Dr. Marc Potenza and Yale’s Gambling CORE (Center of Research Excellence) conduct research on gambling behaviors, including the role that human brain activity plays in the development of pathological gambling. Dr. Potenza , a doctor of psychiatry at the Yale School of Medicine, has worked with researchers at McGill University in Montreal to study adolescent gambling (2008). He’s also worked with doctors at Ramon y Cajal Hospital at the University of Alcala in Madrid to treat pathological gamblers (2009).
Over that time, Potenza has developed theories on the origins of gambling addiction. Alongside a bevy of other Yale researchers, Potenza has collected data to test those theories. Consistently, their research has found that gambling addiction has a neurological component.
Dr. Potenza and his team of researchers have done parallel studies on several types of gaming: non-gambling players, recreational gamblers, problem gamblers, and pathological gamblers. The CORE researchers come from a variety of Yale departments, including the Psychology, Public Health, Child Studies, Epidemiology (health and disease conditions in defined populations), and Psychiatry departments.
The team draws upon expertise from several fields, including substance abuse, women’s health, and psychiatric genetics experts. To conduct their studies, the Yale researchers use a variety of techniques: brain imaging, clinical testing, developmental, psychopharmacological, and longitudinal (“then and now”) research.
During their various projects, the researchers subdivided groups along genetic, gender-based, and epidemiological lines. Yale gambling research is disseminated through peer-reviewed publications and is debated at clinic conferences and outreach events.
Non-Gambling Player: Freeplay gaming either with house money, casino credits, online free chips, or bonus money. These are players who get the same level of fun from playing a game whether money is on the line or not.
Recreational Gambler: Wagering for fun or entertainment. The player views a casino trip as a form of entertainment, similar to buying tickets to a concert or sporting event. Gambling is fun, because they might win, but they have a set price they’ll pay for the entertainment and walk away if they reach that price. This is roughly 96% to 98% of gamblers.
Problem Gambler: A gambler who sometimes has problems stopping their gambling urge. The adrenaline rush causes them to make extra trips to the ATM machine, exceeding the bankroll they planned to use. Comprising 2% to 4% of the betting population, most problem gamblers can arrest their dangerous behavior by calling a hotline or signing up for self-exclusion lists.
Pathological Gambler: A problem gambler who exhibits compulsive behavior to the point it causes harm to their finances and relationships. This is the gambling addict who cannot stop when on a losing streak. A 2003 Yale study isolated the behavior of these gamblers.
In 2003, Dr. Potenza published the first functional magnetic resonance imaging (fMRI) study of pathological gamblers in the Archives of General Psychiatry in August 2003. The research detected changes in brain activity in the frontal, paralimbic, and limbic parts of the brain. When pathological gamblers saw videos of gambling, their neural responses to the stimuli were distinct from non-gamblers or recreational gamblers. Those with pathological gambling addiction had different emotions responses to gambling-related stimuli.
What made the research instructive is pathological gamblers’ response to other videos did not differ from other men. For instance, they were shown videos of sad subjects, such as divorces or a death in the family. Researchers also showed happy moments, such as an unexpected visit from a beloved relative or a wedding event. The pathological gamblers’ response to sad and happy stimuli was no different than the response of non-gamblers.
Dr. Potenza said in the 2003 study that the Yale research proved pathological gamblers’ brain activity towards gambling is different from those who don’t suffer from gambling addiction, yet their brains are not different from the human baseline in other ways. Potenza said the 2003 research would help therapists and neurologists find the best ways to further “the prevention and treatment of pathological gambling” in the future.
A year later, Rani Desai, an associate professor of psychiatry at Yale School of Medicine, conducted telephone interviews of 2,417 adults of all ages. The research, published in a report called “The Gambling Impact and Behavior Study”, found that gambling was healthy for recreational gamblers 65 years old and over.
Those younger than 65 showed “high rates of alcohol use and abuse, depression, bankruptcy, and incarceration” than senior citizens did. The researchers did not give definitive reasons for the changes in elderly gamblers, though elderly people are less likely to be incarcerated in general. Depression and bankruptcy are another matter.
Desai and her co-authors wrote in the report, “Although the underlying reasons remain hypothetical, proposed reasons included the increased activity, socialization, and cognitive stimulation that are related to engaging in gambling. Such a mechanism would be consistent with the literature on healthy aging, which indicates that more socially and cognitively active elders are, in general, healthier.”
