Addiction Machines: How Slots are Designed for Compulsive Play

Your player card, please.

The image of the compulsive gambler has traditionally been the male poker player, drink in hand, recklessly betting the night away. Slot machines? Those were for amateurs, the out-of-towners, the meek and the mild. But that irritating clang and buzz coming from over the card player’s shoulder is not just the sound of new money—it’s the sound of a new technology tuned to a ruthless edge.

Digital slots and poker machines have become the new games of choice for pathological gamblers. In 1999, Harvard addiction researcher Howard Shaffer predicted that, “as smoking crack cocaine changed the cocaine experience, I think electronics is going to change the way gambling is experienced.”

Modern gambling machines drive the casino gambling industry, and generate far more revenue than “table” gambling. Because of the manner in which they “facilitate the dissociative process,” as one psychologist puts it, excessive gambling is built into the design and structural characteristics of the technology itself. One physician has even suggested that machine gambling produces a trance state by closely matching human breathing patterns with its “basal slot play rate.” We don’t have to wait for the Singularity to observe the merging of man and machine.

By 2000, digital gambling machines were generating twice the revenues of “live” games. Today, the modern slot machine “drives the industry,” said the president of the American Gaming Association in Natasha Dow Schull’s book, Addiction by Design: Machine Gambling in Las Vegas. They are allowed, in one form or another, in at least 41 states. Journalist Marc Cooper, who covered Las Vegas in his book, The Last Honest Place in America, said in 2005: “The new generation of gambling machines has, predictably, produced a new generation of gambling addicts: not players who thrive on the adrenaline rush of a high-wager roll of the dice or turn of a card but, rather, zoned-out ‘escape’ players who yearn for the smooth numbness produced by the endlessly spinning reels.”

“A gaming machine is a very fast, money-eating device,” according to a spokesperson for Bally. “The play should take no longer than three and a half seconds per game.” Gambling engineers attempt to fine-tune the “capacitive logic of haptics,” by, for example, designing chairs that tingle and pulse in response to events in the game. The ideal is to achieve an “embodied relation,” in which a gambling machine becomes an extension of the gambler’s own cognitive capacities and spatial skills. Professor Schull of MIT’s Program in Science, Technology, and Society sees a digital gambling machine as “an interactive force that powerfully exerts its program for ‘player extinction’ and in so doing constrains the possible outcomes of play.”

At the simplest level, gambling machines function as Skinner boxes for human rats. Intermittent reinforcement, as psychologists showed long ago, is an effective way of shaping behavior. “If the number of responses required to receive a stimulus varies,” writes biologist Jason Goldman at his Scientific American blog, The Thoughtful Animal,“then you are using a variable ratio schedule. The best example for this is a slot machine, which has a fixed probability of delivering a reward over time, but a variable number of pulls between rewards. It is no wonder that variable ratio reinforcement schedules are the most effective for quickly establishing and maintaining a desired behavior.”

Casinos were early adopters of biometric surveillance methods, and now have the capability of offloading much of this work to distributed digital devices like player loyalty cards. Theoretically, machines could achieve and maintain an active feedback loop with each gambler. The machine could compile data on betting patterns, recent outcomes, time of day, and rhythm of play. The machine would have the ability to “automatically alter the volatility level for gaming events to match the general player preferences at specific times,” in the words of one patent application. The longer you play, the more the machine would understand your style, and offer more of what will keep your ass in the seat.

The advent of poker playing machines brought in more players aiming for time-on-device rather than supersized jackpots. Poker machines gave out some kind of reward on 45% of plays—the perfect intermittent reward, if you asked Pavlov. And there was a razor-thin component of skill to the gambling machines. But all of the trademark features of addictive play are present in Draw Poker machines as well.

Here’s what casinos currently depend on to keep compulsive gamblers at their machines:

—Faster play. The key introduction was the virtual reel, which allowed play to take place faster than mechanical reels could spin. The use of touch screens is on the upswing, to further increase play speed. And the “BET MAX” button is always nearby.

