Tuesday, February 28, 2012
Is Gambling the Opiate of the Masses?
Two new books tackle gambling’s addictive mysteries.
Charles Fey, the American who invented the three-reel slot machine in 1898, is a well-known part of gambling history. But few people have heard of Inge Telnaes, the mathematician credited with the invention of the “virtual reel” almost 90 years later, in 1984. The virtual reel worked like this: The Telnaes patent allowed slot machine makers to store the various symbols on the spinning reels as digital data on microprocessor chips. After that, random number generating software produced the actual results in the form of three-symbol sets. So far so good. But inherent in the process was another step—the “virtual stop.” And this idea was a real killer. As gambling guru Donald Catlin wrote at Casino City Times:
Virtual reels contained more stops than were contained on the real reels, which meant that the probability of a particular symbol appearing on the pay line had nothing to do with its frequency on the real reels and everything to do with its frequency on the virtual reels. If this seems deceptive to you, consider the following quote taken from the Telnaes patent submission: "Thus, it is important to make a machine that is perceived to present greater chances of payoff than it actually has within the legal limitations that games of chance must operate."
Pretty straightforward. You could program a thousand stops per reel, if you wanted to. The advantage was that you could post huge jackpots without the fear of anyone hitting them very often, because when gamblers thought about a line of 7s on those three reels, they were in fact facing many more spin combinations than they realized.
But I digress. We all know the house wins. Gamblers know it, too. Gambling can be defined as an activity in which something of value is put at risk in a situation where the outcome is uncertain. That’s really all there is to it. And for most people, it all adds up to little more than an evening of escapist fun.
So how do pathological gamblers gets so turned around? Viewing their behavior from the outside, it’s hard to have sympathy with them—the same way it can be hard to have sympathy for alcoholics. Willful self-destruction often looks like the only way to account for it.
Heavy gamblers, the kind of gamblers who get into major debt, are people who get an unnatural buzz out of winning and losing money. Like most things having to do with addiction, it’s complicated, and involves a spiral of negative, damaging behavior that transcends bad habits or lack of self-control. They’re the ones in the casinos well past midnight, drink in hand, cigarette burning in the ashtray, and perhaps making the occasional sprint to the restroom for a snort of cocaine or meth. Slot attendants tell stories about gamblers who would rather urinate in their clothes than leave a machine. What, exactly, accounts for that kind of behavior?
For one thing, gambling and alcohol go together like…. cigarettes and alcohol. Gambling is being proposed as an addition to the bible of psychiatry, the DSM-5. All three habits often function together as a set of multiple addictions. The reason for this may be biological. Consider the unexpected side effects caused by certain dopamine-active medications for Parkinson’s. Some seniors who take the drugs begin to feel an uncontrollable urge to, that’s right, go to the casino and gamble. They prefer slot machines, and sometimes lose a lot of money. When they go off the medications, they lose interest in their new hobby—which lends a certain weight to the argument that some compulsive gamblers act the way they do because of innate biochemical dysfunctions. They do it, Howard Shaffer believes, because gambling is one manifestation of the disease he calls “addiction syndrome.”
Howard J. Shaffer and Ryan Martin, writing in the Annual Review of Clinical Psychology, note that just as there are divisions between alcoholic drinking, heavy drinking, and social drinking, there are also differences between pathological gambling, excessive gambling, and social gambling. Pathological gambling has proven to be “a more complex and unstable disorder than originally and traditionally thought.” Once the neurophysiology of the gambling state of mind came under scrutiny, the parallels with addiction cropped up everywhere. Shaffer, a professor of psychiatry at Harvard Medical School and director of the Division on Addiction at Cambridge Health Alliance (see my interview with him here), notes that “the rate of pathological gambling in America has remained relatively constant for the past 35 years, despite a huge expansion in the opportunities on offer.”
Change Your Gambling, Change Your Life, by Howard Shaffer, written with Ryan Martin, John Kleschinsky, and Liz Neporent, follows a relaxed workbook approach to problem gambling. Perhaps the most useful aspect of the book’s organization is its division into what we could call co-morbid chapters. Gamblers with anxiety, mood disorders, impulse control problems, or drug addictions each warrant their own section of the book, in order to personalize the advice. Organized in this way, the authors explicitly recognize the likelihood that problem gamblers do not normally suffer the condition in isolation from other mental health and substance use issues.
