Medical Facts Behind Gambling Addiction

MAUREEN CAVANAUGH: This is KPBS Midday Edition I am Maureen Cavanaugh. The headlines were almost unbelievable. $1 billion wagered, millions lost and legacy of one of San Diego's most possible mayors forever tainted. The legal consequences of Maureen O'Connor's gambling charges of embezzlement from her late husband's foundation have apparently been worked out. But the question remains, how does something of that magnitude happen? O'Connor's attorney says it was partially due to a brain tumor, the legal agreement requires O'Connor to be treated for gambling addiction. Today we discuss both the physical and psychological illnesses that could lead to such an overwhelming compulsion and how to address signs of problem gambling. I'd like to introduce my guests. Dr. Marc Norman is associate professor at UC San Diego with a specialty in neuropsychiatry. Dr. Norman, welcome to the program. MARC NORMAN: Thank you very much. MAUREEN CAVANAUGH: And David peters is a family therapist with offices in Mission Valley and David peters welcome back to the show DAVID PETERS: Always good to join you Maureen. MAUREEN CAVANAUGH: Dr. Norman Maureen O'Connor's attorney focused on the fact that she suffered from a brain tumor, what kind of changes in personality can a tumor cause? MARC NORMAN: A tumor can cause a number of changes in the brain and behavior and a big part of it actually depends on where the tumor is located as well as the type of tumor because some tumors grow very quickly and create a very profound and quick change and other changes may be very slow and almost imperceptible in that they grow very slowly so a lot of it depends on location. MAUREEN CAVANAUGH: Is there a particular location within the brain that is more susceptible, that would lend itself more easily to big personality changes? MARC NORMAN: Definitely, so what we call the frontal lobe, the place more toward your nose, toward the front of the brain is more associated with behavioral change and how behavior is expressed. However, it is a vast real estate in the frontal lobe, so depending on where the frontal lobe may be involved different types of changes or no change may be observed. MAUREEN CAVANAUGH: Dr. Norman, in O'Connor's case the behavior allegedly spanned nine years, is that possible with a brain tumor? MARC NORMAN: I can't address her specific case. I'm not knowledgeable about that however, absolutely. Changes that may have occurred if the tumor grew into certain areas within the frontal lobe early in the course of her illness, or in the course of her change that is certainly possible you may see changes at the time. MAUREEN CAVANAUGH: I'm talking about the period of years, can it take place four years?Because I think may be popularly we think of a brain tumor as something that needs immediate attention and does not you know, the person does not necessarily last for nine years with a brain tumor. A lot of that depends on the type of tumor, so some tumors are rather benign meaning that they do not spread, or they spread very slowly so often when tumors are found we actually just watched the so that over time we may not see that they are growing, or they may not be pressing or invading tissue that is critically important to functioning. So you just leave them alone because the risk could be more in terms of intervening with them than it is in just leaving them alone. MAUREEN CAVANAUGH: Dr. Norman, in your experience have tumors led to problem gambling? MARC NORMAN: Not in my experience with that. There are a lot of behaviors that may come out and it's not very predictable. So you may see changes in striking out at people, in arguing with people, and sexual behavior, all types of things. Gambling is certainly within the realm of behavioral change we may see with a brain tumor. MAUREEN CAVANAUGH: Another thing was that the O'Connor news conferences that if someone's behavior radically changes over the age of 50That you should, or perhaps people should begin to inquire about the possibility of a brain tumor. When you suspect a brain tumor as a cause if someone was over 50 of the personality change? MARC NORMAN: I probably would not say brain tumor first off. There are a lot of things, almost any change to the brain may affect behavior. So for people who may be at high risk for vascular change because of strokes we may see something like that as people get older we may have dementing illnesses which may cause behavioral change so it tumor is the first thing I would think of but it would also depend on the other signs and symptoms that may be there, other areas involved with the frontal lobe has to do with movement, speech and those kinds of things so we would have to look at the whole constellation of symptoms. MAUREEN CAVANAUGH: David Peters, Mayor O'Connor's attorney said this was grief gambling because it followed a series of losses in her life, is that something you've encountered before? DAVID PETERS: Is not most, but it's not unbelievable at all because what happens is with many addictions and compulsive behaviors, they serve to cover or override and uncomfortable emotion. Sometimes it is childhood trauma that has never been resolved. Sometimes it is childhood grief that has not been resolved. If someone is struggling with a grief reaction and they are not successful at it, then maybe isolate themselves, they may be into a clinical depression and they may feel the emptiness inside by something that arouses the, be it food, gambling, cocaine. Whatever the substance or the behavior, if it serves them at the moment to