By Hymie Anisman, Dept. of Neuroscience, 杏吧原创 University

Last week鈥檚 blog outlined several issues related to addictions in general, and then considered some features that were unique to gambling addiction. A discussion (rant?) followed regarding the role of the gambling industry, as well as governments, in facilitating and fueling gambling, and what their creative solution was to enhance their profits, yet 鈥榮eemingly鈥� acting responsibly to deal with the addictions that may emerge as a result of gambling. This amounted to donating a small percentage of gambling revenues to research that might point to ways to prevent gambling addiction or cure this condition if it developed. The motives and behaviors of the 鈥榞aming industry鈥� are clear; get the cash, but without being perceived as having contributed to negative outcomes.

There鈥檚 still another element that needs to be examined more closely. Specifically, the researchers grazing from the trough containing gambling revenues are in a bit of an ethical conundrum. They are, after all, taking money either directly or indirectly from the very organizations that contributed to the problem. A report by Rebecca Cassidy did a good job itemizing some of the factors that compromise gambling research, pointing out that too often research in this realm is devoid of disclosure policies, and as she put it, 鈥榤any researchers are unreflective or outright defiant about industry influence鈥�, and too often, a 鈥榩artnership model鈥� seems to exist between researchers, regulators and policy makers, to the extent that they come to believe that 鈥榳e鈥檙e all in this together鈥�. A cozy little family!

In other research domains, such as in the assessment of particular drugs to treat illnesses, scientists are required to disclose on research publications where funding was obtained, including private funding or from the public sector (e.g., drug companies), and to indicate whether the researcher had any vested interests (e.g., shares) in the company, or whether they sat on scientific boards or were being paid by the pharmaceutical company. Shouldn鈥檛 researchers studying gambling addiction similarly provide full disclosure? They typically disclose that their research was funded by such-and-such a granting agency, but shouldn鈥檛 they also make clear whether the funds actually came from (directly or indirectly) the 鈥榞aming industry鈥�, including government operated gambling venues and activities. Furthermore, shouldn鈥檛 they be indicating whether they received funds, above and beyond those ear-marked for research, such as payment for their efforts (cash or in-kind)? How close is their relationship with the research funders, now or in the past? For instance, have they served as a paid consultant for gambling agencies?

In her critique of the gambling business and research, Rebecca Cassidy pointed to examples of conflicts of interest, concluding that a trust deficit exists concerning what researchers in the field are saying in relation to gambling. As if on cue, some researchers began to protest, much too shrilly I believe, that they have never felt pressure to make or remove particular statements in their published reports. They go so far as to argue in favor of 鈥榯ransparency鈥� and even offer guidelines as to next steps, much as if there is a possibility, however remote, that there might be some wrong-doing out there, but they鈥檙e above the squalor. Aside from this apparent excessive protestation, I wonder if it dawned on them that such rebuttals would be better coming from someone who was at arms length from the issue. In the end, we still come back to the points made earlier. Is it enough to just disclose who funded a particular research project, or should disclosure include statements as to whether the researcher received, now or in the past, personal funding in cash or in-kind?

It would be unwise and unconscionable to paint all gambling researchers with the same broad brush. Most of the research descriptions I鈥檝e viewed on the sites provided by gambling agencies involved funding to excellent researchers, doing very worthwhile research. But, often there are obvious problems with some of the research. For starters, researchers are often restricted from access to casino patrons. Understandably, those running the casinos might be reluctant to have scientists bothering the clientele, or taking time away that could more profitably be spent gambling than answering questions. So, it鈥檚 often the case that scientists must conduct their research in 鈥榓rtificial鈥� gambling venues within university research settings, without any of the normal bells and whistles that are common in real casinos. Some university-based research has involved panoramic virtual reality displays or other venues where there are multiple slot machines, and other doo-dahs to create an environment that facilitates entry to the 鈥榯rance-like state鈥� that often happens with gamblers. In other instances, however, there鈥檚 only a single lonesome slot machine in an otherwise barren room, and the roulette wheel is a home-made device that doesn鈥檛 come close to what one sees at a casino, resembling something seen at a children鈥檚 carnival (essentially a wooden version of a 鈥榃heel of Fortune鈥�). They can call it a 鈥榞ambling lab鈥�, but the reality is that it鈥檚 an unconvincing facsimile of I don鈥檛 know what, but certainly not a casino!

As Cassidy indicated, even some of the research questions being funded are puzzling. Some granting agencies continue to fund projects to find out about the frequency of gambling problems (don鈥檛 we already know that it鈥檚 most common among those who can least afford it?). There are also studies that have attempted to assess neurobiological correlates of gambling by using imaging procedures to monitor brain changes while people are engaged in a virtual gambling exercise, which seems like a reasonable and interesting idea. Other studies opted to assess particular hormones (e.g., cortisol) in saliva in an effort to gauge stress responses. Remarkably, other studies have examined peptide hormones, such as ghrelin, in saliva even though these molecules are simply too large to be reliably detected in saliva, and are most certainly not relevant to activation of specific types of receptors present in brain regions associated with reward processes or impulsivity that might be linked to addictions.

