Close-up of hand resting on slot machineGambling addiction is one of the most prevalent behavioral addictions. Between 1-5% of Americans engage in compulsive gambling. Among young people and ethnic minorities, the rate is even higher. A 2010 study found that 6-9% of adolescents and young adults have a gambling addiction.

Gambling addiction can lead to other problems, including debt and relationship woes. It also commonly co-occurs with other addictions, especially to alcohol. It’s easy to feel hopeless and overwhelmed while in the grips of an addiction to gambling. The right treatment can help those with a gambling problem regain control over their lives.

When Does Gambling Become an Addiction?

A 2016 Gallup poll found that gambling is a common diversion, with 64% of a representative sample of Americans saying they gambled at least once during the last year. Gambling is everywhere, from state lotteries to school raffles. This can make it difficult to distinguish problem gambling from typical gambling. For people in recovery, the omnipresent nature of gambling opportunities can make gambling sobriety challenging.

Typical gambling is a fun activity that a person can easily leave behind. They don’t feel the need to lie about their gambling or gamble in secret, and they are unlikely to feel guilty about gambling. Gambling addiction is often secretive, leading to feelings of shame and guilt. People with gambling addiction may experience a range of other problems related to their compulsive gambling.

The DSM-5 lists the following symptoms of compulsive gambling. To be diagnosed with a gambling addiction, a person must exhibit at least four of these symptoms in a year:

A 2004 study that compared typical gambling to gambling addiction points to the following hallmarks of gambling addiction:

To those unfamiliar with behavioral addictions, it might seem strange to compare gambling addiction to chemical addictions. Yet gambling addiction can, over time, change the brain in ways similar to alcohol and drugs.

What Makes Treatment for Gambling Addiction Difficult?

Unlike drugs such as alcohol and tobacco, gambling doesn’t directly change the brain. To those unfamiliar with behavioral addictions, it might seem strange to compare gambling addiction to chemical addictions. Yet gambling addiction can, over time, change the brain in ways similar to alcohol and drugs.

Gambling offers a powerful sense of reward and achievement. This can strongly motivate people to keep gambling. Research on gambling addicts suggests that gambling can release dopamine, a neurotransmitter that is also linked to chemical addictions. This release of dopamine can make a gambler feel elated, and even “high.”

As a gambling addiction progresses, problem gamblers can face a range of hardships. Those include:

This stress may actually trigger more gambling, since people with gambling addiction may use the behavior to manage stress. This initiates a vicious cycle, in which gambling undermines a person’s quality of life, and they then use it to cope. Life gets steadily worse, leading to progressively more gambling.

Gambling often occurs alongside other addictions, especially alcoholism. One study found that about 23% of people seeking treatment for gambling addiction were also addicted to alcohol. The interplay between two more addictions can complicate treatment, making recovery more challenging.

Most people with a gambling problem find that they have to totally abstain from gambling to avoid relapsing. This can prove difficult. Many forms of gambling are legal, so opportunities abound, making it difficult to avoid. Because gambling is a popular social activity that’s readily available everywhere from church fundraisers to sports events, avoiding temptation can feel like a full-time job.

How People Overcome Their Gambling Problem

Gambling addiction is a treatable issue. The key to effective treatment is addressing the underlying emotions that lead to the addiction, since most problem gamblers use gambling to deal with psychological pain. To be effective, treatment must also respect a treatment-seekers values, cultural needs, and spiritual beliefs. Some options that may help include:

Some people find they have to try several treatments before one works. Others pursue two or more treatment options at the same time. About 90% of people with a gambling addiction relapse the first time, leading many addiction experts to view relapse as a part of the recovery journey. Each relapse affords the chance to learn more about what works and what doesn’t in recovery and to get closer to permanent gambling sobriety.

If You or Your Loved One Has a Gambling Problem

Addiction thrives on shame and so often operates in secrecy. For many people, simply admitting that they have a problem, or contemplating that a loved one might have a problem, is a powerful first step toward recovery. This admission helps remove justifications and excuses and shifts the focus toward finding appropriate treatment.

How to Help Someone with a Gambling Addiction

If someone you love appears to have a gambling addiction, it’s important to treat their compulsive behavior not as a moral or personal failing, but as a health problem no different from diabetes or heart failure. No one willingly chooses to become an addict. Your loved one would stop on their own if they could.

Try talking to them without judgment. Express concern and support, and offer to help them find treatment—or even to go with them to treatment. If someone to whom you are close has an addiction that is affecting your life, it’s important to draw and verbalize clear boundaries. For instance, parents might clarify they will no longer give children money that will be used on gambling, while a partner might open a solo bank account to protect the family’s finances.

How to Stop Gambling Addiction

Some people struggling with gambling hope they can stop on their own without getting help or telling anyone. This goal is often motivated by shame and denial. Most addicts will need treatment and support to get and stay sober.

A compassionate therapist who specializes in addictive behaviors can help you decide if you have an addiction and explore next steps. The right therapist can also help you talk to loved ones, repair broken relationships, and devise a plan for getting your life back.

