“Staying in Action” Part 3

In this third part of our blog on the gambling addicts version of “dry drunk” we look at further “symptoms” of this. We hasten to add that a good 12 step program would soon iron out  most of these emotional and behavourial manifestations and maintenance of our “emotional sobriety” via steps 10-12 keep them in manageable order.

Nonetheless, this article (1) gives us good insight into the emotional malady we suffer from without a therapeutic solution, and which can creep up on us in many ways even when trying to “work our program” .

Other manifestations of “Staying in Action” –

Flooding

Gamblers who rely on avoidance as a defense mechanism are frequently flooded with feelings and memories when they become abstinent. This can occur in several ways. Most commonly the gambler becomes overwhelmed with guilt as he or she remembers things that were done, people that were hurt, episodes of lying and cheating. A common refrain is “I can’t believe I did that.”

A similar experience is the sudden realization of time wasted. During the years they had been gambling, their lives had gone on and they are now older. There is an acute sense of lost opportunities, and of lost youth and innocence. Disappointment becomes self-pity and there is an impulse to give up or to punish oneself by a return to gambling or some other self-destructive behavior.

A third kind of flooding involves the sudden remembrance of painful and traumatic memories of childhood—physical or sexual abuse, extreme neglect, disturbed parents. This may occur when the patient stops gambling or quits other addictive behaviors.

(( we dealt with these ourselves in steps 4 through to seven, followed up with amends 8-9)  As we have already blogged on previously the steps 4-7 in particular allow one to process memories from the past via the adaptive processing of emotions attached to these memories as well as the realisation they we were in the grip of a profound affective and addictive disorder.   Also as the Big Book states “No matter how far down the scale we have gone, we will see how our experience can benefit others. That feeling of uselessness and self pity will disappear. We will lose interest in selfish things and gain interest in our fellows. Self seeking will slip away. Our whole attitude and outlook upon life will change. Fear of people and of economic insecurity will leave us. We will intuitively know how to handle situations which used to baffle us. We will suddenly realize that God is doing for us what we could not do for ourselves.”

This transforms our self pity and sense of wasted years into a powerful transformative tool for helping others. It is no longer wasted but the most precious thing we possess in helping others, in sharing our experience, in being there for others because we know what it’s like to feel the way they do, to be where they are at. )

Boredom

According to the description in DSM-IV, as well as the writings of most clinicians (for example, Custer & Milt, 1985, p. 52), the typical pathological gambler is “restless, and easily bored.”  This proneness to boredom has been the focus of two studies (Blaszczynski, McConaghy, & Frankova, 1990; Elia, 1995) that compared pathological gamblers to normal controls; boredom scores were significantly higher for the pathological gamblers.

(Again this ties in with alcoholics without a recovery as per the BB ” being restless, irritable, and discontented”, page xxvi).

For early onset male gamblers, particularly if there have been decades of gambling activity, the gambling was typically how they defined themselves. Without their identity as a gambler, they do not know who they are. Giving up gambling leaves a large vacuum or hole in their lives. They have no other interests, and there are few activities that can compete with the excitement of gambling.

As already noted, boredom can mean understimulated. when they stop gambling and “get off the roller coaster” of strong sensations and self-created crises, they may find the underlying restlessness unbearable.

Patients who are manic also need time to adjust to being normal. What others regard as normal feels like being in slow motion to them, or as if something is missing. They describe it as strange and uncomfortable.

Boredom can mean that individuals cannot be alone because of problems in self-soothing. Boredom can mean that they are left alone with intolerable feelings, such as depression, helplessness, shame, or guilt. There is a need to escape, to get away from themselves.

(as an alcoholic the main reason I gave for drinking was “to get away from myself!”) 

For some, being alone means an intolerable state of emptiness or deadness. Those individuals who did not bond in infancy may carry within themselves an image of parental rejection or disgust, or affects engendered by an overwhelmed mother. Being alone and quiet means experiencing these intolerable affects, which they instead try to externalize through addictive substances and behavior.

