Parkinson disease is often treated with dopamine agonists such as apomorphine. Dopamine agonists may be the cause of other disorders reported to be prevalent among those with Parkinson disease. Individuals with Parkinson Disease have been reported to have a high rate of disordered gambling and other impulse control disorders.

A new study looks at the relationship between dopamine agonists and impulse control disorders (Weintraub et al., 2010). Besides disordered gambling, other impulse control disorders include compulsive shopping, binge-eating and hypersexuality. The study uses a large cross-sectional design to examine impulse control disorders among those with Parkinson disease.

The researchers recruited 3,090 participants from patients at 46 movement disorder centers in the U.S. and Canada. The participants were included in the study if they met certain criteria. Patients must be between 30 and 75 years; a history of taking medication for Parkinson Disease for at least one year and showing a response to treatment; had not stopped or started therapy in the last six months.

The participants were each assessed for several impulse control disorders using interviews and formal diagnostic tools, including the Massachusetts Gambling Screen, the Minnesota Impulse Disorders Interview, and the DSM-IV.

The researchers used odds rations to determine the impulse control disorder frequencies between Parkinson disease patients on dopamine agonist therapy and patients undergoing other types of treatment.

The results of the study showed that when compared to Parkinson disease patients not being treated with a dopamine agonist, those treated with a dopamine agonist were 2.7 times more likely to be diagnosed with an impulse control disorder, and 2.8 times more likely to be diagnosed with disordered gambling.

The results showed that overall, 17.1 percent of patients taking dopamine agonists were identified as having one or more impulse control disorders. This is in comparison with those on other types of treatment, at 6.9 percent having impulse control disorders. Binge eating disorder was highest among those not using a dopamine agonist at 5.6 percent.
Many of the patients showing an impulse control disorder were diagnosed with more than one. The average number of impulse control disorders among the patients treated with a dopamine agonist was 1.38.

The study’s results may be limited by the use of a cross-sectional design because side effects of treatments for Parkinson disease may change over time.

The findings of the study show the significant risk for impulse control disorder found among Parkinson disease patients who are treated with dopamine agonists. Healthcare providers have an opportunity when prescribing treatment to talk with the patient and the patient’s family about the significant risk for developing an impulse control disorder.

Gambling addiction can wipe you out – financially, physically, emotionally, and socially. Once you reach the point of compulsive gambling, sooner or later you’ll find yourself on the down slope of this addictive pastime. Millions of Americans have come to this painful realization, while many more continue to allow gambling to control their lives. Getting professional treatment and going to 12-step meetings is critical to getting back on track, but you still have to face the consequences of all that indebtedness. While it may seem like a daunting proposition, you can do it. There really is a promising future ahead if you’re sincere about getting out from under after gambling addiction.

The question becomes: How do you proceed? Where should you start? Here are some tips on putting your life in order:

1. Make a List of all Indebtedness

Most compulsive, pathological and problem gamblers have debts related to gambling. In addition, they’re almost always behind on their financial obligations. The only way to begin climbing back from financial ruin caused by gambling addiction is to first see exactly where you are.

Start by listing all your debts. Include overdue payments, money borrowed from family and friends, credit card balances and cash advances, checks you wrote for which there were no funds available, and money you owe to casinos.

If you’ve lost your home or are in the process of foreclosure, this item will be high on your list. The same holds true if your possessions (including cars, boats or other high-ticket items) have been repossessed for nonpayment.

You may have had to declare bankruptcy as a means of righting your financial foundation. But this doesn’t stop the compulsive gambler, as you may well know. Even after getting a clean slate, so to speak, gambling addicts go right back to spending money they don’t have in order to chase the elusive win. After years of such behavior and the resulting negative financial consequences, not only is there no money available (even family and friends won’t lend you money anymore), compulsive gamblers in the final stage of their addiction may see ending their lives as the only viable solution.

Once you have your complete list of indebtedness, put it aside. It’s time to move on to the next area in your self-inventory.

2. Examine How Your Life has been Affected by Gambling

Don’t even think about the good old days of winning big. Those days are gone, if they ever truly existed. Here you need to concentrate on the negative ways that compulsive gambling has affected your life. You’ll need to take a deep breath before you
start, because this self-analysis won’t be pretty.

