies are allowed to receive’ from each player, rather such loot boxes would be illegal [e.g., 15]. However, a recent than limiting the amount of money ‘players are allowed to Dutch judicial decision overruled the Dutch gambling regu- spend.’ This would more accurately reflect that the policies lator’s interpretation of the law [19] and instead effectively are aimed at targeting the product availability that companies affirmed the legality of the fourth category of loot boxes in provide, rather than restricting players’ ability to purchase, the Netherlands [20]. although practically the two might be identical. The respon- Accordingly, no country, besides Belgium, is actively sibility should rest with the companies to do less harm, regulating loot boxes using gambling law at present. Some rather than for players to protect themselves, and the fram- companies quickly sought to comply with Belgian law by ing of any regulation should more accurately reflect with changing the design of the national version of the game, whom that onus lies. specifically removing the possibility of purchasing loot In addition, there are other potential ways of minimis- boxes with real-world money [111, 112]. Doing so allowed ing loot box harms that emulate examples from public these games to continue to be available to Belgian players: health issues other than gambling. For example, promoting importantly, the games were not banned, and only the loot the use of e-cigarettes in smoking is a way of reformulat- box monetisation method was. These corporate actions also ing the delivery of nicotine in a way that is fundamentally suggest that (i) it is possible to rapidly remove the loot box less harmful than combustible tobacco [89, 90]. Similarly, functionality if required to do so and (ii) these games were less harmful and fairer loot boxes could be implemented by still deemed to be commercially sound even without the loot increasing the likelihood of obtaining the rarest rewards; box revenue stream. This might be due to these games being limiting how many different loot boxes may be offered able to generate revenue through the sale of the software or within a single game and how many different potential other non-randomised in-game product offerings, or because rewards may be obtainable from a single type of loot box; maintaining strong brand awareness amongst the player base and not providing players with useless (or significantly •• in Belgium was deemed as being worth the loss in revenue devalued) duplicate rewards [93 ]. Importantly, such design and operating costs. However, in contrast, other compa- changes are plausible because of one fundamental difference nies instead removed their games from the Belgian market between loot boxes and traditional gambling: gambling pro- entirely [113], rather than to only remove the loot box fea- viders profit only when gamblers lose money and so harm to ture, likely because it was no longer commercially viable to gambling participants is inherent to the profitability of that operate those games. This shows that some genres of video industry; however, loot box providers profit from each loot games (so-called gacha games [114]) whose monetisation box sale regardless of whether the video game player has •• models rely heavily on loot boxes were likely more severely ‘won’ a valuable reward or not [93 ] and so profitability 1 3 Current Addiction Reports (2022) 9:163–178 173 is not dependent on the player ‘losing’ money and harm one of many different potential approaches. A whole range is not inherent to the loot box monetisation model. Video of harm minimisation measures of varying levels of restric- game companies’ commercial interests might be negatively tiveness are available to both policymakers and video game affected by the adoption of the aforementioned measures, companies. A broader public health perspective allows the as players would now only need to buy fewer loot boxes loot box issue to be viewed more holistically: specifically, before becoming satisfied with their rewards. However, the by comparing the pros and cons of different approaches business model would still in theory be potentially profit- and by balancing the interests of different groups of play - able (and previously non-spending players may now be more ers (e.g., on one hand, those who benefit from having con- willing to spend small amounts of money on the game as tinued access to cheaper entertainment due to loot boxes the chance of obtaining a valuable item would be higher, and who appreciate this more flexible monetisation model thereby unlocking a new source of revenue for video game [88 ] and, on the other hand, those who may be in need of companies). Similar design changes would be impossible consumer protection from potential financial harms) and the for traditional gambling as the industry would be rendered commercial interests of video game companies. Intrusive •• unprofitable (the house edge would be lost) [93 ]. Such measures might be more immediately effective at reducing design-based approaches are, in the authors’ opinion, the harm but may lead to negative consequences, whilst less best regulatory proposal at present because it balances the intrusive measure better respect all