“You’ve got to know when to hold ’em
Know when to fold ’em
Know when to walk away
Know when to run” Don Schlitz
…therein lays the problem…knowing.
One bet is too many, one hundred is never enough; the saga of the addicted.
By definition, gambling is the practice of risking the loss of something important by taking a chance or acting recklessly. When the practice becomes pattern and the pattern, habit, the consequence begins to undermine the stability of life as one knows it.
Gambling addiction is associated with victimization, criminalization, social and health problems, depression, anxiety, impulsivity, attention-deficit disorder, suicide and substance abuse, which is a close cousin to gambling addiction. Both disorders are characterized by: loss of control, cravings, preoccupation, efforts to cut back or stop, withdrawal, tolerance and a high risk of relapse.
There is an old proverb that says, “In a bet there is a fool and a thief;” makes perfect sense. If something is a sure thing then it’s not a gamble. If a wise many say, only bet on a sure thing, then a wise man never gamble. Yet, with any addiction, the wise mind is not engaged. Therefore, it stands to reason that a characteristic set of emotions that is married to pathological gamblers are guilt and shame. Guilt is the sense of, “I’ve done something bad.” Shame is the sense of, “I am bad.” Financial struggles, employment issues, family conflict and legal problems are direct byproducts of the gambling that subsequently leads to the guilt and shame that in turn, perpetuates the gambling. A gambling oversimplification: the ritual; soothing, the game; intoxicating, the eventual loss; demoralizing. Pathological Gambling is a disorder of lies, manipulations and secrets…has to be…it feels good in the moment but comes at a hefty price and affects a
whole bunch of people.
Here’s the struggle with contending with compulsive gambling, it’s stealthy; hidden.
It’s hard to spot; can’t test for it, can’t smell it, can’t taste it. With other disorders of impulsivity, compulsivity, one can more readily spot problem behavior but less-so with gambling. There are cues to look for, however, such as, betting verbiage, gambling
patterns, increased spending, decreased productivity, increased smoking, criminal activity and mood shifts.
So…what to do?
First, let’s take a look at the cycle of Compulsive Gambling (adapted from Nat’l Counsel
on Problem Gambling):
● Winning Phase –fantasy, excitement, increased betting
● Losing Phase – preoccupation, carelessness, lying, borrowing, anxiety
● Desperation Phase – increased betting, panic, remorse, illegal acts, isolation
● HOPELESSNESS PHASE – problems with the law, family, drugs, alcohol,
withdrawal, suicidal thoughts/attempts
● Critical Phase – treatment introduced, realistic decisions, hope vs. resistance
● Rebuilding Phase – continued treatment, reparations, amends , repayment
● Growth Phase – insight, second chances, rebirth
● Relapse Prevention – remaining abstinent, regaining financial stability
The most effective way to move through this cycle toward recovery is with treatment.
Akin to the substance abuser, the problem or compulsive gambler does well in a contained setting for a period of time, allowing for the distraction of familiar people,
places and things to be removed. Although research does not support one treatment modality to be more effective than another, Cognitive-Behavioral Therapy, along with Motivational Enhancement Therapy, have empirically been shown to be quite effective.
Because of the depth of the accompanying guilt and shame, a therapeutic team who conveys unconditional positive regard, empathy and a strong message of hope, is the team best able to build a strong rapport with their client.
What to do; where to go? While Gambling Disorder is a well-defined mental health disorder, there are few structured treatment programs equipped to manage the recovery
process. GA, or Gambler’s Anonymous, is a great first step and it is free. Mental Health counseling is also hugely beneficial, as it is important to identify the core issues of the compulsive behavior and addiction that protects the pain.
Be brave enough to start the conversation that will change the path. Whether it be for you or a loved one, be courageous enough to give the pain a voice.
Family caregiving, unlike professional caregiving, may just be one of the most challenging and most
complicated roles a family member can take on.
The experience of caring for an unwell family member is a chronic stressor causing negative biological,
psychological and social consequences, to those who give so much.
Without effective support for the caregiver, even the strongest will wane. But what, specifically, are
those consequences? How can they be avoided? How does one find support to counter them?
I, operating in the role of primary caretaker myself, was nudged to do a little informal research, as I
found myself entering what I called, Phase II, of my evolving role as, “It.”