• Physical – In what ways has your physical well-being suffered as a result of your gambling? Have you lost considerable weight or gained pounds due to insufficient diet and lack of exercise? Have you developed a smoking addiction in addition to gambling? Do you also drink, do drugs, or have other addictive behaviors that have contributed to a decline in your physical health? Are you unable to sleep through the night due to a medical condition that you have not paid attention to or that has progressively worsened?

• Emotional – Think about the past few months and years of your gambling addiction and the way you feel about your behavior. Are you frequently depressed, anxious, or fearful? Do you engage in self-justification or tell lies in order to cover up your actions? Are you filled with guilt and shame over your mounting losses and the resulting deterioration in your family life?

• Work – Did you lose your job, fail to get a promotion or get demoted? Have you lost a number of jobs due to your gambling? Are you no longer taken seriously at work? Do co-workers regard you as undependable, untrustworthy, or worse? Are you in danger of losing your ability to provide for your family as a result of your gambling addiction?

• Social – Have you lost a great number of friends due to your gambling addiction? Do co-workers and formerly close confidants avoid you now because you’ve created problems or hardships for them as a result of your need to gamble? Do you neglect your social network so that you can concentrate on gambling? Do the only so-called friends you have consist of other gamblers?

• Legal – Have you been arrested, named in a lawsuit, been served with divorce papers, brought to court over child support issues or had other legal problems as a result of your compulsive gambling?

• Family Life – How has your gambling addiction affected your life with your family? Do your children regard you as a joke? Do you fail to come home to have dinner at regular times with the family? How are your marital relations with your spouse? Have you paid any attention to the needs of your partner and children or are you so consumed with your gambling addiction that you are completely detached from the rest of the family?

There may be other areas where your life has been negatively impacted by your compulsive gambling. If they don’t seem to fall into one of the previously mentioned categories, just list them anyway. The point isn’t classification, anyway. It’s about making a complete self-inventory of all the ways gambling has negatively affected your life.

3. List the Reasons You Gambled

In order to get out from under after gambling addiction, it’s important that you understand the reasons why you gambled in the first place. If you already got professional treatment for addiction or have been seeing a private therapist to help you overcome your gambling addiction, you will already be familiar with this step. You can’t build a foundation of healthy behavior until you first know the underlying reasons for your need to gamble.

Some of the common reasons people say they gamble include:

• Gambling provides excitement
• Gambling makes me feel like a big shot, a winner
• I can win a lot of money gambling
• Gambling helps me feel more outgoing and social, since I am very shy
• I gamble to forget about my problems
• Gambling makes me feel more powerful
• I numb myself out by gambling
• When I gamble, I can avoid other people
• I don’t have to think about my problems when I gamble
• I gamble to get over my depression or unhappiness
• I gamble out of boredom
• When I gamble, I’m no longer bored
• Gambling is entertaining
• I like gambling, everything about it is pleasing to me
• Gambling is a habit

Limit Your Access to Gambling

Overcoming your gambling addiction is tough work. It requires a sincere commitment to abstinence and also making sure that you aren’t able to easily access gambling. If access is readily available, your cravings and urges to get back into the action may quickly cause your resolve to slip and you’ll relapse faster than your money disappears in the slots.

Some of the following steps have proven helpful to other compulsive gamblers who are dedicated to limiting their access to gambling. See if they work for you.

• Self-exclusion – This means you literally bar yourself from the casino.
• No transportation – Cut off your means of getting to and from the place where you gamble.
• No Internet access – If your gambling addiction involves Internet gaming, ditch your Internet access.
• Change residences – You could move to a location that’s farther from the place where you’ve been gambling. This is an extreme measure, but it does work as long as there’s no available gambling location anywhere close by.
• Drop gambling friends – Of course, you can’t resist gambling if all your friends are gamblers. As any gambling addiction treatment professional will tell you, you will need to discontinue seeing those friends and find some new ones – people who don’t gamble.
• Get off casino marketing lists – Make it a point to get your name removed from casino marketing lists. The flyers and promotions (including email reminders) will have to stop if you’re serious about getting your life back.

