M. David Lewis

Article / Updated 05-03-2023

Gambling involves the betting or wagering of valuables on uncertain outcomes and takes many forms — from games of chance to skill-based activities. People have many motivations for gambling, but all involve the hope of gaining more. Gambling is sometimes a rite of passage by which people discover more about themselves and how to compete with others. It is sometimes a way of life (for people such as casino pros and escape gamblers). It can be, in its healthiest form, a way of socializing and having fun. Pathological gambling is a progressive disorder that involves impulse-control problems. The consequences of pathological gambling are severe and may be devastating to the addicted person's family and career, but the disorder can be treated. As with all addictions, pathological gambling has personal, familial, and neurochemical aspects. Pathological gamblers may even have a genetic vulnerability, although such complex behaviors are unlikely to be traced to one specific gene in the same way some medical conditions, like cystic fibrosis, have been. Problem gambling pioneer Dr. Robert Custer identified three phases to a progressive gambling problem: a winning phase, a losing phase, and a desperation phase. Winning phase In the winning phase, you may experience a "big win" or a series of smaller wins that result in excess optimism. You may feel an unrealistic sense of power and control and you're excited by the prospect of more wins. ("Hey Doc, this is a sure thing. I'm betting the farm.") At the same time, you can't maintain the excitement unless you're continually involved in high-risk bets. Your bets increase, and ultimately, the increased risk puts you in a vulnerable situation where you can't afford to lose . . . and then, sure as the sun rises, you do lose. Losing phase In the losing phase, you may brag about past wins; how you had the casino or track or bookie on the ropes. But in the immediate situation, you're losing more than winning. You're more likely to gamble alone, and when not gambling, you're more likely to spend time thinking about how and when you'll gamble next. Most importantly, you're concerned with how you'll raise more money, legally or illegally. You may have a few wins that fuel the size of your bets. But the dominant pattern is that of losing. Moreover, making the next bet becomes more important than the winning of any previous bet. As the losing continues, you start lying to family and friends and feeling more irritable, restless, and emotionally isolated. You start borrowing money that you're unsure about being able to repay. As your life becomes unmanageable, you may be developing some serious financial problems. Your denial of the huge financial pressures that are building may seem unbelievable to some people: You're also likely to start chasing your losses, trying to win back what you lost. ("Doc, I'll stop, but first I've got to get back to even.") If you don't change your pattern, however, you'll be engaging in more and more self-destructive behavior. Desperation phase The next phase, the desperation phase, involves still another marked change in your gambling behavior. You may now make bets more often than is normal, in more desperate attempts to catch up and "get even." The behavior that's now out of control is associated with deep remorse, with blaming others, and with the alienation of family and friends. You may engage in illegal activities to finance your gambling. You may experience a sense of hopelessness and think about suicide and divorce. Other addictions and emotional problems may also intensify during this phase and drag you down.

Article / Updated 04-17-2023

Direct from the Age of Aquarius, with a history going back thousands of years, hallucinogens take people on far-ranging trips inside their own minds. Hallucinogens (also called psychedelics) cause your brain to generate experiences that are profound distortions of reality. We have five senses: seeing, hearing, tasting, touching, and smelling. Hallucinogens distort these senses, and particularly change your impressions of time and space. Hallucinogens specifically disrupt the neurotransmitter serotonin and interfere with the way your neural cells interact. Serotonin can be found in many places in the central nervous system (your brain and spinal cord) and assists in the functions controlling mood, hunger, body temperature, sexual behavior, muscle control, and sensory perception. The trips caused by hallucinogens can last for as long as 6 to 12 hours. Some trips are good, some are bad. A good trip is dependent on your mindset when you take the drug. Your reaction may differ from time to time, even though you take the same amount of a drug. A good trip often involves visual hallucinations (seeing things that aren't really there or that are distorted). These images may be seen as funny or inspiring, or just odd. Colors may be especially intense and intriguing patterns may emerge on surfaces, like tables or ceilings. Distortions of objects, faces, and other body parts may be experienced. A heightened sexual drive — an aphrodisiac effect — has also been reported. A bad trip on the other hand, may be set off by similar doses of drug that in the past provided a good trip. A bad trip is a frightening experience with surging anxiety and fears of being out of control and vulnerable. Terrifying images and hallucinations have been reported. At different times, under controlled conditions, hallucinogens have been used in experimental forms of psychotherapy, because they seem to bring underlying conflicts to the surface. The bad trips may be linked to these conflicts surfacing, especially when they take symbolic forms and distort reality (these distorted thoughts and images are like a very bad nightmare). Some hallucinogens come from plants but most are synthesized and manufactured. Mescaline comes from the cactus plant called peyote. Psilocybin comes from certain mushrooms often referred to as magic mushrooms or shrooms (for short). LSD (lysergic acid diethylamide, also known as acid) and a dissociative anaesthetic, PCP, (phencyclidine or angel dust) are widely available synthetic hallucinogens. Taking LSD may make you feel several emotions simultaneously and may merge senses so that you see sounds and hear colors. LSD itself, is a clear or white, odorless, water-soluble material synthesized from lysergic acid, a compound rye fungus. The potential of LSD for abuse is fairly high because the experiences are exciting to some people and they want to re-experience their excitement until, of course, they have a bad trip. If you value self-control, it's unlikely that you'll want to gamble in this way about having a good versus a bad trip. If you use LSD, you may experience flashbacks — a repetition of earlier LSD experiences. A flashback often has an unsettling effect, because it is something that is frequently beyond your control. Flashbacks can occur later in your life and seem to be set off by past associations. People with post-traumatic stress have reported similar experiences as they relive their trauma. In a flashback you have to redirect your attention to the present and get out of your head. Flashbacks are a significant concern if they occur when you're driving or in other situations where distractions can result in elevated risks.

