2020 National Survey ofGambling Addiction in Japan:
Executive Summary

National Hospital Organization
Kurihama Medical and Addiction Centerh t tp s://kurih a ma .hosp .g o.j p /BACKGROUND AND OBJECTIVESThis report presents the results of a national population-based survey of gambling
disorder in Japan, which was performed in October 2020. This survey was the firstfact-finding study based on Article 23 of the Basic Law on Measures Against
Gambling Addiction (Act no. 74 of 2018), and had the objective of determining theprevalence of gambling disorder. A second objective was to clarify the status ofgambling-related problems, such as multiple debts, poverty, child abuse, suicide,and crime. This research project was funded by the Japanese Ministry of Health,Labour, and Welfare, with the aim of obtaining basic data to support
countermeasures for gambling addiction in Japan.
*The full-length report of the current survey is available in Japanese at https://www.ncasa-japan.jp/pdf/document41.pdf

OUTLINE OF RESEARCH PROJECT
Survey A : A nationwide survey of the general population was performed, in orderto estimate the prevalence of gambling disorder among the generaladult population. In addition, the associations between gambling
disorder and gambling-related problems, such as multiple debts,
poverty, child abuse, suicide, and crime, were investigated.
Survey B : A survey of people with problem gambling at community mental healthcenters and self-help groups was performed, in order to identify thecharacteristics and support needs of people with gambling problems,
and their families, who seek help from community mental health centersand self-help groups.
Survey C : A fact-finding survey of various institutions that provide consultationand counseling services, etc. (counseling institutions), was performed.
The counseling institutions included were not specialized in addiction,
but covered fields such as law, suicide prevention, economic hardship,child abuse, and consumer protection. However, such counselinginstitutions are likely to be accessed by people with gambling-related
problems. The aim of the survey was to investigate how well counselinginstitutions that do not specialize in addiction treatment respond when aperson suspected of gambling problem consults them.

1METHODS
Procedures
The schedule, data collection method, and total number of valid responses toeach survey are shown in Table 1. Self-administered questionnaires were used in
all three surveys.
Survey A : Stratified random sampling based on the Basic Resident Register wasused, with 17,955 adults between the ages of 18 and 74 collected. A totalof 8,499 participants responded (response rate: 47.2%), of whom 8,223
were analyzed.
Survey B : Two recruitment methods were used. Firstly, questionnaires were
distributed to people with gambling problems and their families byservice providers at each community mental health center. Secondly,
the secretariats of self-help groups for gambling addiction were asked
to distribute questionnaires to their members.
Survey C : A questionnaire was mailed to the central office of each counselinginstitution.
Table 1

Survey period
Survey A

Data collection methods

Questionnaires mailed to theOct. 22
address of each household,to Dec. 16, 2020 and responses collected via
Internet or mail.

Survey B

Nov. 30, 2020,
to Feb. 4, 2021

1) Questionnaires handed toparticipants in personby service stuff.
2) Questionnaires distributed bysecretariats ofself-help groups via e-mail.

Survey C

Dec. 23, 2020,
to Jan. 15, 2021

Questionnaires mailed tocentral offices, and data collected
via Internet or e-mail.

Number of responses
Total responses: 8,469 (47.2%)
Valid responses: 8,223

Gamblers’ responses: 377
Family members’ responses: 643

Counseling institutions’ responses
: 166

2

Measurements
Survey A : Sociodemographic variables (sex, age, income, etc.), gambling behavior,gambling-related problems, screening tests for gambling disorder,
cross-addiction, awareness of gambling addiction, and awareness of
support resources were asked.
Survey B : In addition to the variables covered in Survey A, information about thebackgrounds of participants referred to community mental healthcenters or self-help groups was obtained. Moreover, previous experienceof treatment for addiction, experience of the use of other recovery
facilities, and the time it took for participants to acknowledge theirgambling problems and access support resources, were investigated.
Opinions about government policies relating to gambling addiction
were also canvased. Family members were asked about the most
severe effects of the gambling problems on them.
Survey C : Each counseling institution was asked about its basic characteristics,
that is, location, field of consultation, and respondents’ specialties. In
addition, each was asked, “Does your institution confirm about gambling
behavior of clients who suspect they have gambling problems?” , and“Have you ever dealt with a client who had a gambling problem?”This study was approved by the Ethics Review Committee of the National Hospital
Organization, Kurihama Medical and Addiction Center.