Phase I was the initial shock and chaos of realizing my loved one has a chronic disease that I could not
have caused, controlled or cured, although, accepting that notion took a good minute. I was finding
ways to manage my own life while calling doctors, finding appropriate treatments, battling insurance
companies, finding enough money to pay the medical bills when insurance denied, all while not ever
looking like it was all too much. Family and friends rallied hard for me; for us; calling, visiting, cooking,
praying, crying and offering hope. But, as time passed, and those same friends and family members
reached out, their hopeful gestures of support carried the weight expectation; expecting to hear that all
was well and that against all odds, the disease would soon be cured. But my response was the same,
“we’re hangin’ in there but she’s still struggling.” The disease was progressing and despite anyone’s
super hero acts of love to save my baby, the suffering that I was forced to stand by and watch,
continued. Each call I took was met with, “we’re not quite there yet but we’re hopeful.” And over time,
the calls thinned out, the visits were less frequent and when I was asked the same dreaded question,
“how’s it going; everything good now?” I learned to fake it; to tell ’em what they wanted to hear. Over
time, Phase II, which already bore the burdens of Phase I, had the added dimension of aloneness, mask-
Enter Phase III…guilt. Ah, guilt! Guilt! Guilty feelings, for everything, enveloped me. Guilt that I could
not control it, could not cure it, could not have the life I once had because of it, could not stop the
resentments and could not stop me feeling a little angry at the situation; at her. Yes, we know it’s a
disease, we get that, but we still resent that it has caused us physiological, psychological, physical,
occupational, social, financial and relational consequences, and the stress is unrelenting and seemingly
infinite. Yet, we do our best to remain hopeful.
The more I Googled, Bing’d and Yahooed, the more I found that unless I was caring for an aging parent, I
was going to have to be pretty resourceful in my search for finding like-minded people with similar
struggles. If your predicament is similar, maybe some of the things I’ve learned to do for myself may
Allow me to share them with you:
· Share with those you trust that you are a caretaker and are struggling to take care of yourself in
· Don’t pretend, with those you trust, that everything is like it used to be; grieve the loss of your
· Don’t attempt to be ‘super-caregiver’
· Share your difficulties with the person you are caring for; it will alleviate their guilt and yours
· Do not isolate
· Do not neglect your own physical, social or emotional health
· Get support!
· Get therapy!
· There are support groups for caregivers!
o And if you are caring for someone in active addiction, visit a Nar-Anon, Al-Anon or CODA
There is Hope!
You are Not Alone!
All is Well!
“The Coexistence of Eating Disorders and Substance Use”
If some is good, more is better and too much is just enough! For a woman struggling with an Eating
Disorder as well as with Substance Abuse, this is the story of her existence; a hunger unsatisfied. Too
high, too drunk, too thin, too hungry, too full; it’s never ‘too’ enough to disconnect, to numb, to forget.
“More,” ” faster,” “better,” “now,” is the all too familiar refrain of the voices inside her head. If I could
only be as free as I felt that first time I got drunk, got high, got thin, then everything would be okay. My
life would be in order. I could finally be happy. This, we call, “chasing the dragon.”
When a woman (or man) holds a self-imposed, inelastic rubric for herself that says she must be perfect,
must hide pain, must deny her inner self, then there needs to be created, a disconnection from the self.
A disregard for intuition is developed and movement in life becomes mechanical. The cost of this is the
soul, the spirit, and so she becomes ostensibly hollow, vacant even, and looks to fill the space. It
becomes the perfect storm of deflection from inner conflict. This battle is between intuition and self-
truth versus the disingenuous reinvention of the new self. How does she quiet the thunder of the
tempest? She withdraws, numbs, disconnects, broods and gets high. And yes, using her Eating Disorder
(ED) rituals is a high.
More people die from an ED than any other mental health disorder. Women whose ED and Substance
Use (SU) coexist have the highest suicide rate of all psychiatric illnesses. To over simply, where there is
an ED, there is likely SU. Let’s review some of the commonalities in both ED and SU.
● are chronic conditions influenced by genetic and environmental stressors
● show chemical brain imbalances
● exhibit distortions in thought or perception
● prey on those with low self-esteem and depression
● may have sexual, emotional and/or physical abuse or neglect
● display poor impulse control
● have obsessive thoughts and ritualistic behaviors
● carry risk of negative consequences
● are progressive and have potentially fatal outcomes
An appreciation of the relationship between ED and SU is established. Until fairly recently,
conventional wisdom dictated that each be treated separately, however, both serve as avoidance-
based, maladaptive coping and numbing, This then, begs consideration of symptom substitution or
cross addiction; if one is taken away, the other is intensified. Contemporary school of thought teaches
that integrated treatment approaches offer the most promise for reducing the risk of this vacillation
between the ED and the SU, yet scarcely any dual diagnosis facilities effectively treat both
simultaneously. he research supports that the basic tenets for effective treatment are interventions
such as, individual, family, group, psychopharmacological, nutrition and holistic therapies. Holism
adjuncts traditional therapies and may include equine therapy, massage, acupuncture, meditation,
guided imagery, aromatherapy, yoga, recreation, art, music, creative writing, qigong, cranial-sacral, and
mealtime support. Above any of this, and arguably the most effective part of treatment, is working with
a clinician who allows the healing to begin as an exchange of spirit and positive energy. This energy
begins with empathy and a quiet understanding of the pain, and grows to an energetic exchange of
purpose, passion and empowerment. There builds a reciprocity between the healer and the hurting
that is founded in the absence of judgment or shame. Healers give permission to the hurting to give
voice to their thoughts, ideas, opinions; to speak; to open their hearts again and to function on purpose
and with purpose. The restorative environment models passion in action and realness in real time, one
woman to another. Once this alignment of spirituality and knowledge is realized, it is palpable to
believe that there is hope.