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David Baxter

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Medical Anomaly Exposes Compulsive Gambling's Neurological Roots
Friday, August 31, 2007

Tony Soprano is hardly the only American attracted to thrills of risking big money on games of chance: while experts speculate that only 4 to 6% of all individuals who gamble develop a pathological addiction, a large percentage of the population indulges on occasion, and as many 9 million Americans suffer from that diagnosable disorder. Much of the growing awareness of clinically compulsive betting arises from the industry's rapid expansion: gambling brought in $2.9 billion last year in New England alone. A new study observing the bizarre, habit-forming side-effects of a medication designed to treat Parkinson's Disease further highlights the chemical and neurological roots of problem gambling, finding far more parallells between habitual wagers and traditional drug addiction than one might expect.

The average victim of the betting bug is not a clueless sucker duped into wasting hard-earned money on a no-win racket. The problem gambler is, on the contrary, an intelligent, overwhelmingly male individual who truly revels in the "high" borne of big risk and the promise of lucrative if illusory rewards. Gambling literally exploits the excitement generated by a certain reactionary process in our brain's pleasure center - many enjoy it, and a significant portion of those find it irresistable, chasing the highs of victory with an irrational insistence that continues in the face of dangerously diminishing returns.

The dopamine system was originally a survival tool - not only does it identify the pleasure we gain from certain substances or experiences, it learns to anticipate those rewards based on related stimuli. This process was famously illustrated by Pavlov's dogs, trained to salivate at the sound of a bell associated with feeding even when there was no food to be seen.

Such is the way with the compulsive gambler's brain - he/she (far more likely he) learns to associate the act of gambling - the physical roll of the dice or pull of the handle - with the thrilling disbelief borne of that first win, no matter how small. Despite the false belief many card sharks hold in their ability to outsmart the house, most card games and especially slot machines operate purely by chance, and intelligence has nothing to do with luck (though inhuman statistical brilliance can tilt the odds considerably in one's favor). The big score never comes, but that doesn't stop the gambler from trying if he's tasted the thrills of winning. The fact that the process is random only makes the intoxication of victory that much more intense. It's unpredictable, and beyond a certain point it's really not about the money.

In addition to regulating our internal rewards systems, dopamine also works to control bodily movements, and Parkinson's patients often suffer tremors and other unwanted physical tics due to its underproduction. Requip, a medication designed to counter the effects of the disease, mimics dopamine in containing the tremors, but in doing so it also intensifies the immediate gratification response of the brain's pleasure centers, leaving victims more susceptible to the seduction of rewards-based compulsive behavior patterns - like addictions to sex and gambling. Studies reveal that 3 to 13% of patients taking dopamine replacement medications like Requip reported succumbing to these and other dependencies, and most had never experienced such problems when not under the drug's influence.

The problem is so pervasive that it has spawned several high-profile lawsuits. One in particular, brought by a retired doctor against the drug's manufacturers and a string of Las Vegas casinos, alleges that the medication (and the decision of the involved casinos to allow him to gamble despite their supposed knowledge of his condition) directly led him to lose $14 million dollars over a 10-month period. While this case clearly falls on the extreme fringe of the Parkinson's-gambling equation, it highlights the fact that gambling, like compulsive sex or cocaine, can create a very real, physically demonstrable addiction with the potential to spiral out of control. Acknowledging this fact and expanding the methods used to treat it will hopefully save thousands from the same fate.
 

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