stakeholders’ interests interests of all stakeholders: the potential harms of loot but might not provide sufficient consumer protection to the boxes would be effectively curtailed, but players and com- most vulnerable players. Existing legal and self-regulatory panies would still gain from the economic benefits of the responses to loot boxes (whose effectiveness should be sub- loot box monetisation model. ject to empirical assessment) must be viewed critically and The video game industry and individual companies not seen as ultimate ‘solutions’ that have successfully and should be encouraged to self-regulate and adopt so-called effectively removed all potential harms from those coun- ethical game design measures (even potentially through tries. Consideration should be given as to which measure granting tax incentives for making more ‘ethical’ games would be the most appropriate for different types of players or placing tax disincentives on loot box purchases) [119]. (e.g., young children, as compared to adults) in different However, any one particular measure on its own should not countries. be deemed as sufficient consumer protection. The effective- ness of self-regulation should be continually monitored, and Funding L.Y.X. is supported by a PhD Fellowship funded by the IT some legal intervention (e.g., banning certain problematic University of Copenhagen (IT-Universitetet i København), which is aspects of loot boxes) might be appropriate, if voluntary publicly funded by the Kingdom of Denmark. measures are shown to be merely performative and ineffec- tive. Similarly, any legal regulatory measures that have been Declarations adopted (e.g., Belgium’s ban on paid loot boxes and Chi- na’s probability disclosure requirements) should also not be Human and Animal Rights and Informed Consent This article does not assumed to be an ultimate and effective ‘solution’ that other contain any studies with human or animal subjects performed by any of the authors. jurisdictions should immediately emulate without question: the differing cultural contexts should be considered. Which Conflict of Interest L.Y.X. was employed by LiveMe, a subsidiary of approach a certain jurisdiction decides to take is a policy Cheetah Mobile (NYSE:CMCM) as an in-house counsel intern from decision for the people of that jurisdiction to make (national July to August 2019 in Beijing, People’s Republic of China. L.Y.X. was loot box research would allow for evidence-informed regu- not involved with the monetisation of video games by Cheetah Mobile lation) [80]. Consumer protection regulation can always be or its subsidiaries. L.Y.X. was the recipient of an AFSG (Academic Forum for the Study of Gambling) Postgraduate Research Support improved upon and must continue to adapt, as loot boxes Grant that was derived from ‘regulatory settlements applied for social- continue to be designed and implemented in newer ways by ly responsible purposes’ received by the UK Gambling Commission video game companies. and administered by Gambling Research Exchange Ontario (GREO) (March 2022). L.Y.X. has accepted conference travel and attendance grants from the Socio-Legal Studies Association (February 2022), the Current Advances in Gambling Research Conference Organising Conclusions Committee with support from Gambling Research Exchange Ontario (GREO) (February 2022) and the International Relations Office of the Conceptual similarities between loot boxes and gambling Jagiellonian University, the Polish National Agency for Academic Ex- change (NAWA; Narodowa Agencja Wymiany Akademickiej) and the and the potential harms of loot boxes have been high- Republic of Poland (Rzeczpospolita Polska) with co-financing from lighted. A public health approach to gambling regulation the European Social Fund of the European Commission of the Euro- can inform a similar approach for loot box regulation. How- pean Union under the Knowledge Education Development Operational ever, attempting to regulate loot boxes as gambling is only Programme (May 2022). L.Y.X. was supported by academic scholar- 1 3 174 Current Addiction Reports (2022) 9:163–178 ships awarded by The Honourable Society of Lincoln’s Inn and The from Nielsen and Grabarczyk’s framework might infringe City Law School, City, University of London. L.L.H. and R.K.L.N. national gambling laws, with specific reference to the differ - declare no conflict of interest. P.W.S.N. is a member of the Adviso- ing approaches of Belgium, the Netherlands, and the UK. ry Board for Safer Gambling – an advisory group of the Gambling 6. Karlsen F. Entrapment and near miss: A comparative analysis Commission in Great Britain, and in 2020 was a special advisor to of psycho-structural elements in gambling games and massively the House of Lords Select Committee Enquiry on the Social and Eco- multiplayer online role-playing games. Int J Ment Health Addict. nomic Impact of the Gambling Industry. In the last 5 years, P.W.S.N. 2011;9(2):193–207. has contributed to research projects funded by the Academic Forum 7. Woods O. The economy of time, the rationalisation of resources: for the Study of Gambling, Clean Up Gambling, GambleAware, Gam- Discipline, desire and deferred value in the playing of gacha bling Research Australia, NSW Responsible Gambling Fund and the games. Games and Culture. 