—Longer “time-on-device”. One industry expert said: “If the chase lights on the slot signs are running too fast, they make people nervous; if they run too slow, they put them to sleep. If the machine sound is too loud, it hurts the player’s ears; if it’s not loud enough, the energy level of the room suffers.”

—Upping the ante. So that players can spend their money more easily, designers have engineered bill acceptors, digital credit counters, loyalty program cards, and other ways to reduce the actual handling of coins and cash and eliminate physical payouts at the device site. But what about the continued popularity of the nickel slot? “A nickel game isn’t a nickel game,” said one game developer, “when you’re betting ninety nickels at a time."

—Disguising the odds. The wonders of the random number generator are perfectly disguised in digital machines. Virtual reel mapping, or “weighted reels,” is credited to mathematician Inge Telnaes. It describes a system in which there is no logical correlation between the actual number of choices seen by the player and the number of stops contained on the virtual reel. Blank reel spaces help increase the confusion, while a secondary mapping program translates the virtual stops selected by the RNG microchips into the actual stops visible to players onscreen.

Something has to give, since recent research seems to show that machine gambling pushes gamblers into an addictive relationship with gambling at a rate three times faster than gamblers who stick to live table games. Back in the skunk works, where the machines are designed and manufactured by companies like IGT, the nation’s leading maker of gambling machines, weakening the hold of the machines would mean limiting near-miss effects, coming clean about virtual reel mapping, and placing restrictions on building ATM access into upcoming models. But maybe none of that will matter. As a software designer who moved from slot machines to games for kids told Professor Schull, “it wasn’t that big of a leap, in fact it was very similar. That really struck me. I saw it as appealing to the same part of the mind, a really simplistic instinct for distraction. Similar types of customers—toddlers and gamblers.”

Photo credit: http://www.all-slot-machines.com/

How I Quit Gambling

Projectile vomiting can be your friend.

I never should have found myself inside casinos in the first place. As a former alcoholic, cigarette smoker, and drug abuser, taking up gambling does not, in retrospect, sound like a solid life plan. But in my addictive heyday, gambling was definitely a part of my life. I would go the casino, stand inside the entrance, gaze out across the dark, jangling world of the slot machine floor, populated by solitary figures seated on stools, busily drinking and smoking cigarettes, and mutter: “My kinda people.”

And they were. Lurking out there were a significant number of fellow addicts, as I now understand. They weren’t there to have fun, to play games, to be entertained, or to quit while they were ahead. They were there to experience the act of risking more money than they intended to—more money than they wanted to lose. They were self-medicating with machines, as I had learned to do. The money bought you time on the machine, and the time on the machine was the medicine. The money had less to do with it than you might think. The money was only the means.

My spell as a compulsive gambler was nasty, brutish, and short. The extent of my losses is classified. It’s not a well-known fact, but addicted individuals who compulsively gamble tend to prefer the machines to the tables these days. Table gambling—blackjack, roulette, poker—requires a level of social interaction that is the opposite of what the pathological gambler is seeking: total immersion in a null state marked by regularity and the absence of human interactions. Give a cursory glance around any major casino’s slot room, and you will quickly notice that slot and machine poker players don’t talk to each other. They don’t even sit next to each other, if they can help it. Like an alcoholic on a secret binge, they DO NOT WISH TO BE DISTURBED. Even the periodic interchange with a cocktail server can feel like an unwarranted intrusion into the gambler’s zone.

I used to say, only partly in jest, that there is nothing quite like the sick thrill of wagering money you can’t afford to lose. The traditional trajectory has the gambler setting a limit on what she’s willing to lose, then going past that limit and resetting it, repeatedly, until her money is gone. Slot machine players know they are going to lose. They aren’t brain-damaged. (Well, in a way, they are, but that’s another story). They know perfectly well what the house percentage is. Sure, they hope to hit a jackpot against all odds—but they are also playing for time. One of the sacred casino industry metrics is “time on device,” and addicts put up some impressive numbers, since they are known to do things like pee their pants or ignore a medical emergency, rather than give up their machine.