Limit Money Access

You can’t gamble if you don’t have money. It’s as simple as that. So, getting out from under after gambling addiction means you’ll need to limit your access to funds that you’d be tempted to use for gambling.

Strategies to employ to limit your money access include:

• Cancel all your credit cards. An alternative (and, not necessarily a better choice) is to hand them over to your spouse.
• Cancel your ATM access or put a severe limit on it.
• If you do require cash for daily expenses, only draw out the bare minimum to get through the day. Forget the $10 or $30 or $50 extra for walking-around money. It’s too easy to burn through it at the casino, buying Lotto tickets, or other forms of gambling.
• Have your paychecks automatically deposited.
• Have your paychecks deposited in the account of your spouse.
• Make arrangements with your bank to limit the amount of money you can withdraw from your account in any given week.
• Advise your family members, friends, and co-workers not to lend you any money – for any reason whatsoever.
• Arrange for someone else to pay your bills. This could be your spouse who has control over your money or someone outside the immediate family. It will need to be someone you trust completely, and who won’t be persuaded to hand over money to you for any flimsy reason.
• Start to budget all money that comes in and goes out for any expenditure.
• You may wish to have someone else co-sign all your checks. This is a tough strategy to follow, but it may only be a temporary measure. The point is to stop your ready access to cash, and this is a strong and effective way to do it.

Identify and Learn to Recognize Gambling Triggers

Your goal to get out from under after gambling addiction also means that you need to identify and learn how to recognize and deal with gambling triggers. Triggers may be internal (thoughts or feelings) or external (situations) and lead to the urge or desire to gamble.

Internal triggers may be caused by feelings of guilt or shame, helplessness or uncertainty, as well as anger, anxiety, and depression. Internal triggers may also be caused by personal expectations and demands you have for yourself.

External triggers – words, images, or objects – remind you of past gambling episodes. These may include billboards for nearby casinos, TV advertising touting casino gaming, a poker tournament on TV, a travel special about Las Vegas, or the freeway exit sign to the casino. Other external triggers may involve situations you’ve come to associate with gambling. For example, if you always went to the casino when your partner was out of town on business, or went to Bingo or the track frequently with friends, these are situations that may result in a craving to gamble.

How to Deal with Cravings

Getting out from under after gambling addiction involves learning how to deal with cravings. Just because you identify and recognize your gambling triggers doesn’t mean they’ll go away. In fact, cravings and urges may continue to appear intermittently or even years after you’ve stopped gambling for good. It isn’t the fact that you have cravings and urges, but what you do about them.

First you need to be able to tell when you’re experiencing a trigger. It may be that you have a queasy feeling in the pit of your stomach. You may feel a ringing in your ears or your heart starts to race and your blood seems to rush. Your voice inside your head may tell you to gamble, or you may get an image that you associate with gambling. Sounds or smells may also remind you of gambling.

You can try substituting another image for a visual trigger. If you see yourself gambling, picture yourself fishing or hunting or skiing or having dinner with friends instead. This positive substitution also works for activity. Instead of going gambling, go golfing or hunting or fishing with friends.

Another technique for coping with gambling triggers involves playing out the script. When you’re tempted to gamble, fast-forward the scenario in your mind to visualize what happens when you gamble. See the look on your spouse’s face. Think about the losses and the negative consequences that mount up. When you’ve lost everything and are totally bankrupt, exhausted, ashamed, guilty and disgusted with yourself, this is the end result of your gambling addiction. Remind yourself what it feels like. This will serve as a gut-wrenching deterrent to getting back in the game.

Now, take this a bit further and think about all the extremely negative consequences of your gambling addiction. This serves as negative conditioning. If you think of yourself as a complete and utter failure, hating to be a constant disappointment to your spouse or partner, to the point of contemplating suicide, you can link this feeling to your craving so that when the triggers resurface, they will immediately be accompanied by the extreme negative conditioning.

Most cravings will dissipate over a period of 20 minutes to a half hour, according to gambling addiction treatment professionals. If you can make it through this time, you’ll be well on your way to successfully overcoming urges. Try distracting yourself by doing crossword puzzles, vigorous exercise, reading a book, talking with a friend, or tackling physical chores.

