What many people may not realize is that gambling addiction is classified as an impulse control disorder.
Individuals with impulse control disorders feel increasing stimulation before participating in the act of gambling. While gambling they probably will feel a sense of satisfaction; however, they may feel remorse or shame afterward.
We’re nearly halfway through NCAA® March Madness® tournament. The excitement is ramping up as the team in the Sweet Sixteen prepare for the next round. Those whose brackets aren’t already busted are anxiously waiting to see if their picks will help them reign supreme over their friends and co-workers, and maybe even allow them to take home a cash prize.
But some people—an estimated 6 million in fact— might instead be anxiously waiting for the tournament to be over. They are the people who struggle with pathological gambling addictions. For them, this time of year presents an overabundance of challenges and triggers. While many of us are cheering our teams on the road to the Final Four, they are fighting to stay on the road to recovery.
While participating in your friends’ or co-workers’ NCAA bracket pool doesn’t necessarily put you on the path to addiction, many problem gamblers did experience their first gambling-related rush from participating in a March Madness tournament bracket pool or purchasing a Super Bowl square. They are likely to have been introduced to these forms of gambling as teenagers by family members and middle school or high school classmates.
This may partially explain why the rate of gambling addiction is actually higher among young adults and adolescents. According to U.S. News and World Report, the rate of young adults addicted to gambling is up to four times as high as the adult rate, and 4 to 7 percent of college students meet the criteria for pathological gambling. However, it’s important to remember that gambling addiction can affect almost anyone, of any age, at any time—even if they are not entirely new to gambling.
Those who are addicted to gambling feel an uncontrollable urge to place bets, visit casinos, use Internet gambling sites, and/or buy lottery tickets in spite of the negative ways their behavior is affecting their lives and the lives of their loved ones. An untreated gambling disorder can lead to devastating personal debt and bankruptcies, and even prison time if the addicted person turns to stealing or fraud to support their gambling habits.
For those who are prone to addiction, gambling starts out as just another recreational activity but soon triggers strong, uncontrollable biological and psychological responses. Similarly to other forms of addiction, people who develop compulsive gambling behaviors tend to be those who feel disconnected in personal relationships, disconnected from a higher purpose, depressed, isolated and/or anxious. As a matter of fact, most pathological gamblers—68 percent, according to the Journal of Clinical Psychology—also have more than one addiction, often to alcohol and drugs. Another study found that people who struggle with both problem gambling and substance abuse were also more likely to have issues with sexual compulsivity and to have attempted suicide.
This suggests that gambling addiction can be a sign of a very complex set of intermingling behavioral health issues. If you or someone you know seems to be struggling with a gambling addiction, it’s important to seek out a high-quality, comprehensive treatment program right away.
The DSM-5 lists nine criteria for determining whether someone has a gambling disorder:
Since gambling addiction so often coincides with one or more additional addictions—drugs, alcohol, sex, etc.—it’s important to seek a treatment program that can address multiple conditions at the same time. Our staff spends time with each patient to develop a highly-individualized treatment program based on a thorough assessment of his or her primary and secondary conditions, and on releasing the hidden trauma at the heart of them all. Call our intake coordinators today at 800-244-4949 or contact us online to find out if one of our Meadows Behavioral Healthcare programs is right for you.
Football plays an important role in the lives of many Americans. Friendships are forged through small talk about the strengths and weakness of prominent players. Families gather in their living rooms and bond while cheering on their favorite teams. Social connections are strengthened through tailgating, Super Bowl parties, and impromptu touch football games in the backyard. Unfortunately for some, just as football plays a prominent role in our lives, alcohol often plays a prominent role in football celebrations. Can you still enjoy football and its related activities as a recovering alcoholic?
Jim Corrington, Director of The Meadows Outpatient Center and devoted Arizona Cardinals fan, says that you can, as long as you have a solid game plan.