distract you from the uncomfortable feeling, then you could be traveling down the road of addiction. So it is certainly possible. MAUREEN CAVANAUGH: David Peters, when people hear that a prominent person has been gambling away multimillions of dollars for years, that her personal fortune of $50 million is going, that the foundation in her husband's name has reportedly no assets left, how does a gambling problem spiraled to that level? DAVID PETERS: You know when it comes to gambling the amount of money you have available to you is the amount of money you lose, really. I have seen problem gamblers who have very little money and they use all of it. If you have got access to a lot, you just see it as less of a problem to lose a couple hundred here are a couple hundred there, I lost $10,000 I can make better. You realize as I reported she won and lost over $1 billion over time which is an astonishing amount of money but notice their stopping her and the money is there. When someone is isolated this is the critical thing if she's isolated from friends or family or an isolated from those, that they are more vulnerable to problem behavior and if she's struggling with a brain tumor I do not know that myself, but it's possible you have a collective of different elements that together are triggering this event. But, it is not surprising at all that it could be millions and millions of dollars less. MAUREEN CAVANAUGH: Dr. Norman in other addictions like addictions to a drop drug doctors have pretty good idea what particular chemicals cause a rash or high in the brain but do we know what happens in the brains of people who have gambling problems? Do we know where that rash or that height might come from MARC NORMAN: The answer to that is actually know at this point there's a lot of research going on that may implicate certain neurotransmitters, chemicals in the brain's dopamine, serotonin and there are areas of the brain that are actually in the front to love that may be associated with this. But the specifics of gambling is really not well understood. And what may be like this, what may underlie this is actually common pathways of rewards and the common pathways of risk and reward. And anticipating the payoff that may be very common in things like food and sex and Internet and gambling and many other types of things including drugs and alcohol. MAUREEN CAVANAUGH: Let me ask you both that, let's start with you Dr. Norman, is gambling really an addiction? MARC NORMAN: You know it is a tough question and it's one that is very much debated. Is this a habit that changes the brain, or does the brain change actually increase the behavior that may have been there before, or actually release behavior kind of disinhibited the inhibitory response, take it away. So, in the latter case, where we may have brain changes I probably wouldn't classify it as an addiction in that case so there may be multiple reasons that someone may gamble or have these other types of behavioral change. MAUREEN CAVANAUGH: And to you, David Peters. DAVID PETERS: In the therapy world the difference between addiction and compulsive behavior matters less if the treatment is the same and in this case the treatment is being but there's a rushing debate about this from their standpoint the qualifiers are increased tolerance for the drug or the behavior in other words, the rash that you get, and you build the tolerance for it so you need a larger and larger amount of value or direction order to get the effect you want. And then withdrawal symptoms, when you stop, do get depressed anxious or disorganized and those in the recovery community have insisted there is an increased tolerance we see among gamblers and there are withdrawal symptoms so there's been a change coming in the American psychiatric Association stating that okay we will qualify it as an addiction rather than impulse control disorder. But you know what we do for the sense of communication and classification does not always immediately reflect you know, the sites itself. So this debate is going to go on. MAUREEN CAVANAUGH: So David Peters, how big a problem with problem gambling? DAVID PETERS: It is an enormous problem across the country for notes a small percentage of the population. Estimates are between six and 9 million people meeting criteria for canceling, that maybe 2 to 3% of the population and maybe 3 million can be described just as true compulsive or addicted gamblers. The majority are men although the percentage of women is increasing. It seems that men begin more often in the teen years with poker playing with the guys, and women begin more often in their adulthood doing gambling machines, the casinos, that sort of thing. The damage is massive. It can tear apart families. It can cost you your career very easily. It can destroy your psyche if you cannot stop. MAUREEN CAVANAUGH: Now, do casinos bear any responsibility for this, or have they taken any responsibility on their shoulders? DAVID PETERS: I do know that many of the casinos to contribute funds to organizations that help problem gamblers and they try to give gamblers access to phone numbers for problem gambling groups, on the other hand, there they are making enormous sums of money off people who have poor impulse control and I worked at a psychiatric hospital the chronically mentally ill were very vulnerable to going off to the casinos and gambling away what little money they have and they would have no rent money. It would be very tragic to watch. MAUREEN CAVANAUGH: Dr. Norman, has there been any research done as to whether or not there is a