Problem Gambling - Its all in your brain . . . and your genes

At the recently held 5th annual National Center for Responsible Gaming Conference on Gambling and Addiction, researcher, Dr Howard Shaffer of Harvard Medical School presented a paper that suggests gambling and other addictions are caused by an underlying syndrome which affects the brain and is present in our genes.

The NCRG is the gaming industry's research body which has been criticised over its objectivitiy in recent months. The following comes from an description of Shaffer's presentation to the conference on the NCRG website:

To this point, addictions to drugs, alcohol, gambling and other substances have been treated as separate and distinct disorders. According to the research, this current view of separate addictions might be similar to the view espoused during the early days of AIDS diagnosis, when rare diseases were not yet recognized as opportunistic infections associated with an underlying immune deficiency syndrome.

A syndrome is defined as a cluster of symptoms and signs related to an abnormal underlying condition. Not all symptoms or signs are present in every expression of the syndrome, and some manifestations of a syndrome have unique signs and symptoms.

In their review, the Harvard researchers cited multiple studies showing shared neurobiological causes, shared psychosocial causes and shared experiences across different addictions that point to the validity of the syndrome model. The research also indicates that addiction to any particular object is due in large part to exposure, access and the capacity to produce a predictable and sought after shift in the mental state.

For example, many studies have shown that psychoactive drugs (e.g., alcohol, cocaine, heroin) and behaviors (e.g., gambling, shopping) cause similar neurological reactions. In fact, according to the study, neurobiological reward activity represents the most well-known evidence that supports an addiction syndrome.

There is also evidence suggesting substantial genetic and environmental commonality across addictive behaviors. For example, pathological gambling shares a common genetic vulnerability with alcohol dependence. Additional studies have indicated that individuals are frequently dependent on multiple substances, again indicating a general addictive tendency. These further findings suggest that the genetic link to addiction does not account for vulnerability to a specific object of addition, but instead a general and increased risk for addiction.

Dr. Shaffer noted that the causes of addiction include personal vulnerabilities, object exposure and object interaction. More specifically, throughout their lives, people encounter and accumulate specific combinations of neurobiological and psychosocial elements that can influence their behavior and contribute to their susceptibility to addiction. Some elements increase the likelihood of addiction, while other factors, such as support networks or religious beliefs, are protective and reduce the chance of addition. At the same time, individuals are exposed to and have access to different objects of addiction. Exposure increases the chances for interaction, which can lead to problems for at-risk individuals.

Looking at addiction as a syndrome has many important implications for treatment. About 80 to 90 percent of individuals entering recovery from addiction will relapse during the first year after treatment. This circumstance might be due in part to the current standard use of focused, object-specific treatment approaches. By shifting to a syndrome approach, the most effective addiction treatments might include both object-specific and addiction-general treatments. The syndrome model further encourages clinicians to recognize that patients develop new risk factors during treatment that can interfere with recovery efforts, and it requires clinicians to develop multidimensional treatment plans that account for the many relationships among the multiple influences and consequences of addiction.

Whilst this hypothesis may be valid, it is also very convenient for the industry as it places the fault for gambling problems on the individual. Basically it says that you have an underlying syndrome and you should have prevented your exposure to gambling or you wouldn't have a problem. It also says that gambling is fine for everyone else that doesn't have the syndrome.

Another session at the conference, took this even further. “Is Addiction a Brain Disease: What Genetics and Brain Scans Are Telling Us About Gambling and Substance Use Disorders” blames the functioning of the brain as actually playing a part in the poor decision making of problem gamblers. In this except the presenters also blame genetics for vulnerability to problem gambling behaviour.

Kosofsky and Gasic noted that brain scans show that whether a person is addicted to drugs or pathological gambling, the addiction actually changes the shape of the brain, and that this change occurs early in exposure to the substance or activity and is long lasting. Gasic also noted that, in particularly vulnerable populations, long-term drug use can actually cause permanent damage to the brain, which may also be true of pathological gambling.

While the common neurological responses of all addictions are clear, Gasic said the level of vulnerability to addiction is where genetics plays a role. In fact, he said, brain scans show that there are indeed populations that are more susceptible to addiction than others. Studies of twins and families have shown that the brain of a child of an alcoholic and that of a non-alcoholic, even before exposure to alcohol use, develop differently. Yet, both researchers noted that while a genetic predisposition for addiction exists, environment and behavior still play a key role in determining susceptibility to addiction.

Industry seems to be moving to a certain position that problem gambling is a medical problem that is not caused by the machines but by an underlying condition that is not managed by the individual. This seems to be exemplified by this statement:

Finally, Kosofsky and Gasic noted that researchers and clinicians must stop treating each addiction as unique and must begin to adopt the syndrome model. According to the researchers, addiction is both a brain disease and a behavior that individuals can somewhat control. Just as in diseases like diabetes or asthma, the disease can be managed through proper treatments and individual responsibility.

This is an interesting approach from the industry and selected researchers. I would be interested in your opinions on this, as I am still dissecting it and as I am not a psychologist or affected gambler, it is difficult to get a clear position although I am naturally suspicious of the industry.

GG