In the old days, a roulette wheel was more likely to lead to the same result. In the words of the stricken protagonist in Dostoevsky’s The Gambler:

I had lost everything then, everything. I was going out of the Casino, I looked, there was still one gulden in my waistcoat pocket: ‘Then I shall have something for dinner,’ I thought. But after I had gone a hundred paces I changed my mind and went back… there really is something peculiar in the feeling when, alone in a strange land, far from home and from friends, not knowing whether you will have anything to eat that day—you stake your last gulden, your very last! I won, and twenty minutes later I went out of the Casino, having a hundred and seventy guldens in my pocket. That’s a fact! That’s what the last gulden can sometimes do! And what if I had lost heart then? What if I had not dared to risk it?...

I once won a $900 jackpot, and remember being irritated that it took the attendants so long to show up and pay out. Or maybe “pay” is not really the right word. What was that money, exactly? First, it wasn’t $900, it was really $500, since I was down $400 for the evening when I hit. The night before, I was down $250 when I quit. Not big numbers by any means, for a weekend in Vegas, but illustrative of how the numbers work. My $900 payday added up to a net of $250, drinks and room not included. This is an example of the “false jackpot,” a cousin to the “near miss.” A false jackpot occurs when the winnings are less than the wager. A near miss is a design technique where the reels frequently stop so that high-paying symbols appear just above or below the pay line—meaningless from a statistical point of view, but oh-so-close from the gambler’s perspective. 

I have serious tinnitus, the intrusive ringing-in-the-ear condition that can be brought on by a variety of causes, both environmental and neurobiological. Years ago I came down with a version of the condition, called cochlear hydrops, which often evolves into a set of additional symptoms including dizziness, nausea, complete loss of balance, vertigo, and vomiting. Remember that ears are essential for balance and navigation through space, so when things go wrong, it can be very debilitating indeed. But other than hearing loss and that constant roaring in one ear, I had none of the vestibular symptoms.

One weekend at Bally’s, after several hours planted in front of a single slot machine, the old kind, with three reels and cherries and 7s, I uncharacteristically felt like I’d had enough. In fact, I didn’t feel very good at all. And when I finally looked up from the machine, the curving lines of other machines and the swirling pattern of the casino carpet weren’t helping me feel any better. I decided to go to my room and rest for a while. On the way to the elevators, I lurched into a cocktail waitress, spilling drinks off her tray. In my room, I flung myself on the bed just in time to watch the walls beginning to spin. An interesting experience, when you haven’t had any alcohol to drink in years. This was nothing like seasickness, or a hangover. This was an express ride to hell without moving a muscle. Full-on vertigo. Faster and faster went the walls. And when I finally got up and staggered to the bathroom for a glass of water, I made it just inside the bathroom door before an episode of projectile vomiting (my first) convinced me that my gambling days were over.

I have no idea what happened, exactly, or how I have managed so far to have only one major vertigo event due to ear problems. I’m pretty sure that the spinning reels on the hit-the-button-and-go slots set me up for it. I haven’t been back to repeat the experiment. If there’s any better aversive training than vertigo and projectile vomiting, I don’t want to hear about it. Call it serendipity, a not-so-gentle push in the direction of recognizing that casinos were not a healthy place for me to be. Impulse control, risk/reward, anticipation, long-term thinking: these systems are all malfunctioning during active addiction. For recovering addicts, all those buzzes and whistles on the slot machines are like Pavlov’s bells, recalling the old mindset, and priming you for a fall that costs more than money. They now have digital slot machines with 100 pay lines. So I’ve heard. I don’t go there any more.

Photo Credit:  http://vancouvernotvegas.ca/Creative Commons

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.”
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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.”