1. Hire a Good Coaching Team: Consult with your sponsor.
Your early recovery is about survival. If you’re in your first year of recovery, you likely have not completed all 12 steps, and are extremely vulnerable. You often are not even aware of how vulnerable you are. You may not be spiritually fit enough yet to attend events where alcohol is available and where you might be surrounded by people with whom you are likely to fall into old patterns of behavior.
Good sponsorship is so important in this stage. Consulting with a sponsor before attending any potentially risky events, and making a plan together is a must. If you like football, a good sponsor can help you find other people in recovery who throw alcohol-free football parties.
Things may be different after you have a year or more of sobriety under your belt, but not always. More information about choosing a sponsor can be found on the Alcoholic Anonymous website.
2. Build a Good Defense: Avoid alcohol-related stimuli.
In recovery, it is often said that you should be able to go anywhere and do anything if you are “spiritually fit.” But for those in the beginning stages of their recovery that is a big IF. Jim likes to say that “If the room you are in doesn’t have any alcohol or drugs in it, it is impossible for you to use or drink.”
It’s important for those just beginning the next phase of their recovery to try to avoid stimuli that may lead to thoughts about drinking. This may be especially difficult for football related parties and activities, given how intertwined they often are with alcohol and messages about alcohol. Alcohol-related stimuli can include stadium signs and displayed advertisements, music, commercials, sitting in an area of a stadium where others are drinking, parties that serve alcohol, tailgating, etc. There are some small steps you can take to try to avoid these, though. If you are watching a game on TV at home and a beer commercial comes on, change the channel. And, if you’re planning to attend a game in a stadium, ask about alcohol free seating sections. (The Arizona Cardinals stadium, for example, has two alcohol free sections.)
Also, use extreme caution if you are thinking about attending a “Normie” party, which can be dangerous in early recovery. Sometimes, once a person leaves rehab, they become overwhelmed with the desire to feel “normal” again. You have to remember that you are not “normal” in your relationship to alcohol. You have a chronic, progressive, and sometimes fatal disease that requires total abstinence from all addictive substances for life, one day at a time. This doesn’t mean that you can never have fun again. It just means that it may take some time for you to redefine what “fun” means.
3. Build a Good Offense: Find sober buddies.
One of the smartest things you can do to stay sober is to seek out others who are also in recovery and love doing the same things you do. There are many recovering alcoholics who still enjoy football with their friends, and love organizing sober football parties and sober tailgating events.
AA meetings are a great place to start building up your network of sober friends. There are also several recovery-focused social networks online. If you’re a Meadows Alumnus, you may have the option of attending Inspired Recovery meetings in your city.
The Meadows Outpatient Center in Scottsdale, Arizona also regularly hosts meetings and events that are free and open to those in recovery and their families. As a matter of fact, we’re excited to announce that on February 7, we’ll be hosting our first ever Sober Super Bowl party!
If you think you or someone you love may need help breaking free from alcohol or drug addiction, give us a call. The Meadows Outpatient Center is a safe and nurturing community where patients are guided on their journey of recovery by examining the underlying causes of addiction and co-occurring disorders. The goal is for these individuals to gain the courage to face difficult issues, including grief and loss; heal from emotional trauma; and become accountable for their own feelings, behaviors, and recovery. Contact us or call us at 800-244-4949.
The Meadows is pleased to announce the launch of our new blog, addictionrecoveryreality.com, featuring articles by some of the most well-respected and innovative experts in the treatment and recovery fields of drug addiction, alcohol addiction, gambling addiction, depression and anxiety, relationships and childhood trauma.
Contributors to the blog include leaders in the treatment of addiction and trauma: Pia Mellody; John Bradshaw, MA; Bessel A. van der Kolk, MD; Peter Levine, PhD; Maureen Canning, MA, LMFT; Jerry Boriskin, PhD; and Shelley Uram, MD. These experts write about a wide range of addiction-related topics.
If you are interested in writing for addictionrecoveryreality.com, please send submissions to firstname.lastname@example.org.
Note: This article was originally published in the Spring 2007 edition of Cutting Edge, the online newsletter of The Meadows.
