Online Gambling And Mental Health: Research On Loot Boxes & Problem Gambling Disorder

As online gambling has grown into a multibillion-dollar industry, associated mental health concerns have increased. In video gaming, loot boxes are virtual packs of random rewards for game play that users have to buy. Their widespread use has sparked new concerns about online gambling and its potential mental health associations. 

Problem gambling, which may sometimes escalate into a diagnosable gambling disorder, is associated with anxiety and mood disorders, social impacts, and physical consequences. If left untreated, it can become an unhealthy cycle in which an individual’s gambling habit intensifies and its health impacts do as well. Here, we’ll explore new research on potential correlations between loot boxes in online gambling and mental health outcomes.

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When online gambling becomes a disorder

Mental health can be directly impacted by online gambling in similar ways to in-person gambling at a casino. Like many casinos, internet gambling is available 24 hours a day, seven days a week. However, unlike with casinos, a person doesn’t have to leave home to engage in online gambling, since these types of games are available on any smartphone. This easy availability may make it easier for an individual to develop gambling habits that may progress into a gambling addiction. 

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) classifies compulsive gambling behavior that meets certain criteria as a gambling disorder (formerly referred to as pathological gambling). Some of the criteria for a diagnosis include:

• Being preoccupied with gambling
• Needing to gamble with increasing amounts of money to feel the same excitement
• Repeated, unsuccessful efforts to curb or control gambling
• Using gambling as a way to cope with difficult emotions
• “Chasing losses,” or returning to gamble after losing a significant amount in an attempt to win it back
• Lying to loved ones about the level or extent of one’s gambling
• Engaging in illegal acts to get more money to spend on gambling

How problem gambling can affect mental health

Like other addictions, problem gambling affects the brain mechanism that controls the release of dopamine, a hormone that creates feelings of pleasure. In the case of gambling, winning a bet grants an emotional reward. Eventually, other pleasurable activities may not make an individual feel as good. Thus, people with gambling disorder may return to gambling to get the buzz that other activities no longer provide, regardless of the toll it may take on their quality of life.

Feeling unable to stop gambling can cause stress and depression, as can the financial impacts of problem gambling. It’s also common for a person with a preexisting mental health challenge to develop a gambling addiction in an attempt to cope, and this behavior may exacerbate symptoms. Studies suggest that even infrequent online gambling may be linked to mental health challenges, including higher levels of stress and anxiety and increased rates of depression compared to those who do not gamble. 

How online gambling and mental health challenges like stress and anxiety are connected

Many people gamble as a form of entertainment or escape, but for individuals with an online gambling addiction, it can become a source of chronic stress.

Preliminary studies suggest that online gamblers may be at a higher risk of problem gambling than their offline counterparts due in part to increased availability, low-bet stakes, and the highly immersive interfaces of online and mobile gambling sites. Plus, the ease of spending through digital payments can help individuals mentally detach from the consequences of their actions, further encouraging them to continue playing gambling games.

Gambling disorder and loot boxes: What’s the connection?

A person may gamble through sports betting, casinos, the lottery, or gambling online, but the latter is becoming increasingly common, and certain elements of these virtual interfaces may increase the risk of problem gambling. For example, in online gambling, loot boxes—also called loot crates or prize crates—are virtual items found in the games. These boxes can be unlocked by spending real money, and they typically contain randomized “loot”: virtual items that can be used to customize a player’s in-game avatar or offer weaponry or other inventory items.

Much like roulette wheels and slot machines, which are designed to entice players to play again, the process of unlocking a loot box is often accompanied by exciting graphics and audio to add to the thrill of the process. Loot boxes also employ mechanisms similar to slot machines, including randomized rewards and variable payout schedules, which exploit psychological vulnerabilities to encourage repeated spending.

The impact of loot boxes in online gambling on mental health risks, according to research

A 2025 study of more than 1,400 adults who play online video games involving gambling suggests that buying loot boxes is associated with real-world gambling habits and mental health challenges. The researchers indicate that the behavior of buying loot boxes may share mental health risk factors with other behavioral addictions. Internet gamblers may also exhibit increased stress levels, sleep disturbances, and a greater likelihood of developing mood disorders such as major depressive disorder.

Another 2025 study researched the relationship between loot-box buying, gambling, internet gaming, and mental health. Its findings suggest that:

• Individuals who frequently buy loot boxes tend to exhibit higher gambling severity and more problematic video game use than those who do not.
• Loot box spending is associated with increased levels of financial distress and compulsive gambling tendencies.
• Young players who regularly purchase loot boxes may be more likely to develop gambling problems later in life.

This second study also indicates that loot-box buying appears to be associated with increased rates of depression, anxiety, stress and impulsivity. Though the correlation between loot box purchases and symptoms of anxiety and depression was not as strong as in cases of gambling addiction, it is strong enough to warrant further research.

Online gambling, loot boxes, and mental health conditions

Gambling disorder can impact mental, physical, and social health. The elements that contribute to the relative ease of online gambling may cause increased levels of financial strain and heightened rates of addiction, depression, anxiety, and social isolation among online gamblers, potentially reinforcing a cycle of mental health challenges, social withdrawal, and problem gambling. In addition, gambling has a high comorbidity with substance use disorders and has also been identified as a significant contributor to risk of suicide.