Photo credit: http://www.marketmixup.com

That Pesky Gambling Question

The DSM-V is set to label problem gambling an addiction.

Nobody has ever bet enough on the winning horse.
— Unknown wise person

I used to gamble. Back when I did, I was also an active alcoholic and a chain smoker. Camel filters, if you’re wondering. And we had a running joke, my wife and I, although the humor leaked out of it for her pretty quickly. We would breach the doors of the gambling palace, and plunge into the dark, icy interior of a casino at Las Vegas or Tahoe, and stand on the edge of the gaming room, taking it all in for a moment. “Ah,” I would say, surveying the roomful of cigarette smokers with drinks in their hands, making bets or hitting buttons at one o’clock in the morning, “my kind of people.”

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. Howard J. Shaffer and Ryan Martin, whose article in the Annual Review of Clinical Psychology, “Disordered Gambling: Etiology, Trajectory and Clinical Considerations,” takes on all the interesting questions about gambling as an addictive disease, have chosen to favor the term “disordered gambling.” Just as there are divisions between alcoholic drinking, heavy drinking, and social drinking, there are similar states we can call pathological gambling, excessive gambling, and social gambling. On the problematic end of the scale, pathological or problem gambling has proven to be “a more complex and unstable disorder than originally and traditionally thought.” No kidding. Once the neurophysiology of the gambling state of mind came under scrutiny, the parallels with addiction cropped up so rapidly that investigators have been hard pressed to come up with suitable explanations for it all.

The new DSM-V proposes to shift pathological gambling from “impulse control disorder” to the new category of “addiction and related disorders.” So it’s a good time to rethink the question along with the psychiatric community.

In the traditional view, pathological gambling was a matter of exposure to the proper stimuli—it could happen to anyone. But as more and more gambling outlets and opportunities bloomed in Nevada, on reservations and riverboats, and in convenience stores, that view began to fall out of favor, because a funny thing happened. According to Shaffer and Martin, the prevalence of pathological gambling has remained stable over the past 35 years, even as opportunities to gamble have exploded. The lifetime prevalence rate of pathological gambling in the U.S. in the mid-1970s was 0.7%, say the authors, and by 2005, U.S. lifetime rates had actually fallen slightly, to 0.6% or less. Where was the concomitant explosion in the number of pathological gamblers?

Next, researchers got technical, wondering whether certain types of gambling, or certain types of gambling machines, were more “addictive” than others. They quickly ran into the same kind of trouble substance abuse researchers got into when they first tried ranking drugs according to strict hierarchies of addictiveness. In so doing, the staggering metabolic diversity of the human animal got lost in the shuffle, as did the fact that my metabolism and my behavior when taking drugs, or knocking one back, or losing money in a casino, is going to be different from yours.

Then came Internet gambling. In 1996, the first online casino to accept real money began operation, and by 2001, there were more than a thousand. Previously, researchers had to rely mostly on the time-honored but not always accurate system of self-reporting. If you ask people why they gamble, they tend to answer that they do it for the fun, the excitement, the challenge, and the chance to win some money. But what gamblers can’t recall very well are specific patterns of play over time that might benefit researchers. For example, in a 2009 study in which observers actually watched gamblers gambling, one long-standing observation from the self-report literature—gamblers become more liberal risk takers as they approach the end of a gambling session in a behavior called “chasing”—didn’t prove out. When researchers watched actual gamblers in action on the Internet, or playing lotteries, they found that problem gamblers in fact began betting more conservatively as they approached the end of their gambling, the authors write.

Another approach is to consider risk factors of all kinds—neurobiological, psychological, and social—and look for similarities between those for substance addiction, and those for “activity-based expressions of addiction.” The “syndrome model,” or what I usually call the umbrella model, derives from neurobiological research suggesting that “addictive disorders might not be independent: each outwardly unique addiction disorder might be a distinctive expression of the same underlying addiction syndrome…. The specific objects of addiction play a less central role in the development of addiction than previously thought….”