References:

  1. Auter, Z. (2016, July 22). About half of Americans play state lotteries. Retrieved from https://news.gallup.com/poll/193874/half-americans-play-state-lotteries.aspx?g_source=Social%2BIssues&g_medium=newsfeed&g_campaign=tiles
  2. Calado, F. & Griffiths, M. D. (2016). Problem gambling worldwide: An update and systematic review of empirical research (2000–2015). Journal of Behavioral Addictions, 5(4), 592-613. doi: 10.1556/2006.5.2016.073
  3. DSM-5 diagnostic criteria: Gambling disorder [PDF]. (n.d.). Retrieved from http://www.ncpgambling.org/wp-content/uploads/2014/08/DSM-5-Diagnostic-Criteria-Gambling-Disorder.pdf
  4. Gambling disorders [PDF]. (n.d.). National Center for Responsible Gambling. Retrieved from http://www.ncrg.org/sites/default/files/oec/pdfs/ncrg_fact_sheet_gambling_disorders.pdf
  5. Grant, J. E., Kushner, M. G., & Kim, S. W. (2002). Pathological gambling and alcohol use disorder. Retrieved from https://pubs.niaaa.nih.gov/publications/arh26-2/143-150.htm
  6. Ricketts, T. & Macaskill, A. (2004). Differentiating normal and problem gambling: A grounded theory approach. Addiction Research & Theory, 12(1), 77-87. Retrieved from https://www.tandfonline.com/doi/abs/10.1080/1606635031000112546?journalCode=iart20

Gambling chips sitting on green felt tablePeople with a gambling addiction who attended Gamblers Anonymous (GA) meetings gambled less frequently than peers who avoided the 12-step program, according to a new study published in the Journal of Gambling Studies. When GA treatment was combined with other therapies, people with a gambling addiction made even better progress.

Gambling addiction is among the most common behavioral addictions, affecting 3% to 6% of the population. People who compulsively gamble can quickly accrue hundreds of thousands of dollars in debt, spurring a cycle of gambling to regain the money. These effects can be destructive and can create a deadly habit with a high suicide rate. The National Council on Problem Gambling estimates 1 in 5 people with a gambling habit will attempt suicide.

Is Gamblers Anonymous Effective?

The study reviewed 17 other studies on problem gambling published between 2002 and 2015. The studies looked at a range of treatment approaches, including Gamblers Anonymous.

[fat_widget_right]The review showed people who regularly attended Gamblers Anonymous meetings gambled less frequently. They also experienced less depression, stress, sleep deprivation, and anxiety, and higher levels of life satisfaction. The program’s focus on patience, acceptance of financial realities, and identity as a problem gambler all played important roles in recovery.

The program was even more effective when combined with psychotherapy. Cognitive behavioral therapy, which attempts to alter problematic or misleading thoughts to change behavior, proved especially effective.

Gender Differences in Gambling Recovery

Though media portrayals of problem gamblers suggest most people with a gambling addiction are men, the National Council on Problem Gambling suggests the gender gap is narrowing. Data shows women make up the majority of gamblers ages 45-64.

The study looked at how gender affected experiences with Gamblers Anonymous. Though women initially experienced similar benefits to men, the review suggests women may use the program differently. Rather than only attending meetings, women participants are more likely to use GA as a tool for creating informal social networks with other women.

Even though the study confirmed the benefits of Gamblers Anonymous, the authors say their research highlights the need for more research into effective treatments for problem gambling.

References:

  1. Gamblers Anonymous associated with progress, could benefit from more combined approach. (2016, April 5). Retrieved from http://www.eurekalert.org/pub_releases/2016-04/smh-gaa040416.php
  2. National Problem Gambling Awareness Week female gamblers fact sheet[PDF]. (n.d.). Washington, D.C.: National Council on Problem Gambling.
  3. Schuler, A., Ferentzy, P., Turner, N. E., Skinner, W., Mcisaac, K. E., Ziegler, C. P., & Matheson, F. I. (2016). Gamblers Anonymous as a recovery pathway: A scoping review. Journal of Gambling Studies. doi:10.1007/s10899-016-9596-8
  4. Wright, C. (2012, September 13). How gambling can kill you faster than drug abuse or alcoholism. Retrieved from http://www.alternet.org/how-gambling-can-kill-you-faster-drug-abuse-or-alcoholism

Cards, money, and poker chipsThe feeling-state addiction protocol is a modified form of eye movement desensitization and reprocessing, referred to as EMDR in mental health. EMDR is a trauma treatment modality recognized as one of the main treatments for posttraumatic stress (PTSD) and other forms of trauma.

In EMDR therapy, therapists desensitize a traumatic memory by having the person in therapy use eye movements (or other back-and-forth stimulation) while holding the memory in mind along with the feelings, images, and belief about self in that situation. This causes the brain to process the memory in a way that takes the charge off the memory, so it no longer feels disturbing. In feeling-state addiction protocol, we desensitize the pleasant memory causing the addiction by removing the charge from that memory.

