Digital, Culture, Media and Sport Committee
Oral evidence: Immersive and addictive technologies, HC 1846
Wednesday 27 February 2019
Ordered by the House of Commons to be published on Wednesday 27 February 2019.
Members present: Damian Collins (Chair); Clive Efford; Paul Farrelly; Julian Knight; Brendan O'Hara; Jo Stevens.
Questions 55 - 128
Witnesses
I: Dr Henrietta Bowden-Jones, Director, National Problem Gambling Clinic, Dr Daria Kuss, Nottingham Trent University, Dr David Zendle, York St John University.
Written evidence from witnesses:
Examination of witnesses
Dr Henrietta Bowden-Jones, Director, National Problem Gambling Clinic, Dr Daria Kuss, Nottingham Trent University, Dr David Zendle, York St John University.
Q55 Chair: Good afternoon. Welcome to this session of the Digital, Culture, Media and Sport Select Committee as part of our inquiry on immersive and addictive technologies.
I will start by asking the witnesses if they could address one of the central questions to the inquiry: are we right to use the term “addictive” when talking about the way people engage with technology in terms of playing games or engaging with social media? There are some people who would say it is wrong to call it an addiction; it may be a disorder but it is not an addiction. Do you feel we should talk about “addiction” in terms of some people’s engagement with technology?
Dr Bowden-Jones: What a great question to start with. It is a very big issue for people like me—a trained addiction psychiatrist who has spent many years detoxing patients from crack, cocaine, heroin and so on—because we find ourselves in a new world, reading about behavioural addictions and in particular addiction in relation to behaviours that may be excessive but that we perceive as not necessarily addictions as such when you look at the harm.
Let us try to create some linear progression—for example, for alcohol and drugs it can start with recreational use and end up with death, often, or indeed extremely severe consequences, for example someone losing their home if they are a problem gambler, or their marriage. That is helpful when you look at the new behavioural addictions, and trying to incorporate them not only in the diagnostic manuals that everyone uses, but also because it is important not to exaggerate something that is done by many. Even though we do not have at the moment good enough prevalence data to talk about the prevalence of gaming disorders, for example, in the UK—we are much closer to feeling more confident when we looking at gambling disorders—when we look at those prevalences, we realise that millions of people are gaming. A very small minority of people will have the severity of presenting symptoms—later I am sure we will move on to that—that require us to talk about a “gaming disorder”, which is the equivalent, if you look at it in a psychiatric way, of an addiction to gaming. Therefore, we need to be extremely careful.
It alarms me when I look at some of the articles in the media talking about an “epidemic” of “digital addiction” or “gaming addiction” because that is not keeping them at pace with all the other addictions and other behaviours.
Dr Kuss: I would absolutely agree with Henrietta here. It is crucial for us to draw a distinction between something that may be problematic and something that is indeed addictive. This is a question we have been asking ourselves in the research we have been doing at the International Gaming Research Unit for a considerable amount of time. If you take the whole population of gamers, involving millions of people all around the world, only a very small percentage are developing problems that may be associated with addictions in the way that we are used to for substance-related addictions.
For those individuals who are indeed experiencing these kinds of problems, the symptoms are quite similar to substance-addiction related symptoms and can be very severe. For example, I used to work at the first and largest research and treatment centre in Europe, which is based in Germany, and I have seen how very detrimental the symptoms can be to individuals’ lives when they have lost their relationships, lost custody of their children, and lost their jobs as a consequence of their excessive gaming.
Although we do not want to overpathologise something that is a very enjoyable pastime activity for the large majority of gamers, we do need to be aware of the significant problems that a small minority do experience.
Dr Zendle: I agree with the statements made by my fellow witnesses. I would also go further and say that as well as thinking about addiction and harm related to games in general, we also need to consider seriously the specific things that go into the games.
A game can be considered like a box that can have many things in it and new things are always being put into it. Most recently, the thing I am probably going to spend a lot of my time here talking about is loot boxes, which is a new mechanism. As well as considering the games themselves, we also need to consider specific things within the games, specific mechanisms and specific forms of monetisation, and see whether those are linked to any harm as well.
Q56 Chair: With the comparisons you have used looking at, say, alcohol addiction, there may be a relatively small percentage of people who drink alcohol and who are alcoholics, but there are rules in place that encourage the manufacturers of the products to do so responsibly in terms of the volume of alcohol contained within the product, the way in which it is promoted and the extent to which people are encouraged to use the product. A sense of responsibility exists on behalf of the producers.
Do you feel we should also think about how that sort of responsibility should apply to the way different sorts of technologies are developed? Is it responsible for someone to create a game that rewards excessive play, for example? Should we be looking at some of those measures to encourage responsible gaming and playing rather than irresponsible gaming?
Dr Bowden-Jones: Can I take one step back? I realise that in answering your question none of us addressed the fact that we are dealing with a population that is often quite dissimilar to the other populations affected by different types of addictions. There is a journey into alcohol dependency and into heroin addiction that often takes many years.
The population we are looking at here tends to be young, certainly significantly younger even than the problem gamblers we see at the National Problem Gambling Clinic—these are people between the ages of 12 and 22. We are talking about people who are often living at home, and who are under parental control up to a point in relation to how much time they are spending doing things.
When we look at impulsivity levels, which are high in this group of people, we cannot exclude in the conversation the idea that whatever measure we are looking at and whatever extreme symptoms we are looking at, they will always be somehow constrained by the environmental constraints the family imposes, in a good way normally or indeed sometimes in a bad way. Some of the patients I have treated would definitely not have been gaming compulsively if their families had not been pretty dysfunctional and if the anxiety levels within the families had not been as high. We are talking about individuals and their families when they are so young.
Q57 Chair: Absolutely, that is an important point. In the work you have all done, to talk about an addiction to playing games is a very wide-ranging statement because it might suggest that all games are largely the same. But they are very different and the level of engagement and immersion in those games could be different as well.
Do you feel that there are examples of good and bad practice when dealing with people who demonstrate a gaming disorder? Have they been exposed more to one sort of game than another? Do you have any concerns about different products on the market or not?
Dr Kuss: When we look at the research that has been done over the last 10 or 20 years into gaming addiction or gaming-related problems, we find that particular types of games such as massively multiplayer online roleplaying games, or multiplayer online battle arena, games appear to have a higher addictive potential in comparison to other games, including offline games. Players spend increasing amounts of time playing those games, up to 48 hours without an end. Those games are extremely immersive. They give the player all sorts of rewards in terms of social rewards, recognition and achievement-related rewards that they may not be able to get in a real-life offline setting. There are a number of reasons why these games can be more addictive than other types of games.
Given the research we have at this present point in time, it would appear to be a good idea to specifically target those games that show this increased addictive potential with regards to regulation and increased social responsibility measures on behalf of the gaming industry.
Dr Bowden-Jones: We see from a behavioural perspective often a change starts with a switching from a real-life investment in friendships and achievements. A lot of the people I have seen were good at sports. They were winning prizes at school. They were at the top of the class. Gradually, you see a withdrawal from real life, which is noted by the family and ends up being a cause of tension within the household. The individual spends more time online and invests in online relationships. The fact that these are often global relationships means that across multiple time zones it is possible never to want to go to bed. A lot of people I have treated dropped out of university or school because they were compelled—and some of them did have slightly obsessional traits—not to let go because they feared that in doing so they would be letting their new friends and new teams down, having already isolated themselves from their real-life cohorts who used to drive them and give them pleasure.
Dr Zendle: The main thing we are talking about is the social nature of games and that is quite different to how many people think about games. A lot of the time people, be they policymakers or the general public, think about games as being like a film—a story that gets transmitted to a viewer. They are playing a game with guns and soldiers and they are thinking about guns, just like you might be thinking about guns if you are watching a war film, or they think about games as being like a pinball machine, where you play and you try to match a best score and you try to win and do that again and again.
There is a third way to think about games, which we have started talking about here and which is probably more appropriate for many of these modern games that people are playing a lot. A more appropriate way to think about these games is as a playground or a social space. Games are a place where people go out to engage in their culture. It is a culture that might be very alien to the culture of people outside the games, and it might have all sorts of stuff that is hidden from people outside the games who do not understand the culture and socialisation within them.
Because games have started to operate primarily as social spaces for many players, of course there is a range of different ways they can harm people. Some of these social spaces will perhaps be more likely to cause harm than others. For instance, if I have a playground and people are meeting each other and having a nice time, that is okay, but what if I put a slot machine in the middle of the playground? That slot machine metaphor is a loot box. That is what I was going for there.
You are right to say that we should distinguish between the specific features of the games we look at and how they might lead to harm, rather than taking a blanket approach and just looking at games in general.
Dr Bowden-Jones: You asked us about features. We can learn from things that have been done well in other countries, and indeed in this country, in relation to other behavioural compulsions.
These young people are very impulsive. It is not going to be up to them. It is not going to be very easy for them after three or four hours of play to remind themselves that they need to stop to do their homework, get enough sleep or go down and have a meal with their families.
