It's Official - Gambling is a Behavioral Addiction

I’ve heard it said that an addiction is an addiction, meaning that they’re all pretty much the same in one sense--they draw you in and take control. gambler.jpg

Dr. Kenneth Blum. PhD, the eminent scientist who first dicovered the link between genetics and addiction in 1990, has long held that gambling is a Reward Deficiency Symptom.  Now, in February 2010, Join Together explained that for the first time, gambling will have its own category in the DSM, the Diagnostic and Statistical Manual of Mental Disorders: behavioral addiction. (The DSM is the "Bible" for the medical industry and required when providers bill insurance companies.)

However, when you start reading about gambling, some of the differences between problem gambling and substance abuse or dependence are striking.  For example, medicinenet.com  says that people who take medications for Parkinson's disease or restless leg syndrome have developed compulsive gambling. Who’d have thought it? Also, that risk factors for a gambling addiction include antisocial personality disorder, schizophrenia, bipolar disorder, and cocaine or alcohol addiction.

But there’s a lot that’s similar about gambling and substance abuse, too. People can lose jobs and money as a result of gambling as they can with the other activities. Just as there are numerous addictive drugs, there are also many ways to engage in gambling, from casino games and slot machines, to monthly poker games, to lottery tickets. And then there’s horse racing and jail-alai and the office football pool.  Internet gambling has exacerbated the problem.

According to SAMHSA, the Substance Abuse and Mental Health Services Administration, in 2004, at least 30 states provided services for gambling addiction. But as states are dealing with budget woes, addiction services are being cut. The New York Times reported that Nevada, for one, has proposed cutting financing, which doesn’t seem propitious when the state is the country’s gambling capital.

We may all know people who looked to gambling when they were desperate financially, in the hope of making a quick buck. And in these down times, a lot of people are tense about money. It’s not a time to cut gambling treatment programs.

Understanding the Addicted Brain

A potential client called the other day.  We will call her Samantha.  She is a prescription pill addict who by chance shares a doctor with Bill, the 22 year old I wrote about recently (“Addiction by Prescription: The Purdue Pharma-OxyContin Saga Continues’).   oxycontin2.jpg

 

Samantha was taking Oxycontin -- three 80 mg tablets/day plus up to five additional 10 mg tablets.  The list of operations she had undergone in a short span of time indicated she might be suffering from Munchausen  Syndrome, a psychiatric condition wherein those affected feign disease, illness, or psychological trauma in order to draw attention to themselves (or to get more prescription medication).  Her husband, the de facto caretaker of their son was threatening to leave and take their child with him. 

 

Because her insurance was too limited to cover treatment at our facility, I tried to steer her to other rehabs that would take her insurance, but she kept calling.  She wanted a “high end” rehab.  She and her husband wrote a check to cover detox and she checked in.

 

Two or three days later, well before Dr. Thom Lobe could get a baseline, still in the throes of detoxing off the synthetic opiates, she suddenly decided to leave.  There was no stopping her, no convincing her.   Everyone tried.  Other clients, who have been in treatment longer, understood.  They told me:  “That is her disease talking.”  And “Her disease is in control.”

 

They were right.  They have been in treatment long enough already to know that their addiction is a disease of the brain, more specifically it is a disorder of the brain’s reward system.sfo-limbic-brain-with-labels.jpg

 

I had been planning for some time to write an article simplifying for myself and others the science surrounding the “addicted brain.” Then when Dr. Roger Waite (a partner of Dr. Kenneth Blum) scored a home run explaining to clients and their families the role of the brain in recovery, I was inspired to stop procrastinating and start writing.   It was not easy.  I relied on some of Dr. Kenneth Blum’s many writings, Dr. Kevin McCauley’s 2008 “Is Addiction Really a Disease?” presentation at the Conference on Neuroscience and Recovery, and some pretty good information on the web.

 

Here is what everyone agrees on:

 

1)    The brain is the most complex organ in the body. It is the organ that allows us to think, have emotions, move, and even dream.

 

2)     The brain’s Limbic System (unconscious) develops and matures first. It is this part of the brain that governs our thinking process for the first 15-18 years of life. 

 

3)   The Limbic System understands, learns and responds on the most primitive level.  Though it cannot exercise rational judgment, weigh options or postpone satisfaction, it is in charge of survival and reward mechanisms. 

Pre frontal and limbic.jpg

4)   The Frontal Cortex is the most recent addition to the brain.  It evolved to evaluate how best to satisfy and cope with our conflicting demands for pleasure and relief.   In our late teens and early adulthood it becomes the body’s true center for command and control, responsible for functions such as reasoning, problem solving, judgment, impulse control.  It manages higher emotions such as empathy and altruism, causes us to feel love, have morality, decency, responsibility, spirituality.  It is where we make “conscious choices.” 

 

5)   When the Frontal Cortex fails in its ability to inhibit the drive to seek drugs, the decision-making processes pass to the unconscious Limbic system which associates alcohol and drugs with the principal source of pleasure and relief in life, and with survival itself.  

