This cross-sectional study examined whether loot box purchasing (frequency and money spent) is associated with problem gambling severity and gambling-related harms in a nationally stratified sample of adult regular gamblers who also play video games (N=3,709), controlling for traditional gambling activities like electronic gambling machines and sports betting.
Of 3,709 participants, 1,922 (51.8%) had purchased loot boxes. Loot box purchasers showed significantly higher rates of addiction and mental health comorbidities (e.g., substance use, depression). Both frequency of loot box purchasing and money spent were independently associated with greater problem gambling severity and gambling-related harms, even after controlling for other forms of gambling.
Cross-sectional design prevents causal inference. The sample was restricted to regular gamblers who also play video games, limiting generalizability to the broader population. Self-reported measures of loot box spending and gambling severity may introduce recall or social desirability bias.
Clinicians assessing problem gambling should routinely ask patients about loot box purchasing, as it is independently linked to gambling severity and harms—even among those already engaged in traditional gambling. Given the lack of age restrictions on loot boxes, screening may be especially relevant in younger adult populations.
