Marc Kern (Addiction Expert, Director of Addiction Alternatives) gives expert video advice on: How big of a problem is gambling addiction?; What causes addictive gambling?; When addicted gamblers are losing, do they actually believe they'll win? and more...
How big of a problem is gambling addiction?
Gambling addiction takes many forms. It is a very broad addiction, if you'd like to call it that, because it manifests itself in so many ways. Gambling could be everything from the very overt: you go into Las Vegas or Reno or whatever, spending your money. But it's also the stock markets. It's also back of the schoolyard. It's any place where there's sort of a game of sorts being played, or the Internet, or business, are all sort of forms of gambling. It's pervasive. And, our society, and all these lotteries, is sort of endorsing that idea of, "Splash! Win the lottery! Invest your money in this direction." So gambling is very broad, and it's not as specific as, generally, we think of it.
Is playing the stock market as addictive as betting on horses?
Some gambling occurs at the local liquor store or Seven-Eleven, like the little scratches. Have you ever seen anybody standing at the counter, scribbling off? For a few fleeting moments there's excitement, exhilaration, hope, and optimism. It's not that far from somebody who is investing high numbers on a risky investment, or someone who is in Las Vegas, or someone sitting at a poker table every Saturday night. There's that physiological excitement and optimism and hope that draws the individual into it over and over and over again. Some people have a stronger leaning; some people have had some substantial positive experiences, and they go back because it feels good; because there's hope and there's optimism versus going home to maybe an empty household where's there's no love or no warm feelings.
What is the difference between a pathological gambler and a problem gambler?
Pathological versus problem gambler is a matter of degree. I think we all involve ourselves in some sort of gambling, whether it's the lottery, the Super Bowl, or betting in the office. But, it is exactly what the words imply. Does someone spend too much time preoccupied with a gambling activity versus a pathological or excessive amount of time involved with gambling activity? All these behaviors that we call an addiction really do exist in virtually all of us, but only to a certain degree.
What is the "end point" in gambling behavioral addiction?
The end point in gambling behavioral addiction is when the individual is unable to discontinue despite his best attempts, and that's usually due to some of the things we talked about. But also, I feel like we should mention that as someone gets further involved in any of these activities, there are biological, neuro-chemical changes going on in their brain. I.e. what is a feeling? That is nothing more than an electrical charge of a neuro transmitter. It's important to understand that when we ask people to stop, it's partly difficult because our chemistry set upstairs has been reoriented, and this causes the gambling behavioral addiction.
What causes addictive gambling?
There is no one hundred percent consensus on what causes it, but we can draw some very powerful generalities here that seem to go across everybody's idea of what addictive gambling is. Of course, there's probably a propensity for the individual to be impulsive and to like to receive rather quick feedback and rewards system. When you go into a casino or sit in front of a slot machine and you get reinforced, then you're going to start anticipating money coming your way. Now, there are several types of learning. One type of learning is if you went into a casino or something and you won every single time and then all of a sudden you stopped winning and you kept on losing you would walk away from that slot machine because you would say well I was winning then and I'm not winning now, there's no reason to continue or to hope for a turn of events. There's another sort of learning where every time you went to the slot machines and you put in coins and you never won, well chances are you won't become addicted. What happens over time and the casinos are very, very aware of it's called variable reinforcement. This is just another form of learning where they purposely make the slot machines pay out a certain percentage of the time. So you don't know how often, when that next pay off is going to come. The more they can teach you or you can learn that you cannot predict the pattern of when you're going to when to win or know when to pull out and take your money the better for them. So you're going to stay there and stay on until some point when you have to leave because you've been taught if you just hang in there that slot machine that card game will eventually pay off. That's a form of learning people who have come to become gamblers have become hooked by this variable reinforcement principle where they don't know when the next win is going to come yet they're anticipating it, they're salivating waiting for the reward.
When addicted gamblers are losing, do they actually believe they'll win?
