Online gambling: Mental health implications and how to curb the emerging menace

BACKGROUND

Gambling is the act of playing a game or taking a risky action for money or a desired outcome. India has a history of gambling embedded in its tradition – from the epic Mahabharata to the long-standing tradition of gambling during Diwali. Common forms of gambling in Indian culture include teen patti, satta, matka, and cock-fights. However, with massive, rather complete penetration of smartphones in almost every household, online gambling has become a new rage. Various modes of online gambling include gaming (casino, poker, bingo), betting (sports, fantasy, betting), and lotteries. A simple online search reveals close to 30 online betting apps in India. India’s online gambling market is estimated to have 12.17 million users and is expected to grow by 8.5% a year. Illegal gambling has approximately 60 billion dollar market in India.[1]

PSYCHIATRIC ISSUES – NOSOLOGY, ETIOLOGY, AND COMORBIDITY

Gambling disorder has found nosological validity in both DSM-5 and ICD-11 and has been categorized as a “behavioral addiction” rather than “impulse control disorder” in previous versions. ICD-11 also includes a qualifier for “predominantly online” following diagnosis of gambling disorder. Those who are emotionally vulnerable, dissocial, or impulsive are more prone to develop pathological gambling. The former resort to gambling to relieve negative emotional states (negative reinforcement), while the latter enjoy the “high” (positive reinforcement) associated with gambling.[2] There is additional contribution of cognitive distortions like “gambler’s fallacy” (a series of independent events are connected and the probability of an event changes based on what happened before), near-miss effect (where a loss is perceived as close to win), and illusion of control (one may be able to control events over which one does not have control). Existing research data have implicated ventral and medial prefrontal cortex, anterior cingulate cortex, striatum, amygdala, hippocampus, and insula.[2] Dysfunctions in these regions could be related to sensitivity to reward and excitement and emotional problems. Studies have shown that more than 90% of those with pathological gambling have a psychiatric disorder and more than 60% have three or more comorbid psychiatric disorders. Substance use disorders, impulse control disorders, and mood and anxiety disorders are the most common comorbidities.[2]

DOES ONLINE GAMBLING POSE A GREATER RISK THAN OFFLINE GAMBLING?

There is already preliminary evidence pointing to the elevated risk of problem gambling among online gamblers. Some of the reasons include increased availability and accessibility, anonymity, and potential for lower expenditure. Online gambling is more popular among young users who are more impulsive in nature. The mobile apps keep improving their interface to make it more attractive to youngsters. One novel feature is in-play betting where one can place bets during the game based on small events like who will get the next wicket or corner kick. There is a shorter delay between wager, outcome, and reward, and this poses the greatest risk.[3,4]

MENTAL HEALTH CONSEQUENCES OF ONLINE GAMBLING

Those having pathological gambling usually seek help due to financial, legal, or social consequences. Multiple stressors often lead to worsening of mood symptoms and suicidal crisis. Heavy financial debt has been independently linked to suicide despite adjusting for mood symptoms. Online rummy-related suicides in Tamil Nadu (TN) led the government to form an expert committee, which led to the formation of a new act in 2023.[5]

LEGAL ASPECTS OF ONLINE GAMBLING

The laws on gambling are enacted by each state individually. The Public Gambling Act, 1867 has been adopted by many states with modifications. Most of the state gaming laws have been framed in the pre-Internet era and prohibit gambling in “physical premises” only. States of Sikkim, Nagaland, Andhra Pradesh (AP), Telangana, and TN have laws for online gambling.

Mostly state laws have exemptions for games of skill and limit legal restrictions to games of chances. Games of chance are typically those where placing bets do not require any skill, practice does not increase chances of winning, and all events are unique and independent. Examples include bingo, roulette, lottery, and slot machines. Games of skill are those games in which the element of skill is more than the element of chance and the chances of winning improve with practice. Examples include games based on team selection/strategy, soccer, chess, and board games. Games of cards like rummy are considered as games of skills in some states but are banned in TN.

States of AP and Telangana prohibit all activities in relation to online gambling including skill games. TN prohibits online rummy and poker also in addition to obvious games of chance like lottery. In April 2023, the Union Ministry of Electronics and Information Technology (MeitY) proposed that independent self-regulatory bodies will verify whether an online real money game is to be made available to the general public or not. Although advertisements across all print media are prohibited as per most state laws, many apps resort to online advertisements including ambush marketing.

Most of the state gaming laws do not impose social responsibility like age-gating, self-exclusion, and provisions to regulate the content, duration, and targeted audience of advertisements. TN act prohibits banks and payment gateways from processing any transfer of funds for online gaming.

TREATMENT STRATEGIES

Psychosocial interventions like gamblers’ anonymous, cognitive behavior therapy and motivational interviewing are helpful in pathological gambling. Pharmacological agents that are useful include naltrexone (with comorbid alcoholism), N-acetyl cysteine (with comorbid smoking), and SSRIs and mood stabilizers (in comorbid mood disorders).[2]

THE WAY FORWARD

Apart from the adverse consequences on mental health, illegal betting apps pose a serious threat to the country’s economy. Predatory betting platforms lure customers with enticements like “no GST” and “no TDS” and evade existing tax and IT laws. To pay-off losses from such betting apps, many youth resort to informal borrowing channels and get caught in a vicious debt trap. There are also issues of data breach and money laundering. They also cause massive loss in tax revenue to the government. Recently, MeitY blocked 174 betting apps under the IT Act. The Central Consumer Protection Authority issued a recent advisory warning strict action against endorsement of online betting and gambling by celebrities and influencers. The ministry should take appropriate steps to ensure registration of online betting apps. Regulation of payment gateways in relation to online gambling is another important step. There are two major issues which need to be worked out by the stakeholders. First, the gray area between games of skill and games of chance needs to be clearly sorted out. Many a time, certain states have banned certain apps, but they challenged the ban in court and won the argument on the premise that a game of skill was being “wrongly victimized”. Second, a central law which uniformly guides all state laws in this regard would be helpful to reduce ambiguity between so many variations in gambling laws across states. This would also help in framing the necessary guidelines to be followed by all betting apps in order to be eligible to operate in India.

Online gambling has several far-reaching consequences not only for the mental health of the youth but also for the financial growth and prosperity of the country and needs to be reined in for the benefit of both.