Having witnessed how important technology has been in protecting vulnerable problem gamblers from continuing to gamble, how important blocking software has been in keeping people abstinent, how important making it impossible for them to spend on gambling has been, most of our patients are now abstinent also very much because of technology that is helping them.
Translating this to a world of gaming, a new world, how do we help these young people? Personally, I would like to see a big conversation happening with whatever regulatory body ends up being created. We need some sort of multidisciplinary body that is particularly focused on the potential harms of specific games, looking at allowing people to precommit to a specific amount of time, potentially in the company of their teachers or their families—the people who are with them all day long—rather than leaving decisions to 12 or 13 year-olds as to what is right, and just getting things to turn off with a blank screen. I love that idea. It is not as if their business is going to go bankrupt. They are just playing a game. The idea is that if you have done it for too long, that is that. I had to say that. It is a bit extreme.
Q58 Chair: I want to be clear. Do you believe there are features within games that reward and encourage excessive play, or is it just the mental flow of the immersion in the game that encourages people to play?
Dr Zendle: I am not sure, but I would like to find out. That is my opinion.
Dr Kuss: There are a number of features that engage different kinds of motivations on behalf of the player. One of those features is gambling-related content, such as the loot boxes, which I am sure you can talk a little bit more about.
In addition, when we are looking at gamers themselves and the motivations for playing, we cannot disregard the importance of social relationships. Those players who have addiction-related problems as a consequence of gaming tend to have problems with regards to their social relationships outside of the game. They often are socially anxious, maybe socially phobic, particularly awkward in the context of engaging with people outside of the gaming context. The game makes it easier for them to connect to others because a number of the real-life characteristics are taken away—for instance outward appearance—for the requirement of being successful or achieving something within the game. One of the features would also be the social element.
Dr Bowden-Jones: One other feature that people are reporting now clinically is the fact that the game never ends. There used to be years when the game ended and so everyone could stop playing, but now these people often have a sense of identity and self-confidence that is not good. Sometimes it has never been good; sometimes it has been good and has got worse because of their isolation.
Either way, the issue remains that they know that if they let go things will be happening without them. If I look at the more psychological drivers for this particular type of person, feeling they will be losing out on anything that happens when they go to bed is pretty difficult.
Q59 Paul Farrelly: We will be sifting through lots of evidence. We have had nearly 100 submissions so far.
I have just come from some events today that I have been sponsoring during Eating Disorders Awareness Week. There are aspects of compulsive behaviour where you can very clearly measure the health effects. Anorexia nervosa is a leading cause of suicide and people suffer physical and mental harms. Likewise, alcohol and drug addiction are also measurable. When it comes to gambling, as well, you can measure the harm to people in their wealth and how it affects their families.
But when it comes to gaming and measurement, are there lots of value judgments involved about how people should or need to live their lives that makes this area more susceptible to studies that will say this on the one hand and that on the other?
Dr Bowden-Jones: It is great that you raised this because the last thing we would like to see is a perception of gaming as being harmful. One of the initial points made is that the majority of people are gaming very happily and, if someone decides that instead of going fishing for 10 hours on a Saturday they want to game for 10 hours, in a way, as long as there are no negative consequences, it is their right to do so.
But as you rightly point out, you are not dying from not eating, you are not losing your home and your family from not paying your rent. So what do you look at?
If I had to summarise it in one sentence, it is a loss of control over what matters most to you—what matters most to you and potentially to your family. If you are a 12 year-old, that might be helpful. If you are a young child, it will be to do with your academic achievement and we do see a significant drop in grades by the time people are gaming nonstop because they are not sleeping and are gaming in secret. We will see social harm because they become isolated. They are moving away from the traditional social support that most people around them will be relying on.
The family interactions become so difficult and I then struggle with parents who are so horrified by what is happening that, particularly if the child is a bit older—16 or 17—they say, “He is not participating in family life. He has opted out”, and so they let these young children live in their rooms a very monastic life. They have dropped out of school. They are having the meals on their own. The mother—it is normally the mother—is leaving a tray outside the bedroom door.
These people are mainly men, the ones I have treated, and they are switching between porn and gaming. That is what they do all day. They have given up. There is a lot of harm when you feel you are almost abandoned by the structure you have grown up within.
These are just some of the harms, but most importantly you have lost control. A lot of people have tried to stop. Before they seek help, they have tried to stop and they have been unable to, just like many other addictions. The compulsion is so great. You know it is harming you and you realise you should stop, but you cannot do it. That is important, too.
The last thing I will mention is the impact on your mood and on your anxiety levels. After all, you will be assessing things in some moments of clarity when you are not playing and you know, “This is all no good at all. Where is it going?”
Q60 Paul Farrelly: Dr Kuss, can I ask you the same question without repeating it?
Dr Kuss: Yes. Henrietta has summarised very well quite a number of the negative impacts gaming can potentially have on individuals. In addition to what you have already mentioned, we need to think about comorbidity, and the co-occurrence of other mental disorders, which in the context of gaming addiction are quite pronounced and similar to the occurrence of any other mental disorder. They tend to occur not in isolation.
With gaming addiction, we tend to find in the clinical context as well as in the research context so far a high number of individuals who also experience anxiety-related symptoms, mood-related symptoms, depression, for example, and also personality disorders such as bipolar disorder, which is also to do with people’s moods, attention deficit hyperactivity disorder and obsessive-compulsive disorder. In some instances psychosis or psychosis spectrum and schizophrenia spectrum disorders have been mentioned as well.
We need to bear in mind—and this is very important also for the treatment context—that if there are comorbidities present in the respective individuals who are seeking treatment, those comorbidities need to be treated as well. From the research we have been doing, it seems that the treatments that are effective for gaming addiction, both psychopharmacological treatment and psychological treatment, may be effective for the other conditions as well.
Q61 Paul Farrelly: Dr Zendle, you will get plenty of time to talk about loot boxes and how they are different from addictions to Panini, sports cards and the Yu-Gi-Oh gaming cards that cost me a fortune when my son was growing up, but what do you say in response to the question I have just asked?
Dr Zendle: I have nothing further to add to the comments my co-witnesses have made.
Q62 Paul Farrelly: That is the right sort of answer we like. While we are sifting through evidence, it is always nice to know where people are coming from. We know, of course, from the mainstream drug industry that you have to look at some studies and treat them with a health warning unless you know who is paying for them.
This is prompted by no one’s particular submission but just by a general scepticism because gaming and gambling are big industries. In this sphere, from what you have seen, is there a problem at all or not yet, as has been seen in the drugs industry, of the industry paying for studies that therefore may need to be treated with caution?
Dr Bowden-Jones: I have desperately tried to meet some gaming industry people in order to talk to them about the games. I do not even know who the individuals are exactly. I have not seen any—
Q63 Paul Farrelly: Are there sponsored studies or studies that have raised an eyebrow when you have looked at them more closely?
Dr Bowden-Jones: I will have to pass on that question because I am so much more clinical on this and I do not know.
Dr Kuss: As far as I am aware from the work we have being doing at Nottingham Trent University, there is no such study that has been done. I am not aware of any research that has been funded by the gaming industry.
Dr Zendle: When it comes to my field of expertise, which is loot boxes, I cannot think of any example of the gaming industry in any way meddling with the research.
Q64 Paul Farrelly: Maybe I am just a professional cynic, then. That is good to hear.
I wanted to come back to your evidence, Dr Kuss, when you talked about comorbidity. For the layperson, you have already described what that is. That then begs the question of whether there is cause and effect involved, or parallel running, or whether one helps the other to develop.
Dr Kuss: This is a brilliant question. This question has not been addressed sufficiently by the research at this point in time. We know from our clinical experience and from some of the research that has been done that gaming addiction can be both a primary disorder—the disorder that has the most significant direct impact on the individual—and it can also be the secondary disorder by means of which there is a primary condition that has a greater impact on the individual. In that case, therapists and clinicians should decide, based on the situation of the respective client, which one of the disorders should be treated first.
Dr Bowden-Jones: I absolutely concur. Sometimes people with specific types of mental disorders—for example, even just obsessional traits without a full obsessive-compulsive diagnosis, or people who are suffering from anxiety—find the games more compelling than they might have done without the diagnosis. It is bidirectional in a way and it can coexist.
For me as a clinician, the most important thing is to be able to diagnose any other coexisting illness early on presentation. For example, when I look at the thousands of people who are treated at the National Problem Gambling Clinic, a significant proportion either have serious affective disorders or at times are presenting with comorbid psychosis. These people find it so much easier to concentrate on the psychological interventions we provide if they are not ruminating about washing their hands 10 times a day or if they are not hearing voices. It is very important to have that initial moment when collaboration with existing psychiatric teams that are already treating can take place or there is an assessment to look for potential vulnerabilities. You would look at the genetic history as well in the family because then you would know what vulnerabilities these people might be encountering.
