by Trung Nguyen
3. Reasons people become addicted
4. Risk factors
5. Types of gamblers
6. Phases of gambling addiction
7. Characteristics of compulsive gamblers
8. Gambling a type of drug
9. How gambling is similar to drugs
10. Gambling is worse than alcohol and drugs
11. How to tell if a co-worker is a gambler
13. Consequences of gambling addiction
16. Helping a problem gambler
17. How do I overcome gambling addiction?
18. Gambling addiction as a mental illness
The literal meaning of "gambling addiction" is:
Gambling: To engage in reckless or hazardous behavior.
Addiction: Habitual psychological and physiological dependence on a substance or practice beyond one's voluntary control.
The literal definition of gambling addiction implies that it is:
1. a behavioral problem.
2. a psychological problem.
3. a physiological problem.
4. a form of substance abuse.
You will notice that, contrary to what many believe, gambling addiction is not a money problem. Most people gamble to escape from stress, a painful past, to seek arousal, or to be in "action."
Gambling addiction is also known as compulsive gambling, pathological gambling, and problem gambling. The technical definitions of gambling addiction are:
1. Pathological gambling is a psychiatric disorder characterized according to the international diagnostic classification DSM-IV, by persistent, recurrent and maladaptive gambling behavior which disrupts the subject's personal, family and working life.
2. A progressive disorder characterized by a continuous or periodic loss of control over gambling; a preoccupation with gambling and with obtaining money with which to gamble; irrational thinking; and a continuation of the behavior despite adverse consequences. [back to top]
Gambling addiction is classified slightly different depending on how the symptoms are diagnosed. Gamblers Anonymous and the American Psychiatric Association use different symptoms to diagnose the problem.
Gamblers Anonymous (GA). According to Gamblers Anonymous, gambling addiction is the most "insidious and baffling" disease. Like cancer, there is no known cure for it. You can only arrest the problem, or put it in remission but never be fully cured. Gamblers Anonymous believes that character defects are a major contributor to the problem. Some of these character defects listed by Gamblers Anonymous are:
Jealousy Lazines Profanity Procrastination Self-Seeking Remorse Worry Fear Intolerance Egotism Anxiety Dishonesty Impatience Anger Arrogance Frustration Condemnation of others Self-Pity Selfishness Revenge Conceit Inadequacy False pride Bigotry Resentment Hatred
American Psychiatric Association (APA). The American Psychiatric Association has labeled the problem as a "mental illness" or mental disorder. Gambling addiction is classified in the same category as clinical depression, manic depression (bipolar disorder), attention deficit disorder (ADD), schizophrenia, and personality disorder (narcissistic personality). Furthermore, a mental illness is classified as a disease by the APA. Therefore gambling addiction is considered a mental disease that causes a disturbance in thoughts, irrational behaviors, and the inability to cope with the demands of daily life (stress, routines, confrontation, and interpersonal relationships).
Below are some symptoms of mental illness, which gambling addiction is considered one according to the APA.
* irrational and confused thinking
* prolonged sadness or irritability eventually leading to depression
* extreme mood of highs and lows
* irrational and excessive worries and fears
* isolation and social withdrawal
* changes in sleeping and eating patterns
* substance abuse (gambling, prescription drugs, illicit drugs, alcohol, sex, shopping, overeating)
* excessive anger
* hallucinations or delusions
* inability to cope with daily problems as part of normal life
* thoughts of suicide
* denying that problems don't exist
The Centers for Disease Control (CDC). The Centers for Disease Control labeled gambling addiction as an "impulse control disorder." Impulse control disorder is a group of psychiatric disorders whose symptoms include compulsive gambling, pyromania (setting fire), compulsive shopping and spending, addiction to video games and the Internet, excessive anger, compulsive pulling of hair, compulsive stealing, etc.). For example, someone who has an impulse control disorder will act on impulse even when they know the negative consequences in advance.
Scientists. Recently scientists have classified gambling addiction as a neurobiological disorder, a chemical dependency of the brain similar to those addicted to drugs such as cocaine, crack cocaine, heroin, and alcohol (alcohol is considered a drug). According to these scientists, gambling is a drug because its psychoactive effects are similar to tangible drugs. For example, under an MRI (Magnetic Resonance Imaging) scan, the affected areas of the brain of a gambling addict are the same as those of a cocaine addict.
Psychologists. According to psychologists, gambling addiction is a problem rooted in the subconscious mind of the addict, such as the dark, hidden past stemming from childhood, unresolved conflicts with parents and authorities, and narcissism. Some psychoanalysts have suggested that problem gamblers are masochists who subconsciously want to punish themselves( self-punishment) to alleviate feelings of guilt, possibly to amend for transgressions.
According to Sigmund Freud, gambling addiction, like most addictions, is a secondary addiction to the primary addiction of masturbation. Freud suggested that sex and aggression were the primary determinants in our behavior. He suggested that sexuality is linked with anxiety, and that sexuality needed an outlet. One of the triggers for gambling relapse is anxiety, which can be caused by sexual tension, stress, or apprehension about future events. Therefore, sexuality, stress, and anxiety are linked and the gambler gambles to release anxiety, sexual pressure, or stress. Freud gives an example of anxiety as when you feel threatened, feel overwhelmed, or feel as if you were about to collapse under the weight of it all. He once said, "Life is not easy!"
