Problem gamblers often report a loss of agency over their betting, where huge financial losses and the compulsion to cover them up can contribute to severe mental health difficulties and, in some cases, even suicide. But it goes deeper than just the money: gambling changes the way our brain’s reward system functions addicting players to the rush that comes with risk taking. Barbara Sahakian is professor of clinical neuropsychology at the University of Cambridge and a leading expert on gambling addiction…
Barbara – Addiction has to do mainly with the loss of control over your behaviour. So when you aren’t allowed to do something, for instance, if it’s a substance of abuse like cocaine or amphetamine, you’re not allowed to take it anymore, you get symptoms of withdrawal and you get cravings. The same thing actually happens in gambling. So you get irritable and crave gambling. And basically what happens is it frequently starts with a level of impulsivity, when somebody impulsively tries something, and then they slowly become more and more addicted to it, such that it becomes the focus of control. That’s an important thing in gambling, that they only want to gamble. They lose their own ability to stop gambling. But their interest is really only in that to the neglect of other areas of life.
James – I suppose the critical difference with gambling, as opposed to the substances you listed there, is that there’s nothing physically being ingested into the body which we can point to and directly to the harms that it causes. Is that possibly the reason why it’s taken quite a long time for awareness of gambling as an addiction to really become mainstream?
Barbara – Originally, it was classified differently in the Diagnostic and Statistical Manual of the American Psychiatric Association, but now it’s basically been reclassified as substance related and addictive disorders. So it’s actually considered in that category now. And I think you’re right, it’s because it was a behavioural addiction. But that has a lot of benefits too because as I said, the sort of addictive triangle is the loss of control, the craving and withdrawal aspects, and then the neglect of other areas of life. And with the addictive behaviour that you might have to gambling, you can study that in a pure way. So you don’t have alcohol problems, you don’t have other substances of abuse problems such as cocaine or amphetamine. It’s purely looking at the behaviour
James – As I understand it, it often goes hand in hand. I know Bianca mentioned at the top of the program alcohol as a factor as to how she started gambling, and that’s quite common across the board.
Barbara – It is quite common across the board. And unfortunately some places use this. So if you go to a place like Las Vegas, they will often, in the casinos or hotels where there’s gambling, they’ll allow you to have free alcohol because of course it disinhibits you and it allows you to gamble more freely. But there are also some strong relationships with alcohol and gambling. And of course in a lot of the addictions there’s a predisposition for impulsive behaviour which prompts them all. At Yale University, Marc Potenza and others have pointed out that there’s a very strong family association and that genetics is very important as well.
James – I imagine the answer will be, it’s a bit of both, but whether it’s the person or the exposure to gambling which can cause these gambling related harms. If we start with the exposure, what factors are there to bear in mind?
Barbara – Well, there’s people who are very interested in risky behaviour and they go into areas where there’s a lot of excitement and risky behaviour going on. So it used to be that footballers would get involved in a lot of use of alcohol. I mean, they’re more protective about that now because they realise that it’s important to keep fit, but they still probably go into gambling. And as you know, it’s advertised very strongly on TV and so forth when there’s football matches on. So there’s a lot of things to do with advertisements. We’re also finding that internet gaming games that are proposed for children and adolescents have a lot to do with the sorts of activities that you would do while you were gambling. So it’s almost like training them or grooming them to gamble in the future. So that’s another problem. And then it’s quite common that in families where there’s gambling, then other people, younger people will start to gamble as well. So there’s environmental factors like that. There’s also other environmental factors. I mean, we know that socioeconomic status can affect gambling because obviously people who don’t have money are looking for money and how you respond to stress, whether you can emotionally regulate yourself when something negative happens to you and that kind of thing. So the sort of stresses in the environment can promote gambling as well. And we do know that there’s changes, for instance, in the hippocampus and amygdala areas involved in emotional regulation as well as your top-down control of emotion in gamblers. And so it could be that the impact of stress from various environmental sources can affect them as well.
James – And then when we think about it from maybe the more biological perspective or the psychological perspective, I guess that necessitates us having a better grip on the actual mechanisms of what’s going on inside the brain when someone’s suffering from gambling addiction. Is that an exact science at this point?
Barbara – We still need a lot of research on what starts the gambling process and then how it continues. We do know quite a lot about other addictive behaviours as you pointed out, and we do know that many of them start with a kind of impulsive act. You’re sort of excited or your friend takes you into the environment and then you get hooked by the excitement of the whole thing. We found that in our studies with the Cambridge gambling task, which I’ve been involved in inventing, that in some of the studies that have been done with that task, that people actually are poorer decision makers. So when the odds are against them, they will still bet and they might bet quite highly, whereas a healthy person wouldn’t do that. They would notice that the probability is against them and then they wouldn’t take that option or they would go for a much smaller bet with that option. So we can see that there’s also some more risky decision making that goes on in these people who gamble.