Addiction is undeniably a plight of the human condition – it’s the urge to do something we know is objectively harmful to us. On that basis alone, it is right we make clinical help available to those who suffer from addiction, in the same way we provide medical care to those who suffer with heart disease or cancer. We clinically research these diseases because the more we understand them, the more successful the treatment we can develop against them.
But the truth is, if we really want to help those with addiction, we have to be willing to really understand the true nature of addiction. Currently, the debate on gamblingregulation in the UK is consumed by a plethora of anti-gambling research, typically authored by non-clinicians, that suggest gambling harm indiscriminately affects everyone, and is predicated on the notion that everyone is one step away from addiction. This doctrine goes against what we know about addiction as a whole; addiction is a specific condition in individuals, rooted in deficiencies of key neurotransmitters and regions within the brain. This succinctly explains why we do not all have an addiction of some form, despite the mass availability of addictive agents. If exposure to addictive agents was the cause of addiction, as some research tries to suggest, all adults should, in theory, to addicted to something.
Understanding addiction is the bedrock of this legislation, because it is what allows you to identify who requires the help the Government are seeking to provide – arguably the very purpose of these reforms. The reason why this lack of understanding of addiction is so important for the overall debate is because you cannot recognise those who do not need protection, help, and measures, until you are able to correctly recognise those that actually require the protection, help, and measures. Regrettably, the White Paper is predicated on the idea that everyone needs some form of protection, and that is why these proposals will remain deeply flawed until the Government acknowledges that while there are some individuals who need help in identifying, treating, and managing their addiction, the vast, vast majority of individuals need no help whatsoever. Therefore, much of this legalisation, namely affordability checks, is, to them, entirely unnecessary, disproportionate, and meaningless. To understand the nature of addiction is to understand that 99.6% of gamblers should be left to enjoy their hobby as free and independent adults.
Separating out addicts from healthy gamblers requires a willingness from the Government to recognise that addicts cognitively operate in an entirely different way to that of a healthy bettor, and that we need to recognise them as two distinct groups of people that do not need to be subject to the same measures, in a similar manner to the way we recognise children with dyslexia have different needs to the rest of their peers. This is not disparaging; indeed, it is the best way to direct and target resources to those most in need. The White Paper arguably does the opposite of this – its application is general, rather than specifically identifying, based on the sole unscientific notion that because “everyone has a casino in their pocket”, everyone is at equal risk of becoming addicted. We all have the same ability to purchase alcohol, fatty foods, cigarettes, and pornography, but that doesn’t mean we all exploit them equally.
We believe the term ‘problem gambler’, which is so deeply entrenched in the Government’s view of gambling, is based entirely around this ideology, rather than the evidence we have on addiction as a cognitive condition. Indeed, the anti-gambling lobby, who coined this particular phrase, can’t even decide among themselves what the figure of ‘problem gamblers’ is, having left the definition deliberately vague in order to exaggerate the number of individuals who can be said to be adversely affected by gambling. Indeed, for other addictions, there is no comparable terminology – there is no such thing as ‘problem pornography watchers’ or ‘problem heroin users’ – they are simply addicts. To use the phrase ‘problem gambler’ is to falsely conflate the problem with gambling, rather than the problem lying with the cognitive operation of the addict. Indeed, if the problem was solely gambling – that to ban gambling tomorrow would ‘cure’ the 0.2% of those who suffer from gambling addiction – it wouldn’t be the case that many addicts are found to have multiple addictions. Staiger, P. K et al (2013) found that over 30% of those seeking treatment for alcoholism also presented with drug addiction. Furthermore,Slutske, W et al (2000) found that between 45% and 63% of those suffering from pathological gambling also report a history of alcohol abuse or dependence. This provides the reason why it is incorrect to attempt to individualise and separate addictions, since they are all so deeply united by the common thread of compulsive behaviour, and often, as the multiple addiction figures illustrates, exist together. To seek to prevent gambling in addicts through measures such as affordability checks will not prevent addiction. It will either push addicts to a black market where they can continue their addiction off the radar, or push them towards a substitute addiction, if indeed they do not already have one. What is the proposal for gambling addicts who shift their addictions to another agent, as we’ve seen in cigarette vs nicotine use?
We should instead by collating our knowledge from other addictions to help identify, treat, and manage gambling addictions, just as we do with other diseases that have different variations, such as different forms of cancer. The real problem addicts face is, ironically, the anti-gambling lobby. They feel even the measures in the recent White Paper do not go far enough. Actually what addicts need is for the Government to do very little, and to leave it to the clinical professionals who know how to identify, treat, and manage the condition of addiction.