3

RESULTS
Survey A: Nationwide general population survey
1. Participation in gambling by Japanese adults
In Survey A, 45.0% (n = 1781) of males and 22.9% (n = 978) of females reported
engaging in some form of gambling at least once in the past year. Among those
who responded that they had engaged in some form of gambling at least once
during their lifetimes, the most popular type was the lottery (63.7%), and this wasfollowed by pachinko (50.3%), horse racing (29.4%), and pachi-slot (22.7%) (Figure 1).
Figure 1.

Participation for any forms of gambling in the past year
45%

Males

22.9%

Females

33.6%
Total

Most popular forms of gambling in the general adults
63.7%
Lottery

50.3%

Pachinko

29.4%

Horse racing

22.7%

Pachi-slot

4Survey A: Nationwide general population survey
Figure 2. Types of government gambling and governmental regulatory agencies in Japan

Government sponsored gambling
Legally
recreational,
but consideredgambling

Sport-promotion
Lottery

Lottery

Soccer and basketball
betting; TOTO, BIG, WINNER

Jumbo lotteries, BINGO5
LOTO6&7, NUMBERS3&
4, Scratch, etc.

Regulated by

Ministry of Education,
Culture, Sports, Scienceand Technology

Pachinko
Pachi-slot
Japanese original
electoric gaming machine
Regulated by
National Police Agency

Regulated by

Ministry of Internal Affairs
and Communications

Publicly managed race
Bicycle race,
motorcycle race

Horse race

Motorboat race

Regulated by

Ministry of
Economy, Tradeand Industry

Column 1

Ministry ofAgriculture,
Forestry and
Fisheries

Ministry of Land,
Infrastructure
and Transport

Types of gambling in Japan

In Japan, the first legislation to ban gambling dates from the seventh century.
Currently, all forms of gambling are illegal in Japan. Crimes relating to gamblingand sale of lottery crimes are defined by the Penal Code (Articles 185 to 187).
However, there is an exception, termed“government-sponsored gambling” . The
legal status of gambling, and special
legislation for different types of gambling areshown in Figure 2. There is no central authority
regulating these gambling practices, witheach type being under the jurisdiction of andregulated by different governmental
agencies.

5

2. Prevalence of gambling disorder
The prevalence of gambling disorder was calculated using the South Oaks
Gambling Screen (SOGS) total score. In this study, the cut-off point applied for the
total SOGS score was five.
Therefore, individuals with a total SOGS score of five or higher were considered tohave a gambling disorder. The prevalence of gambling disorder was found to be
3.7%* in males, 0.7%* in females, and 2.2%* in total. This rate is somewhat high ininternational terms, as shown in Figure 3.
* These rates were calculated with adjustment for age, on the basis of Japan's demographic distribution.

Figure 3. International comparison of problem gambling
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(Data were obtained from Calado and Griffiths, Journal of Behavioral Addictions, 2016)

3. Association with gambling-related problems
Gambling-related problems that frequently occur among individuals withgambling disorder, including multiple debts, poverty, child abuse, suicide, andcrime, were investigated. The χ2 test and Fisher’ s exact test were used forstatistical analysis (Table 2). The results showed that individuals with gambling
disorder had higher rates of depression and anxiety, smoking, suicidal ideation,suicide attempts, and adverse childhood experiences than other individuals.
Table 2

Association with gambling-related problems

SOGS
<5

SOGS
Ёʨ
Severe depression and/or anxiety suspected

16.6%

22.2%

Suicidal ideation (any time in past)

39.9%

2.8%

Suicide attempts (any time in past)

5.6%

16.8%

Smoking (current)

49.1%

31.4%

Alcohol problem

38.6%

24.8%

Adverse childhood experiences

34.8%

5.3%

6

Survey A: Nationwide general population survey
4.Types of gambling engaged in by individuals with gambling disorder
Among individuals with gambling disorder, the types of gambling on which they
had spent most money in the past year were pachinko (38.7%), pachi-slot (32.3%),
and horse racing (11.0%). Among females, the percentage of lottery was 16%, which
was the same as that of pachi-slot (Figure 4).
Figure 4. Types of gambling engaged in by individuals with gambling disorder