2022;4:15554120221077728. Victorian Responsible Gambling Foundation. P.W.S.N. has received 8. Aarseth E, Bean AM, Boonen H, Colder Carras M, Coulson M, travel and accommodation funding from the Spanish Federation of Re- Das D, et al. Scholars’ open debate paper on the world health habilitated Gamblers, and received open access fee grant income from organization ICD-11 gaming disorder proposal. J Behav Addict. Gambling Research Exchange Ontario. 2016;6(3):267–70. 9. Kiraly O, Demetrovics Z. Inclusion of gaming disorder in ICD has more advantages than disadvantages. J Behav Addict. Open Access This article is licensed under a Creative Commons Attri- 2017;6(3):280–4. bution 4.0 International License, which permits use, sharing, adapta- 10. Billieux J, Flayelle M, Rumpf HJ, Stein DJ. High involvement tion, distribution and reproduction in any medium or format, as long versus pathological involvement in video games: a crucial dis- as you give appropriate credit to the original author(s) and the source, tinction for ensuring the validity and utility of gaming disorder. provide a link to the Creative Commons licence, and indicate if changes Curr Addict Rep. 2019;6(3):323–30. were made. The images or other third party material in this article are 11. Xiao LY, Henderson LL, Nielsen RKL, Grabarczyk P, Newall included in the article's Creative Commons licence, unless indicated PWS. Loot boxes, gambling-like mechanics in video games. In: otherwise in a credit line to the material. If material is not included in Lee N, editor. Encyclopedia of computer graphics and games the article's Creative Commons licence and your intended use is not [Internet]. Springer; 2021 [cited 2022 Jul 3]. (Springer Nature permitted by statutory regulation or exceeds the permitted use, you will Living Reference). Available from: https://doi. or g/10. 1007/ 978- need to obtain permission directly from the copyright holder. To view a 3- 319- 08234-9_ 459-1. copy of this licence, visit http://cr eativ ecommons. or g/licen ses/ b y/4.0/ . 12. Nuffield Council on Bioethics. Public health: ethical issues. Lon- don: Nuffield Council on Bioethics; 2007. 191 p. 13. Belgische Kansspelcommissie [Belgian Gaming Commis- sion]. Onderzoeksrapport loot boxen [Research Report on Loot References Boxes] [Internet]. 2018 Apr [cited 2020 Apr 14]. Available from: https:// web. archi ve. org/ web/ 20200 41418 4710/ https:// www . g amin gcomm ission. be/ openc ms/ e xpor t/ sites/ def au lt/ Papers of particular interest, published recently, have jhksw eb_ nl/ docum ents/ onder zoeks rappo rt- loot- boxen- final- been highlighted as: publi catie. pdf. • Of importance 14. Spillemyndigheden [Danish Gambling Authority]. Statement about loot boxes / loot crates [Internet]. 2017 [cited 2021 Mar •• Of major importance 3]. Available from: https:// www . spill em ynd ighed en. dk/ en/ news/ state ment- about- loot- boxes- lootc rates. 1.•• Xiao LY. Loot boxes. In: Grabarczyk P, Aarseth E, Jorgensen 15. UK Gambling Commission. Virtual currencies, esports and IKH, Debus MS, Vozaru M, Houe NP, et al., editors. Encyclo- social gaming — position paper [Internet]. 2017 Mar [cited pedia of ludic terms [Internet]. IT University of Copenhagen; 2022 Mar 10]. Available from: https:// web. archi ve. org/ web/ 2022 [cited 2022 Apr 25]. Available from: https://eolt. or g/ar tic 20210 11107 5348/ http:// www. gambl ingco mmiss ion. gov. uk/ les/ loot- boxes. An open access introduction to loot boxes PDF/V irtual- cur rencies eSpor ts- and- social- casino- g aming.pdf . that summaries game studies (ludology), psychology and 16. Kansspelautoriteit [The Netherlands Gambling Authority]. legal research. Onderzoek naar loot boxes: Een buit of een last? [Study into 2.• Drummond A, Sauer JD. Video game loot boxes are psycho- Loot Boxes: A Treasure or a Burden?] [Internet]. 2018 Apr logically akin to gambling. Nat Hum Behav. 2018;2(8):530–2. A [cited 2022 Mar 10]. Available from: https:// web. archi ve. org/ consideration of how the loot box mechanic in specic fi games web/20190 50323 2356/ https:// k ansspelau t oriteit. nl/ publi sh/ libr a satisfy various criteria of ‘gambling’ and therefore are con- ry/6/o nderz oek_na ar_l oot_b oxes_-_e en_bu it_of _e en_l ast_-_nl . ceptually and structurally similar to traditional gambling. pdf. 3. Drummond A, Sauer JD, Hall LC, Zendle D, Loudon MR. Why 17. Kansspelautoriteit [The Netherlands Gambling Authority]. loot boxes could be regulated as gambling. Nat Hum Behav. Imposition of an order subject to a penalty on Electronic Arts 2020;4:986–8. for FIFA video game [Internet]. 2020 [cited 2021 Mar 11]. 4.•• Nielsen RKL, Grabarczyk P. Are loot boxes gambling? Random Available from: https:// web. archi ve. org/ web/ 20201 12722 2346/ reward mechanisms in video games. ToDIGRA. 2019;4(3):171– https://k ansspelau t oriteit. nl/ nieuw s/nieuw sber ic hten/2020/ okt ob 207. A framework separating loot boxes into four categories er/ impos ition- an- order/. that assist in helping to distinguish various implementations 18. Electronic Arts Inc & Electronic Arts Swiss Sarl v Kansspe- and their differing levels of potential harms to players, which lautoriteit (2020) Rechtbank Den Haag [District Court of The potentially justifies each category to be regulated to different Hague] [Internet]. 