This headline may sound contradictory. But, step back. Clinical experts and research demonstrate that chronic pain and gambling addiction sport more connections than Charli D’Amelio and her 125 million TikTok followers.
In fact, the relationship between constant pain and pathological gambling involves more moves than Dancing with the Stars. Pain and gambling contort and twist. They are co-dependent, complex collaborators who crisscross and obscure the boundaries between psychological and physiological, emotional and cognitive, cause and outcome, or analgesic and antagonist.
This blog, the first in a series, examines one of the clearest ties between the two by looking at how gambling can actually serve as a temporary relief from chronic pain.
First, understand that pain can range from something temporary (acute pain) to long lasting (chronic pain). Chronic pain can be difficult physically, but also psychologically as ongoing pain can be very stressful, and feel hopeless. Physicians define acute pain as “good pain” because it alerts us that we did or are doing something that harms us.
Contrast acute pain with chronic pain, a sad reality for more than 50 million Americans. Those with chronic pain can live with three or more months of constant, sometimes overwhelming, and debilitating hurt. It can often be attributed to medical conditions that damage tissue, such as arthritis, migraines, lower back pain or fibromyalgia.
Chronic pain often generates or is accompanied by mental anguish. In a later blog, we will examine how it can actually change brain functionality. For now, realize that people dealing with these health issues may resort to nearly anything that brings relief—and gambling might deliver that relief, at least briefly, like a behavioral Tylenol Plus.
“Gambling is a hyperstimulus, designed to pull people in. While gambling, some people report a decrease or elimination, for that moment, of emotional or physical pain. The act of gambling has the capacity to absorb people in, essentially disconnecting the person from their needs and values. Gambling disorder can get very serious, as people gamble rather than following through with responsibilities. Research has demonstrated that people with gambling disorder have high rates of pain, surmising that it may lead one to gamble excessively. The relief found in gambling is reinforced, thus the individual turns to gambling when feeling pain. Unfortunately, in the aftermath of a bout of gambling, the pain worsens due the significant increase of psychological and physical stress,” explains Heather Chapman, Ph.D., Deputy Director, Clinical Psychologist and Supervisor at the Louis Stokes Cleveland VAMC Veteran’s Addiction Recovery Center and an expert with more than two decades of experience working with problem gambling and related mental illnesses.
“Clearly, gambling can be an analgesic,” she says. “I have seen people, who cannot sit in a therapy session for more than 30 minutes without extreme discomfort, report, perplexed, ‘but I can sit at a blackjack table for hours, no problem.’ This is a physical and psychological hijack.”
Research published in numerous periodicals like the Journal of Gambling Issues confirms Dr. Chapman’s hypothesis. Some believe a cause/effect relationship may exist, meaning that people tend to gamble when in pain and that gambling may exacerbate pain long-term. As was noted in The Journal of Behavioral Addictions in 2013, “Higher levels of problem or pathological gambling were found to occur in individuals with [moderate to severe pain] as compared to those with [no or little pain].”
And what hurts should not be solely confined to physical discomfort, notes Maria Garner, clinician for Maryhaven. “I find that people who are in extreme psychological pain are more likely to struggle with gambling,” she says. “They may be in unhappy relationships with no obvious way out. They may feel disconnected, alone, ignored and unsupported. Their heartache may stem from unresolved trauma.”
Dr. Chapman concurs. “The majority of folks we work with are coping with psychological pain. Because I serve veterans, I see many, many cases of Post Traumatic Stress Disorder and anxiety. Not all of the challenges stem from military service. Very often, people who suffered traumatic experiences as children and teens join the military, in part to get away from abuse or neglect.”
These direct and less-than-obvious relationships between physical and emotional hurt cause many in the behavioral health community to argue that clinicians must be better trained in their understanding of pain in all forms. Research using magnetic resonance imaging (MRIs) substantiates their argument, according to a paper published in the January 2011 edition of Archives of General Psychiatry:
“Evidence… is provided by functional magnetic resonance imaging (fMRI) work showing that grief related emotional pain activates classical physical pain circuitry… These findings suggest that emotional and physical pain may become a reinforced stimulus in some conditions (e.g., complicated grief and chronic back pain) thus providing partial explanations for their unremitting course.”
Dr. Chapman tells a story of a former patient who, before Ohio legalized gambling machines, rigged a machine with a toothpick so that he could put in a large denomination bill and just let it play. He contended that the noises anesthetized his chronic pain from a car accident.
Maria and her colleague, the originator of the gambling addiction treatment program at Maryhaven, Bruce Jones, have treated many who used gambling as an escape. David, one of Bruce’s patients, had to face down the demons of childhood sexual abuse before he could begin to successfully recover from pathological gambling. Shelley, one of Maria’s patients, fought off loneliness, first with online auctions and then with virtual betting.
It’s long been said that fear and love constitute the only two primal emotions. Humans naturally entangle fear and hurt and our ancient reptilian brain demands that we flee from people or circumstances that threaten or endanger us. The all-encompassing focus that appears to make gambling a pain reliever for some offers another clue on ways to overcome chronic pain without succumbing to gambling, opioids or addictive behaviors. These positive approaches include mindfulness or meditation practices, prayer, yoga or other exercise, even just learning to breathe more deeply.
Gambling may temporarily comfort, but its side effects can be more costly than you think.