The Therapeutic Genius of Pia Mellody
By John Bradshaw, MA
Pia Mellody joins the company of those who have created highly effective therapeutic models and who can put their theories into practice with unusual skill. Pia's approach is phenomenological, resulting from her own painful struggle with codependency, as well as from thousands of hours spent interviewing and working out healing strategies with patients at The Meadows.
Pia began her unique journey as the head of nursing at The Meadows. In her early days, she suffered from low self-esteem, unhealthy shame, and a hyper-vigilance that accompanied her need to be perfect in every aspect of her work and life. She lived in that lonely place of non-intimacy, polarization and silent anger that most codependents experience.
Pia decided to get some help for her problems at another treatment facility, where she found the experience not only frustrating, but ineffective. Her problems did not seem to fit into any consistent category of the Diagnostic Manual. When she completed treatment, she continued to try to make sense of her raw pain and confusion, reaching out to others to try to get assistance in alleviating the distress. She was grappling with an inner distress exacerbated by a sense of defectiveness, the inability to engage in really good self-care, and living in reaction to other people. Thanks greatly to her, this condition is now called "codependence." At that time, there was no coherent theory or therapy for the problem.
Early Roots of Codependency
Prior to Pia's work, some relevant work had been done concerning the reality of codependence. Ludwig von Bertalanffy's work titled General Systems Theory had filtered its way into several arenas of psychotherapy, notably Ronald Laing, Virginia Satir, and The Palo Alto Group (Gregory Bateson, Don Jackson, Paul Watzlawick and John Weakland).
In 1957 in Ipswich, England, John Howell concluded that the entire family itself was the problem, rather than just the symptom-bearing individuals. Dr. Murray Bowen developed "The Bowen System" of family therapy. He clearly posited the whole family as the problem, maintaining that the most distressed and under-functioning person in the family triggered the rest of the family into over-functioning behaviors. The more the family members over-functioned, the more the distressed person under-functioned. Thus, the more the family tried to change, the more it stayed the same. Bowen was convinced that the whole family was in need of therapy. Bowen did not use the word "codependency," but he emphasized that, like a mobile, every member of a diseased family was dependent on his or her other family members.
Dr. Claudia Black, currently a Senior Fellow at The Meadows, wrote a now classic book called It Will Never Happen To Me. In it, she described the symptoms she carried as an adult that stemmed from living with an alcoholic father and a co-alcoholic mother. Dr. Black made it clear that her whole alcoholic family was diseased, and that each member was codependent on the alcoholic father.
Soon hands-on clinicians like Dr. Bob Akerman and Sharon Wegscheider Cruse (a protégée of Virginia Satir) were describing the symptoms of the adult children of alcoholic families as "codependent," although no one knows who first used the term "codependency."
I did a 10-part series on PBS in April 1985 that met with a huge public response. In it, I used a mobile to describe the family system, moving it energetically to show how the whole family is affected in dysfunction, and allowing the mobile a lightly moving homeostasis to show its functional state. I devoted two parts of this TV series to issues I called "codependency," although my grasp of the concept was still vague and lacked a consistent theory of explanation.
Outside the recovery field, which deals with addictions of all kinds, was the work of Karen Horney and Theodore Millon. Horney's Neurosis and Human Growth presented many descriptions of a dependent personality. Horney's description touched upon many of the primary symptoms of codependency, which Pia Mellody later organized into a coherent theory. According to Horney, those lacking healthy adult autonomy and interconnectedness sought their fulfillment and a sense of self from other people. For these people, relating to other people became compulsive and took the form of blind dependency. Horney used the phrase "morbid dependency."
In the International Encyclopedia of Psychiatry, Psychology and Neurology, John Masters wrote: "I think that mainline academic psychology has not done enough extensive work on dependency as it relates to codependency as an identifiable personality disorder. Codependency is now seen by many to constitute a painful problem for certain clusters in our society. We are on a primitive frontier with regard to understanding codependence."