2020 [cited 2021 Mar 11]. Available from: degrees. https://uitsp r aken.r echtspr aak.nl/ inzie ndocu ment? id= ECLI: NL: 5.• Xiao LY. Which implementations of loot boxes constitute gam- RBDHA: 2020: 10428. bling? A UK legal perspective on the potential harms of random 19. Afdeling Bestuursrechtspraak Raad van State [Administrative reward mechanisms. Int J Ment Health Addict. 2022;20(1):437– Jurisdiction Division of the Council of State (The Netherlands)]. 54. A consideration of how each category of loot boxes Uitspraak [Ruling] 202005769/1/A3, ECLI:NL:RVS:2022:690 1 3 Current Addiction Reports (2022) 9:163–178 175 (9 March 2022) [Internet]. Raad van State; 2022 [cited 2022 Mar 34. Larche CJ, Chini K, Lee C, Dixon MJ, Fernandes M. Rare 10]. Available from: https://www .r aadvans tate. nl/ actue el/ nieuw loot box rewards trigger larger arousal and reward responses, s/@ 130150/ 20200 5769-1- a3/. and greater urge to open more loot boxes. J Gambl Stud. 20. Xiao LY, Declerck P. Video game loot boxes are NOT gambling 2021;37:141–63. under Dutch gambling regulation? Shifting the goalpost in Elec- 35. Yin-Poole W. FIFA player uses GDPR to find out everything tronic Arts v Kansspelautoriteit [Internet]. OSF Preprints. 2022 EA has on him, realises he’s spent over $10,000 in two years [cited 2022 Apr 26]. Available from: https:// osf. io/ pz24d/. on Ultimate Team [Internet]. Eurogamer. 2018 [cited 2020 Aug 21. Sinclair B. EA fined €10m o ver loot boxes as Dutch court sides 3]. Available from: https://www .eur ogamer .ne t/ar ticles/ 2018- 07- with gambling authority [Internet]. Games Indus try. biz. 2020 23-fif a-pla yer-uses- gdpr -t o-find- out- e veryt hing-ea- has- on- himr e [cited 2021 Mar 11]. Available from: https://ww w. games indus alises-hes- spent- o ver-usd10- 000- in- tw o-y ears-on- ultim ate- team . try. biz/ artic les/ 2020- 10- 29- ea- fined- 10m- over- loot- boxes- as- 36. Kleinman Z. ‘The kids emptied our bank account playing Fifa’ dutch- court- sides- with- gambl ing- autho rity. [Internet]. BBC News. 2019 [cited 2020 Aug 3]. Available from: 22. Xiao LY. Regulating loot boxes as gambling? towards a com-https:// www. bbc. co. uk/ news/ techn ology- 48908 766. bined legal and self-regulatory consumer protection approach. 37. Zendle D, Cairns P. Loot boxes are again linked to problem gam- Interactive Entertainment Law Rev. 2021;4(1):27–47. bling: Results of a replication study. PLoS One. 14(3):e0213194. 23.• Zendle D, Meyer R, Cairns P, Waters S, Ballou N. The preva- 38. Gonzalez-Cabrera J, Basterra-Gonzalez A, Montiel I, Calvete lence of loot boxes in mobile and desktop games. Addiction. E, Pontes HM, Machimbarrena JM. Loot boxes in Spanish ado- 2020;115(9):1768–72. An assessment of the prevalence of loot lescents and young adults: Relationship with internet gaming boxes amongst video games on various hardware platforms, disorder and online gambling disorder. Comput Human Behav. which importantly should be read in conjunction with the 2021;107012. updates provided in [25]. 39. Kristiansen S, Severin MC. Loot box engagement and problem 24. Xiao LY, Henderson LL, Newall P. What are the odds? Lower gambling among adolescent gamers: Findings from a national compliance with Western loot box probability disclosure indus- survey. Addict Behav. 2019;103:106254. try self-regulation than Chinese legal regulation [Internet]. OSF 40. Rockloff M, Russell AMT, Greer N, Lole L, Hing N, Browne M. Preprints. 2021 [cited 2021 Oct 1]. Available from: https:// osf. Young people who purchase loot boxes are more likely to have io/ g5wd9/. gambling problems: An online survey of adolescents and young 25.• Xiao LY, Henderson LL, Newall PWS. Loot boxes are more adults living in NSW Australia. J Behav Addict [Internet]. 2021 prevalent in United Kingdom video games than previously con- [cited 2021 Apr 6];Advance Online Publication. Available from: sidered: Updating Zendle et al. (2020). Addiction [Internet]. https://a kjour nals.c om/v iew/j ourna ls/2 006/a op/a rticl e-1 0.1 556- 2022 [cited 2022 Feb 9];Advance online publication. Available 2006. 2021. 00007/ artic le- 10. 1556- 2006. 2021. 00007. xml. from: https:// onlin elibr ar y . wile y . com/ doi/ abs/ 10. 1111/ add. 41. Wardle H, Zendle D. Loot boxes, gambling, and prob- 15829. The world’s first attempt at empirically assessing the lem gambling among young people: results from a cross- effectiveness of a form of loot box regulation, specifically sectional online survey. Cyberpsychol Behav Soc Netw. legally-required probability disclosures in China. 2021;24(4):267–74. 26. Xiao LY, Henderson LL, Yang Y, Newall PWS. Gaming the sys- 42.•• Spicer SG, Nicklin LL, Uther M, Lloyd J, Lloyd H, Close tem: suboptimal compliance with loot box probability disclosure J. Loot boxes, problem gambling and problem video gam- regulations in China. Behavioural Public Policy. 