Article / Updated 03-26-2016

The degree of distress experienced by families affected by addiction is usually underestimated. In all normal situations, families try to take care of each other, especially in times of illness. What happens when you refuse your family's help, and then appear to go out of your way to upset them? Most people in this situation will try even harder to get the result they want — and most family members want their loved one to stop the drinking or using drugs. It's one of life's ironies that the harder the family members try to help you, the worse your problem sometimes seems to get. The blame game In the early stages, the family, especially the person closest to you, doesn't want to believe what is happening to you. Some very normal personalized beliefs come into play for your loved one, including the following: If I were a better wife (or husband, son, daughter, mother), you would love me enough to stop drinking or using. As a parent, I must have done something wrong to make you feel so bad that you have to take these drugs. I need to work harder to make sure you love me, and then you'll stop, and everything will be okay. Believing they're to blame, the family members begin to bend over backward to make things better for you and to keep the family functioning. Meanwhile, you tend to blame someone for your need to drink or use and you likely pick on those nearest you, your family. No one can talk about what's really happening — after all you may get angry or you may leave. Communication begins to break down, and the vicious circle goes around and around, with all players locked into their own very private pain. The consequences to you and your family The addiction problem of a family member can lead to all sorts of harmful consequences: Socially: Through embarrassment and shame, families decline invitations, stop inviting friends to their home, and start to ignore friends and hobbies. The family becomes gradually more and more isolated — unable to tell anyone what's happening. Psychologically: When family members have been lied to many times, they find themselves furiously searching for evidence to support their suspicions. Emotionally: Living with you and your addiction is like being on a roller coaster. The family members feel angry, frustrated, helpless, confused, hopeless, desperate, guilty, and ashamed. Physically: The stress of living in a chronic state of chaos, being on edge all the time (constantly worrying as to what your next phone call will bring and what they'll find when they open the door to your room) eventually takes a toll. Family members of addicts have more than the average prevalence of anxiety, depression, headaches, migraines, digestive disorders, and heart problems. It's not unusual to find close family members of addicts admitting to feeling periodically suicidal. In short, the family becomes so focused on your behavior that they're distracted from all but essential matters. The family develops its way of coping; the family becomes so hooked on helping you that contemplating no longer helping you is as difficult for them as it is for you to stop drinking or using. A huge fear of making changes builds up, and this eventually becomes counterproductive for you and for them.

