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How Do You Get Addicted to Gambling? - Biological

A. Tom Horvath, Ph.D., ABPP, Kaushik Misra, Ph.D., Amy K. Epner, Ph.D., and Galen Morgan Cooper, Ph.D. , edited by C. E. Zupanick, Psy.D.

So how do people get addicted to gambling anyway? The recent contributions of science and medicine during the past 50-60 years have greatly advanced our understanding of addictions. We are beginning to understand biological forces that affect behavior (both humans and animals). Addiction is easier to understand when we consider that our biology programs us to pursue pleasure. However, we are not slaves to our biology. The unrestrained pursuit of pleasure represents a type of developmental immaturity. This type of immaturity is depicted in the classic story of Peter Pan. Therefore, psychological, socio-cultural, and spiritual factors influence whether we mature beyond our biological limitations.

Until fairly recently, people with addictive disorders such as gambling addiction were viewed as selfish, weak-willed folks. They seemed to behave badly without regard for themselves, or others. As people with addictive problems will tell you, willpower is not enough. As we will soon see, our biological make-up explains why this is so.

Advancements in neurobiological research have enhanced our understanding of addiction. Traditionally, the term addiction was limited to drugs and alcohol. We now know that certain activities can also be addictive (sex, gambling). This is because addiction is a problem of brain functioning. We become addicted to the chemicals our brain releases, not the substance or activity that causes this release. Our genetics greatly determine our brain functioning.

The American Society of Addictions Medicine (ASAM) is the nation's largest professional society of addiction physicians. ASAM is dedicated to treating and preventing addiction. ASAM recently released (August 15, 2011) a new definition of addiction. It states that genetics account for about 50% of the likelihood that someone will develop an addiction. http://www.asam.org This ASAM definition of addiction describes addiction as a "chronic disease of the brain." This is quite different from our own definition.

It remains controversial whether or not we should reduce addiction to a "chronic disease of the brain." Nevertheless, there is strong evidence to suggest a genetic component to addiction. Clearly, addiction does not develop merely because someone is weak-willed. Addicted persons do not choose their genetics. Therefore, they do not control whether they are at risk for developing an addiction.

Although our biological make-up is a powerful influence, we are not slaves to our biology. In other words, our biology does not completely drive our behavior. People are certainly capable of choosing recovery over addiction. This makes addictive disorders very similar to other diseases and disorders. Many health problems require lifestyle changes in order to restore health. For instance, people with diabetes must regularly check blood sugar levels and count carbohydrates. People with heart disease must choose a healthier diet and an exercise program. Obviously, these folks did not choose to have these health challenges. However, but they most certainly do choose how to handle them. The same is true for people with addictions such as gambling addiction.

The brain is the most dynamic and complex organ in our bodies. The brain's proper functioning ensures our very survival. When our brains functions well, we are constantly adapting to our environment (our surroundings). Ironically, it is the brain's ability to be so adaptive that contributes to the formation of addiction. Addictions cause changes to the brain in at least four fundamental ways:

1. Addiction causes changes to the brain's natural balance (homeostasis).
2. Addiction alters brain chemistry.
3. Addiction changes the brain's communication patterns.
4. Addiction causes changes to brain structures and their functioning.

The addictions topic center discusses addictions effect on brain in more detail.

Many of the symptoms we commonly associate with addiction are due to these changes in the brain: 1. Changes to the brain's cerebral cortex are associated with impaired decision-making, impulsivity, and compulsivity. These changes make it more likely that someone may act on risky or unhealthy impulses. This is because changes to the cerebral cortex make it more difficult to make wise and healthy decisions. These changes also make it more difficult to resist the urge to gamble, even though it is risky or harmful. For instance, someone might continue to gamble even though it is harming his or her marriage.

2. The brain's reward system is responsible for addictive cravings. From an evolutionary point of view, the brain's reward system ensured our survival. We are more likely to repeat behaviors that are pleasurable. Certain behaviors (eating, sex, gambling to name a few) activate the brain's reward system. This activation causes a release of Dopamine. The release of Dopamine creates a pleasurable sensation. When people attempt to discontinue an unhealthy behavior such as gambling, they experience powerful cravings to re-experience these pleasurable sensations. This function of the brain makes relapse more likely even though people have good intentions to discontinue their addictive behavior.

3. The brain's amygdala is associated with memory and emotion. Certain "cues" are stored as positive or negative memories. For example, let's suppose a man stops at a bank machine every day after a work. He withdraws $20, which the machine delivers as a single $20 bill. He takes this $20 bill to the local gas station to buy lottery tickets. The bank machine, $20 bills, the gas station, and the time (after work) now serve as cues to gamble. This is because these cues are stored as a positive memory associated with gambling. If this man attempted to discontinue gambling, these cues would serve as powerful motivators to purchase lottery tickets despite his best intentions to stop. Likewise, people often describe gambling addiction as a habit that is difficult to break. When people attempt to discontinue an addiction, the initial period can be highly uncomfortable. This is called withdrawal. For gambling addiction, withdrawal might include restlessness, anxiety, depression, or irritability. The memory of withdrawal can be such an unpleasant experience that it serves as a powerful motivator (or cue) to resume the addictive behavior to avoid the unpleasant experience. Relief from withdrawal is achieved by resuming the addictive behavior. Eventually, this relief from unpleasant withdrawal symptoms becomes pleasurable in and of itself. These relapse triggers are due to the amygdala's effect on memory and emotions.

4. Addictions effect on the brain's hypothalamus creates problems with stress regulation. People often turn to their addictions as a temporary relief from stress. Since withdrawal from addiction is itself stressful, this creates a vicious cycle. Discontinuing addictive behaviors creates stress. Simultaneously, addictions diminish the brain's ability to regulate stress.