A Gamble of Life: Adolescent Betting, Mental Health Crisis, and Legal Insights— A Case Report

Dear Editor,

Gambling in India is widely recognized as a leisure activity involving the staking of money on chance-based outcomes. Problem gambling, which ranges from social gambling to addiction, disrupts personal and familial activities and is akin to substance use disorders. Global prevalence rates for gambling disorders are 23% for at-risk, 19% for problematic, and 17% for pathological gambling. ¹ In India, comprehensive studies on gambling are limited, but available data indicates significant problematic behaviors. For instance, a South Indian study found that 33% of gamblers among college students were problem gamblers. ² India’s gambling laws, under the Public Gambling Act of 1867, lack clarity on online betting, which has surged due to technological advances. ³ The Bhartiya Nyaya Sanhita (BNS), ⁴ set to define betting as a crime, aims to address these issues.

Figure 1. The Cycle of Adolescent Gambling Behavior and Its Associated Psychological and Social Impacts: This Figure Illustrates the Progression of Adolescent Gambling Behavior, Starting From Initial Engagement, Which Brings Pleasure, to Repeated Use Leading to Salience and Increasing Bets. It Continues With the Integration of Gambling Into Daily Life, Leading to Social and Academic Decline, and Ultimately to the Development of Compulsive Betting and the Chasing of Losses, Further Increasing Engagement.

Case Report

Mr M, an 18-year-old commerce student, was referred to the psychiatry OPD after attempting suicide by self-poisoning with rat poison. Introduced to a popular online gaming app “Winzo games” two years ago, he initially won ₹50, leading to continuous gambling with tokens. Starting with small bets, he escalated to ₹5,000–₹20,000 over five to six months, spending 10–14 hours daily on the app. His academic performance declined, and he ceased outdoor activities like cricket. To fund his gambling, he took loans using his father’s credit card, amounting to ₹30,000–₹40,000, and bet on IPL matches. Financial stress and losses led to severe anxiety, sleep disturbances, and suicidal thoughts. He used cannabis briefly for anxiety relief. There was no history of other substance use, nor was there any significant family or medical history. Ten days before referral, unable to repay debts and feeling immense guilt, Mr M attempted suicide with rat poison. He was found unresponsive, rushed to the hospital for gastric lavage, and admitted for two days. In the psychiatry, OPD, Mr M had an anxious affect, showed no regret for his attempt, and still hoped for financial recovery through gambling. On initial evaluation, Mr M screened positive for problem gambling with a South Oak Gambling Score of 11, ⁵ and negative for a urinary drug screen. Further, he fulfilled the diagnostic criteria for Gambling Disorder, Predominantly Online, with comorbid Generalized Anxiety Disorder as per the 11th Revision of the International Classification of Diseases (ICD-11). ⁶ He was treated with tablet clonazepam 0.75 mg/day, which were tapered off in two weeks, tablet naltrexone 50 mg/day for cravings, and tablet escitalopram 10 mg/day for anxiety. He received two sessions of motivational enhancement therapy during his hospital stay and four sessions after discharge. At a three-month follow-up, Mr M had resumed academic and occupational activities, reporting no gambling cravings.

Discussion

This case is unique, as the adolescent’s gambling addiction started with seemingly harmless online gaming and escalated into a severe mental health crisis, leading to a suicide attempt. It highlights the growing impact of online gaming apps like “Winzo games,” which blur the lines between gaming and gambling by offering over 70 casual games like Ludo, Candy Crush, and fantasy sports. The monetization of wins fosters a sense of achievement, encouraging continued play. ⁷ The app’s design, incentives, token rewards, partial withdrawals, and targeted ads further fueled his transition from casual gaming to high-stakes betting. While gaming platforms contribute to employment and economic growth, their casual introduction of gambling to vulnerable adolescents without addressing this downside is a serious concern. India’s state-based gambling laws lack uniformity, and there are no specific regulations for online betting. Games like Ludo, classified as games of skill, often escape regulation and act as gateways to gambling. A 2017 survey of Bombay Street students found that they perceived gambling as “only a game of chance,” indicating a lack of awareness of its implications. ⁸ Yash Pal’s study highlights the gambling risks of online fantasy games, where varied stakes, cash-out options, and immersive sound effects encourage continuous play. Frequent near misses, observed by 68.8% of participants, further promote addiction. ⁹ The upcoming BNS, effective in 2024, classifies unauthorized betting and gambling as “petty organized crime,” with penalties of one to seven years. ⁴ However, the BNS lacks clear definitions for “gambling” and “betting,” which could lead to varying state interpretations, particularly for online gambling. Whether these amendments will effectively curb gambling remains uncertain. This case uniquely examines how the design and features of gaming apps contribute to the progression of gambling.

Discussion

Behavioral addictions like gaming and gambling addiction are steadily rising, and without understanding their roots and implementing control measures, this rise could become exponential and harmful to young minds.