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Understanding and addressing the challenges of online gambling addiction in mainland China
  1. Gangliang Zhong1,
  2. Jiang Du1 and
  3. Min Zhao1,2,3
  1. 1 Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
  2. 2 Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai, China
  3. 3 CAS Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Sciences, Shanghai, China
  1. Correspondence to Dr Min Zhao; drminzhao{at}smhc.org.cn; Dr Jiang Du; dujiangdou{at}163.com

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Introduction

Gambling in China has a long and evolving history, from ancient court cockfighting to preliberation casinos with games like baccarat.1 Over time, gambling in China has evolved to include a wide range of activities, including gaming machines, online gambling and commercial gambling. Despite being declared illegal and regulated after the establishment of the People’s Republic of China, gambling remains deeply ingrained in Chinese culture. While recreational gambling is widely accepted, it often leads to excessive time spent and an increased risk of problematic gambling behaviours.

In recent years, the situation has been exacerbated due to the rise of online gambling, which is emerging as the predominant form of gambling in China.2 Online gambling platforms provide a virtual environment that offers short-term relief, excitement and distraction. Their clandestine nature makes them more appealing to vulnerable groups, including adolescents and problem gamblers. The diverse forms of online gambling increase the risk of excessive gambling and present greater challenges for regulation and management. Addressing the associated harms requires simultaneous attention from both regulatory and medical perspectives.

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.

Challenges in gambling management and treatment in China

The legal management and regulation of online gambling in China present substantial challenges due to the rapidly evolving digital platform. While rigorous restrictions have been imposed on video gaming, specifically banning daily login and first-time spending rewards, and imposing strict time limitations on gameplay for minors, similar structures are equally strict for online gambling. Notwithstanding the stringent surveillance and regulations for digital activities in mainland China, a black market for online gambling persists, highlighting profound enforcement challenges. Despite these challenges, relentless efforts from the Chinese authorities, such as multiple large-scale investigations and arrests, have been exerted to curb this issue and have led to a decrease in online gambling engagements.6 Even though state-run lotteries are not classified as gambling by the Chinese government, estimated revenues from illegal gambling markets are thought to be 10 times higher than these lotteries, revealing the extent of the challenge faced by the government in curbing this issue.11

The legal infrastructure regulating gambling in China, principally represented by Article 303 of the Criminal Law of the People’s Republic of China, explicitly prohibits gambling for profit and the operation of gambling activities. Infringements can result in severe legal repercussions, including fines and imprisonment for up to 3 years. This law frames gambling as an activity involving more than three participants wagering over 50 000 RMB. In light of the stringent legal penalties associated with online gambling, Chinese people’s willingness to admit problem gambling behaviours and seek treatment is potentially decreased. This, compounded by limited public awareness of the inherent dangers and consequences of gambling addiction, continues to present significant challenges for the prevention and early intervention measures in China.12 These legal and cultural barriers may further exacerbate the problem, hindering open discussions about online problem gambling and deterring individuals from seeking necessary treatment.

To effectively address the pressing concern of gambling addiction, it is paramount to augment public awareness concerning responsible gambling practices and the detrimental effects of gambling addiction. This can be accomplished through the deployment of educational campaigns and targeted initiatives focusing on promoting responsible gambling behaviour.13 Clear communication of the legal consequences related to online gambling is equally important to ensure adherence to the regulatory framework.

At the medical level, addressing gambling addiction presents unique challenges compared with substance addiction. While the harmful effects of gambling have been recognised,14 establishing screening, assessment and treatment standards within the cultural context of China remains a significant challenge. Additional research, encompassing both mechanistic studies and clinical interventions, holds the potential to contribute to the development of targeted and efficacious treatments for gambling addiction.

To tackle these challenges, comprehensive responses are needed. In addition to advancing the understanding of the mechanisms underlying gambling addiction and developing evidence-based treatment interventions, strengthening online gambling management and regulations is crucial. Drawing from practices witnessed globally could guide these initiatives.15 Collaboration between government agencies, healthcare professionals, researchers and other stakeholders is necessary to develop a comprehensive and effective approach to addressing gambling addiction in China.

