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The immersive nature of Internet gambling is also clear through reports that online gamblers, particularly those experiencing problems, are more likely to report disruption to their sleep and eating patterns than land-based gamblers [ 18 , 36 , 37 ]. A comprehensive review of the existing literature was conducted to provide an overview of significant trends and developments in research that relates to disordered Internet gambling. For example, multiple studies in Sweden did not support the assumption that Internet gambling would attract people with low social support, psychological problems, physical problems or health problems such as risky alcohol consumption [ 41 ]. Intense gambling involvement has been verified as a predictor of gambling problems for online and offline gamblers. It is likely that the profile of those at risk for developing Internet gambling problems will change as this mode of gambling becomes more accepted and widely used and further research is conducted. Analyses of player accounts, including players who exhibit what appears to be risky behaviour, as well as those who have closed accounts due to stated gambling problems, have enabled markers of problem gambling, including early predictors, to be identified. As psychological comorbidities and irrational thinking are related to problems amongst land-based gamblers, these results suggest that the clinical characteristics of Internet problem gamblers are similar to offline gamblers. However, a study comparing behavioural data from online gambling sites with self-report of gambling problems found that not all highly involved gamblers were at risk for gambling-related problems, and likewise, not all those with low involvement screened negatively for gambling-related problems [ 64 ]. Taken together, the evidence reviewed here suggests that Internet gambling does not cause gambling problems in, and of, itself.{/INSERTKEYS}{/PARAGRAPH} It is possible that unregulated sites attract individuals who are at greater risk for experiencing problems, and use of multiple online accounts and multiple activities is a proxy indicator of gambling involvement, a known predictor of harm. This is consistent with one study reporting that problem Internet gamblers prefer land-based over Internet gambling [ 24 ]. Potential predictors of risky Internet gambling or the emergence of problems include engaging in multiple online gambling activities, high variability in betting, multiple bets per day, many active betting days per month, many bets per betting day, high overall stakes and net loss, increasing bet size and losses, chasing losses and intervals of increasing wagering size, followed by rapid drops [ 58 , 59 , 76 — 80 ]. This is consistent with higher rates of mood and substance use disorders and self-harm among highly involved Internet gamblers [ 70 ]. Evidence is emerging that Internet gambling is not only predictive of gambling problems but also that when other variables are controlled for, individuals who gamble online may have lower rates of gambling problems. Analysis of surveys completed by online gamblers indicated that compared to non-problem gamblers, problem gamblers were more likely to smoke cigarettes, have a disability and drink alcohol while gambling online [ 67 ]. Analysis of demographic variables suggests that Internet problem gamblers overall do not represent a distinctly different cohort than gamblers who experience problems related to land-based gambling. The individual factors related to Internet gambling problems are under-researched and would benefit from longitudinal studies to clarify the mechanism of action of any relationships between variables. One notable finding from studies of the bwin. Further research is still required to untangle whether game-specific characteristics play a causal role in the emergence of gambling problems. Furthermore, in a nationally representative Australian telephone survey, Internet gamblers were less likely to drink alcohol and smoke when they were gambling online than when gambling in land-based venues, indicating they were unlikely to be using Internet modes to avoid restrictions on smoking or alcohol [ 13 ]. The ability for large wagers, continuous gambling, rapid feedback and instant, easy access to a vast number of betting options has resulted in concerns that Internet gambling could contribute to excessive gambling [ 1 , 2 ]. However, few online operators have shared their data to be used for research purposes or implemented policies and strategies to detect potentially risky players and implement appropriate resources. Similarly, offline gamblers were more likely to report health and psychological impacts of problem gambling than Internet gamblers in an Australian study comparing at-risk and problem gamblers [ 20 ]. These results were based on a relatively small sample with a limited control group. This mode of gambling, facilitated by technological advances, increased Internet availability and ownership of Internet-enabled devices, is not a separate type of gambling activity. For example, in an Australian nationally representative prevalence survey, the overall problem gambling rate among Australian non-Internet gamblers was 0. Consequently, it has been asserted that the easy access to gambling provided by Internet modes may lead to the development or exacerbation of gambling problems [ 1 , 22 , 24 , 31 ]. Risk factors for Internet problem gambling identified include being male, younger adults, and being from a culturally diverse background [ 13 , 20 , 41 , 66 , 67 ]. Single, unmistakable indicators for problems are uncommon, and therefore detection of risk indicators usually relies on algorithms to detect interaction between these. Internet gamblers are most likely to associate their problems with casino games, sports and race wagering and poker [ 13 , 20 ]. Internet gambling use is likely to continue to grow as online platforms become increasingly used to engage in entertainment and recreational activities, including through phones and other wireless devices. Few studies have investigated the types of gambling that are most likely to be associated with