Today's question is on whether it's possible to have cocaine and gambling addictions treated as a single problem.
What do you recommend to someone who is addicted to gambling and cocaine? Does this call for separate treatments or is there one kind of treatment format that would help me
Janice Dorn: This is a timely question since researchers at the University of Granada in Spain published a study in March showing differences in the brain functions of people with either gambling or cocaine addiction. They demonstrated that gambling addicts have trouble with decision making, and cocaine addicts have impulse control issues.
As if this isn’t enough, there is a pretty high incidence of psychiatric disorders (depression, anxiety, or personality disorders) in patients with two addictions. This is called COD (Co-Occurring Disorder) and requires a higher level of care. Treatment can be done at one of a number of facilities that specialize in COD, but there will be differences in the way that the gambling and cocaine issues are addressed. In addition to treatment for the addictions, the patient would be seen by an addiction psychiatrist to determine the best way to manage the psychiatric condition. This could be with medications, counseling, support groups or a combination.
It’s a lot for the addict and the treatment team to deal with: two separate addictions (cocaine and gambling) plus a mental disorder. As a consequence, many persons with COD tend to have higher relapse rates, so they should be prepared to re-enter a treatment facility immediately upon relapse.
Taken separately, the best treatment for gambling addiction is a combination of therapies: individual, group and family. It is important to focus on and strengthen the ability of the addict to make good decisions and engage in self-care. There is some evidence that medication management with anticonvulsants, antidepressants or opiate antagonists may be of help in gambling addiction but they are best used (if at all), in combination with talk therapies. For certain patients, Gambler’s Anonymous may be a benefit and the family may find some comfort and support with Gam-Anon. I am a strong proponent of exercise, diet and meditation/relaxation techniques as part of a recovery program for gambling addiction.
The best treatment for cocaine addiction alone is a combination of structured talking therapies, including group therapy. Cocaine Anonymous or some non-12 step group may be appropriate, depending on the individual. There are certain medications that may be helpful, but the primary focus is on working with disorders of impulse control that are association with cocaine addiction. As a general rule, I am not an advocate of using a medication to treat a substance disorder unless the patient has a dual diagnosis or COD (Co-Occurring Disorder). That said, there are some promising studies on compounds that block the effects of cocaine on brain receptors. Exercise, diet and relaxation techniques should be part of an integrated treatment program for cocaine addiction.
Despite the heavy burden of COD, many people can and do recover, remain clean and sober and have fulfilling lives. There is hope.
Janice Dorn, MD, PhD, specializes in psychiatry, addiction psychiatry and addiction medicine. She holds a PhD in Anatomy and has done extensive research and teaching in brain anatomy and physiology. She is also an expert on addiction to stock trading and on stock trading itself. Her second book, Mind, Money and Markets, with co-author Dave Harder, is scheduled for publication in the fall. Full Bio.