It's my belief that they really do believe they're going to win and they continue to go to the tables in hopes that they will win because there's no longer any background for them to fall back on. There's no way of backing away from the table because they've undermined their pocketbook sometimes before. But also they believe they're going to win because its been taught to them that if you play the slots long enough, if you play the tables long enough, if you play the video game long enough it's eventually going to happen. It's not like everytime they went there they won or everytime they went to the table they lost. They've been taught week over weeks over months, you stay with it long enough you will eventually win. It's the nature of what the casinos have designed in the exchange and the re-enforcement.
Why is alcohol abuse often linked to compulsive gambling?
Alcohol abuse and gambling seem to go hand in hand. There are a variety of theories and models of why that happens to be. Of course there is again that personality propensity; I want to feel good, alcohol works efficiently, effectively, predictably every single time. Gambling seems also to be more of what I call to be a high arousal form of addiction like sort of amusement parks or other things. Gambling stimulates us, it gets us excited. And what is alcohol? Alcohol is sort of a sedative, so alcohol sort of helps us fine tune ourselves at the gambling table. It also, in Las Vegas, helps the casinos and interferes with judgment. But in my understanding it's mostly about this balancing act that the individual is trying to accomplish.
Is there a drug that can stop compulsive gambling?
There is nothing in the United States anyway that was designed specifically for gambling. There is no drug out on the market specifically for gambling. There are a number of drugs particularly Naltrexone, in the two forms of it, that seems to have a positive effect of decreasing gambling. It basically works in two different ways. One is, if you, you have less craving towards the involvement in the gambling activity, and two, should you gambling, you're going to get less reinforcement. It seems to dampen the reinforcement. We are not substituting opium or another alternative way of feeling good about themselves with a pathological gambling what we're trying to do is to mitigate neurological imbalances that has evolved as function of a constant repetition of a behavior such as gambling.
Who develops a behavioral addiction to gambling?
People seem to gravitate toward gambling primarily, at least as I would understand it, because of more sociological forces than any other. If you're someone who comes from a family where money is tight, or the community does not support gambling, well, chances are you're not gonna lean in that direction. If, on the other hand, maybe you come from as Asian community, or some society that endorses and looks up to a gambler, chances are you're going to find gambling as a potential addictive behavior versus another addictive behavior where that behavior is not as easily endorsed. The selection of the addiction of choice is a very, very interesting topic. And I believe that beyond the social and the exposure, you know, let's, again, let's say mom or dad had a poker game out in the living room every Saturday. Well, there's a greater likelihood you're going to try that one versus another one. But then there's also what I call the "high arousal addictions" and the "low arousal addictions." "High arousal addictions" are like gambling. And most of the behavioral ones are "high arousal." In other words, the addiction itself does not give me necessarily a feeling of calm like you might expect, but rather exhilaration and fun and optimism. And some people, from birth, seem to lean toward liking that sensation of high adrenalin, high stimulation more than others.
Does exposure to a potentially addictive behavior make you immune to its effects?
In general I would say that a child's early social environment has a powerful potential of fostering addiction, and in particular, a particular type of addiction. However, I'm not 100% sure if it's an exact portal. For example, just because your father worked at the track doesn't mean you're going to have a horse racing addiction. In fact, you might look at horse racing more normally than someone who comes off the street and just pays a few bucks to get into the track. It's not quite that simple, it's more about the exposure; did Dad, Mum, Uncle, or Aunt show you in some way that this thing was ok to get overly involved with, or on the other side did your models show that moderation on these things was the right thing. I even support the idea that societies and cultures that support moderation for example, in alcohol, probably have less alcoholism than societies that support abstinence or excess. It's a social-psychological force that influences the individual.
Is behavioral addiction a way of thinking, or a symptom of depression?
