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Medical Minute

Sunspire Health Network


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The Other Legal Addiction
March 2nd, 2015 - Posted By Jonathan Horey, MD

How would you respond if I asked you which addictions are "legal"? Most people would respond by citing cigarettes and alcohol. Some might identify prescription medications, such as prescription opioids or benzodiazepines like Valium (when legally prescribed). Others might insist that food, sex, sports, shopping and social media are also "legal" addictions. However, few people would spontaneously identify "gambling" unless they or a loved one have been affected by what is referred to in the latest edition of the Diagnostic and Statistical Manual as "Gambling Disorder".

While the science behind social media addiction may be limited currently, addictions to alcohol or cigarettes have been extensively studied and shown to have genetic and biological markers like other chronic diseases. So where does Gambling Disorder stand? Is it more like Facebook or more like alcohol? Despite Gambling Disorder's lack of recognition amongst the general public as a bona fide addiction, the evidence for its similarity to other addictions such as alcoholism is strong. So strong, in fact, that Gambling Disorder (formerly known as Pathological Gambling) was reclassified for this edition of the DSM from the section of "Impulse Control Disorders" to the section on "Substance Related and Addictive Disorders". Part of this change is due to the clinical picture of patients with Gambling Disorder who, it turns out, look a lot like patients with substance abuse disorders. That is, patients suffering from Gambling Disorder have similar symptoms of tolerance (increasing amounts of money are needed to achieve a similar effect), irritability/restlessness when cutting down or stopping gambling and making repeated efforts to control or cut down the gambling without success.

Even more compelling is the neuroimaging that demonstrates Gambling Disorder's similarities to other substance use disorders. One example is the finding that patients suffering from Gambling Disorder have blunted activity in the mesolimbic and prefrontal cortex when they are given nonspecific tasks that are either rewarding or punishing. The mesolimbic area of our brains is an important part of the "reward circuit" that is activated when we engage in pleasurable activities. The prefrontal cortex can be thought of as the regulatory part of our brain that evaluates our behavior, before and after we act. Blunting of activity in both of these systems means that patients with Gambling Disorder do not feel as good after generally rewarding activities and, as importantly, do not feel as badly after generally punishing ones. Even more interesting are the results of a study in which problem gamblers were given realistic gambling games in which to participate. The researchers found that there was normal or above normal activity in these same areas when the problem gamblers engaged in these games. These brain imaging findings in problem gamblers are strikingly similar to those seen in studies of reward and punishment in substance abuse patients. In both cases, we better understand why these patients seek out their drug of choice: It is the only thing that makes them feel good even though it is also the only thing that makes them feel miserable.

Much as Gambling Disorder is not well recognized as an addictive illness, treatment for this disorder can be difficult to find. At Sunspire Health, we are proud to offer treatment for Gambling Disorder using evidence based treatments specific to Gambling Disorder that increase the odds of recovery.

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