Defining Addiction And Its Many Forms Whether it's drugs, shopping, or gambling, addiction can take control your life. Today, we kick off our month-long series about addiction. Farai Chideya speaks with Dr. Tim Fong — co-director of University of California Los Angeles' gambling studies program — and Dr. Jon Grant, associate professor of psychiatry at University of Minnesota.

Defining Addiction And Its Many Forms

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This is News and Notes, I'm Farai Chideya. Addiction is a quiet monster. Sometimes, it lurks inside family or friends. Sometimes, we look at it in the mirror. Today, we start our month-long series on addiction. Addiction isn't always about drugs. It can be video games, shopping, sex. Later, we'll talk to a man who nearly lost everything to his gambling addiction. But first we take a closer look at the facts and myths about addiction. For more, we have Dr. Tim Fong, a psychiatrist and co-director at the University of California Los Angeles Gambling Studies Program. Welcome.

Dr. TIMOTHY FONG (Psychiatrist and Co-Director, University of California Los Angeles Gambling Studies Program): Thank you for having me.

CHIDEYA: So, first off, can you give a working definition of addiction?

Dr. FONG: Absolutely. You know when you look in the textbook for addiction in terms of the scientific criteria, you don't really see a clearer definition. But what we like to use is a continued, recurrent engagement of either drugs or behavior despite causing adverse or negative consequences in the person's life.

CHIDEYA: Give me a sense of what - I mean, is there a difference, for example, between chemical addiction and a behavioral addiction?

Dr. FONG: Well, the difference is a sense that one is a behavior is causing the person's problems in the life whereas the other one with a chemical addiction, it is thought that it's the drug itself that's causing changes in the brain and result in behavioral problems. But fundamentally, as we learn more and more about the neuroscience and neurobiology of addiction, we're beginning to see a lot of overlaps in terms of the biology. But there are certainly differences in the psychology and social aspects of addiction.

CHIDEYA: Recently, you know, over this sort of past couple of decades, people have talked about things like online addiction, video game addiction. How does that play into who we are today as human beings? What makes those addictive patterns I guess if they're not substances?

Dr. FONG: Well, one of the things the term that people are using, they've used things like lifestyle addiction, behavioral addictions, process addictions. I think, fundamentally, what we're talking, for instance would caveman have you know gambling addiction? Do they have quote "shopping addiction?" You know, probably not, but they would have differences in some sort of problems related to controls of reward versus inability to control impulses.

So, I think one of the biggest things that we see is that too often we see people labeling, oh, this behavior is just "an addiction" or disease. Where many times, they may actually be just a variant of excessive behavior that's part of the natural social context of things. Or maybe more simply, it may be a byproduct or secondary behavior from underlying depression or anxiety that is actually going on. So, certainly, one of the things we need to do more about is whether are these exact again biomarkers? And what are these - the exact biological causes of what are quote or unquote "pathological behavior" versus those are just excessive behaviors that are done in the context such as, you know, social settings.

CHIDEYA: I want to bring in Dr. Jon Grant, an associate professor of psychiatry at the University of Minnesota. How are you doing?

Dr. JON GRANT (Psychiatry, University of Minnesota): I'm good. Thanks. How are you?

CHIDEYA: Good. I asked Dr. Fong what is addiction. I want to hear your answer as well.

Dr. GRANT: You know, hearing part of what he was saying, I tend to agree. I think it's really when any behavior - I think more, you know, historically the use of a drug. But now, we recognize any behavior becomes so excessive that it really interferes with people's lives in a really meaningful way. And people lose control over whatever the behavior is.

CHIDEYA: What do you think are the changes in addictive behavior patterns between say two generations ago and now, in terms of what are the top addictions now do you think?

Dr. GRANT: Other than you know drugs of abuse which I think have always been - and alcohol which is largely been the primary addictions. You know, I think that we see that with increased availability of certain behaviors that we're seeing a greater addictive side to those behaviors such gambling, sex are two of the ones that are now so readily available to people, as well as spending money which can also be an addictive behavior.

CHIDEYA: When you think about the overall patterns of addiction in society, what do you think and I'm going to ask you as well, Dr. Fong, in a second, but Dr. Grant, what do you think it costs this country that so many people have addictive behavior patterns.

