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

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.

Q & A with Nora Volkow

NIDA director discusses cannabis, addiction vaccines, and gambling.

Recently, Addiction Inbox was offered the opportunity to submit questions to Nora Volkow, the director of the National Institute on Drug Abuse (NIDA). Dr. Volkow was kind enough to provide detailed answers by email. In her responses, she reveals a broad clinical understanding of addiction, and speculates on what this brain disorder might mean for “other diseases of addiction” like gambling.

Q: Clinical studies, like those by Barbara Mason at Scripps Institute, have documented a marijuana withdrawal syndrome among a minority of users. Are we prepared to say that marijuana is addictive? Why didn't we identify this syndrome years ago?

Nora Volkow: Absolutely, there is no doubt that some users can become addicted to marijuana. In fact, well over half of the close to 7 million Americans classified with dependence or abuse of an illicit drug are dependent on or abuse marijuana. It is important to clarify that while withdrawal is one of the criteria used to diagnose an addiction (which also includes compulsive use in spite of known adverse consequences), it is possible for an individual to suffer withdrawal symptoms without he or she being addicted to an abused substance.

Now, to answer your specific question, the reason for the relatively late realization that people who abuse marijuana can develop a cannabis withdrawal syndrome (CWS) if they try to quit is probably the result of at least two factors. First is the fact (which you hint at already) that a clinically relevant cannabis withdrawal syndrome may only be expected in a subgroup of cannabis-dependent patients. This may be partially explained by marijuana’s uptake into and slow release from fat cells, which can occur over days or weeks after last use. Thus, cessation of marijuana use may not be so abrupt, and could thereby diminish signs of withdrawal. The second factor relates to the small to negligible associations between recalled and prospectively assessed withdrawal symptoms, which may have precluded many previous, recall-based studies from detecting or properly characterizing CWS. It is also worth pointing out that other addictions (e.g., cocaine) were also not initially thought of as capable of triggering withdrawal symptoms.”

Q: Are there any anti-craving medications you are particularly excited about at this time?

Volkow: In the context of nicotine addiction, we have a host of nicotine replacement options as well as 2 medications that work through different mechanisms—all of which reduce craving and the risk of relapse during a cessation attempt, particularly when combined with some form of behavioral therapy. However, sustained abstinence from nicotine has been difficult to achieve, even with the current therapeutics that are available. So, at this point, I am very excited about a novel approach to the treatment of addiction—an approach that relies on vaccine development. Currently there are anti-nicotine vaccines in clinical testing, which are designed to capture the nicotine molecules while still in the bloodstream, thus blocking their entry in to the brain and inhibiting their behavioral effects. And while these vaccines were not intended specifically to reduce cravings, they appear to be effective in helping subjects who develop a high antibody response sustain abstinence over long periods of time. Even those people with a less robust antibody response to the vaccine, decreased their tobacco use. So this approach appears very promising.

Similarly, in the context of opiate addiction, we are very excited about the cumulative positive results of the clinical experience so far with buprenorphine, a long-acting partial agonist that acts on the same receptors as heroin and morphine, relieving drug cravings without producing the same intense "high" or dangerous side effects.

Q: You have suggested in the past that certain forms of overeating are addictions. There is good evidence for this. What about non-substance addictions, like gambling?

Volkow: The brain is composed of a finite number of circuits, for, for example, rewarding desirable experiences, remembering and learning about salient features and stimuli in the environment, developing emotional connections to other members of the social group, becoming aware of changes in interoceptive (internal) physiological states, etc. These and a few others are the circuits that the “world” acts upon. So it is almost by necessity that we’ll find significant overlaps in the circuits that mediate various forms of compulsive behaviors. 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. Thus, addiction to sex, gambling, alcohol, illicit drugs, shopping, video games, etc. all result from some degree of dysfunction in the ability of the brain to properly process what is salient, accurately predict and value reward, and inhibit emotional reactivity or deleterious behavior.

As we learn more about the significant overlaps at the genetic, neural, circuit, and systems levels we may be able to reap the benefits from complementary research into these various chemical and behavioral addictions.

Photo Credit: http://www.thechallenge.org

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

America Anonymous—Book Review

Sex, drugs, and shoplifting.

New York Times magazine contributor Benoit Denizet-Lewis interweaves eight personal stories of addiction and obsession and ties them in with a well-researched summary of the drug treatment business in his new book, America Anonymous. Offering deft portraits of people suffering from various forms of addiction and compulsion, Denizet-Lewis brings to life much of the denial, prevarication, giddy hopes of victory, incomprehensible relapses, and endless stream of lies and broken promises with which so many active addicts string together their fractured narratives.

By design, Denizet-Lewis swings wide when it comes to defining addiction. In addition to alcoholics and drug addicts, the author, a self-confessed sex addict, includes in his case histories a woman who is a serial shoplifter, a body builder addicted to steroids, a fifty year-old compulsive eater, and a college student addicted to pornography.

“I believe in an expanded understanding of addiction, “ Denizet-Lewis writes. “That is, I believe that gambling, sex, food, spending, and work (to name a few) can, for some people be as addictive and debilitating as an addiction to drugs.”

While I am not as convinced as the author that the scientific evidence is beginning to weigh heavily on the side of accepting behavioral compulsions as classic addictions, I can only agree when he points out that, for all the heady buzz about addiction medicine and pills for alcoholism, 12 Step programs—which originated more than 50 years ago--still arguably represent the most effective approach to treating addiction that we know of. In addition, Denizet-Lewis writes, doctors and clinicians have been promising medical treatments for addiction for 200 years now, and only in the last ten years or so has there been any real progress.

Point taken. The author basically accepts that addictions are chronic diseases with genetic components, “and an onset and course that vary depending on behavior and environmental factors.” Scientific information is presented accurately and in an understandable fashion. Denizet-Lewis knows his subject, even if he uses that data to reach different conclusions than I do. I liked this book, even though I am at odds with many of its arguments.

So, what do Denizet-Lewis’s people teach us about addiction? The crucial need for honesty, to begin with. “If we’re not rigorously honest,” one addict says, “we can’t recover. It’s impossible.” This rule applies to the healers as well. The author quotes one researcher succinctly: “I would distrust anyone who says they can cure addiction.” This sentence alone, if absorbed by addicts seeking treatment, could save them considerable time, money and self-esteem. The author also quotes addiction researcher Anna Rose Childress to good effect: “Relapse is not a failure of treatment. Relapse is part of the disorder.”

What runs through all the personal sagas is the desire of the subjects to feel normal—to “feel feelings” in a normal way. The author offers compelling narratives that catch the flavor of the addicted way of life, a combination of monotony, mood swings, and fear. Denizet-Lewis is particularly adept at making us care about what happens to these people, and we read the book with a hopefulness laced with dread. We know it cannot end happily for everyone. And it does not.

In the end, the author concludes that most forms of addiction can be accounted for by the childhood trauma model. Since a good deal of sex therapy centers on this conception, perhaps the author’s conclusions in this regard are not surprising. However, trauma theories about the origin of addiction have not translated into reliable and effective treatments for addiction, either. And such theories have had a long run, starting even before Freud.

alcoholics anonymousaddiction drugs