Addictions Part 4. Hallucinogens and Gambling Disorder

Five key types of hallucinogens

LSD

Magic mushrooms (psilocybin)

PCP

DMT

Morning glory seeds

Hallucinogen intoxication effects

Hallucinations, depersonalization, distorted sensory perceptions

Increased heart rate and perspiration

Rapid tolerance—people develop tolerance very quickly

Hallucinogen withdrawal effects part 1

You can’t overdose or die from a hallucinogen, just like with cannabis.

“Bad trips” are scary experiences, such as clouds turning into threatening monsters

People who use hallucinogens often have a poor social circle or environment—their suffering is not just caused by the drug

Interesting classical research findings of hallucinogens

Some classic research showed the people doing only one dose of mushrooms increased the openness to experience personality trait

For some people, it can be a life changing event

Biological-etiological factors of hallucinogens

A spike in serotonin and norepinephrine— though it’s very hard to do research on these drugs

Biological-treatments for hallucinogens

There is no medical treatment that can counteract the effects of these drugs, and none have been explored; you usually just have to wait it out.

How strong is LSD?

Extremely strong—the pink dot in the sugar cube is the LSD, and it’s enough to get high for 12 hours

Psychological-etiological factors of hallucinogens

Motivations for use—why are you taking the drug? Do you have friends who except you to? Are you always bored?

Psychological treatment for hallucinogens

Usually, people just stop using the drug

CBT—few show up, not effective

Harm reduction—not effective

How many DSM criteria for gambling disorder does one require?

Four of the nine, for a period of 12 months

There is no threshold for what you have to spend on gambling; you just have to meet four of the nine criteria

What are some key forms of gambling?

Playing the stock market, casinos, and betting on sports

First two DSM criteria for gambling disorder

Needs to gamble with increasing amounts to achieve the desired level of excitement—tolerance

Is restless or irritable when attempting to cut down or stop—withdrawal

Third and fourth DSM criteria for gambling disorder

Repeated unsuccessful efforts to control, cut down, or stop—impaired sense of control

Often gambles when distressed—they use it as a negative reinforcer to treat some emotional issue

Fifth and sixth DSM criteria for gambling disorder

After losing money, often returns another day in an attempt to break even—chasing losses, such as, “I have to win the $200.00 back before my wife finds out.” And, if they win the $200.00 back, then they think they are on a roll, and so they will keep gambling

Has jeopardized or lost significant relationships, educational opportunities, or job opportunities—a social impairment because of their gambling

12-month prevalence rate for gambling disorder

0.2%--5%

Alex doubts the 0.2%. He thinks its more like 1%, as people have more access to gambling now—the 0.2% was mainly before the internet gambling became a thing, so people in isolated and remote areas didn’t have access to casino’s for gambling

Does gambling just effect youth?

Gambling disorder is also significantly bad for seniors, as they have nothing better to do.

And it’s often not a problem for them as it can be a social thing.

Is gambling a problem for young men, and if so, why?

It’s worst for young males, and a common problem, in teenagers because they can easily bypass ID on gambling apps

Is, “once a gambler, always a gambler true?”

It’s a myth; gambling is usually episodic

They start bad for a year, then they stop when it gets out of control, then they start again

Although for some people it can be very consistent

Severity scale for gambling disorder

Mild 4-5 symptoms

Moderate 6-7 symptoms

Sever 8-9 symptoms

What sets gambling disorder apart from other DSM addiction disorders?

Gambling disorder is the ONLY non-substance addiction disorder in the DSM

Ex. Sex addiction is NOT in the DSM

Biological-etiological factors for gambling disorder

An increase in dopamine and serotonin systems—for long-term gamblers, they have lower levels of these neurotransmitters when they aren’t at the casino

Decreased activity in brain areas associated with impulse control—they have a weaker prefrontal cortex

Biological-treatments for gambling disorder

Medications typically aren’t used to treat gambling disorder, BUT

Opioid antagonists

SSRIs

Lithium

Opioid antagonists

Since endorphins are likely involved in gambling, reducing opioids may reduce some of the cravings, though there is little research

SSRIs

If someone gambles due to an emotional disorder, SSRIs will help treat the emotional disorder, but not the gambling itself

Lithium

People with bipolar often go and gamble, and lithium helps reduce thoughts about gambling.

Strangely however, those on lithium still spend the same amount on gambling

Three psychological-etiological factors of gambling disorder

Positive and negative reinforcement

Overestimates skill

Lack of understanding of “chance” and “random”

Positive reinforcement

When you win money, that is a huge positive reinforcer—often a “big win” get’s an individual hooked

People often get other perks at casinos such as music and free drinks, which are also huge positive reinforcers

Negative reinforcements

When people are sitting at the slot machine, that distracts them from other unpleasant things happening in their life

Overestimates skill

They often think they are better at playing then they actually are—such as thinking they have special skills to call a roulette wheel or slot machine

Lack of understanding of “chance” and ‘“random”

Slot machines reset every single roll, so each pull is independent of the one previous—your odds don’t improve the more times you play

They only increase just because the more you do of anything, your chances go up

Partly, humans are good at finding patterns that don’t exist, so it’s important that humans know about things being random

What are the three psychological-etiological subtypes of gambling disorder?

Behaviourally conditioned

Emotionally vulnerable

Antisocial-impulsive

Behaviourally conditioned

People get into gambling because it’s rewarding to sit there. The lights, the colours, the free drinks, etc.. are really what’s driving them to continue

Emotionally vulnerable

People who gamble as a distraction technique for their emotional issues

Typically, these people have more symptoms and disorder criteria than the behaviourally conditioned

Antisocial-impulsive type

• These people have the most symptoms and the least benefits from treatment

• They often go to casinos without any clear plans, and they set no limits for themselves

• They often describe needing the rush for gambling and follow the under-arousal hypothesis.

• They will also be more likely to rob other people to support their gambling—criminal activity

Treatment for psychological factors of gambling

CBT

Harm reduction

Gamblers anonymous

CBT/harm reduction part 1

One example is calling the casino and asking to be put on the “do not allow through the door list”

You also put checks on how much they can spend, and have them close and delete their online accounts.

Have them work around their thoughts about how chance really works, what randomness really is, etc…

CBT/harm reduction part 2

If they have emotional issues, you obviously will address those, and if they have anxiety/depression or a like disorder, you just do standard CBT to treat that

Helping the person add more fun and new activities to life, as well

You also help the person gain a sense of self-control. People do not “randomly end up in a casino parking lot,” they follow a sequence of steps during their drive home, which leads them to end up at the casino

Gambler’s anonymous

They aren’t super effective, as people often bet on who will leave the club. Maximum of 20% effectiveness, but it does greatly depend on the group