Pathological Gambling- Is it an addiction? Part II

Michael Campos, Ph.D.

This is part II in Michael’s series on pathological gambling (click the preceding for part I):

The risk factors for pathological gambling

Pathological gambing (or gambling addiction)There are a number of factors that are important in pathological gambling including types and number of games played, alcohol use, and socio-demographic factors. Some research suggests that casino gambling, pull tabs, card playing outside a casino, bingo, and sports betting are associated with increased risk for gambling problems. In addition, the number of different types of games played is associated with gambling problems such that the more different types of games a person plays, the greater the risk for gambling problems. Alcohol abuse/dependence is associated with increased risk for gambling problems as well. Finally, socio-demographic factors (e.g., low socio-economic status, minority ethnicity) are associated with gambling problems even after controlling for gambling behavior. Continue reading “Pathological Gambling- Is it an addiction? Part II”

Pathological Gambling – Is it an addiction?

Michael Campos, Ph.D.

In the past few decades gambling has become an increasingly available and socially acceptable activity; however, some individuals who gamble do so in a way that results in severe and wide-ranging negative consequences. Although the majority of individuals who gamble do so without experiencing problems, many people have themselves suffered, or know friends and family members who have suffered dire personal, financial, and social consequences as a result of their gambling behavior. Continue reading “Pathological Gambling – Is it an addiction?”

Gambling on marijuana use makes for bad decisions

I just can’t seem to stay away from the marijuana debate, even given the recent defeat of Proposition 19 that aimed to legalize marijuana in California. This article is a short one, but speaks to some of the cognitive issues associated with marijuana use.

A study (see here) conducted by a Wake Forest University team (Including Doctor Linda Porrino) found that habitual marijuana smokers (those who smoked an average of twice a day for seven years) may be bad at detecting negative outcomes.

The experiment used fMRI scanning technology to examine the brain activity of smokers and controls during the Iowa Gambling Task, which uses four decks of cards. Two of the decks yield large, infrequent, rewards as well as losses. The other two decks yield small, more frequent rewards, and less losses. The first two are considered the “bad” decks, and the latter two the “good” decks, because selecting from the small-gain, small-loss, decks will result in more gain overall. The task is considered a pretty good, if complex, measure of risk-taking, decision making, and loss-discounting.

Marijuana users lose money while controls gainThe take-home result from the study: Not only did marijuana smokers take longer to learn how to maximize their rewards, but their decision-making brain regions seemed to show lower overall responding during the task, meaning they were less active while performing the decisions. And as you can see from the graph on the left, while the controls were able to achieve overall gains, the same was not true for the long-term marijuana users even after 100 repetitions. It seems that marijuana smokers’ brains were not as efficient at detecting losses and responding to them. Maybe that’s why marijuana users are the first to claim that marijuana use has no negative outcomes associated with it…

As usual, it is important to note that since the participants in the study were not randomly assigned to long-term marijuana smoking, it’s impossible to know if these deficits are specifically caused by marijuana use or if they were pre-existing. Nevertheless, these results strongly suggest that individuals who engage in long-term use of marijuana are cognitively distinct from those who don’t. I think that plays into the argument that marijuana legalization would not increase use, because if that’s actually true, then there’s something different about individuals who choose to smoke weed and it is not the legal status that matters. I suspect that in actuality, people who currently choose to smoke marijuana long-term are in fact distinct, in some ways, from some of the people who would take up smoking the stuff if it became legal.

Citation:

Christopher T. Whitlowa, Anthony Liguoria, L. Brooke Livengooda, Stephanie L. Harta, Becky J. Mussat-Whitlowb, Corey M. Lamborna, Paul J. Laurientic and Linda J. Porrino (2004). Long-term heavy marijuana users make costly decisions on a gambling task. Drug and Alcohol Dependence, 76, 107-111.

Why the addiction-brain connection has to be part of the addiction treatment picture

Dr. Dodes recent article, apparently trying to blow up the myth of addiction as a neurophysiological disorder, sounded persuasive, although its underpinning was oversimplified and it’s understanding of the brain-science involved in addiction, and other associated mental health disorders, was lacking. Hopefully, by presenting a more complete picture of the evidence for a brain-aspect to addiction, I can un-bias the discussion somewhat. I, for one, don’t believe that neuroscience will ever be the only factor important in addiction – an individual’s environment, social influences, and other factors will always end up playing important parts as well – still, I think that to dismiss all of the evidence for biological factors at play in the development of addiction is foolhardy. Especially when there’s so much of it that was glossed over in Dr. Dodes’ introduction.

