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Gambling, Relapse, and Recovery: Studying a New Technology

Feature Articles

The problem of compulsive gambling—although often widespread, severe, and with considerable negative consequences, not only for gamblers but also for their families—is often not recognized as one of the addictions. However, it too has a human brain cone connection with cognitive, emotional, and psychological components.

 

The Research 

 

Our research examined the connection between the physiological phenomenon of relapse, memory, and cognitive deficits observed in those recovering from compulsive gambling. The research examined physiological variables such as anxiety, stress, depression, and anger. It also analyzed the effectiveness of the Biotherapy Lounge technology system.  

 

William White’s latest research addressed this critical question: When does recovery today predict recovery for life? After investigating the scientific evidence, he found the point of durability seems to be reached at four to five years of continuous recovery, meaning that less than 15 percent of those who reach that point will reexperience active addiction within their lifetime, with opioid addiction being closer to 25 percent (White & Ali, 2010). If people reach the five-year recovery benchmark, their risk of again meeting diagnostic criteria for a substance use disorder (SUD) is similar to the risk for such a diagnosis within the general population.

 

A NIH study on rates of short-term remission and subsequent relapse demonstrated that treatment or AA subsequent to the first year was not associated with remission. By the sixteen-year follow-up, 60.5 percent of the three-year remitted individuals in the no-help group had relapsed, compared with 42.9 percent of three-year remitted individuals in the helped group (NIDA, 2014). In the no-help group, only 3.8 percent of relapsed individuals and 5 percent of continuously remitted individuals participated in treatment and/or AA. In the helped group, 13.4 percent of relapsed individuals and 12.4 percent of continuously remitted individuals had some additional involvement in treatment in years four through eight (NIDA, 2014).  

 

The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) used a nationally representative sample of US adults aged eighteen years and older originally interviewed from 2001 to 2002 and reinterviewed from 2004 to 2005. The conclusion suggested that abstinence is the most stable form of remission for most recovering addicts (US Department of Health and Human Services, 2006). Study findings highlight the need for better approaches to maintaining recovery among young adults in remission from alcohol dependence, who are at particularly high risk of relapse.

 

Compulsive Gambling

 

Redefining compulsive gambling as an addiction is not mere semantics; therapists have already found that pathological gamblers respond much better to medication and therapy typically used for addiction rather than strategies for taming compulsions. For reasons that remain unclear, certain antidepressants alleviate the symptoms of some impulse control disorders; they have never worked as well for pathological gambling, however. Medications used to treat substance addiction have proved much more effective. Opioid antagonists, such as naltrexone, indirectly inhibit brain cells from producing dopamine, thereby reducing cravings. 

 

Dozens of studies confirm that another effective treatment for addiction is cognitive behavioral therapy (CBT), which teaches people to resist unwanted thoughts and habits (many articles on this can be found on the website of the National Institute of Health). Gambling addicts may, for example, learn to confront irrational beliefs, namely the notion that a string of losses or a near miss such as two out of three cherries on a slot machine signals an imminent win. Unfortunately, researchers estimate that more than 80 percent of gambling addicts never seek treatment in the first place, although many do receive help through CBT (McHugh, Hearon, & Otto, 2010). Unfortunately, of those who do, up to 75 percent return to the gaming halls, making prevention all the more important.

 

Symptoms

 

When physiological dependence occurs, addicts will typically display some of the following symptoms. Firstly, they will spend significant time gambling and this activity can interfere with work, relationships, and their social lives. Secondly, people who are compulsive gamblers will likely continue to gamble although they are aware of the damaging results on their health and lifestyle. Thus, addictions are not the result of just unhealthy behaviors; they do influence the body, the way it works, and its physiology. The nerve cells connect differently, the brain functions differently, and the function of the whole body is altered by alcohol, nicotine or those active behaviors associated with gambling and illicit drugs. While it is important to deal with the mental component, a complete treatment will also take into consideration these physiological changes and treat them accordingly.

 

We have done outcome studies regarding SUDs with similar results.

 

The Biotherapy Lounge

 

The Biotherapy Lounge combines biofeedback, music therapy, meditation, and guided imagery—all modalities frequently used in cognitive behavioral therapies. The Biotherapy Lounge integrates biofeedback through a program based on research on the psychophysiology of stress, anxiety, depression and interactions between the heart and brain. Sound frequency healing, music therapy, and guided imagery include audio and video sessions with positive affirmations and messaging. Coherence is also measured.

 

Coherence is how physiological patterns change with the experience of different emotions. The term “coherence” has several definitions, applicable to the study of human function. Merriam-Webster defines the word as “integration of diverse elements, relationships or values” (2015). Thoughts and emotional states can be considered “coherent” or “incoherent.” Positive emotions such as love or appreciation are coherent states, whereas negative feelings such as anger, anxiety or frustration are incoherent states. These associations are not merely metaphorical; research studies indicate evidence that different emotions lead to measurably different degrees of coherence in the oscillatory rhythms generated by the body’s systems. 

 

The Biotherapy Lounge uses a vibrational platform of memory foam integrated with an audio/visual system synchronized with low frequency sine tones and binaural beats with a monitor at the end of the bed and a finger pulse senor that measures heart rate variability (HRV). Clients practice deep breathing, imagine positive emotional thoughts, and are encouraged through entertaining games and visualizations to generate improved heart rhythm patterns. The combination of music, vibrations, and binaural beats is purported to bring clients from a beta to a theta state in many people in about fifteen minutes. When generating a coherent heart rhythm, the activity of the two branches of the autonomic nervous system (ANS) is synchronized and the body’s systems react with increased balance and harmony. 