Former Addicts and Freewill Advocates. Those who have conquered the problem on their own believe that gambling addiction is simply a problem, or a choice that the addict has made through his or her freewill. They believe the problem is being medicalized (disease theories) and biologicalized (genetic theories) and oppose those views. They do not view gambling as an evil, disease, illness, or disorder, but that it is simply an activity. Some studies have shown that those who were able to overcome gambling addiction did so in stages, relapsing at first but eventually reaching their final goal. Some studies have also shown that it is possible for former compulsive gamblers to gamble responsibly without losing control when they were able to resolve the underlying issues that initially led them to gamble compulsively. [back to top]
3. Reasons people become addicted to gambling
There are 6 main reasons people become addicted to gambling. They are:
1. To cope with traumatic life experiences. People gamble to avoid uncomfortable or painful emotions, including sadness (passing of loved ones), guilt, shame, anger, humiliation, failure and frustration. Gambling provides the illusion of control in uncontrollable situations and environments.
2. To chase losses. Chasing past losses is the result of experiencing early wins. After a winning streak, the gambler is deluded with the idea of the "Big Win." The gambler thinks that through this Big Win, his or her bills will be paid and problems solved. The Big Win is an illusion that keeps the gambler in action until he or she admits there is a problem and seeks help.
3. As a form of stimulation. Some people knowingly or unknowingly seek the risky, naughty, thrill-seeking lifestyle through gambling. They surrender to their impulses and gambling acts as a drug that is as powerful as any available.
4. As a coping mechanism. Problem gamblers seek the "zone out" or "in my own little world" effect. They feel the need to escape the stress, demands, and pressures of daily life.
5. To climb the economic ladder. Some gamblers have the illusion, indoctrinated through advertising, that gambling can provide a steady income and money will solve their problems.
6. To self-sabotage their success. Some problem gamblers feel uncomfortable with, guilty about, or undeserving of their success. Gambling is used as a tool for self-destruction. The reasons behind their need for self-destruction are rooted in the past which psychology can explain. [back to top]
4. What are the risk factors of gambling addiction?
Coping Strategies. Coping strategies are life management skills, which include the ability to deal with the demands of every day life at home and work. These life management skills are required to effectively deal with stress, interpersonal relationships, setbacks, disappointments, and obstacles that are a part of life. Problem gamblers often lack coping strategies and gamble to escape adversity and hardship.
Impulsivity. Impulsivity is the inability of the gambler to control their behavior even when they know the consequences beforehand through experience. Impulsivity stems from personality. One trait of impulsivity is the inability to delay decision-making.
Stress. Most relapses are the result of reaction to stress. Stress can come from work, home, and relationships with acquaintances and friends.
Antisocial Behavior. Gambling is considered a deviant behavior (anti-social in nature) if someone continues to gamble despite knowing the negative consequences to themselves and those in their lives. Some anti-social behaviors include:
* lying to or conning others for fun or for personal benefit
* being irresponsible, not holding down a job or paying back money
* being impulsive and not considering the results of a certain behavior
* breaking laws
* ignoring the safety of self or others
* lacking remorse, not worrying about hurting other people
* picking on other people or getting into fights
Depression. The debate is still ongoing as to whether gambling addiction is the cause of depression or depression is the cause of gambling addiction.
Gender. It used to be that men were more likely to become problem gamblers than women were. However, that is no longer the case. Women are now being targeted by the gambling industry just as men are. Men who become problem gamblers start gambling as teenagers, while women develop the problem later in life, usually 30 years old and up.
Socio-economic Status. As measured by percentage, people with low income lose more to gambling than those with high income. Those making less than $20,000 a year are likely to lose about 3% of their income to gambling, while those making over $30,000 will lose about 2% of their income to gambling. People with low income tend to view gambling as a quick ticket out of poverty.
Family History. If you have a parent or anyone in your immediate family who is a problem gambler, you are at a much higher risk of becoming one yourself. This could be due to hereditary (genetics) or social learning (behaviors you learned from family members and peers growing up).
Irrational Thinking. Irrational thinking is also known as the "Gambler's Fallacy." Problem gamblers tend to look for patterns in random events. For example, if they lose 3 times in a row, then they think a win is due soon. They expect their luck to change if things are going against them. However, in reality any game of chance is fixed according to mathematical probabilities and losing 3, 4, 5, 6, or even 10 times in a row does not guarantee that a win is around the corner. [back to top]
5. How many types of gamblers are there?
There are six types of gamblers identified by Dr. Robert L. Custer.
1. Escape gamblers
3. Professional gamblers
4. Anti-social or personality gamblers
5. Casual social gamblers
6. Serious social gamblers
Furthermore, gamblers can be divided into two main groups: Action gamblers and Escape gamblers.
Action Gamblers: Action gamblers are mostly male who started their gambling careers as teenagers. Their addiction usually lasts anywhere from 5 to 30 years. Action gamblers prefer games that are perceived to have elements of skill involved(in reality, there is very little skill involved in any game of chance). Their games of choice include poker, online poker, blackjack, craps, sports betting, horse racing, or any game where they are presented with the opportunity to beat another player or the house. They usually develop gambling systems that are effective in the short-run but ineffective in the long-run, since the house or casino always has the mathematical advantage in the long-run.
Action gamblers have personality traits that are domineering, manipulative, controlling, and egotistic. They tend to have above average IQ's (over 120 versus the average of 100). They are known to be friendly, sociable, generous, assertive and confident. But despite some of their good character traits, they have very low self-esteem.
Action gamblers gamble to obtain the euphoric high that cocaine addicts crave. After prolonged exposure to gambling, action gamblers get that high just by thinking about gambling or planning when they'll gamble next. Like all problem gamblers, action gamblers eventually become detached from reality and become very good at lying; they eventually even lie to themselves.
Escape Gamblers: Escape gamblers are mostly (over 65%) female who develop the problem later in life, usually after 30 years old. They prefer games that are perceived to have no elements of skill; these games include video poker, lottery, bingo, and slot machines. These games provide the relief from emotional (or sometimes physical) pain. While gambling, escape gamblers are numbed by the drug-effect of gambling and find themselves in a hypnotic-like state--their problems disappear while they're "in action."