Sometimes people are gaming to keep at bay the anxiety that is being created by emerging psychiatric symptoms that are not there yet because they are not old enough to fully experience them. That is an interesting presentation. There are myriad symptoms that I could go through.
Ultimately, I am saying that it is possible to have two, three or four psychiatric diagnoses, one of them being a gaming disorder or a gambling disorder. This does not in any way mean that you cannot be treated for that disease or that you cannot receive medication. For example, Naltrexone is often given to the most severe problem gamblers who are experiencing lots of other psychiatric problems, and on many occasions it has stopped them from gambling. As long as the medications do not interact in a negative way, this would not preclude us from treating pharmacologically.
Q65 Paul Farrelly: People are completely different. Some people are not party animals and do not like going around in a crowd. Some people in different situations might be prone to depression because their life is not going the way they think it should be going or for other reasons. With all the familiar situations that have been described, including tension at home, we are back to what view we take of harm and the way people should lead their lives. We need to tread through that quite carefully, but at the end of the day there will be a value judgment, will there not?
Dr Bowden-Jones: Is it all right if I disagree with you?
Paul Farrelly: Yes, that is what the question is for.
Dr Bowden-Jones: Great. I would like to disagree with you on that because we do not make value judgments when we try to look after people with other forms of addiction. As long as we are using the correct screening tools to identify pathology in its fullest form—and indeed the larger number of people who are at risk and who have not in some way been prevented from developing a number of symptoms that are bad and are causing some level of discomfort but not a fully blown pathology. That will require perfecting those tools and applying them and investing in them. Then we will end up with a very small number of people who are very unhappy, who are making a lot of people unhappy and who are causing problems in their school world, in their university world, in their social world. This is not a value judgment; this is an observation. They will be welcoming our help.
Dr Kuss: I totally agree with what you said. There is not a value judgment involved, particularly from a clinical perspective and also not from a research perspective because we have measurement instruments and psychometric tools that can indeed give us an indication about the severity of the problem. They may not be perfect. We would always want to ensure that there is a psychological or psychiatric interview there to evaluate the respective case of the individual presenting with the problems in order to see whether indeed an addiction is present.
Given the experience we have had over the past 20 years or so of researching that problem, we know we can be quite objective in judging whether or not there is indeed a problem.
Dr Zendle: In a sense there is a value judgment present but only in a very trivial sense and that value judgment is that problems are bad and they are something that we as a culture do not want to see lots of.
Q66 Brendan O'Hara: Dr Zendle, you used a playground metaphor and it got me thinking. In a playground, the individual is in control and can decide where that play goes, how it is done, who it is done with, when it starts and when it stops. They are absolutely in control. But in a virtual playground as you described, surely you can only play to the parameters of what the designer has designed.
Who is to say that those designers do not deliberately put in features that are designed to be addictive and to bring people back? Is the playground metaphor not particularly true?
Dr Zendle: Perhaps a better metaphor would be a playground owned and operated by a corporation and the corporation determines where the slides and the swings are and whether they are going to put in a snack machine. For many of the aspects of our imaginary game playground, there is very little regulatory control over what can and cannot be in the playground.
My research assistants have been going through the highest-grossing games on mobile phones. They went through the top 20, 12 of which have loot boxes. They are all rated PEGI 12+, and 10 out of those 12 are rated PEGI 7+. These are playgrounds where the kinds of things that are being put in there are very nuanced and distinctive and do not fit many pre-existing regulations. They are free for anyone to use.
The playground metaphor might need a nudge, but you are right. The key thing is that in a playground you assume there is a school in control and the school has the best interests of the child, whereas here a company is in control and you are not entirely sure what it is trying to do with that playground. Despite being maybe an overused metaphor, I am trying to say that games companies create environments and those environments can create effects. At the moment we have very little ability to understand how these environments are created, why they are created, and what they are doing to people.
Dr Bowden-Jones: I spent several years sitting on the Responsible Gambling Strategy Board receiving information from the general public and from problem gamblers themselves about things about which they thought, “My goodness, this is not good. This thing has to stop”. We would bring it to the board and would say, “Someone contacted me about this”, or, “This has been happening”, or, “I read about this”. This was a very helpful way of evolving a conversation, by focusing the minds of the people who are there to do the job on things that have been reported from the ground.
Of course, if you do not have boards, then potentially nothing happens. If you have things happening and people do not know who to report them to—again, the idea of these features might just get assimilated into contemporary culture as something we need to watch out for, but not something that is necessarily harmful.
Gaming is several years behind gambling in relation to protecting the vulnerable, I believe, and particularly more because these are younger people with less of a voice, which is why I believe it is important to speak up for them. We will need at some point the equivalent of the RGSB for gaming where people—your researchers, my patients—can come and tell me that they have spent a week in a shark tank in a virtual reality game and now they are not feeling too great. I can then ask, “Is this all right? Are you sure this is fine?” Then we can discuss it.
Q67 Brendan O'Hara: It is interesting that you say that. You are not the first person who has made a call for robust investigation into the nature and prevalence of gaming-related harms.
As a general question, what are those gaming-related harms and where is the research currently at? Have you been able to identify any significant gaps in that research?
Dr Bowden-Jones: Briefly, from me, we are not anywhere close to that. We are only getting to a very good point in the gambling world with a good gambling-related harm paper that has been recently published. It is applicable to look at the individual, the environment and the product. These are the three spheres we need to focus on.
I can talk for hours about this. I will not, but for each one of these three subtopics there are about 20 subsections. One needs to have a look at where we are in this country because, of course, a lot of the research in this field is happening abroad and the vulnerabilities of the individual and indeed the contributory factors linked to the environment will be different. In South Korea, where some people are not even leaving their houses because they are studying so hard in order to get to their chosen university, gaming is encouraged within the home—I have been told that by several of our research colleagues. When the pressures change, we cannot extrapolate to UK habits. We would need to look at the individual, the structural components of the games and the environment, and how the interplay occurs. We can then pronounce ourselves on what we feel could be done to prevent things that we as a cohort might feel are not so good.
Dr Kuss: Absolutely, I totally agree with that. In addition, there is a very broad range of negative impacts that excessive gaming and gaming addiction can have on the individual. That would include impacts on their professional lives, their academic lives, their family lives, and their mental and physical health. It is quite a long list. It is evidence-based and we have the international research to suggest that.
Drawing on the second point you mentioned and what is needed in the research we have at the moment and how we can proceed and take this further, we do not have enough longitudinal research. This is very clear. There is very little longitudinal research available across the world in order to see the causes of the gaming addiction, the effects and the directionality of the relationship.
There is not sufficient clinical research out there that would show us what kinds of problems individuals who seek treatment have experienced and how we can help them. There is some research evidence available for treatment success but on a very limited basis. Normally you get six months post treatment effects and not beyond that, and so we do not know what happens to clients after that six-month period.
There is very little cross-cultural research that would span a number of different kinds of cultural contexts. This is something that is very much needed.
I also needed to add here that within the UK the research base is relatively poor. Very little has been done in the context of research in this country. Specifically in Southeast Asian countries—you have mentioned South Korea, for example, as well as China—there is a lot of research coming out. Internet addiction was officially recognised as a mental disorder in 2009 there, and now in 2019 we are sitting here in the UK and we do not know much.
In order to increase the evidence base, we need all of us to work together with the gaming industry, with the Government, with clinicians and with patients to produce that research and establish the evidence base on which we can continue in terms of developing prevention efforts and how to raise awareness of possible problems.
Q68 Brendan O'Hara: What are the barriers to that taking place? Is it distrust between academics waiting for research to come through, and the industry pushing on ahead regardless because it is profitable? Where are the tensions and how would you suggest we tackle them?
Dr Bowden-Jones: The most important thing is that the research is independent. When was the last time you saw a big call for independent gaming research looking at the population at risk—the population with an illness—and whether it is the same population this year as it will be in three years’ time? We do not know if these people are the same 1% to 5% who are having these issues or if they are completely new children because the older ones have got better through support or growing up or maturation of the frontal lobes. We need independent research.
I am not being critical of the UK in any way but generally, in a country where there is a lack of independent funding, the industry does step in and funds things that then get potentially criticised, when it would be so simple to start from the beginning to say that this is an area that needs to be investigated.
When looking at longitudinal studies, we should be looking at three to five years. We need to see these people come out of their adolescence into their early 20s to understand whether they are going to spend the rest of their lives as gamers. That is the other big conversation: these are all new to us because of course 20 years ago gaming was rather different if it existed at all. Who are these people and where are they ending up in their lives? Only then will we understand properly what harm from gaming signifies. Is it possible that all the pathological gamers become adults who do not fit in properly because they have spent so much time gaming? I do not know, but these are questions that need answering.
Dr Zendle: I would like to respond. You had three questions and I want to respond to each of them: what are the harms, what do we need, and why is the stuff we need not here?
