Am I Overreacting?
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Description
Alicia called in about her husband’s gambling and asked one of the more common questions about uncommon addictions –– is he in denial or am I overreacting? When it comes to the more subtle or nuanced addictions, it can be easy to second guess our concern or convince someone they are overreacting. Which is exactly what happened for Alicia. So, Nzinga helps her answer this question and gives her tools to talk to her husband about gambling.
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Transcript
SPEAKERS
Dr. Nzinga Harrison, Alicia, Claire Jones
Dr. Nzinga Harrison 00:04
Hello, everybody, it is Monday. So I’m glad you’re listening to IN RECOVERY. I’m your host, Dr. Nzinga Harrison, psychiatrist, doctor, addiction expert, Co-Founder and Chief Medical Officer of Eleanor Health. And today we are going to talk about gambling. It’s something that I mentioned a lot in my intro when we’re talking about this show being about all kinds of addictions, not just substance addictions. And so we were excited to get a voicemail from a listener who called in. If you would also like to help us be excited, we want you to call in and leave us a voicemail, you can submit your questions about anything that you think might have to do with addiction. Our phone number is 8334- LEMONADA, that’s 833-453-662. Or you can fill out our contact form at bit.ly/inrecoveryquestions
Claire Jones
Yes, I’m just going to pop in to say that our listener would like to remain anonymous. So we’re going to call her Alicia. And let’s take a listen to her voicemail.
Alicia
I am calling about gambling addiction and denial. So my husband and I met five years ago, we have a fantastic relationship. We got married four years ago. Soon after we met, I realized that he enjoyed the casino a lot. And I do not like wasting my money at a place like the casino. So after a few months, I realized that there might be a problem there. Speaking to his family members, I had found out in the past, that he had blown rent checks, and had to borrow money, and things like that. So right from the get go, I kind of had an uneasy feeling about it. I expressed those feelings from the jump. And it was never really a problem. Other than I just didn’t like it, you know, we would go we would spend, you know, $100 and $50 bucks every time I went and it turned into going twice a month.
02:24
And over the past five years, we’ve went from $100 and something dollars every time we went to now we’re up to three to $400 twice a month. We don’t have a lot of things we argue about in our relationship, other than the casino. So his argument to me every time is this is what I like to do. I work extremely hard for my money, which he does. And he says, Oh, you know, I don’t go to the bar and drink with my buddies. I don’t go hang out and smoke pot with my buddies. I’m home with my family. This is the one thing I like to do; my one outlet and I should be able to do it without you saying something to me. So I guess my question is, am I overreacting? Is he in denial? I just want to know how I can help him see that there’s an issue and some advice on how to handle this situation. Thank you.
Dr. Nzinga Harrison
We thought this was a great question. So we call it up Alicia to talk more through it because it’s so common. Before we get to that conversation, I want to remind everyone of what the cage is. We’ve talked about CAGE before, it’s a set of four questions that determines the likelihood that you could have an addiction. It’s an acronym. So C, have you ever felt like you should cut down? A, have you ever felt annoyed? When this habit is brought up? G, have you ever felt bad or guilty about this habit? And E, Have you ever used this as an eye opener, i.e. first thing in the morning to steady your nerves or as soon as you wake up and open your eyes you’re thinking about this? So cage is a great place to start. If you’re asking yourself the same question as Alicia. Based on what she said in her voicemail, I think we can skip CAGE and hop into the diagnostic criteria, which we’ll go through with Alicia on the phone. So Alicia, thank you so much for coming on in recovery.
Alicia 04:31
Yes, thank you.
Dr. Nzinga Harrison
So when you look at the CAGE, answering one out of four, predicts a substance use disorder. In this case, we’re applying it to gambling 77% of the time.
Claire Jones
That’s just for answering one?
Dr. Nzinga Harrison
Just by scoring one, the DSM-5 so if you listen to the show before you know the DSM-5 is the diagnostic manual that we use as behavioral health professionals, mental health professionals to make our diagnoses. Let’s go through those. You have to reach four of these to determine if a person has a gambling disorder. Okay, so number one, is your husband frequently preoccupied with gambling?
