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Sunday, June 28, 2015

Addiction is not a disease.....

Addiction is not a disease: A neuroscientist argues that it’s time to change our minds on the roots of substance abuse

A psychologist and former addict insists that the illness model for addiction is wrong, and dangerously so

Addiction is not a disease: A neuroscientist argues that it's time to change our minds on the roots of substance abuse (Credit: Alex Malikov via Shutterstock)

The mystery of addiction — what it is, what causes it and how to end it — threads through most of our lives. Experts estimate that one in 10 Americans is dependent on alcohol and other drugs, and if we concede that behaviors like gambling, overeating and playing video games can be addictive in similar ways, it’s likely that everyone has a relative or friend who’s hooked on some form of fun to a destructive degree. But what exactly is wrong with them? For several decades now, it’s been a commonplace to say that addicts have a disease. However, the very same scientists who once seemed to back up that claim have begun tearing it down.
Once, addictions were viewed as failures of character and morals, and society responded to drunks and junkies with shaming, scolding and calls for more “will power.” This proved spectacularly ineffective, although, truth be told, most addicts do quit without any form of treatment. Nevertheless, many do not, and in the mid-20th century, the recovery movement, centered around the 12-Step method developed by the founders of Alcoholics Anonymous, became a godsend for those unable to quit drinking or drugging on their own. The approach spread to so-called “behavioral addictions,” like gambling or sex, activities that don’t even involve the ingestion of any kind of mind-altering substance.
Much of the potency of AA comes from its acknowledgement that willpower isn’t enough to beat this devil and that blame, rather than whipping the blamed person into shape, is counterproductive. The first Step requires admitting one’s helplessness in the face of addiction, taking recovery out of the arena of simple self-control and into a realm of transcendence. We’re powerless over the addictive substance, and trust in a Higher Power, and the program itself, to provide us with the strength and strategy to quit. But an important principle of the 12 Steps is that addiction is chronic and likely congenital; you can be sober indefinitely, but you will never be cured. You will always remain an addict, even if you never use again.
The flourishing of the 12-Step movement is one of the reasons why we now routinely describe addiction as a “disease.” To have a disease — instead of, say, a dangerous habit — is to be powerless to do anything except apply the prescribed cure. A person with a disease is unfortunate, rather than foolish or weak or degenerate. Something innate in your body, particularly in your brain, has made you exceptionally susceptible to getting hooked. You always have and always will contain a bomb, the important question is how to avoid setting a match to it. Another factor promoting the disease model is that it has ushered addiction under the aegis of the healthcare industry, whether in the form of an illness whose treatment can be charged to an insurance company or as the focus of profit-making rehab centers.
This conception of addiction as a biological phenomenon seemed to be endorsed over the past 20 years as new technologies have allowed neuroscientists to measure the human brain and its activities in ever more telling detail. Sure enough, the brains of addicts are physically different — sometimes strikingly so — from the brains of average people. But neuroscience giveth and now neuroscience taketh away. The recovery movement and rehab industry (two separate things, although the latter often employs the techniques of the former) have always had their critics, but lately some of the most vocal have been the neuroscientists whose findings once lent them credibility.
One of those neuroscientists is Marc Lewis, a psychologist and former addict himself, also the author of a new book “The Biology of Desire: Why Addiction is Not a Disease.” Lewis’s argument is actually fairly simple: The disease theory, and the science sometimes used to support it, fail to take into account the plasticity of the human brain. Of course, “the brain changes with addiction,” he writes. “But the way it changes has to do with learning and development — not disease.” All significant and repeated experiences change the brain; adaptability and habit are the brain’s secret weapons. The changes wrought by addiction are not, however, permanent, and while they are dangerous, they’re not abnormal. Through a combination of a difficult emotional history, bad luck and the ordinary operations of the brain itself, an addict is someone whose brain has been transformed, but also someone who can be pushed further along the road toward healthy development. (Lewis doesn’t like the term “recovery” because it implies a return to the addict’s state before the addiction took hold.)