2021;Advance ing: A systematic review and meta-synthesis. New Media Online Publication:1–27. Soc. 2021;17:14614448211027176. A meta-analysis of the 27. Henrich J, Heine SJ, Norenzayan A. The weirdest people in the relationships between loot box purchasing and problem world? Behav Brain Sci. 2010 Jun;33(2–3):61–83. gambling which has been highly consistently found and 28. Zaman B, Mechelen MV, Cock RD, Huyghe J. Perceptions of between loot box purchasing and problem video gaming and exposure to games of chance, gambling, and video gam- which has been less consistently identified. ing: self-reports of preadolescents and parents. J Gambl Issues 43. Yokomitsu K, Irie T, Shinkawa H, Tanaka M. Characteris- [Internet]. 2020 Dec 1 [cited 2021 Dec 19];46. Available from: tics of gamers who purchase loot box: a systematic literature https:// jgi. camh. net/ index. php/ jgi/ artic le/ view/ 4096. review. Curr Addict Rep. 2021;8(4):481–93. 29. Xiao LY. ESRB’s and PEGI’s self-regulatory ‘includes random 44. Montiel I, Basterra-Gonzalez A, Machimbarrena JM, Ortega- items’ labels fail to ensure consumer protection. Int J Ment Baron J, Gonzalez-Cabrera J. Loot box engagement: A Health Addict. 2021;19(6):2358–61. scoping review of primary studies on prevalence and asso- 30. Pan European Game Information (PEGI). What do the labels ciation with problematic gaming and gambling. PLoS One. mean? [Internet]. [cited 2020 Apr 14]. Available from: https:// 2022;17(1):e0263177. pegi. info/ what- do- the- labels- mean. 45. Garea SS, Drummond A, Sauer JD, Hall LC, Williams MN. 31. UK Gambling Commission. Young people and gambling survey Meta-analysis of the relationship between problem gambling, 2019: A research study among 11-16 year olds in Great Britain excessive gaming and loot box spending. Int Gambl Stud. [Internet]. 2019 [cited 2021 Jun 29]. Available from: https:// 2021;21(3):460–79. web.ar chiv e.or g/w eb/20210 12912 3612/ https:// www .g amblingco 46. Sidloski B, Brooks G, Zhang K, Clark L. Exploring the asso- mmiss ion. gov. uk/ PDF/ Young- People- Gambl ing- Report- 2019. ciation between loot boxes and problem gambling: are video pdf. gamers referring to loot boxes when they complete gambling 32. Xiao LY. Conceptualising the loot box transaction as a gamble screening tools? Addict Behav. 2022;29:107318. between the purchasing player and the video game company. Int 47. McCaffr ey M. The macro problem of microtransactions: The J Ment Health Addict. 2021;19(6):2355–7. self-regulatory challenges of video game loot boxes. Bus 33. Yin-Poole W. FIFA 21 rocked by ‘EAGate’ scandal after com- Horiz. 2019;62(4):483–95. pany employee is alleged to have sold coveted Ultimate Team 48. McCaffr ey M. A cautious approach to public policy and loot cards for thousands of pounds [Internet]. Eurogamer. 2021 [cited box regulation. Addict Behav. 2020;102:106136. 2022 Apr 19]. Available from: https:// www. eurog amer. net/ fifa- 49. Collins P, Shaffer HJ, Ladouceur R, Blaszszynski A, Fong D. Gambling research and industry funding. J Gambl Stud. 21-r ocked-b y-ea- g ate-scand al- as- com pan y-em ploy ee-alleg ed- t o- 2020;36(3):989–97. have-soldc o veted-ultim ate- team- car ds-f or-t housands- of- pounds . 1 3 176 Current Addiction Reports (2022) 9:163–178 50. Betting and Gaming Council. Betting and gaming council artic le- 10. 1556- 2006. 2022. 00016/ artic le- 10. 1556- 2006. 2022. pledges to ‘keep up the momentum’ as new report suggests 00016. xml. problem and at-risk gambling rates are falling [Internet]. Bet- 67. Cassidy R, Pisac A, Loussouarn C, editors. Qualitative research ting & Gaming Council. 2021 [cited 2022 Mar 12]. Available in gambling: Exploring the production and consumption of risk. from: https:// web. archi ve. org/ web/ 20220 31214 3711/ https:// London: Routledge; 2013. 288 p. betting andg amingcoun cil. com/ ne ws/be tting- and- g amingcoun 68. Entertainment Software Association (ESA). Video game indus- cil- pledg es- to- keep- up- the- momen tum- as- new- report- sugge try commitments to further inform consumer purchases [Inter- sts- probl em- and- at- risk- gambl ing- rates- are- falli ng. net]. ESA Official Website. 2019 [cited 2021 Mar 12]. Available 51. Abbott MW. The changing epidemiology of gambling disorder from: https:// www. theesa. com/ persp ectiv es/ video- game- indus and gambling-related harm: public health implications. Public try- commi tments- to- furth er- inform- consu mer- purch ases/. Health. 2020 Jul 1;184:41–5. 69. Google. Monetisation and ads – payments [Internet]. Google 52. Livingstone C, Rintoul A. Moving on from responsible gam- play developer policy centre. 2019 [cited 2021 Jun 30]. Available bling: a new discourse is needed to prevent and minimise harm from: https://suppo r t.goog le.co m/goog le play/andr oid- de veloper/ from gambling. Public Health. 2020 Jul 1;184:107–12.answer/ 98587 38. 53. Price A, Hilbrecht M, Billi R. Charting a path towards a public 70. Apple. App store review guidelines [Internet]. Apple developer. health approach for gambling harm prevention. J Public Health 2021 [cited 2020 Aug 3]. Available from: https:// devel oper . (Berl). 2021 Feb 1;29(1):37–53.apple. com/ app- store/ review/ guide lines/. 54. van Schalkwyk MCI, Cassidy R, McKee M, Petticrew M. Gam- 71. Entertainment Software Rating Board (ESRB). Introducing a bling control: in support of a public health response to gambling. new interactive element: In-game purchases (Includes Random The Lancet. 2019;393(10182):1680–1. Items) [Internet]. ESRB Official Website. 