Alicia
Yeah, somewhat.
Claire Jones
Can you can you describe what that looks like? Like what is preoccupied mean?
Dr. Nzinga Harrison
So preoccupied, it’s really thinking about the amount of time that gambling takes up either in your mental space, how much you’re thinking about it, in this case in your relationship space, right? So if he’s like, if we get a scratch off, we’re going gambling. I want to go to the casino tonight. Remember that one time I went to the casino? Remember that one scratch off ticket I got arguing about this casino, right? Just the way you’re describing it. I know that it’s taking up a lot of cognitive space.
Alicia
Yeah. And he also plays the, you know, pop slots, casino apps on his phone. Even though there’s no real money involved.
Dr. Nzinga Harrison 06:02
Still, there’s gambling involved?
Alicia
Yes, yeah.
Dr. Nzinga Harrison
So for your husband, what we’re learning is that it’s not even necessarily about the money. It’s the experience of gambling.
Alicia
Yeah.
Dr. Nzinga Harrison
It’s the scratch off tickets. It’s the game on the app. It’s the casino, right? It’s literally the intoxication of gambling. And when he couldn’t go to the casino, the withdrawal that led him to buy more scratch off tickets.
Alicia
Yeah.
Dr. Nzinga Harrison
So you see how I can so easily apply the language of addiction to the experience that your husband is having with gambling? It’s because it fits. But we’re gonna prove it. Number two, needs to gamble with increasing amounts of money to achieve the desired excitement.
Alicia
Yes.
Dr. Nzinga Harrison
Tell us how.
Alicia
We have literally left the casino fighting because he wanted to pull more money out of the ATM machine. So yes, that is absolutely true. Like I said, when we first started going, it was $100. And then as our income has increased over the years, what we take has increased.
Dr. Nzinga Harrison
Yep. Okay. Number three, has made repeated unsuccessful efforts to limit cut back or stop gambling.
Alicia
Yes, yes, he has made comments. I took him to Vegas for his first time, two years ago. So it was, I’m not gonna go to Vegas, or I’m not gonna go to the casino until we go to Vegas. So that way we could pull back that money to spend in Vegas that also did not happen. made a comment about wanting to buy a car for our daughter for her 16th birthday. And he wasn’t gonna go until he got her that car. That also did not happen. So absolutely.
Dr. Nzinga Harrison
So we’re at three criteria already. We only need four. The fourth one is, is restless or irritable when attempting to cut down or stop gambling.
Alicia 08:06
I would say that that’s hard to notice. When the casinos closed down. He was buying the scratch offs. I don’t know that was hard. That was hard to call.
Dr. Nzinga Harrison
Let’s be conservative. We’re not counted. So we’re still at three. Number five often Gamble’s as a way of escaping from problems or relieving dysphoric mood, so bad moods like helplessness guilt, anxiety, depression, then who will gamble to get rid of those types of feelings?
Alicia
Absolutely. In he also gamble’s when he’s in a very good mood and because he feels lucky, per se, so yes, when he’s very stressed about things, that’s where he wants to go, or if we’re having a really good weekend. He wants to go.
Dr. Nzinga Harrison
So we’re at four. So we already know the answer is yes, your husband meets the diagnostic criteria for gambling disorder. But let’s go through the rest of the criteria. Six, after gambling and losing money, often gamble’s another day to get even
Alicia
No, that would never fly.
Dr. Nzinga Harrison
If it would fly, would he?
Alicia
Yes, yes, he would.
Dr. Nzinga Harrison
Number seven, lies to family members, therapists or others to conceal the extent of gambling.
Alicia
I do not believe so, no.
Dr. Nzinga Harrison
Okay, eight, has jeopardized or lost a significant relationship, spouse, job, education or career opportunity because of gambling.
Alicia
No.
Dr. Nzinga Harrison
Relies on others to provide money to relieve a desperate financial situation caused by gambling.
Alicia
Not since we’ve been together but stories I’ve heard from before we got together. So I had heard from family members that there was many times he needed to borrow rent money from somebody because he had spent it at the casino. But not since we’ve been together, o.