Addiction is both and more. I think addiction is both an expression of certain beliefs, attitudes, and values that you grow up with. I also see addiction as a means of mitigating certain emptinesses that we have inside; loneliness, and boredom's a big one in addictions to video games and sex addictions, and things like that. There are few healthy ways of satiating, working with those addictions. So yes, it's both a filler-upper, and a form of ways of looking at things. Very important though, is was there a big expositive experience early on with that particular addiction? Is there an inner sensation of competence, of being powerful in the early involvement with that particular activity?
Will compulsive gamblers eventually turn to crime?
Crime, in all the addictions we're talking about and in particular in gambling, is definitely an end point. It is definitely the default, the bottom line when all else fails and you've dug yourself a deep hole financially and there's no other option. That doesn't mean that there aren't certain people who grow up in environments where crime is more rampant, where it goes the other direction. But most people do not turn to crime to support their habit. But at some point, when you've dug yourself a deep enough hole and it looks really hard to get out, you're going to do whatever it takes to remedy it. People say they don't understand why they do this. It doesn't make any sense. They've lost all this money. That doesn't make sense. What they're implying is they're talking to the individual from the thinking standpoint. But what's happening is now no longer up here. It's down here in the heart. They're trying to make themselves feel good. It has nothing to do with the logic of thinking morally. It's not a thinking process at that point. It's all about more of an basic animal need to feel okay again.
Are there different types of problem gamblers?
Yes there are very much different types of gamblers and differerent ways of manifesting the gambling behavior. As we spoke about, the stock market, scratching something or the lotto, but the experience of what it brings to a true gambler or a true addict is fundamentally the same. It is a sense of optimism and power and avoiding uncomfortable feelings and distracting them from perhaps loneliness or something like that . Are you a corporate tycoon or somebody in a poker chair? It may look different but inside it's somewhat the same in terms of problem gambling.
Do I need to worry about my teenager's gambling?
Absolutely you have to worry about your teenager's gambling. Absolutely! Our society is endorsing gambling like nobody's business. Every state has a new lottery system. Everybody is trying to finance their latest highway project with another form of gambling. We are passing on to our youth, through the media, that it's okay to go out for the quick fix, the instant win. The mechanics of our high tech world support this whole concept. Google something and you can have what you want and it very much is being filtered down to our youth. It's going to be interesting to see how they handle it, because no one is educating people about gambling and there's even a sort of quiet denial by our society that we're even doing these things to our youth. So yes, I would be worried about your teenager's gambling.
What are the signs of compulsive gambling?
When a full-blown compulsive gambling addiction is present, it's pretty obvious. Outsiders can see that there's a preoccupation with the attainment of money to go play a particular game, fantasizing about the outcome, a lack of other normative behaviors or a discounting of other normal behaviors. It's more important to see the subtler pre-addiction symptoms developing in the individual, the potential gambling addict. It's a gradual increase, a little bit more here, a little bit more there. Spending all their leisure time involved in gambling activities, or spending more time associating with people who involve themselves in the same activities. Once the gambling addiction is present in an individual, it's almost too obvious. You can't miss it.
What does "normative" mean with regard to behavioral addiction?
Normative behavior means just what sort of behavior we think of as 'what everyone around the block here or around where you live, does.' Every community has a different normative behaviors and of course if you live with a normative community where drinking or gambling or spending is normative, there is a greater likelihood that you will engage in it.
What should I do if I see signs of gambling addiction in myself?
The first thing if you see signs of gambling addiction in yourself is not to deny it. Don't just pretend that the addiction not there. You don't have to run to a therapist today. You don't have to go to a GA meeting for your addiction tomorrow. You don't have to go on medication next week. But if it's happening, watch it. If you want to curb it, you're in good shape if you own it and you see it. If anything, track your gambling problem if you start seeing it in yourself. Make a little chart for yourself. How often do you think about gambling, how much money are you spending on it. And watch objectively without moral condemnation. Is it going up? Is it stable? Or is it going down? If you see it continuing over the course of years and continuing to escalate then we're in a different ball park.