problems related to Internet gambling. Nonetheless, the relationships between Internet gambling, gambling problems and other mental health issues are still unclear [ 73 ]. Research suggests that the most commonly reported motivators and advantages of Internet gambling are the convenience and accessibility of this mode [ 15 — 17 ]. Longitudinal research will be an important addition to this field to address these issues. Studies have found that one third to one half of Internet gamblers experiencing gambling problems attribute these to land-based forms of gambling, and over half report that they had existing problems before they ever gambled online [ 13 , 20 ]. In particular, sports betting appeared to be associated with moderate risk and problem gambling, a finding not replicated among land-based only gamblers [ 13 , 20 ]. Other studies have also found that Internet gamblers are more likely to have higher educational levels and socio-economic profiles [e. However, these are associations that do not control for the interaction between variables so it is difficult to draw firm conclusions about problem as compared to non-problem Internet gamblers. Surveys have found that online problem gamblers are significantly less likely to have sought formal help as compared to land-based problem gamblers [ 20 , 42 , 43 ]. This finding was in contrast to earlier analyses [ 31 ] and demonstrates the importance of controlling for confounding factors. This is an important finding as it demonstrates unsurprisingly that a single gambling index such as a frequency of gambling, or expenditure is not adequate to predict gambling problems. However, this finding may be specific to the Australian context as sports wagering is one of the few legal forms of online gambling. This follows recognition of the difficulties of enforcing prohibition and the benefits of regulation, including requiring harm minimization measures to enhance consumer protection, and generating taxation revenue [ 1 ]. However, most studies examining the relationship between Internet gambling and problems are cross-sectional, which do not allow for causality to be determined and self-report is subject to bias and reliant on accuracy of reporting. Similarly, a total of However, there is little evidence available that would enable the causation of Internet-related gambling problems to be determined, and most longitudinal studies contain too few Internet gamblers to provide meaningful analyses. Risk factors identified do not appear to be universal; for example, Gainsbury, Russell, Wood, Hing and Blaszczynski [ 13 ] found problem Internet gamblers more likely to be young, less educated and have greater debts than non-problem Internet gamblers. Research is also needed on a variety of different player accounts, as the vast majority of research has been done with a single dataset from one European gambling site, which may not be generalizable to other online gamblers. The consistent relationship found between problematic Internet gambling and younger age suggests that this population is particularly vulnerable to harms related to this form, and use of Internet gambling amongst young males is an area that warrants further attention in terms of research as well as harm minimisation. No studies have established the causation between associations found and the direction of any link between problem online gambling. In comparison, the rate among Internet gamblers was three times higher at 2. However, there is a growing recognition that Internet gamblers are a heterogeneous group, and research needs to consider how Internet gambling behaviour may be integrated more broadly with offline gambling [ 48 , 65 ]. Despite rates of Internet gambling increasing in several jurisdictions, little evidence has been found to suggest that the prevalence of problem gambling has increased [ 13 , 53 , 54 ]. Conversely, for some Internet problem gamblers, this mode of gambling appears to be the proximal cause of problems, with problem gamblers reporting that their problems started after they first gambled online and around half specifically attributing problems to this mode [ 13 , 20 ]. Rather it is a mode of access that is distinct from gambling in person at terrestrial or land-based retail outlets and placing wagers over the telephone. Mounting evidence of distress and dysfunction related to excessive and problematic Internet use and specifically Internet gaming led the DSM-5 Taskforce to officially call for further research on this behaviour [ 5 ]. Internet gambling a term largely interchangeable with interactive remote and online gambling refers to the range of wagering and gaming activities offered through Internet-enabled devices, including computers, mobile and smart phones, tablets and digital television. {PARAGRAPH}{INSERTKEYS}Due to the high level of accessibility, immersive interface and ease at which money can be spent, concerns have been expressed that Internet gambling may increase rates of disordered gambling. For example, even though Internet gamblers were more likely to be classified as being at risk or experiencing gambling problems in a nationally representative survey, when other variables were controlled for, Internet gambling participation was not predictive of problem gambling severity [ 13 ]. As such, it is a largely automated activity that could be conducted in private, at any time and location, using high-speed Internet connections enabling rapid placement of bets and notification of outcomes. Despite some indications of a positive correlation, the relationship between Internet gambling participation and problems has not been confirmed. Given the similarities in the experience and excessive use of Internet gambling and gaming and the potential for harm based on excessive Internet use, pathological use of Internet gambling also warrants specific consideration [ 4 ]. A subsequent study found only age differed between Internet and non-Internet problem gamblers when controlling for Internet gambling participation, and there were no significant differences based on education or income [ 20 ]. As Internet gambling increases in popularity and use, it is likely that the next generation of gamblers