The negative mental health impacts of gambling disorder are thought to disproportionately affect young adults who are more adept at navigating online environments as well as individuals with preexisting mental health conditions. That said, a 2022 study suggests that people who purchase loot boxes may be at a higher risk of psychological distress, regardless of age and gender. Addressing problem gambling may be essential to avoiding long-term health complications.

How loot boxes may promote gambling addiction

Loot boxes are designed to keep players engaged and returning with the promise of rewards that are perceived to be rare and valuable. Coupled with cognitive distortions that are commonly associated with gambling, these psychological reinforcements may make loot boxes addictive.

Gambling and the role of in-game purchases

Many video games now incorporate microtransactions, allowing players to spend real money on randomly generated loot boxes and other in-game items. Some cognitive distortions related to gambling are often at play when people purchase such items, such as:

• Gambler’s fallacy: Also known as the Monte Carlo fallacy or the fallacy of the maturity of chances, the gambler’s fallacy is the mistaken belief that if a particular event occurs less often than expected, it is more likely to happen in the future.
• Near-miss effect: The near-miss effect is illustrated when a person becomes more motivated to continue playing after an instance in which they “almost won.”
• Illusion of control: The illusion of control is the mistaken belief that repeated purchases will eventually yield desirable rewards for one’s efforts.

In addition to the cognitive distortions that loot boxes play into, there is often a lack of transparency in games when it comes to the odds of winning rare or high-value items in loot boxes.

Problem gambling, impulsivity, and mental health challenges

Impulsivity tends to be a key factor in gambling disorder, and online games may take advantage of this. For example, an online game might suddenly show an engaging and enticing screen advertising a loot box that a person can buy instantly for a small amount of money through their digital payment method. The way it’s presented, and the ease of purchase may make it nearly impossible for a person who may already struggle with impulsivity to resist. 

Online gambling and the risk of compulsive behavior

Impulsivity can contribute to a person developing a problematic gambling habit. Some potential signs of compulsive gambling habits may include:

• An inability to stop gambling despite negative consequences
• Increased risk-taking, which may lead to significant financial impact
• Higher vulnerability in younger players, who are generally considered to be more susceptible to impulsivity and developing addictive behaviors
• Escalation of gambling habits, leading to more severe financial habits and mental health concerns over time

A 2023 article published by the American Psychological Association explores the expansion of gambling to young adults and even children well below the legal age for gambling. According to a 2018 survey, nearly two-thirds of children aged 12 to 18 said they had participated in gambling or gambling-like games (e.g., video game-based gambling) in the previous year. Researchers are still working to understand the psychological impacts of exposure to gambling at a young age. 

How gambling addiction can affect mental health treatment

Despite the potentially serious consequences of gambling disorder, many individuals hesitate to seek professional help. This may be related to a sense of shame, stigma around gambling, or a reluctance to face one’s concerns. Nevertheless, effective treatment for problematic gambling is available, and early intervention may help minimize the risk factors associated with developing or intensifying a gambling disorder.

Support strategies for those affected by gambling addiction

For individuals living with problem gambling or gambling disorder, building a support system may be crucial for recovery. Leaning on friends and loved ones can be important, as can receiving long-term professional mental health care. Research suggests that psychological interventions through therapy can be effective in treating gambling disorder.

Online gambling and mental health recovery tips

In conjunction with receiving the support of a licensed mental health professional, there are multiple steps a person with gambling disorder may take to break the cycle and promote healing. Examples may include:

• Voluntary self-exclusion programs
• Financial management techniques for recovering gamblers
• Self-help strategies to manage gambling urges
• Support groups
• The cultivation of healthy lifestyle habits
• Prescribed medications, such as mood stabilizers and antidepressants

A combination of some or all of these measures may help a person recover. Consulting with a licensed professional is generally recommended. Be sure to also consult with a medical professional before starting, stopping, or changing any medication.

It can help to remember that there’s no shame in seeking support for problematic gambling and that therapists are trained to offer compassionate, nonjudgmental care. As with most mental health conditions, problem gambling rarely resolves on its own without treatment, so seeking help can be crucial and a sign of strength.

Exploring online therapy for gambling disorder

Many people with problematic gambling behaviors experience shame or the effects of stigma. In such cases, online therapy may be a more convenient and comfortable option for receiving care. With a platform like BetterHelp, you can get matched with a licensed therapist who you can meet with remotely via phone, video, and/or in-app messaging from the comfort of home or anywhere you have an internet connection. You can also switch therapists at any time for no additional cost, which can help you find a provider you feel comfortable with.

The effectiveness of online therapy for gambling addiction

A growing body of research indicates that online therapy can often be effective for treating many different mental health conditions, including gambling disorder. For example, a 2024 study suggests that online cognitive behavioral therapy (CBT) may be similarly effective to its in-person counterpart in treating gambling addiction and gambling disorder, making it a viable option for those in need of support. 

As a low percentage of those with gambling disorder typically seek treatment, internet-administered CBT may make it easier for individuals facing this challenge to find support. The same study reported that the online CBT program was well-received and highly rated by participants.

Takeaway

Loot boxes and other elements of online gambling can negatively affect a person’s mental health and overall well-being, as multiple studies have linked them to gambling problems, anxiety, and mood disorders. Recognizing the risks of online gambling and seeking help from a licensed professional may be essential in preventing and treating these disorders. Online therapy, support groups, and self-help strategies may all be part of an effective holistic treatment plan.