Dr. Nzinga Harrison 10:03
Got it. So we have five out of our criteria, we only need it for. So our CAGE predicted that we would meet these diagnostic criteria, we meet the diagnostic criteria. So the answer to are you making this up is No, you are not making this up. Your husband has gambling disorder. When it’s in the mild to moderate phases, it’s hard to recognize it. But it’s the same thing with alcoholism. Just because your alcoholism today is not as severe as it was two years ago. Doesn’t mean you don’t have it, right? Doesn’t mean it’s not a problem.
Claire Jones
We’re going to take a quick break, and we will be right back.
Dr. Nzinga Harrison
You started out by saying we are happily married; we do everything together. He’s amazing. Awesome. He’s a hard worker, like you have nothing but positive things to say about your husband. And so when you really feel like your husband is the bomb, and gambling is such a significant source of distress in the relationship. I already know that we’re going to meet the diagnostic criteria. And we did. And so lack of awareness can very easily come with addiction. That’s where you have to find your footing, to really clearly be able to deliver to him.
One, you’re the bee’s knees, I think you hung the moon, you’re amazing. as a person, as a husband, as a father, like everything I have wanted in a spouse, two, you meet the diagnostic criteria for gambling disorder. Three, this is causing a lot of distress in our marriage. And I know, you would not choose to cause distress in our marriage. If it wasn’t a problem, if it wasn’t somehow outside of your choice, because the rest of your choices, choose our marriage, and choose our kids and choose me and choose not to fight over things. And so the fact that it is so hard for you to make that choice over gambling, lets me know that we’re dealing with the disorder. Do you think you could find your footing and deliver that in a compassionate way? And do you think he could hear it from you?
Alicia 12:46
So I think, and the times I’ve tried to speak to him is when he’s wanting to go, which is probably not the right time. So I think I could deliver that to him. I don’t know how he would take it. I don’t know.
Dr. Nzinga Harrison
You just made a brilliant point, which is very important. So Joel’s my husband, I also think he hung the moon, I think I was actually in an individual session with a therapist, she was saying, you need to bring up these concerns when you’re in a good space. And I was like who wants to ruin a good space with concerns? That sounds counterintuitive. But it’s actually right. Because the just the way our brains work, when we’re not in a corner when our emotions are not high when we’re not feeling defensive, is when we can hear these sorts of things in a way that is, you know, constructive.
Alicia
Yeah. And that’s something we’ve struggled with is when one of us does have a concern. It usually ends up into a bigger fight than it needs to be. And it’s not over like who’s doing the dishes or anything like that. It’s usually something bigger. The casino is one of our main arguments. But yeah, I mean, he gets very defensive. Anytime I try to tell him something that is bothering me. And I think it’s because he’s proud and he knows he’s the bee’s knees, you know, he’ll eventually admit if he’s wrong about something, but it usually blows up before he settles back down and realizes that there was an issue.
Dr. Nzinga Harrison 14:28
It’s like starting out with nothing I am about to say, negates the fact that we both know you’re an amazing human being and amazing father and amazing husband.
Alicia
Yep.
Dr. Nzinga Harrison
Right? Like started like that. Like, let me lay the foundation. And you have to remember like, this is about something you’re doing. And this is that critical distinction that we make, separating the person from the addiction, this is not about who you are. This is about a condition that you have, and the impact that that condition is having on us.
Claire Jones
That’s exactly what I was just thinking like, you know, the way that you define addiction Nzinga, is very much like this is something that is out of your control. It’s the same as thyroid disease, it’s the same as getting diagnosed with cancer, it’s the same as all of those different things and approaching it in that way being like, this is not about your character.
Dr. Nzinga Harrison
That’s right.
Claire Jones
This is about something that you have.
Alicia
And I’m trying to get him there with understanding that with addiction, because his sister, wait, she actually is just started to be in recovery. You know, right now, she’s coming around, and I listened to LAST DAY, and I tried to get him to listen to that. So he could have a better understanding of addiction. You know, he’s still one of those people. It’s a choice. You know, that’s where he’s, but I think he’s slowly starting to come to that it’s not a decision and not a choice. So maybe that defensiveness will come down more once he realizes and he can separate him from the disorder.