Escape gamblers are known to be reserved, but they can also be manipulative when the occasion calls for it (obtaining money to gamble). As an adult, they tend to be nurturing and are afraid of confrontation. Some escape gamblers were physically or verbally abused as children. The escape gambler, like the action gambler, has low-self esteem. [back to top]
6. What are the phases of gambling addiction?
The winning phase: The winning phase is when the gambler experiences the early wins. They brag and exaggerate about their winnings and exude the image of the "big shot." They are very optimistic about winning. They think (falsely) that gambling will provide them with the good life without hard work, patience, and diligence.
The losing phase: The losing phase is when the losing streaks begin; the true odds of gambling are being reflected and the gambler doesn't stand a chance regardless what system he or she uses. At this point the gambler begins to miss work, asks for bailouts, neglects bills, borrows to gamble, lies to cover losses, and manipulates to get money for gambling. In the losing phase, the gambler thinks he's facing a temporary period of bad luck. However, it's not luck he's up against but the mathematics (probabilities) designed into every game of chance to ensure that the house or casino always wins.
The desperate phase: In the desperate phase the gambler faces isolation from friends and family. He feels remorse for the money he's lost and for his inability to control his behavior. As a result panic ensues and he becomes desperate. He now has to decide whether to continue to gamble or quit. His reputation with those around him is affected, but rather than look inward he'll blame others, out of frustration and anger, for the predicament he's in. He is unwilling to accept responsibility and the consequences of his behavior. At this point, some problem gamblers will resort to illegal activities to finance their gambling.
The critical phase: During the critical phase, the gambler realizes he is not making any progress in life and gambling isn't going to provide him with the good life he's imagined. He tries to be more responsible and is hopeful for the future. He is a more productive employee at work and becomes realistic about his money goals. Slowly he puts his pride aside and reaches out for help, either through counseling, Gamblers Anonymous, books, or a combination of the three, and begins to examine his spiritual needs.
The rebuilding phrase: The building phase is about self-examination. Here the gambler accepts his strengths and weaknesses. He begins to pay his bills, develops new hobbies, and seeks new goals. He becomes more patient, less irritable and spends more time with his friends and family. Semblances of a normal life begin to return.
The growth phrase: The growth phase is when the gambler develops a higher consciousness. He seeks self-understanding through studying psychology, philosophy, and spirituality. He learns the power of forgiveness and its role in putting the past behind in order to live in the present. Through self-examination he is able to forgive himself and others. He becomes more generous and understands his own needs and wants and the needs and wants of other people. He also deals with problems as they arise, accepts the hardships of life, and becomes realistic rather than overly optimistic or pessimistic about situations. He takes life one day at a time and deals with whatever life throws at him. He is comfortable in his own skin and doesn't feel the need to control, manipulate, or lie. He makes progress as a human being and begins to contribute to the community in which he or she lives. [back to top]
7. What are the characteristics of compulsive gamblers?
* Thoughts are preoccupied with gambling.
* Increasing the amount wagered to get the same level of excitement.
* Failed in attempts to curtail or quit gambling, becomes restless and irritable when he can't control his impulse to gamble.
* Gambling becomes a means to escape from problems in life.
* Guilt, depression, helplessness, and anxiety become triggers for gambling.
* Chases loss until credit cards, bank cards are overextended and loans are used up.
* Denies and lies to friends and family on the magnitude of the problem.
* Commits crime such as fraud, forgery, embezzlement, and theft to finance gambling.
* Gambling becomes more important than career, education, relationships, and important opportunities in life.
* Becomes co-dependent--relies on others for money and emotional needs. [back to top]
8. Is gambling addiction a type of drug?
Like alcohol, gambling is classified as a drug. However, alcohol is classified as a depressant while gambling is classified as a stimulant. As a drug, gambling is a psycho-stimulant, but at the same time it also has an anesthetic effect. Gambling has the same psychoactive properties as cocaine and heroin--the same chemicals are affected (adrenaline, dopamine, endorphins) in all three drugs when the addicts are in action. Gamblers do not gamble for money but seek "action" through the psychoactive drug-like effects offered by gambling.
Many have argued that gambling is much more dangerous than alcohol, cocaine, or heroin. Chronic Alcoholism may take 5 to 20 years to develop, but people can become addicted to gambling on their very first try. Like cocaine and heroin addicts, problem gamblers go through rituals and seek immediate gratification. These rituals might include what shirt to wear, what machines to play, what table to sit at, what team to bet on, what dealer to play with, or what lucky artifact to bring with them when they're in action. [back to top]
9. How is gambling addiction like a drug?
The same chemicals, or hormones, are released in the brains of gambling addicts and drug addicts when they are in "action." These include adrenaline, dopamine, and endorphins.
Adrenaline: Adrenaline is a hormone made and secreted by the adrenal gland. It makes the heart beat faster, raises blood pressure, and induces a state of excitement or "high." We've all heard of the phrase, "A rush of adrenaline."
Dopamine: Dopamine is an inhibitory neurotransmitter, meaning that when it finds its way to its receptor sites, it blocks the tendency of that neuron to fire. Dopamine is associated with the reward mechanisms in the brain. Drugs like cocaine, opium, heroin, and alcohol promote the release of dopamine, as does nicotine and gambling.
Endorphins: Endorphins is short for endogenuous morphine, which is a type of built-in heroin in the body. Endorphins are structurally similar to the opioid drugs (opium, morphine, heroin, etc.) and have similar functions. Endorphins are mostly involved in pain reduction, similar to the way opioids work: they numb pain. It is known that many problem gamblers gamble to escape emotional pain, stemming from childhood or recent traumatic life experiences.