Pleasure center activation is only part of the picture in addiction

Firstly, supporters of the notion that addiction is, at least partly, an outcome of specific brain function point not only to pleasure center activation, but also to a whole host of findings showing genetic variability that is either protective from, or a risk factor for, dependence on drugs and likely also behavioral addiction like eating disorders, compulsive gambling, and maybe sex addiction as well (you can start out looking up ALDH2-2 variability and alcoholism and cocaine addiction, DRD4 and stimulant addiction, and many more).

While it is true that all those who consume addictive substance activate the brain similarly, there are considerable differences in the specific of that activation in reaction to drugs. Some release more dopamine while others have more “active” versions of specific important receptors; neurotransmitter recycling is quick in some, but not all, and drug metabolism is different in different individuals in ways that have been shown to be important not just for addiction risk, but also for the probability of treatment success. Just look at the nicotine and CPY26 literature for an example. It’s right there.

Additionally an entire body of literature exists that shows differential activation, as well as structural differences, between addicts and non-addicts in regions as varied as the OFC, PFC, Insula, and more. This is not to mention a slew of evidence that shows different behavioral test performance on risk-taking, impulsivity, and delay-discounting, all personality variables highly associated with addiction. If one simply ignore all of this evidence, it may be easy to believe that there is no biological explanation for these phenomena, but that’s just wrong.

To say that mesolimbic activation (what the good doctor called “pleasure centers”) is the only evidence for physiological factors in addiction is dismissive at best.

Drug addiction develops in only some drug users

The notion that not everyone who takes drugs becomes addicted is nothing close to evidence against a brain explanation for addiction. Everyone’s motor–cortex, striatum, and substantia nigra (the areas of the brain responsible for movement) activate in the same way during movement, but only a small group ends up suffering from Parkinson’s or Huntington’s disorders. One fact does not preclude the other but instead may specifically point to the fact the group which develops the disorder has somewhat different neurological functioning. Researchers aren’t concerned with explaining why all individuals can become addicted to drugs, but rather why that small subgroup develops compulsive behavior. A short reading of the literature makes that fact pretty clear. Additionally, while Dr. Dodes’ claims otherwise, imaging technology HAS produced evidence explaining this “mystery”, including differences in the ways addicted smokers respond to smoking-related triggers, and an increased dopamine response in cocaine addicts to cues, and well as to cocaine.

As mentioned in the motor disorder section above, ingestion of chemicals is not at all necessary for brain disorders to occur or indeed develop later in life. Dr. Dodes example of shifting addiction could be used as evidence for an underlying neurological difference just as well as it would serve to make his point… Or even better. If there’s a faulty basic mechanism attached to rewarding behaviors, it doesn’t really matter what the behavior is, does it? Sex addiction, gambling, and more can all be explained using a similar mechanism, though drugs of abuse may just have a more direct impact. I know, I’ve written about them all.

The Vietnam vet heroin story used by Dr. Dodes as evidence that emotional, rather than physiological, factors are responsible for addiction actually fits right in line with the notion of predisposition and underlying differences, and I’m surprised to hear a physician point to group differences as an indicator of no neurobiological basis. Indeed, when it comes to the emotional reactivity associated with drug associated cues, normal learning literature, as well as drug-specific learning research, has revealed over and over that drug-related stimuli activate brain regions associated with drug reward in the same way that natural-reward predictors do for things like food and sex. Once again, these facts are part of the basic understanding of the neuroscience of learning, with or without drug abuse involvement.

My own dissertation work shows that it is very likely that only a subsection of those exposed to nicotine will develop abnormal learning patterns associated with that drug. However, among those, learning about drug-related stimuli (as in “triggers”) continues in an exaggerated manner long after the other “normal” animals have stopped learning. That sort of difference can lead to a seriously problematic behavioral-selection problem whereby drug-related stimuli are attended to, and pursued, more so than other,  non-drug-related ones. If that sounds familiar, it should, since drug users continuously pursue drug-associated activities and exposures in a way that seems irrational to the rest of the world. It just might be due to such a mechanism and others like it.

Some important points about science in Dr. Dodes’ article

One very true fact about mental health pointed out by Dr. Dodes is that diseases like schizophrenia, which used to be explained simply as demon possession and evidence of witchcraft can now be, to a large extent, explained by the study of behavioral neuroscience and cognition. The same is true for bipolar disorder, depression, ADHD, and a host of other such conditions. In fact, the study of psychology has only been able to rely on technological advances that allow us to “see” brain function for a few short decades, leading to incredible advances in the field that I think will continue. The thinking that no such advances have, or will continue to be, made in the study of addiction is, in my opinion short sighted.

