The Worst Of All Bets
New thinking provides hope for gambling addicts
Dopamine--a neurotransmitter in a brain that acts like adrenaline and has lots to do with how people behave and experience pleasure--is also thought to be involved. When dopamine is released, the dopamine receptors act like magnets, telling it where to go. For pathological gamblers, the receptor sites in the midbrain that are driven by the anticipation of rewards are especially sensitive, requiring increasing amounts of dopamine to create the rush of happiness. What triggers the dopamine rush? Gambling, of course, and a vicious cycle is created.
In the past, Gamblers Anonymous, a 12-step, self-help program that began in 1957, was the solution. "Medical people wanted nothing to do with gambling," says Joanna Franklin, president of the Maryland Council on Compulsive Gambling. "Their major prescription to someone was telling them to knock it off." And while many credit Gamblers Anonymous with rebuilding lives, one study found that only 8 percent of those who entered GA were still attending after a year. Casinos have attempted to enforce "self-exclusion" policies, in which pathological gamblers empower the casino to call the police if they are spotted. "It is a very good but very, very limited tool," says Keith Whyte, executive director of the National Council on Problem Gambling.
The fact is, no two gamblers are alike, and the secret to stopping the problem is figuring out what triggers the behavior. Often, cognitive behavioral therapy, which aims to adjust behavior by helping patients recognize and refute negative impulses, provides insight into the cycle and other options for managing the trigger feelings. "They need to have alternate forms of leisure activity," says Henry Lesieur, a gambling addiction expert who sees great merit in the therapy. "They have gotten out of the habit of having fun in their lives." While antidepressants have been used, with mixed success, recent research has looked at gambling as a problem with impulse control. In fact, a drug called nalmefene that is supposed to reduce craving and may be able to treat the longing to gamble is currently undergoing clinical trials.
What saved Nikolakis, who attends GA meetings, was a stint earlier this year at one of the few residential treatment facilities in the country exclusively for pathological gamblers. The Center of Recovery was established in Louisiana in 1998 and has served over 600 clients. "These people know how to start gambling, and they know how to stop," says Corinne Dumestre, the CORE program director during Nikolakis's stay. "You either go to the machine or you don't. What they don't know is what exists between those two poles." The CORE day is filled with physical fitness programs, therapy sessions, education sessions, and chores. Three quarters of those who complete the program never gamble again.
After his CORE success, Nikolakis credits GA with keeping him clean. "I used to be the guy who was the big shot with $600 in my pocket," says Nikolakis, who plans to attend cooking school. Now, "I can have $3 in my pocket and am three times as happy."
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