When problem gamblers quit suddenly or they're forced to because they are out of money, they face the same physical withdrawal symptoms as drug addicts. This is the reason that well-educated, intelligent, wealthy people with no addiction background turn to crime to feed their gambling habit after being "hooked." [back to top]
10. Why do opponents of gambling believe it is worse than alcohol and drugs?
Just as there are drug addiction treatment programs for drug addicts, there are also treatment programs that tackle gambling addiction issues.
Below are some reasons why opponents of gambling believe it is more dangerous than alcohol or drugs (cocaine, heroin, marijuana):
* There are no visible signs. Compulsive gambling has been called an invisible disease because gambling addicts exhibit few signs. A drug addict might act strange or have bodily marks, an alcoholic might smell and stagger, but a problem gambler exhibits no physical signs of his or her problem.
* It is widely available. Take note of how many places you can gamble at a moment's notice: the phone or computer, community halls (bingo), the workplace (raffles and office pools), corner grocery stores (lottery), fund raisers, shopping malls, social events (poker nights, charity), restaurants and bars (VLTs). Gambling is everywhere.
* It is legal. Gambling is advertised as a form of entertainment, and in some cases as a lifestyle, giving the public the perception that it is a harmless activity. Gambling is also advertised as a form of charity, prompting people to believe that if they gamble they are contributing to the good of the community.
* It can lead to financial ruin in a short period. A gambler can lose hundreds, thousands, or millions of dollars in less than 30 seconds by placing a single bet. Your financial losses are unlimited. No other addiction can lead to financial ruin as quick as gambling. [back to top]
11. How do you know if someone you work with is a compulsive gambler?
Henry Lesieur, Ph.D., has performed many studies on compulsive gambling. He identified several signs that you can look for to determine if someone you work with has a gambling problem.
1. Uses telephone often, likely to call bookies, loan sharks or stockbrokers.
2. Uses company vehicle to drive to race track or casino during company time.
3. Absent from work for part of a day, usually after lunch.
4. Usually arrives late for work as the result of gambling on the previous night.
5. Takes vacation on isolated, non-continuous rather than continuous days.
6. Uses sick days ahead of time.
7. Doesn't take days off for fear embezzlement and fraud will be discovered.
8. Inconsistency and severe mood swings, performs well one day and poorly the next.
9. Invites colleagues to gambling excursions and organizes office pools.
10. Borrows money from colleagues and friends to finance gambling.
11. Theft, embezzlement and fraud against company or customers, hiding transactions and skimming money that should have gone to the employer. [back to top]
12. What is cross-addiction in the context of gambling addiction?
Addicts usually have a drug of choice, whether it is gambling, alcohol, cocaine, marijuana, heroin or another drug. However, most addicts are addicted to more than one drug at a time or they might alternate between their drug of choice and another drug. For example, a problem gambler might take up alcohol while he's gambling. Or he might give up gambling for awhile to do other drugs. However, most addicts usually return to their drug of choice after experimenting with other drugs. [back to top]
13. What are the consequences of gambling addiction?
* Large debts that take a long time to pay off
* Relationship problems with spouse, friends, and family members
* Loss of reputation in the community
* Loss of employment
* Poor performance in school; if problem persists, dropping out of school
* Problems with the law if fraud, embezzlement and other crimes are involved.
* Problems with mood swings and physical problems such as losing or gaining weight.
* Thoughts of suicide. Gambler addicts are more likely to commit suicide than drug addicts are. [back to top]
14. What is co-dependency in the context of gambling addiction?
Co-dependency is an emotional and behavioral condition that affects the problem gambler's ability to have healthy relationships. Co-dependency is also known as "relationship addiction." People with codependency are in relationships that are emotionally destructive and abusive. It is believed that co-dependency behavior is learned by imitating family members who are or were co-dependent. Co-dependent behaviors were learned by family members to survive in an emotionally painful and stressful environment. These co-dependent behaviors are passed on from generation to generation. You might want to examine if co-dependency is one contributor to your compulsive gambling.
Co-dependents have low self-esteem and look to externals, rather than internals, to make themselves feel better. They are not comfortable in their own skin and find it hard to be themselves. They try to feel better through alcohol, drugs, nicotine, and of course gambling.
Below are some characteristics of co-dependency:
1. I put my values aside to fit in.
2. I need you to like me in order to feel good about myself.
3. I need approval from you to feel good about myself.
4. I'm worried more about your problems than I am with my problems.
5. I need to put your happiness before mine before I can feel good about myself.
6. You are the center of my attention.
7. I try to manipulate you into doing things my way.
8. When I solve your problems, my self-esteem increases.
10. Your hobbies and interests are more important than mine.
11. You should behave according to my desires for me to feel good about myself.
12. I neglect my feelings and pay attention to your feelings.
13. My dreams and future are linked to yours.
14. My fear of rejection determines what I say and do.
15. My fear of your anger determines what I say and do. [back to top]
15. What is enabling in the context of gambling addiction?
Enabling is when you do anything that helps the gambler to continue with his addiction. For example, if you pay his bills for him, lend or give him money, you become an enabler. If you lie to help him cover his lies, you are an enabler. Or if you offer ultimatums in order to control his behavior, you are an enabler. Even if you in any way, directly or indirectly, make it easier for him to continue with his compulsive gambling, you are an enabler.
By enabling, you are guilty by association. [back to top]
16. How do I help someone who is addicted to gambling?
It is hard to help someone unless they want to help themselves. It's hard enough to change who we are, so trying to change someone else is a daunting, if not an impossible task. The best way to help someone who is addicted to gambling is to make suggestions or offer advice.
