Sure who’s Counting? How to Engineer Addiction?

Sure who’s Counting?

Here’s a great longread from The Verge called Engineers of Addiction about the psychology of slot machines and the tech industry.

“Bally Technologies, one of the world’s largest manufacturers of slot machines.

Compared to the cacophony of a casino floor, Bally’s showroom was practically monastic, the lights low and the room silent apart from the soothing hum of two dozen hibernating consoles…

the expansion of gaming generally is the expansion of slot machines specifically — the modern casino typically earns 70 to 80 percent of its revenue from slots, a stratospheric rise from the 1970s when slots comprised 50 percent or less.

…increasingly, the psychological and technical systems originally built for slot machines — including reward schedules and tracking systems — have found admirers in Silicon Valley.

In the factory, Trask and I passed a ProWave cabinet, a design released by Bally in mid-2014 that features a 32-inch concave screen, like an even more curved Samsung TV. Trask claimed that putting the same exact games on curved screens increased gameplay 30-80 percent…

…Game designers are charged with somehow summoning the ineffable allure of electronic spectacle — developing a system that is both simple and endlessly engaging, a machine to pull and trap players into a finely tuned cycle of risk and reward that keeps them glued to the seat for hours, their pockets slowly but inevitably emptying. As we stood over the gaming cabinet, Trask told me about the floor of the MGM, home to 2,500 machines and hundreds of different games. Trask’s mission, as he saw it, was simple: “Our job is to get you to choose our game.”

The prototypical slot machine was invented in Brooklyn in the mid-1800s — it was a cash register-sized contraption and used actual  playing cards. Inserting a nickel and pressing a lever randomized the cards in the small display window, and depending on the poker hand that appeared, a player could win items from the establishment that housed the machine. In 1898, Charles Fey developed the poker machine into the Liberty Bell machine, the first true slot with three reels and a coin payout. Each reel had 10 symbols, giving players a 1-in-1,000 chance of hitting the 50-cent jackpot if three Liberty Bells lined up. The three-reel design was a hit in bars and became a casino standard, but for decades gaming houses considered them little more than a frivolity — distractions for the wives of table-game players. Accordingly, casinos were dense with table games, and slots were relegated to the periphery.

That began to change in the 1960s, when Bally introduced the electromechanical slot machine. The new rig let players insert multiple coins on a single bet, and machines could multiply jackpots as well as offer up smaller, but more frequent wins. Multi-line play was introduced: alongside the classic horizontal lineup, players could now win with diagonal and zig-zagged combinations. The new designs sped up gameplay and breathed life into the stagnating industry.

William “Si” Redd, the bolo tie-wearing Mississippi native who oversaw some of Bally’s new projects during the era, was instrumental to that renaissance. “The player came to win,” he said, “he didn’t come to lose, [so] speed it up, give him more, be more liberal. Let him win more, but then [you make money] still with the speeding up, because it was extra liberal.” In other words, the new machines lowered slots’ volatility — gaming parlance for the frequency at which a player experiences big wins and losses.

In the 1970s, Redd left Bally and founded another gaming manufacturer that was later renamed IGT. IGT specialized in video gambling machines, or video poker. Video poker machines could be designed to have even lower volatility, paying players back small amounts on more hands. And video poker’s interactive elements made them extra engrossing, turning them into an enormous success: people lined up to play the first machines, and the game’s ability to command a player’s complete concentration for hours gave it a reputation as the “crack cocaine” of gambling.

“If you were to take $100 and play slots, you’d get about an hour of play, but video poker was designed to give you two hours of play for that same $100,” Redd said at the time, instructing game designers to lengthen the time it took a poker machine to consume a player’s money.

Redd also acquired the patent for the newly created Random Number Generator, which computerized the odds-calculator behind the spinning reels and allowed game makers to control volatility. A modern slot machine, at its core, is nothing more than an RNG going through millions or billions of numbers at all times. When a player hits a spin button, they are simply stopping the RNG at a particular moment. Everything beyond that — the music, the mini-games, the actual appearance of spinning reels, Rachel, Monica, and the rest of the gang keeping you company — is window dressing to keep you hitting spin.

IGT now makes 93 percent of the world’s video poker machines and is the largest manufacturer of video slots in the world. Its Wheel of Fortune franchise spans every kind of slot machine — reels, curved screens, and massive installations with enormous physical flourishes.

…certain principles undergird most games. First, there’s a vague aesthetic uniformity: colors tend toward the primary or pastel, franchise tie-ins are a must, and the game soundtracks are typically in a major key. Meanwhile, the multi-line wins introduced by Bally have become an unintelligible tangle: modern slots offer players upwards of 50 and sometimes 100 different winning combinations — so many that without the corresponding lights, sounds, and celebration, most casual and even advanced players would have trouble recognizing whether they’d won or lost.

To keep players gambling, all slots rely on the same basic psychological principles discovered by B.F. Skinner in the 1960s. Skinner is famous for an experiment in which he put pigeons in a box that gave them a pellet of food when they pressed a lever. But when Skinner altered the box so that pellets came out on random presses — a system dubbed variable ratio enforcement — the pigeons pressed the lever more often. Thus was born the Skinner box, which Skinner himself likened to a slot machine.

The Skinner box works by blending tension and release — the absence of a pellet after the lever is pressed creates expectation that finds release via reward. Too little reward and the animal becomes frustrated and stops trying; too much and it won’t push the lever as often.

Like video poker, most multi-line slots rarely pay large jackpots, instead doling out smaller wins frequently. “They’re imitating the formula of video poker, but they’re doing it in a slot formula,” Natasha Schüll, an associate professor at MIT who has researched slots for 15 years, says. In 2012, Princeton University Press published Addiction by Design: Machine Gaming in Las Vegas, the culmination of her research and a deconstruction of the slot machine.

Schüll says modern slot machines essentially continued the trend started by Redd so as not to jolt players too intensely in the form of losses — or wins. “Too-big wins have been shown to stop play because it’s such an intense shift in the situation that you’ll kind of pause, you’ll stop, you’ll take your money and leave,” says Schüll. Stretching out gameplay with minor rewards, Schüll says, “allows you to get in the flow of, another little win, another little win.”

As a result, modern slots pay out on approximately 45 percent of all spins, instead of the 3 percent of traditional slots. “The sense of risk is completely dampened,” Schüll says. “Designers call them drip feed games.”

That analysis is supported by a 2010 American Gaming Association white paper. “Lower-volatility games often have greater appeal in ‘locals markets’ than in destination resort markets like Las Vegas or Atlantic City…Customers tend to play these games for longer periods of time…” In other words, lower volatility games paved the way for gaming’s wild expansion nationwide.

The advent of bonus games has also helped bolster slot machines’ popularity: instead of just winning money, certain combinations can trigger mini games. In the IGT showroom, Lanning showed me the company’s forthcoming Entourage game, in which a bonus game has the player match portraits of characters. In the industry, it’s called a pick-em bonus. “Those are the most popular features,” Melissa Price, the senior vice president of gaming for Caesar’s Entertainment, told me. “Customers enjoy ‘perceived skill’ experience.”

And then, there’s the emotional appeal: Price told me the company commissioned a study to find out why people love the Wheel of Fortune line so much. “People said it was as much about the brand as anything,” she said. “People said, ‘That brand — I used to hear it in the living room at my grandma’s house, I’d hear that wheel spinning because my grandma watched it. It reminds me of my grandma.’ I mean, how can you compete with that?”

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Price and I spoke on the floor of Harrah’s Las Vegas at 9:00AM — the slots players were already at their machines, or perhaps they’d been there all night.

Tracking

As long as a player has her Total Rewards card inserted in the machine, every time she hit the spin button the system recorded the size of her bet, what game it was spent on, at what time, how long she’d been playing for, and so on, until she hits the “Cash Out” button on the machine, at which point all the data is encapsulated in her file, along with all the other games she has ever played at a Caesar’s casino.

Player tracking systems revealed more than a pit boss ever could: over time, Harrah’s can create a portrait of the person’s risk profile, including how much money a player typically loses before they stop playing and what kinds of gifts to give them to keep them on the gaming floor. Sometimes, that can be a penthouse suite; other times, it can be as little as giving a player $15 in cash. In 2012, This American Life charted the lurid and unsettling extreme of how these systems can be used in a story about a Harrah’s in Indiana that enticed a woman to keep playing with unlimited hotel suites, diamond jewelry, and free trips to the Kentucky Derby. The perks fueled her gaming habit until she was $125,000 in debt.

