Alan Rudolph
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This is your brain on gambling...
| Posted on June 22, 2017 at 9:03 PM |
How the Brain Gets Addicted to Gambling Ferris Jabr 10-13 minutes When Shirley was in her mid-20s she
and some friends road-tripped to Las Vegas on a lark. That was the first time
she gambled. Around a decade later, while working as an attorney on the East
Coast, she would occasionally sojourn in Atlantic City. By her late 40s,
however, she was skipping work four times a week to visit newly opened casinos
in Connecticut. She played blackjack almost exclusively, often risking
thousands of dollars each round—then scrounging under her car seat for 35 cents
to pay the toll on the way home. Ultimately, Shirley bet every dime she earned
and maxed out multiple credit cards. “I wanted to gamble all the time,” she
says. “I loved it—I loved that high I felt.” In 2001 the law intervened. Shirley
was convicted of stealing a great deal of money from her clients and spent two
years in prison. Along the way she started attending Gamblers Anonymous
meetings, seeing a therapist and remaking her life. “I realized I had become
addicted,” she says. “It took me a long time to say I was an addict, but I was,
just like any other.” Ten years ago the idea that someone
could become addicted to a habit like gambling the way a person gets hooked on
a drug was controversial. Back then, Shirley's counselors never told her she
was an addict; she decided that for herself. Now researchers agree that in some
cases gambling is a true addiction. In the past, the psychiatric
community generally regarded pathological gambling as more of a compulsion than
an addiction—a behavior primarily motivated by the need to relieve anxiety
rather than a craving for intense pleasure. In the 1980s, while updating the Diagnostic
and Statistical Manual of Mental Disorders (DSM), the American
Psychiatric Association (APA) officially classified pathological gambling as an
impulse-control disorder—a fuzzy label for a group of somewhat related
illnesses that, at the time, included kleptomania, pyromania and
trichotillomania (hairpulling). In what has come to be regarded as a landmark
decision, the association moved pathological gambling to the addictions chapter
in the manual's latest edition, the DSM-5, published this past May. The
decision, which followed 15 years of deliberation, reflects a new understanding
of the biology underlying addiction and has already changed the way
psychiatrists help people who cannot stop gambling. More effective treatment is
increasingly necessary because gambling is more acceptable and accessible than
ever before. Four in five Americans say they have gambled at least once in
their lives. With the exception of Hawaii and Utah, every state in the country
offers some form of legalized gambling. And today you do not even need to leave
your house to gamble—all you need is an Internet connection or a phone. Various
surveys have determined that around two million people in the U.S. are addicted
to gambling, and for as many as 20 million citizens the habit seriously
interferes with work and social life. Two of a Kind The APA based its decision on
numerous recent studies in psychology, neuroscience and genetics demonstrating
that gambling and drug addiction are far more similar than previously realized.
Research in the past two decades has dramatically improved neuroscientists'
working model of how the brain changes as an addiction develops. In the middle of our cranium, a
series of circuits known as the reward system links various scattered brain
regions involved in memory, movement, pleasure and motivation. When we engage
in an activity that keeps us alive or helps us pass on our genes, neurons in
the reward system squirt out a chemical messenger called dopamine, giving us a
little wave of satisfaction and encouraging us to make a habit of enjoying
hearty meals and romps in the sack. When stimulated by amphetamine, cocaine or
other addictive drugs, the reward system disperses up to 10 times more dopamine
than usual. Continuous
use of such drugs robs them of their power to induce euphoria. Addictive
substances keep the brain so awash in dopamine that it eventually adapts by
producing less of the molecule and becoming less responsive to its effects. As
a consequence, addicts build up a tolerance to a drug, needing larger and
larger amounts to get high. In severe addiction, people also go through
withdrawal—they feel physically ill, cannot sleep and shake uncontrollably—if
their brain is deprived of a dopamine-stimulating substance for too long. At
the same time, neural pathways connecting the reward circuit to the prefrontal
cortex weaken. Resting just above and behind the eyes, the prefrontal cortex
helps people tame impulses. In other words, the more an addict uses a drug, the
harder it becomes to stop. Research
to date shows that pathological gamblers and drug addicts share many of the
same genetic predispositions for impulsivity and reward seeking. Just as
substance addicts require increasingly strong hits to get high, compulsive
gamblers pursue ever riskier ventures. Likewise, both drug addicts and problem
gamblers endure symptoms of withdrawal when separated from the chemical or
thrill they desire. And a few studies suggest that some
people are especially vulnerable to both drug addiction and compulsive gambling
because their reward circuitry is inherently underactive—which may partially
explain why they seek big thrills in the first place. Even more compelling,
neuroscientists have learned that drugs and gambling alter many of the same
brain circuits in similar ways. These insights come from studies of blood flow
and electrical activity in people's brains as they complete various tasks on
computers that either mimic casino games or test their impulse control. In some
experiments, virtual cards selected from different decks earn or lose a player
money; other tasks challenge someone to respond quickly to certain images that flash
on a screen but not to react to others. A 2005 German study using such a
card game suggests problem gamblers—like drug addicts—have lost sensitivity to
their high: when winning, subjects had lower than typical electrical activity
in a key region of the brain's reward system. In a 2003 study at Yale
University and a 2012 study at the University of Amsterdam, pathological
gamblers taking tests that measured their impulsivity had unusually low levels
of electrical activity in prefrontal brain regions that help people assess
risks and suppress instincts. Drug addicts also often have a listless
prefrontal cortex. Further evidence that gambling and
drugs change the brain in similar ways surfaced in an unexpected group of
people: those with the neurodegenerative disorder Parkinson's disease.