Dr. Nzinga Harrison 16:16
Just imagine if he’s proud, the way you describe him, and his belief system, is that addiction is a choice. Then, of course, he can’t say I have gambling disorder. Because then that would force him to conceptualize himself as weak and not a good person. He doesn’t have to say, Yes, I have a gambling disorder, you to just have to get online. My gambling is affecting you, which is affecting us. And we’re aligned on changing that.
Claire Jones
Nzinga, I know that you sort of already did an example of this. But can you give another example of a way to talk about this especially because, Alicia, it sounds like what you said in your voicemail, his response is always like, I’m like, the kids are in good shape. I don’t go to the bar. I don’t do any of these other things. This is just something that I enjoy. And so I’m just curious, like, that’s a strong defense argument. You know, it’s like, I think hearing that it’s really hard to be like, it’s still a problem. So what so what are a couple of options that you can say in response to that to communicate like, but it’s negatively impacting me without, like, guilt tripping too much? Or, you know, what are some tools on how to talk about that?
Dr. Nzinga Harrison
Yeah. So I mean, when we talk about gambling disorder, doesn’t language it this way, in the diagnostic criteria, but in substance use disorders criteria, the one that correlates here too has jeopardized or lost a significant relationship job educational career opportunity, because of gambling, the way it’s languished in substance use disorder criteria is failure to fulfill major role obligations because of the substance. And so what your husband is saying, I’m not failing to fulfill any major role obligation, the bills are paid, the kids are taken care of, I love the kids, I’m going to school you’re taking care of I love you, we’re spending time together. But in fact, there is a failure to fulfill a major role obligation here, which is the obligation of spouses not to have any space between. And that’s hard work. Because there’s always something work is always trying to come in the middle COVID is always trying to come in the middle of the kids extracurriculars. Trying to come in the middle, what we think about discipline is trying to come in a middle gambling’s trying to come in the middle, so long line of things.
18:46
And so it’s always active work for a couple to keep those two circles together then to have something come in the middle. And Claire, this is not the answer to your question yet. Because Alicia, if you go to him and say the way you’re failing to throw the rest of that conversation in the trash, Okay, I’m gonna lay a foundation for what we’re gonna get through. This is not it yet. But the way he’s failing in a major role obligation is by failing to do the work that it takes to not have gambling be between you. Now we know the reason for that failure is not because he doesn’t want to or because he’s a bad person, because he doesn’t have willpower. The reason is an illness called gambling disorder. But nonetheless, it is this work. And so I think the way you can take it to him is like, we started out by saying, yes, you are paying the bills. Yes, you are taking care of the family. Yes, you are being a good spouse. Yes, you are being a good dad. But gambling is between us. You can tell by how much we fight about it. And he will say well, we fight about it because that’s you and you will say, but I married you because you protect my feelings. And this is not protecting my feelings.
Claire Jones 20:10
Yeah. Alicia, how does that land for you?
Alicia
Yeah, I mean, it makes sense. I think he could take that. And I think he could still spin it. Well, you know, you’re only you’re taking, you’re trying to take away the only thing that I like to do, you know? So I just got to figure out how to make it, you know, not taking, and I’ve told him I was like, you know, I’m not trying to tell you to never go to the casino again. I’m just trying to tell you; we don’t need to go two-three times a month. Spend three to four or $500 or something.
Dr. Nzinga Harrison
I mean, the other thing is, is it the only thing he likes to do? Because if so that’s also a signal.
Alicia
Yeah. I mean, we really don’t, you know, and that’s another thing. You know, I’ve told him every time we go out for a date, we always end up going to the casino, the one place I don’t like how is that fair? To me? You know, why can’t you plant and why can’t we go somewhere else? When we can you just don’t know where to go?
Dr. Nzinga Harrison
Maybe that’s where you start, right? I’m not trying to take away the only thing you like to do. I’m just also trying to do something I like to do. Yeah. So if we’re going to go out four times a month, which I don’t know if I’ll go out four times a month, I’m trying to be like y’all.
Alicia
No, we do not.