…Jack and Singleton say they’ve both earned “Black Cards” through Sugarhouse’s player tracking system, meaning they’ve each spent more than $10,000 here. Jack says the casino has comped them four cruises so far; Singleton says she threw her card away because it reminded her of how much money she’d spent. I had more questions, but at a certain point it became apparent that Singleton was no longer listening.

“She’s in the zone right now,” said Jack.

The “zone” is at the core of Scüll’s theory about the success and proliferation of slot machines. She heard the term over and over again in her 15 years of research — the players repeatedly told her that they played to zone out, to escape thought.

To understand the zone, you first have to understand “flow,” the concept developed by Hungarian psychologist Mihaly Csikszentmihalyi to describe a hyperfocused state of absorption. During “flow,” time speeds up (hours feel like minutes) or slows down (reactions can be made instantly) and the mind reaches a state of almost euphoric equilibrium. Schüll, in her book, describes Csikszentmihaly’s four criteria of flow: “[F]irst, each moment of the activity must have a little goal; second, the rules for attaining that goal must be clear; third, the activity must give immediate feedback; fourth, the tasks of the activity must be matched with challenge.” For most of their history, slots easily fulfilled the first two criteria; after lowering volatility, they fulfilled the third criterion, and with the introduction of multiple lines, endless bonus rounds, and the occasional mini-game, they finally fulfilled the four criteria.

The “zone” is flow through a lens darkly: hyperfocused, neurotransmitters abuzz, but directed toward a numbness with no goal in particular. When Singleton emerged from the zone, I asked her again why she found the slots so compelling. “I lost my husband two years ago to throat cancer,” she explained. “He was the love of my life, and I started doing this just to — I was out of my mind and spent a lot of time at the cancer center.” Jack had lost his son to pancreatic cancer. As they told their stories, Jack and Singleton hit the spin buttons and the machines blared so loudly that their words were lost in the noise.

Singleton says she never recovered from the pain of her loss, and that’s why she keeps coming back to the slots. Jack echoed that sentiment: “I don’t have to think. And I know I can’t win.”

“Right, so you know that,” said Singleton.

“Every now and then…you get something,” Jack agreed.

“But it’s never what you lost.”

“Because I don’t care whether I win 38 cents or 600 dollars.”

“You just want to see them again.”

Singleton rifled through her wallet filled with $100 bills. “I’ll be right back, guys,” she said, and went off to get change.

Back at the Bally showroom, Trask and I had sat in front of the company’s new Duck Dynasty game. “There’s never been more slot machines in the world than there are today,” he said. “And that’s proliferation not just in the US, but abroad.” His hand rested on the game’s display, his index finger next to a reel symbol of a cast member sticking his tongue out and playing air guitar. Scientific Games’ market now includes 50 countries on six continents. This spring, the company announced it was planning on providing 5,000 of the 16,500 machines recently authorized in Greece.

The industry is also preparing for the eventual deterioration of its key middle-aged demographic and competition from free-to-play mobile games. “People only have so much leisure time and there’s a lot of activity on iPhones,” Price told me. At one point in the Bally’s warehouse, Trask said, “You know how you get people younger to gamble? Hand them a fucking telephone.”

The industry seems to be working on the same hunch. In 2011, Caesar’s acquired Playtika, an online casino games company that offers free and paid mobile games. A year later, IGT acquired the free casino games app DoubleDown, which runs as both a stand-alone mobile app and through Facebook.

The company now offers online table games and a good sample of its portfolio of slots, including Wheel of Fortune, to mobile players. Earlier this year, the gaming giant appointed former Zynga studio manager Jim Veevart as DoubleDown’s vice president of games. And last year, Churchill Downs Incorporated, which runs seven casinos in addition to its Kentucky Derby racetrack, acquired the free games company Big Fish Games.

Meanwhile, the tech sector is adopting the principles of slot design for its own purposes. In the early aughts, the tech writer Julian Dibbell devised the concept of ludocapitalism, a term inspired by watching World of Warcraft players mine gold in the game to making a living in real life. Ludocapitalism was an attempt to explain the growing gamification of society through technology. Dibbell admits the concept’s parameters are vague, but at its most basic it identifies that capitalism can harness the human play drive for better or worse — and that increasingly, games aren’t allegories that say something about our lives; they are our lives. As people move toward more data-driven existences where points are accumulated from health apps (the subject of Schüll’s latest research) and status is accumulated in identifiable quantities on social media, gamification becomes so total that it can sometimes mask whether what we’re doing has any inherent utility outside the game that surrounds it.

Within gamification, Schüll also identifies slotification: we slay an endless procession of monsters with no progress of narrative, mine endless digital coins for no other reason than their aggregation, hit spin on the slot machine with no big payoff. “It’s this ludic loop of, open and close, open and close; you win, you lose, nothing changes,” Schüll says. Writing in The Atlantic, Alexis Madrigal tapped Schüll’s concept of the ludic loop to explain the inextricable entrancement of flipping through Facebook photos: you push a button over and over, primed for an eternally fleeting informational reward.

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A more exact replica of a slot may be Tinder. The mechanics of the dating app mirror the experience of playing slots: the quick swiping results in an intermittent reward of connection, followed by the option to either message your potential date or “Keep playing.” Tinder recently launched a premium version that allows the user to undo an accidental “not interested” swipe, essentially monetizing mistakes made while in the automatic rhythm of the zone.

“I can’t tell you how often I’ve been approached since the publication of my book by Silicon Valley types who say things like, ‘Wow, the gambling industry really seems to have a handle on this attention retention problem that we’re all facing,’” Schüll told me. “‘Will you come tell our designers how to do a better job?’”

Last year, Schüll heard from Nir Eyal, a tech entrepreneur who founded and sold two startup companies that produce advertisements in free-to-play games. “[Eyal] showed me his copy of my book, and it had, like, hundreds of hot pink sticky notes coming out of it,” she told me. In his 2003 book Hooked: How to Build Habit Forming Products, Eyal laid out his “Hook Model” of product development that works on basic behaviorist principles: a trigger turns into an action turns into a variable reward turns into a further personal investment back into the product. Last year, he invited Schüll to speak at his Habit Summit, hosted at Stanford. Schüll gave a talk on the “dark side of habits,” placing slot machines on the undesirable end of the habit spectrum.

Eyal told me he invited Schüll to offer a less self-congratulatory, “rah-rah” voice to the conference. Although the conference focused on how to build habit-forming tech products, “These techniques — they have a dark side,” he said. “If not used appropriately, or if used for nefarious purposes, then they don’t always benefit the user.”

Still, it was difficult to determine whether Schüll’s slot research has been received as a warning or a how-to guide within tech. Eyal criticized slot machines for what he said was a business model dependent on addicted players — “that industry, I have a problem with,” he said. But Hooked is in many ways tech’s version ofAddiction by Design: his model of successful product design is a loop going from “trigger” to “action” to “variable reward” to “investment” and back again. In his trigger section, Eyal uses Instagram to illustrate how emotional pain can be a powerful motivator to use a product — in that app’s case, the mostly insubstantial pain of lost memories. He writes, “As product designers it is our goal to solve these problems and eliminate pain…users who find a product that alleviates their pain will form strong, positive associations with the product over time.”

I asked Eyal what distinguishes mobile games or dating apps from slot machines. He gave a range of answers that sounded at once comprehensive and somewhat defensive — that tech addictions never really plummet to the league of gambling addiction; that people prone to addiction will be addicted no matter what — before finally admitting that, in a sense, everything functions like a slot machine.

“All content needs to be made interesting. What you’re doing as a writer is introducing variable rewards into your story. Everything that engages us, all pieces of content are engineered to be interesting,” he said. “Movies aren’t real life, books aren’t real life, your article isn’t real life. It’s manufactured to pull us one sentence after another through mystery, through the unknown. It’s a slot machine. Your article is a slot machine. It has to be variable. So just because an experience introduces variability and mystery — that’s good!”

“I think the answer is, it’s okay to addict people as long as your business model doesn’t depend on it,” he said, as if finally finding the answer to a problem that had long seemed without a solution. “That’s the answer,” he added. “That’s the answer.”

[h/t: The Verge, by @asthompson]

From

http://score.addicaid.com/engineering-a-new-breed-of-addicts/

“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.

 

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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.

Gambling Disorder and Emotional Dysfunction

Following on from our recent blog on emotional dysfunction in sexual addiction we continue our series which explores the inherent role of  emotional dysfunction in all addictive disorders.