Characterized by muscle stiffness and tremors, Parkinson's is caused by the
death of dopamine-producing neurons in a section of the midbrain. Over the
decades researchers noticed that a remarkably high number of Parkinson's patients—between
2 and 7 percent—are compulsive gamblers. Treatment for one disorder most likely
contributes to another. To ease symptoms of Parkinson's, some patients take
levodopa and other drugs that increase dopamine levels. Researchers think that
in some cases the resulting chemical influx modifies the brain in a way that
makes risks and rewards—say, those in a game of poker—more appealing and rash
decisions more difficult to resist. A
new understanding of compulsive gambling has also helped scientists redefine
addiction itself. Whereas experts used to think of addiction as dependency on a
chemical, they now define it as repeatedly pursuing a rewarding experience
despite serious repercussions. That
experience could be the high of cocaine or heroin or the thrill of doubling
one's money at the casino. “The past idea was that you need to ingest a drug
that changes neurochemistry in the brain to get addicted, but we now know that
just about anything we do alters the brain,” says Timothy Fong, a psychiatrist and
addiction expert at the University of California, Los Angeles. “It makes sense
that some highly rewarding behaviors, like gambling, can cause dramatic
[physical] changes, too.” Gaming the System Redefining compulsive gambling as an
addiction is not mere semantics: therapists have already found that
pathological gamblers respond much better to medication and therapy typically
used for addictions rather than strategies for taming compulsions such as
trichotillomania. For reasons that remain unclear, certain antidepressants
alleviate the symptoms of some impulse-control disorders; they have never
worked as well for pathological gambling, however. Medications used to treat
substance addictions have proved much more effective. Opioid antagonists, such
as naltrexone, indirectly inhibit brain cells from producing dopamine, thereby
reducing cravings. Dozens of studies confirm that
another effective treatment for addiction is cognitive-behavior therapy, which
teaches people to resist unwanted thoughts and habits. Gambling addicts may,
for example, learn to confront irrational beliefs, namely the notion that a
string of losses or a near miss—such as two out of three cherries on a slot
machine—signals an imminent win. Unfortunately, researchers estimate
that more than 80 percent of gambling addicts never seek treatment in the first
place. And of those who do, up to 75 percent return to the gaming halls, making
prevention all the more important. Around the U.S.—particularly in
California—casinos are taking gambling addiction seriously. Marc Lefkowitz of
the California Council on Problem Gambling regularly trains casino managers and
employees to keep an eye out for worrisome trends, such as customers who spend
increasing amounts of time and money gambling. He urges casinos to give
gamblers the option to voluntarily ban themselves and to prominently display
brochures about Gamblers Anonymous and other treatment options near ATM
machines and pay phones. A gambling addict may be a huge source of revenue for
a casino at first, but many end up owing massive debts they cannot pay. Shirley, now 60, currently works as
a peer counselor in a treatment program for gambling addicts. “I'm not against
gambling,” she says. “For most people it's expensive entertainment. But for some
people it's a dangerous product. I want people to understand that you really
can get addicted. I'd like to see every casino out there take responsibility.” This article was originally
published with the title "Gambling on the Brain" |
Categories: Gambling
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