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THE WRONG SIDE OF THE CLIFF

AN INTERVIEW WITH DR. WILLIAM McCOWN (Part 1)

Frank Kneeland was the manager of the largest progressive video poker team in Las Vegas, and has authored a book about his adventures entitled, "The Secret World of Video Poker Progressives". You can get the book as well as some extra info about Kneeland on his website www.progressivevp.com. In addition, there you'll find a show archive from his radio show on pro gambling that he co-hosted with Bob Dancer for six months.

"I am of the mind that thinking well isn't merely a good idea." ~FK

This will be the last of my gaming psychology related articles for a while. I thought it best to save the best for last, so I have a special treat in store for you. This month and next in this two part article, we'll be talking to Dr. William G. McCown, the author of my favorite book on gambling psychology, Best Possible Odds, as well as several other books on psychology, including his latest, Treating Gambling Problems. Dr. McCown is currently the Dean of the University of Louisiana at Monroe and is considered one of the foremost researchers into pathological gambling.

Metaphorical Intro

If we liken a descent into pathological gambling the same as jumping off a cliff, where should we expect to find the psychological community? At the top, preventing people from jumping? Sadly, no. At the bottom, catching people when they fall? Um... no again. Closer to the truth, we'll find them silently waiting at the bottom for bodies to hit the rocks, and then trying, often fruitlessly, to patch the broken and battered pieces back together again. In many states, a person cannot even qualify for problem gambling assistance if they still have money left in the bank.

Though superficially we are all aware that gambling problems are mental in nature, our society treats them as financial problems and even includes your bank statement into whether or not there is a problem. Got money? No problem! To further complicate matters, one must have five out of the ten symptoms listed in the DSM-IV (Diagnostic Statistical Manual) to qualify as a pathological gambler. Stunningly, only three (four if we are being generous) out of the ten would likely be present if the patient wasn't losing. What does this mean to you? Well, I'll be Frank with you; if you are currently barreling towards the cliff like a dutiful lemming, you'll find little help on this side of a nasty fall.

What's worse, problem gambling is widely considered to be the hardest addiction to recover from in its late stages (due to the enormous time required to recover from debt), and the one that could benefit most from early detection. By comparison, a person recovering from heroin addiction can take as little as one month to feel like himself or herself again. For some gamblers in recovery, it can take the rest of their lives.

In an effort to bring balance back to the force, I'm going to dedicate this interview to risk factors and early detection of problem gambling and the comorbid (co-occurring) disorders that are detectable even if you are a stage 0 gambler (never gambled before). Prevention will be our focus. Moreover, don't expect to find this information elsewhere; what you're more likely to find out in the big wide cruel world is people who are only too happy to give you a less than gentle push off the cliff. Some estimates put the income that casinos make from people with
gambling problems at 65% of their total revenue, with only 35% of their net profit coming from normal healthy gamblers. Suffice it to say, for both politicians and the gambling industry, there is a conflict of interest in helping people with anything other than empty pockets. The psychological community is not similarly afflicted with greed as its guide, but unfortunately it is restrained from helping people when they most need it by limited funding, public opinion, and people's general unwillingness to seek help before it's too late.

Interview with Dr. William G. McCown

Q: Iíve already clued people in a little on the sad state of problem gambling prevention in America. Would you like to add anything to my intro?

A: I want to emphasize what you said above. A gambling addiction is one of the hardest addictions to overcome. It is also one of the most destructive, with long-term ramifications. If a person has, say, an alcohol problem, then their life will immediately get better the moment they cease drinking. However, if a person has problems gambling, they may have lifelong debts that no honest person could pay.

Moreover, in other addictions, the addict can avoid the people, places, and things that cue the thoughts and feelings that lead to relapse. For chronic pathological gamblers, a major cue may be money. You can avoid alcohol, heroin, or even cigarettes. However, you cannot avoid the day-to-day stress of handling or not having money.

FK Comment: I was worried my intro was too negative and might need softening, but you emphasized it instead. Ok, not what I expected.

Q: How serious is pathological gambling in America, and where does it rate in comparison to other addictions.

A: The prevalence rates suggest about 2-3% of people have a really hard-core pathological problem. Another 7-8%, (in my opinion more) are what we call "problem gamblers." Some of these people will mature out of abusive gambling. Others will descend into addiction. Right now, there is no way to figure out the path that high-risk people will take.

For our interview today, I will lump the two terms together and refer to both groups as pathological gamblers.

In terms of numbers, pathological gambling is only slightly less of a problem than alcohol abuse and dependence. It is much more of a problem than addiction to heroin, cocaine, marijuana, and other hallucinogens. It's up there with methamphetamine.

The interesting thing about pathological gambling is that the prevalence rates remain fairly constant, regardless of social conditions. For most abused drugs there is about a 5 to 7 year cycle. Heroin, for example, is presently out of vogue. Methamphetamine and prescription drug abuse are now very popular. Pathological gambling seems to resist ever going out of style.

FK Comment: That is really weird. To me that really suggests a strong genetic component.

Q: What is the current treatment success rate for treating problem gambling, and how do the current stats compare to those of years gone by?