Utilize your support network to help you overcome cravings and urges. When you feel like you can’t stop yourself from gambling, call your 12-step sponsor, counselor, close friend or family member and talk it through. If talking on the phone doesn’t suffice, get yourself to a 12-step meeting.

Other Ways to Get Out From Under After Gambling Addiction

Of course, to be successful in getting out from under after gambling addiction, you need to do more than just learn about triggers, limit access to money and gambling. Here are some other things to put in your toolkit.

• Develop other coping methods – Many recovering gamblers find it helpful to do yoga or engage in meditation, deep breathing exercises, getting regular exercise, writing in a journal, taking prescribed medication, getting additional professional counseling, learning anger management, and making more time for themselves.

• Get involved with new activities – Boredom is often a huge factor contributing to relapse in recovering gambling addicts. Guard against boredom by getting involved in new and healthier activities. It doesn’t really matter what these activities are, as long as they are healthy ones that don’t include associating with people, places, or things associated with gambling or other addictions and don’t cause any harm.

• Be forgiving of yourself – To move forward in your recovery from gambling addiction, you need to be able to forgive yourself. This doesn’t absolve you from the responsibility for your actions, but it does set the stage for you to grow and develop healthier behaviors.

• Set goals and plans – Charting a new future means setting goals and making plans to achieve them. Now that you’ve made the decision and commitment to being abstinent, you have numerous options as to what you’ll do with your life in the short and long term. Make a list of things you want to achieve and begin to strategize ways to bring them to fruition.

• Have a plan for relapse – It isn’t guaranteed that you will relapse, but many recovering gamblers do. Again, it isn’t the fact that you slip that matters, but what you do about it. You need to have a plan for how you’ll get back on track if you do relapse. That means getting back into counseling, stepping up attendance at 12-step meetings, telling yourself that you aren’t a failure, figuring out what worked in your coping mechanisms and doing more of them, looking at what happened and figuring out ways to avoid those situations again.

In the end, getting out from under after gambling addiction means that you will need to take whatever amount of time is required to put your life back together. For some, this may be accomplished quicker than others. But every journey is unique and all are worthwhile. The best thing you can do for yourself to ensure that your lifelong recovery is a success is to fully participate in your support network. When you reach the point where you feel confident in your abstinence, you may wish to help others on their journey to come back after gambling addiction.

Many electronic avenues for entertainment have a reputation for supposed addiction. The Internet, the Blackberry smartphone, video games, and Facebook are just a few. One entertainment electronic may be getting a reprieve, however. Electronic gaming machines, once thought to cause a gambling addiction, may only be a problem if a problem already exists.

A study published earlier this year by Nower and Blaszczynski examines whether electronic gaming machines have a causal relationship with gambling problems. The researchers looked at the playing motivations of using an electronic gaming machine and the perceptions of the money-limiting strategies employed in the devices to determine a relationship between problem gambling behavior and the machines.

The participants in the study were recruited as they entered the gaming area of one of four establishments in a metropolitan area in Australia. There were 127 participants used in the study.

The participants were asked to complete a battery of pen and paper questionnaires that assessed gambling preferences, such as the amount of time spent gambling, the number of times the participant gambled each month, their favorite mode of gambling, and the reason they had chosen to gamble using an electronic gaming machine.

The questionnaires also asked questions related to the participants’ perceptions of money-related harm reduction strategies and assessed the gambling severity of each participant. Gambling severity was determined using the Problem Gambling Severity Index of the Canadian Problem Gambling Index (Ferris & Wayne, 2001).

The participants were grouped into non-problem, low risk, moderate-risk and problem gamblers. The researchers used bivariate analyses to determine the relationships that existed between independent variables and gambling severity groups.

The results of the study show that problem gamblers were more likely that their non-problem gambling counterparts to report that they played electronic gaming machines to earn additional income and to escape daily problems.

Those in the problem gambling group were also more likely to report that they lost track of money spent during a session of play, and that they did not endorse using monetary limit-settings like smart cards.

The small sample size of this study and the use of a convenience sample may make the results limited in generalizing to other populations.