When it comes to loot boxes, it is very specific what people are worried about in terms of the harm currently. Currently the harm that people are worried about is the gateway to problem gambling. There was a paper in Nature Human Behaviour by Aaron Drummond and James Sauer that said that loot boxes share so many similar features with other kinds of gambling in the real world that perhaps they are psychologically akin to gambling and therefore can form a gateway to problem gambling occurring.
The idea here is that you go into a video game, you play something that looks an awful lot like a slot machine, you get some sort of hit from playing that—maybe it is subjective excitement, maybe it is physiological arousal, something like that—and you play and play and play and play. Then you go out into the world and you see things that are just like that slot machine in your game and you engage with them because the game has basically taught you that they will be enjoyable.
That is one concern—that it leads to problem gambling. We do not actually know if that is the case, though. We do not know if loot boxes do cause problem gambling. This is as good a place as any to say it.
At the moment—I was counting them on the train on the way here—I believe there are seven studies in existence that look at, with empirical data, the effects of loot boxes. Out of that lot, there are four studies that are currently in the peer-reviewed literature with three available as pre-prints. I am the lead author of four of those. There are seven things out there and I have led on four of them. That is the size of the literature at the moment. Now, the things that I have written are, I think, very good and other people think they are very good as well, but we are in our nascence here with the literature. At the moment, all we have are correlational studies. They are big correlational studies. The first one has over 7,000 people, which is really good for a gaming study, and the others replicate. Basically—I will talk about this in a more coherent way in a second—we found something the first time around and then we went out to see if we could get it again. We got it again and again and again.
The thing we found is that loot box spending is linked to problem gambling. The more money gamers are spending on loot boxes, the more severe their problem gambling appears to be. That might be because of what Drummond and Sauer suggested in their paper, which is that it is acting as a gateway to problem gambling: you go and you buy loot boxes in games, and then you develop a gambling problem because gambling is so similar. That is the real terror when it comes to the harm of loot boxes, that it is providing a gateway to problem gambling, because as I said earlier, these games are being played by children a lot and children are particularly vulnerable to developing problem gambling. We know that a really good predictor of problem gambling is the social acceptance and availability of gambling.
That is one way we can look at the data we have, but it is important to point out that there is another way. These are correlations and if there is one thing we know as scientists, it is that correlation does not equal causation. Something very different might be happening here where people who are already problem gamblers, people who already have a disordered and excessive relationship with gambling-related activities that may to some extent be beyond their control, are now going into their favourite games and saying, “Oh look, it is something that looks an awful lot like this thing I have a disordered and excessive relationship with”. That is why they are spending more money on loot boxes. It is not that it is a gateway; it is that it is a way that video games companies may, accidentally or incidentally, be profiting from problem gambling among their consumers.
Dr Bowden-Jones: Can I just add one thing to that?
Brendan O'Hara: Go for it. Please.
Dr Bowden-Jones: I did my medical doctorate in neuroscience on decision-making and addiction and this is one of my fields of special interest. The other option is that there are neurobiological vulnerabilities that impact on some people’s decision-making and make them less good at postponing gratification, less good at calculating odds, more impulsive and therefore vulnerable to anything like either loot boxes or gambling. It is actually happening because of their neurobiological dysregulated reward pathway.
Dr Zendle: Yes, and we just cannot tease these apart at the moment. This is a really hard issue for you guys. You cannot say that loot boxes cause problem gambling—you just cannot, in good faith, say that at the moment. “Is this harmful enough?” is the question I think you have to ask yourselves, and, “What should we do in response to this?”
Both ways, you can argue that harm is occurring. In one case, loot boxes are literally causing problem gambling—I think we can all agree in the room that that sounds awful and very harmful. In the other case, people who are especially vulnerable are spending a lot of money on these loot boxes. In the data that we collected—we do not know how representative this data is—we see a pattern of people spending many hundreds or thousands of dollars or saying that they will spend many hundreds or thousands of dollars each month on loot boxes, which is an extraordinarily large amount.
Q69 Paul Farrelly: Is it possible at all, with a big enough sample, just to go and ask people which came first?
Dr Zendle: You need longitudinal work. You can ask people which came first but you do not know how much you trust the response. The thing that you really need—and this is echoing what my co-witnesses said—is longitudinal work.
Q70 Paul Farrelly: Can you just define what “longitudinal” is for the laypeople?
Dr Zendle: You say to people, “How much are you spending on loot boxes? What is your problem gambling like?” Then you leave them for a bit and you ask it again. By measuring things at multiple points over a long period of time you are able to chart the development of relationships and you are able to get stuff that tells you things about causality much better than just a correlational study like mine.
Dr Bowden-Jones: But in this case, even then you would not be able to establish it for sure because it could be that availability allows a young person to come across a loot box before they come across gambling and in both cases it is still not causality, it is just an opportunistic engagement with something that crosses their path in their journey.
Q71 Jo Stevens: I wanted to ask Dr Bowden-Jones about treatment. If I develop some of these behavioural problems, what support is there for me in terms of an NHS-funded treatment centre and how is that delivered?
Dr Bowden-Jones: Right now, there is no NHS clinic for gaming disorder but I am very hopeful—I am an optimist—that on the back of all the great evidence of the psychological and pharmacological interventions that are working in the NHS for pathological gamblers, we may see something in the near future. I know that there will be announcements made in the near future and so hopefully we will be able to be optimistic about it.
Q72 Jo Stevens: When you say “near future”, are you talking about this calendar year, do you think?
Dr Bowden-Jones: Yes. But right now, I have a list of about 40 letters from desperate people, desperate parents, sitting in my office—not the people; the letters are sitting in my office—waiting for me to see their children, and I cannot see them because I do not have the funding or the commissioning stream to see gamers. I say to the parents who are desperate, “Is your child in your bedroom gambling?” They say, “No, don’t be ridiculous”. I say, “Well, I am really sorry, I cannot treat them at the National Problem Gambling Clinic”. They say, “Where shall I go?” and I say, “I don’t know”, because I do not know of any free, evidence-based, high-quality intervention that uses the latest research-based techniques. I do not.
Q73 Jo Stevens: How long has that been the situation, where there is a demand but no facility?
Dr Bowden-Jones: The situation with the file in my office has been that since we announced that we would be embarking on some research that required us to treat people in order to understand what they were doing and what the vulnerabilities were, the research project was stalled on the ethics side of things. It was not for anything major; it just got stalled. When people in the papers read about the fact that this piece of very small research was going to take place, they then contacted the clinic. I am keeping their names because I am an optimist and because the clinic that I have run for gamblers is now over 10 years old and has treated thousands of people. I feel that at some point—it could be this year, it could be next year but hopefully at some point there will be treatment for what I think might be a very small number of people. I will just put a number out there, but I do not think I will be seeing more than 200 people a year whenever, if I am lucky enough to be able to open a facility to see gamers as well as gamblers.
Q74 Jo Stevens: Am I right that at the moment there is literally nowhere that people can go—
Dr Bowden-Jones: In the NHS.
Jo Stevens: —for publicly funded treatment?
Dr Bowden-Jones: If there is, let me know because I will send the 40 people to this clinic.
Q75 Jo Stevens: I think you have answered my follow-up question, which was going to be about funding and whether it is sufficient at the moment. On the basis that there is not—there clearly is not—where do you think that funding should come from? Do you think it should come from the gaming industry by way of a levy or it should be Government funding? Obviously we know that there have been huge cuts to public health budgets and nearly two-thirds of local authorities are cutting their services to addiction clinics.
Dr Bowden-Jones: I know I am hogging the mic here and I do not want to do that, but I do feel strongly. These are young people. This is a new illness for us to deal with. It needs to be absolutely free of the gaming industry.
I think the gaming industry need to play its part. It needs to take on the responsibility of making sure it is not polluting the world out there with stuff that is harmful. There is a lot of work to be done on addictive features and I think the industry has a responsibility there, but gaming disorder is treated very cheaply. It works in a group-like fashion, it works on a one-on-one and a family-based cognitive behavioural intervention way. Yes, sometimes one might need to use some pharmacological intervention but it is a very cheap thing for what potentially could be a very small number of people.
I do not believe involving the industry would necessarily be a great thing. If one was to do that, which again would not be something I would support, I would always suggest never more than 50% match funding with the NHS because it is too complicated otherwise in terms of ensuring that control over it. The NHS has fantastic addiction services, it is able to really delivery high-quality treatment and it must not be prevented from doing that in any way.
Q76 Jo Stevens: Thank you. Would either of you like to comment on that?
Dr Kuss: Yes, definitely. I think we all have a collective responsibility to help the individuals who really do require treatment and I can give you some examples from the German context, given that I have been working there. In Germany they started in the early 2000s to treat gaming addiction in specialised treatment centres and this has often been funded by the German Government and by the kinds of health insurance that are available. The possibility has arisen of funding that through comorbidities that have been treated so that gaming addiction could be treated on the side, so to speak. That has been very successful. There are a number of dedicated treatment centres, both in-patient and outpatient treatment centres, within Germany. I think that is probably the closest example that I can give you within Europe, in addition to the Southeast Asian examples that we have mentioned before. That gives us a very positive context in terms of the treatment.