Tom and the Feeling-State Theory of Addictions

The feeling-state theory of addictions assumes that the feeling underlying the behavior, not the apparent object or behavior, is the real goal of unwanted compulsive behavior. In alcohol or drug addiction, the substance creates the [fat_widget_addiction_right]“feeling-state” that causes the compulsive behavior. In behavioral addictions, however, any feeling-state can be linked to any behavior. Feeling-states are state-dependent memories created during an intensely experienced event. With gambling addiction, we look for the positive feeling-state linked to the gambling behavior.

I worked with a person in therapy, who I will call Tom, who came to me because he had “reached bottom with the consequences of his gambling,” as he put it. Tom is a 37-year-old man who started therapy saying that he wanted to overcome two addictions: a very destructive woman and gambling.

The precipitating incident that brought Tom to therapy was having just lost his last $12,000 in a poker game, the final straw that caused him to lose his house. He had recently moved in with his parents, and they insisted he deal with the gambling addiction.

Both of the addictions Tom wished to treat are known as process addictions or behavioral addictions because they are not addictions to a substance. When he first came to see me, Tom was dealing with an intense sadness from losing his relationship and shame from losing his house and moving in with his parents. Tom’s parents agreed to pay for his therapy and insisted he make measured progress, lest they throw him out of the house.

Although addiction to a person and addiction to gambling seem different, like all behavioral addictions, they both involve an addiction to a feeling-state. According to Dr. Robert Miller, who developed the feeling-state addiction protocol in 2011:

“The feeling-state theory of behavioral and substance addictions postulates that addictions are created when positive feelings become rigidly linked with specific objects or behaviors. This linkage between feelings and behaviors is called a feeling-state. When a feeling-state is triggered, the whole psycho-physiological pattern is activated. The activation of the pattern then triggers the out-of-control behavior.”

The first step in eliminating a compulsion, according to Dr. Miller’s feeling-state protocol, is to figure out the feeling-state that drives the compulsion.

Identifying the Real Addictive Behavior

In therapy, we determined that the feeling-state Tom was addicted to with gambling was bonding with his father, which had provided both a sense of belonging and mastery.

Tom had one brother who was five years older. He described his brother as the favorite and the one his dad often Tom was very shy and described himself as someone who had never excelled at anything. He had few friends and participated in few social activities. In fact, the first time he said he felt any positive attention from his father was when he would watch his father’s poker games every week.praised for his intellectual ability and athletic success. Tom was very shy and described himself as someone who had never excelled at anything. He had few friends and participated in few social activities. In fact, the first time he said he felt any positive attention from his father was when he would watch his father’s poker games every week.

By the age of 18, Tom became a good observer and was playing cards with his dad’s poker group. He was skilled and was often the winner. It was this feeling-state of bonding with his father and the feeling of belonging to a group that drove his gambling compulsion.

We processed these strong feeling-states with EMDR, and his craving for gambling started to subside. We then discovered other feeling-states linked to his gambling. They were the feeling-state of freedom and mastery. Once we unlinked or disconnected these feeling-states with gambling, his desire for gambling waned and we could then address the psychological dynamics underlying the “need” for the gambling, such as his relationship with his dad, his feelings of being a “loser,” and the belief he is not smart and can’t succeed at anything.

We also desensitized his attraction to the destructive woman who had recently come back into his life. When he realized how easy it was to remove that attraction for her, it gave his self-esteem a huge boost. This helped him see other dynamics in his life with more clarity and confidence.

I have used this model with many process addictions, including:

I find it to be effective and relatively easy for the person in therapy because the person largely avoids the pain of going through withdrawal.

References:

  1. EMDR International Association. (2014). What is the actual EMDR session like? Retrieved from http://www.emdria.org/?120
  2. Miller. R. (2011). The feeling-state theory of behavioral and substance addictions and the feeling-state addiction protocol. Retrieved from http://www.psychinnovations.com/EMDRSD/Miller_Feeling_State_Addiction.pdf

Waiting room in an officeThere are many different types of residential treatment centers (RTCs) that offer therapeutic care for a wide variety of behavioral and mental health issues. Choosing a center that is suited to your personal needs is important; however, with many options available, making a decision may be difficult. How can you decide which RTC is right for you? Consider these answers to ten frequently asked questions about RTCs, as well as insight from Darren Haber, MA, MFT, an expert on addictions and compulsions.

1. What is a residential treatment center?

A residential treatment center is a health care facility that helps people experiencing various substance dependency and behavioral issues. For some inpatient treatments, residents may be required to live at the facility for a period of time. Some facilities also offer outpatient treatment to help former residents avoid relapse and to provide options for people who cannot commit to living at the facility temporarily. In most cases, treatment lasts for one to three months.

“[The] average stays tend to be 30 days, but some stay longer, and some shorter. Thirty days seems to be the industry norm,” Haber said.

2. What are the most important things to look for in an RTC?

Check and confirm that the RTC and any programs you wish to attend are accredited and the treatment programs are being administered by licensed, qualified mental health professionals. Ask if the program has a clinical director and about his or her credentials. Learn as much as you can about the treatment center you’re considering through third parties such as the Better Business Bureau, online reviews, and any local consumer protection agencies. If you need it, ensure that an active aftercare program is in place to help prevent relapse.