Article / Updated 03-26-2016

Your family often no longer knows what to do. Their lives have been turned upside down. They're worried sick. Every waking moment becomes weighed down with serious concerns. You may have promised many times to end your addiction and get help. As they look back, the explanations for the hours lost, the money gone, and the emotional trauma, are now clearer. These losses are the many sad faces of addiction. You're not yet ready to stop — you may only be capable of empty promises and guilt-ridden apologies. What can they do? What can you do? When you seek professional help, you and your family are scared. You may be more frightened than ever before. Your secrets will be exposed. You may find yourself willing to do anything at this point to avoid getting help. Lying (best with a straight face and indignation) is typical. You may promise anything to take the pressure off. If that doesn't work, you lash back: "What right do you have to tell me what to do? If you don't stop questioning me, our relationship is over." The fear and hostility may be palpable. Family members will find no easy ways to guide you into care. You're in a cycle of denial and fear, fueled by shame, resentment, and deep inner pain. You feel so alone that you become hardened to the emotional outbursts and rage of loved ones. Professional help is strongly recommended if you're at this point. How an intervention works An intervention is an objective, caring, nonjudgmental process. You're confronted with the reality of your actions by those adversely affected. The objective is to motivate you to accept help. Although your family is definitely involved, a professional interventionist guides the process. The first formal interventions used the Johnson method, which was developed by a priest named Vernon Johnson and two friends, Wheelock and Irene Whitney. The Johnson method started as a challenge to the idea that you couldn't be helped until you hit bottom — a point in life where family, job, finances, or a combination of them is lost. The purpose of any intervention method is to help you confront your denial of problems and your fear of change, and to help you get into care. The interventionist is trained to communicate supportively, helping you accept your need for help and educating you and your family about addiction. She provides a link to treatment, ensuring that the right treatment center is found and contacted and that background preparation for your entry is completed. You're invited to a meeting but you may not be told much about the purpose of the meeting. At the meeting, which is carefully planned and structured, concerned persons express love and caring while describing, in behavioral terms, how you're affecting them. They express their wishes and needs for you to enter treatment. Concerned persons need to state concerns clearly, without lapsing into accusations and anger. One simple skill is to communicate with an "I" message versus a "you" message. For example, "I feel sad" versus "You make me feel sad." Describing behavior versus voicing feelings, opinions, and judgments is a learned skill. It is based on making references to the actions that are clearly observable, like those that could be captured on video or audiotape, for example. During the intervention, the realistic consequences of not entering treatment are described, matter-of-factly. The consequences may include separation or divorce, the refusal of adult children to attend family functions, job loss, and loss of friendships. Other people can't control your decisions and behavior. They can only control their responses to your decisions and behavior. The intervention process often exposes weaknesses in the family system. Families who have long suffered from a member's addictive behavior may be angry and punitive. Or they may be numbed into temporary or chronic states of no longer caring about what happens to you. Conversely, they may fear reprisals for breaking your secrets and the codes of silence that have helped you maintain your addictive behavior. The denial of problems and disbelief in the potential for change often add up to turning a blind eye to your addictive behavior. The interventionist has to balance the goal (getting you into treatment) with the complex communications of family members who may have old and new issues to settle. However, an intervention isn't the time for a complete course of family therapy. Family therapy meetings can and should occur after the addicted person is established in treatment. Most interventionists and experienced clinicians are specialists in helping you move past your denial and increasing your motivation for treatment. To achieve this goal, they use a motivational interview. The motivational interview has become one of the more powerful interventions to help you. Such an interview is conducted by a trained professional and is designed to help you go beyond your guilt, fear, and anger to participate in healthy decision-making. The interventionist helps you consider your decisions practically, in terms of what you stand to gain by change and what you stand to lose by change — and what you gain and lose by not changing. The goal is to help you make an informed decision about treatment. Intervention principles There are ten general principles that influence the decision to intervene and that guide the intervention process. These are: Your behavior is causing significant damage in your life. Denial is preventing you from fully appreciating the damage the addiction is doing to you and your life. You're unlikely to seek help on your own. The people involved with you can change the environment by changing the enabling system — making it more likely that you will seek help. The sense of genuine concern and understanding conveyed by the interventionist is one of the most important factors in influencing you to seek help. Anger and punitive measures have no place in interventions, because they increase your defenses, making it less likely you'll seek help. The consequences for not going into treatment should not be designed to punish but rather to protect your health and well being. You require an initial period of intensive treatment such as a 28-day residential program or an intensive outpatient program to address your denial. The intervention may be useful even if you aren't likely to go to treatment. The intervention isn't a confrontation. Rather, it is a well-organized expression of genuine concern for you, given a chronic and serious addiction problem.

Article / Updated 03-26-2016

Dealing with an addiction means you stop wasting energy and time on self-deception. Take a good, hard look at yourself and be perfectly honest. Are any of these statements true for you? Your substance-seeking behavior is increasing (you are going to places where you can score), or your compulsion to do the problematic behavior (such as gambling) is increasing. Your main reason for living is using. You lose touch with important aspects of your life, such as friends, work, school, and family responsibilities, because of substance use or addictive behavior.

Article / Updated 03-26-2016

If you suspect that a loved one is dealing with an addiction or behaving in self-destructive addictive behavior, look at this list of questions, which signal an addiction, and answer yes or no. Does your loved one . . . Turn up late for functions or dates? No longer follow-through on his/her commitments? Have more trouble with illness than usual? Have more problems at work than usual? Appear to be withdrawing from intimate contacts? Have unexplained absences from or inconsistencies in his/her usual schedule? Appear to have a new set of friends who he/she is highly involved with but who you don’t get to meet? Have major financial fluctuations (like carrying more or considerably less money than usual)? Have lapses of concentration or memory? Stay up later at night and sleep in more during the day? Have more trouble than usual getting it together in the morning? Appear surprisingly secretive about specific aspects of his/her life? While this checklist cannot diagnose an addiction in a loved one, the more “yes” answers you produce, the greater the chances are that your loved one is suffering from an addiction.

Article / Updated 03-26-2016

Entering treatment for an addiction involves a sincere effort and finding the right method of treatment. Keep in mind that when deciding on your treatment options, all addiction recovery programs use one or more of these seven views on addiction: Moral: People can sacrifice anything to feed addictions. Disease: Addiction is like other diseases that cause unhealthy brain function. Pharmacological: Addiction stems from chemical imbalances which non-addictive drugs can overcome (for example, antidepressants and anti-anxiety medications). Cognitive-behavioral: "Stinking thinking" or cognitive distortions drive addictions and can be replaced with "healthy thinking" and non-addicting satisfactions. Learning: Different levels of learning cause addiction. Conditioning is important as it can be largely automatic and dominant, involving little or no thinking. Psychodynamic: Difficulties in emotional regulation cause psychic numbing, emotional flooding and other extremes — addictive substances are then used to numb, calm, sedate, excite, sexualize. Biopsychosocial: Physical, psychological and social aspects of addiction are addressed in combined treatments. These views are structured into programs taking place in residential treatment centers (for example, 28 day program) or outpatient centers, guided by professionals or self-help trainers who apply twelve step and other treatment approaches.