Deep in the Brains of Gamblers

This article sums up my 20 plus year struggle with compulsive gambling and also points to hope. I know there is hope because I am very involved with Gamblers Anonymous, I have a wonderful support network from my family and friends and I know I am not alone on this journey. My life is full of hope because I am finally living openly and honestly one day at a time.

Deep in the Brains of Gamblers

Researchers have found that pathological gambling is a disease: The brains of addicts are wired differently than those of nongamblers.

The day that Marilyn Lancelot won the biggest jackpot of her life, she left the casino in Yuma, Ariz., with every penny of the $4,000 that had poured out of the slot machines. This time she knew that she would never gamble again.

She was right, although not for the reasons she thought. The next day, seven police cars appeared in her Phoenix driveway and she was taken out of her house in handcuffs. Lancelot, a 61-year-old grandmother had embezzled more than $300,000 from her employer to support her gambling addiction.

"I had something wrong with me," says Lancelot, now 75 and living in a retirement community in Phoenix. "Some people can't think that gambling is an illness but maybe it is. I know that I couldn't stop. My head wouldn't let me."Lancelot's turn of phrase contains clinical truth.

Researchers are learning that the heads -- or to be more accurate, the brains -- of pathological gamblers are biologically different from those of most of the estimated 73 million Americans who are able to play bingo, pull the arm of a slot machine or flip some aces and then simply stop. Not only does the research shed light on how this addiction is both similar and distinct from other addictive disorders, it also could contribute to new treatments.

An easy temptation

The need is undeniable. With legalized gambling in 48 states, 40 states with lotteries and online gambling available in any home with Internet access and a credit card, the triumph of the occasional big win has been accompanied by a rich yield of individual lives in shambles.

About 1.6 percent of Americans have a full-blown gambling addiction and an additional 2 percent have a serious problem with gambling, says Jon Grant, assistant professor of psychiatry at Brown Medical School and author of Stop Me Because I Can't Stop Myself (McGraw Hill, 2003). By these estimates, nearly 4 percent of the population experiences a mild to severe gambling problem -- and as the number of gamblers goes up, so does the number of those with a gambling problem.

Now, with the aid of neuroimaging techniques and a greater understanding of neurotransmitters, researchers are discovering that the brain's hard-wired reward system and frontal lobes have certain unique characteristics in these gamblers. Even some of their personalities and genes may be different from those without gambling problems."We are finding that pathological gambling is very definitely a brain disease," says Timothy Fong, a psychiatrist and co-director of the Gambling Studies Program at the University of California, Los Angeles.

"The central question is: Were pathological gamblers born that way or are the changes in their brains the results of excessive gambling? We are far from answering that question in a meaningful way."

Stories are the same

Pathological, or compulsive, gamblers simply cannot stop gambling, even when their losses cripple their lives. The narratives, though as unique as each life, have a similar trajectory: a fascination, then obsession with gambling, punctuated by a few wins and colossal losses often involving houses, jobs, personal relations and savings, finally resulting in a shattered life.

Nearly 20 percent of pathological gamblers have filed for bankruptcy protection, compared with 4.2 percent of nongamblers. But perhaps a more telling, and certainly more tragic consequence, is that compulsive gamblers are nearly four times as likely to have attempted suicide than noncompulsive gamblers.

The explanation for why gambling is the drug of choice for one person, and for another it's heroin is still unknown. But the key to most addictions can be found in the brain's reward system, particularly a region called the ventral striatum. Neuroimaging studies of compulsive gamblers point to a different functioning in this neural system.

A study published in February in the journal Nature Neuroscience compared 12 pathological gamblers and 12 healthy people. While lying in a functional magnetic resonance imaging machine, all were asked to choose a playing card by pressing a button. If the card was red, they won money; otherwise they lost money.The task activated the ventral striatum, an area of the brain that is primed for pleasure and reward-seeking behavior. But the experience of pleasure was far less pronounced for pathological gamblers. The more serious the gambling problem, the less activation of that region.

When the area is working normally, it responds to pleasure stimuli -- such as winning money or getting a gift -- filling us with a sense of happiness or satisfaction. When it is not working properly, as in cocaine addicts, this area seems almost indifferent. What would make a normal person react does nothing for people addicted to substances or behaviors. Even more stimuli, such as drugs, alcohol or gambling, are needed to feel the pleasure from a particular activity.

Research presented at the American Academy of Neurology meeting in April found that executive function, the brain circuitry that underlies inhibition and self-control, was deeply impaired in pathological gamblers. These impairments made the gamblers unable to truly comprehend the trade-off between short-term reward and long-term negative consequences.

And many studies suggest that compulsive gamblers may have reduced frontal-lobe activity, which may in turn be triggered by decreased activity in the basal ganglia, a deeper part of the forebrain that generates two important neurotransmitters called dopamine and norepine-phrine.

The feel-good neurotransmitter dopamine, in particular, has intrigued those studying compulsive gamblers. Several studies have looked at a dopamine receptor gene and have found real differences in the structure of that gene between gamblers and nongamblers.

That genetic predisposition has direct consequences on brain chemistry. The dopamine receptor sites in the midbrain that are driven by anticipation, but uncertain of the rewards, are especially sensitive. They require more and more dopamine to create the rush of happiness and satisfaction.

When gambling is the trigger for the dopamine rush, a vicious cycle is created.Drug results are encouragingUntil now, treatment has consisted primarily of cognitive behavioral therapy, which can help gamblers control impulses. But increasing understanding of the neurobiology of the disorder may result in new and more effective treatments.

One promising treatment is the drug naltrexone. In several preliminary studies, that drug reduced the urge to gamble and when gambling occurred, there was much less enjoyment or enthusiasm for it. Side effects can be unpleasant, and the drug can be toxic to the liver.

Marilyn Lancelot credits her recovery to a treatment program, not with drugs. She changed her behavior and simply stopped gambling. For other people, more intensive supportive therapy is necessary, or even placement in a residential treatment facility where each hour of the day is scheduled.

Lancelot now boasts a triple-A credit rating, works part time and is saving money. In January she will celebrate 15 years of being free from gambling. "I'll bet that the next 15 will be even better," she says. "But I don't bet."