I'm concerned about my husband. We've been married for 12 years and have no children. My husband has always had, as he describes it, "an addictive personality". His mother told me that since he was a child, he was always involved in high-risk activities. Since we've been married however, the activities never appeared to be too high-risk, until the last few years when the casinos opened in Connecticut. He is now a compulsive gambler and it's ruining our lives. We've both been to GA and GaAnon a few times. It seems to me that no matter how hard some of these people try, like alcoholism, they keep falling back. They all seem to thrive on the risk. Somebody mentioned that it wasn't until their husband was diagnosed with ADD, that he was finally able to understand what was happening and is now free of the problem. Is there a relationship?

Taking A Chance

Dear Taking A Chance:

Thanks for your very important letter. There is definitely a relationship between compulsive gambling (and substance abuse, teen pregnancy, etc.) and ADD. It happens to be a very strong and direct relationship that many professionals have yet to realize and deal with. There is now a considerable amount of research strongly linking compulsive gambling to attention-deficit disorder (ADD). It sure makes a lot of sense. Keep in mind that the risk of addictive and/or inappropriate behavior is substantially decreased for someone who has been diagnosed with ADD and is receiving the appropriate treatment and education.

Individuals with ADD require immediate gratification. The incentive needs to be in the process. That is, even though the thought of winning is floating in the air, it is the edge, the risk at each moment, that drives the person. All individuals with ADD, and in particular those who are more impulsive, seek stimulation. They are like windup watches (do you remember them). Unless they are wound, the spring runs down and the watch slows and stops. They are impulsive and have difficulty anticipating the consequences of their actions. As a result they are more likely to risk their money and marriages since they don't think the risk through.

If it seems that ADD is a possibility and your husband is willing, he should be assessed as soon as possible. 

Previous studies have compared gamblers, alcoholics and cocaine addicts on measures of impulsivity, negative affect and craving. A team at the Brecksville, OH, Veterans Administration Hospital is adding attention deficits to the mix, and they are looking for symptoms of ADD in gamblers.

The initial study found, overwhelmingly, that the gamblers had more attention problems than comparison groups of substance abusers who showed significantly less attention problems on neuropsychological assessment. The comparison groups also presented fewer behaviors consistent with childhood attention-deficit problems.

Gamblers are first interviewed at a stabilization assessment unit where they get medical and psychiatric evaluations, and a comprehensive battery of psychological testing. They are assessed again six months and one year after treatment.

The study, which began last July, will draw 100 gamblers from around the country. Lead investigator Lori Rugle, PhD, is using the Gambling Severity Index, a modification of the Addiction Severity Index that looks at functioning in the areas of substance use, gambling, family and social functioning, employment, legal problems, medical problems and psychiatric symptoms. Other scales, including the Wender-Utah Rating Scale, Wisconsin Card Slot and Barkley's Structured Interview, test for attention problems.

Thirty gamblers have so far completed the structured interviews. Using the same strict criteria as Paul Wender, MD, an expert on ADD, about 30 percent of the gamblers meet ADD criteria. Using broader criteria based on patients' self-report, 43 percent meet diagnostic criteria.

"I knew that gamblers had features of ADD," Rugle says. "But I was surprised that the numbers were so high for those who met diagnostic criteria based on DSM-IV. I knew that the problem existed, but I wasn't sure we'd be able to diagnose the full-blown syndrome."

The idea that a high percentage of gamblers would have attention problems came the old-fashioned way: direct observation. "One of the first and most obvious things was that these were folks who couldn't relax, couldn't slow down, who were very restless," Rugle says. "If you tried to do any kind of relaxation with them, it was almost too painful for them to endure."

When Rugle began her research in 1984, she set out to find what kind of attention problems gamblers have. She soon discovered that they didn't have trouble paying basic attention over brief periods of time, but with what Rugle calls executive aspects of attention: organizing and sequencing -- skills that require higher order levels of planning and problem solving. Gamblers may have difficulty paying attention from one moment to the next to collect information across time and situation and filter out irrelevant information.

Like alcoholics and cocaine addicts, gamblers are unable to resist urges and cravings, and are more compulsive than the general population. Yet, they meet more highly the criteria for dependence. Gamblers are more likely to get depressed than the alcoholic and cocaine groups. The arousal deficits from which gamblers suffer make it harder for them to self-soothe.

"One way to stop thinking about the craving for a candy bar is to start thinking about something else," Rugle offers. "Gamblers' attentional problems leave them painfully unable to think of something else. They will focus instead on the most important stimulus at the moment – in this case, gambling."

The Addiction Letter, Dec 1995 v11 n12 p1(2) 

Steffgen, Kim A. 

 

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