similar root cause behind most addictions? MARC NORMAN: I'm not familiar with the specifics of that. Because there are so many different types of addictions there's definitely research looking at things like substance abuse and alcohol. There's a tremendous amount of research in alcohol and looking at drugs including methamphetamine. And looking especially at the developmental piece of it. So starting to use drugs out of the holy one is very young and how did the can changes in the brain because of the substances actually change the brain over time. So there is actually a lot of research and but specifically with gambling it's less of a studied area. MAUREEN CAVANAUGH: Would you agree with that, David? DAVID PETERS: I agree with him, but from the therapist experience we run into a people with a variety of different compulsive behaviors and addictions and inevitably when we dig around and find some early childhood issues, or a family lineage of, genetic vulnerability to addictive problems. So with gambling there is really not as most research on their but when you brought into chemical additions and most compulsive behaviors, people who have unresolved issues of trauma in their childhood, people who have secrets they are keeping that cause the shape, those people are more vulnerable to compulsive candidate to behaviors. MAUREEN CAVANAUGH: David, this seems to me, despite the big headlines and the unbelievable figures that came out of the Maureen O'Connor story. It seems to me that this must be a hard addiction to spot if you are not sharing a bank account with the person who is going through this problem. DAVID PETERS: Very difficult to spot, I would say, Maureen, if we could find a way to prove it I would bet a large sum of money that you know someone but do not know if that they have a compulsive behavior problem or an addiction problem. Most of us know someone who has some problems in addictions or compulsions, not the majority of people certainly but the variety is so wide and people-of course because they are shame inducing, but if you have a family member or a friend with a gambling problem they are the ones who are short on money frequently or they are the ones flashing a roll of money now and talking about how great they are doing. These are people who will be borrowing money and be unable to pay you back and you know they seem to be keeping something secret they are often busy, what are they busy doing and they are making up excuses but it's extremely difficult to spot if the person is actively hiding it. MAUREEN CAVANAUGH: What are the treatments like? DAVID PETERS: In the treatment arena most therapists do recommend gamblers anonymous meetings because the effect of speaking out loud about your problem behavior helps you reconceptualize it, helps you learn how the mechanisms in your own mind are triggered and you compare notes with other people at the same addiction. And you can build alternative behaviors, cognitive behavioral therapy is essential for this and other words of cognitive behavioral therapy we trained people to observe their mind, to observe that (inaudible), to observe the lines of thought that they have that lead up to the problem behavior and I teach my clients about kind of neuroscience, any behavior is a series of neurons in the brain firing together. And neurons that fire together wired together. So, the arousal pattern that leads to the addiction becomes a pathway within the brain that is very hot, very easy to activate and it's impossible to cut. The only thing you can do is train yourself to know that it's, arousal is coming there and read yourself to shift her behavior, shift onto something else that contradicts it so you cannot fall into the behavior so we have cognitive behavioral therapy we have mindfulness techniques for meditation which builds the capacity to observe oneself and in some cases, not many, some medications can be helpful. MAUREEN CAVANAUGH: Let me go to you, Dr. Norman, there are medications that can help someone kind of wean themselves off of the gambling problem? MARC NORMAN: There's certainly not approved medication for that right now but I think one of the things that David mentioned before in terms of the underlying issues that may be causing the increase, or the behavior may need to be addressed, so if someone is feeling depressed or down, addressing the underlying piece of antidepressants or other kinds of medications can be beneficial. MAUREEN CAVANAUGH: David, how effective are the treatments? Is this a very difficult problem to care? DAVID PETERS: If the client is highly motivated, we cannot cure them, we can help them build the behavioral repertoire and coping mechanisms so that they are no longer gambling because I care because the brain is still hardwired to be aroused by and that's what I emphasize to the clients. You are not cured, you have to stop for a while and continue the new behaviors. It is easier to do if the client is well motivated. If the client is not fully motivated it is almost impossible to fix or find a reliable set of treatments that are going to be of any benefit at all. So motivation is really important and most often when someone bottoms out and other rights their life is so horrible they cannot stand it any longer that is when they are most likely to fully commit to treatment program. MAUREEN CAVANAUGH: All right then, we will leave it there, David Peters family therapist thank you so much. DAVID PETERS: Always good to be with you MAUREEN CAVANAUGH: And Dr. Norman, thank you very much. MARC NORMAN: Thank you for the opportunity to be here.