What I also wanted to mention, going beyond the treatment, which is integral to help the individuals and their families, is prevention. Why do we have to wait for the problems to become so severe that we require treatment? I think—and this is work we are currently doing in terms of research—prevention is crucial. It is integral for us to implement, in my opinion, campaigns and sessions within the school context for students, teachers and parents to raise awareness of potential problems and to stop the problems from occurring in the first place. These can be very simply integrated within the PSHE lessons, for example, on a regular basis in all different kinds of years. I am sure that in addition to the e-safety measures that are being taken by schools nowadays, that could very much improve the mental health context of individuals who may indeed be susceptible to developing problems as a consequence of their excessive and addictive gaming.
Q77 Jo Stevens: That is very helpful, thank you. Before I come to Dr Zendle, you said you have been treating people in Germany. What sort of numbers? Dr Bowden-Jones, you said you might see maybe 200 people a year. Is that comparable with what you have been doing, Dr Kuss?
Dr Bowden-Jones: A maximum, I would say.
Dr Kuss: Absolutely comparable. Back in the days, the clinic in Berlin, which then became the clinic in Mainz, was the only treatment centre that was available and the numbers were really high because it was the only centre available. Nowadays, given that the research and treatment have had quite a substantial amount of time to progress, we tend to find that there are more treatment centres available and therefore the kinds of client bases are indeed spread across those—across the whole country. From my experience, what used to happen back in the day was that lots of patients did travel quite far—up to 100 or 150 kilometres—to come to those treatment centres because that was the only option for them. They really wanted the help, and they came to see us on a regular basis because we were able to provide the support.
Dr Bowden-Jones: The online treatment would now be a very big component because we know that remote treatment works as well as face-to-face with behavioural addictions if it is delivered on a one-to-one basis. Hopefully, there will not be a situation where young people who cannot travel 150 miles on their own necessarily would be deprived of treatment because of the geographical distance. It would be possible to have some centres that would deliver the treatment through a supervised family environment medium.
Q78 Jo Stevens: Forgive my ignorance. Is that something like Skype?
Dr Bowden-Jones: The equivalent, yes, absolutely.
Q79 Jo Stevens: Dr Zendle?
Dr Zendle: Brilliant. I want to pick up first on something that you said, Dr Kuss, where you mentioned parents. When it comes to loot boxes, parents are key. An Ipsos study from the middle of last year that showed that something like two in five children were spending money in games and something like eight out of 10 children had a spending arrangement with their parents. We do not currently have any data on how aware parents are of what loot boxes are and even if they are in games. Something that would be of specific value would be some sort of public awareness campaign to let people know that they exist. I do lots of radio and TV spots about loot boxes, and the first thing I always get is the presenter saying, “Now, just for our audience, what is a loot box?”
These are not niche features. A UK Gambling Commission study earlier this year that found that 31% of adolescents aged 11 to 16 had opened a loot box. It is an industry that is estimated to have generated up to $30 billion last year. They are really prolific. There is no data on this but my feeling is that there is a lack of awareness among parents that they are even in games. Something the Government could do that would be really positive is literally make people aware of them so that then they could make their own informed decisions about what should happen with their children playing those games.
Another thing when it comes to parental awareness is that there is a broad spread of different things you can do about loot boxes. I have a list that I will be happy to talk through if anybody wants to ask. One of the things on the list is a content descriptor. There is no content descriptor for loot boxes. They are formally very different to other microtransactions and yet there is nothing specifically saying, “This game contains loot boxes”, and that might also be a positive step for Governments to consider.
I will now rewind back to an earlier question, which was about funding. Is there enough funding? Should the gaming industry fund it? When it comes to loot boxes there is next to no funding. There is a GambleAware funding opportunity that is currently out. It is taking submissions and people are waiting to hear who has won that. That is for, I believe, half a million pounds. I know that Aaron Drummond, who was a very early author on loot boxes, has NZ$300,000. He is in New Zealand. Besides that, I am not aware of any other independent research in the world that has specifically been funded on loot boxes.
I wrote my first study on loot boxes with a funding stream of £0. I did it with nothing. I wrote my second with a funding stream of £1,000 of internal money from my university. This is not how it should work when it is a $30 billion industry. We need to fund the research to find out what is going on. That is my next point.
Jo Stevens: OK. Thank you very much.
Q80 Chair: Yes, Dr Bowden-Jones?
Dr Bowden-Jones: Could I add something that might be helpful? Just tying in with what you were saying earlier, we know now that technology allows us to remove spending streams from people’s budgets if they do not want to spend on something. In the way that Monzo and Starling have developed the ability for their customers not to spend on gambling, I do believe that one very helpful new development for the whole country would be for everybody to be able to click on whatever it is and decide that their family will not spend any money on gaming. This would be very quickly implemented. You cannot revert the decision for 48 hours when it comes to gambling but one could make it a full-stop, permanent decision if that was something that the people—
Q81 Jo Stevens: A self-exclusion operation?
Dr Bowden-Jones: Not a self-exclusion from the game but from spending money on the game. That would avoid all these children spending their parents’ money. By the way, I have a personal story. Apparently I bought quite a lot of “Fish Money”, as it was called, because my young six year-old daughter did exactly that years ago and said, “I just thought it was Fish Money”. I said, “It might be Fish Money to you but it has come out of my bank card”. I was horrified that even with the interest I have in this area, I was able to spend money that was play money to her. That kind of intervention might really be helpful.
Dr Zendle: Might I add something as well? In my passion for saying that loot box research should be properly funded I forgot to answer your second question, which is, “Should the games industry fund it?” What you are talking about there sounds very similar to something like what happens with GambleAware. GambleAware is essentially funded by a series of voluntary contributions from gambling service providers. It now has, I think, a good reputation for impartiality—certainly an improved reputation for impartiality—but it took it a long time to get there. Really it has gone through a lot. I worry that if we say, “OK, there will be a tithe from the gaming industry”, it will take us a long time to get research out there that is deemed to be impartial. I am very open to the idea that loot boxes do not cause problem gambling. I am super open to that. I can imagine a world in which that is literally true. But if the research that shows that has been funded by the gaming industry, what is the point in it?
Dr Bowden-Jones: It will not be published either.
Dr Zendle: Yes, it will not be published either. The other thing I want to say is that we need funding but we need it now. We do not need it in a year, we do not need it in two years; we need it asap. The thing with games is that they change very quickly.
Q82 Chair: Yes. All the lights are flashing now. There are two things here though, it strikes me. There is the issue of, “Are loot boxes linked to problem gambling?” but there is a separate issue that probably affects more people, which is, “Are they just a rip-off?” Is this an easy mechanism to make money where people—particularly if they are children who are doing it—are spending more money than they realise they are spending? It is not leading them to addiction or they do not see it as a form of gambling; they are just being extorted. Dr Bowden-Jones, from what you said that seems to be your concern here.
Dr Bowden-Jones: Both are possible. I was just putting the three potential interpretations of what we were looking at as the sequential development of gambling and loot box issues. Yes, I would agree with you.
Q83 Chair: If the problem is, as David Zendle said, that a lot of people are not necessarily aware that loot boxes have been built into the game, and if children are playing them they are not particularly aware that they are spending real money because it is not their money they are spending, that is a design feature that should give us some cause for concern. It is concerning if people are basically being ripped off in that way, particularly if it is a game that has been designed for a child to play but a fundamental part of the design of the game is building in loot boxes. For a lot of free-to-play games the business model is in-game purchase, or it would seem so.
Dr Zendle: If you look at the specific way that loot boxes are implemented, there are lots of ways that people could spend money without necessarily getting the most possible value out of it. Sometimes in loot boxes you are spending real money—it is like you are going to pay £2.50 for this and then open it, and you say, “OK, I will pay £2.50 and open it”—but a lot of the time you are not paying £2.50, you are paying 500 gems or 200 shards or 30 orbs and you have previously bought a load of orbs or shards or gems. That is a very similar technology to financial access technologies in casinos, for instance, or forms of scrip, where the actual money you are spending disappears behind a middle currency. If you look at how loot boxes are designed, they seem to have many features in their designs that very closely mirror very effective ways, from the gambling industry, to take money off people.
Q84 Ian C. Lucas: I wanted to ask Dr Bowden-Jones, when parents are coming to you what is their perception of what the problem is with their children? Why have they come to see you?
Dr Bowden-Jones: One of the most common statements is, “He is no longer the child we raised. We don’t recognise him”. I use the masculine because I do not really see girls coming forward with a gaming disorder. They are worried about the isolation, they are worried about the depression and the suicidal ideation that has been there very often when I have discussed things with people. They are worried about the amount of time spent online, they are worried about the potential crossover into porn watching, which we know happens, and the anxiety, the distance from peers and the lack of social structure that go with that.
Q85 Ian C. Lucas: They are not specifically talking about gambling?
Dr Bowden-Jones: I am talking about gaming today. I have not really discussed gambling.