Dr. Nzinga Harrison
I’ll be like, Joel, I need you to listen to this episode IN RECOVER, because Alicia has been going out four times a month. And he’ll be like, You’re the reason we’re not going out. Not me.
Alicia
I will say sometimes we do sneak away and go have dinner, you know, from the kids. Hey, guys, it’s lazy dinner, we got errands to run. But he saw me we get to go to a dinner a couple few times a month. But it’s usually every two weeks on the nose. He’s mentioning that it’s time to go to the casino. And it’s like, so we get to go out to dinner, and we get to go to the casino. You know, we don’t really do anything else.
Dr. Nzinga Harrison 22:08
Yeah, so that’s my recommendation, right there is try to find some other things that you enjoy doing together because you enjoy being together. So the hard part is done. And so you don’t want to take away from the time you enjoy being with him with the stress that gambling in the casino puts on top of that, because then it turns it from fun time with him to stressful time with him for you. And so that could be another way to approach it, right? Like, if we’re gonna go out and spend fun time with each other twice a month, you get one of those to choose what you want to do with it, I get one of those to choose what I want to do with it. And every third time it has to be different, or something like that, right? Because you might love romantic comedies, and he might hate it. So we also don’t want you forcing him into romantic comedies every single time you go out.
So it’s like every third time, make it be something new. But you’re choosing one and I’m choosing one. And it’s a backdoor method. But it’s still like remember, this is the goal, by any means necessary. And then it could be as arguing over gambling decreases. That’s the other thing is that I would elevate this discussion. you’re arguing over the casino. But you’re not actually arguing over the casino. you’re arguing over gambling?
Alicia
Yes.
Dr. Nzinga Harrison
Your concern is around gambling to include even more than the casino. So that’s kind of like putting all of the weight on the casino when it’s a bigger thing. But maybe as you’re arguing about that reduces. He might be like, wow, we were really arguing about that a lot. Even if he conceptualizes the arguing as the problem. Still reducing the gambling, reduce the arguing. Things are better motivations to keep gambling low. I’ll the back door. I’ll take any door.
Alicia 24:11
Yeah, I think that’s really great advice.
Claire Jones
Well, thank you for coming on.
Alicia
No, thanks for having me.
Dr. Nzinga Harrison
All right. I know we have some amazing sponsors. Should we take a listen to who they are?
Claire Jones 24:33
We talked about how she could find some other things for them to do together that he also enjoys talking about medication or you know, yeah, I guess medication is right. We’re talking about medication for gambling. What are some options is it have to be abstinence only can there be a middle ground? You know, it’s hard because it’s like it seems like a lot of it is also just like, like you’re saying, like, How much is it impacting the relationship, which could mean that the solution actually isn’t about the gambling at all. It’s about the communication. It’s about the relationship. So how does that all work?
Dr. Nzinga Harrison
Right, exactly. So yes, there is some evidence. So we don’t have any FDA approved medication for gambling. But there’s some evidence that Naltrexone, which is the same medication we use to block the opioid receptors for opioid addiction and alcohol addiction, which reduces cravings for those substances and reduces heavy and problematic use of those substances. There is some evidence that now, Naltrexone works for gambling.
Claire Jones
Interesting.
Dr. Nzinga Harrison
The other thing, if there is any depression, anxiety, bipolar disorder, which is very highly commonly associated, like when you have gambling disorder, you always have to look for bipolar disorder, ADHD, if there’s any of those illnesses like that, then we want to make sure we’re treating those also. Yeah, there is another medication that we don’t very commonly use as much as we use Naltrexone but it’s called now Nalmefene, which can also reduce gambling has been shown in studies. So I would say most easily accessed would be the Naltrexone. So when I say gambling shares exactly the same neurobiology as other addictions, and one of the main drivers of that is dopamine. So another dopamine illness that we have is Parkinson’s. So basically, there’s this part of your brain. For my nerds who are listening like me, it’s called your substantia nigra.