We will explore eating disorders later.

Here we use excerpts from a very interesting article (1)  on

Deficits in emotion regulation associated with pathological gambling.

 

“Pathological gambling is recognized as an impulse-control disorder characterized by a loss of control over gambling, deception about the extent of one’s involvement with gambling, and significant family or job disruption (American Psychiatric Association, 1994). Failures in self-control, therefore, represent a defining feature of pathological gambling. Self-control involves over-riding impulses by substituting another response in its place (Tice & Bratslavsky, 2000), and failures in self-control are primarily associated with the desire for short-term gains despite associated long-term negative consequences (Baumeister, 1997, Baumeister, Heatherton, & Tice, 1993).

Failures in control over gambling are likely to be influenced by individual coping styles. Problem-focused coping includes active and effortful problem solving, while emotion-focused coping includes escape and avoidance behaviours (Lazarus & Folkman, 1984). Scannell, Quirk, Smith, Maddern, and Dickerson (2000) suggested that loss of control over gambling is associated with emotion-focused coping such as avoidance or escape. This suggestionhas been supported by evidence that gamblers demonstrate deficits in coping repertoires (McCormick, 1994) and some rely on gambling to provide an escape from personal or familial problems (Corless & Dickerson, 1989; Lesieur & Rosenthal, 1991). Finally, in a sample of adolescent gamblers, those identified as at-risk for developing pathological gambling behaviours were those who exhibited more emotion-focused coping styles
(Gupta & Derevensky, 2001).

Gambling behaviours, therefore, seem to be associated with a deficit in self-control
processes that may be exacerbated by reliance on coping styles characterized by
avoidance and escape. At a more basic level, difficulties managing emotions effectively may contribute to the use of maladaptive coping strategies and result in failures in self regulation and impulse control. Optimal self-regulation relies on being able to focus on long-term goals in the presence of emotional distress that tends to shift attention to the immediate present (Tice & Bratslavsky, 2000). In addition, struggling with one’s feelings may deplete coping resources and leads to decreased self-control (Baumeister, Muraven, & Tice, 2000), leading to increased risk of disinhibited or impulsive behaviour.

Finally, individuals who are feeling acute emotional distress will likely wish to escape via activities that promise immediate pleasure (Tice, Bratslavsky, & Baumeister, 2001) and pathological gamblers often report using gambling to escape from negative mood states (Blaszczynski & McConaghy, 1989; Getty, Watson, & Frisch, 2000).

Emotion regulation refers to strategies to influence, experience, and modulate
emotions (Gross, 1999). Although there are several factors that influence whether a
certain emotion-regulation strategy is adaptive in a particular situation, certain strategies appear to be costly and maladaptive. For example, suppression or avoidance of emotions is associated with increased negative effect and anxiety, physiological activity, and physical pain (Campbell-Sills, Barlow, Brown, & Hoffman, 2006; Gross & Levenson, 1997; Levitt, Brown, Orsillo, & Barlow, 2004; Masedo & Esteve, 2007). Experimental investigations also support the notion that the effort of suppressing emotions drains mental resources (Richards & Gross, 2000), which could lead to decreased self-control.

Ricketts and Macaskill (2003) investigated several techniques that gamblers use to
modify their emotions, one of which was the technique of ‘shutting off’ or using gambling in order to stop an unpleasant emotional state. Participants receiving treatment for gambling were interviewed or watched during treatment sessions and administered questionnaires. Patients who used the technique of ‘shutting off’ were often the ones who also reported poorly tolerating emotional discomfort (Ricketts & Macaskill, 2003).

According to Baumeister, Zell, and Tice (2007), emotional distress leads to an increase in self-awareness, which consequently leads to a desire to decrease ones self-awareness, but at the cost of self-regulation. If one is unable to self-regulate, this could lead to an addiction or a relapse of an addictive behaviour (Sayette, 2004).

Impulse control represents one of the major behavioural aspects of emotion regulation (Gratz & Roemer, 2004) and has been identified as an important component of addictive processes (Evenden, 1999). More specifically, research has demonstrated that failures of emotion regulation are associated with addictive behaviours (Coffey & Hartman, 2008; Fox, Axelrod, Paliwal, Sleeper, & Sinha, 2007; Goudriaan, Oosterlaan, De Beurs, & Van Den Brink, 2008; Lakey, Campbell, Brown, & Goodie, 2007).

Several recent studies have employed the Difficulties in Emotion-Regulation Scale (DERS), a recently developed and validated measure of emotion regulation, in assessing behavioural addictions (Bonn-Miller, Vujanovic, & Zvolensky, 2008; Fox et al., 2007; Fox, Hong, & Sinha, 2008). The DERS assesses both general deficits in emotion regulation and deficits in specific domains of regulation. It is based on a model of emotion dysregulation that includes: (1) deficits in awareness and understanding of emotional experience (i.e., clarity), (2) minimal access to strategies to manage one’s emotions, (3) non-acceptance of emotions (i.e., reactivity to one’s emotional state), and (4) impaired ability to act in desired ways regardless of emotional state (i.e., impulsivity and an inability to engage in goal-directed behaviour).

The goal of the present study was therefore to examine emotion regulation difficulties among individuals being treated in a specialist gambling clinic and
to compare the use of strategies to a mixed clinical comparison group and a sample
of healthy community controls. Specifically, we investigated the association between
emotion-regulation deficits and gambling pathology using two measures of emotion
regulation, the DERS and the Emotional Regulation Questionnaire (ERQ; Gross & John, 2003). The ERQ examines the habitual use of two specific emotion-regulation strategies, namely expressive suppression and cognitive reappraisal. The use of suppression reduces the outward expression of emotions in the short term, but is less effective in reducing emotions in the long term and is, therefore, considered a maladaptive emotion-regulation strategy (Gross, 1998; John & Gross, 2004). Cognitive reappraisal involves changing the meaning associated with a particular situation so that the emotional impact is altered (Gross, 1999; Siemer, Mauss, & Gross, 2007). Reappraisal is considered an adaptive strategy to regulate one’s internal states and is associated with higher self-reported positive emotions and fewer depressive symptoms (Gross & John, 2003; Mauss, Cook, Cheng, & Gross, 2007).

gambling-slots-cover (1)

 

 

Discussion

As expected, we found a significant relationship between self-reported problem,
gambling behaviour, and negative effect as measured by the DASS, as well as deficits
in emotion regulation as measured by the DERS.

With respect to group differences, the gambling group reported a greater lack
of awareness of their emotions compared to both comparison groups.

With respect to the overall findings of emotional dysregulation, Blaszczynski and
Nower (2002) proposed a pathway model of the determinants of gambling and identified three separate trajectories into problem gambling. Of relevance to the current study, the authors identified an emotionally vulnerable group of problem gamblers who used gambling as a way to regulate affective states by providing either emotional escape or arousal.

According to the pathway model, once a habitual pattern of gambling behaviours has been established, the combination of emotional vulnerabilities, conditioned responses, distorted cognitions, and decision-making deficits maintain the cycle of pathological gambling. Blaszczynski and Nower (2002) suggest that such emotional vulnerabilities make treatment more difficult in this particular group of gamblers and emphasize the need to address these underlying vulnerabilities in addition to directly targeting gambling behaviours in therapy. It may, therefore, be of therapeutic benefit to specifically assess for and target emotion-regulation strategies in this population of gamblers.

Given the gamblers in the current study demonstrated limited access to effective strategies for managing difficult emotions, it may be important for clinicians to address coping strategies (including emotion-focussed strategies) as a part of any comprehensive treatment package. Gamblers need to be able to recognize and modify unhelpful thinking patterns (both in relation to problem gambling situations and, more generally, to other life stressors).

It is also important that the clinician is aware of any deficits in emotion-regulation strategies to ensure that the client is prepared to guard against relapse, given that the ability to tolerate distress is associated with increased length of abstinence from gambling (Daughters et al., 2005).

. More specifically, given the finding that gamblers were less aware of their feelings, mindfulness strategies may be useful to increase awareness of one’s
emotions. This could potentially be helpful in reducing automatic and habitual responses, particularly in high-risk situations. Decreasing emotional avoidance through mindfulness may also assist pathological gamblers in better understanding the impact of various mood states on their behaviour. Individuals who experience heightened awareness of emotions, and who learn to observe and act in a more aware manner, are less likely to engage in maladaptive behaviours such as gambling (Lakey et al., 2007).”