Psychiatrist Dr. Timmon Cermak, in Diagnosing and Treating Codependence, argued that codependency was on par with other personality disorders. "To be useful though," wrote Cermak, "codependency needs to be unified and described with consistency. It needs a substantive framework and, until this is done, the psychological community will not recognize codependence as a disease."
Enter Pia Mellody
It was at this point that a young nurse stepped onto the arena of modern psychology and made an extraordinary contribution.
One day, Pia Mellody walked around the corner of a building and had a moment of clarity. She thought of AA and how alcoholics start recovery by simply telling the stories of their troubled drinking. They share their experiences and strength in embracing their shame and their first glimmers of hope.
Pia realized that hundreds of people had passed through her office at The Meadows with stories very similar to her own. For one thing, a large majority had been abandoned, abused and neglected as children. Pia had long suspected that her own symptoms stemmed from her traumatic childhood and severely dysfunctional family system.
At this point, Pia began interviewing the many people who came to The Meadows with stories of abandonment, neglect, abuse of all kinds, and enmeshment with a parent, the parent's marriage or the whole family system.
As Pia interviewed person after person, a unique and clear pattern emerged. All had five similar symptoms:
They had little to no self-esteem, often manifested in the carried shame of their primary caregivers;
They had severe boundary issues;
They were unsure of their own reality;
They were unable to identify their needs and wants;
They had difficulty with moderation.
These symptoms together marked an extreme level of immaturity and a level of moral and spiritual emptiness or bankruptcy. Patients shared their sense of relief in just being able to identify and talk about the distress they were in.
With an interviewing approach fueled by her intuition, Pia Mellody had discovered what she called "codependency." She had come to understand the word "abuse" in a much broader context than clinicians had previously understood it. Pia also showed how codependents carry their abusive caretakers' feelings. Our natural feelings can never hurt or overwhelm us; their purpose is to aid our wholeness. Our anger is our strength, a boundary that guards us. Our fear is our discernment, warning us of real danger. Our interest pushes us to expand and grow; our sadness helps us complete things (life is a profound farewell). Our shame lets us know the limits of our curiosity and pleasure; it becomes the core of modesty and humility. And our joy is the marker of fulfillment and celebration. "Carried" feelings lead to rage, panic, unboundaried curiosity, dire depression, shame as worthlessness or shamelessness, and joy as irresponsible childishness.
Pia later saw the five core symptoms as leading to secondary symptoms: negative control, resentment, impaired spirituality, addictions, mental or physical illness, and difficulty with intimacy.
Pia believed that alcohol and drug addiction, sex addiction, gambling addiction and eating disorders must be treated before the core underlying codependency can be treated.
Understanding that addiction is rooted in codependence is another contribution that Pia helped to clarify. Years ago, Dr. Tibot, an expert on alcoholism, saw that there was an emotional core to alcoholism that he called the "disease of the disease." Pia's work has certainly corroborated that intuitive insight.
Pia Mellody's most important contribution may be how she and her groups of suffering codependents worked out strategies of healing. They did this through trial and error. The results were so striking that The Meadows encouraged Pia to develop a workshop titled "Permission to be Precious." It was an instant success, and Pia began to take it to different cities around the U.S. Soon she wrote a book, Facing Codependence, with Andrea Wells Miller and J. Keith Miller. Later she developed a powerful approach to treating love addicts and their counterparts' avoidant addictions. Her most recent book, The Intimacy Factor, is the only relationship book that treats the core "grief feeling work" around early abuse, neglect and abandonment. I believe that other self-help relationship books fail because they do not address these fundamental issues. "Feeling work" involves exposure, vulnerability and what Carl Jung called "legitimate suffering." Pia has done her share of that and has the know-how to gently nurture others through this work.
Pia's work has become the core model in treating addictions of all kinds and the core of codependence they rest upon. She has personally led hundreds, probably thousands, of people suffering from codependency into recovery and wholeness.
Pia answered Dr. Timmon Cermak's challenge to do the work that established codependency as a treatment issue. She not only found a consistent way to conceptualize this source of suffering, but she found the know-how to address it.
The time has come for a broader recognition of Pia's art and genius.