26:55
That’s the nucleus in your brain that manufactures this chemical called dopamine. That’s our survival chemical, right? Food, water sex nurturing are what’s naturally going to cause a dopamine signal. When your brain your substantia nigra stops manufacturing dopamine that leads to Parkinson’s because dopamine also has everything to do with our ability to have smooth motions and to initiate motion. I know it’s the brain is so interesting. But so the way we treat Parkinson’s, which is basically the substantia nigra has lost its ability to manufacture dopamine is that we give medication that is dopamine, okay, (inaudible), you may have heard of it, is basically leave a dopa. Dopamine. When we are prescribing dopamine, we are dramatically increasing people who have Parkinson’s risk for developing gambling disorder.
Claire Jones
Interesting. It is specifically gambling.
Dr. Nzinga Harrison
Specifically gambling disorder is associated with the treatment of Parkinson’s with dopamine medications. So when I say this is a biologically driven, because it’s hard for people, right? Like it’s easier when you say, alcohol has to do with the chemicals in your brain. It’s like, of course, alcohols, a substance. opioids have to do with the chemicals in your brain.,
Claire Jones 28:22
It’s like you’re in taking something.
Dr. Nzinga Harrison
You’re in taking something that is changing your brain chemistry, gambling, has everything to do with the chemicals in your brain is a harder connection, because gambling is a behavior,
Claire Jones
Right.
Dr. Nzinga Harrison
I’m telling you; the medical literature is strong on the increased risk for developing gambling disorder. When you get your Parkinson’s treated.
Claire Jones
That’s so interesting. But why? Why is it gambling specifically versus other behavior-based addictions? Like, sex addiction? Or I’m trying to think of some other ones. So we’ve talked about technology, you know, technology addiction, or food?
Dr. Nzinga Harrison
Yeah, that’s a good question. And so it’s probably not, that’s probably just the signal that we can see. Right? So the medical literature, and it’s probably gambling is more available, then sex isn’t like you figure an older person with Parkinson’s. What’s more available, probably gambling is more available than sex is probably more available than cocaine for the average older person who has not already been exposed to cocaine in their later lives. And so it’s probably not that it specifically increasing the risk for gambling. It’s specifically increasing the risk for impulse control disorders and gambling is probably the most accessible.
Claire Jones 30:02
That makes sense that is helpful. What are your ending thoughts, Nzinga?
Dr. Nzinga Harrison
My ending thoughts is really again to just shine a light on Alicia’s main question, which was, is he in denial? Or am I overreacting? That doesn’t have to be a black or white question. But I always tell people, like I just said to Claire a few minutes ago, if you’re asking the question, is this a problem? The answer is yes. Where we get tripped up is that we think the answer to is this a problem has to be Is this a severe problem? Is this an addiction? Is this awful? Does this have to completely get out of our lives? And that’s not the question you’re asking the question you’re asking is like, Is this an issue? And if you’re asking it’s Yes, so to put it in the realm of physical health, we know that one of the worst outcomes from diabetes is needing an amputation. We don’t wait until you need an amputation. Right? You go to the doctor, and they check your blood sugar. And the question too, is this a problem?
Yes, can be with a blood sugar as low as 127, 127 not going to get you an amputation. Still, it’s the beginning of a problem. And that’s where we want to jump on it. And so if you have any question mark, just apply the CAGE. This this person ever tried to cut back or change that behavior? Did they ever feel annoyed when other people talk to them about it? Did they ever feel guilty about it? Do they think about it first thing in the morning? Eye opener is the E if you can answer yes to one of those questions, then you don’t have to worry that you’re overreacting because that’s an objective scale that measures risk.
Claire Jones 32:05
And we’ll put the CAGE, shoutouts for everyone too.
Dr. Nzinga Harrison
Awesome.
Claire Jones
Great. Okay. Thanks, everyone.
Dr. Nzinga Harrison
See you next week.
CREDITS
IN RECOVERY is a Lemonada Media Original. The show is produced by Claire Jones and edited by Ivan Kuraev. Jackie Danziger is our supervising producer. Our theme was composed by Dan Molad with additional music by Ivan Kuraev. Stephanie Wittels Wachs and Jessica Cordova Kramer are our executive producers. Rate us review us and say nice things. Follow us at @LemonadaMedia across all social platforms, or find me on Twitter at @naharrisonmd. If you’ve learned from us, share the show with your others. Let’s help destigmatize addiction together.