 

References

1. Williams, A. D., Grisham, J. R., Erskine, A., & Cassedy, E. (2012). Deficits in emotion regulation associated with pathological gambling. British Journal of Clinical Psychology, 51(2), 223-238.

Do Gambling addicts have emotional difficulties?

The article I reposted yesterday Gambling with America’s health!

Gambling-addiction

– mentioned how members of  Gamblers’ Anonymous saw gambling addiction, or gambling disorder, as an emotional rather than financial disease. The addicted person “wants to escape into the dream world of gambling” and “finds he or she is emotionally comfortable only when ‘in action.’”

This very revealing statement “emotionally comfortable only when ‘in action’.’” ties in with what we have being proposing in this blog. That addicts of various varieties engage in motoric or repetitve behaviours prompted by a desire to alleviate emotional distress, that somehow motoric of repetitive, compulsive behaviours almost people these individuals “regulate” or control their emotions. In the language of treatment centres, they “fix their feelings” via these obsessive-compulsive activities.

So there must be an inherent  emotional processing and regulation difficulty which prompts these addictive behaviours. As we have seen in previous blogs, the inability to regulate  and process emotions appears to lead to a recruitment of more motoric or compulsive (sub-cortical) parts of the brain rather than goal-directed, action-outcome, prefrontal cortex part of the brain. This leads to less conscious decision making and more “automatic pilot” type of responding.

Is there evidence of this emotional regulation difficulty in gambling addicts as there appears to be with alcoholics and those with eating disorders? In fact, we will explore in future blogs how there appears to be an emotional regulation and processing difficulty at the heart of all these different addictive disorders.

 

In a study we have recently come across pathological gamblers  reported significantly less use of reappraisal as an adaptive emotion-regulation strategy, and reported a greater lack of emotional clarity and more impulsivity than individuals in the healthy community comparison group. Pathological gamblers reported a greater lack of emotional awareness compared to the healthy control group and reported differences in access to effective emotion-regulation strategies compared to both comparison groups (1).

“Failures in control over gambling are likely to be influenced by individual coping styles. Problem-focused coping includes active and effortful problem solving, while emotion-focused coping includes escape and avoidance behaviours (Lazarus & Folkman, 1984). Scannell, Quirk, Smith, Maddern, and Dickerson (2000) suggested that loss of control over gambling is associated with emotion-focused coping such as avoidance or escape. This suggestion has been supported by evidence that gamblers demonstrate deficits in coping repertoires (McCormick, 1994) and some rely on gambling to provide an escape from personal or familial problems (Corless & Dickerson, 1989; Lesieur & Rosenthal, 1991). Finally, in a sample of adolescent gamblers, those identified as at-risk for developing pathological gambling behaviours were those who exhibited more emotion-focused coping styles
(Gupta & Derevensky, 2001).
Gambling behaviours, therefore, seem to be associated with a deficit in self-control
processes that may be exacerbated by reliance on coping styles characterized by
avoidance and escape. At a more basic level, difficulties managing emotions effectively may contribute to the use of maladaptive coping strategies and result in failures in self regulation and impulse control. Optimal self-regulation relies on being able to focus on long-term goals in the presence of emotional distress that tends to shift attention to the immediate present (Tice & Bratslavsky, 2000). In addition, struggling with one’s feelings may deplete coping resources and leads to decreased self-control (Baumeister, Muraven, & Tice, 2000), leading to increased risk of disinhibited or impulsive behaviour.

Finally, individuals who are feeling acute emotional distress will likely wish to escape via activities that promise immediate pleasure (Tice, Bratslavsky, & Baumeister, 2001) and pathological gamblers often report using gambling to escape from negative mood states (Blaszczynski & McConaghy, 1989; Getty, Watson, & Frisch, 2000).

Emotion regulation refers to strategies to influence, experience, and modulate
emotions (Gross, 1999). Although there are several factors that influence whether a
certain emotion-regulation strategy is adaptive in a particular situation, certain strategies appear to be costly and maladaptive. For example, suppression or avoidance of emotions is associated with increased negative effect and anxiety, physiological activity, and physical pain (Campbell-Sills, Barlow, Brown, & Hoffman, 2006; Gross & Levenson, 1997; Levitt, Brown, Orsillo, & Barlow, 2004; Masedo & Esteve, 2007). Experimental investigations also support the notion that the effort of suppressing emotions drains mental resources (Richards & Gross, 2000), which could lead to decreased self-control.

 

128px-Amyg

Ricketts and Macaskill (2003) investigated several techniques that gamblers use to modify their emotions, one of which was the technique of ‘shutting off’ or using gambling in order to stop an unpleasant emotional state.

Patients who used the technique of ‘shutting off’ were often the ones who also reported poorly tolerating emotional discomfort (Ricketts & Macaskill, 2003).
According to Baumeister, Zell, and Tice (2007), emotional distress leads to an increase in self-awareness, which consequently leads to a desire to decrease ones self-awareness. but at the cost of self-regulation.

If one is unable to self-regulate, this could lead to an addiction or a relapse of an addictive behaviour (Sayette, 2004).

Measures of emotion regulation have proved helpful in identifying patterns of
emotional responding associated with a range of substance-dependent population.

Specifically, we investigated the association between emotion-regulation deficits and gambling pathology using two measures of emotion regulation, the DERS and the Emotional Regulation Questionnaire (ERQ; Gross & John, 2003). The ERQ examines the habitual use of two specific emotion-regulation strategies,
namely expressive suppression and cognitive reappraisal. The use of suppression reduces the outward expression of emotions in the short term, but is less effective in reducing emotions in the long term and is, therefore, considered a maladaptive emotion-regulation strategy (Gross, 1998; John & Gross, 2004). Cognitive reappraisal involves changing the meaning associated with a particular situation so that the emotional impact is altered (Gross, 1999; Siemer, Mauss, & Gross, 2007).

 

We hypothesized that pathological gambling would be associated with increased
habitual use of suppression and decreased use of reappraisal on the ERQ and deficits in emotion regulation across multiple domains on the DERS,  the gambling group would rely more on suppression as a habitual emotion-regulation strategy and report increased difficulty regulating their emotions. We also predicted that the gambling group would report less use of reappraisal as an emotion-regulation strategy compared to the healthy control group.

As expected, we found a significant relationship between self-reported problem,
gambling behaviour, and negative effect as measured by the DASS, as well as deficits in emotion regulation as measured by the DERS

Contrary to expectations, we did not find a significant relationship between gambling behaviour – although the gambling group reported a greater lack
of awareness of their emotions so may account for the lack of association between self-reported gambling behaviour and suppression efforts. If gamblers demonstrate less awareness or insight into their emotional states, there may be less need to suppress emotions.

Gamblers have been shown to  be prone to  depression and anxiety (Beaudoin & Cox 1999; Black & Moyer, 1998; Vitaro, Arsenault, & Tremblay, 1999), substance dependence, and greater difficulty managing stress (Blaszczynski & Nower, 2002) and this may  may further weaken inhibitory control and increase the already present propensity for pathological gamblers to make impulsive decisions (McCormick, Russo, Ramirez, & Taber, 1984).

Once a habitual pattern of gambling behaviours has been established, the combination of emotional vulnerabilities, conditioned responses, distorted cognitions, and decision-making deficits maintain the cycle of pathological
gambling. Blaszczynski and Nower (2002) suggest that such emotional vulnerabilities make treatment more difficult in this particular group of gamblers and emphasize the need to address these underlying vulnerabilities in addition to directly targeting gambling behaviours in therapy. It may, therefore, be of therapeutic benefit to specifically assess for and target emotion-regulation strategies in this population of gamblers.

Given the gamblers in the current study demonstrated limited access to effective strategies for managing difficult emotions, it may be important for clinicians to address coping strategies (including emotion-focussed strategies) as a part of any comprehensive treatment package.

It is also important that the clinician is aware of any deficits in emotion-regulation strategies to ensure that the client is prepared to guard against relapse, given that the ability to tolerate distress is associated with increased length of abstinence from gambling (Daughters et al., 2005).”

References

1. Williams, A. D., Grisham, J. R., Erskine, A., & Cassedy, E. (2012). Deficits in emotion regulation associated with pathological gambling. British Journal of Clinical Psychology, 51(2), 223-238.

 

Gambling with America’s health!

Here I  simply repost a very comprehensive review of the costs of gambling in the USA – “Gambling with America’s Health”  –

THE PUBLIC HEALTH COSTS OF LEGAL GAMBLING

this was written by

This article cites my friend and author  Catherine Townsend-Lyon who discusses her personal experience of gambling addiction.