“The Biology of Desire” is grouped around several case studies, each one illustrating a unique path to dependency. A striving Australian entrepreneur becomes caught up in the “clarity, power and potential” he feels after smoking meth, along with his ability to work long hours while on the drug. A social worker who behaves selflessly in her job and marriage constructs a defiant, selfish, secret life around stealing and swallowing prescription opiates. A shy Irishman who started drinking as a way to relax in social situations slowly comes to see social situations as an occasion to drink and then drinking as a reason to hole up in his apartment for days on end.
Each of these people, Lewis argues, had a particular “emotional wound” the substance helped them handle, but once they started using it, the habit itself eventually became self-perpetuating and in most cases ultimately served to deepen the wound. Each case study focuses on a different part of the brain involved in addiction and illustrates how the function of each part — desire, emotion, impulse, automatic behavior — becomes shackled to a single goal: consuming the addictive substance. The brain is built to learn and change, Lewis points out, but it’s also built to form pathways for repetitive behavior, everything from brushing your teeth to stomping on the brake pedal, so that you don’t have to think about everything you do consciously. The brain is self-organizing. Those are all good properties, but addiction shanghais them for a bad cause.
As Lewis sees it, addiction really is habit; we just don’t appreciate how deeply habit can be engraved on the brain itself. “Repeated (motivating) experience” — i.e., the sensation of having one’s worries wafted away by the bliss of heroin — “produce brain changes that define future experiences… So getting drunk a lot will sculpt the synapses that determine future drinking patterns.” More and more experiences and activities get looped into the addiction experience and trigger cravings and expectations like the bells that made Pavlov’s dogs salivate, from the walk home past a favorite bar to the rituals of shooting up. The world becomes a host of signs all pointing you in the same direction and activating powerful unconscious urges to follow them. At a certain point, the addictive behavior becomes compulsive, seemingly as irresistibly automatic as a reflex. You may not even want the drug anymore, but you’ve forgotten how to do anything else besides seek it out and take it.

Yet all of the addicts Lewis interviewed for “The Biology of Desire” are sober now, some through tried-and-true 12-Step programs, others through self-designed regimens, like the heroin addict who taught herself how to meditate in prison. Perhaps it’s no surprise that a psychologist would argue for some form of talk therapy addressing the underlying emotional motivations for turning to drugs. But Lewis is far from the only expert to voice this opinion, or to recommend cognitive behavioral therapy as a way to reshape the brain and redirect its systems into less self-destructive patterns.
Without a doubt, AA and similar programs have helped a lot of people. But they’ve also failed others. One size does not fit all, and there’s a growing body of evidence that empowering addicts, rather than insisting that they embrace their powerlessness and the impossibility of ever fully shedding their addiction, can be a road to health as well. If addiction is a form of learning gone tragically wrong, it is also possible that it can be unlearned, that the brain’s native changeability can be set back on track. “Addicts aren’t diseased,” Lewis writes, “and they don’t need medical intervention in order to change their lives. What they need is sensitive, intelligent social scaffolding to hold the pieces of their imagined future in place — while they reach toward it.”
Laura Miller
Laura Miller is a senior writer for Salon. She is the author of "The Magician's Book: A Skeptic's Adventures in Narnia" and has a Web site,

Saturday, June 27, 2015

It’s easy to celebrate gambling, just ignore the downside

It’s easy to celebrate gambling, just ignore the downside


PLAINVILLE — Maybe it’s because he reminded me of my brother — same age, same build, same deadpan humor — but halfway into our conversation, I stopped interviewing Steve and started trying to get him to walk away from the slot machine.

Opening day at Plainridge Park Casino was a smashing success — a dinging, bleating, flashing triumph. All around us, crowds waited for others to give up on Kitty Glitter, Black Widow, Temple Tiger, or another of the 1,500 slots and gambling machines, so they could sit down and try their luck. Long lines formed at the food court and the cash stations. Scantily clad, impossibly proportioned virtual dealers tended to players hunched over blackjack video screens. Cocktail waitresses took orders over the din.

