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

How Brain Science Began

Civilization’s debt to opium.

The history of brain science probably began about 4,000 B.C., somewhere in Sumeria, when human beings first discovered the extraordinary effects of the unripened seed pods of the poppy plant. Modern neuroscience owes a great debt of gratitude to this tame-looking plant drug and its sticky, incredibly potent byproduct called opium. Neuropharmacology—the study of the action of drugs on the nervous system—would never have advanced so quickly without it.

Historically, the emphasis has been on opium’s cash value, not its value to science. A trade staple on the Silk Route for centuries, opium was very nearly the perfect business. The present-day drug companies, known collectively as Big Pharma, are not the first capitalists in the world to exert an unprecedented grip on drug retailing.

From roughly 1720 to the late 1800s, the merchants of the British East India Company ran a brisk and lucrative opium business with the Oriental “heathens.” In 1839, the British went to war with China to maintain unlimited trading rights. The British won the war, retained the right to market opium in the Orient, and picked up the island of Hong Kong in the bargain.

Opium’s effects are concentrated at specific receptor sites, while alcohol’s range of action is more diffuse. Nonetheless, the two drugs have similar effects along the limbic reward pathway. Morphine comes right from the source, isolated from the crude opium resin found on Papaver somniferum—the opium poppy. Morphine is known as a “pure mu agonist,” meaning it locks securely into the “mu” subset of endorphin receptors, and activates them. This alters the transmission of pain messages, and induces a contented, euphoric state of relaxation. Codeine, another natural painkiller, is found in opium in very small concentrations. Most medical codeine is synthesized from morphine.

The body’s own opiates are referred to as endogenous opioids. Endorphins and enkephalins are interchangeable terms for these chains of amino acids. An important mechanism of action in this process is morphine’s inhibitive effect on GABA. By inhibiting the inhibitor, so to speak, neurotransmitter levels increase down the line, particularly in the nucleus accumbens. Hence, feelings of pleasure.

Alcohol stimulates the mu receptor as well, so we are back to the same basic chain of limbic activation triggered by drinking. GABA is the bridge that connects the alcohol high and the heroin high.

Rapid cellular tolerance is the hallmark of opiate addiction. Brain cells quickly become less responsive to the same doses of the drug. “The body’s natural enkephalins are not addicting because they are destroyed rapidly by peptide-degrading enzymes as soon as they act at opiate receptors,” writes Solomon Snyder. “Therefore, they are never in contact with receptors long enough to promote tolerance…. As analgesics, the enkephalin derivatives developed by drug companies have not been superior to morphine, or even as good as morphine.” Even the brain’s own morphine is not as good as morphine. Nothing is as good as morphine.

Recent evidence for the heritability of opiate addiction looks strong. “Harvard did some really superb studies using a huge cohort of military recruits in the U.S. Army,” according to Mary Jeanne Kreek, a specialist in opiate addiction at Rockefeller University in New York. “Heroin addiction has even a larger heritable component than any of the other addictions, so that up to 54% of heroin addictions seem to be on a genetic basis or a heritable basis.” Estimates of alcohol’s heritability generally run to 40 or 50 per cent.

--Excerpted from The Chemical Carousel: What Science Tells Us About Beating Addiction. (Spring 2009).

Arguing About Ecstasy

U.K. professor says “E” no riskier than horseback riding.

Professor David Nutt of Bristol University and Imperial College, London, stirred up a hornet’s nest of controversy last week when he compared the dangers of the club drug Ecstasy (MDMA) to people’s addiction to horse riding. In an article titled "Equasy: An overlooked addiction with implications for the current debate on drug harms,” published in the Journal of Psychopharmacology, Professor Nutt wrote: "Drug harm can be equal to harms in other parts of life. There is not much difference between horse-riding and ecstasy."

What makes all of this interesting is that Professor Nutt serves as the chairperson of the Home Office's Advisory Council on the Misuse of Drugs (ACMD), which will rule next week on whether ecstasy should be downgraded to a Class B drug in the British drug classification system. Drug treatment activists and government ministers immediately called for his resignation, saying Nutt was on a "personal crusade" to decriminalize the drug.

The BBC News Service reported that a Home Office spokesperson said recently that the government believed ecstasy should remain a Class A drug. "Ecstasy can and does kill unpredictably. There is no such thing as a 'safe dose'," he said.