Publicly, Scott Stevens, a chief operating officer of a company in Steubenville, Ohio, was a well-regarded member of his community. A married father of three, he was active in his local Catholic church, involved with high school sports teams, and helped develop parks in the area. Privately, Stevens was addicted to gambling. First exposed to slot machines at a trade show in Las Vegas in 2007, Stevens became a regular slot player at the Mountaineer Casino, Racetrack, & Resort, about 30 minutes away in Chester, West Virginia. By 2010, he had embezzled $7 million from his employer to gamble, and when they found out, he lost his job. Stevens continued to gamble secretly for the next 10 months, going to Mountaineer nearly every day, drawing money from his family’s savings, his 401(k), and his children’s college fund.On August 13, 2012, that money ran out. In a suicide note to his wife, he wrote: “I know you don’t believe it, but I love you so much. I have hurt you so much. Our family only has a chance if I’m not around to bring us down any further.” That evening, Stevens asked his 13-year-old daughter to bring him his hunting bag from the attic. He drove to a local park he had helped develop and called 9-1-1. When the sheriffs arrived, he shot himself.

“This is one of the biggest public health issues in America today that no one has been paying attention to.”

“If it can happen to a guy as smart as he was, then it can happen to anybody,” said Indianapolis attorney Terry Noffsinger in a talk last November at Harvard Law School. Noffsinger, with other attorneys, is representing Stevens’ widow Stacy in a lawsuit filed last month against Mountaineer Casino, its parent company MTR Gaming Group, and slot machine maker International Game Technology, alleging they are liable for her husband’s suicide. The suit accuses both the casino and the slot designer of using predatory and deceptive tactics to profit from people with gambling problems, like Scott Stevens.

“Mountaineer Casino knew, or should have known, that the condition of disordered gambling, especially slot machine addiction, is associated with severe adverse health and other consequences for individuals and their families. Not only are gambling addicts like Scott Stevens liable to literally gamble away everything they own and end up in crippling debt, but also to become suicidal at far higher rates than the general population and even the population of persons addicted to substances such as illegal drugs and alcohol,” the suit states.

Vegas-Style Slot Machines Debut In Florida

Although the suit’s success is not assured—the few other cases in this area have not succeeded—it is part of a growing movement of activists, academics, lawyers, and former gambling addicts who are trying to spotlight the health, economic, and social costs of legal gambling. This group believes the gambling industry preys upon vulnerable people, including low-income individuals, youth, and problem gamblers and that gambling availability is linked to larger societal problems like crime and economic inequality.

For its part, the gambling industry points to a record of funding research into gambling addiction and efforts to educate the public about problem gambling. They maintain that they offer a fun activity that most people can do without serious consequences.

The opening of new gambling venues shows no signs of slowing down, despite the planned closing of four casinos in Atlantic City and financial problems for casinos in other states. Last fall, New Yorkersapproved the building of up to seven casinos. Many other states are in various stages of building casinos. Some in the gambling industry are trying to legalize online gambling, which is currently allowed in only three states, Nevada, New Jersey, and Delaware.

A debate over the social and health costs of legal gambling has largely been sidelined even as availability has expanded dramatically in the last 25 years. This is not because of a lack of merit, say experts and activists, but because of the political power of the gambling industry. They allege that the industry has employed tactics in the same spirit as those of tobacco companies, which for many years misled consumers about the addictive properties of cigarettes and advertised to young people and other vulnerable consumers.

According to Les Bernal, the national director of Stop Predatory Gambling, a Washington DC-based nonprofit, “This is one of the biggest public health issues in America today that no one has been paying attention to.”

A few experts predict that as stories of gambling addiction become more common, suits like that of Stacy Stevens will increase and could even succeed, as tobacco lawsuits did. “Ultimately gambling will be linked to the increase in social costs, gambling will be linked to the problems it creates, just like smoking was ultimately linked to cancer,” says Dr. Earl Grinols, a professor of economics at Baylor University. “It can take a while.”

ADDICTIVE PROPERTIES

In the world of gambling, the most addictive property is electronic video gambling machines, often slots, which bring in 70 to 85 percent of the revenue for casinos. In some states, electronic video terminals are even available in other venues, like restaurants and bars. The machines do not typically have warning labels or cut offs for heavy users. Casinos  aggressively market to frequent patrons, giving them complimentary flights, hotels, and other perks. Meanwhile, the success of state voluntary exclusion programs where problem gamblers sign up to ban themselves from casinos is unclear.

gambling_slot-compare

Today’s slots are not the old lever-operated “one-armed bandits” but video game-like terminals that keep users playing by deliberate design, according to Dr. Natasha Dow Schüll, an associate professor in the program of science, technology, and society at the Massachusetts Institute of Technology and the author of Addiction by Design: Machine Gambling in Las Vegas. “The particular addictiveness of modern slots has to do with the solitary, continuous, rapid wagering they enable. It is possible to complete a game every three to four seconds, with no delay between one game and the next. Some machine gamblers become so caught up in the rhythm of play that it dampens their awareness of space, time and monetary value,” writes Dr. Schüll in a New York Times commentary.

“A lot of people think it’s a tax on the stupid,” recovering gambling addict Kitty Martz told the Oregonian. “Really, we’re behaving exactly the way the machines want us to.”

The idea that gambling lends itself to addiction like drugs or alcohol has taken some time to be acknowledged. Until the 2013 publication of the fifth edition of the Diagnostic Statistics Manual, or DSM-5, problem gambling was classified as an “impulse control disorder” in the same category as pyromania and kleptomania, even though most clinicians who treated problem gamblers recognized it as an addiction, says Dr. Silvia Martins, an associate professor of epidemiology at the Columbia University Mailman School of Public Health.

These gamblers exhibit many of the same problems as other addicts. “Everything you see with substance abuse you can make an analogy to gambling problems,” Dr. Martins says, citing family strife, financial hardship, and struggles with depression or anxiety.

“GIVE YOUR DREAMS A CHANCE”

To gamble legally 40 years ago, one had to travel to Nevada, go to a racetrack, or live in one of the handful of states that offered lotteries. In most towns, the closest one came to a betting game was playing charitable Bingo at church. Video slot machines had not yet come to market.

For most Americans today, a casino is just a car ride away. There are about 1,400 of them in 39 states, and 43 states sponsor lotteries with games that are recognizable even to non-gamblers, like Mega Millions, Powerball, Pick 10, and instant scratch off tickets. In advertising to citizens, states use slogans like, “Hey you never know,” “Give your dreams a chance,” and “Believe in something bigger.” Hawaii and Utah are the only states that offer no forms of legal gambling.

Gambling addiction is often considered a small cost, one brought upon by the individual unwise gambler.

Casinos represent a substantial part of the nation’s economy and enjoy support from members of both political parties. In 2012, the industry took in $37 billion in gross revenue, employed 332,075 people, paid $13 billion in wages, and contributed $8.6 billion in taxes, according to the American Gaming Association. Many casinos are not just places to play blackjack and slots but to eat or take in live music and comedy acts.

In this environment, gambling addiction is often considered a small cost, one brought upon by the individual unwise gambler. “They think that it’s an easy painless way to raise revenue but they don’t see the other side of it,”  says Arnie Wexler. Wexler quit gambling over 45 years ago after a nearly three-decade addiction and has since served as executive director of New Jersey’s Council on Compulsive Gambling. He also runs counseling services for compulsive gamblers with his wife, Sheila.

Watch a video of Arnie Wexler speaking about burnout of slot machine addicts on "60 Minutes"

According to a conservative interpretation of the available research by the National Center for Problem Gambling, 1.1 percent or 3.4 million Americans have a pathological gambling disorder and 2 percent or 6.2 million engage in problem gambling, a less severe form of gambling addiction. (The term problem gambling is often used to refer to both problem and pathological gambling.) Internationally, prevalence is as low as .5 percent of the population in Denmark and the Netherlands and as high as 7.6 percent in Hong Kong, according to a 2012 review for the province of Ontario. Though problem gamblers are a minority of visitors to casinos, their spending accounts for anywhere from 35 to 50 percent of the revenues, according to several studies summed up in a paper by the Institute for American Values, a nonpartisan think tank that focuses on family and social issues.

BETTING ON SCIENCE

Neuroscientists have found commonalities between the brains of gambling and drug addicted people,like increased impulsivity and lower levels of activity in a region of the brain’s reward system, which leads people to seek bigger and potentially dangerous thrills. But it is not clear from this research when or how someone becomes addicted to gambling.