Chair: Clive.
Clive Efford: Is this my intervention or is this—
Chair: It could be either.
Q86 Clive Efford: OK. Do gaming companies rely on people with problems to make a disproportionate amount of their money?
Dr Zendle: We do not know. One of the really difficult things about being a video game researcher is that you get second-hand evidence. I am out there and I am asking people, “What is your problem gambling like?” and I am asking them to self-report how much spending they are doing. I am collecting evidence from them because I do not have access to the databanks that video game companies have. If you had access to that kind of data or if industry was willing to work in a co-operative way with researchers we would very quickly be able to clear up many of the most important issues with loot boxes. We just do not know.
Q87 Clive Efford: How do we get the tech companies to co-operate with research? I am getting a vibe here that we are going across the same problem I came across with gambling when I was the Shadow Gambling Minister.
Dr Zendle: At the moment, my feeling is that tech companies are very defensive and I think the reason that they are very defensive is that they are coming off the end of 20 or 30 years of people prodding them about violence, and people saying, “You are making violent games that are going to make our children violent”. The research base for that, it turns out, has not been fantastic and it turns out that the predictive effects of violence in games have failed to transpire in many important ways.
I think the industry in general has developed a way of dealing with academia that is very adversarial and designed to protect it against that. Because of that, we often feel a general unwillingness from industry to talk to us. I can empathise with the reason why, because they have just come off the end of people talking to them about violence. I noticed none of the terms of reference for this were to do with violence, which I think is a sign of the times. They have just come off the end of that and I think they are very concerned that something similar will happen again.
Q88 Clive Efford: Are tech companies capable of designing a game to be addictive?
Dr Zendle: Yes, of course they are.
Q89 Clive Efford: How do they do that? Just sheer dumb luck?
Dr Zendle: I have no information about this, but look at loot boxes. Loot boxes implement things like look like financial access technologies. They look like they implement things like near misses, which we know work with slot machines and things like that. They implement things that give their users a very smooth ride from loot box to loot box. In many ways it is so similar to stuff that is in the gambling industry that I would be astonished if this was convergent evolution with no crossover from experts. I would find it very hard to believe that at some point someone has not consulted an expert on how to best monetise this random chance-based technology.
Q90 Clive Efford: Do we know more about problem gamblers online than we do about problem gamers?
Dr Bowden-Jones: There is a lot more research in the field of gambling. It has just been going on for a lot longer. Internationally speaking, if you look at Canada and Australia, there are many countries who have led on understanding not just the features that products may have to encourage vulnerable players to spend more money but just in general on the behaviours of whole groups of people playing on different types of gambling applications.
Can I go back for one second to your question about the gaming industry? It brings me back to my suggestion. I think the gaming industry would engage more if they felt that there was an open and fair conversation trying to make sure that harm to the vulnerable was prevented while still allowing gaming to be enjoyed by the majority. The equivalent of the Responsible Gambling Strategy Board for gaming, with some gaming industry people on the board who can explain some things that are mysterious to us, might be extremely helpful.
Q91 Clive Efford: Isn’t the problem with the Responsible Gambling Strategy Board that it is dominated by people from the industry?[1]
Dr Bowden-Jones: I do not think it is dominated by people from the industry. In the earlier days it might have been perceived as having a significant component from the gambling industry—certainly a lot more than now—but if you looked at it now I do not think it is. I might be wrong but I am pretty sure that you would not find that many people from the industry on the board.
Q92 Clive Efford: If you take a model like GambleAware, is that a proper model for investment in research and scrutinising the industry?
Dr Bowden-Jones: No, absolutely not. Excuse me if anyone is watching this from GambleAware, but the issue is, as we have mentioned earlier, that the perception from the outside world is that any money coming down from the industry, whether it is punitive payments for fines, voluntary contributions or a levy—fundamentally, if money is used for research that is coming from the pockets of gamblers, it will not make it into the kinds of journals that this research needs to go into if it is going to be listened to by the whole world. The two need to be completely separated.
Q93 Clive Efford: Completely separated in the way that decisions are made, but I think you just said it was a £30 billion industry. Why the hell do they not pay for the research?
Dr Bowden-Jones: I understand. If you said, “Well, £1 billion can be given to the Medical Research Council, which then independently decides who to give it to”—that is certainly one of the things that has been suggested across the last decade by many people to see how that money can be independent, while still having come from a source that is so closely linked to the issue. There are better people than me to speak about whether that would work or not.
Q94 Clive Efford: If you take something like decisions about medicines that are made by an eminent body like NICE, would you not have a similar sort of process for taking decisions about money that is levied from the gambling and gaming industry to put into research? Is that not a sensible way forward?
Dr Kuss: Theoretically, yes. Practically, we need to bear in mind what kind of research is going to come out of this. What kind of research is the public then going to be made aware of? If the research results are not in line with what the funder wants them to be in line with, then it is never going to see the public eye.
Q95 Clive Efford: But if this is an independent body, presumably made up of eminent medical practitioners and researchers, that is not stuffed with greedy betting industry owners or gaming pariahs, then presumably we would get better research and it would be published.
Dr Bowden-Jones: I fully agree with you but the research world is very particular, and rightly so, about the provenance of the funds. That would be declared on the front page of any piece of publication and that in itself would immediately colour the decision. I am not sure how one would get around that in a fair way—fair to the publication world and fair also to the people giving out the money—but it has been suggested as the obvious way forward because of the richness of these industries and the poverty of much of the funding streams.
Q96 Clive Efford: What is the average age of somebody who needs assistance for a gambling or gaming addiction? Is there a difference across the two?
Dr Bowden-Jones: The gamers are younger. From what we know from the international research, the gamers could be anything from 12, 13 up to 20, 25. The gamblers have got younger through the last decade but they still remain significantly older, probably five to 10 years older. We tend to see people in their 30s more. There are plenty of students who come and get help for gambling but the gamers are younger.
Q97 Clive Efford: We are told that the average age of a gamer is 31-plus.
Dr Bowden-Jones: Of a gamer?
Q98 Clive Efford: Yes.
Dr Bowden-Jones: Sorry, I was talking about problem gamers because you said someone who is coming to us for help.
Q99 Clive Efford: So it is the younger people among that community, if it can be described like that, who are presenting themselves with problems?
Dr Bowden-Jones: Do not forget there could be a lot of people out there in their 30s who are having problems but are not seeking treatment. We cannot infer from those facts that there are no older problem gamers but what we can say is that the type of people we are seeing through our research tend to be younger.
Q100 Clive Efford: Is there anything that suggests to you that the use of social media is a stepping stone into problem gaming or problem gambling?
Dr Kuss: I think this is a very good question. From the research that we have done and also the clinical work that has been done internationally, we know that the gamers tend to be different to the social media users, particularly when it comes to excessive use. If you are having a look at the personal characteristics of gamers, as you have mentioned they tend to be male, they tend to be socially anxious and have a number of related characteristics, whereas the individuals who present with problems due to their social media and smartphone use tend to be females. It seems as if—if we are looking at technological addictions—they are split across the genders based on the kinds of activities that individuals engage in. Not disregarding the fact that social media nowadays integrates a lot of gambling-related and gaming-related features, on average, in general, excessive social media users, those who develop addiction-related symptoms, appear to be female.
Q101 Clive Efford: OK. If I am a regular commuter and I go on my mobile phone and my journey takes me an average 10 to 15 hours of sitting on the train—
Dr Bowden-Jones: Ten to 15 hours?
Clive Efford: Accumulated over the whole week. Am I a problem gamer or gambler?
Dr Bowden-Jones: It is all about harm and loss of control. If you did not get off your train because you carried on gaming and you lost your job I would say that you would be in line for experiencing significant harm from your gaming, but if you managed to get off at the right stop, go to work and think about your job instead of your game, you might not be.
Q102 Clive Efford: Last question. What is it that you would like the tech industry to learn from the gambling industry to prevent harm in gaming?
Dr Zendle: I would like them to learn that the best way to protect consumers and potentially also protect your profits as well is to talk to researchers and regulators and engage in a communal discussion of what can best be done, rather than stop that discussion from happening out of perhaps a fear that something huge will be done. If there is anybody from the gaming industry watching now, the one thing I would say is that lots of harm reduction in gambling works because people out there are talking to researchers. Come talk to us.
Dr Kuss: It is crucial. It is crucial that we establish that kind of dialogue between ourselves as researchers and clinicians, the gaming industry and the social media industry as well. We cannot disregard how social media is impacting the everyday lives of everybody, including everybody around these tables here today. We do need to start the dialogue. Then of course what I would want to see would be those big industries opening up their databases to us so that we have access to objective data in order to see what is going on.
Q103 Clive Efford: Long-term data?
Dr Kuss: Long-term data and data that has not been self-report-based. Of course we are dealing with a lot of self-report data at the moment because this is what we can do, but objective data is what we need over the long term and with the kinds of numbers that give us an indication about where the problems lie and what we can do in order to solve them in the future.