39%

Pachinko

60%
35%

32%

Pachi-slot

16%

35%

11%

Horse race

4%
12%

7%

Lottery

16%
5%
Total
11%

Others4%

0%7Females

12%

25%

50%

75%

Males

Column 2

Forms of gambling unique to Japan: Pachinko and Pachi-slot

Pachinko is a form of gambling that is unique to Japan. It is played onelectronic gaming machines (EGMs), and is characterized by accessibility andsimplicity. The basic principle of pachinko is somewhat similar to that of
pinball; a small, silver-colored, steel ball is shot out, and when the ball drops
into a hole the player wins. However, it is different from pinball in the following
ways. Players do not place gambling money directly using the pachinko
machine. At first, they pay money, and buy the steel balls. Subsequently,
hundreds of silver balls move into the machines, and are shot out by turning around knob located at the bottom right of the machine. When players win, theyreceive a large number of additional balls, which can be exchanged for prizes
at the parlor, or for cash at an exchange located outside the parlor. Due to it
working as detailed above, pachinko is classified legally as amusement rather
than gambling. A photograph of a pachinko parlor with machines and players
is shown below. Pachinko parlors are ubiquitous throughout Japan.
Furthermore, like convenience stores, they are open for long hours, from 9:00
a.m. to 11:00 p.m. Anyone aged 18 years or more can easily enter pachinko
parlors without an ID check. One can play with any amount of money, startingfrom ¥1,000.

8

Survey A: Nationwide general population survey

Pachi-slot is another type of EGM that is original to Japan, and operates in asimilar manner to pachinko parlors. At first glance, it looks like a slot machinecommonly found in casinos, but Pachi-slot is different in that the player canstop the spinning reels at any time with the press of a button.
As mentioned above, in both pachinko and pachi-slot, players are fascinatedby the feeling of being able to control the timing of a jackpot using their own
skills. Furthermore, both games are designed to take full advantage of thecharacteristics of the EGMs, with a variety of themes to keep players hooked,
including bright lights, noises, anime, movies, and historical themes.

9

5.Awareness of gambling addiction and preventive measures
When individuals' thoughts about and attitudes toward physical and mental
illnesses (including addiction) were surveyed, 72.6% answered that their gambling
disorder was their own fault. This was higher than the 60.7% for alcohol use disorderand 8.8% for depression (Figure 5).
Figure 5. Thoughts about and attitudes toward physical and mental illnesses:
Responses to “Do you think it is your own fault that you have developed this condition?”

Gambling disorder

72.6%

Alcohol use disorder

27.4%

60.7%

39.3%

8.8%

Depression

91.2%

Cancer 3.6%

96.4%
Strongly agree/ agree
28.5%

Diabetes
0%

71.5%

20%

60%

40%

100%

80%

Strongly disagree/disagree/neutral

Only approximately 10% of respondents were aware of self-exclusion, which iscurrently available as a countermeasure against gambling addiction, involving
restrictions on loans from financial institutions and on entry to gambling venues.
However, for all methods, the percentage who were aware tended to be higher
among those individuals with gambling disorder than among those without(Figure 6).
Figure 6. Awareness of preventive measures for gambling addiction

19.6%

Self-regulation on loans
from financial companies

10.9%
11.1%

16.0%

Self-exclusion fromgambling venues

5.6%
5.8%
ˆ˂ʺˆ˦˖ˢ˥˘Ёʨ

Self-exclusion frompachinko/pachi-slo parlors

25.0%

7.1%
7.5%

SOGS score <5
Total

0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

10

Survey B: Fact-finding survey of users of community mental
health centers and self-help groups for problem gambling
Responses from individuals who sought help from a self-help group for agambling problem showed that the mean time between becoming aware of the
problem and joining a self-help group was 63.1 months, with the median being 36
months.
On the basis of responses of family members, the most common impact on family
members of someone having a gambling problem was “assuming debts” , in thecase of users of both community mental health centers and self-help groups. Thiswas followed by “financial difficulties” and “anger towards the person with agambling problem” (Table 3). Furthermore, approximately 5 years passed fromfamilies becoming aware of a person's gambling problem to accessing support
resources, with a mean of 58.2 months for families using community mental healthcenters, and 55.5 months for families using self-help groups.
Table 3 Effects on family members of people with gambling problems
Families using community mental
health centers (n = 72)

Families using self-helpgroups (n = 378)

Financial difficulties

37 (51.4%)

205 (54.2%)

Assumed debts

46 (63.9%)294 (77.8%)

Money and goods stolen

25 (34.7%)

186 (49.2%)

7 (9.7%)22 (5.8%)

Family discord / separation / divorce

21 (29.2%)

153 (40.5%)

Depression

14 (19.4%)

97 (25.7%)

Verbal violence16(22.2%)

100(26.5%)

Anger towards the person with a gambling problem

45(62.5%)

273(72.2%)10(13.9%)63(16.7%)

Alcohol problems (including drunk driving)

2(2.8%)

23(6.1%)

Nothing3(4.2%)

5(1.3%)