Compared to other nations, there has been relatively little epidemiologic research on rates of problem gambling in the U.S. The existing studies find that problem gambling increases with proximity to casinos. The federal government’s 1999 National Gambling Impact Study found that areas within 50 miles of a casino had twice as high a rate of problem gambling as those within 250 miles. The presence of a casino within 10 miles of a survey respondent’s home was positively related to problem or pathological gambling, according to a 2004 study by the University of Buffalo’s Research Institute on Addictions published in the Journal of Gambling Studies.

“If I were the gambling industry, I would want to fund people who had the disease point-of-view…because [they are] putting the source of problem gambling between the ears of the gambler.”

Gulfstream Park Racing & Casino (Photo: Joe Raedle/Getty Images)

“Basically what we’ve learned is that as with many other kinds of environmental exposures, there typically is an increase in the prevalence rate of problem gambling in the wake of major introductions of new forms of gambling, whether it’s lotteries back in the 1980s and 1990s or casinos in the 1990s and 2000s,” says Dr. Rachel Volberg, a research associate professor of epidemiology at University of Massachusetts at Amherst and a researcher for the Massachusetts Gaming Commission. Dr. Volberg has found that rates of problem gambling began increasing during the most rapid expansion of gambling opportunities in North America and in Australia.

Yet she says problem gambling rates seem to level off after awhile. A study by the Research Institute on Addictions that has not been published yet found that rates of problem gambling did not continue to rise between 2010-2012 despite greater opportunity to gamble. Principal investigator Dr. John Welte, senior research scientist in psychology at the University of Buffalo, says it is not clear why, but he says it could be a result of the economic crisis.

The National Center for Responsible Gambling, or NCRG, is the charitable arm of the gambling industry’s trade association, called the American Gaming Association. NCRG cites a few studies that it says show problem gambling has not risen since the 1970s. After a casino moves in, problem gambling may become more widespread initially, but after a while, people “adapt”—they become more aware of the risks, seek treatment, or simply lose interest, says Christine Reilly, the senior research director of NCRG. This is called an “adaption effect.”

But prevalence studies do not tell the full story, says Dr. Stephen Q. Shafer, the chairman of the Coalition Against Gambling in New York. “One of the fallacies is that, let’s say you assume that your prevalence statistics are absolutely correct and you show that the prevalence of pathological gambling has not risen. It was, say, five years ago 1.1 percent. Last year it was 1.2 percent. What that forgets is that the prevalence is a pool out of which people move and into which people come, and looking at prevalence compared to time one and time two, you have to account for the people who have recovered, died, moved away.” For instance, a prevalence study conducted in 2008 would have counted Scott Stevens, but one in 2013 would not have.

For this reason, there need to be studies that use more rigorous epidemiologic methods, says Dr. Shafer, who is also a retired clinical professor of neurology and epidemiology at Columbia’s College of Physicians & Surgeons and the Mailman School. He has pushed to get New York State to commission such a study, but the state’s health department, the legislature, and the gambling commission have shown no interest.

INDIVIDUAL DISEASE OR PUBLIC HEALTH PROBLEM?

Funding for gambling addiction research in the U.S. is about one-twentieth of funding in Australia and Canada, where gambling availability has also risen significantly in the past several decades, according to Dr. Volberg. Within the National Institutes of Health, there is an institute for research on alcohol disorders and an institute for research on drug addiction, but no institute for general addiction. Investigators who study problem gambling typically have to propose to look at it in conjunction with drug or alcohol use in order to win grants.

Gambling availability has other public health ramifications beyond addiction. It may exacerbate economic inequality, which has a strong relationship to health.

The NCRG is the only private funder of gambling addiction research in the country. According to Reilly, they fund research by top scientists at universities like Caltech, Duke, and Stanford, which are published in peer-reviewed journals. “We are funding some of the best people in the country, people who will lead us and force the issue at a national level,” says Reilly.

The majority of the NCRG’s funding goes to research based on a “disease model”—which investigates what goes on in the brains of individuals addicted to gambling—rather than the public health model, which looks at how availability affects population rates of problem gambling and potential social costs.

Both the disease model and the public health model “have points of truth, and they’re not mutually exclusive,” says Dr. Welte. But he adds, “If I were the gambling industry, I would want to fund people who had the disease point-of-view…because [they are] putting the source of problem gambling between the ears of the gambler.”

According to Reilly, the disease model is more practical because it can lead to treatments and that it is less prone to the flaws of survey research. “To me it seems kind of silly to spend time and money on an issue that is extremely difficult to research, because you can’t count on people’s memory,” she says.

Gulfstream Park Racing & Casino (Photo: Joe Raedle/Getty Images)

But it is not in the gambling industry’s interest to have good research conducted on the social and economic costs of casinos and other forms of gambling, says Dr. Grinols. He points out that the federal government’s 1999 National Gambling Impact Study Commission recommended a moratorium on further gambling expansion until more research could be done on the economic and social costs and benefits. “No research of the type and focus hoped for by the Commission has been forthcoming since. That’s because the gambling industry has done what it could to question these studies and has not itself funded such studies,” says Dr. Grinols. “The whole conclusion of the Commission has been ignored and in fact thwarted by the failure of money to be available for good research.” Dr. John Warren Kindt, a business administration professor at University of Illinois whose research looks at the social and economic costs of gambling, calls what NCRG funds “pabulum research designed not to hurt the gambling industry and to misdirect the debate.” In response to such criticisms, Reilly is adamant that the NCRG has a totally independent review board, which she says mimics the structure of the National Institute of Health and does not interfere in the work of its researchers.

As for self-reporting, there are ways to validate responses. Dr. Robert Williams, a professor of addiction counseling at the University of Lethbridge in Alberta Canada, has compared what respondents report they spend on gambling to actual gambling revenue. He says the more reliable studies are those in which the total of the revenue reported by participants is closer to the total revenue made by the gaming industry. Dr. Williams points out that self-reporting may also underrepresent problem gamblers, who would be more likely to have their phone disconnected.

GROWING THE ECONOMY OR EXACERBATING INEQUALITY?

Gambling availability has other public health ramifications beyond addiction. It may exacerbate economic inequality, which has a strong relationship to health. It levies regressive taxes which take a larger share of income from lower than from upper income Americans. If taxes on gambling revenues substitute tax increases on income—which are progressive—the tax structure in a state becomes even more regressive. And those who spend money on certain forms of gambling are more likely to be low income.

There is “a strong positive relationship” between state lottery sales and the poverty rates, according toa 2007 study in the American Journal of Economics and Sociology by economists at Cornell University that looked at data over 10 years. The most typical lottery player is a black, male, high school dropout making less than $10,000 a year, according to a 1999 report to the National Gambling Impact Study commission. Problem gambling is significantly worse in economically disadvantaged areas according to two studies from 2013, one by Dr. Welte and his colleagues and another by Dr. Martins and her colleagues. And the presence of a casino is associated with rises in bankruptcy filings, according to a 2005 study from Creighton University.

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While casinos may bring new jobs when they open, most are low-paying service work. The national median wage in the gambling industry is $10.76per hour. While better than some service jobs, it is less than the $16.87 hourly median wage for all industries, according to 2013 data from the Bureau of Labor Statistics.

And rather than boosting a local economy, casinos often draw business away from other food and entertainment venues. Many casinos are losing patrons to newer competition in neighboring states, straining state budgets and threatening local economies.

When casinos lose money or fail, the repercussions are significant. Delaware is spending hundreds of millions to keep struggling casinos afloat. In Atlantic City, several casinos plan to close by the end of the month, including the Revel, a two-year-old, $2.4 billion casino, entertainment, and conference center that was supposed to buoy the city’s flagging economy. The closures leave thousands of jobless peoplein a city that already has one of the highest unemployment rates in the country at over 15 percent as of April 2014, a violent crime rate six times the rest of New Jersey, and 29 percent of its population in poverty—a 7 percent increase since 1974, two years before New Jersey voters legalized gambling.

Although these statistics do not prove that the city’s gambling economy caused its problems, they do call into question claims by politicians and developers that casinos are an engine for economic growth. Nevertheless, some New Jersey politicians and business leaders are now talking about opening a new casino—or four—at the Meadowland Sport Complex in Bergen County, New Jersey.

Tribal lands that have casinos have seen improvement in jobs and county-level mortality rates,according to a 2002 study from the National Bureau of Economic Research. Yet these communities still see more bankruptcy, violent crime, and auto thefts and larceny after a casino opens.

