Youth and problem gambling

Introduction

Problem gambling can affect people across the lifespan, although young people aged 10 to 24 years have higher rates of problem gambling than adults. Different factors affect the risk of youth problem gambling compared to adults, and youth with problem gambling frequently experience co-occurring mental health problems. It is important to understand and apply developmentally appropriate screening, assessment and treatment practices for youth with problem gambling.

This webpage looks at the evidence on screening, assessing and treating youth with problem gambling, and shows you how to put it into practice. This information for mental health and addiction service providers is based on a review of the evidence and was reviewed by experts in the field of youth problem gambling.

About problem gambling in youth

Research shows young people aged 10 to 24 years have higher rates of problem gambling than adults (Boak et al., 2018; Calado et al., 2017; lalomiteanu et al., 2018). While these findings may vary due to the context and the tools used to estimate prevalence, the findings point to a need for more research and support services targeted to this population, as behaviours formed in adolescence can contribute to problem gambling in adulthood (Delfabbro et al., 2016; Dowling et al., 2017).

Most people tend to underestimate the number of young people that engage in gambling behaviour. Findings from the most recent Ontario Student Drug Use and Health Survey (Boak et al., 2020) showed that one-third (32 per cent) of students reported participating in one or more gambling activities in 2019. About 4 per cent of secondary school students reported symptoms of low- to moderately-severe gambling problems, and 2 per cent reported symptoms of a high-severity gambling problem.

The Canadian Youth Gambling Survey (Elton-Marshall et al., 2016) indicated that 41.6 per cent of adolescents in their sample (youth aged 13-19 in Newfoundland and Labrador, Saskatchewan and Ontario) had gambled in the past three months. This study also indicated that a higher proportion of youth who gambled online scored "high" (17-4 per cent) or "low-to-moderate" (18.2 per cent) in problem gambling severity than those who engaged in land-based gambling (1.2 per cent and 7.2 per cent respectively) (Elton-Marshall et al., 2016).

Common types of gambling activity

Although most regulated gambling activities are illegal for adolescents due to legal age restrictions, youth still engage in various types of gambling activities (Derevensky & Gilbeau, 2015). For example, Ontario students in grades 7 to 12 report gambling predominantly on dares or private bets (11.6 per cent), sports pools (9.8 per cent) and card games (9-4 per cent) (Boak et al., 2018).

The distinction between gambling and gaming has been blurred in ways that make gambling more appealing and accessible to young people. Beyond traditional types of gambling, youth gambling activities include a variety of unconventional forms of gambling. These activities reflect the convergence of gambling and video game design, as well as newer technological innovations in online and Internet gambling. Some examples include the following:

Loot boxes/loot crates

Loot boxes are mystery video game "grab bags" containing virtual items such as weapons or armour that are rewarded via game play or purchased with real money or in-game currency. Because the contents are unknown, randomly generated and may or may not be useful to the player, choosing to open them equates to gambling in that it involves both risking something of value and an element of chance.

Social casino games

Social casino games are free-to-play gambling-themed games available on social media or mobile apps. They have their own virtual in-game currency (e.g., credits, coins, dice) that can be earned (e.g., watching advertisements, referring friends) or sometimes purchased with real money. These games typically introduce youth to gambling at an early age and offer better odds of winning, which can lead to gambling for money (Velselka et al., 2018).

Skins betting

"Skins" (which can be obtained through loot boxes) are virtual, in-game items that provide cosmetic alterations to a player's weapons, avatar or equipment without increasing the character's abilities. They therefore offer no real advantage to game play. However, skins have value as a "collector's item" within a tiered system where rarer skins are harder to obtain and therefore hold more value. A gambling subculture on unregulated websites allows skins to be used as currency to place bets on e-sports or other games, such as roulette. A major concern in skins gambling is underage gambling, as websites often do not require age or ID verification checks (Greer et al., 2019).