There have also been many funded studies that attempted to get people to stop gambling, although these studies have unfortunately not been particularly successful. This is not unexpected as once well-entrenched, any addiction is difficult to eliminate. Some of these studies were, to be fair, grounded on reasonable theoretical premises (e.g., using particular therapy or other strategies to curb addiction). In other instances, the approaches used are, it seems, somewhat na茂ve. In one case, for instance, researchers chose to examine whether pop-up messages on slot machines reminding players to 鈥榖et within their limits鈥� (an oxymoron, if I鈥檝e ever heard one, akin to 鈥榙oing irrational things rationally鈥�) would diminish gambling. Is it remotely possible that this sort of messaging will have much of an effect on a pathological gambler busy feeding their cravings at a casino? Nothing else has worked to curb their habit, and if their decision-making abilities have been hijacked (as in the case of drug addictions), it鈥檚 hardly likely that they鈥檒l pay any attention to such pop-up message. Certainly not if these messages are divorced from other extensive therapeutic programs? Perhaps the gambling organizations sponsoring such research are aware that this strategy won鈥檛 work, and thus there鈥檚 no danger of their patrons not coming back; however, it provides these agencies with legitimacy regarding their willingness to deal with the problems.

Governments aren鈥檛 about to abandon their pro-addiction policies. They鈥檝e become addicted to the gambling profits, just as they鈥檙e greedy for the profits from alcohol and cigarettes. So, I suppose that the alternative is that we make the best of the situation. Indeed, I wouldn鈥檛 suggest that revenue from gambling not go into research, but this should be done responsibly. Rather than each province, state, or private sector company running their own granting agency, each having to deal with independent up-front administrative costs, it would be much more efficient to have research funding consolidated so that grants are awarded by a single agency with a track record in this capacity (e.g., Canadian Institutes for Health Research; CIHR). If nothing else, such an agency would be several degrees removed from the gaming establishment, and perhaps gambling researchers will have less of an opportunity to cozy up to the funders. Otherwise, somebody more suspicious than me might conclude that the fox is guarding the henhouse.

Hymie Anisman has recently authored two book听providing an evidence-based approach to understanding the role of stress on human health, and identifying听characteristics and听behaviours that render people more vulnerable or resilient. Both are available at Amazon.ca

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By Hymie Anisman, Dept. of Neuroscience, 杏吧原创 University

Addictions, especially those involving drugs, continue to be a problem world-wide. Several neurobiological and psychosocial processes have been implicated in addiction, which have led to a variety of treatment strategies, although most haven鈥檛 been overwhelmingly successful. It鈥檚 hard to eliminate a well-entrenched habit, and it鈥檚 still more difficult to continue to stay clean. As Mark Twain is thought to have said, although others have attributed this quote to W.C. Fields (in the context of alcohol drinking), 鈥淚t鈥檚 easy to quit smoking. I鈥檝e done it hundreds of times鈥�. Reminder cues and stressful experiences seem to activate systems that energize cravings that cause reinstatement of the addiction, particularly among those with impulsive characteristics. Anyone on a diet, or those with medical conditions, such as diabetes, that require them to watch what they eat, will know how easily they can be tempted, 鈥榡ust this once鈥�.

It isn鈥檛 coincidence that I鈥檝e linked eating and drug addiction. There is the belief that cocaine and alcohol addictions and 鈥榚ating addictions鈥� (although eating isn鈥檛 yet fully accepted as a genuine addiction) may involve some of the same neurobiological mechanisms. They each seem to involve activation of brain regions and neurotransmitters (e.g., dopamine) associated with rewarding feelings as well as those that operate in making judgments and decisions. They also share another important characteristic. Specifically, there are 鈥榮top鈥� mechanisms involved in these addictions. In the case of eating, two hormones, ghrelin and leptin are responsible for the initiation and cessation of eating, respectively. There is likewise evidence that leptin might contribute to drug addictions (or reinstatement) and perhaps ghrelin plays some role in this regard as well. When an individual has consumed a certain amount of food, or used enough of a drug, changes of brain activity are provoked so that the message to stop eating or snorting a drug will kick-in, and for the moment, the intake ceases. Once the drug鈥檚 actions have worn off, and the euphoric effects are replaced by dysphoria, the individual again resorts to drugs either to ward off the ill feelings that otherwise emerge, or to regain the high they had experienced previously.

Image from http://sustainablenutritionlifestyle.com/all-addictions-share-the-same-principle-what-is-it/

But there鈥檚 more to addiction than just that. With repeated drug use the functioning of brain regions responsible for decision making and impulsivity are disturbed, so that those who are addicted engage in further use, 鈥榢nowing that they can stop tomorrow鈥�. As much as we would like to believe that each of us has free-will, in a sense, addicted individuals aren鈥檛 governed by the same forces. Simply put, their behavior doesn鈥檛 simply reflect abdication of responsibility, but as Nora Volkow, director of the National Institute on Drug Abuse (in the US) suggested, drug addiction is an illness in which some cognitive abilities have been hijacked.

