The only game to receive the rating for other reasons is Peak Entertainment Casinos (2003), which allows players to gamble using real money. The rating has also been issued for three games due to extreme levels of violence: the canceled Thrill Kill (1998), the initial cut of Manhunt 2 (2007), and Hatred (2015). The majority of AO-rated games are adult video games, those with pornographic or strong sexual content. AO is the highest rating in the ESRB system, and indicates a game is only suitable for players age 18 and over. The Entertainment Software Rating Board (ESRB), the video game content rating board for North America, has issued an " Adults Only" ( AO) rating for 29 games.
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