In this first of two blogs we look more closely at an article (1) which proposes the symptoms of the gambling addict’s equivalent to a sober alcoholic’s “dry drunk”.  When reading this I, as someone in recovery from alcoholism and substance and behavioural addiction thought a lot of the “symptoms” were relevant to me and perhaps anyone in recovery from addictive behaviours. These commonalities may be the habitualised legacy of addiction more generally and emotional dysfunction more specifically.

Here is the second part of this three part blog (written partly from a clinician/therapists standpoint and experience of treating gambling addicts) …

“Although the term “dry drunk” has been used to varying degree by all of the twelve-step programs including Gamblers Anonymous (GA), certain crucial differences are pertinent. For the gambler, not only is there the absence of an ingested substance as the crucial distinguisher between “dryness” and “wetness,” but what the individual is addicted to is not so clearly avoided. In this respect, pathological gambling is more like an eating disorder than like alcohol or cocaine dependence. Pathological gamblers must continue to use money, and while they stop gambling with it, uncertainty and risk continue to be part of their lives. They must learn to manage these things rather than to abstain from them.

Risk and uncertainty can be overtly or covertly played with and manipulated. The pathological gambler, while not technically gambling (in other words, dry), has a number of ways of “staying in action.”

This notion of staying in action is, for the pathological gambler, equivalent to the alcoholic’s dry drunk. It poses a threat to recovery . While gamblers mean different things when they talk of “action” (Rosenthal & Rugle, 1994), the word generally refers to excitement, risk, the thrill of getting away with something, the possibility of significant loss or the opportunity for spectacular success. Action! The term has connotations of movement, of making things happen and of doing something, fixing things,finding solutions. In other words, action means the opposite of passivity, stagnation, paralysis or helplessness

The state of mind in which these actions are carried out is then an omnipotent one. Omnipotence has been defined as an illusion of power and control that defends against helplessness and other intolerable feelings (Rosenthal, 1986). There is a false sense of conviction about what one is doing.

“Omnipotent action” (Rosenthal, 1986) is a defense mechanism in which one must do something, anything, in order to create for oneself this illusion of being powerful and in control. Such attempted solutions may be totally ineffectual, and merely serve as a gesture to show one can do something. More often the action is destructive, and produces the opposite effect from the one needed. As Rosenthal (1986) has  suggested, when pathological gamblers speak of their need for action, they may be referring to just such omnipotent solutions.

Some of the attitudes and behaviors described in this article are obviously more associated with the action-seeking gambler (Lesieur, 1988; Lesieur & Blume, 1991) than with the escape seeker. Although Lesieur’s categorization remains the most clinically useful method of subtyping, on some level most pathological gamblers are seeking both. Action provides physiological arousal, fantasy gratification, and escape from feelings and situations that are believed to be intolerable.

 Symptom substitution/Behavioral equivalents

There are many ways for the gambler to take risks, or remain in a gambling mind-set, without making a bet. For example, a patient with five month’s abstinence reviewed some of his current behavior and concluded: “I’m still a gambler, and I play poker with people all the time. We just don’t use cards.”

Switching addictions

It is well known that addicts will substitute one addiction for another. For example, the alcoholic who stops drinking but then starts gambling is at risk for developing a gambling addiction. He or she is then more likely to start drinking again. Secondary addictions may appear either sequentially or simultaneously. In the latter situation, some therapists believe in treating them one at a time. If at all possible, I would not recommend delaying treatment. As an example, let us consider the rationale for addressing nicotine dependence early in recovery.

There are studies demonstrating that patients in alcohol and drug treatment programs who quit smoking have a much better prognosis than those who do not (Miller, Hedrick, & Taylor, 1983; Bobo, Gilchrist, Schilling, Noach, & Schinke, 1987; Bobo, 1989; Burling, Marshall, & Seidner, 1991). Sees and Clark (1993) found that patients presenting for substance abuse treatment reported high interest in stopping smoking, and for the inclusion of smoking cessation in their initial treatment. Although I do not insist that gamblers stop smoking, I discuss three reasons with them for quitting. First of all, when someone is in treatment and learning to deal with feelings, it does not make sense for them to be doing something that numbs their emotions. Patients begin to recognize that every time they start getting close to something meaningful in therapy, their impulse is to reach for a cigarette. Second, as long as they are smoking, they are still in an addictive state of mind, and third, as many obstacles as they can place between themselves and their gambling, the better off they are. The impulse to smoke can serve such a function, so that when they encounter some uncomfortable situation they will have an urge for a cigarette before they will have an urge to gamble. It will serve as a red flag alerting them to pay attention to the feeling or situation,and maybe to talk to someone about it or go to a meeting.

Following patients over time, the therapist has the opportunity to see addictions change and evolve. Sometimes, what appears to be a new problem is merely new wine in an old bottle: Example:Gambling addict swapping it for sex addiction especially via use of prostitutes. This GA when he found a prostitute who appeared “safe,” would he not go back to her, but would insist on trying someone different each time? Obviously he either wanted to lose, or was excited by the risk of jeopardizing everything and escaping unharmed.  He then recognized that the feelings he had while looking for prostitutes were identical to the feelings previously experienced gambling. He not only had the same “rush,” but the compulsive aspects were the same. He would find himself preoccupied by it while at work, inventing excuses for driving home through neighborhoods where there were streetwalkers.

The anticipation, and the guilt afterwards, and the need to lie about where he spent his time and money, all reminded him of his previous gambling.

His gambling and the sexual compulsion were fused. This is not an uncommon occurrence. Fused addictions need to be recognized and may be difficult to treat.