2020 [cited 2020 Apr 55. van Schalkwyk MCI, Blythe J, McKee M, Petticrew M. Gam- 13]. Available from: https:// www. esrb. org/ blog/ in- game- purch bling Act review. BMJ. 2022;376:o248.ases- inclu des- random- items/. 56. Wardle H, Reith G, Langham E, Rogers RD. Gambling and 72. Pan European Game Information (PEGI). PEGI introduces public health: we need policy action to prevent harm. BMJ. notice to inform about presence of paid random items [Inter- 2019;365:l1807. net]. PEGI Official Website. 2020 [cited 2020 Apr 14]. Available 57. Young M. Statistics, scapegoats and social control: A critique from: https:// pegi. info/ news/ pegii ntrod uces- featu re- notice. of pathological gambling prevalence research. Addiction Res 73. Fiedler I, Kairouz S, Reynolds J. Corporate social responsibil- Theory. 2013;21(1):1–11. ity vs. financial interests: the case of responsible gambling pro- 58. Pickering D, Blaszczynski A. Paid online convenience samples grams. J Public Health (Berl). 2021;29(4):993–1000. in gambling studies: questionable data quality. Int Gambling 74. Schull ND. Addiction by design [Internet]. Princeton University Stud. 2021;0(0):1–21. Press; 2012 [cited 2021 May 17]. Available from: https://doi. or g/ 59. Harrison GW, Lau MI, Ross D. The risk of gambling problems 10. 1515/ 97814 00834 655. in the general population: a reconsideration. J Gambl Stud. 2020 75. Purves RI, Critchlow N, Morgan A, Stead M, Dobbie F. Examin- Dec 1;36(4):1133–59. ing the frequency and nature of gambling marketing in televised 60. Wood RT, Williams RJ. ‘How much money do you spend on broadcasts of professional sporting events in the United King- gambling?’ the comparative validity of question wordings dom. Public Health. 2020 Jul 1;184:71–8. used to assess gambling expenditure. Int J Soc Res. Methodol. 76. Schalkwyk MC, van Maani N, McKee M, Thomas S, Knai C, 2007;10(1):63–77. Petticrew M. “When the fun stops, stop”: An analysis of the 61. Blaszczynski A, Ladouceur R, Goulet A, Savard C. ‘How much provenance, framing and evidence of a ‘responsible gambling’ do you spend gambling?’: ambiguities in questionnaire items campaign. PLoS One. 2021;16(8):e0255145. assessing expenditure. Int Gambl Stud. 2006;6(2):123–8. 77. Newall PWS, Weiss-Cohen L, Singmann H, Walasek L, Ludvig 62. Heirene RM, Wang A, Gainsbury SM. Accuracy of self-reported EA. Impact of the “when the fun stops, stop” gambling message gambling frequency and outcomes: Comparisons with account on online gambling behaviour: a randomised, online experimen- data. Psychol Addict Behav. 2021. tal study. The Lancet Public Health. 2022;7(5):e437–46. 63. UK Gambling Commission. Statistics on participation and 78. Newall P, Weiss-Cohen L, Singmann H, Walasek L, Ludvig E. problem gambling for the year to March 2022 [Internet]. Gam- No credible evidence that UK safer gambling messages reduce bling Commission. 2022 [cited 2022 May 4]. Available from: gambling [Internet]. PsyArXiv; 2021 [cited 2022 Apr 20]. Avail- https:// www. gambl ingco mmiss ion. gov. uk/ stati stics- and- resea able from: https:// psyar xiv. com/ hv6w9/. rch/ publi cation/ stati stics- on- parti cipat ion- andpr oblem- gambl 79. Livingstone C, Rintoul A, Lacy-Vawdon C de, Borland R, Dietze ing- for- the- year- to- march- 2022. P, Jenkinson R, et al. Identifying effective policy interventions to 64. Gunstone B, Gosschalk K, Zabicka E, Sullivan-Drage C, You- prevent gambling-related harm [Internet]. Melbourne: Victorian Gov. Annual GB Treatment and Support Survey 2021 On behalf Responsible Gambling Foundation; 2019 [cited 2021 Apr 24]. of GambleAware [Internet]. YouGov; 2021 [cited 2022 May 4]. Available from: https:// respo nsibl egamb ling. vic. gov. au/ docum Available from: https:// www. begam bleaw are. org/ sites/ defau lt/ ents/640/ Livin gs tone-ident ifying- effec tiv e-policy -inter v entions- f iles/ 2022- 03/ Annual% 20GB% 20Tr e atment% 20and% 20Sup June- 2019. pdf. port% 20Sur vey% 20Rep ort% 202021% 20% 28FIN AL% 29. pdf. 80. Xiao LY. Reserve your judgment on “draconian” chinese video 65. Muggleton N, Parpart P, Newall PWS, Leake D, Gathergood gaming restrictions on children. J Behav Addict [Internet]. 2022 J, Stewart N. The association between gambling and financial, [cited 2021 Dec 16];Advance online publication. Available from: social and health outcomes in big financial data. Nat Hum Behav. https:// doi. org/ 10. 1556/ 2006. 2022. 00022. 2021 Mar;5(3):319–26. 81. Close J, Lloyd J. Lifting the lid on loot-boxes: Chance-based 66. Macey J, Cantell M, Tossavainen T, Karjala A, Castren S. How purchases in video games and the convergence of gaming and can the potential harms of loot boxes be minimised?: Proposals gambling [Internet]. GambleAware; 2021 Apr [cited 2021 for understanding and addressing issues at a national level. J Apr 7]. Available from: https:// www . beg am blea w ar e. or g/ Behav Addict [Internet]. 2022 20 [cited 2022 Apr 26];1(aop). sites/def ault/ f iles/2021- 03/ Gaming_ and_ Gambl ing_ R eport_ Available from: https://akjou r nals.com/ vie w/jour nals/ 2006/ aop/ Final. pdf. 1 3 Current Addiction Reports (2022) 9:163–178 177 82. Mason L. Video gaming – taking a gamble with young peo- 96. Honer P. Limiting the loot box: overview and difficul- ple’s health and wellbeing? Perspect Public Health. 