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Online color-guessing game-related gambling disorder in a young adult: A case report
* Corresponding author: Dr. Poulami Laha, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India. mitul0995@gmail.com
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Received: ,
Accepted: ,
How to cite this article: Laha P, Badhai L. Online color-guessing game-related gambling disorder in a young adult: A case report. Future Health. doi: 10.25259/FH_64_2025
Abstract
Gambling disorder is a persistent pattern of gambling behaviour that leads to significant bio-psycho-social impairment. It increasingly manifests through online platforms due to accessibility, anonymity, and rapid reinforcement cycles. This case report is of a 26-year-old male with a 2.5-year history of online color-guessing game-related gambling disorder, characterized by escalating financial losses, cognitive distortions, and a brief depressive episode. A multimodal strategy was used, which included naltrexone to reduce cravings, cognitive behavioural therapy to address maladaptive beliefs, financial planning, and family intervention. This case demonstrates how circumstances such as access to financial resources can cause relapse. To address the growing problem of online gambling in India, it highlights the importance of early diagnosis, integrated care, and public health measures, including the need for strict law enforcement.
Keywords
Case report
Cognitive behavioural therapy
Cognitive distortions
Gambling
Naltrexone
INTRODUCTION
Gambling disorder is a persistent or recurrent pattern of online or offline gambling marked by impaired control, prioritization of gambling over other life activities, and continuation despite adverse consequences, causing significant distress or impairment in key life areas, as per the International Classification of Diseases (11th revision) (ICD-11).1 It is classified under “Substance-related and Addictive Disorders” in the Diagnostic and Statistical Manual of Mental Disorders (5th edition) (DSM-5).2 Although standardized global estimates are limited, about 1.2% of adults have a gambling disorder, with people gambling at harmful levels accounting for roughly 60% of total gambling losses.3 Because of its accessibility, anonymity, and quick reinforcement cycles, online gambling, especially instant-reward games, has gained popularity in recent years.4 India is witnessing a rise due to its expanding internet penetration and mobile gaming market,5 yet clinical reporting remains limited due to under-recognition and stigma. Even though gambling in casinos, betting, lotteries, and poker are legally prohibited in India, some online games like rummy are legal, being defined as “games of skill,”5 which can act as traps to gambling for young adults.
The present case highlights an instance of online color-guessing game-related gambling disorder in a young adult male, detailing the course of illness, associated cognitive distortions, comorbid psychological features, and a multimodal treatment approach involving pharmacological and psychosocial interventions. This report underscores the need for early identification, comprehensive management, and public health measures to address the growing problem of online gambling in India.
CASE REPORT
History
A 26-year-old male, engineer by occupation, belonging to a middle socio-economic status family of Andhra Pradesh, and having premorbid anxious avoidant traits, introvert in nature, with a personal history of recreational alcohol use, family history of Alcohol Dependence Syndrome and Nicotine Dependence Syndrome in second and third-degree relatives, presented with a 2.5-year history of a progressive, episodic gambling behavior, which began insidiously. It started at age 24 by participating in an online color-guessing game after seeing an advertisement promising easy money with a ₹2000 credit on sign-up. He thought the game would be a chance to change his life after winning the early rounds. As he could move the winnings to his bank account, he felt reassured and kept playing despite a few losses.
These initial successes encouraged him to play larger sums. He borrowed money from friends and instant loan apps. He thought a bigger stake would inevitably result in a victory, even though he had accumulated considerable losses in a few months. Then he borrowed over ₹2 lakh in the hopes of making a sizable gain that would enable him to settle his obligations. But the cycle continued as he chased his losses, confident that the next wager would always result in a win. Mr. X tried to avoid the gaming website when he kept losing. But his worries regarding the inability to pay off the debts and associated guilt made him restless, and he used to think, “This is the last time I will play, and I may hit the jackpot,” which would result in a relapse.