Horse-riding accounts for 100 deaths or serious accidents a year in the U.K., according to Nutt. “Making riding illegal would completely prevent all these harms and would be, in practice, very easy to do.” In contrast, recent figures indicate about 30 deaths attributed to ecstasy use in the U.K. last year. “This attitude raises the critical question of why society tolerates - indeed encourages - certain forms of potentially harmful behaviour but not others such as drug use," Nutt wrote.

In an article by Christopher Hope in the Daily Telegraph, Nutt said: "The point was to get people to understand that drug harm can be equal to harms in other parts of life.” He cited other risky activities such as “base jumping, climbing, bungee jumping, hang-gliding, motorcycling," which, he said, were more dangerous than illicit drugs.

An ACMD spokesperson said: "Prof Nutt's academic research does not prejudice the work that he conducts as chair of the ACMD."

According to the Telegraph article, there are 500,000 regular users and between 30 million and 60 million ecstasy pills in circulation in the U.K.

In a letter published by the Journal of Psychopharmacology two years earlier, Professor Nutt used a more apt comparison to make the same point:

“The fact that alcohol is legal and ecstasy not is merely an historical accident, not a science-based decision. Alcohol undoubtedly kills thousands more people each year than ecstasy.... Many relatively ill-informed and indeed innocent young people will continue to die and many more will end up with the destructive consequences of alcohol dependence or physical damage. If the same effort currently used to deter ecstasy use was put toward reducing alcohol misuse the situation might improve.”


Photo Credit: Foundation Antidote

The Patch and How to Use It

Take the Fagerstrom test.

The U.K. Guardian, in partnership with the British Medical Journal, recently offered its readers a short version of the Fagerstrom test, a questionnaire used for assessing the intensity of physical addiction to nicotine. The Guardian article then made recommendations about which patch strength smokers should be using, based on their scores.

Here is a longer version of the Fagerstrom test, with scoring assessment, followed by the Guardian’s recommendations about patches:

Fagerstrom Test for Nicotine Dependence *

1. How soon after you wake up do you smoke your first cigarette?
-- After 60 minutes
(0)
-- 31-60 minutes
(1)
-- 6-30 minutes
(2)
-- Within 5 minutes
(3)

2. Do you find it difficult to refrain from smoking in places where it is forbidden?
-- No
(0)
-- Yes
(1)

3. Which cigarette would you hate most to give up?
-- The first in the morning
(1)
-- Any other
(0)

4. How many cigarettes per day do you smoke?
-- 10 or less
(0)
-- 11-20
(1)
-- 21-30
(2)
-- 31 or more
(3)

5. Do you smoke more frequently during the first hours after awakening than during the rest of the day?
-- No
(0)
-- Yes
(1)

6. Do you smoke even if you are so ill that you are in bed most of the day?
-- No
(0)
-- Yes
(1)

* Heatherton TF, Kozlowski LT, Frecker RC, Fagerstrom KO. The Fagerstrom Test for
Nicotine Dependence: A revision of the Fagerstrom Tolerance Questionnaire. British Journal of Addictions. 1991; 86:1119-27

0-2 Very low dependence

3-4 Low dependence

5 Medium dependence

6-7 High dependence

8-10 Very high dependence

[Scores under 5: “Your level of nicotine dependence is still low. You should act now before your level of dependence increases. “]

[Score of 5: “Your level of nicotine dependence is moderate. If you don’t quit soon, your level of dependence on nicotine will increase until you may be seriously addicted.”]

[Score over 7: “Your level of dependence is high. You aren’t in control of your smoking–-it is in control of you!”]

The U.K. Guardian’s scoring assessment

Which patch to use:

--2 points = light nicotine dependence. Start with the 7 mg nicotine patch.

--3 or 4 points = moderate nicotine dependence. Start with the 14 mg nicotine patch.

--5 or 6 points = heavy nicotine dependence. Start with the 21 mg nicotine patch.

Graphic Credit: Electronic Illustrators Group

smoking addiction nicotine

Drug Trade Props Up World Economy

U.N. says drug money kept banks in business.

When we think of the international drug trade, we usually think of financial support being funneled to Columbian insurgents or Taliban fighters. Propping up the world banking system is not what usually comes to mind. However, the illicit drug trade may in fact be one of the world’s few growth industries at the moment, with little unemployment, maximum profits, and a plethora of cash-hungry banks ready to lend a hand.

The head of the United Nation’s Office on Drugs and Crime said that profits from the illicit drug trade were being used “to keep banks afloat in the global financial crisis,” Reuters reported last week. In an interview with Profil, an Austrian news magazine, UNODC Executive Director Antonio Maria Costa warned that “in many instances, drug money is currently the only liquid investment capital.” Costa’s Office on Drugs and Crime uncovered evidence that “interbank loans were funded by money that originated from drug trade and other illegal activities,” Costa said. “There were signs that some banks were rescued that way.”