Steve, who did not want his full name used, fed a steady stream of hundreds into the $20-a-bet slot machine — fast. He alternated between pressing the button and pulling the lever “for superstition,” he said. He’d put $7,000 into the slots here so far.

“I’m leaving,” he said. Then he slid another Benjamin into the slot.

So, does he have a problem?

“I’d say it was a problem,” he said flatly, as if the answer were obvious. “What are you gonna do? It is what it is. I do very well businesswise.”

The 45-year-old owns several fast-food places. He usually gambles at Foxwoods. He likes table games, especially blackjack, better than slots.

“With slots, you’re just depending on the machine,” he said.

One night last week, he left Foxwoods $43,000 up. “That’s one time out of 10 that I’m not negative $5,000,” he said.

I’ve met hundreds, maybe thousands, of Steves. I spent half my life around slots. They’re everywhere in Australia, where the average adult bets and loses morethan residents of any other country —especially to slot machines, gambling’s equivalent of crack cocaine.

My mother spent decades in the industry, dispensing drinks and change in veterans’ clubs where slots were the main draw. I worked in them, too, in my late teens and early twenties.

I have seen their benefits: My mother’s was a good job, allowing her to raise six kids alone, even though she had only a fifth-grade education.

And I have seen their costs. The bars where I worked were in poorer neighborhoods, where people had less money to feed into the machines than Steve does. But that didn’t stop them. I saw countless people in thrall: elderly people pouring their pension checks into the slots week after week; younger people whose habits left them reliant on friends for food and beer; they played like it was their job — fast, joylessly.

I pushed all of that depressing stuff out of my head as I took their money. I reminded myself that they were adults, making their own choices. It was the only way I could go back to that smoky, dingy dive day after day.

Plainridge is far more beautiful than the places where I used to work. And on Wednesday night, it sure looked like some of the gambling boosters’ promises would be kept. Money that would otherwise have gone to out of state parlors was indeed coming back to Massachusetts: Several of the punters I spoke to had chosen Plainridge over Twin River, in Rhode Island. The place was so jammed, it seemed entirely possible that Plainridge might actually meet its own crazy optimistic revenue projections — for a while.

And plenty of the people there were having a great time at the low-stakes slots (which make just as much noise announcing a $7.50 windfall as others machines do dispensing thousands), and walking away from them to eat dinner, see the band, or pose with the dancing showgirls.

It’s easy to celebrate all of that, as long as you can push the depressing stuff out of your head. As long as you don’t think about all the Steves, settling in for hours.

I watched as his balance dropped to zero again. Get out of here, I begged him. He stood up.

“I’m walking away,” he said.

Really? I’d convinced him?

“No,” he said. “On this machine I’m walking away.” And off he went to find another.

Globe columnist Yvonne Abraham can be reached at

As Plainridge Park Slot Barn opens, state seeks to blunt gambling addiction

As Plainridge Park Casino opens, state seeks to blunt gambling addiction

Plainville’s new slots parlor will become state’s first casino today

Wednesday, June 24, 2015


PLAINVILLE — Tucked in a corner of Plainridge Park Casino, over by the elevators and away from the glitter and noise of the gambling room, is a small table with brochures on it.

The leaflets are about something called “GameSense.”

They contain information about gambling and prevention measures for problem gambling and addiction.

They are part of the state’s efforts to combat gambling addiction while also greatly expanding the availability of gambling in Massachusetts by allowing casinos to open across the state.

Plainridge, with its 1,250 slot machines, will be the first gambling facility in Massachusetts when it opens at 1 p.m. today.

Gaming Commissioner James McHugh said the availability of the leaflets on site is among the measures that give Massachusetts the most extensive efforts to prevent and treat problem gambling in the nation.