3. What type of issues do residential treatment centers treat?

Because different RTCs specialize in treating different health issues, the structure, routines, and therapeutic methods used will vary from facility to facility. Some centers take a “lock-down” approach where residents are secured within the facility’s premises and their movements inside the center are restricted. Other RTCs may take an unlocked approach and allow residents to traverse the premises with some degree of freedom; however, residents may only be permitted to leave the center if certain conditions are met.

In recent years, the residential treatment field has expanded. At some centers, everything from substance abuse to sex addiction to codependence may be treated. There are also centers that focus solely on substance abuse or eating disorders, for example.

Issues treated at an RTC may include:

It should be noted, too, that some RTCs specializing in mental health treatment may not provide therapeutic care for substance dependency issues.

4. Why do people go to residential treatment centers?

“Usually because their condition or problem has reached the point where it needs containment—that is, 24-hour medical or psychological monitoring due to harmful behaviors or medical problems—and has become so acute that it requires an acute, sustained focus,” Haber said.

5. What kinds of services are provided by RTCs?

Residential treatment centers offer a variety of services, which may include 24-hour supervision, intensive recovery programs, individual counseling, group counseling, structured activities, educational services, social skills training, vocational training, and relapse prevention services.

6. What are the benefits of a RTC over other forms of treatment?

The environment in a residential treatment center is usually more comfortable than the sterile, functional setting of a hospital. The residents are able to focus solely on their healing and recovery programs as they are removed from the stresses of daily life.

Some treatments, such as chemical detoxification, may be life threatening. For those cases, RTCs provide trained medical personal to keep residents safe during such treatments. Residents also have the opportunity to explore the emotional and psychological underpinnings for their behaviors in counseling sessions with a qualified mental health professional.

“Some people also go for legal reasons, such as being ordered by a judge after a DUI or DWI, for example. Usually one goes to an RTC because living life day-to-day has become unmanageable or to the point where one’s well-being, job, or close relationships are threatened,” Haber said.

7. What is the experience of being a resident at a residential treatment center like?

“It’s really what the client or patient makes of it. Anyone who participates to the best of his or her ability can potentially gain much and grow and learn tools for lifelong use. If one has been forced in by family but doesn’t believe, for instance, that one truly has an issue with alcohol or addiction, it can feel almost like jail,” Haber said.

8. How can families or friends keep in touch with residents?

“It depends on the policy of the residential treatment center. Some encourage family contact and some don’t. Some RTCs prefer those in treatment wait until their detox is over, or that the person in treatment only meet family members with counselors present. I believe this is a crucial part of treatment that can easily be overlooked, since dysfunctional family systems often play a crucial role in the formation of the illness or addiction,” Haber said.

9. Are there any RTCs in my area?

With the number of treatment facilities currently providing care across the country, chances are there is a residential treatment center nearby. However, it is important to remember that your chances of recovery may be better if the chosen facility is well suited to your personal preferences and specific health condition.

10. How much does treatment at a residential treatment center cost?

“Some people also go for legal reasons, such as being ordered by a judge after a DUI or DWI, for example. Usually one goes to an RTC because living life day-to-day has become unmanageable or to the point where one’s well-being, job, or close relationships are threatened.”The cost of treatment at a residential treatment center will vary based on the condition being treated, services provided, length of treatment, and the location of the center. For example, The Betty Ford Center, one of the most well-known rehab programs, charges approximately $1,217 per day for inpatient alcohol addiction treatment at their Rancho Mirage, CA location. Other locations may charge more or less, and some may not offer a per-day rate. Most locations develop a program based on a person’s individual needs, which can drastically affect the cost depending on medication or other requirements.

Some facilities may be able to offer a sliding fee based on a person’s income, while some may be low or no cost. Others may offer luxurious settings and amenities. The types and costs of RTCs simply vary. If your personal health insurance covers residential care, even the more costly facilities may become affordable. Call your insurance company for more information regarding your covered benefits if you are in need of inpatient treatment.

References:

  1. The Addiction Recovery Guide. (2015). Drug and alcohol addiction recovery. Retrieved from http://www.addictionrecoveryguide.org/treatment/residential
  2. The American Residential Treatment Association. (n.d.). Types of programs. Retrieved from http://artausa.org/type_programs.html
  3. Federal Trade Commission. (n.d.) Residential treatment programs for teens. Retrieved from http://www.consumer.ftc.gov/articles/0185-residential-treatment-programs-teens
  4. Hazelden Betty Ford Foundation. (n.d.) Addiction treatment specialties. Retrieved from http://www.hazeldenbettyford.org/treatment/locations/betty-ford-center-rancho-mirage
  5. Mental Health America. (n.d.). In patient care. Retrieved from http://www.mentalhealthamerica.net/patient-care
  6. National Institute on Drug Abuse. (n.d.) Principles of drug addiction treatment: a research based guide. Retrieved from http://www.consumer.ftc.gov/articles/0185-residential-treatment-programs-teens
  7. Smith, M., & Segal, J. (2015). Choosing a drug treatment program: What to look for in substance abuse rehab. Retrieved from http://www.helpguide.org/articles/addiction/choosing-a-drug-treatment-program.htm

man silhouette in the fogMany people struggle with addictions in today’s stressful society. Drinking and/or using drugs, overeating, sexual compulsions, and gambling are all ways in which individuals attempt to self-soothe and forget about their problems. These misguided methods all have one thing in common—they enable the individual to temporarily attain a different state of consciousness in order to avoid looking at painful emotions they may be feeling.

