Andy Warhol Was a Hoarder (35 page)

Anna put up with Dostoevsky's gambling, because she worried that the alternatives might be worse. While she was queasy and pregnant with their first child, the couple had taken a trip to the resort town of Baden-Baden in Germany. Despite being short on cash, Dostoevsky quickly set off to gamble. Although he initially handed his winnings over to his wife for safekeeping, he returned again, empty-handed, and begged for more. Dostoevsky worked himself up into such a state after his losses—remorseful, apologetic, self-flagellating—that Anna decided it was better to let him hit the casino than risk a possible epileptic attack. She also believed
that her husband's gambling helped clear his muddled head and fuel his writing. Despite his ongoing losses (he pawned the couple's wedding rings, his wife's earrings and brooch, his coat, and her shawl), Anna stood by his side. “One had to come to terms with it,” she later wrote, “to look at his gambling passion as a disease for which there was no cure.”

W
HAT PROPELS PEOPLE TO
wager everything on a game of chance? There's no simple answer. Maureen O'Connor, a popular two-term mayor of San Diego from 1986 to 1992, started playing video poker after the 1994 death of her husband, Robert Peterson, the Jack in the Box fast-food tycoon. Between 2000 and 2009, O'Connor won more than a billion dollars at casinos in Las Vegas, Atlantic City, and San Diego, according to tax records cited in court papers filed by federal prosecutors in Southern California in 2013. But she lost even more. The ex-mayor, who had grown up in a working-class family and taught at Catholic school early in her career, liquidated her savings and took out second and third mortgages to cover her debts and continue gambling, according to prosecutors, who charged that she had misappropriated $2.1 million from her husband's charitable foundation, leaving it bankrupt. O'Connor's lawyer argued that her actions fit a pattern called “grief gambling” and that her behavior coincided with a slow-growing brain tumor, diagnosed in 2011, which can affect judgment and impulse control. Whatever the cause, her behavior was “totally out of character,” her chief of staff told the
New York Times
. In a teary CBS News interview, O'Connor apologized and admitted that she thought she could beat the machine. “It was like electronic heroin,” she said, acknowledging that she could lose more than $100,000
in one day. “You know the more you did, the more you needed—and the more it wasn't satisfied.” Prosecutors later dismissed the case against O'Connor after she agreed to receive treatment for her gambling addiction and to pay back the $2.1 million when she was financially able to do so.

Gladys Knight, the Grammy Award–winning rhythm and blues singer, revealed in a memoir that she got hooked on the card game baccarat starting in the late 1970s, after her second marriage unraveled. She worried about paying funds she owed to the IRS and affording her kids' college educations—but it wasn't just money that spurred her decade-long addiction. “I had so much weighing on me at home: so many expectations, so many people depending on me, wanting things from me,” she wrote. “When I was performing, it was the same thing. I had to be on all the time. When I gambled, I was a kid again in my private play space.” Knight, who gambled in casinos from Las Vegas to Europe, rationalized her behavior while she made money. But over time, it became clear that she was in too deep. “Gambling became a substitute for actually dealing with my life,” she reflected. One night, after losing $45,000, Knight called Gamblers Anonymous, a 12-step program similar to Alcoholics Anonymous. “I felt like I was going to throw up out of shame and self-revulsion,” she recounted. “I
was
sick. I was an
addict
.”

Most people who gamble do not become addicts. They play poker, cards, slots, and roulette with friends as entertainment for limited periods of time. So-called social gamblers don't risk inordinate sums or suffer other long-term consequences. A second tier of gamblers, referred to as “problem gamblers,” spend a significant amount of time gambling, lose more money than they intend and may be at risk for developing a more serious fixation. Most worrisome are those gamblers who are so consumed by their game of choice—poker,
slots, blackjack, craps—that they neglect their families, endanger their careers, and empty their pockets and bank accounts. Like Dostoevsky, they meet the criteria for gambling disorder.

In the United States, as many as two to three million people qualify for a gambling disorder diagnosis, and the numbers could rise. Over the last several decades, gambling has been legalized in almost every state, with new casinos doing brisk business. The gaming industry, which takes in more than $60 billion in revenues every year, promotes gambling as both entertainment and as a source of state revenue. The practice has become increasingly popular with niche demographics. College students are lured in by TV poker shows and the desire to win fast cash; gambling apps provide instant gratification. More men than women gamble, but the gap is beginning to close. The prototypical male gambler places heavy bets, wants to be the center of attention, and gets a rush from playing, says Nancy Petry, a gambling disorder expert at the UConn Health School of Medicine in Farmington, Connecticut. Women, by contrast, tend to gravitate to slot machines and gambling when they're depressed, and typically start later in life. For seniors who are lonely, isolated, or bored, gambling becomes a social outlet and an escape from the challenges of aging.

Excessive gambling can have adverse consequences on the body. With no clocks or windows, casinos are designed to lure people in, keep them playing, and ensure that they lose track of time. Pulling slots or playing cards all night can lead to sleep deprivation, which can trigger detrimental outcomes, including shut-eye at the wheel. Alcohol flows freely at casinos, and most allow smoking. All of this can exacerbate depression and anxiety in gambling addicts, who are more prone to mood disorders to begin with. The results can be dire: About 17 percent of people in treatment for gambling disorder have attempted suicide, often after suffering a substantial loss.