He said the law legalizing casinos and regulations adopted by the commission “put in speed bumps” to slow gamblers from going too far.

Others agree.

“I feel that our protections go further than many other states and we’ve had an opportunity to learn from states that have had gaming for many years. I think our best asset has been being proactive around regulation and really having a focus on protecting vulnerable populations as best we can,” said Krystle Kelly, spokeswoman for the Massachusetts Council on Compulsive Gambling.

One protection is called self-exclusion.

A person with a gambling problem can have themselves put on a list that bans them from casinos. Families can also petition to have a member put on the list.

Another protection that will become available soon is a warning on slot machines that tells a player when they have reach a spending limit they set in advance.

The council also has a toll-free hotline for people with a problem. It is 800-426-1234.

Kelly said casinos will be required to pay into a public health trust fund that will finance services for problem gamblers.

The brochures available at Plainridge give players advice, tell them where they can get help and dispel myths about gambling.

They tell players up front they should expect to lose money. Winning is a long shot.

One brochure tells the reader that the odds of hitting the top jackpot on a slot machine is 1 in 373,249. The odds of winning any prize is 1 in 5.

It says the belief that if you keep playing a slot machine your odds of winning increases is false.

Each play of a slot machine is an independent event.

“The result of your previous play or series of plays has no bearing on what happens on your next play. There is no way to predict a win. Slots are never ‘due for a win’ and they don’t ‘go cold’ after a win,” the brochure states.

Tinian Dynasty Hotel and Casino refuses to cooperate with commission

Tinian Dynasty Hotel and Casino refuses to cooperate with commission

The Tinian Dynasty Hotel and Casino located on the Commonwealth of the Northern Mariana Islands (CNMI) was hit with a record $75 million fine at the start of June 2015. The fine was imposed by the US Department of Treasury’s Financial Crimes Enforcement Network (FinCEN) as the casino failed to comply with the Bank Secrecy Act and willing allowed customers to break the law.
Casinos have been used by criminals to conduct money laundering activities and FinCEN has been closely monitoring casinos to ensure that their money laundering policies are being implemented at all times. FinCEN found that the Tinian casino was the only casino in the Northern Marianas which continued to be non-compliant with the Tinian Gaming Act,
The Tinian Dynasty Hotel and Casino is owned by Hong Kong Entertainment (Overseas) Investments Ltd, and majority shareholder, Mega Stars Overseas Ltd. Due to the casinos non-conformance the Tinian Casino Gaming Control Commission decided to conduct detailed investigation into the casino’s process and procedures. The commission wanted to analyze how much money was coming into the casino, the source of those funds and where the money ended up going.
However, the owners of the Tinian casino choose not to cooperate with the commission and Tinian Casino Gaming Control Commission Executive Director Lucia Blanco-Maratita said that because of this unwillingness to cooperate, they would have to shutdown the casino.
In a statement, Lucia Blanco-Maratita said “Unfortunately, the Tinian Dynasty has become a rogue casino. It allowed itself to be taken over by outsiders without the permission of the commission. Those same people refused to submit all the necessary documents required to complete their application so that they could be thoroughly investigated, to determine whether they are suitable, whether they are honest people who will run a clean casino. My job is to protect the public — to protect the people of Tinian. That is what needs to be done and what I am going to do.”
The casino has violated numerous laws and the commission has gone ahead and filed a complaint in the court of law against the casino. The hearing is expected to start in the month of July 2015. Lawyers representing the casino will have a tough case to fight as the US authorities had earlier conducted a sting by posing as casino players and collected incriminating evidence of how the casino violated money laundering policies.

Massachusetts’ first slots barn opens to eager gamblers

Massachusetts’ first slots barn opens to eager gamblers

The Heisman Trophy won in 1984 by Boston College quarterback Doug Flutie is displayed at Plainridge Park Casino in Plainville, Mass., Tuesday, June 23, 2015. The casino, a slot machine parlor, opened Wednesday, June, 24, 2015. The Plainridge Park Casino represents the first gambling destination to open since state lawmakers approved a casino law in 2011.