Strategies for managing and treating gambling addiction in China

Given the present state of gambling in mainland China, it is of utmost importance to devise effective strategies for addressing and mitigating gambling addiction. Online gambling and illicit drug use, although both unlawful activities, differ profoundly in their nature and impact. The government of mainland China allocates funds and offers support for screening and treatment programmes aimed at individuals grappling with illicit drug addiction. Their methodology encompasses a pronounced focus on law enforcement and rehabilitation, employing strategies like obligatory rehabilitation, community-based rehabilitation and voluntary drug treatment. Nevertheless, these tactics may not manifest the same efficacy in remedying gambling addiction, considering the distinctive dynamics of gambling behaviour relative to drug abuse. Consequently, the necessity for bespoke strategies to handle gambling addiction becomes paramount. The cultural backdrop of mainland China significantly influences attitudes towards gambling and the hurdles encountered in tackling gambling addiction. Some primary strategies and challenges to be contemplated are as follows:

  1. Establishing adapted screening, assessment and treatment standards: considering the complexity of dealing with gambling addiction in regions like mainland China where most forms of gambling are illegal, assessment tools must be adaptable to the unique social and cultural context. Developing expert consensus on the diagnosis and treatment that are suitable for the current situation in China is crucial. It is important to note that the Chinese government is trying to reconcile the challenge of providing identification and treatment facilities under the context of strict gambling laws. The refinement of assessment tools and the development of treatment options that respect legal boundaries are necessary steps for preventing and treating gambling disorders. The development of psychological interventions and physical intervention techniques such as neuroregulation should also be explored.

  2. Providing accessible treatment services: establishing a comprehensive network of treatment services is crucial for individuals with gambling addiction. This includes specialised counselling, support groups and helplines that cater to the unique needs of individuals in China. Treatment programmes should incorporate evidence-based approaches, such as cognitive–behavioural therapy and motivational interviewing, while considering cultural factors that may influence treatment outcomes.

  3. Addressing legal paradox: crucial to strategising is tackling the paradox of responsible gambling within an illegal context. This situation involves reconciling culturally ingrained acceptance with strict regulations and penalties. The challenge lies in differentiating between illegal and responsibly engaged gambling, the latter being non-profit-driven participation that causes no adverse impact according to the definition of gambling disorder. Gambling, thus blurs the lines between social entertainment and potential medical harm, needing further research and discussion to effectively navigate this contradiction and find a balanced solution.

  4. Encouraging responsible gambling practices: promoting responsible gambling practices can help prevent the escalation of gambling problems. This includes implementing measures like self-exclusion programmes, setting betting limits and providing information about the odds and risks associated with gambling. Collaboration with gambling operators and online platforms is essential for ensuring the implementation and effectiveness of responsible gambling measures.

  5. Conducting research and surveillance: continuous research and surveillance are necessary to monitor the prevalence and patterns of gambling addiction in China. This includes studying the impact of new forms of gambling, such as online gambling and emerging technologies, on addiction rates. Research can also help identify risk factors, protective factors and effective interventions for gambling addiction in the Chinese context.

  6. Enhancing public awareness and education: raising public awareness about the risks and consequences of gambling addiction is crucial. Educational campaigns can help dispel misconceptions about gambling and promote responsible gambling behaviour. Targeted initiatives should focus on vulnerable populations, including adolescents and individuals with pre-existing mental health conditions. These campaigns can highlight the signs of addiction, available support services and the importance of responsible gambling practices.

  7. Strengthening regulatory measures: effective regulation is necessary to curb the negative impacts of gambling, particularly online gambling. Stricter enforcement of existing laws and regulations, along with the development of new policies, can help mitigate the risks associated with online gambling and reduce access to gambling opportunities. Collaboration between government agencies, law enforcement and internet service providers is essential to effectively regulating online gambling platforms.

Conclusion

This commentary highlights the significant features of gambling disorders in China, as well as the prevalence of online gambling. This presents a challenge for diagnosing and treating gambling disorders in China. Moreover, the cultural attitudes towards the entertainment aspect of gambling in China, along with the hidden, virtual and convenient nature of online gambling, further complicate the management of gambling. Therefore, a comprehensive approach is necessary to effectively address gambling addiction in China, taking into account the cultural context, the evolving gambling landscape and the specific challenges posed by online gambling.

Other Asian countries have also encountered significant issues with online gambling as the internet has developed. Therefore, the problems and challenges discussed in this article are not unique to China but are also faced by other Asian countries. Effective strategies developed by China can serve as a valuable reference and have a positive impact on other Asian countries, promoting better approaches to addressing these issues.

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References

Gangliang Zhong is a PhD student at the Addiction Department of Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, China. She obtained her master's degree from the University of Chinese Academy of Sciences in China. Her main research interests include brain stimulation and neuronavigation. Her present research focuses on the precise handling of non-invasive brain stimulation as a treatment for addiction.


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Footnotes

  • Collaborators Not applicable.

  • Contributors GZ: conceptualisation, writing (original draft preparation); JD: conceptualisation, writing (reviewing and editing); MZ: writing (reviewing and editing). All authors read and approved the final manuscript.

  • Funding Funding for this study was supported by National Key R&D Program of China (2023YFC3304204, 2019HY320001); National Nature Science Foundation (82130041, 82171484, 81871045); Brain Science; Shanghai Jiao Tong University Medical Engineering Cross Research (YG2023ZD25).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.