Alcohol and drugs obviously create altered states of mind, but overeating, gambling, or having a sex addiction do as well. For those who overindulge, food typically brings up early memories of comfort and is used to fill up an inner sense of emptiness. Many who gamble tend to forget or overlook everything except the thrill and excitement of the potential win. For many individuals with a sex addiction, there is an attempt to seek connectedness through the sexual act, without having to connect on an emotional level.

So what are some ways that individuals can learn to cope with their emotions in a healthier way? The following steps can be taken to help overcome an addiction:

[fat_widget_addiction_right]

  1. Join a support group. There are many different peer-led support groups available that can be very helpful when trying to overcome any kind of addiction. Alcoholics Anonymous, Narcotics Anonymous, Overeaters Anonymous, Sex Addicts Anonymous, or Gamblers Anonymous, for example, are all groups where people can relate to others who are dealing with the same types of issues. Individuals hold each other accountable and are often inspired by others’ success stories.
  2. Explore issues that the addiction may be covering up. Often, people resort to unhealthy coping mechanisms because they are struggling with painful emotions and/or traumatic situations that have not been integrated. Seeking out a qualified therapist can be helpful in working through past trauma and learning healthier ways to cope.
  3. Keep track of your triggers. By noting the times you feel tempted to indulge in an addiction, you can begin to bring more awareness to the situation. For example, do you start drinking after work every time your boss criticizes you? Do you binge on fast food whenever your self-esteem is at a low point?
  4. Look for the purpose your addiction may be serving. Many people struggling with addictions have difficulties with relationships. The addiction becomes their relationship of choice, and the individual may spend much of his or her time thinking about ways to indulge in it, rather than examining underlying issues related to connecting with others.
  5. Learn to experience emotions rather than avoid them. Addictions are often an easy way to escape from feeling painful emotions, but this is only a temporary solution and ends up making the problem much worse. Try to spend five to 10 minutes a day just sitting with your eyes closed and focusing on the sensations in your body. Painful emotions tend to be held in the body and are typically experienced as a tightness or constriction. Practice mindfully sitting with the sensations, honoring and welcoming them, rather than trying to push them away. Remember to breathe in and out deeply when doing this exercise.
  6. Journal about your feelings. Journaling is a helpful tool to get uncomfortable emotions off your chest. Whenever you feel triggered to indulge in your addiction, try to write about the thoughts and feelings that you are experiencing instead. This technique can also be useful right before going to bed, especially if you tend to toss and turn and ruminate over stressful issues.

Overcoming an addiction can be extremely challenging, but using some or all of the techniques above can be a great starting point. If you have a severe drinking or drug problem, you may need to start off with residential treatment in order to be surrounded by individuals who support you on your healing journey.

The first step can feel like the most difficult one, but recovery from any type of addiction is absolutely possible for anyone willing to reach out for help.

dice bouncingWhen your gambling gets out of control, it can be extremely destructive and devastating to you and to those with whom you associate. Because a gambling addiction develops over time, you, your friends, and family members may not notice that your behavior is compulsive or getting out of hand. However, just because you gamble and enjoy gambling a lot does not mean you are addicted to it.

There are ways to determine whether certain behaviors and activities related to your gambling suggest that you are enjoying a recreational activity or if your gambling has become a compulsive habit with potentially serious consequences. As an addiction psychologist and certified addiction counselor in Pennsylvania, which recently bested New Jersey in combined gambling revenue for 2012 and 2013, many people come to me to find help sorting through the interrelated mental health issues that may fuel gambling behavior in order to determine whether they have a mild gambling problem, a major compulsive and pathological issue, or just an expensive hobby that is all in good fun.

It’s rare, but possible, to develop a gambling addiction after your very first gambling experience. When problems develop, they usually progress over time. Many people participate in social gambling for years with no problems. More frequent gambling or life stressors can contribute to social gambling becoming a serious problem. Most casual gamblers can stop gambling when they have to because of losses; they can set a loss limit and easily follow it. People with a compulsive gambling problem feel strong urges to keep gambling to recoup their lost money. When gamblers are betting to chase losses, things can tailspin out of control, gamblers can lose touch with reality, and the issue can manifest in severe and exacting consequences. Over time, this issue can become more and more destructive.

[fat_widget_addiction_right]

For many compulsive gamblers, gambling is about the thrill, not the money. Some begin to take bigger risks and place larger bets to keep getting more of a thrill; this can take a financial toll. When a gambler is trying to recoup losses, lives can be destroyed. Many folks with whom I work recount that their bottom was when this shift happened and they realized that they were gambling in the hope they could get back their losses.