Problems with intimacy and commitment

By the time the gambler is in treatment and has stopped gambling, spouse and family members are aware of the debts and depleted finances, the pattern of lying, and other problems. The response is usually one of anger, helplessness, and betrayal. Not infrequently, it is only after the gambling has stopped that the brunt of the spouse’s anger is expressed. This is often difficult for the gambler to understand. The anger is often proportional to the fear of being hurt and betrayed again. Holding on to the anger is a way for family members to protect themselves.

Mistrust of the gambler continues longer than it does with other addictive disorders because a relapse can be so devastating in terms of a family’s financial situation, and also because it is so much more difficult to recognize. As frequently stated, gambling is not something that a wife can smell on her husband’s breath nor observe by his gait or coordination. Nor are there blood or urine tests so that one can detect it with certainty. What we need to emphasize with both patient and family is that reestablishing trust will take time, and that if treatment is successful there will be observable changes in personality as well as behavior.

There are usually problems with intimacy that precede the gambling, in which case they will be there after the individual has stopped. Pathological gamblers often have difficulty being open and vulnerable and depending upon others in a meaningful way.

(I can relate to all of the above too – waking up to an awkward and at times profoundly troubling and distressing emotional illiteracy  is perhaps the last thing one needs in the early days of prolonged withdrawal and feelings of almost overwhelming emotional distress that can sometimes accompany the early weeks and months of recovery)

They have learned to suppress their feelings and to detach from potentially painful situations. Much of the work in therapy has to do with identifying emotions and learning how to express them.

Family members have their own issues which if not dealt with may sabotage the gambler’s recovery (Heineman, 1987; Lorenz, 1989). For example, some of the wives of recovering gamblers will admit that they miss the gifts they received when their husband came home after winning. They confess to a wish that he could have just one more big win, which would allow them to pay off their debts. They may realize they had been living vicariously through him, particularly if he was an “action” or “high stakes” gambler. His optimism and grandiosity were contagious. Initially they may have been attracted to him because he was a man with big dreams, a risk-taker, and big spender. According to Heineman (1987) and others, many wives of compulsive gamblers are adult children of alcoholics or of compulsive gamblers. Living from crisis to crisis may be familiar and exciting for them. In some cases there is a need for the gambler to remain “sick” so that they can take care of him.

Many pathological gamblers were brought up in a home in which intimacy was lacking.  They tolerate financial indebtedness far better than they do emotional indebtedness. Many experience claustrophobia in their personal relationships (Rosenthal, 1986), in fact in any meaningful situation. Commitment is experienced as a trap. They have difficulty saying no, or setting limits. This is related to an excessive need for other people’s approval and validation. When they say they feel trapped by another person, what they mean is that they feel trapped by their own feelings about the other person. They may have projected various expectations or demands on to the other, so that they are overly concerned about disappointing them, or about not being adequate to the task.

Excessive reliance on these projective mechanisms leaves them uncertain as to their boundaries, between inner and outer, self and other. A question they frequently ask themselves: what am I entitled to?

Male gamblers, in particular, are preoccupied with power games (Rosenthal, 1986). Power, as opposed to strength,3 is defined in relation to others, and is invariably gained at someone’s expense.

Relationships take on a seesaw quality, with the gambler battling for power and control.

Due to unresolved guilt about his gambling, a patient felt “onedown” in relation to his wife. He felt unworthy of her and not entitled to be treated decently. He did not verbalize this, but instead provoked fights at home. Similarly, his self-esteem was based on material success. When they had to scale down their lifestyle, he felt diminished. Again feeling like a failure, he blamed others and took it out on those closest to him. Compulsive gamblers are often good at “turning the tables,” so that it is the spouse who feels helpless and inadequate or is apologizing to the gambler and seeking forgiveness. For male gamblers, particularly action seekers, relationships are typically adversarial.

In light of the above, it is not surprising that there are frequent sexual problems (Daghestani, 1987; Steinberg, 1990, 1993). Adkins, Rugle, and Taber (1985) found a 14 percent incidence of sexual addiction within a sample of 100 inpatient male compulsive gamblers. When “womanizing” patterns are investigated, the incidence is closer to 50 percent (Steinberg, 1990, also personal communication). The excitement associated with the pursuit and conquest of women resembles the excitement and “big win” mentality of gambling.