 

6)   The reward center of the brain which resides in the Lymbic System is compromised.   Dr. McCauley describes this as “Pleasure Deafness.”   He writes: “The patient is no longer able to derive pleasure from those things that have been pleasurable in the past…Addiction is a stress induced hedonic (pleasure) dysregulation.

 

7)   Dr. Blum puts it this way:  “If someone was to hold your head under water and prevent you from breathing your natural survival instincts would kick in and you would do almost anything to breathe again.  When the Limbic System’s Reward centers are diminished or shut down then the same “breathing” survival instincts activate in order to increase those feelings of Pleasure and Reward."

 

8)   When the Limbic system (the primitive brain) speaks the rest of the brain listens. It is much easier to understand someone’s irrational “Drug Seeking” behaviors when you understand the origins of that motivation.   The key to treatment for these individuals is to normalize these Limbic regions of the Brain so that the Frontal Cortex (Logic & Reasoning) can predominate.      

 

Samantha’s irrational determination to “survive” by leaving treatment in the middle of a difficult detox from powerful prescription pills was made by the Limbic (“survival”) part of her brain.    The drugs had shut down the ability of her Frontal Cortex to think rationally and be rewarded by dopamine surges which come from normal pleasures.   Her behavior was that of someone with low dopamine levels, either  because she was genetically predisposed to addiction, or had depleted her dopamine levels with drugs, poor nutrition, and lack of appropriate exercise.

 

Here is what Samantha looked like to us "normies," clients nearing the end of treatment, and staff in recovery already many years[1]:

 

 

SOBER PERSON

ADDICT

Frontal Cortex Does the Thinking

Limbic System In Control

Free Will Exists                      

No Free Will

Responsibility

No Responsibility

Can stop         

Can’t Stop

Punishment & Coercion DO work

Punishment & Coercion DON’T work

Sounds familiar?

 


[1] Adapted from Dr. Kevin McCauley ‘s explanation of “Choice vs. Disease” 

Dopamine for Dummies - Understanding Dr. Kenneth Blum and the Reward Deficiency Syndrome

Dr. Kenneth Blum.jpgDr. Kenneth Blum, PhD, the internationally recognized authority and researcher on neuropsychopharmacology and genetics, came to lunch the other day with his colleague Dr. Roger Waite.    Here is what Dr. Blum had to say about our program:

"I am very impressed at what you have been able to accomplish. Especially in the non-pharmaceutical and non-nutraceutical arenas (diet, nutritional supplements and breathing techniques).  Everything you have follows the Dopamine Agonist Modus Operandi.  Your treatment program builds dopamine levels.   Your low-glycemic lunch was out of this world…You have what is really going to turn a person’s life around. That includes, and that is, a lifestyle change -- and more importantly -- an easy program that an individual can follow for the rest of their life."

Now coming from Dr. Blum, who has near icon status at the Malibu Beach Recovery Center™, this is BIG.   I have long known that the holistic component of the Malibu Beach Recovery Center System for Treating Addiction™ is an outgrowth in great measure of Dr. Blum’s many years of breakthrough research into the relation between genetics and addiction and to his discovery of the “Reward Deficiency Syndrome.”  Most addicts he has studied have chronically low dopamine levels.  Our combination of diet, yoga breath work, and food supplements was specifically designed to help our clients raise their dopamine levels and re-balance their brain chemistry, enabling them to once again feel happy and get pleasure from something other than seeking and using their drug of choice. 

I barely passed “Physics for Poets,” a class offered by UC Berkeley to help liberal arts majors fulfill General Education science requirements. So, to write this important blog about Dr. Blum’s visit to the Malibu Beach Recovery Center, I had to spend a lot of time on Google, on Dr. Blum’s website and talking to Dr. Waite.  Here is the result, which I have dubbed “Dopamine for Dummies.”  I hope no one will be offended.

Dr. Blum, who has devoted his life to studying the relationship between genetics and addiction, is credited with co-discovering the so-called “alcoholic gene” in 1990.  That was the year he authored with Dr. Ernst Noble, former director of the NIH's National Institute of Alcohol Abuse and Alcoholism (NIAAA) and researcher from UCLA, a study published in the prestigious Journal of the American Medical Association, which found correlations between the Dopamine D2 Receptor Taq 1 A1 allele (a gene) and alcoholism

Dopamine is sometimes called “the reward chemical,” the “pleasure molecule,” and the “anti-stress” molecule. It is the primary neurotransmitter found in the brain that is responsible for happiness and other emotions.  It is essential for the normal functioning of the central nervous system. Dopamine provides feelings of enjoyment and reinforcement that motivate a person proactively to “feel good.”   

Several years after discovering the “alcoholic gene,” additional studies led Dr. Blum and others to conclude that it was a misnomer and there is, in fact, no such thing as a “single” alcoholic gene.  Dr. Blum came to believe that the genetic anomaly previously found in alcoholics is also present in drug addicts and other people with compulsive or impulsive disorders, including overeating and obesity, attention-deficit disorder, pathological gambling and many more.  He has since clarified that this gene is more accurately defined as the “reward gene.” To date there are over 2,866 published peer reviewed articles claiming that the Dopamine D2 receptor gene is associated with addiction and reward dependence behaviors.   