A gambling addiction, unlike drug or alcohol addictions, often has no obvious physical signs or symptoms. Many people with problematic gambling habits deny that they have a problem. They minimize the problem or refuse to admit that their gambling is out of control. They often gamble in secrecy, not allowing friends and family to know about their behavior. They may lie, keep secrets, sneak around, or completely withdraw socially. They do this to make it difficult for anyone to interfere with or confront them about their detrimental behavior.

An important part of recovery from a gambling issue is to expose the gambler’s secrets—extra credit cards, hidden cash, unaccounted-for time, lies about income, etc.—over time to the right, supportive people at the right times. A therapist is a great start, and meeting other people who are recovering from gambling addiction can help a person to feel understood, supported, and guided into long-term recovery.

Just as substance abuse is characterized by uncontrollable urges to consume a particular substance, causing negative consequences to the addicted person and those around the person, a gambling addiction is characterized broadly by tendencies to gamble in ways that cause damage to the person who is gambling and those associated with that person. The urge to gamble can be especially overwhelming during episodes of stress or depression. A person may use gambling as an unhealthy way to cope. As the problem develops and becomes stronger, a gambler may become overly focused on gambling (gambling-seeking) and getting money to gamble.

What Are the Risk Factors?

Certain factors may put you at greater risk for becoming addicted to gambling or having a harder time stopping. These include substance abuse (alcohol abuse is common), mood (often depression) or personality issues or attention-deficit hyperactivity (ADHD); age (younger and middle-aged); sex (women gamblers usually start later in life and tend to have depression, anxiety, or bipolar and can become addicted quicker, although these differences are disappearing); family influence (having a parent with a gambling issue increases your chances); certain medications such as those which treat Parkinson’s and restless leg syndrome (RLS), called dopamine agonists, may have a rare side effect that results in compulsive behaviors, including gambling; and certain personality characteristics such as being highly competitive, a workaholic, restless, or easily bored.

The National Council on Problem Gambling, referring to a Harvard study, estimates that two million (or 1% of) U.S. adults meet the criteria for compulsive gambling in a given year. Another four million to six million do not meet the full diagnostic criteria for compulsive gambling, but meet at least one of them and are experiencing problems due to their gambling behavior. According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, a diagnosis of gambling disorder is made when someone meets at least four of the following nine criteria in a 12-month period:

  1. Tolerance: Needing larger wagers to experience the same “rush” (similar to the “rush” felt by drug users).
  2. Withdrawal: Restlessness or irritability when attempting to reduce or cease gambling.
  3. Loss of control: Repeated unsuccessful attempts to cut down or stop on his/her own.
  4. Preoccupation: Frequent thoughts about gambling experiences, whether past, future, or fantasy.
  5. Escape: Gambling to improve mood or escape problems.
  6. Chasing: Trying to win back gambling losses with more gambling.
  7. Lying: Hiding the extent of the behavior by lying to friends, family, or a therapist.
  8. Risked a significant relationship: Gambling despite damaging or losing an important relationship, job, or other significant opportunity.
  9. Bailout: Turning to friends, family, or a third party for financial assistance resulting from gambling activities.

Do You Have a Gambling Problem?

As with drug and alcohol abuse, it is often an indication that you have a problem if you are wondering whether you have a problem. If you are losing time from your everyday activities because you are gambling or thinking about gambling; spend more time gambling than you intended to; are gambling to escape worries or stave off boredom or loneliness; or spent money you needed to pay your bills or other expenses, you likely do have a gambling problem.

Are your friends and family expressing concern? They might be recognizing the ways in which your gambling is affecting you before you are. The sooner you seek help and treatment, the less damage to your finances, relationships, and work you will have to repair.

Would you like to stop? The first step to getting well is to accept that you have a progressive issue. It is so much easier to change when we want to, at least a little bit, and so much harder to change when we have to.

Quitting for a while or taking a break is a good indication that you have control over your gambling. It’s possible for some compulsive gamblers to go into remission where they gamble less or not at all. Without professional treatment, though, they will usually relapse.

Like other addictions, a gambling issue may wax and wane or come and go, just as different drugs become more in vogue depending on the zeitgeist. Many people who see me for addiction like to think of their compulsive behavior as the whack-a-mole game people play at carnivals. You can whack the mole, but it’s connected to something else and it will pop up again. It might pop up as a different gambling game, drug use, alcohol use, or shopping or food addiction. Whether it pops up in Atlantic City, Philadelphia, Las Vegas, or in a casino near you, gambling is here to stay, and so, too, is addiction. We must learn to live with these tendencies and become curious about how they work and what purpose they serve for us as individuals, our cultures, and society. With increased awareness and understanding, we can learn how to help ourselves and those we love and care about.

For help with an addiction issue, find a therapist.

Thank you for writing. The fact that your brother is angry at you for helping his family is a likely indication of how severe his gambling has become. (In addition to his seeking “lower companions,” as 12-step literature says.) Your question reminds me of how powerful family “systems” are, especially those affected by (what sounds like) addiction or compulsive behavior. It’s remarkable that you are being generous enough to allow his family to stay with you but wonder if you’re doing “enough.” I think the short answer is yes. You’re doing a great service.