 All of this opens the door to some informed speculation about a broader range of disorders that may lurk beneath the umbrella of the addictive disease concept. Among these are such conditions as body dysmorphic disorder, bulimia, depression, and extreme PMS, which are all found more often in addict populations. In addition, impulsivity and low “harm avoidance” are behavioral traits often found in association with addiction. Shaffer and Martin call these “shadow syndromes,” and they are found to be associated with BOTH substance and behavioral addictions.

But what, exactly, is the high in gambling? The researchers believe that, “similar to ingesting stimulants, there is evidence that gambling is associated with autonomic arousal including elevated blood pressure, heart rate, and mood.” That's not very specific, and could also describe a craving for teddy bears. But recently, fascinating evidence of neurobiological influences on gambling arose when Parkinson’s’ patients on strong dopamine agonist treatments, with no history of gambling whatsoever, began behaving for all the world like pathological gamblers. I cannot imagine a better suggestion of neurogenetic involvement than this unexpected finding. Previous research had shown that dopamine-active drugs were capable of increasing the incidence of other addictions, too. Shaffer and Martin list compulsive eating, compulsive sexual behaviors, and compulsive shopping as activities that can also be boosted with dopamine agonists or diminished by lowering dopamine activity. 

And it does not strike me as surprising to learn that, yes, gambling problems tend to run in families, or that twins studies show that pathological gambling is higher among twins born to pathological gamblers than twins born to non-gamblers. It is the same evidence anyone can bring forth to bolster the argument for neurobiological influences on alcoholism, heroin addiction, and the like. “In sum” Shaffer and Martin conclude, “genetic influences might not determine the development of specific expression of addiction; however, genetics does influence the risk of addiction in general.”

If all of this is true, we should expect to see a corresponding connection between pathological gambling and substance abuse disorders. Some degree of overlap would be good evidence. And we have it in spades. Pathological gamblers are five and a half times more likely to have suffered from a substance abuse disorder. “75% of PGs (pathological gamblers) have had an alcohol disorder, 38% have had a drug use disorder and 60% have had nicotine dependence.” Also, “PGs are 4 times more likely than non-PGs to experience a mood disorder in their lifetime….”

So when I used to stand on the edge of the casino floor, as an alcoholic and a nicotine addict, casually calling those gamblers my kind of people, I think I was more right than I ever could have guessed.

Does all this mean that playing games on the Internet is an addictive behavior if making bets with real money is involved? The authors crunched the studies on that question, and discovered that maybe 1% of the Internet population has used the Internet for gambling purposes, and that “the case of Internet gambling provides little evidence that exposure is the primary driving force behind the prevalence and intensity of gambling…. The relationship between the extent of gambling ‘involvement’ is a better predictor of disordered gambling than any particular game that people play.”

By gambling involvement, the authors mean the number of different kinds of games a gambler plays. The more he or she plays, the more likely they are, or are likely to become, problem gamblers. However, it’s not hard to see where the online notion came from. Gambling folklore has always held that addiction is more of a risk with electronic gambling devices like slot machines and 5-Card Draw machines, than with traditional table games like roulette and craps. But the authors don’t find any convincing clinical evidence for this assertion at all. Internet gambling isn’t more addictive, and doesn’t confer any extra risk on people participating in other forms of gambling.

Here is a list of potential gambling behaviors that Shaffer and Martin believe might be risk factors to look out for in the development of problem gambling, with my additions in parentheses showing the connections to other drug addictions.

--Betting Intensity: how many bets per day. (With alcohol, how many drinks.)

--Gambling Frequency: number of gambling days (Number of drinking days.)

--Gambling Trajectory: tendency to increase the amount of wagered money. (Tolerance, in the case of drugs and alcohol.)

--Gambling Variability: deviation from consistent gambling pattern. (Inability to predict duration or outcome of drinking event.)