A: Previous treatment success rates were generally abysmal, usually around 5% at the end of a month. We know that the Twelve Step model pioneered by Alcoholics Anonymous can greatly help a subset of people. However, this treatment is often irrelevant to the needs of the gambler, especially if it is misapplied. It rarely is effective, in my opinion, without other interventions.

The newest studies with more current types of intervention show that more combined treatments are often very effective. These new treatments are easily as effective as therapy for depression or lower back pain.

FK Comment: Wow, thatís good, nay, great news! The best Iíve heard in awhile. Back when you wrote your first book, the difference between getting treatment and doing nothing was negligible.

Q: What is the primary reason for this upturn in success in treatment?

A: Treatment now often involves a combination of approaches. Cognitive behavioral therapy, where a person learns to monitor their thinking and eliminate illogical distortions, is usually the treatment of choice. Occasionally, medications are effective, especially for a subtype of gamblers who clearly have underlying problems with mood.

FK Comment: "Cognitive behavioral therapy," you mean like reading my articles? Never mind, donít bother answering that, we both know your books have been my main inspiration. I know how much of these changes are because of you. Major kudos Dr.!!!

Q: We know that there is a random element involved in gambling and that even if you were playing badly with no strategy, probability predicts that some people will win for a long time. In one of your books, I remember you stated that people with long winning streaks at the beginning of their gambling experience often end up with the worst and most difficult to treat problems when the odds finally catch up to them. What, if anything, is currently being done for people with serious gambling problems who simply haven't been fortunate enough to lose yet?

A: Present treatment has often been successful when it teaches people the basics of probability theory. However, this is hard to do. We have an innate tendency to believe that two or three events always indicate a trend, this is just the way evolution, or Mother Nature has constructed us. We do this all the time, but it's only disastrous when wagering.

FK Comment: Of course, this has been the subject of many of my articles. Iím glad to see Iíve been addressing what you consider to be the only real prevention technique currently available.

Q: I understand that problem gambling has one of the highest comorbid disorder rates of any addiction. Is it known if the gambling causes these other disorders, or if these disorders cause gambling problems? In addition, what are the most common co-occurring disorders with pathological gambling?

A: Good question! In fact, these are all good questions! Bipolar disorder, or manic depression, occurs much more frequently in problem gamblers. Mental health providers now know that there are subtypes of bipolar disorder that do not necessarily resemble the obvious extremes. Many people treat their depression with gambling, which does have a mild anti-depressant effect. Then when they're feeling a little up, they are primed for excitement. The tendency to be bipolar seems to be rooted in genes. Problems with gambling are only one of the difficulties these people have. The good news is that this is a treatable disorder.

Adult ADHD, or attention deficit hyperactivity disorder, another mostly genetic syndrome, is extremely common among people with gambling problems. Often, people with ADHD don't feel punishment like the rest of us, but they are very sensitive to rewards. That type of nervous system is especially vulnerable to the wins and losses of gambling.

Other psychiatric problems may be a cause or effect of problem and pathological gambling. These include substance abuse, anxiety, and depression.

FK Comment: So if you know you have any of these problems, be especially cautious of gambling as a pastime. If you suspect you might have one of these problems, find out first for sure, before you play. If it turns out you donít, you can gamble with more peace of mind. If it turns out you do, you have just avoided one problem, and helped another you did not know you had.

Q : I remember reading in your book, Best Possible Odds, about some marvelous studies using skin conductance and EKG's done into how people get a rush thinking they have found patterns in random events and that when they were told the number sequences were completely random they lost interest and stopped enjoying the activity. I believe recent studies have linked this to dopamine pathways and even likened the effect to doing cocaine. Could you elaborate on the recent research and how this affects gamblers?

A: This is fascinating research that has since been replicated many times. We used to think that the major purpose of dopamine being released in the brain was to give us pleasure when we did something related to survival. The field of neuroscience is moving fast. That view is generally regarded these days, as not quite right. We now know that this dopamine-related pleasure is probably just a side effect. The real reason dopamine is released is that it sensitizes us to situations where we are being rewarded. It makes rewards more noticeable, so that we can find them again and indulge. From an evolutionary perspective, this makes tremendous sense. From a human perspective, where we are surrounded by randomness, well, sometimes the effects do not work out to our advantage.

Simply put, if you believe you find a pattern, even in randomness, your brain will release more dopamine than it usually does. This will become a self-fulfilling loop. Finding a pattern, even a false one, releases more dopamine, which heightens our belief that we found something in randomness.

Here is a thought: The pleasurable and attentional effects of dopamine are most likely to occur in people who donít have enough of this neurochemical. People with ADHD and depression are two groups who fit this category. Not surprisingly, both have elevated rates of pathological gambling. Both are very sensitive to stimuli associated with gambling. Both groups are probably at risk for developing problems.

FK Comment: Iíve known about the whole seeing patterns in randomness issue for years. I had not heard about the new research into dopamine and gambling, that must be very recent.

Thatís all we have time for this month. Part 2 of this interview will appear in next monthís issue of BJI.

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