First chronic pain, now gambling. What’s the real problem?
This is the second post in a three-part series on chronic pain and mental health.
“How did this happen?” In the 17 years that I’ve specialized in addiction, I've heard this question thousands of times. Specifically, how does someone with chronic pain issues suddenly develop a gambling addiction?
People who ask this question are puzzled: certainly, there is an understanding of the risk of dependency on pain medication, but they did not think about increased risk for other addictions like gambling.
When gambling begins to interfere with relationships, finances, and home life, people look for a way to overcome the addiction before things get worse.
What is often overlooked is that pain is the root of the problem.
A 2003 study used the “Iowa gambling task” to examine decision-making among chronic pain patients. Participants were asked to draw cards from different decks: either those returning high immediate gain but larger future losses or those returning lower immediate gain but smaller future losses.
Results showed that the likelihood of choosing the “bad” (high immediate gain) decks increased in parallel to heightened pain intensity for participants with chronic back pain.
Additionally, compared to participants who did not have chronic pain, those who did have chronic pain chose cards with high immediate gains more often and were less consistent with their choices over 20 draws.
The researchers also found that chronic pain appears to shrink a part of the brain’s prefrontal cortex that impacts decision-making; and that it triggers hyperactivity in another area of the brain that governs emotional response. This, in turn, can increase the risk for a gambling problem.
Further evidence for this connection is a 2007 study that found reduced prefrontal cortex activity in people with gambling addiction. This aligns with findings that chronic pain contributes to risk for gambling addiction because it lowers the activity in this area of the brain.
So what does this mean for someone with chronic pain?
Living with chronic pain can feel inescapable. Not only do the physical symptoms impair a person’s daily life, but the pain constantly permeates his or her thoughts and actually alters brain activity.
It’s actually a normal reaction for someone with chronic pain to turn to gambling or other risky behaviors. What is important to keep in mind is that helping someone overcome a gambling addiction means not solely focusing on the gambling aspect, but first helping the person manage the pain that has led to this outcome.
Fortunately, therapy can help people who are experiencing both problems. Through cognitive behavioral therapy, for example, the person learns to change his or her thoughts and perceptions of pain. In doing so, we can actually increase the activity in the prefrontal cortex and improve decision-making ability.
Then people can be better equipped to effectively address the gambling problem and get back on a healthy and productive path.
Jody Bechtold, LCSW, ICGC-II, PC is a respected and established professional who passionately serves as an “Accountability Partner” to her Coaching, Counseling and Consulting clients. She brings a wealth of experience as a trained professional coach, a Licensed Clinical Social Worker, an Internationally Certified Gambling Counselor and as a graduate faculty member of the University of Pittsburgh’s School of Social Work. She is also Quartet’s Director of Behavioral Health Strategy.