Problem gambling researchers in Germany found that pathological gambling is distinct from subthreshold pathological gambling. In August 2011, six German researchers released the report “Gambling Among Adults in Germany” which estimated the prevalence of gambling in German adults. The 2011 study, which was taken from a random cross-sectional sample of German gamblers including 8,006 subjects aged 18 to 64 years, gauged the percentage of those bettors who exhibited pathological gambling and other risk factors.
The researchers used data from the 2009 Epidemiological Survey of Substance Abuse (ESA). The study found that roughly 4 times as many German gamblers exhibited subthreshold pathological gambling (SPG) than pathological gambling (PG). In the Diagnostic and Statistical Manual IV (DSM-IV), a person is judged to be a pathological gambler if the person exhibits five or more of the following maladaptive gambling behaviors. The ten maladaptive behaviors are listed below.
10 Diagnostic Criteria for Pathological Gambling: DSM-IV
Preoccupation with Gambling: Reliving past gambling experiences, planning the next venture.
Tolerance: Escalating gambling activities with increasing amounts of money over time.
Lack of Control: Repeated unsuccessful attempts to control, cut back, or stop one’s gambling.
Withdrawal-like Symptom: Restlessness and irritability.
Escapism: Gambles as a way to escape problems or relieving feelings of anxiety, depression, guilt, or helplessness.
Chasing Losses: Returning another day after a losing session to “get even”.
Lies about Gambling: Deceives family members, therapists, and others to conceal the extent of gambling.
Illegal Acts: Committed forgery, fraud, theft, or embezzlement to finance gambling.
Negative Consequences: The gamblers jeopardized or lost relationships, jobs, or educational or career opportunities due to gambling.
Financial Reliance: Relies on others to relieve a desperate financial situation caused by gambling.
If a person exhibits 1 to 4 of the behaviors, they are considered to exhibit “subthreshold pathological gambling”. Also, if the 10 symptoms above can be accounted better accounted for by manic episodes, then the DSM-IV states a diagnosis of pathological gambling is invalid.
Since the 2011 study was released, the American Psychiatric Association has released the DSM-5. A few changes to the DSM-IV criteria for pathological gambling were made in the DSM-5. The criterion involving illegal acts was removed, while all of the maladaptive behaviors must be exhibited within the same 12-month period.
A study on gender-related functional connectivity by Dr. Potenza and four other scientists will be released in January 2019. The research used fMRI and subjective data to take a look at both male and female groups of people with Internet Gaming Disorder (IGD) when they were made to take mandatory breaks while gambling.
Using a sample group of 119 subjects broken into 4 groups — recreational male gamblers, recreational female gamblers, males with IGD, and females with IGD — the study found significant differences in the genders. Dr. Potenza’s researchers studied “functional connectivity”, or the functionally integrated relationship between spatially separated brain regions, in the brains of the four groups.
The fMRI data was taken when the subjects were gambling and also after they were required to take a mandatory break from gambling. When women with IGD took a mandatory break, their functional connectivity showed a significant change, reverting closer to baseline levels of brain activity. When the males with IGD took the same mandated break, their brains did not show a similar change in activity.
While the full report is unavailable at present, Dr. Potenza speculates the differences in functional connectivity could explain why gambling addiction is more prevalent in men than in women. The abstract of the upcoming study said of the research: “The findings suggest possible neural mechanisms for why males appear more likely to develop IGD, and why it may be particularly difficult for individuals with IGD to cease gaming.”
The Yale Gambling CORE team have conducted a number of studies on addiction over the years. Dr. Potenza has studied how Dopamine levels in the brain might lead to gambling disorder. Outside of the gambling field, he’s also the neurology of cocaine addiction, how schizophrenia might lead to a greater risk for addiction, and how testing methods for children at-risk to develop smartphone addiction and Internet addiction could be improved.
Over two decades, Yale University’s research has shown that neural activity is connected to various kinds of human addiction — and pathological gambling specifically. For those who deal with problem gambling and pathological gambling, their behavior is hardwired into the brain. That might make the problem seem hopeless, but in fact, it’s quite the opposite.
Since this type of human behavior is tied to brain activity, it means that scientists like Dr. Potenza can figure out why compulsive behavior happens. Researchers will use the data to find ways to treat compulsive gambling in people. Therapists will develop techniques to remedy problem gambling or refer their patients to neurologists and psychiatrists who can block the neural responses which reinforce gambling addiction.
If the problem is hardwired, then the wiring can be fixed. The eventual solution could take more years of study by the Yale Gambling CORE team and other researchers around the globe, but Dr. Potenza is doing essential work in the field of pathological gambling. In time, understanding the neurology of gambling addiction will lead to more successful treatments for problem gambling and pathological gambling.