His gambling behavior gradually interfered with his professional life, ultimately leading to his dismissal from his job. After a brief period of abstinence (lasting approximately 9 months, due to exhaustion of financial resources), he secured a new job. He gambled again and spent up to ₹5 lakh in a single day. He obtained a ₹10 lakh personal loan from a bank, pawned his gold ring and chain to finance his gambling, and kept playing in the hopes of winning. His pals alerted his family when they could not get their money back, and his family learned of his gambling behavior. He had a brief depressive episode following this reveal. His family tried to assist by paying off some of his debts, but larger loans remained unpaid. In an effort to regain control, his family also blocked access to the gambling site and brought him in for treatment. He lost ₹1.8 lakh in the most recent episode, which happened a month before his presentation. With current debts of more than ₹10 lakh, his total losses are anticipated to be ₹20 lakh. He admits that the excitement of winning and seeing the money deposited into his account keeps him gambling. Even during presentation to the hospital, he continued to harbor thoughts of winning and believed that gambling could still change his financial situation.
Examination
Physical examination revealed no abnormality. Mental status examination revealed worries about loan repayment and guilt. According to Prochaska and DiClemente’s Stages of Change Model, he was in the action stage.
Management
Investigations: Routine blood tests (complete blood count, liver function test, renal function test, serum electrolytes, random blood glucose, vitamin B12, vitamin D, folate, thyroid function test) were done to rule out any medical comorbidity and to have a baseline record. Vitamin B12 level was found to be low, the rest were within normal limits. Electrocardiography was within normal limits.
Treatment: A collaborative approach with the patient was taken towards holistic treatment, focusing on maintaining recovery and preventing future relapse. It included both pharmacological and non-pharmacological measures.
Pharmacological management: A schedule for vitamin B12 supplementation by injection was added (Inj Optineuron 1 ampoule intramuscular once daily for 7 days, then once weekly for 6 weeks, then once monthly for 6 months). Naltrexone was started in tablet form at 25 mg/day for 4 days and increased to 50 mg/day afterwards to reduce the urge for gambling. No side effects were reported.
Non-pharmacological management: Cognitive behavioral intervention for gambling was conducted with a focus on restructuring cognitive distortions. For example, the patient was supported in identifying distorted beliefs such as the idea that if red had come up five times, then green was due next, or that an “almost win” meant success was close. The principles of probability and randomness were introduced to question these ideas, and he was able to reframe them into logical alternatives by realizing that each gamble was independent and unaffected by past results or intuition. Behavioral methods were used concurrently. Stimulus control techniques, such as limiting access to gambling apps, blocking related websites, and avoiding high-risk environments, were implemented effectively. He practiced behavioral substitution by engaging in healthier activities like exercise, hobbies, walking, or calling a family member whenever gambling urges appeared. The delay technique was used consistently. He started postponing gambling for 15-30 minutes until his urges diminished naturally.
As therapy progressed, he was gradually exposed to gambling triggers, such as opening the gambling app or viewing the colour board on the screen, but refrained from placing bets. During these sessions, he practiced relaxation and mindful-breathing techniques, which enabled them to tolerate cravings until the urge reduced, thereby breaking the cycle between trigger and gambling behavior. Alongside this, skills training was applied, focusing on money management strategies like debt restructuring, budgeting, keeping minimal cash, and restricting access to funds by temporarily handing over financial control to a trusted family member.
Finally, relapse prevention planning was conducted to strengthen recovery. He identified personal high-risk situations, including urgent need for money, boredom, and developed coping strategies. The patient demonstrated notable improvements in urge resistance, healthier coping strategies, and cognitive restructuring after ten sessions. Following the intervention, GRCS (Gambling Related Cognitions Scale)6 scores fell from 102 to 31 [Table 1], and OGSAS (Online Gambling Symptoms Assessment Scale)7 scores fell from 29 to 7 [Table 2]. Family members were provided adequate knowledge about the illness, the required attitude towards the patient, and the required practices to ensure recovery and prevent relapse. Regular follow-ups are being done twice monthly. He has been able to maintain recovery at 5 months from the start of treatment. He started paying off the debts with his salary. Family members continue to supervise his finances.