In treating early onset male gamblers, in particular, one typically encounters two patterns of aberrant sexual behavior: (1) celibacy or a kind of phobic avoidance of sexual relationships, and (2) compulsive sexual behavior consisting of promiscuous womanizing, or compulsive masturbation related to various forms of pornography. The two patterns may be mixed.

Success

A closely related problem has to do with difficulties handling success. It may be blown out of proportion. For example, in some parts of the country a GA birthday is a cross between a bar mitzvah and a Friar’s Club roast. Gamblers compete with each other in seeing how many people will attend and who will receive the most glowing testimonials. It is a critical time, in that the achievement of a year’s abstinence, or some other landmark, poses an immediate risk for relapse.

There frequently are unrealistic expectations of what success will mean, so that its achievement leads to disappointment and depression. Sometimes the gambler abstained in order to prove something to someone, in effect to win a mind bet. Sometimes they were doing it for their family or for the therapist, so that after a period of abstinence they feel justified in saying “Okay, I was  good for a year. Now I feel something is owed me so I’m going out to have some fun.” Fun, in this case, of course, means gambling.

 

compulsioncartoon

 

Sometimes their successes are attributed to omnipotent parts of the personality (Rosenthal, 1986). Success can trigger mania.

They get high on their success and grandiosity takes over. Some gamblers are fearful of success, and there is a subset of gamblers with masochistic character disorders. Some of them feel more alive when they are in debt and having to work hard to pay creditors. A critical time is when they are just beginning to get in the black, when they can start to have something for themselves.

The gambler’s relationship with reality may be adversarial, persecutory, or humiliating. The gambler may want to see himself as an exception—exceptional among people, and an exception to the rules. Not wanting to be pinned down, he is looking for “an edge,” or for loopholes. This search for “freedom” is often what gets him into trouble.

Once initial problems have been dealt with and abstinence established, gamblers are often at greatest risk when life starts becoming predictable. Meeting responsibilities and living a “normal” life leads to a feeling of being trapped for those gamblers who have not yet internalized a value system based on facing responsibility. Rather than viewing their new life as a self determined one, gamblers are more likely to see such behavior as externally imposed. Feeling controlled by their own schedule, they experience a need to rebel.

Conclusion

Staying in action is, for the pathological gambler, equivalent to the alcoholic’s dry drunk. It is a way to maintain attitudes and behaviors associated with gambling while superficially complying with treatment and Gamblers Anonymous. After the patient has initially achieved abstinence, it is important to look for more covert forms of gambling and other ways in which the patient may still be in action.

Lasting abstinence requires personality change. At a minimum, there is a need to identify and confront whatever it is from which the gambler is escaping. This would include the intolerable situation and feelings as well as the mechanism of their avoidance. Honesty means more than not lying to others about one’s gambling; it means being honest with oneself about one’s feelings. One learns to take honest emotional risks, rather than those based on the need to manipulate or control external events.

As is true for all addicts, gamblers at the beginning of treatment cannot trust themselves. Self-trust requires self-knowledge, which in turn requires curiosity about oneself. Stated differently, “The key to building self-trust” (Kramer & Alstad, 1993, p. 252) “is the ability to utilize one’s own experience, including (one’s) mistakes, to change.”

(This article (1)  is worthy in addressing the oft unspoken realities of abstinence/sobriety when the emotional dysfunction and emotional immaturity once solely regulated via addictive behaviours seeps into sober life also and the formerly habitualised compulsive approaches to life re-surface in abstinence. There can be quick and profound self transformation in recovery but many of the habitualised behavioural patterns continue to stalk our every day lives, as we ” trudge the road of Happy Destiny”. They are there waitng to resurface. They are normally the consequence of reacting to the world as opposed to acting responsibly in it.

I have an addicted brain and a recovering mind, they do not always mix very well. They pull me in opposite directions and have sometimes heated arguments in my head.

