Scientific studies notwithstanding, approaches to addiction treatment will always have a strong pragmatic aspect. In other words, counselors and rehabilitation professionals will always choose to go with methods they know actually work based on their past years of experience. But every once in a while, a new research project will come along that adds fresh and unexpected information to the addiction treatment database, leaving the experts scrambling to adjust. When this happens, old strategies for promoting recovery may have to be rethought and standard operating procedures may have to evolve to incorporate the new understanding. This is exactly where we are with respect to gambling addiction. At the recent 27th annual European College of Neuropsychopharmacology (ECNP) meeting in Berlin, new research on pathological gambling carried out by a British research team from London and Cambridge was presented to the assembly for consideration. If these findings are eventually verified by further research, it could lead to a dramatic change in gambling addiction treatment regimens in at least some instances. To explore the idea that gambling addiction might involve the brain’s network of opioid receptors, the London/Cambridge group recruited 14 pathological gamblers and 15 control subjects to participate in their study. In the brains of alcoholics and other drug addicts, there are often elevated numbers of these receptors, and they are particularly adept at soaking up endorphins, the brain’s primary hormones for the transmission and experience of pleasure. The endorphin rush provoked by alcohol consumption and illicit drug use is believed to underlie the addict’s thirst for more and more of his or her favorite intoxicating product. Naturally, the researchers responsible for this new study expected to find a similar dynamic at work in the progressive development of compulsive gambling behavior. But surprisingly, PET (positron emission tomography) scans revealed that both pathological gamblers and non-gamblers possessed a similar density of opioid receptors in their brains. And furthermore, when given amphetamine in pill form in order to provoke an endorphin rush, gambling addicts actually showed a reduced ability to produce this hormone in comparison to non-gamblers, thereby decreasing the intensity of the euphoria they experienced. Later, on questionnaires, the compulsive addicts confirmed the level of elation they felt after taking amphetamine was less than predicted. The implication here is that because compulsive gamblers have gradually deadened their ability to get “high” (the initial endorphin rush), they must gamble more and more often in order to achieve the level of excitement they used to experience after the first wager. They have built up a tolerance to their favorite activity, in other words, and their slide into addiction is caused by their need to keep increasing their involvement until they gain the emotional satisfaction they seek — much to the detriment of their bank accounts, relationships, physical health and sanity. This all sounds like common sense reasoning, but it conflicts with what has been found with other types of addiction, which are known to hyper-activate the endorphin-opioid receptor connection, not counteract it. In fact, two medications that block the actions of opioid receptors, naltrexone and nalmefene, have been used to successfully treat gambling addicts with a family history of alcoholism, and these drugs have also proven effective in combating alcoholism itself despite the differences in opioid receptor system functioning that apparently exist between these two addictions. Based on such evidence, most researchers had previously concluded that elevated opioid receptor activity must be a driving force behind gambling addiction, but these new findings contradict that idea and suggest a more complex picture. It should be noted, however, that regardless of any differences that might exist between drug or alcohol addiction and pathological gambling, in each instance the opioid receptor system is implicated in the unfolding of the disease. That is why drugs that wall off opioid receptors and prevent endorphins from binding to them can be an effective form of treatment in either case. Whether opioid receptors are overstimulated or understimulated, with each type of addiction their functioning has been thrown out of balance, and it is this physical variance in the brain activity that causes so much grief for addicts who can’t seem to stop their self-destructive behavior.
If You’ve Seen One Addiction, You’ve Seen Them All – or Have You?
It is certainly interesting to discover that different addictions may cause diverse physiological responses, rewiring the brain in more than one way depending on the circumstances. Perhaps common sense would tell us this should be so. In the end, every subtle aspect of every particular dependency that can be detected through research will give addiction experts and addicts alike a better understanding of the enemies they are being asked to fight. This new information about the neurobiology of addiction may or may not lead to breakthroughs in the treatment of pathological gambling, but anything that can shed light on why problem gamblers do what they do is important and can only help dedicated rehabilitation professionals who always do their best to offer the most focused and targeted services possible.