In 1995, Dr. Blum defined the condition that occurs when genes do not work together as a cohesive unit as a “Reward Deficiency Syndrome.”  He hopes that this condition will one day be recognized officially as a disease.  His evidence indicates that over 1/3 of the U.S. population has some form of Reward Deficiency Syndrome, and that genetic factors account for between 40 and 60 percent of a person's vulnerability to addiction, including the effects of environment on gene expression and function.

The Brain.jpgIn a healthy person, Dopamine and other neurotransmitters  “cascade” like water cascading from one pool to another in a waterfall.  One neurotransmitter flows into an area of the brain and triggers release of another neurotransmitter.  The flow begins with Serotonin.  When it is released in the hypothalamus area of the brain, Enkephalins are released and initiate the transmission of GABA, which acts like a traffic cop.  GABA is important as it fine tunes the release of Dopamine.  GABA allows just enough dopamine to be released to provide reward, comfort, and pleasure from ordinary activities and a degree of calming to fight off unwanted stress. People who suffer from Reward Deficiency Syndrome cannot cope with the accompanying angst, agitation and emotional pain.  Their brains are unable to produce enough Dopamine, Serotonin, Norepinephrine, and Endorphins. 

When levels of these "feel good" chemicals are low or blocked from the brain's receptors by genetic or environmental influences; stress, pain, discomfort and agitation are the result.  To provide temporary relief  people with low dopamine levels self-medicate with substances that will produce a short-lived Dopamine response including  alcohol, illicit drugs, prescription drugs, junk foods, sugars, carbohydrates, caffeine, nicotine or other stimulants. These substances produce negative behaviors such as poor sleeping patterns that further depress their own endogenous Dopamine levels.  Exposure to prolonged periods of stress and alcohol or other substances can also lead to a corruption of the "cascade.”

Some people with low Dopamine levels do not self-medicate with alcohol and drugs, but become clinically depressed and anxious. 

These behaviors bring with them the possibility of more long-term consequences.

Both genetics and environment greatly affect what Dr. Blum calls the “brain’s reward cascade.”  Therefore, it is often quite difficult to determine what is the root cause of Reward Deficiency Syndrome. However, if Reward Deficiency Syndrome has its origins in your genetic makeup, according to Dr. Blum’s research people have the power to change their genes' expression. That is, they have the ability to respond to whatever life circumstances they may be in right now and change them to something better through healthier choices -- be it healthier nutrition (nutrigenomics) or healthier thoughts, emotions, and lifestyle choices (epigenetics). Either way, the choice and the power are theirs.

Dr. Blum has long believed, and many studies have proven, that in order to overcome genetic predisposition to addiction, certain amino acids and other nutraceuticals must be used to bolster the brain’s ability to increase or decrease certain neurotransmitters or enzymes that control the brain’s reward cascade. 

That is why at the Malibu Beach Recovery Center™, we have always given our clients an individually tailored regimen of food supplements and amino acids, which enhance the ability of the our low-glycemic Malibu Beach Recovery Diet™, along with a yoga breath work program to raise Dopamine levels. We then give our graduating clients the tools they need to sustain their now “normalized” Dopamine levels: an online cookbook with rules, recipes, shopping lists; real time DVDs of an abbreviated yoga breath work program that can be done at home every day; and a list of appropriate food supplements and amino acid products.  Clients who continue to follow the diet, do yoga, take specialized food supplements and become involved in the 12 Step Fellowship have a real chance of long term sobriety. But, more importantly, because of the normalization of their brain chemistry they are happier and can now enjoy and live life.

Before they knew about the Malibu Beach Recovery System™, Dr. Blum and Dr. Waite advocated a non-specific “healthy diet” and non-specific regular exercise to accompany a regimen of taking SynaptaGenX (formerly known as Synaptose), the nutrigenomic neuroadaptogen they developed based on Dr. Blum's many years of research to increase the endogenous production of Dopamine and reduce negative Reward Deficiency Syndrome behaviors.  The scientific evidence they have thus far accumulated, they say,  demonstrates that SynaptaGenX changes the plasticity of the brain synapses while balancing the endogenous neurotransmitters, positively affecting the Brain Reward Cascade. After touring the Malibu Beach Recovery Center™, Dr. Blum decided that the low-glycemic Malibu Beach Recovery Diet™ and the Exercise program based on yoga breath work were the perfect companions to Synaptose™.  He wrote: “I was thinking in the addiction field each of us has the missing part to the global standard of care in this industry.”

Dr Blum stated, “The end result of all these various treatments offered by your clinic will assist the patient to become drug free because they feel so much better due to increased brain function. They do not get so depressed, stressed or anxious that they resort to drug relapse. This type of Neurotransmitter agonistic therapy you have here at Malibu Beach Recovery Center™ reaches far beyond just overcoming an addiction; it prepares the individual for the first time to have a chance at living a happy and joyful sober existence for the rest of their lives.”

We hope he is right.  To find out we have started to give some alumni SynaptaGenX™ in addition to the yoga equipment, cookbooks, and a list of the best 12 Step meetings in their local area. Stay tuned for their feedback.