2021 Jan ties of a common EU response. Interact Entertain Law Rev. 1;141(1):5–6. 2021;4(1):63–83. 83. Select Committee on the Social and Economic Impact of the 97. Schwiddessen S, Karius P. Watch your loot boxes! – recent Gambling Industry of the House of Lords (UK). Report of Ses- developments and legal assessment in selected key jurisdictions sion 2019–21: Gambling Harm— Time for Action [Internet]. from a gambling law perspective. Interact Entertain Law Rev.. 2020 Jul [cited 2020 Jul 2]. Report No.: HL Paper 79. Available 2018;1(1):17–43. from: https:// w eb. ar c hi ve. or g/ w eb/ 20200 70219 5336/ https:// 98. Derrington S, Star S, Kelly SJ. The case for uniform loot box publi catio ns. parli ament. uk/ pa/ ld5801/ ldsel ect/ ldgamb/ 79/ 79. regulation: a new classification typology and reform agenda. J pdf. Gambl Issues. 2021 Feb;46:302–32. 84. Hall W. What are the policy lessons of National Alcohol 99. Xiao LY. Breaking Ban: Assessing the effectiveness of Bel- Prohibition in the United States, 1920–1933? Addiction. gium’s gambling law regulation of video game loot boxes. Stage 2010;105(7):1164–73. 1 registered report recommended by peer community in regis- 85. Xiao LY. Blind boxes: opening our eyes to the challenging regu- tered reports [Internet]. 2022 [cited 2022 Apr 13]; Available lation of gambling-like products and gamblification and unex- from: https:// osf. io/ 8fvt2/. plained regulatory inaction. Gaming Law Rev. 2022;26:255–68. 100. Cerulli-Harms A, Munsch M, Thorun C, Michaelsen F, Hause- 86. Elliott SA, Mason DS. Emerging legal issues in the sports indus- mer P. Loot boxes in online games and their effect on consumers, try: are trading cards a form of gambling? J Legal Aspects Sport. in particular young consumers [Internet]. Policy Department for 2003;13(2):101–20. Economic, Scientific and Quality of Life Policies (EU); 2020 Jul 87. Zendle D, Walasek L, Cairns P, Meyer R, Drummond A. Links [cited 2020 Jul 29]. Report No.: PE 652.727. Available from: between problem gambling and spending on booster packs in https:// www. europ arl. europa. eu/ RegDa ta/ etudes/ STUD/ 2020/ collectible card games: A conceptual replication of research on 652727/ IPOL_ STU(2020) 652727_ EN. pdf. loot boxes. PLoS One. 2021;16(4):e0247855. 101. Hiilamo H, Crosbie E, Glantz SA. The evolution of health 88.• Macey J, Bujić M. The talk of the town: community perspec- warning labels on cigarette packs: the role of precedents, and tives on loot boxes. In: Ruotsalainen M, Torhonen M, Karhu- tobacco industry strategies to block diffusion. Tobacco Control. lahti VM, editors. Modes of esports engagement in overwatch 2012;23(1):e2. [Internet]. Cham: Springer International Publishing; 2022 102. Blackwell AKM, Drax K, Attwood AS, Munafo MR, Maynard [cited 2022 Mar 11]. p. 199–223. Available from: https:// doi. OM. Informing drinkers: Can current UK alcohol labels be org/ 10. 1007/ 978-3- 030- 82767-0_ 11. A paper that begins to improved? Drug Alcohol Depend. 2018;192:163–70. consider the player perspectives on loot boxes and regula- 103. Newall PWS. Dark nudges in gambling. Addict Res Theor. tion thereof. 2019;27(2):65–7. 89. Balfour DJK, Benowitz NL, Colby SM, Hatsukami DK, 104. Pantani D, Sparks R, Sanchez ZM, Pinsky I. ‘Responsible drink- Lando HA, Leischow SJ, et al. Balancing Consideration of the ing’ programs and the alcohol industry in Brazil: killing two Risks and Benefits of E-Cigarettes. Am J Public Health. 2021 birds with one stone? Soc Sci Med. 2012;75(8):1387–91. Sep;111(9):1661–72. 105. Leon Y. Xiao, Fraser TC, Newall PWS. Opening Pandora’s loot 90. Levy DT, Borland R, Lindblom EN, Goniewicz ML, Meza R, box: Weak links between gambling and loot box expenditure in Holford TR, et al. Potential deaths averted in USA by replac- China, and player opinions on probability disclosures and pity- ing cigarettes with e-cigarettes. Tobacco Control. 2018 Jan timers [Internet]. Vol. Forthcoming, J Gambl Stud. 2022 [cited 1;27(1):18–25. 2021 May 28]. Available from: https:// psyar xiv. com/ 837dv/. 91. Forrest D, McHale IG. Exploring online patterns of play: Interim 106. Xiao LY. Drafting video game loot box regulation for dummies: report [Internet]. NatCen Social Research; 2021 Mar [cited 2022 a chinese lesson. Inform Commu Technol Law. 2022;31(3). Apr 25]. Available from: https://w ww.b egamb leawa re.o rg/s ites/ 107.• Petrovskaya E, Zendle D. Predatory monetisation? a categori- defau lt/ files/ 2021- 03/ PoP_ Inter im% 20Rep ort_ Short_ Final_0. sation of unfair, misleading and aggressive monetisation tech- pdf. niques in digital games from the player perspective [Internet]. 92. Close J, Spicer SG, Nicklin LL, Uther M, Lloyd J, Lloyd H. J Business Ethics. 2021 [cited 2021 Oct 21]. Available from: Secondary analysis of loot box data: Are highspending “whales” https:// doi. org/ 10. 1007/ s10551- 021- 04970-6. A study on how wealthy gamers or problem gamblers? Addictive Behaviors. other aspects of video game monetisation, beyond loot boxes, 2021 Jun 1;117:106851. are potentially also deemed as unfair, misleading, or aggres- 93.