Psychoanalysis and Addictive Gambling
It is only relatively recently that addiction science, research, and practice has recognized that in a Venn diagram of chemical (e.g. alcohol, opioids) and behavioral (e.g. gambling, pornography) disorders, there is a good deal in the common area. So much so, that it might be easier to distinguish the two by what is not in the common area: Primarily, symptoms of physical withdrawal associated with cessation of consumption, and even that is a subject of ongoing debate.
In psychology, it is long-established that the most durable and ineradicable behavioral reinforcement occurs when the reward is uncertain, the variable reward. What holds for humans holds for virtually all species that have been studied: Provide a fixed reward when they hit the lever, and the subject will continue to hit the lever. Provide an uncertain reward when they hit the lever, and the subject will continue to hit the lever with increasing urgency. Combine that uncertain reward with societal- and individual-level risk factors such as financial or peer pressure, enticements, co-occurring conditions such as substance use disorders, depression or anxiety, and an endless array of cognitive distortions, and you have a reliable recipe for hooking the subject on the prototypical variable reward mechanism: Gambling.
Exponentially exacerbating the problem, legal options for gambling now lie not only at the bodega (lottery), the track (horses), or the casino (everything else), but in your pocket, eliminating a key barrier to access: Proximity. And thus, the desire to gamble 24/7 is converted into an opportunity to do so.
Many people engage in gambling from time to time, enjoying the experience in a non-problematic way. Thirty-nine percent of Americans have bet on sports in their lifetimes. But… about the same percentage of men bet on sports in the past year; of those, 61% of them bet either daily or weekly. And of those, almost 20% agreed gambling is “destroying their life.” Destroying their life. You may be among them.
What can be done?
Just as in substance use disorders, getting a conceptual handle on how a behavioral disorder initially took root in an individual’s life is an illuminating starting point for psychoanalytic inquiry. While the circumstances that initiated a problematic behavior and those that perpetuate it are typically not one and the same, understanding the linkage between the two is an important first step for demystifying (in the service of reducing or eradicating) its presence and meaning in one’s life.
When one says, “My life is destroyed," it is another way of saying, “My life has been taken over.” And therein lies the hint of where cure can begin. Forgetting for a moment the excruciatingly painful discussions that frequently must be had with one’s partner (who may be totally in the dark or, skeptical of ongoing pledges that the gambling will “stop once and for all”), friends, children, colleagues, creditors, accountant, etc., and forgetting for a moment the seemingly insurmountable challenges associated with figuring out how to pay off debts that may have accrued in endless dark corners of one’s life, the key challenge for many is finding the strength, motivation, and courage to restore – or in some cases, assign for the very first time – meaning in life: Finding happiness and satisfaction in identifying and reaching goals that far exceed the ephemeral pleasure of winning a bet.
No, learning French, climbing rock faces, painting, or riding motorcycles are not perfect substitutes for hitting a long-shot. But the unfamiliar experience of reassigning time and focus to nourishing activities is frequently a key starting point for change. Winning a bet involves a tsunami of dopamine; it’s water, sure, but that water will drown you. In contrast, setting the right goal, whatever that turns out to be, will be more like encountering a river of dopamine that flows at just the right pace.
The psychoanalyst’s task, in the early stages of treatment, is to help a problem gambler overcome a sense of hopelessness or skepticism, to help them develop a methodology for putting their life back in order, and to share with them the extraordinary initiative of (re)assigning meaning to everything their life has to offer. An arduous, faith-based undertaking, for sure. But one that can breathe energy back into the lives of those with a willingness to try.