Dr. GRANT: Well, the costs to society, I think, are really great. You know people are unable to function at the highest level of productivity. As Dr. Fong mentioned how depression can also lead to some of these. Actually, depression can be a byproduct of many addictive behaviors. So that you also get people who are feeling so guilty and embarrassed by their behavior that they become severely depressed, that they need to be hospitalized and families are torn apart by these behaviors. So, I think the ripple effect of addictive behavior is enormous.

CHIDEYA: Dr. Fong, I'm going to change this question a little bit. Given the cause of addictive behaviors, what is the medical world doing about it? You are part of that medical world.

Dr. FONG: Well, I will just tell you a brief story. I mean when I went to medical school in psychiatry residency training, very little training on substance abuse and very minimal and essentially non-existent training for behavioral addictions like gambling, video game addiction, and sexual addictions. And one of the things that Dr. Grant and I are really kind of pushing forth is idea of really training all health care professionals to understand that the impact of addiction, whether it be substances of non-substances, actually can have a very profound medical and psychiatric impact on individual, on family, and on society.

And just some statistics, we know that 500 billion dollars a year is lost to American society for drug-related addictions. We don't know that global number for behavioral addiction because many times these are hidden addictions. So, when you have for instance with gambling, when you have suicides or even homicides or crimes committed or drug overdoses, many times the root cause maybe the gambling addiction. It's not very much - it's not very clearly spelled out or obviously linked from the action to the behaviors and consequences.

CHIDEYA: Dr. Fong, we're actually going to be talking in a moment with a recovering gambling addict in the Los Angeles areas, and here in Los Angeles, certain parts of south L.A., for example, have casinos and a lot a casinos are in more working class neighborhood. So, does the concentration of what you are addicted to? Like a casino, like gambling, how does a concentration of availability affect someone who may have a problem.

Dr. FONG: Well, you know, a question that people have been looking out for a long saying that if we introduce new casinos in new areas, well, that drive up the rate of pathological gambling or gambling addiction. It's very much when you think of out of all the addictive behaviors, what's the most available. Cigarettes. But also spending and now gambling. Here, as an example, in Los Angeles there are several casinos located in the urban settings, but there are several casinos located in rural settings or high socioeconomic settings as well.

Well, I can tell you that what the data shows in California, they're roughly about four percent of all Californians have some sort of problem controlling their gambling. But the highest rates are those who are African-Americans, disabled or unemployed, and those rates are actually significantly higher than the four percent. But what we don't know is that because these casinos are located in urban environments or are there some sort of biological and cultural and social risk factors that predispose those groups to develop higher rates of gambling addiction.

CHIDEYA: Dr. Grant, addiction is certainly not limited by money. We'd seen any number of celebrities fall, sometimes die, to chemical addictions. But do you think that there are issues that affect people who really are economically disadvantaged in some way. I mean, you spoke about depression. We're in a tough economic time and being strapped can be depressing. How does economics link to this if at all?

Dr. GRANT: Well, you know, to build on what Dr. Fong had said, you know there is a disassociation with higher rates of, for example, gambling addiction among our socioeconomic groups. And these are the people that can, you know, are least available or least able to really deal with the repercussions of their gambling. And yet, the gambling is sort of marketed as this enticement of you can get out of poverty. You can get out of update. You can go out of poverty. You can get out of your bad financial situation if you win big at the casino.

So, in part, much of the gambling is marketed toward these people who again can really not afford to take a part in it. And I think that to get back to your point about what the medical establishment can do, I don't think that we do enough to educate people particularly who are going through financial difficulties and lower economic brackets about the real potential addiction of many of these behaviors particularly gambling.

CHIDEYA: Well, Dr. Fong and Dr. Grant, I want to thank you both for your time.

Dr. FONG: Thank you very much.

Dr. GRANT: Thank you very much.

CHIDEYA: Dr. Tim Fong is a psychiatrist and co-director of University of California Los Angeles' Gambling Studies Program, and Dr. John Grant is associate professor of psychiatry at University of Minnesota. He spoke to us from the studios of Minnesota Public Radio in St. Paul, Minnesota.

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