The most compelling research today revolves around scientists' game-changing conclusion that gambling disorder looks a lot like alcohol and drug addiction. The conditions have corresponding patterns and behaviors—the cravings, the risk-seeking, the lack of judgment, the inability to stop. Brain-imaging studies have found that people with gambling disorder, like individuals with other addictions, suffer from impaired decision-making, which leads them to choose immediate gratification over long-term consequences. There are similar patterns in family history, too. Children of gambling addicts run a higher risk of developing gambling disorder themselves; if one identical twin is addicted, the other is more likely to be as well. Compulsive gamblers are also more likely to have a parent, child, or sibling with a substance use disorder—Dostoevsky's father was said to have been an alcoholic—and demonstrate a greater probability of having one themselves, suggesting an overlap in genes that contribute to both varieties of addiction. As with substance use disorders, gambling disorder may start in adolescence or young adulthood; the earlier the onset, the more severe the condition tends to become.

Scientists now believe that addiction is rooted in the brain's “reward system”—the same system that releases the feel-good hormone dopamine when we do something pleasurable, like eat ice cream or have sex. When drugs and alcohol first activate this brain circuitry, levels of dopamine surge, making the person feel good. With repeated use, however, the brain becomes overwhelmed, and the addictive substance or behavior no longer provides the same satisfying jolt. This may lead people with addictions of all types to develop a tolerance and seek out risk as they try to regain the gratifying response they achieved early on.

Growing research shows that gambling strikes at similar pathways in the brain. What does that mean for other behaviors gone
awry? According to the
DSM
, compulsive Internet gaming, which has been linked to extreme self-neglect and social isolation, most notably in Asia, warrants further research. Internet gaming disorder could become a diagnosable condition soon. Some experts believe that binge eating, which is currently classified as an eating disorder, looks like a behavioral addiction as well. What about shopping or sex? Is your brain wired to
make
you buy another pair of shoes or indulge in repeated affairs? You can see the challenge here: If overindulging is deemed to be a brain disorder, one could argue that we are no longer responsible for the bad choices we make. We've all got at least one vice that gives us pleasure, be it too much chocolate or too many hours on Twitter.

Behavioral addiction is an area that has garnered enormous debate in mental health circles. Diagnosing what might be nothing more than a troubling habit raises alarm bells about what psychiatrists perceive as “normal” versus “abnormal” behavior—as well as when and where the line is crossed. Critics argue that psychiatrists are already overpathologizing human behavior. Others wonder if addiction should be reconceptualized altogether. In her memoir
Desire
, the writer Susan Cheever, who has struggled with sex addiction and alcoholism, suggests that perhaps addiction should be categorized by intensity (“ ‘He's a level-five addict' or ‘She's a level-two addict' ”) instead of substance, since many people who are addicted to one thing are or will become addicted to another. “It's as if the addict is addicted to a feeling rather than a specific substance that triggers the feeling,” she writes.

However addiction is defined, the biggest challenge is getting help to people whose lives are in peril. Few people with gambling disorder actively seek treatment. Lured by the prospect of winning, they often lack perspective on how serious their condition has become. As a result, most mental health clinicians have little
experience treating the condition, says UConn Health's Petry. Cognitive-behavioral therapy, one of the therapeutic approaches used to treat substance abuse disorders, can be helpful in teaching patients how to identify the thoughts and feelings that motivate their gambling. Once these triggers are pinpointed, individuals are guided to find alternative activities that deter them from setting foot in a casino or gambling parlor. Some join self-help groups, including Gamblers Anonymous, which attempts to nurture recovery through mutual understanding and support. Anti-anxiety medications or antidepressants may be prescribed as well to combat the highly associated mood disorders. And given the similarities to substance use disorders, researchers are also testing the efficacy of a drug called naltrexone, used to combat cravings in alcoholism and drug addiction, to see if it can reduce gamblers' urges to play.

Rosenthal believes that the majority of compulsive gamblers can be treated successfully without medication. He uses psychodynamic therapy, which explores past experiences to identify a patient's underlying motivations. Most critical, says Rosenthal, is that patients understand why they gamble in the first place and “what it is that they're avoiding or escaping from.”

A
NYBODY WHO
'
S STRUGGLED WITH ADDICTION
knows how grueling it can be to stop. Gamblers who quit on their own usually do so for two reasons, says Rosenthal: Something terrible happens or they fear that it will (job loss, spouse filing for divorce, children walking away) or they experience some kind of breakthrough, perhaps a personal epiphany or some kind of spiritual awakening. Dostoevsky seems to have been motivated by both. In April 1871,
he wrote a letter to Anna, then pregnant with their third child, explaining that once again he had lost everything on a gambling escapade—even the money she had sent him for his return trip. As usual, he begged her to send more cash. But he assured her that he was finally quitting. “A great thing has happened to me: I have rid myself of the abominable delusion that has
tormented
me for almost ten years,” he wrote.