Wednesday, June 2, 2010

Triple Play for Addicts

Why cigarettes, alcohol and gambling are such a perfect fit.

The newer views of addiction as an organic brain disorder cast strong doubt on the longstanding assumption that different kinds of people become addicted to different kinds of drugs. By 1998, the Archives of General Psychiatry had already flatly stated the reverse: “There is no definitive evidence indicating that individuals who habitually and preferentially use one substance are fundamentally different from those who use another.” This quiet but highly influential breakthrough in the addiction paradigm has paid enormous dividends ever since.

From a genetic standpoint, the implication was that an addiction to alcohol, heroin, or speed did not necessarily “breed true.” The sons and daughters of alcoholics could just as easily grow up to be heroin addicts, and vice versa, due to the same brain anomalies.

There are numerous examples at hand. Recovering alcoholics and heroin addicts tend to be notorious chain-smokers, for one. Many prominent nicotine researchers lean toward the theory that those Americans who continue to be hard-core smokers, unwilling or unable to stop, may represent a biological pool of people who are genetically prone to addiction. Alcohol researcher George Vaillant,  who directed the seminal Harvard Medical School longitudinal studies, sees it the same way: “Alcoholism is a major reason that people don’t stop smoking. Those who keep on smoking after age 50 tend to be alcoholics.” 

There you have it. Throw a lasso around America’s cigarette smokers, and you are likely to snare the lion’s share of “drug abusers” and “problem drinkers” as well. This may also explain why there is such a huge overlap between gamblers and alcoholics, and between gambling and cigarette addiction. It is no secret to anyone who has been inside a casino that a striking percentage of the patrons are also smokers and drinkers. If gambling were truly capable of producing the hallmark symptoms of addiction, we would also expect to see such manifestations as continued use despite adverse circumstances, escalating use, and various forms of self-destructive behavior. It depends on whether the dopamine/serotonin patterns produced by addiction, involving midbrain dopamine neurons with divergent connections to the frontal cortex and other forebrain regions, are the same in compulsive gamblers as in alcoholics and other addicts. Many researchers simply do not believe that the alterations in neurotransmission brought about by behaviors are as powerful as the chemical surges produced by drugs, and therefore cannot result in a state technically called addiction. Others disagree.

Nonetheless, human neurostudies continue to show intriguing dopamine patterns during gambling and certain other forms of game playing. Part of what drives the destructive gambling cycle appears to be the intense, dopamine-driven arousal produced by the anticipation of reward—the jackpot.  Recent research has focused on the part played by midbrain dopamine in the anticipation of reward, otherwise known by addicts as “waiting for the man.” In the world of gaming, it is known as the classic “gambler’s fallacy—the expectation that after a series of losses, a win is “due.” Statistics say otherwise, and gamblers certainly know all about house percentages. Yet, the expectation effects of beating those odds may produce the same anticipatory effect on a disordered metabolism as drug-related activities. A very small, speculative, and intriguing study at Duke University suggested that dopamine agonists given for Parkinson’s disease might sometimes be a catalyst for excessive gambling behaviors in elderly patients, even those who had never shown an interest in gambling before.

As for shopping and sex, even an informed guess seems premature at this point.

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Chiropractic St Paul mn said...

Good Addicts information, Smoke, Gambling and Alcohol all are really perfect Addict's items.

Anonymous said...

Did you see the study about how problem gamblers' brains 'light up' at a near miss almost as much as at a win? 'Normal' gamblers' brains don't show the same reaction. I'm sure brain imaging will reveal similar responses for compulsive shoppers, food addicts, etc.

Dirk Hanson said...

Interesting that you mention compulsive shopping and food addiction, since I believe these two behaviors will shortly join gambling as clear examples of addiction. I'm pretty conservative when it comes to broadening the definition of addiction. Substance addiction requires a substance, but in the cases of certain kinds of overeating, bulimia, gambling, and shoplifting, the "substance" may simply be serotonin/dopamine surges produced by a specific behavior in specific people with addictive propensities.

Bobby said...

I don't think it is any surprise to find out that there are certain characteristics among alcoholics that are common. Addictive personalities is just an old fashioned way of saying genetic predisposition. Thanks for the information, it is a very interesting article as well as informative.

Anonymous said...

That's interesting - so you would categorize compulsive gambling and eating as a different variety of addiction because the substance involved is a brain chemical that is only triggered in certain people by those behaviors? Wouldn't smoking pot also fall into that category, even though it's clearly a substance? Or am I misunderstanding?

Dirk Hanson said...

I think pot is addictive in the traditional way for a subset of addiction-prone people, just like any other addictive substance. Sugar foods, gambling, pot smoking--no problem practicing these in moderation for most people. But for those with addictive propensities, all three habits can be perilous.

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