E-sports betting

E-sports are organized video game competitions between highly skilled game players or teams that fans watch either online or in-person where the event is being held. Because they share many of the same elements of traditional professional sports, e-sports gambling services, vendors and practices have proliferated in recent years. There is a lack of reliable data on the prevalence, characteristics, and gambling behaviour of e-sports bettors, although one study showed that rates of e-sports betting were highest among younger adults (18-24-year-olds and 25-34-year-olds). In addition, a greater proportion of the youngest demographic (18-24-year-olds) was more likely to bet on e-sports with skins rather than cash (Gambling Commission, 2018).

Focus on loot boxes

Young people who play video games may consider acquiring & purchasing loot boxes as just a part of the game rather than a form of gambling. This is because loot boxes have become very common in video games, they are not traditional forms of gambling, and they are not subject to the same regulatory laws and restrictions that govern youth behaviour.

Research shows that a significant number of youth gamers purchase loot boxes (Hall et al., 2021; Zendle et al., 2019). There is growing concern among both regulators and researchers that spending money on loot boxes may be linked to gambling-related harm in adults and young people. One study of older adolescents (aged 16-18) found that the more money young people spent on loot boxes, the greater the severity of their problem gambling (Zendle et al., 2019).

Social media, gambling and youth

Young people are active users and consumers across a variety of social media platforms. As a result, they can be exposed to a variety of gambling content, whether via industry-driven marketing campaigns or user-generated content. Some examples include the following (Kleynhans, & Sims, 2020):

• Even on social media sites like YouTube that have strict rules around gambling advertisements (e.g., restricting ads to minors), Mystery Box vendors can pay content creators to promote their products to subscribers (some of which have large youth audiences) and provide links for where to buy these boxes. Similarly, young social influencers commonly promote skins gambling on their channels to large audiences of children and adolescents (Greer et al., 2019).
• Social media streaming platforms such as Twitch allow users to stream themselves gambling for up to 30 minutes. Some streamers are directly sponsored by gambling companies, offering incentives (e.g., discounts, affiliate promo codes) and providing links to viewers for the gambling company's game/website.
• The social media video platform Tik Tok showcases a large amount of gambling-related content in the form of tipsters. Tens of millions of videos discuss gambling tips, fantasy sports, e-sports, and stock market investing, which attracts young viewers.

What does the evidence say?

Several factors can put young people at risk for problem gambling, including (Afifi et al., 2016; Bergevin et al., 2006; Chinneck et al., 2016; Derevensky et al., 2007; Dickson et al., 2008; Dowling et al., 2017; Edgerton et al., 2015a, 2015b; Felsher et al., 2010; McBride & Derevensky, 2016):

• having a parent or other family member with a gambling problem
• substance use
• alcohol use
• depression and/or anxiety
• trauma
• childhood abuse
• impulsivity/attention-deficit hyperactivity disorder
• difficulty making friends
• not being connected or close to family members
• poor coping skills
• not having a sense of belonging at school
• being male.

Many of these risk factors can also co-occur with problem gambling in adolescents, including substance use disorders and mood or anxiety disorders (Ferrara et al., 2018).

Whereas adults are more likely to gamble for financial gain, adolescents are likely to gamble for entertainment, to escape negative emotions, to relieve boredom or loneliness, and to socialize or compete with others. Younger people are also more likely to take risks, which could lead to problem gambling (Derevensky & Gilbeau, 2015).

Youth with problem gambling can face a number of negative consequences, including (Afifi et al., 2016; Apinuntavech et al., 2012;

Brunelle et al., 2012; Cook et al., 2015; Derevensky & Gilbeau, 2015; Dickson et al., 2008; Neighbors et al., 2002):

• substance use problems
• mental health problems
• problem video gaming
• criminal behaviour
• family problems (e.g., parenting difficulties, family conflict)
• social/interpersonal difficulties
• difficulties in school
• financial problems.

Adolescents with gambling problems have also been found to have significantly higher rates of suicidal ideation and attempts than non-gamblers and social gamblers (Cook et al., 2015; Nower et al., 2004). While further research is needed to better understand the significant effects of problem gambling in young people's lives, studies of adult populations have shown that problem gambling produces a wide range of negative consequences that result in significant psychological distress (e.g., disrupted family relationships, financial pressure, deteriorating work or school performance, truancy, aggression, and criminal behaviours to finance gambling) (Nower, 2004).