However, in the next example, gambling is central.

 Example: Mr. B had stopped gambling and was a respectable member of his community. No one, especially not his wife, knew about his anonymous phone calls. He would go through the phone book until he found a woman’s name, and if the name interested him he would call her up. He would then try to keep her on the line and convince her to agree to meet him. His objective was to talk her into having sex with him. That was his “big win.” On occasion he was successful, although one woman met him at a coffee shop accompanied by policemen waiting to arrest him. While on probation he continued making his phone calls.

Mind bets

Compulsive gamblers may stop wagering for money, but may continue making “mind bets.” This is something they may not reveal unless specifically asked. It is common among sports bettors, who will check out the odds, then watch the game on television, making a mental wager with themselves. “If I had bet a hundred dollars on the Dallas Cowboys,” they will say, “and taken the points, then…” They are not betting money, but they are keeping track of what they would have won or lost through the week. Some newly abstinent gamblers say that what they are keeping track of is what abstinence has saved or cost them. Mind bets are a not uncommon way to remain in action. However, the gambler may start to get “juiced” and be unable to shake off the excitement.

Obsessive-compulsive rituals

Some gamblers, particularly those with more obsessive compulsive features to their personality, will make a different kind of wager with themselves. They will be preoccupied with various counting rituals, for example, odd versus even license plate numbers, or how many times a telephone will ring. If they guess right, they win, meaning a certain wished-for event will occur, or that they will or will not be committed to a certain course of action.

Such rituals are used to contain performance anxieties or guilt about forbidden activities. These wagers or tests are arbitrary, and so is the response. If not satisfied with the outcome, they can do “two out of three,” and, in true obsessive-compulsive fashion, keep repeating it. As with the gambling, luck and skill may be accorded a role, or the ritual be viewed as a form of divination.

Covert gambling

Some pathological gamblers engage in a kind of behavior that has been described as “covert gambling” (Rosenthal, 1987). In this respect they resemble patients with narcissistic personality disorders who are not gamblers. The behavior involves a need to take risks and test limits, in effect to continuously test themselves, not at a racetrack or casino, but with the everyday events of their lives. Such individuals typically gamble with time and with the meeting of obligations and responsibilities. Nothing is too small or too big to bet on. They will drive without gas in the car, be late for appointments, or not pay their phone bill. Betting they can get away with it, their self-esteem depends on the outcome.

Similarities between these pathological gamblers and patients with narcissistic personality disorder are found in their win-lose orientation, all-or-nothing thinking, and fragile sense of identity. There is often more at stake than self-esteem. By seeing how close they can come to some imaginary line, and what would happen should they cross it, these narcissistic individuals are challenging their environment, and luck itself, in order to find out where they stand, or even whether they have the right to stand.

They are not seeking punishment, out of some sense of guilt, although that may be present also, so much as they are involved in a kind of omnipotent provocation (Rosenthal, 1981), a deliberate flirting with danger in order to test their powers and prove they are in control.

Procrastination

After the gambling itself, procrastination is perhaps the most common and incapacitating symptom. There are several reasons for this. We have just discussed how a deadline may be used as a test, with the gambler trying to see how close he or she can come to it. Many gamblers feel that nothing they do is good enough, or that they can never do enough. Hence there is a sense of futility about completing a project or assignment where they anticipate failure. They may fear or resent the unrealistic expectations of others. Instead, they cling to their grandiosity, while postponing the cold shower of reality.

Substitutes for stimulation

This includes activities involving speed and danger. One patient, for example, stopped gambling and in his first year of abstinence took flying lessons, tried sky diving, bought a motorcycle, and went skiing every possible weekend. He seemed driven by a need for intense physical activity, strong sensations, and competition. Another kind of stimulation is provided by the ingestion of legal stimulants: coffee, cola drinks, and cigarettes.

Playing catch-up

In one respect, pathological gamblers have a more difficult time of it than other addicts. Their gambling typically has left them in debt; once they stop they find themselves “playing catch-up.” They may be working multiple jobs, juggling bills, struggling to meet expenses and stay ahead of creditors. Their state of mind often  duplicates that of their gambling days.

When they make a sale or put a deal together and get paid, they feel they have won. One patient referred to his situation as “dancing.” He was in a business where he would buy goods at the beginning of the month on credit, and to stay in business he would have to sell them and get more goods. His credit was always at risk, and he felt he was dancing all the time. He would say “At least when I was gambling there was the chance that I could have a big win and get ahead, but I’m just doing this month after month, with no end in sight.”

Lying, cheating, and stealing

The gambler is frequently testing how people will respond, and trying to corrupt them or get them to collude with their dishonesty. Here are also “omissions”—obligations that were forgotten, bills he ignored, promises he failed to keep—a pattern of lying and cheating that are not consciously recognized. These are kinds of “primitive avoidance” so common among pathological gamblers. Uncomfortable realities can be just put out of mind, or “shoved under the rug.”

Primitive avoidance and denial, and the pathology of lying is a nod to  “Lying, cheating and stealing” a phrase used frequently by Gamblers Anonymous members, not only to describe actions taken to support their gambling, but behaviors which continue after abstinence is achieved. “Lying, cheating and stealing” is a common “character defect,” requiring the attention of those who take recovery seriously

The pathological gambler must develop, or re-establish, an internalized value system based on honesty and integrity

The first step toward self-forgiveness is an acknowledgment of change. In other words, being able to say “I used to do such-and-such. I don’t do that any more.””

to be continued…

Reference

1. Rosenthal, R. J. (2005). Staying in action: The pathological gambler’s equivalent of the dry drunk. Journal of Gambling Issues.