PLAINVILLE, Mass. — The start of casino gambling in Massachusetts kicked off Wednesday as the state's first slots parlor, Plainridge Park Casino, officially opened for business to a large and eager crowd of gamblers.

"It's showtime!" state Gaming Commission Chairman Stephen Crosby declared, calling it a "momentous" day for the state, which opened the door to casino gambling with passage of a law four years ago.
Hundreds of special guests cheered as casino officials and state gambling regulators cut a ceremonial ribbon held by two women dressed like Las Vegas showgirls. 
"Take a look at this facility," Crosby said. "Take a look at 500 quality, high paying jobs."
Less than two hours later, hundreds of paying customers streamed into the casino as the doors officially opened for business just before noon.
Some, like Alan Conroy, of Plainville, had been waiting in the summer heat since the early morning hours to try their luck on the facility's 1,250 gambling machines.
"I just want to gamble," Conroy said as he showed off a picture he took earlier with former New England Patriots quarterback Doug Flutie, who was on hand for the opening because he owns a restaurant and bar in the casino. "I've been waiting for this place to open for years."
Massachusetts leaders have high hopes for the $250 million casino, which also features a harness racing track that's long been on the property.
Located near the Rhode Island border, Plainridge is expected to deliver millions of dollars in revenue to state and local government coffers.
The hope is that it can draw Massachusetts residents who would otherwise travel to Twin River Casino in nearby Lincoln, Rhode Island, or the two Indian tribe-run casinos in Connecticut, Foxwoods and Mohegan Sun.
Boston resident Doc Palmer, a regular at Twin River, is among the gamblers the casino hopes to woo. "I go where the money is. They pay out good at Twin River. If they pay out better here, I'll come here," he said as he waited to enter the casino floor.
Plainridge officials bristle at being described as a "slots parlor." Indeed, few of the facility's flashy machines resembled the old-time slot machines fed by quarters and activated by the pull of a lever.
At the same time, the gambling house is not a full-fledged casino in the Las Vegas resort mold.
While it offers electronic versions of blackjack and roulette, it does not offer traditional casino table games managed by a live dealer.
It operates essentially around-the-clock, but last call for alcohol is 1 a.m. and there's no smoking allowed inside.
Plainridge is also the smallest of three gambling halls slated to open in the Bay State in the coming years.
MGM is building an $800 million resort casino, hotel and entertainment complex in Springfield, while Wynn is building a gaudy, $1.7 billion one in the Boston area.
Said Tim Wilmott, CEO of Penn National Gaming, the Pennsylvania-based casino operator that developed the facility: "It's never easy being the first operator in a new jurisdiction."

Gamblers throng to opening day at Plainridge Slot Barn

PLAINVILLE — Some danced down the carpet, high-fiving their way toward the beckoning slot machines. Others walked straight ahead. They were the gamblers and dreamers who thronged to the Plainridge Park Casino to share in a moment in Massachusetts history.
The era of legal, Las Vegas-style gaming dawned in the state Wednesday, and within an hour after opening, throngs swarmed into every corner of the gleaming new slot parlor and set all 1,250 machines ringing at once.

“This is what it feels like to be a celebrity,” said Ed Beauregard, a 74-year-old retiree from Northbridge, after he and his wife, Nancy, were cheered by casino employees on their way in.
Many more chose to skip a sunny summer day to gamble indoors, and within three hours of the opening, the casino had hit its fire department-imposed capacity of 3,750 people. Patrons said they waited about 15 minutes to get in. Some cashiers had to close temporarily because they had run out of money.
The sensational turnout was a welcome sign for Plainridge, which is projected to direct as much as $250 million in revenue to the state in its first two years. To do that, the parlor needs to make nearly twice as much money on each of its 1,500 slot and video blackjack machines as its Connecticut competitors, Foxwoods and Mohegan Sun.