I have to manage my illness. It hasn’t gone away. The drink did not make me ill. It didn’t help but it did not solely make me an alcoholic, some emotional dysfunction worsened by alcohol, drugs and other addictive behaviours did. I had a vulnerability and a propensity to later addictive behaviours. I was primed to go off. If alcohol or drugs were the sole problem I quite simply would have given them up. As I did with cigarettes etc

If I do not try to remain manageable or emotionally sober I can still react and “still go off on one”, on temporary, fleeting dry drunks.

Hey I appear even to have many  “stay in action” similarities and I haven’t gambled since I was 14 years old. Perhaps these emotional and behavioural manifestations have certain commonalities among addictive disorders?  A spiritual malady or emotional dysfunction which activates “old patterns of behaving” ?  

Then again I only gave up gambling on poker machines because I was losing all my drinking money on gambling machines!!))  

 

References

1. Rosenthal, R. J. (2005). Staying in action: The pathological gambler’s equivalent of the dry drunk. Journal of Gambling Issues.

 

 

 

 

“Staying in Action” – A Gambling Addict’s Dry Drunk.

In this first of two blogs we look more closely at an article (1) which proposes the symptoms of the gambling addict’s equivalent to a sober alcoholic’s “dry drunk”.  When reading this I, as someone in recovery from alcoholism and substance and behavioural addiction thought a lot of the “symptoms” were relevant to me and perhaps anyone in recovery from addictive behaviours. These commonalities may be the habitualised legacy of addiction more generally and emotional dysfunction more specifically.

Here is the second part of this three part blog (written partly from a clinician/therapist standpoint and experience of treating gambling addicts)…

“Although the term “dry drunk” has been used to varying degree by all of the twelve-step programs including Gamblers Anonymous (GA), certain crucial differences are pertinent. For the gambler, not only is there the absence of an ingested substance as the crucial distinguisher between “dryness” and “wetness,” but what the individual is addicted to is not so clearly avoided. In this respect, pathological gambling is more like an eating disorder than like alcohol or cocaine dependence. Pathological gamblers must continue to use money, and while they stop gambling with it, uncertainty and risk continue to be part of their lives. They must learn to manage these things rather than to abstain from them.

Risk and uncertainty can be overtly or covertly played with and manipulated. The pathological gambler, while not technically gambling (in other words, dry), has a number of ways of “staying in action.”

This notion of staying in action is, for the pathological gambler, equivalent to the alcoholic’s dry drunk. It poses a threat to recovery . While gamblers mean different things when they talk of “action” (Rosenthal & Rugle, 1994), the word generally refers to excitement, risk, the thrill of getting away with something, the possibility of significant loss or the opportunity for spectacular success. Action! The term has connotations of movement, of making things happen and of doing something, fixing things,finding solutions. In other words, action means the opposite of passivity, stagnation, paralysis or helplessness

The state of mind in which these actions are carried out is then an omnipotent one. Omnipotence has been defined as an illusion of power and control that defends against helplessness and other intolerable feelings (Rosenthal, 1986). There is a false sense of conviction about what one is doing.

“Omnipotent action” (Rosenthal, 1986) is a defense mechanism in which one must do something, anything, in order to create for oneself this illusion of being powerful and in control. Such attempted solutions may be totally ineffectual, and merely serve as a gesture to show one can do something. More often the action is destructive, and produces the opposite effect from the one needed. As Rosenthal (1986) has  suggested, when pathological gamblers speak of their need for action, they may be referring to just such omnipotent solutions.

Some of the attitudes and behaviors described in this article are obviously more associated with the action-seeking gambler (Lesieur, 1988; Lesieur & Blume, 1991) than with the escape seeker. Although Lesieur’s categorization remains the most clinically useful method of subtyping, on some level most pathological gamblers are seeking both. Action provides physiological arousal, fantasy gratification, and escape from feelings and situations that are believed to be intolerable.

 Symptom substitution/Behavioral equivalents

There are many ways for the gambler to take risks, or remain in a gambling mind-set, without making a bet. For example, a patient with five month’s abstinence reviewed some of his current behavior and concluded: “I’m still a gambler, and I play poker with people all the time. We just don’t use cards.”