will use Internet modes earlier in their gambling career, which may increase the proportion of individuals who experience problems that are attributed to this mode. Other commonly stated advantages of Internet gambling include greater value for money, including payout rates and bonuses, the speed and ease of online gambling, greater number of betting products and options and the physical comfort of being able to gamble from home. There is also evidence that Internet problem gamblers have higher rates of drug and alcohol use than non-problem gamblers. Analysis of customer communication with online operators identified risk markers that predicted customers closing their accounts due to stated gambling problems. Other gambling-related behaviours have also been identified as being potential markers of risky Internet gambling. Overall, existing studies fail to define specific personal or behavioural risk factors to differentiate between Internet and non-Internet problem gamblers. These results may indicate that Internet gamblers who are at risk for gambling problems may engage in a range of risk-taking behaviours, for example, due to high levels of impulsivity [ 72 ]. Evidence suggests that there is a relationship, albeit complex, between the availability of gambling opportunities and increased levels of related problems [ 25 — 30 ]. As a result of the empirical comparisons demonstrating the fundamental parallels between gambling problems and substance use, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders DSM-5 includes a new category of Non-Substance Behavioural Addiction within the substance addictions category [ 3 ]. A study examining actual Internet gambling account activity combined with a self-report measure of gambling problems confirmed that gambling involvement, as indicated by number of games played and days bets placed on in past year, is predictive of gambling problems amongst the sample of Internet gamblers analysed [ 58 ]. The use of digital forms of money e. Internet gambling also has some unique features that may pose additional risks for harm, particularly for vulnerable populations. The relationship between Internet and problem gambling is likely mediated by the use of land-based gambling. Internet gambling is growing rapidly in terms of popularity, market share and products offered. Internet gambling represents a fundamental shift in how consumers engage in gambling, and concerns have been expressed by various stakeholders about these changes. However, this relationship has not been investigated in independent samples. A study examining irrational and erroneous thinking found that greater levels of erroneous cognitions significantly predicted problem gambling severity when controlling for other variables among Internet gamblers [ 46 ]. In an Australian national survey, almost half of all gamblers stated that land-based electronic gaming machines were the primary cause of their problems, including among Internet gamblers [ 13 ]. These included expressed doubts about results of games, requests for account reopening, queries about financial transactions and account administration, the frequency of contacts per month urgency and use of a threatening tonality [ 82 ]. Further evidence to question the extent to which Internet gambling increases rates of problem gambling can be taken from prevalence studies. Such preventative action is generally not required by Internet gambling regulators, meaning that further action is reliant on operator-initiated action. Data collected by gambling treatment services suggest that Internet gambling currently makes a small, but growing, contribution to gambling problems among those seeking formal help [ 37 , 40 , 41 ]. An Australian telephone survey found that illicit drug use was a significant predictor of having greater levels of gambling problems [ 13 ]. The current paper aimed to provide an overview of the research to date as well as highlight new and interesting findings relevant to adult Internet gambling addiction. This type of betting allows frequent and repeated bets to be placed during a single sporting event, with rapidly determined outcomes, which may be particularly attractive to people who are highly impulsive and at greater risk for disordered gambling [ 81 ]. The current paper aimed to provide an overview of the research to date as well as highlight new and interesting findings relevant to Internet gambling addiction. Some studies have found similar rates of gambling problems among Internet and land-based gamblers [ 15 , 41 ]. Identifying, detecting and acting on early risk indicators may reduce gambling-related harms sustained by Internet gamblers. Internationally, an increasing number of jurisdictions are legalizing and regulating Internet gambling [ 10 ]. These results are consistent with a wide body of research which suggests that gambling disorder is related to high levels of involvement in terms of expenditure, time, frequency and variety of gambling forms used [ 13 , 36 , 52 , 59 — 63 ]. There is some evidence that these do represent at least partially different cohorts; however, the heterogeneity in each group makes specific risk factors difficult to identify. This paper presents research to inform a greater understanding of adult participation in Internet gambling, features of this interface that may impact problem severity, the relationship between Internet gambling and related problems, as well as considering the role of the wider spectrum of gambling behaviour and relevant individual factors that moderate this relationship. Other concerns include that the high accessibility to Internet gambling may increase gambling, particularly among technology-savvy youth, and lead to an increase in the incidence and prevalence of disordered gambling [ 1 , 21 ]. Therefore, research suggests that highly involved gamblers are more likely to engage with Internet modes, including those with existing gambling problems, than less involved gamblers. This suggests that problems related to Internet gambling may be underrepresented in treatment-seeking samples and are likely to increase over time as more people participate in this mode and problem severity increases.