The findings of Nower and Blaszczynski highlight the importance of looking at the individual gambler, rather than the mode of gambling. It appears from the study that this particular mode of gambling may not be the cause of pathological behaviors.
 

Make no mistake about it. Overcoming a gambling addiction is tough work. If it were as simple as just walking away from the casinos, slots, sports betting, track or card games, there’d be a lot fewer problem and compulsive gamblers in the U.S. – and around the world, for that matter. You’ve probably tried cutting down or even stopping already, with predictable results. In no time at all – sometimes just hours – you’re right back at it. So, what does it really take to beat your gambling addiction?

Two Basic Requirements

It’s quite simple, really, when you get to the essence of what it takes to quit a gambling addiction. The problem or compulsive gambler first has to genuinely want to quit gambling. That’s easier said than done. Many problem gamblers go for years without coming to that realization. When and if they do, it’s often only a fleeting desire and not compelling enough for them to take action. That’s the second basic requirement to quitting gambling: you have to go through the difficult work it will take to overcome your addiction. Oh, the excuses quickly come up here.

• “I don’t have the time. I can’t take off work.”

• “I don’t really have that big a problem.”

• “I can quit anytime I want.”

• “My gambling isn’t hurting anyone.”

• “What I do is my own business.”

• “I don’t need shrinks prying into my affairs.”

• “No way am I going to some rehab clinic filled with addicts.”

• “I don’t have the money to pay for treatment and my insurance won’t cover it.”

There are many more lame reasons people tell themselves and others about why they can’t or won’t go into treatment to overcome their gambling addiction. Maybe you’ve even used one or more of these. The point is, until you are ready to say honestly to yourself that you genuinely want to quit gambling forever and you’re willing to do whatever work it takes to do so, you’ll never overcome your addiction. Period.

That said, let’s assume that you do now have the two basic requirements. What next? What’s really entailed in quitting gambling addiction? What are the kinds of things that you have to do and that have to change in your life for your recovery to be successful?

Get Rid Of These Assumptions

This won’t be easy to accept. Some popular assumptions about gambling are merely traps. By buying into them, you’re only defeating your ultimate goal – to quit gambling.

• Willpower isn’t enough – Many well-meaning self-help gurus may tell you that with strength of willpower, anything is possible. For a problem or compulsive gambler, willpower may only last until the next urge pops into their mind – and won’t leave. Tell a starving man that willpower will make the hunger go away and see how good that does. Same principle applies with the gambling addict. You can’t tell yourself that you’re strong enough to stay away from gambling and expect that it will do anything other than reinforce your feelings of worthlessness, remorse, guilt and shame when you go right back to gambling.

• You can’t manage your gambling – Another assumption gambling addicts and problem gamblers make is that they can somehow manage their gambling. The person may say they’ll only gamble on every other day, or once a week, or limit themselves to a specific amount of money or block of time. The truth is that any gambling at all is like pouring gasoline on a flame. Once it starts, it’s not going to stop anytime soon. The problem gambler and the gambling addict have long since passed the point of turning their back on the tables. Their compulsion to gamble has taken over their lives, often to the point of complete ruin – financial, family relationships, social, loss of job/home/personal possessions, physical, psychological and legal. There isn’t any managing of gambling possible for the gambling addict.

• You’re not sick – While opinions are divided on whether or not addiction is a disease, get out of the mindset that you’re sick. You’re not dying of cancer – that’s a disease. Gambling addiction is a type of impulse-control disorder – and it’s completely treatable. People who look upon themselves as sick have a built-in excuse: “It’s not my fault. I can’t help it.” Ditch that assumption right now. It won’t do you any good, and will probably derail your efforts to overcome your gambling addiction.

What You Need To Do To Quit Gambling

The following strategies, techniques and beliefs are essential to successfully overcoming your gambling addiction. You learn them and incorporate them into your life through counseling, treatment, behavioral therapy, support meetings – and practice.

• Take back the power in your life – You’ve relinquished power to your gambling addiction. Through treatment, you will learn how to take back the power to make your own decisions, instead of having your addiction control you.