The Evidence Informed Practice page on suicide and problem gambling includes more details, along with risk assessment and safety planning tools, some of which are designed specifically for youth.

How do I put the evidence into practice?

When providing clinical care to a young person who may have a gambling problem, it is important to consider their developmental stage, needs and goals. The following screening, assessment and treatment approaches can be effective for youth at any point along the continuum of gambling severity.

Screening and assessment

Although most screening tools for youth have been adapted from adult versions, the following have been validated for use in adolescents (Derevensky & Gupta, 2005; Elton-Marshall et al., 2016):

• Canadian Adolescent Gambling Inventory's Problem Gambling subscale (CAGI)
• South Oaks Gambling Screen-Revised for Adolescents (SOGS-RA)
• Diagnostic Statistical Manual-lV-MR-J (Adapted-Multiple Response format for Juveniles) (DSM-IV-MR-J)
• Massachusetts Adolescent Gambling Screen (MAGS).

If you determine that your client has a gambling problem, an assessment will help you understand their gambling behaviours and any co-occurring mental health problems, medical conditions or environmental factors that may be contributing to the problem (St-Pierre & Derevensky, 2016). Learn more about screening and assessment.

Treatment

Currently, there are no universal best practices for the treatment of youth with gambling problems. Since few youth are referred to or access treatment, there is little research in this area and most treatments used in practice are based on what has been proven effective for adults (St-Pierre & Derevensky, 2016). The following approaches have shown some promise for the treatment of youth problem gambling:

• Cognitive-behavioural therapy (CBT) is a time-limited form of psychotherapy that teaches clients to shift their thoughts and behaviours related to gambling and respond to their urges in a more healthy way. CBT was found to improve gambling outcomes and illusions of control up to six months after treatment when offered as weekly, one-on-one sessions over three months to youth aged 17 to 19 years (Ladouceur et al., 1994) and as weekly group sessions over four or six weeks to college students aged 19 to 25 years (Larimer et al., 2012).
• Motivational and personalized feedback approaches, either offered separately or together, have shown some promise for addressing problem gambling in college students aged 18 years and older. A motivational approach (i.e., motivational interviewing or motivational enhancement therapy) is a person-centred counselling style that addresses ambivalence toward change and emphasizes personal autonomy, while personalized feedback focuses on correcting perceived norms about gambling (St-Pierre & Derevensky, 2016). Two studies examining brief interventions with both motivational and personalized feedback elements found an improvement in gambling outcomes (Larimer et al., 2012; Petry et al., 2009). Other studies have found that personalized normative feedback or becoming aware of the gambling norms of peers can help prevent problem gambling in college-aged students (Neighbors et al., 2015; Takushi et al., 2004).
• Family-based interventions include parental monitoring, connectedness, and involvement in a youth's life. Research shows that these types of interventions lead to fewer gambling problems, although this may be age- and situation-specific (Allami et al., 2018; Dickson et al., 2008). Because parental gambling increases the likelihood of gambling participation and problem gambling in youth (Magoon & Ingersoll, 2006; Zhai et al., 2017), it may be beneficial to involve parents and family in treatment as appropriate.

Other considerations

Depending on the severity of problem gambling and concurrent disorders, young clients may also benefit from these additional supports:

• If your client is experiencing co-occurring mental health problems, address these alongside their problem gambling (Ferrara et al., 2018). It is also important to work together with your client's other healthcare provider(s) to ensure they receive coordinated care.
• If your client expresses suicidal thoughts, address them immediately. Learn more about suicide and problem gambling.
• If your client consents, consider involving family members in treatment sessions and/or providing supports to family members separately, as is done with adults (Kourgiantakis & Ashcroft, 2018; Kourgiantakis, et al., 2013). Parents can benefit from information about youth problem gambling, including ways to address it and engage the youth in treatment.

Additional resources

The following websites provide additional information about youth gambling:

• YMCA Youth Gambling Awareness Program: www.youthbet.com
• International Centre for Youth Gambling Problems and High-Risk Behaviors: www.youthgambling.com
• The Young Gamers and Gamblers Education Trust (YGAM) Parent Hub: https://parents.ygam.org/

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