1. Help them indirectly to set goals and work out a strategy with them to reach those goals. For example, if they gamble to escape problems in life, buy them a book that teaches life management and coping skills. You can also offer your own life experiences that they can relate to. If they gamble to get the high, give them a gym pass or several bungy jumping passes. You can come up with many creative solutions without becoming an enabler or putting his needs and wants before your own.
2. Stop lending them money for bailouts or lying to cover for them. That is stop, enabling them.
3. Buy them books about compulsive gambling, psychology, philosophy, and spirituality. If the problem persists, seek professional help. [back to top]
17. How do I overcome gambling addiction?
You can attend Gamblers Anonymous meetings if there is a chapter in your area. You can seek counseling through a psychologist or psychiatrist, or other health practitioners. Alternatively, you can do it on your own through self-help by reading books and learning from the experiences of others who have gone through what you're going through. Or you can combine several methods, or even come up with your own.
If you want to get different perspectives on the problem, read the forum posts, journals, stories, and discussions on this site.
18. Does mental illness exist?
Gambling addiction is classified as a mental illness or a mental disorder by psychologists and psychiatrists. It is a disease according to most who have studied the problem. Does it mean they're right? You have to educate yourself.
It's a good idea to have a conceptual overview of the problem. That way, you'll be educated on the different aspects of the problem rather than being force fed a particular doctrine of recovery. The links below can help you to better understand the problem.
1. The Myth of Mental Illness. Dr. Thomas S. Szasz, a very respected member of the medical community, argues that a separation should be made between the brain and the mind when diagnosing mental illnesses. His conclusion is that mental illnesses, such as compulsive gambling, do not exist because they are wrongly diagnosed.
2. Gambling is classified as a mental illness, but does mental illness exist? This is an article from Wikipedia that also examines the nature of mental illnesses, if they exist at all.
3. Is Addiction a disease?. Another article that examines the semantics of disease and questions whether most illnesses are actually simply problems.
4. A doctor gives his views on whether addiction is a disease or a choice. Stanton Peele, Ph.D, has written several books on addiction. His conclusion? Addiction, as it is currently classified, does not exist. Addiction, even gambling addiction, is a choice. And the Gamblers Anonymous 12-Step program can be detrimental to recovery.
5. Addiction is a Choice, a book by Jeffrey A. Schaler, Ph.D. Another doctor examines the nature of addiction. He also concludes that the concept of addiction as a mental illness and disease has no scientific foundation.
6. Is Addiction Just a Matter of Choice? by John Stossel, ABC News. A brief article on the controversy of whether addiction is a choice or a disease.
7. Gambling Addiction and Suicide. This article looks at the rise of suicide rates of gambling addicts.
8. How gambling addiction turned a mother into a monster. We have all heard stories of what compulsive gamblers are capable of. This is one gory example of those stories taken to the extreme.
9. A tragic story of how a son's death turns an honest father into a gambling addict. Another tragic story of how a life was ruined by gambling.
10. Does mental illness, such as gambling addiction, exist? A very insightful article into the nature of addiction.
11. Connection between a prescribed drug, Mirapex, and compulsive gambling. Drugs have been prescribed for every problem. This one, Mirapex, the drug prescribed for Parkinson's disease, is known to cause gambling addiction.
12. The rise of gambling deaths. Despair is one result of gambling addiction and this report might just be the proof. [back to top]
1. Gamblers Anonymous.This is the official site of Gamblers Anonymous and its 12-Step program.
2. Illinois Institute for Addiction Recovery. This site contains additional information on gambling addiction.
3. The Electronic Journal of Gambling Issues. A site that offers research and stories on compulsive gambling.
4. CNN Gambling Addiction. This report compares the similarities of gambling addiction to alcholism.
5. The National Council on Gambling Addiction. This site offers literature and support for problem gamblers. [back to top]
"Addictive" redirects here. For other uses, see Addiction (disambiguation) and Addictive (disambiguation).
|Addiction and dependence glossary|
Addiction is a brain disorder characterized by compulsive engagement in rewarding stimuli despite adverse consequences. Despite the involvement of a number of psychosocial factors, a biological process – one which is induced by repeated exposure to an addictive stimulus – is the core pathology that drives the development and maintenance of an addiction. The two properties that characterize all addictive stimuli are that they are reinforcing (i.e., they increase the likelihood that a person will seek repeated exposure to them) and intrinsically rewarding (i.e., they are perceived as being inherently positive, desirable, and pleasurable).
Addiction is a disorder of the brain's reward system which arises through transcriptional and epigenetic mechanisms and occurs over time from chronically high levels of exposure to an addictive stimulus (e.g., eating food, the use of cocaine, engagement in sexual intercourse, participation in high-thrill cultural activities such as gambling, etc.).ΔFosB, a gene transcription factor, is a critical component and common factor in the development of virtually all forms of behavioral and drug addictions. Two decades of research into ΔFosB's role in addiction have demonstrated that addiction arises, and the associated compulsive behavior intensifies or attenuates, along with the overexpression of ΔFosB in the D1-typemedium spiny neurons of the nucleus accumbens. Due to the causal relationship between ΔFosB expression and addictions, it is used preclinically as an addiction biomarker. ΔFosB expression in these neurons directly and positively regulates drug self-administration and reward sensitization through positive reinforcement, while decreasing sensitivity to aversion.[note 1]
As described by two groups of researchers, addiction exacts an "astoundingly high financial and human toll" on individuals and society as a whole through the direct adverse effects of drugs, associated healthcare costs, long-term complications (e.g., lung cancer with smoking tobacco, liver cirrhosis with drinking alcohol, or meth mouth from intravenous methamphetamine), the functional consequences of altered neural plasticity in the brain, and the consequent loss of productivity. Classic hallmarks of addiction include impaired control over substances or behavior, preoccupation with substance or behavior, and continued use despite consequences. Habits and patterns associated with addiction are typically characterized by immediate gratification (short-term reward), coupled with delayed deleterious effects (long-term costs).
