2021. 1. 16. 12:05ㆍ카테고리 없음
Unfortunately for men and women with gambling addictions, opportunities to indulge in this potentially self-destructive pastime are endless. It wasn’t always this way, but with the arrival of the Internet, gambling websites became plentiful and are now just a click away for recovering compulsive gamblers who might easily plunge headlong into the abyss.
If you’ve struggled with a gambling problem, you know that beating a gambling addiction is not easy and can only be accomplished one day at a time. Making the decision over and over not to gamble is the only way to preserve the integrity of your addiction recovery plan, and that can be quite a challenge. Gambling addictions are notoriously hard to subdue and control.
Triggers and the Ever-present Risk of Relapse
A key ingredient of gambling addictions is emotion. Gambling plays a role in helping addicts manage difficult emotions. Gambling addiction is a compulsion but it is also a coping mechanism — a way of escape from psychological disturbance and discomfort. Gambling tattoos are representative of good fortune and luck, or it could be that this person just has a love for everything that has to do with gambling. In this case, it in common to get inked with a 21 in Blackjack, a winning combination on the slot machines, or 7 and 11 in craps.
Wherever there is addiction, there are always risk factors for relapse. There are events, circumstances or even individuals that can trigger a recovering gambler’s fall from grace.
One of the most critical aspects of overcoming a gambling addiction is to identify these triggers, and drag them out from the shadows of the subconscious and into the light. Doing this drains them of their power to sabotage recovery.
Prayer For Gambling Addiction. Prayer For Gambling Addiction – Gambling is a very destructive addiction. It affects 5% of the adult population. Even though not all of them show a high-risk gambling addiction. This addiction, as any other, has a huge negative effect. Not only on the person himself, but also on his family. In a positive step, warnings on packs of antidepressants now state that there is a risk of developing a gambling addiction when taking the medication. This was previous simply labelled as.
No two problem gamblers are exactly alike, but there are some common patterns to gambling relapse triggers that can make them easier to spot.
Trigger #1: Strong Emotional Responses
A key ingredient of gambling addictions is emotion. Gambling plays a role in helping addicts manage difficult emotions.
Gambling addiction is a compulsion but it is also a coping mechanism — a way of escape from psychological disturbance and discomfort. When problem gamblers experience stress, frustration, disappointment, anger, fear or boredom, they will often turn (or return, in the case of recovering addicts who relapse) to gambling to help ease their pain or restore their emotional equilibrium.
Using gambling to cope with life’s challenges is one of the biggest predictors of an eventual gambling addiction. Once such behavior becomes entrenched it changes from a voluntary choice to a reflex, and it is the type of reflex that can undermine your recovery and trigger a relapse. This can happen if you aren’t prepared to handle negative emotions in a more constructive way.
Trigger #2: Environment
Gambling Painting
It is important to realize that opportunities to gamble are everywhere. Stores sell lottery tickets, slot machines are found in bars or clubs, and online gaming and wagering sites are always accessible whenever you’re online. All can offer powerful temptation.
Temptation also comes in the form of friends and acquaintances with whom you may have gambled with in the past. Being careful about where you go, what you do, and who you do it with are all essential strategies for gambling addicts who are serious about their recovery. Environmental triggers can weaken your resolve and leave you vulnerable to influences you swore you’d never be affected by again.
Trigger #3: Money Shortages or Debt
Compulsive gambling is a losing proposition, both personally and financially. But when you need money and need it fast, gambling might seem like a legitimate way to solve your problems.
You should be clear about what your gambling addiction means. It means you have a history of rationalizing to excuse your gambling behavior and that it will be incredibly difficult to stop if you start again.
“Just this one time” is not a phrase a problem gambler should ever use, regardless of the circumstances or the urgency of the cause or motivation.
Trigger #4: Substance Abuse
Drugs and alcohol affect judgment and reduce impulse control, which makes substance abuse and gambling a toxic combination.
Studies show that between 10% and 20% of those with substance use disorders also suffer from gambling addictions. This connection is certainly not a coincidence, and there is little doubt that being under the influence of drugs or alcohol (even if you aren’t addicted to them) can undermine your recovery from gambling dependency — in a heartbeat.
Therapy and the Quest to Understand Your Gambling Addiction
While you should be able to identify at least some of your gambling triggers through private self-reflection, this is a topic you should discuss frequently during your addiction counseling sessions and also during your Gamblers Anonymous meetings (assuming there is a chapter in your area that you actively attend). Your therapist and your peers can give you valuable insight and feedback, helping you gain greater understanding about your gambling behavior and the circumstances that cause or encourage it.