But you ask another question that bears some examining, namely, “Am I doing the right thing here?” I’m coming to the conclusion that when compulsivity or addiction is involved, there is no “right thing.” For instance, partners of addicted spouses will ask me, “Is the right thing to stay or go? Try to help them get into rehab or is that enabling?” The right answer is yes and no to all of the above.

The downside to completely detaching (generally speaking, mind you) is that you begin to feel guilt or self-criticism for being aloof; if you get caught up too much in helping and it goes nowhere, you are likely to feel resentful, taken for granted, and so on. So I suppose there’s this magical balance that much smarter folks than I have not yet figured out. I suppose that, like all things human, God (or the devil) is in the detail. But gambling is particularly destructive because it involves money, which can crush a family’s resources like Thor’s hammer.

The advantage here—not always the case—is that your brother knows he has a problem. Not knowing how to stop is nothing to be ashamed of. Addiction or compulsivity on the level we’re talking about is as much a disease as depression or anxiety. (In fact, addiction parallels both.) How does a person “stop” bipolar? Or diabetes? Well, you see a professional. Fortunately, there are self-help meetings (Gamblers Anonymous) as well as addiction therapists or even treatment centers (such as the Control Center in Los Angeles or Sierra Tucson or The Meadows in Arizona) that can help. (More treatment centers are taking insurance these days.)

The point is, he doesn’t have to know how to stop because he probably can’t. (Step 1 in a 12-step program is saying, essentially, that you can’t stop and your life is chaotic due to that fact.) Also, you might check your own motives in that many family members in your position may (1) minimize the addiction (is it really that bad? Sadly, yes), (2) think you can “do something” best left to a professional counselor or psychologist, or (3) doubt yourself for not “doing more.” You cannot will a person with depression to get better by good intentions; ditto with addiction. The most eloquent Shakespearean speech will not convince an addicted person to do squat. Usually it comes down to setting consequences for the addicted person that may sound hard but tend to get attention: If you don’t stop, you’re going to ruin your family and/or lose your wife and/or access to your children. If you don’t stop, I need to pull away and detach until you get help; it’s too painful for me to watch a ship sink while the captain refuses life boats. Many people addicted to alcohol, for instance, don’t get help until their second, third, or fourth DUI. Many with sex addiction don’t stop until their partner threatens to end the relationship. And so forth.

You may also try to organize a family intervention, either informally or formally. This is trickier than it looks (despite what the movies and TV show us). I know some interventionists who would be willing to consult with you (perhaps for free or low cost) should you want more information on this; you can contact me via this website for more information.

You’re obviously a very caring and loving brother or you wouldn’t be writing. Sometimes the most loving thing you can do is tell the addicted part of the person, “We’re sick of you and how you’ve hijacked the person we love.” I would add that the sooner you and other family members—and your brother—take action, the better. Addiction is progressive and, like a shark, stays hungry and keeps moving. Thanks again for writing.

Best wishes,
Darren

AddictionAddiction occurs when a person becomes physically or psychologically dependent on a substance, thing, or activity, generally leading to withdrawal symptoms when it is unavailable. Many people engage in potentially addictive behaviors recreationally, but when those behaviors are abused to the point of interfering with day-to-day functioning at work, in the classroom, at home, or in relationships, it becomes a serious issue that may require intervention and treatment.

Faces & Voices of Recovery claims on its site that more than 21 million people experience addiction and are not yet in recovery, and according to the National Council on Alcoholism and Drug Dependence, approximately 17.6 million people in the United States experience alcohol abuse or dependence, along with millions more who partake in risky behaviors such as binge drinking. The all-consuming nature of addiction takes a physical, mental, and emotional toll on the addicted person and on those who love and care for him or her. It follows that recovering from addiction takes time, dedication, and support—and ultimately, the addicted person must be the one to summon the resolution and determination to make a full recovery.

[fat_widget_addiction_right]

Thankfully, there are several resources available for coping with addiction, be it yours or that of someone you care about. We’ve compiled a list of the 10 best ones—GoodTherapy.org excluded—for 2013. As with our previous top 10 lists, our selections are based on quality and depth of content, presentation, and functionality.

Nominate another website for our Top 10 awards here.

A woman conceals her phone call from her spouseMany mental health professionals consider the three “A’s”—addiction, affairs, and abuse—sufficient reason to leave a partner. This blog addresses lower-level offenses related to the first two. While most couples can overcome low-level indiscretions in any area of the three “A’s,” when multiple indiscretions occur or the degree of severity is greater, it may be time to throw in the proverbial towel. As couples grapple with why one partner cheated or entered the depths of alcoholism or drug addiction, they need to evaluate the patterns of relating they have become used to, the interpersonal dynamics they engage in, the dances they dance, and the issues they may have brought into the relationship. One theme that consistently emerges is the degree to which couples are honest with each other. How much do they divulge? How important is it to tell the truth? Do you really need to tell your partner everything?

In Alcoholics Anonymous, we hear people say, “We are as sick as our secrets.” Family addiction therapists are fond of saying that there are no family secrets. By this, they mean that even when we believe that other family members don’t know a certain secret, that secret still has an impact on everyone in the family. If individual members don’t know the specifics of the secret, they are still impacted by it and sense or experience it unconsciously—and that can affect the whole family. I work with patients who learned in their twenties or later in life that they were adopted, that their parents were once married to an abusive spouse, or that they have a sibling they never knew, among other revelations.