Shaffer gives a variety of useful advice concerning triggers, and methods for controlling urges. He believes that the risk of developing addiction syndrome involves “a complex interaction of genetic, psychological, social, and other factors.” Shaffer estimates that about two million Americans suffer from some level of addictive gambling disorder, with another 3.5 million gamblers with problem behaviors that don’t meet the addictive threshold.
In fact, the overlap between problem gambling, mental health problems, and other forms of addiction is staggering. According to numbers from the National Epidemiologic Survey on Alcohol and Related Conditions cited in the book, more than 11 percent of heavy gamblers suffer from generalized anxiety disorder; up to 50 percent have exhibited mood disorders; 40 percent qualified for an impulse control disorder; and 50 percent can be classified as “alcohol dependent."
Professor Shaffer takes a nonjudgmental stance on the question of moderation versus abstinence, while cautioning the problem gambler about the realities of having “the self-control to bet a little when he has the urge to bet a lot.” To attempt moderation, a gambling addict (or alcoholic for that matter) must be willing to accept the consequences of being unsuccessful. However, some research shows that those who engaged in disordered gambling “move on from excessive gambling to less gambling over time,” according to Shaffer. There may be a simple explanation for this: “Many people with gambling disorders eventually run out of money.” (Back when I used to gamble regularly in casinos, I often joked that there was nothing quite like the uneasy thrill of risking money you really couldn’t afford to lose.)
But if you are serious about quitting, warns Shaffer, “you also need to be prepared for people who, for their own selfish reasons, deliberately entice you to gamble.” Really? This may sound unlikely, but I recall that in my own case, when I first stopped drinking, an older friend used to pour me drinks and leave them nearby—just in case I came to my senses. If you are a gambling addict, and know it, there are self-exclusion programs at most casinos, designed to allow gamblers to bar themselves for a specified period, in an arrangement rather like Linus and his blanket.
Shaffer also points to continuing work on various drugs for problem gamblers. Naltrexone, used for opiate and alcohol addiction, is one such candidate. (A University of Minnesota study showed that 40 percent of pathological gamblers abstained from gambling for at least a month while taking naltrexone.) So is nalmefene, which also operates on opiate brain receptors. Other medications under study include common SSRI antidepressants like Prozac and Celexa.
Change Your Gambling, Change Your Life is a structured, clearly written, nonjudgmental approach for motivated people wishing to deal seriously with their “disordered gambling.”
Another book on gambling turned up in the book bag recently. In his e-book called Slots: Praying to the God of Chance, David V. Forrest, M.D., notes that casinos can clear as much as $2,500 per day from a popular slot machine. Not considered sexy or the domain of the high roller, slot machine action accounts for roughly 70 to 80 % of casino income. To attract young players, who tend to favor table games, slot machine manufacturers are experimenting with joysticks and a dollop of skill-based play—but it’s not clear, says Forrest, that older, established slot players want to substitute “a competitive mind-set for the meditative trance induced by the random spinning and stopping of the reels.” (Note: The last time your humble narrator played the slots in Las Vegas, the spinning induced an attack of intense vertigo and dizziness due to a chronic ear disorder. Talk about negative conditioning.)
How do you know if you’re a slot addict, like former Drug Czar William Bennett? “Looking forward to slot playing as the best thing in your future is not a good sign,” Forrest helpfully suggests. One casino on the East Coast uses the ominous advertising tag line: “You’ll Come Back.” Forrest mischievously notes that both “the American Psychiatric Association and the American College of Psychiatrists have traditionally refused to hold their annual conventions in Las Vegas for fear of seeming to endorse a behavior that can become pathological.”
Here are some of Dr. Forrest’s suggestions for the problem gambler:
-- Avoid playing alone.
--Play out your time, not your money.
--Break the hypnotic spell through thought and activity.
--Beware the dangers of comorbidity.
With this final admonition, Dr. Forrest lines up squarely with Howard Shaffer: “In my psychiatric experience,” he writes, “some of the most defenseless to the excesses of gambling have been bipolar patients in the manic phase of their illness.”
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