Addiction research has established that dopamine is released in the brain when people gamble. Dopamine is the chemical that the brain produces during sex, eating and other activities. The levels of dopamine are increased when outcomes are not easy to predict. But if you do ever go too far in the casino, then you may want to consider if high dopamine is a problem. Dopamine can make it difficult to maintain control. You may fully know that eating half a pie or gambling too much are bad decisions. But dopamine is sending reward signals to your brain and clouding your judgement. In fact, psychologists have performed multiple studies and experiments measuring the brain’s release of dopamine when gambling. Not only does the brain release dopamine in the same way it would as if you were using drugs, but the brain physically changes when you’re gambling.
When Shirley was in her mid-20s she and some friends road-tripped to Las Vegas on a lark. That was the first time she gambled. Around a decade later, while working as an attorney on the East Coast, she would occasionally sojourn in Atlantic City. By her late 40s, however, she was skipping work four times a week to visit newly opened casinos in Connecticut. She played blackjack almost exclusively, often risking thousands of dollars each round—then scrounging under her car seat for 35 cents to pay the toll on the way home. Ultimately, Shirley bet every dime she earned and maxed out multiple credit cards. “I wanted to gamble all the time,” she says. “I loved it—I loved that high I felt.”
In 2001 the law intervened. Shirley was convicted of stealing a great deal of money from her clients and spent two years in prison. Along the way she started attending Gamblers Anonymous meetings, seeing a therapist and remaking her life. “I realized I had become addicted,” she says. “It took me a long time to say I was an addict, but I was, just like any other.”
Ten years ago the idea that someone could become addicted to a habit like gambling the way a person gets hooked on a drug was controversial. Back then, Shirley's counselors never told her she was an addict; she decided that for herself. Now researchers agree that in some cases gambling is a true addiction.
In the past, the psychiatric community generally regarded pathological gambling as more of a compulsion than an addiction—a behavior primarily motivated by the need to relieve anxiety rather than a craving for intense pleasure. In the 1980s, while updating the Diagnostic and Statistical Manual of Mental Disorders (DSM), the American Psychiatric Association (APA) officially classified pathological gambling as an impulse-control disorder—a fuzzy label for a group of somewhat related illnesses that, at the time, included kleptomania, pyromania and trichotillomania (hairpulling). In what has come to be regarded as a landmark decision, the association moved pathological gambling to the addictions chapter in the manual's latest edition, the DSM-5, published this past May. The decision, which followed 15 years of deliberation, reflects a new understanding of the biology underlying addiction and has already changed the way psychiatrists help people who cannot stop gambling.
More effective treatment is increasingly necessary because gambling is more acceptable and accessible than ever before. Four in five Americans say they have gambled at least once in their lives. With the exception of Hawaii and Utah, every state in the country offers some form of legalized gambling. And today you do not even need to leave your house to gamble—all you need is an Internet connection or a phone. Various surveys have determined that around two million people in the U.S. are addicted to gambling, and for as many as 20 million citizens the habit seriously interferes with work and social life.
Two of a Kind
The APA based its decision on numerous recent studies in psychology, neuroscience and genetics demonstrating that gambling and drug addiction are far more similar than previously realized. Research in the past two decades has dramatically improved neuroscientists' working model of how the brain changes as an addiction develops. In the middle of our cranium, a series of circuits known as the reward system links various scattered brain regions involved in memory, movement, pleasure and motivation. When we engage in an activity that keeps us alive or helps us pass on our genes, neurons in the reward system squirt out a chemical messenger called dopamine, giving us a little wave of satisfaction and encouraging us to make a habit of enjoying hearty meals and romps in the sack. When stimulated by amphetamine, cocaine or other addictive drugs, the reward system disperses up to 10 times more dopamine than usual.
Continuous use of such drugs robs them of their power to induce euphoria. Addictive substances keep the brain so awash in dopamine that it eventually adapts by producing less of the molecule and becoming less responsive to its effects. As a consequence, addicts build up a tolerance to a drug, needing larger and larger amounts to get high. In severe addiction, people also go through withdrawal—they feel physically ill, cannot sleep and shake uncontrollably—if their brain is deprived of a dopamine-stimulating substance for too long. At the same time, neural pathways connecting the reward circuit to the prefrontal cortex weaken. Resting just above and behind the eyes, the prefrontal cortex helps people tame impulses. In other words, the more an addict uses a drug, the harder it becomes to stop.
Research to date shows that pathological gamblers and drug addicts share many of the same genetic predispositions for impulsivity and reward seeking. Just as substance addicts require increasingly strong hits to get high, compulsive gamblers pursue ever riskier ventures. Likewise, both drug addicts and problem gamblers endure symptoms of withdrawal when separated from the chemical or thrill they desire. And a few studies suggest that some people are especially vulnerable to both drug addiction and compulsive gambling because their reward circuitry is inherently underactive—which may partially explain why they seek big thrills in the first place.