What kind of help is available for gambling addicts?
There's not a lot out there for gamblers. There are surprisingly few treatment centers in the United States that specialize in gambling. There are very few professionals, such as myself, who specialize in gambling and to be fully honest my experience with gamblers, even personally, hasn't been so hot. Gamblers are notoriously difficult clients to treat. They tend to be often impulsive, tend to have little patience and the addiction often has a hold on them. Of course there's Gambler's Anonymous, GA, but beyond that there are virtually no self-help support groupsI'd like to recommend Smart Recovery for those of you who'd like to try a cognative approach to gambling, It doesn't specialize, per se in gambling, but the tools are the same for gambling as for alcohol and drug and will be welcome in a Smart Recovery meeting.
What is "SMART Recovery"?
Self-Management and Recovery Training. It is a 51(c) self-help support group. It's national, although nowhere near as large as a 12-step sort of group or GA, but it is available in some larger cities.
How is a program like SMART Recovery different from a 12-step program?
SMART Recovery attendees versus G.A. attendees all have quite a different experience. SMART Recovery's based on cognitive behavioral therapy, and it will be more educational - there is no sponsor system, there is no twelve-step higher power Four Absolute properties in it; it will teach them how to change their thinking, it changes their feelings and behaviors.
What is the difference between SMART Recovery and Gamblers Anonymous?
Someone who would attend a SMART meeting would be sitting in a group usually no larger than 10 to 15 people, as opposed to GA, which could get quite a bit larger. There is no sponsor system. There is no 12 steps or utility for a higher power. It's a science-based support group based on cognitive behavioral therapy. There is an orientation to identify the thinking that leads to the feelings that leads to the behavior, which is central to all cognitive behavioral therapy.
Who leads SMART Recovery meetings?
In all SMART meetings there is a trained leader. They are not peer led. They're led by someone who's been to a training session. Usually sort of endorsed by SMART national and they've read a number of volumes on the topic of cognetive behavioral therapy and have predone homework assignments and other sort of tools. There's even a manual. It's nothing really more than variety of exercises to help people identify the thinking that leads to the behavior.
What is "self-exclusion" for gambling addicts?
Self-exclusion is sort of a mechanical form of intervention. Some people find it very helpful, other people find it unhelpful. If you were a gambler, and let's say there was a casino within driving distance from you, and you didn't want to be tempted by going to this local casino, you could contact the casino and develop an exclusion, a contract with them. And they would try to keep you out of their casino. It's sort of protecting you against yourself.
Can gambling addiction be cured?
We have to define what a cure for a gambling addiction is. Can an addicted individual evolve to a place where gambling no longer has the emotional tie, the compulsive and obsessive attraction. Absolutely, without a doubt, it happens all the time. People are able to self-cure. But the reality is that we never really are cured from alcoholism or gambling, because what we have with all these, is something learned. For example, no one is born with a gambling addition, they practiced and then they practiced some more and over the course of time the person has built neurological pathways in their brain that were not there when they were born. So, over the years, these pathways get stronger and stronger and now they've decided not to gamble anymore. Does that mean that that neurological circuitry that they've self-developed goes away? No, it's like a freeway that's always going to be there. We can develop ways from getting from point A to point B anew. We can develop a new freeway to make ourselves feel good. We can develop ways to avoid going down that old path called gambling, but can we ever eliminate it? I don't think so.
Who becomes addicted to online gambling?
What we have now is modern technology bringing about an availability of reinforcement, a feeling good, a reward instantaneously. It's seductive. Let's say you have an hour to burn and you are bored. You could log on and gamble. It's like having the slot machines at the airport where you're trying to kill an hour and you start playing and you start winning. Gambling is now inside the home. It's now inside your private space. No one knows about it. No one sees it. And you can sort of get seduced and sort of say, “Well, this is sort of fun, and it keeps my mind occupied. It feels good, and why not?”