| No. | Items | Pre-intervention | Post-intervention |
|---|---|---|---|
| 1 | Gambling makes me happier | 5 | 2 |
| 2 | Gambling makes things seem better | 5 | 2 |
| 3 | Gambling makes the future brighter | 6 | 2 |
| 4 | I can’t function without gambling | 4 | 1 |
| 5 | It is difficult to stop gambling as I am so out of control | 4 | 1 |
| 6 | My desire to gamble is so overpowering | 5 | 1 |
| 7 | I’m not strong enough to stop gambling | 5 | 1 |
| 8 | I will never be able to stop gambling | 4 | 1 |
| 9 | Specific numbers and colors can help increase my chances of winning | 6 | 1 |
| 10 | I collect specific objects that help increase my chances of winning | 1 | 1 |
| 11 | I have specific rituals and behaviors that increase my chances of winning | 1 | 1 |
| 12 | I have some superstitions which make me lucky when I gamble. | 1 | 1 |
| 13 | If I know someone who is lucky, I try to be around them so that their luck rubs off on me. | 1 | 1 |
| 14 | There are certain circumstances or situations that increase my chances of winning. | 5 | 2 |
| 15 | A series of losses will provide me with a learning experience that will help me win later. | 6 | 1 |
| 16 | My knowledge and skill in gambling contribute to the likelihood that I will make money. | 6 | 2 |
| 17 | My gambling wins prove that I have skills and knowledge related to gambling. | 5 | 2 |
| 18 | When I win it is mainly due to my skill and knowledge in the area. | 5 | 2 |
| 19 | Praying helps me win | 5 | 1 |
| 20 | Remembering how much money I won last time makes me continue Gambling | 6 | 2 |
| 21 | Relating my losses to bad luck and bad circumstances makes me continue gambling | 5 | 1 |
| 22 | When I have a win once, I will definitely win again | 6 | 1 |
| 23 | Having a gamble helps reduce tension and stress | 5 | 1 |
| Statement | Pre-intervention score | Post-intervention score |
|---|---|---|
| 1. If you had unwanted urges to gamble online during the past week, on average, how strong were your urges? | 3 | 1 |
| 2. During the past week, how many times did you experience urges to gamble online? | 3 | 1 |
| 3. During the past week, how many hours (add up hours) were you preoccupied with your urges to gamble online? | 2 | 1 |
| 4. During the past week, how much were you able to control your urges? | 1 | 0 |
| 5. During the past week, how often did thoughts about gambling online and placing bets come up? | 3 | 1 |
| 6. During the past week, approximately how many hours (add up hours) did you spend thinking about placing bets? | 3 | 1 |
| 7. During the past week, how much were you able to control your thoughts of gambling? | 2 | 0 |
| 8. During the past week, approximately how much total time did you spend gambling online or on online gambling activities? | 0 | 0 |
| 9. During the past week, on average, how much anticipatory tension and/or excitement did you have shortly before you engaged in online gambling? If you did not actually gamble online, please estimate how much tension and/or excitement you believe you would have experienced if you had gambled online. | 3 | 1 |
| 10. During the past week, on average, how much excitement and pleasure did you feel when you won on your bet? If you did not actually win at online gambling, please estimate how much excitement and pleasure you would have experienced if you had won. | 3 | 1 |
|
11. During the past week, how much emotional distress (mental pain or anguish, shame, guilt, embarrassment) has your online gambling caused you? |
3 | 0 |
| 12. During the past week, how much personal trouble (relationship, financial, legal, job, medical, or health) has your online gambling caused you? | 3 | 0 |
DISCUSSION
This case is unique from other Indian reports because, in contrast to the more popular rummy or cricket betting, it features an internet game of colour guessing, a gambling modality with less documentation. From the first sign-up bonuses to the growing debt of ₹20 lakh through multiple loan applications, job loss, abstinence due to a lack of financial resources, relapse with restoration of finances with a new job, and finally, family engagement, it depicts a whole path. The patient’s illness onset was in early adulthood, a typical age for initiation due to increased exposure to online platforms, financial autonomy, and heightened risk-taking behaviour. The episodic course with periods of abstinence and relapse reflects the fluctuating nature of behavioral addictions. Treatment included vitamin B12 correction, Naltrexone, cognitive behavioral therapy (CBT), and family intervention to ensure a supportive, non-enabling environment, reflecting best-practice multimodal care. OGSAS and GRCS were used to indicate objective improvement, and at the 5-month follow-up, there was a sustained recovery.
