Excessive Spending in a "Free-to-Play" Smartphone Game

Background and Objectives Although gaming disorder is increasingly recognized, there has been limited consideration of the impact of free-to-play games with in-game purchases, also called microtransactions. Methods Case report (n = 1). Results A patient with posttraumatic stress disorder, major depressive disorder in remission, polysubstance use disorders in remission, and opioid use disorder on buprenorphine/naloxone developed gaming disorder (based on International Classification of Diseases, 11th revision) and spent up to 40% of his monthly income on microtransactions within a smartphone game. Treatment consisted of relinquishing access to electronic payment mechanisms, motivational interviewing, and couples therapy. Discussion and Conclusions The case highlights how in-game purchases may cause patients with gaming disorder to experience financial consequences, and the need for further characterization of the clinical ramifications of microtransactions. Scientific Significance To the best of our knowledge, this is the first report in the medical literature of a patient with gaming disorder developing excessive in-game spending from expenditures on microtransactions. (Am J Addict 2020;00:00-00)