One of the driving forces behind Massachusetts becoming the 40th state in the country to allow casinos is the hundreds of millions of dollars in tax revenues that state residents have left behind in casinos in Connecticut and Rhode Island.
“As of today, we have to be considered the major player in the New England casino industry,” said Jay Ash, who, as secretary of housing and economic development, represented the Baker administration at the grand opening. “We want to keep our gambling money home.”
Dave Reilly, 66, who arrived from Lowell with his wife Linda, is just the kind of guy Plainridge is looking for. Reilly said he would rather gamble — and lose his money — in his home state rather than taking the couple’s usual trips to Twin River in Rhode Island.
As for the odds he faces as a gambler, Reilly said, “We don’t do it for a living.”
“Good thing,” added his wife.
Reilly was also one of those who struggled to find a place to play in the afternoon, when crowds briefly tested Plainridge’s ability to serve them as long lines formed at the food court, the cash-out machines, and some bathrooms.
Plainville Police Chief Jim Alfred said traffic on Route 1 outside the casino was backed up for about a half-mile in both directions and on the exit ramps from Interstate 495 to Route 1. “We assume it’s going to be like this through the weekend,” he said.
The parlor’s managers focused on the bigger picture.
“It’s been a fabulous success,” said Lance George, the facility’s general manager. He said he expected to exceed his goal of 10,000 people in the first 12 hours of operation.
“A lot of us have put a lot of work in getting this place ready,” said Ray Fuller, a purchasing manager who came upstairs from his office cubicle to witness history.
“We are proud and happy for all this,” he said.
In a state that traces its history to Puritan settlers who practiced a faith that looked askance at worldly pleasures, Plainridge represents a stark cultural break. As hundreds gambled, show girls in elaborate costumes and feathered headwear frolicked and the drinks flowed freely.
Earlier, when it came time for Gaming Commission chairman Stephen P. Crosby to declare the casino open at a ribbon-cutting ceremony that featured former Boston Red Sox star Fred Lynn and football great Doug Flutie, he chose these words: “It’s show time.”
Flutie runs a restaurant in the parlor, and his 1984 Heisman Trophy stands in the center of the casino, greeting bettors as they walk in.
The 2011 state casino law passed after years of debate, pushed by then-Governor Deval Patrick as a source of revenue — forecast to be as much as $400 million a year when two bigger, resort-style casinos come on line in 2018.
Patrick also considered it a jobs bill, expected to put 10,000 people to work. House Speaker Robert DeLeo threw his support behind the bill after a healthy share of casino revenue was dedicated to supporting horse racing in the state.
Plainridge is owned by Penn National, one of the country’s top casino companies, which has sunk $100 million into the project.
“We’re going to be here a long time,” said Tim Wilmott, Penn National’s chief executive officer. “Our typical customer is between 50 and 70 years old, half of them retired, many with families they have raised,” he said. “They have paid off the mortgage, and they have a little extra time and money to spend.”
Judging by license plates on the cars in the parking garage, Plainridge on its first day not only kept Massachusetts gamblers home, it also attracted a sizeable contingent from Rhode Island and a smattering of folks from Maine, New Hampshire, and New York.
Mary Carlozzi, 60, of New Bedford, could barely contain her excitement as she arrived at the casino with two daughters, one of whom is about to be married. “We are here to win money for her wedding,” Carlozzi said with a laugh.
The Carlozzis make family reunions out of their casino outings.
“My three sisters wanted to come, too, but they had to take a rain check until they have more money,” Carlozzi said, still laughing.
By early evening, some of the novelty was wearing off. Carol Caranci, 74, of North Providence, R.I., said she was concentrating so intensely on playing the slot machines that she was barely aware of her surroundings.
“I’m up about $30,” she said, before dropping her head back down to play.

Rene Rancourt sang the National Anthem and pumped up the crowd with his antics.
Rene Rancourt sang the National Anthem and pumped up the crowd with his antics.