Examples of drug and behavioral addictions include: alcoholism, amphetamine addiction, cocaine addiction, nicotine addiction, opiate addiction, food addiction, gambling addiction, and sexual addiction. The only behavioral addiction recognized by the DSM-5 and the ICD-10 is gambling addiction. The term addiction is misused frequently to refer to other compulsive behaviors or disorders, particularly dependence, in news media. An important distinction between drug addiction and dependence is that drug dependence is a disorder in which cessation of drug use results in an unpleasant state of withdrawal, which can lead to further drug use. Addiction is the compulsive use of a substance or performance of a behavior that is independent of withdrawal.
This section needs expansion. You can help by adding to it.(February 2016)
Cognitive control and stimulus control, which is associated with operant and classical conditioning, represent opposite processes (i.e., internal vs external or environmental, respectively) that compete over the control of an individual's elicited behaviors. Cognitive control, and particularly inhibitory control over behavior, is impaired in both addiction and attention deficit hyperactivity disorder. Stimulus-driven behavioral responses (i.e., stimulus control) that are associated with a particular rewarding stimulus tend to dominate one's behavior in an addiction.
Stimulus control of behavior
See also: Stimulus control
Cognitive control of behavior
See also: Cognitive control
Main article: Behavioral addiction
The term behavioral addiction correctly refers to a compulsion to engage in a natural reward – which is a behavior that is inherently rewarding (i.e., desirable or appealing) – despite adverse consequences. Preclinical evidence has demonstrated that marked increases in the expression of ΔFosB through repetitive and excessive exposure to a natural reward induces the same behavioral effects and neuroplasticity as occurs in a drug addiction.
Reviews of both clinical research in humans and preclinical studies involving ΔFosB have identified compulsive sexual activity – specifically, any form of sexual intercourse – as an addiction (i.e., sexual addiction). Moreover, reward cross-sensitization between amphetamine and sexual activity, meaning that exposure to one increases the desire for both, has been shown to occur preclinically and clinically as a dopamine dysregulation syndrome; ΔFosB expression is required for this cross-sensitization effect, which intensifies with the level of ΔFosB expression.
Reviews of preclinical studies indicate that long-term frequent and excessive consumption of high fat or sugar foods can produce an addiction (food addiction).
Gambling is a natural reward which is associated with compulsive behavior and for which clinical diagnostic manuals, namely the DSM-5, have identified diagnostic criteria for an "addiction". There is evidence from functional neuroimaging that gambling activates the reward system and the mesolimbic pathway in particular. Similarly, shopping and playing videogames are associated with compulsive behaviors in humans and have also been shown to activate the mesolimbic pathway and other parts of the reward system. Based upon this evidence, gambling addiction, video game addiction and shopping addiction are classified accordingly.
There are a range of genetic and environmental risk factors for developing an addiction that vary across the population. Roughly half of an individual's risk for developing an addiction is derived from genetics, while the other half is derived from the environment. However, even in individuals with a relatively low genetic loading, exposure to sufficiently high doses of an addictive drug for a long period of time (e.g., weeks–months) can result in an addiction. In other words, anyone can become an addict under the right circumstances.
It has long been established that genetic factors along with environmental (e.g., psychosocial) factors are significant contributors to addiction vulnerability. Epidemiological studies estimate that genetic factors account for 40–60% of the risk factors for alcoholism. Similar rates of heritability for other types of drug addiction have been indicated by other studies. Knestler hypothesized in 1964 that a gene or group of genes might contribute to predisposition to addiction in several ways. For example, altered levels of a normal protein due to environmental factors could then change the structure or functioning of specific brain neurons during development. These altered brain neurons could change the susceptibility of an individual to an initial drug use experience. In support of this hypothesis, animal studies have shown that environmental factors such as stress can affect an animal's genotype.
Overall, the data implicating specific genes in the development of drug addiction is mixed for most genes. One reason for this may be that the case is due to a focus of current research on common variants. Many addiction studies focus on common variants with an allele frequency of greater than 5% in the general population, however when associated with disease, these only confer a small amount of additional risk with an odds ratio of 1.1–1.3 percent. On the other hand, the rare variant hypothesis states that genes with low frequencies in the population (<1%) confer much greater additional risk in the development of disease.
Genome-wide association studies (GWAS) are a recently developed research method which are used to examine genetic associations with dependence, addiction, and drug use. These studies employ an unbiased approach to finding genetic associations with specific phenotypes and give equal weight to all regions of DNA, including those with no ostensible relationship to drug metabolism or response. These studies rarely identify genes from proteins previously described via animal knockout models and candidate gene analysis. Instead, large percentages of genes involved in processes such as cell adhesion are commonly identified. This is not to say that previous findings, or the GWAS findings, are erroneous. The important effects of endophenotypes are typically not capable of being captured by these methods. Furthermore, genes identified in GWAS for drug addiction may be involved either in adjusting brain behavior prior to drug experiences, subsequent to them, or both. 
A study that highlights the significant role genetics play in addiction is the twin studies. Twins have similar and sometimes identical genetics. Analyzing these genes in relation to genetics has helped geneticists understand how much of a role genes play in addiction. Studies performed on twins found that rarely did only one twin have an addiction. In most cases where at least one twin suffered from an addiction, both did, and often to the same substance.