Resources
New York Council on Problem Gambling: Staying Safe after Problem Gambling
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By Colin Hodgen, Ph.D.
Gambling Disorder is recognized in the U.S. as an addictive disorder. Indeed, it is currently the only Addictive Disorder listed in the Diagnostic and Statistical Manual, 5th edition (DSM-5, 2013) published by the American Psychiatric Association (APA).
But, what is gambling disorder exactly? What drives a gambling behavior in problem gamblers? Expert Colin Hodgen explores more here in this article. Then, we invite your questions at the end. In fact, we try to respond to all questions personally and promptly.
What is a gambling disorder?
Previously classified as an Impulse Control Disorder, “Gambling Disorders” are now seen as a behavioral or process addiction with 4 core features. As explained by Dr. Jon Grant of the University of Chicago, these core features are:
- repetitive or compulsive engagement in a behavior despite adverse consequences;
- diminished control over the problematic behavior;
- an appetitive urge or craving state prior to engagement in the problematic behavior; and
- hedonic [pleasurable] quality during the performance of the problematic behavior.
The long term effects of gambling disorder are often observed as:
- Tolerance
- Withdrawal
- Repeated unsuccessful attempts to cut back or stop
- Impairment in major areas of life functioning
In other words, gambling is something we continue to do, over and over, even if it causes problems in our lives. We are no longer able to consistently decide when we will or will not gamble, and if we do gamble, we can’t consistently decide when we will or will not stop. Further, we experience sometimes overpowering urges or cravings to repeat the behavior, and that behavior provides a sense of pleasure, relief, or release in the moment, thereby reinforcing the behavior. This behavior must be repeated and completed to reduce chronic anxiety. Over time, we experience clinically significant impairment or distress in our daily lives at home, school, or work.
Why do people gamble?
Gambling behavior is often separated into two categories: action and escape.
a) Action – Some people seem to gamble for the excitement.
b) Escape – Others tend to gamble to “get away from it all.”
The American Society of Addiction Medicine (ASAM) terms these behavior syndromes as “reward” and “relief.” If we focus on the “escape” or “relief” conditions, it becomes apparent that many gamblers are seeking some sort of pain relief, some reduction in the stress, pain, or anxiety in their lives, whether past or present.
- Numbing pain – Gambling activity becomes a way of “numbing” the acute/chronic pain and can lead into addiction. This numbed condition makes it very difficult for the individual or the treatment provider to connect with and/or resolve the underlying trauma and consequent pain.
- Relieving anxiety – In general, many gamblers engage in the behavior to reduce or relieve a cumulative condition of anxiety. This anxiety state can arise from or lead to chronic psychic pain and cognitive dissonance. Chronic anxiety can be a result of earlier life trauma or persistent excitation of the “fight-or-flight” response within the limbic system of the brain. A brain in chronic pain will often go to desperate measures to reduce or avoid continued pain.
- Coping with trauma – The brain pain is both acute and chronic. The acute state arises from the immediate circumstances of the gambler; the chronic state often is a residue of long-term, perhaps early childhood, trauma.
Over time, the gambler exhausts the repertoire of available coping responses, and is left with a dysfunctional, ineffective, and increasingly harmful set of behaviors and emotional responses. This history of trauma can lead to long-term effects on the brain and its function, through a process of adaptive learning or neuroplasticity.
The brain of gambling addicts
We need to understand brain function to address a gambler’s behavior and plan for recovery. Let’s take a brief look at what goes on in the brain, from the inside out, before taking a brief look at treatments that can be helpful in dealing with the immediate and long-term remediation of the effects of gambling disorder.
The brain is basically an electrochemical generator of the central nervous system and it regulates our thoughts, feelings, and actions. To do so, our brain generates and regulates various neurotransmitting chemicals. Here are five (5) primary neurotransmitters and their associated activities:
When the primary neurotransmitters Dopamine, Serotonin, and Norepinephrine are in balance, we see well-ordered mood and behavior:
Paintings Gambling Cards
Deficits in one or more of these chemicals (shown in italics) cause imbalances, and we see disordered mood and behavior:
Most of these mood states will be familiar to those with addictive behaviors.
A particular combination of neurotransmitter deficits contributes to the distress of the gambler, specifically combined deficits in Dopamine and Serotonin which contribute to the hybrid state of Depression and Craving experienced by most individuals with Gambling Disorder.