Dr Zendle: I would just like to second that and say that is what I should have said. Last time you had one of these sessions, Andy Przybylski came along and he said, “There is a fundamental asymmetry between what the tech companies know and what we as academic researchers know”. If there could be any way to get that difference down, it would be so helpful. We are scrabbling around in the dark here, lighting little matches and seeing tiny bits of the pictures around us. They have flashlights. Let us use your flashlights.
Dr Bowden-Jones: If I may add my point to this, I feel that this country is a much safer place for vulnerable people when it comes to gambling than it was a decade ago and a lot of the good work comes from conversations with the industry, comes from the Gambling Commission’s application of significant measures that were not in place in the early days. There are ways of implementing tech protection measures for the vulnerable now that were not possible then because we know how to do it now. I think we need to learn from all of that, and from the gambling-related harm work that has been done. Then the conversation could progress to implementing these changes much faster. In a year we could do what it took us 10 years to do for gambling.
Q104 Paul Farrelly: Are we towards the end?
Chair: We are towards the end, yes.
Paul Farrelly: I have been so absorbed, immersively, I have lost my place. We have just gone from loot boxes to everything else, really. I hope we will have the Gambling Commission in front of us as part of this inquiry. Just on loot boxes, I see from some of the evidence they are rather more relaxed at the moment than other jurisdictions about loot boxes. The question is whether they are right to be relaxed or are behind the curve, but my question is more general because we can dissect them when they come in. On a scale of one to 10 in this field where would you put the Gambling Commission, each of you, in reverse order, one being a sleepy, quiet, slumbering organisation content to remain unnoticed in Birmingham without doing too much proactively, and 10 being at the cutting edge of regulation, problem-spotting and innovation? Where would you put them, Dr Zendle?
Dr Zendle: The question that the UK Gambling Commission has to answer for me is to do with the value of things in loot boxes. It is what is knocking them off their number 10 spot. The UK Gambling Commission has basically said loot boxes cannot be regulated as a form of gambling because the stuff in them is just in the game and it does not have value. That seems to not take into account secondary markets, which are fairly well known. The idea of the Steam marketplace is maybe something we have all heard of, where people can get things in a loot box and then sell it on for more. I would be very interested to hear the Gambling Commission’s response as to why that does not count as money value outside of the game, especially when these things are often being sold on third-party websites for real money.
I just want to clarify my position. I do not think that regulating cash-out loot boxes as gambling would solve any problems. We have no evidence that it is the cash-only loot boxes that are the harmful ones and the rest are benign. If anything, we have the opposite in terms of evidence: all loot boxes, if you are spending money on them, appear to be linked to problem gambling in some way. I would really like to hear why the UK Gambling Commission made that decision when there were different decisions taken in other parts of Europe.
Q105 Paul Farrelly: Where do you think it is, as an organisation, in thinking over the horizon?
Dr Zendle: I would give it a nine. I would give it a nine out of 10. I will dock a point for not thinking about that issue—but largely good stuff.
Q106 Paul Farrelly: Dr Kuss, would you be so generous?
Dr Kuss: I do not think I would be so generous. I would probably see it more towards the low end. However, loot boxes are very important in the gaming context. I stress the fact that there are so many other features of the games, and so many other variables involved in the gaming addiction research field, and we must be aware of the technology and the related addictions. If we are to do that research, continue with the research and improve on the research as well as the clinical context, we need to look at all the other features as well. Loot boxes are just a small part of a much, much bigger picture that needs collaboration between the gaming industry, clinicians who are working in the field, Governments who can support this, and those individuals and societies who have been affected by it.
Q107 Paul Farrelly: Dr Bowden-Jones, in respect of your experience in the pure gambling field, in this area with the Gambling Commission would you go higher, would you go lower or would you stick in the middle?
Dr Bowden-Jones: Unusual for me but I cannot really tell you. I do not think I know exactly what the Gambling Commission feel. I know that they are trying very hard to gather as much information as possible, not just—as Daria was saying—about the loot boxes but anything else that may fall under their remit, but it is not in my gift to give you a score.
Q108 Paul Farrelly: Just finally, Dr Bowden-Jones, if you have not sent us your outline proposal for your centre, would you do that for us so that we can look at it?
Dr Bowden-Jones: Yes. I do not have an outline proposal for my centre but I would be happy to put one together.
Q109 Paul Farrelly: That would be very useful, I think. Dr Kuss also, could you send us an outline of the activities of your centres in Berlin and Mainz?
Dr Kuss: Absolutely. Plus, of course, I can give you a summary of the kind of research that we are doing at the International Gambling Research Unit at Nottingham Trent University because we have been doing quite a lot of work in that context over the years.
Paul Farrelly: Very useful. Thank you.
Q110 Ian C. Lucas: We have mentioned loot boxes a number of times. What is the primary purpose of loot boxes?
Dr Zendle: From whose perspective?
Q111 Ian C. Lucas: From those who create them.
Dr Zendle: From those who create them, I imagine it is to make lots and lots of money.
Q112 Ian C. Lucas: Okay, and they have similar characteristics to gambling products?
Dr Zendle: Yes. One thing to understand about loot boxes is that they are very diverse. There are some loot boxes where the things that you get are purely cosmetic. There are some loot boxes where you get something that will help you win the game—a pay-to-win loot box. There are some loot boxes that look like slot machines and give you near misses where you see the item you really want just go past you and you think, “I’ll have another roll because I might get that”. There are others which just show you something. There are loot boxes where you buy the box itself for real-world money. There are loot boxes where you buy it for gems. There are loot boxes where you do not buy the box at all, you pick up the box while you are playing the game but then you have to buy a key to unlock it. Yes, in many ways they look like gambling but they are very diverse.
Q113 Ian C. Lucas: How important are they to gaming companies for income?
Dr Zendle: Massively important to many of them. Loot boxes, as far as we know, generate huge amounts of revenue. There is that £30 billion figure that everyone is talking about. It was produced by a theoretically independent research group called Juniper. I had not heard of them before we all started quoting this £30 billion figure. They put it in a report that they titled “In-Game Gambling: The Next Cash Cow for the Industry”, which shows a degree of hubris many of us can only aspire to.
Q114 Ian C. Lucas: From the gaming business.
Dr Zendle: It was a gaming consultancy. It was inside the industry and presumably the people at Juniper are kicking themselves over it because every person who is worried about loot boxes is now seeing that in terms of prevalence. We have other independent stats about prevalence though. Here is one: 31% of adolescents aged 11 to 16—
Ian C. Lucas: Have used loot boxes.
Dr Zendle: That is Ipsos. It is not some think tank we have never heard of, it is Ipsos, and we know that Ipsos does real, valuable work.
Q115 Ian C. Lucas: Do you know what proportion of 11 to 16 year-olds have gambled?
Dr Bowden-Jones: High amounts. I think 400,000 young people had gambled in the last year, something like that, or 450,000. Anyway, large amounts.
Q116 Ian C. Lucas: From the gaming businesses’ point of view, the more loot boxes are used the more income they get. They want to encourage people to use loot boxes.
Dr Zendle: Presumably they want to encourage people to use loot boxes to the extent that they buy the loot box, but they do not stop playing the game. Many of these games are never bought. They are this new business model called “free to play”, where you do not pay any cash for the game when you buy it—you get the game for free, but then you make microtransactions within the game. If I was someone in the gaming industry—I am sure you will talk to people from the gaming industry—my priority would be continuous desire. I want people to carry on playing the game and I want them to carry on spending. But of course this is mind-reading and therefore fallible. This is not based on evidence, this is based on logic and my ability to model a game designer’s mind.
Q117 Ian C. Lucas: What are the likely effects of spending on loot boxes becoming an intrinsic part of the game? You can play the game without getting the loot boxes, can you?
Dr Zendle: It depends what you mean by “play the game”. Say I am playing a pay-to-win loot box game like FIFA or something. Getting stuff in loot boxes will literally make me better at the game. In fact, in order to play at the top tiers in that game I kind of need to be buying the loot boxes because they have all the really good players in. That is one way that you could say that they are integral to playing the game. They might be optional but what does “optional” really mean here?
Q118 Ian C. Lucas: It is a more intense experience if you use the loot boxes?
Dr Zendle: It looks like a way of monetising basic gameplay goals.
Earlier on, someone mentioned the idea of links between social media and these problems. In many ways, games are social media, and because of that there is another reason. When you are socialising with people you want to be liked, you want to fit in, you want to join a group. I have a quote here from an adolescent. We basically got about 1,000 adolescents and we asked them, “Why do you buy loot boxes?” This is what one of them said and this is a common pattern. “There is too much incentive to do so. Once you get better at the game everyone else at your skill level has more and more expensive skins, prompting me to buy more and more to fit in”. If the game is essentially a social medium and you need to belong—
Dr Bowden-Jones: Yes, and this is what we hear when I see people with this problem. That is what they report, especially if they are young. They say, “I am a student”, “I am at school” or whatever, “I don’t have the financial ability to buy into these features. Therefore I’m disadvantaged in the beginning from achieving great things in this game”. That is maybe one of the things we should focus on if there is going to be a conversation, because it really undermines the engagement of young people in terms of their abilities and makes them heavily rely on the spending of money.