But if we list gambling under Addiction and Related Disorders, must we list all the possible variations on the theme—shopping and sex and all the rest, even though the picture is still fuzzy? No, the authors argue, we don’t. Not right this minute. But gambling is ready to join the roster. Shaffer and Martin would like to see their syndrome model of addiction used to identify “core features of addiction and then illustrate these with substance-related and behavioral expressions of this diagnostic class. Conceptualizing addiction this way avoids the incorrect view that the object causes the addiction and shifts the diagnostic focus toward patient needs.”

Shaffer HJ, & Martin R (2011). Disordered gambling: etiology, trajectory, and clinical considerations. Annual review of clinical psychology, 7, 483-510 PMID: 21219194

Graphics Credit: http://gamblinghelp.org/pages/resources/toolkits.php 

Gambling and Parkinson’s Disease

An addendum to the previous post.

Today, a group of Australians taking medications for Parkinson's Disease have filed a class action suit against makers of the drugs, according to a report in the Sydney Morning Herald.

 The Australian newspaper said that "The group includes people who sustained losses of hundreds of thousands of dollars and were involved in family breakdowns as a result of compulsive gambling allegedly linked to drugs they took between 1997 and last year. Most of the claimants developed gambling addictions but a few exhibited compulsive sexual behavior such as looking at pornography on the Internet.”

The drugs involved are dopamine agonists Cabaser and Permax. An agonist binds to particular receptor sites and mimics the action of the substance that normally occupies the site.

A study published in the May issue of Archives of Neurology concluded that, “Dopamine agonist treatment in PD (Parkinson's Disease) is associated with 2- to 3.5-fold increased odds of having an ICD (impulse control disorder)."

According to the study, 13% of the patients were adversely affected by the drugs, exhibiting impulse control problems with gambling (5 percent), sexual behavior (3.5 percent), shopping (5.7 percent) and binge eating (4.3 percent).

The case is not without precedent, according to the Herald. In 2008, “a jury in Minnesota awarded $8.2 million to a man who became a compulsive gambler after using Mirapex (made by Boehringer Ingelheim) to treat his Parkinson's disease. Other lawsuits are being considered in Canada, Britain and France.”


Photo Credit: http://gamingzion.com/

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.

Photo Credit: http://www.health.com/

Gambling Through the Ages

A brief history of playing cards.

In a recent email exchange with NIDA director Nora Volkow, I asked about gambling as a clinical addiction. “It is almost by necessity that we’ll find significant overlaps in the circuits that mediate various forms of compulsive behaviors,” she responded. “We have yet to work out the details and the all important differences, but it stands to reason that there will be many manifestations of what we can call diseases of addiction.”

This got me thinking about the history of addictive drugs, which I researched for my book, The Chemical Carousel.  The litany features long and ultimately unsuccessful histories of campaigns against heroin, against tobacco, against alcohol.

But does fairness demand that we add gambling to the historical list, given the suspicion with which playing cards have been held throughout the ages?

The origin of playing cards is suitable murky, but  they are generally thought to have been invented in China or India in the 10th Century AD, and subsequently refined and redesigned in the Muslim world. By the 1300s, hand-painted playing cards had made it to Europe, mostly affordable only by the nobility. When the advent of woodblock printing brought playing cards to the masses, gambling with cards took on an altogether different reputation. Gambling with cards was banned in Florence, Italy in 1376, followed by Lille, France, then Valencia, Spain, and Ulm, Germany.

The bans proliferated in the 15th Century: In 1404, a bishop in France had to crack down on card gambling among the priesthood. In 1423, St. Bernard of Sienna railed against paying cards so successfully, according to The Standard Hoyle,  that “cards, dice and games of hazard” were gathered up by the townspeople and committed to the bonfire. In 1476, King Ferdinand and Queen Isabella banned gambling with playing cards. None of these prohibitions were even remotely successful, and by the 1600’s the standard “French pack” of 52 cards and four colored suits emerged. They have been the standard in the world’s casinos ever since.

