Current situation of gambling in China
Gambling in China has a complex landscape that includes various forms of recreational activities. While generally considered a major vice alongside pornography and drugs, certain forms of recreational gambling are widely accepted during social gatherings. Favourable attitudes towards gambling increase intention and the likelihood of engagement, as per expectancy-value models like the theory of planned behaviour.3 The perception that insignificant stakes mitigate potential consequences has led to widespread participation, excessive time spent and frequent engagement in gambling activities. However, these factors crucially contribute to the development of gambling disorder.4 In China, this has resulted in a distinct group of problem gamblers primarily experiencing negative consequences in terms of time loss rather than financial loss. Consequently, this outcome poses challenges to current screening and assessment standards for problem gambling in the addiction field in China.
In recent years, the prevalence of gambling in China has experienced a significant increase, surpassing that of many other countries.5 This surge can be attributed to the emergence of new forms of gambling, such as illegal lottery gambling, ‘red envelope’ gambling within WeChat groups (a popular communication medium in China), gambling through digital chess and card games and hotline gambling which combines features of both online and offline platforms. In the sweep of this transformation, ‘skin gambling’ emerged over the last decade as an innovative form of online gambling, gaining considerable traction. This industry divided online gambling activities into virtual ‘skin’ items, which can then be exchanged for cash.6 This strategy effectively shielded these businesses from crackdown orders on traditional online cash gambling activities. The widespread availability of gambling opportunities on the internet, including those facilitated by technology (eg, online applications on smartphones), contributes to its pervasiveness. Moreover, the increasing popularity and extensive use of smartphones globally, coupled with China’s status as the country with the largest number of smartphone users,7 further contribute to the prevalence of online gambling.
The rise of online gambling, facilitated by its anonymity and convenience, presents significant risks by potentially attracting individuals who may have previously refrained from gambling in physical locations such as betting shops or casinos. The virtual nature of online gambling removes geographical and social barriers, thereby increasing the scope and frequency of participation. Online poker, in particular, enables problem gamblers to assume multiple online identities and engage in extended and frequent play, leading to potentially harmful levels of time investment. This accessibility is further compounded by targeted advertising and emerging technologies, creating user experiences that are readily available and conducive to the development of gambling disorders. According to a meta-analysis of 104 studies,4 continuous-play format gambling products, which are known for their fast-paced nature, have been shown to be a significant risk factor for problem gambling. The covert nature of online gambling increases vulnerability among groups such as adolescents and habitual gamblers, who may lack the necessary literacy and self-regulatory measures to resist gambling temptations. In addition, privacy features integrated into popular digital platforms like WeChat or QQ exacerbate these risks. Joining gambling groups on these platforms is notoriously easy, often only requiring approval from a group owner. This superficial vetting process fails to act as a safeguard, putting impressionable and vulnerable groups at risk and exposing them to potential gambling harm. The assumption that group moderators can effectively identify and protect vulnerable participants is flawed. This weakens efforts to insulate these individuals from the adverse effects of problematic gambling activities.
It is important to recognise that these new forms of gambling may have distinct risks compared with traditional forms of addiction-related pathology. The International Classification of Diseases acknowledges the differentiation between online and offline gambling.8 While there is no conclusive evidence that internet gambling is more likely to cause gambling disorder than other forms of gambling, several factors make online activities, such as internet gambling, potentially seductive and addictive. These factors include anonymity, convenience, escapism, immersion, accessibility, event frequency, interactivity, disinhibition, simulation and asociality.4 Virtual environments also have the potential to provide short-term relief, excitement and distraction. A survey9 conducted among 1004 adolescents aged 12–19 years in Hong Kong regarding online gambling and pathological gambling found that those who engaged in online gambling were more likely to develop pathological gambling behaviours, with a 1.5–3.2 times higher risk compared with those who did not engage in online gambling. Furthermore, individuals with gambling disorders often experience other mental health problems, although the causal relationship between the two is uncertain. Complex bidirectional relationships exist between gambling disorders and other disorders, such as anxiety disorders, mood disorders, substance use disorders, impulse control disorders and attention-deficit/hyperactivity disorder.10 These complex relationships highlight the importance of screening and assessing gambling disorders to provide appropriate interventions.