Even more compelling, neuroscientists have learned that drugs and gambling alter many of the same brain circuits in similar ways. These insights come from studies of blood flow and electrical activity in people's brains as they complete various tasks on computers that either mimic casino games or test their impulse control. In some experiments, virtual cards selected from different decks earn or lose a player money; other tasks challenge someone to respond quickly to certain images that flash on a screen but not to react to others.
A 2005 German study using such a card game suggests problem gamblers—like drug addicts—have lost sensitivity to their high: when winning, subjects had lower than typical electrical activity in a key region of the brain's reward system. In a 2003 study at Yale University and a 2012 study at the University of Amsterdam, pathological gamblers taking tests that measured their impulsivity had unusually low levels of electrical activity in prefrontal brain regions that help people assess risks and suppress instincts. Drug addicts also often have a listless prefrontal cortex.
How Gambling Changes Your Brain
Further evidence that gambling and drugs change the brain in similar ways surfaced in an unexpected group of people: those with the neurodegenerative disorder Parkinson's disease. Characterized by muscle stiffness and tremors, Parkinson's is caused by the death of dopamine-producing neurons in a section of the midbrain. Over the decades researchers noticed that a remarkably high number of Parkinson's patients—between 2 and 7 percent—are compulsive gamblers. Treatment for one disorder most likely contributes to another. To ease symptoms of Parkinson's, some patients take levodopa and other drugs that increase dopamine levels. Researchers think that in some cases the resulting chemical influx modifies the brain in a way that makes risks and rewards—say, those in a game of poker—more appealing and rash decisions more difficult to resist.
A new understanding of compulsive gambling has also helped scientists redefine addiction itself. Whereas experts used to think of addiction as dependency on a chemical, they now define it as repeatedly pursuing a rewarding experience despite serious repercussions. That experience could be the high of cocaine or heroin or the thrill of doubling one's money at the casino. “The past idea was that you need to ingest a drug that changes neurochemistry in the brain to get addicted, but we now know that just about anything we do alters the brain,” says Timothy Fong, a psychiatrist and addiction expert at the University of California, Los Angeles. “It makes sense that some highly rewarding behaviors, like gambling, can cause dramatic [physical] changes, too.”
Gaming the System
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Redefining compulsive gambling as an addiction is not mere semantics: therapists have already found that pathological gamblers respond much better to medication and therapy typically used for addictions rather than strategies for taming compulsions such as trichotillomania. For reasons that remain unclear, certain antidepressants alleviate the symptoms of some impulse-control disorders; they have never worked as well for pathological gambling, however. Medications used to treat substance addictions have proved much more effective. Opioid antagonists, such as naltrexone, indirectly inhibit brain cells from producing dopamine, thereby reducing cravings.
Dozens of studies confirm that another effective treatment for addiction is cognitive-behavior therapy, which teaches people to resist unwanted thoughts and habits. Gambling addicts may, for example, learn to confront irrational beliefs, namely the notion that a string of losses or a near miss—such as two out of three cherries on a slot machine—signals an imminent win.
Unfortunately, researchers estimate that more than 80 percent of gambling addicts never seek treatment in the first place. And of those who do, up to 75 percent return to the gaming halls, making prevention all the more important. Around the U.S.—particularly in California—casinos are taking gambling addiction seriously. Marc Lefkowitz of the California Council on Problem Gambling regularly trains casino managers and employees to keep an eye out for worrisome trends, such as customers who spend increasing amounts of time and money gambling. He urges casinos to give gamblers the option to voluntarily ban themselves and to prominently display brochures about Gamblers Anonymous and other treatment options near ATM machines and pay phones. A gambling addict may be a huge source of revenue for a casino at first, but many end up owing massive debts they cannot pay.
Shirley, now 60, currently works as a peer counselor in a treatment program for gambling addicts. “I'm not against gambling,” she says. “For most people it's expensive entertainment. But for some people it's a dangerous product. I want people to understand that you really can get addicted. I'd like to see every casino out there take responsibility.”
More often than not a trip to Las Vegas is not a financially sound decision. And yet every year over 40 million people hand over their cash to the city’s many towering casinos, hoping the roulette ball rattles to a stop on black.
Gambling and other forms of risk-taking appear to be hardwired into our psyche. Humans at least as far back as Mesopotamia have rolled the dice, laying their barley, bronze and silver on the line, often against miserable odds. According to gambling industry consulting company H2 Gambling Capital, Americans alone lose nearly $120 billion a year to games of chance.
Now a set of neuroscience findings is closer than ever to figuring out why. Ongoing research is helping illuminate the biology of risky behaviors—studies that may one day lead to interventions for vices like compulsive gambling. The recent results show an explanation is more complex than looking at dysfunctional reward circuitry, the network of brain regions that fire in response to pleasing stimuli like sex and drugs. Risking loss on a slim chance of thrill or reward involves a complex dance of decision-making and emotion.