As I mentioned above, I don’t for a second think that the entire explanation for drug abuse and addiction will come from neurophysiological evidence. The doctor points out that “If we could take a more accurate image of addiction in the brain, it would encompass much of the history and many of the events that make us who we are.” I agree that we need to advance our technology as well as expand our understanding, but I think that to discount neuroscientific explanations completely is a big mistake.

Oxycontin and Gambling Addiction on A&E’s Intervention

On last week’s episode of A&E’s Intervention, we were able to see how a prescription drug abuse problem can devastate the lives of addicts and their families. As we’ve already mentioned on A3, prescription drug abuse is the fastest growing drug problem in the U.S. at the moment having gone up more than 400% in only a few years.

Prescription Drug Abuse on A&E’s Intervention

Andrew, a 21-year-old, had been terribly addicted to OxyContin for the past 4 years. Because of his addiction, his father and two brothers were on the brink of homelessness as they watched Andrew snort his father’s last 40 dollars. This now made them unable to pay for the motel they had been staying in and all knew it was only a matter of time before they would be asked to leave.

Andrew’s journey with addiction began at 13 when he started experimenting with alcohol and marijuana. By 14, Andrew was using cocaine, crack, and ecstacy. He had also dropped out of school. By 17 he had a baby on the way and had begun his love affair with OxyContin. Though OxyContin is a prescription painkiller, it is attributed to a growing number of debilitating addictions and deaths every year. As the U.S. Drug Enforcement Administration warns, “OxyContin abuse can lead to weakened skeletal muscle, heart and respiratory failure and death”.

Oxycontin – the other heroin addiction

OxyContin is the brand name of the drug Oxycodone and is also known as “hillbilly heroin”. Many who abuse OxyContin crush the pills and then either snort or inject them, giving them a very similar high to that of heroin. Research has shown that when adolescent mice are exposed to OxyContin, lifelong and permanent changes to the brain’s reward system result. OxyContin is highly addictive and withdrawal symptoms are severe. OxyContin related deaths are usually linked to ingestion of the drug in combination with some other depressant of the central nervous system such as alcohol or barbiturates. Prescription drug abuse is a growing problem in the U.S. and according to recent government data, conducted between 1998 and 2008, there has been a 400 percent increase in substance abuse treatment admissions for people abusing prescription drugs.

Like the many others who abuse OxyContin, the drug had taken a fatal grip on Andrew’s life. He now found himself selling drugs to support his habit, stealing from his family and in debt to many drug dealers. In the past 2 years, he had stolen more than $4,000 from his grandmother and in the past year had been in over a dozen drug-related fights. As the dealers were hunting for him, Andrew began to fear for his life.

Gambling addiction can ruin lives

His family’s situation was even worse. His father had lost his car and home and could no longer feed Andrew’s two younger brothers. They often did not eat for days. Andrew’s violent behavior when he did not have the OxyContin made matters worse. Within 2 years, they had been evicted from 7 apartments because of the destruction Andrew caused to them when in a rage. As the situation worsened, Andrew’s father, Dan, was fired from his job of 19 years because he was caught stealing. But just as we begin to blame Andrew for the devastating situation he has placed his family in, the producers of A&E’s intervention revealed that there may be more than one addiction contributing to this family’s pain.

Over the past 9 years, Andrew’s father, Dan, had lost over $80,000 dollars through gambling and had taken more than $100,000 from his mother to support his gambling addiction. Dan had been able to mask his habit by focusing attention on Andrew’s oxycontin addiction. However, once their extended family saw an opportunity for Dan to get help, they came forward, hoping he too would seek treatment.

According to the Illinois Institute for Addiction Recovery, recent evidence indicated that pathological gambling is an addiction similar to chemical addiction. It has been observed that some pathological gamblers have lower levels of norepinephrine than normal gamblers. Norepinephrine is secreted under stress, arousal or thrill so pathological gamblers make up for their deficiency by gambling despite the negative consequences to their lives and the lives of those around them. Brain activation in gambling addict’s brains while receiving a monetary reward has also been linked to the brain activation of a cocaine addict when receiving cocaine. All of this makes gambling addiction difficult to treat and often requires the help of a treatment center or group therapy, like that of drug addiction.

