The Slippery Slope of Making Gambling an Official Addiction

THERAPY LAND—While most people have probably never heard of The Diagnostic and Statistical Manual of Mental Disorders, or DSM, an updated version of which is published every 6-8 years by the American Psychiatric Association, more attention should be given to the process by which the working groups assigned to update the manual come to their decisions. The reason for this is expressed in the DSM Wikipedia entry. "[The DSM] is used in the United States and in varying degrees around the world, by clinicians, researchers, psychiatric drug regulation agencies, health insurance companies, pharmaceutical companies, and policy makers," it reads. In other words, the manual gives professional cover to any number of decisions by businesses and governments that can have a profound impact on your life, including the legal prohibition of certain behavior, the denial of health coverage based on alleged clinical disorders, or even the criminalization of certain acts. Perhaps more insidiously, the designation of certain activities as addictive by the APA almost always leads to federal and state laws designed to inhibit, control or even abolish the industry that serves the so-called addiction. This broad use of the manual by seminal decision-makers is one reason why the Wikipedia entry contains the following comment on critiques of the DSM. "The most fundamental scientific criticism of the DSM concerns the validity and reliability of its diagnoses," it reads. "This refers, roughly, to whether the disorders it defines are actually real conditions in people in the real world, that can be consistently identified by its criteria. These are long-standing criticisms of the DSM, originally highlighted by the Rosenhan experiment in the 1970s, and continuing despite some improved reliability since the introduction of more specific rule-based criteria for each condition." That precise criticism was raised again Monday by renowned addiction expert Stanton Peele, whose consistently contrarian views over 40 years on the subject of addiction are well-known within the therapy community. His current warning, for that is what it is, has to do with the announcement by a member of one of the groups working on DSM-5, the newest iteration of the manual scheduled to be published in May 2013, that a non-substance abuse activity will for the first time be labeled an "addiction." The newly labeled activity is gambling, but as far as Peele is concerned, if DSM-5 is going to embrace such "reductive fallacy," it might just as well include sex and games in the addiction category. Peele calls the culprit, which he has been battling for many years, the "'addiction = chronic-brain-disease' movement," one of whose main proponents, Charles O'Brien, M.D., is also the chair of the DSM-5 working group—ironically, a substance-related-disorders task force—that has decided to include gambling in its list of addictive ... substances? "Where does that leave all the other candidates for inclusion in the addiction category—leading entries for which are sex and games," asks Peele, rhetorically. "For them to be included, will they also have to be 'shown' to affect the same 'brain and neurological reward system' as drugs and gambling? Is there any powerful experience that does not affect this system? Did O'Brien really scrutinize reams of PET scans of gamblers to find that their reward systems were impacted in the same addictive way as cocaine and alcohol abusers?" The notion of a gambling addict is nothing new, of course. Probably 100 out of a 100 people would answer "yes" if asked whether there is such a thing as an addiction to gambling. And certainly, people have been calling themselves such for generations, But Peele then asks, "Didn't we discover gambling was addictive because people gave heartfelt testimony that they were addicted to gambling? Are they right while the people who claim to be addicted to games and sex are just deluded slackers?" DSM. Peele is implying, will have to include all such perceived addictions if it is to include one, which is why he refers to the planned inclusion of gambling as an act that has "opened the floodgates." Peele has been making the same argument for many years, In 1999, for instance, he wrote the following in a critical review of Aviel Goodman's Sexual Addiction: An Integrated Approach: "The universality of sex gainsays deterministic addictive models that entail the stimulation of neuroreceptors and endorphins to explain how daily activities implicate fundamental addictive mechanisms. The obvious question is always, Why then does not everyone who engages in the activity become addicted to it? The idea of 'born addicts' ordained by genes to react addictively to narcotics (or something or everything else) is quickly refuted by standard epidemiological surveys showing tremendous variability in the individual's tendency to be addicted over time and in different settings. Neurochemical and genetic theories are not economical ways to explain how it was that so many heroin addicts in Vietnam came home to use narcotics nonaddictively in the United States (Robins, Davis, & Goodwin, 1974). "Indeed," he added, "sexual addiction should be a primer for understanding how ordinary people can sometimes find a basic experience powerful and often overwhelming." The subject of addiction is fascinating for many people on a personal level, but for the adult entertainment industry addiction it may end up being the most successful justification used to put ever more stifling prohibitions on sexual expression. The term "porn addiction" is already in common use by anti-porners in and out of government who are looking to do to porn what was done to tobacco. As far as the neurobiological argument is concerned, it remains a common theme in the pages of Psychology Today, and was used recently by former senator and presidential candidate Rick Santorum in his call for a renewed war on porn. Aware that he is up against a momentous tide of popular will aided and abetted by the "'addiction = chronic-brain-disease' movement," Peele offered his suggestion how to address what is now a common question. "A sensible person who is asked, 'Are gambling, sex, and games addictive?' will answer, 'Anything can be addictive, or not, depending on how engrossed people become in them, and how much they are damaged by it.' In other words, it isn't which activities we focus on and call addictive, it is how the person engages in the experience (compulsively, unable to halt or to cut back, in ways that interfere with their functioning and that harm them) that counts. "Think about OCD and its diagnosis," he continued. "Do we really care what people obsess or behave compulsively around? if a person endlessly organizes shoes, or washes his or her hands repeatedly, or locks and unlocks the door ad infinitum—the thing they obsess over and behave compulsively towards is not really the matter. It is the pattern of behavior they engage in and its consequences for them. "Same with addiction." For more information about the development of DSM-5, go here. For more on Stanton Peele, go here.