• Learn how to deal with stress – For many gambling addicts, the only way to deal with stress is to escape through gambling. Learn effective techniques to minimize everyday stress and how to cope with unavoidable stress when it occurs.

• Stop labeling yourself an addict – Negative labels are self-perpetuating. Yes, you have an addiction, but you are doing something constructive about it. Learn to think of yourself in recovery.

• Envision a future full of possibilities – free of an addictive lifestyle – Everyone needs to have goals, something they strive for. Learn to envision your life free of addictions, a life that is full of possibilities.

• Mend relationships – Often problem and compulsive gamblers have hurt those they love most, family members and close friends. It’s time to repair that rift, and rebuild close relationships. Remember that those who love and care about you want you to be part of their lives again. Work on making that happen.

• Find a deep life purpose – Why are you here? What deeper purpose does your life hold? Through envisioning, meditation, counseling and discussion you will discover what truly holds meaning for you. This will serve as a foundation upon which to build your future. Reconnect to your values – or form new ones.

• Change your mindset – Learn to stop thinking that you’re doomed to forever be a gambling addict, or that it’s too late to change. Instead, learn to recognize the positive attributes that you possess and work on developing and fostering them.

• Use your mind’s power – Give yourself credit – and that means using the power of your mind to help you work through often contradictory emotions and thoughts. Biofeedback and cognitive behavioral therapy will help you channel your energies in the right direction. This will help you remain on track with your goals.

• No more lying – This simple practice has to become embedded. You must learn to tell the truth in all situations. Practice being truthful – and this will be difficult for gambling addicts so used to telling falsehoods. Start with small things like if you’re hungry or thirsty or if you want to discuss a certain topic or not. The more you tell the truth, the easier it will become.

• Be in control – Related to taking back the power, being in control means that you make this an inner belief. Learn self-management techniques.

• Understand why you’ve been stuck – What caused you to begin gambling in the first place? What perpetuated the habit until it became an addiction. Once you’ve identified the reasons, you will learn new behaviors to change your life.

• Quash your urge to gamble – This is critical to your successful recovery, as urges and cravings will pop up at every opportunity. You will learn tried-and-true techniques to quash these urges.

• Rebuild your self-esteem – Gambling addicts have extremely low self-esteem. Through counseling, discussions, lectures, group exercises, meditation and other therapies you will rebuild your sense of self – self-confidence and self-esteem.

• Eliminate guilt, shame and deprivation – All these are negative constructs that have no place in your life in recovery. You will learn to recognize them when they seek to take over your mind and how to banish them forever.

• Learn to manage your money – Maybe you’ve left a swath of financial ruin in your wake. Perhaps you’ve lost everything – including home and personal possessions. You probably owe a great deal of money to many creditors, including personal loans from family and friends. You will learn how to manage your money and put your finances back on track through practical techniques.

• Identify bad habits – and learn how to change them – Habits are rooted in repetitive behavior. Not all habits are bad, and you will learn to differentiate between the bad and the good. Time to ditch your old bad habits and replace them with constructive new ones.

• Take responsibility for your problems – Being honest and in control of your circumstances means that you take full responsibility for your problems – all of them, not just your gambling addiction. Once you take ownership of your problems, you can work on solving them.

• Learn to live on your own terms – free of dependencies – You may not be able to see this as a reality until you are many months past treatment and into recovery. But it is a goal to strive for. In fact, you probably can’t even imagine being free of your gambling addiction. You will, if you choose to keep to the two basic requirements: sincerely want to quit gambling and do whatever hard work it takes to make that happen. In fact, related to bad habits are other dependencies that you may also choose to relinquish – such as drinking, smoking, overeating, etc.

• Look at recovery a rewarding and exciting – A future of limitless possibilities, a regained sense of self-esteem and self-confidence, fully in control, accepting of responsibilities, loving and close relationships – and the ability to pursue your dreams – these are what you have to look forward to in recovery. In short, your life in recovery will be every bit as rewarding and exciting as you want it to be. Remember, you are in control of your life. Make it what you truly want.

In summary, what does it take to beat your gambling addiction? The answer is: all of the above. And, yes you can do it. So, if you’re ready, why not start now?