By the 17th Century, card playing was well established in America, despite attempts by the Pilgrims to prevent it. And ministers quickly found that the Indians were deep into dozens of gambling games of their own. Little known fact: The American Stamp Act of 1765,  the very act that got the early patriots so riled up, included taxes on newspapers, legal documents—and playing cards.

Compulsive Gambling [Guest Post]

14 hours at the roulette wheel.

[Editors Note: Addiction Inbox has not covered the so-called behavioral or non-traditional addictions--Internet addiction, video game addiction, compulsive shopping and compulsive gambling--because I am not yet convinced that such behaviors show the same chemical and often inheritable propensities associated with alcoholism and other drug addictions. From time to time, however, I offer up an alternative view. The following excerpt has been taken from www.utahstories.com with the kind permission of the author.]


Guest Post by Leo Dirr

If you eat one meal a day and it's a buffet, you might be a compulsive gambler.

That odd, little nugget of wisdom dawned on me while I was wallowing in misery in front of an overloaded plate of tamales and tacos and taters and gravy. Gambler, me? A compulsive gambler? Hmmm.

I guess it takes one to know one. Yep. I had to lose thousands of dollars and countless hours of sleep before I could finally come to grips with my addiction. And at the buffet table, no less. At least the hot chocolate refills were free.

Oh, I had me some grand times. Vegas, Reno, Elko, Mesquite, Wendover. Nevada casino towns that called my name. I played roulette for up to 14 straight hours at a stretch. I never even left the table to take a leak.

I was too zoned in on the game. One time a busty babe sitting next to me at the blackjack table was literally rubbing her hands all over my body, and all I could think about was my next bet. Nothing personal. But while I was gambling, sex never crossed my mind.

As long as I had chips, nothing else mattered. I was completely in tune with my inner gambler. That sense of escapism must have been the draw, the thing that sucked me in again and again. It couldn't have been possible that I actually wanted to throw away all of my money.

Or did I? During my travels, I met a once-wealthy oil man who literally lost millions to the casinos. By the time I stumbled upon him, he was relying on the generosity of a well-heeled friend just to stay off the streets. His sad story did not save me.

I was hooked. I adored the casinos. The glitz of the lights, the sounds of the slots, the hope in the air. It all made me feel so alive.

Gambling thoughts monopolized my ADD-addled brain. Daily rituals that most people relish, or at least tolerate, were unbearably boring to me. The only excitement I could find was of the Ace-King kind. I used to calculate roulette payouts while I was brushing my teeth. It was bad.

Oh, I didn't always lose. Sometimes I won - and won big. But the casinos call their table areas "pits" for a reason. The more I won, the deeper my happy, little gambling hobby sank into a dark and dangerous compulsion.

I literally couldn't stay away. I always gave back everything I'd won, and then some. At one point, I was actually using my Nevada casino winnings to buy Idaho lottery tickets.

That sounds crazy, I know. But is it any crazier than eating all your meals at a buffet? Not really. The crazy part is that I don't really feel bad about any of it. I saw my share of weird things and weirder people along the way. And yes, I lost a ton of money.

But hey, what do you expect? I'm a compulsive gambler.

Some Sobering Statistics

* 15 million people display some sign of gambling addiction
* "Players" with household incomes under $10,000 bet nearly three times as much on lotteries as those with incomes over $50,000
* The average debt incurred by a male pathological gambler in the U.S. is between $55,000 and $90,000 (it is $15,000 for female gamblers)
* The suicide rate for pathological gamblers is twenty times higher than for non-gamblers (one in five attempts suicide)
* Sixty-five percent of pathological gamblers commit crimes to support their gambling habit

(Source: http://www.overcominggambling.com)

If you want to seek help, visit the National Council on Problem Gambling's Web site.

Photo Credit: Carroll College