 

Results of our Study

 

All clients were referred for compulsive gambling (n=8). However, there were some co-occurring problems, such as sexual addiction and substance use. In addition, there were physiological variables of anxiety, stress, and depression. Other factors included:

 

 
  • Age range: Thirty-one to sixty-one years, with an average of 45.8 years 
  • Gender: Four males and four females
  • Ethnicity: Two Hispanic, two African American, four Caucasian
  • Marital status: One married, three divorced, three in a partnership, one widowed
  • Children: two (married), two (married), two (never married), two (divorced), two (none)
  • Educational level: High school to college
  • Employment status: Four employed, two unemployed, two self-employed
  • Length of time in treatment (sessions): Three to over thirty-five sessions, with an average of 21.3 sessions
  • Left treatment early: Four
  • Treatment modalities: Group and individual counseling (CBT, mindfulness); nutrition; yoga/meditation; technologies (Biotherapy Lounge)
 

 

Pre- and posttests involved heart rate variability (HRV), BP, and self-reports using a Likert type self-report consisting of assessing anxiety, stress, anger, depression, fear, body aches, muscle tension, and headaches (see Figure 1). These had a range of one to ten, with one being the least and ten being the greatest. 

 

 

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Readers will note that there is a wide variability in the severity of the different clients’ presenting physiological variables, as evidenced in Figures 2 and 3. This variability might be a possible indicator for the success of treatment with Biotherapy Lounge technology, and the gamblers’ ability to negotiate early recovery and prevent relapse. More research is indicated in this area.

 

 

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Accumulative grand totals:

 

 

  • Pretests: 103.1 
  • Posttests: 31.8 
  • Change: 71.3

 

 

In all of the reported outcome data for the Biotherapy Lounge, the HRV prints out a chart for this aspect of the experience. All of the reported data for this area of improvement is substantiated by the printout of these summary sheets. The HRV also measures coherence, which also showed improvement. 

 

HRV and reaching coherence is an important part of biofeedback. While the word “biofeedback” wasn’t coined until 1969, the roots of biofeedback and self-regulation are much older (Sherlin et al., 2011). Yogis have been consciously controlling their autonomic nervous system—slowing down their heart rate, increasing body temperature, and decreasing oxygen consumption—for thousands of years. This act of self-regulation of the autonomic nervous system was not believed to be possible in the West even as late as 1950 (Carmody & Carmody, 1996; Sarbacker, 2005).

 

Conclusions

 

No matter how successful detox or the early stages of recovery might be, people in recovery might still be at risk for relapse in their early stages of recovery. All the triggers that might influence relapse still have to be addressed; some of the most important are the physiological ones of PTSD, depression, anxiety, and stress. This risk is ameliorated if there has been considerable cognitive impairment in which decision making and planning has been compromised. Therefore, there have to be techniques that can deduce physiological stressors and trained individuals who can help people negotiate these early stages of recovery, such as recovery coaches.

 

We have presented an examination of a device that can possibly assist in these areas.

 

We have also presented evidence that these physiological triggers can be reduced. However, this is an ongoing process, and it is often necessary for a trained mentor to assist the people in recovery through the recovery process, using their own self-designed, unique pathway to recovery, because the risk for relapse during the first few months and years is often high due to triggers based on past behavior. Not to recognize this change in people in recovery can often retard or even prevent further recovery. Continuing aftercare is of the utmost importance, as White has demonstrated (White & Ali, 2010). 

 

Additional research needs to be done in this area, especially follow-up studies including research on the use of recovery coaches and their effect on the recovery process of those in recovery. 

 

 
 

 

 
 

 

 
 
References

 

Carmody, D. L., & Carmody, J. T. (1996). Serene compassion: A Christian appreciation of Buddhist holiness. London, UK: Oxford University Press. 
 
McHugh, R. K., Hearon, B. A., & Otto, M. W. (2010). Cognitive-behavioral therapy for substance use disorders. Psychiatric Clinics of North America, 33(3), 511–25. 
 
Merriam-Webster. (2015). Coherence. Retrieved from http://www.merriam-webster.com/dictionary/coherence
 
National Institute on Drug Abuse (NIDA). (2014). Drugs, brains, and behavior: The science of addiction. Retrieved from https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery
 
Sarbacker, S. R. (2005). Samadhi: The numinous and cessative in Indo-Tibetan yoga. New York, NY: SUNY Press. 
 
Sherlin, L. H., Arns, M., Lubar, J., Heinrich, H., Kerson, C., Strehl, U., & Stermen, M. B. (2011). Neurofeedback and basic learning theory: Implications for research and practice. Journal of Neurotherapy, 15, 292–304. 
 
US Department of Health and Human Services. (2006). National epidemiologic survey on alcohol and related conditions. Alcohol Alert, 70. Retrieved from http://pubs.niaaa.nih.gov/publications/AA70/AA70.pdf
 
White, W. & Ali, S. (2010). Lapse and relapse: Is it time for a new language? Retrieved from http://www.williamwhitepapers.com/pr/2010%20Rethinking%20the%20Relapse%20Language.pdf