Specifically, Costas said interbank credits have been financed by drug money. “It is naturally hard to prove this, but there are indications that a number of banks were rescued by this means.” While most banks have money laundering rules in place, “now criminals stash their funds in cash sums which can be up to hundreds of millions of dollars.”

Viewed from a macroeconomic perspective, drug money represents scarce investment capital for banks. “In many instances,” Costa said, “drug money is currently the only liquid investment capital to buy real estate, for example.”

Costa would not name any countries or banks which may have been involved. He did note that the current global financial crisis was a “golden opportunity” for crime groups needing to launder money, and that the laundering of illegal funds was “certainly happening across the board,” Veronika Oleksyn of AP reported. Costa said the information came from contacts with prosecutors and banking representatives in various countries.

Costa also told the BBC that South American drug trafficking threatens to economically destabilize Mexico, Central America, the Caribbean and West Africa. He estimated that the worldwide illegal drug economy was now worth about $323 billion per year. “If you look at agriculture markets, it is the most important,” according to the Drug War Chronicle account of the Profil article. “According to our calculations, the wholesale value of illegal drugs is more than $90 billion, in the range of world meat and grain trade. The street trade we access at a volume of over $320 million.”


Photo Credit: typicallyspanish.com

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

"Mood Foods"

Why addicts crave sugar and starch.

James Langton of Clearhead.org.uk recently sent me a fascinating article about food and addiction. The technical bulletin from Sure Screen Diagnostics, Ltd., the U.K.'s leading provider of medical and drug testing services, focuses on the age-old and endlessly fascinating connection between addiction and sugar foods (See my post, “Drug Foods and Addiction”).

Entitled "Mood food and Addiction," the technical bulletin asserts that "drug users, alcoholics and those with addictive tendencies routinely resort to certain psychoactive foods between fixes to regulate their mood." Moreover, "certain foods might reduce withdrawal symptoms... the pantry is a veritable 'psychodelicatessen.'"

While some of the conclusions are highly speculative, most of the article is on more solid ground in its discussion of the "psychopharmacology of everyday foods."

Sweet foods and fruits can mitigate or eliminate cravings, the author says, and examples of this are abundant in the addict and treatment communities. Abstinent cigarette smokers sometimes find that "a piece of fruit or something sweet" can banish cravings by temporarily and partially restoring dopamine and serotonin levels.

In an unconscious effort to raise brain levels of serotonin and dopamine, drug users often discover that doughnuts, cakes, ice cream, soft drinks, and other sugar foods can lessen withdrawal symptoms. As evidence, we are far more likely "to see a user with a bar of chocolate in his hand than a sausage roll."

Complex carbohydrates, the bulletin asserts, do not have the same effect. Whole grain breads and starchy vegetables, unlike table sugar and white bread, do not have the same reinforcing impact on neurotransmitters along the reward pathway. "For that reason, they do not tend to be craved as much as sweets, even though they still satisfy [serotonin] 5-HT needs." Because simple sugars eaten in large quantities can cause blood sugar levels to drop below baseline, the result can be the abrupt return of drug withdrawal symptoms.

How does this work out in practice? The bulletin speculates, for instance, that “a amphetamine user who has exhausted his dopamine and noradrenaline levels, and feels depressed and unable to think straight, may be drawn to high-protein, tyramine-rich foods, such as a steak, pizza or a cheese sandwich and a glass of milk. An MDMA or "ecstasy" user experiencing fatigue... would probably crave something like fish and chips rich in carbohydrates, and a sugar-rich drink to temporarily bring the depleted 5-HT levels back up to normal." As for opiate users, foods such as whole milk, ice cream, and milk chocolate are appealing because they contain "biologically active opioid peptides.... It no doubt explains why a pint of full fat milk and a Snicker's bar is a perennial snacking favourite of opiate users."

As for chocolate (you didn’t think I’d forget chocolate, did you?), “the most widely preferred chocolate among the general population is not unsweetened dark chocolate with its higher drug cocktail, but sweetened milk chocolate suggesting that the majority of us may in fact be craving its addictive psychoactive sugars, fats and narcotic casomorphins more than anything else.”

In the end, the specific food preferences of addicts force us “to reconsider how fragile the food-drug distinction actually is.”

Graphic Credit: Anselm

dopamine