Parkinsonâ€™s Drug Feeds Gambling Addiction
The study of Parkinsonâ€™s disease, and how the brain sends signals for movement and mood, also is shedding light on the physiology of gambling.
When patients being treated for Parkinsonâ€™s developed gambling addictions, it didnâ€™t take long to find the link.
â€œThere are many groups of dopamine receptors in the brain,â€ explains Jian Feng, a neurologist and professor in the University at Buffaloâ€™s School of Medicine & Biomedical Sciences: â€œOne type controls locomotion, one controls the normal cognitive state - when that is not working right, you might see schizophrenia - and the third group affects reward behavior.â€
Parkinsonâ€™s results from the death of dopamine neurons in areas associated with locomotion. The illness is commonly diagnosed when people are in their 60s, Feng said, although its onset could be earlier.
Drugs called dopamine agonists, such as pramipexole (brand name Mirapex) and ropinirole (Requip), help restore connections in those receptors, calming the tremors associated with the illness and giving the patient more movement control.
But they affect the entire brain, not only the locomotion areas, which is why, Feng said, they can have unwanted side effects on personality.â€
Feng said that when a person experiences an unexpected reward, like a $50 slot machine win, dopamine triggers a pleasure response. The brain wants to repeat that experience, so it signals the impulse to keep gambling. The very randomness of the reward is what heightens the pleasure, and medication that enhances a patientâ€™s reception to dopamine heightens that pleasure even more - it can make him crave it.
â€œItâ€™s addictive behavior,â€ Feng said. â€œThe other aspect is gambling itself. It is basically an addictive thing.â€
Mayo Clinic researchers in 2011 estimated that more than 20 percent of patients on Parkinsonâ€™s medications also experienced problems with impulse control - including a sudden, compulsive urge to gamble. (Other problems could be hypersexual behavior, binge shopping or overeating.) Indications are that the higher the dose of medicine, the greater the chance a patient will experience the side effects.
Ginaâ€™s full name is not being used to protect her fatherâ€™s privacy.
â€œSo, Iâ€™m going through his papers and his bank accounts,â€ Gina said, â€œand I see he has $18 in the bank, and ATM withdrawals showing he was going to the casino every three or four days.â€
Risked Incomeâ€”and Home
In one week in January, her 83-year-old father gambled away his entire monthly income from Social Security and a small pension.
And that still wasnâ€™t the worst of it. It looks like he will lose his home.
â€œHe hadnâ€™t paid his mortgage payments for 16 months, and his house had gone into foreclosure,â€ Gina said.
Gina doesnâ€™t know when her father started casino gambling. She gets no answers from him, she said.
â€œHe just fluffs it off.â€
Problem gambling, while affecting a small percentage of total gamblers, is growing among people age 60 and older, a key customer base of the burgeoning casino gambling industry in Western New York. With bus trips from senior centers and casinos opening not just here, but across the country, gambling is easier than ever for retirees to pick up and, for a vulnerable minority, a hard habit to quit.
Seniors may not be more likely than other age groups to have a gambling problem. A 2012 study in Ontario indicated seniors are somewhat less likely to get addicted than younger gamblers. But they are not immune, and as more casinos create more gamblers, they also create more problem gamblers of all ages.
â€œNot everyone develops a problem, but for those who do, it can be quite devastating,â€ said David M. Ledgerwood, a researcher at Wayne State University and a clinical psychologist who has seen firsthand the harm of gambling gone wrong with several casinos in the Detroit-Windsor, Ont., area. â€œAnd a big factor Iâ€™ve found is bereavement. An older gambler who has lost a loved one might play for hours so they donâ€™t have to think a lot. Itâ€™s soothing, in a way.â€
â€˜The New Senior Centersâ€™
Some people refer to casinos as â€œthe new senior centers,â€ and a visit to the Seneca Buffalo Creek Casino might show why.
It was a recent Wednesday afternoon, but the casino was so full you might have thought it was a busy Saturday night.