Physical violence

Inappropriate parenting of children

11Survey C: Fact-finding survey of various counseling institutions
A survey was performed with counseling institutions that may encounter problems
relating to gambling addiction, despite not being specialized in counseling about
gambling addiction. These institutions were asked, “Does your institution confirm
about the gambling behavior of clients who suspect they have gamblingproblems?” , and 64.2% of institutions responded that they did so, depending on
the situation (Figure 7). In addition, with the exception of child consultation centers,
most counseling institutions responded that they had had experience of dealing
with gambling problems.
Figure 7. Status of confirmation of clients’ gambling behavior by different types of counseling institution
11.8%

Public health centers

76.5%
68.4%

Child consultation centers
Municipal Health carecenters
Livelihood Protection offices

31.6%

8.3%

83.3%

3.4%

23.5%

55.6%

33.3%

27.3%

Suicide Countermeasure
Promotion Center

13.8%

64.7%

11.1%

Judicial scrivener
consultation office

8.3%

82.8%

11.8%

Consumer Affairs Centers

68.2%

36.4%

Federation of Inochi No Denwa(provider of the suicide hotline)
Social inclusion support centers

11.8%

63.6%

7.1%

78.6%

9.3%

70.7%

Total
0%

4.5%

Confirming withall clients

14.3%

Confirming dependon the situation

20.0%

Not confirming
20%

40%

60%

80%

100%

12

IMPLICATIONS FOR POLICY AND PRACTICE
The results of Survey A showed that the prevalence of gambling
disorder in the general adult population was 2.2%. This corresponds toapproximately two million people in Japan, so it is clear that a
considerable number of people in Japan are suffer from gambling
disorder.
Furthermore, as individuals with gambling disorder has been shown to
be associated with depression and suicidal ideation, it is essential toprovide support for gambling addiction at the same time as suicide
prevention. However, analyses that take into consideration the effects ofconfounding factors are needed.
The types of gambling in which individuals with gambling disorder
engage are predominantly pachinko, pachi-slot, andgovernment-sponsored horse racing. It is therefore expected that any
measures taken will focus on these types of gambling.
More than 50% of respondents believed that addiction to gambling wastheir own fault, and awareness of measures to prevent addiction(e.g. self-exclusion, such as restriction of access to loans and entry togambling venues) was low. Therefore, it is necessary to provide thepublic with accurate information about addiction, and to disseminateawareness of preventive measures.
The results of Survey B showed that it is not until 3 to 6 years after
gambling problems are recognized that the affected person andhis/her family contact a community mental health centers or self-helpgroup. From this perspective, it is necessary to establish an environment
in which people with problems can access support resources muchearlier.
Survey C was a survey of counseling institutions that do not specialize ingambling addiction counseling, but are likely to deal with gambling
addiction problems, such as those relating to severe debts, poverty,
abuse, and suicide. More than 50% of respondents said they had
experience of consultations linked to gambling problems. Therefore, it isnecessary for the staff at these counseling institutions to improve theirskills for dealing with gambling addiction.

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CONCLUSIONS
The aim of this project was to clarify the prevalence of gambling
disorder, and the status of gambling-related problems, using threesurveys. The results provide basic materials for taking measures against
gambling addiction in Japan. However, it should be noted that thesesurveys were performed during the spread of COVID-19, so the survey
method was limited to questionnaires sent by mail, and thepsychosocial conditions of the respondents were different from normal
times. It would be preferable to continue to accumulate data, and toassess the situation on a long-term basis.

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ACKNOWLEDGEMENT
This study was supported by a block grant to the Division of Clinical Research,
National Hospital Organization Kurihama Medical and Addiction Center, fundedby the Ministry of Health, Labor, and Welfare, Japan.

CONFLICT OF INTEREST DECLARATION
The authors declare no conflict of interest in relation to this report or project.

AUTHOR INFORMATION
Chie Nitta, Ph.D.
Institute of medicine, University of Tsukuba, Ibaraki, Japan
Yoshiki Koga, Ph.D.
Department of clinical research, National Hospital Organization Kurihama
Medical and Addiction Center, Yokosuka, Japan
Tomomi Toyama, M.D.
Department of psychiatry, National Hospital Organization Kurihama Medicaland Addiction Center, Yokosuka, Japan
Sachio Matsushita, M.D., Ph.D.
Director of National Hospital Organization Kurihama Medical and Addiction
Center, Yokosuka, JapanTO CITE THIS REPORT
Nitta, C., Koga, Y., Toyama, T., Matsushita, S. 2020 National Survey of Gambling
Addiction in Japan: Executive Summary, National Hospital Organization
Kurihama Medical and Addiction Center, 2023.

National Hospital Organization Kurihama Medical and Addiction Center
5-3-1 Nobi Yokosuka, Kanagawa 239-0841, Japan
Telephone: +81 46 848 1550