A new study by a team from Johns Hopkins University appears to have identified a region of the brain that plays a critical role in risky decisions. Published September 20 in Current Biology, the authors analyzed the behavior of rhesus monkeys, who share similar brain structure and function to our own. And like us, they are risk-takers, too.
First the authors trained two monkeys to “gamble” against a computer to win drinks of water. Then they had to choose between a 20 percent chance of receiving 10 milliliters of water versus a far more reliable 80 percent chance of getting only three milliliters. The monkeys overwhelmingly took the gamble, even when they were no longer thirsty.
Previous work has shown a brain region called the supplementary eye field (SEF) is, along with regulating eye movements, also involved in decision-making. When the authors suppressed SEF activity by cooling the region with an external metal plate—a process that is harmless and reversible—the monkeys were 30 to 40 percent less likely to make risky bets.
Johns Hopkins neuroscientist and study co-author Veit Stuphorn says the findings were not entirely unanticipated, given the role the SEF and its neighboring areas play in decisions. Yet he is intrigued that an area of the brain is so tied in with processing the risk associated with a particular behavior without actually causing the behavior itself. “The specificity of the contribution of SEF to risky decisions was surprising to us,” he says. “We interpret this as a sign that SEF mainly reflects the contribution of higher-order cognitive areas…, such areas build a model of the environment and use it to predict opportunities and dangers.” In other words, the SEF appears to shape the attitude toward a particular risky behavior. It also, Stuphorn suggests, represents a possible treatment target for those prone to excessively risky pursuits like problem gambling.
But not just yet. “We do not understand the risk-taking network in the brain well enough to think about therapeutic implications,” he says. “But as our understanding increases, there is hope for better behavioral interventions based on a better understanding of the factors that drive risky decisions. And in the long run possibly direct interventions in the form of brain stimulation.”
Yale University neuroscientist Daeyeol Lee, who was not involved in the new research, is also optimistic. “Finding that excessive risk-taking might be influenced by the function of a specific brain area might be an important step in treating humans with severe risk-taking tendencies,” he says, adding that certain drug treatments for Parkinson’s disease and other neurological disorders can also cause risky behaviors. “The findings in this study might also have implications in reducing such unwanted side effects,” he says.
What Does Gambling Do To Your Brain Tumor
Typically, the brain’s “reward center” or “reward circuitry,” have not included the SEF but rather other brain regions that drive pleasurable responses via the neurotransmitter dopamine. Yet, as Daeyeol points out, reward is complex. The SEF is likely to be involved in the anticipation of reward and helping control dopamine activity in a reward area called the basal ganglia.
Another study published last week, also in Current Biology, adds an additional layer to the neuroscience of gambling risk—the feeling of regret. In 10 neurosurgical patients the authors measured electrical activity in a brain region called the orbitofrontal cortex—part of the prefrontal cortex near the SEF—while presenting them with gambling scenarios. They used electrodes to analyze brain activity as each study subject decided whether or not to make a bet, right after a bet and when—a half a second later—they learned the outcome.
By comparing the findings to previous brain recordings associated with regret, they deduced that during the split second between placing a bet and learning the outcome our brains frantically replay previous betting decisions. We recall the regret we felt from losing prior bets and from not betting more on those we won.
Senior author Ming Hsu, an associate professor in the Haas School of Business and the Helen Wills Neuroscience Institute, both at the University of California, Berkeley, notes this rumination on past choices is probably an evolutionarily means of improving future decision-making. “This type of replay is particularly prevalent during the lull after one makes a decision and before finding out about the outcome,” he says. “But what we see is that the [orbitofrontal cortex] is incredibly active, and in particular processing how much regret the subject experienced on the previous decision.”
Scientists have long known the prefrontal cortex is involved in complex decision-making. An early clue was the case of Phineas Gage, a 19th-century railroad foreman who, in some accounts, become wildly impulsive after an explosion drove an iron bar through the front of his brain. Hsu thinks the rapid replay of past decisions could explain why the prefrontal cortex is implicated in conditions like depression and addiction, both of which involve a willful neglect of negative consequences, an apathy toward risk.
Washington University School of Medicine in Saint Louis neuroscientist Camillo Padoa-Schioppa, who did not take part in either new study, comments, “Many monkey studies, including work from my lab, have found that decision computations [involve] the orbitofrontal cortex.” The fact this study showed the same thing in humans, he notes, is an important step toward understanding our own decision-making process.
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As researchers like Hsu and Stuphorn gradually unravel the neurocircuitry of risk and reward, perhaps we will one day see better treatments for such conditions, most likely behavioral interventions or brain-stimulating technologies.
We may also see treatments that quell the thrill and compulsion of problem gambling and other risky behaviors and encourage a bit more fiscal prudence. If so, perhaps those at risk of draining their bank accounts on the Vegas Strip will find themselves cashing in their chips, not squandering them.