Q119 Ian C. Lucas: There has to be a conversation, does there not, with the industry? A lot of people have made a lot of money already from all of this. The money has been made but the implications are only feeding through now. Dr Zendle, when you were talking about approaching the gaming industry and so on, have you found them evasive or have they just not answered to you? This is a pretty fundamental point here, is it not? We have issues. There is harm occurring, even if it is on a relatively small scale. It is a new issue that we have to deal with. When that is presented to the gaming industry, what do they say to you? “Go away”?
Dr Bowden-Jones: I think it needs to come from above. It is not ever going to come from a researcher contacting an individual in a gaming company because it is not in their interests. I think their interest is to feel that as a community of people working for this industry, different companies could engage without losing out financially because if everyone is committing to harm prevention then there is an egalitarian approach. Therefore they can commit to doing the right thing and report back. I think it has to come above, from you rather than from us.
Dr Zendle: Yes. I would agree with Henrietta completely and I think this is even more important: I firmly believe that loot boxes are not a problem, they are a symptom. They are a problem but they are also a symptom. They are a problem of something deeper, which is that video games are rapidly changing. They are changing really, really quickly. Five years ago we would not be having this conversation. In five years’ time, we will be having a different conversation about a different new feature of video games. It is crucial that we put in place some structure that will not only help us deal with loot boxes now but will help us deal with whatever the heck happens in five years.
Q120 Ian C. Lucas: Dr Kuss, is there anywhere that is doing this? Is there anywhere in the world that is doing this, anywhere there is a decent level of engagement?
Dr Kuss: From my understanding, the research in the context of making use of gaming industry-related data is pretty much non-existent. There is so much work that needs to be done. In comparison to the gambling field, the gaming research field is in its infancy. We have been doing a lot of work in the context of the research but they are small little pieces of evidence that we have been able to gather, particularly in this country. What we do need is bigger datasets. What we do need is the funding to support individuals who do have problems but also to conduct research on a long-term longitudinal basis, cross-cultural research and clinical research.
Dr Bowden-Jones: In this country.
Dr Kuss: In this country, yes. There is so much that needs doing. We would hope that we can get the support that is needed for that.
Q121 Julian Knight: Apologies for not being here earlier in the session. I have had the joys of, I think, my eighth statutory instrument in the last week.
I am going to ask any of you—whoever feels the most qualified or has the strongest opinion, please just speak out. Five years from now, where do we sit if we get transparency and monitoring right in this sector, and where do we sit if we get it wrong?
Dr Bowden-Jones: Getting it right is simple now. We have mentioned the gambling field before but there is a path forged there. It is not an easy one. It has taken a long time to get there, but we are somewhere now in the gambling field that we could have only dreamt of a decade ago. That path is something that can allow us to replicate the best interventions and the best strategies in terms of communication and harm prevention as well as everything else.
I still really do believe that there will probably be more people gaming in five years than there are now but the people presenting with problems could be kept to an absolute minimum with all of the things we discussed today. That starts with the conversations with industries, where things that look really quite wrong can be tackled way before they are on the market rather than testing harmful products on our vulnerable, all the way through to being able to give support structures to the families and to the schools when they are dealing with people who have issues. We must remove the stigma—there is a lot of stigma. A lot of the people I speak to who have gaming issues are very embarrassed that they missed their exam deadlines or have dropped out of university or whatever because of their gaming. We have a bit of general approach in relation to the mental health removal of stigma. Then we could be in a very good place.
Dr Kuss: We know exactly what needs to be done. Now is the time to do it.
Dr Zendle: I agree. In five years’ time, if we get this right, we could be proud of the fact that the UK has one of the most ethical and responsible creative industries in the world. If we get it wrong, all that success is tainted.
Q122 Clive Efford: I just wanted to follow up with Henrietta. Would you say it is true that the gambling industry was dragged kicking and screaming into recognising that it needed to do more to identify harms that the industry was causing as a consequence of the real focus on the horrific impact of FOBTs? Therefore, the focus of the harm that gambling was doing was very much in the public eye, which led to moving ahead in terms of investing in research.
Dr Bowden-Jones: Let me be far more generous than that. I have lived it on the front line for 12 years so I can speak way before that. I think a lot of it came down to communication. There were changes on all sides in terms of how much conversation people were prepared to have. There were some symbolic figures in the field who managed to broker some of these conversations. Way before the general public united against the FOBT decisions and started to be very vocal, there were already some major pieces of good work around prevention that were being implemented and there were people who really cared. I am not talking about opposing fields, I am just saying in general.
I think the FOBT issue just proved that when people really want to make changes and are brought together from all walks of life—from the problem gamblers themselves, who were very vocal in this, to Parliament, to the House of Lords and so on—together they were able to do it. I think it was more like six years ago that things started to improve.
Q123 Clive Efford: Do you think it is going to take something similar to bring about change in the gaming industry?
Dr Bowden-Jones: No. I am optimistic about this. I think it could literally take 18 months if we find the most prominent and powerful gaming industry people, who actually should be delighted and proud to be invited on to a board like this.
Q124 Chair: Just a couple of quick questions from me to pick up on a few things. Dr Zendle, the quotation you read out about the peer pressure for people to buy new skins for their avatars in gaming—which game was that referring to?
Dr Zendle: I do not have the data to hand. I might have the data somewhere but I cannot remember off the top of my head, I am sorry. It was a survey of about 1,100 adolescents but they came from a variety of different games. We were not just focusing on one game, we were getting a broad spread.
Q125 Chair: It was a quote pulled out from responses?
Dr Zendle: One thing I try to do with all my studies is I make all the data from them openly available. If you give me a google or go to my dotcom, which is just my name, you can find all the data for all the studies, including all the quotes from all the adolescents that took part in that study.
Q126 Chair: Great. We may well do that. Just finally, you said earlier on in response to a question that of course a company could design a deliberately very addictive game. Which are the most addictive games out there, do you think?
Dr Zendle: No, I am not competent to answer that question. Would anybody else like to take it?
Dr Kuss: There are a number of games that have a high addictive potential. We also need to bear in mind that I do not believe the gaming industry goes out there producing games and designing new games with very high addictive potential. They are there to design games that make a lot of money. That is what they want. We need to also then bear in mind that one of the consequences of producing those very engaging games, those games that people want to spend a lot of time playing, is that some gamers will indeed develop symptoms of an addiction because of the game being so engaging.
Q127 Chair: Without opening it all up again now as we are at the end of the session, certainly I think there is a difference between story-based games and free-to-play mobile games where the idea is to get you to come back as often as possible and to stay playing for as long as possible. In that way they work very like how social media works. As I think you said earlier on, there are games that have no end and—
Dr Bowden-Jones: Yes. Games with no end, across time zones, team games—they are all feeding into the solitude and the potential lack of self-esteem that some of the people that we know about who are experiencing the harm from gaming are tending to go towards and do compulsively. Yes, that type of thing is really a never-ending alternative reality with the ability to be someone rather than a nobody, as they say to us.
Q128 Chair: This is why I think it is something of interest of us. There could be games that are incredibly immersive but that is just the nature of the creativity and the design. There could be games in which the game-maker makes more money from that game because you play it longer. There could be some story-based games where the designer does not really make any more money out of it, it is just how they use it. There could be others where there is a commercial incentive to—you could argue that the ‘next up’ function on YouTube exists for commercial reasons, and to keep people on YouTube for as long as possible, and there are probably games that have similar characteristics.
Dr Bowden-Jones: May I suggest that we divide the two things? One is about getting children to spend their parents’ money—not good. There is getting children to spend their own money on things that are compulsive—not good. The more traditional way of looking at harm in very young people who are using games in this harmful way is just about their use of time and the many, many hours of their day that they are unable to prioritise towards anything else. We have been speaking a lot about the financial consequences but there are so many others—the academic, the social, the family things, the mental health issues—that are incredible harms and, I might add, from what I have seen, a greater harm, when we are looking at the whole population of people with gaming disorders.
Dr Kuss: In general, in answer to your question, it is those kinds of games which fulfil a number of psychological needs of the gamers that are potentially the most problematic. Those needs can be needs of relating to other people, being recognised, of having achievement and being successful—very basic human needs. Many games, including those kinds of endless games, are meeting those kinds of needs.
In contrast to this, we have done research on games that are being played on mobile phones, on smartphones. From the research we have done on a European basis in a number of countries, the mobile phone or the smartphone-related games have less of an addictive potential in contrast to the online games that are being played on computers or indeed on gaming consoles.
Chair: That would suggest there might be a relation between immersion and addiction in that case.
Dr Kuss: Yes.
Chair: That is very interesting. Thank you all very much. It has been a fascinating session and very helpful for our inquiry. Thank you.