Considering that the global games market is a multi-billion dollar industry, reaction to the World Health Organization’s recent classification of “gaming disorder” as a form of mental illness was predictable. The Entertainment Software Association (ESA), the industry’s primary lobbying organization, has gone on the attack, criticizing Gaming Disorder and Hazardous Gaming as “fake” conditions. The ESA has issued a statement stating that the WHO should focus on “real” forms of mental illness:

The World Health Organization knows that common sense and objective research prove video games are not addictive. And, putting that official label on them recklessly trivializes real mental health issues like depression and social anxiety disorder, which deserve treatment and the full attention of the medical community. We strongly encourage the WHO to reverse direction on its proposed action.”

On the other side, the WHO defines gaming disorder as

“…a pattern of persistent or recurrent digital game playing that is over-prioritized and escalated despite negative consequences in a player’s personal, family, social, educational, or occupational life.”

That is also the very definition of compulsive gambling.

One of the issues at the center of the debate is the use of what are known as “Loot Boxes,” which a number of governments around the world consider a form of gambling – and therefore subject to regulation.

A “loot box” – also known as a “prize crate” – is a form of virtual currency or a token that a player can exchange for other virtual items. These items can include ways to customize a player’s avatar (character), or special equipment (such as special weaponry or armor) that can give them an advantage. Loot boxes started showing up in massively multiplayer online role-playing games (MMORPGs) about ten years ago. Players can either purchase them directly, or win them in the course of play – after which they must typically buy “keys” in order to redeem them. It is essentially a way to monetize otherwise “free” MMORPGs.

Loot boxes have gained more attention in recent months and have drawn criticism for forcing all players into them by limiting the rewards they can get through free play and pushing them into “microtransactions” – essentially, purchasing small items within a game that the player has already paid for or downloaded free of charge.

Increasingly, this is being considered a form of gambling. A recent story published on Reddit was posted by a 19-year-old gamer who wound up spending $10,000 on such “microtransactions,” which highlighted the connection between gaming and compulsive gambling – the latter of which has long been recognized as a psychological disorder.

Loot boxes are already regulated as a form of gambling in a number of countries, including Australia, parts of the UK, and a number of Asian countries – where gambling is a significant part of the culture. The ESA is determined to stop similar regulations from being enacted in the US and other nations. Last November, legislators in a number of states were considering a ban on sales of Battlefront II to minors, which has been described as “a Star War themed online casino designed to lure kids into spending money.” In response, a spokesperson for the ESA told Rolling Stone:

Loot boxes are a voluntary feature in certain video games that provide players with another way to obtain virtual items that can be used to enhance their in-game experiences. They are not gambling. Depending on the game design, some loot boxes are earned and others can be purchased. In some games, they have elements that help a player progress through the video game. In others, they are optional features and are not required to progress or succeed in the game. In both cases, the gamer makes the decision.”

It appears that the ESA’s protests are falling on deaf ears. Hawaii is moving forward with legislation that would prohibit people under the age of 21 from purchasing games that include loot boxes. The Belgian Gaming Commission has already officially classified loot boxes as a form of gambling and is considering a complete ban on such games – a ban that may eventually extend to the entire European Union. Meanwhile, the WHO is unmoved by ESA protests, and will include gaming disorders in this year’s International Compendium of Diseases.

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K.J. McElrath is a former history and social studies teacher who has long maintained a keen interest in legal and social issues. In addition to writing for The Ring of Fire, he is the author of two published novels: Tamanous Cooley, a darkly comic environmental twist on Dante's Inferno, and The Missionary's Wife, a story of the conflict between human nature and fundamentalist religious dogma. When not engaged in journalistic or literary pursuits, K.J. works as an entertainer and film composer.