Impulsivity in the problem gambler
What may seem to be impulsivity in the compulsive gambling is often also a characteristic of both anxiety and a need for anxiety reduction. Problem gamblers will often present with symptoms of co-occurring Anxiety and/or Depression and will have concurrent difficulty with Impulse Control.
Glutamate and dopamine in the brain
Much of what we know about addictive behaviors relates to dopamine dysregulation, and is often associated with the effects of GABA and Glutamate on dopamine. Glutamate is an excitatory chemical and motivates behavior; GABA is an inhibitory chemical and deters or defers behavior.
Below we see two examples of the interaction of Glutamate and Dopamine, first where Glutamate from the PreFrontal Cortex motivates a pleasurable behavior associated with Dopamine. In the second example, Glutamate triggers GABA to inhibit disordered pleasurable behavior associated with Dopamine:
Psychotropics may not be the best gambling disorder treatment
Oftentimes, individuals, and the primary care physicians and mental health professionals who deal with them, attempt to diagnose and treat the mood/behavioral symptoms (anxiety, depression, sleep disturbance, etc.) without examining the underlying addictive conditions which produce these symptoms. Sadly, from a medication-based perspective, the use of psychotropics may cause more problems than they relieve.
Recently, in fact, the onset of troublesome compulsive behaviors such as compulsive gambling, compulsive shopping, and hypersexual behaviors have been associated with medications such as Mirapex and Abilify, side effects which were not anticipated or sometimes even associated with the medication. This is not to say that appropriate psychopharmacology cannot help reduce the distress of a problem gambler.
However, great care should be used when attempting to address addictive behaviors solely through use of psychotropic medications.
Well, then, what can we do?
Treatments for gambling problems
Cognitive Behavioral Therapy (CBT) – This type of therapy is associated with good outcomes in treatment of addictive disorders and is also associated with better outcomes in long-term recovery. Generally, CBT targets improving the gambler’s “executive functioning,” that is, planning, cognitive flexibility, and inhibition responses. It involves a Functional Analysis of an individual’s Antecedents or triggers, the subsequent Behaviors, and the resultant Consequences. Over time, the gambler is better able to choose more appropriate and effective behaviors and begins to experience more positive Consequences.
Neurolinguistic Programming (NLP) – Another useful and effective approach involves Neurolinguistic Programming (see Dr. Janice Walton’s April 26,2016 article, “NLP Strategies Counselors Can Use When Treating Addictive Behavior” on Addiction Blog. This therapeutic approach also addresses thinking, behavior, and executive functioning. In the absence of co-occurring mental health disorders, this approach can be quite effective with behavioral/process disorders as well as substance-related disorders.
Alternative gambling treatments – For additional information on treatment alternatives, please see an earlier Addiction Blog entry, Jaime Costello’s article, “How to quit gambling: Alternatives for recovery” .
For additional insights into Gambling Disorder, please see any of the other Bybee Initiative posts on Addiction Blog under the Compulsive Gambling category. For more extensive examination of the neurobiology of addictive disorders, see Neurobiology of Addiction (Koob & Le Moal, 2005).
The nature of gambling disorder
Gambling Disorder, and similar process/behavioral disorders, can often resemble substance-related disorders. Many of the components of traditional substance-related disorders can be customized for use in treatment. After all, we’re dealing with the effects of chemicals on brain function. In the case of Gambling Disorder, these are Endogenous (internal source) chemicals (Dopamine, Serotonin, etc.) rather than Exogenous (external source) chemicals such as alcohol, opioids, or stimulants.
Whatever the source, and whatever the etiology of the disorder, individuals, families, and communities suffer the effects and consequences of Gambling Disorder. This disorder is uniquely insidious, a “hidden addiction,” since there are no immediate biochemical tests for the disorder. Oftentimes the disorder and the damage only become evident after some catastrophic event. Our challenge is to stay vigilant for early indicators and early intervention. Our task is Awareness, Education, and Advocacy.
Got any questions about the brain and gambling?
Do you have any additional questions and would like to ask questions regarding the diagnosis, nature, and treatment of gambling disorder? We welcome you to post them in the comments section below. We try to answer all legitimate inquiries personally and promptly, or refer you to someone who can help.
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About the Author: Colin Hodgen, PhD, is the Director of RENEGADE Counseling in Reno, NV. He is a member of the Shannon Bybee Working Group.