Environmental risk factors for addiction are the experiences of an individual during their lifetime that interact with the individual's genetic composition to increase or decrease the his or her vulnerability to addiction. A number of different environmental factors have been implicated as risk factors for addiction, including various psychosocial stressors; however, an individual's exposure to an addictive drug is by far the most significant environmental risk factor for addiction. The National Institute on Drug Abuse cites lack of parental supervision, the prevalence of peer substance use, drug availability, and poverty as risk factors for substance use among children and adolescents.
Adverse childhood experiences (ACEs) are various forms of maltreatment and household dysfunction experienced in childhood. The Adverse Childhood Experiences Study by the Centers for Disease Control and Prevention has shown a strong dose–response relationship between ACEs and numerous health, social, and behavioral problems throughout a person's lifespan, including those associated with substance abuse. Children's neurological development can be permanently disrupted when they are chronically exposed to stressful events such as physical, emotional, or sexual abuse, physical or emotional neglect, witnessing violence in the household, or a parent being incarcerated or suffering from a mental illness. As a result, the child's cognitive functioning or ability to cope with negative or disruptive emotions may be impaired. Over time, the child may adopt substance use as a coping mechanism, particularly during adolescence. A study of 900 court cases involving children who experienced abuse found that a vast amount of them went on to suffer from some form of addiction in their adolescence or adult life. This pathway towards addiction that is opened through stressful experiences during childhood can be avoided by a change in environmental factors throughout an individuals life and opportunities of professional help.
Adolescence represents a period of unique vulnerability for developing addiction. In adolescence, the incentive–rewards systems in the brain mature well before the cognitive control center. This consequentially grants the incentive–rewards systems a disproportionate amount of power in the behavioral decision making process. Therefore, adolescents are increasingly likely to act on their impulses and engage in risky, potentially addicting behavior before considering the consequences. Not only are adolescents more likely to initiate and maintain drug use, but once addicted they are more resistant to treatment and more liable to relapse. Statistics have shown that those who start to drink alcohol at a younger age are more likely to become dependent later on. About 33% of the population tasted their first alcohol between the ages of 15 and 17, while 18% experienced it prior to this. As for alcohol abuse or dependence, the numbers start off high with those who first drank before they were 12 and then drop off after that. For example, 16% of alcoholics began drinking prior to turning 12 years old, while only 9% first touched alcohol between 15 and 17. This percentage is even lower, at 2.6%, for those who first started the habit after they were 21.
Most individuals are exposed to and use addictive drugs for the first time during their teenage years. In the United States, there were just over 2.8 million new users of illicit drugs in 2013, or about 7,800 new users per day. Over half (54.1 percent) were under 18 years of age.
Individuals with comorbid (i.e., co-occurring) mental health disorders such as depression, anxiety, attention-deficit/hyperactivity disorder (ADHD) or post-traumatic stress disorder are more likely to develop substance use disorders. The National Institute on Drug Abuse cites early aggressive behavior as a risk factor for substance use.
Transgenerational epigenetic factors
See also: Transgenerational epigenetic inheritance
Epigenetic genes and their products (e.g., proteins) are the key components through which environmental influences can affect the genes of an individual; they also serve as the mechanism responsible for the transgenerational epigenetic inheritance of behavioral phenotypes, a phenomenon in which environmental influences on the genes of a parent can affect the associated traits and behavioral phenotypes of their offspring (e.g., behavioral responses to certain environmental stimuli). In addiction, epigenetic mechanisms play a central role in the pathophysiology of the disease; it has been noted that some of the alterations to the epigenome which arise through chronic exposure to addictive stimuli during an addiction can be transmitted across generations, in turn affecting the behavior of one's children (e.g., the child's behavioral responses to addictive drugs and natural rewards). More research is needed to determine the specific epigenetic mechanisms and the nature of heritable behavioral phenotypes that arise from addictions in humans. Based upon preclinical evidence with lab animals, the addiction-related behavioral phenotypes that are transmitted across generations may serve to increase or decrease the child's risk of developing an addiction.
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Signaling cascade in the nucleus accumbens that results in psychostimulant addiction
This diagram depicts the signaling events in the brain's reward center that are induced by chronic high-dose exposure to psychostimulants that increase the concentration of synaptic dopamine, like amphetamine, methamphetamine, and phenethylamine. Following presynaptic dopamine and glutamateco-release by such psychostimulants,postsynaptic receptors for these neurotransmitters trigger internal signaling events through a cAMP-dependent pathway and a calcium-dependent pathway that ultimately result in increased CREB phosphorylation. Phosphorylated CREB increases levels of ΔFosB, which in turn represses the c-Fos gene with the help of corepressors;c-Fosrepression acts as a molecular switch that enables the accumulation of ΔFosB in the neuron. A highly stable (phosphorylated) form of ΔFosB, one that persists in neurons for 1–2 months, slowly accumulates following repeated high-dose exposure to stimulants through this process. ΔFosB functions as "one of the master control proteins" that produces addiction-related structural changes in the brain, and upon sufficient accumulation, with the help of its downstream targets (e.g., nuclear factor kappa B), it induces an addictive state.