I’ve also become aware of the extent to which sober and recovering clients keep things from their partners. Even in relatively healthy relationships, there appears to be a fair amount of small-scale concealment and deception, though the extent of the infractions often is debatable. Several clients I see—coincidentally or not, all men—have reported engaging in exercise cheating. What’s that, you ask? Exercise cheating, essentially, is exercising and not telling your partner, or not revealing how much or what type of exercise one engages in.

Even I have been guilty of cheating on my wife. A few years back, as I was setting up my new Philadelphia office, I decided to buy a painting by an artist that my wife and I liked. My wife studies art history, and I thought she would appreciate that I was acquiring a painting by a Temple University master’s graduate. And while $650 is no small chunk of change for this sort of thing, I thought it was a great investment for my new office. I thought I would surprise her with the purchase. Instead, she was angry. “You art cheated!” she cried as soon as she saw it. She was genuinely annoyed that I had not consulted with her on a purchase of this magnitude. Whether I was right or wrong in purchasing something of that cost for my office was not the issue. What is important is my partner’s perceived betrayal and need for dialogue, negotiation, and consultation.

Many hypothesize that cheating behavior is related to vestiges of evolutionary differences among men and women. While this theory would be a gross generalization in today’s society, it suggests that it was more adaptive in an evolutionary way for men to cheat than for women to cheat. Assuming evolution prioritizes any behavior designed to propagate one’s genes, men may benefit from spreading their genes in a quantity-focused way. Women, meanwhile, have long gestation and nursing periods which may temporarily move them to be more devoted and committed to their offspring. Thus, they benefit from finding a better quality mate. In other words, women are biologically, or at least evolutionarily, better at taking care of their young, especially in early developmental stages. Most people agree, and research appears to back this up, that most men think about sex more frequently than women do. While both men and women want to find a quality mate, men may be more inclined to seek quantity than women are.

According to this evolutionary perspective, neither men nor women want their mates to cheat because a mate who cheats may have more offspring, which in turn means that mate is less likely to care for the original partner’s offspring and more likely to leave and care for his or her new offspring. It is in a man’s evolutionarily best interest not to alert his partner to the fact he is cheating. Any behavior—sexual or not—that results in producing healthy offspring is powerfully reinforced to the extent that it aids in propagating an individual’s genes. So, infidelity and hiding that infidelity through the processes of natural selection and evolution can become more prevalent over time.

A fair question would be whether cheating sexually is related at all to other types of cheating. Just because a partner doesn’t tell a mate where he or she is going and what he or she is doing doesn’t mean that an affair is happening, and it doesn’t mean that a tendency toward nonmonogamous behavior is the cause of disingenuous behavior in the context of the couple. In fact, the point of this article is to lessen the impact of minor violations of the honesty contract. Putting small indiscretions of dishonesty in an evolutionary context may allow couples to see this behavior as resulting from the natural instincts of the animals we are. What is important, though, is that as humans we have the capacity to dialogue. This is precisely what can keep our natural tendencies in check. Speaking honestly to our partners about our needs and wants, while often challenging, is the hallmark of a healthy relationship.

Smoking gun example: A client once described an interaction he had with his wife after she busted him for smoking pot in the garage. She smelled the smoke even as he vehemently denied he had been smoking marijuana. When she found his metal pipe, still warm, he stuck to his story. “The lie just came out,” he explained later. “I was so used to it.” He eventually was able to talk about why he lied and why he has often felt the need to cover things up. It had nothing to do with infidelity, but was instead linked to his history of struggling to feel good about himself, to be able to ask for help with his emotions feelings and thoughts and to find purpose and meaning in his life. Beginning to discuss these issues with his wife and therapist helped him think more carefully about his tendency to lie and cover his tracks. He became better at advocating for himself and negotiating with his partner in a more healthy way.

Honesty is important in recovery from any mental health issue, whether it be depression, anxiety, or stress, but it is especially important in recovery from addiction and substance use because of the strong tendencies to hide, deny, and minimize one’s behaviors. Seeing an addiction psychologist or other specialist is an important first step in understanding one’s self. It is in this therapeutic relationship that a quick foundation can be set for the basis of an honest dialogue with one’s partner, friends, and family. Rebuilding relationships with those we love and who love us is essential to recovery from addiction. Understanding ourselves and the reasons we might cheat and lie can enable us to pause just long enough to ask ourselves whether we really want to go ahead with the behavior or if we might be able to rely on those close to us to help us through the difficult times. Honest communication with the people in our lives is the only way we can become and stay sober or make meaningful and lasting changes in our lives.

Important Notice

GoodTherapy is not intended to be a substitute for professional advice, diagnosis, medical treatment, or therapy. Always seek the advice of your physician or qualified mental health provider with any questions you may have regarding any mental health symptom or medical condition. Never disregard professional psychological or medical advice nor delay in seeking professional advice or treatment because of something you have read on GoodTherapy.