Toronto Mayor Rob Ford has declared while he’s smoked crack in a drunken stupor, he is not an addict. What a classic denial of addiction. I watched the Ford drug saga heat up from the city of sin, Las Vegas, where I was at the Age Medicine Management Group physicians’ conference. If you want to see addiction up close and in mass numbers, there’s no better place than Las Vegas.
Whether it is to alcohol, drugs, food, exercise or gambling, addiction is recognized as a medical disorder. Most experts believe addictive behaviours occur because there is a chemical reward of neurotransmitters, known as “endorphins,” released in the brain. This creates a “high” in very simplistic medical terms. While others find the high enjoyable, not all of us seem to need this buzz on a regular basis. Those who do are often diagnosed with other mental health issues, such as depression, obsessive-compulsive disorders and bi-polar illness. The endorphin surge soothes sad feelings and feeds the more manic needs of a person suffering from a mental illness.
Some people may also be genetically wired to be predisposed to addiction. Images from MRI brain scans of obese patients support this notion. The area of the brain responsible for sensing rewards lights up much more brightly when responding to pictures of food in obese patients than among those who are not obese.
While some addictions, such as to drug and alcohol, are easier to recognize (and be videotaped) by those close to the afflicted person, problem gambling usually comes to light when financial and legal issues arise. When the gambler is losing control of their life, mental health practitioners often diagnose this behaviour as an impulse disorder. Addiction therapists agree it can be difficult to distinguish between pathological and non-pathological gambling in contrast to drug and alcohol addiction, where there are obvious signs of intoxication.
They also tend to believe that those at risk for developing a gambling problem will display increased compulsive gambling tendency when exposed to stimuli associated to gaming type environments. While Las Vegas presents an optimal disinhibiting set-up, environments demanding weighty decision-making may also feed compulsive highs. Certainly we have seen notorious financial trading scandals over the years to prove that pathological gambling does happen outside of casinos.
Wall Street and Bay Street are places where many thrive and are rewarded for taking risks with money, for example. I’m not suggesting stock traders are addicted gamblers. The critical difference in addiction related to gambling is between acceptable and pathological risk-taking. Some would serve up Donald Trump and Robert Maxwell as examples of powerful men who gambled with their empires at certain points in their business careers in a pathological way. I point them out because of the size of their risks. In the same way power is said to corrupt, perhaps power can also be connected to compulsion. Certainly, we’ve seen power-fed hubris affect judgment in politicians, too. For others, as well as for themselves. Untreated addicts can mean risky business – whether it be at city hall, on the trading floor, or at the gaming tables.
Elaine Chin, M.D.
Founder, Executive Health Centre