Health Officials Warn of Gambling Risk Tied to Video-Game Features as Northwell Opens Treatment Program

Northwell Health’s Garden City Treatment Center launched a gambling treatment program in March amid rising demand, and within six months had welcomed a dozen patients — from teens to adults over 50 — as well as family members of those struggling with addiction. "In many ways, video games that young people played as children — many of which have loot boxes that can be won or purchased in the game to allow the player to progress — have primed them for gambling at a very early age by impacting their thought processes," said Heather Hugelmeyer, senior director for addiction services at Northwell Zucker Hillside Hospital.

Experts warn that exposure to gambling-like features in video games, online ads and sports betting content is contributing to the normalization of wagering and related health issues. A poll last year found that 10% of men between 18 and 30 show signs of a gambling problem, compared with about 3% of the general population. The prefrontal cortex — the brain region responsible for decision-making, risk evaluation and impulse control — is still developing in young men, making them more vulnerable. Hugelmeyer added, "These are those kids that grew up with games like Minecraft and Fortnite that are susceptible to this."

Exposure can come from online advertising and loot boxes in games; while the Entertainment Software Rating Board began requiring a warning label for games with loot boxes in 2020, critics argue the measure does not go far enough. The official version of Minecraft does not sell loot boxes, but some unofficial, third-party servers have offered them. In 2022, Epic Games settled Federal Trade Commission deceptive practices allegations, saying there have never been pay-to-win or pay-to-progress mechanics in Fortnite and that paid random-item loot boxes were eliminated in Fortnite: Save the World in 2019. "Fortnite" maker Epic Games paid $245 million to the FTC to settle allegations of deceptive practices.

Video games aren’t the only potential issue. Sports shows where betting lines are announced or scrolled across the bottom of the screen can also spell trouble. Hugelmeyer said, "We now have an entire generation that is growing up with this being normalized to them. That has repercussions. Add that with the convenience of online betting, it’s creating a very dangerous combination."

Hugelmeyer also outlined warning signs for parents to recognize gambling behavior in kids. Be careful of normalizing gambling behavior at home and avoid giving scratch-offs as gifts or encouraging children to bet on sports. Take note if a teen shows a sudden interest in competition, winning or being right. Look for missing household money, unexplained charges, or mysterious cash stores. Be mindful of a child playing video games with loot boxes or paid currency, and ask for more information if they use a parent’s credit to make in-game purchases. Pay attention to significant shifts in attitude toward school and activities, especially if classes or assignments are missed. Behavioral changes such as increased anger, anxiety or depression can also appear. While red flags do not always mean a gambling problem, they warrant conversations about the risks and consequences of gambling, Hugelmeyer said, emphasizing the parent’s role in guiding discussions about the issue.