A large study published in The Lancet raises new concerns about how video gaming and gambling are increasingly overlapping in the lives of adolescents — and how one may be linked to the other.
Researchers analysed data from nearly 12,000 Italian students aged 15 to 19, collected as part of the 2023 ESPAD Italia survey.
The findings suggest that gaming is not only widespread among teenagers, but that certain gaming habits — especially spending money on in-game features — are linked to a higher risk of gambling and gambling-related harm.
Gaming and gambling: both common, even among minors
According to the study, two-thirds of Italian adolescents reported playing video games in the past year. Gaming was particularly common among boys, but almost half of the girls also reported playing. One in three gamers said they had spent money on games, and nearly a quarter showed signs of problematic gaming behaviour.
Gambling was also strikingly prevalent. More than half of the participants said they had gambled in the past year — including over half of those under the legal age of 18.
Among recent gamblers, around one in five met the criteria for “at-risk” gambling, and a smaller but significant share showed signs of problem gambling.
Where gaming and gambling meet
The study found a clear association between gaming and gambling. Adolescents who played video games were more likely to have gambled at some point in their lives, to have gambled recently, and to engage in risky gambling behaviours.
The link became stronger when money entered the picture.
Teens who spent more on in-game purchases — particularly on so-called “loot boxes”, which offer chance-based rewards — were much more likely to show signs of problem gambling. Spending more than €50 per month on in-game purchases, or even modest amounts on loot boxes, was associated with a significantly higher risk.
Importantly, the researchers found that it was spending, rather than time spent gaming, that seemed to matter most.
Why this matters for public health
While the study cannot prove that gaming causes gambling — it was based on a snapshot in time — the findings add weight to growing concerns about how modern game design may expose young people to gambling-like experiences.
Chance-based rewards, frequent prompts to spend money, and the normalisation of paying for excitement or progress may mirror mechanisms seen in gambling.
The authors note that adolescents may be particularly vulnerable due to ongoing brain development, peer influence and digital marketing strategies.
What could be done?
The study calls for a precautionary public health approach. This includes clearer and stronger regulation of in-game monetisation systems, better enforcement of age restrictions for gambling, and education for both young people and parents.
While some countries have introduced rules around loot boxes and gambling-like features in games, enforcement remains uneven across Europe. The findings suggest that voluntary labels and age ratings alone may not be enough.
As gaming and gambling continue to converge, the study highlights the need to look beyond individual behaviour — and to examine how digital products are designed, marketed and regulated when it comes to protecting adolescents.
18.12.2025.