Recently, Dr Robert Lefever, former addict and now pioneering addiction specialist, joined me on a podcast to discuss the White Paper. He estimates that 1/6 of the population has an addictive nature, be it alcohol, gambling, sex, substance abuse, food, or shopping. Contrastively, 5/6 of the population have no issue across the board with regards to addiction whatsoever. Why is it some of us take one puff of that cigarette behind the bike shed at school, and some of us go onto to be life-long chain smokers? Clearly, there is a difference between that 1/6 and that 5/6.
This is the research that informs the scientific argument of the Gamblers Consumer Forum, one we believe the Government should also consider.
When a pathological gambler wins a bet, their brain is flooded with dopamine, as with all gamblers – they feel elation – but critically, for a pathological gambler, whenthey lose a bet, they need the dopamine hit again. The pathological gambler will then typically place a high-stake, high-reward bet to compensate for the lack of dopamine in their limbic system. Overtime, their brain’s circuitry system builds up tolerance to an excess of dopamine, and so more dopamine is required to generate a ‘high’. This is all as a result of the way dopamine functions in the brain of an addict.
The brain strives to maintain balance, but altering its neural pathways means a false equilibrium is created. Association networks in the brain of the addict, like the basalganglia, actively work to increase the efficacy of the dopamine signal when a ‘low’ occurs to try and maintain a new balance with an inflated ‘high’. Floresco (2015) found that when an action is followed by an increase in dopamine activity, the basal ganglia circuit is altered in a way that makes the same response easier to evoke when similar situations arise in the future.
The reason for the alteration is circuitry is derived from the regulation of dopamine, which is genetic. Indeed, the National Institute on Drug Abuse estimate genetic factors are 40-60% responsible for addiction.
The COMT gene (the gene that provides instructions for making an enzyme called catechol-o-methytransferase) is responsible for the regulation of dopamine in the brain, and is embedded our in 22nd chromosome. There are two alleles (or variations) to that COMT gene: met, and val. Research has uncovered that those who possess the met allele have a reduced capacity, compared to those with the val allele, to remove dopamine from the brain ie the brain takes a more sustained dopamine hit.
Verhagen et al (2010) estimates that 20-30% of white Europeans carry the met allele. met carriers show more reward sensitivity if they win something, or if they experience high stress. They have higher attention to reward and gain (Bilder et al, 2004) , and these characteristics influence their decision making in the prefrontal cortex. Carriers of met are found to, in some studies up to 25% have more extracelluar dopamine levels in their brain compared to val carriers , so in essence, when triggered, met carriers have significantly more dopamine in their limbic system that majority of the population. Because this affects dopamine neurotransmission in the nucleus accumbens (structures involved in mediating motivational processes) , pathological gamblers ‘want’ to gamble, even if they don’t actually derive pleasure from it.
Turning to the contribution of environmental factors, we know that certain individuals are genetically predisposed to stress, and we also know that stress can increase your dopamine levels (Calipari et al, 2021) , leading to an increased tolerance. By examining the alleles present, researchers have found a link between stress and pathological gambling.
The short allele of the serotonin transporter (5-httlpr) is associated with a heightened response to environmental stimuli and an acute awareness of stressful situations. The short allele was found by Perez De Castro et al (1999) to be significantly more frequent in male pathological gamblers. We also see these in the met allele of the COMT gene – a sensitivity to reward and gain, and susceptibility to stress.
People exposed to psychological adversity, particularly in childhood, have an impaired function of their norepinephrine neurotransmitter (Ibanez et al, 2003) – meaning the neurotransmitters and hormones related to stress are dysfunctional. This was found to be higher in pathological gamblers. However, not everyone who experiences stress then becomes a pathological gambler. This therefore suggests that pathological gamblers are both exposed to stress and have an inhibited genetic predisposition to be able to deal with that stress. Further compounding this idea, Comings et al (1996) found carriers of the Taq1a allele have reduced D2 receptor binding, meaning they have a high pain threshold. This creates the perfect genetic storm for an addict to function: an insatiable desire to win, combined with a lack a pain when experiencing a loss.
The GCF have yet to see an discussion involving clinical and neurological research such as this. What we have seen in abundance is research in the social and economic domain. What we find most worrying is that this is not one study in isolation – study after study shows a genetic link with gambling addiction, and how an addict’s genetic make up leads to difficulty in dealing with environmental factors, such as stress.
The GCF are concerned this is research is largely ignored because the anti-gambling lobby, who have so much power and influence over the debate on gambling regulation, find it inconvenient to their narrative. It is staggering to witness a discussion about a clinical condition with so little clinical research and evidence. Going forward, this is something the Government urgently need to address, as this is what decides whether addicts will get the support that they need, and the fate of those who do not need the support – whether they are able to exercise their perfectly legal right to place a bet and continue to support the industries, such as the horse racing industry who rely heavily on betting turnover, and that are the lifeblood of many local economies. In its current form, the most likely outcome of this White Paper is that it will help nobody at all.
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