Pharmacological intervention in other Indian case reports was a combination of Fluvoxamine (150 mg/day) and Naltrexone (50 mg/day), or Bupropion (150-300 mg/day) and Naltrexone (50 mg/day), or monotherapy with Fluvoxamine (150-200 mg/day) in adults, along with psychotherapy.8-11 In this case, we initiated Naltrexone, an opioid antagonist, at 50mg/day to reduce gambling urges.12,13 Evidence from randomized controlled trials suggests that Naltrexone is effective in attenuating the rewarding aspects of gambling, particularly in individuals with high levels of gambling-related excitement or craving.12 A double blind placebo controlled study by Grant et al. showed similar efficacy of a lower dose of Naltrexone (50 mg/day) compared to higher dosages (100 mg/day, 150 mg/day),14 hence we chose to keep our patient at a lower dosage. A recent network meta-analysis showed higher efficacy and greater improvement in quality of life with Naltrexone over Bupropion, Paroxetine, and Fluvoxamine in pathological gambling, and Olanzapine and Topiramate were not more efficacious than placebo.15
Cognitive distortions such as chasing losses, gambler’s fallacy, magnification of gambling abilities, and temporal telescoping were central to the perpetuation of gambling behavior. Chasing losses involves engaging in the gambling behavior more frequently, persisting for longer periods, and taking on higher financial risks in an attempt to recover previously lost money.16 The gambler’s fallacy is a false belief that a random event becomes less likely to happen if it has occurred recently.17 For example, if red colour has landed five times in a row, someone affected by the gambler’s fallacy might think other colors like green or violet are “due” to happen next, even though each time red still has a 50% probability. Magnification of gambling abilities refers to the overestimation of skill, strategy, or control in gambling activities, believing they are more capable of influencing outcomes than they actually are.18 Temporal telescoping is a memory distortion where individuals misjudge the timing of past events, leading to forward (recalling them as having occurred more recently) and backward (farther in the past than they actually did) telescoping.19 For gamblers, this can mean underestimating the time since their last gambling episode or loss, which may make gambling seem more frequent or recent wins feel closer in time, potentially reinforcing continued play. These maladaptive beliefs are well-documented in literature as maintaining factors in gambling disorder and are prime targets for CBT.20 The brief depressive episode post-reveal of gambling behavior to family members aligns with findings that gambling disorder is often comorbid with mood disturbances, either as a consequence of gambling-related stress or as a contributing factor to relapse.
This case highlights significant issues related to public health. Young adults are particularly at risk due to the 24/7 accessibility and relentless marketing of online gambling platforms, which frequently operate in murky legal areas. Stricter regulations, early screening, and awareness campaigns are all crucial preventive strategies. The Promotion and Regulation of Online Gaming Act 2025, which forbids online money games, associated advertising, and financial facilitation, was recently imposed by the Indian government in August 2025. Although this is a big policy move, its impact remains to be seen.
CONCLUSION
This case describes that gambling disorder in the online era requires addressing of individual’s gambling behavior, cognition, environmental triggers, and family intervention. With the rising trend of internet-based gambling in India, early recognition, evidence-based management strategies, and strict law enforcement are essential to prevent severe financial, social, and psychological consequences.
Author contribution
P.L., psychiatrist, was involved in the clinical evaluation, diagnosis, and management of the patient. She conceptualized the case report, contributed to reviewing the relevant literature, interpreted the clinical findings, and took the lead in drafting and refining the manuscript. L.B., clinical psychologist, played a key role in the psychological assessment, case formulation, and psychological interventions. She contributed to literature review, and helped in shaping and revising the manuscript to ensure clarity and depth. Both authors worked closely throughout all stages of the report, approved the final version, and take full responsibility for the accuracy and integrity of the work.
Ethical approval
Institutional Review Board approval is not required.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation
The authors confirm that there was no use of Artificial Intelligence (AI)-Assisted Technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
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