Chronic addictive drug use causes alterations in gene expression in the mesocorticolimbic projection. The most important transcription factors that produce these alterations are ΔFosB, cAMP response element binding protein (CREB), and nuclear factor kappa B (NF-κB). ΔFosB is the most significant biomolecular mechanism in addiction because the overexpression of ΔFosB in the D1-typemedium spiny neurons in the nucleus accumbens is necessary and sufficient for many of the neural adaptations and behavioral effects (e.g., expression-dependent increases in drug self-administration and reward sensitization) seen in drug addiction. ΔFosB expression in nucleus accumbensD1-typemedium spiny neurons directly and positively regulates drug self-administration and reward sensitization through positive reinforcement while decreasing sensitivity to aversion.[note 1] Specific drug addictions in which ΔFosB has been implicated in addictions to alcohol, amphetamine, cannabinoids, cocaine, methylphenidate, nicotine, phenylcyclidine, propofol, opiates, and substituted amphetamines, among others.ΔJunD, a transcription factor, and G9a, a histone methyltransferase, both oppose the function of ΔFosB and inhibit increases in its expression. Increases in nucleus accumbens ΔJunD expression (via viral vector-mediated gene transfer) or G9a expression (via pharmacological means) reduces, or with a large increase can even block, many of the neural and behavioral alterations seen in chronic drug abuse (i.e., the alterations mediated by ΔFosB).
ΔFosB also plays an important role in regulating behavioral responses to natural rewards, such as palatable food, sex, and exercise. Natural rewards, like drugs of abuse, induce gene expression of ΔFosB in the nucleus accumbens, and chronic acquisition of these rewards can result in a similar pathological addictive state through ΔFosB overexpression. Consequently, ΔFosB is the key transcription factor involved in addictions to natural rewards (i.e., behavioral addictions) as well; in particular, ΔFosB in the nucleus accumbens is critical for the reinforcing effects of sexual reward. Research on the interaction between natural and drug rewards suggests that dopaminergic psychostimulants (e.g., amphetamine) and sexual behavior act on similar biomolecular mechanisms to induce ΔFosB in the nucleus accumbens and possess bidirectional cross-sensitization effects that are mediated through ΔFosB. This phenomenon is notable since, in humans, a dopamine dysregulation syndrome, characterized by drug-induced compulsive engagement in natural rewards (specifically, sexual activity, shopping, and gambling), has also been observed in some individuals taking dopaminergic medications.
ΔFosB inhibitors (drugs or treatments that oppose its action) may be an effective treatment for addiction and addictive disorders.
The release of dopamine in the nucleus accumbens plays a role in the reinforcing qualities of many forms of stimuli, including naturally reinforcing stimuli like palatable food and sex. Altered dopamine neurotransmission is frequently observed following the development of an addictive state. In humans and lab animals that have developed an addiction, alterations in dopamine or opioid neurotransmission in the nucleus accumbens and other parts of the striatum are evident. Studies have found that use of certain drugs (e.g., cocaine) affect cholinergic neurons that innervate the reward system, in turn affecting dopamine signaling in this region.
Summary of addiction-related plasticity
Main article: Reward system
This section needs expansion. You can help by adding to it.(August 2015)
Understanding the pathways in which drugs act and how drugs can alter those pathways is key when examining the biological basis of drug addiction. The reward pathway, known as the mesolimbic pathway, or its extension, the mesocorticolimbic pathway, is characterized by the interaction of several areas of the brain.
- The projections from the ventral tegmental area (VTA) are a network of dopaminergicneurons with co-localized postsynaptic glutamate receptors (AMPAR and NMDAR). These cells respond when stimuli indicative of a reward are present. The VTA supports learning and sensitization development and releases DA into the forebrain. These neurons also project and release DA into the nucleus accumbens, through the mesolimbic pathway. Virtually all drugs causing drug addiction increase the dopamine release in the mesolimbic pathway, in addition to their specific effects.
- The nucleus accumbens (NAcc) is one output of the VTA projections. The nucleus accumbens itself consists mainly of GABAergicmedium spiny neurons (MSNs). The NAcc is associated with acquiring and eliciting conditioned behaviors, and is involved in the increased sensitivity to drugs as addiction progresses. Overexpression of ΔFosB in the nucleus accumbens is a necessary common factor in essentially all known forms of addiction; ΔFosB is a strong positive modulator of positively reinforced behaviors.
- The prefrontal cortex, including the anterior cingulate and orbitofrontal cortices, is another VTA output in the mesocorticolimbic pathway; it is important for the integration of information which helps determine whether a behavior will be elicited. It is also critical for forming associations between the rewarding experience of drug use and cues in the environment. Importantly, these cues are strong mediators of drug-seeking behavior and can trigger relapse even after months or years of abstinence.
Other brain structures that are involved in addiction include:
- The basolateral amygdala projects into the NAcc and is thought to also be important for motivation.
- The hippocampus is involved in drug addiction, because of its role in learning and memory. Much of this evidence stems from investigations showing that manipulating cells in the hippocampus alters dopamine levels in NAcc and firing rates of VTA dopaminergic cells.
Role of dopamine and glutamate
Dopamine is the primary neurotransmitter of the reward system in the brain. It plays a role in regulating movement, emotion, cognition, motivation, and feelings of pleasure. Natural rewards, like eating, as well as recreational drug use cause a release of dopamine, and are associated with the reinforcing nature of these stimuli. Nearly all addictive drugs, directly or indirectly, act upon the brain's reward system by heightening dopaminergic activity.
Excessive intake of many types of addictive drugs results in repeated release of high amounts of dopamine, which in turn affects the reward pathway directly through heightened dopamine receptor activation. Prolonged and abnormally high levels of dopamine in the synaptic cleft can induce receptor downregulation in the neural pathway. Downregulation of mesolimbic dopamine receptors can result in a decrease in the sensitivity to natural reinforcers.
Drug seeking behavior is induced by glutamatergic projections from the prefrontal cortex to the nucleus accumbens. This idea is supported with data from experiments showing that drug seeking behavior can be prevented following the inhibition of AMPA glutamate receptors and glutamate release in the nucleus accumbens.
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induction of ΔFosB[note 2]