Features of Internet Gambling That May Impact Problem Severity
Evidence suggests that there is a relationship, albeit complex, between the availability of gambling opportunities and increased levels of related problems [
25‐
30]. Consequently, it has been asserted that the easy access to gambling provided by Internet modes may lead to the development or exacerbation of gambling problems [
1,
22,
24,
31].
Internet gambling also has some unique features that may pose additional risks for harm, particularly for vulnerable populations. Internet gambling differs from land-based gambling primarily in terms of its constant availability, easy access and ability to bet for uninterrupted periods in private, facilitated by the interactive and immersive Internet environment [
2,
18,
32‐
34,
35•]. The use of digital forms of money (e.g. credit cards, electronic bank transfers and e-wallets) appears to lead to increased gambling and losses, particularly for problem gamblers, as people feel that they are not spending ‘real’ money [
16,
32,
36,
38,
39]. Surveys indicate that 19–28 % of online gamblers report it is easier to spend more money online [
20,
39], while 15 % consider this form to be more addictive than land-based gambling [
15].
The immersive nature of Internet gambling is also clear through reports that online gamblers, particularly those experiencing problems, are more likely to report disruption to their sleep and eating patterns than land-based gamblers [
18,
36,
37]. Data collected by gambling treatment services suggest that Internet gambling currently makes a small, but growing, contribution to gambling problems among those seeking formal help [
37,
40,
41]. Surveys have found that online problem gamblers are significantly less likely to have sought formal help as compared to land-based problem gamblers [
20,
42,
43]. This suggests that problems related to Internet gambling may be underrepresented in treatment-seeking samples and are likely to increase over time as more people participate in this mode and problem severity increases.
The Relationships Between Internet Gambling and Gambling Problems
Initial concerns over the harmful effects of Internet gambling are sensible as numerous studies have found greater levels of problem gambling severity amongst samples of Internet as compared to non-Internet gamblers [
13,
31,
41,
43‐
46,
47•,
48]. For example, in an Australian nationally representative prevalence survey, the overall problem gambling rate among Australian non-Internet gamblers was 0.9 %. In comparison, the rate among Internet gamblers was three times higher at 2.7 % [
13]. Fewer than 60 % of Internet gamblers were classified as non-problem gamblers, compared to more than 80 % of non-Internet gamblers, which was a significant difference. Furthermore, the average PGSI score of Internet gamblers was significantly higher than that of non-Internet gamblers. Similarly, a total of 16.4 % of Internet gamblers were classified as either moderate or problem gamblers, compared to a rate of 5.7 % among non-Internet gamblers [
43]. However, there is little evidence available that would enable the causation of Internet-related gambling problems to be determined, and most longitudinal studies contain too few Internet gamblers to provide meaningful analyses.
Despite some indications of a positive correlation, the relationship between Internet gambling participation and problems has not been confirmed. Some studies have found similar rates of gambling problems among Internet and land-based gamblers [
15,
41]. Research also suggests that very few Internet gamblers gamble exclusively online [
12••,
24,
48,
49]. Further analyses of prevalence studies that control for factors such as demographic variables and gambling involvement have found that participation in Internet gambling does not independently predict problem gambling severity [
13,
20,
36,
46,
50••,
51,
52]. For example, even though Internet gamblers were more likely to be classified as being at risk or experiencing gambling problems in a nationally representative survey, when other variables were controlled for, Internet gambling participation was not predictive of problem gambling severity [
13]. Similarly, using data from the 2007 British Gambling Prevalence Study, LaPlante and colleagues [
50••] found that gambling formats (particularly Internet gambling) and problem gambling were not significantly related when gambling involvement was included in the model (based on the number of gambling activities used in the past 12 months). This finding was in contrast to earlier analyses [
31] and demonstrates the importance of controlling for confounding factors.
Further evidence to question the extent to which Internet gambling increases rates of problem gambling can be taken from prevalence studies. Despite rates of Internet gambling increasing in several jurisdictions, little evidence has been found to suggest that the prevalence of problem gambling has increased [
13,
53,
54]. An analysis across 30 European jurisdictions failed to identify any association between prohibitions against online gambling, gambling licencing systems, the extent of legal gambling opportunities and the prevalence of gambling disorder [
55••].
The Impact of Internet and Land-Based Gambling on Gambling Problems
Evidence is emerging that Internet gambling is not only predictive of gambling problems but also that when other variables are controlled for, individuals who gamble online may have lower rates of gambling problems. Studies that have isolated Internet-only gamblers have found that these gamblers have lower rates of gambling problems than gamblers who only gamble offline and those who use both online and offline modes [
48,
51,
56•]. Gamblers who engage in online as well as offline modes appear to have the greatest risks of harm, which is likely related to their greater overall gambling involvement [
48,
56•,
57••].
The relationship between Internet and problem gambling is likely mediated by the use of land-based gambling. A study examining actual Internet gambling account activity combined with a self-report measure of gambling problems confirmed that gambling involvement, as indicated by number of games played and days bets placed on in past year, is predictive of gambling problems amongst the sample of Internet gamblers analysed [
58]. These results are consistent with a wide body of research which suggests that gambling disorder is related to high levels of involvement (in terms of expenditure, time, frequency and variety of gambling forms used) [
13,
36,
52,
59‐
63]. Therefore, research suggests that highly involved gamblers are more likely to engage with Internet modes, including those with existing gambling problems, than less involved gamblers. However, a study comparing behavioural data from online gambling sites with self-report of gambling problems found that not all highly involved gamblers were at risk for gambling-related problems, and likewise, not all those with low involvement screened negatively for gambling-related problems [
64]. This is an important finding as it demonstrates (unsurprisingly) that a single gambling index (such as a frequency of gambling, or expenditure) is not adequate to predict gambling problems.
Involvement in Internet gambling appears to be more likely among gamblers with existing problems as compared to non-problem gamblers [
35•]. Studies have found that one third to one half of Internet gamblers experiencing gambling problems attribute these to land-based forms of gambling, and over half report that they had existing problems before they ever gambled online [
13,
20]. This is consistent with one study reporting that problem Internet gamblers prefer land-based over Internet gambling [
24]. Few studies have investigated the types of gambling that are most likely to be associated with problems related to Internet gambling. In an Australian national survey, almost half of all gamblers stated that land-based electronic gaming machines were the primary cause of their problems, including among Internet gamblers [
13]. Internet gamblers are most likely to associate their problems with casino games, sports and race wagering and poker [
13,
20]. In particular, sports betting appeared to be associated with moderate risk and problem gambling, a finding not replicated among land-based only gamblers [
13,
20]. However, this finding may be specific to the Australian context as sports wagering is one of the few legal forms of online gambling.
Conversely, for some Internet problem gamblers, this mode of gambling appears to be the proximal cause of problems, with problem gamblers reporting that their problems started after they first gambled online and around half specifically attributing problems to this mode [
13,
20]. These results are consistent with other research findings [
57••,
48], suggesting that for some problem gamblers, Internet gambling played an important causal role, while others had existing problems, which were likely exacerbated by Internet gambling. However, most studies examining the relationship between Internet gambling and problems are cross-sectional, which do not allow for causality to be determined and self-report is subject to bias and reliant on accuracy of reporting. Longitudinal research will be an important addition to this field to address these issues. As Internet gambling increases in popularity and use, it is likely that the next generation of gamblers will use Internet modes earlier in their gambling career, which may increase the proportion of individuals who experience problems that are attributed to this mode. However, there is a growing recognition that Internet gamblers are a heterogeneous group, and research needs to consider how Internet gambling behaviour may be integrated more broadly with offline gambling [
48,
65].