Stuart Milan was one of the 2% to 3%. The 59-year-old Detroit native began gambling as a kid — tagging along to the racetrack with grownups and playing cards with friends. As a young adult, his gambling went from pastime to problem, helped along by parents who couldn’t bring themselves to cut him off financially.

When they finally did stop picking up the pieces, he found his way to treatment and recovery — and to his career as a psychiatric nurse practitioner. Today, he works at The Ranch Mississippi addiction treatment center (formerly COPAC), is vice chairman of the Mississippi Council on Problem Gambling, and recently marked 28 years helping others with similar struggles.

He has learned a lot over the years about the realities of gambling disorder, and key among them is this: “It’s not going to get better on its own.”

But why do some people have problems with gambling in the first place? There’s no single answer, but thanks to advances in genetics and neuroscience, we now have a clearer picture of what has long been suspected — problem gambling is much like being addicted to drugs or alcohol.

For example, gambling activates the brain’s reward circuitry in much the same way that substances do. Problem gamblers also report cravings and highs. And just as with other addictions, problem gambling tends to run in families, indicating a genetic link.

And then there is the more observable similarity between gambling and addiction: the damage done to relationships, finances, careers and well-being.

In 2013, in acknowledgment of this and more, problem gambling got a new definition in the latest version of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, called the DSM-5. No longer was it considered an impulse-control disorder called pathological gambling. Instead, it became gambling disorder and joined the chapter on addictions.

With this landmark change, the APA signaled that it’s not just substances you can get hooked on. Behaviors can be addictive too.

Problem Gambling’s Predictable Course

In the case of gambling, that behavior has a very predictable course, Milan said, one that he likens to pregnancy. “You have a woman who is one day pregnant — you wouldn’t know she was pregnant, she may not even know she’s pregnant. Yet a woman who is nine months pregnant, everyone knows. Same way with gambling. You may be mild now, but it’s progressive. You’re not going to just stay where you’re at. It’s going to grow.”

That progression can be broken down into four stages:

The Winning Stage. “Winning sets the addiction in play because that’s a really reinforcing type feeling. … It’s adventurous, it’s fun, it’s social,” Milan said. And of course, there’s the money. “Most people get very confident when they’re in that stage when they are winning more than they lose. They start thinking things like, Hey, I can do this to supplement my income. I might even be able to do this for a living. Or, It feels so good and it helps with my depression. My problems go away.”

The Losing Stage. Somewhere along the line, the problem gambler inevitably begins to lose more than they win. They may start borrowing money, using a credit card to gamble and delay paying bills. “Nothing horrible really,” Milan said, “but there are warning signs going off that you’re starting to go downhill. You might start lying about your gambling. You minimize what you lost, and talk more about what you won.” It’s a pattern Milan remembers using with his father, who also loved to gamble but who was able to walk away in a way his son never could. “I would tell him, ‘I won,’ and he’d say, ‘Yes, but how much did you lose?’”

The Desperation Stage. The gambler gets more secretive and may borrow money from high-interest lenders or illegal sources, or steal to bankroll themselves. They feel desperate, not only to recoup losses but to capture the same thrill. “It’s the feeling they are going for,” Milan explained. “Money is the way they keep score, but the next best thing to gambling and winning is gambling and losing.”

At this stage, the fallout becomes more and more apparent, but the gambler is somehow able to disconnect from concerns and negative emotions while gambling. “It’s like they’re high. They’re numb. They’re thinking, I’m one bet away from being out of this. It’s going to change. And with gambling, sometimes it actually does. They get these wins and that reinforces, Wow, I actually can get out of this trouble I’m in. But ultimately they’ll give it all back,” he said. “The house always wins.”

Of course, there are professionals who make a living from gambling — who do actually beat the house, Milan acknowledged. But the difference, he said, is “they can stop. It’s a job. They are smart, hardworking and very controlled.”

The Hopelessness Stage. Beyond desperation waits hopelessness. There may be severe legal issues, divorce, psych unit hospitalizations, and suicide attempts. “Gamblers do become suicidal quite frequently,” Milan said, but sometimes talk of suicide is an attempt to garner sympathy when consequences pile up. Such manipulation is a hallmark of addiction, which literally changes the brain, Milan noted. “At first while they are gambling, it is actually a choice, but after a while, it’s no choice anymore.” 

Tips for Helping the Gambling Addict

So what can be done if you or someone you care about is struggling with gambling? Milan offers this advice:

  • When trying to convince someone to get help, be matter of fact about what will happen if they continue on the road they’re on. Remember that addiction is an illness. “You need to let people know what kind of behavior you’ll tolerate and what you won’t,” he said. “But if they feel judged, it will probably get worse.”
  • Realize that gambling disorder is tough to spot. “It’s much more secretive than drug or alcohol addiction because you can’t smell it, there are no marks on their arms. It’s just a lot more hidden.” Secretive behavior, in fact, is a key warning sign, Milan said.
  • Speak up. “I’ve been doing this for a long time, and no one I know comes in for treatment just because they think, Wow, I’m really going down the wrong road here. I’m going to straighten up my act. It’s because someone is motivating them. It could be their spouse. It could be the law. It could be their job. Someone is saying, ‘You’ve got to do something about this.’” An intervention, especially one led with the guidance of a professional interventionist, can be an effective way to get the message across.
  • Be aware that gambling disorder is often a symptom of other issues, such as depression, anxiety, trauma, ADHD and more, and it often goes hand in hand with addictions to drugs and alcohol. Through treatment, the gambler is able to drill down and address these, Milan said — and they must be addressed before successful healing can happen. But Milan adds this warning: “A lot of people place the cart before the horse. They try to fix all that stuff first. They think, ‘Well, if I do all that, I’ll stop gambling. I’ll stop using drugs.’ But they won’t stop. You’ve got to gain some abstinence and learn how to stay abstinent and you’ve got to address those issues.”

The key piece of advice Milan offers is this: Don’t delay. The sooner the gambler gets help, the less damage they do to their finances, career, relationships, self-esteem and mental health, and the more easily they’ll find their way to recovery.

If you’re not sure if you or someone you care about has a problem with gambling, this quiz can help you make an informal assessment. But it comes down to this, Milan said: “When you gamble repeatedly and it keeps causing problems, that’s when you know something’s going on.”

By Kendal Patterson

Follow Kendal on Twitter @kendalpatterson


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