•• Xiao LY, Newall PWS. Probability disclosures are not enough: sive by players. Reducing loot box reward complexity as a part of ethical video 108. Spence-Jones G, Xiao LY. Loot Boxes – Video gaming indus- game design [Internet]. Vol. Advance online publication., Jour- try’s hidden treasure or a Pandora’s Box that misleads consum- nal of Gambling Issues. 2021 [cited 2021 May 3]. Available ers? Gough Square Chambers Website. 2020;8. from: https:// cdspr ess. ca/?p= 5602. A reasoned proposal of 109. Cartwright P, Hyde R. Virtual coercion and the vulnerable con- four simple ethical game design changes to loot boxes that sumer: ‘loot boxes’ as aggressive commercial practices. Legal are tangible and actionable. Making these changes to loot Studies. 2022 Mar;7:1–21. boxes is likely to reduce harm whilst also maintaining the 110. Autorite de regulation des jeux en ligne (ARJEL) [Regulatory economic benefits of this monetisation model. Authority for Online Games (France)]. Rapport d’activite 2017- 94. Digital, Culture, Media and Sport Committee of the House of 2018 [Activity Report 2017-2018] [Internet]. 2018 Jun [cited Commons (UK). Immersive and addictive technologies: fifteenth 2021 Jun 29]. Available from: https:// w eb. ar c hi ve. or g/ w eb/ report of session 2017–19 [Internet]. 2019 Sep [cited 2021 Jun 20200 41418 4944/ http:// www . ar jel. fr/ IMG/ pdf/ r appo r t- activ 20]. Report No.: HC 1846. Available from: https:// web. archi ve. ite- 2017. pdf. org/w eb/2 02106 09191 037/h ttps://p ublic ation s.p arlia ment.u k/p a/ 111. Blizzard Entertainment. Paid loot boxes and loot chests disabled cm201 719/ cmsel ect/ cmcum eds/ 1846/ 1846. pdf. for players in Belgium [Internet]. Official Overwatch Forums. 95. Moshirnia A. Precious and worthless: a comparative per- 2018 [cited 2021 Mar 12]. Available from: https:// eu. forums. blizz ar d. com/ en/ over w atch/t/ paidl oo t- boxes- and- loo t- ches ts- spective on loot boxes and gambling. Minn JL Sci & Tech. disab led- for- playe rs- in- belgi um/ 8139. 2018;20(1):77–114. 1 3 178 Current Addiction Reports (2022) 9:163–178 112. 2K Games. Statement Belgium [Internet]. 2K Games Official 120. Xiao LY. People’s Republic of China legal update: the notice Website. 2018 [cited 2021 Mar 12]. Available from: https:// on the prevention of online gaming addiction in juveniles (Pub- www. 2k. com/ mytea minfo/ be/. lished October 25, 2019, Effective November 1, 2019). Gaming 113. Nintendo. Belangrijke informatie voor gebruikers in Belgie Law Rev. 2020;24(1):51–3. [Important Information for Users in Belgium] [Internet]. Nin- 121. Xiao LY. People’s Republic of China legal update: the notice tendo Belgium. 2019 [cited 2020 Aug 3]. Available from: https:// on further strictly regulating and effectively preventing www.ninte ndo. be/ nl/ Nieuw s/2019/ mei/ Belan g rijke-inf ormatie- online video gaming addiction in minors (Published August voor- gebru ikers- in- Belgie- 15619 11. html. 30, 2021, Effective September 1, 2021). Gaming Law Rev. 114. Woods O. The affective embeddings of gacha games: Aesthetic 2021;25(9):379–82. assemblages and the mediated expression of the self. New Media 122. Committee of Advertising Practice, Broadcast Committee of Soc. 2022 Jan;7:14614448211067756. Advertising Practice. Consultation on new guidance to explain 115. Drummond A, Sauer JD, Hall LC. Loot box limit-setting: a how the Advertising Codes apply to the marketing of in-game potential policy to protect video game users with gambling purchases in apps and video games [Internet]. 2020 [cited 2021 problems? Addiction. 2019;114(5):935–6. Jan 14]. Available from: https:// web. ar c hi ve. or g/ web/ 20210 116.• King DL, Delfabbro PH. Loot box limit-setting is not sufficient 11411 5545/ https:// www. asa. org. uk/ uploa ds/ assets/ 8039d 7d7- on its own to prevent players from overspending: a reply to drum-cac3- 4603- 8c752 e16c2 7aaa84/ In- game- Purch asing- Consu ltati mond. Sauer & Hall Addiction. 2019;114(7):1324–5. A paper sug-on. pdf. gesting many potential ways for loot box harms to be reduced, 123. Committee of Advertising Practice, Broadcast Committee of many of which are borrowed from the gambling context. Advertising Practice. Practice statement on new guidance to 117. Rossow I, Hansen MB. Gambling and gambling policy in Nor- explain how the Advertising Codes apply to the marketing of way—an exceptional case. Addiction. 2016;111(4):593–8. in-game purchases in apps and video games [Internet]. 2021 118. King DL, Delfabbro PH. Video game monetization (e.g., ‘Loot [cited 2022 Mar 23]. Available from: https:// www. asa. org. uk/ Boxes’): a blueprint for practical social responsibility measures. static/ 21e9a 90d- a7ac- 4499- a57c6 6729c d5c3e1/ In- game- purch Int J Ment Health Addiction. 2019;17(1):166–79.asing- state ment. pdf. 119. Xiao LY, Henderson LL. Towards an ethical game design solu- tion to loot boxes: a commentary on King and Delfabbro. Int J Publisher's Note Springer Nature remains neutral with regard to Ment Health Addiction. 2021. jurisdictional claims in published maps and institutional affiliations. 1 3

Journal

Current Addiction ReportsSpringer Journals

Published: Sep 1, 2022

Keywords: Loot boxes; Video gaming regulation; Online gambling; Consumer protection; Interactive entertainment law; Video games; Public health

References