Legal gambling is also linked to social problems like rises in crime and risky behavior in youth. Counties where casinos have opened have seen rises in the number of rapes, robberies, aggravated assaults, burglaries, larcenies, and auto thefts, compared with counties without casinos, according to a study by economists Dr. Grinols and Dr. David B. Mustard, which looked at county FBI data from 1977 to 1996.

gambling-revel-showboat

Because children are now growing up in an environment where gambling is so widely advertised and available, they could be especially vulnerable. Youth are at greater risk for problem gambling than adults, according to a 2007 study from Canada. Two percent or about 750,000 teens ages 14 to 21 described gambling with three or more negative consequences in anational survey by Dr. Welte and colleagues in 2008. Another 11 percent gambled twice or more per week, which is considered frequent. Teen boys who gamble are more likely to become fathers before age 20, especially those who problem gamble, according to a study by Dr. Martins. African-American teens who are problem gamblers are more likely to have sex and get arrested at a younger age than those who don’t gamble. Teens who had depressive symptoms early in adolescence are more likely to have gambling problems later in adolescence, according to another Martins study from 2011.

A PERVASIVE GAMBLING CULTURE

Former U.S. Representative Robert Steele has observed the casino economy at work in southeastern Connecticut, the district he represented from 1970-75, which in the early nineties became home to both Foxwoods and Mohegan Sun Casinos.

The casinos created a “pervasive gambling culture.” He adds: “the people in southeastern Connecticut were in no way ready for the casinos.”

“They became almost instant successes and the two biggest casinos in the world,” says Steele, who has written a novel, The Curse, which is inspired by the story of the two casinos and the tribes behind them. With Atlantic City as their only competition in the Northeast United States, Foxwoods and Mohegan Sun drew about 60 percent of their customers from out of state and created 20,000 jobs.

But soon came problems no one seems to have anticipated. Drunk driving arrests in nearby Norwich more than doubled, and annual calls to the local police department went up fourfold, according to Steele. There was a sharp spike in the number of people who sought treatment for gambling addiction. The rate of embezzlement increased 400 percent, according to a report from the state. Steele’s own tax collector went to prison in 2001 for embezzling money from the town to gamble.

Much of the promised employment was in low-paying service jobs, sometimes part-time and often filled by non-English speaking workers who came from outside the area. This influx put pressure on local housing and social services. The local school system gained 400 children who collectively spoke 31 different primary languages, requiring them to create an “English for speakers of other languages” program. Teachers observed value changes in their students, says Steele. “[They] say, ‘we try to teach the kids the way to succeed in life is through hard work. Then the casino culture comes in and says, ‘you hit it big, you hit the lottery. You hit the payoff.’”

Today, revenue from Connecticut’s casinos is down 35 percent since its high point of 2007. Ultimately, says Steele, who used to have a property abutting Foxwoods, the casinos created a “pervasive gambling culture.” He adds: “the people in southeastern Connecticut were in no way ready for the casinos.”

“When everybody knows everybody, a good portion of the people you know are going to be affected—even if not directly—through broken homes, bankruptcy, the whole gamut,” says Dawley.

CITIZEN ACTION

Unions and community members hold a rally on April 20, 2013, demanding that the planned Caesars in Baltimore's Inner Harbor address economic and environmental concerns of residents. (photo: United Workers)

In Massachusetts, citizens are campaigning to repeal a deal that allows for MGM Resorts International to build an $800 million casino in the economically depressed town of Springfield. “We see this as very much a perpetuation of income inequality, and the implications that income inequality has on public health —that people stay in poverty basically, stay under-compensated. It’s the transfer of wealth from people who don’t have money to people who have abundant resources,” says Steven Abdow, a senior staff member of the Episcopal Diocese of Western Massachusetts. “This would be intentionally bring[ing] in a product that destroys lives.”

Abdow is working on a campaign to oppose the MGM casino. Once viewed as a way to revive the city’s dwindled fortunes, the casino’s fate is now in jeopardy. In June, a judge ruled in favor of ballot measure that would allow the citizens of Massachusetts to repeal a 2011 law that authorized casinos in the state.

Tyre, New York, is a town of less than 1,000 people 270 miles northwest of New York City. The town’s websiteboasts of a community that “strives to maintain its rural flavor,” welcoming visitors to stop by and visit the Montezuma National Wildlife Refuge and the Erie Canal. Last December, residents learned that a Rochester-based real estate company called Wilmorite was bidding to open the Lago Resort and Casino on agricultural land, across from an Amish farm.

Google Earth aerial view of potential Lago Resort and Casino site in Tyre, New York

“I grew up my whole life in this area. A casino certainly is not what you anticipate showing up on your doorstep,” says Jim Dawley, a resident whose property borders the proposed spot.

Dawley and his wife, who own and run a small manufacturing company, and two friends formed an organization called Casino Free Tyre to oppose Wilmorite’s plans. “When everybody knows everybody, a good portion of the people you know are going to be affected—even if not directly—through broken homes, bankruptcy, the whole gamut,” says Dawley.

 

Over 200 residents have signed a petition against the casino, but members of the town board are supportive of Wilmorite, which is promising multi-million dollar revenues. The Dawleys are not letting up, even though they are new to activism. “This is so far outside of my normal realm, it’s unbelievable. I have a little manufacturing business out in the woods. I’ve been involved in our church and things like that but as far as any political-rooted opposition, this is our first time.”

FOLLOWING IN THE FOOTSTEPS OF CIGARETTES?

In the court case over the Massachusetts casino deal, an organization called the Public Health Advocacy Institute filed a friend-of-the-court brief that made a public health argument against the gambling industry. “Legalized casino gambling causes devastating effects on the public’s health, including not only the gambler but also their families, neighbors, communities and others with whom they interact,” the brief says. Electronic gambling machines “are designed to addict their customers in a way that is similar to how the tobacco industry formulates its cigarettes to be addictive by manipulating their nicotine levels and other ingredients.”

“Mirroring the tobacco industry’s strategy of creating scientific doubt where none truly exists, the casino industry has co-opted and corrupted scholarship on the effects of gambling through the use of front groups that funnel money to beholden scientists who are able to sanitize its origin,” the brief continues.

“The commercialization of a dangerous product that threatens both individual and public health has been called an ‘industrial epidemic,’” the brief continues, citing a 2007 paper published in the journalAddiction by Drs. René I. Jahiel and Thomas F. Babor. This is an epidemic “driven at least in part by corporations and their allies who promote a product that is also a disease agent.”

The brief argues that the citizens of Massachusetts have an interest in regulating gambling the way they have regulated cigarettes.

Given the power of the gambling industry and the dependence of states on gambling revenues, winning legal damages and regulating availability may presently seem like a pipe dream in the U.S. However, other countries employ harm reduction strategies in casinos to intervene on potential problem gambling,according to a 2011 report from the Cleveland Plain Dealer. In Holland, computers identify anyone who visits a casino more than 15 times a month as having a gambling problem. In the United Kingdom, casinos have to display the odds of winning on slot machines. And in Australia, there are limits on playing speeds and betting amounts.

The underlying principle behind this is articulated by Dr. Williams: “If provincial governments are going to make gambling available to their citizens, then concerted efforts are needed to prevent problem gambling, to effectively treat gambling addiction, and to minimize the amount of gambling revenue that comes from problem gamblers.”

LITTLE HELP AVAILABLE

People with gambling problems tend to elicit little sympathy. They are seen typically as exercising bad judgment when it is known that the “house always wins.” They have often hurt people they are closest to, both financially and emotionally.

“You don’t even have to be in action or sitting behind a machine because you’re constantly thinking about: When am I going to gamble? When am I going to win or lose? It just compounds.”

Former gambling addicts readily admit to their flaws. But, like most people, they typically started gambling because it was available, entertaining, and provided a potential if unlikely monetary reward. However, unlike most people who gamble, they became “hooked.” That’s how Catherine Townsend-Lyon speaks of her gambling addiction. She began playing video lottery terminals at delis and restaurants near her home in Grants Pass, Oregon, sometime after they were introduced in the 1990s. She became obsessed with a game called Flush Fever and soon began playing before and after work and during her lunch hour. She lied to her husband about her whereabouts and started secretly gambling their mortgage payments. She stole from the collection company she worked for and sometimes wore bladder control underwear so she wouldn’t have to get up to use the restroom while playing. When she lost money, she played to win it back, and when she won, she played to win more. In an extreme moment, she skipped the funeral of a close friend to drive 40 miles to an Indian casino so she could win enough money to prevent her home from being foreclosed. Instead, she lost everything. She drove home in tears and slit her wrists.

