More than 130,000 Irish people suffer from problem gambling or are at risk of it, according to a study that highlights the large and underestimated societal harm involved.

Unregulated social casino games – online games without real money – are associated with problem gambling and may act as a gateway to real gambling and problem gambling, the review by the Economic and Social Research Institute (ESRI) warns.

“The international evidence on problem gambling points to the need for greater action to address gambling-related harms,” it concludes.

Based on survey data, 0.3 per cent of the population (about 12,000 people) are estimated to suffer from problem gambling, it says. A further 0.9 per cent (35,000 people) are at moderate risk, and 2.3 per cent (90,000) are at low risk.

These figures are likely to be underestimates, according to the review of international and Irish evidence by the ESRI’s behavioural research unit, commissioned by the Gambling Regulatory Authority of Ireland.

It says the societal burden of harm from problem gambling is large and may be mostly accounted for by people with less severe problems because they are more numerous. “The implication is that broadly targeted interventions and policies may be warranted, rather than those targeted only at those with those with the most severe problem gambling.”

There is “reasonably strong evidence” that exposure to gambling advertising increases gambling behaviour, says the report, which goes on to highlight the targeting of advertising at specific groups, its “unavoidability” and interactivity, the offering of financial incentives to gamble, and the lack of effectiveness of “responsible gambling” messages.

“Loot box” purchasing in video games is very similar to gambling, but remains largely unregulated and so is accessible to minors, according to the study. Research shows significant correlations between loot box purchasing and problem gambling.

Loot boxes are virtual in-game content paid for using real money. These boxes contain a variety of in-game items that in theory can be earned by playing in-game, but this requires a lot more time and effort than buying them.

At over €2 billion, gambling revenues in Ireland last year were about the same as those from beef exports. The authority was set up late last year after new legislation was passed to tighten regulation of the sector.

The report says supply-side interventions such as limit-setting tools or personalised feedback have been shown to be effective in reducing problem gambling behaviour, as have therapeutic interventions such as CBT. The evidence for educational interventions is “mixed” and there is insufficient evidence for using drugs to treat the problem, it finds.

Men, younger people and disadvantaged groups are at greatest risk of problem gambling, it says, as are those with other addictive and mental health issues. Compared to other gamblers, problem gamblers tend to go for gambling with a high frequency of rounds, and short time intervals between wagers and potential payouts, such as interactive online gambling, casino gambling and electronic gaming machines.

Gambling is negatively perceived by the public and problem gambling tends to be highly stigmatised, the report says. Those affected often have difficulty perceiving their own gambling problems and recalling what they have spent.

In the report, the definition of problem gambling and its most severe form, gambling disorder, is based on the presence of symptoms and behaviours such as lying to conceal gambling, repeated unsuccessful efforts to reduce gambling and needing to gamble with increasingly large amounts to achieve the desired excitement.