Switching addictions

It is well known that addicts will substitute one addiction for another. For example, the alcoholic who stops drinking but then starts gambling is at risk for developing a gambling addiction. He or she is then more likely to start drinking again. Secondary addictions may appear either sequentially or simultaneously. In the latter situation, some therapists believe in treating them one at a time. If at all possible, I would not recommend delaying treatment. As an example, let us consider the rationale for addressing nicotine dependence early in recovery.

There are studies demonstrating that patients in alcohol and drug treatment programs who quit smoking have a much better prognosis than those who do not (Miller, Hedrick, & Taylor, 1983; Bobo, Gilchrist, Schilling, Noach, & Schinke, 1987; Bobo, 1989; Burling, Marshall, & Seidner, 1991). Sees and Clark (1993) found that patients presenting for substance abuse treatment reported high interest in stopping smoking, and for the inclusion of smoking cessation in their initial treatment. Although I do not insist that gamblers stop smoking, I discuss three reasons with them for quitting. First of all, when someone is in treatment and learning to deal with feelings, it does not make sense for them to be doing something that numbs their emotions. Patients begin to recognize that every time they start getting close to something meaningful in therapy, their impulse is to reach for a cigarette. Second, as long as they are smoking, they are still in an addictive state of mind, and third, as many obstacles as they can place between themselves and their gambling, the better off they are. The impulse to smoke can serve such a function, so that when they encounter some uncomfortable situation they will have an urge for a cigarette before they will have an urge to gamble. It will serve as a red flag alerting them to pay attention to the feeling or situation,and maybe to talk to someone about it or go to a meeting.

Following patients over time, the therapist has the opportunity to see addictions change and evolve. Sometimes, what appears to be a new problem is merely new wine in an old bottle: Example: Gambling addict swapping it for sex addiction especially via use of prostitutes. This GA when he found a prostitute who appeared “safe,” would he not go back to her, but would insist on trying someone different each time? Obviously he either wanted to lose, or was excited by the risk of jeopardizing everything and escaping unharmed.  He then recognized that the feelings he had while looking for prostitutes were identical to the feelings previously experienced gambling. He not only had the same “rush,” but the compulsive aspects were the same. He would find himself preoccupied by it while at work, inventing excuses for driving home through neighborhoods where there were streetwalkers.

The anticipation, and the guilt afterwards, and the need to lie about where he spent his time and money, all reminded him of his previous gambling.

His gambling and the sexual compulsion were fused. This is not an uncommon occurrence. Fused addictions need to be recognized and may be difficult to treat.

However, in the next example, gambling is central.

 Example: Mr. B had stopped gambling and was a respectable member of his community. No one, especially not his wife, knew about his anonymous phone calls. He would go through the phone book until he found a woman’s name, and if the name interested him he would call her up. He would then try to keep her on the line and convince her to agree to meet him. His objective was to talk her into having sex with him. That was his “big win.” On occasion he was successful, although one woman met him at a coffee shop accompanied by policemen waiting to arrest him. While on probation he continued making his phone calls.

Mind bets

Compulsive gamblers may stop wagering for money, but may continue making “mind bets.” This is something they may not reveal unless specifically asked. It is common among sports bettors, who will check out the odds, then watch the game on television, making a mental wager with themselves. “If I had bet a hundred dollars on the Dallas Cowboys,” they will say, “and taken the points, then…” They are not betting money, but they are keeping track of what they would have won or lost through the week. Some newly abstinent gamblers say that what they are keeping track of is what abstinence has saved or cost them. Mind bets are a not uncommon way to remain in action. However, the gambler may start to get “juiced” and be unable to shake off the excitement.

Obsessive-compulsive rituals

Some gamblers, particularly those with more obsessive compulsive features to their personality, will make a different kind of wager with themselves. They will be preoccupied with various counting rituals, for example, odd versus even license plate numbers, or how many times a telephone will ring. If they guess right, they win, meaning a certain wished-for event will occur, or that they will or will not be committed to a certain course of action.