A video lottery machine sponsored by the state of Oregon (photo: Curtis Perry)

“It’s like a battle you have with yourself with the triggers and the urges and the obsessiveness. You don’t even have to be in action or sitting behind a machine because you’re constantly thinking about: When am I going to gamble? When am I going to win or lose? It just compounds. It’s exhausting. It’s never-ending,” says Townsend-Lyon, who, after seeking treatment several times, has managed to stay away from gambling for the last seven and-a-half years.

Townsend-Lyon says she turned to gambling at a difficult time in her life. With her husband frequently traveling for work, she found herself bored and looking for a way to fill the time. She had undiagnosed bipolar II disorder and had been sexually abused when she was younger but had not been raised to know to seek therapy. “I wasn’t a drug person or an alcoholic or anything like that, although I did drink more when I gambled. And because I was gambling, that was my coping skill. That’s what I was using to escape it, those feelings. I couldn’t stuff them away anymore. I would just use gambling to escape, not feel, zone out, you know what I mean?” she says.

She published a book last year about her former life, called Addicted to Dimes (Confessions of a Liar and a Cheat). What troubles her is how easy it is for people in her position to gamble. She didn’t have to fly to Nevada or even drive to a casino in state. The video poker and slot machines she played, which are sponsored by the Oregon State Lottery, are allowed at bars, restaurants, and delis.

“[I]f these machines weren’t in the bars and delis, then I would not be gambling. It’s that simple for me,” says a 33-year-old man quoted in a recent series on the state lottery by the Oregonian. He estimates he has lost $15,000 over 12 years from gambling. “That may sound like an excuse, but ‘out of sight is out of mind.’”

Photo credit: Erik Wilson

For people who are trying to recover from gambling addiction, it can be difficult to find help. Calls per month to the National Problem Gambling hotline are over two-and-a-half times what they were 14 years ago, from 9,642 in 2000 to 24,475 in 2013, according to Keith Whyte, executive director of the National Council on Problem Gambling. Yet funding for treatment centers, hotlines, and programs to prevent gambling addiction is minimal, says Dr. Martins. Funding for substance abuse treatment is about 281 times greater at $17 billion than public funding for problem gambling, at $60.6 million, although substance use disorders are only 3.6 times more common than gambling disorders, according to a 2013 survey by the Association of Problem Gambling Service Administrators and Problem Gambling Solutions. Just a little over half of the 50 U.S. states have someone whose full-time job is to administer problem gambling services, according to the same survey. By comparison, there are 113 lottery employees in Iowa and approximately 80 in Rhode Island. In several states legislators have cut gambling treatment funding or seen declines as a result of decreases in gambling revenue, which sometimes funds such programs, according to a Wall Street Journal report from 2011.

Gamblers’ Anonymous, a 12-step program modeled after Alcoholics’ Anonymous, is the most widely available and used treatment in the U.S. Members admit they are powerless over their gambling addiction and embark on changing their character through group meetings and the support of a “sponsor” or older mentor in the group. Little research exists on the efficacy of Gamblers’ Anonymous.A study from 1988 found that only 7.5 percent of members had abstained after one-year, and nearly a quarter of members did not go to a second meeting. However, those who regularly attend Gamblers’ Anonymous say they benefit significantly.

As with any kind of addiction, there is no pill for treating problem gambling. Medication and therapy may be used with varying success to treat a related psychiatric illness like depression or bipolar disorder. Moreover, a small number of problem gamblers seek treatment.

For these reasons, a public health approach, which would favor limiting the “exposure” of gambling to prevent addiction from occurring in the first place, is compelling. It is the same as the argument to tighten access to prescription opioids in order to prevent people from becoming hooked.

A DISEASE OF SOCIETY?

At a Gamblers’ Anonymous meeting in New York in August, about 65 people, mostly men, are celebrating one member’s five-year anniversary of abstaining from gambling. He gets to choose the topic for the night, and he picks “starting over.” Other members stand up to say that adhering to the Gamblers’ Anonymous program has fundamentally changed them. They have gone from being selfish and unable to make mature decisions to being better spouses, parents, friends, and members of society. They talk about small triumphs, their families, jobs, illness, and making amends with the people they hurt and stole from during their addiction.

“People adapt to their dislocation by finding the best substitutes for a sustaining social and spiritual life that they can, and addiction serves this function all too well.”

“I think it was known to pretty much everyone in this room that I was an asshole. And I think I have become a decent member of society,” says a man in his early 30s who has been abstinent for 10 years.

Another man echoes this sentiment. “I was anything but a good citizen,” he says. He has been abstinent for over 22 years, but like many others in this room, attends meetings on the Gamblers Anonymous principle that former addicts are always in recovery. “It’s not just starting over, we still have to own our past. We have to settle up with people as best we can.” When his mom passed away, he says he was grateful that he could access his emotions—not something he could have done in his gambling days.

“I can say without a doubt, gambling has ruined my life,” says another member. He has gone to Gamblers’ Anonymous for eight years but has had relapses, and it has been 201 days since he last bet. “Abstinence is for real this time.”

Compulsive gambling is often viewed as an addiction to money, but Gamblers’ Anonymous believes it is an emotional rather than financial disease. The addicted person “wants to escape into the dream world of gambling” and “finds he or she is emotionally comfortable only when ‘in action.’” But it doesn’t end up being much comfort, say formerly addicted gamblers who speak of how lonely their life was then.

Dr. Bruce K. Alexander, a psychologist and professor emeritus at Simon Fraser University in British Columbia, believes the loneliness experienced by those with gambling and other addictions has a strong social dimension. In his book, The Globalization of Addiction: A Study of the Poverty of the Spirit, he says: “A free-market society is magnificently productive, but it subjects people to irresistible pressures towards individualism and competition, tearing rich and poor alike from the close social and spiritual ties that normally constitute human life. People adapt to their dislocation by finding the best substitutes for a sustaining social and spiritual life that they can, and addiction serves this function all too well,” he says.

A woman plays slots at Gulfstream Park Racing & Casino. (Photo by Joe Raedle/Getty Images)

Bernal of Stop Predatory Gambling believes that our nation’s dependence on gambling reveals a deeper civic problem. “What we incentivize as a government shapes the national character,”  he says. “We look at the greatest generation, we encouraged people to buy savings bonds, in the Great Depression. After World War II, we had the highest savings rate in modern American history because the government encouraged Americans to save. Today, half of Americans don’t own any assets.”

Terry Noffsinger, the lawyer for Stacy Stevens, admits that it has not been easy to make the legal public health case against gambling. Neither of the two cases he has represented has won in court, and one even provoked the Seventh Circuit Court of Appeals to threaten to sanction him for filing a frivolous claim. But he says the tide is turning. He has a conference call with a group of lawyers across the country about once a month to discuss the issue. Last November a group of Harvard Law students published a white paper making the case for legal action “to protect problem gamblers from the predatory behavior of casinos, including legislative reforms, tort litigation, regulations, and public policies.”

A couple of well-known trial attorneys have joined him on the Stevens suit, including Sharon Eubanks, who was lead counsel on the U.S. case that ended in a judgment in 2006 that the nation’s big tobacco companies fraudulently covered up the health risks of smoking and marketed to children. The Stevens case also makes product liability claims that the slot machines from which casinos draw so much revenue are intentionally designed, manufactured, and distributed to hurt people. Such claims have never been tried before.

“This is a blockbuster case. There are other cases that are starting to come out of the woodwork. The courts are ready to look more favorably upon addicted gamblers,” says Dr. Kindt of University of Illinois. Dr. Kindt published several academic articles in the early 2000s outlining the legal justification for mega-lawsuits against the gambling industry, similar to those which states, individuals, and classes of people filed against Big Tobacco.

In his Harvard talk, Noffsinger said he has had 100 or more people call him for help, many suicidal, nearly all of whom he has had to decline to represent. One of the calls came several years ago from a Boeing employee in Seattle who begged him for legal assistance. She had lost all of her money gambling, sold all of her furniture, and was ready to end it all. When Noffsinger told her he couldn’t represent her, she said she had nothing left to live for. Alarmed, he referred her to a lawyer friend in Seattle who found her counseling. About a year ago, she called Noffsinger and thanked him for saving her life.

“Somebody needs to do something…it may not be me.” Noffsinger told the Harvard students. “It’s going to be an uphill battle, but at the top there’s going to be a great big flag to wave.”