I’ve sparingly treated people with video game addiction for almost a decade, but until last year I did not know about loot boxes. When the World Health Organization (WHO) officially stated in June of 2018 that video game addiction was a mental health disorder that would be included in ICD-11, I took notice. Over the last 21 months, Andrew Walsh and I have researched the topic and opened up a program to treat people in NJ with this disorder (we have a book coming out in October of 2019 titled Video Game Addiction 101 that you can purchase on Amazon).

Loot boxes have become ubiquitous in video games. Imagine you are playing a sword and sorcery fantasy game (something like Lord of the Rings, Conan the Barbarian or Game of Thrones). You would like to acquire a new sword that is valued at 1500 gold pieces in the game. You only have 567 old pieces. You can go and purchase five loot boxes for 100 gold pieces each. You don’t know what is in the loot boxes. You could get a terrible item, an average item, or a wonderful item. You might end up with a dagger that is only worth 50 gp (likely) or you could end up with the exact sword you are looking for (unlikely). The gold pieces you have in the game could be acquired either though (a) completing tasks in the game or (b) using a credit card to buy them (so using actual money to buy virtual money that is only good for the video game).

This is an 86 second video where kids explain loot boxes to their parents. This is a 22 minute video of a young child opening loot boxes and discussing them. He knows what is coming out of them by the sound and color before we can even see the object. Clearly he has opened up a great many loot boxes. Besides the initial concern about the actual money that is being spent on virtual items, there is a much greater problem: loot boxes are gambling. Worse, they are exposing millions of people to gambling at a young age. It is well known that the earlier someone uses nicotine, alcohol, or drugs, the more likely they are to develop an addiction to it. This also holds true for gambling. We believe that loot boxes are potentially priming two generations of young people for gambling problems.

Andrew and I are not screaming from the edge of the woods on this. Belgium banned loot boxes in 2018 and the British Parliament, which seemingly can agree on nothing right now, is discussing banning them in the entire UK. Loot boxes are a booming business that non-gamers have no idea about. In 2018, the gambling revenue from all of the Las Vegas casinos was a little over $6 billion. Loot boxes brought in over $30 billion dollars in 2018. It is because of this massive revenue generation that games like Call of Duty have recently added loot boxes.

Loot Boxes are not just in pc games or console games (like Playstation or Xbox), but can also be found in mobile games (which make up over 50% of the worldwide market for video games). If you have a loved one that plays video games (child or adult), ask them about loot boxes. Ask if they purchase any and if so, how are they coming up with the in-game money to buy them.

Back in April, I had to attend the first of two, two-day pre-predeployment sessions with the Army (don’t even get me started on the wisdom of having two of them). One day was spent on medical exams and the other day was dedicated to a massive variety of administrative paperwork.

One station dealt with death. It wasn’t labeled the death station (I’ve asked around – it doesn’t have a formal name. I think it was station three that weekend). The first person I checked in with updated my military insurance information. We discussed who gets money if I die, including a backup recipient in case that person is dead. We reviewed the beneficiaries’ names, addresses, and various contacts. I had to sign several copies of the forms and they were witnessed.

The next person I talked to at the death station asked about who gets my last paycheck. I was also asked if I had a will (at that time, I didn’t, but I had one made during the summer).

The final person at the death station inquired about who gets my remains upon returning to the states and who is my health care proxy.

All of this was asked in a very direct, matter-of-fact way. There were easily 150 soldiers that went through the station that day. No one got angry. Or cried. Or, from what I could tell, was filled with despair. It was similar to reviewing our vaccines or our educational history or other military records. Every year that I’ve been in the Army I’ve had to go over the military insurance and the beneficiaries. But the last paycheck, the will, the remains, and the health care proxy were all new queries.

A close friend of mine had a bit of a difficult time when her father died. There wasn’t a health care proxy or an advanced directive, and it made a stress period in the hospital much harder as her family members argued over what should be done.

Having this paperwork done well in advance ensures that the decisions are made rationally and that the guidelines are in place. It also makes sure the person dying is treated the way they want (and not the way the loudest/most difficult family member wants).

I have been teaching at the Rutgers School of Social Work since 2011. Dozens of my students have interned at nursing homes or convalescent centers. Many of them were tasked with asking the residents questions about their will, funeral plans, advanced directives, and/or health care proxies. My students were regularly berated for bringing these topics up (“she wants me to die!” one octogenarian yelled). Granted, part of it may have been their delivery (mostly their discomfort with it), but these are very important discussions that need to be held. Younger family members usually hesitate to bring these up, as they don’t want to cause their loved ones distress. And that is a massive mistake. These are hugely important matters that must be settled.

Stunningly, the military does an excellent job at this. The civilian world can learn a lot from that process. So, to be clear:

1. people need to have a will and name an executor (you should name a backup, but not co-executors – some people with two children do this and it’s really foolish)
2. people should have an advanced directive written out
3. people should have documentation signed that names a health care proxy
4. people should have life insurance and have it regularly reviewed and updated
5. people should make sure that their loved ones know about the existence and location (of copies) of items 1-4

For those of you that are looking for a simpler solution, this document (thanks April Cardone) covers the advanced directive and health care proxy (you still have to work out your will and insurance). If you are over 40, you should have these done. If you have elderly family members, you should get on them to get these things done. But be mindful of how you bring it up. You might want to enlist the help of a social worker.