This brings me to another form of addiction. Gambling, like drug addictions, has been a considerable societal problem, but it receives much less attention. Perhaps it鈥檚 because gambling problems occur disproportionately often among poor people, although it also occurs among the wealthy, and has been a problem among college-aged individuals. Or perhaps, as problem gamblers don鈥檛 stagger or appear incoherent, and seem to function well, others might assume that a problem isn鈥檛 present. Yet, a gambling addiction can be as devastating as a drug addiction, possibly more so as it can be hidden from close others, at least until their money has evaporated and the house has been mortgaged.

Unlike the appetite for drugs and food, which can be sated, there doesn鈥檛 seem to be a 鈥榮top mechanism鈥� for gambling (other than the fatigue factor), and there鈥檚 no shortage of gambling venues to meet the need of those addicted. The ponies, cards, betting on football, baseball, basketball; gambling can be done at bars, and lottery tickets can be obtained at the gas station or the corner store, and for those who prefer privacy, the internet seems to be a comfortable companion. Of course, for the social gambler, what鈥檚 more enticing than the casino?

In the old days, gambling might have been controlled by the mob, and as their casinos grew, private investors entered the scene as well, and considerable research went into finding ways to enhance profits. This amounted to increasing their customer base, and having customers bet for a longer duration and/or greater amounts. This tax deductible 鈥渕arket research鈥� indicated that the lighting, oxygen circulation, alcohol, the nature of the game (e.g., slots vs cards or craps), presence of hostesses, as well as restaurants, all improved their bottom line. They learned ways of exciting customers by making (tricking) them feel as if they almost won (e.g., getting two cherries and one lemon, but having the lemon appear right next to a third cherry on a slot turn), even though the simple fact is that they lost (again). In lotto games and in slots, winners might win a free ticket or a number of free spins, which might seem like 鈥榓 win鈥�, but the free tickets or the free spins, typically don鈥檛 result in actual wins. Ridiculously, players might win 20 cents on a $1 spin (meaning that they actually lost 80 cents), but with the sounds and lights that accompany this 鈥榳in鈥�, the loss actually feels like a win. Even the term 鈥榞ambling鈥� was changed to 鈥榞aming鈥�, which seems to have less stigma attached to it. Of course, players still call it gambling, but for management that doesn鈥檛 want players to think they鈥檙e taking high risks, the term 鈥榞aming鈥� is preferred. Parcheesi is a game, so is chess. Bingo was a game, until it turned into gambling, but let鈥檚 be realistic, there鈥檚 no way that slots and craps are just a game.

Casinos shared some of their loot (which annually exceeded $37 billion a few years ago) by paying taxes, and governments were fairly happy with this profit-sharing arrangement. However, witnessing the profits that could be made, some governments decided they wanted in on the action, and chose to cut out the middleman. They began to run their own lotteries that offered both instant and delayed gratification (or disappointment), built and operated fancy casinos, and in case you couldn鈥檛 get to the casino they placed the big money maker (slots, which 鈥榚arn鈥� about $100,000 per machine) in bars and at racetrack. Having learned from the years of earlier research, the government operated gambling ventures, involving the very same routines to maximize profits. With unlimited funds, they also advertised their product on every type of media outlet. This has continued for several decades, expanding considerably over time.

Everything seemed to be moving along just fine, but a problem seemed to creep up that could have some negative repercussions. The government-run casinos might be associated with increased gambling addiction and consequently an increase of depressive illness and suicide. Indeed, the likelihood of gambling addictions was elevated in the few kilometers surrounding new casinos. To be sure, this is just a correlation, and the two events could have been independent. It鈥檚 akin to saying that drownings occur where there are oceans, lakes, rivers or swimming pools; these don鈥檛 cause drownings, but they wouldn鈥檛 have occurred if these waters weren鈥檛 accessible.

How would it look for the government to be complicit in provoking addiction? So they came up with the clever notion of funding research to prevent or curb addiction. Why not target a small portion to gambling addiction research? It鈥檚 unlikely that governments were simply paying out 鈥榞uilt鈥� money. Instead, this was a well thought out public relations effort (look, we鈥檙e doing good things in addition to offering the possibility of jobs for the community, and bringing in badly needed tourist money!). The gaming industry (including manufacturers of gambling equipment) soon followed suit, and they too offered funds for research. It was argued that many 鈥榩roblem gamblers鈥� (this is a choice term, as it makes it seem that the individual is the problem, not the system set up to create gambling addiction) would have fallen into addiction irrespective of whether or not governments owned casinos, and so research funded using casino revenues might be a public service. Yup, and I just fell off a turnip truck!

In next week鈥檚 blog, I will take a look at the role researchers have had in fighting against, or in the interests of, the gambling industry.

Hymie Anisman has recently authored two book听providing an evidence-based approach to understanding the role of stress on human health, and identifying听characteristics and听behaviours that render people more vulnerable or resilient. Both are available at Amazon.ca

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