The gambling tables were buzzing and the rows of slot machines were chiming as the credits rang off. Almost all of the folks at the slots and half those at the tables would qualify for AARP membership.
When asked, many seniors say they would like to win but donâ€™t count on it. One after another, they say they go to the casinos for â€œsomething to doâ€ and a chance to have a little luck.
But they also make grim jokes about what the casinos take.
At the Seneca Niagara Casino and Hotel, the morning gamblers â€“ almost all seniors â€“ pile into the lunchtime buffet and say they plan to â€œeat upâ€ their losses. A gray-haired woman whose jacket bears the casinoâ€™s logo laughs when asked if it was free.
â€œHa! Free! Iâ€™d say I only paid about the price of a car for it over the past two years,â€ she said.
In 2008, Wayne State researchers found the prevalence of problem gambling in 10.4 percent of people older than 60 in the Detroit-Windsor area, where they have easy access to four casinos. The study concluded that gambling could become a serious health problem for seniors, particularly those who are alone and have incomes below $20,000.
â€œWith the recently retired, or those in their late 70s, there are a few things that stand out as risks,â€ Ledgerwood said. â€œOne, exposure to gambling, which happens as more casinos open; two, they may or may not have things to fill the free time of retirement; three, if there is a decline in health, going to a casino and gambling is easier than other activities.â€
Whatâ€™s more, medications may also increase the propensity for gambling. Some medications for Parkinsonâ€™s disease â€“ mostly prescribed to seniors â€“ can trigger obsessive behavior, including gambling addiction, in 10 percent or more of those who take it.
No Refunds Allowed
Losses can be hard to comprehend for consumers accustomed to legal protections when they overspend. Laws give people a â€œcooling offâ€ period to back out of contracts, and stores let shoppers with buyerâ€™s remorse return their purchases.
There is no procedure allowing a gambler to get a refund from a slot machine.
â€œThey donâ€™t realize that you can spend a lot more money than you think youâ€™re spending, very easily,â€ said Renee C. Wert, a Buffalo therapist who treats addiction problems of all kinds.
Most clients she sees thought they were just having a little fun before their gambling habit went south, she said.
But when they do overspend, regret kicks in, and the hole keeps getting deeper the more they dig.
â€œA lot of people think, â€˜If I just keep going, I can win the money back,â€™â€‰â€ Wert said. â€œAnd they might win it back and then walk away thinking, â€˜OK, thatâ€™s how to do it!â€™
â€œBut the next time, and the time after that, it doesnâ€™t work.â€
Admitting to gambling away money you couldnâ€™t afford to lose is never easy, and for seniors it can be especially hard. The players can feel like losers personally as well as financially.
â€œIt can be difficult to ask for help. Theyâ€™re pretty embarrassed about it,â€ Wert said. â€œFor all their lives, theyâ€™ve been responsible and handling their money, and all of a sudden they find themselves in debt because of gambling. It can really sneak up on them.â€
Only Did Scratchers Before
Thatâ€™s what happened with Ginaâ€™s father.
â€œHe was a mechanic his whole life,â€ Gina said. â€œHe worked until he was, like, 70. He didnâ€™t gamble. Just scratch-off tickets. I would see those sometimes.â€
Her parents divorced when she was a child, and Gina didnâ€™t see her father often, but she tried to stay in touch. Recently, he was making that harder, not answering his phone, not wanting her to visit.
When she forced the issue around the holidays, she found out why. His life revolved around gambling. His house was unkempt, he had no food, and he had a pile of overdue bills.
â€œHe never told me anything about this,â€ Gina said. â€œAnytime I called, he said everything was fine.â€
That first doctorâ€™s visit in January was only the beginning, Gina said. Her father was ignoring other health problems, too. She found overdue bills for medical co-pays and presumes her father was avoiding doctors because he didnâ€™t want to pay the $45.
â€œHe would rather spend it at the casino,â€ she said.
This is Part 1 of a series. Melinda Miller wrote this article for the Buffalo News with support from a MetLife Foundation Journalists in Aging Fellowship, a program of New America Media and the Gerontological Society of America.