Such rituals are used to contain performance anxieties or guilt about forbidden activities. These wagers or tests are arbitrary, and so is the response. If not satisfied with the outcome, they can do “two out of three,” and, in true obsessive-compulsive fashion, keep repeating it. As with the gambling, luck and skill may be accorded a role, or the ritual be viewed as a form of divination.

Covert gambling

Some pathological gamblers engage in a kind of behavior that has been described as “covert gambling” (Rosenthal, 1987). In this respect they resemble patients with narcissistic personality disorders who are not gamblers. The behavior involves a need to take risks and test limits, in effect to continuously test themselves, not at a racetrack or casino, but with the everyday events of their lives. Such individuals typically gamble with time and with the meeting of obligations and responsibilities. Nothing is too small or too big to bet on. They will drive without gas in the car, be late for appointments, or not pay their phone bill. Betting they can get away with it, their self-esteem depends on the outcome.

Similarities between these pathological gamblers and patients with narcissistic personality disorder are found in their win-lose orientation, all-or-nothing thinking, and fragile sense of identity. There is often more at stake than self-esteem. By seeing how close they can come to some imaginary line, and what would happen should they cross it, these narcissistic individuals are challenging their environment, and luck itself, in order to find out where they stand, or even whether they have the right to stand.

They are not seeking punishment, out of some sense of guilt, although that may be present also, so much as they are involved in a kind of omnipotent provocation (Rosenthal, 1981), a deliberate flirting with danger in order to test their powers and prove they are in control.

Procrastination

After the gambling itself, procrastination is perhaps the most common and incapacitating symptom. There are several reasons for this. We have just discussed how a deadline may be used as a test, with the gambler trying to see how close he or she can come to it. Many gamblers feel that nothing they do is good enough, or that they can never do enough. Hence there is a sense of futility about completing a project or assignment where they anticipate failure. They may fear or resent the unrealistic expectations of others. Instead, they cling to their grandiosity, while postponing the cold shower of reality.

Substitutes for stimulation

This includes activities involving speed and danger. One patient, for example, stopped gambling and in his first year of abstinence took flying lessons, tried sky diving, bought a motorcycle, and went skiing every possible weekend. He seemed driven by a need for intense physical activity, strong sensations, and competition. Another kind of stimulation is provided by the ingestion of legal stimulants: coffee, cola drinks, and cigarettes.

Playing catch-up

In one respect, pathological gamblers have a more difficult time of it than other addicts. Their gambling typically has left them in debt; once they stop they find themselves “playing catch-up.” They may be working multiple jobs, juggling bills, struggling to meet expenses and stay ahead of creditors. Their state of mind often  duplicates that of their gambling days.

When they make a sale or put a deal together and get paid, they feel they have won. One patient referred to his situation as “dancing.” He was in a business where he would buy goods at the beginning of the month on credit, and to stay in business he would have to sell them and get more goods. His credit was always at risk, and he felt he was dancing all the time. He would say “At least when I was gambling there was the chance that I could have a big win and get ahead, but I’m just doing this month after month, with no end in sight.”

Lying, cheating, and stealing

The gambler is frequently testing how people will respond, and trying to corrupt them or get them to collude with their dishonesty. Here are also “omissions”—obligations that were forgotten, bills he ignored, promises he failed to keep—a pattern of lying and cheating that are not consciously recognized. These are kinds of “primitive avoidance” so common among pathological gamblers. Uncomfortable realities can be just put out of mind, or “shoved under the rug.”

Primitive avoidance and denial, and the pathology of lying is a nod to  “Lying, cheating and stealing” a phrase used frequently by Gamblers Anonymous members, not only to describe actions taken to support their gambling, but behaviors which continue after abstinence is achieved. “Lying, cheating and stealing” is a common “character defect,” requiring the attention of those who take recovery seriously

The pathological gambler must develop, or re-establish, an internalized value system based on honesty and integrity

The first step toward self-forgiveness is an acknowledgment of change. In other words, being able to say “I used to do such-and-such. I don’t do that any more.””

to be continued…

Reference

1. Rosenthal, R. J. (2005). Staying in action: The pathological gambler’s equivalent of the dry drunk. Journal of Gambling Issues.