Fortunately, after Andrew agreed to go to a 90-day treatment program, Dan did as well. Andrew has been sober since February 4, 2010 and Dan has not gambled since being featured on A&E’s Intervention. In the future, we’re going to follow up some of our favorite personalities from the show and see how they’re doing now.

Gambling it all away? The connection between gambling and drug addiction

Screaming in the last 10 seconds of a football game, the score is neck and neck, and your team has the ball on the 20 yard line. Needless to say your heart is beating like crazy in anticipation to see the outcome. Would it be beating any harder if you had money riding on the outcome? A recent study has shown that when it comes to gambling, the excitatory aspects are heightened when there is something to be won, no matter what game you’re playing, or the outcome (1).

Gambling’s more exciting when there’s money on the line

Recent work by researchers at SUNY Albany, discovered that in the last 30 seconds of a horse race and the following 30 seconds after the completion of a race, heart rate (HR) rises significantly more in individuals who think they will personally benefit from the race. The HR of those who lost money still rises after learning the outcome of the race—surprisingly just as much as those who won money. So whether you win or lose money in the race, your heart rate still goes up, which may provide a signal from the body that drives the continuation of gambling behavior.

Seems strange right? Win or lose, as long as you bet money on the game your body is going to become more excited about it. Still, when questioned afterwards, individual’s rated their experience as more exciting only if they won money. That, in fact, was the only difference between the men and women in the study. Women rated their subjective excitement higher even for lower winning rates (in this study $2, and $7), whereas men only said they were excited for the highest amount ($15).

How does gambling become addictive?

You become addicted to drugs because of chemicals that change your body and brain in specific ways that make you want more (see a past post here). Gambling doesn’t involve putting chemicals in your body, so how can you become addicted to it?
When you gamble, actual changes occur in your brain, just as they occur with drugs. Though gambling may not put chemicals in your body directly, it does affect the same class of chemicals that become altered by the intake of drugs. It all goes back to the reward pathway in the brain and neurotransmitters like dopamine, adrenaline, and noradrenaline. Whether a good experience or a bad one, the effect on the brain can apparently get some people to the point where they lose control over their betting, win or lose.

The question is: Why can’t you just play the same games without getting in debt?

Betting money creates a heightened excitement by the release of the reward-related neurotransmitters. That feeling of reward becomes associated with all the other surrounding stimuli (i.e. bright lights and sounds of casinos or screaming fans) and Bam! Here comes trouble (see my post about cravings here). As long as the gambling is sometimes paired with an actual win, the arousal from the situation as a whole (even while losing) will continue to create the desired effect. In fact, inconsistent rewarding, and especially the kind that can’t be predicted, produces the strongest, hardest to shake kind of learning. This is why casinos program slot machines (their biggest gambling money maker) to win one out of every five draws o average – it keeps people coming back for more. Every one of those unexpected wins pushes up dopamine levels in the brain making it more likely that you’ll go back for more…

Sound familiar?

Citation:

Wulfert, Franco, Williams, Roland, and Hatley Maxson (2008). The Role of Money in the Excitement of Gambling. Psychology of Addictive Behaviors, 22, 380-390.

Making a difference one post at a time… Helping drug users

Hi everyone,

I’ve been wanting to do something to help drug users for a long time now, so instead of just thinking about it, I’ve decided to go ahead and give this a try.

I’m a doctoral student at UCLA working on my PhD in psychology. I’ve been studying issues related to drug-addiction, sex-addiction, and gambling-addiction for the past 6 years and am continuing on my quest to discover what I call “The pathway to addiction.”

The thing is that on the way I have been, and still am, gaining an amazing amount of knowledge that I think can benefit not only those struggling with drug use and addiction themselves, but also the family members, friends, and loved ones of those being affected by this disease, condition, or whatever each of you feels comfortable calling addiction. As far as I’m concerned, this should all be about somehow actually helping drug users.

I’ve had my own experiences with drug use and addiction, and so I don’t expect my writings to be devoid of subjective input that I feel I can contribute given my experience.

My goal here is to get what we, as scientists, know about addiction to the general public.

I want to do this because I feel that knowledge is a key ingredient not only in curing and fighting conditions (be they medical, academic, psychological, or otherwise), but also in simply being able to handle and accept things as they are more completely.

We tend to be more scared of things when we feel like we don’t understand them.
I’m not going to lie to you on here and I’ll have no problem revealing personal history and experience by they related to my drug use or other aspects of my life.

I want this to be a forum for people to ask honest questions, get honest answers, and be able to look to when they feel like they’re at a loss and need someone who understands. Making a difference takes work. I hope it works…